Nutrition and Beyond

It's all about a healthy lifestyle!

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Breastfeeding: A Vital Act

A few weeks ago my beautiful niece came to this world and wanting the best for her I have advised my sister to breastfeed her exclusively. What is it that makes breastfeeding very crucial? Why is it a vital act?

Breast milk is the optimal source of energy and nutrients for infants in the first 6 months of their lives. Breast milk will not only provide the infant with all the proteins, carbohydrates, fat, vitamins, minerals, and water, but also with bioactive factors needed to build the infant’s immune system and protect against infections. Other factors are also transferred to the infant to help in the digestion and absorption of nutrients.

Breast milk comes into different phases. The first 2 to 3 days after delivery, the colostrum, aka liquid gold, often yellowish in color, is produced in small amounts. This special milk is all what the infant needs at this time to boost the immune system against the first exposure to the micro-organisms of this world and to prepare the lining of the gut to absorb nutrients in the mature milk. It is also a rich source of fat-soluble vitamins (A, E, and K). The mature milk is what comes after the colostrum and it is produced in large amounts.

According to the World Health Organization, early initiation of breastfeeding, within one hour of birth of the infant, protects the baby from catching infection. In addition, exclusive breastfeeding for 6 months is recommended. In other words, the infant should receive breast milk only without any additional food or drink, not even water, in order to achieve optimal growth, development, and health.

Babies can be breasted up to 2 years or more while receiving complementary food after 6 months of age.


Breastfeeding can provide many benefits to both the mother and to the baby. First and foremost, breastfeeding promotes mother-child bonding. It is also economic and convenient as the breast milk doesn’t need to be packed, stored, and heated.

For infants, breast milk enhances sensory and cognitive development, protects against infectious and chronic diseases, reduces infant mortality, and helps for a quicker recovery during illness in addition to the optimal growth and development mentioned above. Breastfeeding can also lower risks of gastro-intestinal infections, respiratory infections, urinary tract infections, ear infections, allergic diseases, insulin-dependent diabetes mellitus, sudden infant death syndrome, and childhood leukemia. In addition, adults who were breastfed as infants are less likely to become overweight or obese and to have cardiovascular diseases.

Advantages offered to the mother include reducing the risk of ovarian cancer, breast cancer, type 2 diabetes mellitus, postpartum depression, hip fractures, and osteoporosis, helping to take off the weight gained during pregnancy, helping the uterus to shrink to its original size, and delaying the return of menstrual periods so it can help in spacing children and family planning.

mother father son

In conclusion, exclusive breastfeeding is the best thing a mother can offer to her child to help establish a healthy lifestyle early in life. You can also contribute in raising healthier generations by sharing this information with your sisters, sisters-in-law, cousins, and friends.. practically with anyone as the father has also an important role in breastfeeding as a main support pillar.

Joana Abou-Rizk

References are available upon request.


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Complementary and alternative medicine use among people living with HIV and AIDS in Lebanon

For the past two years, I’ve been working on my thesis which is entitled “Complementary and alternative medicine use, dietary practices and food security among people living with HIV and AIDS (PLWHA) in Lebanon”. Beautiful findings were extracted from this study and I am looking forward for the articles to be published.

Last month I attended the IUNS 20th International Congress of Nutrition in Granada, Spain. My participation in this congress was very rewarding as I got to present part of my thesis’ findings in a poster successfully!


The poster was entitled “Complementary and alternative medicine use among people living with HIV and AIDS (PLWHA) in Lebanon” and the published abstract is available in the Annals of Nutrition & Metabolism.

To access the abstract online, please visit this link and check p. 1055:


This project was conducted by a research team from the American University of Beirut. The part of the project that was presented in the abstract and the poster aimed to assess the prevalence and determinants of complementary and alternative medicine (CAM) use among people living with HIV and AIDS (PLWHA) in Lebanon since it has been documented in the literature that PLWHA are increasingly seeking CAM. The reasons behind this increased usage could be explained by the lack of availablity of the antiretrovals and by the significant side effects posed by these medications, although these drugs have been shown to improve the quality of life of HIV/AIDS patients and to reduce morbidity and mortality.

What is complementary and alternative medicine (CAM)? CAM, according to the National Center of Complementary and Alternative Medicine (NCCAM), is defined as “a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine”. CAM can be used either on a complementary basis, meaning with the conventional treatment, or on alternative basis, meaning instead of the conventional treatment.

A cross-sectional design was used to interview 116 HIV-positive patients in Lebanon and the results showed that 46.6% of the participants reported using one or more CAM therapies since their diagnosis with HIV/AIDS.

