Prenatal Nutrition Basics: What Every Provider Should Know

dietician first trimester nutrition nutrition in pregnancy pregnancy prenatal vitamins registered dietician second trimester third trimester vitamins May 22, 2023

Dr. Sarah Lea is joined by Registered Dietician Noelle Martin to discuss the latest evidence around prenatal nutrition basics, how to approach a discussion about nutrition with your prenatal patients, and how to give tailored recommendations that go beyond the generic multi-vitamin.



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[00:00:50] Dr. Sarah Lea: Hello Noelle. Welcome to the Pregnancy for Professionals Podcast.

[00:00:54] Noelle Martin: Hi. Thank you so much for having me.

[00:00:56] Dr. Sarah Lea: Oh my God, I'm so stoked. This is our first podcast together in this [00:01:00] category. We've done a bunch for She Found Motherhood.

[00:01:03] Noelle Martin: Yes. So excited. Awesome.

[00:01:04] Dr. Sarah Lea: Are you okay to tell our listeners a little bit about who you are and what we're gonna talk about today?

[00:01:09] Noelle Martin: Absolutely. Absolutely. So my name is Noelle. I'm a registered dietician and I have three boys. I have twins and another little one. And I often think that my RD hat and my mom hat just combine in because I know what I know, obviously from school, from research. Also just learning along the way, what I didn't know and what I needed to learn. And the other thing is just working with moms and working with physicians and working with other allied health and it's amazing how much as a dietician that I think other people are aware of and then they're not. Yeah. So it's really exciting to get to talk about that. My twins were preemies. So I've lived in the NICU world. I dealt with infertility, so I've lived in that world. So just being able to walk [00:02:00] alongside parents and parents to be and walk alongside physicians and other allied health is just a really special part of my job.

[00:02:08] Dr. Sarah Lea: Yeah, I know. And you're so right. That lived experience that you have just helps you see from a completely different sort of frame or lens, right? And like you were saying, and we touched on this beforehand you, we presume that like people have similar knowledge to what we have. But we don't, I don't have the expertise that you have. And so before we started doing this work, I would be like, yep, prenatal vitamin. That's great.

[00:02:35] Noelle Martin: It's a start.

[00:02:36] Dr. Sarah Lea: It's a start. But you're gonna tell us a little bit more today about basic prenatal nutrition and what all pregnancy providers should know. And it's great even if you're a physiotherapist or a doula. Yes, you may get people coming to you with questions and just having a little bit of knowledge and avenues to point people to is hugely helpful.

[00:02:54] Noelle Martin: Absolutely. And I think one important place to start is just remembering the [00:03:00] individualization of where people are at. So we will have pregnant moms that come to us who have done like tons of Google research but haven't actually spoken with anyone.

[00:03:08] And there are some things on Google that are accurate, but there's a lot that, that we need to filter out. The other thing is depending on socioeconomic status something we may recommend may not be reasonable. So I think sometimes when we're asked a question as practitioners, There's a lot of pressure to give an answer, and the first step sometimes is asking more questions. And understanding where a person is at and being willing to refer as needed. But one thing we know is that a general prenatal, it's a nice coverall. We've got some micronutrients in there that can act as a bit of a top up, but some of them even interact with one another leading to lack of absorption for those. Mm-hmm. So just because it's on the label doesn't mean we're going to absorb it. We know that certain micronutrients can lead to [00:04:00] a lot of discomfort. They can exacerbate nausea that comes along with pregnancy. Sometimes someone just might be getting enough of many things in their diet, they're able to eat a lot. And so we just need to top up single nutrient supplements and be very intentional. So just really understanding where that person is coming from is important.

[00:04:18] Dr. Sarah Lea: Yeah, no, it's such good advice and I really like how you pointed out like socio-economic status because unfortunately a lot of these, supplements, nutrients, vitamins, are not necessarily covered by anyone's health plan. So it's an out-of-pocket expense.

