Before we get into today’s post, I’d just like to say that I am shocked this blog is still getting a regular number of hits despite my sporadic posting. My intention was to update once a week but alas, life is getting in the way. So for all of you who are reading: thank you!
A topic many women want to know more about, but of which there is shockingly little written, is the best diet for pregnancy. In this post we are going to look at the differences and similarities between the current conventional wisdom on this topic, and the paleo or ancestral advice given for pregnant women.
Mum-to-be’s want to ensure they are giving their little ones the best start in life, and that begins before your baby is even conceived. Most sources will tell you that a woman should adopt a healthy diet no less than 6 months prior to conception. We know not all women get this chance; some pregnancies are a surprise and mum may not have been eating particularly well in the time before this. Conversely, if you are thinking of, or trying to conceive it is never too soon to get healthy. Don’t think you have to wait until a certain point to get serious about nutrition. In actuality, sooner is better because the healthier you are, the better you are likely to feel and the smoother your pregnancy and labour is likely to go.
I adopted a paleo lifestyle 18 months before I got pregnant and it has helped me tremendously. The changes I’ve made directly led to me conceiving. I say this with confidence because for 3 years prior to the switch, I had unexplained infertility. This means that although doctors, gynaecologists, and reproductive endocrinologists tested me for everything, and in every way they could (including an exploratory surgery to look at my reproductive organs), they could find no explanation for why I wasn’t getting pregnant. Having always wanted a family, it was a painful time for me both physically and emotionally. I quickly realized that if I were to ever have children (without using the IVF offered to me), I was going to have to fix myself. This is what initially spurred my quest for health, and subsequently led me to the paleo lifestyle.
Please note that an optimal pregnancy diet is not too different from an optimal diet in general. The foods that constitute a healthy paleo diet are the same for everyone. Pregnant women may just need more of certain nutrients, such as vitamins A and E.
If we listen to advice given by the pinnacle of mainstream conventional wisdom, the NHS, it would seem the best thing for a mother-to-be is a large number of ‘healthy whole grains’ along with plenty of beans, fruit, vegetables, and some protein and dairy, with small amounts of sugar and fat. While there is some overlapping advice, a paleo pregnancy diet is very different to this. I’ll first list the NHS recommendations, and then we’ll explore the paleo option.
1. Carbohydrates: The NHS advises pregnant women to get plenty of starchy carbohydrates which should ‘be the main part of every meal.’ They say: “Starchy foods are an important source of vitamins and fibre, and are satisfying without containing too many calories. They include bread, potatoes, breakfast cereals, rice, pasta, noodles, maize, millet, oats, sweet potatoes, yams and cornmeal. These foods should be the main part of every meal. Eat wholemeal instead of processed (white) varieties when you can.”
This is the biggest difference between what the mainstream believes and what proponents of a paleo lifestyle believe. Grains are unhealthy and unnecessary. The vitamins and fibre you supposedly glean from grains you can find in other foods; namely fresh fruit and vegetables. Nutrients are also more bio-available in these other foods, meaning your body has an easier time absorbing and using them. Grains have nothing beneficial in them that you cannot find from a better, cleaner source. Most mainstream nutritionists will tell you that grains are necessary and healthy because they contain B vitamins, vitamin E, and fibre. However, grains also contain anti-nutrients in the form of lectins, gluten, and phytates. To read why these substances are harmful and best avoided, check out the explanation by Mark Sisson, creator of Mark’s Daily Apple, of why grains are unhealthy. Also, f you’ve heard the mainstream advice that carbohydrates are the best antidote for morning sickness, check out this post from Peggy the Primal Parent, who has a different take on things.
