How to choose a good Prenatal Vitamin

One of the most common questions I get from readers and clients is, "What prenatal vitamin should I choose"?  I've avoided answering this question for a while because it's hard to give specific brand name recommendations when there is so much to choose from and product availability varies tremendously depending on where you live. That being said, this week I'm going to offer a launching point for women. You'll find a much more in depth answer to this question on Baby Making and Beyond but for now, here's a great place to start. 

Why do I need a Prenatal if I have a tip top diet?

This is a great question. Some women do decide not to take a prenatal combination, which is cool, but there are some things that are important to consider:

- Pregnancy (and while breastfeeding) is a time with increased, some might say insane, nutrient demands. We quite simply just need, LOTS of essential micro nutrients to support the body's process of creating a new life. Most diets, even the best, can't provide all you need. The good news is that most of the time your baby will get what he or she needs by depleting you of nutrients. If you aren't replenishing your stores, you can, and will become deficient. This is especially true if you are having multiple babies  2-3 years apart or less.

If only all farms could look like this :) A view from a home visit a few years back.

If only all farms could look like this :) A view from a home visit a few years back.

- Soil and food quality just isn't what it used to be. Even the cleanest of diets won't provide all of the nutrients you need for optimal fertility and pregnancy. The carrots our grandparents ate are not the same as the ones we find in the grocery store today, even the organic heirloom rainbow ones. A Scientific American article looked at several different studies which demonstrated time and time again that from 1975 to 1997 average calcium levels in 12 fresh veggies dropped by 27%, iron levels by 37%, vitamin A by 21% and vitamin C by 30%. 

- The stress of our modern busy lives and athletic pursuits depletes all of us of essential micronutrients. Stress and high cortisol will drain you of several critical fertility and pregnancy nutrients like B- vitamins (including folate), vitamin C, zinc and magnesium. 

- If you've are a recovering vegan/vegetarian, have had a history of food restriction, over exercise or spent much of your life (like most of us) eating a standard american diet, you are nutrient depleted. It takes many years to correct these imbalances.

What to look for in a Prenatal Vitamin

- Steer clear of drugstore or mainstream brands of prenatal (centrum, costco ect). They are made with synthetic vitamins that are not well absorbed or utilized well by our bodies and may even be harmful. For example, synthetic vitamin E can cause congenital heart defects in babies and DNA damage in mamas. 

My top pick and 100% Baby Making and Beyond approved

My top pick and 100% Baby Making and Beyond approved

- Look for a brand that lists Folate (5- methyltetrahydrofolate) not "folic acid" especially if your have or suspect you have MTHFR or other methylation issues as you won't be able to utilize the synthetic form of this B-vitamin. While high dietary FOLATE is associated with a reduced risk of breast cancer,  a high rate of FOLIC ACID consumption or supplementation has been suspected in promoting the progression of breast tumours in some women and can reduce the expression of beneficial tumor suppressor genes while increasing the expression of HER2 (breast cancer promoting genes). High dose folic acid supplementation can also mask B12 deficiency which could put you at risk for preterm labour. Baby Making and Beyond will have lots more on this critical difference. Folate must be sourced from real food so a "raw or whole food" like brand will usually have folate not folic acid in it. 

- Look for the inclusion of both Vitamin K1 and K2

- Has a combination of Vitamin A from BOTH retinol and retinol palmate (Learn the details about why this is in Baby Making and Beyond) and talk to your provider about elevated or reduced need for vitamin A

- Look for choline in your prenatal  

- Look for synergistic combinations of vitamins with cofactors to aid in absorption and assimilation. These may include fruit powder extracts, enzymes or herbs.

- Ensure they don't contain soy, gluten or dairy and look for 3rd party testing and verification. 


Meg the Midwife's Favourite Prenatal Vitamin

NUMBER ONE VERY BEST: Seeking Health Optimal Prenatal - Not cheap but awesome ingredients and a correct blend of vitamin A sources. If you have low iron, this is pretty much the only thing that is missing.

Innate Response Baby and Me.  I love the ingredient list and in my mind this company is legit. This is a new formulation as of 2016 and it works great for the entire childbearing cycle (aka prenatal-postpartum)

If you’re too nauseated to stomach a prenatal

This happens and don’t worry, there are some options:

Seeking Health Protein Powder: This is my ideal choice. It can help stave off nausea with its high protein content and gives you all the nutrients you need. Great for Vegans.

Seeking Health Chewable: Same formula (more or less) as the Optimal Prenatal capsule but chewable

Smarty Pants Prenatal- For women who have lots of nausea and can't stomach a traditional prenatal vitamin OR who are sensitive to iron (this is iron free). If this is all you can get into you, it's a good option until your nausea clears.

