The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA
Better pregnancy nutrition can grow a healthier baby, keep perineal tissues intact and support VBAC
In my experience, there are significant
things a pregnant woman can do to improve
the integrity of the tissues and thus help
to reduce complications.
Better Baby Book: Use nutrition,
your environment, and your mind to create
the healthiest, smartest, autism-free baby
possible by Lana Asprey, MD, and Dave
Asprey, "To help parents gift their
children with better health and higher
intelligence for life." It's available
either on Kindle or paperback.
This book was written by a couple who
know more about pregnancy nutrition than
anyone I've ever heard, met or read about.
The Better Baby Book: How to Have a Healthier, Smarter, Happier Baby
by Lana Asprey and David Asprey
This is a must-read book
for midwives as well as pregnant women.
It is meticulously researched and presented in a very engaging way.
See also: Water Bottles
and other Plastic Food Containers
Better Baby Book: Use nutrition, your environment, and your
mind to create the healthiest, smartest, autism-free baby possible
by Lana Asprey, MD, and Dave Asprey, "To help parents gift
their children with better health and higher intelligence for
life." It's available either on Kindle or paperback.
This book was written by a couple who know more about pregnancy
nutrition than anyone I've ever heard, met or read about.
book is finally out as of Jan. 1, 2013. You can also
read their Better Baby
The Better Baby Diet - distilled from countless research papers, spending more than 10 years working with some of the world’s top health and nutrition researchers, reading over 150 nutrition books, and self-experimenting for 15 years. Just eat the stuff on the left below and watch what happens for you and your baby. No calorie counting, no measuring. Just eat and feel your brain, body, and hormones re-awaken as your effortlessly lose weight and gain muscle on little or no exercise. Best of all, science shows conclusively that the Better Baby Diet tastes good and is satisfying. It’s not vegan, it’s not low-fat, and you don’t need to limit calories.
Quality Supplements Make All the Difference - A Brief Guide
to Choosing Quality Supplements
Thorne Research makes just
about the highest quality, purest Nutraceuticals and pays extra
attention to using excipient-free substances and hypoallergenic
capsules. Midwives are eligible to register with Thorne to
get a significant professional discount.
During Pregnancy: (1990) from the Institute of Medicine
Healthy eating habits for mommy, baby and the planet by
experts provide recommendations for supplement therapy for
different ailments. You can read hundreds of
full-text nutritional therapy papers from the Journal of
Orthomolecular Medicine free of charge.
Great article from Pregnancy
Basics from Pam Caldwell at HerbLore.
Dr. Tom Brewer's
Blue Ribbon Baby Pages - Help Realize Dr. Brewer's
Dream: That Every Woman Will Know!
Brewer Pregnancy Diet
During Pregnancy: Part I: Weight Gain, Part II: Nutrient
Supplements (1990) from the Institute of Medicine (IOM)
Healing Our Children by Rami Nagel - Prenatal nutrition is one of the greatest ways we can make a positive change for the world.
Pregnancy and Lactation Diet - written from the Weston Price
- Everything is covered here, from appropriate weight gain and
nutrient needs at each stage of pregnancy (preconception through
breastfeeding) to finding healthy fixes for junk food cravings.
Nutrition articles are concise, yet thorough.
& Recipes from the American Diabetes Association - these
are generally good, healthy diets
Biochemical Functions of Essential Macro and Micronutrients - A
Physician Primer - Module III. Nutrition for Health
Promotion and Disease Prevention CME [Medscape registration
ChooseMyPlate.gov - Health
& Nutrition Information for Pregnant & Breastfeeding
Women Need Extra Energy Intake CME [Medscape
registration is free] [Release Date: June 1, 2004; Valid for
credit through June 1, 2005]
Mother from Mother
Nurture, which focuses on practical help for the mother's
well-being, and for building teamwork and intimacy with her mate.
Here's Part 2.
links about nutrition in pregnancy from the University of
Supplementation in Pregnancy - from Medscape [registration
The Organic Revolution from Audobon Magazine - One of the easiest ways to reduce your baby's exposure to environmental toxins is to eat organic food.
the Future - Pre-Conception, Pregnancy and Postpartum
National College of Chiropractic)
Why Absorption of Nutrients is Important
Phytoestrogens in Foods and Herbs
Dr.Tony Helman's Arbor Nutrition
Expecting Mom - I'm
somewhat leery of powdered nutrition, but this does seem to be an
option for women who need a little something extra.
"Expecting Mom contains a fruit and vegetable mix that makes it
more than a prenatal supplement. It makes a great substitute for
those days when it is tough to keep things down." 1-888-665-8243
FitDay.com is an online diet
and fitness journal; there is a calorie and nutrition counter, a
weight loss tracker, an exercise log, analysis and reports.
FDA Center for Food Safety & Applied Nutrition - This complex site provides access to many government resources on nutrition and is best used with a specific topic in mind due to its sheer size.
"Want your child to love veggies? Start early. Very early. Research shows that what a woman eats during pregnancy not only nourishes her baby in the womb, but may shape food preferences later in life.
"At 21 weeks after conception, a developing baby weighs about as much as a can of Coke — and he or she can taste it, too. Still in the womb, the growing baby gulps down several ounces of amniotic fluid daily. That fluid surrounding the baby is actually flavored by the foods and beverages the mother has eaten in the last few hours."
I am just coming to learn the importance of an awareness of systemic pH. Here are some helpful introductory resources:
Vital for Whole Body Health
Balance and Health from Mother Earth Herbs
pH Miracle explains the extraordinary benefits of reducing
acid, or 'Alkalizing' the body using natural means
History of nutrition and acid-base physiology from AlkalizeForHealth.org
Pregnancy from Journal of Midwifery & Women's Health
[08/24/2004] - [Medscape registration is free]
Safely During Pregnancy from the ACNM's "Share With Women"
series of handouts.
Is Your Risk? - Safe Food Handling for a Healthy Pregnancy
vegetable juice concentrates may decrease obstetric
complications: A retrospective study
C. Doug Odom, M.D., Suneet P. Chauhan, M.D., et al.
This is from the "Juice Plus" people. I strongly encourage
all my clients to take some high quality nutritional supplements
during pregnancy. It is impossible to get the nutrients you need
exclusively from food unless you have a very diverse organic
garden in your backyard, and you are eating your fruits and
vegetables fresh from the plants. You can get "Juice Plus" from
Cypress Natural Medicine, a naturopathic office in downtown Palo
Alto. It is only shipped by mail, so you can order it by
phone - call (650) 323-7345
Fruits, Vegetables May Protect Against Upper Respiratory Tract Infection During Pregnancy - Consuming at least 7 servings per day of fruits and vegetables may reduce the risk for upper respiratory tract infection (URTI) during pregnancy [Medscape registration is free.]
Midwifery conferences are often attended by JuicePlus vendors;
they always have studies showing how beneficial their supplements
are for pregnant women who can't manage to eat the 7 servings per
See also: Microbial Colonization of Newborn
Skin and Gut
OK - this is one of the funniest things I've heard in a long
time: "The road to health is paved with good intestines."
Probiotics can help to reduce anxiety during pregnancy, reduce
the incidence of gestational diabetes, improve outcomes and help
moms lose weight postpartum.
Consumer labs does
independent testing of supplements and Jarrow probiotics are shelf
stable so you don't have to refrigerate and their testing
indicates all batches meet or exceeded the listed amount of
microbes as found on the box/label.
I have a very basic understanding of probiotics, and I'll try to
convey what I know here.;*) The gut is filled with good guys
and bad guys (both bacteria and yeasts). There has to be a
good balance between the good guys and the bad guys for optimum
digestion and nutrient absorption. Probiotics are all good
guys that should balance the gut in the case of imbalance
(antibiotics kill good guys along with the bad guys, but this is
just one example of how the intestinal flora gets out of
whack). IMO, probiotics are like *gut insurance*.
There is a book called Bacteria
for Breakfast that explains it all a lot better than I have.
I especially like New
Chapter "Perfect Prenatal" supplements because they contain
helpful probiotics, including
L. acidophilus and especially B. infantis, which will get passed
on to your baby and help prevent colic; they are available
at Whole Foods and other health-food stores. They contain
recommended levels of folic acid, vit. C and acidophilus, as well
as an unspecified amount of choline.
Prenatal Supplements, by Stacelynn Caughlan, including a
subsection on PROBIOTICS
"Living drugs" [Medscape registration is free] - this
article includes treatment for UTI's.
From the July, 2005, Consumer Reports article on "Probiotics
in your diet?": "Some clinical evidence suggests that yogurt
with Lactobacillus acidophilus may boost immune cells that help protect
against abnormal microbes in the urogenital tract and help
reduce the incidence of vaginal bacterial infections. Yogurt
may also help prevent yeast infections." [They also have a Ratings
of Probiotic Products and Ratings
40 yogurt products. Note that their tests found higher
numbers of beneficial bugs in most yogurt products than in
supplements. Consumer Reports is in the forefront of
healthcare activism, and I encourage you to pay their small
subscription fee to gain access to this and all their articles.]
lactobacilli strains to be used in the gastrointestinal tract.
Fernandez MF, Boris S, Barbes C.
J Appl Microbiol. 2003;94(3):449-55.
CONCLUSIONS: These results indicate that the two strains of
Lactobacillus from human origin present important properties for
survival in, and colonization of, the gastrointestinal tract, that
give them potential probiotic. SIGNIFICANCE AND IMPACT OF THE
STUDY: Two strains of Lactobacillus isolated from human vagina of
healthy premenopausal women could be promising candidates to be
used in the preparation of probiotic products and for their use as
A general Internet search for "(probiotics OR acidophilus) NEAR pregnancy"
homocysteine, and pregnancy
About Choline from florahealth.com. They recommend a daily dose of 450 mg/day during pregnancy and 550 mg/day for lactation.
There's some preliminary research showing that choline protects
the integrity of cell membranes and may have a protective effect
against the viruses that can cause schizophrenia
through prenatal exposure. If so, it would also have a
protective effect against the viruses that could cause a variety
of disorders, includeing cerebral palsy.
J Neurophysiol. 2004 Apr;91(4):1545-55.
Dietary prenatal choline supplementation alters postnatal hippocampal structure and function.
Li Q, Guo-Ross S, Lewis DV, Turner D, White AM, Wilson WA, Swartzwelder HS.
"Choline, a compound present in many foods, has recently been
classified as an essential nutrient for humans. Studies with
animal models indicate that the availability of choline during the
prenatal period influences neural and cognitive development.
Specifically, prenatal choline supplementation has been shown to
enhance working memory and hippocampal long-term potentiation
(LTP) in adult offspring. However, the cellular mechanisms
underlying these effects remain unclear. Here we report that
choline supplementation, during a 6-day gestational period,
results in greater excitatory responsiveness, reduced slow
afterhyperpolarizations (sAHPs), enhanced afterdepolarizing
potentials (ADPs), larger somata, and greater basal dendritic
arborization among hippocampal CA1 pyramidal cells studied
postnatally in juvenile rats (20-25 days of age). These data
indicate that dietary supplementation with a single nutrient,
choline, during a brief, critical period of prenatal development,
alters the structure and function of hippocampal pyramidal cells."
Nutrient during pregnancy 'super-charges' brain [12 March 04]
Taking a nutrient called choline during pregnancy could "super-charge" children's brains for life, suggests a study in rats.
Offspring born to pregnant rats given the supplement were known to be faster learners with better memories. But the new work, by Scott Swartzwelder and colleagues at Duke University Medical Center in North Carolina, US, shows this is due to having bigger brain cells in vital areas.
Choline, a member of the vitamin B family, is found in egg yolks, liver and other meats - "exactly the kind of things people were told not to eat" due to their high cholesterol content, says Swartzwelder.
He believes their results in the rats could translate to humans,
and indeed the US Institute of Medicine added choline to the list
of essential nutrients, particularly for pregnant women, in its
development alters progenitor cell mitosis in developing mouse
Craciunescu CN, Albright CD, Mar MH, Song J, Zeisel SH.
J Nutr. 2003 Nov;133(11):3614-8.
"We conclude that the dietary availability of choline to the
mouse dam influences progenitor cell proliferation and apoptosis
in the fetal brain."
