• Burrito made from whole-wheat tortilla with greens, quinoa, and beans
• Mashed sweet potatoes
• Fruit smoothie
BRUCE FRIEDRICH AND ALKA CHANDNA
People for the Ethical Treatment of Animals
Indian dinner combination including:
• Chana masala (spicy chickpeas)
• Aloo gobi (potatoes and cauliflower)
• Achar (Indian pickles)
NATHAN RUNKLE
Founder and Executive Director of Mercy For Animals
• Vegan Reuben Sandwich: sliced seitan, onions, peppers, sauerkraut, vegan Thousand Island dressing, and Daiya cheese served on marbled rye
• Raw lemon coconut cheesecake for dessert
MATT BALL
Co-founder of Vegan Outreach
• Taco made with Gimme Lean, ground-beef style, and Ortega taco seasoning
• Topped with refried beans, Daiya cheese, Tofutti sour cream, and hot sauce
• Spanish rice
NEAL BARNARD, MD
President and founder of the
Physicians Committee for Responsible Medicine
• Green salad with light vinaigrette
• Capellini (angel hair pasta) with arrabbiata sauce
• Broccoli, spinach, and carrots, all steamed and served with lemon wedges
SUE HAVALA-HOBBS, DPH, RD
Director, Doctoral Program in Health Leadership,
School of Public Health, University of North Carolina;
and co-author of the American Dietetic Association’s 1988
and 1993 Position on Vegetarian Diets
• Kale cooked with soy-ginger sauce, tempeh cubes, and toasted pine nuts over steamed rice
• Steamed carrots
• Whole-grain dinner roll
• Baked apple with vanilla soy yogurt
MELANIE JOY, PHD
Psychologist and author of
Why We Love Dogs, Eat Pigs and Wear Cows
• Pizza with whole-wheat crust (from Trader Joe’s) topped with organic tomato sauce with crushed garlic, Field Roast apple sage sausage, baby spinach, black olives, and Daiya cheese
• Mesclun mix salad with goddess dressing or sautéed kale with slivered garlic and toasted almonds
• Sliced Asian pear sprinkled with cinnamon for dessert
CHAPTER
9
A HEALTHY START
Vegan Diets in Pregnancy and Breast-Feeding
F
amily members, friends, and even your health-care provider might express surprise and concern at the idea of a vegan pregnancy. But vegan diets can easily meet the nutritional needs of you and your growing baby. The proof comes from a 1987 study of 775 women living on the Farm, a vegan community in Tennessee.
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The researchers looked at weight gain in pregnant women and birth weights of their babies—two important measures of a healthy pregnancy. They found that the women’s vegan diets had no effect on the birth weights of their babies and that their own weight gain during pregnancy was adequate. In fact, these women actually gained a little bit more than women in the general meat-eating population. And the longer they had been vegan, the better their weight gain.
One other finding was surprising: Preeclampsia, a potential complication of pregnancy that occurs in 5 to 10 percent of pregnant women, was nearly nonexistent among vegan pregnant women living on the Farm. Along with another smaller study, these findings give reassurance that vegan diets are safe and healthy for pregnancy.
In some studies of women following very restrictive diets, particularly macrobiotic diets, infants sometimes had lower birth weights. In these cases, it wasn’t a vegan diet that was to blame. Rather, the diets at issue were too low in fat and calories. It’s important to note that the
findings about poor pregnancy outcomes are from older studies when vegans had less access to nutrition information and a variety of vegan foods. That’s all changed dramatically in the past several decades, and today it’s easier than ever to plan a healthy vegan pregnancy.
GETTING ENOUGH CALORIES
Although adequate weight gain is important for a healthy vegan pregnancy, eating for two doesn’t mean eating twice as many calories. On average, pregnant women need an extra 340 calories per day during the second trimester and 450 extra calories during the last three months of pregnancy. But needs for certain nutrients increase by as much as 50 percent, so packing a lot of good nutrition into that little bit of extra food is important.
