Well-planned vegan, lactovegetarian, and lacto-ovo vegetarian diets are appropriate for all stages of the life cycle, including pregnancy and lactation.
During pregnancy and lactation, a well-balanced vegan diet can give a baby the best possible start and set the stage for a lifetime of good health. This is a vital stage of life for expectant parents to become savvy about nutrition. However, creating an optimal plant-based diet may be a new experience, and well-meaning friends, relatives, and even some health professionals may question or doubt the benefits of a vegan diet. Fortunately, it’s a great time to be vegan because there’s plenty of support available. Mothers can be well nourished during pregnancy and lactation whether they are gourmet cooks, frequent restaurants, or keep meal preparation to the barest minimum. Whatever the situation, designing a nutritionally adequate vegan diet is both possible and less challenging than one might think.
During pregnancy, the nutrients a baby needs for growth come entirely from its mother. Because the baby will frequently draw on the mother’s reserves, it’s extremely important for her body to be well nourished. Women who plan to get pregnant within the next few years should start to make the necessary dietary changes now to establish eating patterns that support excellent health, so their reserves will be well stocked when pregnancy ensues. Great recipes, complete with nutritional analyses, can be found in Cooking Vegan by Vesanto Melina and Joseph Forest (Book Publishing Company, 2012).
The largest study to date on the health of pregnant vegans and their pregnancy outcomes was completed in 1987. Researchers examined the maternity-care records of 775 women at a vegan community known as The Farm in Summertown, Tennessee. Their diets centered on soy foods (tofu, tempeh, and vitamin B12–fortified soy milk), grains, fruits, and vegetables; most foods were organic and grown on The Farm. The women took prenatal supplements with iron and calcium, had regular prenatal care, and had active lifestyles. They didn’t smoke cigarettes or drink alcohol and rarely drank coffee.
Two important findings emerged from this study. First, the participants’ vegan diets didn’t affect infant birth weight. Second, almost no vegan women developed preeclampsia. Just one of the 775 vegan women experienced this complication of pregnancy—a rate of 0.1 percent, compared to a rate of 5 to 10 percent for this health risk in the general population. The research scientists concluded that it’s possible to sustain a normal pregnancy on a vegan diet. In fact, the physician in charge of the study, James P. Carter, of the School of Public Health and Tropical Medicine of Tulane University, wrote, “Since preeclampsia in our culture is frequently associated with unrestrained consumption of ‘fast foods’ (foods having high levels of saturated fat) and rapid weight gain, it’s possible that a vegan diet could alleviate most, if not all, of the signs and symptoms of preeclampsia.”65,66
In a much smaller English study, birth weights of vegan infants didn’t differ from those of nonvegetarian mothers. In this small sample, there was little difference in the incidence of preeclampsia between vegans and nonvegetarians.67
These studies on pregnant vegans were carried out long before numerous nutritious and fortified vegan food options became widely available. While a diet centered on whole plant foods is excellent, including some carefully chosen convenience items appeals to some vegans as a way to make life a little easier.
Occasionally, less-favorable reports have appeared regarding the pregnancy outcomes of mothers who consume vegan or near-vegan diets—particularly among macrobiotic populations that were unwilling to consume supplements, such as vitamins B12 or D. The diets linked with poor birth outcomes were low in calories or lacked certain essential nutrients, such as vitamin B12.68–70 The conclusion is that vegan diets can support very healthy pregnancies. However, as they would on any diet, vegan mothers-to-be must take care to ensure adequate intake of calories and other nutrients.
Calorie requirements don’t change significantly during the first trimester and only increase by about 10 to 15 percent during the second and third trimesters.2 Yet, the requirement for certain vitamins and minerals is greater from early in pregnancy, so food selections really matter. A sample menu designed to meet the nutritional needs of vegans during pregnancy is shown on page 297.
Prepregnancy Preparation Before getting pregnant, a prospective mother should reach a healthy body weight. A weight-loss diet during any stage of pregnancy is undesirable (unless done with medical supervision). To determine whether current weight is in the optimal range, check the body mass index (BMI) in table12.1 (page 363). In women who are overweight (BMI of 25 to 29.9) or obese (BMI above 29.9), weight reduction can decrease the risk of gestational diabetes, high blood pressure, and preeclampsia (a condition that includes high blood pressure, fluid retention, and protein loss in the urine). See chapter 12 for help with healthy weight loss.
In slightly underweight women, gaining a few pounds can increase the chances of becoming pregnant and decrease the risk of having a preterm birth or an underweight infant.3 See page 362 to determine whether your current body weight is under the healthy range and page 377 for helpful tips on achieving optimal weight. For women with a large frame, the lower end of the healthy BMI range could be too low.
To protect a fetus from potential birth defects, ensure that the vegan diet is rich in folate—even before becoming pregnant. This isn’t difficult; beans, greens, and oranges are excellent sources of this vitamin. Folate and the mineral zinc (present in seeds, cashews, and legumes, including soy foods) also are important for male fertility.4,5 For additional sources of folate and other vitamins, see chapter 7; for minerals, see chapter 6.
No extra calories are required before pregnancy (unless the prospective mother is underweight) and few, if any, during the first trimester. A recommended weight gain during the first trimester is 3.5 pounds (1.6 kg). If a woman was underweight, the recommended gain is 5 pounds (2.3 kg); if overweight, 2 pounds (0.9 kg). An expectant mother’s diet does require many vitamins and minerals (see table 9.1), and her food choices may need adjustment to ensure they deliver good nutrition. For example, although the recommended protein intake doesn’t increase during the first trimester compared to prepregnancy requirements, foods rich in protein and iron are needed to build an increased blood supply—especially if these nutrients weren’t high priorities in the past. (See chapters 3 and 6.) Legumes are a great food choice; they provide protein and iron along with fiber, which helps to prevent constipation. Legumes also can reduce the risk of gestational diabetes.6,7
Eating well in the first trimester isn’t always easy. In 80 percent of women, morning sickness arises between the fourth and seventh week of pregnancy; typically, it has resolved by the twentieth week. Pyridoxine (vitamin B6) has been shown to safely and effectively alleviate nausea and vomiting for many women; fortunately, vegan diets can be rich in this nutrient (see page 245 and table 7.3 on page 252). During this period, nature gives some women a craving for bland, dry, high-carbohydrate foods.8–10 Low-fat, high-carbohydrate foods pass rapidly through the stomach and are quickly digested, allowing less time for queasiness. Women experiencing morning sickness may keep a few crackers by the bedside to have upon awakening. Ginger also is a time-honored remedy for nausea; consuming ginger in the form of cookies, teas, preserves, powder, capsules, and ginger ale can provide relief. Another way to limit nausea is to avoid foods that have strong odors or being around cooking; cold foods often are better tolerated, because they have less aroma.9
Sometimes nausea is due to hunger, so pregnant women should eat often, relying on small meals and frequent snacks. Crackers and hummus is a nutritious combination, as is toast with lentil or bean soups. If solid food can’t be tolerated, expectant mothers should try to consume whatever they can; juice, fortified soy milk, or miso broth are good choices. A pregnant woman who is unable to eat or to drink adequate amounts of fluids for twenty-four hours should contact her health care provider.