Our findings also showed that CAM users had a higher education level as compared to nonusers (68.5% vs 32.3% had a high school/university degree, P< 0.01). Many of you will wonder how come that those who have a higher education level are the ones that are using CAM? Shouldn’t it be the other way around? Well, our findings are in accordance with those of numerous studies documented in the literature and it has been proposed that higher education levels allowed individuals to access more information about CAM and seek these therapies as higher CAM use has been associated with higher education among the general population and HIV-positive people.

Getting back to our results, in our study the most commonly used CAM therapies included vitamins and minerals (61.1%) and herbs/natural products (63.0%) and most of the participants used CAM on a complementary basis (79.6%). In addition, a major proportion of the participants did not report using CAM to a health care professional (44.4%) and  the main reason for not reporting was that participants did not need the doctor’s approval to purchase the CAM (70.6%).

To sum up, a significant number of HIV patients are using CAM in Lebanon and an alarming proportion of these patients did not report using CAM to a health care professional. So, efforts should be made to increase awareness of health care professionals on risks of CAM therapies in order to provide proper advices and recommendations to people living with HIV and AIDS.

Why do we need to increase awareness regarding CAM use? It’s because even when CAM could have some beneficial effects, the success of conventional HIV treatment could face several challenges from CAM use. These challenges include interactions between antiretrovirals and CAM and potential decrease of the conventional treatment’s adherence.

Joana Abou-Rizk

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Why is your waist circumference an important indicator of your health?

How can one simple measurement reveal so much about your health? Let’s start by examining what is behind the waist circumference. This measurement is an easy and non-invasive tool that can estimate visceral fat, aka abdominal fat.

Excessive fat accumulated in the abdomen is characterized as visceral obesity. So, what is visceral obesity? Why is it not desired? Well, starting with the term “obesity”, it is a form of malnutrition which is characterized by an excess of body fat and “visceral” refers to the abdominal area. Increased abdominal fat is associated with increased risk for insulin resistance, diabetes mellitus type 2, dyslipidemia, cardiovascular disease, hypertension, cancers, sleep apnea, and the metabolic syndrome. As we can see, abdominal obesity is associated with higher risks of non-communicable diseases and other conditions. So, since abdominal obesity poses a significant number of risks on your health, why not act upon it? Why not be in charge and try to reduce your waist circumference?

Further, the waist circumference has not only been shown to be strongly correlated with risk of diabetes mellitus and cardiovascular diseases, but it has also been integrated in the diagnostic criteria of the metabolic syndrome. Here is a quick definition of the metabolic syndrome; it’s a cluster of risk factors that increase the risk for cardiovascular disease and diabetes mellitus. According to the International Diabetes Federation (IDF), for a person to have the metabolic syndrome, they must have central obesity, which is defined as a waist circumference equal or higher than 94 cm for males and 80 cm for females, coupled with any two of the following four factors: raised triglycerides, reduced HDL-cholesterol, raised blood pressure, and/or raised fasting plasma glucose.

You can measure your waist circumference after you exhale by using a measuring tape and by placing it horizontally above your hip bone.

waist circumference

In order to decrease your waist circumference to below the values mentioned above, it is recommended to lose weight, to improve the quality and watch the quantity of food you consume, and to be more physically active.

In other words, it is best to adopt a healthy lifestyle!

It is important to note that a precise measurement of visceral fat is challenging in clinical practice and that the waist circumference, which has different ethnicity specific values, is not the only measurement that should be taken into consideration. Other measurements and factors combined with the waist circumference are needed to have a complete description of your cardiometabolic risk.

Joana Abou-Rizk

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Nutritional Education

Have you ever wondered why good nutrition is a key to good health? Well, Hippocrates knew the answer more than two thousand years ago; he said “Let food be thy medicine and medicine be thy food”. In other words, good nutrition plays an essential role in both health and diseases; especially that nutrition is involved in all life stages, from the pre-conception phase to being an elderly. That is why establishing healthy eating habits early in the life cycle and receiving proper nutritional education is essential for adequate growth, managing diseases and conditions, and growing old in a healthy way.

Hippocrates, aka The Father of Medicine, also knew more than that. He knew that having a healthy and balanced diet and lifestyle is fundamental by saying “If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health”. So, considering that it’s not only about the quantity of food we consume, nor only about the quality of food, what matters is not only to create a balance between both food quantities and qualities, but also to be active and stay in shape in order to minimize the risk factors of non-communicable diseases such as diabetes mellitus, cardio-vascular diseases, and the metabolic syndrome.

So this is where dietitians step in; we are here to guide you in pinpointing what is healthy for you, to set a balance in your life as well as to tackle poor nutritional habits so you can lead a healthy and balanced lifestyle. Seeing that almost everyone has a complicated relationship with food, let’s start re-evaluating it closely to improve your food choices and together build a harmony in your life.

And remember, it’s never too late to adopt a healthy lifestyle!

Joana Abou-Rizk