Fetal nutrition-placenta health-adaptive programming
Maternal body composition
The fetus is totally dependent on the mother for all the nutrients that are required for a complete and healthy development as well as the placenta health. In the discussion below, we will operate under the assumption that the placenta of every fetus is as close to perfect as possible. We understand that this is not true in most of the pregnancies, but we will accept this assumption to be true in order to be free to examine the influences of maternal nutrition in isolation from other factors. This article will provide information about healthy "fetal nutrition for healthy placenta" and and normal fetal development. (To read part I of this article click here)
The maternal body is a machine that consumes energy in the form of food-stuff and converts it to other forms of energy that help the body grow and maintain its daily functions that are essential for a healthy living. The daily intake of nutrients should meet some minimum requirements in terms of quantity as well as quality.
Body composition is a very essential component of the day-to-day utilization of the nutrients we consume. A well-balanced body with normal composition should contain proportional amounts of water, fat, bone, lean mass and essential dietary elements such as vitamins, trace elements, antioxidants etc. Such a body should then consume only the amount of nutrients that it needs for the daily basic functions.
During pregnancy, the presence of the fetus increases nutritional demands equivalent to the needs of the fetus and the enhanced maternal metabolic demands. The average increase in caloric demands during pregnancy is approximately 300 calories per day. If we assume that the maternal body composition is well balanced then the addition of the 300 calories per day would be enough to provide for healthy pregnancy and complete fetal development. However, one must be very careful here; there are empty calories and nutrient-rich calories.
Quality of nutrition
Empty calories are the calories that provide a lot of energy but little in terms of nutrients. Refined carbohydrates are such an empty calorie food. This is unnatural and very unhealthy. Mothers to be must make an extraordinary effort to consume nutrient-rich calories. For example, eating whole grains is a lot different than eating bread. Even the so-called whole-wheat bread that is sold in supermarkets most of the times is not really whole-wheat. It is the product of refined white flower mixed with bran or part refined and part whole-wheat flour.
Truly whole-wheat products contain intact portions of the grain’s components in natural proportions. This is very important because such foods are dense in nutrients in contrast to refined foods. In addition, when we consume whole grains, their digestion and absorption is slow and gradual. This means that the carbohydrates in these foods are absorbed slowly in the course of the digestive process and thus blood sugar levels remain at acceptable levels in the post-meal periods. As a result, the secretion of insulin is under steady and healthy control. In contrast, the consumption of refined carbohydrates, leads rapidly to excessive elevations of blood sugar and in turn, excessive elevations of insulin. Such insulin elevations lead to metabolic disturbances that are responsible for metabolic syndrome. Similar changes to the fetus’ metabolism can cause permanent epigenetic alterations on its metabolism that can affect the baby for the rest of his/her life, deep into adulthood.
The distinction of “nutrient-dense calories” and “empty calories” is very important to understand. Empty calories are calories that provide a lot of energy but not enough nutrients (vitamins, anti-oxidants, minerals, essential amino acids, essential fatty acids etc.). This induces excessive oxidative damage in the absence of natural antioxidants; this imbalance is the basis for premature cellular aging and death. Foods that provide empty calories are mostly foods derived from refined carbohydrates such as bread, starchy products, pasta related foods, sugar, etc. In contrast, foods that are nutrient rich are vegetables, fruits, whole grains, meat, fish, eggs, dairy products, olive oil etc.
Maternal nutrition and environmental education
Pregnancy is a unique opportunity for the mother-to-be to educate herself on healthy nutrition matters. The baby becomes a strong motivator and most pregnant women are willing to sacrifice a lot for the health of their unborn. What is important here however, is for the mother to continue to apply the principles of healthy nutrition she acquired during the pregnancy for the rest of her life. Eating healthy during the pregnancy is not enough. The mother should continue practicing healthy eating habits for herself and her new child long after birth. Healthy nutrition should be a life-long skill and requires a lot of discipline in today’s nutritionally polluted environment. It is understood that modern lifestyles of working-women make it very difficult to adhere to the process of preparing a natural healthy meal. It is tempting to pick-up the phone and order pizza, or Chinese food instead of preparing a healthy nutritious meal from scratch with fresh ingredients.
Environmental pollution affects the quality of nutrition
It is well understood by now that our environment is heavily polluted with thousands of industrial toxic substances (dioxins, endocrine disruptors, carcinogens, PCBs, etc.). These substances have found their way into every aspect of our lives.