Because morning sickness can interfere with proper nutrition, women who want to become pregnant or who are in the early stages of pregnancy may be advised by their health care provider to take a multivitamin-mineral supplement or a supplement specific to pregnancy. A supplement that includes the vitamins B12, D, choline, and folic acid and the minerals iodine, iron, and zinc is most valuable for vegan mothers-to-be; an online search for “vegan prenatal supplement” can provide sources. For most nutrients, high doses can be harmful; avoid excessive intakes. In addition, the topic of supplementary folic acid is controversial; see page 290 for details.
The recommended intakes for minerals and vitamins change when a woman becomes pregnant and again when she’s breast-feeding. Pregnant women need more copper, iodine, zinc, vitamin A/carotenoids, riboflavin, pantothenic acid, and vitamins B6, B12, and C; during lactation, even higher quantities of these nutrients are needed. The required intakes for other vitamins and minerals (magnesium, iron, thiamin, niacin, and folate) rise in pregnancy and then level off or decrease during lactation. The requirement for vitamin E also increases when a mother breast-feeds her baby. However, for a few nutrients (calcium and vitamins D and K), the recommendation stays the same. For recommended intakes for those younger than age 19 during pregnancy, see pages 446 and 447.
For many of these nutrients, just eating more of an assortment of healthy vegan foods easily takes care of such increased requirements; dietary sources are covered in chapters 6 and 7. Nutrients that need a little extra attention from pregnant women and breast-feeding mothers are addressed in this chapter. For example, omega-3 fatty acids are essential (see page 296 and chapter 4), and a daily supplement of 200 to 300 mg of DHA is often recommended during pregnancy.
In table 9.1, increased amounts of recommended vitamins and minerals are shown in bold; in addition, the periods when the greatest amounts are needed are highlighted.
By the end of the first trimester, morning sickness should be fading, at least to some extent, and expectant mothers may experience a busy bladder, notice a baby bump, and hear the baby’s heartbeat through an ultrasound device.
TABLE 9.1. Recommended nutrient intakes for women from 19 to 50 (not pregnant, pregnant, or breast-feeding)
*The iron RDAs are shown in table 9.1; vegans and other vegetarians may need up to 1.8 times as much; see pages 186 to 189. The Centers for Disease Control (CDC) recommends an iron supplement of 30 mg per day from the first prenatal visit.
**For magnesium, the first figure is the RDA for women from 19 to 30; the second for those 31 and older.
The need for additional calories increases during the second and third trimesters. Pregnant women should eat about 340 extra calories per day during the second trimester and about 450 calories extra per day during the third trimester; the exact amount will vary based on the mother’s metabolism and activity level.2,6
The recommended weight gain during the second and third trimesters is about 1 pound (0.44 kg) per week. For women who were underweight, the recommended gain is an average of 1.1 pounds (0.49 kg) per week; for overweight women, about 0.6 pound (0.3 kg) per week throughout the second and third trimesters.2 Typical recommended weight-gain goals are shown in table 9.2; these vary based on prepregnancy weight, whether the mother is an adult or adolescent, and whether a single baby or multiple babies are expected. Women should follow the guidance of physicians and medical caregivers regarding desirable weight gain during all stages of pregnancy. (To determine prepregnancy BMI, see table 12.1 on page 363.)
During the second and third trimesters, calorie requirements increase by 15 to 20 percent over prepregnancy needs; meanwhile, protein requirements increase by 50 percent. Starting in the fourth month of pregnancy, an extra 28 grams of protein per day is required (this is 10 percent higher than the 25 grams recommended for nonvegetarians and compensates for the slightly lower digestibility of plant protein). For example, a vegan woman whose prepregnancy weight is 135 pounds (61 kg) and whose prepregnancy protein requirement is 55 grams would need to ingest a total of 83 grams of protein every day during this period of her pregnancy. A pregnant woman carrying twins would need 56 grams of added protein daily.
To meet these higher requirements, it makes sense for expectant mothers to have at least one protein-rich food at each meal and at most snacks. Table 9.3 shows foods (and serving sizes) that provide 15 grams of protein. These items typically provide iron, zinc, folate, and choline too. For more extensive lists of foods with their protein contents, see table 3.5 (page 97) and table 13.3 (page 411).
TABLE 9.2. Weight gain during pregnancy
TABLE 9.3. Foods that provide 15 grams of protein per serving (along with iron, zinc, folate, and choline)
*Likely to be about 44 to 69 mg per 100 g of food.
**Likely to be about 31 to 35 mg per 100 g of food.
***Enriched with folic acid (check labels).
Based on human studies to date, it appears that the benefits of taking limited amounts of folic acid in supplement form in early pregnancy outweigh the risks. Relevant research confirms that it makes sense to take 400 mcg of folic acid during the month or so before becoming pregnant and throughout pregnancy to reduce the risk of neural tube defects in the infant—and perhaps the risks of autism, cleft lip, and cleft palate. With an additional 200 mcg of folate from her diet, a pregnant vegan easily meets the RDA.
Alternatively, a diet that includes plenty of beans, greens, and oranges, complemented by enriched or whole grains, can provide the entire RDA during pregnancy of 600 mcg of folate, as noted above. Thus, supplementary folic acid may not be necessary.
In summary, both options can work well in supplying adequate folate. (However, studies to establish effectiveness in preventing neural tube defects have been conducted only with folic acid.)
A developing baby places specific demands on a mother’s body for particular nutrients. In the sections that follow, the roles and recommended intakes during pregnancy of minerals and vitamins of special interest are examined.
This vitamin is crucial for building a fetus’s genetic material (DNA) and for other aspects of fetal growth, including the early evolution of the neural tube, which develops into the brain and spinal cord. The Institute of Medicine (IOM) recommends that nonpregnant women—especially those who hope to become pregnant—aim for a daily intake of 400 mcg DFE (dietary folate equivalents, which take into account the various forms of folate); a pregnant woman should receive 600 mcg DFE daily.14,20
Numerous vegan foods are naturally endowed with folate; this form of the vitamin is well utilized by the body (its other name is vitamin B9, and it is indeed “benign”). Beans, greens, and oranges provide plentiful amounts of folate.14,15,21 A pregnant vegan can get her 600 mcg of folate for the day by eating a reasonable mix of citrus fruits, greens, legumes, and whole grains. For example, 1 cup (250 ml) of orange juice provides 74 mcg of folate, 3 cups (750 ml) of romaine lettuce provide 192 mcg, 1 cup (250 ml) of black beans provides 256 mcg, and 1 cup (250 ml) of cooked quinoa provides 78 mcg, adding up to a total of 600 mcg of folate.17,18,22 (For more on folate, see page 246, table 9.3 on page 289, and table 7.3 on page 252.)
