Books : Your Vegetarian Pregnancy : Excerpts

From Chapter Two

DIETARY GUIDELINES

How can I plan for healthy nutrition during my pregnancy?

The American College of Obstetricians and Gynecologists (ACOG) is the governing body that sets the policies followed by all obstetricians in the United States. The ACOG determines which procedures obstetricians should perform and which guidelines they should follow to achieve optimum outcomes for all pregnant women and all newborns within our country.

In 1996, the American College of Obstetricians and Gynecologists published the ACOG Educational Bulletin Number 229, Nutrition and Women. This was designed to help obstetricians obtain a foundation and a reference point to promote optimum nutrition and health within their patients. In 2000, it published its third edition of Planning Your Pregnancy and Birth to help pregnant women make good choices.

ACOG models its nutritional guidelines on three respected sources:

1. Recommended Dietary Allowances for Women

Compiled by the United States government, this is the recommended nutritional requirements for nonpregnant, pregnant, and nursing women.

2. Dietary Guidelines for Americans
This is a joint publication from the U.S. Department of Agriculture and U.S. Department of Health and Human Services. It is a guide of specific desirable foods. The Dietary Guidelines for Americans recommends for all individuals and is not specific for pregnancy.

3. USDA Food Pyramid
Created by the U.S. Department of Agriculture, the pyramid outlines desirable quantities for every food group. The Food Pyramid recommends dietary guideline for all individuals and is not specific for pregnancy.

We will review the information contained within each of these sources to show how each is easily adaptable to and actually supports a vegetarian lifestyle.

What are the Recommended Dietary Allowances for pregnant women?

The government lists and quantifies the levels of protein, vitamins, and minerals for nonpregnant women, pregnant women, and nursing women. Not all of these nutrients need be consumed on a daily basis, but if you tally up all your nutrition for a week and then divide by seven, this is the average amount of nutrients you should obtain each day.

Nonpregnant
Women

Protein, gm 50

Vitamin A, mcg 800

Vitamin D, mcg 5

Vitamin E, mg 8

Vitamin K, mcg 65

Vitamin C, mg 60

Thiamine (Vitamin B1), mg 1.1

Riboflavin (Vitamin B2), mg 1.3

Niacin (Vitamin B3), mg 15

Vitamin B6, mg 1.6

Folic acid, mcg 180

Vitamin B12, mcg 2

Calcium, mg 1,000

Phosphorus, mg 700

Magnesium, mg 320

Iron, mg 15

Zinc, mg 12

Iodine, mcg 150

Selenium, mcg 55

Pregnant
Women

Protein, gm 60

Vitamin A, mcg 800

Vitamin D, mcg 5

Vitamin E, mg 10

Vitamin K, mcg 65

Vitamin C, mg 70

Thiamine (Vitamin B1), mg 1.5

Riboflavin (Vitamin B2), mg 1.6

Niacin (Vitamin B3), mg 17

Vitamin B6, mg 2.2

Folic acid, mcg 400

Vitamin B12, mcg 2.2

Calcium, mg 1,000

Phosphorus, mg 700

Iodine, mcg 175

Selenium, mcg 65

Nursing
Women

Protein, gm 65

Vitamin A, mcg 1,300

Vitamin D, mcg 5

Vitamin E, mg 12

Vitamin K, mcg 65

Vitamin C, mg 95

Thiamine (Vitamin B1), mg 1.6

Riboflavin (Vitamin B2), mg 1.8

Niacin (Vitamin B3), mg 20

Vitamin B6, mg 2.1

Folic acid, mcg 280

Vitamin B12, mcg 2.6

Calcium, mg 1,000

Phosphorus, mg 700

Magnesium, mg 320

Iron, mg 15

Zinc, mg 19

Iodine, mcg 200

Selenium, mcg 75

The Committee on Dietary Allowance Guidelines sets the standards for the Recommended Dietary Allowances (RDA). These guidelines set a minimum level of the important vitamins and minerals we all need, but they do not delineate any maximum level. Some vitamins and minerals taken in excess can be harmful. No specific nutritional need stands alone; rather, all function together to create a strong nutritional foundation. Each individual on a team is only as strong and healthy as the whole team -- so it is with your nutrients.

