Tuesday, January 11, 2011

PRE-prenatal nutrition

introducing heather, RD
my friend heather from side of sneakers is many things: smart, gorgeous, honest, and an excellent writer. she's also a RD, with one of several specializations in prenatal nutrition!

this lovely photo has been all over the blogosphere! heather is on the right

when i wrote a recent post regarding nutrition in the 0th trimester (ie: the pre-prenatal period, or while one is trying to conceive), heather immediately emailed and offered her services.

logo for heather's business: learn more about personalized counseling here!

and with that, this blog's very first guest post (other than josh keeping the streak alive while i've been sick!) was born. without further ado, here's the Q & A, featuring your questions with answers provided by SoS, RD:

I was looking at a bottle of wine over the holidays, and the surgeon general's warning said something to the effect of "don't consume alcohol while pregnant or trying to get pregnant." I'd never heard that last part before. I know you shouldn't drink while pregnant, but is it really dangerous to have an occasional glass of wine while TTC?
Although more and more research is showing that alcohol isn’t as bad as we’ve always thought during pregnancy, it’s still a major no-no according to most doctors, especially in the early stages of pregnancy. The warning label likely includes “trying to get pregnant” because most people won’t know they’re pregnant until they miss a period, which is usually about two weeks after ovulation occurs [aka when you would have gotten pregnant.] Because of this, it’s best not to drink in the two weeks between ovulation and your next period. Besides that time period, drinking alcohol won’t cause harm to a fetus, but it’s debated how much alcohol affects fertility. It’s usually recommended to drink in limited moderation.

Guys don’t get off the hook here either- excessive drinking can decrease sperm count.

Is consuming caffeine (like one to two cups of coffee/day) while pregnant harmful? What about while TTC? Does drinking caffeine while nursing cause colic?
Consuming a moderate amount of caffeine while pregnant is usually ok. “Moderate” means no more than 250-300mg a day, which is 1-2 6 oz cups of coffee. It’s a big range because there are a lot of factors that can influence the amount of caffeine in one cup of coffee. For example, Starbucks is notorious for their high caffeine content. If you’re drinking coffee, make sure to take other sources of caffeine into consideration, such as soda, tea, chocolate, and Excedrin.

Caffeine is probably a bigger concern while trying to conceive. While moderation is still the recommendation, caffeine intake has been linked with decreased fertility, early miscarriage, and low birth weight babies. It’s not a bad idea to curb your intake a little, but make sure to wean off slowly – caffeine withdrawal headaches are no joke.

It’s possible that consuming caffeine while breastfeeding can be associated with colic, although it’s hard to say definitively. Babies can’t metabolize caffeine as easily as adults, so it affects them more. Drinking caffeine in moderation should be ok, but if you have a colicky baby, it doesn’t hurt to try cutting it out!

Any nutritional advice for wanna-be fathers beyond the standard "eat a healthy diet"?
Yes! Men, you are not off the hook!! A healthy weight and healthy diet are just as important for fathers-to-be as it is for moms-to-be. The number one thing would be to cut back on alcohol intake if your fellow is a heavy drinker. Alcohol decreases sperm count, which decreases the chances of you getting pregnant.

Just like women should take a prenatal vitamin as soon as they’re thinking about becoming pregnant, menshould take a multivitamin. Certain vitamins and minerals can not only help with fertility, but aid in a healthy baby. The first thing that comes to mind is zinc, which is almost always found in a multivitamin. Inadequate zinc levels contribute to a low sperm count.

What is a good way to add calories to a diet but in a healthy way? Last night, I told my husband I was going to just eat dark chocolate (yum!) to bulk up--- we decided that wouldn't be the best way.
Eating chocolate and ice cream would definitely be a fun way to bulk up, but you’re right, probably not the best way [editor's note: damn]. Adding nutrient dense calories is the best way to go- a lot of times this can include healthy fats and proteins like peanut butter, avocado, olive oil, nuts, etc. Adding in more frequent meals can help too- instead of breakfast, lunch, and dinner, try breakfast, 1st lunch, 2nd lunch, and dinner, or substantial snacks between each meal.

Are there any vitamins and/or supplements that you would recommend to pro-actively take in the meantime?
Absolutely. The most important vitamin to be taking if you’re trying to conceive is folic acid. In fact, it’s so important that all women of child-bearing age [aka have gotten their period] should be taking it, whether they’re thinking about babies or not. Folic acid is responsible for preventing a number of birth defects, especially neural tube defects. These occur so early on in pregnancy that it may be before a test even shows up positive- therefore being proactive is the only way to go. All women should be taking at least 400 mcg of folic acid prior to pregnancy. The amount increases once you’re pregnant.

Also, the time to start taking a prenatal vitamin is when you’re trying to get pregnant- it’ll get your body ready for everything it’ll need to do during pregnancy. Most prenatal vitamins will contain folic acid, but check to make sure yours does. It doesn’t matter what kind you take, as long as you can handle taking it- over the counter is fine.

