Eating Fish Before, During, and After Pregnancy

In today's NYT Magazine, Alex Kuczynski details her adventures in choosing surrogate motherhood in her article "Her body, My Baby." After years of infertility, Kuczynski and her husband provided the egg and sperm to create the embryo, which was implanted inside of surrogate gestational-mom Cathy. Describing Cathy's visit to their NY house and her amazement at Cathy's piano skills, she states "I stood outside the living room, holding a tray of tuna sandwiches and listening."

Up until that point in the article, my thoughts focused on the emotional roller coaster the author was on while she endured multiple miscarriages and failed IVF treatments, along with the miracle of my son playing nearby. However, when I read that she served her surrogate placenta a tuna fish sandwich, my immediate thought was "I hope it was chunk light."

Not that eating a couple of sandwiches of regular solid white tuna, with its high level of mercury, during pregnancy will doom her child for poor health outcomes. Yet I was completely surprised that an educated and wealthy woman made no mention of food concerns for her fetus' placenta.

So what is the deal with fish?

Some researchers think that eating fish or fish oil high in omega 3 fatty acids will decrease natural killer cells and help women prevent miscarriages. If fish oil is consumed during pregnancy, some research indicates that your baby may have less eczema, wheezing, and asthma because of a reduction in cytokine activity, altering certain cells in cord blood, and altering fatty acid composition of breast milk. But the benefits of prenatal fish supplements on childhood cognition and behavior are mixed. This may be the result of using different types of supplements in the studies: marine algae oil is likely less beneficial than fish oil. Marine algae oil supplements are the kind used in infant formulas and are probably not as beneficial as fish oil. In adults, fish oil can help in the management of certain GI and autoimmune disorders.

While all of this sounds great, pregnant women, women trying to become pregnant, and children need to be concerned about taking in too much mercury, BCP's, and dioxins that get absorbed into the fat of fish- the exact location of the beneficial properties. These neurotoxins enter our food system through coal-fired power plants, waste incineration, and electrical equipment produced prior to 1970. Runoffs from these products get into the soil and waterways and make their way into placentas, breast milk, cow's milk and infant formula. From there, they make their way into the developing fetal/child brain and can lead to deficits in motor skills, language skills, learning and memory skills, and behavior problems. Some of these effects can persist through adolescence. Consumption in adults can lead to impaired fertility in both men and women.

What can you do about it?

Take a fish oil supplement during pregnancy, especially after 20 weeks. Although I was advised by my OB/GYN to take Expecta, a marine algae oil supplement, after reviewing the research I now only recommend fish oil supplements and will do so myself with my next pregnancy. Fish oil supplements often filter out toxins. Make sure that the brand you buy runs independent tests for impurities.

Since there are also many benefits of consuming actual fish, enjoy fish safely:

* Eat a variety of fish from a variety of waters.
* Limit consumption to 12 ounces of safe fish during pregnancy (see list below)
* Do not consume any shark, swordfish, king mackerel, or tilefish during pregnancy
* Observe fish and wildlife advisories in your area or when fishing
* If you eat more than 12 ounces one week, eat less than 12 ounces the next week
* Trim fat from fish
* Eat both farmed fish and wild fish. Wild fish are higher in omega 3's but also higher in dioxins.
* Small amounts of neurotoxins also exist in the fat of meat, dairy, and eggs so be sure to eat plenty of vegetables, whole grains, fruits, and beans/legumes.

BeyondPrenatal's Safe Fish List:

Due to the nature of our environment this list is subject to change!!!
This list includes fish low in mercury and PCB's but still relatively high in omega 3 fatty acids. This list in not all inclusive but includes most safe fish that are commonly consumed.

(~ = fish has fins and scales and is therefore kosher)

Canned chunk light tuna ~
Clams
Codfish~ (including cod, haddock, pollock, whiting) Note: Freshwater cod is not kosher
Crab
Flounders~ (including sole and halibut)
Mackerel ~ (only Chub Pacific, Chub South Australian, and Spanish South Atlantic)
Oysters
Scallops
Shrimp
Trout ~ (such as Salmon trout, Rainbow trout, etc...)

Sardines and Salmon are both excellent sources of omega 3 fatty acids but are high in PCB's and Dioxins. If you choose to eat them, limit to 6 ounces per week and eat no other fish that week. If you consume tuna steak or solid white canned tuna, eat only 6 ounces per week and eat no other fish that week.

