Archive for the ‘B3RD’ Category

When labels mislead

February 10th, 2018

I have a deep, dark secret. It’s bound to have other dietitians ready to throw me out of the club.

I don’t read labels.

Honestly.

I generally buy food based on price and count on my general tendency towards minimally processed ingredients for ensuring that I don’t end up with too much sodium or added sugar in our diets (although, who am I kidding, we get plenty of added sugar in our diets – I know it’s there because I’m removing it from my sugar bins by the cup- and spoonful.)

Anyway, there is one item where I routinely read the label (or at least read it when I’m deciding between stuff – then I go on autopilot.)

I read the labels on cans of fruit.

We eat canned fruit almost every day. If we were to try to get our 3-4 servings of fruit per day from fresh fruit alone, it could get pretty expensive (or pretty unvaried during certain seasons); but by using a combination of canned, frozen, dried, and (seasonal) fresh fruit, I can feed my family a good amount of fruit without breaking the bank.

But since I feed my family canned fruit on a daily basis, I have nutritional criterion for what I buy. I want as little added sugar as possible. What’s more, I want as little added sweetener as possible.

So, when possible, I try to get fruit packed in water. If that’s not available, I’ll go with fruit packed in its own juice or in extra light syrup. If fruit is packed in some other kind of juice, I want the concentration of that juice to be the same as the concentration of straight juice (so no using half the water to reconstitute fruit juice – that’s the nutritional and flavor equivalent of heavy syrup.) I only buy fruit in heavy syrup as a treat (for instance, you can’t buy canned plums any other way – and I have fond memories of my mom’s home-canned plums so I pick some up a couple times a year.)

Then came Splenda – and fruit canners decided all their dreams had come true. Unlike other artificial sweeteners, Splenda is heat-stable AND replaces sugar molecule-for-molecule. This means that they can use Splenda to get the same results as sugar (sweetness and better fruit texture) without the extra calories/added sugar that consumers don’t want. Perfect. They started using Splenda in their canned fruits.

I am not a fan.

Not to say that I’m not a fan of Splenda in general. It is a wonderful substitute for those who need to reduce sugar and still want to make their own recipes (so, it’s a great choice for diabetics who want to be able to eat their favorite dessert without having to make the rest of the meal completely carb free).

But even in the absence of the calories from sugar, I don’t want my children to grow up thinking canned fruit should be as sweet as it would be if it were canned in heavy syrup. I want to train their taste buds to think that water-packed (or “own-juices-packed”) fruit is “the way canned fruit should taste.”

But then I started using Walmart grocery pickup, where reading labels isn’t as easy as scanning visually while you’re tossing a can into your cart.

At first, I bought the Great Value fruit labeled “No Added Sugar.” But that was packed in Splenda. No go.

I switched to fruit “With 100% Fruit Juice”. It contains an extra 3 grams of sugar per serving (that’s 3/4 teaspoon) than fruit canned in water would.

But last week, I saw that there was a new item available: Great Value canned fruit packed IN WATER.

“Hooray! At last!” I thought, as I added it to my favorites and ordered some cans.

My hooray turned to disappointment when I looked at the label before I opened the first can of peaches.

These were not peaches packed in water. These were peaches packed in Splenda. They’d just changed the name of the “No added sugar” variety.

Grr.

Book Review: The Dinner Diaries by Betsy Block

March 18th, 2016

Feeding a family. Raising healthy eaters. Topics I’m passionate about. Even while I was still working on my degree, I knew that helping mothers feed their families and raise healthy eaters was what I wanted to do as a career. I made that the focus of my graduate work. After a stint in long term care, I moved to WIC, where I was able to live my dream (at least as far as career goes.)

Subtitled “Raising Whole Wheat Kids in a White Bread World”, Betsy Block’s book should be right up my alley, right?

Wrong.

I should have known from the blurb on the back cover:

“A harried mother of two, Betsy Block is in pursuit of the perfect family meal: local, toxin-free, humane, and healthful.”

But the book was in a Dewey Decimal category I was trying to close and I figured “how bad can it be?”

Pretty bad.

Betsy Block’s The Dinner Diaries is basically a manual on how NOT to feed a family or raise healthy eaters. In order to save you the work of reading it, allow me to summarize the main points.

Tip 1: Start with all the wrong priorities

It’s no mistake that “healthful” is last on the list of Block’s priorities a la the back of the book. In reality, her definition of “healthful” is suspect enough that you might as well knock it off the list. Block is all about the local (which has very little impact on health), toxin-free (the American food supply, with the exception of methyl-mercury containing fish, is actually one of the safest in the world), and humane/sustainable (an ideological issue but not a health one.) Her couple of concessions to actually health practices include trying to eat less sugar and (at the very end of the book) attempting to eat more whole grains.

If you’d rather actually have some success at feeding a family or raising healthy eaters, I recommend starting with priorities that will actually help you achieve health. Try: increasing fruit and vegetable intake (no, it doesn’t have to be fresh – frozen or canned are fine), increasing variety (of protein sources, vegetables, starches, you name it – variety is good), sitting down together as a family to eat (even for snacks), having sweets around less frequently and subbing fruit instead, or experimenting with forms of cooking other than frying. I can give you more suggestions if you’d like, but those are some of the biggies.

