Wednesday, February 6, 2019

Parenting – It Looks Different for Everyone

I’ve partnered with the American Gastroenterological Association (AGA) to bring you this blog post. Read on to learn more about a new resource that was just launched to help women navigate IBD and pregnancy.

I think all of us moms can agree that motherhood (especially new motherhood) can be one of the craziest rollercoaster rides that we’ll ever experience. While it’s a time of pure joy as you bring your little one into this world and watch him/her turn into their own tiny human, it can also be a period of uncertainty, fear, and sooooo much self-doubt. And I’ll be the first to admit that I didn’t have a clue what I was doing and it took a while to realize that, you know what? I wasn’t supposed to.

In talking with my Grammie about raising her own seven (!!) children, I realized that child-rearing was much simpler back then. As long as your kids were fed, bathed, and loved, you were a good mother. Now, however, new moms are hit with perfect and unrealistic images of motherhood, especially when it comes to our social media feeds. And don’t even get me started with the “perfect parents” who love to tell you that you’re doing parenthood wrong every step of the way. Geesh, everyone has an opinion!

There really is so much conflicting information about what’s really right for our babies, especially when bringing home a newborn. As mothers, if we don’t keep up with the pressure to “do it right” (which is different for every single mom and baby), if we are unable to breastfeed due to a medical reason (or pure choice!), or if our babies don’t sleep through the night within the prescribed time frame, the first person we blame is ourselves. Because if we can’t immediately figure out the very best way to care for our baby, then we’ve failed as mothers.

I have never felt this way more then when I faced one of the scariest and hardest experiences of my life shortly after giving birth to Quinn. Unfortunately, my ulcerative colitis flared, and I was going to the bathroom 30+ times a day and seeing a toilet full of blood, all while trying to care for a newborn. I knew I needed to do something to get better, but I experienced so much fear, guilt, and shame about trying a new treatment that might negatively affect Quinn.

At the time, I was taking steroids, which both my GI doctor and OB/GYN said were safe for breastfeeding. However, a lactation consultant told me otherwise, which, of course, freaked me out. After that conversation, we started Quinn on formula while my doctors encouraged me to keep pumping, label the milk with the dose of steroids I was on at the time, and freeze it for later if it made me feel more comfortable. We waited for Quinn to get a little bigger (I figured the more he weighed, the less of an effect it would have on his body), and eventually began mixing small amounts of breastmilk with his formula. I still felt uneasy, however, and I never really was able to determine if it was truly safe.

Eventually, because the flare I was experiencing was so bad, I made the decision to start a biologic and to stop breastfeeding. I still remember crying big ol’ alligator tears when I finally came to this conclusion. It was also, by far, one of the hardest, gut-wrenching decisions I’ve ever made because I actually felt terrible for taking care of myself.

During this time, I felt every emotion ever: from inadequacy as a mom, to fears that I was doing something wrong or harmful to my baby. Much of this was due to the fact that I had no real resources to turn to as a new mom who also suffered from IBD. I didn’t really know how treatment would impact pregnancy or breastfeeding, and I had a lot of doubts about the information I did have. Looking back, if I had known what I know now about IBD and the treatment options, I would have given myself far more grace for taking care of myself. If I’ve learned anything, it’s that in order to raise a healthy baby, I needed to first be a healthy mom.

That’s why I’m so excited about the IBD Parenthood Project. The resources on this site are absolutely invaluable to women with IBD at all stages of family planning – from a patient toolkit that contains everything you need to know about IBD and pregnancy, to answers to FAQs such as what treatments are safe during pregnancy and breastfeeding. I was saddened to learn that the percentage of women with IBD who are voluntarily childless is three times greater than the rest of the general population, and I can totally relate because I was hesitant to start a family as well.

With a resource like the IBD Parenthood Project, women with IBD can rest easy knowing that they have a supportive place to turn to when they have questions, concerns, or just want more information. Knowledge is power, and the more informed we are, the more comfortable we can be with the decisions we make for ourselves and our children.

