Nutrition To Manage Postpartum Depression

Transcript:

TERESA: Welcome to Dishing Up Nutrition brought to you by Nutritional Weight & Wellness. We are a Minnesota company that specializes in real food nutrition education and counseling.

We have been helping people connect what they eat to how they feel for the last 20 years. First via our long running radio show in the Twin Cities, and now via this podcast. And if we want to go back in history just a little bit more, Nutritional Weight & Wellness has been helping clients with practical real life solutions to better their health and wellness through changing their food for the last 35 plus years.

It started with Dar Kvist, a former special education teacher turned licensed nutritionist, as a one woman show in a small office in St. Paul, over a pizza parlor of all places. Now it has grown to six different office locations spread throughout the Twin Cities area, and the company now employs ten registered dietitians and licensed nutritionists, several nutrition educators, and numerous other passionate professional and caring support staff.

Real food and a calm, supportive approach truly has stood the test of time. So after that trip down memory lane, let's bring us back to the present. My name is Teresa Wagner and I'm a Registered and Licensed Dietitian. I'm here today with my cohost, Leah Kleinschrodt, who is also a Licensed and Registered Dietitian.

LEAH: Awesome. Hello listeners. And good to be with you again, Teresa. I never get tired of hearing that origin story, or dare I say that birth story, which alludes to our topic today, which is nutrition to manage postpartum depression. So Teresa, you are bringing us back to the present. Let's think about where you and I are at today.

We are both moms of school age kids. So the last several weeks, we've seen that shift, right; back into those that daily routine and back into a just a different pace of life. I still have a two and a half year old at home, but she's made it plenty clear that she's also ready for school and to follow in her big brother's footsteps.

But it doesn't seem that long ago that we were cuddling our little seven or eight pound babies and our schedules revolved more around nap times and feeding times and target runs than the school bell and afterschool activities.

TERESA: Yeah. I do find myself looking back at those days and a lot of times my Google hub will file through the pictures, and I'll see that and I'll be like, how have my kids grown so far or grown up so much, or look at how far we've come. And then I think. Well, if they're that old, well, how old does that make me?

LEAH: Yes. Those flashbacks are good for encapsulating some of those memories.

TERESA: And while we often look back at those early weeks and months with our babies with fond memory, and maybe a little bit of wistful thinking, there can be a very real side to early motherhood that is not so rosy and cuddly and cheerful.

The postpartum period is a time of a lot of hormonal chaos and rebalancing, a body that needs to heal and replenish, adjusting to new responsibilities and a different pace of life. And all of that built on a foundation of getting way less sleep than you need.

These shifts can set the stage for a number of emotional challenges, including postpartum depression, postpartum anxiety, postpartum rage, and even postpartum psychosis.

LEAH: Yeah, I had a client several years ago now who experienced postpartum psychosis and she had to be temporarily hospitalized. And that's not why she was seeing me, but I think we were just doing a little comparing notes of our postpartum experiences and this came up.

She said that she was having hallucinations and like extreme confusion just from all that stress, the stress of the labor, the birth, the sleep deprivation. And like you mentioned that hormonal chaos in those early weeks. So super scary, like a very intense experience. So I want to make a note here before we get too much further into the show that while we will be talking about foods and nutrients to support moms in that postpartum era, this is not meant to replace help that you would seek with another with a medical professional with a counselor, just with other supportive and knowledgeable professionals out there.

TERESA: Yeah, that's a really good point.

LEAH: Yeah. I recently heard the postpartum period described as a temporary menopause and that struck me and it just kind of stuck in my brain because we think about menopause, typically what happens there is it comes on gradually over months or even over years And it's something that has an ongoing course to it, but in postpartum it's like you get menopause immediately and it strikes you within days, even within weeks, within days of that birth. So to me, it feels like, duh, how could you not experience some amount of mental and emotional rollercoaster during this time?

TERESA: Right. That is such an interesting way of thinking about it, right?

LEAH: Absolutely.

TERESA: As I had mentioned before, there can be a wide range of emotions experienced after having a baby, but the most common diagnosis you hear out there is postpartum depression. So let's talk about what that looks like and how many women it affects. The official estimates are that one in seven women will experience postpartum depression within one year postpartum.

