Island Life: Tune in, turn on, score some Vogels.
146 Responses
First ←Older Page 1 2 3 4 5 6 Newer→ Last
-
He also recommended she have a glass of whisky every night before bed!
And then we had mother's little helper washed down with a glass of gin for breakfast once the lil' ones took up residency outside the womb.
-
You're meant to take folate supplements (not just eat healthily) between 1 month before conception to 3 months after. The hard part is taking supplements before something which you're not sure is going to happen. If you have no intention of becoming pregnant, it's impossible to plan for it, and you'd think that another sort of little pill would be further up the list to take if that's a risk. There's no way of knowing for sure whether you're pregnant or not until two weeks after conception, and this time is critical.
If you've got a reasonable (if not optimal) level of folate in your diet, things are less likely to go wrong for neural tube development (spina bifida, anencephaly). Given that most people, male or female, have suboptimal folate intakes, a little bit extra benefits everyone. It's just that the benefits are much more obvious for sub-12 week fetuses. The levels at which one study found a correlation with higher rates of cancer is maybe three times as high as what you'd expect to consume with fortified bread. If you're eating that much bread, you'll have other things to worry about.
-
[coffee is] The number one blurgifier for morning sickness-suffering pregnant women, in my experience anyway.
Hm.
What about fortifying coffee plus whatever people take when they are blurgified? (peppermint lifesavers? or is that just me?)
Once people recognized that they had morning sickness and didn't just feel generally barfy, they would presumably switch to direct supplementation.
-
What about fortifying coffee?
Because pregnant women need to be careful of their caffeine intake? :)
-
What I haven't heard in this whole folic acid debate, are the voices of anyone with spina bifida. Who are we (general public, policy people, politicians etc) to judge their right to exist, and make assumptions about their quality of life?
-
Amy - as I understand it, not having suffered from morning sickness myself, is that it doesn't necessarily show up first thing. The point of fortification is to make it as easy as possible to get your folate without realising it - coffee is even harder than bread, I'd say, because there is such a wide variety of forms people consume, and in widely variable doses. There's your instant, your big brand beans, your little independent roasters and your direct-from-Cuba importers - how do each of these groups comply with a standard?
I completely agree that it would be good to hear from people who actually suffer from spina bifida in this debate, but I can't see the issue of fortification as about judging their right to exist. That's a question every prospective parent who sees a neural tube defect on their 20 week ultrasound has to consider, sure. But the whole folate thing is about enabling people to exist without a serious disability. It's like preventing a car accident. That's spina bifida, anyway. Other NTDs include anencephaly, and it's a bit academic to talk about a right to exist with a condition you can't possibly survive more than a few hours with.
-
Because pregnant women need to be careful of their caffeine intake? :)
But we're specifically talking about supplementation that needs to start before conception and continue through the early period in which pregnancy may not yet be identified. Coffee drinkers will be, well, drinking coffee.
There could be a better option, obviously. I just vaguely suspect that many more young women drink coffee than eat bread on any given day.
-
So the target demographic are some of the least likely to be eating the folic-enhanced bread?
Has anyone seen any statistics regarding the incidence of the neural-tube defects we are hoping to prevent? Is it a sizeable enough incidence to warrant wholesale management of the population's diet?
(I can understand some people saying that any incidence would warrant it, but is that realistic?) -
Stewart: start here and keep reading, particularly the results of fortification in the US. In financial terms alone, the cost/benefit is pretty compelling.
-
There's your instant, your big brand beans, your little independent roasters and your direct-from-Cuba importers - how do each of these groups comply with a standard?
I can't imagine adding folic acid to coffee beans (which is how a fair bit of coffee is purchased) is practical.
Also I suspect that people are so religious about their coffee and its quality that they'd be up in arms if we tried to add anything to it that might affect it.
-
What I haven't heard in this whole folic acid debate, are the voices of anyone with spina bifida. Who are we (general public, policy people, politicians etc) to judge their right to exist, and make assumptions about their quality of life?
I really don't follow your point about "judging their right to exist" but the Spina Bifida folks have been pretty vocal in the media.
Go through Scoop's coverage to see their press releases. -
@ B Jones - the link you provided (for which, thanks) doesn't give any statistics on incidence or the reduction of incidence where folic acid has been supplemented in bread.
Nor did I see any figures for a compelling financial cost/benefit.As an aside, from the info in the link it sounds like the only way to get a suitable amount of folic acid in the diet (a kilo of spinach or broccoli / day) has been beyond the dietary intake of our forebears. If it is so unlikely to achieve it by dietary means why has such a high level of folic acid been deemed appropriate? Aside from the argument that it reduces the incidence of NTDs which I feel is looking at the subject from the other side.
I guess I am struggling with the reasoning behind such an elevated level that cannot be realistically achieved through dietary means. It all smacks of having been influenced by the producers & suppliers of folic acid supplements.
-
And by those with a narrow clinical view where any disability is a tragedy to be prevented.
-
There's more data in the links on the page I linked to, especially this one.
