The iron pills I was given for my anemia make me nauseated and constipated. Is there anything else I can do instead?

You're experiencing the common side effects of this therapy, and the reason why few stick with the regimen. Iron-rich foods, particularly those with heme-iron (blood iron), are a better choice for several reasons. First, it takes more than just iron to correct your anemia--it also takes protein and the B-vitamins, which are found in such foods as red meat, pork, poultry, seafood, and eggs. Second, the iron in these foods is not affected by other factors in the diet, such as calcium and fiber, unlike heme iron. While non-heme iron, found in such foods as spinach, whole grains, and fortified foods, does contribute to your overall iron intake, your first choice should be heme-iron-rich foods.

Now that I'm pregnant I know I should drink milk, but it gives me cramps and gas. Any suggestions?

The majority of adults have the same reaction you do, and it's called lactose intolerance--a sensitivity to the carbohydrate lactose found exclusively in milk and milk products. Try milk that is lactose-reduced or lactose-free, and dairy products that contain little or no lactose due to processing, such as yogurt or cheese. Many individuals can tolerate ice cream or frozen yogurt--there's even lactose-free brands of these foods, too. Or, you could use the lastase enzyme tablets, which you take when you start eating a lactose-rich food. They are available in grocery stores and at pharmacies.

My prenatal vitamins make me nauseated. Any suggestions?

You're not alone. Most pregnant women tell me the same thing. The reason is that the multivitamins you are taking probably contain too high a level of vitamins, and often contain added minerals--and this combination can lead to nausea. My suggestion is to switch to a multivitamin that contains only vitamins, and at the level of the RDA (Recommended Daily Allowance) for adults, such as One-A-Day Essentials. Even taking two of then a day (getting twice the RDA, closer to the requirements during pregnancy) should not make you nauseated.

I have trouble swallowing pills, but I know I need to take a multivitamin. Is it all right to take a children's chewable multivitamin, and if it is, how many should I take?

Many pregnant women find it difficult to swallow prenatal vitamins, and it is perfectly safe to switch to children's chewable vitamins instead. Read the label carefull, though, because you want to make sure that you are getting the doses you need as a pregnant woman--typically this is twice the children's dose. Make sure you are getting 4,000 IU of vitamin A, 1.4 milligrams each of vitamin B-1 (thiamin) and vitamin B-2 (riboflavin), 18 milligrams of vitamin B-3 (niacin), 6 milligrams of vitamin B-5 (pantothenic acid), 1.9 mg of vitamin B-6 (pyridoxine), 600 micrograms of folic acid, 85 milligrams of vitamin C, and 15 milligrams of vitamin E.

My husband read that pregnant women shouldn't eat fish because of the risk of mercury poisoning. I always thought fish was a healthy food, what should I do?

In recent years there has been a growing concern about how pollutants and pesticides have affected our rivers and lakes, and in turn, what this has done to fish as a food. The two culprits that have been identified as causing problems have been PCBs (polychlorinated biphenyls) and methyl mercury. PCBs are a group of substances once used in electrical equipment, and although banned, they are still present some waterways. Methyl mercury accumulates in larger fish, those with long life spans. Fish is still a very healthy food, rich in omega-3 fatty acids (read Program Your Baby's Health in the Book Shelf section for more details), protein, vitamins A, D, B-12, niacin, riboflavin, and zinc. Pregnant women and nursing mothers should not eat shark, swordfish, tilefish, and king mackerel, but should choose other fish instead, such as shellfish, canned fish (including tuna), smaller ocean fish, or farm-raised fish. The American Dietetic Association advises that pregnant women and nursing mothers can safely eat 12 ounces of cooked fish per week, with a typical serving being 3 to 6 ounces. Pregnant women should avoid raw fish (including sushi) to reduce the risk of viral or bacterial illness. In general, its important to keep all fish refrigerated or frozen until ready to use.

What does the term percent daily value mean on nutrition labels?

The following amounts are used to calculate the percent daily value for nutrition labels on food products. They are intended for adults and for children ages four and older, based on a reference diet of 2,000 calories per day.

Total fat   65 grams
Saturated fat   20 grams
Cholesterol   300 mg
Sodium   2,400 mg
Potassium   3,500 mg
Total carbohydrate   300 grams
Dietary fiber   25 grams
Protein   50 grams
Vitamin A   5,000 IU

Vitamin C   60 mg
Calcium   1,000 mg
Iron   18 mg
Vitamin D   400 IU
Vitamin E   30 IU
Thiamin   1.5 mg
Riboflavin   1.7 mg
Niacin   20 mg
Vitamin B-6   2.0 mg

Folate   0.4 mg
Vitamin B-12   6.0 mcg
Biotin   0.3 mg
Pantothenic Acid   10 mg
Phosphorus   1,000 mg
Iodine   150 mcg
Magnesium   400 mg
Zinc   15 mg
Copper   2.0 mg

Now that I'm in the second trimester of my pregnancy, I find that I'm waking up in the middle of the night ravenously hungry, even though I eat a healthy dinner. Any suggestions?

It's clear that with your baby's rapid growth, your blood sugar is dropping, causing you to wake up at night so hungry. My suggestion is to include a dairy food before bed. Dairy foods are broken down slowly, particularly if they also contain some fat, and this should reduce your midnight-munchies. Depending on how big your dinner was, you might try a malted milk shake, ice cream, a grilled cheese sandwich, cheese and crackers, or a bowl of cereal. Many of my mothers enjoy a fruit smoothie before bed--made with milk, ice cream and fruit. When the temperatures drop, try a cup of warm milk with honey and a stick of vanilla.

My mother was diagnosed with osteoporosis at age 56, and now that I'm pregnant with my first child at age 42, I'm worried that I might be headed for the same problem, particularly since I don't like milk. Any suggestions?

Pregnancy and breastfeeding can cause a loss of calcium from the bones, and among women who are pregnant within ten years of menopause (average age of 51), this is an additional concern. Although milk is a rich source of calcium, particularly the brands that are additionally calcium-enriched such as Lact-Aid (see Dr. Luke's Grocery Cart for more detail), there are other alternatives for meeting your 1,000 mg per day requirement. Edy's Frozen Yogurt (both Fat-Free and Regular) provides 450 mg per half cup, hard cheeses have 300-375 mg per 1½ ounces, Light n' Lively cottage cheese with calcium has 200 mg per ½ cup, low-fat ricotta cheese (great in cannolis!) have 400 mg in a ¼ cup, and yogurts contain 350-400 mg per 8 ounces. For nondairy sources of calcium, I would recommend calcium-fortified orange juice (both Minute Maid and Tropicana brands contain 450 mg per 6 ounces), salmon contains 360 mg in 6 ounces, firm curd tofu has 260 mg in ½ cup, and fresh oranges have about 60 mg each. For more ways to boost your calcium intake and to learn about your bone health, read Good Bones: the Complete Guide to Building & Maintaining the Healthiest Bones, available in the Book Shelf section.