However, it's estimated that up to 50 percent of postpartum depression cases go undiagnosed due to the reluctance, to disclose symptoms. In other words, new moms are scared or hesitant to admit that they're struggling with their emotions after having a baby. So they may choose to hide their struggles in the hopes that these feelings will go away on their own. And I completely understand this hesitancy. Here we are with this beautiful new baby that we've been planning for at least the last nine months, anyway, if not much longer.

LEAH: Yeah.

TERESA: You have what you wanted, and maybe you wanted it just so badly, and you're maybe not feeling happy about it or not enjoying it. So there can be these feelings of shame or even sad that you're not feeling the way that you thought you would or you should.

LEAH: Right. Yes. I think that's the opportune word, right? It's like how you think you should be feeling might not match up with your true feelings at that time.

TERESA: Yeah. So we have to think that these true postpartum depression numbers, maybe more like two or three out of every seven women.

LEAH: Mm hmm. Yeah. Yeah. And as you mentioned, there's such a spectrum of emotions and feelings and symptoms that can creep in during this time. I can easily see where some symptoms are easy to dismiss or breeze over and even scary to admit that you are feeling this way. So we just wanted to lay out a couple symptoms.

Possible symptoms of postpartum depression

Symptoms of postpartum depression can look like persistent sadness, lack of interest in things that normally you would have had interest in, sleep disturbances, that one gets a little nuanced there, but loss of appetite, anxiety, being irritable with family and friends, and even getting irritable with the baby;

Feeling disconnected from your baby, low self-esteem, feelings of worthlessness and guilt; the extreme end of these symptoms are thoughts of hurting the baby or hurting yourself. And if these symptoms persist for more than two weeks, that's where postpartum depression may be diagnosed.

So this is not something to brush under the rug or just bite your tongue and get through it. Like, this is where we need to really have a lot of support around new moms during this very vulnerable time.

TERESA: Yes. And I do want to point out that postpartum depression is different than the baby blues, which about 80 percent of women experience after giving birth. Usually the baby blues occur in the day or two after birth and start to lift after that first week or two. Postpartum depression can come on up to a year postpartum and the symptoms persist longer than the first week or two.

No one knows exactly why postpartum depression happens, but the current thinking is that it may be a combination of the drop in estrogen and progesterone that occur after birth. So when the placenta is delivered, to be exact, is when that major drop off happens. And then the stress and the sleep deprivation that comes with caring for an infant, as well as other psychosocial factors. If a woman is prone to depression or anxiety before pregnancy, she may be more prone to postpartum depression.

LEAH: Yep. I mean, I vividly remember I had to have surgeries for after with both of my babies; one was after the birth to repair a severe perennial tear and the other was the birth; I had a C section. And both times I remember thinking, hey, how am I supposed to take care of this brand new little baby when I need to heal and have time and space for myself? Like where do my needs come into play in this whole thing?

And I was lucky enough to have a wonderful support team around me. And I still struggled with a lot of anxiety and some very low, very depressing moments. Research suggests that a traumatic birth experience and even having a high risk pregnancy can also contribute to having higher risk of experiencing postpartum depression. And I think it's super interesting too, that you've mentioned this now a couple of times, Teresa, that it can strike up to a year postpartum where like some of us aren't even thinking about those early, early days anymore. Like we think we're past it or once you're out of the first three months, it's not even a thing, but like up to a year, this could still take effect.

Nutrition support postpartum in traditional cultures

TERESA: Yeah, so when we're thinking about this through a nutrition lens, is there a way that nutrition can support those early postpartum weeks and months up to that year and beyond, as we like to say?

LEAH: And beyond. I would absolutely argue for the beyond.

TERESA: And what we like to do is look back in the past and what people did. Traditional cultures, they absolutely thought so. Many cultures around the world had specific foods and practices in place for the first 40 days or about six to eight weeks to nourish and support the new mother. This usually involved lots of warming foods, which differed by culture. And then they also had lots of like warming fluids, and when I'm saying that it's things that would warm you.

LEAH: Yeah. Yeah. Basically, yeah, think teas, broths, like other warm liquids.

