Pregnancy Nutrition: The Basics

I was honored to have written a 3-part series on pregnancy nutrition for a great product for expectant moms.  The product is called Ritmo™ which is a sound system belt that transmits songs and stories to your baby.  I wanted to share these articles with Mommy Dietitian readers, and with the posting here, you get a bonus healthy weight gain section.  Feel free to pass them along to anyone you know that is pregnant or even thinking about becoming pregnant.

Pregnancy Nutrition: THE BASICS

Congratulations on your pregnancy! Whether it is your first child or you have been pregnant before, it is thrilling news to find out you are having a baby. As a mother of a 3 year old and a 6 year old, I can attest to the road you are on this very minute. I remember the excitement and joy, but also remember the fear of the unknown. Relax! Any new adventure naturally comes with it some fear. It is very normal. The great news is that your body knows exactly what to do in order to grow this baby. My advice is follow some basic guidelines in nutrition so you can provide the fuel required to start this baby’s life off on the right foot.

Pregnancy is certainly a great motivator to eat smart. Balanced nutrition will yield a healthy body weight and will also help you achieve the vital nutrients you and your baby need during this incredible time of growth. It amazes me to know that the blood volume in our bodies increase 45-50% in pregnancy! This increase is needed for extra blood flow to the uterus, higher metabolic needs of the fetus, and increased perfusion of other organs, especially your kidneys. All of this requires proper nutrition. We will touch on the basics of pregnancy nutrition in this article so you can hit the ground running in the right direction.

Proper Weight Gain. Studies show that gaining the right amount of weight really helps your baby in being born a normal weight. Low weight gains, especially in underweight women, are associated with increased risk of perinatal mortality and low birth weights. High weight gains, particularly in obese women, are associated with increased risk of birth weight , longer labor times, complicated deliveries and birth traumas. The first thing you want to do is figure out what your body mass index (BMI) was before getting pregnant. Once you get that BMI number, look at the table below to establish what the weight gain recommendations are for you. Your obstetrician will weigh you periodically to make sure you are on the right track.

Step 1: Figure Out Your Pre-Pregnancy Body Mass Index (BMI)
http://www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.pdf

Step 2: Follow Recommendations for Total and Rate of Weight Gain During Pregnancy, by Prepregnancy BMI















5 Key Nutrients during Pregnancy. Nutrition needs increase during pregnancy due to rapid fetal growth, and there are some key nutrients that you should focus on while you are pregnant.

Folic Acid. Folic acid, folate or less known as vitamin B9, is critical in pregnancy nutrition. Folic acid supports reactions required for rapid cell division, carbon transfers and maintenance of red blood cells during the fetal growth process. Normal female needs are 400mcg, but daily pregnancy needs are 600mcg. Due to the critical nature of this nutrient during pregnancy, it is recommended that all pregnant women take 400mcg of a folic acid supplement to ensure adequacy (if taking a prenatal vitamin, the folic acid requirements should be included). However, foods that are high in folic acid include fruits and vegetables (especially leafy greens), whole grains and fortified cereals.

Iron. Due to the increase in blood volume as mentioned above, iron needs increase during pregnancy from 18mg to 27mg for most pregnant women.* As you progress in your pregnancy, you are at higher risk of becoming anemic due to the increased growth of the baby. Your doctor will do hematocrit finger pricks to check iron status. It is good to be mindful of foods that are naturally high in iron – such as beans, lentils, cooked spinach, fish, nuts, dried fruits, beef and other meats. There is an increase in high iron foods such as tofu of which ½ cup provides 13.2mg. Non-animal sources contain a type of iron that requires Vitamin C for absorption. Iron and calcium fight for absorption so as able, separate high iron foods from foods that are high in calcium.

Zinc. Zinc plays a vital role in protein synthesis, cell division, hormone metabolism and immune function. These bodily functions are highly utilized during pregnancy. Therefore, needs go up from 8mg to 11mg per day.* Vegetarians, depending how restrictive, may need to consider supplementation. Foods high in zinc that are recommended for pregnant women are red meat, poultry, eggs, pork, nuts, pumpkin seeds, summer squash, asparagus, chard, collard greens and broccoli.

Calcium & Vitamin D. Although needs do not increase during pregnancy, calcium (1000mg per day) and vitamin D (200-400mg per day, but amounts currently under review) are essential to bone mineralization and metabolism. Unfortunately, many women do not get adequate levels so purposeful intake is advised. Foods high in calcium are dairy foods, spinach, collard greens, soy, rhubarb and fortified cereals. Vitamin D is mostly found in dairy foods, fatty fish such as salmon and tuna; fortified foods, mushrooms and animal fat such as butter. Sunshine is an excellent source of vitamin D, so consider 15-20 minutes of daily sunshine to help achieve minimum levels.