Although folate is required for proper cell division, it seems that an excess of folic acid may take cell division in the wrong direction and increase the risk of colon cancer and other cancers. Folic acid is a related synthetic compound used in supplements and fortified foods (such as enriched breads and baked goods, pasta, rice, flour, and cereals) because it’s more stable and less expensive. Strong (and often contradictory) expert opinions exist regarding intakes of this form of vitamin B9 in supplements, because the body processes folate and folic acid differently. Folic acid can be converted in the liver to the useable form of this vitamin by an enzyme that the body produces in limited amounts. Because of this potentially incomplete conversion, high intakes of folic acid may result in the circulation of unconverted folic acid in the bloodstream. It’s wise not to exceed a total daily intake of 1,000 mcg DFE per day. Women who use folic acid supplements should choose those that provide 400 mcg—or at most 550 mcg—daily.23,24,25
The most widespread nutritional deficiency in the world is iron deficiency; it’s a common concern for women on any diet, whether vegan, vegetarian, or nonvegetarian.26 Good iron status early in pregnancy and adequate maternal intakes of this mineral during pregnancy are linked with better birth weights and less risk of preterm births.6,26–28
Many otherwise healthy women fail to meet recommended iron intakes—including during pregnancy, when the body’s blood supply increases by 40 to 50 percent to deliver oxygen to the fetus and surrounding tissues. Iron supports development of the brain and nervous system; deficiency can have lifelong neurological and behavioral consequences. Adequate iron also is required to build the baby’s own iron stores. In fact, 80 percent of a term infant’s stored iron is accrued during the third trimester; a premature infant doesn’t have the advantage of this accretion and will need supplemental iron starting early in life.
The RDA for pregnant women is 27 mg of iron per day, an increase of 50 percent over the prepregnancy RDA. Because some plant foods contain substances (such as phytates) that decrease iron absorption, the IOM further advises that vegetarians consume 1.8 times as much iron as nonvegetarians—which would bring the recommended intake to 48 mg per day.13 Some experts question whether the recommendation for vegans needs to be quite this high; plus, 48 mg is above the tolerable upper intake level (UL) of 45 mg per day, so the goal shouldn’t be above 45 mg unless medically advised.
Studies in the United States have repeatedly shown that vegan diets are as high or higher in iron than lactovegetarian and nonvegetarian diets, as well as being rich in vitamin C, which greatly increases iron absorption.31,32 Also, during pregnancy, nature kindly steps in and greatly increases the efficiency of iron absorption from plant foods, especially during the second trimester. Iron-rich vegan foods tend to be the same foods, such as beans, peas, and lentils, that are high in protein, zinc, and the B vitamins folate and choline (see table 9.3 on page 289). (For more on iron, see pages 186 to 189 and table 6.2 on page 204.)
• Consume iron-rich foods, such as beans, lentils, soy foods, whole grains, fortified grain products, seeds, dried fruit, organic blackstrap molasses, and leafy greens (page 188).
• Include vitamin C–rich foods (such as bell peppers, tomatoes, and citrus fruits) in iron-rich meals to maximize absorption of the mineral (page 189).
• Avoid drinking tea or coffee with iron-rich foods; these beverages can decrease iron absorption. (For lactovegetarians and lacto-ovo vegetarians, cow’s milk will have the same effect.)
• Consider taking a prenatal supplement that includes iron or a daily supplement of 30 mg of iron; the latter is necessary with iron-deficiency anemia. 6,27,29,31,34
Supplements that provide 30 mg of iron are recommended by the Centers for Disease Control (CDC) from the first prenatal visit and are commonly prescribed for pregnant women; these are certainly needed when a woman is anemic or has low serum ferritin (iron stores). Large doses of supplementary iron can be toxic, so the amounts recommended by health care providers should not be exceeded. Some experts suggest that iron supplements are unnecessary—and, in fact, not advisable—for women who aren’t anemic; however, the alternative requires the creation of an iron-rich diet.33
Whether vegan or nonvegan, the diets of many North American women are low in zinc. Insufficient zinc intake during pregnancy has been linked with preterm delivery, low birth weight, prolonged labor, and other problems.31 Zinc is involved in cell replication—the duplication of existing cells that is fundamental to growth and healthy birth weight. This mineral also is required for cell differentiation, the process during which cells change from general to more specialized forms that perform particular functions. In choosing a prenatal supplement, it’s wise to choose one that provides zinc.31
The RDA for zinc increases from 8 mg per day before pregnancy to 11 mg during pregnancy (and to 12 mg in lactation). The expectant mother’s absorption of this mineral also becomes more efficient. Good sources of zinc include seeds and seed butters, as well as nuts and nut butters and legumes.6,17,18 Recent research has established that consuming nuts and peanuts during pregnancy doesn’t increase the likelihood of allergies in infants; in fact, the reverse may be true.35 Of course, a pregnant woman should avoid foods to which she is allergic. (For more on zinc, see pages 189 to 191 and table 6.2 on page 204.)
Although iodine is an essential component of thyroid hormone, tiny amounts of this mineral are even more vital for normal development of the infant’s brain and central nervous system—even a mild deficiency can affect cognitive ability. In addition, iodine deficiency during critical points in the development of a fetus and young child causes cretinism (a form of developmental disability). This form of brain damage occurs in locations throughout the world where iodine is in short supply in the soil due to losses caused by floods or, in mountainous regions, by rainfall and glaciation. Although vegetables take up iodine from the soil where they can, amounts in crops vary from one place to another.6,20,31,36,37
Ensuring Adequate Iodine Intake
Select a prenatal supplement that includes iodine; typically, it will provide 150 mcg of iodine (the amount recommended in supplement form by the American Thyroid Association during pregnancy and lactation).40
Plant foods in a vegan diet may well deliver sufficient iodine to top up intakes from a prenatal supplement. But because it’s difficult to be sure, include another option for the remaining 70 mcg per day:
• One-quarter teaspoon (1 g) of iodized salt should add about 46 to 76 mg of iodine.41
• Sea vegetables (seaweeds) typically are not ideal sources, because iodine amounts can vary sixfold. However, small amounts of seaweeds, such as kombu, are an option if the label shows the iodine content; excessive intakes of iodine from kombu have led to health problems.42
• Iodine drops deliver a known quantity of iodine per drop.
Iodine deficiency is easily prevented, and it’s important to get sufficient iodine—but not too much.13,38 The RDA for iodine during pregnancy is 220 mcg per day. Evidence of iodine sufficiency in pregnant women is defined by iodine concentration in the urine of 150 grams per liter.37 There also is an upper limit for daily iodine intake, which is 900 mcg for teens and 1,100 mcg for adults, pregnant or not.11,38
Fortifying salt with iodine has been effective in preventing iodine deficiency in many countries. Iodization of table salt is mandatory in Canada and many other nations and optional in the United States and the United Kingdom; check labels.38 However, a study of vegans in the Boston area found that some were at risk for iodine deficiency because the majority didn’t use iodized salt or take an iodine-containing supplement. (In contrast, one of the Boston vegans had an excessive iodine intake due to high kelp intake.)39 (For more on iodine, see pages 191 to 194.)