How a Vegetarian Diet Surpasses RDA Standards

The RDA list demonstrates that during your pregnancy you will need higher levels of folate, vitamin B6, vitamin C, thiamine, riboflavin, niacin, iron, and protein. A balanced vegetarian diet meets -- and more often than not surpasses -- these requirements quite easily. Following is an example of how simply standard vegetarian foods can fulfill the RDA guidelines.

60 gm protein
1 cup cooked split peas (16 gm) + 1Ž2 cup firm tofu (20 gm) + 2 slices whole-grain bread (9 gm) + 1 cup pasta (8 gm) + 2 cups broccoli spears (12 gm) (Note: Some cereals contain 10 to 20 gm protein/cup.)

800 mcg vitamin A (5,000 IU)
1 raw carrot (20,250 IU) or 1 cup cooked spinach (14,740 IU)

5 mcg vitamin D (200 IU)
1 cup rice milk (100 IU) + 1 cup soy milk (100 IU) + 1 cup 2% milk (100 IU) + 15 minutes of sunlight daily (400 IU)

10 mg vitamin E (15 IU)
1 tbsp wheat germ oil (52 IU) + 1 avocado (6 IU)

65 mcg vitamin K
1 cup cooked kale (975 mcg) or 1 cup broccoli (310 mcg)

70 mg vitamin C
1 medium-size orange (70 mg) or 1 grapefruit (100 mg)

1.5 mg vitamin B1 (thiamine)
1 cup enriched cereal (1.5 mg)

1.6 mg vitamin B2 (riboflavin)
1 cup frozen broccoli (1.5 mg) + 1Ž2 cup enriched bran cereal (0.4 mg) + 1 cup mushrooms (0.44 mg)

17 mg vitamin B3 (niacin)
1 bagel (3 mg) + 1 cup enriched cereal (20 mg) + 2 tbsp peanut butter (4 mg)

2.2 mg vitamin B6
1 cup enriched cereal (2 mg) + 10 oz frozen broccoli (0.4 mg)

400 mcg vitamin B9 (folic acid)
1 cup steamed spinach (448 mcg), or 1 cup boiled lentils (358 mcg) + 1 cup romaine lettuce (76 mcg)

2.2 mcg vitamin B12
1 cup cottage cheese (1.3 mcg) + 2 eggs (1.2 mcg) or 1 cup enriched cereal (6 mcg)

1,000 mg calcium
2 cups cooked spinach (490 mg) + 1 cup cooked black beans (140 mg) + 2 oz Swiss cheese (260 mg) + 2 tsp blackstrap molasses (344 mg)

700 mg phosphorus
1 cup cooked lentils (356 mg) + 1Ž4 cup wheat germ (325 mg) + 1 cup 2% milk (232 mg) + 2 tbsp almonds (184 mg) + 14 spears asparagus (112 mg)

360 mg magnesium
1 cup firm tofu (236 mg) + 2 tbsp cashews (89 mg) + 1 cup hummus (71 mg)

30 mg iron
1 cup prune juice (3 mg) + 2 tbsp blackstrap molasses (7 mg) + 1 cup black-eyed peas (4.3 mg) + 1 oz sesame seeds (4.2 mg) + 1 cup enriched cereal (8.5 mg)

15 mg zinc
1 cup baked beans (3.2 mg) + 4 tbsp pecans (3 mg) + 1 cup hummus (2.7 mg) + 1 cup Kellogg's Raisin Bran (3.75 mg) + 3 oz American cheese (2.5 mg)

175 mcg iodine
1Ž3 tbsp iodized salt or a sprinkling of kelp or seaweed

65 mcg selenium
2 tbsp Brazil nuts (380 mcg)

How can I use the Dietary Guidelines for Americans to help me as a vegetarian during pregnancy?

The U.S. Department of Agriculture and the U.S. Department of Health and Human Services joined forces to create the Dietary Guidelines for Americans. This publication gives advice concerning foods and healthy living, rather than advice concerning specific nutrients. It provides you with an overview of the basic rules for healthy eating during your pregnancy.

