Category Archives: Pregnancy

Thoughts on Choosing a Prenatal Vitamin

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“Are you taking a prenatal?”

Picking a prenatalIdeally, we would all get our nutrients from foods.  However, with food intolerances, food aversions, soil depletion, lack of access to high quality food sources, and food processing, some argue that this just isn’t possible in today’s world.  I won’t argue either way.  All I know is that doctors like it when women who are trying to conceive, pregnant, or nursing take a prenatal vitamin, but they aren’t always helpful in recommending one or up to date on the latest nutrient information.

I have delivered four babies in four different states, and my four different obstetricians never once had a firm prenatal vitamin recommendation.  Often, I just cycled through samples they gave me at different visits or some Walgreen’s over-the-counter product.  The question at OB check-ups always was, “Are you taking a prenatal?”  And my answer usually was, “Yes.”  The doctor’s simple response was, “Okay.”   (Or–“No, I am not taking a prenatal.  I feel too sick.”  “Well, just make sure and get some folic acid.”)  End of conversation.  Never once did the OB request, “What kind?  Let me see it.”  However, I think obstetricians/practitioners need to know of any supplement put in their patients’ mouths so they can have the opportunity to offer guidance.  They may even have some great recommendations and samples based on a patient’s health history needs.  (Or not.)

Anyhow, after the last few folic acid/folate posts, I received a few questions and comments about choosing a supplement for pregnancy.  So I put my fingers to the keyboard and was reminded of what I already knew from my search many months ago for myself at the beginning of our surprise pregnancy.  Choosing a prenatal vitamin supplement is a real bear.  A real maze.  A twisted, contorted game.

The Dilemma

If you read my recent posts on folic acid versus folate, you probably think that it’s probably high time to ditch folic acid in favor of a natural folate in prenatal vitamins (and vitamins in general).  Great.  Now you know.  Now I know.  But what good is knowledge if you don’t know how to act on it in real life?  I tried to pinpoint a good prenatal vitamin with L-methylfolate for myself to take many months ago, but it wasn’t as easy as that.  Let me say it again.  It was not as easy as that.  If I liked the vitamin content profile, then I didn’t like the extra ingredients, for example the use of soy, oats, artificial colors, or vanillin (an artificial vanilla flavor).  If I liked the clean ingredient profile, it didn’t meet the minimum recommended iodine requirements.  Or it didn’t have any DHA.  Or it used ergocalciferol (a plant-based vitamin D) rather than cholecalciferol (the better utilized animal based).  Or the vitamin B 12 was not the methylcobalamin form.  Or it didn’t have any vitamin K2.

What do you do?  You do the best you can.  You choose the best you can.  (And you make EVERY BITE COUNT.  More on my personal experience with that in a subsequent post.)  There is no perfect prenatal out there.  There just isn’t.  I’ll tell you what I looked for.  But this is the story of my thoughts and learning.  Not my medical advice.  Please don’t use my blog posts as medical advice.   You’ll have to figure out for yourself with your practitioner’s help what you need for sure and also where you’re willing to compromise on your prenatal vitamin.

Things I looked for in my prenatal vitamin:

  • Does it use folate or folic acid?  I prefer L-methylfolate or another biological folate.
  • Does it have the recommended dose of iodine?  What is the source of iodine?  I prefer it to have iodine since my iodine sources are limited (I don’t tolerate eggs and dairy well.) and haven’t yet sorted through which source I feel is best for iodine.
  • Does it have selenium to accompany the iodine?  If iodine is taken, then selenium needs to be sufficient as well.
  • Is the vitamin D source from ergocalciferol (vitamin D2) or cholecalciferol (vitamin D3)?  I prefer vitamin D3 (cholecalciferol).
  • Does it have any vitamin K2 in it?  Vitamin K2 is difficult to consume from foods, especially on a dairy-free diet, yet it is very important for health and fetal development.  Many supplements lack this.
  • Does it have the methylated form of vitamin B12 (methylcobalamin)?  I prefer this.
  • Does it have any DHA?  (A type of omega-3)  None of the prenatals I looked at contained DHA.  I made a point to eat DHA-rich foods, and if that wasn’t happening, I supplemented.
  • Does it have biotin?
  • Does it have choline?
  • What extra ingredients does it have?  I don’t see any reason for artificial colors and artificial flavors (like vanillin).  In addition, I am always on the lookout for soy, dairy, and gluten in any supplements due to some sensitivities.  I scan ingredients, also, for added probiotics or FOSs which may not agree with tummy issues.
  • What are the amounts and types of other minerals, like iron, calcium, and magnesium?  Many prenatals don’t have the recommended allowances of these, which can be okay.  However, women need to make sure they know how much of these minerals are in their prenatal vitamins so they can get their needs elsewhere if required.  Some women rely on their vitamins because of food aversions and nausea.
  • What is the vitamin A source and how much is in there?  Striking a middle ground here would probably be wise.  Not too much.  Not too little.  If you eat a lot of vitamin A rich foods, lean on the lower end in the supplement.
  • How many pills need to be taken?  Sure.  One is ideal but probably not optimal for absorption and maximizing nutrients.  For example, the calcium needs of the body cannot be absorbed in one sitting.  It needs to be spread out through the day.

Putting Criteria into Reality

I don’t have a good prenatal to recommend.  Like I said, nothing met all of my criteria.  My most recent obstetrician didn’t mind that I didn’t take a prenatal vitamin as long as I took a “folic acid” supplement.  This was a surprise pregnancy, and by the time I started looking for a prenatal, I was overcome with pregnancy maladies.  (Read:  I am making excuses for not selecting a good prenatal.)

Initially, I took a vitamin B complex with an active form of L-methylfolate made by Designs for Health along with some fermented cod liver oil since we were in the dead of a brutal winter (which would provide vitamin D, vitamin A, and DHA/EPA).  Then, I switched to a Designs for Health multi-vitamin that I already had in my cupboard which would provide some vitamin K2, iodine, zinc, biotin, and choline for baby and me, but it recommended 6 pills per day!  Right.  I was not very compliant with that.  So I eventually picked up a pre-natal from the local health food store, Rainbow Light, and made do with it, but it did not meet all my criteria.  My nutrition overall was strong and well thought out, and I felt the prenatal was more of a safety blanket for me.  Like perhaps to cover my low intake of iodine until I recognized a weak area in my diet.

I went back this week and looked at some prenatal vitamins after reading up on folic acid/folate, and I wished I had had the energy to investigate them all early in that first trimester.  But I didn’t.  So here are some of the vitamins I looked at this week that met a lot of criteria I find important.  I also listed Rainbow Light since I took it and saw a lot of women commenters on other sites mention it.

Do not use this list as a recommendation list.  Use it as a place to start looking, comparing, and contrasting which vitamin might fit you best, and always enlist the help of your physician to make sure you’re not overlooking something.

Nutrient 950 with Vitamin K by Pure Encapsulations

This is not the prenatal from the same company.  The prenatal has folic acid, not folate.

 

Emerald Labs Multi Vit-A-Min Prenatal

  • This has L-5-methyl tetrahydrofolate (L-5-MTHF), vitamin D3, iodine (although a lower amount), selenium, methylcobalamin, and biotin.
  • No DHA or choline.
  • The dose is 4 capsules.
  • With the recommended dose, one does not obtain the recommended daily doses of magnesium and calcium.
  • The ingredient list should be inspected for a person to see if there are any sensitivities to included ingredients, like quinoa and FOS.
  • One source of vitamin A is vitamin A palmitate, rather than simply relying on beta-carotene.  A reader may want to research this a bit.  Especially if they eat many food sources of vitamin A.
  • http://www.ultralaboratories.com/emeraldlabs/Prenatal%20Multi/index.php

 

Thorne Research Basic Prenatal

  • This has calcium folinate and L-5-methyltetrahydrofolate (L-5-MTHF), both biological folates. It also uses vitamin D3, iodine, selenium, methylcobalimin, and biotin.
  • There is no vitamin K2.
  • Calcium and magnesium do not reach the recommended daily doses.
  • The source of vitamin A is also palmitate (and carotenes).
  • The dose is 3 capsules.
  • https://shop.thorne.com/products/womens-health/basic-prenatal

Designs for Health DFH Complete Multi

  • Designs for Health Complete Multi has vitamin D3 (cholecalciferol), vitamin K2, natural folates (5-MTHF and 5-FTHF), methylcobalamin, biotin, choline, iodine, and selenium.
  • The calcium and magnesium are less than recommended allowances.
  • There is NO iron and no copper.
  • Its vitamin A source is carotenoids.
  • The dose is 6 capsules.
  • http://catalog.designsforhealth.com/DFH-Complete-Multi

Optimal Prenatal Vitamin/Vitamin Powder

This vitamin is out of stock reportedly due to popularity, but there is a protein powder designed to be interchangeable.  They are working to get the vitamin back in stock.

Rainbow Light

Rainbow Light is a food-based multivitamin, vegan compliant.  It is what I landed on for a prenatal vitamin due to chance, and it gets good reviews on-line.  It misses some of my criteria.  I landed on it, but I don’t think it’s the best.

  • It’s vitamin D source is D2 (ergocalciferol).
  • It has no vitamin K2.
  • It does not have the methylated form of vitamin B12.
  • It uses folic acid.
  • On the other hand, it does have iodine, choline, and biotin.  It also contains iron.
  • The calcium and magnesium content, like the other brands, is less than the recommended daily doses.
  • It has some added ingredients, like red raspberry leaf, ginger, spirulina, probiotics, and digestive enzymes for readers to investigate.
  • http://www.rainbowlight.com/multivitamins-prenatal-one-multivitamin.aspx

 Conclusion

I think this is a good list of prenatal vitamins/multi-vitamins to start to check out.  Do readers have any others (and thanks to those who gave suggestions)?  Remember, it’s all a game of checks and balances.  Start with a good, strong, well-planned pregnancy diet and make sure your supplement does that–supplements the gaps in your diet.  Run all of your supplements by your doctor.

All the best to you for a happy, healthy family!

~~Terri

 

 

 

Two Follow-Up Articles to Read on Folic Acid in Pregnancy

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Pregnant belly in black and whiteChoosing a supplement for pregnancy, lactation, and trying to conceive is daunting!  Dozens and dozens of prenatal vitamins exist!  How do you choose?  One important way to narrow it down is to choose one with a “natural folate.”  Recently, I ran two posts on folate/folic acid (here and here) and why people may want to steer away from folic acid use in foods and vitamins–but NOT folate in general–just the folic acid form.

Today I will post two really readable articles regarding folic acid versus folate in prenatals that readers may be interested in.  Remember, my blog is a story of what I am learning.  It is absolutely not to be used as medical advice.

Two Fairly Easy to Read Articles on Folic Acid in Pregnancy

“Should you skip prenatal vitamins with folic acid?“

(Click on article title to link to the article.)

This is a nice overview article from the news written in common language.  I think it summarizes the thoughts from my second post on folic acid versus folate (click here to read it).  Basically, those people with MTHFR (methyltetrahydrofolate reductase) issues would benefit from L-methylfolate rather than folic acid.  But how do you know if you’re “one of those people?”  Unless you’re tested, you don’t.  And in this article, it states that about 50% of women can be affected.  So you’re playing a guessing game.  Am I good with folic acid?  Or would I be better off with L-methylfolate?

If you’re trying to conceive, pregnant, or taking folic acid, this would be a good article to read to help you understand whether or not taking folic acid (versus folate) is best for you.

“Multi-vitamin Supplementation During Pregnancy:  Emphasis on Folic Acid and L-methylfolate.“

(Click on article title to link to the article.)

This is a nice little interview between an obstetrician and a nutritionist regarding L-methylfolate, folic acid, and MTHFR issues.  The conclusion is very similar to the article first listed (and similar to what I concluded), but rather than being in the general news, it is from an obstetrical journal.

Closing

The next post will discuss what I look for in a prenatal vitamin along with some vitamins that I looked at, but the take-away message that I learned is this:  If you don’t know your MTHFR status, it might be wise to stay away from folic acid supplements (but not folate).

~~Terri

 

Folic acid or folate? What’s in your vitamin? What’s in your food? What makes a difference?

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Someone is not right.  (Ding. Ding. Ding. Ding.)

Folate versus folic acid.  What was I taught as a medical doctor and pharmacist?  No difference.  So alert bells chimed in myFolic acid vitaimin edited photo head two years ago when I started reading alternative takes on medicine in the effort to fix my gastrointestinal tract (which led to many more benefits in myself and my family than I ever expected) and seeing the “naturalists” crying out against folic acid.

Ding.  Ding.  Ding.  Ding.  Discrepancy alert.  Need real story.  These alternative views felt there was a difference and started slinging around acronyms I had long buried in my medical student past, like MTHF and MTHFR, and referring to tests which could be ordered for diagnosis of disorders revolving around MTHFR deficiencies.  They fear-mongered with increased risks of cancer with folic acid intake.  With complete honesty and openness, my thoughts at the time were:  1) Geesh, where do they come up with this stuff and these tests?  Egads they’re feeding the neuroticism.  Getting vulnerable people all worked up.  AND 2)  My mom always said there’s a bit of truth in every rumor.  I really need to look into this.  Chuck it on the list to research.