Extra Choline During Pregnancy Enhances Memory In Offspring [in rats, anyway] - Duke University, 1998
DURHAM, N.C. -- Pregnant rats fed extra doses of an essential nutrient called choline produced offspring whose brain circuits were "wired" to learn and remember far more efficiently than offspring without the supplement, according to a study at Duke University Medical Center. Conversely, analysis of brain slices of the offspring of rats deprived of choline indicated a decrease in memory capability.
Choline is a naturally occurring amino acid found in egg yolks,
milk, nuts, liver and other meats as well as in human breast milk.
It is the essential building block for a memory-forming brain
chemical called acetylcholine, and it plays a vital role in the
formation of cell membranes throughout the body.
NOTE - Omega-3 fatty acids do increase brain
size and thus head size, which can make the birth more
difficult. It is also an option to increase your
Omega-3 fatty acid intake during the first three months AFTER
the birth; the enhanced breastmilk will also increase baby's IQ
and brain size when the head size won't make the birth more
difficult! Or you could take herbs to help the baby come a
few days earlier, when the head is more flexible.
fatty acids - an excellent, comprehensive resource,
including many food sources
Pregnant women consuming flaxseed oil have high risk of premature birth
1) Mean gestational age at delivery for those who consumed flax
during the 2nd or 3rd trimester was 33 weeks of gestation -
similarly in those who did not use flax during pregnancy,
gestational age at delivery was 39 weeks.
2) We did not study the wellbeing of children after birth within this particular study.
My interpretation of the above is that women might do best to
take lots of krill oil for the Omega-3s throughout pregnancy and
then take flaxseed oil (must be the oil!) in the last month to
encourage baby to come earlier! And, of course, max. out
your dosage of Omega-3s in the first three months after the birth.
Why Fish Oil is NOT the Best Omega-3 Source from mercola.com
"Plant based omega-3 sources like flax, hemp and chia are high in
ALA and are important sources of nutrients as we all need
ALA. However, the key point to remember is that the
conversion of ALA to the far more essential EPA and DHA is
typically severely impaired by inhibition of delta 6
desaturase. This is an enzyme that is necessary to produce
the longer chain EPA and DHA from ALA. Elevated insulin
levels impair this enzyme and over 80% of the country has elevated
insulin levels. So from that perspective alone it is
important to include animal based sources of omega-3 fats."
Chia seeds are also great fiber and a source of fiber and
omega-3s, and they help with heartburn!. [from Nutrition - Chia -
... far more than just a furry green "pet"!]
Nutritiondata.com says that 1
oz. of chia seeds has 4915 mg of Total Omega-3 fatty acids.
This is perhaps too much for a first baby, as you don't really
want the head to be bigger than genetics intend. 0.4
ounces of chia seeds would yield about 2000 mg, which is a
suitably moderate amount for a first-baby pregnancy. It is
best to grind or blend them so the seeds are better digested.
Flax seed oil is not a suitable Omega 3 source.
Flax seeds contain the omega-3 fatty acid ALA that must be converted to DHA by an enzyme so that the body can incorporate it into cells. Children make this enzyme only in small amounts, if at all. If they do not have the enzyme they will not benefit from the omega-3 fat in flax seeds. Newborns are completely unable to convert ALA to DHA. A study of breastfeeding mothers who took a flax seed oil supplement had no resulting increase in their own plasma or breast milk levels of DHA, showing that adults do not make this conversion either (Francois et al., 2003). Flax seeds are not an adequate source of DHA.
Randall Neustaedter OMD recommends that children and adults take a fish oil or cod liver oil supplement. Cod liver oil has the added benefit of vitamins A and D, especially helpful in the winter months when sun exposure may be inadequate to provide enough vitamin D. An alternative omega 3 source for vegetarians is an algae-derived DHA supplement (trade name Neuromins).
A more complete omega 3 discussion
flaxseed oil does not increase docosahexaenoic acid in their
Francois CA, Connor SL, Bolewicz LC, Connor WE.
Am J Clin Nutr. 2003 Jan;77(1):226-33.
CONCLUSIONS: Dietary flaxseed oil increased the breast-milk, plasma, and erythrocyte contents of the n-3 fatty acids ALA, EPA, and DPA but had no effect on breast-milk, plasma, or erythrocyte DHA contents.
By Roger Highfield, Science Editor
Pregnant women who eat more fish, which contains omega-3 fatty
acids, tend to have brighter, more sociable children, claim
researchers. [Dr Hibbeln worked with Prof Jean Golding from
Bristol University's Avon Longitudinal Study of Parents and
Brain Food - This is important! Michel Odent's research shows a correlation between intake of Omega-3 fatty acids (typically found in ocean fish) and the size of baby's brain and the child's IQ. Here's the reference:
Odent MR, McMillan L, Kimmel T
Eur J Obstet Gynecol Reprod Biol 1996 Sep;68(1-2):49-51
"The mean neonatal head circumference was greater in the study
group (34.7 cm vs. 34.4 cm)"
In addition, we know that omega-3s are anti-inflammatory, and the ripening of the cervix is an inflammatory process. So omega-3s would be expected to delay the onset of labor. Some fish-eating cultures have prenant women stop eating fish in late pregnancy so baby comes on time.
Smart Start by Marcia Zimmerman, C.N. - Essential fatty
acids can affect your baby's intelligence.
Am J Epidemiol. 2004 Sep 1;160(5):460-5. Related Articles,
Association of fish and fish liver oil intake in pregnancy with infant size at birth among women of normal weight before pregnancy in a fishing community.
Thorsdottir I, Birgisdottir BE, Halldorsdottir S, Geirsson RT.
"Infants of women in the highest quartile of fish oil intake (> or =1 tablespoon (11 ml)/day), consuming threefold the recommended dietary allowance of vitamin A and twofold that of vitamin D, were shorter (p = 0.036) and had a smaller head circumference (p = 0.003) than those of women consuming less. Infant size at birth increased with fish consumption, especially for women in the lower quartiles of consumption. Smaller birth size was linked to the highest levels of fish oil intake. Constituents of fish and fish oil might affect birth size differently depending on the amount consumed."
[Ed. I find this confusing. Apparently the consumption of
fish but not fish oil helps grow bigger babies?]
of n-3 and n-6 fatty acids supplementation to pregnant and
lactating women. [Free
Helland IB, Saugstad OD, Smith L, Saarem K, Solvoll K, Ganes T, Drevon CA.
Pediatrics. 2001 Nov;108(5):E82.
"CONCLUSIONS: This study shows neither harmful nor beneficial
effects of maternal supplementation of long-chain n-3 PUFAs
regarding pregnancy outcome, cognitive development, or growth, as
compared with supplementation with n-6 fatty acids. However, it
confirms that DHA concentration may be related to gestational
length and cerebral maturation of the newborn."
effect of fish-oil supplementation on pregnancy duration.
Olsen SF, Sorensen JD, Secher NJ, Hedegaard M, Henriksen TB, Hansen HS, Grant A.
Lancet. 1992 Apr 25;339(8800):1003-7.
"The high birthweights and long duration of pregnancy in the
Faroe Islands led us to suggest that a high intake of
marine-fat-derived n-3 fatty acids might prolong pregnancy by
shifting the balance of production of prostaglandins involved in
parturition. We have compared the effects on pregnancy duration,
birthweight, and birth length of a fish-oil supplement, a control
olive-oil supplement, and no supplementation. 533 healthy Danish
women in week 30 of pregnancy were randomly assigned in a ratio of
2/1/1 to fish oil (four 1 g Pikasol capsules [containing 2.7 g n-3
fatty acids] per day), olive oil (four 1 g capsules per day), or
no supplement. The three groups differed in mean length of
gestation (p = 0.006), which was highest in the fish-oil group and
lowest in the olive-oil group; the result was similar when the
analysis was restricted to women with an estimate of gestation
length based on early ultrasound findings (443 women). Pregnancies
in the fish-oil group were on average 4.0 (95% confidence
interval 1.5-6.4) days longer than those in the olive-oil
group; the difference in birthweight was 107 (1-214) g. The effect
of supplementation on length of gestation was influenced by intake
of fish and of fish oil: the difference between fish-oil and other
groups was increased by a low fish intake at baseline. Fish-oil
third trimester seems to prolong pregnancy without detrimental
effects on the growth of the fetus or on the course of labour."
I love playing with the "Related Articles" feature in PubMed. I'll admit that I'm confused by the results of some of the studies, and it sounds as if the researchers aren't entirely clear about the results either.
The studies seem to have been done on otherwise healthy (and presumably well-fed) women. It seems that fish oils MIGHT prolong pregnancy by about 4 days, as well as increase baby's size proportionately to the longer gestation.
Some of the studies didn't seem to pay much attention to the effect on gestational age and were paying more attention to the baby's size, which isn't that helpful if you discount the effects on length of gestation.
Some of my information came from a seminar with Michel Odent in 1996. I took thorough notes, and he said that supplementation with fish oils increases baby's IQ, brain size and head size. At the time, I didn't think to ask about the issue of the effects on length of gestation.
I'm also having trouble finding a good discussion of the different names for the different types of fatty acids and the levels provided by different sources.
At this point, it seems that the research is inconclusive, but
there seems to be some agreement that it is not harmful, per se.
Mercury toxicity issues are serious, though.
omega-3 fatty acids to mother and baby during late pregnancy and
nursing from The
Omega-3 Information Service
From Dr. Barry Sear's Zone FAQ:
Other sources that are rich in EPA include mackerel and sardines. Other marine sources which have a lower EPA content are common fish such as tuna, swordfish, scallops, shrimp, and lobster. Try to consume about 300 mg. of EPA per week. This would translate into one serving of salmon or four servings of tuna or like fish per week.
Concerning Omega-3 and Brain Activity and Vision from the FLAX information web site
Mercury Rising - Our Seafood is Increasingly Contaminated with Toxins from [E] The Environmental Magazine - This lists a lot of potential problems with different fish, but may be more of a political piece than a health piece. Farmed salmon may be your best bet.
FOOD FACTS WEB PAGE - search for "mercury". They claim shark and swordfish are the worst, and should particularly be avoided during the first trimester.
COMMERCIAL FISH: EAT UP, DESPITE LOW LEVELS OF MERCURY from the University of Rochester
Anybody know a way to keep someone from having a huge baby?
What about induction in this situation?
Talk to them *right away* about eating. Personally, I think it's way too late to alter diet after the glucose screening is done.
We tell our women w/ previous large babies/SD:
Do NOT!!! drink lots of juice/eat lots of fruit. Repeat after me sixty zillion times. (We counseled a mom whose previous babe was SD and who ate, for breakfast, 5 - 6 different kinds of fruit in the belief that it was healthy...told her to try oatmeal instead :) Fruit is mainline glucose to the system, no matter how "natural" it is.
Take what you normally eat in 3 meals and spread it out over six (which is the basic GD protocol), but not adding food to the daily diet.
Exercise. Every day. Even upper body exercise (arm
swinging, weights) is helpful in regulating glucose metabolism.
I've had great luck with having clients cut dairy fat. Have them switch to skim or 1/2% milk, low-fat cheeses and yogurts, cut down on butter usage (I'm NOT a margarine person :-)). Increase activity, no overeating. If she is concerned, she'll comply.
Had a client w/ a 12#5oz 3rd baby who kept #4 & #5 <10# by
doing this. If I look at my dairy farm clients, the ones who
drink a lot of milk out of the tank (full-fat) have the biggest
I've got to echo the comments about cutting down severely or
cutting out milk products altogether: milk, cheese, ice
cream. I think milk is one of the biggest culprits for big,
FAT babies. Not always, of course. I've worked with a
few vegans who have had 9 and 10+ lb babies.
I always have to laugh when people say that vegans can't grow
big, healthy babies. It happens that both vegan boy babies
in my practice were around ten pounds, and the vegan girl baby was
a fine, respectable weight.
I'm worrying about soy more and more. Even some of the
nationally renowned naturopathic physicians are recommending that
it be used only as a food accent, the way the Japanese have
traditionally eaten it. Here's a helpful
Brewer Vegetarian Diets for Pregnancy: Two Safe Alternatives
Unsafe for Children by Randall Neustaedter OMD
THE WHOLE SOY STORY blows the lid off nutritional dogma !
* Soy is NOT a miracle food.
* Soy is NOT the answer to world hunger
* Soy is NOT a panacea.
* Soy has NOT even been proven safe.