Though a fetus needs calcium for building bones, a woman’s RDA for this mineral is 1,000 mg whether she is or isn’t pregnant, or is breast-feeding. This situation exists because calcium absorption becomes far more efficient with increased need, essentially doubling during pregnancy. Multivitamin supplements and prenatal supplements typically provide a few hundred milligrams of calcium to top up dietary intake. However, if a pregnant woman’s intake is insufficient, calcium from her bones can be siphoned off to support the growth of the baby.6,12,31,43
Many vegans have calcium intakes below the RDA, so pregnancy should instigate a habit of calcium-rich dining. Many excellent plant sources of calcium are available from each of the food groups. These include low-oxalate greens (bok choy, broccoli, napa cabbage, collard greens, kale, and okra), calcium-set tofu, almonds, blackstrap molasses, and figs, as well as fortified foods (such as calcium-fortified orange juice, soy milk, other nondairy beverages, and cereals). If necessary, a calcium supplement can top up food intakes.18,44 (For more on calcium, see pages 182 to 186 and table 6.2 on page 204.)
This vitamin is essential for calcium absorption and bone health and for many other functions in the body. In pregnant women, insufficient vitamin D levels may increase the risk of preeclampsia and miscarriage.20,45,46 The IOM recommends a vitamin D intake of 15 mcg (600 IU) whether or not a woman is pregnant.11,12 Some experts recommend higher intakes, advising that pregnant women should receive 50 mcg (2,000 IU) of vitamin D per day through the winter months to maintain sufficient vitamin D levels.34,43 (For more on vitamin D sources from sunlight, fortified foods, supplements, or a combination, see pages 225 to 228.)
Vegans, in general, must pay special attention to ensure an adequate intake of this vitamin, and it’s particularly important for pregnant vegans to consume enough vitamin B12 to bring a healthy baby to term. The small proportion of vegans who have failed to ensure reliable sources of vitamin B12 for themselves and their babies has created regrettable situations in which the infants weakened and had seizures, convulsions, irreversible brain damage, and nerve damage. Ultimately, some didn’t survive. This is a devastating and completely avoidable tragedy.
When an infant born of a vegan mother has vitamin B12 deficiency, the reputation of the vegan diet is tarnished. In addition, some health professionals become leery of such “restrictive regimens” and, in some cases, entire medical associations take a stand against vegan diets, discouraging their use during vulnerable periods of life, such as pregnancy and childhood. This is most unfortunate, considering the ethical, ecological, and health benefits associated with vegan diets.11,14,47–49
A pregnant woman’s RDA for this vitamin is 2.6 mcg (slightly higher than before pregnancy). However, based on input from many experts, higher intakes are advised; any excess will be excreted in the urine. The vitamin B12 consumed by the mother is passed on to the fetus (and later on, a breast-fed infant receives this vitamin through mother’s milk). Without an adequate source of vitamin B12, the baby has an increased risk of being pre-term, suffering neural tube defects, and developing other serious complications. As a result, pregnant women must ensure they have a reliable source of this essential nutrient.47,48,50–52
During pregnancy (and lactation), it’s essential that a woman adopts one of the following practices:
• Take a daily supplement that provides at least 25 mcg of vitamin B12; it’s fine to take 100 or 250 mcg or more. This dose can be part of a multivitamin or pregnancy supplement.
• Two or three times a week, take 1,000 mcg of vitamin B12. Taking 2,500 mcg of vitamin B12 twice a week also is acceptable.
• Three times a day, eat a B12-fortified food (such as a breakfast cereal, a vegan meat substitute, or Red Star Vegetarian Support Formula nutritional yeast). Each choice should deliver at least 1.5 mcg per serving; a product whose label shows that a serving contains at least 25 percent of the Daily Value (DV) for vitamin B12 will provide that amount. It’s wise to combine occasional use of a supplement with this approach.
For optimal health of both mother and baby, a healthy vitamin B12 status throughout pregnancy and lactation is imperative. See pages 214 to 222 to review the essential functions B12 performs, the effects of deficiency, and tests that determine vitamin B12 status. Serum vitamin B12 levels should be 350 pg/ml or higher. In vegans who regularly consume seaweeds, serum vitamin B12 may not accurately reflect true levels, depending on the test used; the vitamin B12 analogs present in seaweeds can result in a higher reading even though the true level of serum B12 is inadequate. In such situations, laboratory tests that measure holo-transcobalamin and methylmalonic acid can be conducted to verify B12 status.47,48,50–53
The recommended intake of pyridoxine during pregnancy is 1.9 mg per day. Low intakes of this vitamin may be associated with low birth weight.54 Vegan diets contain plenty of pyridoxine-rich foods; some of the richest sources are avocados, bananas, chia seeds, soybeans, and sunflower seeds. (For more on pyridoxine, see pages 244 and 245 and table 7.3 on page 252.)
For many expectant mothers who experience morning sickness, pyridoxine—in the range of 10 mg taken three times a day for five days—has proved to be a safe and effective way to reduce symptoms.9,10 However, it’s wise to check with a physician before beginning this regimen. Research on this remedy has proved to be a challenge, because morning sickness also seems to resolve without any treatment.
The fetus requires choline to build its cell membranes and for the transmission of nerve impulses. It accumulates in the placenta, so the baby’s environment is rich in this vitamin. Because choline is a part of all cell membranes in both animals and plants, it’s widely distributed in plant foods in moderate amounts. Choline wasn’t classified as an essential nutrient until 1989. As a result, data regarding the choline content of many plant foods is limited, in comparison with data on other vitamins.14,15,19
Choline is available in every food group, including grains; however, it’s lost during the refining process and isn’t restored when grains are enriched. As long as a woman eats a diet high in unrefined foods, consuming enough choline isn’t a problem. In addition, the body has some ability to manufacture choline, depending on the rest of the diet. (For more on choline, see page 249, table 7.2 on page 250, and table 9.3 on page 289.)11,14,15,19
The recommended intake for choline increases just slightly when a woman becomes pregnant, from 425 mg to 450 mg. This amount is available in a diet centered on whole plant foods, in which few calories are wasted on sugars and oils. To prevent potential neural tube defects, it may be advisable for women who plan to become pregnant and those in the first trimester to take a choline supplement. The label of a multivitamin-mineral supplement should be checked to see if choline is listed.11,14,15,19
A baby requires the long-chain omega-3 fatty acids DHA and EPA for the normal development of its retinas, brain, and central nervous system. Higher levels of these essential fatty acids in pregnant women and in breast milk have been associated with improved health outcomes for babies. Although a normal body has the ability to synthesize these fatty acids (DHA and EPA) from alpha-linolenic acid (ALA), to meet the needs of the developing fetus, a pregnant woman’s body develops superpowers in this regard. The baby gains most of its body fat during the last ten weeks of pregnancy and will gain fat from the essential omega-3 and omega-6 fatty acids in the mother’s diet, from her body’s production of DHA and EPA, and from her body’s stores. It’s important that expectant mothers are well nourished with these beneficial fats early in pregnancy—and even before becoming pregnant—and well equipped to pass along long-chain omega-3 fatty acids to the developing baby.55–60
Despite the enhanced ability of a pregnant woman’s body to synthesize DHA and EPA from ALA, levels of these fatty acids are lower in pregnant vegans and in vegan breast milk, compared to the general population. The extent to which DHA and EPA can be synthesized from the ALA in foods such as flaxseeds, hempseeds, and walnuts is the subject of considerable scientific research and debate (see pages 120 to 121).
