Shireen:  Podcasting from Dallas, Texas, I am Shireen and this is the Yumlish podcast. Yumlish Is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type two diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.

In this episode, Dr. Beth Widen will be discussing some of the obstacles pregnant people face when they're unable to access nutritional foods and how it affects the baby during pregnancy. And after we will also be talking about the different kinds of programs that can be created to help educate pregnant people in low income communities.

Dr. Beth Widen is currently an assistant professor at the university of Texas at Austin in the department of nutritional sciences in her research. She develops and applies advanced analytic methods. And interdisciplinary approaches to improve nutrition during the first 1000 days of life, which is conception to age two in relation to short and long-term health of pregnant people and their children.

Welcome Dr. Widen.

Widen:  Thank you for having me. I'm really excited to be here.

Shireen: And a pleasure having you on. Dr. Widen, can you tell us a little bit more about your background as a nutritional and perinatal epidemiologist?

Widen:  Sure. So I am a registered dietician and I, during my dietetic internship which was now many years ago, I learned about research and I got bit by the research bug.

And so I pursued training at the National Institutes of Health, where I did a post baccalaureate fellowship in research, focused on sleep and weight management. And then I went to UNC Chapel Hill for my doctorate, where I focused on nutrition during pregnancy and infancy, among mothers who had HIV and then their babies, based in Malawi.

Then I went to Columbia University in New York City where I did a postdoctoral fellowship that was interdisciplinary in nutrition and population health. I then came to University of Texas at Austin and began my research program here. 

Shireen:  Lovely. And just based on what we were just reading about your profile, will you explain some of the obstacles that you have found in your research when it came to the nutritional needs of pregnant people and their infants during pregnancy and postpartum, in specifically in low income households. 

Widen:  So my research has focused on pregnant people and infants here in the United States, but then also globally and places like Malawi and then also in Kenya and Uganda. And so in all of these places we, we see similar parallels. So we see people facing Food insecurity, where they don't have access to food that they would like, or they don't have enough food.

We also see that there's barriers to accessing food in terms of just being able to In certain places in New York city, for example, people live very far from grocery stores where they can actually purchase fruits and vegetables. Beyond that, we also see really a lot of access to things like, for example, Packaged foods everywhere that are really, really poor and nutritional status.

We also see really easy access to foods, high and added sugar and fat like fritters or French fries. And then also things like fast food as well. So, so we have, you know, the access issue to fresh fruits and vegetables, and then we have really wide access to things that are really not very healthy. And then we have fast food really being available in many places.

And then we also beyond that, there there's just, you know, nutrition knowledge in terms of actually like knowing what is healthy, but then also how to cook food.  if, if you're trying to cook healthy food, you know, being able to cook and prepare food in a healthy manner is something that, you know, takes time and practice and,

people may not also know how to prepare food healthly. And so those are just a few of some of the many obstacles that we've faced. 

Shireen:  And just to double click on this, what would you say is the main reason it is so difficult for mothers, for pregnant people in low income households to properly balance their diet and have a healthy pregnancy.

Widen:  I definitely think the food access issue that I mentioned before is one of the main reasons. And then also, you know, the high availability of foods that are really not very healthy, but I think even beyond that, you know, there's cultural norms just here in the United States where people think that pregnancy is the time to maybe eat for two.

And we still haven't really fully gotten over that. So sometimes people think that it's time for, you know, For eating, whatever they want, for example. But I also think that there's things like food diversions and other sort of cravings that haven't really been studied very much. So some of them come along with with morning sickness or hyperemesis where some people have really strong food diversions, and then they also have strong cravings.

But that even happens in people who don't necessarily have much morning sickness where they may be craving carbs and things like that that may not be healthy. And they may not want things like vegetables or fruit or even protein rich foods, for example which some people have reported in some of our research studies.

So I think that is probably the, I think the food access, but then also being able to prepare food, I think is the main issue. For babies. If we wanna talk about babies a little bit, which I forgot to mention for Christian too. Basically there's a lot of confusion about feeding babies and the recommendations have actually changed quite drastically over the past,

say 15 or so years where basically, for example, it was recommended that you don't feed your babies egg whites because of concerns about allergy, you know, about 15 years ago. And that has since changed. And now it's recommended to feed babies whole eggs early and often. And so even just that one particular food that is really, you know, very nutritious.

