Nutrition Essentials for Childbearing Families

International Journal of
Childbirth Education
The official publication of the International Childbirth Education Association
VOLUME 29 NUMBER 3 JULY 2014
Eating Well in Pregnancy

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S A V E T H E D A T E

Volume 29 Number 3 July 2014 | International Journal of Childbirth Education | 3
International Journal of
Childbirth EducationVOLUME 29 NUMBER 3 JULY 2014
Indexed in the Cumulative Index to Nursing and Allied Health Literature (CINAHL)
Managing Editor
Debra Rose Wilson
PhD MSN RN IBCLC AHN-BC CHT
Associate Editor
Amber Roman, BS ICCE CD
Assistant to the Editor
Dana M. Dillard, MS
Brooke D. Stacey, RN MSN
Caitlin Rose Orman, BS
Michelle Finch, MSN RN
Book Review Editor
William A. Wilson, MBA(c)
Peer Reviewers
Marlis Bruyere, DHA M Ed BA B Ed
Debbie Sullivan, PhD MSN RN CNE
Joy Magness, PhD APRN-BC Perinatal Nurse-BC
Maria A. Revell, DSN RN COI
Karen S. Ward, PhD RN COI
Terriann Shell, IBCLC ICCE FILCA
Pat Carmoney, PhD
Brandi Lindsey, RN MSN CPNP
Dana Dillard, MS
Kathy Zimmerman, MSN FNP-BC AHN-BC
Amy Sickle, PhD
Gloria Hamilton, PhD
Kathleen M. Rasmussen, ScD RD
Heather Dillard, EdD
Michelle Finch, MSN RN
Nancy Lantz, RN BSN ICCE ICD
Ann Fuller, MSN-Ed RN CRT HSM-I CHt
Lorna Kendrick, PhD PMHCNS-BC
Deborah Weatherspoon, PhD MSN RN CRNA COI
Grace W. Moodt, DNP MSN RN
Cover Photography
Tiffany Panas, Call it Love Photography
www.callitlovephotography.com
Graphic Designer
Laura Comer
Articles herein express the opinion of the author.
ICEA welcomes manuscripts, artwork, and photographs,
which will be returned upon request when accompanied
by a self-addressed, stamped envelope. Copy deadlines are
February 15, May 15, August 15, and October 15. Articles,
correspondence, and letters to the editor should be ad-
dressed to the Managing Editor. editor@icea.org
The International Journal of Childbirth Educa-
tion (ISSN:0887-8625) includes columns, announce-
ments, and peer-reviewed articles. This journal is
published quarterly and is the official publication
of the International Childbirth Education Associa-
tion (ICEA), Inc. The digital copy of the journal (pdf)
is provided to ICEA members. http://icea.org/con-
tent/guide-authors provides more detail for potential
authors.
Advertising information (classified, display, or calen-
dar) is available at www.icea.org. Advertising is subject to
review. Acceptance of an advertisement does not imply
ICEA endorsement of the product or the views expressed.
The International Childbirth Education Association,
founded in 1960, unites individuals and groups who sup-
port family-centered maternity care (FCMC) and believe
in freedom to make decisions based on knowledge of
alternatives in family-centered maternity and newborn
care. ICEA is a nonprofit, primarily volunteer organization
that has no ties to the health care delivery system. ICEA
memberships fees are $95 for individual members (IM).
Information available at www.icea.org, or write ICEA,
1500 Sunday Drive, Suite 102, Raleigh, NC 27607 USA.
© 2014 by ICEA, Inc. Articles may be reprinted only
with written permission of ICEA.
The official publication of the
International Childbirth Education Association
Columns
The Editor’s Perspective – Nutrition
by Debra Rose Wilson, PhD MSN RN IBCLC AHN-BC CHT..................................................4
Across the President’s Desk – Pregnancy: Establish a Healthy Eating Plan
by Nancy Lantz, RN BSN ICCE ICD...................................................................................... 5
From the Executive Director – Call for Nominations
by Ryan T. Couch, ICEA Executive Director............................................................................7
Guest Editorial – Helping Women to Conceive at a Healthy Weight
by Kathleen M. Rasmussen, ScD RD.................................................................................... 10
Guest Editorial – You Are What You Eat
by Nancy Quigley, MSN NP-C MEd AHN-BC HWNC-BC................................................... 12
Guest Editorial – The Big O: Oxytocin and the Command to “Eat Right”
by Dana Marie Dillard, MS HSMI........................................................................................13
Features
Mindful Eating and Pregnancy
by Lee Stadtlander, PhD ..................................................................................................... 16
GMOs: What Are They?
by Abbie Goldbas, MSEd JD................................................................................................20
Nutrition and Pregnancy: Folate and Folic Acid
by Gisèle A. Tennant, PhD AFLCA CSEP-CEP...................................................................... 25
Pica and Pregnancy: A Global View
by Pat Carmoney, PhD........................................................................................................29
Raising Nutritional Awareness During Pregnancy
by Yudy Kushkituah, MS..................................................................................................... 33
From Womb to World: Folic Acid and Iron Benefits and Future Health Implications
by Valeria Balogh, BFA IHC PYT......................................................................................... 38
Autism Alert! Vitamin D is a Possible Remedy
by Abbie Goldbas, MSEd JD................................................................................................42
Iodine Deficiency in Pregnancy: A Global Problem
by Maria Dutta, BS and Janet Colson, PhD RD...................................................................44
Calcium and the Developing Mother: Guidance for a Healthy Child and a Healthy Self
by David Andrew Ezzell and Christopher Castelow...............................................................50
Developing and Promoting Language and Literacy Skills of Young Children
by Lesley Craig-Unkefer, EdD...............................................................................................54
Theory Usage and Application Paper: Maternal Role Attainment
by Jerried Noseff, BS BSN DC RN........................................................................................ 58
Sleep Deprivation & Pregnancy Related Risks
by Christina Lorea Dixon, BSC MPsy...................................................................................62
The Birth Experience: Learning through Clinical Simulation
by Teresa D. Ferguson, DNP RN CNE, Teresa L. Howell, DNP RN CNE,
and Lynn C. Parsons, PhD RN NEA-BC...............................................................................66
Munchausen Syndrome by Proxy and the Implications for Childbirth Educators
by Jessica Gilbert, BSN RN.................................................................................................. 73
Exploring the Impact of Stress on Pregnancy Loss
by Marie Peoples, PhD, Anika Thrower, PhD, and Hadi Danawi, PhD................................80
Book Reviews
Nutrition in Pregnancy and Childbirth: Food for Thought
reviewed by Dana M. Dillard, MS HSMI.............................................................................84
Nutrition Guide for Mums: Healthy Eating Tips for You and Your Children
reviewed by Janet Colson, PhD RD...................................................................................... 85
Natural Solutions for Food Allergies and Food Intolerances
reviewed by Kathy Zimmerman, MSN APN FNP-BC AHN-BC CCH ..................................86
The Ancestors Diet: Living and Cultured Foods to Extend Life
reviewed by Anika C. Thrower, PhD MPH CLC....................................................................87
How to Teach Your Baby to Read
reviewed by Heather K. Dillard, EdD...................................................................................88
Poverty and Health: A Crisis among America’s Most Vulnerable
reviewed by Richard C. Meeks, DNP RN COI......................................................................89

4 | International Journal of Childbirth Education | Volume 29 Number 3 July 2014
The Editor’s Perspective
Debra Rose Wilson
Nutrition
by Debra Rose Wilson, PhD MSN RN IBCLC AHN-BC CHT
Self care is a fundamental tenet of being a holistic
practitioner, but each of us struggles with changing habits
in our personal lives. Optimum functioning is only pos-
sible when required nutrients are consistently available
to the body. Unfortunately, even when nutrient rich
whole foods are easily available, we tend to choose the
high sugar, salt, fat combinations at the expense of much
needed nutrients.
As we consider educating the childbearing family
globally, evidence is showing that educating the entire
family is most effective. Learning to adapt traditional
cooking to healthier ingredients first requires an under-
standing of why we need to change our habits. Parent
education will be key to changing the family’s eating
patterns, but perhaps nutrition should be mandatory
education for school-age children.
Eating whole foods is a clear message in this issue.
Whole foods are unprocessed, straight from nature.
Processed foods are missing original parts, and have
sweeteners and oils added or removed. We are really
only beginning to understand the role of micronutrients
in foods and we might be removing essential parts for
health. A perfect example of whole vs. processed foods is
brown rice vs. white rice. White rice is polished, remov-
ing fiber, some
iron, zinc,
magnesium,
and probably
nutrients we
are yet to dis-
cover from the
more natural
brown rice.
Another major
benefit of eating whole grains is their action in slowing
digestion and allowing better absorption of the nutrients.
Fiber content slows the conversion of starches into glu-
cose, maintaining a more stable blood sugar.
Free radicals are the result of normal cell oxidative
processes, in which highly unstable molecules, rogue elec-
trons, have come apart from their atoms. These radicals
are toxic, bounce into healthy
cells, cause damage, and are one of
the main theories behind biologi-
cal aging. Free radicals exposure
also can be caused by environmen-
tal sources such as air pollution,
smoke, and sunlight. Oxidative
stress is known to play a role in
health and specifically disease
processes such as cancer, Alzheimer’s, Parkinson’s, cata-
racts, and diabetes. Some foods and supplements high in
antioxidants are effective in attracting these free radicals,
binding to them, reducing the damage they can do. There
is danger in taking high doses of anti-oxidant supplement,
but natural safe sources include foods high in vitamins C
and E, selenium, and carotenoids, such as beta-carotene,
lycopene, lutein, and zeaxanthin. Vegetables and fruits are
high in natural anti-oxidants. To date there has been no
research done on uncle-oxidants.
Buy local foods. The movement toward consuming
locally grown foods (“locavore” movement), is driven
by several factors. Local food is fresher and therefore
more nutritious and tasty. Doing business with a local
farm circulates money through the local economy. There
is less transportation required, and therefore a lower
carbon footprint. Food imported into the area is older
and has lost the nutrients of fresher food. Buying local
demonstrates good stewardship, adopting practices that
contribute to the general health of the local community.
Let’s all head to the local famer’s market several times this
summer.
A special thanks to our guest editors and article
authors who rose up to disseminate important informa-
tion to those of us in the forefront of educating families
about healthy choices. As always, I am in debt to our peer
reviewers, assistants to the editor, ICEA staff, and ICEA
leadership for their work on this issue. Happy reading.
Peace,
Debra
editor@icea.org