Websites to check out:
http://www.epa.gov/waterscience/fish/
http://www.cfsan.fda.gov/~dms/admehg3.html
http://www.arhp.org/publications-and-resources/quick-reference-guide-for-clinicians/fish-and-health
http://www.montereybayaquarium.org/cr/cr_seafoodwatch/sfw_health.aspx
http://www.safeharborfoods.com/
http://www.edf.org/page.cfm?tagID=17694
http://www.food.gov.uk/science/surveillance/fsisbranch2006/fsis0306 (UK)
http://www.foodrisk.org/commodity/animal/fish_shellfish/

BPA: Background and Tips

Usually when I talk about going "beyond prenatals", I am referring to the importance of eating and serving nutritious food, rather than simply taking prenatal or children's vitamins. However, sometimes going “beyond prenatals” means thinking about non-food sources that can enter the food system and compromise the health of fetuses and children. BPA is one such intruder.

What is BPA?
BPA, or Bisphenol-A, is a chemical used in some plastics. It is also in the resins that line canned goods, infant formula, canned soda, and the inside of some baby food jar covers. Therefore, it is extremely likely that each of us consumes some amount of BPA on a regular basis. Most people have BPA in their urine, which indicates that BPA is being excreted from the body. This is a good thing. However, we know that not all BPA is expelled from our bodies; it is also found in blood and umbilical cords

The Food and Drug Administration and The American Chemistry Council consider BPA to be safe for human consumption at the relatively low levels at which they are currently ingested. In fact, in response to growing concern among consumer groups, the FDA issued a report in September that concluded that BPA was safe:

“Consumers should know that, based on all available evidence, the present consensus among regulatory agencies in the United States, Canada, Europe and Japan is that current levels of exposure to BPA through food packaging do not pose an immediate health risk to the general population, including infants and babies.” (emphasis added)

However, on October 31st, a Science Board Subcommittee report pleaded with the FDA to reconsider. The scientific panel urged the FDA to consider additional articles indicating that low levels of BPA can indeed cause health problems. Without including these additional research articles in their "available evidence," the FDA could not accurately assess the risk of exposure to BPA. According to the Panel, the FDA also made false assumptions about how parents heat baby bottles - and the hotter the temperature, the more BPA leaches from the bottle into the milk. Furthermore, the FDA included in the study many articles funded by the plastics industry. Unsurprisingly, 100% of the research articles funded by the plastic industry (14 in total) concluded that there is no harm associated with BPA, while 92% of the articles funded by government (198 in total) indicated that BPA can cause harm.

Most importantly, the Panel implored the FDA to re-examine safety margins in order to ensure that fetuses, infants, and children are protected from any possible harm that BPA might cause. This is because these three groups are more susceptible to harm due to their still-developing systems. Hence the emphasis added to "immediate risk" in the above statement. As Dr. Leonardo Trasande, assistant director at the Center for Children's Health and the Environment at the Mount Sinai School of Medicine in NYC said in a NYT article, "Once they go off track, you can't hit the rewind button.”

What are the risks?

A representative from a major infant product company once told me that although they are transitioning to BPA-free products, they are merely doing it to placate moms; the research, the rep said, is inconclusive. I agree. Most of the research is done on animals and some of the research studies are equivocal.

To summarize very briefly:
Human studies have indicated that BPA may be related to Polycystic Ovarian syndrome, recurrent miscariages, endometrial hyperplasia, and male fertility problems.
Animal research has indicated that low levels of BPA may cause a range of health problems, including: ovarian disease; thyroid problems; prostate cancer; accelerated puberty and mammary gland development; chemotherapy interference; heart disease; diabetes; altered hormones; altered immune function; reduced antioxidant activity; and behavioral and brain effects. Many of these problems were detected in animals and infants born to mothers who consumed low doses of BPA.

While totally eliminating BPA intake is impractical and probably unnecessary, I think it makes sense to take some precautions to protect oneself from excess BPA consumption.

What you can do?
(in order from least to most taxing on your budget)

1. Breastfeed: Small amounts of BPA are found in infant formulas, as well as the breast milk of exposed mothers (read:most moms). This is simply the reality of living in a BPA contaminated world. Formula is usually placed into bottles that may or may not contain BPA, while breastmilk is usually fed directly from the source. Since infant formula may cause many other adverse health effects and breast milk has many properties in it to protect against pollutants, breastfeeding is still better than formula despite the small amount of possible BPA. Additionally, if there will be any damage from BPA, it is more likely to happen during pregnancy. If you cannot breastfeed or choose not to, choose powder formula instead of liquid. It absorbs less BPA from the formula packaging.

