BASICS OF REAL FOOD PRENATAL NUTRITION

BASICS OF REAL FOOD PRENATAL NUTRITION August 2018 Author, Real Food for Pregnancy; Real Food for Gestational Diabetes OVERVIEW Conventional prenatal nutrition guidelines compared to real food Myths surrounding prenatal nutrition i.e. recommendations that are not evidence-based Why we need a paradigm shift Rationale for a real food diet that incorporates updated research + principles from ancestral nutrition/traditional cultures Sample meal plans and nutrient breakdown from conventional vs. real food prenatal nutrition Practical tips for optimal prenatal nutrition WHAT IS CONVENTIONAL NUTRITION? WHAT IS REAL FOOD? Dietary advice based on the U.S. government s nutrition policies Food pyramid (retired), now MyPlate Advice relatively unchanged in past few decades Low fat, high carb Limit saturated fat (lean meat, low fat dairy, vegetable oils preferable to animal fats) Less meat, more grains Food obtained locally (in-season) and eaten in its natural, unprocessed form Applies wisdom from ancestral diets and those of traditional cultures; omnivorous Acknowledges there is no one-size-fits-all Automatically excludes: refined carbohydrates added sugar foods that require extensive modern processing (such as refined vegetable oil, food additives, etc.) REAL FOOD, CONT D CONVENTIONAL APPROACH Definitions of real food are ambiguous, but generally include: Vegetables & fruit Meat, poultry, fish/seafood nose-to-tail, including naturally-occurring fat & organ meats Eggs Dairy (varies globally) Nuts & seeds Whole grains & legumes (contentious!) Carbohydrates 45-65% (no less than 175g/day) Protein 10-35% Fat 20-35% Limit fat (especially saturated) Limit salt Half your grains whole Emphasis on fortified foods (folic acid, iron, calcium) Vegetarian and vegan diet can be adequate Assumes RDAs are correct 1

Academy of Nutrition and Dietetics sample meal plan Nutrition and Lifestyle for a Healthy Pregnancy Outcome 2014 MYTH: CARBOHYDRATE NEEDS ARE HIGH 45-65% of calories = 250-420g/day (based on 2200-2600 calorie diet) This level of intake during pregnancy (52% calories from carbohydrates) has been linked to obesity in children Even in healthy weight women eating at or below estimated energy needs AJCN, 2017 HALF YOUR GRAINS WHOLE HIGH GLYCEMIC CARBS Half your grains whole results in excessive intake of refined carbohydrates, which is linked to: Higher blood sugar Higher blood pressure Higher gestational weight gain Higher fetal weight Lower micronutrient intake (displacement of nutrient-dense foods) Already, 85% of carbs consumed in US are refined No need to encourage more! Higher glycemic load diet is associated with poorer nutrient intake in women with gestational diabetes. Nutr Res, 2013 High dietary GI and GL = most reliable predictors of inadequate micronutrient intake in pregnancy Am J Clin Nutr, 2015 Diets high in grains linked to excess infant birth weight Eur J Clin Nutr, 2015 CARBOHYDRATES CONT D ANCESTRAL CONTEXT Traditional cultures consumed, on average, 16-22% calories from carbohydrates Based on an analysis of 229 modern hunter-gatherer populations worldwide Equatorial populations consumed more: 29-34% High latitude populations consumed less: 3-15% Most ancestral foods are less carbohydrate dense Higher ratio of fiber to total carbohydrates (low glycemic) Honey is the rare exception More room for foods rich in protein, iron, B12, zinc, vitamin A, iodine, choline, etc. All nutrients of concern in pregnancy 2

