Food Diary of a Pregnant Dietitian

A lot of people have asked me if my eating habits have changed since becoming pregnant.  In general, I'd say they're relatively the same, but I'm certainly hungrier for more food than I used to be!

The whole "eating for two" statement is really a fallacy.  Starting in the second trimester and in addition to greater vitamin/mineral requirements, pregnant women need only 300 extra calories per day to support a growing fetus.  That equates to half a sandwich, an apple with 2 T peanut butter, or a large cookie.  Some of these extra calories should contain protein, since protein needs are also increased.

Does this mean I count out 300 calories and make sure to scarf them down?  Nope.  I don't count calories at all, just like before I was pregnant.  I just listen to my body and monitor my weight gain with my doc to make sure I'm getting enough.  My activity levels have decreased a bit since pre-pregnancy and some days the baby seems to be growing more rapidly than others, so it's really hard - and not necessary - to focus on numbers while eating.  I am aware of my hunger and fullness and make sure to have plenty of snacks nearby for when hunger strikes.  Some days I'm ravenous, while other days it seems like there's just not quite enough room in my abdomen to fit much food (which may be true).

By the way, recommended pregnancy weight gain ranges from 25-35 lb.  I will likely gain around 30ish pounds if I gain at the same rate I'm going, but I absolutely don't obsess about it.  Pre-pregnancy I rarely weighed myself, but now I hop on once a week to make sure I'm gaining enough and to check that I haven't gained a really big amount - such as 5 pounds in a week - because that can indicate that the body is retaining too much fluid and preeclampsia may be setting in.

Generally, physicians want pregnant women want to gain 2-5 pounds in the first trimester and about a pound a week thereafter. That doesn't mean that every person will follow this pattern.  I gained 6 pounds in the first trimester and then stayed there for about 4 weeks despite having an increased appetite.  After that, my weight gain pretty much increased by 0.5 - 1.5 lb per week.

What if you gain more in pregnancy?  While there are some potential risks to you and your baby if you gain a significant amount of weight, what I usually advise clients to do is listen to their bodies and not just eat "because they can."  In fact, if you have an intuitive eating mindset, you always "can" eat anything; pregnancy is no different.  Nutrition is perhaps the most critical during this imperative developmental stage, so focusing on nutrient dense foods and hunger/fullness - not necessarily weight gain - is the most important thing.  Some women will just naturally gain more or less weight than is recommended, and as long as your doctor is OK with it then don't stress.

I wanted to share three days of eating with you all so you could check out what it's really like to be a dietitian while pregnant.  I absolutely like sweets and comfort foods just like the rest of us, and I honor my cravings and only eat foods I really like.  As you will see, I still eat a lot of veggies and fruits while making sure to get protein, fat, and fiber in the form of whole grains and beans.  For more info on the supplements I'm taking, check out this post on first trimester nutrition or this post about pre-conception nutrition.  The prenatal vitamin I'm taking is divided into 3 doses per day to spread out the nutrients and not provide so much iron to the system at one time.  I take one with each meal.

For the record, my major pregnancy cravings have been the following:

- Chocolate - any kind, must have some daily

- Salads

- Turkey burgers from Red Robin

- Asian food

- Avocados

- Beans (any kind)

- Any sort of egg (although I make sure they're fully cooked)

Aversions (mainly during first trimester):

- Mushrooms

- Onions

- Peanut sauce on Picazzo's baked chicken wings (my sister and I used to get these all the time, but no more)

- Frozen yogurt (bad experience)

Note: I drink 2-3 cups of herbal ginger tea and 10-12 cups of water each day.  I don't necessarily eat everything on my plate; it just depends on how hungry I am.  When my body says it is full, I stop.

Day 1:

I was really hungry today!  Thank goodness I brought plenty of snacks to work. 