2. No heating or extended use: Most authorities have told us to stop using plastic #7. However a new investigation by the Milwaukee Wisconsin Journal Sentinel just reported that plastics #1, 2, and 5 leach BPA when they are heated. If you use products that contain BPA, do not wash them in the dishwasher. If you must, use the top shelf only. Once you see scratches or wear and tear, throw it away. Do not leave fluids in the BPA container for extended periods of time. Never heat breast milk or formula in a BPA-containing bottle.

3. Rinse: Wash all canned food items. It is unclear if this rids the BPA from the food, but it also reduces sodium, so you might want to be doing this anyway. I use a small colander from the Pampered Chef, but if you want to move away from all plastic, any small metal strainer or colander will do.

4. Supplement: If you are pregnant, be sure to take folic acid every day and eat some soy foods each week. Research shows that folic acid and genistein (a phytoestrogen found in soy) can reverse BPA damage.

5. Limit: Limit your consumption of canned items and canned soft drinks, with the exception of Eden Beans. Apparently, Eden Foods uses a different type of can for their beans, which is free of BPA. Look for tetra-packs for your drinks and tomatoes, and use frozen vegetables, fruit, and beans instead of canned. They retain more nutrients anyway.

5. Buy: If you are pregnant, or even if you are not, buy BPA-free drinking bottles and foodware. We just bought Kleen Kanteen bottles from Amazon. Currently our son uses a BPA-free Playtex straw cup. However, because of the investigation reported in the Milwaukee Wisconsin Journal Sentinel, I am going to purchase a Kleen Kanteen for him also. I am also trying to find stainless steel toddler sized plates, but there seems to only be one brand. For packed lunches, these Foogo storage containers look great. They make adult versions too.

Have you made any changes to reduce your BPA consumption? Tell us about it!

Fruit Fun for Kids

I meet a lot of parents who are very knowledgeable about nutrition. They know that kids need a variety of foods including whole grains, fruits, vegetables, proteins, and dairy products. However, I get a lot of questions about exactly how many fruits and vegetables to give to their children. Common concerns include: "Don't they need protein to grow?" "If I give them too many fruits and vegetables, they won't get enough calories."

Below I will provide some reasons that will convince you to offer your children lots of fresh produce. I will also provide some guidelines about how many servings of fruits and vegetables to offer your children. Lastly, I will showcase an orange.

I. Why your children need fruits and vegetables:

* For educational purposes: Fruits and vegetables serve as a very clear agricultural lesson. Wheat products, animal products, dairy products, and oils look very different after they have been milled, or slaughtered, cultured, or refined. However fruits and vegetables (and eggs and fish, and maybe a few other products) look pretty much the same as when they are picked from a tree or plucked from the ground. This is great way to teach children where food comes from. The Carrot Seed is a great book for children that also teaches this lesson.

* For taste bud purposes: Children have many more taste buds than adults have. They also have a natural propensity towards sweet fruits and vegetables, and they have the ability to acquire a taste for sour and bitter fruits and vegetables. Take advantage of their adaptability because it is more difficult to teach an adult to eat vegetables than to teach a child. I don't believe that "you can't teach an old dog new tricks," because after all, that is what I do for a living, but it is certainly more difficult than teaching kids. Do your nutritionist a favor and start now!

* For nutritional purposes: Fruits and vegetables come loaded with vitamins, minerals, and phytonutrients. In fact, every year scientists are discovering new phytonutrients in fruits and vegetables, which can prevent cancers, ward off heard disease, and do many more tricks. For those of you concerned about protein or calories...they also have plenty of amino acids, so even fruits and vegetables contribute to total protein intake. They also provide plenty of calories for which to grow. Most 1-3 year olds need 1300 calories and 16 grams of protein each day. The guidelines below will provide at least 200-300 calories and 5 grams of protein each day. Thin kids can add butter, oil, or salad dressing to vegetables and dips for fruit. However, many kids in our culture actually need this low-calorie source of nutrients because of the rise in obesity rates.

*For physical and social development: Fruits and vegetables make great finger foods, giving kids ample time to develop their fine motor skills and assert some contained independence. Of course, help them if they can't quite do it on their own.

