Why eat organic?

I wasn’t always a huge supporter of eating organic.  I was a poor college student… a poor medical student… and a poor resident.  In fact, I didn’t start thinking about my health seriously until my husband and I were planning to get pregnant.  Maybe this was a little late in the game at 37 years old… but better late than never, right?

In college, I lived off of lean cuisine microwaveable meals with plastic and drinking 3 diet dr. peppers a day.  In medical school, I survived off a protein bar, sandwich, and microwaveable dinners as well.  Did I mention that I experimented with smoking to help me study?  Ick, what horrible habits!  In residency, I continued with protein bars, microwaveable meals, and hospital food that was free for residents around 9p.  Not to forget, that I made sure I went to a bunch of residency interview dinners to meet potential incoming residents.  Fast forward to getting ready for my wedding day, I went 3 months on a paleo diet and felt incredible and saw real changes in my body without feeling deprived or hungry.  We went organic during my first pregnancy.  We’ve placed more importance on sustaining our baby and helping her maximize her growth and learning with a more nutritious diet.  During my second pregnancy, I again ate organic.  But, I was diagnosed with gestational diabetes and moved to a more Whole30 diet — eliminating processed foods as well as sweets.  I was able to really control my blood sugars with diet alone, and I feel better without all the processed food and sweets in my system.

Why do I think about this now?  More and more, I feel the impact of a well-balanced diet on my body.  My AGING body.  Perhaps in our youth, we can fake it and make it by eating crap food and maintaining an unhealthy lifestyle.  But as I’m aging, I feel the effects more and definitely sooner.  Additionally, I care more now about what I put into my body and in my family’s.  I would love to teach my kids the importance of healthy eating and what good food tastes like.  So, enter my quest to eat organic as well as grass-fed, hormone-free meats as well as going more plant-based.


Resources:

HelpGuide – Organic Foods: What You Need to Know

HelpGuide – Healthy Food for Kids

Mayo Foundation for Medical Education and Research – Organic vs. Non-Organic PDF

MindBodyGreen – A Doctor’s Top 4 Reasons to Eat Organic

Dr. Axe – Dirty Dozen

EWG – EWG’s 2018 Shopper’s Guide to Pesticides in Produce

Dirty-Dozen-Clean-Fifteen

Time – 4 Science-Backed Health Benefits of Eating Organic

The Organic Center – Bringing you the science behind organic

Food Safety Magazine – 2018 Dirty Dozen and Clean Fifteen Lists Rank Produce Items by Pesticide Level

Association between organic food consumption and metabolic syndrome: cross-sectional results from the NutriNet-Santé study. Eur J Nutr. 2018 Oct;57(7):2477-2488.

Human health implications of organic food and organic agriculture: a comprehensive review.  Environ Health. 2017; 16: 111. 

Organic Food in the Diet: Exposure and Health Implications. Annu Rev Public Health. 2017 Mar 20;38:295-313.

Are organic foods safer or healthier than conventional alternatives?: a systematic review.  Ann Intern Med. 2012 Sep 4;157(5):348-66.

Nutrition-related health effects of organic foods: a systematic review. Am J Clin Nutr. 2010 Jul;92(1):203-10.

blog_image_food

Clean Label Project: Methodology

Center for Ecogenetics and Environmental Health: Health Risks of Pesticides in Food

U.S. Right To Know: Monsanto Papers

U.S. Right To Know: Pesticides

Time: Why Organic is the Right Choice for Parents

NBC News: What a nutritionist wants you to know about pesticides and produce

EH_VENN_GRAPHIC_sm
U of Washington Center for Ecogenetics & Environmental Health

Key Points

  • Eat organic and free-range/cage-free/grass-fed/hormone-free when possible
  • Pesticides are toxic and can lead to health problems later in life
  • Choose organic alternatives to the Dirty Dozen
  • Babies, young children, pregnant women, and breastfeeding women are more susceptible to pesticides and toxins in food.
  • Research the labels and get the facts
  • Consider these Netflix documentaries on Health and Nutrition
Advertisements

Arden’s 1st birthday


Written Jan 2, 2019

I can’t believe Arden is almost a year old! Where did the year go?! I’ve got to start getting ideas for her bday as well as invites, food, party favors, location, etc.
Brainstorming:

The number ‘1’ photo collage of Arden: Ribbet, ShapeCollage, Shutterfly

Electronic invites: Paperless Post

Catering: Yelp Taco catering, Yelp food truck catering

Location: Carmel Valley parks

Carmel Valley Community Park and Recreation Center
3777 Townsgate Drive
San Diego, CA 92130
(858) 552-1616

** Insurance for caterers/vendors/food trucks needed. No glass containers. Alcohol is permitted. If >50 people, then $175 for day use. Tables 1st come, 1st serve.
Things to get:

  • Inflatable swimming pool: Amazon
  • Balls to fill pool: Amazon
  • Bubbles: Amazon
  • Gluten-free Cupcakes
  • sheet cake – Costco?
  • one small cake for Arden
  • decor for Arden high chair: Amazon
  • Plates, silverware, napkins
  • alcohol
  • 529 gifting: https://gift.my529.org/1RU6HD
  • Party favors: bubbles, pinwheels, Amazon
  • Photographer?

Paid Maternity Leave

I had just written a response to a partner’s email regarding outpatient coverage and the focus of work-life balance.  I think it’s a great initiative that she is tackling while brainstorming what could help the group with flexibility as well as some normalcy while raising a family.
This made me think of changes to antiquated practices we currently have in our work environment… primarily, paid maternity leave as well as paid sick leave.  Many of my male colleagues can continue to work and can take as little or much leave as they would like for family bonding or vacation time to spend with their newborns.  This is their option.  Unfortunately, the women physicians in our group are not afforded that same luxury.  There is a 6 week medical leave of absence with a vaginal delivery or an 8 week leave of absence with a C/S as proposed by the OBs.  During this time, we are not paid.  State disability is a joke bc it’s not even enough to cover a mortgage payment.  Look at other large companies, there’s often paid leave or sick leave available to the employees.  Therefore, women who choose to have kids while working as a physician in our group are penalized, especially if they are the breadwinner.
Not only that, even while off on medical leave, we are required to pay into the trust and pay ridiculously high premiums to cover the wide age gap of partners in our practice.  I would be happy to look elsewhere for my medical coverage, but I simply cannot come off our medical insurance plan.
Therefore, I propose there be a fund set aside to create a pool or trust for persons creating families (just as we do for our more distinguished and elderly physician population with our health insurance plans and exorbitant premiums) who will have families and work in our group.
Here are some examples in the news of what is and has been in the pipelines….
Here are examples of companies getting it right:
Please consider updating some or all of the policies for paid maternity leave.  I am open to your thoughts and considerations.

 

Poll on Maternity Leave

What it’s like to be a female anesthesiologist…

Montessori floor bed

As Arden is getting older and bigger, I’m wondering if she will outgrow her pack and play that has been her bassinet and crib since she was born. At school, she naps on a floor bed. The times we have tried to get her to nap at home on a floor mattress, she wanders around her room. That was prior to her really crawling around. Now almost 11 months old, she is so fast at crawling and getting around…I’m worried she’ll wander around her room and not get a good night’s rest. But, maybe the ability to explore and be comfortable in her own space is exactly what she needs…

One family’s Montessori floor bed experience from 2013

How we Montessori – Transitioning to a floor bed

ClockWorkRise – Floor bed transition

Kavanaugh report: realities of a montessori floor bed

CanDoKiddo: Montessori floor bed sleep problems

The Full Montessori: floor bed confidential

The Baby Sleep Site – How and when to transition your toddler from a crib to a bed

YouTube: Live well, Jess – Montessori floor bed experience

YouTube: Why not Montessori – Montessori floor bed and Our Experience

YouTube: Mellow Mama – Montessori floor bed

Gestational Diabetes Mellitus

From my 2nd pregnancy….

Got my glucola test today (11/26) for my 24 week test. This time I stayed NPO. My diet has NOT been good this pregnancy. Everything sweet has been so appealing to me. Sweets and carbs have been my jam. But, I have no real cravings like I did with the first pregnancy.

So I got the results back from the 1 hour glucola test and my BS is 155, and it should be less than 130. Ugh! I read this girl’s blog entry and totally related.

Now, I work on diet, portion control, snacks, and exercise.


Week 25: Dec 4 – 10, 2018

I have been clean eating for the last two weeks since I failed my 1st glucola testing. Today, I did an experiment of doing random blood sugars.

