As mothers tend to sacrifice during their lives to meet their children’s needs, a mother’s body will give up its own essential nutrients to provide health and growth for her developing baby. Unfortunately, the Standard American Diet (S.A.D.) is often so nutritionally deficient that even this sacrifice does not guarantee adequate nutrition for the unborn baby. Fortunately, there are a number of tips that if followed during pregnancy, can help both baby and mother stay healthy and vital!
Here is Dr. T’s top 10 list for ensuring a healthy pregnancy. It includes recommendations on nutrition, vitamins, minerals and other common sense tips that can lead to a happier, healthier and more vital pregnancy. Powdered vitamin formulas are available that can markedly decrease the number of supplement tablets needed – a good multivitamin powder is excellent for both fibromyalgia and pregnancy.
- Zinc. Inadequate zinc is the most common and problematic deficiency during pregnancy. Zinc is critical for two reasons: proper growth and for developing a healthy immune system for the baby. Studies suggest that inadequate zinc may even cause immune deficiency in the next generation (i.e. your grandchild) as well. Be sure to get at least 15 milligrams per day of zinc in your diet, which can be found in high protein foods such as meat and beans.
- Folic Acid. Getting enough folic acid is critical both before and during pregnancy to help assure proper growth and to prevent birth defects. It is present in deep green, leafy vegetables. Women should get at least 400 to 800 micrograms per day.
- Magnesium. Magnesium deficiency is routine in the American diet and can increase the possibility of high blood pressure and seizures during pregnancy, a condition known as eclampsia. To prevent this deficiency, take 200 milligrams of magnesium in the glycinate form daily. Whole grains, green leafy and other vegetables and nuts are good sources of magnesium. Taking the proper amount of magnesium a day also helps to decrease the leg cramps and constipation often experienced during pregnancy. In addition, magnesium is critical for more than 300 other body functions and will generally help you to feel a lot healthier.
- B Vitamins. These are critical for energy, mental clarity and to prevent depression. B vitamins have also been found to improve pregnancy-related complications such as gestational diabetes. Taking 200 milligrams a day of vitamin B6 can improve the health of those women suffering from this form of diabetes. But please note that only women who develop gestational diabetes during pregnancy should take this high level of B vitamins, and should drop the level of consumption to 100 milligrams per day during the last month. For all other soon-to-be moms, take approximately 25 to 50 milligrams a day of B vitamins and plenty of vitamin B12 for normal nerve function.
- Fish oils. The human brain is made predominantly of DHA, an essential fatty acid found in fish oils. Perhaps this is why there is an old wives’ tale about fish being brain food. Regardless, DHA deficiency is very common and it is critical that pregnant women get adequate fish oils so that their baby can develop healthy and optimal brain tissue. DHA may also decrease the risk of postpartum depression. Unfortunately, though, the FDA has raised concerns about high mercury levels in the same deep sea fish (salmon and tuna) that have the highest levels of these oils. However, some special forms of fish oil actually taste good (most do not), and have been tested to make sure that it does not have mercury or other problematic compounds.
- Calcium. Ideally, pregnant women should ingest 1,500 milligrams of calcium per day plus 400-600 units of Vitamin D. It is best to take Calcium at night (it helps with sleep) in the liquid, powdered or chewable form. Many calcium tablets are simply chalk and do not dissolve in the stomach, and therefore are not absorbed properly. Each cup of milk or yogurt contains 400 milligrams of calcium.
- Iron. Approximately 18 to 36 milligrams of iron per day can be helpful. Interestingly, iron deficiency can sometimes cause infertility. And pregnant women who don’t get enough iron are at risk for anemia, fatigue, poor memory and decreased immune function.
- Water. Be sure to drink plenty of water. When pregnant, blood volume can increase about 30 percent and it is easy to become dehydrated. If your mouth or lips are dry, drink more! Adequate salt is also helpful in preventing dehydration (less so if you have problems with fluid retention).