TERESA: Yeah. Maybe even some spice, like warming spices and herbs and those types of things. And of course, when I'm thinking about all those things that Leah said, I'm thinking, oh, soups and stews. That would be a wonderful way to warm from within. These soups and stews would use bone broth for collagen, which helps with repairing the skin and other tissues.

They would use a variety of well cooked vegetables to help the digestive tract stay happy and soft, easy to digest meats for more protein, which helps us feel full, and is also crucial for that healing.

LEAH: Yeah, I jumped the gun on fall a little bit. I mean, as of the time of the recording right now, it's what, 85, 86 degrees outside here in Minnesota. So it doesn't quite feel like fall yet, but I did jump the gun on fall the other week and made a huge batch of our spicy coconut stew recipe, which is on our website. The recipe calls for either chicken breasts or chicken thighs. I've used shrimp or even a mixture of chicken and shrimp in that recipe.

It's really good. And I want to just let everyone know, I know the name of it says spicy, but it's really not very spicy at all. My taste buds personally are very Minnesota spice. I don't do the heat very well. So if anyone has ever been scared away by the title of this recipe, it's truly not bad at all.

TERESA: That's funny, Leah. I am also originally from Minnesota and amongst many Minnesotans who actually cringe when people say that ketchup is as spicy as we get, many of us can handle a little heat. And so for that particular recipe, I love it too, but I do like to turn the heat up on it and add more of that Thai spice, whether it be a red or a green curry spice, whatever I have in hand. So that recipe is so great because it's just so conducive to a number of flavor profiles.

LEAH: Dial it up or dial it down as your taste buds allow.

TERESA: Yeah. I love it though. So going back to our topic, another thing I just want to mention about the postpartum customs from these traditional cultures is that the food was cooked and prepared by someone other than the new mom: grandmas, aunts, cousins, neighbors, community members would take on the role for those six to eight weeks of preparing and cooking meals around the clock for that new mom.

It was a crucial part of letting the new mom rest and recover from the pregnancy and birth. It was a way to let the mother be mothered for a few weeks. Nowadays, this is much more the exception than the rule. We have this idea that we should be able to do it all, right? Moms are often jumping back into their usual duties and responsibilities very quickly after birth without the chance to really take a breath and take care of themselves. This is one of the many aspects of postpartum that can add more stress and create an environment for low moods and postpartum depression.

LEAH: Right, and in Lily Nichols’ book, she, we've mentioned her on the podcast several times, and she's written a couple of books. She has one called Real Food for Pregnancy, which I love, and in this book she poses a very important question for pregnant women or for women who are thinking about their postpartum experience.

How can you receive support postpartum?

She asks, “How will you rest, recover, and receive support?” And I love this question because it gets you thinking about putting supports in place before you are in the thick of postpartum. For me, postpartum was extreme survival mode. I was doing my best some days just to get by hour to hour. And I had to lean on a lot of outside support to make sure I was eating, that I was taking a shower occasionally and if I was lucky, maybe getting a little nap in there, too.

So if you are able to, while you are still pregnant, Could you make some meals and stash them in the freezer for that postpartum period? Can you or someone you trust set up a meal train so that you get a new meal brought to you every day or two in those early postpartum weeks? Can you sign up for a meal delivery service for those six to eight weeks that can just supplement you with an easy, healthy lunch while your spouse goes back to work?

Or, can you enlist or hire someone like a postpartum doula to make food for you during this time and help with a few tasks around the house? These are just some questions that, as a woman might be looking at those postpartum weeks, like how can we think ahead a little bit so that we can do a little planning ahead of the game?

TERESA: Maybe more than just setting up the nursery, right?

LEAH: Yes. Oh my goodness. Yes. And I recently heard, speaking of nursery stuff, I recently heard of someone who, for their baby shower, created a help registry instead of a baby registry.

TERESA: Oh, interesting.

LEAH: So friends and family could sign up to come and do some light cleaning or run errands, cook some meals, like take the dog for a walk, like whatever, whatever is needed in those early couple of weeks. And knowing what I know now, now having been through this twice, I'm like, this is a phenomenal idea. Why did I not think of this?

TERESA: I know. This is a great idea.

