Dear Mark: First Trimester Frustration, Liver Dosage, and NY Times Barefoot Piece
Being pregnant is tough – or so I hear. You’re tasked with creating a child, with actually building an entire human being bit by bit from scratch. You have to carry that child, even as it grows to seven, eight, or even nine pounds or more inside your body. And all the while, your body seems to be rebelling against “what is best.” You want to eat the best food and get the right exercise and do all the right things, but what happens when your body fights you? What are you supposed to do when all you can stomach are mac and cheese and tortilla chips? For the first section, I try to help a woman in her first trimester with these issues. Next, I discuss the question of retinol overload from dietary liver, along with whether or not we need to worry about nutrient density in other organs, too. And finally, I give my take on a recent NY Times piece on barefoot running that seemed to call its usefulness and relevance into question.
Let’s go:
Mark,
I am in my first trimester and have read several of your posts on pregnancy. However, I am seriously struggling to maintain my primal/paleo lifestyle. I can barely stand the sight or smell of meat. I have been able to eat some vegetables and fruit. I have been primal/paleo for a year and love it! It seems though that my pregnant self does not love it. I am so concerned that I am not feeding my body and baby the best food as I have been giving into eating whatever I can manage to keep down. Many foods that sound appealing are foods from my childhood…mac and cheese for instance and tortilla chips. I worry that going away from primal/paleo will make this pregnancy more difficult and is not healthy for my baby. I continue to CrossFit 3-5 times per week, but not having enough good fuel has made that more difficult also. Being so putt off from meat, nuts and many vegetables is making this extremely difficult and I am at a loss as to how to handle this. I guess I am just concerned and would appreciate any words of advice you may have.
Sincerely,
Callie
First of all, don’t stress out about this! While nutrition is important during pregnancy, so is stress management. And not just for the health of the future baby, but also for your health, including your ability to cope with postpartum depression. So, you know, take walks, get massages, try out meditation or yoga, get your partner to give you foot and back rubs – that sort of thing. Besides, the first trimester is notoriously hard on a woman’s appetite. Things should improve as time goes on.
Make super smoothies. Invest in a good blender. Toss in some frozen fruit, ice, some milk (if you do dairy), juice, or coconut milk, some protein powder, a few egg yolks, an ounce or two of nuts, and a handful or two of leafy greens. The egg yolks will provide choline, folate, vitamin A, and healthy fat. The fruit will give you phytochemicals and vitamins. The milk will provide protein, fat, and minerals. The coconut milk will provide medium chain triglycerides. The protein powder will give you protein. The greens will provide folate and minerals. The fruit flavor should predominate, making it easier to get down. You can even toss in some fish oil without it really affecting the taste much.
Get a good prenatal. Prenatals are there to give you what you need in the (likely) event that eating healthy food is impossible or repulsive. Chris Kresser recommends Pure Encapsulations Nutrient 950 with vitamin K2. Whatever you get, make sure it contains folate, rather than folic acid.
Primalize your non-Primal foods. Let’s take your two examples – mac and cheese and tortilla chips. If mac and cheese are all you can eat, dress it up. Buy gluten free mac and cheese (usually made from rice). When you make the cheese sauce, add a few egg yolks (from a farm you trust) to the mix; you won’t even know the difference. See if you can’t handle adding some ground beef or a few ounces of baked salmon to the mac and cheese, or maybe even some chopped, steamed spinach. Get tortilla chips cooked in lard or a high-oleic seed oil. Check the nutrition label for a high monounsaturated fat content and a low polyunsaturated fat content. Instead of just eating salsa, make a nutritious dip for the chips, like guacamole. Add an egg yolk to your guacamole (trust me, it tastes good, especially if you make it from scratch).
Reduce the CrossFitting. Five times a week is too much, in my opinion, especially if you’re doing full-fledged 20-30 minute WODs. Reduce the intensity, the duration, and the volume. Stick to 2-3 workouts a week, focus on strength versus metcons, and do a lot of walking.
Eat high quality cheese as a snack. Since you’re loving mac and cheese, real cheese shouldn’t be too much of a stretch. Cheese is high in protein, fat, calcium (important for the baby’s growth), conjugated linoleic acid (if it’s grass fed, especially), and even vitamin K2 (if it’s grass-fed and aged). Pecorino romano is a nice aged choice that’s almost always made from grass-fed sheep’s milk.
Check out Chris Kresser’s guest post from a while back and focus on the foods he outlined. You may not be able to get all the “sacred fertility foods” down, but at least you’ll have something to work toward.
Dear Mark,
Liver is awesome. But how much is too much of a good thing?
Do other organs (kidneys/hearts/lungs/brains) present the same problems with regards to retinol or other vitamins?
Tyrone
We’ve all heard the stories about the hungry Arctic explorers who died from retinoid overdose after eating polar bear (or sled dog) liver, and almost every pregnant woman has been admonished by her doctor to avoid liver because the vitamin A can increase the risk of severe birth defects. And yes, it’s true: you shouldn’t eat polar bear liver because of the extreme retinol content and vitamin A supplementation has been linked to birth defects.
