Author name: laura@lauracipullo.com

Facts about FODMAP

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Understanding the Low FODMAP Diet: A Guide for IBS Relief By Reva Schlanger MS, RD, CDN   Have you ever heard a friend say they were going on a “FODMAP diet”? FODMAP is an acronym for certain sugar that can cause intestinal distress so when people are on a FODMAP diet, it means they are choosing from foods that are low in FODMAPs. This diet has been helpful for those suffering from irritable bowel disease (IBS) and/or small intestinal bacterial overgrowth (SIBO) as it can help people figure out which foods are irritants and which foods reduce symptoms. It is important to note that the low FODMAP diet is meant as a temporary eating plan as it is very restrictive. The goal is to find out which foods increase gastrointestinal distress and try to eliminate those from a person’s overall diet. The initial process is very restrictive, so it is important to seek guidance from both a medical professional as well as a registered dietitian. What are FODMAPs? FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, which are short-chain carbohydrates (sugars) that the small intestine absorbs poorly. This causes the small intestine to draw in extra water to help move the FODMAPs to the large intestine. There, the bacteria living in your colon ferment these sugars, turning them into gas and chemicals. This stretches the walls of the colon, causing abdominal bloating, pain, distention, cramping and/or changes in bowel habits. FODMAPS are not unhealthy or harmful but may exacerbate GI symptoms in those with sensitive GI tracts.   Are FODMAPs harmful for everyone? Definitely not! Our gastrointestinal tracts are designed to process some foods that our bodies cannot fully absorb. An example of this would be dietary fiber which has an important place in digestive health and has shown to help reduce cholesterol. Feeding the bacteria in our gut is important to have a healthy microbiome. Some people, however, have more sensitive guts and can experience a level of indigestion from these foods that can impact daily living. For those people, the byproducts of fermentation can cause unpleasant symptoms like bloating, flatulence, abdominal pain, and distention. This when a low FODMAP diet may be recommended.   How does it work? The low FODMAP diet is a three-step elimination diet. There is the elimination phase (step one) where you would stop eating any foods high in FODMAPs. The second step is the reintroduction phase where you start to slowly reincorporate the previously eliminated foods to see which ones are problematic. Finally, step three is the maintenance phase. Once you can identify the foods that cause symptoms, tyou can avoid or limit them from your daily eating habits.   It is recommended to have at least two weeks and no more than six weeks of the elimination phase (usually is 2-4 weeks). It can take time for symptoms to subside so one week would likely not be enough time for this phase to work. Remember, this phase is not meant to be permanent as it is extremely restrictive. If symptoms are significantly improved with the elimination phase, patients will then start the reintroduction phase, where groups of FODMAPs are added back one at a time, monitoring for a reoccurrence of symptoms.   The reintroduction and maintenance phase can vary as it is very individualized. During the reintroduction phase, you will stay on the low FODMAP diet while starting to reintroduce a high FODMAP food from each FODMAP category, one at a time. It will take a few days to test out each food and increase the quantities, to find the tolerance threshold. Between each test is a “reset” back on the elimination phase to help avoid any crossover effects.   Many people can feel overwhelmed and stressed with all the “Do’s and Don’ts” of a low FODMAP diet. It can be beneficial to work with an experienced dietitian during the elimination and reintroduction phases. Once you find out which foods work and don’t work, plan a more sustainable and nutrition meal plan with your dietitian for the maintenance phase.     What can I eat? Foods that trigger symptoms vary from person to person. To ease IBS and SIBO symptoms, it’s essential to avoid all high FODMAP foods that aggravate the gut. This includes*: Dairy products (like milk, yogurt, some cheeses, and ice cream) Beans and lentils Wheat-based products such as cereal, bread, and crackers Some vegetables including artichokes, asparagus, onions, and garlic Some fruits including apples, pears, peaches, and cherries Instead, base your meals around some low FODMAP foods such as: Almond or hemp milk Eggs and meat Grains like rice, quinoa, and oats Certain cheeses like brie, cheddar, and feta Vegetables like eggplant, potatoes, cucumbers, tomatoes, and zucchini Fruits like grapes, strawberries, blueberries, pineapples, and oranges Portion sizes do matter when it comes to FODMAPs, as certain foods have a specific serving size in which they would be considered high vs low in FODMAP. Remember to read the labels of packaged foods to ensure they do not have any added high FODMAP ingredients (ex: high fructose corn syrup, onion, garlic, wheat, etc.) *To get a full list of low and high FODMAP foods, ask a registered dietitian and medical doctor.   Takeaway  There is a lot of research on the effectiveness of the low FODMAP diet for IBS and the verdict is still ongoing. While some have found the low FODMAP diet helpful and noticed a reduction in symptoms, this diet may not be effective or appropriate for everyone with IBS or other gastrointestinal issues.   Anyone interested in starting a low FODMAP diet should talk with their doctor and dietitian before starting. It is important to understand the benefits and risks, as this diet is not suitable for everyone. It is very rigid and not meant for long term. A medical team will work on specific plan that will manage symptoms while maintaining a balanced diet.       References: Wang J, Yang P, Zhang L, Hou

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How Much “Weight” to Put on Your Child’s BMI

