Nourished: Understanding Essential Nutrients

It’s important to nourish your body, especially while trying to conceive, during pregnancy, and in the postpartum period. Besides helping to reduce the risk of complications, good nutrition is important for general well-being. It also ensures your baby gets everything it needs to develop properly and is crucial for postpartum recovery.

Unfortunately, nutrition is an area where many of us struggle. It's not always easy, and time and money are two big reasons for this. In addition, we are often inundated with food options that taste great but aren't really nutritious. While the practice of eating well can be very challenging, the concept is really quite simple. Eating a well-balanced diet of nutrient-dense foods on a regular basis is the key. Nutrient-dense foods are packed with the essential nutrients we need and are limited in what we don’t. Nutrient-dense foods are typically "whole" or unprocessed and close to their natural state.

Here’s a definition from the Dietary Guidelines for Americans 2020-2025 publication:

Nutrient-dense foods and beverages provide vitamins, minerals, and other health-promoting components and have little added sugars, saturated fat, and sodium. Vegetables, fruits, whole grains, seafood, eggs, beans, peas, and lentils, unsalted nuts and seeds, fat-free and low-fat dairy products, and lean meats and poultry—when prepared with no or little added sugars, saturated fat, and sodium— are nutrient-dense foods.

In this post, we’re going to explore the six essential nutrients:

• Vitamins
• Minerals
• Protein
• Fats
• Carbohydrates
• Water

The purpose of food is to obtain these six essential nutrients our bodies need for normal functioning but can’t produce (or produce enough of) on their own. 

It’s important to think of this list of essential nutrients as categories. There are different types of vitamins, minerals, protein, fats, and carbohydrates. Also, our specific needs change throughout different life stages, including preconception through postpartum.

Vitamins and Minerals

Vitamins and minerals are considered micronutrients, since they are only needed in very small quantities. These micronutrients are used by our bodies to perform a variety of necessary functions.

Vitamins are organic substances that are made by plants and animals. It’s important to note that vitamins can break down fairly easily. How foods are cooked, prepared, and stored can have an impact on their nutritional value. For example, try lightly cooking foods (versus exposing them to more extreme temperatures) when possible. Also including freshly-picked, raw fruits and vegetables is beneficial. And frozen options can actually be nutritionally superior to fresh produce that has been sitting around for a long time.

Minerals, which are inorganic, can be found in water and in soil. They are absorbed by plants or eaten by animals. Minerals maintain their chemical structure and do not break down, like vitamins.

It's also important to note that vitamins and minerals can actually interact with each other in positive and negative ways. When eaten together, one micronutrient can help your body absorb another. Or the opposite can happen. A micronutrient can actually block the absorption of another consumed at around the same time. You'll see a few examples in this post.

A well-balanced diet of nutrient-dense foods should ensure you are getting all of the necessary amounts of vitamins and minerals you need. Since no one is perfect and many of us do understandably struggle with nutrition, we will take a closer look at just a few vitamins (choline, folic acid/ folate, Vitamin D) and minerals (calcium, iodine, sodium, iron, potassium) in more detail. Below, I've included some basic information about each, a list of example foods, and the specific amounts recommended in Appendix 1 of the Dietary Guidelines for Americans 2020-2025 publication for reference. Other sources are noted where appropriate. The focus on these specific micronutrients is because they:

• are of general public health concern, due to either under or over-consumption amongst people across all life stages AND/ OR
• are of special consideration while trying to conceive, in pregnancy, and/ or while lactating*.

*The Dietary Guidelines for Americans 2020-2025 publication does not include recommendations for those that are lactating and are beyond 12 months postpartum. It also does not include guidance for those feeding more than one child or for those that are lactating and pregnant. Please consult with a health care provider or nutritionist for specific recommendations in any of these cases.

📝 A Note on Supplements: It's ideal to get the vitamins and minerals you need from foods and beverages. However, a prenatal vitamin or more specific supplements may be necessary when trying to conceive, in pregnancy, and while lactating. Needs increase during these stages of life, and it can be challenging for many people to get everything they need from their diet alone. Supplements also help many people at all life stages fill in nutritional gaps. Make sure to talk to a care provider or nutritionist to determine if any supplements are necessary for you. Revisit the discussion as needed through life's many changes. Some vitamins and minerals have upper limits that could be exceeded.

