.;, this, the second of a three-part se-fries of articles, Dr. Howard Loomis discusses the five stages of pregnancy and their special nutritional requirements. In the January/February issue of TAC, he focused on the first stage—conception. This issue, he focuses on stages two, three, and four—the pregnancy itself. Stage Two: First Trimester Proper nutritional planning should be part of essential care before, during, and after pregnancy. Fatty acids are the precursors of prostaglandins and control the ability to impregnate, conceive, prevent spontaneous abortion, induce labor appropriately, and commence lactation. Objective tests are routinely performed to determine specific nutritional needs of a mother-to-be. The nutritional status of the woman prior to conception must be known in order to determine her nutritional requirements for pregnancy. Physicians often use general nutritional guidelines that are based on national averages to make nutritional recommendations for pregnant women. The farther from average the expectant mother is, the more inappropriate those recommendations tend to be. As a healthcare practitioner, you can have a tremendous impact on the health of expectant parents and their children. Begin with the standard nutritional recommendations and modify them to meet the needs of each individual. Remember, it is not only the components of the diet that count, it is what the patient can digest and assimilate that is important. Calories and Weight Gain A pregnant woman does not have to eat for two. Ideally, the diet should be adequate enough to nourish the fetus without extensive modification. Certainly there must be slight increases in calories, and especially in protein. On average, caloric intake should be increased by 300 calories per day. Ideally, an average healthy woman should gain 22 to 29 pounds during pregnancy. Il is imperative to pay spe- cial attention to protein and fat digestion, an area of weakness in most women. In the first trimester, the pregnant woman may not gain weight; especially if she is suffering from morning sickness. The mother-to-be commonly begins to gain weight during the third month and the most weight is gained between the fifth and seventh months. Care should be used to ensure that weekly weight gain does not exceed 2.2 pounds. Nutritional Requirements Many of the hormonal and pregnancy problems encountered during the first months may be related to protein deficiency. Protein requirements increase only slightly during this period, yet protein digestion and assimilation may be the key to many of the problems encountered. Various nutrition textbooks recommend to increase daily protein intake to 70-100 grams. This represents a large increase for most women, especially if they already have sluggish biliary function accompanied by low levels of stomach acid. Adequate protein digestion depends on the presence of stomach acid needed to activate the protein-digesting enzyme pepsin in the stomach. Unless enough stomach acid enters the duodenum, its rate of flow is reduced and bile thickens. Iron supplementation should be increased from 30 to 38-40 mg per day. It is usually recommended that vitamin C also be taken to aid iron absorption. An adequate amount of acid must be present to ionize the iron in the stomach. This is essential for absorption. Protein is essential for iron absorption and transportation, even after iron is ionized. Calcium intake needs to be increased to at least 1000 mg per day. This is important for calcification of the baby's bones and teeth and to protect the mother from calcium depletion. It is recommended that vitamin D be used to enhance the absorp- NUTRITIONAL REQUIREMENTS An ideal diet should be able to provide daily, the following to the pregnant woman: Protein 70-100 gms Iron 38-40 mg/day Calcium 1000 mgs Vitamin C Vitamin B-Complex: Thiamin (B1) 0.2 mg Niacin (B2) 0.2 mg Folic Acid 400 meg Pyroxide 2.5 mg tion of calcium. Inadequate stomach acid severely reduces calcium absorption. The unemulsified fat then binds with calcium, making it insoluble. Symptoms Associated with Digestion and Assimilation Problems A certain amount of nausea or morning sickness is considered "normal" during the first three months of pregnancy. Clinical experience has taught me that morning sickness simply indicates that the kidneys are stressed and unable to adequately cleanse the blood. Plasma proteins are responsible for detoxifying and transporting waste. Thus, nutritional support to the kidneys and the lymphatic system will nearly eliminate morning sickness. Edema is also a common problem associated with pregnancy. The usual advice is to elevate the legs and mildly reduce salt intake. However, with improved protein digestion and assimilation, the problem will be eliminated altogether. Stage Three: Second Trimester Protein requirements increase even more during the second trimester. Additional protein and calcium are needed to meet the rapid growth of the fetus; the enlargement of the uterus, mammary glands, and placenta; and the increase in maternal blood volume. Even though the demand increases, do not expect the ability to digest protein to improve. Most females do not tolerate large increases in dietary protein. I have already mentioned that calcium and vitamin D intake must be increased because they are both dependent on protein/fat assimilation. Poor digestion accounts for the old wives' tale that a woman loses a tooth for every baby she has. The second trimester becomes challenging when the excitement of becoming pregnant has waned, and everyone is now awaiting the baby's arrival. The only real excitement comes with the baby's first kick. The mother-to-be begins to lose her figure as she gains weight and has a difficult time fitting into her clothes. Hormonal changes surface and are accompanied by the inevitable "emotional roller coaster." The Hormonal System The anterior pituitary gland directs the endocrine system and enlarges at least 50 percent during pregnancy. This allows it to increase its production of hormones that stimulate the adrenal and thyroid glands. Improved nutritional support of the adrenal glands is crucial during pregnancy. In addition to its many