Mercury in pregnancy

There are many environmental contaminants that modern humans are exposed to on a regular basis including air pollution, heavy metals, pesticides, plastics and industrial chemicals and fuels. They permeate our spaces inside, outside and on the job. In fact, every pregnant woman in the U.S. is exposed to at least 43 different chemicals. These exposures may result in adverse effects for both mother and child and should be avoided as much as possible. A well known contaminant is mercury, a naturally occurring element, and our exposure is usually from one of two common forms: methylmercury (meHg) and ethylmercury (etHg).

Methylmercury (meHg) contamination in our environment is largely from coal-fired power plants. It is hazardous even in small amounts and typically enters our diet through the consumption of fish, which accumulate it in varying amounts depending on the species. meHg is known to cross the placenta and to accumulate in the fetus at higher levels than in the mother. Toxic levels may result in permanent damage to the fetal brain resulting in impaired neurodevelopment and reduced cognitive performance. On the other hand, there are many benefits to eating fish. Fish are high in protein, low in saturated fat and are rich in many micronutrients including omega-3 fatty acids such as docosahexaenoic acid (DHA). DHA has been shown to have a role in early fetal brain development and may be protective against adverse problems in pregnancy such as preterm birth, fetal growth restriction, gestational diabetes and preeclampsia. Benefits continue for breastfed infants and for children who consume fish. To derive the highest benefits of seafood consumption while minimizing the risk of meHg exposure it is recommended that mothers eat a 4 ounce serving of approved seafood 2-3 times a week. Seafood options that are low in meHg include some fish (salmon, cod, tilapia, canned light tuna), crustaceans (shrimp, crab, lobster) and shellfish (clams, oysters, scallops). Please note that albacore (white) tuna has more meHg than the other variety of tuna so should be limited to no more than 6 ounces per week. See “Advice About Eating Fish” below for more information.

Our exposure to ethylmercury (etHg) is largely through vaccination; etHg is a metabolite of thimerosal, the most widely used vaccine preservative to prevent germ growth. Compared to meHg, etHg is metabolized and eliminated by the body at a much faster rate. It is impossible to reach toxic levels of etHg from thimerosal containing vaccinations, regardless of multiple or repetitive exposures. Many well designed studies have demonstrated that there is no evidence of harm from the low levels of thimerosal present in some vaccines. Likewise there is no evidence linking thimerosal exposure to autism, a neurodevelopmental disorder. While multidose vaccine vials of the influenza vaccine continue to contain thimerosal (individual dose vials do not), the World Health Organization (WHO) considers this to be safe in pregnancy and infancy.

In conclusion, reducing exposures to environmental contaminants is important for human health and especially for pregnant women, infants and small children. Given the benefits of dietary fish in pregnancy and in fetal development, it is recommended to regularly consume a small amount as part of a balanced diet. Staying within the limits established by U.S. government agencies will prevent reaching toxic levels of methylmercury (meHg). In contrast, exposure to ethylmercury (etHg) from thimerosal containing vaccines is safe in pregnancy, infants and small children as it cannot reach toxic levels in the amounts given.


We all fall down

Losing weight is a long and difficult challenge. It requires incredible self-control and persistence. It is all too easy to “fall off the wagon” and to not want to get back up. It actually takes a lot of energy and resolve to get up and try again, often to simply regain lost ground.


On 6/20/12 I mustered the courage to engage my personal “battle of the bulge” yet again. As you can see from my weight record, I have fallen down several times since 2012. The important thing however is that I keep getting back up.

I have struggled with weight issues the majority of my life. Sometimes I like to say that I inherited the “fat gene” from my parents but genetics is only part of the picture. My relationship with food is actually the greater culprit. The art of eating is learned, such as what is eaten, how much, how often and why we eat it.

“Waste not, want not” is an idiom that applied to my dinner table growing up; my parents forced me to clean my plate every meal regardless of how full I was. On the more pleasant side, dinner was always followed by dessert.