To maximize the conversion of plant-based omega-3 fatty acids to EPA and DHA, vegans should aim for a ratio of omega-6 to omega-3 fatty acids in the range of 2:1 to 4:1. Foods containing trans-fatty acids should be avoided, as should alcohol and smoking; all these factors inhibit DHA production. (Labels on margarine, crackers, cookies, pastries, and other processed foods that list partially hydrogenated vegetable oil indicate the presence of trans-fatty acids.)55–60
For pregnant vegans, experts commonly recommend intakes of about 300 mg of DHA (or DHA and EPA combined) per day.57,61–63 Vegan-friendly DHA supplements may be used. Expectant mothers can also consume foods and oils fortified with microalgae-derived DHA, although fortification levels are generally low. According to the Academy of Nutrition and Dietetics, “Because of DHA’s beneficial effects on gestational length, infant visual function, and neurodevelopment, pregnant and lactating vegans should use a microalgae-derived DHA supplement.”1 The DHA in fish is derived from marine microalgae, as is the DHA in these supplements, but the latter is uncontaminated with mercury and is a safer choice. To find suitable supplements, do an Internet search for “vegan DHA.”
BREAKFAST |
1 cup (250 ml) cereal with ½ cup (125 ml) blueberries or other fruit and 1 cup (250 ml) fortified soy milk |
1 slice whole wheat toast with 2 tablespoons (30 ml) almond butter or seed butter |
1 cup (250 ml) fresh-squeezed orange juice or other fruit |
SNACK |
½ cup (125 ml) carrot sticks with ¼ cup (60 ml) hummus |
LUNCH |
Sandwich with ½ cup (125 ml) seasoned tofu, 2 slices whole-grain bread, and lettuce |
2 cups (500 ml) tossed salad with ½ avocado and 2 tablespoons (30 ml) Liquid Gold Dressing (page 219) |
SNACK |
2 figs or another choice of fruit |
2 tablespoons (30 ml) almonds or other nuts, peanuts, or seeds |
1 cup (250 ml) fortified soy milk |
DINNER |
1 cup (250 ml) beans (such as black, red, or pinto) and ½ cup (125 ml) brown rice |
½ to 1 cup (125 to 250 ml) cooked kale with lemon juice |
1 cup (250 ml) tomato slices |
Nutritional analysis:17,18 calories: 2,135; protein: 97 g; fat: 85 g; carbohydrate: 271 g; dietary fiber: 60 g; calcium: 1,400 to 2,109* mg (intake depends on choice of tofu, nuts, and fruit); iron: 22 mg; magnesium: 791 mg; phosphorus: 1,817 mg; potassium: 4,938 mg; selenium: 94 mcg; sodium: 1,451 mg; zinc: 15 mg; thiamin: 3.2 mg; riboflavin: 3.4 mg; niacin: 23 mg; vitamin B6: 2.8 mg; folate: 911 mcg; pantothenic acid: 6.1 mg; vitamin B12: 5.1 mcg; choline: > 450 mg; vitamin A: 1,928 mcg RAE; vitamin C: 234 mg; vitamin D: 5.6 mcg (221 IU); vitamin E: 18 mg; vitamin K: 497 mcg; omega-6 fatty acids: 21 g; omega-3 fatty acids: 6.8 g
Percentage of calories from protein: 18 percent; fat: 34 percent; carbohydrate: 48 percent
• Substitute similar items, such as other fruits, vegetables, or beans.
• For equally high-protein intakes without the use of soy, use a different nondairy milk, increase the hummus in the snack to ⅔ cup (185 ml), and replace the tofu with 1 cup (250 ml) of lentils (perhaps in a soup).
• To replace the Liquid Gold Dressing, use 2 tablespoons (30 ml) of ground flaxseeds, 2 teaspoons (10 ml) of flaxseed oil, or a handful of walnuts (thereby providing omega-3 fatty acids).
TABLE 9.4. Sample guide for pregnancy and lactation (by food groups)
The sample pregnancy menu features protein-rich foods at every meal and snack; no calories are wasted on fats or sugars, which don’t deliver valuable nutrients. Folate, potassium, and choline are provided by the assorted vegetables, fruits, and beans. The high fiber intake, aided by water and walking, helps to prevent constipation. The beans, hummus, soy foods, cereal, nuts, and seeds deliver copper, zinc, and also iron, though not quite as much iron as the high intakes recommended during pregnancy (an iron supplement may still be advisable). The ratio of omega-6 to omega-3 fatty acids is about 3.5:1.
This basic menu meets a pregnant woman’s nutritional requirements, while allowing for substitutions to add variety and for additional foods to increase calories a little or to satisfy cravings. However, expectant vegans should choose treats based on whole foods, such as frozen fruit “ice cream” or nuts and dried fruit. With minor modifications (page 297), this menu also is appropriate for vegan mothers when breast-feeding. (It’s a variation of The Vegan Plate (page 434), with increases in legumes from 3 to 4.5 servings, in grains from 3 to 6 servings, and in vegetables from 5 to 6 servings, with other additions as desired.)
Prenatal or other supplements should include iron, zinc, iodine, vitamin B12, and vitamin D, probably along with folate (page 294). DHA is an optional addition (page 296). Excess intakes of vitamin A in the form of supplements can be harmful; monitor intake to avoid taking too much. Also avoid herbal supplements and botanical remedies unless first discussed with a health care provider.
Drink plenty of water and other caffeine-free fluids.
• Avoid alcohol and smoking; minimize caffeine, pesticides, and other harmful contaminants. There’s no need for a woman to become stressed over a drink consumed early in pregnancy, before the pregnancy was detected. However, once pregnancy is confirmed, alcohol should be entirely avoided throughout the pregnancy, because alcohol is toxic to developing brain cells. In addition, alcohol passes from the mother’s blood through the placenta to the fetus, whose liver isn’t sufficiently mature to manage this substance.
The placenta is a filter that can screen out toxins of a certain size, but it can’t totally protect a fetus, so an expectant mother must do her part and shun toxic substances in the first place. Whenever possible, organic foods grown without pesticides should be chosen. Pregnant women shouldn’t use powerful anti-inflammatory agents, such as chamomile tea and aspirin. Due to the risk of bacterial contamination, sprouts and unpasteurized juices shouldn’t be consumed during pregnancy. Spirulina can contain unsafe contaminants from other types of algae and should be avoided.
