Plant-based TCM Pregnancy Diet -
Can a plant-based pregnancy diet actually work and how does Traditional Chinese Medicine(TCM) views a pregnancy?
That’s the question many vegans/vegetarians have.
During pregnancy and lactation, a well-balanced plant-based diet can give a baby the best possible start and set the stage for a lifetime of good health. This is a vital stage of life for expectant parents to become savvy about nutrition. However, creating an optimal plant-based diet may be a new experience, and well-meaning friends, relatives, and even some health professionals may question or doubt the benefits of a vegan diet. Fortunately, it’s a great time to go plant-based because there’s plenty of support available. Mothers can be well nourished during pregnancy and lactation whether they are gourmet cooks, frequent restaurants, or keep meal preparation to the barest minimum. Whatever the situation, designing a nutritionally adequate plant-based diet is both possible and less challenging than one might think. Vegan Society laid out its guidelines quite clearly.
Plant-based Nutrition before Pregnancy
Before getting pregnant, a prospective mother should reach a healthy body weight. A weight-loss diet during any stage of pregnancy is undesirable (unless done with medical supervision). To determine whether current weight is in the optimal range, check the body mass index (BMI). In women who are overweight (BMI of 25 to 29.9) or obese (BMI above 29.9), weight reduction can decrease the risk of gestational diabetes, high blood pressure, and preeclampsia (a condition that includes high blood pressure, fluid retention, and protein loss in the urine).
In slightly underweight women, gaining a few pounds can increase the chances of becoming pregnant and decrease the risk of having a preterm birth or an underweight infant. For women with a large frame, the lower end of the healthy BMI range could be too low.
To protect a fetus from potential birth defects, ensure that the plant-based diet is rich in folate—even before becoming pregnant. This isn’t difficult; beans, greens, and oranges are excellent sources of this vitamin. Folate and the mineral zinc (present in seeds, cashews, and legumes, including soy foods) also are important for male fertility.
Plant-based Nutrition in Pregnancy
During pregnancy, the nutrients a baby needs for growth come entirely from its mother. Because the baby will frequently draw on the mother’s reserves, it’s extremely important for her body to be well nourished. Women who plan to get pregnant within the next few years should start to make the necessary dietary changes now to establish eating patterns that support excellent health, so their reserves will be well stocked when pregnancy ensues.
Calorie requirements don’t change significantly during the first trimester and only increase by about 10 to 15 percent during the second and third trimesters. Yet, the requirement for certain vitamins and minerals is greater from early in pregnancy, so food selections really matter.
The First Trimester
No extra calories are required before pregnancy (unless the prospective mother is underweight) and few, if any, during the first trimester. A recommended weight gain during the first trimester is 3.5 pounds (1.6 kg). If a woman was underweight, the recommended gain is 5 pounds (2.3 kg); if overweight, 2 pounds (0.9 kg). An expectant mother’s diet does require many vitamins and minerals, and her food choices may need adjustment to ensure
they deliver good nutrition. For example, although the recommended protein intake doesn’t increase during the first trimester compared to prepregnancy requirements, foods rich in protein and iron are needed to build an increased blood supply—especially if these nutrients weren’t high priorities in the past.
Your best buddy during this phase – Legumes
Legumes are a great food choice; they provide protein and iron along with fiber, which helps to prevent constipation. Legumes also can reduce the risk of gestational diabetes. Eating well in the first trimester isn’t always easy. In 80 percent of women, morning sickness arises between the fourth and seventh week of pregnancy; typically, it has resolved by the twentieth week.
Pyridoxine (vitamin B6) has been shown to safely and effectively alleviate nausea and vomiting for many women; fortunately, vegan diets can be rich in this nutrient. During this period, nature gives some women a craving for bland, dry, high-carbohydrate foods. Low-fat, high-carbohydrate foods pass rapidly through the stomach and are quickly digested, allowing less time for queasiness. Women experiencing morning sickness may keep a few crackers by the bedside to have upon awakening. Ginger also is a time-honored remedy for nausea; consuming ginger in the form of cookies, teas, preserves, powder, capsules, and ginger ale can provide relief. Another way to limit nausea is to avoid foods that have strong odors or being around cooking; cold foods often are better tolerated, because they have less aroma.
