Episode 7 – Nutrition for fertility, pregnancy & breastfeeding

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This week’s episode is all about nutrition for fertility, pregnancy and breastfeeding. I answer common questions like:

  • What do you see as the biggest factor keeping women from getting pregnant these days? What one factor, if optimized, has the biggest effect on fertility?
  • How important is the father’s nutritional status pre-conception?  What should a man be eating to improve the chances of conception?
  • Do you recommend significantly different diets during the times a couple is trying to get pregnant versus after she becomes pregnant?
  • Can I continue my paleo/low-carb lifestyle if I fall pregnant? Is it safe to practice a paleo diet while pregnant? Most doctors say it isn’t.
  • When I was pregnant in the past, I had TERRIBLE morning sickness. How can I maintain a healthy eating plan and deal with food aversions/ morning sickness/ sheer exhaustion?
  • What prenatal vitamin (with DHA?) would you recommend? Are generic supplements targeted at pregnant woman worth taking?

We also discuss appropriate weight gain during pregnancy, how to avoid gestational diabetes, how long to breastfeed and how to ensure adequate milk supply.

At the end of the podcast I talk a little bit about the Grow a Healthy Baby Home Study Course, which will be available online by the end of this month or early next month. If you’d like to be notified when it becomes available, click here to join the mailing list. Note that I’ll be making a special offer to people on that list, so sign up so you don’t miss out!

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Full Text Transcript

Danny Roddy:  Hello everyone and welcome to the Healthy Skeptic Podcast. My name is Danny Roddy and with me is Chris Kresser, health detective and creator of thehealthyskeptic.org. A blog challenging main stream myths about nutrition and health. Chris I’m extremely excited for today’s episode. How are you doing man?

Chris Kresser:  I’m great Danny, how are you?

Danny:  I’m very good.

Chris:  What’s new?

Danny:  Nothing much. School, work, that’s pretty much it. Other than studying at the library, nothing new.

Chris:  The school where they teach you everything you don’t want to know about nutrition?

Danny:  Speaking of that I switched my major to Biology just because I couldn’t handle it anymore.

Chris:  Smart move.

Danny:  They’ll probably teach me a lot more in the long run.

Chris:  I think that’s a smart choice actually. Good move.

Danny:  How was the move? How’s the chicken coop? Do you still have it?

Chris:  No, we had to sell the chickens which was sad. We miss them but we just don’t, with a baby coming and the space wasn’t quite as conducive for it, so we dismantled the coop and said our goodbyes. We’re here, we’re surrounded by boxes, and I had no idea when they’re going to get unpacked or if they ever will. But it feels good to be in our new place.

Danny:  I’m glad it was successful. Should we dive in.

Chris:  Yes let’s do it.

Danny:  Why don’t you introduce what the episode is going to be about. This specific episode for your healthy baby course.

Chris:  Sure, I’ve been teaching this course called Grow a Healthy Baby. It’s about nutrition for fertility, pregnancy and breastfeeding. I’ve taught it live in the Bay area a couple of times and it actually sold out a few weeks in advance both times so there’s definitely been a huge demand for this info. And I’ve received a lot of requests by e-mail and Facebook and Twitter and comments on the blog by people who don’t live in the Bay area who would love to get access to some of this information so I thought we’d do a Q&A podcast rather than rehashing the materials in the presentation which would take 3 hours because that’s how long the seminar is. I thought I would just focus on the most frequently asked questions from the seminar and then also some questions that I got from a survey that we did asking people what their main concerns and questions were about fertility and nutrition for fertility, pregnancy and breastfeeding. I think what we’ll do is to start out we’ll dive into just some basic comments about the importance of nutrition in this realm because I’m sure a lot our listeners need to be convinced of this. You guys are all down with that but it’s amazing that in the conventional world there isn’t a lot of awareness about how important nutrition is for fertility and pregnancy or there’s a mistaken idea of what kind of nutrition or what is proper nutrition for pregnancy and fertility. Now, if we look at traditional cultures we see that almost all of them have sacred fertility foods. They were things like organ meats, egg yolks, raw dairy products, fish eggs, things that were extremely nutrient dense and they would feed these foods to mothers to be and even fathers to be. A good example is the Maasai Tribe in Africa. They would actually only allow couples to marry after they had spent about 6 months consuming milk during the wet season which is when the grass is green and the nutrient content of the milk is very high. It’s clear that these cultures knew about the importance of nutrition for healthy kids, healthy babies and of course it’s taken us another couple thousand years to remember that. Recently, modern science has rediscovered what traditional people have known for hundreds of thousands if not millions of years and it’s something called the Developmental Origins Theory. This theory holds that like all living creatures in early life, humans are plastic, but plastic I mean we are flexible, we have the ability to form new connections in our brain and we’re able to adapt to our environment.

Danny:  I thought you were going to say we were made of BPA.

Chris:  Right, we’re plastic little toys from China. What this means that during the developmental period our organs and the systems of our body go through really critical periods when they’re sensitive to the environment and pregnancy is that period for us as human beings as it is for most animals. The plasticity or flexibility we have during the pregnancy period enables us to get what we might call a weather forecast from our mothers. And this weather forecast prepares us for the type of world that we’re going to have to live in so if the mom is poorly nourished, she sends signals to her unborn baby that the environment that the baby is about to enter is likely to be harsh and the baby responds to these signals by adaptations like reduced body weight and altered metabolism, which is actually a really smart strategy because it helps the baby survive food shortages after birth. Is this making sense so far Danny?

Danny:  Yes I’m into it.

Chris:  Okay good sometimes I can’t tell if I’m making sense when I’m talking about this stuff and it all makes perfect sense to me in my convoluted mind.

Danny:  Oddly enough in my Biology class we’re going over reproduction so that might be the only reason I’m able to follow you.

