Nutrition in the First Trimester

We are so excited to be expecting our first baby around January 22nd, 2013!  

It's amazing how quickly my pregnancy has gone already now that I'm almost 16 weeks, and yet when I think back to the first trimester, I remember how long the nausea-filled days seemed then.   I wanted to share how I coped through the first 3 months, having had learned a considerable amount through personal trial and error.  I wrote a more comprehensive post about preparing for pregnancy that talks about the importance of certain nutrients if you want to check out here.  (By the way, this was the most popular post of all time on my blog.  I think babies are on the brain for lots of people!)

First, I'll start with the supplements I'm taking.  The Prepping for Pregnancy post explain why each are so important:

3 Seroyal Pregna Vite (1 with each meal) - I also recommend Thorne Basic Prenatal and Innate Response Baby and Me Trimester I and II, but I personally tolerate Pregna Vite best

2 Nordic Naturals ProDHA Strawberry

1 Seroyal HMF Forte probiotic

2-4 Protocol Calcium/Magnesium/Vitamin D

Make it a point to look at the label of your prenatal vitamin.  Just because it's a prescription product or provided in a sample bag from your doc doesn't mean it is free of artificial dyes, hydrogenated oils, and other additives.  I recommend the products listed above because the are free from all of that yuckiness.

I am pretty vitamin D deficient again, despite having had bumped my serum levels to an optimal 57 ng/mL last year, so I also take some extra vitamin D a few times a week.

Let's review what you (unfortunately) should avoid during pregnancy:

- Deli meats, unless they're heated to 165 internally - they may be contaminated with the listeria bacterium, and pregnant women are 20 times more likely to contract it than others

- Imported soft cheeses and unpasteurized cheese - again, potential listeria risk; I eat soft cheese if I know it's pasteurized and made domestically (and most feta and goat cheese is)

- High mercury shellfish and raw fish - avoid shark, king mackerel, and tile fish, and unfortunately most sushi is out.  On the bright side, eel is considered lower in mercury, so I get cooked eel rolls when I go out for sushi.  Eat up to 12 ounces of low mercury fish per week, such as wild salmon and chunk light tuna.

- Alcohol - there's always some debate on this, but I would hate to wonder whether my drinking alcohol caused something down the road.  I have had a sip of really good wine just to get some of its flavor, but I doubt I'd ever have an entire drink until after the little one is born.  If I really want a drink at a bar, I get a mixed juice "mocktail."

- Artificial sweeteners - this one is my own recommendations, but I think it's extremely important.  Try to kick the diet soda habit, since your teeny, vulnerable baby is also receiving these chemicals.

- Caffeine - you can still do up to 200 mg, but I avoid it all together because it's a stimulant and diuretic.  (Yup, bummer.)

For more on what to avoid, check out this site by the American Pregnancy Association.

First trimester can be hard for women because they may experience nausea, vomiting, food aversions, and sensitivity to smell, all at a time where most people are still trying to not share the news of their pregnancy just yet.  Some don't have very many issues, while others require medical intervention just to get through the first stage of pregnancy.

I personally had a heck of a time with nausea and was pretty uncomfortable from weeks 5 through 13 or 14, but fortunately I could keep most food down.  I did become extremely particular about what I wanted to eat.  Imagine what you feel like when you're sick: you only want certain foods, and most things still you even nauseous, although slightly better than you felt before eating.  

Here are some things I personally found helpful:

- Not getting too hungry.  I ate something every 2-3 hours and often split up my lunch into two separate meals.  I also tried not to eat too much at once, since this made the nausea even worse.  My stash at work:

- Eating protein with breakfast and each snack.  Even though I wasn't quite craving a hard boiled egg or string cheese when my stomach was churning, I felt so much better when I had protein-rich foods. With that being said, I always had saltines from Whole Foods (they don't have partially hydrogenated oils like the name brand ones do) in my desk and purse.

- Ginger, ginger, GINGER!  Candied ginger, ginger chews, and ginger tea were life savers until I realized that I could add some "oomph" with ginger extract supplements.  I took one with each meal after it was cleared by my OB office, and it was an immense help.

- Preggie Pop Drops.  I didn't actually give these a try until I was 10 or 11 weeks along, but their vitamin B6 and essential oil blend really helped.  I bought mine at Buybuy Baby, where I will eventually register.

- Lemons.  I would slice them up and sniff or even suck on them at work.  They really seemed to help cut through the nausea between snacks.  Bonus: when I smelled something strong, such as steamed mussels at a seafood restaurant, I would try to smell the lemon in my water.

- Experimenting with different types of foods.  You'll never know what you will crave, so be open minded to trying new things.  I drank pickle juice (seriously) and craved bagels, eggs, and garbanzo beans.  As long as it's safe for you to eat, just go with it.  The nausea hopefully won't last forever, and it's important to get nutrients into your system.