Across the President’s Desk
Nancy Lantz
continued on next page
Pregnancy: Establish
a Healthy Eating Plan
by Nancy Lantz, RN BSN ICCE ICD
In every childbirth class that I teach, we initially discuss
nutrition and activity during pregnancy. In a ten-question
survey, two questions highlight this issue and the conversa-
tion begins. The first question states, “How do you rate your
diet?” The choices are excellent, good, fair, and poor. The
second question states, “Do you exercise regularly?” If the
answer is yes regarding exercise then the parent states type of
activity and how often.
During pregnancy, a healthy eating plan begins by
knowing the mothers current dietary habits, medical status,
and gestational condition. Resources for healthy eating dur-
ing pregnancy are MyPlate, March of Dimes, and the Ameri-
can College of Obstetricians and Gynecologists (ACOG).
Working with health care providers and a dietitian is a great
beginning for mothers to move forward with a healthy eating
plan.
Dietary recommendations for 2014 are much differ-
ent than 40 years ago and even 5 years ago. The food guide
pyramid which described correct foods and amounts was
established by the United States Department of Agriculture
(USDA). In 2005, the pyramid was renamed ‘MyPyramid.’
In 2011, ‘MyPyramid’ was renamed ‘MyPlate.’ Dietary
guidelines for America are a combined effort by two United
States government agencies – the United States Department
of Agriculture (USDA), and the Department of Health and
Human Services (DHHS).
These guidelines are updated every 5 years. The next
update will be in 2015. The guidelines provide authoritative
information regarding food choices, being physically active,
maintaining healthy weight, and promoting overall health.
Information on current dietary updates can be e-mailed spe-
cific to your needs. This is a valuable source to stay current
with information to share with expectant parents.
‘MyPlate’ teaches and reminds adults to eat a healthy
diet. It is a personalized nutrition and physical activity plan.
The program is based on 5 food groups. These food groups
are grains, vegetables, fruits, dairy, and protein. The program
shows you the amount of food needed daily from every food
group during each trimester. By using
the “super tracker program,” amounts
of food are calculated according to
your height, pre-pregnancy weight,
due date, and the amount of exercise
you have during the week. Visit
www.ChooseMyPlate.gov for more
information regarding the program.
A pregnant woman is vulnerable to food borne illnesses.
Her immune system may not fight off all harmful bacteria.
The bacteria can cross the placenta and affect the baby
whose immune system may be compromised. Prevent poten-
tial problems from food borne illnesses by following smart
and simple food handling and storage guidelines.
The bacteria listeria can be found in refrigerated ready-
to-eat foods. Examples are dairy products, packaged lunch
meat, and unpasteurized milk. Listeriosis symptoms may
include fever, muscle aches, chills, nausea, or diarrhea. It re-
quires immediate medical intervention. For protection from
Listeriosis, follow the US Food and Drug Administration
guidelines. Do not eat hot dogs or lunch meat unless they
are heated and steaming hot. Do not consume soft cheeses
unless they have been made with pasteurized milk. Do not
eat refrigerated patés or meat spreads. Avoid refrigerated
smoked seafood unless it has been cooked (as in a casserole).
Toxoplasma is a parasite found on unwashed fruits,
vegetables, raw and uncooked meats, poultry, eggs and soil.
This parasite may also be found in cat litter. Using gloves and
hand washing will offer protection when working in gardens
and caring for cats. Toxoplasma can be transmitted to an
unborn baby causing hearing loss, blindness and mental
retardation. Salmonella, a bacterium, is spread by direct or
indirect contact of intestinal waste of animals or humans.
Salmonella rarely is passed to the fetus, but can produce
stillbirth, miscarriages or preterm labor. All persons are at
risk for salmonellosis, but it can be more dangerous during

pregnancy. Foods carrying bacteria can include unpasteurized
milk products, raw and undercooked meats and eggs, raw
sprouts, and cream based deserts.
Other nutritional topics important to include in con-
versation are: sources of Omega-3 fats; knowing limits on
fats, sugars and salt; and knowledge of the requirements of
basic minerals (CA) and vitamins (D, FE, Iodine). Folic Acid
can be found in dark leafy vegetables such as spinach and
citrus fruits like oranges. Healthcare providers recommend
a supplement be taken since it is difficult to get sufficient
quantities through diet only.
Special consideration and guidance may need to be
provided during pregnancy for mothers that are diabetic,
vegetarian, lactose intolerant, have celiac disease, or practice
religious diets. Working with a nutritional specialist may be
the healthy choice for some mothers. Dietitians will guide
mothers with a meal plan structured for their needs.
Pregnancy: Establish a Healthy Eating Plan
continued from previous page
Four Ways to Fight Food Borne Illness
Includes:
1. Wash your hands … Wash all food preparation
surfaces … Wash all fruits and vegetables
2. Separate cooked and raw foods when storing in
refrigerator
3. Cook thoroughly all meats, poultry, eggs, and
casseroles using a thermometer to check for
doneness … Know the safe cooking temperatures
4. Adjust refrigerator temperature to 40 degrees and
freezer to 0 degrees
Publishing Assistance to ICEA Provided by
We want to hear
about prenatal
education practices
for the families of
armed forces personnel.
Contact editor@icea.org
for guidance on
writing an article.

Executive Director’s Letter
Ryan Couch
Call for Nominations
Original Text by David Feild, Former ICEA Executive Director; Amended by Ryan T. Couch, Current ICEA Executive Director
Included in this issue of the ICEA journal is printed the
“call for nominations” (see the 2015-2016 Board Selection
Information and Nomination Form on pages 8-9). Thus be-
gins the process of soliciting names from the ICEA member-
ship of individuals who are interested in serving a two-year
term on the Board of Directors, either as an officer or as a
“designated director” (this is a director who serves as chair of
a major ICEA committee and in that role is also given a seat
on the Board of Directors).
ICEA uses a very open, “democratic” nominating pro-
cess wherein members self-nominate for open positions. In
this round, nominations are being sought for the January 1,
2015, to December 31, 2016, term of office.
Under the Bylaws, the individual serving as President-
Elect automatically becomes President when the new terms
begin. So, it is expected that Connie Livingston, the current
President-Elect, will assume the ICEA Presidency on January
1, 2015. Current Board members can submit their names for
re-election to the Board. We are hoping that some will do
so in 2014, but we already know that several Board mem-
bers will step down permanently after their current term in
office ends. Thus, the process is both open and potentially
competitive.
Most of the selection process is in the hands of the
Nominating Committee. This committee has a chair, four
members and the current President-Elect as its “advisor” and
representative from the current Board. These six ICEA mem-
bers will evaluate all of the applicants who have submitted
application forms, including applicants for all of the open
Board seats, officers and designated directors.
The Committee will then go
through a process of “vetting” all of
the candidates. They will give consid-
eration to each candidate’s available
time, previous experience in child-
birth education or related fields, and
a demonstrated firm commitment
to fulfilling the job responsibilities.
Furthermore, the committee is asked to seek a balance be-
tween members with prior board experience and newcomers;
between maternity care providers, educators and consumers;
and between candidates representing different geographic
areas. Although not specifically stated in the Standing Rules
that define the process, the committee will also consider
diversity and take into account the complexion of the overall
ICEA membership.
The result will be a slate that will include the name of at
least one candidate for each position. This slate will be forward-
ed to the Board for final consideration and vote. The results
will be formally announced in the December 2014 journal.
What’s needed for this process to have a really
successful outcome? The answer is simple: a great pool
of applicants from which the Nominating Committee can
develop its slate. Members who truly care about the future of
the organization are needed; members who aren’t afraid to
involve themselves in the potentially foreign world of asso-
ciation governance are needed—all should consider stepping
forward and completing the self-nomination form.
Be part of that experience. Go to http://icea.org/
node/183, print and complete the form, and mail it in today.
ICEA Approved Workshops
Need certification? ICEA has approved a number of workshops for childbirth educators, doulas, nurses, etc.
Please visit the link below and sign up to get your certifications today.
http://icea.org/content/icea-approved-workshops

