Book Review: The Baby Food Bible by Eileen Behan

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.

Essential Oils: Worth the Buzz?

I think you’d have to be living under a rock to have not heard of the powers of essential oils (popularly abbreviated “EOs” on natural living blogs). DoTerra or Young Living are the next Tupperware – parties where you can receive demonstrations of the amazing powers of essential oils and where you can plunk down cash for your very own starter kit.

I tend to live under rocks and managed to not notice or ignore the trend for, well, I’m not sure how long it’s been a buzz – but I first started looking into them at the beginning of this year when a friend recommended Young Living’s Thieves oil as a cold preventative. Then I talked briefly with a sibling who uses oils internally. Since then, I’ve browsed a few online articles, primarily linked from Pinterest; I’ve attended a Young Living party (where I bought nothing); I’ve read two books about essential oils and aromatherapy (I’ll post my mini-reviews tomorrow).

And I’ve spent somewhere between 20 and 80 hours exploring PubMed’s database for research on different essential oils and reading the most recent research regarding essential oils.

While I’d originally intended to simply write a brief introduction summarizing my thoughts regarding essential oils prior to my short reviews of the books I read, I scrapped that idea once I realized how LONG that would make my review post. Instead, you get two full-length posts (Oh joy!)

I think it’s important that you realize that I am a skeptic regarding complementary and alternative medicines. I don’t have any special affinity for “natural” (or, for that matter, for “artificial”) things. Rather, I am a practitioner of Western Medicine (inasmuch as dietetics is medicine) – and believe strongly in evidence-based medicine. Furthermore, while I believe anecdotal evidence is worthwhile as a spur for further research, it is NOT appropriate as a source of practice recommendations. (For example, a supercentenarian attributes her long life to 3 beers and a whiskey daily – but that doesn’t mean we should start recommending 3 beers and a whiskey daily.) So, recognize that I am much less likely than the average “all-natural” mom to recommend the use of, well, anything for treatment of disease or health-enhancing properties.

As I’ve conducted extensive reviews of the existing literature regarding essential oils, I’ve seen that the study of essential oils (from a scientific standpoint) is in its infancy. A few essential oils have been studied in detail but most have four to five studies altogether – and each study might be looking at a different proposed property for the essential oil. Many of the most rigorously designed studies have been conducted with petri dishes or animal models – which have inherent difficulties with translating to human use. And of the studies that are done with humans? The study designs tend to be quasi-experimental and involve a small sample size (not many people in the study). In other words, in most cases, there simply isn’t enough information to make evidence-based practice recommendations for the use of essential oils.

That said, there are a number of areas of research regarding essential oils that show promise:

  • Many EOs have antimicrobial properties. This is where those petri dish studies come in. Some essential oils kill bacteria, some kill fungi, some kill fly larvae, etc. This is exciting. EOs show promise for reducing antibiotic dependence and offer new options for things like food safety. The majority of applications that are being studied so far involve using EOs in animal feed (chicken feed, especially) rather than antibiotics to promote animal health in confinement and using EOs as rinses or sprays on cut fruits and vegetables to keep them from going bad before you get a chance to eat them. It’s important to note that, while this research shows promise and while some applications have been developed that may be effective, we do not have any information so far about whether a few drops of an essential oil in a household cleaner will prevent germs. Nor do we have any information about oils rubbed on the skin or diffused through the air. Almost all antimicrobials have specific effective doses – and unless that concentration is reached (usually for a certain length of time), there is little or no antimicrobial effect. Also, if something is powerful enough and concentrated enough to kill bad bugs, there’s no guarantee that it isn’t powerful enough and concentrated enough to also have potentially damaging effects to human cells. Until we’ve got research on humans, we just don’t know what might happen.
  • Some essential oils have an effect on the central nervous system (CNS). Inhaled lavender oil seems to be a CNS depressant – lowering blood pressure, decreasing basal metabolic rate, and slowing brain activity. Inhaled grapefruit oil seems to be a CNS stimulant – raising blood pressure and basal metabolic rate, and increasing alertness. As such, these have potential to treat conditions such as insomnia, anxiety, ADHD, panic attacks, or narcolepsy. Except that they haven’t necessarily been studied for the treatment of those conditions – they have POTENTIAL to treat, since we know that the central nervous system is involved in those particular disorders, but we don’t know whether they actually WILL treat those conditions.
  • Odors can affect mood. This is something we’ve known for a long time. It’s nothing new. We know that smelling fresh-baked bread or chocolate chip cookies sells houses because people generally have positive associations with those odors and therefore feel that a home that smells like that is more “homey”. The difficulty is that everyone has different associations with different odors. If your grandma wore lavender, you might associate the smell of lavender with trips to the children’s museum with your grandma, or you might associate it with the smell of a dying woman. The highly individual nature of odor associations means that, if we want to use EOs to affect mood, we won’t necessarily be able to just look up a use in a book. On the other hand, it’s certainly possible that you might find a smell that calms you or that makes you hungry or… well, all sorts of things.

In conclusion, there’s a lot of buzz about essential oils these days – and essential oils show some promise for enhancing health. But, the current state of research is such that an evidence-based practitioner should be extremely cautious about making any recommendations regarding essential oils. We simply don’t know enough.

My Child “Choked”

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?

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?

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

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

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

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)

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

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.


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.