7:00a — fasting since 8pm the night before.
BS = 84
8:58a — done one hour after my last bite of breakfast (1/2 cup greek yogurt, strawberries, paleo granola)
BS = 97
9:22am — last bite of homemade beef and bean paleo chili (1 cup). 1 tbsp unsweetened, unsalted organic crunchy peanut butter.
12:33p — last bite of work soup (1/2 chicken and sausage jambalaya, 1/2 lentil and chickpea, salt load thru the roof).
13:43p — BS 93
16:45p — last bite of grilled chicken, brown rice, veggie bowl from FlameBroiler. 1/2 an orange.
17:36p — BS 120
19:15 — granny smith apple; 1 tbsp natural, organic crunchy peanut butter. 1 piece of dark chocolate.

More info I found on glucola testing and GDM:


On Jan 11, 2018, I took my 3 hour glucola test. It’s as awful as the first time but now there’s a 100g sugary drink (yuck!) and 3 hours of hanging out at the lab. Took my 3 hour glucola test and passed the first two blood draws (fasting, and 1 hr after 100g drink)… then got the call that my glucose was slightly elevated on the last two draws (2 hours after the drink and 3 hours after the drink). I’m disappointed that now I have to go and meet with a diabetic educator. Pretty much since I found out that I had a positive 1 hour glucola test, I have been on a lower carb, no-sweets diet. That’s been about a month and a half. I totally related to what this gal said about her diagnosis of GDM.

So, I did more research on what I actually need to do now before meeting with the diabetic educator.

Northwestern Medicine GDM Meal Planning

Yale Health Sample Menu Plan for Women with GDM

Kaiser Permanente; 2000 calorie meal plan for GDM

Sample meal plans from a nutritionist

Intermountain Health Care: GDM Meal Plan

Diabetic food list

optimal-foods-for-gestational-diabetes

GD-Snack-Meal-Ideas
From https://bluepineappleblog.com/blog/gestational-diabetes-diet-tips/


Wed, Feb 27, 2019

Fasting BS @ 6:45a = 82

37 weeks, 1 day

Took a fasting BS bc the perinatologist said if there was only one fingerstick I could do, that would be the most important one regarding prognosis and future DM.


Fri, Mar 1, 2019

2 hour post meal @ 8:50a = 88

37 weeks, 3 days

Had a protein shake, hard boiled egg, 1 tbsp peanut butter, 1 orange, and 1 small can diet Dr. Pepper.

Severe Pre-eclampsia and Anesthesia

Chief Complaint: elevated blood pressures, now with elevated liver enzymes

SUMMARY OF RECOMMENDATIONS
1. Nifedipine 60mg ER BID, next dose at 0900.
2. Continue q4hr blood pressure monitoring; increase to q15mins should she have systolic blood pressure >160 or diastolic blood pressure >110. Please call Perinatologist should that occur.
3. NPO for now.
4. Follow-up serum preeclampsia labs at 1200, along with type & cross x2 units.
5. If AST/ALT continue to rise, would recommend primary cesarean section at that time.
6. Continue magnesium sulfate for now, and for 24 hours postpartum.
7. NICU aware.

PROBLEM LIST
1. INTRAUTERINE PREGNANCY AT 25w6d
2. SUPERIMPOSED PREECLAMPSIA WITH SEVERE FEATURES
3. TRANSAMINITIS, NOT YET 2x THE UPPER LIMITS OF NORMAL

HPI/HOSPITAL COURSE: 37 y.o. G1P0 at 25w6d, hospitalized for exacerbation of chronic hypertension, found to have preeclampsia with proteinuria. Patient received betamethasone and magnesium sulfate course. Since <deleted date> with change of her regimen from labetalol to nifedipine 30mg XR BID, patient had had normal to mild range blood pressures.

Patient had acute exacerbations in her blood pressures to the severe range. Please see my note from <date> in regards to her antihypertensive course. After her 10mg IV hydralazine yesterday evening, starting magnesium sulfate, and increasing her nifedipine to 60mg XR BID, she has now had normal to mild range blood pressures overnight. However, her 0000 and 0600 AM labs show an acute rise in her LFTs above her baseline, with AST now 74 and ALT 81. Platelets remain normal range, as is serum creatinine (0.5). Magnesium level this morning at 6.4, infusion rate decreased to 1gm/hr.

Review of systems: denies headache, visual changes, RUQ or epigastric pain. No contractions, leakage of fluid, or vaginal bleeding. She is feeling fetal movement this morning.

