Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
7 Jan

Dear Mark: Pregnancy Diet Tips for Inquiring Minds

peggers2It’s been a good long while since I opened up the proverbial mail bag. Maybe it’s resolutions for the New Year or the extra time off everyone’s had the last week or so, but my inbox has been working overtime with your questions and comments. They’ve run the gamut—questions about everything from herbal supplements to strength training tips to farm policy.

As always, thank you for your thoughts and questions—and, of course, for reading. I try to answer as many messages as I can, but know that the good folks in the forum community offer great perspectives as well.

This week’s round is for all the expectant moms (and dads) in the MDA community. However many of you fall into this category, I’ve received a string of inquiries lately from the expectant set. Congrats, and here you go!

Dear Mark,

I’m expecting my first baby and would like to make sure I eat the best diet possible. I like your perspective on food and am wondering if there’s anything special to keep in mind.

Thanks, and let me first say that my comments shouldn’t stand in for the professional advice of your doctor or midwife. (He or she should know details of your medical and pregnancy history that I wouldn’t be privy to.) Nonetheless, I know pregnant women are more often than not, with the exception of a prenatal vitamin, advised to follow the standard diet that the establishment suggests for all of us. (And, yes, you all know how I feel about that pyramid of hooey.)

In essence, I’d suggest that the evolutionarily-based Primal Blueprint diet I regularly propose applies to expectants moms too: lean, clean protein, wreckless amounts of veggies, a wide variety of fruit, healthy fats like olive oil and avocado, and the optional addition of useful, true whole grains like quinoa. Cut out processed foods, and go organic whenever possible. Cells are dividing and systems are developing so quickly for your baby that there’s more reason than ever for you to avoid those extra antibiotics, hormones, chemical additives and pesticides.

A prenatal vitamin is a good start, but (as always) get as many nutrients as possible from real food. Remember that you need twice as much iron as you normally do, and you’ll very likely need more fiber in your diet to counteract the, ahem, constipation associated with that extra iron. (Remember, I’m just the messenger!)

I’d also limit caffeine well below the 4 cups a day found to be safe in that Danish study a few years ago. It’s definitely one of those times in life when you don’t want to take a chance.

To this, I’d add the absolute necessity of omega-3 rich fish or fish oil. The FDA has danced around this issue like a horse around fire, but even they recently settled on a recommendation of regular (but limited) fish servings for prenatal development despite contaminant fears.

I believe those fears (e.g. of mercury, PCBs, etc.) are well founded, but fetal development requires these fatty acids, and there’s much you can do to limit exposure to contaminants. For example, forget farmed fish, as I’ve said many a time in the past. The feed and farming conditions are miserable. Go for wild, fatty fish like wild salmon and sardines. Likewise, look for omega 3 supplements that are purified. One last note: flax seed and flax oil are sometimes touted as a vegetarian alternative, but flax and other plant sources (with the exception of certain algaes—more on this later), don’t contain DHA, and not enough of their ALA is converted to DHA to make it an acceptable alternative to fish or fish oil.

One last thing, the American Academy of Pediatrics very recently revised their suggestion that women avoid common infant allergy associated foods during pregnancy. So, feel free to go for that nut butter, but I’d still choose almond over peanut.

Dear Mark,

I’m usually a total veg-head, but since my second month of pregnancy, I can’t stand to even look at a salad or veggie plate!

I can’t claim personal experience here, but I understand from very close and credible female sources that this is all too common. There’s a theory that this sort of aversion keeps the fetus safe at a key point in development from the naturally occurring pesticides in vegetables. I don’t present this as my thinking. Perhaps there’s some evolutionary kernel of truth there, or perhaps it’s as random as the proverbial ice cream and pickles craving. Though it’s a common aversion, it’s nowhere near a universal experience.

Be confident that you’ll be back to your broccoli in no time. These kinds of aversions, like their craving counterparts, typically don’t last long. In the meantime, raid the fruit side of the produce aisle. You might also look up some recipes for cooked vegetables. I’ve been told that cooked veggies often don’t register so strongly on the revulsion spectrum.

Dear Mark,

My wife is 5 months pregnant and eating the most bizarre food combinations. I’m the happy chef in our house, but lately I feel like I’m a short order cook for either a mad person or a small circus. Some perspective here?

Wait until you’re cooking for the tastes and fixations of your child! (But that’s another entry.) And that circus—it won’t just be limited to the dinner table. Enjoy the ride, and be sure to write it all down to read someday with the kids.

meemal Flickr Photo (CC)

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You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. I know this is a tangent to the main point of the article, but this is the first I’ve heard that flax oil isn’t a viable replacement for fish oil. I’m a vegetarian, and not about to start taking fish oil. Is flax not even worth it, or just not as amazing?

    surplusj wrote on January 7th, 2008
    • I know this is an old post, but I’m a dedicated non-fish-eater (due to concern about over-fishing of wild populations) and I have found a brand of algal oil which provides high dose EPA and DHA, the same essential oils found in fish.

      The brand is ‘Nuique’ and I’ve been taking this for the last year or so (and through the 6 months of my pregnancy so far). I found it increased a feeling of wellbeing, and it’s anecdotal I know, but I’m sure it made me smarter :-)

      It’s helped me to reach a balance between my search for health and my ethical concerns and I recommend it to anyone who chooses not to eat fish/seafood.

