Smoothie Building 101

Smoothies are like salads. They can be nutrient dense powerhouses … or they can be health food “traps”. Traps that trick you into thinking you are making a healthy choice but are actually loaded with junk and/or are not very good for satiation and blood sugar. So, I’m giving you a few simple steps to check off to make sure your smoothie falls into the nutrient dense powerhouse category and not the trap category. These steps can be used whether you are making your smoothie at home, or ordering it out. When ordering out it’s a little trickier since you won’t know exactly how much they are using of everything. But don’t stress, most smoothie places list the ingredient and you can work backwards from there.

1. Pick a veggie

   I know this sounds weird, why are you putting VEGGIES in a SMOOTHIE? But trust me, smoothies are a great place to sneak in veggies that you will hardly even taste! Plus, if you bulk up your smoothie with veggies rather than fruit (don’t worry there is room for fruit too) it is MUCH easier on your blood sugar and a higher nutrient density (nutrient per calorie ratio). What this all means is that by adding veggies, you can make a more filling smoothie that will keep you fuller for longer and won’t send your insulin (blood sugar regulating hormone) into haywire mode, which, can also cause excess body fat tissue storage. So it’s a WIN WIN WIN.

   How many vegetables should you add to your smoothie? There is no single right answer, but I give my clients a goal to add at least 2. Dark leafy greens are usually a must, so use those and at least one other veggie. BUT if you hate greens, pick 2 other veggies and skip those. I think 1-3 fist size portions is a good amount. Try some combinations and amounts out and see what works for you. Some of my favorite veggies to add to smoothies are:

   • Frozen riced cauliflower: it’s just like adding ice, it makes your smoothie so much thicker but takes on the taste of whatever else you put in there

   • Frozen zucchini: another one that pretty much takes on the taste of whatever you put in your smoothie. If you make your own zucchini noodles at home you can save the “sticks” that come out of the middle to put in smoothies. Or you can just chop up a zucchini into coins and freeze it.

   • Greens: think spinach/kale etc. There is no “best” green, pick whichever is your favorite. You can buy them frozen, freeze your own or just use fresh ones. I personally think frozen has less of a taste, so keep that in mind.

   • Frozen skinned cucumber: I learned this trick from Bethany Urgate of lilsipper and I was surprised by how much I liked it. This is another one that doesn’t add too much taste but it does add a little bit. However, the taste is really refreshing! Without the skin it’s not as gritty and also adds a lot of water so it’s hydrating. I skin my cucumbers, cut them into coins and then keep them in my freezer.

   • Steamed or roasted (then frozen) root vegetables: this includes all types of sweet potato, butternut squash, beets, even carrots. These all naturally have a sweetness to them (unless you are using something like a regular potato or turnip which I did not list for that reason) so they add some sweetness but not as much as fruit. Because they are starchy, they also make your smoothie really thick and creamy (which I personally love). Just please don’t forget to steam or roast them BEFORE you freeze them or you will have a chunky, gross smoothie.

2. pick a fruit

   People ask me all the time “what is the best fruit to add to smoothies” and there is no right answer. Different fruits have different benefits, so add fruits you actually like! (Remember, different colored fruits and vegetables means different phytonutrients which means different “superpowers” for your body). If you have specific goals or are closely monitoring your blood sugar, you can choose a lower sugar fruit like berries. But if that’s not a concern, I think fruits like pineapple, bananas, dates etc. are all totally fine!

   I think the key with fruit is to watch your total quantity. If you’re making your smoothie at home, one fistful of fruit is enough. You can do less if you want too. This is especially important if you’re ordering the smoothie at a smoothie bar/restaurant since they tend to go crazy on the fruit. It’s common to see something like acai, banana, strawberries, mango and blended with coconut water at a smoothie bar. That example could contain 50-100 grams of sugar. This will send your insulin sky rocketing and if it’s not paired with the right things, will just leave you hungry and jittery after you drink it. A way to modify this is to ask the servers to leave out some of the fruit and add a vegetable instead (a lot of places only have dark leafy greens so just add that if you don’t have another option). Also, be sure that there is a protein and fat source (think hemp seeds or almond butter and read on to find out more).

3. pick a protein source

   Quality protein is KEY for a smoothie. Whether you’re having it as a meal or a snack, protein is what’s going to fill you up. Plus, our bodies need us to consume protein through out the day since we really can’t store it like we can fat or carbs. Our bodies do something called “protein turnover” just to exist as human beings, so we need to replenish it throughout the day. I’m not saying you need to go overboard on it but you should have a source in your smoothie.

   Some of my favorite protein sources to add to smoothies:

   • Nuzest pea protein: this is one of the few protein powders I trust. Use this link to purchase and you can use code PRESS15 to save 15%! SO many plant proteins out there claim to be healthy but are contaminated with heavy metals. Nuzest tests each batch to ensure that is not the case. Plus, it’s made with SPROUTED peas which makes it way easier on digestion than other plant-based proteins. Plus it does not have the weird consistency so many other proteins do when you try to bake with them (so it will be good for more than just smoothies)

   • Furtherfood Collagen: Personally I like adding a bit of each kind of protein to my smoothie (Nuzest and collagen) since collagen has unique properties that NO other type of protein has, I try to get it in daily. You can use this link and code START10 to save on your own. Collagen has special amino acids (building blocks of protein) that are not present in any other protein sources other than bone broth. Not even in traditional protein sources like salmon, chicken, egg etc. These special amino acids strengthen the gut lining and therefore improve immune function, reduce inflammation, help your body produce more serotonin and so much more! Plus they also are great for joint, skin, hair and nail health!

   • Hemp seeds: hemp seeds have one of the highest protein content per ounce for any plant-based protein source. Just 3 tablespoons has about 10 grams of protein! So this is a great one to add to your smoothie if you don’t want to use a supplement OR you can add it in addition to one of the supplements above.

   There are plenty of other protein sources you could add to smoothies so don’t feel limited by this. But these are some of my top picks.