For me, the best choice was starting a biologic to get my flare under control. For another mom, the best choice might be completely different – and that’s ok. Mommy-shaming is REAL and sometimes the worst offenders are other moms themselves. A lot of attention is given to doing what’s best for your baby, and while I wholeheartedly agree, we can’t ignore the other half of the equation, which is making sure that mom is supported as well. Part of this is encouraging mothers to take care of themselves during this special (yet stressful) time because we need to be the healthiest versions of ourselves to take care of our babies to the best of our ability. Ultimately, our jobs as mothers is to love our children. We’re all doing our best, and “best” looks different for everyone.

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Can I Eat Fruit On a Keto Diet?

Question: “Can I eat fruit on a ketogenic diet?”

Answer: “Sure, if you want!”

I’m kidding, of course. I know why people ask this question. It’s because in the keto world fruit is a confusing, often contentious topic. You’ll sometimes see keto folks draw a hard line in the sand, saying that all fruits, or sometimes specific fruits, are “not allowed” on a ketogenic diet. I’ve written before about why I feel it’s inappropriate to label foods as “keto” or “not keto.” People need to consider their own goals, health, activity level, and food preferences when formulating their eating strategies.

Nevertheless, it’s true that it can be hard to figure out how to incorporate fruit into your keto diet. On the one hand, it’s “real” food: unprocessed, “whole,” and full of vitamins, minerals, fiber, and phytonutrients. It’s also Primal/paleo approved in moderation. On the other hand, the carbs in a typical serving of fruit can amount to a considerable chunk out of one’s daily carb allotment, especially for people who adhere to a very strict version of keto that only allows 20 to 30 grams of carbohydrate per day (as opposed to the Keto Reset Diet’s 50 gram per day suggestion).

So where does fruit fit for the average person following a Keto Reset Diet?

Keto People CAN Eat Carbs

Sometimes you’ll hear someone say that keto-ers can’t eat fruit because they “don’t eat carbs.” They really mean that keto folks don’t eat sugar, which is still a gross oversimplification because keto people absolutely do eat carbs. If you’re eating according to the Keto Reset Diet, you’ll start by aiming for 50 grams of carbohydrates per day—perhaps somewhat less if you are dealing with type 2 diabetes or metabolic syndrome—with some wiggle room if most of your carbs come from above-ground veggies and avocados.

From the point of view of the Keto Reset, we want you to choose your carb sources from among those included on the Primal Blueprint Food Pyramid. That means no grains or added sugars, but eating nutrient-dense vegetables and, yes, even some fruit if you wish.

What Fruits Are Best For Keto?

When picking the “best” fruits for keto, it comes down to how many carbs are in a serving. Higher carb fruits are going to be harder to incorporate into a keto diet while still allowing room for the liberal intake of vegetables and avocados encouraged in the Keto Reset.

The information below is taken from the Cronometer database. Make sure you pay attention to the serving size. I selected what seemed like reasonable servings of each by volume instead of weight (who knows what 100g of grapes looks like compared to 100g of watermelon?). I also provided the weight for reference, as well as the fiber content. The Keto Reset Diet does not recommend counting net carbs for fruit though.

Before getting to the data, note that this list omits foods like tomatoes and olives because that’s not what people mean when they ask about fruit.

Let’s also get two items out of the way that always appear on “keto approved fruits” lists:

Avocados: Is there any question about them being keto-friendly? So you know, one whole avocado (136 grams) has 12 grams of carbs (9 grams fiber), as well as 21 grams of fat.

Lemons: Most people aren’t eating lemons but juicing them, right? The juice from one whole lemon has 3 to 4 grams of carb (about 1 gram per tablespoon).

Now for the rest…

Berries:

  • Blackberries (½ cup, 72 grams): 7 grams carb (4 grams fiber)
  • Raspberries (½ cup, 62 grams): 7 grams carb (4 grams fiber)
  • Blueberries (½ cup, 74 grams): 11 grams carb (2 grams fiber)
  • Strawberries (½ cup halves, 76 grams): 12 grams carb (3 grams fiber)

Stone Fruits:

  • Apricot (each, 35 grams): 4 grams carb (1 gram fiber)
  • Plum (1 medium, 66 grams): 8 grams carb (1 gram fiber)
  • Peach (1 medium, 150 grams): 14 grams carb (2 grams fiber)
  • Nectarine (1 medium, 142 grams): 15 grams carb (2 grams fiber)

Melons:

