My Labor Story
It's been a year since Toren was born and I was reborn as a mother. I remember the days as if they were a vivid dream. Some moments remain crystal clear, while others seem like they belong to someone else. But I know, it was all me 100% of the time. Fortunately, I had a very easy pregnancy. During my first trimester I had some light spotting between weeks 6-8, and then afternoon fatigue around that same time. I also remember that my appetite was suppressed and I did not enjoy cooking. Luckily, around week 12, all that went away and my passion for cooking and eating returned. As the pregnancy progressed, everything else went smooth. I gained ~25lbs, which honestly looked like a lot more on my little frame. I am still amazed that I was able to walk let alone balance with all that weight in front of me. Although my pregnancy was easy, my labor and delivery were tough. In retrospect, I think I would do it all over again. Thirty-three hours of insanity for nine months of ease seems like a fair enough trade. In comparison to some moms I know, my labor story would be considered easy. But for me and many others, it would be considered a rough ride. 

​​It all started after a wonderful blue bird day up at Mt. Baker. We decided to rent a cabin in Glacier and go snowshoeing for our last hurrah. It was a week before my due date and we knew it was "risky". Everyone thought we were crazy, but we didn't care. After a glorious day on the mountain concluding with a nice 20 minute hot tub soak, it began. I became Warrior Selva, excited, determined, and courageous. Little did I know that 24 hours later I would be scared for my life. Despite a supportive midwife, doula, and husband, I had to transfer to the hospital. Toren unfortunately was sunny side up and at an angle, causing me to involuntary bear down even though my body was not ready yet. After hours of involuntary pushing and in-between contraction shakes that caused my whole body to tremble rigorously, I was left feeling exhausted and defeated. I needed relief, I needed a break, and I needed to calm down. I believe my high stress and fear caused my body to start developing a syndrome called HELLP, a life threatening pregnancy complication, where the mortality rate has been reported to be as high as 30%. The hospital staff also informed me that there was a good chance that Toren may need to be born via C-Section. Luckily, upon arrival at the hospital, first the fentanyl and secondly the epidural, both saved my life. I was able to relax after four hours. I no longer had the shakes, I was able to "nap", and with the help of Pitocin, Toren was able to turn into the correct position. After seven hours of rotating from side to side with a peanut pillow between my legs, the nurse midwife told me I was ready to push. After an hour and a half, Toren entered our world without interventions. I was beyond relieved that it was over. We both survived and we were healthy. I also clearly remember hearing the nurse midwife comment on my placenta, "this is the largest, most robust placenta I have seen". And that made me proud :) 

Thereafter, the hospital staff was mostly concerned with my recovery. Due to the HELLP syndrome my liver enzymes had shot up and my RBC and platelets dropped. They even wanted to give me blood. But luckily I recovered quickly and since I didn't have any symptoms (such as dizziness or changes in vision), they let us go home two days later. However, due to the many hours of involuntary pushing, I was very sore and swollen. My many nurses at the hospital often commented, "Oh, honey!" every time they examined me. I also had a vaginal wall tear that burned so bad every time I had to urinate. From there on out, recovery was a long road.

Although birth happens every day, a thousand times over, it is not a walk in the park. Many people unfortunately think women should be able to bounce back in no time. Three weeks leave should be enough time right? NO! Six weeks is not enough either! I often hear, "oh maternity leave must be so nice since you aren't working for three months. It must feel like vacation." Umm, no, it is definitely not vacation. Birth is very hard, becoming a mother is a huge transition, and some women may have additional complications with breastfeeding, a colicky baby, or postpartum depression. The Fourth Trimester should be a time where the community supports the new mom and baby. It should not be a period of time when the mother is given additional guilt.

With that said, I want to share some of my professional wisdoms to help support new moms in my community. To empower them with information that will hopefully ease the transition into motherhood. When I became a new mom I realized how little quality nutrition information was given from health care providers. At first I thought they didn't provide me with information because I was a dietitian. But as I asked around, none of my friends received any specific dietary recommendations besides "eat a healthy diet and take a multivitamin". First of all, what is a healthy diet postpartum? And what kind of multivitamin should be considered? Many people may think that a healthy diet means eating salads and smoothies every day for breakfast, lunch, and dinner. But unfortunately, this practice could leave the mom and baby nutrient deficient. Read on for my general recommendations during the Fourth Trimester to make sure you and your baby are getting the nutrients you need for health and recovery as well as breast milk quality.

The Fourth Trimester
Commonly called the Fourth Trimester, the postpartum period is a very critical time for both the new baby and new mom. Many people lose sight after delivery how important proper nutrition is after the baby is born because so much attention is placed on nutrition during pregnancy. But did you know that your nutrition needs actually increase after delivery? During the third trimester calorie needs are about an additional 450kcal per day while exclusive breastfeeding during the first six months requires on average 675kcal per day. Plus, that doesn't take into the account of the extra calories needed to recover from birth and the insane amounts of energy required during birth. This means that some moms require even MORE than that, especially in the immediate weeks following delivery! Thereafter, when baby starts to consume complimentary foods, energy cost of lactation is between 450-500kcal per day. 
 
However, we cannot just focus solely on calorie needs but also the increased needs of certain nutrients that if not provided in adequate amounts via diet or supplementation can reduce the proper growth and development of baby. Furthermore, we cannot forget about mom! After delivery mom also requires special attention to certain foods for proper healing and recovery. And not to mention a lot of rest! Many traditional cultures encourage moms to stay home and heal for on average 40 days, with the first week considered a very fragile time with very limited movement and activity. Check out this book for inspiration. In today’s day and age we often don't give enough credit and attention to the needs of mom during the Fourth Trimester. The “Supermom” “Do it all” mentality is unrealistic and can also be detrimental to both mom and baby. 

​Highlighted Nutrients of Concern For Mom & Baby
Even if a mother is undernourished calories, protein, folate, and most trace minerals are sufficient in the breast milk to ensure survival of the infant by relying on the mother’s stores. However, for other nutrients such as B vitamins (besides folate), fat soluble vitamins A, D, E, and K, choline, fatty acids (such as DHA), and certain trace minerals iodine and selenium, the mother’s diet does affect the amounts found in the breast milk. Compared with pregnancy, lactation requires not only more calories but also more nutrients. Furthermore, radical dietary changes will drastically impact the quality of breast milk. Low calorie diets less than 1800kcal per day and drastic dietary changes, such as very low carbohydrate or low fat diets, can impact breastmilk production. Therefore, it is not recommended to restrict carbohydrates, fats, or proteins while breastfeeding without possibly reducing breastmilk production and quality.

