Baby Making & Beyond with Meg the Midwife - Diane Sanfilippo, Liz Wolfe | Balanced Bites

Podcast Episode #263: Baby Making & Beyond with Meg the Midwife – Part 2

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TopicsBaby Making & Beyond with Meg the Midwife - Diane Sanfilippo, Liz Wolfe | Balanced Bites

1. Reintroducing our guest, Meg Reburn [2:11]
2. Pregnancy and poop [3:48]
3. Preparing for a natural birth [12:30]
4. Gestational diabetes [28:43]
5. The big picture [41:09]

 

 

 

 

 

 

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Baby Making & Beyond with Meg the Midwife - Diane Sanfilippo, Liz Wolfe | Balanced Bites Baby Making & Beyond with Meg the Midwife - Diane Sanfilippo, Liz Wolfe | Balanced Bites Baby Making & Beyond with Meg the Midwife - Diane Sanfilippo, Liz Wolfe | Balanced Bites

You’re listening to the Balanced Bites podcast episode 263.

Welcome to the Balanced Bites podcast. I’m Liz; a nutritional therapy practitioner, and author of the Wall Street Journal best-seller Eat the Yolks; The Purely Primal Skincare Guide; and along with today’s guest, Meg the Midwife Reburn, I created the online program Baby Making and Beyond. My usual podcast partner, Diane, is a certified nutrition consultant, and the New York Times bestselling author of Practical Paleo and The 21-Day Sugar Detox. She lives in San Francisco with her husband and fur kids; and I live on a farm in the mystical land of the Midwest, outside of Kansas City.

Together, Diane and I are the co-creators of the Balanced Bites Master Class, and we’ve been bringing you this award winning podcast for 5 years and counting. We’re here to share our take on modern paleo living, answer your questions, and like this week, chat with leading health and wellness experts. Enjoy this week’s episode, and submit your questions at http://balancedbites.com.

We’ve got part 2 of a great episode coming at you today for the fertility obsessed, reproductively curious, baby feverish, or anything in between, this is the episode for you. I’ve once again been able to wrangle a very special guest for today’s show. But first, let’s hear from one of our sponsors.

Liz Wolfe: The Balanced Bites podcast is sponsored in part by the Nutritional Therapy Association. The NTA trains and certifies nutritional therapy practitioners and consultants, including me, I’m an NTP, emphasizing bio-individuality and the range of dietary strategies that support wellness. The NTA emphasizes local, whole, properly prepared nutrient dense foods as the key to restoring balance and enhancing the body’s ability to heal. Nutritional therapy practitioners and consultants learn a wide range of tools and techniques to assess and correct nutritional imbalances. To learn lots more about the nutritional therapy program, go to http://www.NutritionalTherapy.com. There are workshop venues in the US, Canada, and Australia, so chances are you’ll be able to find a venue that works for you.

1. Reintroducing our guest, Meg Reburn [2:11]

Liz Wolfe: Alrighty. So, again, our special guest today is my partner in the upcoming comprehensive, evolutionary minded, modern-life accommodating, fertility, baby, birth program, Baby Making and Beyond. Welcome, again, Meg the midwife.

Meg Reburn: Thanks for having me back.

Liz Wolfe: Sure thing. I feel like I was just talking to you. Weird how that works.

Meg Reburn: It is strange how that happens.

Liz Wolfe: So strange. So we did an intro for you in part one of the Baby Making and Beyond Balanced Bites podcast. You are a registered midwife in Canada,

Meg Reburn: British, Columbia.

Liz Wolfe: British, Columbia.

Meg Reburn: The west coast.

Liz Wolfe: Yeah, so am I supposed to say that? It’s like saying, in the United States.

Meg Reburn: Well it’s like saying, you know, I’m in; I don’t know, Canada is really big.

Liz Wolfe: Is it; how big is it? {laughs}

Meg Reburn: {laughs} Well, it’s pretty big.

Liz Wolfe: So, British, Columbia, Canada.

Meg Reburn: Yeah.

Liz Wolfe: And you have a bachelor’s degree in health sciences with a specialty in midwifery and women’s health.

Meg Reburn: That’s right.

Meg Reburn: Attending birth since 1999 as a doula, before becoming a midwife in 2009. And if you want to know more about Meg, I would refer you to part one of the Baby Making and Beyond Balanced Bites podcast, because we tackled a bunch of questions that you’ll also want to listen to in that podcast, as well. Good enough for an intro?

Meg Reburn: Perfect.

Liz Wolfe: Alright. Let’s tackle some listener questions related to pregnancy, baby, and birth.

Meg Reburn: Sounds great.

2. Pregnancy and poop [3:48]/b<>

Liz Wolfe: This first one is from Beth; oh wait. No. We did that one.

