Directions

Ingredients

Podcast Ep. 11: Feeding Kids From Infancy Through Adulthood With Tiffani Ghere, RD, CSP, CLEC

In this episode

Justin and Audra are joined by Tiffani Ghere, RD, CSP, CLEC to talk about some serious food for thought: neonatal and pediatric nutrition. Tiffani will discuss formula versus breastfeeding, how to transition babies to solid foods, how to feed kids as they grow up, and much more.


Listen here


About our guest

Tiffani Ghere, RD, CSP, CLEC is a Registered dietitian, a Board Certified Specialist in Pediatrics, and a Certified Lactation Educator. She started her career as a clinical pediatric dietitian at Children’s Hospital of Orange County in 1999. Today, she serves on the CHOC Medical Intelligence and Innovation Institute's (MI3) core leadership team, is acting Executive Director for the International Society for Pediatric Innovation (iSPI), and is on the Medical Advisory Boards of the formula company Bobbie and the Women Leaders of Octane. Tiffani is also a contributing expert to The Family Thrive. Check out her article on breastfeeding and formula here

Show notes

  • 08:01 - Chef Azmin Ghahreman is the chef and CEO of Sapphire Culinary Group and has worked closely with MaxLove Project. Click here for his delicious, fool-proof chicken souvlaki recipe!
  • 08:37 - Chef Azmin also founded the Sapphire at School program, which partners with schools in Orange County, CA to prepare fresh, wholesome meals for over 5,500 Pre-K to high school students daily.
  • 08:50 - Tiffany serves on the Leadership team for CHOC’s Medical Intelligence and Innovation Institute (MI3).
  • 12:57 -  Anthony Chang, MD is a pediatric cardiologist at CHOC as well as Chief Intelligence and Innovation Officer.
  • 13:21 - Imposter syndrome “refers to an internal experience of believing that you are not as competent as others perceive you to be.”
  • 17:24 - Sherry Farrugia served as the Strategic Partners Officer of Georgia Tech’s Children's Healthcare of Atlanta Pediatric Technology Center until 2020, and is now the CEO of Global Center for Medical Innovation.
  • 23:19 - Bobbie is a new brand of organic baby formula that uses a European formula.
  • 52:03 - Lexi Hall, RDN is one of our beloved Family Thrive Experts who appeared in Ep. 6 of The Family Thrive Podcast.
  • 52:09 - Fierce Foods Academy “is culinary medicine in action through a collection of programs that center on risk-reducing and quality-of-life–improving whole foods.”
  • 57:30 - To read more about why eggs should be in every family’s fridge (with exception to allergies, of course) read our Five Things Friday article here!

Justin: I don't know about you, but when our first baby came into the world, feeding him was really hard. It caused us a ton of stress. And then when we transitioned to formula, many months later, we had more stress because we didn't know which kinds were best. And we also had to deal with the stigma around formula in our social circles. We might have stressed out again as we transitioned to solid food, but honestly, it's all a little blurry now.

But I can say that all the stress would have been alleviated had we known today's guest, an amazing clinical dietitian at Children's Hospital of Orange County, Tiffani Ghere. Tiffani specializes in pediatric nutrition with a particular focus on neonatal nutrition. There are few people in the world who know more about the science and practice of feeding newborns and infants.

Audra and I have known Tiffani for several years through our work with MaxLove Project, and we're thrilled now to have her on the podcast. We talk about formula versus breastfeeding, transitioning into solid foods, feeding kids as they grow up, and a whole lot more. So without further ado, here's our deep dive conversation with the always sharp, ever knowledgeable Tiffani Ghere, RD.

Audra: Thank you so much for being here with us and talking with us, Tiffani. I, you know, when we were let's see, we went to Temecula right before a lockdown. Was it a year ago?

Tiffani: Oh my gosh, it was. And I can't believe it was literally right before lockdown. And I remember thinking, “oh, my gosh, I want to go back to Temecula, like hit the undo button,” you know.

Audra: Cause we didn't know if we should go through. We were like, this is a little risky. We'll go do this thing. Didn't really know it was going to happen. And even kind of like, risky sort of being around people, but weren't sure yet. You know, it was at the very beginning, it seemed kind of tenuous.

Tiffani: Yes.

Audra: And then boom.

Tiffani: Yes.

Audra: But I remember on that magical, magical mini trip, which I can't wait to go back to and return to. We will, I just thought it was fabulous. We talked about The Family Thrive. And I was starting to share the seeds of this project even then and talking about, it's crazy. I can't believe that...

Justin: I love it.

Audra: Reflecting on it now, even we're talking because we are talking about various, you know, kind of like synchronicities and overlapping things. And today we, three-quarters of our seed round has been funded.

Tiffani: Oh my gosh.

Audra: We are going to be launching...

Justin: And we had our 19th anniversary a couple of days ago and…

Tiffani: Congratulations.

Justin: You know, like the stars are just coming together and then we're getting vaccinated soon.

Audra: Yup.

Justin: You know, the spring is coming, but it's, COVID’s going to be in the rearview mirror.

Audra: It will be in the rearview mirror. But it has been such a formative, powerful time for us. And it has been the time that we've invested everything in bringing The Family Thrive into being. We have our minimum viable product, our product, The Daily Thrive, which is the app, is ready to roll.

We are so excited to roll it out and to begin building it in live, in real time. And you are a huge part of it. You know, we've had such a wonderful relationship over all of these years, co-developing, co-inspiring, like really working on bringing, you know, kind of not only more awareness to the role of health and wellbeing and living our best lives, but the community aspects of it. And it just feels really incredible to talk with you today because we have so much to talk about, so much that we have, you know, not only in our common interests and passions and all of that, but we are going to be building The Family Thrive with you.

We know that you're going to be a powerful part of this team. We need you. We see you as just a huge asset for this movement. So just really excited to be here with you today because it's a marker for me. It's like a I don't know. It's the….

Tiffani: It feels like a sentinel moment. And I echo everything you just said, because our relationship really has been forged on blood, sweat, tears, lots of amazing meals together where we have broken bread and been inspired. And, you know, you and I met each other before I got to meet you, Justin. And it was a very quick love relationship where these common threads, the synergy was always just like fireworks every time we got together.

So I am so proud of you guys. I am so happy for this getting off the ground. And I have no doubt that it's going to be hugely successful. And the exponential returns of all the families, all the children, the lives that you touch, the work that you're doing here is so needed, but just such a value. It's the stuff in life that is worth getting up for in the morning where you can look back on the work that you do and you go, I did good work. And that's really, really what matters. Now, you're going to make me moved to tears because I love you guys so much.

Justin: Oh, that's so beautiful. Tiffani, thank you. Oh, before we get too far into it, just for the listeners, can you give a brief just, you know, elevator pitch of what you do? Like what do you do and where did you come from?

Audra: You got a cool story, Tiffani. I love it.

Tiffani: Oh, my gosh. I've been asking myself that question for about 50 years now. Yeah, well, by education, I am a clinical dietitian. I'm a clinical pediatric dietitian. There's only a couple hundred of us in the country.

So as I did my educational pathway in studying food science and nutrition science and got into the clinical work, I always knew I loved the clinical acute care environment. And I love the challenge in nutrition of, it affects all parts of the body. And it is very much a mind game. So as a dietitian, when you have to solve a problem, you have to mentally visualize the anatomy, the physiology, where the deficiencies can be. And clinical dietitians are really accountants. It's not just calories in, calories out by any means. We are looking at what is normal and out of anatomy and physiology. And then if you put an illness or a disease condition into it. Ok, now how do we pivot with those variables and how do we optimize? Because we're really looking at: how do we get the best nutrition, the best bang for our buck? And sometimes we're constrained where there could be a reaction to foods that could be a clinical state where they can't get certain nutrients.

So I just love the complexity of it. I think my ADD-type mind just loves the activity that fires on all fronts there and in the hospital, I've had the wonderful benefit of working with almost all of our subspecialties. So I love the connection and the relationship.

And part of the reason why I have such a heart for pediatric nutrition is unlike the adult world, in the children's space, the clinicians really value what the dietitians are doing because they know as kids are growing, if they're not meeting those benchmarks and they're not thriving, then they can't discharge them from the hospital. Their primary care doctors are very engaged. So it is a vehicle by which we have access to working and participating in that care team. So

I've been with CHOC Children's Hospital since 1999. I've covered all of their units, NICU, PICU, Pediatric floor. So it's been a very broad scope with everything from preterm birth to age 18 and lots of disease to stages in between, you know, traumas and illnesses and stuff like that.

And then about, gosh, I want to say it's almost been 10 years since I've been working with the chef, who our dear friend Chef Azmin Ghahreman. He really kind of injected new life into my lens, because a lot of times when you are in the hospital, most of the times our patients are not eating food. If they're really, really ill, they're either being tube fed or they're getting intravenous nutrition. And I love the bio pharmacology part of it.

But in working with the chef and seeing him bring in the possibilities to really evaluate not just the quantity, but the quality of food and the impact, again, on that anatomy and physiology, it just really breathed new life into this. And as you can be in the nutrition board that we both sat on together, we work together in building out his school program, the Sapphire at School program. And so that's been kind of a side pet project for me.

And then in the last four or so years, I've been participating in our hospital’s innovation and intelligence group, which has kind of allowed me to level up in a different way too and take that broader swath of jumping into pushing the boundaries within health care. How do we use the amazing resources and talents we have in our children's hospitals and go beyond what the status quo is?

And what is so interesting in the state of pandemic is that I think all of us have experienced, probably firsthand, some of the shortcomings of our health care system. Not that we don't have amazing, wonderful care providers and people that really have great intentions, but the system itself needs to be pushed on. It needs to be updated. It needs to be digitally efficient. We need to have that common way forward. So my journey has kind of taken me into that space as well. But as you know, my heart is always going to be at the bedside and back to my roots. So, so wonderful to be able to have this conversation today.

Audra: Oh, Tiffani, thank you so much for sharing. You have such of, well, it's connected yet varied history. And one thing that I feel like connects it all is that you're truly a lifelong learner and deeply curious person. I think it's one of the things that I love most about you. You didn't, you know, first of all, you didn't originally go to school to become a dietitian. Am I correct?

Tiffani: No, that's correct.

Audra: Where do you start?

Tiffani: I started with soil science.

Justin: Oh, you started in the soil. That's so cool.

Tiffani: Yep, my roots are in the soil.

Justin: I love it.

Tiffani: Well, it is funny because it, actually I had never thought about that kind of poetic aspect of it, Justin. So that is good. But yeah, I think that God kind of laughs at those who make plans in some way, although we do have direction in our life. I also in my years as they've gone on is, you really have to lean into the opportunities that come before you and I, as a very first born Type-A programmed person, it is in my nature to plan everything. And parenthood will break that down really quickly over time. I have three kids, as you know.

Justin: Yes. Speak.

Tiffani: It will put you on your knees. It is the great equalizer, which is what I love about children in general, because one of my favorite things at the hospital is when you have a fancy pants doctor who got married and now they're pregnant, like, “Ooh, this is going to be fun,” you know.

Justin: Welcome to the jungle.

Tiffani: That's right. Because there's even no matter what kind of resources you throw at it, you will be up in the middle of the night with a vomiting baby or you will be driving in your fancy Porsche and that blowout will happen off the back of their car seat, you know. And I love that, because when you break down those barriers, then you have the reality of the human experience, which is really what's always connected us too.

And I know in your space with MaxLove Project, you are dealing with families at their most vulnerable, at the most raw point of anything that you can experience. And yet something as simplistic as food is a vehicle by which you can connect with them. And I, one of my favorite things to say in the hospital is I've been trying to advocate for pushing for more resources or something like this is, every one of our patients has a diet order that offers us access to every one of those patients. They may not need radiology. They may not need rheumatology or other things that, you know, that they always need nutrition. And that is a common thread that we have.

Justin: You need to eat.

Tiffani: Exactly. So that affords us, you know, as dietitians access to participate.

Justin: One of the things I love about your story, especially in the last five to 10 years, it feels like it's both an expansion. So you're expanding, but you're also going deep. And so, standing by like the work that you've done with Chef at, you know, working in the community and with real food and whole food. And so there's this expansion, but then with the innovation work, it's like a deepening. So it's kind of cool.

Tiffani: Well, and it's you get into that space and I know you all have met Dr. Anthony Chang, our Chief Intelligence and Innovation. They are so brilliant. You know, they have 12 degrees behind their names. So it is, I am a big believer of surrounding yourself with people smarter than you are.

Justin: Yeah.

Tiffani: And you and in that opportunity, when you have the chance to actually glean some insight and you have their attention, you think, wow, I actually you know, that imposter syndrome is very real for me, a lot of times as a woman perhaps, or just as me, Tiffani, the dietitian, in the caste system of the health care system, dietitians rank very low.

And yet still I find the joy in the service. And, but I am in more recent years, part of it's because I'm probably of a certain age and have gone through the hazing of having three boys to raise where you just play the game like you have nothing to lose. Because to the families and you know this well, to the families that we serve, there is no greater sense of urgency. So it is incumbent on us as the care providers to recognize that sense of urgency and do everything we possibly can to expedite the process or to push those boundaries or to find solutions that don't easily come to us.

This is not an easy game. You know, this is everybody who's in the space is, we go to bed at night wrestling with different ideas. So, yes, this Intelligence Innovation space, the stuff they're reaching for is big. It is deep at times. And sometimes when they go down those deep rabbit holes, especially with data science and machine learning, I just my brain goes brrk and I think, thank God there are people in this space and this is what they do.

You know, I've always felt that way about different things in health care. And I love that we have this on the forefront.  We would not have the vaccines for this pandemic at the rate that we had were it not for the tools of genomics and machine learning and all these things. We had access to it. But when you finally get the resources and a concerted effort where the whole globe was trying to solve this problem. Yes, amazing things happen. It doesn't mean that the FDA didn't approve the quality and the safety of it. No. In fact, their groups were even larger than a lot of the other things that got approved. But we had that laser focus. We had the funds, we had the research and we had the talent.

Justin: So now, Tiffani. What if we can put just even a fraction of that towards, like school lunch programs?

Tiffani: I agree. I mean, you know, if 80% of our health problems are from lifestyle choices and let's just talk about the healthy, nonaffected, you know, with chronic condition yet population, young kids, it behooves us. I mean, I try to appeal to people's sense of business. I mean, it's just going to make health care cheaper families less like let's lean into that.

There's not a person out there who won't complain how expensive health care is. I mean, it's expensive to die in this country. You know, when you look at retirement planning, you have to factor in, well, what if I need long-term care, nursing or all this kind of stuff. Let's be a little self-preserving here and invest in things that we know will net us wonderful returns down the road, so, yes, I've always thought that it's a very worthy effort.

Audra: This is just one thing I want to make a note here, that Tiffani, that I love about your voice and your expertise and what you bring to the world, and this is the facet of innovator in you that I really, really appreciate, is that you're in there, going down the rabbit hole in data science with these partners, these researchers, these masterminds. We're going to get to keep going down the rabbit hole.

But you're going to take what you learn from that and you're going to apply it to 10 other areas of need. You play a very critical role in innovation of being a connector and a communicator and a unifier and bringing something that seems like it's isolated over here to a domain over here, like that's an aspect of innovation that we really need. And so it's always been something that I admire about you. You can bring, you know, bring things together, connect the dots, you know, pull the conversation together. It's a very, very important part of this. And I just wanted to share how much I appreciate that in you.

Tiffani: Oh, thank you. Well, I, you know, I've had some wonderful mentors. Certainly. I mean, you know, you've met Sherry Farrugia over at Georgia Tech and some of the women that I have had the good fortune to work with. And awareness is really important. There are so many wonderful things going on. And the awareness, as much as we are in an age of information where we have so much stuff coming at us. It really does.

And I'm really believing more and more coming out of this pandemic that people are craving relationship. So to be able to have that person to person interaction, to listen, actively listen to what their needs are, and if you can help them find a solution and then not only throw ideas at them, but escort them over to someone and so now let's have a conversation.

And if we can find the time, if we can cancel the unnecessary meetings that really I mean, all of us are asking these questions, do I need to be in this meeting? Could this have been an email? Do we have to send an email? Please don't send me an email if you don't have to. You know, these kinds of things, because when we get to the real work, when I can take the time to talk to people like you, when people have a need, if I can even do it one or two times, I feel like my life has value.

You know, it's that story of the guy throwing the starfish or the sand dollars back into the ocean where the whole beach is covered with them. And someone says, “Why you're doing it, you're never going to help them.” And he goes, “But it matters to this one,” you know, and they get them back to the sea. So, and that's what life is. It's a series of one-offs that eventually creates that network effect where people, enough people are touched, they see the value, and that attracts more people. And then together we have this ability to really do amazing things.

Audra: That’s powerful.

Justin: It's beautiful. So I want to talk about one of your latest project that at least I know of, which is related to infant feeding formula versus breastfeeding, how to blend these two. I wanted to first know before talking about what you are, what this project is, what got you interested in this, in the arena of infant feeding in the first place?

Tiffani: That's very easy for me to answer as a dietitian and as a mom, because as a mom, you didn't have a choice. You were in it, right?

Audra: Yeah.

Tiffani: And every mom expects I'm going to breastfeed because I'm going to be perfect and it's going to go wonderful. And I, let me talk about the part as a dietitian. When I was being educated and I learned about food, and then I got into my clinical rotations and I got into, we did community stuff, we did school lunch program stuff and then we got into the hospital. I'm like, ok, hospital is my jam. I love it here.

Then I went into critical care. I'm like, oh, I love this even more because I love the nerdy go deep into the science kind of stuff. And then what else do you have? What's the more challenging thing? And I kept going and going and going. And to me, the most challenging patient you could have is the preterm baby in the NICU, because here we have something that is first of all, you have to understand how humans develop physiologically. You know, they can only be viable so early. And then when they get to term their course is usually that it's a very predictable course in the NICU.

But also, when that baby comes out of the woman's body, immediately, their nutrition is cut off. So it is the burden of the dietitian and the care team to mimic the amount of nutrition that that baby would have otherwise been getting from the mom in utero. I found that so fascinating. I mean, how do we sustain this little life? You know, it is absolutely hanging on.

So that, from a clinical standpoint, was a major challenge then. I love just the sheer I understand now you get to witness the development outside extrauterine, watching this baby do things that we wouldn't otherwise see. You know, we look on ultrasound, we see a baby sucking a thumb. It looks really cute. Now we get to witness the baby learning how to suck, swallow and breathe and coordinate things and how they go through those developmental stages. And we have an amazing care team unit at CHOC with the development and really preserving that.

So I just love that problems that so getting into infant feeding was really, really dear to my heart. In the NICU, we work with breast milk as much as we can. So we deal with the really, really the nuances, the subtle nuances of how a baby can tolerate those feeds, the qualities of breast milk, how amazing it is and what the insufficiencies are, because breast milk is made for a term baby, not a preterm baby. So in all my years in, the NICU is really given, anchoring me in appreciating the value of breast milk.

Now, go back to Tiffani, the mom. I found that when I was breastfeeding my kids and struggling, you know, it's not an easy thing. What do you do when you can't have breast milk? You know, what do you do when you want to be that mom? And so then you turn to formula and many moms feel very like they're failing for whatever reason. And some parents are like breast milk formula, fine, whatever. That's fine. But many people who intend to breastfeed really feel like, that they want to do it perfectly. And we are so binary, right? It's like I need to do it perfect or I don't.

And so in looking at the qualities of the different formulas and certainly knowing that I worked with older populations and understanding nutrition, that formula selection really is the first food choice that you make for a baby. So taking what I know about all the qualities of breast milk and trying to translate into what's a good substitute for it, and then couple that and wrap that around the emotional state of the mom, the economics, the social part, all of those dynamics. I just really my heart goes to that problem set because I've lived it, but also that moms are natural nurturers and mentors, and we need to share what we know with other moms. And so it's neat to be able to come from a mom angle, to come from a dietitian angle.

So recently my work in the infant formula, I've had the opportunity to work with a new company who launched the first new infant formula brand in the last five years. And they've become approved through the FDA. And the company's name is Bobbie. And it's been really wonderful to work with a startup company. It was started by a couple of moms who were faced with the same problem: I really want to breastfeed. It's not going the way I planned. I need to supplement with formula. I go to the formula aisle and how do I make a good choice? And that's a huge, weighty decision for mom.

But from the innovation side, they recognize, too, that there was this huge demand for European formulas and did kind of a deep dive into why. Why are people turning to a European formula versus what we have here in the US? And looked at the standards that were over there. So the EU has very different standards than we do here in the States. And there are families who wanted these formulas that were importing them. You can't ship directly from Germany to the US. So you have people that buy it off of Amazon. But the supply chain wasn't guaranteed and the quality metrics were not in there. And so they were put on the red list by the FDA. And so even though there's a big demand for it with this population, people are still doing it, but there's a safety risk. So now…

Justin: I had no idea. So there's like a black market and European formula like.

Tiffani: Exactly.

Justin: Guys in trenchcoats.

Tiffani: Yeah. Yeah. And so and then if you get a baby, you know, on a formula that they love and then all of a sudden you can't get your shipment, you're stuck. I mean, what are you gonna do?

Justin: Gotta go down to the docks.

Audra: And moms trying to make their own and. Right. Mmhmm.

Tiffani: Yeah. But if you know, if we look at the quality of, what we have to ask ourselves, why would people do this? What is it that they think is in this formula that makes it so unique? And really, when you look at those EU standards, they are looking at how you're sourcing all your ingredients, how your most of them are cow’s milk based. And so how is that cow grown? What is the life of that kind of like?

Audra: What kind of cow is it?

Tiffani: What are the additives that you can put in there? In Europe you are not allowed to put added sugar into infant formula? Like we can't, you can only use lactose, whereas here in the United States, we can use corn syrup solids and other things like that. So those things matter. And so I'm really proud of this company and that they've taken on those very high standards. And that they went through all the rigor of going through our FDA process here in the US, they’re Organically Certified too, which is another very rigorous process. And they just created a very simple, beautiful formula and created a community of support around moms. Because if you look at the community of moms that need formula, they're working. It may be an adoptive mom, it may be mom who had multiples who can't make enough for two or three babies. It could be a mom that had a double mastectomy and realizes that her insurance company will send her a breast pump, but they won't send her reimbursement for formula.

So this company is stepping in to say, to step in and say, you know what? There's a gap here and we can do better and we can support these moms, the moms that feel shame, like they failed, like I tried to breastfeed and I couldn't do it. What about the moms that just need to supplement? I mean, my message as a dietitian was always, listen, your body grades on a curve. So whatever breast milk you can provide, you get credit for it.

Justin: Yeah.

Tiffani: And what and if you have to supplement with formula, you know, don't worry about it. The baby will benefit from both. So, you know...

Audra: Can we just say that again? Like I really want to punctuate that, you know, that every ounce of what you provide in this journey, whenever you provide it, matters. And counts and supportive.

Tiffani: The body is very good about grabbing what it can and it grades on a curve. And so you get all the benefits. So, you know, if you can only provide a little bit of breast milk, that's ok. You get all the benefit of that little bit of breast milk.

Justin: I love it. The body grades on a curve.

Audra: You know what I want, I really, Tiffani, I've shared this with you, but because we are going to be putting this out to listeners and Justin remembers this really well. I had breastfeeding challenges with both kids. Bobbie is making me want to have a baby again. You know, I want to do this again.

Justin: Oh right.

Audra: And it's, I have to share a couple of these challenges. First of all, I had to have C sections with both kids, and I experienced the questions around that just from other mothers. Like why? Why do you need to have a C-section?

Justin: Are you sure?

Audra: Are you sure? Yeah. Yeah. You know, I'm sure medically necessary. I had a myomectomy when I was 20. When I was 21 or 20. Yes. And then on top of it, I'll never forget when Max was born in Santa Monica and we had terrible, terrible trouble with him in the hospital feeding. I mean, he would bend his back backward screaming, didn't want to latch on Justin goes to the pump station, I should say, or this business and says, “Hey, do you have a nipple here? It's kind of like a lot like a real nipple, because I have a baby we’re in the hospital” and they're like, “No, we will not sell this to you. The baby will never latch on if you do that.” Right.

Justin: I forgot about that. I forgot about it.

Audra: So we have to go back and find out about it, of having him suck on a binky for a second and then latch on. And I remember going home with a hospital-grade pump, feeling like such a horrific failure as a mother saying, “Ok, I'm going to pump this milk as much as I can and I'll feed him in a bottle underneath a cover so nobody will see.”

Tiffani: Mmhhmm.

Audra: It's a bottle, even though it's my milk. And then when at six months, you know, I have to go back to work at three months like everyone else. The little bit of supply I had, I was getting through just maimed and tea bags, like trying to heal, and all of it. And I go to work and my supply just starts to go down and down and down. I mean, it's a story of so many moms, right? And down, down and down.

And so I start looking at the formula aisles and we have to start supplementing. We have no other choice. What are we going to do? Max stopped breastfeeding. He just stops at one point. He only wants a bottle, he stops at six months and, you know, an acquaintance at the time said, “oh, oh my god, what are you going to do?” Like, obviously, I'm going to let him die. What do you think I’m gonna do?

You know, and so it is, there's this social pressure. There is this valor that comes with a mom who can breastfeed until she's three. Until the kid’s three. And I'm not critical of that, like you do you. But why has this turned into such an assault on working mothers and mothers of all types and mothers who can't and the judgment that comes when the bottle’s presented.

Tiffani: Yeah. And you touched on something so important. People don't recognize that we're kind of set up to fail, too. So when you say you have a C-section, you probably had prolonged IV fluids given to you. You know what? That delays your milk coming in.

Audra: Oh, that's why it took five days? That’s good to know. They didn’t tell me that.

Tiffani: Yes. They don't tell you that. They don't tell you that you had blood pressure, that you were never had a history of surgery or anything. They don't tell you those things. And if you only get 48 hours for a vaginal delivery or four or five days after a C-section, you haven't even gotten into that window where your milk has come in. And meanwhile, your baby's been hungry for four or five days.

Audra: Right.

Tiffani: You know, what are you supposed to do? You can't win in that way. Now, you can succeed. You can go through and supplement and really commit to breastfeeding. You know, it's not like it's, the baby-friendly hospital, which is what you're talking about, which is very, very well-intentioned, has had a really dynamic effect in this place, especially on women's mental health. So let's talk about that a little bit, because I had never experienced, I didn't know I could be jealous of another mom, because when she pumped, she got 10 ounces every time. I was so envious.

Audra: She's freezing her milk. And you're like, why do you have enough to freeze?

Tiffani: Right. Like they open up the freezer and it would be like a 12-year supply.

Audra: Yeah, yeah.

Tiffani: You know, and it's like. And then the other thing is, I would, whatever I could pump off, I'd put it in the refrigerator and I'd have like the thinnest little layer of fat on top. I like pump like nonfat milk. And, you know, the other moms were Dairy Queens that were pumping cream.

Audra: Yeah.

Tiffani: So, you know, and you have no control over this. Your body as a woman gives you the number of milk ducts that you're going to have, which is why, and usually the dairy queens were like back in their size two jeans like three weeks after delivery too. That is not possible. Is that I am trying to eat, trying to sleep, trying to drink enough water. I'm doing everything. It can't be forced. And then you add the anxiety, like it's snowballing on you. And then they're like, well, you shouldn't be stressed because that will affect your milk supply. You're like, wait a minute here. So we really, moms need people to come alongside them.

And like I said, as mentors, as friends, to just say, “You are enough, you delivered a healthy baby. Let's not forget that point. We have options. Produce what you can think about what works for your family and your lifestyle, and then let everything else go.” Make your decision and then enjoy your baby.

Because I, I hate to think that those new moms who should be one recovering from birth, because we all know that that's got some things there. But two, this is a new little life that you've brought into the world and you need to enjoy that, you need to accept your new position, your new station as the parent. And whether it's your first parent or your first baby or your fourth baby. It changes your family dynamic. And so the kindness factor, coupled with the science, coupled with everything else that moms are trying to handle, this is what really drew me to this company, Bobbie in particular, because they recognized we're not just here to sell formula, of course, that's their M.O. But you know what? 83% of families will turn to formula in some way during that first year of life for their baby.

Audra: Yeah.

Justin: Yeah.

Tiffani: That's a pretty high number.

Audra: Yes, 83%. Yes, we need it.

Justin: There's a dad’s component.

Audra: We need to normalize it. Yeah.

Justin: I just had the flashback. I totally forgot about this. How happy I was to be able to feed Max…

Audra: And Maesie. Yeah.

Justin: Yeah. I mean that. But for the firstborn to realize like, oh, I really I'm so glad that I can take a role in this. And yeah, I remember.

Tiffani: Well, we've had dads come back and say, “I was so relieved when my wife finally gave up trying to pump it, you know, when she wasn’t producing anyway.”

Justin: When we were done.

Audra: Yup.

Justin: Yeah, I remember that. I was just so…

Tiffani: Like, it makes them feel like they get their life back. Yeah. And so, and no one here is advocating against breast milk...

Audra: No.

Tiffani: Don't mistake me. Breast milk is amazing. I mean, I love, you can study. It's like studying space. It has infinite qualities to it between the pre- and probiotics and the immunoglobulins and everything that it does. I mean, I used to in my early days, you know, used to say kind of snarkily, it does everything but clean grout. But now I pretty much have evidence that I can clean grout.

Justin: It can clean grout as well.

Tiffani: It’s amazing. Yeah. But I look at the fragility of these new parents and it, my heart goes to them. I want to help navigate making wise decisions. And I love that something familiar, something like this one says, well, “Ok, if you do need an alternative, let's make it as clean and simple and as beautiful as possible.”

Audra: Absolutely.

Tiffani: And so I think that and my other message to these parents is pace yourself, because this is the first food decision you're making for your kids. You have a whole lifetime of decisions to make.

Audra: Yeah.

Tiffani: So be kind to yourself and pace yourself. So I love even having that language of a formula is your first culinary decision, if you will, as a parent and start learning how to qualify, okay, what are your values around food? And again, maybe an 80-20 rule? We're not aiming for perfection here. We are aiming for being informed and making good choices that work for your family.

Audra: We're all about the 80-20 over here. I think that's phenomenal. And it's a beautiful point to make. Tiffani, I think in our generation, we are a part of the pendulum swings here, right. We have mothers who were advocates, probably our mothers, you know, might have been advocates for breastfeeding in a time that was hostile to breastfeeding. Right?

And even at our ages can experience various hostilities towards breastfeeding and the activism that has gone into helping mothers get access to breastfeeding and understand breastfeeding and feel supported and being able to breastfeed wherever they need to and in public and at work. And, you know, all of the different things. I love the activism. I get it. It's so important. I get that we are coming from a very deep hostility towards breastfeeding. And for it, like in many things, the activism turned towards hostility, towards formula and bottle feeding. Right.

Tiffani: Right.

Audra: And so we're trying to bring grace into the space and trying to help, you know, kind of normalize whatever it is that someone needs to do. Let's just be fully supported in all of these choices.

Tiffani: Yes, exactly. We do tend to have that pendulum swing from one extreme to another. And the reality is that we're all in that swath, the pathway of the pendulum at different points of our lives. Again, my heart goes to these new parents because it's a wonderful time and it's an exciting time, but it's a very fragile time. And so to be able to come in and if we hit them too hard with the science, you know, just like the baby-friendly thing, yes. Most of their efforts were very evidence-based. And I understand their intentions.

But in the meantime, you've got this sobbing mother who is just trying to keep it together. And we are discharging them home. And we want them to have a peaceful, successful home life, to be able to grow a baby that can thrive. Which is why I love the name of your group, The Family Thrive, because it covers everything from birth forward. And each stage and developmental stage and phase that we go through, not only as kids and parents, but the whole family in it.

There are different definitions of thriving and it takes different resources and it takes that empathy from our caregivers in our community to recognize, well, that wasn't my experience. But boy, I can certainly understand yours. And I would like to help. I would like to help provide resources.

Audra: You know, Tiffani, that that brings something up for me, too. Going back to your comment on the very first choice we make in feeding our child. The mental health of the mother and of the parents, that very first choice, setting down the path, starting to think about your values around food. And I think that this is a really powerful time that I don't know that I've acknowledged very much either and it's something that I'd love to talk a little bit more about.

So this, you see these steps that we take when we make these initial choices to incorporate formula and then maybe the next steps in solid foods and things like that. I'd love to know if you have any tips or insights, because it comes down, what I am starting to think of when you start talking about the mental health and well-being of the mother and of the family, is the more that we can de-escalate that initial stress around feeding, because feeding is the most important thing. Right. It seems like when we came home with our babies, it was like, oh, my god. Feeding. Right. And the counting the pee, counting the poops, what goes in, what comes out and that doesn’t leave you. You know, you end up with a six-year-old, you're following around with a spoon of food because, you know, you want to make sure that they get that one little bite of nutrition in.

Do you have any tips for new parents on just developing some mindfulness around those values? Because I think it's something we don't think about or talk that much about. I'd love to know if you have any thoughts on that.

Tiffani: Well, in the early days, for sure. You know, I totally remember what you said about counting the diapers and trying to do it right, especially if you're breastfeeding and you don't have a quantitative volume, that's where the mystery just becomes so hard. I mean, if you are pumping and putting it in a bottle is, you know, what volume you're feeding. So in those early days, I think having the metrics is very valuable, getting that benchmark of back to birth weight within the first two weeks, and then you feel like, ok, we're trying to get our groove on.

And I can even remember as a pediatric dietitian who I think knows more than most about the actual ins and outs of food. When my first was turning one and I had weaned from breastfeeding and we were discontinuing our supplemental formula, I thought, “oh, my gosh, I don't have that insurance policy anymore,” because I knew formula and breast milk is nutritionally complete. So now I was responsible for everything that I said. My kid had to meet all of the needs for nutrition. And I just felt the gravity of that responsibility of like, I better do this right.

You know, in the US, we address it so differently. We label things and I would say this, even for kids and adults, and we like to wear our banners of like “I'm a paleo vegan” or “I'm on this diet.” You know, we like to know that we have those constraints and boundaries and that we're doing it right. And then we take pride in that. If you were to look at other countries around the world, food is love and relationship, and its history and culture. And they feed their babies seasonally because that's what they have access to. And we tend to standardize and make it a protocol.

So when you look at introducing foods, we start with a puree consistency because it's appropriate for what their palate can handle. And you're trying to introduce those different textures as the mouth palate evolves and their developmental skills evolve to the point where then they get some teeth and they can chew. And then you think about not wanting to have choking hazards and stuff like that and being on the lookout for allergies so that you're introducing individual foods and watching and seeing how the baby responds to it.

