Plant-Based Nutrition during Pregnancy, Infancy, and Breastfeeding | Whitney English, RD

- Women are at a higher risk of iron deficiency because they lose iron through the menstrual cycle and they have higher needs because of that. I was in the fitness and the entertainment field. I paid a lot of attention to nutrition and yet I got iron deficiency. Like I was very focused on my diet. It wasn't only 'til I went plant-based that I started actually thinking about where I was getting certain nutrients. And that's really important, especially again, with children is that making sure that the iron you're eating is actually getting absorbed. So including sources of vitamin C in every meal to increase the absorption of iron, choosing sprouted or soaked grains and legumes to again increase the bioavailability of iron. It also helps increase the bioavailability of zinc as well. My iron has been fine ever since, by the way. - That's registered dietitian Whitney English and this is episode 95 of the Proof Podcast. (upbeat music) - Howdy friends. I hope you're doing well. Welcome to the Planet Proof Podcast. It's awesome to be back here with you again for another episode. For new listeners, welcome for the first time. Thank you so much for finally joining us. Nearly at a hundred episodes. Took your time, but you're here and that's all that matters. My name is Simon Hill. I'm the host of this show, physiotherapist, nutritionist and currently writing a book on nutrition with penguin, which with a bit of luck will be published later this year. I hope that all of you get something out of today's episode that helps you become more mindful and conscious of the way that you live. That's what each of these episodes is all about. That's what I want to deliver. A non-judgmental, non-preachy space to talk about diet, to talk about being mindful of our decisions. And really an opportunity for me to sit down and bring you into the conversation with inspiring people from all over the world. Doctors, nutritionist, dietitians, athletes, people who have overcome chronic disease and generally folks that are working hard to create positive change in the world. Today is an episode that I've been very much looking forward to for a long time. A deep dive into plant-based nutrition during pregnancy, breastfeeding and infancy with one half of the plant-based junior's team, Whitney English. Both Whitney and her partner, Alexa, registered dietitians, mothers to plant-based babies and a super passionate about using evidence-based information to help plant-based families optimize their nutrition. What I love about their message is that it's inclusive whether you are a reducer, for example, cutting back on animal products, a pescatarian, vegetarian, or just curious. I am sure that you will find their information helpful. Honestly, I can tell you the reason I haven't touched this topic for the better part of two years or over two years is because I wanted to wait to do it with the right person, the right people. How we feed our kids is so important. And I really must say, the content that plant-based juniors put out is incredible. And I truly believe that both Alex and Whitney are world leaders in this space. They're paving the way in this space of bringing evidence-based information specific to nutrition during pregnancy, breastfeeding, and infancy to the public. And while Alex, unfortunately, couldn't be with Whitney and I to record this episode in Los Angeles, I plan to have both of them back on the show in future to explore their personal stories. So if this is a topic of interest, something that's very relevant to you in your life right now, I strongly suggest to grab a pen and paper and get comfy in a quiet spot. This is a very, very comprehensive conversation. That's enough for me. Time to hear from Whitney English, recorded in Venice Beach, Los Angeles. Friends, I'll see you on the other side. The next generation of Woop is here, and it's more than a fitness tracker. It's a 24/7 health coach designed to help you perform, recover, and even understand your pace of aging. With a slick strap, a 14-day battery life, and zero screen distractions, Woop tracks your sleep, strain, and recovery every single second of the day. And the results are real. Daily wear is linked to more activity, better sleep, and a higher HRV, an indicator of recovery. Woop helps you train smarter, recover better, and live healthier for longer. Take control of your recovery and health span with Woop today. Head to theproof.com/friends and click the Woop link to get one month off your first Woop subscription. I've got you here today. I've been really looking forward to this. This is a very important topic, but also it can be a very divisive topic, I feel, and quite polarizing the nutrition for our kids is something that obviously everyone treats with great importance. And it's nice to sit down today with a registered dietician to walk through everything that you're doing with plant-based juniors with your partner. And just delve into some of these like fears and common questions that mothers, fathers, that families have about changing their diet away from what is sort of the norm in society. Sure. Yeah, it's easy, I think, for adults to see the benefits of a plant-based diet and jump right on board. But when it comes to our kids' health, we're a little bit more cautious. And so it's definitely an area that people need more education on. And we probably should just paint the picture. We're actually fortunate that this podcast is going ahead because I nearly got us locked out of the-- You did. When we need to end up at this, the Airbnb in Venice has a gate that locks behind us. So I walked down and looked behind us, but I was able to jump back over. Well, and the benefits of a plant-based diet were very evident in the fact in your superhuman strength jumping under the roof. No, it's meant to be. Why don't we kick things off before we go through your back story? Why don't we kick things off by explaining what plant-based juniors is? And I guess the sort of nutrition philosophy that underpins it, and why you and Alex are really just so passionate about delivering and bringing this information to the public. So plant-based juniors is a platform for parents and other professionals to educate them on the unique nutritional needs of pediatric plant-based nutrition, because these do differ from the needs of an adult on a plant-based diet. And then to translate that information into an easy digestible, applicable format for parents so that nutrition can be delicious, and your kids will actually eat it, because that's another barrier. What we can get an adult to eat isn't the same thing. That we could get a child to eat. So that's really the mission statement of plant-based juniors. And we started out with an Instagram channel, and that started in early 2018 and rapidly grew, which I think is a testament to just how needed this information is. And from there, Alex and I branched out to doing e-books, a blog, a YouTube channel, and a book coming to print, hopefully in about May 2021. And you guys are writing that now. We are writing that now, right? Is that process being like? It's been interesting. So Alex and I, we don't live in the same location. I'm here in Los Angeles, and she is in St. Louis. Alex is also do with her second baby in just about two weeks. And we signed the deal at the end of the year. So it's kind of been a crunch time. I'm going to be flying out there to shoot the photography, because there will be about 50 recipes in the book with her about a month after she gives birth. So that's probably going to be the most challenging part of the podcast. Now you've got kids of your own as well, right? Yes, so I have a son. He is 21 months old, his name's Kayla. And Alex's son, Vander, is about two and a half. Yeah. So the clan is growing. The clan is growing. And you know, we talk about our mission statement. It really started because Alex and I, we are these parents. We're these people that you describe that are out there looking for credible information on plant-based diets for kids. And we just weren't finding a lot of it. The space was really lacking in evidence-based information that was provided by true nutrition experts. And that was current. So some of the resources that we found were outdated. Or they were written by plant-based mommy bloggers who maybe don't have that nutritional credibility. And then some of it just isn't easily accessible. So Alex and I found ourselves just digging through piles of research to get answers to things that we would have expected to be very easy questions that should just be online that any plant-based parent can access. So that's kind of how plant-based junior started. Alex was a newborn, and I was pregnant. And we were both plant-based. And we were friends from before, both dietitians. And we started just swapping information and questions and research. So you wanted this information first and foremost for yourself so that you had a healthy pregnancy, healthy child. Exactly, yeah. So I guess I got a little bit ahead of the story. Alex and I became friends about 10 years ago. We were both food bloggers. She was a vegetarian and a dietitian at the time. I was an entertainment reporter who ate six egg whites a day. And we both were blogging. And so we met at a blogger's conference. We stayed in touch over the years. I went back to school, got my master's degree, became a dietitian, became plant-based. And then we both had kids. And that's when we started talking more about our fears, which were the common ones that we hear from other parents. And those fears are genuine developed concerns, right? Because of course, you're going to be concerned about what you feed your child. And changing from what sort of just generally accepted into society and schools and what your parents have taught you. And on an all of a sudden being casted as someone just doing things differently. Yeah, yeah, like I said, it's one thing to do something a little differently to yourself and risk your own health. And it's another thing to an infant who has no choice and in whom nutrient deficiencies could result in long lasting irreversible damage. So I've got a question for you because we see these headlines about vegan parents or a vegan baby. And it definitely always makes the mainstream media like to run that as a headline. Had that, those headlines and those sort of thoughts gone through your mind when you were initially pregnant and where you sort of questioning, is this going to be safe for my child? Was that initially some fears that you may have had? A little bit. I will say with those as a nutritional professional, when you actually dig into the situation and what happened with those vegan babies, the issue wasn't a vegan diet. It was a malnourished diet. It was a baby who was being starved of essential nutrients. So it wasn't the source of the nutrients. It was the fact that they weren't getting the nutrients. So these headlines are overblown hyperbolic and they're really describing poorly planned diets, not an optimally planned vegan diet. So yeah, those definitely were startling. It was probably some of the news headlines and even other professionals suggesting that the diet while potentially safe maybe wasn't optimal or had a lot of potential pitfalls. And so making it not only seem potentially detrimental but also extremely challenging. And I think that's something that plant-based parents face as well as they may go, "Okay, well, I guess I can do it safely but this sounds so difficult." I don't understand all of that. I mean, that's only a couple of years ago right for you. So I mean, that's still, I guess, a lot of the information that's being shared by local doctors and not true to parents that are thinking about having a baby or. For my own pediatrician is not exactly on board with a plant-based diet and it was one of the reasons that I. So what gave you confidence then to go, so you're hearing these people around you who are educated that degrees in medicine or nutrition and their dietitians, what not? What gave you the confidence to go, okay? I hear that you're saying it's challenging but I actually think it can be done without too much fuss and it can be done in a very healthy manner. Like what gave you that confidence? A number one science, at the end of the day, I'm an evidence-based dietitian. So I don't care what you tell me. I'm gonna go look it up and I'm gonna read the research for myself and verify that it's accurate. And so when I really did start digging into the research, I found that there were immense benefits during pregnancy, infancy, and that the majority of governmental bodies, I think all of them here in the US and many abroad do advocate vegan and vegetarian diets, appropriately planned vegan and vegetarian diets for all stages of life cycle and state that they're not only nutritionally adequate but potentially beneficial for the prevention of numerous chronic diseases. So I kind of tuned out the noise on other professionals who maybe just weren't very well educated. And I find that happens a lot. A lot of people go with what they're told in their classes or what is the commonly accepted knowledge of the time and aren't really keeping up to date on the research. - Yeah, I guess before that sort of position statement, what was the consensus or just hadn't been reviewed before then there wasn't enough science. - I'm not quite sure because it's actually been out for quite some time. They re-released the positions. And so that position statement was from the academy of nutrition and dietetics, the leading nutrition body in the United States. And that was released in 2006, the revised version but other versions of it that said essentially the same thing have been out as early as like 2009, I believe. - Yeah. - As long as I've been. - I know, I saw you emphasize the word appropriately plan. I mean, really any diet, even in a diet with animal products needs to be appropriately planned for an infant right? - Exactly, for an infant for anyone really. And we see that in the fact that the most common nutrient deficiency for children and adults alike is iron deficiency and rates of. - And this is across the board. - This is across the board. - So that's what, yeah. So it's the most common nutrient deficiency across the board. And rates are similar in adults for iron deficiency, whether they're omnivores or vegans and vegetarians. vegans and vegetarians do typically have lower serum levels of iron, but they don't have higher rates of iron deficiency. So that just goes to show that it's a poorly planned diet. Even people eating meat are still having iron deficiency. It's still the most common problem. - And I guess, have you looked into the sort of typical nutrition of a child in America? Like what does that look like? Let's just start with what is happening across the board, the average child in America. What is their health like? - Yeah. I'm glad you brought that up because we were primarily, the conversation is primarily about the harms and nutrient deficiencies of a plant-based diet. What about the harms and nutrient deficiencies within a standard American diet? Well, a third of our children are overweight and obese, type two diabetes, which is a condition of lifestyle. We believe it's caused by dietary factors, lack of exercise. That is rapidly rising in children. Children as young as 10 years old are being diagnosed with type two diabetes. I think one study put an estimate at the increases about 5% per year. And we know that the