Posts filed under PREGNANCY

Gestational Diabetes: 3 Myths you need to know with expert Lily Nichols

Today I am so excited to have registered dietitian and real food advocate Lily Nichols! 

Lily, who blogs over at www.pilatesnutritionist.com, is an expert with heaps of experience counseling women on their diets throughout gestational diabetes.  She recently published a book earlier this year, Real Food For Gestational Diabetes, and is on a self-declared mad mission to evolve the medical communities archaic approach to caring for women with gestational diabetes and bring it more up to date with the current scienctific research and understanding.  Below is a transcribed interview I had with her a few weeks back.  It is a must read for anyone diagnosed with gestational diabetes!


SSB: So Lily let's start off by going over what you think are the top 3 most notorious myths concerning gestational diabetes?

Lily: I would say that a lot of women have been told that they need to eat a very specific level of carbohydrates and they cannot go lower than this level of carbohydrates without harming their baby.  That is a huge myth, and that is one of the things that I tackle pretty in depth in my book, Real Food For Gestational Diabetes, because it simply just doesn’t hold up to the science, doesn’t hold up to the research.

Another one is that baby will be big no matter what.  So a lot of women have been told that when you have gestational diabetes the chances of having a “big baby”, a macrosomic baby, are higher- and that’s true, it is higher- however statistics, you know it’s statistics, and yes statistically your chances of having a large baby go up but that doesn’t mean that you have to be a statistic, right? So the chances of you having a larger baby correlate very strongly to blood sugar control during pregnancy.  So if you know what to do to keep your blood sugar under control your risk of having a big baby goes way way way down and if your blood sugar stays at pretty much normal levels you have no higher risk of a big baby than somebody who doesn’t even have the diagnosis.  So that’s a big one.

It’s hard to choose just three but I’d say the final one is that a lot of women believe that they will require insulin and that there is nothing that they can do to reduce the chances of requiring insulin and that is also not true. 

The conventional diet therapy for gestational diabetes, which I kind of eluded to earlier, is pretty high in carbohydrates, a minimum of 175 grams per day and women who follow that advice- again from the research- shows that there is about a 40% chance that you’re not going to be able to control your blood sugar through that diet alone.  But they have also shown that if we change up the way we think about the diet for gestational diabetes and instead think of a low glycemic diet and one that is a little lower in carbohydrates we can reduce the likelihood that a woman will need insulin by fifty percent (italics mine), which is huge!  

"...We can reduce the likelihood that a woman will need insulin by 50%, which is huge!"

So I’m into giving women all the information they need to make better choices and reducing those chance because I believe that- and I think most doctors agree- that the goal is to control this as naturally as possible.  As always there are going to be some women that no matter how hard they try, you can do everything right, and you will still need insulin.  But we can put your odds in your favor by giving you better dietary information.

SSB: So if a woman finds herself diagnosed with gestational diabetes, what are the most important first three steps she should take?

Lily: Number one is you want to start monitoring your blood sugar.  Knowledge is power! If you don’t know where your blood sugar is at you are pretty much helpless.  You will have no idea what to eat, a lot of women feel like they have to starve themselves, they just don’t know what’s going on.  If you don’t check your blood sugar you will never have the information to change up your diet or lifestyle to get your blood sugar under control.  It’s kind of like see no evil, hear no evil kind of thing.  You want to be able to see clearly what’s going on and observe patterns in your blood sugar so you know what changes to make.

So for example some women will notice that their blood sugar will go high after breakfast and at lunch and dinner it’s ok.  So that might give them a clue, ok maybe I need to take a closer look at what I’m eating for breakfast and experiment a little to find something that is going to work better.  So monitoring the numbers is huge, you can notice trends, and then you adjust and be proactive.

Number two is I would suggest they pay attention to the foods that raise their blood sugar the most, and that, in general, is the foods that are high in carbohydrates.  Start to get comfortable with which foods contain carbohydrates and which ones contain more or less of them, so you can kind of see “oh I can eat a much larger volume of vegetables versus rice” and still keep the carbohydrates under control.  Especially be cautious of the foods that are high in processed or refined carbohydrates because those tend to digest much quicker, spike the blood sugar much more, lead to unstable blood sugar and insulin levels- which then just further fuel those cravings for more of those foods- it’s kind of like this vicious cycle thing. So just get comfortable with where your carbohydrates are coming in, what sources, and again, tying it into number one, seeing how it affects your blood sugar because carbohydrate tolerance, how well your blood sugar responds to any given amount of carbohydrates, is different woman to woman.  Some people can handle a lot more and still have normal blood sugar and other people have to be super super strict- and you only know if you test your blood sugar and see!