If you are worried about getting enough B-complex vitamins, they are found in meat, liver, eggs, and vegetables. Liver is a rich source of B-vitamins including folate, and contrary to popular belief, liver is not dangerous during pregnancy. That myth was born from a now widely-discredited study that focused on synthetic vitamin A toxicity during pregnancy. Also, it is extremely hard to overdose on naturally-occurring vitamin A, especially in the presence of adequate vitamin D intake. A word on folate: This is different to folic acid, which all midwives will advise you to take prior to conception and during pregnancy. Folate is the naturally-occurring version of folic acid, whereas folic acid is a supplemental form of folate. To read an excellent article distinguishing the two, and why it is important to do so, see Chris Kresser’s explanation.
Vitamin E is found in palm oil, olive oil, avocado oil, and almond oil. Palm oil is the most concentrated source of vitamin E. Sunflower seeds, almonds, and pine nuts are also good sources. Lack of vitamin E may inhibit the ability to conceive. Inadequate levels of this vitamin (along with vitamin A) may also cause longer gestation than normal and a failure to lactate.
I get asked about fibre a lot. People wonder if I don’t eat grains, where do I get fibre from? Fruits and vegetables have plenty of fibre in them. If you are interested in comparing the fibre content of fresh produce to that of grains, go to a site where you can look up the nutritional content of food, such as Paleo Track.
2. Fruits and vegetables: “Eat plenty of fruit and vegetables because these provide vitamins and minerals, as well as fibre, which helps digestion and prevents constipation. Eat at least five portions of fruit and vegetables a day – these can be fresh, frozen, canned, dried or juiced.”
In regards to this advice, there isn’t much difference between mainstream and paleo. It’s generally accepted that fruits and vegetables are good for you, contain a lot of important nutrients, and are very healthy for both mum and baby. The main difference is that from a paleo perspective canned, dried, or juiced versions are not considered optimal. Canned food has had the nutrients leached out of it, and many cans contain BPA and other harmful chemicals which get into the food, and thus into your body (and your baby). I would advise avoiding tinned food if you can help it. Fresh versions are always the best, but flash-frozen is a good substitute if fresh isn’t an option for you. You can also buy fresh produce while it’s in season and then can it, or cook and freeze it, to use later.
If we look at what types of nutrients fruits and vegetables provide us, we find leafy green vegetables are a good source of folate, strawberries and seaweed contain iodine, and kale, strawberries, citrus, peppers, broccoli, and cauliflower all contain vitamin C. You can also get vitamin B6 from bananas. By eating a varied and colorful array of fruits and vegetables, you should be getting plenty of vitamins and minerals that you and baby need.
I want to specifically mention vitamin A: it is very important both before conception and during pregnancy. Inadequate levels of vitamin A in utero can cause severe sight impairment or blindness, hearing impairments, dental arch deformities or cleft palates, club foot, longer gestation periods than is normal, long and difficult labour, and failure to lactate. Lack of vitamin A is also associated with poor mental health and disposition. Although liver is the richest source of vitamin A, you can also get it from vegetables like sweet potatoes, carrots, butternut squash, and dark leafy greens such as kale.
3. Protein: “Sources of protein include meat (but avoid liver), fish, poultry, eggs, beans, pulses and nuts. Eat some protein every day. Choose lean meat, remove the skin from poultry, and cook it using only a little fat. Make sure eggs, poultry, pork, burgers and sausages are cooked all the way through. Check that there is no pink meat, and that juices have no pink or red in them. Try to eat two portions of fish a week, one of which should be oily fish such as sardines or mackerel.”
The first thing I have to do is set the record straight on liver once again; it is truly nature’s multivitamin and one of the best foods you can possibly eat, pregnant or otherwise. A few ounces per week would contribute a lot toward a healthy diet during pregnancy. Beans and pulses are not eaten within a paleo framework, for much the same reason grains are not eaten. They contain anti-nutrients and don’t provide anything you can’t get from other sources. Nuts are full of good fats and moderate protein, but because they also contain high amounts of Omega-6 fatty acids which are inflammatory, I would not recommend eating a lot of them.
