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Welcome to my blog! I am a medical doctor currently in the role of a health entrepreneur and a health coach/consultant. My blogs are focused on using a holistic approach towards healthcare. I believe patients are not just diseases but humans as a whole. Therefore, conventional treatments should be combined with alternative/natural therapies. My blogs focus on providing guidance to fix the cause of conditions and not just reduce the symptoms.

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Pregnancy Care with Balanced Nutrition and Robust Immunity


      

Pregnancy is one of the most beautiful journeys you embark on. But the process of going through it for nine months can be challenging and daunting, both physically and emotionally. My aim in this article is to make the process a little easy for you by providing you with information on how you can maintain a health pregnancy through lifestyle modifications, dietary recommendations, proper nutritional balance and a robust immune system.

Objectives of this article:

  1. How to manage your weight and eating patterns during pregnancy

  2. What is Gestational Diabetes and how to minimize your risk

  3. Why proper hydration is important and why not to over-hydrate yourself

  4. Discussing the vital roles of calcium, magnesium, folate, iron and omega-3 fatty acids in pregnancy

  5. How to maintain a robust immune system in pregnancy

  6. What food items are essential to minimize during pregnancy


Weight Gain:

The amount of weight gained during pregnancy varies for everyone depending on how much the body weight was before pregnancy and what the eating pattern is throughout pregnancy. In general, the baby will weigh about 6 pounds, blood volume will increase by 60%, breasts will start getting enlarged for milk production. Therefore, for an average BMI, there is usually a weight gain of 25-35 pounds. It is also important to be mindful that being pregnant does not mean doubling the calorie intake - you only need about 300 calories extra per day for the developing fetus. Being overweight or obese is linked with gestational hypertension (high blood pressure throughout pregnancy) and gestational diabetes (high blood sugar levels throughout pregnancy). Stress is also a major contributor towards weight gain in pregnancy. Therefore, it is highly recommended to get rid of stressors and distractions and practice mindfulness. This will prevent you from overeating due to stress. Also, small frequent meals are advisable throughout the day as the uterus continues to grow. So, it is ideal to have small 5-6 meals per day along with regular exercise - start with low impact Pilates and prenatal yoga that will exercise your muscles and ligaments as your body prepares for child birth.

Gestational Diabetes:

During the first trimester, a blood work will be carried out to assess your HbA1c value for pre-diabetes and if the values are normal and there is no family history of diabetes, then you will not be tested for diabetes again till around 28 weeks of pregnancy. Otherwise, you may be tested earlier than 28 weeks. This test is a non-fasting test so you will be asked to have a high glucose drink and after one hour, your blood sugar levels will be tested. If the results show elevated blood sugar, then you will be asked to come back again later for a fasting test to determine your risk of gestational diabetes.
You can minimize the risk of developing gestational diabetes by avoiding packaged, processed and sugary food items. Try to consume high fiber foods, non-starchy vegetables, low glycemic index fruits like apples and berries, legumes, artichokes etc. Daily recommendation is to incorporate 25-35 grams of fiber in your diet. Overeating proteins can also shoot up your blood sugar levels. Therefore, it is recommended to have 2-3 servings of protein per day for a total of 10-20 grams. Best sources of proteins: lean meat, poultry and fish. Vegetarian protein options: chia seeds, hemp seeds, fermented soy beans, beans and legumes with rice. Please note that it is very important to supplement with vitamin B12 if you are a vegetarian (look at the supplement label and choose the methylated form of vitamin B12, which is methylcobalamin).

Hydration:

The general recommendation is to drink 8-10 glasses of water. Proper hydration is key in pregnancy as it provides relief in abdominal cramping, constipation and headaches. If you do not like the taste of plain water, you can add lemon and cucumber to make a refreshing drink. While hydration is important, over-hydrating yourself can prove to be unhealthy. The more you drink, the more you have to urinate, and every time you urinate, you lose minerals. That is why it is important to maintain a balance between hydration and essential minerals. To ensure that you have adequate amount of minerals in your system, it is highly recommended that you consume celtic sea salt, which has one of the highest amounts of trace minerals. Just sprinkle them on your veggies and fruits! Salt consumption in pregnancy is crucial because it helps in the maturation of the immune cells of the fetus, aids in the development of the brain cells and helps in maintaining adequate birth weight.