The same goes for other habits that can potentially harm a developing fetus. Smoking tobacco or marijuana causes vasoconstriction that limits the fetal oxygen supply and should be completely avoided.71 Although the amount of caffeine known to be safe for expectant mothers is uncertain, a limit of 200 mg daily is commonly suggested; less may be better. The amount of caffeine in 1 cup (250 ml) of coffee (100 to 200 mg) or tea (40 to 75 mg) or 1 ounce (30 g) of dark chocolate (15 mg) daily appears safe. So, expectant moms can enjoy a vegan brownie.
• Stay active. In Victorian times, a woman’s pregnancy was called her “confinement” or “lying in.” However, staying active during pregnancy has numerous advantages: feeling good, staying fit and shapely, and toning muscles for a vigorous delivery. Although expectant mothers shouldn’t ski, scuba dive, roller blade, perform gymnastics, ride horses, or participate in activities where falling is a risk, many pleasant possibilities are available. Half an hour a day of swimming, water aerobics, prenatal yoga, or walking are high on the list. Mothers-to-be who jogged and cycled before pregnancy may be fine to continue. However, women who aren’t accustomed to exercise—or who have a high-risk pregnancy—should check with their doctor to determine safe levels of activity.6,16,31
• Enjoy soy. Should soy foods be avoided during pregnancy and lactation? In general, it’s important for women who are allergic to soy, or who have unresolved thyroid problems and low iodine status, to avoid soy foods. Of course, low iodine status and thyroid problems are to be resolved for a healthy pregnancy. Apart from these cautions, a maximum of three servings per day of soy foods is both safe and beneficial. In fact, their consumption may reduce the risk of breast cancer later on.4,72,73 (For more on soy, see pages 105 to 106.)
For excellent books and websites on vegan nutrition during pregnancy and lactation, look through Resources on pages 449 and 451.
One of the important decisions a new mother must make is whether her infant should be breast-fed or bottle-fed. As nature intended, breast milk is the best food for a baby. Occasionally, breast-feeding isn’t possible; in such cases, parents can be confident that babies also thrive on commercial iron-fortified formulas. Such formulas have been designed to replicate breast milk as closely as possible and will support healthy development (page 307).74–77
Parents should never try to make their own infant formulas; because it’s not so easy to duplicate nature’s recipe, homemade formulas can lead to poor child development, failure to thrive, or worse. Also, plain cow’s milk, goat’s milk, or nondairy milks are not suitable substitutes. The only safe and nutritionally adequate primary milks for a baby’s first year of life are breast milk or commercial infant formula.
Breast-feeding confers numerous health benefits to the baby as well as to mom. As a result, the World Health Organization (WHO) recommends exclusive breast-feeding for the first six months of life, followed by the introduction of solid foods at six months, together with continued breast-feeding (along with complementary foods) up to 2 years of age and beyond. The American Academy of Pediatrics (AAP) has similar guidelines, advising exclusive breast-feeding for the first four and preferably six months.28,76,78 Even a short period of breast-feeding is beneficial.
The balance of protein, fat, and carbohydrate in human breast milk is ideal for infants. Its low protein content, digestibility, and balance of amino acids closely match infant requirements, and the proportion of sodium is ideal for the infant’s kidneys. Breast milk provides ample vitamins and minerals, as well as DHA. It also contains a number of protective substances, such as antibodies, cytokines, antimicrobial agents, and oligosaccharides.
Breast milk guards against gastrointestinal illness and supports the maturation of the infant’s intestines. A breast-fed baby is less likely to develop colds, ear infections, stomach upsets, allergies, and asthma. Later in life, he or she will have reduced risk of diabetes, heart disease, and childhood leukemia; will be less prone to be overweight as a child or adult; and is more likely to do well at school. Breast-feeding helps avoid excess weight gain; babies nurse until satisfied, and there’s not that push on the part of parents or caregivers for the baby to finish the last half ounce in a bottle.79,80 In addition, breast milk composition adjusts automatically to meet an infant’s changing requirements over time. Scientists continue to study this amazing fluid but have yet to duplicate it exactly.
Advantages for mom include faster postpartum weight loss—especially if breast-feeding lasts for six months or more—and reduced risk of developing diabetes, breast cancer, and ovarian cancer later in life. The slight increase in maternal food intake required to support breast-feeding is economical, compared to the cost of formulas, bottles, and equipment for safe formula preparation. Breast milk is always at the perfect temperature and is “food safe,” so it isn’t necessary to warm bottles and cart quite so many supplies on outings. Most importantly, breast-feeding offers superb one-on-one time with baby.
Unfortunately, potentially toxic environmental pollutants are commonly found in human milk at levels that would prevent its sale as a food for infants. Maternal intakes of meat, fish, and dairy products typically lead to higher levels of dieldrin and polychlorinated biphenyls (PCBs) in breast milk. In contrast, studies have shown that the breast milk of vegan and vegetarian mothers contains fewer toxic contaminants, compared to milk from nonvegetarian women; the breast milk of vegetarians shows lower levels of pesticides, such as DDT, chlordane, and heptachlor, and industrial by-products, such as PCBs. In an American study, the highest value for six contaminants in the breast milk of vegans was lower than the lowest value from the breast milk of women on standard American diets. Naturally, a plant-based diet composed of organic foods would be the best choice to avoid toxins.6,31,81–83
Because nursing is a new experience for both mother and baby, getting started can take a little time. Some infants begin nursing immediately, while others have some difficulty. In those cases, many mothers benefit from the help of a lactation specialist, who can help find the best position for nursing; for example, the baby’s entire body can be arranged in arm and lap (now that mom has a lap again) during feeding. Many mothers find lying down to nurse a comfortable position, especially at night.
With minor modifications, the menu that appears on page 297 can provide a general plan for a mother’s diet during lactation. The Vegan Plate (page 434) also is a good guide, increasing the legumes to at least 4.5 servings for the day, upping grains to 6 or more servings, and adding carotenoid-rich vegetables and other nutritious choices listed in the sections that follow.
For the first six months, breast-feeding mothers need to consume approximately 500 calories more each day than they did before pregnancy. (To gradually lose the extra weight gained in pregnancy, a new mother may choose to get the nutrition she and baby need by consuming only about 330 extra calories a day, focusing on highly nutritious foods.) Mothers who continue to breast-feed during the baby’s second six months and whose weight has returned to the desired level will need about 400 extra calories per day. The actual ideal calorie intake depends on the infant’s appetite and the amount of food he or she consumes apart from breast milk.2 With nursing twins, mothers need more of all nutrients, including calories. As in pregnancy, small frequent meals are a good way to ensure ample intakes of calories and protein.
The key dietary adjustments required during breast-feeding are increased fluid intakes; greater consumption of vitamin A (from the carotenoids in yellow, orange, red, and green foods; see page 233) and most other nutrients; and the addition of calories and small amounts of certain other nutrients. Soy foods have a negligible effect on the isoflavone content of breast milk; it’s safe and reasonable to include two to three servings a day of soy foods.6,31,84 (For specifics on vitamin and minerals, see table 9.1 on page 287; for food sources, see chapters 6 and 7.)
