[As seen in issue #111 of Midwifery Today]
by Amy V. Haas, BCCE
Popular diets are as prevalent during pregnancy as they are in everyday life. Every five years or so a new diet pattern pops up and is touted as the best way to eat. However, during pregnancy if we want to have a better chance at preventing problems such as prematurity, we really need to take a step back, look at the big picture, and use some common sense [Katz 2014].
The latest of these are gluten-free diets and the Paleo/keto diet. There isn’t necessarily a problem when adults decide to make changes to their eating habits, but when a pregnant woman and/or a growing child is involved, we have to be much more cautious. Eliminating whole food groups can severely challenge the ability of pregnant women to get what they need to sustain a pregnancy and grow a new human.
Gluten intolerance is a serious problem for some people and can cause everything from great gastrointestinal distress to allergies. Celiac disease is a serious digestive problem that prevents absorption of many nutrients and other serious health problems. However, these issues are actually quite rare in the general population. The latest research on the subject points to a lack of adequate probiotics and a rash of simple carbohydrates as the culprit. The good news is that probiotics and vitamin C may be used as potential non-dietary treatments for celiac disease and gluten sensitivity (Bakshi 2012; Kuitunen 2013).
A gluten-free diet is not always a healthier diet. Interestingly enough, a good analysis of the most popular books on gluten-free diets highlights that the problem could be the amount of glucose, in direct relation to simple carbohydrates (Perlmutter 2013). Only the most recent studies have looked at the quality of the grains and whether they were processed, contained low fiber or included GMOs or high-fructose corn syrup (Boggs 2014).
What these studies saw was that people jumped on the gluten-free diet, but didn’t check the nutritional quality of the foods they were using as substitutes. A gluten-free diet commonly translates into a diet high in simple carbohydrates and sugars and low in fiber, protein and B vitamins. If you are gluten intolerant or have celiac disease, you need to make sure you are getting the right kinds of gluten-free carbohydrates, and find alternative gluten-free sources of B vitamins, fiber and minerals. Read food labels carefully, as they will reveal the nutritional content or lack thereof. You may wish to talk to your care provider about adding a probiotic to your diet. You must make an effort to eat more beans and legumes and not just rely on the most common packaged gluten-free carbohydrates and foods. Gluten-free grains/complex carbs include amaranth, buckwheat, whole corn, millet, oats, quinoa, brown rice, wild rice, teff, beans and lentils.
Wheat, meats, dairy, fish, soy, eggs, nuts, salt, fat, etc., have all been touted as unhealthy at one time or another, but the truth is that we benefit from nutrients in all of these sources to supply the body with what it needs to stay healthy and function properly (Hamblin 2014, Weber 2014). Great variety gives us the best chance to get everything we need. If you cut out a specific food or food group, then you must make an effort to replace the nutrients you would have been receiving. Most problems have arisen from the use of excessive amounts of processed white flour/sugar/simple carbohydrates and a reliance on large amounts of fatty, low-quality meats. The standard American diet relies mostly on simple carbohydrates and processed fats. It is important to think quality, not quantity.
I am not as worried about how many carbohydrate grams a woman is eating per day as I am about what type of carbohydrates they are. High complex carbohydrates are going to contain more fiber. Fiber aids in digestion and slows the absorption of carbohydrates, which helps to stabilize blood sugar. Studies have found that women who eat a well-balanced, whole food diet that utilizes complex carbohydrates are able to maintain stable blood sugar levels (Boggs 2014). Whereas, other studies show that a high protein/low carbohydrate diet (such as Atkins or Paleo/Keto) can result in complications contributing to miscarriage or premature birth [Boseley 2004, Kramer 2003]. Since the Paleo diet cuts out most complex carbohydrates and dairy, it would not be a good choice during pregnancy (Weber 2014).
When assessing the dietary needs of any pregnant woman, a care provider must analyze each woman individually, taking into account her activity level. I have discovered that very athletic pregnant women have different needs than the average active person. Healthy, slim athletes, especially runners, have very efficient metabolisms. They can eat quite a bit of food and not gain any weight due to their activity level and hyper-metabolism. So while we have been advising all pregnant women to eat a whole-food, healthy, higher protein diet, this advice may not be enough for very athletic women.
Very athletic women need additional complex carbohydrates and protein because their bodies tend to burn any extra protein for energy, so there is not enough available to the liver for the synthesis of albumin. Albumin is a blood protein that helps keep water in circulation and supplies the expanding blood volume of a pregnant woman. Her blood volume will increase by 40–60% during pregnancy to supply her body and the baby and also so that she has an extra supply in the event of hemorrhage. Hypovolemia, or low blood volume, is a major factor in preeclampsia. Preeclampsia puts both mother and baby at risk, so prevention is important. By increasing calories in the form of complex carbohydrates, the athlete’s body has enough to burn for energy.