CARBOHYDRATES, CONT D Average prenatal diet: 2,400 2,600 calories Conventional recommendation 45-65% carbs 270 420 grams 16 g carbs 54 g carbs Hunter-gatherer intake 16-22% carbs 96 143 grams Extreme latitudes (such as the Inuit of Alaska) 3-15% carbs 18 98 grams CARBOHYDRATES, CONT D BUT WAIT A SECOND! No less than 175g per day Origins of this theory Estimated Average Requirement: 100g Energy demand of pregnancy: 35g (~300 kcal, 45% kcal from carb, 4 kcal/g = 35g) Glucose used by fetal brain: ~33g Grand total: 168 (rounded up to 175g) IOM, 2005 The lower limit of dietary carbohydrate compatible with life apparently is zero, provided that adequate amounts of protein and fat are consumed. The marginal amount of carbohydrate required in the diet in an energy-balanced state is conditional and dependent upon the remaining composition of the diet. IOM, 2005 CARBS & KETONES KETONES HARM BRAIN DEV. We now know nutritional ketosis is a benign and physiologically NORMAL state of pregnancy As part of the adaptation to pregnancy, there is a decrease in maternal blood glucose concentration, a development of insulin resistance, and a tendency to develop ketosis. IOM, 2005 Nutritional ketosis is NOT THE SAME AS starvation ketosis or diabetic ketoacidosis FALSE. Entirely depends on the context! Diabetic ketoacidosis + starvation ketosis = harmful Nutritional ketosis = physiologically normal and benign Fetal brain gets 30% of its energy from ketones + ketones are maintained at higher levels in placenta and fetal circulation than maternal circulation (Much more on this topic in a separate webinar!) 3

OPTIMAL CARBOHYDRATE INTAKE? In my practice, ~90-150g per day (total carbs) Emphasize low-glycemic, nutrient-dense carbs Non-starchy vegetables, nuts, seeds, Greek yogurt, legumes Variable tolerance for starchy carbs & fruit Physical activity, weight gain, blood sugar/pressure Usually room for ½-1 cup per meal (can be more/less) PERSONALIZE TO THE CLIENT!!! LOW CARB NO CARB Even if you eat low-carb, you still eat carbohydrates Vegetables, whole fruit, nuts, seeds, Greek yogurt, legumes, etc. Higher-carb foods can still be eaten in moderation, such as whole grains, potatoes, yams, etc. depending on a client s needs/tolerance Priority #1: Eliminate refined grains & cut way back on sugar MYTH: LESS FAT IS BETTER FAT, CONT D Low fat recommendations automatically limit intakes of numerous micronutrients Choline Vitamins A (preformed), D, E, and K Vitamins B12, B6 Zinc, iron, and selenium DHA Less fat automatically means more carbs More carbs usually means less micronutrients Focusing on unsaturated fats = more likely to have an unfavorable ratio of omega-6 to omega-3 fats Linked to higher risk of preeclampsia + developmental delay in infants Fully 94% of women don t meet the current targets for choline; 1/3 don t consume enough vitamin A Animal foods (high in saturated fat) are primary sources of these nutrients MYTH: REC S ARE PERFECT MYTH: REC S ARE PERFECT, CONT D Protein First ever study to directly measure protein needs was performed in 2015 Protein needs are 39% higher in early pregnancy; 73% higher in late pregnancy than current recommendations Choline Didn t even have a recommended intake until 1998 Recommendations based on choline studies in adult men and adjusted via mathematical equation for pregnancy New studies suggest choline rec s should be more than DOUBLE (930 mg instead of 450 mg); more research is needed! Vitamin B12 Optimal intake in pregnancy may be TRIPLE the current RDA Vitamin D Current RDA of 600 IU consistently results in vitamin D deficiency Optimal intake from numerous RCTs is 4,000 IU during pregnancy (and likely more for deficient women) Vitamin B6 Among pregnant women meeting or exceeding current RDA, 58% had low blood levels at delivery 4

MYTH: REC S ARE PERFECT, CONT D MYTH: REC S ARE PERFECT, CONT D Some key nutrients are entirely missing from conventional prenatal nutrition guidelines Vitamin K2 Bone mineralization & mineral metabolism Food sources: natto, aged cheeses, liver Glycine - conditionally essential in pregnancy Fetal DNA, skin, bones, connective tissue, integrity of amniotic sac, uterine expansion, blood pressure/sugar regulation, placental health, etc. Food sources: bones, skin & connective tissue of animal foods (bone broth, pulled pork, chicken skin, pork rinds, etc.) Vitamin A Assumes all vitamin A needs can be met from plant-sourced carotenes (provitamin A), which must be converted in the body to retinol (preformed vitamin A) Many lack ability to convert provitamin A to retinol (BCMO1 gene) Beta carotene is 28x less potent than retinol Estimated that ~50% of population have BCMO1 variant, which means a 30-70% reduced ability to convert VITAMIN A, CONT D MYTH: FORTIFIED FOODS ARE NEEDED Warnings against high intake of vitamin A primarily apply to synthetic vitamin A supplements High doses have been linked to birth defects However Liver and supplements are not of equal teratogenic potential. Advice to pregnant women to limit consumption of liver based on the reported teratogenicity of vitamin A supplements should be reconsidered. In a Dutch study, 70% of women who avoided liver failed to meet the RDA for vitamin A Liver is the #1 food source of preformed vitamin A Folic acid Up to 60% of the population has a mutation in the MTHFR enzyme = reduced ability to use folic acid Must get folate from food and/or L-methylfolate Iron Form used in most fortified foods is very poorly absorbed and often leads to digestive discomfort Heme iron from animal foods = optimal absorption; 25-40% Plant-source iron (non-heme) = 2-13% absorption FORTIFIED FOODS, CONT D FORTIFIED FOODS, CONT D Calcium Calcium needs are NOT higher in pregnancy Too much calcium = inhibition of iron and zinc absorption, which are more likely to be low in a prenatal diet than calcium In a real food, omnivorous diet, fortified foods are not necessary Where fortified foods may be helpful: Vegetarian diets (B12, DHA, iron, etc.) Severe food aversions Inability to take a prenatal vitamin Low income populations without access to adequate whole foods (i.e. fortified refined grains better than unfortified refined grains) 5

MYTH: LIMIT SALT SALT, CONT D Conventional standard: 1,500 mg sodium Upper limit: no more than 2,300 mg; that s 1 teaspoon of salt Salt needs INCREASE during pregnancy Fluid/plasma volume Neural signaling Stomach acid Fetal growth and development Iodine needs Blood sugar/insulin regulation Cochrane: advice to lower salt intake during pregnancy should NOT be recommended Low salt intake does not prevent nor treat preeclampsia and can actually WORSEN it Salt restriction during pregnancy is connected to intrauterine growth restriction or death, low birth weight, organ underdevelopment, and dysfunction in adulthood probably through gene-mediated mechanisms. Several recent studies have shown that higher salt intake during pregnancy LOWERS blood pressure and lessens severity of preeclampsia SALT CONT D MYTH: VEGETARIAN DIETS Best solution Consume salt to taste (optimal intake has not been defined) Honor salt cravings (pickles, olives, etc.) Opt for sea salt also comes with trace minerals Some sea salt is iodized; if not, include seaweed/seafood and ensure PNV contains iodine Note signs of inadequate salt intake Dehydration, leg cramps, headaches, elevated BP, constipation, low amniotic fluid, edema vegetarian patterns meet most nutrient goals except for iron, vitamin D, vitamin E, and choline. AND policy paper on prenatal nutrition The list of potential nutrient deficiencies is FAR more complex Some nutrients not even considered by conventional standards, such as glycine and vitamin K2 VEGETARIAN DIETS, CONT D VEGETARIAN DIETS, CONT D Careful consideration + supplementation is necessary Certain nutrients may be missing entirely (such as vitamin B12) Certain nutrients may be provided in a form that is not as well-utilized by the body (such as the omega-3 ALA instead of DHA and beta-carotene instead of preformed vitamin A) Certain nutrients may not be provided in sufficient concentrations in plant foods (such as choline, glycine, and vitamin K2) Certain nutrients may not be well-absorbed (such as iron and zinc) Options Maintain vegetarian diet (lacto ovo vegetarian) Supplement with high-quality PNV, iron supplement, algae DHA Consume several eggs per day (choline, B12, etc.), soak/sprout beans/grains to enhance mineral absorption, etc. See Ch 3 of Real Food for Pregnancy Opt for semi-vegetarian diet with addition of key nutrientdense animal foods Bone broth (or other glycine-rich animal foods), oysters (extremely high in B12, iron, zinc), fish/sardines, organ meats (including liver) May still benefit from additional supplements 6

