The Kick Pregnancy Podcast
Everything you need to know about getting pregnant, being pregnant, giving birth and bringing your baby home. Your host Obstetrician Dr Patrick Moloney and co-host Brigid Moloney focus on the essentials of growing a baby without heavy medical jargon and with lots of relatable stories of their work helping thousands of women have babies, as well as being parents to four boys. Each episode has expert led content that will help you cut through the swathe of pregnancy information, restoring your calm and giving you the confidence to know that mama, you got this!
The Kick Pregnancy Podcast
107. How to have a healthy diet in pregnancy when food groups are missing with Stef Valakas (The Dietologist)
This week on The Kick, Brigid talks with Stef Valakas from The Dietologists about how to have a healthy diet in pregnancy when food groups are missing.
This episode covers:
- Vegetarian diets
- Vegan diets
- Dairy free diets
+more
You can find Stef on Instagram @the_dietologist
Book a consult with the dietologist here
Listen to Stef's podcast here
If you have a question you want answered, please leave your message on speakpipe to be chosen for Dr Pat to answer during a Q & A:
https://www.speakpipe.com/growmybaby
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Speaker 2:It is not a substitute for professional health advice. If you're trying to get pregnant or you are pregnant and you feel a little bit overwhelmed by all you need to know, then this is the right podcast for you. Welcome to the show. I'm Bridget Maloney. And.
Speaker 2:I'm obstetrician Dr Brigid Maloney, and here we are again with the wonderful dietitian, steph Velarchus. Welcome, steph. Thanks for having me back, bridget, it's a pleasure. I'm so glad that you said yes to this episode. We're going to be covering being a vegetarian and growing a baby. Okay, and it is long overdue.
Speaker 3:Yep, and we've been chatting about it for a few months, haven't we?
Speaker 2:Yeah, that's right, yeah, yeah. Well, we've been chatting about needing to have an episode like this since we probably started the podcast. Good, all right, so what I might do is just introduce you to our listeners. So, people, steph Velarchus is an expert certified fertility and pregnancy dietitian and nutritionist and she's the founder of the Dietologist. She and her team have won numerous awards, including Best Pregnancy and Fertility Nutrition Clinic in 2022, quality in Primary Care Award by Dietitians Australia in 2022. That was a big year, steph, yeah.
Speaker 3:I gave up from the awards. After that I was like that's okay, we won, son, that'll do.
Speaker 2:Steph truly believes every hopeful parent should have access to scientifically backed nutrition information to prepare their body prior to conception, support them through fertility treatments, pregnancy and ultimately bring home a healthy and happy baby. Steph also hosts the popular fertility health podcast, fertility Friendly Food, which everybody who's trying for a baby and listening to this episode go over and have a listen to Steph's podcast. It's wonderful.
Speaker 3:What a new show. That's brilliant, I know.
Speaker 2:There was more I could have said, but I think that is amazing. You're a very productive expert.
Speaker 3:Yes, Do try.
Speaker 2:Yeah, do try. Yeah, so, as I said, we're talking about vegetarian and veganism in pregnancy, but I thought maybe we should start with a recap of the most important aspects of a diet for a pregnant woman. Now, we've had you on the podcast before, so I urge people to go back to Steph's podcasts that we've had a couple of months ago, and I'll put the links in the show notes for all of the podcasts that I suggest today. But just briefly, can you just give us the top nutritional needs that a pregnant or pre-pregnant person needs?
Speaker 3:Yeah. So with pregnancy specifically, we kind of follow the trimester pattern, because in trimester one it's characterized often by nausea, food aversions, constipation, fatigue, bloating, and people are often particularly first-time pregnant. Mums are pretty shocked about how much of an impact this has on their diet quality and the quality of the diet that they thought they were going to have when they're pregnant. And so in trimester one you don't actually need anything extra. You don't need extra calories or energy. You don't need more protein or more carbs or more fats. We do need more micronutrients or vitamins and minerals, which is where that prenatal vitamin element comes in, which is what we talked about in those last couple of episodes that I was on. But in trimester one, if you're symptomatic, I have this moniker of survive now, thrive later. You just got to get by. Don't beat yourself up too much about the quality of your diet. In trimester one, bumps doesn't really need much to kind of get by, and, particularly for those who are very sick, you will know that you will still pretty much grow a perfectly happy, healthy baby in trimester one, despite living off crackers and water and then spewing it up 20 minutes later. So they're really resilient. They're both delicate and resilient all at the same time.
Speaker 3:In trimester two we do get an increase in the energy, and that energy should be coming from an extra serving of carbohydrates or grain foods so think brown rice, quinoa breads, oats, popcorn, things like that and also protein foods so chicken meat, fish, eggs, tofu, legumes and beans, all that good stuff, and so that kind of replicates. Again in trimester three where we get another step up in total energy intake. So in trimester two it's an extra 350 calories or so compared to your pre-pregnancy. And then in trimester three it is an extra 450 calories compared to pre-pregnancy, not compared to trimester two, so it's only a little jump up. So it is not eating for two. The average woman needs about 2000 calories per day, so as a percentage it's not even a quarter. So it is an extra amount. It is generally not too difficult to achieve for most people and we want more of our protein rich foods and our grain foods to be making up that extra energy. And then that switches a little bit.
Speaker 3:When it comes to breastfeeding Preconception I think we kind of touched on a little bit last time but we want to be thinking about our abundance of fruits and vegetables for lots of antioxidants. Seafood is particularly important in pre-pregnancy and it's shown to help support fertility outcomes. We know that whole grains help support implantation. Nuts and seeds can contain vital nutrients to support reproductive health for both female and males. Dairy foods seem to be helpful as well, and optimizing that calcium intake pre-pregnancy.
