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Why “What Not To Eat While Pregnant” is the Wrong Question

Are you worried about what not to eat while pregnant? Do all the lists you’ve seen online stress you out? Well, you can stop worrying. This blog post will teach you why not to avoid those foods and what to do instead.

foods not to avoid during pregnancy (eggs, deli meat, seafood)

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Did you know that only 1 in up to 30,000 eggs is contaminated with salmonella? For reference, if you ate 2 eggs every day, it would take you more than 41 years to eat 30,000 eggs.

Maybe you like them scrambled, fried, poached, boiled, or prepared in some other way. Maybe you like them cooked until they’re firm or maybe you like ‘em runny.

But why all this egg talk?

Well, it’s a pretty common belief that pregnant women shouldn’t eat eggs unless they are well done – absolutely no runny stuff left. They (whoever they are) say it’s safer that way because salmonella can survive in undercooked eggs.

While that’s not necessarily a bad recommendation, the actual outcome is that many pregnant women just avoid eating eggs altogether, either because they’re scared or because the only way they like them is a little oozy.

What’s the problem with avoiding eggs, you ask?

Eggs contain lots of nutrients that are important during pregnancy, including protein, choline, DHA, and many vitamins and minerals.1 So if women are scared to eat eggs, they’re missing out on a lot.

The problem behind that problem?

Ninety percent of pregnant women are nutritionally deficient. And when a pregnant woman is nutritionally deficient, her chances of pregnancy complications like preeclampsia and gestational diabetes go way up.

Not only that, but the chances of preterm birth and other birth complications increase, too.

Let’s Talk About the Importance of Nutrition

A balanced diet is important for everyone, but it’s vital for a pregnant woman and her unborn baby. Nutrients not only support mom’s health and well-being, but provide the building blocks for baby’s brand-new body with all its tissues, systems, and organs. 

The Nutritional Value of Variety

Before grocery stores and factories, people ate what they could grow or raise or catch. Most ancient cultures naturally ate colorful, well-rounded diets. That was the only way for them to get the needed nutrients, and it worked! They got what they needed from their diet.

Our bodies are designed to need certain fuel to function. But that fuel isn’t just a one-ingredient formula. Different nutrients serve different functions in our bodies, and deficiencies of each nutrient can cause different problems.

We know that not getting enough vitamin C leads to scurvy, for example. Low levels of other nutrients cause various symptoms, some less serious, some more so.

When a woman gets pregnant, there’s another whole layer added to it all. Now, missing out on one nutrient might lead to her baby’s poor brain development, and missing out on another might contribute to weaker teeth and bones.

“That’s why we have prenatal supplements,” you might be thinking. Popular belief certainly says a prenatal supplement solves the problem of nutritional deficiency. But unsurprisingly, popular belief comes up short. 

The truth is that 99% of (affordable) prenatal supplements do not have high enough doses to make up for the lack.

We need another solution. Luckily, the answer is as old as time: eat good, real food.

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Demystifying the “Forbidden” Foods

It’s become so common in American culture to talk about long lists of foods not to eat while pregnant that it’s become the first question women ask.

There’s a zillion lists online that will tell you what conventional guidelines say not to eat while you’re pregnant. But here’s my take: when has focusing on what NOT to do helped us DO what is most important? (Answer: probably never.)

Here’s what it comes down to: Are there risks to eating certain foods? Yes, always. Are there risks to NOT eating certain foods? Definitely. 

So it’s really a risk-benefit thing. Are there more benefits to eating eggs or more risks, even if they’re runny?

I’d bet on benefits.

Typical “Foods to Avoid” and Why Not to Avoid Them

Here’s a typical list of foods not to eat while pregnant:

  • Cold meats, like deli cuts and summer sausage
  • Runny or raw eggs
  • Fish with mercury
  • Raw seafood
  • Unpasteurized soft cheeses (brie, queso fresco, feta, etc)
  • Caffeine
  • Pates and meat spreads
  • Raw sprouts
  • Unwashed fruits and veggies
  • Store-made salads
  • Herbal products (supplements and teas)
  • Fresh, unpasteurized juice

I don’t know about you, but that list stressed me out the first time I got pregnant. I worried all the time. Now I know I didn’t need to stress.

Why? Let me explain. I won’t cover everything on the list, but let’s break down a few of the big ones.

Cold Meats

This was a big one for me during my first pregnancy. I’d read the recommendation not to eat deli meats unless they were heated up, so I tried to do that for the first half of the pregnancy. Actually, I’d usually just avoid deli meats altogether to avoid the hassle.

But sandwiches taste better with deli meat and I wanted the added protein! So I decided I wasn’t going to worry about it. I ate cold deli meats whenever I wanted for the rest of my pregnancy. And I was absolutely fine!

