Question: I used to have a huge problem with binge eating, restricting, and overexercising, but I’ve been relatively “clean” for the past 7 years. I’ve been exercising 1/2 hour 3-4 times a week, eating three meals a day, everyday, and my incidences of overeating or undereating are relatively rare. I got to a weight and size that I’m very comfortable with and I’ve felt pretty good food and weight- wise for several years. But then I got pregnant. And suddenly I’m binge eating again. And sometimes restricting, and I’m on exercise restriction as per my doctor, so I’m not even allowed to go swimming, like they say pregnant woman should. I have been eating extremely healthy for years, but all of a sudden, I find myself diving into cookies, cake, soda, pizza, bread, etc. I wish I could stop and just eat normally again. I’m going nuts! Can you help me?- Elissa (New Jersey)

Answer: Hi Elissa,

First off, take a breath. You’re in the realm of normal here. Many women who are in recovery for binge eating or other eating disorders might find that they relapse into bingeing behaviors when pregnant. It’s not uncommon at all. Pregnant woman are hungrier than non-pregnant women. And that hunger can be overwhelming. Especially if you’ve been in remission from an eating disorder for a long time, the feeling of not having any control over your own body can be daunting. You might find that you are eating more than you wanted to and then those old ED feelings of guilt and shame come up which cause you to binge eat.

1.)Never, ever, ever restrict or diet when you are pregnant. This is not the time. It’s okay to use your tools to avoid binge eating, but don’t skip meals, don’t count calories, this is the time to become more mindful of what your body says you need. Let your cravings tell you what to eat in a thoughtful way. Think of your body as having infinite wisdom and use your mind to hone that wisdom. For instance, if you are craving potato chips, your body might be needing some extra salt. Find something healthier that might satisfy that craving, like celery or a hard boiled egg or a piece of cheese or some olives.

2.)Eat when you are hungry, but really, really try to slow down your eating. You will find that as you become more pregnant, it’s more uncomfortable to have food in your belly. So eating fast and furiously will hit you 20 minutes after your finish your meal and you will feel sick. You might want to spread your eating out to 6 or 8 smaller meals a day instead of 3 big ones.

3.)Many women lose weight in their first trimester due to morning sickness. In the second trimester, which is an incredibly growth time for the fetus, you might find yourself being very, very hungry. Don’t try to fight it– let yourself eat and gain the weight that you need to for your baby.

4.)Be careful about what you are eating. Don’t worry about portion sizes when you are pregnant, but do be vigilant about the kinds of foods that you are ingesting. Pregnant women tend to crave lots of carbohydrates. Let yourself have carbs. But follow your cravings but in a thoughtful way. If you are craving cake and cookies and soda, try to eat lots of fruit. Your body might be needing the quick energy of glucose. But because gestational diabetes has become so prevalent, try to reduce your intake of sugar and processed foods.

5.)Do Not Go on a Low Carb Diet when pregnant.  A lot of women find that they have serious meat aversions and just crave lots of fruits and vegetables in pregnancy. Pay attention to your cravings and take them seriously. They exist for an evolutionary reason.  In fact,  Loren Coradain— who created the Paleo diet, a low-carbohydrate diet plan explains why you should not eat low-carb while pregnant : “You probably should increase your fat and carbohydrate consumption, and limit protein to about 20-25% of energy, as higher protein intakes than this may prove to be deleterious to mother and fetus for a variety of physiological reasons. In my next book, I have devoted a chapter to maternal nutrition before, during and after pregnancy and why protein must be limited during pregnancy.

My colleague John Speth (an anthropologist) at the University of Michigan wrote a paper on protein aversion in hunter-gatherer women during pregnancy. Listed below is the abstract: (note the 25% protein energy ceiling!!!)

‘During seasonal or inter-annual periods of food shortage and restricted total calorie intake, ethnographically and ethnohistorically documented human foragers, when possible, under-utilize foods that are high in protein, such as lean meat, in favour of foods with higher lipid or carbohydrate content. Nutritional studies suggest that one reason for this behaviour stems from the fact that pregnant women, particularly at times when their total calorie intake is marginal, may be constrained in the amount of energy they can safely derive from protein sources to levels below about 25% of total calories. Protein intakes above this threshold may affect pregnancy outcome through decreased mass at birth and increased perinatal morbidity and mortality. This paper briefly outlines the evidence for the existence of an upper safe limit to total protein intake in pregnancy, and then discusses several facets of the issue that remain poorly understood. The paper ends by raising two basic questions directed especially toward specialists in primate and human nutrition: is this protein threshold real and demographically significant in modern human foraging populations? If so, does an analogous threshold affect pregnant female chimpanzees? If the answer to both of these questions is yes, we can then begin to explore systematically the consequences such a threshold might have for the diet and behaviour of early hominids.’2

The physiological basis for this aversion stems from a reduced rate of urea synthesis during pregnancy that is evident in early gestation1 as well as increases in the stress hormone cortisol3. Hence, pregnant women should include more carbohydrate and fat (i.e. fattier meats) in their diets and limit dietary protein to no more than 20-25% of their total caloric intake.”