4. pick a healthy fat

   Fat is not often the first thing that comes to mind as a crucial component of a smoothie. However, they’re important to add for several reasons. One is that half the vitamins we eat are fat soluble, so if we’re not eating an adequate amount of fat, our bodies can’t absorb these vitamins. Another reason is that fats help stabilize our blood sugar. The thing that spikes blood sugar the most, is carbohydrates. Most smoothies are relatively higher in carbohydrates (fruits, veggies) which is not necessarily a bad thing, since these are healthy, nutrient-dense carbs. But, we still want to be mindful of our blood sugar here and fats will help with that. Stabilizing blood sugar also helps with satiation, so adding fats to your smoothie will make it naturally more filling. You can read more about all of these concepts and the science behind them in my “Don’t Fear Fat” blog post.

   I recommend picking one or two different types of fat per smoothie. Not because you want to limit your fat, just because choosing too many things from any of these categories will make for a less delicious and harder to digest smoothie. Also, sometimes your fat and your protein can overlap (for instance hemp seeds). Here are some of my favorite fats to add below (there are definitely others beyond this list):

   • Avocado: you can keep peeled avocado frozen to make it really easy for smoothie making. This is my absolute favorite fat to add and I add it to almost every smoothie I make. You really don’t taste it, just makes the smoothie super CREAMY!

   • Cacao nibs: these make your smoothie have a chocolate chip like texture without adding any sugar and they add a ton of nutrients (in addition to healthy fats). If I add these, I like to add them at the end so they don’t get blended in all the way.

   • Coconut: you can buy frozen coconut meat which can be great to add to smoothies. It’s very convenient since it’s already in “chunks” that you can throw in.

   • Nuts/seeds/their butters: obviously good old nuts and seeds and nut and seed butters are a great choice. You can do almond butter, chia seeds, cashews, whatever you want.

   • Full-fat yogurt: I like to add my fatty dairy-free yogurt to smoothies, it adds a tangy flavor and also makes it super creamy. If you do well with dairy, this could be another place that your protein could also double as a fat.

5. Add a booster (optional)

   Smoothies can be a great place to sneak in “superfoods” and other nutritional powerhouses that you wouldn’t want to eat on their own. If you know you’re having a smoothie every morning, this can be an easy way to ensure you’re getting a dose of these things while masking the flavor. Some examples of boosters are prebiotics or probiotics, cacao powder, turmeric, and adaptogens. These are by no means a requirement but like I said smoothies can be a great place to sneak them in.

6. add liquid

   Seems obvious but I couldn’t write this blog post without noting that most smoothies need a liquid added. My favorite liquids to add are almond milk (I make my own) or water. You could also do any other kind of milk. Some things you should look out for in liquids you add to your smoothie are the ingredients and sugar. A lot of milks/nut milks have a lot of added unnecessary ingredients (carageenens, gums etc.) so I’d be mindful of these. And then also be mindful of added sugar. Sugar that comes in a liquid (rather than in whole food form) has no fiber with it. This means it has a much greater impact on your blood sugar (insulin) since fiber is usually what would attenuate that response. I do not recommend adding sugar in your liquid, you should already have some sweetness from the fruit you added (which DOES come with fiber) so no need for extra here. This is another thing to look out for at smoothie bars since a lot of them use fruit juice/coconut water etc. as the liquid and this can greatly increase the sugar content of your smoothie.

other tips

• Don’t try and put too many things in one smoothie, especially if you’re new to making smoothies. this will end up with muddled flavors and will be harder on the digestive system. Pick only one thing from each category until you feel like you’ve found some combinations that you truly love and work for you.

• Smoothies really shouldn’t require a recipe or even exact measurements. People always ask me why I don’t have more smoothie “recipes” on my instagram or website and the answer is because I don’t use a recipe when I make them! I use these steps as a guide and just start experimenting (as you should too). Then remember what you did and if you liked it or not, and modify for next time. I think recipes and exact measurements are much better suited for baking than smoothies.

• You can make your smoothies really thick by adding less liquid and more “thickening agents” like avocado, cauliflower, banana etc. Then you can eat them like ice cream with a spoon!

Some of my favorite combos:

• Berries, avocado, cauliflower rice, greens, chocolate protein (or protein with cacao powder), optional healthy fat/crunch: cacao nibs, water or almond milk

• Banana, greens, frozen zucchini, nut butter, vanilla protein powder, water or almond milk

• Sweet potato, cucumber, a date(s), full fat yogurt, collagen, water or almond milk

Enjoy, and can’t wait to hear what delicious creations you make!

What You Really Need to Know about Prenatal Nutrition

I have seen several types of doctor’s regarding my fertility, and then later, my pregnancy, and I truly loved all of them. However, none of them spoke to what to eat when you are pregnant. I know most medical programs require only a few hours in nutrition training, but pregnancy is a crucial time to be choosing the right foods. The only guidance I personally received were a few handouts about what to avoid (the typical deli meat, raw eggs, certain fish) etc. Many of these guidelines are actually extremely outdated and not necessary to be avoided AND can cause women to miss out on important nutrients for their growing babies (more on that to come in a separate blog post). However, I really did not receive anything that even had basic nutrition advice like to eat lots of fruits and vegetables!

I think there is also the general inclination that if you are taking a prenatal, everything is ok. This is flawed thinking for several reasons - 1) not all prenatal vitamins are created equal, some are synthetically created in labs and will act differently in the body than those from whole food sources and different ones just have different nutrient profiles, synthetic or not and 2) you can’t out-supplement a bad diet. A 2019 study of 1,000 pregnant women in the US found that a majority of pregnant women are not receiving enough of certain nutrients despite being on a prenatal vitamin, the most deficient were Vitamin D, Vitamin E, magnesium and iron. By contrast, most pregnant women were getting too much sodium (6). Given that over 75% of sodium intake is from processed food not table salt, it means many pregnant women in the US are eating too much processed food, and relying too heavily on prenatal vitamins that aren’t holding up .