There is truly “no place to hide” from such pollutants. Mothers must make every effort to use organic foods to the best of their capacity for the preparation of daily meals. It is unfortunate that many have no access to such foods for logistic and /or financial reasons. Such foods appear to be expensive in comparison to the conventional produce, which is the result of heavy use of chemical-rich and nutrient-poor fertilizers, and all sorts of insecticides. If one considers the ultimate cost of poor nutrition during our life span, one will quickly realize that spending a few dollars a day for healthy organic food now, will pay us back handsomely in the future with a healthy and disease-free life. This is even more important when one considers this new life in the making, the unborn.
Navigating the labyrinth of nutrition (what is healthy and what is not)
What should a pregnant woman then eat and what should she avoid? This is the most important question. Giving a detailed answer to this question would require a whole book. This article is too short to give us the opportunity to provide all the answers to this important question. We will try to provide as much information as possible in this limited space. We hope in the future to find the time to publish a complete textbook full of specific advice for a complete, life-long educational experience on the matters of healthy nutrition before, during, and after pregnancy.
A lot of modern mothers to be are health conscious and are under the impression that they eat in a healthy manner. Unfortunately, if one questions such women about their typical breakfast, lunch and dinner, one quickly realizes that their diet is in reality far from healthy. The typical American diet is too rich in refined carbohydrates and unhealthy fats, containing mostly omega-6 type of fatty acids, and clearly unbalanced in regards to the various kinds of nutrients.
A healthy diet should be comprised of well-balanced protein (lean meat, poultry, fish), vegetables, whole grains, legumes, fruits, nuts, and healthy unsaturated fats. In addition to the balanced diet, most women should take a multivitamin and folic acid prior to conception and during pregnancy. Women tend also to be deficient in iron due to the monthly menstrual blood loss. During pregnancy, the baby demands a significant amount of iron; fetuses have their way to absorb iron actively from the maternal blood and if the mother is deficient in iron, then she will become anemic not the fetus.
Anemia has been associated with fetal growth restriction, preterm delivery and other pregnancy complications. Women who suffer from preexisting medical conditions should make every effort to control such conditions prior to conception. For example, diabetes should be well controlled prior to conception or else it increases the risk for fetal loss and congenital defects. Hypertension like-wise should be controlled prior to conception in order to optimize the outcome of the pregnancy and reduce the risk of preeclampsia, the number one killer of pregnant women worldwide. Maternal nutrition should be improved long before one conceives, in order to maximize the nutritional benefits to fetal and adult health. Because in practice is uncommon, obstetricians should see all pregnant women as soon as the first pregnancy test is confirmed and not wait until 12 weeks of gestation. This is too late and the train of prevention has left the station.
The following section will present the various foods in a way that is understood by most women. Our purpose should always be to take the appropriate amount of total calories but more so to obtain nutritious (nutrient dense) calories.
Bakery and grain products; an example of poor nutrition (lots of empty calories)
Grains are the primary source of dietary carbohydrates. Grain products occupy almost 80 % of supermarket selves. Pasta, bread, cookies, cakes, corn syrup, crackers and a large number of processed foods have their origin in grains. This does not make them healthy foods however. Refining of grains makes them very easy to digest. In fact, most of the refined carbohydrates are so easy to digest that by the time they touch our tongue, they are converted to sugar by the enzyme amylase.
This easy digestion causes increased amounts of sugar to be absorbed in a very short period of time. This forces our body to produce excessive amounts of insulin which, long term causes many chronic diseases such as diabetes, hypertension, heart problems, stroke and kidney problems. In addition, the refining process removes all the components of the grain that contain the most nutritious parts. As a result, the consumption of highly processed carbohydrates leads to consumption of empty calories. For this reason, it is of paramount importance to make every effort to consume grain products that are minimally or not processed at all.
Mothers should always make an effort to choose whole grain products; for example, whole-wheat pasta, wild rice, whole wheat or barley instead of refined rice etc. Avoid refined carbohydrate products that are prepared with trans-fats and products that are sweetened with corn syrup. Corn syrup is so pervasive in these processed foods that it is very difficult to find any such food that does not contain a significant amount of corn syrup. I was amazed to discover that most of the pickled vegetables contain significant amounts of corn syrup. If one has to have crackers, chips, breads and other baked products, one must select only products that do not contain the unhealthy hydrogenated oils.
Healthy fetal brain development requires nutrition with healthy-fat containing foods
Over the past 60 years, fats have in general been ostracized as the evil of all foods. This is unfortunate and very damaging to the overall health. Fat is a very essential component of our diet for thousands of years. What our bodies were not made to consume, is refined carbohydrates. Today, with all the bad publicity of fat most Americans reduced the fat consumption by 10% but they continue to get fatter and fatter. This is because by reducing the fat, they reduced also the protein that comes with it. As a result, they replaced the missing calories with the unhealthy refined carbohydrates. This in fact is the dominant reason for the epidemic of obesity and diabetes in this country.
