This blog is intended to provide a discussion forum on topics surrounding pregnancy, labor, birth, breastfeeding and family health. The purpose is to review research studies, articles and highlight the buzz in health news. But please remember, I am not your health care provider and do not intend to give medical advice.:)



For more information about the purpose of this blog, please read the "Welcome" post


Monday, November 22, 2010

Wisdom in Taking Supplements - Excellent NCCAM Resource

I am on a medication kick today...Sometimes we make assumptions that dietary supplements are 'more safe' than pharmaceuticals and that they carry 'less risks.' While these assessments can at times be accurate, it is highly on an individual, substance-by-substance basis. Dietary supplements include vitamins, minerals, herbs, botanicals, protein, amino acids, exogenous hormones and others which come in oral or supplemental form--including suppository and topical, etc--(i.e. not ingested as a result of directly consuming whole foods). As much as with any pharmaceutical substance*, use of wisdom and discernment is vital prior to putting any supplement into or onto our bodies, naturally occurring or not. Natural is not synonymous with safe, natural is not even synonymous with "more safe" than synthetic. There are lots of naturally occurring substances that are in fact quite unsafe. And not all products that are sold as natural are in fact natural. Not all products, brands and manufacturers are equal. Despite what companies may claim on their products, there are in reality very loose standards when it comes to the manufacturing, production and selling of supplements. Sometimes it can be difficult to decipher which are the most effective, purest and safest. This article can be a helpful general tool when considering adding supplements to your diet.

Article: "Using Dietery Supplements Wisely" http://nccam.nih.gov/health/supplements/wiseuse.htm

The A-Z topic page is also a helpful reference for supplements. If you are looking to see if there is any research about individual vitamins, herbs, etc, many of them are on this list. It is a slowly growing body of research, so many substances have not been evaluated. This does not mean they are therefore not effective or safe, but that we simply don't know for sure. List: http://nccam.nih.gov/health/atoz.htm. Cheers! Or Bon appetite?!


*Please note that I am fully aware of the side-effects, adverse-effects and potential risks with pharmaceutical medications as well. This is not a discussion of which "kind" is safer. I apply strong scrutiny to each regardless of how it is sold, packaged, advertised, researched or not researched. 

Tuesday, November 16, 2010

Allergies, Adverse Reactions, Sensitivity and Intolerances—What Does It All Mean?

         In light of my recent posting (Elimination Diets - Are They Healing or Compounding the Problem?)  I think an important clarification is needed in the terminology of allergies and intolerances. So here are just a few definitions and specifications:
           An allergy and an intolerance are separate concepts, though they are frequently used interchangeably. An allergy induces the immune system to respond releasing histamine, antibodies and other chemicals leading to symptoms such as breathing difficulty, hives, rash, itching, coughing, wheezing, sneezing, swelling, anaphylaxis—all responses specific to histamine and the immune system. An allergy is often the result of the immune system overreacting (and not in the hysterical, emotional sense:) to substances it believes are harmful. 
          Response to an intolerance however does not involve the immune system and is not inherently life-threatening. Upset stomach, diarrhea, vomiting, nausea, gas, bloating, fatigue, headaches, cramps are signs of an intolerance. For one to have a true food allergy, it would necessitate the presence of allergic signs such as those mentioned above. Gluten, dairy and MSG intolerances are commonly labeled under “allergy,” but are not in and of themselves allergies. Unless hives, rash, swelling, or difficulty breathing are present, an allergy does not exist. Most often, intolerances involve a lack of necessary enzymes. 
          In the case of a more significant form of gluten intolerance which is celiac sprue or celiac disease, the immune system may get involved but in a different way. The individual’s immune system actually turns on itself (autoimmune response largely involving T cells) and causes damage to gastrointestinal tissues. The issue of whether or not celiac disease is specifically a histamine response is under debate.           
           An adverse reaction is similar to the mechanism of an intolerance. It involves a response to a stimulus that is unwanted or unexpected, such as diarrhea, nausea, vomiting, headache, etc. Adverse reactions are a more general way of describing a response to a stimulus. Strictly speaking, they are defined differently than allergic reaction. When your health history is being taken, and your provider asks whether you have any allergies, he or she usually asks what is your response to that substance. If it is hives, swelling, etc most practitioners note it as an allergic reaction. If it is diarrhea, nausea and vomiting, etc, it is usually indicated as an adverse reaction. 
           A sensitivity can exist without necessitating the existence of a specific  intolerance or allergy. For instance, you put on a pair of rubber latex gloves. Later when you take them off, you notice that your hands are a bit reddened and are itchy, but it clears up on its own after a while. Though at some point this could possibly develop into a allergy, it is simply a sensitivity.


