Folic acid supplementation in the second + third trimesters

It is very important to ensure adequate folic acid intake from 3 months before conception to the end of the first trimester. For most of us that means taking a prenatal vitamin (tricky because that’s usually when we are the LEAST interested in popping pills). My question, however, is how important is it to take folic acid supplements in the second and third trimester?

It is well documented that folic acid supplementation and food fortification reduces the incidence of neural tube defects such as spina bifida. The research about the importance of folic acid supplementation beyond the first trimester is less clear, and in fact, there is a little research to show that perhaps we don’t want extremely high levels later in pregnancy. It may increase the risk of allergy, and also may be correlated with increased risk of autism. There is definitely not enough research yet to draw any conclusions, but I would say that it’s safe to get a little sloppy with your daily prenatal supplement after the first trimester. Dosing of 3-5x per week seems to be safe, and the baby is really growing LOTS later in the pregnancy, so you want to make sure the little one has access to all of the other nutrients needed for development.

The best bet is to skip a couple doses of prenatal vitamins each week (after the first trimester), and be sure that you have a very nutrient dense diet to act as a safety net.

Here are some dietary sources of folic acid to include in your diet:

Table I This table charts the sources of dietary folate from different food.
Food 1 Food Guide Serving Micrograms of folate as dietary folate equivalents (µg DFEs)
Lentils and romano beans 175 mL 265-270
Black beans 175 mL 190
Okra 125 mL 140
White beans 175 mL 125
Asparagus and spinach, cooked 125 mL 120
Salad greens, such as Romaine lettuce, mustard greens and endive 250 mL 80-110
Pinto beans, kidney beans and chickpeas 175 mL 70-100
Pasta made with enriched wheat flour 125 mL 90
Avocado ½ fruit 80
Sunflower seeds, shelled 60 mL 80
Bagel made with enriched wheat flour ½ bagel (45 g) 60-75
Brussels sprouts, beets and broccoli, cooked 125 mL 70
Bread made with enriched wheat flour or enriched corn meal 1 slice or ½ pita or ½ tortilla (35 g) 45-65
Spinach, raw 250 mL 60
Orange juice from concentrate 125 mL 60
Parsley 125 mL 50
Parsnips 125 mL 50
Peanuts, shelled 60 mL 45
Eggs 2 large 45
Corn 125 mL 40
Seaweed 125 mL 40
Orange 1 medium 40
Green peas 125 mL 40
Raspberries, strawberries, blackberries 125 mL 15-35
Enriched ready to eat cereal 30 g 10-35
Broccoli and cauliflower, raw 125 mL 30
Snow peas 125 mL 30
Pineapple juice 125 mL 30
Walnuts, almonds and hazelnuts, shelled 60 mL 20-30
Baby carrots 125 mL 25
Kiwifruit 1 large 20
Clementine 1 fruit 20

Other important supplements in pregnancy include:

  • Omega 3 fatty acids for brain development (DHA in particular)
  • Vitamin D if you are deficient (mostly to ensure adequate levels in breastmilk postpartum)
  • Calcium and magnesium after the first trimester to support bone development and to protect mom’s bones, as well as prevent leg cramping later in pregnancy

Healthy cookies for breakfast!

healthy cookies gluten-free paleo dairy-free veganHealthy cookies are my go-to breakfast food. Seems crazy for someone in the health industry to admit that, but really my cookies are such healthy little morsels of goodness that I can feel really good about it. Here are a few of my favourite recipes:


Healthy cookie recipe #1:

1/2 cup coconut oil (melted)

1/2 cup almond butter

1/2 cup apple sauce

1 ripe banana (mashed)

2 flax eggs (2 tbsp ground flaxseed + 5 tbsp water, and let sit for a few minutes)

1 cup buckwheat

And then you can add dried fruit, coconut, nuts, chia, etc. You might even be so bold as to add chocolate chips 😉

Mix everything together and cook at 350C for about 10 mins (until undersides are starting to brown).


Homemade cookie recipe #2:

Mix in bowl:

2 cups rolled oats

1 1/4 cups buckwheat flour

1/2 teaspoon baking soda

1/2 teaspoon salt

 

Melt on stove top:

1/3 cup coconut oil

1/2 cup nut butter (almond for oatmeal raisin, PB for PB choc chips)

1/2 cup apple sauce

1/2 cup maple syrup

1 teaspoon vanilla extract

 

Mix in separate bowl:

6 tbsp ground flaxseed and enough water for it still be to relatively stirable

Then mix everything together adding options below…

 

Oatmeal raisin variation add:

1/2 teaspoon ground cinnamon

1/4 teaspoon grated nutmeg

1/2 teaspoon ground ginger powder

1 cup almonds/walnuts, chopped

1 cup raisins

 

PB choc chip variation add:

Chocolate chips obviously!