The best sources of protein are organic, grass-fed, and/or pastured meat and eggs, and wild fish/seafood. I would echo the sentiment above that pregnant women should eat protein every day, and go further to add protein should be eaten at most meals. Meat and eggs contain vitamins A, B6, B12, D, K2, zinc, folate, and iron. The best sources of these are liver and egg yolks. Egg yolks also contain a very important nutrient for pregnant women called choline. To read more about choline, see Chris Masterjohn’s posts about it on his Daily Lipid blog.
Where the advice between mainstream and paleo differs drastically is when mainstream advises choosing only lean meats and avoiding the skin. There is no good reason to do this. Saturated fat from natural sources like animals is fantastic for you and baby. Eat fatty meat and chicken skin without worry. You need saturated fat and these are great sources. This is a hard pill for many people to swallow, because it is drilled into us that Fat is Bad! It’s actually the biggest food lie we get fed, aside from the lies about ‘healthy whole grains.’ To read more about saturated fat, see Mark’s Definitive Guide To Saturated Fat.
I would like to mention that there is not necessarily a need to thoroughly cook all meat and eggs. Runny yolks, rare steak, and sushi can all be part of a healthy pregnancy diet. The source of your food is vital though. For example, I buy my meat from a local organic farm and I am confident in their products. I will eat their meat raw or undercooked. I buy the best eggs I can find and I eat runny yolks. If I were eating feed-lot meat or eggs from caged hens fed a poor diet, I would not do this. As an added safety measure with meat or fish, you can freeze it for a minimum of 2 weeks to kill off any pathogens, and then eat it raw when it thaws. I know many pregnant women would not feel comfortable doing this, which is perfectly fine. But for those who want to, just know it is not inherently unsafe, especially if you choose quality sources.
I have not given suggestions for vegetarian protein sources as I personally do not believe that vegetarian diets are healthy. I would like to borrow a quote from Dr. Weston A. Price on this topic which sums up my feelings: “It is significant that I have as yet found no group that was building and maintaining good bodies exclusively on plant foods. A number of groups are endeavoring to do so with marked evidence of failure.”
4. Dairy: “Dairy foods such as milk, cheese, fromage frais and yoghurt are important because they contain calcium and other nutrients that your baby needs. Choose low-fat varieties wherever possible.”
It really frustrates me that the NHS are telling pregnant women to eat low-fat foods. Fat is necessary for life; you cannot live without it. Fat also does not make you fat. Cholesterol does not cause heart disease, and in fact is so vital that our bodies produce it so that we never run out. There is never a good reason to choose a low-fat version of anything.
Dairy is a food that sits on the fence in the paleo/primal world. Strict paleo followers will eschew dairy, but many primal people think dairy is okay in moderation. I personally think it’s okay to eat if your body responds well to it, and as ever the source is important. Grass-fed, organic, raw dairy is the healthiest kind you can eat. (For those in the UK, Red23 sells raw dairy online, delivered to your door.) If you don’t have access to raw dairy, organic pasteurized versions are the next best thing. The best quality dairy contains high levels of vitamins A, D, and K2. Weston A. Price talks a lot about this particular set of vitamins in his book, Nutrition and Physical Degeneration.
Although dairy does provide vitamins and calcium it is not necessary for a healthy diet. If you want to avoid dairy but are concerned about getting enough calcium, why not drink calcium-rich bone broth? Peggy the Primal Parent has a great post on getting enough calcium while being pregnant and dairy-free.
5. Sugar and Fat: “This includes all spreading fats (such as butter), oils, salad dressings, cream, chocolate, crisps, biscuits, pastries, ice cream, cake, puddings and fizzy drinks. You should eat only a small amount of these foods. Sugar contains calories without providing any other nutrients, and can contribute to weight gain, obesity and tooth decay. Fat is very high in calories, and eating more fatty foods is likely to make you put on weight. Having too much saturated fat can increase the amount of cholesterol in the blood, which increases the chance of developing heart disease. Try to cut down on saturated fat, and have foods rich in unsaturated fat instead.”