Speaker 3:So certainly like the kind of five food groups are all come out to play all throughout this life stage but they do modulate at different points and then you're also going to be kind of limited by what you're going through. Every pregnancy. Every person's journey is going to be different. So it's going to be limited by your capacity, either physically or mentally, to navigate those particular foods and your diet as a whole and how much energy you have to actually eat and prepare food and shop and all those kinds of things. So we take a very practical approach to the dietologist and I think that's why people like coming to see us, because we're not going to slap you on the wrist because you've been living off crackers in your pregnancy, because you've been feeling wretched. So there's certainly lots of intricate details and lots of micronutrient shifts and demands that occur over this life stage, but that's probably a little bit of an overview.
Speaker 2:That's wonderful. That is an incredible quick snippet of basically what it is that you're trying to achieve with your diet. Can I just maybe quantify what do you mean by 300 calories? That's about two pieces of bread, isn't it?
Speaker 3:Yeah, so it's pretty much a piece of bread with some peanut butter and banana on top is about what it looks like.
Speaker 2:I definitely made that mistake, but then our listeners won't. Our listeners will know exactly what their nutritional needs will be. I've spoken about it before. Long-time listeners would know that in my first pregnancy, I thought my extra nutritional needs was eating a Magnum every night. Yeah, that was not good. A delicious choice. A delicious choice but, however, not nutritionally sound or needed. All right, so we're focusing mainly on only on vegetarian, and I wondered whether you could describe the levels or the types of different vegetarian diets.
Speaker 3:Yeah Well, we'll go from you know, most limited, and then we'll move up. So the most limited mainstream kind of version of vegetarian diet is the vegan diet. So the vegan diet will completely exclude animal meats but also animal byproducts. So that will be things like red meat. Chicken fish are off the menu, but so too will be eggs and dairy. So their diets are mainly focused on foods like fruits, vegetables, nuts and seeds, whole grains, plant-based milk alternatives, tofu and tempeh, legumes and beans, nuts and seeds and healthy fats that come from plants. So that's the vegan diet.
Speaker 3:Then you've got kind of different variations when it comes to vegetarianism, and the technical terms are lacto-ovo-vegetarian, which means you eat milk, you eat eggs, and then it's basically milk and eggs plus vegan is the way that I always explain it to people. And then you also have lacto-vegetarians they just have dairy but no eggs. And then you have over-vegetarians they have eggs but not dairy. That's a very individual kind of thing, I would say. Overarchingly, vegetarians will limit just the actual animal flesh. So you meet fish, chicken and seafood, and they will eat eggs and dairy products in general. Then you've kind of got this like emergence of this new style of vegetarianism which I like to call flexitarian, which is, you know, a lot of people will be vegetarian part time, so a lot of people will be vegetarian, you know, up until lunchtime, and then dinner will have some kind of meat. Other people will be vegetarian for certain days of the week, and then dinner we'll have some kind of meat. Other people will be vegetarian for certain days of the week, and then they might go out on the weekend and have a piece of fish or have a steak or have some chicken. And this is a more flexible version of the vegetarian diet. It's not strict and they are able to incorporate some meats as they wish in the frequency that they like.
Speaker 3:And then there's also the term plant-based diet, which is very hard to define. I find this really difficult. When a client comes in to me and says, oh, I'm plant-based, I'm like okay, what does that mean to you? Because it doesn't mean anything specific to me, doesn't have a definition. So plant-based diets can sometimes be used to describe a vegan diet. So some vegans will say, oh, I. So plant-based diets can sometimes be used to describe a vegan diet. So some vegans will say, oh, I'm plant-based, and then for other people it just means that they are plant-focused, which means that you can be omnivorous and say you have a plant-focused or a plant-based diet, because you're mostly eating plants like fruits, vegetables, whole grains, nuts and seeds, and so, yeah, that definition can be really loose. So I generally try and get people to kind of give me some sense of it. Sometimes there's no label, and that's okay too, but they're the key kind of groups.
Speaker 2:Well, that's going to make gosh, even this discussion a little bit tricky, because, you know, we can't really give a panacea. This is what a vegetarian woman should eat during her pregnancy.
Speaker 3:Yeah.
Speaker 2:How do you, how can we help people to know what it is that they need to do to meet their nutritional requirements?
Speaker 3:Oh, I like. I know this is such a cop-out answer, but every time somebody says, oh, what should a vegetarian do, I was like see a dietician. Like, please just see a dietician, because you can ask 100 vegetarians how they eat and you probably, if you're not a vegetarian, you probably have a vision of what vegetarianism looks like. And I will get back 100 different types of dietary reports.
Speaker 3:It is just as diverse as omnivorous diets in terms of dietary quality, and I think I'm sure that something we'll get to in our chat today is, just because somebody is avoiding meats or animal byproducts, it doesn't automatically mean that their diet is significantly healthier than someone who does. And I think that's a common trap that even people who follow a vegetarian or vegan diet can fall into themselves. Because they've put this label on and they shop like that they think, oh well, it must be. Only, you know, I must be only eating nutritiously because I'm eating plants. That can be true, but a lot of the times I find it's not the case, because coke zero is vegetarian and vegan oreos are vegan.