The Vegetarian Diet and Birth Defects - possible problems caused by high soy intake in pregnancy.
linked to birth defect
and another version of
Vegetarian Diet in Pregnancy Linked to Birth Defect
Pregnancy by Reed Mangels, Ph.D., R.D. from the Vegetarian Journal
(Jan '97) and a related article, The Vegan
Diet During Pregnancy and Lactation by Reed Mangels, Ph.D.,
Pregnancy & Breastfeeding - from vegetarianbaby.com
FOR PREGNANCY from The McDougall
NOTMILK! - Very interesting
reading for those of you who question the health benefits of cow's
milk or for better understanding of your clients who refuse to
Cow's Milk Protein Linked to Diabetes
stress offspring - "Given the recent popularity of
low-carbohydrate, high-protein diets, such as the Atkins diet,
these data also suggest that these diets should be avoided during
pregnancy." [Source: 8th European Congress of Endocrinology;
Glasgow, UK: 1-5 April 2006]
Elliot's Mother and Baby Guide - Part 1
Rose Elliot's Mother and Baby Guide - Part 2
Here's a web site with lots of information about having a healthy vegetarian pregnancy and subsequently, a healthy baby. There is nothing specific about the babies being "small" though, I'm not sure if you were emphasizing that or not.
One of the great unresolved issues of pregnancy is the significance of a low hematocrit/hemoglobin.
Actually, the studies are clear that lower levels are better, and the unresolved issue is why practitioners continue to encourage iron supplementation and chide women for low levels.
"Normal" values of hematocrit/hemoglobin are determined by studying non-pregnant people. However, a pregnant woman's blood volume expands around 40-60%; this blood volume expansion reduces the concentration of red blood cells and iron in her blood, which is what's measured by hematocrit and hemoglobin.
The best pregnancy outcomes are associated with the lowest hematocrit/hemoglobin. It turns out that 9.5 is optimal. This isn't because pregnant women don't need iron; it's because healthy pregnant women have large increases in blood volume that lower the hematocrit/hemoglobin.
So, in fact, a woman who's having problems with her pregnancy and doesn't have an increasing blood volume will have higher h/h levels than a healthy woman.
There are better ways of assessing anemia in pregnancy; fatigue
is a clue, but the best way to assess how well your blood is
carrying oxygen is to look for pallor in the gums and under
eyelids and to assess capillary refill when you apply pressure to
A woman can have a low H&H for several reasons. The healthy reason is that she has the normal hemodilution of pregnancy. The problematic reason is that she started her pregnancy with anemia (either dietary or from excessive blood loss such as menorrhagia). Or maybe she has thallasemia, malaria, or whatever.
A woman can have a high H&H for differing reasons as well. It could be because she eats really well, or because she has an iron storage disease, or because she never got the hemodilution and is on her way to pre-eclampsia/toxemia/HELLP or whatever.
You don't diagnose based on one lab value. And you can't
predict outcome based on one set of numbers either.
"A Guide to Effective Care in Pregnancy & Childbirth" by Enkin, Keirse, Renfrew and Neilson reports that a hemoglobin count of 9.5 is optimal for fetal growth and maternal well-being:
The normal haematological adaptations to pregnancy are frequently misinterpreted as evidence of iron deficiency that needs correcting. Iron supplements have been given with two objectives in view: to try to return the haematological values towards the normal non-pregnant state, a strange objective when millions of years of evolution have determined otherwise, and to improve the clinical outcome of the pregnancy and the future health of the mother. The first objective can certainly be accomplished; the key question is whether or not achieving the "normalized" blood picture benefits the woman and her baby. Routine iron supplementation raises and maintains serum ferritin above 10 microgram/litre and results in a substantially lower proportion of women with a haemoglobin level below 10 or 10.5 grams per cent (below 6-6.5 mmol/litre) in late pregnancy. Routine folate supplementation as a haematinic after the first few weeks of pregnancy substantially reduces the prevalence of low serum and red cell folate levels, and of megaloblastic haematopoiesis. As yet, neither iron nor folate supplementation after the first trimester have shown any detected effect on the following substantive measures of maternal or fetal outcome: proteinuric hypertension, antepartum haemorrhage, postpartum haemorrhage, maternal infection, preterm birth, low birthweight, stillbirth, or neonatal morbidity. Women do not feel any subjective benefit from having their haemoglobin concentration raised.
A possible advantage claimed for a high level of haemoglobin in pregnancy is that the woman would be in a stronger position to withstand haemorrhage. There is no evidence to support this claim. indeed, as a low haemoglobin in healthy pregnant women generally implies a large circulating blood volume, it is at least possible that women with a low haemoglobin might better withstand a give loss of blood.
There are few data derived from communities in which nutritional anaemia from either iron or folate deficiency is prevalent. Trials are needed in these populations to establish the most appropriate strategies for combatting the deficiencies.
Whether routine iron supplementation causes any harm in well-nourished communities is still unclear, but it is clearly wasteful. The evidence suggests that, except for genuine anaemia, the best reproductive performance is associated with levels of haemoglobin that are traditionally regarded as pathologically low. There is cause for concern in the findings of two well-conducted trials that iron supplementation resulted in an increase in the prevalence of preterm birth and low birthweight. Perhaps there is an adverse effect on fetal growth due to the increased viscosity of maternal blood that follows the iron-induced marcrocytosis and increased haemoglobin concentration, which may impeded uteroplacental blood flow.
An individuals' haemoglobin concentration depends much more on the complex relation between red-cell mas and plasma volume than on deficiencies of iron or folates. The advent of electronic blood counters has given an opportunity for more appropriate criteria to be applied to the diagnosis of anaemia. Mean cell volume may be the most useful; it is not closely related to haemoglobin concentration and declines quite rapidly in the presence of iron deficiency. A low haemoglobin without other evidence of iron deficiency requires no treatment.
If there is evidence of genuine iron deficiency, iron treatment is needed, and the usual approach is to give iron salts by mouth. There is no convincing evidence that the addition of copper, manganese, molybdenum, or ascorbic acid improves the efficiency with which the iron is used.
The cause of megaloblastic anaemia in pregnancy is almost always folate deficiency, and treatment with folic acid supplementation is rapidly effective.
At 11weeks I am having a serious conflict about what to do about
iron supplementation, I have read in most places that no matter
how much iron you get in your diet, as a pregnant woman you will
be incapable of maintaining "normal" iron levels without
supplementation. Hello......isn't our body trying to tell us
something like maybe we are not supposed to have high levels of
iron. Currently I am trying to do a literature search to
find the absolute truth. There are no absolutes in
scientific medicine, but Sheila Kitzinger in her book "THE
COMPLETE BOOK OF PREGNANCY AND CHILDBIRTH" she explains that if
you did not start out anemic, then iron supplementation is not
necessary for the normal drop in hemoglobin from
mid-pregnancy. This reduced hemoglobin is a sign that plasma
volume is rising and that the placenta is providing good nutrition
for the baby."
In a different chapter she explains" A pregnant woman has about 40% more blood flowing in her body. It used to be thought that a woman's hemoglobin levels must be kept high during pregnancy by iron supplementation. But most women whose hemoglobin concentration does fall are more likely to go full term and have babies of good birth weight. If hemoglobin concentrations fail to fall there is a marked increase of the incidence of low birth eight and preterm labor." She quotes two medical studies to back this up. The babies are probably LBW and preterm because the placenta wasn't nourishing the baby properly so therefore hemoglobin levels did not drop.
This is based on information from a variety of sources, but primarily from Gabbe's Obstetrics (which also has some very nice charts utlining this physiology and gives good numbers as well!)
Starts to expand at 10 weeks
Expansion plateaus at 30 - 34 weeks
Average increase is 50%
Normal range considered to be 20% to 100% increase
Bigger babies, multiple gestations will have increases on the higher side
Seen in lab work as dropping hemoglobin/hematocrit (physiological anemia of pregnancy)
Rising Hg/Hct may be early signs of problems, but diagnosis confounded by iron supplementation
Red blood cell count (RBC)
Increases throughout pregnancy
18% increase if not supplemented
50% increase of supplemented
Count progressively decreases in normal pregnancy by about 15,000/mm3
Still stays well within the normal range for non-pregnant women
Average count goes from 275,000 to 260,000
Counts below 150,000 are indicative of potential trouble
Fibrinogen levels increase, other clotting factors stay about the same as in the non-pregnant state
Marked increase in fibrinogen levels a sign of trouble
RBCs are turned over faster during pregnancy, the accelerated breakdown being matched by an accelerated production. This can stress the liver (excreting bilirubin and other byproducts of hemolysis).
Breakdown not matched by production signals a problem.
NOTE - If a woman doesn't respond to iron supplementation as
expected, consider the possibility that there may be underlying
thyroid problems. Even if she's already had her thyroid
tested in this pregnancy, consider doing another thyroid test or
referring to a physician for evaluation.
So you'll have to manage your calcium and iron supplements.
One good approach: take general prenatal in the morning with iron
supplement and extra vitamin C.
Then take 1 Tri-Spartate or other mineral supplement with lunch and dinner and then again at bedtime. The minerals will help you sleep!
Most midwives recommend Floradix
Iron & Herbs or the yeast-free
version. They are easily tolerated by the sensitive
pregnant digestive system and don't seem to cause constipation. A study
shows that Floradix " is effective for preventing iron
deficiency and for treating low serum ferritin - with minimal
side-effects and high compliance by patients."
Supplementation Early in Pregnancy Improves Birth Outcomes -
Oct. 7, 2003 [Medscape registration is free]
Nonanemic Pregnant Women 
Pregnancy from Nutrition
During Pregnancy: Part I: Weight Gain, Part II: Nutrient
Supplements (1990) from the Institute of Medicine (IOM)
I've heard some midwives say that the best way to boost a woman's red blood cell count (and thus hemoglobin/hematocrit) is to have her take chlorophyll supplements with iron. The rationale that goes along with this is that chlorophyll and hemoglobin perform similar functions, i.e. transporting gases in the life fluid of their host, whether plant or animal. The thinking I've heard is that when the chlorophyll and the iron are both available, the iron can replace the magnesium in the chlorophyll to be easily reconstructed into heme. Here are some web pages on this subject:
Re: chlorophyll / hemoglobin - Question and Response
and the method for its clinical use in maternal and fetal tissue
Shramkevych AF, Sol's'kyi IP, Rozumenko MB
Pediatr Akush Ginekol 1979 Sep-Oct;(5):55
Heme and Chlorophyll Biosynthetic Pathways
The following quotes attempt explanations but aren't terribly well documented. If anyone has any good references for this information, please e-mail me. Thanks.
"Interestingly enough, chlorophyll and hemoglobin have a remarkably similar molecular structure, though their functions are different. Chlorophyll is the substance that makes a plant green and helps derive food for the plant by using the sun's energy. Hemoglobin gives blood its red color and transports oxygen through the blood. Both molecules are of the same shape, with a difference in the middle atoms. Hemoglobin's center atom is "iron", while chlorophyll's center atom is "magnesium". Maybe this very similar molecular structure is why ingesting chlorophyll so effectively helps hemoglobin oxygenate and purify the blood. " [http://22.214.171.124/ahs_digest/digest090199.html]
"The way it works is this. The molecule of chlorophyl is almost identical to a molecule of hemoglobin, except for one big difference. The central atom in hemoglobin is iron, and the central atom in chlorophyll is magnesium. This being the case, when you ingest chlorophyll, it readily gives up its central atom of magnesium and apparently exchanges it for, and hear's the cool part:
"1) if you have heavy metal toxicity, it will exchange it for whatever atom of heavy metal you need to get rid of, whether it is lead, mercury, or what have you, OR
"2) If you do NOT have any heavy metal toxicity, it exchanges it for IRON, thereby creating new blood very quickly. This is why someone who is anemic can benefit so drmatically from taking chlorophyll." [Source]
Some PubMed sources:
proteins: a quantitative reappraisal.
Chiancone E, Winzor DJ
Anal Biochem 1986 Oct;158(1):211-6
"A quantitative expression describing the behavior of a
self-associating protein in subunit-exchange chromatography is
derived in a form that is tractable from the viewpoint of
characterizing the pertinent interactions. Its use is illustrated
by application to published results for alpha-chymotrypsin,
oxyhemoglobin, and the light-harvesting chlorophyll a/b protein."
Biosynthesis of the pigments of life.
Proc R Soc Lond B Biol Sci 1985 Jul 22;225(1238):1-26
of function and formation. [No abstract]
Hendry GA, Jones OT
J Med Genet 1980 Feb;17(1):1-14
hybrids: preparation, characterization, and energy transfer.