- CHECK YOUR THYROID! Millions of women have undiagnosed hypothyroidism, which accounts for over 6% of miscarriages, and is associated with learning disabilities when the child is born. Addressing a low thyroid is both safe and easy during pregnancy. The earlier it is addressed the better. As soon as you know you’re pregnant (or trying to get pregnant), check a TSH blood test to check your thyroid. Most doctors do not yet know that the TSH HAS TO BE LESS THAN 3 OR YOU NEED THERAPY, SO SEE THE RESULT FOR YOURSELF (Many still use the dangerous and outdated criteria of a TSH over 5 being abnormal). If you were on thyroid before getting pregnant, it is normal to need to increase the dose during pregnancy (the TSH should be kept between .5 and 2.0). If your doctor is not familiar with the new guidelines, let them know they can e-mail me at the web site above and we’ll send a copy to them. For more information see "Thyroid Hormone Deficiency."
- Things to Avoid. A few cautions for pregnant women: avoid taking more than 8,000 units of vitamin A per day. And don’t partake in anything that can raise your body temperature too high (hot tubs, saunas or steam rooms). These have been implicated as possibly increasing the risk for birth defects. Most pregnant women are also, of course, aware that smoking, drugs and alcohol should all be avoided during pregnancy. Exercise, on the other hand, has been shown to be very beneficial and results in babies and moms that are quite healthy.
Q&A On CFS/FMS and Pregnancy
Do you agree with the following advice for women with FM or CFIDS prior to conceiving (and do you give any other advice)?
• Get in the best shape possible physically
In terms of exercise, it is important to realize that people should not push to the point of crashing. Instead, they should slowly increase walking as is tolerated without causing next day flares. It is a good idea for fibromyalgia patients to reduce stress in general.
Most importantly, I think that the fibromyalgia should be addressed with an integrated metabolic regimen for about a year before pregnancy, so that people have largely recovered before they get pregnant. Our randomized double-blind placebo controlled study showed that therapy can be very helpful (P. < .0001 versus placebo).
|Q||Would you agree that fertility problems with FM are no different than the general population?|
|A||Although infertility is not a significant problem, I do find it to be more frequent in fibromyalgia than in the general population. On the other hand, when the nutritional deficiencies (especially iron) and subclinical hypothyroidism are addressed, the infertility problems often resolve (as is also seen in the Non- fibromyalgia general population).|
|Q||Do you see problems with irregular cycles, hormone imbalances, ovarian cysts, vaginosis, endometriosis, or other GYN problems in women with FM/CFIDS?|
|A||Yes, especially hormonal imbalances, irregular periods, and endometriosis. There is also an increased frequency of polycystic ovary syndrome associated with elevated DHEA—S and testosterone as well as glucose intolerance. This can result in infertility, which responds well to therapy. In addition, elevated prolactin is common in associated with the hypothalamic dysfunction (and rarely pituitary adenoma). This can also result in infertility, and also responds excellently to therapy.|
Should women stop all meds? (please list any acceptable ones to take, if known) particularly:
• NSAIDS, acetominophen
|A||I leave my pregnant patients on a good multivitamin powder, as this was also made to be excellent support for pregnancy. They also need to be on a stabilized, mercury-free fish oil, calcium 1500 milligrams, and iron if needed (i.e., if the ferritin is less than 40). They can also stay on thyroid hormone, and if needed, Ultra low-dose Cortef - both of which supports pregnancy. If critical, they can stay on Prozac, which has not been associated with increased birth defects. Besides for these, I stop almost all medications and herbals. I would note that in general, acetaminophen (Tylenol) is a poor choice for fibromyalgia patients as it depletes glutathione—a critical antioxidant that is likely already deficient in CFS/fibromyalgia.|
PREGNANCY & DELIVERY:
Do you agree with the following concerning addressing FM flares (pain, fatigue, stiffness) while pregnant (and do you give any other advice)?