Speaker 3:Uh, you know coconut ice, the plant-based magnums are vegan. So there's lots of things in the and and like ultra processed, you know, plant-based burgers and things like that, which have been shown to be perhaps just as non-nutritious as the meat versions of them and perhaps lacking more micronutrients. So the commercialization of plant-based diets has caused the diet quality, I think, to go down. But because of this label and this assumption, we're assuming that people who follow a vegetarian or vegan diet are doing a good job at baseline. So it is hard to know what you can and can't have. I think you know starting at the boring Australian dietary guidelines of what to eat in pregnancy is a decent place to start. You have got no place to go, like you're not going to go see a dietician, which I'd strongly advise, but if you're not, I think that's a decent place to start so you can get a feel for how many pieces of fruit you should be having a day, how many servings of vegetables you should be having a day, how many whole grain serves. How the protein is going to be an issue, because that's the group that's mainly limited. Cool, what are we going to do about that? All of a sudden, I hate eggs and I'm pregnant. All of a sudden the smell of milk turns my stomach. Okay, now we have more of an issue that we're going to have to try and navigate. It's always a workaround, but whether you want to navigate that workaround on your own or not is a different story.
Speaker 3:And certainly dairy alternatives, I should say, is another big group that I think gets often overlooked. Dairy is often forgotten, but calcium is such a critical nutrient in pregnancy and not just in pregnancy, just in general for women. We have this awesome opportunity when we're young to build our bone mineral density for life, and then our bone mineral density takes such a knock being pregnant and breastfeeding, and then it just declines once that estrogen drops when we hit menopause that you've got to really focus on it. It's invisible, you're not going to feel it, but one day it will catch up to you. And so, yeah, I talk a lot about calcium with my vegan and vegetarian clients as well, and making sure that we're planning the diet really well to either be using dairy alternatives with added calcium or, you know, sussing out what yogurts are on the market in terms of dairy-free yogurts, which change like the wind and hardly stay on the market for very long and they're often not a great source of calcium.
Speaker 3:And then, like, the cheeses are made out of cashews, like there's no calcium in that. So it can be really, really tricky. And then I think there's just this miseducation that you know, like I always hear from people oh, I'll just eat spinach and that will give me all my calcium and iron. I'm like no, it won't. Like it's a drop in the ocean, like we need a thousand milligrams of calcium a day. Your spinach is giving you 10. And that's like a lot of spinach. I was like that's a lot of spinach.
Speaker 3:It's a lot of spinach, like it's already a lot of spinach to get your 10. So, like, imagine I was just like you can't. You can't rely on those things. So I think people misjudge the micronutrient density of some foods that they kind of have put on a pedestal. And that is the slippery slope. Like people telling me mushrooms are full of protein on a vegan or vegetarian diet, I'm like there's no protein in mushrooms, girl. It's a great vegetable, don't get me wrong. B12. Yeah, there's nothing protein-y about it. It's just a great textural culinary substitute for protein. In terms of texture, it doesn't mean it contains a good source of protein. So I think it's a combination of. You know, if you haven't been really well educated from the jump about plant-based diets from a healthcare professional, then it makes it hard because you can perpetuate those kinds of myths and that can really compromise your nutritional intake, particularly when you have these increased demands in pregnancy.
Speaker 2:I've always thought a vegetarian has to be a really good cook, or at least interested in cooking. I remember going through my first pregnancy and one of my good friends she was a vegetarian, hated cooking, actually, really didn't love food, only ate to survive, and so her main diet through pregnancy was pasta with a bit of cheese on top, and so basically you know, morning, noon and night that's what she ate, and I just thought, well, it would be very, very difficult if you weren't as interested as it sounds as if you need to be plus a really good cook. What do you think about that?
Speaker 3:I agree, I have come to this realisation recently that I me personally I'm in this very, I've had this very privileged upbringing of being surrounded by food and cooking and I have this skill set where I don't need a recipe to cook. I can think of something and I can basically map out how to cook it because I have a basic repertoire of how to cook and I realized most people at least that I talked to don't have that skill set. So often people are coming to me and being like well, how did you make that? What's the recipe Like? How many meals of olive oil did you put in the pan before you? Spaghetti bolognese? I'm like I don't know, it was a dash.
Speaker 2:I went like that with my hand and the oil came out.
Speaker 3:I did my yas well in the pot. I don't know, and I've realized as I've gotten older and kind of further into it that that is uncommon and that is not the kind of the commonality that's the norm. That's not the norm anymore and it's kind of a little bit, I feel like sad, because I think that skill set lends itself so well to flexibility and, like you said, in the context of vegetarianism, like you can pick up something like Otolenghi or one of those you know more vegetarian focused types of cookbooks, and there's incredible, just vegetarian restaurants all over the world that you know have chef hats and all these kinds of michelin stars and all sorts of things, and certainly you can have a delicious, nutritious diet being vegetarian or vegan. But if you're not into cooking or you're a picky eater that's my other bug there If you're a picky eater oh, I don't really like leggings. Oh, tofu doesn't do it for me and you're vegan Sorry, what proteins are we having in our diet then?
Speaker 2:Have we got left?
Speaker 3:We're going to be in a really tricky spot. So if you're very picky, within that range, it's already limited or we're layering lots of dietary restrictions Like. Another common scenario that I see people get themselves into is they'll have IBS, so irritable bowel syndrome. They have some food sensitivities to things like legumes and beans, which are an incredibly nutritious addition to a vegan or vegetarian diet. It's rich in dietary fiber and B vitamins and zinc and plant-based iron.
Speaker 3:They're wonderful and they're something that I wish everybody ate more of, but they can create a little bit of gas and bloating for some people and so if you have somebody who's vegan, who can't eat that, and a selection of some vegetables and fruits and a selection of some grains, you have this extreme limitation. That is really difficult because now we've got this long-term potentially for some people, long-term avoidance of a critical, you know, protein group and it's it can be really tricky to kind of get ourselves out of that. So, yeah, especially if you're a picky eater or you have other diet-related health conditions, that kind of layer and start to give you more restrictions. It's just yeah, it's just a logistical challenge.