Making a pregnancy meal plan. In general, a typical pattern should include 3 meals and 2-3 snacks each day to keep your body running well. The amounts of each type of food really depend based on your individual calorie and nutrient needs. If you are feeling nauseous, try and focus on foods that have more mild smells, spices and flavors. With my daughter, all I felt was a little nausea in the first trimester. With my son, I was very sensitive to smells and even remember changing my mind about foods mid-meal. Yuck! No worries, just make some adjustments if this happens to you. Plan around your aversions as much as you can. Overall, it is good to think this way for each meal and snack:

Breakfast: Dairy, protein, fruit, grain, healthy fat
Lunch & Dinner: Protein, vegetable, fruit, grains, dairy, healthy fat
Snacks (2-3): Protein, grains, fruit or vegetable, healthy fat

Balanced nutrition in pregnancy allows moms to
enjoy decadent treats. Here I am, pregnant with my son,
Evan, pretty excited about my baby shower cake.

Although the MyPyramid website is dynamic, a great way to get a plan that is perfect for you is to consult with a local Registered Dietitian (RD) that specializes in pregnancy nutrition. This is especially important if you have pre-existing health conditions, are having trouble getting nutrients in due to hormonal illness or have special dietary needs.

With a little proper planning and considering, you and your baby will be off on a healthy, exciting adventure. Be sure to cherish these days, write thoughts and feelings down – and above all, enjoy and appreciate this great miracle that is occurring inside your body right now. Blessings of good health to you and baby!

Linked Resources:
*Complete list of the Dietary Reference Intakes (DRIs) in Pregnancy

MyPyramid Plan for Moms

Expect the Best with Elizabeth Ward, MS, RD

Produce Variety Assurance (PVA)

Does your family have produce variety assurance (PVA)? Don’t worry. It’s a new term that I just randomly coined, but involves an important consideration. We often talk about the importance of produce and even variety within that produce, but are we really living this out in our daily lives? I recently had to ask myself that very question for my own family. Do we regularly consume fruits and vegetables? I am happy to report -yes! Do we alternate the varieties of differing kinds of produce? Hmm. Not always. We adore fresh produce and eat them regularly, but we’re like most people. We are creatures of habit! We still have that tendency to flock to our family favorites. I like to pick up some different stuff here and there, but then I slowly start going back to my habitual varieties. That’s when one of my patient’s mothers told me about a thriving local produce co-op here in the area. I immediately joined because I knew this was our family’s answer to PVA.


I just love the concept of produce-co-ops and community supported agriculture (CSA) groups for so many reasons. They bring local families together in mutual admiration for fresh foods and they promote grassroot efforts to support farmers and agriculture. Today I get to pick up my “share” of produce – whatever that may be- which will dictate our family’s menu over the next 2 weeks. What a great way to keep our experiences with food new, interesting and rich in all kinds of colorful varieties.

Our 1/2 share of  of produce via Your Health Source  food co-op.
This delivery, we opted for a full share of produce, which will be
double content.  We look forward to what we'll get this time!

Your Health Source is a family-run food co-op that coordinates the delivery of USDA certified and if possible, local produce for a variety of areas in Texas, into Oklahoma and Colorado. You can also order fresh grains, meats and other foods - and have access to health communities and recipes through e-mail distribution. I recently caught up with Monica Brown to find more information about Your Health Source. They started the co-op 9 years ago when she moved away from what she calls the “standard American diet”. The increase of fruits and vegetables in her family yielded life-changing health benefits for each family member, including helping one of her son’s behavioral problems and solving her own digestion issues. Aside from the nutritional benefits, Monica admits that one of the best benefits to her family has been the new friendships they have formed. “I know people today that I would have never known if it weren’t for the co-op. I rarely make a friend at the grocery store – but at co-op, I have friends for a lifetime now.” Monica is also appreciative that her children have had the benefit of witnessing so many families striving to make healthy choices. Her and her husband see their co-op as a way to serve families everywhere that yield the highest of health benefits. It is families like the Brown’s that inspire us all to make health investments in our local communities. After all, it is one of the many things First Lady Michelle Obama encourages in the Let’s Move initiative to fight childhood obesity.