Pregnant women can follow the vegan food guide in Chapter 7 with just a few adjustments that we’ve shown in the Modified Food Guide for Pregnancy and Breast-feeding on page 140. An added serving each of whole grains and leafy green vegetables and two additional servings of protein-rich foods (legumes, nuts, and soyfoods) will give you needed calories and help meet nutrient needs during the second trimester. During the last trimester, when your baby is growing fastest, add one more serving of either whole grains or legumes/soyfoods.
Calorie-counting during pregnancy isn’t an exact science, but your health-care provider will help you stay on track by monitoring your weight gain. Poor weight gain during pregnancy is associated with low-birth-weight babies, who are at risk for health problems.
NUTRITION CONSIDERATIONS IN VEGAN PREGNANCY
The table on page 139 shows changes in nutrient needs for pregnant and nursing women.
Protein needs increase by almost 50 percent in pregnancy. Most non-pregnant omnivore women consume enough protein to meet the
needs of pregnancy, but that may not be true of all vegan women. It isn’t difficult to get enough, but it’s important to make sure you are including at least five to six servings of protein-rich foods from the food guide in your daily menus.
Iron absorption—especially of the nonheme iron found in plant foods—increases significantly during pregnancy while the lack of menstruation reduces iron losses. Even so, iron requirements nearly double during pregnancy. Some of the increased iron requirement is due to the manufacture of red blood cells in the growing fetus, but most of it is needed to support the expansion of the mother’s blood volume during pregnancy. Theoretically, vegans could be at higher risk for iron deficiency in pregnancy, but the truth is that all women are at risk. It’s difficult to plan diets for either vegans or omnivores that meet iron needs of pregnancy. For that reason, iron supplements are almost always recommended for pregnant women.
Pregnant women typically have zinc intakes that are lower than recommendations, unless they are taking supplements. The benefits of zinc supplements in pregnancy aren’t known, but they may be beneficial for pregnant vegans since zinc absorption from plant foods is lower than from meat.
Vitamin D requirements don’t change with pregnancy, but getting enough is important for both the mother’s and baby’s health. With the exception of vitamin B
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and iron and—depending on your diet—possibly vitamin D and iodine, it is possible to meet all of the nutrient needs of pregnancy on a vegan diet without the use of supplements. But most health professionals recommend a prenatal multivitamin and mineral supplement, particularly one that includes iron and folate, as sensible insurance for both vegan and omnivore women.
Pregnant vegetarians have lower blood levels of DHA (the long-chain omega-3 fatty acid) than pregnant nonvegetarians.
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We don’t know whether that’s a problem, but there is some evidence that DHA intake during pregnancy and breast-feeding improves visual acuity and brain function in the infant. Experts recommend that pregnant women
consume 300 milligrams of DHA per day, so we recommend DHA algae-derived supplements for vegans.
Here are some tips for a healthy vegan pregnancy:
• If you are planning a pregnancy, now is the time to take a good look at your eating habits. Healthy nutrition in the early weeks of pregnancy—often before a woman knows that she is pregnant—is important. Make sure your diet includes plenty of foods that are rich in the B-vitamin folic acid. Good sources are legumes and leafy green vegetables. Think about cutting alcohol out of your diet, too, if there is any chance you might become pregnant, and if you are a coffee drinker, now is the time to cut back.
• Talk to your health-care provider about your weight-gain goals. If you have trouble gaining weight, emphasize foods with a little more fat, such as tofu, nut butters, and avocados.
• Use the Modified Vegan Food Guide for Pregnancy and Breast-feeding on page 140 in making daily food choices.
• Protein needs go up by about 25 grams beginning with the second trimester. It’s not difficult to meet those needs on a vegan diet, but it might require extra attention. Take a look at the list of protein-rich foods in Chapter 2. Aim for at least 15 to 20 grams of protein in each meal and choose a few protein-rich snacks as well.
