Diary: breastfeeding mission completed~

After 7.5months breastfeeding, I guess It should bring to the end... Even tho it is tough but wouldn't forget how warm though v tiring it is to breastfeed Ry, especially during the first month!!! Really enjoyed afterall~~

Diary: Little Ry in hospital

Ry is suffering from acute bronchiolitis (RSV caused)...poor Ry needs to be hospitalized and it's 2nd day today, his breathing gets better. Ry weighs 7.7kg now.

Work: charting

Anthropometric measurements
Weight change overtime - Significant?
Subjectives
Objectives
Problems/progress
Plan

Work: 1 more week, then I'll have to leave for TKOH!

TKOH, I am coming!

Diary: St. Clare's PTA 5th AGM cum Election for 6th PTA

Completed my role as a co-ordinator in St. Clare's 5th PTA for the past year and the appreciation and certificate will be issued on Nov 13th Sat 230-345!

Work: Fussy eater

Seen a fussy eater case yesterday, she was actually here for FU. She was 2.5 yr old and her wt-ht was 10-25%, not really bad indeed. As other fussy eaters, she didn't like veg and most kinds of meat. According to her mom, the pt decided what to eat and when to eat, and this is the major problem that leads the pt having a poor eating habit. The mother tried to starve the pt since the pt refused all the foods offered, but seems like the pt had endurable energy even no foods were taken. Some more suggestions for the mother,

1. Keep trying to offer the pt veg and meat, young kids often refuses new foods, sometimes it may take 15 attempts before the kids try something new.
2. Get the kids involved in food preparation and cooking.
3. Take the control in deciding what to eat.
4. Establish a good eating environment, no TV allowed during mealtimes to avoid distraction.
5. Review other protein rich foods in the meat group
6. Some milk supplements prescribed.

Other suggestions,
Food hunting (go to supermarket together and look for healthy foods)
Read recipe together with the pt

Diary: My career path

Received HR call re. the job offer. The first day will be on nov 1 since Dept Manager said UCH here is simply fed up with all the out-pt cases...So I need to get some of them done to relieve other dietitians workload. 1000 attendance done per year should be achieved by the end of my contract and they are actually having some expectations from me...

Diary: my career path

I do think the God creates a path for each of us ahead of time... Thank you.

Diary: Work-life balance

Interview done for TKOH dietitian post. I personally think i need some improvement in my presentation skill...as i didn't do well in the interview.

What's your vision of this profession in the next 5 to 10 years?
Share 1 difficult case that you have seen in OPD
How do you communicate with others in the same dept? Any hard time you have that could share?
What criteria a dietitian should have?
What is HA lacking?
How do you divide up the work and relieve the referred cases given that the manpower is fixed?

Waiting for the result...meanwhile, need to adjust the time spent on my 2 little kids with my work.

Work: Triple X Syndrome

I met a patient with the above named disorder last week with her mother. Triple X Syndrome (trisomy X) is a genetic disorder which the female infants are born with 3X chromosomes. She weighed 6kg and was about 70cm tall at her 14 months of age, she could walk and spoke a few simple words but she was definitely a small size child and looked very delicate. Her appearance has been in my mind for the whole week because even my 5month-old son is heavier than her. Obviously, she was here for nutritional buildup. I prescribed her some milk supplements and gave her mom tips to increase energy intake...hopefully, I could see her growing a lot in her next visit.

Article: 替花生油平反

撰文：註冊營養師張志君 Michelle Cheung (registered dietitian)

病人：花生油有膽固醇，又好肥，我已經轉用芥花籽油了。

不只一位病人向我反映花生油的不是。言而，我想替花生油平反。

誤解一：很多人誤會了花生油，認為它含有膽固醇，會增加心血管疾病的風險。

事實：植物本生不含膽固醇，膽固醇只會由動物脂肪中找到。花生屬植物類，所以絕不含膽固醇。最令人大跌眼鏡的是，花生油的單元不飽和脂肪酸含量比起粟米油更多，能助降低體內的低密度脂蛋白膽固醇(亦稱壞膽固醇)，而對高密度脂蛋白膽固醇(亦稱好膽固醇)沒有影嚮，能保護心血管的健康。(橄欖油或芥花籽油的單元不飽和脂肪酸含量亦相當高)

膽固醇的主要來源：蛋黃、魷魚、墨魚、動物肥肉、皮層、內臟、頭及糕等。

誤解二：花生油好肥的! 食得太多會易肥!

