Why common pregnancy diet recommendations don’t often work

Since I got pregnant, people have been even more intrigued by my food. “What are you eating? Can you eat that? You should eat/drink this and this when you’re pregnant.” Sometimes people ask because they’re curious and they’d genuinely like to know how I’m eating. I appreciate that approach, but I don’t appreciate it when people try to tell me what to do.

Pregnant women are constantly being told from multiple sources what they should and shouldn’t eat. There are certain accepted dietary restrictions for pregnant women such as no raw meat, no unpasteurized cheeses, and no alcohol. But there’s also a lot of confusion out there about how a woman should eat healthfully when pregnant.

What should a pregnant woman eat?

Pregnant women usually hear that they should gain weight but not too much weight. They should try to slow down their weight gain in order to avoid many scary-sounding complications. But how is a pregnant woman supposed to do that? One’s hormonal landscape is quite different from usual during pregnancy, so hunger cues and cravings can be all over the place. Dealing with those is difficult with “normal” hormones, so what is left for pregnancy hormones!

Most websites and apps recommend a common high-carbohydrate diet to pregnant women. Basically, women are supposed to eat lots of vegetables with some protein, not a lot of fat, and a decent amount of carbohydrates, especially whole grains and fruit.

Now, there are some good and some bad things about this advice. Lots of vegetables? Great! Most people benefit from eating lots of vegetables, as they deliver important nutrients, provide fiber to improve our digestion, and help us stay satiated.

Protein? Yes, please! Protein is super important to keep our hormones balanced, to stabilize our blood sugar, and to promote satiety, thus reducing ravenous hunger and cravings. While the protein recommendations on most pregnancy websites and apps are still too low, some health professionals have started emphasizing the importance of sufficient protein.

Another note on protein: Recently, healthful eating has come to rely less on animal protein, which doesn’t work for a lot of people. I see protein recommendations for pregnant women including, for example, feta cheese, almonds, and chickpeas. While those do include some protein, cheese and nuts have more fat than protein, and chickpeas and other legumes include more carbohydrate than protein. What’s more, humans absorb protein better from animal sources (such as meat and fish) than from plant sources. So these common protein recommendations for pregnant women often don’t meet one’s protein needs. Alternatively, if one eats enough of the food to get sufficient protein, then she is getting too much fat or carbohydrates for her needs, which leads to eating too many calories or unstable blood sugar.

That’s me with a big belly and a bowl of chocolate beans.
Credit: Ani Manahova (a.k.a. my mom)

Confusion: How much carbs should a pregnant woman eat?

Back to the commonly recommended pregnancy diet, many websites encourage women to eat lots of carbohydrates. Paraphrasing from one source (because I don’t want to throw any one organization under the bus), pregnant women should eat lots of starchy foods such as wholegrain bread, jacket potatoes, rice and pasta because these are good sources of vitamins, fiber, and energy. Starchy foods are supposed to take up one third of a woman’s meal. Whoa!

The main problem with this advice is that starchy foods raise blood sugar unfavorably for many of us. When blood sugar is high, insulin is also high because it tries to lower our blood sugar and store the energy from the food in our fat cells. While this is a normal and healthy process, if blood sugar is too high, insulin is also rather high, leading to more fat storage than what we would consider optimal. Therefore, it’s useful not to eat foods that raise our blood sugar too much too often.

This can vary from person to person, but there are some important commonalities between pregnant women. When a woman is pregnant, she is more insulin resistant than usual, meaning she stores fat more easily. This is a smart way for the body to make sure she retains enough fat to fuel the baby’s development throughout pregnancy and afterwards through breast feeding. But in today’s industrialized world, our foods often contain too much carbohydrates for our activity levels, leading to unwanted weight gain and health complications along the way.

Once blood sugar has been driven high by eating lots of starchy foods, it can often drop rather low afterwards. This leads to light-headedness, intense hunger, and cravings for sweets. Is it a surprise, then, that pregnant women, who are encouraged to eat lots of carbohydrates, often report insatiable cravings and ravenous hunger? Once again, pregnant women’s unique hormonal situation also makes them more prone to these swings in blood sugar.

A vicious cycle

This can lead to a vicious cycle. A pregnant woman eats more carbohydrates than she needs for her metabolism and activity levels, her blood sugar spikes and then drops, she feels light-headed, hungry and irritable, and feels that the only solution is to eat something sugary. She consumes something sweet, and the cycle begins anew.

This can lead to too much weight gain, upon which the woman’s health practitioner might tell her to “slow down her weight gain.” But how is she supposed to do that if she’s on the blood sugar roller coaster? The ravenous hunger and intense cravings are way beyond our will power, so, naturally, the steep weight gain continues.

This may be one of the factors contributing to the high levels of gestational diabetes seen today (gestational diabetes is a type of diabetes that develops during pregnancy and can have significant consequences for mother and baby). Interestingly enough, one of the main treatments for a mother with gestational diabetes is to tell her to eat less carbohydrates. Wow! Maybe we should have started with that in order to try to prevent some cases of gestational diabetes in the first place?

Please note that I’m not saying pregnant women should eat no carbohydrates. Not at all! Carbs are an important component of our diet, and many of us need them to function optimally. However, the amount of carbs pregnant women are usually told to eat is way too high for their needs (metabolism and activity level) and ends up causing unwanted issues. It’s time we recognize that and learn how to help pregnant women better.

“You’re pregnant, you can eat whatever you want!”

Pregnant or not, you can always eat whatever you want! You’re an adult (I assume) with a wallet, so you can go to the store and buy whatever food you want. The point is to recognize how your choices are working for you. Once you know how a food affects you (does it give you stable energy, does it make you ravenously hungry a few hours after eating, or does it give you cravings soon after eating), you can link the food to the consequences and decide when/how often to eat it.

Nobody’s ‘diet’ needs to be perfect according to any standard; it just needs to work for you. Many pregnant women would like to avoid excessive weight gain and related health complications, so they need to find foods that allow them to achieve these goals. Unfortunately, the commonly recommended pregnancy diet is not optimal for many people. I wish more women had the tools to figure out what foods work for them and allow them to achieve their health goals.

What do you think pregnant women should eat? If you were ever pregnant, did you experience ravenous hunger? Let me know by commenting below or on FacebookTwitter, or LinkedIn.