Gisele Bundchen, Nutrition Expert?

Here is my recent article, published in The Huffington Post about breastfeeding.
http://www.huffingtonpost.com/jay-gordon/gisele-bundchen-nutrition_b_675130.html
A lively discussion is taking place at the bottom of the page over there.


Gisele Bundchen, Nutrition Expert?

Yes!

In a recent magazine article, Ms. Bundchen was quoted saying that breastfeeding should be the legal norm for all babies for the first six months of life.

Of course, this generated a storm of protest about “feeding choices” and whether or not we should listen to someone with her lack of credentials. Lost in the fabricated drama and controversy is the fact the we mustlisten if her advice and high profile can save babies’ lives. I’m sure that this one famous mother’s words will be heard and heeded by more mothers than we pediatricians can possibly reach. (Ms. Bundchen’s statement that post partum weight loss is faster because of breastfeeding is very much in line with current medical literature and will certainly appeal to most new mothers.)

It’s easy to misinterpret a forceful metaphorical statement about “chemical food”–infant formula–and the crucial lifesaving value of breastfeeding for six months. And, that’s exactly what pundits did to turn this into an “us against them” issue. “How dare she . . . ”

While it is tragic that a supermodel-mom dispenses better advice than many doctors and most governmental agencies, it’s impossible to misinterpret what the World Health Organization says about these artificial (chemical) feeding options:

The protection, promotion and support of breastfeeding rank among the most effective interventions to improve child survival. It is estimated that high coverage of optimal breastfeeding practices could avert 13 percent of the 10.6 million deaths of children under five years occurring globally every year. Exclusive breastfeeding in the first six months of life is particularly beneficial, and infants who are not breastfed in the first month of life may be as much as 25 times more likely to die than infants who are exclusively breastfed.”…

There is a common misconception that in emergencies, many mothers can no longer breastfeed adequately due to stress or inadequate nutrition, and hence the need to provide infant formula and other milk products. Stress can temporarily interfere with the flow of breast milk; however, it is not likely to inhibit breast-milk production, provided mothers and infants remain together and are adequately supported to initiate and continue breastfeeding. Mothers who lack food or who are malnourished can still breastfeed adequately, hence extra fluids and foods for them will help to protect their health and well-being.

If supplies of infant formula and/or powdered milks are widely available, mothers who might otherwise breastfeed might needlessly start giving artificial feeds. This exposes many infants and young children to increased risk of disease and death, especially from diarrhea when clean water is scarce. The use of feeding bottles only adds further to the risk of infection as they are difficult to clean properly.”

Moreover, not breastfeeding has been found to double the risk of SIDS (Sudden Infant Death Syndrome)

Read just one sentence above aloud:

“Infants who are not breastfed in the first month of life may be as much as 25 times more likely to die than infants who are exclusively breastfed.”

No parent in America is allowed to let their infant travel in a car in the “second best” way possible: Car seats are the law in all 50 states. A breastfeeding law will not be passed soon, but there is a moral, ethical and medical imperative to get this nutrition information to mothers and families any way we can. Hyperbole is easy to ridicule but, in this case, the hyperbole will prevent the deaths of many, many babies worldwide.

The World Health Organization estimates that one-and-a-half million babies die from lack of breast milk each year. 1,500,000.

If Gisele Bundchen’s magazine interview, comments and the resultant furor cause more mothers in developing nations to breastfeed, thousands and perhaps tens of thousands of babies will be alive a year, two years or five years from now who might otherwise have succumbed to diseases caused or fatally exacerbated by lack of mother’s milk.

I certainly wish that this legal proposal/metaphor had been issued by the government, health insurers or the American Academy of Pediatrics. In lieu of those recommendations, the very intelligent suggestion of a really smart mom will have to do.

Dairy Terminology

The following is a list of ingredient names that indicate the use of dairy in a food.

