How to eat Paleo during Pregnancy: A guide to every trimester


Second Trimester: Important Paleo Micronutrients and Macronutrients 

Hurray! You’ve made it through the fatigue, nausea and food aversions that are so common during the first trimester. Your baby belly is growing, you’re starting to glow and feeling rather this is what pregnancy should feel like!

Now is the time to start enjoying food and correct any deficiencies that may have arose during the first trimester. A paleo diet is one of the most nutrient dense approaches to eating, so if you’re avoiding all food toxins like industrial seed oils and grains, especially gluten containing grains and excess fructose and soy while eating a diet rich in cold water fish,  organ meats, muscle meats, a variety of vegetables, fruits and starchy tubers and a moderate amount of nuts, seeds, you’re good to go! Some folks may also find that they tolerate raw fermented high fat dairy products, which is great for you as well, if you are able to source it correctly.

Second Trimester Micronutrients

Choline, found in egg yolks are an essential micronutrient for a healthy paleo pregnancy. 

Choline, found in egg yolks are an essential micronutrient for a healthy paleo pregnancy. 

You'll find all the key micronutrients for a healthy second trimester and where to find them in your diet in this post.  

  • Omega -3 DHA
  • Vit A
  • Vit K
  • Calcium 
  • Choline


Second Trimester Macronutrients

            This may be one of the most common questions I get from women who follow a paleo/primal diet. Should I eat more carbs? Less carbs? High fat? High protein? Low protein?

            My best answer: it depends…and here’s why. Newsflash…everyone is different. What works for one woman can create deficiencies in others. The best way to figure out what works for you is by experimenting with your meals and adjusting macronutrients depending on how you feel. In general, I recommend 15-20% Protein, 30% Carbohydrates and 45-50% Fat as a starting point.


Here’s why

As your paleo pregnancy progresses your babies glucose demands steadily rise. This helps baby’s nervous systems develop and helps them put on fat mass. As the baby’s demand increases, your body responds by increasing your resistance to insulin. Many women may interpret this increasing insulin resistance as a reason to eat a low carb diet during pregnancy but this is not the case at all. Carbohydrates are essential for proper hormone and nervous system function and are essential in pregnancy and the developing fetus. You’re body is attempting to maintain a higher blood sugar level for a reason…to feed your baby! This does not mean that you have a prescription to indulge in high sugar paleo treats but it does mean that you should be eating a portion of starchy carbs with each meal and not restricting your overall carb content below 100-150g/day.

In my practice, I often see women who limit their carbohydrate content and replace the lost calories with additional protein. Perhaps this is kick back from the low fat craze of the 90’s?  Gals, please, don't do this! Several studies have found a strong association between a pregnancy diet that was low in carbohydrates and high in protein with elevated cortisol levels (the stress hormone) and blood pressure in the infant. What’s even more interesting is that these markers of stress were still found in these children as they grew past the age of 10. Theoretically, unbalanced high-protein, low-carbohydrate diets in the second and third trimesters may stimulate the hypothalamic-pituitary-adrenal axis in the mother, increasing maternal cortisol levels, exposing the fetus to excessive cortisol in the womb and programming the infant for lifelong hypersecretion of cortisol.

From an interesting ancestral perspective, this paper explores the eating strategies of ancestral human foragers during seasonal periods of food shortage. Researchers found that human foragers, when possible tended to under-utilize foods that were high in protein, such as lean meat, in favor of foods with higher fat or carbohydrate content. Nutritional studies suggest that one reason for this behavior stems from the fact that pregnant women, particularly during times when their total calorie intake is marginal, may be constrained in the amount of energy they can safely derive from protein sources to levels below about 25%-30% of total calories. Protein intakes above this threshold may affect pregnancy outcome through decreased mass at birth and increase the risk for infant morbidity and mortality limiting the growth and health of the tribe.

 Another key problem with getting to much protein in your diet is that you often neglect other critical nutrients that are only found in fats. Ancestral tribes likely had an understanding of this and promoted a diet with rich sources of fats aid in the absorption of key micronutrients for pregnancy and good health including vit A, E, K and D. This is why I most often recommend a diet of 20-30% Protein, 30-40% Carbohydrates and 30-40% Fat. Try these macro’s and then tweak the fat and carbohydrate levels from there depending on individual needs and activity levels. You may find you do better with more fat or more carbs....learn to listen to your body's cues and you'll learn what feels right for you. 


Here are a couple of real life examples:

Susan is 25 wks pregnant with her first baby. She feels great and stays active. She walks, skis or bikes 1-2hrs a day, goes to crossfit twice a week (scaled workouts with a good coach) and does regular prenatal yoga. Susan likely needs a higher percentage of carbs in her diet because she is so active. She enjoys regular portions of yams, potatoes, winter squashes, occasional white rice and sweet vegetables like carrots and beets with each meal. She sleeps well and feels best when she eats around 40-50% of her calories from carbohydrate sources, 20% from protein and the remaining 30-40% from fats.

Kylie is 30 weeks pregnant. She also feels great but struggles with fatigue and cravings for sweets. Kylie had a hard time conceiving, had been diagnosed with PCOS, insulin resistance and is overweight. Kylie became pregnant after adopting a lower carb paleo diet and feels best when her blood sugar is regulated with a high fat, low carb diet. She walks regularly and practices both meditation and hypnobirthing visualizations. For Kylie, a diet with 15-20% carbs, 60% fat and 20% protein may work best. Kylie may also consider adding in some regular strength training to further assist with her insulin response.

What works best for you? What’s your fave second trimester food or recipe? Submit it and I’ll feature it on the site!