Calcium and Magnesium:

The leg cramps of pregnancy are usually a sign of mineral imbalance in the body, especially calcium and magnesium. Magnesium is extremely beneficial in calming the nervous system and the digestive tract. Both versions, magnesium glycinate as well as magnesium citrate, are easily absorbed into the system. Another strategy to reduce stress and calm down the nerves - epsom salt baths are highly useful. The minerals presents in these salts are very easily absorbed through the skin. You can mix magnesium flakes and soak them together for about 20 minutes before bathing. Alternatively, you can also choose to just soak your feet in epsom salt water, which will provide similar benefits. This method of mineral absorption through the skin is particularly beneficial if you have a sensitive digestive system and take antacids for heartburn as that can interfere with proper absorption of the minerals. Best food source of magnesium is dark chocolate (fun fact: magnesium deficiency causes dark chocolate cravings!). In regards to calcium, the best sources are broccoli, steamed green leafy vegetables (note that it is important to steam veggies to receive calcium from them as raw veggies have natural inhibitory enzymes that keep those minerals locked up and make them unavailable for absorption), sardines, sesame seeds. Calcium balance is not just a representation of how much calcium you are consuming but also of how much you are losing through urination. One of the main culprits of dietary calcium loss is the stress hormone cortisol. So, when your cortisol levels are elevated, there is an increased loss of calcium. Here it becomes even more important to practice mindfulness and reduce stress.

Folate:

It is one of the most important elements to add in your diet as soon as pregnancy has been confirmed. In fact, it is very common to start taking folic acid as early as 6 months before pregnancy. However, there is a lot of confusion between the terms 'folic acid' and 'folate'. Folic acid is the synthetic, cheap form of folate that is not found in nature. It is effective in preventing neural tube defects in pregnancy but it does not provide the additional benefits of folate, the natural version, which actually aids in the production of new cells. The methylated form of folate is best absorbed by the body. Look at the labels of your prenatal vitamins. You would want to look for 'methylfolate' or 'methyltetrahydrofolate'. Daily recommended amount is 800-900 micrograms coming from food and supplement combined. Best food source of folate is green leafy vegetables. Alternatively, you can also use the dehydrated greens powder that is equal to 3-5 servings of veggies.

Iron:

Your iron levels are checked once early in the pregnancy, around 10 weeks, and then again at 24 weeks. The reason for the recheck is the increase of blood volume, which can dilute the iron levels. The normal level in pregnancy is 11 or above of hemoglobin. Ferrous sulphate 325mg can either be acquired through prescription or taken over the counter. Note that this dose is taken every other day (not everyday) because it can lead to severe constipation. Also, taking iron with vitamin C boosts its absorption and beneficial effects. Ideally, if you take your prenatal vitamins early morning then it is recommended to take the iron later in the evening between meals. If iron is upsetting your stomach, another option is to take the liquid form of iron, which is more gentle on the digestive tract (search for 'Floradix' on Amazon). Best food sources of iron: red meat from a clean source, particularly liver, and seafood. Vegetarian alternatives are much more difficult to absorb into the body. Here it is crucial to reiterate the importance of incorporating vitamin C in your diet, especially if you are vegan/vegetarian to maximize iron absorption. Some plant-based options for iron are blackstrap molasses, cacao seeds and kale or collard green leafy vegetables. Another strategy is to cook in a cast iron skillet to incorporate more iron. Best sources of vitamin C are citrus fruits, berries and kiwi.

