Q&A with Annabel Karmel
The new recipe book looks at nutrition during pregnancy covering the best foods to eat to promote conception, ideas for avoiding morning sickness and the ideal foods to combat sleeplessness and heartburn later on in pregnancy.
Eating For Two guides expectant mothers through each stage of pregnancy with recipes, tips and advice. Annabel used her experise to answer your questions on a range of topics.
Q. Sporty40: What is your nutritional advice to optimise health when trying to get pregnant? Apart from the obvious 5 a day etc.
A. Annabel Karmel: As soon as you start thinking about wanting to conceive or when you find out you are pregnant you will probably be advised to take folic acid and vitamin D supplements. Interestingly, scientists are currently investigating the importance of vitamin D in women's and men's fertility, so getting enough of this vitamin may be beneficial for conception.
Good nutrition has a huge influence on pregnancy. Before conception and the first three months of pregnancy is the time your baby will benefit the most from a healthy diet. A steady supply of vitamins, minerals, protein and other nutrients is crucial to your baby's development and it allows you as a mother to form a healthy placenta. Your healthy diet also allows your baby to have good stores of nutrients such as iron that will be necessary in their first months after birth.
If you are trying to become pregnant I would also be mindful of some of the guidelines about watching caffeine and alcohol intake, especially as sometimes you may not know you are pregnant for the first few weeks after conceiving.
It is important to get a good balance of foods, for example:
• Plenty of fresh fruit and vegetables (as you said, at least 5 portions a day)
• Protein rich foods such as lean meat, poultry, fish, eggs and nuts
• Dairy foods such as milk and cheese for calcium
• Starchy foods like bread, cereal, rice, pasta and potatoes to give you long lasting energy. Try to choose wholegrain options.
• Restrict the amounts of foods which are high in fat and sugar like biscuits and cakes.
• Plenty of fibre. This will help prevent constipation include foods like wholegrain bread or cereals, pulses and fruit and vegetables.
Q. DOROTHYP: I have found it very difficult to eat well whilst suffering from morning sickness. Are there any recommendations you have for a healthy diet during this time?
A. Annabel: Here are a couple of ideas that will hopefully help:
• Eating a snack or small meal every hour or so based on starchy carbohydrates, which are slow-burning and help ease nausea.
• Don't get up on an empty stomach. Having a plain biscuit, dry toast or plain crackers and a warm drink before you get out of bed can help ease morning sickness.
• Avoid fatty foods as these can take longer to digest.
• Ginger is thought to reduce the nerve stimulation to the brain that prompts nausea and vomiting – try ginger beer, ginger biscuits or ginger tea.
• Dehydration is the biggest danger of morning sickness so make sure that you drink plenty of fluids like water, fruit juice, milk or caffeine free tea.
• Try to get some fresh air before eating. It's a good idea to go for a walk as gentle exercise can help relieve nausea and also helps to build up an appetite.
Q. JKGB: I had postnatal depression with my first child and felt extremely fatigued and low during my second pregnancy. Thankfully as soon as my second child was born I felt much better and all has been good since. Do you have any advice on diet and combatting pregnancy fatigue/low moods?
A. Annabel: I'm sorry to hear you have had such a rough time. Regarding pregnancy fatigue, I would suggest avoiding too much processed sugar such as sweets, chocolate bars or biscuits as whilst it can give you a quick pick up, it may just as quickly leave you with a blood sugar 'slump' that can leave you feeling drained. I know this is hard as the first thing I want when I am feeling tired is sugar. Try to start the day with a good source of complex carbohydrate that slowly releases energy such as wholemeal bread or porridge. Keep snacks such as dried fruit and nut mix or oatcakes to hand that you can use to keep up your energy levels but that won't leave you feeling more tired.
Postnatal depression can be very disabling for women, at a time that should be so happy. One nutritional strategy is ensuring enough omega-3 oils during the pregnancy, which research has shown can reduce the chance of developing postnatal depression. Oil-rich fish such as salmon, mackerel and sardines are great sources, but do remember that it's also important to avoid too much oil-rich fish and limit or avoid some other fish and seafood during pregnancy
Q. PixieCake: When I'm pregnant I crave junk food especially chips, coke, pizza and chocolate. When I'm not pregnant I eat healthily and don't buy/crave/eat junk. I don't have to resist it, I just don't want it. So I assume my body is telling me something about needing more calories/fat when pregnant. Any ideas for healthy-ish recipes that will satisfy a craving for junk?