事實：市面上的橄欖油或芥花籽油，兩者被人喻為健康油，多用亦不怕，而對於花生油就避之則吉。事實上，油便是油，它們提供的熱量是一樣，即每一克油含有9千卡。而一茶匙油已經有45千卡。建議每日每人用3-6茶匙煮食油，即是每餐1-2茶匙。如果午餐你已用了2茶匙煎了一條魚，菜只可灼一灼(不落油)，而飯便要煲，不能炒。

當然，任何食物吃多了都會導致肥胖，所以均衡飲食才是保持身體健康的良方。

Diary: St Joseph's school talk on 10-09-15

Conducted a school talk at St. Jo for P.4 boys on . I realized how much pressure the teachers have and how much they use their voice to keep the boys under control... Then, I was wondering, will my little Ryan be the same in the future...?

Diary: Ryan weans off night feeds

Ever since last week, Ryan has been stopped taking milk during mid night, now his milk time is like: 11pm till 5 or 6am the next morning!

Diary: Old pts

Have been working in UCH for more than 2 months already, started seeing my own pts coming back for FU but none of them showed up today, due to the weather?

Diary: Ryan talks and talks

Little Ryan is so lovely, he tries to speak to you and sing along with you when you sing him a song.

Diary: Ryan @ his 3m of age

Ryan had his 3 month birthday celebration on the 8th, Sunday. He is able to smile at us when he sees us around, so cute!

Diary: Seeing IP

Finally got a chance to see in-patients.

Diary: Patient with RTT

Seen a female teen with Rett Syndrome today. She is FTT and non-communicable, she came with her mom and her elder sister. When I first met the patient, I felt so sorry for the mother. Although the patient is dependent and must be taken care by the mother, her mother was somewhat optimistic though could tell she was tired.

I found myself very grateful having 2 healthy kids and to me, they're my life.

Diary: 正向心理學

今晚上了一課關於正向心理學--社工解說"心流理論"。心流理論由心理學家Mihaly Csikszentmihalyi提出的。

使心流發生的活動有以下特徵：
專注一致
有清楚目標
有立即回饋
對這項活動有主控感
在從事活動時我們的憂慮感消失
主觀的時間感改變--例如可以從事很長的時間而不感覺時間的消逝


有朋友說，當她畫畫時便有心流的感覺。她非常專注畫畫，能忘記所有的事情，不論愉快的或不愉快的。
另一朋友說，她做蛋糕時便有心流。

而我，我覺得當我向病人主理講座時便有心流，我操控講座時間的長短、有清楚的目標、專注講座的內容及有立即的回饋(即病人的回應)。

你曾經有心流的經驗嗎? 試想想...

Diary: Ryan at 2 months

Weighed 5.21kg (11.5lbs) and 55.5cm long

Had 4-in-1 vaccine and Pneumococcal Vaccine, may develop fever in 2-3 days. Hope Ryan is alright with the vaccines.

Diary: What a patient!

激死!

今日見左一個肥妹仔，14歲，Wt-Ht >97th percentile，由媽媽陪見。囡囡一點兒想減體重都沒有，看似是被媽媽捉來的，看到我像看到仇人似的。問她: "早餐會吃什麼? 她答: "唔知" 問10條問題，10個答案都是:"唔知..." Diet record原來是由媽媽寫的。以為她只是對於自己的體重毫不關心，詳細了解，她對於學校的成績亦一點都不在乎。

究竟是囡囡的錯? 或是媽媽的錯? 囡囡一點責任心都沒有、媽媽亦過份溺愛... 我不希望自己的女兒會變成這樣，至少不能夠沒有禮貌... 我相信我可以做到的。

Diary: Ryan at 6th week

Jun 17th: Weighed 4.53kg~

Article: Amazing food--Breastmilk

My little Ryan

Ryan is 24-day-old! He is drinking about 9-10 times a day 3oz each. So happy to see him growing bigger and bigger.

To all lactating mothers out there: work hard and keep it up! Breastmilk is the most wonderful gift for your newborn!

Breastfeeding Success

Breastmilk contains appropriate amounts of carbohydrate, protein, and fat. It also provides the digestive proteins, minerals, vitamins, and hormones that infants need, as well as antibodies that help the baby resist common infections which can never be found in infant formulas. Women who breastfeed also benefit:

1. Have less bleeding after childbirth
2. Return to their pre-pregnancy weight faster
3. Have fewer cancers of the ovary, uterus or breast
4. Less common to diagnose osteoporosis

Initially, BM is similar to skim milk, with a relatively low fat content. As the infant continues to suckle and a period of let down occurs, BM becomes higher in fat and calories. Encouraging baby to suck on each breast for at least 10min ensures adequate calorie consumption. Emptying time of BM from the infant’s stomach is 1.5 hours compared to 3 hours for formula-fed infantsneed to nurse every 2 hours for the first few months of life.

At the beginning of the feeding, the milk (foremilk) is bluish and contains lactose and proteins, but little fat. The end of the feeding produces hindmilk, which contains more fat, the main source of energy for your baby.