Improper eating can also be triggered by emotion. We all want to feel good, satisfied and happy. Food can be comforting when eaten alone or when enjoyed with others. It can be used for celebration as well as depression. It can help take your mind off of things you’d rather not think of. Food can stimulate the reward center in our brains and can in fact become a powerful addiction and a dangerous friend. For my path to begin I had to recognize this, that I had eaten for many reasons other than hunger. I could no longer continue this unhealthy relationship with food.

Diets do not work. There are no magic foods, exercises, herbs, supplements or medications that have been proven to help people lose a significant amount of weight and to keep that weight off over time. The only way to achieve this is through a change in lifestyle. This means eating in a way that is healthy, satisfying and able to be continued for the rest of your life. If you choose to temporarily eat in a unique way (a diet) or to use products you think will help you lose weight, what will happen when you stop? How will you maintain your weight without having learned how to change your lifestyle permanently?

In order to change my eating lifestyle my relationship with food has become very supervised. Hunger alone is an insufficient mechanism for me to control my eating habits. Now I try hard NOT to clean my plate. I eat slowly and try to stop eating the moment I feel satisfied, not when I am full. I now take the time to consider what I want to eat, why I want to eat it and if it’s worth the Calories. I imagine that it will always be this way. I will always be tempted to eat more than I should for reasons like I listed above. And that is okay. I can be observant and continue to make conscious decisions regarding my food choices.

As I have written before, MyFitnessPal has been instrumental in helping me to keep track of my eating habits. I continue to be surprised by how an innocent-looking food can be harboring a huge amount of Calories. Talk about sticker shock! Checking Calorie content before I eat allows me to make an educated decision about whether or not I really want to eat it. That’s not to say that I don’t splurge occasionally. I just consider the cost and decide if it’s worth it.

Calorie counting is a lot like balancing a checkbook. If I overspend I get in debt but if I under-spend I save. My daily Calorie allowance is my budget. If I overeat I gain weight and if I eat less than my allowance I lose weight. Sometimes I want to go out and eat more than my budget allows. I can “earn” extra Calories to eat by burning them with exercise. If I go the to gym and do the elliptical for 30 minutes, I burn 300 Calories. That’s 300 more Calories I can eat for the day.

My favorite meal of the day is dinner. I want to eat as normal of a dinner as possible so I budget accordingly. I simply eat less for breakfast and lunch. My typical breakfast is 1 cup of FAGE Total 0% Greek Yogurt mixed with a Del Monte Fruit Cup and a packet of Truvia (~250 Calories) or an omelette of 6 egg whites with 1 egg yolk and salsa verde (~250 Calories). For lunch I eat a protein bar (Nature Valley or Clif Bar, ~200-250 Calories). If I’m really hungry before dinner I choose low Calorie snacks such as string cheese (~80 Calories). For dessert I like to eat either a JELL-O Sugar-free Pudding Snack (~60 Calories) or Ghirardelli Chocolate Square (~60 Calories).

And then there is dinner. recommends a plate that is 1/4 protein, 1/4 starch, 1/4 fruit and 1/4 vegetables. My personal plate is more like 1/2 protein, 1/4 vegetables and 1/4 starch. I confess that I don’t eat as much fruit as I’m supposed to. Good appetite suppressants for me are coffee and pickles. Go figure!

Now I am more than halfway toward my goal weight. I look skinny enough perhaps by my picture, but I am still overweight by my BMI (see earlier post). It’s been a long road but I can see the finish line… well, at least the beginning of a less steep and difficult road up ahead.


Gay doctor? – Why I’m out, loud and proud


To this day I do not know a single LGBT person from my youth. I was not privileged to have understanding parents nor to have role models with whom I could connect.

Many youth today find themselves in a similar position. Growing up gay, bi or trans* is never easy and each generation has their own struggles. However no generation has felt the wrath of homophobes quite like the youth of today. There are finally words to describe who we are and worldwide communities to which we can belong but these beacons of light also gaze upon and identify kids to themselves and their peers. All too often LGBT kids experience rejection, isolation, discrimination, harassment and physical violence. And this results in low self-esteem, risky or self-destructive behaviors, homelessness and suicide.

While I cannot reach out to those of my community who are suffering and alone, I am yet another adult who is proud to say that I’m here and queer and it does get better.


  • The Trevor Project (http://www.thetrevorproject.orgis a 24 hour help line that is available to anyone who needs a listening ear.
    • 866-4-U-TREVOR (866-488-7386)
  • It Gets Better Project (http://www.itgetsbetter.orgis an inspiring collection of 1,000s of user-created videos from around the world that was created to show young LGBT people the levels of happiness, potential, and positivity their lives will reach – if they can just get through their teen years.
  • Parents, Families and Friends of Lesbians and Gays ( provides support and resources for families and friends of LGBT people.

New favorite app: Wake-up


I have Seasonal Affective Disorder which basically means that my mood and energy are significantly affected by the amount of sunlight I receive. I tend to want to go to bed when the sun sets and to get up when it rises. If there are prolonged periods of overcast skies then I become sluggish and I just want to hibernate. Clearly this is not helpful in trying to maintain a modern lifestyle and it is one of the major reasons why I moved away from Seattle. Getting up on time during the winter months has always been a difficulty; the alarm clock sounds, but it’s pitch black and cold so I end up hitting snooze way too many times.

Finally there is a solution: the Wake-up app by Pico-Brothers available for iPhone and iPad (It works best for me on iPad). Basically I put my iPad against the wall and set the alarm. When the time approaches for me to get up the screen gets brighter and brighter. There is also a sound function which I have set to “birds”. Now I don’t have trouble getting up and I can get to the gym before work, a previously unobtainable dream. This app is now a part of my essential apps collection.


New favorite app: GoodRx

Want to save $100s without traveling to Canada or Mexico or buying from shady internet sources? Check out the iPhone App GoodRx! If you don’t have an iPhone, you can access the same free coupons from

This is not a gimmick. I used it myself to purchase a medication from Target that costs over $200 per month for less than $30. It almost felt like stealing. If you want to read more about the company, check out this Huffington Post review.

In a better world

Reproductive choice would be reproductive freedom.

Sex education would be nonjudgemental and complete and contraception would be accessible to everyone.


Pregnant individuals would find support to scale financial hurdles that threaten lives, families and futures.

They would not have difficulty paying for services that align with their decisions and the futures that they envision.


Protesting would focus on the harms committed against living children.

Not on the individuals who find themselves facing difficult decisions.


Kickstarter film: “American Secret: The Circumcision Agenda”


“American Secret” examines the history behind popularizing male infant circumcision in the United States and the economic and cultural incentives responsible for its continued practice. The film pushes back against this rarely questioned cultural norm, which, though ingrained domestically has long since fallen out of favor abroad.

On the face of it, “American Secret” is about circumcision. At core the film is an examination of how memes proliferate, how ideas spread, and how thought patterns take hold. The film also explores questions we rarely ask ourselves, such as how we decide what we’re going to think about, what we’re going to reconsider, what we’re going to resist, and what we aren’t. The film’s overarching questions being: “How do we come to believe what we believe?” and “What role do reason and fact play in establishing or changing our beliefs?”

We do NOT want to cut your beautiful baby boy!

IMG_5505Dear Dr Pate,

I’m a third-year medical student who is strongly considering going into OBGYN. Unfortunately, I’ve been really dismayed to discover how common it is for OBGYN residency programs to require their residents to perform circumcisions. I’ve begun to worry that my moral opposition to circumcision might be incompatible with going into OBGYN. I don’t want to get into a situation where I might be fired if I don’t perform circumcisions because I would rather get fired–and if that’s the case then why go into that field in the first place. I started to google about the topic and your blog was one of the first to come up.

Do you have any advice for a student in my situation? Should I try to seek out OBGYN residency programs that don’t require residents to circumcise? Should I just match into OBGYN and then refuse once I already have the job (can I be fired for that?).


Dear MS3,

Thanks for writing! I find it so refreshing to hear more and more from students, such as yourself, who desire to refrain from performing circumcision. Clearly you are not alone but tradition is deeply engrained in culture and deviation therefrom is considered illogical and threatening. If you are interested in OB/GYN, don’t worry about circumcisions. I wouldn’t even bother mentioning it in your interviews — it falls under the same legal protection as beliefs about abortion.

I encourage you to check out my post — Do medical students have to assist circumcisions? There are links to resources available to you. Hold you head high! Where there is a will there is a way. You don’t have to compromise yourself.

Some will tell you that refraining will limit your career opportunities. It is true that some jobs will try to push you. You can take either approach — put it out there so that potential problems will fall away before you become too invested or discuss it after the fact and assert your rights.

I chose to be proud and loud throughout my process; I stirred controversy and rocked the boat. This did result in expected consequences and more than a few blows to my ego however it was the right path for me. At least one attending physician and another resident refuse to do circumcisions because of my example. And that, for me, made the pain and suffering worth it.

And I have not been pushed aside by all employers as I was warned. One recruiter even told me that I didn’t have a chance landing a job in a major city. I dropped him like a rock. Instead I have joined a phenomenal group practice in a very coveted location just 20 minutes north of Manhattan.

So my advice to you is this: Follow the path that feels right for you and do not fear the obstacles that you will find. Be true to yourself and work hard and your path will continue to unfold before you. Keep your eyes on that path and drop the rocks!

James Pate, MD

My hunt is over

i-love-nyIt’s official, my hunt is over… I have joined a small, single-specialty OB/GYN group in White Plains, NY and will starting in July of this year!

My journey to this trailhead has been long and arduous. I could not have made it without the amazing support of my family and friends. I would especially like to thank my husband, Patrick, for his love and encouragement. I truly could not have navigated this climb without his support. I thank our children for putting up with our limitations theses many long years and for the joy and happiness they bring to our lives. To Dr David and Monk David, thank you for providing me with foundation when my entire world had burned to ash. You will always have a central place in my heart. Mom, Dad, thank you! In spite of our many differences throughout the years you were willing to extend that out-stretched-hand when I needed it most — I would not have been able to scale the massive financial boulders in my path without your generosity. For this I will be forever grateful. Finally, to my wise faculty advisors — Dr Thorp, Dr Terrell and Dr Rauk — you are my mentors, advocates and role models. THANK YOU.

New York, here I come!

Music to my ears

ghirardelli-chocolateToday was the first day someone asked me, “Have you lost weight?” I was shocked, ecstatic and gave her a big hug. I have now lost 20 pounds and am no longer obese (barely, still quite overweight), but how wonderful it is when someone notices! I am very pleased with the MyFitnessPal program I’ve been using. I feel like I have an allowance of 1500 Calories and I can spend them any way I want. I had a beer with dinner and no biggie! I’m still within my budget. MyFitnessPal simply functions like a checkbook where I get a daily allowance; it helps me keep track of how many Calories I have consumed and how many I have left for the day. And if I decide to splurge — like the weekend my partner had his birthday — a couple days may be “in the red” but by watching the rest of the week carefully I can still come in under-budget. I love the flexibility and I feel like it is teaching me the skills I need to make a true “lifestyle” change… it’s not just losing weight, it’s knowing how to eat for the rest of your life so that you can keep it off. Real life, real food, real change.

Some things I have discovered: Coffee with cream and Splenda makes a great mid-morning snack. It curbs my hunger and only has 25 Calories. One of my favorite comfort foods is cereal. You may think it’s healthy but holy Calories! Eating a real serving size (not the 3/4 cup suggestion) has nearly the same amount of Calories as a greasy hamburger! And the amount of comfort it gives me is not worth the Calories it costs. A can of regular pop has about 150 Calories while a bottle of beer has only 170. Hello?! Gimme the beer! Ghirardelli Chocolate Squares have less than 100 Calories each. They are very rich and satisfy my sweet-tooth without eating up too much of my budget. And aside from the Splenda, note that everything I’ve mentioned is NOT diet food. Yet I am still losing weight… My way!

%d bloggers like this: