Help me plan folate-rich meals in case I get pregnant.
February 6, 2015 12:58 PM   Subscribe

I know that taking folate acid is the sure-fire way to make sure you get enough, but I have to wonder, what the heck did we did before the miracles of modern science to ensure healthy babies? Are there foods from other cultures (south/east asia, africa, latin america) that we don't always think of as being rich in folate?

Right now, I am very consciously making sure I get a high level of folate in my diet, in case I get pregnant (something I am actively pursuing). A nice bowl of lentil soup is always on the stove at home, orange juice is my go-to flavourful drink, and since discovering seaweed is also a good source, a few bites of ready-to-serve wakame salad (way too much sodium but I could make my own) is also becoming a regular thing.

I don't mind carbs in my diet, so I'm making a conscious effort to have a bowl of cereal every day, and bagels/pasta (presumably with enriched flour; I'm in Canada) are a regular staple for me. I love fresh veggies, and it's been a great excuse to make more spinach-based sides, and roasted broccoli/brussel sprouts, none of which my partner particularly likes. I'm indifferent to salads, but maybe when the summer rolls around I'll be more keen.

I could probably do this diet consistently, but I am worried that there is a lack of variety causing me to lose consistency in my consumption over time.

Please help me with suggestions on how to plan my meals (home-cooked or purchased), stay on track with my consumption (without obsessively weighting everything), and/or ideas for folate-rich food from other cultures that I might not have found in the nutritional resources I am reading up on. If you have personal anecdotes, I welcome those too.

Some personal context specific to me: I work during the day, and have time to cook on average twice over the weekend, and twice during the week. Got a fridge at work so I can keep ingredients there and put my breakfast/lunch together there.

Many thanks in advance Mefites. This is a very personal and potentially controversial question, so I have opted to ask this anonymously but hope it will be helpful to others as well.
posted by anonymous to Health & Fitness (26 answers total) 5 users marked this as a favorite
Supplements. You want supplements.
posted by hal_c_on at 1:01 PM on February 6, 2015 [13 favorites]

I'm not sure if this is part of your real question, but before the miracles of modern science, we did not know folate existed or was important for pregnancy, and there were a lot more babies born with neural tube defects. Also, I don't see your question as being controversial at all, although if you want it to be anonymous, that's of course your prerogative. It might be helpful if you explained why you don't want to take prenatal vitamins, though, given what an easy solution to your problem it would be, I am assuming there's a reason you aren't going that route.
posted by treehorn+bunny at 1:04 PM on February 6, 2015 [27 favorites]

Before supplements were common and grain products were fortified with Folate we had a much higher occurrence of Spina bifida and other neural tube defects.
posted by Oktober at 1:05 PM on February 6, 2015 [5 favorites]

More beer. I don't know how one finds the highest folate beers, though.
posted by ldthomps at 1:18 PM on February 6, 2015

Definitely take a prenatal supplement- your body more readily processes the synthetic folic acid found in vitamins/fortified foods than it does the folate found naturally in foods. Very important for the prevention of neural tube defects. Good luck to you!
posted by ThePinkSuperhero at 1:21 PM on February 6, 2015 [3 favorites]

I have to wonder, what the heck did we did before the miracles of modern science to ensure healthy babies

We didn't. There was a high infant and mother mortality rate. It's still horrific in developing countries and countries in conflict.

Take supplements. Eat a variety of foods.

Spina bifida was pretty common, my Dad was born with it, due to the fact that my grandparents had sketchy nutrition during the depression. Thankfully his was pretty mild.

People in third world countries and people with poor nutrition are still at risk. The fact that so many states and federal programs provide prenatal care and vitamins to pregnant women is what is helping keep women and babies in the US healthy. Here's what the CDC says about it.
posted by Ruthless Bunny at 1:22 PM on February 6, 2015 [6 favorites]

what the heck did we did before the miracles of modern science to ensure healthy babies?