The reasoning behind not eating cold meats while pregnant is the risk of listeriosis. Listeria is a bacterial foodborne illness that can cause typical flu-like symptoms. The oft-repeated story is that pregnant women must avoid any foods that could possibly be contaminated with listeriosis because if they get infected their baby will likely die. 

Obviously, that’s a scary thing to hear. But what does the research say?

A study published in 2020 found that the risk of severe infection of listeria that leads to death is rare during pregnancy, with 3 cases per 100,000 births worldwide. For context, the overall infant mortality rate (when a baby dies before their first birthday) in the US is 540 per 100,000 births.

Now get this: the top causes of infant mortality in the US are birth defects and preterm birth, both of which are linked to nutritional deficiencies during pregnancy.

Clearly, in talking so much about what not to eat, we’re focusing on the wrong thing.

Runny or Raw Eggs

I explained this one in the intro, but let me add a little more. We all know the rule: no raw cookie dough. But find me one person who’s never eaten raw cookie dough. We all do it! The delicious benefit far outweighs the risk.

And, like I explained, only 1 in 30,000 eggs is contaminated with salmonella. You couldn’t eat that many eggs during one pregnancy no matter how hard you tried. 

One more fun fact: eggs contaminated with salmonella account for only 2% of foodborne illness cases in the US. Fresh produce accounts for 46% (but don’t panic…we’ll talk about fresh produce later), yet nobody is recommending cutting out all fresh produce while pregnant.

As is the case with most things on the list, eating eggs – even one with a runny yoke – is better than eating no eggs at all.

Mercury and Fish

Mercury is a “heavy metal.” Heavy metals are naturally occurring elements with high atomic weight and a density at least 5 times greater than that of water. They are sometimes found in soil and water which is one way they get into food. Foods can also be exposed to heavy metals during processing.

While a few heavy metals – like iron and zinc – are actually important nutrients that we need for proper health (in small amounts), others like mercury and lead can be dangerous. 

We most often talk about mercury being found in fish, and that’s exactly what the pregnancy recommendations warn against. Pregnant women are told to avoid fish containing high levels of mercury, including shark, swordfish, king mackerel, and tilefish.

Fish that contain lower levels of mercury (shrimp, canned light tuna, salmon, pollock, catfish) are labeled “okay” if eaten in smaller amounts and not too frequently. 

So is the mercury recommendation actually legit?

This is one of those recommendations that has a little more to it. Heavy metals are toxic – to everyone, not just pregnant women. All of us should try to avoid exposure to large amounts of heavy metals.

YET. Multiple studies have found that for women who consume fish regularly, mercury levels have no adverse effects on their babies.

Researchers have found a reason for this seeming immunity: selenium (an essential mineral) binds with mercury and can prevent or reverse its toxic effects in the body.

One researcher stated her opinion that guidelines about avoiding certain kinds of fish “can cause confusion in pregnant women” and lead them to avoid fish altogether, just to be safe. “The guidance for pregnancy,” she says, “should highlight ‘Eat at least two portions of fish a week.’”

I want to say I was surprised to find these answers…but at the same time I’m not. It’s more of the same: Is there a small risk inherent in eating this food? Perhaps. Is the risk of NOT eating these foods more significant? Yep.

Benefits of Eating Fish

Fish is full of omega-3s, an essential nutrient our bodies need, and is a good source of protein. Fish also provides vitamins (D and B12) and minerals (calcium, iodine, and potassium, to name a few) that are vital for the healthy development of a new baby.

Raw Fish and Shellfish

Raw fish is another can of worms. Even when fish contains low levels of mercury or none at all, the conventional guidelines say it’s dangerous if eaten raw. Cut to women being scared, avoiding fishy dishes they normally like, and missing out on nutrients they need.

Raw fish is typically consumed in one of two forms: sushi or raw shellfish.

Sushi

First, sushi. Is sushi safe for pregnant women? I thought not; I avoided it during my first pregnancy. But I needn’t have worried about it. Here’s why.

For one, pregnant women in Japan are encouraged to eat raw fish because of the health benefits. Japanese people don’t have different genetic makeup that makes raw fish good for them while it’s bad for Americans. It’s just a different culture.

To put this practice of eating raw fish in context, you should know that Japanese people are some of the healthiest in the world, with the longest healthy life expectancy. That is, in part, because of the country’s emphasis on preventative lifestyle and care.

For two, fish used in sushi is usually flash-frozen first. Flash freezing is required by the FDA because it kills parasites and halts bacteria growth. That means that as long as you eat the sushi freshly made (meaning it hasn’t been sitting out for a while), you’re probably good to go.

Raw Shellfish

Second, shellfish. Many people enjoy eating raw shellfish. And though people do it all the time and some don’t ever get sick, three-fourths of seafood-related foodborne illness cases are because of raw shellfish. 

