Caution: Anti-inflammatory Foods in the Third Trimester

Caution: Anti-inflammatory Foods in the Third Trimester
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For the same reason that anti-inflammatory drugs like aspirin and ibuprofen are advised against during late pregnancy, anti-inflammatory foods may increase the risk of premature closure of the ductus arteriosus.

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The right side of the heart, shown here in blue, pumps deoxygenated blood from the body to the lungs, where it can fill up with oxygen, and then the left side of the heart, shown here in red, pumps oxygen-rich blood from the lungs to the rest of the body. So, blood travels from the body, to the right side of the heart, to the lungs, to the left side of the heart, back to the body. But what if you’re still in the womb? When you’re a fetus, your lungs don’t work, because they’re filled with fluid. So, how does your heart bypass the lungs and spread the oxygen-rich blood coming in through the umbilical cord to the rest of your body? Before we’re born, we have an extra blood vessel called the ductus arteriosus, that directly connects the right side of the heart with the left side of the heart, bypassing your fluid-filled lungs—until you’re born, and you take your first breath, and this blood vessel closes. But in about 1 in 10,000 births, this blood vessel closes prematurely while the baby’s still inside, necessitating an emergency C-section.

Most cases for which there’s a known cause are thought to be related to taking anti-inflammatory drugs, like aspirin or ibuprofen. This is because the way your body keeps this blood vessel open is with a class of inflammatory compounds called prostaglandins. If you take an anti-inflammatory drug, you can undermine your body’s ability to keep it open, and it could constrict closed prematurely. That’s why most authorities recommend that these NSAID anti-inflammatory drugs be avoided in the third trimester. The likelihood anything bad is going to happen is extremely remote, but better safe than sorry.

Sometimes, this premature constriction happens even when women are not taking drugs, so called “idiopathic” cases, which is doctorspeak for “we have no idea what causes it.” If anti-inflammatory drugs can cause it, though, what about anti-inflammatory foods? A few years ago, I profiled two cases apparently caused by pregnant women drinking chamomile tea, one of which reversed. The ductus opened right back up once the tea was stopped. But the other baby had to come right out. Since then, there have been other case reports; for example, a women who had been drinking a few ounces of an acai berry drink every day or another woman who was drinking prune juice, and a violet vegetable juice containing a blend of fruits and veggies. Pregnant women should, therefore, take special care when consuming lots of these powerful anti-inflammatory berry nutrients.

What about berries themselves, and green tea, and all the other wonderful anti-inflammatory foods and beverages out there? This group of researchers in Brazil compared ultrasounds of third trimester babies’ hearts inside moms who ate a lot of these anti-inflammatory foods, to those of women who ate less and they could tell a difference. The speed of blood through the ductus in the anti-inflammatory diet moms was higher, suggesting it was narrower, just like when you pinch the opening of a hose closed and can make water shoot out faster. And, also, the right sides of the hearts of the babies in the anti-inflammatory diet moms were larger than their left sides, suggesting some blood backup, again an indicator of a tighter ductus. The researchers suggested changes in late pregnancy diets may be warranted. But critics replied that the differences they noted may not have any clinical relevance, meaning it may not matter if the vessel is a little more open or closed. And look, we don’t want to freak women out, as many of these anti-inflammatory foods may be beneficial—like cranberries for example, which may be useful in preventing urinary tract infections that can be a risk factor for premature birth. So, cranberries are attractive from a public health and cost consideration standpoint if they can prevent some premature births.

So, before cutting down on a healthy food like cranberries, we’d want some stronger evidence that they’re potentially harmful. What about confounding factors, for example—maybe women who ate lots of anti-inflammatory foods had other characteristics that could affect fetal blood flow? What we would need is an interventional trial where you take pregnant women, change their diets and see what happens. But we didn’t have such studies, until now. And, a few weeks during third trimester cutting back on anti-inflammatory foods like tea, coffee, dark chocolate, grapes, and citrus did indeed seem to open the ductus a little bit. This was just during normal pregnancies. In women whose fetuses had abnormally constricted vessels, a few weeks of removing polyphenol-rich foods reversed the ductal constriction in 96% of cases. Now, importantly, they didn’t follow these babies after birth to see if it made any difference. That complete closure happens in only 1 in 10,000 births. We’re not sure what effects just relative levels of constriction may have; so it’s too early to be instituting a ban on dark chocolate for pregnant women.

