Folate vs Folic Acid in Pregnancy

Pregnancy often makes us take a closer look at our nutrition. Even if we weren’t taking vitamins in the past, we’re likely to start. At the first appointment with our prenatal care provider, likely we discuss some of the recommended requirements or possibly for those of us that are Type A personalities, we’ve already thoroughly researched the topic because we want to be on top of everything by the time we meet our provider.  I recall hearing from a variety of sources that Folic Acid was one of the key important nutrients and to be sure to make sure you were getting enough.  But what is enough and is a multi-vitamin the best source of this important nutrient?  We’ll take a look at recent research to find out how much is enough, is there such a thing as too much of a good thing, and what are the best sources of folic acid or it’s more natural form, folate.

Folic acid and folate are members of the B vitamin family.  Their names come from folium, the Latin word for leaf. (1) It is not a surprise that leafy vegetables are by far the best sources of folate. This nutrient is found naturally in various leafy vegetables such as spinach, cabbage, turnip greens, collard greens, and romaine lettuce. (18) Often the terms folic acid and folate are used interchangeably as in this excerpt from the Baby Center, “If you’re pregnant or might become pregnant, it’s critically important to get enough folic acid, the synthetic form of vitamin B9, also known as folate.” (3)  But in fact, folate refers to various tetrahydrofolate derivatives naturally occurring in foods. (6) Folic acid, on the other hand, is the fully oxidized synthetic compound (pteroylmonoglutamic acid) used in dietary supplements and in food fortification. (6)

Human exposure to folic acid was non-existent until its chemical synthesis in 1943. (4) In January 1998, the U.S. Food and Drug Administration (FDA) began requiring manufacturers to add folic acid to enriched breads, cereals, flours, cornmeals, pastas, rice, and other grain products. (13) The overwhelming evidence that folic acid supplementation before conception and during early pregnancy prevents neural tube defects (NTD) in newborns is what led to the FDA requirement. Food fortification rather than supplementation was deemed necessary because NTD’s could occur during early pregnancy, before a women knows she is pregnant.

The neural tube is the part of the embryo from which your baby’s spine and brain develop. If something goes wrong in their development, the result is called a neural tube defect. These are birth defects of the spinal cord (such as spina bifida) and the brain (such as anencephaly). (3) A baby’s neural tube is formed and closed in the first four to six weeks of pregnancy. (10) By the time most women know or suspect they are pregnant, the time for the developing fetus to benefit from extra folate has passed. NTDs affect about 3,000 pregnancies a year in the United States. (3) The Centers for Disease Control and Prevention (CDC) reports that women who take the recommended daily dose of folic acid starting at least one month before conception and during the first trimester of pregnancy reduce their baby’s risk of neural tube defects by up to 70 percent. (3)

Beyond protecting against NTD, folate is a key player in essential cell functions. It helps make, protect, and repair DNA (15), aids the complete development of red blood cells that carry oxygen from your lungs to all parts of your body (and to your baby) (14), and helps convert some amino acids (the building blocks of proteins) into others (15). During pregnancy, women’s requirements increase as baby grows in the womb.  The rapid cell growth that takes place in the placenta and as your baby grows makes getting additional amounts of folate important. Some research suggests that folate can also reduce your baby’s risk of cleft lip, cleft palate, congenital heart defects, reduces low infant birth weight, preterm delivery and fetal growth retardation. (3, 13) Not only can this  important nutrient protect your baby, there can be benefits for the mother also.  It may also reduce your risk of preeclampsia, a serious blood pressure disorder that affects about 5 percent of pregnant women. (3)

Folate is found naturally in a wide variety of foods, including vegetables, fruits and fruit juices, nuts, beans, peas , dairy products, poultry and meat, eggs, seafood and grains. (13) Spinach, liver, yeast, asparagus, and Brussel sprouts are among the foods with the highest levels of folate. (13) For a more detailed list, check out the U.S. Department of Agriculture’s Nutrient Database Web site which lists the nutrient content of many foods and provides a comprehensive list of foods containing folate arranged by nutrient content and by food name.

The federal government’s 2015-2020 Dietary Guidelines for Americans notes that “Nutritional needs should be met primarily from foods (13) and folate is no different. Folic acid was once thought to absorb better in the body than natural folate, but studies have found that a whole foods, folate-rich diet is just as effective. (18) Based on a 2007 study published in the American Journal of Clinical Nutrition, the aggregate bioavailability (the degree to which a substance becomes available to the target tissue) of folates from fruit, vegetables, and liver is approximately 80% of that of folic acid. (16) Therefore, it was decided that the consumption of a diet rich in folate from foods can actually improve the folate status of the population more efficiently that was assumed just a few years ago. In part, this may be because although the body may absorb folic acid faster than it absorbs folate, it must then convert it into folate before it can get to work. (15)

Another consideration is that when getting your folate intake through unfortified food, it comes with a whole host of other vitamins, minerals and as-yet undiscovered phytonutrients that work synergistically in the body.  In fortified foods and single supplements, it may be working alone.  Therefore, it’s best to get your nutrients from food. (15)

During pregnancy though, due to the increased demands of the fetus, it is difficult to obtain a therapeutic dose strictly through diet and may be best to supplement to ensure that you are getting appropriate amounts.   Fortified foods can help correct deficiencies, but they can overdo one nutrient. This may prove to be more detrimental that beneficial.  For example, some fortified breakfast cereals contain 100 percent of the recommended daily amount. (3) And some breakfast cereals, nutrition bars, and other fortified foods deliver up to 800 micrograms of folic acid, and that’s about double the recommended daily dose. Studies have more recently emerged which raise concern about the safety of chronic intake of high levels of folic acid from fortified foods, beverages and dietary supplements. It has been shown that many ready-to-eat foods are actually over-fortified with folic acid and that the projected daily folic acid intake from fortified food has been greatly exceeded. (2) In fact, the fortification program was projected to increase folic acid intakes by approximately 100 mcg/day, but the program actually increased mean folic acid intakes in the United States by about 190 mcg/day.(13) Considering this may be in conjunction with a daily prenatal vitamin in pregnancy which typically provides 400 mcg or more, we see how this may exceed the Recommended Daily Allowance.