That is why pregnant women are cautioned against eating raw shellfish.

Just because it’s a good idea to avoid it when it’s raw, though, doesn’t mean you shouldn’t eat it at all. Shellfish contain high levels of various micronutrients that are essential during pregnancy. Those micronutrients include zinc, vitamin B12, iron, vitamin A, selenium, DHA, and more.

So if seafood is your thing, feel free to keep eating shellfish, just make sure it’s cooked first

Soft Cheeses

People talking about what not to eat while pregnant have a hey-day about unpasteurized foods, first and foremost of which are soft cheeses. “Soft cheeses” are cheeses with high moisture content that are soft enough to spread or crumble. Common examples are brie and queso fresco. 

The reasoning behind the recommendation to avoid unpasteurized cheese is the same as for deli meat: it might contain listeria bacteria. So to reiterate, listeriosis is very rare. We would do better to focus on what TO eat so we avoid nutritional deficiencies, which have far greater potential for dangerous outcomes. 

Benefits of Eating Cheese

Cheese (and other dairy products) are good sources of animal protein. Cheese also contains important vitamins and minerals, like calcium.

Caffeine

Caffeine is a hot topic even outside of pregnancy. During pregnancy, it becomes a big worry for lots of moms. Can pregnant women drink caffeine? If so, how much?

Interestingly, the research-based answer is… we don’t really know. High levels of caffeine intake were once thought to be linked to miscarriage and low birth weight but no studies have been conclusive.

What we do know is that caffeine crosses the placental barrier. That means your baby gets caffeine when you do. Caffeine also decreases the blood flow between you and your baby which lowers the efficiency of nutrient transfer through the placenta.

Knowing that, your best bet is probably to stick to the current recommendation of less than 200 mg of caffeine per day while pregnant.

Fruits, Veggies, and Sprouts

If there’s one thing nearly everyone agrees on, it’s that fruits and vegetables are good for you. So why do they make it on the “not to eat while pregnant” list? Typically fruits and vegetables are strung with imaginary caution tape for two reasons: first, they can be contaminated with bacteria and second, they can contain pesticides.

Bacteria can get into – or onto – fruit and vegetables through the soil or water they are grown in. The same is true for sprouts. Bacteria can also start to grow if produce gets bruised or damaged.

It’s always a good idea to wash your fruits and veggies in clean water before eating, whether you’re pregnant or not. In addition to washing, cut off any bad parts. If you’re doing those things and using clean cutting boards when you slice them, bacteria shouldn’t be an issue.

Produce does often carry pesticides and those pesticides are harmful to our bodies. That said, the negative effects of the pesticides you consume when you eat an apple, for example, are going to be far outweighed by the benefits of consuming the apple with all it’s whole-food nutritious goodness.

If you are concerned about pesticides, you can wash your produce in salt water (9 to 1 ratio of water to salt) to get nearly all pesticides off.

The Truth About What Not to Eat While Pregnant

In summary, the typical recommendations of what not to eat while pregnant do have reasoning behind them… the reasoning is just skewed and, honestly, pretty fear-based. If we really look at the risks, they are small and rare. 

And on the other hand, if we look at the nutrients being forgone when women avoid all these foods, we’re risking much more.

The underlying principle here is to be mindful about what you eat and don’t eat. Mindful eating has become trendy, but it’s nothing new. Eat when you’re hungry, don’t eat when you’re not, and be intentional about the kinds of food you’re eating. It’s all about listening to your body and giving it what it truly needs.

Though the internet and the instant availability of so much information has its positives, it definitely has some downsides too. The headlines, blog posts, and “experts” you see online may or may not be providing accurate, helpful information. Make sure you check your sources and don’t just believe everything you hear.

Food Advice You Shouldn’t Take

I think it’s worth mentioning a few more popular eating trends that just don’t cut it. Let’s talk about three classic pieces of food advice that you shouldn’t take, whether you’re pregnant or not.

Low-fat vs Full-fat Dairy

“Low-fat” sounds great, doesn’t it? A food labeled as low-fat must be healthier than full-fat, right? Actually, no.

Fat is one of the essential nutrients we need to sustain life. We need to eat fats because they provide essential fatty acids (like omega-3s) that our bodies cannot produce.

Fats are also important because some vitamins (including vitamin D) are “fat-soluble.” That means our bodies can only use those vitamins if we have fats in us to break them down and help us absorb them.

Fats provide energy, protect our organs, and can help to regulate blood pressure and cholesterol levels.

“Low-fat” Does Not Mean Healthy

Here’s the thing: when people choose low-fat foods they probably think they’re choosing the one that will help them stay healthier or lose more weight, right? The problem is that neither of those is true.

