Caffeine, Heartburn, Fish Oil and Flu Shots

Q: I recently had a practitioner recommend that I take fish oils daily during the last trimester of my pregnancy. But, I also heard that I can get too much Vitamin A from fish oils and harm my baby. How do I know what’s a good balance?


This is a very good question, and a very tough one to answer concisely! Essential Fatty Acids (EFA’s) play important roles in several bodily functions. There is research about the positive outcomes, in terms of future cognition (awareness, perception, reasoning, and judgement), in the offspring of mothers who supplemented with EFA’s in pregnancy. Studies have also clearly demonstrated that EFA’s are crucial to brain cell development and transmission of nerve impulses. In addition to the brain, they also play an important role in the development of the heart and other organs, they support immune function, as well as helping lay down important fatty tissue in the newborn.

Now, onto sources of EFA’s. You can use foods as an original source, and this is always recommended as the first line approach to consuming EFA’s. Foods rich in EFA’s are:

  • nuts and seeds (flax, pumpkin, almonds, sunflower seeds, walnuts, sesame, pecans)
  • legumes and their sprouts (soybeans, garbanzo, chia)
  • whole grains (brown rice, buckwheat, millet, quinoa, corn)
  • avocado and olives (also in cold-pressed oil form)

In food sources, EFA’s are usually found in more balanced ratios of Omega 3’s and 6’s, and the oils are protected and stable while in their original food form. Many of these oils will turn rancid when they are extracted and exposed to oxygen. The exception to this is cold-pressed oils such as flax, pumpkin, borage, hemp, and sunflower seed oils. At most health food stores, and some grocery
stores, you can purchase balanced blends of the Omega 3’s and 6’s, such as UDO’s 3:6:9, or Essential Balance.

As for fish oils, they have been shown to be especially beneficial for brain development and maintenance. This is due to Docosahexaenoic acid (DHA), which is an Omega 3 oil. Fish consumption is currently a controversial topic because of toxins and heavy metals found in ocean water. I will leave toxins in fish for another day, but will leave you with the idea that in moderation and from reputable sources, fish is still an excellent part of a balanced diet. DHA is also found in algaes such as blue-green algae and spirulina. Since fish eat algae, this is how it is incorporated into the food chain. Therefore, if you are vegetarian, or prefer not to eat large quantities of fish, then you can use algae-based DHA supplements, which are usually screened for heavy metals. You can typically find this information on the bottle, or ask at your local health food store for supplements that have been through rigorous screening.

To answer your question about Vitamin A, you will be protected from the retinol form (animal derived), which is the toxic form, if you choose a supplement that is not liver based, such as cod-liver oil. As I mentioned before, make sure you are choosing a fish oil supplement that can guarantee it has been quality controlled for heavy metals and toxins.


Q: Can I drink coffee while I am pregnant? I have a 5-year-old and a 3-year-old and am exhausted most of the time without a cup of coffee in the morning.


Many things need to be sacrificed in pregnancy to ensure optimal health for moms and babies. I am happy to tell you that coffee need not be one of those things that must fall by the wayside!! There have been many studies over the years that showed a relationship between coffee drinking and miscarriage or low birth weight. What has been revealed in these studies, however, is that other factors that contribute to miscarriage and low birth weight were not taken into consideration (smoking, age, environmental
factors). Current studies demonstrate that 150mg/day of caffeine is safe to consume in pregnancy. This is equivalent to 250-300mls of coffee, or 1 to 1&1/2 cups.

Sometimes drinking coffee is more about the ritual than it is about the caffeine, so there are other options available to keep the ritual alive. One of them is to drink decaffeinated coffee. When buying decaffeinated coffee, make sure that you are purchasing coffee that has been through a “Swiss Water” decaffeination process, as some other caffeine extraction methods involve chemicals that may not be safe for consumption in pregnancy. Another option is to make your cup of coffee out of 1/2 decaf and 1/2
caffeinated coffee. This way you can have 2 cups of coffee that only contains the caffeine of one cup!!


Q: My baby is due in January and I am very worried about getting sick during the Winter. Are there ways to naturally boost my immune system? What about a flu shot?