[00:04:33] Noelle Martin: That's right. Yeah. Yeah, that's right. Pregnant is one that is a prescription. Yeah. So that's one that, it has potential but a lot of them aren't. And the other thing to remember as well is some nutrients, although we would like to see them taken in as a supplement on a daily basis, some are more important than others. Meaning if we have a fat soluble vitamin, for example, if we're trying to minimize cost for somebody, then we could say, okay, [00:05:00] let's talk about doing this one every other day. Whereas something like iron, we really need to think about every day. So when we are working within budget, being wise about what we could pull back on a little bit versus just having someone feel so badly that they can't afford it all, so then they do nothing. Leaving people in despair. Just asking more questions, understanding where someone is at, what they really need. Prioritizing, it's so important.

[00:05:25] Dr. Sarah Lea: Yeah. Yeah. So let's start with the basics, what is some solid nutrition that every pregnant person should look at having in their diet?

[00:05:34] Noelle Martin: So one thing we know is folic acid is really important ahead of time. We know that if someone's been on birth control, it's interfered with absorption. We also know that neural tube closes often before we even know we're pregnant, unless we've done IVF and you're just like watching so closely. But you usually, that neural tube is either closing or is already ideally closed and prior to pregnancy, we really wanna think about folic acid. Another one though that [00:06:00] isn't often looked at that much is choline. Yes, I just learned about this, it's a really important one, again, for neural tube development. Also for like overall just like brain development, cell development all throughout pregnancy. And we can get choline in the diet, but we don't often find that it's enough to support pregnancy the way we'd like to, right? So having eggs and soybeans and a lot of like meat you can get some choline, but not usually enough. So I usually recommend either a choline supplement. Or making sure if you're choosing a prenatal, that it's one that has choline in it, cuz they don't always. So we're looking at about 450 milligrams per day that we wanna see mom take in. And the amount of supplement needed will vary a little bit just depending on, if she's having three eggs every day then you're not supplementing, you don't need it as much. You still need some, but not as much as someone who says, oh I don't really, I don't care for eggs. Or I might have one a week or something like that. Having iron levels checked prior to pregnancy is [00:07:00] really wonderful because what happens is, as we know as practitioners, our blood volume changes, so suddenly the blood work during pregnancy doesn't actually tell us what we needed to know. So we typically recommend an iron supplement no matter what, knowing that most women either enter in close to anemic or enter into that place during pregnancy. So babies take iron from us, especially in third trimester, enough to have stores for four to six months.

[00:07:27] Dr. Sarah Lea: That's crazy.

[00:07:28] Noelle Martin: So they're taking, and taking. So we wanna make sure that we have enough for mom and to pass over to baby. And an interesting thing about nutrients is some of them we can see what we call catch-up growth. So calcium for example, is something where we really wanna make sure there's enough available, but if there wasn't for a little bit, we can see catch-up growth in terms of bone growth and development. With iron, it's not the case. So if baby hasn't had enough access to iron for a period of time, whether it be in [00:08:00] utero or after birth into like toddler or preschool years, so on and so forth that portion of brain development, it just can't happen quite the same. We don't see that catch up growth taking place. So it's a really important nutrient for moms to be taking during pregnancy for their own health and for baby's health. Problem is, it's super hard on the GI tract a lot of the time. So we find women who are like, I don't like, ah, my nausea is bad enough without this, and this makes it so much worse.

[00:08:31] So there's a brand that I know you're aware of, but not everyone might be, it's called Kid Star Nutrients and they have a very specific type of iron that is more absorbable, but it also is easier on the GI tract. So a lot of pregnant women that I work with, that's what I'll recommend to them is choosing choosing the Kids Star. There's a tasteless drop, there's a liquid, and there's tablets. And I laugh I, every time when I think of Kid Star, I think of the first time I tried it. I [00:09:00] don't know if you were this way, but I was like, okay, here we go. Cause every iron I had before that was so gross, right? And I remember tasting it and being like, Ooh, can I have more?

[00:09:10] Dr. Sarah Lea: Yeah, no, the liquid I, we have the liquid iron and it's, it's like palatable. It's, it's pretty good.

[00:09:14] Noelle Martin: Oh good. Yeah, and it's not dark, like it doesn't stain your teeth. Like it's just a beautiful supplement. So a really great way to have moms get enough for their own energy level, their own, mental status, all of that, and making sure that baby's getting enough, so mm-hmm, typically we recommend about 30 milligrams per day. If mom entered into pregnancy anemic, or if she is more likely to have low iron like chronically has, then we might up that up that a little bit.