Tip 2: Lecture your children about food

There’s nothing like a good guilt trip to help kids form a healthy attitude toward food, amiright?

Okay, no.

But Block seems to think it’s a great idea. She lectures about all those wrong priorities, lectures when kids won’t eat something, lectures when kids do eat something. She sets up learning opportunities for herself (like going to see a pig that she’s later going to eat) and leaves the children behind lest it be too tense for them – not that she won’t lecture them about it when she gets home. When her daughter asks to help cook, Betsy asks if that means her daughter will eat what they prepare. When her daughter says “probably not”, Betsy declines the offer of help.

If you’d like your children to actually develop a healthy attitude toward food, start by modeling healthy attitudes towards food yourself (by the way, Block’s obsessive interest in “perfect” food isn’t healthy.) Eat in moderation. Eat a variety. Don’t obsess over food (either in a “I must have sweets now” or in a “my diet must be absolutely healthy all the time” way).

If you’d like your children to develop a healthy attitude toward food, involve them in selecting and preparing food. Preschoolers will love searching for a red vegetable at the supermarket. Kids can learn to cook early on. Gardening or going to a farm to see how food is made is a great activity for kids. BUT…not as a way to coerce your kids into eating something. That’s Betsy’s mistake. She read that when kids cook with their families, they’re more likely to eat what they make – so she thought she could coerce her daughter into eating by letting her help cook. Letting your child cook isn’t a one-time magic bullet to healthy eating. Instead, it’s a process by which children develop positive associations with food, take ownership of food (in a healthy way), and learn skills that will help them eat well when they decide that they’re willing to try eating asparagus.

If you’d like your children to develop a healthy attitude toward food, move the conversation from nutrition to habits. Dina Rose’s excellent website It’s not about nutrition is a great resource for changing the way families talk about food. The gist of Rose’s message is to start talking about proportion, variety, and moderation (Check out this article for more info.) Changing the conversation makes a real difference, both in helping kids eat healthfully, but also in helping them think healthfully about food.

In the very first chapter of Betsy Block’s book, she writes of a nutritionist who refused to work with her because of her emphasis on organic foods. Block was shocked that organic foods were controversial. Except that to call the “health benefits” of organic controversial is putting it mildly. Despite many attempts to prove otherwise, there is no compelling evidence that organic foods are more nutrient-rich or more safe than conventionally grown ones. It’s fine for people to eat organic, but they’re fooling themselves if they think that organic = healthy. Block’s choice to focus on secondary issues instead of primary ones meant that her memoir is a recounting of an exercise in frustration, accomplishing next to nothing in terms of changing her children’s habits and attitudes regarding food.

The nutritionist who ended up working with Block (although we only hear about her in the first chapter) did a good job of trying to get Block to focus on some actually beneficial eating practices (unfortunately, she did not address the task of how to communicate with children about food) – but it was all for naught. Block would not be dissuaded from her ill-informed search for dietary perfection and from her agenda of changing her children’s eating patterns by coersion. I think the first nutritionist made a wise choice.

Please, people, don’t be Betsy.


Rating: 1 star
Category: Food memoir
Synopsis: Betsy Block tries to make over her family mealtimes.
Recommendation: Ugh. No.

Dietary Guidelines for Americans summarized

February 22nd, 2016

Remember how I said (back before I stopped blogging) that the Guidelines aren’t written for the general public? The reality is that the five guidelines can sound like mumbo-jumbo to the average consumer. My goal here is to translate the guidelines into more average-person-friendly language.

1. Your entire eating pattern is more important than specific foods or nutrients.

Eating a healthy diet isn’t about vilifying a food group (i.e. grains or meats) or an individual nutrient (i.e. fat or carbohydrates). Nor is it about consuming the current super-food fad (i.e. quinoa or coconut oil).

It’s about your whole pattern of eating and the balance of food groups and nutrients.

2. Choose a variety of the most nutritious foods in the quantities you need to stay healthy.

Variety. You should eat foods from all the food groups (i.e. not just meat and grains). You should eat a variety of foods within each food group (i.e. not just potatoes and lettuce in the vegetable group.)

Nutritious. This means with lots of vitamins and minerals without many empty calories. This means choosing whole grains more frequently and white flour less frequently. It means choosing fresh fruit over fruit drinks. It means choosing a steak (preferably lean) over a hot dog. It’s choosing the grilled chicken over the nuggets.

Quantity. Eat the amount you need to maintain a healthy weight. Eat until you’re satisfied instead of until you’re stuffed.

3. Decrease sugar, solid fat, and salt intake.

Drink less soda and more water. Eat fewer fruit snacks and more whole fruit. Eat less meat and more fish and beans. Eat less cheese and more low fat yogurt. Eat less processed food and make more meals from scratch.