If you want to promote PVA in your family, consider joining a produce co-op, community supported agriculture (CSA) group, schedule regular visits at your local farmer’s market or just reach out to a local farmer. What a great way to expose your children and family to the colors of the produce rainbow! If you have anything to share on the subject, I would love to hear from you.

For more information on The Brown Family’s co-op, go to their website below. A special thanks to my friend and dietitian colleague, Robin Plotkin, for giving me the Edible Communities websites below. What a wonderful resource for us all.

Online Resources for Produce Co-ops, CSAs, Organic and Local Foods

Your Health Source Co-Op: http://www.yourhealthsource.org/
Local Harvest: http://www.localharvest.org/
USDA's Farmer's Market search: http://apps.ams.usda.gov/FarmersMarkets/
Pick Texas: http://www.picktexas.com/
Edible DFW (for the Dallas/Fort Worth area): http://www.ediblecommunities.com/dallasfortworth/
Edible Communities (for all areas throughout the U.S.): http://www.editblecommunities.com/
USDA’s Fruits & Veggies More Matters (includes recipes by produce type): http://www.fruitsandveggiesmorematters.org/

Love Me A Blueberr-y!

I have fallen into a late love affair with blueberries.  Yep, even nutrition lovers like me still fall into those ruts of choosing the same "always" foods.  Guilty as charged - I have for the most part, passed over blueberries for no real reason.  Yes, this is a true and almost hard-to-believe confession.  After all, we all know the great health benefits of blueberries, right?  This great fruit is absolutely loaded with antioxidants, is high in fiber and a great source of Vitamin C.  Emerging research even reveals that it has a significant protective effect on cognitive decline.  They also help protect against urinary tract infections and other urinary diseases.  But here I was, dissin' those blueberries.  Until I got some "blues" in my produce coop share.  I thought to myself, "Hmmm....I wonder if the family will eat these?"  You see, my kids and husband absolutely adore their red counterparts - strawberries, and will eat an entire container within 24 hours.  We enjoy other berries as well, but blueberries have been the ignored ones until now.  I just need to remind myself that this is a new food for the family and resistance will be there.  My kids haven't been exposed much to blueberries and that is no fault of their own (uh-hem).  My task is to make blueberries tasty for all and I am ready for that challenge.  Dah-dah-dah-dah!

Blueberry Breakfast Salad
from Lynn's Paradise Cafe
Louisville, Kentucky

As for me, I have been popping blueberries since last Tuesday and they are now my snack buddies.  I really like the fact that they really aren't that sweet (I am a salty vs. sweety kinda person).  They have a wonderful tangy-to-mild taste without the intimidating "explosion" I so feared with these little round balls.  Recently, I jumped on the US Highbush Blueberry Council website and found some great blueberry recipes.  My personal favorite is the Breakfast Blueberry Salad that was submitted by Lynn's Cafe out of Louisville, Kentucky.  I like this served with some low-fat, low sugar regular or Greek yogurt.  Here it is for you to try (I took the salad portion down to serve one, the dressing to serve many salads):

Ingredients
1 1/2 cups mixed, torn salad greens
1/2 cup fresh blueberries
1/2 cup orange sections or canned mandarin oranges, drained
1/4 cup Granola
*Blueberry vinaigrette

*Blueberry Vinaigrette: In a food processor container, combine 1 cup olive oil, 1 cup blueberries, 1 tablespoon Dijon mustard, 2 tablespoons brown sugar, 2 teaspoons minced shallot, 3/4 teaspoon kosher salt, 1/2 teaspoon ground white pepper and 1/2 teaspoon paprika.  Provcess until mixture is smooth.  Chill at least 30 minutes to blend flavors.

Directions: Toss salad greens with 1 1/2 cups of the blueberry vinaigrette.  Arrange orange sections and blueberries on top of the salad.  Sprinkle each salad with granola.  Drizzle dressing on top.  Serve immediately.

Nutrition Information (without dressing): 192 calories, 2 fat, 0g saturated fat, 44g carbs, 7g fiber, 4g protein.  Daily Values: 135% Vitamin A, 110% Vitamin C, 8% Calcium, 10% Iron.

What is your favorite blueberry recipe?  I'd love to know what they are so we can try them here at the Lemond house.  After all, blueberries are in season somewhere throughout the U.S. all the way through the end of the year.  It looks like I have plenty of time to get to know my new, blue friends. 

Think twice before you diss a nutrition powerhouse such as blueberries.  You will be missing out on many health benefits, and just as importantly, your family may be equally missing out by your personal exclusion as well.

