Tagged Diet

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Constipation

Ah, the joys of pregnancy…

As if our bellies weren’t feeling full enough, what with the whole baby-living-in-there-24/7 thing, constipation during pregnancy can make you feel truly awful. While constipation is one of the most common pregnancy symptoms that can hit during any trimester (and definitely one of the most annoying), it’s also one of the least discussed.

There are several reasons you’re likely to experience constipation at some point in your pregnancy. The first, and most obvious, is that carrying a baby around in an already crowded abdomen can put a lot of pressure on your intestines. As your organs start to shift around to accommodate your growing uterus, things tend to get squeezed which can slow down the movement of stool through the intestinal track.

To add insult to injury, high levels of progesterone that occur during pregnancy tend to relax smooth muscle—which just happens to be the kind of muscle responsible for moving food and waste through your digestive track. As the muscles relax, transit time slows, and things have a tendency to… well, back up.

Another common constipation culprit, both in pregnancy and at other times, is supplementing with elemental iron. This is the form of iron found in most prenatal vitamins and it can cause all sorts of digestive problems in women who are sensitive to it. I’ve written on the ways that prenatal vitamins containing this form of iron can contribute to morning sickness, but they can also slow bowel transit times and contribute to constipation.

Fortunately, there are several easy, natural ways to treat constipation during pregnancy.

Switch Prenatals

If you’re taking a prenatal vitamin that contains iron and are having trouble with constipation, consider switching supplements. Many women who have adequate iron stores going into pregnancy don’t need to supplement with higher levels and can get away with taking a high quality multivitamin along with extra B6, B12, and folate (this is the combo I take during pregnancy). If you’re concerned with anemia or your doctor has suggested taking additional iron, try a food-based prenatal that contains a form of iron that is more easily absorbed by your body and less likely to cause digestive problems.

Just be aware that not all so-called food-based supplements are created equal… Since the term “food-based” is unregulated when it comes to supplements, many brands just throw a couple of true food-based nutrients into their existing mix of synthetic vitamins, slap a new label on the bottle, and jack up the price accordingly. Two brands I trust are Innate Response and New Chapter.

Change Your Diet

In addition to switching your prenatal, be sure you’re you’re getting enough veggies and fruit which contain the fiber and water needed to keep you regular. If you’ve been following the traditional advice for lessening morning sickness in your first trimester (i.e. eat lots of starchy carbs all day long to keep your blood sugar steady and avoid upsetting your stomach), your diet is probably significantly contributing to your constipation. Click here to find out what you should be eating instead to really keep morning sickness at bay.

Drink More Water

Along those same lines, drinking enough water is also necessary to keep things moving in your digestive track. Be sure you’re drinking enough to keep from getting thirsty and if you’re experiencing constipation, try adding in a few extra glasses throughout the day. Walking more can also help with constipation, but be sure to increase your water intake even more as you increase your activity level.

Load Up On Probiotics

Probiotics can also help with constipation. Try adding some full-fat, unsweetened yogurt or kefir to your diet, or add in more fermented traditional foods like sauerkraut, kimchi, kvass, or kombucha.

There’s been a lot of controversy lately over whether or not probiotic supplements can be trusted after one independent research study found that many brands contained ingredients not listed on the label and another found evidence of fungal contamination. Other studies have found that many supplements don’t contain the levels of bacteria they claim to. Since researchers aren’t naming the brands they tested, I can’t currently recommend any widely available supplements and I suggest getting your probiotics from food (kefir is my personal favorite).

There are a few brands of high-quality probiotics I trust that are available through licensed healthcare practitioners. Unfortunately, they all require continuous refrigeration, so shipping on these products can often be two to three times the cost of the product itself. If you can find a local practitioner that carries them though, I like probiotics from Innate Response, Klaire Labs, and Thorne Research.

Supplement With Magnesium

If your diet is up to par, you’re getting enough activity, and you know you’re drinking enough water to prevent getting dehydrated, you might want to try taking powdered magnesium citrate. Most pregnant women are deficient in this mineral and it’s my secret weapon for combatting all sorts of pregnancy symptoms, from morning sickness to insomnia, anxiety, nighttime leg cramps, and more.

To use magnesium citrate to treat constipation in pregnancy, start by taking a half teaspoon in warm water before bedtime and gradually increase your dose until you’re having normal bowel movements that are comfortably soft, but not loose. If you get to the point where you’re taking more than a teaspoon, you can divide your dose so you’re taking half in the morning and half at night. Magnesium can also help with insomnia though, so if you’re having trouble sleeping you might find that taking your entire dose at night helps.

Take magnesium at least two hours away from any calcium supplements or calcium rich foods (i.e. don’t take it with a glass of milk). And although magnesium is usually safe to take at normal dosages during pregnancy, be sure to check with your midwife or OB before adding this (or any) supplement to your daily regimen.