6 am - 45 minute walk with dogs

7 am - Breakfast

Ezekiel English muffin with almond butter topped with sliced banana

Prenatal vitamin, fish oil, probiotic, B complex, and Dr. Ben Kim's Greens

10 am - Snack

Tangerine chickpea and kale salad and an orange

2 calcium/magnesium/zinc + vitamin D (500 mg calcium total)

12 pm - Lunch

Romaine salad with tomatoes and avocado

Figg brand split pea soup topped with crumbled feta

Piece of dark chocolate

Prenatal vitamin

2:15 pm - Snack

Lara bar

2 calcium/magnesium/zinc + vitamin D

4:00 pm - Snack

Brussel sprout and beet salad

5:45 pm - few bites of chicken

6:00 pm - Karve class

7:15 pm - Dinner

Pomegranate chicken on top of quinoa

Salad made with romaine, apples, avocado, feta and homemade vinaigrette

1/2 piece of homemade GF bread with pasture butter

2 Hail Merry macaroons

1 Prenatal vitamin

Day 2:

Officially 27 weeks today!

6 am - 45 minute walk with dogs

7 am - Breakfast

Ezekiel English muffin topped with avocado, sliced tomato and 2 organic eggs cooked in pasture butter

Prenatal vitamin, fish oil, probiotic, B complex, and Dr. Ben Kim's Greens

10 am - Snack

Organic string cheese stick and a pear

12 pm - Lunch

Picazzo's Organic Italian Kitchen! Gluten-free slice of the day (pesto with ricotta and organic Italian sausage dipped in marinara sauce) and Berry Licious Salad (spinach, strawberries, feta cheese, walnuts, orange segments)

1 Dove dark chocolate Promise

Prenatal vitamin

2:30 pm - Snack

Lara bar

4:00 pm - Snack

Baby carrots dipped in garlic hummus

7:00 pm - Dinner

Cheesecake Factory!  Greg and I ordered off the "Skinny" menu because he's going for lighter fare these days

1/2 piece of "brown" bread with butter

1 Vietnamese Shrimp Summer Roll dipped in sauce (cold, wrapped in rice paper)

1 Mexican Chicken Lettuce Wrap

1/4 Skinny Turkey Burger and a few bites of side salad (ordered with regular vinaigrette instead of "Skinny")

Prenatal vitamin

Day 3:

OB appointment today with the lovely glucose drink (test for gestational diabetes):

6:00 am - 40 minute walk with dogs

7:00 am - Breakfast - had to be low-carb prior to test!

3 pasture eggs cooked in 1 tsp. pasture butter

1/4 avocado, sliced

4 slices tomato

Sprinkles of feta cheese 

Prenatal vitamin, fish oil, probiotic, B complex

7:20 am - Yummy (terrible) "Fruit Punch" glucose drink

9:00 am - Decaf latte from Starbucks (2% milk, added stevia and cinnamon)

11:30 am - Lunch

Salad with romaine, cucumber, avocado and hummus

Leftover chicken and a little quinoa

Piece of dark chocolate

Prenatal vitamin

2:30 pm - Snack

Lara bar

2 calcium/mag/zinc + vitamin D supplements

4:00 pm - Snack

Carrots and hummus

Organic string cheese

6:00 pm - Karve class

7:15 pm - Dinner

AJ's salmon, veggies and a few bites of mac & cheese (so heavy it hurt my tummy!)

Piece of healthy fudge 

Prenatal vitamin

So there you have it!  Each day I am for variety as much as possible, and I only eat foods I really love while getting in as much produce as possible.  I have been cooking less lately due to a very busy schedule, so there is less homemade food here than normal.  Sometimes I finish my plate, but most of the time my fullness tells me to stop.  That's the wonderful thing about our bodies - even when pregnant, we can listen to the signals our bodies give us to know when we have had enough.  And you know what?  If we really, really want something but we are full, we can save it for the next meal (or snack!).

