Cheese Puffs

Mindy Kaling recently tweeted that “One embarrassing Hollywood thing about me is I’m into the organic or homemade versions of popular junk food.”  That’s totally what I’ve been doing lately.  I can’t get enough of whatever organic/non-GMO fancy cheese puffs I can find.  I mean, it’s not like I’m eating the questionable chemicals in Flamin’ Hot Cheetos, right?

Day after day of feeling queasy most of my waking hours, and having to force myself to stop eating well before I’m full, has been taking its toll.  I can’t wait till I can eat normally again.  So for now, what little at a time I can eat, I admit I’ve been eating cheese puffs and other very non-Paleo foods.

In the past, I’ve had issues with worrying too much about my weight, and obsessing over what I’m eating.  So it does bother me that now I’m so focused on food and eating all the time.  And it’s an unhealthy mindset to feel like I can sort of eat what I want because I can’t eat enough to gain weight.  Since I can’t eat as much as I normally do, I’ve plateaued at 5 lbs. less than my baseline weight.

I realize it’s not exactly the best thing to be eating junk food (even if it’s the fancy kind), but I feel so gross most of the time, I just want to eat whatever makes me feel temporarily better.  And at some point, when I do finally feel better, I intend to go back to healthier eating for the sake of my fetus.  That is, after I get some gluttonous eating out of my system.

Aromatherapy

This is something that I unexpectedly discovered.  I happen to have a lemon-scented hand wash in the bathroom, and noticed amidst all of the unpleasant smells that I’ve been more sensitive to lately, the lemon smelled heavenly.  So I thought to counteract the unpleasant odors, I’d get something lemon-scented to sniff when needed.  Whole Foods sells a bunch of essential oils, but I found that the lemon ones didn’t smell that great.  Maybe the tester bottles had been sitting out for a while.

Well luckily, they had their table with natural soaps and I found one that had a lemon rosemary scent that was really nice.  When I brought it home, I noticed that when I sniffed it, I’d temporarily feel better.  Briefly, though- just seconds.  It wouldn’t be practical to carry the bar with me everywhere and sniff it constantly.

I decided to Google aromatherapy and pregnancy, lemon, and rosemary.  And look what I found:

http://www.ncbi.nlm.nih.gov/pubmed/24829772

At least someone has done a study and found that inhaling lemon essential oil reduced symptoms of nausea and vomiting in pregnancy.  Other sites also mentioned lime, peppermint, and spearmint as aromatherapy scents that can help as well.

I did also come across some websites that said that rosemary essential oil is to be avoided in pregnancy.  Apparently it might induce miscarriage or something.  I’d never heard of that as an obstetrician, and certainly the amounts of herbs used for cooking are safe.  But I guess I’ll avoid rubbing rosemary essential oil all over my body.  I’m sure sniffing the bit of rosemary in my soap isn’t a big deal.

Frustration

I continue to have to eat small amounts at a time, and don’t feel well much of the day.  I’m definitely not staying strictly Paleo, and am happy to eat what I can.  I’ve never had this happen to me before- I’ve dropped 5 lbs in a week.  One of my colleagues said that when she was in her first trimester, at work she was wretching mid-pelvic exams.  Like when the patient was lying down and in the stirrups and couldn’t see her, she’d be quietly wretching.  And vomiting between patients.  Thankfully, I haven’t actually been vomiting and can get through my work days without disruption, so I think to myself I shouldn’t complain.  But I still do, because it sucks to not be able to eat normally and to feel gross most of the time.

I guess I’ve been trying not to let out my frustration too much to my husband (though I still complain plenty to him) and cry about it all.  But it must have been bottling up because I woke up in the wee hours this morning with a sorta bad dream.  I was arguing with my husband about something unimportant, and then woke up crying as I realized consciously that I’ve been withdrawing myself more from him due to how I’ve been feeling.

