Stephanie Fein MD [00:00:00]:
Hello, fabulous! Dr. Stephanie Fein here with Weight Loss for Fertility. How does your eating change with pregnancy, especially if you've been losing weight? That's the question we're discussing today in this episode of the Weight Loss for Fertility podcast. Specifically, we're talking about the idea of a pregnancy protocol. Now, all the way back in episode 15, and we'll hook that up in the show notes, I discussed weight loss and pregnancy. And there's some really good stuff in there. So I highly recommend going back and listening to that one. And in episode 116, we discussed what a protocol is.
Stephanie Fein MD [00:00:41]:
And we use the example of a period protocol, which is a contingency plan that you have in place when predictable things arise like your period. And that's another one I recommend you go back to listen to. You can listen to this first and then go back. But today we're discussing the idea of a pregnancy protocol. Now this came up because I was speaking to a sweet client who is going for her transfer soon. So exciting. And she was concerned because she's now so aware of her thoughts. We've been working together.
Stephanie Fein MD [00:01:17]:
She's aware of her thoughts around food and she's concerned that she might start thinking of being pregnant as a free-for-all. How many of us can relate to that? This was such great insight for her. And so of course we discussed it, but this idea of a pregnancy free-for-all is like in our culture. So it makes so much sense that it was there. And the fact that she could notice that it was there, it was amazing. And when you've been losing weight, and you've been watching yourself eat when you're hungry, stop when you're satisfied, and completely change how you think about food, it's easier to catch when these sort of thoughts come in that feel so foreign now. They didn't used to feel foreign, right? When we're used to diet mentality, all or nothing, restriction, deprivation, and then the opposite of restriction and deprivation, which is eating everything. That's a normal part of a yo-yo cycle of dieting.
Stephanie Fein MD [00:02:19]:
That's not what we do here specifically for that reason, 'cause that's not sustainable. We can't restrict and then binge and then restrict and then binge. It's never-ending, it feels terrible, it doesn't work. So my client was aware that she was concerned that she would feel this way. Now she didn't yet, but it's so smart to plan for this, to notice that it's something that may come up and then to make arrangements for it, which is exactly why we're talking about the pregnancy protocol, 'cause it's such a good idea. The quintessential pregnancy free-for-all idea. I always get this image of I Love Lucy, Lucille Ball. She was pregnant in one of the episodes.
Stephanie Fein MD [00:03:04]:
I think you weren't allowed to say pregnant. So interesting. It's a really long time ago now. But anyway, she wanted pickles and ice cream. That whole idea that anything baby wants, baby gets, as if it's the baby wanting pickles and ice cream, that idea of the pregnancy free-for-all. And I understand the fear of that. And also sometimes we get excited about that. Ooh, I've been so good.
Stephanie Fein MD [00:03:29]:
I'm putting air quotes around that. I get to eat anything I want when I'm pregnant. And again, I understand where that comes from, but I have not found that to be the case. First of all, there's foods now that we can't eat. So there's already a restriction in place. Not that means that refers to amounts or anything, and it certainly doesn't affect pickles or ice cream, but it feels different. In my experience, however, the opposite happens, especially if weight has been an issue. And if you go back and listen to episode 15, I talk more in depth about this.
Stephanie Fein MD [00:04:09]:
But depending on your BMI, the amount that's safe to gain is very small. Depending on your BMI before you get pregnant, the recommendation could be to not gain anything. And what that would mean is, and that's BMI over 30, just to know about that is that you're losing fat in the process because obviously you're gaining weight, meaning there's many things that increase your blood volume increases your— there's lots of different ways that we gain weight in pregnancy. Fat is only a small amount unless we do the free-for-all thing and start eating everything under the sun. So it's possible depending on your BMI before you get pregnant to not gain anything. And in fact, once you deliver, if you stayed the same weight, you will lose weight once you deliver. I've had that happen with clients often. And it is very safe because of the way that we lose weight here, right? We use the hunger scale.
Stephanie Fein MD [00:05:17]:
We eat when we're hungry, we stop when we're satisfied. We're never starving ourselves. We're never hungry and not eating. And we're still continuing to listen to the body. Even with pregnancy, you may have different signals for your hunger. It may feel different, and certainly it could feel different in each trimester, week to week. But you always are eating when you're hungry and you stop when you're satisfied, not full. So instead of the free-for-all, which I know can be the fear for people who are trying to lose weight, that would happen.
Stephanie Fein MD [00:05:52]:
My experience has been the opposite, so that women start to eat very nutritious food in reasonable quantities because baby's on board. They want to be careful. And I'm always interested in that because I would love for people to want to feed themselves nutritious food when it's just them, not when only when there's a baby in there. But when we're losing weight the weight loss for fertility way, we are starting to pay attention to how our body feels in general. And so that sort of naturally happens is that we're eating foods that make our body feel good. That is not secret code for kale and dry chicken breast. It's literally what foods feel good in your body. And there's— every body has completely different needs, wants, tolerances, everything.