Nursing early (within the first half-hour), and frequently (on demand, or 8 - 12 times per day), allows you to nurse comfortably and efficiently. It usually takes less than 1 minute for an infant to stimulate the milk ejection reflex. You should feel little discomfort or pain when breastfeeding appropriately.

Within 6 - 8 weeks, your milk supply will adjust to your baby's needs. Before that time, your breasts may feel either too full or empty. Frequent, comfortable feedings will maintain your milk supply. Your milk supply will increase or decrease based on your baby's hunger and energetic sucking (milk demand or use). Changes in your milk supply will occur within 1 - 3 days after changes in milk demand or use.

Lactation and nutrition

In general, lactating women should get nutrients from a well-balanced, varied diet, rather than from vitamin and mineral supplements. Eat generous amounts of fruits and vegetables, whole grain breads and cereals, calcium-rich dairy products, and protein-rich foods (meats, fish, and legumes). Make sure you are getting enough calories (Pre-pregnancy energy requirement + 500kcal)

Food guide:
Milk, yogurt, and cheese -- eat at least 4 servings
Meat, poultry, fish, dry beans, eggs, and nuts -- at least 3 servings
Vegetables -- at least 3 to 5 servings
Fruits -- eat 2 to 4 servings (choose two foods high in vitamin C and folic acid, and one food high in vitamin A)
Bread, cereal, rice, and pasta -- at about 6 to 11 servings
Fats, oils, and sweets -- go easy!
Fluid -- 8oz fluid including water, soup, juice

Dos and Don'ts

Breastfeeding mothers can safely eat any foods they like. Some foods may flavor the breast milk, but babies rarely react to this. If your baby is fussy after you eat a certain food, try avoiding that food for a while, then try it again later to see if it is a problem. If you become overly concerned about foods or spices causing problems, try to remember that entire countries and cultures have diets that contain foods that are extremely spicy. In these cultures, the mothers nurse their infants without problems.

It is possible that some highly allergenic foods (strawberries, peanuts) may be passed into breast milk, increasing the risk of a later food allergy in the baby. If this is a concern, discuss food allergies with your pediatrician.

A nursing mother can safely drink moderate amounts of caffeine (equal to 1 cup of coffee per day) without causing harm to her baby. But any more caffeine than that may cause agitation and sleeping difficulties in the baby.

Since alcohol has been found in human milk and can interfere with the milk ejection reflex, avoid alcohol while breastfeeding. An occasional drink, no more than two ounces of alcohol, may be safe, but you should consult your health care provider about the associated risks.

If you are a smoker, this is a great time to quit for yourself and for your baby. Nicotine and other chemicals from cigarettes are found in breast milk. Smoking will increase the number of respiratory infections your baby develops. If you are unable to quit, try to limit the number of cigarettes as much as possible, change to a brand with low nicotine, and visit your doctor regularly.

Returning to work

Here are some tips that have worked well for many breastfeeding mothers who work fulltime outside the home:

If you plan to return to work, introduce your baby to bottle-feeding at 3 to 4 weeks of age. This allows plenty of time to establish good feeding habits. Starting bottle-feeds before 2 weeks of age often results in nipple confusion -- the baby has difficulty changing between the different sucking patterns required for the different types of feeding.

Two weeks before you return to work, buy or rent an efficient and comfortable breast pump and start building up a supply of frozen milk. If the day you return to work arrives and you don't have a freezer full of breast milk, one bottle of formula fed to your baby will be an adequate supplement. After returning to work, express milk 2 or 3 times a day, every 2 to 3 hours to continue exclusively breastfeeding. If you can only get one break a day and you are unable to pump a full day's worth in one pumping, a supplemental bottle of formula may be needed. Be aware, however, that feeding formula decreases the need for breast milk, and your milk supply will decrease accordingly.
Nurse your baby immediately before leaving in the morning and immediately upon return from work in late afternoon. Many mothers find that their babies nurse more frequently in the evenings on days they work. Feed on-demand when you are with your baby.

Info: Medline Plus

Article: Wound healing and nutrition

Wound healing, as a normal biological process in the human body, is achieved through four precisely and highly programmed phases: hemostasis, inflammation, proliferation, and remodeling. Several factors affect the rate of wound healing including oxygenation, infection, age and sex hormones, stress, diabetes, obesity, medications, alcoholism, smoking, and nutrition. One of the factors that will be discussed here is nutrition. Good nutrition facilitates wound healing particularly protein, omega 3 fatty acids, vitamin C and zinc.

Protein depletion can affect the rate and quality of wound healing. Protein requirement is approximately 20-50% higher during wound healing process. Protein is required as part of the inflammatory process, in the immune response and in the development of granulation tissue. The main protein synthesised during the healing process is collagen, and the strength of the collagen determines wound strength.

