Sensible Eating

 

Chapter from Stretching & Pregnancy, 2001/2016

Some basic concepts

It is helpful to begin with some terms commonly used in discussing nutrition. This will be of assistance in understanding the recommendations contained in the rest of the chapter.

The components of food can be classified into three broad categories of macronutrients. These are protein, fat, and carbohydrate. All contain micronutrients. These are vitamins and minerals.

The energy content of food is now measured in kilojoules. Energy content used to be measured in kilocalories – commonly called, simply, Calories (with a capital C). One Calorie equals approximately 4.2 kilojoules.

Protein

Protein (from the Greek proteios, meaning ‘primary’), is made up of amino acids. There are nine essential amino acids (eleven for premature babies).

The proteins made up of these amino acids are the basic elements of:

  • more than 50 000 enzymes (essential to all chemical reactions in our bodies);
  • blood plasma; and
  • the structural proteins (for example, collagen, part of connective tissue, and muscle proteins).

Foods supplying proteins include:

  • meat, eggs, fish, and dairy products (these are high in proteins);
  • legumes, such as beans and lentils (moderately high);
  • whole grains (medium);
  • vegetables and fruit (low, but still significant).

Women require about 50 grams of protein daily. Pregnant women need an extra 30 grams per day (80 grams in total), and lactating mothers require about 20 grams extra per day (70 grams per day). Men require approximately 75 grams daily. These intakes of protein must include the essential amino acids in proportions suitable for our bodies.

Protein contains approximately 16.8 kilojoules (4 Calories) of energy per gram.

Fat

Fat is comprised of fatty acids. Some fats are said to be saturated (for example, animal fats) and others are said to be unsaturated (for example, olive oil). These terms refer to their chemical structure.

Just as there are essential amino acids, there are also essential fatty acids (EFAs) that our bodies must have daily. These are used to make all other required fatty acids. Fats make up (in part):

  • hormones;
  • cell membranes;
  • nerve sheaths; and
  • cellular transport mechanisms.

They are therefore essential to life.

Our bodies are made mostly of protein and fat, with some minerals.

Because fat contains 37.8 kilojoules (9 Calories) per gram, it is a concentrated source of energy.

Carbohydrate

Carbohydrate is the preferred energy source for our bodies. All vegetables, fruit, and grains are sources of carbohydrate. They are usually classified as being simple carbohydrates (sugars) and complex carbohydrates (starches).

Gylcaemic index (GI) is a useful measure of carbohydrate activity in the body. This indicates how rapidly a food is converted to glucose and how quickly blood glucose, the body’s fuel, rises.

Carbohydrate, like protein, contains about 16.8 kilojoules (4 Calories) of energy per gram.

Micronutrients

The micronutrients are:

  • vitamins (the absence of which leads to specific disease); and
  • minerals (which are essential for chemical and metabolic processes).

Some vitamins are antioxidants. This means that they bond with free radicals – which are byproducts of oxygen reactions in the body, and harmful in excess. This bonding leads to elimination of the antioxidants from our bodies.

Taking a new look at food

The majority of articles on food tend to concentrate on the kilojoule (or Calorie) content of food. Because fats contain the most kilojoules, these articles therefore tend to concentrate on the fat content of food. This has serious limitations for pregnant and lactating women. It is better to think about food in terms of the combinations of foods that will provide optimal nutrition for you and your child.

Expectant women (indeed, any person interested in health!) should try to minimise or avoid less desirable foods and maximise desirable foods in their diet. Desirable foods maximise nutrition and thus provide kilojoules that are beneficial. Less desirable foods have high kilojoule density and low nutritional density. The term ‘nutritional density’ refers to the extent to which the fifty nutrients that are essential to life are found in a particular type of food.

Let us look at a few examples.

White bread is very dense in kilojoules. One slice of white bread has roughly the same number of kilojoules as more than three and a half cups of broccoli – but the broccoli contains a huge range of additional vitamins, minerals, and phytonutrients (see below for more on phytonutrients).

White sugar is rich in carbohydrate, but contains no other nutrients –in fact, its digestion removes various micronutrients from the body, and its kilojoule density is relatively high. In contrast, spinach is rich in a large variety of nutrients. However, because of its vegetable structure, it is low in kilojoules.

As far as possible, you should try to eat food that is relatively kilojoule sparse and relatively nutrition rich because this ensures that the amount of nutrition you get in each mouthful of food is optimised. In the process, you will be avoiding unwanted weight gain (body fat). The total amount of energy that you need will depend on your activity level.

Another way of understanding this is to say that if you eat more of your food from the list of ‘What to include’ (below), you can eat a greater amount of food to achieve your desired kilojoule total, and each mouthful is giving you more in terms of nutrition.

And remember that all foods eaten in excess of energy requirements are stored as fat.

When choosing food, it is helpful to know that some complex carbohydrates have a very high glycaemic index (GI). In general, lower GI foods are preferable to higher GI foods because foods with a lower GI provide energy over a longer period. Pure glucose is given the highest rating of 100 and is the benchmark against which other carbohydrates are measured. The basic GI of a food can be altered significantly by refinement. For example, a boiled new potato has a GI of 62, whereas instant potato from a packet has a GI of 83. Whole grains have low GIs (for example, crushed wheat used in Lebanese food is less than 50), but refined grain products (bread and biscuits) can be 90 or more. Although many grain products are described as ‘complex carbohydrates’, they can behave like a simple sugar once digested, so consideration of GI can be helpful.

Notice that many refined foods are found in the list of ‘What to minimise or exclude’ (below). The refining process generally increases carbohydrate density (the amount of carbohydrate in any volume of food). The refining processes also usually remove essential fatty acids and other highly reactive food substances. The result is a tendency to lower nutrient density. These substances are removed in refining to increase the food’s shelf life.

Therefore, if you are concerned with maximising nutrition, you should eat more unrefined food sources. Of course, some foods are nutritionally and relatively kilojoule dense (for example, meat).

