Doctors For Nutrition's co-founder Dr Heleen Roex explains how a well-planned plant-based diet from pre-conception onwards sets your child up for a long and healthy life. Article first published in Nourish Magazine, August 2019.
Addendum, October 2019: Doctors For Nutrition support our Belgian colleagues who have set out the evidence on the safety of plant-based diets in pregnancy and childhood, and provided a rebuttal to the Royal Academy of Medicine of Belgium's guidance warning to the contrary. The response, which is co-signed by Dr Heleen Roex-Haitjema on behalf of DFN, can be read at reponsearmb.com.
A healthy start All parents want to provide their children with the best possible start in life, and pre-conception is the ideal time to establish health-giving conditions for a pregnancy. Spoiler alert: a plant-based pregnancy can be just as safe as any other and can be an even healthier start for bubs.
Parents-to-be who follow (or are considering following) a plant-based diet may sometimes feel uncertain about their decision, and particularly when it comes to ensuring a healthy pregnancy and baby. This sense of trepidation can be intensified by well-meaning family, friends and even physicians who may question this choice. As a paediatrician and a mother of three, I’d like to clear up some of the confusion so you can make an informed decision for you and your soon-to-be bundle of joy.
Science supports a plant-based approach
Most concerns usually stem from questions about whether you’re getting enough of this nutrient or that nutrient and, with the growing volume of reputable evidence-based resources available now, it’s never been easier to do your own research. Some background reading combined with support from a suitably-qualified healthcare professional can enable those considering starting – or growing – their family to feel confident that following a healthy plant-based lifestyle is safe for both mother and baby. The good news is you have the best available nutrition science on your side!
In 2016, the US Academy for Nutrition and Dietetics released a Position Statement confirming that appropriately planned plant-based diets are healthy and nutritionally adequate for all stages of life including pregnancy, breastfeeding and early childhood. The official Australian Dietary Guidelines have also endorsed healthy vegan diets since 2013. This should immediately put to rest all the common misconceptions about animal products being necessary to supply sufficient iron, calcium, protein and so on. And, as more studies are conducted, it becomes ever clearer that diseases related to lifestyle choices respond very favourably to a switch to a whole food plant-based (WFPB) diet and this also applies to pregnancy.
The good news is you have the best available nutrition science on your side!
A caution for traditional diets
What might be shocking for people who follow a traditional diet is that the beginnings of heart disease can be detectable in a baby’s arteries even while still in the womb. Fatty streaks in the aorta of a foetus can be attributed to high cholesterol levels in the mother’s blood. Solid scientific studies have however demonstrated that a WFPB diet can prevent and even reverse heart disease in most cases. For many people, the same applies to the global epidemic of type 2 diabetes, autoimmune diseases and many other chronic conditions. So, rather than questioning whether animal products are necessary during pregnancy, let’s for a moment turn the concern on its head and instead ask the question: How safe is a diet based on animal products during pregnancy?
Many complications in pregnancy are linked to lifestyle diseases where animal products are a major contributing factor. For example, pre-eclampsia is linked with hypertension, a lifestyle disease prevalent in societies with a typical Western diet high in animal-based and processed foods. A study has shown that pre-eclampsia (where pregnant women can develop high blood pressure, fluid retention, and protein in the urine) occurred only once in 775 pregnancies in subjects who avoided animal-based foods. For comparison, in Australia where the typical Western diet is the norm, the prevalence of this condition is around 1 in 33 pregnancies. Pre-eclampsia can lead to eclampsia, a complication that involves damage to other organ systems such as the kidneys, and can be life threatening for mother and child.
Gestational diabetes is also closely linked to eating animal fat, red meat, eggs, cholesterol, as well as to low fibre intake. Remember, cholesterol is found exclusively in animal products and they do not contain any dietary fibre. A well-designed study from 2015 compared omnivores, different kinds of vegetarians and vegans. It showed that the more plant-based people were eating, the less obesity occurred and therefore the less risk of gestational diabetes. It is important to note that obesity also decreases fertility and increases the risk for many complications during pregnancy and delivery.