Finally, avoid taking stimulant laxatives during pregnancy, including herbal formulas or teas. Many herbal laxatives contains senna or cascara sagrada, both of which are unsafe to use during pregnancy.

Number five was a lifesaver for me!

Natural Morning Sickness Remedies: Magnesium

Magnesium is one of those minerals that can seemingly do no harm. Beloved by natural living enthusiasts everywhere, the lists of conditions it’s been credited with curing go on and on… Leg cramps, heart palpitations, insomnia, constipation, migraines, anxiety, even incontinence. And now we can add morning sickness to that list.

I’ve read several explanations regarding the mechanism by which magnesium lessens the symptoms of morning sickness, but frankly, none of them really stand up to close scrutiny. The most popular theory I’ve run across online credits magnesium’s ability to lower cortisol levels. While it’s true that magnesium supplementation has been shown to reduce levels of this hormone, cortisol production actually peaks later in pregnancy. That means that if cortisol was to blame for morning sickness, we’d be feeling nauseated later in pregnancy, not in the first trimester.

Regardless of how it works, I have found that using a magnesium supplement can reduce the symptoms of morning sickness. For me, it seemed to take away the feeling that my digestive tract was super-irritated which was one of the worst parts of morning sickness for me. It can also lessen nausea and aversions to foods and smells.

There are several ways to increase your intake of magnesium. The best is probably to up your intake of magnesium-rich foods such as nuts and seeds, spinach, and black beans. The magnesium found in foods is most readily absorbed by your body, so if you can tolerate eating foods that are high in magnesium, consider adding them to your daily diet. It’s likely however, that you may require additional supplementation if your morning sickness symptoms are severe.

While there are many forms of magnesium supplements available, I prefer powdered magnesium citrate, taken before bedtime. The most popular and widely available brand of magnesium citrate is probably Natural Calm, but independent testing of this supplement has shown it may contain unsafe levels of lead. Not the best thing to be ingesting while pregnant (or at any time for that matter). It’s entirely possible that the lead issue had been resolved, but just to be safe, I prefer Magnesium Serene (manufactured by Source Naturals and available in several flavors — I’m partial to the tangerine).

Start by taking a half teaspoon in warm water before bedtime and gradually increase your dose until you start to experience loose stools. Then back down a bit until you’re having normal bowel movements and stay at that dose. Take it at least two hours away from any calcium supplements you may be taking, or calcium rich foods (ie don’t take it with a glass of milk). And although magnesium is usually safe to take at normal dosages during pregnancy, be sure to check with your midwife or OB before adding this (or any) supplement to your daily regimen.

The last option is topical magnesium oil or gel. Topical magnesium is gaining in popularity, but may people find that it’s irritating to their skin. It has been purported that topical magnesium is better absorbed by the body and some people swear by it, but I have personally never had great results with it for morning sickness. I do recommend it for leg cramps that may occur later in pregnancy. Of the two options available, I prefer the gel since it’s easier to measure and control.

Have you used magnesium to combat morning sickness symptoms? What form have you found to work best for you? Let me know in the comments below!

Natural Morning Sickness Remedies: Herbal Teas

It’s no secret that I think much of the morning sickness advice dispensed online is terribly misguided. There are a few instances however, where conventional wisdom is actually spot on. For example, two of the most well-know remedies for morning sickness are, for many women, two of the most effective: ginger and peppermint. While both of these remedies can be taken in many forms, I usually recommend them to my patients in the form of herbal tea.

Ginger has long been recognized for its ability to quell nausea. In addition to morning sickness it’s been widely studied and proven useful for motion sickness, nausea resulting from chemotherapy treatment, food poisoning, and even the nausea can that sometimes accompany migraines.

The exact mechanism by which ginger reduces nausea is unknown, but it can be taken in many forms including fresh (you can find the root in the produce section at the grocery store), dried in capsules or as tea, crystallized, or as an ingredient in foods or drinks. Most ginger ales, famously given to sick kids with the stomach flu and as a staple on airplanes everywhere, contain much more sugar than ginger. In fact many brands don’t contain any actual ginger at all these days, having been replaced years ago with “natural” or artificial ginger flavoring.

A much better option is ginger tea, made with grated or sliced fresh ginger, or bought in bags as an herbal tea that’s available online and at most health food stores. I find the warmth of the tea is soothing to many women experiencing nausea and drinking it in liquid form gets the ginger into your system to start relieving nausea quickly.

To make a tea from the fresh root, take several thin slices of ginger or about a tablespoon of freshly grated root and add to a cup of hot water. Let the tea steep for three to five minutes and add a squeeze of lemon if desired. You can also nibble on the slices or gratings themselves after the tea is gone.

Although I typically recommend limiting sugar, especially during the first trimester when it can aggravate morning sickness, crystallized ginger or natural ginger chews can easily be stored in your purse for times when nausea strikes and you’re out and about.

