• Motherhood as Motivation: Helping Patients with a High BMI Reach a Healthy Pre-Conception Weight

    by Beth Heller MS, RYT

     Until recent years, physicians worried about women not losing “baby weight,” and creeping up the Body Mass Index (BMI) with successive pregnancies.  Times have changed, though, and more women are entering childbearing years significantly overweight.  In fact, the issue of weight may be the single most important health issue facing U.S. women of childbearing age.   Besides the well-known health consequences of excess weight, overweight and obese women take a longer time to get pregnant.  Once pregnant these women have a greater number of adverse pregnancy outcomes including miscarriage and stillbirth.  Perhaps most troubling is the potential impact maternal weight could have on the health of future generations.  Children of moms with a BMI>30 may have been shown to have a higher risk of serious health conditions including obesity, asthma, Type 2 Diabetes and even autism.

    First Line Therapy for Fertility (FLTF) is a new pre-conception weight loss program that uses a woman’s desire for a healthy pregnancy to motivate overweight women to attain a healthy weight for fertility and subsequent pregnancy.  The program, which teaches women a fertility-friendly Mediterranean-style diet, includes a one-on-one consultation with a Registered Dietitian.  Seven group follow-up sessions reinforce and teach lifestyle behaviors like stress reduction, grocery shopping and healthy exercise in preparation for pregnancy.  Weight loss on the FLTF program is designed to occur safely and is tracked using Bioelectrical Impedance Analysis (BIA) body composition measures to ensure lean mass is preserved.

    Experts believe the adverse metabolic conditions associated with excess body weight (poor glycemic control, excess inflammation and disrupted hormone balance) are the root cause of the poor pregnancy and birth outcomes.  Unlike other diet programs, which focus primarily on calories and promote processed “diet foods,” FLTF emphasizes nourishing low-glycemic meals, increased intake of vegetables, fruits and healthy fats and the limiting of overly processed meals.

    In my work with fertility and pregnancy patients, I find many women caught in a dieting roller coaster: weeks on extreme diet plans that bring short-term success followed by failure and weight re-gain as the new regimen becomes impossible to sustain.  Furthermore, these women are often distressed and distracted by other concerns, such as the all-too-common fertility problems that accompany excess weight.   Many have a history of pregnancy loss and miscarriage.  FLTF group sessions, and the common goal of motherhood, provide a peer support network for emotional support and improved compliance.

    The cost of First Line Therapy for Fertility is just $210 and includes a one-on-one consult with a Registered Dietitian and seven RD led follow up sessions.  The program can also be done one-on-one or as a couple in two private sessions.  More information is available at 312-321-0004 or info@pullingdownthemoon.com.

    References

    Gesink Law et al. Obesity and time to pregnancy. Human Reproduction (2007), 22 (2):pp. 414-420, 2007

    Aviram et al. Maternal obesity:  implications for pregnancy outcome and long-term risks-a link.  International Journal Gynaecology & Obstetrics (2011), 115:S6-10.

    Krakowiak et al. Maternal metabolic conditions and risk for autism and other neurodevelopmental disorders.  Pediatrics (2012) April 9 epub.

    Mann et al.  Medicare’s search for effective obesity treatments:  diets are not the answer. American Psychologist (2007), 62: pp 220 -233.

    Lowe et al. Weight-loss maintenance 1, 2 and 5 years after successful completion of a weight-loss programme.  British Journal of Nutrition (2008), 99: pp 925-930.

    Vujkovich et al. The preconception Mediterranean dietary pattern in couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment increases the chance of pregnancy.  Fertility & Sterility (2010), 94: pp 2096-101.

     

     

     

     

     

     

     

  • Autism: Causes and Early Identification

    Jen Preschern, M.A., CCC SLP

    1.  Researchers have identified the genes that cause autism.  There are 100 genes that can recombine in any  way.  This is why no 2 children with autism are the same.   (This is widely accepted by the research community. PBS has a segment on it:   http://www.pbs.org/wgbh/nova/body/autism-genes.html )

    2.   However, researchers are also looking at what epigenetic causes “turns on” these genes.  Basically, if/what environmental causes are connected with the expression of the genes.    Meaning,  you may inherit your dad’s genes for  high blood pressure.  However, if you eat right and exercise, these genes may never be expressed and you may live to be an old man with normal blood pressure.

    For more information on the fascinating new field of epigenetics, check out PBS:  http://www.pbs.org/wgbh/nova/body/epigenetics.html (As a digression-  I highly recommend the segment on the Tale of Two Mice.  It describes pre-natal epigenetic causes of obesity. Fascinating)

    3.  Jenny McCarthy and Hollywood need to step down .  Autism is not caused by the  MMR vaccine or any other regular vaccine ( at least not those given after a baby is born.  There might be some connection if a mother is given vaccines while pregnant.)

    http://www.ncbi.nlm.nih.gov/pubmed/20837594

    http://www.ncbi.nlm.nih.gov/pubmed/17898097

    http://www.ncbi.nlm.nih.gov/pubmed/20812501

    *If anyone is not convinced yet, I can find about a hundred more studies that show that  AUTISM IS NOT CAUSED BY the MMR shot!!! Get your kids vaccinated, and encourage your friends kids to get vaccinated too.     Measles and Rubella is returning because idiots follow the advice of celebrities over the advice of researchers.