- ACUPUNCTURE.  By far, more than anything, acupuncture helped me the most.  I didn't figure this out until 9 or 10 weeks, and I was so mad that I waited that long to try it for nausea!  I'm a huge proponent of this ancient Asian healing modality, and it made a world of difference.  I go to Joshuah Kim at Holy Hill Acupuncture.  He was my best friend for weeks.

As much as I wanted to drink green juices and eat as wholesomely as possible for the sake of my baby, I couldn't stomach the thought of certain favorite healthy foods.  My normal rice protein shakes sounded horrible, and some nights all I wanted was Pad Thai from Ling and Louie's.  I still don't like certain foods because they remind me of the time I was so nauseous (white fish and homemade Twix bars come to mind), but I'm eating much more normally and with very few symptoms now.  However, don't freak out if you can only eat toast with butter and scrambled eggs for a few weeks.  It will soon pass, and it's much better than forcing down food that won't stay put.

A word about weight: 

In the first trimester, caloric needs really don't increase, although I found myself eating much more often than normal due to the nausea.  Practitioners recommend gaining 0-5 pounds those first 3 months.  I personally gained about 4 or 5, but I'm not freaking out about my weight.  I normally never weigh myself but did invest in a scale so I can check it out once a week.  I mainly want to make sure I don't have a very sudden weight increase, which could be indicative of preeclampsia.  As of now, I'm tracking at about 1 pound a week weight gain and at this rate will gain approximately 30 pounds.  For those who start with a normal BMI pre-pregnancy, 25-35 is the target range.  However, if I gain more, I'm not going to worry.  I trust my body to tell me what it needs, gain the weight it should, and grow and expand like it will.  It's exciting to know that my body can create life, and that's so much more important than still fitting in my jeans.

About fertility:

 

Every woman's body is very different, and your genetics, physiology, environment, intake, and stress levels all influence your chances of getting pregnant.  We were very fortunate to conceive right away, and I do think that although I have really strong genetics in this area, I also tried to prep my body as best as possible for success.  Here's what I think helps:

- Acupuncture.  Again, it's a godsend.  I did it once a week the month before we started trying and every other week once we did.  It took about 5 weeks to get pregnant, and I contribute this mainly to acupuncture.

- Omega-3s and conjugated linoleic acid.  I took fish oil, ate clean fish and flaxseeds/chia/walnuts/hemp for omega-3s, plus organic pasture butter and grass-fed beef for CLA.  Omega-3s are critical for brain development, and CLAs have been found to help with fertility.

- Maintain an optimal weight.  I purposefully gained a few pounds to ensure regular cycles, since I have a history of being very sensitive to irregularity when my weight is slightly lower.  Once I hit a certain weight (literally 2 or 3 pounds up), I was on a 28-day plan.  If you have problems with your periods, check with your provider to see if you are at the right weight for you.

- Manage stress.  I am the last person to say I'm great at stress management, but I have been very conscientious about sleeping enough, breathing deeply, and laying around doing nothing.  Again, acupuncture really helps with stress too.

If you find that you need help with the first trimester or any point of your pregnancy or pregnancy-planning, let me know.  I love working with women at this stage of their life because they're so excited and motivated to be the best mamas they can, and now I have a few personal tips and tidbits to help them even more!

How did you survive the first trimester?

*M*

Black Bean and Salmon Tostadas

I love any chance to make healthy, tasty Mexican-inspired food. This recipe stood out to me because it uses both salmon and avocado, which are good sources of healthy fats, and is relatively inexpensive. While I don't like using a lot of canned products because can linings can contain BPA, sometimes canned foods help when you don't have a lot of time or energy and are OK when not utilized regularly. This recipe, found at one of my favorite websites, can be seen here.

A few considerations:

- I personally don't like jalapenos (and forgot to buy them!), so I used a bit of cayenne pepper and/or Cholula to add a bit of zip.

- Instead of microwaving, which I try to avoid altogether, I heated up the black bean mixture on the stove in a saucepan. It took about 4 minutes.

- Instead of corn tortillas, which my husband doesn't like, I used organic whole spelt tortillas. If you use corn, make sure it's organic so you're avoiding genetically modified corn.

- The cabbage, avocados, lime, and scallions are all from the North Scottsdale Farmers Market.

- I made extra of the salmon mixture and cabbage so I could have leftovers (and add extra veggies!).

Black Bean Salmon Tostadas

4 servings, 2 tostadas each

Ingredients

- 8 6-inch corn tortillas

- Olive oil cooking spray

- 1 6-7 ounce can boneless, skinless wild Alaskan salmon, drained (I used 2 5-ounce cans that had bones, and these bones, while not noticeable, added calcium!)

- 1 avocado, diced

- 2 cups coleslaw mix or shredded cabbage (shred your own if you can!)

- 2 T chopped cilantro

- 1 15-ounce can black beans, rinsed

- 3 tablespoons reduced-fat sour cream (I used organic regular sour cream)

- 2 tablespoons prepared salsa (I used 1/2 cup pico de gallo - more veggies!)