Runner Up:

Thorne Basic Prenatal. Thorne's Basic Prenatal provides the active forms of folate (5-MTHF) and vitamin B12 (methylcobalamin) for optimal tissue-ready use. Basic Prenatal also contains well-absorbed iron bisglycinate, which meets a pregnant woman's increased need for iron while being easy on the stomach and non-constipating. Several of Basic Prenatal's ingredients (including vitamin C, vitamin B6, and vitamin K) have been demonstrated to benefit "morning sickness." Basic Prenatal is manufactured with the purest possible ingredients and without the additives and coatings usually found in mainstream prenatal supplements. This supplement doesn't contain K2 so it's important that you get your K2 from your diet or from another supplement. 

Vitamin Code Raw Prenatal- This one is significantly more affordable than some of the others and has some decent ingredients. If budget is a concern for you, I'd stick with this one. 

Knowing what supplements to take during pregnancy can feel complicated. Prenatals are a good place to start but in order to optimize your health, you may benefit from taking a few other things (such as calcium, DHA ect), it's best to talk to your functional medicine practitioner about this or become one of my wellness clients and book your consult today.  


Supplementing your Paleo Pregnancy

My post this week was inspired by a question from a reader wondering what supplements she should take during her Paleo pregnancy.  As always, I'm happy to answer questions and sometimes, like today, even elaborate a bit further. I hope you enjoy!


Does your supplement basket overfloweth??

More is not always better!

I do a comprehensive health history with every woman I see. Part of this process is asking what supplements she's taking.  I often see women with a laundry list of supplements a mile long! It seems both insane and totally overwhelming to both them and me! Unlike with chocolate, when more is always better, supplementing with high doses of vitamins and herbs is not always the best approach.

If you have a care provider than can test your levels of certain vitamins and minerals such as Vit C, zinc, Vit D, calcium ect then you will have a pretty good guideline on what and how much and what you need to supplement.

Vit D serves as a pretty good example. For the past 5 years, I’ve universally been recommending that all pregnant women should supplement with a minimum of 5000IU of Vit D. I frequently test women’s levels at the beginning of pregnancy; many are deficient, according to the lab reference ranges, which has supported my recommendation. However, new research suggests that optimal vit D levels may be much less than what was previously thought and may fall within the lower limit of the reference ranges.  In response to this, I now base my supplementation guidelines on a client's individual levels, exposure to sunlight, risk for type 2 diabetes, dietary consumption of vit K/A/D and cultural practices (is her face or body covered  for most of the year). Chris Kresser has a great podcast episode summarizing some of these new Vit D guidelines that's worth a listen. 

You are only as good as what you can absorb

Even if you consume a balanced Paleo diet of nutrient dense foods, we are only as good as what we absorb. Stress, sub-optimal sleep, poor digestion and inflammation can all affect the absorption of nutrients from our healthy diets. You can supplement all you like but if you don’t absorb what your taking in it’s literally like throwing money down the pipes. You can from your diet and your supplements:

Here are a few tips to ensure you’re maximizing nutrient absorption:

  • Take iron supplements like Floridix or Inate Iron Response with a food-containing vitamin C. Berries, colourful peppers or cauliflower are great choices. Take away from anything containing calcium such as dairy. Calcium blocks the absorption of iron.
  • Consume fat-soluble vitamins with some fat.
  • Consume vitamins/minerals with food and amino acids or probiotics on an empty stomach.
  • Ensure your digestion is at its best. Chew your food slowly and consider a high potency probiotic or consume grass-fed Kefir daily to help your gut flora flourish.

Try to get the bulk of your nutrients from whole food sources

  • Vit A/B’s - Organ meats like grass-fed beef or lambs liver 1/ wk.
  • Vit E- Organic Red Palm oil 3 times/wk.
  • Choline/Vit D- Egg yolks daily
  • Calcium/Vit D/omega 3- Sardines or other fatty bony fish 3/wk.

Consider supplementing wisely

  •  Fermented Cod Liver Oil or even better, if dairy is tollerated, Cod liver oil butter oil blend
  • Vit K2
  • High quality Probiotic like Inate Women's balance
  • A clean, high quality prenatal vitamin with folate. Watch for “folate” or “tetrahydrofolate not “folic acid”, which is an artificial chemical that can be converted by the body to folate.  Always read the labels and ensure that your vitamins are sourced from real foods and contain enzymes to aid in absorption and assimilation.
  • Extra Vit B6 if you are experiencing nausea
  •  Floridix or Inate Iron Response anemic or at risk for anemia (carrying twins or still breastfeeding)  

Have more questions…feel free to send me a question! Always happy to help you navigate your healthy Paleo Pregnancy.