Well, I have finally made it to the “Folate vs. Folic acid” boxing match.  I see and relate to the good intentions behind the use of folic acid in our supplemented foods and vitamins, and yet I see and admit the potential failures of folic acid compared to folate.  As I’m finding in so many areas I’m reading about now with alternative medical views, medical research is beginning to perhaps support folic acid’s shortcomings too, but it seems to take many decades before things trickle down to the doctors in trenches and the public.  Frustrating but true.

Join me as I summarize what I have learned regarding folate and folic acid.  My blog posts are a collection of what I have learned.  A story.  They are not intended for medical advice.  Don’t use them that way.

1.  Folic acid and folate are both types of vitamin B-9.  FOLIC ACID is synthetically made and does not naturally occur in our bodies or in foods.  FOLATE usually refers to naturally occuring forms of vitamin B-9, although it can be a wastebasket term to include both folic acid and naturally occuring forms of vitamin B-9.

You really need to read well and scrutinize to figure out how the term “folate” is being used when you see it.  Technically, it looks like the term “folate” is used to include ALL forms of vitamin B-9, both natural and artificial.  Kind of like a wastebasket, generic term.  (You know.  Like not all kleenexes are Kleenexes!)   However, some sources specify that “folate” is natural and “folic acid” is artificial.  In many places, you’ll see the terms folate and folic acid used interchangeably, without regard for any distinction.

Why the terminology looseness across sources?  All folates (generic term) share a common structural core.  Natural folates and folic acid are structurally and functionally similar and feed into the same pathways in the body–so some sources don’t see a need to differentiate.  Don’t take it for granted that an article you’re reading or a vitamin you’re taking is referring to a naturally occurring, physiologic type of vitamin B-9 (folate).  If it says “folic acid,” you can be sure it’s the artificial stuff.  If it says “folate,” you need to get more details.

In the remainder of this post and the next folate/folic acid post, I’ll use folic acid to refer strictly to folic acid and try to clarify which folates I’m talking about, food-based or otherwise.  Due to amount of content, folate/folic acid will take two posts.

2.  Real foods contain natural folates, and processed foods (and most vitamins) contain folic acid.  The folate in real foods is not as shelf-stable as the folic acid added to foods and vitamins.

Real foods which contain good amounts of natural folates:

  • Leafy greens like spinach
  • Beans and lentils
  • Asparagus
  • Broccoli
  • Romaine lettuce
  • Broccoli
  • Mango fruit
  • Oranges
  • Liver
  • Egg yolks
  • Wheat germ

Broccoli grouchThe longer fresh, real food sits exposed to air, disconnected from its living source, the more the natural folate breaks down, making the folate content much lower with time.  So the closer you are from garden to mouth, the better in regard to natural folates.  In addition, cooking will diminish the folate content as well, sometimes quite significantly!  So the less you cook foods, the higher the natural folate amount. (Eat a little cooked…eat a little raw…)

On a science note, the forms of folate found in natural foods are primarily tetrahydrofolate (THF), 5-methyltetrahydrofolate (5-MTHF), and 5-formyltetrahydrofolate (5-FTHF).  So when people use the term “folate” regarding foods with intrinsic folate content, please know that it’s not just one form.  It’s not just “folate.”  There are several forms of “folate,” and these three are the most common, with 5-MTHF being the most common.  This tidbit of information will come into play later when I talk about why some people won’t do well with synthetic folic acid.

Processed foods with folic acid added include:

  • Fortified breakfast cereals
  • Enriched bread
  • Enriched flours
  • White, enriched rice
  • Enriched pasta
  • Enriched crackers

When grain products are processed, they are stripped of virtually all their naturally occurring folates.  In the 1990s, the United States began mandating the addition of synthetic folic acid to processed foods to boost women’s levels of folate in the body and drive down the incidence of neural tube defects (abnormalities in the brain and spinal cord).  It worked.

Folic acid is an oxidized form of vitamin B-9 and is used because it is very shelf-stable and inexpensive to make.  Folic acid levels won’t diminish as much in processed foods as they sit on the shelf, and it is easily absorbed from the gastrointestinal tract.  (And experts thought it was similar enough to natural folates to not cause any problems in the general population…)

3.  Back up.  What’s vitamin B-9 (folate/folic acid) for anyhow?

If you remember chemistry class, maybe you’ll remember the one carbon group called a “methyl” group.  Well, folates carry methyl groups for transfer in cellular reactions in the body.  They are involved in “methylation.”  This is very important for making our DNA and RNA; for turning off and on genes; for recycling some of our enzymes that are used for “detoxifying;” for reducing our homocysteine (and therefore cutting down heart disease and stroke levels) to recycle methionine; for our red and white blood cells; for production of a fetus; and for neurotransmitter production.  This just gives you a basic insight to just how valuable folate is.  It’s critical, and you can’t store folates up, so you need a fairly steady supply daily.

4.  What does folate/folic acid do in pregnant women?

My own pregnancy is what moved the folate versus folic acid debate up on my “to-research” list.  I’m just finally getting around to putting it all together in a post.

Folate (generic term) is important for the developing fetus, and demands for it increase during pregnancy.  Without it, there is an increased risk of neural tube defects like spina bifida (an opening in the spine) and anencephaly (lack of brain formation), congenital heart defects, and possibly preterm birth.  For reduction of neural tube defects, enough folate/folic acid needs to be present at conception and very early in pregnancy, often before a woman knows she is pregnant!  (A plug to eat good nutrition lifelong!)

Adding folic acid to the US and Canadian processed food supply in the 1990s decreased the occurrence of neural tube defects (NTD).  The authorities didn’t feel it was possible or reliable to get enough folate through diet to diminish the risks of these serious birth defects.  However, supplementation of folic acid may not be adequate for women with a disorder known as methyltetrahydrofolate reductase deficiency (MTHFR deficiency), which is actually pretty common!  I’ll talk about this next post and also address alternative forms of folate supplementation which could be considered.  Women with a personal history of NTD, prior birth history of NTD, or family history of neural tube defects may have a higher incidence of 5-MTHFR deficiency and will want to know about this.

Closing

Thanks for reading.  Eat lots of folate-rich natural foods!  Next post we will explore much more deeply why folic acid may not be “as good as” natural folates and may even be detrimental for people!  After researching, I’m a big fan now of natural folates.  I work very hard to eat leafy greens daily and liver weekly, both great sources of natural folate.  Folate is now a word we use commonly in the house to teach the kids about the food they eat.  The more they understand WHY we eat, the better they actually WILL eat.  (This post is just a precursor to what I think is such an interesting and fascinating second post, which will describe more why folic acid is demonized.)

~~Terri

Links to Sources:

1.  https://tspace.library.utoronto.ca/bitstream/1807/30137/1/Lakoff_Alanna_D_201006_MSc_thesis.pdf

2.  http://projecthealthychildren.org/wp-content/uploads/2012/03/2012-06-19-PHC-Folic-Acid-FINAL-FINAL.pdf

3.  http://www.fao.org/docrep/004/y2809e/y2809e0a.htm

An Objective Look at Placentophagy

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Nothing on my blog should be used as medical advice.  It is only the story of things I choose to learn about.

Pregnant belly in black and whitePlacentophagy = “Eating” the Placenta

I’ve delivered placentas.  Probably lots more placentas than babies because as a resident, staff doctors liked to deliver the babies, and then turn it over to the lowly resident to finish up.  Anyhow, placentas have a distinct smell about them and quite an unusual appearance, color, and texture.  To eat them, in my mind, is a disgusting thought.  But that’s not what I should base opinion on.  Chopping liver is disgusting, too; I won’t deny that to anyone.  And I know vegans abhor the way I eat, but choosing foods that keep me feeling well and functioning well is one of my top priorities.  So I can appreciate, although maybe not partake in the process, the motivation for women to consider consuming their placentas.  Yet as I do with all “food” now, I analyze it for unintended side effects that could be problematic.  Let’s explore placentophagy.

Why do some people do it or recommend it?

The thought is that there are hormones and minerals, such as iron, in the placenta that impart beneficial effects to the mother (or whoever else eats it–as historically it has been eaten by others, too).  It is often repeated that it:

  1. Improves milk production.
  2. Helps the uterus clamp down to its normal size after pregnancy.
  3. Helps to lessen the amount of bleeding and the duration of bleeding in the post-partum time period.
  4. Helps diminish mood disturbances post-partum (such as post-partum depression).
  5. Helps return iron levels to normal more quickly.
  6. Helps improve pain tolerance.
  7. Provides increased energy.

Advocates are quick to point out that almost all mammals, including apes and monkeys, eat their placentas, so it must be natural.  However, humans usually don’t eat their placentas, and for various speculated reasons, neither do camels, llamas, alpacas, and dolphins.  In an anthropological review, I found only one region that was documented to perhaps practice placentophagy by the mother, and that was in Chicano culture (Mexican-American).  Eating the placenta, despite what you may read elsewhere, just doesn’t seem to be a routine custom for women, even in primitive cultures, although we can’t know for sure as history is often shrouded in mystery.  (1)

However, there is a bit more documentation where the placenta is prepared in various ways (fried, puddings, roasts, teas) and then served to others such as the fathers, family members, the baby itself, or to the sick and ailing.  Historical Chinese texts record the use of placenta for remedies, although it doesn’t seem to imply that the placenta was eaten by the post-partum woman herself.  There is a report of male and female nurse-midwives in Vietnam eating the placentas of (only) healthy women, although they themselves were or Chinese or Thai origin, not Vietnamese. (2)  In addition, many cultures, although they don’t eat the placenta, encourage extra special treatment of the placenta, such as burying it, disposing of it in a lake, or placing it in recommended spot.  Improper disposal is believed to bring consequences.  (1)

Bottom line:  I don’t know about you, but I feel manipulated by those internet sites which imply that placentophagy is something that has been routinely done by post-partum women throughout the ages.  That is speculation.

Can you really take your placenta home from the hospital?

No one ever asked me to take their placenta home when I did deliveries in family medicine residency.  Usually I’d deliver the placenta into a basin, inspect it, and then hand it off, where it was put in a  red biohazard bag at clean-up.  If anything had seemed off in my inspection, the placenta would be sent to the pathology department for evaluation.  In my reading, it looks like different places will have different regulations about the placenta.

Here is a waiver I found if you are interested:  Placenta Benefits Release of Placenta and Waiver of Liability Form.

And here, from the same site, is recommendations on how to obtain your placenta in a friendly fashion:  Hospital Release of Placentas. (3)

What is done after the placenta comes out to prepare it for consumption?

It sounds like once your placenta is out, it should be placed in an appropriate clean container and immediately put on ice and gotten into  a refrigerator as soon as possible.  There are people you can contact to process your placenta for you from this point on or you can do it yourself at home.  (I was able to Google and find someone in my state who offered this service, although I never called.)  They say the placenta should be processed within three days or frozen for later use.  [Freezing doesn’t seem to affect the presumed active substances in the placenta, although cooking may. For example, temperatures above 104 degrees F (40 degrees C) destroy placental opioid enhancing factor (POEF).] (4)

Processing and methods of preparation include:

  1. Eating some raw right away as is or mixing it raw into a smoothie.
  2. Cooking it into some dish, like a roast or spaghetti ragout.
  3. Cleaning it, steaming it, slicing it, and then dehydrating it to make into a desiccated powder to fill capsules with.  (Often steamed with select herbs like ginger.  This way is often referred to as the Traditonal Chinese Method because of its description in historical Chinese texts and use in Chinese medicine.)
  4. Slicing it raw and then dehydrating it without the steaming process, because steaming may inactivate certain placental substances.

What does the research show?

Let’s look.

1.  Improved milk production in humans:  Back in the 1950s, some Czechoslovakian researchers [Soykova-Pachnerova E, et. al.(1954). Gynaecologia 138(6):617-627] fed lactating mothers either dried beef or dried placenta.  Those who ingested placenta seemed to have an increase in their milk production, although this was not quantified:  “Of 210 controlled cases only 29 (13.8%) gave negative results; 181 women (86.2%) reacted positively to the treatment, 117 (55.7%) with good and 64 (30.5%) with very good results. It could be shown by similar experiments with a beef preparation that the effective substance in placenta is not protein.”

2.  Improved pain control with less perception of pain in rat study:  In 2004, DiPirro and Kristal did a study looking at placenta ingestion in rats, and they concluded that placenta ingestion regulates the pain sensation in rats (probably from a substance called placental opioid-enhancing factor–POEF).  (5,6)  Natural endogenous opioids are not actually increased by placentophagy, but instead the body’s response to natural opioids already made is enhanced, allowing for increased pain tolerance.

