Greg and I have been to 19 weddings in the last 3 years. You know what that means - many of our friends are starting to think about having kids (or are well on their way), and as the only dietitian in the group, I get a lot of questions about what to eat prior to conception. A lot of the recommendations I post below actually apply to women once they get pregnant as well, although the needs of a pregnant woman are slightly different. I suppose I'll reserve that information for another post.
Nutrition prior to conception - and of course, during pregnancy - is crucial. Think about it: a baby starts out as only a few cells in a "soup" of hormones and chemicals within a woman's body. Optimizing nutrition status before you're pregnant gives your peanut her best shot at health. This is also not a time to stress about every little bite or worry about eating "perfectly," as this kind of thinking can be destructive. I advocate for a nice, happy medium between general awareness of what is important in getting pregnant and maintaining sanity.
The recommendations below are general and do not necessarily apply to everyone. If you or someone you know is thinking about becoming pregnant and needs some nutrition help, send them my way! Dietitians are trained in maternal, infant, and child nutrition and even do clinical rotations with high risk populations. Furthermore, in my first full-time position after grad school for WIC (a federal nutrition program for low-income women, infants, and children), I spent a lot of time working on nutrition education policy and counseling for this population.
1. Normalize your body weight - and stop dieting. Really.
Many women in their 20s and 30s live on a diet roller coaster, where they're either "on" or they're "off." Subsequently, their weight can fluctuate, and during dieting times they may be restricting calories and even entire food groups. While research suggests that women with very high or low BMIs have trouble conceiving, I usually suggest that my clients focus less on the number and more on the behaviors. Are they eating when they are hungry and stopping when they are full? Do they eat a balance of healthy and "play" foods, instead of only healthy foods when they're being "good" and mostly play foods when they're being "bad"? When we normalize our eating patterns and start following a more "intuitive eating" approach, our weight falls where it should, and our body recognizes that it will get the nutrients it needs. This not only saves our sanity but improves the likelihood of conceiving.
Furthermore, it's important to remember that your eating issues, if unresolved, could be passed on to your children. It's important to address them now, before you hardly have time to take a shower!
2. Focus on key nutrients.
Certain nutrients are especially important when trying to conceive. In an ideal world, we would all have sufficient intake of a variety of foods and would not fall short on any particular nutrient. However, it is likely that you need a little help with one or more nutrient listed below.
- Folic acid. Folic acid (or folate), a B vitamin, has been shown to be important in preventing neural tube defects such as spina bifida (when the spinal cord does not fully close) and anencephaly (when the brain doesn't fully form) in infants. Neural tube defects occur in over 3,000 babies a year, yet adequate folic acid levels could prevent as many as 70% of these cases. Unfortunately, the most critical time in neural tube development is in the first few weeks of pregnancy, when most women don't even know they are pregnant. What's worse is that many women do not understand the importance of this critical nutrient prior to getting pregnant. In fact, according to the March of Dimes, every woman of child bearing age should take some form of folic acid supplement.
Folate can also be found in foods like spinach, broccoli, asparagus, lentils, and fortified orange juice and cereals. You might see it on the label of your favorite white bread, as manufacturers are required to enrich processed grains when they strip naturally occurring folate from the seed to make white flour.
Bottom line: if you're a women who could potentially become pregnant, take a multivitamin or prenatal vitamin that contains 400 micrograms of folic acid. Make sure to check the label - you do not want ingredients like high fructose corn syrup, hydrogenated oils, soy oil, or artificial colors or flavors. I usually recommend professional products like Innate Response (for a multi) and Thorne Basic Prenatal. (The extra iron in a prenatal vitamin might irritate your GI tract, and if you are taking it pre-pregnancy but having problems with tolerance talk to an RD or your doc about getting your folic acid through a basic multivitamin.)
