THE MOTHERHOOD DANCE: Giving Credit on Mother's Day | mothers
How often do we thank our mothers for what they have done for us?
There are no perfect mother-child relationships; most are complex, and some are even ambivalent. But overall, Mothers Day is an opportunity to really take a look at the big picture, to reflect on what our mothers have done for us individually over a lifetime, and societally over world history.
Mothers Day prevents us from taking for granted the formidable – almost impossible — tasks of motherhood.
What is it Like to be a Mother Across One’s Lifetime?
Out of all the jobs we do as women, Motherhood is one of the most difficult to perform adequately; Motherhood requires a level of flexibility that most of us are not trained for. Imagine becoming a doctor, a teacher, a lawyer, a therapist, a journalist without any long-term, formal training. All of these professions require expertise and knowledge and an ability that involves managing transitions with skill. Professionals are clinically trained to manage complicated situations throughout their workdays and careers and are rewarded with degrees, respect, and financial compensation.
But Motherhood is Different.
No matter how many books there are out there trying to help us prepare for childrearing, the only real education we get in motherhood is from our own mothers or mother-figures, and on-the-job trial-and-error.
The job of motherhood has never been more lonely in western civilization as it has been over the past few decades. Mothers are expected to perform their duties with little hands-on support from family, often separated by long distances. Grandparents are now thankfully more healthy and active and are either out enjoying their retirement or busy in their own careers. Aunts and sisters live far away. And communities aren’t quite as tight-knit as they used to be. The concept of the open-door multi-generational home, where aunts and uncles, grandparents and siblings would come in and out to engage and assist and teach new moms how to raise children simply does not exist in our modern, highly-boundaried, urban life-styles.
Yet society’s expectations for mothers have not changed, despite the dramatic reduction in support and hands-on education for moms. So the fact that most mothers still persevere and manage to be good enough mothers is pretty amazing and makes acknowledging their efforts even more important on Mother’s Day.
Think about the extraordinary transitions women face when they take on the Motherhood Dance: They are expected to transition from spending their entire pre-maternal lives completely independent and care-free, to being a mother who is the main provider of physical and emotional food, shelter and knowledge. Once mothers finally settle-in as primary caregivers for their babies, they are then challenged to adapt to their children’s increasing independence over the ensuing 18 years. In order to keep up, mothers find themselves constantly shifting to and from the duties of guide, teacher, referee, and confidant. Alas, oftentimes mothers simply have to step aside and watch helplessly. Then finally, after spending a generation throwing themselves into nurturing their children, mothers must return to an existence independent of dependent children again.
Transitions require people to change and the challenge is to adapt or become overwhelmed and vulnerable. Most mothers somehow adapt well-enough to the stages of motherhood. Few master them. Others simply try and are less than successful; but understanding the difficulties of each stage can help us empathize and appreciate ALL mothers on Mother’s Day:
- DURING PREGNANCY: Regardless of what people say about when life begins for the baby, psychologically speaking, a woman begins to think like a mother when she finds out she is pregnant. This is when she first comes to terms with the reality that motherhood is all about accepting that she is NOT in control and that — from that point on — it will be important to accept imperfection when making decisions for her child.
- FROM CHILDBIRTH THROUGH THE FIRST YEAR POSTPARTUM: Despite the hormonal, marital, career and family dynamic changes that challenge the postpartum period after birth, it is amazing that most mothers succeed in providing their babies with undivided attention and responsiveness, and a safe environment to explore the world and develop a sense of self.
- FROM EARLY CHILDHOOD THRU THE TEEN YEARS: The world’s expectations are high: Mothers are supposed to provide children with the guidance, attention, appreciation, and understanding they need while avoiding over-reaching and becoming too critical, worried, irritated or tired. Daily decisions about when to intervene for the child’s safety and wellbeing need to be balanced against when to retreat to enable them to become more independent. During their kids’ teens, after years of bonding, nurturing, loyalty and hard work, mothers are expected to begin the letting-go process at a time when they their children do not quite have enough experience to navigate life completely independently. What a tough job! Women are not born experts on how to avoid taking childhood or teenage outbursts personally – it takes humility, practice, persistence, – and open-mindedness – to successfully learn how to navigate these years as mothers.
