The elegant and complex systems of flavor and nutritional programming

— This post is part of our “Where are they now?” series where we catch up with some of our very first Our Milky Way interviewees from over a decade ago! — 

“The societal and clinical impact of promoting sustainable food habits is significant, since what a child eats determines in part what the child becomes. (Mennella, et al, 2020, p. 291)

 

The pop of poppy seeds in aloo posto, cough-inducing spice in stir-fried lotus root with chili peppers, the meaty texture of a bowl of Cuban black beans. 

The dishes we crave tell stories. 

“Our food preferences have meaning,” Julie Mennella, PhD begins. “They’re more than just a source of calories. Food preferences provide families with identity.”

[Rough Translation’s Tasting at a Distance and Forgotten Foods of NYC’s Appetite for Home — Bitter-Sweet Memories of Learning to Cook & Eat in America both present beautiful audio embodying these connections.]

Elegant and complex learning systems 

The multidimensional interactions we have with food begin with our mothers. A fetus is passively exposed to the flavors of the biological mother’s diet through amniotic fluid, and the infant goes on to interact with these flavors through human milk. Mennella and her colleagues have called this “intimate bidirectional chemosensory communication.” (Mennella, et al, 2023)

In this complex communication, “diet and xenobiotic exposures of the lactating parent, due to lifestyle choices or necessitated by medical treatments, affect not only milk production and milk composition but also the infant’s biological responses, either beneficially or adversely,” the authors continue. “Developing alongside the chemosensory signaling is the seeding and maturation of the infant microbiome, which transfers and exchanges with that of the parent and of the milk, forming additional bidirectional linkages.” (Mennella, et al, 2023

Infant formulas, although available in many varieties, do not foster this elegant exchange and where developing food preferences are concerned, present a static flavor.

“That constant flavor doesn’t reflect the culture [a child] will grow up in,” Mennella comments.  

The same goes for infants fed jarred and pouched baby foods (what we’ve referred to as “the packet apocalypse” where the convenience of “ready-to-feed-super- glop” has largely replaced the art of dining and sharing meals.) The explosion of the baby food industry means parents often don’t feed their children what they themselves eat. Families can feed their babies canned peas, but never eat a pea themselves, Mennella points out. 

Mennella’s research has always been interested in flavor and nutritional programming in humans and the development of food preferences, but over the last decade, it has diversified to ask questions about the taste of pediatric medicines from a personalized medicine perspective, determinants of sweet and salt preferences during childhood, the development of psychophysical methods to study olfaction, taste and chemesthesis across the lifespan, biomarkers for dietary intake across the lifespan, and reproductive state effects on dietary intake and weight loss in women. [Retrieved from: Monell Center

Collective, family- focused approach

Mennella summarizes a few key points from her work. 

“Children live in different sensory worlds,” she says. ”They are really sensitive to the current food environment.” 

And like she and her colleagues have written, the food environment rich in added sugar and salt that caters to preferred human taste, provides challenges for all of us. 

“Fortunately, our biology is not necessarily our destiny. The plasticity of the chemical senses interacts with experience with foods to modify our preferences, producing an interface between our biology and our culture, our past and our present.” (Mennella, et al, 2020, p. 291

In order to influence our destiny, Mennella says that the strategy can never be for the child alone. She suggests there be more attention paid to the family as a whole in order for healthy behaviors to be sustainable. 

She nods to the success of peer counseling programs and recommends bolstering these opportunities for families to interact and learn from one another. She says she envisions primary care taking on a community approach to provide not only a forum for education but also opportunities for interaction between families.  

Where science and policy meet 

Mennella recognizes that ultra-processed, convenience foods are palatable and often inexpensive and deems this a “much bigger issue.” 

Her research has guided national and global health initiatives like the USDA and HHS Pregnancy and Birth to 24 Months (P/B-24) Project, the Breastmilk Ecology and the Genesis of Infant Nutrition (BEGIN) Project, and the World Health Organization’s (WHO) Commission on Ending Childhood Obesity. [WHO recently released its new guideline for complementary feeding of infants and young children 6-23 months of age. Read about it here.]  

As science evolves– where the picture gradually becomes more crisp and for every one question asked, fifty more arise– policies and practice must reflect and catch up to the robust body of evidence in order to best support child and family health.  

Read our 2012 coverage with Dr. Mennella here



Foundation for Mother & Child Health (FMCH) India tackles maternal child malnutrition by empowering women

Tomorrow is Diwali, a five-day festival that celebrates the victory of light over darkness. 

The Foundation for Mother & Child Health (FMCH) India reported that almost eight lakh (hundred thousand) children in India are not able to celebrate their first Diwali due to poor nutrition and health outcomes. 

FMCH works to empower families from vulnerable communities with actionable information and services, resulting in health seeking behavior and nutritious food choices in order to tackle maternal child malnutrition, ultimately breaking the cycle of poverty. 

“FMCH India’s work empowers women – it gives confidence and encouragement to an FMCH field officer, adds to the skills and knowledge of a government frontline worker, and builds agency and support for mothers in the community,” Shruthi Iyer, CEO and Co-founder, FMCH India tells Our Milky Way

When Our Milky Way first interviewed FMCH in 2018, the organization had reached 10,000 women and children in Mumbai and Thane districts of Maharashtra. To date, FMCH has now worked with 60,000 families across low income neighborhoods of Mumbai.  

Still, in 2020, more than 40 percent of children in India were undernourished and 50 percent of women were anemic. 

Community engagement event
Photo credit: FMCH

Within the first 1,000 Days, FMCH strives to implement education sessions in the community, home based counseling, and the strengthening of systems, each strategy with a strong emphasis on monitoring and maintenance of  quality. Sustainability has been built into the program through community engagement and government systems. 

Because malnutrition and maternal health are complex forces, FMCH engages in a variety of programs. Read in detail about them here

For instance, as part of Project Poshan, the organization identified that in Mumbai, “only 53 percent of newborns are breastfed within one hour of birth, displaying a serious lack of early initiation of breastfeeding. On the other hand, the percentage of breastfed children aged 6 to 23 months receiving an adequate diet is as low as 6.4 percent in the city.” [ Retrieved from https://www.fmch-india.org/wp-content/uploads/2021/10/FMCH-Annual-Report-2021-Interactive.pdf

Most recently, in the last year, FMCH “worked with close to 25,000 families, and recorded an increase in early initiation of breastfeeding – 74% from 59%… The national average is 57%,” documented in the latest Annual Report. What’s more, 70 percent of mothers started complementary feeding at the appropriate age of six months.

Photo by Ganta Srinivas

Their work supporting healthy infant feeding recognizes that breastfeeding is not only the responsibility of the mother though and aims to educate the network of people around the breastfeeding dyad

FMCH’s most recent annual report describes the success stories of health care providers and the families they serve. Explore them here

Iyer says the way forward is to establish more direct interventions, build out indicators for their theory of change and to conduct more trainings for Anganwadi workers. (Anganwadis are rural child care centers started by the Indian government as part of the Integrated Child Development Services program.)

Photo by Gene Brutty

In the earliest Indian literature, the Vedas (a large body of religious texts originating in ancient India) recognize the life-giving powers of breastmilk. 

As documented in The Religious and Cultural Bases for Breastfeeding Practices Among the Hindus “…Milk and breast are symbolic of longevity and nectarine sweetness” and “‘Drinking of the milk, whose sap is the sap of immortal life divine, may your baby gain long life, as do the gods by feeding on the beverage of immortality!’ (Susruta, III, 10).” 

Extolling breastmilk in modern India and globally, through programs like FMCH, is like the light over darkness during Diwali, the FMCH vision achieved: “Healthy mothers and thriving children for a world of unlimited possibilities.” 

Happy National Midwifery Week!

October 2 to 8 marks National Midwifery Week. National Midwifery Week was created by the American College of Nurse-Midwives (ACNM) to celebrate and recognize midwives and midwife-led care.

Two of my three births were attended by midwives. My first birth in a hospital attended by an obstetrician might best be described using words like chaos, fear, coercion, and out of my control. Juxtapose that next to my subsequent home births with professional midwives which conjure words like calm, empowerment, grounded, respect and safety.

Midwives aren’t only attending births though, providing personalized, ethical care, but as this year’s Midwifery Week theme embodies– Midwives for Justice– midwives strive for justice on many fronts. You can find out about the North American Registry of Midwives (NARM) national advocacy efforts here.

Midwives also play an integral role in establishing healthy infant feeding practices. Read the Global Breastfeeding Collective’s advocacy brief The Role of Midwives and Nurses in Protecting, Promoting and Supporting Breastfeeding here.

I am proud of and inspired by the work that my midwife Erin does beyond helping catch babies. You can read about her efforts as an ally here.

ACNM has created a beautiful toolkit to help us celebrate the midwives around us and the midwifery model of care this week and beyond. You can access that PDF here. It includes sample social media posts and ways to engage online, suggestions for community gatherings, and ways to celebrate accomplishments like parties, team building events and award ceremonies.  

Check out past celebrations of the midwife for still relevant resources like WHO’s declaration of 2020 as the Year of the Nurse and the Midwife and the International Day of the Midwives.

For further reading on midwifery care, especially indigenous midwifery care, check out Knowledge Keepers: Why We Need Indigenous Midwives and Giving Birth Where the Family IsCommonSense Childbirth and Changing Woman Initiative’s  Power of One Indigenous Midwifery Fellowship program at http://www.changingwomaninitiative.com/power-of-one-indigenous-midwifery-fellowship.html.

Past Our Milky Way coverage on midwives

Honoring midwives during Women’s History Month

Alabama birth worker facilitates holistic, sustainable care for families

Taking ‘if’ out of the equation

Skin-to-skin in the operating room after cesarean birth

High schoolers explore human placenta, learn about physiological birth

Happy Birth Day, a new project by Dr. Kajsa Brimdyr

An opportunity for normal birth

Renaissance Woman

Dr. Soo Downe: International Breastfeeding Conference presenter Sneak Peak

#MidwiferyWeek2022 #MidwivesforJustice

Colorado pediatric office becomes breastfeeding friendly employer

Castle Rock Pediatrics (CRP) made a splash this summer at the Douglas County Fair Parade where they displayed their incredible Under the Sea themed float. Patients and families created a colorful array of paper plate fish that “swam” through pool noodle crafted seaweed.

CRP also attended the  Renaissance Expeditionary Magnet School Back to School Carnival and the Downtown Castle Rock Concert Under the Lights where they set up a lactation station.

After breastfeeding her own young children and later completing the Lactation Counselor Training Course (LCTC), Laura Westover PA-C, CLC, one of the providers at CRP, dove into helping transform her office into a Breastfeeding-Friendly Employer and soon-to-be Breastfeeding- Friendly Medical Office.

Their work is supported by a grant through the Tri-County Health Department. Westover has been working alongside Susan Howk, a breastfeeding policy specialist, to create their policies and lactation spaces through a six-point plan which includes policy, staff and provider training, patient education, environment, evaluation and sustainability, and continuity of care.

The grant has funded things like a chair, end tables, a hospital-grade multi user breast pump and kits, a stuffed animal nursing dog with her puppies for siblings to play with, and a lactation scale for weighted feeds.

Westover displays the breastfeeding friendly employer certificate in March 2022 standing in their first lactation space.

Their lactation space started in one of their smallest exam rooms, but has recently graduated to one of their larger exam rooms, which is now near the end of its renovation. Westover notes that the space also functions for newborn and young baby visits.

Westover reports that CRP owners since November 2021 Drs. Anderson and Bouchillon have been highly supportive of the breastfeeding-friendly changes.

Prior to the implementation of their lactation policies, Westover says their office “was not lactation friendly at all.” She describes stacks of formula in plain view.

“It gave the impression that we were promoting formula,” she comments.

Gift bags for patients were also riddled with formula-promotions, so the team phased out the branded materials and replaced them for non-branded, breastfeeding-friendly items.

Now, Westover and her colleague Sydney Gruenhaupt RN-BSN, CLC  see breastfeeding dyads weekly for office visits; whereas they once had to refer out. Of mothers’ main concerns are poor weight gain and uncomfortable or painful latch.

Westover points out that Colorado has very high breastfeeding initiation rates, but like the national trend, tapers dramatically at 6 months and beyond. While Westover and her colleagues are not currently tracking their office’s breastfeeding rates, it’s part of the plan in hopes that their numbers will hold steady beyond initiation rates. Westover explains since they’ve switched over to a larger electronic medical records system, there should be potential for a simple, infant feeding tracking system. A 2016 project by the County of San Diego Healthy Works program, implemented by UC San Diego Center for Community Health with funding from First 5 San Diego extensively explores current practices and future possibilities of  breastfeeding measurement in the outpatient electronic health record.

Westover and her colleagues will be out and about again this fall where they’ll craft their  lactation tent at events like Oktoberfest and the town of Castle Rock Spooktacular Halloween celebration.

“[It’s] really wonderful because we are able to promote [to] the whole community,” Westover shares.

For more about CRP’s lactation services visit https://castlerockpediatrics.com/Services/Additional-Services .