Speaker 2:I do find so I'm hearing that. I want to go right back and say firstly, I wish we were flexitarians. Our family could do with less meat, but if someone's a full vegetarian, and. I'm hearing from you that one of the main problems is getting the right amount of protein. Can you just recap what is the grams of protein that somebody needs in the first place? And just so people can relate that back to something a vegetarian would eat, say tofu?
Speaker 3:for example. So the average person, like non-pregnant, needs about 0.8 to 1 gram of protein per kilogram of their body weight. So usually as dieticians we trying to get about about 30 grams of protein into a main meal roughly sometimes because we like to overshoot a little bit. There's some benefits to overshooting a little bit and certainly when you're pregnant and trimester two and three you need quite a bit more protein. And there's some interesting statistics that came out of the US out of a study of about 528 women and they showed that one in eight women in their second and third trimester had inadequate protein intake and that protein inadequacy was three times more common in trimester two than trimester one. Because of that step up in requirements and most people, two-thirds of that protein intake intake was actually coming from animal sources and the remaining third was coming from plant-based sources. So that gives you a snapshot of what people are currently kind of doing and what's going on and what's going, I guess, wrong in a way. And then things like tofu to get your 30 grams you need quite a lot of tofu or quite a lot of legumes and beans, like you need a whole tin of lentils or chickpeas to give you your 30 grams of protein. But it's also going to give you a heap of fiber, which is great. But I don't know about you, but I would struggle to eat a whole tin of legumes and beans because they're really filling, and that is one of the tricky components, particularly on a plant-only diet or a vegan diet is the fiber.
Speaker 3:The fiber is excellent for your bowels.
Speaker 3:It's excellent for our health, we know it's protective against bowel cancer, we know all these things and I do not want to poo-poo fiber at all, pun intended.
Speaker 3:But the one downside that I see, both preconception and in pregnancy, is how satiating, how feeling that fiber can be, and so our stomach gets really full and then we can't eat as much density of calories and then we're struggling to get enough calories in and gain the right amount of weight in pregnancy, or you know, or eat enough food to have a period.
Speaker 3:We know that people who follow a vegan diet preconceptionally have a higher rate of irregular ovulation amenorrhea, and my hypothesis is it's likely because their diets are so high in fiber, they're so filling, because it's fruits and veggies and legumes and beans, they're so full in the fiber it's hard to actually eat enough energy. It kind of caps it, and so that can be a really tricky spot to be in, but trying to leverage the protein when you've got such limited sources. So you can see, it's this constant juggling act between we want to be including the sources that we have available but simultaneously we don't want to drive the fiber up so much that you're getting too full that you can't eat enough total food per day to reach your requirements, and so that's the constant juggle.
Speaker 2:Is there a nice protein that doesn't have all that fiber?
Speaker 3:then Tofu is probably one of the ones that I use the most for that, and also tempeh. They still do have some fiber, but certainly not as much as like yums and beans. But a lot of people, even vegetarians, don't love tofu or they don't, you know, maybe they haven't learned how to prepare tofu to the way that they like, going back to that cooking concept, and so that's really difficult. And then to learn to like a new food whilst you're pregnant and you've got some food aversions at the best of times, it's really tough. It's a hard sell.
Speaker 2:Yes, but you can hide tofu Like. I love tofu and one of my favorite dishes is this like spicy Korean soup that I make with tofu in it. It is delicious and I just do it at home. You know it's my go-to lunchtime dish if I'm at home just by myself and it takes I don't know 10 minutes. It's just such a great dish to have at hand. All right, so I know if there's a micronutrient missing, like calcium you can supplement, but you can't really supplement protein.
Speaker 2:So what the hell are these people doing to make sure that they can get enough protein?
Speaker 3:So something that I usually do when I'm chatting to someone in pregnancy who and look, protein is a nutrient at risk for everybody in pregnancy.
Speaker 2:Yeah, that's a shocking statistic that you read out before. Yeah.
Speaker 3:Honestly, it's not just vegetarians and vegans, you know. So it's something that I'm always screening for and kind of thinking about and talking about anyway. So protein is something that you know I like to call is a negotiation. So I go into the concert. I'm like okay, this is where we want to be, this is where you're at. Here's the gap. Now, here are some ways that we can start bridging these gaps. Here's some creative ways that we can think about this.
Speaker 3:If all of these fail, we may need to look at a protein powder as an absolute backup. It's always my last resort. It's considered safe in pregnancy if you find the right product without the extra ingredients and blah, blah, blah, blah, blah, artificial sweeteners and micronutrients and all that kind of stuff. If you get something kind of plain Jane that's been okayed by your healthcare team, it's safe. But I don't like people relying on that, because then they're missing out on the micronutrients that are coming from the protein foods, which is actually why we're also wanting them to eat them. So our protein foods are going to be richer in iron and zinc and our demands for those nutrients really pick up in trimesters two and three, and they're particularly helpful preconceptionally as well.
Speaker 3:That you know protein powder isn't going to give you that you know, and protein powder is often going to be had in a smoothie with milk and fruit and oats and that's great. But if you already had that for breakfast and then you're having it again for lunch, then you're missing out on your veg and kind of your dietary diversity and it becomes a little bit same same. So it's always a little bit like last stop if need be, maybe not an everyday thing, as needed if you're having a particularly rough day, but often that's quite short lived, I find in most people with pregnancy. But it's just being creative. Like, okay, we're having pumpkin soup for dinner, great, lots of veggies.