Are supplements necessary?
The standard advice for pregnant women in Australia, regardless of diet, is to take a supplement with the particular vitamins and minerals that are important for the developing baby. For women who choose to forgo this supplement, there are some nutrients that need attention to ensure adequate intake.
First of all, let’s talk about vitamin B12. This essential nutrient should be supplemented by anyone following a plant-based diet, whether pregnant or not. It might surprise you to learn that this is not because animal products are the only source of B12. In fact, vitamin B12 is made by soil-bacteria and thanks to modern sanitisation, we no longer reliably ingest it through our food or water. Even animals on modern farms have their feed supplemented with vitamin B12! So, eating a plant-based diet and taking a supplement is actually a more direct way to meet your needs. The vital takeaway here is that people following plant-based diets should ensure consistent, adequate B12 levels through supplementation. The recommended dosage is either 250 micrograms every day, 1000 micrograms twice a week, or 2500 micrograms once a week. Dosage is not linear due to the way it is metabolised. Be aware that the typical pregnancy supplement provided in Australia has only 2.6 micrograms per tablet, so an additional B12 supplement is required.
Iodine intake also requires special care during pregnancy and lactation. Low iodine levels can cause congenital hypothyroidism. This means that the baby is born with a condition where the level of thyroid hormone is too low. If left untreated this can lead to developmental and growth problems. The recommended daily intake of iodine is 150 micrograms for adults, 220 micrograms during pregnancy, and 270 micrograms while breastfeeding. Seaweed is a good source of iodine, especially dulse, wakame and nori. I recommend avoiding kelp (also known as kombu) as its iodine levels are too high, and also hajiki, which is high in arsenic. With regular consumption of seaweed, tablet-based iodine supplementation can be lowered.
Vitamin D is crucial for many metabolic processes in the body. The most natural way to get this essential vitamin is through direct exposure to sunlight. Also, plenty of plant-based milks, cereals and tofu products are fortified with vitamin D. I recommend having your vitamin D levels tested before deciding if you need to supplement.
Omega-3 fatty acids are important in the development and maintenance of the brain, retina, and cell membranes. Good sources of omega-3 include ground flaxseeds, chia seeds and walnuts. Those following a whole-food approach can ensure a good ratio of omega-3 to omega-6 by avoiding added oils and processed foods which are high in omega-6, and not going overboard in their consumption of nuts, seeds, avocado, olives and other high-fat whole foods. However, for pregnant and breastfeeding mothers who do not stick closely to a low-fat WFPB diet, I advise taking a low-dose (around 250 milligrams) DHA+EPA supplement.
Certain key nutrients require special care during pregnancy and lactation
The foundation of a healthy life
It wasn’t until my own children were out of high school that my husband Alphonse (an obstetrician/gynaecologist) and I stumbled upon information about the health benefits of a WFPB diet. What a shock it was to discover that there was such an easy, affordable and safe way to treat so many chronic diseases! Why had we not been taught about dietary interventions in medical school? In fact, our daughter Juliette had less than two hours of lectures about diet in her entire medical degree, and nothing about the benefits of a plant-based approach. This is a major shortfall in our local and global education system I hope can be changed through the work of organisations such as Doctors for Nutrition. I passionately believe everyone has the right to be informed about nutrition and its far-reaching consequences for our health. My whole family made the switch to a plant-based lifestyle over 8 years ago after learning about the vital role of diet in health. We’ve delved into most of the research over this time and the science consistently confirms that we made a sound choice.
I passionately believe everyone has the right to be informed about nutrition and its far-reaching consequences for our health.
Families and parents can be reassured that a WFPB diet is a healthy foundation for both mothers and children, and fathers too for that matter! As a paediatrician, I believe this way of eating is preferable during pre-conception and pregnancy, and then for all stages of life from childhood right up until a ripe old age!
More about the author
Dr Heleen Roex is Doctors For Nutrition's co-founder and Executive Director.
Read her full bio here.