It’s a good idea to get your iron checked before trying to conceive. If it’s low, eating iron-rich foods or taking an iron supplement can help increase your iron stores before pregnancy. Pregnancy demands a lot of iron- you have to supply both you and your baby!

Vegetarians and vegans may need some help with vitamins D and B12 as well.
I could go on and on about what specific nutrients do, but Sarah would probably like her blog back at some point. ;) [editor's note: not when you're on this much of a roll!]

Which are the best sources of protein? And how much does the amount of protein one takes in matter?
The best sources are lean proteins: lean meat/pork/chicken, fish [see below], nuts, low-fat cheese, beans, lentils, etc. The exact amount of protein you eat isn’t a huge deal- as long as you’re meeting your minimum needs and are at an adequate weight. Most people get more than their daily need without even trying.

Which fish are good for TTC women and which are no-goes due to mercury or other toxins?
The best thing to do about fish is to find out where the fish in your area come from, and what the mercury levels are- it can vary greatly by region. In general, the bigger the fish, the higher the mercury content. Fish high in mercury should be limited. The biggest offenders tend to be grouper, swordfish, and mackerel, while safer options include trout, tilapia, flounder, and haddock.

I have heard that full-fat dairy can help with fertility, but the saturated fat content concerns me. What is your take on full-fat dairy?
Personally, I don’t believe that fat from dairy specifically plays much of a role in fertility. I think it’s more important that you’re getting enough fat total, especially from healthy choices such as fish, nuts, avocado, etc. The benefit of dairy is that it also has calcium, but calcium can be found in other foods such as leafy greens and fortified cereal, as well as supplements. If body weight is a concern, a healthy BMI trumps dairy intake.

Other words of wisdom?
Achieving a healthy weight prior to pregnancy is extremely important. Not only does a healthy BMI increase your chances of conception, but it ups your chances of an uncomplicated pregnancy and a healthy child. Obese mothers are more likely to have c-sections, pre-term deliveries, complications like gestational diabetes and pre-eccamplsia, as well as babies that are overweight as both children and adults. Weight loss during pregnancy isn’t recommended, so pre-pregnancy is the best opportunity. Regular physical activity is important too!

a day's worth of food
[it's me again -- you can tell from the aversion to capital letters, right?] i thought it would be interesting to photograph a day's worth of food and have heather comment on my choices, so i spent a few extra minutes on sunday documenting every mouthful (i have no idea how the real food bloggers do it!).

2 whole grain waffles w/ almond butter + kiwi + black coffee (yep all caf . . . )

This is a great breakfast- substantial enough, with most of the nutrient groups covered: whole grains, protein, healthy fat, and fruit. If this is your only caffeine during the day (and you don’t drink the whole pot!) this is probably ok, but it wouldn’t hurt to keep an eye on your caffeine intake.

pecans + craisins

This combination of carbohydrate, protein, and fat is an example of a great snack- it’ll help keep your blood sugar stable between meals, and prevent cravings or overeating later in the day. Just remember packaged dried fruit tends to have more sugar than you think.

leftover homemade sweet potato samosa + tabbouli (actually a wimpier lunch than usual)

This is a nice mix of nutrients, but it looks a little on the small side. Increasing the amount of your side dish, or adding something on the side like veggies, fruit, or whole grains might be beneficial.

bleu cheese + 1/2 pear

Again, pairing carbohydrate with protein and fat is a good nutrition move. It’s usually recommended to stay away from blue cheese (unless you can guarantee it was pasteurized adequately) once you’re pregnant.

lamb/guinness stew with rutabegas, carrots, potato; slice of whole wheat sunflower toast

The lamb here is a good source of iron, which has been a little low the rest of the day. The whole grain toast is a good way to sneak in some fiber to help keep you from getting hungry late at night.

so delicious coconut milk ice cream sandwich (the mini kind - 100 kcals of awesomeneness)

Fabulous. [I love these]. Having something to satisfy your sweet tooth, or something you see as a ‘treat’, is important to make sure you don’t feel deprived and to round out your intake for the day.

It’s hard to judge portion sizes from pictures, but the only thing I’d be concerned about here is that you’re getting enough calories, especially if you’re active. Sarah’s on the small side, so this may be just the right amount for her, but in general, make sure you’re eating enough!

* * * * * * *

i hope this was useful to some of you -- i know it was to me (although i am sobbing into my coffee right now thinking about switching it to half-caf). heather, thank you so much for an interesting an informative post!


  1. This was fantastic and so useful! Thank you, thank you so much, Sarah and Heather!

  2. Thanks Sarah and Heather. I guess I'm putting 1/2 caf coffee on the grocery list, too (booo!). Conception is such a frustrating thing. There are so many young women (and girls!) who get pregnant who aren't ready and aren't taking care of themselves, and then there are so many of us who are ready and want to have a baby desperately and it doesn't come easy.

  3. wow, this was a great post. thanks both of you for it! i really had never considered a man's diet and the impact it might have on getting pregnant.