Such behaviors are promoted heavily by the all mighty food industry that controls most if not all of the regulatory agencies. Cholesterol is the base for the production of most of the vital hormones. Eating healthy fats not only does not affect our cholesterol levels but it is healthy for our entire body. Most of your baby’s brain is comprised of fat. Without healthy fats in your diet fetal brain development is severely compromised. Omega-3 fatty acids that are found in fish, eggs, and nuts help reduce bad cholesterol, increase good cholesterol, bring balance to our coagulation system preventing clotting disorders, and are the most important component for healthy development of your baby’s brain.
Eating fish for example would be the ideal food in terms of omega-3 consumption. However, due to extensive contamination of the seas from mercury, dioxins and other carcinogens and heavy metals, fish is not as healthy a food anymore. During pregnancy, one should not consume fish more than twice a week and it should be of the varieties that are the least contaminated. In general, one should only eat wild fish, and not farm-raised. The smaller the fish the less contaminated. Large fish such as swordfish, tuna and large predator fish should never be eaten consistently because the damage exceeds by far any nutritional benefit. Wild Alaskan salmon is healthy but farm raised salmon is not. Seafood such as shrimp, scallops and oysters contain very little mercury and are safe as long as they are cooked. Other safe to eat fish include cod, Atlantic mackerel, haddock, anchovies, sardines and herring.
A safe alternative to fish consumption during pregnancy is supplements containing DHA that is produced from algae. As for the animal fat, one should always try to eat meat that is raised naturally (grass fed) and not the industrial corn-fed beef. Fat from corn-fed animals is high in very-low-density lipoproteins that are the most harmful and responsible for plaque formation in our vessels. Unhealthy fats during pregnancy are also known to cause atherosclerotic lesions in the placental vessels of both, the mother and the unborn.
Healthy fetal nutrition requires appropriate amounts and quality of protein containing foods
Protein is found in both, animal species as well as earth products (nuts, legumes, etc.). Animal derived proteins are the ideal complete protein food. Animal meat contains all the essential aminoacids as well as essential fatty acids. In contrast, plant derived proteins are incomplete because none of the protein sources provides all the essential aminoacids; one would need to spend significant time trying to obtain a variety of vegetable protein sources that is very difficult to achieve. However, taking a balanced protein approach means that one should take some of our protein from animals and some from plant related products. This will ensure the availability of the additional nutrients that are unique to plants and are complementary to the ones found in animal derived proteins.
The consumption of animal protein is by definition associated with the consumption of fat also. Fish derived fat is the healthiest fat because it is rich in omega-3 fatty acids. In animals that are fed naturally (grass-fed), fat is 50% saturated fat and the rest is polyunsaturated; pastured grass-fed cattle should always be chosen instead of any corn-fed cattle. Eating the appropriate amount of protein during pregnancy means no more than 20% of the total calories. Eating more protein can be harmful due to its negative caloric effect. Protein is a structural food that is best used for the building blocks of our bodies and not for energy production; protein metabolism for energy production leads to energy restriction. For example, when a group of malnourished pregnant women in the Andean highlands were started on a high-protein diet, they delivered growth-restricted babies, what the researchers wished to prevent. This is the equivalent of putting a fetus on an Atkin’s diet. Too much protein restricts fetal growth.
Dairy products for healthy nutrition and much needed calcium
One glass of milk contains 300 mg of calcium; like-wise, 1 ounce of swiss cheese contains the same amount of calcium. Whole milk and cheese as well as other unadulterated dairy products are a good source of high quality protein, a small portion of carbohydrates and of course animal (saturated) fat. Regular unsweetened yogurt is preferable and much healthier than frozen yogurt that contains huge amounts of sweeteners such as corn syrup. In contrast, yogurt with added portions of various fresh fruits can be a very healthy and nutrient dense food. In addition, yogurt provides some probiotics.
Unfortunately, pasteurizing kills most if not all of the probiotic bacteria. For this reason, pregnant women should be advised to take at least one tablet or capsule of probiotics daily. Probiotics are known to improve intestinal function, regulate the gut immune system and reduce the chance of genital and urinary tract infections. Women who take probiotic supplements during the pregnancy are half as likely to have children with food allergies according to some studies.