4. Trade healthier foods for less healthy ones.

Is this starting to sound like a broken record? Use brown rice instead of white. Eat fruit instead of drinking juice. Drink low fat milk instead of whole milk. Choose fish as your protein more frequently. Have a spinach salad instead of an iceberg lettuce one. Choose a baked potato instead of fries.

**And here’s where I need to remind us of the first recommendation again. Your entire eating pattern is more important than specific foods or nutrients. Neither I nor the DGA is recommending that you NEVER EAT white rice, iceberg lettuce, or French fries. Juice is fine on occasion. For that matter, a full-sugar soda is fine on occasion. It’s the overall pattern of your eating that makes the difference.**

5. Everybody is responsible for helping Americans eat healthier diets.

It’s easy to want to play a blame game when it comes to nutrition and health. Some say the poor dietary habits of Americans are each individual’s fault. Others blame food manufacturers or school lunch ladies or food deserts or supersized meals at McDonald’s.

This Guideline doesn’t point fingers, but it does say that everyone can play a role in improving the dietary habits of Americans. Workplaces and schools can make healthy options more available in their cafeterias. Food manufacturers can work to reduce the sodium in their food products. McDonald’s can offer to sub a salad for the fries in a value meal.

A couple things to know about the 2015 Dietary Guidelines for Americans

January 13th, 2016

1. The Audience determines the message and the method of communication

A good question to ask yourself when reading anything is who is the intended audience?

The Dietary Guidelines for Americans (DGA) make clear who their intended audience is. The DGA website splash page states

“Intended for policymakers and health professionals, this edition of the Dietary Guidelines…”

In case that isn’t clear, the introduction to the Guidelines reads

“The primary audiences are policymakers, as well as nutrition and health professionals, not the general public.”

Why is this important? (That is to say, why do *I* think this is important?)

This is important because the intended audience determines what information is shared and how it is shared.

I’ve seen multiple criticisms in the popular media complaining that the 2015 DGA aren’t consumer-friendly or that they contain awkward language. But the DGA aren’t intended for the consumer. They’re to be used by professionals to craft consumer messages. That means they are going to say things like “Americans should limit added sugars to less than 10% of total calories” – leaving the “Americans should consume less soda” to those professionals who are creating consumer messages (such as MyPlate – The federal government’s consumer food guidance graphic.)

2. What the media focuses on is not necessarily what the guidelines focus on

What have you heard about the recommendations?

Let me guess: Cholesterol is okay now. Sugar is the bad guy. Women who drink more than one alcoholic drink per day are binge drinkers and unhealthy. Men need to eat less meat.

The media focuses on these items because they’re new (absence of cholesterol restriction, insertion of sugar restriction) or controversial (alcohol and meat intake in general). They make good stories.

But to focus on the new and the controversial misses the bulk of what the guidelines recommend: Americans need to eat more fruits, vegetables, and whole grains and need to consume fewer empty calories.

Does that feel boring? I’ll bet it does. You already knew that you were supposed to do that. But the reality remains that Americans are NOT doing that – and that those dietary changes (regardless of your views on the new or controversial stuff in the recommendations) are what is most important for improving the dietary quality of Americans.

If the message you got from the news coverage of the guidelines was “cholesterol is no longer the bad guy, sugar is”, you got the wrong message. If your application is to go out and eat a much beef, pork, and eggs as you can while eschewing everything with “sugar” on its nutrition facts panel, you’ve made the wrong application. But I fear that is the sort of messages people are going to be getting from the media coverage of the guidelines.

Book Review: The Baby Food Bible by Eileen Behan

August 17th, 2015

Face it, feeding a baby is hard work. Whether at the breast, from a bottle, or at the table, infant feeding takes time, energy, and savvy. (And don’t even get me started on the cleanup!)

For the health savvy mom, feeding a baby can be even harder – there’s so much conflicting information, so much advice, so many different ways to go. Start at four months or six? Rice cereal or avocado as a first food? Wait 3-5 days between foods or introduce mixtures at will? Cut grapes into quarters or sixteenths? Jarred or homemade baby foods? Or maybe baby-led weaning is the way to go? Should I choose organic foods or are conventionally grown foods okay? Should my baby eat salt? Sugar? Dairy foods? Soy foods? Wheat? Peanuts? The list of potential questions goes on and on.

I wish there were a good quality book that addressed all these issues (and addressed them the way I do – because, of course, I know it all :-P), but unfortunately, to my knowledge, no such book exists.

Eileen Behan’s The Baby Food Bible does a pretty good job though as a basic resource for moms. Behan, a dietitian who works with families, does a decent job summarizing general infant feeding recommendations as of 2008 when The Baby Food Bible was published.

The largest section of the book is a list of healthy food items (from all the food groups), discussing how moms can make them into purees for their infants and how they can incorporate those foods into family meals. She gives easy “recipes” for the purees, including how much water to use per unit of food and both stovetop and microwave cooking times. For the mom who’s going the puree route (which you don’t have to, by the way – Tirzah Mae ate purees maybe twice), it’s a good resource. The next largest section is a collection of multi-ingredient recipes that can be pureed to be fed to babies, as well as to the rest of the family. Again, if you’re going the puree route, it’s a good resource.