Meg Reburn: I think we’re going to talk about Courtney.

Liz Wolfe: Yeah, we’re going to talk about poop.

Meg Reburn: Poop! My favorite.

Liz Wolfe: Alright, this one is from Courtney. Pregnancy and poop. “I’m 29 weeks pregnant. About 10 days ago, my stools changed to floating. I’m going to the bathroom every day, but always floating now since this started. I’m not losing weight, no gas or bloating, not out of the ordinary smelly; sorry. Maybe a little darker in color and a little softer and less formed, but not diarrhea. I called my OB, who said it’s likely due to a lack of fat breakdown and malabsorption during the digestive process, as I suspected. I’m a proud owner of Practical Paleo and familiar with the poop pageant.”

Meg Reburn: {laughs} I love that.

Liz Wolfe: We love poop around here. “But she was otherwise not concerned unless I started to have abdominal pain or yellowing of the skin, at which point she would recommend liver testing. Throughout my pregnancy I’ve taken a probiotic from Klaire labs; digestive enzymes, Rainbow Light brand, plant based, and a magnesium supplement to keep regular. Constipation has been an issue pre-pregnancy. This protocol had been working fairly well, and I was fairly regular without gas, bloating, or any other negative symptoms. Two months before becoming pregnant, I had some lab work done that showed I had a very low lactobacillus count; hence the probiotic and enzymes. My naturopath thought the plant based enzymes would be safest during pregnancy. I eat about 4 tablespoons of unpasteurized sauerkraut daily to get my fermented food intake. I cannot do kimchi or some other fermentables due to a garlic and onion intolerance. I realize I have some digestive issues to resolve in general due to FODMAP intolerance and constipation, but my naturopath did not want to take any steps forward during pregnancy and breastfeeding. Fun fact: Pregnancy has actually improved my digestive situation and food intolerances. I believe due to a down-regulated immune system and lesser inflammatory response.” Yay.

“In the past 10 days, I backed off the digestive enzyme and magnesium, thinking maybe these were making things go through too quickly. No change as a result. My next step is going to be to try a dairy elimination for a couple of weeks. I added a bit more full fat, grass-fed dairy in the form of plain yogurt, hard cheese, and some local ice cream compared to my normal diet during the past month or two due to a low calcium level during testing. To make sure I’m getting the all important fat soluble vitamins per Weston A. Price dogma, and because I seem to tolerate better during pregnancy, as described above.

Also around the beginning of the floating, we had just gotten a bushel of farm-fresh sweet corn. So I was eating far more of that than my usual diet; sorry, but I live in the corn belt. There was some undigested corn visible in the stool during that time, but I’ve not had it in a week, as it was the initial suspect, and floating has not changed. The only other change I can think of is recently adding collagen peptides, no more than 1 tablespoon per day, into my coffee to prevent stretch marks.

Two questions: One, other than trying to eliminate dairy, do you have any recommendations for better absorption? What might be my next food to eliminating if I see no changes with dairy? I do eat gluten, mostly in the form of sprouted bread or fresh sourdough where I know the ingredients; but I’m not going to lie, other gluten treats have been known to make their way into my diet recently because pregnancy. I’m obviously not drinking alcohol at this time.

Two; I’m more concerned that all of the good fats I consume from my mostly paleo diet; lots of ghee, coconut oil, full fat dairy, avocado, olive oil, olives, fatty fish, at least two pastured eggs daily, are not getting to the babe. Or, as I’ve heard more often, the baby will take what he needs and I will end up depleted. Should I be concerned about this? Thanks for your wisdom; love the podcast.”

Meg.

Meg Reburn: Wow. Well, I do love poop questions. {laughs}

Liz Wolfe: Don’t we all.

Meg Reburn: We do, you know, and my job, everything going in and coming out we talk about, and it’s great. I love it. So first of all; floating poops might not be the worst. They can indicate a malabsorption of fats, like her doctor suggests, but only if they’re really; this is going to sound weird. But only if they’re really smelly and greasy. Floating on its own doesn’t necessarily mean malabsorption; but floating with the smelliness and greasiness, so; this is going to sound even worse, but if the toilet water has a film of greasy sludge, that might tell you, yeah for sure there’s some fat malabsorption going on. Same thing if she’s nauseated after eating or isn’t gaining weight or is in fact even losing weight. This would be the number one tip off.

So assuming that none of those things exist; it could just be extra gas. So if her poops are kind of fluffy; {laughs} I sound really gross.

Liz Wolfe: {laughs} Fluffy!

