• Choline: Are You Getting Enough?

    By Margaret Eich, MS, RDN

    Are you getting enough choline in your diet? Most women are not, and most women may not have even heard of choline. Choline plays an important role in fetal development, including brain development. Most people have heard they need to get enough folic acid (or folate) before and during pregnancy to prevent neural tube defects, but did you know that choline may also play a role in preventing neural tube defects, like spina bifida? Research has produced conflicting results in this area, but ensuring adequate choline intake makes sense while the research sorts itself out, especially given choline’s other benefits.

    In addition to a potential role in preventing neural tube defects, choline deficiency may also play a role in the development of fatty liver. Choline is also a precursor to the neurotransmitter acetylcholine, which is involved in muscle control and memory. In addition, choline is converted to betaine in your body, which assists in the conversion of homocysteine to methionine, thus preventing homocysteine levels from becoming elevated. Elevated homocysteine is associated with increased risk for cardiovascular disease and miscarriage.

    Choline is not technically considered a vitamin, since our bodies make small amounts, but our bodies don’t make enough to meet our daily choline needs. Therefore, we need to get choline in our diet. Non-pregnant women need 425 mg choline daily, and this goes up to 450 mg during pregnancy, and 550 mg while breastfeeding. In the US, average choline intake is well below this recommended level with women on average only taking in 260 mg choline per day!

    The best food sources of choline include liver, eggs, meat, seafood, legumes, and cruciferous vegetables like Brussels sprouts, and broccoli. One egg provides almost 150 mg choline, which underscores how helpful eggs are in meeting your choline needs. Not only are eggs rich in choline, but they are also just a very nutrient dense food to support your overall health, fertility, and pregnancy. Because choline is most concentrated in animal foods, vegans or vegetarians who eat limited eggs and dairy products are at highest risk for choline deficiency. Since so many US women struggle with getting enough choline, it’s a good idea to take a prenatal vitamin that contains choline, especially if you are vegan or vegetarian with limited intake of eggs.

    Looking for more information about nutrition for fertility and pregnancy? Book a nutrition consult today!

    References:

    1. Linus Pauling Institute at Oregon State University: Choline
    2. Caudill, et al. Pre- and Postnatal Health: Evidence of Increased Choline Needs. J Acad Nutr Diet. 2010; 110:1198-1206

     

  • Vitamin A: Are you getting the right amount?

    By Margaret Eich, MS, RDN

    Vitamin A is a fat-soluble vitamin that is essential for reproduction, vision, immune system function, and embryo and fetal development. There are two main types of vitamin A: preformed vitamin A known as retinoids, which are found in animal products, and are converted to retinoic acid, which regulates transcription of a number of genes. The second type of vitamin A is called carotenoids, which includes beta-carotene and hundreds of others. Only about 10% of carotenoids are capable of being converted to retinol and further to retinoic acid. Beta-carotene, alpha-carotene, and beta-cryptoxanthin are all capable of being converted to retinoic acid, though only small amounts are converted.

    Most women hear about vitamin A in terms of toxicity – that you shouldn’t take too much vitamin A prior to and during pregnancy, as it may cause birth defects, which is true. We recommend limiting the amount of preformed vitamin A from supplements to no more than 5000 IU (which is equivalent to 1500 mcg RAE). RAE stands for Retinol Activity Equivalents and is the standard way of expressing vitamin A requirements and amounts in food, as it accounts for the differential bioavailability of preformed vitamin A and carotenoids. Supplement labels usually use International Units (IU) to list vitamin A doses, which can sometimes make sorting out your vitamin A intake confusing! There is no limit for carotenoids like beta-carotene, as they haven’t been shown to be capable of causing vitamin A toxicity or birth defects. Some prenatal vitamins do contain preformed vitamin A, such as retinal palmitate, which is fine and maybe helpful if you struggle to meet your vitamin A needs, as long as the preformed vitamin A is less than 5000 IU. Make sure to check all of your supplements for vitamin A, as other combination formulas aside from your prenatal vitamin may contain vitamin A.

    The daily recommendation for vitamin A is 700 mcg RAE and increases to 770 mcg RAE in pregnancy. In the US, women are getting on average only 580 mcg per day – in other words, US women are not getting enough vitamin A. So while it’s important to make sure you’re not taking in excess vitamin A from supplements, it’s also important to make sure you’re getting enough vitamin A due to its essential role in reproduction, embryo development, and organ formation during fetal development.

    Your best sources of preformed vitamin A include liver, fish, dairy, kidneys, eggs, poultry skin, butter, and dark meat chicken. Your best (plant) sources of carotenoids include: sweet potato, pumpkin, carrots, cantaloupe, spinach, kale, collards, and butternut squash. Absorption and conversion of carotenoids to active vitamin A is variable based on the food it’s contained in, and an individual’s ability to digest and absorb it. Because of the variable in absorption, it makes sense to include a mix of preformed vitamin A and carotenoids to meet your vitamin A needs.

    Need some help sorting out your vitamin A intake. Book a nutrition consult today!

     

  • Supplements for Immune Support: Separating the Research from the Hype

    By Margaret Eich, MS, RDN

    It’s January, which means it’s officially cold and flu season. When you’re trying to conceive or pregnant, you have to be extra conscious of what you’re putting in your body. Certain over-the-counter medicines may not be appropriate during this time; so it’s important do what you can to stay healthy. Hand washing, getting plenty of sleep, eating healthy, and managing stress are all helpful ways to do that. What about supplements? There’s plenty of info online about miracle immune support supplements, but what does the research really show? Here’s a quick summary of some popular immune support supplements and the ins and outs of what you should know while trying to conceive or pregnant:

    Vitamin D: Vitamin D supplementation may help prevent upper respiratory infections, though the evidence is mixed. Vitamin D plays an important role in the immune system, so you definitely want to avoid vitamin D deficiency as this may impair immune system function. Vitamin D also may affect fertility, so it’s a good idea to have your vitamin D level tested, so you can supplement at an appropriate level. Vitamin D is a fat-soluble vitamin that can be toxic at very high doses, so make sure to discuss an appropriate dose with your healthcare practitioner.

    Vitamin C: While there is currently no evidence that taking vitamin C once a cold starts helps reduce severity, people who take vitamin C regularly tend to have colds that don’t last as long as people who don’t take vitamin C. Also people who take vitamin C regularly and are under lots of physical stress (marathon runners, skiers, etc.) had lower incidence of colds in one study. Vitamin C is generally well tolerated and safe to take while try to conceive or pregnant, though high doses of vitamin C may cause diarrhea. Vitamin C supplementation is not recommended in people with a history of oxalate-containing kidney stones.

    Zinc: Zinc deficiency makes it more likely that you’ll catch a cold or other infection, so ensuring adequate zinc intake is important. Make sure to avoid oversupplementing zinc. The daily upper limit is 40 mg. You should not take more than 40 mg daily except for short time periods as directed by a healthcare practitioner. Make sure to check all supplements for zinc content when determining your daily intake, as some prenatal vitamins have as much as 25 mg zinc.

    Sources

    1. Linus Pauling Institute at Oregon State University: Vitamin D: https://lpi.oregonstate.edu/mic/vitamins/vitamin-D#immunity

     

    1. Linus Pauling Institute at Oregon State University: Vitamin C: https://lpi.oregonstate.edu/mic/vitamins/vitamin-C#common-cold-treatment

     

    1. Linus Pauling Institute at Oregon State University: Zinc: https://lpi.oregonstate.edu/mic/minerals/zinc