Now, every so often, Behan says something about a specific food that reflects traditional infant feeding biases that I don’t agree with (and that don’t have research to back them up) – like when she says that cucumbers are “not recommended for infants”, but are “a good snack food for older toddlers.” It’s true that cucumbers do not puree well, but I don’t see any reason why an infant eating stage 3 or 4 foods shouldn’t have little chunks of the inner portion of a cucumber (Tirzah Mae does whenever we’re eating cucumbers). Likewise, Behan writes that “onions are not a baby food” and suggests only that they can be included in recipes for older children because they add flavor. I’ve never seen any reason to avoid onions with babies (except cultural biases against it) – and we eat sauteed onions (or sauteed onions and zucchini or onions and peppers or…) rather frequently.

Other recommendations Behan makes are outdated – the most notable being that she gives the (then current) recommendation to avoid potentially allergenic foods in the first year. Pediatricians and dietitians had been giving that advice for years based on a “better safe than sorry” principle while research was being conducted to determine whether it made a difference. Well, in the past 2 (maybe 3?) years, the research has come out and indicates that holding off on potentially allergy-causing food has the exact opposite effect than the one we’d hoped for. We now know that introducing potential allergens between the ages of 4 and 6 months has a protective effect against the development of food allergies.

And then there are the philosophical questions that don’t necessarily have scientific evidence on their side – organic foods, local foods, humane foods, etc. Behan generally jumps on the bandwagon with each of these, although she does acknowledge to some degree that parents may have different priorities.

So… now for the difficult part. Do I recommend The Baby Food Bible?

If you’re a mom with a baby younger than 8 months, you intend to go the puree route, and you want to learn how to make your own baby food, this is a great resource. If you’ve got a baby older than 8 months, you should be working on introducing textures (which Behan doesn’t talk a whole lot about but which I consider a very important step in ensuring healthy eating patterns into adulthood – something I believe the research supports). If you intend to skip purees – hey, I did too – wanna compare notes? If you intend to just buy staged baby food from the store, the bulk of this book won’t apply to you.


Rating: 3 stars
Category: Infant feeding
Synopsis: Behan discusses then-current recommendations for infant feeding and gives a giant list of foods and how to prepare and puree them for your baby.
Recommendation: Worthwhile if your baby is under 8 months, you intend to feed your baby purees, and you want to learn how to make your own baby food.

My Child “Choked”

June 24th, 2015

Little scares a mother more than hearing that half-retching, half-coughing noise that she almost universally describes as “choking”.

But just because it scares a mother doesn’t mean it should scare a mother.

You see, that little cough/retch? That’s not choking. Generally, it’s gagging.

According to the Mayo Clinic, choking is “when a foreign object becomes lodged in the throat or windpipe, blocking the flow of air”. By definition, choking makes no sound, since no air is able to flow through a blocked windpipe.

Gagging, on the other hand, is a function of the gag reflex, defined by Merriam-Webster as “the reflex contraction of the muscles of the throat caused especially by stimulation (as by touch) of the pharynx”. Gagging is an involuntary reaction in which the the throat contracts to prevent choking.

Did you catch that?

Gagging prevents choking.

While the sound of gagging can make a mother’s heart jump into her throat, it isn’t a sign that something is going wrong with your child. It’s a sign that something’s going right. Your child’s body is working as it’s supposed to, protecting your child from choking.

What does this mean for the mother?

For one, it means you can breathe a sigh of relief. When I’m feeding Tirzah Mae and she gags on a bite, my heart leaps just like other moms’ hearts do – but since I know what gagging means, I can then relax and thank God that He created her body to help keep her safe.

For two, it means you need to be vigilant when feeding your child. A choking child isn’t going to give a cough to let you know to rush to her side. A choking child can’t breathe, can’t make noise. Which is why young children should sit down to eat and why mom should be right there beside them while they’re eating. Letting a child wander with snack in hand ups the choking risk in two ways: a child distracted by walking is more likely to chew insufficiently or to send something down the wrong pipe (I find this to be the case when I’m walking and eating) and a child who is wandering about while eating is not necessarily being supervised in such a way that a caretaker can quickly intervene were true choking to occur. (There are social and nutritional benefits of sitting down to eat as well, but I won’t go into those here.)

When I was working as a WIC dietitian, mothers mentioned choking often in reference to introducing solids to their babies. Often, mothers insisted that their eight to nine month old babies couldn’t eat anything but pureed baby foods because they choked on them. Of course, these moms didn’t realize that their children were gagging rather than choking. But what about their response? Is mom right to say that her child can’t eat a certain food or a certain texture because she gags on it?

Yes and no.

Gagging is an interesting thing. While the gag reflex is classically induced by touching the pharynx (that is, the soft tissue at the back of the throat), it can also be induced by smells (as of rotten food), by sight (as with seeing maggots), or even by a thought (such as the thought of eating rotten food or finding maggots in the bottom of your lunch pail). Additionally, some people have more or less sensitive gag reflexes – such that different textures, different smells, and different tastes cause them to gag.