The amino acid arginine becomes essential during severe stress. It is abundant in the structure of collagen, and increases its tensile strength. Arginine metabolism is also related to the production of nitric oxide, which is bactericidal, and also aids wound healing through microvascular and haemodynamic changes.

Omega 3 fatty acids are essential fatty acids and are anti-inflammatory which aid wound healing, but it is debatable as to whether omega 3 fatty acids are beneficial to wound healing.

Vitamin C involves in collagen synthesis. Copper is also another important nutrient that stimulates collagen synthesis.

Zinc is required for protein synthesis and is also a co-factor in enzymatic reactions. During cell proliferation and protein secretion, increased demand for zinc has been shown. Zinc also has an inhibitory effect on bacterial growth, and is involved in the immune response.

Diary: Appointment

New job in June =)

Diary: Wound healed

Visited Dr. Mok today. Dressing pad is removed (a bit painful when the tapes torn off) and wound is healed, can start drinking herbal soup. Now I weigh 124lb...about 17lb to lose.

BF making me extremely hungry and thirsty all the time...and feel super hot too!

Diary: Baby Ryan

Ryan weighed 3.05kg upon discharge and gained 0.05kg on the 2nd day post discharge during doctor's FU visit.

He is somewhat quite calm and silent which is a good thing, he only cries when he needs feeds. Right now, I am feeding him every 2-3 hours BM and getting up about 3 times at nights...hope he can do better soon. I think he looks like Silas, especially when he smiles with his dimples.

My wound is more or less healed, at least not painful when I walk. It had been a nightmare on the first 2 days post-op. Contracting uterus plus the wound definitely made me cry, diarrhea, stabbing pain when urinate after off foley but very luckily, it only lasts for 2 days and with the girdle, it's even better.

New milk product for picky eater:
http://www.onelessworry.hk/PE/

diary: bb ryan is here now

birth date: may 8th
weight: 3.16kg
length: 49cm

initially the c-section was scheduled on may 10 but he was too desperate to see the world so he comes 2 days earlier than the scheduled delivery. this time, i had SA, i could feel my tummy was being pulled and stretched but couldnt feel the pain... at around 1230nn, ryan was out and crying...

he was once found to be sob, but then, the day after, his breathes return to normal, no extra O2 is required (SpO2 100). thanks god. he is still in the incubator to have his lung function monitored.

Article: 健腦食物

文：註冊營養師張志君 Michelle Cheung (registered dietitian)

腦袋有六成均屬於脂肪，脂肪參與腦部的主要功能包括學習、記憶及情緒。

脂肪有分好壞，大致上可分4大類別，飽和脂肪酸、單元不飽和脂肪酸、多元不飽和脂肪酸及反式脂肪。脂肪攝取量應佔總熱量的百分之25至30。我們常聽到奧米加3脂肪酸，是屬於多元不飽和脂肪，包括DHA、EPA及alpha-ALA。奧米加3脂肪酸有助腦部及眼部發展。

健腦食物：

1. 核桃、杏仁
維持大腦正常功能
促進中樞神經運作，避免智力下降及反應遲鈍

2. 銀杏 (又稱為白果)
有助腦部運作及增強記憶能力
保護腦細胞免受自由基的破壞
如白果薏米粥、白果腐竹糖水或香芹白果蝦仁

3. 三文魚、吞拿魚、沙甸魚
增加腦部發育和記憶力
牛肉、羊肉、豬肉、青口、蠔(含豐富鐵質)
減低精神不集中、語言學習困難、記憶力衰退和情緒不安

4. 黃豆
增強記憶能力及腦部靈活性

可惜，奧米加3脂肪酸到現時還未有研究指出對老人癡呆症有效用。

Article: 妊娠嘔吐/晨吐

妊娠嘔吐/晨吐
文：註冊營養師張志君 Michelle Cheung (registered dietitian)

妊娠嘔吐的原因? 很大機會是因為荷爾蒙(hCG或estrogen)水平的變化。
一般輕度的妊娠嘔吐不會影嚮胎兒的發展，懷孕初期，體重有輕微的下降均屬正常。但因嚴重的嘔吐而導致食慾不振，應盡快找醫生及營養師幫忙。

市面上有多種『媽媽奶粉』，一般孕婦如果飲食均衡，每日有兩至三份奶品類(脫/低脂為佳)則不需要沖飲孕婦奶粉。因為孕婦奶粉的熱量及碳水化合物較高，如體重升得過快、有糖尿病或過往曾有妊娠性糖尿病，應小心服用。但，對於食慾不振或體重有減無增的孕婦，不妨嘗試孕婦奶粉。

減輕食慾不振及晨吐飲食方法：
1. 少吃多餐
2. 流質飲品應避免在正餐時飲用，改為餐與餐之間
3. 起床前可吃梳打餅乾或烘面包等較乾身的食物
4. 維他命B6如香蕉、雞胸肉、薯仔等及薑能減少嘔吐的感覺