Another great morning sickness remedy is peppermint. Peppermint can be purchased fresh, dried or as a bagged tea, often found blended with other mints and herbs.

If using the fresh leaves, rub gently between your fingers to release the plant’s natural oils and then rip them into smaller pieces before adding a couple of tablespoons to a cup of hot water. Alternately, add about a tablespoon of the dried herb to hot water and let steep for three to five minutes before drinking.

Again, I recommend avoiding sugar during your pregnancy, but for emergencies natural mint candies or gum can be a lifesaver when you’re out and about and don’t have another option. Just be sure to check the label and avoid anything that contains artificial sweeteners.

Try experimenting with both ginger and peppermint to see how you react to each. Some people find that one will sometimes bring on heartburn, but are ok with the other. I personally found that ginger relieved my nausea more quickly, but peppermint kept it at bay longer. Try them both to see what works for you!

Do you use ginger or peppermint to relieve your morning sickness? Which form works best for you? Let me know in the comments below!

References:
Willetts K, Ekangaki A, Eden J. Effect of a ginger extract on pregnancy-induced nausea: a randomised controlled trial. Aust N Z J Obstet Gynaecol2003;43:139–144. http://www.ncbi.nlm.nih.gov/pubmed/14712970

Vutyavanich T, Kraisarin T, Ruangsri R. Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. Obstet Gynaecol 97;2001:577–582. http://www.ncbi.nlm.nih.gov/pubmed/11275030

Natural Morning Sickness Remedies: Diet Change

The internet abounds with dietary advice to help keep morning sickness at bay. Unfortunately, much of this well-intentioned (but misguided) advice centers around keeping saltines on hand at all times… Possibly some of the worst advice ever. The good news is that there are much more effective dietary measures that can be taken to combat the nausea and vomiting of early pregnancy.

Although the exact cause of morning sickness remains unknown, it can be greatly aggravated by falling blood sugar. Many women notice that if they go too long without eating, morning sickness returns with a vengeance. The advice to eat saltines when you start to feel nauseated is based on this fact and the idea is that a fast infusion of glucose into the bloodstream will quickly raise blood sugar and relieve the resulting queasiness.

The problem with this advice, as most people now know, is that empty, white-flour carbs (like those found in saltines) will cause a blood sugar spike and subsequent crash that may leave you feeling even worse once the initial effects of the carbs wear off.

Alternately, a diet higher in protein and lower in quickly absorbed carbs (sugar, white flour, etc) will help keep blood sugar at a more consistent level throughout the day. In fact one study published by the University of Michigan Medical Center showed that meals high in protein decreased nausea and digestive dysrhythmia much better than meals that emphasized carbohydrates or fats.

Although many women experience strong aversions to meat and eggs during their first trimester (probably a biological left-over from the days before refrigeration when these types of foods spoiled quickly), if you can stomach them, they’re great sources of the healthy protein your body needs to grow a baby. Don’t worry if you find it difficult (or impossible) to eat meat and eggs, you still have plenty of other good protein options available.

Smoothies made with fruit, milk and whey, egg, rice, or pea protein can satisfy cravings for sweets while also upping your protein intake. Just make sure the protein powder you choose doesn’t contain any sugar, artificial sweeteners, or additives. I feel comfortable recommending limited amounts of stevia-sweetened powders to my pregnant patients (and consuming them myself), but check with your midwife or OB if your pregnancy is high-risk or if you have concerns regarding stevia. My favorite all natural, stevia-sweetened protein powder comes in egg and whey varieties and can be found here.

Many women with food aversions can tolerate dairy products, so Greek yogurt and hard cheeses can be another good protein option. Choose full-fat dairy products that are organic and / or grassfed when possible. As Greek yogurt has increased in popularity, so have knock-offs that contain far more sugar than protein. Look for plain, unsweetened versions that contain at least twice the amount of protein as carbs. My personal favorite is Fage Total (check out their store locator to find the Classic Plain at a store near you).

Nuts are another good source of protein and can also help with salt cravings. Raw unsalted nuts pack the biggest nutritional punch, but roasted salted nuts can be a great substitute for those nutrient deficient saltines everyone keeps trying to push on you. Choose dry-roasted nuts when possible and be sure to check labels for added sugars, sweeteners, and additives.

Sometimes when you’re experiencing morning sickness you’re just going to have to eat whatever you can get (and hopefully keep) down, but if you aim to keep your protein intake high on most days while keeping sugar (including honey, maple syrup, agave nectar, etc) and starchy carbs to a minimum, you’ll greatly reduce the nausea most women experience during the first trimester.

What diet changes have you made that have helped with your morning sickness?

References:
Jednak MA, Shadigian EM, Kim MS, et al. Protein meals reduce nausea and gastric slow wave dysrhythmic activity in first trimester pregnancy. Am J Physiol. 1999;277(4 Pt 1):G855–G861. http://www.ncbi.nlm.nih.gov/pubmed/10516152