For most children, gagging when introduced to a new texture is simply the body doing what it’s supposed to do, keeping foreign bodies from entering the airway. As a child becomes more adept with and used to the new texture, gagging should decrease. However, in certain circumstances, children with hypersensitive gag reflexes will have severe sensory issues with food which can be exacerbated by forcing a child to eat foods that stimulate their gag reflexes.

So what should mom do?

In general, if your child gags at the first taste of a new food (or first try with a new texture), I recommend waiting until your child is calm (which may be two seconds or may be much longer) before trying another bite.

If your child eats several bites of that new food, gagging two or three times throughout the feeding, this represents a normal response and there is no reason to stop feeding your child that food or texture. Gagging will become less frequent as the child becomes more familiar with the taste and/or texture of that food.

If, on the other hand, your child gags on three successive bites of the same food (or if your child turns away or clenches his/her teeth when you offer a bite), I recommend that you call it quits for the meal. This ensures that you aren’t creating unpleasant associations with that food in your child’s mind – those unpleasant associations can actually condition your child’s gag reflex to always respond to that particular food, a situation you definitely want to avoid.

Then, you’ll want to do a little Sherlock-style sleuthing. What do you think it was that triggered your child’s gag reflex? Was this a brand new flavor for your child or has he tasted it before? Was this a new texture for your child or has he had a similar texture before? If this was a brand new flavor, try mixing that food with another accepted food the next time you try it. If it was a brand new texture, try modifying the texture just a little bit the next time you try it (if baby has only had watery purees and baby gagged on a lumpy mix, offer a thicker puree before introducing a lumpy mix; if baby has only had purees with some lumps and gagged on chunks, try getting your child used to minced textures before introducing chunks; etc.) The goal is to ease a child’s transition into the next texture “level” or novel flavor.

It is valuable to continue working at introducing novel flavors and textures, despite the gag reflex (while being respectful of a child’s cues – remember to stop and try again later if a child gags on every bite or if the child turns away or clenches his teeth). Children who do not learn to eat textured foods by 8-9 months are more prone to persistent sensory food issues lasting into adulthood.

But what if your child does persist in gagging at every bite? This may be a sign of a hypersensitive gag reflex, in which case it would be worthwhile to ask your doctor about a referral to a multidisciplinary feeding therapy team that can evaluate causes of the difficulty and develop strategies for helping your child overcome these difficulties.

Rice Cereal Time?

March 25th, 2015

Tirzah Mae had her “4 month” appointment today (Born five months ago and due 3 months ago) – and her doctor went through the standard four month advice, ending with “You can also start rice cereal now.”

To which Tirzah Mae’s dietitian mother answered, “Thanks but no thanks.”

Despite what your next door neighbor, the label on the baby cereal, and maybe even your family doc says, you do not need to introduce solids at 4 months. Most babies don’t need anything but breastmilk or infant formula until they’re six months old – and both breastfed and formula fed infants are at a disadvantage if they start solids too early.

For breastfed infants, the risk of adding solids before six months is related to what we breastfeeding people call the “virgin gut”. As long as Tirzah Mae is only receiving breastmilk, her gut has a protective layer (a simplified explanation that isn’t precisely correct, sorry!) that practically sheds pathenogenic bacteria and other icky stuff. Once that layer has been broken, baby can get sick more easily (now, don’t get me wrong – this does not mean that breastmilk is no longer beneficial after the gut’s barrier has been broken – keep breastfeeding even if you introduced solids prematurely!) The longer the breastfed baby waits before breaking that barrier, the better off she is – to a point. That point is right about 6 months , when an infant’s iron stores from birth are depleted and she needs some extra iron (this is why iron fortified infant cereal is recommended as baby’s first food).

For the formula fed infant, there’s no gut barrier to break – it’s been broken long ago (after that first two ounces of formula), but that doesn’t mean that we should be gung-ho about starting those solids right at four months. A few babies are developmentally ready at four months – but the vast majority develop the head and neck control needed to safely eat solids later. And introducing solids too soon can risk replacing the relatively nutrient-rich formula baby has been receiving with the (mostly) “empty calories” of (most) “Stage 1” baby foods (as well as increase risk of allergies).

So, when SHOULD you start solids?

If you’re breastfeeding your baby, when your baby shows signs of developmental readiness, no sooner than six months. If you’re formula feeding, when your baby shows signs of developmental readiness, no sooner than four months.

What are these signs of developmental readiness I speak of? I’m so glad you asked.

First, your baby should be sitting up with minimal support. This means with a pillow behind him – not strapped into a seat with a five point harness or sitting in a Bumbo.

Second, your baby should be able to hold his head steady and make controlled head movements in the sitting position. If I had a dime for every parent who has told me their two week old already has great head control… Remember, I said “in the sitting position”.

Finally, your baby should open his mouth wide for a spoon of food and close it once the spoon’s inside. If your baby is still sticking out his tongue when the spoon touches his lips, he’s not ready for solids. His tongue is under reflexive control – it needs to be under his control before he starts eating solids.

As for Tirzah Mae? We’ll be breastfeeding with nothing else added at LEAST for another month (six months from her birthday) but probably closer to three more months (until six months after her due date).