妊娠嘔吐與嬰兒智力有關?
2009年7月份有一項加拿大多倫多研究針對妊娠嘔吐與嬰兒智力的關係，研究對象是年齡介乎3-7歲小朋友。研究指出，如母親於懷孕初期有妊娠嘔吐的情況，日後子女均有較高智力、記憶及語文能力。研究總結，妊娠嘔吐不但沒有對懷孕期有任何的壞影嚮，長遠來說，對子女日後的心理發展反而有利。

最近有另一項研究則指出，如上一代有妊娠嘔吐的情況，下一代有百份之3的機會會遺傳妊娠嘔吐。

Diary: 2.76kg at 37th week

At 37th week:
I weighed 62.7kg (gained 0.2kg in 1 week)
Ryan weighed 2.76kg (6lbs) and is med sized.
Ryan covered his eyes with his arm and can only barely saw his nose and mouth.

Article: 多吃維他命C可以嗎?

文：註冊營養師張志君　Michelle Cheung (registered dietitian)

深信現在10個都市人有9個都聽過維他命C。究竟維他命C的功用是什麼? 服用過量會有什麼壞影響?

維他命C能治感冒?
常常聽到別人說，"有感冒? 快吃維他命C!" 其實，沒有實質研究指出維他命C能預防感冒或能作治療的用途。當然，維他命C是抗氧化營養素，能增強免疫力，減低自由基對身體的破壞。

維他命C能有效地治療壞血病(Scurvy)，避免牙齦及皮下組織出血。
部份研究指出，於懷孕期間，攝取適量的維他命C能減少尿道炎的情況。

如果你有缺鐵性貧血，應多吃含有豐富鐵質的食物如紅肉、蛋黃、蜆、青口、乾果、深綠色蔬菜等。但由植物來源的鐵質(non heme iron)則不易被人體的腸道吸收，要靠維他命C的幫忙助增加吸收。於日常飲食中增加維他命C量的方法很簡單，可於飯菜中加以燈龍椒、水果作伴菜及飯後吃水果如橙、奇異果、士多啤梨等。此外，維他命C是製造骨膠原的物質，增加皮膚的彈性。

維他命C接觸空氣、陽光及熱力便會受破壞，而抽煙及口服雌激素(即避孕丸)亦會減低維他命C的效力。
服用過量的維他命C會引致腹瀉、腸胃不適亦會阻礙薄血丸(如Warfarin)的效用，減慢凝血酵素原時間(Prothrombin time)。PT值越大，即血液凝固需時越長。

美國國家科學院(Institute of Medicine)建議每日攝取量:
成年人
男性: 90毫克
女性: 75毫克
孕婦: 85毫克
哺乳中的婦女: 120毫克

而抽煙者應額外多攝取35毫克

上限不應超過2000毫克

18歲以下的兒童:
0-6個月: 40毫克
7-12個月: 50毫克
1-3歲: 15毫克
4-8歲: 25毫克
9-13歲: 45毫克
14-18歲(男): 75毫克
14-18歲(女): 65毫克

上限
1-3歲: 400毫克
4-8歲: 650毫克
9-13歲: 1200毫克
14-18歲: 1000毫克

Diary: 2.57kg at 36th week

At 36th week:
I weighed 62.5kg
Ryan weighed 2.58kg

Dr. Mok said Ryan is normal and will be median-sized.

Article: 高血脂飲食

血脂過高是心血管病的主因，香港公立醫院心臟醫生協會主席劉育港指，該會早前調查五間公立醫院約七百名高血脂病人，約七成二人的低密度膽固醇（壞膽固醇）過高、兩成半的三酸甘油脂過高，三成二人的高密度膽固醇（好膽固醇）過低。病人接受一年降血脂他汀藥療程後，壞膽固醇及三酸甘油脂情況有明顯改善，但仍有兩成三及一成二人超標；在好膽固醇方面，仍有三成二人過低，顯示他汀藥對提升好膽固醇作用不大。

太陽報登於4月22日

你有高血脂嗎?
脂肪種類 / 正常水平
膽固醇 / <5.2mmol/L
三酸甘油脂 / <1.7mmol/L
壞膽固醇 / <3.4mmol/L
好膽固醇 / >1.0mmol/L

飲食治療
低密度膽固醇(壞膽固醇)過高之飲食建議
1. 減少進食飽和脂肪如動物皮層、腩位、排骨、肥肉、棕櫚油及椰油等，改選為單元不飽和脂肪酸，如食油多採用芥花籽油或純正橄欖油、果仁及牛油果
2. 多吃水溶性纖維，如水果、蔬菜、燕麥或豆類等
3. 避免吃高膽固醇的食物，如內臟、動物性食物
4. 多吃含有豐富抗氧化營養素的食物，如維他命C、E、胡蘿蔔素、蕃茄紅素、兒茶素及異黃酮素等

