​Planning and Preparing for My Second Pregnancy
As a commercial fisherman’s wife whose husband is gone April through September, I have to plan my pregnancies. There really is only a very short window of time to conceive. Once we finally decided that we did indeed want a second child, we opened up January, February, and March 2022 as potential conception months. If we didn't get pregnant during that three month window we decided we would only have one child. But alas, luck was on our side and we got pregnant in February, honestly the perfect month. That gave us a due date of November 13th, neither too close to Dane’s homecoming in October nor right in the midst of the holidays. A November baby would allow us to have plenty of time together as a new family of four before my husband would have to leave again. 
 
My pregnancy spacing of three years was very intentional. I wanted to fully recover my nutrient stores after a 22 month breastfeeding journey with my first kiddo and regain full strength in my pelvic floor. Plus, I thought having a more independent preschooler would hopefully make the solo parenting of two kids a tad easier?? Luckily as a dietitian I have access to tools to easily assess my nutrition status including a comprehensive micronutrient test through Vibrant America and a hair tissue mineral analysis through Trace Elements Lab. Furthermore, I check some maintenance labs 1-2x per year just to make sure everything is on point. I offer all this testing to clients of Happy Belly as well. 

​Lab Testing & Wellness Support
Prior to getting pregnant I had already been working on addressing nutrient deficiencies (zinc, K2, and coQ10, as well as other nutrients that were in suboptimal range) that I had tested a year prior via diet and supplementation. Then in January 2022 I ordered a hair tissue mineral analysis (HTMA) test to check my mineral status and my nervous system state. The results highlighted that I was low in my macrominerals magnesium, calcium, potassium, and sodium, and that I needed to really focus on managing my stress. Based on the results I started back up on my magnesium supplement and became very intentional about my dietary calcium, sodium, and potassium sources to ensure I met my needs. Both of these tests are great tools to complete at any time in your preconception journey. 
 
At the beginning of my first trimester I also ordered my own personal blood labs including full thyroid and iron panels, CBC, CMP, vitamin A, vitamin D, vitamin B12, folate, RBC magnesium, copper, ceruloplasmin, and zinc. The results highlighted suboptimal vitamin A, magnesium, and zinc levels. With the above blood lab results along with my HTMA results I was able to implement my own unique food and supplement routine. 
 
Along with addressing my nutrient status and stress levels, I went to see Dr. JoAnne at Rooted in Wellness Chiropractic. She uses more tonal chiropractic techniques along with diagnostic tools to test your sites of muscle tension and your current nervous system state. With her adjustments and my individualized nutrition support I was able to recalibrate my nervous system to be the best she has seen. I continued to see her throughout my entire pregnancy to support my alignment and overall wellness. I highly recommend that anyone local to Bellingham reach out to her as well!

​Pregnancy Journey
Otherwise, my second pregnancy was very similar to my first. No complications and no real complaints. I also gained similar amounts of weight with each, about 25-30lbs. During my first trimester I did experience some mild nausea and fatigue during weeks 6-8, but that cleared up pretty quick. Eating balanced meals, with a big focus on protein rich foods, really helped keep my blood sugars stable and my nausea and fatigue within control. I also had some mild constipation, but I knew how to keep things moving. In addition to a whole foods diet rich in fiber, I focused on drinking plenty of coconut water and enjoyed a variety of papaya, kiwi, chia seeds, and Nancy’s Probiotic yogurt daily. 
 
The second trimester went by really fast, it was summer after all. I intentionally reduced my client load, and tried to find more “quiet solo time” usually as a nature walk. Throughout my entire pregnancy I made sure to walk every day if possible. My daily goal was 3 miles. Sometimes it was more, sometimes it was less. And sometimes, I didn't get any “real” movement in, and that was okay too. I tried to give myself grace when it didn't work out like I intended. Honestly, pregnancy and postpartum are the most important times in your life to try and chill out. The harder you work, and the more you add to your list, the more you dig yourself a hole. So please, don't try to do it all. If you can take things off your list, reduce your exercise intensity if you are used to pushing yourself hard, and find some time to just relax. During my mid second trimester I also repeated my blood labs and completed another HTMA test to see what dietary and supplement adjustments I might need to make. Magnesium levels dropped a little bit (not surprisingly because pregnancy increased magnesium demand so much), so I increased my magnesium supplements again from 240mg to 360mg and took them every day religiously before bed. 
 
The third trimester was smooth sailing as well. I tested negative for gestational diabetes and Group B Strep. Woohoo! However, based on current classifications of anemia during pregnancy (hemoglobin <11g/dL), my labs at 27 weeks indicated “slight anemia” at 10.9g/dL. Currently there is much debate in the medical field around classifying anemia with a cut off of <11g/dL or <10.5g/dL. Many argue that 10.5g/dL should be the true cutoff point due to the natural hemodilution that happens in the late second trimester and early third trimester. Therefore, I declined the three IV iron infusions that were suggested by my nurse midwife and instead continued to focus on eating 2-3oz of liver per week and eating grass-fed red meat almost daily. I only supplemented with a small dose of easy to digest iron bisglycinate (28mg) occasionally when I did not eat liver or red meat, which was about 2x per week because my prenatal did not contain any iron (which is intentional). I am very cautious with iron supplementation as there are both benefits and risks to assess and personally don't agree with blindly supplementing high dose iron or IV iron infusions unless there is a true need. Generally speaking “mild” cases of anemia (hemoglobin of 10 - 10.9g/dL per WHO) respond beautifully to dietary interventions and do not need high dose iron replacement or iron infusions. Normally over the course of the third trimester hemoglobin levels rise naturally from their lowest levels around 24-30 weeks of pregnancy. So if hemoglobin levels were fine all throughout your first and second trimesters, and then dip, know that they will start increasing again at 33 weeks. If you start your pregnancy with a hemoglobin of <12g/dL you may need earlier interventions (food first, then supplementation) to avoid more moderate or severe anemias later on in pregnancy. As you can see, iron metabolism during pregnancy is much more complicated than just replacing iron. Along with normal hemodilution during the third trimester, there are other nutrients of concern, including vitamin A and copper which play an essential role in iron metabolism that unfortunately are never tested for or mentioned in the traditional health care model. Furthermore, in addition to checking vitamin A and copper, testing a full iron panel along with ferritin instead of just hemoglobin is ideal to assess true iron need. So please, work with a skilled dietitian to help guide you throughout your unique journey. And just to note, with my food focused interventions and the natural increase in hemoglobin concentration my hemoglobin levels were at 13g/dL at the time of delivery. No IV infusions needed and no harsh ferrous sulfate supplements. Yay for self-advocacy!

Birth
Since I was considered a “geriatric pregnancy” this time around, I did have more ultrasounds and weekly non-stress tests during the last four weeks of my pregnancy. Luckily the results all came back great and I was able to push back the suggested 39 week induction to the middle of my 40th week. I hoped I wouldn't need it. I hoped that the baby would come before 40 weeks just like my son Toren. But alas, my journey this time around was not the same. At 40 weeks and 4 days, I was admitted to Peace Health Child Birth Center to start my induction process. After a week of processing high and low emotions, and the wonderful support and guidance of a dear friend, I arrived at the Child Birth Center feeling very grounded, empowered, and ready. Ready to have an amazing labor. I left fear behind me, and entered with such presence. I had an amazing team ready to help me have the best experience - my nurse midwife, two awesome Labor & Delivery nurses, and of course my amazing husband. Since I was only 2cm dilated my induction process started with Cervidil – a cervix ripening prostaglandin that is inserted vaginally. My midwife said, “We will wait 4 hours, and then check how far you are at that point. If you are 3cm or more, then we can start Pitocin”. With four hours of waiting time, my nurse helped me through a Miles Circuit (to help get baby in the best position) and she massaged my hips to help release and relax my ligaments. I also got to enjoy a steaming hot bowl of delicious Pho and a side of diced papaya and lime that my husband brought me for lunch. 
 