Let’s take a look at what the recommendations actually are for folic acid.  The Recommended Daily Allowance (RDA) is the average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%) healthy individuals. (13)  The intake recommendations for folate and other nutrients are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) at the Institute of Medicine (IOM) of the National Academies.(13). It states that women of childbearing age should get 400 mcg of natural folate daily. It is recommended that women get 600 mcg during pregnancy, and lactating women get 500 mcg of folate each day. (18)  In table 1 below taken from the National Institute of Health, you’ll see that folate is listed as micrograms (mcg) of dietary folate equivalents (DFE’s). This term was developed to reflect the higher bioavailability (the amount of a nutrient that reaches the body’s tissues after it is eaten or the amount that your body absorbs)  of folic acid than that of food folate. This chart assumes that at least 85% of folic acid is estimated to be bioavailable when taken with food and that only about 50% of folate naturally present in food is bioavailable.

Table 1: Recommended Dietary Allowances (RDAs) for Folate*

Age Male Female Pregnant Lactating
Birth to 6 months* 65 mcg DFE* 65 mcg DFE*    
7–12 months* 80 mcg DFE* 80 mcg DFE*    
1–3 years 150 mcg DFE 150 mcg DFE    
4–8 years 200 mcg DFE 200 mcg DFE    
9–13 years 300 mcg DFE 300 mcg DFE    
14–18 years 400 mcg DFE 400 mcg DFE 600 mcg DFE 500 mcg DFE
19+ years 400 mcg DFE 400 mcg DFE 600 mcg DFE 500 mcg DFE

*chart from National Institutes of Health (13)

As discussed previously, while there is no agreement on the extent of difference between folic acid and folate bioavailability, folate bioavailability is more efficient than this chart assumes. So, the concern might be that you are consuming too much folate, but rest assured, you can’t get too much from foods that naturally contain folate. (12) It comes naturally packaged in balance with other micronutrients, and the body regulates its absorption. It is possible, however; to get too much folic acid from man-made products such as multivitamins and fortified foods, such as breakfast cereals.

While low levels of folate present many health concerns, new research is showing that excess levels may be a concern as well.  The Institute of Medicine advises not to take more than 1,000 mcg per day of folic acid unless advised by your healthcare provider. (15)  Certain situations that may require a higher dosage are:  (3)

  • Women who are obese appear to be more likely to have a baby with a nueral tube defect.
  • Previously pregnant with a baby with a neural tube defect (have a 3-5% chance of having another pregnancy complicated by an NTD.
  • Carrying twins
  • Methylenetetrahydrofolate reductase (MTHFR) mutation – that makes it more difficult to process folate and folic acid (about 50% of women in the U.S. are unable to methylate or fully convert folic acid to folate because of one of more defects in their MTHFR gene (19) )
  • Diabetic or taking certain antiseizure medications

Studies show that the body can’t properly process a high intake of folic acid into folate. It is possible that unconverted folic acid circulating in the bloodstream could elbow aside folate for spots inside binding enzymes, carrier proteins, and binding proteins. (16) In theory, this could decrease the amount of folate carried into brain and other tissues—like dying of starvation in a land of plenty. In practice, though, whether this is a real problem is not clear yet. (16)

Looking more specifically at MTHFR issues, this mutation makes it more difficult for the body to detoxify. During pregnancy this is especially concerning because the build up of unusable folic acid (from fortified food and certain prenatal vitamins) can cause toxicity and folate deficiency because it blocks absorption of naturally occurring folate. (20)

Multiple studies have been released in the past few years expressing health concerns about excess folic acid consumption. One of those studies presented preliminary findings in 2016 and suggests that excessive amounts of folate (vitamin B9) and vitamin B12 in a mother’s body might increase a baby’s risk of developing an autism spectrum disorder. (9) The researchers found that if a new mother has a very high level of folate right after giving birth – more than four times what is considered adequate – the risk that her child will develop an autism spectrum disorder doubles. (9)  Very high vitamin B12 levels in new moms are also potentially harmful, tripling the risk that her offspring will develop an autism spectrum disorder. If both levels are extremely high, the risk that a child develops the disorder increases 17.6 times. (9)

While this may spark concern in new mothers, it’s important to view the new findings with perspective.  M. Daniele Fallen, PhD, director of the Bloomberg School’s Wendy Klag Center for Autism and Developmental Disabilities and the study’s senior author urges us to remember that “Adequate supplementation is protective: That’s still the story with folic acid.” (9)  She feels that this study tells us “that excessive amounts (of folic acid) may also cause harm. We must aim for optimal levels of this important nutrient.” (9)  In other words, more research needs to be done.  It still needs determined just how much folic acid a woman should consume during pregnancy to provide optimal blood folate levels for the best outcome for her baby.

Additional studies point to other concerns of excess folic acid during pregnancy.  A 2015 Portugese study published in the Journal of Edocrinology expresses a concern that excessive amounts of folic acid during pregnancy may predispose their daughters to diabetes and obesity later in life. (11)  This study also calls for a need to establish a safe upper limit of folic acid intake for pregnant women.

A few studies have also suggested that excess folic acid may be associated with increased risk for colorectal, breast, and prostate cancers. (15)  While these studies are limited, they sound an additional warning about getting too much folic acid and confirms that this topic certainly deserves further investigation.

Despite mounting studies about the concerns of excess folic acid and statistics from the CDC that indicate on the other end of the spectrum that one in four women of reproductive age in the U.S. have insufficient folate levels (8), it’s surprising that levels are not routinely monitored during pregnancy. Likely testing was previously thought not to be needed once food fortification requirements were put into place to raise levels of folic acid in women of childbearing age. Since conventional belief is that B vitamins are water soluble it was thought that any excess would be flushed out. Until recently, there wasn’t a concern about high levels in the body.

As discussed previously, most folic acid cannot be converted into the active folate 5-MTHF, and instead it is converted in the liver, or other tissues in the body. (18) While both folate and folic acid need to be converted into the bioactive MTHF for the body to use, it’s easier to convert when it comes from food. (19)  The process of converting folic acid is very slow and has been shown to be even worse when fortified foods and folic acid supplements are consumed together. (18) When this happens, it can lead to unmetabolized folic acid in the bloodstream. (18) Possibly as more studies are done to find a safe upper limit of folic acid regular testing will be included in a future prenatal panel checklist to ensure optimum levels.  Keep in mind though that by the time you know you are pregnant, it may be too late, so it may be better to be proactive and get testing beforehand if you want to know for sure.