 Further Resources:

Definition of Adverse Reactions to Food

Elimination Diets - Are They Healing or Compounding the Problem?



This is not scientific, it is just a theory that I am mulling over. There are millions of people using different elimination diet practices all over America, and I am sure in other parts of the world as well (though only in the parts of the world where individuals are fortunate enough to actually choose which foods they want to eat and which they don't). It's all a buzz, especially in the last couple of years on blogs, Facebook, Twitter, discussion forums, magazines and on websites contributed to by professionals (Mercola, WebMD, etc). Elimination diets are not a revolutionary concept, but in terms of the foods being added to the growing list, well, let's just say that list is getting rather lengthy. What will we be left with to eat with so many possible culprits? I am not speaking to the risks and benefits or even the effectiveness of the diet regimens for different individuals. That is a very difficult task to determine since there are so many millions of people engaging in some form of elimination diets. And some are doing so for specific health complications while others' reasons are more nebulous.           
 It all just makes me wonder. Instead of using elimination diets to "treat" possible intolerances and suspected allergies (please see posting on Allergies, Adverse Reactions, Sensitivity and Intolerances—What Does It All Mean?), why are we not looking at ways to bolster our bodies' ability to metabolize those foods? In fact, regarding one such villified substance--gluten--researchers at Stanford University are conducting animal tests using the specific enzyme Barley Endoprotease EP-B2 and are having some success in finding improvements in gluten metabolism (J. Gass, et al, 2006http://jpet.aspetjournals.org/content/318/3/1178.full). Another enzyme that is being looked at is propyl endopeptidase (PEP). C. Khosla el al have extensively researched enzymes and their roles in gluten metabolism. One study found that when combined with the effects of EP-B2, PEP had significant impact on metabolization of gluten, though alone, neither enzyme completely inhibited the gastrointestinal cell destruction triggered by gluten.  (Please see Chaintan Khoslahttp://www.stanford.edu/dept/chemistry/faculty/khosla/Khosla_publications.pdf for a list of his publications.) 
To me, and I realize others see it differently, an intolerance (especially to *normal* food sources that have been consumed by many cultures for thousands of years) doesn't say that the food itself is "bad" or a culprit. To me it says that it is our bodies that are ill and need the healing/fixing and that there is nothing inherently allergenic or intolerance-inducing about the actual food--its ourdeficiency that's the problem. We want to have outside culprit to condemn because accusing our body of falling short sounds mean or guilt-inflicting, or politically incorrect or what have you. But consider, we don't say that diabetes is a sign that glucose is bad, allergenic, intolerance-inducing or toxic. A person with diabetes either has a difficult time metabolizing glucose or has a difficult time releasing insulin or a combination of both issues. We recognize that it is the person's body that has damage or disease and that it is the individual's body that needs help, rather than "eliminating" glucose.  Or perhaps there are some people out there advocating for elimination of glucose in their diet in order to "treat" diabetes? Hmm, well, stranger suggestions have been made, but as a person who cares very much about people's well-being, I do hope no one jumps on that theoretical band-wagon. 
I wonder if all of these elimination diets (some are quite extensive and I would even call 'severe') are actually compounding the problem rather than helping it--that in the future we will be passing along a true genetic intolerance to our offspring, because our bodies not only had an initial possible intolerance, but now have no reason to produce the enzymes and hormones that allow for metabolism of those foods. Some enzymes are extremely specific to only one or two substances. If those enzymes are not employed for their purpose, then they no longer have a purpose and the body doesn't need to produce them any longer. It can create an enzyme deficiency. It is quite possible to pass this enzyme deficiency along to offspring.   
Not only the possible genetic impact, but when a normal whole food group is eliminated (in the name of minimizing exposure to a possible offending substance), so are the remaining nutrients that are in those foods. Proteins, amino acids, vitamins, minerals, etc. One has to be very very savvy at these diets to know that "if I am taking out these foods, I need to replace them with foods that have high density of X vitamins, minerals, amino acids." Much like those who opt for vegan and vegetarian diets, one has to be very calculating and self-educated to know adequate pairing of food groups to ensure a variety of balanced, nutrient-dense foods are being eaten. This adequate pairing is not impossible, but many people don't know where to start. Sometimes they don't even know they need to start.            
Curious what will come about in the next decades following the quite adventurous advent of elimination diets.