[00:09:42] Dr. Sarah Lea: Yeah. And it's funny, I've actually read recently some recommendations that you do iron every other day because of the receptor saturation. If the receptors in the gut get too saturated, they down-regulate. Yeah. So if folks are having trouble keeping it in, that's another option too. Yeah.

[00:09:59] Noelle Martin: And [00:10:00] that is another option. Absolutely. Another big piece to that too is how much calcium they're consuming. So if mom's consuming calcium like all day every day, which is great for bones and teeth, but it interferes with iron absorption. So if we're very intentional and we're leaving that four to six hour gap, so two hours on either side of when we take iron, it makes a big difference in terms of whether you can then, span out and that's the case with most nutrients though. Mm-hmm. Right? Is we don't have to think about perfection every day. Yes. It's overall.

[00:10:34] Dr. Sarah Lea: Progress over perfection. Absolutely. And that's the reason when you were saying like, prenatal vitamins do contain iron, but they also contain calcium. Yep. Yep. What's the point? Question mark.

[00:10:47] Noelle Martin: Exactly. All the others in there, if you're looking for a top up of them, fine. But if you think about it like most people get enough B vitamins. If we're looking at someone who's experiencing a lot of nausea and we wanna supplement [00:11:00] with b6, we can be very intentional about that. If someone has low b12, they don't need a prenatal for that. Yeah. We need b12. So more just looking at that single nutrient, let's put investment of our money into the nutrients that we really aren't getting enough, through feed.

[00:11:18] Dr. Sarah Lea: Yeah. So we've touched on the importance of iron. Yeah. Folic acid, pre-pregnancy. No, we didn't talk about the different levels of folic acid depending on risk factors. So do you wanna briefly touch on that?

[00:11:30] Noelle Martin: Sure. So if typically we say about the 600 micrograms per day. If someone has had an issue with a neural tube defects in the past, often we go up to a thousand. So I don't know if that's what you're recommending in your practice. Yeah, that's typically what I recommend. There's been some buzz around tongue tie, lip tie, folic acid, that type of thing. So my response to that would be yes, there's research going on, and yes, we see a potential correlation to the fact that we [00:12:00] started to see more lip and tongue ties after the nineties when we started to see more of a push for more folic acid.

[00:12:06] So a couple things to think about. One is, are we just seeing them more because we're looking for them more? Is it just a happenstance that we actually and you know, figured both out at the same time, right? So it's correlation, not necessarily causation. But even if you extrapolated it, even if we had like perfect research done and we could say, yes, this is together, I would much rather deal with a lip and tongue tie than a neural tube defect. Yeah. Yeah. So we're, it's really not, like when questions come in, I validate mom for asking. Absolutely. If you've heard about this, I understand your concern, but here's the two things we're looking at. So even if someone out there is I'm not sure about this cuz of lip and tongue time, my encouragement would be, validate the individual because they're very anxious about everything right now.

[00:12:53] Yes. Validate it, but then educate Yeah. Of there's a huge difference. And we can work [00:13:00] with a lip and tongue tie or you can have it lasered, there's things we can do. Yeah. So definitely in terms of that, and I recommend for any, this is a hole for me in the DRI recommendation, to be honest with you, is it goes back down during lactation, not all the way back down, but a bit back down. Yeah. And we have women who are breastfeeding that could become pregnant again. Oh yeah. That's a good point. Like me, there's nothing, in the literature for the combination of breastfeeding and being pregnant. So if we have a woman who's breastfeeding and she's pregnant again, also we wanna up it to that 1000 because it would be 600 for pregnancy and there'd normally be 500 during citation. So we level that off at a thousand.

[00:13:40] Dr. Sarah Lea: That's a good one. And then, I don't know if there's still the chatter around this, but I remember you and I talked about this a few years ago. There was something to do with methylated folate versus folic acid, right? And all this buzz around what's natural and synthetic. Yeah. Are you able to speak to that a little bit?