*M*

The Truth About Healthy Holiday Eating

I always expect my consulting business to die down around December. Who wants to talk about nutrition during this time of year? Surprisingly enough, every year I get a slew of new clients who really want the added support and encouragement that a dietitian can offer during the stressful, and usually food-focused holiday season. Inevitably, we talk about how to handle holiday parties, family gatherings, and mall food courts. As fun and festive as these eating experiences can be, they tend induce a great deal of anxiety about overindulgence and weight gain.

Instead of offering my own suggestions, I'm going to share some of my favorite tips from the mindful eating experts. They might not be quite what you expect...so follow along!

1. Michelle May, MD, "Am I Hungry?" - "Rewrite Those Ridiculous 'How to Prevent Weight Gain Articles'"

I love Dr. May's approach to listening to your body and giving it what it really needs. Here's what she says about the typical holiday eating articles: "The onslaught has begun... I'm not talking about the holiday shopping frenzy, the incessant Christmas music (Winter Wonderland is particularly annoying here in Phoenix), or even the delicious food everywhere (for that I'm grateful). I'm talking about the onslaught of "How to Prevent Holiday Weight Gain" stories. Perhaps you recognize their formula:

Cheery opening + Fear mongering + Clever strategies =
"Newsworthy" story to attract fearful/hopeful eyeballs

I’ve already seen, read, and been interviewed for dozens of these stories this year. An online search for "prevent holiday weight gain" turned up 50 million entries. If you read one article every minute, it would take you 96 years to read them all - except that the number of articles would continue to explode while you were reading them!

These stories pop up on a rotating basis: New Year's, Super Bowl Parties, Getting Ready for Swim Suit Season, etc., and most follow a similar formula. (A notable exception during the Thanksgiving onslaught was this Huffington Post article quoting my friend Evelyn Tribole, co-author of Intuitive Eating.)

These stories must sell because they are often the teasers for the news (is this really NEWs?) and displayed prominently on the cover of magazines, ironically next to "Simple Sinfully Sumptuous Sugar Cookies." The stories go something like this (I couldn't resist reading between the lines):

1. Eat before you go to a party so you won’t be tempted by all the goodies. (Really??? Do you also recommend maxing out your credit cards before you go Christmas shopping?)
2. Wear tight clothing to the party to prevent yourself from overeating. (Feeling uncomfortable and self-conscious is a small price to pay to prevent yourself from enjoying your favorite food.)
3. Drink seltzer water with a squeeze of lime in place of eggnog with rum. (I don’t know many people who love eggnog, but for those who do, this is like recommending crunching on carrots when you love potato chips.)
4. Hold a glass and a plate so it’s impossible to eat. (You’ll look ridiculous trying to nibble off a rolling meatball or sneaking slurps from the side of your cheesecake.)
5. Schedule a session with your personal trainer the next morning to burn off any extra calories that slipped by your radar. (The punishment must fit the crime.)"

Copyright © 2004-2011, Michelle May, M.D. All Rights Reserved.

Dr. May points out that so many of us punish ourselves for eating rich or less healthy foods, but this only causes us to restrict, feel deprived, and crave them even more. A more sane (and less punitive) approach would be to listen to our bodies, really enjoy those "special" foods at parties and family gatherings, and really take care of ourselves during this busy time. Here are Dr. May's tips for surviving the holidays:

1. "Trust your body wisdom. Tune into your signals of hunger and satiety to guide your eating before, during, and after the party. Being either famished or already full when you arrive sets you up for being uncomfortably full when you leave.
2. Treat yourself to pleasures besides food. Choose clothing that is beautiful, flattering, and comfortable so you feel and project your best.
3. Eat (and drink) what you really love. And skip anything that isn’t fabulous! The first few bites are for flavor, the rest are for fuel. (After the first few delicious bites, the flavor begins to fade anyway so you're just eating a memory.)
4. Love what you eat. Sensuously savor one small bite at a time, appreciating the appearance, aromas, flavors, and textures of your favorite foods as you eat them.
5. Practice extreme self-care. Choose activities that are the most meaningful to you, stay active and schedule down-time to relax and enjoy the holidays! (For one of {Michelle's} favorite articles on this topic, check out {her} new blog, DiabetesandMindfulEating.com)"

