Yo! Microphone Check One, Two! What Is This?! Phife Dawg, Diabetes, and Maternal Wellness!

So nowadays I go and see wifey just to cure me from stress

Lay my head on her breast, Sugar Dumpling knows best

Explaining all my problems to her, gettin' things off my chest
A lil hug up, squeeze up and no more am I vexed
Aye yo Sun, without my peeps I'd be truly assed out
Making sure I have my medications so I wouldn't pass out 
~Stressed Out, Phife Dawg, A Tribe Called Quest 

Now Here's a Funky Introduction of How Nice I Am... 

Before I was a mother, childbirth educator, yogini, nutritionist, or lactivist, I was hip-hop. Although I grew up in suburban Ohio, and attended a Catholic school, I was deeply connected to hip-hop (even if just in my heart and mind). I was in a breakdancing group, where my classical ballet, tap, and gymnastics lessons helped me to stand out; I had a rap alias: Def Lady J; I memorized and recited other artists' rhymes in my sparer time- many of which I still know; I spent every dime of my allowance in the brand new, but very tiny, rap section of my local record store; between 1987 and 1992, my mother made sure that I didn't miss a rap concert within the tri-state area... and I sold dubbed copies of songs that weren't available in stores- I'm still not revealing my sources, but I don't  get down like that anymore. Today, I'm always blasting Backspin and marauding for ears at classic Hip-Hop Karaoke events. I love and live this stuff.

Check The Rhyme

Hip-Hop Karaoke

Heartbeats & Hip-Hop

My Aura's Positive, I Don't Promote No Junk

Why does any of this matter, and what does any of it have to do with maternal health and wellness? Last week, beloved lyricist, and member of the quintessential rap group, A Tribe Called Quest, Malik "Phife Dawg" Taylor, passed away at the age of 45, after a 25+ year battle with juvenile diabetes. Even though his struggles with the incurable disease have been largely public and referenced in his own rhimes, interviews, and the terribly difficult-to-digest documentary Beats, Rhymes, and Life, the hip-hop community was still buggin' out that the 5 Foot Assassin had met his final day. In the middle of the night, as I cruised the Internet for information to share with my new and expectant moms, I saw the first posts and tweets about the Funky Diabetic. I initially prayed that it was one of those sick Internet jokes. It wasn't. Phife is gone. It is difficult to accept that our contemporaries, those whom we've watched grow up, are now too soon passing away from health related conditions: J-Dilla,  Guru, Nate Dogg, Heavy D, DJ EZ Rock, Sean Price, and (maybe) Chris Lighty. Now Phife Dawg adds to that number and brings subject of diabetes to the forefront. It's time to expand the subject matter that touches everybody, so that it reaches everybody. 

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Styles Upon Styles Upon Styles... 
Three Types of Diabetes

Diabetes or diabetes mellitus (DM), is a group of metabolic diseases in which a person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. Individuals with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia). There are three types of diabetes: Gestational, Adult Onset. and Juvenile- the latter was Phife's kryptonite.

Gestational diabetes begins when a pregnant woman's hormones interfere with her ability to make and use all the insulin she needs for growing her baby. Gestational diabetes affects a mother late in pregnancy who is often asymptomatic; therefore pregnant women are routinely tested for this condition during their second trimester. The condition shows up in women not previously diagnosed with diabetes. It typically resolves after the birth of the baby, but the mother is now at greater risk for developing type 2 diabetes, while the child is at a greater risk of being a "big baby", becoming obese, and also developing type 2 diabetes later in life. Having a big baby (8 lbs. 3 oz., or heavier) can lead to additional discomforts toward the end of the pregnancy, and long term pelvic floor damage beyond pregnancy. More importantly, women with gestational diabetes are more likely to develop preeclampsia, be on bedrest, go into preterm labor, request an epidural, be induced, receive an episiotomy (or natural tear), or have a planned or emergency C-section. Incidentally, all of these complications can make breastfeeding more challenging. However, breastfeeding decreases the risk of the infant developing both type 1 and type 2 diabetes, so ask for help from a lactation consultant early and often. 

{Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, often the kidneys. Preeclampsia usually begins after 20 weeks of pregnancy in a woman whose blood pressure had been normal. Even a slight rise in blood pressure may be a sign of preeclampsia. Left untreated, preeclampsia can lead to serious — even fatal — complications for both you and your baby. If you have preeclampsia, the only cure is delivery of your baby}

During the process of vaginal birth, this big baby is at a greater risk for nerve damage, shoulder injury, or even brain injury. If a woman’s diabetes was not well controlled during pregnancy, her baby can very quickly develop low blood sugar after birth. The baby’s blood sugar must be watched for several hours after delivery. Often gestational diabetes can be controlled through eating healthy foods and regular exercise. Sometimes a woman with gestational diabetes must also take insulin during pregnancy. Even if the diabetes does go away after the baby is born, half of all women who had gestational diabetes develop type 2 diabetes later. It's important for a woman who has had gestational diabetes to continue to exercise and eat a healthy diet after pregnancy to prevent or delay getting type 2 diabetes. She should also remind her doctor to check her blood sugar every 1 to 3 years.

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I Drink A Lot Of Soda, So They Call Me Dr. Pepper 
Diabetes Type 2

Adult onset, or Type 2 Diabetes, is the most common type. The name can be misleading as more American children are being diagnosed with type 2 diabetes because of our high sugar and high fat diets, along with our increasingly sedentary lifestyles. In type 2 diabetes, the body produces more blood sugar than it is able to use efficiently, without overtaxing other organs. There are many factors that can place an individual at risk for type 2 diabetes, including a genetic predisposition, extra weight, excess glucose from the liver, poor communication between cells, and metabolic syndrome.

{Metabolic Syndrome describes a group of conditions including insulin resistance, high blood glucose, extra fat around the waist, high blood pressure, high cholesterol, high blood pressure, and high triglycerides, that increases the risk for diabetes, heart disease, and stroke}

Women who have polycystic ovary syndrome (PCOS), have given birth to a baby weighing over 9 pounds, or as mentioned previously, gestational diabetes, are also at an increased risk for developing type 2 diabetes. Over time, mismanaged blood sugar can cause complications with the heart, arteries, veins, kidneys, eyes, nerves, digestion, libido, wound healing, and of course pregnancy. Having type 2 diabetes at the onset of pregnancy can cause birth defects early in the formation of the baby, unlike gestational diabetes, which does not begin to complicate the pregnancy until after the baby has already been formed. Type 2 diabetes is also a risk factor for preeclampsia and its associated issues. Embracing a general healthy lifestyle can decrease in one's risk of developing type 2 diabetes. Enjoying a well-balanced, nutrient dense, low sugar, low-fat diet; exercising regularly; managing weight and  stress; getting adequate rest; and not smoking; are ways to minimize the risk of developing type 2 diabetes, as well as reversing it if a diagnosis has already been given. 

Random Facebook Conversation Among Some Headz, Just Days Before Phife's Transition

When's The Last Time You Heard A The Funky Diabetic? 

Diabetes Type 1

Phife was diagnosed with the less common, but more complicated Type 1 Diabetes, a few months before his 20th birthday. His grandmother, a nurse, recognized one of the signs (frequent urination) and tested him after a show. In type 1 diabetes, the body does not produce insulin, the hormone needed to get glucose from the bloodstream into the cells. Type 1 diabetes is incurable and is not preventable. There are known factors that increase the risk of developing type 1 diabetes, including a family history and genetic susceptibility. There are additional risk factors, including Viral exposure: Exposure to Epstein-Barr virus, coxsackie virus, rubella or cytomegalovirus may trigger the autoimmune destruction of the islet cells, or the virus may directly infect the islet cells. Low vitamin D levels: Research suggests that vitamin D may protect against type 1 diabetes. However, early intake of cow's milk — a common source of vitamin D — has been linked to an increased risk of type 1 diabetes. Other dietary factors: Drinking infant formula and water that contains nitrates may increase the risk of type 1 diabetes. The timing of the introduction of cereal into a baby's diet also may affect a child's risk of type 1 diabetes. Between the ages 5 and 7 months appears to be the optimal time for introducing foods. The current recommendation is to skip rice cereal altogether, and certainly, DO NOT put it in a bottle with breastmilk or formula, no matter what Nana says! Proper education on maternal and infant nutrition, could help to decrease the numbers of those affected by diabetes, and save billions of dollars in health care costs.