And then it was go time. At 1pm my midwife checked me again and said, “You're at 3 cm, we can start Pitocin or do another round of Cervidil”. I asked the nurse what dose is usually required to help kickstart labor for women and she said that it ranges between 8ml/min to 20ml/min. I opted for Pitocin, and jokingly said “Hopefully I will only need a little Pitocin Kiss to get going”. With Pitocin they generally start at 2ml/min and increase by 2ml every 30 minutes until contractions start to get intense. With the first 2ml, I noticed gentle contractions. By 4ml/min I had to do some breathing through them, and by 6ml/min I was groaning through my contractions and moaning my mantras “Opening”, “Releasing”, and “Sensation”. When the nurse came in to check in on me at 4:30pm my water broke. It felt like a water balloon had popped inside me. Then things got really intense fast. They started to titrate the Pitocin back down again, and eventually weaned me off. So indeed all I needed was a little “Pitocin Kiss” to get my body to do its own thing. At 5pm they checked me and I was at 5cm. With the support of my amazing husband I continued to labor another hour with my mantras and deep groans and relaxed in between contractions with deep breathing, cold wash cloths, and the loving touch of my husband. At 6pm I hit transition, the intense contractions that leave you shaken to your core. I was checked again and I was at 9.5cm. “You’re ready to start pushing!” said my midwife. And so I did, surrounded by my amazing support team. 
 
After 20 minutes, my husband caught our 8lb 2oz baby and announced that it was a girl – the most amazing blessing I could have ever asked for! My little golden girl Aspen finally made her debut. She immediately came to my chest, latched to my breast right away, and the cord clamping was delayed at least 5 minutes if not longer (time has no meaning so it’s hard to know exactly). I was so in love, so blissed out, and so extremely happy. I did it! I was 200% there mentally, emotionally, and physically…and for an extra bonus I didn't even tear. Phew!
 
Although I was much more present with myself this time around, I felt much more disconnected with this pregnancy. I have talked to many mamas and most agree they felt the same. Life is much busier when you have another kiddo in tow while you are working and pregnant. It’s also not your first rodeo. The “new” excitement isn’t there. You have been there done that already. I also struggled with an intense worry that I wouldn't be able to love my second child as much as I loved my first. But trust me….this is NOT something you need to lose brain cells on. Aspen has shown me that your heart can grow twice as big to allow for so much more love than you could have ever imagined. And now as a family of four we navigate the change of pace and adjust to the ebbs and flows of this wonderful journey. 

​Potassium is a macromineral that plays a big role in supporting optimal GI function. Unfortunately, 98% of Americans are not getting adequate amounts of potassium in their diet due to inadequate fruit and vegetable intake. Fad diets that remove fruit and starchy veggies like potatoes and squash, as well as avoid quality dairy, increase the risk of inadequate potassium intake. Furthermore, individuals may lose potassium due to potassium wasting medications (like diuretics), high coffee or alcohol intake (also diuretics), excessive sweating from high intensity exercise or sauna, and high levels of stress (hello COVID years!). 

Why is it important to focus on potassium intake?? There are many reasons why focusing on potassium intake can benefit your health. But today I want to focus on two directly related to gut function.

1. Firstly it helps produce stomach acid. Potassium plays an essential role in gastric acid secretion from the parietal cells via the Hydrogen-Potassium ATPase pump. Inadequate stomach acid production is one of the first root causes to unconformable symptoms such as bloating because it is helps break down our food for easier digestion in the small intestine, it helps signal the release of bile for fat absorption and pancreatic enzyme release for further breakdown of food. Without adequate stomach acid, the entire digestive system, falls apart. PMID:31670611
2. Secondly, potassium helps stimulate muscle contractions throughout the GI tract. Potassium channels are located throughout the GI tract which signal smooth muscles to contract and relax. Inadequate potassium can therefore contribute to alterations in colonic motility and lead to constipation. PMID: 33326312

​For healthy individuals aim for 3500mg or more of potassium per day. If you are unsure how much potassium you are getting daily, I highly recommend tracking your food intake for three days on Cronometer. Get an average, and see how close you are to getting 3500mg per day, then make some dietary changes or tweaks to boost that level. Some potassium rich foods are listed below. You can also check out this awesome source listing out the top 100 potassium rich foods. 

