Alan Greene, MD (1s):

The things that kids get exposed to again and again, and again, are the things that their brain becomes a cousin to. They become comfort foods. It's so powerful to be able to have the whole family fall in love with the same food.

Katie Ferraro (13s):

Hey, there I'm Katie Ferraro, registered dietitian, college nutrition professor and mom of seven specializing in baby led weaning here on the baby led weaning made easy podcast. I help you strip out all of the noise and nonsense about feeding, leading you with the competence and knowledge you need to give your baby a safe start to solid foods using baby led weaning. Well, hello, Dr. Green, and thank you so much for joining me today on the podcast.

Alan Greene, MD (44s):

It is so great to get to be with you today. Important, exciting topic, and great to be joining the work that you're doing.

Katie Ferraro (49s):

It is such an honor to interview you. I've admired your ambitious work, particularly in the field of infant feeding. For years, I've been dying to have you on the podcast. This, this is so exciting. Tell our audience a little bit about yourself and why you decided to pursue a career in medicine. And in particular, pediatrics,

Alan Greene, MD (1m 4s):

Start with why I got into medicine in the first place. I was inspired by a nurse that I met in Guatemala, and she was taking care of people in a a hundred square mile area by herself and just, I really wanted to get involved in healthcare. And I ended up in medical school and while I was there and my internal medicine rotation, I was taking care of an elderly woman with osteoporosis, crippling osteoporosis. And I was shocked to learn, right, little research that osteoporosis is a pediatric disease. It's kids. It's how kids eat, how kids move when they're building their bone density that set the cast, the dye for later in life. And so I wanted to get involved upfront where you're building bodies and building systems and for a long and healthy life.

Katie Ferraro (1m 48s):

I am so excited to speak with you. There's so many interesting topics, but your initiative, the Whiteout movement, which for our audience members who may not be familiar advocates against the use of white rice cereal as the first food to feed your baby. Tell us about that. How did you come to be involved in this topic, which to be honest, most of your contemporaries and colleagues like I teach at UCSF in the nurse practitioner program, we know 95% of primary care practitioners in this country have never even had a dedicated nutrition class. How is it that this became your passion?

Alan Greene, MD (2m 15s):

So during my career, I've seen the childhood obesity epidemic take off, and I've been involved in a lot of initiatives to try to help curb that a lot focused on schools and school aged kids and teaching them how to eat, providing really great whole foods in schools. But when you look at the data, the obesity epidemic starts way before school age by the time kids are nine months old, about 30% of the kids in the U S have excess fat cells and altered metabolism. So you have to start before that if you're gonna make a big impact. And so looking at that, I looked and found that the number one source of solid food calories in American kids for decades when this obesity epidemic was building was ultra processed white rice cereal.

Alan Greene, MD (2m 60s):

And there was zero good reason for it. So I thought if we could change that, we would be able to have a big impact on getting people thinking about food in the first place and making a significant, really easy change. So the idea was real simple that every baby's first food be a real food, that every baby's first grain meal, whole grain.

Katie Ferraro (3m 18s):

I love that. And we actually had Dr. Lustig, a fellow UCF colleague on the podcast talking about sugar and why your baby should avoid it. And there's so much confusion, like parents know, okay, avoid added sugars. But what they don't realize is the difference between refined grains and whole grains. And we've also had a lot of other guests and do a lot of content around just, you know, the entire industry of commercial baby food. That, to be honest, wasn't around prior to the earlier part of the 20th century. And like, what do you think? You know, cave mama fed her baby. It was a modified version of the same food. The rest of the family was eating like this idea of feeding her babies, real food. It should not be so revolutionary. It should not be the exception. It should be the norm,

Alan Greene, MD (3m 55s):

Right, and it's been almost all of human history and every culture. And if they did have something dedicated for the baby, it was still a real food. It wasn't a processed, packaged food

Katie Ferraro (4m 3s):

As a diron-fortifie-octor. What advice would you give to our listeners who are parents and caregivers, and they are hearing from their pediatricians day in and day out that they need to start and they need to use iron-fortified, white rice cereal. As the first food happens everyday. My inbox, my DMS and Instagram full of this concern. It's still happening despite all the work you've been doing.

