PCOS : what is it and what the heck to do about it.

Polycystic Ovarian Syndrome (PCOS) has become so UBER COMMON in our world. I would simply love to do a study on how many women actually ovulate each month in 2019 when compared to how many women ovulated each month in 1819…I think the results would be astonishing. PCOS truly is a ‘disease’ of the modern age. I use the term ‘disease’ with caution because really what PCOS is most of the time is an imbalance of hormone levels (most importantly insulin) which is most often triggered by the influence of modern day life: stress, poor sleep, diet, exercise and also epigenetic changes (more on that another time!) Here’s a quick rundown of what PCOS is all about and how you can fix it.

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Polycystic Ovarian Syndrome (PCOS) is a broad term for lack of / delayed ovulation, absent or irregular periods, excess androgens, blood sugar imbalance, and of course, polycystic ovaries (multiple follicles). 

Not all follicles produce eggs that will be ovulated. Follicles are, in essence, “baby eggs” that are immature and not large enough to become a dominant follicle, and only dominant follicles are ovulated in a normal menstrual cycle. In PCOS, a mature, dominant follicle rarely develops, if it develops at all.

And it’s not just the lack of dominant follicles that is problematic; it’s also those multiple “baby follicles:” they can produce estrogen, which can lead to estrogen overload, and this estrogen can get “aromatized” into testosterone, driving androgen excess.


Up to 70% of anovulatory cycles (aka you do not ovulate) are related to PCOS, which is generally diagnosed with blood testing for hyperinsulinemia, elevated blood sugar, androgen and sex hormone levels or with ultrasound to detect multiple follicles. Ultrasound alone is NOT a good way to diagnose PCOS, however, as many women without PCOS have multiple follicles. PCOS needs to be diagnosed with blood work and ultrasound.

While the typical PCOS sufferer is overweight, PCOS can happen to all types of women - 20-25% of cases are in lean women with BMI under 25.

PCOS is incredibly paradoxical: it may be over-diagnosed, under-diagnosed, or misdiagnosed depending on the woman and the practitioner. When it is properly diagnosed, there is a very poor clinical understanding of how it should be managed. Many functional medicine practitioners, including me, have found great success helping women with PCOS using a whole body-mind approach - much like the Core Four in my Baby Making and Beyond program

Signs You Might Have PCOS

  • Skin issues. Acne or hair growth on your chin or upper lip are signs of excess androgens, a marker for PCOS.

  • Hair thinning or hair loss. This is also a sign of excess androgen production.

  • Irregular periods without ovulation (no temp rise when you chart your BBT), a sign of overall hormone imbalance, often driven by androgens.

Blood Work & Ultrasound Testing

  • This is the most important step! Get a full blood sugar and hormone panel that includes progesterone, estrogen, testosterone, DHEA, LH, FSH, prolactin, AMH (anti-mullerian hormone), HbA1C, fasting insulin, cholesterol, and a full thyroid panel. If your practitioner is not willing to order these tests, find a new practitioner or order labs directly.

  • Blood work will likely show low progesterone; high testosterone, DHEA, LH, and AMH; high- to borderline-high HbA1C; and thyroid irregularities.

  • Ultrasounds are used to check for follicles are done in ADDITION to blood work. With PCOS, there are often 12 or more follicles within the ovary, with a diameter of 2-9 mm and/or ovarian volume 10 cm3 or greater. This many follicles do not mean you’ll release multiple eggs; follicles in PCOS are not mature and don’t develop into an egg that gets ovulated.

Common Causes

  • Elevated insulin, insulin resistance, and androgen excess. This is the primary cause of PCOS and should be the target for your treatment strategies. Insulin resistance (IR) occurs when your body’s cells become resistant to the effects of insulin, which is supposed to move glucose (sugar) into the cells when the body senses a rise in blood sugar. In IR, your cells don’t soak up all that glucose - so it stays in your bloodstream, resulting in chronically high blood sugar. The elevated insulin drives the overproduction of almost anything, including an ovarian enzyme called cytochrome P450c17α that increases androgen concentrations in the body. At the same time, if your body stays in this state for too long, the pancreas, which is responsible for making insulin, eventually gets worn out and stops making enough insulin. This is when Type 2 diabetes can develop.

  • Inflammation caused by blood sugar imbalance and high insulin. Inflammation is also a marker for PCOS.

  • A diet heavy in processed foods. This drives high blood sugar and insulin levels without providing adequate nutrients to the body.

  • Uncontrolled stress levels. Cortisol and other stress hormones increase blood sugar and make it harder for glucose to get out of your bloodstream and into your cells. It also makes you crave more sugar. This also applies to exercise stress, which can also lead to hypothalamic amenorrhea due to suppression of the HPA/HPG axes. Learn more about this good stuff in the Hormones and Fertility Modules of Baby Making and Beyond.

Risks Associated with PCOS

  • Infertility because you stop ovulating

  • Should pregnancy occur despite uncontrolled PCOS, there is an elevated risk for gestational diabetes, preeclampsia, and problems with breastfeeding.

  • Depression and mood imbalances

  • Possible increased risk for metabolic disease

  • Liver inflammation

Treatments for PCOS

While drugs are available to address some of the causative factors for PCOS, we also advocate a whole-body approach centered around blood sugar balance. Be sure to read our lifestyle and supplements section and find a practitioner who can help guide your treatment plan.

Drugs prescribed by your caregiver

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  • Metformin is a drug that works by lowering blood sugar and improving the cells’ sensitivity to insulin, which helps insulin levels decrease. This can increase fertility, making it a miracle drug for many women with resistant PCOS. Always take B12 with metformin, as it will decrease your B12 levels.

  • Oral contraceptives are often used to treat PCOS, but they do not address any of the underlying causes like insulin resistance or high stress. They can also deplete certain nutrients critical to a healthy pregnancy, like folate. If your provider offers this as the only solution, consider finding a new provider for a second opinion.

Supplements

In addition to our baseline supplement recommendations found in Baby Making and Beyond, the below supplements might be a worthy addition to your protocol. As always, talk to your provider before adding these into your plan.

  • Melatonin + myo-inositol. Several studies in women undergoing IVF have demonstrated the effectiveness of this combination. The sweet spot seems to be about 3 mg of melatonin (taken nightly as a chewable or drop) combined with 2-4g of myo-inositol.

