Archive for the ‘Health’ Category

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.

Lactose intolerance in babies

November 21st, 2014

It happens in my office all the time. A mother declares that her infant is lactose intolerant: “Everyone in my family is”.

The professional in me keeps a neutral facial expression while I internally groan. And since the doctor has marked that the infant should receive Similac Sensitive for Fussiness and Gas, helpfully providing an additional diagnosis of “lactose intolerance”, I issue the infant checks for the lactose-free formula.

I groan because lactose intolerance in babies is incredibly rare. Babies’ guts make the lactase enzyme so they can break down the lactose found in their mother’s milk (all mammals’ milk includes lactose). It is only as children grow older and less dependent on mothers’ milk that their bodies stop producing the enzyme to process it.

The few exceptions are 1) primary lactase deficiency, which rarely ever occurs, 2) secondary lactase deficiency, where a gastrointestinal illness temporarily wipes out the body’s ability to make lactase, and 3) prematurity, where an infant is born before her gut lining has started to produce lactase.

Which brings me to my biggest groan.

Tirzah Mae had only ever received my breastmilk, slowly increasing feedings as the IV nutrition was decreased. Most of what she got was via the feeding tube, but she’d started taking it by bottle in the last few days – and we’d started practicing breastfeeding once a day as well.

As I prepared myself for our breastfeeding practice, I noticed that Tirzah Mae had spit up – and I mentioned it to the nurse, who observed that the spit up was bright yellow (my color discrimination has been poor since I delivered, so I didn’t notice anything odd about it under the dim lights.) When the nurse checked the residuals left in Tirzah Mae’s stomach, they were green. Feedings were put on hold and breastfeeding practice suspended.

That evening, the nurse practitioner came in to discuss the situation. She explained the plan: to start again with smaller feedings and work our way up again – and asked me how much dairy I consumed.

She explained how preemies sometimes don’t yet have the ability to process lactose and requested that I reduce my intake of dairy down to maybe one serving a day – and maybe I could try lactose-free milk instead of regular.

I put on my patient face, inquiring about what she thinks might help, while inwardly groaning.

You see, despite the opinions of plenty of doctors and nurses, lactose intake by a woman actually has no impact on the amount of lactose present in her milk.

In a lactose-tolerant woman, any lactose she eats is broken down into its component sugars in her gut, from which the component sugars are absorbed into her blood stream. Then, independently, her breasts take sugars from her blood stream and synthesize them into lactose for her breastmilk.

In a lactose-intolerant woman, any lactose she eats passes through her gut into her colon unabsorbed – and bacteria in her gut ferment it, producing the typical symptoms of lactose intolerance (gas, diarrhea, abdominal cramping, etc.) Then, independently, the mother’s breasts take sugars from her blood stream and synthesize them into lactose for her breastmilk.

It’s simple science, really. But doctors and nurses didn’t spend their educations studying the science of digestion and absorption and metabolism like dietitians do.

So they give silly, unscientific advice related to diet and mothers swear by it because they see improvement when the prematurity (or the GI illness) that caused the problem in the first place resolves (sort of like thinking the antibiotic cured your child’s cold when it resolves in 7-10 days)**.

I choose not to argue and dutifully consume just one serving of dairy daily (actually, I only ever consumed one serving of lactose-containing dairy daily – since my former pattern was one cup of milk, one cup of yogurt, and one serving of hard cheese daily). I label my breastmilk “low dairy” and dream of the day when I can go back to eating whatever I want to without being dishonest. (Since the only reason I’m not eating the dairy now is so I wouldn’t be dishonest in writing “low dairy” on my breastmilk – I already know the restriction isn’t affecting her at all.)

**Caveat: Some women who are told that their infant has lactose intolerance and who reduce dairy as a result discover that this truly is helpful (and symptoms resume when milk is reintroduced). This is generally a case of mistaken identity. While lactose in mom’s intake and lactose in breastmilk are not related, the more cow’s milk a mother consumes, the more cow’s milk proteins will end up in her milk – and some babies do have sensitivities to cow’s milk proteins, which would resolve when mom reduces dairy intake.**

Desperate women will do anything

October 8th, 2014

Ask any healthcare professional what causes pre-eclampsia and they’ll tell you that we honestly don’t know. We suspect that there’s a nutritional component, but clinical studies have been unsuccessful at isolating a root cause or identifying beneficial nutritional practices.

I know this. I try to stay up on the research, on the recommendations. I counsel pregnant women on nutrition for a living.

But when I start gaining fluid rapidly and my blood pressure starts creeping up and I’m afraid I’m going to risk out of home birth?

I’m willing to do anything, research be darned.

Up my protein from 80 grams per day to 100? Sure.

Cut out sugar? Sure.

