All posts by Kyle Boland

Diastasis Rectus Abdominis: Filling the Gap Part 2

As discussed in Part 1 of the DRA blog series, in order to understand how to heal diastasis and properly train the core, we need to understand how our bodies were made to function in the first place. Babies are born with immature motor patterns. You will notice newborns tend to have knees tucked and hands and arms often flexed close to body and even near the face. Development begins with the drive to learn more and explore the surrounding environment. As babies are exposed to lights, sounds, and touch, they have the desire to discover more of this world and begin to integrate different parts of their body into learning.

Babies are not taught to roll, hold or grasp objects, sit up, crawl, or walk. Movements do, however, occur in a typical sequence and it is crucial that each milestone is met. Our movement patterns in the first year of life are the basis for function in movement as adults. As we watch the movements of babies and toddlers we can teach ourselves. If milestones are not met, the area is not used properly with movement patterns and can lead to problems later on. For example if support on elbow during tummy time, rolling or crawling does not happen, the scapula (shoulder blade) is not secure within movement and can eventually lead to impingement issues or even tears in the rotator cuff, etc. This is also one reason a patient can have surgery on that same shoulder and end up with the same problem. If the movement pattern is not addressed, the problem remains. Meeting milestones seems exciting as the little ones progress but the saying holds true “let them be little.” Let them do it on their own and do not push before they are ready.

 

Developmental Milestones:

 

6 weeks:

Thumbs move from inside closed fist to outside closed fists

Eye contact begins

 

3 months:Big Mac

Open fist

Support on elbows

Can rotate head without moving trunk

Spine starts to upright from mid to upper back

 

 

 

4.5 months:

Start support on opposite knee and elbow (helping to begin closure of DRA)

Diaphragm flattens and mature breathing patterns begin

Free hand grabs objects but cannot cross midline

Hands can touch hips and groin

 

6 months:

Oblique muscle activation occurs

Able to roll from back to belly

Can grab feet with hands

 

 

7 months:

Can bring toes to mouth

Rocking from base of support on hands up to all fours: video example

 

 

7-8 months:

Start to creep forward with use of upper body

Oblique sit occurs (first elbow and down thigh, eventual open hand and down thigh)

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8 months:

Crawling

Sitting upright

 

9-10 months:

Further crawling development

Stepping forward to standing

Side walking along furniture

 

10-12 months:

Stand freely after standing with support

Walking between objects (side to side)

Walking in sagittal (forward) plane

 

14-16 months:

Stand independently from “bear” position

 

The movements attained in the first year of life are the foundation of all basic human movements. Following a major event like childbirth (or surgery or other major trauma), re-learning these movements IN ORDER helps heal the body as well as establish a solid foundation to build strength on. The diaphragm is used for both breathing and postural support. At 4.5 months as the diaphragm flattens and a more mature breathing pattern begins. When addressing the core, especially postpartum, the first step is establishing a strong breathing pattern. (Check out Dr. Mumma’s video here.) This is key in reconnecting to your core. After creating a human in that space for the the majority of a year, a woman needs to discover her new normal. Working on diaphragm activation can and should be done in the first day after birth while bonding with baby. This does not mean you need to start exercise but just focusing on what you are already doing, BREATHE!

 

12-16 times per minute: BREATHE.

In through your nose, out through your nose or mouth, filling your entire abdomen with air. When you inhale, your chest should not rise, but rather your belly should expand 360 degrees. This begins the healing process of the postpartum period internally.

Healing of the core needs to come from within. This occurs only after proper diaphragm activation which is a movement downward of the diaphragm during inhalation and upward during exhalation. From the outside, there will be expansion of the chest and abdomen in an outward direction as opposed to a dysfunctional upward motion of the chest and shoulders, as you saw in Dr. Mumma’s video above. As diaphragm moves downward, abdominal and lumbar musculature are contracted eccentrically (bracing outward, NOT SUCKING IN) and simultaneously counteracted by pressure of the pelvic floor. How awesome is it that we can gain a strong core by doing exactly what the baby just born will be doing?! Start with diaphragm activation, gaining proper intra-abdominal pressure, and move through the sequence of developmental movements, and the core will be strong enough to support day to day movements and eventually more vigorous exercise.

 

Functional Progression Demonstration Video

 

Breathing and movement patterns need to be discussed before birth and definitely assessed postpartum. Change is needed. It starts NOW.