Fruits and Vegetables for healthy nutrition
Our ancestors thousands of years ago received all of their carbohydrates from fruits, vegetables, and nuts. Such carbohydrates comprised approximately 20-30% of their calories; the rest was from animal meat and fat (game). Fruits contain in addition to the fructose a large number of various vitamins and antioxidants. Vitamins help our cells function properly and antioxidants neutralize “reactive oxygen species” that damage our cells and promote premature aging. Fruits also provide a significant amount of water, minerals and fiber. Fiber promotes a healthy intestine and minerals are essential in the various metabolic processes as well as for the creation of electrical signals for the transmission of messages by the nerves to the various organs as well as across the membranes of the cells. Vegetables also contain protein and fat albeit in smaller quantities than the legumes and nuts. Ideally, all the carbohydrates should be provided by means of fruits, legumes, whole grains, and vegetables. Potatoes for practical purposes should not be considered vegetables. Baked or boiled potatoes are the healthier form of this food but still, potatoes contain so much pure simple carbohydrates that they are almost equivalent to plain sugar. Potatoes in all their forms are a significant part of the American diet and most frequently, they are consumed after deep frying. This is a major problem.
Dry fruit that is not sweetened with extra sugar is healthy also but one should remember that dry fruit is high in fructose and it is easier to eat more than when one eats fresh fruits, which are balkier, and more filling; this leads to excess amount of fructose. The frozen varieties of fruits and vegetables are acceptable but the canned should be avoided due to added sugar and corn syrup.
Organically grown fruits and vegetables are much better and nutrient richer than conventionally grown. For good fetal nutrition, to the extent possible, one should seek to get only organic unless not available. Although organic fruits and vegetables are preferable to conventionally grown, conventionally grown fruits and vegetables are far more important than no fruits at all. Like-wise, a glass of natural fruit juice is better than nothing but eating the whole fruit is the better thing to do.
Foods and substances to avoid during pregnancy (poor nutrition items)
- One should be aware of the environment and try to avoid exposure to industrial contaminants. On average, all newborns are born loaded with about 85% of all industrial man-made toxic substances. This is enough!
- Industrial chemicals are part of our everyday life and exert profound effects on our bodies; such effects are more damaging to fetuses because fetuses are developing and minor damage in utero can become magnified due to epigenetic effects that last for more than a generation.
- Large fish and fish that is known to contain toxic substances, such as farm raised fish, should be avoided at all cost. If one is not sure of the origin and quality of the fish one should avoid it and instead take a daily DHA/EPA supplement.
- Avoid eating uncooked meat products to reduce the risk for toxoplasmosis.
- One should wash vegetables well to avoid parasitic infections.
- Limit coffee and caffeine containing beverages to no more than 1-2 drinks a day.
- Avoid if possible all highly refined carbohydrate products.
- Avoid meat from corn-fed beef. Choose instead meat from grass-fed cattle.
- In salads, one should only use virgin olive oil and avoid all vegetable oils and ready-made dressings. Making one’s own olive oil-based dressing and keeping it in the refrigerator for a few days is much healthier than all commercial dressings, not to mention the substantial savings.
- One should use only natural sweeteners such as honey, agave syrup, and minimally processed stevia. All artificial commercially available sweeteners should be avoided because they act as endocrine disruptors and can cause significant hormonal changes to the mother’s body as well as to the baby’s body; such fetal metabolic effects can last for the entire life of the new adult and even more.
- One should avoid cold cuts unless cooked. Toxoplasmosis is a serious parasitic infection that can damage the fetus.
- Hand washing with soap thoroughly prior to handling vegetables and before and after handling raw meat is very important.
- While processing vegetables and raw meat on the kitchen counter, wipe the counter clean and wash with soap to avoid contaminating the counters with parasites that can infect everything placed upon them.
- Avoid exposure to volatile chemical substances such as gasoline fumes, oil based wall-paints and furniture paints etc.
- Avoid using cookware that is treated with anti-stick surfaces (Teflon). Cooking on such cookware produces volatile chemicals that act as endocrine disruptors. Use cast-iron or ceramic cookware if possible and store food in glass instead of plastic containers.
- Avoid using plastic bottles. Even more so, one should never use plastic food containers in the microwave; instead, one should transfer the content of plastic containers into ceramic cookware.
- Avoid the use of all kinds of packaged processed foods that contain additives with names you do not understand.
- Avoid using new cosmetic (bath) products that contain new and untested chemicals. Instead, try to use simple soap and old-fashioned cosmetics but be aware of paraben and other harmful chemicals.
- Quit smoking and avoid second hand smoke. Pregnancy is a great opportunity for women smokers to kick this bad habit.
- Avoid regular use of alcohol. Occasional use of wine with dinner on special occasions is acceptable according to recent studies.
- Avoid all kinds of fast foods. They are harmful to both, you and your baby.