1. Firstly focus on eating more fruit and cooked vegetables. Big hitters include cooked dark leafy greens, steamed or baked potatoes, avocados, bananas, melon, and dried fruit. 
2. Enjoy quality grass-fed dairy (fermented dairy and milk) as tolerated.
3. Enjoy cooked white fish like halibut, rockfish, and cod 2-3x per week. 
4. Drink coconut water.
5. Add a splash of organic inner leaf aloe vera juice to beverages. 
6. Try Bumbleroot Hydration powders for a big boost of potassium. 

​If you are a SIBO or IBS patient and are on a limited diet consider adding in the following low FODMAP, high potassium foods. 

1. Fruit: 1 medium banana, 1 cup cantaloupe, 2x kiwi, 1x orange, 1 cup papaya, star fruit
2. Veggies: Cooked dark leafy greens (Swiss chard, spinach), medium white potato, ½ cup tomatoes/tomato juice (I love Bionaturae or Organic Bello), ½ cup carrot juice (Lakewoord Organics), bamboo shoots, lotus root, parsley
3. Protein: Cooked halibut, cod, rockfish, lactose free yogurt (white mountain) 
4. Other: ¼ cup aloe vera juice (Lakewood Organic inner leaf with lemon juice – pink label)

 
NOTE OF CAUTION: 
If you have kidney disease or are taking potassium sparing medications (including spironolactone, amiloride, eplerenone, triamterene, etc) work with your health care provider because you may need to REDUCE your potassium intake and not increase it. 

​How many times should we poop a day or a week?? What should a healthy poop look like? This unfortunately can be kind of hard to study because most people don't really think about their poop much nor do they know what is considered normal. So when asked in a survey to describe their bowel frequency and texture, some people may not even really know how to answer these questions. Do you know?? 
 
Unfortunately, WE DON'T TALK ABOUT POOP ENOUGH. Granted, it’s not the best table talk (unless of course you’re out to dinner with a group of dietitians), but it is something we all need to be aware of and educated about.
 
A recent study in 2017 studied the US population via a survey asking these exact questions. How often do you poop each week and what does it look like (based on the Bristol stool chart). Here is what they found:
 
3% have < 3 poops per week
60% have 3-7 poops per week
30% have 8-14 poops per week
6% have 15-21 poops per week
1% have >21 poops per week
 
They also found that normal poops happen more often in men than women, in those with a higher education and income, in those requiring less medications (<2 per day), and in those who eat more fiber (>20g per day). 
 
Based on the above results, researchers concluded that normal for the US population is considered at least 3 poops per week up to 3 poops per day. However, this doesn't really highlight the other considerations of what is considered a healthy bowel movement such as the texture of the poop (is it firm, sticky, loose, pebble-like), the stool weight (how big is it), or the sense of complete evacuation (do you feel empty afterwards?). 

​Another study of Coastal Indians, who eat a predominately plant based diet, found that the average stool frequency was 14 poops per week, mostly resembling an easy to pass smooth banana. They also found that vegetarians and more physically active individuals tended to pass stool more frequently. Average stool weight in Asia is also much higher than that of a Western populations, with an average of 311g per 24 hours. Stool weight in many Western populations is low (80-120g per day) which is associated with an increased risk of colon cancer. Stool weights of 150g per day can help reduce this risk. 
 
So what is considered optimal?? Clinically, I do not agree with 3x per week! The Western population as a whole is not eating enough fiber. If you look at other higher fiber eating populations, they average 2 poops per day, with an average poop weight of 150g. This translates to TWO LARGE, firm but not hard, easy to pass, bowel movements per day. I also see this in my clients. When they are pooping 2x per day, they feel good, they look good, and they are happier. 
 
So just because you are pooping every day, it does not mean your poop is considered optimal. If you are concerned about your pooping habits, work with a gut health dietitian (like me!)

In healthy individuals after eating a mixed meal, it usually takes about 4-5 hours for that meal to completely empty the stomach and 5-6 hours for that meal to empty the small intestine. This all can vary depending on what you eat and how well your gut muscles are working. 
 