  • Myo-Inositol. Taken alone, this member of the B vitamin family supports healthy insulin regulation within the body. Women with PCOS seem to be deficient in the insulin signaling pathway (inositol- containing phosphoglycan mediators), which seems to be implicated in the development of insulin resistance. (Papaleo E et al 2009)  Inositol is also important for healthy ovulation and follicle formation, so this is particularly good for women with PCOS who would like to conceive.

  • Choline. Inositol works with choline to help with the proper utilization of insulin in the body.

  • Berberine. This compound is thought to improve insulin sensitivity by upregulating insulin receptors and stimulating glucose uptake in the cells. It might also improve acne, another common complaint in PCOS. Berberine can act as an anti-microbial, which might harm the balance of your gut bacteria if taken for extended periods of time (see below for why).

  • Proboitics: In women who are overweight with PCOS, studies have shown that the gut microbiome actually plays a pretty significant role in PCOS ( due to diminished microbiome diversity) . Take a solid probiotic and alternate strains every bottle.

  • Other nutrients. Ensure you have enough Vitamin D, magnesium (we like topical magnesium or the form magnesium glycinate) and zinc. A practitioner will help you decide what levels are right for you.

A note about maca and Vitex: I can almost always tell if someone has been taking Maca or Vitex when I look at a hormone profile. I’ll see someone with high DHEA who is depleted across the board in estrogen, progesterone, cortisol, and melatonin. Maca is most often the culprit. Maca seems to raise DHEA levels and androgen hormones more than dominant female hormones, like estrogen and progesterone. Meg has also seen Vitex exacerbate PCOS.

Diet & Lifestyle

Refer to the Core Four Nutrition section in Baby Making and Beyond for expanded recommendations, and focus on the following:

Lettuce wrapped grassfed burgers are a GREAT option. I ate these with a big green kale salad. Bonus points for eating your dinner while watching the sunset instead of wheel of fortune.

Lettuce wrapped grassfed burgers are a GREAT option. I ate these with a big green kale salad. Bonus points for eating your dinner while watching the sunset instead of wheel of fortune.

  • Higher protein and fiber, and lower sugar and carbs. Eat plenty of protein and lower-carb fiber-rich plants, and incorporate some starches that feed gut flora and improve insulin levels.  (Bindels et al. 2017)

  • Organic and grassfed when possible. Watch sourcing of your animal products. Organic and grassfed likely contain fewer exogenous hormone contaminants and fewer potentially inflammatory fats.

  • Focus on an anti-inflammatory foods. Watch your consumption of excess Omega 6 fats from modern processed foods. It may also be appropriate to reduce nut and seed consumption. Reduce or eliminate processed foods, simple sugars and ALL alcohol.

  • Not keto, I repeat, not Keto, but lower-ish carb. Full-on keto can raise cortisol levels, so we’d only recommend this approach with the guidance of a health professional. Eliminating processed carbs, grains, and the highly carb-rich plants, like sweet potato and higher-carbohydrate fruit, might help.

  • No calorie restriction or dieting. Consider consulting a nutritionist or health care provider who can help you figure out how much you should be eating.

  • Intermittent fasting. Fasting for short periods of time can improve insulin sensitivity in some women, but we recommend consulting with a practitioner first to ensure it will help you. If you feel absolutely miserable while fasting, it’s probably not the right solution for you. In this case, you can simply choose a 12-hour daily “eating window” (first bite or sip of anything that’s not water starts the clock; keep your meals and snacks within that 12 hour window), AND/OR try small and frequent (5-6) protein rich meals during the course of the day to help re-sensitize your cells to insulin and keep blood glucose regulated. Experiment and see which approach works for you.

  • Cinnamon. It’s delicious, and several studies suggest it helps improve blood sugar response.

  • Get your hormones and stress in check. Test for and correct thyroid and adrenal issues, ensure your exercise is appropriate and your stress is managed, and make sure you’re sleeping.

Sometimes the best thing you can do is just chill out and watch the sunset……..

Sometimes the best thing you can do is just chill out and watch the sunset……..

How to choose a good Prenatal Vitamin

One of the most common questions I get from readers and clients is, "What prenatal vitamin should I choose"?  I've avoided answering this question for a while because it's hard to give specific brand name recommendations when there is so much to choose from and product availability varies tremendously depending on where you live. That being said, this week I'm going to offer a launching point for women. You'll find a much more in depth answer to this question on Baby Making and Beyond but for now, here's a great place to start. 

Why do I need a Prenatal if I have a tip top diet?

This is a great question. Some women do decide not to take a prenatal combination, which is cool, but there are some things that are important to consider:

- Pregnancy (and while breastfeeding) is a time with increased, some might say insane, nutrient demands. We quite simply just need, LOTS of essential micro nutrients to support the body's process of creating a new life. Most diets, even the best, can't provide all you need. The good news is that most of the time your baby will get what he or she needs by depleting you of nutrients. If you aren't replenishing your stores, you can, and will become deficient. This is especially true if you are having multiple babies  2-3 years apart or less.

If only all farms could look like this :) A view from a home visit a few years back.

If only all farms could look like this :) A view from a home visit a few years back.

- Soil and food quality just isn't what it used to be. Even the cleanest of diets won't provide all of the nutrients you need for optimal fertility and pregnancy. The carrots our grandparents ate are not the same as the ones we find in the grocery store today, even the organic heirloom rainbow ones. A Scientific American article looked at several different studies which demonstrated time and time again that from 1975 to 1997 average calcium levels in 12 fresh veggies dropped by 27%, iron levels by 37%, vitamin A by 21% and vitamin C by 30%. 

- The stress of our modern busy lives and athletic pursuits depletes all of us of essential micronutrients. Stress and high cortisol will drain you of several critical fertility and pregnancy nutrients like B- vitamins (including folate), vitamin C, zinc and magnesium. 

- If you've are a recovering vegan/vegetarian, have had a history of food restriction, over exercise or spent much of your life (like most of us) eating a standard american diet, you are nutrient depleted. It takes many years to correct these imbalances.

What to look for in a Prenatal Vitamin

- Steer clear of drugstore or mainstream brands of prenatal (centrum, costco ect). They are made with synthetic vitamins that are not well absorbed or utilized well by our bodies and may even be harmful. For example, synthetic vitamin E can cause congenital heart defects in babies and DNA damage in mamas. 