[00:13:56] Noelle Martin: Absolutely. So the very top part of that is just to remember [00:14:00] that folate, which is in food, remember it, it ends in a t e, like I ate the folate, right? Is most absorbable. So hands down, cantaloupe, orange juice, anything we can get from food. Most absorbable. But we still wanna consider this supplement piece. And yes, some are genetically predisposed to not being able to absorb this synthetic form unless it's the methylated version. And so a lot of prenatal company, like a lot of companies offering a prenatal, are now putting that in. Because we don't know. We can't look at someone and be like, oh yeah, you're gonna need this type. So they're just like covering all. So if someone sees that sometimes long words, we look at it and we're like, I dunno what that means. Yeah. Is it safe? Yeah. Yes, it is. It's just a more observable form.

[00:14:44] Dr. Sarah Lea: Okay. So it's not, but the, I think I saw someone say the research was on folic acid, not on methylated folate. Is that right? In terms of the efficacy, one would presume that it would have the same benefit.

[00:14:58] Noelle Martin: I should speak. I forget. You can see [00:15:00] me.

[00:15:00] Dr. Sarah Lea: Oh, I can see you nodding yes!

[00:15:02] Noelle Martin: Know. Podcast. Yes. But we have more research coming out. It's just that previous when, like previously when they were doing all of the research for the DRIs this was years ago now, right? Yeah. Yes. So more research is being done to show the efficacy of the methylated, and then companies are following suit. Cause as soon as it's out there in the literature, then it gets into the media and makes a difference in what people choose.

[00:15:28] Dr. Sarah Lea: Oh, totally. It's just and it's just this so much once it gets out there and if we as providers don't have any information or background we can kinda be scrambling to offer advice, so that's really helpful.

[00:15:39] Noelle Martin: Absolutely. In fact, some women who end up with baby with neural tube defects, it wasn't necessarily because the folic acid wasn't there. It's sometimes because they couldn't absorb it. Yeah.

[00:15:50] Dr. Sarah Lea: Yeah. That's a good point.

[00:15:51] Noelle Martin: When we look at neural tube defects, sometimes it's because there just wasn't enough folic acid there or choline, like there's other nutrients too. Folic [00:16:00] acid really has taken the brunt of the attention, but there's other nutrients that are so important in there. But also sometimes it's absorption, right? So sometimes a nutrient can be there. It's the same with vitamin b12. We have this intrinsic factor in our stomach that we need, and older people don't always, yeah, have it and then they don't absorb as much.

[00:16:18] Dr. Sarah Lea: Yeah. That's really important to consider, especially because we are seeing the average age go higher

[00:16:22] Noelle Martin: Yeah. Another nutrient that doesn't get talked about very much. It's another vitamin is biotin. Oh, yeah. Yep. So we have some research to show that about a third of pregnant women, typically even with enough intake, they're not getting enough.

[00:16:38] Like even with intake, they're not absorbing it as well as we would like to see, and they're not necessarily getting enough through their diet to be able to service themselves and baby. It is found in most protein rich foods and some of the speculation around it is just like in that first part of pregnancy, that's often the top aversion. So maybe they dunno why their diet [00:17:00] previously, but during that short term, they don't. So interesting just to look at if protein rich food intake reduces, making sure that biotin is something that's either in the prenatal they're choosing, or a little bit of a single nutrient. We don't need much just 30 micrograms per day, so we don't wanna over supplement.

[00:17:18] Dr. Sarah Lea: Yeah. Postnatal, some prenatal. Have it question mark?

[00:17:21] Noelle Martin: Yeah, some prenatals have it, but it's, you know how like we talked a lot about folic acid and then it became normal and then we started talking about choline and it's still kinda like a buzz one, but becoming more normal. And biotin is one that we're talking about more now. So basically any nutrient that's really important in cell division and cell health and cell function. We need to make sure there's enough there. And so some research was done to say, you know what, we're actually seeing deficiency in about a third of these women who are halfway through their pregnancy. So did they just reduce their protein rich food intake, in that first trimester? And that's why were they already hard to say, but just 30 micrograms [00:18:00] per day. Not a ton. Yeah. But something to be aware of. Yeah, totally. To educate women about same with beta-carotene, it's so important in all areas of the body.

