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Written by Christopher Kelly
July 28, 2019
Christopher: Well, Lily, thank you so much for joining us this morning. We very much appreciate you making the time, especially as you're so close to having your next baby. Tell us about that. How's it been going? How's your pregnancy been going?
Lily: Luckily, my pregnancy is uneventful, so no complications or anything. It's just the usual tiring saga that pregnancy is that simultaneously goes really fast and really slow. So just hanging in there for the final stretch and literal stretch and expansion that happens at the end here. But yeah, we're looking forward to another addition.
And all my sites are on postpartum recovery this round. I think everybody does that, the second, third, fourth, whatever round you're on because you do a lot more meal prep and prepping for the real event, which is after birth. That's what I'm doing.
Christopher: And that's what we're going to be talking about today. And with me, I have a real postpartum woman.
Julia: Alive and in person. Yeah.
Christopher: Yeah. Alive and in person, which I thought was important because –
Julia: You are not a postpartum woman?
Christopher: Yeah. I have imposter syndrome at the best of times. Never is it stronger than now. And I think it's an important and underdiscussed topic. You hear lots of people talking about the importance of getting yourself in good shape to conceive and pregnancy and childbirth, but you don't really hear a lot of people talking about what happens after that, right?
Lily: Yeah. And all of those things are all well and good. They set you up for a better postpartum recovery coming into pregnancy with better nutrient stores. And maybe aside from the nausea, food aversion phase, generally eating more nutrient-dense real foods, like that sets you up for positive pregnancy experience or positive birth experience and an easier recovery. But your work isn't done. There is so much that means healing and repairing postpartum. And now, your time is stretched thin caring for a baby.
So it's a lot to think about. And I think it's important that we make this conversation more the norm because in many other cultures and centuries passed, the mom didn't really need to think too much about it. She didn't need to do a whole lot of prep because it was built in to all these cultural traditions of caring for new mothers. And now, we have to take the torch for ourselves and do almost extra work upfront, it seems like, to prepare for a support in postpartum.
Christopher: This is the part that makes me the saddest, if I'm honest. There's all these problems that we find. And most of them are environmental mismatches, right? This is the difference between the inputs your genes were expecting and what is happening in reality. And most things are fixable. For example, there's no problem getting outside first thing in the morning to get some bright light and it's not that hard to avoid artificial light at night. However, having a village to take care of your baby is not as easy a problem to solve.
Julia: No, it's a really hard problem. I mean Chris thought I was absolutely have lost my mind during my last pregnancy with our son because I just went into this hyperactive state almost the whole pregnancy where I just felt like the world was literally going to end after I gave birth because I knew that I had this other four year old to take care of and I was going to have this infant. And I knew how hard it was the first time around and it's on my mind. It just multiplied that by a factor of probably a hundred.
So I did a lot of things that were really out of character for me. I found myself reaching out to almost perfect strangers, like acquaintances from [0:03:39] [Indiscernible] moms who I had only just met on the periphery and saying, “Hey, I'm having this baby. Can I write you down as an emergency contact for my daughter if something goes wrong to birth? Would you mind bring me some ingredients over so I can make some meals out of [0:03:56] [Indiscernible]? Do you want to be part of my like group?” and just really trying to overprepare. And I think I redid the entire house, but I just felt this real urgency to take care of all of these things because I didn't know how else I was going to survive.
Lily: Oh yeah. I can completely relate to that. Last round, I was lucky that I had some friends who arranged a Meal Train for me. And I had people from the community that I didn't even know dropping off meals for weeks. And this time around, we're in a different place with not as tight knit of a community. And that won't be the case. That's not going to happen.
Around 20 weeks, I made a -- it's not like a spreadsheet because I'm not that organized, but I made a list on my fridge with the dates of each week to remind me to put something in the freezer for postpartum meal. And this round -- and I haven't stuck to that perfectly, but I've tried. I try to make double batches of things and freeze half for example. And this time, I invited my mom up for a whole month or longer. “Hey, stay as long as you want. Like my house is your house.”
So yeah, there's a lot more prep going into it this time than last time. You're so focused on the birth. It's just, “Oh, we have to have the good birth experience, have to have the good birth experience.” And this time, I'm like, “Yeah, the birth is going to be fine.” That's not my concern. I want to make sure I'm supported after the fact because that's when it gets real.
Julia: My friend hired a postpartum doula this time around for her second. We delivered around the same time. And I was so jealous. I wish I had done because it was just so incredible to see all the things that she had done for her. But yeah, you've got to do the prep.
We see that. We can talk about that because we've been through it or you're going through it right now. I'm really thinking about first time moms who I think aren't prepared for this at all. I mean I don't –
Christopher: They don't even know it's coming. They don't know what they don't know.
Julia: They don't even know what’s coming. What kind of impact does that have on them going into that process when they don't even see it coming, so they're sideswiped by it? What have you seen as you're researching all of this stuff and working with people on the nutrition side? How have you seen that come into play?
Lily: I think we need to normalize that postpartum recovery is not a one week, two weeks, six weeks thing. First of all, what's hard is that I think the way in which people approach trying to prepare other parents or new parents for what's coming is these “just you wait” comments and then horror stories. And that's not helpful. That was really frustrating to me my first time. It's actually still frustrating to me this time around. “I know what's coming. You don't have to warn me about Armageddon here.” I’m like, “My expectations are real low this time.”
But I think that if we had an -- actually the data shows this when they've done qualitative research studies interviewing new mothers. It’s that they wish there was a more open and honest discussion about what's ahead, what to expect for recovery, how much time you might want to take off from work, which in the US, unfortunately, we don't have paid mandatory maternity leave, like at least nationwide mandated maternity leave. So that's a tricky one for people.
We don't talk about how long it takes the pelvic floor to recover and return to normal function. So I think people have expectations that you go to a six week checkup and as long as everything's looking okay, you're cleared for all the normal things, but it's not full on pelvic floor assessment like you might get from a women's health PT. And really, the full recovery takes at least a year for the pelvic floor to return to normal functions.
I think we have people jumping into activities maybe that are a little too intense for where they are in their recovery too soon. Then I don't think we talk about the nutritional demands of recovering from pregnancy and childbirth as well as supporting mothers’ breast milk production and the nutrient transfer into breast milk. So we just like -- there's so much emphasis on this prenatal nutrition aspect. Then there's not a whole lot of emphasis on like -- this still matters now. And actually your nutrient needs and calorie needs are higher while you're recovering.
The challenges, like trying to communicate that to people ahead of time. And the best that I've found is having open and honest discussions. I think it does need to make its way into birth and healthcare providers, discussions with clients during pregnancy. For me, I put a whole chapter in real food for pregnancy on postpartum recovery in the fourth trimester because I knew I didn't pick up any books on postpartum nutrition when I was pregnant. But if it was in a prenatal book that I had been reading, I would have been better prepared.
And I was in a fortunate position that I had had six friends who had had babies within the last 18 months who lived locally to me at the time. So I actually was prepared for the slowdown that was ahead of me and the shift in my schedule and expectations and what I could accomplish and all of that. But I had unrealistic expectations on the physical recovery because I just saw so many people “bounce back.”
And physically on the outside, it looked like I had bounced back. But you're really nutrient depleted for quite a long time. Your adrenals are taxed, like everything. All of your connective tissue takes so long to recover. That's the part where it was like, “All right. I was prepared for the mental challenges ahead and the adjustment to my schedule and workload. I was not prepared for how long the physical recovery would take because I figured I was so healthy going into pregnancy and had such an easy pregnancy and a relatively non-eventful birth. All is good. I should be good to go at six weeks.”
Then you're like, “Wait, I still don't feel like myself again.” And that's A, normal; B, okay; and C, we still need to focus on our nutrition so we can support this normal, long, slow recovery process that's ahead.
Christopher: Can you talk about some of the appropriate activities for postpartum? You mentioned that the pelvic floor takes time to recover. Can you talk more about that? It's really interesting to look at this through that evolutionary health lens or it takes a village, like what would women have been doing 300,000 years ago postpartum? Maybe 300,000 is a little bit too long. It's not that far. So humans were anatomically the same 300,000 years ago. It's hard to get your head around that.
And humans were controlling fire 1.5 million years ago. All this stuff is really, really new. So what would have happened? And what is appropriate for somebody that's trying to recover their pelvic floor?
Lily: Well, first of all, I think it's important to bring up that we have been removed from our traditional ancestral environment. So we aren't moving in all the ways at the same duration and intensity that we once did. So maybe our bodies are less prepared for birth.
And I think Katy Bowman makes that point quite well in her work. And I attended her pregnancy workshop last year, which was really –
Christopher: Oh wow. I didn't know she was doing those.
Lily: Yeah. Well, it’s the first one that she ever did. She's doing another one this year as well. But her perspective, which is very different from a lot of what you hear from women's health physical therapist is it's really like recoveries aren't happening as well as they once were because the strength of our pelvic floor and adaptability of our pelvic floor has not been adapted. It’s not adapted in the way that it used to be when we were doing this long duration movement, so much squatting just for gathering your food and making your food and cooking your food and going to the bathroom. All of these things, our bodies have adapted differently, I think, was her point.