earlier you get type two diabetes, the higher your risk of having diabetes-related complications and the lower your life expectancy. - Of which cardiovascular disease is like the number one complication? - Exactly. And you bring up cardiovascular disease plant-based children, have been shown to have lower levels of cholesterol. And as we know saturated fat, which is much higher in a omnivorous diet is a risk factor for high cholesterol and cardiovascular disease. And we also know that cardiovascular disease starts in childhood. So there was one study actually of infants under 12 months of age. And these were autopsies of children. I believe that diet in car accidents, 30% of them had fatty streaks in their aorta. - Yeah, I've actually included this in my book. - Okay. - Yeah. I mean, like cardiovascular disease, we kind of like to think of it as something that happens in our 40s or 50s or more or not. But it is such a progressive disease. - Absolutely. - And I believe even the health of the mother during pregnancy can affect the child's arteries when they're born. - Yeah. - I went through that in the book. It's very interesting. It was a great study, a Korean, the Korean War study. I'm sure if you've come across that. But it was kind of one of the first studies brought this to the forefront. This idea that cardiovascular disease can start earlier. They did autopsies on American soldiers who died in the Korean War from gunfire. You know, presumably healthy fit men that were over there, you know, fighting for their country. And 70 odd percent of them, there were, there were edge between, on average, I think it was 17 to 20 something, early 20s, 70 odd percent of them had already developed atherosclerosis to some extent, some severe. - Yeah, it's unbelievable. I mean, we're learning more and more, especially with like studies of the microbiome about just how early on nutrition can have an effect. I mean, there are studies in mice showing that depleted microbiomes in mice are carried down through the generations, even when diet is improved. Like the grandchildren of the mice will still have reduced microbiomes and. - It's incredible. - And some sort of. - Impaired, yeah. - Yeah, to your community. So it's crazy. And it just highlights the fact that nutrition is so important to begin, I mean, prior to conception. This sort of brings me, I guess, to what I want to explore today. I want to dive into pregnancy. And even before pregnancy, important things for a woman in terms of nutrition and preparing the body for pregnancy. And then during pregnancy, infancy, some things maybe after infancy, when you're, you know, a toddler age, but also the nutritional requirements or things to focus on when breastfeeding and maybe we can sort of work through this in chronological order of how people sort of tend to experience it in real life. So let's kick things off with great pregnancy, I guess. If someone's listening and they're not pregnant, they're thinking about in the next few years, having a baby, are there specific parts of their nutrition that they should be focusing on now? - Definitely a few years in advance would be beneficial, having optimal health status is going to be important for fertility, but really in the few months probably leading up to when you're about to begin trying to get pregnant would be the time to really hone in on certain things. The good news is that by eating a plant-based diet, you're already probably doing almost all of the things that you should be doing, but there are a few things to keep in mind, especially if you're plant-based. The first one, actually, this is not especially if your plant-based, this is the reverse, is that folate. Folate, folic acid is incredibly important to prevent neural tube defects. This is really well known information, which is why all women are recommended to be taking 400 micrograms of folate or folic acid, even prior to conceiving. So some bodies recommend that you start supplementing that about three months before you begin trying to get pregnant. - Sure. Is there a difference between folic acid and folate in terms of what you would recommend? - Yes. So, well, first I want to say that folate is actually very easy to obtain in the diet, especially for a plant-based diet. Vegans typically have the highest intake of folate. Vegetarians have moderate intake and omnivores actually have the porous folate intake. And that's because it's widespread in plants and predominantly in leafy greens. Folate is the natural form of folate. And that's what's found in plants. Folic acid is the synthetic nutrient. And recent studies have begun to show that certain people with genetic variations of a certain gene called MTHFR do not properly metabolize folic acid. And so for those people, it's better to take a methylated form of folate, which is more comparable to the folate that we find in plants, although it can be more expensive. So it's debatable. I think if you know you have that genetic abnormality, then you definitely should seek out a methylated form of folate but just making sure you're getting folate somewhere in the diet, whether that be through supplementation through a large intake. - Just to clarify, you're saying even a plant-based woman would likely be getting more folate through her diet than an omnivorous woman that still should supplement on top. - That's the recommendation. And that's what we go by because really, even when you're eating what you think is an optimal diet, what you're actually eating on a daily basis can differ, especially in pregnancy, the first trimester with morning sickness, you might not even be able to touch a salad. So your safest bet is really just to supplement with folate. And if you're concerned about the potential issues with folic acid, find a methylated, methylated or plant-based folate source. And many prenatal vitamins have that now. - So that's folate. - So that's folate. The next thing would be to check your iron levels. Again, we talked about iron is the most common nutrient deficiency. So really, really all women should just go get a physical before thinking about becoming pregnant and specifically have these things tested, have iron tested. Iron deficiency, even before conception, conception has been linked to low birth weight, which sets babies up for a host of- - Interesting. - Of issues. Yeah, so even if it's corrected later, something's going on that's affecting probably the egg even prior to fertilization. The other thing you wanna get tested is vitamin D, specifically, if you're trying to get pregnant, suboptimal vitamin D levels have been linked with infertility and vitamin D is typically low in a plant-based diet, mainly because the main source is our fortified plant milk or seafood. So really- - Particularly if you're not getting much suns well. - And if you're not getting much suns. I mean, you probably get a lot of vitamin D. - Yeah, I mean, well, Sydney's a fairly similar climate, I guess, to here. - Yeah. - All right, so- - We do as well. - So not too much trouble. - Yeah. - I guess a little bit different to sort of people from Northern Europe or perhaps Melbourne. - And that's, and that's really the issue is that even though we do have the ability to synthesize vitamin D and likely historically, that's where we got it. Modern society doesn't really, most people are not getting the adequate sun exposure. - Well, we wear clothes now. - We wear clothes, we wear sunscreen, we sit inside. And yeah, different climates, different skin pigmentation, all of these things can affect your body's ability to synthesize vitamin D. - I mean vitamin D is a fairly prevalent deficiency as well. - Correct, yeah. - So behind eye and it also affects people that are reading all sorts of different dietary. - Absolutely. And so again, I say like some of these things are things that you specifically want to look for as a plant-based dieter, but really again, all women who are thinking about being pregnant should look at these factors because a lot of people are deficient. - What do you, you mentioned plant-based milk? So I quite often recommend people consume plant-based milk that are like fortified with calcium or vitamin D, B12, things like that. Are you, is that something that you also recommend? - Yes, that's a must, I, both for children and for adults, it's an easy, highly concentrated source of many nutrients that we, and so we'll probably get into that a little bit more with the toddlers, but fortified soy and p-milk, that's what we recommend. - No, ripple. You had ripple. - I have, that's what my son drinks. - Yeah. - That's not a plug, I just thought I got some of the fridge. - You do? - They don't sell it in the store. - Yeah. - Yeah, so if someone's listening and wants to make that in Australia, I will definitely be a good customer. - Listen up, ripple. That's interesting. It is a polarizing beverage. I feel like some people either love the flavor and some people. - Yeah, I love, I mean, I was first attracted to it by the nutrition, but I must say the flavor is great. And yeah, it's, I think they've done a really good job in terms of bringing something that tastes, I can see kids who would enjoy it, and it has a lot of nutrition in it. - Yeah, I'm pretty sure, this may have changed, but when we first started recommending plant-based milk for children, it was the only one that contained B12. It's also, I believe it's the only one. If you get the original, that also has DHA. So they're working really hard to-- - I think it has DHA. It's got calcium, vitamin D, like a little bit of vitamin A. - Yeah, we'll circle back to this. - Yeah, so much to talk about with plant-based milk, but we just need to add the kids and plant-based milk. Okay, so we've worked our way through folate. You've spoken about ion, vitamin D. - Polyunsaturated fat is really important to optimize in the diet to improve fertility. And again, this is something that's, my best dieters probably are already doing, focusing on nuts, seeds, vegetable oils, which end being controversial. - Yeah, I mean, some of this is controversial. I mean, my stance and where I sort of sit on all this stuff is, for some people, I don't necessarily think this super low fat plant-based diet is the best diet. You know, I can see that there is science for certain diseases where clinical trials have shown it's effective, but to your point there, do you find that women in particular child-bearing age? It's not so much about restricting fat. It's more the type of fat, that is most. - We definitely do see that. I spoke from the low fat Whole Foods plant-based community. And that's a place where education is really important, especially, yes, for pregnancy, but especially for children. So I talked about earlier the unique nutritional needs of children. Children should be getting about 30 to 40% of their nutrient intake from fat. And that's really hard to achieve on a strict plant-based diet if you're not including vegetable oils. And like you just said, my personal position for adult nutrition is that vegetable oils. Absolutely, you can be a part of a healthy diet when consumed in moderation. Sure, avocados, nuts and seeds. We want to include those as much as possible. But as far as the research goes, I think it generally supports the idea that vegetable oils are a nutritious component of the diet. - Okay, so an emphasis on polyunsaturated fats. - Yes, and so the ones I just talked about were mainly the plant-based sources of the ALA, but it's also important to include DHA as well. So DHA is the omega-3 fatty acid. It's primarily found in seafood. Our bodies produce small amounts of it from alphalino-lenic acid, which is the omega-3 fatty acid found in plants, but that conversion rate is extremely low. Some studies estimate it's only about 1%. And DHA needs are incredibly ramped up in pregnancy, especially in the third trimester and then lasting throughout the first two years of life. And this is because DHA is an important component of the brain and the retina. So additionally, it's been shown to be beneficial for fertility. So I recommend we recommend DHA supplementation, starting even before you're pregnant, but carrying on throughout pregnancy, lactation and then potentially even. - And that's true, like an algae oil supplement? - Yes, so most people think DHA, they think a fish fish oil, but there are now products on the market that have algae oil sourced DHA. And this comes from microalgae, which is actually the original source of DHA and fish, fish eat microalgae and they accumulate the DHA and EPA in their tissues. So essentially you're cutting out the meal man. You're getting those beneficial fatty acids without any potential environmental talk. - That's a great thing because they're able to do this sustainably away from the ocean, so they can control the environment. They can make sure those heavy metals are not in there. - Absolutely. - Which sort of bio accumulate in seafood? - Yeah, yeah, so. - Most people still think of creatine as something only for athletes, but while creatine is certainly good for muscle health, that's only part of this mighty supplement story. Researchers at the University of Kansas Medical Center are even studying creatine today for treating Alzheimer's with preliminary data suggesting that high dose is around 20 grams per day can increase brain creatine levels by about 11% in Alzheimer's patients, which may result in improved cognitive function. While the data here is certainly emerging, it's a very positive early signal in a field of science that has thus far largely failed to find helpful interventions. 