- Vitamin D. Vitamin D has become a superstar in recent years as researchers learn more about its role in disease prevention, general health, and - you guessed it - pregnancy! So many of us are vitamin D deficient, and it's important to get your numbers to optimal level before conceiving. The Vitamin D Council recommends that optimal serum vitamin D levels remain around 50 ng/mL, but almost all of my clients who have been tested have reported levels ranging from 17-45 prior to supplementation. Vitamin D deficiency in pregnant women has been linked to increased risk of C-section, pre-eclampsia (high blood pressure during pregnancy), gestational diabetes, and bacterial vaginosis. In infants, vitamin D deficiency may lead to cognitive and psychiatric disorders, asthma, diabetes, seizures, and a host of other maladies. Breast milk has been mistakenly labeled as a "poor source" of vitamin D, but the only reason why it is low in this vital nutrient is because many breast feeding moms are deficient themselves!
Unless you are in the sun often without sunscreen, which has its own concerns, you might have low vitamin D serum levels. The only way to know is to have your 25-hydroxyvitamin D, or 25(OH)D, checked through a blood test. Fortunately, many doctors are keeping up with the research on vitamin D and are testing many of their patients during annual check-ups. You might have to ask your doc to order the test, but hopefully he or she will know why it's important!
Current federal recommendations for vitamin D stand at only 800 IU per day, and unfortunately this is not enough to get blood levels to optimal levels. The Vitamin D Council recommends supplementing 5,000 IU of vitamin D3 per day for adults, and 6,000 IU daily for pregnant or lactating women. Remember, our bodies produce about 10,000 IU after just 20 minutes of sunlight, so these high doses are hardly unreasonable.
Bottom line: First get your levels checked to see where you are, and then consider supplementing with vitamin D3 to obtain serum levels of about 50 ng/mL. I personally had mine checked and was at 27.1 even though I was taking 1,000-2,000 IU per day. After supplementing daily for 6 months with BioD Mulsion Forte (6,000-20,000 IU per day), my levels climbed to about 60 ng/mL.
- Omega-3 fatty acids. These "super" fats play a crucial role in decreasing inflammation, reducing disease risk (heart disease, diabetes, even cancer), and improving cognition in adults. Optimizing omega-3 fatty acids in the body prior to conception and during pregnancy also aids in development of brain, eye, immune system, and nervous system development in babies, and optimal omega-3 levels during pregnancy and lactation help prevent cognitive and attention-related disorders in kids.
Bottom line: The best source of omega-3 fats is fatty fish like salmon, tuna, and mackerel. Unfortunately, many fish are also high in mercury and other environmental toxins like PCBs, so it's important for women considering pregnancy to limit consumption of fish to 3 times per week. The best way to ensure adequate consumption of omega-3 fats is to eat other good food sources of omega-3s, such as walnuts, and flaxseed; eat low-mercury fish like wild salmon and chunk-light tuna no more than 3 times per week; and supplement with a high quality fish oil. I usually recommend Nordic Natural's Strawberry DHA or Pro DHA 1000.
Many women in their 20s and 30s live on a diet roller coaster, where they're either "on" or they're "off." Subsequently, their weight can fluctuate, and during dieting times they may be restricting calories and even entire food groups. While research suggests that women with very high or low BMIs have trouble conceiving, I usually suggest that my clients focus less on the number and more on the behaviors. Are they eating when they are hungry and stopping when they are full? Do they eat a balance of healthy and "play" foods, instead of only healthy foods when they're being "good" and mostly play foods when they're being "bad"? When we normalize our eating patterns and start following a more "intuitive eating" approach, our weight falls where it should, and our body recognizes that it will get the nutrients it needs. This not only saves our sanity but improves the likelihood of conceiving.
Furthermore, it's important to remember that your eating issues, if unresolved, could be passed on to your children. It's important to address them now, before you hardly have time to take a shower!
2. Focus on key nutrients.
- Folic acid. Folic acid (or folate), a B vitamin, has been shown to be important in preventing neural tube defects such as spina bifida (when the spinal cord does not fully close) and anencephaly (when the brain doesn't fully form) in infants. Neural tube defects occur in over 3,000 babies a year, yet adequate folic acid levels could prevent as many as 70% of these cases. Unfortunately, the most critical time in neural tube development is in the first few weeks of pregnancy, when most women don't even know they are pregnant. What's worse is that many women do not understand the importance of this critical nutrient prior to getting pregnant. In fact, according to the March of Dimes, every woman of child bearing age should take some form of folic acid supplement.