At this stage, what we’re left with is a note of caution. So, during the rest of life, I recommend piling on these healthy foods, like berries and cocoa powder, but from about 28 weeks until birth, pregnant women may want to cut back until we know more.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to ZooFari via Wikimedia Commons.

The right side of the heart, shown here in blue, pumps deoxygenated blood from the body to the lungs, where it can fill up with oxygen, and then the left side of the heart, shown here in red, pumps oxygen-rich blood from the lungs to the rest of the body. So, blood travels from the body, to the right side of the heart, to the lungs, to the left side of the heart, back to the body. But what if you’re still in the womb? When you’re a fetus, your lungs don’t work, because they’re filled with fluid. So, how does your heart bypass the lungs and spread the oxygen-rich blood coming in through the umbilical cord to the rest of your body? Before we’re born, we have an extra blood vessel called the ductus arteriosus, that directly connects the right side of the heart with the left side of the heart, bypassing your fluid-filled lungs—until you’re born, and you take your first breath, and this blood vessel closes. But in about 1 in 10,000 births, this blood vessel closes prematurely while the baby’s still inside, necessitating an emergency C-section.

Most cases for which there’s a known cause are thought to be related to taking anti-inflammatory drugs, like aspirin or ibuprofen. This is because the way your body keeps this blood vessel open is with a class of inflammatory compounds called prostaglandins. If you take an anti-inflammatory drug, you can undermine your body’s ability to keep it open, and it could constrict closed prematurely. That’s why most authorities recommend that these NSAID anti-inflammatory drugs be avoided in the third trimester. The likelihood anything bad is going to happen is extremely remote, but better safe than sorry.

Sometimes, this premature constriction happens even when women are not taking drugs, so called “idiopathic” cases, which is doctorspeak for “we have no idea what causes it.” If anti-inflammatory drugs can cause it, though, what about anti-inflammatory foods? A few years ago, I profiled two cases apparently caused by pregnant women drinking chamomile tea, one of which reversed. The ductus opened right back up once the tea was stopped. But the other baby had to come right out. Since then, there have been other case reports; for example, a women who had been drinking a few ounces of an acai berry drink every day or another woman who was drinking prune juice, and a violet vegetable juice containing a blend of fruits and veggies. Pregnant women should, therefore, take special care when consuming lots of these powerful anti-inflammatory berry nutrients.

What about berries themselves, and green tea, and all the other wonderful anti-inflammatory foods and beverages out there? This group of researchers in Brazil compared ultrasounds of third trimester babies’ hearts inside moms who ate a lot of these anti-inflammatory foods, to those of women who ate less and they could tell a difference. The speed of blood through the ductus in the anti-inflammatory diet moms was higher, suggesting it was narrower, just like when you pinch the opening of a hose closed and can make water shoot out faster. And, also, the right sides of the hearts of the babies in the anti-inflammatory diet moms were larger than their left sides, suggesting some blood backup, again an indicator of a tighter ductus. The researchers suggested changes in late pregnancy diets may be warranted. But critics replied that the differences they noted may not have any clinical relevance, meaning it may not matter if the vessel is a little more open or closed. And look, we don’t want to freak women out, as many of these anti-inflammatory foods may be beneficial—like cranberries for example, which may be useful in preventing urinary tract infections that can be a risk factor for premature birth. So, cranberries are attractive from a public health and cost consideration standpoint if they can prevent some premature births.