    4.  There is a correlation (research is not sure if it’s a cause) of paternal age and autism.

    http://www.ncbi.nlm.nih.gov/pubmed/20837314

    5 . While researchers are debating as to exactly WHAT epigenetic factors turn on the autism genes, there is some promising research on exposure to chemicals while  in-utereo

    There is a link between pre-natal exposure to common pollutants and autism (one chemical in particular: polycyclic aromatic hydrocarbon benzo(a)pyrene.    US News did an easy to follow report on this too- second link.

    http://www.ncbi.nlm.nih.gov/pubmed/20889680

    http://health.usnews.com/health-news/family-health/womens-health/articles/2009/07/20/exposure-to-common-pollutant-in-womb-might-lower-iq.html?PageNr=1

    If you are pregnant, or know someone who is pregnant, I recommend eliminating chemicals from your home as much as possible, including the use of plastics for microwaving/storing food/water bottles, and the use of chemical cleaners as much as possible.     I would also look at eating only grass-fed beef and organic milk.   The amount of chemicals in our standard meat and dairy system in the USA is staggering.     High fructose corn syrup while pregnant  is also a no-no.   Look at the labels. These things are all derivatives of processed corn: sucrose, dextrose, fructose, corn syrup.  If  a food item has one these ingredients listed, and it is not a candy product- don’t buy it!    A recent Stanford study proved that this stuff makes you fat.   Another study printed in the recent Economist magazine  showed that a mother’s diet while pregnant pre-disposes her child to the same food preferences.  (I did not provide research on this paragraph here, but I can get it if anyone is interested).      Until researchers can identify what specific chemicals are linked to autism, I’d recommend staying away from all of them if you are pregnant.

    6.   If the genes are expressed, autism is caused by abnormalities in the pre-frontal lobe of your brain.  In a nutshell, the left pre-frontal lobe controls language, working memory, executive functions.  The right prefrontal lobe controls the mirror neuron system, which is the location of the ability to feel emphathy or  ”feel” what another person is going through.   Here is an interesting PBS segment on the mirror neuron system:

    http://www.pbs.org/wgbh/nova/body/mirror-neurons.html

    In children with autism,  the area in the brain responsible for the mirror neuron system, the pons opercularis(the symmetrical site of Broca’s – language production area- on the left hemisphere), is not working as compared to normally developing children.   In a recent FMRI study, the activity recorded in the pons opercularis during a facial expression/matching test  was directly correlated to the severity of autism. In children with the most severe autism, the area was not activating at all!  This means that the part of the brain that is able to connect with other people is just not working!!!

    It is also believed that the genes/environment cause the brain to myelinate, or form connections between parts in the brain, improperly-  In some places too much too fast, in other places not enough-  Myelin in the brain is absolutely necessary- It creates connections and allows skills to become automatic.         (As a digression- the myelin that connects the occipital area(vision),with Wernicke’s area(language comprehension), with Broca’s area(language), with the amygdala(emotion regulation), with a not-yet fully formed  yet pre-frontal lobe(goal setting, inhibiting of impulses, attention, working memory)  becomes fully connected around age 6 in most children-  This is why children can being reading at this age!!  Before this time, the brain is literally not connected! )

    Thus, a child with autism can not “feel” other people’s emotions,  and they are easily over-stimulated because any incoming stimuli not only activates one brain area like a normally developing child, but large portions of the brain (due to the too strong/too much myelin connections).  It all makes sense-   Children with severe autism  then use compensatory strategies, such as hand flapping/perseveration, in orde to help regulate themselves.  They are also unable to deal with change in the environment, because the area of the brain responsible for regulating change is not functioning properly.

    http://www.ncbi.nlm.nih.gov/pubmed/20564327

    *research that shows more myelin in left and front medial frontal cortex-  These are the executive function areas that help children regulate emotions, set goals,  monitor progress.    They are also the areas responsible for language, and social interaction (the mirror neuron system)

    7.  Researchers believe that children can be identified with autism as early as one, maybe even earlier-

    Some red flags for very young children-

    • A child spends an inordinate amount of time focusing on dynamic geometric images(staring at fans, watching movement of cars, looking at things not people) –    http://www.ncbi.nlm.nih.gov/pubmed/20819977 This type of child would be more interested in staring at moving objects than interacting with you.    Meaning, most babies can be entertained by games like “peek-a-boo” for quite a long time.   When you play with normally developing babies, they will be looking at your face and smiling with you.  Children with autism will be more interested in the object that is covering your face in peek-a-boo than in you.  Their eyes would be following the towel you use to cover your eyes, instead of looking at your face when you lift up the towel.
    • Delayed/missing development of eye gaze.  For instance,  with a normally developing child, if you stop playing and look towards another family member, the baby’s eyes will look where you look.    Or, if you point to a cup on the counter, the baby will follow the pointing of your finger and look where you are looking when you say “cup!”    A child with autism will appear to “not be paying attention” and will not follow your gaze or finger points.
    • Delayed/missing development of gestures- Even before babies communicate with words, they use gestures (pointing, pulling on your hand to show you something). If a child is not doing this by age 1, it is a huge red flag.    Gestures are considered the pre-cursor to oral language.
    • And of course,  delayed oral language development-  but all these other factors can be identified much earlier.

    8.  What is a parent to do if they suspect autism?  Find a friendly speech/language pathologist!    www.asha.org can help you locate someone in the area  or let me know and I can help you find one.

    Jennifer Preschern, M.A. CCC-SLP

    Jen has worked as a speech/language pathologist in the public school setting and in the private setting. She currently works with Leap Learning Systems in Chicago, IL as a reading/language consultant.  Jennifer holds masters degrees from Northwestern University in speech/language pathology and in learning disabilities, and a school administration degree from Loyola University. She is also certified in early intervention techniques from the Hanen Center and in phonics instruction from Orton-Gillingham.   She has published several teacher resource books, and presented at numerous state and local educational conventions primarily in the areas of reading, writing, and language.

    If you would like to contact Jen with any questions, feel free to email her at jenpreschern@onebox.com.