[00:18:12] So beta-carotene is it's an antioxidant on its own, but it can be converted to vitamin A. In the body. The beautiful thing about it is it will only convert the amount we need. So preformed vitamin A can be very dangerous for pregnant women to have too much of, whereas beta-carotene will only convert over what its needs and it's super important in development throughout the entire body. Like eyes would be a big one we hear about, but also in cell differentiation and function. So you will see that in prenatals, but my goodness, we know time and time again that pre, like any supplement form of beta-carotene pales in comparison to sweet potatoes and butternut squash and carrots. Like we just really ideally wanna look for this through food.[00:19:00]

[00:19:00] Dr. Sarah Lea: Yeah. Yeah. It's so important, right? And I think you said it at the beginning, like sometimes most, some people can get everything they need through their diet alone.

[00:19:08] Noelle Martin: Most things. Yeah. I would say like iron, folic acid, vitamin D, those would be the top ones that I get concerned about diet, just not being enough. Yeah. During pregnancy, choline would be in the air as well? Yeah, depending on intake. D H A is a form of omega-3 that's incredibly crucial for optimal brain development. Can the brain develop without as much. Yes. But we know that the groundwork for the brain development starts in utero all the way through to beginning of grade school years, and then, the brain can blossom throughout life. Beyond that. So we really want to give babies the best shot from day one. So if mom's having a fatty fish a few times a week, great. But I don't know about you, but I had a huge fish aversion during pregnancy. I was like, no, I cannot handle [00:20:00] this. Yeah. So something like, there is a, there's a DHA supplement that, oh, I'm trying to remember the name of it right now. It's escaping me. I'll think of it. It's a liquid, it's like a mango peach smoothie. Oh. And it's awesome because there's no, like fish after we can put it in the show notes, there's no fish aftertaste. It's there's other ones on the market that are super high quality and amazing, but being realistic about what a pregnant person with some aversions can handle, it's often the one that people go for.

[00:20:30] Dr. Sarah Lea: Yeah. Yeah. Okay, so I'm gonna review. We've talked about folic acid, iron choline, biotin, DHA. What about vitamin D?

[00:20:42] Noelle Martin: Really important. Really important. So we know that vitamin D has been long praised for its importance in absorption of calcium and bone health. And it's not to minimize that because it is very important, but top of my mind for vitamin D is really development of the immune system along with many [00:21:00] other things. But that's something it doesn't really get the attention it deserves for. So it is fat soluble. So again, we don't need it every single day, but we know pretty much 80% of the body has to be exposed to sun for 20 minutes for the body to make what we would need as a non-pregnant human being. Yeah. Soon as we're pregnant we need more and we don't really want the damage to our skin. Or it's too cold out. No. Depending on time of year. So going with a supplement is really great for that. And we wanna aim for about a minimum of 600 international units a day, but often go up to the thousand quite easily. You're not even close to going overboard if entered into pregnancy with a deficiency. We're talking probably more than that too.

[00:21:46] Dr. Sarah Lea: Yeah. I know. I just tell everybody to always take vitamin D.

[00:21:49] Noelle Martin: Oh yeah.

[00:21:50] Dr. Sarah Lea: Forever and ever. Amen.

[00:21:52] Noelle Martin: Absolutely. And there's tasty ways, right? There's like droppers, there's sprays. You can get it as part of you could do [00:22:00] a calcium vitamin D combined. There's so many ways that, one thing I would say though is, also to have awareness to raise awareness with moms who do start grabbing these single nutrient supplements that they're not always single nutrient. Yeah. So if you grab a DHA and a calcium, there's probably vitamin D in both of those. So just having an awareness of where everything is coming from.

[00:22:23] Dr. Sarah Lea: Yeah. Yeah. It can get overwhelming.

[00:22:26] Noelle Martin: It can, which is why sometimes people just go back to the multi vitamin, like one thing.

[00:22:31] Dr. Sarah Lea: Yeah, totally. Any other key nutrients that we haven't touched on? That sort of basic, it's good for providers to know and ask about.

[00:22:38] Noelle Martin: I think that if someone is suffering from a little bit of insomnia or trouble sleeping, having magnesium before bed can really help. And again, we're not going overboard, so we're not going to worry about an electrolyte imbalance. Yeah. Like just to, pretty calm. So I really like the raspberry lemonade version of natural calm. It's literally just magnesium in a powder that you can mix with [00:23:00] water. It's a nice warm drink. So if mom's complaining of some insomnia or discomfort or trouble getting to sleep, that can be, you could just take magnesium, but there's something about just the warm drink that's quite lovely.

