Tears rolled down my cheeks as I sat in the front seat of my miniature van, parked in the Chik-Fil-A parking lot, baby bump nearly touching the steering wheel, I called my mom. “Mom, she’s a junkyard dog!” I said recalling the embarrassing scene I had just fled. The small 2 year old child strapped in her carseat behind me had just bit 4 people in less than 3 days. At this rate, she was surely on the path to Juvie. 

I knew I had to intervene, but how? I felt like I couldn’t take her anywhere for fear that she would bare her teeth and the rest would be history. I sought out advice, most mom’s remembered their kids biting, but couldn’t remember how they stopped biting (funny how that works). Some moms suggested I bite her, so she knew how much it hurts (since I don’t want trouble from the law, I avoided this option). Others suggested I model nice interactions for her (she just ran away when I did this). The wisest moms of all shrugged it off and insisted she would outgrow it. 

So what did I do? I took a combination approach. I prompted her to bite her own arm. I pretended to bite my own arm at the same time. She was really excited at first, but soon, I had her full attention. That is when we talked about how important it is to use words to express yourself, instead of hurting people. Viola. She was a reformed 2 year old. 

What would I have done if the biting had persisted post intervention? I would have sought expert consultation that extends beyond my circle of mom friends. Here at IFM, we’re regular parents too (our children aren’t perfect), you can tell us the whoas going on in your family and we won’t judge. What we will do is listen. If necessary, we can refer you in house to our pediatric sensory specialist and our behavioral health specialist. So keep your chin up parents, IFM has your back!

Sara Lynn, RN, BSN

“If you don’t invest in your health, no one else will.”

This month’s blog is focused on diabetes awareness so I will be addressing this condition and how it relates to weight gain. I will be primarily focusing on Type 2 diabetes as it relates to weight gain much more so than Type 1. So when I use the term “diabetes,” I am referring to Type 2 and not Type 1. 

Type 2 diabetes simply means insulin resistance. What does insulin do? Insulin is a hormone secreted by the beta cells of our pancreas in response to eating food. Most food, when absorbed, gets converted into various forms of simplified, broken-down sugars. These sugars are meant to be used as an energy source for muscles, liver, brain, etc. Insulin is the hormone that gets the blood sugar into these organs’ cells.

Diabetes occurs when there is dysfunction in the hormone receptors on the cells of our organs making it difficult for the body to maintain a healthy level of blood sugar. The body responds to this by secreting more insulin to get the job done which ultimately perpetuates the problem. I equate it to hitting your car brakes harder and harder to make them work until they just simply don’t which is disastrous. Once your body has trouble balancing your blood sugar levels, an autoimmune reaction occurs because of this accumulation.

These autoimmune chemicals then react with various parts of your body leading to nerve damage in your extremities, eyes, heart, stomach, brain and more central nerves that control your balance. These also damage the vascular walls throughout your body putting you at risk for heart disease, perivascular disease, and stroke. The longer and more severe diabetes is, the worse the risk is. 

What does weight gain have to do with Type 2 diabetes? Well there is no simple answer to this as we are still investigating the exact mechanisms but I will do my best to relay what we think we know. There is a certain time when, as you gain weight, that your fat cells become dysfunctional themselves. Dysfunction breeds an inflammatory response. Specifically, these dysfunctional fat cells promote pro-inflammatory macrophages in response to fat cell death, low oxygen levels inside the fat cells, and other dysfunctional processes.

The cells then secrete pro-inflammatory chemicals lead to a decrease in insulin receptors on cells along with other similar receptors that regulate blood sugar levels as well as promote dysfunction of current insulin and other blood sugar receptors. That is the basic concept with no need for further in-depth discussion as the point of knowing this to help you understand that as a person gains weight, so too does one’s chance of developing diabetes. 
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Thankfully we now have options to reverse this course and return you back to your normal state! Of course, the first and most obvious answer to this problem is a good healthy balanced diet. Specifically, when it comes to lowering your diabetes risk or simply treating diabetes, you must consume foods that are of low glycemic index. These are foods that do not spike up your blood sugar after eating them. This consists of healthy options with natural sugars that are complex as well as in general low-carb food options. The healthy higher-carb food items contain more complex natural sugars that are harder to break down by the body’s digestive tract so less gets absorbed over that time. Versus those sweets and snacks we like contain added sugars which are simple already-broken-down sugars which are all readily absorbed leading to a greater spike in your body’s blood sugar levels which then demand a higher amount of insulin secretion ultimately leading to weight gain and insulin resistance. 