As a practitioner, my work with pregnant and postpartum women continues to grow. This is where I not only see the literal gap in the body’s system (DRA) but also see the figurative gap in our system.

Consider this scenario: mom has baby, mom and baby are both healthy, mom presents for postpartum check up and pending no major issues is “cleared” for exercise. The evaluation being done of the core function at the postpartum visit is minimal at best and often completely overlooked. In fact, full movement patterns are never assessed. There is occasionally a check for diastasis rectus abdominis but not the entire core function. This leads to mom turning to online forums for help with a “gap” in her stomach or she may have been told to do crunches and sit-ups to help. The fact that our society has made “mommy tummy” a marketing ploy is an entirely different topic.

Let’s think about this though. In a hospital setting, as most births in our country are, practitioners are allowed limited time with patients as it is. For them to take on a thorough, functional physical would not only add appointment length but also require further education. My opinion is this is the point that collaboration in postpartum care must occur. Furthermore, my experience has proven time and time again that restoring core function in the immediate postpartum period launches moms into better recovery postpartum and overall better movement patterns. Long term, this leads to everything from less leaking when she sneezes (or runs, or laughs) to reduction in neck and back issues.

Beyond that, when assessing and treating the DRA, we must recognize that this is related to the entire movement patterns of the mother and not the diastasis alone. Sit-ups, crunches, holding the belly together during a contraction of the abs, and “zipping” the waist are not exercises that will be relatable to true movement. These are exercises towards strengthening single muscle groups and while they may seem to be beneficial temporarily, long term problems are likely to remain. We do not decide to get up from the chair and use transverse abdominus to walk to the yard. We also don’t consciously think about using our pelvic floor to stand at the park and watch our kids play. We need these muscles to be working together without conscious thought and in order for the muscles to work together they need to be trained through movement patterns we will use. Often that means taking it back to the basics of moving like a three or four month old infant. Trust me, even athletes moving heavy weights are humbled by this training and while they may be frustrated at the idea of dropping their weights, they are happy with the eventual improved strength and reduced risk of injury.

 

How does this all relate to your pelvic floor? Your core function is directly related to your pelvic floor function (fun fact: your pelvic floor is part of your core). It is actually directly related to ALL movement. Your core is your powerhouse. Without stability in your core, your foundation is off and eventually the pieces will crumble.

BIRTHFIT is education! We refer to the postpartum period as Queen in Training, and expect this specific healing time to last 9-12 months. Postpartum lasts a lifetime, but we want you to focus on the movement milestones to meet as a mother and hold yourself accountable to this. Approach your immediate postpartum period with intention and purpose. Know your body and understand how it functions as one unit. You will heal in less than a year and you will function better than before. If you can grasp this concept and share this with others, together we will create the shift in care that we need.

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Dr. Erica Boland, DC

BIRTHFIT Wisconsin

@EMOMDC

 

 

 

 

 

 

PART THREE… next week, relating core function to training

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Diastasis Rectus Abdominis: Filling the Gap Part 1

DIASTASIS RECTUS ABDOMINIS: FILLING THE GAP

Part 1 What and Why of Diastasis Recti

As I search the Internet and question colleagues, hungry for more information, what I actually learn is that we have a problem. The problem is the large gap; both figuratively and literally speaking. The gap in our postpartum healthcare is directly related to the gap in your abdomen.

It is beyond frustrating to see the misinformation marketed to new moms: “lose that mommy pouch” or “get your belly bikini ready” and “simple steps to a six pack.” (Unfortunately, “move well and quit screwing shit up” doesn’t sell as well.)

What is even more frustrating is many of the trusted resources, even the “experts” in the field, are still missing the boat. The consequences remain: misinformation and what I consider an epidemic of dysfunction.

I am sure by now you have heard the term Diastasis Recti or Diastasis Rectus Abdominis (DRA). For the sake of this post series I am going to refer to women. Just don’t forget, men have a core (and pelvic floor) too.

In my time as a chiropractor, doula, BIRTHFIT affiliate, coach, and mother of four I see firsthand the many issues that lead to and come from core dysfunction. It is time we start looking at the system as a whole and healing it that way.  I am thankful for having studied Janda, Lewitt, and Kolar’s work. Their work has paved the way for an in depth understanding of how our bodies were born to move.