Low cost food has, you know, a lot of people still have that notion from either their, their their mothers or grandmothers or other people in their family who have that knowledge. But then that's not necessarily up to date with the current recommendations for food allergy prevention. And so it's beginning to get out there more.

And so this affects everybody, not even low income, not even only just low income households, but there's a lot of just misconceptions about what's appropriate to feed [a] baby. And then once you learn what is appropriate for feeding [a] baby there's just confusion about how to do it, how to advance, how quickly to advance textures.

What is a normal varied diet for babies? And things like that. We just now, in the latest dietary guidelines from the United States actually have recommendations for feeding babies and toddlers. So that is the first time that we've actually had national recommendations for that. And so I think that is also one of the barriers where we didn't really have, you know, strong guidance to go on when for providers and practitioners in helping their families feed their babies in themselves.

Shireen:  Can you, when you're talking about the recommendations, can you give us some broad strokes ideas? You mentioned the egg example in particular. Can you give us some broad strokes ideas on what that nutritional guidance looks like for moms, for babies? In particular. 

Widen:  Sure. So, so really, you know for I'm just gonna focus on, on babies because I feel like the, the guidance for pregnancy is still pretty much, it's similar, or I can actually focus on both.

So the guidance for pregnancy is similar for, for adults as it is for pregnant people, but there's certain key nutrients that are really important during pregnancy for pregnant people. For moms and other pregnant people. So for example, you know, Eating a well balanced diet with, you know, a variety of fruits, fruits, and vegetables is what you're gonna hear me say for pregnant people and also for their babies.

And it's the same sort of story, but there's certain key nutrients that are really important to focus on during these what we call critical periods, which during this first thousand days from conception to age two. So for example, one food or nutrient that's really important to focus on is omega-3 fatty acids and really making sure that the babies haven't, babies and pregnant people have enough fatty acids in their diet to promote brain growth in the baby in utero, but then also support the pregnancy in the mom's health and then support the baby's brain growth postpartum.

So for example, one particular food where there's also misconceptions about it is fish because of concerns of mercury. And so. People often just don't eat fish very much in general that I feel like it's just one of the food groups where people, or one of the high protein foods where people just sometimes just avoid it completely, maybe cause of concerns about smell, but also just cause it doesn't smell that great.

But also, you know just because of the concerns about mercury. And so for example there there's ways to, to limit the amount of mercury. So choosing lower mercury food, fish. So for example like dairy, so choosing foods that are really avoiding fish that are really high in mercury content.

So avoiding things like swordfish, or shark, but then eating fish that are, you know, lower in mercury. So like salmon or canned tuna, or even shellfish those ones, those particular fish have lower mercury levels.  so, so for pregnant people, I think the, the overall dietary pattern is really good. But then when we come to babies, we also want to see, you know, a wide variety of foods.

So the recommendations for allergies, for example. So I just briefly touched on eggs, but now it's actually recommended to, to introduce all of these top eight allergens. So fish, shellfish, peanuts, tree nuts, a wheat, wheat, dairy, and eggs and soybeans. Those are them. Yeah. It's hard to remember all of 'em cause it's a handful.

But introducing all of those sort of foods early and often there's not really a particular regimen for how often you're supposed to be giving your baby these particular foods, but, but providing them early and regularly as part of a diet. Diet that has a lot of variety in it is really important.

So other key nutrients during pregnancy, and then also infancy include iron. So, so iron rich foods are also really important to focus on for pregnant people and then their babies. So during pregnancy, in particular your blood volume expands quite a bit. And so in order to support that the recommendations are to take iron supplements as part of prenatal vitamin.

But then also to eat a variety of iron rich foods. And so that could include foods that are sort of, high sources of heme iron, like beef, for example, or foods that are sources of non-heme iron, like spinach or kale or other dark leafy greens. For babies it's a little bit harder or there's a lot more there's more concerns where people have about giving babies, certain iron rich foods.