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Rethinking Your Child’s BMI: A Balanced Perspective By Paige Mandel, MS RD CDN   Body Mass Index (BMI) is often a point of confusion for many parents and kids alike. Should we pay much attention to it or not? “My child’s pediatrician said he/she is overweight, do I need to put them on a diet?” “What does it mean if my child is considered underweight/overweight/obese?” Are often questions we get as dietitians from concerned and proactive parents. Basically, any classification outside of “normal weight” raises an eyebrow and gets the mind running for parents, caregivers and the child themselves.   Keep in mind, BMI is simply a mathematic formula developed in the 1830’s by a Belgian statistician that equated to taking your weight (in kilograms), and dividing by the square of your height (in meters). “The result, which slots you into one of four main categories, is meant to describe your body in a single word or two: underweight (BMI less than 18.5), normal weight (18.5 to 24.9), overweight (25.0 to 29.9) or obese (30 or greater)”1. Although calculated the same, BMI is interpreted slightly different for children and teens, varying by age and sex2. “Due to changes in weight and height with age, as well as their relation to body fatness, BMI levels among children and teens are expressed relative to other children of the same sex and age. These percentiles are calculated from the CDC growth charts, which were based on national survey data collected from 1963-65 to 1988-944.”2 Similarly, the result is into one of four categories: underweight (less than the 5th percentile), healthy weight (5th to 85th percentile), overweight (85th to 95th percentile), or obesity (95th percent or greater)3.   An example of a BMI growth chart is represented below: 2   At LCWNS, we think the measurement called Body Mass Index is overrated, antiquated, and has the potential to misdiagnose ourselves and our kids4. On it’s own, it has the power to create a vision of health status, with not much validity or information to it.   In research, this is a helpful tool to generalize a population for correlated health outcomes or behaviors, yet for the individual, it’s pretty meaningless. BMI and growth chart percentiles do not give any information on body composition i.e., muscle mass, fat mass, bone structure, just simply their weight for their height. The healthcare system still uses this measure as a standard for data comparison, but it is not an evaluation of health status. “ In a 2016 study of more than 40,000 adults in the United States, researchers compared people’s B.M.I.s with more specific measurements of their health, like their insulin resistance, markers of inflammation and blood pressure, triglyceride, cholesterol and glucose levels. Nearly half of those classified as overweight and about a quarter of those classified as obese were metabolically healthy by these measures. On the other hand, 31 percent of those with a “normal” body mass index were metabolically unhealthy”1,5. This is one of many studies that highlights the misclassification of health in relation to BMI.   Unfortunately, while some are, many pediatricians may not be weight-sensitive or trained in eating disorders and the nuances of preventing them. Therefore, it is most important to actually understand the facts and advocate for a weight neutral approach to your child’s care. If weight is of concern to the doctor, seek professional advice from a registered dietitian, who will holistically evaluate your child’s needs, behaviors, and beliefs to guide you to take the appropriate next steps.   At the end of the day, it always comes back to this same question: “What can we as parents do to prevent disease?” This includes obesity-related disease. I recognize we need measurements for statistic purposes and possibly diagnostic tools. However, I think BMI should be emphasized less and instead we can focus on behaviors and a cluster of measurements.   As parents, healthcare facilitators and makers of change, we must remember that obesity does not always equate with overeating, high cholesterol and/or inactivity. Additionally, must remember that BMI is not a measure of self-worth. Rather, it’s merely one tool that aims to measure health—and a flawed tool at that4.   At LCWNS we are here to help guide you and your family toward size-acceptance, promoting confidence and self-esteem in our children. We propose to start with the following: Foster a positive opinion of food in the household. Feed your children a balanced intake of whole grains, lean proteins and heart healthy fats. Tell your children you love them. Have them look in the mirror and tell themselves they are loved. Tell them they are more than a number. Encourage healthy behaviors by setting an example. Focus on your children’s efforts and behaviors, not on outcomes or measures. Praise them for trying a vegetable or sport rather than for being a veggie eater or a great baseball player.     References: Callahan A. Is B.M.I. a Scam? The New York Times. https://www.nytimes.com/2021/05/18/style/is-bmi-a-scam.html. Published May 18, 2021. Accessed May 18, 2022. CDC. About Child and Teen BMI. Centers for Disease Control and Prevention. Published April 12, 2022. Accessed May 18, 2022. https://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html CDC. BMI for Children and Teens. Centers for Disease Control and Prevention. Published December 3, 2021. Accessed May 18, 2022. https://www.cdc.gov/obesity/basics/childhood-defining.html Laura Cipullo, RD | Too Much Weight on BMI. Accessed May 18, 2022. https://lauracipullo.com/too-much-weight-on-bmi/ Tomiyama AJ, Hunger JM, Nguyen-Cuu J, Wells C. Misclassification of cardiometabolic health when using body mass index categories in NHANES 2005–2012. Int J Obes. 2016;40(5):883-886. doi:10.1038/ijo.2016.17

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How Parents Influence Children’s Eating Habits

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Influencing Children’s Eating Habits: The Role of Parents By Rebecca Jaspan, MPH, RD, CDN, CDCES   As a parent, your children are always observing you.  Even when they are babies, they are noticing how you speak, eat, and look at yourself in the mirror.  You play an important role in shaping their eating behaviors and their relationship with food and body.  You also have a significant influence over the eating environment where your meals take place and the types of foods your children eat.  In the first five years of life, children develop the foundation of behaviors that shape their future eating patterns.   In these early years, children learn what, when, and how much to eat based on cultural and family beliefs, attitudes, and practices surrounding food.1  Parents play a vital role in structuring these early eating experiences, which have an impact on children’s relationship with food as they get older.   Research suggests that parents’ food choices make an impact even before the child is born.  Food the mother eats during pregnancy may set the stage for the baby’s acceptance of foods later in life.  Flavors from the mother’s diet pass through the amniotic fluid that surrounds the fetus.  One study detected smells and compounds of garlic, cumin, and curry in the amniotic fluid of pregnant women who consumed garlic capsules and spicy food.2 This research shows that fetal experience with different flavors can help familiarize the infant with a variety of different flavors and plays an important role their acceptance of different food.   The same sensory properties of amniotic fluid are seen in breast milk as well.  Breast milk may help facilitate the transition to an adult diet as many flavors the mother eats are found in breast milk.  One study looked at the impact of flavor in breast milk on infants’ acceptance and enjoyment of foods.  In women who drank carrot juice during pregnancy, their infants’ had increased acceptance and enjoyment of carrot flavor in infant cereal.3   As children get older, their eating patterns develop in early social interactions and caregivers play an influential role.  Parents are in charge of selecting the foods their children eat and they serve as models that children emulate.4 Children learn about food both through the direct experience of eating and by observing the eating behavior of others. In one study, children’s intake of new foods increased when they observed their teacher enthusiastically eating the food.5  While there is limited research on this same effect in parents, we can expect that modeling by parents would have a similar, if not stronger, influence on children’s food choices and preferences.1   Here are some tips that you can practice to positively influence your children’s eating habits:   Serve a variety of foods to your children and model eating all foods, everything from pizza to vegetables to ice cream, pending your own food allergies, medical conditions, or dietary preferences. Maintain the division of responsibility that you are in charge of serving your kids and they are responsible for eating. Research shows that excessive parental control over feeding, especially restrictive feeding practices, is associated with overeating and poor self-regulation of energy intake in children.6 Try to have regular meal and snack times and eat together as a family as often as possible. Speak neutrally about food and bodies rather than labeling anything as “good” or “bad”. Promote a positive eating experience by keeping meal conversation fun and light and speak about how delicious the food is or how it is providing nourishment.   Feeding children is certainly no easy task and the dietitians at Laura Cipullo Whole Nutrition are here for you!  We can help you with tips and tricks to make meal times easy and stress-free for you and your family so you can feel confident you are setting your children up to develop a healthy relationship with food.       References: Savage JS, Fisher JO, Birch LL. Parental influence on eating behavior: conception to adolescence. J Law Med Ethics. 2007;35(1):22-34. doi:10.1111/j.1748-720X.2007.00111.x Mennella JA, Johnson A, Beauchamp GK. Garlic Ingestion by Pregnant Women Alters the Odor of Amniotic Fluid. Chemical Senses. 1995;20(2):207–209. Mennella JA, Coren P, Jagnow MS, Beauchamp GK. Prenatal and Postnatal Flavor Learning by Human Infants. Pediatrics. 2001;107(6):88–94 Young EM, Fors SW, Hayes DM. Associations between Perceived Parent Behaviors and Middle School Student Fruit and Vegetable Consumption. Journal of Nutrition Education Behavior. 2004;36(1):2–8 Hendy H. Effectiveness of Trained Peer Models to Encourage Food Acceptance in Preschool Children. Appetite. 2002;39(3):217–225 Faith MS, Scanlon KS, Birch LL, Francis LA, Sherry B. Parent-Child Feeding Strategies and their Relationships to Child Eating and Weight Status. Obesity Research. 2004;12(11):1711–1722.            

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kosher bread for picky eaters

Tips For Feeding a Picky Eater- Kosher Edition

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Feeding a Picky Eater: Strategies for the Kosher Diet By Reva Schlanger MS, RD, CDN   Is your toddler refusing to eat anything other than chicken nuggets and pizza? While picky eating is common in children, following kosher guidelines can make feeding your child even more stressful. The inability to have milk and meat together (or milk right after eating meat) can lead to a limited repertoire of foods for a picky preschooler. That coupled with Shabbat, when families will go out to eat at friends’ houses can create added stress for both a child and a parent. Do not forget about Passover where bread and wheat products are off limits. While this can all seem daunting to tackle, with the right attitude and skills, your child will be able to grow her/his pallet to incorporate a variety of different nutrients despite any kosher restrictions. See below for a few tips on how to help feed a picky eater without burning yourself out in the process.   Do not give up! Every child is unique and will have different eating habits. If you have multiple children, try not to compare what each kid eats as that can cause more tension and angst for both you and your children. One of the main keys to helping a picky eater is to not stress! While easier said than done, it is important to remember that picky eating is very common among young children. Even if it feels that your kid will never enjoy fruits or vegetables, do not give up! Research shows that it can take eight to fifteen times to introduce a new food before you child will like it.  Gentle persistence can help rid a child’s resistance around a new food.   Be Creative Does your child struggle with dairy? Try to get creative and experiment with some nondairy alternatives. For instance, if your child dislikes milk or is lactose intolerant, try to find a milk substitute. Some parents have given their kids Ripple (a nondairy milk alternative make from pea protein) and have been successful. Add some chocolate syrup in it as well to enhance the taste! Is your kid iffy with produce? Once Upon a Farm has kosher fruit blends of different flavors in cute pouches.   Perhaps your kid loves cheese and thus struggles with eating meat. Nondairy cheese alternatives can help spice up a burger and ensure that the laws of Kashrut are being followed. If you kid enjoys having pancakes for breakfast, try adding one or two veggie sausages for added protein- Morning Star makes a lot of vegetarian alternatives that are kid friendly. Of Tov makes chicken nuggets in fun shapes which you can decorate with some cut up veggies!   Stay Positive Try and make mealtimes a fun and positive experience. One of the most important things is to try and hide your frustration. Praise your child when he eats well or tries something new. You may need to ignore some bad eating behavior to refocus attention on good behavior. If tension is high at mealtime, try to relieve it by playing a game or telling a joke. If at the Shabbat table, the game Headbandz can be fun to play as a family. Another idea is to read the jokes from laughy taffy wrappers – they are usually kid friendly jokes and might incentivize your kid to try some food before having post Shabbat lunch candy!   Make Food Fun!  At the grocery store, ask your child to help you select fruits and vegetables. Allow them to pick some foods they enjoy while also picking out 2-3 new special foods to try. When deciding what to cook for Shabbat, have your kids have a say in what to make. Looking through cookbooks together can help open their eyes (and hopefully soon pallets) to new and exciting foods.   At home, encourage your child to help you crack eggs and knead the challah dough. Ask them if they enjoy any toppings on their challah- if you child enjoys sweets try making a cinnamon and sugar crumb topping or adding some dark chocolate chips to the dough. If you make cholent for Shabbat, try having your kid wash the produce and pour the barley into the crock pot. This can help a child feel more inclined to try a new food.     Stay Consistent Consistency is key for helping your child develop a more extensive pallet. Serve meals and snacks at about the same times every day. If your child chooses not to eat a meal, a regular snack time will offer an opportunity to eat nutritious food. You can provide milk or 100 percent juice with the food but offer water between meals and snacks. Allowing your child to fill up on juice, milk, or snacks throughout the day might decrease his or her appetite at meals.   Try as best as possible to continue these set times even on the weekends. Try to have your kid wake up in the same time frame so he/she can get all meals and snacks in. If going out for lunch on Shabbat, call ahead of time to see what they will be having. This can help you decide if you need to bring over any food so that they do not sit at the table hungry. Try not to let your child fill up on challah and grape juice as that will surely ruin their appetite for the meal! Always keep snacks in a bag just in case the meal runs late and goes through snack time. If your kid is having a playdate on Shabbat, try to have the playdate at your house to provide snack time for all the kids.   Be Organized  Make a list of familiar and unfamiliar foods to add to your cart on the next grocery trip. Try serving unfamiliar foods or flavors young children tend to dislike at first, with familiar foods toddlers naturally prefer. Think

