What NOT to eat while pregnant

OK, so I just wrote a post two days ago about what can you eat while pregnant and nursing  Unfortunately, in that post, I had neglected to mention what you should definitely NOT eat while pregnant due to the potential risk to the unborn child.  The following information was put forth by the March of Dimes.  You should definitely NOT eat:

• Unpasteurized milk or juice
• They can carry disease-causing bacteria (such as Salmonella and E. coli), making them unsafe choices for pregnant women.
• Pregnant women can sometimes become seriously ill from these infections. Occasionally, a pregnant woman can pass a Salmonella or E. coli infection on to her fetus, who can develop diarrhea, fever and, less frequently, meningitis after birth. 
• The FDA requires that packaged, unpasteurized juices carry a label stating that they are not pasteurized
• Soft cheeses, such as feta, brie, Camembert, Roquefort, blue-veined, queso blanco, queso fresco or Panela, unless the cheese is labeled as made with pasteurized milk. Hard cheeses, processed cheeses, and cream and cottage cheeses are safe.
• Certain soft cheeses can cause a form of food poisoning called listeriosis. Listeriosis is caused by a bacterium (Listeria monocytogenes) and is especially dangerous during pregnancy. 
• When a pregnant woman is infected with listeriosis, she may have a miscarriage, premature delivery or stillbirth, or her newborn baby may become seriously ill and may die.
• Unheated deli meats and hot dogs
• Ready-to-eat meats (including packaged luncheon meats and deli meats) poses the same listeriosis hazard as mentioned above.
• Refrigerated, smoked seafood
• Pregnant women should not eat fish that can be high in mercury, like shark, swordfish, king mackerel and tilefish
• Pregnant women can eat up to 12 ounces a week of fish that are low in mercury, including shrimp, salmon, pollock, catfish and canned light tuna.
• Women should eat no more than 6 ounces of albacore (white) tuna, which has more mercury than canned light tuna, in one week
• Some omega-3 rich fish that are low in mercury include salmon, herring, anchovies, sardines and trout.
• According to the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA), women who are pregnant or planning pregnancy should avoid eating game fish without first checking its safety with their local health department
• Some game fish also may be contaminated by other industrial pollutants, such as PCBs (polychlorinated biphenyls). Some studies suggest that exposure to high levels of PCBs before birth may contribute to learning problems, decreased IQ and reduced birthweight
• A pregnant woman should avoid sushi and other raw fish, especially shellfish (oysters, clams). These can be polluted by raw sewage and can contain harmful microbes that can lead to severe gastrointestinal illness. 
• Undercooked poultry, meat or seafood
• Pregnant women should avoid eating raw or undercooked meats, poultry and eggs because they can increase their risk of a number of food-borne illnesses (including listeriosis, E. coli and Campylobacter infections, salmonellosis and toxoplasmosis). 
• If a pregnant woman contracts toxoplasmosis, there’s about a 50 percent chance she will pass it on to her unborn baby. Some affected babies develop vision and hearing loss, intellectual disabilities, seizures and other problems.  Toxoplasmosis can also be found in cat feces and pregnant women should not change a cat's litter box.
• Pregnant women should use a meat thermometer to make sure that meat and poultry are thoroughly cooked. 
• Eggs, which can be contaminated with Salmonella, should be cooked until both the yolk and white are firm. Pregnant women should avoid foods made with raw or partially cooked eggs, like egg nog and hollandaise sauce. 

What you should definitely take if you are of child bearing age (whether you're pregnant or not), is at least 400mcg of folic acid daily.  According to the March of Dimes, "An overwhelming body of evidence shows that daily consumption of folic acid is a safe and effective means of preventing neural tube defects, serious birth defects of the brain and spine."   

Eating Nuts While Pregnant May Cause Less Allergy in Kids

I ran across an interesting article today which was written after a study was published in the Journal of Allergy and Clinical Immunology.  The study, titled, "Peanut and tree nut consumption during pregnancy and allergic disease in children—should mothers decrease their intake? Longitudinal evidence from the Danish National Birth Cohort" looked at the peanut and tree nut consumption by pregnant women and the development of allergies in their children.

The study involved 61,908 mothers who were a part of the Danish National Birth Cohort.  The mothers were questioned about the frequency of their peanut and tree nut consumption (i.e. almonds and walnuts) while pregnant.  Their babies were followed-up at 18 months and 7 years to determine if they had developed asthma and allergies.

The results of the study "do not suggest that women should decrease peanut and tree nut intake during pregnancy; instead, consumption of peanuts and tree nuts during pregnancy might even decrease the risk of allergic disease development in children."