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Head to aid sleep.com/theproof and use the code TheProof for $350 off the pod for ultra. You'll get a 30-day trial, and they ship to many countries worldwide. - You know, the research is pretty clear that eating fish does have benefits. - Absolutely. - But we have to weigh that against the pollution in our oceans, the bio-accumulation of these toxins that we know cause neurological damage. So they're especially dangerous for developing fetus or a young child. - Yeah, it's interesting 'cause like across the board of science, you know, even away from pregnancy, when you look at different diseases, the science on fish can be somewhat neutral, it can be positive in certain areas. I mean, there are a number of factors. It could be the way that people are cooking the fish, are they frying, are they baking it, but it could also be the accumulation of toxins where the fish has come from. - Yeah. - So it is nice to know that you can get DHA directly without having to take that risk if that's your choice. - Yeah, absolutely. And then, let's say, another nutrient definitely to get tested for is B12. Hopefully all plant-based dieters are also supplementing with B12 already. There was actually a study that tested the B12 levels of vegans, vegetarians and omnivores and found that many of them were deficient, including those who were taking prenatal vitamins with B12. - Because there's not enough in it. - Because there's not enough probably. So it's imperative for pregnant women, lactating women and children to be taking it, but also low B12 levels have been shown to be associated with infertility and also with abnormalities and sperm. So it's also important for dad to be adequately supplementing as well. - There you go, dads. - So now. - Dad should be taking B12 anyway. (laughing) - So put all the weight on mom. - And the same thing exists there, I guess, with that gene mutation that you were talking about before, with folate. - Yes. - In terms of the types like the submethal cobalamin, I believe, is for some people may not be able to convert cyanocobalamin? - Yes, and it's not as well defined as the issue with folic acid. So I, that's not a recommendation that I typically make. A lot of experts actually recommend the cyanocobalamin form because it's been shown to be more stable and it has a lot of research on it. - We've gone back and forth. I think-- - I'll definitely go back and forth as well. - Yeah. - I don't think we have an answer, unfortunately, at this time, to what's really ideal, I think, again, some studies show that the cyanocobalamin form is more stable, more reliable, because there's such a breadth of information that's been put out on it. But unfortunately, most of the supplements these days are now in the methyl form. - I've kind of landed in this position of, if you know you have the genetic mutation, take the methyl version, but then obviously you're doing your blood test, you'll be able to check. - Exactly. - How are you going? And then if you're taking cyanocobalamin and you are doing some blood tests, you, again, you can monitor your levels. And if it looks like it's dropping off, then maybe you're not converting it. - Yeah, I like that approach. - And at least that way, it's objective to you. And I kind of also realize that the cyanocobalamin version is much cheaper for people as well, like you said before. - Yeah, I mean, I would hate to have this be a roadblock to someone choosing a plant-based diet, is that they're herring this and they're going, "I have to get this expensive DHA "and I have to get methylated folate and methylated B12." And it starts to add up. So just knowing that if you're getting some form of these micronutrients, you are likely covering your needs. The last thing I wanted to point out because this can sort of be a controversial topic is soy. You hear a lot, primarily from non-evidence-based practitioners that soy can actually harm fertility, or it's bad for women with infertility complications like PCOS. And the research is actually the opposite. There are some studies that have shown that, one study in particular showed a 77% increased chance of a live birth with a hike, soy consumption for women that were undergoing IVF. And also I think reduced rates of PCOS with soy consumption. So I just want to alleviate any fears for especially plant-based dieters who consider, probably, hopefully consider soy a large part of their diet that it's not only safe, but it's also a problem- - And so that's soy milk-type food? - That's the thing. They really don't break it down. A lot of these studies, they're food-frequency questionnaires and they don't end up diversifying the different food groups. So it's really just soy food intake in general. That we're looking at almost any of the time when we're talking about soy. - Yeah, I mean, I think the general consensus now from an evidence-based point of view is that soy is beneficial. It's providing a lot of important nutrients and that any sort of suggestions of harm are really based on very weak science, which is very-- - Yeah, weak animal outdated animals. - And it's very much outnumbered. It's outnumbered in terms of more quality science, but unfortunately, because soy is the sort of whipping boy, it probably, it's a bit of false equivalence because you go out on all the blogs and you see all of these blogs tearing soy down and it makes it feel like, okay, there's evidence on both sides when, you know, I know, for example-- - Kind of like when people didn't believe in climate change, right? - Yeah, well, that's it. You know, I know, speaking, I guess, from the Australian side of things, the Australian Cancer Council Association, I mean, they openly in their position statement recommend for soy consumption as part of a healthy diet that has predominance of plant-based foods. So I think that information is starting now to come to light. Hopefully people are placing a bit more trust in soy and opting for high quality soy if they can. - Yeah. - And like any food, just putting it into a diet that is diversified and just one food. - Exactly. I think you hit the nail on the head with that. - Cool. So that's the sort of leading into pregnancy and pregnancy, both of those or-- - We talked a little bit about pregnancy too. And again, most of the things that are beneficial for fertility are also going to be beneficial for pregnancy. There are a couple new things that we could talk about though, related to pregnancy. I didn't mention a prenatal vitamin. That's again, to cover your bases. It's definitely something that we recommend when you begin trying to get pregnant, but also it's completely essential once you are pregnant. One of the main reasons is iron. Again, we'll talk about iron a lot today, but iron needs are incredibly increased during pregnancy. Women need about 27 milligrams a day, which is a huge amount. - Why do you think iron deficiency is so perfect? Is it, what's the easiest sort of root cause of that? - Why are we having such a difficulty with it? I'm putting on the spot to come up with a theory here. - Well, I mean, I just think that if it's something that all, you know, a large percentage of people, no matter what dietary pattern they're eating, they're having an issue with it. And I do get messages all the time from people that are not vegan, people that are vegan. They're mainly women, to be honest, that have had iron issues for many years. - Potentially a lack of high quality foods and a lack of nutritional knowledge. Women tend to be, women are at a higher risk of iron deficiency one because they lose iron through the menstrual cycle, and they have higher needs because of that. But another thing, I think we do see a lot of women being a little bit stereotypical now, but that don't eat meat. And so actually I had iron deficiency long before I went, I became plant-based. But when you, things like chicken and fish and eggs are not very good sources of iron. So really the best source of iron on an omnivores diet is meat. So if you're not eating meat, you may think you're getting iron because it just, wouldn't come to mind since you're not alerted about it, like you are on a plant-based diet. - Yeah, well, I mean, when you're easily become deficient. - When you're eating an omnivores diet, I'm not really thinking about you. - You're not really thinking about much, right? That's harsh. - Well, I should say, when I was eating an omnivores diet, I was just going through the motions. I never stopped thinking about, am I getting this, this, this, this or am I getting too much of something? It was swollen on my radar. - I mean, I think that, and I think that is because the recommendations indicate that you will get everything you need as long as you eat these types of foods, and that you don't need to focus on them as much. Same, I was in the fitness and the entertainment field. I paid a lot of attention to nutrition, and yet I got iron deficiency, like I was very focused on my diet. It wasn't only until I went plant-based that I started actually thinking about where I was getting certain nutrients. So yeah, I think a lot of people that are on omnivores diets actually aren't eating a lot of iron. They're not worried about it because they think all animals have iron. And then on the other side, people eating a plant-based diet, they may think they're getting iron because they're eating lots of nuts, seeds, like gooms, whole grains, but they're not taking consideration of the reduced bioavailability of iron and a plant-based diet. And that's really important, especially, again, as we'll talk about with children, is that making sure that the iron you're eating is actually getting absorbed. So including sources of vitamin C in every meal to increase the absorption of iron, choosing sprouted or soaked grains and leg gooms to, again, increase the bioavailability of iron. So lack of education in both cases, I suppose. - Yeah, home with you on that. Maybe some changes in microbiome or something that we haven't yet discovered. - That's possible. - That's possible. But yeah, I think you hit the nail on the head there. I think it's just not appropriately planning. - And we see a worldwide too in a lot of malnourished populations, so populations, again, that probably can't afford animal products or meat that are eating, by default eating plant-based diets, but definitely don't have the information or the resources to figure out that if you're going to get all of your iron from these sources, then you need to make sure you're taking steps to proper lives. - Yeah, yeah. So just so quickly, you're not recommending me, you're saying. - No. - It is a good source of iron, but it's coming with a whole lot of things. If you're going to remove it to get those benefits that are removing me, you need to focus and appropriately plan the diets you have. - Yeah, yeah. Yeah, I mean, it's a good source of various things. Does it mean it's a good food? Does it mean that it's helpful? No, we're talking about nutrients. And as long as you're getting those nutrients and you're absorbing those nutrients, then let's aim for the best source possible to get them from. And that's again, a common misconception across a board about meat and iron, specifically in pregnancy. You hear a lot of practitioners or pseudoscience influencers spouting off about how red meat improves fertility and it really doesn't. Yeah, it's a good source of iron. We can say that, but there are a lot of other factors that are going to impair fertility. It's almost like Chinese whispers, it just goes from one person to the next and to the next until it just seems like it's the truth. I hear all the time from women who fall pregnant, who message me and say, I went to my doctor, they said, "Adding red meat comes weak and fish." What do you think? Which is why you're here today? - Yeah. - So now I can just send them this thing. - Yeah, there's no science to support that. I had another dietitian actually that reached out to me that had been trying to get pregnant for a long time and she was predominantly plant-based and she had been getting a lot of pressure from family as well as her OB/GYN telling her that, maybe she just needed to start including me and then she would get pregnant. And I reassured her that there was no evidence behind that recommendation and to stay strong, focus on these other aspects of fertility that are really important to get pregnant. And you know, that's an anecdote, but still like that, it's very common that women hear this. - So these sort of other aspects of fertility that you're talking about is just dialing in on those nutrients of focus, I guess. - Exactly. - I'm sure that you are getting enough of everything and absorbing. - Yes, exactly. - The new, those nutrients. - Exactly. - Cool. - And you know, we touched on male fertility too and it's really important that men are eating a proper diet as well, red meat intake, process meat intake and saturated fat, I've actually all been linked with decreased fertility for men. - Wow, there you go. - Yeah. - Hand erectile dysfunction probably, which is an early sign of cardiovascular disease. So you need that to make babies too. - Exactly. - Okay, cool. So anything else during the-- - Prenatal, you're gonna want to continue to be taking DHA from the algae oil source. An interesting thing to note that I don't think a lot of people know about is that only preformed DHA, so dietary DHA, actually reaches the fetus or reaches a breastfeeding infant. So studies have shown that increasing ALA, the plant-based sorts of omega-3 fatty acids in the diet does not increase the level of DHA that's going to reach your infant. And in fact, vegan mothers have been shown to have the lowest levels of DHA. So it's really important that you're getting that preformed DHA from a supplement. The American Academy of Pediatrics and the American pregnancy association both recommend about 200 to 300 milligrams per day. But some emerging research has shown increased benefits, especially for preventing low birth weight or preterm birth with higher amounts around 600 milligrams. So we typically recommend anywhere between 400 and 600 milligrams. - And you're gonna continue that once the baby's born in your breastfeeding? - Yes, yeah. So again, during breastfeeding, those same groups recommend continued some supplementation. And this is if you're not eating fish. So probably everybody we're talking to right now. - So just so everyone's clear what we're talking about is the DHA microalgy oil. - Yes. - You're making sure that you're supplementing that through pregnancy. You said sort of 300 milligrams. - I said yeah, the recommended amount is about 200 to 300 milligrams during pregnancy and 300 milligrams during breastfeeding, but higher amounts have been shown to have benefits both during pregnancy and especially for preterm birth. - How high are we talking like, still less than like one? - Yeah, like 600 milligrams a day. Some of the studies have shown. - And you can find that like around the world now. It's online everywhere. - It's available everywhere. - So that sort of takes us, I guess, to infancy and breastfeeding, right? - I have a couple more things to mention. - Well, I've jumped ahead. - That's good. And we've got-- - We've got a good few. - There's a lot to know. - There's a lot to cover you. - But again, it doesn't have to be difficult. I mean, we're really talking about taking a prenatal, taking a DHA supplement, and then the next few things I'm going to talk about are dietary. So one of them is choline. Choline is not considered an essential micronutrient, but it's a B vitamin-like nutrient. It's really important, again, for baby's brain development. And it is found in many different plant foods, but in a much lower amount than in some animal foods. So that's why it is often considered a nutrient of importance for plant-based dieters to focus on. And it's also been the subject of a lot of alarmine reports in the media in recent years. The good news is that soy is a very rich source of choline. So my recommendation is basically, if you're vegetarian, to be including about two eggs a day, if you're not to be including at least two servings of soy foods a day, and then during pregnancy, you should probably be supplementing with about half of the RDA of choline. And many prenatal vitamins do now include choline, but it's in pretty low amounts. So either paying very specific attention to the choline in your diet and including sources like soy, at least a couple of times a day, or supplementing is the recommend. Cool. - Yeah, I remember that because it was headlines last year about choline, you know, that was quite controversial. The interesting thing that when I looked into it was that, and I'm definitely saying, I'm definitely not saying don't supplement. That's not what I'm saying. We probably don't have enough information, so it's probably wise to supplement. But the interesting thing when I looked into it was, you would expect some of the diseases or like neural tube defects that might come from a choline deficiency. You'd expect to be higher in vegan women, but we haven't seen that play out. So I think it's a sensible and good recommendation to do this supplementing, but I don't want to alarm people listening to sort of suggest that, you know, there is a huge issue with vegan women in choline deficiency in the tube defects. - Definitely is not. There's no research showing on specifically on vegans and choline intake. And in fact, research shows