[00:23:11] Dr. Sarah Lea: Yeah. Yeah. It almost adds to the ritual and the routine.

[00:23:14] Noelle Martin: Exactly. Yeah. And whether there's a little bit of placebo effect there doesn't really matter. No, totally. It's if mom can get to sleep, thumbs up. Yeah. Awesome. Yeah, don't, what are the main ones?

[00:23:25] Dr. Sarah Lea: Yeah, and I was gonna say, can we touch on vegetarian and vegan, like any additional things that you might wanna think about? Because where I am on the west coast, we have a lot of folks that have those dietary lifestyles.

[00:23:37] Noelle Martin: Absolutely. Top one. Many of the ones we've already spoken about, correct? Yeah, sure. Become even more important. Not more important, but you might need more of them. Yes. Because you wouldn't be just supplementing the diet. You may not be getting any in the diet. But one would be zinc. Ooh. It is one is really important in cell division and function and that type of thing. So pregnant women need about 11, [00:24:00] 12 milligrams per day of zinc. And if we have a lot of protein in the diet, we don't really worry too much. But I would be concerned. And it's too, it's one of those like trace minerals, like iron where it just gets bullied out by some of the major mineral absorptions, like calcium, right? So we also know that depending on if there's like a ton of milk in the diet, even if mom's not vegan, but they're vegetarian, but have a lot of milk, cuz they're getting a lot of their protein from there, it can interfere with the absorption of things like iron and zinc. Soy interferes with the absorption of zinc. So that's why for vegan women who are pregnant and they have a lot of soy in their diet, I become very concerned about zinc then. Okay. And the supplementation becomes even more important. For vegan sometimes calcium, but not always. It's just this assumption that as soon as we exclude, cow or goat milk from the diet, that we're going to be looking at a calcium deficiency. And that wouldn't always be the case if we have a fortified milk available, if there's, green, the green leafy vegetables, there's almonds [00:25:00] sometimes it's enough. The in the amount that calcium of calcium that's recommended during pregnancy does not increase. Oh, interesting. The same, yeah. Ok. We increase our absorption.

[00:25:10] Dr. Sarah Lea: We're so amazing, aren't we?

[00:25:12] Noelle Martin: Yeah. Yeah. And so it's, it is, it's very cool. However, when, as soon as we say the recommendation doesn't increase, it's very easy to translate that into, I don't need more than I was having, but someone might not be having enough. So as much as the recommendation doesn't increase, sometimes we still do need to level up. Yeah. So something, a calcium liquid or chew is actually what I would recommend. So something like a caltrate, because it's the most absorbable. As soon as we put calcium into a pill, it's not necessarily spending enough time to be broken down in the stomach.

[00:25:47] Dr. Sarah Lea: Oh, interesting. That's good to know.

[00:25:49] Noelle Martin: That's the other issue with a lot of these prenatal as well, and just multivitamins in general. If you think about the amount of time that it can sit in the stomach acid versus what it needs to actually break [00:26:00] down. Just because the nutrient is in there doesn't mean you have access to it. Whereas when you look at single nutrient supplements, they're usually much smaller or in the form of a liquid, and therefore we're able to absorb them better.

[00:26:11] Dr. Sarah Lea: Yeah. Yeah. It's so important to consider like that, especially if you have unique dietary requirements or some restrictions, like getting a little bit of extra support in pregnancy...

[00:26:21] Noelle Martin: Absolutely. And if someone has like celiac disease or a dairy allergy, right? There's things where certain parts of the diet are just excluded or they may have had damage to their GI tract as part of that, and so don't absorb quite the same. So definitely lots of things to consider and important. Again, going back to beginning remark of ask more questions first. Yeah. Because if you just have someone say, how much iron do I need? That depends on a lot of things. Help me understand like what's your iron status prior to pregnancy and what type of iron-rich foods are you eating? How much milk or tea are you [00:27:00] having in a day? There's so many questions to ask before we just give that plain answer.

[00:27:05] Dr. Sarah Lea: And then one more thing, I think we touched briefly on b12. Yeah. And so for the general population, like someone who has a full diet, we generally have...