Within these innate movement patterns lies our answer.

I hope to help you understand this as simply as it actually is. Think about this for a minute: when is the last time you witnessed a baby doing a sit-up? How about “zipping” in his or her transversus abdominis? Nope. Me either. Want another fun fact? Babies are BORN with diastasis. Yes, that’s right. YOU were born with a diastasis and immature movement patterns. Guess what else? Babies heal that diastasis on their own through functional movement patterns. By four and a half months the diastasis should approximate or come together. This is also around the time that baby starts to roll to both sides. Not a coincidence.

Big-Mac-DRA

No one teaches baby to roll or sit up on his or her own or crawl or squat or walk. We should not be putting them in these positions before this occurs naturally (Stop Interfering with Your Child’s Development). All of these movements are formed as neurological stimulation occurs in the environment. That simply means that baby’s brain is intrigued and wants to learn more about surroundings, hence baby is motivated to movies the most instinctive, natural way. Again, movement is life.

Why then, are we still attempting to look for treatment of DRA and core dysfunction by singling out muscle groups? We are not made to function that way, so hoping to return to full function by rehabbing or training that way is setting ourselves up for failure in the form of continuous injuries or dysfunction.

DRA does not have to occur. It is a separation in the rectus abdominus muscle due to immature movement patterns. Basically, this happens when movement reverts back to that of a newborn infant and can happen for a number of reasons. The simplicity of this concept is actually great news. If we return to what our bodies were born to do, we fix the problem at its roots and avoid simply making the surface look better.

The Functional Progression that I pieced together is not new. It is simply taking the work that I have studied into a fluid movement pattern that is more functional than a Turkish Get-up. The progression addresses the entire core and allows for resistance or weight to be added as normal movement patterns are solidified.

Dysfunction of the core and pelvic floor is much more than DRA and is so common that even upon questioning patients, it is often not mentioned. As founder of BIRTHFIT, Lindsey Mathews states, common does not always mean normal. Peeing in your pants when you are 50 (or younger) because you are “getting older and have had children” is NOT a rite of passage. Yes, it is common. No, it is not normal. And until we start filling our gaps, women will continue to suffer from these issues.

Stay tuned for Part 2!

-Dr. Erica Boland, DC

@EMomDC

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Kombucha and Scoby

We have had many inquiries on making kombucha. Here is a little “how to.” To top that, we have 2 Scobys that are looking for a new home! Contact us if you are interested.

couleehealthkombucha               couleehealthkombucha1

 

NEED:

Live Scoby (can order online but finding a friend to share is much better J)

1 C. Starter Kombucha (bottle of plain kombucha from supermarket)

1 gallon glass jar

Cheese cloth or thin towel to cover

Rubber band to put around cloth

Organic black tea

Organic or natural cane sugar

1 gallon distilled water

DIRECTIONS:

Wash glass jar with white vinegar

Pour in plain kombucha

Rinse hands with white vinegar and handle Scoby gently into jar

Cover with cloth and place rubber band around

Set aside in dark, cool location while preparing tea

 

Boil 1 gallon of distilled water

Once boiling add 8 bags of Organic tea

Stir in 1 cup of sugar

Let cool to room temperature (too warm and it will kill scoby)

Pour into gallon jar

Recover and place in dark, cool location

May want to mark date brewed

 

Ferment for 7 days

Funnel  to glass pint mason jars

Cover with lid

Refrigerate until ready to drink

OPTIONAL 2ND FERMENT

After funneling into glass mason jars add several small pieces of fruit/spice of choice

Cover with lid and place back in dark, cool location

Let sit for 3 more days

Be sure to refrigerate to cool before opening to avoid rupture of glass due to carbonation

NOTES:

*We have found 4-5 chunks of pineapple in 2nd ferment to be our favorite.  Other suggested fruits: papaya pulp, guava pulp, mango, apple, raspberry, prunes, chia seeds. Give it a try!

*First ferment can last up to a month but 7-14 days is best

*Scoby will regenerate on it’s own in which case you can split and share with a friend or start another batch

*After 1st ferment, may choose to have continuous Kombucha to just ladle out on counter

*Whenever touching scoby use vinegar to rinse hands. Make sure ladle and funnel are clean also

*Mini scoby may form in second ferment. This is normal and actually ok to consume!

