Slow Moving…

One of the most common, troublesome complaints pregnant women report to me is constipation. Women, who before pregnancy were so normal and regular with their bowel movements that they could plan their day around them, become pregnant and all bets are off. While constipation happens to everyone at some point, pregnant women are particularly predisposed to constipation because of unique factors related solely to pregnancy.

Progesterone

The primary culprit for constipation in pregnancy is the hormone progesterone. Prior to pregnancy, progesterone is produced in the ovaries and levels of the hormone rise monthly to promote growth of the uterine lining in the event fertilization and implantation of an ovum occurs. During pregnancy, progesterone continues to be produced in the ovaries until approximately the second trimester when production of progesterone is taken over by the placenta. Progesterone is a key pregnancy hormone; its name alone comes from the idea of promoting gestation.

Progesterone promotes the proper functioning of the placenta throughout pregnancy and maintains the thickened uterine lining that houses and protects the growing baby and placenta. One of progesterone’s most important functions is to halt any unnecessary contractions of the smooth muscle that makes up the uterus so a baby stays inside the uterus and grows. The uterus, however, is not the only organ that contains smooth muscle in the body. The entire lining of the GI tract contains smooth muscle that is equally as responsive to the progesterone that is circulating throughout the body. Progesterone, with the help of an additional pregnancy hormone called relaxin, halts contraction of the smooth muscle within the GI tract and, therefore, slows all activity throughout the tract.

The result, then, is delayed transit time of the intestines. With the decreased transit time, stool sits longer in the intestines and colon where any excess water is reabsorbed, thereby drying the stool and making it more firm or hard. The drier the stool, the more difficult it becomes to pass during a normal bowel movement, hence constipation and all the discomfort that follows. Left untreated, pregnant women will have increased lower abdominal or rectal pressure and increased straining at bowel movements. Painful hemorrhoids can follow that add to further discomfort, especially with walking, driving, or sitting.

Fiber

The good news is that there are simple things pregnant women can do to combat constipation and maintain bowel regularity. The secret: fiber. Lots of it. Fiber works to draw water into the stool so it stays soft and, above all, easy to move along through a slower intestinal tract. The softer the stool, the faster and easier it moves through the colon and, ultimately, the easier it is to pass during a bowel movement without straining.

The US Department of Agriculture (USDA) recommends pregnant women consume 25 to 30 grams of fiber from food sources alone. Most American women, pregnant and non- pregnant, are lucky if they consume 10 to 14 grams daily. Supplements are available, but the best, most usable form of fiber comes from food that is high in fiber then digested naturally throughout the GI tract. I instruct women to not “eat to treat” constipation but eat to keep their fiber intake adequate so they can reap the benefits of fiber not only for their GI tract but also for their cardiovascular system.

Fiber is not something a woman can suddenly ingest in large quantities and have a desired effect. Too much fiber at once leads to abdominal cramping, distention, gas, and diarrhea. Additionally, fiber rich foods are not the most flavorful, especially in their purest, natural or raw form. The best way, then, to incorporate fiber is to introduce fiber-rich foods gradually or, better, incorporate the fiber rich foods into other recipes where you can extract all the benefits of their fiber with flavor.

I always recommend high fiber foods like barley, beans, peas, oat bran, lentils, wheat fiber, dates, figs or bulgur to women who struggle with finding sources of food that are high in fiber. I also recommend cereals like Kellogg’s Raisin Bran or All Bran. While there are several brands of cereals, both hot and cold, that have sufficient fiber and flavor, I particularly like the Kellogg’s products here because I find they also contain sufficient quantities of other key nutrients needed during pregnancy like niacin, folic acid, and other vitamins plus a taste that many pregnant women enjoy.

However, a lot of women cannot consume a bowl of cereal regularly; they have a hard time, I find, swallowing a lump of cereal or they get full too fast and do not finish their portion. To get the full benefit that a portion of Raisin Bran or All Bran provides, I recommend making them into muffins that can be made in advance then eaten as a snack or a meal on the run. I also recommend a gold standard high fiber food: prunes. Most people dislike the taste of prunes and the thought of eating them is unappealing to many. Prunes, like cereal, can also be incorporated into a tasty muffin that can be made in advance and eaten at different times of the day to provide adequate fiber. I’m giving you two of my best recipes to try for a fiber- packed meal or snack.

