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How Your Diet Affects Your Pregnancy:  Nutritional Deficiency in Common Diets

1/30/2018

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Many women are familiar with the increased calorie requirements (right to indulge!) associated with pregnancy:  no increased requirements in the first trimester, 340 calories per day in the second (about 7 and 1/2 Oreos), 450 calories (10 Oreos) in the third trimester.  I was originally going to use Twix Bars, because I love Twix bars, but with two sticks in a package, the math got kind of complicated, and my degree is in biology.  Regardless, these additional calories are not only easily obtained, but quite often exceeded.  So, today, we’ll focus on what’s often missed in common diet trends in the U.S. and how these deficiencies can affect your pregnancy.

A recent study published earlier this month was the first to suggest a potential link between low-carb diets and an increase in neural tube defects in babies born to women.  Low carb diets can include Atkins, Paleo (hello fellow Crossfitters!), and ketogenic diets, among others.  These are often effective methods of weight loss, and hence, pretty popular among women looking to lose weight.  The issue appears to come into play with reduced folic acid intake from fortified grains, so for women participating in a low-carb diet, be sure to begin a prenatal vitamin several months prior to conceiving to help offset the potential deficiency that may occur in a carb-restricted diet.  Some food sources of folic acid are dark, leafy green vegetables and some fruits.

Gluten-free dietary advocates can also be deficient in folic acid.  These products generally aren't enriched with the same vitamins that gluten-containing ones are, so supplementation is important.  This is especially true for those with celiac disease as leaky intestinal cells are less efficient at nutrient absorption.  In this case, you may require higher amounts of vitamin intake to reach the recommended levels.  Fiber can also be an issue for those adhering to a gluten-free diet, and pregnancy generally predisposes to constipation anyway, so be sure to supplement your diet with extra fruits, vegetables and water to help keep bowel movements regular.


Another group at risk for nutritional deficiency in pregnancy are vegetarians.  The American Pregnancy Association recommends 75-100 grams of protein per day during pregnancy.  One of the highest concentrations of protein for vegetarians is in soy beans at 29 grams per cup of boiled soy beans.  3 cups of beans per day is a lot, and would also involve taking in about 30 grams of fiber.  Alternatively, protein supplements may be reasonable to help attain your protein goals.  Other potential deficiencies for vegetarians include Vitamin B12 (only found in animal products, so supplement would be recommended) and calcium, especially for vegans.  In the absence of dairy, dark green vegetables do contain some calcium as can calcium-enriched or fortified products.  Omega 3 fatty acids, like DHA, can be deficient in vegetarians as the best sources include fish and eggs, but walnuts, soy and canola oil, and flaxseed also contain Omega 3 fatty acids.  Lastly, iron deficiency affects as many as 40% of pregnant women, but because the recommended iron intake in vegetarians is roughly double that of non-vegetarians, they are particularly susceptible because iron is tougher to absorb from plant sources.

The last group to mention today involve women following the DASH diet.  This diet focuses on reducing sodium intake in order to help lower blood pressure.  In the U.S., iodized salt is the primary source of iodine, which plays a critical role in thyroid function.  That means if sodium restriction is severe, then thyroid function of mom and baby may be affected.  In turn, thyroid dysfunction can affect fetal growth and development as well as maternal miscarriage risk and cardiovascular concerns for pregnancy and beyond.  In addition to supplementation, shellfish are also a good source of iodine.

So, there you have it.  While we framed today’s blog on how pregnancy can be affected by deficiencies in various diets, the non-pregnant can still suffer from nutritional deficiencies and benefit from their correction.  Diet is important not only to help you have the healthiest possible pregnancy, but it affects weight, energy, and risk of chronic disease (like heart disease and cancer) after pregnancy as well.  Good luck to all of those who have made healthy diet a part of their New Year, and congratulations to those who have stuck with their resolution so far!  Only 2 days until February and getting the first month under your belt :)

Dr. Nick
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What is More Expensive: In Vitro Fertilization or Adoption?

