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Prenatal Nutrition/Diet/Supplements

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See also:

Subsections on this page:

The Better Baby Book: How to Have a Healthier, Smarter, Happier Baby
by Lana Asprey and David Asprey

This is a must-read book for midwives as well as pregnant women.
It is meticulously researched and presented in a very engaging way.

I am very sad to hear that Garden of Life was purchased by Nestle.
I have engaged in a long-time boycott of Nestle because of their
deceptive practices regarding pushing infant formula in developing
countries where clean water is not always available or parents cannot
afford to buy enough formula to keep their babies healthy.



See also: Water Bottles and other Plastic Food Containers

The Supplement Pyramid: How To Build Your Personalized Nutritional Regimen

Valuable Nutrition Information at Your Fingertips With Mercola Food Facts [8/6/16]

The Better Baby Book: Use nutrition, your environment, and your mind to create the healthiest, smartest, autism-free baby possible by Lana Asprey, MD, and Dave Asprey,  "To help parents gift their children with better health and higher intelligence for life." It's available either on Kindle or paperback.

This book was written by a couple who know more about pregnancy nutrition than anyone I've ever heard, met or read about.

The book is finally out as of Jan. 1, 2013.  You can also read their Better Baby Blog.

The Better Baby Diet - distilled from countless research papers, spending more than 10 years working with some of the world’s top health and nutrition researchers, reading over 150 nutrition books, and self-experimenting for 15 years. Just eat the stuff on the left below and watch what happens for you and your baby. No calorie counting, no measuring. Just eat and feel your brain, body, and hormones re-awaken as your effortlessly lose weight and gain muscle on little or no exercise.  Best of all, science shows conclusively that the Better Baby Diet tastes good and is satisfying. It’s not vegan, it’s not low-fat, and you don’t need to limit calories.

DR. NANDI’S TOXIC INGREDIENTS TO AVOID AT ALL COSTS! - I hope you will use this guide to take a closer look at the packaged product you have in your kitchen that could be dangerous to your health. Use my Toxic Ingredients Guide and wallet sized list to ensure you are making empowered choices at the grocery store. [Ed: Even if you can't manage all organic, at least you can avoid these overtly toxic foods.]

Understanding Supplements - John Hicks, MD - audio of lecture.  His online store offers inexpensive high-quality supplements.

The NIH has an Office of Dietary Supplements (who knew?) which produces some excellent fact sheets on various supplements.

Antibiotic-resistant bacteria in your meats - so-called superbugs that can trigger foodborne illness and infections that are hard to treat - are now common in the meat aisles of American supermarkets.  These bacteria can be dangerous to your unborn baby and to your newborn.

For when you really want to dig in - Resources to help you find healthier meat sources.

High Quality Supplements Make All the Difference - A Brief Guide to Choosing Quality Supplements

Low-Carbohydrate Nutrition in Pregnancy - For many pregnant women, they will need to reduce their carbohydrate intake in order to maintain healthy blood sugar levels.

Healthy Alternative Sweeteners for Pregnancy - safety of stevia, maltitol and other natural sweeteners with low glycemic index.

Kick Your Sugar Habit With These Bulletproof Alternative Sweeteners
- this is an excellent guide to let you know which alternative sweeteners are actually good for you and which are toxic.

Does the Type of Sugar in Your Beverage Matter? - Yes! Avoid fructose like the plague!  Sad to say, this includes fruit juices.

Eating for two, gaining too much (LA Times) - Women who start their pregnancies at a normal weight are currently advised to gain at least 25 but no more than 35 pounds. Underweight women are told to gain more, overweight women less. But with the nation's overall waistline expanding, the guidelines that set these ranges are being criticized as too lenient.

Thorne Research makes just about the highest quality, purest Nutraceuticals and pays extra attention to using excipient-free substances and hypoallergenic capsules.  Midwives are eligible to register with Thorne to get a significant professional discount.

It's About Eating Right from the Academy of Nutrition and Dietetics.

Fit for Two - Tips for Pregnancy from the NIH (11/09)

Nutrition During Pregnancy: (1990) from the Institute of Medicine (IOM)

The Green Pregnancy Diet: Healthy eating habits for mommy, baby and the planet by Radha McLean

DoctorYourself.com - experts provide recommendations for supplement therapy for different ailments.  You can read hundreds of full-text nutritional therapy papers from the Journal of Orthomolecular Medicine free of charge.

Great article from Pregnancy Basics from Pam Caldwell at HerbLore.

Functional Nutrition and Our Products - This 50-minute DVD effectively answers such questions as:

What is Functional Nutrition?
What makes Simplexity's microalgae unique in the marketplace today?
How do they work in the body?

Dr. Tom Brewer's Blue Ribbon Baby Pages - Help Realize Dr. Brewer's Dream:  That Every Woman Will Know!

The CureChild program is a set of powerpoint presentations, including Pregnancy Supplements

The Brewer Pregnancy Diet

Nutrition During Pregnancy: Part I: Weight Gain, Part II: Nutrient Supplements (1990) from the Institute of Medicine (IOM)

Healing Our Children by Rami Nagel - Prenatal nutrition is one of the greatest ways we can make a positive change for the world.

Healthy Pregnancy and Lactation Diet - written from the Weston Price philosophy

BabyCenter  - Everything is covered here, from appropriate weight gain and nutrient needs at each stage of pregnancy (preconception through breastfeeding) to finding healthy fixes for junk food cravings. Nutrition articles are concise, yet thorough.

Pregnancy and Prenatal Care - Health and Nutrition - a resource list from Auburn University

Association of Perinatal Naturopathic Doctors (APND)

Nutrition & Recipes from the American Diabetes Association - these are generally good, healthy diets

The Biochemical Functions of Essential Macro and Micronutrients - A Physician Primer - Module III. Nutrition for Health Promotion and Disease Prevention CME  [Medscape registration is free]

ChooseMyPlate.gov - Health & Nutrition Information for Pregnant & Breastfeeding Women

Arbor Clinical Nutrition Updates

Healthy Pregnant Women Need Extra Energy Intake  CME [Medscape registration is free] [Release Date: June 1, 2004; Valid for credit through June 1, 2005]

How does dietary fat help us absorb vitamins? - Women need to be sure to take the fab-soluble vitamins with some fats.

Good Nutrition for a Mother from Mother Nurture, which focuses on practical help for the mother's well-being, and for building teamwork and intimacy with her mate.
Here's Part 2.

Organization for Nutrition Education - a Canadian organization with an extensive collection of links.

Another collection of links about nutrition in pregnancy from the University of Toronto.

Cochrane Review Abstracts Nutritional Supplementation in Pregnancy - from Medscape [registration is free]

The Organic Revolution from Audobon Magazine - One of the easiest ways to reduce your baby's exposure to environmental toxins is to eat organic food.

cornucopia.org rates organic dairy products.

Nutrition FAQ

Nourish the Future - Pre-Conception, Pregnancy and Postpartum Nutrition Classes

Pregnancy Nutrition (from the National College of Chiropractic)

Why Absorption of Nutrients is Important During Pregnancy

Phytoestrogens in Foods and Herbs

Dr.Tony Helman's Arbor Nutrition Guide

Expecting Mom - I'm somewhat leery of powdered nutrition, but this does seem to be an option for women who need a little something extra.  "Expecting Mom contains a fruit and vegetable mix that makes it more than a prenatal supplement. It makes a great substitute for those days when it is tough to keep things down." 1-888-665-8243

FitDay.com is an online diet and fitness journal; there is a calorie and nutrition counter, a weight loss tracker, an exercise log, analysis and reports.

FDA Center for Food Safety & Applied Nutrition - This complex site provides access to many government resources on nutrition and is best used with a specific topic in mind due to its sheer size.

MayoClinic.com  - This site offers good nutrition information in a fun, user-friendly format. Bookmark it as a source of nutrition advice that you can trust.

Baby's Palate And Food Memories Shaped Before Birth -

"Want your child to love veggies? Start early. Very early. Research shows that what a woman eats during pregnancy not only nourishes her baby in the womb, but may shape food preferences later in life.

"At 21 weeks after conception, a developing baby weighs about as much as a can of Coke — and he or she can taste it, too. Still in the womb, the growing baby gulps down several ounces of amniotic fluid daily. That fluid surrounding the baby is actually flavored by the foods and beverages the mother has eaten in the last few hours."

General Supplements Recommendations

See also: Methylated Prenatal Vitamins

I am very sad to hear that Garden of Life was purchased by Nestle. I have engaged in a long-time boycott of Nestle because of their deceptive practices regarding pushing infant formula in developing countries where clean water is not always available or parents cannot afford to buy enough formula to keep their babies healthy.


Which Supplement Companies Do the Experts Swear By? [2/4/15] - this has a nice list of reputable supplements compounders and purveyors.

- I just heard of them in Sept., 2016, and I'm not sure about their overall reputation, but I like the idea of a sort of Consumer Reports for supplements.

My primary sources for supplements are Thorne Research and Metagenics.

I recommend the Metagenics Wellness Essentials® Pregnancy daily multiple vitamin packets:

These contain the right kind of folate, to help counter the epidemic of tongue-tie and lip-tie that we're seeing.

I also recommend high doses of vitamin D.  Ideally, you would be able to get a blood test to assess your vitamin D levels and then adjust until they're between 50 and 60.  However, it's less expensive simply to take 10,000 I.U. daily.  In addition to helping your body absorb the calcium, iron and other minerals necessary to build a healthy baby, vitamin D also supports your immune system. This can help prevent cerebral palsy.

And I recommend vitamin C with bioflavonoids on a daily basis.  Your body needs this in order to make collagen, which is the basic building block of your tissues.  Your body uses it up fairly quickly.  I love the Thorne brand and have seen good results in my clients in terms of reducing varicose veins, preventing perineal tearing, etc. So I feel confident that it's good for all your tissues! Ideally, you'd be taking 100 mg every hour.  More realistically, I recommend 500 mg in the morning and 500 mg again with dinner, more if you have particular issues such as varicose veins or hemorrhoids.  And vitamin C is always a first go-to remedy for constipation.

Many people are deficient in magnesium, since it's one of the minerals that that has been depleted from our soils with poor farming practices.  If you have any kind of muscle spasms, pain, any concerns that could be related to muscles, magnesium citrate is an excellent remedy. I can help with sleep, too.  It's also another remedy for constipation in some anxious people.

So this brings me to a recommendation for regular or occasional supplementation with a calcium/magnesium supplement.  I like Thorne's Citramins® with Copper & Iron; it also has some good trace minerals, such as zinc.

If you don't already get lots of probiotics through a variety of fermented foods, then a probiotics supplement may be helpful.

You want to be cautious with omega-3 supplementation.  Too much can make the baby's head bigger and delay the onset of labor.  However, if your hair or skin are dry or you have mood issues, then extra omega-3s might be overall beneficial for you.  If this is a first baby for you or you have concerns that the baby might have trouble fitting through your pelvis, then you might not even want to take the amount of omega-3s in the daily multiple vitamin packets.  You can save these in an airtight jar in the fridge and use them after the baby is born to help with mood!

Upgrade Your Energy, Optimize Your Supplements - This is very helpful in that it discusses the best times of day to take different supplements!  Here are the ten nutrients (almost) everyone should supplement with.

Nutrition Trackers and Analyzers

The USDA National Nutrient Database for Standard Reference - Find nutrient information on over 8,000 foods.  It has a good food search.

SuperTracker from the USDA can help you plan, analyze, and track your diet and physical activity.  It does a very nice job of analyzing your diet to let you know how much protein and vitamins you're getting. Or you can look at (or download?) the USDA National Nutrient Database for Standard Reference

Cronometer is the nutrient analytic tool recommended by Dr. Mercola.

I also really like the one at nutritiondata.com

Some others:

The USDA maintains a list of Dietary Assessment Tools

Systemic pH - Acidity and Alkalinity

I am just coming to learn the importance of an awareness of systemic pH.  Here are some helpful introductory resources:

pH is Vital for Whole Body Health

I like this pH chart from alkaline-alkaline.com.

A metallic taste, also known as dysgeusia, can indicate a high level of acidity in a woman's mouth and digestive tract.  It can also be caused by a high level of estrogen and can also indicate zinc or calcium deficiency (Heckmann 2005).

pH Balance and Health from Mother Earth Herbs

The pH Miracle explains the extraordinary benefits of reducing acid, or 'Alkalizing' the body using natural means

History of nutrition and acid-base physiology from AlkalizeForHealth.org

There are some very pricey alkalizers out there, but I like this moderately priced home Alkaline Water Pitcher - they also make a portable alkalizing water bottle.  It's sold on a site related to dental care because less systemic acidity inhibits the nasty oral bacteria that cause tooth decay.  (It's the acid the bacteria thrive that eat holes in the teeth; those bacteria also thrive in the acid environment they create.)

Respected healthcare providers recommend The Alkalizer - it's pricey, though - around $1500 some years ago.  Personally, it's worth it to me for the reduced dental expense and pain!  Other health benefits are gravy.

However, Dr. Mercola argues against alkalized water: Alkaline Water: If You Fall for This "Water Fad" You Could Do Some Major Damage [9/11/10

Immune System Support

Check with your healthcare provider, but good basic immune support in pregnancy is adequate vitamin D (probably 5000 to 10000 I.U. daily), vitamin C (avoid high doses in the the first trimester, but after that, 2000 to 5000 daily of vitamin C with bioflavonoids helps build strong cell walls) and probiotics.  If this isn't enough, adding garlic supplements may help.  [Of course, it's important to use high-quality supplements.  The cheapest ones from your local drug store or grocery store may not be enough.]

A moms writes, I used to have the same issue with frequent sinus infection, bronchitis/cold, abdominal discomfort, fatigue, etc., but staying away from gluten and minimizing sugar (especially refined sugar) made it all go away. Have you consulted your doctor about food sensitivity? I tested negative on celiac, but my doctor put me on elimination diet, and I found out gluten was eating me alive. No more sinus infection ever again.

Food and Water Safety

See also: Drinking Water

Why drinking water during pregnancy is crucial [9/25/14] - Women should increase their total water intake by an extra 300 ml/day during pregnancy and 700 ml/day during breastfeeding, make water the first choice when it comes to hydration.

Eating Safely During Pregnancy from Journal of Midwifery & Women's Health [08/24/2004] - [Medscape registration is free]

Eating Safely During Pregnancy from the ACNM's "Share With Women" series of handouts.

Listeriosis and Pregnancy: What Is Your Risk? - Safe Food Handling for a Healthy Pregnancy

Methylfolate is Safe and Folic Acid is Not / Methylation and MTHFR

This section has been moved to: Learning About Your DNA and Childbearing

CDC recommendations for 400 micrograms  (0.4 mg) for all women of child-bearing age.

Folic Acid and the Prevention of Neural Tube Defects from the Department of Medical Genetics, Alberta Children's Hospital.  Here are their recommendations for dosage.

Maternal Folate and B12 Supplementation is Protective Against Neural Tube Defects and Autism Spectrum Disorder

Some women experience negative side effects when they change their folate supplements:

The best dose of methylfolate for MTHFR mutants - "You may  notice that you’re a little agitated, or anxious, or depressed or just feel a little spacy or off." This discusses possible side effects from increasing MTHF

Methylfolate Side Effects:

Mood changes: depression, irritability, severe anxiety
Pain: sore muscles, joint aches, headaches, migraines
Physical Symptoms: rash, acne, heart palpitations, nausea, insomnia

Fruits and Vegetables

Phytonutrients from fruit and vegetable juice concentrates may decrease obstetric complications: A retrospective study
C. Doug Odom, M.D., Suneet P. Chauhan, M.D., et al.

This is from the "Juice Plus" people.  I strongly encourage all my clients to take some high quality nutritional supplements during pregnancy. It is impossible to get the nutrients you need exclusively from food unless you have a very diverse organic garden in your backyard, and you are eating your fruits and vegetables fresh from the plants. You can get "Juice Plus" from Cypress Natural Medicine, a naturopathic office in downtown Palo Alto.  It is only shipped by mail, so you can order it by phone - call (650) 323-7345

Editor: I have always had concerns about the fact that JuicePlus is a multi-level-marketing product.  I am always concerned anytime a healthcare provider gets kickbacks from a supplier, whether that supplier is BigPharma or BigVitamins  I finally found an article that looks critically at JuicePlus products:

Debunked!: Juice Plus (A Research Review) by Devin - You can skip ahead to the SUMMARY: The Three Minute Version of This Juice Plus Review.

Their conclusion: You get more benefit at less cost by taking a good multivitamin and a powdered greens supplement.

Fruits, Vegetables May Protect Against Upper Respiratory Tract Infection During Pregnancy - Consuming at least 7 servings per day of fruits and vegetables may reduce the risk for upper respiratory tract infection (URTI) during pregnancy [Medscape registration is free.]

Midwifery conferences are often attended by JuicePlus vendors; they always have studies showing how beneficial their supplements are for pregnant women who can't manage to eat the 7 servings per day.


See also: Microbial Colonization of Newborn Skin and Gut

OK - this is one of the funniest things I've heard in a long time: "The road to health is paved with good intestines."

PRO-Moms is a probiotic formula from Hyperbiotics meant for pregnant and lactating women. Some of the probiotics help to suppress GBS (as in FemDophilus), and some of them help to prevent colic in newborns. (b. infantis).  Robin Lim and the Bumi Sehat Foundation are associated with this company.

5 Good Bacteria Strains That You Should Watch Out For - [from Dr. Mercola] different probiotic bacterial strains support different functions in your body

7 Ways Probiotics Detoxify Your Body [1/25/16] by Sayer Ji - this is an excellent explanation.  I never knew!

3 Ways to a Healthy Gut Biome and Reduce Histamine Intolerance - discusses a low-histamine, anti-inflammatory diet, histamine-producing bacteria (like Lactobacillus casei, Lactobacillus reuteri, and Lactobacillus bulgaricus) and increase histamine-degrading bacteria (Lactobacillus plantarum, Bifdocaterium lactis, and Bifidobacterium longum).

