I had a Light Schedule Today, and Pre Conception Counselling
I had a light schedule today. It was a real treat for me. My usual Monday hours are 1 pm to 8 pm. Lately I have been very busy and I need to work hard to keep up with the work. I book a checkup or Ob visit every 15 minutes, with time off for lunch, and I schedule a new patient for 45 minutes. I think that should be plenty of time, but obviously if I discover a major problem, or if the patient really needs some help with some problem, that won't be enough time. Lately my hours have been very full.
But today, there was plenty of time to speak to most of my patients. What that means is that I had more time to discuss things that are important to me. I had a new preconceptional patient and that was a lot of fun, talking about how to keep her and the baby safe during the pregnancy, and about the spiritual values of attempting a conception. As readers of my blog know, many people never get to experience the spiritual happiness and value of attempting a conception. Most people miss this opportunity because of inadequate contraception. All of their pregnancies are unplanned. The kids are still loved just as much, though, of course.
Today, one preconceptional patient was a vegetarian, and she is trying to work her way up to being a vegan. We discussed the challenges of being a vegan while pregnant. It is certainly safe and possible to be pregnant and have a happy outcome as a vegan. I stress that the new moms must take particular care to eat from all of the food groups every day. Proteins she can get from beans, nuts, and lentils. She will get an extensive amount of vitamins, minerals, and fiber from the healthy vegetables. She should also try get some natural fats, such as olive oil or canola oil. She should never consume synthetic fats, such as margarine or shortening. And she should never consume saturated fats. Fortunately there aren't any vegetarian saturated fats, unless you count synthetic ones like margarine.
There will be two particular challenges do deal with as a pregnant vegan mom. One, she will need to get DHA. DHA is an essential (which means it must be consumed orally) fatty acid. It is one of the common omega 3 fatty acids. DHA makes human brains and eyes. Most women and humans get their DHA from fish or fish oil. A vegan obviously cannot. Fortunately, nature provides an answer for these new moms. DHA is available in algae. So pregnant women can get "vegan fish oil". It is marketed like that by the companies that provide it. Unfortunately, algae oil can get a bit expensive. It can cost 20 dollars a month, or much more if consumers are not careful where they get it. I usually recommend "Expecta" algae oil. It is made by one of the largest baby formula providers, Johnson and Johnson, a large and successful corporation with worldwide operations. The price for algae oil varies between 10 dollars and 200 dollars a month. The usual price seems to be about 16 dollars a month.
The second challenge that a vegan will have is getting her Probiotics. Probiotics are living bacterial cultures that are necessary to consume to keep a human in a healthy state of commensual life with the bacteria that live upon us. Bacteria actually outnumber our human cells by millions to one. This is because that bacteria are enormously smaller than human cells. Human cells are very large compared to the bacterial cells that live in our intestinal system and on our skin. There is no such thing as a sterile human, and a human would certainly not survive if he or she tried. The bacteria in and upon us are an important part of our immune system, our digestion, and our cleanliness. A person needs to get a sufficient amount of Probiotics in her diet in order to replace the ones that are lost inside of us due to natural loss, chemicals in our food, and antibiotics that we have to live around to maintain a normal state of sanitation. There are antibiotics in and on our food, in our toothpaste, and in and on our environment due to cleaning chemicals. We certainly cannot live without modern sanitation, so in cleaning up our environment aggressively, we are also altering our probiotic bacterial environment. This is just a natural consequence of our modern life. We need to consume probiotics to replace what it missing.
Most people get their probiotics with Yogurt and communal living. Newborns get it from the mother and father, via the skin of the mothers nipples, and just being held and fed. Nobody really gets enough probiotics. We also get some from fresh uncooked vegetables, which are certainly not sterilized before we eat them.
I encourage my patients to get some yogurt, or, better yet, try a bit of Keffir every day. Keffir is a drinkable smoothie yogurt that originated in Russia. And it has been a tremendous improvement to the western diet. Vegans may object to the dairy source of Keffir. That is why I try to ask a vegan if they will allow a bit of dairy. And this hinges on why they are vegan to begin with. If they are vegan because they object to the treatment of dairy animals, then they cannot consume yogurt. If they are vegan because they are afraid of the cholesterol, then maybe I can try to get them to have some low-fat Keffir in their diet. Keffir is really yummy. I like the blueberry smoothie. It is about 3 dollars a quart. And it is a super probiotic. The ones that I buy, like Lifeway, claim to have 12 or more strains of acidophilus, or other probiotic organisms. It only takes a little bit to colonize our intestines. We don't have to drink the whole bottle every day. But if we did, the whole bottle is only 600 calories. So that is not so bad, if we had an attack of a Keffir binge. That would be infinitely preferable to a 32 ounce soda, or a big ice cream smoothie, which would have thousands of calories from the sugar and fat.