This study further supports the policy of the American Academy of Pediatrics regarding what to eat while pregnant and nursing that I wrote about yesterday.  I am glad that more studies are being done to show that there is no risk to my unborn child of consuming peanuts or tree nuts.  Due to my gestational diabetes, I have practically been living on nuts for snacks.  They are healthy, high in protein and contain healthy omega-3 fatty acids.  The March of Dimes even states that peanuts are a good source of protein and folate.  "Folate is the form of folic acid that is found naturally in foods. Taking folic acid before and during early pregnancy helps prevent certain serious birth defects of the brain and spine. The March of Dimes recommends that all women who could become pregnant take a multivitamin containing 400 micrograms of folic acid daily, and make healthy food choices that include foods rich in folic acid. "

Is there anything that you should not eat while pregnant or nursing?

This is an interesting question that I have seen pop up quite frequently on some of the pregnancy message boards that I frequent.  According to the American Academy of Pediatrics (AAP) revised policies published in January 2008, "current evidence does not support a major role for maternal dietary restrictions during pregnancy or lactation" for mothers of children that are not at "high risk of developing allergy (ie, infants with at least 1 first-degree relative [parent or sibling] with allergic disease)."

When reading the policy, the AAP defines "atopic disease" as "clinical disease characterized by atopy; typically refers to atopic dermatitis, asthma, allergic rhinitis, and food allergy."

The AAP summarizes their findings based on available data below:

1. At the present time, there is lack of evidence that maternal dietary restrictions during pregnancy play a significant role in the prevention of atopic disease in infants. Similarly, antigen avoidance during lactation does not prevent atopic disease, with the possible exception of atopic eczema, although more data are needed to substantiate this conclusion.
2. For infants at high risk of developing atopic disease, there is evidence that exclusive breastfeeding for at least 4 months compared with feeding intact cow milk protein formula decreases the cumulative incidence of atopic dermatitis and cow milk allergy in the first 2 years of life.
3. There is evidence that exclusive breastfeeding for at least 3 months protects against wheezing in early life. However, in infants at risk of developing atopic disease, the current evidence that exclusive breastfeeding protects against allergic asthma occurring beyond 6 years of age is not convincing.  
4. In studies of infants at high risk of developing atopic disease who are not breastfed exclusively for 4 to 6 months or are formula fed, there is modest evidence that atopic dermatitis may be delayed or prevented by the use of extensively or partially hydrolyzed formulas, compared with cow milk formula, in early childhood. Comparative studies of the various hydrolyzed formulas have also indicated that not all formulas have the same protective benefit. Extensively hydrolyzed formulas may be more effective than partially hydrolyzed in the prevention of atopic disease. In addition, more research is needed to determine whether these benefits extend into late childhood and adolescence. The higher cost of the hydrolyzed formulas must be considered in any decision-making process for their use. To date, the use of amino acid–based formulas for atopy prevention has not been studied.
5. There is no convincing evidence for the use of soy-based infant formula for the purpose of allergy prevention.
6. Although solid foods should not be introduced before 4 to 6 months of age, there is no current convincing evidence that delaying their introduction beyond this period has a significant protective effect on the development of atopic disease regardless of whether infants are fed cow milk protein formula or human milk. This includes delaying the introduction of foods that are considered to be highly allergic, such as fish, eggs, and foods containing peanut protein.
7. For infants after 4 to 6 months of age, there are insufficient data to support a protective effect of any dietary intervention for the development of atopic disease.
8. Additional studies are needed to document the long-term effect of dietary interventions in infancy to prevent atopic disease, especially in children older than 4 years and in adults.
9. This document describes means to prevent or delay atopic diseases through dietary changes. For a child who has developed an atopic disease that may be precipitated or exacerbated by ingested proteins (via human milk, infant formula, or specific complementary foods), treatment may require specific identification and restriction of causal food proteins. This topic was not reviewed in this document.

With this revision, the AAP is stating that unless a child is at high risk for developing an allergy, there is no restriction as to what a mother can eat while pregnant or breastfeeding.  If a child is at high risk, exclusive breastfeeding (with no formula supplementation) for at least 4 months decreases the risk of developing atopic dermatitis (eczema) and an allergy to cow's milk.  For all children, breastfeeding for at least three months may protect against wheezing in early life.  If a child is at high risk for developing an allergy and is not exclusively breastfed, there is some evidence that eczema may be delayed or prevented by using extensively hydrolyzed formulas compared with cow milk formula in early childhood.  There is no evidence for the use of soy-based formula for the purpose of allergy prevention.  Solid foods should not be introduced before 4-6 months of age.  Furthermore, delaying introduction of solid foods after 6 months does not offer more protection against the development of allergies regardless if a baby has been fed formula or breastmilk.  Also, there is no evidence that delaying the introduction of foods such as fish, eggs or peanuts will protect against the development of allergies to those foods.