Kuki A, Boxer SG
Biochemistry 1983 Jun 7;22(12):2923-33
This is a topic that fascinates me - if anyone has any better
sources, please, please e-mail them to me.
Usually we recommend somewhere around 4-6 chlorophyll a day for a
typical low hemoglobin. Some like to get on it toward the end of
their pregnancy as a hemorrhage prevention, but we don't regularly
recommend it for that purpose alone. My hemoglobin is OK (11.4 at
30 weeks), but I wouldn't mind it being a little higher, so I've
been taking 2 a day.
For low hemoglobin, fill blender fairly full with dark green
leafy veggies (spinach, kale, etc.) Then pour pineapple juice into
the blender to 2/3 full. Blend well. I call this the "Green Drink"
and it works marvelously for low Hg. Also, the women who have used
it have very minimal pp bleeding.
Wheat grass juice - 4 oz at least four times a day! I swear by
At least one tablspoon blackstrap molasses daily.
Clams are very high in iron. Eat along with vegetables that are high in iron.
Do not take calcium, vitamin E, zinc, antacids, or fiber at the same time as foods high in iron/or supplements.
Omit all sugar.
With Floradix, take 100 mg of vitamin C for better absorption.
Vitamin B 12, 2,000 mcg 3 times daily.
Vitamin B complex 50 mg 3 times daily.
Folic acid plus biotin 800/300 mcg daily.
Vitamin C 3,000 to 10,000 mg daily
Brewer's yeast - rich in basic nutrients and a good source of iron.
Eliminate coffee and tea, sodas, beer, dairy products.
If a mom is taking iron supplements, and they don't seem to be
helping with anemia, consider that she may be deficient in vitamin
D, which is necessary for the absorption of minerals.
Take Homeopathic Ferrum Phosphoricum each morning and take Kali
Sulphuricum each evening for three weeks to aid the body's
assimilation of iron. For other tips on homeopathics for
pregnancy and birth, see the EMAZING.com
of the Homeopathic Health Tip of the Day
I don't rec. ferrous sulfate. I start with floradix, one
bottle every 3 days max, plus any ferrous glucinate or fumerate, 3
or 4 of those. Then folic acid, 5 800 mcgs with the iron.
Then red meat if they eat it. Then chlorophyll, and the
"iron sheet" that has foods with iron, inc. cooking in the old
cast iron pots. I've had a couple of other women over the
years who had very low hgbs following emergencies who have gone on
the iron diet. The first 2 points happen in 1 week, then 1
point a week. We don't stop until her hgb is 12.5.
Although I prefer herbal support for most things, my favorite
iron supplement is Source Natural's chelated iron. Seldom even
turns stool black, which makes me think it's being well absorbed,
virtually never constipates moms, and works pretty quickly. Lots
cheaper and easier to take than Floridix. Along with the
supplement I advise 500 mg vit C, assuring adequate folic acid,
and 20 minutes of pulse-raising exercise every day (Let the body
know it NEEDS more O2 capacity).
I have never been one to use lots of herbs in my practice, although I am now slowly adding certain herbal items. The main reason for the turnabout is the herb Yellowdock (Rumex Crispus, Buckwheat Family) (aka: sour dock, curled dock, narrow dock, Rumex)
This was suggested to me by a MW friend, so I tried it once with a client whose HgB at week 35 +2, was, in my opinion, too low for homebirth consideration. At the time I was sending my clients to a friendly OB for all testing, and he called me when the lab results came in to let me know that he was concerned about this birth happening at home, and I concurred.
We discussed if there was a way to get my client's bld levels up before birth. He assured me there was not a way to do this in the amount of time we had left. I talked to him about an herbal remedy, and he agreed to order tests for her each week so that we could find out for real if it would work or not.
I had her use the yellowdock root as prepared in Susan Weed's Herbal for the Childbearing year. Also did intensive nutritional counseling, and had her keep a daily food intake log for the remainder of her pregnancy.
Every week she went back in to be tested. She birthed (at home) at week 41 +4. So was on this regimen for 6 weeks, two days. Her last lab was 2 day pre-birth. The necessity of good hydration was stressed to the client so that we wouldn't get higher lab results due to hemoconcentration..
over the course of that time her HgB levels were (in g/dl) :
8.9 (end of one week)
11.1 (end of 6th wk, last lab)
Total increase of 2.8.
I have never tested this intensely since this time, as this was pretty convincing to me. Also, the OB was absolutely amazed and began recommending yellowdock to his patients. I do not know what results he has obtained, and I am sure he does not work as closely with his patients regarding the nutritional aspects of this method.
Admittedly, if someone's HgB was sitting at 5.5, and an increase of this same amount was obtained, they would still only be at 8.3. But I would think that a pp woman would feel a heck of a lot better sitting at this level with a new baby during pp recovery than she would at 5.5.
Also, my case involved a little more time than is allotted in the case mentioned above. But again, I would think that any increase would prove beneficial.
I have also used this same method for pp women, and definitely for any client with a history of pp hemorrhage in preparation for birth..
Also, I cannot say how much the increase was attributable to the
Yellowdock and how much to the nutrition. So I always do both.
I love Yellow Dock too! I've seen amazing results with it. I was confused though, because I had always understood that it worked because it had a good amount of easily assimilated iron in it. when i studied it i found that it really didn't have that much- 1.6 mg per 100 grams. dandelion has 3 times that amount, willow has 11 times as much! i came to a theory that the when the liver is under stress it stores iron and gets toxic. if one stimulates the liver to release the stored iron into the blood stream it becomes usable to the system. Then one would see a noticeable rise in H&H. This is also (according to this theory) why one gets constipated during pregnancy and while taking extra iron- the toxic liver isn't manufacturing enough bile. But Yellow Dock is also known as a gentle laxative, I think because it cleanses the liver and stimulates it into bile production. Bile is the body's natural laxative. Just my opinion.
Rumex has many chemicals with antihepatotoxic properties, and erythrocytogenic properties as well, which is another angle. Check it out at James Duke's phytochemical plant database.
Here are some abstracts on Rumex that don't include anything on
raising H&H but are fun if you love getting to know an herb at
all angles, which I do. They are from Michael
site (who is the most brilliant herbalist America has had
since George Washington Carver IMHO.)
Another point to consider with that low of a HgB:
Any chance she may have beta thalassemia minor? We have several of these women in our mid-Michigan practice, whom have no clue they have the disease; their HgB is initially just a bit low, then continually drops during the pregnancy and is unresponsive to iron supplementation.
One of the important implications of beta thal minor is that if FOB also has it, baby can have beta thal major; a VERY serious, life-threatening condition.
So we always refer to the hematologist these women who are anemic
with a non-iron deficiency etiology per labwork.
I don't know what to say about the black outs, but I never
recommend iron supplements as a tx for low hemoglobin...it is hard
for the body to absorb and often leads to constipation and
attendant hemorrhoids. I usually recommend liquid chlorophyll, or
alfalfa tablets.....9 times out of ten it does the trick and
brings the hemoglobin up...also tends to soften the stool, so I
see considerably less hemorrhoids. I have a tincture that I made
that includes alfalfa and nettles...replaces the chlorophyll and
also does the trick. In my opinion iron supps are largely
ineffective and cause problems for most women. Don't know what to
say about your black outs tho...good luck, and stay off the road!
There is a company that sells a grapeseed product that has a
great pamphlet that explains everything about it. The company is
called; Flora, and the product is called; Bio Berry Grapeseed
Extract Plus. Yes, they also sell Floradex. Anyway, they have an
800 number which is; 1(800)446-2110.
I still think the best stuff is the Liquid Iron product from NF Formulas in oregon - Iron citrate which is much less constipating along with B-12 and folic acid to aid in the rest of the blood building. a teaspoon twice per day and usually within 2 weeks they're convinced and on their feet (not tired anymore).
NF Formulas # 800-547-4891 - at least get a catalogue.
I like the plain flavor mixed with pineapple juice instead of the
Iron deficiency anemia can be characterized by fatigue, headache,
and poor concentration. A balanced diet along with a
vegetable-based iron supplement should correct this condition.
Consider also homeopathic Ferrum Phosphoricum to aid assimilation
of dietary iron.
Using 14C-labeled arachidonic acid as precursor for in vitro prostaglandin synthesis, the effect of an antacid containing Al (OH)3, Mg(OH)2 and CaCO3 on endogenous prostaglandin synthesis was investigated in antral and duodenal mucosa of healthy volunteers. After three weeks of treatment with a high-dose antacid, there was no detectable change in the total capacity of the mucosa for prostaglandin synthesis, but the prostaglandin profile was markedly altered. The relative amounts of PGE2 and PGF2 alpha synthesized by antral and duodenal mucosa increased at the expense of the prostaglandins A2/B2, thromboxane A2, and prostacyclin. In a short-term study, this change was not observed following a single antacid dose within 1 hr after application. It is concluded that long-term antacid treatment may alter the prostaglandin pattern formed by gastroduodenal mucosa and this may be related to its therapeutic effect.[Prostaglandin synthesis in stomach and duodenal mucosa of the human: effect of aspirin with and without antacid].
A decreased PG E2 content in gastric mucosa of humans receiving a longterm antirheumatic therapy has been reported to be partially reversed after a one week treatment with an antacid (Reimann et al., Fortschr Med 102 , 25-26). . . . It is concluded that antacids do not influence the suppression of the endogenous prostaglandin synthesis by NOSAC's, however another effect, eg a prolonged stability of PG E2 in a less acidic environment is more likely.Protection of the upper gastrointestinal mucosa: the role of antacids.
[I]n 28 patients with gastric antral ulcer of various sizes in different stages of activity with or without erosive gastritis. After the antacid treatment, a significant prostaglandin E2 reduction was observed . . . [Note that the reduction of PGE2 is likely associated with reduced inflammation from lesions, which would not occur in healthy individuals..]Alimentary tract and pancreas. Stimulation of mucosal prostaglandin synthesis in human stomach and duodenum by antacid treatment.
Total prostaglandin synthesis in antrum (623 (110) pmol/mg protein) and duodenum (432 (72) pmol/mg) was stimulated after three weeks administration of low dose antacids by 176% (p less than 0.05) and 154% (p less than 0.05), respectively.[In vivo and vitro study of prostaglandins E2 and I2 participation in protective function of antacids on gastric mucosa].
It was shown that antacids stimulate generation of PGE2 and PGI2 . . .PGE2 is the prostaglandin contained in dinoprostone vaginal insert (Cervidil). Is it possible that use of antacids as calcium supplements could cause preterm labor and/or prevent postmature pregnancies?
Which specific type of antacid is associated with elevated levels
of PGE2? Is it the specific ingredients or the antacid
nature of the preparation that are implicated?
Is.there an association between elevated levels of PGE2 and premature labor?
Is there an association between decreased levels of PGE2 and postmature pregnancies?
Could antacid use prevent postdates pregnancies?
Is the higher level of PGE2 caused by inflammation of the digestive tract in response to higher levels of bacteria in the gut caused by hypoacidity? Is this, in and of itself, harmful to the mother or fetus?
associated with excessive ingestion of calcium carbonate antacid
(milk-alkali syndrome): successful treatment with hemodialysis.
Kleinman GE, Rodriquez H, Good MC, Caudle MR
Obstet Gynecol 1991 Sep;78(3 Pt 2):496-499
Severe hypercalcemia, a potentially life-threatening condition, has been reported rarely during pregnancy. A patient with hypercalcemic crisis associated with excessive ingestion of absorbable calcium antacid was treated successfully with hemodialysis as well as other therapeutic measures, such as saline diuresis. This acute therapy resulted in long-term normalization of maternal calcium levels. The fetus, who exhibited a low biophysical score during the initial admission, was delivered a month later and had an uncomplicated neonatal course.
reversible form of acute renal failure.