Meg Reburn: {laughs} But if they’re fluffy, and I think you all know what I mean, it could just be extra gas, which might have been triggered by all that extra corn that she was eating. You know, FODMAPs says that a little bit of corn; if she’s FODMAP sensitive, a little bit of corn is ok, but it might have just been way too much. And again, seeing corn in your poop is totally normal; don’t worry about that at all, everybody gets it. And you know, pregnancy hormones can also kind of slow down your transit time, so when your transit time, and what I mean by that is the motility of the things moving through your digestive system gets slowed down, which is why women tend to have more problems with constipation in pregnancy. It gives more time for carbohydrates to sit there and ferment, making gas, and thus making poops float. So that could be it; I’m just kind of hacking her poop. I don’t know.

Other things that she could try are eliminating gluten; you know, I recommend that to everyone so I’m totally biased there, but it’s not the most nutrient dense choice that she could be making. The phytic acid could cause inflammation and trigger a leaky gut, especially when she’s kind of got some autoimmunity red flags going on here with her digestion. Sprouted wheat that’s she’s been eating is certainly better than the gluten bomb of wonder bread, but I just recommend taking it out of the diet if she can.

She could also try switching more to coconut oil rather than animal fats for a little while, just to see if that made any difference at all. Coconut oil doesn’t need bile to be processed, so if she’s having any problems with her gallbladder or pancreas, which can flare up during pregnancy that should alleviate the extra stress.

She really shouldn’t be too concerned about the baby not getting what he or she needs to develop. Babies really mostly only get glucose from your body. In medical books; I’ll never forget this, because I was offended deeply to the core {laughs} but in medical books, babies are described as glucose dependent parasites. I’ll never forget that; your baby is not a parasite, but it is very glucose dependent. So really, in terms of fatty acids, it only needs a very small amount of amino acids from your diet. The importance of you getting fatty acids and amino acids from your diet is so that you can absorb nutrients. So getting the fatty acids will help you absorb the fat soluble vitamins that your baby needs, if that makes sense.

Liz Wolfe: Mm-hmm.

Meg Reburn: The baby will pull what he or she needs from you; you just don’t want to run the risk of deficiency. So that’s why it’s important for you to keep going with having lots of good healthy fats in your diets. The one exception to that would be DHA. The amount of DHA in your diet; so let’s just say if you increase your DHA in your diet, the amount of DHA going to your baby will increase, same thing through breast milk, and that’s the only fatty acid that seems to do that. We don’t know why, but that’s why it’s really important to get lots of DHA from fatty fish in your diet. But those would be the only things I’d try. Really, I’d see your doctor again if you do get that slimy film or if your poops are really smelly, but other than that, don’t worry too much about it.

Liz Wolfe: Hormones can cause variation in bowel emissions.

Meg Reburn: They really can. Oh, and in terms of magnesium, I think she mentioned having taken magnesium. Magnesium will cause diarrhea really, really, really loose bowel movements when you start taking it to kind of the threshold of what your body can tolerate. If she’s having problems with that and she wants to keep taking lots of magnesium, she can try rubbing magnesium oil on her skin and taking it transdermally. That can really help.

Liz Wolfe: Alright.

Meg Reburn: Cool.

3. Preparing for a natural birth [12:30]

Liz Wolfe: This next one is from Niki. Preparing for a natural birth, if possible. “Hi Liz and Meg; I was wondering what you would suggest to best prepare physically for, ideally, a natural birth. Also, any tips for the day of when planning a hospital birth? Birth plan ideas, what to ask for, what to avoid; what to talk to my doctor about beforehand, etc. first timer here, so any advice would be appreciated.”

I really like this question, but I’d like to know what you, as someone with so much experience and having seen this so many times; I want to know what you have to say before I say anything.

Meg Reburn: {laughs} Well, there’s a few things that I would say you definitely should do, because I’ve seen some rather interesting birth experiences based on a slight lack of planning. But the trick here is to strike that balance between planning and not planning too much; right?

Liz Wolfe: Mm-hmm.

Meg Reburn: So, first of all, you want to make sure that you have a bag packed for the hospital. I usually recommend having everyone; everyone should have a bag packed by about the time they’re 36 weeks pregnant. And things that you want to put in your hospital bag vary drastically. You can find all sorts of premade lists on the internet, but essentially you want to pack for a 2 or 3-day stay. Hopefully, depending on what center you’re at, you’ll be able to go home later that same day or the next morning, but essentially you want a bathrobe, so something that opens to the front to help with easy breastfeeding. You want some sort of footwear, so flip flops are a really good option. If your water breaks on your flip flops, you can just rinse them off; no big deal. Like, a washable footwear; really important thing.