International Childbirth Education Association (ICEA)
2015-2016 Board Selection Information
Do you have a few hours a month to volunteer for
your profession? Would you like to help others all over
the world support family-centered maternity care? Do
you enjoy the camaraderie of working together as a
team developing new skills, while promoting freedom
of decision-making based on knowledge of alternatives
in childbirth?
If you answered yes to all the questions, then
please consider joining the ICEA Board of Directors.
You can do it! We’d love to have you.
The slate of candidates for the 2015-2016 ICEA
Board of Directors will be prepared this fall by the
ICEA Nominating Committee. All nominees must be
members of ICEA at the time of the nomination and
must have been ICEA members for two consecutive
years prior to being placed in nomination. Positions to
be filled are listed below.
Responsibilities of Board Members
Members of the Board of Directors are expected to
consistently contribute time and energy to Board business
and to the specific responsibilities of their position. Serving
on the ICEA Board of Directors offers a unique opportunity
to enhance skills and develop expertise in new areas.
Time: The term for all positions is from January 1, 2015
to December 31, 2016. Business is conducted primarily by
monthly conference calls as well as frequent e-mail commu-
nications between Board members. One face-to-face meeting
per year is held.
Financial: Unfortunately, because of ICEA’s financial
situation, most authorized expenses incurred carrying out
ICEA business are NOT reimbursed. Office equipment is not
provided. No Board member may receive remuneration for
services to ICEA as a Board member.
Nomination and Selection Schedule
The ICEA Nominating Committee will meet in per-
son following the submission deadline and will report to
the President by September 5, 2014. The committee will
consider all persons who have submitted nomination forms
by the deadline.
The results of the selection will be announced in the
2014 December issue of the International Journal of Child-
birth Education.
The Nomination Procedure
The Nomination Committee uses ICEA Selection Stand-
ing Rules as its guide in selecting candidates.
Consideration is given to:
• available time;
• previous experience in childbirth education or related
fields; and,
• firm commitment to fulfilling the job responsibilities.
The Nominating Committee will seek a balance between:
• persons with prior board experience and newcomers;
• maternity care providers, educators and consumers; and,
• geographic areas.
The slate shall include one candidate for each position
unless the committee is unable to locate any qualified candi-
dates. An interested member must submit her/his own name for
consideration.
Complete the attached nomination form. Send com-
pleted form to ICEA Nominating Committee at info@icea.
org or print out and mail to 1500 Sunday Drive, Suite #102,
Raleigh, North Carolina 27607 USA. All forms must be
received by August 8, 2014. You may copy this form.
Position to Be Filled
The President-Elect makes a four year commitment –
two years as President-Elect and two years as President. The
President-Elect assists with implementing the major business
of ICEA and serves as an ex officio member of all commit-
tees. The President-Elect must have served a term on the
ICEA Board of Directors. As President s/he will be respon-
sible for the overall operation of ICEA.
The Treasurer reviews the monthly and annual state-
ments of financial condition and assists with preparation of
the annual budget.
Designated Directors serve as members of the ICEA
Board of Directors and as such chair committees that are of
prime importance to the organization. The available com-
mittees are conventions, education, communications, public
policy and marketing, international relations and lactation.
The duties of each committee chair are:
Public Policy: This chair assists with development of
advocacy and public policy. Also serves as ICEA represen-
tative to the Coalition for Improving Maternity Services
(CIMS). This chair advises on marketing strategies.
Membership/Marketing: This chair advises and assists
with membership and marketing strategies.
Lactation: The chair assists with lactation program de-
velopment/revision. Serves as ICEA representative to United
States Breastfeeding Coalition.

International Childbirth Education Association (ICEA)
Board Nomination Form, 2015-2016 Term
Name of Nominee_________________________________________________________________________________________
Address_________________________________________________________________________________________________
Telephone (________)____________________ Email____________________________________________________________
Positions of Interest________________________________________________________________________________________
_______________________________________________________________________________________________________
Please provide background information on nominee (past and present work experience, experience with local group or
community contributions to childbirth/parent education, work in ICEA, support of family-centered maternity care, etc.).
Attach curriculum vitae or resume if available.
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
List the goals and directions you would like to see ICEA adopt for the next three years.__________________________________
_______________________________________________________________________________________________________
Do you have the time and commitment to give to the position? q Yes q No
Do you have access to a computer and access to the Internet for e-mail? q Yes q No
Provide a listing of your capabilities for the position/s of interest:___________________________________________________
_______________________________________________________________________________________________________
What particular strengths or interests will make you an asset to the ICEA Board of Directors?_____________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Name, address and phone number of individuals who can provide information regarding your interest, capabilities and
accomplishments. At least one reference must be an ICEA member.
Name___________________________________________________________________________________________________
Address_________________________________________________________________________________________________
Telephone (________)_____________________________________________________________________________________
Name___________________________________________________________________________________________________
Address_________________________________________________________________________________________________
Telephone (________)_____________________________________________________________________________________
Name___________________________________________________________________________________________________
Address_________________________________________________________________________________________________
Telephone (________)_____________________________________________________________________________________
PERMISSION STATEMENT: The statements contained herein reflect my qualifications and goals.
Signature________________________________________________________________________________________________
This form must be received by August 15, 2014. Please send form to ICEA Nominating Committee, 1500 Sunday Drive,
Suite 102, Raleigh, North Carolina 27607 USA. Non-US nominees may return form via telefax to ICEA at 919-787-4916 or by
e-mail to info@icea.org.

Helping Women to Conceive at a
Healthy Weight and Gain Within
the Guidelines
by Kathleen M. Rasmussen, ScD RD
Today, 58.5% of American women of reproductive age
are either overweight [body mass index (BMI) > 25 and
<30 kg/m2] or obese (BMI > 30 kg/m2
) and 7.8% have
reached obesity grade 3 (BMI > 40 kg/m2
) (Ogden et al.,
2014). Many kinds of obstetric risk increase with maternal
prepregnancy BMI values above normal-weight (Rasmus-
sen & Yaktine, 2009), so the recommendation of the 2009
expert committee at the Institute of Medicine/National
Research Council (IOM/NRC) that women should conceive
at a healthy (normal) weight poses a considerable challenge
to American society at large. Excessive gestational weight
gain (GWG), which is most frequent among overweight and
obese women (Board on Children, Youth & Families & Food
and Nutrition Board, 2013), only exacerbates the obstetric
problems posed by being overweight or obese at conception.
According to the 2009 expert committee (Rasmussen &
Yaktine, 2009), gaining within the guidelines is an important
way to mitigate these risks. Childbirth educators and other
health professionals who work with pregnant women have
an important role to play in helping women to be healthy
before, during and after pregnancy.
Conceiving at a Healthy Weight
Although preconceptional counseling has yet to become
common, American women today need good advice about
how to eat well, encouragement to be physically active and
access to adequate contraception so pregnancies occur when
women are healthy and ready to conceive. The most obvi-
ous opportunity for preconceptional counseling is among
women who have not yet had children and express a desire
to learn more about how to be healthy. When women seek
such counseling and are above normal-weight, the stepped
approach used in the LEVA study in Sweden (Bertz et al.,
2013a) provides a set of easily implemented approaches to
weight loss and long-term weight management. The steps
used in this study, which were insti-
tuted one at a time over a four-week
period, were: (1) limit sweets and
snacks to 100 grams (~4 ounces)/
week, (2) substitute low-fat and
low-sugar alternatives for prepared
foods, (3) cover one-half of the plate
with vegetables at lunch and dinner,
and (4) reduce portion sizes. Women found that these steps
taught them “how to eat” and helped them to increase their
weight loss over time (Bertz et al., 2013b).
Preconceptional counseling is also possible postpartum
for women who wish to have more children. Women can be
encouraged and supported to breastfeed because it increases
postpartum weight loss among women regardless of their
prepregnancy BMI or GWG (Baker et al., 2008). In addition,
the approach in the LEVA study described above can be used
among breastfeeding women as it was tested among them.
Gaining Within the Guidelines
Most of what we know about the importance of gaining
within the guidelines is based on the results of the many
observational studies that have linked GWG to a range of
obstetric outcomes. In these studies, researchers have shown
consistently that gaining within the guidelines is associated
with better outcomes before and during delivery than gain-
ing more or less than the guidelines (Rasmussen & Yaktine,
2009). Moreover, gaining above the guidelines is not only
associated with risks to the mother after delivery (e.g. post-
partum weight retention and the development of obesity)
but also to the fetus, who may be too large at birth and have
a high risk of becoming obese at a young age (Rasmussen &
Yaktine, 2009).
Kathleen Rasmussen
Guest Editorial