So I think that's worth noting that there is definitely going to be some degree of difference in how people “bounce back” if there is such a thing or recover physically from birth depending on how active they are. I mean arguably, I was very active previously and during my pregnancy in the ways that probably were more ancestral to move, meaning most of my movement was hiking. I was living in Alaska at the time, so there's not much to do but hike, right? So I was out hiking quite a bit and was really in pretty good physical shape.
But in terms of how quickly you're going to recover and what's appropriate at which stages, I mean really, the first six weeks or so, if we look at what a lot of cultures, -- at least in our modern data that we have, so probably going back a couple hundred years -- there was usually a period of about 40 days or six weeks where they encouraged more rest and more recovery and less intense physical activities.
So lying in for a week was pretty normal in a lot of different places across the globe. And that's really important for the initial healing of any tearing or anything. Then after that, it was a gradual return to activities. In some cultures, they actually wanted you to stay indoors and not do anything outside during those 40 days or during the first month or so. Then gradually, your duties would expand beyond that.
But of course, we have to think if we're really thinking ancestrally. I mean you had your infant with you usually a lot. So that would impact the types of movement that you would be doing and even how you were carrying your baby. There was probably a lot more carrying in arms and less so relying on structured carriers where you held your baby in one fixed position at all times. You would shift the weight. And that develops your musculature and return to movement differently as well.
But from a modern perspective, usually, the recommendation is up to six weeks, keep it really light, so gentle walking and then just pelvic floor and transversus abdominis activation to try to help your diastasis regain your integrity of your core and pelvic girdle and everything.
Then once you've been cleared for movement, that's where it gets really wonky, I guess I'll just say, because you're not necessarily given really detailed information unless you get an assessment with the pelvic floor or Women's Health Physical Therapist. In which case, they can actually assess the healing of your pelvic floor, of your diastasis, of your abdominal muscles separated, which for most people they do. That's a normal part of pregnancy. Then they can assess what level of intensity might be appropriate based on where you are in your healing process.
So beyond six weeks, it's extremely variable on what people can handle. I think some people are really well adapted to go back to movement pretty quickly. And probably, the vast majority on the other hand are much better doing that gradual return to movement with more of a focus on low intensity walking and just getting used to engaging and relaxing their pelvic floor and maintaining core stability with proper engagement of their abdominal muscles.
Julia: And obviously, we can't separate this from the fact that your vast majority is also extremely nutrient depleted. So how does that nutrient depletion play into that ability to regain that strength even slowly?
Lily: Yeah. Actually, I love that question because I think people are usually looking at the nutrition thing and the movement thing as separate items. Because you have the physical therapists and exercise specialists and whatever who are focused solely on the movement. Then they have the nutrition people focused solely on nutrients and thinking of serum levels of nutrients and things like that.
But yeah, our connective tissue has to undergo a ton of remodeling in the postpartum time, so it's especially reliant on the nutrients that make up your connective tissue, all the amino acids in there. So your glycine, proline, hydroxyproline, the things that make up collagen, that all needs to remodel.
I mean you've had nine months where your joints and ligaments have been carrying more weight. A lot of your ligaments have actually stretched. You think about the round ligament. I mean that stretches significantly. The uterus grows to the size of a watermelon, so that contains 800% more collagen at term than it does in a non-pregnant state. So that's going to shrink down. You have the stretching of the pelvic floor muscles that happens during birth. If you birth vaginally or if you had a caesarean section, you now have a whole bunch of scar tissue through multiple layers of tissue. And that requires nutrients to heal.
So I think we need to do heavier focus on these collagen enriching nutrients. So really, that's looking at collagenous animal products. That's where you get collagen. So the bone skin, connective tissue of animal foods and/or even supplementing with gelatin or collagen powders, which we can now source from grass fed animals. They even have marine collagen. I think that stuff is really helpful.
And I think this is why you see so much nose to tail influence on a lot of the cultural traditions around postpartum food. There's a ton of emphasis on bone broth and soups and stews made with all of those odd cuts of meat. And pig's feet soup is a classic in the Chinese tradition. In South America, you see a lot of chicken soup made with a whole chicken, so that would -- if you were really harvesting your own chickens, there'd be chicken feet in there. All the skin would be in there, right? You're getting a lot of collagen from that as well.
So I think we do need to think about that. And then the nutrients that support the crosslinking of collagen such as your vitamin C and other nutrients for tissue integrity like zinc, protein, vitamin A, they're all involved in that tissue remodeling happening really early in the postpartum period.
And personally, I've heard from a lot of people who have either eaten a vegan or vegetarian diet in pregnancy and postpartum and then gone on to do different in their next pregnancy and embracing omnivorous real food approach. And I have people that have emailed me about the differences in their postpartum healing.
I had one lady who had been vegetarian. And she had a non-healing perennial tear that required corrective surgery. It was a problem for more than six months. Then with her next birth, she healed super-fast and super well. And she was really emphasizing those collagen rich foods. And that would be something that'd be missing on either a vegetarian or a vegan diet. So I think that's something to consider as well. We don't see vegan postpartum traditions in terms of which foods are emphasized.
Christopher: And of course, these are all great foods that you can batch ahead of time, right? You can stick it all in the freezer so that it's ready for you.
Lily: Soups and Stews, they freeze and defrost and reheat extremely well. Yeah.
Christopher: Talk about entity requirements. Maybe women might be thinking that they need less energy once the babies arrive, but that might not be the case, right?
Lily: Yeah. Actually, your energy needs do increase postpartum, particularly if you're breastfeeding. So what's interesting, just to make this point from the get-go, is we have -- in terms of what our guidelines have set up -- we have guidelines for pregnancy. Then we have guidelines for breastfeeding. But we don't have guidelines for postpartum non-breastfeeding.
So a lot of what I say about postpartum nutrition is going to be at least somewhat influenced by the assumption that you're breastfeeding because that's really what's the heavily, more nutrient requiring process going on. But even for people who choose not to breastfeed or don't breastfeed long-term, we still need to think about replenishing the nutrient stores from pregnancy and also making up for the marathon and/or major abdominal surgery that happened with birth.
So I would still say the energy needs would be higher regardless of whether someone's breastfeeding or not. The data on how much it increases is based on breastfeeding women, so I’ll say that. And the assumption is that it's about 500 extra calories per day in order to supply enough for exclusive breast milk feeding of an infant.
That's significant. That's a lot more energy. We're talking about 500 more than preconception needs by the way. So compared to pregnancy, you're only looking at a few hundred extra calories. I would actually argue in the first week or two or three or four, I think you need even more than that. Based on my experience postpartum and what I hear from a lot of clients is like you're just ravenous early on.
I feel like I was eating -- I was out eating with my husband, and he is a big eater. I mean he brought me breakfast like the [0:21:28] [Indiscernible] postpartum. I can't remember. I looked at the plate. It was like a normal amount of food I would have eaten during pregnancy. And I literally laughed out loud. I was like, “I'm going to need two more plates of food.” The size, that is nowhere near enough. I mean just bottom was pit. And that, for me, it's hard to say because everything is awash, right, looking back at those first three months. But I think for me, that lasted at least a good month, the really, really high appetite. And I think a lot of that was about --
Christopher: That was going to be my question. Do women have to think about this consciously or will your appetite just take care of it, right? Is that you're going to have to be like tracking calories and eating beyond your normal hunger or are you almost just going to be really hungry like you were?
Lily: I think you can just trust your mindful eating cues. Your body will take care of it. I think the problem is that so many people don't trust those cues. And they think that it's excessive. And they feel pressure to lose the baby weight or bounce back or, “I shouldn't need to eat this much because I'm no longer growing a baby.”
Christopher: I see.
Lily: If you're nursing, you're still growing a baby. Even if you're not nursing, you still got to recover from birth. I mean either surgery or a marathon, come on, you've got to replenish.
Julia: Yeah. That was my question because I don't think I've heard anybody talk about this. And I don't think anybody considers it like what kind of labor you had and delivery because that is usually taxing. I mean I know -- my best friend just gave birth a month ago. She had a really intense, long 40-hour labor with lots of pushing that ended in a C-section. That recovery is going to be different than the woman who had a quick three hour. I'm sure it was intense, but a quick three-hour vaginal birth, that is going to be very different. And I don't know anybody that takes that into consideration when they're recovering.
Lily: I completely agree. As I said, postpartum nutrient requirements and needs of women are -- it's just very understudied as a whole. But I think logically, we need to think about the timing of delivery, whether it's preterm or full-term, if they had a physiologic birth or a C-section thinking about, like you said, the length of labor or the intensity. I mean I know for me, I was vomiting a lot during the birth of my son so I wasn't taking in a lot of food. I think I needed a lot more for replenishment because it was like a whole day of not eating, expending energy and not eating, essentially trying to eat but throwing everything up.
Blood loss and postpartum hemorrhage, that's huge. That's actually a really big risk factor for anemia. So if you had a significant amount of blood loss or full on hemorrhage, you're going to need a lot more replenishment than if you have very little blood loss.
C-Sections, by the way, tend to have a pretty significant amount of blood loss more so than most vaginal birth. So I think that's something to consider. Also, you generally are going to have a larger wound than a vaginal birth even if you had some pretty serious tearing or an episiotomy. So there's more tissue healing that needs to go on.
But I think we also need to consider, “Was it a scheduled C-section, an elective C-section versus a C-section after a super long labor?” That's like adding insult to injury, right? You’ve had this huge long energy, expensive labor. And then you have surgery on top of it. I mean that seems like it would just dramatically increase your nutrient needs for recovery and your needs for rest as well.