Sometimes nausea is due to hunger, so pregnant women should eat often, relying on small meals and frequent snacks. Crackers and hummus is a nutritious combination, as is toast with lentil or bean soups. If solid food can’t be tolerated, expectant mothers should try to consume whatever they can; juice, fortified soy milk, or miso broth are good choices. A pregnant woman who is unable to eat or to drink adequate amounts of fluids for twenty-four hours should contact her health care provider.
Because morning sickness can interfere with proper nutrition, women who want to become pregnant or who are in the early stages of pregnancy may be advised by their health care provider to take a multivitamin-mineral supplement or a supplement specific to pregnancy. A supplement that includes the vitamins B12, D, choline, and folic acid and the minerals iodine, iron, and zinc is most valuable for vegan mothers-to-be; an online search for “vegan prenatal supplement” can provide sources. For most nutrients, high doses can be harmful; avoid excessive intakes.
The recommended intakes for minerals and vitamins change when a woman becomes pregnant and again when she’s breast-feeding. Pregnant women need more copper, iodine, zinc, vitamin A/carotenoids, riboflavin, pantothenic acid, and vitamins B6, B12, and C; during lactation, even higher quantities of these nutrients are needed. The required intakes for other vitamins and minerals (magnesium, iron, thiamin, niacin, and folate) rise in pregnancy and then level off or decrease during lactation. The requirement for vitamin E also increases when a mother breast-feeds her baby. However, for a few nutrients (calcium and vitamins D and K), the recommendation stays the same.
By the end of the first trimester, morning sickness should be fading, at least to some extent, and expectant mothers may experience a busy bladder, notice a baby bump, and hear the baby’s heartbeat through an ultrasound device.
How TCM views First Trimester
In ancient China, many gynecologists concentrated their attention on what they called ‘fetus
education’, i.e. a set of hygiene rules for pregnant women formulated in the belief that the mother’s diet, lifestyle and emotions affect the fetus. Thus, by manipulating her diet and environment and paying attention to her emotional life, the expectant mother could affect the fetus positively.
In the first three months of pregnancy the woman should eat nourishing and easily digestible cooked food; she is allowed to eat some sour foods if she wants to, for many pregnant women develop cravings for certain foods. She should also avoid sexual activity and excessive physical work. At this time, she may develop joint pains all over the body: these are due to the growth of the fetus.
According to TCM, blood circulation in the first trimester is slower and the woman should not over-exert herself physically. She should also avoid becoming overly anxious or fearful.The fetus feels pain when the mother is exposed to excess cold and feels fear when the mother is exposed to excess heat. If the mother develops abdominal distension or frequent urination and a bearing-down sensation, she should seek a TCM consultation on how to treat this problem.
The Second and Third Trimester
The need for additional calories increases during the second and third trimesters. Pregnant women should eat about 340 extra calories per day during the second trimester and about 450 calories extra per day during the third trimester; the exact amount will vary based on the mother’s metabolism and activity level.
The recommended weight gain during the second and third trimesters is about 1 pound (0.44 kg) per week. For women who were underweight, the recommended gain is an average of 1.1 pounds (0.49 kg) per week; for overweight women, about 0.6 pound (0.3 kg) per week throughout the second and third trimesters. Women should follow the guidance of physicians and medical caregivers regarding desirable weight gain during all stages of pregnancy.
During the second and third trimesters, calorie requirements increase by 15 to 20 percent over prepregnancy needs; meanwhile, protein requirements increase by 50 percent. Starting in the fourth month of pregnancy, an extra 28 grams of protein per day is required (this is 10 percent higher than the 25 grams recommended for nonvegetarians and compensates for the slightly lower digestibility of plant protein). For example, a vegan woman whose prepregnancy
weight is 135 pounds (61 kg) and whose prepregnancy protein requirement is 55 grams would need to ingest a total of 83 grams of protein every day during this period of her pregnancy. A pregnant woman carrying twins would need 56 grams of added protein daily.