Desirable foods

These lists are only a rough guide. They are designed to help you look at food a different way, and to assist you to choose food that is better for you.

High-quality protein and low-to-medium saturated fat

  • lean meat (beef, lamb, pork, venison, game meats)
  • chicken (remove skin)
  • fish (especially salmon, tuna); fresh, smoked, or canned

Medium-quality protein and medium-density carbohydrates

  • dried beans
  • kidney beans
  • lentils
  • chick-peas
  • cracked wheat
  • brown rice
  • soy beans (canned beans are OK)
  • tofu

Medium-quality protein and beneficial fat; high nutrition

  • brazil nuts
  • pecan nuts
  • almonds
  • cashews
  • hazel nuts
  • avocado

Low-density carbohydrates; high nutrition (fruit with medium-to-high GI)

  • grapes (black grapes best; but also green grapes)
  • bananas
  • oranges and other citrus fruits
  • apples and pears
  • figs (fresh)
  • dates (fresh)
  • cherries

Low-density carbohydrates; high nutrition (vegetables with relatively low GI)

  • capsicum
  • spinach
  • broccoli
  • cauliflower
  • potatoes (boiled)
  • celery
  • zucchini
  • Chinese vegetables
  • onion
  • garlic
  • ginger
  • peas
  • beans
  • carrots (raw)
  • Brussels sprouts
  • other sprouts (mung, soy, alfalfa)

Medium-high density carbohydrate; low-medium protein; good nutrition

  • ‘heavy’ breads (dark rye, pumpernickel)
  • slow-cooking oats
  • whole-grain pasta
  • skim milk
  • skim-milk yoghurt

Less desirable foods

Medium-high GI carbohydrate; low protein; kilojoule-dense

  • breakfast cereals (packaged)
  • rice (white)
  • bread (white; ‘light’)
  • pasta
  • potatoes (instant)
  • rice (instant)
  • fruit juices
  • sugar (raw)
  • honey
  • potato chips
  • biscuits
  • cakes
  • instant noodles
  • soups (packaged)
  • chocolate
  • fruit (canned; versions with no added sugar better)

High saturated fat; trans-fatty acids; low-medium protein; kilojoule-dense

  • ‘TV’ dinners (including ‘low-fat’)
  • pizza
  • hamburgers
  • ‘fast’ or ‘junk’ food

Medium-low density carbohydrate; low protein; high GI

  • carrots (cooked)
  • potatoes (baked or fried)
  • parsnips (cooked)
  • broad beans
  • dried apricots
  • baked beans (canned)

Foods with no known nutritional value

  • cordials
  • sweet carbonated drinks
  • white (refined) sugar
  • sugar-coated food

Some suggestions for meals of the day

In the pages that follow is a list of what foods to include in a sensible eating plan (and what to minimise or avoid), followed by a discussion of the reasons for our recommendations.

What to include

Breakfast

  • grain-based source (unrefined if possible);
  • protein source, or health shake (recipe suggestions below);
  • piece of fresh fruit.

Mid-morning snack

  • piece of fruit plus piece of cheese; or
  • closed handful of raw mixed nuts and piece of fruit; or
  • two to three tablespoons of cottage cheese and fruit; or
  • small tin of tuna or salmon and piece of fruit; or
  • meal replacement (drink or bar).

Lunch

  • palm-sized lean protein source;
  • two-hand-sized salad; or
  • hand-sized lightly cooked vegetables; or
  • half-and-half salad and cooked vegetables (approximately two-hand-sized);
  • piece of fruit (optional).

Afternoon snack

  • same as mid-morning snack.

Dinner

  • protein source;
  • fresh vegetables (starchy and leafy);
  • piece of fruit.

What to minimise or exclude

  • recreational drugs;
  • coffee and tea;
  • refined packaged food sources;
  • ‘fast’ food;
  • fried food;
  • foods that are kilojoule-rich and nutrient-sparse (high GI foods);
  • excessive kilojoules;
  • foods rich in saturated fats;
  • sweet carbonated drinks and refined sugar;
  • low-fat packaged foods; and
  • ‘convenience’ food.

Reasons for recommendations

Breakfast

In our list of ‘What to include’ (above), the following recommendations were made for breakfast:

  • grain-based source (unrefined if possible);
  • protein source, or health shake (recipe suggestions below);
  • piece of fresh fruit.

Some thoughts on each of these is included below.

Grain-based source

There are two traditional Australian breakfasts – which might be termed the ‘bacon-and-eggs approach’ and the ‘cereal (grain) approach’. Both have good aspects, and not-so-good aspects. (Cereals are considered immediately below; for bacon and eggs see under ‘Protein source’, below.)

The best grains for breakfast are ordinary oats. Not only are they a source of slow-release energy (low GI of around 40), but also they contain gamma linolenic acid. Indeed, oats are one of the very few plant sources of this desirable fatty acid. You can add some honey, fruit, and milk (dairy or soy) if you wish. Note that the more ‘instant’ forms of oats generally have a higher GI.

Less-desirable sources of carbohydrate are the more-refined breakfast cereals. Try to get organically sourced and wholegrain cereals if you can. The least desirable grain-based carbohydrate sources are the even more refined versions of these foods, and the worst ones have the individual flakes covered in sugar.

Other desirable sources of unrefined carbohydrates are the heavier (in weight) of the wholegrain breads, pumpernickel (dark rye) bread, and mixed-grain breads. Less desirable are the ordinary brown breads, and the least desirable is white bread – even if the label does say that it is fortified with extra fibre. If you are eating sensibly, fibre will not be a problem.

Protein source

There are many sources of protein.

If you eat animal protein, a couple of soft-boiled or poached eggs, or an omelette made of two or three eggs (with your favourite filling) is an excellent choice. If you are concerned about excess cholesterol intake, simply do not eat some of the yolks. (The yolk contains some cholesterol, but many nutritious substances too.) If you have two or three soft-boiled eggs for breakfast, you can choose to have the yolk of one and eat only the whites of the other two. (However, it is always a good idea to have at least one yolk.)