2. Elyse Resch, MS, RD, FADA and Evelyn Tribole, MS, RD, Intuitive Eating - "Intuitive Eater's Holiday Bill of Rights"

I participated in supervision under Elyse during grad school to become an Intuitive Eating counselor. Elyse and Evelyn's gentle approach to listening to your body, eating foods you enjoy, and honoring hunger and fullness changed me from a chronic dieter to a mindful eater about 5 years ago, and I am so grateful for their insight and guidance. I really miss seeing Elyse on a regular basis, but thankfully I honor her and Evelyn's philosophy her every time I work with a client.

Below is the Intuitive Eater's Holiday Bill of Rights:

1. "You have the right to savor your meal, without cajoling or judgment, and without discussion of calories eaten or the amount of exercise needed to burn off said calories.

2. You have the right to enjoy second servings without apology.

3. You have the right to honor your fullness, even if that means saying "no thank you" to dessert or a second helping of food.

4. It is not your responsibility to make someone happy by overeating, even if it took hours to prepare a specialty holiday dish.

5. You have the right to say, "No thank you," without explanation, when offered more food.

6. You have the right to stick to your original answer of "no", even if you are asked multiple times. Just calmly and politely repeat "No, thank you, really."

7. You have the right to eat pumpkin pie for breakfast.

Remember, no one, except for you, knows how you feel, both emotionally and physically. Only you can be the expert of your body, which requires inner attunement, rather than the external, well-meaning, suggestions from family."

Copyright © 2010 by Evelyn Tribole, MS, RD Published at www.IntuitiveEating.org

3. Karin Kratina and Amy Tuttle, Nourishing Connections - "Holiday Season Self-care Strategies" (from their "Stay Attuned e-zine", December 2009)

Check out the Nourishing Connections website to sign up for their e-zine, which offers great mindful eating tips and insight.

"Through the holidays, we may find ourselves wanting to use food after spending time - good and bad - with family or friends. Pausing for a moment to tune into our feelings and the reasons for our emotional eating will help us figure out how to take care of ourselves differently at the next get-together. In spite of (or because of) being in the midst of family and friends, we may have felt alone, or invisible, or taken advantage of. Or perhaps we had a wonderful time, and afterwards, we were hungering for more. Just as we practice tuning into our basic needs related to hunger signals and food preferences before and after eating, we can practice tuning into our emotional needs and wants before and after holiday gatherings. Being attuned to our needs and wants helps us to make nourishing connections and avoid depleting experiences. With a little self-care strategizing, we will be able to lessen our emotional eating after holiday gatherings arriving home satisfied and content.

Stay Attuned Tip

Think back to the last time you needed to use food after a holiday get-together. What were you feeling that led up to eating? In what ways did the food help with your feelings? Without judgment, write down some of the reasons you used food. Before each gathering this season, ask yourself: What do I want to experience or not experience at this gathering, with this group of people? What am I hungry for? Is what I want available from this crowd? From one person or others among the crowd? Who? If what I want or need is available, what gets in the way of my going after it? Will there be someone there who could affect my experience and undermine my satisfaction? Who is it? What can I do about that? Who in this crowd are my safe, nourishing people? Ask yourself, how much do I need and want of: Connection? If I have a good time with friends or family, yet I'm hungering for more afterwards, what will I do to manage these left-over feelings? Being polite and "nice"? What do I do that is nice but turns into selflessness? Cleaning up? Allowing myself to get stuck talking to a draining person? Spending more on gifts than my budget allows. Why do I give too much to others and not give enough to myself? How much is enough? To clean up? To listen to someone? To spend? What about quiet time? Pie? Alcohol? How much is enough? How much is too much?"

© Copyright 2009. Dr. Karin Kratina and Amy Tuttle. All rights reserved.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

We only have a few weeks left of the holiday season. May you share laughs, love, and wonderful food with your family and friends.

