In Episode 50 of The Holistic Nutritionists Podcast, Natalie Douglas, Kate Callaghan, and their guest, Lily Nichols (Registered Dietitian and Nutritionist) discuss how to eat right when pregnant and what is a good pregnancy diet for expecting moms.

• Gestational Diabetes- what is it and why is it an issue for mum and bub?
• Glucose Tolerance Test- is it necessary and what are the other options?
• Dietary management of gestational diabetes using a real foods and evidence based approach
• Changing health policy and influencing current schools of thought on lower carb eating for pregnancy
• Prenatal nutriton and when to start eating for pregnancy 
• Key nutrients that women should be mindful of when preparing for pregnancy and where they can be found
• Choline- the underrated nutrient for healthy pregnancy
• Prenatal supplements
• Lily’s “superfoods” for pregnancy and breastfeeding
• The appropriateness of vegetarian and vegan diets for pregnancy- what the research says and Lily’s clinical experience
• SO much more!!

Lily Nichols
Registered Dietitian/Nutritionist
https://lilynicholsrdn.com/

Intro 0:00
Hello and welcome to The Holistic Nutritionists Podcast, with your hosts Natalie K. Douglas, Thyroid Healer, and Kate Callaghan, The Holistic Nutritionist. Nat and Kate are degree-qualified dietitians and nutritionists, certified fitness instructors, speakers, and authors. If you love unfiltered banter, unedited bloopers, and authentic heart-sharing, then we are your ladies! Now it’s time to sit back, relax, and get ready for our latest tips on living your healthiest life possible.

Natalie K. Douglas 0:42
Hey guys, welcome back to the podcast. We have another very exciting guest interview for you today. Today, we are joined by Lily Nichols who is a registered dietitian and nutritionist, certified diabetes educator, researcher, and author, with a passion for evidence-based prenatal nutrition and exercise. Joined from the current scientific literature and the wisdom of traditional cultures, her work is known for being research focus, thorough, and sensible. Her best selling book Real Food for Gestational Diabetes, and an online course of the same name presents a revolutionary nutrient-dense, lower carb diet for managing gestational diabetes. Her unique approach has not only helped tens of thousands of women manage their gestational diabetes, most without the need for blood sugar lowering medication, but it’s also influenced nutrition policies internationally. Lily’s second book Real Food for Pregnancy is an evidence-based look at the gap between conventional prenatal nutrition guidelines and what’s optimal for mother and baby with over 930 citations. This is the most comprehensive text on the on prenatal nutrition today. Lily is also the creator of the popular blog, LilyNicholsRDN.com which explores a variety of topics related to real food, mindful eating, and pregnancy nutrition. And we will definitely link to all of Lily’s website and social areas at the end and in the show notes. So check those out. But Lily thank you so much for joining us and welcome to the podcast.

Kate Callaghan 2:23
Welcome!

Lily Nichols
Thank you.

Kate Callaghan
So, when we start every podcast off with, with our guests is, what did you have for breakfast and what did your little man have for breakfast?

Lily Nichols 2:34
Well, I attempted to have eggs but he ate most of them. I cooked a couple of eggs, sauteed some beet greens. I bought a big bunch of beets this weekend. I always use use all the parts so I sauteed beet greens, crack some eggs in there, had some baby tomatoes. He pretty much ate like most of my egg yolks. Thanks. And I always have tea and heavy cream in the morning. I’m a tea drinker, not a coffee drinker. So that’s just me. And then he had Greek yogurt, which like half of it then I ate the rest and then he had some blueberries, but then left some of those, I had some of those. We do breakfast pretty casual here. So you know off each other’s plates.

Kate Callaghan 3:22
It’s a little bit of a buffet.

Lily Nichols
Yeah.

Kate Callaghan
So you’re not quite predictive of your food. You don’t worry about him stealing your food? I do.

Lily Nichols 3:31
You know, it’s hard because I’ve tried the whole like, okay, you get your own plate, I get my plate. And I mean, we sometimes do that usually dinnertime, we try to do a little more, you know, formal and sitting at the table and he has his plate of food and I have my plate of food but I don’t know if it just tastes better off of my plate or, or what but it’s like I serve him his own plate and that food ends up not being eaten, which then is like, okay, if you throw this way I really hate food waste or do you eat it, but maybe I’m already too full and you put it away for later like, before it’s conundrum. I’m just like, whatever. With breakfast, I just make my own. I see whatever he wants to eat. He eats most of it. I just make myself more breakfast and call it.

Kate Callaghan 4:15
Yeah. Good call. Good call. All right, thank you for sharing that. So can you tell us a little bit more about what you specialize in and why you decided to go down this path?

Lily Nichols 4:25
Yeah, so prenatal nutrition and gestational diabetes has been my specialty for most of my career as a dietitian and a certified diabetes educator. My work in this field has spanned from a lot of different angles. I’ve gone the nutrition public policy side of things in the state of California to clinical practice, and consulting, and research, and helping train other professionals. I feel like I’ve seen it inside and out. In all of these roles, it pretty much became clear that our conventional prenatal nutrition guidelines are not exactly as evidence-based as we’d hope. There’s a lot of new scientific research coming out showing that some of these guidelines are due for an overhaul and specifically when it comes to gestational diabetes, which I know you want to go into more detail today, I found that a high percentage of my clients were failing diet therapy, and meaning that they couldn’t manage their blood sugar with the nutritional information that I was giving them when I was following conventional guidelines. And I mean, we’ll talk about this in a little more detail as we go. But essentially, the conventional gestational diabetes diet is so high in carbohydrates that people with blood sugar abnormalities, or it’s literally called carbohydrate intolerance during pregnancy, it’s hard for them for their bodies to process large amounts of carbohydrates without having high blood sugar. So, I did a lot of research to see whether or not going lower carb could be safe, there was a lot of pushback against going lower carb and ultimately decided to develop a different approach for managing gestational diabetes, which was lower carb, more nutrient-dense than conventional recommendations. And we had way better outcomes. So that ultimately led me to write real food for gestational diabetes. And then, you know, years later to write another book on prenatal nutrition, incorporating some of that advice, and a whole bunch of other research tackling a whole bunch of other topics that I didn’t tackle with that first book.

Natalie K. