I am about to throw out some very theoretical information. I am not a doctor, or a nutritionist. What I am is either very lucky to have avoided some crappy pregnancy symptoms, or very lucky to have had my ducks in a row before getting knocked up. Either way, nothing I suggest here is bad for you. In fact, it’s all good for you anyway, so worth a shot. If you are planning on getting pregnant, or are currently swimming in first-trimester misery, the following are my theories as to why I avoided some of the worst.
There are a lot of advantages a healthy well-nourished runner should have going into pregnancy. I say “should have” because I know a lot of competitive runners who let their numbers slide (I’m looking at you teammate with a ferritin of 8). Back in 2010, otherwise known as the worst year of competitive running of my life (I clocked an 11:20 3000m steeplechase when my PR was 9:58), I committed to getting a firm grasp on my nutrition. It’s sad that it took this long to get the importance of nutrition through my thick skull because my college coach (Mark Wetmore, University of Colorado) was very on-top of our anemia profiles and constantly drilled the importance of keeping those numbers up. However, it took some seriously embarrassing races to convince me to get this under control. Since then I have been working with Bioletics to test a number of factors (vitamin D, Omega 3, Mineral Balance, DHEA to name a few). I also used to use them for Ferritin, but they don’t offer the test anymore. Unfortunately, New York State doesn’t allow drop-in Ferritin tests at blood labs, which is the stupidest law I have ever heard. Because of this I haven’t seen my Ferritin numbers in quite awhile because most primary care physicians and gynecologists fail to see the importance of Ferritin and forget to add it to my labs, despite my requests. However, I do keep up on everything else, so I generally know where I stand with iron needs.
That being said, I went into my pregnancy with the huge advantage of having very healthy B12, vitamin D, Omega-3 and iron levels, all of which have made this first trimester much more pleasant. Omega-3 (specifically DHA) is already drilled into pregnant women, but here is my breakdown of the rest and their corresponding symptoms:
1) B12 (Morning Sickness and Fatigue)
Everyone says “every pregnancy is different” in response to varying degrees of morning sickness. However, the interwebs are also overflowing with suggestions that vitamin B12 helps alleviate morning sickness. Thanks to my running-career-long struggle with anemia, B12 injectons have become a staple in my life. My personal theory is that my abundant stores of B12 is one of the main reasons that I have avoided all morning sickness, and have only had to deal with a little nausea.
The normal range for B12 for a 30ish year old female according to lab work documentation is 211-946 pg/mL. As a runner, my eyes always shoot to the high end of any range. I have never technically been deficient according to this range, but I have been unsatisfied. So about once a month when I am feeling particularly run-down, I will give myself a B12 injection. For the competitive athletes: Intramuscular injections of non-prohibited substances are not prohibited by USADA, but Intravenous infusions of all kinds above a certain volume are prohibited. Emergency care is an exception that requires a therapeutic use exemption and clinical paperwork to support the fact that you probably would have died without an IV (only a slight exaggeration).
I believe the lowest I have have tested has been around 250 pg/mL. The highest I have tested, in the week after an injection, was about 1200 pg/mL. My doctor did not raise concerns about the above normal B12 levels. B12 is not considered a risky vitamin for overdose, as the body efficiently flushes out excess.
2) Iron (Fatigue and Mood)
For runners, my understanding is that goal levels are >55 ng/mL for Ferritin, >40% for Hematocrit and >13 g/dL for Hemoglobin. My lowest recorded Ferritin has been 28 and my highest has been 127. My Hematocrit is usually between 38-40 and I recently PRd in my Hemoglobin with a 13.1. I recently observed a recreational runner’s paperwork, in which she clocked in at 6 for Ferritin, 33.7 for Hematocrit and 10.4 for Hemoglobin. I imagine that the general population is closer to these numbers because I have put a lot of work into getting my numbers up to just passing. I thank my passing numbers to the fact that my fatigue was not as debilitating as it seems to be for many first trimester women. Don’t get me wrong, I felt like I was running 85 mile weeks and my brain became useless after 9pm, but my energy was not totally awful. Additionally, anemia makes you feel depressed and generally unmotivated. You don’t need that on top of the rush of hormones, which will pretty much do the same. I take a dose of liquid iron most mornings with vitamin C, long before I consume any eggs or caffeine. When I was more deficient, I took more frequent doses of iron, but at this point I am okay with just most mornings plus whatever is in my prenatal.
3) Vitamin D (Fatigue and Mood)
For the athlete, vitamin D is essential for performance. For the mother-to-be, vitamin D is essential for cell growth, immunity, inflammation and regulating mood. For baby, vitamin D is essential for a healthy musculoskeletal system. When I started testing my vitamin D in 2011, I clocked in at 47 ng/mL, with a goal of 60-80 ng/mL. I bottomed out at 27.5 at one point, but my most recent test came back with a score of 77. I use a sublingual spray to get my vitamin D because it is very hard to absorb. I am also very paranoid about overdosing and causing neurologic damage in my little minion. I have done a lot of research and from what I have found, 10,000 IU per day is the absolute maximum dosage a pregnant woman should be taking, while 4000 IU is the recommended upper limit. Finding the line between not being deficient and toxicity is stressful, but 4000-10,000 is a pretty generous range that I feel like I am respecting.
4) Coffee + Running (Constipation)
Apparently when you start to host that parasite that you will some day call your child, your body immediately puts on the breaks and slows down digestion to allow it to absorb as many nutrients as possible. This leads to constipation and maybe even hemorrhoids. Oh joy. However, this has not really been a problem for me, I assume thanks to my two favorite indulgences: coffee and running.
There is some controversy over coffee, but most sources set the upper limit at 200mg a day. I generally only require about four ounces of coffee in the morning to feel like I got my fix, and I save the other ~12 ounces for post run and afternoon indulgences like another cup of coffee, tea, or massive amounts of dark chocolate.
There is also a little controversy over exercise. Specifically heart rate. My doctor told me to make sure I can hold a conversation while I am running and I should be fine. Well, I’m not sure she realizes how hard I can run and still hold a conversation, my lungs are of another breed. However, I feel like if Serena Burla could run the Olympic Trials 10,000m while pregnant, that would be a good place for me to set my upper limit. That is my limit decision and I encourage you to talk to your doctor and do your own research and find an acceptable limit for yourself.
That being said, I highly recommend combining the above two elements and doing them both in the morning. And then you can sit back and feel superior to all the women who are complaining about being constipated.