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pregnant woman with gestational diabetes

What is Gestational Diabetes and What Should I Expect?

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Understanding Gestational Diabetes: Management and Expectations By Paige Mandel, MS RD CDN   In a time of so much change and unpredictability (and yes, lots of excitement too!) the thought of a gestational diabetes diagnosis may feel scary or daunting for many mama’s and mamas-to-be.  We are here to calm your nerves and empower you by giving you the facts of what to expect and how to manage it. What is Gestational Diabetes? First, what is it? Most simply stated by the CDC, “gestational diabetes is a type of diabetes that can develop during pregnancy in women who don’t already have diabetes”1. Most often, gestational diabetes goes away after pregnancy, but it remains important for you and your baby’s blood sugar to remain monitored following delivery. The key hormone involved in diabetes of all types is insulin.  Insulin is a hormone produced by the pancreas that guides the sugar molecules in your blood into your cells to use as energy. The hormonal changes that occur during pregnancy can cause your body to become more insulin resistant, meaning your body needs even more insulin to do its normal job of facilitating the blood sugar into your cells1. With gestational diabetes, your body may not be able to keep up with the insulin production, and/or your insulin resistance is so high that your body cannot stabilize to normal blood sugar levels2.   How to Tell If You Have Gestational Diabetes Second, how do I know if I have it? For the most part, there are not really signs and symptoms of gestational diabetes as there are with Type 1 and Type 2 Diabetes. Therefore, gestational diabetes is screened for towards the end of the second trimester between 24-28 weeks1,2. In the US, gestational diabetes is most commonly screened for via the glucose tolerance test, otherwise known as GTT, OGTT or glucola2. This is a one to two-part test depending on your results. First, you are instructed to drink 50 grams of glucose in the form of a drink provided by your practitioner, non-fasted, and your blood sugar is measured one hour after consumption. If you “pass” this test, you do not meet the criteria for gestational diabetes, and your blood sugar response to the glucose load was within normal range. If you “fail” this screening, you return back to your doctor for a diagnostic test, which involves drinking 100 grams of the glucose drink (double the amount used for the initial screening test), and measuring your blood sugar response fasting, after 1 hour, after 2 hours and after 3 hours2. Interestingly, the US is one of the only countries that uses this two-step process for diagnosis, nearly all developed countries aside from the US recommend a one-step method of drinking 75 grams of glucose and measuring blood sugar at fasting, after 1 hour and after 2 hours, with any elevated reading indicating a positive diagnosis2.   How to Treat Gestational Diabetes Third, what do I do if I get a positive diagnosis? The answer in short, is optimize blood sugar regulation. For some women, following a moderate carbohydrate diet is effective in maintaining normal levels, while others may need additional insulin to get these numbers down. While these recommendations are especially important to women diagnosed with gestational diabetes, every pregnant woman should have blood sugar regulation in mind for most optimal outcomes as the fetal production of insulin is in response to maternal blood sugar. Lifestyle factors strongly impact the body’s utilization and thus maintenance of blood sugar. From a dietary perspective, the key nutrient to pay attention to is carbohydrates, as carbs have the strongest impact on your body’s blood sugar and insulin response. In addition, it is the combination of foods, often referred to as “mixed meals”, that can affect how quickly and how high your blood sugar rises after eating. This means, a meal with moderate carbohydrates paired with a protein and/or fat will have a lower glycemic response, aka slower rise in blood sugar, that the carbohydrate meal on its own.  A 2009 research study found “ using a low–glycemic index diet for women with GDM effectively halved the number needing to use insulin, with no compromise of obstetric or fetal outcomes”2,3. It is essential to consider this as only PART of the treatment, keeping in mind this is not something you did or could completely control, it is not a perfect science. Moderate carbohydrates, carbohydrate counting, and mixed meals may help regulate your blood sugar response, in addition to moderate movement daily movement such as brisk walk after meals, but some women need insulin for further regulation as well. This does not make you or your body a failure, it just means you need more support. If you have history with disordered eating or an eating disorder, it is recommended to work with a dietitian and medical team before making any modifications to the diet, as an adequately nourished mama is most important. To monitor your blood sugar levels throughout the day, your doctor will most likely recommend using a glucose monitor and tracking before and after meals in order to determine how to best keep your you blood glucose in the safe ranges. The American College of Obstetricians and Gynecologists (ACOG) recommends blood sugar below 95 mg/dL before meals, below 130mg/dL 1 hour after eating, and below 120 mg/dL 2 hours after eating4. Your doctor might recommend different blood sugar targets, based on your individual response, therefore it is most important to consult and follow the ranges provided by your doctor.   Lastly, we are often asked “is this preventable?”. The real answer to this is both yes and no. Many women are genetically predisposed and thus at a higher risk of developing gestational diabetes, in which case lifestyle factors such as adequate nutrition, a diet balanced with carbohydrates, protein and fat, moderate exercise, and “healthy lifestyle” cannot reverse—but they can make management easier. For others, these lifestyle modifications both before and during conception could