There are plenty of examples of things that were beyond the abilities of our forebears to avoid - rickets, goitre, smallpox etc, that we've been able to reduce in the last hundred years. It's a measure of the success of those efforts that we can take them completely for granted.
-
I challenge anyone who considers their view to be broader than a "narrow clinical" one, to explain how anencephaly is anything other than a heartbreaking, pointless tragedy. NTDs go well beyond disability territory.
-
fortification of bread will deliver a mean increase in folic acid intake in the target
population of 101 μg and 140 μg in Australia and New Zealand respectively, resulting
in an estimated reduction of between 14-49 out of 300-350 pregnancies in Australia and
4-14 out of 70-75 pregnancies in New Zealand affected by an NTD each year;So, if I am reading this correctly, folic acid supplementation of our bread will result in (approx) 9 fewer NTD births/year in Aotearoa out of a total of (approx) 72 NTD births.
That's preventing 1 in 8, or a decline in NTD births of approx 12%.Shit, I was expecting it to be more in the order of 90%.
-
Folic acid mints would work. Young sexually active women generally value fresh breath highly and morning sicky women are often helped by peppermints.
-
How times have changed
-
Stewart - births and pregnancies are very different in this context. Numbers aren't very well recorded in NZ, but a significant proportion of pregnancies where NTDs are detected are terminated. I'm not sure why you expected fortification to be so effective - even vaccines aren't 100% effective, and NTDs aren't purely caused by low folate levels - there's a heredity component to them that means "at-risk" women are prescribed significantly higher levels than the general population. Fluoridation doesn't prevent all cavities, after all.
-
If numbers aren't well recorded how can a cost/benefit be compelling?
I expected fortification to be more effective because they are expecting everyone who eats bread to be happy with extra folate, when it positively affects a tiny minority. Why not just identify "at-risk" women and ensure they get plenty of folate? And see if there is something else that can be done to effect a positive outcome for the NTDs that are caused by something other than low folate levels.
Don't get me wrong, I am happy to think that the incidence of NTDs can be reduced but the proposed method seems like the old sledgehammer to crack a nut analogy.
-
The numbers of terminations as a result of NTD diagnosis isn't well recorded here. The rest of the numbers are ok.
By cost/benefit, I mean the costs to bakers (and therefore consumers) of mandatory fortification over the cost of the ongoing support and healthcare of the NTD-affected children who, with fortification, would have been born without NTDs, or perhaps less serious ones. But damned if I can find the exact numbers now. The Paediatric Society alludes to them.
The sledgehammer/nut analogy implies a level of harm to fortification that nobody has been able to demonstrate. But yes, fortification is broad-brush rather than targeted.
-
Why not just identify "at-risk" women and ensure they get plenty of folate?
How? I can't think of any effective way to get more folate into the vast majority of women of child-bearing age, without putting it in some common food that we're all going to eat.
-
I would also like it noted that ultrasounds do not necessarily pick up all "birth defects" associated with NTDs. If my own NTD son had lived, he (Paul) would be 20 years old now. What the ultrasound picked picked up was high level spina bifida, meaning a sac high up on the spinal cord where it had not fused. From this, they could say that he would have no feeling from the neck down, they could also see that respiration was impaired. What they couldn't see was that he also had a hare lip and cleft palate.
While I appreciate what Hilary and Sacha are saying about quality of life and not making presumptions on behalf of those disabled, i think parents are entitled to make those choices. Having said that, I am profoundly grateful that I never had to make the final decision to abort because my son died in utero. I cannot be 100% sure, but i think i would have chosen to abort - I couldn't see much quality of life for him - or for myself.
Also, folate deprivation may or may not have been a cause - at the time, I was playing Romantic Artist living in a bach on an orchard. it simply never occurred to me that the vast amounts of spraying done by the farmer wearing his spacesuit was dangerous to me and I hadn't planned a baby.
-
Kerry, thank you for your story. Having been through something similar (although not NTD) I very much believe that parents should be able to make informed decisions about such things.
What I was saying is that there are probably many people with spina bifida (and I know of adults with the condition, who are taxpayers even) who may feel that their lives are not valued as this debate swirls around. Some of the language is very insensitive and some posts have even put a dollar value on the 'burden' they create for society. I have not heard their voices (their voices - not their parents'). And this is a big gap especially as we have NZ Disability Strategy and a UN Convention on the Rights of Persons with Disabilities which claim that we do value the lives of disabled people.
-
Gotcha. The dollar value of creating a burden to society - I just love how our Money First - Values Last system prioritises pushing women out to work caring for others at the cheapest possible rates, but resists paying women to care for their own children or other loved ones, because the money-go-round matters more.
If human values came first, the rest would follow - because you purchase the intangibles - goodwill, co-operation, an emotional investment in developing better ways of doing things because citizens feel affirmed and secure. This is where Real productivity is born.
I also think there is a cultural streak of Needy is Uncool - probably rooted in the pioneer ethic and exacerbated by the current political climate. As they say, you find out who your friends are when the chips are down - too often they've vanished. The compression of time, space and demands means spare energy for helping your fellows is rare.
It's actually disabling the intrinsic human spirit.
Post your response…
This topic is closed.