Monday, November 15, 2010

My Personal Reasons for Staying at Home With My Young Children:

Here is a bit of personal history. I was raised in a home where my mother stayed home with us as kids. My mother was anything but a desperate housewife. There is a joke that stay-at-home moms spend their day eating bon bons and watching soaps. Certainly there are some stay-at-home-moms who are such in title only. The fact that these few women stay home is really a theoretical excuse for them to not work at all. They may spend the entire day simply surfing the internet, on the phone, watching TV and then off to go shopping and getting manicures. I do know of a very few women who have adopted this style of “mothering,” but this is not the rule in stay at home mothers.
Upon completing my nursing school after 5 tedious years of studying, clinicals, exams and papers, I immediately began my career as a nurse in a busy pediatric hospital unit. In those early years as a nurse, I gained the skills needed to advance my knowledge and preparation to care for acutely ill children. A few years later I met my husband, fell in love and we married. Shortly thereafter we started our family. We both always knew when children came along, I would stay home full time and raise them while they were young. So right up to 5 days before giving birth, I worked two jobs as a nurse. The decision to stay home with my baby was not admittedly as much of a true “decision” for me as it is for many women. I fully understand that after one has obtained much training and education for a career the idea of putting it on hold for X number of years is difficult. Culture would tell you that it is a waste of a degree and a waste of a successful woman.
Some women have admittedly said they went back to work because, quite frankly, they couldn’t handle being home that long and more specifically, they couldn’t handle being around their children that long. I actually appreciate these particular women who are willing to be honest about their reasons. I think many women taut the tune that they don’t want to loose all of their training, don’t want to fall behind their colleagues and point to the common feminist rhetoric, but really I think many women feel completely inadequate when it comes to being totally responsible for their children-their physical needs, their education, their training, maturity and moral development, their socialization, etc. This is no easy task. And the fact that some women are very uncomfortable with this realization is completely understandable. Not every woman was a born “nurturer” and many women aren’t kid people. I fully understand that for these women, the idea of staying home and doing a job in which they feel like they lack “skills” or even desire is unappealing. Compare this with doing a job that they already know they are good at, receive monetary compensation and rewards in the forms of promotions, bonuses, clients', colleague’s and superior’s respect, completed projects etc. Which seems more “rewarding?”
Mothers choose to work and choose to stay home for many reasons. Some reasons to do either are very compelling and sacrificial while many are not. I want to put a caveat out there at the beginning of this editorial. This is not intended to inflict guilt on any mother for the choices she has made. I understand there are many factors that go into the decision to stay home or go back to work after your little one has been born. I understand it is not black and white. Your reasons are your own and only you can assess whether you are comfortable with your decision. No person can actually make another person feel guilty. It is feeling or perception or reality that only each individual can control for herself. Thus, regardless of how carefully or objectively I present my thoughts, some women will still be bothered by those thoughts. Though I admit I tend toward being a peacemaker and a people-pleaser, I cannot help that some women may feel irritated and some women wouldn’t respect me regardless of the reasons I articulate. I am sorry for these women, but I hold to my decisions. I know that some women, especially single mothers (especially those not single by choice) who in particular live away from their extended families often do not have a choice in whether or not to work to support their family. I fully acknowledge these women’s burden to work and do not diminish their commitment to their children. However, these are not the women who are part of my discussion. So lest you assume I am writing to badger working mothers or “make them feel guilty,” I ask you to simply allow me a forum to express my personal decision-making process. Although it may be self-focused, that is what I intend it to be—about my choices. It is not a discussion or a judgment on women who do work out of the home but on why I personally chose to stay home. You cannot argue with my choices, because they are only mine:). If my own reasons for staying home help other women articulate and solidify their reasons, I will also have done a service to women out there who are fighting against an out-dated feminist mindset that says being a “slave to your biology” and staying at home with your children diminishes you as a citizen as a woman and as a person.
Here are just a few practical reasons why I stay home full time with my children. I would like to go back at some point and write on the “statistical” impacts on my kids and my family were I to work outside the home, but that will have to be another time and another venue. This is simply an opinion/editorial piece. Someday, I will go back and take each of these subcategories and summarize the research on the issues. Not today, for it is Monday and on Mondays I am too slow for such things.  