Experiments published to date have not been uniformly
successful in getting pregnant women to gain within the
guidelines. The interventions that were the most successful
involved many contacts with a dietician (Wolff et al., 2008)
or fewer contacts with a dietician but a more comprehensive
set of services (Phelan et al., 2011). Investigators in the Fit
for Delivery Study found that it was particularly important to
begin these interventions early in pregnancy because exces-
sive early gain made it difficult for women to reach their
target to gain within the guidelines (Phelan et al., 2011).
These two trials were each too small to determine if gaining
within the guidelines affected common obstetric outcomes.
In contrast, the LIMIT trial, which was carried out in Austra-
lia and employed an approach similar to the Fit for Delivery
Study, was large enough to investigate obstetric outcomes.
However, the intervention used in the LIMIT trial was not
effective in reducing the likelihood of delivering a large baby
or in improving maternal obstetric outcomes (Dodd et al.,
2014).
Helping Women to Meet These Goals
With a high proportion of women in every BMI
category gaining outside of the guidelines (Rasmussen &
Yaktine, 2009; Board on Children, Youth & Families & Food
and Nutrition Board, 2013) and, particularly, above the
guidelines, it is clear than many American women need help
to gain within the guidelines. To provide some assistance to
women and their care providers, the IOM/NRC convened
an expert committee that was charged with disseminating
the 2009 GWG guidelines. A summary of the committee’s
closing workshop (Board on Children, Youth & Families
& Food and Nutrition Board, 2013) is available as is a free
webinar on this subject (http://iom.edu/Activities/Children/
PregnancyWeightDissemination/2013-SEP-09.aspx). The
materials that the committee developed (e.g. a poster and
a weight-tracker, booklets for women and their care provid-
ers, bilingual information sheets, etc.) are available online
(http://www.iom.edu/About-IOM/Leadership-Staff/Boards/
Food-and-Nutrition-Board/HealthyPregnancy.aspx). These
materials also include a free, interactive infographic (http://
resources.iom.edu/Pregnancy/WhatToGain.html) for use
on many pregnancy-related websites. It helps women to
determine their correct prepregnancy BMI category and then
answers many questions that they may have about GWG.
These materials are designed to help women to become
aware that there are guidelines for GWG and to know what
their personal weight gain target should be. They do not
replace the assistance in meeting this target that can be pro-
vided by well-informed and engaged health care providers
working with the woman to achieve her goal.
References
Baker, J. L., Gamborg, M., Heitmann, B. L., Lissner, L., Sørensen, T. I., &
Rasmussen, K. M. (2008). Breastfeeding reduces postpartum weight reten-
tion. American Journal of Clinical Nutrition, 88, 1543-1551.
Bertz, F., Brekke, H.K., Ellegård, L., Rasmussen, K.M., Wennergren, M. &
Winkvist, A. (2013a). Diet and exercise weight-loss trial in lactating over-
weight women. American Journal of Clinical Nutrition, 96, 698-705.
Bertz, F., Sparud-Lundin, C., & Winkvist, A. (2013b). Transformative Life-
style Change: key to sustainable weight loss among women in a post-partum
diet and exercise intervention. Maternal & Child Nutrition, doi: 10.1111/
mcn.12103
Board on Children, Youth and Families and Food and Nutrition Board.
(2013). Leveraging Action to Support Dissemination of the Pregnancy
Weight Guidelines. National Academies Press, Washington, D.C. Available
at: http://iom.edu/Reports/2013/Leveraging-Action-to-Support-Dissemina-
tion-of-Pregnancy-Weight-Gain-Guidelines.aspx.
Dodd, J.M., Turnbull, D., McPhee, A.J., Deussen, A.R., Grivel, R.M., Yel-
land, L.N., Crowther, C.A., Wittert, G., Owens, J.A., & Robinson, J.S. for
the LIMIT Randomized Trial Group. (2014). Antenatal lifestyle advice for
women who are overweight or obese: LIMIT randomized trial. BMJ, 348,
g1285.
Ogden, C.L., Carroll, M.D., Bit, B.K., & Flegal, K.M. (2014). Prevalence of
childhood and adult obesity in the United States, 2010-2012. JAMA, 311,
806-814.
Phelan, S., Phipps, M.G., Abrams, B., Darroch, F., Schaffner, A. & Wing,
R.R. (2011). Randomized trial of a behavioral intervention to prevent exces-
sive gestational weight gain: the Fit for Delivery Study. American Journal of
Clinical Nutrition, 93, 772-779.
Rasmussen, K.M., & Yaktine, A. (Eds.) (2009). Weight Gain During Preg-
nancy: Reexamining the Guidelines. National Academies Press, Washington,
D.C.
Wolff, S., Legarth, J., Vangsgaard, K., Toubro, S., & Astrup, A. (2008). A
randomized trial of the effects of dietary counseling on gestational weight
gain and glucose metabolism in obese pregnant women. International Jour-
nal of Obesity, 32, 495-501.
Professor Rasmussen’s research focuses on maternal nutrition
during pregnancy and lactation. She chaired of the recent expert
committee that revised the guidelines for weight gain during
pregnancy and also chaired the committee to disseminate these
guidelines. Professor Rasmussen received Agnes Higgins Award
from the American Public Health Association in 2012 for her
contributions to maternal-fetal nutrition.
Helping Women to Conceive at a Healthy Weight

You Are What You Eat
by Nancy Quigley, MSN NP-C MEd AHN-BC HWNC-BC
Guest Editorial
“You are what you eat”, there is no time to take those
words more seriously than during pregnancy and before.
Paleo, gluten free, sugar free, fat free, Atkins, vegan – it
can be very confusing to know what is best for you and
your baby. All of these plans have merits and flaws. Food
companies have exploited each of these plans to maximize
profits. So how do couples choose the ideal diet plan for
their baby? Teach them that they are individuals and should
speak to their primary care practitioner about specific needs,
and ideally a team member in the practice with expertise in
nutrition.
Here are some tips to share with them, while navigat-
ing the mixed messages they hear from the media, medical
professionals and well-meaning friends.
Focus your choices on whole, real foods, prefer-
ably organic, preferably local. Here’s how that works. In a
perfect world we would get all of our food straight from the
farm, grown with organic practices, minimally processed to
reduce toxins and increase nutritional value (phytonutrients
mainly). Organically grown food typically is grown in soil
that is not depleted, by farmers who are passionate about
their work. Think of it as a continuum, not all or nothing.
The more you head towards the organic, real food side of the
spectrum, the better. Very few people can or do eat every-
thing straight from the farm.
Eat a wide variety of foods from all the food groups.
Try a new fruit or vegetable every couple of weeks, look up a
new recipe online, and visit a new restaurant. Pick up a local
farm-to-table magazine to discover restaurants that focus on
locally grown produce. Ask the farmer at the farmer’s market
or Community Supported Agriculture (CSA) for a great
recipe utilizing the pick of the week if you are not familiar
with it. Choose grass-fed beef and free-range chicken, again
ideally from a local farmer where you can learn their farming
practices.
Join a CSA (Community Supported Agriculture)
or visit a farmer’s market. Organically grown produce is
usually much more expensive in the grocery stores, especially
when not in season.
Try to eat seasonally. There
is more and more research on the
benefits of how the body responds
positively to the foods that are
naturally more available each season.
Think of the availability of cleansing
greens in spring.
Read labels, not the market-
ing on the front of the package. Look at the ingredients,
not just the calories. If you don’t recognize the word as food
then it’s best to limit or avoid it. Food companies use many
substances to extend shelf life, enhance flavor, and improve
texture and appearance. These substances are not added to
nourish us. No one knows what the cumulative impact is
over time and the mystery of what the ingestion of multiple
preservatives, additives, artificial colorings and pesticides
does to our bodies.
Try to cook as much of your food as possible. Check
into cooking classes at Whole Foods, Viking, and community
centers or pick a favorite celebrity chef to pick up some great
ideas.
Eat mindfully. Take your time eating. Sit at a table, not
in front of the TV or while driving down the road. Multiple
studies have shown how more food is consumed when eaten
in a distracted state.
Avoid the most dangerous “food-like” substances.
Processed foods containing trans fats (if partially or hydro-
genated oils are in the ingredients, stay away), high fructose
corn syrup and artificial sweeteners are the most detrimental
ingredients added to our food products.
You are eating for two. Focus on nutrient dense whole-
some foods to fulfill the added calories needed to support
your pregnancy. Try to keep sugar and sweets to a minimum.
The work of Dr. Robert Lustig has been tremendously instru-
mental in shifting the focus of fat being the culprit in disease
states towards sugar being the main culprit.
Focus your choices on whole, real foods, preferably
organic, preferably local.
It’s that simple.
Nancy Quigley

Guest Editorial
The Big O: Oxytocin and the
Command to “Eat Right”
by Dana Marie Dillard, MS HSMI
What does oxytocin, the hormone most commonly
known for its role in uterine contractions and milk ejection,
have to do with nutrition in pregnancy? Maybe nothing, but
I am inclined to think otherwise and believe that we may be
looking at another argument for the more holistic, woman-
centered approach to care provided by many doulas and
midwives.
Oxytocin appears to exert a greater influence on behav-
ior and emotion than previously understood. For example,
oxytocin promotes social bonds, monogamous relationships,
and development and maintenance of closeness and trust,
although these processes have not all been well-studied in
humans (Leng, Ludwig, & Douglas, 2012). Miriam (2014)
offered the idea that compassionate midwifery can enhance
the natural oxytocin process, thereby reducing childbirth
complications and the need for medical interventions.
Take, for instance, massage and touch therapies. Physi-
cal contact initiates the process that stimulates the release
of oxytocin (Uvnäs Moberg, 2011). The skin is a major
component of the endocrine system and serves as a point of
regulation. Massage therapy, hugs, a light touch to the hand,
and even the sucking of thumbs and pacifiers for infants and
the petting of bonded animals for women stimulate oxytocin
production through skin contact (Field, 2007; Miller et al.,
2009; Uvnäs Moberg, 2011). Digestion quite possibly serves
a similar function-the smooth muscles of the gastrointestinal
system arise from the same fetal precursor as the skin, the
ectoderm, and may act as a sort of internal masseuse during
and following eating (Uvnäs Moberg, 2011). In this way, eat-
ing is (or should be) a comforting experience that promotes
bonding and building harmonious relationships.
However, as a society, the United States has a devastat-
ingly disturbed relationship with food and eating. Consider,
for instance, that at about 13.1% of the female population
the United States has some of the highest rates of reported
disordered eating as well as abnormal eating attitudes in
adolescent and adult women (Stice, Marti, & Rohde, 2013;
Makino, Tsuboi, & Dennerstein, 2004). Worldwide estimates
from 2008 indicate that over 1.4
billion adults over the age of 20 are
overweight (World Health Organiza-
tion [WHO], 2013). Of those who
are overweight, nearly 35% (ap-
proximately 200 million men and 300
million women) could be categorized
as obese (WHO, 2013). Although
a causal relationship between disordered eating and social
representations of beauty ideals has not been established
conclusively, significant evidence supports the role of these
images in influencing self-reports of body image, which may
influence eating behaviors and subsequent relationships with
food (Witcomb, Arcelus, & Chen, 2013). So how does this
relate to “eating right” in pregnancy?
When we speak of nutrition, it tends to sound so
clinical, so formulaic, so easy. The premise is simple: get the
proper nutrients into a body to promote optimal health.
However, much like Western medicine, this approach
compartmentalizes (and perhaps dissects, medicalizes, and
pathologizes) the process of eating to make it scientific, while
leaving out the individual, cultural, and social factors that
influence, how, what, when, why, how much, and how much
we enjoy what we eat.
From a nutrition perspective, it often feels that “eat-
ing right” is about meeting guidelines, crunching caloric
numbers, and adding supplements when something seems to
be missing. From a more holistic approach, we must identify
what it is we are nourishing. This dichotomy mirrors the
debate that has raged in scientific circles (quantitative versus
qualitative; width versus depth) and has now generalized to
the consuming public (quantity or quality; healthy or un-
healthy; good or bad). However, from an individual perspec-
tive, every meal, indeed every morsel, reflects a conversation
we have with ourselves, our minds, our bodies, our families,
our culture, our society, and the ghosts of the ancestors
before us. In the Midwest, for example, we were raised on
Dana Dillard

