If you feel confused over conflicting medical advice on what to take and what not to take during pregnancy, you’re not alone. Here are a few myths on prenatal supplements that we’d like to debunk.
Myth #1: If it says “prenatal multivitamin,” you’re good to go.
Fact: Not all prenatal vitamins are the same.
It’s your job to ensure your purchase a quality prenatal multivitamin. The news has jumped all over stories suggesting multivitamins might not be so useful. The reality is most multivitamins are made with cheap, synthetic ingredients, which your body cannot recognize as actual nutrition.
These multivitamins may also be filled with binders and fillers that are toxic to some individuals. This puts a burden on the liver and gut, decreasing absorption of the nutrients listed. I encourage everyone to seek out “physician-grade supplements.” You want to know that the actual nutrients are “bioavailable.” That means recognizable by the body and in therapeutic doses. You won’t typically find these types of prenatals at a drug store over the counter.
Beware the following additives in your prenatals:
- FD&C Blue #2 Lake
- FD&C Yellow #5 (tartrazine) Lake
- FD&C Yellow #6 Lake
- Hydroxypropyl methylcellulose
- Polyethylene glycol
- Stearic acid
Prenatal Vitamin Brands I Recommend:
- Fairhaven Health: FH Pro for Women and Men
- Pure Encapsulation Prenatal Nutrients
- Thorne Research Basic Prenatal
What makes me trust these prenatal multivitamins? These companies focus on quality control, third party testing, and research.
FH Pro is my favorite for added nutrients and botanicals specifically for antioxidants and egg/sperm health!
Myth #2 – All folic acid is the same.
Fact: There’s both folate and folic acid, and the difference to your body couldn’t be more striking. Aim for folate every time.
Folate is a water soluble B vitamin (folate converts to vitamin B9). Folic acid is a synthetic compound that a lab makes. You don’t find folic acid naturally in food.
So where did folic acid come from?
The processing of many foods causes a major loss in folate. As people began to eat more processed foods, the food industry wanted to head off a potential nutritional crisis. So, folic acid was introduced to many processed breads and cereals in the 90s. It aimed to compensate for the loss of folate during processing.
Let’s be clear: folic acid only exists to make up for the human destruction of nutrition.
You can do better than that.
Eat whole foods for optimal folate intake.
Folate is absorbed in the small intestine, but folic acid has to be broken down by the liver. Unfortunately, the liver doesn’t have much in the way of tools to break it down.
Why avoid synthetic folic acid?
If the liver can’t break folic acid down, it circulates in the blood as unmetabolized folic acid. Studies indicate an increased cancer risk with unmetabolized folic acid. However, for certain people, the risk is more pronounced.
If you have MTHFR genetic mutation, you want to avoid folic acid strictly. It can cause depression, anxiety, miscarriages, cardiovascular disease, and more. Most especially, if you’re struggling with infertility and have an MTHFR genetic mutation, it’s worth noting that folic acid can cause infertility.
Don’t know if you’ve got an MTHFR mutation? It’s a simple blood work test. Ask your doctor to order the test.
Supplement with methyl-folate in a quality prenatal
You still need to supplement—even if you’re eating lots of green leafy vegetables. But instead of taking a folic acid supplement, look for a supplement with actual folate.
A quality supplement will contain 5-methyl-THF (methylfolate), which is a reduced form of folate. This is more beneficial for people with a MTHFR mutation.
Start taking extra folate at least one month (I recommend 3-4 months) prior to conception. This will help give you and your partner healthy eggs and sperm, as well as a healthy pregnancy.
It’s not just to prevent birth defects like spina bifida, but also for your baby’s overall nervous system health and overall DNA replication.
Folate supplementation should be balanced with adequate levels of vitamin B12. An oversupply of either could mask a deficiency of the other causing anemia. Anemia can present with either small red blood cells due to a deficiency of iron, or large red blood cells due to deficiency of vitamin B12 or folate.
Myth #3 – Vitamin A is toxic to embryos.
Fact: Your eggs and sperm need vitamin A, and so will any developing fetus.
Someone once asked me if they could get a prenatal multivitamin without vitamin A. Their fertility specialist had told them it was “teratogenic” (meaning toxic to developing embryos).