II. Let's get down to business: How many fruits and vegetables do kids need?
The following guidelines are for children 2-5 years old. For a 1-2 year old, strive towards achieving these goals by the time they reach 2, and hopefully before. You can also check out the new Food Guide Pyramid for Preschoolers.

At least:
One and a half cups vegetables each day
and
Two servings fruit each day (not fruit juice)
[One serving of fruit is one small fruit, or 1/2 cup cut fruit, or 1/4 cup dried fruit]

Although this seems manageable, many kids still fall short. To help meet these goals, you can use BPA-free Rubbermaid 1/2 cup storage containers to pack up food for lunches and snacks at home and for day care/school. Gladware also makes BPA-free 1/2 cup storage mini-rounds. Three- 1/2 cups of vegetables and two- 1/2 cups of fruit is enough for most kids.

III. Knock, knock. Who's there? Orange. Orange who? Orange you glad I didn't say banana?

Oranges are a good source of vitamin C, folate, calcium, fiber, magnesium, potassium, vitamin A, lutein and xeanthin (phytonutrients), amino acids, and trace amounts of other minerals and even trace amounts of fat.

Step 1. Cut an orange into triangle segments.

Split the segments apart using your fingers:

Step 2:

Use the triangles to teach shapes, color, and counting. Blood oranges and grapefruit can add to the color scheme. Oh yeah, they can eat them too!

Step 3:
Pack up leftovers

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Find The Carrot Seed here:

Newsworthy: Caffeine During Pregnancy

Pregnant- and soon-to-be-pregnant- coffee drinkers beware: a new research study shows that the probability of having a baby born at a lower birth weight was higher among women who consumed more than 100 mg, 200 mg, and 300 mg of caffeine per day as compared to women consumed less than 100 mg caffeine.

Prior to this study, we knew that caffeine does in fact cross the placenta, and we knew there was an association between coffee and lower birth weight and maybe even miscarriage. However, we did not know how much caffeine produced this effect. That is why some doctors said it is okay to have one cup of coffee per day, while some doctors advised not having any coffee. This new research study examined specific amounts of coffee and even coffee brands, and non-coffee caffeine sources. Additionally, instead of simply examining birth weight as an outcome, the researchers defined "growth restriction" taking the mother's height, weight and ethnicity, and number of previous children into account.

The research study also found:
1- Women who drank more than 300 mg of caffeine pre-pregnancy but reduced it to less than 50 mg by weeks 5-12 of pregnancy, had babies with higher birth weight than their still-coffee-drinking counterparts. So if you just found out you are pregnant, each day you decide to reduce your consumtion can help add some weight to your unborn baby.

2- Some women cleared coffee from the system faster than others. This was more dangerous for their fetus, probably because a great caffeine load came through the placenta.

3- Surprisingly, 60% of the caffeine consumed was from from tea, and only 14% was from coffee. Even more surprising, 26% of caffeine was from other sources such as cola, chocolate, and food items containing coffee, tea, cola, and chocolate such as coffee ice-cream.

To give you an idea of caffeine content, this week's grande Starbucks coffee of the week has 330 mg, a grande green tea latte (pictured above) has 80 mg caffeine, and their grande hot chocolate has 20 mg.

So, how much weight are we talking about? Women who consumed less than 100 mg of caffeine saw an increase of 2.11-2.46 ounces. While that does not sound like a lot, for an infant, it could mean a world of a difference for an already compromised fetus. Additionally, I have already discussed how low birth weight can affect later health conditions. I think the researchers sum it up best: "Sensible advice to pregnant women would be to reduce caffeine intake before conception and during pregnancy."

Menu Plan Monday

When I first joined a CSA we were overwhelmed by the amount of vegetables we received, especially because we had no idea how to cook them! After three years, and splitting the share with friends, the vegetables have become more manageable. Additionally, one of the lessons I have learned from working full time and being a mom, is that we need to organize our meals for the week or else we end up eating food that is not as nutritious as it can be. I do not make a menu plan every week but I love it when I do. It is a great habit to get into for pregnant women and anyone who has kids.

Here is our menu for our weekday dinners, in which we will use up all of our CSA veggies- it is always a game to see whether we can finish them before we pick up the next week's share:)

Monday: Kale with shallots, onions, beets, and minute steak over rice

Tuesday: Cauliflower, potatoes, and onions in tomato curry sauce over whole wheat couscous with tofu steaks (Mollie Katzen's Vegetable Heaven)

Wednesday: Gnochi with mushroom-kombu sauce, chicken breast, and green beans

Thursday: Leftovers!! And baby bear pumpkin.