Moral, Spiritual and Emotional Reasons:
            No caretaker, regardless of how nice they are and how good they are with children has the same love for and commitment to my child (granted, some parents do not have love and commitment for their children, but again, this is not meant to be a compare and contrast). They also do not have the mindset of “raising a child” rather they have the goal of meeting basic physical and emotional needs and assisting with a few life and social skills. These are the excellent childcare teachers, which unfortunately are the exception rather than the rule. Many are concerned with preventing injury, meeting basic physical needs (toileting, feeding, and sleep, etc), teaching basic social skills and gaining a livelihood (paycheck). And this is all they should be concerned about. After all, their job is childcare, not childrearing. The task of teaching morality and life long skills for living are the parent’s job, not the caretakers’ job (Sorry, Hillary Clinton, I have to disagree with you on this one, it is not the “Village’s” job to raise a child, it is a parent’s job. And now that I think of it, I hope you weren’t referring to M. Night Shyamala’s version of the Village…). This is not a strike against childcare workers. They do their job, many do it well. But their job has specifications and limitations. I know this well. I worked at a preschool/kindergarten (which was actually a day care, but the staff did not appreciate this inference) throughout college. It was a great place to gain more skills with caring for children, to enjoy kids and to earn money to pay for my own education. I did have compassion for those kids. I did have care for them. I was a good caretaker who engaged the kids and was gentle and kind and patient. But what happened to them after I clocked out didn’t really matter to me. They weren’t my kids. The responsibility to rear them wasn’t mine. I did my job to its expectations and specifications. There were times that did tug on my heart. We had children who would be dropped off at 7 am (opening) and their parent would come at 6 pm (closing). They did this every day. That’s 11 hours away from home, away from family. The point that this experience drove home to me was that even good, kind caretakers cannot replace good parents. Even loving grandparents and other loved ones who generously take care of the children in their family cannot replace loving parents. Only I can be fully responsible teach my children principles and nurturing as I raise them from birth to18. The time away from home my children would experience were they in day care (even in a home-based daycare) would indeed make me feel guilty. And for me personally (not speaking for or to anyone else here), had I chosen that route, the guilt would have been appropriate. If my kids were away from the house and from me from the time I dropped them off before work, to when I or my husband could pick them up, when do I have time to read to them, sing to them, teach them about truthfulness, kindness, right and wrong, goodness, patience, honesty, respect and all the other virtues? On the weekend? I didn’t want my children to be like pets that we took out to the park on a Saturday and called it good in the parenting department, or in the case of a pet, in the owner department. And I don’t trust that a childcare giver (even a very good worker/teacher) has the same personal beliefs as I do and would teach my children truthful information.

So, those are my more “philosophical” reasons for staying home, which I realize many women will not relate to nor will they agree with my musings. The rest of these reasons are much more practical and perhaps even more applicable to many women of varying philosophical backgrounds.     

Physical/Health Aspects:
Less frequent exposure to illnesses (colds, other viruses and bacteria, etc)
- Some exposure to illness-producing organisms can help strength children’s immune systems. Frequent and over-exposure can affect the efficiency and health of the immune response, rendering it weakened, which in turn may make children vulnerable to more serious diseases.
- When my children do get sick, I can attend quickly and fully to their needs, thus decreasing their recovery time. Children who are not able to have this kind of care may remain sick for weeks or more. Some parents are unable to miss work themselves, requiring that the child attend day care, school or alternate childcare anyway when his body is sending the message that he needs to rest. Resting at home in bed and mama’s chicken noodle soup to me are the perfect combination.
- In my particular line of work as a nurse, the knowledge that I could be bringing home illnesses (some pretty serious) to my family on a daily basis was not something I was comfortable with. Even if I did not work in a hospital or around sick individuals, there are always contractible illnesses floating around the community and workplace. Me being home with my children means I am less frequently exposed to illnesses and consequently, so is my family. In addition to me not sharing illnesses with my family, if I am less often exposed and therefore less often sick, I am more available to my family and more able to enjoy and care for them because I do not need to worry about nursing myself back to health. 