There's some strategy to it, if you will. But it's not necessarily adopted with other cultures around the world. I think knowing what the family's values or what their approach to food is, helps people drive what they're going to aim for. Because ultimately, when a child is about a year old and everything developmentally has been on track, they're pretty much eating what the family is eating. It just might be modified in its chopped size or consistency just for hat. So you're really trying to get them from birth to 12 months to kind of get in line with what the family's doing.

Now, I have seen families take the opportunity in trying to do such a good effort with their child that they've actually improved their own eating habits in anticipation. If they can make that connection of like we are a family unit, what do we want to do for the family? And so I've actually seen some families rise to that occasion of like, ok, well, you know, I'm glad he likes the jarred peas because we don't eat peas. And I'm like, “well, should you?” You know, like what do you want to aim for? Because you're giving him sweet potatoes and carrots and, you know, all these different things. You're giving him cut up pieces of banana and now you're doing berries and stuff like that. How does that incorporate into your family? Because ultimately a family is a unit. Basic home economics will tell you that it's a whole lot cheaper to cook for many than for one. So know from a practical standpoint, as that kid develops their eating habits, you want to streamline that in there.

So I don't know if that's what you were aiming for know, but it's kind of a global lens on what are the goals, what are the aims? There's obviously very iterative steps to get there. But if you look at it holistically on what does the family aim to do, what's practical, do you have two working parents, how much time do you have for shopping and meal prep and stuff like that? But I think with a little bit of strategic planning, you can get there. And then it again takes away that power from the mystery and that you feel like, ok, I feel like I've got a sense of understanding of what we're aiming for and this is what we do. And you step into that identity of this is how the Ghere family is approaching food. And I am getting to experience the wonderful. It only took 18 years, but the wonderful opportunity of the kids being able to advocate for their own food choices, to see them go out with friends and get creative and experience new cultural food experiences, as well as cooking their own meals.

Audra: Yeah. Tell us more about what you are seeing, because it sounds like to me that if we can de-escalate the stress around the home and like bringing baby home, breastfeeding, bottle feeding, you know, all of the stress and anxiety, that is really, I think, social pressure.

Tiffani: It is.

Audra: And if we can de-escalate that and provide that focus on how we want, we want to nourish this new this child, this new baby we want to nourish, and then we want to provide a home environment where we keep that goal of nourishing. So whatever that timeline, strategic plan is in place, even the mindset that we can level up, that we can rise to the occasion. We had that experience only when faced with a medical crisis. I think it's really powerful to think like this baby is coming to the family table. We can level up for all of our benefit. I think that's just such an amazing point to make.

And then I'm so curious. Mom of three boys. Three boys raised by a culinary-inclined dietitian who, you know, knows all about how things start with soil health from the ground up. What are some of the cool things you've seen in your sons as they're like autonomist folks now?

Tiffani: Well, I will tell you that we are just like every other family. They’re kids, you know, you can't necessarily groom them to be exactly the way that you want them to. You know, my goal, as much as I have had a lot of experience with food, my goal was always to be kind to myself, too, and not to be too overarching and to just expose them. I can remember sitting at the table when everyone has that where they don't want to try something or whatever. And I would try to remind them this was probably a grade age.

You know, my goal as your parent is that when you're a grown-up and if you got invited to the White House that whatever they serve, you would be cool with that, that you wouldn't be afraid of it, that you could you know, if someone said you get to take a mission trip to a foreign country, could you adapt to what's going on? I wanted them to have. It's funny because as an anal and as Type-A as I tend to be, I try to actually train myself to be a little bit more chill on it, and recognizing that it's not a battle. And really, the victory is going to be won in the very long game, which is, I wanted them to have an adventurous relationship with food.

I wanted them to be inquisitive. I wanted them to understand where it came from. I wanted them to taste things. Everyone goes on their own timeline. But I do have three pretty open, adventurous eaters now as they're getting into their late teens or early adulthood, which is, that was my goal. So now I can hand them off to the world, right?

Audra: Yeah. Yeah. It's a great point, too, that it's a long game. I think that's one of the things that's so rushing in this is that there are a lot of no's along the way. You know, you provide a lot of really cool different things or broccoli or whatever, and there's a ton of no's before you get to yes. And so it's a long game that takes a good amount of kind, graceful, open persistence.

Justin: Well, there's a lot of no's on the side of the kid. But I'm curious, Tiffani, what were the no's or what are the no's for you when thinking about food in the home, meals in the home? Are there some, I don't want to call them like hard and fast rules, but food general guidelines, where like, no, we're not going to do that here.

Tiffani: Yeah. You know, for us, it is interesting because we never had, don’t anyone misunderstand me. If this is in your pantry, this is not a judgment. This was just my own personal choices. But knowing that the affinity for sugar is an acquired taste. So the more exposure you have to the high, sweet things that you would be, you know, you would continue to have that high affinity for sugar. So we never had juice in the household or the sodas or those really high artificial sweetener things. We did use yogurt. We had berries with it.

It wasn't that things were a no. I just tried to do the best decision making with the quality that we could, always having that mindfulness of quality and knowing that if they went to a friend's house and they got the Gogurts and they got the you know, that they had mom, how come you never told me about fruit punch? It’s awesome. How come we don't have jello, you know?

Justin: My gosh.

Tiffani: And it's fun. But you know what, what I love. We got to travel to my sister's house. We got to travel by plane over Christmas. And here I am with my two, two of my three grown kids. And they were doing a beverage service. And the biggest treat that they always thought was to get apple juice. So they both I watched them order their apple juice because we just never had juice in the house. And you know, now they, are they candy fiends? Yes. When you go to junior high, there's like a black market for trading candy out there. And it is hard to fight, you know.

But I do remember that especially with grade school, you know that packing the lunches, especially with the first one and trying to be very thoughtful. And then they go and they're surrounded by all kinds of processed foods and things that are high in sugar. And they didn't feel as popular. So my angle was always, we're going to have all kinds of treats and cookies in the house, but I'm just going to make them from scratch. And then I have control. Like I can downgrade the you know, if it calls for a cup of sugar, I can do it with like two-thirds of a cup and it's still ok, you know, and using that high-quality butter, my approach was like most of our food will probably rot in two to three days. And, you know, sweets included. And that's kind of the road that we took.

But there's many ways to get to a path of success. And sometimes there are drivers in your life, as you guys know, where you have to put that and if something is forced on you. Let's say two of my three kids have very close friends that are type one diabetics. And it's been very interesting to watch them and their empathy that they have and understanding what they have to do.

In fact, one was very protective of her, and she didn't get diagnosed until she was, I want to say nine, which is a little bit later down the road, so he had that awareness that tore my heart strings open, I just I burst, I was my heart was breaking for the family because I knew how much of a lifestyle change is going to be. But my heart was so proud of my son who had that empathy and recognize that she has to look at her food differently. And I know. I want to. I want to. He was watching out for her at lunch time and trying to like protect her from other kids, going how come you don't eat the Gogurt or how come you don't do that? He was trying to like, kind of jockey to protect her.

So, you know, this is why we can't forecast everything we want to do with food with our kids, because hopefully they come back and surprise you in a delightful way. And I tend to go to that holistic overview so that they have the context, because our job as parents, my mom used to tell me this, and I do agree with her that if you're parenting, if you're doing it right every day, you're working yourself out of a job.

Justin: Beautiful.

Audra: I love that.

Tiffani: When you get to that phase where you're actually working yourself out of a job, it tears your heart open, but it is the marrow of life. And so, you know, you plant those seeds and then you get to see those wonderful returns. But at the early years, you know, there's a lot of support needed.

And I think what's really important is that we give these new parents the confidence to say, you know, “we thought about this, we made a deliberate decision. I'd appreciate it if you could support our decision” and then we can enjoy, you know, I think about Thanksgiving, right, where grandma or someone always has an opinion about what you're doing. And, you know, just to equip people with the language to say, you know, “we really we really thought about this and it would really help, but this is how you can support me,” because when you use that language, it actually we're struggling. And so could you please. And then you get to give people the equipped messaging that actually creates that better support system. And it's not about the food. It's about control. It's about who has to be right. And I try to break that down so that we can disarm people and really have true meaningful relationships that are supportive.

Audra: I think that's so helpful, Tiffani. Yeah. Thank you for bringing that up in like, we have a module on that MaxLove Project that I think we need to bring into The Family Thrive setting as well. Lexi Hall, the dietitian we work with who you know very well, from CHOC, did a Fierce Food's Academy with us around Friendsgiving and specifically to help families with these challenges that come up around, you know, bringing your own family's choices into family settings, social settings, and things like that.

I also want to just reflect on your comments on your parenting. I love hearing this and hearing this from a dietitian. I feel like it's such a beautifully, you know, open, pragmatic way that there's not. We don't have to have like, super tight reins, but we can figure out our own kind of equilibrium in the home. You know, that makes sense for us. And I think it can be hard to sort of stake your own claim in that, like without having a model out there. So the more stories we hear from other parents on how they've done it, the easier I think it is for new parents.

You know, I think in our case, we ended up with a kid, we needed to go on the ketogenic diet. You know, we needed to do it as a family. But then raising his little sister to make her own choices and to be her own person and getting into bio-individuality and kind of the diversity of what we provide in the home. And I will be totally straight up with you. We have these like Annie's mac and cheese, little plastic things in there that she can fill with hot water to have mac and cheese. And one thing that I've really loved is she will down two flights of strawberries. No problem. She'll eat entire English cucumbers. No problem, like you know, when she goes into the fridge, she's going for this stuff and she still has it.

And she was like obsessed with these. Like, can I have mac and cheese? Sure will buy you the mac and cheese. She wants to have it for breakfast. Fine. And she's making them for herself. She's doing it for a couple of weeks. You know, they're in the pantry still. And what is she making for breakfast? She's making an egg sandwich. She's been making smoked salmon with cream cheese and capers and lemon. You know, as her, I mean, she's making these fabulous choices. And I said, “why don't you eat the mac and cheese anymore?” And she was like, “eh, it's just not really that great,” you know? And that has worked for us. Talking about bio-individuality, providing some of these choices has worked for us.

Justin: No offense to Annie’s.

Tiffani: No offense to Annie's at all.

Audra: Oh no, no, no, no. It’s not about that. Not about that at all.

Tiffani: It's a testament to the evolution of her palate. You know, and you touch on something else really important, too, is as kids grow, especially in their you know, it becomes less frequent as they get older, but they go through phases. You know, you see it radically in ages one through three where they'll go on food drags where it's like all they want are goldfish crackers. And last week, he was eating lots of kind of chicken. Now this week, he doesn't want it. So they go on strikes and they go on drags and then they go through different phases, too.

And I love that you're also touching on the fact that, because it takes a lifetime to develop that palate, you know, we know that it takes at least 20 exposures to a food for a kid to know if they do or don't like something. And many times that they don't like something in their early years. It's not because of the taste. It's usually the texture or the temperature. So there are different forms of offering of foods. Like it's not that you don't like carrots, but, maybe you don’t like cooked carrots or cut, you know, raw carrots.

Justin: Yeah. Right.

Tiffani: So, I mean, that's really important to know. But the fact that Maesie has that sense of curiosity and exploring and then mashing up different, that's the evolution of the palate. And Chef Azmin can definitely explain it in better terms than me. But I love that. I saw the same with my youngest, Carter, too, who was definitely a fierce advocate for mac and cheese. I think we had the Costco, the Costco brick of Annie's mac and cheese.

Audra: Yeah. Yeah.

Tiffani: And now I do, I think somewhere in an old closet, that brick is still there because he's evolved and he still loves pasta, but he's making his own rigatoni alfredo, and adding the vegetables and the chicken to it. And, you know…

Audra: Does he like the feta pasta? Does he like the TikTok feta pasta? Maesie loves that. Loves it.

Justin: Just so we don't run out of time...

Audra: Because we could talk forever.

Tiffani: Yes, I know. No, keep that keep us on track.

Justin: I have one final topic before we get into our last three quick questions. So the last final topic is when we had our podcast interview with your colleague, Lexi Hall, we ended by talking about food myths, you know, because in not just in the world at large, but especially in the parent world in the discourse, there's all these food myths that are circulating. So we talked about a couple with Lexi Hall. And I'm wondering if you have a food myth that you have come across or that you regularly come across and you want to bust it?

Tiffani: Well, I don't want to cover something Lexi already did. What did she tell you?

Justin: So well, we covered meat. So like meat is going to kill you. So that's a myth.

Tiffani: That's a good one.

Justin: Alkaline diets are these super healthy, magical things. Yes, we busted that one. And then eight glasses of water a day. We busted that one. So those are the ones we…

Tiffani: I agree with all of those. Let's see, so I'm often asked, and I end up saying this when I'm educating families, like if there were five foods, if I could only choose five foods to live on. And one of those five foods is eggs. And so I think one of the myths is that if you eat too many eggs, you're going to have high cholesterol. I think that came out of our ‘90s education on heart health. Again, well-intentioned, but it's not been validated. And if any part of cholesterol gets raised is the HDL, and that's for good cholesterol. So I love eggs, and I eat them every day.

Justin: Heck, yeah.

Tiffani: I have decent cholesterol. I have pretty good blood glucose control and there is a tie to that. So dietary cholesterol doesn't necessarily tie to serum cholesterol, which is your blood cholesterol. And I, the way I explain it is this: there is enough nutrition in that egg to grow a whole chicken. So I love caloric density. There's enough nutrition in a nut to grow a whole tree.

So when people ask me what are the five foods, I think of avocado, eggs are on there. I think of nuts. I think of a fish. And again, those are very nutrient-rich type things. So I think that would be the myth-buster that I would go to just because I am such a fan of chickens and while not vegan. You can eat an egg and glean a lot of great nutrition in an ethical way that actually isn't a harm to a chicken. And so I'm hoping that it also reaches a wider part of the population that as a food choice.

Justin: Brilliant. Yes.

Audra: I love hearing that from you. Yeah. Thank you so much. That's one that has come up recently with yet another study that was pulled in by the media attempting to disparage eggs. So thank you.

Justin: Yeah. And speaking of Maesie, this is one thing that, one of the hardest things right now to do with her is to get protein in. And, you know, because she, yeah. Audra’s, right. She'll eat tons of berries or eat tons of veggies and all. But it's like, ok, can we just get the protein? Or so I will tell her. I'll stop bothering you for the rest of the day. If you just eat an egg, just eat and then I'll be done.

All right, so let's get into the final three. These are quick ones. All right. So if you could put a big Post-it note on every parent's fridge tomorrow morning, what would that Post-it note say?

Tiffani: You're doing a good job. You are enough, really. You are trying to raise a human being. And it takes a lot of effort. And we are so hard on ourselves and we think we're not good enough. It's like imposter syndrome again or something. And everything, we will hear the one negative, the one negative thing will completely derail us, even in the presence of 100 compliments. And so reinforcing that they are enough and that they are doing a good job is enough to get them to pause and breathe. But any insufficiencies or gaps that they have, it affords them the time to go seek out help or find the education and they can do it. So it starts with, except that, you know, you can do this. You're completely capable.

Audra: Tiffani, I feel like you just put that on my fridge. Thank you. Like I sort of get emotional. Yes. Thank you. Thank you.

Justin: We need that.

Tiffani: I know you probably wanted us food one, but.

Justin: No.

Audra: No.

Justin: No, no, no, no.

Tiffani: It's again, it affords me that access to connect with people in all the years that I've been working with families and patients. And it's such a pervasive reality that we have these people that are struggling with a clinical status of a child. Let's back it up. Let's look at what you're actually doing. You've walked a hard road. You can do this.

Justin: Absolutely. Second quick question. Do you have a quote that has recently changed the way you think or feel?

Tiffani: I do. And it's funny, because the one that I used to always cite was Maya Angelou’s, “When someone shows you who they are, believe them the first time.” And part of that speaks to being burned and becoming aware of like, ok, I'm going to recognize people for who they are.

But Audra, you actually posted it to Instagram, I think it was just a couple of days ago from Angela Davis. “I am no longer accepting the things I cannot change. I'm changing the things I cannot accept.” And that just really speaks to my present of mind right now where, like I said, go bold or go home. Children and family are depending on those of us that are in this professional world, we owe it to them to swing from the fences.

Audra: Oh, absolutely.

Tiffani: Obviously, another testament to how in-sync we are in our like-mindedness, but.

Audra: Beautiful. Yes, I feel that fierceness in you, Tiffani, that it's like this is your life's work.

Justin: Yeah. Oh, for sure.

Audra: This is your world changing. You know one starfish at a time. And this is it. You know, it's really, really inspiring. And it's a beautiful call to action. And it's something that The Family Thrive is all about. And I really appreciate hearing your fierceness in it. And the emotional component to this. Like this is really, really powerful, needed work. And I just really appreciate hearing that call to action from you. I feel more charged up in my day.

Tiffani: Oh, it's amazing how cyclical it is, because that's how I feel about talking with you guys. You know, this is what synergy is, where you find that like-mindedness, you find that common goal that you reach for, and then you allow people with their different skill sets and talents to come together and create something unique and dynamic. And people respond to that. And as someone who's given many a lecture or a nutrition talk in my day, it's always in the back of my mind that people walk away with how you make them feel, not what you say.

Audra: Yeah.

Tiffani: And so if you can touch, if you can connect in any way, no matter what kind of information you're dispensing that day, that connection is what people truly crave. And it's not that, that's not all that they need, but that's how you start. And then it affords you the opportunity to gain their trust, to create that awareness. And then you can provide the education and then you have a bonded loyalty that creates that greater network that's going to be really, really powerful.

Justin: Awesome.

Audra: Couldn't agree more.

Justin: So the final question we ask, because for, at least for parents of young kids, you know, it's a marathon. It's exhausting. And at the end of a day, you can say, oh, kids, just like so much work. But at the same time, kids are totally awesome. So let's celebrate them. So we want to know, what do you love most about kids?

Tiffani: Well, like I said before, I think they are the great equalizer because it does break down the adult to a place where it does open us up too, because if we are so closed and buttoned up, we lose a lot of things in life. But kids don't lie and they let you know with complete transparency and utter honesty how things are.

And it's positive in the negative. You make something for dinner and they hate it. I mean it. And as much as we get thrown back in your face. Right. We know that with a toddler. But they're forgiving and they're loyal and they're loving. And they show us as adults that that compassion and that commitment is hardwired in us. And this is who we were supposed to be from day one.

And so I think it reminds us as adults to remember that, you know, and for those of us that are spiritually-minded, I think about biblical teachings where even Jesus connected with children, and that even relating to something as grave as pondering the existence of God and relating to God, he did it through the vehicle of children.

So I think that for these big things that we wrestle with and parenthood is a big thing to wrestle with. To remember to look at it through their eyes and we'll glean such great insight. And I've seen it, like I said, with all those wonderful doctors that I work with that are so accomplished and so brilliant, you bring a child into their life.

Justin: Yeah.

Tiffani: Like what do you really know?

Justin: Exactly. Yeah. Tiffani, ok, before we sign off, how can people find out more about your current work and just how to follow you?

Tiffani: Oh, well, I am with CHOC Children's in their Medical Intelligence and Innovation Institute. We call it MI3. And you can certainly reach out to me via LinkedIn. Yeah, I love to connect with anybody who wants to be in the space. Anything I can do to support The Family Thrive. You know, I'm in.

I'm so excited to see your efforts grow and the community that you're building. And it reminds me of how we drafted the banyan tree all those years ago. And it's just taken roots and it's just growing, only it's under the umbrella of a magnolia tree instead of a palm tree. But I'm so excited that I get to see you next week.

Audra: Me too, I can't wait. Thank you so much for spending this time with us today, Tiffani, it was beautiful catching up with you.

Tiffani: Thank you, guys. Love you guys so much.

Audra: The first of many, too. We love you, too. A first of many.

Tiffani: I love it. I love it.

Justin: Awesome.

Tiffani: Well take care of you guys. And I get to see you next week.

Audra: Yeah.

Tiffani: Travel safe.

Audra: Okay. Thank you so much. Bye Tiffani.

Justin: Hey, thanks for listening to The Family Thrive podcast. If you like what you heard, please subscribe, tell two friends and head on over to Apple Podcasts or anywhere you listen to podcasts and give us a review. We're so grateful you've chosen to join us on this Family Thrive journey.

Podcast Ep. 11: Feeding Kids From Infancy Through Adulthood With Tiffani Ghere, RD, CSP, CLEC

Close
Theme icon

Podcast /

Content /

Nourish

Podcast Ep. 11: Feeding Kids From Infancy Through Adulthood With Tiffani Ghere, RD, CSP, CLEC

Tiffani Ghere, RD, CSP, CLEC is here to discuss neonatal and pediatric nutrition and squash some food stigmas and myths!

Join The Family Thrive community and download the mobile app, all for free!

JOIN TODAY

Key takeaways

1

2

3

Low hassle, high nutrition

Fierce Food: Easy

Fierce Food: Easy

50/50 mixes of powerful veggies and starchy favorites

Fierce Food: Balance

Fierce Food: Balance

Maximize nutrients, minimize sugar and starch

Fierce Food: Power

Fierce Food: Power

Ingredients

Kitchen Equipment

Ingredient Replacement

View replacement list (PDF)

Reading time:

65 minutes

In this episode

Justin and Audra are joined by Tiffani Ghere, RD, CSP, CLEC to talk about some serious food for thought: neonatal and pediatric nutrition. Tiffani will discuss formula versus breastfeeding, how to transition babies to solid foods, how to feed kids as they grow up, and much more.


Listen here


About our guest

Tiffani Ghere, RD, CSP, CLEC is a Registered dietitian, a Board Certified Specialist in Pediatrics, and a Certified Lactation Educator. She started her career as a clinical pediatric dietitian at Children’s Hospital of Orange County in 1999. Today, she serves on the CHOC Medical Intelligence and Innovation Institute's (MI3) core leadership team, is acting Executive Director for the International Society for Pediatric Innovation (iSPI), and is on the Medical Advisory Boards of the formula company Bobbie and the Women Leaders of Octane. Tiffani is also a contributing expert to The Family Thrive. Check out her article on breastfeeding and formula here

Show notes

  • 08:01 - Chef Azmin Ghahreman is the chef and CEO of Sapphire Culinary Group and has worked closely with MaxLove Project. Click here for his delicious, fool-proof chicken souvlaki recipe!
  • 08:37 - Chef Azmin also founded the Sapphire at School program, which partners with schools in Orange County, CA to prepare fresh, wholesome meals for over 5,500 Pre-K to high school students daily.
  • 08:50 - Tiffany serves on the Leadership team for CHOC’s Medical Intelligence and Innovation Institute (MI3).
  • 12:57 -  Anthony Chang, MD is a pediatric cardiologist at CHOC as well as Chief Intelligence and Innovation Officer.
  • 13:21 - Imposter syndrome “refers to an internal experience of believing that you are not as competent as others perceive you to be.”
  • 17:24 - Sherry Farrugia served as the Strategic Partners Officer of Georgia Tech’s Children's Healthcare of Atlanta Pediatric Technology Center until 2020, and is now the CEO of Global Center for Medical Innovation.
  • 23:19 - Bobbie is a new brand of organic baby formula that uses a European formula.
  • 52:03 - Lexi Hall, RDN is one of our beloved Family Thrive Experts who appeared in Ep. 6 of The Family Thrive Podcast.
  • 52:09 - Fierce Foods Academy “is culinary medicine in action through a collection of programs that center on risk-reducing and quality-of-life–improving whole foods.”
  • 57:30 - To read more about why eggs should be in every family’s fridge (with exception to allergies, of course) read our Five Things Friday article here!

In this episode

Justin and Audra are joined by Tiffani Ghere, RD, CSP, CLEC to talk about some serious food for thought: neonatal and pediatric nutrition. Tiffani will discuss formula versus breastfeeding, how to transition babies to solid foods, how to feed kids as they grow up, and much more.


Listen here


About our guest

Tiffani Ghere, RD, CSP, CLEC is a Registered dietitian, a Board Certified Specialist in Pediatrics, and a Certified Lactation Educator. She started her career as a clinical pediatric dietitian at Children’s Hospital of Orange County in 1999. Today, she serves on the CHOC Medical Intelligence and Innovation Institute's (MI3) core leadership team, is acting Executive Director for the International Society for Pediatric Innovation (iSPI), and is on the Medical Advisory Boards of the formula company Bobbie and the Women Leaders of Octane. Tiffani is also a contributing expert to The Family Thrive. Check out her article on breastfeeding and formula here

Show notes

  • 08:01 - Chef Azmin Ghahreman is the chef and CEO of Sapphire Culinary Group and has worked closely with MaxLove Project. Click here for his delicious, fool-proof chicken souvlaki recipe!
  • 08:37 - Chef Azmin also founded the Sapphire at School program, which partners with schools in Orange County, CA to prepare fresh, wholesome meals for over 5,500 Pre-K to high school students daily.
  • 08:50 - Tiffany serves on the Leadership team for CHOC’s Medical Intelligence and Innovation Institute (MI3).
  • 12:57 -  Anthony Chang, MD is a pediatric cardiologist at CHOC as well as Chief Intelligence and Innovation Officer.
  • 13:21 - Imposter syndrome “refers to an internal experience of believing that you are not as competent as others perceive you to be.”
  • 17:24 - Sherry Farrugia served as the Strategic Partners Officer of Georgia Tech’s Children's Healthcare of Atlanta Pediatric Technology Center until 2020, and is now the CEO of Global Center for Medical Innovation.
  • 23:19 - Bobbie is a new brand of organic baby formula that uses a European formula.
  • 52:03 - Lexi Hall, RDN is one of our beloved Family Thrive Experts who appeared in Ep. 6 of The Family Thrive Podcast.
  • 52:09 - Fierce Foods Academy “is culinary medicine in action through a collection of programs that center on risk-reducing and quality-of-life–improving whole foods.”
  • 57:30 - To read more about why eggs should be in every family’s fridge (with exception to allergies, of course) read our Five Things Friday article here!

In this episode

Justin and Audra are joined by Tiffani Ghere, RD, CSP, CLEC to talk about some serious food for thought: neonatal and pediatric nutrition. Tiffani will discuss formula versus breastfeeding, how to transition babies to solid foods, how to feed kids as they grow up, and much more.


Listen here


About our guest

Tiffani Ghere, RD, CSP, CLEC is a Registered dietitian, a Board Certified Specialist in Pediatrics, and a Certified Lactation Educator. She started her career as a clinical pediatric dietitian at Children’s Hospital of Orange County in 1999. Today, she serves on the CHOC Medical Intelligence and Innovation Institute's (MI3) core leadership team, is acting Executive Director for the International Society for Pediatric Innovation (iSPI), and is on the Medical Advisory Boards of the formula company Bobbie and the Women Leaders of Octane. Tiffani is also a contributing expert to The Family Thrive. Check out her article on breastfeeding and formula here

Show notes

  • 08:01 - Chef Azmin Ghahreman is the chef and CEO of Sapphire Culinary Group and has worked closely with MaxLove Project. Click here for his delicious, fool-proof chicken souvlaki recipe!
  • 08:37 - Chef Azmin also founded the Sapphire at School program, which partners with schools in Orange County, CA to prepare fresh, wholesome meals for over 5,500 Pre-K to high school students daily.
  • 08:50 - Tiffany serves on the Leadership team for CHOC’s Medical Intelligence and Innovation Institute (MI3).
  • 12:57 -  Anthony Chang, MD is a pediatric cardiologist at CHOC as well as Chief Intelligence and Innovation Officer.
  • 13:21 - Imposter syndrome “refers to an internal experience of believing that you are not as competent as others perceive you to be.”
  • 17:24 - Sherry Farrugia served as the Strategic Partners Officer of Georgia Tech’s Children's Healthcare of Atlanta Pediatric Technology Center until 2020, and is now the CEO of Global Center for Medical Innovation.
  • 23:19 - Bobbie is a new brand of organic baby formula that uses a European formula.
  • 52:03 - Lexi Hall, RDN is one of our beloved Family Thrive Experts who appeared in Ep. 6 of The Family Thrive Podcast.
  • 52:09 - Fierce Foods Academy “is culinary medicine in action through a collection of programs that center on risk-reducing and quality-of-life–improving whole foods.”
  • 57:30 - To read more about why eggs should be in every family’s fridge (with exception to allergies, of course) read our Five Things Friday article here!

Enjoying this? Subscribe to The Family Thrive for more healthy recipes, video classes, and more.

Justin: I don't know about you, but when our first baby came into the world, feeding him was really hard. It caused us a ton of stress. And then when we transitioned to formula, many months later, we had more stress because we didn't know which kinds were best. And we also had to deal with the stigma around formula in our social circles. We might have stressed out again as we transitioned to solid food, but honestly, it's all a little blurry now.

But I can say that all the stress would have been alleviated had we known today's guest, an amazing clinical dietitian at Children's Hospital of Orange County, Tiffani Ghere. Tiffani specializes in pediatric nutrition with a particular focus on neonatal nutrition. There are few people in the world who know more about the science and practice of feeding newborns and infants.

Audra and I have known Tiffani for several years through our work with MaxLove Project, and we're thrilled now to have her on the podcast. We talk about formula versus breastfeeding, transitioning into solid foods, feeding kids as they grow up, and a whole lot more. So without further ado, here's our deep dive conversation with the always sharp, ever knowledgeable Tiffani Ghere, RD.

Audra: Thank you so much for being here with us and talking with us, Tiffani. I, you know, when we were let's see, we went to Temecula right before a lockdown. Was it a year ago?

Tiffani: Oh my gosh, it was. And I can't believe it was literally right before lockdown. And I remember thinking, “oh, my gosh, I want to go back to Temecula, like hit the undo button,” you know.

Audra: Cause we didn't know if we should go through. We were like, this is a little risky. We'll go do this thing. Didn't really know it was going to happen. And even kind of like, risky sort of being around people, but weren't sure yet. You know, it was at the very beginning, it seemed kind of tenuous.

Tiffani: Yes.

Audra: And then boom.

Tiffani: Yes.

Audra: But I remember on that magical, magical mini trip, which I can't wait to go back to and return to. We will, I just thought it was fabulous. We talked about The Family Thrive. And I was starting to share the seeds of this project even then and talking about, it's crazy. I can't believe that...

Justin: I love it.

Audra: Reflecting on it now, even we're talking because we are talking about various, you know, kind of like synchronicities and overlapping things. And today we, three-quarters of our seed round has been funded.

Tiffani: Oh my gosh.

Audra: We are going to be launching...

Justin: And we had our 19th anniversary a couple of days ago and…

Tiffani: Congratulations.

Justin: You know, like the stars are just coming together and then we're getting vaccinated soon.

Audra: Yup.

Justin: You know, the spring is coming, but it's, COVID’s going to be in the rearview mirror.

Audra: It will be in the rearview mirror. But it has been such a formative, powerful time for us. And it has been the time that we've invested everything in bringing The Family Thrive into being. We have our minimum viable product, our product, The Daily Thrive, which is the app, is ready to roll.

We are so excited to roll it out and to begin building it in live, in real time. And you are a huge part of it. You know, we've had such a wonderful relationship over all of these years, co-developing, co-inspiring, like really working on bringing, you know, kind of not only more awareness to the role of health and wellbeing and living our best lives, but the community aspects of it. And it just feels really incredible to talk with you today because we have so much to talk about, so much that we have, you know, not only in our common interests and passions and all of that, but we are going to be building The Family Thrive with you.

We know that you're going to be a powerful part of this team. We need you. We see you as just a huge asset for this movement. So just really excited to be here with you today because it's a marker for me. It's like a I don't know. It's the….

Tiffani: It feels like a sentinel moment. And I echo everything you just said, because our relationship really has been forged on blood, sweat, tears, lots of amazing meals together where we have broken bread and been inspired. And, you know, you and I met each other before I got to meet you, Justin. And it was a very quick love relationship where these common threads, the synergy was always just like fireworks every time we got together.

So I am so proud of you guys. I am so happy for this getting off the ground. And I have no doubt that it's going to be hugely successful. And the exponential returns of all the families, all the children, the lives that you touch, the work that you're doing here is so needed, but just such a value. It's the stuff in life that is worth getting up for in the morning where you can look back on the work that you do and you go, I did good work. And that's really, really what matters. Now, you're going to make me moved to tears because I love you guys so much.

Justin: Oh, that's so beautiful. Tiffani, thank you. Oh, before we get too far into it, just for the listeners, can you give a brief just, you know, elevator pitch of what you do? Like what do you do and where did you come from?

Audra: You got a cool story, Tiffani. I love it.

Tiffani: Oh, my gosh. I've been asking myself that question for about 50 years now. Yeah, well, by education, I am a clinical dietitian. I'm a clinical pediatric dietitian. There's only a couple hundred of us in the country.

So as I did my educational pathway in studying food science and nutrition science and got into the clinical work, I always knew I loved the clinical acute care environment. And I love the challenge in nutrition of, it affects all parts of the body. And it is very much a mind game. So as a dietitian, when you have to solve a problem, you have to mentally visualize the anatomy, the physiology, where the deficiencies can be. And clinical dietitians are really accountants. It's not just calories in, calories out by any means. We are looking at what is normal and out of anatomy and physiology. And then if you put an illness or a disease condition into it. Ok, now how do we pivot with those variables and how do we optimize? Because we're really looking at: how do we get the best nutrition, the best bang for our buck? And sometimes we're constrained where there could be a reaction to foods that could be a clinical state where they can't get certain nutrients.

So I just love the complexity of it. I think my ADD-type mind just loves the activity that fires on all fronts there and in the hospital, I've had the wonderful benefit of working with almost all of our subspecialties. So I love the connection and the relationship.

And part of the reason why I have such a heart for pediatric nutrition is unlike the adult world, in the children's space, the clinicians really value what the dietitians are doing because they know as kids are growing, if they're not meeting those benchmarks and they're not thriving, then they can't discharge them from the hospital. Their primary care doctors are very engaged. So it is a vehicle by which we have access to working and participating in that care team. So

I've been with CHOC Children's Hospital since 1999. I've covered all of their units, NICU, PICU, Pediatric floor. So it's been a very broad scope with everything from preterm birth to age 18 and lots of disease to stages in between, you know, traumas and illnesses and stuff like that.

And then about, gosh, I want to say it's almost been 10 years since I've been working with the chef, who our dear friend Chef Azmin Ghahreman. He really kind of injected new life into my lens, because a lot of times when you are in the hospital, most of the times our patients are not eating food. If they're really, really ill, they're either being tube fed or they're getting intravenous nutrition. And I love the bio pharmacology part of it.

But in working with the chef and seeing him bring in the possibilities to really evaluate not just the quantity, but the quality of food and the impact, again, on that anatomy and physiology, it just really breathed new life into this. And as you can be in the nutrition board that we both sat on together, we work together in building out his school program, the Sapphire at School program. And so that's been kind of a side pet project for me.

And then in the last four or so years, I've been participating in our hospital’s innovation and intelligence group, which has kind of allowed me to level up in a different way too and take that broader swath of jumping into pushing the boundaries within health care. How do we use the amazing resources and talents we have in our children's hospitals and go beyond what the status quo is?

And what is so interesting in the state of pandemic is that I think all of us have experienced, probably firsthand, some of the shortcomings of our health care system. Not that we don't have amazing, wonderful care providers and people that really have great intentions, but the system itself needs to be pushed on. It needs to be updated. It needs to be digitally efficient. We need to have that common way forward. So my journey has kind of taken me into that space as well. But as you know, my heart is always going to be at the bedside and back to my roots. So, so wonderful to be able to have this conversation today.

Audra: Oh, Tiffani, thank you so much for sharing. You have such of, well, it's connected yet varied history. And one thing that I feel like connects it all is that you're truly a lifelong learner and deeply curious person. I think it's one of the things that I love most about you. You didn't, you know, first of all, you didn't originally go to school to become a dietitian. Am I correct?

Tiffani: No, that's correct.

Audra: Where do you start?

Tiffani: I started with soil science.

Justin: Oh, you started in the soil. That's so cool.

Tiffani: Yep, my roots are in the soil.

Justin: I love it.

Tiffani: Well, it is funny because it, actually I had never thought about that kind of poetic aspect of it, Justin. So that is good. But yeah, I think that God kind of laughs at those who make plans in some way, although we do have direction in our life. I also in my years as they've gone on is, you really have to lean into the opportunities that come before you and I, as a very first born Type-A programmed person, it is in my nature to plan everything. And parenthood will break that down really quickly over time. I have three kids, as you know.

Justin: Yes. Speak.

Tiffani: It will put you on your knees. It is the great equalizer, which is what I love about children in general, because one of my favorite things at the hospital is when you have a fancy pants doctor who got married and now they're pregnant, like, “Ooh, this is going to be fun,” you know.

Justin: Welcome to the jungle.

Tiffani: That's right. Because there's even no matter what kind of resources you throw at it, you will be up in the middle of the night with a vomiting baby or you will be driving in your fancy Porsche and that blowout will happen off the back of their car seat, you know. And I love that, because when you break down those barriers, then you have the reality of the human experience, which is really what's always connected us too.

And I know in your space with MaxLove Project, you are dealing with families at their most vulnerable, at the most raw point of anything that you can experience. And yet something as simplistic as food is a vehicle by which you can connect with them. And I, one of my favorite things to say in the hospital is I've been trying to advocate for pushing for more resources or something like this is, every one of our patients has a diet order that offers us access to every one of those patients. They may not need radiology. They may not need rheumatology or other things that, you know, that they always need nutrition. And that is a common thread that we have.

Justin: You need to eat.

Tiffani: Exactly. So that affords us, you know, as dietitians access to participate.

Justin: One of the things I love about your story, especially in the last five to 10 years, it feels like it's both an expansion. So you're expanding, but you're also going deep. And so, standing by like the work that you've done with Chef at, you know, working in the community and with real food and whole food. And so there's this expansion, but then with the innovation work, it's like a deepening. So it's kind of cool.

Tiffani: Well, and it's you get into that space and I know you all have met Dr. Anthony Chang, our Chief Intelligence and Innovation. They are so brilliant. You know, they have 12 degrees behind their names. So it is, I am a big believer of surrounding yourself with people smarter than you are.

Justin: Yeah.

Tiffani: And you and in that opportunity, when you have the chance to actually glean some insight and you have their attention, you think, wow, I actually you know, that imposter syndrome is very real for me, a lot of times as a woman perhaps, or just as me, Tiffani, the dietitian, in the caste system of the health care system, dietitians rank very low.

And yet still I find the joy in the service. And, but I am in more recent years, part of it's because I'm probably of a certain age and have gone through the hazing of having three boys to raise where you just play the game like you have nothing to lose. Because to the families and you know this well, to the families that we serve, there is no greater sense of urgency. So it is incumbent on us as the care providers to recognize that sense of urgency and do everything we possibly can to expedite the process or to push those boundaries or to find solutions that don't easily come to us.

This is not an easy game. You know, this is everybody who's in the space is, we go to bed at night wrestling with different ideas. So, yes, this Intelligence Innovation space, the stuff they're reaching for is big. It is deep at times. And sometimes when they go down those deep rabbit holes, especially with data science and machine learning, I just my brain goes brrk and I think, thank God there are people in this space and this is what they do.

You know, I've always felt that way about different things in health care. And I love that we have this on the forefront.  We would not have the vaccines for this pandemic at the rate that we had were it not for the tools of genomics and machine learning and all these things. We had access to it. But when you finally get the resources and a concerted effort where the whole globe was trying to solve this problem. Yes, amazing things happen. It doesn't mean that the FDA didn't approve the quality and the safety of it. No. In fact, their groups were even larger than a lot of the other things that got approved. But we had that laser focus. We had the funds, we had the research and we had the talent.

Justin: So now, Tiffani. What if we can put just even a fraction of that towards, like school lunch programs?

Tiffani: I agree. I mean, you know, if 80% of our health problems are from lifestyle choices and let's just talk about the healthy, nonaffected, you know, with chronic condition yet population, young kids, it behooves us. I mean, I try to appeal to people's sense of business. I mean, it's just going to make health care cheaper families less like let's lean into that.

There's not a person out there who won't complain how expensive health care is. I mean, it's expensive to die in this country. You know, when you look at retirement planning, you have to factor in, well, what if I need long-term care, nursing or all this kind of stuff. Let's be a little self-preserving here and invest in things that we know will net us wonderful returns down the road, so, yes, I've always thought that it's a very worthy effort.

Audra: This is just one thing I want to make a note here, that Tiffani, that I love about your voice and your expertise and what you bring to the world, and this is the facet of innovator in you that I really, really appreciate, is that you're in there, going down the rabbit hole in data science with these partners, these researchers, these masterminds. We're going to get to keep going down the rabbit hole.

But you're going to take what you learn from that and you're going to apply it to 10 other areas of need. You play a very critical role in innovation of being a connector and a communicator and a unifier and bringing something that seems like it's isolated over here to a domain over here, like that's an aspect of innovation that we really need. And so it's always been something that I admire about you. You can bring, you know, bring things together, connect the dots, you know, pull the conversation together. It's a very, very important part of this. And I just wanted to share how much I appreciate that in you.

Tiffani: Oh, thank you. Well, I, you know, I've had some wonderful mentors. Certainly. I mean, you know, you've met Sherry Farrugia over at Georgia Tech and some of the women that I have had the good fortune to work with. And awareness is really important. There are so many wonderful things going on. And the awareness, as much as we are in an age of information where we have so much stuff coming at us. It really does.

And I'm really believing more and more coming out of this pandemic that people are craving relationship. So to be able to have that person to person interaction, to listen, actively listen to what their needs are, and if you can help them find a solution and then not only throw ideas at them, but escort them over to someone and so now let's have a conversation.

And if we can find the time, if we can cancel the unnecessary meetings that really I mean, all of us are asking these questions, do I need to be in this meeting? Could this have been an email? Do we have to send an email? Please don't send me an email if you don't have to. You know, these kinds of things, because when we get to the real work, when I can take the time to talk to people like you, when people have a need, if I can even do it one or two times, I feel like my life has value.

You know, it's that story of the guy throwing the starfish or the sand dollars back into the ocean where the whole beach is covered with them. And someone says, “Why you're doing it, you're never going to help them.” And he goes, “But it matters to this one,” you know, and they get them back to the sea. So, and that's what life is. It's a series of one-offs that eventually creates that network effect where people, enough people are touched, they see the value, and that attracts more people. And then together we have this ability to really do amazing things.

Audra: That’s powerful.

Justin: It's beautiful. So I want to talk about one of your latest project that at least I know of, which is related to infant feeding formula versus breastfeeding, how to blend these two. I wanted to first know before talking about what you are, what this project is, what got you interested in this, in the arena of infant feeding in the first place?

Tiffani: That's very easy for me to answer as a dietitian and as a mom, because as a mom, you didn't have a choice. You were in it, right?

Audra: Yeah.

Tiffani: And every mom expects I'm going to breastfeed because I'm going to be perfect and it's going to go wonderful. And I, let me talk about the part as a dietitian. When I was being educated and I learned about food, and then I got into my clinical rotations and I got into, we did community stuff, we did school lunch program stuff and then we got into the hospital. I'm like, ok, hospital is my jam. I love it here.

Then I went into critical care. I'm like, oh, I love this even more because I love the nerdy go deep into the science kind of stuff. And then what else do you have? What's the more challenging thing? And I kept going and going and going. And to me, the most challenging patient you could have is the preterm baby in the NICU, because here we have something that is first of all, you have to understand how humans develop physiologically. You know, they can only be viable so early. And then when they get to term their course is usually that it's a very predictable course in the NICU.

But also, when that baby comes out of the woman's body, immediately, their nutrition is cut off. So it is the burden of the dietitian and the care team to mimic the amount of nutrition that that baby would have otherwise been getting from the mom in utero. I found that so fascinating. I mean, how do we sustain this little life? You know, it is absolutely hanging on.

So that, from a clinical standpoint, was a major challenge then. I love just the sheer I understand now you get to witness the development outside extrauterine, watching this baby do things that we wouldn't otherwise see. You know, we look on ultrasound, we see a baby sucking a thumb. It looks really cute. Now we get to witness the baby learning how to suck, swallow and breathe and coordinate things and how they go through those developmental stages. And we have an amazing care team unit at CHOC with the development and really preserving that.

So I just love that problems that so getting into infant feeding was really, really dear to my heart. In the NICU, we work with breast milk as much as we can. So we deal with the really, really the nuances, the subtle nuances of how a baby can tolerate those feeds, the qualities of breast milk, how amazing it is and what the insufficiencies are, because breast milk is made for a term baby, not a preterm baby. So in all my years in, the NICU is really given, anchoring me in appreciating the value of breast milk.

Now, go back to Tiffani, the mom. I found that when I was breastfeeding my kids and struggling, you know, it's not an easy thing. What do you do when you can't have breast milk? You know, what do you do when you want to be that mom? And so then you turn to formula and many moms feel very like they're failing for whatever reason. And some parents are like breast milk formula, fine, whatever. That's fine. But many people who intend to breastfeed really feel like, that they want to do it perfectly. And we are so binary, right? It's like I need to do it perfect or I don't.

And so in looking at the qualities of the different formulas and certainly knowing that I worked with older populations and understanding nutrition, that formula selection really is the first food choice that you make for a baby. So taking what I know about all the qualities of breast milk and trying to translate into what's a good substitute for it, and then couple that and wrap that around the emotional state of the mom, the economics, the social part, all of those dynamics. I just really my heart goes to that problem set because I've lived it, but also that moms are natural nurturers and mentors, and we need to share what we know with other moms. And so it's neat to be able to come from a mom angle, to come from a dietitian angle.

So recently my work in the infant formula, I've had the opportunity to work with a new company who launched the first new infant formula brand in the last five years. And they've become approved through the FDA. And the company's name is Bobbie. And it's been really wonderful to work with a startup company. It was started by a couple of moms who were faced with the same problem: I really want to breastfeed. It's not going the way I planned. I need to supplement with formula. I go to the formula aisle and how do I make a good choice? And that's a huge, weighty decision for mom.

But from the innovation side, they recognize, too, that there was this huge demand for European formulas and did kind of a deep dive into why. Why are people turning to a European formula versus what we have here in the US? And looked at the standards that were over there. So the EU has very different standards than we do here in the States. And there are families who wanted these formulas that were importing them. You can't ship directly from Germany to the US. So you have people that buy it off of Amazon. But the supply chain wasn't guaranteed and the quality metrics were not in there. And so they were put on the red list by the FDA. And so even though there's a big demand for it with this population, people are still doing it, but there's a safety risk. So now…

Justin: I had no idea. So there's like a black market and European formula like.

Tiffani: Exactly.

Justin: Guys in trenchcoats.

Tiffani: Yeah. Yeah. And so and then if you get a baby, you know, on a formula that they love and then all of a sudden you can't get your shipment, you're stuck. I mean, what are you gonna do?

Justin: Gotta go down to the docks.

Audra: And moms trying to make their own and. Right. Mmhmm.

Tiffani: Yeah. But if you know, if we look at the quality of, what we have to ask ourselves, why would people do this? What is it that they think is in this formula that makes it so unique? And really, when you look at those EU standards, they are looking at how you're sourcing all your ingredients, how your most of them are cow’s milk based. And so how is that cow grown? What is the life of that kind of like?

Audra: What kind of cow is it?

Tiffani: What are the additives that you can put in there? In Europe you are not allowed to put added sugar into infant formula? Like we can't, you can only use lactose, whereas here in the United States, we can use corn syrup solids and other things like that. So those things matter. And so I'm really proud of this company and that they've taken on those very high standards. And that they went through all the rigor of going through our FDA process here in the US, they’re Organically Certified too, which is another very rigorous process. And they just created a very simple, beautiful formula and created a community of support around moms. Because if you look at the community of moms that need formula, they're working. It may be an adoptive mom, it may be mom who had multiples who can't make enough for two or three babies. It could be a mom that had a double mastectomy and realizes that her insurance company will send her a breast pump, but they won't send her reimbursement for formula.

So this company is stepping in to say, to step in and say, you know what? There's a gap here and we can do better and we can support these moms, the moms that feel shame, like they failed, like I tried to breastfeed and I couldn't do it. What about the moms that just need to supplement? I mean, my message as a dietitian was always, listen, your body grades on a curve. So whatever breast milk you can provide, you get credit for it.

Justin: Yeah.

Tiffani: And what and if you have to supplement with formula, you know, don't worry about it. The baby will benefit from both. So, you know...

Audra: Can we just say that again? Like I really want to punctuate that, you know, that every ounce of what you provide in this journey, whenever you provide it, matters. And counts and supportive.

Tiffani: The body is very good about grabbing what it can and it grades on a curve. And so you get all the benefits. So, you know, if you can only provide a little bit of breast milk, that's ok. You get all the benefit of that little bit of breast milk.

Justin: I love it. The body grades on a curve.

Audra: You know what I want, I really, Tiffani, I've shared this with you, but because we are going to be putting this out to listeners and Justin remembers this really well. I had breastfeeding challenges with both kids. Bobbie is making me want to have a baby again. You know, I want to do this again.

Justin: Oh right.

Audra: And it's, I have to share a couple of these challenges. First of all, I had to have C sections with both kids, and I experienced the questions around that just from other mothers. Like why? Why do you need to have a C-section?

Justin: Are you sure?

Audra: Are you sure? Yeah. Yeah. You know, I'm sure medically necessary. I had a myomectomy when I was 20. When I was 21 or 20. Yes. And then on top of it, I'll never forget when Max was born in Santa Monica and we had terrible, terrible trouble with him in the hospital feeding. I mean, he would bend his back backward screaming, didn't want to latch on Justin goes to the pump station, I should say, or this business and says, “Hey, do you have a nipple here? It's kind of like a lot like a real nipple, because I have a baby we’re in the hospital” and they're like, “No, we will not sell this to you. The baby will never latch on if you do that.” Right.

Justin: I forgot about that. I forgot about it.

Audra: So we have to go back and find out about it, of having him suck on a binky for a second and then latch on. And I remember going home with a hospital-grade pump, feeling like such a horrific failure as a mother saying, “Ok, I'm going to pump this milk as much as I can and I'll feed him in a bottle underneath a cover so nobody will see.”

Tiffani: Mmhhmm.

Audra: It's a bottle, even though it's my milk. And then when at six months, you know, I have to go back to work at three months like everyone else. The little bit of supply I had, I was getting through just maimed and tea bags, like trying to heal, and all of it. And I go to work and my supply just starts to go down and down and down. I mean, it's a story of so many moms, right? And down, down and down.

And so I start looking at the formula aisles and we have to start supplementing. We have no other choice. What are we going to do? Max stopped breastfeeding. He just stops at one point. He only wants a bottle, he stops at six months and, you know, an acquaintance at the time said, “oh, oh my god, what are you going to do?” Like, obviously, I'm going to let him die. What do you think I’m gonna do?

You know, and so it is, there's this social pressure. There is this valor that comes with a mom who can breastfeed until she's three. Until the kid’s three. And I'm not critical of that, like you do you. But why has this turned into such an assault on working mothers and mothers of all types and mothers who can't and the judgment that comes when the bottle’s presented.

Tiffani: Yeah. And you touched on something so important. People don't recognize that we're kind of set up to fail, too. So when you say you have a C-section, you probably had prolonged IV fluids given to you. You know what? That delays your milk coming in.

Audra: Oh, that's why it took five days? That’s good to know. They didn’t tell me that.

Tiffani: Yes. They don't tell you that. They don't tell you that you had blood pressure, that you were never had a history of surgery or anything. They don't tell you those things. And if you only get 48 hours for a vaginal delivery or four or five days after a C-section, you haven't even gotten into that window where your milk has come in. And meanwhile, your baby's been hungry for four or five days.

Audra: Right.

Tiffani: You know, what are you supposed to do? You can't win in that way. Now, you can succeed. You can go through and supplement and really commit to breastfeeding. You know, it's not like it's, the baby-friendly hospital, which is what you're talking about, which is very, very well-intentioned, has had a really dynamic effect in this place, especially on women's mental health. So let's talk about that a little bit, because I had never experienced, I didn't know I could be jealous of another mom, because when she pumped, she got 10 ounces every time. I was so envious.

Audra: She's freezing her milk. And you're like, why do you have enough to freeze?

Tiffani: Right. Like they open up the freezer and it would be like a 12-year supply.

Audra: Yeah, yeah.

Tiffani: You know, and it's like. And then the other thing is, I would, whatever I could pump off, I'd put it in the refrigerator and I'd have like the thinnest little layer of fat on top. I like pump like nonfat milk. And, you know, the other moms were Dairy Queens that were pumping cream.

Audra: Yeah.

Tiffani: So, you know, and you have no control over this. Your body as a woman gives you the number of milk ducts that you're going to have, which is why, and usually the dairy queens were like back in their size two jeans like three weeks after delivery too. That is not possible. Is that I am trying to eat, trying to sleep, trying to drink enough water. I'm doing everything. It can't be forced. And then you add the anxiety, like it's snowballing on you. And then they're like, well, you shouldn't be stressed because that will affect your milk supply. You're like, wait a minute here. So we really, moms need people to come alongside them.

And like I said, as mentors, as friends, to just say, “You are enough, you delivered a healthy baby. Let's not forget that point. We have options. Produce what you can think about what works for your family and your lifestyle, and then let everything else go.” Make your decision and then enjoy your baby.

Because I, I hate to think that those new moms who should be one recovering from birth, because we all know that that's got some things there. But two, this is a new little life that you've brought into the world and you need to enjoy that, you need to accept your new position, your new station as the parent. And whether it's your first parent or your first baby or your fourth baby. It changes your family dynamic. And so the kindness factor, coupled with the science, coupled with everything else that moms are trying to handle, this is what really drew me to this company, Bobbie in particular, because they recognized we're not just here to sell formula, of course, that's their M.O. But you know what? 83% of families will turn to formula in some way during that first year of life for their baby.

Audra: Yeah.

Justin: Yeah.

Tiffani: That's a pretty high number.

Audra: Yes, 83%. Yes, we need it.

Justin: There's a dad’s component.

Audra: We need to normalize it. Yeah.

Justin: I just had the flashback. I totally forgot about this. How happy I was to be able to feed Max…

Audra: And Maesie. Yeah.

Justin: Yeah. I mean that. But for the firstborn to realize like, oh, I really I'm so glad that I can take a role in this. And yeah, I remember.

Tiffani: Well, we've had dads come back and say, “I was so relieved when my wife finally gave up trying to pump it, you know, when she wasn’t producing anyway.”

Justin: When we were done.

Audra: Yup.

Justin: Yeah, I remember that. I was just so…

Tiffani: Like, it makes them feel like they get their life back. Yeah. And so, and no one here is advocating against breast milk...

Audra: No.

Tiffani: Don't mistake me. Breast milk is amazing. I mean, I love, you can study. It's like studying space. It has infinite qualities to it between the pre- and probiotics and the immunoglobulins and everything that it does. I mean, I used to in my early days, you know, used to say kind of snarkily, it does everything but clean grout. But now I pretty much have evidence that I can clean grout.

Justin: It can clean grout as well.

Tiffani: It’s amazing. Yeah. But I look at the fragility of these new parents and it, my heart goes to them. I want to help navigate making wise decisions. And I love that something familiar, something like this one says, well, “Ok, if you do need an alternative, let's make it as clean and simple and as beautiful as possible.”

Audra: Absolutely.

Tiffani: And so I think that and my other message to these parents is pace yourself, because this is the first food decision you're making for your kids. You have a whole lifetime of decisions to make.

Audra: Yeah.

Tiffani: So be kind to yourself and pace yourself. So I love even having that language of a formula is your first culinary decision, if you will, as a parent and start learning how to qualify, okay, what are your values around food? And again, maybe an 80-20 rule? We're not aiming for perfection here. We are aiming for being informed and making good choices that work for your family.

Audra: We're all about the 80-20 over here. I think that's phenomenal. And it's a beautiful point to make. Tiffani, I think in our generation, we are a part of the pendulum swings here, right. We have mothers who were advocates, probably our mothers, you know, might have been advocates for breastfeeding in a time that was hostile to breastfeeding. Right?

And even at our ages can experience various hostilities towards breastfeeding and the activism that has gone into helping mothers get access to breastfeeding and understand breastfeeding and feel supported and being able to breastfeed wherever they need to and in public and at work. And, you know, all of the different things. I love the activism. I get it. It's so important. I get that we are coming from a very deep hostility towards breastfeeding. And for it, like in many things, the activism turned towards hostility, towards formula and bottle feeding. Right.

Tiffani: Right.

Audra: And so we're trying to bring grace into the space and trying to help, you know, kind of normalize whatever it is that someone needs to do. Let's just be fully supported in all of these choices.

Tiffani: Yes, exactly. We do tend to have that pendulum swing from one extreme to another. And the reality is that we're all in that swath, the pathway of the pendulum at different points of our lives. Again, my heart goes to these new parents because it's a wonderful time and it's an exciting time, but it's a very fragile time. And so to be able to come in and if we hit them too hard with the science, you know, just like the baby-friendly thing, yes. Most of their efforts were very evidence-based. And I understand their intentions.

But in the meantime, you've got this sobbing mother who is just trying to keep it together. And we are discharging them home. And we want them to have a peaceful, successful home life, to be able to grow a baby that can thrive. Which is why I love the name of your group, The Family Thrive, because it covers everything from birth forward. And each stage and developmental stage and phase that we go through, not only as kids and parents, but the whole family in it.

There are different definitions of thriving and it takes different resources and it takes that empathy from our caregivers in our community to recognize, well, that wasn't my experience. But boy, I can certainly understand yours. And I would like to help. I would like to help provide resources.

Audra: You know, Tiffani, that that brings something up for me, too. Going back to your comment on the very first choice we make in feeding our child. The mental health of the mother and of the parents, that very first choice, setting down the path, starting to think about your values around food. And I think that this is a really powerful time that I don't know that I've acknowledged very much either and it's something that I'd love to talk a little bit more about.

So this, you see these steps that we take when we make these initial choices to incorporate formula and then maybe the next steps in solid foods and things like that. I'd love to know if you have any tips or insights, because it comes down, what I am starting to think of when you start talking about the mental health and well-being of the mother and of the family, is the more that we can de-escalate that initial stress around feeding, because feeding is the most important thing. Right. It seems like when we came home with our babies, it was like, oh, my god. Feeding. Right. And the counting the pee, counting the poops, what goes in, what comes out and that doesn’t leave you. You know, you end up with a six-year-old, you're following around with a spoon of food because, you know, you want to make sure that they get that one little bite of nutrition in.

Do you have any tips for new parents on just developing some mindfulness around those values? Because I think it's something we don't think about or talk that much about. I'd love to know if you have any thoughts on that.

Tiffani: Well, in the early days, for sure. You know, I totally remember what you said about counting the diapers and trying to do it right, especially if you're breastfeeding and you don't have a quantitative volume, that's where the mystery just becomes so hard. I mean, if you are pumping and putting it in a bottle is, you know, what volume you're feeding. So in those early days, I think having the metrics is very valuable, getting that benchmark of back to birth weight within the first two weeks, and then you feel like, ok, we're trying to get our groove on.

And I can even remember as a pediatric dietitian who I think knows more than most about the actual ins and outs of food. When my first was turning one and I had weaned from breastfeeding and we were discontinuing our supplemental formula, I thought, “oh, my gosh, I don't have that insurance policy anymore,” because I knew formula and breast milk is nutritionally complete. So now I was responsible for everything that I said. My kid had to meet all of the needs for nutrition. And I just felt the gravity of that responsibility of like, I better do this right.

You know, in the US, we address it so differently. We label things and I would say this, even for kids and adults, and we like to wear our banners of like “I'm a paleo vegan” or “I'm on this diet.” You know, we like to know that we have those constraints and boundaries and that we're doing it right. And then we take pride in that. If you were to look at other countries around the world, food is love and relationship, and its history and culture. And they feed their babies seasonally because that's what they have access to. And we tend to standardize and make it a protocol.

So when you look at introducing foods, we start with a puree consistency because it's appropriate for what their palate can handle. And you're trying to introduce those different textures as the mouth palate evolves and their developmental skills evolve to the point where then they get some teeth and they can chew. And then you think about not wanting to have choking hazards and stuff like that and being on the lookout for allergies so that you're introducing individual foods and watching and seeing how the baby responds to it.

There's some strategy to it, if you will. But it's not necessarily adopted with other cultures around the world. I think knowing what the family's values or what their approach to food is, helps people drive what they're going to aim for. Because ultimately, when a child is about a year old and everything developmentally has been on track, they're pretty much eating what the family is eating. It just might be modified in its chopped size or consistency just for hat. So you're really trying to get them from birth to 12 months to kind of get in line with what the family's doing.

Now, I have seen families take the opportunity in trying to do such a good effort with their child that they've actually improved their own eating habits in anticipation. If they can make that connection of like we are a family unit, what do we want to do for the family? And so I've actually seen some families rise to that occasion of like, ok, well, you know, I'm glad he likes the jarred peas because we don't eat peas. And I'm like, “well, should you?” You know, like what do you want to aim for? Because you're giving him sweet potatoes and carrots and, you know, all these different things. You're giving him cut up pieces of banana and now you're doing berries and stuff like that. How does that incorporate into your family? Because ultimately a family is a unit. Basic home economics will tell you that it's a whole lot cheaper to cook for many than for one. So know from a practical standpoint, as that kid develops their eating habits, you want to streamline that in there.

So I don't know if that's what you were aiming for know, but it's kind of a global lens on what are the goals, what are the aims? There's obviously very iterative steps to get there. But if you look at it holistically on what does the family aim to do, what's practical, do you have two working parents, how much time do you have for shopping and meal prep and stuff like that? But I think with a little bit of strategic planning, you can get there. And then it again takes away that power from the mystery and that you feel like, ok, I feel like I've got a sense of understanding of what we're aiming for and this is what we do. And you step into that identity of this is how the Ghere family is approaching food. And I am getting to experience the wonderful. It only took 18 years, but the wonderful opportunity of the kids being able to advocate for their own food choices, to see them go out with friends and get creative and experience new cultural food experiences, as well as cooking their own meals.

Audra: Yeah. Tell us more about what you are seeing, because it sounds like to me that if we can de-escalate the stress around the home and like bringing baby home, breastfeeding, bottle feeding, you know, all of the stress and anxiety, that is really, I think, social pressure.

Tiffani: It is.

Audra: And if we can de-escalate that and provide that focus on how we want, we want to nourish this new this child, this new baby we want to nourish, and then we want to provide a home environment where we keep that goal of nourishing. So whatever that timeline, strategic plan is in place, even the mindset that we can level up, that we can rise to the occasion. We had that experience only when faced with a medical crisis. I think it's really powerful to think like this baby is coming to the family table. We can level up for all of our benefit. I think that's just such an amazing point to make.

And then I'm so curious. Mom of three boys. Three boys raised by a culinary-inclined dietitian who, you know, knows all about how things start with soil health from the ground up. What are some of the cool things you've seen in your sons as they're like autonomist folks now?

Tiffani: Well, I will tell you that we are just like every other family. They’re kids, you know, you can't necessarily groom them to be exactly the way that you want them to. You know, my goal, as much as I have had a lot of experience with food, my goal was always to be kind to myself, too, and not to be too overarching and to just expose them. I can remember sitting at the table when everyone has that where they don't want to try something or whatever. And I would try to remind them this was probably a grade age.

You know, my goal as your parent is that when you're a grown-up and if you got invited to the White House that whatever they serve, you would be cool with that, that you wouldn't be afraid of it, that you could you know, if someone said you get to take a mission trip to a foreign country, could you adapt to what's going on? I wanted them to have. It's funny because as an anal and as Type-A as I tend to be, I try to actually train myself to be a little bit more chill on it, and recognizing that it's not a battle. And really, the victory is going to be won in the very long game, which is, I wanted them to have an adventurous relationship with food.

I wanted them to be inquisitive. I wanted them to understand where it came from. I wanted them to taste things. Everyone goes on their own timeline. But I do have three pretty open, adventurous eaters now as they're getting into their late teens or early adulthood, which is, that was my goal. So now I can hand them off to the world, right?

Audra: Yeah. Yeah. It's a great point, too, that it's a long game. I think that's one of the things that's so rushing in this is that there are a lot of no's along the way. You know, you provide a lot of really cool different things or broccoli or whatever, and there's a ton of no's before you get to yes. And so it's a long game that takes a good amount of kind, graceful, open persistence.

Justin: Well, there's a lot of no's on the side of the kid. But I'm curious, Tiffani, what were the no's or what are the no's for you when thinking about food in the home, meals in the home? Are there some, I don't want to call them like hard and fast rules, but food general guidelines, where like, no, we're not going to do that here.

Tiffani: Yeah. You know, for us, it is interesting because we never had, don’t anyone misunderstand me. If this is in your pantry, this is not a judgment. This was just my own personal choices. But knowing that the affinity for sugar is an acquired taste. So the more exposure you have to the high, sweet things that you would be, you know, you would continue to have that high affinity for sugar. So we never had juice in the household or the sodas or those really high artificial sweetener things. We did use yogurt. We had berries with it.

It wasn't that things were a no. I just tried to do the best decision making with the quality that we could, always having that mindfulness of quality and knowing that if they went to a friend's house and they got the Gogurts and they got the you know, that they had mom, how come you never told me about fruit punch? It’s awesome. How come we don't have jello, you know?

Justin: My gosh.

Tiffani: And it's fun. But you know what, what I love. We got to travel to my sister's house. We got to travel by plane over Christmas. And here I am with my two, two of my three grown kids. And they were doing a beverage service. And the biggest treat that they always thought was to get apple juice. So they both I watched them order their apple juice because we just never had juice in the house. And you know, now they, are they candy fiends? Yes. When you go to junior high, there's like a black market for trading candy out there. And it is hard to fight, you know.

But I do remember that especially with grade school, you know that packing the lunches, especially with the first one and trying to be very thoughtful. And then they go and they're surrounded by all kinds of processed foods and things that are high in sugar. And they didn't feel as popular. So my angle was always, we're going to have all kinds of treats and cookies in the house, but I'm just going to make them from scratch. And then I have control. Like I can downgrade the you know, if it calls for a cup of sugar, I can do it with like two-thirds of a cup and it's still ok, you know, and using that high-quality butter, my approach was like most of our food will probably rot in two to three days. And, you know, sweets included. And that's kind of the road that we took.

But there's many ways to get to a path of success. And sometimes there are drivers in your life, as you guys know, where you have to put that and if something is forced on you. Let's say two of my three kids have very close friends that are type one diabetics. And it's been very interesting to watch them and their empathy that they have and understanding what they have to do.

In fact, one was very protective of her, and she didn't get diagnosed until she was, I want to say nine, which is a little bit later down the road, so he had that awareness that tore my heart strings open, I just I burst, I was my heart was breaking for the family because I knew how much of a lifestyle change is going to be. But my heart was so proud of my son who had that empathy and recognize that she has to look at her food differently. And I know. I want to. I want to. He was watching out for her at lunch time and trying to like protect her from other kids, going how come you don't eat the Gogurt or how come you don't do that? He was trying to like, kind of jockey to protect her.

So, you know, this is why we can't forecast everything we want to do with food with our kids, because hopefully they come back and surprise you in a delightful way. And I tend to go to that holistic overview so that they have the context, because our job as parents, my mom used to tell me this, and I do agree with her that if you're parenting, if you're doing it right every day, you're working yourself out of a job.

Justin: Beautiful.

Audra: I love that.

Tiffani: When you get to that phase where you're actually working yourself out of a job, it tears your heart open, but it is the marrow of life. And so, you know, you plant those seeds and then you get to see those wonderful returns. But at the early years, you know, there's a lot of support needed.

And I think what's really important is that we give these new parents the confidence to say, you know, “we thought about this, we made a deliberate decision. I'd appreciate it if you could support our decision” and then we can enjoy, you know, I think about Thanksgiving, right, where grandma or someone always has an opinion about what you're doing. And, you know, just to equip people with the language to say, you know, “we really we really thought about this and it would really help, but this is how you can support me,” because when you use that language, it actually we're struggling. And so could you please. And then you get to give people the equipped messaging that actually creates that better support system. And it's not about the food. It's about control. It's about who has to be right. And I try to break that down so that we can disarm people and really have true meaningful relationships that are supportive.

Audra: I think that's so helpful, Tiffani. Yeah. Thank you for bringing that up in like, we have a module on that MaxLove Project that I think we need to bring into The Family Thrive setting as well. Lexi Hall, the dietitian we work with who you know very well, from CHOC, did a Fierce Food's Academy with us around Friendsgiving and specifically to help families with these challenges that come up around, you know, bringing your own family's choices into family settings, social settings, and things like that.