steak-and-potatoes and liver-and-onions, but grew up during
the reign of McDonalds and Monsanto while being force-
fed the beauty ideal of Kate Moss. If that sounds angry, it is:
every meal becomes a conversation that we may not know
we are having, or even worse is a conversation in which we
are given no voice.
Talking about food can evoke significant anxiety for
many women, especially for those with disordered eating
(Steinglass et al., 2012). It might be worthwhile to note that
the regulation of both food intake and anxiety behaviors are
closely related to corticotropin-releasing factor (CRF) and
CRF receptors located in the paraventricular nucleus of the
hypothalamus which, in addition to the supraoptic nucleus,
houses the magnocellular axons responsible for the release of
oxytocin (Nakayama et al., 2011; Sztainberg & Chen, 2012;
Leng et al., 2012). In addition to skin contact, the produc-
tion of oxytocin itself causes changes within the brain that
may alter receptivity to oxytocin (Garcia-Segura, 2009).
Stated more simply, oxytocin, that remarkable hormone of
bonding, appears to have significant influence over anxiety
and may influence how we feel about what we eat (de Jong,
Beiberdeck, & Neumann, 2014; Tops, Van Peer, Korf, Wi-
jers, & Tucker, 2007). Although food conversations can be
unsettling, these conversations, if built around compassion,
trust, respect, and non-judgment, can provide opportuni-
ties for building stronger interpersonal relationships that
can help alleviate fears and food anxieties. In contrast, but
also worth noting, women with anorexia nervosa appear to
have dysregulated oxytocin receptors, which may mean that
individuals with eating disorders perceive the effects of oxy-
tocin differently than those without eating disorders (Kim,
Kim, Kim, & Treasure, 2014). Eating may not be comforting;
furthermore, discussions on eating may evoke anxieties that
are not tempered by traditional neurophysiologic pathways
and may challenge the establishment of rapport. Despite the
discomfort associated with talking about food, the develop-
ment of a genuine relationship built through equality, open
exchange, and trust can change the landscape of the brain
and perhaps even one’s relationship with food.
It is for these reasons then that talking about food,
about eating, and about nutrition must be done respectfully,
mindfully, and with an appreciation for and understanding
of how complicated the mandate to “eat right” truly is. For
some people the conversation may be easy and enjoyable.
However, imagine the difficulty of this conversation for,
say, a 19-year-old who has engaged in binging and purging
secretly since before puberty and now finds herself pregnant
with an unplanned and unwanted baby; or a 35-year-old
vegetarian who has faced criticism and condemnation for her
dietary lifestyle for which she now endures a new round of
accusations of prenatal child abuse despite her nutritionally-
informed preconception supplementation of key nutrients;
or for a Muslim woman who fasts during Ramadan, or a
woman with celiac disease, or indeed any woman who has
individual, cultural, social, faith-based, or medical consider-
ations that make it difficult or impossible to follow a blanket
approach to dietary guidelines. To be fair, the most recent
round of guidelines attempts to take some of these aspects
under consideration, but the approach is still generalized for
large populations (United States Department of Agriculture,
2013). This is where midwives, doulas, and other childbirth
educators have the potential to create lasting change in
women’s lives or at least to encourage women to look at
the status of the relationships in their lives, including their
relationship with food.
So, I return to the idea of compassionate care. What
is compassionate care? In a model described by Lloyd and
Carson (2012) in mental health care, compassionate care in-
volves relationship building between care providers and users
who “…share universal goals whilst respecting diverse needs
and encouraging recovery” (p. 151). Lloyd (2013) dissected
these components into three areas: empathic collabora-
tion, sympathetic presence, and knowledgeable persistence.
Compassionate care involves critical conversations employing
active listening, respectful dialogue, and informed healthcare
options (Lloyd & Carson, 2012). One of the critical conversa-
tions that should occur in pregnancy is that of nutrition but
framed within the context of food and eating-not numbers
and blanket guidelines. Through active listening, sensitive in-
formation-gathering, and, when appropriate, touch, a doula
can develop a profound relationship of trust that may change
not only how a woman looks at a plate but the very nature
of that conversation with eating. As a final note, oxytocin is
by no means the only hormone or neurotransmitter involved
in the complex processes described above. To sell it as such
would be a disservice to the idea of holism, yet the idea that
our words, our touch, and our presence profoundly influ-
ence the body, the mind, and the spirit serves as a powerful
reminder of the unseen influence that we have in each and
every interaction that we have with another.
The Big O: Oxytocin and the Command to “Eat Right”

References
de Jong, T. R., Beiberdeck, D. I., & Neumann, I. (2014). Measuring female
aggression in the Female Intruder Test (FIT): Effects of oxytocin, estrous
cycle, and anxiety. PLoS ONE, 9(3), e91701. http://dx.doi.org/10.1371/
journal.pone.0091701
Field, T. (2007). Massage therapy effects. In A. Monat, R. S. Lazarus, & G.
Reevy (Eds.), The Praeger handbook on stress and coping (Vol. 2, pp. 451-
474). Westport, CT: Praeger.
Garcia-Segura, L. M. (2009). Hormones and brain plasticity. New York, NY:
Oxford University Press.
Kim, Y. R., Kim, J. H., Kim, M. J., & Treasure, J. (2014). Differential meth-
ylation of the oxytocin receptor gene in patients with anorexia nervosa:
A pilot study. PLoS One, 9(2), e88673. http://dx.doi.org/10.1371/journal.
pone.0088673
Leng, G., Ludwig, M., & Douglas, A. J. (2012). Neural control of the
posterior pituitary gland (neurohypophysis). In G. Fink, D. Pfaff, & J. Levine
(Eds.), Handbook of neuroendocrinology (pp. 139-155). London, England:
Academic Press.
Lloyd, M. (2013). Developing a methodology for compassionate care in
nursing practice [Online presentation]. Retrieved from http://www.rcn.org.
uk/__data/assets/pdf_file/0015/512232/2013_RCN_research_6.2.3.pdf
Lloyd, M., & Carson, A. M. (2012). Critical conversations: Develop-
ing a methodology for service user involvement in mental health nurs-
ing. Nurse Education Today, 32(2), 151-155. http://dx.doi.org/10.1016/j.
nedt.2011.10.014
Makino, M., Tsuboi, K., & Dennerstein, L. (2004). Prevalence of eating
disorders: A comparison of Western and non-Western countries. Medscape
General Medicine, 6(3), 49-66. Retrieved from http://ncbi.nlm.nih.gov/pmc/
articles/PMC1435625
Miller, S. C., Kennedy, C., DeVoe, D., Hickey, M., Nelson, T., & Kogan, L.
(2009). An examination of changes in oxytocin levels in men and women
before and after interaction with a bonded dog. Anthrozoös, 22(1), 31-42.
http://dx.doi.org/10.2752/175303708X390455
Miriam, C. (2014). Childbirth in a fat-phobic world. In L. Davies & R. Deery
(Eds.), Nutrition in pregnancy and childbirth: Food for thought (pp. 154-
168). New York, NY: Routledge.
Nakayama, N., Suzuki, H., Li, J.-B., Atsuchi, K., Tsai, M., Amitani, H., …
Inui, A. (2011). The role of CRF family peptides in the regulation of food
intake and anxiety-like behavior. Biomolecular Concepts, 2, 275-280. http://
dx.doi.org/10.1515/BMC.2011.022
Steinglass, J., Albano, A. M., Simpson, H. B., Carpenter, K., Schebendach,
J., & Attia, E. (2012). Fear of food as a treatment target: Exposure and re-
sponse prevention for anorexia nervosa in an open series. International Jour-
nal of Eating Disorders, 45(4), 615-621. http://dx.doi.org/10.1002/eat.20936
Stice, E., Marti, C. N., & Rohde, P. (2013). Prevalence, incidence, impair-
ment, and course of the proposed DSM-5 eating disorder diagnoses in an
8-year prospective community study of young women. Journal of Abnormal
Psychology, 122(2), 445-457. http://dx.doi.org/10.1037/s0030679
Sztainberg, Y., & Chen, A. (2012). Neuropeptide regulation of stress-
induced behavior: Insights from the CRF/urocortin family. In G. Fink, D.
Pfaff, & J. Levine (Eds.), Handbook of neuroendocrinology (pp. 355-375).
London, England: Academic Press.
Tops, M., Van Peer, J. M., Korf, J., Wijers, A. A., & Tucker, D. M. (2007).
Anxiety, cortisol, and attachment predict plasma oxytocin. Psychophysiology,
44, 444-449. http://dx.doi.org/10.1111/j.1469-8986.2007.00510.x
United States Department of Agriculture. (2013). Dietary guidelines for
Americans. Retrieved from http://www.cnpp.usda.gov/DietaryGuidelines.
htm
Uvnäs Moberg, K. (2011). The oxytocin factor: Tapping the hormone of
calm, love, and healing (R. W. Francis, Trans.). London, England: Pinter &
Martin. (2nd ed. Original work published 2000).
Witcomb, G. L., Arcelus, J., & Chen, J. (2013). Can cognitive dissonance
methods developed in the West for combatting the “thin ideal” help
slow the rapidly increasing prevalence of eating disorders in non-Western
cultures? Shanghai Archives of Psychiatry, 25(6), 332-341. http://dx.doi.
org/10.3969/j.issn.1002-0829.2013.06.002
World Health Organization. (2013). Obesity and overweight (Fact sheet no.
311). Retrieved from http://www.who.int/mediacentre/factsheets/fs311/en/
Dana is working toward a PhD in Health Psychology through
Walden University and is Associate Faculty with Ashford Uni-
versity. Inspired by holistic stress management, Dana’s interests
revolve around holistic self-care that incorporates nutrition and
movement, spirituality, and emotional and psychological wellness.
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The Big O: Oxytocin and the Command to “Eat Right”