If one is seeking medication to help cure them of diabetes, consider the GLP-1 agonists class. Examples of these include Ozempic, Mounjaro, Wegovy, Saxenda, Trulicity. These work by countering your “hunger-hormones” and promote increased insulin sensitivity. These combined with another class of medication called the SGLT-2 inhibitors are very good at not only getting your blood sugars under control but also help you to lose weight in the process. The idea behind these medications is to not only fix the current diabetes problem but to hopefully help one in negating one of the main causes behind diabetes which is weight gain. For those on insulin therapy, these medications will not only help much more than insulin but it is always my goal for my patients to wean off their insulin to promote further weight loss. Insulin, as a medicine you give yourself, leads to weight gain as well. This is because the levels of this hormone are not as carefully regulated since you are giving insulin on top of your natural production. Weaning off helps the weight loss process. The ultimate idea of these medicines is to be on them as long as the increased weight continues to put you at risk. Once your weight is at a healthy level, then we can start to wean off these medicines themselves as the hope is now you can control everything with diet and exercise alone. 

I hope that this blog has been good in helping you to understand diabetes and how it relates to weight gain. There are of course other causes behind Type 2 diabetes and not just weight alone but this is an area that we can control ourselves by making the necessary lifestyle changes we know we all need to make. Remember that even a mild weight gain can increase your risk of diabetes so do take care in managing your appetites and attachments to certain foods you know are not good for you. If you’re ready to take the next step in attaining greater wellness, schedule a weight loss appointment with me, I’d love to accompany you on this journey, and so would our Health Coach Kala. 

Stephen Hoelscher, MD, Board Certified in Internal Medicine, Obesity, and Weight Loss

​1. Prenatal breastfeeding education: An IBCLC can help identify any potential issues that would complicate breastfeeding and review any advanced questions and concerns that you may have. She will cover what to expect prior to delivery, the golden hour, the first few days after birth, and may cover other topics; such as using a breast pump, depending upon what you want to know!
 
2. Dealing with breastfeeding issues: An IBCLC can assist with lactation difficulties, such as poor latching or sucking, perceived low milk supply, relactation, induced lactation, breastfeeding multiples, damaged nipples, incorrect pump flange sizes, or a fussy baby. 
 
3. When a mother plans to return to work, an IBCLC can address questions about pumping, milk storage, and your rights.
 
4. General support: An IBCLC is that shoulder to lean on and someone to give you gentle guidance, especially in a group setting. A great support system significantly helps mothers reach their personal breastfeeding goals. 
 
5. Pump questions
Discuss pump usage, pump settings, flange fitting, pump filter use, and milk storage.
 
6. Bottle feeding issues
Poor tongue use, poor sucking, infant weight loss, transitioning to combination feeding

​It’s a common joke these days that people plan their Thanksgiving outfits around how stretchy the waist band of their pants are. What’s not as funny is the difficult emotions many people face when seated at the dinner table, let alone seated around lots of family members. The holidays are filled with memories, family, favorite dishes, and many times guilt and uncomfortable emotions. 

As a health coach, I always encourage my clients to focus on what they can control. Sometimes in hard settings, that means just focusing on controlling our breath. In holiday settings, this many times looks like bringing their own “healthier” option as a side dish. Maybe meeting a basic hydration goal before an event or party. Practicing staying sober or saying “no” to an offer we don’t feel inclined to fulfill.  Not having a super restrictive mindset but simply limiting the favorite once a year treats and heavier dishes. Many times restrictions can lead to binging. Know yourself and your personality though, will that “taste” or just small spoonful lead to greater cravings than if you just avoided the dessert table all together? 