Many people take the 10 months of pregnancy as a free pass to forget nutrition since they aren’t trying to fit into their skinny jeans… so why eat healthy right? This is really unfortunate, and I am not trying to blame anyone. I think most people are genuinely trying to do their best with the information they are given. However, the information they are given is, unfortunately, not very complete. So, I’m trying to correct this by highlighting a FEW of the most important things to consider when eating while pregnant. Please note this blog post is not all inclusive, it is just a few topics that I think are not mentioned enough in the mainstream, so if you are pregnant or looking to become and want to optimize your nutrition, I recommend working with me or someone else on a one on one basis or reading a book about prenatal nutrition or a combination of the above. My two favorite books on the topic are Real Food For Pregnancy by Lily Nichols and Expecting Better by Emily Oster (this second one only has a few chapters on food but it does go into the data behind food borne illnesses and pregnancy so you know what’s actually important to avoid and what isn’t). Hint: a lot of the stuff we are told to avoid is not supported by the clinical evidence!

Vitamin A

It’s important to look closely at your prenatal and your diet to ensure you are actually getting enough of this important nutrient since it can be confusing. Many people think vitamin A is found in beta carotene rich foods (brightly colored vegetables like sweet potatoes, carrots, bell peppers). However, this is actually provitamin A, or carotenoids (5). There is nothing wrong with carotenoids but most people have a very low conversion rate of provitamin A to preformed vitamin A. Preformed vitamin A is crucial for fetal growth and gene development and specifically impacts the heart, eyes, ears, limbs and immune system (7). Lack of vitamin A (this is PREFORMED vitamin A) can lead to serious malformations of the head, face, limbs, and internal organs (8).

So back to where you can get your vitamin A. Since our conversion of provitamin A or beta carotene is low and even lower in individuals who eat a lot of beta carotene (unfortunately, since I am one of those people) (9). I actually had my conversion rate tested and assumed since I ate so healthy it would be high, but actually my healthy eating worked to my detriment since I do not convert much betacarotene into preformed vitamin A so I must eat my preformed vitamin A. Even if you don’t eat a lot of sweet potatoes and carrots, the maximum conversion rate in any human is pretty low so it’s important to get your vitamin A in it's usable form.

I always think the best source for anything is food, preformed vitamin A can come from things like pasture-raised egg yolks, grass-fed beef, full-fat grass-fed dairy and liver (be careful with liver since too much vitamin A in pregnancy can have detrimental effects and this one is the most concentrated sources). But you can also check your prenatal vitamin to see if it says the form of vitamin A. Mine says “vitamin A …. beta carotene, carrot”. This is not preformed vitamin A, I know I must eat some sources of preformed vitamin A, which, is why I’ve made sure to eat properly raised meat and eggs through out pregnancy. You can read more about what to look for in meat in blog post here.

Calories

My personal opinion is that calories oversimplify things. I don’t believe in counting calories as a means of healthier eating ever, let alone in pregnancy. Our bodies are not calculators or machines and there are SO many factors that will impact your overall nutrient need each day. And by the way calories totally ignores nutrients, it just tells you how much energy is required to raise the temperature of 1 kilogram 1 degree celsius… so really calories are not important, but the types of foods we eat are. And then in terms of quantity, I am a big believer of listening to your body. Hunger is a message from your body telling you to eat more. When you are full stop eating. This same principle applies to pregnancy.

Yes, you will need more calories when pregnant. Even when your baby is just a few cells, your body is doing A LOT behind the scenes, so you may experience increased hunger. In these cases, the calorie guidelines can seem too low. Personally, I was hungriest first trimester and was eating more than the “zero” extra calories (1) recommended by the American Academy of Dietetics, but it didn’t seem like the right time to ignore the signals from my body and stay hungry so I did not surpass recommended calorie guidelines.. However, some women experience nausea and food aversions that counteract this hunger in the first trimester. So for these people, the zero extra calories in the first trimester may work. Also each pregnancy is different. So I don’t necessarily think a very specific calorie number (340 calories in second trimester and 450 in third) is helpful (1). Like I said, each day is different and counting calories can be tedious and distracting from making healthful food choices.

Long story short, I don’t think anyone should get too hung up on the calorie guidelines during pregnancy (or ever). I will repeat it again, we are not machines or calculators and there are too many factors to count that will impact our daily nutrient needs. A much better policy, is to focus on getting a diversity of real whole foods that will nourish ourselves and our growing babies and to listen to the signals our amazing bodies will give us!

Carbohydrates

This is the only non-essential macronutrient. There are three macronutrients - carbohydrates, proteins and fats. Of these three, there are essential amino acids (which are the building blocks of proteins), essential fatty acids (fats) but no such thing as essential carbs (2). Essential nutrients are ones that your body cannot produce itself, but needs to survive. I am not saying everyone should go 100% carb-free, or even low carb. However, there are lots of non-nutritive carbs in the modern diet. So I am definitely saying be wary of these. And also noting that if you don’t include as many carb-dense foods, it won’t necessarily be detrimental.

One of my favorite colorful, unprocessed ways to get carbohydrates and load it up with fat, fiber, protein and other nutrients is sweet potato toast. Recipe is on my website!

In fact there is lots of data to support that too many carbohydrates can have detrimental outcomes for pregnancy. Most people know about gestational diabetes as one of these risks but there are risks even before women reach the gestational diabetes threshold. I think processed carbohydrates are overemphasized during pregnancy, which, inevitably crowds out more nutrient dense items from people’s plates and causes chronically spiked insulin levels (which, is problematic even if one does not have gestational diabetes). As my clients and those who follow me closely know, I always recommend colorful carbs first (carbs that come from whole foods like fruits and vegetables) since these are rich in phytonutrients (vitamins, minerals, antioxidants etc.) and are naturally paired with fiber. I also recommend avoiding “naked carbs” to help manage blood sugar, by pairing carbohydrates with a quality protein and/or a fat. You can read more about this in my balanced plate blog post here.