Julia: Yeah. I think it's just so dangerous that we don't talk about it more because if you're that person who's had this ridiculously long, painful, strenuous, intense labor and then deliver with a C-section, you're talking to somebody who is able to just jump right back up on their feet and get back to normal. Not only that but that person is just as much required to go back to work in six weeks as the other person who may be required less recovery during that time.
It's absolutely insane. I think that's why it's really, really important to have these conversations to normalize this a little bit more so that women start asking these questions ahead of time or planning for these. I think even when I talk to women about their birth plans, encouraging them to understand plan for the best obviously, but also prepare for what could go wrong and know all of -- really inform yourself about all of this stuff and really pushing people to have some kind of a postpartum recovery plan should you need to have extra time to recover.
Christopher: Do employees ever do that? Do they ever say, “Oh, you can have an extra and weeks of maternity leave because…”
Julia: I have known. And maybe, Lily, you have more information on this because you worked more closely with this population. But I have known people who have gone on disability because they were not able yet, but I don't think everybody has that option. Definitely not everybody has that option. It's probably without pay.
Lily: It's probably without pay. And you're usually dipping into emergency family leave. I don't know all the laws around it but you're usually doing something outside of maternity leave. But it really depends on the employer too because I know some people who have really great employers who allow a more flexible return to work in terms of hours and working from home and whatnot. Then you have others that are like, “If you don't come back fulltime in two months, you will lose your job. You cannot switch.”
I had one friend who they wouldn't allow her to switch to part-time. She would have to quit her job and reapply and potentially not even get her job back to have a part-time schedule. So she really pushed to get back at two months because she didn't want to lose her job. I mean they couldn't afford it. So it's frustrating when this stuff lands on political and legal decisions that are usually not made by women or with women in mind.
Christopher: Well, I've heard you talk about some really good stuff. You've been producing some fantastic training that people listening to this can get access to. And I'll link to that in the show notes. We you can talk about that later, Lily, but talk about measuring micronutrient status. Is that appropriate? So you were talking about how there may be some specific demands of breastfeeding, but then you also just mentioned anemia. Obviously, you need certain micro nutrients to produce heme and red blood cells. Can you talk about -- is it appropriate for all women to test micronutrient status or could you just assume that you're going to be depleted in this, that or the other?
Another thing I've heard you talk about is the benefits of carbohydrate restriction for gestational diabetes. Is that still appropriate postpartum when you're making breast milk? I realize now that I've asked you 55 questions in one. So maybe we should start with micronutrient status. Is it appropriate to test right off the bat?
Lily: I would hold off on any lab tests until at least your sixth week visit. I mean you're hormonally so all over the place post birth. You can pretty much assume that everything is going to be messed up. Not to mention there's so much going on with recovery. It's an unnecessary but inflammatory process, the whole recovery process.
I've seen studies where they're assessing Vitamin A status in moms. Even in women who are super well-nourished and eating liver a bunch, all their vitamin A status was low. And they could only assume that it was because their inflammation levels were so high. Their C-reactive protein was way high because you're going through probably the most intense physical feat other than birth but including birth, I would say, that your body is ever going to go through again until you do it again.
So we're going to assume that it's pretty inflammatory. So I would weight just out of convenience for that sixth week check with your doctor to check a few things -- doctor, midwife, whatever health practitioner you're working with. And I would specifically be -- if you had an excessive amount of bleeding or full-on postpartum hemorrhage, I would definitely get an iron panel CBCs. You can get your hemoglobin, hematocrit and the ferritin and see where you're at with that.
The research has shown the risk of anemia is up to 75 times higher for women who had blood losses greater than a thousand mils at delivery. That's a lot of times higher. So that's when I think it’s really important. Even in the US, up to 30% of new moms face anemia. So I think that's something to consider.
I would also recommend getting your Vitamin D levels tested. We'll talk about some of the nuances of what that means. But this is more about checking for moms’ status so that -- because Vitamin D plays a role in your bone remodeling. A lot of women actually lose bone mass postpartum. So Vitamin D is important for calcium deposition.
But also your mental health and thyroid health are really reliant upon Vitamin D. So I'd want to make sure that that was adequate. Vitamin D does also transfer into breast milk, but it's not the circulating Vitamin D that transfers into it. So that's more about just making sure you're continuously taking in Vitamin D from food supplements and/or sunlight exposure.
Christopher: I was going to say, can I reverse that list? Can I say sunshine first, then food and supplements?
Lily: Yeah. Sunshine first. The hard thing about sunshine is it's entirely dependent on where you live. So I had my son in Alaska and not in the summer. So in the very short amount of time that I could even make Vitamin D, that wasn't a possibility. So for me, supplementation was the route to go. But if you're in southern California, Texas --
Christopher: That really goes back to the environmental mismatch idea as well because they probably were not humans in Alaska more than 50,000 years ago, right? That's like --
Lily: Maybe not or they were eating so many marine, fatty marine mammals.
Julia: Or they were specifically designed to be there.
Lily: Yeah. They were actually getting a lot of Vitamin D from their food. They're eating nose to tail. I guess you can still say nose to tail about seafood. Yeah. They were actually getting their fat soluble vitamins from their seafood. Yeah, those ones, I think, would be important.
Then beyond that, I think we don't have real research guiding us. So this is just my opinion on the matter. It’s that if you want to look beyond iron and Vitamin D in terms of micronutrients specifically, then I'd probably wait until maybe six months or so postpartum to think about doing a full micronutrient panel that you might run with a functional health practitioner.
Reason being, it's probably all going to come up low anyways. So you're just going to give yourself a ton of maternal anxiety over something that -- what you're already doing or should be actively doing, which is eating as much nutrient-dense food as possible, continuing with probably the majority of your prenatal supplements for the first six months or so postpartum. You're already doing the things to rebuild your nutrient stores.
So assuming that's happening, I don't know if you're adding any benefit, if you're finding out anything new by testing your micronutrient status earlier. I think by about six months, that might help you fine-tune some of your dietary choices or supplement choices. And you usually have a little more brainpower back at six months compared to three months postpartum. So that's what I would wait for those.
Unlike -- it's the same as pregnancy. With early postpartum, since so much inflammatory stuff is happening, necessary and beneficial inflammatory stuff is happening, we don't know if all the reference ranges would even apply to early postpartum women.
Julia: Probably not.
Lily: Yeah. They probably wouldn't.
Julia: Barely [0:33:13] [Indiscernible].
Lily: Exactly. And that's something where I think it's like, “Let's just wait till we get a little bit more towards baseline. You do all the proactive things. You eat all the nutrient-dense foods. You take your supplements. Then we'll test at a later point.”
Christopher: So talk about micro and macro nutrient requirements for breastfeeding. Is there anything you think about? Tommy did some rodent experiments where he showed a greater amount of medium chain triglycerides in the breast milk of rats when they were fed carbohydrates versus ketones. And I wondered whether women eating a very low carbohydrate diet would actually be changing the composition of their breast milk unfavorably and may benefit from more carbohydrates postpartum. I wondered if you had any ideas about that.
Lily: What's interesting is there's actually research showing that the more MCTs you consume, the more of those end up in your milk as well.
Christopher: Oh really? Oh you definitely have to send me those because we couldn't find that. So it would seem that the liver is super greedy. And if you consume MCT oil, then that's just going to be metabolized by the liver and used by mom rather than ending up in the breast milk. So yeah, I'd love to see those studies.
Lily: Yeah. There's data on both. So certainly, carbohydrates can up the lauric acid concentrations in breast milk, but MCTs as well. So that's something to think about.
That said, to go back to the whole carbohydrate conversation on how much might be required for breastfeeding, I personally don't think you need to try to go keto necessarily while you're breastfeeding, particularly while your milk supply is getting established, which is usually the first three months or so, if the goal is long-term breastfeeding. Some people don't want to breastfeed long-term. And in which case, if your supply drops, you're good to go. You don't worry about it.
But for people who want to continue breastfeeding, there's such a mix in people's responses to carbohydrate restriction during lactations. And I think there's a couple reasons for this. I think a lot of people go keto. And they go from like standard American diet to hardcore keto and they're not easing into it. So it's a big stressor on your body if you're doing it in that way. They might be under eating energy-wise that usually people are going keto for the weight loss or the fat loss. Thus, they're also either accidentally or intentionally under-eating calories.
They're also often not getting enough electrolytes. So some people in the keto space will argue that, “You don't need carbs for breast milk. It's all about just getting your electrolytes in your fluids.” But you still hear from people who are doing all the right things for supplementing their electrolytes where they still have a dramatic drop in their milk supply. So people have a different response to it.
For me personally, even though -- I don't eat keto per se. Moderately low carb diet is how I describe it. And usually, it’s nowhere near 20 grams of carbs, right? It's like it's a lot more than that. Probably more in the 75 grams plus category if that helps people understand where I'm at.
But I needed so much more food in general that also some of that additional food was in the form of carbohydrates. I needed that for satiety. I would not have been able to feed my body a sufficient amount of food and stay satiated if I didn't have more carbs. That was my personal experience. So I didn't worry about it. But at the same time, I wasn't somebody who had a whole bunch of extra weight to lose. So that might play a factor into it, too, how much endogenous body fat you have to burn because that's a form of energy storage versus how much you need to take in from food.
So I personally think you're okay to eat more carbs because you're going to need more food. And some of that food is going to come from carbs. And don't worry about it. And if you want to go keto, wait until your supply is established. Then just gradually decrease your carbohydrate intake over time.
What a lot of people don't realize is your body's actually way more insulin sensitive in the early postpartum period. So people usually have actually better carbohydrate tolerance for a period of time, probably the first month or so postpartum, maybe more when you're breastfeeding because your breast milk requires -- I mean it uses a lot of glucose in order to produce breast milk.
So I don't know that we need to try to push ketosis. There's a whole phenomenon if you look in the dairy literature. That's where we have a ton of lactation research because they're obviously concerned about producing a lot of milk because they're selling it for profit.
Christopher: Of course, yeah. For the money.
Lily: So there's a ton of research on ketosis and dairy cows. And it's a phenomenon in ruminants that they call it lactational ketosis. They go into ketosis. And the dairy farmers try to avoid it because they can maintain better milk supply when the cows are not in ketosis.
Christopher: Oh, interesting.
Lily: So it's like pregnancy where it's going to push you into ketosis no matter what. You're in this energy hungry state. You're burning everything including ketones. I don't know that we have to try so hard to restrict carbohydrates to push that more than necessary.
Christopher: But that was my understanding. It was that medium chain triglycerides were synthesized from carbohydrates in epithelial tissue in the breast, right? So you're actually making fatty acids from glucose. It's not like the glucose is going straight through. It might be too. I don't know about that. But I just thought that was interesting that you were making fatty acids from glucose in the breast tissue.
Lily: Yeah. So the interesting thing with fat in breast milk is that you have endogenous fat stores. You have the fat that's produced in the breast tissue itself. Then you also have dietary fat. And all three of those contribute to the fat content of breast milk. And even women who have larger body fat, more body fat storage on board, so higher percent body fat, they tend to have a higher percent fat milk. But also the greater amount of dietary fat you consume also can increase the fat percentage in milk as well.
It's the most variable of all the macronutrients in milk. The lactose levels, the carbohydrate level is pretty fixed. The protein level is pretty fixed unless you're severely depleted in protein or eating a very low protein, like less than 9% of calories diet. But the fat is the one that we have the most control over. And it doesn't necessarily mean that you increased the proportion of fat and it decreases the proportion of the rest. It's like the levels of the other two, protein and carbs, stay relatively constant. You can actually increase the caloric density of the milk potentially with a higher fat intake.
It's not going to be huge. You're not going to go from skim milk to cream for example, if we're making a comparison to dairy milk. But you might go from 2% to whole milk equivalent, up the fat percent by maybe from a 2% fat milk to a 3% fat milk. And that is influenced by the diet.
Julia: And is this a different conversation? Like if you were having this conversation with someone who, say, had experienced gestational diabetes versus someone who hadn't, what would the differences be there? I wonder.
Christopher: Does the diabetes just go away once you give birth?
Lily: In about 90% of women, their blood sugar will pretty much go back down to baseline within a couple of weeks postpartum. Now, back down to baseline, if their gestational diabetes was really prediabetes in disguise that hadn't been identified before pregnancy, -- but because we identify it in pregnancy, we call it gestational diabetes -- their baseline might be somewhat pre-diabetic, blood sugar levels, just to throw that out there.
But for most people, their blood sugar goes back down to wherever it was baseline pretty quickly, even in Type One diabetes. So people are who are producing no insulin or very, very little insulin and they need exogenous insulin shots to maintain their blood sugar, they will go from the huge requirements of pregnancy, which could be triple or maybe even more than what they were pre-pregnancy, down to baseline or below baseline for a couple of weeks postpartum. Because their insulin sensitivity, it's like almost as quickly as the placenta is born, like within 24, 48 hours. It's like their insulin needs just plummet back down to baseline or below. It's fascinating.
Christopher: Well, I want to be respectful of your time. And I know that you've produced some fantastic resources. But is there anything else that I should have asked that maybe I forgot. You covered so much. I've got a lot of notes here in front of me that we could have gone into. But there's no way that we're going to go to get into all of this right now. And perhaps you should just refer people to the training courses that you've been producing.
Lily: Yeah. Well, for people who want to learn more -- I mean first of all, I would say the last chapter of Real Food for Pregnancy, Chapter 12, is all about the fourth trimester, postpartum recovery, nutrient repletion, breastfeeding nutrition, the nutrient transfer from mom's intake or mom status into breast milk and all that. So if you just want like a primer on it without as many nitty-gritty details, just read that section of the book.
For people who are really interested in a deep dive in it, I do have two webinars. They're each 90 minutes plus going into a whole bunch of detail on both of these topics. So one of them focuses on mom as postpartum recovery and nutrient repletion. So that's where we're looking at -- lab tests, repleting nutrients stores, exercise and postpartum recovery, like movement wise and your physical body, assessing for postpartum thyroiditis, mental health, weight loss, body image, all the stuff about mom is in the Postpartum Recovery and Nutrient Repletion Webinar.
Then I have a separate webinar specifically on nutrition for breastfeeding, looking at the effects of maternal intake on the nutrient content of breast milk. And that one is focused mostly on baby. It's like what mom's doing, but how that affects her milk and again, the 90 minute webinar. And both of those are up at the Women's Health Nutrition Academy website, so whnacademy.com.
For dietitians, it gives you some continuing education credits. So that's fun. But we have plenty of non-dieticians who take them as well. And those are probably the most detailed resources on these topics that I'm personally aware of. I mean when I'm going through those, I'm looking at three, four or 500 plus studies when putting them together. And there's so much information in there that I don't see the research on it being covered anywhere else. So if you really want the deep dive, I'd go to those.
Christopher: I do have much more content besides on the Women's Health Academy, right?
Lily: Yeah. So Women's Health Nutrition Academy, I co-run with a colleague of mine, Ayla Barmmer, who also is in their real food nutrition sphere. And her practice mostly focuses on fertility and pregnancy prep. So we've been putting together these really deep dive continuing education webinars for a little over a year now. And I think we have nine or ten webinars up on the site. So I have the two that I mentioned. I have one on Vitamin D in pregnancy. Believe it or not, you can talk about that for 90 plus minutes, just that topic alone. And I have some on pregnancy nutrition, gestational diabetes nutrition.
Then Ayla has done a number on fertility, estrogen metabolism. She does a lot of Dutch testing in her practice. So she has a lot of case studies in her presentations as well. So yeah, there's a lot on there. And it's really for the people who, again, want to get really detailed into the information.
Christopher: Well, I think you're doing fantastic work.
Julia: Yeah, definitely.
Christopher: I was talking with a client, Mark Alexander, recently. And we were talking about, “What's the goal? What are we trying to do here?” And I suggested that maybe the goal should be to maximize health span. And the most efficient way to do that is to get to people sooner, right, rather than working with people who are 60 years old and there's only so many years left in their life. You get to kids. Like had my mom gone through this course and things could be very different, right? I may not be here recording this podcast if that was the case.
Yeah, I too think about that wretched soybean oil based maltodextrin, casein, SMA crap that I got fed for the first. However, many [0:46:12] [Indiscernible] like didn't get breastfed at all. It’s super sad. Although you might argue that if mum was eating a bunch of soybean oil, then that would've just showed up at the breast milk anyway, right?
Lily: It's true.
Christopher: That’s terrifying.
Lily: Although there's some endogenous production going on there, right? The nutrient levels in breast milk though, there are some people that would argue that in certain situations, formula would actually be on your nutritious choice if a mom is really nutrient depleted.
So yeah, it gets into some controversial territory. But there's also so much wisdom in breast milk as well. Even if the nutrient levels might be low, you would have to account for the probiotic feeding human milk oligosaccharides. They don't know how to mimic that in formula. So that significantly impacts the microbiome, the antibodies, the –
Christopher: And I think we did a whole podcast episode with Megan -- I've forgotten her surname. We'll link to that in the show notes, as we’ll link to everything else that you've mentioned. The Women's Health Nutrition Academy, I'll link to that in the show notes. You can find over at nourishbalancethrive.com/podcast or if you poke around inside of your podcast, you’ll surely find the show notes and that everything will be hyperlinked.
How long have you got? Do you know how many weeks you've got to go, Lily?
Lily: I have about a month and a half.
Christopher: And you know what you're having. Is it boy or girl?
Lily: No. We play team green. We do the surprise thing.
Christopher: And you've done that before? How many kids you got?
Lily: I just have one. I have one son. He's about three and a half. And yeah, we didn't find out with him either. So we played the surprise card.
Christopher I really agreed with you on when you said that, “I think that having a baby is surprise enough. I don't really need any more surprise.”
Julia: That’s what I said.
Christopher: “I think we can know the gender. That's okay.” I was like, “Yeah, you're right. It is a surprise.” Yeah.
Julia: Well, the first one was a major surprise.
Lily: There's no right or wrong way to do it. I think it just makes it easier with the pre-purchasing cute baby clothes. But because we had a boy first and I air on the neutral, not super-gendered clothes anyways, it doesn't matter. Like if we have a girl, she'll be wearing like gray and blue and white and yellow. And it's all good. It's all good.
Julia: Oh yeah. Good. Oh man. Well, I’ll be thinking of you. And I hope to hear wonderful things soon on that front.
Lily: Thank you. Yeah. We're looking forward to this next stage and preparing for the recovery.
Julia: Yeah. Where do you guys live now?
Lily: We're in Washington State.
Julia: Oh, okay. You're not too far away then. We're in California. Yeah. If I was closer, I would zip on up and make you some meal.
Lily: Right. I always say that with friends who live far away like, “I wish I could give you a postpartum recovery meal.”
Christopher: Well, we might be. One of the doctor that started NBT -- Sheila's in Bellingham in Washington, so we'll be up there in September.
Julia: Yeah. Yeah.
Lily: Oh, there you go. Yeah, stop by with some food.
Julia: Yeah. I would love to visit anyways because I would love to check out that area. We didn't make it over there last time we were over there, so nice. Well, thank you.
Lily: Thank you.
[0:49:29] End of Audio

domain: health


Nakuru give Kenya Cup champions something to think about ahead of their clash with Kabras
Will KCB survive Kabras in Kakamega this weekend? Kenya cup rugby enthusiasts are eager to find out how the defending champions will fare when they play their main challengers in an away match this coming Saturday after the Bankers were exposed by Nakuru in the second half of the sole fixture in round 11 on Saturday.
KCB Sports club hosted the sole league fixture after two matches were postponed and it was expected that the hosts, who annihilated Mwamba 50-3 in the tenth round, would sweep aside Nakuru who came in from their fifth consecutive defeat claimed by Strathmore Leos in a 44-5 upset but the visitors had a good second half and a solid comeback attempt.
Against Nakuru, KCB heavily relied on their forward who scored all their four tries, two tries in each half through their backrow trio of Felix Ojo, Rocky Aguko and Elly Mukaizi and their skipper Curtis Lilako who sealed the win for a crucial bonus point.
Nakuru’s second half fight was hampered by the quality of the hosts substitutes and failure to make the most out of their first half penalties.
KCB bonus point win contributed to their current 38 points lead which is eight points ahead of their next opponent, Kabras.
Nakuru left Ruaraka having tipped Kabras to exploit the home advantage against the defending champions should they maintain their superior forward play in the league that has earned them consecutive six bonus wins.
The Bankers came to this encounter hungry for their eighth consecutive win while Nakuru were not willing to register their sixth straight loss without a fight having been wounded by students in the previous round.
KCB opened the scores with a try by Felix Ojoo in the fifth minute and after the conversion, Nakuru dominated possession and earned penalties but failure to capitalise on their first half penalties was costly in the end after two penalty kicks sailed wide before Fredrick Odongo gave them their only three first half points after a successful penalty in the 23rd minute but the gap was widened shortly afterwards after a few phases by the hosts to earn a scrum down for Elly Mukaizi to scored their second converted try.
The second period saw Nakuru score through Kenyan international John Okoth but a missed conversion left a gap the hosts were able to increase through their third try by forward Rocky Aguko in the final quarter of the match where captain Curtis Lilako sealed a 26-3 win with his try off a rolling maul.
The loss for Nakuru left the side still perched eighth on the standings with 10 points.
Wanyore needed a win to climb to position five or a losing bonus point to break their 10-point deadlock with seventh placed Nondescripts and ninth placed MMUST.


text:
Those driving through Houston County can feel a bit safer during their travels.
The Houston County Road and Bridge Department has been given the highest road grade by the state.
The county earned this award by having the lowest fatality rate in accidents.
This is not the first year Houston County has won this award, either. The roads were the best in the state last year, also.

domain: news


text: 300-400$ Gaming PC Tags: Homebuilt Gaming Monitors Systems Product Last response: May 28, 2011 3:55 PM in Systems Share waitforchris May 28, 2011 12:12:21 PM Sorry for the 2 threads I'll try again: Approximate Purchase Date: within a month Budget Range: 300-400$ System Usage from Most to Least Important: I would use it for gaming mainly. Parts Not Required: Keyboard, mouse, monitor, speakers, OS. Preferred Website(s) for Parts: Newegg.com Country of Origin: Hungary Parts Preferences: I don't have any preferred. Overclocking: Yes SLI or Crossfire: Maybe,depends on price Monitor Resolution: 1440x900 Additional Comments: More about : 300 400 gaming dalylink May 28, 2011 3:55:41 PM Something like this on another thread might meet your budget. http://www.tomshardware.com/forum/312072-31-very-cheap-... Can't find your answer ? Ask ! Publish Related resources Solved300-400 dollars Gaming PC without OS, HDD, Optical Driver or Monitor ASAP!! Forum SolvedBeginner's Gaming PC Build - Budget $ 300-400 Forum SolvedFirst Budget Gaming PC Build (~300-400 Dollars) Forum SolvedBudget Gaming PC Build $300-$400 Forum Solved$300-$400 gaming pc? Forum SolvedGaming PC (£300-400 budget) Forum Solved$300-$400 ultra budget indie gaming PC advice. Forum Looking to build gaming pc (cost $300-$400) Forum improving gaming pc around 300-400 euro Forum SolvedPC Build (Non-gaming) Very small $300-$400 (max) budget Forum SolvedNeed a Super Budget Gaming PC ($300-400) Forum 300-400$ PC: primary use - gaming Forum 300-400 pound gaming pc Forum 300-400 pound gaming pc Forum Gaming PC Build $300-$400? Forum Gaming PC Build $300-$400? Forum Gaming PC Build $300-$400? Forum Best upgrade for 300-400 bucks for my gaming PC Forum $300-$400 build for non gaming PC w/ capacity for 3 monitors Forum $300-400 Hardcore Budget Gaming PC Forum More resources Read discussions in other Systems categories Homebuilt New Build Prebuilt Cases Power Supplies RAM CyberPower !

domain: game


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text:
"The Plating of the Penny - 1840-1864"
by Harold Fisher & Roland Brown
published by The Great Britain Philatelic Society.
An Index is available to the marvelous work by Mr. Harold W. Fisher based on the
Regretfully, the Index has minimal value to those who do not have the books. In a joint project Allan Oliver and I have created a means of obtaining the measurements through some HTML trickery. With other resources, Statham, Seymour, Stone and Proud, plus the available Imprimatur imagery, you may be able to plate many copies.
Some browsers 'protect' you from loading your own images.
This Index is taken from a searchable, full information database which I created while Mr. Harold Fisher was alive, and with his permission. It contains an encoded version of all the relevent positional data for the five volumes of the "Plating Of The Penny".
Because of the written agreement between Mr. Fisher, his publishers, and myself - I can not make copies of the original programmed database available - Sorry!
No book data is available through the Index, only a search for possible matching plates.
For some 10 years I'd paid for and maintained these pages, offering the Index to all comers. Rising charges made it necessary to either discontinue or to ask the users to defray the ongoing costs. Thus, for a short time, the Index was only available by Paid Subscription.
I have donated the Index to the GBPS,
The books may occasionally be found at auction and some volumes are still available through booksellers. For those just wanting the MX plates or Alph II Imperforate - it's not too much of a job to manually check the single volume for matches.
Recent acquisitions by members of the Missing Imprimatur Group on Yahoo are leading to filling in some of the missing measurements.
These 'provisionals' and corrections to the original data will have the Plate Number in the returned list marked with an asterisk.
The listings returned include any exact matches, the matches for the range you have selected and a list of those plates for which there is no data.
For ease of working, you may 'print' the results. That will open a pop-up window with all the information for the example and may then be copied and pasted into any text editor.
ONLY if you have considered all possible returned matches out to +/-4 should you begin to consider the example as a possible "Missing Imprimatur".
For those having the books and as yet not having updated the data,

