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How Clean Should Your Diet Really Be?

When it comes to dietary strategies these days, what’s out is what’s in. Jettisoning full food groups or nutritional elements (wheat, dairy, sugar, animal products) in an effort to eat clean has become the cool way to cut through the clutter. But is it the right move for pregnant women or those looking to conceive?

“The goal of a healthy diet for fertility is to provide the body with a good amount of antioxidants, vitamins and minerals to support a healthy reproductive system, a healthy hormone balance and to promote energy and build important nutrient stores,” explains Stephanie Middleberg, a noted registered dietitian and founder of the health-and-wellness practice Middleberg Nutrition. “Cutting out specific food groups may be fine, while others may pose a greater risk for woman trying to conceive, as specific nutrients can be lacking.”

Here, her take on four common categories that often get the ax.


Wheat isn’t necessary in a healthy pregnancy and there are plenty of other sources where woman can get carbohydrates. Wheat is a lot different than it used to be; it is essentially a super grain. Our products now contain 40 percent more wheat and our bodies aren’t used to digesting that much. It is also found in 70 percent of the foods we eat. As a result, many people are developing reactions and getting sick.


I get this question a lot from many of my clients who are lactose intolerant and are interested in getting pregnant or are pregnant and worried about getting enough calcium—the recommended three servings a day. Calcium isn’t the only nutrient necessary for bone health and much of the new research indicates that woman should aim for a lower intake of calcium and a higher intake of the vitamins and minerals that support bone health like vitamin D, vitamin K and magnesium.

Additionally, recent studies indicate that antioxidants found in fruits and vegetables and seeds help reduce bone loss. Women can get calcium from non-dairy sources like leafy green veggies, canned salmon, sardines, nuts, broccoli and sweet potatoes. For those that can tolerate dairy, I recommend organic, grass-fed, full-fat sources and to limit options that aren’t organic, as they contain hormones and antibiotics that can possibly lead to increased estrogen levels in the body.

Lactose intolerance is usually genetically determined, though some lactose intolerance does develop from damage to the gut lining, say from food poisoning or from an imbalance of gut bacteria, which prevents a person from making sufficient lactase. But it is not likely that cutting out dairy will lead to a decrease in lactase production and, ultimately, lactose intolerance.


Refined sugar is not necessary and should be eaten in limited quantities and not daily—especially to prevent gestational diabetes [in pregnant women]. I still recommend clients consume at least two servings of fruit a day, as it also contains important vitamins and minerals and phytonutrients. For sweeteners, maple syrup, organic honey, sucanat [whole unrefined cane sugar], dried fruit and coconut sugar are my top preferences.

Animal Products

You can have a healthy pregnancy on a vegetarian or vegan diet. But if clients are having fertility issues, I recommend they look at possible nutritional deficiencies in vitamin B12, iron, zinc and fat-soluble vitamins, which are mostly found in animal-product foods. Higher iron stores have been linked to great fertility rates. Good vegan sources of iron include spinach, pumpkin seeds, molasses, beans, lentils, tofu and sesame seeds.

Getting adequate protein can also be more difficult on a strict vegan diet. I recommend clients stay away from processed soy products like soy milk, veggie burgers, fake cheese and bars with soy protein isolate and stick to whole fermented soy like miso and tamari.

Many clients choose to be pescatarian because of the health benefits of fish, especially cold-water fatty fish like wild salmon, sardines, mackerel and herring (which are also low in mercury). These provide the long-chain omega-3 fats EPA and DHA, which are important for brain development.

For vegetarians who can tolerate dairy, I often recommend including organic, grass-fed, full-fat sources and fermented dairy products like yogurt and kefir, as they are good sources of beneficial bacteria. I also recommend my clients include whole pasture-raised eggs because they are rich in choline, which has been found to prevent neural tube defects [defects of the brain, spine and spinal cord] and plays an important role in brain development.

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