A. Annabel: You don't want to constantly deny yourself what you crave as it always makes me want something more! For healthy versions of the 'junk food' you are craving, there are some great alternatives you can make.
If you are wanting pizza you can make a quick version by using an English muffin cut in half or a tortilla as a base (you can make your own pizza dough but this takes a bit more time). Cover in some tomato sauce or passata and some grated cheese or mozzarella and whatever other topping you fancy like mushrooms or peppers. Home-made burgers are delicious and are great to make in a batch and freeze for when you have less energy to cook. Make with lean mince and add lots of different flavours such as fresh herbs and grated apple. If you crave chips I think cutting sweet potato into chunks, brushing with a little olive oil and a little bit of salt baked in the oven until cooked so the edges crisp up a bit, are delicious.
Q. ProfCoxwouldgetit: I have a highly stressful job, where I find no matter what I eat I suffer from serious fatigue. What advice can you give to mums who have to work through all of their pregnancy in high stress jobs on how to maintain the best diet not only for their baby, but also the added stress and fatigue that pregnancy puts on a mum's body?
A. Annabel: This is a tough one as more mums to be are having to work right up to the last minute of their pregnancy now. Think about having a supply of low GI foods with you at all times, as these carbohydrates are slowly released and may help to maintain energy levels over a longer time. Good examples of low GI foods include porridge, muesli and oatcakes, wholegrain bread, apples, pears and grapes as well as milk and plain yoghurt. It is a good idea to have some of these things with you at work or in your handbag. When you are working often the last thing you feel like when you get home is cooking, so have foods that allow you to throw together quick but nutritious meals like stir fry's or eggs for an omelette. Getting enough sleep is also so important, as is guarding against dehydration, which can leave people feeling fatigued.
Q. Orangeshortbread: I have food intolerances - gluten, dairy, eggs and also several types of meat and veg. How can I ensure that this does not affect my growing baby?
A. Annabel: Looking at the foods that you will be cutting out of your diet there are a couple of key nutrients that you need to watch out for and find alternative sources of. Firstly, if you're avoiding eggs, dairy foods and some types of meat, aim to eat enough of other protein sources, including the types of meat, fish or poultry that you can eat, as well as vegetarian sources such as soy foods, pulses and nuts. If you are dairy free I would find an alternative source that contains a good amount of calcium which is important for bone development. Calcium-fortified soy milks and puddings are a good source, and beans, lentils, almonds, figs, tofu and fish with edible bones like sardines also provide calcium.
If it is red meat you cut out then you will need to think about iron. Iron fortified breads and cereals often contain gluten! In which case you need to eat foods like pulses and dark green leafy vegetables, but eat these with a good source of vitamin C so the iron is absorbed such as a glass of orange juice or serve the pulses with a salad including chopped raw peppers and tomatoes. I would also make sure you have two portions of oily fish a week, as these will be a source of fat, protein and importantly essential fatty acids. I would speak to your doctor if you are feeling particularly exhausted or are worried that you are not getting enough nutrients in your diet.
Q. Bagelmonkey: I didn't manage a very varied diet when I was pregnant due to multiple food aversions. How would you overcome this problem, given the suggestion that what we eat during pregnancy is important for our baby's food preferences later on?
A. Annabel: If you have various food aversions I am sure you will be used to finding alternatives and having to spend a bit more time thinking about what you are going to eat. The same goes for when you are pregnant. You need to look at your typical diet and see if it includes good sources of nutrients that are important for both you and your baby such as complex carbohydrates, fat, protein, a variety of vitamins and minerals such as calcium, iron and essential fatty acids. You need to make sure you have a good balance of all these things. As long as you have a good variety of fruit and vegetables, some complex carbohydrates, and protein from meat, poultry, fish (including some oil-rich varieties), eggs or vegetarian alternatives and dairy foods you should be fine.