 

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Dr. Jagim’s Weight Loss 101 Coming to Seneca on April 9!

We have had great feedback from the Weight Loss 101 Program offered at our office in West Salem by Dr. Jagim. However, some individuals expressed interest but couldn’t make the long drive. Well, Dr. Jagim has condensed this series from 5 one-hour weekly sessions into a one-day seminar held at Seneca High School on April 9 from 9:30-3:30. We are very lucky to have him come to Seneca for a ONE DAY event!!!

Here are the details, but you can always contact us if you still have any questions. And, of course, contact us to get signed up before it fills up!

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Whats included?

  • An educational program breaking down the science behind weight loss.
  • We will focus on different aspects of weight loss including dietary strategies, exercise strategies and everyday tasks intended to help you with your weight loss goals.
  • A pre and post body composition assessment using advanced Body Comp equipment.
  • An exercise program
  • Exercise demonstrations in small groups with Dr. Jagim and Dr. Boland
  • An individualized nutrition program.

About

Dr. Jagim

Dr. Jagim is an exercise physiologist, certified personal trainer and sports nutritionist. His research interests focus on the use of exercise and nutritional strategies to improve health, body composition and performance. He has published in several academic journals and presented at various national conferences relating to exercise science.

Dr. Jagim has taken his educational expertise and years of experience and developed an easy to understand approach to weight loss that can be instantly incorporated into your daily life.


Check out this podcast for a preview of some of the information Dr. Jagim covers in his program! Click Here

Woman weighing herself on scales in health club

What is it?

Tired of constantly struggling to lose weight or not knowing where to begin? Join us for an educational program focused on the science behind weight loss and how to use it to your advantage. This program is intended to help provide you with the tools to lose weight and keep it off.

Dr. Jagim will walk you through techniques that have been developed from the latest research to guide you through the weight loss process. Different topics relating to weight loss will be covered and we will discuss how to incorporate these strategies into your everyday lives. Topics will include exercise and nutritional strategies for weight loss, what makes losing weight so hard and how to keep weight off once you’ve lost it. This one-day event will be held from 9:30-3:30 on April 9 on the gymnasium stage at Seneca High School.

Why?

Weight loss is a complicated process and one that a lot of people struggle with throughout their lives. There is a lot of conflicting advice when it comes to nutrition, dieting and exercising for weight loss. A lot of people go about weight loss in such a way that it either doesnt work, only works for a brief period of time or maybe even makes things worse! Let us help taking the guessing game out of weight loss and provide you with the tools to finally achieve your goals using evidence based practices.

What if I dont understand physiology?

No problem! Dr. Jagim simplifies things in a way to help you understand it and incorporate it into your life style. No gimmicks, no false promises, just tried and true practices when it comes to weight loss and exercise programming. This program is one that works with your lifestyle and not against it. Learn simple approaches to eating that are appropriate for your goals and lifestyle while still allowing to eat the foods you love with the ones you love.

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Weight Loss 101 Seminar Schedule

  • 9:30-10:30: Introduction and Defining Energy Balance
    • Misconceptions surrounding weight loss
    • How we lose weight
    • Energy Balance: Determining your optimal calorie intake
  • 10:30-10:45: Break / Time for Questions
  • 10:45-11:30: Nutritional strategies for weight loss
    • Determine the types & amounts of calories to consume
    • Learn about a Flexible approach to dieting and why it’s beneficial
  • 11:30-12:30 Break for Lunch
  • 12:30-1:30: Exercising for Weight Loss
    • Misguided exercise efforts. Are you doing more harm than good?
    • Efficient and effective ways to approach weight loss through exercise
  • 1:30-1:45: Break / Questions
  • 1:45-2:30: Why weight loss is so hard and maintaining it is even harder!
    • Metabolic Adaptation
    • How to maintain weight loss
    • Strategies for reducing sedentary behavior
    • Final Overview
  • 2:45-3:30: Exercise Demonstrations

The program includes two body composition assessments and personalized instruction for the exercise program with Dr. Jagim and Dr. Boland.