I also want to just reflect on your comments on your parenting. I love hearing this and hearing this from a dietitian. I feel like it's such a beautifully, you know, open, pragmatic way that there's not. We don't have to have like, super tight reins, but we can figure out our own kind of equilibrium in the home. You know, that makes sense for us. And I think it can be hard to sort of stake your own claim in that, like without having a model out there. So the more stories we hear from other parents on how they've done it, the easier I think it is for new parents.

You know, I think in our case, we ended up with a kid, we needed to go on the ketogenic diet. You know, we needed to do it as a family. But then raising his little sister to make her own choices and to be her own person and getting into bio-individuality and kind of the diversity of what we provide in the home. And I will be totally straight up with you. We have these like Annie's mac and cheese, little plastic things in there that she can fill with hot water to have mac and cheese. And one thing that I've really loved is she will down two flights of strawberries. No problem. She'll eat entire English cucumbers. No problem, like you know, when she goes into the fridge, she's going for this stuff and she still has it.

And she was like obsessed with these. Like, can I have mac and cheese? Sure will buy you the mac and cheese. She wants to have it for breakfast. Fine. And she's making them for herself. She's doing it for a couple of weeks. You know, they're in the pantry still. And what is she making for breakfast? She's making an egg sandwich. She's been making smoked salmon with cream cheese and capers and lemon. You know, as her, I mean, she's making these fabulous choices. And I said, “why don't you eat the mac and cheese anymore?” And she was like, “eh, it's just not really that great,” you know? And that has worked for us. Talking about bio-individuality, providing some of these choices has worked for us.

Justin: No offense to Annie’s.

Tiffani: No offense to Annie's at all.

Audra: Oh no, no, no, no. It’s not about that. Not about that at all.

Tiffani: It's a testament to the evolution of her palate. You know, and you touch on something else really important, too, is as kids grow, especially in their you know, it becomes less frequent as they get older, but they go through phases. You know, you see it radically in ages one through three where they'll go on food drags where it's like all they want are goldfish crackers. And last week, he was eating lots of kind of chicken. Now this week, he doesn't want it. So they go on strikes and they go on drags and then they go through different phases, too.

And I love that you're also touching on the fact that, because it takes a lifetime to develop that palate, you know, we know that it takes at least 20 exposures to a food for a kid to know if they do or don't like something. And many times that they don't like something in their early years. It's not because of the taste. It's usually the texture or the temperature. So there are different forms of offering of foods. Like it's not that you don't like carrots, but, maybe you don’t like cooked carrots or cut, you know, raw carrots.

Justin: Yeah. Right.

Tiffani: So, I mean, that's really important to know. But the fact that Maesie has that sense of curiosity and exploring and then mashing up different, that's the evolution of the palate. And Chef Azmin can definitely explain it in better terms than me. But I love that. I saw the same with my youngest, Carter, too, who was definitely a fierce advocate for mac and cheese. I think we had the Costco, the Costco brick of Annie's mac and cheese.

Audra: Yeah. Yeah.

Tiffani: And now I do, I think somewhere in an old closet, that brick is still there because he's evolved and he still loves pasta, but he's making his own rigatoni alfredo, and adding the vegetables and the chicken to it. And, you know…

Audra: Does he like the feta pasta? Does he like the TikTok feta pasta? Maesie loves that. Loves it.

Justin: Just so we don't run out of time...

Audra: Because we could talk forever.

Tiffani: Yes, I know. No, keep that keep us on track.

Justin: I have one final topic before we get into our last three quick questions. So the last final topic is when we had our podcast interview with your colleague, Lexi Hall, we ended by talking about food myths, you know, because in not just in the world at large, but especially in the parent world in the discourse, there's all these food myths that are circulating. So we talked about a couple with Lexi Hall. And I'm wondering if you have a food myth that you have come across or that you regularly come across and you want to bust it?

Tiffani: Well, I don't want to cover something Lexi already did. What did she tell you?

Justin: So well, we covered meat. So like meat is going to kill you. So that's a myth.

Tiffani: That's a good one.

Justin: Alkaline diets are these super healthy, magical things. Yes, we busted that one. And then eight glasses of water a day. We busted that one. So those are the ones we…

Tiffani: I agree with all of those. Let's see, so I'm often asked, and I end up saying this when I'm educating families, like if there were five foods, if I could only choose five foods to live on. And one of those five foods is eggs. And so I think one of the myths is that if you eat too many eggs, you're going to have high cholesterol. I think that came out of our ‘90s education on heart health. Again, well-intentioned, but it's not been validated. And if any part of cholesterol gets raised is the HDL, and that's for good cholesterol. So I love eggs, and I eat them every day.

Justin: Heck, yeah.

Tiffani: I have decent cholesterol. I have pretty good blood glucose control and there is a tie to that. So dietary cholesterol doesn't necessarily tie to serum cholesterol, which is your blood cholesterol. And I, the way I explain it is this: there is enough nutrition in that egg to grow a whole chicken. So I love caloric density. There's enough nutrition in a nut to grow a whole tree.

So when people ask me what are the five foods, I think of avocado, eggs are on there. I think of nuts. I think of a fish. And again, those are very nutrient-rich type things. So I think that would be the myth-buster that I would go to just because I am such a fan of chickens and while not vegan. You can eat an egg and glean a lot of great nutrition in an ethical way that actually isn't a harm to a chicken. And so I'm hoping that it also reaches a wider part of the population that as a food choice.

Justin: Brilliant. Yes.

Audra: I love hearing that from you. Yeah. Thank you so much. That's one that has come up recently with yet another study that was pulled in by the media attempting to disparage eggs. So thank you.

Justin: Yeah. And speaking of Maesie, this is one thing that, one of the hardest things right now to do with her is to get protein in. And, you know, because she, yeah. Audra’s, right. She'll eat tons of berries or eat tons of veggies and all. But it's like, ok, can we just get the protein? Or so I will tell her. I'll stop bothering you for the rest of the day. If you just eat an egg, just eat and then I'll be done.

All right, so let's get into the final three. These are quick ones. All right. So if you could put a big Post-it note on every parent's fridge tomorrow morning, what would that Post-it note say?

Tiffani: You're doing a good job. You are enough, really. You are trying to raise a human being. And it takes a lot of effort. And we are so hard on ourselves and we think we're not good enough. It's like imposter syndrome again or something. And everything, we will hear the one negative, the one negative thing will completely derail us, even in the presence of 100 compliments. And so reinforcing that they are enough and that they are doing a good job is enough to get them to pause and breathe. But any insufficiencies or gaps that they have, it affords them the time to go seek out help or find the education and they can do it. So it starts with, except that, you know, you can do this. You're completely capable.

Audra: Tiffani, I feel like you just put that on my fridge. Thank you. Like I sort of get emotional. Yes. Thank you. Thank you.

Justin: We need that.

Tiffani: I know you probably wanted us food one, but.

Justin: No.

Audra: No.

Justin: No, no, no, no.

Tiffani: It's again, it affords me that access to connect with people in all the years that I've been working with families and patients. And it's such a pervasive reality that we have these people that are struggling with a clinical status of a child. Let's back it up. Let's look at what you're actually doing. You've walked a hard road. You can do this.

Justin: Absolutely. Second quick question. Do you have a quote that has recently changed the way you think or feel?

Tiffani: I do. And it's funny, because the one that I used to always cite was Maya Angelou’s, “When someone shows you who they are, believe them the first time.” And part of that speaks to being burned and becoming aware of like, ok, I'm going to recognize people for who they are.

But Audra, you actually posted it to Instagram, I think it was just a couple of days ago from Angela Davis. “I am no longer accepting the things I cannot change. I'm changing the things I cannot accept.” And that just really speaks to my present of mind right now where, like I said, go bold or go home. Children and family are depending on those of us that are in this professional world, we owe it to them to swing from the fences.

Audra: Oh, absolutely.

Tiffani: Obviously, another testament to how in-sync we are in our like-mindedness, but.

Audra: Beautiful. Yes, I feel that fierceness in you, Tiffani, that it's like this is your life's work.

Justin: Yeah. Oh, for sure.

Audra: This is your world changing. You know one starfish at a time. And this is it. You know, it's really, really inspiring. And it's a beautiful call to action. And it's something that The Family Thrive is all about. And I really appreciate hearing your fierceness in it. And the emotional component to this. Like this is really, really powerful, needed work. And I just really appreciate hearing that call to action from you. I feel more charged up in my day.

Tiffani: Oh, it's amazing how cyclical it is, because that's how I feel about talking with you guys. You know, this is what synergy is, where you find that like-mindedness, you find that common goal that you reach for, and then you allow people with their different skill sets and talents to come together and create something unique and dynamic. And people respond to that. And as someone who's given many a lecture or a nutrition talk in my day, it's always in the back of my mind that people walk away with how you make them feel, not what you say.

Audra: Yeah.

Tiffani: And so if you can touch, if you can connect in any way, no matter what kind of information you're dispensing that day, that connection is what people truly crave. And it's not that, that's not all that they need, but that's how you start. And then it affords you the opportunity to gain their trust, to create that awareness. And then you can provide the education and then you have a bonded loyalty that creates that greater network that's going to be really, really powerful.

Justin: Awesome.

Audra: Couldn't agree more.

Justin: So the final question we ask, because for, at least for parents of young kids, you know, it's a marathon. It's exhausting. And at the end of a day, you can say, oh, kids, just like so much work. But at the same time, kids are totally awesome. So let's celebrate them. So we want to know, what do you love most about kids?

Tiffani: Well, like I said before, I think they are the great equalizer because it does break down the adult to a place where it does open us up too, because if we are so closed and buttoned up, we lose a lot of things in life. But kids don't lie and they let you know with complete transparency and utter honesty how things are.

And it's positive in the negative. You make something for dinner and they hate it. I mean it. And as much as we get thrown back in your face. Right. We know that with a toddler. But they're forgiving and they're loyal and they're loving. And they show us as adults that that compassion and that commitment is hardwired in us. And this is who we were supposed to be from day one.

And so I think it reminds us as adults to remember that, you know, and for those of us that are spiritually-minded, I think about biblical teachings where even Jesus connected with children, and that even relating to something as grave as pondering the existence of God and relating to God, he did it through the vehicle of children.

So I think that for these big things that we wrestle with and parenthood is a big thing to wrestle with. To remember to look at it through their eyes and we'll glean such great insight. And I've seen it, like I said, with all those wonderful doctors that I work with that are so accomplished and so brilliant, you bring a child into their life.

Justin: Yeah.

Tiffani: Like what do you really know?

Justin: Exactly. Yeah. Tiffani, ok, before we sign off, how can people find out more about your current work and just how to follow you?

Tiffani: Oh, well, I am with CHOC Children's in their Medical Intelligence and Innovation Institute. We call it MI3. And you can certainly reach out to me via LinkedIn. Yeah, I love to connect with anybody who wants to be in the space. Anything I can do to support The Family Thrive. You know, I'm in.

I'm so excited to see your efforts grow and the community that you're building. And it reminds me of how we drafted the banyan tree all those years ago. And it's just taken roots and it's just growing, only it's under the umbrella of a magnolia tree instead of a palm tree. But I'm so excited that I get to see you next week.

Audra: Me too, I can't wait. Thank you so much for spending this time with us today, Tiffani, it was beautiful catching up with you.

Tiffani: Thank you, guys. Love you guys so much.

Audra: The first of many, too. We love you, too. A first of many.

Tiffani: I love it. I love it.

Justin: Awesome.

Tiffani: Well take care of you guys. And I get to see you next week.

Audra: Yeah.

Tiffani: Travel safe.

Audra: Okay. Thank you so much. Bye Tiffani.

Justin: Hey, thanks for listening to The Family Thrive podcast. If you like what you heard, please subscribe, tell two friends and head on over to Apple Podcasts or anywhere you listen to podcasts and give us a review. We're so grateful you've chosen to join us on this Family Thrive journey.

Justin: I don't know about you, but when our first baby came into the world, feeding him was really hard. It caused us a ton of stress. And then when we transitioned to formula, many months later, we had more stress because we didn't know which kinds were best. And we also had to deal with the stigma around formula in our social circles. We might have stressed out again as we transitioned to solid food, but honestly, it's all a little blurry now.

But I can say that all the stress would have been alleviated had we known today's guest, an amazing clinical dietitian at Children's Hospital of Orange County, Tiffani Ghere. Tiffani specializes in pediatric nutrition with a particular focus on neonatal nutrition. There are few people in the world who know more about the science and practice of feeding newborns and infants.

Audra and I have known Tiffani for several years through our work with MaxLove Project, and we're thrilled now to have her on the podcast. We talk about formula versus breastfeeding, transitioning into solid foods, feeding kids as they grow up, and a whole lot more. So without further ado, here's our deep dive conversation with the always sharp, ever knowledgeable Tiffani Ghere, RD.

Audra: Thank you so much for being here with us and talking with us, Tiffani. I, you know, when we were let's see, we went to Temecula right before a lockdown. Was it a year ago?

Tiffani: Oh my gosh, it was. And I can't believe it was literally right before lockdown. And I remember thinking, “oh, my gosh, I want to go back to Temecula, like hit the undo button,” you know.

Audra: Cause we didn't know if we should go through. We were like, this is a little risky. We'll go do this thing. Didn't really know it was going to happen. And even kind of like, risky sort of being around people, but weren't sure yet. You know, it was at the very beginning, it seemed kind of tenuous.

Tiffani: Yes.

Audra: And then boom.

Tiffani: Yes.

Audra: But I remember on that magical, magical mini trip, which I can't wait to go back to and return to. We will, I just thought it was fabulous. We talked about The Family Thrive. And I was starting to share the seeds of this project even then and talking about, it's crazy. I can't believe that...

Justin: I love it.

Audra: Reflecting on it now, even we're talking because we are talking about various, you know, kind of like synchronicities and overlapping things. And today we, three-quarters of our seed round has been funded.

Tiffani: Oh my gosh.

Audra: We are going to be launching...

Justin: And we had our 19th anniversary a couple of days ago and…

Tiffani: Congratulations.

Justin: You know, like the stars are just coming together and then we're getting vaccinated soon.

Audra: Yup.

Justin: You know, the spring is coming, but it's, COVID’s going to be in the rearview mirror.

Audra: It will be in the rearview mirror. But it has been such a formative, powerful time for us. And it has been the time that we've invested everything in bringing The Family Thrive into being. We have our minimum viable product, our product, The Daily Thrive, which is the app, is ready to roll.

We are so excited to roll it out and to begin building it in live, in real time. And you are a huge part of it. You know, we've had such a wonderful relationship over all of these years, co-developing, co-inspiring, like really working on bringing, you know, kind of not only more awareness to the role of health and wellbeing and living our best lives, but the community aspects of it. And it just feels really incredible to talk with you today because we have so much to talk about, so much that we have, you know, not only in our common interests and passions and all of that, but we are going to be building The Family Thrive with you.

We know that you're going to be a powerful part of this team. We need you. We see you as just a huge asset for this movement. So just really excited to be here with you today because it's a marker for me. It's like a I don't know. It's the….

Tiffani: It feels like a sentinel moment. And I echo everything you just said, because our relationship really has been forged on blood, sweat, tears, lots of amazing meals together where we have broken bread and been inspired. And, you know, you and I met each other before I got to meet you, Justin. And it was a very quick love relationship where these common threads, the synergy was always just like fireworks every time we got together.

So I am so proud of you guys. I am so happy for this getting off the ground. And I have no doubt that it's going to be hugely successful. And the exponential returns of all the families, all the children, the lives that you touch, the work that you're doing here is so needed, but just such a value. It's the stuff in life that is worth getting up for in the morning where you can look back on the work that you do and you go, I did good work. And that's really, really what matters. Now, you're going to make me moved to tears because I love you guys so much.

Justin: Oh, that's so beautiful. Tiffani, thank you. Oh, before we get too far into it, just for the listeners, can you give a brief just, you know, elevator pitch of what you do? Like what do you do and where did you come from?

Audra: You got a cool story, Tiffani. I love it.

Tiffani: Oh, my gosh. I've been asking myself that question for about 50 years now. Yeah, well, by education, I am a clinical dietitian. I'm a clinical pediatric dietitian. There's only a couple hundred of us in the country.

So as I did my educational pathway in studying food science and nutrition science and got into the clinical work, I always knew I loved the clinical acute care environment. And I love the challenge in nutrition of, it affects all parts of the body. And it is very much a mind game. So as a dietitian, when you have to solve a problem, you have to mentally visualize the anatomy, the physiology, where the deficiencies can be. And clinical dietitians are really accountants. It's not just calories in, calories out by any means. We are looking at what is normal and out of anatomy and physiology. And then if you put an illness or a disease condition into it. Ok, now how do we pivot with those variables and how do we optimize? Because we're really looking at: how do we get the best nutrition, the best bang for our buck? And sometimes we're constrained where there could be a reaction to foods that could be a clinical state where they can't get certain nutrients.

So I just love the complexity of it. I think my ADD-type mind just loves the activity that fires on all fronts there and in the hospital, I've had the wonderful benefit of working with almost all of our subspecialties. So I love the connection and the relationship.

And part of the reason why I have such a heart for pediatric nutrition is unlike the adult world, in the children's space, the clinicians really value what the dietitians are doing because they know as kids are growing, if they're not meeting those benchmarks and they're not thriving, then they can't discharge them from the hospital. Their primary care doctors are very engaged. So it is a vehicle by which we have access to working and participating in that care team. So

I've been with CHOC Children's Hospital since 1999. I've covered all of their units, NICU, PICU, Pediatric floor. So it's been a very broad scope with everything from preterm birth to age 18 and lots of disease to stages in between, you know, traumas and illnesses and stuff like that.

And then about, gosh, I want to say it's almost been 10 years since I've been working with the chef, who our dear friend Chef Azmin Ghahreman. He really kind of injected new life into my lens, because a lot of times when you are in the hospital, most of the times our patients are not eating food. If they're really, really ill, they're either being tube fed or they're getting intravenous nutrition. And I love the bio pharmacology part of it.

But in working with the chef and seeing him bring in the possibilities to really evaluate not just the quantity, but the quality of food and the impact, again, on that anatomy and physiology, it just really breathed new life into this. And as you can be in the nutrition board that we both sat on together, we work together in building out his school program, the Sapphire at School program. And so that's been kind of a side pet project for me.

And then in the last four or so years, I've been participating in our hospital’s innovation and intelligence group, which has kind of allowed me to level up in a different way too and take that broader swath of jumping into pushing the boundaries within health care. How do we use the amazing resources and talents we have in our children's hospitals and go beyond what the status quo is?

And what is so interesting in the state of pandemic is that I think all of us have experienced, probably firsthand, some of the shortcomings of our health care system. Not that we don't have amazing, wonderful care providers and people that really have great intentions, but the system itself needs to be pushed on. It needs to be updated. It needs to be digitally efficient. We need to have that common way forward. So my journey has kind of taken me into that space as well. But as you know, my heart is always going to be at the bedside and back to my roots. So, so wonderful to be able to have this conversation today.

Audra: Oh, Tiffani, thank you so much for sharing. You have such of, well, it's connected yet varied history. And one thing that I feel like connects it all is that you're truly a lifelong learner and deeply curious person. I think it's one of the things that I love most about you. You didn't, you know, first of all, you didn't originally go to school to become a dietitian. Am I correct?

Tiffani: No, that's correct.

Audra: Where do you start?

Tiffani: I started with soil science.

Justin: Oh, you started in the soil. That's so cool.

Tiffani: Yep, my roots are in the soil.

Justin: I love it.

Tiffani: Well, it is funny because it, actually I had never thought about that kind of poetic aspect of it, Justin. So that is good. But yeah, I think that God kind of laughs at those who make plans in some way, although we do have direction in our life. I also in my years as they've gone on is, you really have to lean into the opportunities that come before you and I, as a very first born Type-A programmed person, it is in my nature to plan everything. And parenthood will break that down really quickly over time. I have three kids, as you know.

Justin: Yes. Speak.

Tiffani: It will put you on your knees. It is the great equalizer, which is what I love about children in general, because one of my favorite things at the hospital is when you have a fancy pants doctor who got married and now they're pregnant, like, “Ooh, this is going to be fun,” you know.

Justin: Welcome to the jungle.

Tiffani: That's right. Because there's even no matter what kind of resources you throw at it, you will be up in the middle of the night with a vomiting baby or you will be driving in your fancy Porsche and that blowout will happen off the back of their car seat, you know. And I love that, because when you break down those barriers, then you have the reality of the human experience, which is really what's always connected us too.

And I know in your space with MaxLove Project, you are dealing with families at their most vulnerable, at the most raw point of anything that you can experience. And yet something as simplistic as food is a vehicle by which you can connect with them. And I, one of my favorite things to say in the hospital is I've been trying to advocate for pushing for more resources or something like this is, every one of our patients has a diet order that offers us access to every one of those patients. They may not need radiology. They may not need rheumatology or other things that, you know, that they always need nutrition. And that is a common thread that we have.

Justin: You need to eat.

Tiffani: Exactly. So that affords us, you know, as dietitians access to participate.

Justin: One of the things I love about your story, especially in the last five to 10 years, it feels like it's both an expansion. So you're expanding, but you're also going deep. And so, standing by like the work that you've done with Chef at, you know, working in the community and with real food and whole food. And so there's this expansion, but then with the innovation work, it's like a deepening. So it's kind of cool.

Tiffani: Well, and it's you get into that space and I know you all have met Dr. Anthony Chang, our Chief Intelligence and Innovation. They are so brilliant. You know, they have 12 degrees behind their names. So it is, I am a big believer of surrounding yourself with people smarter than you are.

Justin: Yeah.

Tiffani: And you and in that opportunity, when you have the chance to actually glean some insight and you have their attention, you think, wow, I actually you know, that imposter syndrome is very real for me, a lot of times as a woman perhaps, or just as me, Tiffani, the dietitian, in the caste system of the health care system, dietitians rank very low.

And yet still I find the joy in the service. And, but I am in more recent years, part of it's because I'm probably of a certain age and have gone through the hazing of having three boys to raise where you just play the game like you have nothing to lose. Because to the families and you know this well, to the families that we serve, there is no greater sense of urgency. So it is incumbent on us as the care providers to recognize that sense of urgency and do everything we possibly can to expedite the process or to push those boundaries or to find solutions that don't easily come to us.

This is not an easy game. You know, this is everybody who's in the space is, we go to bed at night wrestling with different ideas. So, yes, this Intelligence Innovation space, the stuff they're reaching for is big. It is deep at times. And sometimes when they go down those deep rabbit holes, especially with data science and machine learning, I just my brain goes brrk and I think, thank God there are people in this space and this is what they do.

You know, I've always felt that way about different things in health care. And I love that we have this on the forefront.  We would not have the vaccines for this pandemic at the rate that we had were it not for the tools of genomics and machine learning and all these things. We had access to it. But when you finally get the resources and a concerted effort where the whole globe was trying to solve this problem. Yes, amazing things happen. It doesn't mean that the FDA didn't approve the quality and the safety of it. No. In fact, their groups were even larger than a lot of the other things that got approved. But we had that laser focus. We had the funds, we had the research and we had the talent.

Justin: So now, Tiffani. What if we can put just even a fraction of that towards, like school lunch programs?

Tiffani: I agree. I mean, you know, if 80% of our health problems are from lifestyle choices and let's just talk about the healthy, nonaffected, you know, with chronic condition yet population, young kids, it behooves us. I mean, I try to appeal to people's sense of business. I mean, it's just going to make health care cheaper families less like let's lean into that.

There's not a person out there who won't complain how expensive health care is. I mean, it's expensive to die in this country. You know, when you look at retirement planning, you have to factor in, well, what if I need long-term care, nursing or all this kind of stuff. Let's be a little self-preserving here and invest in things that we know will net us wonderful returns down the road, so, yes, I've always thought that it's a very worthy effort.

Audra: This is just one thing I want to make a note here, that Tiffani, that I love about your voice and your expertise and what you bring to the world, and this is the facet of innovator in you that I really, really appreciate, is that you're in there, going down the rabbit hole in data science with these partners, these researchers, these masterminds. We're going to get to keep going down the rabbit hole.

But you're going to take what you learn from that and you're going to apply it to 10 other areas of need. You play a very critical role in innovation of being a connector and a communicator and a unifier and bringing something that seems like it's isolated over here to a domain over here, like that's an aspect of innovation that we really need. And so it's always been something that I admire about you. You can bring, you know, bring things together, connect the dots, you know, pull the conversation together. It's a very, very important part of this. And I just wanted to share how much I appreciate that in you.

Tiffani: Oh, thank you. Well, I, you know, I've had some wonderful mentors. Certainly. I mean, you know, you've met Sherry Farrugia over at Georgia Tech and some of the women that I have had the good fortune to work with. And awareness is really important. There are so many wonderful things going on. And the awareness, as much as we are in an age of information where we have so much stuff coming at us. It really does.

And I'm really believing more and more coming out of this pandemic that people are craving relationship. So to be able to have that person to person interaction, to listen, actively listen to what their needs are, and if you can help them find a solution and then not only throw ideas at them, but escort them over to someone and so now let's have a conversation.

And if we can find the time, if we can cancel the unnecessary meetings that really I mean, all of us are asking these questions, do I need to be in this meeting? Could this have been an email? Do we have to send an email? Please don't send me an email if you don't have to. You know, these kinds of things, because when we get to the real work, when I can take the time to talk to people like you, when people have a need, if I can even do it one or two times, I feel like my life has value.

You know, it's that story of the guy throwing the starfish or the sand dollars back into the ocean where the whole beach is covered with them. And someone says, “Why you're doing it, you're never going to help them.” And he goes, “But it matters to this one,” you know, and they get them back to the sea. So, and that's what life is. It's a series of one-offs that eventually creates that network effect where people, enough people are touched, they see the value, and that attracts more people. And then together we have this ability to really do amazing things.

Audra: That’s powerful.

Justin: It's beautiful. So I want to talk about one of your latest project that at least I know of, which is related to infant feeding formula versus breastfeeding, how to blend these two. I wanted to first know before talking about what you are, what this project is, what got you interested in this, in the arena of infant feeding in the first place?

Tiffani: That's very easy for me to answer as a dietitian and as a mom, because as a mom, you didn't have a choice. You were in it, right?

Audra: Yeah.

Tiffani: And every mom expects I'm going to breastfeed because I'm going to be perfect and it's going to go wonderful. And I, let me talk about the part as a dietitian. When I was being educated and I learned about food, and then I got into my clinical rotations and I got into, we did community stuff, we did school lunch program stuff and then we got into the hospital. I'm like, ok, hospital is my jam. I love it here.

Then I went into critical care. I'm like, oh, I love this even more because I love the nerdy go deep into the science kind of stuff. And then what else do you have? What's the more challenging thing? And I kept going and going and going. And to me, the most challenging patient you could have is the preterm baby in the NICU, because here we have something that is first of all, you have to understand how humans develop physiologically. You know, they can only be viable so early. And then when they get to term their course is usually that it's a very predictable course in the NICU.

But also, when that baby comes out of the woman's body, immediately, their nutrition is cut off. So it is the burden of the dietitian and the care team to mimic the amount of nutrition that that baby would have otherwise been getting from the mom in utero. I found that so fascinating. I mean, how do we sustain this little life? You know, it is absolutely hanging on.

So that, from a clinical standpoint, was a major challenge then. I love just the sheer I understand now you get to witness the development outside extrauterine, watching this baby do things that we wouldn't otherwise see. You know, we look on ultrasound, we see a baby sucking a thumb. It looks really cute. Now we get to witness the baby learning how to suck, swallow and breathe and coordinate things and how they go through those developmental stages. And we have an amazing care team unit at CHOC with the development and really preserving that.

So I just love that problems that so getting into infant feeding was really, really dear to my heart. In the NICU, we work with breast milk as much as we can. So we deal with the really, really the nuances, the subtle nuances of how a baby can tolerate those feeds, the qualities of breast milk, how amazing it is and what the insufficiencies are, because breast milk is made for a term baby, not a preterm baby. So in all my years in, the NICU is really given, anchoring me in appreciating the value of breast milk.

Now, go back to Tiffani, the mom. I found that when I was breastfeeding my kids and struggling, you know, it's not an easy thing. What do you do when you can't have breast milk? You know, what do you do when you want to be that mom? And so then you turn to formula and many moms feel very like they're failing for whatever reason. And some parents are like breast milk formula, fine, whatever. That's fine. But many people who intend to breastfeed really feel like, that they want to do it perfectly. And we are so binary, right? It's like I need to do it perfect or I don't.

And so in looking at the qualities of the different formulas and certainly knowing that I worked with older populations and understanding nutrition, that formula selection really is the first food choice that you make for a baby. So taking what I know about all the qualities of breast milk and trying to translate into what's a good substitute for it, and then couple that and wrap that around the emotional state of the mom, the economics, the social part, all of those dynamics. I just really my heart goes to that problem set because I've lived it, but also that moms are natural nurturers and mentors, and we need to share what we know with other moms. And so it's neat to be able to come from a mom angle, to come from a dietitian angle.

So recently my work in the infant formula, I've had the opportunity to work with a new company who launched the first new infant formula brand in the last five years. And they've become approved through the FDA. And the company's name is Bobbie. And it's been really wonderful to work with a startup company. It was started by a couple of moms who were faced with the same problem: I really want to breastfeed. It's not going the way I planned. I need to supplement with formula. I go to the formula aisle and how do I make a good choice? And that's a huge, weighty decision for mom.

But from the innovation side, they recognize, too, that there was this huge demand for European formulas and did kind of a deep dive into why. Why are people turning to a European formula versus what we have here in the US? And looked at the standards that were over there. So the EU has very different standards than we do here in the States. And there are families who wanted these formulas that were importing them. You can't ship directly from Germany to the US. So you have people that buy it off of Amazon. But the supply chain wasn't guaranteed and the quality metrics were not in there. And so they were put on the red list by the FDA. And so even though there's a big demand for it with this population, people are still doing it, but there's a safety risk. So now…

Justin: I had no idea. So there's like a black market and European formula like.

Tiffani: Exactly.

Justin: Guys in trenchcoats.

Tiffani: Yeah. Yeah. And so and then if you get a baby, you know, on a formula that they love and then all of a sudden you can't get your shipment, you're stuck. I mean, what are you gonna do?

Justin: Gotta go down to the docks.

Audra: And moms trying to make their own and. Right. Mmhmm.

Tiffani: Yeah. But if you know, if we look at the quality of, what we have to ask ourselves, why would people do this? What is it that they think is in this formula that makes it so unique? And really, when you look at those EU standards, they are looking at how you're sourcing all your ingredients, how your most of them are cow’s milk based. And so how is that cow grown? What is the life of that kind of like?

Audra: What kind of cow is it?

Tiffani: What are the additives that you can put in there? In Europe you are not allowed to put added sugar into infant formula? Like we can't, you can only use lactose, whereas here in the United States, we can use corn syrup solids and other things like that. So those things matter. And so I'm really proud of this company and that they've taken on those very high standards. And that they went through all the rigor of going through our FDA process here in the US, they’re Organically Certified too, which is another very rigorous process. And they just created a very simple, beautiful formula and created a community of support around moms. Because if you look at the community of moms that need formula, they're working. It may be an adoptive mom, it may be mom who had multiples who can't make enough for two or three babies. It could be a mom that had a double mastectomy and realizes that her insurance company will send her a breast pump, but they won't send her reimbursement for formula.

So this company is stepping in to say, to step in and say, you know what? There's a gap here and we can do better and we can support these moms, the moms that feel shame, like they failed, like I tried to breastfeed and I couldn't do it. What about the moms that just need to supplement? I mean, my message as a dietitian was always, listen, your body grades on a curve. So whatever breast milk you can provide, you get credit for it.

Justin: Yeah.

Tiffani: And what and if you have to supplement with formula, you know, don't worry about it. The baby will benefit from both. So, you know...

Audra: Can we just say that again? Like I really want to punctuate that, you know, that every ounce of what you provide in this journey, whenever you provide it, matters. And counts and supportive.

Tiffani: The body is very good about grabbing what it can and it grades on a curve. And so you get all the benefits. So, you know, if you can only provide a little bit of breast milk, that's ok. You get all the benefit of that little bit of breast milk.

Justin: I love it. The body grades on a curve.

Audra: You know what I want, I really, Tiffani, I've shared this with you, but because we are going to be putting this out to listeners and Justin remembers this really well. I had breastfeeding challenges with both kids. Bobbie is making me want to have a baby again. You know, I want to do this again.

Justin: Oh right.

Audra: And it's, I have to share a couple of these challenges. First of all, I had to have C sections with both kids, and I experienced the questions around that just from other mothers. Like why? Why do you need to have a C-section?

Justin: Are you sure?

Audra: Are you sure? Yeah. Yeah. You know, I'm sure medically necessary. I had a myomectomy when I was 20. When I was 21 or 20. Yes. And then on top of it, I'll never forget when Max was born in Santa Monica and we had terrible, terrible trouble with him in the hospital feeding. I mean, he would bend his back backward screaming, didn't want to latch on Justin goes to the pump station, I should say, or this business and says, “Hey, do you have a nipple here? It's kind of like a lot like a real nipple, because I have a baby we’re in the hospital” and they're like, “No, we will not sell this to you. The baby will never latch on if you do that.” Right.

Justin: I forgot about that. I forgot about it.

Audra: So we have to go back and find out about it, of having him suck on a binky for a second and then latch on. And I remember going home with a hospital-grade pump, feeling like such a horrific failure as a mother saying, “Ok, I'm going to pump this milk as much as I can and I'll feed him in a bottle underneath a cover so nobody will see.”

Tiffani: Mmhhmm.

Audra: It's a bottle, even though it's my milk. And then when at six months, you know, I have to go back to work at three months like everyone else. The little bit of supply I had, I was getting through just maimed and tea bags, like trying to heal, and all of it. And I go to work and my supply just starts to go down and down and down. I mean, it's a story of so many moms, right? And down, down and down.

And so I start looking at the formula aisles and we have to start supplementing. We have no other choice. What are we going to do? Max stopped breastfeeding. He just stops at one point. He only wants a bottle, he stops at six months and, you know, an acquaintance at the time said, “oh, oh my god, what are you going to do?” Like, obviously, I'm going to let him die. What do you think I’m gonna do?

