Confessions of a Pregnant Doctor Part 2: Nutrition, Food Safety and Solutions for Nausea
In part 2 of this ongoing series, pregnant doctor Cheryl Kam shares her secrets to avoiding nausea, eating well, and steering clear of environmental nastiest.
In part 2 of this 3-part series, Dr Cheryl Kam discusses how she's avoided nausea, her personal recommendations for the best prenatal vitamins, and why it's important to eat the rainbow.
You are what your mother ate...
I’ve been extremely fortunate with my energy and appetite and I wish the same for all mamas out there! I attribute it to having actively addressed any nutritional weak spots before conception as pregnancy is not a time to go on any elimination or fancy detox diets.
Nutrition has been proven to play a huge part in fertility, pregnancy and birth outcomes. Maternal nutrition is also linked to a person's chances of chronic disease decades down the line.
On our dinner plates lie the destinies of our great grandchildren!
One forthcoming large study - the Nipper Study - designed to study the effect of nutrients and probiotics in the prenatal and antenatal periods on the epigenetic outcomes of children, is recruiting from NUH in Singapore, the UK and New Zealand. You might be eligible for the study so let them know if you’re keen to participate!
Achieving your protein and nutrient goals
The ideal daily protein intake for a pregnant woman is at least 75g, and I found this really difficult to hit without drinking my eggs, Singaporean style. God bless Ya Kun Kaya!
I love runny eggs; fortunately undercooked eggs have recently been cleared from Salmonella risk (a legacy from a breakout back in 1989) in the UK. In Singapore pasteurised eggs are available at supermarkets.
Furthermore, despite its cholesterol content, people who eat eggs had lower blood cholesterol than those that didn't eat eggs!
Each egg contains a good 6g of protein and is like an antenatal pill in a shell. It is a source of selenium, vitamin D, B6, B12 and minerals such as zinc, iron and copper, choline.
So despite the prevailing nutrition trends, I found it easiest to get an all rounded nutrition with a daily serving of two whole eggs, a glass of cow's milk (three cheers for Paris Creek Farm and their predominantly A2 casein producing cows), colourful vegetables, red meat, whole grains of sorts and plenty of small fish such as sardines for omega 3 fatty acids. I would regulate my intake of big fish too high on the food chain (such as swordfish or tuna) due to their tendency for mercury build up.
"Eat all the colours of the rainbow," I began, to the stringy 10 year old brought in by his mum for being a fussy eater. And I jolly well took my own advice!
Purple skinned sweet potatoes, red beans (antioxidant, protein) orange coloured vegetables and fruit (vitamin A), dark green leaves (iron, folate)...and on it goes.
Counting calories is so last season...
It's time to break out of the outdated calorie/cholesterol/fat counting as weight loss is not the goal in pregnancy, while getting a nutrient-dense diet is.
Start counting nutrients and colours and you're on the right track.
It is good to get a little geeky here as it is a well known fact that mums who eat well have less birth complications and healthier bubs.
I write down what I eat after every meal, and calculate my protein intake per day. No app I’ve tried so far got me this aware and empowered about my nutrition choices.
Pen, paper and mental sums! Just do it.
A note about Essence of chicken
Essence of chicken has been a firm Asian health boost for generations and is loosely what nutritionists call "bone broth". It is traditionally made by slow cooking a whole chicken without adding any water, collecting whatever fluid comes out of it, removing the fat and concentrating it 3-4 times.
It contains a wonderful array of essential amino acids that are indeed good for your gut and nutritional status. Even though there are only the beginnings of formal studies to prove its effects, the basic principles make great sense.
Leading brand sells a box of 12 chickeny shots for $35 dollars, and often with bulk discounts.
I'm vegetarian/vegan/celiac/dairy intolerant...
Those with true dietary restrictions need to obtain a well-rounded nutrition as much as possible with whole foods.
Having a good sit down with a nutritionist or doctor with a special interest in nutrition will set you and your family up for success.
Nutritionist Karin Reiter from Nutritious N Delicious has a fabulously balanced view on nutrition in pregnancy in special populations, and is one of the best around for a session of practical meal planning with you.
A bit about Gestational Diabetes
Letting your guard down on simple carbs and sugars increases one's risk of developing gestational diabetes no matter how skinny you are, and may take some by surprise when they get their OGTT done around the 28 week mark.
What foods are bad news and which are kind of "okay"?
With regards to keeping baby safe, I present the baddies:
Over 2 units of alcohol more than twice a week
Over 200mg caffeine a day (more two cups of coffee)
Unpasteurised "raw" dairy products, such as left out salads, raw sprouts and uncooked foods as they may contain Listeria, E. Coli, Cambylobacter or Salmonella.
Listeria is the worst of the lot and while it is rare, pregnant women are over 10 times more susceptible to an infection. Furthermore, symptoms of infection can range from mild to severe. We may not realise we have been infected, yet it is able to cause miscarriage, premature birth and death in utero.
Listeria is a bacteria found in contaminated soil and water as well as in uncooked meats, uncooked vegetables, unpasteurised dairy, pates and processed foods. Packed salads and sandwiches are bad news, too, so lay off the cold cuts if you can.
The current rate of new listeriosis infections during pregnancy in the USA is 17%.