MYTH: FOODS TO AVOID FOODS TO AVOID, EXAMPLES Food safety advice means many nutrient-dense foods are limited Must weigh the likelihood of foodborne illness with chances of nutrient deprivation Australian study of nearly 7,500 women found that those who consciously limit their consumption of potential Listeria-containing foods are likely to have suboptimal nutrient intake from foods. Eggs with runny yolks Rationale: Salmonella Risk of eggs containing Salmonella 1 in 12,000-30,000 7-fold lower in eggs from organic farms Nutrients provided: choline (#1 source), DHA, protein, iodine, B vitamins, lutein, zeaxanthin Options Continue eating eggs with runny yolks Rec d pasture-raised! Cook until yolks are solid Avoid eggs entirely! FOODS TO AVOID, EXAMPLES FOODS TO AVOID, EXAMPLES Deli meat Rationale: Listeria Risk Listeriosis per servings of deli meat 1 in 83,000 Nutrients provided: protein, iron, zinc, B6, etc. Not a major nutritional trade off unless this is the only source of animal protein in the diet Options: Continue eating; common sense on food safety Heat until steaming before consuming Soft Cheese Rationale: Listeria Risk Listeriosis per servings of soft cheese 1 in 5 million Nutrients provided: protein, vitamin K2, calcium, B vitamins, iodine, etc. Options: Continue eating; common sense on food safety Avoid entirely; plenty of other cheeses to enjoy! Raw cheese/dairy from reputable small dairies is also unlikely to be contaminated MYTH: LIMIT FISH/SEAFOOD FISH/SEAFOOD, CONT D Rationale: source of mercury, a neurotoxin Conventional advice: limit to <12oz per week No swordfish, shark, king mackerel, tilefish Limit tuna to <6oz per week; preferably canned light tuna Truth Women who eat more than 12oz/week have children with best cognitive outcomes, despite higher mercury intake Selenium, also high in most types of fish, protective against mercury absorption Smaller fish contain less mercury, on average Nutritional trade-offs Protein, DHA, iodine, selenium, zinc, B6, B12, glycine, etc. Seafood is the #1 source of iodine in the diet: Iodine deficiency remains the leading cause of preventable intellectual disability worldwide. - JAMA Recommended types of fish/seafood Salmon, sardines, cod, herring, fish roe (eggs) Cooked* oysters and clams *75% seafood outbreaks = undercooked shellfish Seaweed & sea vegetables 7