*M*

Do Dietitians Eat Junk Food?

When I tell people I'm a dietitian, I'm usually met with at least one of three reactions:

1) I'm asked if I only eat healthy foods;

2) People beg me not to judge them for what they eat; and

3) Some people - usually women - look me up and down to (I assume) assess my weight.

I want to clarify a few things.

Eating should be pleasurable and enjoyable. As a staunch believer of intuitive eating, a philosophy that promotes eating based on our inherent hunger, satiety, and satisfaction signals, I love food and am not afraid to admit it. I love it so much that I try - even on my most stressed of days - to treat it with respect. I sit down when I eat, try to eat as slowly and mindfully as I can, and honor when my body says it has had enough. I also eat the foods that I love. Some days that means I have a salad for breakfast. On other days, I'm craving gooey chocolate. So yes, dietitians do eat "junk" food...we just try to enjoy it and view it for what it is: just food. Of course, balance is important, as healthy foods help us live and feel better, but what's the point of eating if we cannot enjoy special foods some of the time? (If you feel that your eating habits or relationship with food are "strained," consider working with a dietitian or therapist who practices intuitive or mindful eating principles. The Intuitive Eating National Counselor Directory is here.)

By the way, as a dietitian I don't like to "watch people" while they eat and analyze their eating patterns. Like everyone else, I don't actually want to work all the time, and constant analysis of food and eating habits of everyone around me would become exhausting. Furthermore, open judgement of others' food patterns would only promote disordered eating behaviors and would leave me without any lunch companions!

As for those who look me up and down after learning what I do, I understand why they do it. Most people equate nutrition with weight and assume that "healthy" eaters are thin and "unhealthy" eaters are overweight. This assumption could not be further from the truth, and some of my most disordered or "unhealthy" eaters who are miserable around food are the envy of their less svelte friends. For more on this, check out the Health at Every Size webpage.

My husband Greg and I go out for ice cream about once a week. When it comes to eating ice cream, I want the real thing. Full-fat, real ice cream is more satisfying than fake fro-yo and doesn't have artificial sweeteners, which I avoid as much as possible because of how poorly it makes me feel. We are usually Cold Stone fans because it's so close to our house, but I'm not always comfortable with their long ingredient lists on each ice cream flavor. I'd rather fill my body with real ingredients, and I find that I feel much better when I do so, even after eating ice cream.

My dad recommended a local artisan ice cream shop called Sweet Republic. Located on Shea and 92nd Street in Scottsdale, Sweet Republic has been voted "Top 10 Ice Cream Shop" by Bon Appetit magazine and won "Best Ice Cream" by the Phoenix New Times.

I especially like it because they serve real, 100% natural, preservative- and artificial ingredient-free ice cream. They use whole, fresh ingredients, such as real mint leaves in their mint chip flavor. They even have unusual and unexpected featured flavors such as Honey Blue Cheese (actually kind of good!) and Jalapeno Avocado. Sweet Republic also has a traveling 59 Chevy van that serves up scoops of the good stuff at farmers' markets, events, and private parties.

Greg and I both enjoyed a scoop of the Salted Butter Caramel flavor in a waffle cone. I never paid much attention to cream cones before; after all, wasn't the ice cream the main attraction? I now realize why my dad emphasized the importance of the waffle cone at Sweet Republic: it was absolutely delicious! We sat and ate our treats with little spoons, fully enjoying each bite. The best part? We felt much better physically after eating ice cream from this local shop because it doesn't contain unusual ingredients and preservatives.

If you're in the Phoenix area, I encourage you to pop into Sweet Republic and grab yourself a cone. If you're not nearby, you might be able to find Sweet Republic ice cream at your local Whole Foods store. Just make sure to savor each spoonful!

Enjoy!