My top pick and 100% Baby Making and Beyond approved

My top pick and 100% Baby Making and Beyond approved

- Look for a brand that lists Folate (5- methyltetrahydrofolate) not "folic acid" especially if your have or suspect you have MTHFR or other methylation issues as you won't be able to utilize the synthetic form of this B-vitamin. While high dietary FOLATE is associated with a reduced risk of breast cancer,  a high rate of FOLIC ACID consumption or supplementation has been suspected in promoting the progression of breast tumours in some women and can reduce the expression of beneficial tumor suppressor genes while increasing the expression of HER2 (breast cancer promoting genes). High dose folic acid supplementation can also mask B12 deficiency which could put you at risk for preterm labour. Baby Making and Beyond will have lots more on this critical difference. Folate must be sourced from real food so a "raw or whole food" like brand will usually have folate not folic acid in it. 

- Look for the inclusion of both Vitamin K1 and K2

- Has a combination of Vitamin A from BOTH retinol and retinol palmate (Learn the details about why this is in Baby Making and Beyond) and talk to your provider about elevated or reduced need for vitamin A

- Look for choline in your prenatal  

- Look for synergistic combinations of vitamins with cofactors to aid in absorption and assimilation. These may include fruit powder extracts, enzymes or herbs.

- Ensure they don't contain soy, gluten or dairy and look for 3rd party testing and verification. 

 

Meg the Midwife's Favourite Prenatal Vitamin

NUMBER ONE VERY BEST: Seeking Health Optimal Prenatal - Not cheap but awesome ingredients and a correct blend of vitamin A sources. If you have low iron, this is pretty much the only thing that is missing.

Innate Response Baby and Me.  I love the ingredient list and in my mind this company is legit. This is a new formulation as of 2016 and it works great for the entire childbearing cycle (aka prenatal-postpartum)

If you’re too nauseated to stomach a prenatal

This happens and don’t worry, there are some options:

Seeking Health Protein Powder: This is my ideal choice. It can help stave off nausea with its high protein content and gives you all the nutrients you need. Great for Vegans.

Seeking Health Chewable: Same formula (more or less) as the Optimal Prenatal capsule but chewable

Smarty Pants Prenatal- For women who have lots of nausea and can't stomach a traditional prenatal vitamin OR who are sensitive to iron (this is iron free). If this is all you can get into you, it's a good option until your nausea clears.

Runner Up:

Thorne Basic Prenatal. Thorne's Basic Prenatal provides the active forms of folate (5-MTHF) and vitamin B12 (methylcobalamin) for optimal tissue-ready use. Basic Prenatal also contains well-absorbed iron bisglycinate, which meets a pregnant woman's increased need for iron while being easy on the stomach and non-constipating. Several of Basic Prenatal's ingredients (including vitamin C, vitamin B6, and vitamin K) have been demonstrated to benefit "morning sickness." Basic Prenatal is manufactured with the purest possible ingredients and without the additives and coatings usually found in mainstream prenatal supplements. This supplement doesn't contain K2 so it's important that you get your K2 from your diet or from another supplement. 

Vitamin Code Raw Prenatal- This one is significantly more affordable than some of the others and has some decent ingredients. If budget is a concern for you, I'd stick with this one. 

Knowing what supplements to take during pregnancy can feel complicated. Prenatals are a good place to start but in order to optimize your health, you may benefit from taking a few other things (such as calcium, DHA ect), it's best to talk to your functional medicine practitioner about this or become one of my wellness clients and book your consult today.  

 

My Struggle with Hypothalamic Amenorrhea (HA). How I got my period back.

If you follow me on Instagram you may have noticed my post last week where I welcomed back my monthly visitor (this is what my grandmother would say) after a 10-year absence. I’ve kept pretty quiet about my struggle with HA. To be truthful, admitting my illness made me feel like an imposter and a fraud. How could someone whose job and life revolved around helping women find and nourish their own fertility be infertile and unhealthy herself?

I’ve helped countless women in my nutrition practice regain their cycles and balance their hormones. I’ve also supported hundreds more in my job as a midwife though their pregnancies and in the early months postpartum. Yet here I was, no period, no cycles, in fact, I had hormones in general (aside from cortisol). Sick, tired and at my wits end something had to give.

 

How did I lose my cycle?

 I lost my cycle 10 years ago directly following the sudden death of my fiancé. I was in a busy midwifery residency, which on it’s own was stressful, but when I lost my partner I had to find ways to cope that would allow me to feel like I had some sort of control over my life and simply keep going.

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I’ve always loved mountain activities like rock climbing, backcountry skiing and trail running. So, while in the final years of my residency, I took it upon myself to stay as “fit as possible” ,  to enable myself to enjoy the sports I loved and be fast and strong enough to keep up to all my mountain guide and professional athlete friends. The thing was, I wasn’t a professional athlete, I was staying awake for 30+ hr stretches regularly catching babies and instead of sleeping and resting to recover I would run 15- 30km. While this genuinely did feel GOOD, it resulted in over exercise, under fuelling and a general lack of relaxation in my life.

Some people call what happened to me a “female athlete triad”, but essentially what it means is you are sending your body the signal that all is not well. You force it to go into a state of self-preservation. With a lack of fuel and an abundance of stress hormones (like cortisol, which is produced during excessive exercise and a hard job where you often don’t sleep), your body prioritizes survival and shuts down reproduction because it fears that a pregnancy would not be able to be sustained.

Sometimes tragedy can be a blessing in disguise 

Sometimes tragedy can be a blessing in disguise 

            In October 2016 I had another terrible climbing accident that left me in a cast for 8 weeks and kept me away from midwifery for almost 8 months. Although I tried to exercise during this time, being in a cast and in terrible pain forced REST on my body. I also experienced regular predictable sleep, for the first time in 12 years. I ate the same but overall, my calorie deficit was reduced and my body’s hormonal systems WOKE UP! I started to have all the symptoms of PMS (sore breasts, cramps, bloating). My body was starting to grow ovarian follicles, which produced precious ESTROGEN. This surge of estrogen stimulated my body to start holding onto body fat again.

Get psycked to buy new clothes...and belts:) For the record, I'm now ANOTHER jean size larger than I was here and I give zero fucks about it. 

Get psycked to buy new clothes...and belts:) For the record, I'm now ANOTHER jean size larger than I was here and I give zero fucks about it. 