Bacon and eggs supply a good amount of protein – often missing in many modern breakfasts – but can supply significant amounts of saturated fat. Reserve for special occasions, and use lean bacon!

Other good protein sources are cheese and yoghurt (especially good with mixed raw nuts, fresh fruit, and/or honey for additional flavour).

Health shake

A health shake is a good way to ‘jump-start’ your morning with excellent quality nutrition.

The basic liquid into which the other ingredients is blended is a matter of choice. You can use 50:50 fruit juice and water, or you can use a low-fat high-calcium milk source (or a soy-milk equivalent). If you prefer, you can use whole milk. However, if you are adding yoghurt and other products to it, the end mixture can be quite thick and heavy.

To the basic liquid, add two or three generous tablespoons of yoghurt (flavoured or non-flavoured). The organic ones are best, or you can make your own. If you look at the contents of many of the brands of yoghurt that you find on the supermarket shelves, you will be amazed at how much sugar they contain. The best of the organic yoghurts are flavoured with real fruit and do not contain preservatives or any other extra chemicals. A raw egg or two can be added.

Add some fresh fruit. Bananas taste good, and they blend extremely well, but any ripe fruit can be used. Some people don’t like the idea of mixing citrus fruit with a milk-based drink (if you are using milk or similar as the base), but the resulting mixture has an excellent taste.

If you feel that you need additional protein at the beginning of the day, you can add about 10 grams (about a tablespoon or two) of a suitable protein powder. Whey protein powder is said to have the highest ‘biological value’. This means that more of the protein in the powder is taken up by the body than a similar amount of another protein source, but really any powdered protein will do. If you are on a budget, use two or three tablespoons of skim milk powder. Skim milk contains casein which is an excellent high-quality protein. Vegetarians can fortify their shakes with soy protein, available from a health food shop. If you need extra fibre, Psyllium husks (one or two teaspoons) can add the right kind of fibre – good insurance with no ‘down’ side, in any case.

The final part of the health shake is a tablespoon of an oil containing the essential fatty acids (EFAs). These are linolenic acid (LNA) and linoleic acid (LA). Research suggests that the average Western diet is low in LNA. The addition of oil to the basic mixture makes the resulting shake taste creamy and delicious, even if you haven’t used yoghurt. Flax seed oil is the best source of LNA, and is obtainable from a health food shop. It is stored in dark bottles and must be kept in the refrigerator.

This is a useful place to discuss the fats that everyone is afraid of. Cholesterol, a saturated fat, is an essential substance in the body, but does not need to be eaten. Cholesterol is produced by the liver and is a major fraction of brain tissue and the nerves of the body. High blood cholesterol is usually a result of genetics, but good dietary habits (increasing EFAs and fibre) and adopting the relaxation strategies described in Chapter 2 can be beneficial. Trans-fatty acids are toxins produced by heating and refining oils, and using oils to fry. In the pursuit of good health, these cooking practices need to be minimised. Sufficient EFAs and antioxidants (such as vitamins A, C, and E) should be included in your diet to help your body process transfatty acids.

LNA is also found in soy bean and walnut oils, and dark green leafy vegetables. The other essential fatty acid, LA, is found in safflower, sunflower, soy bean, sesame, and flax seed oil. Buy oils that contain EFAs from a health food shop, and choose coldpressed organic sources. These oils cannot be used for cooking.

A note for lactating mothers: the Nursing Mothers Association of Australia (NMAA) states that ‘if you are eating enough for your own energy requirements, the fatty acid pattern in your milk will resemble that of your diet’ (Carafellam ,1996). This is good reason for asking yourself if you have sufficient EFAs in your diet.

The breakfast is finished with an optional piece of fresh fruit (discussed below).

Mid-morning snack

In our list of ‘What to include’ (above), the following recommendations were made for mid-morning snack:

  • piece of fruit plus piece of cheese; or
  • closed handful of raw mixed nuts and piece of fruit; or
  • two to three tablespoons of cottage cheese and fruit; or
  • small tin of tuna or salmon and piece of fruit; or
  • meal replacement (drink or bar).

Some thoughts on each of these are included below.

Piece of fruit plus piece of cheese

Any ripe fresh fruit is a good source of simple (and some complex) carbohydrates, minerals, vitamins, and fibre. Ripe bananas are especially good. The notion of complex carbohydrates can be a bit misleading however, because the bonds between the glucose molecules (that give rise to the term ‘complex’) are easily broken down. This process begins in your mouth (during chewing) and is normally completed in your stomach (during the first stage of digestion). Some complex carbohydrate sources can raise your blood sugar level quite quickly. However, because you are having only one piece of fruit and a small amount of protein together, this will not be a problem. Any cheese will do, but if you are concerned about your intake of cholesterol, consider a low-fat variety.

Closed handful of raw mixed nuts and piece of fruit

All nut varieties contain beneficial fatty acids. If the nuts are roasted, the chemical composition of some of the fatty acids can be changed, so it is probably best to eat nuts raw. Eating mixed raw nuts ensures that a greater variety of essential fatty acids is consumed. Nuts are also a good source of protein, contain no cholesterol, and have minimal amounts of saturated fats.

Two to three tablespoons of cottage (or ricotta) cheese and fruit

Cottage cheese is made from milk and contains casein, an excellent high-quality protein. It is also low in saturated fat. Add this to a piece of fresh fruit and you have an excellent snack.

Small tin of tuna/salmon and piece of fruit

Fish is a form of protein that cans very well. Two fatty acids found in the oils of coldwater fish are part of the same omega 3 fatty acid family that includes LNA. Salmon is a migratory fish, and it has a high oil content.

The oil found in fish is good for your body. Recent research suggests that increasing your consumption of these fatty acids can help prevent cardiovascular disease. The extent to which these fatty acids are changed by the canning process is unclear. A better source of these oils is sliced smoked salmon (found in supermarkets).