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mother teaching daughter how to cook with a healthy relationship to food

5 Tips for Helping Your Child Have a Positive Relationship With Food

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5 Essential Tips for Promoting a Positive Food Relationship in Children By Rebecca Jaspan, MPH, RD, CDN, CDCES   We are all born intuitive eaters.  Babies cry when they are hungry and tell you when they are full by unlatching from the breast or bottle, moving their head away from their spoon, or going to play. As we get older, many of us lose our abilities to eat intuitively.  This may be due to overriding hunger and fullness cues, hearing adults speak about food in negative ways, and exposure to confusing messages about what we should or shouldn’t eat.  We also live in a society that values thinness and equates a small body with a healthy one.  It is no wonder that so many adults develop disordered eating behaviors and a negative relationship with food.   The good news is there are many ways you can help your kids have a positive relationship with food.  As parents, you have a lot of influence over the way your kids view food and their bodies and you can help them make food one part of their life that is associated with joy, rather than a source of preoccupation and obsession.  Here are five tips to help your child develop a positive relationship with food and a lifetime of stress-free eating.   Start young Since your child is born an intuitive eater, you can capitalize on that from the start and help them maintain those innate cues as they get older. You can help them maintain their natural hunger and fullness cues and trust in their bodies by using a responsive feeding approach.  When your baby starts solid foods, you can let them feed themselves with a method called baby led weaning.  You can also take a responsive approach if you are feeding purees with a spoon.  Watch your baby’s cues for when they are showing signs of being full and satisfied.  They may start moving their mouth away from the spoon, flail back in their seat, or become fussy.  Honor these cues rather than forcing them to eat more if they are no longer interested.  Here is another resource with tips for giving your child more autonomy at the dinner table.   Use neutral language about food The language children hear you use around food is extremely influential.  We want kids to know that all foods have a place in our diets and we can eat all foods in moderation.  Notice if you are labeling any foods as “good” or “bad”.  It is important for children to understand that we are not “good” for eating vegetables or “bad” for eating cookies.  Labeling foods can cause feeling guilty for eating less nutritious foods and could even lead to hiding food or overeating certain foods that are viewed as “bad” when they are offered.  Instead, try to focus on what the foods do for our bodies and mind.  For example, try statements like “eating yogurt gives us strong bones” or “baking cupcakes together is so much fun!”.   Use non-food rewards If you are begging your kids to eat more vegetables or needing a consequence for bad behavior, it may be tempting to reward with or takeaway treats.  Food used as rewards or withheld as punishments teaches children to attach certain emotions to food, rather than viewing the food neutrally.  It also sends the message that some foods are more desirable than others and they can expect certain types of foods when they do something well.  Try rewarding kids with stickers, toys, doing a fun activity with you, or playdates with friends.   Set a positive example Kids are very observant and they model your words and behaviors.  They will likely pick up on the way you speak about your own food and body and other people’s bodies.  Try to avoid speaking negatively about your own body and other people’s bodies.  Celebrate what bodies can do by teaching what certain organs do to keep us alive or pointing out strength or flexibility, taking the focus off of body shape and weight.  Here are some additional tips for focusing on other measures of health beyond weight.   Eat meals together Just like kids pick up on the way we speak about bodies, they will also observe behaviors around food.  And what better time to set a positive example around food than family meal time.  If they see you are relaxed around food, they will be too.  Keep meal time conversation light and fun and let children enjoy all foods equally, from vegetables to dessert.

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pregnant woman with healthy thyroid hormones

Thyroid Hormones and Miscarriage Risk

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Thyroid Hormones and Miscarriage Risk: Essential Insights for Expectant Mothers By Rebecca Jaspan, MPH, RD, CDN, CDCES   Among a number of recognized causes of miscarriages, thyroid disease is a common one and often goes undiagnosed.  Thyroid hormones are essential for the growth and development of the fetus.  The mother supplies the fetus with thyroid hormones.  If she has hypothyroidism, or inadequate amounts of thyroid hormone, she cannot supply enough to the growing fetus and is therefore at risk for a miscarriage.1   Thyroid Hormones and Their Role in Miscarriage   Thyroid hormone imbalances and disease are often seen in women of reproductive age.  Any thyroid dysfunction causes disturbances in human reproductive physiology and may reduce the likelihood of pregnancy and adversely affects pregnancy outcomes.  It is estimated that 8-12% of all pregnancy losses are due to endocrine factors.  Thyroid disease is present in 4% of women of reproductive age and up to 15% of women are at risk for miscarriages because they may be thyroid-antibody positive.2   What are the hormone levels to look for?   Thyroid-stimulating hormone, or TSH, plays a role in miscarriage.  The risk of miscarriage increases as TSH increases.  A normal TSH level is .2-2.5mU/L.  One study that looked at women with hypothyroidism found that women with TSH of 4.5-10mU/L had 1.8 times more chance of miscarriage compared to women with normal TSH levels during early pregnancy.  It was also noted that women with TSH levels of 2.51-4.5mU/L did not have an increased risk of miscarriage.3   While there is not yet enough evidence for direct causality and more research needs to be done in this area, it is known that thyroid disease is related to unexplained infertility and implantation failure.  Existing and poorly controlled hyper- or hypothyroidism are also associated with infertility and miscarriage.  Even mild hypothyroidism shows increased rates of miscarriage and may also have adverse effects on the cognitive development of the fetus.4  Additionally, excess thyroid hormone increases the risk of miscarriage.5   When a woman becomes pregnant, significant changes occur in the thyroid gland including changes in iodine metabolism, serum thyroid binding proteins, and potential development of goiter, which is an irregular growth of the thyroid, in the mother.4  There are also immunologic changes that occur during pregnancy.  Thyroid peroxidase antibodies may rise and research shows that they are present in 10% of women at 14 weeks gestation.  This is associated with miscarriage, increased incidence of gestational thyroid dysfunction, and predisposition for postpartum thyroid dysfunction.6   Screening for Thyroid Problems   At the current time, there are no recommendations for routine screening of thyroid abnormalities. However, if you are at risk for thyroid disease, it is recommended to speak with your doctor about checking your thyroid function and testing your blood for thyroid hormone and antibody levels.  Additionally, if you feel you have symptoms of hyper- or hypothyroidism, ask your doctor about testing.  If you have been treated for hyperthyroidism in the past with radioactive iodine treatment or surgery, make sure to alert your doctor to this as well, as your body will still produce antibodies that could affect the baby.   Treatment of Thyroid Problems and Miscarriage Prevention   Treatment for thyroid conditions is typically correcting for over or underproduction of thyroid hormones with medication.  Levothyroxine is used for hypothyroidism to replace thyroid hormones and methimazole is used for hyperthyroidism to reduce excess hormone levels.  These medications are considered safe to take throughout pregnancy.  Your thyroid hormones will be monitored throughout pregnancy as changes in hormone production often cause women to no longer need medication by their third trimester.  There are also limited studies showing that giving the hormone thyroxine may be effective at preventing miscarriage when given in the early stages of pregnancy.2   While it is difficult to know if a thyroid problem caused a previous miscarriage, if you are aware of a thyroid problem, it is a good idea to explore the condition with your doctor and manage it well before getting pregnant again.       References: Rao VR, Lakshmi A, Sadhnani MD. Prevalence of hypothyroidism in recurrent pregnancy loss in first trimester. Indian J Med Sci 2008;62:357-61. Sarkar D. Recurrent pregnancy loss in patients with thyroid dysfunction. Indian J Endocrinol Metab. 2012;16(Suppl 2):S350-S351. doi:10.4103/2230-8210.104088 Vol 7 Issue 12 p.3. American Thyroid Association. Kennedy RL, Malabu UH, Jarrod G, Nigam P, Kannan K, Rane A. Thyroid function and pregnancy: Before, during and beyond. J Obstet Gynaecol. 2010;30:774–83. https://www.uptodate.com/contents/recurrent-pregnancy-loss-definition-and-etiology Abbassi-Ghanavati M. Thyroid autoantibodies and pregnancy outcomes. Clin Obstet Gynecol. 2011;54:499–505.    