Less of a risk that my child will be sexually or physically abused by caretakers:
This is a difficult issue to have to discuss. But it is nonetheless a reality and I cannot turn a blind eye as a mother. Abuse statistically occurs more within the home than in a school or child care setting. But daycares and schools are not immune. There is always a bad grape in the bunch. Regardless of how well-intentioned child care facilities are and how well they vet their employees, there are absolutely no guarantees that abuse will not occur. There are measures taken to prevent this, background checks, one-way windows allowing views off the entire classroom from the outside, no doors on bathrooms. Many facilities do not allow men (who are the more common perpetrators, but by no means the only ones) to help with diapering or toileting or even applying sunscreen (as was the policy at the facility where I worked). Sometimes abuse is so subtle that a parent or other childcare worker would not recognize the signs. Often children carry the abuse as a secret. They may not show obvious behavioral signs of abuse. In other words, children will infrequently share direct comments with an adult that “so and so was hurting, touching, etc me.” They often withdraw or become aggressive or have less straightforward behavioral changes. In particular during the ages when children would be in childcare, these ages are very vulnerable to silent abuse. This happens in big facilities and in home-based facilities. The perpetrators often attempt to gain the trust of the child or may threaten them if they tell anyone. Children are vulnerable, na├»ve, trusting and taught to be respectful of adults. If my children are always in my care besides the occasional times with my family and very few friends (whom I fully trust), I do not have to live in fear that my children could be silently abused. Sometimes abuse that occurred as a child during time in childcare does not surface well into adulthood. Sometimes it never actually comes to the surface, but still wreaks havoc because it is a wound that is being carried for a lifetime. Sometimes, it repeats itself. A child who was abused when young, grows up and might come to repeat his perpetrators violations on other people. This is a great cost, morally, physically, spiritually, emotionally. It is a risk I am not willing to take as a mother for my children. Not only this, but because I am home full time nurturing and pursuing a relationship with my children and learning who they are, what their temperaments are, I believe this time allows me to invest time that leads to a trusting, open relationship. Fostering an open trusting relationship with my children enables them to more freely share what is going on in their lives under the surface.

Breastfeeding
Some research has shown that even when a mother works part time outside the home, the breastfeeding relationship and ability is compromised. Even without studies, common-sense would reiterate this message as well. Not being able to allow my babies to breastfeed unrestricted and for at least the “recommended” minimum length (AAP states at least to 1 year of age) is a shot at their health I choose not to take. Withholding breastfeeding from my babies, regardless how legitimate the reason does put them at higher risk for many health and physical problems. This is not meant to lay any guilt on mothers who cannot breastfeed or who started and were unable to continue. This is speaking to my personal decision which is based on what I know about breastfeeding and conversely on withholding breastfeeding. I am personally not willing to make that decision to withhold something so nutritious for a substitution. Even pumping and bottle feeding breast milk on a regular basis does not provide the same benefits as actually breastfeeding. There are many reasons why this can be true, but the one I will mention is that breast milk content fluctuates many times throughout the day. If a baby has a cold, mom can start to produce specific antibodies in the milk specific to what is needed to combat the illness. This can occur within hours of the last feeding. If mom pumps milk (EBM=expressed breast milk) on Sunday and freezes it and baby gets a cold on Thursday, the EBM he will be receiving won’t have the specific antibodies needed because mom pumped it on Sunday (though less specific antibodies will still be present). The fat content in breast milk also changes throughout the day, so if mom is pumping only during certain times of the day, the baby misses out on the milk with the highest amount of fat. A person might wonder if staying at home as a mother is associated with longer breastfeeding overall (less early weaning). I have not found specific information assessing how returning to work can affect the total number of months of breastfeeding, but am on the look out for studies surrounding these questions. I could go on about how a mother’s decision to return to work can impact the breastfeeding relationship, but that will have to be a separate post.

