Nutrition and Pregnancy, I: Nutritional Triage

Happy Mother’s Day!

2013 Mothers DayMother’s Day seems an auspicious time to begin a series on nutrition in pregnancy. It is an important topic, as I believe pregnant mothers are often alarmingly malnourished.

Triage Theory

“Triage theory,” put forward by Bruce Ames [1], is an obviously true but nevertheless important idea. It offers a helpful perspective for understanding the consequences of malnourishment during pregnancy

Triage theory holds that we’ll have evolved mechanisms for devoting nutrients to their most fitness-improving uses. When nutrients are scarce, as in times of famine, available nutrients will be devoted to the most urgent functions – fuctions that promote immediate survival. Less urgent functions – ones which affect end-of-life health, for instance – will be neglected.

Ames and his collaborator Joyce McCann state their theory with, to my mind, an unduly narrow focus: “The triage theory proposes that modest deficiency of any vitamin or mineral (V/M) could increase age-related diseases.” [2]

McCann and Ames tested triage theory in two empirical papers, one looking at selenium [2] and the other at vitamin K [3]. McCann & Ames used a clever method. They used knockout mice – mice in which specific proteins were deleted from the genome – to classify vitamin K-dependent and selenium-dependent proteins as “essential” (if the knockout mouse died) or “nonessential” (if the knockout mouse was merely sickly). They then showed experimentally that when mice were deprived of vitamin K or selenium, the nonessential proteins were depleted more deeply than the essential proteins. For example:

  • “On modest selenium (Se) deficiency, nonessential selenoprotein activities and concentrations are preferentially lost.” [2]
  • The essential vitamin K dependent proteins are found in the liver and the non-essential ones elsewhere, and there is “preferential distribution of dietary vitamin K1 to the liver … when vitamin K1 is limiting.” [3]

They also point out that mutations that impair the “non-essential” vitamin K dependent proteins lead to bone fragility, arterial calcification, and increased cancer rates [3] – all “age-related diseases.” So it’s plausible that triage of vitamin K to the liver during deficiency conditions would lead in old age to higher rates of osteoporosis, cardiovascular disease, and cancer.

Generalizing Triage Theory

As formulated by Ames and McCann, triage theory is too narrow because:

  1. There are many nutrients that are not vitamins and minerals. Macronutrients, and a host of other biological compounds not classed as vitamins, must be obtained from food if health is to be optimal.
  2. There are many functional impairments which triage theory might predict would arise from nutrient deficiencies, yet are not age-related diseases.

I want to apply triage theory to any disorder (including, in this series, pregnancy-related disorders) and to all nutrients, not just vitamins and minerals.

Macronutrient Triage

Triage theory has already been applied frequently on our blog and in our book, though not by name. It works for macronutrients as well as it does for micronutrients.

Protein, for instance, is preferentially lost during fasting from a few locations – the liver, kidneys, and intestine. The liver loses up to 40 percent of its proteins in a matter of days on a protein-deficient diet. [4] [5] This preserves protein in the heart and muscle, which are needed for the urgent task of acquiring new food.

Protein loss can significantly impair the function of these organs and increase the risk of disease. Chris Masterjohn has noted that in rats given a low dose of aflatoxin daily, after six months all rats on a 20 percent protein diet were still alive, but half the rats on a 5 percent protein diet had died. [6] On the low-protein diet, rats lacked sufficient liver function to cope with the toxin.

Similarly, carbohydrates are triaged. On very low-carb diets, blood glucose levels are maintained so that neurons, which need a sufficient concentration gradient if they are to import glucose, may receive normal amounts of glucose. This has misled many writers in the low-carb community into thinking that the body cannot face a glucose deficiency; but the point of our “Zero-Carb Dangers” series was that glucose is subject to triage and, while blood glucose levels and brain utilization may not be diminished at all on a zero-carb diet, other glucose-dependent functions are radically suppressed. This is why it is common for low-carb dieters to experience dry eyes and dry mouth, or low T3 thyroid hormone levels.

One “zero-carb danger” which I haven’t blogged about, but have long expected to eventually be proven to occur, is a heightened risk of connective tissue injury. Carbohydrate is an essential ingredient of extracellular matrix and constitutes approximately 5% to 10% of tendons and ligaments. One might expect that tendon and ligament maintenance would be among the functions put off when carbohydrates are unavailable, as it takes months for these tissues to degrade. If carbohydrates were unavailable for a month or two, there would be little risk of connective tissue injury. Since carbohydrate deprivation was probably a transient phenomenon in our evolutionary environment, except in extreme environments like the Arctic, it would have been evolutionarily safe to deprive tendons and ligaments of glucose in order to conserve glucose for the brain.

Recently, Kobe Bryant suffered a ruptured Achilles tendon about six months after adopting a low-carb Paleo diet. It could be coincidence – or it could be that he wasn’t eating enough carbohydrate to meet his body’s needs, and carbohydrate triage inhibited tendon maintenance.

Triage Theory and Pregnancy-Related Disorders

I think triage theory may helpfully illuminate the effects of nutritional deficiencies during pregnancy. When a mother and her developing baby are subject to nutritional deficiencies, how does evolution partition scarce resources?

Nutritional deficiencies are extremely common during pregnancy. For example, anemia develops during 33.8% of all pregnancies in the United States, 28% of women are still anemic after birth [source].

It’s likely that widespread nutritional deficiencies impair health to some degree in most pregnant women.

Those who have read our book know that we think malnutrition is a frequent cause of obesity and diabetes. Basically, we eat to obtain every needed nutrient; if the diet is unbalanced, then we may need an excess of fatty acids and glucose before we have met our nutritional needs. This energy excess can, in the right circumstances, lead to obesity and diabetes.

But obesity and diabetes are common features of modern pregnancy. Statistics:

  • 5.7% of pregnant American women develop gestational diabetes. [source]
  • 48% of pregnant American women experience a weight gain during pregnancy of more than about 35 pounds. [source]

I take the high prevalence of these conditions as evidence that pregnant women are generally malnourished and the need for micronutrition stimulates appetite, causing women to gain weight and/or develop gestational diabetes.

Another common health problem of pregnancy is high blood pressure: 6.7% of pregnant American women develop high blood pressure [source]. This is another health condition which can be promoted by malnourishment.

It’s likely that nutritional deficiencies were also common during Paleolithic pregnancies. If so, there would have been strong selection for mechanisms to partition scarce nutrients to their most important uses in both developing baby and mother.

A Look Ahead

So:

  1. Nutritional deficiencies are widespread during modern pregnancies.
  2. They probably lead to measurable health impairments and weight gain in many pregnant women.
  3. The specific health impairments that arise in pregnant women or their babies are probably determined by which nutrients are most deficient, and by evolutionary triage which directs nutrients toward their most important functions and systematically starves other functions.
  4. Due to variations in how triage is programmed, deficiency of a nutrient during pregnancy may present with somewhat different symptoms than deficiency during another period of life.

This series will try to understand the effects of some common nutritional deficiencies of pregnancy. Triage theory may prove to be a useful tool for understanding those effects. Based on the incidence of possibly nutrition-related disorders like excessive weight gain, gestational diabetes, and hypertension, it looks like there may be room for significant improvements to diets during pregnancy.

Leave a comment ?

65 Comments.

  1. This looks like being a good series. I’m not sure if this stuff is on your radar (but expect it is), there looks to be heaps of it: http://www.ncbi.nlm.nih.gov/pubmed/9840568

  2. I am looking forward to the rest of this series! My first and only pregnancy so far, I gained 60+ lbs. I was sooo hungry – I’d wake up at night and not be able to go back to sleep until I had a snack, even though I ate pretty well: pastured eggs, grassfed butter, pastured meats, seafood, potatoes, greens, coconut, etc., and supplemented choline, vitamin D, magnesium, and a better-than-most prenatal vitamin/mineral supplement. I hope I can figure out what I was missing for future pregnancies.

    • Hi Amelia,

      That’s odd, it sounds like you were eating really well.

      • My mother always gained a lot during pregnancy, too, though on a diet scarcely better than average. She hates eggs! My gain was all in the belly until late pregnancy. I do plan to replace the multi with better supplements next time, and there could be some other devil in the details of how I ate.

        Fortunately a weight loss-oriented PHD with 16/8 fasting is starting to work now without damaging my energy, mood, or milk supply. Phew!

  3. Hi Paul, I’m looking forward to this series. My wife is now about 7 weeks pregnant, and although we were eating in accordance with the PHD most of the time, I’m still scouring your book for everything pregnancy related. Everyone is recommending to her that she take a multivitamin, and although I was reluctant I don’t want to go against her Doctor. Any advice?
    Looking forward to your next post very much.

    • Hi Alan,

      No, I don’t think a multivitamin is beneficial. I do recommend supplementing magnesium (200 mg/day), iodine (225 mcg/day), vitamin C (500 mg/day), vitamin D if necessary to reach optimal serum 25OHD, liver, 3 egg yolks, bone and joint broth, seafood, vegetables, zinc once a week, B vitamins once a week, vitamin K2. Dark chocolate or beef or lamb liver for copper. Salmon/sardines once per week. Follow her taste preferences. If she gets hungry even with a seemingly appropriate amount of calories, try eating an extra salad with mixed vegetables before adding calories. Eat plenty of potatoes and safe starches; citrus fruits, berries, potatoes, beets, carrots are good sugary plants.

      The liver, egg yolks, and seafood are the most important foods.

      I know the multivitamin recommendation is standard but if you are willing to eat a good set of whole foods and do individual supplements, the evidence is really against it. Multivitamins are not well formulated, unfortunately.

      • How about folic acid?

        • Hi Teresa,

          Choline is the key, you need lots of that. Three egg yolks a day, liver once a week, plus appropriate amounts of meat including organ meats.

          If you get adequate amounts of choline then I believe there is no benefit to folic acid supplementation. Normal food amounts of folate should be optimal. I would rather recommend eating extra liver, giblets, egg yolks, and spinach for folate than taking folic acid supplements. (Note PHD is already high in food folate due to the egg yolks and liver.) But, if you do supplement, limit it to 400 mcg/day at most. High intakes of folic acid introduce epigenetic changes that are probably undesirable; and they may make the baby dependent on a high folate environment so that it doesn’t function as well without supplementation later.

          • Hi Paul,

            Thanks for your response. Seeing as I have always been a little squeamish about offal, would it be okay to just eat extra egg yolks to make up for the choline? How many would your recommend daily?

            Thanks,
            Teresa

          • Hi Teresa,

            4 eggs would make up for the choline, but liver has other desirable nutrients, such as vitamin A. If you can try duck liver, I strongly recommend it.

          • Hi Paul,

            Any thoughts on fermented cod liver oil during pregnancy?

          • Bison liver may be worth trying. A couple of people (including Chris Masterjohn) have recently indicated bison liver is more palatable than beef liver.

      • Thanks so much Paul. I read your comment last night and started her on Iodine and Magnesium right away, and we’ll pick up the others soon. I like the idea of eating a salad to top up her appetite if necessary. We’re pretty close to a strict PHD diet every day so we should be good to go as soon as supplements are taken care of. Thanks again.

  4. Ah, how fitting! Just found out two days ago that I am pregnant with my first :D. Looking forward to the rest of the series.

  5. Thanks for another series Paul and Shou-Ching! I get so much out of them and the one on cholesterol has been most convincing for friends and family of the wisdom of PHD, especially when I link to your post on how cholesterol of breast-fed newborns is higher than bottle-fed newborns, and how the former has less chance of infection.

    I think it’s facts like in the context of your series that show people how PHD is appropriately scientific and logical and helps them receive the book and diet and theory of infections causing chronic health problems much better.

    I appreciate all the time and effort put into your series and Happy late Mother’s day to you both.

  6. sorry, not less chance of infection, I think the paper showed breast-fed babies had lower mortality at the 6 month mark. anyway, thanks for another series!

  7. Apologies for the randomness of this, but I love this clip. I am a science geek and love it when some place in the world gets me. Paul, if this is just too inconsistent with the spirit of PHD.com, I won’t be offended if you delete it. It’s just that I take a considerable amount of flack for my inability to be bored and my ever energized enthusiasm for that thing we call the learning curve. This blanket permission to love what I love without restraint, is a nice ending to a busy Monday. If you’re not into RM’s version of the news, please forgive and leave me my peace; but do click on the “What It Means to be a Nerd” thumbnail.
    http://www.nbcnews.com/id/26315908/#51872849

  8. My (pregnant) wife and young daughter prefer scrambled eggs. I know there might be some benefits so keeping the yolk more intact (i.e. over easy) when cooking such as not damaging the o-3s, but are the other egg nutrients (such as choline) affected by serving them scrambled?

    • Hi Greg,

      Actually cooked yolks are more digestible and less likely to cause food sensitivity. I think as long as they aren’t burned the nutrients should be fine. Cook on gentle heat.

      • Hi Paul, do you have a cite for the digestibility of raw egg yolk vs. cooked? The one study I know of compared yolk and whites combined. I think Chris Masterjohn attributed the reduced digestion almost entirely to the whites.

        http://www.cholesterol-and-health.com/Egg_Yolk.html

        • Hi Joel,

          See http://www.ncbi.nlm.nih.gov/pubmed/10564098 and http://www.ncbi.nlm.nih.gov/pubmed/9772141. The studies look at whole eggs but sensitivities are due to the protein and while most of egg protein is in the white, there is some in the yolk too. Cooking denatures the protein, making it more digestible — 91-94% digestible cooked versus 51-65% raw.

          • Thanks for the response.

            My reservation about the study is that the test meal consisted of 200 grams of egg whites and only approximately 17 g of egg yolk. Since its the whites that contain trypsin inhibitors it seems a bit unfair to assume that raw egg yolks will have a similar digestive response.

            OK yes, I have a vested interest since I eat raw egg yolks and throw away the whites!

          • Hi Joel,

            I’m not primarily concerned with trypsin inhibitors, but the compounds that trigger food sensitivities.

            From http://en.wikipedia.org/wiki/Egg_allergy:

            Most people who are allergic to hen’s eggs have antibodies which react to one of four proteins in the egg white:[5] ovomucoid, ovalbumin, ovotransferrin, and lysozyme; ovomucoid, also called Gal d 1, is the most common target of immune system attack.[5] The egg yolk contains several potential antigens: livetin, apovitillin, and vosvetin.

            A person who reacts only to a protein in the egg yolk may be able to easily tolerate egg whites, and vice versa. Some people will be allergic to proteins in both the egg white and the egg yolk.

  9. Really interesting about the connection you’ve possibly made to triage theory and Kobe Bryant. This sounds like a really interesting series, looking forward to it 🙂

  10. I was thinking I would not have anything to contribute to this series on pregnancy and nutrition, but then Sarah Pope recently posted a note about the ability of grass fed butter to erase stretch marks and other scars.

    During my first pregnancy, each evening before bed I lubricated the skin on my belly with cocoa butter. My diet was SAD those many years ago, but, still, no stretch marks at all. Late in my second pregnancy an old friend from school came to visit and when she smelled the cocoa butter she asked why I didn’t use baby oil. Well, she was always the prettier one, and always more stylish, so I figured here again she likely knew better than I. So, in my seventh month, I gave up the cocoa butter and used baby oil each evening. Soon after the baby was born I noticed two small stretch marks in the shape of a lazy “T” on my lower left abdomen. When, four years later, my third pregnancy ensued I stocked up on cocoa butter and used it throughout. No new stretch marks.

    The other evening, after reading Sarah’s post, I made it a point to check that familiar lazy “T” on my belly. Well, I couldn’t find it. I wasn’t even sure where it had been. So, I pulled and stretched my skin and finally saw part of the “T.” But I had to look very closely. Standing in front of the mirror it truly seems to be gone. To be sure it’s still there, but very hard to see.

    Sarah says it’s about “strong skin” from eating healthy fats.

    Good luck and pretty bellies to all the young moms and moms-to-be.

    🙂

  11. Hi Paul,

    Do you not get comment notices for old posts? You’re usually pretty quick at responding to people, but a comment by MarkES back in February 23, 2013 on an old post of yours from 2011 still has no response. He was asking questions about the critique from the “Plant Positive” website’s “Primitive Nutrition” video, “Playing Games with Your Heart, Part I”, which directly looks at some of your chart analysis:

    http://perfecthealthdiet.com/2011/06/blood-lipids-and-infectious-disease-part-i/comment-page-1/#comment-181083

    Paul, can you please provide a response to these questions? Or direct me to where you did if you did so in a new post instead of in the comments section of that old post.

    Thank you,
    Chris

  12. Interesting series. What I really wanted to know is how important pre-natal milk is. How different is that from just taking the pre-natal vitamins?

    • Hi Chris,

      I don’t think drinking milk is necessary. It would certainly improve an unbalanced or vegetarian diet. I also don’t support prenatal multivitamins, rather supplementation of individual nutrients.

  13. Wow, this looks like it’s going to be a great series! I’ve been thinking a lot about pre-pregnancy nutrition lately, as my husband and I are putting off starting a family until we reach certain financial milestones within the next few years. I want to be sure to protect my fertility and health until then (I’ll be in my mid-thirties). I especially appreciate your comments above about multi-vitamins, as I can’t even swallow those giant horse pills!

  14. I posted this question earlier but it wasn’t answered – was hoping to get your thoughts on Fermented Cod Liver Oil – prenatally.

    Thanks

    • Hi Merle,

      I think it’s better to eat salmon and liver than to take cod liver oil, and I think unfermented cod liver oil is better than fermented. But, there are worse things to do. Be careful though, you can get too much vitamin A.

  15. Thank you for the informative series. It’s so true in our society that malnutrition and obesity go hand in hand. Our diet of processed foods is poison. In pregnancy and in like we need to eat natural foods and our bodies will thank us for it.

  16. Interesting info.

    I too had serious tendon issues for years. At 22 I was put on disability for bilateral tendinitis from finger tip to shoulder, all seemingly induced by working in a coffee shop. Later I had tendon issues in my legs too. But, this was when I was on an extremely high-carb diet (vegetarian, low-fat SAD, and then vegan). I also had other nutrient deficiencies, due to diet and undiagnosed Celiac disease.
    Since going on a lower carb Paleo diet, I haven’t had any tendon issues. My arms, which still have scar tissue from the previous injury, don’t bother me often at all. I’m able to dance with no leg tenon issues.
    Why do you all think this is?

    • Hi Drea,

      Tendons are only 5-10% carbs, they’re mostly protein, so one possibility is low protein. Another is low vitamin C. Another is lack of animal food to provide pre-made collagen and GAGs — we may not be able to make enough from just amino acids and glucose and vitamin C. It could also be various nutrients in bones and other attachment points, eg vitamins A/D/K/C/magnesium. But probably the most likely is autoimmunity brought on by the celiac disease.

      Best, Paul

  17. Fascinating stuff.

    I’ve had three kiddos and with my two daughters, have suffered some pretty serious melanoma (though I think it has a different name when it occurs during pregnancy.) I’m pretty convinced that it developed because my baby was taking a nutrient that my body needed and thus I was deficient. Last time, when I weaned my daughter, it went away. I am still breastfeeding the second daughter, so I don’t know whether that will hold true again.

    I wish I could figure out what it is my body isn’t getting – or isn’t processing – that it needs!

  18. When are you going to continue the series, please? I’m two months pregnant and waiting!

    • Hi Babka,

      Sorry, I’m very busy at the moment. I work on the next post between 10 and 11 pm when I’m not too tired. The one I have planned requires a lot of research so it is slow coming.

  19. Do you recommend the iodine supplement if I am pregnant and currently on 50 mcg of Levithyroxine. I have wanted to add Icelandic Kelp as a supplemnt but since becoming pregnant, I was afraid it would mess with my levels as they are holding steady now.

  20. Nutrition and Pregnancy, I: Nutritional Triage – Perfect Health Diet | Perfect Health Diet

  21. Hi Paul, what is your take on L-5-MTHF? Is it worth supplementing with this in preparation to a 2nd pregnancy? Overall, we eat very healthy including drinking raw milk so I think my folate levels should be ok? But there is a lot of scare mongery out there regarding folate so your input would be most welcome. I also want to take it for lethargy an hair loss after my first child 2 years ago. Still don’t feel my old self.

    • Hi Maderetha,

      I would supplement choline instead. I don’t think you want to supplement folate, just eat a natural whole foods diet that includes liver, egg yolks, and green leafy vegetables like spinach and seaweed.

      • Thanks Paul, we already follow the WAPF diet guidelines mixed in with a bit of your diet guidelines. Could you give me an idea for quantity of seaweed that would be safe to consume and do you have a preference for a specific type?

  22. Hi Paul,

    Little late to the game here, but am researching morning sickness and was hoping you may have touched on it. Do you think morning sickness might be a result of nutrient deficiency? I find it incredible that the medical community knows so little about morning sickness, and yet portray it as a rite of passage. Come across anything that suggests it’s not a necessary evil?

    Thanks!

  23. Thank you for all your great work! Is there a part 2 to be found somewhere?
    Regards from Sweden

  24. Hi Paul,

    I was wondering about fasting 16/8 during pregnancy and if you have any experience of this/studies?

    Also what causes morning sickness and possible remedies.

    I am not pregnant, I was just interested.

    Thank you,

    Claire

    • Hi Claire,

      Intermittent fasting during pregnancy is great for you and the baby as long as you don’t undereat. Since you’re eating for two, that means a lot of food has to be squeezed in. Don’t hesitate to eat during a fasting window if you get hungry. Just try to eat as much as possible in the afternoon, and as little as is needed to avert hunger at other times.

      Morning sickness — I don’t know, but it seems to go away on PHD.

