WATER
Yes, water is a nutrient, and it’s an important one. Our adult bodies are composed of about 65 percent water. Water is required for nearly every physiologic function. One can derive a good amount of water from your foods, particularly if consuming fresh, raw fruits and vegetables. Otherwise, drink water in the form of pure filtered water stored in glass (with no added sugars or artificial sweeteners). Aim for the equivalent of about 12 eight-ounce glasses per day from all sources.
CARBOHYDRATES
These macronutrients, often referred to as “carbs,” are classified as either simple or complex, and should form the majority of what gives us energy in a healthy diet. This is especially true during pregnancy. Carbohydrates have always (even in Paleolithic times) formed the basis of almost every culture’s diet. It is important to get enough healthy carbohydrates during pregnancy to ensure the baby’s good neurologic development and overall health. Fiber is a carbohydrate that actually goes through your digestive system undigested and does not contain calories but is equally essential. Let’s explore the different types of carbs and which foods pack the best healthy carb punch.
Simple carbohydrates are found in nature in things like fruits, where they are complemented and balanced by large amounts of water, fiber, vitamins, minerals, and phytonutrients. Since they are only made up of one or two sugar molecules (thus, their name “simple”), simple carbs are more rapidly broken down by the body and able to enter the bloodstream and utilized as a source of immediate energy. Milk contains the simple sugar, lactose. Raw honey, raw cane juice, and raw maple sap are examples of items that are very high in simple carbs and do not have much balance from fiber, fats, or proteins to modify the speed at which they are absorbed. These simple carbs should be taken in sparingly, but go ahead and eat a wide variety of fresh fruits and berries.
Complex carbohydrates are made up of multiple sugar molecules linked together. These foods take the body a little longer to break down than simple carbs, and as such, provide a great source of sustained energy over time. Complex carbohydrates found in nature can be starchy, like rice, potatoes, oats, and other whole grains. Complex carbs can also be fibrous, like broccoli, asparagus, spinach, and mushrooms—these foods are also packed with a wide array of vitamins, minerals, prebiotics, and phytonutrients.
Fiber is a type of complex carbohydrate that is non-digestible. Edible fiber is found in unrefined whole plant foods, like fruits, vegetables, and whole grains. There is virtually no fiber in meat, dairy products, oils, or refined sugars.
Prebiotics are actually fibers that serve as food for probiotics, which are good bacteria that control harmful bacteria in the digestive tract. Naturally occurring prebiotics can be found in foods like bananas, garlic, onions, and asparagus. Some foods containing probiotics or that support probiotic growth include sauerkraut, kimchi, miso soup, coconut kefir, tempeh, and kombucha. A good probiotic supplement will also do the trick.
FATS
Fats are defamed but fats are essential for human life. They make up the cellular membrane that surrounds and encloses every single cell in our bodies. They are required for the body’s absorption of vitamins A, D, E, and K. So, fat itself is not bad. But some types of fats are healthier than others. Essential fatty acids (EFAs) cannot be created by the human body and need to be taken in through our diet. Omega-3 and omega-6 fatty acids are good or valuable fats are found in plants—particularly black beans and kidney beans, edamame, walnuts, flaxseed, chia seeds, and winter squash—as well as wild fatty fish, and are very important to our health. Other fats can be generated by the body, so they don’t need to be ingested.
Trans fats exist in small amounts in animal fats like beef, lamb, and butterfat. It is not known how harmful naturally occurring trans fats may be. What are harmful to our bodies are the man-made trans fats that are produced when certain unsaturated vegetable oils are partially hydrogenated. This man-made process creates a substance that is not found in nature and should not be a part of our diets in any type or quantity.
Saturated fats are naturally occurring fats that are usually solid at room temperature. Meats and dairy products, as well as coconut oil and cocoa butter, have a high proportion of saturated fats. Though not as bad as trans fats, saturated fats are best kept to a minimum
Monounsaturated (omega-9) fatty acids are not considered essential fatty acids because they can be produced by the body, but it is still beneficial to have omega-9 fatty acids in the diet. Good sources include nuts, avocados, and olive oil. They are protective against metabolic syndrome, cardiovascular disease, and stroke. Oils rich in monounsaturated fats can be an important source of the antioxidant vitamin E.
Polyunsaturated (omega-3 and omega-6) fatty acids are needed by the body to synthesize other fats, including hormones. These are important to include in your diet, especially during pregnancy, and can be found in vegetable oils, nuts and seeds, fatty fish, and leafy vegetables.
PROTEINS
Proteins are built from amino acids, which are classified as either essential (need to be taken in through the diet) or nonessential (can be manufactured by the body). We need protein for every cellular function, and our baby needs a lot of protein to grow and develop optimally. But most Americans eat far too much protein. The average non-pregnant woman in the United States eats 70 grams of protein a day. This meets the Institute of Medicine’s Dietary Reference Index (DRI) for protein requirements in pregnancy. So, most women do not need to increase their protein consumption when they get pregnant. Good protein sources include nuts, seeds, legumes, whole grains, wild fish, and organic dairy products, eggs, and meats.