Avoid foods that contain any of the following ingredients:
  • artificial butter flavor
  • butter, butter fat, buttermilk
  • casein
  • caseinates (ammonia, calcium, magnesium, potassium, sodium)
  • cheese
  • cottage cheese
  • curds
  • custard
  • half and half
  • hydrolysates (casein, milk protein, protein, whey, whey protein)
  • lactalbumin, lactalbumin phosphate
  • lactoglobulin
  • lactose
  • milk (derivative, protein, solids, malted, condensed, evaporated, dry, whole, low fat, non fat, skim)
  • nougat
  • pudding
  • rennet casein
  • sour cream, sour cream solids
  • sour milk solids
  • whey (delactosed, demineralized, protein concentrate)
  • yogurt

Ingredients that MAY indicate the presence of milk protein:

  • brown sugar flavoring
  • caramel flavoring
  • chocolate
  • high protein flour
  • margarine
  • natural flavoring
  • Simplesse
  • A “D” on a product label next to a “K” or circled “U” may indicate the presence of milk protein.

Links

Weight Loss After Pregnancy

I see a lot of moms in my office who would like to lose weight and get back into shape faster. Most of them are either being too hard on themselves or someone who should be supporting their wonderful mothering is being to hard on them.

Nursing babies “cost” about 1000 calories per day so breastfeeding is one of the most efficient ways to make sure that the extra fat and water added during pregnancy are transferred to the rightful owner.

Nursing moms, and almost everyone else, need about 1800 calories/day to “get by” and much less than that is not healthy. Here are a few tips for getting into shape safely and a little bit faster:

  • Eat healthy foods. (All together now, “duh.”) This really is overlooked, though. Emphasize nutrient-rich foods which are not “calorically dense.” Avoid greasy snack foods and so-called healthy foods like cheese and whole milk. Eat more fruits, grains, pastas and beans and avoid red meat and salads laden with dressing.
  • Try to build some outdoor activity into your day. (“In my spare time and with my spare energy??) Somehow. Walk with your baby every day and try to get a jogging stroller added to your wish list. Slings make carrying your baby more efficient and burn more calories. In my experience, even moms who really didn’t have the time and energy to exercise a little, feel just great when they somehow do it.
  • Drink more water. Avoid soda and juice. These are truly empty calories.
  • Combining 100 to 200 fewer calories per day of higher fat foods (that’s just a couple spoonfuls of dressing or a piece of cheese) with 20 to 40 minutes of a good walk with your baby (200 calories out) will lead to exactly the weight loss and conditioning you want. Add in a little formal or informal yoga and stretching and you’ll get there even sooner.
  • Above all, be nicer to yourself. This is not a contest nor a sprint. You are an extraordinarily important and extraordinarily busy person: a Mother. Get into shape at a pace that suits you, not the rest of the world.

Dietary Recommendations for Pregnancy

I see most of the couples in my practice prior to their delivery. I like to do a prenatal discussion fairly early but most people come in during the last month or two of pregnancy. One reason I’d like to talk earlier is to discuss the best pregnancy diet. There is excellent medical and common sense evidence that the best nutrition during pregnancy gives the best outcome. Specifically, moms with any family history of allergies should avoid dairy products. There is not much disagreement in the medical literature about the benefits of a dairy-free diet to the developing fetus. Allergies are increased by prenatal exposure to this allergenic protein. Whatever you do, avoid the outdated advice to increase your milk intake during your pregnancy.
Avoid alcohol and other noxious chemicals. We know that medium to large amounts of wine, beer or liquor can seriously damage a baby and produce Fetal Alcohol Syndrome. It’s now recognized that lesser amounts of alcohol at critical stages of pregnancy lead to “Fetal Alcohol Effect.” If we know this, why would you drink at all during pregnancy?

The warning signs in super markets about swordfish telling pregnant women to limit the number of servings per month would lead me to a similar conclusion: Why eat any mercury-containing fish at all?

Stay active, eat as well as you can focusing on meals with lots of fruits, veggies, reasonable amounts of healthy protein, avoid alcohol, decrease or eliminate dairy products to have the healthiest pregnancy and the healthiest baby.