Dietary Guidelines for Americans

• Eat a variety of foods.
• Balance the food you eat with physical activity -- maintain a healthy weight.
• Choose a diet with plenty of grain products, vegetables, and fruits.
• Choose a diet low in fat, saturated fat, and cholesterol.
• Choose a diet moderate in sugars.
• Choose a diet moderate in salt and sodium. • If you drink alcoholic beverages, do so in moderation.

These guidelines are perfectly compatible with a healthy vegetarian diet. They are also clearly better suited to a vegetarian diet, particularly a vegan diet. As a vegetarian, you will obviously see that the guidelines do not mention the need for people to consume animal flesh or animal protein. The guidelines encourage a diet rich in grain products, vegetables, and fruits -- a diet that is the mainstay of vegetarian nutrition. The guidelines also discourage a diet with fats, saturated fats, and cholesterol. Vegetarians are well aware that there is no cholesterol in any food that did not originate from an animal.

Does a vegetarian diet meet the nutritional recommendations found in the USDA Food Pyramid?

As a vegetarian, you do not have to modify your diet at all. Actually, you are obtaining all of the nutrients you need, in some ways better than a non-vegetarian can. First, we should look at the pyramid:
The USDA Food Pyramid illustrates the desirable quantities of foods recommended daily from each of the five major food groups:
1. Breads and cereals.
2. Vegetables.
3. Fruits.
4. Dairy products.
5. Protein-rich foods such as dry beans, peas, nuts, eggs, meat, poultry, and fish.

It is important to note that the protein-rich food group is the only group containing foods derived from animal flesh. This group, however, does not limit the sources of protein to those of animal origin. It includes vegetarian sources such as beans, nuts, and eggs (for lacto-ovo-vegetarians). Although it does not mention the sources of protein vegetarians obtain from vegetables, these certainly qualify. The animal-derived sources of protein are included with vegetable-derived sources, and neither source is considered to be of higher nutritional value.

What are the basic nutrient categories I need to consume for my baby to be healthy during my vegetarian pregnancy?

The desire to maintain optimum nutrition throughout pregnancy is undeniably one of the most important goals each pregnant woman strives to fulfill. During your pregnancy, you will require an increased intake of several nutrients, but no reciprocal decrease in any other nutrient. For you to reach this improved nutritional level, you must either
• increase your total food intake; or
• increase your choices of foods with higher nutritive value.

As a pregnant woman, you need an adequate amount of all nutrients. There are two categories of necessary nutrients:

Macronutrients

These are required in large quantities as sources of energy and include

Carbohydrates: sugars, starches, fiber
Proteins: amino acids
Fats

Micronutrients

These are required in small quantities to help macronutrients function. They include

Vitamins: Water-soluble vitamins
Fat-soluble vitamins

Minerals: Macrominerals
Microminerals

Calcium

I don't eat dairy products. Does this mean I won't be able to obtain a sufficient amount of calcium during my pregnancy?

Calcium is the most abundant mineral in nature. You will find it in a great variety of vegetarian foods, like nuts, seeds, broccoli, greens, soybeans, dried figs, apricots, and molasses. You don't need to rely on dairy products for your calcium requirements. Calcium is one of the most important minerals for your body. It contributes to the growth and maintenance of your bones, the health of your teeth, normal circulation, and the health of your body tissues. Calcium is not the only mineral necessary for your bones, as you also require vitamin D, phosphorus, magnesium, silicon, and strontium to keep your bones strong.

If you feel you're not getting enough calcium from your diet and you want to take calcium supplements, you should know this:

Form of Calcium Supplements

• Calcium citrate is your most easily absorbed calcium supplement.
• Oyster shell or bone meal (ground-up cow's bones, certainly not very appetizing) may contain chemical impurities such as lead and other heavy metals. These are therefore not your best sources of calcium.
• Calcium lactate or calcium carbonate (such as Tums) create an alkaline environment in your intestinal tract and can actually slow down calcium absorption. These are not your best form of calcium supplement.

In most individuals, calcium excess is not a health problem, although those with parathyroid dysfunction may deposit excess calcium within their muscles, bones, and soft tissues. Most of these individuals know of their problem and do not consume a high-calcium diet. However, some people may not know they have a problem with their parathyroid gland, and that is why most people should not take calcium supplements without a specific reason.