You know, and so it is, there's this social pressure. There is this valor that comes with a mom who can breastfeed until she's three. Until the kid’s three. And I'm not critical of that, like you do you. But why has this turned into such an assault on working mothers and mothers of all types and mothers who can't and the judgment that comes when the bottle’s presented.

Tiffani: Yeah. And you touched on something so important. People don't recognize that we're kind of set up to fail, too. So when you say you have a C-section, you probably had prolonged IV fluids given to you. You know what? That delays your milk coming in.

Audra: Oh, that's why it took five days? That’s good to know. They didn’t tell me that.

Tiffani: Yes. They don't tell you that. They don't tell you that you had blood pressure, that you were never had a history of surgery or anything. They don't tell you those things. And if you only get 48 hours for a vaginal delivery or four or five days after a C-section, you haven't even gotten into that window where your milk has come in. And meanwhile, your baby's been hungry for four or five days.

Audra: Right.

Tiffani: You know, what are you supposed to do? You can't win in that way. Now, you can succeed. You can go through and supplement and really commit to breastfeeding. You know, it's not like it's, the baby-friendly hospital, which is what you're talking about, which is very, very well-intentioned, has had a really dynamic effect in this place, especially on women's mental health. So let's talk about that a little bit, because I had never experienced, I didn't know I could be jealous of another mom, because when she pumped, she got 10 ounces every time. I was so envious.

Audra: She's freezing her milk. And you're like, why do you have enough to freeze?

Tiffani: Right. Like they open up the freezer and it would be like a 12-year supply.

Audra: Yeah, yeah.

Tiffani: You know, and it's like. And then the other thing is, I would, whatever I could pump off, I'd put it in the refrigerator and I'd have like the thinnest little layer of fat on top. I like pump like nonfat milk. And, you know, the other moms were Dairy Queens that were pumping cream.

Audra: Yeah.

Tiffani: So, you know, and you have no control over this. Your body as a woman gives you the number of milk ducts that you're going to have, which is why, and usually the dairy queens were like back in their size two jeans like three weeks after delivery too. That is not possible. Is that I am trying to eat, trying to sleep, trying to drink enough water. I'm doing everything. It can't be forced. And then you add the anxiety, like it's snowballing on you. And then they're like, well, you shouldn't be stressed because that will affect your milk supply. You're like, wait a minute here. So we really, moms need people to come alongside them.

And like I said, as mentors, as friends, to just say, “You are enough, you delivered a healthy baby. Let's not forget that point. We have options. Produce what you can think about what works for your family and your lifestyle, and then let everything else go.” Make your decision and then enjoy your baby.

Because I, I hate to think that those new moms who should be one recovering from birth, because we all know that that's got some things there. But two, this is a new little life that you've brought into the world and you need to enjoy that, you need to accept your new position, your new station as the parent. And whether it's your first parent or your first baby or your fourth baby. It changes your family dynamic. And so the kindness factor, coupled with the science, coupled with everything else that moms are trying to handle, this is what really drew me to this company, Bobbie in particular, because they recognized we're not just here to sell formula, of course, that's their M.O. But you know what? 83% of families will turn to formula in some way during that first year of life for their baby.

Audra: Yeah.

Justin: Yeah.

Tiffani: That's a pretty high number.

Audra: Yes, 83%. Yes, we need it.

Justin: There's a dad’s component.

Audra: We need to normalize it. Yeah.

Justin: I just had the flashback. I totally forgot about this. How happy I was to be able to feed Max…

Audra: And Maesie. Yeah.

Justin: Yeah. I mean that. But for the firstborn to realize like, oh, I really I'm so glad that I can take a role in this. And yeah, I remember.

Tiffani: Well, we've had dads come back and say, “I was so relieved when my wife finally gave up trying to pump it, you know, when she wasn’t producing anyway.”

Justin: When we were done.

Audra: Yup.

Justin: Yeah, I remember that. I was just so…

Tiffani: Like, it makes them feel like they get their life back. Yeah. And so, and no one here is advocating against breast milk...

Audra: No.

Tiffani: Don't mistake me. Breast milk is amazing. I mean, I love, you can study. It's like studying space. It has infinite qualities to it between the pre- and probiotics and the immunoglobulins and everything that it does. I mean, I used to in my early days, you know, used to say kind of snarkily, it does everything but clean grout. But now I pretty much have evidence that I can clean grout.

Justin: It can clean grout as well.

Tiffani: It’s amazing. Yeah. But I look at the fragility of these new parents and it, my heart goes to them. I want to help navigate making wise decisions. And I love that something familiar, something like this one says, well, “Ok, if you do need an alternative, let's make it as clean and simple and as beautiful as possible.”

Audra: Absolutely.

Tiffani: And so I think that and my other message to these parents is pace yourself, because this is the first food decision you're making for your kids. You have a whole lifetime of decisions to make.

Audra: Yeah.

Tiffani: So be kind to yourself and pace yourself. So I love even having that language of a formula is your first culinary decision, if you will, as a parent and start learning how to qualify, okay, what are your values around food? And again, maybe an 80-20 rule? We're not aiming for perfection here. We are aiming for being informed and making good choices that work for your family.

Audra: We're all about the 80-20 over here. I think that's phenomenal. And it's a beautiful point to make. Tiffani, I think in our generation, we are a part of the pendulum swings here, right. We have mothers who were advocates, probably our mothers, you know, might have been advocates for breastfeeding in a time that was hostile to breastfeeding. Right?

And even at our ages can experience various hostilities towards breastfeeding and the activism that has gone into helping mothers get access to breastfeeding and understand breastfeeding and feel supported and being able to breastfeed wherever they need to and in public and at work. And, you know, all of the different things. I love the activism. I get it. It's so important. I get that we are coming from a very deep hostility towards breastfeeding. And for it, like in many things, the activism turned towards hostility, towards formula and bottle feeding. Right.

Tiffani: Right.

Audra: And so we're trying to bring grace into the space and trying to help, you know, kind of normalize whatever it is that someone needs to do. Let's just be fully supported in all of these choices.

Tiffani: Yes, exactly. We do tend to have that pendulum swing from one extreme to another. And the reality is that we're all in that swath, the pathway of the pendulum at different points of our lives. Again, my heart goes to these new parents because it's a wonderful time and it's an exciting time, but it's a very fragile time. And so to be able to come in and if we hit them too hard with the science, you know, just like the baby-friendly thing, yes. Most of their efforts were very evidence-based. And I understand their intentions.

But in the meantime, you've got this sobbing mother who is just trying to keep it together. And we are discharging them home. And we want them to have a peaceful, successful home life, to be able to grow a baby that can thrive. Which is why I love the name of your group, The Family Thrive, because it covers everything from birth forward. And each stage and developmental stage and phase that we go through, not only as kids and parents, but the whole family in it.

There are different definitions of thriving and it takes different resources and it takes that empathy from our caregivers in our community to recognize, well, that wasn't my experience. But boy, I can certainly understand yours. And I would like to help. I would like to help provide resources.

Audra: You know, Tiffani, that that brings something up for me, too. Going back to your comment on the very first choice we make in feeding our child. The mental health of the mother and of the parents, that very first choice, setting down the path, starting to think about your values around food. And I think that this is a really powerful time that I don't know that I've acknowledged very much either and it's something that I'd love to talk a little bit more about.

So this, you see these steps that we take when we make these initial choices to incorporate formula and then maybe the next steps in solid foods and things like that. I'd love to know if you have any tips or insights, because it comes down, what I am starting to think of when you start talking about the mental health and well-being of the mother and of the family, is the more that we can de-escalate that initial stress around feeding, because feeding is the most important thing. Right. It seems like when we came home with our babies, it was like, oh, my god. Feeding. Right. And the counting the pee, counting the poops, what goes in, what comes out and that doesn’t leave you. You know, you end up with a six-year-old, you're following around with a spoon of food because, you know, you want to make sure that they get that one little bite of nutrition in.

Do you have any tips for new parents on just developing some mindfulness around those values? Because I think it's something we don't think about or talk that much about. I'd love to know if you have any thoughts on that.

Tiffani: Well, in the early days, for sure. You know, I totally remember what you said about counting the diapers and trying to do it right, especially if you're breastfeeding and you don't have a quantitative volume, that's where the mystery just becomes so hard. I mean, if you are pumping and putting it in a bottle is, you know, what volume you're feeding. So in those early days, I think having the metrics is very valuable, getting that benchmark of back to birth weight within the first two weeks, and then you feel like, ok, we're trying to get our groove on.

And I can even remember as a pediatric dietitian who I think knows more than most about the actual ins and outs of food. When my first was turning one and I had weaned from breastfeeding and we were discontinuing our supplemental formula, I thought, “oh, my gosh, I don't have that insurance policy anymore,” because I knew formula and breast milk is nutritionally complete. So now I was responsible for everything that I said. My kid had to meet all of the needs for nutrition. And I just felt the gravity of that responsibility of like, I better do this right.

You know, in the US, we address it so differently. We label things and I would say this, even for kids and adults, and we like to wear our banners of like “I'm a paleo vegan” or “I'm on this diet.” You know, we like to know that we have those constraints and boundaries and that we're doing it right. And then we take pride in that. If you were to look at other countries around the world, food is love and relationship, and its history and culture. And they feed their babies seasonally because that's what they have access to. And we tend to standardize and make it a protocol.

So when you look at introducing foods, we start with a puree consistency because it's appropriate for what their palate can handle. And you're trying to introduce those different textures as the mouth palate evolves and their developmental skills evolve to the point where then they get some teeth and they can chew. And then you think about not wanting to have choking hazards and stuff like that and being on the lookout for allergies so that you're introducing individual foods and watching and seeing how the baby responds to it.

There's some strategy to it, if you will. But it's not necessarily adopted with other cultures around the world. I think knowing what the family's values or what their approach to food is, helps people drive what they're going to aim for. Because ultimately, when a child is about a year old and everything developmentally has been on track, they're pretty much eating what the family is eating. It just might be modified in its chopped size or consistency just for hat. So you're really trying to get them from birth to 12 months to kind of get in line with what the family's doing.

Now, I have seen families take the opportunity in trying to do such a good effort with their child that they've actually improved their own eating habits in anticipation. If they can make that connection of like we are a family unit, what do we want to do for the family? And so I've actually seen some families rise to that occasion of like, ok, well, you know, I'm glad he likes the jarred peas because we don't eat peas. And I'm like, “well, should you?” You know, like what do you want to aim for? Because you're giving him sweet potatoes and carrots and, you know, all these different things. You're giving him cut up pieces of banana and now you're doing berries and stuff like that. How does that incorporate into your family? Because ultimately a family is a unit. Basic home economics will tell you that it's a whole lot cheaper to cook for many than for one. So know from a practical standpoint, as that kid develops their eating habits, you want to streamline that in there.

So I don't know if that's what you were aiming for know, but it's kind of a global lens on what are the goals, what are the aims? There's obviously very iterative steps to get there. But if you look at it holistically on what does the family aim to do, what's practical, do you have two working parents, how much time do you have for shopping and meal prep and stuff like that? But I think with a little bit of strategic planning, you can get there. And then it again takes away that power from the mystery and that you feel like, ok, I feel like I've got a sense of understanding of what we're aiming for and this is what we do. And you step into that identity of this is how the Ghere family is approaching food. And I am getting to experience the wonderful. It only took 18 years, but the wonderful opportunity of the kids being able to advocate for their own food choices, to see them go out with friends and get creative and experience new cultural food experiences, as well as cooking their own meals.

Audra: Yeah. Tell us more about what you are seeing, because it sounds like to me that if we can de-escalate the stress around the home and like bringing baby home, breastfeeding, bottle feeding, you know, all of the stress and anxiety, that is really, I think, social pressure.

Tiffani: It is.

Audra: And if we can de-escalate that and provide that focus on how we want, we want to nourish this new this child, this new baby we want to nourish, and then we want to provide a home environment where we keep that goal of nourishing. So whatever that timeline, strategic plan is in place, even the mindset that we can level up, that we can rise to the occasion. We had that experience only when faced with a medical crisis. I think it's really powerful to think like this baby is coming to the family table. We can level up for all of our benefit. I think that's just such an amazing point to make.

And then I'm so curious. Mom of three boys. Three boys raised by a culinary-inclined dietitian who, you know, knows all about how things start with soil health from the ground up. What are some of the cool things you've seen in your sons as they're like autonomist folks now?

Tiffani: Well, I will tell you that we are just like every other family. They’re kids, you know, you can't necessarily groom them to be exactly the way that you want them to. You know, my goal, as much as I have had a lot of experience with food, my goal was always to be kind to myself, too, and not to be too overarching and to just expose them. I can remember sitting at the table when everyone has that where they don't want to try something or whatever. And I would try to remind them this was probably a grade age.

You know, my goal as your parent is that when you're a grown-up and if you got invited to the White House that whatever they serve, you would be cool with that, that you wouldn't be afraid of it, that you could you know, if someone said you get to take a mission trip to a foreign country, could you adapt to what's going on? I wanted them to have. It's funny because as an anal and as Type-A as I tend to be, I try to actually train myself to be a little bit more chill on it, and recognizing that it's not a battle. And really, the victory is going to be won in the very long game, which is, I wanted them to have an adventurous relationship with food.

I wanted them to be inquisitive. I wanted them to understand where it came from. I wanted them to taste things. Everyone goes on their own timeline. But I do have three pretty open, adventurous eaters now as they're getting into their late teens or early adulthood, which is, that was my goal. So now I can hand them off to the world, right?

Audra: Yeah. Yeah. It's a great point, too, that it's a long game. I think that's one of the things that's so rushing in this is that there are a lot of no's along the way. You know, you provide a lot of really cool different things or broccoli or whatever, and there's a ton of no's before you get to yes. And so it's a long game that takes a good amount of kind, graceful, open persistence.

Justin: Well, there's a lot of no's on the side of the kid. But I'm curious, Tiffani, what were the no's or what are the no's for you when thinking about food in the home, meals in the home? Are there some, I don't want to call them like hard and fast rules, but food general guidelines, where like, no, we're not going to do that here.

Tiffani: Yeah. You know, for us, it is interesting because we never had, don’t anyone misunderstand me. If this is in your pantry, this is not a judgment. This was just my own personal choices. But knowing that the affinity for sugar is an acquired taste. So the more exposure you have to the high, sweet things that you would be, you know, you would continue to have that high affinity for sugar. So we never had juice in the household or the sodas or those really high artificial sweetener things. We did use yogurt. We had berries with it.

It wasn't that things were a no. I just tried to do the best decision making with the quality that we could, always having that mindfulness of quality and knowing that if they went to a friend's house and they got the Gogurts and they got the you know, that they had mom, how come you never told me about fruit punch? It’s awesome. How come we don't have jello, you know?

Justin: My gosh.

Tiffani: And it's fun. But you know what, what I love. We got to travel to my sister's house. We got to travel by plane over Christmas. And here I am with my two, two of my three grown kids. And they were doing a beverage service. And the biggest treat that they always thought was to get apple juice. So they both I watched them order their apple juice because we just never had juice in the house. And you know, now they, are they candy fiends? Yes. When you go to junior high, there's like a black market for trading candy out there. And it is hard to fight, you know.

But I do remember that especially with grade school, you know that packing the lunches, especially with the first one and trying to be very thoughtful. And then they go and they're surrounded by all kinds of processed foods and things that are high in sugar. And they didn't feel as popular. So my angle was always, we're going to have all kinds of treats and cookies in the house, but I'm just going to make them from scratch. And then I have control. Like I can downgrade the you know, if it calls for a cup of sugar, I can do it with like two-thirds of a cup and it's still ok, you know, and using that high-quality butter, my approach was like most of our food will probably rot in two to three days. And, you know, sweets included. And that's kind of the road that we took.

But there's many ways to get to a path of success. And sometimes there are drivers in your life, as you guys know, where you have to put that and if something is forced on you. Let's say two of my three kids have very close friends that are type one diabetics. And it's been very interesting to watch them and their empathy that they have and understanding what they have to do.

In fact, one was very protective of her, and she didn't get diagnosed until she was, I want to say nine, which is a little bit later down the road, so he had that awareness that tore my heart strings open, I just I burst, I was my heart was breaking for the family because I knew how much of a lifestyle change is going to be. But my heart was so proud of my son who had that empathy and recognize that she has to look at her food differently. And I know. I want to. I want to. He was watching out for her at lunch time and trying to like protect her from other kids, going how come you don't eat the Gogurt or how come you don't do that? He was trying to like, kind of jockey to protect her.

So, you know, this is why we can't forecast everything we want to do with food with our kids, because hopefully they come back and surprise you in a delightful way. And I tend to go to that holistic overview so that they have the context, because our job as parents, my mom used to tell me this, and I do agree with her that if you're parenting, if you're doing it right every day, you're working yourself out of a job.

Justin: Beautiful.

Audra: I love that.

Tiffani: When you get to that phase where you're actually working yourself out of a job, it tears your heart open, but it is the marrow of life. And so, you know, you plant those seeds and then you get to see those wonderful returns. But at the early years, you know, there's a lot of support needed.

And I think what's really important is that we give these new parents the confidence to say, you know, “we thought about this, we made a deliberate decision. I'd appreciate it if you could support our decision” and then we can enjoy, you know, I think about Thanksgiving, right, where grandma or someone always has an opinion about what you're doing. And, you know, just to equip people with the language to say, you know, “we really we really thought about this and it would really help, but this is how you can support me,” because when you use that language, it actually we're struggling. And so could you please. And then you get to give people the equipped messaging that actually creates that better support system. And it's not about the food. It's about control. It's about who has to be right. And I try to break that down so that we can disarm people and really have true meaningful relationships that are supportive.

Audra: I think that's so helpful, Tiffani. Yeah. Thank you for bringing that up in like, we have a module on that MaxLove Project that I think we need to bring into The Family Thrive setting as well. Lexi Hall, the dietitian we work with who you know very well, from CHOC, did a Fierce Food's Academy with us around Friendsgiving and specifically to help families with these challenges that come up around, you know, bringing your own family's choices into family settings, social settings, and things like that.

I also want to just reflect on your comments on your parenting. I love hearing this and hearing this from a dietitian. I feel like it's such a beautifully, you know, open, pragmatic way that there's not. We don't have to have like, super tight reins, but we can figure out our own kind of equilibrium in the home. You know, that makes sense for us. And I think it can be hard to sort of stake your own claim in that, like without having a model out there. So the more stories we hear from other parents on how they've done it, the easier I think it is for new parents.

You know, I think in our case, we ended up with a kid, we needed to go on the ketogenic diet. You know, we needed to do it as a family. But then raising his little sister to make her own choices and to be her own person and getting into bio-individuality and kind of the diversity of what we provide in the home. And I will be totally straight up with you. We have these like Annie's mac and cheese, little plastic things in there that she can fill with hot water to have mac and cheese. And one thing that I've really loved is she will down two flights of strawberries. No problem. She'll eat entire English cucumbers. No problem, like you know, when she goes into the fridge, she's going for this stuff and she still has it.

And she was like obsessed with these. Like, can I have mac and cheese? Sure will buy you the mac and cheese. She wants to have it for breakfast. Fine. And she's making them for herself. She's doing it for a couple of weeks. You know, they're in the pantry still. And what is she making for breakfast? She's making an egg sandwich. She's been making smoked salmon with cream cheese and capers and lemon. You know, as her, I mean, she's making these fabulous choices. And I said, “why don't you eat the mac and cheese anymore?” And she was like, “eh, it's just not really that great,” you know? And that has worked for us. Talking about bio-individuality, providing some of these choices has worked for us.

Justin: No offense to Annie’s.

Tiffani: No offense to Annie's at all.

Audra: Oh no, no, no, no. It’s not about that. Not about that at all.

Tiffani: It's a testament to the evolution of her palate. You know, and you touch on something else really important, too, is as kids grow, especially in their you know, it becomes less frequent as they get older, but they go through phases. You know, you see it radically in ages one through three where they'll go on food drags where it's like all they want are goldfish crackers. And last week, he was eating lots of kind of chicken. Now this week, he doesn't want it. So they go on strikes and they go on drags and then they go through different phases, too.

And I love that you're also touching on the fact that, because it takes a lifetime to develop that palate, you know, we know that it takes at least 20 exposures to a food for a kid to know if they do or don't like something. And many times that they don't like something in their early years. It's not because of the taste. It's usually the texture or the temperature. So there are different forms of offering of foods. Like it's not that you don't like carrots, but, maybe you don’t like cooked carrots or cut, you know, raw carrots.

Justin: Yeah. Right.

Tiffani: So, I mean, that's really important to know. But the fact that Maesie has that sense of curiosity and exploring and then mashing up different, that's the evolution of the palate. And Chef Azmin can definitely explain it in better terms than me. But I love that. I saw the same with my youngest, Carter, too, who was definitely a fierce advocate for mac and cheese. I think we had the Costco, the Costco brick of Annie's mac and cheese.

Audra: Yeah. Yeah.

Tiffani: And now I do, I think somewhere in an old closet, that brick is still there because he's evolved and he still loves pasta, but he's making his own rigatoni alfredo, and adding the vegetables and the chicken to it. And, you know…

Audra: Does he like the feta pasta? Does he like the TikTok feta pasta? Maesie loves that. Loves it.

Justin: Just so we don't run out of time...

Audra: Because we could talk forever.

Tiffani: Yes, I know. No, keep that keep us on track.

Justin: I have one final topic before we get into our last three quick questions. So the last final topic is when we had our podcast interview with your colleague, Lexi Hall, we ended by talking about food myths, you know, because in not just in the world at large, but especially in the parent world in the discourse, there's all these food myths that are circulating. So we talked about a couple with Lexi Hall. And I'm wondering if you have a food myth that you have come across or that you regularly come across and you want to bust it?

Tiffani: Well, I don't want to cover something Lexi already did. What did she tell you?

Justin: So well, we covered meat. So like meat is going to kill you. So that's a myth.

Tiffani: That's a good one.

Justin: Alkaline diets are these super healthy, magical things. Yes, we busted that one. And then eight glasses of water a day. We busted that one. So those are the ones we…

Tiffani: I agree with all of those. Let's see, so I'm often asked, and I end up saying this when I'm educating families, like if there were five foods, if I could only choose five foods to live on. And one of those five foods is eggs. And so I think one of the myths is that if you eat too many eggs, you're going to have high cholesterol. I think that came out of our ‘90s education on heart health. Again, well-intentioned, but it's not been validated. And if any part of cholesterol gets raised is the HDL, and that's for good cholesterol. So I love eggs, and I eat them every day.

Justin: Heck, yeah.

Tiffani: I have decent cholesterol. I have pretty good blood glucose control and there is a tie to that. So dietary cholesterol doesn't necessarily tie to serum cholesterol, which is your blood cholesterol. And I, the way I explain it is this: there is enough nutrition in that egg to grow a whole chicken. So I love caloric density. There's enough nutrition in a nut to grow a whole tree.

So when people ask me what are the five foods, I think of avocado, eggs are on there. I think of nuts. I think of a fish. And again, those are very nutrient-rich type things. So I think that would be the myth-buster that I would go to just because I am such a fan of chickens and while not vegan. You can eat an egg and glean a lot of great nutrition in an ethical way that actually isn't a harm to a chicken. And so I'm hoping that it also reaches a wider part of the population that as a food choice.

Justin: Brilliant. Yes.

Audra: I love hearing that from you. Yeah. Thank you so much. That's one that has come up recently with yet another study that was pulled in by the media attempting to disparage eggs. So thank you.

Justin: Yeah. And speaking of Maesie, this is one thing that, one of the hardest things right now to do with her is to get protein in. And, you know, because she, yeah. Audra’s, right. She'll eat tons of berries or eat tons of veggies and all. But it's like, ok, can we just get the protein? Or so I will tell her. I'll stop bothering you for the rest of the day. If you just eat an egg, just eat and then I'll be done.

All right, so let's get into the final three. These are quick ones. All right. So if you could put a big Post-it note on every parent's fridge tomorrow morning, what would that Post-it note say?

Tiffani: You're doing a good job. You are enough, really. You are trying to raise a human being. And it takes a lot of effort. And we are so hard on ourselves and we think we're not good enough. It's like imposter syndrome again or something. And everything, we will hear the one negative, the one negative thing will completely derail us, even in the presence of 100 compliments. And so reinforcing that they are enough and that they are doing a good job is enough to get them to pause and breathe. But any insufficiencies or gaps that they have, it affords them the time to go seek out help or find the education and they can do it. So it starts with, except that, you know, you can do this. You're completely capable.

Audra: Tiffani, I feel like you just put that on my fridge. Thank you. Like I sort of get emotional. Yes. Thank you. Thank you.

Justin: We need that.

Tiffani: I know you probably wanted us food one, but.

Justin: No.

Audra: No.

Justin: No, no, no, no.

Tiffani: It's again, it affords me that access to connect with people in all the years that I've been working with families and patients. And it's such a pervasive reality that we have these people that are struggling with a clinical status of a child. Let's back it up. Let's look at what you're actually doing. You've walked a hard road. You can do this.

Justin: Absolutely. Second quick question. Do you have a quote that has recently changed the way you think or feel?

Tiffani: I do. And it's funny, because the one that I used to always cite was Maya Angelou’s, “When someone shows you who they are, believe them the first time.” And part of that speaks to being burned and becoming aware of like, ok, I'm going to recognize people for who they are.

But Audra, you actually posted it to Instagram, I think it was just a couple of days ago from Angela Davis. “I am no longer accepting the things I cannot change. I'm changing the things I cannot accept.” And that just really speaks to my present of mind right now where, like I said, go bold or go home. Children and family are depending on those of us that are in this professional world, we owe it to them to swing from the fences.

Audra: Oh, absolutely.

Tiffani: Obviously, another testament to how in-sync we are in our like-mindedness, but.

Audra: Beautiful. Yes, I feel that fierceness in you, Tiffani, that it's like this is your life's work.

Justin: Yeah. Oh, for sure.

Audra: This is your world changing. You know one starfish at a time. And this is it. You know, it's really, really inspiring. And it's a beautiful call to action. And it's something that The Family Thrive is all about. And I really appreciate hearing your fierceness in it. And the emotional component to this. Like this is really, really powerful, needed work. And I just really appreciate hearing that call to action from you. I feel more charged up in my day.

Tiffani: Oh, it's amazing how cyclical it is, because that's how I feel about talking with you guys. You know, this is what synergy is, where you find that like-mindedness, you find that common goal that you reach for, and then you allow people with their different skill sets and talents to come together and create something unique and dynamic. And people respond to that. And as someone who's given many a lecture or a nutrition talk in my day, it's always in the back of my mind that people walk away with how you make them feel, not what you say.

Audra: Yeah.

Tiffani: And so if you can touch, if you can connect in any way, no matter what kind of information you're dispensing that day, that connection is what people truly crave. And it's not that, that's not all that they need, but that's how you start. And then it affords you the opportunity to gain their trust, to create that awareness. And then you can provide the education and then you have a bonded loyalty that creates that greater network that's going to be really, really powerful.

Justin: Awesome.

Audra: Couldn't agree more.

Justin: So the final question we ask, because for, at least for parents of young kids, you know, it's a marathon. It's exhausting. And at the end of a day, you can say, oh, kids, just like so much work. But at the same time, kids are totally awesome. So let's celebrate them. So we want to know, what do you love most about kids?

Tiffani: Well, like I said before, I think they are the great equalizer because it does break down the adult to a place where it does open us up too, because if we are so closed and buttoned up, we lose a lot of things in life. But kids don't lie and they let you know with complete transparency and utter honesty how things are.

And it's positive in the negative. You make something for dinner and they hate it. I mean it. And as much as we get thrown back in your face. Right. We know that with a toddler. But they're forgiving and they're loyal and they're loving. And they show us as adults that that compassion and that commitment is hardwired in us. And this is who we were supposed to be from day one.

And so I think it reminds us as adults to remember that, you know, and for those of us that are spiritually-minded, I think about biblical teachings where even Jesus connected with children, and that even relating to something as grave as pondering the existence of God and relating to God, he did it through the vehicle of children.

So I think that for these big things that we wrestle with and parenthood is a big thing to wrestle with. To remember to look at it through their eyes and we'll glean such great insight. And I've seen it, like I said, with all those wonderful doctors that I work with that are so accomplished and so brilliant, you bring a child into their life.

Justin: Yeah.

Tiffani: Like what do you really know?

Justin: Exactly. Yeah. Tiffani, ok, before we sign off, how can people find out more about your current work and just how to follow you?

Tiffani: Oh, well, I am with CHOC Children's in their Medical Intelligence and Innovation Institute. We call it MI3. And you can certainly reach out to me via LinkedIn. Yeah, I love to connect with anybody who wants to be in the space. Anything I can do to support The Family Thrive. You know, I'm in.

I'm so excited to see your efforts grow and the community that you're building. And it reminds me of how we drafted the banyan tree all those years ago. And it's just taken roots and it's just growing, only it's under the umbrella of a magnolia tree instead of a palm tree. But I'm so excited that I get to see you next week.

Audra: Me too, I can't wait. Thank you so much for spending this time with us today, Tiffani, it was beautiful catching up with you.

Tiffani: Thank you, guys. Love you guys so much.

Audra: The first of many, too. We love you, too. A first of many.

Tiffani: I love it. I love it.

Justin: Awesome.

Tiffani: Well take care of you guys. And I get to see you next week.

Audra: Yeah.

Tiffani: Travel safe.

Audra: Okay. Thank you so much. Bye Tiffani.

Justin: Hey, thanks for listening to The Family Thrive podcast. If you like what you heard, please subscribe, tell two friends and head on over to Apple Podcasts or anywhere you listen to podcasts and give us a review. We're so grateful you've chosen to join us on this Family Thrive journey.

Justin: I don't know about you, but when our first baby came into the world, feeding him was really hard. It caused us a ton of stress. And then when we transitioned to formula, many months later, we had more stress because we didn't know which kinds were best. And we also had to deal with the stigma around formula in our social circles. We might have stressed out again as we transitioned to solid food, but honestly, it's all a little blurry now.

But I can say that all the stress would have been alleviated had we known today's guest, an amazing clinical dietitian at Children's Hospital of Orange County, Tiffani Ghere. Tiffani specializes in pediatric nutrition with a particular focus on neonatal nutrition. There are few people in the world who know more about the science and practice of feeding newborns and infants.

Audra and I have known Tiffani for several years through our work with MaxLove Project, and we're thrilled now to have her on the podcast. We talk about formula versus breastfeeding, transitioning into solid foods, feeding kids as they grow up, and a whole lot more. So without further ado, here's our deep dive conversation with the always sharp, ever knowledgeable Tiffani Ghere, RD.

Audra: Thank you so much for being here with us and talking with us, Tiffani. I, you know, when we were let's see, we went to Temecula right before a lockdown. Was it a year ago?

Tiffani: Oh my gosh, it was. And I can't believe it was literally right before lockdown. And I remember thinking, “oh, my gosh, I want to go back to Temecula, like hit the undo button,” you know.

Audra: Cause we didn't know if we should go through. We were like, this is a little risky. We'll go do this thing. Didn't really know it was going to happen. And even kind of like, risky sort of being around people, but weren't sure yet. You know, it was at the very beginning, it seemed kind of tenuous.

Tiffani: Yes.

Audra: And then boom.

Tiffani: Yes.

Audra: But I remember on that magical, magical mini trip, which I can't wait to go back to and return to. We will, I just thought it was fabulous. We talked about The Family Thrive. And I was starting to share the seeds of this project even then and talking about, it's crazy. I can't believe that...

Justin: I love it.

Audra: Reflecting on it now, even we're talking because we are talking about various, you know, kind of like synchronicities and overlapping things. And today we, three-quarters of our seed round has been funded.

Tiffani: Oh my gosh.

Audra: We are going to be launching...

Justin: And we had our 19th anniversary a couple of days ago and…

Tiffani: Congratulations.

Justin: You know, like the stars are just coming together and then we're getting vaccinated soon.

Audra: Yup.

Justin: You know, the spring is coming, but it's, COVID’s going to be in the rearview mirror.

Audra: It will be in the rearview mirror. But it has been such a formative, powerful time for us. And it has been the time that we've invested everything in bringing The Family Thrive into being. We have our minimum viable product, our product, The Daily Thrive, which is the app, is ready to roll.

We are so excited to roll it out and to begin building it in live, in real time. And you are a huge part of it. You know, we've had such a wonderful relationship over all of these years, co-developing, co-inspiring, like really working on bringing, you know, kind of not only more awareness to the role of health and wellbeing and living our best lives, but the community aspects of it. And it just feels really incredible to talk with you today because we have so much to talk about, so much that we have, you know, not only in our common interests and passions and all of that, but we are going to be building The Family Thrive with you.

We know that you're going to be a powerful part of this team. We need you. We see you as just a huge asset for this movement. So just really excited to be here with you today because it's a marker for me. It's like a I don't know. It's the….

Tiffani: It feels like a sentinel moment. And I echo everything you just said, because our relationship really has been forged on blood, sweat, tears, lots of amazing meals together where we have broken bread and been inspired. And, you know, you and I met each other before I got to meet you, Justin. And it was a very quick love relationship where these common threads, the synergy was always just like fireworks every time we got together.

So I am so proud of you guys. I am so happy for this getting off the ground. And I have no doubt that it's going to be hugely successful. And the exponential returns of all the families, all the children, the lives that you touch, the work that you're doing here is so needed, but just such a value. It's the stuff in life that is worth getting up for in the morning where you can look back on the work that you do and you go, I did good work. And that's really, really what matters. Now, you're going to make me moved to tears because I love you guys so much.

Justin: Oh, that's so beautiful. Tiffani, thank you. Oh, before we get too far into it, just for the listeners, can you give a brief just, you know, elevator pitch of what you do? Like what do you do and where did you come from?

Audra: You got a cool story, Tiffani. I love it.

Tiffani: Oh, my gosh. I've been asking myself that question for about 50 years now. Yeah, well, by education, I am a clinical dietitian. I'm a clinical pediatric dietitian. There's only a couple hundred of us in the country.

So as I did my educational pathway in studying food science and nutrition science and got into the clinical work, I always knew I loved the clinical acute care environment. And I love the challenge in nutrition of, it affects all parts of the body. And it is very much a mind game. So as a dietitian, when you have to solve a problem, you have to mentally visualize the anatomy, the physiology, where the deficiencies can be. And clinical dietitians are really accountants. It's not just calories in, calories out by any means. We are looking at what is normal and out of anatomy and physiology. And then if you put an illness or a disease condition into it. Ok, now how do we pivot with those variables and how do we optimize? Because we're really looking at: how do we get the best nutrition, the best bang for our buck? And sometimes we're constrained where there could be a reaction to foods that could be a clinical state where they can't get certain nutrients.