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The Relationship between Eating Disorders and Pregnancy

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Eating Disorders and Pregnancy: Understanding Their Complex Relationship By Reva Schlanger MS, RD, CDN   Pregnancy is a time filled with angst and excitement. While there is a lot of information out there on ways to conceive and guidelines around pregnancy, there is not as much information on the relationship between eating disorders and pregnancy. A common misconception is that those actively in an eating disorder will not be able to conceive. This, however is untrue as there are many studies noting the relationship between eating disorders while in pregnancy. Current evidence suggests that eating disorders play a significant part on pregnancy, pregnancy outcome, and infant outcomes.14 Many have a chronic course, and result in psychiatric and medical comorbidities for both mothers and their offspring. The literature on the relationship between maternal eating disorders and pregnancy indicates a decrease in eating disorder symptoms during pregnancy, followed by a revival when in postpartum. Here we will review the current scientific evidence on the effects of pregnancy on eating disorder symptoms, the effects of eating disorders on pregnancy, and the effects eating disorders have on pregnancy outcomes.   Do Eating Disorders Affect Fertility?   Eating disorders affect 5-7% of women of child-bearing age, leading to many women managing pregnancy with an eating disorder.1 The onset of these disorders is typically in adolescence or young adulthood, a critical phase of a woman’s reproductive life. Eating disorders have important impacts on the endocrine system including a decrease in hormone production, especially in women with anorexia nervosa. While this accounts for reduced fertility in women with severe and active anorexia nervosa, recent advances in fertility treatment make it possible for women with eating disorders to still conceive. Two small studies have found a high rate of eating disorders in women attending fertility clinics, (approximately 10%).2,3 Women with anorexia nervosa seem to have lower rates of pregnancy in the long term, though there are inconsistent findings in the existing literature.4,5 It is important to note that many women with a past or current eating disorder do become mothers of healthy children.   Research has shown that fertility problems appear to be less frequent in women with bulimia nervosa, compared with women with anorexia nervosa. Important to note that there is more information on the relationship between fertility and anorexia than with bulimia. However, it is suggested that women with bulimia nervosa are more often at a normal weight and have regular menstrual cycles leading to more consistent ovulation.6 To have a better understanding of fertility and bulimia nervosa, there needs to be more research/literature on the topic.   Effects of Pregnancy on Eating Disorder Symptoms   Few studies have investigated the patterns of eating disorder symptoms during pregnancy. The current literature on healthy pregnant women indicates a more positive attitude to weight and body image during pregnancy.9,10 However this might not apply to women who have concerns about shape and weight pre-pregnancy, including women with eating disorders. On a positive note, research focusing on the course of eating disorder symptoms in women with active bulimic disorders during pregnancy shows an improvement in bulimic symptoms.  Few women, however, reported a complete cessation of symptoms and behaviors during pregnancy. Results from a large Norwegian cohort showed similar patterns of remission for a sample of women with bulimia nervosa while pregnant.12 Fewer studies have investigated symptom changes in anorexia nervosa; however, one of the above studies showed a smaller decline in symptoms compared to bulimia nervosa. Despite the reported decrease in eating disorder related behaviors during pregnancy, weight concerns and body dissatisfaction remained prevalent. Therefore, it is important to seek help from a team of eating disorder professionals as well as maternal-fetal medicine specialists.   Effects of Eating Disorders on Pregnancy Outcomes   Despite the variable quality, size and nature of samples, most studies on the effects of active or lifetime eating disorders suggest an increased risk of adverse obstetric and pregnancy outcomes. Higher levels of prematurity have been reported in three studies of women with lifetime or current anorexia nervosa, with an approximate two-fold increase in risk.4,5 Most studies have highlighted lower birthweights in samples of infants born to women with active or lifetime eating disorders, particularly in the case of children born to mothers with active or life-time anorexia nervosa. One study published has researched the obstetric outcomes of women with binge eating disorder (BED), and results suggest an increased risk of large-for-gestational-age offspring in this group of women.14 There is also convincing evidence for an approximate two-to-three-fold increase in risk of miscarriage secondary to maternal active bulimia nervosa.7,12 In two small studies on the outcome of pregnancy in a sample of bulimic women, a higher than expected number of fetal complications (breech presentation, caesarian delivery) were found in women with active bulimia nervosa.8,11   Several studies, suggest that the postpartum period is a high-risk period for the recurrence or exacerbation of eating disorder symptoms. Most of the studies that have investigated the postpartum period to date have shown that most women whose symptoms decreased during pregnancy, relapsed, or returned to pre-pregnancy behaviors after giving birth.11,14 In particular, a study of 94 women with active bulimia nervosa, found that in more than half of the sample, bulimic behaviors were more severe in the postpartum period than pre-pregnancy. Some studies have investigated other psychological symptoms in this population, mainly focusing on depression. Women with current and/or past eating disorders have high rates of postnatal depression; over 30% across studies.7,14   Patients who report having an eating disorder should be offered an in-depth assessment of the type and severity of symptoms present. Research has shown that most women with eating disorders will be motivated to change their disordered behavior or will have lower levels of symptoms during pregnancy. However, a small portion of patients may still have eating disorder behaviors or be ambivalent about the need to change these behaviors in pregnancy. This is likely driven by the importance placed upon controlling weight, shape, and appearance, which is