On the other hand do be balanced about your indulgences and don't fret to the point of anxiety.
I have myself enjoyed a good sashimi here and there from trustworthy sources, eaten a beautiful grassfed steak with a bit of pink in it, and enjoyed sipping on a cup of English Breakfast tea (75mg caffeine) during the day.
How about other nasty bugs out there?
If you are not immune, stay away from anyone with chicken pox, shingles, and unvaccinated kids (Rubella and chicken pox during pregnancy are linked to birth defects, miscarriage, stillbirths).
While you’re at it, get someone else to clear the cat litter or do the dirty gardening (Toxoplasmosis) and be extra vigilant against mozzies (Dengue, Chikugunya, Zika, Malaria).
Thoughts on herbs and medicines?
After the fragile first trimester had passed, I've brewed myself the occasional raspberry leaf tea, Korean ginseng and Goji berry (Wolfberry) tea.
Despite my interest in botanical medicine, no herbs to date have been as well researched as drugs. I would therefore err on the side of caution, using herbs personally only in moderation or in my medical practice when the clinical benefits far outweigh the risks.
Over the counter pain and cold medicines
The Infantrisk Centre app is an excellent and up to date resource for safety of drugs and supplements in pregnancy and breastfeeding.
As a general rule, Paracetamol, antihistamines such as Chlorpheniramine (Piriton) and Fexofenadine (Telfast), Gaviscon and other antacids, Charcoal and oral rehydration salts are OK. Decongestants or anything stronger than an antihistamine for a runny or blocked nose, certain acne creams and tablets that contain retinol are to be avoided. Further to that do seek your GP's advice.
Prenatal Vitamins -- essential?
It is incredibly difficult to check all the boxes for nutrients, every single day, given we are also dealing with nausea, taste and energy fluctuations.
Food is medicine and all that, but try getting 30-60mg of iron daily from servings of beef or liver, it's actually tiring! And if you're already deficient, that's going to be an impossible number of cows.
At the absolute minimum, take 400mcg folate in the form of folinic acid or methyltetrahydrofolate (MTHF) daily from a month prior to conception til at least 12weeks' gestation, as this is the time when baby's neural tubes are being formed.
Often on top of the basic prenatal you may need additional Iron, Vitamin D, B vitamins, Zinc, Magnesium and Omega fish oils as our needs for these go up in the later stages of pregnancy and in breastfeeding.
I love Thorne Research's Basic Prenatal, as it has safe and effective doses of nutrients that target weak spots in pregnancy, tough to obtain from just foods alone.
I suspect I'm lacking in some nutrients but am not sure what...
Being nutritionally deficient is not much fun when you're already trying your darned best to grow a human.
This is an important time to consult with your integrative medical physician, to get your nutrition and additional supplements tailored exactly to your needs.
Some people would like a broad recommendation and that is indeed fine, however if you are excessively fatigued or have issues with immunity during pregnancy it is likely you have more severe deficiencies and blood levels are best tested, therapeutic doses used, and the condition monitored. Taking a multi alone will not save you from a severe B12 deficiency, for example.
I'm not eating anything at all and my tastes have gone awry, but I do take my prenatals! Is this OK?
Sadly, pills will never replace whole foods; studies show a worse outcome when you try to do that.
Combining real actual food with good quality supplements are the way most of us in this millenium will strike a balance.
Why in today's world we need so many supplements and whether it's a sign our soils are simply deplete from irresponsible over-farming, is another story altogether.
So I'm making a huge effort at ditching the empty (and deliciously starchy!) calories, and eating a rainbow of whole, unprocessed foods to ensure my amniotic fluid yields a buffet of tastes. Apparently baby won’t grow up picky if he’s tasted it in the waters of his incubation pod...
But really, doc, this nausea is real!
A thumb of ginger ground into warm water, or as dried candy, has time and again been shown to be magical for nausea from all causes.
Another anti-nausea remedy is 25mg Pyridoxine (Vitamin B6). Good prenatal vitamins will already have an easy absorbable form of B6 in their formulas.
Try splitting 3 meals into 5 small dry meals and skip having soup or drinks with meals, as that bloats you quickly even before any nutrition has got its chance in. Don't forget to plan your fluid intake for between meals instead.
If those measures fail, do consult your GP or Gynae for options.
Other toxins, and keepin’ it real
BPA-free plastic bottles, have 99 other problems with xenohormones even if BPA ain't one. Use glass, silicone or stainless steel and don't wear makeup if you really are worried. Toxins are everywhere!
Even your ultrasound generates heat. How much? How safe?
Should I even be using aluminium foil to wrap stuff anymore?
Is this air I'm breathing even legit?
Before you fall down the rabbit hole of worries, take a breath. I simply conjured up the memory of experimenting with my first cigarette as a pre-teen and drinking myself to oblivion at an undeclarable young age, which I expect every kid to experience, without a shred of thought to the extreme measures my mum went through to "avoid toxins".
I felt transient relief from my scruple, had a wedge of blue cheese, a swig of the hub's Champagne and enjoyed the rest of my buffet brunch.
I hope happiness is a good antioxidant.
Keep your eyes peeled for part 3 - a juicy piece on bodily changes, stretch marks, sex and other mishaps!
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