Calcium deficiency can occur, not only if your diet is low in calcium, but also if your diet is high in phosphorus. The ratio of calcium to phosphorus in your bones is 2.5 to 1. If your diet includes higher levels of calcium than phosphorus, it is more likely that you will maintain this healthy ratio and healthy bones. To do this, it is best if you maintain a ratio of phosphorus to calcium within your diet of 1:1. The diet of many Americans contains a phosphorus-to-calcium ratio of 4:1. Calcium is a positive ion, which means it will bind with negative ions. Foods that contain phosphorus form negative ions. So if you have excess phosphorus in your diet, it will bind calcium to it and you will excrete both of these minerals. If such a situation develops, you may actually lose more calcium than you took in, and you will deplete the calcium stored in your bones. Phosphorus is present in carbonated drinks, meat, eggs, and cheese spreads.

You will absorb higher levels of calcium if your diet contains adequate amounts of vitamin D, magnesium, dairy products, and vitamin C. Regular exercise also helps the body to absorb calcium. However, if you follow a high-fat or high-protein diet that is rich in phosphorus, it will be more difficult for your body to absorb calcium.

If you have a calcium deficiency, you may develop twitching, nerve sensitivity, brittle nails, insomnia, depression, numbness, and heart palpitations. Painful muscle cramps in the calves may occur often during pregnancy, particularly in women who are deficient in calcium.

The Recommended Dietary Allowance of calcium is 1,000 milligrams daily, and you don't need to increase your calcium intake beyond this amount during pregnancy.

How Do You Fare as a Vegetarian with Calcium Intake?

Food Sources of Calcium

VEGETARIAN
Soybeans, boiled, 1 cup (178 mg)

Tofu, firm, 1Ž2 cup (258 mg)

Blackstrap molasses, 1 tsp (172 mg)

All-Bran cereal, 1 cup (200 mg)

Turnip greens, 1 cup (198 mg) Broccoli, 2 spears (143 mg)

Yogurt, skim, 1 cup (452 mg)

Milk, 1 cup (290 mg)

Cheese, cheddar, 1 oz (200 mg)

NON-VEGETARIAN
Sardines with bones, (199 mg) 3 oz

Salmon with bones, 3 oz (203 mg)

Steak, 3 oz (10 mg)

Pork loin, 3 oz (10 mg)

Chicken breast, 3 oz (18 mg)

Food for Thought: Animal protein creates an acidic waste product that binds with calcium in your body and pulls it out with the other wastes. Vegetarian women have much lower rates of osteoporosis than do women on meat-based diets. Vegetarians fare better not just from the amount of calcium they achieve in their diet, but also from the amount of calcium that they are able to retain.

Iron

I don't eat red meat. Will it be difficult for me to obtain sufficient iron during pregnancy?

If you maintain a well-balanced and well-planned vegetarian diet, you will consume more than enough iron. Some vegetarian foods that are rich in iron are kelp, wheat germ, pumpkin and sesame seeds, blackstrap molasses, dried prunes, and almonds. Aside from these nutritional sources, there are many dietary factors that can help you increase your absorption of iron. Try eating vitamin C and citrus fruits with iron-rich foods -- the acid in vitamin C helps your body to absorb iron. Certain foods -- like caffeine, soy protein, whole grains, chard or spinach, and milk -- can inhibit the body's absorption of iron. With the exception of caffeine, these foods contribute to a healthy vegetarian diet; however, when consumed with iron-rich foods, they prevent your body from absorbing that iron. The simplest solution is to exclude these foods only when you are preparing a meal that is rich in iron.

The primary function of iron is to form hemoglobin. Hemoglobin is a component of red blood cells, and it enables your blood cells to carry oxygen. Hemoglobin contains almost 70 percent of all the iron within the body. Your liver, spleen, and bone marrow store the rest of the iron as a reservoir until your red blood cells require more. Some people are susceptible to iron toxicity. Thalassemia is a genetic blood condition in which the red blood cells cannot hold normal levels of iron. People with thalassemia may accumulate excess iron in their liver, leading to serious liver scarring. However, people with normal blood cells can also develop iron toxicity, usually from taking too many iron supplements and from natural food sources. Any excess iron accumulates in the liver and causes scarring and cirrhosis. In the case of iron deficiency, anemia usually develops and causes weakness, fatigue, shortness of breath, a rapid heart rate, and an increased susceptibility to infections.