One of my friends (also an OB/Gyn) says she hates the first trimester because she gets depressed.  While mood changes in pregnancy are certainly common, I can’t say I’ve been feeling depressed per se.  It’s more like these days on end of feeling gross, and having my thoughts consumed by food all the time makes me frustrated and upset.  It just wears on you after a while.

I’ve had one patient and her partner recently tell me that she gets short and blows up at him all the time.  While some hormonal changes are to be expected in pregnancy (and PMS), I still think that going to the extreme of blaming your behavior on it and not taking responsibility for your ability to control your actions and how they affect other people is wrong.

I did want to acknowledge that all of this can be tough on partners as well (like the poor guy above).  Although they may not be going through the actual symptoms themselves, they still feel the effects.  Guess this is a good warm-up.  Just wait till she’s in full-blown labor and is in extreme pain for hours on end!  Talk about feeling helpless seeing her going through that.

It makes such a huge difference to have a supportive partner through all of this.  I feel for all of the women out there who feel alone and/or unsupported as they are going through the difficulties of pregnancy.  And I feel grateful for my always supportive and patient (and silly) husband. ❤

Gut Flora

Anyone who works in a hospital is probably familiar with Clostridium difficile (C. difficile or C. diff for short).  It’s a bacteria that causes diarrhea, and worse can kill people who are already sick and compromised in the hospital.  Routine hospital room cleaning and antibacterial hand sanitizers don’t kill C. diff, so patients who are diagnosed with it are quickly given precautions.  When entering their room and before touching the patient, everyone is required to put on a disposable gown and gloves, and remove them before leaving.  They are also required to wash their hands thoroughly.  Basically, in the hospital setting it’s a big deal- something you don’t want being transmitted to other patients.

People who have taken antibiotics, particularly broad-spectrum antibiotics that disrupt the normal bacteria in the intestine, are at risk for C. diff.  Traditionally, additional antibiotics are used to treat C. diff, but they are not always effective.

One new treatment that is being used to treat C. diff is stool transplant.  It involves taking the presumably normal bacterial flora from a healthy person’s stool, and transplanting it into the patient with C. diff.  By re-establishing normal intestinal flora, it can treat the disease.  Yes, it sounds disgusting but there is evidence that it can be effective.  It’s still a fairly new treatment, though.

Well, I came across a very interesting article related to this.  There is a case report of a woman who was treated for C. diff by receiving a stool transplant from her overweight/obese daughter.  After the treatment, her C. diff was successfully treated, but she rapidly gained 40 lbs despite a medically supervised diet and exercise program.

http://ofid.oxfordjournals.org/content/2/1/ofv004.full

Of course this is a single case report, so there could be other reasons for the weight gain, but this isn’t the first time I’ve heard suggestions that the gut flora of obese people may be different from that of normal-weight people.  According to the case report, there are animal models that suggest that “an obese microbiota can be transmitted.”

I bring this all up because I think it’s very interesting how important one’s intestinal flora (bacteria) can be.  Kind of like how our skin is a barrier from the outside world, the gut (gastrointestinal tract or GI tract) also serves a protective function, among other things.  In other words, in addition to the food we ingest, we also are potentially ingesting bacteria and allergens.  The GI tract serves to protect us from many of those potentially harmful things from getting into our body.  So the gut is kind of like an interior barrier- if these harmful things stay only in the gut and get pooped out, then they’re not absorbed into the body itself to potentially cause harm.

This system is quite complex, and not being a GI specialist, I won’t pretend to fully understand it myself.  But there is a significant immune function of the GI tract.  Also, the enteric nervous system (the nerves and such of the gut) communicates with the central nervous system (the brain and spinal cord).  We call this the brain-gut connection.

What it comes down to is that it’s very important to keep this whole system healthy.  This whole immune function of the gut, and keeping the normal healthy bacterial flora- it’s all key to our health.  It is thought that there are a lot of things that can disrupt this.  A high glycemic diet, processed foods, pesticides and other toxins in food, too much burnt/charred food, unhealthy fats, and unnecessary antibiotics are all thought to negatively affect the gut’s health.  Also, lifestyle factors like obesity, stress, poor sleep, sedentary lifestyle, and even poor social connections are thought to affect it as well.  Eating fermented foods like kimchi, sauerkraut, or one of my favorites, natto (Japanese fermented soybeans) can help maintain a healthy gut flora.  And one can also take probiotics in pill form as well.