If you feel your choices are very limited, you could always discuss a suitable pregnancy multivitamin and mineral supplement with your GP or pharmacist. In regards to it affecting your baby's food choices, I know there has been some research on this but I think it is more important to give them a good variety of foods in the formative first year of their lives. There is a window of opportunity you have between six months and one year where they are more willing to try new foods. I would say this has more of an influence on their food preferences.
Q. Blackcatsdancing: I'm pregnant. I have to follow a low fibre diet due to IBS. Advice for healthy eating especially when you're pregnant is always about eating a high fibre diet which I can't do. I have gradually upped my fibre intake from the initial very low hospital plan to one that I can tolerate without getting symptoms and I try to get my fibre intake from fruit and veg rather than brown rice and wholemeal pasta/bread, but what else would you suggest I eat?
A. Annabel: I'm so pleased that a change to your diet has helped with your IBS, it can be a very challenging problem. The main reason a high fibre diet is recommended during pregnancy is to avoid or reduce the constipation (and sometimes resulting haemorrhoids) that can cause discomfort to pregnant women. Your digestive system seems to be quite sensitive to fibre levels, so you may find that the slight increase in fibre that you've already made is enough to keep you from becoming constipated. If not you could try increasing it a little more, but if the IBS symptoms become an issue I'd suggest you discuss it with your GP.
You will know very well which sources of fibre your body tolerates better than others. If fruit and vegetables work best for you, you might like to try dried fruit, including prunes, but always increase the amounts gradually. You might also try a gradual introduction of oat or wholegrain rice foods – the fibre from these is better tolerated by some people with IBS than fibre from wheat-based foods.
Q. Ivanapoo: I am vegetarian. In the first few months of pregnancy I really went off pulses, seeds and nuts and now I'm concerned the baby didn't get enough protein. Am I worrying over nothing?
A. Annabel: It's very common for people to go off foods that are so important to our and our baby's nutrition during these first few months of pregnancy. Please be reassured that neither of you are likely to have come to any harm. Your baby is very tiny at this point, and you are gaining very little weight, so your requirements for extra protein as well as nutrients such as iron and zinc are much less than at later stages of the pregnancy.
It is worth focussing on these foods now though, since your baby will be building up stores of iron for after the birth and these are great sources (when combined with a food containing vitamin C to aid iron absorption). Eggs and dairy foods such as cheese are also excellent sources of protein for vegetarians.
Q. Lovemarmite: I would be very interested in a book that looks specifically at a vegetarian diet as there are lots of us here on Mumsnet and many women who eat very little meat. Please advise if you have written a book that would cover this only.
A. Annabel: At the moment I haven't got a book that only covers vegetarianism, but the fact that a couple of you have mentioned it on this chat is interesting and definitely something for me to think about. Especially as the nutritional needs of a child with a vegetarian diet are different to that of an adult (children need proportionally more fat and less fibre than adults so including eggs and cheese in their diet is a good idea). I have some vegetarian recipes on my website you could try in the meantime. If you are a vegetarian and pregnant it is important to remember about iron, as well as nutrients such as omega-3 oils (if you don't eat oily fish).
Q. LuvileeJubilee: Do you agree with baby-led weaning approaches? I think they are more modern and your prescriptive approach is outdated. Now that parents wait until six months to begin weaning, purees are an unnecessary step in my opinion. I have ordered your 100 finger foods though and look forward to trying some of them with my six-month-old son.
A. Annabel: I am not at all against finger food, I think it is such an important part of weaning and a great way to get your babies into the transition of eating the foods that you eat as a family. It is also important for hand-eye coordination and using muscles in the jaw to chew. When I was weaning my three I did a mixture of purees and finger foods. A baby's hand-eye coordination is not fully developed at six months for them to feed themselves completely; they need to practice with soft finger foods that carry little danger of choking.
I think it is a good idea to include purees as certain foods are hard to get your babies to eat as finger food, such as meat which is tough to chew. The store of iron a baby is born with runs out at about six months, and is the most common nutritional deficiency in babies. The best source of this is red meat which is not very easy to give as a finger food, but a slow cooked casserole makes the meat lovely and tender. You can make enough for yourself and puree some for you baby, adding any salt later. This also goes for oily fish like salmon which are brilliant for sources of essential fatty acids, pureed with cooked tomato and carrot or with a cheese sauce is delicious. Weaning your baby is such a personal thing and in no way prescriptive. Often you find out what works best for you and your baby in the process.