Stephanie Fein MD [00:06:45]:
Most people already know the things to avoid as recommended by your doctor in pregnancy. Always listen to the recommendations of your doctor. Things like alcohol, raw fish, certain cheeses, deli meats, that sort of thing. I will attach links to PDF that have the government recommendations for foods to avoid in pregnancy. I'll do that in the show notes. And I'll also link up which fishes to avoid. Remember, we're not eating any raw fish, but even if you eat cooked fish, the ones that are higher in mercury should be avoided. So I'll hook that up in the show notes too, just so you have it.
Stephanie Fein MD [00:07:19]:
You likely have been exposed to it already. And those things are good to incorporate when you're pregnant. And that is not about nutrition. It's about bacteria. So the reason to avoid the foods that they're talking about to avoid is because your immune system changes. It has to change because you're having a foreign object growing in your body. So your immune system has to be different when you're pregnant than when you're not. And then you're more susceptible to bacterial infections from things like raw fish.
Stephanie Fein MD [00:07:59]:
And that's the basis of the recommendations from the government about which foods to avoid. Things like alcohol That's different. That's not about bacteria. That is about like a toxicity to the growing fetus. So those things aside, the free-for-all generally doesn't happen. And it doesn't happen because of paying attention to what your body's telling you and the way you've been thinking about food. If you've been losing weight the Weight Loss for Fertility way. With the hunger scale.
Stephanie Fein MD [00:08:38]:
Remember, with losing weight, the Weight Loss for Fertility way, you can have any food you want. Again, not in pregnancy. Remember, there's those recommendations. I'm talking about when you're before pregnancy and after. You can eat literally any food. You can have pickles and ice cream anytime you want. You're going to eat them when you're hungry and stop when you're satisfied, not full. And then you're going to notice how you feel.
Stephanie Fein MD [00:09:03]:
If you have a meal of only pickles and ice cream, you're probably not going to feel that great. Now, if you have that for every meal for an entire week, you're going to feel really crappy. Likely that's not an issue. So there's nothing you're avoiding. And that could be part of this idea of a free-for-all during pregnancy because you've been so restrictive before that you can have anything you want during, like weight gain doesn't matter in pregnancy, which is not true. There is a higher risk of complications with a lot of weight gain or certain BMI numbers going in. This is why there is weight loss for fertility because there's a benefit. And also we're preventing potential gestational diabetes by losing weight before pregnancy.
Stephanie Fein MD [00:09:59]:
But also during the pregnancy, again, in a safe way if your BMI is over 30. So the free-for-all generally does not happen, but I really understand the fear. We've spent so many years, decades even, with the all-or-nothing diet mentality, and our brain is wired that way. So if we've had less exposure to the weight loss for fertility way of doing it with hunger scale, listening to our bodies that way, then we have that default that would go to free-for-all with pregnancy because I restrict when I'm not pregnant. But when we use the hunger scale and the food date, the Weight Loss for Fertility weight loss plan, then we're untangling those thoughts. We are training our brain to think about it in a different way. And And that is the beauty. When we have that skill in place, that practice in place, we can just continue to use it.
Stephanie Fein MD [00:11:03]:
We use it before pregnancy, during, and after. So throughout the pregnancy, you listen to your body's hunger. And you will either continue to lose depending on your BMI. Remember, listen to episode 15 for more on that. You're going to maintain your weight even through pregnancy, which is in effect losing fat, or you'll gain minimally. Certainly less than if you were eating in a different way, overeating, which you don't do with hunger scale because you stop when you're satisfied, not full. The things to watch for in pregnancy are that your hunger can be different in each trimester, in each week, things are changing constantly. There's so much going on in your body that hunger signals can be different, and that's not a problem.
Stephanie Fein MD [00:11:50]:
We are used to then staying connected to how we're feeling and checking in. And so we're just going to be checking in, not even more often, the same amount. You just may be getting different ideas, different communications. It also depends on symptoms. So you may be nauseous, you may not. The nausea I have found is not nearly as much as, again, in our culture thinks about it. Now, There are certain people I know, and I'm so sorry, who get very nauseous. That's a very different thing.
Stephanie Fein MD [00:12:23]:
Although a protocol could work for that too, and you may want to create a protocol for that ahead of time if that's something you're worried about. Part of it, if you're very nauseous, is you just get in what you can. That's that same idea of eating when you're hungry, stopping when you're satisfied, not full. If you're never hungry, that's one thing. What's more likely is that your hunger signals are changed and they might be more subtle. As you get more and more pregnant, your hunger may be different again, and it may be lightheaded. You may never get stomach growling. Also, the baby will be pressing in on the stomach and the stomach size can really change.