That said, polar bear liver is special; just a gram of it contains between 24,000 and 35,000 IUs of retinol. A gram of beef liver contains just 165 IUs. Lesson? Don’t eat polar bear liver.
As to the risk of birth defects from liver, that’s been overblown. Retinol from food does not have the same effect on the fetus as supplemental retinol, and even though a 1995 study proved this, “avoid liver” is still standard advice given to pregnant women. In the study, women received retinol in the form of fried calf liver, oral supplements, or intramuscular injections. Both types of supplemental retinol caused huge spikes in all-trans-retinoic acid, the primary teratogenic (causing malformations to the fetus) metabolite of retinol, while liver caused no such spikes. Levels of the birth defect metabolite were 20-times higher than baseline after supplementation.
We’ve also heard that “vitamin A causes osteoporosis.” But that’s an oversimplification that ignores the very real phenomenon of nutrient interactions. Our bodies didn’t evolve eating isolated supplements. They evolved eating whole foods, and, as Chris Masterjohn has shown, it appears that vitamin A only really becomes a problem for our skeletal health in a vitamin D-deficient state. Of course, most experts won’t ever speak with that kind of nuance, instead preferring the easy way out of making declarative statements about isolated compounds.
None of the other organs you listed contain comparable levels of retinol, but they, along with liver, are rich sources of copper and iron – two essential minerals that we need but can also overdo. Folks with iron overload disease should limit their organ intake, or at least keep an eye on their levels.
I’d stick to around a half pound to a pound of liver per week, max. A bit more if you’re eating non-ruminant liver, which is lower in retinol. Less if you’re also eating other organs (not because of the retinol, but because of the copper and potentially the iron).
Good on you for eating organs!
Thought I’d show this to you. Thoughts? I’m a barefoot runner of 3 years. I can run 30km easy. I can’t run 1 km in shoes without pain. Obviously I’m on team barefoot.
Myths of Running: Forefoot, Barefoot and Otherwise
Joshua
Ultimately, by defining the “best way to run” as that which allows the runner to “use the least energy and run the fastest,” I think they miss the main point of barefoot running: to reduce injury and prolong one’s ability to run and be active. Going barefoot isn’t really about being the fastest runner around. It’s about removing a barrier between the ground and your foot to heighten proprioceptive awareness and allow your body to make subconscious adjustments on the fly. Instead of having to consciously decide to adjust your gait to avoid injury, an experienced barefoot runner will do so more quickly and with less hesitation – since that barrier to awareness has been removed or reduced. And besides, there is evidence that running barefoot or minimalist improves running economy. Anyone who’s seen Barefoot Ted trotting along a trail can attest to this. And I’d assert that you when running barefoot you don’t have to run as far (or as fast) to get the intended strength and muscle development.
Although it’d be tough to put together a study that tested for this, I also think a big advantage to barefoot running is that it’s simply more enjoyable to experience the world that way. Our feet are remarkably attuned sensory organs, with nerve endings blanketing the bottoms of our feet, just begging to be used. Ram Dass once said “If you wear shoes, the whole world is covered in leather,” and I believe it. Feeling the grass between your toes, the sand beneath your feet, and yes, even the occasional sharp rock digging into your heel is an essential (but now missing) part of the human running (or walking) experience. You won’t find that aspect detailed in PubMed, but I think it’s pretty darn important all the same.
For some people, heel striking might be the fastest way to run and win races. I don’t care about that anymore, and I’ve never claimed that. All I know is that the heel strike is the improper way to land for the bare, natural human foot. So the fastest runners in the nation land on the heel, with the foot splayed out, with pigeon toes, and so on? Great. They’re fast in spite of their form. And the millions of people who read that article aren’t the fastest runners in the nation, nor are they getting paid to go out and run. They’re running to be healthier, and I worry that looking at what the professionals get away with is only going to open up the amateurs to injury and disappointment.
Thanks for reading, folks. Take care and Grok on!
Grab The Primal Blueprint Cookbook Today and Receive Free S&H and a Free Primal Blueprint Poster
Read more: http://www.marksdailyapple.com/how-to-prepare-for-barefooting/#ixzz2AMU9B91U
Posted By: Mark Sisson
Dangit, Mark. Wish you’d written this post back when I was still in my first trimester.
Also, where’d that poor lady’s belly button go???
During my 3 pregnancies, meat tasted to me like dog poop smells. Can you force yourself to eat dog poop? I sure can’t! But, I did need to eat, and often, in the first trimester, or I would throw up. Carbs from bread were ok, but what my body really craved was mashed potatoes and blue cheese. Bananas were okay, as long as there was not a single brown spot, then they smelled so bad I couldn’t eat them.
When pregnant, my sense of smell was much better the whole pregnancy – things that effected me not at all before could make me throw up. I was dehydrated for the first one, until I figured out how to keep liquids in. I did my absolute best to eat good foods (we had lots of elk and venison then) but it just couldn’t make it into my mouth. Fried or grilled zukes, though, now those were great!