So, before cutting down on a healthy food like cranberries, we’d want some stronger evidence that they’re potentially harmful. What about confounding factors, for example—maybe women who ate lots of anti-inflammatory foods had other characteristics that could affect fetal blood flow? What we would need is an interventional trial where you take pregnant women, change their diets and see what happens. But we didn’t have such studies, until now. And, a few weeks during third trimester cutting back on anti-inflammatory foods like tea, coffee, dark chocolate, grapes, and citrus did indeed seem to open the ductus a little bit. This was just during normal pregnancies. In women whose fetuses had abnormally constricted vessels, a few weeks of removing polyphenol-rich foods reversed the ductal constriction in 96% of cases. Now, importantly, they didn’t follow these babies after birth to see if it made any difference. That complete closure happens in only 1 in 10,000 births. We’re not sure what effects just relative levels of constriction may have; so it’s too early to be instituting a ban on dark chocolate for pregnant women.

At this stage, what we’re left with is a note of caution. So, during the rest of life, I recommend piling on these healthy foods, like berries and cocoa powder, but from about 28 weeks until birth, pregnant women may want to cut back until we know more.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to ZooFari via Wikimedia Commons.

Doctor's Note

The video in which I profile those two case reports is here: Chamomile Tea May Not Be Safe During Pregnancy. As I note in Anti-Inflammatory Antioxidants, high antioxidant foods are, in general, high anti-inflammatory foods.

For comparisons between the strength of anti-inflammatory foods and drugs, see:

More on healthy (and unhealthy) diets in and around pregnancy:

Update: In 2018, I released a couple of videos about a food that is good for late pregnancy. Check out Best Food for Late Pregnancy and Best Food for Labor & Delivery.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

66 responses to “Caution: Anti-inflammatory Foods in the Third Trimester

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  1. Aha, very interesting in that there are some inflammatory needs within our body. Makes you wonder if there are not some other times when inflammation is needed that we may not yet understand.

    1. Local inflammation is needed to promote healing at the site of an injury and I understand that more systemic inflammation is needed to fight bacterial infections. Anti-inflammatory foods help keep inflammation from reaching runaway levels or a chronic state which can injure the body and cause chronic diseases including diabetes, heart disease and cancer and possibly Alzheimer’s disease which seems to be related to inflammation but whose cause is not completely understood.

    2. This is a unique scenario in an extremely tiny blood vessel in the hearts of developing babies and we are not even sure if it is clinically relevant. For a pregnant woman in her 3rd trimester, this is a interesting thing to keep in mind but I would not generalize this outside of a very specific situation.

      Generally speaking, in adults, inflammation unchecked is a common pathway of many diseases.

      Here is a relevant passage by Dr. Greger related to Diet and Inflammation.
      http://nutritionfacts.org/2011/10/04/inflammation-diet-and-vitamin-s/

      Many chronic disease processes involve inflammation, including our top three killers—heart disease, cancer, and stroke—so doctors prescribe a daily aspirin to those for whom the benefits are thought to outweigh the risks. About 1 in 10 people on chronic low-dose aspirin develop stomach or intestinal ulcers, which in rare cases can perforate the gut and cause life-threatening bleeding. My video Aspirin Levels in Plant Foods suggests that the low levels of salicylic acid in fruits (particularly nectarines), vegetables (particularly asparagus), and herbs and spices (especially mint, cumin, thyme, and paprika) may provide the best of both worlds.

      The way aspirin and salicylic acid work is by helping our body keep inflammation in check by reducing the assembly of the enzyme responsible for producing inflammatory compounds from something called arachidonic acid, an omega-6 fatty acid that both we and other animals make. In my video-of-the-day yesterday, Chicken, Eggs, and Inflammation, I explain that arachidonic acid is like cholesterol, in that our bodies make all we need for optimal function. The problem is that so do the bodies of birds and mammals, and so when we consume those other animals the level of arachidonic acid in our blood may climb too high.

      For example, inflammation in our brain caused by dietary arachidonic acid may explain why those eating plant-based diets appear less stressed and depressed (see my video Plant-Based Diet & Mood) and why eliminating chicken, fish, and eggs may improve symptoms of mood disturbance, depression, and anxiety within two weeks (see Thursday’s Improving Mood Through Diet). Arachidonic acid may also play a role in cancer, asthma, inflammatory bowel disease, rheumatoid arthritis, and other autoimmune disorders (see Friday’sInflammatory Remarks about Arachidonic Acid).