Monsanto - Friend or Foe?

Who or what is Monsanto?  According to their company website, Monsanto is a Fortune 500 Company headquartered in St. Louis, Missouri.  They sell agricultural and vegetable seeds which have traits "developed through biotechnology."  They also manufacture "crop protection chemicals."  On their website, they state, "producing more, conserving more, improving lives that's sustainable agriculture.  And that's what Monsanto is all about."

They plan to "produce more" by "working to double yields in our core crops by 2030.  These yield gains will come from a combination of advanced plant breeding, biotechnology, and improved farm-management practices."  They plan to "conserve more" by strengthening their "goal of doubling crop yields by committing to doing it with one-third fewer resources such as land, water, and energy per unit produced."  They aim to "improve lives" by "working to help farmers achieve big increases in yield and productivity.  And for all of the world's farmers who raise themselves from poverty to prosperity, many more people will also prosper."

At Monsanto, they "are dedicated to providing farmers the broadest choice of products and services that will help them produce more, conserve more and lead improved lives."  They offer:  "high-yielding conventional and biotech seeds,  advanced traits and technologies that enable more nutritious and durable crops, and have safe and effective crop protection solutions."  They state that "product stewardship is something as a company, Monsanto takes very seriously.  Whether it's ensuring environmental standards are not only met, but exceeded or protecting the safety of our people and communities, Monsanto's stewardship commitments are a top priority."

They are the "world's leading producer of the herbicide glyphosate, marketed in the Roundup brand, and in other brands.  They are also the largest producer of genetically engineered seed."

Sounds like a great company, right?  They are innovating agriculture by using technology to improve crop yields.  Unfortunately, despite their marketing efforts, Monsanto has been controversial among the "alter-globalization movement and environmental activists."

Since its inception in 1901, Monsanto has been responsible for the development of the artificial sweetener saccharin, DDT, Agent Orange, Aspartame (NutraSweet), rBST (bovine growth hormone), and PCBs.  They were the first company to genetically modify a plant cell.  All of these products, many of which have been shown to cause cancer, have made them the target of activists.

They further "endeared" themselves to activists when they sued farmers in Canada and the US over "patent infringement" when farmers were selling seeds containing Monsanto's patented genes.  The farmers were actually the "victims" of contamination of their own crops by winds that carried Monsanto's genetically modified seeds into their own fields.  Monsanto failed to secure their fields from contaminating their neighbors fields.

Monsanto has genetically engineered seeds to produce plants that "produce its own insecticide. This it can do in every cell of every leaf, stem, flower, root and spud."  The idea behind this is the plant would be immune to pests without having to be actually sprayed with chemical insecticides.

If you planted in your garden seeds developed at Monsanto, the genes you are using "remain the intellectual property of Monsanto."  Were you to "save even one" of the seeds "to plant next year," you "would be breaking Federal law."  The plants seeds themselves are considered a "pesticide, registered with the Environmental Protection Agency."

The plants were "developed" to produce Bt (Bacillus thuringiensis), which is a bacterial toxin produced in the plants to kill insects which are susceptible to this toxin when ingested.  Organic farmers have been using this toxin in their farming practices.  However, "the widespread use of Bt in biotech crops is likely to lead to insect resistance, thus robbing organic growers of one of their most critical tools; that is, Monsanto's version of sustainable agriculture may threaten precisely those farmers who pioneered sustainable farming."

"Uncertainty is the theme that unifies much of the criticism leveled against biotech agriculture by scientists and environmentalists. By planting millions of acres of genetically altered plants, we have introduced something novel into the environment and the food chain, the consequences of which are not -- and at this point, cannot be -- completely understood. One of the uncertainties has to do with those grains of pollen bumblebees are carting off. That pollen contains Bt genes that may wind up in some other, related plant, possibly conferring a new evolutionary advantage on that species. ''Gene flow,'' the scientific term for this phenomenon, occurs only between closely related species."  Scientists are worried about this "biological pollution."  Biological pollution has the potential to create "super" species like weeds or other noxious plants.

It is alarming that the "F.D.A. regulation of biotech food has been largely voluntary since 1992.  Under the guidelines, new proteins engineered into foods are regarded as additives (unless they're pesticides).  The determination whether a new protein is GRAS can be made by the company.  Companies with a new biotech food decide for themselves whether they need to consult with the F.D.A. by following a series of ''decision trees'' that pose yes or no questions like this one: 'Does. . .the introduced protein raise any safety concern?''"  Unfortunately, according to an executive with Monsanto, "Monsanto should not have to vouchsafe the safety of biotech food.  Our interest is in selling as much of it as possible. Assuring its safety is the F.D.A.'s job.'"  With a response like that, it appears no one is regulating biotech food.  The FDA leaves it up to the manufacturer and the manufacturer leaves it up to the FDA.

