pregnancy | bekahcubed

This is basically a defense of the Weston A. Price diet for pregnancy and early childhood. The nutrition advice ranges from odd to downright dangerous. The rationale for the advice is nostalgia and cherry-picked scientific studies. And Michaelis (like a lot of self-taught nutritionists) despises me and my ilk (that is, people with actual training in nutrition.)

A review in which I annoy you by summarizing each chapter of the book using the words “In which…” Don’t say I didn’t warn you.

Chapter 1
In which Michealis reveals that she has no credentials that give her any right to be talking about nutrition – apart from watching food-fright documentaries and reading people like Michael Pollan, Joel Salatin, and Sally Fallon (all of whom are interesting to read, but hardly bastions of science-based nutrition recommendations.)

Chapter 2
In which Michaelis explains that nutrition matters (*gasp*). Except don’t pay any attention to those nasty reductionist dietitians with their advice meant to avoid specific proven risks. No, you should jump on the fetal origins hypothesis (which is a reasonable and scientifically supported hypothesis that a mother’s environment during pregnancy affects her child well into adulthood, but which currently has little evidence of sufficient quality to use to make broad-ranging dietary recommendations) which means you should eat a primitive diet (what? Okay, fetal origins really doesn’t suggest need for a Weston Price style diet – but that doesn’t stop Michaelis from using the one to support the other.)

Chapter 3
In which Michaelis tells you what to avoid: MSG, corn, GMOs, vegetable oils, industrial meats/dairy/eggs, refined sweeteners, and modern gardening/farming practices. Michaelis’ rationale is a mixture of misguided nostalgia and alarmist pseudoscience. Oh, okay. She occasionally includes a bit of real science – and then completely screws up the application. For example, she recommends avoiding corn (and corn-fed animals) because corn oil has a much higher than recommended Omega 6 to Omega 3 fatty acid ratio. It is true that corn oil has a high Omega 6 to Omega 3 fatty acid ratio – and that almost all Americans could stand to eat more Omega 3s relative to Omega 6s. But…the list of corn ingredients Michaelis wants you to avoid? Only 3 of the 21 corn-derived ingredients contains fat. So… unless she’s got another good reason to avoid corn products, she’s just being silly.

Chapter 4
In which Michaelis tells you what TO eat: bone broth, traditional fats and oils, wild and pastured animal foods, natural sweeteners, and “properly prepared” grains. In general, there’s nothing wrong with these items, even if the emphasis is off. Good advice: choose butter or olive oil over partially hydrogenated margarines or shortenings. Advice with some nutritional support, although not enough to warrant broad-based recommendations: wild or pastured animals have a more favorable fatty-acid profile and soaked grains have better nutrient bioavailability (but a diet rich in fruits, vegetables, and whole grains – even the unsoaked kind – is unlikely to be deficient in those micronutrients.) Completely spurious advice? bone broth and natural sweeteners. As far as sweeteners go, your body doesn’t care whether it’s “natural” or not – if it’s sugar (and that includes honey, maple syrup, sucanat, sorghum syrup, coconut palm sugar, and others), the body treats it as sugar. If it isn’t sugar (stevia and “artificial sweeteners”), the body processes it as whatever it is – whether a sugar alcohol, an indigestible starch or whatever. Of course, the real travesty of this chapter is what Michaelis omits. Please note the two food groups she doesn’t bother to mention in any degree: fruits and vegetables. Whatever the controversies nutrition science may have, there is one thing about which every science-based dietitian and nutrition researcher can agree – the general US population should be eating more fruits and vegetables.

Chapter 5
In which Michaelis helps you learn what to eat to poop well. Because your gut is your second brain. Sigh. I don’t even know where to start with this. Let’s just say that some people do have digestive issues that compromise their overall health. Most people don’t. Probiotics are good – but their benefits are frequently overstated. The most important thing you can do to have a healthy digestive system is to get sufficient fiber and water – like, say, from fruits and vegetables (which don’t necessarily need to be lactofermented, thank goodness!)

Chapter 6
In which Michaelis tells you what to eat to be fertile and to have a healthy pregnancy. The “fertility” section is more of Price’s general theories combined with more recent research from the Nurse’s Health Study. Want to hear what the science actually says? Read the highly readable The Fertility Diet by Jorge Chavarro, Patrick J. Skerrett, and Walter Willett – and keep in mind that even a well-executed study like the Nurse’s Healthy Study can’t prove causation.