*M*

When to Eat

As a dietitian, I work with clients on how to eat almost more than what to eat. Sound surprising? Think about it. How often do you eat until you're "too full"? How many times during the week are you so hungry that you shovel everything in as fast as possible? Your body has many ways of telling you when you're hungry, when you're full, what kinds of foods you need, and what foods really taste best to you. We were all born with the wherewithal to properly nourish ourselves, but somewhere along the way we lost our ability to self-regulate eating. Perhaps it was when we were required to finish our plates, or maybe it was when we were told we would get some candy for good behavior. Most of us began associating food with some sort of emotion or reward (eat your veggies and you get dessert!) at a pretty young age. No wonder we have difficulty knowing how much to eat and how to listen to our bodies!

The first principle of intuitive or mindful eating that I work with my clients on is eating when you're hungry. Hunger is how your body tells your brain to start eating. It's a survival mechanism; without it, we would have no drive to eat and would starve to death. Unfortunately, in this diet- and weight-obsessed world in which we live, hunger has become something feared. "What if I get hungry?" people ask, or "I always get hungry in the afternoon. What should I do?" Do you know what I say? EAT! Hunger is a sign that your body needs fuel. Most people get hungry every 3-5 hours (more or less depending on your individual physiology). If you're never hungry, it's either because your metabolism has slowed so much that your body requires less fuel, or (more likely) because you're so mentally preoccupied or stressed that you almost "forget" to eat. Hunger is a GOOD thing. It means that your body is working through the fuel it has been given and that your metabolism, or the rate at which you use fuel, is kickin'.

What does hunger feel like? For some people, it can be sensed as an uncomfortable feeling or "rumbling" in the stomach. For others, it comes along as a headache, irritability, or crankiness. The most important thing is that we don't let ourselves get TOO incredibly hungry. Why is this? Because when we're really hungry, we tend to feel like we need to eat everything but the kitchen sink to feel satisfied. Thus, we eat foods that we might not normally eat, and we eat really quickly. If you start to identify what true hunger is (about a 3 on a scale of 1 - empty - to 10 - stuffed), you can have a better idea of when to start eating.

What about snacking? Snacks are a great way to give ourselves an energy and nutrient boost between meals. We don't have to eat until we're full (more on this later) if we're having a snack; we just want to ward off hunger for a few more hours until we can have a more substantial meal.

Sometimes, however, it's not convenient to eat as often as our bodies ask. That's why it's important to have foods that are more satisfying and have better "sticking" power. High fiber foods, such as vegetables, fruits, beans, and whole grains (like brown rice, quinoa, and sprouted whole wheat) are great options. Balance is also important. When choosing meals and snacks, aim to have some protein, fat, and carbohydrate to feel most satisfied until your next meal or snack. Organic apples (carbohydrate, fiber) with raw almond butter (protein, fat) or carrots (minimal carbohydrate) with hummus (carbohydrate, protein, and fat) are great snack options.

Another reason why recognizing hunger as the main driver for eating is because sometimes we eat when we're not hungry. This can happen when we're bored, stressed, upset, tired, or even happy. Sometimes we look at the clock and decide that it's time to eat, or perhaps we smell cookies baking in the oven and all of a sudden want food, even though we're not necessarily hungry. The main difference between intuitive eaters and everyone else is that hunger is almost always the drive for eating.

It may take some time to get used to eating when you feel true hunger instead of waiting until you're starving, but when you start practicing this technique, you may notice that you choose healthier choices and don't get too full after each meal. Similarly, if you're used to eating when you're bored or upset, it can be challenging to find substitutes for food. The most important thing is that you begin to recognize your motivation for eating. Ask yourself if you really are hungry, and if you are, what do you really want to eat? When you eat when you're hungry, you're honoring how your body is meant to work: when your blood sugar drops and all of your fuel is used up, you get hungry, and you eat. Sound simple? It can be...with a little practice!

In upcoming posts, I'll talk about three more principles of intuitive eating that I use with every client. I wish you happy, healthy eating - when you're hungry!