Intro:
Amanda: Hey, this is Amanda, women’s health dietitian.
Emily: And I’m Emily, nutritional therapy practitioner.
Amanda: And this is the Are You Menstrual? podcast where we help you navigate the confusing world of women’s hormones and teach you how to have healthy periods.
Emily: Each week we will be diving into a different topic on women’s health and sharing our perspective using nutrition, female physiology, and metabolic health.
Amanda: Our goal is to help you wade through conflicting health information and empower you on your healing journey.
Emily: We hope you enjoy it.
00:37
Amanda: In this episode, we are back for round two with Loren De La Cruz or you may know her as @innatefunctionalnutrition on Instagram, to expand on our last episode. We really focused on preconception there, talking about, like, preparing your body to conceive, timelines for all that kind of stuff. But in this episode, we really want to dig more into nutrition for pregnancy specifically. And if you didn’t listen to the last episode, quick little synopsis of Loren and kind of her career, what she does in this field. Loren is a Functional Nutritional Therapy Practitioner, Root Cause Protocol Consultant, and Functional Diagnostic Nutrition Practitioner that specializes in preconception nutrition. Her mission is to empower women with the tools and the knowledge they need to regulate their cycles, balance their hormones, heal their metabolism, optimize their fertility, and have a thriving pregnancy. So of course, that’s why she came to mind when I was creating this series.
And honestly, there’s, there’s a lot of fear around nutrition in pregnancy. It seems like I, especially, and I’m sure you see this a lot to and with like the women that follow you, that are your clients and stuff, they make all these changes, right? They, they start beef liver, maybe they start with adrenal cocktails and making more conscious choices around nutrient dense foods. And they might even change their supplements, you know, maybe they’re like rethinking the D and the zinc and all that kind of stuff. And then they get pregnant. And they’re like, wait, what am I, what am I supposed to do? Like, everything all of a sudden, like, goes out the window I feel like and they’re, like, kind of back on the supplements that maybe weren’t the best options as far as like optimizing minerals and stuff goes. They’re afraid to eat certain foods, even though a lot of that stuff likely helped them with their fertility. So the goal of this episode is to help remove a lot of that fear around nutrition during pregnancy and hopefully clear up some of that confusion. So I’m super happy to have you here.
02:25
Loren: Oh, thanks so much for having me again. I’m, I’m super excited to be here and excited to chat with you.
02:30
Amanda: And we covered a lot in the last episode for preconception. Like we talked about vitamin D, folate, prenatals, a lot of different things that obviously they’re applicable for pregnancy, but I also think most women started thinking about those during conception. So why don’t we get started with probably the most common question that I get, and that is around foods to avoid during pregnancy—things like raw fish, sushi, deli meats, high mercury seafood, like, being told not to eat things like tuna, raw milk, runny egg yolk, soft cheeses, all that kind of stuff. So, like, maybe you can break down why we’re told to avoid these and then your perspective on including these foods during pregnancy.
03:10
Loren: Yeah, of course, that’s a really great way to start this episode. It’s, it, they’re definitely questions that cross a lot of women’s minds when they first get pregnant, and they’re like trying to figure out what they can and can’t eat. And there is a lot of, you know, definitely interesting information out there. A lot of it I think has been passed down from a lot of dogmatic views of nutrition. And I think the most important thing to understand, too, is, as you know very well, most of the information that they’re receiving is from their doctor, and doctors aren’t trained in nutrition. They maybe get, you know, a couple hours, maybe a course if they’re super lucky in nutrition, but, you know, these kinds of questions, they’re usually answering them based on their very limited knowledge of nutrition, especially nutrition during pregnancy. So, you know, gotta, gotta preface that there. It’s not that, you know, they are necessarily doing, trying to do this on purpose, but it’s just a lack of awareness I should say. So why we’re told to avoid these is usually fear of foodborne illness and/or compounds within the food that are seen as “risky.”