      This morning’s video-of-the-day Chicken’s Fate is Sealed documents the meat industry’s attempts to lower the arachidonic acid level in chicken muscles through genetic manipulation and the egg industry’s attempts to lower arachidonic acid levels in hens by feeding hens blubber from baby harp seal pups clubbed to death in the Canadian seal hunt. But any arachidonic acid from chicken and eggs is in excess of what our body needs.

      In summary, plant-based diets are anti-inflammatory diets because “Vitamin S” and other anti-inflammatory phytonutrients in plants may help prevent the body from overproducing inflammatory compounds, and also because plant-based diets minimize one’s intake of inflammatory precursors in the first place.

      -Michael Greger, M.D.

      1. I get the feeling then that the real goal of as diet that doesn’t create inflammation is so that or body can truly control inflammation. And by eating a diet high in things that creates inflammation leaves our body without the ability to control, resulting in many negative affects. Here it seems the concern is that some dietary factors are so good at reducing inflammation that in some cases our diet may actually dampen inflammatory response our body may need.

      2. I’m 42 years old and 12 weeks pregnant. I conceived naturally after having unprotected sex ONE TIME! Both my partner and I have been vegan 20 years. I’ve never been pregnant and I’ve had a super easy pregnancy so far. I have no health issues and eat mostly a whole foods diet.

        My midwife who has yet to meet me or know anything about my medical history other than that this is my first pregnancy and my age, suggested on the phone that I should start taking baby aspirin everyday to help implantation of my placenta. I did a little research online and found that other women who were prescribed this had previous miscarriages, blood clotting disorders, diabetes, high blood pressure or are obese. I do not fit into any of those categories.

        I have not put aspirin in my body for over 10 years and am not about to start now without a really good reason to do so. I want to tell my midwife that I refuse to follow her orders. But I want to check first if this would be a wise decision.

        1. Just check out our many videos on hibiscus! We mention research showing that like a quart per day is safe and beneficial to drink.

        2. Nobody should be done with tea, there is too many benefits. Take it from a person that drank so much tea that this actually caused me to be iron deficient! Now, dr. Greger recommends drinking tea separately from meals. Thats the point. And if you are iron deficient, add vitamin C rich foods to your meals – ta-da!

  2. What about dha/epa from algae oil supplements? These omega 3 fatty acids are anti-inflammatory, but are also highly recommended during pregnancy for healthy brain development.

    1. They are anti-inflammatory for sure. Check out our info on DHA and EPA. Yes, definitely important during pregnancy as preformed omegas are preferred.

  3. Thank you for sharing! Though I must say I am a bit concerned now, being 38 weeks pregnant on a 100% whole-foods-plant-based and high anti-oxidant diet. Do you recommend an extra check of my baby’s heart?..

    1. Linda: As a lay person, I can’t answer your question about whether an extra heart check is a good idea or not. Dr. Greger does point out that we aren’t sure if these differences are clinically relevant or not.

      But he also advises caution… I wanted to share my 2 cents on what I think caution might look like. I don’t think Dr. Greger is recommending pregnant women start eating pro-oxidant foods like meat, diary or eggs. So, what then? I’m wondering if the cautious diet for a woman in the 3rd trimester might be something more akin to Dr. McDougall’s starch diet. It’s still plant based and whole foods, but less emphasis on the higher anti-oxidant foods. So, more focus on potatoes, quinoa, beans etc and less of the berries, dark green veggies, cocoa, etc. Just a thought. I don’t know if my suggestion makes any sense or not. Just wanted to share.

      And to wish you and your baby well! A mama who is eating a whole plant food based diet is miles ahead of so many other mamas out there. Your baby will be one lucky kid!