H1N1 Flu Update

I have seen more children and adults with influenza-like illness: 104 degree fevers, muscle soreness, sore throat and negative tests for strep, than in any summer I can remember. I haven’t used the “flu swab” to test anybody, but I’m sure that many if not most of these sick people had Swine Flu. They all felt miserable, and they are all feeling just fine now.

Preventing outbreaks of this “novel H1N1″ influenza may be a mistake of huge proportions. Yes, sadly, there will be fatalities among the 6 billion citizens of the planet. Tens of millions of cases of any illness will lead to morbidity and mortality, but this is completely (tragically) unavoidable. The consequences of not acquiring immunity this time around, however, could be really terrible and far outweigh a mass prevention program.

Here’s my rationale for not using Tamiflu: If (if, if, if) this virus circles the globe as the rather innocent influenza it now appears to be, but mutates and returns as a very virulent form of influenza, it will be quite wonderful and life-saving to have formed antibodies against its 2009 version. These antibodies may be far from 100% protective, but they will help. This is incredibly important but being ignored in the interest of expediency.

In 1918, it appears that influenza A (an H1N1, by the way) did this globe-trotting mutation and killed millions. The times and state of medical care are not comparable, but a milder parallel occurrence is possible. Perhaps this happens every 100 years or so, perhaps every three million.

Whenever possible, we should form antibodies against viruses at the right stage of their existence and at the right stage of our lives (For example, chickenpox in childhood and EBV/mono in early childhood. There are many other examples.) Getting many viral illnesses confers lifetime immunity, and very few vaccines do.

Tamiflu is a very powerful drug with little proven efficacy against this bug, and with its major side effect being tummy upset. I’m not using it at all. Psychiatric side effects are also possible.

I also won’t be giving the flu shot to the kids and parents in my practice unless there are extraordinary risk factors. I anticipate giving none at all this year. I doubt that there will be any really large problems with the vaccine, but I also doubt any really large benefits. As I said, I think that this year’s version of this particular H1N1 is as “mild” as it will ever be and that getting sick with it this year will be good rather than bad. The chances that a new “flu shot” will be overwhelmingly effective are small.

I consider this, and most seasonal and novel influenza A vaccines, as “experimental” vaccines; they’ve only been tested on thousands of people for a period of weeks and then they’ll be given to hundreds of millions of people. Not really the greatest science when we’re in that much of a hurry. Yes, one can measure antibodies against a certain bacterium or virus in the blood and it may be associated with someone not getting sick, but there are very few illnesses common enough or enough ethics committees willing enough to do the right tests. That is, give 1000 people the real vaccine and 1000 placebo shots, expose all of them to the disease and see who gets sick. Seriously. I know it sounds terrible.

This is, obviously, a difficult public discussion because it touches on the concept of benefits and risks, again, of morbidity and mortality. Few public officials have the courage or inclination to present all facets of this difficult decision. I give vaccines to my patients every single day, but I always err on the side of caution. Implying that this is a dangerous new shot is not scientifically or statistically correct and represents hyperbole and even dishonesty on the part of the so-called “anti-vaccine” camp.

It sure isn’t “sexy” to suggest handwashing, good nutrition, hydration, extra sleep and so on. It’s not conventional to suggest astragalus, echinacea, elderberry and vitamin C. Adequate vitamin D levels are crucial, too.

I just think that giving this new H1N1 vaccine is not the cautious nor best thing to do.

Best,

Jay Gordon, MD, FAAP

Goliath and the Gnats

Well, that wasn’t April’s only storm. An April Fool’s joke I posted to a private group of a few thousand doctors, lactation experts and other medical experts triggered alarm in the halls of my club, The American Academy of Pediatrics.

Interestingly, the AAP may actually have dramatically increased integrity under Dr. David Tayloe, our new president, but someone else violated the first rule of publicity: Don’t complain when some one makes you look a lot better than you really are. Even if he does it on April First!!

Dr. Susan E.Burger is one of the world’s foremost experts on international nutrition and epidemiology who shared with me her submission to the New York Times. The Times did not publish this excellent article and I asked her permission to post it here. Thank you very much, Dr. Burger

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