Alan Greene, MD (4m 23s):

So a few things one is that you can, if you want to go to Dr. greene.com/whiteout and it's drgreene.com/white out and print out materials there for pediatricians. When pediatricians read it, they often turn around. When we did started the campaign at the beginning, most pediatricians were recommending processed white flour. At the end of the year. Many of them had said that they would never recommend it again once they just saw the data. So getting them information is good. Another thing that I think could be really helpful is to think through why do we feed babies solid foods in the first place? And pretty much there's three reasons. One is to provide nutrition right then for that exciting time of life.

Alan Greene, MD (5m 3s):

But they're already getting the nutrition they need from breast milk or a great formula if they need to. And the white rice cereal doesn't add anything to that. The second reason is to create a great microbiome. The microbiome, the beneficial bacteria in the gut are established in those that first year or two. And it's by the food that you're feeding them. And a white rice cereal is building the wrong kind of microbiome. And then thirdly is to teach the flavors. Kids are going to love, and you don't want to teach kids to love processed white flour.

Katie Ferraro (5m 35s):

Can you talk a little bit about the whiteout movement? Like I know you have materials on your website. I mean, I'm very familiar with your work because I work exclusively in infant feeding, but what else does the movement consist of? And also how can we help spread the message against the use of white rice cereal as the first food?

Alan Greene, MD (5m 52s):

Yeah. So the WhiteOut the movement, we started that my wife, Cheryl and I were brainstorming, how do we make this happen? And we found that there were five places in the country where most of the social media messaging was coming from. I was a group called ISIS up in Boston. It was big city moms in New York. It was Metro moms in Dallas, the pump station in LA. And so what we did is just went around and did a free talk at each of those places and told the story of white rice cereal, how it got started, how it really took over in the fifties and all the detrimental pieces of it. And then said, the idea here is so simple that every kid's first grain view a whole grain, their first food be a real food, and it doesn't cost you anything extra. And it's easy to do.

Alan Greene, MD (6m 32s):

The kids won't mind, the babies will love it. And all we ask is that you tell a couple of friends and they did, and it started to take off like wildfire. So in July, after we launched the whiteout movement, wrote an article for pediatricians on Medscape. And it was the number one most read article on all of the Medscape where doctors gather online. I'm not just for pediatricians for that day and for the entire month of July and for the year, it was the top read article by pediatricians and in the top 10 of all physicians anywhere. So they're starting to think about it.

Katie Ferraro (7m 2s):

I also had Amy Bentley on the podcast, the author of the book, inventing baby food out at NYU. And the episode was, you know, what did babies eat before baby food was invented? And to be honest, like, you know, those who do not study history are doomed to repeat it. Like if we don't understand the history of commercial baby food, and it's all our parents have known, and you know, this happens all the time with my audience. My mom says, I fed you white rice cereal and you turned out fine. And if we haven't ever seen the alternative, which is feeding babies, real food, you know, I work day in and day out to convince parents and show them and help them to believe that babies can eat so many more foods than we give them credit for. We do have a centuries worth of work to undo though, with this just tradition and habit of feeding babies, white rice cereal

Alan Greene, MD (7m 42s):

And the idea that this generation turned out fine. Isn't quite right.

Katie Ferraro (7m 46s):

It's not, I agree with you. And that's hard to say to your audience, well, you know, do you have a perfect relationship with food? Not that anyone does, but it then opens up a bigger conversation about reliance on packaged and processed foods as the primary food staple in the United States, which I think anyone would agree regardless of your nutrition background is not ideal. Right?

Alan Greene, MD (8m 1s):

Right. And the way that we acquire his preferences, we now understand it happens very early in childhood, primarily. And the things that kids get exposed to again and again, and again, are the things that they're brain becomes accustomed to. They become comfort foods. And for many of us that is refined grains. If you look at the, what kids eat in the U S there was a big federal survey looking at where kids calories come from, and from age two, all the way up through 18, and they're listed in order, like they would be on an ingredient label and the ingredients of today's kids, the United States, the number one ingredient is processed white flour treats. And it goes all the way back to baby food. The only vegetable on the list of the top 25

Katie Ferraro (8m 44s):

French fries. I got it always and Ketchup as a vegetable too.

