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Confessions Of a Pregnant Nutritionist

In my years as a nutritionist in private practice, I have created dozens of picture-perfect meal plans for my pregnant clients. My mom-to-be menus had all the right elements and ideal amounts of vitamins and minerals, all wrapped up in the appropriate number of calories. I always figured that, when my turn came, I would have it all together. Ha!

When I was pregnant, the gods must have laughed as my idea of perfection was thrown out the window. I quickly learned firsthand what it's like to contend with the all-consuming forces of morning sickness, a raging appetite, and powerful cravings. It's amazing how your perspective changes when it's your own swollen feet walking a mile in those pregnant woman's shoes.

That's not to say that during my pregnancy I scrapped all my knowledge about good prenatal nutrition. Of everything you feel during pregnancy, the desire to have a healthy baby and to stay healthy yourself ranks highest. But I certainly had a lot to learn about what getting through morning sickness, conquering cravings, and navigating nutritional dangers really takes when you're expecting.

Riding the Waves

Whoever coined the term "morning sickness" was clearly never pregnant. As most expectant women know, that queasy just-got-off-the-worst-roller-coaster-ride-of-your-life feeling does not magically dissipate when the clock strikes noon. Sometimes, it lasts all day and night. At least for me it did.

That awful, perpetual nausea was my first stumbling block on the path to the perfect diet. For my first three months of pregnancy, I couldn't so much as look at a vegetable if I wasn't near a bathroom. There was just no way I could swallow even a bite of spinach, asparagus, or any similar birth defect-preventing, folic acid-rich veggie. I couldn't even stomach the idea of meat, chicken, or fish -- those all-important prenatal sources of protein and iron.

Truth be told, all I could really eat for three months was cream of wheat, grapefruit, hot chocolate, pizza, mashed potatoes, bagels, and Saltine crackers -- not exactly a nutritionally stellar combination. In fact, it's a combination of foods that could have easily added up to a dietary nightmare -- too few nutrients and too many calories. I was, however, able to use my professional wiles to avoid that trap.

To get the most out of my limited gastronomical repertoire, I snuck in valuable nutrients where I could and minimized empty calories as much as possible. I made my cream of wheat and hot chocolate with low-fat milk instead of water, which added calcium and protein to my diet. I also made my mashed potatoes healthier by moistening them with low-fat milk and using just a dab of butter. I whipped up easy pita pizzas at home with low-fat mozzarella instead of going for the greasy slice at my neighborhood pizza place. And instead of downing whole bagels and sleeves of Saltines to calm my stomach, I found that just a quarter of a bagel or five or six saltines did the trick (and spared me the refined-carbohydrate overload). In the end I still fell short in the iron-rich protein category, and I would have benefited from something green, but overall my diet wasn't a total disaster.

During those months of morning sickness, I was disappointed to find that my usual nausea remedy, ginger tea -- something I've recommended to dozens of pregnant clients -- was completely unappealing to me. The one thing that did keep my churning stomach at bay was to never let it get empty. That meant eating every three hours or so, even at night. (I had to forfeit precious sleep for my midnight feedings.) In the end, I learned a golden rule for dealing with morning sickness: Stomach what you can, when you can, and do your best to make the most of it.

From Churning to Yearning

It figures a nutritionist would crave grapefruit during her pregnancy. My friends just rolled their eyes when I told them. I didn't want chocolate or ice cream, but for the first six months of my pregnancy, I simply had to have grapefruit. There was just something so ultimately appealing about the astringent sweet-tart juiciness of the fruit. My mouth waters thinking about it even now.

Some would say that my body was ultimately craving what it needed, and that doesn't sound too far off with regard to grapefruit. My body probably did need the vitamin C, beta-carotene, fiber, fluid, and folic acid that grapefruit provides. But no one really knows exactly why we crave what we crave. And we can run into problems when what we crave most is mocha almond chip ice cream or New York cheesecake. When I did get hit by that rare sweets craving I had two tactics: 1) try to find a healthier substitute, and 2) if number one fails, go for the "real" thing, just don't go too crazy. So if I wanted ice cream, for example, I'd opt for low-fat whenever possible. But if nothing but the rich and creamy full-fat variety would do, I'd just have a small scoop.

More difficult for me to wrangle was my constant craving for starchy foods like bagels, pasta, and potatoes. It's not that these foods are bad, in fact they are an important part of a prenatal diet, especially the whole-grain varieties which provide essential minerals, fiber, and other trace elements. All good stuff, when prepared healthfully. I just had the tendency to want these carbohydrate-laden foods to the exclusion of most others.

Unfortunately, my interest in protein was just the opposite. The baby's rapidly growing cells are all made of protein, significantly increasing the mother's need for this nutrient. Plus, protein foods are excellent sources of key minerals such as calcium, iron, magnesium, and zinc, all important for expectant moms. Aim for three to four servings of dairy foods like milk, yogurt, and cheese, and three servings of proteins such as meat, chicken, fish, beans, eggs, and nuts each day.

Easier said than done, sure, but not impossible. Throughout my pregnancy I had to make a real effort to balance out the carbohydrates I really wanted with the protein I knew I needed. For example, I'd have half a bagel with an egg, top my baked potato with broccoli and cheddar, and make my pasta with a lean meat sauce.

One thing that shocked me about my cravings was how irrational they made me. Thank goodness my husband isn't easily spooked by demons because I was possessed one day during what I now call my "egg meltdown." That morning in the shower I was hit with the urge to have eggs for breakfast. By the time I dried off and dressed, I was a laser beam of focus, a woman on a mission. Eggs for breakfast.

But when I reached into the fridge, I found that -- horror of horrors -- all the eggs had been eaten. I went ballistic. I literally ranted and raved, shouting at my husband, "How many eggs can you possibly eat in one week?" I was in tears. He offered to make me a number of my favorite breakfast foods, offered to go to the store for eggs. But I was inconsolable.

Eventually I calmed myself down and managed to find something agreeable to eat. Although I laugh now, I was shocked at my behavior. The thing about cravings is they can really take you over, completely demolishing your ability to reason. I found that whatever your cravings, however irrational you become, the key is to be patient and forgiving with yourself -- and hope your loved ones can be, too.

Forget Sushi (and Other Raw Deals)

One thing that really irked me was how many foods you can't eat when you're pregnant. Although I would faithfully list all the no-nos for my clients, the list never seemed so long as when I had to abide by it.

It wasn't so hard when I had time to cook at home, but when dining out it seemed like every item on the menu had some delicious forbidden food as a key ingredient. And this aside from the fact that I love a glass of wine with a good meal. (If there was one blessing in the early weeks of morning sickness, it was that I was disgusted by the smell of alcohol, so abstaining from that lovely glass of Cabernet was a nonissue.)

I also considered it an occupational hazard that each time I picked up a professional journal I read about another food to avoid during pregnancy. I knew the basic ones: raw or undercooked fish and meat; unpasturized cheeses; soft cheeses such as feta, brie, goat, Camembert, blue-veined, and the Mexican-style queso fresco (any of these can be contaminated with the bacteria listeria); and unpasturized juices. But then I read about how it's important to avoid cold cuts and smoked fish "unless thoroughly heated" to guard against listeria. It seemed a bit oxymoronic to me to heat a cold cut. I could just imagine the expression of the guy at the deli counter if I had asked him to heat my ham sandwich to a steaming 165 degrees.

And then there's fish. Seafood menus are a veritable landmine of pregnancy don'ts. Pregnant women shouldn't eat high-mercury fish like swordfish, king mackerel, shark, and tilefish, as per an advisory from the Food and Drug Administration (FDA). Easy enough. But then the FDA began issuing warnings about tuna. Limit canned albacore "white" tuna (canned light tuna is okay) and fresh tuna steaks to just 6 ounces per week, they said.

So what was left? As far as quick and easy lunch foods go, I survived on grilled chicken sandwiches and salads, hummus and pita, egg salad, homemade pizzas, bean soups, and the occasional hamburger. I also made a point of preparing extras at dinner the night before, so I'd have an instant, pregnancy-friendly lunch the next day. And although I grumbled a bit at restaurants, I always managed to find something appealing.

Weight Woes

One of the most misleading ideas about pregnancy is that you are eating for two. Sure, you are eating for two beings, but remember, one of them is very, very small. So don't get caught in the dangerous mindset that you need to eat double. In fact, you only need an extra 300 calories (450 to 600 if you are carrying twins) a day when you're pregnant. That's the equivalent of a yogurt with fruit and a little granola, a couple of handfuls of nuts and dried fruit, or a small sandwich. I always found that keeping this in perspective helped my pregnant clients put down that pint of ice cream. It helped me, too.

What I wasn't prepared for, though, was my raging appetite, which seemed to have its own ideas about how many calories I needed. One morning my growling stomach woke me at 5:30. The next thing I knew I was in my sweatpants at my corner diner eating the "Lumberjack" breakfast -- pancakes, eggs, juice, Canadian bacon - the works. It was just what I needed, and I felt great afterwards.

Although the gorge-fest was rare, my hunger often exceeded 300 extra calories worth of food. But that guideline is an average need: Some days you need more and some days you need less. I have always believed that the best way to insure the right caloric intake, pregnant or not, is to listen to your appetite. And I believe that even more strongly now. I know I couldn't have possibly ignored my insatiable hunger that morning.

By listening to my appetite and eating the right foods (most of the time), I knew I'd gain the right amount of weight. The problem I encountered was that the right pregnancy weight for me wasn't exactly what I had in mind. I figured I would gain about 30 pounds, an amount that sounded reasonable enough (after all, it was smack in the middle of the recommended 25-35 pounds). But when my weight edged past the 35-pound benchmark somewhere in my eighth month, I was enlightened (after I cried and panicked-like any red-blooded, body-conscious woman would, that is).

Once I calmed down, I came to a certain peace with the whole weight issue. By that point I was eating consistently well, swimming, and doing yoga regularly. My pregnancy was progressing beautifully. Apparently, this weight was where my body needed to be.

Now I believe that normal-weight pregnant women shouldn't obsess over an "extra" couple of pounds. Yes, weight is an indicator of your health and the growth of your baby, and you should keep an eye on it along with your obstetrician. But if you direct your energy towards eating healthfully and staying as active as possible instead of towards your weight, you'll probably be just fine.

My pregnancy made me a better nuritionist. I now know the real deal. I haven't just done the reading -- I've been there. Those perfect meal plans are a good starting point, but I've come to realize that flexibility, creativity, and patience are key to a good prenatal diet.

Those ingredients are key to motherhood as well. Now that my daughter is 2 years old, I realize that those fickle food cravings, midnight feedings, and tantrums I experienced in pregnancy were just a little taste of what I would deal with in the months and years ahead with my child. And they made me realize that I'd do anything (including forsaking red wine!) for that tiny person inside me.

Ellie Krieger is a registered dietician and freelance writer in New York City.