Now, back to what can happen when you don’t manage your blood sugar in pregnancy. Reminder: the food that will impact blood sugar/insulin the most is carbohydrates, so you can manage it by choosing whole foods carbs and pairing them with protein, fat and fiber. A 2015 Stanford University study that shows that elevated blood sugar far below the threshold for gestational diabetes is linked to significantly higher risk of congenital heart malformations in the babies of those mothers (3). Another study shows that high insulin levels in early pregnancy were linked to significantly higher risk of neural tube defects in babies (4). A higher carbohydrate diet during pregnancy is also linked to a higher risk of developing gestational diabetes, preeclampsia (high blood pressure), gall bladder diseases in pregnancy and for your baby to grow unhealthily large (macrosomia) and increases baby’s chances of having heart disease, diabetes and impaired lung development (5). A little processed carbs won’t kill you or your baby or give you a completely unhealthy baby. I don’t think it’s a good use of time to stress about every morsel that goes into your mouth. However, I do think we need to all take our carbohydrate consumption during pregnancy a little more seriously given that they are non-essential, so there is in’t a minimum required for life AND there can be detrimental outcomes of eating too many, especially of the non-nutritive ones.

My favorite sources of carbohydrates for anyone, pregnancy included, are COLORFUL whole foods sources. Whole foods means unrefined carbohydrates as close as possible to their original source. So if you look at the label on whole wheat bread, there are usually 20 plus ingredients and each of those ingredients may be processed. That’s not necessarily very close to the source. However, if you look at a sweet potato or some lentils those ARE the original source so they are great whole foods carb sources. And nature is so smart it filled these foods with nutrients that are important for the developing baby. The things that gives fruits and vegetables their colors also have so many health benefits. The phytonutrients are what gives these fruits and veggie carbs their colors (and yes white is a color so I’m pro potatoes, cauliflower, coconut, garlic etc.) Plus, the less processed the carb, the more it will allow your blood sugar to remain balanced (which means it is less likely to cause the complications mentioned above with gestational diabetes or really just high insulin variability even before GD kicks in. So moral of the story here is to choose your carbs wisely (whole foods carbs) and if you don’t choose to eat that many every day, you may just be fine, as long as you are eating enough overall since carbohydrates are not essential.

Choline

One of my favorite choline-rich meal prep recipes is my easy frittata! This is a version of the one on my website in the recipes section.

This nutrient is very often forgotten or not mentioned when it comes to prenatal nutrition but it is extremely important. Choline is required for fetal brain development, prevents neural tube defects and helps with placental function (23). In fact, some of its functions are actually similar to folate, which is commonly discussed, however, choline is rarely discussed.. One of the best sources of choline, and my personal favorite is egg yolks. Beef liver is also rich in choline. However, it is very hard to get choline from a plant-based diet. The recommended minimum of choline in pregnancy is 450 mg a day. One egg with the yolk provides 115 mg, by comparison 1/2 cup of cooked pinto beans, brussels sprouts, or broccoli provides 30 mg (30 mg). So you could have 4 eggs with yolks and get to your daily choline requirement, or have 8 cups of broccoli, pinto beans or brussels sprouts. I LOVE broccoli and that even seems like a lot to me. Feel free to get your choline how you want, but in my opinion it is easiest to get enough choline when eating animal foods. I also specifically picked a prenatal for myself that contained some choline as insurance for if I’m not eating 4 eggs a day, which let’s be honest, I definitely do some days (I LOVE eggs), but there are days I don’t eat any eggs.

Although 450 mg is the minimum required amount of choline (I made sure to find a prenatal that includes choline, this is honestly pretty rare!) and also ate a lot of eggs during pregnancy (those who follow my social media probably noticed this), studies have shown that the optimal amount of choline is more than 900 mg per day. This level is specifically beneficial to fetal brain development and placental function (24, 25). A 2018 randomized, double-blind, controlled study (AKA the gold standard when it comes to clinical studies) tested the effect of a prenatal diet containing 480 mg of choline per day compared to a diet of 930 mg per day on infant brain development. The infants of mothers who were given both the 480 mg and 930 mg choline per day during the third trimester were tested at 4, 7, 10, and 13 months of time for visuospatial memory and information processing speed. The infants born to the mothers who got 930 mg of choline per day had significantly faster reaction times at all four age testing intervals (26), thus showing that perhaps our current choline guidelines are not enough or mothers do fine with the current choline recommendations but would do better with more choline.

Vitamin D

Here I am shading myself from the sun (so therefore reducing my vitamin D exposure) and hence why supplementation is often necessary. I’m also snacking on nuts and fruit! Great, portable, unprocessed combo that hits PFFP.

Most prenatal vitamins only contain about 400 IU of vitamin D but at this level most pregnant women are still deficient in vitamin D. 40-60% of the pregnant population in the US is deficient in vitamin D (6, 10). That’s a lot! So additional supplementation clearly seems necessary or making sure to eat lots of vitamin D rich foods (or both). Studies have shown that 4,000 IU of vitamin D daily is ideal for both mother and baby during pregnancy (11). Unfortunately so many of our modern diet resources tell us to avoid naturally vitamin D rich foods (ex: eat only low-fat dairy when vitamin D is a fat soluble vitamin and will be more bioavailable and present in full fat dairy, or eat only egg whites even though the yolks contain the fat necessary to absorb vitamin D and vitamin D itself). But by sticking to a more whole foods based way of eating we can make sure we are getting more usable vitamin D, whether we are pregnant or not. I consider full fat dairy to be more of a whole food than reduced fat, since they replace the fat with sugars, chemicals etc. and it decreases the nutrient value of things like vitamin D, and same with eating whole eggs vs. egg whites.

Since vitamin D is so important for the mother’s health, and there are increased needs during pregnancy, it is related to immune function, healthy cell division, bone health, metabolic function, insulin sensitivity, good sleep and brain health and has even been shown to be preventative for many types of disease such as cancer (11). That being said vitamin D is super important for mama and she has increased needs because baby is taking some, so I don’t think 400 IU cuts it!