It’s clear that the science is not settled on this issue, so what’s an expecting mama to do regarding folate intake?  T.H. Chan of the Harvard School of Public Health recommends to continue taking your standard (prenatal) multivitamin, but to stay away from heavily fortified foods that deliver a full day’s dose – or sometimes more – of folic acid. (15) If eating fortified foods, Chan recommends avoiding foods fortified with more than 100-200 micrograms of folic acid (25% to 50% of the % Daily Value). (15) While no supplement can replace the synergistic effects of whole foods, it’s a great insurance policy, especially when trying to conceive, during pregnancy and lactation.  There are now high quality prenatals that contain folate – the natural methylated form, 5-methyltetrahydrofolate (5-MTHF) on the market.

Seeking Health, Optimal Prenatal

MTHFR-Seeking-Health-Optimal-Prenatal

Thorne Research

Thorne-Research-prenatal-supplement-facts

Zahler Prenatal + DHA

Zahler-Prenatal-DHA-prenatal-supplement-facts

You can get more info about nutrient profiles of prenatals in this blog post by Mama Natural.

Prenatal vitamins containing l-methylfolate have been compared with ones containing folic acid during pregnancy and the results are mixed.  Some experts say that new research will eventually change the guidelines for women, while others say there’s not a compelling case to do so. The choice is yours until more clear information is provided, but as always, be sure to check with your doctor or midwife before making any changes.  Let us know what you decide in the comments.

References/Sources

  1. https://www.hsph.harvard.edu/nutritionsource/folic-acid/
  2. http://blog.designsforhealth.com/blog/bid/115121/Folic-Acid-vs-Folate-Part-I
  3. https://www.babycenter.com/0_folic-acid-why-you-need-it-before-and-during-pregnancy_476.bc
  4. https://www.ncbi.nlm.nih.gov/pubmed/18038944
  5. https://chriskresser.com/folate-vs-folic-acid/
  6. http://blog.designsforhealth.com/blog/bid/115121/Folic-Acid-vs-Folate-Part-I
  7. http://healthybabycode.com/5-myths-about-pregnancy-nutrition-5-folic-acid-supplements-are-safe
  8. https://consumer.healthday.com/cognitive-health-information-26/autism-news-51/too-much-folic-acid-in-pregnancy-tied-to-raised-autism-risk-in-study-710859.html
  9. http://www.jhsph.edu/news/news-releases/2016/too-much-folate-in-pregnant-women-increases-risk-for-autism-study-suggests.html
  10. https://www.betterhealth.vic.gov.au/health/healthyliving/folate-for-pregnant-women
  11. https://www.sciencedaily.com/releases/2015/02/150210083651.htm
  12. https://www.womenshealth.gov/a-z-topics/folic-acid
  13. https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/
  14. http://www.marchofdimes.org/pregnancy/folic-acid.aspx#
  15. https://www.hsph.harvard.edu/nutritionsource/folic-acid/
  16. https://www.ncbi.nlm.nih.gov/pubmed/17284745
  17. https://www.ncbi.nlm.nih.gov/pubmed/20608755
  18. http://www.doctorshealthpress.com/general-health-articles/folate-vs-folic-acid
  19. http://www.foxnews.com/health/2014/07/27/should-skip-prenatal-vitamins-with-folic-acid.html
  20. https://www.mamanatural.com/best-prenatal-vitamins/

Holly Keich, LSW is the owner of Om Baby Pregnancy & Parenting Center in Camp Hill, PA.  When she became pregnant with her first child she began teaching prenatal yoga classes that impart not only the wisdom of poses for the childbearing year, but also knowledge of the spiritual and emotional process of becoming a parent. Holly has attended pre and postnatal yoga teacher trainings with Stephanie Keach and Mindful Mamas. She has also attended Baby Om Yoga training in NYC and is a Certified ChildLight Yoga Instructor, including Baby & Toddler Yoga as well as a Certified Infant Massage Instructor. She supports mother, child & family connections through the opening of Om Baby in 2008.

Share the Love

by Kelly Bolt

Have you heard of the Share the Love program? You probably haven’t, and I’m hoping to change that!  I’m Kelly. I’m a new site host with the Share the Love program.

GCDC2015-Share the Love Optimized
Share the Love is a unique program sponsored by CottonBabies. This program offers assistance to families in need of help diapering their child(ren) we provide a loan of cloth diapers, and inform parents how to use and care for them. These diapers are on loan until the child’s 3rd Birthday or until the family’s need is no longer there.  There are currently over 150 sites across the United States. Each site host is a volunteer, and we donate our time to helping families in need.
We all know that WIC helps cover the cost of food and formula for families. Food stamps helps supplement the grocery budget. But there is not a government assistance program designed to help families meet the (expensive) cost of diapering a child. That’s where Jennifer Labit, CEO and founder of CottonBabies, wanted to step in.
Jennifer knows what it’s like to have to choose between diapering your baby and buying food for the week. This is what motivated her to create STL! She didn’t want anyone else to struggle that way. She knows that the inability to afford diapers can lead to reusing disposables, stretching the use of each diaper by leaving it on too long, and other ways to “recycle” disposables. This can lead to baby getting severe rashes, which causes a need to see the doctor, leading to another bill and another stress on the family. Share the Love is here to help alleviate the stress and strains that come with struggling to diaper your baby.
I decided to get involved with volunteering to become a site host because I want to help others. I saw that there wasn’t a local host, and I knew that the need was here in York, Dauphin, and Lancaster counties. We currently accept donations of new and gently used cloth diapers, wet bags, pail liners, and other cloth diaper accessories. You can drop off any donations at Om Baby, and we will have a special bin set up at the Great Cloth Diaper Change on 4/22/17
If you are in need, or know someone in need, you (or they) can fill out an application at www.cottonbabieslove.com
If you feel it in your heart to become a site host, and help others in your community, you can submit an application at www.cottonbabieslove.com/join-in/

 

The Lightness of Being Organized

by Holly Keich   (originally published September 2011)

This past month, I’ve been trying to clear out dsc06821the mess contained in our basement to make way for a wonderful new useable, living space in our lives.  I was forced into cleaning by the heavy rains and subsequent flooding of our basement in this past April.  And finally I’ve scheduled the time and have started to get to work.  But every time I traverse into the depths of our basement, I wonder “Where do I start?”