Abreo K, Adlakha A, Kilpatrick S, Flanagan R, Webb R, Shakamuri S
Arch Intern Med 1993 Apr 26;153(8):1005-1010
An increased frequency of this syndrome seems likely with the growing popularity of the use of calcium carbonate as an antacid or as calcium supplementation to prevent osteoporosis. We treated five patients who had six episodes of the milk-alkali syndrome; four of these cases were diagnosed between 1990 and 1992. All patients were ingesting massive quantities of calcium and absorbable alkali and were unaware of the toxic effects of these compounds. All patients presented with the triad of hypercalcemia, metabolic alkalosis, and renal failure.
binders by calcium and magnesium carbonates in long-term
Zellweger U, Zaugg PY, Dambacher M, Binswanger U, Gautschi K, Hany A
Dtsch Med Wochenschr 1989 Apr 28;114(17):659-664
Hypercalcaemia was an expected disadvantage: repeated symptom-free episodes of hypercalcaemia occurred in six of 20 patients during the first three months and in a further two up to 12 months.
serum calcium level of 22 mg/dl and J waves on the ECG.
Jenkins JK, Best TR, Nicks SA, Murphy FY, Bussell KL, Vesely DL
South Med J 1987 Nov;80(11):1444-1449
of chronic antacid abuse.
Newmark K, Nugent P
Postgrad Med 1993 May 1;93(6):149-150
Patient education regarding the hazards of abusing calcium-containing antacids is essential.
Antacids Can Cause Major Problems
In Tums, calcium carbonate is the "antacid" portion. It is 40% elemental calcium, inexpensive, and readily available. It should be noted, however, that there are several very distinct disadvantages to its use as a calcium supplement:
1) Tums/calcium carbonate is an antacid. According to a study published in "The Annals of Internal Medicine", the only subjects who failed to absorb calcium carbonate were those who were found not to secrete sufficient stomach acid for proper digestion.
2) With the growing use of antacids, such as Tums, in the US (approximately 27% of the adult population consumes them) and the regular consumption of calcium carbonate as an inexpensive calcium source, the risk to Milk-Alkali-Syndrome is increasing.
This syndrome was first identified in 1923 and is characterized by hypercalcemia, alkalosis, and renal impairment. It may occur in an acute, sub-acute or chronic form. Joint stiffness with calcium deposits have also been observed in this disorder. It is called Milk-Alkali Syndrome.
Milk-Alkali Syndrome develops as a result of ingesting large amounts of calcium and absorbable alkali, particularly calcium carbonate. The reason this is of concern is that the National Institute of Health is now recommending 1000-1500 mg per day of calcium to prevent Osteoporosis. Since the most inexpensive form of calcium is calcium carbonate, many of the calcium formulas today contain calcium carbonate. Such popular products as Tums and Os-Cal, as well as many other inexpensive calcium supplements, are composed of calcium carbonate.
In addition, when taken with other substances such as adrenal
cortical hormones or thiazide diuretics, calcium carbonate can be
toxic at much lower does. In some individuals, even in the absence
of other medications, calcium carbonate may produce Milk-Alkali
Syndrome of four to five grams (four grams of calcium carbonate
provides 1200 mg of elemental calcium). Since calcium carbonate
has risks associated with it and is also shown to be mal-absorbed
in patients with low hydrochloric acid levels, other forms of
calcium supplementation are preferable.
PRENATAL CALCIUM SUPPLEMENTS/GALLSTONES IN INFANTS - Calcium
supplements during pregnancy may induce gallstones in infants and
young children. The two year-old daughter of a woman given calcium
carbonate and vitamin D during the last four months of the
pregnancy required surgical removal of gallstones which were found
to be made up entirely of calcium carbonate. This is the first
case reported of pure calcium carbonate gallstones. (Journal of
Pediatric Surgery 20:143-144, April, 1985)
Pregnancy and Aspartame
caffeine metabolite, and the risk of spontaneous abortion.
Klebanoff MA, Levine RJ, DerSimonian R, Clemens JD, Wilkins DG
N Engl J Med 1999 Nov 25;341(22):1639-44
"This suggests that moderate consumption of caffeine is unlikely
to increase the risk of spontaneous abortion." [Moderate is
defined as 1-2 cups of coffee daily.]
Moderate Sodium Intake Necessary for Good
Magnesium is essential for muscle relaxation, so it helps to
prevent uterine hyperexcitability, which can cause preterm labor
or painful, prodromal labor. Noting that magnesium sulfate
is used for treatment of preterm labor as well as pre-eclampsia,
it seems reallly important to make sure that pregnant women are
getting adequate magnesium supplementation unless they already
have a magnesium-rich diet.
to Magnesium - great explanation of the importance of
balancing calcium with magnesium. Peter Gillham is also
the creator of MamaCalm, which is helpful for pregnant women who
are experiencing anxiety, constipation or muscle cramping.
and Vitality - Magnesium is nothing short of a miracle
mineral in its healing effect on a wide range of diseases as well
as in its ability to rejuvenate the aging body.
Preventing pregnancy complications from babycenter.com
Intake during Pregnancy
Magnesium Deficiency in Pre-Eclampsia
importance of gestational Mg deficiency.
J Am Coll Nutr. 2004 Dec;23(6):694S-700S.
Chronic primary Mg deficiency is frequent. About 20% of the
population consumes less than two-thirds of the RDA for Mg. Women,
particularly, have low intakes. For example, in France, 23% of
women and 18% of men have inadequate intakes. Mg deficiency during
pregnancy can induce maternal, fetal, and pediatric consequences
that might last throughout life. Studies of gestational Mg
deficiency in animals show that Mg deficiency may have marked
effects on parturition and postuterine involution. It has
interfered with fetal growth and development, and caused morbidity
from hematological effects and disturbances in temperature
regulation, to teratogenic effects. Emphasis, here, is on effects
of chronic clinical gestational Mg deficiency as it affects the
infant. Premature labor, contributed to by uterine
hyperexcitability caused by chronic maternal Mg deficiency, that
can be intensified by stress, gives rise to preterm birth. If the
only cause of uterine overactivity is Mg deficiency, its
supplementation constitutes nontoxic tocolytic treatment, as an
adjuvant treatment, that is devoid of toxicity and enhances
efficacy and safety of tocolytic drugs such as beta-2 mimetics.
Evidence is considered that Mg deficiency or Mg depletion can
contribute to the Sudden Infant Death Syndrome (SIDS). SIDS may be
a fetal consequence of maternal Mg deficiency through impaired
control of Brown Adipose Tissue (BAT) thermoregulation mechanisms
leading to a modified temperature set point. SIDS can result from
dysthermias: hypo- or hyperthermic forms. Possibly, simple
nutritional Mg supplements might be preventive. Various stresses
in an infant can transform simple Mg deficiency into Mg depletion.
For example, lying prone can be stressful for the baby, as can
parental smoking. The role of chronopathological stress appears to
be often neglected, as it constitutes a clinical form of primary
hypofunction of the biological clock [with its anatomical and
clinical stigma such as reduced production of melatonin (MT) and
of its urinary metabolite: 6 Sulfatoxy-Melatonin (6 SMT)]. SIDS
might be linked to impaired maturation of both the
photoneuroendocrine system and BAT. Prophylaxis of this form of
SIDS should include atoxic nutritional Mg therapy for pregnant
women with total light deprivation at night for the infant.
Consequences of maternal primary Mg deficiency have been
inadequately studied. To determine ultimate outcomes of
gestational Mg deficiency in infants, a long-term multicenter
placebo-controlled prospective study should undertaken on effects
of maternal nutritional Mg supplementation on lethality/morbidity
in fetus, neonates, infants, children and adults, not only during
pregnancy and the baby's first year, but throughout life.
If the magnesium citrate still causes diarrhea, you might try slow-release magnesium. Jigsaw Magnesium w/Sustained Release Technology (SRT) allows for maximum absorption without the diarrhea side-effect common to magnesium supplements.
Report: Lead Found in Vitamins by Michael Mooney, September
"To underline how safe multivitamins are, the amounts of lead in the supplements in FDA’s report are well below the amounts of lead found in many of the healthy foods that we consume safely every day."
Where to find out whether there's lead in your magnesium supplement [6/15/09]
It appears that the Calm products have pretty much the same ratio of lead/magnesium as other products. However, they recommend a higher daily dose, so then the daily intake for the recommended dose is also higher.
Here's the text of a letter from Gillham Products:
Peter Gillham’s Natural Vitality
2530 N. Ontario Street Burbank, Ca 91504
Natural Calm is and has always been a safe and healthful product. There was a recent question as to whether the higher therapeutic doses provided by Natural Calm meet the most stringent California Proposition 65 requirements for lead. We believe they do. The amount of lead in question was minute (far less than would be contained in a glass of drinking water or a salad), naturally occurring in our raw materials, and, even according to the president of the testing lab, not a health issue.
We nevertheless have tightened up our allowance on lead levels acceptable on raw materials, particularly our magnesium, which many of you know is derived from sea water. In addition, to assure compliance, our dosage per day is being dropped. As many of you may have noted in your correspondence to us, if our dosage had been in line with other companies we would have passed all tests.
This product will meet all Federal and California state
Customer Service Dept
(800) 446-7462 ext 121
Great article from Pregnancy
Basics from Pam Caldwell at HerbLore.
The body's demand for protein increases but ability to digest/
assimilate doesn’t. You may need to take an enzyme supplement to
help. Get a Nutritional Evaluation to find out which one.
I found that following the standard recommendations of
80-100 grams of protein daily (mostly high fat animal
protein) and consuming prenatal vitamin pills resulted
in a sluggish metabolism as my body labored to assimilate
and eliminate the excess that it could not use.
Isn't the FDA "standard" 60 gms of protein for pregnant women?
100 gms is a LOT of food to eat.
I usually recommend 75 gms, and many women have a hard time with that amount. I stress that there are days when they'll get a bit more and days when they'll get less.
Two vegan clients last month had babies weighing 7-11 and 8-10. They were not getting 75 gms daily. But they eat really well and a good amount of calories. I did not want to muck through all the info on the Hallelujah Acres site, but the recommendations of diet that I saw didn't even look like a normal vegan diet. Vegan diets are usually better than that.
Common sense says that if they are not eating well we will see it
prenatally. I give lots of nutritional info but I only see them
about 12 times throughout their pregnancy. They will eat what they
will eat and we probably don't always know what that means. I bet
many of you, like I, have been shocked at the birth when looking
in the cupboards of someone we thought was eating a lot better.
But they have usually grown a healthy baby and placenta and had a
and Easy Protein from Mother Nurture,
which focuses on practical help for the mother's well-being, and
for building teamwork and intimacy with her mate.
I find that if I just kind of lightly boil them, I still get the sweet, delicious, crunchy taste, and I figure I'm probably getting the protein. I still haven't found any reliable information about how much heat is needed to destroy the enzyme, but I figure lightly boiling should do it. (And, it turns out that this is an easy food to take to a birth, too! I just grab a bag out of the freezer, they defrost on the way to the birth, and then I boil them up while we're boiling the herbs. :-) [separate pot]. And I can snack on them throughout the evening/night/whatever.
I strongly recommend lightly boiled edamame to my pregnant
clients; one frozen bag of "edamame" is about 30 grams of protein
- 3 servings worth, but they're such a tasty "snacky" kind of food
for me that I have no problem eating a whole bag at a sitting or
two. They make a great snack for pregnant women to graze on
through the day.
Excess Calcium (not balanced by other minerals) can lead to
irritability by stimulating sympathetic nervous system.
Intake and Metabolism During Pregnancy and Lactation" in the
Journal of Perinatal Education,14 (1), pages 52-57.
online calcium resources from the Arbor Nutrition Guide.
- No. 20 1997 - Calcium throughout life
Magnesium from Nutrition
During Pregnancy: Part I: Weight Gain, Part II: Nutrient
Supplements (1990) from the Institute of Medicine (IOM)
Our local naturopath says that more than 500 mg of calcium at a
time can cause thyroid problems.
I would have to go through my resources, but I know there was a large randomized trial recently that showed a significant reduction in incidence of PIH with CA supplementation (does anyone out there know the one I am talking about? Was it the McMaster's study?). There was also a reduction in preterm labor. Pretty significant. I know that there is some controversy about whether calcium supplementation actually decreases blood pressure elevations once it has started to climb. Some of the literature I have read says yes, some says no. Elevations of BP in pregnancy and symptoms that suggest what we commonly call pre-eclampsia, in my opinion, are likely to be multi-factorial in origin, and researchers and clinicians are still not in total agreement about the pathophysiology involved.
I have seen separate reports of research which suggests that
calcium supplementation may also play a role in preventing or
decreasing essential hypertension, not pregnancy related. This is
of intense interest to me as I see a fair number of older women
and do lots of work around peri and post menopausal health issues
in my practice, and hypertension is a common problem in the
community where I work.