Another factor to consider when thinking about vitamin D, is vitamin K2 since vitamin K2 will impact the absorption of vitamin D and also vitamin A (all fat soluble vitamins). Vitamin K2 is different from the plant form of the vitamin (vitamin K1) which does not help with vitamin D and calcium absorption and therefore bone health in the same way. Vitamin K2 is important for mineral metabolism in the body (making sure all the minerals get to the right place, i.e. making sure baby’s skeleton, teeth etc. are all formed correctly and are strong!) It is also important for mother’s bone health and if she does not have enough to provide for baby, her body will leech vitamin K2 from her bones and tissues to give to baby, which, is a good thing for baby but can leave mom with all sorts of complications postpartum, like maternal osteoporosis (5). So the solution here is to get a vitamin D supplement that also includes K2 (I like this one) and/or eat vitamin K2 rich foods such as full fat dairy, egg yolks (yep the same ones that include vitamin D, how smart is nature!?), liver, grass-fed butter and ghee, grass-fed beef, dark chicken meat (12). Finally, vitamin D can be absorbed from the sun. However, if you live somewhere with short days part of the year and do not spend the majority of your day outside and/or avoid sun exposure, you can’t rely on the sun for your vitamin D. Again, I’d look at your total intake and assess how much supplementing you think you will need, but most people need at least SOME.

Omega-3 Fatty Acids - DHA

One of my favorite meals during pregnancy was salmon with zoodles and my avocado pesto (SO creamy and decadent!) Recipe for the pesto is on my website. This salmon is Sizzlefish of course! See link and discount below.

There are several types of omega-3 fats: ALA (the plant-based form), EPA and DHA. DHA is by far the most important for brain health and baby’s and toddlers brain development, in fact the plant-based form has almost no impact on baby’s brain development because the conversion into the usable form of DHA is so low (5). These important DHA fatty acids are found almost exclusively and most prevalently in wild caught seafood. Unfortunately, many pregnant women have been told to avoid seafood or to limit it to very small amounts. The reasoning behind this is mercury toxicity which could be a very harmful neurotoxin, however, if you are smart about your fish consumption this should not be an issue (more on this below). Avoiding fish can have a detrimental effect on their baby’s developing brain. A study of over 1,200 mother-infant pairs looked for a correlation between fish consumption and IQ and eating over 12 oz of fish per week correlated strongly with the baby’s with the highest IQs and actually the babies with the lowest IQs came from mothers who consumed no fish at all (13).

Well if mercury is a neurotoxin and some fish contain mercury, how can eating fish be good for you? First of all, fish are also naturally high in selenium (even more so in their raw form so the sushi off limits thing does not make total sense either but again that’s another blog post). Selenium helps the body detox mercury (14). Mother nature at it again with how amazingly smart she is! So the net effect of any mercury should be minimal especially if you are choosing the right type of fish. Fish to avoid:

• Farm-raised fish, these are usually given antibiotics and hormones that you and baby don’t need in your body, and also can be hosts to antibiotic resistant bacteria that can be harmful (15, 16, 17). Additionally, farm raised fish are also proven to have higher levels of mercury than wild-caught fish.

• High mercury fish like tilefish, king mackerel, swordfish and shark. The amount of mercury is pretty directly correlated to the size of the fish and if it was wild caught or not (5).

• What about tuna? Skipjack is one of the smallest kinds and therefore contains way less mercury, this is mostly what I ate during pregnancy. Larger breeds like bluefin and albacore have much higher mercury ratings (22), the recommendation is to keep this to less than 6oz a week. Also wild caught is still important here! That will greatly reduce mercury amount.

More Sizzlefish wild caught salmon, cooked with avocado oil and Trader Joe’s bagel seasoning (another one of my fave combos)

Now, back to why DHA is so darn important! If the study above didn’t convince you that DHA helps the baby’s brain develop and have a higher IQ here are some more facts. DHA is incorporated into the rapidly developing brain and eyes of the fetus in utero where it forms neurons (brain cells) and protects the brain from inflammation and damage (18). It is crucial during pregnancy, and remains crucial during the first two years of life. If you are planning to breastfeed, it is important to get enough DHA since the amount of DHA found in breast milk is directly correlated to mother’s consumption (19).

So where to get your DHA? Personally, I have been eating a lot of wild caught salmon. Not only is it delicious but it’s loaded with DHA. It’s the top pregnancy-safe fish source of DHA (20). I like to order mine from Sizzlefish (code PRESS10 to save 10% on any non-subscription order). Other good sources of DHA are trout, oysters (these should be completely safe during pregnancy if from a reputable source (21) but if you don’t feel comfortable I totally understand, cod and other smaller whitefish, sardines, shrimp. Some of these are also available on Sizzlefish if online ordering is your thing (it’s mine). I also have been eating low mercury tuna as I mentioned, like skipjack and also have been keeping this to wild caught.

Folate vs. Folic Acid

You have most likely heard of folate and/or folic acid and the importance of this nutrient in preventing neural tube defects in the baby. Folate deficiencies can also lead to problems in mother's during pregnancy too (like anemia and peripheral neuropathy) (30, 31). Most sources suggest supplementing at least 3 months before you plan to get pregnant. This is one nutrient that supplementation is definitely necessary for since folate in foods diminishes the longer they are on the shelf, and the needs during pregnancy are high. However, many practitioners do not distinguish between folate and folic acid. And the truth is, these two are not exactly the same thing, as you may have been told.

Folic acid is the synthetic form of folate. The fact that is synthetic is not the problem, it's the fact that most people's bodies just can't use this synthetic version quite as well. In fact, 40-60% of the population can't convert folic acid properly to folate. And with this being such an important nutrient during pregnancy, I'd say use the most bioavailable (usable) form for your body and baby. Additionally, unconverted folic acid in the bloodstream may also cause problems (29). So if you are among the half of the population that does not convert it well, not only might your baby not be getting enough folate, but you might run into other problems for your own health.

Some of the best food sources of folate are dark leafy greens like spinach, lentils, beef liver and some nuts and seeds. However, like I mentioned, we actually need about 800 mcg per day during pregnancy, which would mean several cups of one of the above foods (29). This is also assuming those foods kept all their folate content, which, is rare unless you are picking the spinach right from your garden with perfect soil. So what should you look for in your prenatal vitamin? Look for folate, not folic acid, but also make sure that folate is not misrepresented. Sometimes it says “folate” with an * that says something like “as folic acid”. So it’s really just the synthetic form. Other terms for folate that you may see on a prenatal or another supplement are: L5MTHF, Methylfolate, 5-MTHF, Quatrefolic (a brand name of methylfolate). For instance, the prenatal I take says “Folate… L-5-MTHF as broccoli”.

