Pregnancy brings about many considerations, from lifestyle to wardrobe choices. Suddenly you're playing the highest stakes game imaginable. One wrong move and your baby's life and therefore your own life will be ruined — at least that's what it feels like.
Many women experience unparalleled motivation to eat healthy while pregnant, which leads us to wonder: What is healthy, after all?
Health is relative
Health is absolute only in its relativity. If a recovering alcoholic smokes cigarettes instead of opening the bottle, cigarettes are healthy. If someone usually consumes 200 grams of sugar per day, 100 grams of sugar is healthy. Health is not a one-size-fits-all kind of glove. We have different constitutions, sensitivities and genetics.
That being said, all humans share 99.9 percent of the same DNA. Accordingly, our bodies evolved eating similar foods and we can thrive on similar diets. But with so many options, we are easily confused about what we should be eating. Plants? Animals? Dairy? No dairy? Low fat? High protein? Low carb? No fruit? Tons of fruit? You could probably find an Instagram feed of a pregnant woman adhering to any one of these diets and feel inspired to follow suit (if you don't believe me, check out Loni Jane Anthony, the fruitarian mom who came under fire for eating up to 20 bananas per day while pregnant).
Erika Herman, nutritionist, author of Eat Like A Fata**, Look Like A Goddess and creator of The 28-Day Goddess Lifestyle Transformation, says in her book, "The most all-bases-covered way to ensure a nutrient-dense diet is to look for foods that have been eaten by humans for a long time, foods that made us strong and fertile enough to make babies (how the h*** else would humanity have lasted this long?)." Namely, animal products. (Though The Goddess Lifestyle is distinct from the popularized Paleo diet.)
Meanwhile, the somewhat bourgeois trend for the modern health-seeking woman is to eat plant foods and plant foods only. Vegan cafés, restaurants, cookbooks and blogs are prolific and seem to be growing in numbers. So we come to the question: Is it okay to follow a vegan diet during pregnancy? If so, how? If not, why?
The omnivore argument
Weston A. Price, an early 20th century dentist and researcher who traveled the world studying the diets and nutrition of various cultures, concluded that aspects of a modern Western diet (flour, sugar and processed vegetable fats) cause nutritional deficiencies that are a cause of many dental issues and health problems (Wikipedia.org). He found that indigenous cultures with the healthiest babies and fewest dental problems prepared women for pregnancy with a diet high in fat-soluble nutrients that can only be found in animal products.
Herman writes, "Price learned that even in vegetarian cultures, like the Kikuyu tribe of Africa, the women who plan to become pregnant are fed special animal-based diets in order to ensure fertility and conception. The Jains, an India religious sect often thought of as entirely vegan, would encourage female monks to be lacto-vegetarians through the consumption of full-fat dairy. Why? Because these cultures have learned over millennia that ya can't make babies without whole-fat animal foods… As author Nina Planck puts it, 'Anthropologists have yet to identify a society living on plant foods alone [a vegan diet], without synthetic supplements, spanning generations of vegan mothers and fathers, children and grandchildren.'"
Vegan concerns
Lauren Slayton, a registered dietician, author of The Little Book of Thin and founder of Foodtrainers in Manhattan where she has educated thousands of people on nutrition, says, "Yes, you can be vegan, pregnant and healthy for sure." She recommends pregnant women watch their protein intake and take a supplement of the vitamin B12.
Vitamin B12 is a significant and well-known hole in the vegan diet. Herman explains, "Unlike animal foods, plant foods only contain B12 analogues, which actually inhibit absorption of real B12 and further up your body's need for it. Herbivore animals may get real B12 from plants and roots contaminated with feces and bacteria that make B12 — a no-go for humans. A compelling meta-analysis of 17 studies with 3,230 participants indicates B12 deficiency in humans is almost always present in vegan diets. Keep in mind, real whole food offers way more — a wise, intricate synergy — than supplements ever can."