Chris:  Alright, good. To make this as practical as possible, what this means is the 9 months of pregnancy are now considered by a lot of researchers to be the most consequential period of our lives. Just think about that for a second. They’re saying that before we’re even born is the most important period of time in determining our health for the rest of our life. It’s kind of not fair really.

Danny:  We have no choice.

Chris:  As much as we love to blame our parents, it was the same for them so it just keeps going back and back and back so there’s good news and bad news on that right? This period, the gestation period, they’ve found that it permanently influences the wiring of the brain and the functioning of the organs like the heart, the liver and the pancreas. It also suggests that the conditions encountered during pregnancy shape everything from our susceptibility to disease to our appetite and metabolism to our intelligence and temperament. There’s some amazing research that is shown, and I cover this in the presentation, that has shown that babies that are born at a low birth weight, which is primarily determined by maternal nutrition, have a significantly higher risk for diseases like heart disease, diabetes, hypertension, kidney disease and things like that later in life independently of lifestyle risk factors. We used to think that heart disease was simple a disease of lifestyle, like not exercising and eating the wrong foods. Certainly that all contributes we know that but we’re actually finding is that the conditions in utero during pregnancy actually strongly influence whether someone’s likely to develop heart disease prematurely before they’re 65. It’s just amazing don’t you think?

Danny:  Is this the definition of epigenetics or is not even that doesn’t go that far back in our genealogy.

Chris:  Exactly, this is more just the conditions in utero. It doesn’t involve epigenetics. Epigenetics is related to this in the sense that that is an environment that is then altering and affecting our genes but usually when epigenetics is discussed we’re talking more about the environmental conditions that we encounter after we’re born. So this is a whole new angle on it. Anyway that’s just a little, well not little, a significant reason to be very attentive to what you’re eating prior to conception and during pregnancy and during the breastfeeding period because it has a really profound affect not only on your health as a mom but on the health of your baby. Not just during infancy and early childhood but actually for the rest of the baby’s life. I know this maybe sounding a bit heavy and I’ve freaking people out and I don’t want to do that because stress of course is also not beneficial to the baby or to the mother. And if there’s anything we know about humans is we’re both remarkably fragile and remarkably resilient. We know that babies are being born all around the world in pretty adverse circumstances, famine and war time and pretty harsh conditions and many of these babies go on to live long and healthy lives. We’re talking about patterns and probabilities here, we’re not saying that if the nutritional conditions are suboptimal that you have 100% chance of developing heart disease earlier on in life. We’re saying that the risk for that goes up. Just keep that in mind as we talk about this stuff, these are small increases in risk but they’re significant enough that we should really be paying attention. I don’t want to belabor this because I think most people who are listening to this are already pre-convinced to that.

Danny:  I’ll add some light hearted sound effects to that section.

Chris:  Make sure you put some Christmas music in the background Danny. Okay so why don’t we… Oh one more thing before we go on. I feel like I have to do the little mandatory disclaimer here. I’m not a doctor, nothing I’m going to say in the next period of time is medical advice and I think particularly for women who are pregnant, breastfeeding it’s important to be under the care of a licensed healthcare practitioner. It’s also important to know that while nutrition is, in my opinion, probably one of the single most important factors in determining a successful pregnancy and successful, healthy childhood it’s not magic. It doesn’t solve structural reproductive problems. It may not be enough to solve serious metabolic, physiological problems. What we’re talking about today is how to optimize your nutrition and increase your chances of having the healthiest baby you could possibly have.

Danny:  Agreed. Chris only a zero carb diet is magic. Just kidding. Sorry.

Chris:  Or the body type, or the Atkins, or the Paleo diet or…

Danny:  Alright Chris do you want to get to the questions?

Chris:  Let’s do it.

The biggest factor keeping women from getting pregnant

Danny:  Our first question. What do you use as the biggest factor of keeping women from getting pregnant these days? What one factor, if optimized, as the biggest effect on fertility?

Chris:  Well, this is kind of a set up right? We just talked about it. I would say poor nutrition. I would say stress would be a close second and actually in some cases it might actually be first. These kinds of questions are hard to answer because I think there is no canned answer that’s the same for everybody. If somebody’s following a really good diet but they’re stressed to the 9’s, I think in that case stress is the biggest factor that limiting their chances of getting pregnant. If they’re managing their stress really well but they’re eating bagel dogs and cheese doodles then that’s poor nutrition. I think environmental toxins are actually pretty high up there on the list as well because there are a lot of toxins that end up being endocrine disrupters and that throw the hormones out of whack and that makes it difficult for women to get pregnant. We have medications like birth control, if I woman has been on birth control for a long period of time there’s actually a medical term called Post Birth Control Syndrome which basically means their hormones are totally out of whack from being the Pill for so long. There are a lot of medications that affect hormones, metabolism, and synthesis. We could summarize all that as modern lifestyle basically. The biggest factor keeping women from getting pregnant is the modern lifestyle and it is a big problem because already 1 in 7 women have trouble conceiving and I just read a study out of the UK that suggested that that number could rise to 1 in 3 by 2020. That’s serious, that’s a big deal.

Danny:  Do you think chronic dieting, all the women in my life have always been so obsessed with dieting and I know from my sisters they’ve all lost their periods for an abnormal amount of time and then when they started eating normally it came back. Do you think that’s a factor?

Chris:  Absolutely because one thing we know about chronic dieting is that it elevates cortisone levels.

Danny:  Totally.