To meet these higher requirements, it makes sense for expectant mothers to have at least one protein-rich food at each meal and at most snacks.
How TCM views Second/Third Trimester
In the fourth to sixth month of pregnancy the fetus begins to receive essential Qi from the mother to establish its temperament. It is therefore advisable for her to sleep long hours, wear enough clothing and be exposed to a little sunshine. The woman should take light exercise and not stay indoors all the time.
In China, we still find the belief that the mother’s emotional state during pregnancy has a lasting effect not only on the child’s health and intelligence, but also on the emotional state in his or her future life. Sun Simiao(one of the great TCM physician) therefore recommends that pregnant women look at objects of great beauty and create internal clarity by meditating.
Behavioral recommendations therefore aim especially at a calm, cheerful emotional state. Cultivating inner harmony and joy allows the pregnant woman, the father, and the child to develop an intimate heart-connection to each other, which has a beneficial effect on their mutual wellbeing. Especially significant in this context is cultivating the fire of the partnership, of love and sexuality, which should be nurtured particularly consciously in this time.
At the third trimester, the mother should avoid emotional upsets and practise quiet breathing to maintain her Qi which will promote a moist and lustrous skin in the fetus. The pregnant woman should be without great hunger and should not eat to excessive satiety either, nor should she consume dry foods. She should not work to the point of fatigue and she should pay attention to dressing warmly and getting enough sleep. Avoid dryness and cold.
In the ninth month, the child is fully formed, and especially women with a difficult pregnancy
are reassured by the thought that they have managed to reach this stage. A premature baby could now also survive on its own. The kidney channel supplies the child and should therefore not be treated with acupuncture. By contrast, anything that nourishes the kidney is beneficial: a lot of sleep, rest, good nutritious food (meat broths) and warm clothing. Pay attention particularly to warm feet, knees, and a warm back, because we can otherwise see increased pain in the area of the lumbar spinal column. The woman should not dwell in damp and cold places or overexert herself, but regular movement is considered strengthening.
These recommendations, which apply to uncomplicated pregnancies, are especially fitting for women who experienced problems with their fertility and therefore bring a constitutional kidney weakness to the situation.
Is folate that important?
This vitamin is crucial for building a fetus’s genetic material (DNA) and for other aspects of fetal growth, including the early evolution of the neural tube, which develops into the brain and spinal cord. The Institute of Medicine (IOM) recommends that nonpregnant women—especially those who hope to become pregnant—aim for a daily intake of 400 mcg DFE (dietary folate equivalents, which take into account the various forms of folate); a pregnant woman should receive 600 mcg DFE daily.
Numerous vegan foods are naturally endowed with folate; this form of the vitamin is well utilized by the body (its other name is vitamin B9, and it is indeed “benign”). Beans, greens, and oranges provide plentiful amounts of folate.
A pregnant vegan can get her 600 mcg of folate for the day by eating a reasonable mix of citrus fruits, greens, legumes, and whole grains. For example, 1 cup (250 ml) of orange juice provides 74 mcg of folate, 3 cups (750 ml) of romaine lettuce provide 192 mcg, 1 cup (250 ml) of black beans provides 256 mcg, and 1 cup (250 ml) of cooked quinoa provides 78 mcg, adding up to a total of 600 mcg of folate.
Although folate is required for proper cell division, it seems that an excess of folic acid may take cell division in the wrong direction and increase the risk of colon cancer and other cancers. Folic acid is a related synthetic compound used in supplements and fortified foods (such as enriched breads and baked goods, pasta, rice, flour, and cereals) because it’s more stable and less expensive. Strong (and often contradictory) expert opinions exist regarding intakes of this form of vitamin B9 in supplements, because the body processes folate and folic acid differently. Folic acid can be converted in the liver to the useable form of this vitamin by an enzyme that the body produces in limited amounts. Because of this potentially incomplete conversion, high intakes of folic acid may result in the circulation of unconverted folic acid in the bloodstream. It’s wise not to exceed a total daily intake of 1,000 mcg DFE per day. Women who use folic acid supplements should choose those that provide 400 mcg—or at most 550 mcg—daily.