Alan Greene, MD (8m 47s):

Yeah, yeah, yeah. And I guess the cheese pizza is a vegetable too.

Katie Ferraro (8m 51s):

And when you say the only fruit like parents, you know, if you look at most of the products sold to parents for baby food, it's just different versions of applesauce. Like get, oh, my baby ate kale. Why? Because you bought a kale pouch. That's not kale that is apple sauce. That's tinted green with a very small amount of kale. I would like to show you how your baby can safely eat kale among other foods to have, you know, established this healthy relationship with food, not rely on, you know, high sugar, high sweetened foods, which unfortunately is reality, but it doesn't have to be that way. Our audience believes in a food first approach, very much in line with everything that you teach and work on, they use solid foods offering modified versions. So it's safe for babies to eat. And the point being that they can eat the rest of the foods, the family eats, but a lot of parents who are exploring baby led weaning, or just starting out, they might be first-time parents.

Katie Ferraro (9m 35s):

They get pressure from friends and family and members who say, you know, you do have to start with white rice cereal. And I know you mentioned obesity, but could you just list a few of the other drawbacks of over-reliance on white rice cereal, just to kind of make maybe like a punch list of all the reasons why we don't want to feed it.

Alan Greene, MD (9m 50s):

Yeah. So one reason we talked a little bit about tastes acquisition. So we are hardwired. Babies love anything that's sweet right out of the gate. They love anything that's salty right out of the gate, but anything that's bitter, they tend to distrust the first several times that they try it. And that makes sense, because in nature, bitter things might be toxic and you wouldn't want them to pick up something off the ground and eat it and tastes good right away if it was bitter, but things that they get on average six to 10 times, what's your starting solid foods. It can happen actually before that, during breastfeeding and in utero as well. But those are the things. Once they have six to 10 times that they're going to then fall in love with it because it becomes safe in their brains. And same with anything sour like most fruits. So most vegetables, most fruits, they're not going to like at the beginning, unless mom had often during pregnancy or during breastfeeding, otherwise it takes six, 10 times.

Alan Greene, MD (10m 40s):

Most American parents will give up a food after two or three times and say, oh, they don't like broccoli. They don't like peas. Let's give up. The one exception to that is processed white flour and they get it again. And again, and again, and again, often for two weeks at a time, 28 times more than the time before anything else solidly imprinting them on the wrong flavors. So it's a, I would say disaster in terms of the kinds of foods that you want them to be getting for flavor acquisition. We already mentioned obesity, but it's not just obesity. That is a physical marker. Before the introduction of all this, it was really rare to see a child with high blood pressure today.

Alan Greene, MD (11m 20s):

Millions of kids in the US have high blood pressure because of the way they eat. It was really rare to see a kid with blood sugars that were out of control. Let's say had what used to be called juvenile diabetes type one is rare to see an abnormal cholesterol seal or waist size of 40 inches in a boy or 38 inches in a girl. And today two thirds of American high school students already have at least one of those middle-aged conditions tied back to the way that they eat and tied all the way back to the beginning of the white rice. So it's bad for obesity and all of the metabolic problems that go along with that. And it's bad for the microbiome. It's cultivating to kind of bacteria that lead towards metabolic problems, obesity, and cravings for the wrong kinds of foods.

Katie Ferraro (11m 60s):

All right. So we've got obesity and the metabolic situations, we've got the flavor and taste acquisition. We've got the wrong type of microbiome. What else can we add to the list of reasons why we don't want to feed? I mean, I would add costs because it costs extra money to go and buy a special food for a baby. When you could just be feeding foods that the rest of the family is eating. What beyond that?

Alan Greene, MD (12m 17s):

Well, another really good one. It's arsenic. Rice is a plant that tends to pull out whatever's in the soil in which can be a great thing. If the soil is good and not contaminated, but much of the process rice cereal does have arsenic in it, both the FDA and the academy of pediatrics have recommended minimizing the amount of rice that kids get in the first year.