So if you didn’t already need the motivation, more reason to follow not just the dietary aspects, but all of the aspects of the Paleo/Primal lifestyle: limit sugar and processed foods, stay active, get quality sleep, control stress, play, and stay connected with loved ones in your life.

Throwback Thursday

My husband randomly brought up Widget the World Watcher yesterday.  Well, he brought it up in the context of my attire when I’m relaxing at home.  Between my pajamas and robe, I’m as purple as this guy:

I honestly hadn’t thought about Widget in over 20 yrs.  When I think of the cartoons I used to watch as a kid, I think of the Smurfs, Snorks, Gummi Bears, and DuckTales to name a few.  Totally forgot about Widget.  Have fun reminiscing, all you ’90s kids!

Week 10

For some reason the nausea has gotten worse lately.  Like many of my patients, I have it worse in the evening.  Now I can have only tiny amounts of food at a time.  I call it the parasite diet.  This is seriously the amount I have been known to eat at a time:

Mini Pizza

This was a minuscule slice of an almond meal crust pizza.

So far, what have I tried?

  • Ginger tea- somewhat helpful.  Not always, but definitely a noticeable difference sometimes.
  • Ginger ale- the kind with the little ginger bits and low sugar content.  Not so helpful.
  • Ginger capsules- not so helpful.  Taking a pill when I already don’t feel well doesn’t seem to help me.
  • Doxylamine (Unisom SleepTabs)- somewhat helpful, but makes me sleepy.*
  • Vitamin B6- alone without the doxylamine, not so helpful.
  • Gum- somewhat helpful.  Got the Glee brand sweetened with just xylitol.

Next up, gonna try Sea-Bands and see how that goes.  Can’t wait till I can eat normally again.  I’m probably going to gorge myself on a bunch of non-Paleo food.

*I should mention that despite making me sleepy, I’m not so sure about the quality of my sleep.  One night when I took doxylamine before bedtime, I went to bed with one earplug in each ear, and woke up to find two earplugs in one ear.  And no recollection of it!

The Likely Cause of Addiction

I recently came across this article that was posted on the Mark’s Daily Apple website:

http://www.huffingtonpost.com/johann-hari/the-real-cause-of-addicti_b_6506936.html

It really blew my mind- changes everything I was ever taught about addiction in my medical training.  My current experience with addiction is mainly with pregnant patients.  Most patients who are drinking too much alcohol, or smoking cigarettes and/or weed prior to pregnancy are able to stop, but sometimes there are patients who continue to use in pregnancy.  And sometimes there are patients who remain addicted to harder substances like methamphetamines in pregnancy.

The main gist of the article is that it’s actually the lack of human connection, as opposed to simply the addictive nature of the substance, that seems to play a large part in an individual becoming an addict.  The author cites interesting rat experiments, as well as human examples that support this.  Very fascinating stuff.

What worries me in this age of electronics and social media is that our current culture is potentially encouraging a lack of human connection, and based on the above article, may be inadvertently fostering addiction in various forms.  As a soon-t0-be parent, I can certainly try to raise my children in a way that fosters human connection.  But ultimately, I worry about the ramifications as a whole on our future generations.  I previously posted a link to the Fed Up documentary on the obesity epidemic.  The movie clearly shows what kinds of effects that broad systems issues can have on our nation (in this case, the powerful food industry and the limited ability of our government to combat it), and how difficult these issues can be to reverse once the damage is so pervasive.

Parasite!

My husband and I recently went hiking with our friend Beverly, who we met through.  The week after I finished residency, I was in town looking for a place to live, and Beverly had a Wayne’s World themed party.  Everyone was dressed in their ’90s best- flannel, slap bracelets, cutoff jeans.  And that was how I met my husband.  Beverly was also our officiant at our wedding.