So, with all of this uncertainty about safety, how do we know if we are consuming a product that has been genetically modified?  There is absolutely no regulatory requirement in the US to indicate if a product has been genetically modified.  Residents of the State of California will have an opportunity to vote on a ballot measure in November's election to make it mandatory that products that contain or were derived from a genetically modified organism must be labeled as such.  This would mirror requirements in Europe.  Passing a law in California is similar to passing a nationwide law since manufacturers and growers will not label something one way for California residents and another for other states.  It is similar to the application of flame retardants.  California's laws have a way of becoming "standard" throughout the country.

The biggest opponent to this, obviously, is Monsanto who stands to lose millions of dollars should this pass.  There is an interesting blog post about a mother who tried to rid herself and her family from Monsanto's reach.  She found it difficult without labeling indicating a product has been genetically modified.  She also discovered just how many products contain a genetically modified organism.  There are also whole organizations dedicated to "exposing" Monsanto that you can read about.  A great article, published in 1998, details the controversies surrounding genetically modified crops.  Despite being 14 years old, many of the points addressed in the article are still relevent.

Since there are no labeling requirements, if you want tips for avoiding foods that are genetically modified, you can find them on my blog post from yesterday.

Is Monsanto a friend or foe?  Only you can decide.

How to Avoid Genetically Modified Food

I have stumbled across a few posts with tips to avoid genetically modified food or organisms (GMOs).  Since there are no mandatory labeling requirements for GMOs, how can you tell if something is genetically modified?  According to www.safe-food.org, "if you really want to avoid the influence of genetic engineering, buy fresh organic produce. If you want to buy processed foods and avoid genetically engineered ingredients, you will have to read product labels. If the label mentions any of the ingredients listed below without explicitly qualifying it as organic, then the product probably contains genetically engineered ingredients."  The following list was compiled from the safe-food website as well as from wikiHow:

• Soybeans: Gene taken from bacteria (Agrobacterium sp. strain CP4) and inserted into soybeans to make them more resistant to herbicides.  The following are soy products:  soy flour, soy oil, lecithin, soy protein isolates and concentrates. Products that may contain genetically engineered soy derivatives: vitamin E, tofu dogs, cereals, veggie burgers and sausages, tamari, soy sauce, chips, ice cream, frozen yogurt, infant formula, sauces, protein powder, margarine, soy cheeses, crackers, breads, cookies, chocolates, candies, fried foods, shampoo, bubble bath, cosmetics, enriched flours and pastas.
• Corn: There are two main varieties of GE corn. One has a Gene from the soil bacterium Bacillus thuringiensis inserted to produce the Bt toxin, which poisons Lepidoteran (moths and butterflies) pests.  There are also several events which are resistant to various herbicide. Present in high fructose corn syrup and glucose/fructose which is prevalent in a wide variety of foods in America.  The following are corn products:  corn flour, corn starch, corn oil, corn sweeteners, syrups. Products that may contain genetically engineered corn derivatives: vitamin C, tofu dogs, chips, candies, ice cream, infant formula, salad dressings, tomato sauces, breads, cookies, cereals, baking powder, alcohol, vanilla, margarine, soy sauce, tamari, soda, fried foods, powdered sugar, enriched flours and pastas.
• Rapeseed/Canola Oil:  Gene added/transferred to make crop more resistant to herbicide.  Products that may contain genetically engineered canola derivatives: chips, salad dressings, cookies, margarine, soaps, detergents, soy cheeses, fried foods.
• Sugar Beets:  Gene added/transferred to make crop more resistant to Monsanto's Roundup herbicide.
• Rice:  Genetically modified to resist herbicides; not currently available for human consumption, but trace amounts of one GM long-grained variety (LLRICE601) may have entered the food supply in the USA and Europe. More recently, golden rice, a different strain of rice has been engineered to produce significantly higher levels of beta carotene, which the body uses to produce vitamin A. Golden rice is still undergoing testing to determine if it is safe for human consumption.
• Cotton:  Engineered to produce Bt toxin. The seeds are pressed into cottonseed oil, which is a common ingredient in vegetable oil and margarine.  Products which contain cotton are:  oil, fabric. Products that may contain genetically engineered cotton or its derivatives: clothes, linens, chips, peanut butter, crackers, cookies. 
• Potatoes: Right now the only potato that has been genetically engineered is the Burbank Russet, but you still have to look out for potato starch and flour. Products that may contain genetically engineered potatoes or derivatives: unspecified processed or restaurant potato products (fries, mashed, baked, mixes, etc.), chips, Passover products, vegetable pies, soups. Fast-food chains appear to have responded to consumer concerns and requested genetically natural potatoes.
• Dairy Products: Cows injected with GE hormone rBGH/rBST; possibly fed GM grains and hay.  The following are dairy products:  milk, cheese, butter, buttermilk, sour cream, yogurt, whey. You have to ask several questions when you are looking at dairy products. Have the cows been treated with rBGH? What kind of feed have they been given? If they are not being fed organic grains, chances are quite likely that they will be eating genetically engineered animal feed. What does this do to their milk products? No one knows.
• Animal Products: Because animal feed often contains genetically engineered organisms, all animal products, or by-products may be affected.
• Papayas
• Farm Raised Salmon
• Aspartame/AminoSweet - Addictive and dangerous artificial sweetener commonly found in chewing gum and "diet" beverages. A building block of aspartame, the amino acid phenylalanine, is usually manufactured with the aid of genetically modified E. coli bacteria. This process has been used industrially in the USA for many years.

