Food Ratios and How to Keep Weight Down While Pregnant


I got an email from a beautiful and healthy lady the other day who wanted some advice on eating while pregnant. She was thin and super fit before her first pregnancy but gained quite a bit of weight, quite unexpectedly during pregnancy. Now she’s pregnant with number 2 and doesn’t want this to happen again. So she came to me for advice. Here is my answer to her:

The brilliant thing about being Primal is that one really doesn’t need to focus on ratios. The focus on macronutrient ratios is a modern response to bad food options. It didn’t apply in Paleo times and it doesn’t apply to hunter gatherers now. Native people eat what they can when it is available and they don’t get fat. So, if you’re eating Paleo, you probably won’t have much to worry about.

While you’re pregnant you should probably eat starch, just try to make them safe starches. Oatmeal, brown rice, and Ezekiel bread are definitely not safe starches. These all contain high amounts of anti-nutrients (very bad for a pregnant woman and bad for cravings) and the bread contains gluten. It doesn’t matter much that it has been sprouted. Plus, as you would find in the book Wheat Belly, the wheat used in “Ezekiel” bread is definitely not ancient wheat, as the name implies. It is a modern derivative of an old plant and it is problematic for our bodies, and our waistlines.

A tangent about what I eat…

These days, I eat white rice and sometimes white potatoes for my starch. Tapioca starch works well for me too. I have fructose malabsorption (which I would encourage you to look into if you suffer from a lot of cravings) and so I cannot have sweet potatoes. I have experimented with many starches over the years and ultimately settled on these. Other safe starches that I don’t eat on a regular basis include yuca and plantain. As you may know, I went through a long low carb phase. That ended right around when I nailed down the fructan issue. I knew I couldn’t eat fruit but onions and garlic (two huge offenders for me) were a mainstay in my diet. My “issues” with carbs disappeared once my gut stopped fermenting everything that passed through it.

High Fat, Low Starch or Vise Versa

Another thing that can contribute to weight gain is the combination of a lot of fat with starch. If the fat is high, keep the starch low. If the starch is high, keep the fat low. This is not what you will find in best-selling processed foods, of course, because it doesn’t taste as good as super fatty, super starchy stuff. It has been my experience that the two combined can make us gain weight, or not be able to lose weight, than if we eat one or the other. Now, while I was pregnant I ate a whole lot of fat and I did not worry about how much starch I was eating at the same time. That fat was mostly butter, fish oils, and olive oil.

I ate much more fat with pregnancy #2 than with #1 because my experience and beliefs have changed over the years. I did gain a little bit more weight with #2. With my first I gained just under 20lbs. It was a healthy pregnancy with no complications and I didn’t deliver early. With my second I gained just under 30lbs. With my first I had 0 lbs to lose after pregnancy, with this one I had 10lbs to lose, which has all burned up by now.

What About Protein?

As for protein, just eat enough. While I was pregnant I ate 2 or 3 eggs for breakfast. For lunch I might have a 1 can or maybe just ½ a can of salmon or something else like soup or chicken salad. For dinner maybe fish or raw beef. My taste for protein while I was pregnant was lower than usual but I did eat some protein at every meal. I wasn’t thinking about ratios, I was just following my senses (our senses can be quite refined when we eschew junk food). When not pregnant, I never eat more than three meals a day. And I don’t eat snacks. While I was pregnant I ate 4 meals a day most of the time.

Focus On Nutrition Not Ratios

You should be thinking more about nutrients than about ratios. Nutrient deficiencies can actually contribute to weight gain. And you should also take great care to eat anti-inflammatory as inflammation also causes weight gain.

Eat only good fats like those listed above, plus coconut oil and lard. Eat organs for a powerhouse of nutrients. This can include liver, kidney, and heart. Eat fish – the smaller, cold water fishes like sardines and salmon are considered safer to eat while pregnant. Eat some muscle meat if you so desire but don’t overcook it. Eat safe starches. Eat fermented foods. Eat veggies.

Dairy can be addicting for many of us, and so staying away from that can help keep weight under control. I don’t think I need to say that you should not over-indulge in sugar but I’ll say it anyway. ;) Fruit is sometimes craved like crazy by pregnant women. For those trying to be healthy, it often replaces packaged junk food. That is certainly a step in the right direction but fruit does contain a lot of sugar so it should be limited to a couple of pieces a day.

In my book, Primal Moms Look Good Naked, there is a wealth of advice about diet, exercise, and weight loss,. The book is perfect both for the pregnant mother and for a recovering mother.

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  1. Excellent post! This is like the distilled essence of the primal lifestyle and the way you should view your food, whether you’re a pregnant mother or anyone else! Nutrient quality, density, and satiety and you need not count, weigh or measure anything….just learn to discern what is REAL, and eat until you are no longer hungry.

    …cold water fishes like sardines and salmon are considered safer to eat while pregnant.

    Meh. “Considered” like everything else about conventional wisdom, is BravoSierra.

    The supposed reasoning is “Mercury” content.

    Yes, it’s true, open ocean fish have MethylMercury. What is not “considered” is that the level of Selenium in the fish counteracts the Mercury, binds to it and doesn’t let your body absorb the mercury. You only need avoid certain species of fish, in which their Mercury levels are higher than their selenium levels.

    Most fish however, have higher selenium than mercury levels.

    Pregnant women especially, should eat fish!

    Here, check out this chart: ,from Chris Kresser’s blog post:

    • We can always count on you to expose bullshit. I don’t worry about mercury in fish either. There are few areas of the ocean where man has actually influenced the amount of mercury found in fish bodies. Mercury is out there and fish just contain it. And people have always eaten it.

      White rice also contains considerable selenium by the way!

  2. Biggest thing *is* to trust yourself. Your body knows what it needs, if you have a good enough foundation for it to be picky. *Don’t* worry about your protein. You want to puke up your protein for a reason: fetuses are highly sensitive to protein poisoning. Up your fats to compensate; it’s good for growing brains and full of yummy micronutrients.

    I tend to feel that if you’re eating real food, the fat/carb combo doesn’t matter that much. I mean, it does under normal circumstances, but pregnancy changes everything. You’re biologically borderline diabetic, on purpose, so I’d think you’d need something to buffer your carbs. But this is more your area, my focus is on out-of-the-womb kiddies. ;-)

  3. Yeah, the thing that’s always perplexed me with the ‘ideal macronutrient ratio’ discussions is… my body knows. It varies day to day, but if i just take a moment to concentrate on the eating urge I just know what I need and how much.

    Without a doubt fake food screws up that sensor, but these discussions go on in paleo circles! Have people been out of tune with it for so long that they don’t even know they have it?

    • “Have people been out of tune with it for so long that they don’t even know they have it?” They sure have!

      It’s important that we try to get it back though. Our needs do vary from day to day not just in the ratio of foods we eat but in the types and amounts.

  4. When you were pregnant, how did you eat your eggs, raw or cooked? If they were cooked, how did you prepare them? Also, please list the recipe for your chicken salad. Thanks!

    • Lya, I ate them both raw and cooked. I prefer eggs scrambled. My chicken salad recipe isn’t a recipe at all. I mostly eat just green veggies and the chicken was always plain old grilled. I am so boring when it comes to food.

  5. Wow, I would like to hear more about this canned salmon business. That sounds like something I can stock up or bulk up on… what would you sudjest Peggie?

    • I love canned salmon, Carrie, because it is fast and full of bones and skin. With lemon it is delicious and it has a lot of calcium. But I don’t love canned salmon because it never seems to digest quite right and somehow it never makes me feel really full like fresh fish does. I don’t know why exactly. Is it the processing? Is it the BPA in the lining of the can? Is it my imagination? :P I don’t know. I’m not sure what to recommend but what I can do is steer you away from the kind that whole foods sells in the large cans (not sure what the brand is off the top of my head). I am quite sure that something in that fish is toxic because of the way it makes me smell. It’s weird. I’m not a smelly person so it is majorly noticeable on the occasions that I have eaten that stuff.

  6. So why white rice but not brown rice? Wouldn’t brown rice be better?

    • Brown rice is a whole grain which contains high amounts of anti-nutrients. Traditional cultures who eat grains ferment them first to make them more digestible and the nutrients more available. White rice removes the bran and the germ, which is where the problem is. Now of course, there are nutrients in the bran and the germ, but if your body can’t use them, then they don’t do you any good. Additionally, those anti-nutrients can bind to other minerals in your meals, reducing the nutrient value even further.

      If you eat white rice with protein, fat, and fiber, then the glycemic index that you’ve probably been told to watch, will not be a problem. White rice does have a high glycemic index by itself, but in a meal it is a different story.