Choline

Choline is needed for a variety of important functions in the bodies of all humans and is important for a fetus's brain and spinal cord development. Many people that are pregnant or lactating are not getting enough of this important micronutrient. Also, not all prenatal supplements contain this vitamin.

Example foods: egg yolks, organ meats, fish, beef, chicken, shiitake mushrooms, Lima beans, cauliflower, soybeans, wheat germ

Adequate Intake:

• Not pregnant (ages 14-18): 400 mg
• Not pregnant (ages 19+): 425 mg
• Pregnant (ages 14-50): 450 mg
• Lactating (ages 14-50): 550 mg

Folic Acid/ Folate

Folate is a general term for the different forms of vitamin B9. Folate is found naturally in food but also has a synthetic form called folic acid. It’s important to get enough of this vitamin during pregnancy and even before. Adequate intake at least one month prior to becoming pregnant is ideal. This is because of the critical development a baby goes through in very early pregnancy. Adequate amounts of this vitamin can help protect against neural tube defects (birth defects of the brain and spine).

Example foods: asparagus, lentils, leafy greens, beets, avocado, oranges, papaya, bananas, fortified grains, beef liver

Recommended Dietary Allowance:

• Not pregnant (ages 14+): 400 mcg DFE
• Pregnant (ages 14+): 600 mcg DFE
• Lactating (ages 14+): 500 mcg DFE

In addition to the above, a daily vitamin supplement that contains 400 mcg folic acid is recommended for those that are pregnant, trying to conceive, or that even have a chance of becoming pregnant. 

‼️ Important: You may hear individual health care professionals (and social media influencers) recommending supplements containing “natural food folate” instead of folic acid, especially for those with an MTHFR gene variant. I go more into this topic and debate in a blog post (linked below). 

🧭 MTHFR and the Folate Debate

Vitamin D

Adequate amounts of Vitamin D are needed for proper development of a baby’s bones and teeth. This vitamin is important for everyone, as it helps with the absorption of calcium. It has other functions, as well. Besides getting this vitamin through foods, your body can make it on its own if you spend time in the sun! Even so, most people do not get enough. A supplement can help out, if needed.

Example foods: egg yolks, fish, fish oil, fortified dairy products, fortified orange juice, fortified plant-based beverages, pork, fortified cereals, cod liver oil, mushrooms

Recommended Dietary Allowance:

• Not pregnant (ages 14-70): 600 IU
• Pregnant (ages 14-50): 600 IU
• Lactating (ages 14-50): 600 IU

Calcium

Our bodies need calcium for a variety of functions, like muscle contraction and nervous system function. It's also crucial in the development (your baby) and maintenance (you) of healthy bones and teeth. And for so much more!

Example foods: canned salmon, canned sardines, dairy products, kale, broccoli, fortified orange juice, fortified plant-based beverages, tofu made with calcium sulfate, almonds

Recommended Dietary Allowance:

• Not pregnant (ages 14-18): 1300 mg
• Not pregnant (ages 19-50): 1000 mg
• Pregnant (ages 14-18): 1300 mg
• Pregnant (ages 19-50): 1000 mg
• Lactating (ages 14-18): 1300 mg
• Lactating (ages 19-50): 1000 mg

Iodine

Recommendations on iodine intake greatly increase during pregnancy and while lactating. It's really important to make sure you get enough of this mineral, as it plays an important role in healthy brain development for your baby. One easy way to increase your intake is to make sure the salt you use in cooking and on food is iodized. This doesn't necessarily mean increase your intake of salt! It's just about making a simple replacement, if necessary. Be aware that not all prenatal supplements contain iodine. Look for one that contains 150 mcg of this mineral.