Over the course of 8 months I gained about 15lbs and went from a body fat of 16% to 24%. My body did this despite any modifications in my diet and despite my resumption of a high level of activity. My body wanted to survive and heal. For most women to regain their cycles they need to overshoot their previous weights and body fat percentages by an average of 5 lbs and 3-5% hitting a new “set point “ of sorts. It’s worth noting that a fertile BMI ranges anywhere from 21-24 and fertile body fat % ranges from 22-26%. If you’re below this, I’m sorry to say, but 90% of you will have to gain weight to regain your cycle.

Recognizing that my body was taking charge of it’s own health and fertility, I finally decided to pay attention and support my body’s valiant efforts to recover a cycle, hormonal health and my own precious fertility.

How did I do it?

There are lots of ways to get your period back. Some things will work better for others but these are the things that worked for me.

Get properly diagnosed

Hypothalamic amenorrhea isn’t something you should “self diagnose”. It could me a symptom of a much bigger issue. Approach your primary care provider and find a good functional medicine specialist to work with you to diagnose the cause of your lack of period. Here are the tests you should be asking for:

1.     Blood Hormone Levels: Estradiol, progesterone, LH, FSH, testosterone, cortisol, prolactin and b-HcG. Most women who have HA have: Low estrogen, low to absent progesterone, low LH, low FSH, low testosterone, high cortisol.

2.     Thyroid hormones: TSH, T3/T4, TPO antibodies, Reverse T3

3.     Blood nutrient levels: B12, Vit D, Iron and ferritin

4.     DUTCH urinary hormone panel. This is a GREAT test that I did and I now offer to patients. It helps diagnose problems with hormone pathways and tests for not just hormones but also hormonal metabolites

5.     Ultrasound: To check for excess cysts (when combine with high testosterone this may indicate PCOS) and test for uterine thickness.

 

Diet:

1.     Move less and eat more: Reduce and aim to eliminate your caloric deficit. If you need help calculating your calorie and nutrient needs you can use an online calculator.

Never restrict when recovering. This organic vegan chocolate ice cream (with magic shell) was a key part of my recovery :) 

Never restrict when recovering. This organic vegan chocolate ice cream (with magic shell) was a key part of my recovery :) 

2.     Don’t restrict any macronutrient: You need carbs, fats and proteins to be healthy and produce hormones. Trust me I tried everything (low carb, high carb, keto, high protein)  but in the 3 months preceding my period returning I found that I was intuitively eating a balanced diet of about 33% fat 33% protein 33% carbs

3.     Eat clean, well-sourced, organic and nutrient dense foods: These are better absorbed and will cause less stress in your body. An anti-inflammatory diet is best. If you need help finding the best diet for you, send me a message. 

4.     Let go of foods and drinks that may cause stress to your body: While I’ve never been a big caffeinated coffee drinker thanks to a CYP1A2 enzyme gene) one of the biggest things I did was give up coffee (opting for organic Swiss water process). If you suspect food intolerances or if your digestion isn’t top notch, I’d encourage you to work with a practitioner to tease out what could be triggering your symptoms. All forms of stress should be eliminated in the body. I recently started working with a woman who lost her cycle and regained it by dietary modifications alone! It’s an important piece to the puzzle.

Exercise:

Move less: You’re going to have to mellow out a little bit or a lot. While some women have to give up exercise 100%, honestly, I didn’t completely. Much of the research I’ve come across suggests that giving up exercise completely (aside from short gentle walks and yoga) may help your period return faster but what really makes a difference is having a higher percentage of body fat sustained and maintained over multiple months. This sends signals to your hypothalamus that there are enough resources available to sustain a pregnancy.

How you choose to get there is up to you. But seriously, have a solid look at your workout routines and ask yourself if they support your body and goals or are causing more harm than good.

Sometimes the best activity is  rest  and spending time with the people you love

Sometimes the best activity is rest and spending time with the people you love

Supplements:

I’m a firm believer in “smart supplementation”. I don’t like to over supplement and I think that there is no real one size fits all approach to adaptogenic or hormone balancing herbs. If you’d like help finding what may work for you please send me a note. I was continually testing my hormone and nutrient levels using DUTCH testing and blood analysis to ensure smart supplementation. Here’s what I tried and here’s what you can try too.

1.     Vitamin C: Supports your body’s response to stress

2.      Magnesium: Supports progesterone levels and reduces stress

3.     Acetyl L-Carnitine: Supplementing with acetyl-l-carnitine (ALC) restarted menstrual cycles in 40% to 60% of women with HA in two studies. This compound has been shown to affect serotonin, dopamine, and beta-endorphins, reducing the impact of those molecules on the hypothalamus resulting in higher luteinizing hormone (the hormone you need to ovulate). This did seem to help me.

4.     Maca root: This seemed to boost my estrogen levels and accelerate fat gain. For me, I think it caused a state of estrogen dominance and increased my bad estrogen (yes there is good and bad kinds). I’d use this adaptogen with caution. See how it goes for 3 months and re-evaluate.

5.     DIM: I treated my estrogen dominance with DIM. This compound found in gassy veggies like broccoli and cauliflower helps promote healthy levels of good estrogen and clears unhealthy bad estrogen (as long as your liver is strong). This may only work if you’ve already increased your estrogen levels by increasing your body fat levels AND you have maintained a higher body fat for at least 3 months.  Please don’t try this unless you’ve put on a healthy amount of weight.

6.     Calcium diglutamate: This supports your livers processing and clearance of hormones. 500mg is best for most. 

7.     Vitex- If you lose your cycles it may be due to an increase in a hormone called Prolactin. If it’s high, Vitex may work for you. This wasn’t the case for me but I tried it anyway ;) 1000mg is best for most. 

8.     Probiotics: A healthy gut is a cornerstone of a healthy hormonal system. Alternate strains regularly for a robust microbiome.

9.     Sustained Release T3: After years of HA and a high stress job, my Reverse T3 levels were sky-high. Taking a sustained release T3 (prescribed to me by my naturopathic physician) helped me clear my high RT3 and was the final missing piece to getting my period back. Please ladies, have ALL your thyroid levels checked (TSH, TPO antibodies, T3/T4 and FT3). It can be a game changer.

Lifestyle:

1.     Learn to say no:  Over the past year, my blog hasn’t gotten as much attention. I’ve been taking more time to myself to really focus on getting well. Sometimes you just have to simplify. Have a good look at what you can say “no” to in your life and just say “no”.

