Dr. Sarah Stombaugh:
This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight Podcast, episode number 22.

Announcer:
Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here’s your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh.

Dr. Sarah Stombaugh:
Hi everyone. I’m sorry to leave you all hanging last week just right in the middle of our pregnancy talk. I will say though, I have gotten so much feedback about the consistent length of my episodes, and so wherever I can, I want to do my best to stick with that. So let’s dive back into weight gain in pregnancy. If for some reason you haven’t had a chance to listen to the last episode, episode 21, do go back and listen to that before today’s episode because I literally left off sort of right in the middle of the episode and we’re gonna be picking up right where we left off. So last week we started talking about the four things to do to prevent excess weight gain and pregnancy. We talked about, one, how much weight should you gain during pregnancy? Two, what are your caloric needs during pregnancy?

And then we started to talk about three, what should a healthy diet look like in pregnancy? So today we’re going to finish off talking about a healthy diet in pregnancy, and we’re also going to address the last item, which is how to manage cravings. So as I mentioned last week, I think the nutritional guidelines for gestational diabetes are really excellent jumping off point for many women during pregnancy. Those guidelines recommend to eat enough protein at least 71 grams per day and emphasize carbohydrates in their whole form for at least 175 grams per day. And I don’t mean that you need to track your calories or track your macronutrients day to day, but it is really important to emphasize getting enough protein and choosing those carbohydrates in their holist forms. What the guidelines don’t go too in depth about is how to handle fats in the diet.

So for reference, if you ate 71 grams of protein per day and 175 grams of carbohydrate per day, you’d be starving. Protein and carbohydrates have four grams or rather four calories each per gram. So if you do the math, 71 grams of protein is 284 calories, 175 grams of carbohydrate is 700 calories. Adding those together, that only gives you 984 calories. That’s certainly not enough food for most people, let alone any pregnant woman. So where are the rest of your calories supposed to come from? Fat. They should be coming from fat, and certainly you might choose to eat a bit more protein or carbohydrates as well, but it’s important to make sure you’re getting enough healthy fat in your diet. So I wanna take a few minutes today and talk about what that means to get healthy fats in the diet. And pardon me a bit here because I am going to seriously simplify things.

But broadly speaking, fat can come in the form of saturated fat or unsaturated fat. And saturated fats are typically from animals. So this is things like butter are full fat dairy products like cheese, meat, and poultry where unsaturated fats come from, things like vegetables, nuts and fish. And most cooking oils like olive oil for example, are unsaturated fats as well. There are certainly exceptions. Coconut oil is mostly saturated fat, for example. But as a general rule of thumb, if it came from an animal, it’s going to contain primarily saturated fat. If it came from the earth or from fish, it’s going to be primarily unsaturated fat. Now, I should point out nutrition and healthcare professionals will argue up and down, left and right about saturated fats. Are they bad for you? Are they good for you? Are they okay in moderation? And I’ve spent a lot of time reading the literature, talking to my colleagues, working with my patients when it comes to their weight, their hunger and fullness signals and their labs.

And I’ll say, I have a fairly neutral stance on saturated fats. For the average patient, it doesn’t really make sense to go out of your way to either include them in your diet or exclude them from your diet. When you choose a dairy product, for example, it might make sense to choose the full fat version to help with flavor and satiety, which is your fullness signal. But on the other hand, I’ve had patients who are eating eight slices of bacon for breakfast every day, and I’m not sure that’s the best choice for most people either. So because I’m not your doctor, I literally know nothing about you or your labs, your medical conditions, or your family history. I can’t say what’s going to be the right answer for you, but it is worth having a conversation with your doctor so that you can make the like a decision that makes the most sense.

On the other hand, I will tell you there’s one thing that everyone agrees upon, which is that emphasizing unsaturated fats in the diet is great. So with that background, I wanna take a step back and look at a comparison and we’re gonna do a food choice comparison with the oatmeal dish I had last week compared to a bagel with cream cheese. Last week we were talking about my oatmeal dish. I, on one day had counted all of my calories and my macronutrients. That oatmeal dish I had for breakfast was a cup of plain cooked rolled oats that contained ground flax seed. And I topped that with a cutup peach, a tablespoon or so of sliced almonds, a couple tables, spoons of pepitas, which are pumpkin seeds, a drizzle of honey, a little sea salt, and then I like to put half and half on top of that.