Things that make you comfortable and make you feel like a whole human. So one thing that I really love women putting in their bags are those little pre-moistened facial wipes they can just, you know, in the middle of a labor or after a labor, just the simple act of being able to wash your face can make you feel like your back in your body again. I could be really helpful. Toothbrush, toothpaste, something to bring your baby home from the hospital in. So a couple of different outfits of various sizes, because while we have a kind of a guesstimation of how big your baby will be, there can massive variations in that. I’ve seen women who you think; oh my god, they’re going to have a 9-pound baby, and out pops this little 6-pound little peanut, and the clothes that that little person requires are different than the clothes of a 9-pound baby. So, some different sizes of outfits.

Chargers for all of your devices, although I don’t really like the use of any electronic devices in the birth room, you’re still going to want to take pictures of your little one after the baby is born, and you do not want your phone or your camera to be running out of batteries; that would be a shame. And other than that, you don’t need much.

So, the second thing that all parents should do without a doubt is do a dry run. So kind of know where to park, know what doors to go into, know what desks to go to, and kind of get an idea of what’s going to happen. So if you’re having to do these things at 3 in the morning when you’re in the throes of labor, you kind of know where to go and you can kind of put yourself on a little bit of autopilot.

The other thing you want to do is talk to your doctor or midwife about your preferences. You can’t assume that they can read your minds. They’re not mind readers. And we know that everybody wants something different. Make sure you ask about their call schedule. So are you going to always have that one physician or midwife who is on call to you, or is it going to be a team? And if it is a team, then making sure that you get to meet other people on that team. What are their epidural rates, and what can be expected if things go as planned, but also if things go not as planned. So asking them some questions about how they might deal with that and what you can expect is an important thing to do. As well as your individual preferences, like having skin to skin with your baby if you do require a C-section can they do that in the operating room? Letting them know if you want things like delayed cord clamping or if you’re planning to keep your placenta. These are things that they all need to know well ahead of time.

So those would be kind of the three key things that I would do; so pack a hospital bag, do a dry run, and talk to your care provider about your preferences.

Liz Wolfe: Lovely. I definitely overpacked.

Meg Reburn: {laughs} Yeah, most people do.

Liz Wolfe: I really over did it.

Meg Reburn: I’ve had people bring in; like I had one family bring in like lamps, and a bean bag chair {laughs}.

Liz Wolfe: {laughs} Well, I did think about bringing a rug. {laughs}

Meg Reburn: {laughs} A rug?

Liz Wolfe: In case I needed to just squat the baby out, I wanted it to come out on my rug.

Meg Reburn: Yeah, no that’s a fair thing. That’s definitely a fair thing. But what you’ll find at all hospitals are an endless supply of towels, an endless supply of warm blankets. Pillows are kind of a hot commodity in hospitals, you might want to bring your own pillow with a brightly colored pillow case on it; not your white pillow case or else it might get snagged by the hospital, but pillows might be another thing to add to that. But again, you can find all sorts of lists. I think I have a list up on my blog about what to pack in your hospital bag. We’ll certainly have pre-printed lists available on Baby Making and Beyond, too.

Liz Wolfe: So, ok. I know Niki, so she probably has listened to all my talk about my birth experience and how it didn’t go how I expected it to go. Well, first of all, just the little baby stuff. Encapsulate your placenta; bring a cooler to put the placenta in. A couple of things that I thought were important to add to the birth plan were not to give the baby a bath; I decided against the eye goop, for example, some of that stuff.

Meg Reburn: And actually, I don’t know what the stance of that in the United States is, but in Canada, our pediatric society has actually come out discouraging it’s use and saying it has no evidence anymore.

Liz Wolfe: I don’t think we’re caught up to that, yet. I need to go back and go over all of these things before we hit publish on the program, but I’m pretty sure that’s standard practice still at this point.

Meg Reburn: Interesting.

Liz Wolfe: Yeah, I could be totally wrong at this point, but it was when we first started working on this.

Meg Reburn: So yeah, you want to talk to your care provider about that, for sure.

Liz Wolfe: It’s so cool to have the perspective from you in Canada. Because, I mean, Canada and the United States are similarly stymied in many ways, they’re similarly progressive in many ways, but I’ve just found; I feel like Canada is a little bit quicker on the uptake around the knowledge around these interventions.

Meg Reburn: We’re same-same but different.

Liz Wolfe: Mm.

Meg Reburn: And you know what, it can be that our health care system is just so different because it’s universal, right?

Liz Wolfe: Yeah.

Meg Reburn: So we don’t have these private systems that are acting more in the ways of legal based medicine.

Liz Wolfe: Oh, right.

Meg Reburn: We’re a little bit more socialist when it comes to those sorts of things. So things can happen a little bit faster and on a more united front, so to speak.