Number three is to listen to your body.  And that is kind of a weird one to choose for gestational diabetes but gestational diabetes tends to medicalize pregnancy, right, you have to be monitored and you have to follow a certain meal plan, so they say, and you have to eat this many grams of carbohydrates and you have to check your blood sugar at this hour after eating, it kind of puts you in this very regimented schedule, and even though some of those things need to happen, it’s important, but there’s still room within any of these plans or regimens to customize it based on what is going on in your body.  So how are you feeling after you eat whatever recommended amount of food that was on your meal plan?  Are you completely stuffed? Are you starving?  Are you just right?  You know that’ll give you different information.  So instead of trying to meet a certain goal of your meal plan, you’re meeting your body’s needs instead.  How do you feel when you move or exercise a little more?  How do your blood sugars respond?  All these things, these mindful practices, really go a long way in helping you become a master of gestational diabetes and getting your blood sugar under control, and thus making sure your pregnancy is as healthy as possible.

SSB: And I will also add that they should go out and buy your book! (laughing) Because that one was darn good!  The thing that I loved the most about your book was the stories that you included in there of past clientele.  I mean it just knocks your socks off to see these women struggle, some for so long, through so many pregnancies, and then just have these, like, miracle stories basically, just by changing their diet!   It just was amazing.

Lily: And I could write a whole other book with only those stories now!  I have an online program as well, in edition to the book, which offers more support and guidance to make this as easy as possible, and the stories that I am hearing from the program are insane!  One of the women had had two previous gestational diabetes pregnancies and this was her third gestational diabetes pregnancy.  Both previous times she required insulin.  And the statistics are, you know, that if you’ve had gestational diabetes once, you’re going to get it again.  And then the odds are if you have to take insulin to control your blood sugar, you’ll likely have to take insulin again.  And then as you get older, which you know obviously as time passes and you have a later pregnancy, your older, usually your insulin resistance gets worse and again more likely to require insulin.  So this gal was able to avoid insulin in her third gestational diabetes pregnancy.  She was completely diet controlled.  No complications, baby was born perfectly healthy, I believe close to 8 pounds, no issues.  And I mean as a clinician I like people to be proactive about things but I’m also a realist.  So you know, I’m like, “given your history, it’s pretty likely that you will require insulin, keep that in mind, it’s not a bad thing, having your blood sugar under control is the number one most important thing and greatly reduces risks for your baby”, right? But lets do everything we can and just see what happens, and it just goes to show that when your given the right information and you’re not overwhelming your body with the wrong foods, and the wrong quantities, and all this garbage, literally miracles can happen.

SSB: Yeah, yeah, it’s the power of food.

Lily: Yeah, super empowering that your body is on your side.  You know a lot of women feel like their body has failed them with gestational diabetes.  And I’m like, no no, your body is just talking to you my friend. (Laughing)  Lets just respond as kindly as we can.

SSB:  So protein is of paramount importance in pregnancy but it becomes even more so in gestational diabetes.  What are some plant based protein options for vegetarian and vegan mamas or do you think these women should rethink the boundaries of their diet with gestational diabetes?

Lily: Vegetarian protein is a little bit tricky with gestational diabetes because many plant based protein options also contain a high amount of carbohydrates so it makes it a little bit tricky to find the right balance while still giving you enough energy, enough calories.  So it kind of becomes a battle between protein versus carbohydrates so sometimes vegetarian women will kind of need to get a little more into the numbers with food to make sure they are balancing things out ok. 

As an example beans, like lentils, are a classic staple protein option for vegetarian moms.  Half a cup has around 7 grams of protein, which is the amount you would find in an egg, but it has 15-20grams of carbohydrates, while an egg has zero. So if you were to have, say, your complimentary protein matching, making a complete protein, having beans and brown rice at a meal, maybe you’ve hit 15 grams of protein-which in my opinion is a little low for a meal- but for many women you have already exceeded your carbohydrates limit for the meal. 