In terms of protein, Herman cautions that plant sources aren't comparable to animal sources. "We constantly hear how we can get just as many grams of protein from broccoli as we can from beef, or how quinoa is a 'complete' protein because it provides all the essential amino acids." But according to Herman's research, this is a misinformed way of looking at nutrition. She explains, "Broccoli isn't a 'complete' protein, and although quinoa is, it only contains 8 grams of protein per 1-cup serving." This means, "An average-sized woman would need to eat 5.5 cups of quinoa every day to meet her protein needs (based on grams of protein, and Net Protein Utilization or NPU). Unfortunately, that much quinoa also contains a whopping near-200 grams of blood-sugar-and-insulin destabilizing, inflammation-provoking starch. The numbers don't make sense for health." Erika also cautions us about turning to protein powders, "Higher-NPU, plant-based vegan protein powders require lots of land and unsustainable agricultural 'inputs' to manufacture. Ecologically speaking, they're not a better option than grass-fed/pastured animal foods, and are arguably worse because pastured animals have a negative carbon footprint."
Slayton also notes that omega-3 fatty acids are a concern as they are essential for Baby's brain development. She says, "Too many omega-6 [fatty acids] in your diet can reduce the conversion of ALA [alpha-linolenic acid — the type of omega-3 fatty acids found in plant sources] to DHA [docosahexaenoic acid — the type of omega-3 fatty acids that baby needs] so avoid cooking in corn, safflower or sunflower oil." She recommends taking a prenatal vitamin containing omega-3 fatty acids and consuming omega-3 fatty acids every day, citing her favorite vegan sources: hemp, chia seeds and walnuts.
DHA and EPA
Researchers found that infants born to mothers with higher blood levels of DHA at delivery had advanced levels of attention spans well into their second year of life. During the first six months of life, these infants were two months ahead of those babies whose mothers had lower DHA levels. Attention is considered an important, but not the only, component of intelligence early in life (WebMD.com).
In her book, Herman cites research that plant foods do not have comparable levels of essential nutrients found in animal foods, or even comparable forms of those nutrients. The omega-3 fatty acids you find in plants are not the pre-formed omega-3 essential fatty acids DHA and EPA (eicosapentaenoic acid, a precursor to DHA), which have been converted by cold-water fish and pastured animals. Studies show our bodies don't efficiently convert ALA (the omega-3 fatty acids in plant foods) to EPA and DHA. The one vegan-friendly DHA-containing plant food, algae, still isn't comparable to animal foods because it lacks sufficient EPA to work in synergy with DHA. To boot, Herman notes, all plant sources of omega-3 fatty acids contain higher amounts of the pro-inflammatory omega-6 fatty acid than the anti-inflammatory omega-3 fatty acid, which inhibits EPA and DHA conversion. If the diet lacks sufficient saturated fat, conversion is further inhibited.
Even Natalie Portman, who is famously vegan, chose to eat dairy and eggs during her pregnancy because she felt her body needed it. And yes, hens, cows and other livestock make EPA and DHA when they are "pastured," which means they eat grass, seeds and insects as opposed to the soy and grain feed used in factory farms, and even organic farms. (If you choose to eat animal foods, always look for the pastured variety.)
Follow your truth
The choice is ultimately yours. If you want to adhere to veganism while pregnant, you can load up on plant sources of omega-3 fatty acids, take supplements and increase your protein intake by consuming plenty of quinoa, legumes, nuts and seeds. Be aware that you're taking your chances on how much DHA your body will convert — you must rely on supplements, some synthetic, which Herman says, "cuts nature off at the knees" by losing "the wisdom of whole-food nutritional synergy" — and you're consuming a lot of starch along with plant protein which can increase your risk for disease in general, including gestational diabetes, by provoking inflammation and destabilizing blood sugar and insulin.
In other words, tread carefully. Listen to your pregnant body à la Natalie Portman and don't deny yourself if you're craving animal foods. During my first pregnancy, I ate a hamburger for the first time in many years and I'll never forget how good it tasted.
Above all, know your truth. Don't let your vegan friends make you feel bad if you choose to expand your palate. Likewise, if veganism is a part of your identity and something you wholeheartedly believe is right for you — if veganism is your truth — tell your doctor or midwife and ask for blood work before (if you can), during and after pregnancy. Regardless of diet, you should obtain adequate prenatal care, eat consciously and enjoy this special time in your life.
More on prenatal nutrition
What not to eat
Nutrition and managing gestational diabetes
The importance of DHA during pregnancy and breastfeeding