2.     Sleep your ass off:  Your body is stressed and in a negative energy balance. Sleep is the MOST effective way to recover and rebuild. If you have struggled with insomnia and poor sleep while you’ve had HA, many women find that once you put on some body fat you’ll sleep like a baby again. I certainly did.

3.    Stress less: I’ve taken up a solid meditation practice. It only takes 10 min each day and has changed the way I think, feel and even breathe.

4.    Care for yourself. Get a massage, spend time in nature, Netflix and chill …..if it feels good do it and make sure you do it every damn day.

5.    Acupuncture:  Give it a try, there are several studies that support its use for both stress reduction, hormone balance and fertility. I found it uber helpful.

Coping with your changing body:

1.     Buy new clothes: seriously, tight clothes are such a huge trigger and for me totally ruined my day and made me feel so bad about myself. Sell your tiny sized clothes and use the money to buy some well fitting duds. Most women, myself included, go up 2 sizes when recovering.

2.     Change the way you think about your body.: This one is hard but essential. Your body is trying to survive. It’s trying to get back into balance and be healthy. Resist the urge to pinch your fat or have negative thoughts when you see your body change…..instead, just witness it. Your body is the vessel for your soul. It’s beautiful and dynamic. This is temporary and is the birth of a new normal. If you can’t think of anything positive to say, simply try to witness your body changes without judgment. Be like Switzerland and stay neutral.

3.     Say, “Fuck it” to what people think (including yourself): This needs no explanation. You’re getting healthy; I think you’d be surprised to find that most people, if they understood what you were doing would look at you with admiration not criticism. Often times we are our own worst critics. So perhaps we really need to say “fuck you” to our own self judgment.

4.     Join a support group.:There are countless online forums and FB groups for women coping with the same things as you. Reach out, you’ll be surprised to find that you’re not alone. Ask for help from your loved ones. Reach out. You're not alone! 

This is just my journey. I'm always happy to share. Everyone's journey is their own. If you need support or help, feel free to send me a message

 

The Real Deal on Vitamin A

2019 POST UPDATE** During my research for Baby Making and Beyond, there are some key changes to the vitamin A info I share below. One day soon, I’ll update this post but if you are TTC or are pregnant, check out Baby Making And Beyond’s core 4 nutrition guidelines for more details and recommendations!

Vitamin A is awesome (get it "A"wesome?) that vitamin A is the first one because in my mind, it is one of the most important micronutrients not only to help you boost your fertility and prepare for pregnancy, but also during pregnancy and breastfeeding. So, let's explore the wonders of this over achieving vitamin. 

The Scoop on Vitamin A 

Vitamin A is important for many key functions in the body. These include: 

  • Eyesight

  • Hormone Balance and Fertility

  • Thyroid function

  • Bone growth and skin health

  • Cell differentiation and multiplication

  • Immune Function (viruses and bacteria seem to retreat in the presence of high vit A)

  • For your growing baby specifically: Vitamin A is important for the development of the neural pathways between the brain and sensory organs and in the development of the nephrons in the kidney.

  • Vitamin A deficiency is also associated with pregnancy loss...needless to say, it's an important part of a healthy diet.

Two Types of Vitamin A

Liver is one of the very best sources of vitamin A

Liver is one of the very best sources of vitamin A

Retinoids (Reteinol Esters): Derived from animal sources. Retinoids are found in the liver of any animal and in smaller quantities in egg yolks,  butter and cream from grass fed cows. 

Carotenoids:  AKA Beta-carotene. Vitamin A derived from plant sources. Think carrots, winter squash, pumpkin, sweet potatoes, cantaloupe. Basically, if it has an orange hue, it's probably rich in carotenoids. Carotenoids must be converted by the body into retinol in order to be used by the body. This is kind of tricky for the body to do and is a pretty inefficient process. This process can be even trickier if you suffer from a hormone imbalance, thyroid condition, it can be effected by food preparation and cooking methods and also if don't have enough fat in your diet or if you have digestive problems. Babies also don't convert well (another reason to feed your infants over 6months liver).  

Vit A in a Nutshell

  • Fat soluble Vitamin. This means it must be consumed with a fat to be properly absorbed.

  • Both Retinol Esters from animals and Beta Carotene from plants must be converted by the body into Retinoids. Once converted they are stored in the liver as Retinol Esters. This is why liver is such a rad source of Vit A and also why high doses of vitamin A retinol, when taken in a concentrated form, can cause birth defects months after discontinuing them. High potency topical skin serums are known for this.

  • Traditional cultures around the world seem to instinctively know the the benefits of proper vitamin A consumption. In fact, liver is found in the diets of almost every tribal group around the world, from the Canadian Inuit to the Maori in New Zealand. Many cultures even make special efforts to ensure pregnant women consume liver regularly. They instinctively know that vitamin A is critical for the health and wellbeing of our growing babies and is an KEY part of there development. Weston A Price has a great article that goes into the details about why Vitamin A is so critical for fetal development. Take home message....CONSUME LIVER in reasonable amounts! 

Vitamin A Toxicity in Pregnancy

The fear about Vitamin A toxicity in pregnancy over the past 20 years is something that commonly worries women whenever I suggest regular  dietary liver consumption. Here's the deal.....In 1995, a small study based in Boston found that high does of vitamin A could cause neural tube defects. The issue with this study is that it only looked at higher does (25,000 IU+) Vitamin A consumption from SYNTHETIC sources (retinol & retinol esters).  Follow up studies from several sites in Europe concluded that doses up to 30-50,000 IU in pregnancy from REAL FOOD sources were very safe, in fact, potentially beneficial to pregnant women. Sadly however the FDA did not change it's message and the public was once again misinformed.

Retinol Sources and Levels

  • High-vitamin cod liver oil 230,000IU /100g

  • Regular cod liver oil 100,000IU /100g

  • Duck liver 40,000IU/100g

  • Beef liver 35,000IU/100g

  • Goose liver 31,000IU/100g

  • Liverwurst sausage (pork) 28,000IU/100g

  • Lamb liver 25,000IU/100g

  • Egg Yolk 1,442IU/100g

  • Pasture Raised Butter 2,500IU /100g (this level varies greatly depending on diet of cows)

The US  and Canada currently recommend 5,000 IU per day . From the work of Weston Price, we could guess that the amount of Vitamin A in primitive diets could have as high as 50,000 IU per day. Current  recommendations from a variety of sources hover around the  10,000 IU-15,000IU level when obtained from a modern diet rich in daily grass fed butter, eggs from pastured animals and beef, lamb or poultry liver several times once a week. If you're not eating liver adding a 1 tablespoon of fermented cod liver oil can help. You can also take liver capsules, which are also a great source of b-vitamins. Vital proteins makes a good product. What's a Pregnant Paleo Mama to do?