"Please note that a food may contain some of these items and yet be free from genetically engineered organisms, but we have no way of knowing without tracking down every brand, every product and every ingredient. Even reading labels is no guarantee that you will be able to avoid genetically engineered ingredients, because manufacturers are not required to list every little ingredient, enzyme or organism used in the manufacturing process. The following products may also be genetically altered, contain or originate from genetically engineered organisms: candies, cookies, breads, cereals, corn syrups, oils, juices, detergents, dough conditioners, yeast, sugar, animal feed, vitamins and enzymes used in the processing of cheese."

This is quite the list and almost impossible to check every label to find out if it contains these ingredients.  It is upsetting that as consumers in the United States, we do not have information up-front indicating if something contains a GMO.  The European Union (EU) has specific requirements for products containing greater than 0.9% of GMOs to be labeled as such.  The EU feels that "labeling provides information for consumers and allows them to make an informed choice. In the case of pre-packaged products consisting of, or containing, GMOs, the list of ingredients must indicate "genetically modified" or "produced from genetically modified [name of the organism]". In the case of products without packaging these words must still be clearly displayed in close proximity to the product (such as a note on the supermarket shelf)."  Why can't Americans have the same ability to make an "informed choice" with mandatory labeling?

Since there are no mandatory labeling requirements in the US, the following taken from wikiHow is a list of 8 steps that can be taken to avoid genetically modified food in the absence of specific labeling.

1. Become familiar with the most common applications of genetic modification.
• See the list above for the most common applications of genetic modification (i.e. soybeans, corn, etc). 
2. Buy food labeled 100% organic.
• The US and Canadian governments do not allow manufacturers to label something 100% organic if that food has been genetically modified or been fed genetically modified feed. 
• Just because something says "organic" on it does not mean that it does not contain GMs. In fact, it can still contain up to 30% GMs, so be sure the labels say 100% organic.
• Eggs labeled "free-range", "natural", or "cage-free" are not necessarily GE-free; look for eggs to be 100% organic.
3. Recognize fruit and vegetable label numbers.

• If it is a 4-digit number, the food is conventionally produced.
• If it is a 5-digit number beginning with an 8, it is GM. However, do not trust that GE foods will have a PLU identifying it as such, because PLU labeling is optional.
• If it is a 5-digit number beginning with a 9, it is organic.
4. Purchase beef that is 100% grass-fed.
• Most cattle in the U.S. are grass-fed, but spend the last portion of their lives in feedlots where they may be given GM corn, the purpose of which is to increase intramuscular fat and marbling. 
• If you're looking to stay away from GMOs, make sure the cattle were 100% grass-fed or pasture-fed (sometimes referred to as grass-finished or pasture-finished). 
• The same applies to meat from other herbivores such as sheep. 
• There is also the slight possibility that the animals were fed GM alfalfa, although this is less likely if you buy meat locally. 
• With non-ruminants like pigs and poultry that cannot be 100% grass-fed, it's better to look for meat that is 100% organic.
5. Seek products that are specifically labeled as non-GM or GMO-free. 
6. Shop locally.
• Although more than half of all GM foods are produced in the US, most of it comes from large, industrial farms.
7. Buy whole foods.
• They don't mean the supermarket chain of the same name.
• Favor foods that you can cook and prepare yourself, rather than foods that are processed or prepared (e.g. anything that comes in a box or a bag, including fast food). 
8. Grow your own food.

Until there is more information available to determine if GMOs are safe both short-term and long-term and in the absence of any mandatory labeling requirements, as a consumer, we have to take the extra steps to determine if a product contains a GMO and make our own "informed choice."

What is rBST & what does it have to do with milk?

Since I've become a mother, I have noticed that milk and milk products will sometimes come with a label designating if it is "rBST free" or "no artificial growth hormones."