Study Shows Calcium Doesn't Reduce
Protein's role in preventing PIH is highly questionable.
I am taking my information primarily from Bonnie Worthington-Roberts book: Nutrition in Pregnancy and Lactation. This is an extremely well-researched and enjoyable text which I highly recommend. I quote:
"The notion that protein deficiency causes pregnancy-induced hypertension is a highly controversial issue. Brewer contends that consumption of adequate protein will obliterate PIH. For several years he ran a prenatal clinic in northern California in which the value of a high-protein diet was stressed. In 1971, a scientific review group examined the records of patients from the clinic and from the Contra Costa Hospital for the frequency of PIH from the years 1965 to 1970. The frequency of PIH in the patients seen by Brewer was not significantly different than in those patients not seen by Brewer (9 of 548 versus 12 of 367, respectively). In his analysis of the data, Brewer removed six of the cases from his group, stating that he had not seen two, one was in the project for only one week, and three had no evidence of PIH in their records. He also removed three cases of preeclampsia from the hospital. With these adjustments, there was a highly significant difference between the groups."
She goes on to summarize the studies that have shown a correlation between protein intake and elevated blood pressure and those which have shown no correlation. (These are probably the same studies Brewer refers to?)
The Temple University women received a protein-mineral supplement. (Doesn't say, but I bet calcium was one of those minerals.)
The Motherwell Scotland group also differentiated between "good diet" and "poor diet," the "good diet" consisting of high protein, low carbohydrate.
Of course, a large part of the Brewer diet is high calcium...it's pretty hard to differentiate between these two nutrients in human studies!
Her conclusion is:
"The role of protein deficiency in the etiology of preeclampsia
has not been satisfactorily proved or disproved. Research in this
area is lacking...Use of a protein supplement for prevention of
PIH is not appropriate."
Thanks for the reference opposing Dr. Brewer's work. One little bone to pick, however....is it not correct that Dr. Brewer's work was concerning Metabolic Toxemia of Late Pregnancy (MTLP) and not PIH? I've read a few things that state that PIH is a catch-all term and really isn't the same thing as MTLP. According to Anne Frye, hypertension in pregnancy is defined as a rise in systolic BP "of 30 points or more and/or a rise in the diastolic pressure of 15 points or more, on two occasions, at least 6 hours apart" (Understanding Diagnostic Tests...196). Frye later goes on to discuss how studies have shown that pregnant women who have normal blood pressure, hypertension, and toxemia all have varying BPs within this definitive "range."
I do agree that Brewer's diet is very high in calcium and
probably has a lot to do with its benefits for women
experiencing symptoms of PIH or toxemia. The main point is, I
don't think we should discount his ideas that diet and nutrition
can help a lot in these "mysterious" pregnancy diseases.
The calcium losing effect of protein on the human body is not an area of controversy in scientific circles. The many studies performed during the past fifty-five years consistently show that the most important dietary change that we can make if we want to create a positive calcium balance is to decrease the amount of protein that we eat each day--John A. MacDougall, M.D.
His two books, The MacDougall plan, and MacDougall's Medicine, should be required reading for anyone entering the health professions. Why isn't his name more widely recognized? For one thing, he's not on the payroll of the National Livestock and Meat Board or the National Dairy Council.
CALCIUM COMES FROM SOIL THAT PLANTS ABSORB AND INCORPORATE INTO THEIR STRUCTURE. Animals consume the plants that absorb the calcium. That's where cows get their calcium. Cows don't consume dairy products and yet they have all the calcium they need. How is it that cows have no difficulty whatsoever meeting all their calcium requirements for themselves and their young without ever having to consume even one glass of milk?
WHATSOEVER NUTRIENTS THE BODY NEEDS THAT IT DOES NOT ITSELF
PRODUCE CAN BE OBTAINED FROM THE PLANT KINGDOM. In other words, if
you can't get them from fruit, vegetables, nuts, seeds, sprouts,
and whole grains, you don't need them. Everything else you hear is
propaganda and is patently untrue. NUTRIENTS COME FROM THE GARDENS
AND THE ORCHARDS, NOT FROM THE PHARMACEUTICAL LABORATORIES OR DEAD
ANIMALS. (Fit For Life II: Living Health by Harvey and Marilyn
Calcium in Pregnancy Lowers Child's Blood
Low-Protein Diet Reduces Calcium
The Journal of the American Medical Association (JAMA) published a study that reported that consuming sufficient calcium during pregnancy can reduce the risk of PIH and pre-eclampsia. The researches found that 1500 - 2000 mg daily of calcium supplementation can lower the risk of PIH by 70% and the risk of pre-eclampsia by over 60%.
Most prenatal vitamin prescriptions only contain 200 mg of calcium, which I took during my first pregnancy and suffered from PIH. During my second pregnancy I took Twin Labs, which gave me 1200 mg a day, and an additional smaller supplement of calcium and magnesium. Then I also ate foods high in calcium like milk, cheese, yogurt, and broccoli. I had no problems during that pregnancy, labor, or birth with my BP.
Calcium is a natural pain reliever, so when I was in labor, I
took 2000 mg of calcium lactate with a glass of milk halfway
through my labor. I had read about it in Easing Labor Pain my
Adrienne Lieberman. Anyway, my contractions, even at the end of
1st stage, got to a certain level of discomfort, but never got
worse. It was close to a painless labor, because I listened to my
body and stayed upright and active.
When choosing a calcium supplement for the support of the
skeleton, the most preferred source in microcrystalline
hydroxyapatite as found in Cal-Apatite (microcrystalline
hydorxyapatite is the only calcium substance, documented in human
studies to regenerate lost bone density).
Questions..... Would anyone with a nutritionist background like
to translate this "2000 milligrams" into servings of
milk/dairy/broccoli/whatever? Can a non-dairy user get enough
calcium without supplementation, and if not, which supplements
would you recommend over calcium carbonate (and why?)?
First of all, I am stating that I am not a firm believer in the mega-calcium necessity during pregnancy! However, I am not prepared at this time to back that up with research so I'll let it slide...though I would like to remind everyone that high doses of calcium can also prevent zinc absorption. This would be a problem during pregnancy. I'd like to find out if those doing the mega-calcium studies are finding any corresponding zinc deficiencies?
Secondly, the best source of calcium is without a doubt seaweed! (Other sources: spinach (eat with rice to counteract oxalic acid problems), chard, broccoli, turnip greens, kale, beans, nut milks, seed butters (such as tahini), calcium-fortified soy milk, tofu made with calcium sulfate/silicate, comfrey, oat straw, nettle, dandelion greens, mustard greens, horsetail, chickweed, amaranth, watercress.) Seaweeds are not a major food source in America, but they /are/ in many parts of the world! 3.5 oz of cow's milk contains 118mg calcium (whose absorbability has already been argued here!). The same amount...3.5 oz...of hizkie (a mild-flavored seaweed) contains 1400mg; kelp, 1093mg; wakame, 1300mg. As you can see the amounts are incredibly higher. The calcium:phosphorus ratio is closer to the 2:1 which increases absorption, sodium levels (as mentioned by someone else today) are higher than in milk too.
"A diet based on leafy green vegetables and legumes will provide sufficient calcium, even taking into account the greater calcium absorption rate found in vegans. As Gill Langley reports in a 1988 survey of research on vegans, no finding of calcium deficiency in adult vegans has turned up." (Vegetarian Pregnancy, Sharon Yntema, 1994) The survey referred to is Vegan Nutrition: A Survey of Research by Gill Langley, Vegan Society, East Sussex, England, 1988.
More from Vegetarian Pregnancy:
"Some green vegetables, particularly spinach and chard, contain oxalic acid, which inhibits the absorption of calcium. There has been some evidence that long-term vegans adjust to plant greens as a source of calcium by developing the digestive ability to override calcium inhibitors.
"Rice, more than any other grain, contains a substance that neutralizes oxalic acid. If rice is eaten in the same meal with spinach or chard, the calcium in the greens becomes available once again. Remember, Popeye may have had rice pudding for dessert!
"Other greens, like kale, mustard greens, and collards, are very low in oxalates and are excellent sources of calcium. To assure sufficient calcium in your diet without milk, eat a variety of green vegetables, favoring spinach and chard with rice dishes and other greens with grains. Beans, nut milks, seed butters (such as tahini), and calcium-fortified soy milk are also good sources of calcium and should be incorporated into a vegan diet (especially) on a daily basis."
Here's a list of foods that can be exchanged for dairy because of their high calcium contents:
Almonds-2 oz. or 36 nuts
Bok choy, cooked- 1/3 cup
Brazil nuts- 2 oz. or 12 nuts
Brewer's yeast- 5 T.
Broccoli- 1 cup
Collard greens, cooked- 1/3 cup
Dandelion greens, cooked- 3/4 cup
Dulse- 1 oz.
Eggs, whole- 4
Kale- 1/2 cup
Kelp- 1/2 oz.
Molasses, blackstrap- 2 T.
Mustard greens, cooked- 1/2 cup
Sesame tahini- 2 T.
Soybeans, cooked- 1 cup
Tofu- 3 1/2 oz., 3x3x1/2 in.
Sunflower seeds- 3 1/2 oz. or 2/3 cup
Wheat germ- 4 1/2 oz.
Increasing calcium and eating dairy really don't have to have much to do with each other. You were right when you said that there are nuts and other things that contain calcium -- more are listed below (I also agree with the "too much fish" stuff, btw ;-) ). I had to give dairy up for allergy reasons.
I have discovered many interesting things since giving up dairy. One of the biggest shocks to me was to discover that the calcium in milk products is not very usable because of the high levels of phosphorus in the milk. If anyone is interested in more info on that, I can give you more sources to do some digging. So, if you want to increase your calcium, according to the things I have read (that are not put out by the dairy industry) then decreasing your dairy intake can actually be one step, and would then allow you to meet both of your goals during your next pg: decreasing you dairy intake and increasing your calcium through diet and supplements. They don't have to be mutually exclusive!
I know that I, for one, ate a ton and a half of dairy during the pg when I ended up almost dying from eclampsia. I also was not eating other foods high in calcium or taking a calcium supplement beyond what was in my pre-natal. At all. So it leaves me with some speculation anyway.
And btw the good news is that the calcium found in the other
foods is much more usable by our bodies. Leafy green
vegetables, almonds, tahini, kidney beans, tofu and broccoli are
all great sources of calcium. I also still take a calcium
supplement -- especially if my legs start aching. One of the best
sources of information to look in is books about vegan eating
(vegetarian w/ no eggs, meat or dairy). I am not eating a vegan
diet currently (my Polish/German dh would rebel, I think ;-) ),
but I find these excellent sources for recipes to add to our
collection since my youngest son and I can no longer have dairy
I'm confusing myself please help me....if an infusion is one
ounce of herb in a quart jar covered with boiling water lid put on
steeps for 8+ hours yielding double strength of tea then...does
that mean 4 cups infusion = 8 cups f tea = 30mg calcium or does it
mean that four cups infusion has 60mg of calcium?? What about a
tincture? I tell my clients 4 cups of infusion per day or 60 drops
of tincture. How do they really compare? How much calcium is in 60
drops of tincture??? Susun Weed where are you???
An alcohol based tincture doesn't extract a large amount of
calcium from the herb- a vinegar based one would be better, and a
glycerin based one would be essentially worthless for this use.
The amount of calcium in the red raspberry is in the dried herb -
the infusion of hot water extracts what is already in there, so if
you infuse it a short time, then you're only getting a portion of
the available calcium. Numbers are very difficult to pin down,
because it would require the standardization of the herb (Let this
NEVER be! ) : ) But my gut feeling on this is that it is a high quality
source of calcium , very easily assimilated, and besides that,
Rubus has so many other time proven benefits as a uterine tonic ,
that it should be recommended for all pregnancies, except in the
early trimester if one has a prior history of miscarriages or a
"sensitive" uterus. What I've recommended to my clients is a
wonderful combination sold by Blessed Herbs that includes Alfalfa,
Oatstraw, Nettles, Rubus, and Rose Hips. 6oz (two tea bags) per
quart infusion, apprx 200-300 mgs of calcium. You could buy it in
bulk, like I do for my pregnancies. I personally throw in a
healthy handful of the mixture (more like 1/2 a cup) per quart.
