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How to Manage Weight Safely During and After Pregnancy: an Interview with Lauren Talbert

The topics of weight management and nutrition have always been surrounded by a lot of myths and misconceptions, especially during and after pregnancy. In this interview, Lauren Talbert, a clinical dietitian certified in oncology nutrition, will shed some light on a healthy diet during pregnancy and after delivery, as well as nutrition for over- and underweight people trying to conceive.

Yes, particularly with PCOS, which can be one of the most common fertility issues for women.

There was a recent study that proved that women with PCOS who followed this plant-based diet and ate more fruits, vegetables, whole grains, nuts, and seeds increased their chance of becoming pregnant three times versus those who reported not eating as healthy and balanced. So it's pretty cool.

I would not recommend it because during pregnancy you need 28 grams of fiber each day — that's needed for your digestion. During pregnancy, your digestion slows. So if you are going to follow the ketogenic diet, on top of the issues with digestion during pregnancy, you're going to have even more issues with constipation. And constipation is a common symptom during pregnancy.

The other thing with the ketogenic diet is that it may not provide all of the other vitamins and minerals that you need during pregnancy. So, for example, you need a good amount of vitamin A in your diet, and you can get that through plant foods, or you need to get a wide variety of antioxidants in your diet when you're pregnant. Think about Vitamin C — it would be hard to obtain as much that you need through following the ketogenic diet because the ketogenic diet is more animal-heavy and very minimal with plant-based foods. So I would not recommend it during pregnancy, particularly because of constipation, but also because of the lack of nutrients.

It's interesting because it's not defined. Some say they're following a ketogenic, and in my opinion, they're just eating healthy. In their mind, if they're following a ketogenic diet, and they're just eating whole grains and fruits and vegetables, I'm fine with that. But if they were to try to lose the baby weight and follow a very strict low-carbohydrate diet, I wouldn't suggest that long-term because they're definitely going to be deficient in particular vitamins, and specifically they're going to be deficient in fiber.

Particularly for people who are underweight who have a history of an eating disorder who become pregnant, this can be very very challenging, especially if they have body image problems before their pregnancy.

For that, I would really encourage them to work closely with a dietitian in a team during their pregnancy to help them focus on the positives and health benefits of what they would be recommended to do in terms of eating and then also help them manage the changes that their body goes through while they're pregnant and really remind them that they are growing another person.

In terms of eating more calories, whenever I'm recommending more calories for weight gain, I'm obviously recommending healthy foods. What I typically suggest for easy quick things — cook liberally with olive oil. So any time you're eating any dish that is savory after you plated that dish, drizzle about a tablespoon or so of olive oil on it; it can add some extra healthy calories.

It's important to know that when you're pregnant you actually only need an extra 300 calories a day. And that's the amount in something like yogurt or some fruit.

Also, being liberal with nuts and seeds when cooking or snacking, and then also, add an avocado to different things to add healthy calories. But again, if somebody has an eating disorder such as anorexia prior to pregnancy, it's really important that they have a whole team to help support them both mentally and physically during their pregnancy because as their pregnancy progresses and their body changes even more, it's going to be hard for them mentally.

With regards to patients who have higher BMIs, I definitely would suggest following more of a plant-based diet. And it's important to know that when you're pregnant you actually only need an extra 300 calories a day. And that's the amount in something like yogurt or some fruit. So it's not a lot of extra calories.

But what happens is, when people get pregnant, people have food cravings or certain symptoms that they're trying to manage with food, like headaches or nausea. And it's really important to just try to develop the healthiest habits you can during pregnancy. Because that's only going to benefit you when the baby's born.

When I meet with patients who have a pretty high BMI at the start of their pregnancy, I really focus on this whole plant-based diet. The way that I explain it is that it’s important to take the time now while your baby's inside of you to develop your healthy habits, so then when your baby is with you, you have more energy and your health is overall improved to be with your child, to take care of them, but then also to help you lose the weight, so for your own health.

But if you can start the healthy habits during your pregnancy, it's a lot easier than trying to start them after pregnancy when you have a child that you're taking care of.

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