Butter, Yogurt, Buttermilk and Milk

What exactly is "rBST" or "artificial growth hormones?"  rBST stands for recombinant bovine somatotropin or recombinant bovine growth hormone (rBGH) or artificial growth hormone.   rBST was artificially synthesized using recombinant DNA technology to mimic bovine somatotropin.  Bovine somatotropin is a hormone naturally produced by a cow's pituitary gland.

rBST was first developed by a company called Monsato under the brand name Posilac.  Posilac was designed to be given to cows to produce more milk over the course of lactation by preventing or delaying the natural mammary cell death that happens during lactation.  "To apply Posilac for maximum effect, farmers are recommended to make the first Posilac application about 50 days into the cow's lactation, just before she peaks. The Posilac then sustains already-present mammary cells, limiting the rate of production decrease after production peaks. After the peak, production declines with or without application of Posilac, but declines more slowly with Posilac than without. This decrease in the rate of production decline permits dairy cows to produce more milk over the span of a lactation—at its best, this will be seen by seven to eight more pounds of milk being produced per day than would be produced without Posilac."  Posilac is available without a prescription and can be bought and administered by a farmer without the guidance of a veterinarian.

The Food and Drug Administration (FDA), approved the use of Posilac in 1993 after "determining that its use would be safe and effective. Part of the FDA’s safety evaluation was to ensure that milk from treated cows was safe for human food."  "FDA believes that the available data confirm that biologically significant amounts of rbGH are not absorbed in humans following the consumption of milk from cows treated with rbGH."

The FDA currently does not require dairy products to be labeled as having been derived from a cow treated with rBST.  "The agency found that there was no significant difference between milk from treated and untreated cows and, therefore, concluded that under the Federal Food, Drug, and Cosmetic Act (the act), the agency did not have the authority in this situation to require special labeling for milk from rbST-treated cows.  FDA stated, however, that food companies that do not use milk from cows supplemented with rbST may voluntarily inform consumers of this fact in their product labels or labeling, provided that any statements made are truthful and not misleading."

If rBST is "safe and effective," why is there controversy surrounding its use?  It turns out that cows treated with rBST have higher levels of IGF-1.  According to the American Cancer Society, IGF-1 is a hormone that "helps some types of cells to grow. Several studies have found that IGF-1 levels at the high end of the normal range may influence the development of certain tumors. Some early studies found a relationship between blood levels of IGF-1 and the development of prostate, breast, colorectal, and other cancers, but later studies have failed to confirm these reports or have found weaker relationships. While there may be a link between IGF-1 blood levels and cancer, the exact nature of this link remains unclear."  "More research is needed to help better address these concerns."

The second controversy involves a side effect of rBST.  Cows treated with rBST tend to develop more mastitis (udder infections).  As a result, they are given more antibiotics than cows not treated with rBST.  If a cow is given more antibiotics, does it cause more antibiotic resistance and if so, does that resistance pass onto humans?  Will the organisms treated by these antibiotics be harder to eradicate if it were to infect a human?  This issue has "not been fully examined in humans."

A third controversy involves the effect rBST has on cows.  The European Union (EU) has banned the use of rBST based on the effects on the cow and not the effects on humans.  In cows, rBST "causes substantially and very significantly poorer welfare because of increased foot disorders, mastitis, reproductive disorders and other production related diseases. These are problems which would not occur if BST were not used and often results in unnecessary pain, suffering and distress. If milk yields were achieved by other means which resulted in the health disorders and other welfare problems described above, these means would not be acceptable. The injection of BST and its repetition every 14 days also causes localised swellings which are likely to result in discomfort and hence some poor welfare.  BST use causes a substantial increase in levels of foot problems and mastitis and leads to injection site reactions in dairy cows. These conditions, especially the first two, are painful and debilitating, leading to significantly poorer welfare in the treated animals. Therefore from the point of view of animal welfare, including health, the Scientific Committee on Animal Health and Animal Welfare is of the opinion that BST should not be used in dairy cows."

Like the Europeans, Canadians have also banned the use of rBST based on the effects of the cow and not on the effects on humans.  "The veterinary experts cited an increased risk of mastitis of up to 25%, of infertility by 18%, and of lameness by up to 50%. These increased risks and overall reduced body condition lead to a 20-25% increased risk of culling from the herd.  The findings of the animal safety committee, when combined with our own assessment, made it quite clear that Health Canada had to reject the request for approval to use rbST in Canada, as it presents a sufficient and unacceptable threat to the safety of dairy cows.  The safety of both human and animal health are critical considerations when assessing a new veterinary drug."

It appears that the US is the only major country still using rBST.  However, despite the FDA's position that rBST is "safe and effective" many companies like Safeway, Starbucks and Tillamook are pledging to eliminate using milk products from cows treated with rBST.  Obviously, controversy is brewing with Monsato, the sole manufacturer of Posilac.  They stand to lose millions of dollars if more consumers opt out of purchasing milk from cows treated with their medication.  It is estimated that the company has spent "a much as $1 billion in research and development and makes upward of $270 million a year on sales of rBST."