Macronutrients
It is essential to honor your hunger cues during the postpartum period. If you have been following a low to moderate carbohydrate diet (~90-150g per day) throughout pregnancy to manage gestational diabetes or weight gain, it is fine to continue this during lactation. However, if you start to restrict carbohydrates drastically after delivery in hopes to lose weight then this may negatively impact breastmilk production as well as adrenal and thyroid function. Carbohydrate needs depend on a variety of factors. In my practice I have found a range of 30-40% of calories (or about 170-230g of complex carbs based on a 2300kcal diet) to work for most lactating women. However, it is best to work with your dietitian to find a carbohydrate range that will best support you through the postpartum period. Furthermore, pairing these complex carbohydrates with quality fats and proteins helps stabilize blood sugars, providing more stable energy, and reducing added stress on the adrenal glands. Aiming for around 100g of protein per day, divided between meals and snacks, is a good baseline for most nursing moms. Furthermore, protein rich foods are often excellent sources of the highlighted nutrients below. Quality fats provide the remaining energy, omega-3 fatty acids, and are essential for the absorption of fat soluble vitamins.
 
B12
Women who consume vegan or vegetarian diets are at a high risk of developing vitamin B12 deficient milk. Inadequate vitamin B12 content in the mother’s diet or lack of supplementation can cause the infants brain to shrink and present itself as irritability, failure to thrive, and anorexia with severe growth stunting. Tip: Add in B12 rich foods daily via clams, liver, eggs, seafood, and animal meats. If vegan, supplementing with 1000mcg of cyanocobalamin bi-weekly (or this product once weekly) can help maintain adequate vitamin B12 stores. Recommendations change if you have been diagnosed with a deficiency. 
 
Choline 
Choline needs increase dramatically during lactation and is essential for proper brain development along with folate. Adequate choline intake increases memory capacity and prevents age-related memory and attention deficit. The estimated daily need is 550mg per day for breastfeeding moms. Foods rich in choline include eggs (150mg per egg), oysters (110mg per 3oz), and organ meats (liver – 360mg/3oz and kidney 440mg/3oz). Many traditional cultures encourage plenty of choline rich foods in the postpartum period with some eating 8-10 eggs per day! Unfortunately, many young women are not getting enough choline through diet alone. Plus, many multivitamins contain only very little choline or none at all. Once again vegans or vegetarians are most at risk for inadequate choline intake. Tip: Recommend eating choline rich foods daily and ensure additional choline content in multivitamin. Additional supplementation for mother’s eating a vegan or vegetarian diet may be warranted.
 
Iodine  
Worldwide many people are at risk for iodine deficiency due to low intake of seafood and seaweed, iodine deficient soil, increased exposure to chlorine, and limited use of iodized salt. Iodine plays an essential role in thyroid health and metabolism. In infants the iodine pool turns over rapidly and therefore requires a consistent, steady source of iodine via the maternal diet to make sure baby gets enough. Tip: Add dulse flakes when cooking savory meals, add a kelp frond to soups, and enjoy quality seafood, eggs, and dairy often. Also, check your multivitamin to see if there is added iodine. 
 
Fat Soluble Vitamins A & D
Both vitamin A and vitamin D are crucial for infant growth, immune system development, and prevention of infection. Vitamin A needs increase significantly during lactation. However, just eating carrots or sweet potatoes will not provide enough of the active pre-formed vitamin A (retinol) that is required. You will also want to be careful with supplements that provide only beta-carotene for vitamin A supplementation. Research found that women who supplemented with only beta-carotene (without the pre-formed vitamin A) had vitamin A deficient breast milk 40% of the time vs. 4% in women whose multivitamin contain both beta-carotene and retinol. Furthermore, you need fat in your diet in order to absorb fat soluble vitamins. If fat is restricted due to weight loss goals, the content of fat soluble vitamins (such as vitamin A, E, K, and D) in breastmilk will be lower. Tip: Animal fats and organ meats are a great source of pre-formed vitamin A, including egg yolks and grass-fed butter, as well as liver.
 
Breast milk has long been noted to be vitamin D deficient and exclusively breast fed infants are encouraged to supplement with additional 400IU of vitamin D/day. Exposure to sunlight via mother’s skin during the months of March through September can provide a good source of vitamin D. Additional vitamin D3 supplementation of 1000-2000 IU/day is also recommended to maintain blood serum levels of 40-60ng/mL. Alternatively, recent research has found that mothers can increase their supplementation dose to 6400IU per day to ensure adequate vitamin D3 in breastmilk for the infant. Therefore, eliminating the need for additional baby vitamin D3 drops. Tip: recommend all breast feeding mothers check their vitamin D3 status and adjust supplementation per health care provider recommendations. 
 
DHA & Fatty Acids
The maternal diet directly effects the fatty acid content of breast milk. Omega-3 fatty acids have been found to be especially important for infant brain development. Infants whose mother’s had high DHA levels have improved neural and visual development. Dietary choices definitely make a difference. Women who eat on average of 4.5oz of seafood/day have DHA concentrations of about 2.8% whereas vegan mothers only have a DHA concentration of about 0.05%. Furthermore, DHA levels are only adequate in breastmilk when mothers diet contains omega-3 rich foods or supplements consistently. Tip: Consume low mercury seafood like salmon and sardines, grass-fed beef and eggs, and continue to take a quality DHA fish or algae oil supplement while breast feeding. Flaxseed oil supplementation does not increase DHA in breast milk. 

​Highlighted Nutrients of Concern For Healing & Recovery
Mom's go through the wringer. Whether it was a long labor, vaginal tearing, or a c-section, healing needs are high postpartum. Tissues that have been stretched, torn, or cut require additional protein for regeneration and repair. The amino acids proline and glycine are especially important because your body uses these to make collagen for the regeneration of connective tissue and skin. Foods rich in collagen like bone broth, slow cooked meats, chicken skin, fish skin, or pork rinds will provide these amino acids. Check out my recipe for a collagen rich bone broth here. Tip: Aim for 12-15g of collagen protein per day. You can also use collagen peptide powder supplements for ease. 