      1. Dear Thea, thank you so much for your wonderfull and kind response. The funny thing is that the dr. Mc Dougall diet is exactly what I switched to after seeing this video! I looked into the list of anti-oxidant values of 1300+ products and saw that starchy items and vegetables seemed quite low. Recently I had ‘coincadentally’ come across The Starch Solution, so now I made the switch. I have good hopes that IF there’s any ‘damage’, this will reverse it.
        Luckily, I have a very lively little boy inside me, reassuring me multiple times a day that he is doing just fine! :)
        Thanks again for your support!

      2. I was thinking, remember that video on this site that showed how soy milk acted the same way as cow’s milk in suppressing polyphenol uptake in coffee? I looked for the video but couldn’t find it, but I clearly remember it. Maybe soy is the answer to this situation! So if a third trimester women wants to have, say, an acai drink, just make sure you put some soy milk in it! Or use edamame for dishes that are very polyphenol rich. Maybe just increasing soy food intake, which is high protein and they always want you to increase protein intake in the third trimester anyway, is the answer and will protect from this potentially serious condition.

        1. Benjamin Dowell: I remember something like you remember, but not the details. I couldn’t even speculate, but I like how you think. :-) Interesting idea!

    2. Hi I wouldn’t stop taking one tablespoon ground flax seeds daily. It’s not so much. If you want the baby to slide out without an epidural don’t stop taking that little bit of flax. I can’t imagine eating too much antioxidants.

  4. So no turmeric in the third trimester. Expecting mothers can sense this opening? That’s amazing. Perhaps the baby needs more atomic nutrition like Iron, Phosphorus, Iodine, and protein. Do expecting mothers like pumpkin seeds?

      1. Why is that (my wife has kept up on her flax up to the 3rd trimester now… should she stop)? Should she just get all her omega 3 from greens/fruits/vegetables from now on?

        1. Good question! Not sure exact reasons of course it probably lays out the mechanisms in some of the studies.

    1. Disagree Only stop taling that small amount of flax if you want to have a C section. If you’re worried about too much take it in divided doses 1/2 tablespoon twice a day or one teaspoon 3 times a day.

  5. Is the human body amazing or what?

    But, how on Earth would the mother or the doctor know that his blood vessel is closing up in the womb? Are their any symptoms or is this just a lucky catch if the mother is in the doctor’s office?

  6. What about causing idiopathic non-sustaining ventricular tachycardia? Any studies there? I was taking high dose of IBUPROFEN for a phlebitis (doctors orders) , and having cocoa, green tea, blueberries, daily.. when I had my first episode

  7. I don’t want to change the subject, but I need some help finding some studies comparing vegans with vegetarians, pescetarians and omnivores. I have a document with almost all the concepts the Doc mentioned since the beginning but I did not save individual studies. Let me explain: I am having a debate with a friend of mine and going through all the videos looking for comparison between the above mentioned categories is very time-consuming. I am looking preferably for controlled studies rather than cohort (observational) studies. Thanks!

    1. Look into the Adventist Heath Study-2 cohort and the EPIC cohort. Both look at different diets and health outcomes. We have many videos on these populations. Let me know if you cannot find? I can also email you some hard copies of the research if you’d prefer? Please give me some time though I am out of the Country.

      Thanks, Sebastian,
      Joseph

      1. I was looking more for intervention trials. I have already spoken about the EPIC studies with my friend but the EPIC studies don’t show vegans are healthier (something the Doc has already mentioned). I understand that there are many problems: cohort studies, low fiber intake, Vit. B12 deficiencies. That’s why I want simple controlled studies comparing vegans, vegetarians, pescetarians, omnivores. Thanks.

        1. Hmmm. Less trials in that category. Perhaps Dr. Barnard’s work comparing vegan to ADA diet or the National Cholesterol Education diet can help?