- 2 scallions, chopped

- Lime wedges (optional)

Here are most of the ingredients:

Instructions

Position racks in upper and lower thirds of the oven; preheat to 375 degrees. Coat tortillas on both side with cooking spray.

Place on 2 baking sheets. Bake, turning once, until light brown, 12-14 minutes. I only made 3 tortillas because I knew we wouldn't be able to eat 4 (2 each).

Combine salmon, avocado, and jalapenos (or cayenne pepper) in a bowl.

Combine cabbage, cilantro and the pickling juice (or Cholula) in another bowl.

Process black beans, sour cream, salsa and scallions in a food processor until smooth.

Heat on the stove (instead of a microwave) until warm.

Here's what my little assembly line looked like:

To assemble tostadas, spread each tortilla with some bean mixture.

Top with the salmon mixture.

Add the cabbage salad and serve with lime wedges.

It was really filling and light, not heavy and dense like a lot of traditional tostadas. Enjoy!

*M*

Should You Take Fish Oils?

As promised, here is some more information on omega-3 fatty acids. I am a guest blogger on Get In Shape Arizona, a blog for EduFit Personal Training Studio, so please go to their site here to read more about these amazing - and essential - fats! Learn what they are, where you get them, and whether or not you should take them. Of course, talk to your doctor before starting a supplement regimen.

Additionally, please remember that while walnuts and flaxseeds have omega-3's, they are in a form that is not fully converted to EPA and DHA, the two essential omega-3 fatty acids. This does not mean that we should avoid walnuts and flaxseeds; recent studies suggest they still have great heart promoting benefits. The take home message is that fish and nuts, as long as you're not allergic to them, are both important parts of our diet. If you don't eat fish, then fish oil supplementation is recommended.

I personally take two fish oil supplements: Carlson Labs Norwegian Cod Liver Oil and Carlson's Very Finest Fish Oil, both of which can be purchased on Amazon.

I take 1 teaspoon of the cod liver oil with food in the morning. It tastes like lemon and doesn't have a fishy aftertaste. It also has vitamins D and A, along with essential fatty acids DHA and EPA.



I also take 2 capsules of Carlson's Very Finest Fish Oil, which is orange flavored, in the morning or at night with food. Both supplements together provide about 2,000 mg omega-3 fatty acids per day.

If you take any supplement, I highly recommend good quality fish oils and cod liver oil, such as Carlson's or Nordic Naturals. I personally aim to eat fatty fish 2-3 times per week and eat walnuts, flaxseeds, or almonds on a daily basis. These fish oil supplements help me cover my bases when I can't seem to get in enough wild salmon or mackerel.

*M*

Sablefish BBQ

I bought wild Alaskan sablefish (also known as black cod, though it's not technically cod) at the North Scottsdale Farmers Market on Saturday from Alaskan Pride Seafood. Sablefish is a very good source of omega-3 fatty acids. Omega-3 fatty acids have been highly publicized for their anti-inflammatory, disease preventing effects, and I will post later on them this week. Sablefish has about 2 grams (2,000 mg) of these super fats per serving, which is the same as taking 4 high quality fish oil pills. This is up to 50% more omega-3's per serving than salmon! I like purchasing fish from this vendor at the market because they use sustainable fishing practices, avoid farming, and offer fish that's lower in PCBs and mercury than conventional versions.

Because of its high oil content, sablefish has a buttery, rich taste and is highly prized in the Japanese fish market. It's about $20 per pound at the market, which is cheaper than wild Alaskan salmon. Since it is very flavorful on its own, I only seasoned it with sea salt and pepper.

My husband, the grill master, BBQ'd the fish, marinated portobello mushrooms, and pesticide-free corn (all purchased at the market). I prepared a quick salad of greens, heirloom tomatoes, onions, cucumbers, and goat cheese. The tomatoes were grown in a French-inspired garden only 1 mile south of the market, and they were spectacular!

Delicious sablefish, thawed in the refrigerator:

Whole corn, pre-peeled:

Post peeling and cleaning:

Portobello mushrooms, marinated in organic cold-pressed olive oil from Queen Creek, sea salt, black pepper, garlic powder, and oregano:

Salad prior to goat cheese and dressing:

The fish is really easy. Place it on aluminum foil skin side down and season with sea salt and black pepper:

Place the fish and veggies on the grill and close the lid for 5 minutes:

You will know that the fish is ready to be turned when you can slide a spatula between the flesh and the skin and it peels off easily:

You might need a few utensils to flip the fish entirely:

You can simply turn the fish over, place it on the skin, and cook for another 2 minutes. This is what it all looked like when Greg brought it inside:

And here's the finished plate:

It was absolutely spectacular! The fish is pretty rich, so I could only finish half of it. The rest will be great atop a big salad for lunch this week.

*M*