Eat apples and beets for liver function? Why not.

So what if we don’t have any proof that any of those things will do any good – if there’s any chance that they will, I’ll do it.

It gives me a new compassion for the moms of kids with autism who desperately try eliminating artificial colors, and then gluten, and then dairy. So a professional (like me) tells them that there is no evidence that any of those are associated with autism or decrease in autistic behaviors.

They’re desperate and feel powerless – they’ll do anything, however bizarre to try to maintain some level of control.

As do I – putting my feet up on every occasion, lying down on my left side as soon as I get home from work, avoiding processed foods and sugar, loading up on protein.

Meanwhile, the clinician and evidence-based practitioner in me frets over the fact that I really have no idea if any of this will do any good. None of it is based on good science. It’s all just guesses.

So I do the one thing that will definitely not help my blood pressure stay low. I fret. I worry. I am anxious.

I resist the one thing I have been commanded to do by the One who made my body and who knows exactly what is best for it.

He says to be anxious for nothing, to lift everything to Him in prayers and supplications with thanksgiving. He promises peace that will guard my heart and mind.

Yet I fret, I resist, I try to do something myself, not willing to trust God with my body and my baby’s.

Lord, forgive me. I come to You desperate – able to do nothing. Take my fears, I choose to entrust them to You.

I dream of swine

September 24th, 2014

Some people dream of farm-fresh eggs, delivered daily by their own backyard chickens.

I admit that a really fresh egg is delicious – but my local supermarket sells eggs with 660 mg Omega 3 fatty acids per egg for $2.49 per dozen. That’s 3.14 cents per 100 mg Omega 3s.

For reference, I could purchase salmon at $7.99 per pound (Going on memory for the cheapest I’ve seen it) and get 100 mg Omega 3s for 8.2 cents. If I went with the cheaper canned salmon, I could get 100 mg for 7.5 cents. Canned tuna could give me 100 mg for 5.5 cents, but I’d have to moderate intake to ensure that I don’t ingest too much mercury. So the eggs are definitely cheaper (and far easier to get my husband to eat regularly).

Now, I could go to Walmart and get a fish oil supplement with 100 mg Omega 3s for 1 cent each – but I’d also have to pop a pill, deal with fishy burps, and weigh the risks and benefits of unknown mercury exposure.

If I wanted fresh eggs that gave me the same amount of Omega 3s, I’d have to dig through the scientific literature to develop a balanced feed, purchase flax seed (which isn’t cheap either) to feed my chickens, and take care of the chickens. It may be that my finished eggs would be comparable in price to the store-bought Omega 3 eggs – but I suspect not, and it would take a fair bit of work even to figure out if it’d be economically feasible.

On the other hand, I cringe every time I am forced to dump spoiled milk, a bad batch of yogurt, or moldy buttermilk down the drain. I hate waste – and that’s good protein I’m dumping down the drain. Likewise, when I drain the chicken stock off an otherwise vegetable and bean soup before dumping the rest in the trash. That’s good organic matter I can’t compost because it contains animal products.

And then I get to the store where I take my chances with sausage and bacon, never knowing if the brand that’s on sale or lowest price will taste right in my recipes – wishing I could just buy ground pork and season it myself, but unable to do so unless I’m willing to pay exorbitant prices.

It makes me hanker for a pig.

Apart from poultry (which require a fairly large amount of labor in processing for the amount of protein you get from them), pigs are the most efficient converters of energy. They are omnivores, which means they could actually translate my kitchen waste into edible protein. As far as day to day maintenance goes, they’re fairly low maintenance (not so for a nanny goat or a cow!) And, they’re delicious.

Yes, I dream of swine. Well, probably not multiple swine (they *do* smell, you know.) But a single pig a year, grown fat on kitchen waste and field corn, slaughtered for a fresh supply of sausage, bacon, hams, pork chops, and lard. Ah, I dream of swine.

Having a Healthy Pregnancy (Part 1.0)

July 31st, 2014

Having made my way through the first trimester, I have officially decided that the key to having a healthy first trimester is surviving.

If you’d been establishing some healthy habits in preparation for pregnancy, you’re well set up for this first trimester. You don’t need to really focus on adding anything – just on managing symptoms.

The most common first trimester complaints (in my experience as a WIC dietitian) are nausea and vomiting, fatigue, constipation, heartburn, and frequent urination.

I experienced all but heartburn (and help women with all five on a regular basis), so I do have a few tips for you.