1/23/2018

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For most couples getting pregnant is simple and easy.  They just get pregnant and don’t have to go through expensive infertility testing and years of praying and hoping for a successful pregnancy.  For others it is a difficult struggle.  While there are many reasons couples may suffer from infertility, one of the biggest hurdles that prevents them from getting pregnant is the financial aspect.  Infertility treatment is expensive and not covered by most insurances.

So, I get this question a lot from patients struggling from infertility.  If you are going to dip into your personal savings or take out a loan to start a family, what makes more financial sense IVF or adoption? 

Let’s start with IVF.  Let’s just review what IVF is first.  The infertility specialist will extract some of your eggs and then add your partners sperm in a laboratory outside of your body and then at the appropriate time place that embryo in your uterus.  Now, what does IVF cost?   On average, one IVF cycle will cost somewhere between $10,000-$15,000.  Of course, the variation in cost is also dependent on the reason for infertility and a lot of other parameters.  Now this in no way guarantees you a baby.  However, the technology is improving every day and the success rate is rather impressive at certain facilities.  A good percentage of youngish (early thirties) healthy women will likely get pregnant by three cycles.  

My patients that pursue IVF frequently get asked- why not just adopt?  Well for one it is way more expensive than the average person realizes.  The average adoption in the U.S. costs between $27,000-$30,000.  The average adoption overseas can cost as much as $58,000-$65,000.  Most patients have this perception that adoption is cheaper until they have already invested in the process.  And again, just because you spend this money, there is no guarantee that you will get a baby.  Another consideration with adoption is time.  Even under the best of circumstances, adoption can take years to bring a child home.  

Another less well-known option that is much more affordable than IVF or traditional adoption is embryo adoption/transfer.  When couples go through IVF, they usually end up creating more embryos that they can use.  So, thousands of embryos sit in a lab and go unused.  With this procedure, couples with infertility will use donated embryos and just have them placed in their uterus at the appropriate time.  The cost of this procedure is about $3,000-$5,000.  

The decision on how to expand your family if you suffer from infertility is very complex.  It is important that you educate yourself on your personal fertility.  If the cause of infertility is known, treatment will likely be a lot more successful.  Know and research different options on building your family before deciding whether it be IVF, adoption or even foster care.  If electing to try IVF or embryo transfer, be sure to research your local infertility specialists and make sure you know their pregnancy rates.  The best programs out there will have a high pregnancy rate and a lower number of embryos transferred.  We are fortunate to have two options here in town:  Idaho Fertility Center and Reproductive Care Center.  If seeking adoption (and there are definitely many children who would benefit from these services), then be sure to research and find a reputable adoption agency.  Your needs may vary depending on the area from where you are hoping to adopt a child.  Whatever you decide, good luck in finding the best option for you to bring the newest member of your family into your home :)

​Dr. Pam
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Want to Live Forever?  Lift Weights and Run!

1/16/2018

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Some of the most common New Year’s resolutions typically involve changes to a person’s health, but these resolutions often go quickly by the wayside as school resumes and kids’ activities return (what am I, a taxi service?) and/or work deadlines begin to loom again.  Soon, “I’ll get that workout in tomorrow” can easily change into “let’s see what happens next year.”  So if you’re looking for something to get or keep you motivated, here are a few recent study results that show some real benefit to working out.

Strength has a direct influence on how long you live.  In short, a recent study looked at the relationship among strength, muscle mass and mortality.  While muscle mass didn’t have much of an effect on life expectancy, those people who fell into the low muscle strength group were twice as likely to have died during the roughly 10 year follow-up.  So, even though I don’t look like the Rock (yet!), as long as I have good functional strength, I’m likely to live longer.  A second study of 80,000 subjects in Great Britain showed that those who reported doing strength training were 23% less likely to die during the study period and 31% less likely to die of cancer.