The “pregnancy” section is where it gets exciting, because Michaelis has somehow figured out the cause of both morning sickness and preeclampsia, two relatively common pregnancy conditions that researchers have been puzzling over for years! (Can you sense the sarcasm?) Of course, the problem is nutrition. And the solution is a variation of the Brewer’s Diet, a favorite diet of natural childbirth advocates everywhere. Problem with the Brewer diet? Well… there are several. While the Brewer diet apparently had great success for Dr. Brewer’s (low-income, minority, teenage) patients in the 60s and 70s, nutrition science has failed to find links between the components of Brewer’s diet and healthy pregnancy. While protein deficiency may have played some role in increasing risk in Brewer’s patients, studies of moderate vs. high protein intake in pregnant women have failed to show any protective effect of increased protein intake. While Brewer’s teenaged patients may have needed the 3000 calories per day that his diet recommends (because they were still developing themselves, in addition to supporting a growing baby in their wombs), research clearly links excess weight gain during pregnancy to development of preeclampsia (and we’re talking weight gain even before those preeclamptic women started putting on all that fluid.) Additionally, while Brewer’s patients may have had nutrient deficiencies that made intake of large quantities of liver helpful and not dangerous, those of us who are adequately nourished in the first place should not be overloading our diet with items high in retinol (preformed Vitamin A), which is highly toxic to a developing baby. We should instead be getting our Vitamin A in the form of carotenoids (from vegetable sources) which our body converts to Vitamin A as needed, without the toxicity to the developing baby.

It’d be nice if we knew the exact cause of preeclampsia and could avoid it at all costs. But the reality is that we don’t know what causes preeclampsia. We know risk factors – first pregnancy with a new partner, high or low maternal age, overweight or obesity prior to pregnancy, excess weight gain during pregnancy. But none of those are a guarantee of preeclampsia – and the absence of those are not a guarantee against preeclampsia. As nice as it would be to just put ourselves on a diet for nine months to keep preeclampsia at bay, the truth is that there is very little evidence that dietary interventions make any difference in the development of preeclampsia. And if there is any promising research along that vein at present? It suggests that maybe increasing dietary fiber might make a difference. What, you mean like eating more fruits and vegetables? Oh. My. Word. That’s pretty much the most preposterous thing I’ve ever heard suggested (Sarcasm, again, in case you didn’t catch it.)

Chapter 7
In which Michaelis reminds you that everything those nasty government-shill dietitians tell you is wrong. (I have a feeling I’m becoming less charitable and more cynical as this book goes on.) But this chapter rehashes that cholesterol and saturated fat aren’t bad for you (dietitian me: it’s complicated). Michaelis also tells you that you don’t need an iron supplement (dietitian me: anyone who is routinely recommending iron supplementation to pregnant women without confirmation of anemia is acting outside the bounds of science-based practice anyway). According to Michaelis, sushi won’t give you listeria but raw cheese might (dietitian me: both sushi and raw cheese are relatively more risky than cooked fish and hard cheeses. In both cases the odds of problems are low but the problem – miscarriage or stillbirth – could be severe if it happens. Mothers should be aware of the risks and make their decisions based on information.) And finally, the occasional glass of red wine won’t harm your baby (dietitian me: probably not, but excess drinking can… and it’s worthwhile for you to find better coping mechanisms than drinking.)

Chapter 8
In which Michaelis leaves the realm of nutrition to promote every other kind of quackery you can think of. After all, Western medicine KILLS PEOPLE (dietitian me: but not as many people as would die prematurely if they opted out of Western medicine for the mumbo-jumbo you’re suggesting.)

