Nitrates in Food and How They Impact Pregnancy

When you are pregnant your diet will likely change, after all, you are now eating for two. It is easy to feel deprived of many favorite foods and beverages during pregnancy. Still, if your doctor recommends a newly restricted diet or asks you to refrain from certain foods, like nitrates, there’s a good reason for doing so.

Limiting or cutting out processed meats from your diet — such as hotdogs, sausage, bacon, and deli meats — is often a safe option for both you and your growing baby. While they’re already full of fat and sodium, they also contain nitrates, which have been linked to some potentially harmful health effects.

Thankfully, there are ways to be mindful of nitrate consumption during pregnancy. Finding the right diet with healthy whole foods — and natural dietary nitrates from vegetables and fruits — is key. Read on to learn more about sodium nitrate and how it can affect your pregnancy.

Food companies may use additives to extend the shelf life, freshness, and quality of products. But what exactly are these preservatives and how do they affect the body?

Sodium nitrate — and its cousin additive, sodium nitrite — is a type of salt used in food preservation, specifically for cured meats. You can find it in a variety of processed foods including beef jerky, bacon, ham, deli meat, and hotdogs. Sodium nitrate provides a distinct flavor, pink color, and extended shelf life. It serves as an antimicrobial, meaning it reduces the spread of microbes like mold and bacteria.

You can also find nitrates in tap water, plants, and vegetables — particularly spinach, celery, lettuce, radishes, carrots, beets, and cabbage. Nitrogen, which is necessary for plant growth, converts to sodium nitrate in the soil. The plant then absorbs sodium nitrate from the soil.

Whether they’re in produce or processed meats, nitrates and nitrites are a natural part of the human diet. They assist bodily function and bacteria reduction in the digestive system. However, research suggests that high levels of sodium nitrate from processed meats can potentially lead to various health concerns, which is essential to note when you’re pregnant.

Sodium nitrate may increase the risk of certain cancers — specifically pancreatic, colon, stomach, ovarian, esophageal, and thyroid. Foods treated with sodium nitrate can produce nitrosamines, a compound that largely contributes to the toxicity of nitrates and nitrites. Nitrosamines are considered a carcinogen, or a cancer-causing substance.

This additive has been limited and removed from certain foods due to these concerns. The United States Food and Drug Administration (FDA) limits the amount of sodium nitrate present in meats to no more than 500 parts per million. It also requires that these foods contain additional vitamin C to help prevent nitrosamine formation.

Infants younger than four months have the highest risk of developing adverse health effects from nitrite and nitrate overexposure. This can occur through the ingestion of baby formula that was diluted with nitrate-contaminated water. Infants may also contract nitrate poisoning by consuming baby food from unregulated water wells. This nitrate poisoning can increase infants’ risk of a blood disorder called methemoglobinemia.

Naturally-occurring nitrates in fruits and veggies are healthier than those in processed meats. However, experts still recommend that you avoid feeding your baby spinach, lettuce, beets, cabbage, carrots, and other nitrate-rich vegetables until they’re 6 months old, which is generally the ideal age to introduce solid foods. Bathing is considered safe since these nitrates can’t pass through the infant’s skin.

The daily recommended intake of sodium nitrate via the Environmental Protection Agency is no more than 0.33 milligrams/body weight. If you wish to track your nitrate consumption, you’ll typically find either sodium nitrate or sodium nitrite listed on the packaging of processed meats like ham, salami, smoked fish, and bacon.

Let’s explore some of these nitrate-rich foods more in detail below.

Processed and cured meats are high in added nitrates. While sodium nitrate can be useful for preserving the food’s freshness and enriching color, it can be potentially harmful to your health as we discussed earlier.

Here are some high-nitrate processed meats to look out for:

• Ham: Ham is typically the highest source of dietary nitrates. A single 100-gram serving of cured ham can contain up to 890 micrograms of nitrates. This is what causes the distinct pink color of cured hams.
• Bacon: Bacon is incredibly high in nitrates, containing up to 380 micrograms of nitrates per 100 grams of weight. While some brands label their bacon packaging as nitrate-free, this isn’t always the case.
• Beef jerky: Curing is an important first step when making beef jerky. Either sodium nitrate or sodium nitrite must be added to consider the meat cured. This also prevents bacterial growth and adds rich color and flavor. Even if beef jerky is labeled as nitrate-free, the brand still could have used celery juice or celery powder additives, which are naturally rich in nitrates.
• Hotdogs: One of the most processed meat sources on the food market, the average hotdog has about 50 micrograms of nitrates per 100 grams of meat.

The above foods are merely a few examples. Sodium nitrate and nitrite are found in many other processed meats, like sausage, corned beef, bologna, salami, pepperoni, and others.

Cured and processed meats aren’t the only sources of nitrates. Natural sources of nitrates from vegetables are healthier for the body. They’re often found with other vitamins and antioxidants.

Here are some examples of veggies that are rich in natural nitrates:

• Spinach: Fresh spinach is both a great addition to salads and a healthy source of natural nitrates. While a 100-gram serving of spinach can have anywhere from 24 to 387 micrograms of nitrate, this amount can vary depending on plant growing conditions.
• Bok choy: Bok choy is the highest source of natural dietary nitrates in the cabbage family. A 100-gram serving of bok choy can contain up to 309 micrograms of nitrates depending on growing conditions.
• Carrots: While many leafy green vegetables are known for their natural nitrate concentration, carrots can be a good source of nitrates, as well. A 100-gram serving can have anywhere from 92 to 195 micrograms.
• Lettuce: Lettuce has a considerable amount of natural nitrates, despite not always being rich in other nutrients. One 100-gram serving can contain anywhere from 13 to 267 micrograms of nitrates.