Probiotics During Pregnancy May Ward Off Eczema, Food Allergy

In research reported in the October 18, 2012, issue of the Journal of Allergy and Clinical Immunology, infants whose mothers took probiotics during pregnancy and while breast-feeding were less likely to develop eczema. The mothers all had a history of allergy, so their children were at high risk. About 30% of infants whose mothers took probiotics developed eczema compared with 79% of infants whose mothers did not. However, the study found no difference in the incidence of other allergies at age 2 years, including milk, wheat, soy, and dog and cat dander. And in a separate review published online April 17, 2013, the authors write, "Twenty-three randomized, placebo-controlled intervention studies regarding the clinical effect of probiotic supplementation on development of [food] allergy and eczema in particular have been published. Around 60% of the studies show a favourable effect decreasing the risk of eczema during the first years of life. The remaining studies fail to show an effect."
from Probiotics: How Good Are These 'Good' Bacteria?
Deborah Flapan; Darbe Rotach
July 16, 2013

Probiotics During Pregnancy May Ward off Eczema
[Oct 25, 2012

Maternal probiotic supplementation during pregnancy and breast-feeding reduces the risk of eczema in the infant.
Rautava S, Kainonen E, Salminen S, Isolauri E.
J Allergy Clin Immunol. 2012 Dec;130(6):1355-60. doi: 10.1016/j.jaci.2012.09.003. Epub 2012 Oct 16.

CONCLUSION: Prevention regimen with specific probiotics administered to the pregnant and breast-feeding mother, that is, prenatally and postnatally, is safe and effective in reducing the risk of eczema in infants with allergic mothers positive for skin prick test.

Probiotics can help to reduce anxiety during pregnancy, reduce the incidence of gestational diabetes, improve outcomes and help moms lose weight postpartum.

Impact of maternal probiotic-supplemented dietary counselling on pregnancy outcome and prenatal and postnatal growth: a double-blind, placebo-controlled study.
Luoto R, Laitinen K, Nermes M, Isolauri E.
Br J Nutr. 2010 Jun;103(12):1792-9. Epub 2010 Feb 4.

The perinatal nutritional environment impacts upon the health and well-being of mother and child also in the long term. The aim of the present study was to determine the safety and efficacy of perinatal probiotic-supplemented dietary counselling by evaluating pregnancy outcome and fetal and infant growth during the 24 months' follow-up. Altogether, 256 women were randomised at their first trimester of pregnancy into a control and a dietary intervention group. The intervention group received intensive dietary counselling provided by a nutritionist and were further randomised, double-blind to receive probiotics (Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb12; diet/probiotics) or placebo (diet/placebo). Firstly, probiotic intervention reduced the frequency of gestational diabetes mellitus (GDM); 13 % (diet/probiotics) v. 36 % (diet/placebo) and 34 % (control); P = 0.003. Secondly, the safety of this approach was attested by normal duration of pregnancies with no adverse events in mothers or children. No significant differences in prenatal or postnatal growth rates among the study groups were detected. Thirdly, distinctive effects of the two interventions were detected; probiotic intervention reduced the risk of GDM and dietary intervention diminished the risk of larger birth size in affected cases; P = 0.035 for birth weight and P = 0.028 for birth length. The results of the present study show that probiotic-supplemented perinatal dietary counselling could be a safe and cost-effective tool in addressing the metabolic epidemic. In view of the fact that birth size is a risk marker for later obesity, the present results are of significance for public health in demonstrating that this risk is modifiable.

Probiotics Cut Belly Fat After Pregnancy

Study Shows 'Good' Bacteria May Help Women Reduce Belly Fat After Childbirth

Consumer labs does independent testing of supplements and Jarrow probiotics are shelf stable so you don't have to refrigerate and their testing indicates all batches meet or exceeded the listed amount of microbes as found on the box/label.

I have a very basic understanding of probiotics, and I'll try to convey what I know here.;*)  The gut is filled with good guys and bad guys (both bacteria and yeasts).  There has to be a good balance between the good guys and the bad guys for optimum digestion and nutrient absorption.  Probiotics are all good guys that should balance the gut in the case of imbalance (antibiotics kill good guys along with the bad guys, but this is just one example of how the intestinal flora gets out of whack).  IMO, probiotics are like *gut insurance*.  There is a book called Bacteria for Breakfast that explains it all a lot better than I have.

I especially like New Chapter "Perfect Prenatal" supplements because they contain helpful probiotics, including L. acidophilus and especially B. infantis, which will get passed on to your baby and help prevent colic; they are available at Whole Foods and other health-food stores.  They contain recommended levels of folic acid, vit. C and acidophilus, as well as an unspecified amount of choline.

Super Prenatal Supplements, by Stacelynn Caughlan, including a subsection on PROBIOTICS

Probiotics: "Living drugs" [Medscape registration is free] - this article includes treatment for UTI's.

From the July, 2005, Consumer Reports article on "Probiotics - Are enough in your diet?": "Some clinical evidence suggests that yogurt with Lactobacillus acidophilus may boost immune cells that help protect against abnormal microbes in the urogenital tract and help reduce the incidence of vaginal bacterial infections.  Yogurt may also help prevent yeast infections." [They also have a Ratings of Probiotic Products and Ratings and recommendations of 40 yogurt products.  Note that their tests found higher numbers of beneficial bugs in most yogurt products than in supplements.  Consumer Reports is in the forefront of healthcare activism, and I encourage you to pay their small subscription fee to gain access to this and all their articles.]

Probiotic properties of human lactobacilli strains to be used in the gastrointestinal tract.
 Fernandez MF, Boris S, Barbes C.
J Appl Microbiol. 2003;94(3):449-55.

CONCLUSIONS: These results indicate that the two strains of Lactobacillus from human origin present important properties for survival in, and colonization of, the gastrointestinal tract, that give them potential probiotic. SIGNIFICANCE AND IMPACT OF THE STUDY: Two strains of Lactobacillus isolated from human vagina of healthy premenopausal women could be promising candidates to be used in the preparation of probiotic products and for their use as health-promoting bacteria.

A general Internet search for "(probiotics OR acidophilus) NEAR pregnancy" 

Healthy Fats

Why Coconut Oil is Better than Vegetable Oil by: DAVE ASPREY

What they said: Coconut oil is unhealthy for you to consume and should be replaced with vegetable oils like canola, peanut and corn.

What You Need To Know

The American Heart Association is backing big ag and big pharma companies in a PR blitz to scare people away from coconut oil and other saturated fats.
They only used four studies from the 1960’s and ignored newer, bigger studies that disagree.
Saturated fat doesn’t cause heart disease, sugar and inflammation do. The AHA should know better than to recommend inflammatory sugar and vegetable oil.

But coconut oil does have a dark side. Check out this post to see how it can escort gut toxins into your blood. That's one reason the trademark bulletproof coffee recipe uses Brain Octane, not coconut oil, not MCT oil. We remove the parts of coconut oil that cause the problem, and sell them to the companies that will sell you generic "MCT oil."

Coconut Oil Is Still Healthy, Despite AHA Claims
[6/27/17] by CHRIS KRESSER - A recent AHA presidential advisory recommends yet again that we reduce our saturated fat intake to reduce the risk of cardiovascular disease. This time, coconut oil was added to the “avoid” list. But is it really unhealthy? Read on to learn what the research says and why we shouldn’t take this AHA report to heart.

Ed: Dave Asprey provides the most honest nutrition information I've found. He reads and understands the issues and makes it available to the public without commercial conflict.

Here's what he wrote about the June, 2017, reports saying that coconut oil is not healthy for you, and that you should be eating margarine instead of butter!

It's hard to even know where to begin.
The American Heart Association is now saying you should use vegetable oil instead of coconut oil.
Because, you know, saturated fat. And cholesterol. (note there's no cholesterol in coconut oil...)
It boggles the mind how an organization making its living off of heart disease can ignore the role of inflammation and still focus on cholesterol. Cholesterol without inflammation doesn't do the same thing. We *know this*. It's not new.
We also know that vegetable oil is highly inflammatory and linked to...cancer.
But hey, the American Heart Association doesn't have to pay attention to that. That's what the American Cancer Society is for, right?
It's liberating to realize your body is a system that interacts with everything in your environment, and the part of your body that "reads" the environment is your mitochondria. When you have that perspective, you don't make recommendations that harm your mitochondria.
When they're dysfunctional, you can expect heart disease AND cancer. That's why I wrote Head Strong, all about mitochondria.
The available data show that you should eat some coconut oil, but maybe not eat masses of it. That's because lauric acid, (also known as liar's MCT because it's legal to call it MCT even though it doesn't act like true biological MCTs like Brain Octane) escorts toxins across the gut barrier, which are linked to Parkinson's.
You won't have that problem if you eat a lot of vegetables as I recommend because they ferment to make protective compounds.
Or you could primarily use Brain Octane, which raises fat burning ketones far more than coconut oil or MCT oil.
But vegetable oil? If you want to live a long time, avoid that stuff. It's not food.
And the AHA and ACS should know that by now.

Choline for Baby's Brain Development

Choline, homocysteine, and pregnancy

About Choline from florahealth.com.  They recommend a daily dose of 450 mg/day during pregnancy and 550 mg/day for lactation.

There's some preliminary research showing that choline protects the integrity of cell membranes and may have a protective effect against the viruses that can cause schizophrenia through prenatal exposure.  If so, it would also have a protective effect against the viruses that could cause a variety of disorders, includeing cerebral palsy.

J Neurophysiol. 2004 Apr;91(4):1545-55.
Dietary prenatal choline supplementation alters postnatal hippocampal structure and function.
Li Q, Guo-Ross S, Lewis DV, Turner D, White AM, Wilson WA, Swartzwelder HS.

"Choline, a compound present in many foods, has recently been classified as an essential nutrient for humans. Studies with animal models indicate that the availability of choline during the prenatal period influences neural and cognitive development. Specifically, prenatal choline supplementation has been shown to enhance working memory and hippocampal long-term potentiation (LTP) in adult offspring. However, the cellular mechanisms underlying these effects remain unclear. Here we report that choline supplementation, during a 6-day gestational period, results in greater excitatory responsiveness, reduced slow afterhyperpolarizations (sAHPs), enhanced afterdepolarizing potentials (ADPs), larger somata, and greater basal dendritic arborization among hippocampal CA1 pyramidal cells studied postnatally in juvenile rats (20-25 days of age). These data indicate that dietary supplementation with a single nutrient, choline, during a brief, critical period of prenatal development, alters the structure and function of hippocampal pyramidal cells."

Nutrient during pregnancy 'super-charges' brain [12 March 04]

Taking a nutrient called choline during pregnancy could "super-charge" children's brains for life, suggests a study in rats.

Offspring born to pregnant rats given the supplement were known to be faster learners with better memories. But the new work, by Scott Swartzwelder and colleagues at Duke University Medical Center in North Carolina, US, shows this is due to having bigger brain cells in vital areas.

Choline, a member of the vitamin B family, is found in egg yolks, liver and other meats - "exactly the kind of things people were told not to eat" due to their high cholesterol content, says Swartzwelder.

He believes their results in the rats could translate to humans, and indeed the US Institute of Medicine added choline to the list of essential nutrients, particularly for pregnant women, in its 2003 recommendations.

Choline availability during embryonic development alters progenitor cell mitosis in developing mouse hippocampus.
Craciunescu CN, Albright CD, Mar MH, Song J, Zeisel SH.
J Nutr. 2003 Nov;133(11):3614-8.

"We conclude that the dietary availability of choline to the mouse dam influences progenitor cell proliferation and apoptosis in the fetal brain."

Extra Choline During Pregnancy Enhances Memory In Offspring [in rats, anyway] - Duke University, 1998

DURHAM, N.C. -- Pregnant rats fed extra doses of an essential nutrient called choline produced offspring whose brain circuits were "wired" to learn and remember far more efficiently than offspring without the supplement, according to a study at Duke University Medical Center.  Conversely, analysis of brain slices of the offspring of rats deprived of choline indicated a decrease in memory capability.

Choline is a naturally occurring amino acid found in egg yolks, milk, nuts, liver and other meats as well as in human breast milk. It is the essential building block for a memory-forming brain chemical called acetylcholine, and it plays a vital role in the formation of cell membranes throughout the body.

Importance of Omega-3 Fatty Acids for Baby's Brain Development

NOTE - Omega-3 fatty acids do increase brain size and thus head size, which can make the birth more difficult.  It is also an option to increase your Omega-3 fatty acid intake during the first three months AFTER the birth; the enhanced breastmilk will also increase baby's IQ and brain size when the head size won't make the birth more difficult!  Or you could take herbs to help the baby come a few days earlier, when the head is more flexible.

omega-3 fatty acids - an excellent, comprehensive resource, including many food sources

Krill Oil vs. Fish Oil: Battle of the Omega-3 Fats

Prenatal DHA Supplementation: No Benefit to Kids' Development [5/7/14] - Taking prenatal supplements of omega-3 fatty acid docosahexaenoic acid (DHA) results in no significant differences in measures of early childhood development on 4-year follow-up of a randomized controlled trial (RCT),

Prenatal Omega-3 Fatty Acid Does Not Make Offspring Smarter [Clinical Tip | May 07, 2014] - Still, the study results, as expected, showed that those women who took the prenatal DHsupplements were less likely to deliver preterm babies, the authors noted.  [Ed: I recommend weaning off omega-3s at 38 weeks. to allow for the ripening of the cervix, which is an inflammatory process.]

Four-year follow-up of children born to women in a randomized trial of prenatal DHA supplementation.
JAMA. 2014 May 7;311(17):1802-4. doi: 10.1001/jama.2014.2194.
Makrides M1, Gould JF2, Gawlik NR3, Yelland LN4, Smithers LG4, Anderson PJ5, Gibson RA6.

Prenatal Inflammation May Increase Autism Risk [1/31/13] - "I think it's also important for clinicians to advise these women to avoid certain sources of infection. For example, hand washing is very important, especially since we're now in the middle of flu season. "Dr. Brown said that past research has also shown that prenatal infections are associated with schizophrenia. The investigators note that these types of infections and immune dysfunction are also "biologically plausible potential causes of autism."   [Ed: Omega-3s can help reduce inflammation, but too much makes the baby's head bigger.]

Pregnant women consuming flaxseed oil have high risk of premature birth

1) Mean gestational age at delivery for those who consumed flax during the 2nd or 3rd trimester was 33 weeks of gestation - similarly in those who did not use flax during pregnancy, gestational age at delivery was 39 weeks.
2) We did not study the wellbeing of children after birth within this particular study.

References from Nordic Naturals

My interpretation of the above is that women might do best to take lots of krill oil for the Omega-3s throughout pregnancy and then take flaxseed oil (must be the oil!) in the last month to encourage baby to come earlier!  And, of course, max. out your dosage of Omega-3s in the first three months after the birth.

Apteka Naturel offers a vegan/vegetarian omega-3 supplement called VegOmega Naturel. It’s a 100 percent natural source of omega-3 docosahexaenoic acid (DHA) derived from highly-purified oceanic algae; they will be offering a vegetarian source of DHA and EPA, expected to be available in August, 2013. [from Omega-3 for Vegetarians with Diabetes by David Mendosa, 3/21/13.]

DEVA™  Vegan DHA & EPA - Delayed Release is a new product that is rich in both DHA and EPA derived from a completely vegetarian source (i.e. Schizochytrium sp microalgae). Algal Omega-3 oil has been commercially available for a while but it did not contain meaningful amounts of EPA. This new product contains both DHA and EPA from microalgae that is grown in a controlled environment, eliminating the risk of oceanic contamination.

Why Fish Oil is NOT the Best Omega-3 Source from mercola.com

"Plant based omega-3 sources like flax, hemp and chia are high in ALA and are important sources of nutrients as we all need ALA.  However, the key point to remember is that the conversion of ALA to the far more essential EPA and DHA is typically severely impaired by inhibition of delta 6 desaturase.  This is an enzyme that is necessary to produce the longer chain EPA and DHA from ALA.  Elevated insulin levels impair this enzyme and over 80% of the country has elevated insulin levels.  So from that perspective alone it is important to include animal based sources of omega-3 fats."

An Update on Omega-6 PUFAs [9/6/16] from chriskresser.com - Don’t go overboard with the nut flours.

Chia seeds are also great fiber and a source of fiber and omega-3s, and they help with heartburn!. [from Nutrition - Chia - ... far more than just a furry green "pet"!]   Nutritiondata.com says that 1 oz. of chia seeds has 4915 mg of Total Omega-3 fatty acids.  This is perhaps too much for a first baby, as you don't really want the head to be bigger than genetics intend.  0.4 ounces of chia seeds would yield about 2000 mg, which is a suitably moderate amount for a first-baby pregnancy.  It is best to grind or blend them so the seeds are better digested.

Thorne makes a couple of vegan sources of essential fatty acids: Black Currant Oil and DHA Omega-3 fatty acid from algae.  [Oh, darn, they're in fish oil gelcaps!!!]  You need to get these through a practitioner, but midwives can set up accounts with them and get a nice discount, too.

Flax seed oil is not a suitable Omega 3 source.

Flax seeds contain the omega-3 fatty acid ALA that must be converted to DHA by an enzyme so that the body can incorporate it into cells. Children make this enzyme only in small amounts, if at all. If they do not have the enzyme they will not benefit from the omega-3 fat in flax seeds. Newborns are completely unable to convert ALA to DHA. A study of breastfeeding mothers who took a flax seed oil supplement had no resulting increase in their own plasma or breast milk levels of DHA, showing that adults do not make this conversion either (Francois et al., 2003). Flax seeds are not an adequate source of DHA.

Randall Neustaedter OMD recommends that children and adults take a fish oil or cod liver oil supplement. Cod liver oil has the added benefit of vitamins A and D, especially helpful in the winter months when sun exposure may be inadequate to provide enough vitamin D. An alternative omega 3 source for vegetarians is an algae-derived DHA supplement (trade name Neuromins).

A more complete omega 3 discussion

Supplementing lactating women with flaxseed oil does not increase docosahexaenoic acid in their milk.
Francois CA, Connor SL, Bolewicz LC, Connor WE.
Am J Clin Nutr. 2003 Jan;77(1):226-33.

CONCLUSIONS: Dietary flaxseed oil increased the breast-milk, plasma, and erythrocyte contents of the n-3 fatty acids ALA, EPA, and DPA but had no effect on breast-milk, plasma, or erythrocyte DHA contents.