Ironically, in the midst of clearing out magazine clippings that I’ve saved, I found an article on The Lightness of Being…Organized by Marilyn Paul. Paul is the author of It’s Hard to Make a Difference When You Can’t Find Your Keys.  In an attempt to find a link to the article online, I stumbled across the FlyLady.  I’ve been told of her, even took steps to ‘like’ her on Facebook, but had yet to implement any of her suggestions to make my life flow easier.  Possibly both of these findings are signs that now was the time not only to revamp the basement, but to organize and supercharge my personal and spiritual growth as Paul’s article suggests.

Really, it could happen.  Don’t you feel more centered and focused in life after cleaning and organizing?  They say it’s in the mundane where spirit truly lies. By bringing awareness to the details of life and finding joy in them I’m certain I can bring sparks of holiness to my life and fill my every day tasks with bliss.

But the question still remains…”Where do I start?”  The obvious would be to work on the physical task of decluttering and purging, but clearing your mind must work synergistically with physical clearing.  Paul says, “Developing a spiritual practice can help you see with greater clarity the areas in your life that need cleaning up, literally and figuratively, and will help you accomplish the everyday organizing that we so often avoid: folding the laundry, washing the dishes, paying the bills.”  Here are some ideas taken from the article by Paul found in the March/April 2003 issue of Body&Soul about where to begin:

Meditation can help you to clear your mind and stop grasping for happiness through acquisition.  It can even help you cut back on the obligations in your life as you pare away what is necessary and what isn’t in your life.
Try this:  Your meditation does not need to be formal. When you have kids, it’s hard to find time for a formal meditation practice.  Instead, you can “sit” behind the wheel of your car when you are stuck in traffic, or pause at a coffee shop and close your eyes. Taking just a few moments to get lost between the thoughts typically governing your mind.

Mindfulness, bringing one’s attention to the present moment, to the direct, sensual, tactile engagement with your surroundings, rather than paying attention to the often negative chatter in the mind, can help you to get past the resistance of the mundane.  Making the bed, doing the dishes, picking up toys, scrubbing a burned pot can all be a way to directly engage with the world around us.
Try this:  Perform an ordinary everyday chore, maybe one that you typically dislike, with a quiet, attentive mind for just three minutes, as if this were the first time you ever performed this task.  Pay attention to your sensations – the feeling on your skin, what you see, the shapes and the sounds.  Notice your breathing. Observe the results. Consider incorporating this into your routine so you can do more of your daily tasks with a better attitude.

Sabbath, creating a time to deliberately do nothing on a weekly basis as a retreat from the everyday world of work, chores and obligations, gives you a time for renewing the soul.  Breaks are essential for your wellbeing and long-term productivity.  When you are refreshed, you can bring great insight and energy to bear on tasks and problems that seemed insurmountable just the day before.  For those of us who feel we are too busy for a Sabbath we can work towards it slowly by setting aside a few hours in the morning or evening to start and let go of the world of deeds.
Try this:  Pick some activities that are spiritually renewing for you. Perhaps you like to walk or meditate, Perhaps it’s time to play with the kids or to read.  Maybe you take out those watercolors that have been drying up in the closet. The important thing is to break your normal routine. This time will give you life if you give it life.

With a fresh mind, you can work towards purging and letting go of material objects that you may no longer need to possess.  Often we substitute things to obtain a spiritual connection with the world and once we’ve found that elsewhere we are better able to be free of possessions that are weighing us down.  You’ll have more ability to create your physical space with harmony and balance.  Finding a place for everything and putting (and keeping) everything in it’s place.  Clearing spaces allowing more spaciousness internally. Now, rather than engaging in a constant battle against the external disarray that is a reflection of your internal struggles we will be able to clean with ease.  And as we become more organized, we’ll find gaps in time that previously seemed chaotic and rushed.  Rather than filling those gaps with action, you can choose to use this time to deepen your soul-nourishing awareness.  Take that time to ask your soul what wants to emerge.  This creates sacred intervals throughout your day where you can tune into the abundant, rich qualities of life and truly enjoy each moment.


Holly Keich is a Licensed Social Worker, Yoga Instructor and the owner of Om Baby Pregnancy & Parenting Center in Camp Hill, PA.

The Science of Love

by Holly Keich

Standing in line at the local craft shop, Valentine’s items strewn about the aisle, I choose to make an impulse purchase of a heart chalkboard. Two, one for each of my children.  Not for decoration, but in hopes of instilling kindness and love into their days by hanging them on their door and writing a daily message of gratitude for having them in my life.

love-2

As I move towards bringing more love into my family’s life and the world around me, what better time to delve deeper to answer the question, “What inspires love?” than February, the month of LOVE.  Perhaps you’ve already heard of the “love hormone,” oxytocin.  It is said to be responsible for social bonding. When we hug or kiss a loved one our oxytocin levels increase. (1) Positive comments and positive conversations also spur the production of oxytocin. (2) But as with anything we give a quick glance on the surface, as I delve deeper there is much more to learn about this hormone.

Oxytocin was first recognized for it’s role in the birth process and breastfeeding and it’s particular importance in women. (3) The hormone, when released during labor, promotes contractions and also helps the uterus shrink back to shape after birth. It also increases the production of prostaglandins, which move labor along and increases the contractions even more. (4) The life-altering event of childbirth is a stressful experience, but with the release of oxytocin, not only is the labor moved along, but many women are able to experience the event with love and joy rather than a fight or flight response. (5) Additionally, this hormone has anti-inflammatory and antioxidant properties that may help modulate pain perception. (6)  Certainly a bonus when giving birth.