Allowing yourself to feel the bigger emotions that come up through this season is important. This leads to placing our focus outside of food and material items.  A lot of emphasis is placed on the foods that bring us together or the gifts that will no doubt bring you all the peace in the world (yeah right). News flash, that piece of pie and that really great Black Friday Deal (on that thing you didn’t know you needed until it went on sale) will not bring you true contentment or joy. Contentment and joy come from living with what you have, right where you are.  Even if right where you are isn’t exactly where you want to be. 
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What are the things you are going to shift your focus to this holiday season?   

​When I was a little kid, I loved when Fall rolled around. I’d be grocery shopping with my mom and we’d carefully pick out cans of Libby’s canned pumpkin off the freshly stocked seasonal end caps. I knew that those cans of pumpkin would be turned into something delightful that would certainly be shared with the company. I loved having company over, still do. 

Flash forward to 2009, the year of the pumpkin shortage. Canned pumpkin was nowhere to be found. Sure we’re used to this now with the supply chain issues and what have you, but in 2009 this caused an uproar. My friend's grandma saved the day when she cooked me a pumpkin and it came delivered in a mason jar. How did she do it? I wondered to myself. 

​Well, I’ve learned a lot since 2009 and I’ll be darned if I’m forced to go without pumpkin desserts. This year my pie pumpkins didn’t survive. Raccoon? Deer? Rabbits? Mower? No one is fessing up, so it's a good thing our very own Alyssa at IFM had a stellar pumpkin crop this year. She knew just who to share with- me. 

So, let me show you how to take those fall pie pumpkins you've been decorating your house with, and turn them into something edible. 

First, wash the pumpkins thoroughly with warm water and dish soap. Since they grow on the ground, its just a good practice.
​Then cut them in half with a sharp knife and scrape out the seeds. Seeds can be saved for baking. Then place them cut side down in a baking dish with an inch or so of water. Bake at 400 degrees until soft. When the pumpkin is soft, let it cool slightly and scoop out the orange flesh, avoiding the skin

Your cooked pumpkin can then be mashed by hand or run through a food processor to smooth it. I’ve found that the food processor is helpful if you intend on making a pie or soup. For coffee cakes or bars- hand mashing works just fine. Excess pumpkin can be frozen to use later.

Let's turn that orange mash into some pumpkin bars, here’s my mom’s recipe that she’s been making since I was little.

Batter Ingredients:
4 Eggs
1 ⅔ Cup Sugar
1 Cup Non GMO Oil (I use Avocado or Coconut)
2 Cup Cooked Pumpkin (or 15oz Canned Pumpkin)
2 tsp Baking Powder
2 tsp Cinnamon
1 tsp Salt
1 tsp Baking Soda
2 Cup Flour

Cream Cheese Frosting Ingredients:
1 8oz Brick of Cream Cheese
1 Stick Butter
1 tsp Vanilla
2 Cup Powdered Sugar

Directions:

Preheat oven to 350 degrees and grease an 8in x 12in baking dish. Beat together the eggs, sugar, oil, pumpkin, baking powder, cinnamon, salt, and baking soda with an electric mixer. Sir the flour in by hand. Spread the batter evenly into greased baking dish.

Bake for 25-30 minutes at 350 degrees, until a toothpick inserted in the center comes out with only a few crumbs. 

​To make frosting, beat all ingredients together with an electric mixer until smooth.

Cool the bars and frost with cream cheese frosting. 

You’ll be amazed at how simple it is to cook with fresh pumpkin instead of using store bought canned pumpkin. It really does taste better and is a fun activity to do with children, showing them where their food comes from. 

​Sara Lynn, RN, BSN 

“If you don’t invest in your health, no one else will. “

When should I have my first appointment with a lactation consultant?

Whether you’re expecting your first baby, or you’ve welcomed one before, visiting with an International Board-Certified Lactation Consultant (IBCLC for short) before your baby arrives can help you prepare to breastfeed or provide expressed milk. Here are some answers to common questions about prenatal breastfeeding visits.
 
Why should you visit a lactation consultant before delivery?