hormonal responsibilities before pregnancy, the adrenals must now produce an androgenic steroid that is carried to the placenta and converted to estrogen and progesterone. It is imperative that this process be in place by the 12"' week to replace the role of human chori-onic gonadotrophin. These hormones prevent spontaneous abortion, loosen the ligaments of the sacroiliac pubis, and prepare breast tissue for lactation. Adrenocortical secretion is moderately increased throughout pregnancy. It helps mobilize amino acids from the woman's tissues to be used for synthesis of tissues in the fetus, an obvious need for improved protein ingestion, digestion, and assimilation. A deficiency here probably accounts for another old wives' tale that the mother loses two years of her life for every child. Aldosterone secretion is increased three-fold. This causes the retention of excessive amounts of sodium and water, often leading to hypertension. Aldosterone monitors water volume in the extracellular fluids. Because protein also holds water, aldosterone secretion can be reduced significantly with improved protein digestion, thus preventing the occurrence of hypertension. Secretions by the Thyroid Gland The thyroid gland enlarges about 50 percent during pregnancy and increases the secretion of thyroxine by approximately the same amount. The placenta and the pituitary both secrete thyroid-stimulating hormones. You may recall that the thyroid requires iodine (transported by fatty acids) and protein to produce thyroxine. The use of caffeine and white sugar greatly COMMON PROBLEMS EDEMA is normally kept un der control with adequate pro tein intake, digestion, and absorbtion. FREQUENT URINATION: caf- feine and cola drinks should be avoided because they increase urination. ► CONSTIPATION: a diet high in refined sugar and white flour is more often the cause. increases the need for additional thyroxine—a need the mother-to-be can hardly meet. Secretion by the Parathyroid Glands The parathyroid glands enlarge during pregnancy, especially if the mother is calcium (protein) deficient. This causes calcium resorption from the mother's bones. Parathyroid secretion is greatly increased during lactation because the newborn baby requires more calcium than it did as a fetus. It is apparent that proper nutritional planning should be part of essential care before, during, and after pregnancy. Unfortunately, it is also apparent that improved protein and fat inges-tion and digestion are seldom part of the planning. Stage Four: Third Trimester Many things happen during the final twelve weeks—much of it having to do with weight of the baby and of the mother. Most of the critical fetal formation is already finished, or at least well advanced, by the beginning of the final trimester. The baby begins to gain weight rapidly. The mother, on the other hand, gained most of her weight between the fifth and the seventh months. As mentioned previously, an average healthy woman should gain only 22 to 29 pounds during pregnancy. Care should be taken to ensure that weekly weight gain is not excessive. Sugar cravings play a prominent role here and are related to poor fat digestion and absorption. The women who have digestive issues prior to becoming pregnant struggle with weight during pregnancy because their already stressed system now has even greater metabolic needs to meet. Protein and fat digestion are of paramount importance. Edema is a common problem in the latter part of pregnancy and should be carefully monitored to rule out pregnancy-induced hypertension. Edema is normally kept under control with adequate protein intake, digestion, and absorbtion. Frequent urination is another problem because the enlarging uterus exerts pressure against the bladder, resulting in the urge to urinate. It is important that fluid intake not be reduced. However, caffeine and cola drinks should be avoided because they increase urination. Constipation is common during pregnancy. This may be due to hormonal changes or because the heavy uterus compresses the intestine. However, a diet high in refined sugar and white flour is more often the cause. Plant enzyme supplements will improve digestion of protein and fat, thereby curbing sugar cravings and making a diet of whole grains, fresh fruits and vegetables more tolerable. Desserts, caffeine, cola drinks, and alcohol should be avoided. There are several consequences of ignoring diet, digestion, and assimilation. Severe toxicity, diagnosed medically as toxemia of pregnancy or eclampsia, is a life-threatening condition that can develop in the second half of pregnancy. It has no known etiology, although some believe it is a result of poor nutrition. In the early stages (preeclampsia), signs include high blood pressure, protein in the urine, and excessive edema (not always present). While the exact etiology may not be known, it is obvious that the organs of detoxification are severely stressed. This includes the liver, the kidneys, and the spleen—in other words, the reticu-loendothelial system (macrophages). This can result from poor dietary choices and enzyme deficiencies. The protein-digesting enzymes are of critical importance in this area. All nutritional planning during pregnancy should revolve around the prevention of the symptoms of preeclampsia; this requires understanding the critical role that protein, including its digestion and assimilation, plays in the creation and maintenance of life. In the next issue of The American Chiropractor, we'll address the postpartum nutritional requirements for both the mother and the baby, including the effect on lactation and postpartum depression. Howard F. Loomis, Jr., DC, president of Enzyme Formulations, Inc., has an extensive background in enzymes and enzyme formulations. As president of 21" Centiuy Nutrition, Inc., for fifteen years, he has forged a remarkable career as an educator, having conducted over 400 seminars to date, in the United States, Canada, Germany, and Australia, on the diagnosis and treatment of enzyme deficiency syndromes. Call 21" Century Nutrition at 1-800-662-2630 for more information. SUGAR CRAVINGS Poor fat and protein digestion and absortion T Get Specific Enzymes for Help!