that most people are not getting the adequate amount of choline to add to that, all of the recent studies, or at least the majority of the recent studies on choline that I've seen have been funded by the egg board. Eggs are one of the best sources of choline in the diet or one of the highest sources of choline in the diet. - Yeah, so it's hard to know. - It's a nutrient that we need more information on. - Yeah. - Even the first, the main study that was used to set the adequate intake level, all they did was compare 450 milligrams to 50. So there was only two groups. The ones with 50 had some side effects. The ones with 450 didn't. And it got set, I think, around that 45500 level, right? But there was nothing in between. - Yeah. - So really what is the amount that someone needs to be healthy is still up in the air and I believe it's an adequate intake level, right? I don't think it actually is an R. - Yeah, it's an A.I. - Yeah. - Yeah, and that's, especially when it comes to kids nutrition, that's something you have to keep in mind is that a lot of our nutrient recommendations were not set based on actual studies in children. They were extrapolated from research that was done on adults and then they figured out based on body weight, yeah. So it's tough to say. Like you said, it was choline too. Choline deficiency, actual choline deficiency is very rare. It's mostly associated in adults with liver dysfunction. Yeah. I think the sensible approach is just to make sure that you are getting an adequate intake in the diet and then with the rest of the similar to the rest of the micronutrients, if you're including a little bit to get that extra boost to cover anything you don't need in your diet, just to meet the A.I. That's probably the best way to go. Actually, I'm not sure if it is an RDA or an A.I. I know for children it's an A.I. It may be an RDA for it. - Okay, we'll look that out later. I'll put that in the show notes. - Put them in the show notes. - I think well, in Australia I think it's an adequate intake. - Okay. - Maybe different now. - Okay. The next thing I want to mention is calcium intake. Calcium needs are not, the RDA for calcium is not increased during pregnancy and that's because our bodies do absorb more calcium during pregnancy, but it's really important for pregnant women to focus on getting adequate sources of calcium in the diet. Because if you don't, the baby will then start leaching. Your body will start leaching calcium from your bones to give to the baby. So that's really what it does with a lot of nutrients is that it's gonna try to make sure the baby gets it and then you're going to suffer. - So how do you recommend that the mother gets enough calcium? - So consuming good sources of calcium throughout the diet, things like cruciferous vegetables, beans, not seeds, but also including fortified foods. Because this is another area where I think we think we're getting adequate calcium intake, but really if you sat there and did a daily log without fortified foods, it's a lot more challenging. And especially during pregnancy again, when you're gonna have these food aversion early on and may not be including cruciferous vegetables several times a day. - So the plant-based milks. - Plant-based milks. - Tofu, things like that. - Exactly. - Because calcium is not in a large amount in prenatals. - Sure. - And that's because of it. - Do you have like a supplement or a nutrient kind of guide? Is that for the fake children, or is that all? - Yeah, so on the link in our bio on our Instagram channel, you can download our supplement guide and it has a brief explanation of each of the different nutrients of importance and our favorite supplements for both infants and pregnant women. - I'll put that in the show tonight. So if you're listening and you're thinking, this is a lot to take in. - Yeah. - Okay. - You'll have a resource to come back to. - Yes, and both in our pregnancy, our e-book pregnancy guide as well as the book we're writing right now, we're gonna have really easy quick guides in the back where it just lists each thing, how much you need, or where you can find it. So that you don't have to kind of go back through and canvas all this information and piece it together. - Yeah, I mean, it is a bit to learn. I think there is definitely an investment in time required to get across this, but once you understand this stuff and you start changing the way you're eating, what you're buying and it becomes into a habit, it becomes second nature. And you might need to read ahead of different stages. So while you're pregnant, read about what you're gonna change when you're breastfeeding or when you could goes from four months to starting eating solids and things like that, but I feel like all of this stuff, particularly with the way that you're putting information out, it is quite palatable and easy for people to pick up. - Yeah, definitely. And like we said before, there's always something to learn regardless what diet you're on. When you become pregnant, there are certain things that you need to start doing differently. So you're gonna have to learn about these things one way or another and the health benefits that come with a plant-based diet, vastly outweigh the little bit of information. You're gonna have to absorb. I think that's what you need to keep reminding yourself as you're going through this, is that it might seem like you're having to be really careful, but you're actually moving to a dietary pattern that is so much healthier for yourself, for your baby. - Absolutely, like sure, you could eat a ton of red meat and drink three cups of dairy a day during your pregnancy and then you're not gonna have to worry about calcium and iron it up. - You're gonna increase your risk of just non-diabetes. - Exactly. Three E-clamsia, we haven't even gotten into that yet, but the benefits of a plant-based pregnancy, some research has shown lower rates of cesarean section, lower rates of neonatal and maternal mortality, lower rates of postpartum depression, and definitely trends for lower risk of gestational diabetes and other pregnancy-related complications, so. - So there's benefits there of taking. - Trade off is huge, yeah. - Okay, cool. Anything else for pregnancy? - The last thing I wanna mention just is protein and extra calories. We hear protein is pushed, again, in all diets and people who aren't well versed on a plant-based diet are worried about it, but protein needs aren't easily met. It's just important that pregnant plant-based women, or I'll women understand that you need about 25 grams more protein per day, which is not a lot. So the RDA for pregnancy is, I believe, 71 grams. So just knowing that you need a little bit more and that can easily be met by an extra serving, an extra one to do servings of beans or tofu or some other protein-rich food. - I should have asked, I've just sort of something. I mean, everything we're talking about now is that sort of, does that cover all three trimesters there? Any differences between the trimesters? I know, like, I think, which trimester is it where the amount of total calories sort of goes up? Is that the last trimester? - It's actually the second trimester. - Yes, so things change a little bit. Most of the micronutrient needs are pretty steady or if there's differences, it's not something that people really need to know about. It's really knowing that DHA increases in the third trimester. However, you should probably be taking that again. - If you'll take in the 300 milligram, you'll get the whole way through. - Exactly, yeah, yeah. So just physiologically, if you want to know that needs do ramp up there, but basically during the first trimester, your caloric needs are not increased. Maybe it's not big enough to be needing that much energy. But the second trimester-- - I can't use the first trimester as an excuse. - As an excuse to go buckwild. Exactly, but I feel it out. - Feel it out. For all dietary patterns and life stages, I always recommend that people listen to their hunger for fullness cues versus worrying about a caloric intake anyway. So if you're pregnant and you're hungry, go ahead and try to choose high quality sources, exactly. So yeah, you need 340 calories more during the second trimester and 450 more during the third trimester, which is less than what people maybe originally think, especially if you've heard the recommendations that you're eating for two. - Yeah, well, I mean, what's that? Like another small meal a day. - Yeah, exactly, yeah. Couple snacks, maybe just a little bit bigger portions at your meals than you would have had before too. - Hmm, cool. - And that wraps it up. - Let's go into infancy. And we can more probably talk about breastfeeding in this and then we can talk both from an infant point of view, but also the mother's nutrition in terms of continuing to supplement things like that. So what changes other than the obvious after you have a baby and you're-- - You're exhausted, you're not getting any sleep. That's what changes. You don't have time to go to the kitchen and your cell food. I'm sorry, I'm pointing a very grim portion. - So let's go through the nutrition for the child. - Okay. - So breast milk is considered gold standard, Ron? - Yes, yes. So breast milk is the ideal first food for babies. It has the perfect composition of nutrients, immunological factors, bioactive compounds. It actually has bacteria, my cobiotic in there that are going to start to colonize the baby's digestive track as well as prebiotic sugars known as human milk, obliosaccharides, which really have not been recreated and added to formula yet. And these are-- - They tried to. - They tried to. I believe one brand might have a very small amount, but I think it's just a marketing ploy, so they have not scaled that yet. Formula is getting better and better though, as the more they learn about the beneficial components about breast milk, the more they try to mimic it in infant formula. But breast milk, aside from just the unique components, it also changes throughout breast feeding, so the composition of the fat changes even within one feeding. It's, breast milk is lower in fat in the beginning of the feed and higher in fat in the end. - That's hard to make in a formula. - Yeah, so a formula is always the same. And the breast milk is very dynamic. It's constantly changing to meet the unique needs of an infant, so it's like you said, it's a gold standard. There are numerous benefits associated with breast feeding. First of all, for the mom reduced risk of breast cancer and no variant cancer. So we see a 26% reduced risk of breast cancer in some studies and a 37% reduced risk of ovarian cancer. - It's interesting, isn't it? - It is. - I wonder what the mechanism is there, a ploy. - I know there are theories, but I am not well versed on them. - Yeah, we can lay that. - Yeah, and I believe they are just theories. But yeah, it's pretty fascinating. For infants, we see a reduced risk of infections primarily ear, nose and throat. We see a reduced risk of obesity in children later in life. And again, this is something that experts don't know for sure what the reasoning is, but there are a couple of things that are proposed. One of them is that breastfed infants might have a better regulation of their intake, their hunger and satiety cues, not only because they actually are responsible for taking in their nourishment versus someone else feeding them, but also because they've seen different hormone changes in infants who are breastfed versus formula fed. So breastfed infants typically have higher levels of leptin, which is the satiety hormone where formula fed infants have had higher levels of growl in, which is the hunger hormone. - It's very interesting. - Yes. - I mean, this is slightly different, but there was a metabolic ward study last year or two years ago by a researcher called Kevin Hall. And he looked at these radolts, by the way. Not babies, they wouldn't do this with babies. They, it was a crossover study, so they had people follow a diet for four weeks, monitor them, follow another diet for four weeks. And they did it in random order. So some did diet A and then diet B, some did diet B and then diet A. And one diet was an unprocessed whole food diet and the other was an ultra-processed diet. But what was interesting was they matched that protein, fiber, carbohydrates, everything, salt, sugar, all of these different components. And they gave this food to them in a manner where they just said, look, eat until you're satisfied. So they matched all these macronutrients, which you'd think would explain maybe why someone would eat more of, say, a processed food 'cause you'd go, okay, there's less fiber, they weren't as full, but they matched this stuff. - Wow. - And even still with all of these macronutrients matched and salt and sugar, they ate on average 500 calories more day, more a day from the ultra-processed food compared to the food that was the natural source of calories. - That's very interesting. - And again, there's a conclusion. - Which usually here with the ultra-processed food is it's this perfectly derived combination of sugar and salt and fat that drives that. - Yeah, so they sort of concluded though back to your point that they believed that there was something in that ultra-processed food, which was causing a different hormone response. - Yeah, I mean, it just goes to show that as much as we try, we can't completely mimic nature, there's going to be any differences. So yeah, another thing for why infants potentially, formula-fed infants potentially have higher rates of obesity and diabetes, and this is more of a theory is that breastfed infants have a greater exposure to different flavors. Anything mom eats, that flavor is transferred during the breast milk, into the breast milk. So just like the nutrient composition changes, the flavor is constantly changing. So this potentially sets children up for more adventurous eating, because we know that early exposure to a variety of flavors promotes more acceptability to different types of foods. For instance, they did a study on pregnant women. Flavor exposure actually begins in utero in the amniotic fluid, so what mom eats? Those flavor compounds are actually in the amniotic fluid, and they did a study where pregnant women ate a lot of carrots. In the last trimester, some of them did, some of them were the control group, and the babies to the moms who ate a lot of carrots had a greater acceptability of carrots when they started in 50. - Wow, moral of the story, why don't you kid state her in bed? Stop silly. - You got to do it, and you got a surgery. - You got to lay by example. - Exactly, and we see that across the board. So research also shows a reduced risk of certain childhood cancers, a reduced risk of sudden infant death syndrome, and potentially cognitive benefits from breastfeeding, although there are confounding issues with the intelligence studies based on what a mother's intelligence is, so it's hard to draw from conclusion about that. - Sure, and I guess it's not always an option for some mothers to be able to breastfeed for any number of reasons. - Exactly, yeah, so that's why my partner Alex and I, we, you may have heard the saying breast is best, we actually like to say that fed is best. As long as your child is getting nutrients, the essential nutrients that they need from somewhere, they are going to be completely fine, healthy, and have a nutritionally adequate diet. Because like you said, not all women can breastfeed. It's very stigmatized in the population, that