Lambs liver...one of the milder livers. It makes great meatballs and pate spreads.

  1. Always enjoy your vitamin A sources with a fat. Vitamin A is fat soluble and needs fat to be properly absorbed.

  2. Enjoy liberal amounts of butter from grass fed cows and egg yolks. 

  3. Enjoy liver from grass fed animals once or twice a week to ensure you have a good supply of retinoids. Unless you are consuming Polar Bear or walrus liver, a serving or two of liver per week is not likely to cause any trouble. If you find the flavour of liver to be strong, try chicken liver, duck liver or lambs liver. They are milder. I have a great lambs liver meatball recipe ! It's easy to hide a few ounces of liver in meatballs, burgers or meatloaf. If you're feeling adventurous you could also try one of  Liz's Liver Smoothie Shots I'm going to give this a go this week....keep your eyes out for me on Instagram giving this a shot...literally. Ha ha. 

  4. Consume beta-carotene rich foods to your hearts content. Yumm squash (I am a squash addict) 

    • Always consume vitamin A rich food with a FAT. This helps you absorb to absorb the nutrient. This gives you full permission to slather your yam or kabocha squash liberally with grass fed butter or coconut oil. 

  5. Make sure you are getting enough Vitamin E in your diet

    • Vitamin E is necessary for the absorption of Vitamin A. Vitamin E can be found in: spinach, turnip, chard, sunflower seeds, almonds, bell peppers, asparagus, collard greens, broccoli, kale and brussels sprouts.

  6. Pregnant or planning for pregnancy? I'd give your high dose Retinol skin creams a miss to reduce the chance of toxicity. Try a vitamin C skin serum instead to achieve a beautiful glow!  

 

Pregnancy cravings. The why and heck, why not!?

I was recently asked by a reader about why she craves carbs so intensely during her pregnancy. Given that 80% of women experience pregnancy cravings, I thought this would make a spectacular next blog post topic. Please keep your comments and questions coming. Your questions inspire my future posts and direct my otherwise mindless evening research projects, preventing me from online shoe shopping purchases that I will likely regret. Who really needs purple patented leather wedges after all? 

What’s a craving?

By definition, a craving is “a powerful desire for something” (like my frequent shoe purchases). Food cravings can totally hijack your brain and consume your thoughts. This is a common and well documented occurrence among dieters who are restricting a certain type of food or calories in general. Why do cravings happen to so many pregnant women who are not dieting or restricting? Is there any science to help us understand this phenomenon? Well, according to the research, not really….but, here’s my take on the situation.

There seems to be no defined physiological reason for pregnancy food cravings, however, they do seem to have a sort of 'bio-psycho-social' paradigm. What do I mean by that? Research suggests that cravings, particularly in pregnancy, may be influenced by a complicated relationship between sociocultural factors, stress and hormonal fluctuations. Basically, we are complicated creatures and we sometimes turn to food for reasons that aren’t simply nutritionally driven.

To demonstrate this complicated relationship, let’s look at a crowd favourite ...chocolate.

Chocolate contains certain properties that influence our feelings of satiety and contain compounds such as tyramine, tryptophan and magnesium that act as mood altering psychoactive agents. Milk and turkey have these same compounds and yet don't seem to elicit the same intense cravings. 

"I just NEED to eat a turkey breast",  said no one ever. 

Here my friend Laurie demonstrates the power of a chocolate craving. Nothing like cake in the car.

Here my friend Laurie demonstrates the power of a chocolate craving. Nothing like cake in the car.

The answers may lie in our complicated socio/cultural influences. Chocolate cravings, particularly among women, may result from a combination of factors such as, a reaction to stress, hormonal fluctuations and modulations of certain neuropeptide concentrations but also from our relationship with food. For example, studies from countries, like Spain, where chocolate consumption viewed as a part of a healthy diet and is generally higher, report very limited cravings for chocolate. This is contrasted by American women, who’s chocolate consumption is more restricted or considered a "treat". American women report the strongest craving for this rich delicious treat.

In North American culture, chocolate, and carbs in general are often turned to in order to treat and soothe our emotional selves. It is possible that when pregnant, especially in the first trimester, when we might feel nauseous, bloated, tired and crabby (because of hormones), we turn to foods that are easy to digest (make us less nauseous and require less energy to process), increase our comfort levels and boost our feel good serotonin levels. 

Chocolate is also rich in magnesium. Pregnancy, the first trimester in particular, is a time when the body's demand for magnesium is elevated. Perhaps you're body is telling you it needs some magnesium? Satisfy the urge with some high quality 80%+ dark chocolate or mix raw cacao with some psyllium husk (great for constipation) and water or nut milk. When you make this cacao "paste/pudding" and eat it with a spoon (I like some cacao nibs on top), it will eliminate your cravings and give you a solid dose of magnesium, potassium and a shot of iron. Other foods rich in magnesium include: dark leafy greens (spinach in particular), cashews, almonds and sesame seeds (eg tahini). 

Craving Carbs? 

Carb cravings in particular, in the first trimester may also be a result of a few different things going on inside your body.

First, a more relaxed attitude surrounding food when pregnant. Women who were previously restricting carbs, a common practice in the Paleo/Keto community, may see pregnancy as a ‘hall pass’ to enjoy carbs in all forms and as a result may experience intense cravings for these starchy and/or sweet delights. I say, go for it, just remember to take your vitamins and don’t go ‘hog wild’ on sugar. Whole grain gluten free toast, pastas, rice, quinoa, sweet / white potato, squashes and cereals are your best bet.

Secondly, when nausea hits sometimes all your body can tolerate are carbs. They are easily digested, bland and palatable to most women who feel nauseated. If this is all you can get in, go for it. As I’m writing this, I myself am pregnant in my first trimester, nauseated AF and I’ve eaten nothing but gf toast/ bagels, muffins and pasta over the past 48 hrs. I don’t feel bad about it one bit.