Fish diet 'brings a brighter baby'
By Roger Highfield, Science Editor
(Filed: 20/01/2006)

Pregnant women who eat more fish, which contains omega-3 fatty acids, tend to have brighter, more sociable children, claim researchers. [Dr Hibbeln worked with Prof Jean Golding from Bristol University's Avon Longitudinal Study of Parents and Children.]

Brain Food - This is important!  Michel Odent's research shows a correlation between intake of Omega-3 fatty acids (typically found in ocean fish) and the size of baby's brain and the child's IQ.  Here's the reference:

Prenatal care and sea fish.
Odent MR, McMillan L, Kimmel T
Eur J Obstet Gynecol Reprod Biol 1996 Sep;68(1-2):49-51

"The mean neonatal head circumference was greater in the study group (34.7 cm vs. 34.4 cm)"

In addition, we know that omega-3s are anti-inflammatory, and the ripening of the cervix is an inflammatory process.  So omega-3s would be expected to delay the onset of labor.  Some fish-eating cultures have prenant women stop eating fish in late pregnancy so baby comes on time.

A Smart Start by Marcia Zimmerman, C.N. - Essential fatty acids can affect your baby's intelligence.

Am J Epidemiol. 2004 Sep 1;160(5):460-5.  Related Articles, Links
Association of fish and fish liver oil intake in pregnancy with infant size at birth among women of normal weight before pregnancy in a fishing community.
Thorsdottir I, Birgisdottir BE, Halldorsdottir S, Geirsson RT.

"Infants of women in the highest quartile of fish oil intake (> or =1 tablespoon (11 ml)/day), consuming threefold the recommended dietary allowance of vitamin A and twofold that of vitamin D, were shorter (p = 0.036) and had a smaller head circumference (p = 0.003) than those of women consuming less. Infant size at birth increased with fish consumption, especially for women in the lower quartiles of consumption. Smaller birth size was linked to the highest levels of fish oil intake. Constituents of fish and fish oil might affect birth size differently depending on the amount consumed."

[Ed. I find this confusing.  Apparently the consumption of fish but not fish oil helps grow bigger babies?]

Similar effects on infants of n-3 and n-6 fatty acids supplementation to pregnant and lactating women. [Free full-text article]
Helland IB, Saugstad OD, Smith L, Saarem K, Solvoll K, Ganes T, Drevon CA.
Pediatrics. 2001 Nov;108(5):E82.

"CONCLUSIONS: This study shows neither harmful nor beneficial effects of maternal supplementation of long-chain n-3 PUFAs regarding pregnancy outcome, cognitive development, or growth, as compared with supplementation with n-6 fatty acids. However, it confirms that DHA concentration may be related to gestational length and cerebral maturation of the newborn."

Randomised controlled trial of effect of fish-oil supplementation on pregnancy duration.
Olsen SF, Sorensen JD, Secher NJ, Hedegaard M, Henriksen TB, Hansen HS, Grant A.
Lancet. 1992 Apr 25;339(8800):1003-7.

"The high birthweights and long duration of pregnancy in the Faroe Islands led us to suggest that a high intake of marine-fat-derived n-3 fatty acids might prolong pregnancy by shifting the balance of production of prostaglandins involved in parturition. We have compared the effects on pregnancy duration, birthweight, and birth length of a fish-oil supplement, a control olive-oil supplement, and no supplementation. 533 healthy Danish women in week 30 of pregnancy were randomly assigned in a ratio of 2/1/1 to fish oil (four 1 g Pikasol capsules [containing 2.7 g n-3 fatty acids] per day), olive oil (four 1 g capsules per day), or no supplement. The three groups differed in mean length of gestation (p = 0.006), which was highest in the fish-oil group and lowest in the olive-oil group; the result was similar when the analysis was restricted to women with an estimate of gestation length based on early ultrasound findings (443 women). Pregnancies in the fish-oil group were on average 4.0 (95% confidence interval 1.5-6.4) days longer than those in the olive-oil group; the difference in birthweight was 107 (1-214) g. The effect of supplementation on length of gestation was influenced by intake of fish and of fish oil: the difference between fish-oil and other groups was increased by a low fish intake at baseline. Fish-oil supplementation in the third trimester seems to prolong pregnancy without detrimental effects on the growth of the fetus or on the course of labour."

I love playing with the "Related Articles" feature in PubMed.   I'll admit that I'm confused by the results of some of the studies, and it sounds as if the researchers aren't entirely clear about the results either.

The studies seem to have been done on otherwise healthy (and presumably well-fed) women.  It seems that fish oils MIGHT prolong pregnancy by about 4 days, as well as increase baby's size proportionately to the longer gestation.

Some of the studies didn't seem to pay much attention to the effect on gestational age and were paying more attention to the baby's size, which isn't that helpful if you discount the effects on length of gestation.

Some of my information came from a seminar with Michel Odent in 1996.  I took thorough notes, and he said that supplementation with fish oils increases baby's IQ, brain size and head size. At the time, I didn't think to ask about the issue of the effects on length of gestation.

I'm also having trouble finding a good discussion of the different names for the different types of fatty acids and the levels provided by different sources.

At this point, it seems that the research is inconclusive, but there seems to be some agreement that it is not harmful, per se. Mercury toxicity issues are serious, though.

Benefits of omega-3 fatty acids to mother and baby during late pregnancy and nursing from The Omega-3 Information Service

From Dr. Barry Sear's Zone FAQ:

Other sources that are rich in EPA include mackerel and sardines. Other marine sources which have a lower EPA content are common fish such as tuna, swordfish, scallops, shrimp, and lobster. Try to consume about 300 mg. of EPA per week. This would translate into one serving of salmon or four servings of tuna or like fish per week.

Studies Concerning Omega-3 and Brain Activity and Vision from the FLAX information web site

Concerns about Eating Fish During Pregnancy

Mercury Levels in Fish - this has a nice, long list of fish that are safe to eat frequently during pregnancy.

Mercury Rising - Our Seafood is Increasingly Contaminated with Toxins from [E] The Environmental Magazine - This lists a lot of potential problems with different fish, but may be more of a political piece than a health piece.  Farmed salmon may be your best bet.

FOOD FACTS WEB PAGE - search for "mercury".  They claim shark and swordfish are the worst, and should particularly be avoided during the first trimester.


Avoiding Growing a Huge Baby

Anybody know a way to keep someone from having a huge baby?  What about induction in this situation?

Talk to them *right away* about eating.  Personally, I think it's way too late to alter diet after the glucose screening is done.

We tell our women w/ previous large babies/SD:

Do NOT!!! drink lots of juice/eat lots of fruit.  Repeat after me sixty zillion times.  (We counseled a mom whose previous babe was SD and who ate, for breakfast, 5 - 6 different kinds of fruit in the belief that it was healthy...told her to try oatmeal instead :)  Fruit is mainline glucose to the system, no matter how "natural" it is.

Take what you normally eat in 3 meals and spread it out over six (which is the basic GD protocol), but not adding food to the daily diet.

Exercise.  Every day.  Even upper body exercise (arm swinging, weights) is helpful in regulating glucose metabolism.

I've had great luck with having clients cut dairy fat.  Have them switch to skim or 1/2% milk, low-fat cheeses and yogurts, cut down on butter usage (I'm NOT a margarine person :-)).  Increase activity, no overeating.   If she is concerned, she'll comply.

Had a client w/ a 12#5oz 3rd baby who kept #4 & #5 <10# by doing this.  If I look at my dairy farm clients, the ones who drink a lot of milk out of the tank (full-fat) have the biggest babies.

I've got to echo the comments about cutting down severely or cutting out milk products altogether: milk, cheese, ice cream.  I think milk is one of the biggest culprits for big, FAT babies.  Not always, of course.  I've worked with a few vegans who have had 9 and 10+ lb babies.

Vegan/Vegetarian Pregnancy

I always have to laugh when people say that vegans can't grow big, healthy babies.  It happens that both vegan boy babies in my practice were around ten pounds, and the vegan girl baby was a fine, respectable weight.

I'm worrying about soy more and more.  Even some of the nationally renowned naturopathic physicians are recommending that it be used only as a food accent, the way the Japanese have traditionally eaten it.  Here's a helpful search.

The Brewer Vegetarian Diets for Pregnancy: Two Safe Alternatives

Soy Unsafe for Children by Randall Neustaedter OMD

THE WHOLE SOY STORY blows the lid off nutritional dogma !

    * Soy is NOT a miracle food.
    * Soy is NOT the answer to world hunger
    * Soy is NOT a panacea.
    * Soy has NOT even been proven safe.

complete endnotes

The Vegetarian Diet and Birth Defects - possible problems caused by high soy intake in pregnancy.

Vegetarian diet in pregnancy linked to birth defect
and another version of
Vegetarian Diet in Pregnancy Linked to Birth Defect

Vegan Pregnancy by Reed Mangels, Ph.D., R.D. from the Vegetarian Journal (Jan '97) and a related article, The Vegan Diet During Pregnancy and Lactation by Reed Mangels, Ph.D., R.D.

Veg Pregnancy & Breastfeeding - from vegetarianbaby.com

NUTRITION FOR PREGNANCY from The McDougall Newsletter

NOTMILK! - Very interesting reading for those of you who question the health benefits of cow's milk or for better understanding of your clients who refuse to drink it.

Cow's Milk Protein Linked to Diabetes

Protein-rich pregnancy diet may stress offspring - "Given the recent popularity of low-carbohydrate, high-protein diets, such as the Atkins diet, these data also suggest that these diets should be avoided during pregnancy." [Source: 8th European Congress of Endocrinology; Glasgow, UK: 1-5 April 2006]

Rose Elliot's Mother and Baby Guide - Part 1
Rose Elliot's Mother and Baby Guide - Part 2
Here's a web site with lots of information about having a healthy vegetarian pregnancy and subsequently, a healthy baby. There is nothing specific about the babies being "small" though, I'm not sure if you were emphasizing that or not.

Anemia - Low Hemoglobin at 28 Weeks A Good Sign

Be Careful About Iron Supplementation in Pregnancy
[1/24/15] - from Gloria Lemay with info from Dr. Michel Odent.

This is a question that comes up a lot in pregnancy. . .”What kind of iron supplements should I be taking? My practitioner says I’m anemic.” It turns out that a lot of practitioners mistakenly diagnose anemia based on old information and lack of understanding of the physiology of the pregnant woman.

Personally, as a homebirth midwife, I think it's important to emphasize that a hemoglobin dip around 28 weeks is a sign of a healthy pregnancy AND that it's important for women to fill all that new blood with lots of healthy hemoglobin. Increased oxygen-carrying capacity makes the birth safer.

One of the great unresolved issues of pregnancy is the significance of a low hematocrit/hemoglobin.

Actually, the studies are clear that lower levels are better, and the unresolved issue is why practitioners continue to encourage iron supplementation and chide women for low levels.

"Normal" values of hematocrit/hemoglobin are determined by studying non-pregnant people.  However, a pregnant woman's blood volume expands around 40-60%; this blood volume expansion reduces the concentration of red blood cells and iron in her blood, which is what's measured by hematocrit and hemoglobin.

The best pregnancy outcomes are associated with the lowest hematocrit/hemoglobin.  It turns out that 9.5 is optimal. This isn't because pregnant women don't need iron; it's because healthy pregnant women have large increases in blood volume that lower the hematocrit/hemoglobin.

So, in fact, a woman who's having problems with her pregnancy and doesn't have an increasing blood volume will have higher h/h levels than a healthy woman.

There are better ways of assessing anemia in pregnancy; fatigue is a clue, but the best way to assess how well your blood is carrying oxygen is to look for pallor in the gums and under eyelids and to assess capillary refill when you apply pressure to the nailbed.

A woman can have a low H&H for several reasons.  The healthy reason is that she has the normal hemodilution of pregnancy. The problematic reason is that she started her pregnancy with anemia (either dietary or from excessive blood loss such as menorrhagia).  Or maybe she has thallasemia, malaria, or whatever.

A woman can have a high H&H for differing reasons as well.  It could be because she eats really well, or because she has an iron storage disease, or because she never got the hemodilution and is on her way to pre-eclampsia/toxemia/HELLP or whatever.

You don't diagnose based on one lab value.  And you can't predict outcome based on one set of numbers either.

"A Guide to Effective Care in Pregnancy & Childbirth" by Enkin, Keirse, Renfrew and Neilson reports that a hemoglobin count of 9.5 is optimal for fetal growth and maternal well-being:

The normal haematological adaptations to pregnancy are frequently misinterpreted as evidence of iron deficiency that needs correcting.  Iron supplements have been given with two objectives in view: to try to return the haematological values towards the normal non-pregnant state, a strange objective when millions of years of evolution have determined otherwise, and to improve the clinical outcome of the pregnancy and the future health of the mother.  The first objective can certainly be accomplished; the key question is whether or not achieving the "normalized" blood picture benefits the woman and her baby.  Routine iron supplementation raises and maintains serum ferritin above 10 microgram/litre and results in a substantially lower proportion of women with a haemoglobin level below 10 or 10.5 grams per cent (below 6-6.5 mmol/litre) in late pregnancy.  Routine folate supplementation as a haematinic after the first few weeks of pregnancy substantially reduces the prevalence of low serum and red cell folate levels, and of megaloblastic haematopoiesis.  As yet, neither iron nor folate supplementation after the first trimester have shown any detected effect on the following substantive measures of maternal or fetal outcome:  proteinuric hypertension, antepartum haemorrhage, postpartum haemorrhage, maternal infection, preterm birth, low birthweight, stillbirth, or neonatal morbidity.  Women do not feel any subjective benefit from having their haemoglobin concentration raised.

A possible advantage claimed for a high level of haemoglobin in pregnancy is that the woman would be in a stronger position to withstand haemorrhage.  There is no evidence to support this claim.  indeed, as a low haemoglobin in healthy pregnant women generally implies a large circulating blood volume, it is at least possible that women with a low haemoglobin might better withstand a give loss of blood.

There are few data derived from communities in which nutritional anaemia from either iron or folate deficiency is prevalent.  Trials are needed in these populations to establish the most appropriate strategies for combatting the deficiencies.

Whether routine iron supplementation causes any harm in well-nourished communities is still unclear, but it is clearly wasteful.  The evidence suggests that, except for genuine anaemia, the best reproductive performance is associated with levels of haemoglobin that are traditionally regarded as pathologically low.  There is cause for concern in the findings of two well-conducted trials that iron supplementation resulted in an increase in the prevalence of preterm birth and low birthweight.  Perhaps there is an adverse effect on fetal growth due to the increased viscosity of maternal blood that follows the iron-induced marcrocytosis and increased haemoglobin concentration, which may impeded uteroplacental blood flow.

An individuals' haemoglobin concentration depends much more on the complex relation between red-cell mas and plasma volume than on deficiencies of iron or folates.  The advent of electronic blood counters has given an opportunity for more appropriate criteria to be applied to the diagnosis of anaemia.  Mean cell volume may be the most useful; it is not closely related to haemoglobin concentration and declines quite rapidly in the presence of iron deficiency.  A low haemoglobin without other evidence of iron deficiency requires no treatment.

If there is evidence of genuine iron deficiency, iron treatment is needed, and the usual approach is to give iron salts by mouth.  There is no convincing evidence that the addition of copper, manganese, molybdenum, or ascorbic acid improves the efficiency with which the iron is used.

The cause of megaloblastic anaemia in pregnancy is almost always folate deficiency, and treatment with folic acid supplementation is rapidly effective.

At 11weeks I am having a serious conflict about what to do about iron supplementation, I have read in most places that no matter how much iron you get in your diet, as a pregnant woman you will be incapable of maintaining "normal" iron levels without supplementation. Hello......isn't our body trying to tell us something like maybe we are not supposed to have high levels of iron.  Currently I am trying to do a literature search to find the absolute truth.  There are no absolutes in scientific medicine, but Sheila Kitzinger in her book "THE COMPLETE BOOK OF PREGNANCY AND CHILDBIRTH" she explains that if you did not start out anemic, then iron supplementation is not necessary for the normal drop in hemoglobin from mid-pregnancy.  This reduced hemoglobin is a sign that plasma volume is rising and that the placenta is providing good nutrition for the baby."
In a different chapter she explains" A pregnant woman has about 40% more blood flowing in her body.  It used to be thought that a woman's hemoglobin levels must be kept high during pregnancy by iron supplementation.  But most women whose hemoglobin concentration does fall are more likely to go full term and have babies of good birth weight.  If hemoglobin concentrations fail to fall there is a marked increase of the incidence of low birth eight and preterm labor."  She quotes two medical studies to back this up.  The babies are probably LBW and preterm because the placenta wasn't nourishing the baby properly so therefore hemoglobin levels did not drop.

This is based on information from a variety of sources, but primarily from Gabbe's Obstetrics (which also has some very nice charts utlining this physiology and gives good numbers as well!)

Blood volume
    Starts to expand at 10 weeks
    Expansion plateaus at 30 - 34 weeks
    Average increase is 50%
    Normal range considered to be 20% to 100% increase
    Bigger babies, multiple gestations will have increases on the higher side
    Seen in lab work as dropping hemoglobin/hematocrit (physiological anemia of pregnancy)
    Rising Hg/Hct may be early signs of problems, but diagnosis confounded by iron supplementation
 Red blood cell count (RBC)
    Increases throughout pregnancy
    18% increase if not supplemented
    50% increase of supplemented
    Count progressively decreases in normal pregnancy by about 15,000/mm3
    Still stays well within the normal range for non-pregnant women
    Average count goes from 275,000 to 260,000
    Counts below 150,000 are indicative of potential trouble
    Fibrinogen levels increase, other clotting factors stay about the same as in the non-pregnant state
    Marked increase in fibrinogen levels a sign of trouble
    RBCs are turned over faster during pregnancy, the accelerated breakdown being matched by an accelerated production.  This can stress the liver (excreting bilirubin and other byproducts of hemolysis).
    Breakdown not matched by production signals a problem.

About Iron Supplementation

NOTE - If a woman doesn't respond to iron supplementation as expected, consider the possibility that there may be underlying thyroid problems.  Even if she's already had her thyroid tested in this pregnancy, consider doing another thyroid test or referring to a physician for evaluation.

Please note that Floradix Iron + Herbs has synthetic B6 and B12. I was shocked that such a revered pregnancy remedy for anemia isn't as natural as I thought.  This is a problem for mothers with variant MTHFR genes and subsequent methylation issues.  Gaia Herbs PlantForce® Liquid Iron is free from synthetic (non-bioactive) additives.