So I just love the complexity of it. I think my ADD-type mind just loves the activity that fires on all fronts there and in the hospital, I've had the wonderful benefit of working with almost all of our subspecialties. So I love the connection and the relationship.

And part of the reason why I have such a heart for pediatric nutrition is unlike the adult world, in the children's space, the clinicians really value what the dietitians are doing because they know as kids are growing, if they're not meeting those benchmarks and they're not thriving, then they can't discharge them from the hospital. Their primary care doctors are very engaged. So it is a vehicle by which we have access to working and participating in that care team. So

I've been with CHOC Children's Hospital since 1999. I've covered all of their units, NICU, PICU, Pediatric floor. So it's been a very broad scope with everything from preterm birth to age 18 and lots of disease to stages in between, you know, traumas and illnesses and stuff like that.

And then about, gosh, I want to say it's almost been 10 years since I've been working with the chef, who our dear friend Chef Azmin Ghahreman. He really kind of injected new life into my lens, because a lot of times when you are in the hospital, most of the times our patients are not eating food. If they're really, really ill, they're either being tube fed or they're getting intravenous nutrition. And I love the bio pharmacology part of it.

But in working with the chef and seeing him bring in the possibilities to really evaluate not just the quantity, but the quality of food and the impact, again, on that anatomy and physiology, it just really breathed new life into this. And as you can be in the nutrition board that we both sat on together, we work together in building out his school program, the Sapphire at School program. And so that's been kind of a side pet project for me.

And then in the last four or so years, I've been participating in our hospital’s innovation and intelligence group, which has kind of allowed me to level up in a different way too and take that broader swath of jumping into pushing the boundaries within health care. How do we use the amazing resources and talents we have in our children's hospitals and go beyond what the status quo is?

And what is so interesting in the state of pandemic is that I think all of us have experienced, probably firsthand, some of the shortcomings of our health care system. Not that we don't have amazing, wonderful care providers and people that really have great intentions, but the system itself needs to be pushed on. It needs to be updated. It needs to be digitally efficient. We need to have that common way forward. So my journey has kind of taken me into that space as well. But as you know, my heart is always going to be at the bedside and back to my roots. So, so wonderful to be able to have this conversation today.

Audra: Oh, Tiffani, thank you so much for sharing. You have such of, well, it's connected yet varied history. And one thing that I feel like connects it all is that you're truly a lifelong learner and deeply curious person. I think it's one of the things that I love most about you. You didn't, you know, first of all, you didn't originally go to school to become a dietitian. Am I correct?

Tiffani: No, that's correct.

Audra: Where do you start?

Tiffani: I started with soil science.

Justin: Oh, you started in the soil. That's so cool.

Tiffani: Yep, my roots are in the soil.

Justin: I love it.

Tiffani: Well, it is funny because it, actually I had never thought about that kind of poetic aspect of it, Justin. So that is good. But yeah, I think that God kind of laughs at those who make plans in some way, although we do have direction in our life. I also in my years as they've gone on is, you really have to lean into the opportunities that come before you and I, as a very first born Type-A programmed person, it is in my nature to plan everything. And parenthood will break that down really quickly over time. I have three kids, as you know.

Justin: Yes. Speak.

Tiffani: It will put you on your knees. It is the great equalizer, which is what I love about children in general, because one of my favorite things at the hospital is when you have a fancy pants doctor who got married and now they're pregnant, like, “Ooh, this is going to be fun,” you know.

Justin: Welcome to the jungle.

Tiffani: That's right. Because there's even no matter what kind of resources you throw at it, you will be up in the middle of the night with a vomiting baby or you will be driving in your fancy Porsche and that blowout will happen off the back of their car seat, you know. And I love that, because when you break down those barriers, then you have the reality of the human experience, which is really what's always connected us too.

And I know in your space with MaxLove Project, you are dealing with families at their most vulnerable, at the most raw point of anything that you can experience. And yet something as simplistic as food is a vehicle by which you can connect with them. And I, one of my favorite things to say in the hospital is I've been trying to advocate for pushing for more resources or something like this is, every one of our patients has a diet order that offers us access to every one of those patients. They may not need radiology. They may not need rheumatology or other things that, you know, that they always need nutrition. And that is a common thread that we have.

Justin: You need to eat.

Tiffani: Exactly. So that affords us, you know, as dietitians access to participate.

Justin: One of the things I love about your story, especially in the last five to 10 years, it feels like it's both an expansion. So you're expanding, but you're also going deep. And so, standing by like the work that you've done with Chef at, you know, working in the community and with real food and whole food. And so there's this expansion, but then with the innovation work, it's like a deepening. So it's kind of cool.

Tiffani: Well, and it's you get into that space and I know you all have met Dr. Anthony Chang, our Chief Intelligence and Innovation. They are so brilliant. You know, they have 12 degrees behind their names. So it is, I am a big believer of surrounding yourself with people smarter than you are.

Justin: Yeah.

Tiffani: And you and in that opportunity, when you have the chance to actually glean some insight and you have their attention, you think, wow, I actually you know, that imposter syndrome is very real for me, a lot of times as a woman perhaps, or just as me, Tiffani, the dietitian, in the caste system of the health care system, dietitians rank very low.

And yet still I find the joy in the service. And, but I am in more recent years, part of it's because I'm probably of a certain age and have gone through the hazing of having three boys to raise where you just play the game like you have nothing to lose. Because to the families and you know this well, to the families that we serve, there is no greater sense of urgency. So it is incumbent on us as the care providers to recognize that sense of urgency and do everything we possibly can to expedite the process or to push those boundaries or to find solutions that don't easily come to us.

This is not an easy game. You know, this is everybody who's in the space is, we go to bed at night wrestling with different ideas. So, yes, this Intelligence Innovation space, the stuff they're reaching for is big. It is deep at times. And sometimes when they go down those deep rabbit holes, especially with data science and machine learning, I just my brain goes brrk and I think, thank God there are people in this space and this is what they do.

You know, I've always felt that way about different things in health care. And I love that we have this on the forefront.  We would not have the vaccines for this pandemic at the rate that we had were it not for the tools of genomics and machine learning and all these things. We had access to it. But when you finally get the resources and a concerted effort where the whole globe was trying to solve this problem. Yes, amazing things happen. It doesn't mean that the FDA didn't approve the quality and the safety of it. No. In fact, their groups were even larger than a lot of the other things that got approved. But we had that laser focus. We had the funds, we had the research and we had the talent.

Justin: So now, Tiffani. What if we can put just even a fraction of that towards, like school lunch programs?

Tiffani: I agree. I mean, you know, if 80% of our health problems are from lifestyle choices and let's just talk about the healthy, nonaffected, you know, with chronic condition yet population, young kids, it behooves us. I mean, I try to appeal to people's sense of business. I mean, it's just going to make health care cheaper families less like let's lean into that.

There's not a person out there who won't complain how expensive health care is. I mean, it's expensive to die in this country. You know, when you look at retirement planning, you have to factor in, well, what if I need long-term care, nursing or all this kind of stuff. Let's be a little self-preserving here and invest in things that we know will net us wonderful returns down the road, so, yes, I've always thought that it's a very worthy effort.

Audra: This is just one thing I want to make a note here, that Tiffani, that I love about your voice and your expertise and what you bring to the world, and this is the facet of innovator in you that I really, really appreciate, is that you're in there, going down the rabbit hole in data science with these partners, these researchers, these masterminds. We're going to get to keep going down the rabbit hole.

But you're going to take what you learn from that and you're going to apply it to 10 other areas of need. You play a very critical role in innovation of being a connector and a communicator and a unifier and bringing something that seems like it's isolated over here to a domain over here, like that's an aspect of innovation that we really need. And so it's always been something that I admire about you. You can bring, you know, bring things together, connect the dots, you know, pull the conversation together. It's a very, very important part of this. And I just wanted to share how much I appreciate that in you.

Tiffani: Oh, thank you. Well, I, you know, I've had some wonderful mentors. Certainly. I mean, you know, you've met Sherry Farrugia over at Georgia Tech and some of the women that I have had the good fortune to work with. And awareness is really important. There are so many wonderful things going on. And the awareness, as much as we are in an age of information where we have so much stuff coming at us. It really does.

And I'm really believing more and more coming out of this pandemic that people are craving relationship. So to be able to have that person to person interaction, to listen, actively listen to what their needs are, and if you can help them find a solution and then not only throw ideas at them, but escort them over to someone and so now let's have a conversation.

And if we can find the time, if we can cancel the unnecessary meetings that really I mean, all of us are asking these questions, do I need to be in this meeting? Could this have been an email? Do we have to send an email? Please don't send me an email if you don't have to. You know, these kinds of things, because when we get to the real work, when I can take the time to talk to people like you, when people have a need, if I can even do it one or two times, I feel like my life has value.

You know, it's that story of the guy throwing the starfish or the sand dollars back into the ocean where the whole beach is covered with them. And someone says, “Why you're doing it, you're never going to help them.” And he goes, “But it matters to this one,” you know, and they get them back to the sea. So, and that's what life is. It's a series of one-offs that eventually creates that network effect where people, enough people are touched, they see the value, and that attracts more people. And then together we have this ability to really do amazing things.

Audra: That’s powerful.

Justin: It's beautiful. So I want to talk about one of your latest project that at least I know of, which is related to infant feeding formula versus breastfeeding, how to blend these two. I wanted to first know before talking about what you are, what this project is, what got you interested in this, in the arena of infant feeding in the first place?

Tiffani: That's very easy for me to answer as a dietitian and as a mom, because as a mom, you didn't have a choice. You were in it, right?

Audra: Yeah.

Tiffani: And every mom expects I'm going to breastfeed because I'm going to be perfect and it's going to go wonderful. And I, let me talk about the part as a dietitian. When I was being educated and I learned about food, and then I got into my clinical rotations and I got into, we did community stuff, we did school lunch program stuff and then we got into the hospital. I'm like, ok, hospital is my jam. I love it here.

Then I went into critical care. I'm like, oh, I love this even more because I love the nerdy go deep into the science kind of stuff. And then what else do you have? What's the more challenging thing? And I kept going and going and going. And to me, the most challenging patient you could have is the preterm baby in the NICU, because here we have something that is first of all, you have to understand how humans develop physiologically. You know, they can only be viable so early. And then when they get to term their course is usually that it's a very predictable course in the NICU.

But also, when that baby comes out of the woman's body, immediately, their nutrition is cut off. So it is the burden of the dietitian and the care team to mimic the amount of nutrition that that baby would have otherwise been getting from the mom in utero. I found that so fascinating. I mean, how do we sustain this little life? You know, it is absolutely hanging on.

So that, from a clinical standpoint, was a major challenge then. I love just the sheer I understand now you get to witness the development outside extrauterine, watching this baby do things that we wouldn't otherwise see. You know, we look on ultrasound, we see a baby sucking a thumb. It looks really cute. Now we get to witness the baby learning how to suck, swallow and breathe and coordinate things and how they go through those developmental stages. And we have an amazing care team unit at CHOC with the development and really preserving that.

So I just love that problems that so getting into infant feeding was really, really dear to my heart. In the NICU, we work with breast milk as much as we can. So we deal with the really, really the nuances, the subtle nuances of how a baby can tolerate those feeds, the qualities of breast milk, how amazing it is and what the insufficiencies are, because breast milk is made for a term baby, not a preterm baby. So in all my years in, the NICU is really given, anchoring me in appreciating the value of breast milk.

Now, go back to Tiffani, the mom. I found that when I was breastfeeding my kids and struggling, you know, it's not an easy thing. What do you do when you can't have breast milk? You know, what do you do when you want to be that mom? And so then you turn to formula and many moms feel very like they're failing for whatever reason. And some parents are like breast milk formula, fine, whatever. That's fine. But many people who intend to breastfeed really feel like, that they want to do it perfectly. And we are so binary, right? It's like I need to do it perfect or I don't.

And so in looking at the qualities of the different formulas and certainly knowing that I worked with older populations and understanding nutrition, that formula selection really is the first food choice that you make for a baby. So taking what I know about all the qualities of breast milk and trying to translate into what's a good substitute for it, and then couple that and wrap that around the emotional state of the mom, the economics, the social part, all of those dynamics. I just really my heart goes to that problem set because I've lived it, but also that moms are natural nurturers and mentors, and we need to share what we know with other moms. And so it's neat to be able to come from a mom angle, to come from a dietitian angle.

So recently my work in the infant formula, I've had the opportunity to work with a new company who launched the first new infant formula brand in the last five years. And they've become approved through the FDA. And the company's name is Bobbie. And it's been really wonderful to work with a startup company. It was started by a couple of moms who were faced with the same problem: I really want to breastfeed. It's not going the way I planned. I need to supplement with formula. I go to the formula aisle and how do I make a good choice? And that's a huge, weighty decision for mom.

But from the innovation side, they recognize, too, that there was this huge demand for European formulas and did kind of a deep dive into why. Why are people turning to a European formula versus what we have here in the US? And looked at the standards that were over there. So the EU has very different standards than we do here in the States. And there are families who wanted these formulas that were importing them. You can't ship directly from Germany to the US. So you have people that buy it off of Amazon. But the supply chain wasn't guaranteed and the quality metrics were not in there. And so they were put on the red list by the FDA. And so even though there's a big demand for it with this population, people are still doing it, but there's a safety risk. So now…

Justin: I had no idea. So there's like a black market and European formula like.

Tiffani: Exactly.

Justin: Guys in trenchcoats.

Tiffani: Yeah. Yeah. And so and then if you get a baby, you know, on a formula that they love and then all of a sudden you can't get your shipment, you're stuck. I mean, what are you gonna do?

Justin: Gotta go down to the docks.

Audra: And moms trying to make their own and. Right. Mmhmm.

Tiffani: Yeah. But if you know, if we look at the quality of, what we have to ask ourselves, why would people do this? What is it that they think is in this formula that makes it so unique? And really, when you look at those EU standards, they are looking at how you're sourcing all your ingredients, how your most of them are cow’s milk based. And so how is that cow grown? What is the life of that kind of like?

Audra: What kind of cow is it?

Tiffani: What are the additives that you can put in there? In Europe you are not allowed to put added sugar into infant formula? Like we can't, you can only use lactose, whereas here in the United States, we can use corn syrup solids and other things like that. So those things matter. And so I'm really proud of this company and that they've taken on those very high standards. And that they went through all the rigor of going through our FDA process here in the US, they’re Organically Certified too, which is another very rigorous process. And they just created a very simple, beautiful formula and created a community of support around moms. Because if you look at the community of moms that need formula, they're working. It may be an adoptive mom, it may be mom who had multiples who can't make enough for two or three babies. It could be a mom that had a double mastectomy and realizes that her insurance company will send her a breast pump, but they won't send her reimbursement for formula.

So this company is stepping in to say, to step in and say, you know what? There's a gap here and we can do better and we can support these moms, the moms that feel shame, like they failed, like I tried to breastfeed and I couldn't do it. What about the moms that just need to supplement? I mean, my message as a dietitian was always, listen, your body grades on a curve. So whatever breast milk you can provide, you get credit for it.

Justin: Yeah.

Tiffani: And what and if you have to supplement with formula, you know, don't worry about it. The baby will benefit from both. So, you know...

Audra: Can we just say that again? Like I really want to punctuate that, you know, that every ounce of what you provide in this journey, whenever you provide it, matters. And counts and supportive.

Tiffani: The body is very good about grabbing what it can and it grades on a curve. And so you get all the benefits. So, you know, if you can only provide a little bit of breast milk, that's ok. You get all the benefit of that little bit of breast milk.

Justin: I love it. The body grades on a curve.

Audra: You know what I want, I really, Tiffani, I've shared this with you, but because we are going to be putting this out to listeners and Justin remembers this really well. I had breastfeeding challenges with both kids. Bobbie is making me want to have a baby again. You know, I want to do this again.

Justin: Oh right.

Audra: And it's, I have to share a couple of these challenges. First of all, I had to have C sections with both kids, and I experienced the questions around that just from other mothers. Like why? Why do you need to have a C-section?

Justin: Are you sure?

Audra: Are you sure? Yeah. Yeah. You know, I'm sure medically necessary. I had a myomectomy when I was 20. When I was 21 or 20. Yes. And then on top of it, I'll never forget when Max was born in Santa Monica and we had terrible, terrible trouble with him in the hospital feeding. I mean, he would bend his back backward screaming, didn't want to latch on Justin goes to the pump station, I should say, or this business and says, “Hey, do you have a nipple here? It's kind of like a lot like a real nipple, because I have a baby we’re in the hospital” and they're like, “No, we will not sell this to you. The baby will never latch on if you do that.” Right.

Justin: I forgot about that. I forgot about it.

Audra: So we have to go back and find out about it, of having him suck on a binky for a second and then latch on. And I remember going home with a hospital-grade pump, feeling like such a horrific failure as a mother saying, “Ok, I'm going to pump this milk as much as I can and I'll feed him in a bottle underneath a cover so nobody will see.”

Tiffani: Mmhhmm.

Audra: It's a bottle, even though it's my milk. And then when at six months, you know, I have to go back to work at three months like everyone else. The little bit of supply I had, I was getting through just maimed and tea bags, like trying to heal, and all of it. And I go to work and my supply just starts to go down and down and down. I mean, it's a story of so many moms, right? And down, down and down.

And so I start looking at the formula aisles and we have to start supplementing. We have no other choice. What are we going to do? Max stopped breastfeeding. He just stops at one point. He only wants a bottle, he stops at six months and, you know, an acquaintance at the time said, “oh, oh my god, what are you going to do?” Like, obviously, I'm going to let him die. What do you think I’m gonna do?

You know, and so it is, there's this social pressure. There is this valor that comes with a mom who can breastfeed until she's three. Until the kid’s three. And I'm not critical of that, like you do you. But why has this turned into such an assault on working mothers and mothers of all types and mothers who can't and the judgment that comes when the bottle’s presented.

Tiffani: Yeah. And you touched on something so important. People don't recognize that we're kind of set up to fail, too. So when you say you have a C-section, you probably had prolonged IV fluids given to you. You know what? That delays your milk coming in.

Audra: Oh, that's why it took five days? That’s good to know. They didn’t tell me that.

Tiffani: Yes. They don't tell you that. They don't tell you that you had blood pressure, that you were never had a history of surgery or anything. They don't tell you those things. And if you only get 48 hours for a vaginal delivery or four or five days after a C-section, you haven't even gotten into that window where your milk has come in. And meanwhile, your baby's been hungry for four or five days.

Audra: Right.

Tiffani: You know, what are you supposed to do? You can't win in that way. Now, you can succeed. You can go through and supplement and really commit to breastfeeding. You know, it's not like it's, the baby-friendly hospital, which is what you're talking about, which is very, very well-intentioned, has had a really dynamic effect in this place, especially on women's mental health. So let's talk about that a little bit, because I had never experienced, I didn't know I could be jealous of another mom, because when she pumped, she got 10 ounces every time. I was so envious.

Audra: She's freezing her milk. And you're like, why do you have enough to freeze?

Tiffani: Right. Like they open up the freezer and it would be like a 12-year supply.

Audra: Yeah, yeah.

Tiffani: You know, and it's like. And then the other thing is, I would, whatever I could pump off, I'd put it in the refrigerator and I'd have like the thinnest little layer of fat on top. I like pump like nonfat milk. And, you know, the other moms were Dairy Queens that were pumping cream.

Audra: Yeah.

Tiffani: So, you know, and you have no control over this. Your body as a woman gives you the number of milk ducts that you're going to have, which is why, and usually the dairy queens were like back in their size two jeans like three weeks after delivery too. That is not possible. Is that I am trying to eat, trying to sleep, trying to drink enough water. I'm doing everything. It can't be forced. And then you add the anxiety, like it's snowballing on you. And then they're like, well, you shouldn't be stressed because that will affect your milk supply. You're like, wait a minute here. So we really, moms need people to come alongside them.

And like I said, as mentors, as friends, to just say, “You are enough, you delivered a healthy baby. Let's not forget that point. We have options. Produce what you can think about what works for your family and your lifestyle, and then let everything else go.” Make your decision and then enjoy your baby.

Because I, I hate to think that those new moms who should be one recovering from birth, because we all know that that's got some things there. But two, this is a new little life that you've brought into the world and you need to enjoy that, you need to accept your new position, your new station as the parent. And whether it's your first parent or your first baby or your fourth baby. It changes your family dynamic. And so the kindness factor, coupled with the science, coupled with everything else that moms are trying to handle, this is what really drew me to this company, Bobbie in particular, because they recognized we're not just here to sell formula, of course, that's their M.O. But you know what? 83% of families will turn to formula in some way during that first year of life for their baby.

Audra: Yeah.

Justin: Yeah.

Tiffani: That's a pretty high number.

Audra: Yes, 83%. Yes, we need it.

Justin: There's a dad’s component.

Audra: We need to normalize it. Yeah.

Justin: I just had the flashback. I totally forgot about this. How happy I was to be able to feed Max…

Audra: And Maesie. Yeah.

Justin: Yeah. I mean that. But for the firstborn to realize like, oh, I really I'm so glad that I can take a role in this. And yeah, I remember.

Tiffani: Well, we've had dads come back and say, “I was so relieved when my wife finally gave up trying to pump it, you know, when she wasn’t producing anyway.”

Justin: When we were done.

Audra: Yup.

Justin: Yeah, I remember that. I was just so…

Tiffani: Like, it makes them feel like they get their life back. Yeah. And so, and no one here is advocating against breast milk...

Audra: No.

Tiffani: Don't mistake me. Breast milk is amazing. I mean, I love, you can study. It's like studying space. It has infinite qualities to it between the pre- and probiotics and the immunoglobulins and everything that it does. I mean, I used to in my early days, you know, used to say kind of snarkily, it does everything but clean grout. But now I pretty much have evidence that I can clean grout.

Justin: It can clean grout as well.

Tiffani: It’s amazing. Yeah. But I look at the fragility of these new parents and it, my heart goes to them. I want to help navigate making wise decisions. And I love that something familiar, something like this one says, well, “Ok, if you do need an alternative, let's make it as clean and simple and as beautiful as possible.”

Audra: Absolutely.

Tiffani: And so I think that and my other message to these parents is pace yourself, because this is the first food decision you're making for your kids. You have a whole lifetime of decisions to make.

Audra: Yeah.

Tiffani: So be kind to yourself and pace yourself. So I love even having that language of a formula is your first culinary decision, if you will, as a parent and start learning how to qualify, okay, what are your values around food? And again, maybe an 80-20 rule? We're not aiming for perfection here. We are aiming for being informed and making good choices that work for your family.

Audra: We're all about the 80-20 over here. I think that's phenomenal. And it's a beautiful point to make. Tiffani, I think in our generation, we are a part of the pendulum swings here, right. We have mothers who were advocates, probably our mothers, you know, might have been advocates for breastfeeding in a time that was hostile to breastfeeding. Right?

And even at our ages can experience various hostilities towards breastfeeding and the activism that has gone into helping mothers get access to breastfeeding and understand breastfeeding and feel supported and being able to breastfeed wherever they need to and in public and at work. And, you know, all of the different things. I love the activism. I get it. It's so important. I get that we are coming from a very deep hostility towards breastfeeding. And for it, like in many things, the activism turned towards hostility, towards formula and bottle feeding. Right.

Tiffani: Right.

Audra: And so we're trying to bring grace into the space and trying to help, you know, kind of normalize whatever it is that someone needs to do. Let's just be fully supported in all of these choices.

Tiffani: Yes, exactly. We do tend to have that pendulum swing from one extreme to another. And the reality is that we're all in that swath, the pathway of the pendulum at different points of our lives. Again, my heart goes to these new parents because it's a wonderful time and it's an exciting time, but it's a very fragile time. And so to be able to come in and if we hit them too hard with the science, you know, just like the baby-friendly thing, yes. Most of their efforts were very evidence-based. And I understand their intentions.

But in the meantime, you've got this sobbing mother who is just trying to keep it together. And we are discharging them home. And we want them to have a peaceful, successful home life, to be able to grow a baby that can thrive. Which is why I love the name of your group, The Family Thrive, because it covers everything from birth forward. And each stage and developmental stage and phase that we go through, not only as kids and parents, but the whole family in it.

There are different definitions of thriving and it takes different resources and it takes that empathy from our caregivers in our community to recognize, well, that wasn't my experience. But boy, I can certainly understand yours. And I would like to help. I would like to help provide resources.

Audra: You know, Tiffani, that that brings something up for me, too. Going back to your comment on the very first choice we make in feeding our child. The mental health of the mother and of the parents, that very first choice, setting down the path, starting to think about your values around food. And I think that this is a really powerful time that I don't know that I've acknowledged very much either and it's something that I'd love to talk a little bit more about.

So this, you see these steps that we take when we make these initial choices to incorporate formula and then maybe the next steps in solid foods and things like that. I'd love to know if you have any tips or insights, because it comes down, what I am starting to think of when you start talking about the mental health and well-being of the mother and of the family, is the more that we can de-escalate that initial stress around feeding, because feeding is the most important thing. Right. It seems like when we came home with our babies, it was like, oh, my god. Feeding. Right. And the counting the pee, counting the poops, what goes in, what comes out and that doesn’t leave you. You know, you end up with a six-year-old, you're following around with a spoon of food because, you know, you want to make sure that they get that one little bite of nutrition in.

Do you have any tips for new parents on just developing some mindfulness around those values? Because I think it's something we don't think about or talk that much about. I'd love to know if you have any thoughts on that.

Tiffani: Well, in the early days, for sure. You know, I totally remember what you said about counting the diapers and trying to do it right, especially if you're breastfeeding and you don't have a quantitative volume, that's where the mystery just becomes so hard. I mean, if you are pumping and putting it in a bottle is, you know, what volume you're feeding. So in those early days, I think having the metrics is very valuable, getting that benchmark of back to birth weight within the first two weeks, and then you feel like, ok, we're trying to get our groove on.

And I can even remember as a pediatric dietitian who I think knows more than most about the actual ins and outs of food. When my first was turning one and I had weaned from breastfeeding and we were discontinuing our supplemental formula, I thought, “oh, my gosh, I don't have that insurance policy anymore,” because I knew formula and breast milk is nutritionally complete. So now I was responsible for everything that I said. My kid had to meet all of the needs for nutrition. And I just felt the gravity of that responsibility of like, I better do this right.

You know, in the US, we address it so differently. We label things and I would say this, even for kids and adults, and we like to wear our banners of like “I'm a paleo vegan” or “I'm on this diet.” You know, we like to know that we have those constraints and boundaries and that we're doing it right. And then we take pride in that. If you were to look at other countries around the world, food is love and relationship, and its history and culture. And they feed their babies seasonally because that's what they have access to. And we tend to standardize and make it a protocol.

So when you look at introducing foods, we start with a puree consistency because it's appropriate for what their palate can handle. And you're trying to introduce those different textures as the mouth palate evolves and their developmental skills evolve to the point where then they get some teeth and they can chew. And then you think about not wanting to have choking hazards and stuff like that and being on the lookout for allergies so that you're introducing individual foods and watching and seeing how the baby responds to it.

There's some strategy to it, if you will. But it's not necessarily adopted with other cultures around the world. I think knowing what the family's values or what their approach to food is, helps people drive what they're going to aim for. Because ultimately, when a child is about a year old and everything developmentally has been on track, they're pretty much eating what the family is eating. It just might be modified in its chopped size or consistency just for hat. So you're really trying to get them from birth to 12 months to kind of get in line with what the family's doing.

Now, I have seen families take the opportunity in trying to do such a good effort with their child that they've actually improved their own eating habits in anticipation. If they can make that connection of like we are a family unit, what do we want to do for the family? And so I've actually seen some families rise to that occasion of like, ok, well, you know, I'm glad he likes the jarred peas because we don't eat peas. And I'm like, “well, should you?” You know, like what do you want to aim for? Because you're giving him sweet potatoes and carrots and, you know, all these different things. You're giving him cut up pieces of banana and now you're doing berries and stuff like that. How does that incorporate into your family? Because ultimately a family is a unit. Basic home economics will tell you that it's a whole lot cheaper to cook for many than for one. So know from a practical standpoint, as that kid develops their eating habits, you want to streamline that in there.

So I don't know if that's what you were aiming for know, but it's kind of a global lens on what are the goals, what are the aims? There's obviously very iterative steps to get there. But if you look at it holistically on what does the family aim to do, what's practical, do you have two working parents, how much time do you have for shopping and meal prep and stuff like that? But I think with a little bit of strategic planning, you can get there. And then it again takes away that power from the mystery and that you feel like, ok, I feel like I've got a sense of understanding of what we're aiming for and this is what we do. And you step into that identity of this is how the Ghere family is approaching food. And I am getting to experience the wonderful. It only took 18 years, but the wonderful opportunity of the kids being able to advocate for their own food choices, to see them go out with friends and get creative and experience new cultural food experiences, as well as cooking their own meals.

Audra: Yeah. Tell us more about what you are seeing, because it sounds like to me that if we can de-escalate the stress around the home and like bringing baby home, breastfeeding, bottle feeding, you know, all of the stress and anxiety, that is really, I think, social pressure.

Tiffani: It is.

Audra: And if we can de-escalate that and provide that focus on how we want, we want to nourish this new this child, this new baby we want to nourish, and then we want to provide a home environment where we keep that goal of nourishing. So whatever that timeline, strategic plan is in place, even the mindset that we can level up, that we can rise to the occasion. We had that experience only when faced with a medical crisis. I think it's really powerful to think like this baby is coming to the family table. We can level up for all of our benefit. I think that's just such an amazing point to make.

And then I'm so curious. Mom of three boys. Three boys raised by a culinary-inclined dietitian who, you know, knows all about how things start with soil health from the ground up. What are some of the cool things you've seen in your sons as they're like autonomist folks now?

Tiffani: Well, I will tell you that we are just like every other family. They’re kids, you know, you can't necessarily groom them to be exactly the way that you want them to. You know, my goal, as much as I have had a lot of experience with food, my goal was always to be kind to myself, too, and not to be too overarching and to just expose them. I can remember sitting at the table when everyone has that where they don't want to try something or whatever. And I would try to remind them this was probably a grade age.

You know, my goal as your parent is that when you're a grown-up and if you got invited to the White House that whatever they serve, you would be cool with that, that you wouldn't be afraid of it, that you could you know, if someone said you get to take a mission trip to a foreign country, could you adapt to what's going on? I wanted them to have. It's funny because as an anal and as Type-A as I tend to be, I try to actually train myself to be a little bit more chill on it, and recognizing that it's not a battle. And really, the victory is going to be won in the very long game, which is, I wanted them to have an adventurous relationship with food.

I wanted them to be inquisitive. I wanted them to understand where it came from. I wanted them to taste things. Everyone goes on their own timeline. But I do have three pretty open, adventurous eaters now as they're getting into their late teens or early adulthood, which is, that was my goal. So now I can hand them off to the world, right?

Audra: Yeah. Yeah. It's a great point, too, that it's a long game. I think that's one of the things that's so rushing in this is that there are a lot of no's along the way. You know, you provide a lot of really cool different things or broccoli or whatever, and there's a ton of no's before you get to yes. And so it's a long game that takes a good amount of kind, graceful, open persistence.

Justin: Well, there's a lot of no's on the side of the kid. But I'm curious, Tiffani, what were the no's or what are the no's for you when thinking about food in the home, meals in the home? Are there some, I don't want to call them like hard and fast rules, but food general guidelines, where like, no, we're not going to do that here.

Tiffani: Yeah. You know, for us, it is interesting because we never had, don’t anyone misunderstand me. If this is in your pantry, this is not a judgment. This was just my own personal choices. But knowing that the affinity for sugar is an acquired taste. So the more exposure you have to the high, sweet things that you would be, you know, you would continue to have that high affinity for sugar. So we never had juice in the household or the sodas or those really high artificial sweetener things. We did use yogurt. We had berries with it.

It wasn't that things were a no. I just tried to do the best decision making with the quality that we could, always having that mindfulness of quality and knowing that if they went to a friend's house and they got the Gogurts and they got the you know, that they had mom, how come you never told me about fruit punch? It’s awesome. How come we don't have jello, you know?

Justin: My gosh.

Tiffani: And it's fun. But you know what, what I love. We got to travel to my sister's house. We got to travel by plane over Christmas. And here I am with my two, two of my three grown kids. And they were doing a beverage service. And the biggest treat that they always thought was to get apple juice. So they both I watched them order their apple juice because we just never had juice in the house. And you know, now they, are they candy fiends? Yes. When you go to junior high, there's like a black market for trading candy out there. And it is hard to fight, you know.

But I do remember that especially with grade school, you know that packing the lunches, especially with the first one and trying to be very thoughtful. And then they go and they're surrounded by all kinds of processed foods and things that are high in sugar. And they didn't feel as popular. So my angle was always, we're going to have all kinds of treats and cookies in the house, but I'm just going to make them from scratch. And then I have control. Like I can downgrade the you know, if it calls for a cup of sugar, I can do it with like two-thirds of a cup and it's still ok, you know, and using that high-quality butter, my approach was like most of our food will probably rot in two to three days. And, you know, sweets included. And that's kind of the road that we took.

But there's many ways to get to a path of success. And sometimes there are drivers in your life, as you guys know, where you have to put that and if something is forced on you. Let's say two of my three kids have very close friends that are type one diabetics. And it's been very interesting to watch them and their empathy that they have and understanding what they have to do.

In fact, one was very protective of her, and she didn't get diagnosed until she was, I want to say nine, which is a little bit later down the road, so he had that awareness that tore my heart strings open, I just I burst, I was my heart was breaking for the family because I knew how much of a lifestyle change is going to be. But my heart was so proud of my son who had that empathy and recognize that she has to look at her food differently. And I know. I want to. I want to. He was watching out for her at lunch time and trying to like protect her from other kids, going how come you don't eat the Gogurt or how come you don't do that? He was trying to like, kind of jockey to protect her.

So, you know, this is why we can't forecast everything we want to do with food with our kids, because hopefully they come back and surprise you in a delightful way. And I tend to go to that holistic overview so that they have the context, because our job as parents, my mom used to tell me this, and I do agree with her that if you're parenting, if you're doing it right every day, you're working yourself out of a job.

Justin: Beautiful.

