By: Robin Berzin MD
Pregnancy is an incredible time in a woman’s life. It’s also one of the most confusing. When I found out I was pregnant earlier this year I felt like everyone had a question for me. Are you tired? Can you still go to yoga? But what about hard yoga, like the kind where you stand on your head? Can you travel? How long can you be on a plane? What prenatal are you taking? What are you eating?
They were asking because they were curious, of course. They wanted to know about me, but they also wanted straight talk from an actual doctor about how she handled her own pregnancy.
I soon learned just how much misinformation is out there about being pregnant. It gets spread by word of mouth and by a pregnant woman’s worst enemy — Google. Much of it is even perpetuated by well-meaning experts, even doctors, who are schooled in the old ways of thinking.
I want to cut through a lot of these myths. Pregnant women and women who are trying to get pregnant deserve the truth. These are the answers I repeat over and over for my patients at Parsley Health.
Well you might be more tired than usual, especially in the first trimester. But what you need to do is listen to your body, not force yourself to rest. Women all over the world work in the fields until the day they give birth. We were designed to do this. Pregnancy is not a disease.
I found that the more I exercised and the more I relied on a healthy diet free from sugar and carbs to keep me energized, the better I felt. In other words you might have to push through a little fatigue — but the reward is feeling that much more productive and energized. Another patient of mine was in a yoga teacher training program when she found out she was pregnant. She wanted to finish the certification so she had to go to yoga class four days a week. Yes, she was tired, but she told me that pushing through it helped her combat nausea and fatigue and made her feel strong going into her second trimester.
The truth is the stronger you are going into pregnancy and during pregnancy, the faster you’ll recover afterwards and you’ll need that energy to be a new mom. In addition exercise will help with better sleep and more balanced blood sugar.
Yes there are certain things you want to avoid, including anything first trimester that could lead to destabilizing the placenta, such as a hard fall skiing or outdoor cycling. You also want to avoid doing core strengthening work like sit-ups crunches and plank pose that harden the rectus abdominus muscles instead of letting them stretch — this is not a good idea because the belly needs to stretch slowly over the pregnancy, not harden, or you may get worse diastasis recti, the splitting of the connective tissue between the frontal abdominals if your abs are too tight.
But, generally, more exercise than less is a good thing. If you’re confident in yoga keep doing yoga, modifying as you get larger.
If you lift weights keep lifting, getting a trainer experienced in prenatal workouts to guide you on how to avoid overusing your core as you get bigger in trimesters two and three.
If you run on a treadmill or spin keep doing that as long as it feels comfortable. Just keep in mind that you need to stay well hydrated as your blood volume has expanded and is redirected toward your uterus. And if you go to spin you might reduce the resistance a bit or slow down that run.
But there is no documented reason to stop exercising.
I had a doctor friend who was a marathon runner who ran half marathons as late as six months pregnant. She was in extremely good shape to start so she could keep up a lot of her training. As she got larger she switched to spinning, hiking yoga and even assisted rock climbing to stay in shape.
The truth is you should not drink alcohol daily, have more than one drink in a day, or drink to excess — ie, never get drunk. These behaviors can cause fetal alcohol syndrome. But there is no evidence that light alcohol consumption is unhealthy during pregnancy.
On caffeine, you can have one serving of coffee a day, but should stick to under 200mg of caffeine daily.
I know plenty of women including myself who had a glass of wine or two a week or an occasional beer throughout. I think organic biodynamic red wine is a food and having half a glass with dinner during pregnancy occasionally is not harmful.
I also have had a double espresso with about 100mg of caffeine each morning. I never have a second coffee and I never drink soda tea or caffeinated beverages other than my espresso.
I know women who quit coffee and still drink caffeinated diet soda! Go for the coffee, the organic beans if possible.
You actually don’t need to eat more. I see too many women using pregnancy as an excuse to overeat, eat more carbs and sugar and to let the guardrails down around food guidelines they would normally follow.
Meanwhile their obstetricians give little to no guidance on what to eat to grow a healthy baby — they just tell them what to avoid, like alcohol, unpasteurized dairy products, raw fish and sushi.
Trust me when I tell you that you only need about 200–300 extra calories a day on top of a 1600 or 1700 calorie a day diet, starting in the second trimester to grow a healthy baby. That’s a handful of raw organic almonds (about ¼ a cup or 23 almonds) and an apple.
If you’re already eating over 2000 calories a day, which most people are, the truth is you don’t need any additional calories.
What’s most important is balancing blood sugar, avoiding processed foods with additive dyes trans fats and preservatives.
Instead focus on the Parsley Health eating philosophy: protein, greens and healthy fats, and eat real food. If it comes in a bag you have to pop open, is vacuum sealed or is a color that doesn’t grow naturally in the ground, it’s not real food.
Many of the prenatal vitamins on the market contain preservatives additives dyes sugar and poor formulations of nutrients.
For example everyone hears you need folic acid in pregnancy but what you really need is the natural form of vitamin B9, folate, which is in dark leafy greens, broccoli and organ meats. Before pregnancy it’s best to supplement with 800–1000mcg of THF (tetrahydrofolate) — daily and once you are pregnanct 600–800mcg should be plenty. Or, if you have an MTHFR genetic variation like I do you need methylated folate, known as 5-MTHF, rather than regular folate, and also methyl-B12 “methylcobalamin” instead of regular B12 which are labeled as “cyanocobalamin” or “adenosycobalamin.”
Most over the counter prenatals do not have the right kinds of folate. If you’re not sure what genetic variant you are you will need to work with a doctor at Parsley Health or a physician who can test you and recommend the right supplements. MTHFR can impact your mental health and your body’s ability to repair DNA.
When I got to my third trimester I actually stopped taking my prenatal and instead took calcium malate (since I don’t eat dairy), fish oil derived DHA for building baby’s brain, and one of my Rebuild protein shakes just three or four days per week which has plenty of extra iron, 5-MTHF and methyl-B12 in it to supplement my diet. You do not need high quantities of supplemental nutrients throughout pregnancy — just enough — and if you are eating the right diet filled with greens healthy fats and a bit of lean protein you are getting these nutrients through food as well.
In addition, algae and other plant based omega-3 fatty acids are not as usable by the body as fish oil derived Omega 3s so while being vegan may be important to you, your baby’s brain depends on high quality fish oil. And you need to be sure that the fish oil your prenatal is tested and safe. Fish can be contaminated with mercury.
Iron is also important for baby, but synthetic iron sources are not as usable by the body as meat. If you are vegan and aren’t eating 1–2 servings of pasture raised animal protein a week, be sure that the iron in your prenatal is ferrous bisglycinate, the most usable and absorbed form.
The truth is you should avoid all unnecessary medications — prescribed or over the counter — while pregnant.
According to the CDC, only 2 of the 54 over the counter medications most used by women in the first trimester have been studied in pregnancy, and hundreds of industrial chemicals have come to market, hiding in your average drugstore product, that have not been studied and are not regulated. Don’t assume that if it’s over the counter it’s safe. In a world where as many as 1 in 20 baby boys will be diagnosed with Autism Disorder by 2025 and more and more children are being diagnosed with ADD and prescribed drugs like ritalin at a young age, how these chemicals affect our pregnancies and our childrens’ brains is in question.
Originally published at www.parsleyhealth.com on December 7, 2016.