Together with a piece of fruit, you obtain a small amount of excellent-quality protein and a small amount of easily digested carbohydrate.

Meal replacement (drink or bar; check label for the ‘extras’)

There is an increasing variety of meal-replacement bars or powders on the market. Careful reading of the labels reveals an extraordinary variation in the proportions of carbohydrate, protein, and fat in these products. If you want to use a meal replacement, choose one in which these various nutrients are present in approximately equal amounts in terms of kilojoules. Many manufactured substances can be used to make the final product taste and feel like food. Check the labels!

Be aware that if you use low-fat or fat-free meal replacements, the rate at which the carbohydrate enters your bloodstream is faster than it would be if some fat is present in the product, and this can raise the blood sugar level of some people a bit too rapidly. For this reason, the bars that have some fat in them (depending on the kind of fat) are generally preferable to the ones with little or no fat.

Lunch

In our list of ‘What to include’ (above), the following recommendations were made for lunch:

  • palm-sized lean protein source;
  • two-hand-sized salad; or
  • hand-sized lightly cooked vegetables; or
  • half-and-half salad and cooked vegetables (approximately two-hand-sized);
  • piece of fruit (optional).

Some thoughts on each of these are included below.

Palm-sized lean protein source

The basis of our sensible eating plan is to maximise the amount of nutrition in the food that we eat and minimise the number of ‘empty’ kilojoules (little or no nutrition). A quick way of assessing your diet is to consider it in terms of how much carbohydrate, protein, and fat are likely to be in it.

The various Zone books by Barry Sears, and Body of Life by Bill Phillips, both recommend an ‘eyeballing’ method for assessing protein and carbohydrate quantities. This is because the body can assimilate only about 25 grams of protein at any one sitting. The rest is excreted or stored. Accordingly, it is a good idea to have just the right amount of any nutrient. A palm-sized piece of lean protein will contain 25–40 grams of protein, depending on its thickness (and the size of your palm!). To help you assess, 100 grams of steak contains about 25 grams of protein. Vegetarians (vegans or lacto-ovo vegetarians) will need to give some thought as to how much protein (and what proportion of which amino acids) is being consumed in their favourite food sources.

Two-hand-sized salad

Have some raw vegetables at most main meals, before or during the rest of the meal. Raw vegetables contain many enzymes that the body can use to help digest proteins, carbohydrates, and fats in the food that you eat. To ensure the greatest variety of phytonutrients, try to have as many colours in the salad as you can.

Many vegetables can be added to salads. These include varieties of lettuce (common in many salads), beetroot and carrot (can be grated), beans and peas (added raw), and broccoli and other brassicas (lightly steamed before adding). There are, of course, many other vegetables that can be added.

Nuts can be added to salads to increase the protein and (beneficial) fat content.

If you use one of the recommended oils as part of your dressing, salads provide a very convenient way of getting some of the two essential fatty acids.

Eat roughly ‘hand-sized’ if you are having other vegetables; increase the salad serving size if not.

Because these foods are low in carbohydrate density, you can eat as much as you like.

Hand-sized lightly cooked vegetables

The recommendation of a ‘palm-sized’ piece of lean protein (above) provides a simple assessment of how much protein to eat at each meal. This also applies to the suggestion to have a hand-sized serving of lightly cooked vegetables. This amount provides a good balance to the palm-sized protein source that you are combining with this meal. Together, you will get an excellent source of carbohydrates, proteins, and fats.

In addition, the vegetables (raw or lightly cooked) will provide you with many of the vitamins and minerals that are needed in daily life. Your body requires nutrition ‘as needed’. This means that you need to have all of the fifty essential nutrients (discussed below) almost every day. This means, for example, that it is not good to have a big serving of spinach on Monday, and not eat any other dark-green leafy vegetables until Friday.

Food is cooked to make it more palatable, and some nutrients are released by the process. However, many enzymes are denatured or destroyed if food is cooked for too long or too hot. This is why we recommend lightly cooked vegetables.

The best way to cook vegetables is to use a non-stick pan, or to cook in a quarter of a teaspoon of butter or coconut oil. Add a quarter of a cup of water, fit a tight lid, and steam the vegetables. Add some of your favourite oil as a dressing after cooking. Recommended oils include virgin olive (Australia is making some wonderful olive oils now) or a mixture of the oils that will supply the essential fatty acids.

Half-and-half salad and cooked vegetables (approx. two-hand-sized)

An even better suggestion to increase enzyme and nutrient intake in the diet is to have a salad and some cooked vegetables which, together, form roughly a hand-sized serving. This is fiddly, however, and you might choose to have your cooked vegetables at lunch and your salad at dinner, or vice versa. Have a slice of a heavy bread, if you wish.

Piece of fruit (optional)

To finish lunch, you can have a piece of fruit. But this is optional, and you might simply be too full to eat another thing! If you do leave fruit out of your lunch, you can have it for an afternoon snack.

Afternoon snack

Same as for mid-morning snack.

Dinner

In our list of ‘What to include’ (above), the following recommendations were made for dinner:

  • protein source;
  • fresh vegetables (starchy and leafy);
  • piece of fruit.

Some thoughts on each of these are included below.

Protein source

We need a protein source at dinner too. We have suggested using the palm of your hand as a rough assessment of the desired 25–30 grams of protein. But where does that leave someone who wants to eat spaghetti bolognese or similar for dinner? The answer is that the same ‘palm-sized’ vs ‘hand-sized’ proportion as a guide still applies, but consider a small kitchen ladle to be equivalent to a palm-sized serving. Assuming a sauce that contains protein and carbohydrate, consider the ladle volume to be the protein part, and have an equivalent amount of the pasta. Compared with vegetables, pasta is carbohydrate dense, so a smaller amount is required for balance. Have some additional low GI vegetables on the side.

A salad with many different kinds of vegetables is an excellent complement to this meal. However, starchy vegetables are denser carbohydrate sources and, if you choose a lean palm-sized protein source, you will probably want to include some of these starchy vegetables as well – to make sure that you are getting sufficient carbohydrates. (You might also have a slice of one of the heavy breads.) Starchy vegetables include the tubers (including potato, sweet potato, and pumpkin).