Katie Ferraro (12m 37s):

I think this whole discussion about arsenic has really helped to bring your work with the WhiteOut movement back up to the surface, because it's just another reason why we don't want to feed commercial baby food. Even if you do organic, what right? Rice cereal, organic rice is still a plant. It still has the potential to Harbor metals. There's still the potential for arsenic. And how do you avoid that? You can't avoid eating plants, but you can not feed your baby white rice cereal. Every single day. And small amounts of rice in moderation are perfectly safe and fine, but some of these families are doing rice cereal two and three times a day for weeks and even months on end, which is not only necessary. We now know it could actually be dangerous. So I think it's, that's probably the biggest check mark against white rice cereal at this point, because it's the newest thing and the newest reason why we don't want it.

Alan Greene, MD (13m 20s):

And the best way to avoid arsenic today is to eat varieties of real food, minimize the amount of rice and also minimize fruit juices. There's plenty of other reasons to minimize friction.

Katie Ferraro (13m 29s):

I can tell you hangout out with Dr. Lustig, if you're going to get on the fruit juice. So bucks, I'm kidding. Our audience knows no fruit juice for babies, but it's something to think when they move into toddlerhood well, now toddlers need to drink fruit or need to drink juice. No, we always just like adults. We want you to eat your fruit, not to drink it. Right. Can we talk a little bit about iron? Because I would say every fifth episode we do in the podcast is about iron and the downloads go off the charts because unfortunately it's something parents don't understand. They over-complicate it. And they think the only way to get iron is from white rice cereal or else their baby will become iron deficient. And I don't want to do anything. That's going to affect my babies, you know, cognitive development. So I got to push all this iron from this fortified food helped me alleviate the parents' fears about iron.

Katie Ferraro (14m 11s):

If they skip white rice cereal.

Alan Greene, MD (14m 12s):

So a few things that was the big pediatric pushback against the WhiteOut movement, by the way, a pediatrician,

Katie Ferraro (14m 19s):

No offense. They don't always know what other real foods have iron in them. No,

Alan Greene, MD (14m 23s):

Exactly. Right. And real foods are plentiful sources of iron. But so several thoughts on that one is I went back and thought about where did I originally come from for kids? They didn't get it from box food, right? And one big source of it. And this may not apply to a lot of your families right now, but it might to their friends, another initiative we started called Tik TOK, which is transitioning immediate cord clamping to optimal cord Clare.

Katie Ferraro (14m 47s):

I actually want to have you back on a whole different episode to talk about core clamping, because it's so important, but kind of different from rice cereal. So I also like that you were there, you're the original Tik TOK. Dr. Green.

Alan Greene, MD (14m 57s):

Yeah. I know. Pretty wild. Right, but by just waiting a little bit, even 90 seconds, like all animals, all mammals on the planet do after the baby's born, you get extra blood pumped in, which is enough iron to prevent almost all iron deficiency. It's a really simple way. That's the way it happens. Breast milk is low in vitamin D, but that's not a mistake. It's because babies got vitamin D from the sun and breast milk is low in iron. And that's not a mistake either. It's because maybe Scott iron from their moms during childbirth. But apart from that, once they start solid foods, many foods are great sources of iron for kids, which you've educated people on. And if you have a need to give extra, I'm a big fan of something called the lucky iron fish.

Katie Ferraro (15m 38s):

Oh, we had the CEO on talking all about it. It's so cool. It's

Alan Greene, MD (15m 41s):

Really cool. Just a little chunk of iron that goes in when you're cooking and adds about four milligrams of iron to an older kids food for the day.

Katie Ferraro (15m 49s):

We actually, when we had the lucky iron fish episode, Gavin, the CEO was giving examples of how we could use it for baby food, you know, because the parents were exactly how much and, and parents do get really bogged down in the numbers and actually working on a lot of content about like, you know, moving away from focusing on the numbers. They see, you know, the DRI values and my baby needs to eat a 11 milligrams of iron. And like I'm a full blown adult person who eats meat. And I can't even eat 11 milligrams of iron a day. We need to back away from the numbers and look more at the sources. And as you're talking about, the variety is such a wonderful way. As we know, to prevent food allergies, to help babies get their nutrients. And I love that you said that breast milk being low in vitamin D and iron, that's not a mistake, but there are other lifestyle factors that we have adopted that make breast milk, quote, unquote problematic.