women should breastfeed, and if they don't, that it was their choice, and it's not always a choice, it's there's physical components. There's emotional components, sometimes societal pressures get in the way, maybe they don't have the support they need, maybe they have to go back to work within a few weeks of birth. There's so many different factors as to whether or not a woman breast feeds, and we want to just support mothers, no matter what feeding decision that they make. With that said, I want to add the fact that all of these studies on the benefits of breastfeeding have actually shown that the benefits do persist even when it's not exclusive breastfeeding. So any little bit of breastfeeding you can do, whether that includes some supplementation with formula, whether it's only for a few months that is going to be better than the no breastfeeding at all. - Cool. Unfortunately, there are other options to help women who are the physiologically unable to produce enough milk, or like you said, perhaps their social circumstances don't allow for it. And so let's go through some of these options, donor milk formula, where they come in, and people can navigate through it. - Absolutely. So donor milk, you mentioned, is a great option. It is recommended that you go through the proper channels to obtain donor milk, the Academy of Breastfeeding Medicine discourages getting donor milk from online sources. And this is mainly because the milk has not been tested, and you have no idea what kind of storage or food safety procedures have been taken with the milk. That said, you can always ask a donor mother if they can provide you with blood tests to make sure they don't have any diseases. You can also home-pasturize donor milk, and there are protocols that you can find online, or in our pregnancy guide, we also list home-pasturization techniques. That is one option. - And I should say actually, 'cause my mom will kill me if I don't, she's a lactation consultant. - Oh. - And a nurse, so. - Should I have her come on here and talk about the benefits of breast milk? - Well, I mean, while we were talking about breast milk, I mean, if we're talking about from a physiological supply point of view, there are resources out there as well to help mothers navigate through that and work with the way the baby's latching, and don't worry, I've heard it all about it. (laughing) - I mean, talk about a lot to learn. - Yeah. - Like, they're long, long books on breastfeeding. It's something that you would think should be so innate and natural, and yet there is a steep learning curve. And I think in our modern day society, we don't always have those older women in our lives who are teaching us how to breastfeed. So, lactation consultants are essential, I think, for success. I saw a number of them in my breastfeeding journey. - Yeah, so there is some support out there. - Yes. - So you've got breast milk being the sort of gold standard, but Fed is best in making sure that they're getting enough calories, like you said, and nutrients no matter what is most important. - Yes. - Don't milk as an option, but making sure you're probably doing it to do diligence and getting it from the right source, if possible, doing your homework there and don't milk, obviously being very important for preterm infants. I guess if someone had no oversupply to try and donate. - Yes. - Your own breast milk for other babies, if you can. - And we talked about this off camera offline, but never trying to sell your breast milk. It was a major faux pas, morally, ethically, everything. Yeah, actually, I actually donated a lot of breast milk online. - Yeah, so you can do some Googling, find someone local and help those in the community that might need it. - Yeah, turn to friends. You can look at your church at breast feeding support groups. There are resources out there. - Cool. So if breast milk is not an option, don't milk is not an option, I guess then we landed that formula. And there are different types of formula on the market. There's various brands we don't need to go into brands and keep this sort of high level, because they tend to differ in market to market anyway. But what's your advice from a formula point of view? How does it differ from breast milk? Are there any considerations that we need to think of there in terms of the child's nutrition? And how does one sort of make a choice between, say, a plant-based formula and dairy formula? - So one of the good things about formula is that it actually contains all of the essential micronutrients that infants need. So if you're providing formula, you can be sure that your child is getting everything that they need. Aside from DHA, some formulas don't have it. This is less of a concern though. In recent times, I believe all of the formulas in the US actually do have DHA. So that would be the only thing to consider for breast feeding. However, while breast milk is the ideal perfect food for babies, there is one nutrient that you need to watch out for specifically, and that's vitamin D. Breast milk is very low in vitamin D, and that's regardless of intake. So even though you're taking, you may be taking a postnatal vitamin with the RDA of vitamin D, it is not transferred over in an adequate amount for babies. So the American Academy of Pediatrics recommends that all exclusively breastfed babies receive a supplement of 400 I use of vitamin D starting at birth. - That's through a dropper. - And that's through a dropper, yeah. So you can just put that on your finger and stick it in the infant's mouth or put it directly in their mouth. I will say there are some studies showing that very high amounts of vitamin D around 6,400 I use if the mother supplements with that much, an adequate amount can be transferred in the breast milk. However, that exceeds the upper tolerable level for vitamin D for a lactating woman. So it just makes more sense. We believe to directly supplement your infant. - Sure, and that's that's a recommendation for an exclusively breastfed infant to be given a vitamin D supplement is across the board. That's all dietary patterns. - Sure, and that's yes, because of the low level in breast milk. Another nutrient to be cognizant of is iron. So breast milk is also very low in iron. And again, this is an area of contention, especially in lactation communities because we never want mothers to think that breast milk is in optimal. It certainly is, but it is lower in iron and that iron has a higher bioavailability but it is not enough to meet infant's needs. Now, luckily, infants accumulate iron in utero. So they store up enough iron to last them until about four to six months, at which point they need to start getting iron in the diet. - It's very clever. - Yeah, nature is very smart. - Yeah. So. - Well, I mean, that kind of makes sense then, like if you're saying that the breast milk's low in it. So clearly there's something else going on that makes sense that physiologically before pregnancy, this, they're accumulating that. - Yeah. - Almost in anticipation of having a period with low amounts going through the diet. - I mean, some of the proposed theories are that iron actually has, can promote infectious microbial, species like being able to persist in milk and in infant's digestive tract. So that's why it's very low to prevent that for the immune problem. - So you're saying compared to say a formula, a formula will have vitamin D in it, right? - So a formula like, yeah, it has vitamin D, it has iron, it has everything. So the reason I bring up iron is because while stores dwindle between four and six months, the American Academy of Pediatrics and other groups have recently started saying that solid introduction, the introduction of solid foods shouldn't actually begin until about six months. So that leaves infants depending on how much iron they stored up in utero with a period of about two months where they potentially have iron stores and low iron stores. And for that reason, the American Academy of Pediatrics now recommends that all exclusively breastfed infants receive a daily iron supplement from four to six months. - There you go. - Until they start getting. It's a little bit, so that four to six month, it seems to differ a little bit around the world, but you're saying so most recent advice is six months. - Yeah, so previously it was recommended to start at four months, even before that, I don't know if it was recommended, but people did start even earlier two, three months. There's the old myths that adding baby cereal to milk will help the infant sleep longer at night. That's a complete myth. And we've actually seen higher rates of intestinal complications as well as things like type one diabetes when kids start getting food too early. Their digestive systems just aren't fully developed, and then their motor skills are not developed enough to actually handle solid food. So that's why they changed it to six months, but then that kind of causes this conundrum of where they're gonna get their iron then. - A gap. - The dialed little gap. So for breast, exclusively breastfed babies, especially babies that were preterm or that had a very rapid weight growth or a very rapid growth in the early months, they are more at risk of having low iron stores as well as if you did not do delayed cord clamping during your birth. That's another thing. Delayed cord clamping can increase iron stores. So all of these factors are going to contribute to whether or not your baby's iron stores are going to carry them over to when they start solid foods. - The sort of best practices, if you're exclusively breastfeeding to supplement vitamin D from day one, and at four to six months supplement iron, and you're continuing vitamin D until you're introducing foods. At that point, you can stop supplementing the iron. - Correct. - But you continue with vitamin D. - Correct, well, if you're a plant based. - If you're a plant based, you continue with vitamin D. Different story, if they've jumped over to formula, which has vitamin D and iron in it. - Correct, correct. And then the majority of the other nutrients will be transferred in the mother's breast milk provided that she has a nutritionally adequate diet. So one nutrient I wanna point out there, which I actually should have brought up earlier in pregnancy, is B12. B12, I think we talked about the absorption earlier. Perhaps the absorption of B12 is very low. So you need much more than the RDA to actually meet your needs. So plant-based dieters should be taking in a minimum of 25 micrograms a day within their prenatal in order to make sure they have adequate amounts of it transferred through the breast milk and transferred to the fetus during pregnancy. And a lot of multivitamins and prenatal vitamins do not have that high of amount. So we definitely recommend that mothers take a separate individual B12 supplement if their multivitamin is not that high. That's a good point, because I mean the multivitamins and prenatals are not necessarily geared towards someone who's consuming a plant-based diet. - Right. - I've spoken about that before in terms of B12, the absorption rate, I think it's limited by something called intrinsic factor or something complex, but people don't need to worry about that. But if you're buying any sort of exclusive B12 supplement, then it'll be over 25 micrograms. A lot of them are 200, 250. And again, you're only absorbing a small amount of that. - Right, right. And it's a water soluble vitamin. There's no upper tolerable level. So you're safe with however much you take. - Cool. So that's kind of, I guess, the difference is from a new trend point of view between formula and breast milk. Now, within the context of formula, there are different options on the market. It's the best way to navigate that and what's your sort of advice there? - So the main decision you're gonna have to make is whether you're going with a dairy-based formula or a soy-based formula. There are a couple, maybe one or two now formulas on the market that are made with pea protein, but there really isn't any established guidelines on them. So the main choices are soy and dairy. The good news is that study show similar rates of growth, energy intake and bone mineralization with babies that are fed either cow's milk or soy milk. So whichever one you go with, your baby is going to get all of the nutrients they need and grow adequately. - Which is the most important thing, right? - Which is the most important thing. - Exactly, yeah. So then you can get into the intricacies of the different types of formulas, what types of sugars they use, what types of oils they use, and that is a conversation, I think, for another day, but generally we recommend an organic formula and one with minimal additives. Most plant-based parents are immediately going to choose a soy formula just because that's what meets their requirements ethically and morally, but I do know some plant-based parents who have chosen cow's milk over soy milk formula because of the fact that one of the main nutrients, the main sugar that is found in milk, whether it's cow's milk or breast milk is lactose. And that really can't be replicated. So in a soy formula instead of using lactose, they use things like corn syrup or brown rice syrup. The long-term implications of that are unknown. Again, I said that the rates of growth, energy intake, bone mineralization, these are all the same, but for some parents, we talked about highly processed foods before, it just doesn't sit well with them. - Yeah, so that's a personal decision. - It's just a personal decision right there. - You mentioned, I know you correct yourself there, but it's a good point. We're talking about formula. And at no stage, soy milk or cow's milk places this. - Yeah, so that's a very important thing to note is that before 12 months of age, the only appropriate beverages for children are breast milk or a formula. You should never give cow's milk, never give plant milks before the age of 12 months. I do want to note that there are two indications in which soy formula would not be appropriate. One of those is for preterm infants, despite a normal bone mineralization with healthy full-term infants consuming soy formula, preterm infants have shown to have an increased risk of osteophenium. And they're not sure exactly why this happens. One of the proposed mechanisms is that the soy plant actually uptakes aluminum from the soil. Aluminum is not a necessary mineral for growth in any way, for the human body. However, the amounts of aluminum that are in soy formula have been shown to fall below safety limits. But what's believed to happen is that preterm infants, their kidneys aren't mature enough to filter out the aluminum and an aluminum can inhibit calcium absorption. So that's potentially what's causing bone mineralization. The second group is infants with congenital hypothyroidism who have to be on medication for this condition, fightates, which are absorption inhibitors found in soy, which aren't a problem for adults or children eating normal diets and using techniques to overcome these absorption inhibitors. But for infants with congenital hypothyroidism, these fightates can inhibit the absorption of their medication. The AAP does note that taking more medication can overcome this, but again, that's something that parents will just have to decide for themselves. - Okay. Cool. So to summarize that, you're saying, I mean, the choices rather personal, there's soy, there's dairy, for those that do not or can't breastfeed and don't have access to donor milk. And then to