WOW! Avoid liver? My mum (Aussie) was told by her doctor to eat liver once a week during pregnancy, and this was passed onto me in the 80s and 90s. I don’t know of any anti liver advice given to Australian mums to be? I could be wrong tho.
I spent the first six months of my three pregnancies in hospital for around 5 days out of each 14 days. I was so sick I could not stand it. I used to drug myself with antihistamines in order to sleep. Even sipping water to take those tiny pills would make me vomit. I used to vomit into a ice cream container to make sure the pill didn’t come up.. and if it did I’d take another. My doctor said if I was born in a different century I would have died. I lost weight with each pregnancy. My hair fell out, my skin was ruined, I looked like death warmed up. I ate literally nothing for months. I threw up bile til my throat bled. Morning sickness is quite possible the most disgusting nausea ever. I’ve suffered from sea sickness and air sickness and assorted other tummy things but NOTHING compares to pregnancy. As soon as I got to 7 months pregnant I ate anything and everything I could get my hands on. If carbs are all you can stomach I say eat them. It’s temporary. Be thankful we live in a society where you can get a dry cracker. The other option, starvation isn’t fun. My babies were all born full term and of healthy weight.
For the preggo mama, I always blend liver to a paste and then sneak it into my foods (like marinades, soups, etc). You can barely taste it, and it’s one of the most nutritious foods on earth.
Boy, can I ever sympathize with the first letter. I’m in my first trimester too (8 1/2 weeks) and I’m struggling to eat well. Something healthy will sound appealing, so I’ll buy it or make it, and I can eat two bites before it’s so awful I can’t bear the sight of it anymore. Thanks to Mark and all the commenters for the tips and sympathy. Smoothies and full-fat dairy definitely sound appealing (though gosh knows how long that’ll last).
If you are experiencing morning sickness, please read this:
http://wellnessmama.com/6065/how-i-avoided-morning-sickness/
I’m preggo with my 4th, and this is the first time I have not been hugging the toilet bowl every morning. Perhaps I had a magnesium deficiency?
I was doing all she suggested from even before I got pregnant with the exception of very little bone broth and less CLO. It didn’t help here.
The best thing you can do while pregnant is get your sleep and even that’s not always possible.
When I was pregnant, my midwife told me that when you are craving sugar/carbs, your body neeeeeds more protein – get it however you can. If meat is gross, there are lots of other protein options! She also told me if you are craving chocolate, then your body is crying out for more calcium. For what it’s worth! I’ve been through 6 pregnancies (4 full, 2 miscarriages partway through), so I’ve run the gamut of morning/noon/night sickness. The smell of chicken made me want to vomit my first pregnancy, but didn’t bother me during any of the others. Most of the time, nut butters and eggs were my proteins of choice.
I wanted to say a very special THANK YOU for writing this article Mark.
I had spent several months getting rid of processed foods, then several months going low carb, until I went more primal. I had great success too, until something changed. I went two months before realising I was pregnant.
That was two months I had turned off my successful primal eating habits, and wanted only carbs and sugar, without realising the cause.
Reading in the comments, about how other women feel nauseous in regards to primal foods too (craving carbs instead) made me feel “normal”. I gave myself a hard time, believing I had caved back into the lifestyle which had previously made me sick.
Now I realise, my body had it’s own programing it had to stick to after millions of years of evolution. So thanks for airing the subject!
Ugh, huge sympathies. I got pregnant in June having been primal (and feeling amazing)for just 4 months. Did great for the first couple of weeks then the food aversions kicked in and I totally went off meat, eggs and veg. Could manage some fruit but basically existed for 4 months on rice krispies, toast and ginger ale. So not primal. I’m 3rd tri now and things are improving but I can still take or leave meat and can’t face veggies. Did manage a scrambled egg the other day. I need to get back off the gluten for the sake of my digestive system but still really struggling at the moment, once pregnancy is over and breastfeeding established I’ll be back onto primal living for sure!
Ugh… Pregnancy aversions…. I had them really badly with my first pregnancy pre-primal, and was hoping to avoid this this time around due to a better diet, but so far, it’s not going great. I was really glad to have Mark’s “blessing” to just do the best you can. I’ve been experimenting with healthy carb-like baking and wonder if Callie might find some recipes she could tolerate in the same vein: think almond flour “focaccia”, coconut flour muffins and breads, etc. This morning, I ate some leftover pumpkin bars (a recent recipe on Elana’s Pantry) and I think that was not too bad a breakfast for my queasy tummy: with pumpkin, eggs, coconut oil, etc., it was filling and full of good nutrition, too, but felt like I was eating cake!!
Good luck, Callie, I know how hard it is!!
I just have to put it down here that raw egg yolks are a big no no for pregnant women! I’m all about the green smoothies but if protein intake is your issue look into protein powder or maybe silken tofu but no raw egg! (I’m in my 1rst tri for baby #2)