Breastfeeding is the natural conclusion to pregnancy and birth. But “natural” doesn’t always mean “easy”! Breastfeeding is a skill that takes some time for both parent and baby to learn, and each breastfeeding pair is unique. Breastfeeding is a skill, passed along between generations, and that link has been broken for a lot of families. Education during pregnancy for lactation is one way we can continue to pass along knowledge of breastfeeding and caring for a new baby.
Prenatal breastfeeding education can take many forms such as books, breastfeeding classes, support groups like those coming to IFM, browsing trusted websites, YouTube, and talking to your midwife or provider. Another option is having a one-on-one visit with a board certified lactation consultant to discuss any specific questions or concerns you have.
 
What will you talk about?

During these prenatal consults, the IBCLC will cover what to expect prior to delivery, the golden hour, the first few days after birth, and may cover other topics, such as using a breast pump, depending upon what you want to know! The goal of this appointment is to help you feel prepared and increase your confidence, so your lactation expert will talk about the topics that matter most to you, after covering the basics.
 
Who should have a prenatal breastfeeding visit?

Anyone who is expecting a baby, no matter how long you’re planning to breastfeed or pump, can benefit from a prenatal breastfeeding visit. Partners and other support people are welcome to come along; they can ask questions and hear the same expert information, so everyone understands what to expect once your baby is born.
 
There are some cases where a prenatal breastfeeding visit is highly recommended:

• First baby/ don't know what to expect
• Planned early delivery
• syndrome (Trisomy 21); heart conditions; or any other expected issues
• Adoption, surrogacy, or induced lactation

 
What should you bring to the visit?
​
Bring your questions and concerns to us at IFM. Many people bring a written list of things they’re curious about, such as advice they’ve heard from friends or family.
If you have a breast pump, bring that along with you and we can show you how to put it together, and find the correct size flange.
Lastly, bring your nursing pillow if you have one.

​

As the year winds down and the holiday season is among us, I was thinking about family traditions and what lessons I want to teach my daughter during this time. What do I want her to remember about the holidays and pass on to her own children one day? That thought spun into family traditions, and sparked this discussion on how family traditions are important for social emotional development in children. 

First, what is social emotional development? Social emotional development is the child’s experience, expression, and management of emotions and the ability to establish positive and rewarding relationships with others. There are five main social emotional skills that develop typically within the first 3 years of life: self-awareness, self-management, social awareness, relationship skills, and responsible decision making. 

We all know that children learn through play, but how do they develop their emotions and learn to regulate them? You may notice your child becoming more emotional as they move from the infant to toddler stage. Maybe they are throwing things, hitting, crying more, or even biting. Are they just being naughty? No, as easy as it is for us to let our minds think that, this is just their way of communication. They do not have the words to express their feelings, and just like everything else they need you to teach them how to communicate their emotions and work through the tough moments appropriately. 

So how do we do that? There are three main ways to support your child’s social emotional development. First, start by  creating a secure safe home where they can be free to express themselves and feel your unconditional love. Give your child praise and tell them often how much they are loved. Then, acknowledge and validate your child’s feelings and discuss how they can regulate them such as, “I see you are feeling upset, it’s okay to feel upset. I feel upset too sometimes, so let's take a breath and read a book to help our body calm down.” Lastly, give your child opportunities to play with other children their age. Teach them through role play how to interact with other children, and once they are in the moment with another child don’t be afraid to step back and watch their skills strengthen as they practice what you’ve taught them. 

So how does all this correlate to the importance of creating family traditions? Well, when I think about my own family traditions I instantly get a warm sensation, a smile on my face, and an overall feeling of happiness. Why does that happen? Well my parents were successful in teaching me social emotional skills and creating family traditions that promoted the secure bond of family, feeling of being loved, trusting others, as well as promoted my own self-confidence. These are all things I wish to instill in my own children. By doing so they will be able to form long lasting bonds with family and friends, and one day create their own traditions with their family. So don’t be afraid to get a little silly and keep things fun, this is an important time for your child's development as well as memory building for you both. 

Sensory classes will resume in January. Until then I encourage you to enjoy the holiday season by celebrating your families unique traditions. 