Speaker 3:It's always that question Where's the protein? Okay, can we add a tin of chickpeas and blend that up? Can we serve that with a piece of toast with high protein cottage cheese on the side? Can we buy a higher protein bread than what you're getting now? Can we switch out your regular pasta for pulse pasta, because it gives you more protein?
Speaker 3:Those kinds of upgrades that we're constantly doing to try and get that up and then it quickly adds up and then we're already there. But if you're not aware of it and you're not consciously trying to make those upgrades, then you hit kind of a wall. But at the same time, on the other side of the coin, I see people obsessing too much about protein and then their diet is lacking in other departments and I'm like, okay, like you need to back off with the protein bar at breakfast and the protein shake at lunch and then the high protein. Like it's like what about vegetables? What about carbs? What about fats? Like yeah, yeah, like you've gone too far. So yeah, is it? We're kind kind of the moderator in that regard and trying to keep people on an even keel.
Speaker 2:But yeah, it is tricky. It is tricky and you know most people, a lot of people, are still working when they're pregnant. Good, and I think it's really hard to find the right sort of convenience food. Say, you're out and about and you need to grab lunch, or you're starving, hungry, and it hits you really hard when you're pregnant and you're just like, oh my God, I need to eat something now, otherwise I'm going to vomit. For a vegetarian, what can they grab?
Speaker 3:I think a lot of the things that work for non-vegetarians work for vegetarians here. So you know your nut bars and your cheese and crackers and your you know roasted chickpea snacks and I love roasted edamame beans. They're not always in stock in the supermarkets but they're a super high protein, savory, crunchy snack. Those quick things that you can kind of grab and go can be such little life savers when you're pregnant and you're feeling sick and you just need like a little bit of a snack rather than a whole meal, and I find whole meals can be quite overwhelming, particularly in early pregnancy. So I think that that is like one of the things that you shouldn't get too bogged down in is that you know a lot of things are still on the menu for you as well.
Speaker 3:So, and interestingly, a lot of my pregnant clients who were omnivores before, almost become vegetarian probably the first half of their pregnancy because of meat and fish and chicken is just too gross, and so we get by like we just get creative and we start introducing different things. Like instead of having, you know, spaghetti bolognese with mincemeat, we're having it with lentils, and you know all those kinds of things. So there's always ways to get around it. But I always say lean into, like what you're feeling like as well, because there's no point in me outlining a great meal plan for you and you're feeling like as well, because there's no point me outlining a great meal plan for you and you're like ew, gross.
Speaker 2:I don't need any of that, yeah totally so.
Speaker 3:If, like, the thought of tofu makes you want to spew, like, don't force yourself to eat tofu, like nobody wants to force feed. You know, particularly in pregnancy, but I think having those things that you know kind of work for you, that are grab and go, are particularly helpful. And then you know, particularly in pregnancy, but I think having those things that you know kind of work for you, that are grab and go, are particularly helpful. And then you know, once you're feeling a little bit better, you can, you know, put a little bit more effort into things and you know, think more about planning things out. But I find in those early days people just don't have capacity to do that at all, it's just survival load.
Speaker 3:There's heaps of great products that you can definitely leverage, and it doesn't have to be always whole foods only. Yes, we want a whole food-based diet, but we're time. Poor people want convenience, and so we can make the best out of the packaged food category as best as we can.
Speaker 2:I make a really delicious, if I say so myself.
Speaker 2:I know it's had the tick of approval from Dr Pat this scrambled tofu which is kind of like scrambled eggs and it's just so great and it's got turmeric in it and I don't remember the other spices. But it's just something that I pre-prep, yeah, and then I keep in a container and it's a morning, it's a breakfast for a few days in a row, like you know, if you're feeling unwell, pick the day that you're not feeling unwell and do some meal prepping. Yeah, meal prepping becomes your life later on when you have a baby. Yeah, it's a good habit to get into.
Speaker 2:All right, so we've talked about protein as the macronutrient. Are there any other macros that you're kind of concentrating on with a vegetarian diet?
Speaker 3:Yes, and it's probably not the one that most people will be thinking of, but it's omega-3 fats, which isn't its own macronutrient, equally speaking, but it sits in that fat category. Omega-3 fats are so, so important preconceptionally in pregnancy, postpartum. They help to support healthy blood flow, they help to support baby's brain and eye development, and recent data shows that it may help prevent preterm birth and labor, and so maximizing omega-3s preconceptionally, in my opinion, is so, so critical for people who follow a vegetarian diet, because it does not increase overnight. Even some people who are vegetarian who are like, oh okay, yeah, maybe I'd be willing to add a piece of salmon in or something like that. I'm just like great, still not enough. Because you've been vegetarian for 10 years, you've probably had very little omega-3s. It's not going to really touch the sides at this point, like your blood level of omega-3 would be so low and I've seen some frightening, because we do some omega-3 testing at the dietologist every now and then.
Speaker 3:And the people who are vegan or vegetarian. It should be between 8% to 12% is a normal omega-3 blood level, and people who are vegan will be 2% or 3%, which is extremely low. Omnivore is like 5% to 6%, so omega-3 fats are going to mainly come from your oily fish like salmon, ocean trout, mackerel, sardines and anchovies. There are plant-based omega-3s from walnuts, flax seeds or linseeds, chia seeds, hemp seeds. However, the body's ability to convert that plant-based omega-3 called ALA into the long-chain omega-3s called EPA and DHA, which have the research benefits for pregnancy specifically DHA which are found in the marine sources, is very, very low. So it's only 4% to 12%. So what we call the bioavailability of that omega-3 is so, so low that it certainly has its own independent health benefits.
