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As an expecting mother, despite all the excitement and the anticipation, there are indeed many things to worry about and proper nutrition during pregnancy might be one of them. Aspiring to give your baby a strong healthy start to life and to ensure their flourishing growth, you might be wondering what types of food or nutrients to actively incorporate in your diet throughout the duration of your pregnancy.  

If this is your situation, you have come to the right blog post! Wellspring Nutrition is here to clear up any confusion and steer you to the right path of healthy eating for you and your baby.     

While doing your research, you have likely come across recommendations regarding the different B vitamins, vitamin D &C , calcium, omega 3 fatty acids, iodine, iron, folate, choline and so on…  

Some of these may sound familiar while for the others not so much. This might become a bit overwhelming. 

Thus, in today’s blog post, we will specifically breakdown the importance and the purpose of choline, a potentially overlooked but critical nutrient that pregnant women are highly encouraged to consume adequate amounts of and how you can add them to your prenatal nutrition repertoire.   

What is choline?

Choline is a nutrient that plays an essential role in the physiological process of living organisms, as it supports metabolic functions, maintains the structural integrity of cells, and aids the activities of the brain and nervous system. They are present in many of the foods that we are already familiar with (more on this later in this article!), although they are also naturally produced in the human liver. Despite this, many people, including pregnant women, do not reach the recommended intake of choline set by the Institute of Medicine (IOM). As a matter of fact, the National Institute of Health (NIH) reports that 90-95 percent of pregnant women do not consume the adequate intake (AI) of choline. For pregnant women, this AI is set to be 450 milligrams per day, while for lactating women, it is 550 milligrams per day. This is because lactation further increases the bodily demand of choline due to the rich source of choline in human breast milk, making choline a crucial nutrient postpartum as well.   

Why is choline intake during pregnancy so important?

Choline assists the anatomical development of the fetus, and consuming the sufficient intake level is associated with decreasing the likelihood of certain birth defects. Several studies also link adequate choline consumption to an improved cognitive function and development for the fetus. Let’s look at these one by one.

Development

Choline plays a crucial role in the overall physical growth of the fetus, particularly for the establishment of the spinal cord as well as the proper brain and neural pathways development especially in the hippocampal region, where its core features involve attention, learning and memory. Choline also supports cellular growth, transportation of macronutrients from the mother to the baby and provides anti-inflammatory benefits during pregnancy. Because certain  neurodevelopmental processes of the baby are completed within the duration of the pregnancy, it is important to be conscious of not being deficient in such key nutrients.

Healthy Birth

Research suggests that choline deficiency during pregnancy is linked to the increased risk of Neural Tube Defects (NTD) while the risk decreases with higher choline consumption. NTD is a serious condition where the neural tube, which is responsible for the initial development of the brain and the spine, does not go through proper closure. The Center for Disease Control and Prevention (CDC) reports that a spinal cord defect and a brain defect are the two most common forms of NTD.  

Additionally, choline supplementation may help prevent premature birth. This is because docosapentaenoic acid (DHA), a type of omega 3 fatty acid, has recently been found to be associated with decreasing the likelihood of a preterm birth, and studies have shown that choline supplementation could be a effective approach to increase the availability of DHA in our body. 

Cognitive Function 

Maternal choline intake during pregnancy is also potentially associated with the improved long-term cognitive function of the child although further research is needed to support this claim for humans (Many of the previous studies are done on rats and mice…). 

There are however several human studies that indicate a strong connection between improved cognitive outcomes such as for information processing speed, memory and learning ability of the child and higher prenatal intake of choline. This may be unsurprising considering how as discussed earlier, adequate choline intake provides the foundation for the healthy neurodevelopment of the fetus.  

What food should I eat for choline? 

So, how can we achieve this 450~550 milligram-a-day goal? 

Here are some foods that are excellent sources of choline:

• chicken
• salmon
• eggs
• beef
• milk
• legumes
• quinoa
• pork
• wheat germ
• tree nuts such as almonds and pecans
• cruciferous vegetables

For more information, we suggest checking out the USDA Database for the Choline Content of Common Foods to make more informed food consumption decisions!

Should I take supplements? 

Animal food products such as whole eggs, meat and seafood contain the most concentrated amount of choline.  If you are on a vegan or a vegetarian diet and are concerned about not hitting the daily choline intake goal, the Dietary Guidelines for Americans 2020-2025 (chapter 5 covers all of the basics of nutrition during pregnancy) recommend consulting a healthcare specialist for guidance of whether or not taking choline supplements would be suitable for you. It is important to note that many prenatal supplements contain an insufficient amount of choline if any at all. Thus, it is recommended to seek out dietary supplements that consist only of choline, or a combination of choline and B-complex vitamins. These usually contain somewhere between 10 milligrams to 250 milligrams of choline per dose.   

The Dietary Guidelines for Americans 2020-2025 reports that many Americans including pregnant women are failing to meet the recommendations for the consumption of different food groups and subgroups such as vegetables, fruits, grains, and proteins. These are food groups/sub groups that contain choline and other essential nutrients that aids a healthy pregnancy.    

We will be releasing more articles to spread increased awareness of the importance of prenatal nutrition so please stay tuned and we look forward to seeing you again! 

References 

1. Caudill MA, Strupp BJ, Muscalu L, Nevins JEH, Canfield RL. “Maternal choline supplementation during the third trimester of pregnancy improves infant information processing speed: a randomized, double-blind, controlled feeding study.” FASEB J. 2018;Apr;32(4):2172-2180. doi: 10.1096/fj.201700692RR. Epub 2018 Jan 5. PMID: 29217669 PMCID: PMC6988845
2. “Choline.” https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/
3. “Dietary Guidelines for Americans.” 2020-2025, https://www.dietaryguidelines.gov/food-sources-calcium
4. “Facts About Neural Tube Defects.” https://www.cdc.gov/ncbddd/birthdefects/facts-about-neural-tube-defects.html#:~:text=NTDs%20occur%20when%20the%20neural,anencephaly%20(a%20brain%20defect).
5. Irvine N, England-Mason G, Field CJ, Dewey D, Aghajafari F. “Prenatal Folate and Choline Levels and Brain and Cognitive Development in Children: A Critical Narrative Review.”  Nutrients. 2022 Jan; 14(2): 364. doi: 10.3390/nu14020364 PMCID: PMC8778665 PMID: 35057545
6. Korsmo HW, Jiang X, Caudill MA. “Choline: Exploring the Growing Science on Its Benefits for Moms and Babies.” Nutrients. 2019 Aug; 11(8): 1823. doi: 10.3390/nu11081823 PMCID: PMC6722688 PMID: 31394787
7. “Science Update: High-dose DHA influences immune responses during pregnancy, may reduce risk of preterm birth.”

https://www.nichd.nih.gov/newsroom/news/012122-DHA#:~:text=longer%20being%20updated.-,Science%20Update%3A%20High%2Ddose%20DHA%20influences%20immune%20responses%20during%20pregnancy,reduce%20risk%20of%20preterm%20birth&text=Taking%20supplemental%20docosahexaenoic%20acid%20(DHA,the%20risk%20of%20preterm%20birth.

8. Zeisel SH, da Costa KA. “Choline: An Essential Nutrient for Public Health.” Nutr Rev.  2009 Nov;67(11):615-23. doi: 10.1111/j.1753-4887.2009.00246.x. PMID: 19906248 PMCID: PMC2782876

If you are currently pregnant you are most likely encountering quite a lot of surprising changes to your body. It is normal for your body to experience certain levels of discomfort, as the mother’s organs, especially the lungs, kidneys and heart get strained due to the fetus’ need for oxygen and nutrients, and the elimination of waste products.   

Thinking about the health of you and your baby during pregnancy can be overwhelming. There are numerous health complications that may occur and thus maintaining your well being can be a challenging endeavor. 

Today, we will specifically discuss gestational diabetes, a health condition during pregnancy that has been on the rise, and tips on how to manage it.  

What is Gestational Diabetes? 

Gestational diabetes is diabetes (excessively high blood glucose/sugar levels) that may occur during pregnancy. 

An organ called placenta that supports the growth and development of the baby forms in the mother’s uterus during pregnancy. The placenta synthesizes hormones that reduce the effectiveness of insulin, a type of hormone that is secreted by the pancreas. 

When food is consumed, insulin controls the storage and the usage of the blood sugar. Therefore, because insulin is less effective during pregnancy, a modest increase in blood sugar levels is common and a normal part of pregnancy. However gestational diabetes is detected when this increase in blood sugar becomes excessive. 

This type of diabetes usually goes away once the pregnancy is over but it has potential long term consequences for both the mother and the baby. Having gestational diabetes increases the likelihood of the mother developing type 2 diabetes later in life. It is also linked to the development of obesity and type 2 diabetes for the child.  

Wellspring Nutrition has compiled a list of five tips that can help you get through your pregnancy in the most healthful way possible, especially if you are struggling with gestational diabetes or have risk factors.   

Tip #1: Exercise

Research suggests that consistent physical activity during pregnancy reduces the risk of gestational diabetes by 50 percent.  

The recommended amount and level of physical activity depends on how active you were prior to pregnancy, but the general recommendation is 150 minutes of low to moderate intensity physical activity per week. Here are some examples of activities that are generally safe to do: 

• Walking
• Swimming 
• Light aerobics 
• Cycling
• Yoga
• Pilates
• Light jogging 

If you were very active before pregnancy, you should be able to maintain the same level of activeness but it is best to consult with a health care specialist first.  

Other than lowering the risk for gestational diabetes, there are many benefits to staying active during pregnancy for both you and the baby. For the mother, physical activity can also lower the risk for gestational hypertension, high blood pressure during pregnancy. Staying active also boosts cardiovascular function, decreases back pain, contributes to better sleep, minimizes the loss of bone density due to pregnancy, and reduces edema (swelling caused by pregnancy) of legs and feet. For the baby, an appropriate amount of exercise leads to longer gestation (prevention of preterm birth), potential improvement for their brain development, and an increased likelihood of them having a healthy BMI during childhood.  

Please keep in mind, however, that there are certain types of physical activities that pregnant women should avoid. Activities that could lead to abdominal trauma must be avoided. These are few examples of physical activities that you should avoid: 

• Contact sports (soccer, wrestling, basketball, football etc.)
• Downhill skiing 
• Scuba diving 
• Horseback riding
• Heavy weightlifting 
• Hot yoga

Regardless of your background or your specific condition, if you are looking to stay active during your pregnancy, you should speak with your health care provider to ensure the safety of you and the baby.  

Tip #2: Being aware of optimal weight gain during pregnancy

Gaining weight during pregnancy is a natural and normal process. This is absolutely not the time to be attempting any kind of weight loss. It is also important to be mindful of what a healthy weight gain should look like during this critical period. 

During the first trimester, mothers should be consuming around the same amount of calories as prior to pregnancy and should be expecting around 2 to 4 pounds of weight gain. After the first trimester, gaining around 0.8 to 1 pound per week is considered to be ideal. During the second and third trimester, mothers should be consuming about 350 to 450 additional calories compared to their pre-pregnancy days. 

The optimal total weight gain is around 25 to 35 pounds for someone with a BMI in the normal range. If you are carrying twins, however, the optimal range is between 37 to 54 pounds.  

Tip #3: Eating quality carbohydrates

Controlling your blood sugar levels is essential for managing gestational diabetes. Choosing the right type and amount of carbohydrates to consume is a great place to start. 

Although skipping carbohydrates might sound tempting if you are worried about your blood sugar levels, this is never recommended. Carbohydrates supply energy for the placenta and it supports the healthy growth of your baby. There is no evidence for the effectiveness of a low carbohydrate diet for managing gestational diabetes and the general recommendation is a minimum of 175 grams a day, although it may depend on the individual.   

When consuming carbohydrates, choosing the type with a low glycemic index is highly recommended. The glycemic index of a food indicates how rapidly it causes the blood sugar level to rise.  Low glycemic index foods raise the blood sugar level much more slowly compared to high glycemic index foods, due to its slower rate of absorption.    

Mothers with gestational diabetes should avoid refined grains such as white rice, white bread, white pasta, and white flour as well as foods containing a lot of added sugars since they usually have higher glycemic index. 

The recommended carbohydrates on the other hand are starchy foods with high dietary fiber content such as whole/unprocessed grains, beans/legumes, vegetables, and fruits. 

Additionally, carbohydrate consumption should be spread out throughout the day- instead of eating a few big meals a day, having smaller meals distributed within a day helps control major blood sugar fluctuations.  

Tip #4: Watching your diet

Although pregnant women should consume more calories during their second and third trimester, the quality of your food should be prioritized over quantity. 

Other than carbohydrates, there are several macro and micro nutrients that you should be actively incorporating in your diet during your pregnancy especially if you are dealing with gestational diabetes.

Research suggests that consuming protein from lean meat (unprocessed), fish, and plants are favorable for the treatment of gestational diabetes. In fact, women with gestational diabetes are recommended to consume 350 grams of fish per week. Check out our blog about high protein foods here as well, as we talk about safe types of fish to consume during pregnancy. 

The overall fat intake for women with gestational diabetes should be around 20 to 35 percent of total energy intake and the consumption of saturated fat should be restricted.  

There are several vitamins and minerals that play an important role during pregnancy. Iron, calcium, folic acid (Vitamin B9), and 25-Hydroxyvitamin D are a few examples. 

Here are the Institute of Medicine (IOM) recommendations for these micronutrients:

• Iron: 27 milligram/day
• Calcium: 1000 milligram/day
• Folic acid: 600 microgram/day
• 25-Hydroxyvitamin D: 5 microgram/day

These dietary advice are not just specific to women with gestational diabetes but apply to all pregnant women to ensure a healthy pregnancy with the best possible outcomes.

Tip #5: Screening 

This is especially important if diabetes runs in your family or you are considered to be overweight prior to pregnancy. 

Although lifestyle modification is key for gestational diabetes management, visiting your healthcare provider and receiving nutritional guidance or possible clinical treatment tailored to your individual needs should be a priority as well.

It is recommended that all women regardless of a history of type 2 diabetes be screened between 24 and 28 weeks of pregnancy. If you have risk factors for type 2 diabetes, getting screened at your first prenatal visit is advised. Regardless of your health history, receiving prenatal care, especially during the first trimester is crucial as that is the most critical time for the baby’s development.

Looking for more support? 

Whether it is guidance regarding hormonal imbalances like PCOS, or any fertility or pregnancy concerns, Wellspring Nutrition has your back! Our fertility dietician is available for consultation. 

References: 

1. “Exercise During Pregnancy: Safe And Beneficial.” https://newsnetwork.mayoclinic.org/discussion/exercise-during-pregnancy-safe-and-beneficial-too/
2. “Insulin Basics”, https://diabetes.org/healthy-living/medication-treatments/insulin-other-injectables/insulin-basics
3. Rasmussen L, Poulsen CW, Kampmann U, Smedegaard SB, Ovesen PG, Fuglsang J. “Diet and Healthy Lifestyle in the Management of Gestational Diabetes Mellitus.” Nutrients 2020 Oct 6;12(10):3050. doi: 10.3390/nu12103050. PMID: 33036170

 PMCID: PMC7599681

4. Smith A, Colleen A, Spees C. “Wardlaw’s Contemporary Nutrition, 12th Edition.” McGraw Hill, 2022. 

1. “What Is Glycemic Index.” https://www.eatright.org/health/wellness/diet-trends/what-is-glycemic-index

If you are currently pregnant, the journey of sustaining a whole other life in your body probably feels like an extraordinary experience but at the same time, a great deal of responsibility ( in a positive way of course! ) 

Although there are many aspects relating to the healthy growth and development of the fetus that are beyond our control, one of the main factors that we do have control over is our lifestyle choices- namely our diet. 

There are a handful of nutrients that you do not want to be missing out on during your pregnancy to ensure the best possible health outcome for your baby. These include choline, iron, calcium, Vitamin D, iodine, and folate to name a few. 

If you recently found out that you are pregnant or are planning on conceiving, you are in luck! Today, Wellspring Nutrition is specifically going to highlight the importance of folate, and how this nutrient can be a powerful ally for preventing a common type of birth defect- the neural tube defect.     

What is a Neural Tube Defect?

Neural tube defect is a birth defect that affects the central nervous system of the baby. In a developing embryo, the neural tube is the precursor to their brain and the spinal cord. Neural tube defect occurs when the neural tube does not properly go through the closure process to complete its formation. The two common types of neural tube defect include: 

• Spina bifida (swelling or protrusion of spinal cord or fluid in the back) 
• Anencephaly (exclusion of a major segment of the brain) 

What is folate?

Folate, otherwise known as vitamin B-9, is found in various foods. As they play an important role in the nucleic acid (DNA and RNA) production and amino acid (the building blocks of protein) metabolism, they are crucial to the functioning of cells.    

Folic acid is its synthetic form- meaning folate that is found in dietary supplements and fortified foods. 

Why folate is important

The need for folate significantly increases during pregnancy especially because the event of a neural tube defect is closely linked to maternal folate deficiency. Inadequate folate intake can lead to a high homocysteine level in the blood, which is considered to be a risk factor for neural tube defect. Homocysteine is an amino acid and as it is broken down by the vitamin B-complexes, having a high level of this usually indicates deficiency in vitamins. 

According to a recent study, another risk factor for neural tube development is the lack of DNA repair function. Since folate is crucial to DNA synthesis, folate deficiency can lead to a loss in the integrity of DNA. Thus, the mechanism for DNA repair is going to be negatively impacted. Genome stability is an important aspect of neural development for the embryo, and adequate folate intake is necessary for a properly functioning DNA repair mechanism. 

The timing of sufficient folate intake is important to consider. Neural tube formation of an embryo is completed around three to four weeks after conception. This means that anyone trying to conceive should ideally start incorporating folate in their diet as soon as possible, even if pregnancy is yet to be confirmed. 

Even if you are reading this much further into your pregnancy, there are still reasons to consume an adequate amount of folate.  

Other than lowering the risks of neural tube defects, research shows that sufficient folate intake during pregnancy is beneficial for the neurodevelopment of the child. There is a study that links prenatal folic acid supplementation to a lowering of the risk of Autism Spectrum Disorder (ASD), and advancements to the cognitive, motor and intellectual functions of the child.     

What food should I eat for folate?

Although the general recommendation is about 400 micrograms a day, pregnant women are advised to consume about 600 micrograms of folate every day.   

Here are some food items that are good sources of folate to help meet this target:

• Beef Liver 
• Spinach
• Black-eyed peas
• Chickpeas 
• Asparagus
• Brussel sprouts
• Romaine Lettuce
• Broccoli
• Eggs

As you can see, leafy greens, legumes, and liver are the best sources.  

Moreover, it is important to note that folate tends to be sensitive to heat and oxygen.  Especially for the leafy greens, it is advised to eat them fresh or have them lightly cooked. In a study that compared the folate retention for different food products, for spinach, boiling led to only 49 percent retention of folate. On the other hand, steaming proved to be the best way to preserve folate in vegetables. Another good news is that the same study found that grilling beef for an extended period of time did not result in much loss of folate as well. 

Other than foods naturally present with folate, consuming grain products may be helpful as well. This is because starting in 1998, the U.S Food and Drug Administration (FDA) mandated a folate fortification of grain products such as bread, rice, cereal, flour, and pasta.

However, consumption of refined grain products should be limited during pregnancy to prevent significant spikes in your blood sugar levels.  

Looking for more support? 

Our fertility dietician Anabelle is available for one-on-one consultation and can help you address any of your concerns regarding fertility, pregnancy or hormonal imbalances like PCOS! 

References

1. “Chickpeas (garbanzo beans, bengal gram), mature seeds, cooked, boiled, without salt.” https://fdc.nal.usda.gov/fdc-app.html#/food-details/173757/nutrients

2. “Embryology, Neural Tube.”  https://www.ncbi.nlm.nih.gov/books/NBK542285/

3. “Folate.” https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/

4. “Folate and Folic Acid on the Nutrition and Supplement Facts Labels.”https://www.fda.gov/food/new-nutrition-facts-label/folate-and-folic-acid-nutrition-and-supplement-facts-labels#:~:text=For%20folate%2C%20the%20DV%20is,consume%20500%20mcg%20DFE%20daily.

5. Gao Y, Sheng C, Xie RH, Sun W, Asztalos E, Moddemann D, Zwaigenbaum L, Walker M, Wen SW. “New Perspective on Impact of Folic Acid Supplementation during Pregnancy on Neurodevelopment/Autism in the Offspring Children – A Systematic Review”PLoS One. 2016 Nov 22;11(11):e0165626. doi: 10.1371/journal.pone.0165626. eCollection 2016.PMID: 27875541 PMCID: PMC5119728 https://pubmed.ncbi.nlm.nih.gov/27875541/

6. “Homocysteine” https://my.clevelandclinic.org/health/articles/21527-homocysteine

7. McKillop DJ, Pentieva K, Daly D, McPartlin JM, Hughes J, Strain JJ, Scott JM, McNulty H.“The effect of different cooking methods on folate retention in various foods that are amongst the major contributors to folate intake in the UK diet.” Br J Nutr. 2002 Dec;88(6):681-8. doi: 10.1079/BJN2002733. PMID: 12493090 https://pubmed.ncbi.nlm.nih.gov/12493090/

8. “Pregnancy diet: Focus on these essential nutrients.”https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy-nutrition/art-20045082

9. Smith A, Colleen A, Spees C. “Wardlaw’s Contemporary Nutrition, 12th Edition.” McGraw Hill, 2022. 

10. Wang X, Yu J, Wang J.“Neural Tube Defects and Folate Deficiency: Is DNA Repair Defective?” Int J Mol Sci. 2023 Jan 22;24(3):2220. doi:10.3390/ijms24032220. PMID: 36768542 PMCID: PMC9916799 https://pubmed.ncbi.nlm.nih.gov/36768542/

Apple cider vinegarー the name surely gives it a cozy fall vibe doesn’t it? 

Vinegar in general has demonstrated numerous health benefits but apple cider vinegar (ACV) , which is made from fermented apples, in particular has been gaining attention from many health experts in recent years (And no, ACV is not seasonalー thankfully it is around all year).

If you were curious as to what makes ACV beneficial to our health, you have come to the right place! 

Blood sugar control:

Hyperglycemia, more commonly known as high blood sugar, affects countless people worldwide. This phenomenon is usually attributed to the lack of insulin in the body and is associated with both type 1 and type 2 diabetes. Insulin is a hormone that is secreted by the pancreas that controls what the body does with the energy obtained from food; it determines if it wants to use or store the blood sugar. 

Research suggests that ACV may assist with glycemic control- that is our blood sugar levels. 

Studies have shown that ACV consumption is associated with the overall reduction of blood glucose (sugar) levels. 

Therefore, the consumption of ACV may serve as an ally for diabetes management as well as prevention.     

Preventing cardiovascular diseases:

Now let’s talk cholesterol ー

Cholesterol travels throughout the bloodstream carried by “lipoprotein”, a type of protein. 

There are two types of these lipoproteins: 1) LDL (low-density lipoprotein) cholesterol 2) HDL (high-density lipoprotein).

LDL is commonly referred to as the “bad” cholesterol while HDL is referred to as the “good” cholesterol. Since HDL, along with the liver, helps get rid of the cholesterol in the blood, higher HDL level can contribute to lowering the risk of cardiovascular diseases such as stroke, heart attack and peripheral artery disease. 

ACV consumption was associated with higher levels of HDL for people who do not have diabetes. 

Furthermore, studies have found that for those with type 2 diabetes, ACV consumption was linked to an improved lipid panel- a blood test that serves as a screening for cardiovascular diseases. 

This blood test is based on cholesterol and triglycerides (a type of fat in our blood) levels. The buildup of these fats in the blood will lead to a hardening of the arteries and increase the risks of cardiovascular diseases. A decrease in both triglyceride and cholesterol levels in patients with type 2 diabetes was seen with the consumption of ACV.   

Overall, this suggests a positive association between our heart health and ACV.  

Antioxidative properties and other disease prevention: 

ACV is said to have antioxidative and anti-inflammatory properties. There have been several studies that have linked such properties to the potential prevention and the remedy of kidney/urinary stones.  

The kidney filters our blood, removes wastes from it and produces urine. It plays an important role in the body’s maintenance of the balance of fluid and minerals which is crucial for our physiological functioning.  

Kidney stones are relatively common and may unfortunately lead to chronic kidney diseases. Although ACV should not be relied on as a sole treatment, its therapeutic effect says a lot about its defensive nature against oxidative stress and inflammation in our body.  

Relatedly, ACV contains a phytochemical (compounds found in plants that can yield positive health effects) called flavonoid. Flavonoid have been found to have favorable effects on the following health complications: 

• angina pectoris
• cervical lesions 
• chronic venous insufficiency 
• dermatopathy
• gastrointestinal diseases 
• lymphocytic leukemia 
• menopausal symptoms 
• rhinitis 
• traumatic cerebral infarction      

Looking for more support? 

If you would like to get more inspiration- whether it is about how to specifically incorporate ACV into your meals or anything related to concerns regarding PCOS and/or fertility struggles   please feel free to check out our meal plans or any other services with our fertility dietician. We would love to provide guidance to your wellness journey!

References: 

1. “Familial Hyperlipidemia.” https://www.upmc.com/services/heart-vascular/conditions-treatments/hyperlipidemia#:~:text=Hyperlipidemia%20defines%20an%20elevated%20level,stroke%2C%20and%20peripheral%20artery%20disease.

2. Gambaro G,  Croppi E, Bushinsky D f,  Jaeger P g,  Cupisti Ad, Ticinesi A e,  Mazzaferro S c,  D’Addessi A b,  Ferraro PM.  “The Risk of Chronic Kidney Disease Associated with Urolithiasis and its Urological Treatments: A Review.” J Urol. 2017 Aug;198(2):268-273. doi: 10.1016/j.juro.2016.12.135. Epub 2017 Mar 10. PMID: 28286070
3. Hadi A, Pourmasoumi M, Najafgholizadeh A, Clark CCT, Esmaillzadeh A. “The effect of apple cider vinegar on lipid profiles and glycemic parameters: a systematic review and meta-analysis of randomized clinical trials.” BMC Complement Med Ther 2021 Jun 29;21(1):179. doi: 10.1186/s12906-021-03351-w. PMID: 34187442 PMCID: PMC8243436

4. “Hyperglycemia (High Blood Glucose)” https://diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hyperglycemia#:~:text=Hyperglycemia%20is%20the%20technical%20term,can’t%20use%20insulin%20properly. 

5. Kumar A, Nirmal P, Kumar M, Jose A, Tomer V, Oz E, Proestos C, Zeng M, Elobeid T, K S, Oz F. “Major Phytochemicals: Recent Advances in Health Benefits and Extraction Method.” Molecules. 2023 Jan; 28(2): 887. Published online 2023 Jan 16. Doi: 10.3390/molecules28020887 PMCID: PMC9862941 PMID: 36677944

6. “LDL and HDL Cholesterol and Triglycerides.” https://www.cdc.gov/cholesterol/ldl_hdl.htm

7. “Lipid Panel” https://my.clevelandclinic.org/health/diagnostics/17176-lipid-panel#:~:text=A%20lipid%20panel%20is%20a,a%20measurement%20of%20your%20triglycerides.

8. “Phytochemicals.” https://lpi.oregonstate.edu/mic/dietary-factors/phytochemicals

9. Singh AS, Singh A, Vellapandian C, Ramaswamy R, Thirumal M. “GC–MS based metabolite profiling, antioxidant and antiurolithiatic properties of apple cider vinegar.” Future Sci OA. 2023 Apr; 9(4): FSO855. doi: 10.2144/fsoa-2023-0035 PMCID: PMC10116371 PMID: 37090488

10. “Your Kidneys & How They Work”https://www.niddk.nih.gov/health-information/kidney-disease/kidneys-how-they-work

Protein plays a vital role in supporting our health and wellness. Without proteins, our body would have trouble forming blood cells and other crucial structures, as well as regulating and maintaining its various functions.

A “high-protein diet” has become quite a buzzword in the health and the wellness field in recent years, especially in the realm of body-building or weight loss endeavors.  As nutrition experts specializing in women’s health, we are going to specifically discuss the important relationship between sufficient protein intake and healthy pregnancy as well as potential impact for PCOS.

“I am currently pregnant- what should my protein intake look like?”

The current Recommended Dietary Allowance (RDA) for protein for adults is 0.8 grams of protein per kilogram of body weight. If a person weighs 154 pounds or 70 kilograms, 56 grams of protein would be the adequate daily intake.  

However, for pregnant women, this recommendation is slightly different. Although the RDA for the first trimester remains the same as regular adults (0.8 grams per kilogram), the second and third trimester requires about 1.1 grams of protein per kilogram of body weight.  

Furthermore, seafood consumption is highly recommended for pregnant women due to their positive association with young children’s cognitive development. Seafood is rich in healthy fats like ​​Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).The recommendation is 8 to 12 ounces of various types of seafood that is low in methylmercury each week. High exposure to methylmercury is harmful to both the mother as well as the developing fetus. 

Here are some of the best seafood choices (not an exhaustive list):

• Anchovy  
• Atlantic mackerel 
• Black sea bass 
• Butterfish 
• Catfish 
• Clam 
• Cod 
• Haddock
• Salmon
• Oyster
• Sardine
• Shrimp
• Tilapia
• Canned tuna
• Lobster 

On the other hand, here are the seafoods to avoid during pregnancy: 

• King mackerel 
• Marlin 
• Orange roughy
• Shark
• Swordfish
• Tilefish (Gulf of Mexico) 
• Tuna, bigeye  

*From the FDA’s “Advice about eating fish”

Blood sugar balance and pcos 

Insulin is a type of hormone that is secreted by the pancreas. When food is consumed, this hormone controls if the body wants to use or store the blood sugar. Previous studies have shown that with sufficient levels of insulin, protein does not increase blood sugar levels. This stabilizing effect was seen in patients with type 2 diabetes as well.       

Furthermore there was also a study that suggested that a high protein diet is associated with lowering hemoglobin A1C levels (blood sugar level). 

Studies have also shown that high protein and lower carbohydrate diets have led to a reduction in insulin resistance for women with Polycystic Ovary Syndrome (PCOS) who are also more prone to developing type 2 diabetes.        

What are the high quality, high protein foods?

There are both animal and plant sources for protein.

Animal sources include meats, poultry, eggs, dairy and seafood.  Plant sources include nuts, seeds, soy products, beans, peas, and lentils.

Processed and/or high-fat meats should be limited and instead fresh, frozen or canned forms of lean meat and poultry, seafood, and beans, peas, and lentils are recommended. 

There is an increased interest in plant-based diets so here are some good plant-based protein sources:

• Dairy alternatives such as soy milk and fortified nut or pea milk
• Whole grains such as chickpea pasta, oatmeal, quinoa, or whole wheat bread
• Nuts and seeds such as almonds, hummus, peanut butter, tofu or chia seeds
• Vegetables such as broccoli, edamame, green peas or lima beans

The average American adult meets the required amount of protein consumption although this target is achieved (and even exceeded) mainly through animal based protein foods. Seafood and plant-based protein are categories that many Americans are lacking in. 

Furthermore, despite the benefits that were mentioned in this article, it is important to keep in mind that more protein does not necessarily mean better. Overconsumption of protein has negative consequences as excess protein not only could get stored as fat but also could strain the kidneys as well. 

Looking for more support?

If you would like more guidance as to what type of protein sources to incorporate in your diet as well as the adequate amount, check out our meal plans for more inspiration! We would love to support your journey.      

References:

1. “Advice About Eating Fish.” https://www.fda.gov/food/consumers/advice-about-eating-fish
2. “Are You Getting Too Much Protein?” https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/are-you-getting-too-much-protein#:~:text=Extra%20protein%20intake%20also%20can,people%20predisposed%20to%20kidney%20disease. 

3. Murphy MM, Higgins KA, Bi X, Barraj LM. “Adequacy and Sources of Protein Intake among Pregnant Women in the United States, NHANES 2003–2012.” Nutrients. 2021 Mar; 13(3): 795. doi: 10.3390/nu13030795 PMCID: PMC7997328 PMID: 33670970
4. Dietary Guidelines for Americans 2020-2025, https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf 

5. Dong J, Zhang Z, Wang P, Qin L. “Effects of High-protein Diets on Body Weight, Glycaemic Control, Blood Lipids and Blood Pressure in Type 2 Diabetes: Meta-Analysis of Randomised Controlled Trials.” Br J Nutr. 2013 Sep 14;110(5):781-9. doi: 10.1017/S0007114513002055. Epub 2013 Jul 5. PMID: 23829939
6. Franz, MJ. “Protein: Metabolism and Effect on Blood Glucose Levels.” Diabetes Educ. 1997 Nov-Dec;23(6):643-6, 648, 650-1. doi: 10.1177/014572179702300603. PMID: 9416027
7. Gannon MC,  Nuttall JA, Damberg G, Gupta V, Nuttall FQ. “Effect of Protein Ingestion on the Glucose Appearance Rate in People with Type 2 Diabetes.” J Clin Endocrinol Metab. 2001 Mar;86(3):1040-7. doi: 10.1210/jcem.86.3.7263. PMID: 11238483

8. “Insulin Basics”, https://diabetes.org/healthy-living/medication-treatments/insulin-other-injectables/insulin-basics

9. Smith A, Colleen A, Spees C. “Wardlaw’s Contemporary Nutrition, 12th Edition.” McGraw Hill, 2022. 

10. Sørensen LB, Søe M, Halkier KH, Stigsby B, Astrup A. “Effects of Increased Dietary Protein-to-carbohydrate Ratios in Women with Polycystic Ovary Syndrome.”  Am J Clin Nutr. 2012 Jan;95(1):39-48. doi: 10.3945/ajcn.111.020693. Epub 2011 Dec 7. PMID: 22158730

Oatmeal contains high levels of minerals, such as magnesium and zinc, in addition to fiber and B vitamins. This makes it a great food option if you are struggling with PCOS. Oatmeal can be your quick fiber-rich breakfast, an afternoon snack or eaten really anytime of day! The ingredients are minimal, and you probably have them in your pantry already. It’s a win-win.

Which type of oats is best for PCOS?

The less processed it is the better! Instant oatmeal is the most processed form of oats. Then it’s old fashioned oats and lastly steel cut oats. Steel cut oats have a sharper texture than old fashioned oats that some people don’t enjoy. If it’s your preference, old fashioned oats would still be a healthy choice!

Which breakfast is best for PCOS? 

The best breakfast for PCOS is well balanced with lean protein, healthy fats, and whole grains/complex carbohydrates. As a bonus you could even add in some veggies, like if you were having a smoothie or eggs. 

Examples of lean protein choices for breakfast include:

• Eggs
• Nut butter (peanut, almond, etc.)
• Nuts and seeds (chia seed, ground flaxseed, etc.)
• Greek yogurt
• Leftover fish or chicken — Hey, who says breakfast has to be “breakfast food”? 😉
• Tofu
• Some plant-based milks with protein like Ripple

Healthy fats such as polyunsaturated and monounsaturated fats are also important in helping us to feel full. These fats give us energy to start the day off right! We can get these healthy fats from foods such as salmon, sardines, avocado, nuts (walnuts, pistachios) and seeds (for example chia and ground flaxseeds).  

And last but not least, don’t forget the healthy carbs! Most women with PCOS think they have to avoid carbs and this is simply not true. Fruit, whole grains/complex carbohydrates are considered healthy carbs.

Best fruit choices for PCOS:

• Whole, fresh fruit – all kinds!
• Frozen fruit
  • Most of the time frozen fruit does not have added sugar. So there is nothing wrong with eating frozen fruit. 
• Dried fruit without added sugars
  • Double check the nutrition facts label and try to avoid dried fruit with sugar. 
  • If it does have sugar remember this quick tip: Keep total added sugars under 25 grams per day for women. 

Examples of whole grains/complex carbs for breakfast include:

• Whole grain bread or English muffin
• Oatmeal
• High fiber, low sugar cereal
• Low sugar granola
• Plantains/potatoes

Best Oat Recipes For PCOS

Chocolate Peanut Butter Cup Oatmeal:

1/4 cup rolled oats
1/2 cup unsweetened nut milk
1 tbsp all-natural peanut butter
1 serving chocolate protein powder
2 tsp ground flax seeds
1 tsp chia seeds
sea salt to garnish

Instructions:

Mix oats, flax seeds, chia seeds and nut milk in a bowl.

Microwave for 1-2 minutes

Stir in peanut butter and protein powder.

Top with a sprinkle of sea salt.

Looking for more Support?

Be sure to check out our Free Live Masterclass all about the top 3 ways to naturally enhance your fertility (perfect for those struggling with PCOS and hormone imbalances!)