So comparing that to a traditional plain bagel with plain cream cheese, it’s really interesting because attic glance, they actually look pretty similar. The oatmeal dish has 21 grams of fat, 50 grams of carbohydrates, and 14 grams of protein for a total of 430 calories where the bagel and cream cheese has 13 grams of fat, 67 grams of carbohydrates, and 13 grams of protein for a total of 420 calories. So interestingly, the bagel and cream cheese actually has slightly less calories, it also has less fat. But let’s talk about why that oatmeal dish is a better choice. When we start looking at the fat from the bagel and cream cheese compared to the oatmeal dish, the first thing you’ll see is that the oatmeal dish has more fat. It has 21 grams of fat where the bagel and cream cheese only has 13 grams of fat.

But when you look a bit closer looking at the saturated fat and the unsaturated fat, you’ll see that most of the fat in the bagel and cream cheese comes from saturated fat. So while there’s only 13 grams of fat total, eight grams of those comes from saturated fat, which makes sense. We’re talking about cream cheese on the other hand, in the oatmeal dish there’s more fat overall 21 grams of fat and only about six grams comes from saturated fat. And those six grams are mostly from the half and half that I like to add. The rest of the fat is unsaturated fat coming from the nuts and the flax seed. And remember, the jury is a bit out about saturated fats, but what we do agree on is that unsaturated fats are good for you. Eating unsaturated fats is an excellent way to get nutrition and calories and stay full after your meal.

For pregnant women, healthy fats like unsaturated fats from nuts and seeds also play an important role in your baby’s neurological development. So even though the oatmeal dish has more fat overall, it actually ends up being a good thing because it’s primarily coming from unsaturated fat. The other major difference between this meal or these two meals is where the carbohydrates are coming from. Remember, the goal for pregnancy is not necessarily to limit carbohydrates, but to make sure to choose complex or whole carbohydrates when you can because those are digested slowly and they help keep your blood sugar levels stable. In the bagel, the carbohydrates are mostly coming from white flour and then a little bit of sugar. White flour basically then turns into sugar in the bloodstream, which bli drives your blood sugar up quickly and then down quickly. And I will say the fat and the protein from the cream cheese do help to balance the response a bit, but we’re still talking about an extremely processed carbohydrate.

And when we eat processed carbohydrates like this, we’re likely to feel hunger sooner. We’re likely to get that sort of crashy hangry feeling and we might end up eating more or eating our next meal sooner than we would have otherwise. On the other hand, rolled oats are a form of whole grain. I like to combine that with flaxseed as well as sometimes other things like in this dish I added the peach and I added the nuts. And so not only are you getting a whole carbohydrate, but there’s a lot of fiber there and those contain a lot of healthy fats as well. And I’m really getting into the weeds, but I wanted to stop and compare those two things so that you can see there’s a lot more than what just meets the eye. You want to be choosing enough protein, emphasizing carbohydrates in their whole form and choosing fats throughout the day.

Alright, let’s get into the final topic, which is how to manage cravings and pregnancy. And let me first say pregnancy cravings are a very, very real thing, both as a physician who’s treated many pregnant women, and as a woman who is now in my third pregnancy, I can tell you firsthand, they are very real. And it’s interesting when I look back at my first pregnancy, I actually don’t remember that I craved any specific foods. I certainly have in my second and my third pregnancies During my second pregnancy, I had a serious craving for fried chicken, and there’s an excellent Korean fried chicken restaurant that’s about a block away from the office I practiced in in Evanston. It’s called 10 Q chicken. If you happen to be in the area. And I kid you not, when I tell you the owner knows me by name.