Skip The Rice Cereal! Start With These Foods Instead!

Can I Kick It? (Yes You Can!)

Lifestyle Management

It is often a challenge to talk about health conditions that can be managed by lifestyle changes, without making the individual or parent feel guilty or defensive. Diabetes- all types- is one of those conditions. Type 1 diabetes can affect nearly every major system in your child's body, including the heart, blood vessels, nerves, intestines, eyes, bones, immunity, and kidneys. Long-term complications of type 1 diabetes develop gradually, so it is important to stay on alert of even subtle changes in health. Eventually, if blood sugar levels aren't well-controlled, diabetes complications may be disabling or even life-threatening, requiring dialysis or kidney transplant. Phife had both. The good news is that keeping the blood sugar level close to normal most of the time can dramatically reduce the risk of these complications. Maintaining a healthy diet, that includes plenty of fruits, vegetables, and whole grains, while limiting processed, high fat, high caloric, and high sugar foods, is a great first step. Eating on schedule, exercising regularly, checking insulin, taking medication, and resting well, are other important ways to manage type 1 diabetes.

Rare Phife Dawg Freestyle From 1999

Stressed Out, Stressed Out 
Other Considerations

People with diabetes have an increased risk of depression and anxiety, which may be why many diabetes specialists regularly include a social worker or psychologist as part of their diabetes care team. Women with any type of diabetes during pregnancy are at an increased risk for developing postpartum depression, and should be assessed and monitored accordingly.

When it comes to diabetes and infertility, there IS a connection for both men and women. In men, DM is a triple threat to fertility. It causes erectile dysfunction, lowers testosterone and libido, and reduces ejaculate volume. For women, diabetes alone does not keep them from getting pregnant, but it often times keeps them from staying pregnant. In many cases, “a woman with higher than normal glucose levels does get pregnant month after month. Unfortunately her diabetes status prevents that embryo from implanting in the uterus, causing a miscarriage before she ever realizes she is pregnant.” In this case, the diabetes isn’t preventing conception, but is preventing an ongoing pregnancy. High glucose levels are reported to increase a woman’s chances of miscarriage by 30-60%. If a couple is having fertility issues, insulin levels may be the culprit.

Prediabetes is a “pre-diagnosis” of diabetes— a warning sign. Take heed! It’s when your blood glucose level is higher than normal, but it’s not high enough to be considered diabetes. Prediabetes is an indication that you could develop type 2 diabetes if you don’t make serious lifestyle changes. It is possible to prevent prediabetes from developing into type 2 diabetes. Consistently eating healthy food, losing weight, and being physically active can help you bring your blood glucose level back into the normal range.

Phife As A Spokesperson For Diabetes 

With All These Trials And Tribulations, Yo! I've Been Affected

Addressing prevention or lifestyle management in the time of a loved-one's passing, or failing health, can seem calloused or accusatory, but I feel confident that Phife himself would want his illness and subsequent transition to be used to benefit others. He spoke often about not taking his health seriously but wanting to help others. He had been very candid about having challenges managing his diet, exercise, and rest needs. Maintaining a healthy lifestyle may not be easy or convenient, initially, but it does not have to be dull or restrictive. In fact, it is nothing more than the lifestyle from which we could all benefit every day. The routine can become second nature, especially within a supportive environment. It is essential for all of us to be educated about how and why we need to make healthy choices and encourage our favorite mothers, children, and hip-hop icons to do the same. For Phife, let's all eat and move like our lives depend on it.

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Phife Dawg's Final Interview and Flow

Rest in Peace, Power, and Love

Phife for Life!