Naturally, we wanted to share the news of the pregnancy to her in person.  Beverly had initially suggested that she and I do a ladies’ spa day.  But I had to make an excuse as to why I couldn’t do the hot tub, so I emailed her that I had some skin issue, will spare her the details.

On our way up to the hike, I brought up the skin thing.  Then I told her that it’s actually more of a parasite.  Not to worry, it’s not communicable.  In fact, I have a picture of it.  Then I showed her a picture of my ultrasound.  It took her a few seconds to figure out if what she was looking at is what she thought it was.  When she did realize, she was super happy for us!

It is true, a fetus is the ultimate parasite! 😉

The Primal Lifestyle

I mentioned it a bit in my last post, but I’ve adopted many of the ways of the Paleo/Primal lifestyle in addition to just the food.  Nearly 3 years ago when I started all of this, it was just food and exercise.  In addition to significant changes in my diet, I also adopted the Primal exercise regimen.  I never really loved running and the “chronic cardio” as Mark Sisson calls it, so it worked well for me to do brisk walking instead- it was an easier goal to accomplish regularly.  For the “heavy lifting,” I found the thought of going to the gym to the testosterone-filled weights area intimidating, so I discovered the Physique 57 (barre-based workout) DVDs which I still use to this day.

I would also occasionally do sprints.  Early on when I was starting the lifestyle, my husband (then boyfriend) and I happened to find ourselves on Ocean Beach in San Francisco.  Despite being in a dress, I asked if he was up for doing sprints.  We did a nice set of sprints… until I stepped on a bee with my bare foot.  Turns out that my impromptu willingness to do sprints, and my (not horribly dramatic) reaction to getting stung by a bee, were some of the moments that made him realize he wanted to be with me long term.  He later ended up proposing on Ocean Beach.

Since then, we’ve gradually adopted more aspects of the lifestyle, me more so than my husband.  We have a Squatty Potty, which is basically a stool you rest your feet on when using the toilet to simulate a squatting position.  This is more beneficial for digestive health than the normal toilet position- reducing constipation, etc.  We have installed f.lux on our computers and use blue light blocking glasses at bedtime to decrease stimulation from screen time before sleeping.  We avoid using the microwave as much as possible, and try to store leftovers in glass containers.

I’ve been regularly using a meditation app called Headspace which I highly recommend.  Meditation was always one of those things that I heard was good for me, but I never quite knew how to go about doing it right.  Well, the app makes it very doable to meditate on a daily basis, and helps apply it to real life.  The initial Take10 is free- 10 minutes a day for 10 days.  After that, you do have to subscribe to the app.  If it’s something that’s right for you, it’s a worthwhile investment in your health.  They have all kinds of series on topics like stress, sleep, relationships, appreciation, and even creativity.  I can’t recommend it enough:

Lately, I’ve gone even farther.  I’ve started using my Primal Pit Paste baking soda-based deodorant.  My husband says I don’t have any BO to begin with, so it’s the equivalent of covering up ambient air.  He hasn’t bothered trying it yet.  They also just started making a tooth powder, so I’m trying that out as well, though still alternating with regular toothpaste.  The powder does leave my teeth feeling clean, though it doesn’t last as long as my old triclosan-containing toothpaste did.

My husband jokes that pretty soon we’re gonna be THOSE people- you know, those hippies that compost everything and raise their own chickens.  He asked if one day we’ll forgo the Squatty Potty and instead just get a squatting toilet instead.  Easy for him to joke about- I’ve used those hole-in-the-ground toilets in other countries, and I’m good with the Squatty Potty!

Medications for nausea & vomiting in pregnancy

When it comes to medications and supplements for nausea and vomiting in pregnancy, I’ve been recommending the following to my patients for years:

  • Doxylamine (Unisom SleepTabs) 1/2 tablet (12.5 mg) orally up to 4 times daily.
  • Vitamin B6 25 mg orally up to 4 times daily.
  • Ginger-containing foods, such as ginger tea, ginger candy, and pickled ginger. You may also consider ginger supplements: 250 mg capsule orally up to 4 times daily.

These are based on recommendations from ACOG, The American Congress of Obstetricians and Gynecologists.  Each medical specialty has an equivalent organization that among other things regularly puts out practice management recommendations.  For women who have more severe symptoms, we go to prescription medications like promethazine (Phenergan), metoclopramide (Reglan), and ondansetron (Zofran).  In some cases, these need to be given in intravenous form and/or with steroids, and some unlucky women like Kate Middleton need to be hospitalized for hyperemesis gravidarum.

There is a prescription medication called Diclegis which is used for nausea and vomiting in pregnancy.  It’s a delayed-release form of 10 mg each of doxylamine (Unisom) and pyridoxine (vitamin B6).  Since it’s expensive and not covered by insurance for my patients, I tell them to do the over-the-counter regimen above.  I hear it works well.

It’s not exactly ethical to perform research studies of medications on pregnant women- let’s give half of these pregnant women the drug, and the other half the placebo, and see what happens!  As a result, there are very few medications that are Category A- safety established using human studies.  Doxylamine is one of these medications.

Most medications that we prescribe in pregnancy are Category B- presumed safety based on animal studies, or Category C- uncertain safety; no human studies and animal studies show an adverse effect.

Medications that we avoid in pregnancy are Category D- unsafe; evidence of risk that may in certain clinical circumstances be justifiable, or Category X- highly unsafe; risk of use outweighs any possible benefit.

These are the most commonly used categories, but there are other resources that can inform us more specifically about each drug and the evidence behind its safety.  There are also separate guidelines for use of medications in breastfeeding.

I recently found out that there is a number that the general public can call to find out about specific medication safety in pregnancy and lactation: 866-626-6847.  They also have a helpful website for patients:

http://www.mothertobabyca.org/resources/fact-sheets/

I feel very fortunate that my symptoms have been uncomfortable and annoying, but certainly not so severe as to require prescription medications.  I fully support use of those medications for appropriate patients.  When these symptoms are severe, they can be really debilitating.  Even when they’re not severe, it can be rough, causing missed work days.

Now that I’m pregnant, I do think more about what I put into my body.  Even knowing the safety, I must be honest that I had second thoughts about trying doxylamine.  So far I’ve tried it once and it made me sleepy.  Since then, it hasn’t been practical to take it if I know I’ll be driving or working.

Even from before, I’ve made changes that are in alignment with the Paleo/Primal Blueprint lifestyle.  I’ve always loved yummy-scented body products, so I’ve now switched to using 100% Pure products.  I try to avoid using the microwave, and definitely avoid microwaving in plastic containers.  I even recently decided to try a Primal tooth powder that I alternate using with regular toothpaste.

What I discovered thanks to the nausea of pregnancy was that chewing gum made me feel better.  I found whatever standard chewing gum I’d had around for ages, since I normally don’t chew gum regularly.  Well, when I finally checked the ingredients, they included a host of sugar alcohols, as well as aspartame.

Here’s what Mark Sisson has to say about sugar alcohols:

http://www.marksdailyapple.com/sugar-alcohols/#axzz3QhddhCpa

For now, I’ve settled on a gum I found at Whole Foods that is sweetened with xylitol only.  The flavor doesn’t last as long, and interestingly it doesn’t help as much with nausea as the standard chewing gum did, but ultimately I feel better avoiding too many questionable artificial sweeteners.

Ultimately, I’m lucky that my symptoms are not severe and I don’t need prescription medications.  For myself as well as for my patients, I try to avoid unnecessary medications.  But everyone is different, and in appropriate situations, prescription medications are needed, whether it’s for nausea/vomiting or other medical conditions.  I try to inform my patients of the pros and cons the best I can, and ultimately it’s each woman’s personal choice.