Chris:  Which is a stressor on the body, so yes. Chronic dieting is a problem and if there’s any time in our life when we need to be nourishing your body and making sure we’re getting enough nutrients, it’s preconception and pregnancy. I just want to point this out if I didn’t make it clear already it’s not like we can just eat whatever we want, eat whatever we want and get pregnant and clean up our diet. In the ideal situation, once you’re planning to get pregnant you start implementing the type of nutritional recommendations I’m making in the seminar and home study course that’s about to be released. 4 to 6 months before you try to conceive, that’s the ideal we don’t always live in the ideal world, often we don’t, but that’s building the foundation so to speak so that you’re body is ready to provide a nourishing environment for growing a baby.

What should a man be eating to improve the chances of conception?

Danny:  Awesome, cool, let’s get to our next question. How important is the father’s nutritional status preconception? What should a man be eating to improve the chances of conception?

Chris:  I think you know it’s not bagel dogs and cheese doodles but it’s a good question because I think a lot of people would be surprised to know or to learn that statistics suggest that in about between 20 and 50% of infertile couples there’s a male factor that’s either causing the problem entirely or contributing to the problem. I don’t know if it’s just me but I think historically from what I’ve observed there’s this idea that if a couple’s not getting pregnant it’s the woman’s fault. I’m sure that partly this whole sexist patriarchal culture that we all live in. I don’t know does that ring any bells for you?

Danny:  I know just in my own experience in the forums I used to frequent it was always a problem for men. Are you talking more about nutritional deficiencies like zinc deficiency and the inability for proper sperm…

Chris:  All I’m saying is that when I look at who comes to my seminars it’s almost always women and sometimes they’re dragging their husband along. Sometimes their husband comes and is willing but if it’s true that 50% of infertility is caused by male factor then you’d think that 50% of people coming to these courses would be men. I think there’s this persistent idea, it’s not my idea, and I just want to make that clear. It’s more often the women, there’s some issue in the woman’s physiology but actually male fertility is right up there. The lower the sperm count and the poorer the sperm quality, the longer it will take to get pregnant. I think the omega6/omega3 balance is probably one of the biggest factors in male infertility. We know that excess omega6 promotes infertility in men. We know that infertile men have lower concentrations of DHA and EPA in their sperm so they’re not eating enough of the long chain omega3 fats. We know that metabolic syndrome is an issue in male infertility because insulin resistance up regulates something called aromatase. And aromatase converts testosterone to estrogen, that’s bad in men. Men should be testosterone dominant not estrogen dominant and estrogen dominance in men leads to hypogonadism and infertility. We also know that oxidative stress is caused primary by excess intake of industrial seed oils, stress and lack of physical activity can damage sperm quality. Another factor is obesity because accumulation of fat in the thighs increases the temperature of the scrotum which in turn adversely impacts sperm quality so yes it’s really important the father’s nutritional status preconception because their nutritional status definitely influences sperm quality and sperm count and sperm motility which are the main factors. That’s our job when it comes to that equation so I think it’s really important, I think it’s underrepresented, it think it’s not talked about enough and guys you have to step up to the plate and do your part here.

Do you recommend significantly different diets during the times a couple is trying to get pregnant versus after she becomes pregnant?

Danny:  Awesome, okay, let’s get to our next question. Do you recommend significantly different diets during the times a couple is trying to get pregnant versus after she becomes pregnant?

Chris:  No I don’t and I actually don’t think that makes any sense whatsoever at all. There was a Harvard study, I talk about this in the seminar, where the authors found that women who consumed skim milk, low fat and non fat, skim dairy products. Skim milk, non fat yogurt and all that stuff had 85% higher infertility rates than women who ate whole fat dairy which is significant to say the least. And they of course recommended that women who are trying to get pregnant eat full fat dairy but then in an act of, exactly the type of bizarre, no other word comes to mind then stupidity, they then suggested that as soon as the woman gets pregnant they should go back to eating skim milk or drinking skim milk and skim dairy products. I don’t understand what sense does that make? The things that nourish the body and prepare it for pregnancy and actually make it happen how could that be different than what would nourish a baby growing in the womb?

Danny:  I don’t get it either.

Chris:  Silence. It’s this group think thing. It’s like when people, researchers, doctors, people in general get wedded to a particular point of view it becomes really difficult to step outside of that paradigm even when there’s clear research that contradicts it, instead of coming to the conclusion that maybe that whole other entire paradigm is maybe wrong it’s like there’s this almost unconscious reflex to go back to that. Yes well whole fat dairy is great if you want to get pregnant but as soon as you get pregnant, you better go back to a low fat diet. I know these people are not dumb, I know that they are very intelligent, sharp people who are well trained and I can see in my own life examples of where it’s hard for me to step outside a paradigm in my case it’s usually not the dominant paradigm it’s more of an alternative paradigm but I have compassion and empathy for people in that situation but it just drives me nuts. The answer no I don’t think the diet should be different at all.

Is it safe to practice a paleo diet while pregnant?

Danny:  Let’s get to our next question. Can I continue my Paleo low carb lifestyle if fall pregnant? Is it safe to practice a Paleo diet while pregnant? Most doctors say it isn’t. What say you?

Chris:  I say how the heck are we even having this conversation if it wasn’t possible?

Danny:  This question is pretty self explanatory.

Chris:  I mean there were 2.5 million years and 77,000 generations of humans eating a Paleo diet and somehow we managed to procreate and make it all the way up to the present day. The idea that it’s not safe to be on a Paleo diet while pregnant is just preposterous. I don’t know how anyone with any kind of grasp on evolutionary history can say that. Just on a really common sense level, it’s obvious that it’s safe. More specifically, Paleo diet is one of the most nutrient dense approaches to eating that there is so if you’re doing a Paleo diet and you’re eating organ meats and muscle meats and glycine rich foods like skin, bone broths made from skin and bones, a variety of vegetables and fruits and starchy tubers and a moderate amount of nuts and seeds and then you add some really nutrient dense raw fermented dairy, high fat dairy products, you’re eating cold water fish for the long chain omega3 and you’re avoiding all food toxins like industrial seed oils and grains, especially gluten containing grains and excess fructose and soy, that’s it. You can’t really be doing any better than that. Unfortunately as I’m sure most people who are listening to this podcast know that the conventional medical paradigm is far behind and off the track when it comes to nutrition in general and nutrition for conception and pregnancy and breastfeeding.