VITAMINS
Vitamins are vital to our good health. Every vitamin has a specific role in the growth and function of our bodies. Synthetic and semi-synthetic vitamins have been mass produced and sold for decades, but their safety and value remain debatable. A whole-foods diet with lots of plant-based foods will provide you with plenty of vitamins. As an insurance policy in pregnancy, however, it is helpful to take a prenatal vitamin.
Vitamin A
Vitamin A comes in two forms: retinol (found in animal products) and carotenoids (found in plants). Adequate vitamin A is essential for normal fetal internal organ development. But excess retinol can build up, causing toxicity. You can easily avoid this risk. Simply eat plenty of healthy carotenoid-containing vegetables. Think orange here: sweet potatoes, carrots, mangos, and cantaloupe are all good vitamin A foods, as are spinach, , iceberg lettuce, and red peppers. If you eat retinol-containing animal products, like meat and poultry, just do so in moderation. Avoid supplements containing retinol, as well as prescription drugs containing vitamin A or synthetic equivalents (like Accutane and Retin-A).
Vitamin B6
This good and kind vitamin is known to bring relief from the nausea and vomiting associated with morning sickness in the first trimester. It is also an important factor in metabolizing carbohydrates, fats, and proteins, and crucial to nervous system development. Foods rich in vitamin B6 include spinach, bananas, potatoes, chickpeas, and wild fish.
Vitamin B9 (folate/folic acid)
Folate is a naturally occurring vitamin in foods such as dark leafy greens, whole grains, and beans. Folic acid is the synthetic crystalline version of this vitamin, which is contained in most prenatal vitamins and fortified foods. This important B vitamin is involved in DNA repair, cell division, and many other biological processes. It is also critical to the brain and spinal cord development of the fetus. Since one has started fortifying foods and recommend prenatal supplements with folic acid, rates of infant brain and spinal cord anomalies have decreased dramatically.
Vitamin B12
This vitamin is helpful to the development of the brain and nervous system, and is closely related to folate. Adequate B12 levels ensure that folate can be metabolized and properly used by the body. Vitamin B12 is known to be protective against cleft lip and cleft palate, and is also essential to preventing maternal anemia. Some foods containing this vitamin include sauerkraut, kimchi, tempeh, spirulina, eggs, and milk.
Vitamin C
Vitamin C is essential for creating collagen (the protein found in connective tissue), and is therefore important for normal fetal growth. It is involved in building healthy skin and connective tissues, and is an antioxidant with powerful immune capabilities. Oranges comes to mind in relation to vitamin C, but some perhaps more surprising foods providing vitamin C include strawberries, papaya, broccoli, Brussels sprouts, bell peppers, and guava.
Vitamin D
Vitamin D is manufactured in the skin by exposure to sunlight. This vitamin is needed for proper absorption and utilization of calcium and phosphorus in the body, and is essential for the growth of healthy bones and teeth. Recent recommendations to cover or use sunscreen on exposed skin may actually be contributing to low vitamin D levels. Especially during pregnancy, this vitamin is critical to both mom (prevents gestational diabetes) and baby (ensures skeletal development and full-term gestation). Sardines, chanterelle mushrooms, egg yolks, cheese, and of course sunlight are good sources of vitamin D.
Choline
Choline is not actually a vitamin. It is a vitamin-like micronutrient that is absolutely vital for numerous cell processes. Choline is particularly important during pregnancy to ensure proper development and functioning of the nervous system. It’s also recommended early in pregnancy, along with folate and vitamin B12, to prevent neural tube defects. Later in pregnancy, choline will enhance baby’s brain development. Eggs, scallops, spinach, broccoli, and quinoa are among the many foods containing choline.
MINERALS
Minerals are essential to every bodily function, from brain to heart to bowel. Their levels tend to be well regulated by the body, which is helpful as problems can arise with either a deficiency or an excess of most minerals. The kidneys do a lot of work maintaining this balance. Nurture good kidney health by drinking plenty of water and avoiding excess sugars and sodium.
It’s also important to consider the quality of the soils in which our food is grown when we consider a food’s mineral content. Conventional fertilizers and agricultural techniques degrade the soil mineral quality and contaminate groundwater supplies. Choose USDA organic as often as possible to maximize the nutritional value of your food.
Calcium
Calcium helps the baby grow a healthy skeleton and teeth, cardiovascular system, and heart rhythm. If you don’t supply enough calcium in your diet, your growing baby will take the calcium it needs out of your bone stores, leaving you vulnerable. Conversely, getting adequate calcium during pregnancy actually protects your child from increased fracture risk later in life. Calcium is commonly associated with dairy products, but it can also be found in fortified almond or soy milk, broccoli, tofu, bok choy, and Chinese cabbage.