Example foods: breads, cereals, dairy products, iodized salt, potatoes, seafood, seaweed, turkey, chicken, eggs

Recommended Dietary Allowance:

• Not pregnant (ages 14+): 150 mcg
• Pregnant (ages 14-50): 220 mcg
• Lactating (ages 14-50): 290 mcg

Iron

Iron is necessary for your red blood cells to carry enough oxygen to other parts of your body. An iron deficiency leads to a lack of adequate oxygen in the body. Someone with this deficiency will have low energy/ feel fatigued. It can cause other issues, as well, like negatively impacting the immune system, for example.

Iron obtained from animal sources is more easily absorbed by the body. Eating plant-based sources of iron along with foods containing Vitamin C will help with absorption. Be aware that calcium can inhibit iron absorption. If you're taking an iron supplement, avoid drinking milk or taking a calcium supplement at the same time or within a couple hours.

Recommendations regarding iron intake increase during pregnancy. This extra iron is needed to make more blood, which supplies oxygen to the baby. An iron deficiency during this life stage can lead to premature birth, low birth weight, and postpartum depression. Iron needs actually decrease below pre-pregnancy levels in those that are lactating and not yet menstruating. If you're still taking a prenatal supplement, adjustments may need to be made.

Example foods: beans, eggs, oysters, prunes, meat, nuts, seeds, soy products

Recommended Dietary Allowance:

• Not pregnant (ages 14-18): 15 mg
• Not pregnant (ages 19-50): 18 mg
• Pregnant (ages 14-50): 27 mg
• Lactating* (ages 14-18): 10 mg
• Lactating* (ages 19-50): 9 mg

*This recommendation is valid until menstruation resumes, at which time follow recommendations for those that are not pregnant.

Potassium

Potassium is needed for a variety of functions, like blood pressure regulation and to keep fluids balanced. Most people do not get enough of this mineral, and you won't find it in a prenatal supplement. You have to get this nutrient from food.

Example foods: beans, milk, yogurt, bananas, dried apricots, stewed prunes, carrot juice, orange juice, pomegranate juice, clams, salmon, tomato products, sweet potatoes

Recommended Dietary Allowance:

• Not pregnant (ages 14-18): 2300 mg
• Not pregnant (ages 19-50): 2600 mg
• Pregnant (ages 14-18): 2600 mg
• Pregnant (ages 19-50): 2900 mg
• Lactating (ages 14-18): 2500 mg
• Lactating (ages 19-50): 2800 mg

Sodium

Sodium is a mineral that our bodies need, but we need to be careful about getting too much, as it can be harmful in excessive quantities. Therefore, this is a food to limit. It's recommended to consume less than 2,300 mg per day. Too much sodium on a regular basis can lead to high blood pressure and other issues. It can also cause increased swelling in pregnancy. Table salt contains sodium, but that typically isn't the culprit in over-consumption of this mineral. It's foods like processed meats, soups, bread, burritos, and packaged foods.

Protein, Fats, and Carbohydrates

Protein, carbohydrates, and fats are macronutrients. They are a source of energy for our bodies and are needed in larger quantities. The calories you eat throughout the day will be divided amongst these three groups.

Looking at the big picture, for those ages 19-50:

• 10-35% of calories should come from protein
• 20-35% should come from fats
• 45-65% should come from carbohydrates

For those ages 14-18:

• 10-30% of calories should come from protein
• 25-35% should come from fats
• 45-65% should come from carbohydrates

These recommended ranges are the same for those not pregnant, pregnant, and lactating (though you may shift around within them). Each day may look a little different, and that is completely ok! These are guidelines! The pie graph below shows an example of how calories may be distributed on a particular day.

Not only do these macronutrients provide our bodies with energy, they have other functions, as well. Also, macronutrients consumed in excess of what our bodies need for the day will be stored by the body, mainly as fat. Let's take a look at some more general information, as well as pregnancy-specific recommendations.

Protein

Amino acids link together in long chains to form protein. There are twenty different amino acids, and nine are considered essential. Humans must get these essential amino acids from food. Have you ever heard the terms complete and incomplete proteins? A complete protein has all nine essential amino acids, while an incomplete protein is missing at least one. Protein foods from animal sources are complete proteins. Protein foods from plant sources are usually incomplete, though there are a few that are complete (soy and quinoa are two examples). A person that eats a variety of foods containing incomplete proteins throughout each day can still get all the essential amino acids, though.

