Dispelling nutrition myths, ranting, and occasionally, raving


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How pregnancy has made me confront my own weight bias

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Two months to go! Photo credit: Randall Andrews

I have a confession to make and I’ve gone back and forth about whether or not to write about it because I’m not proud of this. However, I’m taking a deep breath and going for it because I think that it’s important to acknowledge these things.

During the first trimester as I started to gain weight but wasn’t yet obviously pregnant I found myself struggling with the thought that people might think I was *gasp* fat. As someone who has always had a small body I have lived a life rich in thin privilege. Despite my support of HAES and firm belief that people should not be judged by their weight I realized that I wasn’t comfortable extending this mindset to my own body. My body is small, my body has always been small, and therefore, my body should remain small. It’s great for other people to accept their own larger bodies but I, I am ashamed to admit, am not willing to accept that my own body could be anything other than small.

When I would go running at the local indoor track, as my clothes became a little tighter around my belly, I imagined people thinking “good for her, trying to lose weight”. I also imagined people who knew me thinking “looks like she’s not running as much these days”. or passing other judgements on my physique. I was pissed at these people for judging my body. I wanted to wear a sign to tell the world that my imperceptible weight gain was due to the fetus growing inside of me, not because I’m incapable of taming my unruly body. And then I was ashamed and disappointed in myself for not extending the courtesy of body acceptance to my own body as it changed. I was also ashamed because this was how I envisioned others thinking about strangers bodies. Do people really pass these judgements on each other? On themselves? Why did I care what people were (or weren’t) thinking about my body? How have I allowed so much of my identity to be tied to my size? And how self-absorbed of me to presume that others are spending any time judging my body – given the number of people who expressed surprise upon learning I was pregnant when I thought it was pretty obvious people are not nearly as attuned to my body as I imagined. 

As my belly grew and it became more obvious that it contained a tiny human and not just one too many cheeseburgers I became physically less comfortable but mentally more comfortable. People started to compliment me on my “adorable bump”. It feels good to have an acceptable larger body but I’m still carrying that extra guilt around too. It’s not right that women in larger bodies should be shamed while I’m praised for my belly. I truly have no more control over the shape and size of my “bump” as this fetus grows inside me than I have over my height or the size of my feet. 

I truly believe that we do people, particularly women, a disservice by not talking more about how our bodies change over time. It’s as though we all expect to reach a certain size and then remain there permanently. This is not realistic. Our sizes and shapes changes over time for myriad reasons. This is part of being a human in possession of a body. Some people may remain a similar size and shape for decades while others will evolve by the season (winterspeck anyone?). This is all natural.

As I previously wrote, women don’t need to “get their bodies back” after pregnancy. Our bodies have not gone anywhere, they have simply adapted to meet current demands. My new philosophy (during pregnancy and postpartum): my body is going to be the size it wants and needs to be right now.


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What to eat when you’re pregnant

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By now you may be aware that I’m pregnant. This is great news both personally and for more blog material – apologies if prenatal nutrition is of no interest to you. Now that the word is out, I feel comfortable sharing some of my observations.

First off, take the nutrition advice from apps with a grain of salt. These were likely not developed by registered dietitians and may not contain the greatest information. Aside from those, you might be getting your nutrition recommendations from prenatal classes which you would think would be better but I wasn’t super impressed with some of the information provided in the online class that I did (here’s hoping the in-person class is better!).

The general advice is fine: this is an important time to be getting adequate nutrition as, though technically not, the fetus is pretty damn close to a parasite. It’s going to deplete you of all of your iron and calcium stores if you don’t makes sure you’re consuming enough to replenish them. However, I took exception to some of the outdated advice I saw in the class I completed.

There’s a section on gestational diabetes which is followed-up by the section on prenatal nutrition. In this section there’s a sample meal plan which is whack for anyone, let alone a pregnant woman who is concerned about developing gestational diabetes. Highlights include breakfast: toast, oatmeal with banana, jam, and a glass of milk; snack: vanilla yoghurt and dried apricots; bedtime snack: frozen yoghurt. Hello blood sugar spikes! And I mean honestly, who eats toast and oatmeal for breakfast? Get some damn protein in there (nut butter, nuts, seeds, eggs…). And that snack, smh. Plain or no sugar-added yoghurt with berries would be a better choice or there are loads of other nutritious snack options that don’t contain sugar. I thought we’d moved past recommending frozen yoghurt like a decade ago. It’s generally higher in sugar than ice cream and not nearly as nutritious as regular un-frozen yoghurt. Which leads me to the swap suggestions.