In the midwifery practice that I work with, we have had NO high blood pressure problems in women who do the following: (A year ago we had a client who would not follow this) anyway:
Also -- quit working! Relax as much as possible with a nap and a walk every day.
It's pretty radical, it's very hard, but IT WORKS. Some people
don't think it's worth it -- but some people don't mind the
thought of pitocin inductions, either!
recommendations for 400 micrograms (0.4 mg) for all
women of child-bearing age.
Prevention of Neural Tube Defects from the Department of
Medical Genetics, Alberta Children's Hospital. Here are their
recommendations for dosage.
Why is Vit. D so important in pregnancy? Because it is essential for the absorption of minerals, and pregnant women need to absorb minerals (iron, calcium, magnesium) from their food and supplements in order to grow a healthy baby and sustain a healthy pregnancy.
NOTE - For some reason, most of the research studies measure vitamin D blood levels in nmol/L, while most labs report results in ng/mL. The conversion factor is roughly 2.5, i.e. 1 ng/mL is roughly 2.5 nmol/L. So, the target blood levels are 50–80 ng/mL (or 125–200 nM/L), but there's some controversy about this, mostly because newer research is increasing the healthy minimum. Here are recommended blood levels from a variety of sources:
The Vitamin D Council: 50–80 ng/mL (or 125–200 nM/L)
Quest Diagnostics: "levels < 20 ng/mL [are] indicative of Vitamin D deficiency, while levels between 20 ng/mL and 30 ng/mL suggest insufficiency. Optimal levels are > 30 ng/mL."
Important Vitamin D Update from Dr. Mercola [12/27/08]: 50-65 ng/mL optimal
Husbands: 40-65 ng/mL
Assess vit. D levels at initial labs with 25-hydroxyvitamin D
Recommend vit. D supplementation (vitamin D3-cholecalciferol) depending on vit. D levels:
50–80 ng/mL (or 125–200 nM/L): recommend maintenance
supplementation of 3800 IU daily [Note that this is an impractical
daily dose as most tablets come in 1000 IU tablets, so recommend
4000 IU daily instead]
< 50 ng/mL (125 nmol/L): recommend 5000 IU daily
> 80 ng/mL (200 nmol/L); recommend reduction in vitamin D supplementation until lower levels are reached.
Re-test after 2 months and adjust recommendations according to the above numbers. If necessary, re-test every 2 months until the test result is at the desired level: >= 50 ng/mL (125 nmol/L). It is considered safe to have levels as high as 80 ng/mL (200 nmol/L) as that's the level achieved by natural skin exposure. Daily doses as high as 10000 IU seem to be considered safe, although this number is mildly controversial. (Health Canada says 2000 IU a day is the safe upper limit, but numerous studies were dosing test subjects with 5000 IU daily, and no adverse effects were reported. )
Vitamin D supplementation is inexpensive, and testing can be expensive. It is less expensive to buy 5000 IU of vitamin D as a single tablet than as 5 tablets of 1000 IU each. [Thorne sells D-5000 at $13.50 for 60 capsules and D-1000 at $8.70 for 90 capsules. The respective daily cost of 5000 IU is 22.5 cents and 48.3 cents.] It's entirely possible that the most cost-effective approach would be to forego all testing and simply recommend a daily dose of 5000 IU. There is strong evidence that this is safe and efficacious for almost all pregnant women. (In fact, I don't know offhand of any reason this wouldn't work in an essentially healthy women. There are some weird conditions that affect vit. D absorption, which might be detected with followup vit. D bloodwork.) The greatest value of the initial vit. D assessment is to convince women that they are deficient; many of my clients tell me they get lots of sunshine, yet they are deficient, even at the end of the summer months.
In my own practice, it was interesting that several clients with
BV were deficient in vit. D, just as the research predicts.
This protocol was effective in rising serum 25OHD of most vitamin D insufficient patients with a BMI less than 25kg/m(2), but not in overweight patients. As almost one half of our patients had a serum 25OHD level less than 30ng/mL at M2, we suggest that regular doses should be started quite soon after this initial supplementation.
Linked to Lower Risk for Female Pelvic Floor Disorders
Liver Oil and additional information about vitamin D from
The Weston A. Price Foundation - also lists good/better/best
D - contains an interesting table of levels of vitamin D
supplementation necessary to bring blood levels up to normal over
a six-month period.
More Vitamin D? from Dr. Andrew Weil - The more I read about all the benefits of vitamin D, the more I wonder if there’s any harm in taking more than the 1,000 IU per day that you recommend. Is there?
Vitamin D by Dr. Andrew Weil
The NIH has a very good
fact sheet on vitamin D.
Testing done through grassrootsheath.org
is only $40, much more resonalble than most labs.
From a highly respected pregnancy nutritionist: "My favorite way
of supplementing vitamin D is using drops from Carlson's. They
some in 2000IU in a coconut oil base, are tasteless and very
economical. Purchased online, a bottle containing 365 drops is
only $11. I do think it is important to recognize the vitamin
A/vitamin D connection, as a couple of studies have shown a
correlation between vitamin D supplementation in children and
increased incidence of asthma (a symptom of vitamin A deficiency).
I tell my clients to take cod liver oil in addition to drops; the
brand I recommend has 5000IU A/2000 IU D in one teaspoon, so they
take one drop of the Carlson's 2000IU vit D drops in addition for
a total of 4000IU of vitamin D a day. Hopefully most
pregnant women are getting at least 1200mg of calcium a day
anyway, but vitamin D supplementation will increase heavy metal
uptake if calcium is not supplied in the diet, so it is important
to include that as well."
A 2009 study on vitamin D deficiency in newborns with acute lower respiratory infection (ALRI) confirmed a strong, positive correlation between newborns’ and mothers' vitamin D levels. Over 87 percent of all newborns and over 67 percent of all mothers had vitamin D levels lower than 20 ng/ml, which is a severe deficiency state.
of subclinical vitamin D deficiency in newborns with acute lower
respiratory infection and their mothers.
Karatekin G, Kaya A, Saliho?lu O, Balci H, Nuho?lu A.
Eur J Clin Nutr. 2009 Apr;63(4):473-7.
RESULTS: The two groups were similar in gestational week, birth
weight, birth height, head circumference, age and gender. The mean
serum 25(OH)D concentrations in the study group newborns were
lower than those of the control group (9.12+/-8.88 ng/ml and
16.33+/-13.42 ng/ml, respectively) (P=0.011). Also, mean serum
25(OH)D concentrations in the mothers of the study group were
lower than those in the mothers of the control group
(13.38+/-16.81 ng/ml and 22.79+/-16.93 ng/ml respectively)
(P=0.012). In 87.5% of all newborns and 67.5% of all mothers,
serum 25(OH)D concentrations were lower than 20 ng/ml. The 25(OH)D
concentrations of newborns were highly correlated with mothers'
serum 25(OH)D concentrations.
CONCLUSIONS: Our findings suggest that newborns with subclinical vitamin D deficiency may have an increased risk of suffering from ALRI. The strong positive correlation between newborns' and mothers' 25(OH)D concentrations shows that adequate vitamin D supplementation of mothers should be emphasized during pregnancy especially in winter months.
between vitamin D deficiency and primary cesarean section.
Merewood A, Mehta SD, Chen TC, Bauchner H, Holick MF.
J Clin Endocrinol Metab. 2009 Mar;94(3):940-5. Epub 2008 Dec 23.
"Poor muscular performance is an established symptom of vitamin D
CONCLUSION: Vitamin D deficiency was associated with increased odds of primary cesarean section.
deficiency and supplementation during pregnancy.
Yu CK, Sykes L, Sethi M, Teoh TG, Robinson S.
Clin Endocrinol (Oxf). 2009 May;70(5):685-90. Epub 2008 Sep 2.
CONCLUSION: Single or daily dose improved 25-hydroxyvitamin D levels significantly. However, even with supplementation, only a small percentage of women and babies were vitamin D sufficient. Further research is required to determine the optimal timing and dosing of vitamin D in pregnancy.
intake to attain a desired serum 25-hydroxyvitamin D
Aloia JF, Patel M, Dimaano R, Li-Ng M, Talwar SA, Mikhail M, Pollack S, Yeh JK.
Am J Clin Nutr. 2008 Jun;87(6):1952-8.
CONCLUSIONS: Determination of the intake required to attain serum 25(OH)D concentrations >75 nmol/L must consider the wide variability in the dose-response curve and basal 25(OH)D concentrations. Projection of the dose-response curves observed in this convenience sample onto the population of the third National Health and Nutrition Examination Survey suggests a dose of 95 microg/d (3800 IU) for those above a 25(OH)D threshold of 55 nmol/L and a dose of 125 microg/d (5000 IU) for those below that threshold.
response to vitamin D supplementation among postmenopausal
African American women.
Talwar SA, Aloia JF, Pollack S, Yeh JK.
Am J Clin Nutr. 2007 Dec;86(6):1657-62.
"On the basis of our findings, an algorithm for prescribing vitamin D so that patients reach optimal serum concentrations was developed. The algorithm suggests a dose of 70 microg (2800 IU/d) for those with a concentration >45 nmol/L and a dose of 100 microg (4000 IU/d) for those with a concentration <45 nmol/L. CONCLUSIONS: Supplementation with 50 microg/d (2000 IU/d) oral vitamin D(3) is sufficient to raise serum 25-hydroxyvitamin D concentrations to >50 nmol/L in almost all postmenopausal African American women. However, higher doses were needed to achieve concentrations >75 nmol/L in many women in this population."
Vitamin D Levels During Pregnancy Affect Childhood Bone Mass
during pregnancy and childhood bone mass at age 9 years: a
Javaid MK, Crozier SR, Harvey NC, Gale CR, Dennison EM, Boucher BJ, Arden NK, Godfrey KM, Cooper C; Princess Anne Hospital Study Group.
Lancet. 2006 Jan 7;367(9504):36-43.
INTERPRETATION: Maternal vitamin D insufficiency is common during pregnancy and is associated with reduced bone-mineral accrual in the offspring during childhood; this association is mediated partly through the concentration of umbilical venous calcium. Vitamin D supplementation of pregnant women, especially during winter months, could lead to longlasting reductions in the risk of osteoporotic fracture in their offspring.
The Importance of Vitamin D from Thorne
Understanding Vitamin D Cholecalciferol from vitamindcouncil.org
Test Values and Treatment for Vitamin D Deficiency from Dr. Mercola
Dr. Mercola's comments on the issue of Vitamin D in breastmilk - Pregnant women have an added reason to get their vitamin D levels checked. As the study shows, if a breastfeeding woman is deficient in vitamin D, then her breast milk and breastfeeding baby will be too.
Which test to use? Vitamin
Toxicity: Laboratory Support of Diagnosis and Management
Clinical Focus from Quest Diagnostics.
"Serum 25(OH)D measurements should be used to determine vitamin D deficiency or intoxication and to monitor patients receiving vitamin D therapy."
NOTE - Most people agree that the reference values from Quest Diagnostics are too low. Here's what Dr. Mercola says: Vitamin D Levels - 25 Hydroxy D: Deficient (< 50 ng/ml), Optimal (50-65 ng/ml), Treat Cancer (65-90 ng/ml), Excess (>100 ng/ml) You cannot get excess vitamin D from sun exposure.
during pregnancy, impact on bones in children
Javaid M, Crozier S, Harvey N, et al. Maternal vitamin D status during pregnancy and childhood bone mass at age 9 years: a longitudinal study. Lancet 2006; 367(9504): 36-43.
Maternal vitamin D insufficiency is common during pregnancy and is associated with reduced bone-mineral accrual in the offspring during childhood; this association is mediated partly through the concentration of umbilical venous calcium.
Vitamin D supplementation of pregnant women, especially during winter months, could lead to longlasting reductions in the risk of osteoporotic fracture in their offspring.
My friend who knows more about prenatal nutrition than anyone
else I know says that all pregnant women should be taking
supplementary vitamin C (up to 10,000 mg), vitamin D (up to 6000
units), lecithin and collagen, particularly Collageena.
I especially like New
Chapter "Perfect Prenatal" supplements because they contain
helpful probiotics, including L. acidophilus and especially B.
infantis, which will get passed on to your baby and help prevent
colic; they are available at Whole Foods and other health-food
stores. They contain recommended levels of folic acid, vit.
C and acidophilus, as well as an unspecified amount of choline.
