Healthy Eating During Pregnancy

An Interview with Susan Levin MS, RD

Susan Levin MS, RD
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Is Feeding Your Children Meat and Dairy Sabotage

Director of nutrition education for The Physicians Committee for Responsible Medicine, Ms. Levin researches and writes about the connection between plant-based diets and a reduced chronic disease risk. Ms. Levin assists in teaching nutrition and health classes to participants in clinical studies exploring the links between diet and various medical conditions.

In the world of gestational diabetes it’s not only not necessary it’s not ideal, eating animal products comes with it’s own hosts of risks for anybody. But, especially for somebody who might be at risk for gestational diabetes. You want to go into a pregnancy as healthy as possible and that means eating the healthiest diet we know exists and we know that diet is a plant based low fat diet. For gestational you want to minimize your risk because once you’re diagnosed your options are pretty limited. Meat and dairy products puts you at risk in the sense that some risk factors for it, things that are not controllable like your age, your genes. Some of the risk factors that are controllable include your blood pressure and weight, we know from research that people who follow vegan diets are the healthiest weight category, that’s where you want to be when you get pregnant.

This is the ideal scenario to be prepared for pregnancy to be as healthy as possible and keeping your blood pressure in a normal range. Again we know a plant based diet is a way to have that normal blood pressure range. What’s so interesting to me about pregnancy and being a Mother is that we suddenly become more interested in our fetuses health than our own. I always tell people the things you don’t want to expose your child to for example fish, fish comes with a lot of risk factors if your pregnant because it has a buildup of toxins in it. To me, why would I want to expose myself, it’s not that it’s healthy for you, it’s bad for the fetus, it’s bad for everybody. Avoiding the animal products especially things like fish, you don’t need to expose yourself to those risks when you can get those same nutrients that they say are good in fish you can get from plant sources with no risk at all and actually comes with benefits. It comes with fiber, antioxidants, phytochemicals, all the things you want to have in your body especially when your pregnant.

For nutrients like calcium, yes there is a lot of calcium in dairy products, but there is also a lot of saturated fat, cholesterol and other toxins in animal protein which comes with other risks. You can get that calcium where that cow got the calcium eating dark leafy greens. You can get it from beans, these are food sources that not only come with no risk associated but they come with other benefits. The ability to make your insulin more sensitive, make you full on fewer calories, keep your digestion clean, and fast. For someone whose pregnant not being constipated is a pretty good side effect, so get your calcium from plant sources. With iron people who follow plant based diets actually consume more iron than people who follow omnivorous diets, it’s just a different kind of iron, it’s a non-heme iron. Being sure to eat different types of leafy greens like your spinach and your chard, lentils and beans, your going to have all these amazing minerals that you need and are very helpful for you.

There’s heme, which means blood, heme iron from the blood of animals and non-heme that comes from plants. The heme iron, to put a positive spin on it, is highly absorbable, but, to be frank it’s almost over-absorbable. Your body has no mechanism to regulate absorption of heme iron, it gets absorbed whether you need it or not. That’s not necessarily a good thing because iron can be toxic, high levels are associated with cancer, diabetes and heart disease as well. You never want to overdo iron. Non-heme iron, when you eat a plant that’s high in iron, and there’s lots of iron in your plant foods, because it’s not heme your body knows exactly what to do. It recognizes it and it recognizes not to absorb it if you have enough in your system already. People who worry they have too low iron stores, or their on the low side, personally I think that’s a good thing, you don’t want to be high normal with something that’s associated with chronic diseases.

The sources from plant foods are so healthy they don’t come with those side effects and those high risks that the other sources that have the heme iron do. For anyone who’s diagnosed with anemia there may be a situation where you need to supplement with iron but, I would do it with extreme caution and I would do it with the supervision of a clinician to make sure your iron is stable and where it needs to be. Ideally you could build up your iron stores to normal level with food, non-heme iron sources, because it’s safer. It’s especially important for pregnant woman with so much hype about making sure you have enough iron. Your blood volume grows so much that it might diffuse your iron so much that it might look like you’re anemic. In that case just eat more plants and non-heme sources and your body will figure out how much you need.

Don’t go crazy with the supplements, sometimes those prenatal vitamins are packed pretty high with iron so just be cautious. With essential fatty acids if you just eat lot’s of plants foods and a variety of them your going to get this perfect ratio of omega 6 to omega 3 which is what it’s all about. It’s about converting your omega 4 to it’s elongated form, the DHA and the EPA. When you get those elongated forms of omega 3s you have all the benefits to your brain health and your fetus has the benefits. You have to eat those sources in the right ratio, overdo your omega 6 it doesn’t allow your omega 3s to elongate to it’s better forms. Plants because their fats are in that perfect ratio there like 1-2, 1-1, 1-3, and the recommendation is 1-4, 3-6. If you go more to the 1-3, 1-2, you’re doing even better. If you’re not sure and when you’re pregnant it’s not the best time to try and figure out if you’re doing it right. If you’re not sure take an algae derived EPA, DHA, that’s safe. You don’t want to take too much of that either, if you take a range that’s within the recommended amount you should be fine.