3 Keys to True Food Love

Have you ever thought of how the state of your body image impacts the relationship you have with food? It sounds obvious. But in my experience with hundreds of adult weight management clients, I certainly have seen the connection firsthand. I coach people on how to establish healthier food patterns and have observed that their own self-image seems to be a big determinant to their success.  If there are serious issues, of course I refer them out to a counselor that will assist with that compoenent. However, I was reminded of body image the other day in my own life, which was the catalyst of today’s blog post.  How, you ask?

Children can say the darndest of things! The other day, we were running around getting ready to head out to yet another 4th of July celebration when my 6 year-old daughter turned to me and grabbed my belly. She said, “Mommy, you look like you are going to have a baby.” Well, that certainly stopped me in my tracks. I thought to myself, “Did she really just say that to me? Yep, she did!” I would be lying if I said I was completely unaffected. But it’s a good thing that I have a health self-image. And it’s also a good thing that I have a great respect for food and how it nourishes my body. Otherwise, as I have seen so many times with others – the comment can cause a cascade of negative reactions. It would start with the allowance of that one comment to question my body satisfaction. This could then cause me to want to restrict food in order to achieve that body image that does not “look pregnant.” Do you see how this negative cycle can start so easily?

A positive body image not only helps
your relationship with food, but also
your children's.

This situation made me think of all the moms, women and even men out there that allow negative influences to impact their body images. I deal with so many adults in my private practice that are striving so hard to be that perfect body image that they imagine in their minds. This obsession most certainly impacts their relationship with food. You see, I am 5’5” and weight 118 pounds.  The only reason I share this information about myself is to prove a point - which is that even a normal body weight may not eliminate negative comments about your body.  It does not matter what your mind is telling you, there is no body weight that will allow you to achieve “body nirvana.” It starts with the inside and how you see your self-worth altogether. So, invest in your surroundings so they can promote a healthy body image regardless of body size. I came up with my top 3 things I tell my clients when discussing building a positive body image which in turn promotes a healthy relationship with food:

1. Rid Yourself of Negative Influences. No, that doesn’t mean disowning your children for saying negative things about your body! {giggle} It means avoiding magazines, television programs, friends, or places you go that might flood your mind with unrealistic body images or that might over promote aesthetic beauty. You may think that these are positive motivators, but they are not. As many people that I have seen in my practice, I have learned that these influences do not help you in keeping your overall health the highest priority in maintaining a healthy weight. It all becomes about the body weight and body image – and desperation becomes a sad part of this circus ride.

2. Consciously Surround Yourself with Positive Influences. Be around people that are positive and encouraging to you. Seek out reliable resources when it comes to food and nutrition so that you can truly see how food has so much more power than causing weight gain or loss. A local Registered Dietitian can help put you on a balanced plan that can be customized specifically for you. Dietetics school blew me away with the facts of food’s power in our lives. Food has the power to protect, prevent and in some cases, cure. Think of food in this way instead of only as a means of gaining or losing weight. And equally important, step back and realize the person you are regardless of what the scale says, and this will free you up to living a healthy lifestyle for the right motivations.

3. Be a part of something bigger than yourself. You can see the power of this perspective when becoming a parent. I was so much more self-absorbed when I was single. But now that I am a wife and mother, I make decisions not only for my own sake, but also those around me. If I don’t invest in a positive self-image that is grounded in more than aesthetics, it will certainly impact how I teach my children about food. Eating well and taking care of my body gives me the energy and good health I need in order to raise a family. Become part of a group, church or community that makes strives to make the world a better place for all. Being a part of something bigger than yourself really helps a person go deeper – deeper than surface motivations. For me, my faith in God is a huge part of why I do what I do - personally and professionally. It helps keep the focus off of me and instead on others.

You may be wondering what I said to my daughter after she made that comment. I calmly explained to her that it is not nice to say that to someone if they really are not pregnant. [I recalled a similar situation from back when she was 4 years old when she did the same thing to a morbidly obese friend at church. She asked her if she was pregnant. All of us in the group were extremely embarrassed, as you can imagine.] It is important that we have these teaching moments with our children without making it a huge deal. Fortunately, I was able to move on with my day pretty easily. I hope that if something like this happens to you that you can do the same. A positive body image frees oneself to truly appreciate food for what it truly offers.

For more information on how to achieve a positive body image, I recommend http://www.womenshealth.gov/bodyimage/. Consider reading the section on how the attitude of parents about appearance and diet affects their kids’ attitudes. They provide good tips on how to positively influence your child’s body image.