For example, a couple, a couple of examples here: deli meat contains, potentially contains listeria, eggs potentially contain salmonella, soft cheeses potentially contain listeria, or raw oysters potentially contain, you know, this bacteria called vibrio vulnificus. I’m not even sure if I pronounced that right but…and you know, seafood contains mercury. These are definitely, there’s potential, but I think what most people don’t understand is that every food has the potential to cause foodborne illness. And it’s not just animal foods either. I think a lot of people think you know, okay, I’m going to avoid eating you know, eggs and cheese and deli meat because of these things, and I’ll stick to my salad and I’ll be safe there. But really when you look at the data, and I think Lily Nichols has done a really good job of explaining this. When you break it down, it’s pretty much 50/50. You know, you can get foodborne illness from plant-based foods or animal-based foods pretty equally. So it’s not necessarily you know, you’re dodging a bullet by avoiding animal foods. And then, you know, what are you eating instead of those nutrient dense foods? What are you replacing them with? So I think that that’s really important to kind of consider.
When we look at a couple of these foods, let’s start with raw milk for example, you know, unlike its cousin soft cheese, I don’t believe it has the potential to contain listeria so we’re pretty much in the clear. And the reason we worry so much about listeria is that this pathogen can potentially cause miscarriage if we get sick with it. That’s the risk there. And that’s why people are so afraid of listeria. If you’re getting raw milk from a really high-quality source, your risk for getting foodborne illness from raw milk is pretty insignificant. It’s like .0005, or something or four. So it’s pretty low. And you know, you’re like 10s of 1000s times more likely to contract foodborne illness from other foods other than raw milk. And because there’s so much focus, or I guess, a magnifying glass on raw milk producers, they tend to have even more hygienic practices than your regular conventional milk producers. So that’s, you know, an example there.
06:40
Runny eggs, you know, doctors often say make sure to cook your egg yolks all the way through. And the reason for that is, you know, salmonella, like I mentioned earlier, which could potentially make someone very ill. But what also most people don’t realize is that salmonella is a topical bacteria. So when you are consuming eggs, it’s really the egg shell that is most likely to contain the salmonella. And if you crack it incorrectly and, you know, drop, maybe you’ve dropped the shell in and it has salmonella, then your egg might contain salmonella. But there is a rule for most supermarkets and most conventional egg producers that they have to actually sterilize the outside because of this anyway. But I will say that if you get pasture-raised eggs, you’re about seven times less likely to get salmonella from eggs if, especially if they’re coming from an organic farm. So, really sourcing matters in most of these cases. Of course, you really want to make sure you trust the source. And of course, preparation matters, too. But this is another example where you know, it’s really down to okay, how carefully am I preparing the food and where is it coming from, because there’s really not too much to worry about in that case. And there’s one case of salmonella in, you know, one to 12 or 30,000 eggs. So it’s really, if you, if you get it from a good source and you prepare it properly, you’re pretty in the clear and you can enjoy your runny egg.
08:10
The next one is raw cheese, and here the concern is listeria. And I will say there’s interesting sort of stances on raw cheese. The Weston A. Price Foundation does say to avoid this, but Lily Nichols registered dietitian for a, prenatal registered dietitian, she says to, it’s really up to you. And so it’s again, another instance where you want to weigh the risks versus the benefits. If you really want raw cheese, it can, raw cheese can be a great source… I need a regular pasteurized cheese too. But raw soft cheese can potentially contain listeria. It’s like one case and 5 million servings. that’s so
Amanda: That’s so low! It’s just like, I know their concern. I understand why it’s there, but I think a lot of this, I’m like, I feel like we’re using this energy and putting it in the wrong place you know?
08:59
Loren: I, I’m 100% with you. There’s so many other things that you know we do during pregnancy that are like, okay, you’re not going to eat a runny egg, but you’re going to do this? And you know, it’s not coming from a judgmental place, but it’s like, okay, if we can take a step back, before we try to freak, before we start freaking out about anything. Like let’s just have a reality check.
09:21
Amanda: And it’s just what society is focusing on. Like, I can’t tell you how many clients are like, I can’t eat deli meat. And sometimes it’s one of the only proteins they can tolerate. They just want sandwiches in that first trimester. And I’m like, we just have to use our food safety skills that most of us have if you make food at home. You know, like, not gonna let it sit in the fridge for too long, and, like, don’t, if you open deli meat on Sunday and it’s the next Sunday, maybe don’t eat that same deli meat you know. So it’s, but I get it, it’s, it’s scary.