3.  Improved growth rate of breast-fed infants:  In 1918, Hammett published a paper in The Journal of Biological Chemistry looking at breast-fed babies from moms who did and did not ingest dried (desiccated) placenta.  He found that breast-fed babies whose moms received desiccated placenta had an increased rate of growth over those who did not. (7)

4.  Alteration of prolactin and progesterone levels post-partum in rats:  Blank and Friesen, in 1980 Journal of Reproductive Fertility, found that giving rats placenta induced an early rise (day 1) in prolactin and a later (day 6) drop in progesterone compared to the control groups, who received various treatments of estrogen injections or human or bovine placenta.  The significance of these changes could only be speculated at.  (8)

5.  Anecdotal survey of women who practiced placentophagy:  Researchers performed a survey of women who practiced placentophagy.  Although not providing much in the scientific light, it is interesting none the less. Nearly all of the 189 women were satisfied and would practice placentophagy again.  (9)

6.  Upcoming research due out in 2015 by UNLV’s Dr. Benyshek and team:  “Research professors in UNLV’s Department of Anthropology, Department of Nutrition and the School of Community Health Sciences at the University of Nevada Las Vegas are working on a randomised double-blind placebo trial for placenta encapsulation and have plans to complete the data proportion of their study by late summer 2014, and published results sometime in 2015!”
(See more at: http://www.placentanetwork.com/new-placenta-research-study-randomised-double-blind-placebo-trial-2014/#sthash.djtk1Ezv.dpuf) (10)

7.  This is not research, but benefits of placentophagy circulate around substances found in the placenta such as oxytocin, human placenta lactogen, corticotropin releasing hormone, other hormones, and iron.  Let’s look at a few:

  • Oxytocin is present in the placenta.  It is a hormone which helps promote contractions, expulsion of the placenta, uterine contraction/clamping down, and milk ejection–among other roles.  Proponents of placentophagy make a conclusion that the oxytocin in the placenta can help with milk supply and ejection and the return of the uterus to its pre-partum size.
  • Human placenta lactogen is present in the placenta.  It is presumed that this will help with the prolactin regulation in the mother.  Prolactin helps in the production of milk (whereas oxytocin is more useful in the “ejection” of the milk).
  • Corticotropin releasing hormone (CRH), usually only made in the hypothalamus, is made in the placenta during pregnancy and increases throughout pregnancy to unusually high levels in the last trimester.  This hormone stimulates the body to make cortisol, a valuable stress hormone, which is important to prepare the body for the stress of labor and delivery.  Because the placenta supplies a richCRH production, it inhibits the hypothalamus from doing its normal job.  When the placenta is expelled, it no longer providesCRH and soCRH production, and therefore cortisol production,  drops off precipitously after delivery until the hypothalamus resumes its normal production.  It is believed that this contributes topost-partum blues and anxiety in women until the body re-adjusts for the loss of the placental production ofCRH.  (11)  Theoretically,placentophagy could provide a “bridge,” not allowing the stress hormone production to just plummet after the loss of the placenta.
  • Iron is rich in the placenta.  Aside from simple anemia, there have been some studies to suggest a role of iron supplementation on post-partum fatigue and mood changes.  Critics of placentophagy, however, point out that there are other options to increase iron in women besides placenta.

We have looked at reasons why some advocate placenta consumption.  Why NOT consume your placenta?

Although nearly all mammals DO eat their placentas, human beings historically–that we can track–DO NOT and HAVE NOT.  Why?  What is the reason?  There is no answer at this time.  Is it something that became socially taboo?  Is it something that traditional, ancient cultures determined could be detrimental to health?  We don’t know.  Reading the potential positives starts to make you think maybe you should consume your placenta.  Maybe we are missing out on something here.  But let’s explore reasons why a woman would NOT want to consume her placenta because I think they are important.

Although the placenta is an organ formed in your body, it is formed from the fertilized egg and has therefore the same chromosomal make-up as your baby.  It is your baby’s organ.  You are in essence eating an organ of the baby and the cells of your baby, albeit cells that are no longer needed.

Prion formation in the placenta.  When you eat placenta, you are eating human tissue.  What medically speaking is at issue here?  There are bad diseases out there caused by these misfolded proteins called “prions.”  Maybe you’ve heard of kuru or Creutzfeldt-Jacob Disease (CJD, pronounced in my med school as kroyts-field-yah-cub)?  These are prion disease which are unpreventably lethal to the affected person.  They are acquired by ingestion of tissue which carries the prion.  In the case of kuru it was the ingestion of human nervous tissue.  I know.  It is very strange that a protein can act as a an infectious-like agent.  But now to the money, increased expression of prion protein was found in placentas from mothers who experienced preeclampsia (a syndrome characterized by high blood pressure during pregnancy).  (12)  So could eating placenta lead to prion disease?  That’s a jump.  But one that I personally can’t get out of my head.

Heavy metals cannot be detoxified by the placenta and therefore will be in the placental tissue.

There are some reported side effects.  These listed come directly cut from Placenta Network (www.placentanetwork.com):

  1. Mild headaches (reported 3 times – we believe a lower dose is recommended to solve this problem)
  2. Stomach cramping or abdominal pain (reported once – possibly the result of bacteria growth due to improper storage of capsules)
  3. Stomach cramping for those also taking iron supplements (we recommend not taking iron supplements and placenta capsules at the same time)
  4. Pruritic urticarial papules and plaques of pregnancy (PUPPS) rash returning after 3 days of consuming capsules (reported twice)
  5. Pelvic girdle pain (PGP) sufferers feel less relief (we believe this is due to the high level of relaxin hormone in the placenta, which is the cause of PGP)
  6. Unexplained lack of milk production (reported from 4 women over the last 5 years)
  7. Emotional symptoms, stress, anxiety, depression (reported 5 times)

See more at: http://www.placentanetwork.com/placenta-encapsulation-faq-for-pregnant-mothers/#sthash.tYoHOajv.dpuf

Conclusion

I hope that I gave you a good overview of what to think about as you learn about placentophagy.  Reading only the enthusiastic advocates left me thinking I should swallow my “yuck” factor or else maybe I’d be missing out on this beneficial opportunity.  Digging deeper has allowed me to see a few reasons why placentophagy is not for me.

My mind doesn’t like to wrap itself around eating human tissue of my own child.  (I am not speaking for you.)  Prions frighten me a bit, and I don’t think we know enough about the factors which can cause them to increase in the human placenta.  And lastly, I cannot even tell you how badly my hips, groins, and pelvis hurt this pregnancy, and it started at 12 weeks along.  I am ready to be done with the hormone called relaxin, which is wreaking this havoc and pain on my body, and it looks like anecdotally relaxin’s effects can be prolonged with placentophagy.

Walk wisely in this world.  Warmest wishes.

~Terri

Sources:

  1. Young, Sharon M. and Benyshek, Daniel C. (2010)  “In Search of Human Placentophagy: A Cross-Cultural Survey of Human Placenta Consumption, Disposal Practices, and Cultural Beliefs”, Ecology of Food and Nutrition, 49: 6, 467 — 484.  (Link to full text)
  2. WB Ober.  Notes on Placentophagy.  Bull N Y Acad Med.  June 1979;  55(6):  591-599.  (Link to full scanned in text)
  3. http://placentabenefits.info/specialists.asp
  4. Mark B. Kristal, Jean M. DiPirro & Alexis C. Thompson (2012): Placentophagia in Humans and Nonhuman Mammals: Causes and Consequences, Ecology of Food and Nutrition, 51:3, 177-197.  (Link to full text)
  5. DiPirro, J.M.; Kristal, M.B. (2004).  Placenta ingestion by rats enhances delta-and kappa-opioid antinociception, but suppresses mu-opioid antinociception.  Brain Research, 1014:22-33.  (Takes you to a page where you can scroll, find the article and pull up the PDF.)
  6. MB Kristal.  (1991) “Enhancement of Opioid-Mediated Analgesia:  A Solution to the Enigma of Placentophagia.”  Neurosci Biobehav Rev 15(3) 425.
  7. Hammett F.  (1918)   “The Effect of Ingestion of Desiccated (dried) Placenta on Milk Production.”  The Journal of biological chemistry.  Volume 36: 569-573.  (Link to a Free Google ebook)
  8. Blank MS, Friesen HG.  “Effects of placentophagy on serum prolactin and progesterone concentrations in rats after parturition or superovulation.”  J Reprod Fertil November 1, 1980 60 273-278.  (Link to abstract, but the full text is available.)
  9. Jodi Selander , Allison Cantor , Sharon M. Young & Daniel C. Benyshek (2013):  Human Maternal Placentophagy: A Survey of Self-Reported Motivations and Experiences Associated with Placenta Consumption, Ecology of Food and Nutrition, 52:2, 93-115.  (Link to abstract where you can further link to full text.)
  10. http://www.placentanetwork.com/new-placenta-research-study-randomised-double-blind-placebo-trial-2014/
  11. Ilona S. Yim, PhD; Laura M. Glynn, PhD; Christine Dunkel Schetter, PhD; Calvin J. Hobel, MD; Aleksandra Chicz-DeMet, PhD; Curt A. Sandman, PhD.  “Risk of Postpartum Depressive Symptoms With Elevated Corticotropin-Releasing Hormone in Human Pregnancy.”  Arch Gen Psychiatry. 2009;66(2):162-169. (Link to full text.)
  12. Hwang HS, Park SH, Park YW, Kwon HS, Sohn IS.  “Expression of cellular prion protein in the placentas of women with normal and preeclamptic pregnancies.”  Acta Obstet Gynecol Scand.  2010 Sep;89(9):1155-61. (Link to abstract.)

Splitting Apart in Pregnancy: Diastasis recti

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Today marks my entry into 37 weeks of pregnancy.  Likely, at least three more weeks to go as my body’s smooth muscle doesn’tPregnant belly in black and white seem to appreciate moving spontaneously, and I don’t have a pattern of early births.  (Sigh.)  Yeah, the last month of pregnancy hurts, but I try to savor the appreciation of how my family and life is right now, knowing that although it will be better, it will never be the same again.  This week I am hoping to push out several personal posts on pregnancy because once this pregnancy is over, I plan to not be lookin’ back.  Severe joint pain, nausea, headaches, moodiness, exhaustion, and constipation are not my cuppa’ tea.  However, definitely before I leave this golden field behind and while it is still fresh in my mind, I want to write a post on diastasis recti in case anyone else out there is dealing with this.

What is this strange pain?

I had heard of and seen things like round ligament pain, symphysis pubis pain, sacroiliac joint pain, acid reflux pain, and so on in training.  But early in the third trimester of my first pregnancy, I developed a very strange stretching, burning, pulling type of pain in the midline of my abdomen.  I knew from experience it wasn’t something serious–nothing coming from my internal organs.  But, dang!  It was uncomfortable!  I felt like my midline was literally being torn apart!  I asked my girlfriends who had been pregnant about it.  Nothing.  I asked my OB about it.  Nothing.  Just one more lovely thing about pregnancy to add to the tally!  And it was uncomfortable!

Post-delivery of Baby One

After pregnancy, I noticed when I’d sit up in bed, my midline abdomen would bulge out like one of those old-fashioned water bottles!  My husband, being the musculoskeletal expert in our family, said, “Hey!  You have a diastasis recti!”  My OB confirmed that’s what I had and felt it would improve with time.  It didn’t.  Okay.  It did improve some.  But I could still shove a ball somewhere between the size of a golf and tennis ball where my belly button used to be.  Beautiful.  Simply beautiful.  The battle ground of my belly.  I will never see the belly button of my childhood days again.

What is diastasis recti?

Think of a bodybuilder with the perfect six-pack (the six-pack muscle is made of several parts and is scientifically called the rectus abdominus muscle) .  The line dividing the six-pack right in half down the middle, placing 3 “soda pops” on either side, is called the linea alba (the “white line”).  Smack dab there in the middle from the top to the bottom of your midline, where your belly button lives, there is no muscle.  All that is there is a strong layer of connective tissue between the two halves of muscle, the linea alba.

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When that strong layer of connective tissue becomes stretched wider and thinner than it ought to be, it is called a diastasis recti.  This can frequently occur in pregnancy with all the stretching due to size and hormonal changes that occur to loosen up our tendons and ligaments to allow our bodies to accommodate and deliver the baby.  It makes good sense for that sheath to be able to stretch out during pregnancy!  Unfortunately, in some women, the diastasis is quite large and doesn’t ever return to normal (or even close to normal).  These women have “mummy tummy,” distorted belly buttons, billowing out of the abdominal contents with abdominal wall contraction or gravity, and problems with core body strength!  If women don’t know about this condition, they may wonder why in the world their abdomens don’t shrink no matter how “skinny” they get!

I know for me, I was left with a large crater for a belly button, lots of extra skin right around the belly button, stretch marks only around the belly button, and a large ballooning out of the midline with trying to sit up.  On bad diastasis days, I get the “Mommy, you look pregnant” remark.  (That is–before I WAS pregnant!  In pregnancy, with a diastasis recti, you seem to really “pop” big in the first trimester and always look further advanced than you really are.  Another sigh.  How many times do you have to listen to the “Man!  You are big!” remark?)