The government recommended ratio of omega 3 to omega 6 is a 1-4 and most of us eat a 1-10 so we’re not doing so good. The resolution proposed mostly by marketing is you need to jack up your 3s to get them into that range but really we just need to pull down our 6s and pull down all our other fats. What we find naturally in the plant food sources is what you’re getting. What’s so great is you don’t even have to think about it, it’s like everything with a plant based, low fat, not a lot of oils, vegan diet, it all just kind of works out in your favor, you’re getting exactly what you need. The actual amount of omega 3s that you need in your diet is very tiny, it’s the elongation that’s really critical. If all of your other fats are low, that’s what your doing if you’re eating plants, I’m not talking about coconut oil and avocados but all the other plants non-tropical plants you’re going to be in that perfect range. However, if you find yourself unable to avoid olive oil and all these other fats in your diet maybe you need to think about eating more walnuts and flax seeds because those are concentrated sources of omega 3 and that’s what I need in my diet to compensate for all the other fats that I’m eating.

A mother will know if she has gestational diabetes because she is tested around 24-28 weeks. The clinician will give her a pretty unsavory tasting drink test to see how her blood sugars react, that’s pretty standard whether you’re at risk or not. When I was pregnant and being very cautious about what went into my body I refused the drink so they let me prick my finger three times a day for a week just to make sure my blood sugars were reacting well to all the foods I ate. That may be another option for people.

Preventing gestational diabetes there are some risk factors that are unavoidable, I mentioned genetics, your age. But, some risk factors are in your control that includes your body weight going into pregnancy and your blood pressure. We know from all sorts of data if you follow a low fat plant based diet, a vegan diet, you’re more likely to be in the healthy body weight range than if you don’t. Eating a healthy plant based diet your more likely to have a healthy BMI that puts you at less risk. You’re more likely to have a normal blood pressure range, which high blood pressure can also be a risk for developing gestational diabetes. If you are diagnosed with gestational diabetes then you not only have to start thinking about how to control it while you’re pregnant but how to minimize your risk for developing Type 2 after the pregnancy. Because even though once the baby is born, that gestational diabetes disappears so to speak, you are much higher risk for developing Type 2. The goal at that point if you haven’t already, is to develop the healthiest diet possible to minimize your risk because frankly the likelihood of developing Type 2 after gestational is very high.

Once your diagnosed with gestational you can have better control but you can’t fix it at that point, you can’t beat yourself up, at that point you have to keep very strict blood sugar control. It’s different advice than people who develop Type 2 when they’re non-pregnant. Because at that point if you have an out of control blood sugar reading once and it comes in control when you’re diet improves it’s not such a big deal. But that’s not something that you want to play around with when you’re pregnant, it can be very harmful to the fetus. Gestational need to be just managed because to me it looks like Type 1 and it’s not a time to try to fix or reverse. Even though it acts more like a Type 2 insulin sensitivity issue, your thinking needs to be more about control at that point.

Morning sickness is very normal and natural and some research shows beneficial to the outcome of the child once he or she is born. However, there has been some research to show an association to the intake of saturated fat and extreme morning sickness. While I would never advise anyone to eat a lot of saturated fat anyway, but if you’re pregnant and you’re feeling ill maybe it’s the time to analyze if you’re eating a lot of saturated fat. What’s even more interesting about morning sickness is the research showing that it may be a manifestation of the biological wisdom to avoid eating animal products because they are the number one source of food pathogens. And at that vulnerable state, the first trimester when morning sickness develops, the last thing you want is a pathogen in your system that could potentially harm that fetus. There is also some research to show that populations who don’t eat a lot of animal products don’t have morning sickness. I had no morning sickness during my pregnancy being a vegan for twenty plus years. There is so much evidence for a vegan diet, you can’t believe anyone out there with a medical degree who can open a medical journal and isn’t advocating for this with all the evidence.

From population studies, case control studies and anecdotally peoples stories. I think that it’s slowly changing because some of the mainstream position are drastically different than they were 10-20 years ago. Even the dietary guidelines for Americans which has to be filtered through the USDA of all organizations, says a vegetarian diet is a healthful eating pattern that people should be following. And it has a vegan index in the back to show you how to do it. If that’s the USDA speaking believe you me the last thing in their financial interest is having people eating a vegan diet, the science must be pretty rock solid that they just can’t even avoid it. Even the Academy of Nutrition and Dietetics, the governing body for registered dieticians, has a position paper that says vegan diets are not only healthful and adequate they’re beneficial in terms of dealing with diseases like diabetes, heart disease and cancer. They’re beneficial for children and pregnant people, slowly it’s changing. More and more health professionals will be reading and realizing what they learned in their younger years might not be completely accurate.