Liz Wolfe: You know, that’s funny because that’s not how people in the United States; people in the United States, when we think of socialized medicine, we think of just, it’s slow, it’s cumbersome, and all of that. But it’s really interesting, it makes a lot of sense that things could travel a little bit faster throughout an overarching system.

Meg Reburn: Yeah. They can. Sometimes; sometimes not.

Liz Wolfe: Sometimes.

Meg Reburn: Like, if you needed a knee replacement you might be waiting a little bit longer, but if you’re having a baby, your baby won’t get eye goop. {laughs}

Liz Wolfe: {laughs}

Meg Reburn: If that makes sense.

Liz Wolfe: Awesome. So yeah, stuff like that. Your thoughts on; I don’t know, circumcision, that type of thing. Those types of little details that maybe you want to kind of have in place. What I want to add is that I advocate going ahead and making a plan for all contingencies. So, for me, from the beginning, it was C-section is not an option. Hospital birth is not an option. It’s only the birth center, it’s only going to go the way I have prepared and planned for it to be. And when I ended up having a C-section, I had nothing written out for that. I specifically, with my baby’s presentation, I had not planned or even thought about it for a second, so I was not prepared to ask for some of the things that I wish in hindsight I had asked for. I didn’t have the information behind me. For example, I begged the operating doctor to do delayed cord clamping, but she had all of these weird reasons why she couldn’t do that with a C-section baby. So, not having prepared, not having backed myself up with adequate information, and also being deep into labor, I was not prepared to argue one way or the other.

So, I just think in my head it was planning for that opens the door to that. I didn’t want to acknowledge the reality of any other kind of possibilities besides what I was planning for, because I felt like that was acknowledging it as an option. And that is simply not true. Your focus should absolutely be what you desire for your birth experience, but there’s absolutely nothing wrong with having your contingencies in place.

Meg Reburn: I think having them written down is a really helpful thing.

Liz Wolfe: Yes.

Meg Reburn: Because when you are in the throes of active labor, you cannot advocate for yourself.

Liz Wolfe: Right.

Meg Reburn: You are completely vulnerable. So having them written down on paper and giving them to your partner or to your doula or whoever is with you, when you’re laboring is essentially.

Liz Wolfe: And having a doula is a really good tool.

Meg Reburn: Yeah.

Liz Wolfe: For me, I actually had two doulas, but I was laboring at home and then went into the birth center ready to go, and then all of a sudden it was like; See ya! Get out of here, and they couldn’t even get there in time.

Meg Reburn: Yeah.

Liz Wolfe: So, just a lot of preparation. Preparation is just good. And that’s also part of parenthood. There are so many things you cannot prepare for, but you want to have the tools in place to the degree that you can. And this is going to be a little bit out there. But let go of resistance.

Meg Reburn: Yeah.

Liz Wolfe: And mental blocks against anything, and apprehension, and fear. And I thought I was doing that in my preparation. I was like, “I’m not afraid to give birth, I’m giving birth naturally, it’s going to be beautiful, I’m going to be unmedicated, I’m going to squat this baby out, I’m going, use the fetal ejection reflex, I will push when I feel like pushing.” You know, those things. I was very open to one way of doing things. But I still had resistance and blocks and blinders and unwillingness. And that I am convinced was reflected in my body and the way I experienced birth. So, I needed to learn to trust my body, not just to birth as I thought it was supposed to and as it was meant to, but to trust my body to birth beautifully no matter what the circumstances. So eliminating any of those walls that you’ve built around yourself.

I’m not saying that Niki in any way is resistant to anything that might happen; but being flexible and eliminating those walls is not conceding to an approach to birth that you don’t believe in. that’s not what it is. It’s a matter of; oh my gosh. So I just read a post from Margaret Barry from Eat Naked Now. She just posted on; she posted a tale of two births; what my daughters taught me. And it was amazing, because what she talked about was her first birth that ended in a C-section, and her second birth that did not. The difference was releasing that resistance, those walls, those pre-conceived notions and just being open to where birth is going to take you. And that’s parenthood too.

Meg Reburn: That’s very much parenthood, yeah.

Liz Wolfe: Yes. You just cannot prepare. You just have to observe and adjust and observe; and I don’t know what the word would be. Just; you know, like water, it fills a vessel, whatever the shape of the vessel is.

Meg Reburn: Yeah, it’s being present and being a witness to. And you know, the exercise that I get a lot of my clients to do is to meditate, not only on the birth outcomes that you want, and to really put that idea and put the power of positive thinking into your mind and visualize the way that you want it to go, and then take that and put it on the shelf. And then visualize the exact opposite experience. Where will people be in the room? How will you react to this situation? And put yourself really in that situation, and put yourself in that situation so that you can feel everything around that situation. Not physically feel, but emotionally feel that. And then whichever way your birth experience goes, you’ve kind of prepared your body and your mind to be able to deal with it. So each idea of, it’s going to go one way versus another way; both of those ways aren’t foreign to you, and you’re somewhat prepared as to how to deal with them emotionally, and your cells are prepared to know that this is ok.