My Subsequent Pregnancies and Discovery of an Umbilical Hernia

I didn’t really get any more of that horrible stretching sensation where it felt like I was splitting apart with Baby 2 or Baby 3.  I guess I was as split as I could be.  Shortly after Baby 3, I developed a kidney stone, requiring an abdominal CT scan.  The scan, aside from the kidney stones, showed that I also had an umbilical hernia–an actual hole in the linea alba right there at the belly button.  After a visit to my general surgeon for consultation, it was decided that the hernia was large enough that it would not “strangulate” any bowel.  With an umbilical hernia, sometimes loops of intestine can squeeze through the hole and get their blood circulation cut off.  The intestinal tissue strangulates and dies, leading to an exceptional emergency situation.  My hernia was big enough to let my intestine slip in and out unimpeded.  Yippee.

I carried on.  For me, it was a cosmetic issue only.  No bikinis or half-tanks.  Carefully chose apparel.  It never interfered in my ability to exercise and work-out.  I didn’t do traditional sit ups.  I wore Spanx if I had to for special occasions.  No biggie for me.  (I know other women have different stories to tell.)

Don’t Touch My Midline…

Then, I became pregnant again with Baby 4.  Ooh-la-la.  Ouch.  At about 13 weeks, when horrible bloating hit, my midline felt that horrible stretching sensation again.  Kind of like someone taking your ankle or shoulder and contorting the ligaments and tendons in positions they aren’t meant to go.  And it hurt and has only let up here and there throughout the pregnancy.  Coughing, bloating, laughing, trying to get off the couch or bed, and sometimes just sitting are painful events.  Pain like my kidney stone?  No.  But painful still.  And PLEASE don’t touch my belly in the midline!  The sides, where I still have good tissue support–fine, touch and push like the dickens.  But please not the midline!  Another wonderful blessing of a diastasis recti is the visibility of the uterus and baby parts right there seemingly under your skin!  Like it’s going to fall out of there or something!

The Belt

Baby Belly BandTo help with the pain, I invested in a belt after researching a bit on-line.  The belt helps.  Not completely.  I don’t wear it all the time because I don’t want to lose the core abdominal strength that I do have.  But when I feel the tearing pain increasing, I put it on and it kind of lifts up my belly, taking pressure off of the damaged linea alba.  Sometimes I wear it at night after a bad day.  Sometimes I wear it on a long walk.  If I’m having bad bloating, which also hurts it, I will wear the belt, too.  It comes with extra attachments.  (Doesn’t that sound so funny!?  Attachments.)  I have the “suspenders” and the “extra cinch” piece.  Here in the last 6 weeks I have just started needing to occasionally use the suspenders and extra cinch.  Before this point, simply the belt seemed like enough, as it is adjustable and has grown with me.  The belt is soft, but my pregnancy belly is itchy no matter what so I always wear the belt over a cami or undershirt.  A last point on the belt:  I have found that it helps my sacroiliac joint pain also.  Again, it doesn’t remove all the pain, but it really does reduce it.  I have never had another belt to try, so this is the only one I can vouch for.  To me, it has been worth it.  The belt I purchased was Baby Belly Band.  This is NOT a thin, stretchy type band to use for aesthetics or mild support.  I have those, too, and they are not the same deal.

Precautions I take

Although I’m an independent cuss, this pregnancy, with that ripping sensation resurfacing (at least in my mind telling me that my hernia is probably enlarging), I have turned over most all lifting so as to not make matters worse.  Makes me so mad to have to have others lift my water jugs.  To lift me up.  To move the furniture around.  To lift my sick 5-year-old.  But I know that is best and probably should have been standard with Baby 1!  I remember being in fine nesting mode with Baby 1, moving the couch here and there and snowblowing after a blizzard in the last trimester.  If this is you, stop it now!  🙂

I try to not use my abdominals to get up off the couch, bed or floor (when I make it down there).  I either wait for help up or use every ounce of arm strength to push myself up to some position where I can use my legs.  In addition to asking for help with pretty much all that requires abdominal use, I’ve rigged up a rope system to use to help me pull myself up out of bed at night for the standard 5 trips to the bathroom.  (I hide it when the cleaning lady comes.  Who knows what she might think that’s for!  As if!  LOL!)

Is there a way to fix it?

As this is a personal post, speaking off the top of my head, I’m not going to go into much detail.  There are surgical procedures that can be done.  The technique offered will differ based on many factors, including whether or not you have a hernia and even what kind of surgeon you seek out to do your procedure.  Many insurances will not cover this unless you are having some medical issues related to the diastasis/hernia.  Also, many doctors don’t recommend fixing them unless you are done with pregnancies.  So if I HAD had my diastasis/hernia repaired, the result could have been compromised by my current pregnancy.

Alternatively, there are physical therapy programs out there which try to address the diastasis.  There are a few of them which I’ve read about.  Some people report good success and some don’t.  (Imagine that.)

There are binders out there.  This is not a fix, but I know that my diastasis is hugely apparent during the months after delivery.  At this time, I do often wear a binder to “hold it all in.”  It doesn’t work permanently for me, and again, I like to make sure I’m never putting my own core abdominal strength in peril due to a binder, but it does “bring it all in” temporarily for me.  This is different from the belt/band I describe above.  It is much wider to wrap around your entire midline section–or at least much of it.

Closing

So if you have this splitting feeling in your midline with pregnancy which you’ve discussed with your doctor to rule out the “bad stuff,” maybe check out the term diastasis recti on a computer search.  Or, if after reading this you think, “Yeah!  That’s me!  I have a diastasis recti still!”  Search.  You’ll find a lot more than I’ve got summarized here.  This post was not for diagnosis or treatment.  It was a sharing of my story to heighten awareness.  Wishing you joy in parenthood and life.

~Terri

Iodine Post 4, Pregnancy

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Personal Anecdote

One of the most serious effects of iodine deficiency is damage to a fetus.  (Echo:  Damage to a fetus…damage to a fetus…damage to a fetus.)  Iodine deficiency wasn’t on my radar when I conceived last fall!  I had had no dairy, no eggs, and no iodized salt for at least a year and a half, and I was taking no iodine supplementation, prenatal vitamin or otherwise.  So I have to wonder about my iodine status prior to pregnancy and in early pregnancy.  Early in pregnancy, I was too sick to tolerate a prenatal vitamin, and both my doc and I agreed that all I probably really needed to be sure to choke down was a folic acid supplement to prevent neural tube defects.   (Strangely enough with the food and smell aversions, in my first trimester, I could not get over the urge to eat any and all kinds of seafood, which is a good source of iodine:  sardines, oysters, mussels, clams, mahi mahi, tuna, shrimp, scallops, soft-shelled crabs, Nori, and dulse–you name it.  I threw seafood cautions to the wind and gobbled that stuff down, since nothing else sounded good!  Anecdotal but interesting.)

I wish someone would have told me that my best sources of iodine had all been removed from my diet, and even with them included, I would still have been at risk for iodine deficiency.  So if you’re dairy-free, skipping iodized salt, vegan, intolerant or allergic to eggs, autoimmune Paleo, or follow a crazy diet (I can say that because I follow a crazy diet.), please just make it a point to make sure you’re getting sufficient iodine.  And as always, don’t use anything on my blog as medical advice.

Not good.  Statistics show that pregnant women’s iodine intake and levels are not sufficient and are continuing to decrease.

In the United States, there is a periodic survey which evaluates how our iodine intake is doing, the National Health and Nutrition Examination Survey (NHANES).  NHANES has revealed that urinary iodine levels for pregnant and non-pregnant women in the United States have dropped significantly since the early 1970s.  Adequate urinary iodine levels for pregnant women should be 150-249 micrograms/L (based on the World Health Organization standards).  The United States has hovered around and then dropped below this point:

  • 1971-1974:  327 micrograms/L
  • 1988-1998:  141 micrograms/L
  • 2001-2006:  153 micrograms/L
  • 2005-2010:  129 micrograms/L  (Goal is greater than 150 micrograms/L) (1, 2)

In the most recent survey, some regions such as California and Pennsylvania were alarmingly low, 105 and 125, respectively.  And this doesn’t even take into account the interfering factors of halides in our food and environment which interfere despite levels of iodine!

So what does low iodine mean for pregnant women and their babies?  (Not good.)

IodineIodine deficiency can lead to what is called “reproductive failure” in the female, which simply refers to repeated miscarriages and increased stillbirths.  The more severe the iodine deficiency, the more the risk increases.  One study showed that the frequency of reproductive failure was directly proportional to the severity of the iodine deficiency.  Women who had iodine deficiency had twice the risk of reproductive failure.  (There are many causes of “reproductive failure” besides iodine deficiency.  Other nutritional factors such as selenium deficiency could also be responsible for reproductive failure.  And aside from nutritional factors, there are many other causes, as well.  So I am not saying, “Iodine is it.”  Please don’t think that.) (3)

Known iodine deficiency effects on the fetus are numerous and include:

  • Increased miscarriages (loss before 28 weeks of pregnancy)
  • Increased stillbirths (loss after 28 weeks of pregnancy)
  • Increased premature births
  • Congenital anomalies (birth defects)
  • Increased perinatal morbidity and mortality (increased bad outcomes and death occurring shortly before or after delivery)
  • Cretinism (mental retardation with changes in stature, hearing–often a high tone defect, and sometimes the inability to use arms/legs due to severe rigidity)
  • Goiters in newborns
  • Hypothyroidism in newborns
  • Mental retardation
  • Lower IQ (3, 4, 5)

Medical literature supporting iodine’s role in producing a healthy, in utero fetus and subsequent neonate is NOT hard to find!

All degrees of iodine deficiency…affect thyroid function of the mother and the neonate as well as the mental development of the child. The damage increases with the degree of the deficiency…

Iodine deficiency results in a global loss of 10–15 IQ points at a population level and constitutes the world’s greatest single cause of preventable brain damage and mental retardation. (5)

When a mom is iodine deficient, iodine deficiency is passed on to the developing fetus who has NO way of getting iodine or thyroid hormone except through the mom.  You are it, Mama.

When a woman becomes pregnant, her baby absolutely relies on the mom’s thyroid hormone, which requires iodine to be made.  The baby cannot make its own thyroid hormone until later in the pregnancy, and even then, it still needs iodine provided by mom as the raw material for its own thyroid hormone production. 

Iodine is 100% necessary for the production of thyroid hormone, and if it is not sufficient, then the mother and baby will be exposed to hypothyroidism (lack of thyroid hormone).  Thyroid hormone is necessary for the function of all cells and is critically important for brain development, especially in a fetus and newborn.  Thyroid hormone helps to make sure that the fetus’s cells grow, develop, differentiate, and express the right genes.

Most health organizations recommend about 150 micrograms of iodine daily for non-pregnant adults, but iodine needs increase when a woman becomes pregnant.   To make more thyroid hormone to cover the baby’s needs, the woman needs more iodine.  She also needs more iodine because during pregnancy, the blood filtration through the kidneys increases and extra iodine is lost in the urine during pregnancy.

It doesn’t end with pregnancy, either.  Nursing mothers need more iodine because the iodine is transferred to the baby Saltby her milk.  The baby still needs iodine. (6)

The developing brain of the fetus is probably the most vulnerable target organ for iodine deficiency.

First Growth Spurt of the Brain

The developing baby’s brain has two major “growth spurts.”  The first one is at 12-20 weeks (months 3-5).  During this first one, the brain cells (neurons) are rapidly multiplying, moving to their correct places, and organizing themselves appropriately.  Studies indicate that iodine repletion should occur by three months of pregnancy to prevent cretinism (severe mental retardation, deaf/mute, and effects on the arms and legs).  Most of us in developed countries probably won’t fall into iodine deficiency enough that cretinism would develop, but I think it may be revealing in other neurological conditions as well, that getting the iodine levels back up in the first trimester is probably optimal.  However, even if the first trimester is missed, iodine supplementation still shows beneficial effects in pregnant women and their fetuses.

Second Spurt

The second spurt of brain growth occurs in the third trimester and doesn’t finish until the child is 2-3 years old!  This spurt allows the cells that support the brain’s neurons (knows as “glial cells”) to multiply, move to their appropriate places, and to become coated with myelin.  By the time of the second spurt, the baby has a functioning thyroid, so it doesn’t rely on mom for thyroid hormone anymore, per se, but it relies on mom for its source of iodine.  If mom is not eating enough iodine, baby still can’t make thyroid hormone for itself and its brain.  If mom didn’t get enough iodine in the first trimester, damages can still be minimized.

“Correction of iodine deficiency during the second trimester reduced neurological abnormalities, increased head growth, and improved the development quotient in a severely iodine-deficient area of western China. Correction at a later period did not improve neurological development, although there was a trend toward slightly larger mean head circumference and higher development quotients than in untreated individuals. ”  (6)

There is a spectrum of how insufficient iodine levels affects the fetus.