So. Then you know, there's baby cereals. And so there's baby cereals that are iron fortified. So there's certain ones like rice cereal has actually there's been some current concerns about it due to arsenic in the rice. And so what's recommended now is to, you know, not just give your baby only rice cereal as their cereal of choice, but offer a variety of, of iron rich fortified cereals to baby. And then also to give baby iron rich foods that are like sources of heme or non-heme iron like beef or spinach or things like that early and then often through and beans are also another really great food to feed babies early and often.

Shireen:  Great. And speaking of these nutritional guidance, can you speak to some of the social, cultural barriers you found pertaining to nutrition guidance and accessibility? 

Widen:  Sure. So thanks for that great question. So a lot of our research really has focused on trying to take what's currently recommended in the guidelines and actually make sure that what we're using for educating our families and working with them to guide them through this period of pregnancy and infancy.

A lot of the materials aren't necessarily totally culturally appropriate for foods. So they're very, you know, sort of, you know, centered around like the, the more standard U.S. Diet. That's, you know, what we see in the current dietary guidelines for Americans, where, where, you know, culturally appropriate foods are, are touched on some, but you know, they're not really featured.

Really quite broadly. And so I think that there just might be some confusion about what's actually appropriate in terms of like culturally normative foods for different cultures, for example. Other sort of barriers that we've seen, like for example, you know, the recommendations suggest not giving salt to food, to babies when they're young up to a year, but that might not mesh with certain Latinx cultures where, where it's actually like common and, and like part of practice to actually give babies a little bit of salt in their meals. So, so there's, there's the guidelines not actually being tailored or, or really accessible to like mesh up with culturally appropriate foods. But then also there's things that are just like in practice one thing, but then recommendation is completely the opposite and like how to reconcile that is really sometimes unclear. And I feel like providers aren't really trained in how to do that. 

Shireen:  And so that would be more of a cultural competence piece in understanding some of those things that are more…

Widen:  So I think the cultural competency, but then also just like having the guidelines actually being like accessible to be tailored.

Like it just doesn't it, like, I just feel like there's a gap between, and you know, another part that comes into play here. And I think I meant I I think I've talked about this before with several of my colleagues is that we have these methods to measure diet in our research programs and these methods that we use for measuring diet aren't necessarily able to capture the nuance of certain foods in certain cultures.

And so, for example, Like we, we we have a research project where we're, where we're working with with lower income, Latinx families here in the Austin area and their babies. And we're measuring the diet of these babies. But some of the foods that the babies are eating, like certain empanadas or other sort of stews or soups, just like aren't in our system.

And so we can't actually truly measure what they're giving their babies because we don't really, we can like put in the ingredients, but it's still not truly capturing, like what's actually this like very common culturally appropriate food. If that makes sense. So there's research barriers too, in terms of,

having the methods to assess the diet in these families in order to actually make guidelines and recommendations too. So there's a gap there as well. 

Shireen:  It, it sounds like these tools aren't set up to incorporate some of those nuances as this stands correctly. Interesting. Mm-hmm . During pregnancy, some pregnant people suffer from morning sickness and you mentioned the fish earlier.

And because of this, they're unable to get the nutrition their bodies need for the baby. What healthy alternatives would you recommend and would supplements be a better alternative? 

Widen:  Thanks for this great question. So morning sickness really, you know, affects people in many, you know, different ways. So some people just have morning sickness in the morning and then others, you know, have it,  continuously around the clock, around the clock, which is quite terrible.

And so there's, there's several different ways to you know, ensure that mom is able to support her own nutrition in health, and then also support the baby with morning sickness. And so really there's different strategies to take. And so basically healthcare providers sometimes recommend certain types of supplements.

And so there's vitamin B six in ginger and then there's some some over the counter options, like unison, for example. But other things to do in addition to that are, you know, having… having small frequent meals. So basically like having crackers next to your bed. And and basically before you get up, like eating a cracker, like a Saltine or another type, very plain bland cracker, which is like, contributed to what, like we think of as dietary recommendation, cuz it was not like a complex carbohydrate with whole grains.

So like having crackers or something like that, right before you get up just to kind of help quell the nausea before you get outta bed sometimes.  also things like mint, mint tea, or other more ginger tea or things like that. Those are also sort of other ways to approach it. I think one of the key things with, with morning sickness is to, you know, Make sure that, that you are eating and like just choose foods that are appealing for you.