A whole-food, balanced diet is one that contains real food, as close to its original state as is possible, from all food groups. Protein bars and powdered protein supplements are not real food. They are processed differently by the body and are not as bio-available [Kramer 2003, Harvard Medical School, 2022]. Whole food proteins contain many nutrients, anti-oxidants, enzymes and fiber that your body needs, and have a decent amount of natural fats, which may be lacking in powdered protein supplements. Protein supplements are only advisable for moms who are pregnant with multiples, and then the supplements should be used in addition to the whole-food Brewer diet (see http://www.drbrewerpregnancydiet.com/).
When discussing recommendations on how much to eat, doctors will often say to add an extra 300 calories to a normal diet but say nothing of what types of foods pregnant women should or shouldn’t be eating. A woman needs 2000–3000 calories per day to sustain a healthy pregnancy. But how does she know where along that range she may fall? Well, that depends upon her general size and activity level. A woman who is 5 feet tall might do well on 2000 calories per day, but a woman who is 5 ft 10 in would more likely need 3000 calories per day.
Portion size is also a consideration. The size of your fist is generally an adequate portion size. Each meal should contain a fist-sized portion each of a protein, a complex carbohydrate and a vegetable. Add a glass of milk or soy milk and you have a complete meal. Keep a daily food diary for about 12 weeks to help you see what you might be missing or pinpoint where you might be going overboard.
The latest analysis of available research actually shows that humans should be eating minimally processed, varied whole foods, in moderation (Hamblin 2014). How much women gain should not be the issue, but rather the quality and quantity of what they are eating and how much exercise they are getting.
So remember: quality over quantity with moderate exercise. For more information on this subject, refer to Anne Frye’s Holistic Midwifery or her Midwifery Today article titled, “Turning Toxemia Around.”
References:
Bakshi, A, et al. 2012. “Emerging Therapeutic Options for Celiac Disease: Potential Alternatives to a Gluten-free Diet.” Gastroenterol Hepatol 8 (9): 582–88.
Boggs, W. 2014. “A Diet Rich in Complex Carbs Can Achieve Glycemic Targets in Gestational Diabetes.” Reuters Health Information.
Hamblin, J. 2014. “Science Compared Every Diet, and the Winner Is Real Food.” TheAtlantic.com. http://www.theatlantic.com/health/archive/2014/03/science-compared-every-diet-and-the-winner-is-real-food/284595/
Kuitunen, M. 2013. “Probiotics and Prebiotics in Preventing Food Allergy and Eczema.” Curr Opin Allergy Clin Immunol 13 (3): 280–86.
Perlmutter, David. 2013. Grain Brain: The Surprising Truth about Wheat, Carbs, and Sugar: Your Brain’s Silent Killers. New York: Little, Brown and Company.
Boseley, S. (2004, Jun 29). “Atkins diet may cut chance of pregnancy, study shows.” Guardian Unlimited. www.midwiferytoday.com/enews/enews0617.asp#news
Kramer, M.S. (2003A). Energy/Protein Restriction for High Weight-for-height or Weight Gain During Pregnancy. (Cochrane Review) In: The Cochrane Library, Issue 2. Oxford: Update Software.
Weber, P.; “The Paleo diet is a horrible way to start the new year: The so-called “caveman diet” ranks dead last in U.S. News & World Report‘s rankings” | January 7, 2014 The Week Magazine. http://theweek.com/article/index/254733/the-paleo-diet-is-a-horrible-way-to-start-the-new- year?utm_source=links&utm_medium=website&utm_campaign=facebook
“The Hidden Dangers of Protein Powders”; Harvard Health Publishing, Harvard Medical School, August 15th, 2022; https://www.health.harvard.edu/staying-healthy/the-hidden-dangers-of-protein-powders
Amy V. Haas, BCCE has been a Bradley childbirth educator, writer, consultant and lecturer in the field of pregnancy and birth for the last 27 years. In addition to her other education, she had the honor of studying with Dr. Tom Brewer for five years(originator of the Brewer Pregnancy Diet). She is a founding member of Rochester Area Birth Network, and a mother of two wonderful young men. She lives outside of Rochester, New York, with a very patient husband and one activec dog. www.healthybirth.net
Amy V. Haas, BCCE©2023
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