“Mental retardation from iodine deficiency is not limited to the extreme form of cretinism, but instead extends over a broad continuum to mild intellectual blunting that may go unrecognized unless carefully investigated. Thus, iodine deficiency puts virtually everyone in the affected population at some risk for brain damage. Many studies have compared performance of iodine-deficient children with that of iodine-sufficient peers on standardized intelligence tests…iodine deficiency lowered a mean intelligence quotient by 13.5 points. In view of the many people living in iodine-deficient areas and their vulnerability to its effects on the developing brain, these numbers indicate a staggering public health problem. This and neonatal mortality, rather than goiter, have become the main reasons for advocating urgent correction of iodine deficiency.”  (6)

Severe iodine deficiency and cretinism:  The most notable and sad outcome of iodine deficiency, as it is completely preventable, is cretinism.  I have read that early Alpine explorers would come across entire villages of “cretins” isolated in the mountains.  These local pockets of population lived off of iodine deficient land, and it wasn’t until food started coming in from elsewhere and iodine supplementation was implemented in the 1900s that the incidence of cretinism was reversed.  At the time, doctors and people in general felt it was something “in the air”  or “in the water” of the valleys or perhaps a “genetic fault.”  Cretinism presents with:

  • Short stature
  • Mental retardation
  • Deaf and mute
  • Spasticity of limbs (the arms and legs can draw up tight and not extend properly)

Mild iodine deficiency:   Mild iodine deficiency effects are more pervasive and not as concrete to pinpoint.  Children from low iodine pregnancies have been found to have:

  • Lower IQs
  • ADHD
  • Elevated hearing thresholds/ hearing loss (4, 7, 8)

Dr. Jerome Paulson, chairman of the American Academy of Pediatrics council on environmental health says this in May, 2014 for NBC News:

“The brain development issues are very subtle and are not likely to be noticed in an individual child.  It’s an issue for society as a whole when you have a large number of children who are not reaching their full potential.” (9)

If iodine deficiency is increasing in our pregnant women, wouldn’t congenital hypothyroidism in the newborn be increasing?

So as I typed this post up, I thought, well–if iodine deficiency is creeping up among our pregnant patients, then our babies should have a higher risk of hypothyroidism (low functioning thyroid).  In fact, a month ago, my hairdresser was telling me about her good friend whose baby just wasn’t very active.  They checked, and it was hypothyroidism.  I’ve never really looked at or been notified about increases in newborn hypothyroidism (congenital hypothyroidism) in any of the journals I subscribe to, so I Googled it.  (Because low thyroid function is SO detrimental to a newborn’s health and brain function, one of the tests mandated by every state in the newborn screening poke includes a test for congenital hypothyroidism.)  Sure enough, there is a rise of congenital hypothyroidism.  I cannot and will not say it is due to maternal iodine insufficiency because I think most health problems are usually caused by a combination of factors, but I certainly am suspicious about iodine deficiency’s role in this.  In Krakow, Poland, before the introduction of iodized salt, 1 in 3920 newborns had transient hypothyroidism, and after the introduction of iodized salt, the rate dropped to 1 in 48,474. (2)  Experts are also considering the roles of perchlorate (a toxic byproduct of rocket fuel and fireworks production) exposure, as these seem to be contaminating our environment and entering our bodies, interfering with thyroid use of iodine, and whether use of iodine-containing disinfectants at the time of birth could contribute. (2, 10)

So why don’t we just put our pregnant women on iodine and crank her up good?

Case studies show reports of hypothyroidism in significantly iodine supplementing moms:  So you’re a natural person.  You’re not afraid of supplements.  You’re pregnant, and you think you’re going to run out and start loading up on iodine.  Not so fast.  There have been cases of congenital transient hypothyroidism in newborns from maternal iodine supplementations, at doses of about 12.5 mg.  Whoa.  I would never want a baby to have hypothyroidism from over-supplementation!  On the other hand, I think this area should be explored better.  Was the mom supplementing other important nutrients needed along with iodine?  How transient would the hypothyroidism have been in the baby?  If the mom had kept supplementing, would the thyroid disorder have stabilized naturally?  But we don’t know the answers to these nebulous questions, and so I accept that too high of a dose of iodine in pregnancy may be dangerous to the baby as well!  On iodine deficiency in pregnancy, it is probably best for the iodine naïve woman to err on the side of recommended amounts. (11)

Prenatal vitamins:  Slowly, recommendations are moving toward making sure women get iodine in their prenatal vitamins, and word is getting out there. NBC News had a little blurb on their site about it in May 2014. But, in my opinion, the information still is not out there to women OR their obstetricians.  I just don’t think obstetricians are aware of iodine deficiency numbers in pregnant women, and I would venture to say many (most?) obstetricians don’t look at the prenatal vitamins their patients take!  Only about 50% of prenatal vitamins in the United States contain iodine!  And if they do contain iodine, the iodine content may vary by up to 50% of what is on the label. (1, 12)  The American Thyroid Association recommends that all prenatal vitamins contain iodine, 150 micrograms. (13)

Best to get iodine optimized BEFORE pregnancy:  This is good, but I feel iodine sufficiency needs to be in place WELL BEFORE pregnancy!  If our pregnant women are low, that must mean that our child-bearing population is riding completely on the edge.  In addition, it may be that some of the ill effects seen with iodine supplementation have to do with the iodine status of a person in the long-run!  So the more iodine sufficient a person is their whole life, the more they tolerate extra supplementation without conversion to hypothyroidism.  Dr. Elizabeth Pearce et al report on a study from Sicily which shows that moms who re-introduce iodized salt in the first trimester after having been off of it for two years have markedly increased risk of mom being hypothyroid!  However, in patients who had used iodized salt routinely prior to pregnancy for two years, the risk of hypothyroidism in mom was much less (although not absent). (14)

Conclusion:

Iodine deficiency is absolutely a problem in many pregnant women.  Iodine should optimally be sufficient in the first trimester, and unfortunately this is often a period when women are not aware that they are pregnant or they are too ill to take a prenatal vitamin with iodine or eat iodine containing foods.  I think that brings us back to the idea that we are functioning, many of us as a population, on a near empty tank of iodine to begin with.  Adequate iodine intake should occur BEFORE pregnancy.  I hope you are taking note and continue to take inventory of you and your family members’ sources of iodine.  Eventually, after I summarize why in the heck we need iodine, I will do a more detailed post on iodine content of foods.  You can see some basic summaries of this in my previous iodine posts.

I would like to tell you that your doctor, especially your obstetrician, is up on this.  And maybe they are.  But I have a sinking feeling most are not.  If getting pregnant is possible for you, it is best to start thinking about iodine intake today.

Sorry for the long post.  Hope those interested found some tidbits to ponder.

~~Terri

Citations:  

1.  Kathleen L. Caldwell, Yi Pan, Mary E. Mortensen, Amir Makhmudov, Lori Merrill, and John Moye.  Iodine Status in Pregnant Women in the National Children’s Study and in U.S. Women (15–44 Years), National Health and Nutrition Examination Survey 2005–2010.  Thyroid.  Volume 23, Number 8, 2013.  (Link to full text)

2.  John S Parks, Michelle Linn, et al.  The Impact of Transient Hypothyroidism on the Increasing Rate of Congenital Hypothyroidism in the United States.  PEDIATRICS Vol. 125 No. Supplement 2 May 1, 2010. pp. S54 -S63.  (Link to full text)

3.  Dillon, J. C. and Milliez, J. (2000), Reproductive failure in women living in iodine deficient areas of West Africa. BJOG: An International Journal of Obstetrics & Gynaecology, 107: 631–636. doi: 10.1111/j.1471-0528.2000.tb13305.x.  (Link to full text)

4.  Cresswell Eastman and Michael Zimmerman.  Chapter 20:  The Iodine Deficiency Disorders.  Thyroid Disease Manager.  Online.  Updated February 12, 2014.  (Link to online text.)

5.  F Delange.  Editorial:  Iodine deficiency as a cause of brain damage.  Postgrad Med J 2001;77:217-220 doi:10.1136/pmj.77.906.217 (Link to full text)

6.  John Dunn and Francoise Delange.  Damaged Reproduction: The Most Important Consequence of Iodine Deficiency.  The Journal of Clinical Endocrinology & Metabolism. 2001 86:6, 2360-2363.  (Link to full text)

7.  DeLong GR, Stanbury JB, Fierro-Benitez R. Neurological signs in congenital iodine-deficiency disorder (endemic cretinism).   Dev Med Child Neurol. 1985 Jun;27(3):317-24.  (Link to abstract)

8.  Alida Melse-Boonstra, Ian Mackenzie.  Iodine deficiency, thyroid function and hearing deficit: a review.  Nutrition Research Reviews.  2013 Dec;26(2):110-7. doi: 10.1017/S0954422413000061. Epub 2013 Jun 12.  (Link to abstract)

9.  NBC News Online.  Link:  http://www.nbcnews.com/health/womens-health/pregnant-women-need-iodine-supplement-doctors-say-n113326

10.  Richard S. Olney, MD, MPHa, Scott D. Grosse, PhDa, Robert F. Vogt Jr, PhDb.  Prevalence of Congenital Hypothyroidism—Current Trends and Future Directions: Workshop Summary.  PEDIATRICS Vol. 125 No. Supplement 2 May 1, 2010
pp. S31 -S36 .  (doi: 10.1542/peds.2009-1975C)  (Link to full text)

11.  Kara Connelly, MD, Bruce Boston, MD, Elizabeth Pearce, MD, David Sesser, David Snyder, MD, Lewis Braverman, MD, Sam Pino, Stephen LaFranchi, MD.  Congenital Hypothyroidism Caused by Excess Prenatal Maternal Iodine Ingestion.  The Journal of Pediatrics.
Volume 161, Issue 4 , Pages 760-762, October 2012.  (Link to full text)

12.  Angela M. Leung, M.D.,  Elizabeth N. Pearce, M.D., Lewis E. Braverman, M.D.  CORRESPONDENCE:  Iodine Content of Prenatal Multivitamins in the United States.  N Engl J Med 2009; 360:939-940February 26, 2009DOI: 10.1056/NEJMc0807851.  (Link to full text)

13.  Public Health Committee of the American Thyroid Association, Becker DV, Braverman LE, Delange F, Dunn JT, Franklyn JA, Hollowell JG, Lamm SH, Mitchell ML, Pearce E, Robbins J, Rovet JF.  Iodine supplementation for pregnancy and lactation-United States and Canada: recommendations of the American Thyroid Association.  Thyroid. 2006 Oct;16(10):949-51.

14.  Elizabeth N. Pearce.  Iodine in Pregnancy: Is Salt Iodization Enough?  J Clin Endocrinol Metab. Jul 2008; 93(7): 2466–2468.  doi: 10.1210/jc.2008-1009.  PMCID: PMC2453047  (Link to full text)

Great overview of hypothyroidism in pregnancy adn a section on iodine:

Click to access The%20Regulation%20of%20Thyroid%20Function%20in%20Pregnancy.pdf

Iodine Post 2, More Iodine Introduction and Review to Lead Up to Iodine in Fertility

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Today continues on in the long, arduous, controversial trek that is iodine.  For this post, I had wanted to take a critical look at how iodine affects fertility, both male and female, and pregnancy.  The post was too long, so I am splitting it into three parts.

  1. More iodine introduction and review today because I want to stress again how iodine deficiency may be present despite the common medical community saying it isn’t in industrialized/developed countries.
  2. Iodine and pre-conceptual/conceptual fertility tomorrow or so, as time allows me to get my citations in somewhat presentable documentation form.
  3. Iodine and post-conceptual fertility/pregnancy the post or so after that.  (Notice the “or so?”  Moms always learn to be wishy-washy on timing of events, right?)

I spent a long time searching about fertility and iodine, and thus my absence in publishing blog posts lately.  One article and question always leads to another and another.  Despite looking high and low, I will make no great conclusions regarding iodine and fertility.  Sorry.  Hypothyroidism (low functioning thyroid gland) and hyperthyroidism (over-functioning thyroid gland)  clearly do play a role in male and female fertility, but connecting the dots to iodine has not been performed much yet in research studies.  However, we DO know that iodine deficiency is one cause of hypothyroidism.

My take, off the  cuff, without sources and science, regarding iodine

Although we absolutely need iodine, our bodies seem to become adjusted to regulating our thyroids and bodily systems based on how much iodine we give them.  Our bodies make do, down-regulating this pathway and up-regulating that pathway, until a critical iodine low point at which the system fails and you see the serious consequences of overt hypothyroidism and offspring with severe deficits, such as mental retardation.  Before that severe iodine deficiency crisis hits, there are varying degrees of “normal” a body can manage to function at in different people with the iodine amount provided–which probably aren’t really “completely normal” functioning states but good enough to sustain life and reproduction with little noticeable compromise.

To significantly replace iodine at this point, when a person is “low in iodine” but functioning “okay” (where the body has managed to find a nice “homeostasis” regarding iodine use), can do one of three things.  It can:

  • 1)  Benefit the body without negative thyroid side effects (the goal and the most common outcome).
  • 2)  Bring about a hypothyroidism.
  • 3)  Bring about a hyperthyroidism.

If a person is already hypothyroid from low iodine intake, even if mildly so, hopefully iodine replacement will allow the body to start optimizing its iodine use for improved thyroid function and the functioning of other tissues that use iodine, such as the ovaries, breasts and prostate without any ill effects.  In fact, most people do fall under the umbrella of tolerating iodine supplementation just fine and benefitting from it, but doctors worry a lot about iodine bringing about hypothyroidism and hyperthyroidism in what were observably “normal” people.  And this does happen.  Cruise the internet for research studies and iodine supplementation anecdotes, and you’ll see good and bad outcomes.  (To optimize replacement with the least amount of negative thyroid response, iodine supplementation needs to be taken along with some other important co-nutrients: selenium, vitamin C, and zinc.  This is a topic for another post.)  Iodine is a mixed, controversial medicine bag.

