Tuesday, May 14, 2013

Eating for Two: Good Nutrition for Carrying Twins

For an updated version of this article, visit the Texas Health blog, Are You A Well Being, here

Question: What kinds of foods did you eat while you were pregnant?

This is probably the number one question I get - eating while pregnant.  Even as a dietitian this became a serious struggle for me when trying to keep a balance of what I was supposed to provide my body and the two babies inside of it and what I actually wanted to eat.

I never dealt with nausea (thank goodness) in the early months at all, ever.  I was expecting the most horrible morning sickness due to the fact that I was walking around with hormones through the roof, but I never got sick.  On the nausea end of things- I can recommend simple carbohydrates to soothe an upset stomach (saltines, dry toast, apple sauce, bananas).  These will help it to subside and pass quickly- pretty much the only food sources that will work on that issue.

Carrying twins I knew I needed more calories than a normal pregnancy.  The daily recommended caloric intake for normal-BMI women pregnant with twins is 40-45 kcal/kg- which meant I needed anywhere between 2,200-2,500 calories/day.  For the most part I was able to hit this goal every day, but it was definitely easier said than done towards the end of my second trimester.  I would focus on small meals often throughout my day.

A typical day during my first and early part of my second trimester:

BREAKFAST 7am: (home) 8oz decaf coffee with creamer, 5-6oz Greek yogurt with 1/2 cup pumpkin flaxseed granola mixed with 2 tablespoons wheat germ (for a good source of folic acid).

SNACK 10am: (work) 1 apple with 2 tablespoons peanut butter or 2 (2%) string cheese sticks.

LUNCH 12p-1p: (work) leftovers from dinner the night before or 2 cups mixed steamer veggies with 5 ounces natural deli turkey or ham (I like Boar’s Head) and some kind of fruit with 5 ounces plain Greek yogurt.

SNACK 3:30pm: (home) 2 slices whole wheat toast with peanut butter and small sliced banana, OR graham crackers and peanut butter, OR a bowl of whole grain cereal (Cheerios) with organic skim milk.

DINNER 6pm-7pm: varied, but most often it was a grilled or baked meat, veggies and a carbohydrate (potatoes, whole wheat pasta, brown rice).

SNACK 9pm-10pm: dry whole grain cereal (helped with regularity and offset hunger in the middle of the night.

I had a weird issue with chicken and craved seafood!  So, often times my protein in the evening was plant based or shrimp, tilapia or some kind of beef.  We usually eat meatless a couple times/week in our house- so a homemade bean burger or something like that was regular.  I love, love, love to cook and was thankful at that point to still have some energy to cook a dinner meal.  About the middle of my 2nd trimester I found that I couldn't eat much at all before I felt miserably full.  I started having to limit my intake of fluid during meals or else I couldn’t finish the already small portion of food I was consuming.  The biggest thing for me was making sure I got enough protein in my diet.

Protein is the building blocks of development and tissue production, so I wanted to make sure I was getting enough to grow my beautiful babies!  Carrying twins you need 175-200 grams of protein/day.  I know. I couldn't believe that either!!  After a brief evaluation of my diet, I decided that there was no way I was getting that on a daily basis.  Although protein from food sources is best, I knew I had to do something extra to get all I needed.  I bought a whey protein supplement and mixed it into plain Greek yogurt. One plain Greek yogurt is around 15g protein and one scoop of the protein powder I use is 25g protein.  When choosing a protein supplement, look for one low in saturated fat and limited artificial sweeteners. I think Ensure, Boost, or any of those type of nutritional drinks would have been acceptable to use, too!

Once I went on strict bed rest at 24 weeks and wasn't nearly as active as I had been, I found that I was hardly hungry at all.  Meals became anything that was easy enough for my husband to prepare and sounded especially good at the moment.  I got to a point that nothing sounded good at all and if I wasn’t careful would go all day without eating hardly anything really.  Not good for me and not healthy for my babies.  Even from bed rest, my dietitian brain was always at work and I began to make serious effort in planning my 'meals' and snacks out.  I realized that I could no longer eat foods that were too filling and didn't provide enough calories/protein (I was stuffed after about 3 bites of pasta). This is when I learned to make every bite count.

I had terrible insomnia and was up every night around 3:30am until about 7am then back to sleep until nine or ten in the morning- so I would always eat something small during that window I was awake.

SNACK 5am: 6 oz plain Greek yogurt

BREAKFAST 9am: 8oz decaf coffee with creamer 2 pieces sprouted grain toast with peanut butter and sliced banana

SNACK 10am: 1 cup low fat cottage cheese with 1 cup mandarin oranges or pineapple

LUNCH 12p-1p: 6 ounces natural deli turkey or ham on whole wheat pita bread with flax with about a tablespoon of basil pesto and olive oil mayo, lettuce, tomato, and onion, and veggie chips or  some kind of fruit.


Protein Fruit Bowl: 1 chopped apple, 1 sliced banana, 1 chopped plum or 15 grapes, 5 chopped strawberries, mixed with 6 oz plain Greek yogurt and 1.5 scoops protein powder

SNACK 3:30pm:  Bowl of Cheerios with skim milk.

DINNER 6pm-7pm: varied, but most often a grilled meat and a vegetable OR Protein Fruit Bowl made with 2 scoops protein powder

SNACK 9pm-10pm: 6 oz Greek yogurt with 1 scoop protein powder and a small bowl of dry cereal

SNACK 3am-4am: dry cereal, saltines, or honey wheat pretzel sticks and string cheese

The hubby was forced to take over cooking and so it was always some kind of grilled meat and a veggie in the evening for me.  I really couldn't eat a whole lot of carbohydrates in the evening or I wouldn't be able to get in the protein like I needed to.  I found that my peanut butter and banana toast would fill me up all day and into the evening if I wasn't careful! The protein powder and yogurt before bed was a treat for me.  Almost like eating ice cream, a healthier version of the stuff, but still with the calories but  lower saturated fat, and higher in protein.

In the end, I carried my babies to term (37 weeks and 1 day) and they came home with me from the hospital without issues.

I think that my efforts of bed rest, along with maintaining good nutrition throughout my pregnancy paid off and made a difference in the well-being.  While literally eating for two isn’t necessarily the best mindset when pregnant (pregnant women only need an additional 300-400 calories/day in their second and third trimester) I think keeping a balance of  good nutrition goes a long way when providing for not only baby, but for Momma as well!

Amber Massey is a registered dietitian with the Executive Health program at Texas Health Harris Methodist Hospital Fort Worth and New Mom to twin girls.

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