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Nutrition Basics for Pregnancy

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Nutrition Basics for Pregnancy: A Guide for Nourishing Both Mother and Baby By Paige Mandel, MS RD CDN   “The message that a mother’s nutrient intake during pregnancy affects the development of her baby is well accepted across multiple nutrition philosophies and among traditional cultures”1. While this is true, this also puts an immense amount of pressure on a mother, especially a first-time mom or a mom who has struggled with her own relationship with food. As mentioned in our previous blog, while this is an exciting time, it is also a time when you are facing many physical, mental, emotional changes, that can make it hard to know what is best. You are not expected to have all the answers, especially with how crowded the nutrition space is on social media for mamas-to-be. Our dietitians at Laura Cipullo Whole Nutrition are here to support you and your needs, as well as educate you on how to adequately nourish yourself and your growing baby in a way that best fits your lifestyle and preferences. It is most important to recognize and note, that our society has created a “standard” process for pregnancy guidelines. Yet, it is really most essential (and will serve both you and your baby best) for you to tune into your own needs and requirements physically and mentally.   Top 5 FAQ’s:     Should I “Eat for Two”?1 In short, no, not necessarily, as this is a common myth. Many people assume that as soon as you become pregnant your nutrition needs double, and you have to “eat for two”. Research tells us that caloric needs do not increase for the mother to support the fetus until the second trimester.2 An additional 340 calories per day are recommended starting in the second trimester (that’s roughly the calorie count of a glass of skim milk and half a sandwich)3. “Women carrying twins should consume about 600 extra calories a day, and women carrying triplets should take in 900 extra calories a day”2. An additional 450 calories more per day is recommended in the third trimester.   What Foods Should I Limit or Avoid? Many women who are pregnant have had the basic knowledge of what foods to avoid: soft cheeses, unpasteurized milk, raw seafood, undercooked meat and poultry, eggs with runny yolks/raw eggs, and deli meats1,4. Yet, many do not know why these common foods make the “no, no” list. Ultimately, it is for food safety reasons. This is because during pregnancy, your immunity is slightly decreased, making you more susceptible to food poisoning, which could lead to further complications in pregnancy1.  Due to the fact that strictly cutting out all of these foods leaves you with less options to meet your nutrition needs, it is most important to understand that it is in the prep that is the key. At LCWNS, we always encourage our clients to find the shade of gray, to challenge the black and white thinking. The same holds true for the “foods to avoid” list in pregnancy. You could safely eat many of these foods with more mindfulness in the way they’re prepared:4 Food to “Avoid” How to Safely Eat Raw seafood Fish cooked to 145 degrees F Unpasteurized milk Pasteurized versions Soft cheese and cheese made from unpasteurized milk (brie, camembert, blue cheese, gorgonzola) Hard cheese and cheese made with pasteurized milk (American, cheddar, pepper jack, mozzarella, muenster, provolone, swiss, gouda, parmesan, cottage cheese or any other cheeses (cow, goat, sheep) made using pasteurized milk5) Undercooked eggs Eggs with firm yolks Premade deli salads Make these dishes at home i.e, chicken salad, tuna salad Deli Meats Reheat to steaming hot or 165 degrees F Undercooked Meat and Poultry Cook well done, at or above USDA internal temp.   How to Handle Nausea and Food Aversions? It can be extra challenging to meet your nutrition needs when you are experiencing morning sickness or nausea throughout your pregnancy. Our biggest piece of advice- be your own detective and be curious if there is a trigger to your nausea. You may benefit from smaller more frequent meals versus a more standard 3 meals a day with snacks, to prevent you from getting too hungry or overfull. If you need to opt for more bland foods such a toast, try your best to incorporate even a small portion of protein or fat (i.e., nuts, cheese, Greek yogurt, avocado, scrambled eggs) to avoid a blood sugar spike1. You can try things like smoothies or smoothie bowls if a liquid, cold texture is more tolerable to your palate that solid foods, plus a good way to sneak in some extra nutrients or greens without flavor. It is ok if all you can tolerate is plain carbs. This won’t be the last time you hear this- fed is best. Cravings and aversions can come with guilt and self judgement, do your best to practice self-compassion and remember this will pass.   How Much Weight Should I Gain? This question comes with lots of controversy. As mentioned earlier, our society has created what feels like a standardized process, that feels very controlled and leaves little room for deviation from the “norm” without red flags raised. Medical doctors may mention your rate of weight gain in your visits, this is your reminder that it is most important to listen to your body and your needs, nobody knows your body better than you. While there are “weight gain guidelines” that exist, published by the CDC from the Institute of Medicine, these are simply broad ranges and average recommendations. “If before pregnancy you were, you should gain”6 Underweight:28 to 40 pounds Normal:25 to 35 pounds Overweight:15 to 25 pounds Obese:11 to 20 pounds For twins, the recommendations naturally go up: Normal:37 to 54 pounds Overweight:31 to 50 pounds Obese:25 to 42 pounds   In fact, these standards differ widely around the world, in some countries they do not use weights as any parameter. It is most important to consult with your doctor, dietitian