Let us make an important distinction right now: sugar and fat are not on par with one another in the nutritional stakes. Not. Even. Close. It’s common for conventional wisdom to demonize both, but fat gets an undeserved bad rap. Once again I will say: Fat does not make you fat. Cholesterol does not cause heart disease. Sugar, on the other hand, is a toxic substance that provides no essential nutrients. You and baby are far better off without sugar.
The above advice from the NHS seems to lump together unrelated foods. Butter, cream and oils are all natural foods that have their place in a healthy pregnancy diet. (There is one unhealthy oil however; vegetable or canola oil is inflammatory crap in a bottle. No one, pregnant or otherwise, should be eating that stuff.)
The salad dressings, margarine, chocolate, crisps, biscuits, pastries, ice cream, cake, pudding, and fizzy drinks they mention are all heavily processed foods and are devoid of nutrition. They recommend eating only a small amount of these foods, but I would suggest that you try to eliminate them altogether. They don’t provide anything we need, but they do harm us.
Although our cultural and societal take on pregnancy seems to be that it’s a chance for a woman to eat whatever she wants in any quantity now that she’s ‘eating for two’, I think we need to remind ourselves that these 10 months are actually about growing a person. It’s pretty selfish to use that as an excuse to eat a bunch of crap. Our babies deserve plenty of body-building nutrients instead of foods that are going to harm them. The only difference between sipping a cocktail or smoking a cigarette during pregnancy, and eating a poor diet full of processed and fast foods and fizzy drinks during pregnancy is that the latter is socially-approved. All of those things have a negative impact on our babies and ourselves.
That being said, I don’t think a woman should feel too guilty for eating a less-than-optimal treat once in awhile. Pregnancy is a hard time for us physically and emotionally, and while eating a nutrient-dense diet will help ease that, it’s only natural to occasionally want comfort food. As long as it remains a rare treat, those foods are not going to have a massive negative impact on you or baby during pregnancy.
To summarize the perfect pregnancy diet; eat fresh fruits and vegetables, fresh meat, eggs, and seafood, and good quality dairy. The quality of food during this time is especially important, as organic versions contain fewer pesticides, antibiotics, and other nasty ingredients we don’t want our babies receiving. It’s also important to stay hydrated during pregnancy so drink plenty of fresh filtered water. Some herbal teas are great for pregnant women as well. I recommend nettle, peppermint, ginger, lemon, rooibos, or red raspberry leaf (in the 3rd trimester only).
Avoid grains, beans, pulses, processed foods, and any fizzy drinks or drinks that contain added sugar. I know it may be hard, especially when you are slogging through weeks of morning sickness, poor quality sleep, and low energy, but the better your diet the better you will feel and the healthier your little one will be.
I feel pregnant women do not need a prenatal vitamin if their diets are nutrient-dense, and most prenatals include poor-quality versions of nutrients (such as folic acid, not folate). However, I would recommend a select few supplements during pregnancy. The #1 supplement that I would suggest is Green Pastures Blue Ice Royal Blend which is a blend of fermented cod liver oil and high-vitamin butter oil. It is high in vitamins A, D, and K2 and is based on Weston A. Price’s original formula. I would also recommend a vitamin D3 supplement if you think you may not be getting adequate amounts. I don’t get much sunlight where I live so it is impossible for me to make adequate amounts. I like NOW! Foods brand 5000IU capsules. I don’t take them daily, but I might take a few per week to top up the amount I get from food. Finally, if your midwife advises you to take an iron supplement during pregnancy, in my opinion the best one is Floradix Floravital liquid iron supplement. It’s gluten-free, easier for your body to absorb, and has no unpleasant side effects (unlike the typical iron tablets which are known to cause constipation).
Pregnancy can be a difficult time for us physically and emotionally, but if you feed your body a nutrient-dense diet you and your baby will reap the rewards. The far-reaching effects of nutrition in the womb are still not fully realised by many people, but it is vitally important to give your body and your baby the best food you can during this time.