Furthermore, iron rich foods like organ meats, grass-fed beef, and oysters can be especially helpful to replace iron lost during birth and the days following. My Blood Building Liver Pate is a family hit and an excellent way to provide nutrients for RBC production, including iron, folate, B12. Plus, did you know that vitamin A plays an essential role in iron metabolism? Research has found that vitamin A supplementation along with iron supplementation improves anemia better than iron supplementation alone. Liver, once again, is an excellent source of vitamin A. 

Finally, plenty of fluids are essential for mama and baby during the postpartum period. During the first two weeks when hormones levels are fluctuating and leaving you soaked upon waking, fluid and electrolyte needs are very high. Therefore, it is recommended to aim 3-4L per day, including savory broths, warm beverages, and coconut water to help replace electrolytes. Thereafter, aiming for 3L per day while breastfeeding is adequate. 

In Conclusion
If you have made it this far, I applaud you! As you can see warming and hearty meals rich in animal proteins, offal, and quality fats, is an essential part of a quality postpartum diet. Don't get me wrong, vegetables and fruits are important too, but they should not be the only focus. Raw vegetables can be difficult to digest, and during the early period of recovery, cooked vegetables are easier on the digestive tract allowing for enhanced absorption of nutrients. Gentle starches such as cooked tubers, squash, and well-cooked grains can help provide sustained energy when paired with quality proteins and fats. Raw fruit when paired with a fat or protein can be an excellent snack. For example, diced strawberries topped with organic whipped cream, a diced kiwi served with organic whole milk yogurt, or a pitted medjool date stuffed with almond butter. Getting enough calories is important as well. If you are hungry, please eat! Even if it is in the middle of the night between feeds. Avoid skipping meals or going too long between meals. Simply honor your hunger. Finally, it can be helpful to work with a skilled dietitian to help guide you through the postpartum period. Additional labs and supplements can be helpful in varying cases, especially if energy/vitality is low, anxiety/depression persists, or nutrient deficiencies are noted by your health care provider. 

If you would like more in depth nutrition information to support the postpartum period and breast milk quality, then please join me at the Bellingham Center for Healthy Motherhood on select dates. For more information regarding this class click here.

So I know I am going against the grain by saying this (especially as a dietitian)….but I don't like weekly meal plans or Sunday Meal Prep. There I said it. I see the appeal, and for some it may be helpful, but it may not be helping YOU. Meal planning principles take away from intuitive eating. It also reduces the potential to explore creative and seasonal cooking, which can make cooking so much fun in the first place! This is why I NEVER create week long meal plans for my patients. I provide them with recipes and put together a Sample Meal Plan based on their unique needs and preferences to be used as a template moving forward, including timing of supplements, portion sizes, etc. It is meant to be a guide, not the law. Meal plans can be a barrier to change and in my opinion do NOT support intuitive eating and food freedom. 
 
I am a firm believer that if you listen, your body will guide you towards what you need nutritionally speaking. However unfortunately, there is a lot of nutrition confusion in the public due to generalized nutrition statements usually heightened by mass media, Instagram "influencers", propaganda, and well meaning friends/family members who are "into nutrition". So many times, people come to me with a variety of food rules (and anxiety around food) that they "read about", "heard about",etc. Most of the time, they have not been given individualized nutrition recommendations by a qualified nutrition practitioner. Consequentially, they are left with many nutrient gaps and possible nutrient deficiencies. However, if you are able to quiet the nutrition "noise" given by unqualified individuals and mass media, and simply focus on eating a whole foods diet limited in processed ingredients and rich in a variety of plants, slow starches, quality proteins, and fats, then the nutrient density of your diet will be more robust. Plus, if you eat a balanced whole foods diet, eating intuitively and listening to your body cues becomes a much easier practice. There is no need to follow a fancy meal plan using expensive superfood ingredients. With minimal mental power expended, you can create healthy meals that you CRAVE and WANT (and your body needs) in the moment using whole foods, no matter what kind of diet you may be following for therapeutic/religious/cultural reasons. How do you do that? Casual creative cooking!

​The thing is, meal planning and Sunday Meal Prep can be helpful for some. They do expose you to different foods and methods of preparation, and also offer portion size control. For some people this rigid practice helps reduce stress around food. BUT, they totally disregard intuitive and mindful eating practices. Rather, you are eating food that you prepared on Sunday and may not actually want or desire to eat on Wednesday. What happens then? Either food waste, or lack of satisfaction, and food boredom. I know when I am not satisfied, I crave or want what WILL satisfy me. If I eat the pre-prepared bean/grain salad pictured above 3+ meals a week, I am not going to feel satisfied even if it is a healthy whole food based recipe. It may even cause me to desire choices that are not going to help me reach my health goals, especially if the meal I prepped is still leaving me hungry. Also, pre-made meal plans do not address what YOUR body needs. Eating the same meal over and over again can increase the likelihood of the development of nutrient deficiencies due to lack of variety. Nutrient needs fluctuate hourly, daily, and weekly depending on your activity levels, age, stress, menstrual cycle, etc. Food cravings are often signals that the body needs certain nutrients found in that food. By working with a skilled dietitian, they may be able to bring to light your cravings in relation to possible nutrient gaps in your diet. 
 
Since meal plans and Sunday Meal Prep take away our innate ability to "listen to our bodies", I encourage casual creative cooking (CCC) as an alternative. With some tools, you can do this too and save mental power, save time, enjoy foods that you want here and now, and be more able to listen to your body cues. It also helps you be creative with what you have in the fridge instead of following a recipe to a “T”. Recipes are great to help you find new flavor profiles and cooking techniques, but cooking this way all the time, takes away flexibility. Buying foods that look good or sound good to you at the market or grocery store and preparing something on the whim is going to be so much more satisfying and fun! Plus, casual creative cooking can help you become more comfortable creating meals with "what's in the fridge", thereby reducing food waste, and naturally opening up a few days a month when "take out" or a dinner out can be a fun tasty way to fill the grocery gap. 
 
So how can you do this?? Of course a little prep is required…but not all at once, and not a ton. I like to compare this to cleaning. If you clean the toilet one day, vacuum the living room the next, water the plants on the third, etc, etc… they all only take a few minutes each. BUT if you do them all at once, it seems daunting, and it DOES take a lot of time…usually leaving you stressed and exhausted. It isn’t fun. But if it’s in the moment, you have good music playing, and it’s only a few minutes here and there, you do not even realize that you spent time doing it.