[00:27:15] Noelle Martin: Typically we don't. Yeah. Typically we don't see a deficiency there. But if someone is vegan, then sometimes we do. There's a lot of like foods that are created to help to, for vegans to consume that are now B12 fortified. Oh, I didn't know that. Yeah, like you'll find, textured vegetable protein, B12 fortified, you'll find vegan milks, B12 fortified. Like you'll find that whether it's enough or not. Again, just depends on intake. So that's an important thing for an assessment. Typically though, when it comes to b12, if we have someone who's vegan, even if they're taking those foods in, we offer them a supplement, they're not gonna go overboard cuz the supplements aren't, Yeah, of huge quantities. Yeah. So that would [00:28:00] be definitely one to consider as well. Anything where we get most of a particular nutrient from anything animal-based, especially if it's like meat, right? Then we would obviously wanna be considering a supplementation there. In terms of actual protein, we just wanna make sure that the education is there for complete proteins. Yes. Making sure that they're getting enough. But if they've been vegan for a really long time and they're used to that, it's probably okay. But not something we wanna risk. It's very important.

[00:28:33] Dr. Sarah Lea: Yeah. And that's what is it? Quinoa? Is quinoa a complete protein?

[00:28:36] Noelle Martin: Quinoa is a complete protein. Soy is a complete protein. Yep. Hemp parts and chia seeds are top of my list for recommendations, like three tablespoons of hemp hearts and you've got 10 grams of complete protein. Wow. So that's really easy to add throughout the day. Salads, cereals. Smoothies. And chia pudding. That's a fun thing to do with kids.

[00:28:55] Oh yeah. Oh yeah. Chia with the plant-based milk and then it gelled up over the course of a [00:29:00] day.

[00:29:00] Dr. Sarah Lea: Oh yeah. That's fun. I should do that. Cause I have both of those in my fridge right now. Yeah. Amazing. Yeah. Amazing. And now do you mind now we are not, connected to one brand or another, but just maybe sharing with us some of your sort of go-to recommendations in terms of like prenatals and certain you've mentioned a few, but it's just nice for folks to know when we get asked to have a well known and not, I don't know what the right word is, but a safe self reputable, reputable, that's the word. Thank you. Yeah.

[00:29:30] Noelle Martin: Yes. So I typically. Steer away from some of the ones that might come to mind very first. Because we're looking for companies that are, that specialize in this area, that have thought through the process of what's going to be most absorbable and what to combine. So granted, we're going to see iron and calcium in there together. We're just gonna take an iron supplement on top of it. We basically have to say if there's iron in the prenatal, pretend there wasn't, because you're not gonna. That is really what it comes [00:30:00] down to. Yeah.

[00:30:00] Dr. Sarah Lea: So scratch it off, take a Sharpie and write, scratch it off.

[00:30:04] Noelle Martin: Exactly. It did, it doesn't exist. Yeah. Kids Star nutrients is fantastic. I really love their prenatal. I love their whole product line, to be honest with you. Yeah. There's a brand-

[00:30:14] Dr. Sarah Lea: It's a mom based out of Vancouver, that company.

[00:30:17] Noelle Martin: Yes. Oh, cool. So Caitlin, like she has three girls and one was deficient in iron and she was like, there's nothing on the market that I'm interested in giving my child, so I'm going to create it.

[00:30:27] Dr. Sarah Lea: Amazing.

[00:30:27] Noelle Martin: And then it just went from there. Yeah, she's pretty incredible. There's a brand called Needed. Okay. They have a really nice prenatal. Garden of Life is a Canadian brand that has a really good lineup in general. But they're prenatal I like. New Chapter is a good one. Mega Food Canada, NF8 is another one. I really like a lot of their products actually. And then there's a liquid one called Pink Stork. Oh, like the name, try a liquid. Pretty cool, right? Yeah. In terms of [00:31:00] DHA, the OmegAvail, that's the name I couldn't think of earlier. Okay. So it's like a peach mango smoothie. So that's a really great one. You don't have to put it in a smoothie. I had a client once, so I thought it had to always go in a smoothie. It just, it's just called a smoothie. Oh yeah. So you just like a tablespoon of it. Yeah. Um,

[00:31:16] Dr. Sarah Lea: Smoothie on a spoon!