We had a lot more neural tube defects. Eating a diet rich in folate (dark green leafy veggies, eggs, asparagus, beans, avocado, seeds like sunflower and flax) and other nutrients is a great idea. But hedging your bets with a good supplement is also a great idea.
posted by quince at 1:23 PM on February 6, 2015 [4 favorites]

Eat your greens.

"Excellent sources of dietary folate include vegetables such as romaine lettuce, spinach, asparagus, turnip greens, mustard greens, parsley, collard greens, broccoli, cauliflower, beets, and lentils. (13) Not surprisingly, some of the best food sources of folate are calf’s liver and chicken liver."
posted by SemiSalt at 1:34 PM on February 6, 2015

Just to echo what treehorn+bunny says, this document shows the decline in neural tube defects in the UK over the last fifty years. Basically "what people used to do" before fortification/supplementation was have a lot more babies with neural tube defects.

As you no doubt know, the important time to take folate is almost immediately after conception, before you know that you are pregnant, which is why a pre-conception supplement is recommended. I know that there is a lot of woo around what pregnant women should and shouldn't do and should and shouldn't take (and it annoys me too), but that particular medical advice is not woo.
posted by tinkletown at 1:39 PM on February 6, 2015 [5 favorites]

[This is a followup from the asker.]
Thanks to all who pointed to reference materials. I know the odds of having a health baby are increased, so I need no convincing of that or to see more stats; but it won't convince me that there isn't an equally effective sourced-from-nature alternative out there, which is what I am asking. I do not doubt the miracles of medical science (and I don't want this thread to turn into a debate about that), nor do I have any physical/spiritual/otherwise limitations that prevents me from taking it (to answer treehorn+bunny's question).

Seriously, 1 cup of of cooked lentil gets you ~350 mcg, which is already pretty close to the 400 mcg we are all suppose to get, and two servings of that a day (or one big serving of it if I've got the appetite) will be more than enough for the 600 mcg that is recommended for women. And who doesn't like a bowl of delicious lentil soup in the winter time? This is the best solution I came up with, and wondering what other foods that I might not have come across that are as rich in folate as lentils.

I am still looking for answers to my question for foods from other cultures that are rich in folate (so many types of asian greens and beans, which ones have the highest content? How to best cook it?).

Maybe I should have just asked for the most incredible lentil recipes y'all have.
posted by cortex (staff) at 2:19 PM on February 6, 2015 [1 favorite]

it won't convince me that there isn't an equally effective sourced-from-nature alternative out there, which is what I am asking

Please keep in mind, they are not the same thing; your body processes folate and folic acid differently, so folate is not a direct substitute for folic acid. Your two bowls of lentils wont get you to 400mcg; you need more. Hope you really like lentils.

The body absorbs folic acid more readily than it does food folate. It is estimated that 50% of ingested food folate is absorbed. In contrast, approximately 85% of folic acid when consumed with food and 100% of folic acid when consumed as a supplement on an empty stomach is absorbed. Therefore, folic acid in food is 1.7 times (85 divided by 50) more bioavailable than food folate. A folic acid supplement taken on an empty stomach is 2 times (100 divided by 50) as bioavailable as food folate.
posted by ThePinkSuperhero at 2:28 PM on February 6, 2015 [12 favorites]

Just a note: I think there have been fairly recent studies that linked rates of autism with mothers who did not have sufficient folic acid prior to pregnancy. Not that there's anything definitely conclusive about causes of autism yet but last I heard, this was the closest to a linked condition that had been found.
posted by provoliminal at 2:58 PM on February 6, 2015

I just want to really add in for emphasis. People ask questions like this often, here and elsewhere, saying things like "babies/children/people did just fine without modern-medicine-or-safety-thing-X".

And the thing is - no, they absolutely did NOT. That's survivorship bias.

In the year 1900, infant mortality in Germany was 250 in 1000. That's ONE in FOUR babies dying. That's just over a hundred years ago.

In 17th century England, about 2 in 3 children died before the age of four.

Hundreds, or thousands, or tens of thousands of years ago? Forget it. If you made it through to your teens, yes, it's likely you would live fairly long, but almost nobody did. That's why women started having babies in their early teens and typically had at least a dozen -- until extremely recently, it was likely that only two or so of those would survive.