09:52
Loren: It can be and you know, I’m not one to judge or you know where someone’s fear is coming from could be they’ve had a really bad experience with a particular food and they really don’t want to mess with it. And I get that, I’ve had food poisoning before and it’s really not fun. But just, you know, taking the emotion out of the equation, just looking at the numbers and sort of the reality of the situation, you know. You can make a decision to eat these foods if you’re comfortable with the risks, and that’s really what this is all about. So, yeah, raw cheese, you know, up to you.
A couple more, too. Raw fish, so this is interesting too. Sushi grade fish is usually flash frozen to kill pathogens, so…And there’s a couple of cultures and countries that do recommend it as part of a prenatal diet. So especially in Japan, where raw fish consumption is really, really common. So of course, what you know, sourcing matters again, preparation matters again. Wild-caught is going to be really high quality, going to provide a lot more nutrients. The way that they’re raised in, in farm-raised, I guess, fisheries, you know, there’s a lot more potential to, I guess, more access to bacteria-infested fish. They usually do give them sort of antibiotics, because they’re in enclosed areas and really tight knit, and the foods that they’re feeding them are not super great. So, you know, wild-caught, I would say is probably what you want to go with. But definitely, you know, it’s really up to you whether…if fish, raw fish, is the only way that you eat fish and say you can’t stomach anything else, like any other proteins, then you might want to consider eating raw fish and having that sushi as long as it’s from a place that you trust. I will say, though, that that rule does not apply to raw shellfish. So things like lobster, crab, scallops, oysters, clams, so the bacteria that I mentioned before with oysters, that is pretty considerably…that’s pretty considerable. And I would probably make sure if you did want oysters to have them smoked or cooked. And that goes for any other shellfish there. Deli meat, too, you know, I know women that like microwave their deli meat as like a workaround… That sounds just so terrible to me.
12:35
Amanda: If you’re making like a grilled ham and cheese, you know, like, like cooking it or something, like, I feel like you could do, make it maybe tastes a little.
12:43
Loren: Yeah, I mean, yeah, you know, Italian sandwiches. Sometimes the warm meat is like delicious and amazing. But I don’t think you have to like microwave it if you want to eat it. For deli meat, there’s like one case of listeria in about 83,000 servings. So again, it’s really up to you and if you want to take that risk, but of course, you can mitigate your risk further by properly preparing it and making sure you’re getting it from a good source, etc. So just some, some numbers there. The sources for that primarily are the Weston A. Price Foundation and Lily Nichols’ “Real Food for Pregnancy.”
I will also say in terms of mercury, that also is definitely a really interesting topic too, like a lot of women are avoiding fish and avoiding seafood because they’re scared of high mercury content. And yes, there are fish that do contain higher amounts of mercury, like swordfish and like tuna. But really those, and that’s because they’re larger fish, and they live longer, and they tend to accumulate these toxins in higher amounts. But, you know, it’s really, again, just because there’s this one potential doesn’t mean we need to cross this whole thing off our list. And, you know, there’s, there’s reasonable middle roads here that we can take. And so, the interesting part about mercury is that gut bacteria can actually trap mercury-containing food and prevent it from being absorbed. So good gut function is going to support you in terms of mitigating the effect of mercury on you and your fetus. Getting sufficient selenium…so again, seafood also has tons of selenium in it. It binds to mercury which is great. And so glutathione as well can also protect against mercury. Raw milk is a great source of that. And also good copper status will also influence mercury levels. So making sure you have good copper status, and again, seafood is also a great source of copper. So nature, I don’t know if I mentioned this last time, but nature kind of provides foods in, like, this amazing, beautiful package. So, you know, again, it’s up to you, if you really like seafood and, you know, it’s one of your primary proteins, like, you might want to just consider this information and, you know, work that into your nutrition approach for pregnancy.