OTHER OVERSIGHTS FOOD QUALITY VS. BUDGET Quality of foods and how it impacts nutrient-density Pasture-raised eggs, grass-fed beef = higher in vitamins A, E, D; more DHA; more favorable ratio of omega-3:omega-6 Wild-caught fish = more DHA, less toxins (PCBs, dioxins), less antibiotic residues Organic or pesticide-free produce, grains, legumes = fewer pesticide residues As budget allows, opt for: Produce from farms that don t use pesticides or grow organically Meat, eggs, dairy from pasture-raised/grass-fed operations Wild-caught fish/seafood If this is not possible, conventionally-sourced real food is still superior to processed foods BUDGET-FRIENDLY REAL FOOD OTHER OVERSIGHTS, CONT D Always consider economic status of clients & make recommendations they can meet No discussion of food packaging/storage/ cookware and potential effects of toxins ***Prioritize avoidance of sugar, refined grains, industrial trans fat ( partially hydrogenated oils )*** Produce: Consider dirty dozen or highest volume items (if purchasing local/organic is possible) Animal foods: Shop sales, direct-from-farm (meat shares), tough cuts of meat + organ meats, local/inseason Non-stick pans (PFCs) Thyroid dysfunction, preeclampsia, low birth weight Plastic containers (phthalates, BPA) insulin resistance, defects in genital development (boys), preterm birth, brain development & behavioral problems Aluminum cookware/foil Toxic to placental cells, bone dev. & neurological problems MYTH: EATING FOR TWO HOW IS REAL FOOD DIFFERENT? Does NOT mean double portions at each meal Actual energy needs only increase ~300 kcal/day a pregnant woman needs to eat for 1.1 What does increase is nutrient needs, so emphasize nutrient-dense foods Especially foods rich in iron, iodine, DHA, vitamin A, glycine, choline, vitamin B12, and folate Aim to meet nutrient needs from food as much as possible (without reliance on fortified foods) Considers modern nutrition research in the context of ancestral diets Emphasizes nutrient-dense foods Acknowledges that nutrition research is always evolving; RDAs are best guesses, but not perfect Minimal processing, avoidance of food additives, local/in-season when possible 8

KEY FERTILITY FOODS CONVENTIONAL VS. REAL FOOD Liver & organ meats Meat on the bone, slow-cooked meat, bone broth Eggs Full fat & fermented dairy products Fatty fish & sea vegetables Green, leafy vegetables The meal plans + numbers tell the full story Breakfast: Oatmeal Low-fat milk Strawberries Conventional Nutrition Sample Meal Plan Morning Snack: Trail mix (almonds + mixed dried fruit) Low-fat Breakfast: Oatmeal Low-fat milk Strawberries Conventional Nutrition Sample Meal Plan Morning Snack: Trail mix (almonds + mixed dried fruit) Low-protein Lunch: Turkey sandwich (whole wheat bread, turkey, light mayonnaise) Salad (lettuce, tomato, kidney bean salad, French dressing) Banana Low-fat milk Lunch: Turkey sandwich (whole wheat bread, turkey, light mayonnaise) Salad (lettuce, tomato, kidney bean salad, French dressing) Banana Low-fat milk Afternoon snack: Carrot slices Whole wheat crackers Afternoon snack: Carrot slices Whole wheat crackers Dinner: Coleslaw (cabbage, pineapple, light mayonnaise) Grilled salmon (w/ oil) Broccoli stalks, steamed White rice Low-fat milk Evening snack: Air-popped popcorn Dinner: Coleslaw (cabbage, pineapple, light mayonnaise) Grilled salmon (w/ oil) Broccoli stalks, steamed White rice Low-fat milk Evening snack: Air-popped popcorn No red meat/organ meat No eggs Low in animal fats High carb Dessert: Frozen vanilla yogurt, low fat Dessert: Frozen vanilla yogurt, low fat Real Food for Pregnancy Sample Meal Plan Real Food for Pregnancy Sample Meal Plan Breakfast: Crustless spinach quiche Pork breakfast sausages (pasture-raised) Banana Morning Snack: Apple + almond butter Lunch: Homemade chicken & vegetable soup Lentils (mixed into soup) Arugula salad Lemon-herb dressing Parmesan cheese Afternoon snack: Sardines packed in olive oil Brown rice crackers Dinner: Grass-fed beef meatloaf Roasted Brussels sprouts Roasted red potatoes Choline Glycine Folate Vitamin K2 DHA, iodine, selenium, zinc, etc. Hidden liver Choline, iron, B12, zinc, retinol, B6, folate, etc. Breakfast: Crustless spinach quiche Pork breakfast sausages (pasture-raised) Banana Morning Snack: Apple + almond butter Lunch: Homemade chicken & vegetable soup Lentils (mixed into soup) Arugula salad Lemon-herb dressing Parmesan cheese Afternoon snack: Sardines packed in olive oil Brown rice crackers Dinner: Grass-fed beef meatloaf Roasted Brussels sprouts Roasted red potatoes Protein + fat at every meal/snack Animal fats allowed High-quality carbs Food sources of tricky nutrients, like heme iron, retinol, glycine, choline, vitamin K2 No vegetable oils = better omega-6:3 balance Evening Snack: Greek yogurt (full-fat) + vanilla extract Chia seeds Probiotics, K2, etc. Evening Snack: Greek yogurt (full-fat) + vanilla extract Chia seeds Dessert: Raspberries + homemade whipped cream No sugar dessert Dessert: Raspberries + homemade whipped cream 9