A new mother needs plenty of fluids while breast-feeding and should keep a glass of water near the comfortable chair used during nursing. Juices, soy milk, soups, and smoothies also are suitable. (Note that avoidance of cow’s milk on the part of the mother may lessen the likelihood that her breast-fed baby will experience colic.)
The word protein is related to the German word meaning “primary” and the Greek word meaning “first.” High-protein foods (such as legumes, whole grains, greens and other vegetables, and nuts and seeds) need to be the top priority as meals and snacks because they provide plenty of iron, zinc, calcium, other minerals, and many B vitamins along with the protein. The recommended daily intake for protein is unchanged from the second and third trimesters of pregnancy—about 25 grams above the amounts the mother consumed when not pregnant. The menu on page 297 provides 97 grams of protein and can be suitable as a general meal planner for nursing mothers, who can add foods or increase portions to suit appetite and needs. (Also see table 9.3 on page 289.)
The nutritional demands placed on a mother’s body during lactation are slightly different than those of pregnancy. The following sections describe the roles and recommended intakes of minerals and vitamins during lactation.
A woman’s RDA for iron is high during pregnancy, but this requirement drops dramatically during lactation. Her body is no longer building an increased blood supply, menstrual iron losses have not yet resumed (at least for a while), and breast milk contains only moderate amounts of iron. As a result, the RDA for a lactating vegan mother is 9 mg (see table 9.1 on page 287 and the section on iron on page 186).
Although the iron present in breast milk is extremely well absorbed by baby, some newborns may require iron supplements. The AAP provides the following guidelines regarding iron supplementation for infants. A preterm infant, whose iron stores are not sufficiently built up and who is breast-fed, requires supplemental iron under medical supervision; if bottle-fed, an iron-rich formula is necessary. Full-term breast-fed babies may be given iron drops starting at 4 months of age until sufficient iron-rich foods are introduced, because their iron stores start running low around 4 to 6 months of age.28
A breast-feeding mother’s recommended intake for zinc (12 mg) is even higher than it was during her pregnancy (11 mg). Mothers must make it a priority to include zinc-rich foods (see page 292).11,13,34
At 1,000 mg per day, the RDA for calcium stays constant during pregnancy and lactation (see table 10.1 on page 312). Breast milk contains adequate calcium because of physiological changes in the mother’s body that include doubly efficient absorption and also because she may pass some of her own stored calcium (from bones) to her baby. It’s important to meet the calcium RDA, though high intakes from diet and supplementation don’t seem to prevent the temporary maternal losses from bone. However, studies show that after weaning, the mother’s bone mineral content is restored.11,12,34
During lactation, a woman’s RDA for vitamin D remains at 15 mcg (600 IU). Medical experts who advise higher intakes suggest that, through the winter months, a breast-feeding woman should receive 50 mcg (2,000 IU) of vitamin D per day to meet her own body’s needs. If a mother with little or no access to sunshine were to meet both her own needs for vitamin D plus those of her infant (through her milk), it’s estimated that she would need 100 mcg (4,000 IU) of vitamin D daily.43
Because transfer of this vitamin through breast milk can be uncertain, and breast milk is typically low in vitamin D, an infant should receive his or her own vitamin D drops directly, starting soon after birth. The AAP recommends that infants and children through adolescence have a daily intake of 10 mcg (400 IU) of vitamin D to age 1 and 15 mcg (600 IU) thereafter. (For more on vitamin D, see pages 222 to 230.)11,12,55
Vitamin A has an important role in cell differentiation, allowing cells to become specialized to carry out specific tasks. Thus, the effects of this nutrient are diverse. Vitamin A is needed for the growth of bones and teeth, for reproduction, and for the building and regulation of hormones.13
During lactation (and pregnancy), a woman should adopt one of the following practices:
• Take a daily supplement that provides at least 25 mcg of vitamin B12; it’s fine to take 100 or 250 mcg. This dose can be part of a multivitamin or pregnancy supplement.
• Two or three times a week, take 1,000 mcg of vitamin B12. Taking 2,500 mcg of vitamin B12 twice a week also is acceptable.
• Three times a day, eat a B12-fortified food (such as a breakfast cereal, a vegetarian meat substitute, or Red Star Vegetarian Support Formula nutritional yeast). Each choice should deliver at least 1.5 mcg per serving; a product whose label shows that a serving contains at least 25 percent of the Daily Value (DV) for vitamin B12 will provide that amount. It’s wise to combine occasional use of a supplement with this approach.
In vegan diets, vitamin A is derived from the carotenoids in orange, yellow, and green vegetables and fruits. The menu on page 297 provides sufficient vitamin A from the carrots, lettuce, kale, and tomatoes as well as the soy milk. (For more on vitamin A, see pages 233 to 235.)
Generally, the amounts of water-soluble vitamins in breast milk reflect the mother’s intake from diet and supplements. Thus, maintaining a good diet is important for the health of the child. The pattern of food groups and number of servings from each in table 9.4 on page 299 was designed to cover these vitamins.
It is absolutely critical that lactating mothers continue to consume a reliable source of vitamin B12 (see page 294). Babies require this nutrient for the normal development of brain, nerve, and blood cells, and their supply of B12 comes from the mother’s diet, not her body stores. The fetus stores a little vitamin B12 obtained during pregnancy, though if the mother was deficient during pregnancy, infant stores will be negligible. At best, infant stores will last for only about three months after birth, sometimes less. Lack of vitamin B12 can impair the infant’s brain development and cause neurological problems.85–89
Even if a nursing mother shows no symptoms of vitamin B12 deficiency, the situation is precarious if her vitamin B12 intake is inadequate and her stores are low. To ensure adequate intakes, nursing mothers require supplemental vitamin B12 or B12-fortified foods as sources for themselves, as well as for their infants. In fact, supplements are a better choice than fortified foods, due to reliability of the delivered dosage.47,48,50,51,85–89 The summary in the sidebar above is a duplicate of that from the pregnancy section, repeated due to its importance.
The recommended intake for folate during lactation (500 mcg) is lower than it was in pregnancy, but higher than before a woman became pregnant (see table 9.1 on page 287).12,14 (For more on folate, see pages 246 and 290.)
The recommended intake for pantothenic acid increases from 6 mg in pregnancy to 7 mg during lactation.12,14,18 To modify the menu on page 297 to meet this recommendation, include the remainder of the avocado, add ¾ cup (185 ml) of sweet potato or mushrooms at dinner, or make the breakfast choice 2 cups (500 ml) of oatmeal plus a big banana.
The nursing mother’s RDA for vitamin E also increases to 19 mg; nuts, seeds, and avocados are great sources of both vitamin E and pantothenic acid.12,18 (For more information on good sources of these vitamins, see pages 237 and 243, and table 7.3 on page 252).