高密度膽固醇(好膽固醇)過低之飲食建議
1. 多吃單元不飽和脂肪酸
2. 植物固醇(plant sterol)-能抑制腸道膽固醇的吸收，從而減低血膽固醇的水平
水果、蔬菜、菜油、種子、硬殼果、燕麥及全麥食物中可找到少量植物固醇
3. 適量的酒精


當然，生活習慣亦是另一主要因素。多運動、戒煙、每餐定時定量都是良好的飲食及生活習慣。

由註冊營養師張志君Michelle Cheung (registered dietitian)提供

Article: 專注力失調過度活躍症

過度活躍症遺傳達75%，根據調查顯示，全球兒童的「專注力失調過度活躍症（ADHD-Attention Deficit/Hyperactivity Disorder）」發病率約為百分之三至百分之七；在本港，六至十六歲兒童的ADHD發病率與國際數字相若，當中七至八歲男童的平均發病率為百分之八點九；而十三至十四歲兒童的平均發病率為百分之三點九。估計約有超過四萬名本港兒童是 ADHD的患者，但確診的只有約七千至八千名兒童，因此發病率可能遠遠被低估。

究竟過度活躍症是(ADHD)什麼?
根據《專注力不足/過度活躍症(香港)協會》，專注力不足/過度活躍症是一種神經生理性的異常情況，醫學界至今還未找出其成因，但相信跟腦部疾病、腦部化學傳遞或物質失去平衡，以及家族遺傳等因素有關。 我曾接觸過不少患有過度活躍症的小朋友，治療前後的他們有360度的不同。未吃藥前，莫說想控制他們，跑也跑不過他們。但吃了藥後，他們會靜靜的坐在你身旁，聽你的指示。

其實一直有很多科學家均向奧米加3/奧米加6脂肪酸對過度活躍症治療作出不同的研究，結果亦不一。甚至乎有些認為攝取過量的糖份如汽水或糖果及食物添加劑亦有可能導致過度活躍症。當然，遺傳才是其中的一個重要原因。

ADHD藥物的副作用
一般服用ADHD藥物後有食慾不振的副作用，而醫生每次亦會替你磅重及量血壓。萬一胃口不佳及體重有不自主的下降(如1個月內體重下降了5%、3個月下降7.5%或6個月內下降了10%，已屬於嚴重體重下降)，應開始注意飲食習慣。

建議：
1. 少吃多餐，每三餐應保持4-5小時及每正餐之間可加入小食，小食以高澱粉、高蛋白質為主如香蕉乳酪、芝士火腿三文治、花生糊、芝麻糊、豆腐花或燉蛋，避免飽肚及低營養價值的食物。
2. 胃口不佳可嘗試甜酸的食物來增加食慾，如菠蘿粒、西瓜汁、梨汁或檸蜜。

建議由註冊營養師張志君 Michelle Cheung (registered dietitian)提供

Diary: 2.14kg at 34th week

At 34th week
I weighed 61.5kg
Ryan weighed 2.14kg

Ryan's body has been turned upside down.

Article: 妊娠性高血壓

文: 註冊營養師張志君 Michelle Cheung (Registered Dietitian)

認識有位懷有37週的孕媽媽朋友患上妊娠性高血壓(pregnancy-induced hypertension, PIH)，即血壓高於140/90。一般高血壓都頗普遍，那妊娠性高血壓值得注意嗎?

當然要注意! 如果不理會的話，不單只影響孕婦，並會影響胎兒的健康。 胎兒所得到的氧份及營養素由臍帶從母親的血液運送到胎兒身上，患有高血壓的孕婦會減低氧份及營養素的輸送，亦會令胎兒出生後有低血壓、生長遲緩及因過少的羊水而危害胎兒的腎功能。

如果同時間患上高血壓、蛋白尿及水腫的話，很大機會會被醫生診斷為懷孕子癲前症 (Pre-eclampsia)。高血壓是由血液中含有大量的蛋白質所引致的。正常的尿液不含或僅含有微量蛋白，如尿液中含有大量的蛋白質則代表腎功能衰退，腎小球濾過率(GFR)大幅下降，令蛋白質排出體外。而一般孕婦到懷孕後期均有水腫的情況出現，多出現於腳部，但如果同時出現於臉部及手部的話則要特別留意，因腦腫脹會導致癲癇症及捐害腦細胞。現時懷孕子癲前症沒有完全醫治的方法，唯一的只是提早分娩。