In order to be successful with casual creative cooking, think staples. A healthy balanced meal usually consists of four main parts; a slow starch (carbohydrate), a protein, a fat, and veggies (cooked or raw). Plus, a few other fun things as you have them available. See the Bastyr Healthy Plate for reference. The main thing that helps you succeed is preparing some starches or veggies casually throughout the week, just like you would causally clean your home. For example, steam a bag of Yukon gold potatoes (or any tuber). This can be done without any real effort. Once they are steamed, you can eat the potatoes cold in a salad, quickly chopped as part of a breakfast hash, added into soups, reheated and eaten as is (with butter of course), or mashed into potato pancakes. You can use them in any way that YOU WANT IN THE NOW. Another example is you can cook some lentil pasta, rice, or quinoa, or simply drain a couple cans of beans. Once they are prepared and ready, they are easy to add into stir-fries, salads, or reheated with leftovers. The possibilities are endless when they ARE in your fridge. If they are in the cupboard, out of sight, out of mind waiting for that “perfect” recipe, then they will not make it on to your plate. As simple as that. 
 
For veggies, casual prep is also essential. When you decide to use some chard or kale for a meal, wash and chop the whole bunch at once. It only takes a couple more minutes, and then you have easily available prepped greens to throw into omelets, pasta, one skillet bakes, smoothies, anything! They are just waiting for you to grab a handful! Same goes for onions, cabbage, etc. Also, buy veggies that don't require any prep at all, like sugar snap peas, baby bell peppers, cucumbers, cherry tomatoes, avocados, or bagged broccoli/cauliflower florets for easy snacking. All you have to do is buy them, as you crave them!
 
When it comes to protein, this is the only ingredient that requires a little bit of forethought. I have a  freezer full of different pasture-raised protein options. An hour or two before a meal (or earlier that day), I ask myself, what sounds good? Then I pull that out of the freezer to thaw in some cool water. I also usually keep a few “easier” staples around in case I come home too late and don't have the time to thaw a protein. These include extra firm tofu, eggs, liver pate or deli meats, and packaged chicken sausages. I also always have canned sardines and salmon in the pantry just in case. Naturally, cooking larger portions of protein, also allows me to have leftover protein for the following day or days, making life even easier moving forward. For example, if I want a burger, I thaw a whole pound and make 4-6 burgers to eat throughout the week, or freeze for later. 

​Fruit is usually easy because it doesn't require cooking or much preparation. Generally, as part of a anti-inflammatory lifestyle, aiming for 2-3 fruit per day is ideal. Buying a variety of different fruits once again offers you a variety of nutrients. Read my article on Fruitphobia if you are concerned about the carbohydrates in fruit. 
 
Finally, thinking outside of the box is essential to causal creative cooking and food freedom. If you let go of the idea that a certain food needs to be prepared or served a certain way, then you have endless possibilities. Not everything has to be Instagram worthy. If it tastes good, and if it satisfies you, then you did it! Just aim to have all four components of a balanced meal: a slow starch, quality protein, quality fat, and veggies. For example, the burger can be so many things. It can be used in a traditional hamburger with a whole grain bun and side salad, it can be cut up into a veggie soup with some steamed potatoes and handful greens, it can be served like a steak with roasted squash and asparagus, or it can be crumbled into tacos, etc. You get my drift. Also, casual creative cooking allows you to utilize leftovers in a different way then they were originally prepared. 
 
So, what do you think? Is meal planning a MUST for you? Or would you rather learn the way of casual creative cooking, listening to what YOU WANT AND NEED IN THE NOW?
 
For this new year I encourage you to try something different. Your success as a human is not based on how many perfectly prepared work lunches you have stacked in your fridge. Instead of spending money on pre-made meal plans that don't address your unique needs and preferences, or spending hours planning out meals for the entire week, instead use the money and time to take a cooking class with a friend or buy an ethnic cookbook for recipe inspiration. THIS will help increase your kitchen skills and allow you to cook more creatively and intuitively. Just like anything, causal creative cooking is a skill that is honed over time. But it is a skill that will support you (and your family) forever. Your children will learn from you, and their children will learn from them. And yes, cooking from recipes is a great way to learn and experiment, but don’t let recipes and meal plans define you.  Cooking should be fun, tasty, and nourishing. Try not to make it so complicated, and you (and your family) will reap the benefits of casual creative cooking, intuitive eating, and food freedom! You can follow me on Instagram to see how I incorporate casual creative cooking (or CCC) into my meals everyday. Please share with me how you incorporate CCC at home. And if its not for you, and you thrive on meal plans, please share your thoughts. Once again this is just an alternative to support food freedom and intuitive eating. 
 
Some Staples I like to Have in My Kitchen to make Casual Creative Cooking Easy 
(I don't usually have all of these at once, but a variety from each category depending on what I crave, what looks good at the farmers market/grocery store, what is in season, etc. Frozen foods are always great to have on hand when I am in a pinch. Also, this does not include all of my pantry staples.)
 
PROTEIN
Protein (fridge): organic deli meats, liver pate, extra-firm tofu, organic chicken sausages, grass-fed jersey/guernsey yogurt, cooked protein leftovers
Protein (freezer) wild caught fish, different cuts of pastured-raised chicken, beef, or pork (including ground).
Protein (pantry): wild caught skipjack light tuna, canned salmon, or sardines in olive oil or water
 
STARCH
Starch (fridge): steamed rice, quinoa, or potatoes/sweet potatoes, cooked lentil pasta, rinsed/drained beans, corn tortillas, GF bread. 
Starch (freezer): cauliflower gnocchi, GF bread, corn tortillas
Starch (pantry): canned beans, rolled oats, pastas, whole grains, winter squash, potatoes
 
VEGGIES
Veggies (fridge): broccoli sprouts, chopped hearty greens, zucchini, eggplant, mushrooms, asparagus, broccoli/cauliflower, fennel, Brussel sprouts, baby bell peppers, pre-trimmed green beans, cucumber, sugar snap peas, leafy greens (washed and stored), fresh herbs (usually cilantro and parsley), onions (green or red/yellow usually), leeks, garlic, whatever is on sale and in season
Veggies (freezer): riced cauliflower, frozen spinach/butternut squash
 
FRUIT
Fruit: whatever is fresh and in season and frozen berries. 
 