Q. WinkyWonkela: I used one of your weaning books in 2005 where you recommended weaning at six months, then you changed recently to weaning at four months. Why did you change when the NHS advice hasn't?
A. Annabel: The current UK Department of Health recommendation states that babies should not begin weaning until they are six months and should be exclusively breastfed until this time. It is true that breast milk will provide all the nutrients that your baby needs for the first six months but after this you do need to introduce solids. Whilst I agree that it would be good to breastfeed for the first six months, not all mothers can or want to do this and for some mums who are going back to work it is not practical. My advice is to follow the guidelines if possible, however not all babies are the same and some babies may need solids earlier.
I don't believe in strict timings and a mum will probably know when her baby is ready. However the minimum age to introduce solids should be 17 weeks as a baby's digestive system won't be fully mature for the first few months. For babies with no history of allergy, there is no evidence to show that introducing simple non-allergenic foods from 17 weeks will mean that your baby is more likely to develop an allergy. One of the reasons for the change in the recommendation - which was originally to introduce solids sometime between four and six months - is that in developing countries, whilst breast milk is sterile, introducing solids can cause problems and so it is better to delay. This does not apply so much to the UK where we are used to following good hygiene rules.
Q. Lamazaroo: What are your nutrition qualifications?
A. Annabel: When writing books, I always work with a qualified dietitian. For my latest book Eating For Two I worked with Consultant Dietitian/Nutritionist Fiona Hinton BSc MNutDiet RD, she is credited on the book. We worked very closely together discussing all aspects of nutrition in pregnancy and the scientific research behind the advice.
I have been writing books on feeding babies, children and families for 23 years and am constantly working with experts in many different fields of nutrition. My skill is in taking this advice and the foods that are important, for example iron or essential fatty acids, and coming up with recipes that are tasty and easy to prepare. In fact tonight I'm making the Salmon Fillet with Tomato Salsa from Eating for Two for my family, not, I hasten to add because any of us are pregnant, but because it's delicious, healthy and easy to prepare.
Q. Deepfriedcupcake: How do you deal with changes to advice on nutritional needs when working on and publishing a book?
A. Annabel: It is true that sometimes advice on aspects of health change. Research is always being carried out, and sometimes this contradicts the previous research! I am always talking to health professionals and reading the latest research and my books are frequently being revised and updated based on latest research as it is important to keep up-to-date.
Q. SeventhEverything: Do you think there is a risk that we have too many 'experts' now, which is taking away mothers' confidence in trusting their instinct? It's all very well knowing what is healthy, but when all your body is craving is calamari rings, that would seem the best option.
A. Annabel: There is so much information available to us all now. In some ways it is great as you can pick and choose what you want to use or read about, the decision is totally up to you, but on the other hand I don't think it is a good idea to be scaremongering parents into what they should and shouldn't be doing, parenthood is stressful enough as it is. I think a mother's instinct is of vital importance, no one knows a child better than a parent. I think it is important to encourage mums to use their own instinct. I want to provide basic nutritional information in my books so that parents can choose whether to use it as a guide and make informed decisions on how they want to feed their children. I know how fussy children can be so I have spent many years putting together tried and tested recipes in my recipe books.
Recipe: Seabass / Red Snapper with Tomato Relish
This fresh tomato relish is delicious with fillets of white fish.
4 tbsp olive oil
1 small onion, finely chopped
1 clove garlic, crushed
1 tbsp red wine vinegar
2 tomatoes, deseeded and chopped
Dash of sugar
1 tbsp parsley
2 sea bass or red snapper fillets, skin on
A little plain flour
To make the relish, heat 2 tbsp of oil in a small pan. Add the onion and garlic and sauté for 5 to 6 minutes until soft. Add the vinegar, tomatoes, sugar and parsley. Warm through for a few minutes, then remove from the heat and season to taste.
Season the fillets and lightly coat in flour. Heat the remaining 2 tbsp of oil in a frying pan and cook for 2 to 3 minutes each side until lightly golden and cooked through.
Serve with the relish.
Makes two portions