[00:31:18] Noelle Martin: Yeah, exactly. That's what it is. Nordic Naturals has a really nice prenatal DHA and Aqua Omega is a company out of Toronto. I love the way they source their omega, so that's usually top of my list. So they have a liquid and they also have gummies and capsules. They have the three options there. So if I didn't name one, it doesn't mean they're not good. Yeah, these are just some of the top ones. I typically recommend. We have some other really great brands out there...

[00:31:44] Dr. Sarah Lea: where like a good starting and you can always reach out to Noelle. She's accessible on Instagram. Yeah. To answer questions. And then do you have any recommendations for vegan prenatals or vegan supplements that folks might need?

[00:31:58] Noelle Martin: Yeah. Some of those. [00:32:00]

[00:32:00] Dr. Sarah Lea: Mary Ruth's was the name. That was...

[00:32:02] Noelle Martin: Mary Ruth is a good one. Mary Ruth's Organics. Yeah. For sure. And for DHA although we always say fatty fish algae actually has DHA in it. So these lines do have like a plant-based version.

[00:32:16] Dr. Sarah Lea: Okay. That's great. So what we'll try and get all of those linked in the show notes for folks. We'll get our amazing podcast producer to get all the links from you. Yeah. Okay. So thanks Noelle that was a great overview. We just talked about like basic nutrition to think about, understanding to get information from folks before you give a generic response. Yes. And to to make sure you consider the whole diet. Yes. Not just and particularly I always think of calcium when it comes to that.

[00:32:44] Noelle Martin: Yes.

[00:32:45] Dr. Sarah Lea: We make a blanket recommendation, but we, most of us have a significant amount of calcium in our diet.

[00:32:50] Noelle Martin: Absolutely. The one other thing we actually haven't talked about, it's not a micronutrient, but it's something that I'm not sure practitioners focus on as much as we could, is that the baby's micro [00:33:00] flora, like their gut. Yes. It starts in utero. Ooh, interest. Okay. Yeah. So there's some controversy around whether a probiotic should be taken in first trimester because of the immune shift that goes on in that first trimester. So we'll set that aside. It can remain its controversy, but from the beginning of the second trimester on, I definitely recommend a probiotic and it can be a cycled one, like two weeks on, two weeks off, or three weeks on, one off, or 10 days, 10 days. It doesn't have to be every single day, but I definitely recommend that mom work on gut flora in order to allow baby to be born with the ultimate that they can of microflora. We also know it's affected based on birth. So when baby is born vaginally, their microflora is very similar to mom and when they are born via C-section, then there's a little bit of a change, like a shift there cuz of the slight exposure to skin and so on, and just everything that goes on with that. And so then we consider, something like a BioGaia to be very, I very impactful, [00:34:00] like a three drops a day in terms of reducing reflux and just helping baby build that microflora up. But we do know that it starts in pregnancy.

[00:34:06] Dr. Sarah Lea: Interesting. Can we do a whole podcast on that?

[00:34:09] Noelle Martin: Sure. I love talking about gut health.

[00:34:11] Dr. Sarah Lea: Right. And we could also talk about GBS and, yes. Oh my gosh. Okay. We'll put a pin in that discussion, but I love that consideration. And we'll do another whole podcast about that because yeah, I think it deserves a lot more exploration and I'm curious to learn more about that too.

[00:34:27] Noelle Martin: Awesome. Sounds good.

[00:34:28] Dr. Sarah Lea: Thank you so much, Noelle, for joining us today and for imparting your wisdom. It is always a pleasure.

[00:34:33] Noelle Martin: Thanks for having me.

[00:34:35] Dr. Sarah Lea: Oh yeah. And can you tell folks where they can find you if they want to learn more from you?

[00:34:38] Noelle Martin: Sure. Yes. So our company is called Nourished Beginnings, and you can find us on Instagram. We have Nourished Beginnings Pregnancy, Nourished Beginnings Kids, and Nourished dot Women. You can also come chat with me over at Motherhood and Meals, so I'm a few different places.

[00:34:57] Dr. Sarah Lea: Yes. And we'll link all those in the show notes as well. [00:35:00] Amazing. Thanks Noelle!

[00:35:02] Noelle Martin: Thank you.


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