FATS
Fats/Oils: Grass-fed butter/ghee, extra virgin olive oil, avocado, nut/seeds and their butters, coconut oil, canned full fat organic coconut milk
 
THE FLAVOR
Dried Herbs/Spices (always) – TJ’s Taco Seasoning, TJ’s Everything But Bagel Seasoning, TJ’s Chili Lime Seasoning - see below for some common flavor profiles.
Toppings/sauces: goat & sheep cheeses, capers, garlic, pesto, a couple different dips (hummus/tzatziki/pesto), hot sauce, mustard
 
DIFFERENT SPICE PROFILES
Italian: fennel seed, chili flakes, oregano, thyme, basil, garlic, balsamic vinegar, olive oil
Mediterranean: Rosemary, thyme, oregano, garlic, red wine vinegar, olive oil
German: parsley, caraway, green onions, chives, apple cider vinegar, butter
Spanish: Smoked paprika, capers, garlic, parsley, red wine vinegar, olive oil/avocado
Mexican: cumin, paprika, chili, cinnamon, garlic, cilantro, lime/lemon, olive oil
Indian: curry, cardamom, star anise, cumin, parsley, lemon/lime, butter/ghee
Moroccan: ras el hanout, cumin, ginger, cinnamon, coriander, allspice, cloves, olive oil/butter
 
Some Local Bellingham Cooking Classes:
Bellingham Food Co-op Community Classes
In the Kitchen Class by Ciao Thyme
Tiny Onion Cooking School (for kids)
 
Cookbooks For Cooking Inspiration:
Mastering Spice
Orange Blossom & Honey
Ottolenghi Simple
Salt, Fat, Acid, Heat
Grandma’s German Cookbook

The first 1000 days (~2 years) of baby's life is a critical window to ensure proper neurodevelopment and epigenetics. Epigenetics, the modification of gene expression, is influenced by the baby's diet (as well as mother's diet during pregnancy and breastfeeding), lifestyle, and environment. Nutrient deficiencies and/or poor quality food choices may cause some genes to turn off and on in unfavorable ways, increasing the risk for disease as the baby ages (1). Furthermore, during the first 4 years, but especially during the first few months and up to a year, baby starts to develop its' own unique microbiome. The microbiome of infants is influenced by the type of birth, feeding practices (such as breastfeeding vs formula feeding), antibiotic usage by mom or baby, and type of complimentary foods introduced. By the time baby reaches 3-5 years of age, the microbiome resembles that of an adult. Although the microbiome is still more adaptable to dietary changes up until the teen years, this initial period of time sets the stage for both health and disease moving forward (2).   

Having a basic understanding of infant nutrition becomes essential when you start to introduce complimentary food around 6 months of age. After reading this article, I hope you will understand why making homemade baby food provides your baby with the most nutrient dense and affordable options. But first, in order to understand where my recommendations are coming from, we have to understand the average composition of breastmilk. Fat provides the majority of energy in breastmilk, providing about 50% calories. Approximately 40% of the energy in breastmilk is derived from carbohydrates, and the remaining 10% from protein. Furthermore, energy from fat in breastmilk continues to increase as babies get older. Research found that breastmilk from moms who had breastfed for > 1 year had a greater fat percentage than those that breastfed only 2-6 months (3). 
​

​Between the age of 6-12 months babies needs on average 80kcal/kg per day with at least 13g protein and at least 30g of fat per day. Generally, after about 6 months of age, the total volume of breast milk consumed by the infant becomes insufficient to meet the baby’s daily needs for energy, protein, iron, zinc, and fat soluble vitamins (4). Now look at the popular commercial baby food nutrition labels below. How is your baby going to get at least 30g of fat and 13g of protein by eating only these? The first three products make it very difficult to make a dent in either the fat or the protein recommendations. Granted babies are still drinking breast milk or formula as complimentary foods are introduced, but that doesn't mean the complimentary foods should consistently lack essential macronutrients and micronutrients. If we look at most of the choices available in grocery stores, they contain very little to no fat and protein. Although whole food based fruit/starch baby purees are not “unhealthy”, they are just lacking BALANCE, and therefore lacking some very critical nutrients that are found in protein and fat rich foods. The fourth, Serenity Kids, is the best option, but it is very expensive costing $4 per pouch (compared to $1.50-$2 for the other ones) and is only available online. Serenity Kids baby pouches are great for on-the-go or last minute options, but are not affordable if used for the majority of baby food provided.

​Fat and protein are essential macronutrients. Fat is essential to help absorb fat soluble vitamins A, E, D, and K. Foods rich in quality fat like fatty fish, egg yolks, avocados, nut butters, grass-fed butter and heavy cream, olives, and extra virgin olive oil are naturally excellent sources of one or more fat soluble vitamins. Fat soluble vitamins play a big role in growth and development, they support a healthy immune system, and reduce inflammation. Without adequate fat, we cannot digest and absorb these critical nutrients. Interestingly, mature human milk is comprised of mostly saturated (~40%) and monounsaturated (~35%) fats. Omega-6 (12-26%) and Omega-3 (0.8-3.6%) fatty acid content varies greatly depending on the mothers diet (5). Due to the high amount of fat in breast milk infants rely more heavily on both salivary and gastric lipase (enzymes that breaks down fat for absorption) compared to adults because pancreatic lipase doesn't reach maturity until 1 year of age. These enzymes preferentially break down short and medium chain fatty acids, which are abundant in milk fat and coconut oil (6,7). These enzymes allow infants to break down fatty acids found in breast milk for easier absorption. Fats in the adult diet that are rich in short and medium chain fatty acids are grass-fed butter and cream (butyric acid - short chain) and coconut milk (lauric acid - medium chain). Longer chain fats like mono and polyunsaturated fatty acids from avocados, nuts & seeds, and fish, require more complex digestion in the small intestine including pancreatic lipase and bile for absorption. Not surprisingly, research has also found that the dietary fat content of breastmilk fluctuates based on mom's dietary fat intake. If mom eats a low fat diet, her breastmilk will have a lower percentage of fat in the milk, and also a lower percentage of fat soluble vitamins. Therefore, fat intake and fat quality is VERY important for both mom and baby (8,9,10). Plus, fats increase satiety by slowing down the rate at which food empties from the stomach! This can be especially helpful to support better sleep and nap patterns.

​Adequate protein is essential because the demand is high for tissue replacement, development of lean body mass, and growth. Infants require more protein per kilogram of body weight than do adults (1.2g/kg vs. 0.8g/kg). Furthermore, protein rich foods are excellent sources of iron and zinc, two nutrients that become important as complimentary foods start to replace breastmilk. Animal sources of protein like grass-fed beef, liver, and egg yolks, etc. contain more bioavailable sources of iron and zinc than do plant based alternatives such as beans/legumes and dark leafy greens. Pairing plant based iron sources with vitamin C rich fruit and vegetables aids in absorption. Infants between 7-12 months of age require 11mg/day of iron and 3mg/day of zinc (4). 
 