With winter months approaching it is a time when many people are likely to become ill. Amongst the most vulnerable groups to acquire a contagious cold, flu, a mild or serious illness in general are infants less than 6 months old, the elderly, immune compromised individuals and of course pregnant women. If you get any type of flu while you are pregnant, you are more vulnerable to developing complications such as pneumonia and preterm labour which could put you and your baby at risk. Most illnesses are spread from one person to another by airborne droplets, direct skin contact, by coming into contact with contaminated surfaces or using contaminated towels. Adhering to good hand hygiene with the use of soap and water is the simplest and most effective means to prevent the spread of bacterial or viral infections.

Simple measures you can do will make a big difference:

  • Wash your hands well and often with soap and water
  • When you cough or sneeze, cover your nose and mouth by coughing into your arm
  • Always wash your hands after you cough or sneeze
  • Use a tissue and throw it away after use
  • Don’t touch your nose, mouth, or eyes because they are places where germs can enter your body
  • Don’t go to work or school if you are sick
  • Stay away from people who are sick

Natural ways to boost your immune system is by getting plenty of rest and exercise and maintaining a work life balance. Of high importance is ensuring that you maintain adequate hydration, eat a diet high in protein, fresh grains, fruits and vegetables. In addition taking a daily prenatal supplement can help maintain a steady intake of vitamins and minerals that your body needs regularly and that you may not always be getting from your diet. Many approaches and opinions exist when it comes to natural remedies and boosting your immune system, these can include ingestion of whole garlic, ginger tea, or a variety of herbal remedies. Most of the natural approaches are safe but remember to always read the labels of any products whether they are natural or medicated, not all are safe during pregnancy.

As for a flu shot, it is a public health recommendation for pregnant women who are pregnant throughout the influenza season of October – May to receive the flu shot at any stage of pregnancy.

A few precautions should you decide to receive the flu vaccine:

  • The safety of the nasal spray influenza vaccine during pregnancy has not been determined; therefore, pregnant women or those intending to become pregnant should receive the influenza vaccine or flu shot given by needle, which contains dead influenza viruses (inactivated influenza vaccine) that cannot cause infection.
  • If you are sick and have a fever, wait until your symptoms are gone to get your flu shot.
  • Do not get the vaccine if you are allergic to eggs or have ever had an anaphylactic hypersensitivity or severe allergic reaction to a flu shot.
  • Let your care giver know if you have ever had a rare condition called Guillain-Barre syndrome.


Q: I am in my third trimester and suffering from major heartburn. What can I do to help?


Heartburn is a very common occurrence in pregnancy, albeit one that may cause great discomfort. It has been shown that between 30-50% of women will experience heartburn in pregnancy. There are many reasons why women develop heartburn in
pregnancy. In early pregnancy, it may have to do with hormones relaxing the muscles of the lower esophageal sphincter and allowing food and stomach acid to surge back up into the throat. In later pregnancy, heartburn may be a result of the growing uterus
putting pressure on the stomach. Some of the symptoms of heartburn are as follows:

  • Burning sensation or pain in the upper abdomen, chest or throat.
  • Sour taste in the mouth.
  • Regurgitation of food and acid into the throat and back of mouth.

There are many safe and natural remedies to alleviate the discomfort associated with heartburn:

  • Small meals frequently throughout the day instead of large meals.
  • Drink plenty of fluids throughout the day, but avoid drinking with meals.
  • Allow at least 3 hours after a meal before going to bed.
  • Raise the bed 6 inches, or elevate yourself on several pillows.
  • Stay upright after eating.
  • Avoid foods with a high oil content, and try to incorporate more protein into your diet.
  • Avoid acidic foods and drinks such as coffee, citrus, tomatoes, spicy foods and carbonated beverages.
  • Eat foods such as pineapple and apples, and try digestive teas such as fennel. Sometimes milk or dairy products such as yogurt can help as well.
  • Thayer’s Slippery Elm lozenges have been found to provide relief from heartburn symptoms.
  • TUMS are safe to take in pregnancy, but try to minimize the amount that you take in a day, as in larger quantities they may affect absorption of vitamins and minerals from your food.

If none of these remedies are able to provide you with relief from the discomfort of heartburn, it is recommended that you follow up with your midwife, family physician, or obstetrician.

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