Some other vegetables that contain natural dietary nitrates are beets, celery, radishes, onion, kale, and turnips. Fruits can sometimes contain nitrates, but these amounts are generally smaller. Some fruits with traces of nitrates include watermelon, apples, grapes, bananas, kiwi, peaches, and oranges.

Now that we’ve covered the basics of sodium nitrate and examples of nitrate-rich foods, why are nitrates bad in pregnancy?

First, medical research suggests that nitrates and nitrites in your body may increase the risk of delivering your baby too early. A Stanford University study of over 1 million California births showed that pregnant women exposed to excessive nitrate in their drinking water were at greater risk of premature delivery. Preterm birth can result in health complications for infants.

Agricultural runoff containing animal waste and fertilizer can considerably increase the groundwater’s nitrate level. The Stanford University study found that the risk of preterm birth more than doubled among women whose drinking water contained nitrate levels of over 10 milligrams per liter — exceeding the federal limit — compared to women whose tap water nitrate levels were below 5 milligrams per liter.

Besides the potential risk of preterm birth, here are some other possible health risks associated with high levels of nitrate in drinking water:

• Blue baby syndrome: Nitrate can influence how the blood carries oxygen. It can turn hemoglobin — the oxygen-carrying protein in blood — into methemoglobin. High methemoglobin levels may turn the skin a gray or bluish color. They can also cause more serious health effects such as increased heart rate, weakness, dizziness, and fatigue. Because infants’ bodies are more sensitive to nitrate, high levels can affect them more seriously.
• Birth defects: High amounts of nitrate in drinking water may cause neural tube defects, which can occur very early in pregnancy. The neural tube turns into the spine and brain in a developing baby.
• Thyroid disease: High nitrate levels in drinking water may heighten the risk of thyroid disease. Nitrate can impact thyroid function by blocking iodine, which the thyroid needs to produce hormones. Reduced thyroid hormone levels may cause weight gain, fatigue, hair loss, and dry skin.
• Cancer: Excessive levels of nitrate in drinking water may increase the risk of cancer. Nitrate can enhance the cancer potential of other compounds.

When nitrate levels are high, everyone — whether they’re pregnant or not — should try to avoid long-term use of their tap water for drinking and preparing foods.

Here’s how you can practice healthy dieting during pregnancy with nitrate consumption in mind:

Many pregnant women opt for nitrate free-food. However, food labels that claim to have no added nitrates can still have naturally occurring nitrates — like celery or beet powder — even if they were added during the processing stage. Meats like beef jerky with added natural nitrates are often labeled “uncured.”

While you can opt for nitrate-free foods if desired, there’s no guarantee they’ll be truly free of nitrates or healthier than their nitrate-rich counterparts. Because processed foods with nitrate like bacon, sausage, deli meats, and hotdogs may be carcinogenic due to nitrosamines, you may want to play it safe — for both the baby and yourself — and limit or avoid these foods during pregnancy.

Nitrates aside, there are other reasons to avoid processed meats and cold cuts. Among the biggest is the increased risk of listeriosis, an infection that results from consuming foods contaminated with listeria bacteria. Listeriosis can cause vomiting and flu-like symptoms — and in more serious cases, preterm delivery, miscarriages, and stillbirth if you contract it when pregnant.

Additionally, high-nitrate processed foods are loaded with sodium and saturated fat. This makes them unhealthy for you in general, no matter how good they may taste. For a healthy and safe pregnancy, try sticking to well-cooked and lean cuts of your favorite meats instead.

Natural nitrate consumption through vegetables and fruits is generally a healthier option than consuming nitrates through processed meats. With that in mind, here are some of the healthiest foods to eat when pregnant, some of which contain natural dietary nitrates:

• Dairy products: It’s important to consume extra calcium and protein when pregnant. That’s why dairy products like cheese, milk, and yogurt can be great options. Greek yogurt in particular is rich in probiotics and often has more calcium than other dairy products. Plus, parfaits and yogurt smoothies can beat those pregnancy cravings for a sweet treat.
• Legumes: Legumes such as beans, peas, chickpeas, lentils, and peanuts are a great source of fiber. They also fuel the body with protein, folate, calcium, and iron — all of which your body needs more of while pregnant. From hummus on toast to a taco salad with black beans, there are many ways to add legumes to your pregnancy diet.
• Salmon: Loaded with essential omega-3 fatty acids, salmon is another healthy option. It’s even known to help develop the baby’s eyes and brain. It’s also a great alternative to high-mercury fish like swordfish, shark, tilefish, and king mackerel. Make sure the fish is fully cooked through to avoid listeria.
• Leafy greens: Full of fiber, potassium, iron, vitamins — and of course, nitrates — broccoli and dark leafy greens like kale and spinach are a nutritious addition to your pregnancy diet.
• Berries: Berries offer an array of health benefits like vitamin C, antioxidants, fiber, and healthy carbohydrates. Some of the best berries to eat when pregnant are raspberries, blueberries, acai berries, and goji berries. Strawberries — which contain natural nitrates — are another healthy option.

Remember that part of a healthy diet is staying hydrated regularly, so be sure to drink plenty of water each day, as well.

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