Iron Rich Animal Foods (with easily absorbed heme iron)
Chicken Liver, Beef Liver, Beef/Lamb, Dark Turkey/Chicken Meat, Eggs, Sardines, Salmon, Skipjack Light Tuna
 
Iron Rich Plant Foods (with non-heme iron)
Extra firm tofu, beans, lentils, peas, spinach
 
Pair Non-Heme Foods with Vitamin C Rich Foods 
Strawberries, Kiwi, Cantaloupe, Citrus, Papaya, Pineapple, Bell Peppers, and Broccoli
 
Research suggests that healthy full term babies have adequate iron and zinc stores that last them for at least the first 6 months. Therefore the American Academy of Pediatrics Committee on Nutrition recommends that breast-fed infants receive 1mg/kg/day of iron by 6 months, preferably from iron rich complimentary foods. Interestingly, recent research found that when compared to infants who received iron-fortified cereals vs iron and zinc rich pureed beef, the babies that consumed the beef had an increase in head circumference and had a trend towards a higher behavior index at 12 months (11). See my Baby Liver Pate recipe for a rich source of iron, zinc, and many more critical nutrients! 
 
Black Beans (1oz) vs Grass-fed Ground Beef (1oz)
Beans: 40kcal, Protein 2.3g, Fat 0.2g, Iron 0.7mg, Zinc 0.3mg
Beef: 56kcal, Protein 5.5g, Fat 3.6g, Iron 0.6mg, Zinc 1.3mg

Another important reason to make homemade baby food purees is the ability to increase the variety of foods used in the purees. Increasing variety increases both the nutrients and phytonutrients in the baby's diet. Nutrients are vitamins and minerals, while phytonutrients are plant compounds that provide a wide array of health benefits including reducing inflammation. Most interestingly, phytonutrients act as prebiotics, the food for good gut bacteria, and can modulate the gut microbiome in favorable ways. Did you know that by age 3, the gut microbiome becomes an adult like ecosystem? The adult microbiome is very resilient and difficult to change. Only 30-40% of the microbiome can be influenced by long-term dietary and lifestyle interventions (12). This is very important as the gut microbiome place a huge role in the development of health and disease.

​​One can increase the phytonutrient density of the diet by simply increasing the variety of plant foods consumed including fruit, vegetables, beans/legumes, nuts/seeds, herbs/spices, etc. Each plant food provides its' own unique array of phytonutrient compounds. Most baby food is limited to certain standard ingredients including bananas, apples, sweet potatoes, and carrots. They are also commonly peeled, even if they do not need to be peeled such as apples, potatoes, and carrots. Keep in mind, the peels of fruit and veggies contain the majority of the phytonutrients. So if you don't need to peel it, then don't. Just make sure its organic! Other foods that are rich in prebiotics that are often not included in baby food purees include garlic, leeks, and onions. Not only are they great for gut health, but they add a lot of flavor. The more flavor babies are exposed to through their diet and mother's breastmilk, the less likely they will be picky eaters later on, and more likely to have a varied diet rich in phytonutrients and prebiotics. 
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​Finally, another reason to make homemade baby food is heavy metal contamination. A recent study from Healthy Babies Bright Future, has highlighted the problem with the contamination of heavy metals in commercial baby foods. The organization looked at 168 products over 61 brands, and measured the amount of arsenic, mercury, cadmium, and lead found in the samples. They found at least one heavy metal in 95% of the products tested. Rice based foods, especially cereals where at the top of the list, with highest levels of arsenic. Fruit juice, carrots, and sweet potatoes were also found to have a higher risk for heavy metal exposure (13). If you are curious to see if your baby food products are high in heavy metal check out this website. The less stars, the more heavy metals are in the product. 

When we combine all the data highlighting the needs for 50% of the calories to come from fat, increased need for fat soluble vitamins, as well as iron and zinc, and the importance of adequate protein, then the simple fruit and veggie blends just do not meet the infant’s needs. Plus, commercial baby foods, especially rice based products, could be a source of heavy metals in your baby’s diet. Therefore, making simple BALANCED baby purees rich in a variety of plant foods at home is the best choice for your baby. Offering two to three different purees at each meal ensures adequate variety and nutrient density. 

​Making baby food at home doesn't need to be complicated. Simply steam or bake a veggie that you have at home and mix it with a protein and/or fat item. Use a little bit and mash it up as needed or prepare a whole batch with a food processor and freeze into individual servings. The VERY SIMPLE combinations below only require a fork for mashing…no processor needed. Depending on your baby you may need to adjust the texture, adding more liquid for a smoother texture. As the baby gets older and swallow/chew function improves, you can increase the texture, leaving more chunks.

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​Baby FORK MASHABLES
Zesty Avocado Chickpea (makes 4 servings)
INGREDIENTS
1/3 cup canned chickpeas (rinsed) + ½ avocado + squeeze lemon/lime juice + pinch salt/pepper
 
DIRECTIONS: Place rinsed and drained chickpeas in a bowl and heat in microwave for 30 seconds. Mash with a fork until desired texture. Stir in a small squeeze lemon/lime juice and a pinch salt and pepper. Add the avocado and mash together until desired texture. 
 
Garlicky Cauliflower Yolk (makes 4 servings)
INGREDIENTS
1/3 steamed medium cauliflower (florets only) + 1 steamed garlic clove + 1 egg yolk + 2 teaspoons grass fed butter + pinch salt/pepper + sprinkle dulse granules
 
DIRECTIONS: Steam cauliflower head in steamer basket along with garlic clove, ~ 20 minutes. Meanwhile medium boil and egg for ~ 8 minutes. Rinse under cold water. Peel and remove white and keep the yolk. Once the cauliflower is fork tender remove 1/3 of the cauliflower (florets only) and place into a bowl along with egg yolk and steamed garlic clove. Mash until desired texture. Season with pinch salt, pepper, and sprinkle dulse granules. 
 
Spiced Banana Chia (makes 4 servings)
INGREDIENTS
1 medium banana + ¼ cup whole milk yogurt + 1 teaspoon chia seeds + ¼ teaspoon cinnamon 
 
DIRECTIONS: Mash the banana to desired texture. Stir in the yogurt, chia seeds, and cinnamon until combined. Allow to sit at least 1 hour to allow chia seeds to plump up. 