Avoid deep-frying these vegetables. Deep-frying in otherwise good vegetable oil changes the oil and creates substances called trans-fatty acids, which are no good for your body at all. It is far better to steam or boil the vegetables and add some sort of good oil at the serving stage.

If you wish, have a tasty ripe piece of fruit to finish the meal.

Reasons for minimising or excluding

Recreational drugs

This might seem obvious as a suggestion for a pregnant woman, but it is nevertheless worth emphasising. Once you know you are pregnant it is very wise to avoid all recreational drugs – including alcohol. The most important reason is that in developed countries, folate deficiency is often linked to excessive consumption of alcohol. Alcohol limits the absorption of this vitamin. Inadequate folate is definitely associated with neural tube abnormalities in the foetus (producing disorders such as spina bifida) and might well be associated with miscarriage. A list of foods containing folate can be found below.

Another reason for our strong recommendation against the use of recreational drugs during pregnancy is the increased likelihood of various other birth defects. Apart from alcohol, recreational drugs include tobacco, stimulants of various kinds, marijuana, and other non-prescription drugs.

You should also check all prescription drugs with your doctor to make sure that these drugs pose no threat to the developing foetus.

Tea and coffee

Green teas, in particular, have been found to be good sources of various antioxidants. This is good news if you like tea! However, tea is a mild diuretic (that is, it causes the body to lose water), so make sure that you have your tea reasonably weak and have a glass of water for every cup.

Coffee, unfortunately, doesn’t seem to have any benefits according to many researchers – unless you count its great taste! If you consume too many cups (usually reckoned at more than three per day) you will encounter one of the disadvantages of this drink – too much caffeine. This can make you irritable and can make your hands tremble. Coffee, depending on the strength, is a stronger diuretic than tea, so have a glass of water with every cup you drink to offset this effect.

Anecdotal evidence suggests that coffee can affect the foetus. Many women note increased foetal activity if they drink coffee.

Expectant women are advised to limit both tea and coffee.

Refined packaged food sources

These are not recommended because of the refinement process which removes some, and sometimes many, of the original nutrients.

The exception is packaged frozen vegetables. Unlike supermarket produce, it is picked and ‘snap frozen’ when ripe. Research suggests that some of the desirable phytonutrients form during the ripening period. With fruit, this is in the last few days of ripening. Canned fruit can be used when fresh fruit is not available. Use the ‘no added sugar’ varieties.

Because ripening is so important, organic fruit and vegetables are desirable. They are picked closer to this ideal time before being brought to market.

‘Fast’ foods

‘Fast foods’ include takeaway hamburgers, pizzas, and the like. The carbohydrates of these foods are usually kilojoule-dense and nutrition-poor, and a high proportion of the fats are saturated.

In addition, the method of manufacture of these foods tends to produce trans-fatty acids. Trans-fatty acids are broken down much more slowly in your body than the recommended fatty acids, producing much larger amounts of free radicals. Some researchers have linked high amounts of trans-fatty acids to an increased susceptibility to various cardiovascular and degenerative diseases.

Fast foods also usually contain a large (often surprisingly large) amount of sugar and salt.

Margarine vs butter

Trans-fatty acids, in addition to being found in fried foods, are also found in hydrogenated vegetable oil products, in many packaged foods (check the label to be sure), and in margarine. All margarines start their life as vegetable oils – some of which are unsaturated and some of which are polyunsaturated. All are liquid at room temperature.

During manufacturing, these oils are hydrogenated (an artificial saturation process) to make them more or less solid at room temperature, and thus able to imitate the spreadability and texture of butter. This process leaves the final product full of trans-fatty acids (which, as explained above, should be minimised).

Products that are a combination of butter and margarine must be treated with caution for the same reasons.

Butter might be better, after all.

Fried food

The inadvisability of eating deep-fried food has been mentioned above, but how can you cook all of the other food that you eat?

One way is to use a variation on a traditional Chinese method of stir-frying. Instead of throwing oil into the bottom of the wok or a non-stick frying pan – and heating vigorously until it smokes, as some recipe books suggest – put in a ladleful of water or stock, instead of the oil. Depending on the recipe, you can substitute canned or fresh tomatoes. To this, add garlic and the other seasonings. Once the seasonings and other condiments have been cooked sufficiently, add the vegetables and other ingredients. Immediately cover the pan or wok with a tight-fitting lid.

Cooking this way ensures that the minimum amount of nutrients will be lost and that the food will be steamed and partially boiled.This method will ensure that the cooking temperature of the foods will not go above 100 degrees Celsius – the highest temperature that cooking water can reach.

Keeping the cooking temperature at or below 100 degrees Celsius reduces the conversion of fatty acids to trans-fatty acids. In addition, because the temperature is relatively low, some of the enzymes and other volatile food elements remain largely unchanged.

When you remove the lid and are ready to serve, you can add a good-quality oil. Olive oils and other oils can be added in this way, and the taste is different from cooking with oils. It is, in fact, delicious.

As well as the other benefits, the oil itself hasn’t been changed by the cooking process. Therefore, the benefits of the particular oil that you add will be experienced.

Most foods that are traditionally fried can be cooked in this way. Of course, you can’t make chips like this! However, chips and other fried (or roasted) vegetables should not be part of your usual diet. Keep these for special occasions!

Foods that are kilojoule-rich and nutrient-sparse (high GI foods)

The ratio of kilojoules (or Calories) to nutrients, and the GI, of any food can be changed by its method of preparation. For example, carrot juice has a much higher GI than a whole raw carrot, and is missing most of the beneficial fibre contained in a whole raw carrot. To take another example, whole grains are excellent sources of all sorts of vitamins, minerals, fibre, essential fatty acids, proteins, and carbohydrate. However, the refining process used to produce the final form of the food that most of us eat removes almost all of the nutritional components except the carbohydrate.