On a personal level, as an animal lover and a mother, I am opting to buy products that do not come from cows treated with rBST.  Until more studies are done regarding the long term effects of growth hormone, I cannot justify exposing my children to that risk however small that may be at the moment.  Furthermore, it appears the cows really do suffer when given this medication.  This is another product that I can add to avoid.  Since this uses recombinant DNA technology, it would be considered by my definition, a genetically modified organism.

Pediatric Growth Charts

When I had my first child, I often wondered if he was gaining enough weight.  I breastfed him exclusively and found it difficult to assess if I was producing enough milk for his needs.  Looking at his growth in comparison to standardized growth charts was the only way for me to determine if he was getting enough breastmilk.  My baby was always on the smaller side and that concerned me.  However, as I began researching the topic, I began to realize that the growth charts in use today is very different from the growth charts used several years ago.

Prior to the year 2000, most providers referenced a growth chart from 1977.  The chart developed in 1977 was from a single study whose data was collected from primarily "formula fed, white middle-class infants in a limited geographic area of southwestern Ohio from 1929–75."  This chart was even adopted internationally by the World Health Organization.

The problem with this chart was it tried to compare children from around the world to a select group of people in the United States.  As you know, many people around the world differ in size according to their nutritional status and ethnicity among other factors.  It was this discrepancy that led to the  development of the new guidelines in use today.

In the US, the current growth charts now include a Body Mass Index (BMI) for age charts.  "BMI (wt/ht2) is calculated from weight and height measurements and is used to judge whether an individual's weight is appropriate for their height. BMI is the most commonly used approach to determine if adults are overweight or obese and is also the recommended measure to determine if children are overweight. The new BMI growth charts can be used clinically beginning at 2 years of age, when an accurate stature can be obtained."  The new charts also had a revised head circumference chart which "also show some noticeable differences when compared to the earlier charts. Compared to the original infant charts that were based on primarily formula-fed infants, the revised growth charts for infants contain a better mix of both breast- and formula-fed infants in the U. S. population."

The Centers for Disease Control (CDC) recommends the charts developed by the World Health Organization (WHO) for children 0-2 years old and the CDC growth charts to monitor children 2 and older in the United States.  There are separate charts because the WHO chart only covers children until they are 5 years old.

The WHO standards "establish growth of the breastfed infant as the norm for growth.  The WHO charts reflect growth patterns among children who were predominantly breastfed for at least 4 months and still breastfeeding at 12 months."  "The WHO standards provide a better description of physiological growth in infancy.  Clinicians often use the CDC growth charts as standards on how young children should grow. However the CDC growth charts are references; they identify how typical children in the US did grow during a specific time period. Typical growth patterns may not be ideal growth patterns. The WHO growth charts are standards; they identify how children should grow when provided optimal conditions."  For example, according to the CDC growth chart reference, if a "typical" growth pattern for a particular region is for children to be overweight, it is not an "ideal" growth pattern and children should not be compared to that reference.

"The CDC growth charts are based on primarily formula fed infants.  Only about 50% of infants measured to construct the growth reference charts were ever breastfed.  By 3 months of age, only 33% were breastfed.  In the US, 75% of infants born in 2008 were ever breastfed, 44% were breastfed for at least 6 months and 24% were breastfed at 12 months.  Consequently, the CDC growth charts may not adequately reflect the current growth patterns of infants in the US and they do not reflect a growth pattern typically seen in breastfed infants."

"Growth patterns differ between breastfed and formula-fed infants. Beginning around 3 months of age weight gain is generally lower for breastfed infants than for that of the formula-fed infant.  Linear growth generally follows a similar pattern for both breast- and formula-fed infants.  Formula-fed infants tend to gain weight more rapidly after age 3 months, they may be more likely to cross upward in percentiles on the WHO growth charts, perhaps becoming classified as overweight."

The WHO Standards were developed from data collected from "The WHO Multicentre Growth Reference Study (MGRS)."  "The WHO Multicentre Growth Reference Study (MGRS) was undertaken between 1997 and 2003 to generate new growth curves for assessing the growth and development of infants and young children around the world.  The MGRS collected primary growth data and related information from approximately 8500 children from widely different ethnic backgrounds and cultural settings (Brazil, Ghana, India, Norway, Oman and the USA)."  "The children included in the study were raised in environments that minimized constraints to growth such as poor diets and infection. In addition, their mothers followed health practices such as breastfeeding their children and not smoking during and after pregnancy."