Take your supplements.
posted by dmd at 3:01 PM on February 6, 2015 [12 favorites]

Keep in mind that you might not want to eat so much lentil soup and greens when newly pregnant, but folic acid is important for a wide variety of issues beyond NTD so you can't stop taking it once you conceive.

By all means, eat more foods with natural folic acid, but if you don't have any issues or objections to taking a supplement, it's somewhat ridiculous not to take that precaution. It's not like the warning not to consume any caffeine - having a cup of coffee a day won't damage your kid, but not having enough folic acid is a pretty big gamble to take.
posted by barnone at 3:22 PM on February 6, 2015 [2 favorites]

I was prescribed 4 *MG* of folic acid for an entire year before both of my pregnancies. 400 mcg from lentils are not enough to prevent neural tube defects. You probably don't need to take as much as I did, but you should be taking a supplement in addition to a folate rich diet. There isn't such a thing as too much in this case.
posted by sonika at 3:24 PM on February 6, 2015 [3 favorites]

You don't need to take prenatal vitamins, just take a folic acid supplement. And my doctor's recommendation was 800mcg, not 400.

Nature doesn't particularly care about the rates of neural tube defects in newborns as long as enough are healthy in the long run. Statistically you'd probably be perfectly fine eating lots of lentils or eating no lentils at all. But why chance it?
posted by lydhre at 3:54 PM on February 6, 2015 [1 favorite]

I can understand where you are coming from because for when it comes to your general health (things like preventing cancer, diabetes, heart disease) taking a multivitamin is not as beneficial as doing things the hard way and eating a nutritious diet. For conditions like these the performance of multivitamins in controlled studies has been pretty disappointing.

However when it comes to neural tube defects, the opposite is true. Taking folic acid supplements when you are pregnant and trying to conceive is MUCH better than relying on dietary sources alone. This is extremely well supported and not at all controversial.

And it is one of the easiest things you can do to reduce birth defects with no real downside. Please take a supplement in addition to your healthy diet.
posted by insoluble uncertainty at 4:24 PM on February 6, 2015 [6 favorites]

If you are willing to eat cereal and bread that is fortified, how is that any different than a supplement? Those added vitamins are not 'sourced from nature' any more or less than vitamins in a tablet. The only difference is that, with a tablet, you can actually ensure you get an adequate dose.
posted by Ausamor at 5:09 PM on February 6, 2015 [3 favorites]

Just so you know, I had 9 miscarriages and one baby who died due to a cord accident. It's a good idea to reconsider the concept of Nature -- red in tooth and claw -- right now. I was eating a great diet much of that time and was very healthy.

You can totally take just folic acid.

I'm sure you've read that folic acid isn't stored so yeah, you will need a lot of recipes if you are planing to ignore all that. I think your best bet is two bowls of a fully fortified cereal (check if the Canadian versions are.)
posted by warriorqueen at 5:11 PM on February 6, 2015 [2 favorites]

Just as a minor dissenting voice, there is a body of work (related to the Paleo/Primal movement, but older) that posits that traditional foods that people ate before the rise of processed/industrial food did make a difference. Weston A. Price was a dentist who traveled the world in the 1930's and studied cultures/peoples to see what helped prevent dental/facial defects in traditional cultures such as Swiss living in isolated valleys, Scotsmen in fishing villages, Inuit, and various Pacific Islanders that had not had much contact with modern foods yet. His book is of course outdated in some ways (it's from the 1930's after all) but I found it very interesting, and it's free at the Gutenberg Project. Nutrition and Physical Degeneration. Other than folic acid, some things that he noticed people ate to fortify their bodies before pregnancy were seafood (e.g. shellfish and fish oil) and organ meats. A more modern interpretation of the principles can be found here: Weston A Price Foundation.
posted by permiechickie at 5:14 PM on February 6, 2015 [1 favorite]

Like insoluble uncertainty, I suspect you are confusing the research about [in]efficacy of multivitamin supplements with the efficacy of taking pre-conception/pre-natal folic acid supplements.