Glycine

Glycine is conditionally essential during pregnancy. This means that when you’re not pregnant your body may be able to make enough glycine to support your bones, skin, nails, dental health & gut lining on its own. During pregnancy, this changes. Your body’s demand for this amino acid increases so much that you must consume glycine from food sources to support a healthy pregnancy. While there is no RDA for glycine, researches estimate that the minimum amount of glycine needed in the diet (this is in addition to what your body is able to make itself) for non-pregnant adults is 10 grams or 10,000 mg (27, 5). So even when you are not pregnant, it's advisable to eat glycine-rich foods in addition to just relying on your body's natural production.

I have been sneaking in collagen peptides (one of the best sources of glycine) EVERYWHERE. Especially places like home-baked goods. I made so many loaves of my no-sugar added paleo banana bread and would usually put about 1/4-1/2 cup of collagen in each batch. Recipe is on my site!

During pregnancy, glycine supports the growth of the baby’s teeth, internal organs, skeletal system, hair, skin, nails and is important for mama’s growing uterus and placenta and stretching skin. Glycine is the simplest amino acid structure so it serves as the building block of SO many parts of our bodies and our fetuses. It is also an important metabolic precursor (28). Since glycine is a structural amino acid, found mostly in connective tissue, skin and bones, it’s not actually contained in high amounts in most usual animal protein sources such as muscle meat, and is contained in very low concentrations in any form of plant-based protein. The best sources for glycine are connective-tissue based which may not be a part of everyone's diet.

My favorite source during pregnancy was a grass-fed collagen protein supplement (I actually take this when not pregnant too since it is one of the best ways to support a healthy gut and your own connective tissue - skin elasticity, nails etc.). I use Further Food (code START10 to save). Another great source is bone broth, since this is made by soaking connective tissue (bones and ligaments) it will contain some of those amino acids. Also eating any animal connective tissue is also a great source, for instance pork rinds or eating chicken or fish with the skin on will give you some glycine.

Magnesium

About half the American population is deficient in Magnesium (31). So I think we ALL need to consider this mineral a little more, not just pregnant people. As I mentioned previously, magnesium was one of the top nutrients that pregnant women who ARE on a prenatal vitamin supplement are still deficient in(6). Additionally, women with gestational diabetes are more likely to be deficient in magnesium. Magnesium deficiency can also be made worse in the presence of excess calcium and this combination can make pregnant women more susceptible to conditions like preeclampsia (32). I think the importance of calcium is often over-emphasized at the detriment of magnesium. Magnesium is also essential for many metabolic functions, nerve and muscle communication, protein synthesis and and regulations body temperature (36). These functions are all important in pregnancy or not but pregnancy is a good time to get your ducks in a row, since postpartum can be a little hectic and adding a magnesium supplement to your regimen may not be top of mind.

This picture doesn’t have much to do with magnesium but pregnancy overalls are the best and so is Claudette the frenchie!

Magnesium has particular importance during pregnancy. It helps reduce muscle cramps during pregnancy, reduce the risk of high blood pressure/hypertension and preeclampsia in pregnant women. Magnesium supplementation has been shown to reduce or prevent these medical complications in over 50% of those who supplemented with additional magnesium (33, 34). Magnesium can also prevent fetal growth restriction and prevent small for gestational age babies (35). A 2017 study showed that pregnant women who supplemented with 200 mg of magnesium daily had significantly lower risk of numerous complications including: intrauterine growth retardation, preterm labor, maternal body mass index (BMI) that was too high, neonatal weight, pregnancy-induced hypertension, preeclampsia, gestational diabetes mellitus, cramps (36).

Anecdotally, I have been supplementing with magnesium glycinate (there are many kinds of magnesium so I would check with a practitioner to see which one is right for you before supplementing) orally since the beginning of my pregnancy, and have not experienced any of these symptoms. The nausea was to my particular surprise. I’m not sure if the magnesium is the cause of my minimal nausea during the first trimester, but I’m sure it didn’t hurt. Now that I am in my third trimester and it’s the middle of summer and my feet and ankles are swelling, I have been using magnesium topically in the form of a lotion in the evenings on my feet.

Probiotics

Probiotics are the “friendly bacteria” that live in and on our bodies (no they are not a traditional “nutrient” like many of the other things we discussed but they are still very important for prenatal, or any health). They actually outnumber our own human cells (and genes) in a 10:1 ratio. So we are 90% probiotics. Whoa, that’s a lot. Many of these good bacteria, funghi and single-celled organisms live in our digestive system, but they are also on our skin (our largest organ), our mouthes and in our vaginas. So they will have an impact on far more than just gut health. They impact our skin (acne, exema, rashes can all be because of probiotic dysbiosis or imbalance), our oral health (these play a huge role in propensity to get cavities and other oral diseases or not) our vaginal health (yeast infections are also when the bad bacteria outgrows the good bacteria), and of course our digestive health (everything from our metabolism, how many nutrients we are able to extract from food, how many calories we extract from food, whether we have bloating, gas, constipation, diarrhea etc.) These, among other reasons I will discuss below, are all great reasons to make sure our bacterial population are in balance.

This bowl I ate on our baby moon in Ojai, CA was loaded with probiotics (there were several types of fermented veggies in there and not to mention all the different colors) and other pregnancy-friendly foods (hello grass-fed bison burger).

Shockingly, this is another supplement that I have heard many prenatal practitioners say is “not safe” during pregnancy. There is no clinical evidence to show that probiotics are not safe, and in fact they are extremely important during pregnancy. I would say, don’t go taking a “homemade probiotic” from an unreputable source, but other than that, make sure you are getting a good source of probiotics. This is another one I recommend supplementing with to ensure survivability through the gastric juices in the stomach. Early in my pregnancy, I actually switched to Just Thrive probiotic (and prebiotic) supplement because they have the strongest clinical evidence to support 100% survivability through the gastric juices. You can use code PRESS15 to save on your own, whether you are pregnant or not.