Breast milk is rich in choline, a nutrient that’s good for baby’s brain development; infant formulas, including soy-based versions, tend to provide less choline.14 To ensure a good supply of choline, see table 9.3 (page 289) and table 7.2 (page 250).
During lactation—as at other life stages—it’s essential to consume excellent sources of alpha-linolenic acid (ALA), such as chia seeds, ground flaxseeds, flaxseed oil, hempseeds, or walnuts (see suggested quantities in The Vegan Plate on page 434). ALA can be converted to DHA, which is present in all cells and especially in the gray matter of the brain and the retina of the eye.
Certain dietary choices affect a vegan mother’s ability to convert ALA to DHA, allowing her to increase the amount of DHA delivered to baby through her breast milk. The body converts ALA to DHA most efficiently when the intake of oils high in omega-6 fatty acids is somewhat limited, thereby maintaining the optimal ratio of omega-6s to omega-3s (see page 296). Avoiding trans-fatty acids, processed and deep-fried foods, alcohol, and smoking also assists the conversion process (see pages 120 to 121).
Research suggests that DHA plays an important role in the mental and visual development of infants.57 Preterm infants need supplemental DHA because this essential fat is so important to their development during the third trimester, and a premature baby is not yet able to synthesize his or her own DHA. Formulas for premature infants have been designed to include DHA; similar formulas also are available for full-term infants.90
In one small UK study, the amount of DHA in the breast milk of vegans who didn’t use supplemental DHA was shown to be about 38 percent that of nonvegetarians.99 However, the balance of omega-6 to omega-3 fatty acids in these mothers’ diets averaged about 18:1—far greater than what’s recommended for optimal conversion. Studies from the UK have also shown reduced DHA in the breast milk of lacto-ovo vegetarians, compared to nonvegetarians, although US studies found no significant differences.59 The amount of DHA added to formula is quite variable (check labels) and can be less than what’s found in breast milk, even that of unsupplemented vegans.
Taking a microalgae-derived DHA supplement seems a reasonable option to boost the DHA levels of breast milk. (Compared to fish oil, microalgae-based supplements offer a distinct advantage for all lactating women because the plant-based supplements are free of environmental contaminants.) The amount recommended by several groups of experts is in the range of 200 to 300 mg of DHA per day.61–63 Nursing mothers also can consume foods or oils fortified with microalgae-derived DHA, although most contain only small amounts. A combination of DHA and EPA also is suitable, because the body can covert from one to the other, to some extent.
Although, to a new mother, the needs of the baby come first, she shouldn’t neglect her own well-being during the baby’s early months.
• Regaining a pre-baby figure. A vegan diet is a great help in supporting a gradual return to prepregnancy weight. Women lose, on average, 1.75 pounds (0.8 kg) per month during the first six months after birth. More-rapid weight loss isn’t recommended while a mother is breast-feeding, because severe cuts in calories can affect the milk supply. A better choice is to find ways to gradually include exercise in the daily routine; walking is a very good choice.
• Diet for role models. Whether or not a new mother chooses to breast-feed, her diet still matters—and not just for her health. An alert baby’s eyes take in every move made by caregivers; mom’s and dad’s dietary habits can create a healthy foundation for their children’s lifelong practices. Knowing the impact their habits will have, this often is the time for parents to make big improvements in food choices, if they haven’t already.
• Lack of time. Among all the new demands that nursing mothers face, the thought of preparing elaborate meals and snacks (or any meals at all) can seem daunting. However, healthy meals don’t have to be fancy, nor do they need a great deal of preparation. A nutritious meal can be as simple as a bowl of cereal and fruit with nondairy milk; crackers with peanut butter and an apple; or a baked potato and a salad with black beans or chickpeas sprinkled on top.
To reduce preparation time, parents can use convenience foods: canned beans, frozen vegetables, mixes, chopped vegetables, and frozen veggie burgers or entrées. Stir-fries offer endless variety. Time-saving appliances, such as slow cookers and pressure cookers, can be useful when preparing big batches of favorite bean dishes or lentil or pea soups; the excess can be served as leftovers or frozen in individual portions for future meals.
A focus on easy-to-prepare foods can leave more time for other activities. For example, one smart mom whose infant is thriving chose a combination of beans, kale, and quinoa as her dietary mainstay during lactation to find time to get herself back into shape (quinoa cooks in fifteen to twenty minutes). Such a combination can be eaten for breakfast or, for variety at other meals, spiced up with salsa. Snacks add interest to such a basic menu: vegetables with hummus, tofu, or avocado dip; rice or corn cakes with nut or seed butters; or trail mix and fruit or juice.
Finally, instead of hosting a baby shower, suggest that friends or family provide the gift of time, by supplying a frozen vegan meal, a vegan restaurant or take-out coupon, an hour or two of housekeeping help or babysitting, or a massage.
Vegetarian (including vegan) women tend to extend breast-feeding longer, compared to nonvegetarians. The WHO and the AAP support breast-feeding for two years or longer, along with the introduction of iron-rich foods and other foods starting at about 6 months of age (see page 309).28,76,77 Nature seems to have intended the natural age of weaning to be between 2 and 4 years of age, when lactase, the enzyme that breaks down the milk sugar lactose, naturally declines.
In certain circumstances, mothers may need to supplement breast-feeding with the use of infant formula, either as the baby’s primary source of nutrition or as an occasional option.
The AAP advises that the only acceptable substitute for breast milk during a baby’s first year is iron-fortified infant formula. This formula choice can help prevent the development of iron-deficiency anemia. (Formula contains higher levels of iron than breast milk; however, the iron in breast milk is more readily absorbed.) Premature infants are at the highest risk of iron deficiency, because their iron stores can be very low. In full-term infants, iron stores typically last for about the first six months; solid foods—particularly those containing iron—should then be introduced.
Though infant formula lacks some of the immune-protective compounds found in breast milk, it does supply adequate amounts of vitamins D and B12. The selected formula should also contain added DHA.28,75 (For a link regarding formula choices, see Resources on page 449.) Standard formulas are based on cow’s milk or on soy milk; these are fortified carefully so they provide nutrition that’s similar to breast milk, as much as possible. For parents who wish to raise vegan infants, soy formula is the best option. Both the AAP and the US National Toxicology Program have approved the use of soy formula for infants.91–95 Soy formula is as safe as formula based on cow’s milk; it ensures normal growth and has been used successfully since 1909. Soy formula isn’t intended for preterm infants or for those with congenital thyroid problems.100
As this book goes to press, soy infant formulas currently available in North America are close to being 100 percent vegan. However, they contain vitamin D3 derived from lanolin in sheep’s wool. At least one soy formula contains oleo (beef fat), making it unsuitable for vegans, so check labels. Unfortunately, vitamin D2, which normally is derived from irradiated yeast, can’t be included in a product labeled “organic,” so organic products generally contain vitamin D3. Formula companies continually make improvements in their products, and with sufficient consumer demand, any of these companies could produce an entirely vegan formula using vitamin D2 or using vitamin D3 from lichen (a plant-sourced vitamin D3).