I might be the self proclaimed “muddling through mom”, but that doesn’t mean I don’t strive for those truly meaningful surprises. In order to do so, burning the midnight oil from time to time has become a necessity. How else would the baby books get caught up? The Christmas presents get wrapped? Or the birthday cakes get made…

Yes, it was one particular birthday cake however, that made me question my whole approach. This cake was for a four year old with a January birthday. You know how January birthdays ride off the coattails of Christmas get togethers (when everyone is too tired from the holidays to brave the icy roads to come to a kids’ party)? The birthdays where everyone shows up with presents in Christmas wrapping paper, because… it's easier. The birthdays where your child really needs to be made to feel special and you designate yourself just the superhero to make it happen.

Well, this superhero (me, remember) decided to make a hot chocolate flavored bundt cake after everyone went to bed. I would decorate it with dinosaur figurines to match the theme of the party. It would be such a great surprise for a January birthday girl currently obsessed with becoming a paleontologist. 

​Everything was working out wonderfully. That is until the bundt cake refused to release from the pan, spiraling me into panic mode. I was tired. Stores were closed. How would I ever fix this crumbled cake mess that sat on the counter in front of me? In 10 hours my house would be filled with party guests.  

​What did I do?

Nothing. I covered that mess up with a glass cake dome and slid it to the back of the counter. Deciding sleep was more important. I set my alarm for before everyone would be awake the next morning. 

In the morning, I woke up rested with a plan. I’d crumble that cake up even more, layer it in a trifle dish with frosting, dust the layers with hot chocolate powder and hide the dinosaurs in the cake. YES! All wasn’t lost, in fact this cake had just turned into a party game of sorts. After cake and ice cream we would find out who’s archeological dig was the most successful.

​Sleep is so important. Often as humans, we underestimate the power of sleep. Our thinking suffers, our mood suffers, our productivity suffers and ultimately our bodies suffer the consequences. Here at IFM, our providers know how crucial sleep is. That’s why our primary care and mental health providers, as well as our health coach will ask you about your sleep. If your sleep is suffering, we have a lot of non-pharmacologic options to offer you to help you get the Z’s you need. That’s the beauty of our integrative approach. You talk, we listen, then we create a plan together, and get you to optimal wellness. 

Sara Lynn, RN, BSN

“If you don’t invest in your health, no one else will.”

How many of us know that exercise is beneficial for our health? Does anyone in 2022 seriously question whether or not exercise is a helpful activity or habit? Yet, how many of us still find all kinds of reasons NOT to exercise despite knowing all the possible health benefits? “I’m too tired. I don’t have enough energy. I don’t have enough time. I don’t even know where to start.” The list of excuses for why we can’t exercise can get quite long. In an attempt to quiet some of those excuses, I want to dive a bit deeper into the evidence supporting exercise and the positive impact it can have on mental health.

There is a fantastic organization out there called the John W. Brick Mental Health Foundation. I would recommend this organization as a resource for those seeking additional mental health support, but today, I want to focus on a yearly report they publish called “Move Your Mental Health.” This report basically summarizes all of the available scientific research that pertains to exercise and mental health.

The first takeaway from the report, while it may seem obvious, is certainly worth repeating: “Three decades of science make it clear: exercise should be integrated into prevention and treatment of mental illness and promotion of mental wellness.” I’m sorry to break it to all those excuses, but they don’t hold a candle to 30 years of scientific evidence.

Astoundingly, they found that “89% of all the published peer-reviewed research between 1990 to 2022 found a positive, statistically significant relationship between exercise/physical activity and mental health.” That’s 89% of over 1200 experimental studies. They go on to say that those meeting criteria for depressive disorders should be prescribed 30-45 minutes of moderate to vigorous exercise 3-5 times per week as this seems to be a sweet spot in the literature for “optimal mental health benefits.”  On top of that, there is evidence to support prescribing low intensity exercises like yoga, qi gong, or mind-body movement for those experiencing symptoms of anxiety.

I don’t want anyone to get too hung up on those numbers because they did conclude that the optimal type, intensity and duration of exercise generally remains unclear and that more studies are needed to determine the ideal exercise routine. While we might not know how much or how often, we do know definitely that exercise is an essential element to mental wellness.

