Dispelling nutrition myths, ranting, and occasionally, raving

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Are prenatal vitamins a waste of money?


Last week the news that pregnant women don’t need vitamin supplements seemed to be all over social media. The articles were based on this review article published in the Drug and Therapeutics Bulletin. The authors concluded that based on the evidence, much of which was from research in developing nations, that women (in Britain) do not need to take prenatal vitamins.

They reached this conclusion based on examining studies of the effects of folic acid, vitamin D, iron, vitamin C, vitamin E, and vitamin A supplementation on birth outcomes. While they concluded that multivitamin supplements are unnecessary for women during pregnancy, they stated that there was strong evidence to support women taking folic acid supplements and vitamin D supplements during pregnancy.

The message that came across most strongly (from the news articles) to me was that women are being shamed into purchasing vitamins that they can ill-afford, and don’t need, under the guise of wanting the best for their baby. The implications of these news articles concern me.

Firstly, women should be aware that many pharmacies (in Canada at least) have prenatal programs through which pregnant women can receive free multivitamin supplements, amongst other things. An inability to afford multivitamins should not prevent women from receiving them. Let’s not make this about drug companies trying to make money from poor women desperate to do the best for their unborn children. This should be about doing the best for women and their unborn children.

Okay, now that, that’s out of the way… I worry that the message that women should still be taking folic acid supplements and vitamin D supplements (and not just pregnant women I should add as most women of childbearing age should be taking folic acid supplements and most women in North America at least, should be taking vitamin D during the winter months) will be lost amid the cry that multivitamins are unnecessary. The message is not that all vitamin supplements are unnecessary for most Western women during pregnancy, just that the current evidence doesn’t support the use of multivitamins.

I’d also like to note that the researchers were focussing on birth outcomes. The conclusion that multivitamins are unnecessary was based on whether or not mums gave birth to healthy full-term babies. The authors did not take into consideration any potential long-term benefits maternal supplementation might have on their children. The authors did not take into consideration benefits that multivitamin supplementation might provide to mums. They did note that multivitamins can lower the mums risk of anemia, but as that didn’t seem to affect birth outcomes iron supplementation was deemed unnecessary. There are many other vitamins and minerals in multivitamins that the authors didn’t look at. Quite likely there’s not enough research on them to make a call either way. Regardless, the needs of pregnant women, not just their babies, should be taken into consideration when determining whether or not supplements are needed. Not all mums are going to get all the nutrients they need from food. Especially if they’re suffering from “morning” sickness. Perhaps not all mums will benefit from taking multivitamins. However, some very well may, and I think it would be a shame to tell them that they’re “wasting their money”.

Finally, as my friend Mark (who asked me to write about this topic) mentioned, taking two pills is more effort than taking just one. If it’s still being recommended that women take folic acid and vitamin D during pregnancy then they may as well just get those nutrients from a prenatal multivitamin rather than buying separate bottles of two supplements and having to remember to take both pills. It may be ever so slightly less expensive to buy vitamin D and folic acid instead of a multivitamin but I can’t even be certain of this because there was no folic acid for sale at my local grocery store when I went to price them all out. Which raises the issue of availability as well.

Women shouldn’t be made to feel guilty about not being able to afford a prenatal multivitamin. They also shouldn’t be made to feel like they’re wasting their money by buying them.


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Why obesity prevention is not the answer


One of my twitter friends recently shared a link to this article: How Early Should Obesity Prevention Start? My immediate reaction was that they’re asking the wrong question. They should be asking how early health promotion should start.

While I think that the authors make some good points about obesity influences beginning in the womb, I stand by my initial reaction. No one likes to hear the term obesity. No one wants to be told that they’re obese or that their weight may cause their children to become obese. Is an obesity intervention really going to make much of a difference? I’m doubtful. Framing such an intervention as health promotion, and not only targeting overweight and obese women might be slightly more effective. However, these interventions are still putting the onus on the individual. Interventions targeting individuals and groups serve a purpose in the battle against obesity in the same manner that food banks serve a purpose in the battle against food insecurity and poverty. They are bandaid solutions for gaping wounds.