LEAH: Yeah. It's anything you can think of to take some of that burden off your plate as a new mom. I mean, it's absolutely worth its weight in gold.

TERESA: Yeah. I think that that's something really to consider.

LEAH: Yeah. And I do want to say too, when I say new mom and when we've been saying new moms, I think you also become a new mom when you have a second baby or a third baby because you are having to shift those dynamics all over again. So it's not like first time mom, you know, it's your first baby kind of thing.

This is actually, I mean, you are becoming a new and different mom every time you have a new baby too. So keep your ears perked, even if it's not your first baby.

TERESA: Right. And I think, just even thinking of that, on that registry, it could be taking the older child out for an activity while you stay home alone, which is having some one on one time with that infant. You know, there's all kinds of things that, that could go on that list.

LEAH: Yeah, so those are just some ideas and we are going to take a break here for just a moment. But then we do also want to talk about what happens when you're already in the thick of postpartum, of like what are some simple things that we can do if we're already on the struggle bus?

So you are listening to Dishing Up Nutrition, brought to you by Nutritional Weight & Wellness. I am Leah Kleinschrodt, along with Teresa Wagner, and today we are sharing how nutrition and real food can make an impact on postpartum depression, and we'll be back in a moment.

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We are back with your weekly Dishing Up Nutrition episode. Before we jump back into our show, I wanted to highlight a cooking class that we are offering this Wednesday, September 25th, at 6 p.m. Central Standard Time called Cooking for Better Digestion. Marianne is a wealth of knowledge and has expertise in the kitchen and students walk away with all of the delicious recipes and a shopping list.

Plus, a sparkle of inspiration to go with it. You can register for this class today by calling our offices at 651-699-3438 or by visiting our website at weightandwellness.com. So before we went to break, we were talking about ideas to support moms as they’re, maybe they haven't quite had their baby yet. We're getting ready for baby. What can we do to support her? So that hopefully as she transitions into being a new mom, that she can avoid maybe some of the..

LEAH: Stress, anxiety, intensity of that season.

TERESA: Yes. So, as we always talk about in counseling sessions and in our classes, having a plan is key. If you can make some of those arrangements, stash some food in the freezer ahead of time, it saves you a lot of trouble down the road.

Progesterone cream can help postpartum

But, what if you're already in the thick of it? What if you're already postpartum? One simple suggestion I have is to get a bottle of natural progesterone cream and start using it daily. We carry this at all of our locations, and it's called Emerita Progest Cream. Take one quarter of a teaspoon of cream and rub it into the thin areas of the skin, like the inner wrists, on the neck or behind the knees. I tell people the perfume places, right? The places you see to spray your perfume. You can do this one to two times per.

LEAH: And here's the reason progesterone cream is important. So when women are pregnant, the ovaries and the placenta are making up to 300 to 400 milligrams of progesterone per day. Now, just for reference, a woman generally makes about 20 to 25 milligrams of progesterone per day after ovulation. So progesterone levels during pregnancy are incredibly high.

But once the placenta is delivered after the baby is born, progesterone levels plummet immediately. And it can take quite some time to come back for those hormone levels to come back up after birth. The ovaries have to start coming back online in order for the progesterone to start being made again.

And this process just, it depends on a number of factors, like if you're breastfeeding or not. Progesterone is our calm, cool, chill pill hormone. And it also acts on the GABA receptors in our body. And I always describe GABA as another calm, chill pill type of neurotransmitter. So like, who wouldn't want progesterone all the things, right?

TERESA: Yeah.

LEAH: So if a woman goes from a super high amount of progesterone to almost nothing after birth, it can certainly set the stage for more emotional outbursts, more sadness, crying, mood swings, more anxiety, and even trouble sleeping.

TERESA: Yeah. And you know, I have my own story with that progesterone cream. So I had become familiar with Nutritional Weight & Wellness when I was after my first two were born and before my third. And I had heard of a radio show, and they were talking about using the progesterone cream and packing it in your bag to take to the hospital with you.