Women/ people assigned female at birth (between the ages of 14 and 50) need 46 grams of protein everyday. Protein is used by the body for so many functions, like repairing cells and body tissue and the production of hormones, just to name a few. During pregnancy and while lactating, the recommendation increases to 71 grams daily. This extra protein is needed for a baby’s growth during its time in the womb.

Carbohydrates

Carbohydrates, which are mainly found in plants and dairy products, are considered the primary source of energy used in the body. They are broken down into glucose (blood sugar), and the pancreas releases insulin in order to help the body absorb it. This energy is either used immediately or stored as fat. Many of us have a negative association with carbs and view them as something to avoid. And some are unhealthy. But our bodies do need carbohydrates, so, instead, it's best to focus on making better choices. Let's start by talking about the different types of carbohydrates.

Based on chemical makeup, a carbohydrate can be classified as simple or complex. Simple carbs (sugars) are made up of smaller chains of molecules and are easier and quicker to digest, leading to a quick spike in blood sugar. Complex carbs (starches) are made up of longer chains of molecules and take longer to digest, leading to a slow and steady increase in blood sugar. Dietary fiber is also a complex carbohydrate, but our bodies can't digest or absorb it (but has a crucial role in digestion). So are simple carbs always unhealthy and complex carbs always healthy? This is a common misconception, but it's not quite that simple!

Simple carbohydrates or sugars are found naturally in fruit and dairy products. These types of foods are healthy, because they are nutrient-dense. Besides containing important vitamins and minerals, the fiber in fruit and the protein and fat in dairy products help to slow digestion and, therefore, the blood sugar spike. Added sugars are a different story and are important to limit. Less than 10% of our daily calories should come from added sugars. Often, foods and beverages that contain high amounts of added sugars, like candy and sodas, are also devoid of nutrients.

Complex carbohydrates or starches include foods like bread, pasta, rice, and starchy vegetables. Whole grains and starchy vegetables are healthy, nutrient-dense foods. Refined grains, like white bread and pasta, are processed foods that have had much of the nutritional value (vitamins, minerals, and fiber) removed. Some refined carbs have been enriched (vitamins and minerals added back in), but they are still lacking in fiber. Because the fiber has been removed, refined grains are easier and quicker to digest, leading to a more rapid spike in blood sugar.

📝 Note: Over time, frequent spikes in blood sugar can lead to health issues, like type 2 diabetes and heart disease. This is why it's important to focus on making good choices when it comes to carbohydrates.

As mentioned in a previous paragraph, dietary fiber is a complex carbohydrate that our bodies can't digest or absorb. It is the roughage or bulk in our diets that is necessary for digestive health. Lower cholesterol levels and help in controlling blood sugar levels are some other benefits, as well. Ensure you are getting enough dietary fiber each day. 14 grams per 1,000 calories is recommended. So, for example, someone eating 2,000 calories each day should consume 28 grams of fiber. As far as specific benefits while expecting, adequate fiber can help to prevent constipation, which is more common at this time. It can also help to reduce the risk of gestational diabetes (high blood sugar levels during pregnancy).

To summarize, don't think of simple carbohydrates as always "bad" or unhealthy and complex carbohydrates as always "good" or healthy. Fruits are simple carbohydrates that are considered a healthy choice, while refined grains are complex carbohydrates that are definitely less healthy. It comes down to nutrient- dense whole foods being a healthier choice than processed foods full of empty calories. The chart below shows examples of healthier and less healthy types of simple and complex carbohydrates.

Fats

Fats aren't just a source of energy for our bodies. They play an important role in keeping us healthy and our systems (like reproductive, immune, and endocrine) functioning properly. Fats come from both plant and animal sources and can be divided into two main categories: saturated and unsaturated fats. Saturated fats are usually solid at room temperature, while unsaturated fats are usually liquid. Fats are made up of/ break down into fatty acids during digestion, which can be absorbed by the body.