look out for formulas that are ideally organic, don't have too many artificial ingredients, the DHA mentioned before that summer and our fortified would be good. - Yes, most, most are. - Yeah. And we covered off on the fact that if you're exclusively breastfeeding just to pay attention to vitamin D from the start and iron from four to six months. - And to take your prenatal or postnatal vitamin, most women just continue to take their prenatal vitamin. - Cool. All right. That kind of brings us up to when the the little one is ready to start introducing solids. So talk me through that where we're at that sort of six month mark. What does that look like? - Yeah. So there are two different routes to go when introducing solids. There's the traditional option of providing purees via spoon feeding and then there is newer option in at least newer in the US. It started maybe in Australia or New Zealand, New Zealand. - I have, I've heard my. - Yeah. And it's called baby lead weaning. And baby lead weaning is essentially giving baby solid foods right from the start. So skipping purees, skipping food feeding, spoon feeding and providing age and texture appropriate foods that the baby can pick up and feed himself. And so both of those should start around six months. You should talk to your pediatrician about when is ideal for your baby. But we have, by partner and I, Alex both did baby lead weaning with our sons and we recommend it for others. That said, we don't think it needs to be done exclusively if you want to do a combination of spoon feeding and baby lead weaning, you absolutely can. There's no research showing that providing purees via spoon is going to get in the way of baby lead weaning. But one of the reasons that you may want to try baby weaning is some of the potential benefits. So the research is just emerging in this field. But some of the things that we're seeing is potentially increased motor skills because the babies are actually using their hands and their mouths to manipulate food in an earlier age. A more adventurous eating, baby lead weaning babies are typically exposed to a greater variety of flavors and textures from the very beginning. - Does that make sense? I mean, yeah, given that if you're blending everything, that texture's pretty similar. - Yeah, the textures that's similar, especially if you're using store-bought purees, the diversity of them is not very great. It's often like one or two foods. Yeah, so it results in a wider exposure. It's also just beneficial for parents because what people like to talk about with baby lead weaning is the fact that babies eat with the family's eat. So we'll talk maybe a little bit later about how that is not 100% accurate because babies can't have salt and sugar which are traditionally in adult meals. But generally they should be eating a lot of the same types of meals as the rest of the family. So hopefully it's easier on the parent who's making that food. - So what are some examples of if you're doing baby lead weaning and another point we'll come back to this but by baby lead weaning, presuming you're talking about you're weaning off of breast and all kick exclusively, but that's still there. - Yeah, so this is kind of a misnomer. It shouldn't be exactly weaning isn't actually a appropriate term, complimentary feedings because we're complementing their major source of nutrition. So breastfeeding and formula should still provide the majority of energy and nutrients up until about 12 months. It's complimentary because there are certain things that we need to start getting from the diet. Primarily iron. - Yeah, okay, so you're breastfeeding or donor or infant formula exclusive to six months but you're making sure you're carrying that through whatever modality it is to 12 months as a minimum. - Correct, yeah. - And then that food's coming in at six months which is complementing that, okay. So you're talking about the two different methods you've got the sort of puree food method and then the baby lead. - Baby lead weaning. - Baby lead. - Baby lead complimentary feeding to be changed in term. - What are some examples of that? - Yeah, so the most important thing whichever feeding approach that you're choosing is that you're focusing on iron and protein because these are the two nutrients that babies really need at this age. Other than that, you may have heard the term food before one is just for fun. Well, that's partially true. A lot of the food between six months and one year of age is really intended for exposure. - That's why that other, the mindset of new trends is still coming through. - Yeah, and that's why we're still focusing on breast milk and formula but we really want to make sure. So we want to make sure that we're using these feeding periods to expose them to a wide range of flavors and foods. Predominantly fruits and vegetables as those are the things that we're really going to want them to be eating lifelong and to develop an acceptability to. So exposing them early and often to a wide variety of fruits and vegetables is really key. For baby lead weaning, this looks like providing different vegetables that are steamed in a form that baby can pick up. So between about six and eight months babies have what's called a palm or grasp and that means that they pick up things using their entire palm and hand. So foods need to be in a long stick like form. So they'll grab it with their palm and they'll not on the end that's coming out of their fist and anything else they can't eat, they drop. - So can you do that with broccoli or is that not long enough? - So you can do it with broccoli because broccoli actually has a natural handle on it. So you can provide a big hunk of broccoli and they can really just kind of nibble on the end. On the tree portion of the tree. Yeah, I'm like trying to remember how big my son's hand was. Probably like this bit. Yeah. So yeah, broccoli, you're cutting up butternut squash into long strips and you're roasting it or steaming it, you're steaming carrots, really anything. So plant-based juniors, we have our first bites, our guide to baby-led weeding for plant-based babies. And it shows you how to make all of these foods in an agent texture appropriate form. So that's your fruits and vegetables. But as I said, that's more of the exposure component there. The biggest nutrient to focus on during this period is really iron and your major sources of iron in a plant-based diet are things like beans and whole grains and soy foods, nuts and seeds. Babies can't really pick up any of those, not with their whole palm. - Yeah. - So you have to get a little bit creative. So with these things, I mean tofu's the one thing that's a little bit easier. You can definitely cut that into a nice little strip. But with our beans and our grains, we're taking those, we're making them into patties, we're making them into muffins, things that babies can pick up. - I mean, they can make you self. - Yeah. - That gets me thinking those foods tend to be good sources of fiber, which is obviously great. It's a great nutrient, but too much of it could potentially reduce appetite, which I consider to be problematic for a child that's growing right, or potentially for some children. - Yes. - So how do you sort of monitor, I guess, fiber intake and making sure that the very small stomachs not filling up too quickly and they're not getting enough calories? - Yeah. So this is one of the main ways that a baby's plant-based diet and an adult's plant-based diet differs. For adults, like you said, we really want a high fiber intake. It reduces the risk of numerous chronic diseases and helps to manage healthy weight, but in babies, they have small appetites and they have tiny stomachs and a very dense diet and low calorie fiber-rich plant foods could lead to sub-optimal growth if they're not getting enough energy nutrients. So we recommend, under the age of two, for one, providing only half of the grains that they receive as whole grains and the other half as refined grains. So serving white rice on occasion, my son, for instance, gets a bread that's made with half whole grain flour and half refined wheat flour. And I know this kind of chucks some people who have constantly heard the message, complex carbs, whole grains, but in this population, it's really important and those refined grains are not a useless source of nutrients that are providing essential energy for the babies that need the energy for. - Comes back to feed as best. - Exactly. - And it's contextual. If you're just sticking to whole grains and the child can't eat enough and that's affecting their total calorie intake. - Yeah. - Then you can't say that that's healthier. - No, right. - Gotta come back to the context sometimes. - Absolutely, yeah. And there are other strategies to reduce fiber too, if your baby really isn't growing well and you need to get in more nutrients, you can strain fruits and vegetables, remove skins or peels, removing the skins from beans. There's a lot of different techniques, but that's something that is definitely individual. We didn't do those things with our sons, both of our sons, very optimal growth. - I'm sure you get this question all the time, but I'm just thinking in my head, what if parents they're plant-based? They plan to have a plant-based kid, but for some reason, at that six month block, they're very picky, they're not eating these foods, like, and I'm sure you probably get messages that I'm thinking of adding in fish or whatever it is, these calorie-dense animal products. What's your response? Do you ever get that? - I haven't gotten that specifically. We get a lot of questions about picky eating and kids not eating enough. Under the age of 12 months, I would say take comfort in the fact that they're still getting the majority of their nutrition again from that formula or that breast milk. And then I'd say to seek out a pediatric dietitian and preferably a plant-based pediatric dietitian who's going to be well-versed in this, picky eating is not necessarily going to change because you add animal products. Your child might not like those either. So it's really about working on the behaviors versus the actual foods. - Gotcha. - Yeah. But that said, if there are certain populations that maybe a strict plant-based diet doesn't work for, and there are children with allergies who can't consume soy. - Or feed security. - Yeah, there's a lot of different issues that come into play. Alex and I, we advocate a predominantly plant-based approach. We were all inclusive, all forms of plant-based eating are beneficial for your health, for the health of the planet. We meet people where they're at. If you can't have a fully plant-based diet, if you don't want a fully plant-based diet, if your kid needs to consume things, then you know, work around it. - Yeah, you just do your best. - Yeah, we're all doing our best. - Cool, okay, so that's the introduction of food. And two different sort of methods, where we're looking at giving food to children to help them explore the main source of nutrition is still coming from the formula with breast milk, concentrating on foods rich in protein and iron. - And to add to that, making sure to include a source of vitamin C for optimal iron absorption. So iron from a plant-based diet has a lower bioavailability. Some estimates say that plant-based dieters need 1.8 times the amount of an omnivorous dieter, but those studies really don't take into account optimal absorption. So pairing sources of iron with a source of vitamin C can increase the absorption by three to six times. So that looks like pairing your tofu with some marinara sauce and in a squeeze of lemon juice to your bean patties. We have an awesome baby lead weaning muffin recipe on our website that includes chickpeas and kale. So making sure that you are optimizing iron bioavailability. - Cool, another question that just come to mind is, I mean, there are a lot of sort of popular food brands for a few kids out of that six to 12 and even toddler age group. How do you pick and choose between those and when you're looking at labels, are some of those helpful for adding into the diet in addition to these sort of whole foods we're talking about with carrots and broccoli and things like that? - Yeah, some of them can be helpful for convenience. Generally, we're recommending that parents stick to whole foods as much as possible, especially for the six to 12 month range. - Sure. - And even the under two range because under the age of two, baby's kidneys aren't fully developed and they're not equipped to handle large amounts of sodium or really much sodium at all. The sodium limit and recommendations varies by country and is not well established. They don't even include it in the dietary guidelines. The message is pretty much the less sodium, the better. And the same really goes for sugar. The AAP recommends no sugar for children under the age of two. So anytime you buy processed food, it's gonna have both in there, period. Even the healthiest whole grain bread on the market has at least one or two grams of sugar in it. So it's not completely avoidable. Again, I told you my son gets bread every day and it has a couple grams of sugar. And I let it slide. But generally the more packaged foods you're providing, they're going to have those types of things and we want to avoid. So those are the main two things that I say to look for on a label. As low as possible with sugar and sodium. Low for sugar would be no more than one or two grams per serving. Yeah. And sodium really just as minimal as possible. The recommendation is, I believe it's no sodium for four, 12 months. And then, and again, the stiffer is depending on the group that set the recommendation. But between 12 and 12 months and two years old, I believe it's 800 milligrams, which is about a third of a teaspoon, which is a very low. 800 milligrams is for a day or per day. Per day. Yeah. Two. Yeah. Okay, so how do things sort of progress from a food point of view, nutrition point of view? Whether it's a supplement point of view from this baby-led, weaning stage to those 12 months. So I talked about the palm or grass. So with the way that babies actually eat around 8 to 10 months, they develop what's called a pinch or grass. So they can actually pick things up between their thumb and their forefinger, which will make providing family meals a lot easier. You don't actually have to manipulate them into a form that baby can pick up. And more and more, they'll start to eat the foods the family is eating. Nutrition wise, iron remains a very important nutrient, as well as protein, and that doesn't change. Although, iron needs actually do drop once babies turn one years old. So I don't like to say that you don't have to pay as much attention, but you don't have to worry as much, perhaps. If you're supplementing your baby with, say, an iron fortified baby cereal between six and 12 months, you may not need to continue doing that after 12 months. And actually that's something I want to talk about quickly. Baby cereals get a really bad rap. People say that they're highly processed and that they're unnecessary. And we find that they're a very helpful component of the diet, especially for our plant-based babies and baby-led winters. They're a concentrated source of iron. And there's many brands out there that are simply made with oats that have basically been ground up and have some iron in there. So adding in iron through a baby cereal like that around six months is a really great, easy, affordable way to meet iron needs. And that can be added to oatmeal that can be added to those bean patties. Cool. It's recommended. Beautiful. And that's actually even recommended for omnivores diets, because contrary to popular belief, even the iron in some of these baby foods, there's only about one milligram and an entire baby food, beef, baby food container. And most babies aren't eating more than a couple, maybe three of those a day, at least in the beginning. Yet iron needs are 11 milligrams a day, from six to 12 months. And an entire thing of beef has one milli. There you go. It's a huge nutrient gap, and that's why things like iron fortified baby cereal are really, really important. I think to include in the diet of all children. That's a good time. Back to nutrients, so at 12 months is 12 months is the recommended amount by the American American Academy of Pediatrics for breastfeeding. They recommend exclusive breastfeeding in six months, and then continued breastfeeding to 12 months if you can. The World Health Organization, however, recommends breastfeeding up until two years, and the way they state it is, and longer if possible. Sure. As long as it works for you and your infant, there isn't a ton of research on extended breast feeding, but the research on breastfeeding before 12 months shows that the longer, the better. So it would, we would assume that the benefits persist and historically, and in some tribal communities, people, women have breastfed even up to six years of age. The average age of waning historically and globally is about two to three years. 