Chapter 9
In which Michaelis informs us that breast isn’t always best – in which case you should opt for a homemade baby formula! Dietitian me: Where do I go with this train wreck of a chapter? She’s right that breast isn’t always best. In the developed world, the risk of a woman transmitting HIV through her breastmilk is greater than the risks of formula feeding. For women who are unable to produce breastmilk because of hypoplasia/insufficient glandular tissue, forcing a baby to an empty breast is not best! A drug abuser can pass drugs through her breastmilk to her baby. A severely malnourished woman may have trouble producing high quality milk. BUT… the women reading Michaelis’ book are unlikely to be drug abusers and the degree of maternal malnutrition required to malnourish a breastfed baby is incredibly rare in the United States. As for the appropriate alternative to breastmilk? Iron fortified infant formula. Period. Full stop. Even if you scrupulously follow Michaelis’s recipes for “whole food” infant formula, you’re going to end up with variations in nutrient content because (I’ve got a big surprise for you here) whole foods don’t always have the same nutrient content (even if it’s the same brand). Some organic liver will have more Vitamin A and some will have less. Some homemade broth will have more calcium and some will have less. It’s the nature of natural. But unlike your breastmilk, that liver and homemade broth wasn’t designed by God to be consumed by your baby. Your infant could end up with too much or too little and you’d have no way of knowing until the damage was done. At least with infant formula, you actually do know what the nutrient content is. It’s regulated, controlled. It tries to get as close to breastmilk as possible (which, yes, it doesn’t get close – but it can get closer than anything you can mix up at home.)

Chapter 10
In which Michaelis slams WIC and promotes baby-led weaning. At least she’s honest: “I don’t remember much of what my WIC nutritionist told me.” I’m hoping that what she DID remember was a false memory. Because no WIC dietitian worth her salt is encouraging moms to “just mix a little [infant cereal] in with their [baby’s] milk in a bottle or sippy cup.” Michaelis goes on to explain why this was terrible advice. It’s because babies can’t digest starch like that found in infant cereal. For that reason, babies shouldn’t be given starchy foods until they cut their two year molars. Problem is, Michaelis only knows the beginning of the research (that babies have less pancreatic amylase than adults) and didn’t bother to look at the whole picture (Check out Alice Callahan’s excellent treatment of the topic at Science of Mom if you’re interested in learning more about whether infants can digest infant cereal.) On the other hand, offering cereal in a bottle is truly terrible advice that can promote excess weight gain and possibly increase choking risk. Cereal should be served by spoon.

The ironic thing is that while Michaelis goes full-on WIC-hating in this chapter, I don’t disagree with her basic premise. Once infants are ready to eat solid foods, they can eat “real foods” (that is, the same foods the family is eating.) Most infants and toddlers eat WAY too many starches and sweets – because they’re being plied with cookies and crackers all day long instead of what they should be getting, little bits of everything the family is eating. But then again, I’d be emphasizing fruits and vegetables and whole grains and lean protein sources instead of liver and bone broth and sauerkraut (not that I don’t love me some bone broth and sauerkraut – they’re just not really necessary for good health.)

Conclusions
Fortunately for me, the last 50 pages of this book are recipes rather than more of the same from the first 170 pages. If I’d have had to go on… I might have bashed my head against a wall.

The reality is that nutrition science is in its infancy. There’s a lot we don’t know about how to optimize our diets for health. Some government recommendations (cholesterol restriction) and the ensuing dietary changes (a population going crazy on hydrogenated vegetable oils instead of animal fats) have been for the worse. And for every government recommendation that isn’t fully founded in the research there are two thousand non-governmental, non-reputable recommendations based on a single bit of research (that happens to be contradicted by every other piece of research.) But the answer to an infant science that sometimes lets us down isn’t to ignore science altogether or to cherry-pick studies that fit our predetermined viewpoint, as Michaelis does all throughout her book. The answer is to evaluate the science critically and to go with the stuff that has the most support (rather than jumping on the bandwagon for the newest study). That is not at all what Michaelis does.

With the risk of sounding like a broken record, Michaelis majors on the minors – things that have minimal to no scientific support – while completely ignoring what I (as a nutrition professional) consider to be the most important food advice any American can receive: eat more fruits and vegetables. It’s not sexy advice. It doesn’t have the cachet of ancient wisdom only available to primitive cultures – or the allure of a governmental cover-up. But it’s the soundest advice I can give you. Eat more fruits and vegetables. Aim to include a fruit or vegetable (or two or three) at every meal and snack. You – and your babies – will be better for it.

Rating: 0 stars
Category: Diet Advice
Synopsis: A defense of the Weston Price diet – and a slam on people like me.
Recommendation: I do not recommend this book.

The front cover of Your Pregnancy Week by Week proudly announces that it is “The only best-selling guide written by a doctor.” The spine contains a medallion announcing “The only best-selling guide written by a doctor.” The back cover proclaims the book to be “The expanded, fully updated edition of the best-selling pregnancy guide written by a doctor.”

So the major selling point of this book is that it is written by a doctor. Glade Curtis is a board certified OB-GYN, which means he’s the perfect guy to walk a woman through every week of her normal pregnancy, right?