Allergies:
• Amoxicillin Rash
CONV. REACTION:Rash
• Penicillins

Exam:
Vitals:
BP: (!) 140/97
Pulse: 89
Resp: 18
Temp: 36.7 °C (98 °F) 36.7 °C (98 °F)
TempSrc: Oral Oral
SpO2: 98% 98% 98%
Weight:
Height:
General: no acute distress
Cardiovascular: regular rate, normal rhythm. Intact S1/S2
Pulmonary: clear to auscultation bilaterally
Abdomen: gravid, non-tender to palpation
Extremities: non-tender; trace lower extremity edema, symmetric. 2+ brisk patellar reflexes

Ultrasound (12/5): Cephalic presentation. estimated fetal weight 28th percentile, 776g. Normal umbilical artery dopplers.

Labs:
Lab Results
Component Value Date
WBC 14.4 (H)
RBC 4.51
HGB 13.7
HCT 41.3
MCV 91
MCH 30
MCHC 33
RDW 11.8
PLT 313
PRENEUTROABS 9.56 (H)
DIFFTYPE Auto
NEUTOPHILPCT 66.4
LYMPHOPCT 24.0 (L)
MONOPCT 7.9
EOSPCT 0.7
BASOPCT 0.9
NEUTROABS 9.56 (H)
LYMPHSABS 3.46
MONOSABS 1.14 (H)
EOSABS 0.11

Lab Results
Component Value Date
NA 133 (L)
K 4.0
CL 102
CO2 22
GLUCOSE 84
BUN 11
CREATININE 0.5
OSMOLALITY 275 (L)
ALBUMIN 4.0
LABPROT 7.4
CALCIUM 7.0 (CL)
ALKPHOS 91
AST 74 (H)
BILITOT 0.2
ANIONGAP 9
ALT 81 (H)
GFRCNAFA >60
GFRCAFA >60

NST: appropriate for gestational age and magnesium sulfate administration. Baseline 135, mild to moderate variability, occasional 10×10 accelerations. Rare variable decelerations.
Toco: irritability

Assessment/Plan:
37 y.o. G1P0 at 25w6d, admitted for superimposed preeclampsia with severe features.

With preeclampsia with severe features, we do try to wait until 34 weeks for delivery; however, delivery is recommended once in the steroid window for the following: persistent symptoms of preeclampsia (i.e., headache, vision changes, upper abdominal pain), worsening or uncontrolled blood pressure despite medication therapy, development of pulmonary edema, placental abruption, eclampsia, HELLP syndrome (i.e., platelets < 100,000 or LFTs > 2x normal), evidence of acute kidney injury (i.e., creatinine >/= 1.1 mg/dl), eclampsia or non-reassuring fetal testing.

I discussed my concern that her liver enzymes, which had mildly been elevated on admission, are now acutely rising, which would be an indication for delivery at this time. However, at 25+6 weeks, I recommend rechecking her preeclampsia labs again at 1200. If there is a further acute rise, I do recommend delivery via cesarean section at that point.

We discussed the risks/benefits/alternatives of primary cesarean section, as well as the possibility for a classical hysterotomy, in which she would not be allowed to labor in the future. Risks of cesarean section discussed included:

Risks of cesarean section:
1. Bleeding, with the possibility or requiring a transfusion. Risk of transfusion include allergic reaction (1/50,000), transmission of HIV/Hepatitis B or C 1/1.5-1.7 million. The patient is accepting of blood transfusion if needed, and a type and cross x2 units will be ordered at noon.
2. Infection, requiring intravenous antibiotics and potentially prolonged hospital stay
3. Damage to surrounding organs, not limited to baby (<1%), bowel, bladder, nerves, vessels, ureters.
4. Possible need for hysterectomy in the event of irreversible catastrophic bleeding
5. Wound complications not limited to separation and/or infection
6. Medical complications not limited to deep venous thrombosis, pulmonary embolism, cardiovascular accident, myocardial infarction, death.

I would not advise induction of labor at 26 weeks, as the chance of a successful vaginal delivery prior to 28-30 weeks in a primip is low.

Patient will remain NPO and on magnesium sulfate (for maternal seizure prophylaxis and fetal neuroprotection) at this time, as we await her 1200 labs. Will continue q4hr blood pressure monitoring, and she will be given her 60mg XR nifedipine at 0900.

Scientists-discover-critical-molecular-biomarkers-of-preeclampsia
From Debuglies.com

Spinal Anesthesia in Severe Preeclampsia. Anesthesia & Analgesia: September 2013 – Volume 117 – Issue 3 – p 686–693.