60 years. So that's, they're obviously having another child in between, that's why this is why it's continuing. Yeah. Yeah. So it's, that's very rare. I don't know if anyone does that these days. This is in reports of, of a historical, but yeah, but moral, the story you're saying, if you're working for you and your baby continue doing it, it's the best, it's the best source of nutrition with provided that you are decreasing slightly to two to three times a day and providing them with three meals a day and two snacks a day. So the progression is around six months. You start with about one meal a day, probably about nine months. You'll move up to providing two meals a day. And then by 12 months, you're providing three meals a day and possibly two snacks. That's the goal to get to with breast milk or formula intertwined around 12 months. You can stop formula and kids can be provided with either cow's milk or a plant-based milk alternate. Gotcha. Neither is biologically necessary, but both are convenient, compacted sources of many essential nutrients. Okay, so what's coming to mind for me as I think through that is that we're working towards this goal of, as you said, three meals a day, a couple of snacks with or without formula or breast milk. But they could be some, I guess, quite a bit discrepancy, I guess, in calories there. And I'm sure people are not counting calories, but how do you sort of gauge whether your child, I guess from a growth point of view, is a normal, normal meeting these developmental goals. How do we know, personally, when I look at a kid, I see a kid with some rolls and chubby and I think, oh, very healthy, but is that healthy, how do we sort of gauge that? Yeah. So, normal weight and height has a very, very wide range. It's normal for one child, may not be normal for another. We base it on growth charts. So under the age of two, we have height and weight growth charts. And anywhere from 5% even to the 95th percentile is considered normal, provided that a child is staying on their growth, their growth trajectory. So when you know that there's a problem either with under eating or overeating, or I shouldn't say eating because it's not always tied into eating. If there's a problem, an underweight, or a problem with too quick of growth, usually these are related to some sort of health condition. And you will know this because they'll start jumping into different percentile categories. So provided your child, even if they're at a very high or a very low percentile, is maintaining their growth trajectory, they're doing fine. They're healthy. And when it comes to how much they eat, I know three meals and two snacks a day can sound like a lot. It is frequent. It's every two to three hours. Babies need a lot of energy to fuel their growth, but we really want to let them lead the way when it comes to their portion size and how much they eat. So we subscribe to an approach known as the Division of Responsibility. This was set forth by Ellen Sadder. She's a dietitian who specializes in feeding children. And what the Division of Responsibility does is it outlines a parent's responsibility and a child's responsibility when it comes to eating. Parents are responsible for the what and the when. So they decide what we're serving and when we're serving it. And children are responsible for deciding if they want to eat and how much they want to eat. And really that's all. You know, there are general guidelines about the appropriate portion size, maybe to start with with an infinite six months, two tablespoons, three tablespoons is normal, but children have a wide range of what's normal. One child may eat a very small amount, one may eat a large amount, and they may be the same size and the opposite may be true. So you really want to let your child be the guide. It's always better to start with smaller portions and then to refill if they want more than it is to place a large amount in front of children. What research actually shows is that the more you pressure kids to eat, the less they eat and the less they weigh, the more you try to restrict kids, the more they want to eat and the more they end up weighing. So it really backfires. The key to infant feeding is exposure, continuing to offer and removing, removing any pressure in a positive atmosphere. So if they're picky and they're not eating as much as you'd like, not just taking that away, continuing to show that food out. Exactly. Yeah, especially in that early feeding range and like right when you're starting solids around six months exposure and continued exposure to foods is key. So studies have shown it can take up to 15 times of seeing or even tasting the same food before the child will regularly accept it. So yeah, just persistence, persistence without pressure. Got you. We're just going to good term right in there. That could never, never. I could be like a subtitle within one of you. I like it. I might include it. Yeah. So you're providing that broccoli, but you're not saying you have to eat that broccoli. You're not saying, mm, isn't that broccoli good? Even positive pressure can, yeah, is pressure. So you're simply putting it on their plate and allowing them. That's the hands off approach. Exactly. It's a baby letter. There we go. That's cool. Yeah. Okay. So that's kind of dealing with, I guess, piquet is as well and encouraging kids without actually encouraging them, but encouraging them through the, the what and when. Exactly. Oh, another thing is getting them involved in their nutrition and that this comes a little bit at an older age. You're not going to do this with a six month old baby, but allowing them to select foods at the grocery store, getting them in the kitchen and cooking with you. I just bought this thing called a kitchen helper, which is essentially like a stool that's enclosed that your child could stand on and reach the the counter and get up there and cook with you. So making them part of the process and making it fun, yeah, taking them to the market with you. And you can do that. Yeah, that's cool. You know, and that's a learning experience itself and seeing where it comes from. Yeah. Tell me, we, we, we mentioned before that that dairy just straight up milk and any form of plant-based milk is not appropriate for substituting for formula or breast milk. What happens after the first year can, what, what, what are the, what's the, the beverages of choice talking me through water, plant-based milk, things like that. Sure. So after 12 months, if you're breastfeeding and you want to continue, you continue, as, as I said, and then parents have a decision whether to transition to cow's milk or plant-based milk. There's no need to continue with formula after 12 months of age. The recommended amount is to be getting about 12 to 16 ounces of milk a day, again, because I said it is a condensed, a convenient source of nutrients. So again, you, you potentially could have a diet where you don't provide either, but you'd be really hard pressed to meet children's calcium needs specifically protein probably meet other places in the diet, vitamin D, you could supplement, but really calcium I think is the main benefit of of either cow's milk or a plant-based milk alternative. That said, plant-based milk alternatives and cow's milk also provide protein and fat and energy and other nutrients that kids need. So if you're choosing between the two, when you're choosing a plant-based milk, for instance, you really want to only choose soy or pea. We hear there's so many different plant-based milks out there on the market with almond and coconut and cashew, oats, macadamia. Macadamia. I feel like you hear of a new nut that they convert into a milk every day. Bull milk. There you go. I'll say there you go. And really, none of these are nutritionally adequate for children. The thing is, when we're providing another milk, we're trying to find something that is the most nutritionally comparable to cow's milk, essentially. So it needs to be high in protein, it needs to be higher in fat. If you provide something like almond milk, it's very low in protein, it's very low in fat, and it's very low in calories, but it's got a large volume. So it's similar to the fiber issue. Babies have small stomachs. If you're giving them eight, 16 ounces of these fluids that really don't have any nutrition and then you're displacing other important nutrients. I mean, almond milk, many of the brands are almost very much just water. They really are. There's a little tiny bit of nutrition in there, but you wouldn't want to be using that as a drink that is providing a whole lot of nutrition or things like that. It is. Okay. Cool. Here's soy. Correct. It should be fortified with calcium. It should be fortified with vitamin D, and some of them do fortify with B12. The main thing that we're wanting to derive from this beverage is that protein, that fat, and then primarily the calcium. We recommend that past the age of 12 months, if you're no longer getting these nutrients from your mother's breast milk, or you won't be getting it from formula anymore, that the child is in supplemented with vitamin D. Actually, they would have already started vitamin D supplementation if they're exclusively respite, but formula fed babies who are then going on to a plant-based diet should be supplemented with vitamin D. They should receive their own B12 supplement, and they should also receive an iodine supplement. And we recommend those supplements, even though vitamin D may be found in your plant milk. Maybe you do get the plant milk with B12, because fortification process is very, and intake varies from day to day. So the safest, most reliable option is to actually give them a supplement versus trying to get it from fortified foods. Interesting. We didn't talk too much about iodine before, but iodine is a critical nutrient for metabolism, for healthy thyroid functioning, and it's included in prenatals and your postnatal. So pregnant moms will be getting it there, lactating moms will be getting it there, and then transferring it to their baby, but once they stop getting breast milk, babies will not have a very adequate source of iodine. And iodine is found in the soil, but it varies widely in plant-based sources, so it's really not that reliable, which is why most governments started iodizing salt. But we're not giving the kids salt. Yeah, we're trying not to give the kids salt for one. And then for two, especially in more health-conscious communities, there's been this belief that specialty salts, like pink Himalayan salts, or sea salt are healthier, and so people will switch to them, and they are not iodine. So, and then the next source of iodine is seafood. So plant-based dieters are not eating seafood. A lot of them are very health-conscious, they're not consuming iodized salt. Processed foods, the salt in the processed foods, is not usually iodized, because it's more expensive to do that. So, company, and they're not required to. Yeah, and the seaweeds are variable. Exactly. So, okay. Sounds like you're already well-versed. So, there's a supplement there. I mean, something that we spoke about folate before, but also same thing, government brought in folate fortification in bread. Right. For a similar reason, just from a population level of, you know, not enough, the average person not getting in a folate. Right. So, like, fortification in the food system is not anything new. That's right. Been around. Right. Yeah. So, those are the main considerations for children, and then there's the potential to give them a DHA supplement as well. We know that DHA accumulation in the brain does continue through the first two years of age. There aren't a lot of studies on normal, healthy children in DHA supplementation. There have been some benefits shown in children with certain cognitive issues, like ADHD, and preterm infants. There have been beneficial, beneficial results in supplementing DHA, but it's debatable whether there are extended benefits for normal, healthy children. Sure. So, there's no recommendation to provide it. We think it can't hurt. We both provide DHA to our expenses as well, again, because they're not getting it through their diet, and the conversion rate from ALA is low. Okay. So, let's bring this back to beverages, so we spoke about the plant basements. What about water? Where does water come in? What's the role? What's the sort of importance of water and at what time? You can begin providing your baby with water at about six months when solids are introduced, and this is partially just, again, for exposure, teaching them how to drink water, getting them used to the taste, you definitely don't want it to displace formula or breast milk. So, the recommendation is to offer about an ounce or two with meals. And parents can do this in an open cup. You know, this sounds a little bit crazy, giving a little tiny baby an open cup. They're going to drop on themselves, but the earlier you start the better, there's no harm in doing it. So, providing it, kind of, for practice at that age, a little bit of water can help with constipation, too, especially with that higher fiber intake that plant-based kids have. It's about one year of age that kids will want to start regularly incorporating water. And so, just making water available at all times, getting your baby a little glass straw cup or stainless steel bottle and having them keep it with them throughout the day, others need about two to four cups of water per day is the recommendation. Sure. And then, as we're sort of progressing through that first year, you're just increasing volume based on what they're eating, as you said, putting it out, putting it in front of them and letting them decide how much they're going to eat. Exactly. Yeah. And continuing to provide new foods, try not to get in a rut of only providing the same things that they like. Is there any plans to avoid, like, is it straight out that you wouldn't suggest eating in the first couple of years? Yeah. There's really no plant foods to avoid just anything that's a