Dr. Arturo M. Volpe

It is no mystery to anyone today that pregnant women’s lifestyle and diet can affect the health of the baby to be. Research continues to show that maternal diet and possible deficiencies not only have a determining effect on the mental and physical health of babies and children, but also that of adults even late in life. This article will touch briefly on the major aspects of diet and supplementation during pregnancy but also provides interesting reading for anyone seeking to improve their health.

In fact scientists in this field now consider maternal nutrition to be a risk factor for cancer, diabetes and heart disease, regardless of when these might occur in life. Not only, but this risk factor is independent of other known factors like a person’s own diet, lifestyle and genetics. Lack of nutrients in pregnancy can turn on genes that would otherwise lie dormant and cause no harm, but that once activated become triggers for illness at any time in life.

In most cases, aside from being told to “eat well” and take a multivitamin, women are not informed of new research in this field or all the components of a healthy pregnancy that contribute to thriving babies who grow into healthy adults.

Diet
The three major dietary factors that were found to adversely affect the baby are insufficient protein, excessive sugar and starchy foods, and lack of fresh fruits and vegetables.

Protein is basically what the body is made of. It is the most essential building-block for the baby to be, but it is also as essential for the mother’s own health maintenance. Lack of protein in pregnancy can deplete the mother setting the stage, among other things, for post-partum depression.

The body has no way of storing protein, so it has to be consumed on a daily basis, and preferably several times a day. In the excellent book (now out of print) “Metabolic Toxemia of Late Pregnancy”, Thomas Brewer, MD showed how pre-eclampsia and eclampsia can be effectively prevented by making sure women eat enough protein during pregnancy.

According to the FDA a pregnant woman weighing 150 lbs needs 75 grams of protein a day. This is likely to be an underestimate because of a medical anti-protein bias that exists today and therefore it should be considered as a strict minimum. To give you an idea of how much food is involved, 2 large eggs contain a total of 12 grams of protein, lean meats or seafood around 7 grams per ounce, hard cheese 10 grams per ounce, and beans 7-10 grams per half cup cooked.

Sugar and starchy foods all contribute to raising blood sugar and insulin levels. Insulin acts as a growth hormone for the developing fetus and leads to larger babies independently of whether the mother is diagnosed with gestational diabetes. Large babies are not really a good thing. In fact research found that larger than average babies have a higher risk of leukemia during infancy, as well as prostate cancer, breast cancer, diabetes, and polycystic ovary syndrome later in life. Not only, but the risk of these diseases increases in direct proportion to how much larger than average babies are at birth.

When it comes to sugar and starches the goal is not complete elimination, but balance. A moderately low-carb diet such as can be found in many popular diet books is adequate in most cases. I don’t recommend anything as extreme as the Atkins diet but something like the Zone diet seems appropriate even if loosely implemented.

Fruits and non-starchy vegetables should be consumed freely as a staple of the diet but with an emphasis on vegetables and salads over fruit because fruit can also raise insulin levels. A good rule of thumb is eight servings a day of vegetables and two of fruit.

Fatty acids
Fat is also an important part of the diet that is essential for fetal development. I recommend sticking with natural oils, like organic olive oil, coconut oil, plus some form of animal fat like butter. In addition, several studies show that when mothers-to-be take cod liver oil as a supplement, their babies perform better at developmental tasks and even sleep through the night at an earlier age.

Choline is another important nutrient that the body combines with fats to make phospholipids, a major building block of the brain and nervous system, so it is very important in pregnancy. Without enough choline the brain and nervous system cannot develop to their full potential.

Unfortunately choline is not considered essential and is often ignored because the body can make it. However, new research shows that even though the body can make a little, it cannot make nearly enough to fulfill its needs, especially in pregnancy, and some dietary intake is therefore essential.

Major dietary sources of choline include egg yolks, liver, and full-fat tofu. With so many people today avoiding these foods, deficiency has become common. Supplement sources of choline include lecithin, phosphatidylcholine or a product called Lipoflow Forte, which is the one I like the most because it is natural and contains all the forms of choline found in food. Given the central role that choline plays in brain development I recommend that all pregnant women take it as a supplement.

Folic Acid and a multivitamin
The importance of folic acid to reduce the risk of neural tube defects including spina bifida is widely known. Studies show that folic acid cuts the occurrence of these conditions by about 50%, but also that it works better when taken with a multivitamin. This combination was shown to also reduce the occurrence of birth defects of the heart, urinary tract and limbs, as well as childhood cancer.

However, all prescription multivitamins contain synthetic folic acid, which needs to be activated in the body before it can work. For a majority of people this activation takes place without glitches and the synthetic folic acid works very well.

Some people however, have one of several genetic variants grouped under the name of MTHFR variants and their bodies are partially to completely unable to process synthetic folic acid. These people do not have a genetic defect and they do very well with folic acid from food, they just cannot handle the synthetic form of this vitamin.

These genetic variants are fairly common, accounting for anywhere from 10 to 30% of the population depending on the type of variant and the severity of the impairment. In these people synthetic folic acid not only does not protect from malformations of the baby, it is also likely to act as a toxic chemical just like any other chemical the body cannot break down.

