Is it Safe to go Grain-Free During Pregnancy?

One of my specialties is prenatal nutrition and gestational diabetes, and I have heard so much controversy on whether or not it’s safe to ditch the wheat (or grains altogether) during pregnancy. 



Personally, I believe it is (and many times offers benefits) as long as you are eating a real food, nutrient-dense diet. I’m sure you agree, but in my field (I’m a registered dietitian and certified diabetes educator), this is still a hotly debated topic. I’m one of the first healthcare professionals to endorse a lower carb diet during pregnancy in my book, Real Food for Gestational Diabetes.

I believe every woman wants to do the best thing for her baby, so when you hear from a conventional doctor or nutritionist that you must eat “healthy” whole grains to get enough nutrients, it’s no wonder there’s so much confusion.

If you even hint at going grain-free during pregnancy, you’ll probably hear rebuttals like this:

• How will you get enough fiber?
• Where will you get your folate?
• You won’t get enough B-vitamins!
• What about iron? Cereal is a great source of iron!
• Where will you get your carbohydrates? Going low-carb is unsafe in pregnancy!

So here’s how to handle the nay-sayers, point by point.

How will you get enough fiber?

I’m not sure where this myth that grains are the best or only source of fiber came from. I blame it on clever food marketing. There are so many non-grain sources of fiber. Here’s a taste: chia seeds, flax seeds, avocados (really!), coconut products (made with coconut meat, like coconut flour and shredded coconut), nuts, most vegetables, and most fruit (especially berries). Many of these foods have more fiber, especially compared to their carbohydrate content, than grains do.

For example, a “good” whole grain bread might have 3-5g of fiber per slice. You’ll get 5 grams of fiber in just 2 tablespoons of coconut flour, ⅓ of an avocado, 1 tablespoon of chia seeds, or ¾ cup raspberries.

Where will you get your folate?

Because the importance of prenatal nutrition is so widely accepted, there are many public health policies that are designed for the masses. One of the major health concerns during pregnancy is obtaining adequate folate, which is a B vitamin known to help prevent neural tube defects. Since not everyone obtains enough of this nutrient from food and most people eat grains (in fairly high amounts), most grain products are fortified with folic acid in the United

States and these products are widely distributed through programs like Women Infants and Children (WIC) to families that are food insecure.

While that program and its nutrition policies aren’t perfect, they do provide a valuable service to families that otherwise would not be able to obtain enough food. In other words, it’s better than nothing.

But for those of us who have the luxury to eat a real food diet, there are plenty of other sources of folate. The word folate literally derives from the word “foliage”, meaning plants. It’s no surprise that green, leafy vegetables are an excellent source of folate. Same goes for animals that eat plants, like the meat and milk from grass-fed cows and eggs from pasture-raised chickens. Foods like nuts and seeds are also a good source.

While you DO find folate in grains, it’s in lesser amounts than the above foods. Plus, the grain products that are fortified add in synthetic folic acid, which isn’t as good as the stuff from food. At least 40% of us are unable to utilize folic acid due to our genetics, but we can use the form found in food! [ref 1]

You won’t get enough B-vitamins!

This is just silly. B-vitamins are found in so many other foods! Liver, for example, is the richest known food source of B-vitamins (as are many organ meats). In fact, organ meats are at least 10-fold more concentrated in nutrients than muscle meats, like steak or chicken breasts. Other foods that contain B-vitamins in abundance are eggs (mainly in the yolks), meat, fish, poultry, dairy products, vegetables, nuts, and seeds.

What about iron? Cereal is a great source of iron!

Cereal is only a “great” source of iron because it’s been fortified. But much like the issue with folic acid I outlined above, the type of iron used to fortify cereals isn’t ideal. In the case of fortified iron, they usually use what’s called “ferrous sulfate”, which is really difficult for the body to absorb. That means most of it gets flushed down the toilet. Plus, grains are notoriously high in a compound called phytic acid, which inhibits mineral absorption, including iron. Now, if you soak, sprout, or ferment your whole grains before consuming, you’ll absorb significantly more iron from them (i.e. the iron in a whole grain, naturally fermented sourdough bread is more easily absorbed than regular whole grain bread [ref 2]).