As mentioned previously, although white bread is often described as a good source of complex carbohydrate, it can have a GI as high as 90. Surprisingly, ordinary white table sugar has a GI of only 65, which suggests that its rate of conversion to glucose is significantly slower than white bread. (For a quick comparison, according to Brand Miller et al. 1996, cherries have a GI of only 22, apples 36, and bananas approximately 55.)

The biggest surprise in looking at GIs is that many ‘complex’ carbohydrates are treated like simple sugars by your body. Foods in the ‘desirable’ list above have lower GIs on average, and foods in the ‘less-desirable’ list have higher GIs. (Some foods in the ‘desirable’ list have relatively high GIs, but these are nutritionally dense as well.)

Don’t cut out all of the things that you really love to eat. Rather, use the lists to think about whether or not the food you are about to eat is located more at one end of the nutrition spectrum than the other, and make adjustments to suit. During pregnancy, the food that you eat feeds both you and your baby. Every nutrient advantage that you can manage is to the benefit of both of you.

Sweet carbonated drinks and refined sugar

These drinks are a perfect example of a kilojoule-dense nutrient-sparse food. The amount of refined sugar contained in sweet popular beverages is extraordinary. For example, a standard can of drink can contain 10–20 teaspoons of refined sugar. If you consume one or two cans (or bottles) of these drinks a day, you are getting a huge number of extra kilojoules that are of no nutritional benefit.

Minimise these products as far as possible. Much the same goes for the commercially made fruit juices. These also contain lots of sugar and not too many nutrients. You are much better eating a piece of fruit instead.

Some years ago, a book came onto the market with the alarming title Pure, White and Deadly. The book referred to ordinary refined white table sugar (sucrose). It now seems likely that the alleged dangers of white table sugar were exaggerated, but it is a good idea to minimise the amount of additional sugar added in cooking – simply because sugar is pure carbohydrate with no other nutrients. There might be some benefit in using unrefined sugar (rather than the refined version), but any nutritional benefits are likely to be small.

So what should you do about desserts? Desserts (like chips) are best reserved for special occasions. This is because desserts are usually relatively kilojoule-dense compared with the rest of the meal. Of course, you can calculate the approximate number of kilojoules (Calories) that you want to eat in a meal, and make the necessary adjustments. But if you are eating for two people, there are grounds for reducing the consumption of desserts and increasing the consumption of more nutritious foods.

There are, however, some desserts that are nutritious in their own right. These sorts of desserts can simply be considered as part of the total meal.

Low-fat packaged sources

Labels advertising ‘low cholesterol’ can be found on all manner of foods these days—including avocados in supermarkets and greengrocers’ shops. This preoccupation with ‘cholesterol’ is reflected in the stated goals of a US Senate Select Committee on Nutrition and Human Needs which published its report in 1977 (Grills and Bosscher 1981). These goals focus on the prevention of diet-related diseases such as obesity, cardiovascular diseases, diabetes, and dental disease. Among the goals was a recommendation to reduce overall fat consumption from approximately 40% to about 30% of energy intake (not a huge reduction) and a further recommendation to reduce cholesterol consumption to about 300 milligrams per day. Most people have absolutely no idea of what 300 milligrams a day of cholesterol means. (I certainly don’t!)

Much has been made of the association of cholesterol and other saturated fats with cardiovascular disease, and this is one of the reasons for fat-free and low-fat foods being promoted so aggressively. The problem with this recommendation is that it makes no distinction between beneficial and harmful fats. A further problem with very low-fat products is that the remainder of their composition is largely carbohydrate. Above, we noted that if complex carbohydrate is eaten without the GI-lowering effects of the right kind of fat and fibre, the conversion of complex carbohydrate to glucose can be very rapid.

Another associated problem is that in the effort to make the processed food as low in fat as possible while retaining the ‘taste’ of fats, the use of various substances not found in the original food has increased. For example, commercially prepared yoghurt contains all sorts of chemicals that are not in the original milk (soy, dairy, or goat’s milk) that is used to make traditional yoghurt. Minimising the intake of these additional substances is probably prudent.

Artificial sweeteners should also be regarded with caution. Sears (1999, page 281) states that aspartame ‘should never have become part of the food supply’. Use natural sweeteners sensibly.

‘Convenience foods’

Many of the remarks made about other foods also apply to convenience foods. The only real ‘convenience’ here is preparation time. If one is eating with nutrition in mind, the ‘convenience’ might turn out to be an illusion.

The basis of the sensible eating plan

The following section provides more detail on certain elements of nutrition. You might feel that you already have enough information on which to base your eating plan. However, if you feel that more detail will assist your food choices, read on!

Fifty nutrients are essential to support human life. They are discussed below.

Essential amino acids

There are twenty-two amino acids, but only nine (or eleven for premature infants) are ‘essential’ in your diet. If your body has the full spectrum of these essential amino acids your body can make the remainder.

All animal sources of protein are ‘complete’ – meaning that all the essential amino acids are present in a ratio that is favourable for humans. However, all animal protein sources contain saturated fat as well.

Vegetarian sources vary in the favourability of their ratios. For example, corn has been traditionally eaten with beans in some parts of the world. Corn on its own lacks an amino acid called lycine, but beans have this amino acid in abundance. Together, corn and beans contain all the essential amino acids in a favourable ratio.

Recent research suggests that your body has an amino acid ‘pool’ – which exists for half a day to a number of days. If you are a vegetarian and you eat a protein source that is low in a particular amino acid, you probably don’t have to worry too much. At the next meal you will probably eat a food containing the missing amino acid. However, if you wish to be meticulous, and you think that there is a benefit from eating complete proteins at every meal, give some thought to combining your proteins.

Another traditional protein combination is rice and sesame seeds. There are several other similar combinations. Diet for a Small Planet, an excellent source of nutritional advice, is an invaluable source of this kind of information. Note that all the grain sources have some high-quality protein, and this content is higher if the grain source is unrefined (unprocessed).