  8. this is what i called a scientific fair way of “cherry picking” journal (if some people said that Dr. Michael Greger does cherry picking). this is why i like Dr Michael Greger and rest of the team, they provide a reliable conclusion in a fair ground and peeling every part of the truth even in this rare “unique” case of inflmatory. THUMBS UP FOR Dr. Michael Greger and Nutrtionfacts’s Crew ! I love it

  9. Is there any information available on what a safe upper limit per day in the 3rd trimester might be? I found this list ranking foods by polyphenols (http://www.nature.com/ejcn/journal/v64/n3s/fig_tab/ejcn2010221t1.html) but I am not sure how low I need to go in the third trimester. I am actually pregnant so I this is not a theoretical question. ;) It looks like I need to cut back on the cocoa powder / dark chocolate in any case… drat!! I would be loathe to cut out the flax seeds, however (as others have mentioned), as it really helps with the, um, digestive sluggishness of pregnancy!

  10. Oh wow. I’m 35 weeks pregnant and was just stuffing my face with grapes, blueberries, black berries, and cherries while poking around this site. Perhaps I should cut back my daily 5-7 servings of berries and fresh fruit until after the baby arrives. That’s a tall order for a pregnant woman who predominantly craves fruit though!

      1. We have a healthy 6-month-old. We are just one example and by no means dictate anyone else’s experience though. But yeah I craved fruit and ate to my hearts content. Our babe showed up at 41 weeks and had a healthy, unmedicated delivery and postpartum experience. Now he’s eating solids and has an affinity for strawberries, but nothing interesting to note here!

        1. Awesome! Congratulations! This video really worried me. It would probably be a rare thing for this to actually happen from eating healthy foods. Thanks for the update! We’ll just take it easy on the berries and spices in the 3rd trimester to be safe.

  11. I noticed that green tea and coffee were included in the anti-inflammatory foods that constricted the duct. Could the caffeine have an affect on this and not the inflammatory/anti-inflammatory effects of the food themselves? I would really like to see caffeine content controlled in a study like this.

    1. Actually, caffeine seems to be nefarious as it apparently stiffens our arteries. Check the latest videos on caffeine and coffee in the video section.

  12. I’m 24 weeks pregnant and I am having green smoothies with blueberries, hemp seeds, walnuts, Moringa, and cacao. The smoothies feel so good. But maybe I should start moving towards more starch solution as well?

    1. As he said in the video after 28 weeks or a little later you should probably decrease the fruits and chocolate until after delivery. The starch will also help you feel full, particularly if you’re like me and ravenously hungry your entire pregnancy. Congratulations and best wishes.

      1. Thanks for the information. My wife is 7 weeks pregnant. We have been following a daily dozen type diet for years. It’s going to be hard for us to change it up at 28 weeks. How many greens do you think is safe? Normally we would consume a huge green salad and then cooked broccoli and kale to get the calcium requirements. We also consume blackstrap molasses to get an extra 200mg calcium from just one tablespoon in water with one teaspoon amla powder. I guess we will stop the amla powder. I guess we will focus on bananas for fruit? Bananas are pretty low anti-oxidant fruits.

  13. As one of the moderators for NF.org, I wanted to respond to your question about cod liver oil and excessive bleeding, especially during pregnancy. I’m afraid there is not enough research to give this substance a stamp of approval. Looking at the following authoritative source:https://medlineplus.gov/druginfo/natural/1040.html#Safety (search for Cod Liver Oil) the following sconservative advice is given: “Not enough is known about the use of cod liver oil during pregnancy and breast-feeding. Stay on the safe side and avoid use.” At this point that is the best advice available about use of cod liver oil and pregnancy, with reasons outlined in the full article. Hope that answers your question. :

  14. Hi Saj and thanks for your question. Consuming about 1/4 tsp of turmeric daily (but not more than 1 tsp) of the culinary herb is considered safe throughout pregnancy. Avoidance of the nutraceutical curcumin however would be advised.

  15. There is actually a human study evaluating flax oil use in pregnancy. It was used in that case as a laxative. They studied its use from 2nd trimester on, and found it to be safe. Here’s a link to the abstract of this review, which summarizes data for several herbs and their safely profile at different points in pregnancy. https://www.ncbi.nlm.nih.gov/pubmed/28610933 -Dr Anderson, volunteer

  16. What can you reccommend to a 30w pregnant lady with an awful cold? Wanting to up my antioxidant rich foods but dont want to overdo it! I’ve noticed all the videos on upper respiratory infections are about prevention not about treatment too, so I’m finding it hard to know what to do differently with my diet in order to get better. You missed my question on your live q&a by about two questions! Unlucky! I’m hoping someone on here might have some suggestions?