      Primal-V wrote on January 8th, 2014
  2. All of this conversation about children and health concerns just amplifies that old saying that, “their isn’t a manual written on raising children.” This is why I know I am not ready.

    Obama moma wrote on January 7th, 2008
  3. Pregnant women should be sure to take adequate folic acid (vitamin B9) on a daily basis to protect against neural tube defects. As Mark said, discuss this with your pregancy health care practitioner.

    Karen wrote on January 7th, 2008
    • Actually, folate – not folic acid – that is an engineered chemical that we fully don’t understand the effects of. There is some negative research associated with folic acid.

      Jen wrote on May 29th, 2013
  4. Surplusj,

    Flax is NOT as good as purified fish oil. It’s an OK fallback or substitute if you are vegetarian, but here’s the issue: We are looking for the most beneficial forms of Omega 3 DHA and EPA, both of which are present in the fish oil, but not in the flax. Your body will take some of the ALA (the form of omega 3 that’s in the flax) and enzymatically convert it to EPA and/or DHA, but the body doesn’t always have the tools or the inclination to perform that task as effectively as we’d like. That’s why I recommend you go straight for the fish oil. Still haven’t convinced my vegetarian son of that though…

    Mark wrote on January 7th, 2008
  5. for various reasons, I refuse to take vitamins. My diet is mostly organic and includes a large variety of fruits & vegetables.

    When it comes time for me to get pregnant, I don’t intend on taking prenatal vitamins, or pills of any type. Will I have a lot of trouble finding a doctor who will support me on this?

    Zorbs wrote on January 7th, 2008
    • How odd, we have the same name…The real Zorbs

      Zorbs wrote on January 18th, 2012
      • Can someone tell me how to secure my name.

        Zorbs wrote on January 18th, 2012
    • Look for a midwife as your care provider when you are pregnant – they are generally more in tune with the importance of nutrition than obstetricians. Shop carefully, interview several, ask lots of questions – remember, you are ultimately responsible for your health and the health of your baby.

      lynne wrote on May 6th, 2012
  6. Zorbs, I think yes, because folic acid is very important, as Karen said. It is most important just before pregnancy and during the three first months. At the end of the pregnancy it may be advisable to take extra iron and maybe other supplements.

    There are alternatives, and you might want to look into which important nutrients might be found in what food. If you tell your doctor that you refuse to take supplements, I hope he will do the best of the situation and that he is able to inform you what “natural” food to eat instead.

    Pelikan wrote on January 8th, 2008
  7. Zorbs – you might try tracking your normal diet for several weeks before you ever see a doctor to show that you get adequate folate. (Of course, if you’re not getting adequate folate, you should start eating more leafy greens and other folate-rich foods.) I personally would prefer not to take a prenatal vitamin, either – I do take vitamins and supplements, but I put a lot of effort into reading labels and getting the most bioactive form of an ingredient. I’m not thrilled about taking a supp just because a mainstream medical practitioner prescribes it.

    Mark, I wonder if you can further clarify “you need twice as much iron as you normally do.” That doesn’t necessarily mean you should consume twice as much iron as you ordinarily do – it means you should consume twice the RDA, right? I think that’s important to note, because excessive iron is a bad thing. Also, isn’t it better to get heme iron than the reduced iron that’s in breakfast cereals and a lot of supplements?

    Migraineur wrote on January 10th, 2008
  8. I am very pleased with my results thus far using the Made from Earth Aloe and Jojoba Cream Therapy. I have been using this daily for 1 month and have seen an improvement in the depth and color of my stretch marks. My stretch marks were a result of rapid growth and weight gain; therefore, did not expect such a noticeable improvement, since most creams are seemingly made for pregnancy/women. I would highly recommend this for everyone and anyone. Have not had as much success with other products.

    TinaNYC wrote on February 14th, 2011
  9. This article has a slight flaw to it. Glucose is the preferred fuel for the fetus (studies have been conducted and show poor fetal growth who have less than optimal glucose). Ketones are also toxic for a fetus.

    Keep this in mind ladies. In some cases, U.S. nutrition advice isn’t necessarily wrong.

    Kyle wrote on February 21st, 2011
    • Kyle, can you tell me where the “flawed” statement is?

      Mark Sisson wrote on February 21st, 2011
  10. never took prenatal vitamins. got it all from healthy diet. folic acid is in tons of veggies! and iron rich meats are a better source of iron than a pill that causes constipation.

    katie wrote on December 7th, 2011
    • Actually folic acid is not in any food. It is engineered to mimic folate, but is not as readily available as the folate in foods. Hope this helps. I was very confused by these two for a while.

      Jen wrote on May 29th, 2013
  11. Mark, can you recommend a range for carbs during pregnancy? Seems like if eating unlimited fruit too along with veggies, it will be natually a bit higher than the mid-range weight management 100-150. Can you also comment on the Ketosis/Fetus point? Is it really bad for the fetus??? Thanks! Love this article – so helpful!

    Jenee wrote on January 4th, 2012
  12. I am 40 weeks and 1 day pregnant today. I did the very best I could with the primal lifestyle while pregnant, and while I was not perfect I think it did me well! I just blogged about my (sort of) primal experience for any other pregos who may want to read about it. http://lolaandoatmeal.com/460/my-sort-of-primal-pregnancy/

    Lola wrote on April 17th, 2012
  13. Is the fish oil from your site approved for prenatal?

    Meg wrote on November 19th, 2012

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