飲食能助控制懷孕子癲前症嗎?
到目前為止，醫學上亦未找出懷孕子癲前症的主要原因。唯一令孕婦可順利地完成整個懷孕過程及寶寶可健康地成長，均衡飲食是絕對不可缺少的。有研究報告指出，鈣質可有助減低高血壓，而一般高血壓飲食則包括低鹽(低鈉)飲食如避免食鹽、醬汁、鹹魚、鹹酸菜及大多數罐頭食品，及高鉀質飲食如綠葉菜、水果、根莖類蔬菜等。

Article: 奶品類

文: 註冊營養師張志君 Michelle Cheung (Registered Dietitian)

見過無數不愛喝奶的客人，他們的理由都是，"我受不到奶，肚子會不舒服。"詳細再了解，他們會吃雪糕、芝士、芝士蛋糕，喝奶茶等...只是受不了純鮮奶。雖然以上列出的都屬於奶品類(除奶茶)，含有豐富的鈣質及蛋白質，但不得不提的是這些都屬於高脂高糖的食物，不宜多吃。

奶品類助瘦身
如果我解釋奶品類對身體有多好、有多健康的話，我好肯定他們會"變樣"。所以，我會說："多喝/吃脫脂奶品類可助瘦身"。他們聽後都覺差異："真的嗎?"

對! 根據多項研究指出，每日3份低脂或脫脂的奶品類可有效地助肥胖人士減去體重及體脂，當然要配合低脂低糖的飲食才可。當中的鈣質真是功不可沒，它能增加新陳代謝，間接助消脂。但，可能有些人真的受不了奶品類，我們稱為"乳糖不耐症"。他們可嘗試其他高鈣的食物如高鈣荳奶、高鈣米奶、豆腐等，甚至有些食物都加入鈣質如加鈣橙汁等。可是，研究指出奶品類所含有的鈣質對於瘦身尤其顯著，因鈣質於不同食物中以不同的化學形態出現，而不同的化學形態於腸道吸收的能力亦不一樣。

再者，牛奶的GI值很低(20-34)。很多報告均指出低GI值的碳水化合物有助控制體重，因其減慢血糖水平的升幅，減低因多餘糖份轉化為脂肪的機會。

最後，我當然會問我的客人，那你會嘗試脫脂奶品類如脫脂奶嗎?

Interview: 減肥咖啡愈飲愈肥

訪問：註冊營養師張志君 Michelle Cheung (registered dietitian)

營養講座: 學童體重控制及健腦食物 10-03-25

講者：註冊營養師張志君 Michelle Cheung (registered dietitian)

體膠原蛋白有20種本文重點
年紀愈大製造機制愈慢


【本報訊】何謂膠原蛋白？消委會引述學者指，膠原蛋白屬人體主要蛋白質的其中一種，由於具良好抗拉強度，有支撐血管、骨骼及各個器官的作用，包括修補血管、傷口及骨骼，眼角膜及晶體亦是膠原蛋白功能所造成。至於針對皮膚的功能，則包括維持皮膚的外形及結構，令皮膚看來又平又滑、皺紋消失，可謂功能多多。
年紀愈大製造機制愈慢
人體內的膠原蛋白合共約二十種，最常見於皮膚、肌肉、骨骼、血管及眼角膜。不過身體要製造膠原蛋白，過程一點也不簡單。以人體攝取食物的蛋白質為例，攝入後首先經消化道消化，分解成不同種類、用作組成膠原蛋白的月太及氨基酸，再運送至身體各部分，製成膠原蛋白及其他蛋白質。當中負責製造膠原蛋白的氨基酸亦分為多種，部分可透過人體自行組成，部分亦須靠食物如肉類、芝士等攝取。製作過程亦受人體狀況、充分休息、飲食習慣等因素影響。

中大內科及藥物治療學系教授陳重娥提醒，隨着年齡增長，人體製造膠原蛋白的機制會逐漸放緩，即使食用膠原蛋白補充，亦無助增加製造膠原蛋白的數量。

踏入第30週

已經第30週，肚子越來越大，開始感到有少少害怕，分別有心理同生理上的害怕。一來怕開刀帶來的痛楚，二來害怕面對人生又一次的轉變。

News Alert: 胃酸倒流人士注意事項

東方日報2010-03-10有以下報導：

醫知健：「胃酸反流病」易引發「經常焦慮症」「胃酸反流病」是本港其中一種普遍的功能性腸胃病。當患者的下食道括約肌功能出現異常而不尋常地放鬆，或因長期勞損而變得不能關緊，胃液便有機會逆流回食道。患者會出現胃酸湧上心口/喉嚨，或在心口中間位置感到灼熱，甚至口吐酸水等症狀。
根據早前進行的一項全港性調查，發現接近一成半受訪者患有「胃酸反流病」，推算全港約共有七十三萬名患者。調查亦發現「胃酸反流病」與「經常焦慮症」存在極為密切的關係。在「胃酸反流病」患者中，接近一成會同時患上「經常焦慮症」，相比沒有「胃酸反流病」的受訪者的患病風險高出接近三倍。更重要的是，當「胃酸反流病」患者的症狀愈頻密，患上「經常焦慮症」的機會亦較大。