"The MGRS was designed to provide data that describe “how children should grow,” by including in the study’s selection criteria specific health behaviors that are consistent with current health promotion recommendations (e.g., breastfeeding norms, standard pediatric care, non-smoking requirements). This new approach is fundamentally different from that taken by the traditional descriptive references. By adopting a prescriptive approach, the protocol’s design went beyond an update of how children in presumably healthy populations grow at a specific time and place and explicitly recognizes the need for standards (i.e., devices that enable value judgments by incorporating norms or targets in their construction). Arguably, the current obesity epidemic in many developed countries would have been detectable earlier if a prescriptive international standard had been available 20 years ago."  This study "reiterate the fact that child populations grow similarly across the world’s major regions when their needs for health and care are met."

A result of the new standards will be "that stunting (low height for age) will be greater throughout childhood when assessed using the new WHO standards compared to the previous international reference. There will be a substantial increase in underweight rates during the first half of infancy (i.e., 0-6 months) and a decrease thereafter. For wasting (low weight for length/height), the main difference between the new standards and the old reference is during infancy (i.e., up to about 70 cm length) when wasting rates will be substantially higher using the new WHO standards. With respect to overweight, use of the new WHO standards will result in a greater prevalence that will vary by age, sex and nutritional status of the index population."  This is not surprising considering the previous reference was based on "formula fed, white middle-class infants in a limited geographic area of southwestern Ohio."

The new standards establish the following cutoffs:
"Infants and children with a weight-for-length < 2nd percentile are classified as low weight-for-length.
Infants and children with a length-for-age < 2nd percentile are classified as having short stature.
Infants and children with a weight-for-length > 98th percentile are classified as high weight-for-length."

When a child transitions after the age of 2 "from the WHO weight-for-length chart to the CDC BMI-for-age chart may result in a change in a child's percentile classification" because of:

• Changes from one indicator to another indicator.
• Weight-for-length chart to BMI-for-age chart.
• Changes from a recumbent length measurement to a standing height measurement.
• "Standing height measures less than recumbent length. "  
• Changes to a different cutoff value and a different reference population.
• "Breastfed reference population to a primarily formula-fed reference population."

Apparently, many parents do not understand growth charts.  If a doctor is using the CDC growth chart instead of the WHO growth chart, who can blame them?  There was a study published in the journal Pediatrics in October 2009 titled, "Do Parents Understand Growth Charts?  A National Internet Based Survey."  "Understanding a growth chart requires the ability to understand several concepts, including trending over time, proportionality (height compared with weight), and graphical presentation. Health care providers may mistakenly assume that parents understand these concepts."  The study found "the majority of this survey's respondents were not able to comprehend growth chart data fully. The concept of percentile seemed particularly difficult for respondents to understand. Although most reported having heard of the term, many could not identify the percentile of a point shown on a growth chart, and an even larger number could not identify the definition of the term percentile."  "A significant number of respondents were mistakenly concerned about a proportionate child who is smaller (shorter and lighter) than average but growing normally, and they thought that it would be healthier for the child to be at higher percentiles. This confirms the findings of a recent study in which mothers misinterpreted percentile as indicating the percentage of children at that height or weight and thought that growth curves were more satisfactory at higher percentiles. Most respondents expressed concern if a child's growth was shown to measure in the 10th percentile for both height and weight, whereas significantly fewer showed concern about the health of a child who was in the 90th percentile for height and weight. Also, respondents showed much greater concern about a child's absolute weight, compared with a child's height or height/weight proportionality."  The study concluded, "few parents understand growth charts and the implications of the data they present."  The authors recommend, "non–growth chart-based approaches to teaching parents about their children's growth should be considered, because our results reveal that many parents clearly lack knowledge about the growth process and are uncertain about the best ways to assess a child's growth or, indeed, whether tracking a child's growth is even important. For example, our results indicate that parents typically rely on comparisons they make with other children of similar age, rather than growth charts, to judge their child's physical development, which can be deceiving when a large proportion of children in a community are overweight."

The big take home message for me, from all of this, is that if my child is proportionally growing normally (height and weight) and within the 2-98% cutoff, then it is OK.  My child may not necessarily need to be in the higher percentiles to be considered "healthy."  Also, I need to make sure my provider is using the WHO standards when evaluating my breastfed infant as opposed to the CDC references which show typical growth patterns that might not be ideal growth patterns.

Here are the links to the WHO Growth Charts:
Birth to 24 months: Boys Weight-for-length percentiles and Head circumference-for-age percentiles
Birth to 24 months: Boys Length-for-age percentiles and Weight-for-age percentiles
Birth to 24 months: Girls Weight-for-length percentiles and Head circumference-for-age percentiles
Birth to 24 months: Girls Length-for-age percentiles and Weight-for-age percentiles