Folate can also be found in foods like spinach, broccoli, asparagus, lentils, and fortified orange juice and cereals. You might see it on the label of your favorite white bread, as manufacturers are required to enrich processed grains when they strip naturally occurring folate from the seed to make white flour.
Bottom line: if you're a women who could potentially become pregnant, take a multivitamin or prenatal vitamin that contains 400 micrograms of folic acid. Make sure to check the label - you do not want ingredients like high fructose corn syrup, hydrogenated oils, soy oil, or artificial colors or flavors. I usually recommend professional products like Innate Response (for a multi) and Thorne Basic Prenatal. (The extra iron in a prenatal vitamin might irritate your GI tract, and if you are taking it pre-pregnancy but having problems with tolerance talk to an RD or your doc about getting your folic acid through a basic multivitamin.)
- Vitamin D. Vitamin D has become a superstar in recent years as researchers learn more about its role in disease prevention, general health, and - you guessed it - pregnancy! So many of us are vitamin D deficient, and it's important to get your numbers to optimal level before conceiving. The Vitamin D Council recommends that optimal serum vitamin D levels remain around 50 ng/mL, but almost all of my clients who have been tested have reported levels ranging from 17-45 prior to supplementation. Vitamin D deficiency in pregnant women has been linked to increased risk of C-section, pre-eclampsia (high blood pressure during pregnancy), gestational diabetes, and bacterial vaginosis. In infants, vitamin D deficiency may lead to cognitive and psychiatric disorders, asthma, diabetes, seizures, and a host of other maladies. Breast milk has been mistakenly labeled as a "poor source" of vitamin D, but the only reason why it is low in this vital nutrient is because many breast feeding moms are deficient themselves!
Unless you are in the sun often without sunscreen, which has its own concerns, you might have low vitamin D serum levels. The only way to know is to have your 25-hydroxyvitamin D, or 25(OH)D, checked through a blood test. Fortunately, many doctors are keeping up with the research on vitamin D and are testing many of their patients during annual check-ups. You might have to ask your doc to order the test, but hopefully he or she will know why it's important!
Current federal recommendations for vitamin D stand at only 800 IU per day, and unfortunately this is not enough to get blood levels to optimal levels. The Vitamin D Council recommends supplementing 5,000 IU of vitamin D3 per day for adults, and 6,000 IU daily for pregnant or lactating women. Remember, our bodies produce about 10,000 IU after just 20 minutes of sunlight, so these high doses are hardly unreasonable.
Bottom line: First get your levels checked to see where you are, and then consider supplementing with vitamin D3 to obtain serum levels of about 50 ng/mL. I personally had mine checked and was at 27.1 even though I was taking 1,000-2,000 IU per day. After supplementing daily for 6 months with BioD Mulsion Forte (6,000-20,000 IU per day), my levels climbed to about 60 ng/mL.
- Omega-3 fatty acids. These "super" fats play a crucial role in decreasing inflammation, reducing disease risk (heart disease, diabetes, even cancer), and improving cognition in adults. Optimizing omega-3 fatty acids in the body prior to conception and during pregnancy also aids in development of brain, eye, immune system, and nervous system development in babies, and optimal omega-3 levels during pregnancy and lactation help prevent cognitive and attention-related disorders in kids.
- Other nutrients. Depending on your current intake, you may have to supplement with calcium and iron prior to conception. Again, get in touch with a registered dietitian to assess your intake and needs.
3. Get real.
I usually advocate eating whole, real foods as often as possible for all of my clients, and it's especially important for those trying to get pregnant. It's important to minimize intake of artificial chemicals, additives, and preservatives, as a tiny fetus is more vulnerable to chemical affects than you are. Stick to organic or low-pesticide vegetables and fruits; organic and grass-fed meats, organic poultry and eggs, and wild fish; whole grains like quinoa, brown rice, and minimally processed whole wheat (try Ezekiel products); organic, full-fat and low-fat dairy (if you eat dairy); and fats like extra virgin olive oil, avocados, virgin coconut oil, and organic pasture butter. Try to increase your intake of "things from the ground" like whole, raw (or lightly cooked) vegetables and fruits, since these foods are extremely nutrient dense and provide vitamins, minerals, and plant chemicals ("phytochemicals") that are critical for fetal development.
