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Authors: Pearl Barrett

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Sadly, the bottom line is that miscarriage is extremely common. An article entitled “Miscarriage Statistics” adapted from the book
Hope Is Like the Sun
states, “Sources vary, but many estimate that approximately 1 in 4 pregnancies end in miscarriage; and some estimates are as high as 1 in 3. If you include loss that occurs before a positive pregnancy test, some estimate that 40 percent of all conceptions result in loss.” Before stevia is blamed, one should look at all the known causes.

Solid evidence does back up many reasons for miscarriage, though, but in the end, only God knows.

Real Blame

One thing is for sure, while solid evidence that stevia causes
infertility or miscarriage is not to be found (even though multiple studies have attempted to do so), there are many reputable studies pointing to high blood sugar and insulin resistance as certain reasons for both miscarriage and infertility. We would never want to go around saying “Sugar caused my miscarriage!” or “Too much honey caused my friend's or sister's miscarriage,” but it is good to know the facts. We have talked to several doctors about the concern over stevia and miscarriage, and their belief meshes with ours. If there is blame to place, let's place it solidly where it is founded—on a high-sugar and high-starch modern lifestyle, which causes disastrous metabolic and hormonal changes to the human body.

The American Diabetes Association says that high glucose levels can increase a woman's chance of miscarriage anywhere from 30 to 60 percent. These are not maybes or
rumors—these are hard numbers. According to Dr. Christine Lee in a 2013 article entitled “Diabetes and Your Fertility,” high blood sugar also creates an increased risk of having a baby with
birth defects. She says, “During the first few weeks of pregnancy, when a baby's vital organs are just beginning to form, high blood glucose can cause damage to the embryonic cells.”

There are too many studies to cite supporting the connection between
miscarriage and high blood sugar and insulin issues, but here are a few of interest: A 1998 study published in
Cell Biochem Function
found that plasma levels of glucose (blood sugar) were significantly higher in habitual miscarriage than in controls. A 2006 study in
Akush Ginekol (Sofiia
), published in Bulgaria, showed that high Hb A1-c levels (average levels of blood sugar) in the first trimester of pregnancy had a primary role in the occurrence of early miscarriages. Women who are insulin resistant are four to five times more likely to have a miscarriage.

Choose Peace

Sorry we had to go all hyper-study on you—hope your eyes are not glazing over—but we felt we had to clearly lay out some of this evidence to help clear stevia's name. Having said all this, pregnancy should not be a time for stress and worry. Everyone on plan should feel comfortable with the particular sweetener they choose to use. To use stevia or not will be your own decision to make. But a word of caution: Keep the amounts of any glycemic-impact sweeteners small, especially if you have any form of gestational diabetes. In light of all the evidence concerning high blood sugar and risk of miscarriage, infertility, and higher birth defects, we do advise that you not go overboard with honey or other natural higher-glycemic sweeteners for your own and your baby's health's sake.

chapter 14
FAMILY FRIENDLY

T
he Trim Healthy Mama way of eating is nutritionally sound for the entire family. Even if other family members are not on the weight-loss part of this plan, you don't have to make completely separate meals. In fact, they can enjoy on-plan meals without even knowing they are on plan at all. This plan is simply regular whole foods, kept in safe blood-sugar boundaries. You may have toddlers, grade school children, teenagers, and full-grown adults all eating around the Trim Healthy Table and all getting their individual needs met.

HOW DOES IT WORK?

There are times, of course, when it is natural to have your own quick “alone Mama” meal. In our homes,
lunchtime is usually a free-for-all. Our children are homeschooled and the older ones love to make their own sandwiches or fry up some eggs with toast. This leaves us with endless options. You could make up a quick fillet of salmon and put it on a salad or use leftover chicken in a Wonder Wrap found in the “Breads and Pizza Crusts” chapter in the companion cookbook, or in a store-bought low-carb wrap if you're more like Drive Thru Sue. Have a quick two-minute soup: Just Like Campbell's Tomato Soup is a Trim Healthy Mama favorite (you can find that free recipe on our website). Have it with a grilled cheese made with Swiss Bread if you want—yum! (Check out the Swiss Bread recipe in the “Breads and Pizza Crusts” chapter in the
Trim Healthy Mama Cookbook
, or if you are more of a Drive Thru Sue, use a Joseph's pita to make a grilled cheese.)

Breakfast can be an occasion for gathering around the table or a separate mad rush. A big pot of oatmeal can either go E for you or Crossover for your children, depending on what you pour on top of it: Butter or cream on oatmeal would be a Crossover, and unsweetened almond milk or 0% Greek yogurt would keep it in E mode. Eggs can be S for you or Crossover for them, depending on whether you add a side of veggies or bacon, or your children put theirs on whole-wheat toast. Smoothies? Maybe the whole
family is going to love a chocolate berry smoothie—S or FP for you. Add some honey to the blender for extra glucose if your children need a bit more fat on their bones. A wisely sweetened smoothie using our on-plan sweeteners is healthy for all family members, so the honey is an option, not a necessity. Trim Healthy Pancakes found in the “Pancakes, Donuts, Crepes, and Waffles” chapter in the
Trim Healthy Mama Cookbook
are perfect full-family fare. Our children LOVE them slathered with butter and topped with honey. You can keep your pancakes in E mode with 0% Greek yogurt, or if you are a Drive Thru Sue, a squirt or two of fat-free Reddi-wip can keep you happy. Close your eyes if you are a purist—you didn't just read that. We also have a Fuel Pull, dairy-free easy yogurt recipe that will be great on your pancakes. Check out NoGurt in the “Sweet Bowls” chapter of the
Trim Healthy Mama Cookbook
.

—

The evening meal is the perfect time to get the family together. It is simple to harmonize your fuel choice with the needs of the whole family. Say you choose S, everyone at the table can eat that same yummy protein source. Maybe it is chicken with crispy skin or meat loaf. Make a huge salad with S goodies topping it and your meal will be complete. If you'd like an additional side, roast, steam, or sauté your favorite non-starchy veggies with butter or coconut oil and spices. Your children can enjoy the veggies and salad because they'll be tossed in those decadent fats that children are naturally drawn to, but they can cross this meal over with choices like brown rice, mashed potatoes, or even something as simple as whole-grain bread and butter or a glass of raw, whole milk. The core of your plates is the same, it is only the edges that are a bit different. This is not two meals, this is just one with the ability to choose which sides suit each person.

Let's say you make a big pot of lentil soup for a budget-friendly, E-fueled night and you add some optional chopped chicken breast to the soup for extra protein. You can enjoy a large bowl of the soup, topped with Greek yogurt and maybe a very small amount of part-skim mozzarella (purists can enjoy one tablespoon of raw Pecorino Romano cheese,
which has a robust flavor with little fat and calories). You might enjoy a piece of plan-approved toast for dunking. Children can really go to town with grated cheddar and sour cream on their soup for a Crossover effect.

OFF TO WORK

Brown-bag lunches are easy on plan whether you are packing them for yourself or for your family. Your favorite sandwich stuffings, such as egg, chicken, or tuna salad, or deli meat, can easily be placed on S-, E-, or FP-friendly breads or wraps. Or take a salad, a kefir smoothie, or a portion of a leftover soup or casserole. Sides can be little zippy bags of cubed cheese and nuts or Skinny Chocolate (there are many creative versions of our Skinny Chocolate, on Pinterest) jerky, on-plan muffins, mini meat loaves, quiche, fruit, veggie crudité with on-plan dips, boiled eggs, Greek yogurt swirls with frozen berries, or on-plan cookies. Check out
Chapter 22
, “Heads Up: Working Mamas!,” for more ideas.

chapter 15
EATING OUT

A
s a Trim Healthy Mama you won't have to agonize over slim pickings at restaurants. It is very easy to eat out on plan. A steak house date with Hubby? Yes, ma'am! A chicken-topped Caesar salad for lunch at a café? Absolutely! Bacon, eggs, and mushrooms or a cheesy omelet at a pancake or waffle house for breakfast? You bet! Here's how to eat THM at your favorite restaurant.

STEAK HOUSE

Choosing a delicious on-plan meal here is so easy simply because
steak house menus are centered around protein sources. S meals are the easiest. Choose from unbreaded chicken, beef, salmon, or other fish such as trout. Order a non-starchy veggie or two for your side instead of the usual potato, mac and cheese, or rice. What's your pleasure—asparagus, broccoli, sautéed mixed veggies, mushrooms? All those veggies are staples at most of these restaurants and can be tossed with butter if you ask your waiter. Your meal will often come with a house salad. Remember to choose a dressing that is not sweet. Oil-and-vinegar, Ranch, or Caesar are usually the safest options. You can be very liberal with oil and vinegar but don't go crazy with Ranch or blue cheese. Although on plan, they're far from superfoods and can turn into caloric abuse if you overdo. But we also want you to enjoy yourself, so don't obsess over the dressing—just be mindful.

Here are some tips to help you out:

•  Nix the
bread. It is always best to ask your waiter not to bring any bread to your table. If you are dining with someone who would prefer to have bread, simply ask your waiter not to bring your portion. If you forget to do that, know this: The wafting aroma of fresh yeast bread can bring down the strongest of us. It's too hard to resist, except possibly if you're Serene (I couldn't resist writing that from me, Pearl, because bread has undone my best intentions
at restaurants while Serene annoyingly remains as strong as a statue.) It is best to ask your waiter to remove the bread and mention that you haven't touched it so he or she can eat it on break. We've made many friends of waiters doing just that.

•  Don't eat the croutons on your salad—okay, we'll try not to spy if you just eat one or two. But liberal amounts of croutons can take a perfectly good S meal and ruin its slimming capabilities. Or bring a zippy of Blendtons, found in the “Condiments and Extras” chapter of the
Trim Healthy Mama Cookbook.

•  For special occasions you can sip on a glass of dry
wine while you wait for your meal. Other great
drink ideas are mineral or soda water with lemon or unsweetened tea (which you can sweeten up yourself with a little trusty stevia that you carry in your purse).

•  E meals can be a little more challenging but are not impossible. Sweet potatoes make great E sides with a whitefish or grilled chicken breast. Use the lightest dressing on your salad and hold the cheese. Baked sweet potatoes with butter make fantastic Crossovers with either steak or salmon.

FAST FOOD

Although you'll never see Serene eating fast food, many of us can still enjoy it (had to get another dig at Serene there—Pearl). Many burger joints offer
low-carb burgers on their menus. They'll cook up any juicy burger of your choice, whether beef, turkey, or chicken; pile it with your favorite burger fixins; then wrap it in lettuce. Who needs those buns?
Blech to buns when the real flavor of the burger is only enhanced wrapped this way. Okay, so if you don't agree with “Blech to buns” and do miss a bread casing, be not dismayed. Take along a couple of homemade Swiss Bread slices (found in the “Breads and Pizza Crusts” chapter in the companion cookbook) or store-bought Joseph's pitas in a little plastic bag. Throw away those devitalized, health-destroying buns and put your burger and fixins between your blood sugar–friendly bread options. Smart!

No fast-food joint, including McDonald's and Burger King, will think you strange if you ask for your burger without a bun (order it that way and they'll put it in a little box and give you a fork to eat it with), but the following restaurants have low-carb burgers on their actual menus:

Carl's Jr.

Five Guys

Hardee's

In-N-Out Burger

Jimmy John's

Red Robin

Fast-food restaurants usually offer a variety of great protein-topped salads, too. Avoid toppings like craisins or fruit if you intend to use a fatty dressing. Dressings such as Italian, Ranch, blue cheese, or Caesar will be better options than French or honey mustard, as any sweet dressings contain sugar.

Sandwich and sub places don't have to throw you right off plan, either. It might not be a perfect approach but you can order a six-inch whole-wheat sub with lean fillings such as turkey, mustard, a smear of low-fat mayo, and lots of veggies. No, the bread won't be sprouted or sourdough, most likely; but you're doing your best and hopefully this won't be your daily fare. Most popular sub shops such as Subway won't bat an eyelash if you ask them to take out the center of the bread filling so you don't have to have as many of those less-than-stellar wheat carbs. They do it all the time for more health-conscious folks. Panera Bread has a hidden power menu with lots of on-plan S and E options. You can look up the menu online or ask to see it at the restaurant.

MEXICAN

The biggest temptations you'll face at a Mexican restaurant are the chips they place directly in front of you as soon as you sit down. Steer clear of
Mexican restaurants if you can't resist those, or ask for cucumber slices and guacamole instead to scratch that dip-and-crunch itch. If you can wait for your food without chowing down on chips, Mexican food works fabulously with a Trim Healthy approach.

The best item to order at a Mexican restaurant is fajitas. Who needs refried beans, rice, and white flour tortillas when you can have seasoned grilled meat with caramelized onions, peppers, and tomatoes? Tell the waiter you won't need the tortillas, rice, or beans. You can top with sour cream, salsa, guacamole, and pico de gallo. Who would miss the bland starches? Not us! Taco salad is another great option—nix the fried corn tortilla shell.

Those who are at Crossover stage can add beans to their meal, but the white rice that is usually served at Mexican restaurants is best avoided.

CHINESE AND JAPANESE

If you follow our tips and avoid the foods that will fatten you up in a jiffy at
Chinese restaurants, you can find wonderful dishes of tasty meats and vegetables to fill you all the way up. S meals are once again the easiest.

•  Avoid anything that is battered.

•  Avoid all sweet sauces.

•  Avoid the white rice that only looks brown due to the soy sauce.

What are you left with? Lots of fantastic non-breaded meats and veggies. Try pepper chicken, beef and broccoli, mushroom chicken, and garlic string green beans, just to name a few. Once again we need to throw in the caution not to get too crazy and visit Chinese restaurants too often. Although you will be avoiding the real nasties for your health, most Chinese sauces still do contain a bit of cornstarch used for thickening. But you'll survive this every now and then and if it is a dish you absolutely love, get creative and try to make it at home using glucomannan instead of cornstarch. Try meats and veggies tossed with sauces made from broth; plan-approved sweetener; soy sauce, Bragg Amino Acids, or
Coconut Aminos; chile flakes; and vinegar. Thicken up with glucomannan (aka “Gluccie,” available on our website) and you'll have wonderful sweet and spicy flavor. Check out our Orange Chicken recipe in the “Family Skillet Meals” chapter in the
Trim Healthy Mama Cookbook
—amazing!

Japanese hibachi grills are easily THM friendly (if you avoid the rice). Ask for extra veggies and then pick your protein—salmon, steak, or chicken (or shrimp if you eat it). A broth-based soup to start your meal won't be a problem, either.

INDIAN OR
THAI

Coconut- or cream-based sauces from these cuisines are perfect for S options. Chicken masala or butter chicken are dishes that won't mess with your weight too much if eaten on occasion. If you eat them too often, these cream-based Indian dishes can bring on calorie abuse from their richness. We're talking oodles and oodles of cream in those sauces, which is fine on occasion but problematic if eaten too often. Add lots of veggies and you won't miss the rice.

Thai curries and soups can be another wonderful option. Avoid the real sweet sauces and starchy noodles and focus on coconut-based red or green curries with lots of health-promoting veggies and chicken or fish.

PIZZA JOINTS

How could one possibly eat at a pizza joint and stay on plan, you wonder? It can be done. Many pizza restaurants have started offering pizza in a bowl for people concerned about their blood-sugar levels. Basically that is just pizza toppings without the crust—super yummy. Go real high on the veggies and meats to get your protein in. If your local pizza buffet does not do that—yep, some of us Trim Healthy Mamas have been known to just eat the toppings, over a green salad, and throw away the crusts—that's not exactly wasteful because white pizza crusts cause health decline, so you're not gaining anything but weight by eating them. Another option is chicken wings. Many pizza places offer those as an option. Just make sure they are not breaded or covered in sweet sauce. Buffalo-style hot sauces are your safest bet, and have a side salad to balance your meat-heavy meal.

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