Omega-3 Fatty Acids:

Omega-3 fatty acids are essential nutrients, especially in early pregnancy when the vital organs of the baby are developing. Daily recommendation is 2-3 servings of fatty fish per week like salmon and herring. Docosahexaenoic Acid, or DHA, is the form that is readily absorbed by the developing fetus and is crucial till the first two years of life. Research has shown that DHA has a profound impact on mental acuity, visual acuity and hyperactive or irritable behaviors in children. A 'superfood' to mention here is cod liver oil, which is not only rich in DHA but also has high levels of fat soluble vitamins like vitamin A, which is converted to retinol, a beneficial element for skin and eyes and vitamin D, which boosts immunity. It is recommended to incorporate 400-600mg of cod liver oil in your diet, preferably cold pressed and minimally processed. Vegetarian/vegan options include microalgae, chia seeds and flax seeds. 

Immunity:

Pregnancy is an immunocompromised state where women tend to get sick more easily and remain sick for longer. Therefore, it is important to maintain a robust immune system. Stress has the largest impact on immunity - cortisol suppresses the immune system. You are encouraged to go out in nature, have a walk, get involved in activities that are enjoyable and have an adequate high-quality sleep. Not having proper sleep is the number one cause of decreased immunity (Read in detail here about the relationship between sleep, stress and nutrition). Additionally, there are three main nutritional stressors to be aware of. First is the sugar. Eight teaspoons of sugar has been shown to suppress the immune system for 5-7 hours! If you are craving sweet, opt for a fruit, which will curb the cravings and also provide you with healthy fibers. Alternatively, honey can be incorporated into the diet that has antiviral and antibacterial properties. Second enormous stressor is alcohol. No matter which type of alcoholic drink you take, it is processed as a toxin by the body. It slows down digestion and cognition and reduces the body's ability to burn fat. The third one is food sensitivities. Gluten or lactose intolerance, for example, will absolutely wear out the immune system (Read in detail here about food sensitivities and how you can navigate through them and maintain your nutritional balance successfully).
Natural strategies to boost immunity is adequate sleep and stress reduction through breathing exercises and meditation. Vitamin C is the nutrient that is used most readily by the adrenal glands that also process cortisol. Therefore, as cortisol levels increase, vitamin C consumption should also increase. Some food sources of vitamin C as mentioned earlier are citrus fruits, berries, kiwi, raw bell peppers, raw spinach. 1000mg of vitamin C is the daily recommendation that can be incorporated into the diet gradually beginning with 200mg. If vitamin C causes digestive discomfort, you can opt for the liposomal vitamin C, which is the liquid version of tiny nano particles that you hold under your tongue for 30 seconds and it gets absorbed directly into the bloodstream. Another important nutrient that boosts immunity is vitamin D and as mentioned previously, some sources are cod liver oil and mushrooms. Again, if vitamin D upsets your digestion, you can choose the liposomal version of it. Daily recommendation for vitamin D is upward of 2000 international units (IU) to 4000 IU for boosting immunity in pregnancy.
Last but not the least, our gut houses 70-80% of  the immune system in our body so it is crucial to maintain robust gut health. Best method to keep your digestive tract healthy is by consuming probiotics. Best food source to increase probiotic levels naturally is the intake of high fiber diet. Gut bacteria will ferment fibers, which will increase the strength and diversify the probiotic strains present in the gut. In case you are on antibiotics and absolutely need to take probiotic sources then the best recommendation is to incorporate soy-based or spore biotic for 90 days as they mimic nature more.

Foods to Minimize:

Although caffeine should ideally be avoided in pregnancy but it is safe to consume about 200mg of it per day. That equals to a large cup of coffee, a coca-cola and a piece of chocolate. The biggest risk with increased caffeine is miscarriage in the first trimester. Post that period, it is considered safe to consume caffeine.
It is absolutely important to avoid all types of uncooked food items like raw meat, eggs and fish and also unpasteurized milk and other dairy products.
Alcohol should also be refrained from throughout pregnancy but can be resumed gradually post pregnancy and it is advisable to take a glass of wine just before breastfeeding before alcohol is absorbed into your bloodstream.



Reference: UCSF Centering Pregnancy Program




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