      So, why not just eat fermented brown rice then? Many of us don’t feel as great when we eat it as when we do. And fermenting grains is a lot of work… Check out what Mark Sisson had to say on the same subject here:

      • Peggy, have you ever tried haiga rice? We’re totally hooked on it. It’s (short grain) rice that’s been polished enough to take the bran off, but the germ is still attached. I soak it overnight and find it has the digestibility of white rice but a slightly nuttier flavour and probably a better nutritional profile.

  7. I agree that this is good advice for anyone. But I think that it’s especially important for pregnant women to hear the “eat real food” message because I hear so much “baby wants a cookie!” and “I don’t even care, I’m pregnant and I deserve whatever I want.” I expect that my own turn is still several years off yet, but when I’m choosing a food I try to ask myself “Do I want to build my future baby out of this stuff?” Of course, there is still a better than even chance that my future baby will be built primarily out of chocolate, but the rest of the ingredients should be good stuff.

    I am looking forward to the book, Peggy, and I have just one question – will there be a kindle version available? It would blow my husband’s mind to see me reading the hard copy, and if my MIL saw it on the coffee table she would start planning a baby shower ASAP!

    • Hey Laura,

      That’s some smart sense you’ve got thinking about your future baby early on. His or her genes will thank you for it!

      Yes, there will be a kindle version as soon(?) as the print is out.

  8. This is a little off-topic, but I wanted to thank you for your post(s) on fructose malabsorption. It is because of your writing on the subject that it was even something on my radar; otherwise it may have been years before I discovered what was making me so incredibly sick! Despite eating along primal guidelines since Aug 2011, I was still having emotional ups & downs, and all manner of crappy physical symptoms. (you know the story, I’m sure.) Since self-diagnosing myself, via elimination diet, I truly feel amazing.

    Thank you Peggy!

    • Dara, that’s so good to hear. I hope more people stumble upon the fructose posts and solve their long time issues as well.

  9. This pregnancy, I’m totally listening to my body. I realized that I’ve been trying to follow ancient wisdom, that I’ve been ignoring my bodies signals – just like when I used to drink raw milk – I didn’t feel good but continued to drink because – you know – all those people Dr. Price studied thrived on it. Same with fermented foods. I’ve made my own ferments as well as buying them for years now. Well it just recently sunk in: Fermented foods make me sick! So do some raw foods – like broccoli and garlic, and maybe lettuce, I’m not sure yet.

    I’ve learned a big lesson here, and it’s to listen to my body. The fact is, I have to be pretty strict and limit what I eat or I feel horrible, and have bad digestion issues. It’s so stupid but it took me forever to figure out that just following this or that lifestyle of eating healthy foods doesn’t work for me. I’ve tried water fasts, I’ve tried salt water flushes, I’ve tried the SCD intro diet. Now I’m going to try some good old fashioned body wisdom.

    This means that I’ve been eating pretty low carb – which I’m not normally. I’ve done my own research though and do not believe this is a problem. I don’t count, and sometimes I want a sweet potato, banana pancake or whatever, and have a higher carb day, but for the most part, I’ve just been eating what makes my body feels good. Lots of cooked veggies either as a stir fry or in a soup, always with added fat. Eggs, meat, offal, canned and fresh seafood make up the rest of my rather limited diet. I’ve never felt so good, pregnant or not, and my baby is growing right on target, and those two things are worth more than you can imagine unless you’ve experienced years of ill health yourself.

    • I had a similar thing with fermented foods. I went all out and kept it up for a while and it made me sick. My body never got used to them.

      Then I read about the slow introduction of ferments in GAPS (I think a tbsp at a time). At first I scoffed, then I thought about it, then I implemented – turns out ferments are just fine for me as long as after any kind of break I reintroduce them reeeaaaaally slowly.

      It seems weird that your body wouldn’t just get used to the large amount after a while, but for some reason mine didn’t.

      But yeah, I really noticed a difference in my digestive health when I cut out raw (unfermented) veggies. Actually, cooked too at first, but I’m able to reintroduce those now bit by bit.

      Peggy, you’re able to eat some raw veggies now, right? As long as you avoid the fructans?

      • Thanks for the tip Alexandra. I will look it up. I’m not the most patient of people, but I could do TBS a day. It’s good to know I’m not the only one with these weird problems.

  10. Cannot wait for your book to come out! It’s sitting on my wish list til the release date. :) I’m hoping to be pregs in the near future and plan to use it as a reference! Been paleo for almost a year and during my last pregnancy I was on the “healthy” SAD diet…turns out it wasn’t so healthy after all! Would love more posts like this. There is a serious lack of paleo pregnancy information out there. Thanks!