As an obvious reminder, don’t use anything in my posts as medical advice, only use it for introductory informational purposes.  The internet is a not a doctor.  And there can be huge risks from implementing what you find on internet health sites.  Walk cautiously, and find a healthcare person you DO trust to talk things over with.

Let’s remind ourselves of why a person would be iodine deficient from the last Iodine Post and then eventually move on to what I could find regarding iodine on male and female pre-conceptual/conceptual fertility tomorrow…

Iodine deficiency erratically riddles the population of developed societies.  Why?  Who is at risk?  Am I?  Are you?  Why do they say we are “iodine sufficient” if we are not?

Why would well-fed people be iodine deficient?

(I am omitting the discussion of goitrogenic foods and halides, which put people at risk for iodine deficiency disorders, Grand Caymandespite adequate iodine intakes.  I will discuss those in later posts.  It is an important topic which needs its own post.)

Real food iodine sources primarily include dairy, eggs, ocean seafood, and seaweed.  Iodine can be a dietary toughie to get because levels of iodine fluctuate greatly EVEN IN THESE REAL FOODS.  I would like to contrast this with nutrients such as B vitamins and magnesium, which although they are diminished in our modern food sources, they are abundant in MANY, diverse food sources which people eat, especially real food advocates.

  • Milk iodine content will vary depending on if the grass cows eat has iodine (Are they grazing on coastal pastures or iodine-deficient Great Plains grass?), if cows are supplemented with iodine-containing feed, and if iodine containing washes are used prior to milking.
  • Egg iodine content will vary depending on if the chickens are fed iodine supplemented chicken feed or not.
  • Vegetables and plants have no need for iodine, although they will take it up from the soil, passing it graciously on to us.  Most soils away from the ocean coasts are iodine deficient (iodine is most abundant in ocean water, which falls on the land in the form of the rain cycle, replenishing coastal soil and plants with iodine from the sea), so eating “locally grown” food from iodine deficient soils will provide less iodine content.
  • Meat iodine content will vary, again based on what animals are fed or where they are grazing.
  • Sea salt mostly has only trace amounts of iodine.
  • Bread products use bromine rather than iodine-type dough conditioners, like they used to.  (Heck, homemade bread doesn’t use either!)  I realize to some readers that bread is a processed food, but it is eaten by most people.  And the replacement of iodine-based dough conditioners for bromine-based dough conditioners, which interfere with iodine utilization in the body, plays a significant role in iodine deficiency disorders and the decreasing amount of iodine intake in the United States.
  • Seafood and seaweed’s iodine content vary by the kind of seafood but is usually a lot more predictable than the foods listed above.

Who is at risk?  Examples.

If you stop and think, you can easily identify why people would be iodine deficient:

Case 1:  An American woman who is dairy-free, doesn’t like seafood, and who has switched over to non-iodized sea salt because she thinks it tastes better.  She still eats bread, but her bread has no iodine, and in fact does use a bromine derivative for dough conditioning.  Hopefully she eats eggs and lives on the coast.

Case 2:   An American college student who eats only bagels, cereal bars, or Pop Tarts for breakfast, sandwiches with chips at Subway for lunch, and some freezer-kits for supper.  All these processed foods may not provide enough iodine, since non-iodized salt is used.  Hopefully, some iodine is sneaking in through the cheese and eggs used in the products chosen.  But we don’t know.

Case 3: A family in Australia who eats strictly organic, without realizing that studies show that organic dairy has less iodine, organic bread in Australia has no iodine, and their fruits and vegetables are grown in an iodine depleted area.  They worry about mercury and radiation in seafood, and one child has an egg intolerance/allergy, so they shy away from eggs.  I’m not sure where this family gets enough iodine.  Maybe they take a multivitamin.

Case 4:  A 67-year-old man who has lactose intolerance, who shuns salt because of blood pressure issues, who only eats the egg whites (not high in iodine) due to cholesterol concerns, and whose wife doesn’t like fish at all.

Case 5:  A vegan who eats no dairy, no eggs, no meats, and no seafood.  She could eat seaweed but doesn’t like the taste.  Iodine intake is not lookin’ good.

Why do they say we are “sufficient” if we are not?

(Emphasized phrases are bolded by me.)

From The Proceedings of the Nutrition Society, 2010:

The WHO [World Health Organization] prevalence data emphasise that iodine deficiency is not only a problem of developing countries; the highest prevalence of iodine deficiency is in Europe (52.0%), where the household coverage with iodised salt is the lowest (approximately 25%), and many of these countries have weak or nonexistent control programmes for iodine-deficiency disorders. (1)

and The American Journal of the Medical Sciences, 2009:

IDD [iodine deficiency disorder] can occur in iodine replete-environments. A high index of suspicion is needed to recognize these cases. It is pertinent that the correct diagnosis be made to avoid unwarranted life-long thyroxine therapy in patients presenting with goiter and hypothyroidism, which is easily treatable with iodized salt. These cases underscore the need for considering iodine deficiency in the etiologic diagnosis of goiter and hypothyroidism, even in iodine sufficient regions. (2)

From my research, I am concluding that iodine deficiency is insidiously surfacing in individuals and small subpopulations (for example, pregnant women, vegans, or those with multiple food intolerances) in many developed countries, probably riddling whole populations like a shot-gun due to unique dietary patterns and habits of individuals and their families.  How is it that the medical community, chomping on their brominated office donuts, sipping their Coffee-Mate tainted coffee, and brushing their teeth with fluoridated Crest, may be slow to recognize this?  (Yes.  This was me.)  Well, when the scientific community prudently checks to see if an area is getting enough iodine, they look at levels as a POPULATION, not in individuals.  To determine the iodine sufficiency of an area, “on-the-spot” urines are checked for iodine in a sample of hopefully “representative” people.

Swimming with sting raysSpot checks of urine for iodine content are known to be erratic and insensitive, so they can’t be used to determine true iodine status of an individual, but when they are collected and pooled together an overall snapshot of the area (or population) in question can be gained.  The median (That’s the number that occurs in “the middle” when all the result values are lined up from smallest to greatest–it is not the average/mean.) is then used to determine if the tested population is iodine sufficient.

The median value determined can still “hide” a significant amount of the population who may be deficient.  What values are on the low side of the median?  How low do they go?  If most people in the community who are checked use iodized salt and drink milk, well, those folks are probably iodine sufficient and pooled results tell the researchers that “all is well.”  However, if you and your family don’t drink milk and skip iodized salt, plus you all hate seafood, your low urinary iodine spot check will be lost on the low side of the median.  You’ll be told your community or population is iodine sufficient, and you won’t change a thing you eat.  Iodine deficiency affects us as individuals, but unfortunately, iodine evaluations are made based on populations.  True, accurate testing in individuals is pretty intensive.  It requires a 24-hour urine collection, and so just getting “eyeball” spot urine results and pooling them together makes the most sense for determining a society’s iodine status. (3)

Bottom Line

So as I did in the last post, I encourage you to take inventory of your family’s commonly eaten foods to see if you may be at risk for mild iodine deficiency despite your government and medical societies saying: “There is no concern of iodine deficiency in the United States (or Australia, France, etc.).”  I’ll bring a wealth of information eventually on iodine to the blog, but it takes me time.  Meanwhile, just explore your diets, and make sure you’re getting some foods which usually have decent sources of iodine.

Remember, food counts.  It really matters.  It matters for you and your family and their families to come.  Let’s move on to iodine and fertility tomorrow-ish…

Terri

Sources:

1.  Iodine deficiency in industrialized countries.   Zimmerman M.  Proceedings of the Nutrition Society:  Conference on ‘Over-and undernutrition:  challenges and approaches.    2010; 69: 133-143.  (Full text link.)

2.  Iodine Deficiency Disorders in the Iodine-Replete Environment.  Nyenwe EA and Dagogo-Jack S.  The American Journal of the Medical Sciences.   Jan 2009; 337 (1):  37-40.  (Full text link.)

3.  Estimation of iodine intake from various urinary iodine measurements in population studies.  Vejbjerg P, Knudsen N, et al.  Thyroid. Nov 2009; 19(11):1281-6.  (Abstract link.)

Iodine, Post 1

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Iodine All Boxed Up

As far as most of the medical community is concerned, iodine has been boxed up in its cylindrical Morton’s salt-box (with that cute umbrella girl on it) and shelved–as if there is nothing further to know or learn about it.  Not so.

SaltFor iodine, I want you to be aware of three ideas:

1.  Iodine deficiency is insidiously on the rise in developed countries and putting people, particularly women and children at HUGE risk.  (Pregnant or pregnancy-eligible women need to take note.)  Many US doctors are not aware yet of this re-emerging problem.  We took care of “severe” iodine deficiency, and now years later, mild iodine deficiency is invisibly in our midst, wreaking its damage without our awareness.

2.  It’s not just the thyroid that needs iodine, but brains, immune systems, prostates, and breasts, too.  (Ahem, you got some of those, don’t you?)  I know my knowledge-base had a huge gap here regarding iodine, and therefore, I assume other medical doctors (I’ve asked a few too) and people in general may be lacking information in this area as well.

3.  There is a fear of iodine supplementation and excessive iodine intake because of the risk of hypothyroidism and hyperthyroidism.  There are different camps of thought.  Who is right?  Who does know yet?  Debatable.  Regardless, many people aren’t even getting the bare minimum amount.

Could I be iodine deficient?

A resounding, “Yes.”  Iodine deficiency was believed to be a resolved health issue in the US, but as I research, I see an insidious re-emergence of iodine deficiency in places such as the United States, Australia, and the United Kingdom.  And I also see a lack of knowledge in standard health-care providers about the re-emerging deficiency.  In pharmacy school and medical school we were taught that iodine deficiency was remedied in the United States by the implementation of iodizing salt back in the 1920s.  Job accomplished!  No more goiters!  No more cretins (infants who are severely affected by iodine deficiency)!  Celebrate and no more worries, right?  Not so fast…

Apparently, somewhere in the realm of 38% of the world’s population is still deficient in iodine.  Thirty-eight percent seems awful high to me, especially considering the nefarious effects on unborn fetuses.  Looking at a few developed countries, the United States, Australia (New Zealand included in one of the citations), and the United Kingdom, each has pockets of iodine deficient populations (1, 2, 3, 4, 5).  Increasingly, studies are showing iodine deficiency in modernized countries where iodine deficiency was presumed to be eradicated, yet I hear little hubbub about it, despite the potential gravity of the consequences!  This bothers me.  Apparently and quite sadly, iodine deficiency hasn’t yet made the consciousness of mainstream practicing medical doctors, like deficiencies of vitamin D and folate have.  Why?  I think because we rested on the laurels of “curing” severe iodine deficiency maladies.  But laurels shrivel and decay, and the world changes and moves on.  Changes in our food sources and practices greatly affect our iodine levels.

Why would a problem that we had “taken care of” Iodinebe re-emerging?

Why is iodine deficiency re-emerging?  As with almost all things, it’s due to multiple hits in our iodine intake.  Take a look!  Do any apply to you and your family?

1.  Cutting down on salt use for health and also cutting down on other iodine-rich foods.  People are following medical advice to cut down on salt, and therefore using less iodized salt.  Also, egg yolks contain some iodine, but people have been told to cut down on those, too, due to cholesterol concerns.  Seafood contains iodine, but we’re told to limit seafood due to mercury concerns.

2.  We eat out lots more and we eat more processed foods–and iodized salt is not used in these foods.  The commercial-grade salt used in processed foods and in restaurants is usually not iodized.  I repeat:  the salty foods you eat from a box or at a restaurant are (most likely) not iodized.  So none of the salt in Ruffles potato chips or from McDonald’s French fries counts toward your necessary iodine intake.

3.  Switching to sea salt and shunning iodized salt.  Sea salt does not contain enough natural iodine to prevent iodine deficiency.  It may have traces of iodine, but not nearly enough!  Sea salt, unless specifically stated to be enhanced with iodine or seaweed, does not provide you with enough iodine.  It is not a good source of iodine.

4.  Iodine deprived soils.  Some soils have always been low in iodine content (plants don’t need iodine to survive but they take it up if it’s in the soil), especially in areas away from the sea or under cover of mountain ranges.  Some soils have become depleted of iodine with use and lack of iodine restoration.  Plants grown in coastal areas should theoretically have more iodine in them, but lately there is a huge emphasis on eating locally so this could contribute to iodine deficiency, as well.