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Supplements for Pregnancy

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Essential Supplements for a Healthy Pregnancy: A Comprehensive Guide By Paige Mandel, MS RD CDN If you are pregnant or trying to conceive (TTC), one of the first (of many) questions you may ask your doctor and/or dietitian is “what supplements should I take?”. Meeting nutritional requirements is at the utmost importance during this time, as deficiencies can affect both maternal and fetal health. At Laura Cipullo Whole Nutrition, our dietitians are here to help you learn, understand and meet your perinatal nutritional needs through food, as well as recommend supplements when and where necessary to fill any nutritional gaps that food alone won’t fulfill.   While we will always recommend to consult with your medical doctor first, our most standard supplementation recommendation is a prenatal vitamin and DHA. Some prenatal vitamins will contain DHA, if not, additional supplementation is most recommended. It is important to review your bloodwork with your medical team and discuss any dietary restrictions you adhere to, in order to screen for additional specific nutritional deficiencies that may require further supplementation.   What should I look for in a prenatal vitamin? The American College of Obstetricians and Gynecologists outlines the key nutrients of focus for pregnancy to be “folic acid, iron, calcium, vitamin D, choline, omega-3 fatty acids, B vitamins, and vitamin C”.1   *These values are general recommendations, it is most important to consult your OBGYN and medical team to review your blood work to assess your individual needs. Higher or lower doses of certain nutrients might be suggested by your health care provider for supplementation depending on circumstances and medical history*   Folic acid: at least 400 micrograms (pregnant mamas actually need 600 micrograms each day- you will get some but not enough from diet, so your prenatal vitamin should have at least 400 mcg and up to 800) Folic acid is B vitamin that has been studied to help prevent birth defects of the fetus’s brain and spine called neural tube defects (NTDs), and supports the general growth and development of the fetus and placenta. “When you are pregnant you need 600 micrograms of folic acid each day. Because it’s hard to get this much folic acid from food alone, you should take a daily prenatal vitamin with at least 400 micrograms starting at least 1 month before pregnancy and during the first 12 weeks of pregnancy”.1 Iron: 27 milligrams1 Iron helps red blood cells deliver oxygen to the fetus. This is the general recommendation for iron needs, consult with your OBGYN to review your labs, as needs may be higher in individuals with iron deficiency anemia, suggesting further supplementation. If you are experiencing any symptoms of vertigo, this could be indicative of your iron levels being too low, have your doctor check your levels.2   Calcium: 1,300 milligrams for ages 14 to 18; 1,000 milligrams for ages 19 to 501 Calcium is helps support the growth of your fetus’s bones and teeth. It is not essential for your prenatal to contain 100% of your calcium needs, as it is one of the easier minerals to meet needs through the diet. Milk and dairy products such as cheese and yogurt at optimal sources. If you have intolerance to dairy or adhere to a dairy-free diet, consult with your dietitian to discuss other sources of calcium to determine need for supplementation.   Vitamin D: 600 IU Vitamin D helps promote healthy eyesight and skin as well as supports (with the help of calcium) the building of your fetus’s bones and teeth. Generally, all women require at least 600 IU/day of vitamin D. Vitamin D levels are often low in many individuals, therefore further supplementation may be indicated above this value.   Choline: 450 milligrams Choline contributes to your fetus’s brain development, yet is not often found in many prenatal vitamin brands. Brands that do contain choline: Honest, Ritual. Choline needs are more easily met through the diet (chicken, beef, eggs, milk, soy products, and peanuts)1.     What about DHA?   Docosahexaenoic acid (DHA), is an omega-3 fatty acid essential for the growth and functional development of the brain in infants3. “Several studies confirmed the benefit of omega-3 supplementation during pregnancy in terms of proper development of the brain and retina”4, as DHA is a “major structural fat in the human brain and eyes, representing about 97% of all omega-3 fats in the brain and 93% of all omega-3 fats in the retina”5.   To optimize pregnancy outcomes and fetal health, consensus guidelines have recommended that pregnant women consume at least 200 mg of DHA per day6.   If your prenatal vitamin does not contain DHA, it is recommended to additionally incorporate a prenatal DHA supplement, also referred to as fish oil, with a dosage of at least 200 mg.   LCWNS clients have successfully used and reviewed Honest Prenatal DHA and Nordic Naturals Prenatal DHA as brands they continue to use and tolerate in their pregnancies. Note, this is not sponsored, and we always recommend consulting with your medical doctor and team before beginning any supplementation to ensure it is best for your individual needs.     When should I start taking them?   Ideally, you begin taking a prenatal vitamin at least one month before conception. If you are a woman of reproductive age, it is generally safe to begin finding a prenatal vitamin long before trying to conceive to find one you best tolerate and adjust to taking a vitamin consistently, daily. Due to the fact that the baby’s neural tube, which becomes the brain and spinal cord, develops during the first month of pregnancy, it is essential to begin any necessary supplementation with folic acid and the other key nutrients discussed if not before, as soon as you are aware you are pregnant7. It is important to take only the recommended dose of a prenatal vitamin and avoid taking excess of your daily needs. Higher doses not medically indicated could be harmful to your baby.     Resources Nutrition During

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