Well, that depends a lot on your view of what pregnancy is. Is pregnancy a medical condition to be monitored and controlled (as you would diabetes or heart disease?) or is it a life event to be cherished and enjoyed (as you would an engagement and preparation for a wedding?)

Curtis (and the obstetric community as a whole) tends to think that pregnancy is a medical condition to be monitored and controlled. As such, Your Pregnancy Week by Week consists of telling a woman all the things that might go wrong with her at any given point during her pregnancy, all the tests which might be necessary to make sure that nothing is going wrong, and why she should trust her doctor implicitly and herself not at all during pregnancy.

Okay, someone not quite as passionate about pregnancy and birth as I am might feel that I’m overreacting to this book. Things can go wrong during pregnancy, they might say. Tests are sometimes necessary. You should be able to trust your doctor. Your own instincts aren’t always right when it comes to pregnancy. And, for that matter – pregnancy isn’t simply a life event like an engagement. Things are happening in your body!

And I agree completely, dear not-so-passionate-about-birth-as-I. Things do go wrong during pregnancy – I, of all people should know. I could have died during my pregnancy with Tirzah Mae. Tests are sometimes necessary – the ultrasounds to make sure Tirzah Mae was still growing when my body was no longer functioning as designed, the blood tests that finally told us that my kidneys and liver had stopped doing their jobs – those were necessary (and without the blood tests indicating the need for delivery both Tirzah Mae and I would have died.) It is incredibly valuable to have a caregiver you can trust – which is why I am SO grateful for my midwife, who was alert to normal pregnancy and knew when to refer when my pregnancy became anything but normal. That’s why I’m SO grateful for my OB, who values women and who works with them to help them have as normal a delivery as possible.

Pregnancy isn’t SIMPLY a life event like an engagement. Your body is changing, your hormones are changing. You’ve got extra blood pumping through your veins, an extra body inside your own. Things are happening to your body that you want to understand. You want to know if those changes are normal or if they’re something to be worried about. In some cases, you NEED to know if they’re normal or if you should be worried about them (ten pounds weight gain in one day – that’s not normal. It’s definitely something to be worried about.)

But Curtis and his co-author aren’t simply helping women understand what is normal and what isn’t. They are detailing, every week, another horrible thing that can go wrong during pregnancy (tacking a line at the end about how really only two in a thousand women are going to have this problem, so don’t worry.)

Curtis explains (week after week) why a woman shouldn’t ever be afraid to get a test or a procedure because they only ever help your doctor and you and your baby (and have never been PROVEN to be harmful – the anti-precautionary principle). And he explains (week after week) why a woman should be afraid to drink caffeine, eat sugar, eat artificial sweeteners, take an over-the-counter drug, etc (because it has never been PROVEN to be safe – the precautionary principle.) The doctor is always right and can do no harm. The woman is always to be doubted and will kill her baby if left to her own devices. (Okay, I’m exagerating a little.)

Oh, and don’t even get me started on the unscientific suggestions Curtis has for labor. He encourages enemas (for the patient’s safety and comfort, of course!), fasting during labor, lying down during labor, and episiotomies. Continuous fetal monitoring is necessary for baby’s safety. And if you aren’t sure you want a natural labor? A doula is a bad idea (well, actually, are you SURE you want a natural labor? If I give you this epidural, then you’ll be so much more comfortable and will be so much easier to monitor and won’t try to move around or anything… big plus? you won’t have to hire a doula!)

Yeah. No.

Choose to have a pregnancy and childbirth not defined by fear. Choose to trust that your body is fearfully and wonderfully made. Choose NOT to read Glade Curtis and Judith Schuler’s Your Pregnancy Week by Week.

Rating: 0 stars
Category: Pregnancy
Synopsis: An overmedicalized, fear-based, doctor-is-always-right tome on pregnancy
Recommendation:If you want to be scared out of your mind by all the things that could go wrong in pregnancy and to be convinced that every intervention your doctor might suggest is absolutely the right decision, you’ll want to read this book. If you prefer to learn what a normal pregnancy looks like, how to deal with the normal problems of pregnancy, and to make evidence-based (versus fear-based) decisions for your pregnancy and childbirth – this is not at all the book for you.

Book Review: Beautiful Babies by Kristen Michaelis

Book Review: Your Pregnancy Week by Week by Glade B. Curtis and Judith Schuler