The true excitement about this hormone began in the 1990’s though when researchers discovered that breastfeeding women are calmer in the face of exercise and psychosocial stress than bottle-feeding mothers. (7) The reason for this is because when an infant suckles at the mother’s breast it stimulates a release of oxytocin which creates the “let down reflex” moving the milk to the breast for baby to consume. At the same time, oxytocin is released into the mother’s brain to stimulate further oxytocin production to enhance bonding with baby. Once the baby stops feeding, the production of the hormone stops until the next feeding. (8) A lack of sufficient oxytocin can prevent the milk letdown reflex and may be one of the reasons that make breastfeeding difficult for some women.

Further studies show that It’s even been found that the higher the levels of oxytocin in the first trimester, the more bonding behaviors we see after birth, such as singing or bathing baby. (9)  Interactions such as these (and many others) builds bonds between babies and the parent or caregiver as well and studies show that their oxytocin levels also increase. (10) This comes from the evolutionary process that has shown that pro-social behaviors are beneficial to survival.  According to Loretta Graziano Breuning of the Inner Mammal Institute, mammals have learned through the years that “leaving the herd can mean instant death in the jaws of a predator, so the brain rewards you with oxytocin when you have safety in numbers. The nice safe feeling is triggered by trust and touch: they go together in the state of nature because a critter close enough to touch you is close enough to hurt you. The brain makes careful decisions about when to trust instead of releasing oxytocin all the time.” (11)

While oxytocin is typically known for it’s purpose in birth and breastfeeding, there are many other triggers of this hormone such as warm temperature and touch, smells, sounds and other social cues. (12) Even more fascinating is that the release of oxytocin is not limited to just the pituitary gland, a pea-shaped structure at the base of the brain; it can be released from the uterus, ovaries, testes, blood vessels, and the heart. (13)  But what I find most fascinating is the oxytocin is released as part of the stress response.

Typically when we think of a stress response, we think of the hormone cortisol coursing through our bodies promoting a “fight or flight” response.  Cortisol is the body’s emergency response system.  It’s triggered when we face criticism, rejection or fear, when we feel marginalized or minimized and when we feel pain and the anticipation of pain. When present in birth it can slow down labor so you can take care of the actual or perceived threat.  In all these situations, it shuts down the thinking center of our brains and activates protective behaviors.

The release of oxytocin instead creates a “tend and befriend” response.  When oxytocin comes on board during times of high social stress or pain, it may “lead people to seek out more and better social contacts,” says social psychologist Shelley E. Taylor, PhD, who directs the University of California, Los Angeles, Social Neuroscience Lab. (14)  This hormonal response actually encourages people to seek out contact with others in times of stress.

As with all things, balance is key; too little adversity and too much adversity disrupts oxytocin balance, while experiencing just enough stress helps to maintain oxytocin balance. Often we think that our hormones rule us, but there are strategies that we can use to help re-wire the brain and maintain balance. Kelly McGonigal, PhD tells us in her book The Upside of Stress that “viewing a stressful situation as an opportunity to improve your skills, knowledge, or strengths makes it more likely that you will have a challenge response instead of a fight-or-flight response.  This, in turn, increases the chance that you will learn from the experience.” (15) In fact, it was her TED Talk the spurred my interest in the topic. If you haven’t already seen it, it’s worth 15 minutes of your time to watch it here.

Now we know we have the opportunity to grow just by our perception of stressful events.  What are some other ways that we can encourage hormonal balance and love in our life?

  1. Volunteering – especially if you are experiencing the same stress or subjected to the emotional trauma or disaster event.
  2. Journaling – even just 10 minutes where you reflect on your core values and motivation can change how you face stressful events.
  3. Assigning Meaning – giving your life events greater meaning through aspirational goals, reflection on core values that keep you connected to the greater purpose of life – realizing we’re all ONE.
  4. Self Care – Exercising, spiritual practice, reading, listening to music, spending time with family or friends, get a massage, walking, yoga, creative hobbies
  5. Strengthen Mindfulness – Being in the present moment protects you from anxiety and depression. Daily meditation for just 5 minutes a day can make an impact for a lifetime.
  6. Avoid Continuous Negative News – Watching or reading the news about stressful events is one of the largest triggers of stress. We also often watch the news alone which can exacerbate our stress response and deplete willpower.
  7. Avoid Dopamine Releasing Activities – Gambling, shopping, smoking, drinking, eating, playing video games, surfing the internet or binging on TV or movies for more than 2 hours.

Practicing these activities you can build new neural circuits through repetition.  For the most effect, perform the new behaviors or thought patterns for 45 days consistently. (16)  The more you practice these activities the more balanced and stress-free you will feel, the more in balance your oxytocin will be, and the more love you will feel in your life and be able to share those around you.

  1. https://www.psychologytoday.com/basics/oxytocin
  2. https://www.psychologytoday.com/blog/conversational-intelligence/201612/chemistry-lessons
  3. http://www.livescience.com/42198-what-is-oxytocin.html
  4. http://www.hormone.org/hormones-and-health/what-do-hormones-do/oxytocin
  5. http://www.apa.org/monitor/feb08/oxytocin.aspx
  6. http://dralexrinehart.com/stress-benefits/how-to-increase-oxytocin/
  7. http://www.apa.org/monitor/feb08/oxytocin.aspx
  8. http://www.hormone.org/hormones-and-health/what-do-hormones-do/oxytocin
  9. http://www.livescience.com/42198-what-is-oxytocin.html
  10. http://www.livescience.com/42198-what-is-oxytocin.html
  11. https://www.psychologytoday.com/blog/your-neurochemical-self/201610/you-have-power-over-your-brain-chemistry
  12. https://www.ncbi.nlm.nih.gov/pubmed/15834840
  13. https://www.ncbi.nlm.nih.gov/pubmed/18655874
  14. http://www.apa.org/monitor/feb08/oxytocin.aspx
  15. http://dralexrinehart.com/stress-benefits/how-to-increase-oxytocin/
  16. https://www.psychologytoday.com/blog/your-neurochemical-self/201610/you-have-power-over-your-brain-chemistry

Holly Keich is a Licensed Social Worker and Owner of Om Baby Pregnancy & Parenting Center in Camp Hill, PA.  For more info about her work, visit www.ombabycenter.com.

Yoga for Gestational Diabetes

by Holly Keich

What is Gestational Diabetes?