Features
Mindful Eating
and Pregnancy
by Lee Stadtlander, PhD
Abstract: Mindful eating is based on the
premise that the relationship to food can
be enhanced by using all the senses in
choosing to eat food that is both satisfy-
ing and nourishing, acknowledging the
responses to food (likes, dislikes or neu-
tral) without judgment, and becoming
aware of physical hunger and satiety cues
to guide decisions to begin and end eat-
ing. The hormonal changes of pregnancy
bring about a host of changes in olfac-
tory (smell) and taste perception. Many
women report experiencing enhanced
sensitivity or other alterations in their
ability to smell while pregnant. In addi-
tion, a majority of pregnant women ex-
perience changes in taste perception and
cravings for particular foods. Given these
issues, mindful eating, whereby foods
are carefully selected based upon sensory
responses, makes a great deal of sense. An
instruction sheet and resources on mind-
ful eating are provided for sharing with
students.
Keywords: pregnancy, mindful eating. mindful
In the United States, the incidence of obesity among
pregnant women ranges from 18.5% to 38.3% (Galtier-De-
reure, Boegner, & Bringer, 2000). However, an awareness of
and concern for obesity must be balanced with the nutrition-
al needs of the developing fetus and pregnant woman (U.S.
Department of Agriculture, 2014). A method to consider
for achieving adequate nutrition for all pregnant women is
through the practice of mindful eating.
Mindful Eating
Mindful eating (also called “intuitive eating” in the
psychological literature; Tylka, 2006), brings one’s full atten-
tion and awareness to the experience of eating food, in the
moment, without judgment. Mindfulness allows a release
from automatic reactions, fears and attachments, allowing
an engagement of inner wisdom (Center for Mindful Eat-
ing, 2014). Mindful eating is based on the premise that the
relationship to food can be enhanced by using all the senses
in choosing to eat food that is both satisfying and nourish-
ing, acknowledging one’s responses to food (likes, dislikes or
neutral) without judgment, and becoming aware of physical
hunger and satiety cues to guide decisions to begin and end
eating.
Mindful eating is based on the idea that disordered
eating is due to a disconnection between appetite and other
physical needs. When physical and mental events go un-
recognized they sometimes trigger automatic behaviors like
eating unrelated to true appetite (Boudette, 2011; Caldwell,
Baime, & Wolever, 2012; Kristeller & Wolever, 2011; Wo-
lever & Best, 2009). Mindfulness trains individuals to notice
distressing thoughts, emotions, and sensations that would
have otherwise gone unnoticed. One learns to bring the
experience fully into awareness so that many types of distress
that would have provoked an automatic reaction, such as
eating, can be tolerated. Thus, distress tolerance is increased,
and automatic eating is reduced. Because reduced reactivity
enhances tolerance, the cultivation of mindfulness becomes
self-reinforcing.
Mindful eating appears to work by increasing awareness
of the physical sensations of hunger and fullness, which results
in decreased food intake and increased appetite satisfaction.
The cultivation of nonjudgmental awareness also allows the

individual to better understand and separate automatic behav-
iors that over time have become linked to emotional reactions,
negative or distorted thinking processes, or misattribution of
physical sensations (Wolever & Best, 2009). Increased physi-
cal activity may also be evident with mindfulness through
responsiveness to the body’s need for movement. Mindfulness
cultivates self-acceptance and compassion, qualities that may
disrupt the cycle of distress-overeating, negative emotions,
and harsh self-recrimination that is common in compulsive
eating (Gongora, Derksen, & van Der Staak, 2004). Together,
these elements can re-engage the body’s internal feedback
mechanisms that help regulate weight (Caldwell et al., 2012;
Kristeller, Baer, Quillian-Wolever, 2006; Kristeller & Wolever,
2011; Wolever & Best, 2009).
Advantages of Mindful Eating during Pregnancy. The
hormonal changes of pregnancy bring about a host of chang-
es in olfactory (smell) and taste perception. Many women
report experiencing enhanced sensitivity or other alterations
in their ability to smell while pregnant (Doty & Cameron
2009). In addition, a majority of pregnant women experi-
ence changes in taste perception (Ochsenbein-Kölble, von
Mering, Zimmermann, & Hummel, 2005), and cravings for
particular foods. Given these issues, mindful eating, whereby
foods are carefully selected based upon sensory responses,
makes a great deal of sense. Mindful eating stresses that one
becomes aware of feelings of hunger, satiety, or sensitivity,
and to react in accordance with those cues. All senses are
used in response to the food, making each taste and sensa-
tion important, whether it is the color, smell, and juiciness of
a ripe strawberry to the cold creaminess of ice cream.
Youngwanichsetha, Phumdoungm, and Ingkatha-
wornwong (2014) conducted a recent empirical study with
pregnant women. The authors examined the use of mind-
ful eating and yoga with pregnant women with a history of
gestational diabetes during previous pregnancies. Young-
wanichsetha et al. (2014) reported that mindful eating com-
bined with yoga was helpful in reducing blood glucose levels.
An introduction to mindful eating requires some guid-
ance; therefore, an instruction sheet for students follows. I
also recommend the books Eat What You Love, Love What You
Eat, an easily understood guide by Michelle May (2013) and
Mindful Eating by Jan Chozen Bays (2009). Bays’ book takes
a more detailed meditative approach and includes a CD with
guided meditation exercises.
Mindful Eating During Pregnancy
Mindful eating is based on the premise that your
relationship to food can be enhanced by using all of
your senses in choosing to eat food that is both satisfy-
ing and nourishing, acknowledging the responses to
food (likes, dislikes or neutral) without judgment, and
becoming aware of physical hunger and satiety cues
to guide decisions to begin and end eating. Mindful
eating has been shown to help people control inappro-
priate eating and to lose weight.
Here are some tips to introduce mindfulness to
mealtimes in an easy, accessible fashion.
Why Do I Want to Eat Now?
Before you take a bite, try to tune in to what
your body is telling you. Are you physically hungry,
or is it another kind of hunger? Maybe it’s emotional,
or maybe it’s simply a craving for certain foods. One
way to buy time and figure it out is to have a glass of
water; you may just be thirsty. If it’s not meal time,
you could just be bored. Try taking a walk or listening
to music.
What Do I Want to Eat?
Don’t just grab the nearest food. Do you want
something salty? Something sweet? A particular snack
or specific type of food? When people start to tune
in to that, they are more satisfied and eat smaller
amounts.
It is always a good idea to steer yourself and your
kids toward something nutritious: whole wheat crack-
ers with three dice-sized cubes of reduced-fat cheese
instead of chips if you want something salty, or grapes
instead of candy if you want something sweet.
How Much Am I Enjoying This Food Right Now?
Once you start eating, pay attention to the
flavors, the texture, the scent, how the food looks
on your plate. Encourage your family to take time to
enjoy it! It takes 20 minutes for your brain to get the
message from your stomach that you’re full. So if you
eat in a hurry, you may be full and not know it yet.
As you eat, keep thinking about how satisfying
the food is on a scale of 1-10. You may be surprised
how soon it stops being so tasty. Often it is the first
few bites that really satisfy. You and your kids can test

this with raisins or a similar small, healthy snack that you
enjoy. If you pay attention to how much you’re enjoying
them, by the fourth raisin you may not want another one.
How Full Am I?
If you are eating mindlessly, you may eat well past the
point of fullness. So instead, pay attention to how full you
are on a 1-10 scale, with 1 being famished and 10 being
uncomfortably full.
After you have finished a meal, you should be between
a 5 and 7 on this scale --satisfied, with no reason to eat
more. You could eat more (if the food is really good), but
you do not need to. So don’t.
Chew thoroughly and eat slowly. Research has shown
that how long you take to eat something may be just as
important to how full you feel as how much you eat.
Why Did I Eat That (Or That Much)?
If you go crazy eating ice cream and stuff yourself to a
9 instead of a 5 or 6, do not spend the next hour beating
yourself up. Instead, just notice it and take the time to
think about why. Part of mindful eating is learning from
your mistakes. Take that knowledge, and use it to help you
next time.
Eat Slower
Eating slowly does not have to mean taking it to ex-
tremes. Still, it is a good idea to remind yourself, and your
family, that eating is not a race. Taking the time to savor
and enjoy your food is one of the healthiest things you can
do. You are more likely to notice when you are full; you’ll
chew your food more and hence digest it more easily, and
you’ll probably find yourself noticing flavors you might
otherwise have missed. If you have young children, why
not try making a game of it — who can chew their food the
longest? Or you could introduce eating with chopsticks as a
fun way to slow things down.
Savor the Silence
Yes, eating in complete silence may be impossible for
a family with children, but you might still encourage some
quiet time and reflection. Again, try introducing the idea as
a game — “let’s see if we can eat for two minutes without
talking” — or suggesting that one meal a week be enjoyed
in relative silence. If the family mealtime is too important
an opportunity for conversation to pass up, then consider
introducing a quiet meal or snack time into your day when
you can enjoy it alone. One option is simply to savor a few
sips of tea or coffee in complete silence when you are too
busy for a complete mindful meal.
Silence the Phone. Shut Off the TV and Computer.
Our daily lives are full of distractions, and it is com-
mon for families to eat with the TV blaring or one family
member or other fiddling with their iPhone. Consider
making family mealtime an electronics-free zone.
Pay Attention to Flavor
The tanginess of a lemon, the spiciness of arugula, the
crunch of a pizza crust — paying attention to the details
of our food can be a great way to start eating mindfully.
After all, when you eat on the go or wolf down your meals
in five minutes, it can be hard to notice what you are even
eating, let alone truly savor all the different sensations of
eating it. If you are trying to introduce mindful eating to
your family, consider talking more about the flavors and
textures of food. Ask your kids what the avocado tastes
like or how the hummus feels. And be sure to share your
own observations and opinions too. (Yes, this goes against
the eating in silence piece, but you don’t have to do every-
thing at once.)
Know Your Food
Mindfulness is really about rekindling a relationship
with our food. From planting a veggie garden through
baking bread to visiting a farmers’ market, many of these
things are ways to connect with the story behind our
food. Even when you have no idea where the food you are
eating has come from, try asking yourself some questions
about the possibilities: Who grew this? How? Where did
it come from? How did it get here? Chances are, you’ll not
only gain a deeper appreciation for your food, but you’ll
find your shopping habits changing in the process too.
Mindful eating does not have to be an exercise in
super-human concentration, but rather a simple commit-
ment to appreciating, respecting and, above all, enjoying
the food you eat every day. It can be practiced with salad