The foundation found that exercise appears to positively impact mental health though biological pathways like increasing brain neurotransmitters and improving hormone function, as well as social and self-efficacy pathways. There is also evidence to support the combination of cardiovascular exercise and strength/resistance training for mental wellbeing. They conclude that exercise and movement can be considered mainstream elements of mental health care vs. the outdated view that exercise is only a complementary or alternative approach to treatment. There were some other findings in the report that you can explore further here: https://www.johnwbrickfoundation.org.
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There is certainly room for additional research to help uncover answers to the how’s and why’s of exercise and the benefits it can have on our mental/emotional wellbeing, but the evidence is clear: exercise is beneficial for mental health. I’m not asking for 30-60 minutes of exercise right out of the gate, but can we take some small steps toward that goal. There is a lot to be said for 10-15 minutes of regular exercise, especially if we are stuck in a pattern of not doing it for months or years.

​Start slow, be kind with yourself, and maybe consider looking into a personal trainer or group fitness class to help ease into the process of a regular exercise routine. It is becoming increasingly clear that exercise is a foundational element of health and well-being. I am confident that you will feel and see the benefits for yourself if you can nurture this aspect of your life consistently and compassionately. 

​If you’re like me, the concept of “gentle parenting” or “conscious parenting” is a fairly recent idea. I definitely grew up in a more traditional home, where we finished our food, were given time outs, and expected to act a certain way. Now I am not knocking traditional parenting, my parents were great parents and still continue to show me unconditional love. However, I have found in my own personal and professional experiences that a more gentle approach to parenting can be more effective and the benefits are long lasting. 

So that’s great, I am on board 100% with a gentle parenting style. Problem is, I am not the only one who influences my child or cares for her on a daily basis. If you didn't know, I am a single mother, who relies heavily on my parents to help raise my child while I work. My daughter also attends a part time early education school a couple days a week. This has worked well for us, and I know I could not pursue my career without the outside support from my family and her school. According to the US childcare statistics over 58% of working parents (single or not) rely on childcare centers to care for their children while at work. That doesn’t account for those of us using private childcare such as a nanny or family and friends. So, how do we get these caregivers on the same page with the gentle style we have adapted? 

First, accept that you will not be able to have complete control of the actions of others. Have faith in what you are instilling in your child, and know that they will have the tools to make the right decisions when left to their own devices. This is particularly important in situations like childcare centers and schools. If you decide a childcare center is best for your child, consider your style when selecting the center. Tour the facility, and ask questions to ensure their values align with your own. It is a good idea to talk with other parents whose children also attend that center to get a real feel of what to expect. The same goes for school. You have some control over selecting a program that fits your child best. 

When it comes to friends and family, well it can get a little tricky. You will need to find a balance between educating them about gentle conscious parenting and offending them. I have found the best way to explain the expectations for caring for my child is by modeling and showing examples. I find this particularly difficult with grandparents, as this is simply not how they were raised and the concept is completely foreign to them. My best advice is to set clear boundaries and expectations, while giving them grace. Once they start seeing the results from a more gentle approach they will be more likely to use the same approach. You can say something like, “I choose not to use time outs with my child, instead please redirect her. If she is being physically aggressive or endangering herself, please let her know that her feeling is ok but the action is not and then use a calming technique and redirect.” Make sure to set them up for success, give them a few techniques that you have used successfully with your child to help them through hard moments. 

Finally, remember to have patience. Gentle parenting can be difficult to implement, especially when you go a lifetime utilizing a different approach. If you need help integrating gentle conscious parenting into your style, feel free to reach out to Stephanie at Stephanie@integrativemediowa.com  to set up a home consultation where she can give you in the moment tools to use with your child. Remember gentle conscious parenting is about teaching self-regulation without external pressures, in a peaceful relaxed way. So take a breath, be confident in your own abilities to be the best teacher for your child, and give patience to those helping you along the way. 

Sensory classes will resume in January. Grab and go activities will be available at our West Des Moines and Ankeny locations the months of November and December.