由於「胃酸反流病」與「經常焦慮症」的關係密切，尤其是當患者服用了「胃酸泵抑制劑」等腸胃藥物後，胃酸倒流的情況依然未有改善，便應慎重考慮症狀是否與「經常焦慮症」等情緒病有關，及早診斷和接受適當的治療。 中大醫學院消化疾病研究所　胡志遠教授
**************************************************

從營養角度來看，患有胃酸倒流人士應減少以下食物：
1.高脂食物如油炸食物
2.辛辣食物
3.有汽飲品、咖啡、濃茶及酒精

此外，定時定量及以少吃多餐進食方式，減少睡前進食、避免餐後馬上躺卧及穿著緊身衣服亦有助舒緩胃酸倒流。

提供：註冊營養師張志君 Michelle Cheung (registered dietitian)

News Alert: 學童壓力大

昨晚看到一篇報導，講述現在大部份學童都受到很大的壓力，需向政府有關部門救助。現今社會，人人都受著不同程度的壓力，而壓力往往帶給我們身體很多負面的影嚮。

壓力增加體內自由基
自由基會破壞體內正常細胞，導致細胞異常增新及發展。長期處於壓力底下，慢性疾病會漸漸衍生，如糖尿病、心血管疾病及癌症等。

營養飲食抗壓力
蔬菜及生果是抗氧化營養素的來源，它們含豐富的維他命A及C，能有效地減低自由基的活躍性。而色氨酸，則是另一種抗壓力及安睡的營養素，食物如香蕉、牛奶及火雞均含有豐富的色氨酸。如果想令心情輕鬆一點，可嘗試低GI(血糖指數)食物，如全榖類食物、燕麥、五榖包等。

小食建議
香蕉燕麥片加脫脂奶
蕃茄火雞肉全麥麵包

提供：註冊營養師張志君 Michelle Cheung (registered dietitian)

Thyroidectomy

Mom will have thyroidectomy today...

News Alert: 減肥產品含未標示西藥成分

減肥產品含未標示西藥成分
(明報)2010年3月4日 星期四 19:50
衛生署 呼籲市民不要購買或服用名為Marsha Slim Plus的減肥產品，服後可引致嚴重的副作用。

署方在旺角 一間商店取得該產品的樣本，化驗結果顯示產品含有「西布曲明」和其類似物，以及「酚酞」，而為該產品含未有標示的西藥成分。

該產品以「瑪沙醫學美容 補身美肌配方」的盒裝形式發售，盒內有一樽60粒的樽裝Marsha Slim Plus及30個Marsha茶包。

衛生署今午採取行動，在該商店搜獲27樽上述產品。行動中一名64歲女子被捕。

發言人說，「西布曲明」是一種用於抑壓食慾的西藥，其副作用包括可能導致血壓上升及心跳加劇，精神異常和痙攣，患心臟病 的人士不應服用。「西布曲明」類似物的化學構造和「西布曲明」近似，相信有相同副作用。

「酚酞」曾用作治療便秘，但因可能致癌而被禁用。含有「西布曲明」的產品必須註冊為藥劑製品才可在港發售，並須有醫生處方及在藥劑師監督下方可售賣。

市民應立即停止使用該產品。如服用後感到不適，應尋求醫生意見。市民可於辦公時間內，把產品交給衛生署位於九龍南昌街382號公共衛生檢測中心三樓的藥劑事務部辦事處，或將產品銷毀。

Interview: 賀年食品陷阱

訪問：註冊營養師張志君 Michelle Cheung (registered dietitian)

Interview: 甜品與情緒

訪問：註冊營養師張志君 Michelle Cheung (registered dietitian)

Interview: 運動飲品

訪問：註冊營養師張志君 Michelle Cheung (registered dietitian)

Article: "脂"多少

文：註冊營養師張志君 Michelle Cheung (registered dietitian)

Article: 脂肪亦要優質

文：註冊營養師張志君 Michelle Cheung (registered dietitian)

Japanese patient

下星期一會去見Dr. Wong個patient (係Japanese)...佢話同個日本人溝通有少少困難，要比D耐性...我諗都要睇下多D日本既食物名先得.

My first blog

終於可以休息下，之前一日去2-3間老人院，走到我氣喘!!! Quit左份工，可以free多D時間陪欣欣同安下胎...D人個個話我個肚都唔似7個月，最多似4-5個月... 亦都可以趁住呢個安胎既期間寫下自己D野先，我諗小小B出世後都冇咩時間寫野啦...