Essential fatty acids

There are only two essential fatty acids. If you have the two essential fatty acids in your diet in the right proportion, your body can make all of the other fatty acids needed for health.

The opinions of researchers differ considerably on the ideal proportion of omega 3 to omega 6 fatty acids. Erasmus (Fats that Heal, Fats that Kill) suggests that most people in the modern Western world are significantly deficient in LNA, an omega 3 fatty acid. If your diet in the past has been high in saturated fats and you have eaten a lot of fried foods (and hence have had significant amounts of trans-fatty acids in your body), Erasmus recommends adding extra omega 3 fatty acids to your daily intake for six months or so.

The best vegetable source of this particular fatty acid is the oil derived from flax seeds. This is available in the refrigerated section of health food shops. This is a particularly reactive substance, and for this reason it is sold in opaque containers, and must be kept refrigerated. Never use this for cooking. It is best added to foods after cooking, or on top of other breakfast cereals or yoghurt. A tablespoon or two is the recommended daily amount. Once you feel that you have achieved some sort of balance in the fatty acids in your body, you might wish to change the proportion of the two essential fatty acids.

Apparently hemp oil contains a more or less ideal balance for human consumption – but I haven’t seen any hemp oil available in my local health food shop! A better way is to combine flax-seed oil with one of the other cold-pressed vegetable oils that is rich in omega 6 fatty acids. These include safflower oil, sunflower oil, and sesame-seed oil. Again, do not use these oils for cooking—they are damaged by heat. They should be mixed up and used as a salad dressing, or used as a topping on other foods.

The main fatty acid of olive oil is oleic acid. This is not an essential fatty acid, but it might have benefits for people at risk of cardiovascular disease—provided it is virgin or extra virgin olive oil. These terms refer to the pressing process that removes the oil from the olives, and virgin or extra virgin olive oil are produced in a way that maintains the maximum nutritive value of the oil. The term ‘light’ (and other terms that you see on oil labels) tells you that it is not virgin—and hence processed in some way. Such oils should be minimised or avoided.

Minerals

In Australia, until recently, vitamin and mineral preparations were not permitted to contain selenium – even though Australian soils are said to be the poorest in selenium of any soils in the world. The reason for this prohibition was that, like many substances, selenium is toxic in large doses. However, selenium is now a permitted mineral in supplements.

The results of a full blood assay can be very helpful in planning food choices and possible mineral supplementation. This test is available on Medicare if recommended by a doctor, so you might wish to discuss this with your medical practitioner.

Of particular interest to expectant women are three minerals – iron, calcium, and magnesium.

Anaemia (low haemoglobin level) is caused by insufficient available iron. Sometimes women can feel tired and be told that their haemoglobin levels are ‘within normal limits’. Despite this apparent ‘normality’, many women find that iron supplements can help, and can increase their energy significantly. A daily supplement of one tablet per day (each containing about 100 milligrams of elemental iron) is recommended. These are available ‘over the counter’ at pharmacies.

You might prefer to address this problem through diet rather than supplements. Constipation can be a side-effect of iron tablets, if there is insufficient fibre in your diet. Everyone Jennifer talked to about this problem, including midwives, believes constipation is a problem regardless of dietary fibre intake. Consider a couple of teaspoons of Psyllium husks with all meals if this is the case for you. Dark-green leafy vegetables are an excellent source of dietary iron.

Calcium and magnesium are required for healthy bones – both in yourself and your baby. The recommended daily allowance of calcium is 800–1200 milligrams per day, and the recommended allowance for magnesium is 300–400 milligrams per day. Some recent US research suggests that magnesium is also an important mineral in avoiding or reducing the likelihood of cardiovascular problems. To be on the safe side, it is probably a good idea to have a daily mineral and vitamin supplement obtained from some reputable source. (Floridix is a preparation that Jennifer used.)

The best supplements contain different forms of the various minerals, some of these being described as ‘chelated’. This means that the element is coated, or prepared with a particular amino acid, so that the substance in question can be better assimilated by your body. If you are concerned about any possible effects that such a supplement might have, discuss it with your doctor.

Vitamins

There are thirteen recognised vitamins. No new vitamins have been named since 1954, even though thousands of phytonutrients (compounds contained in plants) have been discovered since then. The term ‘vitamin’, and how it can be applied to particular substances, is subject to two strict criteria. The first is that the absence of the substance in the diet must be causally linked to a particular disease. The second is that the addition of that substance to the diet must be able to reverse the course of the disease. For example, the absence of vitamin C causes scurvy, and the reintroduction of the vitamin reverses the disease process.

However, these criteria have proven to be too restrictive in terms of adding to the list of vitamins. Some researchers feel that many phytonutrients (not classed as vitamins) have important health-giving properties – even if they are not essential. Certain phytonutrients are likely to be extremely important in helping your body deal with cancer cells that are produced every day. For example, the brassica family (including cauliflower, Brussels sprouts, and broccoli) is said to contain a number of phytonutrients that are beneficial in halting the course of some cancers. This is another good reason to get a significant fraction of your day’s carbohydrates from a variety of vegetables – because they each contain different phytonutrients in various proportions.

Some of the vitamins are called ‘antioxidants’. These include vitamins A, C, and E. If you are going to supplement vitamin A intake, it is better to take beta-carotene (a double molecule of vitamin A that your body breaks down as needed), or to make sure that you eat as many different coloured vegetables as possible. The antioxidants combine with substances called ‘free radicals’ – which are produced in all oxidative reactions in the body (such as those required to metabolise trans-fatty acids). Some researchers claim that excess free radicals in your body can damage your chromosomes, and hence compromise your body’s ability to reproduce its cells accurately. This might be a significant part of the ageing process. Most of the cells in your body are renewed within a brief two-year period – that is, at the end of a two-period you are actually composed of different molecules. In this sense, ‘we are what we eat’ – because our bodies can be ‘remade’ only from the things that we take in each day.