The best way to help get iron into your blood stream is to take it with food that is high in vitamin C. These two help each other in your body. But there are enemies as well. Caffeine and calcium block the absorption of iron. So try to avoid having anything with caffeine or calcium when you are trying to get iron.

So you'll have to manage your calcium and iron supplements.  One good approach: take general prenatal in the morning with iron supplement and extra vitamin C.
Then take 1 Tri-Spartate or other mineral supplement with lunch and dinner and then again at bedtime.  The minerals will help you sleep!

Intermittent Iron as Effective as Daily Iron for Pregnant Women [Medscape, July 11, 2012]

Depleted Iron Stores Without Anaemia Early in Pregnancy Carries Increased Risk of Lower Birthweight Even When Supplemented Daily With Moderate Iron [Medscape, 5/10/2012] - Excellent Summary Article with great list of references.

Dietary iron intake during early pregnancy and birth outcomes in a cohort of British women.
Hum Reprod.  2011; 26(4):911-9 (ISSN: 1460-2350)
CONCLUSION There was a positive relationship between total iron intake, from food and supplements, in early pregnancy and birthweight. Iron intake, both from diet and supplements, during the first trimester of pregnancy was higher in vegetarians and women with a better socioeconomic profile.

Most midwives recommend Floradix Iron & Herbs or the yeast-free version.  They are easily tolerated by the sensitive pregnant digestive system and don't seem to cause constipation. A study shows that Floradix " is effective for preventing iron deficiency and for treating low serum ferritin - with minimal side-effects and high compliance by patients."

Iron Supplementation Early in Pregnancy Improves Birth Outcomes - Oct. 7, 2003 [Medscape registration is free]

Extra Iron Won't Help Nonanemic Pregnant Women [2011]

Iron Nutrition During Pregnancy from Nutrition During Pregnancy: Part I: Weight Gain, Part II: Nutrient Supplements (1990) from the Institute of Medicine (IOM)

Chlorophyll And Anemia

I've heard some midwives say that the best way to boost a woman's red blood cell count (and thus hemoglobin/hematocrit) is to have her take chlorophyll supplements with iron.  The rationale that goes along with this is that chlorophyll and hemoglobin perform similar functions, i.e. transporting gases in the life fluid of their host, whether plant or animal.  The thinking I've heard is that when the chlorophyll and the iron are both available, the iron can replace the magnesium in the chlorophyll to be easily reconstructed into heme.  Here are some web pages on this subject:

Re: chlorophyll / hemoglobin - Question and Response

Chlorophyll/hemoglobin structure

[Antihypoxic effect of chlorophyllypt and the method for its clinical use in maternal and fetal tissue hypoxia].
Shramkevych AF, Sol's'kyi IP, Rozumenko MB
Pediatr Akush Ginekol 1979 Sep-Oct;(5):55

Heme and Chlorophyll Biosynthetic Pathways

The following quotes attempt explanations but aren't terribly well documented.  If anyone has any good references for this information, please e-mail me.  Thanks.

"Interestingly enough, chlorophyll and hemoglobin have a remarkably similar molecular structure, though their functions are different.  Chlorophyll is the substance that makes a plant green and helps derive food for the plant by using the sun's energy. Hemoglobin gives blood its red color and transports oxygen through the blood. Both molecules are of the same shape, with a difference in the middle atoms. Hemoglobin's center atom is "iron", while chlorophyll's center atom is "magnesium". Maybe this very similar molecular structure is why ingesting chlorophyll so effectively helps hemoglobin oxygenate and purify the blood. "  []

"The way it works is this. The molecule of chlorophyl is almost identical to a molecule of hemoglobin, except for one big difference. The central atom in hemoglobin is iron, and the central atom in chlorophyll is magnesium. This being the case, when you ingest chlorophyll, it readily gives up its central atom of magnesium and apparently exchanges it for, and hear's the cool part:

 "1) if you have heavy metal toxicity, it will exchange it for whatever atom of heavy metal you need to get rid of, whether it is lead, mercury, or what have you, OR
"2) If you do NOT have any heavy metal toxicity, it exchanges it for  IRON, thereby creating new blood very quickly. This is why someone who is anemic can benefit so drmatically from taking chlorophyll."  [Source]

Some PubMed sources:

Subunit-exchange chromatography of self-associating proteins: a quantitative reappraisal.
Chiancone E, Winzor DJ
Anal Biochem 1986 Oct;158(1):211-6

"A quantitative expression describing the behavior of a self-associating protein in subunit-exchange chromatography is derived in a form that is tractable from the viewpoint of characterizing the pertinent interactions. Its use is illustrated by application to published results for alpha-chymotrypsin, oxyhemoglobin, and the light-harvesting chlorophyll a/b protein."

The Bakerian lecture, 1984. Biosynthesis of the pigments of life.
Battersby AR
Proc R Soc Lond B Biol Sci 1985 Jul 22;225(1238):1-26

Haems and chlorophylls: comparison of function and formation. [No abstract]
Hendry GA, Jones OT
J Med Genet 1980 Feb;17(1):1-14

Chlorophyllide-substituted hemoglobin tetramers and hybrids: preparation, characterization, and energy transfer.
Kuki A, Boxer SG
Biochemistry 1983 Jun 7;22(12):2923-33

This is a topic that fascinates me - if anyone has any better sources, please, please e-mail them to me.  Thanks!

Usually we recommend somewhere around 4-6 chlorophyll a day for a typical low hemoglobin. Some like to get on it toward the end of their pregnancy as a hemorrhage prevention, but we don't regularly recommend it for that purpose alone. My hemoglobin is OK (11.4 at 30 weeks), but I wouldn't mind it being a little higher, so I've been taking 2 a day.

Food for Anemia

For low hemoglobin, fill blender fairly full with dark green leafy veggies (spinach, kale, etc.) Then pour pineapple juice into the blender to 2/3 full. Blend well. I call this the "Green Drink" and it works marvelously for low Hg. Also, the women who have used it have very minimal pp bleeding.

Herbs, Vitamins and Homeopathics for Anemia

Wheat grass juice - 4 oz at least four times a day! I swear by it.
  At least one tablspoon blackstrap molasses daily.
  Clams are very high in iron. Eat along with vegetables that are high in iron.
  Do not take calcium, vitamin E, zinc, antacids, or fiber at the same time as foods high in iron/or supplements.
  Omit all sugar.
  With Floradix, take 100 mg of vitamin C for better absorption.
  Vitamin B 12, 2,000 mcg 3 times daily.
  Vitamin B complex 50 mg 3 times daily.
  Folic acid plus biotin 800/300 mcg daily.
  Vitamin C 3,000 to 10,000 mg daily
  Brewer's yeast - rich in basic nutrients and a good source of iron.
  Eliminate coffee and tea, sodas, beer, dairy products.

If a mom is taking iron supplements, and they don't seem to be helping with anemia, consider that she may be deficient in vitamin D, which is necessary for the absorption of minerals.

Take Homeopathic Ferrum Phosphoricum each morning and take Kali Sulphuricum each evening for three weeks to aid the body's assimilation of iron.  For other tips on homeopathics for pregnancy and birth, see the EMAZING.com archives of the Homeopathic Health Tip of the Day

I don't rec. ferrous sulfate.  I start with floradix, one bottle every 3 days max, plus any ferrous glucinate or fumerate, 3 or 4 of those. Then folic acid, 5 800 mcgs with the iron.  Then red meat if they eat it.  Then chlorophyll, and the "iron sheet" that has foods with iron, inc. cooking in the old cast iron pots.  I've had a couple of other women over the years who had very low hgbs following emergencies who have gone on the iron diet.  The first 2 points happen in 1 week, then 1 point a week.  We don't stop until her hgb is 12.5.

Although I prefer herbal support for most things, my favorite iron supplement is Source Natural's chelated iron. Seldom even turns stool black, which makes me think it's being well absorbed, virtually never constipates moms, and works pretty quickly. Lots cheaper and easier to take than Floridix.  Along with the supplement I advise 500 mg vit C, assuring adequate folic acid, and 20 minutes of pulse-raising exercise every day (Let the body know it NEEDS more O2 capacity).

I have never been one to use lots of herbs in my practice, although I am now slowly adding certain herbal items. The main reason for the turnabout is the herb Yellowdock (Rumex Crispus, Buckwheat Family) (aka: sour dock, curled dock, narrow dock, Rumex)

This was suggested to me by a MW friend, so I tried it once with a client whose HgB at week 35 +2, was, in my opinion, too low for homebirth consideration. At the time I was sending my clients to a friendly OB for all testing, and he called me when the lab results came in to let me know that he was concerned about this birth happening at home, and I concurred.

We discussed if there was a way to get my client's bld levels up before birth. He assured me there was not a way to do this in the amount of time we had left. I talked to him about an herbal remedy, and he agreed to order tests for her each week so that we could find out for real if it would work or not.

I had her use the yellowdock root as prepared in Susan Weed's Herbal for the Childbearing year. Also did intensive nutritional counseling, and had her keep a daily food intake log for the remainder of her pregnancy.

Every week she went back in to be tested. She birthed (at home) at week 41 +4. So was on this regimen for 6 weeks, two days. Her last lab was 2 day pre-birth. The necessity of good hydration was stressed to the client so that we wouldn't get higher lab results due to hemoconcentration..

over the course of that time her HgB levels were (in g/dl) :
8.3 (beginning)
8.9 (end of one week)
11.1 (end of 6th wk, last lab)
Total increase of 2.8.

I have never tested this intensely since this time, as this was pretty convincing to me. Also, the OB was absolutely amazed and began recommending yellowdock to his patients. I do not know what results he has obtained, and I am sure he does not work as closely with his patients regarding the nutritional aspects of this method.

Admittedly, if someone's HgB was sitting at 5.5, and an increase of this same amount was obtained, they would still only be at 8.3. But I would think that a pp woman would feel a heck of a lot better sitting at this level with a new baby during pp recovery than she would at 5.5.

Also, my case involved a little more time than is allotted in the case mentioned above. But again, I would think that any increase would prove beneficial.

I have also used this same method for pp women, and definitely for any client with a history of pp hemorrhage in preparation for birth..

Also, I cannot say how much the increase was attributable to the Yellowdock and how much to the nutrition. So I always do both.

I love Yellow Dock too! I've seen amazing results with it. I was confused though, because I had always understood that it worked because it had a good amount of easily assimilated iron in it. when i studied it i found that it really didn't have that much- 1.6 mg per 100 grams. dandelion has 3 times that amount, willow has 11 times as much! i came to a theory that the when the liver is under stress it stores iron and gets toxic. if one stimulates the liver to release the stored iron into the blood stream it becomes usable to the system. Then one would see a noticeable rise in H&H. This is also (according to this theory) why one gets constipated during pregnancy and while taking extra iron- the toxic liver isn't manufacturing enough bile. But Yellow Dock is also known as a gentle laxative, I think because it cleanses the liver and stimulates it into bile production. Bile is the body's natural laxative. Just my opinion.

Rumex has many chemicals with antihepatotoxic properties, and erythrocytogenic properties as well, which is another angle. Check it out at James Duke's phytochemical plant database.

Here are some abstracts on Rumex that don't include anything on raising H&H but are fun if you love getting to know an herb at all angles, which I do. They are from Michael Moore's site (who is the most brilliant herbalist America has had since George Washington Carver IMHO.)

Another point to consider with that low of a HgB:

Any chance she may have beta thalassemia minor? We have several of these women in our mid-Michigan practice, whom have no clue they have the disease; their HgB is initially just a bit low, then continually drops during the pregnancy and is unresponsive to iron supplementation.

One of the important implications of beta thal minor is that if FOB also has it, baby can have beta thal major; a VERY serious, life-threatening condition.

So we always refer to the hematologist these women who are anemic with a non-iron deficiency etiology per labwork.

Iron and Hemoglobin

Your going to get more info if you look at the MCV, MCH, & MCHC on a CBC, than looking at the H&H.  Look first at the MCH; the mean corpuscular HGB. See if there is a normal amt of hgb in the cell structure.  If there is she not iron deficient.  The MCV is the size of the cell.  If she is making normal sized, hgb rich cells, she's OK.  Regardless of how hemodiluted she is.  MCV and MCHC (HGB concentration) are inverse to each other. If you have large cells the MCHC  is lower.  If you have small cells it's higher.  This is normal individual stuff.  If you have small. hgb low cells, something is wrong.  Don't assume they're iron deficient.  There are common genetic coding problems like thalassemia; and the body CAN'T make normal cells regardless.  If you have crummy indices; you do a ferritin.  Ferritin only.  Everything else is redundant and a waste of money.  Ferritin is the iron stored.  If the ferritin is nl, or high, then she has a manufacturing problem.  If it's low she is iron deficient.  Watch out for the iron indoctrination; it's mostly bull shit.  A healthy woman, with good ferritin stores, will have her h & h back to normal in 4-6 weeks max, after a hemorrhage.  Too much iron stores are toxic.  And people are always pumping huge amts of Fe to thalassemics, much to their livers detriment.  What makes Fe more important then any other mineral? I don't need messages telling me it necessary for building blood.  A pregnant woman needs a mineral rich diet period.

I don't know what to say about the black outs, but I never recommend iron supplements as a tx for low hemoglobin...it is hard for the body to absorb and often leads to constipation and attendant hemorrhoids. I usually recommend liquid chlorophyll, or alfalfa tablets.....9 times out of ten it does the trick and brings the hemoglobin up...also tends to soften the stool, so I see considerably less hemorrhoids. I have a tincture that I made that includes alfalfa and nettles...replaces the chlorophyll and also does the trick. In my opinion iron supps are largely ineffective and cause problems for most women. Don't know what to say about your black outs tho...good luck, and stay off the road!

There is a company that sells a grapeseed product that has a great pamphlet that explains everything about it. The company is called; Flora, and the product is called; Bio Berry Grapeseed Extract Plus. Yes, they also sell Floradex. Anyway, they have an 800 number which is; 1(800)446-2110.

I still think the best stuff is the Liquid Iron product from NF Formulas in oregon - Iron citrate which is much less constipating along with B-12 and folic acid to aid in the rest of the blood building. a teaspoon twice per day and usually within 2 weeks they're convinced and on their feet (not tired anymore).

NF Formulas # 800-547-4891 - at least get a catalogue. 

I like the plain flavor mixed with pineapple juice instead of the mint flavor.

Iron deficiency anemia can be characterized by fatigue, headache, and poor concentration. A balanced diet along with a vegetable-based iron supplement should correct this condition. Consider also homeopathic Ferrum Phosphoricum to aid assimilation of dietary iron.

Antacids Can Cause Major Problems

Possible Role of Antacids in Ripening the Cervix and/or Premature Labor??

Effect of antacid treatment on endogenous prostaglandin synthesis in human antral and duodenal mucosa.
Preclik G, Stange EF, Gerber K, Fetzer G, Horn H, Schneider A, Ditschuneit H
Dig Dis Sci 1989 Dec;34(12):1860-1864
Using 14C-labeled arachidonic acid as precursor for in vitro prostaglandin synthesis, the effect of an antacid containing Al (OH)3, Mg(OH)2 and CaCO3 on endogenous prostaglandin synthesis was investigated in antral and duodenal mucosa of healthy volunteers. After three weeks of treatment with a high-dose antacid, there was no detectable change in the total capacity of the mucosa for prostaglandin synthesis, but the prostaglandin profile was markedly altered. The relative amounts of PGE2 and PGF2 alpha synthesized by antral and duodenal mucosa increased at the expense of the prostaglandins A2/B2, thromboxane A2, and prostacyclin. In a short-term study, this change was not observed following a single antacid dose within 1 hr after application. It is concluded that long-term antacid treatment may alter the prostaglandin pattern formed by gastroduodenal mucosa and this may be related to its therapeutic effect.
[Prostaglandin synthesis in stomach and duodenal mucosa of the human: effect of aspirin with and without antacid].
Stange EF, Preclik G, Gerber K, Fetzer G, Horn H, Schneider A, Ditschuneit H
Z Gastroenterol 1987 Aug;25 Suppl 3:162-165
A decreased PG E2 content in gastric mucosa of humans receiving a longterm antirheumatic therapy has been reported to be partially reversed after a one week treatment with an antacid (Reimann et al., Fortschr Med 102 [1984], 25-26). . . . It is concluded that antacids do not influence the suppression of the endogenous prostaglandin synthesis by NOSAC's, however another effect, eg a prolonged stability of PG E2 in a less acidic environment is more likely.
Protection of the upper gastrointestinal mucosa: the role of antacids.
Gasbarrini G, Andreone P, Baraldini M, Bonvicini F, Cursaro C, Brocchi E
Int J Clin Pharmacol Res 1990;10(3):173-178
[I]n 28 patients with gastric antral ulcer of various sizes in different stages of activity with or without erosive gastritis. After the antacid treatment, a significant prostaglandin E2 reduction was observed . . . [Note that the reduction of PGE2 is likely associated with reduced inflammation from lesions, which would not occur in healthy individuals..]
Alimentary tract and pancreas. Stimulation of mucosal prostaglandin synthesis in human stomach and duodenum by antacid treatment.
Preclik G, Stange EF, Gerber K, Fetzer G, Horn H, Ditschuneit H
Gut 1989 Feb;30(2):148-151
Total prostaglandin synthesis in antrum (623 (110) pmol/mg protein) and duodenum (432 (72) pmol/mg) was stimulated after three weeks administration of low dose antacids by 176% (p less than 0.05) and 154% (p less than 0.05), respectively.
[In vivo and vitro study of prostaglandins E2 and I2 participation in protective function of antacids on gastric mucosa].
Mach T
Folia Med Cracov 1992;33(1-4):37-51
It was shown that antacids stimulate generation of PGE2 and PGI2 . . .
PGE2 is the prostaglandin contained in dinoprostone vaginal insert (Cervidil).  Is it possible that use of antacids as calcium supplements could cause preterm labor and/or prevent postmature pregnancies?