There was a page of “if you’re craving this, try that”. Not that there was anything wrong with the suggestions (things like pretzels instead of potato chips and a grilled chicken burger instead of a regular beef burger) but I’m of the mind that you should listen to your body and give it what it wants. There is nothing wrong with having some chips or a burger when you’re pregnant, or when you’re not. And then there was that freaking frozen yoghurt again! I saw ice cream and groaned and said to my boyfriend, “how much do you want to bet they’re going to say to have froyo instead?” Wisely, not a bet he was willing to take as, of course, it was frozen yoghurt.

At one point they advised to “avoid foods with chemicals” which is meaningless and completely unhelpful advice. All food is comprised of chemicals.

I also wish that they had acknowledged the food aversions, cravings, and nausea/vomiting that many pregnant women experience. For women who are experiencing severe “morning” sickness it can be better to eat what they can stomach when they can stomach it. You can tell women to eat lots of vegetables, fish, and whole grains but if these foods aren’t going to sit well with them then that advice is not helpful. Women who require advice beyond that provided in the online class should ask their doctor for a referral to see a Registered Dietitian. Those living in Ontario can also call Telehealth Ontario at 1-866-797-0000 Monday-Friday 9-5 to speak with a RD for free.

There should also be recognition that listening to our bodies and our hunger and fullness cues is important. If you want ice cream, eat some ice cream. And if you want frozen yoghurt (to each their own), eat some froyo. Just like you’ll learn when it comes time for infant feeding, you should trust yourself and trust your tummy.


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If men got pregnant…

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Today I just want to rant a little bit about the patriarchy and research, particularly in relation to mothers and pregnant women. You’ve likely all heard about the difference between men and women when it comes to heart attacks, leading to missed diagnoses in many women, and how most drug trials are done using men so that we have very little evidence regarding the efficacy and side effects of many medications on women across their lifespan.

Then you see results of studies like this one which, despite the cognitive effects of alcohol consumed during breastfeeding no longer being evident when children are 10 years of age, provides the message that breastfeeding women should not consume alcohol. This despite the fact that alcohol is removed from breastmilk at the same rate as it is from the bloodstream. This means that while pumping and dumping is an ineffective measure to prevent infants from consuming alcohol via breastmilk that mothers can still safely consume alcohol and breastfeed provided they allow for adequate time for alcohol to clear from the milk. If you’re a breastfeeding mum, you can use this table to determine how long you’ll need to wait after drinking before you can breastfeed your baby (unfortunately, it might be longer than you would think).

Women who are of childbearing age are often told not to consume alcohol at all. Just on the off chance that they might get knocked up and damage the fetus before they realize that they’re pregnant. Women who are pregnant should definitely never consume any alcohol at all because their baby might end up suffering the effects of Fetal Alcohol Spectrum Disorder (FASD). And yet, many perfectly healthy babies are born to women who consume alcohol during pregnancy, indicating that there is likely a window (or windows) during which a certain amount of alcohol may be consumed without affecting the development of the fetus.

Pregnant women are shamed for drinking coffee, and some have even been refused coffee by baristas (and they say dietitians are the food police!). This despite the fact that pregnant women can safely consume up to 300 mg of caffeine a day (about the amount you’d get from a grande coffee). And the fact that the research on caffeine consumption during pregnancy is mixed.

Pregnant women are not allowed to eat: soft cheese, deli meat, sushi (unless it’s veggie), raw eggs, tuna (and other large fish), organ meat, raw sprouts, paté, unpasteurized juice or cider, store-made salads, and packaged salads, many herbal teas.

Naturally we want to exhibit an abundance of caution when the health of the woman and the fetus/infant are potentially at risk. However, I bet that if men were the ones giving birth that we would know exactly how much of all these things could be safely consumed during pregnancy and breastfeeding and the precise windows during which they needed to be avoided. But because (cis) men don’t give birth or breastfeed but they generally conduct most of the scientific research we are told to err on the side of caution. I mean what do they care if we can’t have a beer for 30 or so years because we might get pregnant at some point during that time, or enjoy some lovely brie because there is a teensy risk that we might get listeriosis and miscarry. As long as we are protecting their offspring that’s all that matters. And if a woman dares to defy all of the dietary restrictions placed on her during pregnancy societal shaming will cause her to toe the line. After all, questioning these restrictions shows that you are an unfit mother and selfishly putting your enjoyment of bruschetta ahead of your own child for whom you should be enthusiastically giving up everything for while your husband is out drinking with his buddies.