Put one tab/cap/? in enough distilled or apple cider vinegar to cover it for 30 min. The vinegar closely simulates stomach acid as it takes about 30 min to break down supplements. If in 30 min it hasn't broken down at all, try a different supplement brand. If it doesn't break down, your body isn't getting it. Centrum has been found in the bottom of lots of porta-potties. Make sure your vitamins are working for you.
A great brand I've spotted in 3 years of looking is New Vision.
People have even slept better on that brand.
What do You think about the use (or abuse) of vitamins and minerals in ALL pregnant Women? No matter if the Patient is healthy.
I suggest a good nourishment, and only give iron (300 mg. fumarato ferroso) and acid folic (300 mcg.), in Patients with hemoglobin less than 12 g/100 ml. or hematocrito below 35% (Mexico city altitude 2,220 m.). In Patients with any vitamin deficiency, must give the specific vitamin.
A in pregnancy from The Arbor
Clinical Nutrition Update
Moderate Doses of Vitamin A OK in Pregnancy
"Effect of Vitamin A Supplementation on Plasma Progesterone and
Estradiol Levels During Pregnancy", Panth, Meena, et al.,
International Journal of Vitamin and Nutrition Research, 1991;61:
17-19. (Address: Dr. Leela Raman, National Institutes of
Nutrition, Indian Council of Medical Research, Jamai Osmania P0,
Hydrabad-500 007, A.P.,India)
1000 mg of vitamin C is not a good idea in pregnancy. Especially
since Amanda doesn't give any idea of how far along this pregnancy
is. In very early pregnancy, large doses of vitamin C can cause
miscarriage. Later in pregnancy, high doses of vitamin C can
result in a newborn with scurvy. Large maternal doses of vitamin C
can stress the newborn's kidneys. Also, during pregnancy or not,
large doses of vitamin C can cause diarrhea, which is certainly
unpleasant! Anyway, I wouldn't recommend 1000mg during the first
trimester or for any extended length of time later in pregnancy
Y'all aren't going to believe this one. The midwife I apprenticed with, who is an EXCELLENT midwife and is also a clinical nutritionist, used to recommend 1000 mg. Vit C per day, times the month you were pregnant. That's right at 9 mos. her clients were taking 9,000 mg. of Vit. C per day. She said she had researched it and had several reasons for this recommendation which I don't remember all of them now. A lot of what I remember had to do with building the strength of the blood vessel walls, increasing the elasticity of the skin (something to do with collagen I think), helping to prevent hemorrhage, assisting absorption of iron and we suspected it helped prevent Rh isoimmunization. She was really confident in this and recommended it no more than 2,000 mg. at a time, spaced out throughout the day. After the pregnancy was over the women would gradually decrease the amount - going down 1,000 mg. per day each week. She believed a healthy maintenance dose was 3,000 mg. per day, but I don't think most women stayed with that. I know I didn't. Now, there was pretty good compliance in her practice. These women rattled when they walked! (in addition to vitamin C, they took a PNV, Vitamin E, Calcium & Magnesium and in the last 6 weeks Alfalfa and in the last 5 weeks an herbal supplement.) I can verify that the women did not get diarrhea from this - they did build up to it slowly though as described.
I can also verify that there was no scurvy nor problems with baby's kidneys. Again - her protocol was probably the reason - she did explain that they had to protect against scurvy by going down gradually. I also did not see any miscarriages result from this that I know of, I only remember attending a couple of miscarriages with her and I don't think they were even taking very much vitamin C - one lost hers to an accident. I read one time that the amount they were talking about with this incidence of Vitamin C causing miscarriage was 10,000 mg. per day in first trimester. (Sorry, this is probably not valuable to y'all because I don't remember where or when I read this.) She never transferred for sutures and I didn't get to see her suture until the end of my apprenticeship (about 100 births or so - I don't even think it was a second degree). I read in Susan Weed's book (Wise Woman Herbal for the Childbearing Year) that she suspected high Vit. C might help reduce the chances of Rh isoimmunization. This midwife's practice is anecdotal, but of about 25 Rh- women I watched her follow - none of them got RhoGAM and none were sensitized. (She always followed up with lab work if they didn't get RhoGAM) One of the mom's had an IUFD that went undetected for 3 days until labor (at 37 weeks) and had a still birth. (Baby had the kind of Down Syndrome accompanied with heart defects that is incompatible with life) She was Rh- and I was really surprised she didn't get sensitized. Should I have been? Or was there really no reason for her to be sensitized? I remember that the umb.cord was just full of clotted blood.
Anyway, in my partnership practice, we continued with the Vit C recommendation since we both had apprenticed with her and my partner was really sold on the idea of the Vitamin C. I always made it real clear though, that this was not the standard of care of physicians or even most midwives, and they could do what they wanted to about the Vitamin C. We didn't have as good compliance with the suggestion.
When my partner retired last year. I quit with the Vitamin C. I have not done the same research as my Sr. midwife or even read up on it specifically and I just wasn't comfortable doing this just because she did it. Even though it appeared she had good success. I recommend 1,000 mg. per day though, as part of their prenatal diet.
The point of my bringing all this up, is because I think the FDA
or AMA or whoever, is brainwashing us with "recommendations" of
what is safe and what isn't in the vitamin world. I for one don't
believe we get good nutrients from our food anymore because of
soil depletion, cooking, farming changes, pollution, etc. I also
don't think a lot of the supplements on the market make much of a
difference. I'm not a religious vitamin popper, but I think I
should be. I just thought this anecdotal information might be
interesting to y'all and see what other's think.
I don't claim to be an expert, but in my research and experience,
1000 mg of Vit C is not an amount large enough to cause
miscarriage or diarrhea or any ill effects at all, and actually,
far from it. Any others' experience or opinions on this? I am very
I recommend 1,000 mg. per day though, as part of their prenatal diet.
The point of me bringing all this up, is because I think the FDA
or AMA or whoever, is brainwashing us with "recommendations" of
what is safe and what isn't in the vitamin world. I for one don't
believe we get good nutrients from our food anymore because of
soil depletion, cooking, farming changes, pollution, etc.
I agree. 1000 mg is not much at all. I have no problem with women
taking larger doses - up to 10000mg (10 grams). I am a diehard
Linus Pauling fan.
Lots of midwives here advise "large" amounts of vit C in pregnancy, and are really sold on the (perceived) results -- less preterm births, less greatly lessened PROM etc.
Lots of experiences with women who "always" rupture membranes before labor, who stay intact with the next pregnancy if they use vit C.
I'd be interested where your midwife/teacher found solid research on it though -- it seems to be pretty rare, and all I know of is anecdotal.
I feel a bit more comfortable with lower amounts than 9 gms at term! - - - but lots of folks here on the left coast are into high-dose vit C, and we commonly find moms taking a gram or two per day -- and increasing that amount if ill.
I think it would be hard to find anyone in this region who would
agree that vit C should be considered a miscarriage risk. if
anyone has data we would LOVE to hear it!
My partner and I started getting them down to about 6 gms per day
at 9 mos. because it seemed like there were too many over due
moms. In my Sr. midwife's practice, we practically never saw a
baby before it's due date.
Well, I've looked all over and can't find my references on
Vitamin C use in pregnancy- : / but it was a great study (
not American) and they were using MEGA doses of C and getting
really interesting results....I'll keep looking. Meanwhile, you
can check out Anne Frye's Understanding Lab Work if you consider
her a good reference- I consider 1000mg a therapeutic dose but by
no means a mega dose- if one experienced runny stools I would
recommend backing off a few mgs and building up slowly.
a good vit c with bioflavinoids would work for RH- but it has it
be a complete c with bioflavinoid and rutin which strengthens the
vein walls and can prevent interbleeding.
In one of my classes we discussed abortion methods and included
herbal and alternative methods. Vitamin C, was one of them in
doses above 10,000 mg (10gm). I was shocked that anyone could
tolerate that high of a dose. I think that the vitamin C may not
actually cause the abortion through direct action on the
embryo/fetus or uterus/lining, but cause severe toxicity in the
mom and thus make the body a hostile territory for implantation
and growth. I have no scientific studies, or any other
information, but was taught this in class. On the other hand I was
also taught that 500mg-1000mg was a good dose for someone who was
attempting pregnancy, along with Vit E 400 iu-600iu. Any opinions
or experience on that one?
I've seen scurvy. A pregnant, 17 yo in Pasadena Tx. She had a
sore tongue, red eyes, and some kind of skin lesions. The
nurse-practitioner was convinced it was scurvy. The girl denied
eating any fruit or vegetable we named except french fries. No
bananas, no apples, no salads, no no no. It was quite amazing. I
still wonder about it. She must not have eaten much cereal either,
there are vitamins in most of them. She was tall and not to
skinny. Didn't look sickly, otherwise.
Working with a woman hesitant about a homebirth because she was a bleeder - recommended over-the-counter vitamin K, one pill per day, taken for just one week before the birth.
We found a little blood on the chux that she sat on for 2 hours
afterward, but no blood in bowl, no blood when she got up, just --
no blood. This would be unusual for any of my clients, but
especially someone that is supposed to be a heavy bleeder.
We've been using chlorophyll for a long time, and I like the
results I get with it, but I know that some of the midwives I used
to know always insisted on kelp. I also know that some use
alfalfa. Does anyone know that vit K content of these three
substances? I've never been able to find the vit K content of
Most swear by alfalfa tablets or capsules here.. At least four a day and the more the better -- - -and (anecdotally) we seem to see very little bleeding with the moms who us lots of alfalfa.
Vit K OTC might be just fine.... I remember hearing worries about
"too much" causing blood clots and other problems... How much is
We used to recommend 8 a day. Even after 4 a day by the end of the pregnancy, most women will complain of what I call the bovine burps
VitK OTC comes in 100 mcg doses. I just recommend 1 every other
day or 1 a day if she's a bleeder. If she has varicosities she
shouldn't use vit k
Do you rec. all your moms take alfalfa then? Are most of them
taking it throughout preg or towards the end? I'm always pushing
chlorophyll and getting the "can't tolerate the taste" response.
Alfalfa is such an affordable food supplement, why didn't I think
My midwife "prescribes" calcium/magnesium/zinc supplements, red
raspberry leaf, kelp or seaweed, Vit C, - towards the last few
weeks, she will have me begin taking evening primrose too. For low
energy she recommends liquid chlorophyll.
I took red raspberry, red clover tinctures as uterine tonics. For my iron, I took dandelion, nettles, and yellow dock. I took the Pregnant/Lactating formula prenatal vitamins by Twin Labs - these have 1300 mg calcium. Adequate calcium in pregnancy (above 1200 mg) has been show to reduce the risk of pregnancy induced hypertension and pre-eclampsia. I took extra vitamin b-6, for nausea in the beginning and swelling at the end, (25 mg, 2x a day). I also used skullcap tincture for the occasional headache. At the end, I used an antioxidant formula in addition to everything else - my midwife said it would reduce my risk of hemorrhage. I also used evening primrose oil.
In labor, I took 2000 mg of CALCIUM LACTATE with a big glass of
milk. I read about this on p. 85(?) of Easing Labor Pain. It was
suggested that some women who did this experienced much less pain.
I AGREE! I had a much easier time, I was laughing between
contractions when I was at 8 cm. I got into the birthing tub at
8cm, and Amanda was born 15 minutes later.
Food Supplements During Pregnancy? Study Shows Risky
Peanut allergies, children and pregnancy from the March of Dimes - Women who are allergic to peanuts should not eat peanuts or peanut products during pregnancy or at any other time. Studies suggest that women who are not allergic to peanuts can safely eat peanuts during pregnancy.
A visible sign of zinc deficiency is white specks on fingernails. Or you can buy a zinc sulfate solution from most online supplement stores (sometimes called 'zinc status'). If it tastes like water, you're likely deficient, if it tastes bad, then you're probably okay.
One way to test for a deficiency of stomach acid is to eat beets
and see if any of the red beet pigment shows up in your urine. The
pigment in beets is denatured at a pH of 3-4, and your stomach
should be more acidic than that. So if the pigment is
surviving long enough to be absorbed into your bloodstream, it's a
pretty good bet that more stomach acid (HCl) would be
helpful. The two main ways I know of increasing HCl are
supplementing zinc and eating fermented foods or other foods high
in histamine with meals. Dietary histamine promotes the
release of stomach acid.
Unsafe for Children from Randall Neustaedter OMD
Eight Glasses of Water a Day? from Dr. Mercola