Real Food for Pregnancy Sample Meal Plan Breakfast: Crustless spinach quiche Pork breakfast sausages (pasture-raised) Banana Morning Snack: Apple + almond butter Breakfast: Oatmeal Low-fat milk Strawberries Conventional Nutrition Sample Meal Plan Morning Snack: Trail mix (almonds + mixed dried fruit) Real Food for Pregnancy Total calories 2,329 Macronutrients Carbohydrate: 156 g 26% Fiber: 41 g Protein: 140 g 24% Fat: 134 g 51% Conventional Nutrition Total calories 2,302 Macronutrients Carbohydrate: 319 g 54% Fiber: 43 g Protein: 109 g 19% Fat: 72 g 28% Nutrient Comparison Nutrients Higher in Real Food for Pregnancy Lunch: Homemade chicken & vegetable soup Lentils (mixed into soup) Arugula salad Lemon-herb dressing Parmesan cheese Afternoon snack: Sardines packed in olive oil Brown rice crackers Dinner: Grass-fed beef meatloaf Roasted Brussels sprouts Roasted red potatoes Evening Snack: Greek yogurt (full-fat) + vanilla extract Chia seeds Dessert: Raspberries + homemade whipped cream Lunch: Turkey sandwich (whole wheat bread, turkey, light mayonnaise) Salad (lettuce, tomato, kidney bean salad, French dressing) Banana Low-fat milk Afternoon snack: Carrot slices Whole wheat crackers Dinner: Coleslaw (cabbage, pineapple, light mayonnaise) Grilled salmon (w/ oil) Broccoli stalks, steamed White rice Low-fat milk Evening snack: Air-popped popcorn Dessert: Frozen vanilla yogurt, low fat Essential Fatty Acids Omega-3s: 3.3 g Omega-3-to-6 ratio: 3.2:1 Vitamins Vitamin A: 13,935 mcg Retinol: 2,492 mcg Vitamin C: 194 mg Vitamin D: 18 mcg Vitamin E: 18 mg Vitamin B1: 1.5 mg Vitamin B2: 3.1 mg Vitamin B3: 32 mg Vitamin B6: 3.0 mg Vitamin B12: 23 mcg Folate: 609 mcg Choline: 633 mg Minerals Calcium: 1,462 mg Copper: 4,700 mcg Iron: 20.5 mg Magnesium: 482 mg Potassium: 4,522 mg Selenium: 131 mcg Zinc: 17 mg Essential Fatty Acids Omega-3s: 2.9 g Omega-3-to-6 ratio: 4.3:1 Vitamins Vitamin A: 6,753 mcg Retinol: 83 mcg Vitamin C: 171 mg Vitamin D: 16 mcg Vitamin E: 9.3 mg Vitamin B1: 1.5 mg Vitamin B2: 2.0 mg Vitamin B3: 25 mg Vitamin B6: 2.6 mg Vitamin B12: 8.1 mcg Folate: 518 mcg Choline: 374 mg Minerals Calcium: 1,394 mg Copper: 1,200 mcg Iron: 15 mg Magnesium: 433 mg Potassium: 4,027 mg Selenium: 126 mcg Zinc: 11 mg Omega-3: 114% Vitamins Vitamin A: 206% Retinol: 3002% Vitamin C: 113% Vitamin D: 112% Vitamin E: 193% Vitamin B2: 155% Vitamin B3: 128% Vitamin B-6: 115% Vitamin B-12: 284% Folate: 118% Choline: 169% Minerals Calcium: 105% Copper: 392% Iron: 137% Magnesium: 111% Potassium: 112% Selenium: 104% Zinc: 155% WHY WE NEED A PARADIGM SHIFT NAUSEA Key nutrient-dense foods are limited or off-limits by conventional standards Limiting saturated fat and animal foods (and favoring a high-carbohydrate diet) increases the likelihood of nutrient deficiencies Iron, zinc, choline, retinol, glycine, B12, etc. Outdated recommendations can put women & babies at risk for health problems Common, especially in first trimester. Nutritional management: Eat small, frequent meals/snacks (never get too hungry or too full). Eat slowly and mindfully. Balance blood sugar aim to include some protein and fat when you eat, even if the portion is small (protein at breakfast is especially helpful). It s OK to eat more carbs! Try salty, sour, or cold foods. Avoid strong odors let someone else cook for you! If vomiting, replenish fluids and electrolytes. Most compelling theory on nausea: Thyroid adapting appropriately to pregnancy FOOD AVERSIONS/CRAVINGS Possible causes: Help a woman consume enough beneficial nutrients (or may be a sign of a nutrient deficiency) Ice cravings often a sign of anemia Protection from toxins or food poisoning Be one way to get through the nausea phase (carb cravings) Avoidance of strong odors Be a sign of an imbalanced diet (too high in sugar, refined carbs, or processed food) Body attempting to correct/avoid low blood sugar Be the result of cultural expectations to have pregnancy cravings PRACTICAL TIPS 10