5.  Changing from iodine based dough conditioners to bromine based dough conditioners.  Iodine used to be used (specifically iodate) when making bread products.  Now a form of bromine, bromate, is used, although its use is being discouraged. (6) Not only does this provide LESS iodine, but if you look at your periodic table, you’ll see that iodine and bromine are in the same group of the periodic table (halides).  So bromine will actually compete with iodine in the body and “displace” iodine from necessary body reactions.  I will try to explain this concept in more depth later because it is so intriguing.  The same holds true for fluorine and iodine competition. (7)

6.  The iodine amount in iodized salt is not uniform.  The amount of iodine in a carton of iodized salt is not uniform.  Sometimes the top of the carton of salt has less iodine than the bottom of the carton.  Some brands do not contain as much iodine as others.  The amount of iodine in a box may wane over time.  These idiosyncrasies often have to do with the chemical properties of iodine which will allow it to “leach” out of the carton. (7)

7.  Changing dairy-farming practices.  Dairy is touted as a good source of iodine because the cows are frequently given iodine-supplemented feed and their teats are washed prior to milking with an iodine antiseptic to kill bacteria.  However farming practices are changing and dairy cattle may or may not be receiving these interventions now.  (When I bought milk and butter from the dairy farmer yesterday, I asked her about this.  Her cattle are all grass-fed and she does not use an iodine-based cleanse for the teats.  So I cannot imagine that the milk is rich in iodine that we personally buy, although it will be rich in vitamin K2 at the moment and butyric acid because it’s spring-grass eating time!)

8.  Choosing organic milk over conventional milk.  Organic milk usually has less iodine than conventional milk due to the cows being grass-fed.  (9, 10)

Points to be eventually covered in Iodine Posts

Iodine is a big topic that I don’t want to undermine, so I will break it down into several posts.  A few months ago, I thought iodine’s role was limited to prevention of goiter and keeping enough thyroid hormone around.  That is all true, but there is so much more to iodine’s story, and some parts haven’t even been unraveled yet!  Take home points that I will eventually cover in iodine posts, but probably not in this order. (If you are pregnant, able to be pregnant, or nursing, I urge you to start reading about iodine today, and don’t wait for my posts to roll out.  Here is a simple article to get you started:  Iodine Deficiency Common in Pregnancy, Docs Warn.):

  • Do I need iodine?  Absolutely.  Can’t live without it.  Function poorly with too little of it.  “But what’s it do?  What’s it for?”  That is a bit challenging to answer.  Kind of like, “What’s the sun for?”  Is it for the trees?  The flowers?  Your vitamin D production?  Your food production?  Light?  Energy?  What aspect of our lives does the sun not touch?  What aspect of our health does iodine not touch?  Whether it is through the effect of thyroid hormone, which is composed of iodine, or direct effects we’re just now learning about, the body needs iodine.  So it’s your job to make sure you know where you can get it.  I will go over where to get iodine in future posts and “what it does.”
  • Iodine deficiency is increasing for multiple reasons in developed countries, and I’ll bet money that you are affected by a couple or more of the reasons no matter what your health and food choices.  No diet group is allowed to snicker here or stick their noses in the air.  Many people are just not getting the iodine they need, and if they are, there’s a good chance that the body’s use of iodine is being interfered with by food and health choices they maybe haven’t even considered.  I will go into food and environmental factors that may be interfering with your body’s use of iodine.
  • Our childbearing women and their offspring for sure are hit VERY hard by an iodine deficiency.  Women, did your obstetrician prescribe you a prenatal vitamin with iodine in it?  If not, did your obstetrician ask you if the prenatal vitamin you chose has iodine in it?  I will go over why women of childbearing age, their fetuses, and their children NEED adequate iodine.  SADLY, these populations seem to be the most iodine deprived!
  • Prostate, breast and immune health are starting to be linked to iodine.  I will do my best to present some of this information.  Much of it is newer, not well understood, and not well accepted.
  • Iodine is important in brain health!  Low IQs, increased ADHD, and apathy have been linked to iodine deficiency.  We have studies to support this, and I will present those for your perusal.
  • Iodized salt is not the devil.  Iodine deficiency is a devil.  I know so many of you treat processed, iodized salt like the plague.  But there is a reason why The Morton Salt Company iodized their salt here in the States, and it helped immensely!  I can’t underscore that enough.  I guess I don’t really care if you shun iodized salt, I just want to make sure that no matter who or where you are, that you are aware of the body’s need for iodine and you take measures to get you and your family some good source of iodine.  For many, the simple answer may just be adding iodized salt back into their diets.  Others lean toward seaweed.  Still others rely on supplements.
  • Do I need to take high doses of iodine?  Not sure.  That might fall into the “voodoo” realm.  (Voodoo is my tongue-in-cheek word for food and health related things I see that I’m just not sure about.  I used to call diet changes “voodoo.”  I don’t anymore, but it took a lot of reading!)   Tread cautiously.  I will eventually talk about how some people use high doses of iodine and what the proposed benefits and risks of this are, particularly fibrocystic breast disease, prostate cancer, and a touch on the big topic of thyroid disease.  The turf here is largely uncharted and uncertain.

Eat well to live well.  Make sure you’re getting an iodine source.  And lastly and importantly, my blog posts are never intended for use of diagnosis, evaluation, or treatment.  Hopefully you’ll use them as stepping-stones to learn more about the topics I present and be able to have a conversation with your favorite healthcare provider.

 

~~Terri

1.  Are Australian children iodine deficient? Results of the Australian National Iodine Nutrition Study.  Li M1, Eastman CJ, Waite KV, et al.  Med J Aust. 2008 Jun 2;188(11):674.  (Abstract link.)

2.  The Prevalence and Severity of Iodine Deficiency in Australia.  December 2007.  Prepared for the Population Health Development Principal Committee of the Australian Health Ministers Advisory Committee. (Full text link.)

3.   Iodine deficiency in the U.K.: an overlooked cause of impaired neurodevelopment?  Bath SC1, Rayman MP.  Proc Nutr Soc. 2013 May;72(2):226-35. doi: 10.1017/S0029665113001006.  (Abstract link.)

4.  Iodine in Pregnancy: Is Salt Iodization Enough?  Elizabeth N. Pearce.  J Clin Endocrinol Metab. Jul 2008; 93(7): 2466–2468.  doi: 10.1210/jc.2008-1009  (Full text link.)

5.  http://ods.od.nih.gov/factsheets/Iodine-HealthProfessional/

6.  http://www.newsweek.com/five-controversial-food-additives-83551

7.  Iodine Nutrition: Iodine Content of Iodized Salt in the United States.  Dasgupta PK, Liu Y, Dyke JV.  Environ. Sci. Technol. 2008, 42, 1315–1323. (Link to full text.)

8.  Iodine concentration of organic and conventional milk:  implications for iodine intake.  Bath SC1, Button S, Rayman MP.  Br J Nutr. 2012 Apr;107(7):935-40. doi: 10.1017/S0007114511003059. Epub 2011 Jul 5.  (Link to abstract.)

9.  Essential trace and toxic element concentrations in organic and conventional milk in NW Spain.  Rey-Crespo F1, Miranda M, López-Alonso M.  Food Chem Toxicol. 2013 May;55:513-8. doi: 10.1016/j.fct.2013.01.040. Epub 2013 Feb 4.  (Link to abstract.)

10.  http://www.sciencedaily.com/releases/2013/07/130704094630.htm

Delayed Cord Clamping Isn’t So Weird After All: Part 2

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Delayed Cord Clamping

A little science lesson 

Baby is attached to the placenta by the umbilical cord, which has two arteries and a vein.    The umbilical cord transfers blood between the placenta and the baby.  The umbilical arteries take deoxygenated blood back to the placenta from the baby, and the umbilical vein brings oxygen rich blood from the placenta.  (An interesting side note, this is a very rare case when arteries carry deoxygenated blood.  Usually arteries carry oxygen rich blood.)  A jelly-like substance called Wharton’s jelly surrounds the arteries and veins, giving support to the cord and keeping the arteries and vein open.  Wharton’s jelly is also very rich in stem cells.

Even after delivery, the placenta continues to provide blood, oxygen, and nutrients to the baby as long as blood is still pulsing through the cord.  Blood usually ceases to be exchanged between the baby and placenta anywhere from about 3-10 minutes after birth.  At one minute after birth, 80 mL of blood has been transferred from the placenta to Baby.  At three minutes after birth, 100 mL has been transferred.  One hundred mL is about 3 and 1/2 ounces, and this translates into about 30% more blood volume for the baby (and about 60% more red blood cells).  If the cord is clamped early, about 1/3 of Baby’s blood will be lost in the placenta and cord.

Temperature changes finally cause Wharton’s jelly to structurally collapse and spontaneously shut off the blood flow through the arteries and vein–kind of nature’s own natural cord clamping, if you will.  If you cut the cord immediately without clamping it, blood will spurt out because the vessels are still patent (open).  However, in delayed cord clamping, the vessels have collapsed in on themselves because Wharton’s jelly no longer provides a pull to keep them open.  As the vessels close down, the blood is forced out of the cord.  The once robust, thick cord becomes thin and scrawny appearing.  After the baby is delivered, it takes awhile for the placenta (at this point you can think of it as “afterbirth”) to detach and be expelled from the uterine wall.

What is the “old way” of cord clamping–the kind I was taught?

In “old school” cord clamping procedure, there is (was) no regard for waiting to cut the umbilical cord.  As soon as 250px-Umbilicalcordthe baby is delivered, the cord is cut, usually just in the amount of time it takes to get the baby cradled on one arm and the clamps on the cord.  It is an expedient process designed to get the baby moving on to the next step.

A typical birth scenario:  Baby is pushed out and doctor is holding the baby.  Pretty much immediately, clamps are placed on the cord to staunch blood flow through the cord, and most often Dad is offered the opportunity to cut the cord between the clamps.  Once cut, the OB hands the baby off.  Depending on your doctor and the appearance of the newly born baby, the baby may be given to the nurse for drying before being given to you or your baby may be given immediately to you.  Then, there is waiting while the placenta (afterbirth) is delivered.  Most of the doctors I trained with were fairly patient waiting on the placenta and provided gentle traction when visible signs appeared that the placenta was separating from the uterus.  Upon its ignoble delivery, the placenta is placed in a red biohazard bag.  Job done.

So what is “delayed” cord clamping procedure–the kind I want done now?

Delayed cord clamping procedure calls for waiting to cut the cord rather than doing it immediately on birth.  The definition varies depending on who you talk to.  Some will say 30-60 seconds after birth.  Some will say three minutes.   Some will argue it needs to be delayed until the cord stops pulsing.  Heck, some even say to keep that cord attached to the placenta until it dries up and separates from the baby on its own!  (This is called a lotus birth.  It does create an interesting visual in the mind, doesn’t it?)

What are the potential benefits of delayed cord clamping? 

At a 30-60 second delay in clamping the baby potentially gets:

  • Additional iron stores and less iron deficiency anemia during the first six months to perhaps one year of life.  (Infants need iron for physical and mental development.  Very important.  Usually at 6 months, breastfed babies are given some kind of iron supplementation since breast milk does not contain enough.)
  • Increased blood volume (which allows for better perfusion of organs).
  • Reduced need for blood transfusion in premature infants.
  • Decreased incidence of intracranial hemorrhage (bleeding in the brain) in premature infants.

With a longer delay in cord clamping you potentially get:

  • Increased immunoglobulin (antibody) transfer.
  • Increased stem cell transfer.  (Stem cells are cells that haven’t yet committed to becoming a particular type of cell yet in the body.  They have the ability to develop into many different cell types that may be needed anywhere.  When needed, they can differentiate into heart cells, blood cells, bone cells, brain cells, and more!  They are very valuable cells to have for the baby.)
  • (My input:  Benefits we haven’t yet determined at this time–that we aren’t able yet to be aware of and measure.)

What are the real or perceived potential drawbacks of delayed cord clamping?