Outstanding questions:

Which specific type of antacid is associated with elevated levels of PGE2?  Is it the specific ingredients or the antacid nature of the preparation that are implicated?
Is.there an association between elevated levels of PGE2 and premature labor?
Is there an association between decreased levels of PGE2 and postmature pregnancies?
Could antacid use prevent postdates pregnancies?
Is the higher level of PGE2 caused by inflammation of  the digestive tract in response to higher levels of bacteria in the gut caused by hypoacidity?  Is this, in and of itself, harmful to the mother or fetus?

Hypercalcemic crisis in pregnancy associated with excessive ingestion of calcium carbonate antacid (milk-alkali syndrome): successful treatment with hemodialysis.
Kleinman GE, Rodriquez H, Good MC, Caudle MR
Obstet Gynecol 1991 Sep;78(3 Pt 2):496-499

Severe hypercalcemia, a potentially life-threatening condition, has been reported rarely during pregnancy. A patient with hypercalcemic crisis associated with excessive ingestion of absorbable calcium antacid was treated successfully with hemodialysis as well as other therapeutic measures, such as saline diuresis. This acute therapy resulted in long-term normalization of maternal calcium levels. The fetus, who exhibited a low biophysical score during the initial admission, was delivered a month later and had an uncomplicated neonatal course.

The milk-alkali syndrome. A reversible form of acute renal failure.
Abreo K, Adlakha A, Kilpatrick S, Flanagan R, Webb R, Shakamuri S
Arch Intern Med 1993 Apr 26;153(8):1005-1010

An increased frequency of this syndrome seems likely with the growing popularity of the use of calcium carbonate as an antacid or as calcium supplementation to prevent osteoporosis. We treated five patients who had six episodes of the milk-alkali syndrome; four of these cases were diagnosed between 1990 and 1992. All patients were ingesting massive quantities of calcium and absorbable alkali and were unaware of the toxic effects of these compounds. All patients presented with the triad of hypercalcemia, metabolic alkalosis, and renal failure.

[Replacement of aluminum-containing phosphate binders by calcium and magnesium carbonates in long-term hemodialysis].
Zellweger U, Zaugg PY, Dambacher M, Binswanger U, Gautschi K, Hany A
Dtsch Med Wochenschr 1989 Apr 28;114(17):659-664

Hypercalcaemia was an expected disadvantage: repeated symptom-free episodes of hypercalcaemia occurred in six of 20 patients during the first three months and in a further two up to 12 months.

Milk-alkali syndrome with a serum calcium level of 22 mg/dl and J waves on the ECG.
Jenkins JK, Best TR, Nicks SA, Murphy FY, Bussell KL, Vesely DL
South Med J 1987 Nov;80(11):1444-1449

Milk-alkali syndrome. A consequence of chronic antacid abuse.
Newmark K, Nugent P
Postgrad Med 1993 May 1;93(6):149-150

Patient education regarding the hazards of abusing calcium-containing antacids is essential.

Antacids Can Cause Major Problems

"Tums" Is a Poor Choice as a Source of Dietary Calcium

The use of Tums as a supplemental source of dietary calcium is being purported by television and magazine advertisements, and even some health practitioners.

In Tums, calcium carbonate is the "antacid" portion. It is 40% elemental calcium, inexpensive, and readily available. It should be noted, however, that there are several very distinct disadvantages to its use as a calcium supplement:

1) Tums/calcium carbonate is an antacid. According to a study published in "The Annals of Internal Medicine", the only subjects who failed to absorb calcium carbonate were those who were found not to secrete sufficient stomach acid for proper digestion.

2) With the growing use of antacids, such as Tums, in the US (approximately 27% of the adult population consumes them) and the regular consumption of calcium carbonate as an inexpensive calcium source, the risk to Milk-Alkali-Syndrome is increasing.

This syndrome was first identified in 1923 and is characterized by hypercalcemia, alkalosis, and renal impairment. It may occur in an acute, sub-acute or chronic form. Joint stiffness with calcium deposits have also been observed in this disorder. It is called Milk-Alkali Syndrome.

Milk-Alkali Syndrome develops as a result of ingesting large amounts of calcium and absorbable alkali, particularly calcium carbonate. The reason this is of concern is that the National Institute of Health is now recommending 1000-1500 mg per day of calcium to prevent Osteoporosis. Since the most inexpensive form of calcium is calcium carbonate, many of the calcium formulas today contain calcium carbonate. Such popular products as Tums and Os-Cal, as well as many other inexpensive calcium supplements, are composed of calcium carbonate.

In addition, when taken with other substances such as adrenal cortical hormones or thiazide diuretics, calcium carbonate can be toxic at much lower does. In some individuals, even in the absence of other medications, calcium carbonate may produce Milk-Alkali Syndrome of four to five grams (four grams of calcium carbonate provides 1200 mg of elemental calcium). Since calcium carbonate has risks associated with it and is also shown to be mal-absorbed in patients with low hydrochloric acid levels, other forms of calcium supplementation are preferable.

PRENATAL CALCIUM SUPPLEMENTS/GALLSTONES IN INFANTS - Calcium supplements during pregnancy may induce gallstones in infants and young children. The two year-old daughter of a woman given calcium carbonate and vitamin D during the last four months of the pregnancy required surgical removal of gallstones which were found to be made up entirely of calcium carbonate. This is the first case reported of pure calcium carbonate gallstones. (Journal of Pediatric Surgery 20:143-144, April, 1985)

Pregnancy and Aspartame

Pregnancy and Aspartame


Maternal serum paraxanthine, a caffeine metabolite, and the risk of spontaneous abortion.
Klebanoff MA, Levine RJ, DerSimonian R, Clemens JD, Wilkins DG
N Engl J Med 1999 Nov 25;341(22):1639-44

"This suggests that moderate consumption of caffeine is unlikely to increase the risk of spontaneous abortion."  [Moderate is defined as 1-2 cups of coffee daily.]


Moderate Sodium Intake Necessary for Good Health


Magnesium is essential for muscle relaxation, so it helps to prevent uterine hyperexcitability, which can cause preterm labor or painful, prodromal labor.  Noting that magnesium sulfate is used for treatment of preterm labor as well as pre-eclampsia, it seems reallly important to make sure that pregnant women are getting adequate magnesium supplementation unless they already have a magnesium-rich diet.

Dr. Mercola has a short, helpful video on different types of magnesium.  Or you can just take a look at the chart. In brief, magnesium oxide is probably best for getting your bowels moving, because it's not absorbed as well.  Magnesium citrate is better for getting into the muscles and relieving spasms.

Calcium and its Relation to Magnesium - great explanation of the importance of balancing calcium with magnesium.  Peter Gillham is also the creator of MamaCalm, which is helpful for pregnant women who are experiencing anxiety, constipation or muscle cramping.

Magnesium's Impact on Health and Vitality - Magnesium is nothing short of a miracle mineral in its healing effect on a wide range of diseases as well as in its ability to rejuvenate the aging body.

Magnesium: Preventing pregnancy complications from babycenter.com

 Magnesium Intake during Pregnancy

Role of Magnesium Deficiency in Pre-Eclampsia

New data on the importance of gestational Mg deficiency.
Durlach J.
J Am Coll Nutr. 2004 Dec;23(6):694S-700S.

Chronic primary Mg deficiency is frequent. About 20% of the population consumes less than two-thirds of the RDA for Mg. Women, particularly, have low intakes. For example, in France, 23% of women and 18% of men have inadequate intakes. Mg deficiency during pregnancy can induce maternal, fetal, and pediatric consequences that might last throughout life. Studies of gestational Mg deficiency in animals show that Mg deficiency may have marked effects on parturition and postuterine involution. It has interfered with fetal growth and development, and caused morbidity from hematological effects and disturbances in temperature regulation, to teratogenic effects. Emphasis, here, is on effects of chronic clinical gestational Mg deficiency as it affects the infant. Premature labor, contributed to by uterine hyperexcitability caused by chronic maternal Mg deficiency, that can be intensified by stress, gives rise to preterm birth. If the only cause of uterine overactivity is Mg deficiency, its supplementation constitutes nontoxic tocolytic treatment, as an adjuvant treatment, that is devoid of toxicity and enhances efficacy and safety of tocolytic drugs such as beta-2 mimetics. Evidence is considered that Mg deficiency or Mg depletion can contribute to the Sudden Infant Death Syndrome (SIDS). SIDS may be a fetal consequence of maternal Mg deficiency through impaired control of Brown Adipose Tissue (BAT) thermoregulation mechanisms leading to a modified temperature set point. SIDS can result from dysthermias: hypo- or hyperthermic forms. Possibly, simple nutritional Mg supplements might be preventive. Various stresses in an infant can transform simple Mg deficiency into Mg depletion. For example, lying prone can be stressful for the baby, as can parental smoking. The role of chronopathological stress appears to be often neglected, as it constitutes a clinical form of primary hypofunction of the biological clock [with its anatomical and clinical stigma such as reduced production of melatonin (MT) and of its urinary metabolite: 6 Sulfatoxy-Melatonin (6 SMT)]. SIDS might be linked to impaired maturation of both the photoneuroendocrine system and BAT. Prophylaxis of this form of SIDS should include atoxic nutritional Mg therapy for pregnant women with total light deprivation at night for the infant. Consequences of maternal primary Mg deficiency have been inadequately studied. To determine ultimate outcomes of gestational Mg deficiency in infants, a long-term multicenter placebo-controlled prospective study should undertaken on effects of maternal nutritional Mg supplementation on lethality/morbidity in fetus, neonates, infants, children and adults, not only during pregnancy and the baby's first year, but throughout life.

If the magnesium citrate still causes diarrhea, you might try slow-release magnesium.  Jigsaw Magnesium w/Sustained Release Technology (SRT) allows for maximum absorption without the diarrhea side-effect common to magnesium supplements.

The FDA issued a report

FDA Report: Lead Found in Vitamins by Michael Mooney, September 2008
"To underline how safe multivitamins are, the amounts of lead in the supplements in FDA’s report are well below the amounts of lead found in many of the healthy foods that we consume safely every day."

Where to find out whether there's lead in your magnesium supplement [6/15/09]

It appears that the Calm products have pretty much the same ratio of lead/magnesium as other products. However, they recommend a higher daily dose, so then the daily intake for the recommended dose is also higher.

Here's the text of a letter from Gillham Products:

Peter Gillham’s Natural Vitality

2530 N. Ontario Street Burbank, Ca 91504

 Dear Customer

Natural Calm is and has always been a safe and healthful product. There was a recent question as to whether the higher therapeutic doses provided by Natural Calm meet the most stringent California Proposition 65 requirements for lead. We believe they do. The amount of lead in question was minute (far less than would be contained in a glass of drinking water or a salad), naturally occurring in our raw materials, and, even according to the president of the testing lab, not a health issue.

We nevertheless have tightened up our allowance on lead levels acceptable on raw materials, particularly our magnesium, which many of you know is derived from sea water. In addition, to assure compliance, our dosage per day is being dropped. As many of you may have noted in your correspondence to us, if our dosage had been in line with other companies we would have passed all tests.

This product will meet all Federal and California state standards.

Crystal Currie

Customer Service Dept

Natural Vitality

(800) 446-7462 ext 121



Great article from Pregnancy Basics from Pam Caldwell at HerbLore.

The body's demand for protein increases but ability to digest/ assimilate doesn’t. You may need to take an enzyme supplement to help.  Get a Nutritional Evaluation to find out which one.

I found that following the standard recommendations of 80-100  grams of protein daily (mostly high fat animal protein) and consuming   prenatal vitamin pills resulted in a sluggish metabolism as my body  labored to assimilate and eliminate the excess that it could not use.

Isn't the FDA "standard" 60 gms of protein for pregnant women? 100 gms is a LOT of food to eat.

I usually recommend 75 gms, and many women have a hard time with that amount. I stress that there are days when they'll get a bit more and days when they'll get less.

Two vegan clients last month had babies weighing 7-11 and 8-10. They were not getting 75 gms daily. But they eat really well and a good amount of calories. I did not want to muck through all the info on the Hallelujah Acres site, but the recommendations of diet that I saw didn't even look like a normal vegan diet. Vegan diets are usually better than that.

Common sense says that if they are not eating well we will see it prenatally. I give lots of nutritional info but I only see them about 12 times throughout their pregnancy. They will eat what they will eat and we probably don't always know what that means. I bet many of you, like I, have been shocked at the birth when looking in the cupboards of someone we thought was eating a lot better. But they have usually grown a healthy baby and placenta and had a nice birth.

Quick and Easy Protein from Mother Nurture, which focuses on practical help for the mother's well-being, and for building teamwork and intimacy with her mate.

Don't Eat Soybeans Raw

I love raw soybeans!  Unfortunately, it turns out that if you eat the soybeans raw, it's much harder to get the protein out of them. Apparently, soybeans contain an enzyme that inhibits absorption of the protein, and this enzyme is destroyed in cooking, so then you can absorb the protein from those lovely tasty "edamame", as they're called out here.

I find that if I just kind of lightly boil them, I still get the sweet, delicious, crunchy taste, and I figure I'm probably getting the protein.  I still haven't found any reliable information about how much heat is needed to destroy the enzyme, but I figure lightly boiling should do it.  (And, it turns out that this is an easy food to take to a birth, too!  I just grab a bag out of the freezer, they defrost on the way to the birth, and then I boil them up while we're boiling the herbs.  :-)  [separate pot].  And I can snack on them throughout the evening/night/whatever.

I strongly recommend lightly boiled edamame to my pregnant clients; one frozen bag of "edamame" is about 30 grams of protein - 3 servings worth, but they're such a tasty "snacky" kind of food for me that I have no problem eating a whole bag at a sitting or two.  They make a great snack for pregnant women to graze on through the day.

Concerns about Tradeoffs between Protein and Calcium

A letter written by Jock Doubleday.

Calcium and PIH

Excess Calcium (not balanced by other minerals, particularly magnesium) can lead to irritability by stimulating sympathetic nervous system.

Food sources of calcium - this is a fairly good list, with an emphasis on dairy.

Extra Calcium During Pregnancy Has No Benefits, Except to Prevent Hypertension [10/6/11]

"Maternal Calcium Intake and Metabolism During Pregnancy and Lactation" in the Journal of Perinatal Education,14 (1), pages 52-57.

List of online calcium resources from the Arbor Nutrition Guide.

Food, Nutrition and Agriculture - No. 20 1997 - Calcium throughout life

Calcium, Vitamin D and Magnesium from Nutrition During Pregnancy: Part I: Weight Gain, Part II: Nutrient Supplements (1990) from the Institute of Medicine (IOM)

Our local naturopath says that more than 500 mg of calcium at a time can cause thyroid problems.

I would have to go through my resources, but I know there was a large randomized trial recently that showed a significant reduction in incidence of PIH with CA supplementation (does anyone out there know the one I am talking about? Was it the McMaster's study?). There was also a reduction in preterm labor. Pretty significant. I know that there is some controversy about whether calcium supplementation actually decreases blood pressure elevations once it has started to climb. Some of the literature I have read says yes, some says no. Elevations of BP in pregnancy and symptoms that suggest what we commonly call pre-eclampsia, in my opinion, are likely to be multi-factorial in origin, and researchers and clinicians are still not in total agreement about the pathophysiology involved.

I have seen separate reports of research which suggests that calcium supplementation may also play a role in preventing or decreasing essential hypertension, not pregnancy related. This is of intense interest to me as I see a fair number of older women and do lots of work around peri and post menopausal health issues in my practice, and hypertension is a common problem in the community where I work.

Study Shows Calcium Doesn't Reduce PIH/Eclampsia

Questionable Role of Protein in Preventing PIH

Protein's role in preventing PIH is highly questionable.

I am taking my information primarily from Bonnie Worthington-Roberts book: Nutrition in Pregnancy and Lactation. This is an extremely well-researched and enjoyable text which I highly recommend. I quote:

"The notion that protein deficiency causes pregnancy-induced hypertension is a highly controversial issue. Brewer contends that consumption of adequate protein will obliterate PIH. For several years he ran a prenatal clinic in northern California in which the value of a high-protein diet was stressed. In 1971, a scientific review group examined the records of patients from the clinic and from the Contra Costa Hospital for the frequency of PIH from the years 1965 to 1970. The frequency of PIH in the patients seen by Brewer was not significantly different than in those patients not seen by Brewer (9 of 548 versus 12 of 367, respectively). In his analysis of the data, Brewer removed six of the cases from his group, stating that he had not seen two, one was in the project for only one week, and three had no evidence of PIH in their records. He also removed three cases of preeclampsia from the hospital. With these adjustments, there was a highly significant difference between the groups."

She goes on to summarize the studies that have shown a correlation between protein intake and elevated blood pressure and those which have shown no correlation. (These are probably the same studies Brewer refers to?)

The Temple University women received a protein-mineral supplement. (Doesn't say, but I bet calcium was one of those minerals.)

The Motherwell Scotland group also differentiated between "good diet" and "poor diet," the "good diet" consisting of high protein, low carbohydrate.

Of course, a large part of the Brewer diet is high calcium...it's pretty hard to differentiate between these two nutrients in human studies!

Her conclusion is:

"The role of protein deficiency in the etiology of preeclampsia has not been satisfactorily proved or disproved. Research in this area is lacking...Use of a protein supplement for prevention of PIH is not appropriate."

Thanks for the reference opposing Dr. Brewer's work. One little bone to pick, however....is it not correct that Dr. Brewer's work was concerning Metabolic Toxemia of Late Pregnancy (MTLP) and not PIH? I've read a few things that state that PIH is a catch-all term and really isn't the same thing as MTLP. According to Anne Frye, hypertension in pregnancy is defined as a rise in systolic BP "of 30 points or more and/or a rise in the diastolic pressure of 15 points or more, on two occasions, at least 6 hours apart" (Understanding Diagnostic Tests...196). Frye later goes on to discuss how studies have shown that pregnant women who have normal blood pressure, hypertension, and toxemia all have varying BPs within this definitive "range."

I do agree that Brewer's diet is very high in calcium and probably has a lot to do with its benefits for women experiencing symptoms of PIH or toxemia. The main point is, I don't think we should discount his ideas that diet and nutrition can help a lot in these "mysterious" pregnancy diseases.

Studies Show that the More Protein You Consume, the More Calcium You Lose!

The calcium losing effect of protein on the human body is not an area of controversy in scientific circles. The many studies performed during the past fifty-five years consistently show that the most important dietary change that we can make if we want to create a positive calcium balance is to decrease the amount of protein that we eat each day
--John A. MacDougall, M.D.