Breastfeeding: Normal or Best?

March 19th, 2015

It’s popular, in breastfeeding circles, to talk about how breast isn’t best – it’s normal.

In general, I find the arguments uncompelling (and whenever I do find one compelling, it is unable to withstand discussion with my husband, who is my resident sharpener-of-thought.)

The problem with the debate, I think, is that it adds nothing useful for the woman who is undecided or opposed to breastfeeding. It serves as a rallying cry for the lactivist, but does little for average-Jane-moms.

The other problem with the debate is that there are a couple of different definitions of normal that come into play. There are cultural norms and physiologic norms – two quite different things. Cultural norms refers to what is usual or expected in our cultural. Unfortunately, breastfeeding is not currently normal in our culture. Physiological norms refers to the expected standard for health. So a physiological norm might be a BMI between 18 and 25 (despite many in our culture falling above that range).

Proponents of the “breastfeeding is normal, not best” argument state that using the “best” terminology suggests that breastfeeding is something that women can do to go above and beyond – like telling them that a glass of wine daily can reduce their risk of heart disease. No one would fault a woman for choosing not to go the extra mile to drink a glass of wine daily. They could still be acting appropriately and normally without consuming wine. But breastfeeding is not like a glass of wine daily, adding some benefits but not really something women should be expected to do.

In my opinion, this only adds fuel to the mommy-war flame, without really helping women (who experience great pressure from cultural norms opposing breastfeeding.)

To tell a woman that something is normal and expected physiologically (as it certainly is – just as heterosexual sex is normal and expected versus homosexual sex**) before it is normal and expected culturally is more likely to cause her additional anguish rather than to assist her in making a decision and holding to it.

As an aside, I would love to live in a world where breastfeeding was the cultural norm – where women breastfeeding was common and accepted and where bottles were not the ubiquitous symbol of a baby. I would love to live in a world where all husbands made enough money that their wives could stay home for a minimum of six months after delivering so they could breastfeed their babies (without having to pump and provide expressed breastmilk) – and where there were no husbandless mothers. But that is not the world we live in, so calling breastfeeding “normal” when it is not culturally so confuses the issue.

So I’m not a fan of the “normal” argument. Or at least I wasn’t until I read the following in Jack Newman and Teresa Pitman’s The Ultimate Breastfeeding Book of Answers:

“There is no evidence that what is called ‘breastmilk’ jaundice is bad for the baby. None. On the contrary, bilirubin may be good for the baby, protecting him from potentially damaging chemicals in the body. What we have here is a lack of understanding; that is, too many people do not understand that breastfeeding is the normal physiological method of feeding infants and young children. If most exclusively breastfed, well-gaining babies are jaundiced, then this is normal and not a concern. On the contrary, we should be concerned about babies fed with formula (advertised as being ‘close to breastmilk’) who are not jaundiced. What’s wrong with them that they are not jaundiced? The breastfed baby should be the model of what to expect, not the artificially fed baby.”

This argument, I can agree with wholeheartedly. It would be incredibly useful if medical practitioners got used to the reality that breastfeeding is the physiological norm – and evaluated babies accordingly. If medical practitioners had growth charts that expressed biological norms for breastfed babies instead of formula fed babies, it is likely that fewer women would be encouraged to supplement with formula. If medical practitioners understood biologically normal levels of bilirubin and blood sugars in the breastfed neonate, many more women would be able to successfully establish breastfeeding.

This is a “normal” argument I can get behind.

As another aside (in other words, stop reading if you’ve got hurts related to breastfeeding that are exacerbated by women celebrating breastfeeding), I love Newman and Pitman’s follow-up paragraph:

“For these reasons, there is no call to take the baby off the breast for 24 or 48 hours ‘to be sure that it is breastmilk jaundice,’ and to bring the baby’s bilirubin down to those of the artificially fed baby. In fact, logically, we should not be worrying the breastfeeding mother at all about her jaundiced baby. We should be saying to the formula-feeding mother, ‘Your baby’s bilirubin is too low. This is probably not dangerous, but just to make sure that it is the formula that is keeping his bilirubin too low, I would like you to put the baby to the breast for a few days, so that his bilirubin moves up into the normal range.’ That’s logical.”


**Please don’t misunderstand me, I am in no way suggesting that formula feeding and homosexual sex are at all morally equivalent. That is absolutely untrue. What is true is that they are both different from the physiological or biological norms.

Trying times

May 6th, 2014

Warning: This post is about trying to conceive and I do refer to sex in my treatment of the topic. If this is something you’re uncomfortable with or that will be unhealthy for you, feel free to skip it.

At my preconception visit, both the medical assistant and the doctor gave a decent bit of advice for the trying time.

From the medical assistant: “I got one of those ovulation kits and took it for a month so I knew what day I ovulated. Then we saved it up for when I ovulated the next month – we had a baby on our first try.”

From the doctor: “Relax. Have fun. Call me if you don’t conceive after six months of trying.”

Now, it might appear that these are contradictory messages. Yet, I think both contain wisdom.