Friday: Unstuffed-cabbage, garnet yams, spinach-orange salad

For lunches we will be eating sandwiches on whole wheat bread (bread machine) and for snacks we will noshing on pumpkin muffins.

Some food profiles for this week

Kale: Rich in Calcium, magnesium, potassium, folate, vitamin A, vitamin C, iron, fiber, lutein + zeaxanthin. It truly is a superfood. If you don't like the taste or texture, try pureeing it in a food processor and hiding it in other dishes (like meatballs and soup)

Cauliflower: Rich in fiber, potassium, vitamin C, folate, vitamin b6, pantothenic acid

Vitamin Profile: Vitamin A and Pumpkin Muffins

The effect of vitamin A during pregnancy is often misunderstood. Many of you may have heard that too much vitamin A is dangerous to your fetus. This is certainly true: too much vitamin A can cause birth defects. However, excess vitamin A is almost always related to the synthetic form (from vitamins). It is for this reason that pregnant women need to make sure they are not taking too much Vitamin A from supplements and food combined (over 3,000 ug/day or about 5,000 IU/day). However, some prenatal vitamin manufacturers have actually removed Vitamin A from their formulas, so check your supplement. If it does not have vitamin A that is okay- it was probably removed to make room for omega-3 fatty acids, or other vitamins that are more difficult to get from food.

A healthy pregnancy requires vitamin A for embryonic and fetal developments. Animal studies show that vitamin A affects gene expression and the formation of the heart, central nervous system, circulatory, urogenital, and respiratory systems, along with the development of the skull, skeleton and limbs. A deficiency of vitamin A during early pregnancy results in abnormalities of these systems or even miscarriages. There is also some research that vitamin A has anti-viral and anti-tumor properties, which can be passed on to the fetus. Vitamin A requirements are even higher during breastfeeding (1,300 ug/day) because deficiency of vitamin A in children can cause blindness and problems with lung development .

Many pregnant women in the United States have no problem getting the recommended daily intake of 770 ug/day from food sources. Vitamin A carotenoids are found in yellow, orange, and deep green vegetables. Vitamin A retinols are found in milk, butter, fish oils and animal livers. It is safer for pregnant women to obtain vitamin A from fruits and vegetables, rather than fish oils and animal livers. For example, cod liver oil is healthy for non-pregnant women and children but may not be safe for pregnant women or women who might become pregnant due to the toxic levels of vitamin A to the fetus. If you want to take a fish oil supplement consider another source, or make sure not to take more than 5,000 IU/day from cod liver oil, supplements, and food combined. Beef liver should only be eaten occasionally and you should probably skip your prenatal vitamin that day. Always consult with a Registered Dietitian if you think you need more personalized guidance.

If you do not eat yellow, orange, and deep green fruits and vegetables (such as carrots, winter squash, pumpkin, sweet potato, apricots, cantaloupe, tomatoes, watermelon, broccoli, kale, collards, and spinach), make sure you eat vitamin A-fortified foods or take a prenatal vitamin that contains Vitamin A. In order for vitamin A to be well absorbed, your body needs to have sufficient fat intake and zinc stores as well.

These seasonal muffins are a fun way to get some vitamin A and they also contain fat, and zinc!

Vegan Pumkin Muffins
(Modified from Vegan with a Vengeance. Found at Bunnyfoot)

Stir together:
1 3/4 cup whole grain pastry flour
1 cup sugar
1 tablespoon baking powder
1/4 teaspoon salt
1 teaspoon cinnamon
1/2 teaspoon each nutmeg, ginger, and allspice
1/8 teaspoon cloves

Mix together:
1 cup pureed pumpkin (I used canned)
1/2 cup soymilk
1/2 cup coconut oil, canola oil, or melted Earth Balance
2 tablespoons molassess

Add wet ingredients into dry ingredients and stir, being careful not to over-mix. Pour into muffin tins 2/3 full and bake for 18-20 minutes. Allow to cool before serving or they will be chewy.

My family loves this recipe because the muffins are yummy and I love it because it works for families with food allergies (like ours). I have also tried some variations, such as using agave instead of sugar (add to wet ingredients) and Toffuti sour cream instead of oil. The muffins come out more 'bread-like' but still descent. Stick to the recipe as listed above to be safe.