His two books, The MacDougall plan, and MacDougall's Medicine, should be required reading for anyone entering the health professions. Why isn't his name more widely recognized? For one thing, he's not on the payroll of the National Livestock and Meat Board or the National Dairy Council.

CALCIUM COMES FROM SOIL THAT PLANTS ABSORB AND INCORPORATE INTO THEIR STRUCTURE. Animals consume the plants that absorb the calcium. That's where cows get their calcium. Cows don't consume dairy products and yet they have all the calcium they need. How is it that cows have no difficulty whatsoever meeting all their calcium requirements for themselves and their young without ever having to consume even one glass of milk?

WHATSOEVER NUTRIENTS THE BODY NEEDS THAT IT DOES NOT ITSELF PRODUCE CAN BE OBTAINED FROM THE PLANT KINGDOM. In other words, if you can't get them from fruit, vegetables, nuts, seeds, sprouts, and whole grains, you don't need them. Everything else you hear is propaganda and is patently untrue. NUTRIENTS COME FROM THE GARDENS AND THE ORCHARDS, NOT FROM THE PHARMACEUTICAL LABORATORIES OR DEAD ANIMALS. (Fit For Life II: Living Health by Harvey and Marilyn Diamond)

Calcium in Pregnancy Lowers Child's Blood Pressure

Low-Protein Diet Reduces Calcium Requirements

Calcium and High BP or PIH

The Journal of the American Medical Association (JAMA) published a study that reported that consuming sufficient calcium during pregnancy can reduce the risk of PIH and pre-eclampsia. The researches found that 1500 - 2000 mg daily of calcium supplementation can lower the risk of PIH by 70% and the risk of pre-eclampsia by over 60%.

Most prenatal vitamin prescriptions only contain 200 mg of calcium, which I took during my first pregnancy and suffered from PIH. During my second pregnancy I took Twin Labs, which gave me 1200 mg a day, and an additional smaller supplement of calcium and magnesium. Then I also ate foods high in calcium like milk, cheese, yogurt, and broccoli. I had no problems during that pregnancy, labor, or birth with my BP.

Calcium is a natural pain reliever, so when I was in labor, I took 2000 mg of calcium lactate with a glass of milk halfway through my labor. I had read about it in Easing Labor Pain my Adrienne Lieberman. Anyway, my contractions, even at the end of 1st stage, got to a certain level of discomfort, but never got worse. It was close to a painless labor, because I listened to my body and stayed upright and active.

When choosing a calcium supplement for the support of the skeleton, the most preferred source in microcrystalline hydroxyapatite as found in Cal-Apatite (microcrystalline hydorxyapatite is the only calcium substance, documented in human studies to regenerate lost bone density).

Questions..... Would anyone with a nutritionist background like to translate this "2000 milligrams" into servings of milk/dairy/broccoli/whatever? Can a non-dairy user get enough calcium without supplementation, and if not, which supplements would you recommend over calcium carbonate (and why?)?

First of all, I am stating that I am not a firm believer in the mega-calcium necessity during pregnancy! However, I am not prepared at this time to back that up with research so I'll let it slide...though I would like to remind everyone that high doses of calcium can also prevent zinc absorption. This would be a problem during pregnancy. I'd like to find out if those doing the mega-calcium studies are finding any corresponding zinc deficiencies?

Secondly, the best source of calcium is without a doubt seaweed! (Other sources: spinach (eat with rice to counteract oxalic acid problems), chard, broccoli, turnip greens, kale, beans, nut milks, seed butters (such as tahini), calcium-fortified soy milk, tofu made with calcium sulfate/silicate, comfrey, oat straw, nettle, dandelion greens, mustard greens, horsetail, chickweed, amaranth, watercress.) Seaweeds are not a major food source in America, but they /are/ in many parts of the world! 3.5 oz of cow's milk contains 118mg calcium (whose absorbability has already been argued here!). The same amount...3.5 oz...of hizkie (a mild-flavored seaweed) contains 1400mg; kelp, 1093mg; wakame, 1300mg. As you can see the amounts are incredibly higher. The calcium:phosphorus ratio is closer to the 2:1 which increases absorption, sodium levels (as mentioned by someone else today) are higher than in milk too.

"A diet based on leafy green vegetables and legumes will provide sufficient calcium, even taking into account the greater calcium absorption rate found in vegans. As Gill Langley reports in a 1988 survey of research on vegans, no finding of calcium deficiency in adult vegans has turned up." (Vegetarian Pregnancy, Sharon Yntema, 1994) The survey referred to is Vegan Nutrition: A Survey of Research by Gill Langley, Vegan Society, East Sussex, England, 1988.

More from Vegetarian Pregnancy:

"Some green vegetables, particularly spinach and chard, contain oxalic acid, which inhibits the absorption of calcium. There has been some evidence that long-term vegans adjust to plant greens as a source of calcium by developing the digestive ability to override calcium inhibitors.

"Rice, more than any other grain, contains a substance that neutralizes oxalic acid. If rice is eaten in the same meal with spinach or chard, the calcium in the greens becomes available once again. Remember, Popeye may have had rice pudding for dessert!

"Other greens, like kale, mustard greens, and collards, are very low in oxalates and are excellent sources of calcium. To assure sufficient calcium in your diet without milk, eat a variety of green vegetables, favoring spinach and chard with rice dishes and other greens with grains. Beans, nut milks, seed butters (such as tahini), and calcium-fortified soy milk are also good sources of calcium and should be incorporated into a vegan diet (especially) on a daily basis." 

Here's a list of foods that can be exchanged for dairy because of their high calcium contents:

Almonds-2 oz. or 36 nuts
Bok choy, cooked- 1/3 cup
Brazil nuts- 2 oz. or 12 nuts
Brewer's yeast- 5 T.
Broccoli- 1 cup
Collard greens, cooked- 1/3 cup
Dandelion greens, cooked- 3/4 cup
Dulse- 1 oz.
Eggs, whole- 4
Kale- 1/2 cup
Kelp- 1/2 oz.
Molasses, blackstrap- 2 T.
Mustard greens, cooked- 1/2 cup
Sesame tahini- 2 T.
Soybeans, cooked- 1 cup
Tofu- 3 1/2 oz., 3x3x1/2 in.
Sunflower seeds- 3 1/2 oz. or 2/3 cup
Wheat germ- 4 1/2 oz.

Increasing calcium and eating dairy really don't have to have much to do with each other. You were right when you said that there are nuts and other things that contain calcium -- more are listed below (I also agree with the "too much fish" stuff, btw ;-) ). I had to give dairy up for allergy reasons.

I have discovered many interesting things since giving up dairy. One of the biggest shocks to me was to discover that the calcium in milk products is not very usable because of the high levels of phosphorus in the milk. If anyone is interested in more info on that, I can give you more sources to do some digging. So, if you want to increase your calcium, according to the things I have read (that are not put out by the dairy industry) then decreasing your dairy intake can actually be one step, and would then allow you to meet both of your goals during your next pg: decreasing you dairy intake and increasing your calcium through diet and supplements. They don't have to be mutually exclusive!

I know that I, for one, ate a ton and a half of dairy during the pg when I ended up almost dying from eclampsia. I also was not eating other foods high in calcium or taking a calcium supplement beyond what was in my pre-natal. At all. So it leaves me with some speculation anyway.

And btw the good news is that the calcium found in the other foods is much more usable by our bodies. Leafy green vegetables, almonds, tahini, kidney beans, tofu and broccoli are all great sources of calcium. I also still take a calcium supplement -- especially if my legs start aching. One of the best sources of information to look in is books about vegan eating (vegetarian w/ no eggs, meat or dairy). I am not eating a vegan diet currently (my Polish/German dh would rebel, I think ;-) ), but I find these excellent sources for recipes to add to our collection since my youngest son and I can no longer have dairy products.

I'm confusing myself please help me....if an infusion is one ounce of herb in a quart jar covered with boiling water lid put on steeps for 8+ hours yielding double strength of tea then...does that mean 4 cups infusion = 8 cups f tea = 30mg calcium or does it mean that four cups infusion has 60mg of calcium?? What about a tincture? I tell my clients 4 cups of infusion per day or 60 drops of tincture. How do they really compare? How much calcium is in 60 drops of tincture??? Susun Weed where are you???

An alcohol based tincture doesn't extract a large amount of calcium from the herb- a vinegar based one would be better, and a glycerin based one would be essentially worthless for this use. The amount of calcium in the red raspberry is in the dried herb - the infusion of hot water extracts what is already in there, so if you infuse it a short time, then you're only getting a portion of the available calcium. Numbers are very difficult to pin down, because it would require the standardization of the herb (Let this NEVER be! ) : ) But my gut feeling on this is that it is a high quality source of calcium , very easily assimilated, and besides that, Rubus has so many other time proven benefits as a uterine tonic , that it should be recommended for all pregnancies, except in the early trimester if one has a prior history of miscarriages or a "sensitive" uterus. What I've recommended to my clients is a wonderful combination sold by Blessed Herbs that includes Alfalfa, Oatstraw, Nettles, Rubus, and Rose Hips. 6oz (two tea bags) per quart infusion, apprx 200-300 mgs of calcium. You could buy it in bulk, like I do for my pregnancies. I personally throw in a healthy handful of the mixture (more like 1/2 a cup) per quart.

Increased dietary calcium may protect against effects of caffeine.

Spokane - April 12 (Reuters) "Caffeine consumption stresses calcium metabolism in hypertensive individuals, especially those consuming less than 700 mg calcium daily," according to Dr. Kevin J. Wise of Washington State University in Spokane. That caffeine "...contribute to hypertension since it increases urinary calcium excretion." Dr. Wise believes that these observed "...homeostatic perturbations may be partially compensated for by higher intakes of dietary calcium...and...higher dietary calcium may protect against caffeine-induced metabolic stress." Am J Hypertens 1996;9:223-229.

Protein Powders

I'm not a fan of protein powders, but if someone is going to do them, I'd suggest something like Vital Proteins Collagen Peptides.

There are lots of good protein powders out there now. You can even get vegan, Pea powder, Whey, etc.  I use one every morning in my smoothie with My kefir. Tell her to just be sure to look for non-GMO, non-food additives, colorings, artificial sweeteners etc.

I found Amazing Grass/Amazing Meal when I was pregnant and it was great. It was clean and came with a fruity option as well as the standard chocolate and vanilla. Be aware it's not as sweet as most powders so she may want to couple it with a banana or some kind of milk rather than water.

I'm currently using an Orgain product when I need extra protein and it's not bad either.

If you want to go with the highest-quality protein powders, look for those made from organic whey from grass-fed cows such as Terra's Whey or Bulletproof Protein Powder.  Terra's Whey is sweetened with stevia so it won't worsen glucose issues.

I'm personally not a fan of protein powders and find they can stress kidneys. I do have my moms needing more protein make a shake with Greek yogurt and other real foods (fruit or cocoa powder, a natural sweetener, and whole milk or almond milk, and a couple tbsp of plain kefir too) and have had good results with that.

Do you worry about the protein powders stressing the kidneys because of the amount of protein they're eating?

Or is there something else about the protein powders that stresses the kidneys more than another source with the same amount of protein?

I agree that they're hard on kidneys (which has huge implications for pregnancy), and can oft cause digestive issues. Our bodies are a bit challenged with being pregnant already. Easily digested proteins are so much better, so i rec. poultry, fish... Unless a vegi. I also rec org Miso's. w/ added hard-boiled egg chopped inside, nutritional yeast, coconut oil, pinch 'o cayenne. Great birthing and comfort food.
Protein powders are often overly processed and harder to breakdown.

I rec safely using greek yogurts, kefir - greens, avocado, hemp seed and/or chia and women make-up their own quite effectively. Just tell them to count the grams of protein and minimize the sugars. ALWAYS eat clean and organic as possible.

In the old days we used very effectively, raw egg and non-instant powdered milk etc. Made our own.  So many good ways to get protein other than processed powdered.

I've never heard this before about protein powders being hard on the kidneys, and sometimes my clients are very enthusiastic about their protein powders.

So I did a very simple web search:

The top three well-known, reputable web sites were webmd.com, livestrong.com, mercola.com

All three of them say that it is the amount of protein that is hard on the kidneys, rather than the type of protein.

Then I went to the place where I buy my protein powders: bulletproof.com

This web site extols the virtue of collagen protein as "the gold standard for achieving the fastest possible healthy tissue repair, muscle matrix, bone renewal and recovery after exercise."

The Bulletproof guy, Dave Asprey, is also co-author of "The Better Baby Book". Their recommendations are better researched than anything else I've seen.

So, I'll share what they say from "The Better Baby Book", p. 105:

"There are a number of things to watch out for when buying whey protein, because there's a lot of unhealthy, poor-quality protein products out there.  Many are geared toward body builders and contain extra sugar, flavoring, and harmful chemicals.  Many are processed in such a way that they cause the proteins to become unusable inside the body, or even harmful.  Whey protein concentrates are a bad idea.  They often contain casein and lactose, which we have already discussed under the topic of milk.

"During pregnancy, you should look for whey protein isolate that is labeled "low-temperature processed" and "nonhydrolyzed". Low-temperature processing preserves the natural forms of the proteins and prevents them from being damaged (denatured) from high heat. The natural forms are healthier for the body.  For this reason, we never cook with whey protein or mix it into very hot liquid.  Whey protein from grass-fed cows is ideal, but it's expensive.  If you have allergies, goat whey protein may be better for you than the standard bovine product.

"You can find a list of whey protein brands that meet our standards at our website, www.betterbabybook.com/whey."

They have a very long list of research and references.

Their list of acceptable whey protein brands doesn't include Terra's Whey, and I believe there list is a few years old and might have been written before Terra's Whey was available. So I have an email out to Terra's Whey to ask about the temperature and hydrolization issues; I couldn't find that info on their web pages.

I get that a lot of clients would be tempted to buy the cheapest protein powder they can get at Target or GNC or maybe the grocery store.  I can see that those would be very inferior to good nutrition from real food.

And there are also sometimes women who say they are too busy or just can't stomach the amounts of food required to get good amounts of protein.  For them, I would feel comfortable recommending the proteins from the Bulletproof Executive web site.

This is from the rep. at Terra's Whey!

We are a non-denatured (cold processed) (nonhydrolyzed) (processed at low temperatures). There are several different ways to say it. I would also like to add that we don't have extra sugar/flavors/harmful chemicals in our protein powders.

All of our products are made with simple ingredients, pure nutrition and earth friendliness in mind.

Diet for High Blood Pressure

In the midwifery practice that I work with, we have had NO high blood pressure problems in women who do the following: (A year ago we had a client who would not follow this) anyway:

supplements: (all tablets- take recommended amount on bottle)

Also -- quit working! Relax as much as possible with a nap and a walk every day.

It's pretty radical, it's very hard, but IT WORKS. Some people don't think it's worth it -- but some people don't mind the thought of pitocin inductions, either!

Vitamin B12

This issue is especially important for those with one or both defective MTHFR genes since they may not be able to convert B12 supplementation into an active form their body can use.  A good naturopath can help you with all these and related issues.

What Everyone (Especially Vegetarians) Should Know About B12 Deficiency [1/18/13] by Chris Kresser
One of the biggest problems with diagnosing B12 deficiency is that the conventional serum B12 test that most doctors run only picks up a small fraction of people who are actually B12 deficient. This test measures the total amount of B12 in the blood, and does not rule out functional B12 deficiency. (1) More sensitive markers for B12 deficiency are now available, including methylmalonic acid (MMA) and holotranscobalamin II (holo-TC). MMA is converted to succinic acid via an active-B12 dependent enzyme, so if MMA levels are high, it suggests that active B12 is lacking. Holotranscobalamin II is composed of vitamin B12 attached to transcobalamin, and it represents the biologically active part of B12 that can actually be delivered to the cells and perform all of the functions of B12. Studies using these newer methods report much higher levels of deficiency than studies using only serum B12. . . .

Of all of the available markers I mentioned above, holo-TC is considered to be the most sensitive. It can detect B12 deficiency in Stages I & II, whereas urinary MMA and homocysteine typically don’t become elevated until Stage III. Unfortunately, holo-TC is not yet widely available. Quest Diagnostics has recently begun to offer it, though, and it is one of the largest national laboratories so your doctor should be able to order it if you ask. [Update: although Quest lists it on their website, they apparently do not offer it at any Quest location in US as of 1-18-13.] . . .

I have come to view a high serum B12 in the absence of supplementation as a potential red flag for active B12 deficiency. . . .

A common myth amongst vegetarians and vegans is that it’s possible to get B12 from plant sources like seaweed, fermented soy, spirulina and brewers yeast. But plant foods said to contain B12 actually contain B12 analogs called cobamides that block intake of and increase the need for true B12.

Cyanaocobalamin is the most frequently used form of B12 supplementation in the US. But recent evidence suggests that hydroxycobalamin (frequently used in Europe) is superior to cyanocobalamin, and methylcobalamin may be superior to both – especially for neurological disease. (9, 10 p. 225) This is probably because methylcobalamin bypasses several problems in the B12 absorption cycle and doesn’t need to be decyanated or reduced to the (+1) state (the only state that can cross the blood-brain barrier). On top of that, methylcobalamin provides the body with methyl groups that play a role in various biological processes important to overall health.

[The article provides links into the combination of active supplements recommended.]

Quest's Methylmalonic Acid, GC/MS/MS, Urine - Elevated MMA is thus a functional indicator of vitamin B12 deficiency, and is a better indicator of early vitamin B12 deficiency than plasma vitamin B12 levels.

Quest's Vitamin B12 Binding Capacity, Unsaturated (Transcobalamin) - Decreased concentrations are seen in individuals with megaloblastic anemia or Transcobalamin deficiency. [Ed: Note - This isn't exactly the test mentioned above, and it's not clear whether it's equivalent.]

Vitamin D

High Vitamin D Not Harmful, Whites Most Susceptible to Low Levels - Medscape [5/15/18] - High vitamin D levels that exceed recommended ranges — an increasingly common trend in the population — show no association with all-cause mortality, while the better-known risks of vitamin D deficiency appear notably stronger in whites than any other race or ethnicity, according to new research.