Kristeller, J. L., & Wolever, R. Q. (2011). Mindfulness-based eating aware-
ness training for treating binge eating disorder: The conceptual foundation.
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80/10640266.2011.533605
Kristeller, J. L., Baer, R. A., & Quillian-Wolever, R. (2006). Mindfulness-
based approaches to eating disorders. In R. A. Baer (Ed.), Mindfulness-based
treatment approaches: Clinician’s guide to evidence base and applications
(pp. 75-90). Boston, MA: Academic Press.
May, M. (2013) Eat what you love, love what you eat. Phoenix, AZ: Am I
Hungry Publishing.
Ochsenbein-Kölble, N., von Mering, R., Zimmermann, R., & Hummel,
T. (2005). Changes in gustatory function during the course of pregnancy
and postpartum. International Journal of Obstetrics and Gynaecology, 112,
1636–1640.
Tylka, T. L. (2006). Development and psychometric evaluation of a measure
of intuitive eating. Journal of Counseling Psychology, 53(2), 226-240.
U.S. Department of Agriculture. (2014). Health and Nutrition Information
for Pregnant and Breastfeeding Women: Nutritional Needs during Pregnan-
cy. Retrieved from http://www.choosemyplate.gov/pregnancy-breastfeeding/
pregnancy-nutritional-needs.html
Web MD. (2014). How to practice mindful eating. Retrieved from http://
www.webmd.com/parenting/raising-fit-kids/food/mindful-eating-for-
families
Wolever, R., & Best, J. (2009). Mindfulness-based approaches to eating
disorders. In F. Didonna & J. Kabat-Zinn (Eds.), Clinical handbook of mind-
fulness (pp. 259-287). New York, NY: Springer Science.
Youngwanichsetha, S., Phumdoungm, S., & Ingkathawornwong, T. (2014).
The effects of mindfulness eating and yoga exercise on blood sugar levels
of pregnant women with gestational diabetes mellitus. Applied Nursing
Research. Advance online publication. doi:10.1016/j.apnr.2014.02.002
Lee Stadtlander is a researcher, professor, and the coordinator of
the Health Psychology program at Walden University. As a clini-
cal health psychologist, she brings together pregnancy and health
care issues.
or ice cream, donuts or tofu, and you can introduce
it at home, at work, or even as you snack on the go
(though you may find yourself doing this less often).
And while the focus becomes how you eat, not
what you eat, you may find your notions of what you
want to eat shifting dramatically for the better too.
For additional information see: Eat What You
Love, Love What You Eat, an easily understood guide
by Michelle May (2013) and Mindful Eating by Jan
Chozen Bays (2009). Bays’ book takes a more detailed
meditative approach and includes a CD with guided
meditation exercises.
References for this Guide:
Grover, J. (2014). http://www.mnn.com/food/healthy-eating/stories/
mindful-eating-5-easy-tips-to-get-started
Web MD. (2014). http://www.webmd.com/parenting/raising-fit-
kids/food/mindful-eating-for-families
References
Bays, J. C. (2009). Mindful eating: A guide to rediscovering a healthy and
joyful relationship with food. Boston, MA: Shambhala.
Boudette, R. (2011). Integrating mindfulness into the therapy hour. Eating
Disorders, 19, 108-115. doi:10.1080/10640266.2011.533610
Caldwell, K. L., Baime, M. J., & Wolever, R. Q. (2012). Mindfulness based
approaches to obesity and weight loss maintenance. Journal of Mental Health
Counseling, 34(3), 269-282.
Center for Mindful Eating. (2014). The principles of mindful eating.
Retrieved May 31, 2014, from http://www.thecenterformindfuleating.org/
principles
Doty, R. L., & Cameron, E.L. (2009). Sex differences and reproductive
hormone influences on human odor perception. Physiology & Behavior,
97(2), 213–228.
Galtier-Dereure, F., Boegner, C., & Bringer, J. (2000). Obesity and preg-
nancy: complications and cost. The American Journal of Clinical Nutrition,
71(Suppl.), 1242S-1248S.
Gongora, V. C , Derksen, J. J., & van Der Staak, C. P. F. (2004). The
role of specific core beliefs in the specific cognitions of bulimic patients.
Journal of Nervous and Mental Disease, 191, 297-303. doi:10.1097/01.
nmd.0000120889.0161L2f
Grover, J. (2014). Mindful eating: 5 easy tips to get started. Retrieved from
http://www.mnn.com/food/healthy-eating/stories/mindful-eating-5-easy-
tips-to-get-started

by Abbie Goldbas, MSEd JD
Abstract: Genetically modified organisms
(GMOs) have been altered by changing
their genetic make-up. The most familiar
ones are used as food and in medicine.
There are advantages and disadvantages
to their use. Foods can be pest-proofed,
food production can be increased, and
the food can be nutritionally improved.
The disadvantages are that GMOs can
be harmful. Caution must be used when
dealing with GMOs. More research has
to be conducted to determine benefits
and risks. While regulations are being
enacted, a wide grass-roots movement is
currently promoting non-GMO foods and
agriculture because many people believe
they must protect themselves and the
agricultural environment.
Keywords: GMO, GE, soy, labels, medical research and treatment,
GMcassava, Round-Up Ready Soy
Genetically modified organisms (GMOs) and geneti-
cally engineered (GE) foods have become very controversial
(Wohlers, 2013). However, GMOs are not just used in
foods. They have been successfully used for years in a vari-
ety of fields such as in medical and biological research, drug
production, and medical treatments (Phillips, 2008). They
are also used in the development of biodegradable plastics
and the development of bacteria for bioremedial treatments
of oil spills (Macaulay & Rees, 2014; Yunxuan, Yingxin, &
Min, 2014).
The most controversy and confusion appears to be in
regard to food safety (Goldstein, 2014). While this article
includes descriptions of GMOs in food and medicine (the
medical information is included to assist in a broader under-
standing of GMOs), the main focus is an explanation about
what GEs foods are, an analysis of the current controversy
in the food industry, and some suggested ways to avoid GE
foods if it is deemed necessary.
GMOs
GMOs are organisms whose genetic make-ups have
been changed by mutating, inserting, or deleting genes,
by using genetic engineering techniques or biotechnology
(Klein, Wolf, Wu, & Sanford, 1987). For instance, genes
attached to a virus can be exposed to an animal, or shot
with a syringe into the nucleus of a host’s cell (Klein et al.,
1987). Various hosts include bacteria, insects, plants, fish,
and mammals. Animals have been genetically modified since
they were first domesticated around 12,000 BCE and altered
plants were available around 10,000 BCE (Root, 2007). More
recently, in 1973, the process of genetic engineering, which is
the process of directly transferring DNA from one organism
to another, was developed (Collins, Green, Guttmacher, &
Guyer, 2003).
Advantages
Medicines
Plants, animals, and bacteria have been used since the
1980s, for instance in the production of pharmaceutical
drugs (biopharmaceuticals) such as the hepatitis B vaccine as
well as in gene therapy (Phillips. 2008). Edible vaccines that
do not require refrigeration are now being developed for use
in remote locales where refrigeration is not feasible (Zapalska
& Kowalczyk, 2013).
Genetically modified organisms (GMOs)
and genetically engineered (GE) foods
have become very controversial
Animals are now genetically altered for many human
medical purposes including research about diseases, the cre-
ation of pharmaceutical products, and the growth of curative
tissues for implants (Phillips, 2008). The drug ATRyn is from
transgenic goat’s milk; it is an anticoagulant used to reduce