It’s worthwhile to get to know your body before you conceive. Knowledge is power – and making sure that you’re trying when you’re capable of conceiving can certainly help the process along.

That said, I think there are tons better ways than using an ovulation kit from the drugstore. If you have used either natural family planning (NFP) or fertility awareness methods (FAM) of birth control, you’re already familiar with your times of peak fertility based on signals like basal body temperature or cervical mucous. All you need to do is look over your past charts and figure out on what day of your cycle your peak fertility is at. Easy peasy.

If you haven’t been using NFP or FAM, do a little research and start logging your fertility signs now. Even if all you’re doing is checking your cervical mucous (a zero-cost activity), you can get a pretty good idea of when you’re fertile. Just swipe your vagina with a clean piece of tissue before going to the bathroom and then stretch that mucous between your two fingers. Is it stretchy and egg-whitey? There’s a good chance you’re approaching or at peak fertility. Is it nonexistant or just a little creamy? You’re unlikely to conceive just now.

Does that mean you should follow the medical assistant’s advice and “save it up” for when you’re fertile? I don’t necessarily think so. You should try to have sex during your fertile window – but it’s valuable to remember that sex isn’t JUST for procreation (even if that’s what you’re focusing on at the moment.) Here’s where my doctor’s sage advice comes in. Relax. Have fun.

Don’t turn sex into a baby-making exercise. Yeah, be sure you aren’t choosing your fertile week of the month to abstain; but otherwise choose to let sex be about loving and enjoying your spouse.

So, what’s the six month thing?

My doctor advised me to give him a call if Daniel and I haven’t conceived within six months of starting to try. Having difficulty conceiving after a prolonged period of “unprotected” sex can be a sign of infertility – and it’s always worthwhile, if one is having difficulty conceiving, to check out possible causes. Because I am nearing my 30th birthday (and therefore have only 5 years in which to get pregnant before I enter my gynecologically “elderly” years), my doctor recommended looking into things after six months of trying without conceiving. It is important to note that I will not be considered to be infertile at this point. Infertility is defined as not conceiving after 12 months of regular unprotected sex. For the younger woman, doctors will probably recommend trying for the full year before investigating for possible causes of infertility.

If you’ve been tracking your fertility with NFP or FAM, you’ve been collecting valuable data that can be used by your doctor to evaluate possible causes for difficulties conceiving – which is just another reason to NOT abandon your careful tracking during the trying times (and another reason to start tracking if you haven’t been already.)

In summary: Find out when you’re fertile. Relax. Have Fun. Call your doctor if you don’t conceive within six months to a year of trying.

Planning for a Healthy Pregnancy (Part 4)

April 30th, 2014

We’re in the home stretch now, almost ready to start trying for a baby. You’ve quit the bad stuff and attained a healthy weight. You’ve gotten pre-existing conditions under control. And you’ve gotten immunizations and dental care out of the way. Now, all you need to do is head down to the supplement aisle of your nearest drugstore and…

…and stare blankly at the thousands of options that meet your eye.

What on earth should you be taking before you try to conceive?

6. Start taking a vitamin

There are lots of opinions on the value of vitamin supplementation or the lack thereof. The standard professional response to the question of “should I be taking a vitamin?” is that “the best source of vitamins and minerals is a healthy diet.” And that’s absolutely right.

Unfortunately, a lot of us don’t eat a healthy diet. Which is why a whole spate of other professionals respond with “a good multivitamin is good nutritional insurance.”

So what’s a hoping-to-become-pregnant woman to do?

Well, there is one nutrient for which we know supplementation is absolutely beneficial. All women who are capable of becoming pregnant (whether they’re actively trying or not) should ensure that they are getting 400 mcg of folic acid, either from fortified foods or from supplements.

Folic acid is essential for a baby’s brain or spinal cord development, but the most important weeks for this development are before you miss your first period – which means you need to make sure you’re getting enough folic acid BEFORE you get pregnant.

It’s possible that you don’t need a supplement to get even this – if you religiously eat breakfast cereal or a sandwich daily and your daily intake from fortified foods equals 100% of the Daily Value (check the nutrition facts panel on your cereal and bread), you can breathe a sigh of relief. But if you don’t currently eat 100% every single day, you should be taking a supplement that contains 400-800 mcg of folic acid.

That’s all you really need for the prepregnancy period, unless you have reason to suspect that you have a nutritional deficiency. (For my part, I knew that I should probably take my known Vitamin D deficiency more seriously since I’d be hurting not just myself but potentially a growing baby by staying deficient.)

But it might be worthwhile to also look into what your increasing needs will be during pregnancy and incorporate those supplements in now.

The three nutrients that are worth looking at are 1) iodine, 2) iron, and 3) calcium.