Eventually, the remaining unabsorbed food matter (like fiber) and water, move through the ileocecal valve, the doorway from the small intestine to the large intestine. As the unabsorbed matter passes through the ileocecal valve, the large intestine  monitors how much undigested material there is. If there are increasing amounts of undigested food, especially fats, it signals to the small intestine to S L O W  D O W N.  This is called the ileal break and is necessary to help maximize our absorption of nutrients. This mechanism also reduces our appetite. This is why when individuals struggle with diarrhea, they often do not have much appetite. 
 
Once the unabsorbed liquid food matter passes through into the large intestine a few things happen:

• Water, sodium, and chloride are absorbed to create a dehydrated mass including sloughed off dead gut cells, fiber, waste (hormones, chemicals, toxins), bile salts, bacteria, and small amounts of unabsorbed nutrients and food. Normal stool is about 75% water and 25% solids.
• Most of our gut bacteria reside in the large intestine and ferment undigested food especially fiber. I call this our FERMENTATION STATION. However, undigested protein and fats also act as fuel for gut microbes (this generally leads to a more dysbiotic profile). 
• When bacteria ferment fiber, they produce short chain fatty acids and vitamins such as biotin and vitamin K2. 
• The dehydrated mass of waste is then compacted in the rectum, along with bilirubin from broken down red blood cells (which makes poop brown), and is released through the anus, as POOP!

​On average in healthy folks it takes about 30-40 hours for the mass to travel the entire 1.5 meters of the large intestine, going up along your right side (called the ascending colon), across your upper abdomen (called the transverse colon) and back down your left side (called the descending colon). In individuals struggling with idiopathic constipation, their colonic transit time can be greater than 100 hours! When colonic transit time is slowed and stool is stagnant in the colon, it allows chemicals, toxins, and hormones originally bound for elimination, to be reabsorbed into circulation. This can increase your risk of hormonal imbalance and impaired detoxification due to increased stress on the liver and kidneys. Also, slowed transit time can contribute to diverticulosis and colon cancer, as well as the overgrowth of bacteria and fungus in both the small and large intestines. Furthermore, slowed motility usually presents along with hard to pass stools and straining, leading to uncomfortable hemorrhoids. 
 
The total amount of time for a meal to be digested and absorbed and the remainder excreted as a bowel movement is called your gastrointestinal transit time (GTT). If your transit time is <12 hours you are likely struggling with nutrient malabsorption, if your transit time is >48 hours then you are likely struggling with constipation. If it takes more than 72 hours for food to travel from mouth to toilet, there is significant backup. I find that around 24 hours is usually the sweet spot for most—what you ate yesterday, leaves you today!
 
Are you curious what your stool transit time is? Generally, if you eat a higher fiber diet, stool transit time should be faster than if you eat a low fiber diet. However, if you eat a high fiber diet and still struggle with constipation something else is going on. This is the perfect time to work with a gut health dietitian for guidance. 

TESTING YOUR STOOL TRANSIT TIME
Although not the gold standard, testing stool transit time at home can give you a rough estimate on your personal window. Sesame seeds remain undigested and pass through the gut intact. White hulled sesame seeds are more easily seen than dark sesame seeds. Alternatively, eat a steamed red beet.
 
THE SESAME SEED (or red beet) CHALLENGE

1. Mix  ~2 tablespoons of white sesame seeds into a glass of room temperature water or eat a steamed medium red beet.
2. Drink it up and write down the date and time in the chart below. Then wait and monitor every stool until you see the white sesame seeds or colored red stool. 
3. Write down the date and time and calculate the difference in hours. This is your personal stool transit time. 
4. Continue to monitor your stools until all the sesame seeds or red stool has been evacuated. Make note of last bowel movement with sesame seeds or red color. 

You WANT a stomach NINJA, not a stomach COUCH POTATO.  
 