Sleep
I do not have to awaken my babies before the sun rises in order to get them dressed, fed and out the door. I do not have to worry that they are not getting a nap or down time in childcare. I also do not have to pick them up after a long day of work, only to take them home, feed and bathe them and put them to bed. I do not have to concern myself with being exhausted from work, only to come home and deal with family and household affairs. The hours of the day I am able to spend with my children teaching, nurturing and training them is uninterrupted by me being away at work. Consequently, I and my children get more down time, more sleep and less over stimulation. More rest and down time means healthier immune systems and healthier children. Even working part time can still have many of these challenges.

Nutrition
            I have had very busy weeks as a stay at home mom. Yes, stay at home moms are busy people too. During those weeks we are more prone to eating out, going through the drive thru, buying frozen and packaged foods simply to get a bite to eat before rushing off to such and such. I know there are families who have both parents working and they do manage to make home made meals many days a week. But let’s be honest, this is not a reality in most cases and even those families don’t have an ideal diet. If I am not able to spend time shopping for and preparing nutritious snacks and meals that means the quality of our meals will be compromised, which in turn means the quality of our health will also be compromised. This again circles back to the susceptibility to illnesses.

Financial
When I started mentioning to colleagues that I was going to stay home after my baby was born, I got a bit of a mix in responses. One coworker was incredulous. “Why?” she said. “Your schedule is ideal for being a mom.” Others said, “well, I make it work…its not that bad.” Most others responded with “good for you!” and several said, “I wish I stay home with my kids too, but we just can’t make it work.” Strangers have told me and other friends who stay home that we are “so lucky” as though all it took was me turning in a notice letter and I could just skip home blowing bubbles and playing everyday with my baby among lilies and rainbows. It took sacrifice. We had to make cuts in certain areas and do with out the things we wanted. But we both had the understanding that it was more important to sacrifice our needs and wants for our children, rather than sacrifice our children. When we looked just for kicks at the idea of me working part time, as little as 1-2 shifts per week, it still was two full days away from my family, and away from my home. And in my case, that would be two 12-hours days away. The money I would make going back to work part time would go directly to: taxes, childcare and convenience foods, leaving us with no “extra” cash. Some mothers believe they cannot afford not to work, but when they price it out, they may not be making what they think they are.

This certainly does not exhaust all the reasons why I or others might choose to stay home, but it addresses some key motivations. I know many will not agree with my reasons, but that is okay, you do not have to:). 

Thursday, November 4, 2010

CMV - If You Are Pregnant or Soon-To-Be, Here are Some Things You Should Know.

Not many people have heard of CMV (cytomegalovirus), though it is actually a common infection. A large portion of individuals have contracted the virus at some point in their life (it is a member of the herpes viruses, which include herpes simplex and herpes zoster [chickenpox]). For the vast majority of individuals, the infection does not cause significant issues. As with chicken pox, pregnant women, however can be at a higher risk of transmitting the virus to their unborn babies, which could lead to significant issues for those babies. In fact, CMV is one of the most common causes of congenital anomalies. Simple measures that pregnant women can take can help prevent an infection and/or fetal transmission. Young children often carry the virus, often without symptoms, and often are the ones who transmit it to pregnant women. It is primarily transmitted through urine and saliva. Good hand washing techniques (especially after diapering or wiping noses of young children) and minimizing sharing food, utensils, straws, etc with young children will go a long way at prevention. If we didn't already have enough reasons to practice good hand washing, here is another.:)

For more details on transmission, prevention and detection, please visit:http://www.cdc.gov/cmv/overview.html

Here also is a short video from an epidemiologist providing information and prevention tools. http://www.medscape.com/viewarticle/728532?src=mp&spon=24&uac=149984FY

**As a teensy aside, this is information to share with pregnant women about simple disease prevention tools and awareness...I am not a fan of fearmongering and am rather disappointed when others present health information with the purpose of scaring people into participating or not participating in specific actions. So, just a gentle reminder to be sensible and professional in sharing health information. Avoiding sensationalizing or exaggerating information to get people on board with your way of thinking is far more professional and compassionate. Support responsible free-thinkers, not needy clones:)...hmm I feel another Bella Dolce soap box blog entry coming on...