 

And I bet you could also use cashew butter and put in lemon extract and poppy seeds for another variation.


Healthy cookie recipe #3… okay these are brownies:

1/2 cup coconut oil (melted)

1/2 cup maple syrup

2 large flax eggs (2 tbsp ground flaxseed + 5 tbsp water, and let sit for a few minutes)

1 tsp vanilla extract

3/4 tsp baking powder

1/4 tsp sea salt

1/2 cup dutch-process cocoa powder

3/4 cup buckwheat flour

(Optional add-ins:) 1/3 cup walnuts, hazelnuts, coconut or chocolate chips

 

Instructions

Melt coconut oil in large pot. Remove from heat and add remaining ingredients in order listed.

Scoop batter evenly into 7-8 muffin tins until 3/4 full and bake on the middle rack for 22-26 minutes, or until the brownies start to pull away from the sides and they spring back slightly to the touch.

Food As Medicine Guide

Whole food diet

You are what you eat. Really you are! Putting good food in your mouth is one of the most personally and socially responsible things you can do. Not only does it impact your health (and demonstrates the highest form of self-care) but it affects those around you. You are modelling behaviour either way, so while you’re on your path to wellness, you might as well make positive choices that can ripple through your family, co-workers and beyond.

Eat a whole food diet

Eat real food. Stuff that looks, smells and sounds like food. No processed foods or anything with ingredients that you don’t understand. No food additives!

Avoid pesticides

Eat organic as much as possible. Especially avoid the dirty dozen.

dirty-dozen-clean-fifteen

Eat rainbows

Make 50% of your diet fruits and veggies. Not only do a lot of fruits and veggies in your diet have their own benefits, but they also crowd out other unfavorable foods.

For omnivores

If you eat meat, buy local organic grass fed meat or wild game. And eat only wild caught fish (no canned tuna or farmed salmon).

  • Red meat no more than once per week.fish
  • At least 3 vegan dinners per week.
  • Consider eating completely gluten-free vegan before 5pm.

 

Dietary sources of antioxidants

Antioxidants are vitally important to keep us healthy and young! They are easy to incorporate into your diet once you know where to find them.

  • Fruits and veggies of all colourstumeric-milk
  • Fresh veggie juice
  • Turmeric milk with black pepper
  • Antioxidant rich super foods: aim for 3 of these AT LEAST per day
    • Pomegranate, blueberry, goji berries, clove, cinnamon, oregano, cumin, parsley, basil, ginger, thyme, ALL herbs (fresh or dried), pumpkin seeds, chia, dark chocolate/cacao, red wine, brazil nuts, hemp hearts, coconut oil, rooibos teas, nutritional yeast, seaweed…
Fermented Foods
  • Provide exposure to good microbes.kombucha
  • Fermentation may alter some allergens.
  • Increases antioxidant content of food.
  • Kombucha, fermented veggies (including saukeraut), apple cider vinegar.
Liver + Immune Support
  • Dandelion tea
  • Raw garlic
    • At least 3 cloves per week.
    • TIP! Make a salad dressing with 3 cloves andtop veggies with it throughout the week
  • Cruciferous veggies

cruciferous-veggies

Naturopathic Doctors help with prescription medications

Naturopathic Doctors are experts in holistic wellness, including diet, exercise, stress reduction, and also prescription medications!

Why is it important to see a Naturopathic Doctor when you’re taking a prescription medication?

prescription-medications-deplete-nutrientsMany medications are life saving and necessary, but they can also strip the body of vital nutrients required for long-term wellness. A Naturopathic Doctor has extensive medical knowledge and database access to determine which nutrients and hormones are being impacted by a drug.