PRACTICAL TIPS MINDFUL EATING Reduce intake of refined grains and sugars Low nutrient-density ( empty calories ) Include adequate protein & fat Emphasize vegetables, especially non-starchy vegetables Customize carb needs to the client Low carb is safe, if needed/preferred First trimester carb cravings are physiologically normal Encourage honoring hunger/fullness cues Naturally helps find right balance of macronutrients, portion size, etc. Women who practice mindful eating during pregnancy tend to eat healthier + consume less junk food Appetite, 2017 Mindful eating does NOT mean ignoring nutritional common sense AIM FOR BALANCED BLOOD SUGAR DON T EAT NAKED CARBS Reduces cravings Prevents/manages high blood sugar & high blood pressure, excessive weight gain, and excessive fetal growth (macrosomia) Tends to displace foods low in micronutrients How to accomplish this? Adequate protein + fat + non-starchy vegetables Conscious of carb intake (no naked carbs ) Minimize refined grains + added sugar Mindful eating DON T EAT NAKED CARBS PLATE METHOD Meal version of no naked carbs ¼ protein/fat ¼ carbs* ½ non-starchy vegetables 11

PLATE METHOD VS. MYPLATE MEAL IDEAS Roasted salmon, green salad, roasted butternut squash Lettuce-wrapped burger with sweet potato fries Chili (meat, beans, veggies) with all the toppings (avocado, salsa, sour cream, etc.) Lamb chop, Greek salad (topped with garbanzo beans, olives, cheese) Omelet/frittata w/ vegetables + wholegrain toast Spaghetti squash with meatballs + tomato sauce Coconut chicken curry with riced cauliflower (or rice/potatoes), sautéed spinach SNACK IDEAS NUTRITION COUNSELING 24 hour food recall/3-7 day food diary Are there any places you think you could improve your eating habits? How do you feel after meals? How long does that meal/snack keep you full? Any symptoms better/worse with different foods? Are there any foods you crave? ID specific nutrients lacking, if indicated Leave it open ended. Reflect. Motivational interviewing. Choose 1-3 things to work on. Q&A MORE WEBINARS COMING! 12

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