This 2017 study suggests that vitamin D levels around 100 are healthiest for all adults.  Vitamin D is especially important in pregnancy for the absorption of minerals such as calcium and iron to grow a healthy baby.  It also helps regulate glucose levels and may prevent pre-eclampsia.

The Big Vitamin D Mistake.
[full text]
J Prev Med Public Health. 2017 Jul;50(4):278-281. doi: 10.3961/jpmph.16.111. Epub 2017 May 10.

The new recommendations are for daily vitamin D intake averaging about 10,000 IU with the goal of reaching serum levels of around 100.

"A statistical error in the estimation of the recommended dietary allowance (RDA) for vitamin D was recently discovered; in a correct analysis of the data used by the Institute of Medicine, it was found that 8895 IU/d was needed for 97.5% of individuals to achieve values ≥50 nmol/L. "

This 2015 study suggests that vitamin D levels above 50 are healthiest for pregnancy.

Vitamin D status is inversely associated with anemia and serum erythropoietin during pregnancy.
Thomas CE1, Guillet R2, Queenan RA2, Cooper EM2, Kent TR1, Pressman EK2, Vermeylen FM3, Roberson MS4, O'Brien KO5.
Am J Clin Nutr. 2015 Oct 7. pii: ajcn116756. [Epub ahead of print]

RESULTS: Maternal 25-hydroxyvitamin D [25(OH)D] was positively associated with maternal hemoglobin at both midgestation and at delivery (P < 0.01 for both). After adjustment for age at enrollment and race, the odds of anemia at delivery was 8 times greater in adolescents with delivery 25(OH)D concentrations <50 nmol/L than in those with 25(OH)D concentrations ≥50 nmol/L (P <0.001). Maternal 25(OH)D was inversely associated with erythropoietin at both midgestation (P <0.05) and delivery (P <0.001). The significant relation observed between 25(OH)D and hemoglobin could be explained by a direct relation between 25(OH)D and hemoglobin and an indirect relation that was mediated by erythropoietin.

Vitamin D Status During Pregnancy and Risk of Multiple Sclerosis in Offspring of Women in the Finnish Maternity Cohort
- these findings suggest that detecting and correcting maternal vitamin D deficiency in early pregnancy may help reduce risk for MS in their offspring.

Munger KL, Åivo J, Hongell K, Soilu-Hänninen M, Surcel HM, Ascherio A
JAMA Neurol. 2016 Mar 7. [Epub ahead of print]

I was particularly struck by the fact that most women are deficient in vitamin D, per "Mean maternal vitamin D levels, based on chemiluminescence assay, were in the insufficient vitamin D range overall . . . "  Why is this not routinely tested as part of initial prenatal bloodwork?  Many women don't focus on vitamin D supplementation unless they know they're deficient.

Could vitamin D make childbirth less painful? [10/15/14] - Low vitamin D levels could make childbirth more painful, according to a new study.

Could Vitamin D Make Childbirth Less Painful?
- Study finds women with higher levels needed less medication
Women with lower vitamin D levels required more pain medication than those with higher vitamin D levels, according to the study scheduled for presentation Tuesday at the annual meeting of the American Society of Anesthesiologists in New Orleans.
"Women often experience lower than normal levels of vitamin D during pregnancy. We found that patients with low levels of vitamin D experienced an increase in pain during childbirth," senior author Dr. Andrew Geller, an anesthesiologist at Cedars-Sinai Medical Center in Los Angeles, said in a society news release.

Vitamin D - Fact Sheet for Health Professionals, from the NIH

Optimal levels of vitamin D during pregnancy by John Cannell, MD [March 13, 2012] - Although there are no trials that support taking more, the Vitamin D Council believes 5,000 IU/day is equally safe and would be more effective at maintaining adequate fetal blood levels of vitamin D.

Vitamin D levels during pregnancy and infant brain development Posted on November 9, 2012 by John Cannell, MD   

Maternal serum vitamin D levels during pregnancy and offspring neurocognitive development.
Whitehouse AJ, Holt BJ, Serralha M, Holt PG, Kusel MM, Hart PH.
Pediatrics. 2012 Mar;129(3):485-93. Epub 2012 Feb 13.

"Maternal vitamin D insufficiency during pregnancy is significantly associated with offspring language impairment. Maternal vitamin D supplementation during pregnancy may reduce the risk of developmental language difficulties among their children."

Medscape summary of

National osteoporosis society vitamin D guideline summary.

Aspray TJ, Bowring C, Fraser W, Gittoes N, Javaid MK, Macdonald H, Patel S, Selby P, Tanna N, Francis RM.
Age Ageing. 2014 Sep;43(5):592-5. doi: 10.1093/ageing/afu093. Epub 2014 Jul 28.

 . . . The guideline also states that routine vitamin D testing is unnecessary where vitamin D supplementation with an oral antiresorptive treatment is already planned and sets the following serum 25OHD thresholds: <30 nmol/l is deficient; 30-50 nmol/l may be inadequate in some people; >50 nmol/l is sufficient for almost the whole population.  . . .

The Vitamin D Epidemic and its Health Consequences [4/28/14] - This is a fascinating article about the increasing role of vitamin D as sea creatures moved onto land.

Low First-Trimester Vitamin D Predicts Gestational Diabetes

Taking Vitamin D During Pregnancy [4/9/12] by Randall Neustaedter OMD - Vitamin D prevents language problems.


Undiagnosed Vitamin D Deficiency in the Hospitalized Patient
- this AAFP article says, "In patients with severe vitamin D deficiency (serum levels of below 8 ng per mL with hypocalcemia), 50,000 IU of vitamin D should be given daily for one to three weeks, followed by weekly doses of 50,000 IU."

Vitamin D supplementation during pregnancy: double-blind, randomized clinical trial of safety and effectiveness.
Hollis BW, Johnson D, Hulsey TC, Ebeling M, Wagner CL.
J Bone Miner Res. 2011 Oct;26(10):2341-57. doi: 10.1002/jbmr.463.

It is concluded that vitamin D supplementation of 4000 IU/d for pregnant women is safe and most effective in achieving sufficiency in all women and their neonates regardless of race, whereas the current estimated average requirement is comparatively ineffective at achieving adequate circulating 25(OH)D concentrations, especially in African Americans.

Can Vitamin D Treat Pain? by Pauline Anderson [Medscape, 2/27/12] - Vitamin D may have anti-inflammatory properties and interfere with prostaglandins.  This can be helpful to a lot of processes during pregnancy and might even help to prevent preterm labor, but it could also delay the onset of labor.  Once you get to term, you might want to scale back a little bit.  Your body stores vitamin D anyway, so you're not going to get into a deficiency state if you stop taking vitamin D a couple of weeks before your due date and then start up again after baby comes.

Improvement of Primary Dysmenorrhea Caused by a Single Oral Dose of Vitamin D: Results of a Randomized, Double-blind, Placebo-Controlled Study.
Lasco A, Catalano A, Benvenga S.
Arch Intern Med. 2012 Feb 27;172(4):366-7.
[No abstract available.]

Why is Vit. D so important in pregnancy?  Because it is essential for the absorption of minerals, and pregnant women need to absorb minerals (iron, calcium, magnesium) from their food and supplements in order to grow a healthy baby and sustain a healthy pregnancy.

NOTE - For some reason, most of the research studies measure vitamin D blood levels in nmol/L, while most labs report results in ng/mL.  The conversion factor is roughly 2.5, i.e. 1 ng/mL is roughly 2.5 nmol/L.  So, the target blood levels are 50–80 ng/mL (or 125–200 nM/L), but there's some controversy about this, mostly because newer research is increasing the healthy minimum.  Here are recommended blood levels from a variety of sources:

The Vitamin D Council:  50–80 ng/mL (or 125–200 nM/L)

Quest Diagnostics: "levels < 20 ng/mL [are] indicative of Vitamin D deficiency, while levels between 20 ng/mL and 30 ng/mL suggest insufficiency.  Optimal levels are > 30 ng/mL."

Important Vitamin D Update from Dr. Mercola [12/27/08]: 50-65 ng/mL optimal

Dr. Husbands: 40-65 ng/mL

Proposed Vit. D Protocols

I haven't seen any good evidence-based protocols for vit. D supplementation during pregnancy, but I've come up with this, based on what I can find:

Assess vit. D levels at initial labs with 25-hydroxyvitamin D blood test.
Recommend vit. D supplementation (vitamin D3-cholecalciferol) depending on vit. D levels:

50–80 ng/mL (or 125–200 nM/L): recommend maintenance supplementation of 3800 IU daily [Note that this is an impractical daily dose as most tablets come in 1000 IU tablets, so recommend 4000 IU daily instead]
< 50 ng/mL (125 nmol/L): recommend 5000 IU daily
> 80 ng/mL (200 nmol/L); recommend reduction in vitamin D supplementation until lower levels are reached.

Re-test after 2 months and adjust recommendations according to the above numbers.  If necessary, re-test every 2 months until the test result is at the desired level: >= 50 ng/mL (125 nmol/L).  It is considered safe to have levels as high as 80 ng/mL (200 nmol/L) as that's the level achieved by natural skin exposure.  Daily doses as high as 10000 IU seem to be considered safe, although this number is mildly controversial.  (Health Canada says 2000 IU a day is the safe upper limit, but numerous studies were dosing test subjects with 5000 IU daily, and no adverse effects were reported. )

Vitamin D supplementation is inexpensive, and testing can be expensive.  It is less expensive to buy 5000 IU of vitamin D as a single tablet than as 5 tablets of 1000 IU each.  [Thorne sells D-5000 at $13.50 for 60 capsules and D-1000 at $8.70 for 90 capsules.  The respective daily cost of 5000 IU is 22.5 cents and 48.3 cents.]  It's entirely possible that the most cost-effective approach would be to forego all testing and simply recommend a daily dose of 5000 IU.  There is strong evidence that this is safe and efficacious for almost all pregnant women.  (In fact, I don't know offhand of any reason this wouldn't work in an essentially healthy women.  There are some weird conditions that affect vit. D absorption, which might be detected with followup vit. D bloodwork.)  The greatest value of the initial vit. D assessment is to convince women that they are deficient; many of my clients tell me they get lots of sunshine, yet they are deficient, even at the end of the summer months.

In my own practice, it was interesting that several clients with BV were deficient in vit. D, just as the research predicts.

What are the Benefits of Vitamin D? [August 19, 2009 from Nutrition Diva with podcast] - good introduction

Vitamin D insufficiency: Evaluation of an oral standardized supplementation using 100,000IU vials of cholecalciferol, depending on initial serum level of 25OH vitamin D.
Rouillon V, Dubourg G, Gauvain JB, Baron D, Glemarec J, Cormier G, Guillot P.
Joint Bone Spine. 2011 Nov 4.


This protocol was effective in rising serum 25OHD of most vitamin D insufficient patients with a BMI less than 25kg/m(2), but not in overweight patients. As almost one half of our patients had a serum 25OHD level less than 30ng/mL at M2, we suggest that regular doses should be started quite soon after this initial supplementation.

Higher Vitamin D Levels Linked to Lower Risk for Female Pelvic Floor Disorders

Cod Liver Oil and additional information about vitamin D from The Weston A. Price Foundation  - also lists good/better/best sources.

Vitamin D - contains an interesting table of levels of vitamin D supplementation necessary to bring blood levels up to normal over a six-month period.

More Vitamin D? from Dr. Andrew Weil - The more I read about all the benefits of vitamin D, the more I wonder if there’s any harm in taking more than the 1,000 IU per day that you recommend. Is there?

Why You Need More Vitamin D by Dr. Andrew Weil

The NIH has a very good fact sheet on vitamin D.

Testing done through grassrootsheath.org is only $40, much more resonalble than most labs.

From a highly respected pregnancy nutritionist: "My favorite way of supplementing vitamin D is using drops from Carlson's. They some in 2000IU in a coconut oil base, are tasteless and very economical. Purchased online, a bottle containing 365 drops is only $11. I do think it is important to recognize the vitamin A/vitamin D connection, as a couple of studies have shown a correlation between vitamin D supplementation in children and increased incidence of asthma (a symptom of vitamin A deficiency). I tell my clients to take cod liver oil in addition to drops; the brand I recommend has 5000IU A/2000 IU D in one teaspoon, so they take one drop of the Carlson's 2000IU vit D drops in addition for a total of 4000IU of vitamin D a day.  Hopefully most pregnant women are getting at least 1200mg of calcium a day anyway, but vitamin D supplementation will increase heavy metal uptake if calcium is not supplied in the diet, so it is important to include that as well."

 A 2009 study on vitamin D deficiency in newborns with acute lower respiratory infection (ALRI) confirmed a strong, positive correlation between newborns’ and mothers' vitamin D levels. Over 87 percent of all newborns and over 67 percent of all mothers had vitamin D levels lower than 20 ng/ml, which is a severe deficiency state.

Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers.
Karatekin G, Kaya A, Saliho?lu O, Balci H, Nuho?lu A.
Eur J Clin Nutr. 2009 Apr;63(4):473-7.

RESULTS: The two groups were similar in gestational week, birth weight, birth height, head circumference, age and gender. The mean serum 25(OH)D concentrations in the study group newborns were lower than those of the control group (9.12+/-8.88 ng/ml and 16.33+/-13.42 ng/ml, respectively) (P=0.011). Also, mean serum 25(OH)D concentrations in the mothers of the study group were lower than those in the mothers of the control group (13.38+/-16.81 ng/ml and 22.79+/-16.93 ng/ml respectively) (P=0.012). In 87.5% of all newborns and 67.5% of all mothers, serum 25(OH)D concentrations were lower than 20 ng/ml. The 25(OH)D concentrations of newborns were highly correlated with mothers' serum 25(OH)D concentrations.
CONCLUSIONS: Our findings suggest that newborns with subclinical vitamin D deficiency may have an increased risk of suffering from ALRI. The strong positive correlation between newborns' and mothers' 25(OH)D concentrations shows that adequate vitamin D supplementation of mothers should be emphasized during pregnancy especially in winter months. 

Association between vitamin D deficiency and primary cesarean section.
Merewood A, Mehta SD, Chen TC, Bauchner H, Holick MF.
J Clin Endocrinol Metab. 2009 Mar;94(3):940-5. Epub 2008 Dec 23.

"Poor muscular performance is an established symptom of vitamin D deficiency."
CONCLUSION: Vitamin D deficiency was associated with increased odds of primary cesarean section.

Vitamin D deficiency and supplementation during pregnancy.
Yu CK, Sykes L, Sethi M, Teoh TG, Robinson S.
Clin Endocrinol (Oxf). 2009 May;70(5):685-90. Epub 2008 Sep 2.
CONCLUSION: Single or daily dose improved 25-hydroxyvitamin D levels significantly. However, even with supplementation, only a small percentage of women and babies were vitamin D sufficient. Further research is required to determine the optimal timing and dosing of vitamin D in pregnancy.

Vitamin D intake to attain a desired serum 25-hydroxyvitamin D concentration.
Aloia JF, Patel M, Dimaano R, Li-Ng M, Talwar SA, Mikhail M, Pollack S, Yeh JK.
Am J Clin Nutr. 2008 Jun;87(6):1952-8.
CONCLUSIONS: Determination of the intake required to attain serum 25(OH)D concentrations >75 nmol/L must consider the wide variability in the dose-response curve and basal 25(OH)D concentrations. Projection of the dose-response curves observed in this convenience sample onto the population of the third National Health and Nutrition Examination Survey suggests a dose of 95 microg/d (3800 IU) for those above a 25(OH)D threshold of 55 nmol/L and a dose of 125 microg/d (5000 IU) for those below that threshold.

Dose response to vitamin D supplementation among postmenopausal African American women.
Talwar SA, Aloia JF, Pollack S, Yeh JK.
Am J Clin Nutr. 2007 Dec;86(6):1657-62.
"On the basis of our findings, an algorithm for prescribing vitamin D so that patients reach optimal serum concentrations was developed. The algorithm suggests a dose of 70 microg (2800 IU/d) for those with a concentration >45 nmol/L and a dose of 100 microg (4000 IU/d) for those with a concentration <45 nmol/L. CONCLUSIONS: Supplementation with 50 microg/d (2000 IU/d) oral vitamin D(3) is sufficient to raise serum 25-hydroxyvitamin D concentrations to >50 nmol/L in almost all postmenopausal African American women. However, higher doses were needed to achieve concentrations >75 nmol/L in many women in this population."

Vitamin D Levels During Pregnancy Affect Childhood Bone Mass

Maternal vitamin D status during pregnancy and childhood bone mass at age 9 years: a longitudinal study.
Javaid MK, Crozier SR, Harvey NC, Gale CR, Dennison EM, Boucher BJ, Arden NK, Godfrey KM, Cooper C; Princess Anne Hospital Study Group.
Lancet. 2006 Jan 7;367(9504):36-43.

INTERPRETATION: Maternal vitamin D insufficiency is common during pregnancy and is associated with reduced bone-mineral accrual in the offspring during childhood; this association is mediated partly through the concentration of umbilical venous calcium. Vitamin D supplementation of pregnant women, especially during winter months, could lead to longlasting reductions in the risk of osteoporotic fracture in their offspring.

The Importance of Vitamin D from Thorne

Understanding Vitamin D Cholecalciferol from vitamindcouncil.org

Test Values and Treatment for Vitamin D Deficiency from Dr. Mercola

Dr. Mercola's comments on the issue of Vitamin D in breastmilk - Pregnant women have an added reason to get their vitamin D levels checked. As the study shows, if a breastfeeding woman is deficient in vitamin D, then her breast milk and breastfeeding baby will be too.

Which test to use?  Vitamin D Deficiency and Toxicity: Laboratory Support of Diagnosis and Management Clinical Focus from Quest Diagnostics.
"Serum 25(OH)D measurements should be used to determine vitamin D deficiency or intoxication and to monitor patients receiving vitamin D therapy."
NOTE - Most people agree that the reference values from Quest Diagnostics are too low.  Here's what Dr. Mercola says: Vitamin D Levels - 25 Hydroxy D: Deficient (< 50 ng/ml), Optimal (50-65 ng/ml), Treat Cancer (65-90 ng/ml), Excess (>100 ng/ml)  You cannot get excess vitamin D from sun exposure.