An individual absorbs only a small percentage of the iron ingested. There are two types of iron in the diet, heme iron, which comes from animal sources, and nonheme iron, which is found in plants, eggs, and dairy. Although nonheme iron is not absorbed as easily as heme iron, vegetarians can absorb plenty of iron from their diets and still maintain optimum health during pregnancy.

Many people criticize the vegetarian diet because they don't believe it contains enough iron. You may think that by taking iron supplements during your vegetarian pregnancy, you will be proving those critics right. You are not.

Should I start taking iron supplements once I know I'm pregnant?

Supplemental iron is very beneficial for most women during pregnancy, whether they are vegetarian or not. Ask your health care provider if there are any reasons you should not be taking iron. At the beginning of your pregnancy, your blood will be checked for anemia and your physician will let you know if you need supplements. As your baby grows, you should expect your blood count to vary, because your body is transferring much of your iron to your baby and placenta. If you take care to keep your iron levels stable through diet and supplements (if needed), you'll prevent the onset of anemia and feel much healthier by the end of your pregnancy. Some iron supplements cause a considerable amount of undesirable side effects, including intestinal upset, constipation, and blackening of the stool.

Most often, iron in the form of iron sulfate (also called ferrous sulfate) causes these side effects. If you take supplements in the form of ferrous gluconate or ferrous fumarate during your pregnancy, you will experience these side effects very mildly. Overall, the easiest forms to take are ferrous succinate and ferrous fumarate. Some are more user-friendly to the intestinal tract than others. It is important that you not take calcium supplements with your iron, as calcium will decrease your absorption of iron. Remember that your prenatal vitamins usually contain calcium and iron within the same pill. If you are taking an iron supplement, please do not take it the same time you are taking your general prenatal vitamin; give yourself a four-hour interval, or the calcium in the vitamin will decrease your absorption of iron.

For an example of how much iron you will use during pregnancy, an individual normally uses 1 milligram of iron daily. During a full-term pregnancy, however, a mother transfers 500 to 1,000 milligrams of iron to her baby. Most of this transfer (500 to 700 milligrams) occurs during the last few months of pregnancy. In comparison, a menstruating woman loses only about 35 milligrams of iron during her entire menstrual period. Another comparison is that a unit of blood donated to the blood bank contains 200 milligrams of iron. Therefore, a pregnant woman is transferring two to five units of blood to her baby during the nine months of pregnancy.

The Recommended Dietary Allowance of iron is 15 milligrams daily. During your pregnancy, this recommendation is increased to 30 milligrams daily.

How Do You Fare as a Vegetarian with Iron Intake?

Food Sources of Iron

VEGETARIAN

Blackstrap molasses, 2 tbsp (7.0 mg)

Lentils, 1 cup (6.6 mg)

Black turtle beans, 1 cup (5.3 mg)

Chickpeas, 1 cup (4.8 mg)

Product 19 cereal, 1 cup (18.0 mg)

All-Bran cereal, 1 cup (9.0 mg)

Kellogg's Corn Flakes, 1 cup (6.0 mg)

Lima beans, 1 cup (4.5 mg)

Prunes, dried, 1Ž2 cup (2.8 mg)

Apricots, dried, 1Ž2 cup (3.1 mg)

Broccoli, 2 stalks (2.6 mg)

Avocado, 1 medium (2.0 mg)

Asparagus, 12 spears (1.8 mg)

Non-Vegetarian

Chicken liver, 4 oz(9.6 mg)

Beef liver, 4 oz(7.5 mg)

Beef, 4 oz (3.5 mg)

Pork, 4 oz (1.2 mg)

Chicken, 4 oz(1.2 mg)

Food for Thought: It is a challenge for most women to obtain enough iron in pregnancy. Vegetarian women are no exception. Although many plant-derived foods contain iron, the amount you actually absorb is considerably less. A good way for you to increase your iron intake is to cook with a cast-iron skillet. Not only are we what we eat, but we are also what we eat off of. Stomach acids play an important role in iron absorption, so it's a good idea to limit your use of antacids so you can get the optimum amount of iron from your foods.