What Nutrients are Important for Intrauterine Nutrition?
Author: Joseph Pizzorno, ND
Source: Vitamin Magazine, June 2010
A pregnant woman's health, nutritional status and toxic load have a profound impact on the health of the fetus she is nurturing. Books have been written on each of these important topics, but space limitations allow me to only address a few here. While everyone seems to appreciate the importance of adequate amounts of folic acid, few seem to be paying enough attention to vitamin D, omega-3 fatty acids, iodine and choline.
In late March 2010, I was invited to speak about vitamin D at the University of Calgary. The small auditorium was packed and the audience asked good questions. After my lecture, one of the attendees came up and told me I was wrong about breastfeeding for more than six months being a risk factor for vitamin D deficiency in children. I assured him the research was very clear about this but he asserted, "Breast milk is low in vitamin D only because the mothers are deficient." "Hmmm," I thought to myself, point-does not make sense for nature's perfect food for infants to be so grossly deficient in this key nutrient." So, I went to look more deeply at the research and was quite surprised by what I found.
According to the Food and Nutrition Board (FNB) at the Institute of Medicine of The National Academies the Daily Reference Intake for pregnant and lactating women is a mere 200 iu/d.(1) This is grossly inadequate and is a major cause of increased risk disease for both the mother and her infant. The attendee at my lecture was right; breast milk contains inadequate vitamin D simply because the mother is deficient. While more recent standards are starting to recommend 400 and are considering higher, the research is clear that even this dosage has no effect on serum levels. As can be seen in the following diagram, the typical woman's vitamin D levels drop from conception to giving birth to six months of breastfeeding. As 79 percent of mothers are deficient when they give birth (and it gets worse the longer they nurse), it is no wonder that human breast milk is deficient!
In order for a child to experience the best protection from diseases such as asthma, both the mother and the nursing infant must have an adequate intake of vitamin D.(3) As can be seen, deficient children with deficient mothers have a 2.6 fold increased incidence of asthma.
So how much vitamin D do lactating women need? Even doubling the DRI to 400 iu/d has virtually no effect.(4) Getting a lactating woman into the optimal range and keeping her there requires 6,400 iu/d and it takes four months. The research is replete with many more examples. Normalizing a woman's vitamin D levels should start before conception if she wants the best health for her infant.
How much? Although the typical dosage looks like 4-6,000 iu/d, the only way to tell is by measuring the woman's 25(OH)D3 in the blood and giving increasing amounts of vitamin D until her levels reach the range of 50ng/ml. To optimize vitamin D nutrition, she should also be consuming around 3,000 IU of vitamin A daily and eating foods rich in vitamin K2 such as green leafy vegetables and butter made from grass-fed cows.
Omega-3 Fatty Acids
Twenty-one percent of the variation in IQ at 6.5 years of age is predicted by the ratio of DHA/AA in the mother (as measured in the colostrum-the first milk). (Adding length of breastfeeding and gestation week predicts 76 percent of the variation in IQ).(5) Fish intake by the mother during pregnancy, and by the infant postnatally, is associated with higher developmental scores.(6) Finally, women who take cod liver oil, a rich source of omega-3 fatty acids, during pregnancy and lactation have children who are not only healthier but also have a higher IQ (four percent). Remarkably, this benefit is still measurable at four years of age even though the mothers were only given the cod liver oil until three months after birth. Of perhaps even greater benefit for all, since the infant's nervous system is better mature, they-and their parents-sleep better at night!(7) Bottom line, the more fish a pregnant woman eats (make sure it is low mercury fish) the smarter and more neurologically developed her children. How much? Four ounces of wild salmon, anchovies, mackerel or sardines twice a week; or 2g a day of total EPA and DHA.
In an earlier column, I discussed the iodine deficiency epidemic in North America. Recent research assessing iodine levels in the breast milk of lactating mothers in Boston found that only 47 percent contained sufficient amounts of iodine to meet infant requirements.(8) This has a huge impact on the health of the infant, starting in the uterus, who is at especially high risk. An increasing level of iodine uptake inhibitors-perchlorate, nitrate and thiocyanate-in the food supply makes this worse. During pregnancy, the woman's thyroid production has to increase to meet the needs of her growing fetus. If the woman is deficient, the infant's psychoneurointellectual development is impaired.(9) If severely deficient, the infant can be mentally retarded, a condition called cretinism. How much? 250-500 ug/d.
In foolishly demonizing cholesterol and by inference eggs, we have deprived pregnant women of their primary source of choline. This nutrient is a precursor of acetylcholine, a neurotransmitter critical for the development of the fetus' brain and nervous system.(10) Unfortunately, with current diet the typical woman's choline reserves drop during pregnancy and lactation.
How much? Two eggs a day (preferable range fed and high in omega-3 fatty acids). If the woman can't eat eggs, take phosphatidyl choline.
1 Dietary Reference Intakes: Vitamins
2 Narchi H, Kochiyil J, Zayed R, et al. Maternal vitamin D status throughout and after pregnancy. J Obstet Gyn. 2010;30(2):137-42.
3 Camargo CA Jr, Rifas-Shiman SL, Litonjua AA, et al Maternal intake of vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y of age. Am J Clin Nutr. Mar2007;85(3):788-95.
4 Hollis BW. Vitamin D requirement during pregnancy and lactation. J Bone Miner Res. 2007;22 Suppl 2:V39-44.
5 Gustafsson PA, et al. Breastfeeding, very long polyunsaturated fatty acids (PUFA) and IQ at 6 1/2 years of age. Acta Paediatr. 2004;93:1280-7.
6 Daniels JL, et al. Fish intake during pregnancy and early cognitive development of offspring. Epidemiology. 2004;15:394-402.
7 Cheruku SR, Montgomery-Downs HE, Farkas SL, et al. Higher maternal plasma docosahexaenoic acid during pregnancy is associated with more mature neonatal sleep-state patterning. Am J Clin Nutr. Sep2002;76(3):608-13.
8 Pearce EN, Leung AM, Blount BC, et al. Breast milk iodine and perchlorate concentrations in lactating Boston-area women. J Clin Endocrinol Metab. 2007;92:1673-1677. PMID: 17311853.
9 Glinoer D. Clinical and biological consequences of iodine deficiency during pregnancy. Endocr Dev. 2007;10:62-85.
10 Zeisel SH. The fetal origins of memory: the role of dietary choline in optimal brain development. J Pediatr. Nov2006;149(5 Suppl):S131-6.<
Dr. Joe Pizzorno is the founding president of Bastyr University and editor-in-chief of Integrative Medicine, A Clinician's Journal. He is the co-author of seven books including the internationally acclaimed Textbook of Natural Medicine and the Encyclopedia of Natural Medicine, which has sold over a million copies and been translated into six languages. Readers can now follow him at Twitter at http://www.twitter.com/drpizzorno or directly tweet him at "@drpizzorno".
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