The best solution according to experts I respect is to take a semi-activated form folic acid called folinic acid instead of the one usually prescribed. Fully activated folic acid called 5-methyl-folate is also available but there is some divergence of opinion as to whether it is preferable and no conclusive research to know for sure.

Possibly an even better solution could be to take natural food-derived folic acid contained in many products including one I recommend called Asparagus Extract. The problem here is that it is impossible to reach the recommended dose of 1 mg per day of folic acid using a natural source. In the absence of definitive studies I suggest taking both folinic acid and natural folic acid.

Iodine
Iodine is another essential nutrient that is becoming increasingly deficient in the American diet. The reason is that the major source of iodine for many of us is iodized salt, which a growing number of people have stopped using. Many avoid salt altogether, and others have switched to more natural sea salt which contains no iodine.

Iodine is critical for thyroid function and the widespread deficiency of this nutrient may account, at least in part, for the current epidemic of thyroid disorders. During pregnancy, severe iodine deficiency is known to cause mental retardation. Less severe deficiencies, as are common today, have been linked with neurological deficits including a higher incidence of ADHD.

In addition, there is an anti-iodine bias in the medical profession due probably to confusion with the many toxic forms of iodine, like radioactive iodine, used today in medicine. Because of this bias, a recent survey found that only 28% of prescribed multivitamins contain iodine, and those that do contain it, only contain an average of 119 mcg, far short of the recommended daily allowance (RDA) of 220 mcg for pregnancy.

Remember that the RDA is defined as the minimum daily intake to prevent symptoms of deficiency, and in this case deficiency equates with harm to the developing nervous system, so it is imperative that women take at least the RDA and this is very easy to achieve with a number of over-the-counter supplements, including all natural kelp. For a more comprehensive discussion of this essential nutrient I recommend that you read the informative book “Iodine Why You Need It” by David Brownstein, MD.

Vitamin D
This is the only vitamin that the body is able to synthesize when exposed to the sun. However, we have all been told to avoid the sun, or to use sunblock, which also inhibits vitamin D formation.

In recent years a number of studies have shown the benefits of vitamin D for just about every aspect of health: from cancer prevention, resistance to viral illness, to improved moods and neurological function. At the same time as people started to be tested, it became apparent that virtually every American is deficient in this vitamin.

When it comes to pregnancy, vitamin D is critical for the health of the mother as well as development of the baby. Some experts are suspecting that the widespread deficiency of vitamin D may be associated with the current epidemic of autism as well as a number of immune system disorders in children.

A full discussion of vitamin D is clearly beyond the scope of this article, however you can read about it and find many references to research on this site: http://www.vitamindcouncil.org/.

Vitamin D supplements in the range of 2,000 to 4,000 IU per day have been found to be safe and beneficial in pregnancy. However, prescribed multivitamins rarely contain more than 400 IU, so an extra supplement needs to be taken. This vitamin should also be supplemented in the natural D3 form and not the synthetic D2 that is sometimes prescribed. Vitamin D status can also be checked through a simple blood test that is now covered by insurance and may be worth doing at some point.

Magnesium
Magnesium is essential for almost every aspect of health, and yet it has become depleted in the soil and consequently in the human diet. According to the US government’s own sources 60% of the US population do not get their required intake of magnesium through their diet (http://www.ars.usda.gov/Services/docs.htm?docid=10709).

Restless leg syndrome – a common condition in pregnancy – is often nothing more than a symptom of magnesium deficiency that can be fully reversed by taking a magnesium supplement. Other symptoms of magnesium deficiency include shortness of breath, headaches, wheezing after exercise, frequent urination, constipation, leg cramps, palpitations, and high blood pressure.

Research has shown that magnesium supplementation is beneficial in pregnancy for both the mother and the baby. If we consider that almost every enzyme in the human body depends on magnesium to function this only makes sense.

Foods rich in magnesium include green vegetables, nuts like almonds and especially Brazil nuts, and whole grains. Women whose diets have not been particularly high in magnesium or those who have a symptom of magnesium deficiency should consider supplementing with magnesium during pregnancy.

Unfortunately there isn’t a simple test to assess magnesium status and blood tests are of no help because levels of magnesium in blood are normal even in people who are severely deficient.

When taken by mouth, magnesium supplementation is extremely safe and loose stools are the only sign that someone is taking more than they need. Therefore, I recommend that you find your individual dose of magnesium by increasing your intake of it gradually until you experience loose stools and then cutting back to the point where you no longer experience this side effect. This is called dosing magnesium to “bowel tolerance”.

Summary
• Diet: balanced, high in protein, non-starchy vegetables, and fresh fruit
• Cod liver oil and choline
• Folinic acid, natural folic acid and a multivitamin
• Iodine – 220 mcg
• Vitamin D3 – 2,000 to 4,000 IU
• Magnesium to bowel tolerance

Tags: Diet, Pregnancy, Vitamin D | 5 Comments »