I’ve had some (panicked) questions about the recent articles on folic acid supplementation during pregnancy and increased risk of autism. Let’s chat science:
1. This study is what is called an Observational Study. Do these types of studies have their merits? Absolutely. Do they establish causation? Absolutely NOT. This study looked at blood levels of folate and B12 in newborns 24-72 hours after birth, and then the development of ASD later in life. A correlation was established. Correlation – just like how eating ice cream increases your risk of being bitten by a shark.
“LOGIC”: eating ice cream happens more in the summer –> the summer equals more people swimming in the ocean –> more people swimming in the ocean increases the risk of shark attacks, therefore eating ice cream –> increased risk of shark attack. Absurd.
Now it’s important to not simply throw out a study because it’s correlational. Correlational studies are the jumping off point for mechanistic studies. But, we can’t make recommendations, especially dramatic ones, on correlation.
2. No mechanism is established. But you know what we do have a mechanism for? Folate deficiency and neural tube defects. The neural tube is the part of the embryo that turns into the spine. It closes at 3 weeks post-conception, and REQUIRES folate to do so successfully. There is a known, causal mechanism for folate deficiency and NTDs like spina bifida. And the fact that it is required so early in pregnancy, before many women know they’re pregnant, shows how important it is to be taking folate (or eating a TON of leafy greens and chicken livers) prior to conceiving.
3. Population. Direct quote from the study:
“Data are from the Boston Birth Cohort…that recruited low-income urban, primarily minority mother-offspring pairs…followed them from birth through childhood…”
There are many confounding factors in that statement alone. For example, income is the number one determinant of health. This shows that it is important to analyze the actual study, instead of just reading a headline.
4. Folate vs. Folic Acid. Have you noticed that I’ve only used the word “folate” thus far? That’s because FOLATE is the food-based version of this important B vitamin. It’s the one the body needs and recognizes as usable. Folic Acid is a synthetic form of folate – it is not the same thing, and in some cases (usually with genetic anomalies) it can cause problems. Most people uses these 2 terms interchangeably but I cannot stress the importance of recognizing the difference. Finding a pre-natal supplement that contains FOLATE is challenging, but there are a few out there. You want to look for something that says “folate” or “active folate” or “methylated folate”. My favourite is Designs for Health, in combination with lots of leafy greens and regular liver consumption.
5. More isn’t better, it’s just more. As with all supplementation, more isn’t better. Follow your practitioner’s recommendations for the amount of folate to consume (just make sure it’s folate, not folic acid, and make sure that if your practitioner wants you to stop supplementing, they read the STUDY not the news article…otherwise get a second opinion.) Better yet, get most of it from your food. Leafy greens and chicken livers are your best sources!
6. Nutrients do not work in isolation. High levels of plasma folate and B12 indicate a metabolic issue – either stemming from a genetic anomaly (like the MTHFR mutation) or more often, other nutrient deficiencies. A diet high in all the nutrients (as in, not just from a pre-natal, but from consuming lots of vegetables, fruit, liver, meat, fish, eggs and quality fats) is required for all systems to function properly. Check out my free handout for a nutrient dense diet for fertility and pregnancy.
7. The media and nutrition. This is a post in and of itself, but to sum up quickly – the media should be ashamed of themselves for the way they create fear through headlines. No one ever reads the study before creating a shocking, and terrifying title. Case in point this study – the study authors conclusion:
“In this urban low-income minority birth cohort, we observed an elevated risk of ASD associated with high maternal plasma folate levels (>59 nmol/L), which far exceeds the excess cutoff suggested by the WHO (>45.3 nmol/L); however reported maternal vitamin supplementation was protective. Excess maternal vitamin B12 (>600 pmol/L) in pregnancy was also shown to be associated with greater ASD risk in offspring. The risk of ASD was highest if mothers had both excess prenatal folate and vitamin B12 levels. Our findings warrant additional investigation and highlight the need to identify optimum prenatal folate and vitamin B12 levels that maximize health benefits, at the same time minimize the risk of excess and its associated adverse consequences such as ASD.”
“Our work is very consistent with previous work showing that supplementation is critical to maternal health and child development and health, so at this point the recommendation is definitely to continue supplementation. What this study finds is that while maintaining adequate levels of folate is important, extreme levels may be harmful.”
What does all that mean?
Continue supplementing during pregnancy!
In summary, please do not freak out if you’ve been taking prenatals thus far. They are incredibly important (and this is coming from someone who prefers food over supplements most of the time!). Ideally switch to a version that contains folate, the active form of the nutrient recognized by the body. Keep the diet incredibly rich in nutrients by focusing on lots of leafy greens, quality meat & organ meats, egg yolks, fish, grass-fed dairy (if tolerated), bone broth and probiotic-rich foods (like sauerkraut & kombucha).
In an effort to share as much information as possible, this post is about my experiences around food during the first trimester of my first pregnancy. I kept this post in drafts for my first trimester, with the intention of sharing my experiences, so it’s written a little differently than my other posts. It’s little more dear diary and a little less all the science!
Weeks 1 – 4
I took a pregnancy test on New Years Eve, day 27 of my normally 31 day cycle. I hadn’t been taking tests, because I found it was driving me crazing waiting to test. So instead I would wait for my period to come, and if it didn’t, then I would test. However, NYE was an exception. I tested early so I would know if I could enjoy a few drinks with my dear friends as we rang in the new year. And thank goodness I did, because the line was faint, but it definitely was there! (I tested again a week later and there was no doubt!)
Since weekly measurements make no sense (they start on the first day of your last period, so by the time you conceive, you’re already 2 weeks), when I tested I was just about 4 weeks pregnant.
So since we were trying to conceive, the previous 3 weeks had been about continuing following my Pregnancy & Fertility Foods protocol, aiming to hit as many of the super foods as possible over the holiday season. Christmas Eve oysters at my parents house helped 🙂 although limiting my champagne intake was tricky. Thanks to the hubby for finishing my glass for me! I avoided alcohol most days, and limited it to just under a glass a few days during the holidays. I took extra precaution not to get glutened or dairyed, since those are 2 big triggers for me, and if I was pregnant, I didn’t want to add a massive inflammatory hit to a precarious and new situation!
Once I got that BFP (“big fat positive” for all those not in the online pregnancy world…oh the acronyms) I continued to follow my pregnancy & fertility protocol with renewed vigour! At this point I’ve yet to experience any nausea, aversions or appetite restrictions, so I’m taking the opportunity to get in all the liver, seafood and ferments possible! The only time I experienced nausea was a few days after NYE, the first normal day post holidays (a Monday), where I brewed myself a cup of decaf coffee and added some full-fat coconut milk (ie. pure fat – or a pseudo bulletproof coffee. It works great for me). This is my standard pre-workout snack. After about 15 minutes, I got whacked with some nausea. Luckily I had a sweet potato flat bread in the fridge I could grab with me on my way out the door to Crossfit. That seemed to suppress the nausea. I instantly changed up my routine, cause that sucked, lol. I made a batch of pumpkin spice muffins, and am having one, slathered in coconut oil, and a cup of tea before the gym now. Seems to be working!
5 Weeks
The beginning of this week brought appetite suppression. Which is surprising, because I’m usually able to eat ALL THE FOOD! Especially, after a workout. But this week I just have no desire. Luckily I know how important nutrients are, especially so early in development of fetus and placenta, so I’m pushing through. I’m also starting to get some minor food aversions. Nothing huge, but the weirdest thing happened. My husband asked me if I wanted some leftover Pizza Spaghetti Pie for lunch (which I had readily consumed the previous 3 days cause it’s delicious!) and I instantly shuddered and said “uggghh no” followed by a “holy $h!t that was weird!” I’m finding that if I think about it too much, I’ll be turned off by the food. So instead, I just grab something and eat! It’s helpful having lots of leftovers in the fridge. Case in point – this morning for breakfast I had leftover rice (that had been cooked in bone broth, of course, and slathered in ghee) and some reheated bacon & apple braised cabbage.
By the end of this week I started getting pretty strong morning sickness. I would wake up okay, but within 10 minutes the nausea would hit. I would spend about an hour or so curled up, in and out of sweaty sleep on the couch. But then it would pass. The third morning this happened I tried having breakfast immediately after I got up. It made for almost painful nausea, so that didn’t work. Gonna have to try something else…
6 Weeks
That night (after my 3rd morning of painful nausea) I went out for a friends 30th birthday. I was up way later than I’ve been in a while, which meant it had been about 7 hours since I ate by the time I got home and ready for bed. Needless to stay, the nausea was starting because I let myself get hungry. So, in a desperate attempt to feel better I had a bowl of rice (always cooked in bone broth) slathered in ghee, right before I went to bed. I was so worried of how I would feel the next morning because even when I’m not pregnant, if I don’t get enough sleep I get nauseated. Oh dear. Turns out it was the best decision ever because I felt almost normal in the morning! I tried it the next few nights and it worked again! It is such a relief to find a trick that works (for now). That trick being, fill my stomach with carbs before going to sleep, so there’s no time to digest, so I wake up in the morning with a full stomach still…lol. My biggest worry was going to CrossFit. I go in the mornings because that’s the only time that works for me, and with the level of nausea I was experiencing, there was no way I’d be able to get through a WOD. I thought about rejigging my schedule to the afternoons, but that’s when I’m so tired I feel like I could fall asleep standing up, so that wasn’t going to work either.
Speaking of Crossfit – I had a lengthy discussion with my amazing chiropractors, one of whom specializes in peri-natal, infant and child chiropractic, about how to modify my current routine. There were a few key things that they recommended:
No More Inversions – dammit! I just got handstand push ups last week. Alas, I’ll have to wait til post-baby to really get good at this move. The reasoning was redirecting blood and lymphatic flow away from the uterus which is in the delicate stage of creating a brand new placenta.
No Twisting – interestingly Crossfit doesn’t include a lot of work in the twisting plane, other than sort of twisting/countering a twist in rope climbs. This one wasn’t too hard. I just started working on strict pull ups instead of rope climbs.
No Explosive Jumping – step ups instead of box jumps
Don’t Get Out of Breath – if you’re panting, baby’s not getting oxygen. This one was the hardest for me to swallow. I’ve always been intense when it comes to athletics, so I push myself hard at Crossfit. However, once I made the connection of the whole lack of oxygen to the baby situation, I started taking breaks during the WODs. In many cases I would go heavier with stricter movements. This has been especially good especially since I’m not fuelling my body the way it loves for Crossfit – carbs post-workout, only fat prior. That dietary approach went out the window as soon as I hit 4.5 weeks and could not tolerate coffee with coconut milk!
I told my Crossfit coaches I was pregnant very early (like 4 weeks early), so they would understand and help me scale appropriately. They’ve been awesome.
So my husband said something very perceptive this week. The hubs has been awesome at trying to feed me 🙂 and just yesterday he said “It’s really hard because I’m used to you having such strong opinions about exactly what and how we’re going to eat for dinner. And now you’re all wishy-washy. I don’t know what to put on your plate!” LOL. I guess I do have strong ideas about food, but he’s bang on. I have lost my foodie-ness. I used to LIVE to eat. Now I need to eat otherwise I’ll get nauseated. But I don’t want anything. I don’t have any food aversions (except to tequila – which I just smelled at the birthday party on the weekend and almost vomited everywhere, lol) and I don’t have any cravings. I just am blah about food. It’s so sad! One thing I have noticed is if I all I do is graze on anti-nausea food like plantain chips, rice crackers, banana (i.e. carbs) I feel really crappy really fast. I need real food. Specifically vegetables. Even if I don’t think I want a real meal, I always feel better after I eat it.
I’m also not digesting food properly and everything seems to be sitting and fermenting (thank you progesterone). Gross. So I’ve been supplementing with digestive enzymes and betaine HCl – which seems to be helping immensely.
7 Weeks
This week I noticed that I’m really into cold food. LOL. SO weird. I don’t have any aversions per se (except coffee and alcohol), but I’m struggling with eggs in the morning. I’d rather have a smoothie. This is blowing my husband’s mind because it’s winter and I normally hate cold food in the winter but all I want are salads and smoothies. Luckily the pate is sitting well – and that’s consumed with cold apples.
Speaking of fruit, cold fruit is my favourite thing on earth right now. I’m not really a huge orange fan, but we were at my uncles’ this week and I was jonesing for something. Saw an orange and thought that might hit the spot. Literally the best orange I’ve ever had in my life, and probably will ever have again.
This week was different as I realized that every day can throw something new at me. Last Sunday I had no nausea in the morning which freaked me out. However by mid-afternoon I was so exhausted I was literally in pain and felt epically hungover. Last time I ever stress about not feeling crappy 😉
So now it depends on the day – some days I’m amazing, others I experience waves of nausea on and off throughout the day and others I’m so tired I nap twice. Not getting hungry is still absolutely key to keeping the nausea at bay though.
Lessons Learned So Far
Rice before bed.
Don’t allow myself get starving. 3-4 meals/snacks throughout the day at 4ish hr intervals. (none of this snacking every 2 hours business to “maintain my blood sugar”. While that might be necessary when I have a small stomach due to a large baby, maintaining blood sugar through quality protein and fat is working way better than crazing on carbage like all the books recommend.)
High fat doesn’t work anymore.
If I eat dinner close enough to bed time, I don’t need to add that extra bowl of rice.
Have a banana as soon as I wake up. This seems to manage the nausea.
8-13 Weeks
So I feel very fortunate that most of my symptoms have disappeared. However, I also feel like I put in a ton of work prior to conception (we’re talking 2 years friends) and I worked hard at hacking my diet once the nausea did appear.
One thing I’ve learned from places like BabyCentre.ca message boards, is many people are required to eat every 90 minutes to keep the nausea at bay. They often describe a history of getting “hangry” if they didn’t eat every few hours prior to pregnancy, and now it’s majorly exacerbated.
It seems to me that maintaining blood sugar levels is critical to managing nausea. However, the conventional approach to doing that is to eat “complex carbs every 2-3 hours to balance your blood sugars”. This does not teach your body how to naturally balance blood sugars. It artificially controls it through food. The body will use fat and carbs as fuel, if you give it a chance. So with all of the carbage we’re encouraged to eat in North America, it’s setting us all up for epic blood sugar dysregulation during pregnancy. I used to be like that – having to eat every 3 hours or I’d get shaky, panicky, headaches, nauseous and become a jerk. But as I switched to a real food diet, I unchained myself from the kitchen and can now go anywhere from 4-8 hours between meals (most days it’s about 5 or 6). It was very freeing not having to worry about where my next hit of carbage was coming from, but little did I know how much it would prepare me for pregnancy.
Current Nutrition Habits
Don’t get super hungry. If I eat a good sized meal, 5 hours is really starting to push it. I don’t get nauseated if I eat every 4-5 hours.
Lower fat. I seem to be having a harder time digesting fat, so a meal that includes lots of bacon or avocado actually brings the nausea on a bit.
Higher carb. I cannot have a low carb meal. Now, I’ve never been a carb-conscious person – I crossfit, have a history of adrenal fatigue and run pretty high energy all day. So I love me some (quality) carbs. But occasionally we’d have a low carb meal if it was Taco night, or if I made cauli-rice or a cauli-crust pizza. That does not fly right now. Even if I eat 2 meals worth of calories of low-carb pizza, I’ll still need to eat some carbs.
Go with the cravings. I am super enjoying cold food right now. So while I can’t do cooked eggs for breakfast, hard boiled are working great! (Also, smoothies > bacon, salads > roasted veg, and sushi > cooked fish… now the safety of that is the topic for another post…)
Know your limits, know where you can bend a bit. I can’t tell you how many people were almost excited for me to cave on something like bread. But I know it won’t ever happen because of (a) the massive inflammatory response is horrible for my body, not to mention painful and (b) um, I’m definitely not putting my unborn child through an unnecessary bout of inflammation. But, I did find that my typical carbs (sweet potato, plantain) weren’t sitting well in the morning. So I found a simple gluten-free white bread that I would load up with spinach, a bit of avocado and 2-3 hard boiled eggs for breakfast. I was happy with this GF bread because it was practically homemade (from Cup of Tea Bakery) and it was made out of white rice/potato/tapioca starches which I tolerate very well (as opposed to so many GF breads which are trying to be healthy so they use things like quinoa and brown rice flour – kills my gut). So while I normally don’t recommend relying on GF products most days, I had it every morning for 6 weeks because it got eggs, avocado and spinach in me!
In Summary…
That was my experience during my first trimester. Not rainbows and butterflies, but very manageable. However, I do not believe my experience was due to luck or being fortunate. Sure that might have played a bit of a part, but I strongly believe becoming very nutrient sufficient over the 6-12 months prior to conception; healing my gut issues and continuing to focus on a strong, healthy gut; and having good blood sugar regulation was critical in my success!
So I’ve been sick. Really sick. It came on as a slight cough last Tuesday – I thought it was residual from a cardio-intensive workout that morning. But by the evening it was still there. I immediately started hitting it with everything I had. Now normally my arsenal is pretty large, considering my hubby is a naturopath and we have a dispensary in our basement, lol. But considering the fact that I’m pregnant, most of the herbs we have on site are off-limits. So I stuck with a large dose of Vitamin C, some essential oils, and a plan to sleep in as late as possible the next morning.
And then the morning arrived. I felt ok. The cough had settled in for sure, but not too bad. By mid-morning my whole body hurt. Again I chocked it up to yesterdays workout, but the level of discomfort was not appropriate for that workout. That’s when I started realizing I was seriously sick. This wasn’t just a little cough. When I started feeling listless and realized I had laid in bed for an hour doing nothing (no TV, reading, podcasts – nada), I took my temperature:
101.6F
Yowza that’s high (ish). And I’m pregnant. And the risk of injury to the baby with a chronically elevated temperature is real. I was able to bring it down a full degree within an hour, by implementing some classic natural anti-febrile techniques, which I’ll share with you below! But first, a bit on fevers…
NOTE: I am not a medical doctor. I am not making any medical recommendations and this is not medical advice. I am simply trying to provide some clear information on a common health occurrence. Please speak with your health care practitioner before making any changes to your health care routine.
What is a fever?
A fever is a natural rise in your body temperature, in response to an infection – either bacterial or viral. It is not a disease in itself, but a symptom of an underlying issue. So like all health issues, it’s important to address the underlying cause, instead of just suppressing the symptoms.
Why do we develop a fever?
It is believed that the elevation in temperature is actually a critical step in helping our bodies fight off infection. It seems to (a) activate our immune system by sending white blood cells and macrophages to the infection site, and (b) inhibit enzymes and other functions required for viral and bacterial replication. For example, it has been hypothesized that most bacteria can’t survive in temperatures above 101F and viruses, above 102F.
Well yes, it can be. Uncontrolled, very high body temperatures can result in severe dehydration and possibly induce febrile seizure. Which is why you want to monitor it. But mostly, they’re just damn uncomfortable.
Now, when it comes to fever during pregnancy, there’s a little more to consider. Your baby is developing and that requires a specific temperature for everything to work properly. This is why your doctor told you not to use a hot tub or take hot baths. Prolonged, elevated body temperatures may impair important developmental processes, specifically in the brain.
Anti-Febrile Meds?
The conventional approach is to take an anti-febrile medication as soon as your temperature gets a little above normal. Ibuprofen (Advil), acetaminophen (Tylenol) and naproxen (Aleve) are the 3 recommended meds. Do they work? Oh hell yeah. Are there side effects? Definitely. So it becomes a relative risk-reward assessment situation.
Acetaminophen is the leading cause of acute liver failure in the USA. The metabolic byproduct of detoxifying acetaminophen is NAPQI, which is responsible for necrosis of the liver. While NAPQI does not cross the placental barrier, acetaminophen readily does. Which needs to be considered since a developing baby’s liver starts being responsible for its own detoxification at around 18 weeks.
MONITOR: Most importantly I was monitoring my temperature every hour, making sure it didn’t get to a temperature that we (my husband, my health care provider and I) had decided would be our “time for serious action” temp. I also monitored every few hours at night.
WARMING SOCKS: This age-old home remedy is a favourite amongst crunchy mamas. You take a pair of thin cotton socks and soak them in cold tap water. Put them on your feet, and add a second pair of socks, preferably wool to keep the water in. When the socks warm up, rinse them in cold water again and repeat. The idea behind this hydrotherapy technique is by keeping the feet cold and wet, you create a sort of “heat exchange”. Your body increases circulation to your feet, dissipating heat in order to warm up the feet/socks.
ICE PACK: Place a cool ice pack at the base of the neck, where there is a high concentration of temperature receptors. This can help dictate the internal temperature of the body.
ESSENTIAL OILS: I’m new to the field of essential oils, but I’m quite enjoying learning how to use these additional tools. I hit up the Wellness Mama (she’s my go-to for natural remedies) and she recommended pure peppermint essential oil (I use Young Living brand) on the back of the neck and on the bottom of the feet (see above for why those locations).
I did all 3 things and brought my temperature to 100.1 within an hour.
BACK UP…MEDS: Considering the risk of a high fever and developmental issues regarding the baby, I had an Ibuprofen on stand by, just in case my temp got above the predetermined comfortable zone for us (I’m purposely not sharing, because that’s something for you to determine with your health care provider). I chose Ibuprofen because although I have a history of major gut issues and serious autoimmune risk, I am 18 weeks pregnant. Which is far enough out from my third trimester to decrease the risk of ibuprofen and heart defects, but definitely far enough in that I didn’t want my baby’s liver to take the hit of the acetaminophen. Luckily I didn’t have to use either, because the above tricks worked tremendously.
Additional Support
There were a few other things I did to help my body recover from this (likely) flu as fast as possible.
Convalesce. I did nothing. Nada. Even though by day 3 I was so bored of TV, I rested, napped, and generally took it easy. Pushing through is a sure way to stay sick and get sicker. I’d rather take a few days off and get better, then push through and 2 weeks from now find out I have pneumonia and have to go on antibiotics.
Bone broth. Like crazy. It helps keep the gut strong and regulates your immune system. I had soup multiple times a day. I also cooked white rice in broth, to get some calories in me. Find out how I store my bone broth to make it easy to use, even when you’re sick and have no energy for food prep! I added onions and garlic to my broth for an additional immune boost. I also added some gentle veggies like spinach.
Vitamin C. There aren’t very many supplements that are considered safe during pregnancy. Again, I worked with my team and determined a few herbs that are generally recognized as safe during pregnancy, but mostly focused on the simple stuff. High doses of vitamin C at regular intervals can shorten the duration of an illness. Good rule of thumb with vitamin C – take to bowel tolerance. As in, when you start noticing loose stool, pull back on your dose!
Ginger, lemon and raw honey tea. I took a few slices of ginger root, a ¼ lemon and about 2 cups of hot water. I let simmer for about 20 minutes on the stove top. Strain and add a spoonful of raw honey. Alternately, you can juice a whole whack of ginger and lemons, and store the potent elixir in the fridge, adding a few tbsp to a mug of hot water and a spoonful of raw honey. This is what we normally do, but I was by myself during this illness and didn’t want to deal with the mess of the juicer (normally my hubby would take care of that), and by the time he returned home, he was sick too.
Fluids. Water, tea (see above), bone broth, mineral water and kombucha (specifically homemade lemon/ginger booch) were on constant rotation. Fever causes dehydration so keep your fluid intake high!
Conclusion
Fevers can be a scary situation, especially in young kids or during pregnancy. But understanding their benefit can help decrease the stress around them. Monitoring and implementing some solid, natural remedies – combined with immune support to help your body fight the cause of the infection – can help you recover quickly and decrease the potential need for risky pharmaceutical intervention. Keeping in mind, that drugs save lives so there is definitely a time and a place for their use!
So I’ve been sick. Really sick. It came on as a slight cough last Tuesday – I thought it was residual from a cardio-intensive workout that morning. But by the evening it was still there. I immediately started hitting it with everything I had. Now normally my arsenal is pretty large, considering my hubby is a naturopath and we have a dispensary in our basement, lol. But considering the fact that I’m pregnant, most of the herbs we have on site are off-limits. So I stuck with a large dose of Vitamin C, some essential oils, and a plan to sleep in as late as possible the next morning.