While we are on the topic of carbs, I think it’s also important to recognize the biological aspects of carb cravings, aside from chocolate, in pregnancy. Your body needs carbs when you’re nourishing your fertile and pregnant self. Carbs are required for proper hormone function and once you become pregnant, your body becomes increasingly more insulin resistant as a way of increasing fuel availability to your growing baby. This insulin resistance can cause carb cravings particularly in the first trimester. More on Carbs can be found on my previous post, "How Many Carbs Should I Eat When Pregnant?" 

Craving Fat?  

Want really really good and good for you bacon? Don't fart around, pick up some  Pete's Paleo Bacon ...it will change your life forever.

Want really really good and good for you bacon? Don't fart around, pick up some Pete's Paleo Bacon...it will change your life forever.


Many women experience strong cravings for the fat and salt. In particular, the combination of the two. This craving seems to be more prominent in the second and third trimesters when our body's increasing its blood volume. During this time we naturally want to hold on to excess water and building new fat stores. Just as carb cravings are not 100% biological, the combination of fat and salt have a real psychological component. This combination seems to activate certain pleasure centres in our brains, again, making us feel happy and satiated. I have had several friends who just couldn't get enough Cobb salad (blue cheese plus bacon = fat + salt heaven). Real Food Liz's most intense craving was Caesar salad...much for the same reason.

Craving Citrus and fruit?

The craving for citrus is another very common one. Like salt, it tends to become more prominent in the third trimester. Real Food Liz has been going crazy over pineapple and I have TONS of clients who just can't get enough orange juice and watermelon. What does this mean? Well, it could indicate a deficiency in vitamin C but I think that it could also be your body's way of trying to boost your natural iron levels in preparation for the inevitable loss of blood during birth and the postpartum period. Your body requires high vitamin C levels to absorb iron from your diet...maybe your cravings are trying to help you fill up on nutrients? Just a theory. These cravings also may be a result of your increasing insulin resistance in the third trimester. During this time your body is a sugar monster. It does this to try to create a robust baby who can withstand the stress of the first weeks of life.

 

Craving Salt?

Cravings for salty foods, in the first trimester in particular are often associated with the body trying to increase it's blood volume. During pregnancy, by 20-28wks, the body has increased it's blood volume by almost 50%!  If you've been suffering from morning sickness and vomiting, you also may need extra electrolytes. Salt, helps your body draw in more water. Go ahead, satisfy these salty cravings with some healthy treats like sauerkraut, naturally fermented pickles, a well salted potato/sweet potato, salty bone broth or some good organic salty cheese (if tolerated), US Wellness meats Grassfed Franks dipped in mustard are a client favourite. Stay away from excess deli meats if you can. They aren't the best choice in pregnancy and if you must have them choose nitrate free, clean meats (like US wellness meats), being sure to heat them well before consuming to reduce the risk of listeriosis.  

Cravings to pay attention to

While the most cravings are more or less meaningless from a health standpoint, there are a few that are worthy of paying attention to and telling your health care provider about:

  • Ice: If you crave the crunch of ice and find yourself chewing on ice cubes this is a strong sign of anemia. Why ice when you have low iron? Being anemic causes swelling of the tongue and mouth. Ice relieves it. That's why it feels soooo good. Have your blood levels checked and increase the animal based heme iron rich foods in your diet.

  • Chalk, dirt or other 'non-food' based items (aka Pica): These cravings may seem insane but women DO experience them. They often indicate a mineral or vitamin deficiency. See your doctor and don't eat chalk. It can be harmful to you and your baby.

What should a Real Food or Paleo Mama do about these cravings?

  • Eat carbs, just don’t go crazy. Aim for a diet of between 40-45% carbohydrates from a variety of sources such gluten free grains, non-starchy vegetables, starchy veggies like sweet potato, winter squash, plantains and purple potato (more on that little jewel on my next post). If you need a better list, check out this post all about carbs.

  • Limit your sugary treats. Notice I said limit, not restrict. Don’t deprive yourself. Deprivation only creates stress and will intensify your cravings. Practice portion control, enjoy your treat and then be done with it.

Meg the Midwife Approved Craving Busters

 While it's reasonable to 'cave' into some of your cravings, pregnancy is not time to fill your diet with garbage. Try to find good paleo, primal or real food versions of the things your heart so desires. Here are a few ideas to get you started. 

  • Watch out for refined or concentrated fructose sources of carbohydrates like sodas, sports drinks, agave, honey, juice and dates (in excess). Stick to glucose based sources of sugars such as bananas, berries, potatoes. Eating too much refined fructose can wreak havoc on your liver and increase stress within your body.

  • Consume your carbs with a fat or protein. This will slow the glycemic response in your body making it gentler on your system. Added bonus, your body will LOVE the combination of fat and sugar so hopefully it will satiate you and put a halt to your craving.

 

My Paleo friendly version of 'Cherry Garcia'

My Paleo friendly version of 'Cherry Garcia'

  • Baked hot Yam/Sweet Potato smothered in Almond, Sunbutter or Coconut butter and sprinkled with cinnamon (cinnamon will also slow down your glycemic response and balance your blood sugar)....feel the need for salt? Pop a pickle on that bad boy. No joke. I've tried it and it's a winner.

  • Full fat dairy or coconut based ice creams. Try my Dairy Free "Cherry Garcia" Recipe...it's sure to satisfy your chocolate, fruit and fat cravings! 

  • Dianne has a great avocado based chocolate mousse

  • Yams, plantains or purple potatoes sliced thin and then either baked or fried in ghee or coconut oil. Once cooked, salt those tasty nuggets (duh!) with mineral rich sea salt or pick up a bag of Jackon's Honest chips. My fav is the purple potato...I'll tell you why next post. 

  • Real Food Liz's Pregnancy Cesar Salad (Recipe to come) 

  • Good Food For Bad Cooks Cinnamon Whipped Parsnips. Not only is this treat easy to digest and made from real food but, the cinnamon will help balance your blood sugar. 

  • Need salty? Jackon's Honest chips, Siete tortillas, plantain chips (fried in coconut oil or palm oil), a few naturally fermented pickles, or a simple half a potato with a touch of sea salt will satisfy most urges. 

I'll have LOTS more real food paleo friendly recipes, and a TON of information to help you optimize your fertility, have a healthy paleo pregnancy and nourish your postpartum body over at Baby Making and Beyond so check it out!