That may be easy to digest. So like things that are really bland, like bananas or apple sauce or toast. And then sometimes people like salty foods, like crackers, or even like plain tortilla chips. I really think the snacking and getting outta bed before or eating something before getting outta bed really helps

quite A lot of people and then eating really continuously throughout the day. So your stomach doesn't get too full, but then. You're also your stomach doesn't get empty, cuz that might actually make the nausea worse and then paying attention to triggers, certain prenatal vitamins also can trigger nausea or vomiting.

So like some people just can't handle the huge horse pills. And so there might be ways to, you know, have a gummy sort of vitamin that has most of the nutrients that you need. And then like a smaller additional vitamin like a slow release iron tablet that you take along with the gummy. Some people have found that to be helpful too, and that's sometimes what I've recommended to, to clients.

And then if you're having major, if, if someone is having morning sickness and it's really perpetual, and they're not able to keep anything down, then make sure that you talk to your healthcare provider. Because there, there may be other drugs in, in, in remedies that, that are accessible. To them, to you after talking to your provider.

Shireen:  Got it. And what kind of health programs can be created to help educate pregnant people about nutritional practices during pregnancy and infancy? 

Widen:  So I really think that that effective health programs are really important for supporting pregnant people, pregnant moms, and then their infants on nutrition during pregnancy.

And then also postpartum for both, for both. The pregnant person and then also their baby. And so some types of programs that I think are really great are. These groups called centering groups where you bring a group of pregnant people together who go to a certain healthcare practice and the OBGYN or the pediatrician, depending on if it's for mom or for baby, you know, has a lesson for that group.

And so it's pregnant people at the same gestational age or pregnant postpartum parents with babies of the same age, you bring the group together and you talk about an issue. And then everyone has their, like a quick little visit at the end of that program. And so you're able to talk about the issue, but then you can also talk as a group and support each other as well.

So I really like these centering groups, other types of programs that I think might be really beneficial in the future, particularly for people who have high risk pregnancies or pregnancies affected with conditions where you actually have really. Challenging dietary rec regimens like following the gestational diabetes recommendations.

For example, I think having either remote or even like an app based program where the patient can actually enter in some information and then it can be coupled with their lab values and then that can be used to guide the patient provider conversation. So I think that might be something that we might be seeing in the future to support pregnant people and their babies.

Shireen:  That is very helpful, Dr. Widen. With that we are toward the end of the episode at this point. Can you tell our listeners how they can connect with you? And then just learn more about your work? 

Widen:  Well, thank you so much for having me today. So I am on Twitter. My Twitter handle is @BethWiden. And then also folks can reach out to me through my university website.

My lab has a website as well, where we talk about our research.  and we also have a Facebook group where we post our latest papers and things like that too. And so so feel free to visit us there, like our facebook group, Facebook groups. And we look forward to connecting with you all. It's called widen lab, but it has a really long profile now.

Okay. Okay. So I think, yeah.

Shireen:  Okay. And what, and so what we can do is we can share the website. We can share the Facebook link for the group as well. We'll just put it in the show notes so that folks can access to it.

Widen:  Yeah, that sounds great. Yeah. I don't know why there's not like a name at the end of it.

It just has like a long ID number. 

Shireen:  All good. All good. Okay. Well, perfect. Well, thank you so much, Dr. Widen, and I really, really appreciate your time to work. Of course, for our listeners. Here's a quick question for you head over to her social media on Facebook, on Instagram to answer this quick question, let us know.

What are some of your healthy habits that you've adopted during your pregnancy or when you were pregnant? What are some of those healthy habits that you adopted? Let's get that conversation going on facebook on Instagram, find us at Yumlish and at yumlish_ specifically for Instagram. We'll see you there. Again, Dr. Widen, and thank you so very much for your time.

Widen:  Of course. Thanks for having me.

Shireen: Thank you for listening to the Yumlish Podcast. Make sure to follow us on social media @Yumlish_ on Instagram and Twitter and @Yumlish on Facebook and LinkedIn. For tips about managing your diabetes and other chronic conditions and to chat and connect with us about your journey and perspectives. You can also visit our website Yumlish.com for more recipes advice and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week's show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we'll see you next time. Remember your health always comes first. Stay well.

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