PDF version of article above

Subarachnoid block for caesarean section in severe preeclampsia. J Anaesthesiol Clin Pharmacol. 2011 Apr-Jun; 27(2): 169–173.

Comparing the Hemodynamic Effects of Spinal Anesthesia in Preeclamptic and Healthy Parturients During Cesarean Section. Anesth Pain Med. 2016 Jun; 6(3): e11519.

Recent advances in pre-eclampsia management: an anesthesiologist’s perspective! Anaesthesia, Pain & Intensive Care ISSN 1607-8322, ISSN (Online) 2220-5799.

Hemodynamic Changes Associated with Spinal Anesthesia for Cesarean Delivery in Severe Preeclampsia. Anesthesiology 5 2008, Vol.108, 802-811.

Slow Cooker Beef Stew

Earlier this week, I was craving some beef stew.  It complements the cold evenings so well!  Plus, I need more iron in my diet.  So, the stars aligned.

I gathered my basic recipe foundation from Food Network: Slow Cooker Beef Stew.

But, I had to make some tweaks to the recipe based on what my tastes are and what I had on hand in the kitchen.

1386172173354
From Food Network: Slow Cooker Beef Stew

Level: Easy
Total: 8 hr 40 min
Prep: 20 min
Cook: 8 hr 20 min
Yield: 8 to 10 servings

Ingredients

  • 2 pounds beef chuck, cut into 1 1/2-inch pieces — cut as much fat off as possible
  • 1 teaspoon smoked paprika (that’s all I had in the kitchen) plus more for garnish
  • Kosher salt and freshly ground black pepper
  • 2/3 cup corn starch (what I had available)
  • 3 tablespoons olive oil
  • 1 pound small white potatoes, halved
  • 1/2 pound cremini mushrooms, halved
  • 4 medium carrots, cut into 1-inch chunks
  • 1 medium onion, chopped
  • 4 stalks celery, cut into 1 -inch chunks (addition to recipe)
  • 2 tablespoons tomato paste
  • 1 cup red wine
  • 2 cups low-sodium beef broth
  • 3 sprigs fresh thyme (I used several dashes of dried thyme as that’s what I had)
  • 1 teaspoon caraway seeds, optional (didn’t use this bc didn’t have)
  • 1/2 cup loosely packed parsley leaves, chopped
  • Sour cream, for serving (we used greek yogurt)

Directions

  1. Toss the beef with the paprika, 1 1/2 teaspoons salt and 1/2 teaspoon pepper. Coat in 1/3 cup corn starch and shake off any excess.
  2. Heat 2 tablespoons of the oil in a large nonstick skillet over medium-high heat. Add the beef and cook undisturbed until it begins to brown, about 3 minutes. Continue to cook, turning the beef as needed, until mostly browned, about 3 minutes more. Remove the skillet from the heat and transfer the beef to the insert of a 6-quart slow cooker
  3. Add the potatoes, mushrooms, carrots, celery, and onions and stir to combine.
  4. Heat the remaining 1 tablespoon of oil in the skillet over medium heat. Add the tomato paste and stir until the oil begins to turn brick-red, about 1 minute.
  5. Add the 1/3 cup corn starch and wine and whisk until thick (it’s OK if there are some lumps).
  6. Add the beef broth, thyme, caraway if using, 1/2 teaspoon salt and a few grinds of pepper and bring to a simmer, whisking
  7. Continue simmering and whisking until the gravy is smooth and thick, about 4 minutes.
  8. Pour the gravy into the slow cooker, cover and cook on low for 8 hours. The meat and vegetables should be tender.
  9. Season with salt and pepper and stir in the parsley.
  10. Serve the stew in bowls with dollops of sour cream/greek yogurt and a sprinkle of paprika.

I browned the meat the night before and set the crockpot on low overnight.  When it was done, I took out the crockpot insert and left in on the stove top to cool.  Got home around 5:30pm and was ready to serve for the family.  This modified recipe was able to feed 4 servings the first night, and 3 servings for leftovers.  Keep in mind, we used large bowls.

This recipe definitely tackled my craving (yep, 24 weeks preggo!) and satisfied my husband and my mother-in-law as well!  Bonus, our 9.5 month old really enjoyed eating the tender beef and vegetables as well!  Family friendly meal!

VID_20181125_133548-ANIMATION