  11. On fructose malabsorption – is that something that can be healed with an intensive gut-healing diet like GAPS or SCD?

    • I don’t know Susie. Some claim, based on theory, that it can be. So far, my experience is that it can’t. I’ve done zero fructose diets for many many years and haven’t had a glimpse of reversal. The first time I did it was after figuring out through experimentation which foods i couldn’t eat. I was strict for more than 2 years that time. Now, after learning about FM formally over a year ago, we have been very strict and still the problem foods are problem foods. But we feel better and that’s what matters!

      • Peggy, here’s the reason I think it should be fixable.

        I was completely unable to eat fruit or alliums. I confirmed this over and over. Then I got pretty bad food poisoning back in September (from raw meat at a restaurant, arrrgh). Ever since I’ve been able to eat a bunch of different fruits and some alliums. I mean, garlic! Previously the source of inevitable diarrhea.

        On the flip side my digestion of starch, previously perfect, became less than perfect.

        The point is, it’s still down to the populations in your gut. They can obviously be modified. I’m not sure how to go about it safely, but there should be some way (after healing the gut) to reintroduce the right bacteria for digesting fructose and fructans (or anything else).

        It just seems absurd that one’s digestion could be strongly altered by food poisoning, but not through some intentionally applied means.

        • Fructose malabsorption is not about the population in your gut.

          Fructose is absorbed into the blood stream, transferred to the liver, and then used as energy or stored as fat. In people with FM the fructose is NOT ABSORBED. At this point it travels through the gut undigested. Our bacteria population breaks it down then and this causes all of the symptoms like bloating and gas. If any carbohydrate travels through the large intestine undigested, you are going to experience symptoms. Undigested carbs are not supposed to be down there.

          If you are not experiencing symptoms after eating fructose, then you are either absorbing fructose or you have totally lost your population of carbohydrate-fermenting bacteria. However, the latter isn’t a good sign. The undigested fructose still shouldn’t be in your gut. You should absorb the food you eat.

          • You’re right, my bad.

            I wonder how I could tell which of the two is going on. My digestion of starches did get slightly worse, so maybe the carbohydrate-fermenting bacteria were damaged, but not totally? I dunno. My digestion is really pretty good overall, it’s just that now I’m aiming for perfect!

          • Peggy would you please clarify what you mean by “or you have totally lost your population of carbohydrate-fermenting bacteria. How would you know if you had FM if you were not experiencing any symptoms!?!?

          • Lya,

            I was throwing out the possibilities as to why she wouldn’t experience symptoms, but I didn’t expect that a lack of carbohydrate fermenting bacteria would really be the cause. I don’t know if that is likely or even possible.

            Is there such a thing as asymptomatic FM? I don’t know.

  12. Your thoughts on white rice are fascinating! It is something I would never have thought of on my own because it seems so anti-Paleo, but I’m ready to give it a whirl. After about three weeks on a highly-imperfect diet revolving around raw meats, I’m ready to give it a try. The raw meat thing is great and tastes delicious, but there’s only so much I want, and then at the end of the week I’m just HUNGRY and wanting to eat everything in sight. Still, my skin actually has started to clear up, save one or two really nasty cysts that probably come from the “imperfect” part of the diet.

    When I experimented with a Japanese-inspired diet for about one day, I used brown rice, and I felt like garbage. Now I have a potential clue why.

    I love the whole “eat real food” approach to motherhood. My husband and I are talking more about having kids soon because honestly I’m starting to think they would be a fun experiment in how to raise kids properly! All the women I work with have baby-babies (less than 2), and they keep sharing stories of, “Wow, my kiddo’s favorite treat is mushed-up pancakes!” and it’s so hard to bite my tongue from screaming that pancakes aren’t food! An adult on a diet or an adult trying to eat healthy knows not to eat that crap, but oh, it’s sooooooo cute to see how the 1-year-old will face-plant in the birthday cake because he loves it so much!

    Makes me want to vomit.

  13. Peggy, what do you think about this study that Mark S. posted in regards to constipation? I know a lot of pregnant women suffer with this…myself included during my last pregnancy….you said you do eat veggies, though…I’m guessing no ill effects? Would you care to expound upon your veggie intake please? Thanks!

    • Ashley,

      You know I think that high fiber diets are generally dangerous for bowel health. During my first pregnancy, I followed the “wisdom” to eat high fiber for the baby’s sake. I was constipated and it was horrible.