If you plan to sign up for the program, click on the link below to reserve your spot for a body composition analysis at UW-La Crosse. You’ll need to get this done before April 9th. You will need these body composition numbers to personalize the program during the seminar. Be sure to follow the testing instructions prior to your appointment at UW-L.

https://docs.google.com/spreadsheets/d/125z4XII6tBpL4cO7lEsfyEmMw_67dDx6P5boe6tYtJs/edit?usp=sharing

The testing will be in the Human Performance Lab in Mitchell hall room 225. You can park outside of Mitchell Hall in the 2 hr parking on either street.

Also make sure to wear spandex/compression shorts and for females a sports bra for the body composition test.

Participant Instructions

  1. No strenuous exercise is permitted 3-4hrs. prior to body composition testing.
  1. You are to fast at least 2-3 hrs. prior to your testing.

Costs and Registration

Cost of the program is $150.00 and there is a limit of 10 people so first come, first serve… Spots are filling up so be sure to register soon! You can make your $150 check payable to J2 Fitness and drop it off at Seneca Schools or Coulee Health to reserve your spot.  Or you can pay via paypal to J2fitnesslacrosse@gmail.com.

Contact Us

Phone: 608-498-4669
Email: info@couleehealth.com

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BIRTHFIT Wisconsin Welcomes Maclin Kyle

We are very excited to announce the arrival of our fourth son, Maclin Kyle Boland. Maclin entered our home late in the afternoon on January 27th, weighing 9 lbs. 6 0z. and measuring 22 inches long.

We feel beyond blessed to have another beautiful baby boy in our lives and Maclin’s older brothers are completely in love.

Maclin’s birth story will be posted on BIRTHFIT Wisconsin Facebook page later this weekend or early next week as we relax as a family of SIX!

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Weight Loss Program

Join us for Weight loss 101 -with Dr. Jagim
scale
What’s included?
  • Weekly educational classes breaking down the science behind weight loss.
  • Each week we will focus on different aspects of weight loss including dietary strategies, exercise strategies and everyday tasks intended to help you with your weight loss goals.
  • A pre and post body composition assessment using advanced Body Comp equipment.
  • An exercise program
  • 1, one-on-one training session with Dr. Jagim
  • An individualized nutrition program
About:
Dr. Jagim
Dr. Jagim is an exercise physiologist, certified personal trainer and sports nutritionist. His research interests focus on the use of exercise and nutritional strategies to improve health, body composition and performance. He has published in several academic journals and presented at various national conferences relating to exercise science.
Dr. Jagim has taken his educational expertise and years of experience and developed an easy to understand approach to weight loss that can be instantly incorporated into your daily life.
Woman weighing herself on scales in health club
What is it?
Tired of constantly struggling to lose weight or not knowing where to begin? Join us for a 6-week educational program focused on the science behind weight loss and how to use it to your advantage. This program is intended to help provide you with the tools to lose weight and keep it off.
Dr. Jagim will walk you through 5 steps that have been developed from the latest research to guide you through the weight loss process. Each week a different topic relating to weight loss will be covered and we will discuss how to incorporate these strategies into your everyday lives. Topics will include exercise and nutritional strategies for weight loss, what makes losing weight so hard and how to keep weight off once youve lost it. We will meet every Tuesday night from 7:00-8:00 or every Wednesday night from 6:00-7:00 at Coulee Health.
Why?
Weight loss is a complicated process and one that a lot of people struggle with throughout their lives. There is a lot of conflicting advice when it comes to nutrition, dieting and exercising for weight loss. A lot of people go about weight loss in such a way that it either doesnt work, only works for a brief period of time or maybe even makes things worse! Let us help taking the guessing game out of weight loss and provide you with the tools to finally achieve your goals using evidence based practices.
What if I dont understand physiology?
No problem! Dr. Jagim simplifies things in a way to help you understand it and incorporate it into your life style. No gimmicks, no false promises, just tried and true practices when it comes to weight loss and exercise programming. This program is one that works with your lifestyle and not against it. Learn simple approaches to eating that are appropriate for your goals and lifestyle while still allowing you to eat the foods you love with the ones you love.
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Costs and Dates:
The program will run for 6 weeks from Jan. 5 to Feb. 10 and there will be two different sessions to accommodate busy schedules. One session will meet on Tuesday nights (starting Jan. 5) from 7:00-8:00 PM and another session will meet on Wednesday nights (starting Jan. 6) from 6:00-7:00 PM, both right here at Coulee Health. During the first week we will be completing body composition assessments and going through the exercise program which will be scheduled during individual appointments with Dr. Jagim.
Cost of the program is $125.00 and there is a limit of 10 people per session. Spots are already filling so first come, first serve!
Contact Us:
Phone: 608-498-4669
Email: kbolanddc@gmail.com
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Can I be BirthFIT?