Speaker 3:But you cannot rely on that to have a meaningful contribution to your omega-3 status and in my opinion, as a dietitian, it's too too important to miss out on so omega-3s and in my opinion, as a dietitian, it's too too important to miss out on so omega-3s are something that we pretty much supplement all the way through, because most people don't get enough at baseline, but then, in addition, just without poor omega-3 statuses and that's where the research for the preterm birth came from was that people going into pregnancy with a poor omega-3 status ended up with worse-off outcomes, and so naturally, this group are a higher-risk group of being in that category. So, speaking to your healthcare provider, there are algae oil supplements that you can get that will provide you with some DHA. Some of them also have a little bit of EPA as well. They're usually a little bit less concentrated, sometimes a bit harder to find or a bit more expensive, but it's definitely something that I don't think is worth compromising on.
Speaker 2:If someone was willing to put aside their veganism, their vegetarianism, for a minute. Are the fish sauce omega-3s better?
Speaker 3:Yes, in terms of bioavailability, yes, and some people do choose to do that. And this is the thing, like I know, talking about vegetarianism and veganism, it can feel really personal, I think you know, and the reasons why somebody has chosen to adopt that way of eating can be tied into culture, religion, ethics, health, so many reasons and it's not. I don't want this to come across as me poking holes in it. To poke holes in it, I guess it's just the practicalities. Poke holes in it, I guess it's just the practicalities and I guess it's part of I feel like it's part of your responsibility of adopting this way of eating is to know about this stuff so that you can navigate it. And you know, and also some people will be flexible and malleable. Hey, if it's about my health and my kids' health, like if I need to eat a piece of fish a week, like, I'm open to it.
Speaker 3:And other people are like I just can't do that, Like I would like to, logically, but I can't do it, that's okay too, and it's not something I ask people. People will often offer it up. They'll be like, oh, would it be good if I did this? I'm like, yes, it would be good if you want to. I'm not forcing you to, but if you would like to offer it up, sure. I think fish and probably eggs are the two groups that people will sometimes offer up as an addition to their diet, but maybe they're not willing to add chicken or meat or milk back in, you know, and that's fine. So you know, I always try and just take what's in the ginger.
Speaker 3:Yeah, yeah, that's right, and I realize, oh, this kind of makes my life a little bit easier to hit some of these targets that you've outlined for me. So I would say omega-3 fats and protein are the biggest ones. You can certainly still get the right amount of carbs and the right amount of fats and certainly you can get the right amount of protein if you plan well on a vegetarian or vegan diet.
Speaker 2:Moving to micronutrients now, and actually this is where the need for this podcast came from, because I think we did an iron podcast ages ago, which actually I think everybody should go back and have a listen to, and Pat said that it's very difficult for a vegetarian to get their iron needs, and that did cause a little furor because people were offended by that and it definitely was not our intention. I think what we're trying to do in this podcast is what you just said is be practical and say, okay, like everybody has the choice of how they eat, yeah, how can we help you do that so you have the best outcomes? So, moving to micronutrients, what does a vegetarian need to consider and put into their diet?
Speaker 3:Yeah, so iron is one of them. However, I would argue everybody universally struggles with iron, whether you're vegetarian or not. It's just probably a quicker decline with iron, particularly in pregnancy. I recently did a post on iron on our Instagram page and I kind of just showed the practicality. I was like look, if you're menstruating, good luck to you. Unless you're eating half a cow a day, I don't think you're going to be Adding the red meat once a week is really not doing anything. So if it tortures you to do it, don't worry about it. If you're iron, it's. If you're iron deficient, you're iron deficient. You just got to fix the problem like that's fine. Uh, iron is one.
Speaker 3:Zinc can be another one, sometimes, particularly vegans. Um, iodine can be one as well, although that has some very simple workarounds, iodine mostly coming from seafood, but there's seaweed, there's iodized salt, there's bread with iodized salt. Vitamin D can also be another one to think about in relation to calcium, because they need to be friends to be absorbed. We know vitamin D mostly comes from the sun, though, but also things like eggs and fish are kind of not well known but very high sources of vitamin D, so that's obviously something that can be off the menu. Veganism-wise, we talked about omega-3s, which isn't a micronutrient, so we won't cover that. And the last one that nobody talks about but I'm very passionate about is choline. So maybe we'll walk through each of those and talk a little bit about each.
Speaker 3:And then the only other caveat is vitamin B12 for vegans, and I cannot stress enough how important that is, if you're a vegan, to know your B12 status and monitor your B12 status, especially if you're new-ish to being vegan. B12 is a water-soluble vitamin, but it is one of the few B vitamins that we store for quite some time. We now live for about two years. We have enough to kind of survive off. So if you've gone vegan in the last couple of years and you go and get your first few blood tests and you're not taking any B12 or a perinatal vitamin with B12, it'll come back completely normal and then after usually the two to three year mark, it'll just go down all of a sudden. And B12 is super critical for your absorption of folate, which we know is important for neural tube defect prevention. It's also really important for our DNA within our cells, our nervous system and the development of baby's nervous system.
Speaker 3:So I cannot stress enough if you're vegan and you're strictly vegan, you need to take B12 or you need to take a prenatal that has sufficient B12. You need to monitor your B12 status. It is too important not to the reason. I stress it is. My lecturer at university gave us a case study from a million years ago, before they knew this, and the example was a pregnant, breastfeeding woman and it stuck with me and I'll never forget, and he did a good job because something I'll emphasize forever Vegetarians will get some B12 from eggs and dairy. I do find that it's still a nutrient at risk for vegetarians, even though technically speaking, and there's also B12 added into a lot of foods now, like soy milks and nutritional yeast and things like that.