  • “You can’t resuscitate the baby, if needed, easily.” :  If a baby needs resuscitation, delayed cord clamping makes “getting all the gear” and necessary people around the baby much more challenging.  However, although it is more challenging, it definitely is not impossible.  Some hospitals have arranged for resuscitation set up to accommodate resuscitation efforts with the baby still cord-attached.  These hospitals make the effort because some doctors believe that it is the babies who need resuscitation (particularly the preterm babies) who can benefit MOST from the blood, oxygen, and nutrients provided from waiting to clamp the cord.  Until the cord clamps down on itself, it acts kind of like a natural ventilator (if mom is cardiovascularly intact), actually facilitating resuscitation.  On the other hand, if the resuscitation crew isn’t familiar with resuscitation with the cord intact–well, when you take someone out of their routine, they are more likely to make mistakes.
  • “It can cause polycythemia with hyperviscosity.” :  In studies, there was no difference reported between early and late clamping for occurrence of polycythemia with hyperviscosity.   However, certain at-risk babies can get too much blood, causing an abnormally increased, pathologic hemoglobin level (polycythemia) and “sludging” of blood in vessels (hyperviscosity).  Which births may be at risk?  Those with underlying risk factors such as maternal diabetes, severe intrauterine growth restriction, and high altitude birth location (I’m not sure how high!).
  • “You can’t cord blood bank.” :  It can make it more difficult to have enough blood left over for cord blood banking.  I have not read about cord blood banking much.  But as I wrote this article, I found this cord blood banking company which says delayed cord clamping and cord blood collection are compatible for their agency:   Americord.  So I guess you should look around if you’re going to cord blood bank to determine which companies say they’re compatible, which say they are not, and how the company expects collection to take place.  Then, make sure your delivery provider understands how to delay clamping and still get enough blood collection for the blood bank.
  • “You have to hold the poor baby at the level of the placenta during the delay to get gravity’s help–isn’t it better to give mom the baby sooner?”  :  Yes!  Give mom the baby!  The position that is/has been recommended was for the baby to be at or below the level of the placenta–which most often translates into a doctor/midwife holding a slippery, wet, possibly screaming baby at the level of the vagina while standing right there between the mom’s legs, waiting.  I’m sorry–but can you say “awkward?”  The great news on this is that a 2014 study in The Lancet indicates that baby location does not matter!  (See The Lancet citation below.)  Moms can safely and effectively hold their babies on their tummies or chests, allowing the often desired skin-to-skin contact.  Sometimes the cord is even long enough to allow breast feeding!  (Which as I sit here thinking, could stimulate oxytocin and then help the placenta to more readily expel.)
  • “Isn’t there an increased risk of hemorrhage in the mom?” :  No.  Studies do not support this.  There is no increased risk of hemorrhage and not even an increase in blood loss between early and late clamping.  However, in women who are hemorrhaging from placenta previa (when the placenta lies too closely over the cervix) or from placental abruption (when the placenta pulls away from the uterine wall before it should), waiting for cord clamping can be a matter of life and death for the mom.  So if the mom IS hemorrhaging from these obstetrical emergencies, then immediate cord clamping will probably occur.  (Not to mention the blood flow to the placenta will be compromised by these issues anyhow.)Many physicians were taught that immediate cord clamping is part of a three-step process that decreases post partum hemorrhage (prolonged and excessive bleeding)  in the mom.  (The three steps include immediate cord clamping, administration of a medicine to clamp the uterus down, and active traction on the placenta to speed its delivery.)  Post partum hemorrhage is a BIG deal and not taken lightly.  However, studies show that delayed cord clamping is not associated with increased hemorrhage (unless the mom has the hemorrhage risks described above).
  • “There’s an increased risk of jaundice.” :  The difference in jaundice is not significantly different between early and late cord clamping, but in the delayed clamping group, if there was/is jaundice, it has about a 2% higher chance to require phototherapy (light therapy).
  • “I don’t know about twins…” :  I didn’t read much about it, but I did see that if you’re carrying twins, it may not be recommended.  Check this out well if this is you!

So how long should clamping be delayed?

There is no consensus yet as to what defines late cord clamping.  Some providers will wait one minute.  Some two to three.  Some until the cord stops pumping.  They kind of base their opinions and practice on the idea that most of the blood is transfused somewhere between the one and three-minute mark (see above in “A little science lesson”).  If you have a preference, you should probably bring it up and be more specific than just requesting “delayed cord clamping.”  Flexibility may be required for different scenarios:  cord blood banking, unpredicted complications, your delivery provider is in the middle of two or three births happening at the same time…

Why would a provider not allow delayed cord clamping?

  • Unintentional ignorance.  Perhaps this just never made it as an update to their education.  Maybe that journal with the delayed clamping article got trashed by the wife before the provider got home from work.  Medicine is changing ALL the time!  It is VERY hard to keep up!  Granted I haven’t read on obstetrics for a long time, but this was definitely new news for me!
  • Impatience.  Perhaps the provider knows that delayed clamping doesn’t offer a huge amount of statistical significance to measurable outcomes in term babies, and the provider has another birth or two happening in another room.  The need to actively do something and move on is great in physicians.  It’s the way most are wired and is often required in their day-to-day life.  However, even after they baby is delivered, the provider has to wait on the placenta to detach, which takes much longer than the time it takes for the cord to stop pulsing.  So although I can feel they physician’s anxiety to “do something,” what is done doesn’t necessarily speed up the process much, if any.
  • Good intentions relying on outdated information that suggests increased risk of jaundice, maternal hemorrhage, polycythemia, and other conditions described already above.
  • The mom or baby isn’t doing well. 
  • Belief that the measurable gains from delayed clamping in term infants are insignificant and disputable.  For example, there are some inconsistencies reported in the duration of iron deficiency protection.  Is it three months of iron deficiency anemia protection?  Six months?  A year?  It’s not clear.  However, if there is a gain in iron levels at all, that’s helpful!  In addition, the infants have better organ perfusion by receiving the rest of the blood in the placenta and immeasurable effects from the gain of additional stem cells and immunoglobulins that would otherwise be tossed into the red biohazard bag for disposal.
  • A very tight nuchal cord (cord wrapped around the neck).  As a resident in one delivery I was working in, when the head popped out (I love that part!), I noticed the baby had a nuchal cord wrapped very, very tightly around the neck several times.  My staff doctor jumped in, clamped and cut the cord before the baby was even out, and then proceeded to help me deliver the baby.   After taking time to stop and think about the cord and its function now, I wonder if we need to do that in deliveries, since the cord continues to give oxygen to the baby–BUT on the other hand, a tight cord will decrease cerebral perfusion of that oxygen and that can be catastrophic.  Not a clear topic, and I got my poor husband all heated up in discussion about it this past weekend.  Something about, “I’m okay with delaying cord clamping.  Eating what you feed me.  But I will NOT go messing around with this.  These doctors do this all the time…” (It’s really fun being in a two-doctor marriage with one partner starting to explore natural ideas!)  I’ll leave unreducible, strangulating nucchal cords for you to research and explore on your own more if interested.

Can delayed cord clamping be done in C-sections? 

Yes, as long as there has been no damage to the placenta.  Different physicians who practice this have different approaches.  They can deliver the head from the incision and allow the baby to breathe spontaneously while attached, then deliver the rest of the baby.  Or they can deliver the baby and hold the baby at or below the placental level for a minute.  (In C-sections, the position of the baby is likely important because you may not have the rhythmic contraction of the uterus to help propel flow to the baby like you do in vaginal deliveries.)  They can milk the cord, drawing the blood toward the baby.  Or keeping the baby attached to the placenta while removal of the placenta occurs.  So you see, in C-sections it is possible, and the ways to accomplish it many.  However, usually after a C-section, babies are handed off quickly to specialized teams to “resuscitate” them, and these teams may not be comfortable with the delays.

What I have decided for my cord clamping preferences:

1.  I would like to delay cord clamping until the cord stops pulsing.

2.  I plan to let the doctor(s) know ahead of time at office visits, carrying my citations along with me to show, if needed.  But I know that I may get the on-call doctor for delivery, so at a convenient time at the hospital, I plan to tell the doctor, nurse, and/or delivery assistant, too.

3.  My husband is to pay attention and remind them as soon as the baby is born if, for some reason, I’m unable to.  He worried a little bit and said, “Well, what if it takes a half of an hour for it to stop pulsing?”  “Then cut it,” I said.  My husband is an orthopedic surgeon, and he doesn’t like being in the position to tell another medical person how he thinks the job ought to be done.  Anyhow, it won’t take a half hour for the cord to stop pulsing.  It usually takes only 3 to 10 minutes to stop pulsing, during which time the OB will be inspecting for tears and waiting for the placenta to deliver.

4.  I will not ruminate or fuss if delayed cord clamping for some reason doesn’t work out.  I think that delayed cord clamping is beneficial, but I am confident that my baby will have good outcomes regardless.  Delayed cord clamping is just a part of a cumulative effort to give my baby an advantage in health.

~~Terri

 

1.  McAdams RM.  Time to implement delayed cord clamping.  Obstet Gynecol.  2014 Mar; 123(3):  549-52.

2. Timing of Umbilical Cord Clamping After Birth.  Committee Opinion No. 543.  American College of Obstetricians and Gynecologists.  Obstet Gynecol 2012; 120; 1522-6.  (Link to full text.)

3.  Vain NE, Satragno DS, Gorenstein AN,  et al.  Effect of gravity on volume of placental transfusion:  a multicenter, randomized, non-inferiority trial.  The Lancet.  Early online Publication 2014 April.  (Link to abstract.) 

4.  McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD004074. DOI: 10.1002/14651858.CD004074.pub3.  (Link to full text)

5.  Photo:  Wikipedia commons, subst: npd

 

Delayed Cord Clamping Isn’t So Weird After All: Part 1

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Drats. We’re doing it wrong again. Darn those midwives and home birthers and granola-crunchers…

Delayed cord clamping ought to be routine obstetrical procedure in most deliveries, yet I’m not sure how much it is.  Pretty much, alternative delivery providers have known and instituted delayed cord clamping routinely, yet conventional obstetrical services have been slow to change outmoded tradition.  I was a little anxious about asking my obstetrician for delayed cord clamping until I researched this topic for posting; I try to not make waves when I don’t have to.  After preparing the posts, I have no doubt that I’m standing on very firm ground, and my OB, if not already practicing delayed cord clamping, will readily agree to delayed cord clamping for our birth.  And I won’t be labeled “whacko.”  (LOL!)

Beyond Simply Accepting

Although I write about homeschooling, nutrition, and this or that, The HSD blog was opened due to my conviction that what I learned as a medical doctor ((and continue to be offered as continuing medical education) needed revised, enhanced, modified, and shared with others.  In my medical and pharmaceutical training, I undoubtedly learned the tools I needed to THINK about health, but sadly, I’ve been much more likely to just ACCEPT, for whatever good or bad reasons.  I really thought that the experts doing studies at the institutions who got together and created guidelines for the rest of us knew best and were looking out for the interest of health.  The last two years I have tried to stop “simply accepting,” and I have tried to forge together in my mind alternative viewpoints of medicine and conventional medicine–creating what I feel is a better approach to health and well-being.

My day-to-day health has improved dramatically thanks to alternative health ideas and alternative nutrition ideas, yet it’s not easy sorting through all the chaff.  To do so requires reading all sides of the story, like watching Fox and CNN and MSNBC to try to come up with your own belief of reality.  There is a lot of mud-slinging, which gets nobody nowhere fast.  Reminds me of a line from a Metallica song I liked back in the day, “You labeled me; I’ll label you…”  The post today and the next post cover delayed cord clamping, something that used to be performed pretty much only by alternative providers of delivery and completely shunned by conventional medicine.  My last trimester of pregnancy dawns upon me, and lately I’ve been trying to find the threads of truth as I sort through obstetrical and newborn care.

Recent Journal Article Encouraging Delayed Cord Clamping

In natural delivery settings provided by midwives, delaying the clamping and cutting of the umbilical cord has been common practice. However, conventional medical practice has routinely practiced immediate cord clamping and seemed (seems) reluctant to transition to a new way of doing things, even with increasing evidence advocating change!

“Immediate umbilical cord clamping after delivery is routine in the United States despite little evidence to support this practice. Numerous trials in both term and preterm neonates have demonstrated the safety and benefit of delayed cord clamping…The failure to more broadly implement delayed cord clamping in neonates ignores published benefits…”

Obstetrical Gynecology, March 2014

Ouch. That’s pretty blunt! Back when I was a resident delivering babies, immediate cord clamping was the norm. Catch and cradle Baby. Clamp. Cut. Hand off Baby. Deliver placenta (with gentle traction).

My Own Prior Experiences and Exposure to the Idea of Delayed Cord Clamping

All three of my own girls received immediate cord clamping on delivery. I had never heard of anything different or been taught of anything different as a young doctor. Cutting the cord upon delivery was just what we did, and I never thought of a reason to question it. I mean, how do you know to ask a question when you’re too ignorant to ask a question? To me, cutting the cord the way we did was just as routine and necessary as tying my tennis shoes before a run.

When I read about delayed cord clamping about a year ago on a site called Atlanta Mom of Three, I thought, “Huh! Well, that sounds like it’s probably a good thing.” Being done having kids and certainly not delivering babies professionally anymore, it was only curiously, scientifically interesting, not worth more study on my part because it didn’t pertain to my personal pursuit of GI health and overcoming food intolerances. However, I do remember being intrigued by it enough to mention it to my husband as table conversation. Now, here I am nearly a year later unexpectedly expecting our fourth child, and I am revisiting all these routine obstetrical (and pediatric newborn) “daily acts of living.” Having more time to read natural medicine and conventional medicine, I now have questions and new opinions–well-mingled together like a tasty sangria.

Closing

Although delayed cord clamping seems to have moved into the realm of acceptable, at least in the medical journals, that doesn’t mean every doctor/provider will do it. You and I can be the impetus for our physicians/providers to broaden the use of delayed cord clamping.  Our requests prompt thought and change, especially, as in this case, it is founded on research and changing guidelines.  I have not yet asked my obstetrician about how he handles clamping, but with my journal citations in my purse, I expect delayed cord clamping should be no issue–but I will not leave it to chance. Of course, my OB may not be the one delivering me in the middle of the night so I’ve assigned my husband the task of making sure delayed cord clamping happens in case I’m too far exhausted to be able to let the delivering doctor know of our wishes.  As you’ll see next post, there are virtually no harms in delayed cord clamping, and I feel it gives the newborn an edge.

Anyone recently had this conversation with their delivery provider?

~~Terri