- MOTHERHOOD WHEN CHILDREN ARE ADULTS: Requires yet another adjustment in mothers’ approaches to their relationships with their children: This time, ideally it involves backing off and watching, intervening only when requested or gently making suggestions. This is a lot to expect from mothers. Think about it –this is usually around the time a mother is going through the hormonal and emotional fluctuations of menopause while being separated for the first time from her now adult child, often at the same time she is managing the care of her own aging parents.
So Give Mothers Credit, especially on Mother’s Day!
Motherhood is impossible without making mistakes, especially with the diminishing societal and familial support out there for most moms; We need to recognize the formidable tasks mothers take-on and appreciate them. Mother’s Day is a good day to look at the big picture and thank your mom for weathering all the transitions of your childhood and for willing to get messy in the process of developing a full relationship with you.
If you found this post about mothers interesting, take a look at our recent post on pregnancy.
What is the Recommended Calcium Intake?
In light of my most recent posts on vitamin D, it is also important to ingest the correct amount of calcium. The Institute of Medicine recently made the following recommendations:
1,000 mg/day of Calcium is Recommended For:
- All adults aged 19-50 years old
- Pregnant or lactating women aged 19-50 years old
- Men aged 51-70 years old
1,200 mg/day of Calcium is Recommended For:
- Women aged 51-70 years old
- All adults older than 70 years of age
Since there is a limit to how much calcium can be absorbed by the gastrointestinal tract, I recommend dividing the dose in half and taking it twice daily to meet the daily requirements and taking it in the form of calcium citrate. For example, a female aged 51-70 years old should take 600mg of calcium citrate twice daily.
Foods High In Calcium
1 cup of milk 300 mg
6 oz of yogurt 350 mg
1.5 oz of hard cheddar cheese 300 mg
1 cup of broccoli 180mg
If you drink lots of milk or eat lots of cheese, you may not need to take as much calcium supplementation as the daily recommended level, since you already are ingesting some calcium in your diet. It is important to keep this in mind as excessive calcium intake increases the risk of developing kidney stones and may increase the chances of heart disease.
What is the Right Amount of Vitamin D Supplementation?
VITAMIN D SUPPLEMENTATION – A FINE BALANCE
Although having extremely low levels of vitamin D can be dangerous for a person,
what may be equally troublesome is actually having too much of it. This can occur when a person overdoes it when taking supplements, and as a result, conditions like poor bone health and toxicity may occur. So how can we reach a happy medium when it comes to vitamin D supplementation? There are a few guidelines to keep in mind.
First, it’s important for you to recognize about how much vitamin D you ingest in the foods you eat or absorb through sunlight. If you are not at risk for deficiency and are not experiencing any signs or symptoms of low vitamin D levels, then all you have to do is make sure you get the Institute of Medicine’s (IOM) recommended daily allowance (RDA) of 600 IU for adult males and females between the ages of 9 and 70 years old, or 800 IU daily if you are older.
On the other hand, if you are at risk or are experiencing symptoms, you should have your vitamin D levels checked by your general doctor or psychiatrist. If your vitamin D level is too low, you can get supplements prescribed and dosed to resolve the issue.
When it comes to these supplements, the IOM states that 20 to 30 nanograms of 25-hydrovitamin D per milliliter (ng/mL) of blood is the minimum needed to maintain bone health. However, the organization does not provide guidance on how to provide vitamin D supplementation to best address other conditions and non-specific symptoms that may be associated with vitamin D deficits.
It is my opinion that patients who are at risk for these other conditions or who have non-specific symptoms of low vitamin D should take supplements to achieve levels that are higher than the minimal 20 ng/mL. However, they should also be cautious and not allow their levels to go above 50 ng/mL, which may put the body at risk for toxicity.
Some individuals should not take vitamin D supplements at all, as it may cause complications to their health. This includes people with lymphoma and cancers of the bone, sarcoidosis, William’s Syndrome and Granulomatous Diseases, such as tuberculosis.
What are the best Vitamin D treatment methods?
So which form of vitamin D is best? When it comes to raising levels of 25-hydroxyvitamin D, vitamin D3 is the most effective and the most favored form of vitamin replacement.
If you are an adult between the ages of 18 and 70 and do not have psychiatric symptoms or symptoms of vitamin D deficiency, it is important to make sure that you get an RDA of 600 IU of vitamin D3. In my psychiatric office, many patients have their vitamin D levels tested. My goal is to supplement low vitamin D levels in adults aged 18 to 70 to achieve moderate 40 ng/mL 25-hydroxyvitamin D levels, and I have found that patients suffering from depression, aches and fatigue often benefit dramatically within three months of taking adequate vitamin D supplements. If 25-hydroxyvitamin D is between 10 and 20 ng/mL, I will generally supplement with 2,000 to 3,000 IU per day for two to three months, and then retest the patient. If the level is even lower than 10 ng/mL, then I generally recommend 50,000 IU vitamin D per week for 8 weeks and retest before the 8 weeks are up.
For older patients (over the age of 70) who are symptom-free, taking an RDA of 800 IU should be adequate. However, for those who are symptomatic of vitamin D deficiency, supplementation needs to be approached more gingerly, as current literature suggests that there is a U-shaped relationship between serum levels of 25-hydroxyvitamin D and “frailty.”
Vitamin D levels below 15 ng/mL and above 30 ng/mL in older patients have been associated with symptoms of fatigue, weakness, slower walking speed and duration. Another study suggests that older patients receiving a yearly dose of vitamin D of 500,000 IU actually had an increased rate of falls and bone fractures.
Taking this information into account, my goal with older patients above age 70 is to keep their levels of 25-hyrdoxyvitamin D levels between 20 and 30 ng/mL, supplementing conservatively and testing regularly.
REFERENCES:
Bordelon P, Ghetu M, Langan R. Recognition and Management of Vitamin D Deficiency. Am Fam Physcian. 2009;80(8):841-846.
DeLuca HF. Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr 2004; 80:Suppl: 16898-16968.
Ensrud K, et al “Circulating 25-hydroxyvitamin D levels and frailty status in older women” J CLin Endocrinol Metab 2010;95:5266-5273.
Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357:266-81.
Institute of Medicine report on calcium and vitamin D. Washington, DC: Institute of Medicine 2010.
Rosen CJ. Vitamin D Insufficiency. N Engl J Med 2011;364:248-254.
Rosen C, et al “Frailty: A D-ficiency Syndrome of Aging?” J Clin Endocrinol Metab 2010;95:5210-5212.
Schwalfenberg G. Not enough vitamin D: health consequences for Canadians. Can Family Physician. 2007;53(5): 841-854.
Like vitamin D, it is important to learn the appropriate amount of calcium to ingest daily.
What is Vitamin D and How Does It Impact Our Health?
Over the past several years, there have been some exciting advances in what we know and understand about vitamin D, including how it affects our overall health and well-being. And, while many people know that it has physical benefits for things like bone health, I have found that the maintenance of vitamin D levels is a critical component to mental health, as well.
In fact, it seems that without sufficient levels of vitamin D, it can be very difficult to address issues like depression, fatigue and muscle pain and weakness. Lately, studies have also linked vitamin D with other organ systems, forcing medical professionals to question whether or not they should more aggressively treat vitamin D deficiencies.
What is vitamin D?
Vitamin D is a fat-soluble vitamin that humans acquire naturally in three different ways:
- Exposure to sunlight. Scientifically speaking, sunlight on our skin converts cholesterol derivatives to vitamin D3, which is then processed in our liver to 25-hydroxyvitamin D3. In turn, that is converted by our kidney into an active form of vitamin D.
- Certain foods we eat. Mushrooms, yeast, egg yolks, fish (including wild-caught salmon, cod, tuna and sardines), milk and Swiss cheese are all great sources of vitamin D.
- Our own livers. When necessary, our liver converts fat stores of vitamin D to its active form.
As time has gone on, we have seen an increased awareness about the dangers of excessive sun exposure due to skin cancer risks, and so most people rightfully apply more sunscreen when they go outdoors. However, one unexpected consequence of this behavior is that we wind up generating less vitamin D from our skin.
Because of this, we now must rely more on the foods we eat for our recommended daily value of vitamin D. Unfortunately, it is very difficult to get adequate levels through this method, even if we do regularly eat the foods listed above. That’s where vitamin D supplements are helpful.
Why is vitamin D so important?
Vitamin D has a myriad of benefits, and is critical for healthy bone metabolism and calcium regulations. There are vitamin D receptors all over the body, including in the brain and the digestive tract, and as a result it has an impact on mood, cognition, inflammation, the immune system, energy, blood sugar and our ability to manage cell division.
When we have low levels of the vitamin, it can have major negative effects on the body, including in our bone health where it is critical for bone mineralization. Without an adequate presence of vitamin D, a very small percentage of dietary calcium is absorbed into the bloodstream, meaning that the body is literally forced to start dissolving its own bone to maintain acceptable electrolyte levels.
Chronically low levels of vitamin D can therefore cause osteoporosis and dramatically increases the risk of falls and broken bones. This is often fatal for the elderly.
In other areas of the body, preliminary studies suggest that there is a link between low vitamin D levels and issues like heart disease, diabetes, depression, multiple sclerosis, cancer, asthma and autoimmune disorders.
Can we have too much vitamin D?
What complicates things is that it is very possible to have too much vitamin D in our system, which occurs when we take too many supplements (usually in excess of 10,000 IU per day). Ironically, decreased bone health has also been associated with having high levels of vitamin D in one’s system.
More specifically, blood levels higher than 60ng/mL of 25 hydroxyvitamin D have been linked with toxicity, pancreatic cancer and increased mortality. Simply put, while it is important to have a sufficient amount of vitamin D, it is possible to have too much of a good thing. The signs of vitamin D toxicity may include:
- Metallic taste and dry mouth
- Headache
- Dizziness
- Nausea/Vomiting
- Pancreatitis
- Calcium build-up in the kidneys and blood vessels (nephrocalcinosis and vascular calcinosis)
To avoid vitamin D toxicity in people taking unsupervised over-the-counter vitamin D supplements, the Institute of Medicine (IOM) recently recommended a daily maximum of 4,000 IU per day for adults.
The Bottom Line
While individuals should be careful about how much they take, it is still important to note that taking vitamin D supplements might be a good option to prevent a wide range of potential health hazards. To learn more, I suggest speaking with your doctor about your vitamin D levels.
The Importance of Getting Tested for Low Vitamin D
While the impact of vitamin D on bone health and the immune system is fairly well-known, what many individuals do not realize is that low levels of the vitamin can have a negative impact on how well they recover from health issues like depression, bipolar disorder, muscle aches and fatigue. In fact, low levels of vitamin D can be associated with low blood sugar levels and decreased energy, which may have a major effect on our everyday lives. With that in mind, it is important for people at risk of having low levels of vitamin D to have their levels checked by a physician.
Certain people are more at risk than others, including the elderly, vegetarians, individuals with darker skin pigmentation and those who live in parts of the globe where there is limited exposure to sunlight. People who have conditions like inflammatory bowel disease, have had stomach surgery or are on certain anti-seizure medications or steroids may also have a heightened risk.
Low vitamin D levels may result in a variety of conditions, such as cardiovascular disease, diabetes, asthma, multiple sclerosis and cancer. There are also non-specific symptoms, including obesity, decreased cognitive function, back pain, muscle weakness, severe fatigue, depression, increased falls, tenderness in the chest or shin bones and muscles aches or throbbing in the hips, forearms and upper legs.
How are vitamin D levels measured?
The best indicator of your overall vitamin D status is your blood level of 25-hydroxyvitamin D, which reflects both dietary and sunlight-generated levels of the vitamin. However, it is important to note that these levels will vary depending on the season or how close to the equator you live, so if you are at risk for low levels of vitamin D, it is important to get tested often, preferably whenever the seasons change.
If tests do find that you have low levels, your doctor may recommend that you take vitamin D supplements. These supplements can help ensure that your body gets an adequate amount of the vitamin in order to function as effectively as possible.
If you feel that you may be at risk for low levels of vitamin D, I would encourage you to consult with your medical doctor soon. It just might change your life!
REFERENCES:
Bordelon P, Ghetu M, Langan R. Recognition and Management of Vitamin D Deficiency. Am Fam Physcian. 2009;80(8):841-846.
DeLuca HF. Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr 2004; 80:Suppl: 16898-16968.
Ensrud K, et al “Circulating 25-hydroxyvitamin D levels and frailty status in older women” J CLin Endocrinol Metab 2010;95:5266-5273.
Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357:266-81.
Institute of Medicine report on calcium and vitamin D. Washington, DC: Institute of Medicine 2010.
Rosen CJ. Vitamin D Insufficiency. N Engl J Med 2011;364:248-254.
Rosen C, et al “Frailty: A D-ficiency Syndrome of Aging?” J Clin Endocrinol Metab 2010;95:5210-5212.
Schwalfenberg G. Not enough vitamin D: health consequences for Canadians. Can Family Physician. 2007;53(5): 841-854.
*The blog post on vitamin D does not address children below the age of 9, pregnant or lactating women.
Learn more about vitamin D supplementation.
Reconnecting To Our Authentic Selves
FIVE STEPS TO AUTHENTICITY & RECONNECTING
STEP ONE: AWARENESS
By reading this blog, you are completing the first step towards authenticity. You are becoming more aware of the problems our frenzied world has inflicted on your core relationships and personal goals.
STEP TWO: DEFINING PROTECTED TIME & GOALS
I suggest that you sit down in a quiet place and answer the following questions on paper:
- Do I truly listen to my partner when s/he talks to me, or am I interrupted or distracted by technology or other intrusions? What about my children? My parents? My siblings?
- Who are the three most important non-family friends in my life with whom I interact face-to-face? Do I truly nurture those relationships with enough real-time, in-person contact?
- Do I spend more time with technology forging superficial connections with people I almost never see instead of nurturing my face-to-face relationships?
- Am I estranged from my loved ones because of constant email checking, texting and news searching (and yes even blogging!)?
- Does the time I spend on social networking sites and on the telephone truly prevent me from being lonely? Is it truly fulfilling?
Then, for a start, based on your answers to the above questions, write down just one goal that you would like to work on. For example, one goal could be “To spend more meaningful and focused time with my children after work.”
STEP THREE: COMMIT TO YOURSELF
The Protected Time Contract. Write down and actually sign a contract and put it on your refrigerator describing the time period, the purpose, and the way you are protecting your time. Protected Time Contracts might look like:
PROTECTED TIME CONTRACT (EXAMPLE #1)
Purpose: To spend more meaningful and focused time with my children after work.
Time Period: From 5:30PM – 6:30PM each weeknight
Commitment to:
1. Turn off: Cell phones, Email, Pagers.
2. Do not answer or check: Home Phone, Fax Messages, Pagers, and Voice and Text Messages.
3. No outside work-related tasks.
4. Some Activity Options to Consider:
a. Make dinner while the kids do their homework in the kitchen (be available and observe them).
b. Set the dinner table and eat together as a family.
c. Watch 30 minutes of child-focused TV or play 30 minutes of video games with the kids. This does not include news or reality programs.
Signed: _________________________ Dated:____________________________
PROTECTED TIME CONTRACT (EXAMPLE #2)
Purpose: To develop a calmer, more accepting and present self.
Time Period: From 6:00AM-6:30AM (cardiovascular exercise); 12:00-12:30 pm (meditation/breathing).
Commitment to:
1. Turn off: Cell phones, Email, Pagers.
2. No not answer or check: Home Phone, Fax Messages, Pagers, and Voice and Text Messages.
3. No outside work-related tasks.
4. 30 minutes of Daily Mindful Meditation or Deep Breathing (References Below).
5. 30 minutes of cardiovascular exercise.
Signed: _________________________ Dated:____________________________
STEP FOUR: SETTING RESPECTFUL LIMITS
Initially, family, friends, coworkers, employers might be caught off guard, not having access to you 24/7, so it is important to “re-set” their expectations. This is where email and outgoing voice messages can be used to save you time. Simply send out a message saying that you do not answer the phone on weeknights or weekends from ____ to ____ and that you generally check your messages by the next day. Initially, some of your friends might be upset by their limited contact with you, but eventually they will grow to respect your attempts to balance your life. It is important to reassure those who are excluded from a particular protected time that your new schedule actually enables you to be more emotionally present and available when you are with them, which in the long run is better for the relationship.
STEP FIVE: CONSCIOUSNESS & MINDFULNESS
Plugging-Out. First, during protected time it is important to “plug-out” from electronic devices such as mobile phones, text messages, the internet, your email, even your home phone when protecting your time. Plugging-out means turning these devices off, not simply turning the volume down or changing the volume to “silent” or “vibrate” mode. This way your mesolimbic reward pathway won’t be teased by alerts to distract you. This will facilitate your frontal cortex to override your mesolimbic tendencies to be distracted.
Living consciously. Living consciously can mean being completely aware and conscious of the people with whom you have chosen to interact on a deeper level. Observe them, listen and hear them, ask questions about what they have done with their day, how they feel about what they have accomplished and how they currently feel and respond to what they just said. Be in the moment and conscious of the interaction.
Mindfulness. Learn to be completely present. Accept your own thoughts and feelings, and acknowledge that it is not always appropriate or healthy for you or your relationships to immediately act on all of your thoughts and feelings. A number of mindfulness resources are listed at the bottom of this blog article.
Unhealthy distractions. Of course, TV and other media have important places in our lives. With moderation, they can enrich our knowledge of the world and our extended families and friends, but healthy limits need to be explored and discussed with your closest relationships. For some people, 30 -60 minutes of TV is essential to unwind from a long day of work, whereas for others, it is preferable to take a swim or a jog, or eat a healthy snack with one’s kids in order to relax. TV does not need to be on all day, all the time, though, and telephones do not need to be answered whenever they ring. We turn off phones in movie theaters, why not when we are engaged in exercise, meditation, or designated family time? Why do we afford crowds of anonymous people in a movie theatre more courtesy than ourselves or the people we love?
Give Yourself a Break: Take the time to identify what is most important to you. Take a few hours a day, or even one entire day per week “sabbatical” to safeguard that which you consider most meaningful. Rest your mind from artificial pressures of your career, and occupy your mind and body with activities that allow you to appreciate what you have in the world around you, literally. Protecting your time will develop your ability to prioritize, develop patience, and clarify the most meaningful relationships and experiences in your life. It will give you perspective, confidence and ultimately peace of mind.
REFERENCES & RECOMMENDED READING:
Ready, Set, Relax : A Research-Based Program of Relaxation, Learning and Self-Esteem for ChildrenReady, Set, Release CD
The Sabbath (A book by Rabbi Abraham Joshua Heschel for people of the Jewish faith seeking to make protected time a spiritual experience).
With more protected time and reconnecting, take care of yourself by making sure you understand the importance of vitamin D.