Iron Deficiency during Pregnancy
The most widespread nutritional deficiency in the world is iron deficiency; it’s a common concern for women on any diet, whether vegan, vegetarian, or nonvegetarian. Good iron status early in pregnancy and adequate maternal intakes of this mineral during pregnancy are linked with better birth weights and less risk of preterm births. I have written an article solely on iron deficiency, you can check it out here.
Many otherwise healthy women fail to meet recommended iron intakes— including during pregnancy, when the body’s blood supply increases by 40 to 50 percent to deliver oxygen to the fetus and surrounding tissues. Iron supports development of the brain and nervous system; deficiency can have lifelong neurological and behavioral consequences. Adequate iron also is required to build the baby’s own iron stores. In fact, 80 percent of a term infant’s stored iron is accrued during the third trimester; a premature infant doesn’t have the advantage of this accretion and will need supplemental iron starting early in life.
The RDA for pregnant women is 27 mg of iron per day, an increase of 50 percent over the prepregnancy RDA. Because some plant foods contain substances (such as phytates) that decrease iron absorption, the IOM further advises that vegetarians consume 1.8 times as much iron as nonvegetarians— which would bring the recommended intake to 48 mg per day.
Some experts question whether the recommendation for vegans needs to be quite this high;
plus, 48 mg is above the tolerable upper intake level (UL) of 45 mg per day, so the goal shouldn’t be above 45 mg unless medically advised.
Studies in the United States have repeatedly shown that vegan diets are as high or higher in iron than lactovegetarian and nonvegetarian diets, as well as being rich in vitamin C, which greatly increases iron absorption. Also, during pregnancy, nature kindly steps in and greatly increases the efficiency of iron absorption from plant foods, especially during the second trimester. Ironrich vegan foods tend to be the same foods, such as beans, peas, and lentils, that are high in protein, zinc, and the B vitamins folate and choline.
How TCM views pregnancy
During pregnancy, a woman may experience numerous discomforts, including morning sickness, abdominal pain, backache, bloatedness, water retention, anxiety, constipation, headache to name a few. All these CAN be managed with TCM herbs, not just conventional medicine. Some are even contra-indicated in pregnancy. Therefore, if you are experiencing these discomforts, you can always consult a TCM physician for advice. Maybe one day I will write in detail how TCM can manage pregnancy ailments such as morning sickness in a separate article.
One thing I hope to emphasise is emotions. As always, emotions play the greatest role (not only in pregnancy). Any excessive or long-term emotion is also transferred to the fetus as the first stimulus. If the internal energy of a pregnant woman (as a result of these emotions) is disturbed, this condition may prevent adequate development of the internal organs of the fetus, leading either to birth defects and diseases or even abortion.
Secondly, diet. According to TCM, foods such as beans and legumes are particularly suitable foods during pregnancy and boiled water with lemon is recommended for drinking. A varied, simple and balanced diet is the basis, as well as regularity, which prevents starvation or overeating.
On the other hand unsuitable foods include alcohol, cold drinks and foods with cold energy, such as raw salads. After the 7th month, salty foods are not recommended (due to swelling). Oily and fatty foods are also difficult to digest and damage the spleen that in turn produces stagnation while spicy and hot foods (spicy meals, onions, chives) produce an internal fire that disturbs the fetus.
I strongly discourage pregnant women to self-medicate and take TCM herbs without a detailed consultation with a TCM physician as they can be detrimental. Not ALL TCM herbs are suitable for pregnant women. Could not stress that enough.
Edmund graduated with a First Class Hons in Biomedical Sciences and Traditional Chinese Medicine from Nanyang Technological University, before taking a Masters in Gynaecology(TCM) in Liaoning, China.
He has successfully treated patients with unexplained infertility, Polycystic Ovarian Syndrome(PCOS) and endometriosis and helped them conceive naturally with Traditional Chinese Medicine.