15:23
Amanda: Yeah, I feel like it can be hard because on one hand, I understand why they make such generic statements, because it’s like they’re trying to give a very large population nutrition advice which is hard. I mean, I think about like, the stuff I post on Instagram, I’m like, there’s not enough room for nuance here. But there’s so much more nuance than what I can fit into a caption, you know. Like, I understand the general recommendations, but I hope that as women listen to this podcast, maybe they’re doing more research, doing your course, reading “Real Food for Pregnancy,” going into the Weston A. Price Foundation looking at their blogs…you can start to educate yourself and see like, what, what do I feel comfortable with, like, risk-wise. And you know, because you just listed all the numbers, the likelihood of getting that foodborne illness exposure is much lower when it’s properly prepared, when you’re being smart about food safety. So I, and like sourcing and everything. So I feel like there are so many ways to include these foods and not to necessarily be afraid of them.
It just, it’s, I think the thing that’s sad is it requires so much more education, you know, and not everyone has access to that. So hopefully people listen to this podcast and share it. But I mean, a lot of these foods can be very nourishing and they’re really healthy, and they’re things you were eating before. So it’s like if, especially if you, it’s like if you have a raw fish source that you really trust, then I wouldn’t necessarily be worried about including that during pregnancy. There’s way more iodine in raw fish. A lot of women crave sushi during pregnancy likely for that reason, or we need more iodine then. So it’s like, I would also, like, listen to your body, like, do you really want those foods, you know, and it doesn’t have to be this like crazy all or nothing approach.
17:02
Loren: Totally. Alright, I think that’s really well-said and well-balanced view of nutrition during pregnancy—doesn’t have to be either extreme, there’s a lot of gray area that you can take advantage of.
Mid-Episode Ad
Hey, Amanda here, just giving you a quick break, hopefully a break for your brain in the middle of this podcast episode to remind you that if you haven’t gone through our free training, Optimizing Hormone Health Through Mineral Balance, we really do recommend starting there. And the main reason for that is because you’re going to hear us say things like mineral foundation, having a solid foundation, are you putting the foundations in place, especially as we get deeper and deeper into different hormonal topics and specific imbalances in the body. The mineral foundation is always going to be so essential. So if you haven’t watched the free training, you can find it in our show notes or you can go to hormonehealingrd.com and it’s going to be right on that front page there. But we really recommend starting there so that you can understand how is your current mineral status, how do you assess this, and how to get started with all that just so you can get as much as you possibly can out of the rest of the podcast episodes. But that’s it. I hope you enjoy the rest of this episode.
18:19
Amanda: So let’s talk about beef liver, because that’s another very controversial food. And it’s probably the most common supplement that I get clients asking, like, I stopped taking the beef liver because I’m pregnant, or should I stop taking it? My doctor told me not to take beef liver during pregnancy. Why is this such a controversial food or supplement kind of depending on someone who’s taking it during this time?
18:42
Loren: Yeah, great question. It goes back to a lot of what I mentioned earlier, where, you know, doctors are not really trained on nutrition very much. And so the issue with that, too, is there were, they’re focusing on other things and they also are not staying on top of the literature either. It’s just, their job is too large, they have too little time to be able to do that. So the main controversy around liver is primarily due to its high vitamin A content, so high retinol content, and this is preformed vitamin A—not beta carotene. And this is you know, the really good stuff that our body needs to differentiate properly, supports our immune system, it supports the differentiation of baby symmetry, their immune system, eye development, lung development, or other organ development. It’s, it’s so important. I think our ancestors were doing something right too, because this was typically part of the, the preconception and pregnancy diet. They knew liver and other organ meats were high in this nutrient and it was really essential for not only supporting the baby but also mother’s health and healing.
So the really the controversy comes back to a 1995 study that found that women that consumed more than 10,000 IU of vitamin A gave birth to children with a greater risk of specific birth defects. Like many other studies, though, this one was flawed. And much of the vitamin A content that, you know, they were serving in the foods were from multivitamins or fortified food sources. So they really didn’t distinguish synthetic, which, you know, if you want to fortify food with vitamin A, it’s going to be synthetic. So they weren’t distinguishing between synthetic vitamin A or natural vitamin A—that was really the primary issue with that study. But unfortunately, this led to the interpretation that all rich sources of vitamin A must be bad, because—regardless of whether it’s synthetic or natural—and unfortunately, this misinformation has been carried through decades. So it’s really unfortunate, because liver is such a nourishing food. It’s got so many other nutrients that are so important for baby’s development and pregnancy. So there, I will say there have been other studies following this one that show exponentially higher vitamin A intake and have either no correlation with birth defects or actually lower birth defects. So you know, go figure there.
Liver is rich in vitamin A, and it’s also rich in many other nutrients like choline, folate, other B vitamins, copper. And, you know, it’s such a important food, and to completely avoid this food because of fear of this high level of vitamin A, which, you know, if you have a little bit…it’s really difficult, it’s, first of all, it’s really difficult to like stomach a lot of liver. And you’re only going to probably have it a couple times a week, and the actual supplements, they really don’t have a lot in all the caps, like, you’re not going to be getting an exponential dose of vitamin A in those caps, so it’s relatively fine. And what’s beautiful too, as I mentioned, a couple other nutrients that it has, but also it has nutrients that allow it to function properly in the body, like other fat-soluble vitamins, like vitamin K, and you know… So it’s, it’s, again, an instance where nature kind of gift wraps this beautiful food for you with all the amazing other nutrients that it needs to function properly. So that’s kind of where I go. And you know, if you are scared of liver, like, it’s definitely one of the only food sources the highest, richest food sources of vitamin A out there, and it’s really, really nourishing, and you’re going to hit so many other nutrient needs by eating it. I will say if you are so worried about your vitamin A intake, I would look at what prenatals you’re taking or fortified foods you’re also intaking versus something that’s so natural that your body will actually know what to do with.
22:58
Amanda: That’s such a good point because it, I mean, I mean, not all most prenatals I see don’t, they usually have the beta carotene version, which is obviously not the preformed, your body then has to convert it. But it is added to different foods, it’s added to milk, certain dairy products, because they’re trying to re-fortify, get that A and D in there even though it’s usually already present. I think that’s really good advice and it hopefully remove some of the fear for people. It is, it’s truly the vitamin A, even though most women I see are very low in vitamin A, their retinol status is low, especially as they kind of move through pregnancy because we are, you know, it’s such a big demand on the body. So that, I usually will say if someone can just get a retinol blood test, they’re not that expensive, you can order it online from some place like Request a Test. That’s usually what I recommend if they’re like, I don’t feel comfortable taking the beef liver or eating beef liver, because my doctor said this about the vitamin A, I’m like, why don’t you just test and see if you need it. I think that’s the other thing that’s difficult. I know not everyone has access to testing. But it’s, I mean, you can pay $60 for a retinol test. And it’s, if you’re worried about consuming beef liver or taking it during pregnancy, that could be one of those things that, that takes a big stress off of you. And you know, actually I do need this and I, this could even help me piece a few things together later, like iron deficiency during the third trimester. So let’s go there next since we’re already talking about vitamin A. Why are so when so many women told that they’re anemic, especially during like that second half of pregnancy?
24:29
Loren: Yeah, so iron deficiency anemia is pretty common, or at least it’s, I wish I had the stats right in front of me. I don’t know what percentage of women get it, but because I deal with iron deficiency anemia in the space that I’m in, I do get a lot of women reaching out to me like, hey, I just got my hemoglobin tested, I’m in third, the third trimester and my midwife is saying I have to get my iron up otherwise I can’t do my home birth or like, you know, I gotta get it up to deliver, for delivery.
So, I will first say that there’s a lot going on in the third trimester. So there’s a lot of natural changes that can lead to natural decreases in iron levels in the body. So estrogen is at its highest, and this matters because higher estrogen levels are correlated with lower hemoglobin levels. So just with that, there’s a huge, you know, pregnancy is very hormonal. And the third trimester is like the peak of the hormone. So keep that in mind. There’s also a huge transfer of nutrients to baby in the third trimester. So this includes iron and copper. And so hemoglobins will naturally, hemoglobin levels will naturally drop, excuse me. And copper, a copper enzyme called zyklopen is a really supportive enzyme that allows the transfer of iron to baby as well. So that’s just a side note. But what that means is that, and what I’m trying to get at is that when there’s an increased need for iron, there’s also usually an increased need for copper and vitamin A. I can’t remember if we went over that last podcast, but…
Amanda: I don’t think we did.
Loren: Okay, well, yeah, so iron requires copper to function properly. You know, a lot of nutrients, there’s no nutrient that really operates on its own, it’s going to have many partners and cofactors. And iron’s cofactors and partners include copper as well as vitamin A, which is kind of an ancillary partner, but really important because it also activates copper and it has a relationship with copper. So, you know, given the relationship between these three nutrients, we need, if we need more iron, usually, we might actually need more copper or vitamin A. Because what happens without copper and vitamin A is iron is a very volatile metal, and it feeds pathogens in the body. And so what the body will do is if there’s not enough of the cofactors to manage it properly, it will remove the iron from the bloodstream and sequester it into the tissues away from the pathogens, because pathogens love to feed on iron. And the body doesn’t want to, you know, sort of feed this potential illness that you might have in the bloodstream. So it sequesters it and it can also make it look like we have anemia. So you know, that, that can also be part of the sort of lowering of iron in the third trimester.
We’ve been hyper focusing on iron, iron, iron, but not enough of the cofactors. And the body may just not have enough to manage iron properly, or, you know, once you download to baby, too, it’s priority, the body’s prioritizing baby. So you know, it’s going to need the other cofactors to then create new red blood cells and utilize the iron recycling system, which is made up of a bunch of organs. And so there’s this really amazing system in the body that allows you to recycle iron really efficiently. So we actually don’t need too much. But it’s these other two nutrients, copper and vitamin A are really, really essential to make this run properly. So we might be missing that.
And so, again, medical practice tends to focus on the increased need for iron in pregnancy, but they forget the other two nutrients. And so, you know, we end up taking iron pills or getting iron infusions. And that’s really unfortunate, because a lot of women experience, at least the ones that I’ve worked with that have had these things arise in the past, they basically say like, my health has never been the same. Or like, I’ve, I’ve had this issue since I’ve had to take an iron infusion for, you know, the third trimester with my previous son or my last child. So it’s, it’s, it’s hard and it sucks because a lot of women experience a lot of pressure from their medical providers, like I just said, for the example that I gave in the beginning, like midwives do give ultimatums.
29:22
So, and it sucks because a woman might not be able to give birth the way that they want to just because of this thing that, you know, I will actually talk a little bit more about that, you know, we might be looking at it incorrectly. So, again, I will also clarify, too, the, the reason the ultimatums are given is because low iron is thought to be, cause a bleeding out during delivery. So that is definitely a very serious consideration and concern. But, you know, it’s, it’s tough because there is other research that I would love to see more research expanded upon that could potentially help ease the concern here.
So there was a study done by Dr. Lee, and he’s an OBGYN. And he measured the levels of hemoglobin in about 1000 of his patients. And he found that the healthiest babies were born to mothers that had hemoglobin levels of 8.5 to 9.5, which is way lower than the low end of the ultimatums that doctors and midwives are putting on women. I think the lowest, you know, those things like maybe 11. And otherwise, you have to give birth at the hospital. And you know, even if you are giving birth at the hospital, your doctor will probably say get on iron pills if you’re lower than 11. So that’s considerably lower than that sort of low, low end, the threshold there. But, you know, what he witnessed was healthy babies and healthy moms.
And another, there’s other interesting research that correlates the level of copper in the liver to hemorrhaging. And so low levels of copper in the liver, are associated with a higher level of hemorrhaging, so bleeding out. Or higher levels of copper in the liver are associated with lower levels of bleeding out. So you know, I would, again, these are very, like, unknown or not well-known pieces of research that I’m citing here. And I would definitely love to see somebody do more. But it’s just very interesting, because it, you know, it does kind of nod to what we were talking about in the relationships between iron and copper and vitamin A. And I also should mention, you know, in the 1930s, so almost 100 years ago, there were three doctors that won the Nobel Prize for curing anemia with beef liver, because beef liver contains iron, copper and vitamin A. So it’s, it’s just really interesting. So if you are struggling with iron deficiency anemia in the third trimester, I would definitely look into, you know, making sure you’re getting enough of the other nutrients that are required to manage iron properly. And a great way to do that is with beef liver.
32:18
Amanda: And that brings us back to the beef liver. But I think like the biggest thing, because a lot of it comes back to I feel like we’re so worried about rules within pregnancy, whether it’s, li