Speaker 2:Can I just ask is B12 also in mushrooms?
Speaker 3:B12 is not generally in mushrooms specifically, vitamin D sometimes is in mushrooms because the gills you know the brown bit of the mushrooms. If you put them in the sun, they will synthesize vitamin D in their skin and when you cook them we get some of the vitamin D. So in the coals and woolies and stuff you'll sometimes see vitamin D mushrooms. So they've done that process for you. Again, the bioavailability of dietary sources of vitamin D is not very good, so, generally speaking, it's not the way to get it up, but it's a nice thing to know. And you only got to stick the mushrooms in the sun for like 20 minutes. But no, there's not a great deal of B12 in any major plant food.
Speaker 3:I remember I talked about this one time on my Instagram and somebody said to me time on my Instagram and somebody said to me watercress is such a huge source of B12. Everyone's sleeping on it. And I remember going what are you talking about? And you know what I'm a humble. I will eat my humble pie If I'm wrong. I'm wrong, it's cool, like whatever. I was like what Really Am I sleeping on watercress? I look up watercress and I'm like and it just comes back 0.0 milligrams of B12. And I was like where have these meats come from? Like, how Like.
Speaker 2:I don't know. Anyway, it's just Clever marketing and I think that's where I've got the B12 from, because I do remember it being marketed as meat for vegetarians because of the B12. Yeah, not necessarily the protein, and so you know. You're saying that there's not much or no B12 in mushrooms. That's news to me. Yeah, I thought I was getting B12.
Speaker 3:Yeah, and it's. Look, this is so, so common in nutrition at the best times. But I find vegetarian and vegan nutrition, especially these myths seem to last longer. I'm not sure if it's because I I personally think it's probably the advent of social media and, um, they get propagated and kind of stay in our ecosystem a bit longer. But, yeah, it look all the time and, yeah, like often I'm like I've never heard of that and so there's always a part in my brain, like before I say, no, let me do a check. Yeah, yeah, you never know. Sometimes you know people will teach you something new every day. So I'm never that silly to be like no, no, I know I've got to be confident in my no.
Speaker 2:So tell us about choline, because I don't know what choline is or what it does.
Speaker 3:The forgotten nutrient. Why is that important? The forgotten nutrient, choline. So choline is not technically a vitamin, because we actually make a little bit of it. So the definition of a vitamin or a mineral is we can't get it, we can't make it, or we can't make enough of it to survive. We can make enough choline. It's not really enough for optimal health. So it's kind of like if you look it up it kind of says it's a vitamin but it's kind of not. It's confusing. We're all confused in the nutrition world about choline, but it is a very important nutrient in relation to pregnancy and it's got some fascinating data behind it.
Speaker 3:So choline helps support folate and B12. So I call B12 and choline the friends of folate. So they need to work synergistically together, which means they all need to partner together to do the right job. So that's part one. Part two is another study looked at people that took folic acid alone and folic acid and choline and they looked at the rate of neural tube defects and they found that the group that also took choline had significantly less neural tube defects. So it seems to help to support the role of folic acid there and the formation of neural tube.
Speaker 3:And then they did studies and they looked at giving women in pregnancy much higher amounts of choline supplementally. So it gave them a choline supplement at double what our government more than double double what our government recommends at the moment as the target, which 23% of women aren't are meeting this target already. So, like, most of us aren't, and certainly I would say vegetarians and vegans generally don't. And they showed that the group that took more than double that their babies. So they looked at their babies and they showed that the baby's cognitive abilities were slightly better. And then they followed these babies to seven years old now and a new study just came out and they're showing that the seven-year-olds whose mums took choline in trimester two, trimester three and breastfeeding up a higher amount, that they're doing better at school.
Speaker 2:Wow, I can just imagine everyone scrambling to like how can I get my hands on choline?
Speaker 3:So choline? One of the richest and most efficient sources of choline is actually egg yolks, specifically the yolk, obviously, don't just make egg yolk omelettes a bit gross, but if you're just an egg white person then that's why I emphasize it. So egg yolks Per egg, you will get 150 milligrams of choline per egg. So if you eat two eggs a day, that's about 300 milligrams of choline. The government recommends 440 milligrams per day and that study was on 930 milligrams per day.
Speaker 3:Now if you don't eat eggs, if you're vegan, that makes it a little bit hard. If you don't eat eggs because you hate them when you're pregnant, it makes things a little bit hard. You can get some from beef, chicken, dairy things like that less efficiently. And then the next most efficient source from a plant-based perspective are soybeans. So endomame beans and whole soybeans, specifically wheat, germ, quinoa, peanut butter, potatoes much, much smaller amounts, nowhere near as concentrated as eggs. So it becomes an efficiency problem Like how do you fit all these foods in? And then we also got to think about omega-3s and we've got to think about iron-rich foods and making sure we're putting the vitamin C with the iron to maximize the absorption, because we need so much iron in pregnancy. So it's just it's. Jenga, it's, jenga, it's like.
Speaker 3:Tetris like we're trying to like, fit all this in.
Speaker 3:And that's why I say to people look more than happy to support you to stay vegan, stay vegetarian before, during, after pregnancy. However, you're going to have to be a little bit more open to the fact that we're going to have to monitor nutrient levels a bit more frequently and you're probably going to be on more supplements in the average pregnancy. And that's okay, like there's nothing wrong with that. But if you're fighting me about it, this is where we're going to have difficulty, because there's going to come a time where we're going to struggle to fit all this in. Okay, we don't want to have calcium-rich foods. Okay, we might need calcium supplement. Okay, the iron's not looking too good. Which pregnant woman's iron is good? Most of the time, hardly any, so we're going to iron supplement. Okay, we can't take those two together because they inhibit each other and cancel each other out, so put them on either end today. Okay, we need our prenatal vitamin. Oh, you want to take extra choline? Oh, your vitamin D is low. We're going to add that. Oh, your B12 sucks.