Surviving Nausea and Vomiting

One of the most important things you can do to manage nausea is eat. Oftentimes, nausea is worse when blood sugars drop too low (baby is pulling a steady stream of glucose from your blood) – so small frequent snacks that keep your blood sugars up (but not too high) are useful. Try to include as many food groups as you can in these snacks throughout the day, and add a protein food (peanut butter, yogurt, cheese, eggs, nuts, seeds, etc.) if you can stomach it to help modulate your blood sugar response (protein helps your blood sugar rise slowly and not dip low after the rise.) If you generally have nausea first thing in the morning, keeping some crackers or dried fruit beside the bed to eat before you get out of bed might be helpful. If you’re throwing up just about anything, don’t worry too much about the variety, just eat anything you can hold down.

Some women experience nausea and vomiting when taking their prenatal vitamin. If this is you, taking the prenatal with food or at night may help.

Other women find that odors give them problems. Some techniques for managing odors include trying cold foods instead of hot (the odor isn’t as intense that way), opening a window or turning on a fan to get air moving, taking a walk somewhere away from the odors, and having a “masking odor.” Occasionally get a whiff of BO while you’re shopping that sends you running for the bathroom? Carry a handkerchief with a non-nausea-inducing odor (essential oils or even cooking extracts – some women find lemon, vanilla, or mint to be soothing) on it and delicately dab your nose as you walk past.

Surviving Fatigue

Lower your standards. You’re working hard growing a baby – some things are going to slide. Enlist help with dishes, groceries, whatever. Don’t start ambitious projects. Work to establish good sleep habits. Fatigue most likely won’t last through the entirety of pregnancy – although most women do experience it during the first trimester (and many during the last as well.)

Surviving Constipation

Before I got pregnant, I didn’t spend much time discussing this with my clients. They’d check on their diet questionnaires that they were experiencing constipation but I didn’t bring it up in conversation – and neither did they. Now that I’ve experienced constipation during pregnancy (even if only for two weeks), I bring it up if it shows up on their questionnaire. It’s TERRIBLE.

If you’re constipated, your number one priority is getting unstuck. While you might be tempted to spend a lot of time straining on the toilet, this can lead to unexpected and undesirable consequences (like hemorrhoids). For now, go to the bathroom when you feel like you have to but don’t sit there if there’s no urge. When you do get that urge, squatting on the toilet seat is actually a better approach for getting hard stool out (as opposed to sitting on the seat with your feet on the floor.) In between the urges to go, eat fruits and vegetables and whole grains, drink lots of water, and get moving around. Physical activity (taking a walk or dancing a while) can get your bowels moving. Sitting in a squatting position with your feet flat on the ground and your butt hanging near the floor behind you lets gravity help things out. Fiber and water bulk up and soften your stool. If you’ve already been doing these things and they’re not helping, adding in some apple or prune juice or prunes and raisins can serve as natural stool softeners. Other women find that a little coffee works well as a bowel stimulant (keep it at about 1 cup a day – moderation is important here.) If you’ve been taking an iron supplement or a prenatal with iron, talk to your doctor about switching to an iron free prenatal or taking a single iron supplement just a couple times a week instead of iron with your prenatal daily. If none of the above are helping, talk to your doctor about an appropriate over-the-counter stool softener or laxative. Remember, you only want to use medication as a last defense to get you moving – and then you want to rely on diet and activity to keep things moving from there.

Surviving Heartburn

This is the one I haven’t dealt with much, for which I consider myself fortunate.

For those that are struggling with heartburn, it’s valuable to eat small amounts frequently (rather than large meals only occasionally). Find your trigger foods and avoid them. Many women find that spicy or greasy foods trigger heartburn. Avoid caffeine and mint, both of which relax the sphincter (closure) between the stomach and the esophagus. Drink a little milk with your meals to help neutralize the stomach acid. And avoid lying down within a half hour to hour after eating.

Surviving Frequent Urination

Drink lots of water. Does that sound counterintuitive? It is – and it probably won’t really make you go to the bathroom any less. But it’ll help ensure that you don’t end up with something worse: dehydration or a urinary tract infection. Go ahead and go when you have the urge – and contact your doctor if you have burning with urination. Frequent urination is a bother, but it’s not actually a bad thing – just go with the flow on this one.

Does anyone else have any great tips for handling these first trimester woes? I’m always eager for more suggestions to share with my clients!

How to take “as needed” painkillers

May 13th, 2014

Typically, when you get a bottle of painkillers after some sort of operation, the instructions will read something like “Take 1 to 2 every 4 to 6 hours as needed for pain.”

If you’re anything like me, you don’t like to take more meds than necessary, especially not painkillers – so you struggle with figuring out how exactly to take “as needed” meds.

Your temptation may be to go as long as absolutely possible between taking meds – resulting in excrutiating, hard to control pain. I’ve been there and done that. It’s not good – and it actually doesn’t help you take less, because you have to take more at that point to control the now-out-of-control pain.