  4. Anonymous11:41 AM

    Very interesting post. I always enjoy reading your thoughts and now Heather is icing on the cake (food blog pun)

  5. Great post! I'm definitely not TTC anytime soon, but I've always wondered about alcohol prior to conception since I'm sure it has played a role in a few of these little kids running around...ha.

  6. I just found your blog---and I really enjoyed this post! I love the educational side of healthy living blogs, and although I'm not trying to get preg, it's still all very interesting to me!

  7. really liked these tips :)

    I'll have to book mark this and come back 4 years later because I most definitely am trying to NOT get pregnant while I'm in school and Brad is expecting us to start a family immediately up on graduation!

  8. oh my goodness. I wil definitely need to book mark this. thanks for a fabulous guest post!

  9. Great post! Now you can put about 8x more almond butter on those waffles to get extra calories. ;)

  10. what an informative post! this is awesome. i'm not TTC but i really enjoyed reading this post. someday in the future i might.

  11. Anonymous5:13 PM

    Great post. Two years ago I had to give up coffee b/c it was exacerbating a health issue. I remember asking my doctor, can people really live without coffee? First I switched to half caf, then decaf, then black tea, green tea and I was still being affected by the caffeine. I then switched to an outstanding white early grey tea that I spend far too much money on and I beat my health issue. It was hard, hard, hard. I even had dreams of drinking coffee. But now 2 years out, I can say that people can live without drinking coffee and can actually be quite happy doing so. Also, I was drinking nearly a pot a day.............Hang in there an good luck!

  12. So informative! I'll definitely tuck these tips away for when I'm actually thinking about having a baby. Thanks Sarah and Heather!

  13. atilla8:52 PM

    I thank god for my coffee full caf and all day...my drug of choice but if I had to stop for health issues I guess I would

  14. Great post, I had no idea caffeine can sneak in and pile up so easily.

    On a totally different note,Sarah , I just tagged you for the stylish blogger award on my blog, check it out!

  15. It's important for pregnant women to always be healthy. Eating the right food and taking prenatal vitamins are the best for them.

  16. Great post! I was wondering though, about not drinking between ovulation and the first missed period - how would that really affect the fetus? I mean, there is no blood vessels connecting the mother to the fetus yet, and all of the nutrients are provided by the yolk sac. What is your take on that?

  17. priyanka: thank you!!

    jenny: i definitely agree that it would not be likely to affect the fetus in any adverse way (as in fetal alcohol syndrome), but i could imagine that the systemic effect could have an impact on whether the pregnancy is sustained. (that's what some of the lay-sources say but i have not done the scientific legwork to see if it's really been shown!)

  18. Great suggestions! I think women sometimes forget to think about their health and nutrition before even trying to get pregnant, but there's so much value in taking these topics into consideration as soon as a baby is even a possibility.

  19. Anonymous9:59 AM

    So how do you quantify all this in your life? Your diabetic pts. have to watch what they eat on a meal by meal basis. Your ICU patients get I/O done twice a shift and their diets are carefully monitored, yet it would seem the focus on TTC in the discussion has now become "caf v. half caf". The amount of protein you need is the "minimum" but what is your personal minimum? How much are you actually eating per day? I actually know how much I eat per day, in fact per meal I know because I am trying to effect the hormonal environment in my body towards anabolism and that is important to me. It seems to me if you are trying to effect the hormonal environment in your body to be most amenable to conception with food, rest, and moderating your exercise you would devise some measures to try and trend this.

    You are uniquely qualified to BE an experiment and in being the experiment your experience may help thousands. What can you measure easily? Weight, daily temp fluctuations, activity log, food log with macronutrient breakdown, sleep log, maybe alcohol consumption, given the recent data on the stress reaction to prolonged periods watching TV or playing video games, maybe a media log, simple things to measure. Maybe a little more involved cortisol levels, CRP, blood pressure heart rate RR etc

    I've suffered several injuries during my athletic career. I work with orthopedic surgeons every day and I have worked with PT's and trainers. But in the end it was ME who devised the plans most successful for my rehabilitation. I had to become my own expert and I had to do the work of actually doing the rehab. In becoming MY own expert I learned a lot of rational solutions that I can now share with others. One thing I found is if I am pretty anal about maintaining an anabolic diet during injury I heal better.

    If you figure this out, you in fact could become a world expert in the area of dietary manipulation and TTC and you would then be able to write books or articles and do speaking and make a difference in the lives of couples who are TTC. This is not trivial.

    The potential is there if you choose to engage it, and in fact some kind of study could all be developed via the internet with motivated couples spread across the country.

  20. anonymous: wow -- thank you for your thoughts. i guess i'm just not ready to add this level of quantification to my life. (i think i tend towards ocd too much already!). i also truly hope that my fertility experiment doesn't have to LAST that long (ie, that i won't have months of pre-prenatal data . . . i'd like things to just work already!). you made a comment about protein, though, and i do wonder whether my intake could use a boost. i will ask the RD what she thinks about that when i see her (if they ever get back to me!)

  21. Anonymous7:51 PM

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