domain: hobby


text:
DUBLIN, Apr. 10, 2017 /PRNewswire/ --
Research and Markets has announced the addition of the "Industrial Pumps Market Analysis By Product, By Application, By Region And Segment Forecasts, 2014 - 2025" report to their offering.
The global industrial pumps market is expected to reach USD 88.43 billion by 2025
Further key findings from the report suggest
- Centrifugal pumps were the largest product segment in 2015 and accounted for over 70% of the market share on account of its low cost and long shelf life
- Construction is one of the largest applications and is expected to witness considerable growth over the next nine years on account of rising number of upcoming projects particularly in Asia Pacific and the Middle East
- Asia Pacific accounted for over 45% of the overall market share in 2015 and is estimated to exhibit a growth of 6.7% over the forecast period owing to upcoming infrastructural projects coupled with the surging industrial developments
- China has been one of the fastest-growing markets for US pumps due to the country's rapidly expanding industrial bases and infrastructure projects. Other emerging markets that account for a growing share of industry revenue include Mexico, Saudi Arabia and Brazil.
- Companies present in this sector focus their marketing strategies on increasing sales and targeting specific applications so as to exploit their competitive strengths by emphasizing on expanding their geographical presence and capitalize on new markets and industries for existing as well as new products
Increasing product energy use pumps for the extraction and transport of oil and natural gas is expected to have a positive impact on the market per the next nine years. High crude oil prices will fuel the energy sector's revenue, thereby resulting in more demand for the product.
Government of India has passed Petroleum Chemicals Petrochemicals Investment Region (PCPIR) policy intended for promoting FDI investments in oil & gas sector. This regulatory move is expected to result in increasing production of petrochemicals and polymers in India, thus fueling industrial pump demand over the forecast period.
Technological advancement in enhanced oil recovery and deploying hydraulic fracturing activities in Russia and Ukraine are expected to increase availability of tight oil and shale gas which in turn will have a positive impact on the industrial pumps market over the forecast period. further rising water & wastewater treatment plants in the region will fuel market growth over the next nine years.
Improving economic conditions in Asia Pacific are expected to open new opportunities for pump manufacturers, as the construction, manufacturing and automotive, industries are likely to witness considerable growth over the forecast period. However, tough competition from low-cost manufacturers is expected to be major restraint for development this market.
Key Topics Covered:
1. Methodology and Scope
2. Executive Summary
3. Industrial Pumps Market Variables, Trends & Scope
4. Industrial Pumps Product Outlook
5. Industrial Pumps Application Outlook
6. Industrial pumps Regional Outlook
7. Competitive Landscape
8. Company Profiles
- ITT Corporation
- Wilo AG
- Roper Industries
- Baker Hughes, Inc.
- Schlumberger Ltd.
- Clyde Union, Inc.
- SPX FLOW
For more information about this report visit http://www.researchandmarkets.com/research/skh5c9/industrial_pumps
Research and Markets
Laura Wood, Senior Manager
For E.S.T Office Hours Call +1-917-300-0470
For U.S./CAN Toll Free Call +1-800-526-8630
For GMT Office Hours Call +353-1-416-8900
U.S. Fax: 646-607-1907
Fax (outside U.S.): +353-1-481-1716
SOURCE Research and Markets

domain: geography


Public bathrooms are noisy, poorly designed, and often nonexistent. What to do?
We spend billions on our pets, and one of the fastest-growing costs is pet "aftercare." But are those cremated remains you got back really from your pet?
Okay, maybe the steps aren’t so easy. But a program run out of a Toronto housing project has had great success in turning around kids who were headed for trouble.
If U.S. schoolteachers are indeed “just a little bit below average,” it’s not really their fault. So what should be done about it?
Boris Johnson -- mayor of London, biographer of Churchill, cheese-box painter and tennis-racket collector -- answers our FREAK-quently Asked Questions.


text:
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An additional way with which you can easily enhance the full control of the battle is through making use of jewels as well as pieces. When you have limited amount of ammunition, you can easily regenerate by using treasures.
You can boost the catbird seat of the war by putting numerous catches to snare your foes. They can easily obtain trapped inside the trap as well as when you reside in the middle of struggle, you may effortlessly relocate to one more component of the arena so that you may have complete control over the battle. You can have complete control of the whole fight. You can boost the complete control of the fight through increasing the number of enemies. This way you will possess overall management over the full fight.
It is actually also a wonderful tip to boost the catbird seat of the struggle by including more levels of problem. As soon as you start playing the game, you will certainly obtain the full suggestion of the game. After betting time, you are going to get the comprehensive idea of the activity. You will certainly know regarding the proper way to relocate and also fire the enemies as well as use the various items. You will definitely likewise acquire the full tip regarding just how to complete the complete struggle.
A terrific tip is to include more foes in the monitor. So that you will definitely be able to hammer additional opponents. This are going to bring in the video game much more interesting and also will increase the complete control of the total battle.
You may quickly acquire the total war without stressing a lot if you may increase the complete command of the total fight. regarding the degree of challenge. You will definitely additionally receive more satisfaction from the video game.
Pixel Weapon 3D hack isn’t operating? Don’t you wish you could appreciate the video game without must worry about any one of those irritating bugs?
Given that the designers of the video game were actually capable to make the graphics appear like true opportunity activities does not suggest you will have a smooth games experience, only. There has never ever been a far better unit put in to place for fighting 3D pixel generators than the Pixel Weapon 3D Hack.
The Pixel Weapon is a game that is actually used computer systems. The computer is a type of computer like the ones that are actually utilized for playing on-line video games. It uses the exact same software program that is actually made use of to create these video games, which is actually a type of system that is set to assist produce the player’s graphics more sensible.
Some of these programs may feature a genuine video game on its own. Many of all of them include a variety of various applications that will certainly aid you to improve the graphics of your games.
A lot of these courses are going to in fact change the graphics of your activity so as to create them look better, and it is actually commonly extremely simple to figure out what is wrong and correct it. You do not need to be a personal computer wizard to figure this out, yet you may possibly determine how to take care of traits that are gotten used to the data that the activity is actually utilizing.
You can easily additionally make use of these systems to personalize your activities. You can easily make changes to the settings that the activity uses, including the lot of enemies and degrees that you are heading to use. You can easily additionally make these adjustments on a per level basis, which may produce all of them a whole lot less complicated to get across in a game that you are already accustomed to.
Various other features that you can easily locate in the Pixel Weapon 3D Hack are points such as a video game conserve program, in-game tutorials, and also a lot of other points that will certainly aid you have the ability to get going straightaway. Along with all of these various possibilities, there is actually likewise a component that will certainly allow you to modify the settings on the activity without ever must stand up from your chair.


text:
The Things I Said To Hurt You
Age 14, Wyoming, USA
It’s taken me a long time to get over the fact that you screwed over not only your own life, but also your children’s lives. You left us because he screwed you over. I thought you didn’t love me or my sister.
I told you I didn’t want to speak to you anymore. That your calls hurt me. That I didn’t love you, that I couldn’t love an addict mother who couldn’t enjoy your children’s birthdays because you just wanted to get high.
And I’m sorry. As if sorry could ever stop the hurt I caused you. As if two little words could ever take back all I’ve done and said to you. I know you’re trying to get better and don’t have control anymore. I love you. I hope you forgive me.
What did you learn?
I learned that I need to breathe and get over myself.