  • Watermelon (1 cup cubed, 152 grams): 12 grams carb (1 gram fiber)
  • Cantaloupe (1 cup cubed, 160 grams): 13 grams carb (1 gram fiber)
  • Honeydew (1 cup cubed, 191 grams): 17 grams carb (2 grams fiber)

Tropical Fruits:

  • Papaya (1 cup cubed, 144 grams): 16 grams carb (3 grams fiber)
  • Pineapple (1 cup cubed, 165 grams): 22 grams carb (2 grams fiber)
  • Banana (1 small, 101 grams): 23 grams carb (3 grams fiber)
  • Coconut meat (½ cup, 163 grams): 25 grams carb (15 grams fiber)
  • Mango (1 cup sliced, 165 grams): 25 grams carb (3 grams fiber)

Other Fruits:

  • Clementine (each, 74 grams): 9 grams carb (1 gram fiber)
  • Fig (1 medium, 50 grams): 10 grams carb (2 grams fiber)
  • Kiwi (1 each, 69 grams): 10 grams carb (2 grams fiber)
  • Orange (1 small, 96 grams): 11 grams carb (2 grams fiber)
  • Apple, green (1 small, 144 grams): 20 grams carb (4 grams fiber)
  • Grapefruit (1 small, 200 grams): 21 grams carb (3 grams fiber)
  • Pear (1 small, 148 grams): 23 grams carb (5 grams fiber)
  • Apple, red (1 small, 158 grams): 24 grams carb (3 grams fiber)
  • Cherries (1 cup, 154 grams): 25 grams carb (3 grams fiber)
  • Grapes (1 cup, 151 grams): 27 grams carb (1 gram fiber)

You can see why it is difficult to work fruit into a ketogenic diet, and also why blackberries and raspberries are the most often recommended fruit for keto-ers. Nevertheless, it’s possible.

Just for comparison, the 7 grams of carbs you “spend” on ½ cup of blackberries could also be allocated to any of the following:

  • 1 cup of cooked whole Brussels sprouts
  • 1 cup cooked chopped broccoli
  • 2 cups of raw chopped broccoli
  • 1¾ cups raw shredded cabbage
  • 8 medium baby carrots
  • 4 cups of baby spinach
  • 5 cups of raw kale
  • 1 whole small cucumber
  • 1 medium red bell pepper

Tips For Incorporating Fruit Into Your Keto Diet

  1. Select lower-carb fruits and limit portion sizes.
  2. Eat whole fruit, not fruit juices. Whole fruits induce a smaller glycemic and insulin response. Smoothies can quickly become carb bombs, and they are generally less satiating than their ingredients eaten separately because you don’t have to chew them. Include smoothies mindfully.
  3. Consider timing them strategically around the times when you are most insulin sensitive: in the morning and especially after exercise. (This is solid advice for any higher carb food or meal.) Likewise, you might save fruit intake for designated higher carb meals (“carb ups”) if this is part of your routine. However, if you struggle with insulin resistance, any kind of carb ups might not be appropriate for you at this time.
  4. Eat seasonally and locally. This recommendation isn’t unique to keto dieters, but eating seasonally and locally will automatically limit your consumption of fruits for much of the year unless you live someplace warm (in which case, hopefully you’re getting lots of outdoor time and sun exposure year round, too!)

But I Heard I Need to Avoid Fructose For Health?

Fructose is often demonized because it’s thought (incorrectly) that fructose uniquely contributes to de novo lipogenesis. As Mark has written previously, although fructose and glucose are metabolized differently in the body, it is probably splitting hairs to argue that one is more or less healthy than the other when they are considered in the context of one’s entire diet. And while reducing sugar intake has been shown to improve various health markers, this usually means cutting back on high fructose corn syrup and other added sugars, not eliminating a green apple and a serving of berries. If you’re eating a Primal-aligned ketogenic diet and are already limiting your total sugar intake, it’s probably not necessary to specifically avoid fructose that comes in the form of whole fruit.

That said, some of the GI disorders that are so common nowadays might be attributable at least in part to issues of fructose malabsorption. If you have been diagnosed with IBS or otherwise experience chronic GI symptoms, you might consider asking your doctor for a hydrogen breath test to detect fructose malabsorption. You can also try eliminating and then reintroducing fruit to see if it affects your symptoms.