|A||Pregnant women need to be careful to avoid hot tubs and hot baths (and likely hot packs in the area of the fetus) as the increased body temperature is associated with an increased risk of birth defects. Taking calcium and magnesium at night can help sleep. In addition, taking 5-HTP 200-300 mg/night can help both sleep and pain, although it takes six weeks to work. As long as the PT is done gently, it can be helpful, as can stretching and massage therapy. Most importantly, by giving appropriate therapy before pregnancy, flares can usually be avoided during pregnancy.|
|Q||What can a woman do if she experiences a flare of: depression, migraine or irritable bowel while pregnant?|
|A||Migraine attacks can often be knocked out by giving magnesium 2 g IV over a ten minute period. In addition, avoiding chocolate and sugar, which are common triggers for migraines, is helpful. Taking magnesium orally (and this is already present in the vitamin powder) decreases migraine attacks as well. Taking the fish oil and the nutrients in the vitamin powder and B-complex (plus 5-HTP) decreases the tendency to depression considerably. Our study and clinical experience show that most people will find that their irritable bowel syndrome resolves when the underlying opportunistic bowel infections have been addressed (e.g., Clostridium, SIBO, fungal infections, and parasites). These do however need to be addressed before the patient becomes pregnant. If the patient is constipated, taking magnesium is very helpful. Adjusting the thyroid dose for those who are hypothyroid is also critical, and constipation can be a marker for this. The iron and calcium dose can be adjusted to help with diarrhea.|
|Q||Anecdotaly, women with FM report improvement of symptoms with pregnancy. The few studies and surveys generally report the opposite. What is your experience? Are there particular trimesters when an improvement or exacerbation is likely to occur? What would be the reason for improvement (immune system turned off, particular hormones, or other reason?)|
|A||In my experience with helping thousands of patients, once the patient has gotten past the morning sickness, they usually feel much better during pregnancy. Morning sickness can often be avoided by taking adequate vitamin C (500 milligrams a day) and vitamin B6 (100-200 milligrams a day). The improvement that occurs during pregnancy can occur for many reasons (increased CRH, blood volume, estradiol levels which improve immune function, relaxin levels, etc.). Overall, people do great during pregnancy (if given proper nutritional and thyroid hormone support) but may crash after. Even the crash after pregnancy can often be avoided with proper therapy.|
|Q||Are there any particular complications of pregnancy or delivery related to FM or CFIDS (ectopic pregnancies, miscarriages, symphysis pubis disruption, breech presentation, for example)? Do women with FM lack muscle strength or tone for pushing? Do you advocate warm water birthing to ease the muscle pain of FM?|
|A||As long as the woman is on adequate magnesium to decrease to risk of eclampsia, they tend to do just fine with their delivery. Warm water birthing would be reasonable for anybody.|
|Q||Does an epidural help to conserve energy during birth and speed recovery afterwards?|
|A||I think that an epidural is quite reasonable, but leave this to the preference of the mother as in any other delivery.|
|Q||Does FM affect length of stay in the hospital for mom or baby?|
|A||Not in my experience.|
|Q||If FM or CFIDS inheritable? Do you find many parents worried about that?|
|A||Although approximately half of my patients have a family member with CFS/fibromyalgia, the risk of any one individual child getting it is low because we have so many family members. This reassurance is very helpful for the parents. In addition, regardless of the popular misconception, fairly effective therapy has shown to be available for fibromyalgia—as demonstrated in a placebo-controlled study. (I would note that the journal of the American academy of pain management—one of the largest multidisciplinary societies of pain specialists in the U.S. had an editorial noting that our protocol is “an excellent and highly effective part of the standard of practice for treating fibromyalgia and myofascial pain syndrome.”)|
|Q||Should moms with FM breastfeed? Are there the same restrictions on meds? Is it too tiring to breastfeed?|
|A||I generally apply the same principles to breast-feeding as being pregnant. If possible, I have the Mother breast-feed for at least six months and avoid the same medications that were avoided during pregnancy. I do not think it is too tiring to breast-feed and breast-feeding also helps with weight loss—which is emotionally important to the patient as well (while also decreasing the risk of sleep apnea). It is, of course, also very healthy for the baby. It is critical however that the Mother stay on her nutritional regimen while breast-feeding.|
|Q||Is the severity or incidence of postpartum depression worse in moms with FM?|
|A||If adequate support is given with fish oils and progesterone, postpartum depression seems to be less common.|
|Q||Do you have any other advice for women concerning pregnancy and fibromyalgia?|
|A||Be sure that thyroid hormone levels are adjusted to the level that feels optimal while keeping the free T4 within the normal range. Otherwise, the information in the top 10 tips for pregnancy article apply.|