Low vitamin D levels during pregnancy, impact on bones in children
Javaid M, Crozier S, Harvey N, et al. Maternal vitamin D status during pregnancy and childhood bone mass at age 9 years: a longitudinal study. Lancet 2006; 367(9504): 36-43.
Maternal vitamin D insufficiency is common during pregnancy and is associated with reduced bone-mineral accrual in the offspring during childhood; this association is mediated partly through the concentration of umbilical venous calcium.
Vitamin D supplementation of pregnant women, especially during winter months, could lead to longlasting reductions in the risk of osteoporotic fracture in their offspring.


From the Vitamin D Council:

A blood test to measure your 25(OH)D levels can tell you whether you have too high of vitamin D levels. If your 25(OH)D levels are above 150 ng/ml this is considered potentially toxic and potentially harmful to your health. You know if your 25(OH)D levels are toxic by a blood test to measure calcium. If calcium is high and 25(OH)D is high, then you are getting too much vitamin D.

Very high levels of 25(OH)D can develop if you:

    take more than 10,000 IU/day (but not equal to) everyday for 3 months or more. However, vitamin D toxicity is more likely to develop if you take 40,000 IU/day everyday for 3 months or more.
    take more than 300,000 IU in a 24 hour period.

Other Supplements

My friend who knows more about prenatal nutrition than anyone else I know says that all pregnant women should be taking supplementary vitamin C (up to 10,000 mg), vitamin D (up to 6000 units), lecithin and collagen, particularly Collageena.

I especially like New Chapter "Perfect Prenatal" supplements because they contain helpful probiotics, including L. acidophilus and especially B. infantis, which will get passed on to your baby and help prevent colic; they are available at Whole Foods and other health-food stores.  They contain recommended levels of folic acid, vit. C and acidophilus, as well as an unspecified amount of choline.

Testing Vitamins for Absorbability

Here is a test you can do at home on your 'vitamin' supplements:

Put one tab/cap/? in enough distilled or apple cider vinegar to cover it for 30 min. The vinegar closely simulates stomach acid as it takes about 30 min to break down supplements. If in 30 min it hasn't broken down at all, try a different supplement brand. If it doesn't break down, your body isn't getting it. Centrum has been found in the bottom of lots of porta-potties. Make sure your vitamins are working for you.

A great brand I've spotted in 3 years of looking is New Vision. People have even slept better on that brand.


Spirulina is fantastic for nursing mothers! It is filled with chlorophyll, rich in protein, contains all 8 amino acids and has B12 (important source for vegetarians). The chlorophyll nourishes blood (a precursor to breast milk in Chinese Medicine) and helps remineralize the body--including calcium, which is obviously lost during lactation & pregnancy. Spirulina helps balance blood sugar and helps with energy and stamina. I recommend a product called Pure Synergy for all my patients including pregnant and nursing moms. There's more in it than spirulina.

What do You think about the use (or abuse) of vitamins and minerals in ALL pregnant Women? No matter if the Patient is healthy.

I suggest a good nourishment, and only give iron (300 mg. fumarato ferroso) and acid folic (300 mcg.), in Patients with hemoglobin less than 12 g/100 ml. or hematocrito below 35% (Mexico city altitude 2,220 m.). In Patients with any vitamin deficiency, must give the specific vitamin.

Vitamin A in pregnancy from The Arbor Clinical Nutrition Update

Moderate Doses of Vitamin A OK in Pregnancy

Vitamin A and Progesterone

In this study 50 pregnant females between 16 and 20 week's gestation from a low income rural area were given either 6000 I.U. of vitamin A in conjunction with 60 mgs of elemental iron, or 60 mgs of elemental iron only in the control group. Initial blood samples were taken at 16 to 20 weeks, and then again after 12 weeks of supplementation between 34 and 38 week's gestation. Plasma levels of estradiol and progesterone were elevated at 34-38 weeks as compared to baseline levels. Estradiol was not significantly different between the control and experimental groups. The progesterone level was considerably higher in the experimental vitamin A treated group. Vitamin A plays a role in steroidogenesis. It has been reported that vitamin A doses in excess of 10,000 I.U. can be teratogenic in early pregnancy. The Teratology Society recommends taking no more than 8000 I.U./d during pregnancy. In this study 6000 I.U. per day was used which is within safe limits. This supplementation of vitamin A was beneficial in that it increased maternal and fetal vitamin A levels as well as progesterone levels. 12697

"Effect of Vitamin A Supplementation on Plasma Progesterone and Estradiol Levels During Pregnancy", Panth, Meena, et al., International Journal of Vitamin and Nutrition Research, 1991;61: 17-19. (Address: Dr. Leela Raman, National Institutes of Nutrition, Indian Council of Medical Research, Jamai Osmania P0, Hydrabad-500 007, A.P.,India)

Vitamin C

1000 mg of vitamin C is not a good idea in pregnancy. Especially since Amanda doesn't give any idea of how far along this pregnancy is. In very early pregnancy, large doses of vitamin C can cause miscarriage. Later in pregnancy, high doses of vitamin C can result in a newborn with scurvy. Large maternal doses of vitamin C can stress the newborn's kidneys. Also, during pregnancy or not, large doses of vitamin C can cause diarrhea, which is certainly unpleasant! Anyway, I wouldn't recommend 1000mg during the first trimester or for any extended length of time later in pregnancy either.

Y'all aren't going to believe this one. The midwife I apprenticed with, who is an EXCELLENT midwife and is also a clinical nutritionist, used to recommend 1000 mg. Vit C per day, times the month you were pregnant. That's right at 9 mos. her clients were taking 9,000 mg. of Vit. C per day. She said she had researched it and had several reasons for this recommendation which I don't remember all of them now. A lot of what I remember had to do with building the strength of the blood vessel walls, increasing the elasticity of the skin (something to do with collagen I think), helping to prevent hemorrhage, assisting absorption of iron and we suspected it helped prevent Rh isoimmunization. She was really confident in this and recommended it no more than 2,000 mg. at a time, spaced out throughout the day. After the pregnancy was over the women would gradually decrease the amount - going down 1,000 mg. per day each week. She believed a healthy maintenance dose was 3,000 mg. per day, but I don't think most women stayed with that. I know I didn't. Now, there was pretty good compliance in her practice. These women rattled when they walked! (in addition to vitamin C, they took a PNV, Vitamin E, Calcium & Magnesium and in the last 6 weeks Alfalfa and in the last 5 weeks an herbal supplement.) I can verify that the women did not get diarrhea from this - they did build up to it slowly though as described.

I can also verify that there was no scurvy nor problems with baby's kidneys. Again - her protocol was probably the reason - she did explain that they had to protect against scurvy by going down gradually. I also did not see any miscarriages result from this that I know of, I only remember attending a couple of miscarriages with her and I don't think they were even taking very much vitamin C - one lost hers to an accident. I read one time that the amount they were talking about with this incidence of Vitamin C causing miscarriage was 10,000 mg. per day in first trimester. (Sorry, this is probably not valuable to y'all because I don't remember where or when I read this.) She never transferred for sutures and I didn't get to see her suture until the end of my apprenticeship (about 100 births or so - I don't even think it was a second degree). I read in Susan Weed's book (Wise Woman Herbal for the Childbearing Year) that she suspected high Vit. C might help reduce the chances of Rh isoimmunization. This midwife's practice is anecdotal, but of about 25 Rh- women I watched her follow - none of them got RhoGAM and none were sensitized. (She always followed up with lab work if they didn't get RhoGAM) One of the mom's had an IUFD that went undetected for 3 days until labor (at 37 weeks) and had a still birth. (Baby had the kind of Down Syndrome accompanied with heart defects that is incompatible with life) She was Rh- and I was really surprised she didn't get sensitized. Should I have been? Or was there really no reason for her to be sensitized? I remember that the umb.cord was just full of clotted blood.

Anyway, in my partnership practice, we continued with the Vit C recommendation since we both had apprenticed with her and my partner was really sold on the idea of the Vitamin C. I always made it real clear though, that this was not the standard of care of physicians or even most midwives, and they could do what they wanted to about the Vitamin C. We didn't have as good compliance with the suggestion.

When my partner retired last year. I quit with the Vitamin C. I have not done the same research as my Sr. midwife or even read up on it specifically and I just wasn't comfortable doing this just because she did it. Even though it appeared she had good success. I recommend 1,000 mg. per day though, as part of their prenatal diet.

The point of my bringing all this up, is because I think the FDA or AMA or whoever, is brainwashing us with "recommendations" of what is safe and what isn't in the vitamin world. I for one don't believe we get good nutrients from our food anymore because of soil depletion, cooking, farming changes, pollution, etc. I also don't think a lot of the supplements on the market make much of a difference. I'm not a religious vitamin popper, but I think I should be. I just thought this anecdotal information might be interesting to y'all and see what other's think.

I don't claim to be an expert, but in my research and experience, 1000 mg of Vit C is not an amount large enough to cause miscarriage or diarrhea or any ill effects at all, and actually, far from it. Any others' experience or opinions on this? I am very interested.

I recommend 1,000 mg. per day though, as part of their prenatal diet.

The point of me bringing all this up, is because I think the FDA or AMA or whoever, is brainwashing us with "recommendations" of what is safe and what isn't in the vitamin world. I for one don't believe we get good nutrients from our food anymore because of soil depletion, cooking, farming changes, pollution, etc.

I agree. 1000 mg is not much at all. I have no problem with women taking larger doses - up to 10000mg (10 grams). I am a diehard Linus Pauling fan.

Lots of midwives here advise "large" amounts of vit C in pregnancy, and are really sold on the (perceived) results -- less preterm births, less greatly lessened PROM etc.

Lots of experiences with women who "always" rupture membranes before labor, who stay intact with the next pregnancy if they use vit C.

I'd be interested where your midwife/teacher found solid research on it though -- it seems to be pretty rare, and all I know of is anecdotal.

I feel a bit more comfortable with lower amounts than 9 gms at term! - - - but lots of folks here on the left coast are into high-dose vit C, and we commonly find moms taking a gram or two per day -- and increasing that amount if ill.

I think it would be hard to find anyone in this region who would agree that vit C should be considered a miscarriage risk. if anyone has data we would LOVE to hear it!

My partner and I started getting them down to about 6 gms per day at 9 mos. because it seemed like there were too many over due moms. In my Sr. midwife's practice, we practically never saw a baby before it's due date.

Well, I've looked all over and can't find my references on Vitamin C use in pregnancy- : / but it was a great study ( not American) and they were using MEGA doses of C and getting really interesting results....I'll keep looking. Meanwhile, you can check out Anne Frye's Understanding Lab Work if you consider her a good reference- I consider 1000mg a therapeutic dose but by no means a mega dose- if one experienced runny stools I would recommend backing off a few mgs and building up slowly.

a good vit c with bioflavinoids would work for RH- but it has it be a complete c with bioflavinoid and rutin which strengthens the vein walls and can prevent interbleeding.

In one of my classes we discussed abortion methods and included herbal and alternative methods. Vitamin C, was one of them in doses above 10,000 mg (10gm). I was shocked that anyone could tolerate that high of a dose. I think that the vitamin C may not actually cause the abortion through direct action on the embryo/fetus or uterus/lining, but cause severe toxicity in the mom and thus make the body a hostile territory for implantation and growth. I have no scientific studies, or any other information, but was taught this in class. On the other hand I was also taught that 500mg-1000mg was a good dose for someone who was attempting pregnancy, along with Vit E 400 iu-600iu. Any opinions or experience on that one?

I've seen scurvy. A pregnant, 17 yo in Pasadena Tx. She had a sore tongue, red eyes, and some kind of skin lesions. The nurse-practitioner was convinced it was scurvy. The girl denied eating any fruit or vegetable we named except french fries. No bananas, no apples, no salads, no no no. It was quite amazing. I still wonder about it. She must not have eaten much cereal either, there are vitamins in most of them. She was tall and not to skinny. Didn't look sickly, otherwise.

Vitamin E

Has anybody heard about there that taking Vit E during pregnancy will help with stretching of the perineum? I'd like any input as possible 

Vitamin K to prevent Postpartum Hemorrhage

Working with a woman hesitant about a homebirth because she was a bleeder - recommended over-the-counter vitamin K, one pill per day, taken for just one week before the birth.

No blood.

We found a little blood on the chux that she sat on for 2 hours afterward, but no blood in bowl, no blood when she got up, just -- no blood. This would be unusual for any of my clients, but especially someone that is supposed to be a heavy bleeder.

We've been using chlorophyll for a long time, and I like the results I get with it, but I know that some of the midwives I used to know always insisted on kelp. I also know that some use alfalfa. Does anyone know that vit K content of these three substances? I've never been able to find the vit K content of chlorophyll.

Most swear by alfalfa tablets or capsules here.. At least four a day and the more the better -- - -and (anecdotally) we seem to see very little bleeding with the moms who us lots of alfalfa.

Vit K OTC might be just fine.... I remember hearing worries about "too much" causing blood clots and other problems... How much is "too much"

We used to recommend 8 a day. Even after 4 a day by the end of the pregnancy, most women will complain of what I call the bovine burps

VitK OTC comes in 100 mcg doses. I just recommend 1 every other day or 1 a day if she's a bleeder. If she has varicosities she shouldn't use vit k

Do you rec. all your moms take alfalfa then? Are most of them taking it throughout preg or towards the end? I'm always pushing chlorophyll and getting the "can't tolerate the taste" response. Alfalfa is such an affordable food supplement, why didn't I think of that?

My midwife "prescribes" calcium/magnesium/zinc supplements, red raspberry leaf, kelp or seaweed, Vit C, - towards the last few weeks, she will have me begin taking evening primrose too. For low energy she recommends liquid chlorophyll.

I took red raspberry, red clover tinctures as uterine tonics. For my iron, I took dandelion, nettles, and yellow dock. I took the Pregnant/Lactating formula prenatal vitamins by Twin Labs - these have 1300 mg calcium. Adequate calcium in pregnancy (above 1200 mg) has been show to reduce the risk of pregnancy induced hypertension and pre-eclampsia. I took extra vitamin b-6, for nausea in the beginning and swelling at the end, (25 mg, 2x a day). I also used skullcap tincture for the occasional headache. At the end, I used an antioxidant formula in addition to everything else - my midwife said it would reduce my risk of hemorrhage. I also used evening primrose oil.

In labor, I took 2000 mg of CALCIUM LACTATE with a big glass of milk. I read about this on p. 85(?) of Easing Labor Pain. It was suggested that some women who did this experienced much less pain. I AGREE! I had a much easier time, I was laughing between contractions when I was at 8 cm. I got into the birthing tub at 8cm, and Amanda was born 15 minutes later.

What Are the Right Food Supplements During Pregnancy? Study Shows Risky Knowledge Gaps

When to Take Supplements

I *always* take my vitamins at night -- it's the only way I could keep them down while pregnant, and I just kept up the habit.

If you have been told you are anemic then I would probably not take the iron at the same time as the prenatal as it may not be absorbed as well because of the calcium present. Other wise it doesn't really matter when you take the vitamins.

It does not matter. Calcium is definitely better at night. Everything else whenever you remember.

If you are taking a high-B vitamin-containing prenatal and you find that you have difficulty sleeping, taking them at night might not be the best course of action.  B vitamins can increase energy.

Food Allergies

A pregnant woman's digestive tract changes with pregnancy hormones.  The intestinal villi grow longer for better absorption of food.  This can trigger new food allergies.  If you have seasonal or grass allergies, consider the possibility of cross-reaction, meaning that you are also allergic to related foods.

Food Sensitivities

You might want to develop an awareness of foods that "don't agree with you", i.e. foods that cause subtle signs that your body is in distress: lumps of phlegm in the throat, runny nose, the need to clear the throat often, clicking or tickle in the ears when swallowing (fluid in ears), heartburn, smelly stools, grumbling sounds in intestines, diarrhea, constipation, windburned look to cheeks, reddened/itchy chin or other area of the body, eczema, a feeling of fatigues, especially 20 minutes after a meal and you were not noticeably tired before the meal, passing smelly gas, burping up the food aftertaste, a feeling like a hangover after eating a food, a bad taste in your mouth, a crack down the center of your tongue, bleeding gums, canker sores in your mouth. 

Was it something you ate? by Sabine Spiesser BS, Grad Dip Dietetics - Reactions to food

Peanuts and Peanut Allergies

There is a lot of old literature suggesting that maternal peanut exposure can cause allergies in their offspring.  In 2012, we no longer teach that.

Maternal peanut exposure during pregnancy and lactation reduces peanut allergy risk in offspring. [free full text]
López-Expósito I, Song Y, Järvinen KM, Srivastava K, Li XM.
J Allergy Clin Immunol. 2009 Nov;124(5):1039-46.

CONCLUSION: We show for the first time maternal transmission of susceptibility to first-exposure peanut reactions and active peanut sensitization. Low-dose peanut exposure during pregnancy and lactation reduced this risk.

Peanut allergies, children and pregnancy
from the March of Dimes - Women who are allergic to peanuts should not eat peanuts or peanut products during pregnancy or at any other time. Studies suggest that women who are not allergic to peanuts can safely eat peanuts during pregnancy.

Brief discussion of peanuts and allergies

Simple Techniques for Detecting Nutritional Imbalances

A visible sign of zinc deficiency is white specks on fingernails.  Or you can buy a zinc sulfate solution from most online supplement stores (sometimes called 'zinc status').  If it tastes like water, you're likely deficient, if it tastes bad, then you're probably okay.

One way to test for a deficiency of stomach acid is to eat beets and see if any of the red beet pigment shows up in your urine. The pigment in beets is denatured at a pH of 3-4, and your stomach should be more acidic than that.  So if the pigment is surviving long enough to be absorbed into your bloodstream, it's a pretty good bet that more stomach acid (HCl) would be helpful.  The two main ways I know of increasing HCl are supplementing zinc and eating fermented foods or other foods high in histamine with meals.  Dietary histamine promotes the release of stomach acid.


Soy has been getting  a bad rap recently - what's the truth?  Personally, I'm not sure, but here's some info:

Whole Soy Story: The Dark Side of America's Favorite Health Food from Mothering Magazine

Soy Unsafe for Children from Randall Neustaedter OMD

Where to Find Potassium in Foods from Consumer Reports

Do You Really Need Eight Glasses of Water a Day? from Dr. Mercola

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