So if that is not a testament to pregnancy cravings, I don’t know what is. And in this pregnancy, I cannot get enough pickles. I always thought that craving pickles was a joke because it was not a craving I had experienced during my first two pregnancies. But seriously y’all, this is a real craving. I will take all the pickles all day long. Literally the other day I drank the brine from the bottom of a pickle jar. So they’re real. But the crazy thing is that as a medical community, we don’t fully understand food cravings in general, especially food cravings during pregnancy. I actually did a lot of research before uh, doing today’s episode to make sure that I had the most up-to-date information, and I found a great comprehensive article that was published in the Frontiers of Psychology Journal in 2014. It’s aptly titled Pickles and Ice Cream, food Cravings and Pregnancy Hypotheses, preliminary Evidence and Directions for Future Research.

There have certainly been further papers regarding pregnancy cravings since 2014, but none of them provided as broad of an overview as this one did, and none have really found the quote answer as to why pregnancy cravings happen. So I wanna talk through this a bit. There are a lot of different hypotheses as to why food cravings during pregnancy occur. Is it the hormonal changes? Is it nutritional deficits? Is it something about the food themselves, like a pharmacologically active ingredient in the desired food? Or is it cultural and psychological factors? Some combination of the four something different? So let’s talk about it a little bit. It makes sense that hormonal hormonal factors play a role, but as a scientific community, we haven’t exactly figured out how this is the case. There’s a lot of proposed theories about the balance of estrogen and progesterone at different times of the menstrual cycle and in pregnancy, but there’s actually been quite a few studies in the menstrual cycle and they’ve given women hormones via a pill.

And interestingly, it doesn’t make a significant impact on their premenstrual cravings. So that’s cravings that happen in the week or so leading up to their period. And if you aren’t aware, not familiar with medical research, as is the case with most medical research, it’s not ethical to conduct these type of experiments in pregnant women. So we’re looking at other hormonal states like the premenstrual period. Certainly there are psychological studies in that type of thing, but you’re not gonna be giving hormonal pills to pregnant women. So we still think that there’s a big hormonal factor. We don’t totally understand why. What about the nutritional deficits? So it makes sense that hormonal or rather nutritional deficits could play a role in pregnancy cravings. And interestingly, I’ve actually seen this in other aspects of my medical practice. So for example, one of my vegan patients would crave hamburgers whenever she was iron deficient.

And over the years she had actually done experiments on herself where she would have her hemoglobin and her iron levels drawn when she was having these cravings. And she found that her hamburger cravings indeed corresponded to the times when she was ironed, deficient, or sometimes even anemic. But interestingly, this doesn’t always seem or usually seem to be the case for pregnancy cravings. The most commonly craved foods in the United States are sweets and then calorically dense, savory like chips and pizza. So these aren’t exactly foods that are meeting our nutritional deficits. And even if you look at a craving like ice cream for example, so you’re thinking, okay, maybe you’re calcium deficient, so you’re craving ice cream, okay, sure. But it’s not like women are craving milk or craving yogurt in that same way, which would have similar calcium content, and they certainly aren’t craving tofu, which has twice as much calcium per serving as ice cream.

Furthermore, with broad prescribing of prenatal vitamins, nutritional deficits in developed countries like the United States are exceedingly rare. So what about is it something about the food themselves that make them crave it? Interestingly, there’s actually good data to show the opposite. So when we look at pregnancy food aversions, they often correspond with sensitivity to smells or certain chemical com compounds in the food. And that is proposed to decrease our risk of eating contaminated foods, which is generally important, but especially during pregnancy when it could harm not just the mom but the baby as well. But there’s nothing to show that foods themselves are causing our cravings. And most interestingly, cravings vary broadly around the world. So surveys in the United States show that women tend to crave chocolate and sweets, but around the world those cravings vary. Like women in Japan tend to crave rice. That leads us to the final hypotheses, which is that cultural and psychosocial factors influence her cravings and for good or for bad.