As I’ve said many times before: we need systemic change. The only way that we’re going to truly see a decrease in obesity rates is if we, as a society, change. We need to put more emphasis on food preparation and incorporating physical activity and exercise into our daily routines. We need to stop wearing long workdays and sleep deprivation as badges of honour. The best way to address the obesity problem is to not talk about obesity.


Hyperemesis gravidarum: beyond morning sickness

With Kate Middleton’s recent hospitalization, hyperemesis gravidarum (extreme nausea and vomiting during pregnancy) has been thrust into the spotlight. Coincidentally, I’ve had several friends suffer from it recently as well (supposedly it only affects 1-2% of pregnant women). It’s much more severe than the “normal” morning sickness (which itself is a misnomer as it can occur at any time of day) and often lasts throughout much of the pregnancy.

Frequent vomiting during pregnancy can lead to weight loss, dehydration, and electrolyte imbalances. Women who suffer from hyperemesis, and who do not gain as much weight as hoped during pregnancy, are at risk of delivering small infants.

Essentially, women suffering from hyperemesis should consume foods that they best tolerate in an effort to gain a healthy amount of weight. Different foods may be better tolerated, or may trigger nausea, depending on the woman. However, oftentimes starchy foods are best tolerated. Trying to consume energy dense foods that us dietitians would normally be advising people to limit intake of may be beneficial for women suffering from hyperemesis. Things such as dried fruits, nuts and nut butters, granola, crackers, even chips may be good choices for these women. Ginger is a natural anti-nausea agent that may also be helpful.


Pregnancy, a licence to eat?

Myth 32: When you’re pregnant, eat up! You are eating for two.
What Dietitians of Canada says:
“Pregnant women are commonly told they are “eating for two.” In reality, you need just a little more food, during the second and third trimesters, to get enough nutrients and calories to support a growing baby…”
What I say:
This is a good myth! The people who seem to spread this myth the most are pregnant women themselves. I think it’s often used as a licence to eat as much of whatever you want. While I am not at all opposed to the occasional indulgence, I don’t think that eating unhealthy foods to excess is a good plan during pregnancy. Your unborn child is pretty small, especially during the first trimester, they don’t need a whole lot of calories. As DC says, you don’t need any extra calories during the first trimester, and only about 340 per day during the second, and 452 per day during the third. That’s just a couple of extra snacks a day. It’s not about quantity, it’s about quality. You have a responsibility to give that baby the best possible start possible. As the fetus cannot control the nutrients that are being provided to it, the pregnant woman shoulders the responsibility of providing their child with a healthy diet. More calories are actually needed to support breastfeeding than pregnancy. It takes at least 500 extra kcal/day to support lactation. If you want to use your pregnancy as an excuse to change your diet try to use it as an excuse to choose healthier nutrient-dense foods, not as an excuse to double your calorie intake.

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Baby making

What with all this talk about babies, I thought that I should talk a little bit about related nutrition. Let’s start with preconception. Provided you’ve actually made the conscious choice to conceive, both of you need to think about your nutrition. It’s not just about cutting out alcohol and it starts months before conception. What a man eats affects sperm production quality. If you want a good product, it just makes sense to use the best ingredients. There’s enough pressure on the woman to do things right, the man needs to assume some responsibility here too. Potential dads: if you want to make a better baby then make sure your diet includes lots of fresh vegetables and fruits and consider cutting out alcohol. Exercise is also important. The healthier you are, the healthier your baby will be, both at birth and years down the road. The other thing that really annoys me is hearing women say that they’re “eating for two.” Or using pregnancy as an excuse to eat loads of high calorie, low nutrient foods. You’re not eating for two! Your foetus is tiny. You do not need to double or triple your caloric intake during pregnancy. Sure, if you have a craving, go ahead and indulge yourself, but do so with the same restraint that you would if you were not carrying a small person around inside you. Also, there is an increasing body of research showing that what you eat during pregnancy can affect your child’s health throughout their entire lives. Check out the study of nutrigenomics if you’re interested in learning more about how nutrition can affect gene expression. Sure, it’s a lot of pressure, but you are responsible for this unborn person’s future. It is a lot of pressure.