Don't be afraid of fat, especially if it comes from olive oil and high quality animal fats like grass-fed beef and organic pasture eggs and butter. The conjugated linoleic acid found in whole milk, butter, and meats has been shown to improve fertility. Just make sure you get products from organically raised animals who eat what they should - grass!
It's especially important to avoid artificial sweeteners like saccharin, Splenda (sucralose), Nutrasweet, aspartame, neotame, and acesulfame potassium. These lab-made sweeteners can be found in a lot of products, including dietary supplements, chewing gum, and packaged foods, so be sure to check the label. I usually recommend that all clients stick to honey, stevia, real maple syrup, agave nectar, fruit juice or puree, or raw cane sugar for a touch of sweetness.
4. Consider probiotics.
Probiotics, or those microscopic "healthy" bacteria that normally inhabit the gut, can become imbalanced when we take antibiotics, birth control pills, become ill, or even experience a lot of stress. They are a critical component of our immunity and digestion, and they are being heavily researched for their effects on cholesterol, blood pressure, inflammation, and even cancer prevention.
Probiotics may be especially important during pregnancy, as new research is suggesting they not only help the mother with constipation, heartburn, digestion, and immunity, but they also may fend off illness and allergies in children. A recent study credits probiotics with helping moms cut belly fat after delivery. They have even been linked to improving brain chemistry and behavior.
Personal and professional experience has led me to believe that probiotics may just be one of the most important pieces of the health puzzle, which is why it's important to take in good sources of probiotics, like yogurt and kefir, before, during, and after pregnancy. In fact, I recommend probiotic-containing foods or supplements to almost all of my clients because of their potentially critical health effects.
The brand I take and recommend is a professional product called Genestra's HMF (Human Micro-flora). I especially like the HMF Forte blend, but other probiotics in this line may be appropriate for you. You can purchase them online through Amazon.com or through a qualified health care provider such as myself. For more information on this product and why I think probiotics are so important, check out this post.
5. Rethink what you drink.
5. Rethink what you drink.
Many of us non-pregnant folks don't think twice about downing two double espressos before lunch time. Once a bun is in the oven, however, it's important to cut caffeine intake to no more than 200 mg per day (about 12 ounces of coffee) in order to avoid miscarriage, stillbirth, fertility problems, and health problems for the baby. Quitting caffeine cold turkey once you're pregnant can be very uncomfortable, so I usually recommend slowly decreasing caffeine intake in the months leading up to conception. Caffeine can be found in so many foods and drinks, like coffee, tea, soda, energy drinks, and chocolate, so if you're thinking about becoming pregnant, consider evaluating your current caffeine intake and slowly reducing it to no more than 200 mg per day. I usually recommend little to no caffeine once you're pregnant to mitigate any potential risks, but it's important to discuss your personal situation with your doctor.
If you can do anything to improve your health and the health of your baby, consider cutting out soda. Diet soda contains artificial sweeteners that, among other things, make us crave sweetness, and while regular soda is preferred over diet, it still contains high fructose corn syrup. HFCS increases or risk of metabolic syndrome and is usually made with genetically modified corn, which is why I recommend staying away from it as much as possible. Furthermore, the carbonation in all soda leads to bone loss and is very corrosive to teeth. Suitable alternatives include water with a splash of citrus juice or mint, iced or hot herbal tea, and organic milk (if you do milk), almond milk, hempseed milk, or rice milk. If you must do soda, try to get decaffeinated, cane sugar- or stevia-sweetened versions, found at most health food stores.
To all of you thinking about becoming mamas - congrats, and let me know if I can do anything to help you be the healthiest you can be!
*M*
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