Sweet Potato & Chèvre (makse 4 servings)
INGREDIENTS
1 small steamed and cooled sweet potato/yam + 1oz plain chèvre (fresh goat cheese) + salt and pepper + 2 teaspoons extra virgin olive oil

DIRECTIONS: Remove the peel from the sweet potato and place into a bowl/glass food storage container. Top with chèvre and sprinkle salt and pepper. Microwave for 90 seconds or until the sweet potato and chèvre are warm. Drizzle with olive oil and mash with fork.

You can also make puree blends (adjust texture per baby’s development) to increase the variety of flavors and spices baby gets exposed to. Babies love flavor just like adults! Keep in mind that it may take 10-15 tries before baby likes a new food item. Allow them to explore a new flavor or texture multiple times before giving up on the food itself. Some babies even like the food served cold or room temperature. See some of my recipes below for inspiration! They have all been approved by baby Toren :)
 
Berry Prune FRUIT BLEND
Banana Strawberry Cream FRUIT BLEND
Thai Carrot VEGGIE BLEND
Apple Butternut VEGGIE BLEND
Potato & Fennel with Greens VEGGIE BLEND
​Baby Liver Pate PROTEIN BLEND
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​Although initially it can be overwhelming to make your own baby food (amongst everything else you have to do as a parent), it is good to know HOW & WHY. Not only is it the more budget friendly choice, but it can be the more nutrient dense choice if done right. During the first 2 years of life (and beyond), it is so important to provide high quality, nutrient dense food options, that do not omit certain critical nutrients. Although fruits and vegetables are essential to health, don't forget to add some quality FAT and provide some quality PROTEIN. There are many other nutrients of concern regarding infant and early toddler nutrition not highlighted in this general overview. Consider working with your dietitian for more personalized recommendations, especially if food allergies or food intolerances are an issue. 

FRUITPHOBIA 
Fresh seasonal fruit is so delicious! There is nothing that compares to a bright red strawberry picked in the middle of June or a fresh papaya drizzled with lime juice when traveling in Hawaii. Especially in the hotter months, cooler water-rich foods like fruit are more often desired than a hot meal. 
 
Unfortunately, with the popularity of low carbohydrate diets many individuals are fearful of fruit. Many paleo and low carb diet advocates recommend sticking to only small amounts of low sugar fruits like berries stating that other fruit provide too much unnecessary sugar. I have had multiple patients in practice that are too afraid to eat more than a ½ cup of berries per day! 
 
I agree that it is important to reduce your intake of added refined sugars like high fructose corn syrup, maple syrup, honey, sugar, and other processed foods. However, this does not immediately place fruit into the same category. Although fruit does contain sugar (glucose and fructose), it is not found in the same concentration as high fructose corn syrup in sodas, pastries, pancake syrups, etc. For example, soda contains a sugar ratio of 60% fructose to 40% glucose. One 20 oz bottle of Coke contains roughly 36 grams of fructose. Now compare that to a banana, which contains 7 grams of fructose, or a medium sized apple with 13 grams fructose. When do you sit down and eat 7 bananas in one sitting? Never! Plus, that banana comes in a completely different package, rich in fiber, and made by nature.
 
However, this way of thinking can cause harm. You are not addicted to sugar if you enjoy fruit. Fruit is rich in easy to digest carbohydrates, antioxidant rich vitamins and minerals, gut healing fiber, and anti-inflammatory polyphenols. Plus, they are easy to throw into a bag and hit the road. Rather, if fruit is lacking in your diet you may be missing out on a lot of health benefits. 
 
REASONS WHY FRUIT ARE GOOD TO EAT

Fruit are Rich in Polyphenols: Polyphenols are plant compounds that are found most concentrated in the outer parts of plants. These chemical compounds have been studied in relation to their potent anti-inflammatory and antioxidant capacities. Each type of polyphenol has different health benefits. Therefore, it is important to consume a variety of unpeeled fruit (unless it's a melon or banana of course). Polyphenols have been shown to help:

• Reduce inflammation
• Prevent cancer, cardiovascular disease, and neurological disorders. 
• Fight infections
• Promote the growth of good gut bacteria. 

Fruit Are Rich in Soluble Fibers and Prebiotics:
Soluble fibers and prebiotic fibers help support the growth of good gut bacteria. When these fibers reach the large intestine, they are fermented by bacteria and produce short chain fatty acids which help fuel colon cells and prevent colon cancer. 

• Apples, oranges, and bananas are rich in soluble fiber. 

Fruit Are Rich in Vitamin C: Vitamin C is a nutrient that is very sensitive to heat, light, and air. Therefore, whole fruit become an excellent source of vitamin C. It is suggested that the current RDA for vitamin C is too low (75-90mg) and that we should be shooting for at least twice as much from whole foods. Especially if you are under a lot of stress, exercise a lot, or have an inflammatory condition, getting plenty of vitamin C is essential. 

• Excellent sources of vitamin C include: kiwis, oranges, papayas, strawberries, and pineapples.

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Fruit Are Easy to Digest Whole Food Carbohydrates for Active People:If you are on the go and active, especially in the summer months, then fruit can be a great way to fuel your activity. Generally, your carbohydrate intake increases with your amount of activity. If you are unsure what to pack to fuel a mountain bike ride, trail run, or hike, pack some fruit! It comes in its own protective barrier, and is easy to eat!

• Easy Fruit to Pack: Apple, Banana, Orange, Grapefruit,

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Fruit Can Help You Digest Protein: Some fruit contain unique enzymes that aid in digesting proteins and help reduce inflammation, support wound healing and relive constipation. You can even buy digestive enzymes in supplement stores made with these fruit enzymes. 

• Protein Digesting Fruit: papaya, pineapple, and kiwi.

 
SOME CONSIDERATIONS
Daily fruit consumption depends on the individual. Some can tolerate more than others due to activity levels and certain health conditions. For example, individuals with a fructose intolerance or severe gut imbalances may not do well with apples, pears, cherries, figs, and mangos. On the other hand, those that have metabolic disorders like diabetes and PCOS (polycystic ovarian syndrome) may have to stick to lower sugar fruits like kiwi and berries or pair their fruit with protein for better blood sugar balance. If you have any of these issues it may be best to work with a dietitian to help you find out what fruit and what portion is right for you. 
 