While current evidence suggests saturated fats are not as harmful to heart health as once believed, this is still a food to limit. Less than 10% of your daily calories should come from saturated fats. Some examples of foods that contain these are meat and poultry, dairy products, coconut and palm oils, vegetable shortening, desserts, and processed foods. In an effort to reduce saturated fat intake, it's been common for people to replace them with unhealthy types of carbohydrates, which has actually lead to worse health outcomes. When cutting back on saturated fats, it's important to replace them with unsaturated fats, instead.

Unsaturated fats can be further broken down into different types. I've included a chart, below, to help in understanding some of the terms you may already be familiar with.

While unsaturated in fats in general are an important part of a well-balanced diet, let's focus on one particular type (as this type of fat is so important yet may be lacking in the diets of many people). Omega-3 fatty acids are beneficial for heart and brain health and for a baby’s brain development. Because of this, it's recommended to consume eight to twelve ounces of seafood each week. We'll talk later on about the best sources of seafood, as some types contain high levels of mercury, which can be harmful to a baby in utero. If you don’t eat seafood, talk to your care provider or a nutritionist about alternate sources and/ or a dietary supplement (more on this on the next page).

📝 Note: DHA, EPA, ALA, oh my! You may have seen these acronyms before. These are the main types of Omega-3 fatty acids. DHA and EPA are mainly found in fish and other types of seafood. Fish oil supplements can help people who may not eat enough fish in consuming enough of these important fatty acids. ALA is typically found in plant sources, and your body can convert it (very inefficiently) into DHA and EPA. It can be tough to get enough DHA and EPA from a plant-based diet. However, an algae oil supplement could be an option for those who are vegetarian or vegan.

Trans fats are another type of unsaturated fat, but they aren't beneficial in any way. Trans fats should be avoided, as they cause a rise in bad cholesterol (LDL) and a reduction in good cholesterol (HDL). Trans fats can occur naturally in foods, but they can also be made artificially. These manufactured trans fats are called partially hydrogenated oils, which are so unhealthy that the U.S. Food and Drug Administration now prohibits them from being added to processed foods. You may still encounter these unhealthy fats, so make sure to check food labels and avoid foods fried in partially hydrogenated oils.

Water

Water is vital to the proper functioning of our bodies. During pregnancy, there is an increased need for water. Eight to twelve glasses a day is recommended, and urine should be a light yellow color. A dark yellow color indicates a need to increase fluid intake. Staying properly hydrated during pregnancy can help to avoid problems, like birth defects, low levels of amniotic fluid, and premature labor. It's also important to stay hydrated when lactating.

More on Nutrient-Dense Foods

Limiting foods high in added sugars, saturated fat, and sodium will leave space for foods containing the nutrients our bodies need. Each day, 85% of our calories should come from nutrient-dense foods. This applies to everyone, not just those pregnant or lactating. Diets that include too many foods high in sodium, added sugars, and saturated fat can result in exceeding daily recommended calories and/ or falling short on consuming necessary nutrients.

I touched on these specific recommendations in the previous section, but I wanted to summarize them here:

• Sodium: Less than 2,300 mg per day
• Added Sugars: Less than 10% of calories per day
• Saturated Fat: Less than 10% of calories per day

Together, added sugars and saturated fat should make up no more than 15% of total daily calories.

For more information on this, click the link below:

🔗 More Key Topics | MyPlate

Additional Resources to Explore

Final Thoughts

It’s important to incorporate the six essential nutrients into your diet each day. Check out my other blog post on nutrition that can help you decide what foods to eat each day (and in what proportions and portions) in order to ensure you’re getting them all.

🧭 Planning Your Plate

This post contains general nutrition information. If you want or need more individualized recommendations, make an appointment with a dietician with an RD or RDN credential. This would be especially helpful if you’re pregnant with multiples or have certain health issues.

‼️ Important: There is a scary amount of nutrition misinformation on social media. If someone is recommending you to do or take anything that differs from established guidelines, that would be providing medical advice. Only YOUR care provider or YOUR registered dietician/ registered dietician nutritionist should be providing you with medical advice.

📑 References