      A year or so later I quit veggies all together and was finally well.

      I do eat veggies now, but I’m not sitting down to a huge plate of them 3 times a day. For the most part what I eat is a salad of green leafy veggies. I still don’t eat a huge variety of veggies. I have never agreed with Sissons (maybe antiquated now?) suggestion to add lots of veggies to the Paleo diet. Maybe it works for some. I don’t know, I’m not in their bodies. But it has sure never worked for me.

  14. hello!i’m a polycystic and wanted to get pregnant!. . I am 32 and obese. . .what should i take in , what should i eat so that ill soon be pregnant? thank u!

  15. Hello Peggy and everyone on here posting helpful comments. I signed up to this blog at the beginning of my pregnancy when I was told not to exercise for the 1st Trimester and was looking for answers then – I am now back in the gym with a moderate programme designed for me, and happy for it! I am 18 weeks pregnant now, have gained 7kg (about 15lb) to date, and have just been told that that is too much and really I should gain no more than 2kg (about 4lb) and to cut out sugar and bread. I am 170cm tall and now weigh 156lb.

    This has sent me in to a bit of a spin and I feel in a bit of a mess with my eating now. I am a recovering bulimic – I was bulimic for 16 years but since moving to Spain 4 years ago have been much less body-obsessed (I lived in London before) and chilled out and managed to cut the habit apart from the odd re-lapse usually related to hormones: ie on the run up to my period! But more or less binge free. I had found over the years that wheat was a real problem and trigger for me, as was other starch – (although potatoes always the safest option!) so have followed a diet high in dairy, nut, fish and meat protein with lots of fresh fruit and vegetables (I try and restrict fruit to breakfast only and eat a lot more raw than cooked veg) and low carb although and have always eaten the odd serving of toasted rye bread/ pumpernickel, both rye and white oats, and rice pasta/ rice noodles. However I have always had a sweet tooth and try not to beat myself up about a chocolate bar here and there. In weeks 6 – 10 of my pregnancy I felt ‘off’ almost all of my favourite foods and all I could face was bread/ white starches/ sugar: I decided to go with it for that time, for the first time in 16 years, guilt free (hence 6kg on my bum and thighs! )But my normal appetite returned week 10. However now I feel in a bit of a mess – I am craving (and giving in to) sugars & bread, now with the added guilt that I should not be eating these things and feeling, only 5 days after being told to cut out these foods by my doctor, that I am pushing towards that out of control binge behaviour that I had very much wanted to keep well out of my pregnancy. I know I need to re-establish balance and will be researching FM and also implementing the high fat/ low starch and vice versa rule – but more importantly want to get regular safe starches into my diet to try and level out my cravings.

    Is rye out with whole grains and perhaps not as stable for me as I thought it was? Could fruit (mostly pineapple & dates) be making my sugar cravings worse?

    I am really keen to get myself back on track…any thoughts or advice greatly appreciated!

    • Hi Louise,

      It is wonderful that you are reaching out for help. Please know that I am not a doctor or nutritionist and am in no way qualified to give medical advice. If bulimia has become a problem again while you are pregnant, please talk to your doctor! You and the baby could suffer severe nutritional deficiencies as a result.

      While there are a number of imbalances that can lead to binge eating behavior, I would urge you to look into fructose malabsorption or other digestive disorders like lactose intolerance. Also, strive to balance your hormones. This means CUTTING OUT wheat and sugar and possibly dairy. Elevated insulin can lead to leptin resistance which can lead to a continued desire to eat even when you’re not hungry. High fat and moderate protein should be eaten with every meal. Pineapple and dates are both very high in fructose, and sugar in general. You should cut them out. Remember that if you go low carb, your cravings for carbs can get out of control, especially while you’re pregnant and need them. Obviously, you don’t want to go overboard with carbs by eating sugar or limiting fats and protein, but your body’s cravings for some carbohydrates is legit. Making starches a regular part of your meals should actually help to control cravings.

      For information on getting calcium while pregnant please read this:

  16. Hi

    I am pregnant in 21 weeks and I would like to know your suggestion for woman who does not have gallbladder. I have accident and gallbladder had to be removed so I do not eat high fat diet. I eat starch a lot fruit squashes sweet potato raw sheep dairy, raw grassfed butter, fish lamb lots of veggies. so my ratio can be 40%-50carbs 15%protein and rest fats. somedays I eat lots of fruit due summer season and have never problem with my weight gain only 5 pounds and is skinny for whole life.
    Thanks a lot

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