TAKEWAY
Don't fear fruit!! If you are a healthy individual, eating seasonal organic fruit to your liking can provide many health benefits and should not be avoided. I generally recommend 2 servings of fruit per day and adjust the types of fruit based on the individual needs of the patient.  

Many people have heard of vitamin D and understand its relationship to the sun. I often hear people say “soaking up my vitamin D”, when a nice, sunny day arrives. But is it really as simple as that? Of course not. Today I will clarify what vitamin D is, why you need to make sure you are getting enough, and how to make sure you are getting what you need. 
 
Vitamin D is a fat soluble vitamin with hormone like properties that is found naturally only in a few foods and can be synthesized in the skin from the sun’s UVB rays. It is commonly known for its facilitative role in bone health by increasing calcium absorption and for its role in improving seasonal affective disorder. However, many people do not know that it also is required for proper immune function, hormone health, cellular growth and development, and blood sugar and blood pressure regulation. That's a lot! Many studies have found an inverse relationship between vitamin D status and autoimmune disorders, diabetes, eczema, cancer, depression, and more. The current recommended dietary allowance (RDA) is set at 400IU per day for infants, 600IU per day for children and adults alike, and 800IU for the elderly. 
 
SOURCES OF VITAMIN D
 
Vitamin D from the Sun
The sun doesn’t give you vitamin D3, it merely starts a process. Upon the skin’s exposure to the sun’s UVB rays, pre-vitamin D3 is converted to inactive vitamin D3 (cholecalciferol). After conversion in the skin, cholecalciferol is quickly transported to the liver and then to the kidneys to be metabolized to active vitamin D3, also known as calcitriol. Therefore, if the liver or kidneys are not functioning properly, vitamin D status can be impaired. 
 
However, the darkness of your skin, the fat deposition underneath your skin, and the coverage on your skin (including sunscreen and clothing) all play a role into if and how much pre-vitamin D3 is converted to cholecalciferol. If you have darker skin tone, are elderly (less fat under skin), wear a protective clothing layer, or apply a sunscreen greater than 10 SPF you will have reduced or no vitamin D3 conversion. Furthermore, the time of year and time of day also play an important factor. In latitudes above 42 degrees North (or below 42 degrees South), there is inadequate UVB radiation to support vitamin D synthesis from mid-October to mid-March. Keep in mind Bellingham is at 48 degrees North. Plus, the best time for good UVB exposure is between 10am – 2pm. Therefore, if you are working an indoor job from 9am to 5pm, are fully clothed, and wear sunscreen on your face, then you will not synthesize any vitamin D. And if you think you will get some vitamin D when sitting in a sunny spot inside, think again. It doesn’t matter what time of year it is, or time of day, if you are sitting in front of a window, all UVB rays will be blocked and you will not synthesize any vitamin D.   
 
Nutritionist Tip: Get outside around noon for 15 minutes and expose your hands, arms, and face (without sunscreen) in the late Spring, Summer, and early Fall months to synthesize about 1000IU. Then you can layer on the sunscreen or seek shade. 
 
Vitamin D from Food
Vitamin D is only found naturally in very few foods including fatty fish like salmon and sardines (340IU per 3oz), eggs (40IU per egg), and liver (40IU per 3oz). Mushrooms, although advertised as a source of vitamin D, often do not provide much useable vitamin D unless the grower purposefully has exposed the mushrooms to UV light. One cup of sliced “unexposed” crimini mushrooms only provides 5IU, whereas the “exposed” provides around 400IU. Ask your grocer what kind they offer. However, there are other foods on the market that are fortified with vitamin D such as dairy and plant milks, orange juice, and some cereals, usually providing anywhere between 50-100IU per serving. 
 
Nutritionist Tip: Enjoy fatty seafood like salmon, UV “exposed” mushrooms, and fortified milk or non-dairy milks multiple times per week for substantial food sources of vitamin D. 
 
Vitamin D from Supplements
Vitamin D supplements can be found as vitamin D3 (cholecalciferol) and vitamin D2 (ergocalciferol). Vitamin D2 is synthesized via UV irradiation of yeast, whereas D3 is synthesized via UV irradiation of lanolin. However, research studies have found that vitamin D2 may not be as effective in increasing active (calcitriol) vitamin D3 serum levels. Taking supplements is essential when adequate dietary intake and proper sun exposure are lacking. 
 
How Much to Supplement?
The optimal intake of vitamin D to support general health and wellbeing remains controversial. Researchers have found a U shaped curve regarding vitamin D status, indicating that both low and high vitamin D serum levels are correlated with disease development and progression. The Linus Pauling Institute recommends that generally healthy adults supplement with 2000IU of vitamin D3 daily. Some may need more or less depending on all the factors discussed previously. However, more is not always better! High dose vitamin D supplementation that is not monitored can lead to abnormally high serum calcium concentrations which can damage the kidneys and heart. Research suggests that daily intakes of less than 10,000IU per day in healthy individuals is very unlikely to result in toxicity.  
 
Nonetheless, it is best to test not guess! Work with a health care practitioner to check your vitamin D status 1-2x per year to get a feel for what your unique needs are. Research studies suggest that a serum vitamin D concentration between 40 ng/mL and 60 ng/mL is ideal. 
 
Nutritionist Tip: Supplement with 1000 - 2000IU per day and check your vitamin D levels annually to ensure a serum vitamin D between 40-60ng/mL. Make sure to check your multivitamin, as they often already contain some vitamin D.
 
RESOURCES FOR THE INSPIRED INDIVIDUAL
 Overall, low vitamin D status can impact your health in many ways. Unfortunately, testing vitamin D status is not as routine as it should be, especially here in the Pacific Northwest. Ensuring optimal vitamin D levels year round can help keep you feeling your best. Be an advocate for yourself and request vitamin D labs at your annual doctors visit or see the resources below for more helpful research, testing, guidelines, and applications. 

• Check out GrassRoots Health for more vitamin D information and research. They also provide vitamin D testing for $65. 
• Check out the free DMinder App to monitor your vitamin D status and local sun exposure. 
• Check out the Environmental Working Group “Guide to Sunscreen” for safe sunscreen products. 

 
Article References:
Krause’s Food & The Nutrition Care Process, 14thEdition. Pages: 1071-1072.
Linus Pauling Institute. Vitamin D. https://lpi.oregonstate.edu/mic/vitamins/vitamin-D#RDA
GrassrootsHealth. Resources. https://grassrootshealth.net/documentation/