Katie Ferraro (16m 30s):

Even though we know it's not, but if we never go outside and we sit in front of screens all day long, and if we don't allow for delayed cord clamping, we could be messing with the biological process that that really would allow breast milk to do its job, which is to nourish your baby exclusively up until the six month mark.

Alan Greene, MD (16m 45s):

Yeah, a lot of the early baby food advertisements and magazines for about how nobody could feed your baby as reliably, consistently, scientifically as we can, but that's not true. We're biologic creatures and our bodies are adapted to have a variety of real foods that are different every time and our absorption of iron or calcium or whatever. It depends on what's going on in the body right now. If you're lower on air, you're going to absorb more. And if you're taking supplements, you're going to absorb less than your body does the calibrating for you. You just get great sources of real food.

Katie Ferraro (17m 17s):

I love the idea of spreading the word about the WhiteOeut movement, via word of mouth. Like that's how people learn about baby led weaning. They go to their pediatrician and say, I I've heard about this. And I want to learn more. Can you share with our audience how they can share more about the whiteout movement so that it becomes something that everyone is always talking about and that we actually can make more inroads into removing this recommendation of starting solid foods with white rice cereal.

Alan Greene, MD (17m 42s):

So two things, one I would ask you to, if you can mention it to your pediatrician, because pediatricians do talk to a lot of parents, so that that's a really useful to do. And then eventually the two or three friends that you know, that are having kids. And if you go to Dr. green.com/whiteout, you can get materials there and have easy stuff to share.

Katie Ferraro (18m 0s):

I will link to all of Dr. Greene's resources, including where you go to get the information, to have these conversations with your pediatrician on the show notes page for this episode. And that will be at blwpodcasts.com. So Dr. Greene, I know you're the author of feeding baby green actually have it right here. Kind of a Bible play on words, feeding baby green. It's the earth friendly program for healthy nutrition. You are Dr. Greenee, albeit with an E. Tell us a little bit about the book and information in there. The parents might be interested in.

Alan Greene, MD (18m 26s):

So it's a complete plan starting during pregnancy and all the way up through toddlerhood helping parents learn how to go about feeding babies. There's very similar to the kinds of things that you teach. I do, and I'm not opposed to baby spoons. So that was one of the oldest artifacts of humans or spoons. I think that could be fine, but I am a fan of whole foods, real foods, and letting babies set the base for how much to eat and not try to trick them into eating a little bit more.

Katie Ferraro (18m 51s):

Dr. Greenee, to close it out. Is there any advice you can give us? We're all going to go get the materials to talk to our pediatrician about and tell two or three friends about the whiteout movement, but what else can we do in order to help promote a healthy relationship with food from baby's first bites, without relying on white rice cereal?

Alan Greene, MD (19m 8s):

I recently found that my mom's diary from when I was a baby and it showed what the family ate and what I ate. Everybody ate the same thing, but the baby and the family had entirely different food, but I was the first one in my lineage that happened for, for my grandparents, everybody else, the family at the same thing. It's so powerful to be able to have the whole family fall in love with the same food.

Katie Ferraro (19m 29s):

I love that. Well, thank you so much, Dr. Greene for being here. I really appreciate your time and we are all on board with the whiteout movement.

Alan Greene, MD (19m 35s):

Thank you, Katie. So great being with you and thank you for all you're doing to educate parents everywhere.

Katie Ferraro (19m 40s):

Well, I hope you guys enjoyed getting to hear from Dr. Greene. He is one of my favorite people in infant feeding because he's not afraid to stick his neck out there and say what needs to be said, which is we should stop feeding babies, white rice cereal so much all the time. It's not necessary. And pediatricians should stop recommending white rice cereal as a first food for babies. There's plenty of other foods that your baby can safely eat. And I'm going to link to all of Dr. Green's resources, the articles he was talking about his book, the materials that you need to download and take to your pediatrician as well as how you can learn more about the white out movement. And that will be on the show notes for this episode, which you can find at blwpodcast.com/160. Thanks so much for listening.

Katie Ferraro (20m 20s):

Bye now.