Normally, insulin, secreted continuously by the pancreas, acts like a key to open the door to cells in our muscles, liver and fat tissue so glucose can enter. When pregnant though, generally between the second and third trimester, the mother’s insulin requirement increases by 2 to 3 times above normal levels. (1) Also during pregnancy, the placenta produces hormones that help the baby grow and develop. These hormones however make cells less responsive to insulin. Consequently, during pregnancy, the mother’s body needs to produce higher amounts of insulin to keep her blood glucose levels within the normal range. Typically this would not be a problem and the pancreas would secrete more insulin to lower the blood glucose levels. It’s when the pancreas cannot produce enough insulin to control blood glucose levels that glucose intolerance develops. When this happens during pregnancy it is called Gestational Diabetes Mellitus (GDM). After the baby is born, the mother’s blood glucose levels usually return to normal.

It is estimated that Gestational Diabetes affects 18% of pregnancies (2) based on new diagnostic criteria developed in 2015 by the International Association of Diabetes in Pregnancy Study Group and the American Diabetes Association, with it’s prevalence increasing worldwide. GDM usually has no obvious symptoms, therefore diagnosis is typically made through an oral glucose challenge screening between 24 to 28 weeks of pregnancy.(3) If a woman tests positive during this screening test, a second test, called the Glucose Tolerance Test (or the 3-hour challenge), may be performed. This test will diagnose whether diabetes exists or not by indicating whether or not the body is using glucose effectively. (4) This screening recommendation has been upheld by the US Preventative Service Task Force as of January 2014.  Some sources question testing procedures, from the ingredients in Glucola, the sugary drink you consume when tested, to controversy about screening and the effectiveness of treatment.

Elevated blood sugar in pregnancy creates oxidative stress and can lead to high blood pressure, preeclampsia, premature labor and possibility of delivery by cesarean section due to macrosomia (large baby). (5,6) Women who develop GDM also have at least a 50% chance of becoming diabetic later in life and a 60% chance of developing type 2 diabetes within 4 years. (5,7) Also babies born to diabetic moms have an increased risk of being born with low blood sugar and having prolonged jaundice. (8) They also have a much higher lifetime likelihood of developing chronic health problems associated with obesity and diabetes. (9)

 

Risk Factors

Certain women are more prone to experiencing gestational diabetes. Risk factors include (10):

  • Ethnicity – higher incidence in African Americans, Native Americans, Hispanics and Orientals and non-white Hispanic women
  • Greater Maternal Age (35 years plus)
  • Polycystic Ovarian Syndrome
  • Family History of Diabetes Mellitus
  • Experienced GDM in a Previous Pregnancy – 30%-60% greater risk
  • Pregnancy Induced Hypertension
  • Hypertension – twice the risk as women without hypertension*
  • Poor Nutrition and Diet*
  • Overweight and Obesity*
  • Sedentary Behavior – two fold increase risk*

Those noted with an asterisk (*) are lifestyle related risk factors that are modifiable. When risks are combined there is a greater chance of developing GDM.

 

Prevention and Treatment

The management of GDM aims to mediate the effects of hyperglycemia by controlling blood glucose levels to improve pregnancy outcomes. Likely your doctor will begin by asking you to modify your diet and begin an exercise regime. Exercise has a powerful potential to assist with blood glucose control. In fact, exercise has been shown effective in preventing, reducing or even delaying the need for insulin management. If adequate glucose levels are not achieved with diet and exercise alone, a woman will generally be directed to anti-diabetic medications to reduce blood glucose levels for mother and baby.

Records as early as the 17th and 18th Centuries have shown encouragement of exercise during pregnancy as it was thought to ensure good health and prevent miscarriage (11). Modern research shows that this is not far from the truth. Despite a trend in the last century which encouraged women not to exercise during pregnancy, current trends show that it is increasingly recognized as safe in low-risk pregnancies and is encouraged as part of routine prenatal care. Physical activity during pregnancy may prevent both GDM and possibly later-onset Type 2 Diabetes. (12) Studies even show that regular physical activity prior to becoming pregnant has shown a reduced risk of developing GDM. (13) In fact, women with a higher risk for GDM may even be able to prevent it by managing those four modifiable lifestyle risk factors noted above with an asterisk. Diet and regular physical activity are frequently sufficient to manage hyperglycemia.

Exercise during pregnancy is helpful for a whole host of associated conditions or symptoms accompanying pregnancy beyond gestational diabetes, such as edema, gestational hypertension, mood instability, musculoskeletal discomfort, aches, and weight gain. (14) Engaging in 30 minutes of moderate intensity physical activity most days of the week has been adopted as the most recent recommendation for all pregnant women, unless otherwise directed by your doctor. (15)

 

Yoga, Pregnancy & Gestational Diabetes

The general recommendation if beginning a new yoga practice during pregnancy is to wait until the 2nd trimester to begin. This may be especially appropriate for women who were previously sedentary, waiting until after the initial discomforts of morning sickness, nausea and fatigue have settled down. Since exercise in early pregnancy can reduce the risk of GDM, the sooner you feel up to exercising comfortably, the better. If you have a regular practice, continuing through the first trimester is fine as long as you are listening to your body. You’re growing a whole new human being which can deplete your energy and vitality, so rest when you’re tired. Yoga has always been about being in the moment and you may find that pregnancy pulls you deeper into the here and now as you move along with the daily changes happening in your body.

Numerous studies have already proven the remarkable effects yoga has on reducing stress. This is important when talking about gestational diabetes, because there is a direct correlation between stress and elevated blood sugar levels. (16) Yoga moderates the impact of diabetes through the lowering of stress hormones like adrenaline and cortisol. (17) When these stress hormones are elevated, blood glucose levels are raised. When we are able to lower their impact, we are able to modify the potential for GDM.  Yoga’s known ability to lower both the oxidative stress level and the perceived stress levels help to control this condition. (18)

While no one yoga pose will help to prevent or alleviate gestational diabetes, practicing this flow of beneficial poses* on a regular basis as a recommended portion of a regular exercise routine may help to lower stress and regulate blood sugar levels.

Alternate Nostril Breathing (Nadi Shodana)
Sun Salutations (modified) – feet hip distance apart
Mountain (Tadasana) – arms stretched upward
Standing Forward Bend (Uttanasana)
Lunge
dsc05456
Cow
Child’s Pose
dsc05446
Lunge
Standing Forward Bend (Uttasana)
Round to Mountain (Tadasana)
Cat/Cow
Triangle Pose (Trikonasana)
1110_keich_30_lores
Extended Side Angle
dsc05457

Warrior 1
dsc05449
Warrior 2
Standing Twist

Tree Pose (Vrksasana)
Seated Forward Bend (Paschimottansana)
Bharadvaja’s Twist
dsc05470
Bridge (Setu Bandha Sarvangasana)
dsc05472
Reclining Twist
Mindfulness Meditation or Yoga Nidra
dsc05473

*Adapted from Yoga as Medicine: the Yogic Prescription for Health and Healing
By Timothy McCall, MD

Contraindications: If any of the following warning signs occur, it is advised that exercise should be terminated: vaginal bleeding, dizziness, headache, chest pain, muscle weakness, preterm labour, decreased foetal movement, amniotic fluid leakage, calf pain or swelling and dyspnoea without exertion. (19) Additional contraindications are listed here.  Hot yoga should also be avoided during pregnancy.

 

Be sure to check out Om Baby’s Prenatal Yoga schedule and join us for a class to help reap the many benefits of yoga during pregnancy.  Modifications and adjustments available for all stages of pregnancy.


 

References:

(1) http://www.healthandyoga.com/html/news/yoga_diabetes.aspx

(2) http://www.diabetesincontrol.com/exercise-benefits-for-gestational-diabetes/

(3) http://www.diabetesincontrol.com/exercise-benefits-for-gestational-diabetes/

(4) http://americanpregnancy.org/prenatal-testing/glucose-tolerence-test/

(5) http://avivaromm.com/dont-drink-glucola-gestational-diabetes/

(6) http://www.eufic.org/article/en/artid/The_rising_concern_of_gestational_diabetes/

(7) http://www.fitpregnancy.com/exercise/prenatal-workouts/prenatal-exercise-diabetes-pregnancy

(8) http://www.healthandyoga.com/html/news/yoga_diabetes.aspx

(9) http://avivaromm.com/dont-drink-glucola-gestational-diabetes/

(10) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515443/

(11) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515443/

(12) http://www.diabetesincontrol.com/exercise-benefits-for-gestational-diabetes/

(13) http://www.diabetesincontrol.com/exercise-benefits-for-gestational-diabetes/

(14) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3424788/

(15) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3424788/

(16) McCall, MD, Timothy. Yoga as Medicine: the Yogic Prescription for Health and Healing, p. 283.

(17) McCall, MD, Timothy. Yoga as Medicine: the Yogic Prescription for Health and Healing, p. 283.

(18) http://prenatalyogacenter.com/blog/high-risk-pregnancy-and-yoga/

(19)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515443/

 

all images copyright Om Baby Pregnancy & Parenting Center


Holly Keich is the owner of Om Baby Pregnancy & Parenting Center in Camp Hill, PA. She began her yoga journey at Be Fit Yoga Studio with Bobbi Misiti in 2002.  She began teaching Ashtanga at Be Fit in fall of 2004. In 2007, when Holly became pregnant with her first child she began teaching prenatal yoga classes that impart not only the wisdom of poses for the childbearing year, but also knowledge of the spiritual and emotional process of becoming a parent. Holly has attended pre and postnatal yoga teacher trainings with Stephanie Keach  and Mindful Mamas. She has also attended Baby Om Yoga training in NYC and is a Certified ChildLight Yoga Instructor, including Baby & Toddler Yoga as well as a Certified Infant Massage Instructor. More recently she has become a Certified Sacred Pregnancy Instructor.  She continues to develop her support of mother, child & family connections through the opening of Om Baby Pregnancy & Parenting Center in 2008.

 

 

Remaining Kind Amidst Chaos

by Holly Keich

There are times when life spins furiously around you, leaving you breathless, confused and disoriented. This is one of those times. Converging around me are a variety of storms, some self-created dramas and some mere perceptions of a false reality perpetuated by a vengeance for directing my thoughts towards what calamities the future may hold. Some storms are grounded in feelings of loss for friends and family no longer with us this holiday season. Mostly though they are all created by a world beyond my control.

And so, here I find myself either being swept away in the chaos, or alternately, instinctively knowing there is another option – the option to remain centered, calm and peaceful in the eye of the hurricane that swirls around me. It’s a familiar option. Having practiced yoga for nearly a decade now, I understand the power of calming the mind, remaining still until the thoughts settle. Some days it’s harder than others.
little-gardeners-tree-cropped
In this instance, I feel a stronger power guiding me to settle. As I sit typing, I realize that the sun is still shining, the sky remains blue and there are many gifts surrounding me. Each evening I am able to lay with my children, reading them a story, talking about their day and making heartfelt connections that will turn into fond memories. I have a warm, albeit cluttered home, that provides me shelter from the brisk cold winds of winter. And my refrigerator is overflowing with food, even if some of it is rotting in the “crisper”.

These realizations bring the awareness that life is neither good nor bad, it just is. My thoughts are what offer the judgment of contentment or chaos, just as my actions can offer kindness or contention.   When I listen closely in the stillness of the eye of the hurricane, I hear not only the howl of the winds around me, but also the cries for more kindness and the pleas for contentment. The world and I are not separate in this moment, but are one entity crying from within for peace.

This veil of separation allows us to distance ourselves, protect and defend what is ours and rally against the “other.” But at the heart of it all we are all one, we have more similarities than differences, we are all seeking appreciation, kindness and love. In our moments of disorientation, we believe love must come from outside of ourselves to fill our empty hearts. It is in these moments that we forget we are one with the “other”, that we combined are love in its’ truest form.

It is not an outside force that allows us to love ourselves more. There is no more than we need to do than to look inside to find peace. Because it’s not a break through or a break down that’s needed. It is about loving yourself here and now in the darkness and chaos of the storm of life that matters most.

So how do we find kindness for ourselves in the midst of the storm? Gently, my friend. Know that you are valuable and deserve kindness. When we feel valuable, we feel strong enough to ask for what we need, even from ourselves. The more we ask for what we need, the more likely we are to get it.