In addition to strength training twice a week, we’re technically supposed to get at least 150 minutes of moderate aerobic exercise or 75 minutes of vigorous exercise.  In fact, running may be the single most effective exercise to increase longevity.  On average, runners live about 3 years longer than non-runners, even if it’s done slowly or intermittently, and regardless of whether they drink, smoke or are overweight.  Even 5 minutes a day can make a difference, although the recommendations are certainly for a bit more sustained activity.  Risk of premature death, from causes like heart attacks, decrease by about 40%.  The return from running is pretty good as well.  For the average runner who runs 2 hours per week (about 6 months total over 40 years), he or she typically lives about 3.2 years longer than a non-runner.  That means, for every hour run, life expectancy increase about 7 hours.  So, does that mean if I run 4 hours a day, I can live forever?!  Not exactly...the maximum return for time invested peaks at about 4 hours per week.  That being said, 4 hours x 7 is 28 hours, or a little more than a day per week of running.

So, if I hate to run, am I gonna die?  Even walking, cycling and other aerobic activities can help reduce the risk of premature death by around 12%, so there’s still some benefit to be had with the other choices, too.  Not to mention, the best outcomes typically occur with a combination of strength and aerobic training.  Whether you’re looking to enjoy a long, healthy retirement with a significant other or meet your great grand-children (or even to just keep up with your 18 month old), the time to begin that investment in yourself and your health starts today :)

Dr. Nick
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Raw Water: A Dangerous New Health Craze?

1/9/2018

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What is raw water?  It is supposedly unfiltered, untreated, unsterilized spring water that can cost more than $60.99 for a 2.5-gallon jug.  So, what is the concern here?  Why would someone pay so much to get their drinking water from the Middle Ages before proper sewer and sanitation systems had been created?  The rationale is that the existing water supply has many chemicals and pollutants and that there are naturally occurring minerals that are filtered out when the water is treated.  
 
How does water treatment occur?  Step one is coagulation and flocculation.  This is a fancy way of saying that dirt has a negative charge so adding a chemical with a positive charge will grab the dirt floating in the water (opposites attract).  This new bigger particle is heavy and settles to the bottom of the water (sedimentation).  Filtration happens next.   Small holes allow water to pass while trapping bigger particles (remaining dirt, bacteria, etc).  Lastly, a small amount of chlorine is added to kill any remaining viruses and bacteria.
 
What are the health risks of consuming “unfiltered, unsterilized, untreated spring water?” Unfiltered and untreated water even from the cleanest streams can contain animal feces which can lead to the spread of Giardia, Hepatitis, E. Coli and cholera.  Not to mention, runoff from our streets generally drains through a creek system.  Because of the advances in sanitation and safety of our water supply, most of us don’t know anyone that has died of hepatitis and cholera (although a recent outbreak in the homeless population in California led to 20 deaths in 2017).  Ever hear of dysentery, that illness which can kill people by extreme dehydration from nonstop defecation (pooping)?  It’s another example of water-borne illness.  Even for those who recover, it’s hard to imagine them calling bloody diarrhea a fun way to spend 2-4 weeks of recovery time.  One last example is naegleria fowleri.  This little amoeba isn’t ingested, but if some water contaminated with this species accidentally goes up your nose, it can cause primary amebic meningoencephalitis (PAM).  With fever, nausea, seizures, hallucinations and coma, nearly all cases of this illness have been fatal.
 
Who is consuming this raw water?  It’s currently limited to a largely wealthy clientele and seems popular in more expensive neighborhoods.  At 60 bucks for 2.5 gallons, this is only something that only the likes of Silicon Valley executives can afford in significant quantities.  If you are spending $4000.00 to rent a one-bedroom apartment- what is 60 bucks for a gallon of water?  Otherwise, people are left to collect their own.
 
From the standpoint of a health professional, recommendations would certainly be to avoid drinking untreated water due to concern for water-borne infection, and this applies doubly during pregnancy.  We know that the immune system is weaker during pregnancy, and any of the bacteria, viruses or amoebas listed above could easily cause a pretty devastating illness.  Not to mention, if you’re spending nearly $30 per gallon of drinking water, how much money are you going to have left over for diapers?  😊

​Dr. Pam
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