Let’s clear the air on this one.
Vitamin A is a fat soluble vitamin like vitamins D, E and K. These are essential vitamins both for your health and the development of a fetus.
In fact, vitamin A is a fantastic antioxidant, useful for egg and sperm health!
Why you need vitamin A for a healthy baby
In fact, researchers at MSU found that vitamin A is necessary to the fetus’s formation of the heart and circulation, as well as her hindbrain. This occurs between two and three weeks gestation.
You might not even know you’re pregnant yet, but your baby needs vitamin A.
Without enough vitamin A, miscarriage is possible. Even a partial vitamin A deficiency can affect the developing nervous system.1 2 3 This affects your baby’s vision, inner ear, spinal cord, brain, and hormones.
Vitamin A is necessary for growth and the development of skeletal and soft tissues, as well as vision. It is an anti-cancer nutrient and supports the integrity of mucus membranes. Your mucus membranes provide you protection from bacterial, viral, and parasitic infections. And most importantly for reproduction, vitamin A is involved in hormone production and cell differentiation. This is critical for the growth of a fetus.
Where to get your vitamin A
Vitamin A naturally occurs in animal fats, particularly liver, butter, and fish eggs.
I love Cod Liver Oil as an omega-3 and vitamin A supplement! Many people think of beta carotene (found in orange/red/yellow foods like carrots) being vitamin A, but it is actually a precursor that is converted to vitamin A in the gut.
I recommend eating foods rich in both vitamin A and beta-carotene for the production of vitamin A.
Good sources vitamin A:
- Beef and chicken liver
- Cod liver oil
- Egg yolks
- Fish eggs
Good sources of beta carotene (in addition to a quality supplement):
- Sweet potatoes
Avoiding foods rich in vitamin A (or RDA levels of vitamin A in supplementation) out of fear of birth defects is absurd.
How much vitamin A for pregnancy?
Women need a minimum of 4000 IU and men 5000 IU of retinol (vitamin A) from food daily. Most of the caution regarding vitamin A and pregnancy is due to a limit. Research suggests that women stay under 10,000 IU retinol daily during pregnancy.
But retinol is not beta carotene.
As for beta carotene, we need 25,000 IU per day. Most supplements contain about 5,000 IU – 10,000 IU as beta carotene, not retinol.
Myth #4 – It’s not worth the mercury risk to eat anything with the word “fish” in it during pregnancy.
Fact: Your baby’s brain needs omega-3’s, which are most commonly found in fish oils.
Omega-3 fatty acids are necessary for the brain development of a fetus. Fish oil isn’t just about brain development, though. Most Westerners get an abundance of omega-6 fatty acids, and not so many omega-3’s. That’s a recipe for inflammation.
That said, omega-6 fatty acids are still essential to a healthy diet. Unfortunately, they are overabundant in today’s diet.
Omega-3 fatty acids are anti-inflammatory, while omega-6s are more mixed, containing some anti-inflammatory and some pro-inflammatory components.
Humans may have evolved with a diet eating omega-6’s and omega-3’s in a 1:1 ratio. Our modern lifestyle typically consumes omega-6’s and omega-3’s in a 16:1 ratio from food. We should aim for a ratio of 4 to 1, realistically.
How did we get to such an unbalanced diet? Look at our farming practices.
- Farmers feed cows omega-6 dominant grains, rather than allowing them to eat grass naturally.
- Farmed fish are eating grain rather than algae, again more omega-6 heavy.
The list could go on. The point is, our food chain gets increasingly omega-6 dominant. And we end up with more inflammation.
What’s wrong with too many omega-6’s?
The problem is it leads to inflammation. And inflammation causes a lot of problems, including infertility and subfertility.
Chronic inflammation from reproductive infections can interfere with ovulation and implantation of a fertilized egg. When the prostate and testicles are infected, chronic inflammation halts sperm production.
One simple lifestyle change to reduce inflammation and increase your fertility is to decrease your omega-6’s and increase your intake of omega- 3’s.
Sources of omega-6 fatty acids
Omega-6’s are common in foods with trans fatty acids or partially hydrogenated oils. For example:
- Vegetable oils
- Fried foods
- Low fat products
- Many peanut butters
- Other processed foods
In general, there’s no need to avoid omega-6 fatty acids that exist naturally in vegetables and nuts. For example, don’t stress over eating an avocado or a handful of walnuts.