Audra: I love that.

Tiffani: When you get to that phase where you're actually working yourself out of a job, it tears your heart open, but it is the marrow of life. And so, you know, you plant those seeds and then you get to see those wonderful returns. But at the early years, you know, there's a lot of support needed.

And I think what's really important is that we give these new parents the confidence to say, you know, “we thought about this, we made a deliberate decision. I'd appreciate it if you could support our decision” and then we can enjoy, you know, I think about Thanksgiving, right, where grandma or someone always has an opinion about what you're doing. And, you know, just to equip people with the language to say, you know, “we really we really thought about this and it would really help, but this is how you can support me,” because when you use that language, it actually we're struggling. And so could you please. And then you get to give people the equipped messaging that actually creates that better support system. And it's not about the food. It's about control. It's about who has to be right. And I try to break that down so that we can disarm people and really have true meaningful relationships that are supportive.

Audra: I think that's so helpful, Tiffani. Yeah. Thank you for bringing that up in like, we have a module on that MaxLove Project that I think we need to bring into The Family Thrive setting as well. Lexi Hall, the dietitian we work with who you know very well, from CHOC, did a Fierce Food's Academy with us around Friendsgiving and specifically to help families with these challenges that come up around, you know, bringing your own family's choices into family settings, social settings, and things like that.

I also want to just reflect on your comments on your parenting. I love hearing this and hearing this from a dietitian. I feel like it's such a beautifully, you know, open, pragmatic way that there's not. We don't have to have like, super tight reins, but we can figure out our own kind of equilibrium in the home. You know, that makes sense for us. And I think it can be hard to sort of stake your own claim in that, like without having a model out there. So the more stories we hear from other parents on how they've done it, the easier I think it is for new parents.

You know, I think in our case, we ended up with a kid, we needed to go on the ketogenic diet. You know, we needed to do it as a family. But then raising his little sister to make her own choices and to be her own person and getting into bio-individuality and kind of the diversity of what we provide in the home. And I will be totally straight up with you. We have these like Annie's mac and cheese, little plastic things in there that she can fill with hot water to have mac and cheese. And one thing that I've really loved is she will down two flights of strawberries. No problem. She'll eat entire English cucumbers. No problem, like you know, when she goes into the fridge, she's going for this stuff and she still has it.

And she was like obsessed with these. Like, can I have mac and cheese? Sure will buy you the mac and cheese. She wants to have it for breakfast. Fine. And she's making them for herself. She's doing it for a couple of weeks. You know, they're in the pantry still. And what is she making for breakfast? She's making an egg sandwich. She's been making smoked salmon with cream cheese and capers and lemon. You know, as her, I mean, she's making these fabulous choices. And I said, “why don't you eat the mac and cheese anymore?” And she was like, “eh, it's just not really that great,” you know? And that has worked for us. Talking about bio-individuality, providing some of these choices has worked for us.

Justin: No offense to Annie’s.

Tiffani: No offense to Annie's at all.

Audra: Oh no, no, no, no. It’s not about that. Not about that at all.

Tiffani: It's a testament to the evolution of her palate. You know, and you touch on something else really important, too, is as kids grow, especially in their you know, it becomes less frequent as they get older, but they go through phases. You know, you see it radically in ages one through three where they'll go on food drags where it's like all they want are goldfish crackers. And last week, he was eating lots of kind of chicken. Now this week, he doesn't want it. So they go on strikes and they go on drags and then they go through different phases, too.

And I love that you're also touching on the fact that, because it takes a lifetime to develop that palate, you know, we know that it takes at least 20 exposures to a food for a kid to know if they do or don't like something. And many times that they don't like something in their early years. It's not because of the taste. It's usually the texture or the temperature. So there are different forms of offering of foods. Like it's not that you don't like carrots, but, maybe you don’t like cooked carrots or cut, you know, raw carrots.

Justin: Yeah. Right.

Tiffani: So, I mean, that's really important to know. But the fact that Maesie has that sense of curiosity and exploring and then mashing up different, that's the evolution of the palate. And Chef Azmin can definitely explain it in better terms than me. But I love that. I saw the same with my youngest, Carter, too, who was definitely a fierce advocate for mac and cheese. I think we had the Costco, the Costco brick of Annie's mac and cheese.

Audra: Yeah. Yeah.

Tiffani: And now I do, I think somewhere in an old closet, that brick is still there because he's evolved and he still loves pasta, but he's making his own rigatoni alfredo, and adding the vegetables and the chicken to it. And, you know…

Audra: Does he like the feta pasta? Does he like the TikTok feta pasta? Maesie loves that. Loves it.

Justin: Just so we don't run out of time...

Audra: Because we could talk forever.

Tiffani: Yes, I know. No, keep that keep us on track.

Justin: I have one final topic before we get into our last three quick questions. So the last final topic is when we had our podcast interview with your colleague, Lexi Hall, we ended by talking about food myths, you know, because in not just in the world at large, but especially in the parent world in the discourse, there's all these food myths that are circulating. So we talked about a couple with Lexi Hall. And I'm wondering if you have a food myth that you have come across or that you regularly come across and you want to bust it?

Tiffani: Well, I don't want to cover something Lexi already did. What did she tell you?

Justin: So well, we covered meat. So like meat is going to kill you. So that's a myth.

Tiffani: That's a good one.

Justin: Alkaline diets are these super healthy, magical things. Yes, we busted that one. And then eight glasses of water a day. We busted that one. So those are the ones we…

Tiffani: I agree with all of those. Let's see, so I'm often asked, and I end up saying this when I'm educating families, like if there were five foods, if I could only choose five foods to live on. And one of those five foods is eggs. And so I think one of the myths is that if you eat too many eggs, you're going to have high cholesterol. I think that came out of our ‘90s education on heart health. Again, well-intentioned, but it's not been validated. And if any part of cholesterol gets raised is the HDL, and that's for good cholesterol. So I love eggs, and I eat them every day.

Justin: Heck, yeah.

Tiffani: I have decent cholesterol. I have pretty good blood glucose control and there is a tie to that. So dietary cholesterol doesn't necessarily tie to serum cholesterol, which is your blood cholesterol. And I, the way I explain it is this: there is enough nutrition in that egg to grow a whole chicken. So I love caloric density. There's enough nutrition in a nut to grow a whole tree.

So when people ask me what are the five foods, I think of avocado, eggs are on there. I think of nuts. I think of a fish. And again, those are very nutrient-rich type things. So I think that would be the myth-buster that I would go to just because I am such a fan of chickens and while not vegan. You can eat an egg and glean a lot of great nutrition in an ethical way that actually isn't a harm to a chicken. And so I'm hoping that it also reaches a wider part of the population that as a food choice.

Justin: Brilliant. Yes.

Audra: I love hearing that from you. Yeah. Thank you so much. That's one that has come up recently with yet another study that was pulled in by the media attempting to disparage eggs. So thank you.

Justin: Yeah. And speaking of Maesie, this is one thing that, one of the hardest things right now to do with her is to get protein in. And, you know, because she, yeah. Audra’s, right. She'll eat tons of berries or eat tons of veggies and all. But it's like, ok, can we just get the protein? Or so I will tell her. I'll stop bothering you for the rest of the day. If you just eat an egg, just eat and then I'll be done.

All right, so let's get into the final three. These are quick ones. All right. So if you could put a big Post-it note on every parent's fridge tomorrow morning, what would that Post-it note say?

Tiffani: You're doing a good job. You are enough, really. You are trying to raise a human being. And it takes a lot of effort. And we are so hard on ourselves and we think we're not good enough. It's like imposter syndrome again or something. And everything, we will hear the one negative, the one negative thing will completely derail us, even in the presence of 100 compliments. And so reinforcing that they are enough and that they are doing a good job is enough to get them to pause and breathe. But any insufficiencies or gaps that they have, it affords them the time to go seek out help or find the education and they can do it. So it starts with, except that, you know, you can do this. You're completely capable.

Audra: Tiffani, I feel like you just put that on my fridge. Thank you. Like I sort of get emotional. Yes. Thank you. Thank you.

Justin: We need that.

Tiffani: I know you probably wanted us food one, but.

Justin: No.

Audra: No.

Justin: No, no, no, no.

Tiffani: It's again, it affords me that access to connect with people in all the years that I've been working with families and patients. And it's such a pervasive reality that we have these people that are struggling with a clinical status of a child. Let's back it up. Let's look at what you're actually doing. You've walked a hard road. You can do this.

Justin: Absolutely. Second quick question. Do you have a quote that has recently changed the way you think or feel?

Tiffani: I do. And it's funny, because the one that I used to always cite was Maya Angelou’s, “When someone shows you who they are, believe them the first time.” And part of that speaks to being burned and becoming aware of like, ok, I'm going to recognize people for who they are.

But Audra, you actually posted it to Instagram, I think it was just a couple of days ago from Angela Davis. “I am no longer accepting the things I cannot change. I'm changing the things I cannot accept.” And that just really speaks to my present of mind right now where, like I said, go bold or go home. Children and family are depending on those of us that are in this professional world, we owe it to them to swing from the fences.

Audra: Oh, absolutely.

Tiffani: Obviously, another testament to how in-sync we are in our like-mindedness, but.

Audra: Beautiful. Yes, I feel that fierceness in you, Tiffani, that it's like this is your life's work.

Justin: Yeah. Oh, for sure.

Audra: This is your world changing. You know one starfish at a time. And this is it. You know, it's really, really inspiring. And it's a beautiful call to action. And it's something that The Family Thrive is all about. And I really appreciate hearing your fierceness in it. And the emotional component to this. Like this is really, really powerful, needed work. And I just really appreciate hearing that call to action from you. I feel more charged up in my day.

Tiffani: Oh, it's amazing how cyclical it is, because that's how I feel about talking with you guys. You know, this is what synergy is, where you find that like-mindedness, you find that common goal that you reach for, and then you allow people with their different skill sets and talents to come together and create something unique and dynamic. And people respond to that. And as someone who's given many a lecture or a nutrition talk in my day, it's always in the back of my mind that people walk away with how you make them feel, not what you say.

Audra: Yeah.

Tiffani: And so if you can touch, if you can connect in any way, no matter what kind of information you're dispensing that day, that connection is what people truly crave. And it's not that, that's not all that they need, but that's how you start. And then it affords you the opportunity to gain their trust, to create that awareness. And then you can provide the education and then you have a bonded loyalty that creates that greater network that's going to be really, really powerful.

Justin: Awesome.

Audra: Couldn't agree more.

Justin: So the final question we ask, because for, at least for parents of young kids, you know, it's a marathon. It's exhausting. And at the end of a day, you can say, oh, kids, just like so much work. But at the same time, kids are totally awesome. So let's celebrate them. So we want to know, what do you love most about kids?

Tiffani: Well, like I said before, I think they are the great equalizer because it does break down the adult to a place where it does open us up too, because if we are so closed and buttoned up, we lose a lot of things in life. But kids don't lie and they let you know with complete transparency and utter honesty how things are.

And it's positive in the negative. You make something for dinner and they hate it. I mean it. And as much as we get thrown back in your face. Right. We know that with a toddler. But they're forgiving and they're loyal and they're loving. And they show us as adults that that compassion and that commitment is hardwired in us. And this is who we were supposed to be from day one.

And so I think it reminds us as adults to remember that, you know, and for those of us that are spiritually-minded, I think about biblical teachings where even Jesus connected with children, and that even relating to something as grave as pondering the existence of God and relating to God, he did it through the vehicle of children.

So I think that for these big things that we wrestle with and parenthood is a big thing to wrestle with. To remember to look at it through their eyes and we'll glean such great insight. And I've seen it, like I said, with all those wonderful doctors that I work with that are so accomplished and so brilliant, you bring a child into their life.

Justin: Yeah.

Tiffani: Like what do you really know?

Justin: Exactly. Yeah. Tiffani, ok, before we sign off, how can people find out more about your current work and just how to follow you?

Tiffani: Oh, well, I am with CHOC Children's in their Medical Intelligence and Innovation Institute. We call it MI3. And you can certainly reach out to me via LinkedIn. Yeah, I love to connect with anybody who wants to be in the space. Anything I can do to support The Family Thrive. You know, I'm in.

I'm so excited to see your efforts grow and the community that you're building. And it reminds me of how we drafted the banyan tree all those years ago. And it's just taken roots and it's just growing, only it's under the umbrella of a magnolia tree instead of a palm tree. But I'm so excited that I get to see you next week.

Audra: Me too, I can't wait. Thank you so much for spending this time with us today, Tiffani, it was beautiful catching up with you.

Tiffani: Thank you, guys. Love you guys so much.

Audra: The first of many, too. We love you, too. A first of many.

Tiffani: I love it. I love it.

Justin: Awesome.

Tiffani: Well take care of you guys. And I get to see you next week.

Audra: Yeah.

Tiffani: Travel safe.

Audra: Okay. Thank you so much. Bye Tiffani.

Justin: Hey, thanks for listening to The Family Thrive podcast. If you like what you heard, please subscribe, tell two friends and head on over to Apple Podcasts or anywhere you listen to podcasts and give us a review. We're so grateful you've chosen to join us on this Family Thrive journey.

Justin: I don't know about you, but when our first baby came into the world, feeding him was really hard. It caused us a ton of stress. And then when we transitioned to formula, many months later, we had more stress because we didn't know which kinds were best. And we also had to deal with the stigma around formula in our social circles. We might have stressed out again as we transitioned to solid food, but honestly, it's all a little blurry now.

But I can say that all the stress would have been alleviated had we known today's guest, an amazing clinical dietitian at Children's Hospital of Orange County, Tiffani Ghere. Tiffani specializes in pediatric nutrition with a particular focus on neonatal nutrition. There are few people in the world who know more about the science and practice of feeding newborns and infants.

Audra and I have known Tiffani for several years through our work with MaxLove Project, and we're thrilled now to have her on the podcast. We talk about formula versus breastfeeding, transitioning into solid foods, feeding kids as they grow up, and a whole lot more. So without further ado, here's our deep dive conversation with the always sharp, ever knowledgeable Tiffani Ghere, RD.

Audra: Thank you so much for being here with us and talking with us, Tiffani. I, you know, when we were let's see, we went to Temecula right before a lockdown. Was it a year ago?

Tiffani: Oh my gosh, it was. And I can't believe it was literally right before lockdown. And I remember thinking, “oh, my gosh, I want to go back to Temecula, like hit the undo button,” you know.

Audra: Cause we didn't know if we should go through. We were like, this is a little risky. We'll go do this thing. Didn't really know it was going to happen. And even kind of like, risky sort of being around people, but weren't sure yet. You know, it was at the very beginning, it seemed kind of tenuous.

Tiffani: Yes.

Audra: And then boom.

Tiffani: Yes.

Audra: But I remember on that magical, magical mini trip, which I can't wait to go back to and return to. We will, I just thought it was fabulous. We talked about The Family Thrive. And I was starting to share the seeds of this project even then and talking about, it's crazy. I can't believe that...

Justin: I love it.

Audra: Reflecting on it now, even we're talking because we are talking about various, you know, kind of like synchronicities and overlapping things. And today we, three-quarters of our seed round has been funded.

Tiffani: Oh my gosh.

Audra: We are going to be launching...

Justin: And we had our 19th anniversary a couple of days ago and…

Tiffani: Congratulations.

Justin: You know, like the stars are just coming together and then we're getting vaccinated soon.

Audra: Yup.

Justin: You know, the spring is coming, but it's, COVID’s going to be in the rearview mirror.

Audra: It will be in the rearview mirror. But it has been such a formative, powerful time for us. And it has been the time that we've invested everything in bringing The Family Thrive into being. We have our minimum viable product, our product, The Daily Thrive, which is the app, is ready to roll.

We are so excited to roll it out and to begin building it in live, in real time. And you are a huge part of it. You know, we've had such a wonderful relationship over all of these years, co-developing, co-inspiring, like really working on bringing, you know, kind of not only more awareness to the role of health and wellbeing and living our best lives, but the community aspects of it. And it just feels really incredible to talk with you today because we have so much to talk about, so much that we have, you know, not only in our common interests and passions and all of that, but we are going to be building The Family Thrive with you.

We know that you're going to be a powerful part of this team. We need you. We see you as just a huge asset for this movement. So just really excited to be here with you today because it's a marker for me. It's like a I don't know. It's the….

Tiffani: It feels like a sentinel moment. And I echo everything you just said, because our relationship really has been forged on blood, sweat, tears, lots of amazing meals together where we have broken bread and been inspired. And, you know, you and I met each other before I got to meet you, Justin. And it was a very quick love relationship where these common threads, the synergy was always just like fireworks every time we got together.

So I am so proud of you guys. I am so happy for this getting off the ground. And I have no doubt that it's going to be hugely successful. And the exponential returns of all the families, all the children, the lives that you touch, the work that you're doing here is so needed, but just such a value. It's the stuff in life that is worth getting up for in the morning where you can look back on the work that you do and you go, I did good work. And that's really, really what matters. Now, you're going to make me moved to tears because I love you guys so much.

Justin: Oh, that's so beautiful. Tiffani, thank you. Oh, before we get too far into it, just for the listeners, can you give a brief just, you know, elevator pitch of what you do? Like what do you do and where did you come from?

Audra: You got a cool story, Tiffani. I love it.

Tiffani: Oh, my gosh. I've been asking myself that question for about 50 years now. Yeah, well, by education, I am a clinical dietitian. I'm a clinical pediatric dietitian. There's only a couple hundred of us in the country.

So as I did my educational pathway in studying food science and nutrition science and got into the clinical work, I always knew I loved the clinical acute care environment. And I love the challenge in nutrition of, it affects all parts of the body. And it is very much a mind game. So as a dietitian, when you have to solve a problem, you have to mentally visualize the anatomy, the physiology, where the deficiencies can be. And clinical dietitians are really accountants. It's not just calories in, calories out by any means. We are looking at what is normal and out of anatomy and physiology. And then if you put an illness or a disease condition into it. Ok, now how do we pivot with those variables and how do we optimize? Because we're really looking at: how do we get the best nutrition, the best bang for our buck? And sometimes we're constrained where there could be a reaction to foods that could be a clinical state where they can't get certain nutrients.

So I just love the complexity of it. I think my ADD-type mind just loves the activity that fires on all fronts there and in the hospital, I've had the wonderful benefit of working with almost all of our subspecialties. So I love the connection and the relationship.

And part of the reason why I have such a heart for pediatric nutrition is unlike the adult world, in the children's space, the clinicians really value what the dietitians are doing because they know as kids are growing, if they're not meeting those benchmarks and they're not thriving, then they can't discharge them from the hospital. Their primary care doctors are very engaged. So it is a vehicle by which we have access to working and participating in that care team. So

I've been with CHOC Children's Hospital since 1999. I've covered all of their units, NICU, PICU, Pediatric floor. So it's been a very broad scope with everything from preterm birth to age 18 and lots of disease to stages in between, you know, traumas and illnesses and stuff like that.

And then about, gosh, I want to say it's almost been 10 years since I've been working with the chef, who our dear friend Chef Azmin Ghahreman. He really kind of injected new life into my lens, because a lot of times when you are in the hospital, most of the times our patients are not eating food. If they're really, really ill, they're either being tube fed or they're getting intravenous nutrition. And I love the bio pharmacology part of it.

But in working with the chef and seeing him bring in the possibilities to really evaluate not just the quantity, but the quality of food and the impact, again, on that anatomy and physiology, it just really breathed new life into this. And as you can be in the nutrition board that we both sat on together, we work together in building out his school program, the Sapphire at School program. And so that's been kind of a side pet project for me.

And then in the last four or so years, I've been participating in our hospital’s innovation and intelligence group, which has kind of allowed me to level up in a different way too and take that broader swath of jumping into pushing the boundaries within health care. How do we use the amazing resources and talents we have in our children's hospitals and go beyond what the status quo is?

And what is so interesting in the state of pandemic is that I think all of us have experienced, probably firsthand, some of the shortcomings of our health care system. Not that we don't have amazing, wonderful care providers and people that really have great intentions, but the system itself needs to be pushed on. It needs to be updated. It needs to be digitally efficient. We need to have that common way forward. So my journey has kind of taken me into that space as well. But as you know, my heart is always going to be at the bedside and back to my roots. So, so wonderful to be able to have this conversation today.

Audra: Oh, Tiffani, thank you so much for sharing. You have such of, well, it's connected yet varied history. And one thing that I feel like connects it all is that you're truly a lifelong learner and deeply curious person. I think it's one of the things that I love most about you. You didn't, you know, first of all, you didn't originally go to school to become a dietitian. Am I correct?

Tiffani: No, that's correct.

Audra: Where do you start?

Tiffani: I started with soil science.

Justin: Oh, you started in the soil. That's so cool.

Tiffani: Yep, my roots are in the soil.

Justin: I love it.

Tiffani: Well, it is funny because it, actually I had never thought about that kind of poetic aspect of it, Justin. So that is good. But yeah, I think that God kind of laughs at those who make plans in some way, although we do have direction in our life. I also in my years as they've gone on is, you really have to lean into the opportunities that come before you and I, as a very first born Type-A programmed person, it is in my nature to plan everything. And parenthood will break that down really quickly over time. I have three kids, as you know.

Justin: Yes. Speak.

Tiffani: It will put you on your knees. It is the great equalizer, which is what I love about children in general, because one of my favorite things at the hospital is when you have a fancy pants doctor who got married and now they're pregnant, like, “Ooh, this is going to be fun,” you know.

Justin: Welcome to the jungle.

Tiffani: That's right. Because there's even no matter what kind of resources you throw at it, you will be up in the middle of the night with a vomiting baby or you will be driving in your fancy Porsche and that blowout will happen off the back of their car seat, you know. And I love that, because when you break down those barriers, then you have the reality of the human experience, which is really what's always connected us too.

And I know in your space with MaxLove Project, you are dealing with families at their most vulnerable, at the most raw point of anything that you can experience. And yet something as simplistic as food is a vehicle by which you can connect with them. And I, one of my favorite things to say in the hospital is I've been trying to advocate for pushing for more resources or something like this is, every one of our patients has a diet order that offers us access to every one of those patients. They may not need radiology. They may not need rheumatology or other things that, you know, that they always need nutrition. And that is a common thread that we have.

Justin: You need to eat.

Tiffani: Exactly. So that affords us, you know, as dietitians access to participate.

Justin: One of the things I love about your story, especially in the last five to 10 years, it feels like it's both an expansion. So you're expanding, but you're also going deep. And so, standing by like the work that you've done with Chef at, you know, working in the community and with real food and whole food. And so there's this expansion, but then with the innovation work, it's like a deepening. So it's kind of cool.

Tiffani: Well, and it's you get into that space and I know you all have met Dr. Anthony Chang, our Chief Intelligence and Innovation. They are so brilliant. You know, they have 12 degrees behind their names. So it is, I am a big believer of surrounding yourself with people smarter than you are.

Justin: Yeah.

Tiffani: And you and in that opportunity, when you have the chance to actually glean some insight and you have their attention, you think, wow, I actually you know, that imposter syndrome is very real for me, a lot of times as a woman perhaps, or just as me, Tiffani, the dietitian, in the caste system of the health care system, dietitians rank very low.

And yet still I find the joy in the service. And, but I am in more recent years, part of it's because I'm probably of a certain age and have gone through the hazing of having three boys to raise where you just play the game like you have nothing to lose. Because to the families and you know this well, to the families that we serve, there is no greater sense of urgency. So it is incumbent on us as the care providers to recognize that sense of urgency and do everything we possibly can to expedite the process or to push those boundaries or to find solutions that don't easily come to us.

This is not an easy game. You know, this is everybody who's in the space is, we go to bed at night wrestling with different ideas. So, yes, this Intelligence Innovation space, the stuff they're reaching for is big. It is deep at times. And sometimes when they go down those deep rabbit holes, especially with data science and machine learning, I just my brain goes brrk and I think, thank God there are people in this space and this is what they do.

You know, I've always felt that way about different things in health care. And I love that we have this on the forefront.  We would not have the vaccines for this pandemic at the rate that we had were it not for the tools of genomics and machine learning and all these things. We had access to it. But when you finally get the resources and a concerted effort where the whole globe was trying to solve this problem. Yes, amazing things happen. It doesn't mean that the FDA didn't approve the quality and the safety of it. No. In fact, their groups were even larger than a lot of the other things that got approved. But we had that laser focus. We had the funds, we had the research and we had the talent.

Justin: So now, Tiffani. What if we can put just even a fraction of that towards, like school lunch programs?

Tiffani: I agree. I mean, you know, if 80% of our health problems are from lifestyle choices and let's just talk about the healthy, nonaffected, you know, with chronic condition yet population, young kids, it behooves us. I mean, I try to appeal to people's sense of business. I mean, it's just going to make health care cheaper families less like let's lean into that.

There's not a person out there who won't complain how expensive health care is. I mean, it's expensive to die in this country. You know, when you look at retirement planning, you have to factor in, well, what if I need long-term care, nursing or all this kind of stuff. Let's be a little self-preserving here and invest in things that we know will net us wonderful returns down the road, so, yes, I've always thought that it's a very worthy effort.

Audra: This is just one thing I want to make a note here, that Tiffani, that I love about your voice and your expertise and what you bring to the world, and this is the facet of innovator in you that I really, really appreciate, is that you're in there, going down the rabbit hole in data science with these partners, these researchers, these masterminds. We're going to get to keep going down the rabbit hole.

But you're going to take what you learn from that and you're going to apply it to 10 other areas of need. You play a very critical role in innovation of being a connector and a communicator and a unifier and bringing something that seems like it's isolated over here to a domain over here, like that's an aspect of innovation that we really need. And so it's always been something that I admire about you. You can bring, you know, bring things together, connect the dots, you know, pull the conversation together. It's a very, very important part of this. And I just wanted to share how much I appreciate that in you.

Tiffani: Oh, thank you. Well, I, you know, I've had some wonderful mentors. Certainly. I mean, you know, you've met Sherry Farrugia over at Georgia Tech and some of the women that I have had the good fortune to work with. And awareness is really important. There are so many wonderful things going on. And the awareness, as much as we are in an age of information where we have so much stuff coming at us. It really does.

And I'm really believing more and more coming out of this pandemic that people are craving relationship. So to be able to have that person to person interaction, to listen, actively listen to what their needs are, and if you can help them find a solution and then not only throw ideas at them, but escort them over to someone and so now let's have a conversation.

And if we can find the time, if we can cancel the unnecessary meetings that really I mean, all of us are asking these questions, do I need to be in this meeting? Could this have been an email? Do we have to send an email? Please don't send me an email if you don't have to. You know, these kinds of things, because when we get to the real work, when I can take the time to talk to people like you, when people have a need, if I can even do it one or two times, I feel like my life has value.

You know, it's that story of the guy throwing the starfish or the sand dollars back into the ocean where the whole beach is covered with them. And someone says, “Why you're doing it, you're never going to help them.” And he goes, “But it matters to this one,” you know, and they get them back to the sea. So, and that's what life is. It's a series of one-offs that eventually creates that network effect where people, enough people are touched, they see the value, and that attracts more people. And then together we have this ability to really do amazing things.

Audra: That’s powerful.

Justin: It's beautiful. So I want to talk about one of your latest project that at least I know of, which is related to infant feeding formula versus breastfeeding, how to blend these two. I wanted to first know before talking about what you are, what this project is, what got you interested in this, in the arena of infant feeding in the first place?

Tiffani: That's very easy for me to answer as a dietitian and as a mom, because as a mom, you didn't have a choice. You were in it, right?

Audra: Yeah.

Tiffani: And every mom expects I'm going to breastfeed because I'm going to be perfect and it's going to go wonderful. And I, let me talk about the part as a dietitian. When I was being educated and I learned about food, and then I got into my clinical rotations and I got into, we did community stuff, we did school lunch program stuff and then we got into the hospital. I'm like, ok, hospital is my jam. I love it here.

Then I went into critical care. I'm like, oh, I love this even more because I love the nerdy go deep into the science kind of stuff. And then what else do you have? What's the more challenging thing? And I kept going and going and going. And to me, the most challenging patient you could have is the preterm baby in the NICU, because here we have something that is first of all, you have to understand how humans develop physiologically. You know, they can only be viable so early. And then when they get to term their course is usually that it's a very predictable course in the NICU.

But also, when that baby comes out of the woman's body, immediately, their nutrition is cut off. So it is the burden of the dietitian and the care team to mimic the amount of nutrition that that baby would have otherwise been getting from the mom in utero. I found that so fascinating. I mean, how do we sustain this little life? You know, it is absolutely hanging on.

So that, from a clinical standpoint, was a major challenge then. I love just the sheer I understand now you get to witness the development outside extrauterine, watching this baby do things that we wouldn't otherwise see. You know, we look on ultrasound, we see a baby sucking a thumb. It looks really cute. Now we get to witness the baby learning how to suck, swallow and breathe and coordinate things and how they go through those developmental stages. And we have an amazing care team unit at CHOC with the development and really preserving that.

So I just love that problems that so getting into infant feeding was really, really dear to my heart. In the NICU, we work with breast milk as much as we can. So we deal with the really, really the nuances, the subtle nuances of how a baby can tolerate those feeds, the qualities of breast milk, how amazing it is and what the insufficiencies are, because breast milk is made for a term baby, not a preterm baby. So in all my years in, the NICU is really given, anchoring me in appreciating the value of breast milk.

Now, go back to Tiffani, the mom. I found that when I was breastfeeding my kids and struggling, you know, it's not an easy thing. What do you do when you can't have breast milk? You know, what do you do when you want to be that mom? And so then you turn to formula and many moms feel very like they're failing for whatever reason. And some parents are like breast milk formula, fine, whatever. That's fine. But many people who intend to breastfeed really feel like, that they want to do it perfectly. And we are so binary, right? It's like I need to do it perfect or I don't.

And so in looking at the qualities of the different formulas and certainly knowing that I worked with older populations and understanding nutrition, that formula selection really is the first food choice that you make for a baby. So taking what I know about all the qualities of breast milk and trying to translate into what's a good substitute for it, and then couple that and wrap that around the emotional state of the mom, the economics, the social part, all of those dynamics. I just really my heart goes to that problem set because I've lived it, but also that moms are natural nurturers and mentors, and we need to share what we know with other moms. And so it's neat to be able to come from a mom angle, to come from a dietitian angle.

So recently my work in the infant formula, I've had the opportunity to work with a new company who launched the first new infant formula brand in the last five years. And they've become approved through the FDA. And the company's name is Bobbie. And it's been really wonderful to work with a startup company. It was started by a couple of moms who were faced with the same problem: I really want to breastfeed. It's not going the way I planned. I need to supplement with formula. I go to the formula aisle and how do I make a good choice? And that's a huge, weighty decision for mom.

But from the innovation side, they recognize, too, that there was this huge demand for European formulas and did kind of a deep dive into why. Why are people turning to a European formula versus what we have here in the US? And looked at the standards that were over there. So the EU has very different standards than we do here in the States. And there are families who wanted these formulas that were importing them. You can't ship directly from Germany to the US. So you have people that buy it off of Amazon. But the supply chain wasn't guaranteed and the quality metrics were not in there. And so they were put on the red list by the FDA. And so even though there's a big demand for it with this population, people are still doing it, but there's a safety risk. So now…

Justin: I had no idea. So there's like a black market and European formula like.

Tiffani: Exactly.

Justin: Guys in trenchcoats.

Tiffani: Yeah. Yeah. And so and then if you get a baby, you know, on a formula that they love and then all of a sudden you can't get your shipment, you're stuck. I mean, what are you gonna do?

Justin: Gotta go down to the docks.

Audra: And moms trying to make their own and. Right. Mmhmm.

Tiffani: Yeah. But if you know, if we look at the quality of, what we have to ask ourselves, why would people do this? What is it that they think is in this formula that makes it so unique? And really, when you look at those EU standards, they are looking at how you're sourcing all your ingredients, how your most of them are cow’s milk based. And so how is that cow grown? What is the life of that kind of like?

Audra: What kind of cow is it?

Tiffani: What are the additives that you can put in there? In Europe you are not allowed to put added sugar into infant formula? Like we can't, you can only use lactose, whereas here in the United States, we can use corn syrup solids and other things like that. So those things matter. And so I'm really proud of this company and that they've taken on those very high standards. And that they went through all the rigor of going through our FDA process here in the US, they’re Organically Certified too, which is another very rigorous process. And they just created a very simple, beautiful formula and created a community of support around moms. Because if you look at the community of moms that need formula, they're working. It may be an adoptive mom, it may be mom who had multiples who can't make enough for two or three babies. It could be a mom that had a double mastectomy and realizes that her insurance company will send her a breast pump, but they won't send her reimbursement for formula.

So this company is stepping in to say, to step in and say, you know what? There's a gap here and we can do better and we can support these moms, the moms that feel shame, like they failed, like I tried to breastfeed and I couldn't do it. What about the moms that just need to supplement? I mean, my message as a dietitian was always, listen, your body grades on a curve. So whatever breast milk you can provide, you get credit for it.

Justin: Yeah.

Tiffani: And what and if you have to supplement with formula, you know, don't worry about it. The baby will benefit from both. So, you know...

Audra: Can we just say that again? Like I really want to punctuate that, you know, that every ounce of what you provide in this journey, whenever you provide it, matters. And counts and supportive.

Tiffani: The body is very good about grabbing what it can and it grades on a curve. And so you get all the benefits. So, you know, if you can only provide a little bit of breast milk, that's ok. You get all the benefit of that little bit of breast milk.

Justin: I love it. The body grades on a curve.

Audra: You know what I want, I really, Tiffani, I've shared this with you, but because we are going to be putting this out to listeners and Justin remembers this really well. I had breastfeeding challenges with both kids. Bobbie is making me want to have a baby again. You know, I want to do this again.

Justin: Oh right.

Audra: And it's, I have to share a couple of these challenges. First of all, I had to have C sections with both kids, and I experienced the questions around that just from other mothers. Like why? Why do you need to have a C-section?

Justin: Are you sure?

Audra: Are you sure? Yeah. Yeah. You know, I'm sure medically necessary. I had a myomectomy when I was 20. When I was 21 or 20. Yes. And then on top of it, I'll never forget when Max was born in Santa Monica and we had terrible, terrible trouble with him in the hospital feeding. I mean, he would bend his back backward screaming, didn't want to latch on Justin goes to the pump station, I should say, or this business and says, “Hey, do you have a nipple here? It's kind of like a lot like a real nipple, because I have a baby we’re in the hospital” and they're like, “No, we will not sell this to you. The baby will never latch on if you do that.” Right.