  25. Hello Paul,

    I have recently adopted the Perfect Health Diet and am trying to get pregnant with my second child, and I have three questions:

    1) I am taking EnLyte, a prescription medication which is methylfolate as a therapy for depression; I did genetic testing and was found to be unable to convert folate into methylfolate. It does help tremendously with my depression, but do I need to modify the supplements as listed to accommodate this medication? Because I am unable to convert folate, my folate levels are always extremely high when we do blood work. The info on EnLyte can be found here, and may be useful for your work in advising people with depression: http://enlyterx.com/wp-content/uploads/2015/05/Slim-Jim-Final-EnLyte.compressed.pdf.

    2) I am supplementing with all recommended supplements in the book and on your supplements web page; are ALL items safe for consumption during pregnancy? We do not have access to safe liver at the moment (working on it) so I am taking copper though I do eat dark chocolate.

    3) I purchased a brand of lithium you recommended, Solaray Lithium Aspartate, which cannot be cut in two (it is a powder capsule) so I have to take all 5mg at once; is this safe?

    Thank you for answering my questions!!

    Jennie

    • Hi Jennie,

      I think you would find that if you improve choline and B6 status by eating 5 egg yolks per day, liver weekly, and green leafy vegetables that you wouldn’t need the EnLyte, or would be fine on a lower dose. No, you don’t need to modify the diet on account of the EnLyte.

      Yes, they are safe. If you can’t eat liver, take vitamin A as well as copper, and eat more egg yolks and green leafy vegetables.

      Yes, you can take the 5 mg once a week, or twice if you find it helpful.

      Best, Paul

      • Hi Paul,

        Thank you for your prompt reply.

        I wanted to clarify my first question, as I think I did not communicate my issue clearly: I have enzyme issues synthesizing folate into methylfolate, so upping foods high in B6/folate will not help me go off the medication since as far as I know methylfolate is not found in food directly and I am physiologically unable to make the conversion effectively. In fact, when I do blood work, my folate levels are so high that they are consistently above the ‘excessive’ range at >24.00 ng/mL and have been measured as such both before and after methylfolate therapy.

        I am concerned about the effects of excessive folate as anything in the ‘excessive’ range tends to not be positive.

        It would also not be a leap to have some concern about my ability to synthesize choline since choline and B6 share methylation pathways, but I have no idea how to approach that issue!

        Please let me know your thoughts on the excessive folate in my blood work and if you would like more information about my chromosomal issues as I’m certain that as more genetic testing is recommended to personalize medicine, more and more people you work with will discover this issue.

        Thanks again,
        Jennie

  26. hi, i started reading the 1st part of the series and couldn’t find the rest…
    is it available?
    thanks!

  27. Hi Paul,

    First of all, Thank you for writing the PHD book. I think it’s so invaluable and educational. I’m pre-diabetic. I didn’t know this until I read your book and decided to go get myself tested. Anyway, I started doing the 16 hour fast a while back and my fasting levels have gone down. However, my husband and I are trying to fall pregnant and I’m trying to find more information on fasting and pregnancy. I read here in your website in one of your responses that “fasting can be very beneficial to the mother and the baby”. Can you explain a little more on how that is and how it can be done safely? Also, in the event that I do develop gestational diabetes, what can be done? Your help would be greatly appreciated.

    Also, Michael Moseley has just released a new book called “8 weeks blood sugar diet” where he advocates a low calorie of 800 a day for eight weeks to get your blood sugar levels down. He also advocates fasting. Where as I believe you have stated that you need to eat enough calories and if we look at the food you advocate (eggs, liver, rice etc) that would go well beyond 800 calories. Would a high calorie plus 16 hour fast still work as good as the 800 a day?
    Thank you. May

    • Hi May,

      Fasting safe if (a) you do all your feeding in the daytime, not at night, and (b) you get sufficient food & nutrition during the feeding window. It is important not to undereat.

      Intermittent fasting, circadian rhythm entrainment, and eating a nutritious diet will prevent gestational diabetes.

      I don’t recommend calorie restriction of the 800 calories a day type for anyone, but especially not for anyone trying to get pregnant.

      Best, Paul

  28. Michelle Esau

    Paul, you are right, morning sickness does get better on the Perfect Health Diet. I was mistakenly eating oatmeal every morning, and once I became more strict on not eating grains, as well as incorporating the nutrient rich foods like liver, yolks, fish, the nausea decreased from an 8.5/10 to ranging between a 1-4. Some days are better than others. Rest and sleep and stress management also play a huge role in the nausea for me. And ALMONDS HELP!!! As well as not letting yourself get too hungry at a time. Here’s hope to all the nauseous pregnant ladies!

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