blood clots in childbirth and surgery (Erickson, 2009). This
was the first human biological drug from an animal ap-
proved by the U.S. Food and Drug Administration in 2009
(Erickson, 2009). Malaria-resistant mosquitoes have been
developed. Besides saving people from this disease, these
new mosquitoes may eventually mean harmful chemicals
such as DDT will no longer be needed to control mosquito-
borne malaria (Resnik, 2012). Genetically modified bacteria
is used to make protein insulin to treat diabetes as well as
human growth hormones used in the treatment of dwarf-
ism (Baxter, Bryant, Cave, & Milne, 2007; Lamont & Lacey,
2013). Further, new combinations of organisms are used in
biological and medical research. One procedure is to remove
green fluorescent protein (GFP) from jellyfish and insert it
in mammals. Once in the mammalian genes, the bright GFP
can be tracked and certain biological processes, such as the
activity of neuronal cells in the brain can be studied (Zim-
mer, 2009).
Another illustration is human gene therapy. Viruses
are genetically modified to implant genes that can alleviate
diseases and treat genetic disorders (Phillips, 2008). Some of
these diseases are cystic fibrosis, Parkinson’s, heart disease,
muscular dystrophy, and cancer (Center for Health Ethics,
2011).
Plants and Other Foods
To many, especially those charged with preventing star-
vation and malnutrition in developing countries, GMOs are
considered major biotechnical advancements in agriculture.
Breakthroughs include food plants which have been altered
to be pest-resistant and have greater nutritional values (Gold-
stein, 2014). A case in point is South African white corn that
can now be enriched to have greater protein content (Sayre
et al, 2011). Additionally, plants have been modified to be
resistant to herbicides and virus damage (Phillips, 2008).
Plants are also being developed for increased yields which
can grow in heretofore useless geographical areas plagued
with droughts (Phillips, 2008).
The proposed altered cassava plant (GMcassava) is an
illustration. The cassava is a starchy root eaten by people in
tropical Africa. Approximately 40% of the food calories in
this land come from cassavas (Hinneh, 2012). GMcassavas
boast increased minerals, vitamin A, and protein content.
The nutrient dense food can help prevent childhood blind-
ness, iron deficiency anemia, and infections due to damaged
immune systems. They are also pest-resistant (Hinneh, 2012).
Animals, too are genetically modified and are con-
sidered remarkable developments in food production.
Examples include modified dairy cows: scientists in China
can now produce cow milk that is similar to human breast
milk for those mothers who cannot breastfeed (Stevenson,
2011). New Zealand scientists have genetically engineered
cows that produce allergen-free milk (Jabed, Wagner, Mc-
Cracken, Wells, & Laible, 2012). Additionally, a new fish
called AquAdvantage salmon developed by AquaBounty can
grow in half the time and twice the size of ordinary salmon
(Ahrens & Delvin, 2010).
Disadvantages
Medicines
There is far less of a debate regarding the use of GMOs
in the field of medicine. Nevertheless there are several
controversies, one of which is the risk factors of possible haz-
ardous gene products from gene therapy; another concerns
ethical and philosophical issues. The uncontrolled combina-
tions of genes and the release of hazardous GMO viruses
are real, frightening risks (Bergmans et al., 2008). And, gene
therapy, for instance, engenders ethical dilemmas and to
some, fears of designer children and the unlimited extension
of human life spans. Thus, GMOs appear beneficial but must
be regulated and used with particular care (Goldstein, 2014).
Plants and Other Foods – Regulation
Both scientists and consumers world-wide do not com-
pletely understand GMO food crops, neither their benefits
nor their risks (Hinneh, 2012). The United Nations (UN) has
established the Cartagena Protocol on Biosafety to provide
TaraRenaud

guidelines for GMOs (Hinneh, 2012). The UN guidelines are
“precautionary measures that employ countries to undertake
in-depth testing based on sound understanding on scientific
principles governing modified organisms, environmental
impact assessment, health and safety risks as well as benefits
and economic benefits before adopting the technology”
(Hinneh, 2012, p. 2). On the African continent, while South
Africa, Burkina Faso, and Egypt now grow the genetically
altered crops of maize and cotton, other countries such as
Nigeria, Kenya, and Uganda are cautiously limiting GMO
agriculture to confining field trials (Hinneh, 2012). Further,
Project on Strengthening Capacity for Safe Biotechnology
Management in sub-Sahara Africa (SABIMA) proposes the
coordination of scientists, farmers, processors and consumers
in evaluating GMcassavas and promoting them to overcome
people’s anxiety and fear regarding environmental impacts
and chemical-laden foods (Hinneh, 2012). When faced
with African extreme hunger, malnutrition, food security
problems, and low agricultural productivity, the advantages
of GMcassavas and other foods seems to be inarguable. But
caution remains, not only among African nations but in
other countries as well (Goldstein, 2014).
The European Union (EU), on the other hand, has a dif-
ferent approach to regulating GMOs. The countries compris-
ing the EU are guarded: GMOs are banned if they engender
scientific uncertainty; empirically established dangers need
not be proven (Hinneh, 2012). By contrast, the United States
is one of the least regulated countries. U.S. federal regula-
tions are minimal – companies can sell GMO products that
pass ostensible tests for toxicity and allergenicity, and diges-
tivity only (Hinneh, 2012).
In the United States today, the most popularized and
polarizing issue is whether products that contain GMOs
should be labeled as such (Goldstein, 2014). Goldstein
(2014), a Monsanto researcher, expressed a positive but dis-
criminating attitude towards GMOs. He made a cogent argu-
ment that the current debate is the result of “a combination
of unfounded allegations about the technology and purvey-
ors, pseudoscience, and attempts to apply a strict precau-
tionary principle” (p. 1). While hyperbole, such a declaration
can be said because there is little empirical evidence that has
identified GMOs as direct culprits of ill health. Nevertheless,
the recent debates over the need for laws to force GMO-full
disclosure labeling on products (labeling circumvents the
necessity to prove harmful effects) in the states of California
and Washington have alerted the nation to the possible risks
of GMOs (Gillam, 2013).
Labels are important, especially if one is allergic to soy.
Genetically modified soy-based products have various names
listed in the ingredients: gum Arabic, mixed tocopherols,
soya, soja or Uba, textured vegetable protein (TVP), lecithin,
natural flavoring, stabilizer, and hydrolyzed plant protein
(HPP) or hydrolyzed vegetable protein (HVP). The list goes
on (Bradley, 2014).
Without federal regulations, a few states including Ver-
mont and Oregon have taken the lead with regard to labeling
(Loew, 2014; Wohlers, 2013). In April of this year, Vermont
was the first state in the union that passed a statute that
requires all GE foods sold in that state (except for food sold in
restaurants, dairy products, meat, and alcohol) to be labeled
as such by July 1, 2016 (Burlington Free Press, 2014). This law
was enacted despite the powerful campaign that was waged
against it by the GMO industry. Oregon is the next state that
will try to enact a labeling statute (Loew, 2014).
Monsanto, known mainly as an herbicide manufacturer,
is an example of a company fighting the labeling laws. It is
one of a number of companies in the food industry that has
spent millions of dollars lobbying against labels on GMOs
(Gillam, 2013). The Grocery Manufacturers Association
(GMA), which represents Monsanto and more than 300
other companies (mostly pesticide and junk food manufac-
turers), has threatened to sue any state, including Vermont,
which passes a law such as the one enacted in Vermont (Gil-
lam, 2013; The Burlington Free Press, 2014).
Monsanto makes Roundup-Ready Soy, a plant that
resists the herbicide Roundup. Soybean oil, according to
the U.S. Soy Board, is in most of our processed foods and
is used in fast food preparation (Mercola, 2013). According
to the U.S. Department of Agriculture, approximately 94%
of the soybeans grown in the U.S. are genetically modified
(Dupont, 2013). It has been shown that Roundup-Ready
soybeans are nutritionally inferior to non-GMO soybeans. In
addition, they have more chemical residues, including the
herbicide glyphosate, a possible contributor to chronic dis-
eases and female hormonal imbalances (Bohn et al., 2014).
Pollan (2007) in a remarkable article about the his-
tory and vagaries of modern food consumption noted that
more than 17,000 processed food products are introduced
in the U.S. each year. They contain high fructose corn syrup,
unhealthy fats, and undisclosed chemicals.

Alternatives to Government Regulations
As the debates continue over safety regulations of
GMOs, and because people are re-evaluating the industrial
food model as well as what exactly they may be eating, there
has arisen a movement toward better alternatives through
local food initiatives that support smaller, biodynamic farms,
community gardens, and home-grown products. These
grass-roots endeavors provide sustainable agriculture and
nutritious GMO-free foods. They boost the concepts of
culture and community (Biodynamics Association, 2014). An
example is the Community Supported Agriculture (CSAs).
They are pre-paid programs that enable farmers to supply
fresh produce to people at less cost to them and the consum-
ers. The Internet website, www.localharvest.org/csa/, lists
databases for local CSAs in the U.S. Slow Food USA is a
world-wide organization dedicated to “good, clean, and fair
food for all” (Slow Food USA, 2014). It can be found on the
Internet at www.slowfoodusa.org. There are Buy Fresh Buy
Local (BFBL) chapters listed by state that assist consum-
ers in finding fresh products. The Internet address is www.
foodroutes.org/buy-fresh-buy-local/bfbl-chapters/. The
Institute for Responsible Technology has a website that has a
Non-GMO Shopping Guide (an app is available). Finally, one
can purchase products that bear the USDA 100% Organic
label or buy groceries at Whole Foods Markets starting in
2018 when they will require all GE products to be labelled
accordingly (Polis, 2013).
Conclusion
GMOs are not all bad. If fact, if used appropriately,
they can relieve much human suffering, whether it be due
to malnutrition or disease. But safety is the issue. Research
and regulation are paramount. Phillips (2008) suggested that
“due diligence and thorough attention to the risks associated
with each new GMO on a case-by-case basis” (p. 215). This is
expecting a great deal, however a great deal is at stake.
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Abbie Goldbas, MSEd, JD is a practicing appellate attorney in
upstate New York. She used to specialize in Family Court law
and child advocacy. Her interest in this topic stems from her
experiences with her own seven children and her training as a
Health Coach. Abbie is currently writing her dissertation in a
PhD program in Health Psychology at Walden University.
Brief Writer’s Guidelines for the ICEA Journal
Submitted articles should express an opinion, share
evidence-based practice, disseminate original research, provide
a literature review, share a teaching technique, or describe an
experience.
Articles should be in APA format and include an abstract
of less than 100 words. The cover page should list the name of
the article, full name and credentials of the authors and a two
to three sentence biography for each author, postal mailing
addresses for each author, and 3 to 5 keywords. Accompanying
photographs of people and activities involved will be
considered if you have secured permission from the subjects
and photographer.
In Practice Articles
These shorter articles (minimum 500 words) express an
opinion, share a teaching technique, describe personal learning
of readers, or describe a birth experience. Keep the content
relevant to practitioners and make suggestions for best practice.
Current references support evidence-based thinking or practice.
Feature Articles
Authors are asked to focus on the application of research
findings to practice. Both original data-driven research and
literature reviews (disseminating published research and
providing suggestions for application) will be considered.
Articles should be double spaced, four to twelve pages in
length (not including title page, abstract, or references).
For more information for authors please
see our website at http://www.icea.org/content/
information-journal-writers
If you have a teaching practice you want
to share, but don’t feel confident writing,
let me help you. editor@icea.org

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