Iodine is a mineral that is very important for thyroid function – and thyroid controls our rate of metabolism and therefore baby’s rate of growth. Iodine needs are increased during pregnancy from 150 mcg to 220 mcg per day. The majority of the iodine in our diets (especially for those of us who live far from the sea and don’t eat seaweed :-P) comes from iodized salt. During pregnancy, you would need to be eating 3/4 tsp of iodized salt daily to get enough. If you’re a really liberal salter, you might be okay – but if, like me, you use little salt in your cooking and don’t usually salt at the table, you’re probably not getting enough. While I do recommend making sure that the salt you DO use is iodized (I had to switch mine since Daniel and I somehow managed to end up with some non-iodized salt that I’d been trying fruitlessly to use up), I don’t recommend that you start salting things more. While a small portion of the population could handle additional salt, the majority of us get way too much sodium from the processed foods we eat – but this salt generally doesn’t contain any iodine. So, to make sure you’ll be getting enough iodine during pregnancy, I recommend looking for a multivitamin that contains both that 400-800 mcg of folic acid AND 100% of the daily value for iodine (that’ll be 150 mcg).

Iron is a tricky one. The research is mixed regarding the benefits or drawbacks of iron supplementation during pregnancy – and the evidence is currently insufficient to recommend that all pregnant women take an iron supplement. On the other hand, iron-deficiency during pregnancy is one of the most common preventable pregnancy complications. If you have been diagnosed with anemia in the past, it might be a good idea to ask your doctor about checking your hemoglobin before you conceive and treating anemia now. If you suspect that your iron intake is low, you could do a three day food diary and check out how close your current intake comes to the daily value. Check labels to see if your daily intake comes up to 100% of the Daily Value. If you’re usually getting 100%, don’t fret unless your doctor tells you otherwise. But if you’re generally getting less than 75% of the Daily Value, it might be worthwhile to include iron in your supplement.

Calcium is the third nutrient that some women may not get quite enough of during pregnancy. If you’re a milk drinker who currently drinks 3 cups (24 oz, not 3 glasses) of milk a day, you probably don’t need to worry. But if you only have milk in your cereal, you may not be getting enough calcium. Like iron and folic acid, though, calcium values are listed on the nutrition facts labels. So, do that three day food diary, count up your calcium intake. If you’re usually getting less than 75% of the daily value, you might want to consider supplementing some calcium as well.

Now that you know what your supplement should contain, it’s time to choose your supplements.

I generally recommend starting with a multivitamin that contains at least 400 mcg folic acid and 150 mcg iodine. If your daily intake of iron and calcium is less than 75% of the daily value, go ahead and look for a supplement that contains 100% of the daily value for iron and at least 20% of the daily value for calcium. If you already have anemia or if your calcium intake is less than 50% of the daily value, it’s probably better than you choose a multivitamin without extra calcium and iron and choose to supplement those separately instead. It’s also important to note what the multivitamin should NOT contain. It should NOT have any more than 100% of Vitamins A, D, E, and K (the four fat soluble vitamins can build up in your body and lead to toxicity – and Vitamin A, in particular, can be very dangerous for a growing baby) and it should NOT have any herbal additives.

If you’re most women, that one multivitamin should be all you need for the preconception period and during pregnancy. You should NOT take any additional vitamin, mineral, or herbal supplements unless they are prescribed by your doctor.

If you were anemic before pregnancy, your doctor will likely give you directions for how to supplement. Generally, iron-deficiency anemia is treated with a ferrous sulfate supplement containing 65 mg iron once or twice a day. You should take these as the doctor recommends, keeping in mind that “twice a day” does not mean “two pills a day.” Your body can only absorb a certain amount of iron at a time, so taking two pills at a time means one will probably just go right through. Take the iron pill with a little bit of 100% fruit juice (which contains extra vitamin C) to help you absorb the iron better.

If your intake of calcium is very low (less than 50%), you should probably be taking a separate calcium supplement. Choose calcium carbonate or calcium citrate (NOT oyster shell calcium, which can be contaminated) in a dose that will bring you up to 100% of the daily value for calcium. The calcium in the supplement will be best absorbed if it contains no more than 500 mg of calcium in each dose, and if it is accompanied by some vitamin D. I do recommend trying to keep your daily intake of Vitamin D from supplements below 2000 IU daily unless you have a documented Vitamin D deficiency and are taking Vitamin D under the supervision of a doctor – so check the labels of both the multivitamin and the calcium and make sure your daily intake will be less than 2000 IU.

In my case, I ended up with a generic men’s over 60 one-a-day multivitamin (which contains 400 mcg folic acid and 150 mcg iodine), a iron supplement (65 mg iron), and a calcium supplement (600 mg calcium and 500 IU vitamin D-yep, I know I’m losing 100 mg worth of calcium, but it’s actually cheaper for me to flush that extra 100 mg than to buy a smaller dose). I’m taking the iron primarily because the men’s one-a-day doesn’t contain iron, not because I have preexisting anemia. If I were having constipation with the iron supplement (as many women do, but I am not so far), I would take it only every other day (since it contains a little over double the daily requirement.) I take the multivitamin with breakfast, the calcium at lunch, the iron at supper, and a second calcium (actually used to correct my vitamin D deficiency, not so much for the extra calcium) right before bed.

Most of you should be able to get away with just a multivitamin – so you can breathe a sigh of relief!


And now, at last we’re done planning and ready to START TRYING!!!

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