Among the B group of vitamins is folic acid (vitamin B9). This vitamin is essential to the developing foetus. Below, you will find a chart reproduced from a recent source showing which ordinary foods contain folate, and in what amounts.

The recommended daily allowance of cobalmin (vitamin B12) is extremely small (0.006 milligram per day). However, it is a crucial nutrient, and vegetarians should know that strict vegans are likely to have low B12 stores. If you suspect that you might be low in vitamin B12, it is worth getting a vitamin and mineral supplement that has adequate amounts of this vitamin.

Vitamin D is manufactured by the body and its manufacture is accelerated by exposure to ordinary sunlight.

Be aware of the interaction between vitamins and minerals on the one hand, and the macronutrients (protein, carbohydrate, and fat) on the other. As mentioned, all the minerals and vitamins are necessary for the effective metabolism of the macronutrients.

Foods containing folate

Folate helps to prevent neural tube (spinal cord) abnormalities in the foetus. These abnormalities include spina bifida. Folate might also be important in preventing miscarriage in the early stages of pregnancy.

The recommended daily allowance (RDA) for folate is 400 micrograms. This should be taken by all women who might become pregnant because it is important to have adequate folate at the very beginning of pregnancy (indeed, before women know that they are pregnant), as well as during confirmed pregnancy. Women who have a history of giving birth to babies with neural tube disorders should take as much as 4 milligrams per day.

Adequate folate must therefore be consumed, and most women should probably take supplements in addition to being aware of the following dietary sources. If you have any queries about this important matter, consult your medical practitioner.

Folate and food sources (pdf, 204kb)

Energy sources

There are no essential carbohydrates in the way that there are essential amino acids and essential fatty acids. However, everyone needs good sources of energy.

The best sources of carbohydrates are wholegrain products, fruits, and vegetables. Commonly, food pyramids separate these foods, giving the impression that the carbohydrates that they contain are somehow fundamentally different – but they are not. Most of the food pyramids have grain sources at the bottom, and recommend that they should form the major fraction of your carbohydrate intake. If the food from these grain sources is largely unrefined, this is good advice. Such food is full of minerals, vitamins, good-quality protein, beneficial fatty acids, and carbohydrate. However, in the refining process, much of the good nutrients are lost and you are left with relatively nutrient-poor carbohydrate.

All vegetables and fruits are excellent sources of carbohydrate and are comparatively rich in nutrients. It is therefore advisable to use these for your carbohydrates – rather than emphasising the grain-based sources.

Another consideration is the glycaemic index of a food source. In one sense, the concept of a glycaemic index is deceptive. For example, if you combine a high GI food with a low GI one (depending on the precise nature of the foods involved), the glycaemic index of the whole meal will be a figure between the index of each food. It is desirable to get a balance of high and low glycaemic foods in the same meal, to avoid excessive increases in blood sugar following eating.

A further dimension to consider in assessing energy sources is the amount and kind of fat and fibre present in the same meal. Both of these decrease the overall glycaemic index of the meal.

Finally, individual reactions to particular foods will vary the GIs by very significant amounts. A variation of 20% or more can be seen in the figures cited (see Brand Miller et al. 1996, pages 207–40).

Oxygen

This element is an obvious necessity. No one can survive more than a few minutes without oxygen. Make sure that you have enough fresh air blowing through your house during the day. If you work in an office, it is essential to get out of the office environment at some time – perhaps at lunchtime – and expose yourself to cleaner air (it is to be hoped that it is cleaner!) than you find inside a typical office. Walking at any time of the day that you can manage it is good too.

Light

The action of light on the skin helps your body create the essential vitamin D. The action of light on the retina also stimulates the pineal gland and helps some people to avoid the unpleasantness of seasonal mood disorder – sometimes called ‘seasonal affective disorder’ (SAD).

Water

Recommendations for how much water one should consume daily vary quite widely. It depends on your body weight, level of activity, and so on. However, a minimum recommendation for water consumption is two litres per day.

If you are concerned about your water intake, substitute a glass of water for the cup of coffee or cup of tea that you might otherwise have.

Because water forms approximately 70% of your body weight, it is wise to give some thought to the purity of the water you drink. Benchtop water purifiers can be helpful, or drink best-quality bottled water. Read the label on bottled water to determine the source – the information might surprise you. Tap water in Australia is usually safe to drink. Another way to increase your fluid intake is to have nutritious soups at mealtimes. If you like fruit juices, but are concerned about getting too many kilojoules, dilute the juice by half with water.

Movement

In a book concerned with stretching and strengthening exercises, the recommendation for movement might seem superfluous. However, it is an essential consideration on a daily basis and, when taken together with the need for oxygen and light, provides a good reason for getting out of the house or out of the office at least once a day, and going for a walk.

Every authority considers walking to be excellent exercise – provided that walking doesn’t give you neck or back pain, or aggravate some pre-existing condition. If this is the case, swimming can be substituted for walking. Going for a walk gives you a chance to open your lungs fully, to breathe deeply, and to make sure that you get enough direct sunlight (to stimulate your brain and help your body make vitamin D).

Walking is also fun! Of course, if the conditions are too hot or too bright, make sure that you go out with a hat on and cover your skin. The last thing you want is a case of sunburn while pursuing your health goals.

Breastfeeding

Breastfeeding is desirable. Apart from the health benefits – the full extent of which have become obvious only in the last ten years or so – women tend to return to their previous weight much more quickly if they breastfeed. One reason for this might simply be the huge energy requirement of lactation.

Maureen Minchin (Breast Feeding Matters) identified what she called the ‘six o’clock starvation syndrome’. This can be attributed to the energy cost of lactation. Breastfeeding mothers should eat as many nutritious snacks as you feel you need. The reasons for this are obvious—not only do you need to run around and do the normal things that people do in their daily lives, but also you need to have enough energy to produce sufficient milk for your new baby. When you are breastfeeding, you will need to give additional regard to what you eat. In Jennifer’s case, for example, eating chick-peas had an undesirable effect on her daughter immediately following breastfeeding.

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