Examples of nutrient-robbing medications:
Drug Category Nutrients Depleted
ACE Inhibitors (for cardiovascular disease): Lotensin, Vasotec Zinc, sodium
Antibiotics: Penicillin, sulfonamide, erythromycin Calcium, magnesium, potassium, vitamin K, disruption of beneficial intestinal bacteria
Benzodiazepines (for anxiety and sleep): Valium, Xanax Melatonin
Beta Blockers (for cardiovascular disease): Inderal, Lopressor Coenzyme Q10, melatonin
Birth Control Pills: Ovral, Demulen Folic acid, vitamins B1, B2, B3, B6, B12, C, zinc, selenium, trace minerals
Bronchodilators (for asthma and respiratory problems): Albuterol, Serevent Potassium
Calcium Channel Blockers (for cardiovascular disease): Cardizem, Norvasc Potassium
Diabetes Drugs: Glucophage, Avandia Vitamins B12 and B6, folic acid, coenzyme Q10, sodium, zinc, magnesium, potassium
Estrogen: Premarin, Prempro Vitamin B6
NSAIDs: Ibuprofen, naproxen Folic acid, iron, vitamin C
Potassium-Sparing Diuretics: Aldactone, Dytac Folic acid, iron, vitamin C, zinc
SSRI Antidepressants: Prozac, Paxil Sodium, folic acid, melatonin
Statins (for lowering cholesterol): Mevacor, Zocor Coenzyme Q10
Thiazide Diuretics: Diuril, hydrochlorothiazide Magnesium, coenzyme Q10, potassium, sodium, zinc, thiamine, vitamins B6 and C
Thyroid Replacement: Synthroid Calcium
Ulcer Drugs: Zantac, Pepcid Vitamin B12, vitamin D, calcium, iron, zinc, folic acid, impaired protein digestion

Source: www.drwhitaker.com

It’s important to not see naturopathic medicine from an all-or-nothing perspective, but more so how it can support your current medical care and lifestyle. NDs are very happy to coordinate care with family physicians, specialists, dieticians, you name it. We are all members of your health team and speak the same medical language and have your wellbeing at heart.

Organic diet in Sudbury, Ontario

Moderation is key to a balanced lifestyle. That’s why it’s usually okay to eat that chocolate cake at a birthday party, as long as you generally eat healthy throughout the week. Eating organic as much as possible is a necessary step towards long-term health.

Organic diet in Sudbury, OntarioIt turns out that positive change can happen really fast! Eating organic can reduce the amount of pesticides circulating in your body by 90% after only ONE WEEK! Wow. You can’t ask for quicker results than that.

The study was performed in Australia in 2014 and involved eating 80% organic which might not be as easily done in Sudbury, Ontario. However, you can feel more motivated because any shift in the right direction will have nearly immediate consequences.

Naturopathic Doctors are your best allies for formulating your ideal organic diet free of allergens and FULL of nutrients.

Naturopathic health care accessibility

I am a Naturopathic Doctor in Sudbury, Ontario, and I see myself as a naturopathic health investigator. I also see myself as a vehicle for people to access natural but also more comprehensive health care.

My visit structure

naturopathic blood testI gather all relevant information (health history, medications, supplements, dietary habits, exercise, previous lab results, etc) and then sort through to determine the origin of the patient’s concern. This usually entails a 1 to 1.5 hour intake, blood work performed at LifeLabs and often some additional homework done by the patient (such as a diet and activity log like My Fitness Pal). Once all of the information is compiled the root cause if often quite obvious. It is then up to the patient (with my support of course) to put in the work required to turn things around. The sooner we catch it, the quicker the turn around. It is really rewarding to see such dramatic shifts in a patient’s health with such gentle interventions!

naturopathic checklistAfter the initial 1 to 1.5 hour naturopathic appointment I am almost always able to make some initial suggestions to get the ball rolling while we wait for the blood work results (be that dietary, lifestyle or supplement-based). I will then request a second appointment within an appropriate timeline (2-4 weeks depending on the initial suggestions), and it’s in this second appointment that I can really prescribe a comprehensive naturopathic treatment plan. The third visit is usually a quick check in to make sure we’re on the right path (often scheduled 4-6 weeks later), and after that visits are typically every 3 months if not longer… though many patients are completely better by the third appointment and I just ask them to come in if anything new arises.

Why it’s important to make naturopathic medicine accessible

I believe this is how naturopathic care should be. No, we can’t gather everything within a typical 15 minute appointment many of my patients are accustomed to with their family physician, but nor should our patients have to wait three full visits before receiving any recommendations. Naturopathic Doctors are well educated and that wisdom allows us to be able to have a good sense of what’s going on with the patient in the first visit based on the extensive intake. The labs and follow-up should be narrowing down and ruling out.

naturopathic diagnosisAs Naturopathic Doctors we are THE alternative diagnosticians to the conventional health care stream, and often times our first visit is a patient’s one foray into the natural health realm. We need to make our medicine accessible and useable. Having to wait until the third (often viewed as expensive – though covered by extended health care plans) visit for any sort of explanation of underlying cause or treatment can spook our patients, and more importantly limit their access to our knowledge.

If you have any questions or comments about this visit structure of style of practice please contact me at my practice Nickel Ridge in Sudbury, Ontario.