domain: literature


text:
ThoughtCloud CBD Dog Treats – Full Spectrum Formula
$28.00 — or subscribe and save 10%
These ThoughtCloud CBD dog treats are the healthy snack your pet will love. Perfect for the nervous dog, the aging pet, and every canine in between!
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Made from 100% organic, raw, non-GMO hemp plants grown on select farms throughout the US
No herbicides, pesticides, or chemical fertilizers were used.
A third-party lab tests every batch for purity.
Scan or click the links below to view the product cannabinoid profile and the extract lab results.
Your pet will come running for our CBD dog treats. They can help with pain management, energy levels, and overall quality of life. Research shows cannabidiol can help with pet anxiety, reducing seizures, and so much more! CRUNCHY DELICIOUS.
CBD treats for dogs are safer than prescription pain medicine. They won’t make your pet sick or cause long-term internal damage. Help your furry friend feel better and restore their energy with these delicious biscuits!
Why CBD Dog Treats:
It’s utterly heartbreaking to see our furry friends in pain. Oftentimes, treatment options can be limited, and many of them are invasive or come with warnings of scary complications.
CBD, on the other hand, can help your dog without causing new problems. Unlike pain medicine, CBD won’t cause diarrhea or an upset stomach. They’re healthy dog treats packed with benefits to improve your furry friend’s quality of life.
Research shows cannabidiol can help pets with anxiety, general pain, osteoarthritis, seizures, and so much more. When your dog feels better, its energy can return. Your ball chasing, tail-wagging, an affectionate friend is back. It’s little signs like these that show their quality of life is improving.
How the CBD Dog Treats Work:
Dogs, like humans, have an endocannabinoid system (ECS). CBD and other cannabinoids activate this system facilitating the body’s natural ability to heal. So, when you give your pet treats with CBD, their ECS works to help alleviate inflammation, pain, anxiety, seizures, and so much more!
If you have a nervous dog that hates car rides, try putting some CBD treats in their carrier. If your dog struggles with separation or gets jittery from loud noises, these biscuits can help. The best part is, dogs love them and don’t experience adverse reactions. No diarrhea, nausea, or tiredness to cope with. Instead, the cannabinoids just help your dog feel better. What a treat!
Alternative Pain Medicine for Dogs –
There’s nothing worse than watching our furry family members suffer in pain. They can’t communicate with us to tell us what’s wrong. It makes it hard to get them feeling better.
Research shows CBD can help with several types of pain from acute to chronic. There’s evidence CBD can provide relief to the furry friend suffering from osteoarthritis. It can even reduce inflammation throughout your pet’s body. Swelling limits range of motion and often inflicts pain. By reducing swelling, CBD can help with one of the causes of your pet’s discomfort.
Prescription pain medicine for dogs often comes with a long list of side effects. Many times, a vet will have to provide several different medication options before finding one that doesn’t make your pet miserable. CBD lacks these types of complications, making it easy to start giving it to your furry one with peace of mind.
Calming Treats for Dogs –
Anxiety isn’t just for humans! There are several reasons your dog might be stressed out. They may have fears of separation, jitters from loud noises, or get uneasy in small spaces.
Whatever the cause, evidence shows CBD can help. Cannabidiol relieves symptoms of anxiety according to vets and pet owners in a recent study. Additional research points to the possibility of CBD increasing serotonin levels. Nicknamed the “happy chemical” for a reason, increased serotonin can improve your pet’s mood.
The next time your nervous dog gets anxious, you’ll have the perfect treat to help them. Give your furry friend a biscuit they’ll love and will help them feel better.
Reduce Pet Seizures –
It’s incredibly scary to watch your pet uncontrollably convulse. Sometimes it’s a one-time thing, but unfortunately, it can become a frequent occurrence in your pet’s life. While CBD cannot cure epilepsy or seizures, it can help reduce the severity and frequency.
Research shows that cannabidiol can reduce the number of seizures in dogs. In some cases, the CBD treats for dogs completely stopped the animals’ seizures. In such studies, there was a direct correlation between effectiveness and length of use. So, while the first biscuit may not fix the problem, consistency in treatment can make all the difference. We’re sure your furry friends won’t mind the daily snacks!
Overall Quality of Life –
When our pets aren’t feeling well, they aren’t up for much. You may start to see your furry friend sleeping more or becoming disinterested in their favorite activities. It’s heartbreaking to watch your pet struggle to be comfortable.
Because CBD can help with several different ailments, it can improve your dog’s overall quality of life. A dog in less pain can get their energy back. Their interest in chasing the ball returns. Your favorite little greeter waits eagerly at the door for you again. The same goes for reducing their anxiety. When fears stop inhibiting your pets’ happiness, they can live their best life.
These CBD dog treats provide countless benefits for your furry friends. Don’t just take our word for it though, check out the research!
Managing Pain and Inflammation –
CBD can be a lot safer than conventional pain medicine for dogs. It lacks adverse side effects and can help with other symptoms as well! There’s a lot of research into these benefits proving that CBD can help ease your pet’s discomfort. In a study on cannabidiol and pain management, the compound relieved several types of pain. In the study, 90% of the animal participants experienced moderate to significant improvements in chronic pain.
The same study resulted in 83% of the dogs experiencing moderate to significant improvements in acute pain. These findings are indicative of CBD easing multiple types of pain. The researchers also saw major reductions in various kinds of swelling in the pets.
A separate study focused on osteoarthritis, a painful condition marked by inflammation. The dogs in this study experienced a reduction in both pain and inflammation.
Helping Dogs with Anxiety –
For the nervous dog struggling with anxiety, CBD is here to help! In a study on pet anxiety, CBD reduced anxiety symptoms. This study looked to veterinarians’ investigations into a pet’s health to collect data. Through the reports, the team saw significant improvement in anxiety symptoms and recommended CBD as a treatment option.
A separate study looked at the reactions in the brain from cannabidiol. This experiment showed increased serotonin levels in the animals. While this doesn’t directly target anxiety, increasing levels of serotonin can improve your dog’s mood. A happier pet is often less anxious.
Canines, Epilepsy, and Seizures –
While CBD may not seem like enough to prevent your pet’s convulsions, research shows that it can help! Researchers conducted an extensive survey to verify the effects of CBD on seizures. In the study, 75% of dogs experienced fewer seizures.
Additional research has confirmed these effects. In one study, CBD reduced or completely stopped seizures. This study took place over eight weeks. The duration of the study emphasizes the importance of regular administration of CBD for it to work.
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
Statements regarding dietary supplements have not been evaluated by the FDA and are not intended to diagnose, treat, cure, or prevent any disease or health condition.
The effects of cannabinoids described here are based on preliminary data and are to be treated as such. No claims are made as to the statistical significance of the results, or lack of bias in the data.
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The publication of the NHS Workforce Plan on the eve of its 75th birthday represents a landmark moment for the UK healthcare system.
It both acknowledges the ongoing supply and demand mismatch within healthcare and seeks to provide a comprehensive long-term strategy. With a core focus on training, reform and investment, the plan contains a range of initiatives detailed to grow the NHS workforce.
Here, we unpack 5 key takeaways for digital healthcare.
1: Investment in technology
The plan states an aim to increase capacity and work differently “taking full advantage of digital and technological innovations.”
Such a focus is welcome. Solving the challenges of today and tomorrow will not only depend on a significantly larger workforce, but also fresh approaches to support efficiency and ease pressure on care teams. Digital tools are a foundational element for success and a key enabler for productivity gains outlined by proposals.
Here at Livi, we see the impact digital technology can have first hand working with our primary care partners. Whether it’s reducing DNAs through smart message platforms, providing remote capacity at scale via digital channels, or supporting care navigation through optimised patient platforms and health and care websites.
“Limited historical investment in estate and technology is negatively impacting labour productivity.” - NHS Long Term Workforce Plan
Alongside embracing the ‘art of the possible’ there is also a need to get some of the basics right. Indeed, findings published within the recent The House of Commons' Health and Social Care Committee report, Digital Transformation in the NHS, reveal that basic IT systems and infrastructure require significant improvement. This will be essential to supporting care providers to meet the demands of a modern health system.
With studies suggesting clinicians spend more than 70% of their time on administrative tasks, we can do more to alleviate some of the burden on care teams.
The plan outlines gains that could potentially be made through AI and automation. This includes the application of speech recognition technology to clinical documentation and records.
Already in use in some areas of the system, a physician-patient conversation can now be transcribed and ordered into accurate notes. As soon as a clinician begins to type about a patient’s symptoms or prognosis, suggestions can be made, populated and edited by the treating physician. This could further help to increase capacity and give clinicians and teams more time to focus on what matters most of all – patient care.
Indeed, the Topol Review estimates that one minute could be saved per patient consultation. This could equate to roughly 5.7 million hours of GP consultation time and 400,000 hours of emergency department consultation time.
3: Serving complex populations
Today, the healthcare system is facing growing and increasingly complex, elderly patient populations. This has caused demand to increase exponentially, outstripping clinical supply. With predictions that the number of people aged 85 and over will grow by 55% in the next 15 years, the system needs new solutions to serve rising multimorbidity and those living with chronic conditions.
The role of genomics is highlighted within the plan for its potential to facilitate earlier diagnosis and treatment of disease. This is reflective of an ethos to move the health system from ‘responding to care’ to focusing more on prevention.
“Genomics and artificial intelligence in particular will transform our ability to prevent, diagnose, treat and manage disease, supporting a shift towards better prevention of disease and more personalised care outside hospital.” - NHS Long Term Workforce Plan
Additionally, the plan recognises the role digital technology can play in supporting delivery of care in low cost settings, outside of hospital and closer to home.
Examples noted include hospital at home programmes and virtual wards. These models can also facilitate involvement of multidisciplinary skill sets which have many benefits for at-risk patient groups. While digital tools can also enable ongoing condition management and remote monitoring, helping people stay healthier for longer outside of hospital.
4: Building digital expertise
There are also aims to grow digital skill sets within the NHS. It is said that this endeavour “will change ways of working, releasing staff time to focus on patient care.”
Initiatives highlighted include the launch of a digital skills assessment tool, the Digital Learning Solutions platform, the NHS Digital Academy, the Health Innovation Placements Programme and Fast Futures Programmes. While The Ives Review will set the stage for building digital skills within nursing and midwifery.
“With strong local leadership and management, combined with enabling technology, the use of more diverse roles will change the skills required to meet patient needs and will expand the capacity of community services to deliver this type of care.” - NHS Long Term Workforce Plan
5: System working
NHS England recognises the crucial role of ICSs in connecting the NHS to local authorities, system partners and improving population health. Care delivery at a system level is said to require “sufficient capacity and technical capability for workforce planning.”
To that end, NHS England will provide a new tool to support ICSs with system-level workforce intelligence, alongside an accredited Strategic Workforce Planning course.
NHS England will also “take measures that allow greater mobility of staff across boundaries and sectors through collaborative banks.” It is noted that all ICSs now have a primary care flexible pool that supports staff to work across a locality’s different primary care settings.
Both initiatives rightfully reflect the importance of capacity optimisation. Flexible, border-spanning resource and optimal planning are both required to meet emerging needs in a given footprint. This can be ably supported through digital platforms of course. At Livi, capacity optimisation is one of the core ways we serve integrated care partners, delivering flexible clinical resource that scales to meet demand.
Want to learn more?
Read the full NHS Long Term Workforce Plan here.
How can we help you?
Livi is the UK’s leading digital healthcare provider. We partner with the NHS and increase capacity of GP practices, primary care networks, integrated care systems and urgent care services.
We help to optimise access so patients receive the right care at the right time. While our digital tools and platforms drive efficiencies and support partners to serve rising patient demand.

domain: medical


Mats Hummels will re-sign for Borussia Dortmund from Bayern Munich following an agreement between the two clubs. Reports surfaced at the weekend that Dortmund were interested in taking the defender back to the club following three years with the Bundesliga champions.
Related: Kimmich Hopes For Sane Deal
Now, a deal has been officially agreed with the clubs and, subject to a medical, he will return to the Signal-Iduna Park where he spent eight seasons and established himself as one of the best central defenders in the world. Hummels won three Bundesliga titles with Bayern but will go to Dortmund after a fee was agreed in the region of 38million euros.
The German international, who won the World Cup in 2014 as part of his 70 appearances for Die Mannschaft, also won the DFL Supercup three times as well as the DFB-Pokal in 2018-19. Hummels will attempt to win his second Bundesliga title with Dortmund next season after they narrowly lost out this season, despite leading for much of the campaign.


Everyone knew it was coming, and so did MPs. The years of clubby confidentiality over expenses were always going to end by July. But it was shocking nonetheless to see how much information was still not subject to disclosure when the heavily expurgated records of MPs' expenses claims were finally released. What is more, many of the more colourful, and so memorable, details were missing: the moat-clearing, the duck-house and the like were nowhere to be seen.
Such embarrassing, if entertaining, revelations were symptomatic of an ingrained and cavalier attitude to spending from the public purse. The bigger scandal, though, is that if The Daily Telegraph had not obtained the unredacted version of MPs' claims, and filleted it for publication, those who made serious money from their position would have got clean away. The secrecy MPs were granted for their addresses – itself, it could be argued, a privilege that should not go unchallenged – kept crucial information about claims for second homes under wraps.
There would have been no hint that Margaret Moran's claim to remove dry rot was for a house nowhere near either Parliament or her constituency; no hint either that several ministers had avoided paying Capital Gains Tax by virtue of "flipping" their main and second homes. Some MPs also designated one and the same residence their second home for the sake of maximising their parliamentary allowance and their first home for minimising CGT. Strictly legal this may have been, but ethically it was out of bounds.
Voters sensed this at once, which should console anyone who feared Britain had lost its moral compass. The revelations unleashed a crisis of confidence in Parliament and prompted questions about the whole political system. We doubt whether all MPs yet understand the public mood.
There are other questions to be asked. The role of the Commons Fees Office, which advised and signed off on the claims, deserves scrutiny. Sir Christopher Kelly's inquiry into MPs' expenses seems to be working to an unnecessarily leisurely timetable, while Speaker Martin's expensive efforts to exempt MPs' claims from the Freedom of Information Act were reprehensible. Without the dogged efforts of Heather Brooke and her campaign, we might know none of what we know now.
That the path from there to here was so long and thorny is inexcusable. What had to be done was clear pretty much from the start. Any reimbursement MPs claim from the taxpayer must be completely transparent and spent only and necessarily in the course of duty. If private companies can manage this, so can Parliament. It is true that MPs from outside London need to live in two places, but too many turned inconvenience into an opportunity for property speculation. And MPs must not benefit from special tax arrangements; legislators need to feel the pain of the levies they inflict on everyone else.
These are basic, and obvious, guidelines. It is to MPs' collective shame that they could not accept reasonable reform of the system far sooner. The one consolation from the resulting mess is that the public has re-engaged with politics and that wider reforms are back on the agenda. The momentum must be maintained.


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The Red Strings Club is the latest project from indie developers Deconstructeam, an outfit based in Spain who are slowly making a name for themselves with their offbeat works (with the most well known being Gods Will Be Watching). Set in a fairly familiar feeling cyberpunk dystopian future, and treading some equally familiar thematic territory surrounding transhumanism and corporate control, The Red Strings Club is a thoughtful adventure which deftly blends some deep philosophical musings with some quirky wrinkles to keep it fresh.
Don’t look at it, don’t look at it. You looked at it
The events of The Red Strings Club play out mostly from the perspective of legendary barkeep and information broker Donovan. Donovan has the ability to tap into his patrons’ emotions by concocting specific cocktails that align with their moods, which not only makes them feel good (or occasionally bad), but is also capable of loosening their tongues in the process. Knowledge is power, and while Donovan is at heart a good egg, his varied clientele and the information he trades means he is capable of pulling more than a few strings in the city. And pull a string or two he shall, as he attempts to uncover the nefarious plot of a mega-corporation with the help of his hacker boyfriend Brandeis.
It’s a narrative that sounds kind of familiar on paper, but the strong writing manages to give the proceedings a substantial amount of philosophical depth and throws out black and white morality in favour of murky tones of grey. Even Donovan, who is generally guided by a strong moral compass and is relatively steadfast in his convictions, is made to question some of his own beliefs. Oddly enough there is no real true good or true evil in the world of The Red Strings Club, and every character – be they protagonist, antagonist, genderless android or corporate shill – simply want everyone to be happy and to make the world a better place. The question is what level of sacrifice is justified in the quest to rid society of its fundamental woes? How much control are we willing to concede over our thoughts and feelings in the pursuit of universal happiness?
Gameplay-wise the game is most aptly compared to a point-and-click adventure, but really it boils down to a series of mini-games that serve as minor hurdles to moving the narrative forward. Whether it be crafting a bionic implant (in a process that strongly resembles the art of pottery with a futuristic twist) and installing it in a human to boost their confidence before a big meeting, or mixing the perfect cocktail to put a client at ease, player input is often fairly perfunctory and quite simple but enjoyable enough and only present in short bursts so as not to overstay its welcome. The game’s real pleasures come from the deep conversations that take place between characters and the moral quandaries that arise, and the minimalist gameplay aptly keeps this process ticking along.
While there’s a fair bit of choice in how you approach a conversation and what moods you want to heighten through your drink-mixing skills, you can’t ever really fail in the game. If you blunder an important conversation or event you won’t be greeted with a Game Over screen, but not being armed with enough information or losing key characters during your playthrough will make it harder to unravel the mystery in the game’s final moments. It’s a short and sweet experience that can easily be knocked over in a few hours, but further playthroughs can reveal insights and allow you to explore different consequences of your actions.
Let’s get goofy
Patrick Swayze is behind me, isn’t he?
Oddly enough there is no real true good or true evil in the world of The Red Strings Club, and every character – be they protagonist, antagonist, genderless android or corporate shill – simply want everyone to be happy and to make the world a better place. The question is what level of sacrifice is justified in the quest to rid society of its fundamental woes? How much control are we willing to concede over our thoughts and feelings in the pursuit of universal happiness?
The Red Strings Club features a distinct pixelated art design, and unashamedly celebrates the tropes of classic dystopian cyberpunk fiction like Bladerunner and Total Recall. It’s well executed if a little derivative, but it couples nicely with the silky smooth synth soundtrack peppered with jazzy splashes and sombre tones, perfectly nailing the futuristic film noir vibe it ardently strives for.
Donovan knows the score
You must be this rad to use this phone
The Red Strings Club’s greatest asset is the food for thought that it deals out in large helpings. For fans of high-concept sci-fi and philosophy in general, The Red Strings Club will provide plenty of beard-stroking moments of introspection. I’m not sure who exactly I’d recommend this game to, but if you’re keen to question the nature of humanity and still wonder if androids dream of electric sheep then there’s a lot to love here.
Reviewed on Windows | Review code supplied by publisher

domain: artistic