We know from small studies, from large reviews, that eating a plant based diet is beneficial on lowering blood pressure. In fact a staple dietary recommendation for people with hypertension is the DASH diet, dietary approach to stop hypertension, it’s foundation is a vegetarian diet. There was a review recently looking at blood pressure comparing plant based and non plant based, the plant based did better. If you’re at risk for high blood pressure, or have high blood pressure before you get pregnant, you want to handle that with a healthy dietary pattern. If you are pregnant and your blood pressure goes up you want to adopt this low fat plant based diet. In terms of preeclampsia one of the only studies I know was done on this community of midwives in Tennessee called the farm, they use a completely vegan diet. A researcher went down there to look at the outcomes of the pregnancies and in terms of preeclampsia there was virtually none compared to what you would see in the best hospitals in the country. There was maybe one case out of eight hundred, but it was just statistically what you don’t see, it not only speaks for midwifery but it also speaks for the diet. There was actually a documentary done on the farm and it’s on you-tube called birth story Ina May Gaskin

Postpartum we know that children who eat plant based diets do better, you’ll be surprised to hear they eat fewer salty and sweet snacks, they eat more fruits and vegetables. They grow up with less risk for obesity, they grow up more likely to continue eating a healthy diet and having healthy body weight. Which body weight is associated with every chronic disease from which we suffer in America anyway. Getting kids started eating this way early is probably your best bet for long term health problems, not just short term because you get those too. Yes, for the naysayers it’s perfectly safe to raise a child on a vegan, plant based diet, absolutely, it’s completely adequate. Again the ADA, Academy of Nutrition and Dietetics, has a position on this very topic, it’s looked at all the research and all the research says it’s completely safe. You can get all your nutrition on this diet with one exception that’s B12, this must be supplemented when your vegan. A step beyond that is it’s better, these kids eat better, they do better in terms of eating more fruits and vegetables. Everybody’s goal in the world is how to get kids to eat more fruits and vegetables, maybe this is the secret you just get them to eat plants in the beginning setting them up for life long habits  and there is research to back that up as well.

There is decades of misinformation trying to convince people you absolutely have to drink milk from a cow, it’s asinine but we believe it, dieticians have been hearing this all their lives. We are inundated with this information, since kindergarten all the nutrition information has been sponsored by dairy. Once you read the science it just doesn’t pan out, it’s not there, no science to back any of that up. Heart disease really is a disease of time, start now because it’s not normal to have a heart attack in your forties and people think it’s normal. It’s a buildup of years of a bad diet, there is research showing it’s happening in children younger than ten, bad things happening in utero to a babies heart when mother’s don’t eat well. It’s critical in utero, it’s critical in infants, toddlers, children, but I want to encourage people it’s never too late. There is research to show you can also reverse the damage that you have done over the years, that’s important too.
When I was pregnant on a vegan diet I didn’t have any cravings, I wasn’t super hungry because I felt so full, full of baby. I did make sure that when I did eat it was nutrient packed, I didn’t want to waste my calories if I didn’t have that big of an appetite. I knew I needed more protein so I ate beans, whole grains, tofu, fruit, it was a pretty normal me diet. After having the baby and nursing I was hungry all the time, the weight was dropping off eating all I want. My son is almost two and starting to eat what we eat at the table, no meat, dairy or fish, I just know too much.

There are benefits when starting from an omnivorous diet to vegetarian to vegan, the risk declines with the less animal products you have in your diet. That tells me that there is a spectrum here that if you reduce the animal products you will see benefits, you don’t see all the benefits a vegan will but you are remiss to think it’s all or nothing.

My advice to a pregnant woman or one that just delivered is to look at your diet now and tweak it, change the marinara and meatballs to marinara and vegetables. If you like your oatmeal with milk in the morning just try almond milk and some berries, make small tweaks to what you’re already comfortable with. When you start to learn more and read more about the varieties of different kinds of lentils and beans, all these grains and vegetables and fruits. Your options increase a hundred fold, from what I was eating as a child, omnivorous, to what I eat now. Realize it’s not a diet of what you’re not eating it’s a diet about what you will be eating. You’re not going to believe it, forget how good you’re going to feel and maybe how good you’re going to look. All that is just side effects to eating a more varied and delicious diet, start small, I was an all or nothing kind of person but you can ease into it.

The information contained on this site is for educational purposes only and should not be used as a substitute for diagnosis from a licensed physician. It is essential that you discuss with your doctor any symptoms or medical problems you may be experiencing.

M. Scherker medical researcher