I also seen a woman, a surgical operating room nurse, come in with the dreaded postmenopausal bloating and cramping. There were tears in her eyes. On exam, the bloating and cramping came from her uterus and not her ovaries, which should be a tremendous relief for her. I ordered her a vaginal sonogram, an abdominal CT scan, an ovarian cancer screening test called an "OVA-1", and an Gastrointestinal specialist consult. The OVA-1 test is easily found on Google, for those interested in looking it up. It is far more advanced than the old CA125 test. My ordering of the OVA-1 test is slightly off label, because it is approved for the pre-operative workup of ovarian cysts. I warned her that false positives are common, and that I did not think she had any ovarian tumors, cysts, or problems. But her tears turned into a smile, knowing that the workup is well under way, and that her ovaries are likely ok. Since she works at a local hospital, she won't be charged anything to get the tests done. I think she is going to be fine.
Altogether it was a great day.
Everyone should be fine.
Thank you sincerely,
John W Marcus MD FACOG
Obstetrics and Gynecology
89 North Maple Ave
Ridgewood, NJ 07450
Phone number 201-447-0077
Blog at doctorjohnmarcus.blogspot.com
There will be two particular challenges do deal with as a pregnant vegan mom. One, she will need to get DHA. DHA is an essential (which means it must be consumed orally) fatty acid. It is one of the common omega 3 fatty acids. DHA makes human brains and eyes. Most women and humans get their DHA from fish or fish oil. A vegan obviously cannot. Fortunately, nature provides an answer for these new moms. DHA is available in algae. So pregnant women can get "vegan fish oil". It is marketed like that by the companies that provide it. Unfortunately, algae oil can get a bit expensive. It can cost 20 dollars a month, or much more if consumers are not careful where they get it. I usually recommend "Expecta" algae oil. It is made by one of the largest baby formula providers, Johnson and Johnson, a large and successful corporation with worldwide operations. The price for algae oil varies between 10 dollars and 200 dollars a month. The usual price seems to be about 16 dollars a month.
The second challenge that a vegan will have is getting her Probiotics. Probiotics are living bacterial cultures that are necessary to consume to keep a human in a healthy state of commensual life with the bacteria that live upon us. Bacteria actually outnumber our human cells by millions to one. This is because that bacteria are enormously smaller than human cells. Human cells are very large compared to the bacterial cells that live in our intestinal system and on our skin. There is no such thing as a sterile human, and a human would certainly not survive if he or she tried. The bacteria in and upon us are an important part of our immune system, our digestion, and our cleanliness. A person needs to get a sufficient amount of Probiotics in her diet in order to replace the ones that are lost inside of us due to natural loss, chemicals in our food, and antibiotics that we have to live around to maintain a normal state of sanitation. There are antibiotics in and on our food, in our toothpaste, and in and on our environment due to cleaning chemicals. We certainly cannot live without modern sanitation, so in cleaning up our environment aggressively, we are also altering our probiotic bacterial environment. This is just a natural consequence of our modern life. We need to consume probiotics to replace what it missing.
Most people get their probiotics with Yogurt and communal living. Newborns get it from the mother and father, via the skin of the mothers nipples, and just being held and fed. Nobody really gets enough probiotics. We also get some from fresh uncooked vegetables, which are certainly not sterilized before we eat them.
I encourage my patients to get some yogurt, or, better yet, try a bit of Keffir every day. Keffir is a drinkable smoothie yogurt that originated in Russia. And it has been a tremendous improvement to the western diet. Vegans may object to the dairy source of Keffir. That is why I try to ask a vegan if they will allow a bit of dairy. And this hinges on why they are vegan to begin with. If they are vegan because they object to the treatment of dairy animals, then they cannot consume yogurt. If they are vegan because they are afraid of the cholesterol, then maybe I can try to get them to have some low-fat Keffir in their diet. Keffir is really yummy. I like the blueberry smoothie. It is about 3 dollars a quart. And it is a super probiotic. The ones that I buy, like Lifeway, claim to have 12 or more strains of acidophilus, or other probiotic organisms. It only takes a little bit to colonize our intestines. We don't have to drink the whole bottle every day. But if we did, the whole bottle is only 600 calories. So that is not so bad, if we had an attack of a Keffir binge. That would be infinitely preferable to a 32 ounce soda, or a big ice cream smoothie, which would have thousands of calories from the sugar and fat.
I also seen a woman, a surgical operating room nurse, come in with the dreaded postmenopausal bloating and cramping. There were tears in her eyes. On exam, the bloating and cramping came from her uterus and not her ovaries, which should be a tremendous relief for her. I ordered her a vaginal sonogram, an abdominal CT scan, an ovarian cancer screening test called an "OVA-1", and an Gastrointestinal specialist consult. The OVA-1 test is easily found on Google, for those interested in looking it up. It is far more advanced than the old CA125 test. My ordering of the OVA-1 test is slightly off label, because it is approved for the pre-operative workup of ovarian cysts. I warned her that false positives are common, and that I did not think she had any ovarian tumors, cysts, or problems. But her tears turned into a smile, knowing that the workup is well under way, and that her ovaries are likely ok. Since she works at a local hospital, she won't be charged anything to get the tests done. I think she is going to be fine.
Altogether it was a great day.
Everyone should be fine.
Thank you sincerely,
John W Marcus MD FACOG
Obstetrics and Gynecology
89 North Maple Ave
Ridgewood, NJ 07450
Phone number 201-447-0077
Blog at doctorjohnmarcus.blogspot.com
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