Even still, the most absorbable form of iron is called “heme iron” and is found in animal foods, like meat (especially organ meats), poultry, fish/seafood, and eggs. Non-grain, plant sources of iron include dark green vegetables, molasses and some dried fruit (although these are not ideal because they are very high in sugar) and certain nuts, like pumpkin seeds. Keep in mind that you can boost your absorption of plant-sourced iron by eating them with foods high in acid (like vinegar) or vitamin C (like citrus, broccoli, strawberries, or bell peppers). You can also “add” iron to your food by cooking in cast iron pans.

Where will you get your carbohydrates?

Grains are definitely not the only source of carbohydrates, though for many people, grains may make up the bulk of their carb intake. You’ll also find carbohydrates in dairy products (like milk and yogurt), fruit, starchy vegetables (like potatoes, sweet potatoes, winter squash, and peas), and in smaller quantities in nuts, seeds, and non-starchy vegetables (such as kale, lettuce, celery, asparagus, etc.)… and of course, anything sweet. Unless you are only eating meat and pure fat, you’re eating some carbohydrates.

If cutting out (or cutting back on) grains reduces your carbohydrate intake during pregnancy, it’s likely a good thing! Studies have shown slightly lower carb diets based on foods with a lower glycemic index can prevent blood sugar issues (and for women with gestational diabetes, can reduce the chances that you’ll need insulin by up to 50% [ref 3]). The safety of a lower carbohydrate, real food diet for pregnancy and for managing gestational diabetes is something I cover extensively in my book, Real Food for Gestational Diabetes.

Cautions Before Going 100% Grain-free

If you’re new to eating grain-free, one of the common side effects is weight loss. This is typically because reducing your grain intake can reduce your total carbohydrate or calorie intake. Of course, weight loss is not always desirable during pregnancy. If you started your pregnancy at a healthy weight (or were underweight preconception), are physically active, and/or do not have blood sugar problems, you may want to replace the carbohydrates that you would be getting from grains with other foods, such as starchy vegetables (like potatoes, sweet potatoes, and winter squash) or fruit. If you choose to consume dairy, you’ll also find carbohydrates in milk and yogurt.

If you started your pregnancy at a higher weight and your healthcare provider has advised you to watch your weight gain during pregnancy – or- if you have blood sugar problems, like insulin resistance or gestational diabetes, you may benefit from maintaining a lower carbohydrate intake. Just be sure you’re eating enough calories from other real foods, like meat, poultry, fish, eggs, nuts, seeds, avocados, fats (like grass-fed butter, olive oil, etc.), non-starchy vegetables, and berries (or other fruit in moderation). You may also consider gradually decreasing the quantity of grains (or carbohydrates) you consume rather than quitting “cold turkey,” so you allow your body time to adapt.

Summary

Rest assured, you don’t need grains (and especially not processed, fortified cereals and breads) to meet your prenatal nutrient needs. By ditching grains (or eating less of them), you might actually find yourself eating less junk food, like cakes, cookies, crackers, and noodles, leaving more room for nutrient-dense foods that nourish your growing baby.

About Lily:

Lily Nichols, RDN, CDE, CLT is one of the country’s most sought after ‘real food for pregnancy’ experts whose approach to nutrition embraces real food, integrative medicine, and mindful eating. You can learn more about Lily by visiting her popular blog, www.PilatesNutritionist.com and get her book, Real Food for Gestational Diabetes (and snag an exclusive FREE guide on managing gestational diabetes), at www.realfoodforGD.com .

References:

1. Greenberg, James A, and Stacey J Bell. “Multivitamin supplementation during pregnancy: emphasis on folic acid and l-methylfolate.” Reviews in Obstetrics and Gynecology 4.3-4 (2011): 126.

2. Brune, Mats et al. Iron absorption from bread in humans: inhibiting effects of cereal fiber, phytate and inositol phosphates with different numbers of phosphate groups.” The Journal of nutrition 122.3 (1992): 442-449.

3. Moses, Robert G et al. “Can a low–glycemic index diet reduce the need for insulin in gestational diabetes mellitus? A randomized trial.” Diabetes Care 32.6 (2009): 996-1000.