This seems to be the predominant theory for pregnancy cravings. So let me read this straight out of the journal article because I like the way it’s stated and then we’ll go back and summarize it a bit. The proposed model for craving etiology cravings are hypothesized to be due to competing approach and avoidance conflicts brought about by the exposure to foods that are perceived as being simultaneously appealing, meaning that due to innate preference for high caloric, sweet and fatty foods, and forbidden due to cultural norms, prescribing, restrained intake and a thin figure. So while most individuals are thought to attempt to resolve the resulting ambivalence in favor of abstinence, pregnancy is hypothesized to be a culturally sanctioned permissive factor, allowing women to circumvent their usual conflicting response and efforts to restrict, restrict intake and indulge in foods they would otherwise avoid, resulting in increased intake and heightened risk for weight gain specifically during pregnancy.

Alright, that was a mouthful. I think I stumbled through it a bit, but let me say what that means is that one, you may have foods that are appealing to you, but you may also look at them as forbidden. And usually like outside of the pregnancy, outside of the pregnancy state, you don’t eat those foods. But during pregnancy, culturally we say it’s okay. It’s totally fine. And so women feel more comfortable eating those foods, even if it’s different than that, what they would do outside of pregnancy just because our culture says that it’s okay. So basically our culture says pregnancy cravings are a normal thing. So it boils down to pregnancy cravings happen for hormonal reasons that we don’t fully understand, and then culturally, it’s socially acceptable to both be having those cravings and giving into those cravings during pregnancy. Addressing cravings though can be far more complex.

One of the things we know about humans is that reverse psychology is a real phenomenon. As soon as we tell ourselves, I can’t eat that food, I’m not allowed to eat that food, I shouldn’t eat the food, all of a sudden it sounds a lot more desirable. And so ironically, restricting foods using these type of thoughts can lead to craving them more and likely eating them more. And these type of thought patterns can quickly lead to disordered eating. And this is where learning to understand your body and learning to understand your mind can be so valuable. Oftentimes, those underlying thoughts are completely subconscious. We don’t even realize we’re having them. We see a food and have a thought like, oh, that sounds good, and we’ve slipped into a pattern where we’ve thought about the food, we’ve craved the food and we’ve eaten the food. It happens so quickly and we may have followed that same neural pathway so many times we don’t even realize it’s optional or that it’s possible to stop somewhere along that neural pathway.

The good news is, however, is that all of these thoughts are completely optional, and once you understand that, you begin to feel in control. The first and most important step is having an awareness of how to approach yourself from a place of love and a place of understanding. You are the boss of you. You get to eat whatever you want. Nothing is quote off limits, but you might choose to think about your food differently. For example, asking yourself, does this food serve me and my nutritional goals right now? And so instead of a thought like, I can’t have that food, it becomes a matter of you can eat whatever you want, but you’re not choosing that food right now. And while thought swaps like that seem minor, they end up playing a really big role. The other thing I find really helpful is to name what’s going on, to have a food craving and literally think this is just a craving.

And from that point, you get to decide how to handle it. But regardless of whether you choose to eat the food or not, you’ve named what’s going on, which brings an intentionality to the neural pathway that may have felt automatic before. And all of this gives you more information for how you can understand your cravings and manage your cravings. Thank you all for joining me today, whether you’re pregnant or not, I hope you found some helpful information in this episode. If you listen to this episode and you’re thinking, that’s all fine and dandy, Dr. Stombaugh, but I’m 40 years old. I’m done having kids. I already did that. I gained too much weight during my pregnancy. I wish I could go back in time and do it differently. But a last time travel has not yet been invented. Girl, I’ve got you. You can still lose the weight.

Connect with me over at my website at www.sarahstombaughmd.com. That’s S-A-R-A-H-S-T-O-M-B-A-U-G-H-M-D dot com. Even if you don’t live in Illinois or Virginia where I’m licensed to practice medicine, please reach out to me on my contact page. I’m happy to connect you with a local physician who can help. Thank you so much for joining me today. If you’ve enjoyed the episode, please subscribe and leave me a review wherever you listen to podcasts. Please share this with anyone who you think may benefit. I can’t wait to see you next week. Bye-bye.