And so it kind of had stuck in my mind and they were talking about how it's calming and all the things that we were saying, how our progesterone levels drop and how using it can be helpful. And with my first two, I didn't have that information and I did have some anxiety. I would not say that I had postpartum depression, but for sure the blues and for sure the anxiety, which that’s hard to distinguish with, is this normal because it's a new situation or is it, what is the cause of it?

But whatever it is, that anxiety is very uncomfortable. And so with my third child, I was able to take that information and use it. And I had a completely different experience. Well, I don't know if it's completely different, but it was a noticeable difference in experience with just calm and way less anxiety.

Granted it was my third child. So, there's that to take in account too, but just that sort of underlying anxiety just wasn't really present and it was a really nice switch and so I do recommend it to women who come to me and are asking for solutions for that because it worked really well and it's worked well for other people, too so I don't think it's just an end of one situation

LEAH: No, definitely not one of our other counselors recently a couple of months ago shared a client story about a new mom who was in that family fourth trimester. So those early weeks postpartum, and she was sharing that she was struggling with explosive moods in those couple of weeks. And she was happy to report that the progesterone cream was “the best thing that ever happened to me”. So there you go.

TERESA: Isn't it so incredible that a little bit of progesterone can do so much for the body and the brain?

LEAH: Yeah.

TERESA: This would absolutely be in my top recommendations for a pregnant woman to pack in her bag to take with her to the hospital when she goes into labor or to have on hand at home after birth. A little bit of hormone resuscitation can go a long way to taking off the edge of that postpartum experience.

Continue supplementing with a quality prenatal & omega-3 postpartum

LEAH: Mm hmm, indeed. And on top of the progesterone cream, I would also encourage a new mom to continue supplementing with her prenatal multivitamin, as well as making sure she's getting in a consistent source of omega-3 fatty acids. Some prenatal multivitamins include omega-3s or include some DHA in them; DHA being one of the omega-3s. But most often you're going to need to add a quality fish oil supplement or a DHA supplement on the side.

TERESA: Right, Leah, I think that those are some really important points. And if we use a bank analogy, pregnancy is a time of major nutrient withdrawals, while pre pregnancy and later postpartum are the times to make deposits into that nutrient bank.

Pregnancy and a growing baby require moms to donate a lot of their own nutrient stores to the baby. This includes those special fatty acids, the DHA. DHA is crucial for building baby's brain, nervous system, and eyes. So it plays a very, very important role. But DHA can also be a crucial part of mom's brain and mental health during and after pregnancy. So we want to make sure we're getting enough for both.

LEAH: Correct. Yeah. Or that we're replenishing as quickly as we can afterwards.

TERESA: Yes.

LEAH: Yeah. Absolutely. Yeah, research shows correlations in postpartum women with postpartum depression and low omega-3 status. There was a meta-analysis that I was looking at as we were preparing for this show. It was published back in June of 2020 from the journal, Translational Psychiatry. And this research study showed that “omega-3 fatty acids significantly improved depressive symptoms in perinatal women regardless of pregnant or postpartum, and was well tolerated.”

And so this was a meta-analysis that looked at eight different studies, and each of those studies used a slightly different protocol when dosing omega-3s, surprisingly to me, most of these studies demonstrated positive effects on postpartum depression, even with just a thousand to twelve hundred milligrams of omega-3 fatty acids for four to eight weeks, which is one softgel in most brands.

There was one study that did use six softgels or about 6,000 milligrams of omega-3s. That one was primarily DHA. But we routinely recommend a lot more omega-3s, even if you're not pregnant and postpartum. So just even one softgel actually made a significant difference that kind of blew my mind.

TERESA: Yeah, that is, that's very interesting. So if you're a fish lover, this could look like eating one four to five ounce serving of wild caught salmon per day. You could do a few scrambled eggs with some smoked salmon mixed in for breakfast.

And then maybe you have some canned salmon for a quick lunch or snack. Or maybe you make up some salmon cakes for the freezer in those last few weeks during pregnancy. You could put that salmon dish on your postpartum meal train wish list so that maybe someone could make it for you.

LEAH: Even better. I like that idea. Yeah. And I do like salmon. I just don't know about doing it daily. Thinking back to those early postpartum weeks especially if I was already in the thick of postpartum, I would be way more apt to just supplement with a quality omega-3 supplement every day, like our Nutrikey Omega-3 1000 or our DHA 200, and then splash some fatty fish in here and there.