  17. Prevention always wins. Once you’re infected there is not much you can do other than eat a healthy WFPB diet, drink plenty of fluids (not fruit juice) and get plenty of rest/sleep. There has been some evidence of reduction of cold symptoms with zinc, but I would suggest against taking any supplements like this as we have no idea what the effect on your baby could be. I can tell you my anecdotal experience: I eat mostly raw, unprocessed, WFPB. My meals look like this: raw broccoli, raw spinach, raw nuts, raw fruit (sometimes frozen), raw carrots. raw asparagus. I eat like this all day. My kids are 20 and 22, and eat WFPB but like to cook a lot so they eat a lot of beans and brown rice (I’ve warned them about arsenic). They get several colds per year. I get maybe one cold every other year, and it’s usually when I cheat and eat things like bread or other cooked food. My guess is that the reason is that my diet has much more probiotics/prebiotics that protect my airway…..just a guess…no real objective evidence here.

    Dr. Ben

  18. I love the chocolate banana smoothies in the How Not To Die Cookbook – they are epic! I am 1st trimester pregnant can I still have the smoothies from a perspective of caffeine from the cocoa?

    I would really love it if Dr. Michael Greger wrote a book called How to Eat when You’re Pregnant. The pregnancy videos section is great, but to have it summed up in a book would be nice because it feels like such a hurry to figure out once you know you’re pregnant and you don’t want to mess up.

  19. Congratulations on your pregnancy and what a good start you are giving your baby. Now about that caffeine in those smoothies you love:I looked up the recipe you mentioned in the How Not to Die cookbook (one of my favorites!) and I see it calls for 2 TBSP of cocoa powder which then would contains only 24 mg caffeine (12 mg caffeine/Tbsp) A cup of coffee is about 200 mg, the recommended limit of caffeine, so enjoy your smoothies although you should drink less than a full cup of coffee on days when you have your smoothie. Hope that helps.

    http://americanpregnancy.org/pregnancy-health/caffeine-intake-during-pregnancy/

  20. Thank you Joan! That is reassuring! I actually don’t have tea of coffee as a regular life thing. This might sound overcautious, but I have found in a lot of pregnancy literature an approach of telling people what they think they can accomplish rather than the unadulterated advice. Dr Greger has spoke about that in regards to recommended meat levels etc… it’s so fun to watch him on video. I’m curious as to the origin of the 200 mg recommended limit? The reason I ask is because I’m seeing shocking articles popping up in typical catchy internet click things where they say that now a certain amount of alcohol is safe, and a certain amount of fish is safe, and just because it hasn’t be proven otherwise artificial sweeteners are safe…. As an ironic side note, the book What to Expect When you are Expecting the recent version says that because chia has not been proven to be safe, best to stay away during pregnancy (shock face emotocon)! Please ask Dr. Greger to write a book on pregnancy – I’d probably pay $1,000 for one copy. And then ask him to please write a book on feeding young kids.

    So my follow-up question is, does the recommended limit come from a threshold that is clinically proven safe or an number selected to be realistic for human beings? If ideal is 0 mg caffeine, then that is what I want to accomplish. (I was thinking of trying molasses in the recipe in lieu of cocoa, molasses has a chocolately something about it and extra iron).

  21. Hello! I’ve reviewed the topic, and found that this 200mg caffeine limit suggested by the March of Dimes came from summarizing the findings of several different studies. Since one cup of coffee has about 200mg caffeine, the studies often used 200mg as one of the levels of evaluation. One study found that over 1 cup of coffee increased miscarriage. Another found that up to 200mg daily had no effect on pregnancy outcomes. Hence the punt: if you’re going to have caffeine, work to have no more than 200mg daily. This isn’t the same as a single study looking at safety threshold, but a best guess. Bets of luck to you! -Dr Anderson, Health Support Volunteer

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