“Can I be BirthFIT?”

BIRTHFIT Venn DiagramThis is a question I recently received from a patient that is a few years, instead of few months postpartum. The answer to that question is, “YES!”

Ideally, women start preparing to be BirthFIT before conception and pregnancy by staying active, eating healthy, hydrating and working on mindfulness and emotional well being. The postpartum series is targeted at women 2 weeks-6 months postpartum. This is simply because this is also the ideal time to heal your body and mind after birth. However, there is no time limit on when that can occur! The fitness portion of the postpartum series emphasizes the strength and improvement of the core. This includes the diaphragm, all abdominal musculature and the pelvic floor. Your core is your powerhouse and proper function sets you up for proper movement patterns and easier transition into or back to fitness. It is never too late to address this!

As women there are many things thought of as some sort of “right of passage” coming with giving birth and aging. This is absurd! Below is a list of just a few issues that are “common but not normal” (and certainly not a badge of honor as a woman) that may develop with improper core function (and can be helped).

Diastasis of rectus abdominis (a split in centerline of abdomen)

Decreased diaphragm breathing

Stress or urge urinary/bowel incontinence

Abdominal trigger points/pain

Frequent or recurring injury during exercise due to decreased activation of the core in unison

Pelvic pain

As stated previously, it is NEVER too late to become BirthFIT! Do not accept these issues as something normal to deal with. Seek assessment from your local chiropractor and contact your local BirthFIT affiliate!

www.birthfit.com

Please watch for corresponding video to come on Coulee Health’s Facebook page.

Follow Dr. Erica on Twitter and Instagram: @EMomDC

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BirthFIT Postpartum Series

BF facebook ad

NEXT CLASS STARTS OCT 5!!!

We discovered a need in the birthing world.  If you’re not hemorrhaging or overtly depressed at your 6 week postpartum appointment, you’re usually sent on your way with a green light to return to activity.  But many women are finding it hard to figure out how to return to (or start) working out.  BirthFIT has taken this as an opportunity to help offer women guidance on working out postpartum.

Whether you worked out through your pregnancy, worked out before your pregnancy, or are completely new to working out, the BirthFIT Postpartum Series can help you navigate movements and fitness in your postpartum body.  It doesn’t matter if this was your first or eighteenth birth – BirthFIT can help you improve your movements and your body.

The BirthFIT Postpartum Series is ideal for mothers interested in any or all of the following:

-beginning/returning to functional movements
-healing physically, mentally, and emotionally after giving birth
-connecting with other moms who have recently given birth
-getting back to working out comfortably and empowered

This is a four week class that will meet twice per week for an hour per class.  We’ll work on functional movements – mostly bodyweight, but also weighted; share birth stories/journeys; heal visible and invisible scars from birth; and return to working out feeling stronger and empowered.  The courses are geared towards women who are 2 weeks-6 months postpartum, but is appropriate for any mother who is looking to improve herself and her health through movement and community.

Dates: Monday/Thursday, 10/5-10/29

Time: 5:30-6:30 pm

Cost: $149

Contact me to reserve your spot: ebolanddc@gmail.com

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Painting, Wine, and Fun!

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Join Hands on Health, Therapeutic Massage and Coulee Health for:

Painting, Wine and Fun!

Join us for wine and appetizers while we paint the canvas shown below with instruction led by                Holly Hanson, LMT

When: Wednesday, August 26 @ 6 pm

Where: Coulee Health: 920 W Cty Hwy 16, Suite A, West Salem, WI

Cost: $25 per person

Space is limited to 10 so call or email to reserve your spot!

608-498-4669

ebolanddc@gmail.com

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Chocococo Smoothie

Chocococo Smoothie
1 frozen banana
2 c coconut milk
2 tbsp almond butter or peanut butter
1/2 tsp vanilla
2 tsp unsweetened coco powder
1-2 tbsp honey (optional)
1 tbsp coconut oil (optional)
1 c ice
top with toasted coconut (optional)
Blend! Serves two 🙂
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