• Eat plenty of iron-rich foods and include a good source of vitamin C at every meal to boost absorption. Most health-care professionals recommend iron supplements for all pregnant women. This can be especially helpful for vegans since iron needs are higher for those on plant-based diets.
• Eat plenty of foods high in the B-vitamin folic acid. If you don’t typically use refined enriched grain products, which are fortified with folic acid, make sure you are consuming plenty of folic acid–rich foods if there is a possibility you could become pregnant. Vegans generally have higher intakes of folic acid than omnivores, but they still aren’t high enough to meet pregnancy
needs. A prenatal supplement that contains folic acid is a wise choice for all pregnant women.
• Some pregnant vegans don’t meet requirements for zinc, a nutrient that can fall short even in well-planned vegan diets. Be sure to include whole grains, legumes, and a serving or two of nuts or seeds in your meals. A supplement providing 15 to 25 milligrams of zinc can be a good choice for pregnant vegans. It should also supply 2 milligrams of copper since zinc can lower copper absorption.
• Because calcium absorption is more efficient during pregnancy, pregnant women don’t have increased needs for this nutrient. It’s important to get enough, though, so make sure you emphasize foods that are calcium-rich. Make it a daily habit to eat a serving or two of leafy green vegetables and choose calcium-fortified soymilk and orange juice. Recommendations for calcium intake are 1,000 milligrams per day.
• Supplement daily with vitamin B
12
and, unless you are absolutely certain that you are getting adequate sun exposure, take a supplement of vitamin D as well.
• Although it is usually called morning sickness, nausea associated with early pregnancy can occur at any time of day. In addition to being unpleasant, nausea can keep you from eating healthfully. Here are a few tips to help you deal with pregnancy-induced nausea:
• Eat frequent small meals since an empty stomach can make nausea worse. (Small meals can also help with heartburn, which can be a problem for some pregnant women.)
• Eat something immediately upon waking, when your stomach is likely to be empty. Keep crackers or raisins or whatever appeals to you on the bedside table.
• Avoid liquids with meals if you find that this increases your nausea.
• Identify healthy foods that are less likely to make you feel sick. You’ll need to follow your own instincts, but good choices to
consider include whole-grain breads, dry cereals, cooked or dried fruits, and white or sweet potatoes. Try adding small pieces of vegetables and tofu to miso soup to make them saltier and easier on your stomach.
The rate of breast-feeding is higher among vegan mothers than in the general population. And that’s nice for their babies since breast milk is the ideal food for infants. Ideally, babies should be fed human milk for at least the first year of their lives and preferably throughout the second year as well.
Nursing mothers need extra calories for the process of synthesizing milk and to provide the calories that babies need for growth. Energy needs, therefore, are higher during lactation than in pregnancy. If you have post-pregnancy pounds to drop, a small reduction in calories can usually produce a gradual weight loss while still maintaining adequate milk volume. Don’t decrease calories too much, though, as it can cause the milk supply to decrease as well. Drinking plenty of fluids is also important for producing adequate milk.
Needs for some nutrients go up slightly, so keeping the emphasis on nutrient-rich foods is as important as ever. (One exception is iron: Since breast-feeding women don’t menstruate, iron needs drop to very low levels during lactation.) Diet affects the levels of all of the vitamins in breast milk as well as the type of fat.
The two nutrients that require the most attention in vegan diets are ones that nutrition-savvy vegans are already focusing on—vitamin D and vitamin B
12
. Deficiencies of these nutrients have been seen in babies whose mothers didn’t follow recommended guidelines and they can cause serious problems. Nursing women should consume a daily vitamin B
12
supplement. We also recommend continuing with a DHA supplement since one study showed that the milk of vegan women is lower in this nutrient than that of omnivores.
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Many women continue with a prenatal supplement for the first few months of breast-feeding (but without the extra iron). And the American Academy of Pediatrics recommends vitamin D supplements for all breast-fed infants (not just those in vegan families).
NUTRIENT RECOMMENDATIONS FOR NONPREGNANT, PREGNANT, AND BREAST-FEEDING WOMEN