That, that would probably be my approach. And I do like fatty fish, just probably not every single day. And I made some of those salmon cakes recently with a lemon aioli sauce for the first time. And it was pretty delicious. I could see myself doing one of those like every day pretty easily. They were so good.

TERESA: Yeah. I think using a supplement is a little bit more realistic for most people. That's a lot of fish.

LEAH: Yeah, it is a lot of fish for sure.

The importance of protein consumption postpartum

TERESA: I, but I love those salmon cakes with a lemon aioli sauce. Yum. That's a great postpartum protein idea. We mentioned earlier in the show that protein plays a crucial role in helping heal the body after pregnancy and birth. Protein is also the backbone for making our bodies neurotransmitters, like the GABA we mentioned earlier, the chill pill, right?

And also serotonin and dopamine. Protein helps keep us full and helps to balance our blood sugar. Neurotransmitters and balanced blood sugar are key for supporting moms in their postpartum journeys.

LEAH: Yeah, absolutely. I know when I get hungry and my blood sugar gets low, like my anxiety, my sadness, my irritability goes way up. And this is whether I'm postpartum or not, and it is so easy during those early weeks and months with baby to accidentally under eat or to even accidentally skip meals and snacks, or to rely just a little bit more on those processed convenience foods. And then if you have postpartum depression, you might also not have much of an appetite or a zest for eating. So again, like it's easy to get dug into a hole postpartum and that can have consequences.

TERESA: Yeah, so having a strategy for this is important.

LEAH: Yes.

TERESA: And this is where a daily protein smoothie can be so helpful. It goes down easier than foods that need to be chewed. You can stack up on the protein, you can add the healthy fats and fruit, maybe even throw in a handful of spinach. They can be made in batches, so you only need to get the blender out every few days. Or, ideally, someone else is getting out the blender and making them for you.

LEAH: Yes, ideal world. I know not everybody has a second set of helping hands in there, but sometimes you don't know it unless you ask as well. I love the protein smoothie or the protein shakes idea. It might not necessarily qualify as one of those warming foods that we mentioned earlier, but it is indeed a way to pack a nutritional punch with minimal cooking and minimal effort.

My easiest postpartum meal that I relied on a lot, especially after my son was born was I did a lot of shredded meats in the crock pot. So it just kind of stew them in bone broth and a little bit of seasoning, but just kind of let it cook down until you could take two forks and just pull it all apart.

So I would do something like a pork roast, pull that apart, shred it up. Throw some sauerkraut in there, throw some avocado oil mayonnaise in there, like in a big bowl. And for some reason that was just so satisfying to me postpartum. It is so good. So then maybe you pair that with some apple slices or a banana or some leftover brown rice from the fridge and you've got that complete meal.

TERESA: Right, and just you got to do what you got to do postpartum.

LEAH: Yeah.

TERESA: You might throw together some things that you wouldn't consider in other times and you come up with these great meal ideas. We hope today's discussion provided some relatable information and some simple tools to help you if you are in that postpartum dark place, or so that you can relay this information to a spouse, a family member, a friend, a coworker.

Postpartum depression is very serious and many moms struggle. Some in silence. Balanced real food nutrition and some key nutrients can absolutely be factors to help manage postpartum depression, but it is also not meant to replace professional help and therapies sought with a licensed health care provider.

New moms need all the help they can get, and we think it's important to keep the conversation open and unbiased so that more mothers can feel heard and understood during this very vulnerable time.

LEAH: Yeah. So if you like what you heard on the show today, please head over to iTunes or your favorite podcast app to leave a review and help others find our show. And if you are needing more help in your postpartum journey, you can give us a call at 651-699-3438, or visit our website at weightandwellness.com and ask away.

Check Out Our Website for More Information!

As a woman dominated company, most of us have been there and done that and can help provide the compassion and support to moms in the trenches of early motherhood.

TERESA: Our goal at Nutritional Weight & Wellness is to provide each and every person with practical, real life solutions for everyday health through eating real food. It's a simple, yet powerful message. Eating real food is life changing. Thank you for listening.