Once food is swallowed as a bolus, it enters the stomach and stretches the stomach lining, activating stretch receptors and stimulating the parietal cells to make more stomach acid. In fact, the gastric phase is responsible for 60% of stomach acid production whereas the cephalic phase is responsible for about 30%. Continuous activation of the enteric nervous system (which can be influenced by the parasympathetic and sympathetic nervous systems) also stimulates the release of gastrin causing an increase in strong and vigorous muscle contractions, and pepsinogen from chief cells. Pepsinogen, in the presence of adequate amounts of stomach acid, is then activated to pepsin, a protein digesting enzyme.
 
As your stomach churns your food and mixes it with stomach acid and digestive juices, it also starts the process of B12 digestion and absorption. Stomach acid separates B12 from animal proteins so that B12 can bind to another protein called intrinsic factor which is only produced in the stomach. This process is essential in order to absorb B12 from our food. Plus, it can also kill potentially harmful bacteria, viruses, and parasites, coming in through your food. So now your stomach is not just a powerful blender…it is a mean blender NINJA. 
 
After foods have been properly broken down, the stomach gradually releases the stomach contents (now called chyme) into the upper small intestine. However, if you have a higher fat or higher fiber meal, stomach emptying is slowed, and can contribute to longer feelings of fullness, than if you had a low fat processed meal, like cereal. 
 
Common symptoms of low stomach acid:

• Bloated after meals
• Belching/burping
• Protein rich meals "feel heavy"
• Excessive fullness after meals
• “Deja Vous” poos (you see food that you ate like greens, carrots, grains, etc)
• Brightly colored stools (acid breaks down color pigments)
• Constipation/diarrhea
• Acid Reflux and heartburn
• Brittle nails/hair
• Food sensitivities
• Chronic nutrient deficiencies (especially B12 and iron)
• Excessive gas

I see many of the aforementioned symptoms in my practice all the time. There are many reason why someone might have low stomach acid, and sometimes there is more than one variable involved. Below I have highlighted those that I see most often. 

1. Stress directly inhibits the parasympathetic nervous system ("rest and digest) and negatively impacts the enteric nervous system, leading to reduced digestive functioning, including stomach acid production and gastric motility. 
2. Low stomach acid production is common is those with advanced age (>65), mostly related to a chronic atrophic gastritis from a current or previous H. Pylori infection. Pepsin production also declines by 40%.
3. About 50% of people world-wide have an H. Pylori infection which reduces stomach acid production and can lead to gastritis and ulcers. 
4. Antacids (TUMS, Prilosec, and Pepcid) impact stomach acid production. TUMs directly neutralize stomach acid via calcium carbonate while Prilosec and Pepcid work at the cellular level, directly inhibiting stomach acid production in the first place. A single 20mg dose of omeprazole can reduce stomach acid by more than 90%, where as a single 5mg of Pepcid reduces stomach acid by 40%. 

 
Okay, now you likely want to know, “Do I have low stomach acid?” If you experience chronic digestive issues and any of the symptoms mentioned above, then the answer is  likely yes. Once you address your stomach acid production, then you can help improve many things downstream on the river of gut health. Therefore, it is essential to address this first!
 
How do you Test for Low Stomach Acid? 
The gold standard is a Heidelberg Stomach Acid Test and can get expensive, averaging around $350. Unfortunately, many GI doctors do not run this test, even when patients ask for it. If you want an alternative to this, then check out the simple at home test below to see if you struggle with low stomach acid.
 
Baking Soda Challenge
Although this test is not supported by any studies, it can be a simple and cheap way to check your stomach acid production. All you need is a fresh container of baking soda and water. 

1. Mix ¼ teaspoon of baking soda with ½ cup of cold water.
2. Drink this mixture on an empty stomach upon waking. 
3. Watch the clock and document how long it takes until you start burping. 
4. If you burp within the first 2-3 minutes, you likely have enough stomach acid. 
5. However, if its take 3-5 minutes, then stomach acid production is likely suboptimal. 
6. If it takes >5 minutes, then you likely have very low stomach acid levels. 
7. Repeat this test 3 times to get an average result and better sense of your normal. 

 
If your results suggest LOW stomach acid, then it’s time to figure out WHY and work with a gut expert. If you want my help and guidance, then make your discovery call today!