It's been scientifically proven that taking enough folic acid via supplement is the best way to prevent certain often-fatal problems with fetal development. It is easy and safe and I highly recommend you go that route.

This is going to sound harsh, but I know from sad experience that plenty of shit can go wrong when you are pregnant that you have absolutely no control over and no way to prevent. This is something you do have control over, so why wouldn't you do it?
posted by hurdy gurdy girl at 5:15 PM on February 6, 2015 [3 favorites]

Just wanted to add as a clarification: my suggestion to check out traditional foods in no way means you should not also take folic acid supplements. It's actually kind of hard to eat a traditional diet in the modern world, and since ways exist to supplement a vitamin that causes a known defect when lacked, there is absolutely no reason not to take it. If only to hedge one's bets.
posted by permiechickie at 5:18 PM on February 6, 2015

Have you tried nutritional yeast? It's pretty high in most of the B vitamins, including folic acid.

Do you eat meat, dairy, and eggs? Those have good amounts of folic acid as well.
posted by sam_harms at 6:11 PM on February 6, 2015 [1 favorite]

Ok, I agree wholeheartedly with what's been said, but in the interest of actually answering your question. From the NIH:

Folate occurs naturally in the following foods:
Dark green leafy vegetables
Dried beans and peas (legumes)
Citrus fruits and juices
Fortified means that vitamins have been added to the food. Many foods are now fortified with folic acid, including enriched breads, cereals, flours, cornmeals, pastas, rice, and other grain products.

So I'd say just find recipes from those other countries with those foods in 'em!

Also recommended doses from NIH:
Pregnant females 19 and older: 500 mcg/day
Breastfeeding females 14-18 years: 600 mcg/day
Breastfeeding females 19 and older: 500 mcg/day
posted by Toddles at 7:27 PM on February 6, 2015

If you want specifical information about what women in third world countries eat during pregnancy: in Tanzania, where I used to work, they ate the same as everybody else - kidney beans, spinach, and ugali (maize porridge, a bit like polenta) or rice. That's the staple diet, they (and I) ate that for practically every meal (we had chai and dry bread for breakfast, and my non-vegetarian colleagues had barbecued meat and rice on special occasions. Not everyone would be able to afford that). I can't give you a specific recipe, but basically everything was boiled in heavily salted water until tender (hot country, manual labour, people needed the salt).

That's a reasonably nutritious diet and contains plenty of legumes and green leafy vegetables. However the (limited) info available suggests that their incidence of neural tube defects is about five times what ours is (182 per 100000 live births as compared to 30 per 100000).

People are not giving you the type of answers you want because 1) There isn't a magic traditional alternative that we've lost touch with in the industrialised West. People in traditional cultures really do just get more NTDs. 2) What you are suggesting is going to be difficult to maintain. It took me two years to conceive in my early thirties, there is no way I would have wanted to eat three bowls of lentils every single day without fail for those two years, and I definitely could not manage it through my queasy first trimester. I like lentils very much, but not for every meal for 850 days in a row. 3) A folic acid supplement will be substantially easier to take, and actually probably more effective anyway for all the reasons given above.

It just seems to me that since you are obviously worried about this (or why else ask about it), the easiest solution is to just take a supplement. It's not like you can't eat lentils as well. There's no maximum dose of folate in a day. There isn't really a downside to taking it, but there is plenty of potential downside to not taking it. I say this as somebody who does not take vitamins usually, who regularly tells non-pregnant people to stop taking their daily multivitamin because it's a racket, and I don't recommend any other supplements or medications during pregnancy unless there are specific medical reasons.
posted by tinkletown at 12:35 AM on February 7, 2015 [6 favorites]

I'm slightly confused here. You don't want to take a supplement; instead you are eating more fortified foods in the hope that they are more "natural" but what is it you think cereal is fortified with? "The fully oxidized monoglutamate form of the vitamin that is used in dietary supplements and fortified foods." It's the same thing.
posted by DarlingBri at 4:24 AM on February 7, 2015 [5 favorites]

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