I’ve had a couple of surgeries – a septoplasty and a wisdom tooth extraction – where I tried holding out longer than I should have and ended up with more pain than I should have. My sister, the Physician Assistant, told me to NOT wait until the pain was bad to take my painkillers. “That’s less effective,” she told me, “You need to keep your blood levels of the painkiller high enough to control the pain.” Foolishly, I didn’t listen.

After my second wisdom tooth extraction a couple months ago (they’re all out now!), I finally figured out how to take those “as needed” painkillers.

The instructions on my pill bottle were to take one or two every 4-6 hours as needed for pain.

I took one pill as soon as I got home from the oral surgeon’s office, and jotted down the time and the number of pills I took. As soon as I felt pain returning (4 hours later), I took another and jotted it down. 4 hours later, I felt the pain returning, so I took another and jotted down the time. So far, I was taking one every 4 hours.

But my situation changed overnight and it took 6 hours to start feeling more pain. I took one pill and jotted down the time. It was another 6 hours before I needed more. Then ten hours. Then 13 hours. Then 4. Then 6. And so on and so forth.

I took 13 pain pills in a total of 112 hours. That’s one every 8.5 hours on average. I never experienced any side effects of the painkillers, I never felt excrutiating pain, and I had no problem at all not taking them once my pain was gone.

Success.

Moral of the story: Take your painkillers when you have pain. Write down the time you take them and the amount you take so that you don’t exceed the maximum dose (in my case, 2 every 4 hours-which I didn’t even get close to reaching, much less exceeding.)

There you go.

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!!!

Planning for a Healthy Pregnancy (Part 3)

April 23rd, 2014

Even if you’ve done the three steps in Part 1 and Part 2, you’ve still got more you can do before you conceive to improve your pregnancy’s health.

4. Get immunized

Did you get all your shots as a child? Are you up-to-date on all your boosters? If you haven’t gotten or aren’t sure if you’ve gotten the MMR (measles, mumps, and rubella) vaccine and the Hepatitis B vaccine, now’s the time to get it done. If you didn’t get chickenpox as a child, you need the varicella vaccine too. And if you haven’t gotten a tetanus booster in the past ten years, you need one of those.

Play it safe and take your shot records along with you to your preconception appointment with your doctor and have him make sure you’re up-to-date. He may want to do some blood tests to make sure you’ve still got immunity to some of the things you were vaccinated against as a child.

Additionally, if it’s flu season when you’re thinking of trying, go ahead and get the flu vaccine. If it’s not yet flu season, don’t freak out yet, you can (and should) get your flu shot while you’re pregnant if you happen to be pregnant when the next flu shot becomes available.

I got all my shots as a child (including the MMR) and got the Hepatitis B vaccine when I first started working in healthcare. I had chickenpox three times, the last time of which rendered me immune (and allows me to experience shingles as an adult). I get a flu shot every year, this one no exception… and I cut myself badly enough that I got a Tdap (Tetanus, Diphtheria, and acellular pertusis) booster earlier this year. So no shots for me until next flu season (and another Tdap in my third trimester, since pertussis or “whooping cough” is not something I want to mess with and getting a shot myself is the best way to protect my newborn).

5. Take care of your teeth

Does this seem a weird one to you? It kinda does to me.

But it’s true. Having healthy teeth and gums can make a big difference in your pregnancy. Gum disease prior to pregnancy increases adverse pregnancy outcomes. It’s wild but true. And while you can try to get your teeth healthy during pregnancy, there isn’t really much evidence that this helps prevent those adverse pregnancy outcomes. You’ve got to get to it beforehand. So, if you haven’t had a dental cleaning in the past 6 months, get one scheduled. If you don’t already brush your teeth twice a day with fluoride toothpaste, get started. And if you aren’t flossing every single day? Find a floss or an interdental cleaner that you will use and start using it. (Flossing is the single best way to prevent or solve the gum disease that increases pregnancy risk.)

And if you’ve been putting off some dental work that needs to be done? Get it done before you start trying to get pregnant. If you have teeth that need extracted (like my wisdom teeth!), it’s tons nicer to be able to be OUT for the procedure – and they won’t do that if you’re pregnant. Maybe you just need a cavity filled? While you can get that done during pregnancy, it’s best to avoid silver-amalgam (aka mercury amalgam) fillings during pregnancy – and it’s also a good idea to avoid doing anything in the mouth that might release some of the mercury from your existing fillings into your bloodstream. So get that dental work done now!

Up-to-date on your cleanings and don’t have any work that needs done? Don’t worry about it. Keep practicing good oral hygiene; you can keep your next 6-month check up even if you’re pregnant when that comes around.


We’re on the home stretch now – I’ll be talking next about how to choose the right vitamin(s) to start taking to prepare your body for pregnancy and then we’ll be READY TO START TRYING!

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