Iron
Iron is required to make heme, the central component of hemoglobin, which is the part of the blood that carries oxygen around on your red blood cells. Iron is that vital. There has been, though, an overemphasis placed on iron in pregnancy. Pregnant women should check their ferritin level (this reflects your iron stores), and take a supplement only if your level is low. Heme iron comes from animal sources and is more readily absorbed. Non-heme iron comes from both plants and animals. It is better absorbed (up to three times as well) by your body if you take it in along with a food or drink rich in vitamin C. Iron-rich foods include lentils, squash, and pepitas (shelled pumpkin seeds), black sesame seeds, dark leafy greens, and dried fruits, such as prunes and raisins.
Magnesium
Magnesium is important for manufacturing the vitamin D absorbed via the body’s exposure to sunlight. It’s also beneficial for calcium absorption, normal bowel function, muscle relaxation, and mental calmness. Industrial agriculture (think fertilizers and pesticides, which empty the soil of micronutrients) and food processing, have led to a magnesium deficiency in our diets. To counter this, eat magnesium-rich plant foods, use occasional Epsom salts baths (to absorb magnesium sulfate through the skin), and consider taking a prenatal vitamin containing magnesium. Magnesium is found in dark leafy greens (yes, you’ve seen a lot of these—part of what gives them their status as “superfoods”; see here), beans, nuts, seeds, fish, avocado, dried fruit, and dark chocolate, to name a few.
Zinc
This mineral is essential for cell division, protein synthesis, nucleic acid metabolism (helps make DNA), and a healthy immune system. Unlike naturally occurring folate, folic acid can inhibit zinc absorption. For increased zinc absorption, try soaking nuts and legumes in filtered water before sprouting (see box below) or cooking them. In addition to nuts and legumes, some good sources of zinc include wheat germ, collard greens, cocoa, and oysters.
Daily Building Blocks
The table below contains a summary of the Institute of Medicine’s most current Dietary Reference Intake (DRI) in Pregnancy and Lactation of major nutrients for an average-weight adult female. Some experts and organizations may recommend more or less of a given nutrient. You may have slightly different needs. If your dietary intake comes from whole foods and is pretty consistent with the requirements listed in this table, you’re on the right track.
| Key nutrient | Daily requirement in pregnancy/lactation | What it does | Where to get it |
| Water | About 12 eight-ounce glasses | Assist in nearly every physiologic function | Fresh fruits and veggies, filtered water stored in glass |
| Carbohydrates | 175 g/210 g | Gives you usable energy for life | Fruits, vegetables, whole grains |
| Protein | 71 g/71 g | Needed for growth, cell division and immune function | Nuts, seeds, legumes, whole grains, organic dairy products, eggs, meats, wild fish |
| Fats | 500 mg omega-3 fatty acids EPA and DHA (at least 300 mg of this from DHA) | Makes up cell membrane, important in all growth and development, hormone synthesis | Nuts, seeds, avocado, coconut, wild fatty fish, organic eggs |
| Fiber | 28 g/29 g | Feeds the good gut bacteria, keeps stool soft and bulky, prevents constipation | A variety of fruits, vegetables and whole grains |
| Probiotics | Minimum 10 billion live organisms | Maintains healthy gut microflora, prevents yeast infections and bacterial vaginosis, improves digestion and immune system function. | Cultured and fermented foods, high quality probiotic supplements |
| Vitamin A | 770 mcg/1300 mcg | Assists in organ development, fat metabolism, healing and tissue repair, vision | Carrots, iceberg lettuce, sweet potatoes, mangoes, kale, cantaloupe |
| Vitamin B6 | 1.6 mg/1.7 mg | Involved in brain development and immune system function | Sunflower seeds, pistachio nuts, prunes, wild salmon, bananas, avocados, chickpeas |
| Vitamin B7 (Biotin) | 30 mcg/35 mcg | Assists in metabolizing carbs, fats and proteins, normal immune function, healthy hair and skin | Mushrooms, avocados, Swiss chard, berries, raw shelled sunflower seeds, eggs |
| Vitamin B9 (Folate) | 600 mcg/500 mcg | Prevents birth defects (especially related to the nervous system), needed for cell division | Dark leafy greens (kale, collards, spinach), whole grains, legumes |
| Vitamin B12 | 2.6 mcg/2.8 mcg | Helps with brain and nervous system development, needed to absorb folate and choline | Tempeh, nutritional yeast, spirulina, organic eggs, wild fish |
Eating for Twins (or More)
The biggest difference when one carry multiples is that one’s pregnancy-related symptoms may be magnified, and one’s caloric and nutritional needs is somewhat amplified. Instead of growing one little being, one is growing two, or three, or sometimes more. One will also be seeing obstetrician and/or perinatologist more frequently for prenatal care, so ideally, any weight concerns will be recognized and addressed appropriately. A good rule of thumb with multiples is to aim to gain at least 24 pounds by 24 weeks. If one achieves this mark then it is very likely keeping up calorically with the needs of developing babies. In the meantime, gaining either significantly less or more than an average of a pound per week, demands doctor’s attention.
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