Danny:  I’m sure the doctor didn’t even know what a Paleo lifestyle was. What would he suggest to eat if it wasn’t for meat, vegetables and nutrient dense food?

Chris:  Considering that most medical schools fail to meet the 25 unit minimum for nutrition that’s recommended by the National Academy of Sciences, literally, they’re not even getting 25 units of nutrition education so why would anybody ask a doctor what to eat? Honestly and I said this before and I’ll say it again, I have respect, most of the doctors I’ve met really want to help their patients, they’re doing the best job they can do. They’re really smart, they now a lot of stuff about a lot of things, but generally and I think most doctors would agree with me, nutrition is not one of those things that they know a lot about. Because they weren’t educated unless they educated themselves which a lot of good doctors do. But just because a doctor is an expert in surgery or gastrointestinal diseases or whatever it is that they specialize in it doesn’t make them an expert in nutrition so my advice is to be careful taking nutritional advice from doctors.

Danny:  I agree.

Chris:  That could get me in some trouble I realize.

Danny:  You already put the disclaimer out there, it is fine. Let’s get to our next question.

Maintaining a healthy eating plan and dealing with food aversions/ morning sickness/ sheer exhaustion

Danny Roddy: When I was pregnant in the past I had terrible morning sickness, how can I maintain a healthy eating plan and deal with the food aversion/morning sickness/sheer exhaustion? How do you battle meat aversions and white carb cravings in pregnancy?

Chris:  Well that’s another really common question obviously and I wish I could say that I had the magic bullet solution that worked 100% of the time but the truth is that I don’t. I’m going to give you a few ideas that can be really helpful and tend to be really helpful in my practice and were helpful with my wife who’d now 5 months pregnant. But having said that, I’ve had women who followed all of these recommendations and still experienced some nausea and some morning sickness. We don’t fully even understand why and you can look in medical textbooks I have a big think textbook about physiology during pregnancy and there’s a lot of theories but we don’t fully understand why at this point and actually interestingly enough there are a lot of midwives who believe that nausea is actually a sign of a strong pregnancy. I’m not sure what the mechanism is there either but I’ll just throw that out there in case some women are worried that it’s a sign that something’s wrong. One of the main theories is that morning sickness is caused by low blood sugar and hormone fluctuations or from micronutrient deficiencies especially B6 and zinc. One thing that you can do is to eat a high fat, moderate carb, moderate protein diet this in general helps balance blood sugar and of course avoid excess of any kind of refined sugar and excess fructose. Another thing you can do is to eat more frequently throughout the day. You could eat at least 150 calories every 2-3 hours to keep the blood sugar dropping too far and it’s especially important if you’re going to follow this approach is to eat breakfast within of 30 minutes of getting up even if you not really that hungry when you get up. Generally when people try this, after 3-5 days of doing it they start to wake up feeling hungrier so that’s something to try. Then stress management is a really important part of dealing with nausea and morning sickness because it can help regulate cortisol levels and cortisol imbalance or disregulated cortisol can wreak havoc on blood sugar. Pregnancy is usually a stressful time for women for a lot of reasons and doing some kind of regular stress management throughout pregnancy can actually help with the nausea and the morning sickness. Acupuncture can be really effective it was super helpful for my wife throughout pregnancy and I did acupuncture with her quite a bit. There are a couple of points, acupuncture points, located on the wrist that you can actually even just press on, use acupressure yourself. The point is called P6 and the way you find it is if you suppenate your forearm so that the underside of your forearm is pointing up towards the sky or the ceiling then you look at the crease of your wrist and you take your thumb and you put it horizontally right against the crease of your wrist. That’s one thumb length and if you move it back one thumb length more towards your elbow that’s 2 thumb lengths up and then right in between those 2 tendons there there’s a point that’s called P6. And if you press on that point when you start to feel, it works best if you do it right when you’re starting to feel nauseous. If you press on it yourself or you have your partner press on it fairly firmly that can actually help quite a bit. Those are a few ideas and like I said, they work in a lot of cases but it’s not a guaranteed cure unfortunately.

Danny:  I just found my P6.

Chris:  Good. By the way it’s a really good point for anybody dealing with digestive issues or stress or nausea or any gut pain. Try it.

Pregnancy and weight gain

Danny:  Next question, what should I eat during pregnancy to minimize weight gain? How much weight should I really be gaining?

Chris:  Another good question.

Danny:  Should a woman really be concerned with well I guess gaining weight anybody would be concerned but minimizing food or anything like that?

Chris:  You must be reading my mind because my response is in most cases the question should be how can I be concerned about gaining weight during pregnancy because a lot of women are doing my diets during pregnancy and that’s a really, really bad idea. If you’re eating a nutrient dense Paleo primal type of diet, whatever and you avoid the common food toxins that we talked about ad nauseum at this point. You don’t need to worry about your weight during pregnancy. A woman can gain safely anywhere between 20 and 40 pounds during pregnancy as a rough guide depending on their weight prior to preconception. So please, please don’t restrict calories or try to avoid weight gain during pregnancy as I said before earlier in the podcast, you nutritional status during pregnancy determines the lifelong health of your baby. You have to put on an appropriate weight to nourish your baby. Don’t worry you can lose it later if you follow the same sound dietary principle we’ve been talking about all along. Gain the weight, nourish the baby and don’t worry about it.