Justin: I forgot about that. I forgot about it.

Audra: So we have to go back and find out about it, of having him suck on a binky for a second and then latch on. And I remember going home with a hospital-grade pump, feeling like such a horrific failure as a mother saying, “Ok, I'm going to pump this milk as much as I can and I'll feed him in a bottle underneath a cover so nobody will see.”

Tiffani: Mmhhmm.

Audra: It's a bottle, even though it's my milk. And then when at six months, you know, I have to go back to work at three months like everyone else. The little bit of supply I had, I was getting through just maimed and tea bags, like trying to heal, and all of it. And I go to work and my supply just starts to go down and down and down. I mean, it's a story of so many moms, right? And down, down and down.

And so I start looking at the formula aisles and we have to start supplementing. We have no other choice. What are we going to do? Max stopped breastfeeding. He just stops at one point. He only wants a bottle, he stops at six months and, you know, an acquaintance at the time said, “oh, oh my god, what are you going to do?” Like, obviously, I'm going to let him die. What do you think I’m gonna do?

You know, and so it is, there's this social pressure. There is this valor that comes with a mom who can breastfeed until she's three. Until the kid’s three. And I'm not critical of that, like you do you. But why has this turned into such an assault on working mothers and mothers of all types and mothers who can't and the judgment that comes when the bottle’s presented.

Tiffani: Yeah. And you touched on something so important. People don't recognize that we're kind of set up to fail, too. So when you say you have a C-section, you probably had prolonged IV fluids given to you. You know what? That delays your milk coming in.

Audra: Oh, that's why it took five days? That’s good to know. They didn’t tell me that.

Tiffani: Yes. They don't tell you that. They don't tell you that you had blood pressure, that you were never had a history of surgery or anything. They don't tell you those things. And if you only get 48 hours for a vaginal delivery or four or five days after a C-section, you haven't even gotten into that window where your milk has come in. And meanwhile, your baby's been hungry for four or five days.

Audra: Right.

Tiffani: You know, what are you supposed to do? You can't win in that way. Now, you can succeed. You can go through and supplement and really commit to breastfeeding. You know, it's not like it's, the baby-friendly hospital, which is what you're talking about, which is very, very well-intentioned, has had a really dynamic effect in this place, especially on women's mental health. So let's talk about that a little bit, because I had never experienced, I didn't know I could be jealous of another mom, because when she pumped, she got 10 ounces every time. I was so envious.

Audra: She's freezing her milk. And you're like, why do you have enough to freeze?

Tiffani: Right. Like they open up the freezer and it would be like a 12-year supply.

Audra: Yeah, yeah.

Tiffani: You know, and it's like. And then the other thing is, I would, whatever I could pump off, I'd put it in the refrigerator and I'd have like the thinnest little layer of fat on top. I like pump like nonfat milk. And, you know, the other moms were Dairy Queens that were pumping cream.

Audra: Yeah.

Tiffani: So, you know, and you have no control over this. Your body as a woman gives you the number of milk ducts that you're going to have, which is why, and usually the dairy queens were like back in their size two jeans like three weeks after delivery too. That is not possible. Is that I am trying to eat, trying to sleep, trying to drink enough water. I'm doing everything. It can't be forced. And then you add the anxiety, like it's snowballing on you. And then they're like, well, you shouldn't be stressed because that will affect your milk supply. You're like, wait a minute here. So we really, moms need people to come alongside them.

And like I said, as mentors, as friends, to just say, “You are enough, you delivered a healthy baby. Let's not forget that point. We have options. Produce what you can think about what works for your family and your lifestyle, and then let everything else go.” Make your decision and then enjoy your baby.

Because I, I hate to think that those new moms who should be one recovering from birth, because we all know that that's got some things there. But two, this is a new little life that you've brought into the world and you need to enjoy that, you need to accept your new position, your new station as the parent. And whether it's your first parent or your first baby or your fourth baby. It changes your family dynamic. And so the kindness factor, coupled with the science, coupled with everything else that moms are trying to handle, this is what really drew me to this company, Bobbie in particular, because they recognized we're not just here to sell formula, of course, that's their M.O. But you know what? 83% of families will turn to formula in some way during that first year of life for their baby.

Audra: Yeah.

Justin: Yeah.

Tiffani: That's a pretty high number.

Audra: Yes, 83%. Yes, we need it.

Justin: There's a dad’s component.

Audra: We need to normalize it. Yeah.

Justin: I just had the flashback. I totally forgot about this. How happy I was to be able to feed Max…

Audra: And Maesie. Yeah.

Justin: Yeah. I mean that. But for the firstborn to realize like, oh, I really I'm so glad that I can take a role in this. And yeah, I remember.

Tiffani: Well, we've had dads come back and say, “I was so relieved when my wife finally gave up trying to pump it, you know, when she wasn’t producing anyway.”

Justin: When we were done.

Audra: Yup.

Justin: Yeah, I remember that. I was just so…

Tiffani: Like, it makes them feel like they get their life back. Yeah. And so, and no one here is advocating against breast milk...

Audra: No.

Tiffani: Don't mistake me. Breast milk is amazing. I mean, I love, you can study. It's like studying space. It has infinite qualities to it between the pre- and probiotics and the immunoglobulins and everything that it does. I mean, I used to in my early days, you know, used to say kind of snarkily, it does everything but clean grout. But now I pretty much have evidence that I can clean grout.

Justin: It can clean grout as well.

Tiffani: It’s amazing. Yeah. But I look at the fragility of these new parents and it, my heart goes to them. I want to help navigate making wise decisions. And I love that something familiar, something like this one says, well, “Ok, if you do need an alternative, let's make it as clean and simple and as beautiful as possible.”

Audra: Absolutely.

Tiffani: And so I think that and my other message to these parents is pace yourself, because this is the first food decision you're making for your kids. You have a whole lifetime of decisions to make.

Audra: Yeah.

Tiffani: So be kind to yourself and pace yourself. So I love even having that language of a formula is your first culinary decision, if you will, as a parent and start learning how to qualify, okay, what are your values around food? And again, maybe an 80-20 rule? We're not aiming for perfection here. We are aiming for being informed and making good choices that work for your family.

Audra: We're all about the 80-20 over here. I think that's phenomenal. And it's a beautiful point to make. Tiffani, I think in our generation, we are a part of the pendulum swings here, right. We have mothers who were advocates, probably our mothers, you know, might have been advocates for breastfeeding in a time that was hostile to breastfeeding. Right?

And even at our ages can experience various hostilities towards breastfeeding and the activism that has gone into helping mothers get access to breastfeeding and understand breastfeeding and feel supported and being able to breastfeed wherever they need to and in public and at work. And, you know, all of the different things. I love the activism. I get it. It's so important. I get that we are coming from a very deep hostility towards breastfeeding. And for it, like in many things, the activism turned towards hostility, towards formula and bottle feeding. Right.

Tiffani: Right.

Audra: And so we're trying to bring grace into the space and trying to help, you know, kind of normalize whatever it is that someone needs to do. Let's just be fully supported in all of these choices.

Tiffani: Yes, exactly. We do tend to have that pendulum swing from one extreme to another. And the reality is that we're all in that swath, the pathway of the pendulum at different points of our lives. Again, my heart goes to these new parents because it's a wonderful time and it's an exciting time, but it's a very fragile time. And so to be able to come in and if we hit them too hard with the science, you know, just like the baby-friendly thing, yes. Most of their efforts were very evidence-based. And I understand their intentions.

But in the meantime, you've got this sobbing mother who is just trying to keep it together. And we are discharging them home. And we want them to have a peaceful, successful home life, to be able to grow a baby that can thrive. Which is why I love the name of your group, The Family Thrive, because it covers everything from birth forward. And each stage and developmental stage and phase that we go through, not only as kids and parents, but the whole family in it.

There are different definitions of thriving and it takes different resources and it takes that empathy from our caregivers in our community to recognize, well, that wasn't my experience. But boy, I can certainly understand yours. And I would like to help. I would like to help provide resources.

Audra: You know, Tiffani, that that brings something up for me, too. Going back to your comment on the very first choice we make in feeding our child. The mental health of the mother and of the parents, that very first choice, setting down the path, starting to think about your values around food. And I think that this is a really powerful time that I don't know that I've acknowledged very much either and it's something that I'd love to talk a little bit more about.

So this, you see these steps that we take when we make these initial choices to incorporate formula and then maybe the next steps in solid foods and things like that. I'd love to know if you have any tips or insights, because it comes down, what I am starting to think of when you start talking about the mental health and well-being of the mother and of the family, is the more that we can de-escalate that initial stress around feeding, because feeding is the most important thing. Right. It seems like when we came home with our babies, it was like, oh, my god. Feeding. Right. And the counting the pee, counting the poops, what goes in, what comes out and that doesn’t leave you. You know, you end up with a six-year-old, you're following around with a spoon of food because, you know, you want to make sure that they get that one little bite of nutrition in.

Do you have any tips for new parents on just developing some mindfulness around those values? Because I think it's something we don't think about or talk that much about. I'd love to know if you have any thoughts on that.

Tiffani: Well, in the early days, for sure. You know, I totally remember what you said about counting the diapers and trying to do it right, especially if you're breastfeeding and you don't have a quantitative volume, that's where the mystery just becomes so hard. I mean, if you are pumping and putting it in a bottle is, you know, what volume you're feeding. So in those early days, I think having the metrics is very valuable, getting that benchmark of back to birth weight within the first two weeks, and then you feel like, ok, we're trying to get our groove on.

And I can even remember as a pediatric dietitian who I think knows more than most about the actual ins and outs of food. When my first was turning one and I had weaned from breastfeeding and we were discontinuing our supplemental formula, I thought, “oh, my gosh, I don't have that insurance policy anymore,” because I knew formula and breast milk is nutritionally complete. So now I was responsible for everything that I said. My kid had to meet all of the needs for nutrition. And I just felt the gravity of that responsibility of like, I better do this right.

You know, in the US, we address it so differently. We label things and I would say this, even for kids and adults, and we like to wear our banners of like “I'm a paleo vegan” or “I'm on this diet.” You know, we like to know that we have those constraints and boundaries and that we're doing it right. And then we take pride in that. If you were to look at other countries around the world, food is love and relationship, and its history and culture. And they feed their babies seasonally because that's what they have access to. And we tend to standardize and make it a protocol.

So when you look at introducing foods, we start with a puree consistency because it's appropriate for what their palate can handle. And you're trying to introduce those different textures as the mouth palate evolves and their developmental skills evolve to the point where then they get some teeth and they can chew. And then you think about not wanting to have choking hazards and stuff like that and being on the lookout for allergies so that you're introducing individual foods and watching and seeing how the baby responds to it.

There's some strategy to it, if you will. But it's not necessarily adopted with other cultures around the world. I think knowing what the family's values or what their approach to food is, helps people drive what they're going to aim for. Because ultimately, when a child is about a year old and everything developmentally has been on track, they're pretty much eating what the family is eating. It just might be modified in its chopped size or consistency just for hat. So you're really trying to get them from birth to 12 months to kind of get in line with what the family's doing.

Now, I have seen families take the opportunity in trying to do such a good effort with their child that they've actually improved their own eating habits in anticipation. If they can make that connection of like we are a family unit, what do we want to do for the family? And so I've actually seen some families rise to that occasion of like, ok, well, you know, I'm glad he likes the jarred peas because we don't eat peas. And I'm like, “well, should you?” You know, like what do you want to aim for? Because you're giving him sweet potatoes and carrots and, you know, all these different things. You're giving him cut up pieces of banana and now you're doing berries and stuff like that. How does that incorporate into your family? Because ultimately a family is a unit. Basic home economics will tell you that it's a whole lot cheaper to cook for many than for one. So know from a practical standpoint, as that kid develops their eating habits, you want to streamline that in there.

So I don't know if that's what you were aiming for know, but it's kind of a global lens on what are the goals, what are the aims? There's obviously very iterative steps to get there. But if you look at it holistically on what does the family aim to do, what's practical, do you have two working parents, how much time do you have for shopping and meal prep and stuff like that? But I think with a little bit of strategic planning, you can get there. And then it again takes away that power from the mystery and that you feel like, ok, I feel like I've got a sense of understanding of what we're aiming for and this is what we do. And you step into that identity of this is how the Ghere family is approaching food. And I am getting to experience the wonderful. It only took 18 years, but the wonderful opportunity of the kids being able to advocate for their own food choices, to see them go out with friends and get creative and experience new cultural food experiences, as well as cooking their own meals.

Audra: Yeah. Tell us more about what you are seeing, because it sounds like to me that if we can de-escalate the stress around the home and like bringing baby home, breastfeeding, bottle feeding, you know, all of the stress and anxiety, that is really, I think, social pressure.

Tiffani: It is.

Audra: And if we can de-escalate that and provide that focus on how we want, we want to nourish this new this child, this new baby we want to nourish, and then we want to provide a home environment where we keep that goal of nourishing. So whatever that timeline, strategic plan is in place, even the mindset that we can level up, that we can rise to the occasion. We had that experience only when faced with a medical crisis. I think it's really powerful to think like this baby is coming to the family table. We can level up for all of our benefit. I think that's just such an amazing point to make.

And then I'm so curious. Mom of three boys. Three boys raised by a culinary-inclined dietitian who, you know, knows all about how things start with soil health from the ground up. What are some of the cool things you've seen in your sons as they're like autonomist folks now?

Tiffani: Well, I will tell you that we are just like every other family. They’re kids, you know, you can't necessarily groom them to be exactly the way that you want them to. You know, my goal, as much as I have had a lot of experience with food, my goal was always to be kind to myself, too, and not to be too overarching and to just expose them. I can remember sitting at the table when everyone has that where they don't want to try something or whatever. And I would try to remind them this was probably a grade age.

You know, my goal as your parent is that when you're a grown-up and if you got invited to the White House that whatever they serve, you would be cool with that, that you wouldn't be afraid of it, that you could you know, if someone said you get to take a mission trip to a foreign country, could you adapt to what's going on? I wanted them to have. It's funny because as an anal and as Type-A as I tend to be, I try to actually train myself to be a little bit more chill on it, and recognizing that it's not a battle. And really, the victory is going to be won in the very long game, which is, I wanted them to have an adventurous relationship with food.

I wanted them to be inquisitive. I wanted them to understand where it came from. I wanted them to taste things. Everyone goes on their own timeline. But I do have three pretty open, adventurous eaters now as they're getting into their late teens or early adulthood, which is, that was my goal. So now I can hand them off to the world, right?

Audra: Yeah. Yeah. It's a great point, too, that it's a long game. I think that's one of the things that's so rushing in this is that there are a lot of no's along the way. You know, you provide a lot of really cool different things or broccoli or whatever, and there's a ton of no's before you get to yes. And so it's a long game that takes a good amount of kind, graceful, open persistence.

Justin: Well, there's a lot of no's on the side of the kid. But I'm curious, Tiffani, what were the no's or what are the no's for you when thinking about food in the home, meals in the home? Are there some, I don't want to call them like hard and fast rules, but food general guidelines, where like, no, we're not going to do that here.

Tiffani: Yeah. You know, for us, it is interesting because we never had, don’t anyone misunderstand me. If this is in your pantry, this is not a judgment. This was just my own personal choices. But knowing that the affinity for sugar is an acquired taste. So the more exposure you have to the high, sweet things that you would be, you know, you would continue to have that high affinity for sugar. So we never had juice in the household or the sodas or those really high artificial sweetener things. We did use yogurt. We had berries with it.

It wasn't that things were a no. I just tried to do the best decision making with the quality that we could, always having that mindfulness of quality and knowing that if they went to a friend's house and they got the Gogurts and they got the you know, that they had mom, how come you never told me about fruit punch? It’s awesome. How come we don't have jello, you know?

Justin: My gosh.

Tiffani: And it's fun. But you know what, what I love. We got to travel to my sister's house. We got to travel by plane over Christmas. And here I am with my two, two of my three grown kids. And they were doing a beverage service. And the biggest treat that they always thought was to get apple juice. So they both I watched them order their apple juice because we just never had juice in the house. And you know, now they, are they candy fiends? Yes. When you go to junior high, there's like a black market for trading candy out there. And it is hard to fight, you know.

But I do remember that especially with grade school, you know that packing the lunches, especially with the first one and trying to be very thoughtful. And then they go and they're surrounded by all kinds of processed foods and things that are high in sugar. And they didn't feel as popular. So my angle was always, we're going to have all kinds of treats and cookies in the house, but I'm just going to make them from scratch. And then I have control. Like I can downgrade the you know, if it calls for a cup of sugar, I can do it with like two-thirds of a cup and it's still ok, you know, and using that high-quality butter, my approach was like most of our food will probably rot in two to three days. And, you know, sweets included. And that's kind of the road that we took.

But there's many ways to get to a path of success. And sometimes there are drivers in your life, as you guys know, where you have to put that and if something is forced on you. Let's say two of my three kids have very close friends that are type one diabetics. And it's been very interesting to watch them and their empathy that they have and understanding what they have to do.

In fact, one was very protective of her, and she didn't get diagnosed until she was, I want to say nine, which is a little bit later down the road, so he had that awareness that tore my heart strings open, I just I burst, I was my heart was breaking for the family because I knew how much of a lifestyle change is going to be. But my heart was so proud of my son who had that empathy and recognize that she has to look at her food differently. And I know. I want to. I want to. He was watching out for her at lunch time and trying to like protect her from other kids, going how come you don't eat the Gogurt or how come you don't do that? He was trying to like, kind of jockey to protect her.

So, you know, this is why we can't forecast everything we want to do with food with our kids, because hopefully they come back and surprise you in a delightful way. And I tend to go to that holistic overview so that they have the context, because our job as parents, my mom used to tell me this, and I do agree with her that if you're parenting, if you're doing it right every day, you're working yourself out of a job.

Justin: Beautiful.

Audra: I love that.

Tiffani: When you get to that phase where you're actually working yourself out of a job, it tears your heart open, but it is the marrow of life. And so, you know, you plant those seeds and then you get to see those wonderful returns. But at the early years, you know, there's a lot of support needed.

And I think what's really important is that we give these new parents the confidence to say, you know, “we thought about this, we made a deliberate decision. I'd appreciate it if you could support our decision” and then we can enjoy, you know, I think about Thanksgiving, right, where grandma or someone always has an opinion about what you're doing. And, you know, just to equip people with the language to say, you know, “we really we really thought about this and it would really help, but this is how you can support me,” because when you use that language, it actually we're struggling. And so could you please. And then you get to give people the equipped messaging that actually creates that better support system. And it's not about the food. It's about control. It's about who has to be right. And I try to break that down so that we can disarm people and really have true meaningful relationships that are supportive.

Audra: I think that's so helpful, Tiffani. Yeah. Thank you for bringing that up in like, we have a module on that MaxLove Project that I think we need to bring into The Family Thrive setting as well. Lexi Hall, the dietitian we work with who you know very well, from CHOC, did a Fierce Food's Academy with us around Friendsgiving and specifically to help families with these challenges that come up around, you know, bringing your own family's choices into family settings, social settings, and things like that.

I also want to just reflect on your comments on your parenting. I love hearing this and hearing this from a dietitian. I feel like it's such a beautifully, you know, open, pragmatic way that there's not. We don't have to have like, super tight reins, but we can figure out our own kind of equilibrium in the home. You know, that makes sense for us. And I think it can be hard to sort of stake your own claim in that, like without having a model out there. So the more stories we hear from other parents on how they've done it, the easier I think it is for new parents.

You know, I think in our case, we ended up with a kid, we needed to go on the ketogenic diet. You know, we needed to do it as a family. But then raising his little sister to make her own choices and to be her own person and getting into bio-individuality and kind of the diversity of what we provide in the home. And I will be totally straight up with you. We have these like Annie's mac and cheese, little plastic things in there that she can fill with hot water to have mac and cheese. And one thing that I've really loved is she will down two flights of strawberries. No problem. She'll eat entire English cucumbers. No problem, like you know, when she goes into the fridge, she's going for this stuff and she still has it.

And she was like obsessed with these. Like, can I have mac and cheese? Sure will buy you the mac and cheese. She wants to have it for breakfast. Fine. And she's making them for herself. She's doing it for a couple of weeks. You know, they're in the pantry still. And what is she making for breakfast? She's making an egg sandwich. She's been making smoked salmon with cream cheese and capers and lemon. You know, as her, I mean, she's making these fabulous choices. And I said, “why don't you eat the mac and cheese anymore?” And she was like, “eh, it's just not really that great,” you know? And that has worked for us. Talking about bio-individuality, providing some of these choices has worked for us.

Justin: No offense to Annie’s.

Tiffani: No offense to Annie's at all.

Audra: Oh no, no, no, no. It’s not about that. Not about that at all.

Tiffani: It's a testament to the evolution of her palate. You know, and you touch on something else really important, too, is as kids grow, especially in their you know, it becomes less frequent as they get older, but they go through phases. You know, you see it radically in ages one through three where they'll go on food drags where it's like all they want are goldfish crackers. And last week, he was eating lots of kind of chicken. Now this week, he doesn't want it. So they go on strikes and they go on drags and then they go through different phases, too.

And I love that you're also touching on the fact that, because it takes a lifetime to develop that palate, you know, we know that it takes at least 20 exposures to a food for a kid to know if they do or don't like something. And many times that they don't like something in their early years. It's not because of the taste. It's usually the texture or the temperature. So there are different forms of offering of foods. Like it's not that you don't like carrots, but, maybe you don’t like cooked carrots or cut, you know, raw carrots.

Justin: Yeah. Right.

Tiffani: So, I mean, that's really important to know. But the fact that Maesie has that sense of curiosity and exploring and then mashing up different, that's the evolution of the palate. And Chef Azmin can definitely explain it in better terms than me. But I love that. I saw the same with my youngest, Carter, too, who was definitely a fierce advocate for mac and cheese. I think we had the Costco, the Costco brick of Annie's mac and cheese.

Audra: Yeah. Yeah.

Tiffani: And now I do, I think somewhere in an old closet, that brick is still there because he's evolved and he still loves pasta, but he's making his own rigatoni alfredo, and adding the vegetables and the chicken to it. And, you know…

Audra: Does he like the feta pasta? Does he like the TikTok feta pasta? Maesie loves that. Loves it.

Justin: Just so we don't run out of time...

Audra: Because we could talk forever.

Tiffani: Yes, I know. No, keep that keep us on track.

Justin: I have one final topic before we get into our last three quick questions. So the last final topic is when we had our podcast interview with your colleague, Lexi Hall, we ended by talking about food myths, you know, because in not just in the world at large, but especially in the parent world in the discourse, there's all these food myths that are circulating. So we talked about a couple with Lexi Hall. And I'm wondering if you have a food myth that you have come across or that you regularly come across and you want to bust it?

Tiffani: Well, I don't want to cover something Lexi already did. What did she tell you?

Justin: So well, we covered meat. So like meat is going to kill you. So that's a myth.

Tiffani: That's a good one.

Justin: Alkaline diets are these super healthy, magical things. Yes, we busted that one. And then eight glasses of water a day. We busted that one. So those are the ones we…

Tiffani: I agree with all of those. Let's see, so I'm often asked, and I end up saying this when I'm educating families, like if there were five foods, if I could only choose five foods to live on. And one of those five foods is eggs. And so I think one of the myths is that if you eat too many eggs, you're going to have high cholesterol. I think that came out of our ‘90s education on heart health. Again, well-intentioned, but it's not been validated. And if any part of cholesterol gets raised is the HDL, and that's for good cholesterol. So I love eggs, and I eat them every day.

Justin: Heck, yeah.

Tiffani: I have decent cholesterol. I have pretty good blood glucose control and there is a tie to that. So dietary cholesterol doesn't necessarily tie to serum cholesterol, which is your blood cholesterol. And I, the way I explain it is this: there is enough nutrition in that egg to grow a whole chicken. So I love caloric density. There's enough nutrition in a nut to grow a whole tree.

So when people ask me what are the five foods, I think of avocado, eggs are on there. I think of nuts. I think of a fish. And again, those are very nutrient-rich type things. So I think that would be the myth-buster that I would go to just because I am such a fan of chickens and while not vegan. You can eat an egg and glean a lot of great nutrition in an ethical way that actually isn't a harm to a chicken. And so I'm hoping that it also reaches a wider part of the population that as a food choice.

Justin: Brilliant. Yes.

Audra: I love hearing that from you. Yeah. Thank you so much. That's one that has come up recently with yet another study that was pulled in by the media attempting to disparage eggs. So thank you.

Justin: Yeah. And speaking of Maesie, this is one thing that, one of the hardest things right now to do with her is to get protein in. And, you know, because she, yeah. Audra’s, right. She'll eat tons of berries or eat tons of veggies and all. But it's like, ok, can we just get the protein? Or so I will tell her. I'll stop bothering you for the rest of the day. If you just eat an egg, just eat and then I'll be done.

All right, so let's get into the final three. These are quick ones. All right. So if you could put a big Post-it note on every parent's fridge tomorrow morning, what would that Post-it note say?

Tiffani: You're doing a good job. You are enough, really. You are trying to raise a human being. And it takes a lot of effort. And we are so hard on ourselves and we think we're not good enough. It's like imposter syndrome again or something. And everything, we will hear the one negative, the one negative thing will completely derail us, even in the presence of 100 compliments. And so reinforcing that they are enough and that they are doing a good job is enough to get them to pause and breathe. But any insufficiencies or gaps that they have, it affords them the time to go seek out help or find the education and they can do it. So it starts with, except that, you know, you can do this. You're completely capable.

Audra: Tiffani, I feel like you just put that on my fridge. Thank you. Like I sort of get emotional. Yes. Thank you. Thank you.

Justin: We need that.

Tiffani: I know you probably wanted us food one, but.

Justin: No.

Audra: No.

Justin: No, no, no, no.

Tiffani: It's again, it affords me that access to connect with people in all the years that I've been working with families and patients. And it's such a pervasive reality that we have these people that are struggling with a clinical status of a child. Let's back it up. Let's look at what you're actually doing. You've walked a hard road. You can do this.

Justin: Absolutely. Second quick question. Do you have a quote that has recently changed the way you think or feel?

Tiffani: I do. And it's funny, because the one that I used to always cite was Maya Angelou’s, “When someone shows you who they are, believe them the first time.” And part of that speaks to being burned and becoming aware of like, ok, I'm going to recognize people for who they are.

But Audra, you actually posted it to Instagram, I think it was just a couple of days ago from Angela Davis. “I am no longer accepting the things I cannot change. I'm changing the things I cannot accept.” And that just really speaks to my present of mind right now where, like I said, go bold or go home. Children and family are depending on those of us that are in this professional world, we owe it to them to swing from the fences.

Audra: Oh, absolutely.

Tiffani: Obviously, another testament to how in-sync we are in our like-mindedness, but.

Audra: Beautiful. Yes, I feel that fierceness in you, Tiffani, that it's like this is your life's work.

Justin: Yeah. Oh, for sure.

Audra: This is your world changing. You know one starfish at a time. And this is it. You know, it's really, really inspiring. And it's a beautiful call to action. And it's something that The Family Thrive is all about. And I really appreciate hearing your fierceness in it. And the emotional component to this. Like this is really, really powerful, needed work. And I just really appreciate hearing that call to action from you. I feel more charged up in my day.

Tiffani: Oh, it's amazing how cyclical it is, because that's how I feel about talking with you guys. You know, this is what synergy is, where you find that like-mindedness, you find that common goal that you reach for, and then you allow people with their different skill sets and talents to come together and create something unique and dynamic. And people respond to that. And as someone who's given many a lecture or a nutrition talk in my day, it's always in the back of my mind that people walk away with how you make them feel, not what you say.

Audra: Yeah.

Tiffani: And so if you can touch, if you can connect in any way, no matter what kind of information you're dispensing that day, that connection is what people truly crave. And it's not that, that's not all that they need, but that's how you start. And then it affords you the opportunity to gain their trust, to create that awareness. And then you can provide the education and then you have a bonded loyalty that creates that greater network that's going to be really, really powerful.

Justin: Awesome.

Audra: Couldn't agree more.

Justin: So the final question we ask, because for, at least for parents of young kids, you know, it's a marathon. It's exhausting. And at the end of a day, you can say, oh, kids, just like so much work. But at the same time, kids are totally awesome. So let's celebrate them. So we want to know, what do you love most about kids?

Tiffani: Well, like I said before, I think they are the great equalizer because it does break down the adult to a place where it does open us up too, because if we are so closed and buttoned up, we lose a lot of things in life. But kids don't lie and they let you know with complete transparency and utter honesty how things are.

And it's positive in the negative. You make something for dinner and they hate it. I mean it. And as much as we get thrown back in your face. Right. We know that with a toddler. But they're forgiving and they're loyal and they're loving. And they show us as adults that that compassion and that commitment is hardwired in us. And this is who we were supposed to be from day one.

And so I think it reminds us as adults to remember that, you know, and for those of us that are spiritually-minded, I think about biblical teachings where even Jesus connected with children, and that even relating to something as grave as pondering the existence of God and relating to God, he did it through the vehicle of children.

So I think that for these big things that we wrestle with and parenthood is a big thing to wrestle with. To remember to look at it through their eyes and we'll glean such great insight. And I've seen it, like I said, with all those wonderful doctors that I work with that are so accomplished and so brilliant, you bring a child into their life.

Justin: Yeah.

Tiffani: Like what do you really know?

Justin: Exactly. Yeah. Tiffani, ok, before we sign off, how can people find out more about your current work and just how to follow you?

Tiffani: Oh, well, I am with CHOC Children's in their Medical Intelligence and Innovation Institute. We call it MI3. And you can certainly reach out to me via LinkedIn. Yeah, I love to connect with anybody who wants to be in the space. Anything I can do to support The Family Thrive. You know, I'm in.

I'm so excited to see your efforts grow and the community that you're building. And it reminds me of how we drafted the banyan tree all those years ago. And it's just taken roots and it's just growing, only it's under the umbrella of a magnolia tree instead of a palm tree. But I'm so excited that I get to see you next week.

Audra: Me too, I can't wait. Thank you so much for spending this time with us today, Tiffani, it was beautiful catching up with you.

Tiffani: Thank you, guys. Love you guys so much.

Audra: The first of many, too. We love you, too. A first of many.

Tiffani: I love it. I love it.

Justin: Awesome.

Tiffani: Well take care of you guys. And I get to see you next week.

Audra: Yeah.

Tiffani: Travel safe.

Audra: Okay. Thank you so much. Bye Tiffani.

Justin: Hey, thanks for listening to The Family Thrive podcast. If you like what you heard, please subscribe, tell two friends and head on over to Apple Podcasts or anywhere you listen to podcasts and give us a review. We're so grateful you've chosen to join us on this Family Thrive journey.

Discover Nourish

See more
Podcast Ep. 11: Feeding Kids From Infancy Through Adulthood With Tiffani Ghere, RD, CSP, CLEC

Podcast

Condimentum eu tortor bibendum.

By

Jackie Kovic

Podcast Ep. 11: Feeding Kids From Infancy Through Adulthood With Tiffani Ghere, RD, CSP, CLEC

Podcast

Condimentum eu tortor bibendum.

By

Jackie Kovic

Podcast

Condimentum eu tortor bibendum.

By

Jackie Kovic

Podcast Ep. 18: What Every Parent Needs to Know About the Food Industry With Insider Josh Field

Podcast

Podcast Ep. 18: What Every Parent Needs to Know About the Food Industry With Insider Josh Field

By

The Family Thrive Podcast

Chocolate Date Energy Bites

Podcast

Chocolate Date Energy Bites

By

Willett Children's Hospital

Portobello Pizza

Podcast

Portobello Pizza

By

Chef Andrew Johnson

Oven-Baked Garlicky Mushrooms

Podcast

Oven-Baked Garlicky Mushrooms

By

Chef Andrew Johnson

Mushroom Ramen With Shirataki Noodles

Podcast

Mushroom Ramen With Shirataki Noodles

By

Chef Andrew Johnson

Easy Banana Pancakes

Podcast

Easy Banana Pancakes

By

Lexi Hall, RDN

Blueberry Lemon Ricotta Pancakes

Podcast

Blueberry Lemon Ricotta Pancakes

By

Chef Andrew Johnson

5 Research-Backed Practices For Feeling More Positive Emotions

Podcast

5 Research-Backed Practices For Feeling More Positive Emotions

By

The Family Thrive Expert Team

Level Up Your Parent Communication Skills #1: Slowing Down When Things Heat Up

Podcast

Level Up Your Parent Communication Skills #1: Slowing Down When Things Heat Up

By

Alicia Wuth, PsyD and Justin Wilford, PhD

Give This a Try: Low-Sugar Sweet-Treats

Podcast

Give This a Try: Low-Sugar Sweet-Treats

By

The Family Thrive Expert Team

Podcast Ep. 18: What Every Parent Needs to Know About the Food Industry With Insider Josh Field

Podcasts

Podcast Ep. 18: What Every Parent Needs to Know About the Food Industry With Insider Josh Field

By

The Family Thrive Podcast

Chocolate Date Energy Bites

Recipes

Chocolate Date Energy Bites

By

Willett Children's Hospital

Portobello Pizza

Recipes

Portobello Pizza

By

Chef Andrew Johnson

Oven-Baked Garlicky Mushrooms

Recipes

Oven-Baked Garlicky Mushrooms

By

Chef Andrew Johnson

Mushroom Ramen With Shirataki Noodles

Recipes

Mushroom Ramen With Shirataki Noodles

By

Chef Andrew Johnson

Easy Banana Pancakes

Recipes

Easy Banana Pancakes

By

Lexi Hall, RDN

Blueberry Lemon Ricotta Pancakes

Recipes

Blueberry Lemon Ricotta Pancakes

By

Chef Andrew Johnson

5 Research-Backed Practices For Feeling More Positive Emotions

5 Things Friday

5 Research-Backed Practices For Feeling More Positive Emotions

By

The Family Thrive Expert Team

Level Up Your Parent Communication Skills #1: Slowing Down When Things Heat Up

Pro Perspective

Level Up Your Parent Communication Skills #1: Slowing Down When Things Heat Up

By

Alicia Wuth, PsyD and Justin Wilford, PhD

Give This a Try: Low-Sugar Sweet-Treats

Give This a Try

Give This a Try: Low-Sugar Sweet-Treats

By

The Family Thrive Expert Team

Subscribe to get all the goods

Join for free
Login