You might be at 30 or 40 grams of carbohydrates, and again, some women can get away with that and for some other women that is far too high to be able to keep their blood sugar under control.  So that part is a challenge just from the fact that vegetarian and especially vegan sources of protein often contain carbohydrates. 

Nuts happen to be a lot lower in carbs and you have a lot more fat to go along with the protein, so that is a good option.  If women are not strictly vegan and are willing to do greek yogurt, cheese or eggs, those are all very high in protein and fairly low in carbohydrates.  There are some vegetarian protein powders like pea or rice protein, again a low carb option. 

But even beyond meeting a certain protein goal, it’s not just protein that matters, it’s the type of protein and also the other nutrients that go with it.  For example needs for certain amino acids go up in pregnancy and protein foods are all made up of amino acids.  Some are essential, you have to get them from foods.  Some are nonessential, you generally don’t have to get them from foods, your body can make enough from other proteins. 

So one example is there is an amino acid called glycine which under normal circumstances is nonessential, but during pregnancy needs go up so drastically because it’s needed to grow a lot of the growing fetal tissues, a lot of the connective tissues needed for the growing uterus- so because your needs go up so drastically your body cannot get enough from other protein sources alone, you have to consume it directly. 

The highest sources of glycine are found in the bone, skin, and connective tissues of other animals.  So we are talking bone broth, slow cooked tough cuts of meat, pulled pork, or beef roast, chicken with the skin, fish with the skin, those give you a ton of glycine, and that is a really key nutrient for your growing baby and to support your uterus and all the changes that are going on in your own system.  In addition to that we have nutrients that we simply can only get from animal foods: vitamin B12- of course you could always do a supplement, the most absorbable forms of iron come from animal foods, DHA- aside from algae, is an animal based omega-3 fat, preformed vitamin A- not the beta-carotene that you get from carrots we only convert a very very tiny percentage of that into true vitamin A….and vitamin A needs to go up during pregnancy…..all those you can only get from animal foods.  So if women are willing to rethink the boundaries of their vegetarian/vegan diet, then yes, absolutely, I suggest some animal protein during pregnancy and, I’m trying to remember, I think it’s chapter 5 in my book that I go into all the research behind some of these foods that are super health giving during pregnancy and that provide a lot of these nutrients naturally, and quite a few of them happen to be from animal foods.  So I think as along as you are sourcing your animal foods from good places, grass fed beef, pasture raised chickens, wild caught fish, grass fed dairy, you are going to be ensuring that A: the animals are raised with respect but also B: there are higher nutrient levels in them too so it’s kind of a win win.

SSB: Well thank you so much for taking the time to be with us!

Lily: Your welcome!


You can find more of Lily on her website here.  If you or someone you know has gestational diabetes make sure to pick up a copy of her book Real Food For Gestational Diabetes.  I have read it and cannot recommend it more!  Get one for your ob or midwife too! 

 

The Dirty Little Secret About Prenatal Vitamins

Think all prenatal vitamins are equal? Think again.

Here is the truth: Prenatal vitamins...and all supplementation for that matter.....are not really regulated by the FDA.

What does that mean?

It means things can go on the shelf without any sort of review process.  So what you think is in the bottle, might not actually be in there and/or they could be tainted with extra fillers or contamination from the factory floor due to poor manufactoring procedures.

The rule that the FDA has put in place to regulate supplements is: What’s on the label should be what’s in the bottle, and if it’s not, heavy fines ensue.

But there is no one actually watching on the side of the FDA to make sure that happens. 

This verification responsibility has been put on, what they like to call, "independent watch dogs".  

The thing is though, it costs a ton of money to do this. So the majority of these independents charge supplement companies a major heavy duty fee to get tested, cleared, and given the stamp of approval. 

However, it still is not a requirement. 

Therefore we have this situation where there are many genuine companies that are honestly manufacturing high quality products, with the best ingredients possible, but that cannot afford to pay the heavy fee to get verified. Next to that are companies that are large enough that can afford the seal of approval on their high quality product. And then, last but not least, there are the bad seeds.  The ones who are not doing business for the right reasons, selling you shoddy products, and who are essentially getting away with it.

Bottom line that you need to know is: All prenatals are not created equal.

So can you trust the ones your care providers may endorse? Meh. Maybe, maybe not.

Many times even physicians and midwives don’t know how to look for high quality products because they don’t learn that stuff in school.  They’ve got people coming in their door left and right, trying to sell 'em their goods, and sometimes a health care provider makes their decision on whomever offers the best package, not necessarily on the quality standards.

So lets get savvy on how to shop for a good prenatal.  

Here is what to look for:

Seals of approval. The biggest ones being USP verified and NSF certified.  Also, look for ConsumerLab approval.  These seals mean the product has been cleared of contamination, delivers what it claims, and manufactures products in alignment with the FDA Good Manufacturing practices.

Other labeling to look for is Potency Guaranteed. This isn't exactly the gold standard, but if a company is willing to put themselves in a legal position as this, then I'm pretty certain they are confident that their products will check out ok.

Third, look for an expiration date.  Expiration dates are not required by the FDA, but any company that doesn’t put an expiration date means sketchy business to me.  There are some vitamins like B and C that have a short shelf life….so if there is no expiration date, how long do you know that bottle has been sitting there??! Not good.

Fourth, look for red flags on the ingredient list. If you see sugar, artificial colorings, preservatives, shellac or chlorine, put it back.  It means subpar quality.

Next, make sure your prenatal has the appropriate dosage:

Folic Acid should be in the 600-800 mcg range.

Iron, around 10-18 mg.

Calcium, around 400-800 mg, and should be in the forms of calcium citrate, calcium lactate, or calcium malate NOT calcium carbonate as that is the form that is the least absorbable…of course it also happens to the cheapest.

And nowadays the newer prenatals are focusing on Vit D, somewhere in the 200-400 IU range.

If you have something special going on like celiac disease or you are taking other medications it is crucial to sit down with your doctor and make sure you are getting compatable doses.  Sometimes you might need more of something, other times less than the recommended value.

If your doctor has no clue, find somebody who does.  I always think it’s worth getting their opinion.

The following list is of brands that have consistently proven their worth: GNC, New Chapter, MegaFood, Garden of LIfe, Delta Labs, Spring Valley, and Nordic Naturals. 

(I'll add here that this list is not exclusive, so just because your prenatal is not on here doesn't mean it might not be good, nor am I affiliated with any of them.)

See ya next time!

xoxo

Allyson

Posted on August 24, 2015 and filed under CHILDBIRTH, POSTPARTUM, PREGNANCY.

How To Tell If You Have The Right OB or Midwife.

SMART SEXY BIRTH BLOG

Finding the right maternity care provider can make or break your overall pregnancy and delivery experience.

As I talked about here, regardless of whether you choose a homebirth with a midwife or need the skill of an obstetrician in a high-risk group, respect is the foundation that creates the positive experience we look for during our journey into motherhood.

Here are some questions you can run through to make sure you’ve got a keeper.

  • Do you feel like you are welcome to ask questions?  Do they answer your questions clearly or vaguely?  Do you feel listened to?
  • Do you feel you can be honest and completely open to them without judgment?
  • Is he or she open to talk about their practice and usage of interventions?  Inductions, cesareans, etc. or do you feel ridiculed or patronized for asking about such things?
  • Does he or she treat your questions seriously and patiently or do they seem annoyed and agitated by them?
  • Does he or she look at you and smile when entering the room?  (I know this sounds so silly, but seriously who wants to be cared for by someone who doesn’t like people?!)
  • Do you feel rushed during your prenatal appointments or do you feel you are given ample time?
  • Does your provider explain things to you? Labs, ultrasounds, etc. or do you feel you are kept totally in the dark?
  • Do they ask your opinion on matters or do they make decisions without your consent?
  • Is your providers’ philosophy of birth supportive of your own?  (Obviously if you are shooting for a natural birth you don’t want to be with a doc who thinks au natural is the bane of his existence!)
  • Do you feel good and positive leaving an appointment or disappointed, uncomfortable, invisible, confused, annoyed etc.?
  • No one is perfect, we all wake up on the wrong side of the bed every now and then, however, if you consistently find yourself answering these questions negatively, it might be time to give them the boot and put your moneys elsewhere.

Remember, they work for you, not the other way around.

Big hugs to all of you!

Posted on August 17, 2015 and filed under PREGNANCY, CHILDBIRTH.

A Healthy Pregnancy Diet: Part Four

Smart Sexy Birth Blog

Last but not least is our final installation of the Healthy Pregnancy Diet series.  We are talking the five core essential nutrients that lay the foundation for a tip-top healthy pregnancy, birth, baby, and postpartum experience.  If you didn't catch the earlier ones you can find Part One here, Part Two here, and Part Three here.

OMEGA-3'S

Omega 3’s are a family of fats made up of three essential fatty acids: ALA, EPA, and DHA.

The human brain is about 60% fat, and basically it takes fat to make fat.

One of these fats that plays a particular role in brain makin' is DHA.

In the last trimester babies brains grow by four or fivefold, and DHA is the lady in charge of all that happening.

"Your baby is literally pretty much sucking you dry of your DHA reserves and he/or she will continue to do so even after birth through breastfeeding when brain growth is moving in the fast lane."

Your breast milk is only as good as your diet is.

So if you want to pass on Omega-3’s in your milk you gotta eat em'.  Also, it’s not just the quality of your milk but also the quantity as Omega-3’s play a crucial role in making breast milk to begin with.  Women who are deficient often have issues with low milk supply. 

Once again takes fat to make fat.

Going even further, Omega-3 fats not only affect your babies, brain but it also effects YOU!

You have a brain and body that need essential fatty acids to function as well!

Women who are low in Omega-3’s have shown a sixfold greater risk of developing postpartum depression as well as obsessive compulsive disorder and this risk can hang around even two years after the birth of your child. 

Life is difficult enough.  Life with an infant is difficult enough.  And life with an infant and postpartum depression is heart wrenching.

Obviously PD can show up regardless of diet, but to know that we can do something to decrease our risk for it should be at the top of our priority list.

We know that with each pregnancy you have, you get depleted in your Omega-3's. So if you don’t put some effort into replenishing yourself after baby, the next pregnancy will deplete you even more. 

We also are beginning to see that these things may be passed on. So if your mother did not have enough DHA, she passed that onto you.  If you don’t do anything about it, you pass even less onto your daughter and she comes out and continues the cycle with her kids.

Single best way to get your Omega-3's in is by eating fish 2-3 times a week.

Countries that have high consumption of fish like Finland, Iceland, Norway, Sweden also have some of the best infant and maternal mortality rates, smoothest labors, and lowest postpartum depression issues.  Obviously that’s correlation not causation BUT something to take note.

We have a bit of a fear with fish in this country because of the mercury issue.  There are fish that you should avoid.  They are tilefish, swordfish, shark fish, blufin tuna, and king mackerel.  But don't let that dissuade you!

There is way more of an assortment that you can choose from compared to those that you can't.

Top picks are wild salmon, trout, halibut, and sardines (canned or fresh).  You can find a handy dandy wallet sized cut-out, listing all the fish do's and don'ts, in our Perfect Pregnancy Nutrition fun sheets (sign up below).  Pop it in your wallet and whip it out for easy reference when shopping or eating out.

Bottom line is: you need to get smart about your fish but don't shy from it completely.

In fact the importance of Omega-3's on fetal brain development have become so apparent that the FDA and EPA have recently revised their previous recommendations of throwing caution to pregnant women about eating fish to actually encouraging them to get at least 8 ounces of low-mercury fish in per week. 

All in all I think it's fair to say that there was a real reason why primitive cultures back in the day would go to great lengths to get access to fish products just to bring back to their childbearing ladies in the village. They knew it was vital to a healthy pregnancy and baby! 

If you don’t like fish, no way no how, get your hands on a quality Omega-3 supplement.  I always say nothing beats the real thing, but it's better than nothing.

So that's it!  Get your Calcium, Protein, Vitamin D, Folate, and Omega-3's in every day and you will be well on your way to rockin' this pregnancy thing out!

Isn't it amazing to see how powerful our food can be?!

xoxo

 

 

Posted on August 3, 2015 and filed under PREGNANCY.