You also don’t need to avoid oils that may technically have a high omega-6 to omega-3 ratio but are more dominated by a fat called oleic acid. Oleic acid, or gamma-linolenic acid (GLA), is a very healthy fat. A great example of an oleic acid-dominant oil would be olive oil. Olive oil is a very healthy oil to enjoy.
Be more cautious over using a lot of omega-6 dominant vegetable oils in your cooking, such as corn oil or soybean oil. As in all things, moderation is key.
Sources of omega-3 fatty acids
Great sources of omega 3-dominant fatty acids include:
- Fish oil
- Fish (salmon, sardines, atlantic mackerel, rainbow trout)
- Cod liver oil
- Grass-fed dairy products
- Flax seeds and oil
- Hemp seeds
- Chia seeds
- Pumpkin seeds
- Borage seeds
- Sesame seeds
According to the American Journal of Obstetrics and Gynecology, women should aim for 2-3 servings of low-mercury fish per week preconception.
Fish and fish oils are some of the easiest sources of omega-3’s. However, if fish isn’t your thing, make sure the animal products you consume are actually eating grass, not corn. When the animals consume an omega-6 dominant diet, they give us an omega-6 dominant product.
Fishy smells make you nauseous?
Unfortunately, many folks (especially if you’re fighting morning sickness) steer away from fish oil due to the taste. You can get gel caps that mask the smell well. Some companies even flavor their fish oil liquids and gel caps with lemon, orange or strawberry.
If you’re worried about burping it up, try sticking the gel caps in the freezer. Then take your dose in the evening with food. This will minimize burping.
Pay attention to quality in fish oil
With fish oil, like most supplements, you need to pay attention to quality.
Fish absorb contaminants in the water. That’s why fish sourcing matters. Deep water fish, such as sardines, mackerel, and anchovies, are used in high quality fish oils.
Also pay attention to therapeutic dosing. You need 1000-2000mg of EPA and DHA omega-3’s combined every day. If you are getting a poor quality fish oil, you may be wasting your time. Many cheap supplement suppliers sell fish, salmon, or krill oil that do not come anywhere near those levels. You’d have to take a handful of gel caps to accomplish a therapeutic dose.
A physician-grade fish oil will be efficient with 1-2 gel caps, 1-2 times per day, or one tsp 1-2 times per day.
Remember to keep your fish oil in the refrigerator, especially after opening it. Rancid fish oil only causes inflammation—it doesn’t fight it.
Myth #5: I get enough vitamin D from being outside.
Fact: Most women in northern climates don’t get enough vitamin D.
It’s true your skin manufactures vitamin D with sun exposure. But those of us in cloudy climates or northern exposures aren’t necessarily getting adequate UV light exposure for vitamin D. That can put you at risk for serious deficiencies, despite even daily outdoor time.
And a vitamin D deficiency influences both fertility and the health of any baby you do conceive.
Where to get more vitamin D
- Fish oil – It’s not just a great source of omega-3’s, but also vitamin D3 and vitamin A. That makes fish oil one of my favorite fertility and pregnancy supplements.
- Cod liver oil
- Unpasteurized dairy products
If you are buying milk fortified with vitamin D, make sure it is the active form of vitamin D (called vitamin D3), rather than D2. Vitamin D2 doesn’t work the same as vitamin D3. What your body requires is vitamin D3.
Most plant-based “milks,” such as soy milk or almond milk, also fortify with vitamin D2, instead of D3. If this is what you have access to, you will still need to supplement.
Most individuals, particularly those in northern states (further from the equator) have lower levels of vitamin D. Most naturopathic doctors recommend vitamin D supplementation, especially in winter months when UV exposure is minimal.
Ask your provider to run a blood test so you know how much supplementation you actually need. Since vitamin D is a fat-soluble vitamin, its stores can increase pretty quickly. That’s why it is important to check your levels and avoid toxicity.
If you don’t have a naturopathic or functional medicine physician to work with you, I’d love to chat with you. As a functional fertility physician, I’ve worked with countless couples to conceive a child.