Supplementation during pregnancy

Danny:  My apologies I jumped the gun on that one. Let’s get to our next question. This one is about prenatal vitamins. What prenatal vitamin “with DHA” would you recommend? Are generic supplements targeted at pregnant women worth taking if my diet is nutrient dense do I need to take a supplement while breastfeeding? Are certain supplements particularly that aren’t standard like fermented cod liver oil plus butter oil or spirulina safe/wise to use while trying to conceive? Also she lists 5 HTP progesterone cream, vitex, etc.

Chris:  Okay so there are a few questions in here and we’ll just take them one at a time. Prenatal vitamins, the problem with most prenatal vitamins like most multivitamins too much of stuff that can potentially harmful like Iodine or Iron and not enough stuff that is beneficial like vitamin D or vitamin k2 or DHA. In fact there is no, I’m not aware of any multivitamins with DHA because the only sources of DHA are seafood or marine algae and the creatures that eat green algae like fish so you’d have to get a completely separate DHA supplement. DHA is in cod liver oil I basically recommend that people eat fish to get the DHA that they need but there’s also some of it in the fermented cod liver oil which I think is a fantastic idea during preconception and pregnancy and breastfeeding. Having said that, I also think it’s always best to try to meet nutrient needs from food because that’s the way that we’re adapted to get nutrients is from food not from supplements. But you know again we don’t live in a perfect world and a lot of times it can be difficult to meet all of our nutrient needs through food. There is one multivitamin/multi-mineral that I think gets pretty close to how I would design one if I did and it’s made by Pure Encapsulations it’s called Nutrient 950 with vitamin k and it has a good balance of all the nutrients. It even has a really good dose of vitamin D and both vitamin k1 and k2 which is really rare in a multi. That’s something to consider. In terms of specific supplements a lot of it depends on food intake if you’re following a nutrient dense diet with animal products like a Paleo or primal approach that’s adequate for most people before pregnancy and conception but during pregnancy, conception and breastfeeding you still probably need additional vitamins A and D from fermented cod liver oil and this is especially true if you’re not eating organ meats which most people aren’t. You might want to take additional Folate, not Folic Acid because they’re different. But Folate and maybe consider freeze dried liver capsules from somebody like Dr. Ron’s for the Choline because liver is such a nutrient dense food and contains a lot of nutrients that are really difficult to find in other foods. Now as far as supplements such as 5 HPT, progesterone cream, vitex, etc. I definitely recommend not taking those supplements when pregnant or breastfeeding without supervision of a licensed healthcare practitioner and even in the period leading up and there’s no way I can possible answer whether those supplements are useful or beneficial would completely depend on the persons hormonal status, physiology, what’s going on, what they’re trying to achieve with those supplements. I will say that I’m not at all a fan of hormone creams because they bypass the body’s natural regulatory mechanism which means that they can really build up and accumulate in the body and just wreak all kinds of havoc.

Danny:  Sounds really risky.

Chris:  Progesterone cream for example, the upper end of the normal range is usually around 400. I’ve seen women in my practice who’ve come in on progesterone creams for even as short as 6 months and they have progesterone levels of 4,000. Ironically, what happens in that situation is they have progesterone deficiency symptoms because what happens is when there’s that much extra progesterone in the system the receptors shut down. It’s like insulin resistance. They say we don’t want anymore, we have enough. And so whatever progesterone there is in the system isn’t actually getting in and activating the receptors and having the physiological effect that it’s supposed to have. Women start taking more because they’re still experiencing the progesterone deficiency signs and often they don’t get retested. So they just keep taking more and more and they keep feeling worse and worse and having more and more progesterone deficiency signs which doesn’t add up. It doesn’t make sense to them, nobody’s explaining it to them and it’s a big problem so during pregnancy and breastfeeding it’s certainly a very minimalist, less is more approach. Better safe than sorry situation, I’m very conservative in my approach with supplementation during pregnancy.

Danny:  I think I know your answer on this one but spirulina, not a good idea, right.

Chris:  I would say no.

Danny:  I think some doctor uses that to detox mercury or something.

Chris:  Some of the ingredients, the chlorella and spirulina, are natural chelators. I just don’t see any need for it either. If you’re eating the kind of diet that we advocate you don’t need to be eating spirulina.

Danny:  Especially trying to detox mercury while having a child.

Chris:  Absolutely because it can cross the placenta. Trade the spirulina for liver.

Preventing gestational diabetes

Danny:  I agree, totally agree. Next question, how can I prevent getting gestational diabetes as an overweight pregnant woman with PCOS?

Chris:  Another great question. It’s going to take me a little while to answer this because there are several things to consider. Number 1 the diagnosis of gestational diabetes is somewhat overblown and misunderstood. There’s a fantastic midwife named Anne Frye who’s written, I have her textbook I think it’s called, it’s called Understanding Diagnostic Tests in the Childbearing Year. It’s definitely not for consumer consumption, it’s really technical but it’s an excellent book and there’s a great quote in there, she said “true gestational diabetes amounts to a diagnosis in search of a condition” so basically the Cochrane review, you know Cochrane is a group that reviews all of the scientific studies in meta analysis to see what the bulk of the scientific literature says about something. They found no correlation between gestational diabetes and poor outcome when confounding factors were taking into account. What’s more, the diagnosis of gestational diabetes is not in itself predictive of high birth weight. In other words, they didn’t find any significant correlation between glucose levels in the mother and birth weight until birth weight exceeded the 99th percentile. It might sound like I’m saying gestational diabetes doesn’t exist and you don’t need to worry about it. That’s not what I’m saying. Hear me out here for a little while I’m making a case. The important thing to understand that few people do understand even in the conventional medial world, which is strange, is that blood glucose metabolism is dramatically altered in a normal pregnancy and glucose levels rise in a linear fashion throughout pregnancy. Now this isn’t a sickness or a pathology this is a totally normal physiological mechanism. The baby, the fetus needs glucose to develop properly but throughout most of evolutionary history, glucose or sugar containing foods were scarce so to deal with this the mother’s body becomes naturally insulin resistant so that any sugars she does take in doesn’t get pack away in her cells but it stays in the blood and can cross the placenta and reach the fetus. Make sense?