Liz Wolfe: Mm-hmm. I love that. Love that. Alright, I’ll put the post to Margaret Barry’s post in the show notes, as well.

Meg Reburn: Yeah, that’s a great idea. I’d like to read that, too.

Liz Wolfe: It’s really good, you’d love it.

Meg Reburn: And it’s amazing how if we have one birth outcome, and not to say this has anything to do with Niki, I’m just speaking generally. But I know we had talked about this in the part 1, was, you know, a second birth can be really healing, and even if that birth, let’s say your first birth with a C-section and your second birth is a C-section, just changing your mindset around how your birth needs to be can be really healing for most women.

Liz Wolfe: That’s really, in a lot of ways where I’m at right now personally. I think the narrative that I’ve had, and that I’ve still had, is that I can’t have another baby because if it ended the same way, or if it happened the same way this last one happened, I don’t think that I could take it. But then the other side of that, I also think to myself I would feel so guilty if it did go the way that I wanted it to go, that I couldn’t give that same gift to my first baby.

Meg Reburn: Mm.

Liz Wolfe: So it’s just this stand still, right? But I also understand that when I can come around to either reality, and find peace with either one, that’s when I think the clouds will kind of break for me.

Meg Reburn: Yep.

Liz Wolfe: Yeah.

Meg Reburn: Yeah, I agree.

Liz Wolfe: Ok. I forgot why I even felt the need to say that, but it just came to me while we were talking.

Meg Reburn: It don’t matter, feelings don’t need to have a reason! {laughs}

Liz Wolfe: This is so true.

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4. Gestational diabetes [28:43]

Liz Wolfe: Alright, this is; we don’t have a name for this question, but this is about gestational diabetes, which is a question I know you get all the time, Meg.

Meg Reburn: All the time, yeah.

Liz Wolfe: Alright, here’s the question. “I was diagnosed with gestational diabetes with both my first and second pregnancies. The insulin resistance never went away. I’m constantly checking my blood sugar to see how I react to different types and amounts of carbs. It’s been about 5 years of this. It’s very frustrating, because I can’t understand the source of the insulin resistance. I’m 5’1” and 100 pounds. Somewhat active, and I’ve always been a health eater. I’ve never even drank an entire soda in my life. I’ve accepted the fact that this is just where I am, and it might be this way forever, and that if this was spurred by pregnancy I accept it fully in gratitude for my children.

However, my question is do either of you know what an ideal insulin response is? There is so much talk about including carbs for female hormones that I’m unsure of what to aim for. Typically, they say you don’t want your blood sugar over 120 at two hours post meal; however I’m wondering if 120 is on the high side, or if I should aim for less carbs to be closer to, let’s say 100 or 85. Not to stress too much about the numbers, but when I get my A1c checked every year and I come back as pre-diabetic or borderline, it’s hard not to go a little crazy about what I should strive towards with post meal insulin responses. I seem to do best with steel cut oats, rice, brown and white, spike my sugars, and potatoes are a little better. Fruit can make me spike, too. I’m very conscious of combining my carbs with protein. Thank you so much for any thoughts you have on this topic. For me, it feels that the specifics of insulin responses are so never really part of these conversations in the community.”

Meg.

Meg Reburn: Well, I just want to preface this by saying, again, we can’t give; we’re not giving medical advice at all. Gestational diabetes is, it puts you in the category of being a higher risk pregnancy, so really important to follow your doctor’s advice, and you can take what we say on this podcast to your doctor, discuss it, and then make a plan to move forward. So I just want to preface it with that. This is a really interesting case. I’d love to work with this woman, just as an aside.

But you know pregnancy, it can often kind of “unmask” preexisting tendencies towards diabetes later in life, and it can really unmask, especially these little markers of insulin sensitivity. There was just a study published in the last two years, and they looked at long-term outcomes after a pregnancy complicated by gestational diabetes, and what they found that was up to 70% of women develop type 2 diabetes. So this can be a real red flag into long-term health and well being, and it can offer women the potential to make some significant nutrition and lifestyle modifications that can make a big difference in their long-term health and wellbeing. So that’s a complete aside, I just thought that was interesting.

But you know, for this woman in particular, her blood glucose is just kind of on the borderline of the high side. It’s not grossly elevated to the point where, you know, cellular damage would occur in her own body or to her baby’s. Cellular damage with diabetes in pregnancy tends to happen when blood sugars are running in excess of 180-200, so 120 is kind of a reasonable number. Just so she’s aware of that; I don’t think we talk about this enough in our diabetes clinics or with our reproductive endocrinologists, what that threshold number is for actually harming the baby on a cellular level.

However, that being said, it’s really important to control your blood sugars when you're pregnant. When they’re on the high side constantly, it can put your baby at risk for becoming really large, and really large babies are just tricky to fit out from a mechanical sense, but they’re also used to having that constant supply of sugar, so their blood sugars can crash when they’re born, they can also have breathing difficulties when they’re born, and they can have difficulty with obesity and insulin response later in life, themselves, too. So that’s why it’s important to have that blood sugar under control.

A few thoughts for this gal; she has a really normal BMI. Most women who suffer with gestational diabetes; well, I shouldn’t say most, but a lot of women that suffer from gestational diabetes tend to have a higher BMI. She’s kind of more in the 18.9, so almost in the low end of the scale. And I’m just wondering, you know, if her blood sugar constantly runs high because she’s trying increase her fat stores for breastfeeding and just for fertility in general. There’s not a lot of science to back that up, but it’s just something that I’ve seen in my practice and I wonder about.

My other question to her would be, we can see where her diet is at, we can see where her blood sugar levels are at, but where are her stress levels at? I think I talked about this a little bit in part one, if you haven’t listened to part one, go back and listen to that, about the stress/cortisol/blood sugar connection. Essentially when you have really high stress, your cortisol goes up, when your cortisol goes up your blood sugar level increases. So stress management is a big thing to include, as well as diet.

The other thing that I’m curious about with this woman, and she didn’t make any mention to it, was hemoglobin A1c levels and blood sugars in different ethnicities. All of our guidelines are based on a Caucasian model in North America; if this lovely lady is Hispanic, or African American, or of Aboriginal or Asian descent, she might just have naturally higher blood glucose levels with no harmful consequences to her baby. There is a link to a study which I can give to you, Liz, to put into the show notes that you can bring to your doctor that links to this, and I think it’s a good conversation to have with your care provider. I think it’s a good thing that she continues to do her A1c annually. She obviously has some tendency towards higher blood sugar levels, and it should be monitored just for long-term health.

But in terms of what to do right now while she’s pregnant, following a whole foods diet that’s rich in proteins, fats, and moderate carbohydrates is good. She mentioned she notices that she’s really conscious of combining her carbs and proteins to kind of blunt that insulin response, but I would encourage her to make sure she’s getting enough fats, too. Fats do wonderful things for insulin response of our foods. And making sure she’s having lots of dark, leafy greens; staying active; staying active helps burn off excess glucose. So going for a good walk after each meal, anywhere from 10 to 20 minutes can help blunt the glucose response in your body. And don’t stress too much about it. Again, do some regular meditation and yoga, practice some mindfulness to reduce your stress and that’s your cortisol.

Did you have anything else to add to this?

Liz Wolfe: No, jeeze. You {laughs} I remember seeing your notes on this, and I was like; whoa.

Meg Reburn: You know, glucose and pregnancy is just such an interesting thing. You know, pregnancy is kind of; it’s a healthy state of insulin resistance, and it’s the one time in our lives where we’re meant to be a little insulin resistant. And I think we focus so much on these numbers and these tests. Having more blood sugars available to you and your baby in pregnancy helps you store fat so that you can properly breastfeed. Remember, that happy thigh fat, right? That’s the fat we get when we’re pregnant. It’s also the fat that we lose first when we start breastfeeding. Having higher blood sugar can help increase your metabolic needs for pregnancy. It can shuttle sugar to your growing baby through the placenta. It’s like, it does all these amazing things. And so, you know, it’s a tricky, tricky thing that I think a lot of women struggle with, because we do do these tests, and we come back with these really high sugars. And you know, who knows if we’re seeing more of this because we have more sugars in our diet in general, right? And who knows if we’re seeing more of this because our mothers and our grandmothers had more sugar in their diet, in general, which is a whole other can of worms.

So there are these theories, these epigenetic theories, that basically say that the diets of our mothers and our grandmothers, and the environments around them; so including stressful environments, changed our insulin response to foods, and predisposes us to having higher blood sugars. So for example, if your mother and grandmother ate lots of crappy foods, or were really stressed out by being, for example, in times of war and their blood sugars were really high because they were stressed or because they were eating wonder bread, it could have created epigenetic changes in ourselves. So even if you’ve never opened that can of soda your entire life, your body thinks that it needs to have these higher blood sugars because this is your normal. Does that make sense?

Liz Wolfe: Yes! Absolutely.