A study of over 135,000 people in 18 countries found that people who ate low-fat diets had a higher risk of dying than those who ate low-carb (i.e. higher-fat) diets. That included dying from heart attacks, heart disease, and strokes.

As far as weight loss, the truth might surprise you.

The fact of that matter is that fat tastes good. That means low-fat foods don’t taste very yummy. And that means that when companies make low-fat products, they add sugar and other refined ingredients that make the food taste better.

It’s as simple as that: when we remove fat, we replace it with something else, and that something else is doing the exact thing we were trying to avoid in the first place.

So next time you go to the grocery store, ignore the “low-fat” label and remember that fat isn’t something to be afraid of; it’s essential.

Note: In addition to full-fat dairy products, you can get fats from nuts and seeds, avocados, eggs, and fish.

Calories vs Nutrients

Maybe you count calories, maybe you don’t. But many food experts don’t recommend it. In short, calories do not equate to nutrients.

Some high-calorie foods are low in nutrients (read: sometimes high-calorie foods are good to avoid) and some low-calorie foods are high in nutrients (read: sometimes low-calorie foods are a good choice) but there’s no consistent correlation.

If you put most of your energy into making sure you stay under a calorie threshold, chances are you’re going to avoid nutritious foods that would be far better for you than the low-calorie item you chose. (Read: sometimes high-calorie foods are also highly nutritious and therefore the better choice.)

To illustrate the irrelevance of calories let’s look at an example: one 1-ounce bag of Flamin’ Hot Crunchy Cheetos has 170 calories…but almost no nutritional value. It contains ingredients like MSG, sugar, and artificial dyes. On the other hand, one 1-ounce bag of plain almonds has 160 calories and contains 6 grams of protein and 13 grams of healthy fat, as well as some calcium, iron, and potassium.

That comparison makes it clear that it’s less important to get a certain amount of calories and far more important to ensure you’re consuming nutrient-dense foods, especially during pregnancy.

To Carb or Not to Carb

If you’re like me, you hear “carbs” and think “bread.” Breads and grains do contain carbohydrates, but so do lots of other things, including fruits, vegetables, and beans. 

Carbohydrates are one of the essential nutrients our bodies need. But not all carbs are created equal. Broccoli has carbs and so does soda, but obviously one is better for you than the other.

The problem with carbohydrates isn’t that they’re bad for you. The problem is that most Americans are getting their carbs from highly processed foods like refined white flour and sugars. Two pieces of white bread have 26 grams of carbs and almost no nutritional value. One apple has 25 grams of carbs and is a natural source of fiber, vitamin C, and other vitamins and minerals. 

Long story short, like pretty much everything else, we should be paying more attention to nutrients than to carbohydrate numbers.

What Your Doctor Doesn’t Know About Nutrition (and Who Does Know)

One of the sad facts of the American education and healthcare systems is that doctors receive almost no training in nutrition.

When I was pregnant with my first, I asked my OB if there were certain foods I should be eating or foods I should be avoiding. His only advice was, “Be a grazer.”

I now know I can’t blame him for not knowing more than that. He was never taught. But it was an unhappy surprise to realize that the care provider I was trusting with my health and the health of my baby didn’t know anything about the nutrients I needed and how to get them.

That’s just one reason I recommend a midwife. Because they approach things holistically, midwives are far more likely to have nutritional training and to know the importance of adequate nutrition during pregnancy. 

If you have special circumstances, such as gestational diabetes or preeclampsia, you may want to find a dietician or nutritionist you trust that can help you manage your pregnancy from a “food is medicine” perspective.

Two People Who Know

Lily Nichols (Registered Dietitian/Nutritionist, Certified Diabetes Educator, researcher, and author) has an incredible, research-backed book full of solid nutrition advice called Real Food for Pregnancy. If you want more than a book, she also has a course on gestational diabetes and offers limited one-on-one coaching calls. 

Ryann Kipping “The Prenatal Nutritionist” (Master of Public Health and Registered Dietitian/Nutritionist) founded The Prenatal Nutrition Library. Using her app or website, you can find information on hundreds of foods, their nutrition, and whether or not they’re “safe” for pregnancy.

The Bottom Line

In the end, here’s what you need to know:

  • The common recommendations of what not to eat while pregnant are usually more harmful than they are helpful.
  • Instead of keeping a long list of foods to eat and not to eat, pay attention to the nutrients any food is providing and choose nutrient-dense foods.
  • Beware of popular food trends and “expert advice” that overgeneralize or leave out important information.
  • During pregnancy, find a care provider or professional who has nutritional education.

Above all, remember that the most important element of a healthy diet, pregnant or not, is balance. Our bodies need many different nutrients and those nutrients come from lots of different foods. To over-focus on one nutrient, one food, or one rule just isn’t helpful. 

Until next time,

Allison 

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