choking hazard. So, anything that you wouldn't provide on any type of diet, hard foods, popcorn, round foods that can get lodged in the esophagus, like grapes, cherry tomatoes, vegan sausages, off-roading cubes. All of these things need to be cut. About nuts and nut butters, like, peanuts and allergies and what sort of lightest summer. So the old belief was that you should delay the introduction of allergens, like peanuts and eggs and other things until about two to three years of age in order to reduce the risk of allergy. And there's been a complete flip-flop on that. New research has shown that early introduction is actually key to reducing the risk of allergy. Gotcha. So, depending on your infant's allergy, risk would depend on the exact month that they recommend introducing peanuts. So for very high-risk infants, and this is defined as those with severe eczema or other food allergies, they actually recommend introducing peanuts between four and six months of age. And this should be medically supervised done at your pediatrician's office. For kids that are at a moderate risk or a low risk of allergy, and this would be defined as babies with no eczema, no other allergies or only mild or moderate eczema, the recommendation is to introduce around six months of age. And there's not as much research on the other top allergens, but it's likely that there's a similar effect. So we recommend trying to introduce all of the eight most common allergens within, like, starting at six months and regularly providing them. Now, I'm going to double back here just because this is a lot of this knowledge, it's really incredible to hear. And it's going to be so helpful for people, just sort of something else. You mentioned before the importance of fat in the plant-based milks and the soy or the oil in some markets where you can get that being the better options to provide that and the nutrients. And that gets me thinking about the importance of fat. We've mentioned a couple times about how some of the requirements as a child, different to an adult, talk to me about fat. Why it's really important for the developing body and what are the best sources, particularly from a fat point of view, from a food point of view to be introducing. Mm-hmm. Yeah. So fat is a critical nutrient for babies. It makes up 44% of breast milk. And as you just said, this is one of the key differences, again, between proper adult nutrition and proper children's nutrition, toddlers should be getting 30 to 40% of their calories from fat. And this is one of the things I think that really needs to be hammered home in the plant-based community, especially to those people who practice a low fat, Whole Foods Plant-based diet, is that kids need this fat. And plants are naturally low. Most plants are naturally low in fat. So you need to be conscious and figuring out ways to get this worked in throughout the day. And it's actually after 12 months when they're not getting as much fat from the formula or the breast milk, again, which is another reason why we like people to continue offering some sort of milk or milk alternative. Fat is essential for energy, it's essential for brain growth, for the absorption of fat soluble vitamins, it provides structure to all the cells in the body, and it makes hormones to fight infection and disease. So just wide, widespread benefits. You need fat. Yeah. Where are we going to? What are the go-to sources? So our go-to sources. Number one is avocado. Avocado is so easy to do with baby lead weaning too. You slice it into little strips. It can be a little slippery. So a good trick is to roll it in some hemp seeds or some wheat germ to get some grip on there. Nut butters, although nut butters can be a choking hazard for younger children. So you don't want to give big wops of nut butters. You want to spread it thinly on a piece of bread. And as they get older, they can tolerate bigger amounts, but for your like six-month-old infant, it should be a very thin smear. Nuts are not appropriate, whole nuts until about four when kids can actually chew them proficiently and they're no longer a choking hazard. So nut butters like go easy on that. Not butters but go easy on it, at least when they're younger and could choke on it, when they're older. And there's other ways to offer them. So you could mix a nut butter into their oatmeal, you could blend it, you could use it in a sauce. Sure. So when you say when they're older, when does that choking hazard sort of reduce the likelihood? It really depends on the child. I'd say probably by 12 months, they should be able to handle a little bit more than a thin smear. Yeah. But it's really going to depend on your baby and their motor skills. Let's say seeds, seeds are an awesome source of healthy fats, especially ALA, the omega three plant-based omega three. I include chia seeds and hemp seeds in my son's oatmeal every morning. Again, you can use those to roll avocados in, roll bananas in, really toss them in everything. We have them in different ball recipes, for meat ball recipes, little bite bars. Seeds are key component, I think, of all diets they should be. No. Sesame seeds. Great. Sesame seeds. Yep. Tahini. We offer regularly hummus. These are all great ways to get some fat in the diet. In the vegetable oils, so we recommend that parents roast vegetables in oil, saute, things in olive oil and avocado oil. It's a really easy, concentrated source of calories. Beautiful. Okay. Wow. We've covered some real territory there, so I will definitely provide some links to some of your resources that summarizes all of this. Yeah. But it sort of makes sense out of that, yeah, I want to say, we have, it does sound like a lot of information, but we have created something called the PB3 plate, and that really breaks down all of these nutritional needs into an easy visual guide where parents are just selecting foods and where they go on the plate instead of having to be so hyper focused on the exact nutrient content. Yeah. What's your, I mean, through your communities, you've got a very big community speaking with a lot of, a lot of mothers know down directly, like what's, what's their experience like? Are you finding that people do pick up this information quite easily? Yeah. We really are. You know, there are some things that take a little bit more education. The plant milk one seems to stump people a lot, but in general, we're finding that our community is easily, easily amenable to this information and applying it really well. And excited about it, I think parents that care about nutrition are also excited about cooking and figuring out how to meet their nutrient needs. Definitely. What would your advice be to, to someone who is feeding their child a plant-based diet and they have, whether it's doctors or other health professionals around them who are skeptical and are either, you know, passing comments or they're telling them that they're doing things the wrong way? What would you advise someone in that situation to do, whether it's to, you know, how they would respond or, you know, how would you navigate that situation? We tell parents to fight fear with facts, bottom line. If someone's coming at you and whether it be a well-intentioned family member or your pediatrician with claims about plant-based diets, educate them. A lot of these people don't know, and they're scared because they've heard these headlines out there. They just don't know. And so if you are armed with the information, you can easily, easily combat some of these claims. We actually have a blog post on this topic for how to talk to your OB/GYN about your plant-based pregnancy. And I believe we have a YouTube video that's coming out on it soon. Beautiful. So, alming yourself with the facts, obviously, your resource is hugely beneficial. Are there any other books or things in the market currently, anyone who's listening that might be pregnant or whatnot and wants to deep dive into this a bit more? Yeah. We recommend the vegetarian nutrition dietetic practice groups website. They've got a ton of free resources on their site for children and pregnant women, different facts sheets breaking down nutrients and the best sources. So that's a really great, great place to find information. veganhealth.org is written by a fellow dietitian, Jack Norris, and you want to talk about a deep dive. He's a wealth of knowledge. Have you seen this? Oh, yeah. Oh, my goodness. Yeah, it's something. If I have any question, I know he's answered it most. Absolutely. Yeah. Yeah. If you really want to get to the bottom of something, it's right there. Vegan health. Yes. Highly recommend that. On Instagram, we really like Dr. Yami. At the Dr. Yami, she is a vegan, I don't know if she's vegan, but she has a veggie doctor radio podcast. And then Dr. Jackie Busy at the plant-based pediatrician are both a wealth of information for plant-based parents. Awesome. I will put all of that into the show notes. So let's leave this with a parting message, if someone listening is intrigued by a plant-based lifestyle, they're looking to have kids and raise a family. Why would you encourage them to dig a bit deeper into this information and potentially change the way that they're eating a way that is different to what the majority of people in society are doing? Yeah. I'd say the overwhelming research supporting a plant-based diet for adults, for reduced chronic disease, for potential longevity benefits suggests that this type of dietary pattern is the way to go starting early in life. We know that food preferences and we know that disease risk starts early in life. So why wouldn't you start providing your child as soon as possible with nutrition that we know leads to health and longevity? And all governmental bodies in the U.S. and many worldwide advocate a plant-based diet for kids as safe, nutritionally adequate, and potentially beneficial. And it tastes good. Beautiful. Now how can people get in touch with you? You can find us at plant-based juniors on Instagram, plant-based juniors.com. This is the main spots. We have a plant-based juniors YouTube channel, and we should have a book coming out in May 2021. Incredible. I have to have you and Alex back on after the book comes. We would love to. And chat about everything else. We could probably chat for another two hours. Thank you so much. Thank you. Thanks for having me. Well, knowledge, I really appreciate the information that you're putting out. This one's been a long time coming, but super helpful. Keep doing what you're doing and look forward to reading your book. Thank you so much. There we go, friends. Well, a lot of information. But fortunately, as I said at the start, it has been summarized into two e-books on the plant-based juniors website, which I will provide links to in the show notes. And although it really does sound like a lot of information, it's actually not that crazy. Once you sit down and read the information, you can create a very simple plan for the current stage that you're in with your pregnancy or baby. And perhaps a little pre-reading for the stage ahead. You don't need to read about all stages at once unless you really want to. The information will really become second nature when you're in that phase of your life and able to use it practically day to day. And for anyone that has an infant or toddler, another great resource that I highly recommend to help summarize everything from this episode is downloading the PB3 plate that Whitney mentioned from the plant-based juniors website and putting this onto your fridge. So that is free to download from their website. It is super easy to understand with sections for legumes, nuts and seeds, grains, starches, fruits and veggies. And it has little notes to remind you about the importance of calcium-containing foods, omega-3-rich foods, iron and vitamin C superstars. And what's great, there's a separate section for fats, which spans all food groups because fats are found in all of those food groups. As we spoke about, getting adequate fats is incredibly important for infants and toddlers. It also has the plant-based milk options for kids over 12 months. Remember, that's not a replacement for breast milk or formula in year one and also a reminder to the side of the plate about a few of the supplements that we spoke about. And of course, it's good piece of mind to remember that this is very much considered a safe and healthy diet for people of all stages. As Whitney rightly stated during our conversation, the American Dietetics Association released a position paper and stated, "It is the position of the American Dietetic Association that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate and may provide health benefits in the prevention and treatment of certain diseases." Health planned vegetarian diets are appropriate for individuals during all stages of life cycle, including pregnancy, lactation, infancy, childhood and adolescence and for athletes. They then go on to say, "In evidence-based review showed that vegetarian diets can be nutritionally adequate, pregnancy and result in positive maternal and infant health outcomes." The results of an evidence-based review showed that a vegetarian diet is associated with a lower risk of death from his schemic heart disease. Vegetarians also appear to have lower low-density lipoprotein cholesterol levels, lower blood pressure and lower rates of hypertension and type 2 diabetes than non-vegetarians. Furthermore, vegetarians tend to have a lower body mass index and lower overall cancer rates. Features of a vegetarian diet that may reduce risk of chronic disease include lower intakes of saturated fat and cholesterol and higher intakes of fruits, vegetables, whole grains, nuts, soy, products, fiber and phytochemicals. And remember, they're using the word vegetarian, including vegan diets. And for those who are regular listeners, all those things that are just reeled off the health benefits and the fact that vegetarian diets may reduce chronic disease because they're lower in saturated fat and cholesterol and home in fiber and phytochemicals and whole grains. This is stuff that the guests on this show talk about all the time when they're talking about the evidence-based information that we have to make the very best decisions when it comes to our diet. So, the take home message here is, plant-based diet is safe and healthy for pregnant women and their baby, but of course, like any diet, it needs to be appropriately planned. And we discuss this in this episode. Of course, whether that's plant-exclusive or plant- predominant, that's going to be unique to your situation, the support you have, the food access you have and your overall confidence. There is no one way, there is only the best way for you and your kids. With all of the information, it is then only you that can decide this. With that said, that's all for this one. Please share your feedback on this episode online and let both. Whitney and Alex know how it landed for you by tagging at plant-based juniors and of course, if you haven't already and can take a spare minute to leave a review for the plant-proof podcast on the Apple Podcast app, that would be incredible, would be greatly appreciated. Coming up in the next few weeks, I sit down with Rich Roll, Dr. Volta Longo, a scientist specialising in aging and two fellers deeply involved in the regenerative agriculture world. I'm really looking forward to that. Thank you for tuning in. I hope you feel better for listening and I look forward to catching you in the next episode. Bye for now, friends. [BLANK_AUDIO]