Take the time to sit down to think of a list of basic, simple acts that bring joy to your heart. Did you know that Random Acts of Kindness apply to yourself too? When we are able to apply self-love and self-care regularly, our cup will eventually overflow and those joyful feelings will ripple out to others calming the storms that impact our lives. Below I’ve shared some ideas to get us started. I’d love to hear your ideas too and how implementing them has changed your perceptions of the world.

  1. Take a hot bath with some Epsom salts and essential oils. Why not throw in some candles and relaxing music too?
  2. Go for a walk to your favorite park or even just a walk around the block. You could even join Hike it Baby and meet a few new friends at their next outing.
  3. Special Treats. What’s something that makes you smile? Keep a drawer full of treats like chocolates, candles, cards, tea or coffee that you can explore when you need a little self-love. Or savor a small indulgence by making an impulse purchase of flowers or other treat for yourself.
  4. Schedule a massage, reiki or check out Dissolve Float Spa for a new relaxing sensation.
  5. Write yourself a love note to be opened later. This could be tucked into your special treats drawer too. You can make it short & sweet with a quote or mantra or a long love letter that goes into great detail about all your wonderful qualities.
  6. Paint a Picture even if you can’t paint. Don’t worry about the final project. Enjoy the experience. Expressive Art Inspirations has some ideas to get you started.
  7. Dress to Impress only You.
  8. Say Goodbye to your inner critic and Say I Love You!
  9. Sleep In.
  10. Laugh, no really…Laugh like you haven’t in years.

dsc07015


Holly Keich is the owner of Om Baby Pregnancy & Parenting Center in Camp Hill.  She is a Licensed Social Worker, Yoga Instructor, Certified Infant Massage Instructor, Parent, Wife and adamant learner in the school of life.

‘Tis the Season to Be Grateful

nupponen-family-3

photo by Jessie Gallagher

by Jessica Nupponen

‘Tis the season to be grateful, fa la la la la la la la la!  It’s November! This is the month when we set aside a whole day to focus on giving thanks. And boy, do we need it! In the increasingly negative political-climate that we call “these days,” how do we ever manage to stay grateful?  It’s something I spend a lot of time thinking about, but first – why bother?

If you’re reading this column, chances are good that you’re a parent.  As parents, we want our children to appreciate what they have and Stop. Nagging. Us. For. That. Newest. Toy/Device/Fad.  We all dream of a beautiful time when our children bypass the rampant holiday consumerism and truly appreciate the holidays as a time to be with the ones we love. And that’s why we bother trying to add gratitude to our lives. We want it for our children and they won’t learn it unless they see us demonstrating it.

So how can we feel more gratitude?

One of the things I learned from living with a chronic illness is that gratitude is an absolute necessity in order to soldier on and enjoy life. So I pursued it fiercely and… gave up quickly. I couldn’t figure out what I was doing wrong. I wanted the gratitude so, so much, but it just wasn’t coming to me naturally.

I muddled through until my then-toddler helped me realize that having an “attitude of gratitude” was not enough. Just like his little brain needed tactile ways to learn, I needed to do something to signify the gratitude. Since then I have discovered so many possibilities! Here are a few that might help you too!

1.    List at least one thing that makes you grateful every day at a certain time. For us, we do this as part of bedtime, but it can be any time that works for you. I know people who do this as part of a dinner time routine.  (Make sure to make it mundane sometimes. I mentioned once that I was grateful for running water and it sparked a wonderful conversation about how people live in different ways.)gratitude-tree

2.    Use Thanksgiving as an excuse to write them down. When November rolls around,
we get leaf-shaped cut-outs and write what makes us grateful that day on our respective leaf.  We then tape them to the wall or hang them from a plant in the house.  It doesn’t have to be fancy, but it sure does make an amazing visual of all the things that make you grateful!

3.    Get the whole family involved.  Everyone in the household can do this! We even ask our 5-year-old what he thinks makes the baby grateful. You could include the family pet! That way we’re also sneakily teaching empathy! (It’s like putting spinach in their brownies – they’ll never know! Mwahahaha!)

4.    Have older kids? Get them to use their devices to take a photo of something that makes them grateful every day. They could post it on social media if they’d like and spread the gratitude! Or they could make a digital  photo album out of it later. It also sparks creativity and mindfulness (a.k.a. spinach brownies)!

5.    Share the love!!!  If you’re feeling grateful for something, post it on social media or tell a friend.  I have a Gratitude Photojournal that I’ve kept going on social media for years and you’d be surprised how many people have told me that it makes them look around and appreciate the little things too.  This is not about the “humble brag,” friends. This is genuine, heartfelt gratitude. You know what the best part of my day was today? An iced mocha. A really, really good iced mocha that gave me the oomph to get through a big morning. And tonight that will be my post. Tomorrow it might be something much bigger and more important like my beautiful boys, a roof over my head, a husband who lovingly tucks in the boys when I work late, yadda yadda. But today was tough and that iced mocha got me through it, so it is the winner today.

6.  Take it to the next step.  Once gratitude starts to sneak into your daily routine, you’ll probably have a stronger feeling of hope edge in too. If you want all of this to equal happiness, here is your equation:  Gratitude + Kindness = Happiness. This is a fairly well-known equation, so put it to work. Use your gratitude and new-found hope to make the world a little brighter. It doesn’t take much: a friendly smile, a door held on a rainy day, a genuine compliment to a stranger or a friend, a kind word to someone who seems down, a listening ear, a warm hug.  I could go on, but you’ll find your way.

7.     Bonus!!!  When you start actively searching for things that make you grateful, you might just see your partner, your kids, your house, your job, your life in a whole new light.

It may sound trivial, but it’s true. Gratitude + Kindness = Happiness.  So let’s make a habit of practicing gratitude and cultivating gratitude, so that it becomes second nature.  I can guarantee it will make a difference to your family, to you, to your circle of friends, and maybe – just maybe – it will ripple out much further than you’ll ever know.


Jessica Nupponen is an events coordinator, choir director, sometimes-music director, and all times mom. Her hobby is running Sidewalk Chalk PA, an opportunity to make the world a little brighter through chalk. Jessica lives in the Harrisburg area with her husband, and their two “ridiculously adorable” boys.