Danny:  Yes.

Chris:  Then the other thing is the placenta makes hormones like lactogen and estrogen and progesterone which all counteract the action of insulin and then the placenta makes really potent enzymes that destroy insulin and the shift in maternal hormones also helps suppress insulin as does maternal weight gain. In fact as pregnancy advances insulin resistance and insulin insensitivity rise to a level that approximates that scene in people with type 2 diabetes so…

Danny:  This is kind of like the physical versus pathological insulin resistance?

Chris:  Yes exactly. Pregnant women are naturally insulin resistant.

Danny:  Fascinating.

Chris:  Yes and as I said the reason for that is the baby needs glucose to develop properly and in Paleolithic times for the vast majority of our evolutionary history when we couldn’t just go down to the 7-11 and get a Big Gulp there’s wasn’t a lot sugar around. We had berries and even the berries were really fibrous and didn’t have that much sugar and honey was seasonal and not easy to find so women became naturally insulin resistant so that any sugar that they were able to get their hands on would go to their baby instead of into their own cellular machinery. A woman when she’s pregnant is naturally insulin resistant and is going to have different blood sugar than a non pregnant woman so that’s really important to understand. On the other hand a mother’s pancreas secretes more insulin to compensate for this phenomenon so that results in a 2.5 to 3 fold increase in maternal insulin secretion b the time the baby is born. If you put all this together if you can imagine since if mom’s are naturally insulin resistant during pregnancy eating a lot of processed and refined carbs is a complete disaster and women I think have a natural carbohydrate craving due to that evolutionary mechanism that we just talked about and that was no problem when you couldn’t just go get a donut or bagel or something like that on the corner but now that really dense refined carbohydrates are so readily available it’s just a recipe for disaster. This I think is the real reason why we’re seeing some rising rates of blood sugar problems and diabetes during pregnancy. If a woman has pre-existing insulin resistance which is almost always the case if she has PCOS going into pregnancy it’s important to eat a nutrient dense Paleo type of diet and restrict carbohydrate intake to maybe 400 calorie a day and to do resistance training, like strength training. Getting back to the answer how can I prevent getting gestational diabetes as an overweight pregnant woman with PCOS is actually the same answer to how can I prevent getting gestational diabetes period. Which is to eat the diet that I just described a Paleo primal type diet with low to moderate carbohydrate intake and moderate protein intake and do resistance exercises which helps improve glucose tolerance and insulin sensitivity.

Risk of birth defects in later pregnancies

Danny:  Awesome, great answer. Let’s get to our next question this one is about birth defects. I am 29 years old going on 30 soon are there real problem with pregnancy in the 30’s? Mainstream medicine says my risk of birth defects is increasing every year I wait. What is your opinion on this? What can a whole food Paleo diet do to minimize this concern?

Chris:  While there is a really small statistical increase in the risk of birth defects as women age but we’re not talking about, it doesn’t go from 1% to 50%, we’re talking about really incremental small changes. I feel sad when I think about how much fear there is around pregnancy and childbirth these days, such a natural beautiful, instinctual process and in traditional cultures they don’t have to deal with all the fear mongering that rows and rows of books are warning women about all the possible birth defects that their kids could have if they wait until they’re older and it really doesn’t serve anybody in my opinion. That’s kind of a side bar but I think it’s best to try to avoid as much as possible exposure to that kind of information because in the vast majority of cases births are going to be completely healthy and normal.

Danny:  Turn off the news.

Chris:  Yes basically. Turn off the news, eat well, eat the kinds of foods we’ve been talking about and manage your stress, have fun, cultivate pleasure in your life, connect with your partner if you have one while you’re pregnant and enjoy life as much as you can and celebrate the coming of the baby. Pregnancy is a really sweet time. My only regret in the last month is that we had to move which has made our lives really crazy. But before that Elanne and I, my wife have really just been trying to enjoy the pregnancy period as much as we can. Because it’s the last time that there’s just going to be the 2 of us and we’re fascinated by the whole process of how the baby is developing and feeling the first kick and it’s just a really amazing time and for us. It’s been really important to not just fall into that fear based mentality and so we don’t read a lot of stuff about that and we pretty much completely opted out of the conventional paradigm. We haven’t had a single ultrasound and we don’t plan to we’re just having a baby as millions and millions, billions of our ancestors have done. Anyway, back to the question to my knowledge there haven’t been any studies done on how Paleo nutrition particularly affects birth outcomes but of course we know that several nutrients that are found in abundance in a Paleo diet are essential to pregnancy. We know that both from anthropological research of what our ancestors ate for 2.5 million years and we also know if from modern science. The other thing is that I understand that maybe in the past 29-30  years old sounded kind of getting old to have a kid but really these days 30 is really young so don’t worry about it at all. I have lots of friends, my wife’s 40, I have lots of friends who are having healthy kids at 40, 41, 42. Is the risk of birth defects higher? Yes it is. Does that mean it’s not possible to have a healthy baby? Absolutely not in fact in my small sample of friends everybody I know they’ve all had healthy babies. I would just, like I said, eat a healthy diet, enjoy life, enjoy being pregnant and enjoy your baby.

Breast milk nutrition

Danny:  Cool, let’s get to our next question. Is breast milk made up of all the nutrients that my baby needs regardless of my own diet? If I consume foods higher in fats will my breast milk be richer with a higher fat content?

