Dr Liza Keating, 33, is a specialist registrar in emergency medicine at the John Radcliffe Hospital, Oxford. Her life is impressively hectic. She has three children - Millie (4), Carmen (2) and Joe (seven months) - and has just returned to work after maternity leave. Her hours are long and erratic, as she does shifts at the hospital, and is also studying part-time for a masters degree at the University of Oxford. She is still breastfeeding baby Joe.
7.30am Large, mug-sized portion of All-Bran, 1/2 cup semi-skimmed milk, one medium banana and two cups of tea with a dash of semi-skimmed milk in each.
12noon One cup of tea (all teas have a dash of semi-skimmed in them), white fist-sized roll, olive oil spread, two medium slices of cheddar cheese and an apple.
6pm Small slice of cheese-and-tomato pizza. Half a glass of white wine.
10pm Mushroom risotto - a fist-sized portion, (made with arborio rice), green beans, chocolate mousse with a wafer.
9am Full mug of All-Bran, 1/2 cup semi-skimmed milk, one medium banana, tea, glass of orange juice.
3pm Bowl of vegetable soup, one slice of wholemeal toast with Marmite and olive oil spread.
11pm One white roll, packet of crisps, apple, one glass of lemon squash.
1am Two cookies, one apple.
11am All-Bran, 1/2 cup semi-skimmed milk, one medium banana, cup of tea.
3.30pm Bowl of veg soup, white roll, two slices of cheddar cheese, olive oil spread, one sweet. One glass of lemon squash.
1am White roll, apple, orange, packet of crisps.
"There are several major challenges for a busy breastfeeding women such as Liza," says Dr Toni Steer, a nutritionist at MRC Human Nutrition Research in Cambridge. "Calcium intake is important, as is getting enough fluid and fibre. It is also important to eat regular meals as energy requirements are higher while breastfeeding (though this can be incredibly hard when you have little children and a demanding job).
A normal adult needs 700mg of calcium a day. This is the equivalent of 1/3 of a pint of milk, a small pot of yoghurt and a matchbox-sized piece of cheese. If you are also breastfeeding, your requirement rises to 1,250mg a day. This means you need the equivalent of an additional pint of milk each day. When you are pregnant, there is evidence that your body has an enhanced ability to absorb iron and calcium, but whether this continues while you are breastfeeding is controversial. Liza does get some calcium from the cheese in her rolls, the milk in her tea and on her breakfast cereal. But she needs to increase this to be sure of meeting her nutritional needs, to reduce the risk of osteoporosis in later life."
Liza's diet, though she drinks a lot of tea, may also lack fluid. "Fluid intake is essential for breastfeeding women as they can easily become dehydrated," Steer explains. "Tea and coffee have a slight diuretic effect and so it may be best to consume less tea and coffee and more water, milk and fruit juices - the recommendation is eight glasses of fluid a day."
Not surprisingly given her lifestyle, Liza goes for long periods without eating. She is not having many substantial cooked meals (though home-made vegetable soup, says Steer, is a great idea for a quick, nutritious meal).
"A breastfeeding mother will benefit from regular snacks and meals - even if it is just some toast or a banana with some milk or juice. Maximize your precious time by choosing healthy convenience foods - there are great ranges available in supermarkets now - even low-salt tinned foods and frozen vegetables are fine - but watch out because some ready-meals can contain too much sugar, fat and salt."
Getting enough fibre can be a challenge for busy women like Liza, particularly if they are not getting enough fluid. Lack of dietary fibre can lead to constipation (Liza does well with her bowls of All-Bran), and has also been linked to an increased risk of bowel cancer. "Switching to wholemeal breads and pasta, and unrefined rice is a good idea. And you should have five portions of fruit and veg a day," advises Steer.
In general, Liza's diet is certainly not unhealthy, though it is a little repetitive. She does not eat very much - but she is petite and, it seems, has abundant energy. However, says Steer, "Variety is important in any diet - the more variety you have the more likely you are to get the balanced nutrients you need".
Improve Your Diet: Tips
· To increase calcium: try to have more milky coffee, an extra yoghurt a day, and put extra milk on your cereal (choose low-fat products). Tinned fish is also a good source of calcium.
· To increase your fibre, switch to whole grain foods - Liza, for instance, could make her rolls wholemeal, and use brown rice in her risotto.
· To increase fluid, aim to drink eight glasses of water a day. Keep a bottle of water with you and sip from it as you go. Limit your caffeine and alcohol.
· To get regular, varied meals: go for easy, quick meals: jacket potato with beans and cheese, boiled eggs on toast or toast with sardines are good ideas. Vary your sandwiches. Focus on small, regular meals and snacks.