Pregnancy is a time where fiber is essential for both health benefits and comfort. Indeed, it is probably one of the most important times in a woman’s life where fiber intake is paramount. Thankfully there are creative, tasteful, healthy ways to incorporate fiber into everyday food that can be useful long after pregnancy is over. Many foods have high fiber content naturally. Try them in different ways and at different meals to add another layer of flavor, and nutrition, to regular meals. Everyone benefits from more fiber in the long run.

The “Smooth Move” Muffin

(12 servings or 12 muffins)

These muffins are packed with just the right amounts of fiber in their natural forms. I recommend these as a daily snack or for breakfast every-other-day. They contain ingredients like chia seeds, prunes and applesauce that, together, make a tasty muffin that makes either a great snack as mini muffins or meal on-the- go as a regular size muffin.

• 1 cup packed pitted prunes
• 1 cup unsweetened applesauce
• ½ cup brown sugar
• 1 egg
• ½ cup butter, melted
• ½ cup milk
• 1 ¾ cup all purpose flour
• ½ cup chia seeds, soaked  (Note: soak chia seeds for 10-15 minutes before using then discard soaking liquid)
• ½  teaspoon salt
• 1 teaspoon baking powder
• 1 teaspoon baking soda

1. Preheat oven to 350. Line muffin tin with cupcake liners
2. In medium bowl, mix flour, salt, baking powder and baking soda. Set aside.
3. In food processor: add prunes, applesauce, and soaked chia seeds. Pulse until mixture looks moist but without lumps
4. In another bowl, add prune/applesauce/chia puree and mix in honey, melted butter, and brown sugar. Stir to combine
5. Add in egg and stir well. Add milk and stir
6. Add in flour mixture until all dry ingredients are well incorporated. Avoid overmixing or the muffins will be too tough
7. Spoon into a muffin tin- use an ice cream scooper to fill each cup about ¾ full.
8. Bake 12 to 14 minutes our until a toothpick inserted in the center comes out clean.  If using a mini muffin tin, bake 15 to 18 minutes.

Raisin Bran Muffins

(12 servings or 12 muffins)

I find this recipe is the best way to incorporate servings of cereal into a tasty muffin. They are easy to make and they keep for days after baking. Try one as a snack using a mini muffin tin or as a quick meal on-the-go.

• 1 tablespoon sugar
• ½ teaspoon cinnamon
• 1 ¼ cup all purpose flour
• ½ cup sugar
• ½ teaspoon salt
• 1 tablespoon baking powder
• 3 cups Kellogg’s Raisin Bran
• 1 ¼ cups of milk (skim, 2% or regular depending on preference)
• 1 egg
• ¼ cup vegetable oil

1. Preheat oven to 350. Line muffin tin with cupcake wrappers
2. In a small bowl, combine 1 tablespoon of sugar with the cinnamon (Note: this is an optional topping to add more flavor so that you and other members of your family can enjoy them more)
3. In a medium bowl, stir flour, ½ cup sugar, salt and baking powder. Set aside
4. In a large bowl, combine cereal and milk. Let stand 2 to 5 minutes to allow cereal to soften. Avoid cereal becoming too soft or pasty.
5. Add egg and oil to cereal mix and beat well.
6. Add flour mixture to cereal mix and stir until combined. Avoid overmixing or the muffins will be too tough
7. Use an ice cream scooper to fill the pre-lined muffin cups about ¾ full.  If using additional topping, sprinkle it over the tops of each muffin.
8. Bake 25 minutes or until tester inserted in the center comes out clean. Cool completely.
9. Store in an air- tight for up to one week. For an additional layer of flavor, slice muffin in half and toast. Serve with a drizzle of honey or a smear of Greek yogurt.