Chris:  Well again no to harp on the evolutionary argument here but it is a pretty good one. We’ve been around as modern homo, human, human, the modern homo human for 2.5 million years and have been evolving for millions of years before that so mother nature’s had a long time to figure out, or to get it right, in terms of what the perfect food is for babies and that’s breast milk. To me it’s like the height of human arrogance to think that we can improve on millions of years of evolution in that regard. But of course modern science tells us and confirms what we’ve already figured out by just looking from evolutionary argument that breast milk contains, it’s the perfect food for baby. It has all the substance that give the growing baby immunity to infection and disease, it bonds a mother to her baby, it stimulates important hormonal activities in the mother’s body, breastfeeding helps her lose weight after pregnancy and protects her against future breast cancer and osteoporosis. We also know, the World Health Association has issued this report, it’s really good, it’s actually pretty accessible to read, I should post a link to it when we post the podcast. They recommend exclusive breast feeding for 6 months. No doubt at all that breast milk alone can meet the baby’s nutrient needs, all nutrient needs for 6 months. Then they recommend complimentary feeding which means breast milk plus introduction of solid foods slowly until at least 2 years of age but unfortunately statistics show that fewer than 35% of infants are exclusively breastfed for the first 6 months. I certainly wasn’t and most people I know weren’t because my parent’s generation they we were told that formula was better than breast milk which is the most ridiculous idea in the world. I don’t know how an entire generation of people could be hoodwinked like that. It’s that power of group think that we were talking about before. Having said that, the mother’s diet is extremely important in determining the composition of breast milk and in fact there have been a few studies in which the mother’s nutritional status was poor that showed that breast milk didn’t offer any advantage over formula. Please don’t misinterpret this as a testament for formula, it’s not at all. It’s the indicator instead of how important proper nutrition during breastfeeding is. Breastfeeding has short term and long term benefits on both the child and the mother. It helps protects kids against all kinds of acute and chronic disorders. We know that infants not breastfed are between 6 and 10 times more likely not to survive the first months of their life. We know that formula fed infants have an increased risk of long term diseases with immunological basis like asthma, type 1 diabetes, celiac, Crohn’s disease, ulcerative colitis and even childhood leukemia. And we’ve seen in other studies that suggested obesity and high blood pressure and heart disease are more common later in life in kids that aren’t breastfed. Ant the kids that are formula fed on average have cognitive scores 3 points lower than kids that are breastfed so there’s all kinds of benefits to breastfeeding especially following the WHA recommendations for exclusive breastfeeding for 6 months and then complimentary feeding until at least 2 years of age.

Danny:  Is it true of a woman is deficient in vitamin D her breast milk will also share that same characteristic?

Chris:  It is absolutely true and I think we’re going to talk about this in a later question but there was a recent study that showed that what happens is in the 2nd and 3rd trimesters the fetal skeleton starts developing rapidly that increases the need for vitamin D and so that will tax the mother’s supply of vitamin D. We also know that 50% of mothers go into pregnancy with already being deficient in vitamin D. Then the baby really takes all the vitamin D that it needs, which is considerable, the mother’s levels drop considerably and then there’s nothing left for the baby through the breast milk. This study in the UK showed something like 32% of babies were born with vitamin D levels of 0. They had no detectable vitamin D levels in their blood. I don’t’ know if you remember the recent story that some vegans in France got arrested because their baby died because they breastfed exclusively for 11 months they didn’t introduce any solid foods and one of the causes of death was vitamin D deficiency.

Danny:  I remember hearing about that it’s really sad.

Chris:  Anyway good question and it definitely makes a difference.

Increasing milk production

Danny:  Our next question follows right into that. How do I make sure I have enough milk? How do I increase milk production while still maintaining a low carb, high fat lifestyle?

Chris:  This question comes up a lot and I’m not actually why sure it’s such a big concern. There seems to be some kind of mean that’s been propagated out in the mainstream that milk supply is limited and it’s going to run out and that a lot of women run out of milk and the truth is, if you look at the statistics on this it’s actually rare for a woman to not be able to produce enough milk for her baby. Most women can produce 25-40 ounces of milk per day which is plenty. Milk production is not, while nutrition does have some influence, milk production is more a factor of feeding frequency so milk supply declines when feedings are infrequent or restricted which is one of many reasons why breastfeeding should always be on demand meaning whenever the baby wants to eat. Research shows that when a mother breastfeeds early and on demand maybe an average of 10 times a day in the first 2 weeks her milk production is greater and her infant gains more weight and she can continue to breastfeed for a long period. That initial period is super important to breastfeed a lot the average was 10 times a day but don’t stick to that as a number but basically as much as the baby wants to. The milk ejection reflex operates most strongly in the presence of a good supply of milk which occurs when the baby’s feeding happens on queue rather than on a schedule that’s imposed by the parents. Some of the most common causes of milk supply problems which aren’t’ that common anyway are infrequent feedings and sometimes poor latch, latch on or positioning where the baby’s not latching properly.

Danny:  That’s going to bring us to the end of this episode. Chris, how can we find more of your work on the internet this week?