Now back to probiotics and pregnancy. First of all, we populate our baby’s microbiome (friendly bacteria population) when they pass through our birth canal and even those who give birth via cesarean pass on bacterial populations through the placenta and also breast-milk if breastfeeding (29). So if we want to give our baby the best start at life, I recommend taking care as to what bacteria is living in and on you. In addition to the important roles I mentioned above, our gut is home to our enteric nervous system (ENS) which plays a huge role in how our brain functions and our mood. In fact, 90% of our serotonin is produced in our gut (37, 39). Happier gut = happier moms and babies! Additionally, our guts are home to something called GALT, or gut activated lymphatic tissue. Lymphatic tissue refers to immune tissue. So this is a fancy way for saying our gut health plays a huge role in our immune system. About 75-80% of our immune system is actually controlled by our gut (40). Additionally, our gut helps our bodies detox harmful substances like small particle LDL cholesterol and can help prevent things like the onset of cardiovascular disease (38) and, when in the right “balance” can help reduce inflammation in the body, which is the root cause of almost every disease (41). However, when not in “balance”, or when the gut is in a state of “dysbiosis” it can cause widespread inflammation in the body, which can cause many diseases. So by taking care of your gut, you can stay healthy during pregnancy and give your baby the best chance at starting life out happy (serotonin) and not sick (immune system) and so much more.

Our microbiome, or bacterial balance in our bodies also has some other direct impacts on pregnancy outcomes. Studies have shown that dysbiosis (imbalance of unhealthy and healthy bacteria in the gut) can increase the mother’s risk of excessive weight gain during pregnancy, preeclampsia, gestational diabetes and preterm birth (42). Probiotics can actually help prevent mother’s who do have gestational diabetes for having a too large baby (which is common in this population) and can help balance blood sugar in both mothers with gestational diabetes and without (see carbs paragraph for why balanced blood sugar is important) (44). Additionally, a good probiotic supplement can reduce inflammation in the placenta, which, can prevent many other conditions. In fact, the placenta has recently been discovered to have its own microbiome (or bacterial population), which, of course is entirely populated by the mother in utero (43). In addition to a quality probiotic supplement that will survive (see above, most do NOT survive gastric juices which is why I have carefully chosen mine), it is important to care for our microbiome and thus our baby’s micro biome by eating a diversity of colorful, whole foods, and avoiding things that harm gut bacteria such as traditional cleaning chemicals, phthalates, BPA and BPS, many compounds in traditional beauty products, antibiotics (such as those in conventionally raised meat and seafood), gluten (to the extent possible) and much more. If you want more guidance on this, please contact me.

summary

Another plate loaded up with the pregnancy goods! Eggs (hi choline, protein, DHA, vitamin D, vitamin K) and sweet potatoes for those unrefined carbohydrates and green veggies for folate. So you don’t need to eat out of the ordinary foods, just be mindful of what you’re taking in!

Whoa, that was a lot of information. If you made it this far, thank you for reading! Like I said, this should not replace working with a practitioner to optimize your prenatal nutrition, but hopefully, can teach you some new things to at least look into for your own prenatal diet and care. I always advocate for a diverse diet of whole foods (minimally processed). But I also think pregnancy is as good a time as any to listen to your body. So I am not trying to impose guilt or shame on anyone who ate some bread or pasta or candy during pregnancy, but rather trying to clue you in on what other things you might want to consider including, whether that’s a supplement or a food group or both. And finally, I will put a link to the main prenatal vitamin that I took during pregnancy again here since I know I will get questions about it. However, please note that this is NOT the only supplement I took, and I still recommend working with someone to see what you might need in addition. And finally, if you are mama to be reading this, CONGRATS and try to enjoy the process!

References:

1. https://www.eatright.org/health/pregnancy/prenatal-wellness/healthy-weight-during-pregnancy

2. https://academic.oup.com/ajcn/article/75/5/951/4689417

3. https://www.ncbi.nlm.nih.gov/pubmed/26457543

4. https://www.ncbi.nlm.nih.gov/pubmed/11679789

5. Nichols, L. (2018). Real food for pregnancy: The science and wisdom of optimal prenatal nutrition. {United States?: Lily Nichols.

6. https://www.reuters.com/article/us-health-pregnancy-diet/average-pregnant-woman-in-u-s-may-have-poor-nutrition-idUSKCN1TM2KL

7. https://academic.oup.com/nutritionreviews/article-abstract/57/11/350/1812707?redirectedFrom=fulltext

8. Ross, A. Catharine. “Modern Nutrition in Health and Disease / Edition 11|Hardcover.” Barnes & Noble, barnesandnoble.com/w/modern-nutrition-in-health-and-disease-a-catharine-ross/1118877753.

9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2855261/

10. https://academic.oup.com/jn/article/137/2/447/4664564

11. https://americanpregnancy.org/pregnancy-health/vitamin-d-and-pregnancy/

12. https://www.todaysdietitian.com/newarchives/060113p54.shtml

13. https://www.ncbi.nlm.nih.gov/pubmed/17307104

14. https://www.ncbi.nlm.nih.gov/pubmed/20561558

15. https://jamanetwork.com/journals/jama/fullarticle/203640

16. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)00100-6/fulltext

17. https://www.sciencedirect.com/science/article/pii/S095671351400632X

18. https://academic.oup.com/jn/article/137/4/855/4664682

19. https://www.medicalnewstoday.com/articles/323144.php

20. https://www.medicalnewstoday.com/articles/323144.php

21. Oster, Emily. Cribsheet: a Data-Driven Guide to Better, More Relaxed Parenting, from Birth to Preschool. Penguin Press, 2019.

22. http://seafood.edf.org/tuna

23. https://www.ncbi.nlm.nih.gov/pubmed/23637565

24. https://www.ncbi.nlm.nih.gov/pubmed/22549509

25. https://www.ncbi.nlm.nih.gov/pubmed/23195033

26. https://www.ncbi.nlm.nih.gov/pubmed/29217669

27. https://link.springer.com/article/10.1007/s12038-009-0100-9

28. https://academic.oup.com/jcem/article/90/3/1594/2836828

29. Wolfe, Liz. “Baby Making & Beyond.” Baby Making & Beyond, Dec. 2018, www.babymakingandbeyond.com/products/bmb-core-four.