Please note: I am not suggesting that women who are pregnant reject all of this dietary advice. There are very real risks to consuming these foods and beverages during pregnancy. I am however suggesting that we reject the unquestioning acceptance of these restrictions because you know that if men were the ones getting pregnant there would already be a body of research into precisely what could be consumed when.


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Are prenatal vitamins a waste of money?

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Last week the news that pregnant women don’t need vitamin supplements seemed to be all over social media. The articles were based on this review article published in the Drug and Therapeutics Bulletin. The authors concluded that based on the evidence, much of which was from research in developing nations, that women (in Britain) do not need to take prenatal vitamins.

They reached this conclusion based on examining studies of the effects of folic acid, vitamin D, iron, vitamin C, vitamin E, and vitamin A supplementation on birth outcomes. While they concluded that multivitamin supplements are unnecessary for women during pregnancy, they stated that there was strong evidence to support women taking folic acid supplements and vitamin D supplements during pregnancy.

The message that came across most strongly (from the news articles) to me was that women are being shamed into purchasing vitamins that they can ill-afford, and don’t need, under the guise of wanting the best for their baby. The implications of these news articles concern me.

Firstly, women should be aware that many pharmacies (in Canada at least) have prenatal programs through which pregnant women can receive free multivitamin supplements, amongst other things. An inability to afford multivitamins should not prevent women from receiving them. Let’s not make this about drug companies trying to make money from poor women desperate to do the best for their unborn children. This should be about doing the best for women and their unborn children.

Okay, now that, that’s out of the way… I worry that the message that women should still be taking folic acid supplements and vitamin D supplements (and not just pregnant women I should add as most women of childbearing age should be taking folic acid supplements and most women in North America at least, should be taking vitamin D during the winter months) will be lost amid the cry that multivitamins are unnecessary. The message is not that all vitamin supplements are unnecessary for most Western women during pregnancy, just that the current evidence doesn’t support the use of multivitamins.

I’d also like to note that the researchers were focussing on birth outcomes. The conclusion that multivitamins are unnecessary was based on whether or not mums gave birth to healthy full-term babies. The authors did not take into consideration any potential long-term benefits maternal supplementation might have on their children. The authors did not take into consideration benefits that multivitamin supplementation might provide to mums. They did note that multivitamins can lower the mums risk of anemia, but as that didn’t seem to affect birth outcomes iron supplementation was deemed unnecessary. There are many other vitamins and minerals in multivitamins that the authors didn’t look at. Quite likely there’s not enough research on them to make a call either way. Regardless, the needs of pregnant women, not just their babies, should be taken into consideration when determining whether or not supplements are needed. Not all mums are going to get all the nutrients they need from food. Especially if they’re suffering from “morning” sickness. Perhaps not all mums will benefit from taking multivitamins. However, some very well may, and I think it would be a shame to tell them that they’re “wasting their money”.

Finally, as my friend Mark (who asked me to write about this topic) mentioned, taking two pills is more effort than taking just one. If it’s still being recommended that women take folic acid and vitamin D during pregnancy then they may as well just get those nutrients from a prenatal multivitamin rather than buying separate bottles of two supplements and having to remember to take both pills. It may be ever so slightly less expensive to buy vitamin D and folic acid instead of a multivitamin but I can’t even be certain of this because there was no folic acid for sale at my local grocery store when I went to price them all out. Which raises the issue of availability as well.

Women shouldn’t be made to feel guilty about not being able to afford a prenatal multivitamin. They also shouldn’t be made to feel like they’re wasting their money by buying them.

 


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Why obesity prevention is not the answer

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One of my twitter friends recently shared a link to this article: How Early Should Obesity Prevention Start? My immediate reaction was that they’re asking the wrong question. They should be asking how early health promotion should start.

While I think that the authors make some good points about obesity influences beginning in the womb, I stand by my initial reaction. No one likes to hear the term obesity. No one wants to be told that they’re obese or that their weight may cause their children to become obese. Is an obesity intervention really going to make much of a difference? I’m doubtful. Framing such an intervention as health promotion, and not only targeting overweight and obese women might be slightly more effective. However, these interventions are still putting the onus on the individual. Interventions targeting individuals and groups serve a purpose in the battle against obesity in the same manner that food banks serve a purpose in the battle against food insecurity and poverty. They are bandaid solutions for gaping wounds.

As I’ve said many times before: we need systemic change. The only way that we’re going to truly see a decrease in obesity rates is if we, as a society, change. We need to put more emphasis on food preparation and incorporating physical activity and exercise into our daily routines. We need to stop wearing long workdays and sleep deprivation as badges of honour. The best way to address the obesity problem is to not talk about obesity.