Stephanie Fein MD [00:13:10]:
And what happens in the last weeks is that you're eating much more frequently, but tiny meals because it just doesn't fit. And having the food available for wherever you are when you're doing your day is something that ends up being important. This is also where the food date comes in. It's really a great thing to do in pregnancy because each week really is different. So you're evaluating the week that just passed and then you're making plans for the next week. This is so valuable in pregnancy. To get prepared to use your protocol. So to have your protocol with you as you're doing your food date, amazing.
Stephanie Fein MD [00:13:51]:
Each week can be different in pregnancy. So you want to check in with that. The protocol is basically a plan ahead of time. What you're going to do if things change, if you can't do what you normally do. An example of that is this client as her go-to meal out. So if they were tired and they didn't want to make dinner, even if they had it planned, their go-to was always sushi. So that just, they were like, oh, we don't have to think about it. We're just going to go.
Stephanie Fein MD [00:14:22]:
So when we talked about this, what she realized is, oh, if I just come up with a different go-to meal, then I have that in place. That would be part of a pregnancy protocol. Where am I going to get to go for my, when we're tired, where do we, eat out. It's so perfect because I love that example because you can imagine that if it wasn't thought of ahead of time, that could totally derail you. Oh, I usually go for sushi and I can't have sushi and I can't have anything. And then your brain starts to go. And then foods that don't necessarily feel good that you wouldn't normally have start to sound good or it's, or overeating it or any of these sorts of things, it starts to, it could actually spin out of control. Like that one decision can be an all or nothing trigger.
Stephanie Fein MD [00:15:19]:
And so having an idea ahead of time just makes it that moment that's challenging. You're already tired. You're deciding not to, you don't have the energy to make the food that you have, so you're going to go out. That's the worst time to make a great decision. We want it to be easy. That's the setup with the food date in general, that you have a general plan for the week, because our brains are terrible at making decisions when they're hungry, desperate, tired. So even if you just started to look at your regular general way of eating and found the places that the foods are not safe for pregnancy and then just came up with alternatives. Just like the sushi place, you're going to pick a different place.
Stephanie Fein MD [00:16:06]:
Mexican food, soup and salad bar, something like that. And remembering that the hunger scale works through pregnancy and food dates are really valuable. When we have that in place, when we have those tools in place, we're set. They're just a couple tools and those are all you need to get through and continue your weight loss or whichever road you've decided for your pregnancy in terms of food. Creating a pregnancy protocol for eating and weight during pregnancy is an excellent practice to prepare your brain for what's to come. And when we use our prefrontal cortex to plan, we calm that part of us that can worry and spin. And when we have a plan in place, we can point to it, oh my gosh, I'm nauseous today, I'm gonna be nauseous forever, which that's what our brain likes to do, even though it might just be one day. It could have been something you ate, you know what I mean? It's not forever.
Stephanie Fein MD [00:17:06]:
When we have a plan in place, we can say, oh, don't worry, brain, we already know what we're gonna try. It's so valuable. The brain doesn't have a comeback for that one. So it's a really, it's like, ace in the hole. It's really, this works really well for managing our brain. What the protocol looks like is a list in your notes app or a page of your favorite journal. And it's the swaps you make for the foods that are not safe to have in pregnancy. They're your favorite pregnancy-safe practices for dealing with symptoms.
Stephanie Fein MD [00:17:42]:
And you may have friends who've told you things that work for them, or your doctor told you things and having them in one place. And also writing down the things you know that work for you in terms of comfort or self-care practices like time with friends or baths or Sudoku puzzles or favorite reruns or those sorts of things that will be helpful when you need them. For symptoms, this is general self-care for pregnancy and food, nutritious eating, but also caring for yourself when you're not feeling well are really important things to have in there. Like when you're tired, what do you want to start doing? So it may be that you want to go to bed earlier, but you may be at the end of pregnancy and you're uncomfortable. So you're starting to figure out things. I get this pillow, I take a nap here. I ask my partner to rub my feet. You know what I mean? Like certain things so that you have a plan for when you need to deal with things that could otherwise derail you.
Stephanie Fein MD [00:18:51]:
Having this protocol available to you calms the brain and assures that you have a plan for when things feel overwhelming when it comes to food and pregnancy. So a pregnancy protocol is a really great idea. It helps you stay with what you want for your pregnancy in terms of food and weight, and it supports you to feel as good as you can during the whole thing. And I wish you such a safe, comfortable pregnancy for all you in transfers right now. And I know all of you are on your road and I'm always thinking of you and holding your pregnancies in my heart for beautiful outcomes and dreams coming true. I am sending you so much love. If you have any questions ever about this or anything, I'm @stephaniefeinMD on Instagram and LinkedIn, and stephaniefeinmd.com is where you can find me. You click the Lose Weight With Me button, we can work together.
Stephanie Fein MD [00:19:59]:
But also, if you have a question, there's a Contact Me. Just email me anything you have in terms of questions or comments. Sending you so much love. Until next week. Mwah!