30. https://www.ncbi.nlm.nih.gov/pubmed/30976786

31. https://www.ncbi.nlm.nih.gov/pubmed/22364157

32. https://www.ncbi.nlm.nih.gov/pubmed/7892840

33. https://www.ncbi.nlm.nih.gov/pubmed/7631676

34. https://www.sciencedirect.com/science/article/pii/S2210778914004115

35. https://www.ncbi.nlm.nih.gov/pubmed/24696187

36. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5590399/

37. https://www.ncbi.nlm.nih.gov/pubmed/28164854

38. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5579652/

39. https://www.scientificamerican.com/article/gut-second-brain/

40. https://www.ncbi.nlm.nih.gov/pubmed/28164850

41. https://www.ncbi.nlm.nih.gov/pubmed/28089638

42. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4658310/

43. https://www.ncbi.nlm.nih.gov/pubmed/24848255

44. https://www.ncbi.nlm.nih.gov/pubmed/20128938

Balanced Breakfast Tips

One of the most common things I see on food diaries is missing breakfast or a nutrient deficient breakfast. For reference, I have all my incoming clients do a food diary before we begin working together. They don’t record calories or exact measurements, it’s just to see their general eating habits. This trend is not unique for my clients, only 47% of US adults eat breakfast daily (1) so that means more than half skip breakfast pretty regularly. I am not saying you have to eat the second you wake up. However, there is considerable research that shows starting your day with a balanced breakfast (see my take on this below) can jumpstart your metabolism, help muscle building over time, balance your blood sugar, fight nagging cravings later in the day, help with natural satiation and portion control and give your body the dose of nutrients it needs to start the day (2,3,4). The clinical research points positively towards breakfast as well as my own anecdotal experiences (from myself and my clients). Even if you practice intermittent fasting, which is a longer topic for another day, the first meal of the day should be balanced. So here are my tips on how to do so:

Tip #1 PFFP:

Breakfast should include as many of the PFFP components as possible. If you can’t include all four, that’s fine, 3/4 is still great and even 2/4 is doing pretty darn good. PFFP stands for Protein, Fat, Fiber, and Phytonutrients. This combination will keep you full, satiated, energized and with your metabolism on fire. Here are some ideas of foods that contain each component:

• Protein: comes from meat, seafood, eggs, greek yogurt/cottage cheese, and there is some in nuts and seeds and their derivatives (butters, flours), legumes, and some supplements (my favorites are Nuzest pea protein “PRESS15” saves you $$ and Further Food collagen “START10” saves you $$)

• Fat: comes from whatever oil you cook with, ghee, butter, dairy, avocado, coconut/oil, nuts and seeds and their derivatives (butters, flours), and from meat and seafood (will depend on what meat you buy but there will usually be at least a little fat)

• Fiber: comes from fruits, vegetables, nuts and seeds and their derivatives (butters, flours), legumes and whole grains

• Phytonutrients: comes from fruits and vegetables, specifically, these are the compounds that give fruits and vegetables their colors, so eat the rainbow!

As I said, you don’t need all four PFFP components at every meal, but the more the better. The thing you want to avoid is having a meal or a snack comprised of “naked carbs”. Some examples of naked carbs would be (a piece of fruit, a bagel, some juice, cereal). Ways to “dress up” those carbs so they have more PFFP components and are not naked would be a piece of fruit with some nut butter or greek yogurt, a bagel with smoked salmon or an egg, a smoothie that includes protein and healthy fats (instead of a juice), and greek yogurt or cottage cheese with a granola that includes lots of nuts and seeds instead of cereal.

Some more EASY no fuss PFFP breakfast ideas:

• Eggs of any kind and avocado (I love having this on sweet potato toast) you can even add bacon if you like

• Full fat greek yogurt with some fruit and nuts

• Chia pudding & berries

• Smoothie with protein & healthy fats

Tip #2 You don’t have to be traditional:

The above examples all include traditional “breakfast fare”. However, breakfast does not have to include “traditional breakfast food”. It is more important to eat foods you like and will crave, are realistic and accessible to you at breakfast time. And of course, strive for as many components of PFFP as you can.

I often eat regular “meals” for breakfast if that’s what I wake up craving and I have leftovers in the fridge anyways. For instance, I love a good “breakfast salad” like the one pictured to the right. Nothing like starting your day with greens. Or sometimes I’ll have something from dinner the night before such as salmon and roasted veggies (hello PFFP).

Breakfast foods can feel constraining to people when they don’t know what’s healthy and convenient in the breakfast category, the default can be to just grab coffee and skip breakfast, or grab a packaged protein bar and be on your way. But when we think about breakfast in narrow terms we can get pigeon-holed into the naked carb items above (cereal, bagel etc.) By expanding our definition of what’s “allowed” at breakfast, the possibilities are endless!

Tip #3 Make it easy on yourself:

For most people, mornings can be the busiest time of day. Hence the tendency to skip breakfast. Plan ahead and plan realistically. If you love a cozy bowl of oats, make a batch of overnight oats on the weekend that’ll be read for the week. If you love omelettes and bacon, make egg muffins with your favorite bacon chunks in it ahead of time. If you love pancakes or waffles, make and freeze a big batch so they can easily be reheated during the week. If you’re a smoothie and go type, put your smoothie ingredients in individual bags so all you have to do is dump them in the blender when morning arrives. You can check out more of my “meal-preppable” breakfast recipe ideas here.

tip # 4 look forward to your breakfast!:

Waking up is hard enough, no matter how much sleep you got the night before. So why not have something to look forward to in the morning. You should always start your day with something delicious you want to eat. Not only will this set the tone for the day in a positive way, but it will make you more likely to eat breakfast. Instead of preparing foods you feel like you should eat for breakfast, start your day with foods you get to eat for breakfast!

References:

1) https://www.thedailymeal.com/news/healthy-eating/more-half-americans-skip-breakfast-least-once-week-study-says/081815

2) https://www.ncbi.nlm.nih.gov/pubmed/30373105

3) https://www.ncbi.nlm.nih.gov/pubmed/30527257

4) https://www.ncbi.nlm.nih.gov/pubmed/28701389