Chris:  Well this week just a few blog posts and Facebook page. I’m on Twitter, it’s been a little slower than usual because of the move and getting settled but as I mentioned a couple times earlier in the podcast, I’m really, really excited about offering the Grow a Healthy Baby course as an online home study course. I’ve been teaching this locally, it’s been really well received and I’m just really excited about getting the information out there to a wider audience. I just want to tell you a little bit about it. It’s going to be, like I said, and online home study course so when you sign up you’ll have instant lifetime access to it via a password protected website. We’re going to cover things like which foods super charge your fertility and ensure a healthy pregnancy and lifelong health for your baby. We’re going to talk about which foods might be harmful for you and your baby and should be avoided. We’re going to talk about what modern research shows are the essential vitamins and minerals for conception and pregnancy and breastfeeding and how to find them in foods. We’re going to talk about which supplements you need and which ones you should avoid which is an important topic. Then we’re going to also answer common question some of which we talked about today like how to increase your chances of conceiving naturally without drugs, maintain a healthy weight during pregnancy, how to combat nausea, mood swings, and address other common problems. I’m going to include a 2 week meal plan with recipes so that you can get right at preparing delicious nutrient dense meals that will nourish your baby even if you don’t know a lot about cooking this type of food. There’s going to be that special report on first foods that I mentioned. What your baby should start eating in terms of solid foods and how to introduce them without any potential food reactions or allergies. There’s going to be some information about making nourishing homemade formula for whatever reason you’re not able to breastfeed because not to spite best intentions there are just situations where breastfeeding isn’t possible. Then we’re going to have an audio program with a guided stress management program for pregnant women which I think is really helpful in terms of avoiding the frustration and overwhelmment that a lot of women feel when they’re trying to conceive or get pregnant. I’m hoping to release this course in the next 3-5 weeks if you’d like to sign up to be notified when the course is available go to growahealthybaby.com and enter your e-mail address in the box and I’m going to be making an exclusive offer to people on that list. I’m not going to tell you what it is yet but if you want to be part of that offer make sure to sign up on that list before the course is released. That’s about it for me. Thanks everybody for listening and I look forward to talking to you in a couple of weeks.

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Comments Join the Conversation

  1. Paul says

    I have enjoyed listening to the podcast. I have a particular (lay) interest in thyroid health and have collected a few papers regarding thyroid health in pregnancy. These are below.

    http://www.bmj.com/content/342/bmj.d2616.full
    http://jcem.endojournals.org/cgi/content/abstract/jc.2010-0340v1
    http://bit.ly/iSLDQB
    http://bit.ly/lunHnh
    http://jcem.endojournals.org/cgi/content/abstract/91/7/2587

    What are your thoughts on:
    - Screening
    - TSH upper limit to initiate T4 therapy
    - Response to positive Ab in otherwise euthyroid woman
    - Changing thyroid requirements increase in pregnancy

    Thanks

  2. Janeen says

    Hi Chris,

    When I was breastfeeding my son I had an excess lipase problem. Any milk I pumped would go rancid within 24hours and I had to throw away everything in my freezer stash and ended up supplementing with formula while I was working. I’m trying to conceive child # 2 and I am now eating 80% paleo. Do you think my lipase problem will go away? Anything I can do to avoid the problem in the future?

    Thanks!

  3. Remko Kuipers says

    Chris,
    Did you read my latest paper on milk in Sub-Saharan African women? PLEFA 2012. We measured higher MCSAFA but lower MUFA in these African (traditional, Paleo-like) women compared to Western women. Possible cause: higher insulin sensitivity in African women, resulting in less de novo MUFA synthesis, which therefor compete less with endogenous MCSAFA from the mammary gland. So Western infants are prematurely exposed to high MUFA intakes… What’s the consequence??

  4. N. Boyd says

    Hi Chris,

    I’m currently 12 weeks pregnant and am getting confused on the supplementation recommendations. I take about half the dose of Pure Encapsualtions Nutrient 950 with Vitamin K (too nauseating to take more than one dose at bedtime), and have recently begun taking 1/2 tsp of Green Pastures Fermented Cod Liver Oil/Butter Oil blend. I am also about to start eating a serving of liver once a week as well. Is there any chance of getting too much of anything on this regiment? I eat mainly paleo, though my green leafy vegetable intake has been really suffering the last couple of months due to nausea. I’m still getting a lot of grass fed beef, wild salmon 1-2 times a week, organic chicken, I mix a small amount of heart/tounge/kidney? into my ground beef once a week, and have recently found a source of pastured eggs (will prob eat 1-2 a day).

    I’m mainly concerned about taking too much of anything with supplementation. As in, you mention iodine, which is in the Pure Encapsulations. Is there a danger of an overdose if I am also eating nori wraps/other sea vegetables a couple times a week? Can you point me to a list of supplement limits?

    Thanks so much,
    N. Boyd

    • Chris Kresser says

      If you’re taking CLO and eating liver and plenty of leafy greens, you probably do not need the Nutrient 950. You could just take 200-400 mcg of folate and do the rest with diet.

      • N. Boyd says

        Hi Chris,

        I started the FCLO a few weeks ago (1tsp a day). I had been on it about a week and then had a series of blood tests. I was just informed that my Vitamin D level is at 92. Do I need to stop the FCLO or, stop the 1/2 dose of the Nutrient 950 K? I am 14 weeks pregnant. Not sure if this is concerning or not.

        N. Boyd

  5. says

    Hey Chris, I was wondering if there was an optimal body fat % for fertility. I can’t seem to find much research on it, but see people saying >17% and many even say >20%. I’m at 12% with a normal cycle and not much PMS. My nutrition is pretty much aligned with what you went over in the Healthy Baby Code (well, I should probably get some more organ meats in). I am also taking the Nutrient 950, CLO, fish oil, Mg, Vit D (winter), and probiotics.

  6. Heather Bergen says

    Chris, plenty off decent research exists- women leaving in drought/starvation conditions provide perfectly optimal nutrition to their babes: worrying you discourage bf’ing ( tho’ doubtful given your upper -middle class, educated audience) by quoting studies that compare poor nutrition + bf’ing is no better than formula.

  7. M. Turner says

    I recently found out I am pregnant. The doctor said that my progesterone levels are low and she wants me to supplement with progesterone twice a day. I really don’t want to supplement at all. Does anyone have any suggestions or can you refer me somewhere? Thank you.

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