Speaker 3:We're going to add that, yeah, you can see how it can become like this. You know, cocktail of supplements and, yes, in an ideal world can we get this through food short. But in a practical world where people are going to work, they're busy, they don't love to cook, they're not sitting there thinking about it like I am because you know my job, so that's fair, it's it's hard, it's hard and then, and then the anxiety of not meeting it each day is so high that you're like, yeah, give me this up.
Speaker 3:Well, just get it and deal with. Deal with the rest later, you know. So I think it's about having an appreciation for what is what the gaps may be. When you sit, where you should be, looking at lab work and then looking at the practicality of it, okay, great, this is where we should be, let's not. It's not to make you feel bad, it's just to say, hey, we have these gaps. Now what are we going to do about them? Okay, we can get half of our calcium through our diet. Then let's just do the other half.
Speaker 3:Supplements, that's fine. The iron's not low yet. Let's think about that in six weeks time. Then come back to that. That's cool, all right.
Speaker 3:Choline you want to add that in? All right, let's try and do the first. And then we might choose a prenatal vitamin that has a lot more choline in it than most of them on the market. Or we may say, let's add, tack one onto your current prenatal and so you can start to kind of, like I said, negotiate what's going in, what's going out and what they're willing to do and able to do, and, like I said, some food aversions and nausea can really persist. It really makes it really challenging and I think pregnant women already become really distressed about their diet not being what they hoped and layer other dietary restrictions, even like vegetarian. It can feel really anxiety inducing and it can sometimes feel like no one understands why you want to keep doing that, and I think that's often why people will come to us and be like I want to stay vegetarian, but I also want to do the right thing by my baby how do I do this? And by you too, and by themselves, yeah.
Speaker 2:Exactly. I think you need the energy and you need to feel like you've got enough for you in the tank. I think that's really important. Steph, every time we talk to you, I think, well, everybody just should see a dietician and have that kind of support throughout their pregnancy. So if that's the case and somebody's listened to this and gone, well, I think I have got a good diet. But listening to this, perhaps I do need support. How can they get in touch with you?
Speaker 3:Yeah, Thanks for having me and thanks for the opportunity to share. So you can come find us on Instagram the handle is at the underscore dietologist and our website, thedietologistcomau, are the main places we hang out. We do run a virtual practice, which means we see everyone via Zoom from all over Australia so you don't need to be in Sydney where I am. My team even isn't in Sydney, so the incredible dietitians that I work with, georgia and Candice, are up in Queensland. We all work virtually to support. I think we've already helped like 400 people this year so far. I just did the report last week and was mind blown. So I think we're on track for a thousand consults by the end of the year. So we help lots of people.
Speaker 3:There's pretty much nothing that we haven't seen at this point, having been in fertility and pregnancy and postpartum nutrition for the last five plus years. So please don't feel I think the other thing is like I kind of said like don't feel um shame about your diet. You know um, whether that's you're vegetarian or vegan or you're just not having the diet that you thought you would in pregnancy, you know there's it's nothing to be ashamed of at all, and particularly when you're coming to a nutrition professional. I do find that people feel like they're scared of judgment. You know they're scared to tell us they're vegetarian. They're scared to tell us they're vegan and it's nothing to be scared about. Be upfront, be honest, say this is what it is. Here's what I'm eating. How to, how, where to from here. That allows us to do our job easier. So we'll take into account your lab work, your pregnancy, any past medical history, any medications you're on. We can provide you the supplementation advice as well as dietary guidance and take you from preconception all the way through to pregnancy and I think most a lot of my clients from a few years the way through to pregnancy and I think most a lot of my clients from a few years ago now up to baby number three prep. So we take people through growing their whole family until they reach their desired family size and it's an absolute privilege to be part of their journey.
Speaker 3:And I think you know, like I also want to be completely transparent in this podcast episode I'm not personally a vegetarian or vegan and I know sometimes hearing about a vegetarian or vegan diet from someone who isn't because sometimes feel finger pointy. So I don't want it to come across like that at all. I think there are so many benefits to having a plant focused diet. However, I think a lot of people don't get enough support with it and that's where these big gaps and challenges can arise. So I just really encourage you if you can definitely reach out to somebody like us to get some professional advice you may not need a whole heap of it, but at least some to kind of get you up and going and to have that confidence so you can feel good about eating well in your pregnancy and eating plant-based diet if you want to in pregnancy. There's nothing wrong with it at all. You just got to be clever about it and get some professional input. So that's what we're for.
Speaker 2:You're amazing, Steph. Thank you so much for this time that you've given to us on the eve of a nice holiday for you. I really, really do appreciate it, and there's so much that somebody can take away from this episode and you know, I've learned a lot as well, which is great.
Speaker 3:Well, thank you for having me. I can't believe the time has flown my gosh, I know.
Speaker 2:Exactly, that's fantastic. Good on you, steph. Well, thank you everyone for listening. I hope you enjoyed that episode with Steph just as much as I did. If you're listening and you want some of the information that she gave about pre-pregnancy and pregnancy in our other episodes we did with Steph, just go back to our back catalogue and have a little listen. I'll put that in the show notes. Thank you for listening and we'll see you again next week.