Remember, Constant Ketosis Is Not Required

If you’re avoiding fruit because you’re afraid to get knocked out of ketosis, remember that once you’re keto-adapted it’s unnecessary to stay in ketosis 100% of the time unless you’re using a therapeutic keto diet to treat a serious medical condition. Also, if there’s a fruit you especially want to include in your keto diet, you can also test your individual physiological response to it using a blood ketone meter.

A final word: When considering whether to add more fruit to your keto diet, ask yourself whether you’re still at a point where you would be better off abstaining in order to avoid triggering cravings for sweet foods. This is an n=1 situation. If you feel like some fruit would add to your general enjoyment of your keto way of eating, or you’re looking for ways to incorporate more Primal-approved carbs, go for it. If you’re still struggling to break the sugar habit, perhaps hold off for now, knowing you can always choose to add fruit later.

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References:

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10 and 2 Qs: How to decide if you should fast, drink bulletproof coffee, go keto, or do any other diet or lifestyle protocol

One of the most common questions I get is: “Should I try XYZ health diet or protocol?”

And while, yes, most of the time, the dietary intervention in question can be a great tool, that doesn’t mean it’s going to transform you into a glowing vision of health.

In this video I share my advice to people when deciding whether or not that given dietary intervention is right for them:



from The Paleo Diet http://bit.ly/2GdXfJ6

Meal Planning 3.0

As a post-baby followup to my meal planning posts, I wanted to write a little about what I’ve been doing to keep the fresh food flowing. Here are some of the ways we’re getting our food on the table.

Prepping Lots of Veggies

I’ve gotten back into the prep day a bit after realizing how lovely it is to have cooked veggies in the fridge during the winter when I’m craving less salad. I’ve been making a massaged kale salad with lacinato kale (my new fav) and roasting up a few sheet pans of veggies and sweet potatoes to pair with Plenty dishes (see below) or have on the side of a sandwich or salad for lunch. Favorite: roasted bell peppers!

Using The Instant Pot For Staples

I’m also trying to get some use out of the Instant Pot and making either egg salad, hard-boiled eggs, baked sweet potatoes or mac and cheese once a week. This doesn’t always happen on a prep day, but when I do make it, it lasts a while. I also always make 2-serving smoothies these days and have one for breakfast and the other for snack or breakfast the next day. Might as well blend once, eat twice! Same goes for oatmeal – I always make extra portions now to reheat the next day.

The “egg loaf” made in the Instapot makes the fluffiest egg salad!

Using Plenty For Weeknights and Lunches

I’ve written about Plenty several times on the blog, but we have LOVED the personal chef service! It’s surprisingly affordable – a one-time $50 cost to cover glass Pyrex containers and then an a la carte menu each week. I love that you don’t have to commit to a certain amount of food. We’ve been spending $50-100 a week on 1-2 entrees and some staples like quiche or soup. Naturally our grocery bill has gone down, so it balances out. The meals are SO GOOD and very healthy, real food-based too. It’s been so, so nice to have things like made-from-scratch meatballs with pesto or ramen soup to have on hand. The quiches are my favorite because I can eat them anytime!

Saving Fancier Recipes For The Weekends

On Saturdays and Sundays we’ve been planning longer recipes. Maybe a special steak from the freezer or a smoked meat on the Big Green Egg. Or grilled pizzas! It makes the weekend feel extra special to plan something nicer, and it’s always good to have more hands on deck and the whole day to prep. I also realized that it’s convenient to do some prep day work during happy hour on Saturday when I have a glass of wine in hand and Mazen is often with Matt. Saturday happy hour is the new Sunday afternoon : )

Ordering Meat Through Butcherbox

To fuel those special weekend meals, we’ve been relying on Butcherbox for our grass-fed products, wild salmon, and the like. I love that our box has staples like chicken breast, special steaks that we might not otherwise buy, and larger cuts of meats that Thomas loves to smoke. Plus wild salmon!

Going On One Quick Grocery Trip Every Saturday

And since we’re using Butcherbox and Plenty for the bulk of meals, our grocery store visits are usually very quick. The list usually says: Milk, coffee, yogurt, eggs, fruit and a ton of veggies.

Instant Pot egg salad on prepped kale salad!

Obviously we are not meal planning all-stars over here, but we are doing our best navigating life with our two kiddos and busy weeks.

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