How many carbs to eat when you're breastfeeding and following a Paleo diet

To carb or not to carb? That is the question....it seems like I'm asked about carb levels all the time and when I received an email from a client about a suddenly low milk supply after starting a Paleo diet, I knew her story would probably resonate with lots of other gals. So, here you have it. 

My former (most wonderful client) is about 4 months postpartum. She started going to Crossfit mom's as a way of connecting with other women and it was the only program in town that made it easy for her to workout with her baby. Since the start of the new year, her Crossfit group decided to start a one month "Paleo Challenge". Of course, I support this kind of awesome nutritional reset ANYTIME, no challenge required, but I was thrilled to hear she was going to give paleo a good ol' college try.

10 days into the challenge, she had lost 6 lbs. She wasn't sleeping and neither was her baby, who previously slept through the night. She also noticed that her milk supply had significantly decreased. What was going wrong? Should she give in to the bread cravings that were taking over her life?

Typical SAD Macro Levels

Typical SAD Macro Levels

I asked her to punch her nutrition into an online app (I usually recommend My Fitness Pal) which as it turns out, she already did (she's so smart). When she told me her macro's, I instantly knew what the problem was. Carbs were only making up about 20-25% of her diet. Not by choice, just by accident. This would explain the insane weight drop, often caused by rapid water loss when switching from a SAD diet where carb levels are anywhere between 50-60%. The most common mistake folks make when going Paleo is going too low carb by accident. While a Paleo diet is typically lower in carbs than the modern SAD, it isn't designed to be a "low carb diet". Going low carb can happen by accident when we replace the grain laden starches with more filling veggies, fats and meats. 

What was going on?

Her body was STRESSED. While going low carb can result in weight loss, it also can result in systemic stress on your body. Cortisol levels will ramp up disturbing your sleep patterns and your body will begin limiting how much energy it spends on "unnecessary" reproductive functions like ovulation, menstruation and, in this case, breastmilk supply. After all, what body wants to sustain another growing life when it's having a hard time sustaining itself?

If this diet was to continue, it may also cause her thyroid hormones to plummet. Low thyroid in a postpartum woman can cause postpartum depression, stall natural weight loss and cause breastmilk to all but disappear. 

This would explain why both she and her baby were not sleeping through the night.  Her body was holding on to extra calories by dropping her milk supply. Some studies have suggested that when a mom is calorie depleted, her milk may also decrease in fat content. This can cause babies to get hungry faster (aka waking up needing to feed more often) and may also cause them to miss out on critical DHA fatty acids they need for brain and neurological development. 

What To Do if this is happening to you? 

Eat Paleo Friendly Starchy Carbs!  Breastfeeding women NEED carbs. Please ladies, eat the sweet potato, eat the white potato....eat all the potatoes.

These are some good macro's for a breastfeeding mama

These are some good macro's for a breastfeeding mama

While 20-25% may be a good level for an active male or to optimize body composition, it isn't enough to support fertility, pregnancy or lactation. I generally recommend 30-40% depending on activity levels and individual needs. Does she need to eat the bread? Well, no, but, at the end of the day if you eat a slice of gluten free bread, will it really be the end of the world? Probably not. Dianne has a great post about starchy carbs found here with a handy chart, which you can downloadable chart to help you on your way. 

 Eat sufficient calories. When starting a Paleo challenge it's not uncommon for women to drop their calories down too low to support healthy womanly functions. When breastfeeding, this can lead to low milk supply and an unhappy baby. Never drop below around 1800 cals/day when breastfeeding, you'll likely need more if you're active. 

 Lose weight slowly. When women lose weight rapidly they are not only at risk for low milk supply (for the reasons stated above) but, it's also been documented that weight loss of more than 1 lbs or 0.45kg/week can increase the toxic load found in your milk. Say what? True story....

Environmental contaminants such as PCBs and pesticides, are stored in body fat. According to Breastfeeding and Human Lactation (3rd Edition, Riordan, pp 440), when a breastfeeding mother loses weight rapidly (>1lbs/wk), these toxins are released into her bloodstream, and the toxin load of her milk can dramatically increase. These toxins are directly offloaded to a growing baby. Not bueno. 

What about Ketones? When a woman goes very low carb (20-50g/day) she may start producing ketones. Ketones are the waste products of fatty acid metabolism, aka when the body burns some of its own fat for fuel. Ketones will pass into the breastmilk and I wondered if these could be damaging to infants. Apparently not. When I asked famous Breastfeeding Physician Dr. Jack Newman about them, he said that they don't pose any dangers for infants. For more info on ketones during pregnancy, check out this post. Your biggest danger when dieting seems to be is low milk quality and overall supply.

Need more help?

Liz and I cover a whole swack more info just like this a LOT bit more in detail including learning how to dial in your macros head over to Baby Making and Beyond to enrol now.

Or if you’d like a bit more 1:1 advice Fill out this handy form and register for a nutritional assessment. Let me help you on your journey towards being a rad nourished mama! 

Tasty Living Amaze Bars....Meg the Midwife Approved!

These hempy happy chips are my regular nutrient dense stand- in for standard corn chips

These hempy happy chips are my regular nutrient dense stand- in for standard corn chips

My friend, former Midwifery client and fellow nutrition enthusiast Lindsey Williams has done it again! She first hit the nutrition scene with her company Tasty Living which brings raw whole food goodies straight from her kitchen to your tummy. Over the past few years, I've grown addicted to her line of paleo friendly crackers, "granolas" and cookies. It's so nice to be able to go to the grocery store and find treats that are local, well sourced, healthy and nutrient dense. 

My spelendid samples of Tasty Living's new Paleo Amaze bars

This week I had the honour and privilege to sample her NEW product the AMAZE bar. Let me tell you, these bars are just that..... AMAZEing. I sampled the Crunchy Hemp-Cacao Fudge Bar and the Green Goddess Bar. The Cacao bar is loaded with cacao nibs giving this chocolatey treat a splendid bit of texture and crunch. It was the Green Goddess bar really surprised me...I wasn't expecting to like it but the sea salt paired beautifully with the matcha and spirulina, making this healthy treat my favourite among the bunch. These bars are nutrient dense, locally sourced and PALEO friendly. They will be available across Western Canada to start but it wouldn't surprise me if we see her line of products hitting store shelves nation wide and even internationally in the future. 

Lindsey has launched a new kickstarter campaign to help launch her new products. I'm more than happy to support this new adventure of hers. She needs our help so please support REAL FOOD and join me in showing her some love with a small donation.