Meg Reburn: Yeah, so you know we’re seeing this whole other generation of people with higher blood sugars and more insulin resistance, even when they’re of healthy weight, which is what this woman is, and have a healthy diet, which is what this woman has. So part of me wonders if that’s what’s going on; I mean, I don’t know anything about her family history or perhaps I’m just a complete nut job, but it’s nice to know if we have; it’s nice to have a reason for these things.

Liz Wolfe: Yes. I’m so fascinated and I want to look into it more for the benefit of the program, and just for myself, the resonance of stress, wherever that stress comes from, over generations. And I think several generations before us, there was the stress of the great depression, there was the stress of war. And then a few generations later it was the stress of a totally and completely different food sheds; like a total change in the foods that we were eating and what they contained. And then there was the stress of probably in the last generation an overuse of medicines, unnecessary medical challenges to the immune system; antibiotics.

Meg Reburn: Overuse of antibiotics and exposures to BPA.

Liz Wolfe: Yes, estrogen.

Meg Reburn: Oh it’s just; the list goes on and on and on, and I wonder; I’d just love to be a fly on the way and see what happens in two generations from now. Yeah. I think that’s why the more changes we make now and the more we pay attention to it and the more we focus on having really good nutrition and having as clean of a lifestyle as possible, it’s not only going to make a difference for us right now, and for our babies right now, but for our baby’s babies. And so it’s kind of like stopping the cycle. And stopping this madness of these negative epigenetic changes that are happening in our world. Maybe I’m just an optimist, but I really think it makes a big difference.

Liz Wolfe: I don’t think you're just an optimist, I think you are a lot of things.

Meg Reburn: {laughs}

Liz Wolfe: Today’s podcast is sponsored by Vital Choice Seafood and Organics, where a healthy diet is a vital choice. Purveyors of wild fish, shellfish, grass-fed beef and bison. Vital Choice offers premium quality, sustainably sourced foods that are wildly delicious and delivered to your door, with minimal prep from freezer to table, it’s easy to get delicious protein like wild Alaskan salmon, my favorite; and Wagyu beef into your paleo menu rotation. Vital Choice also has a wide array of ready to eat canned seafood along with satisfying snacks like organic dark chocolates, super antioxidant trail mix, and bison jerky. As the days get shorter and the grilling season cools down, www.vitalchoice.com is your source for premium seafood and organics.

5. The big picture [41:09]

Liz Wolfe: You know, part of what we say in the introduction to Baby Making and Beyond; we do ask people to take into account that there are many, many things that could be impacting their experience whether they’re having trouble conceiving or they’re having fertility issues; or they’re not. Whatever it is, you have this entire broad pictures that you want to paint, so you just kind of imagine yourself looking through a little, I don’t know, a little paper towel roll or a rolled up newspaper at a painting and you only see one part of it. That’s kind of what I feel like; that’s the extent that a lot of the tools that pregnant women or people that want to get pregnant and their partners have. They just have this little tunnel view of just a part of this overall picture, and what we’re kind of trying to do is open that up so you can see the full picture, and that includes genetics, lifestyle, food, movement, self care, exposures, generational exposures, and looking at it that way I feel like can feel overwhelming at the beginning, but really it’s actually empowering, and I think that’s really important to know. Because this can feel really scary learning so many things. But in the end it’s actually empowering, because you can figure out exactly what your priorities are to target.

Meg Reburn: Yeah, that’s right. And even though it can feel so incredibly overwhelming, all of the answers are really simple.

Liz Wolfe: Yeah.

Meg Reburn: And if we just go back to what our great-grandparents were doing, most of the time, and then with a few modern modifications, it’s like; it’s not that hard to do. Although it feels like a never-ending, daunting task, it’s not that complicated.

Liz Wolfe: How do you eat an elephant?

Meg Reburn: {laughs} How do you eat an elephant.

Both: One bite at a time.

Liz Wolfe: {laughs} Alright. ON that note, we’ll close it down for this week. Thanks for joining us for part two, Meg, I really appreciate it. I love having you on.

Meg Reburn: Any time.

Liz Wolfe: Yay! Well not any time, you’ve got babies to catch.

Meg Reburn: Yeah, that’s true. I do have babies to catch.

Liz Wolfe: Any time that you and I are mutually available and have internet connection.

Meg Reburn: And awake.

Liz Wolfe: And awake! Yes.

Meg Reburn: {laughs}

Liz Wolfe: Alright, friends, thanks for listening. That’s it for this week. You can find me, Liz, at http://realfoodliz.com/ and you can find Meg at http://megreburn.com. Join our email lists for free goodies and updates that you don’t find anywhere else on our website or on the podcast. And I forgot to mention this last week, but go to http://BabyMakingandBeyond.com to get signed up for updates for when the program is ready to launch. While you’re on the internet, please leave us an iTunes review for the Balanced Bites podcast, we’d appreciate it. See you next week.

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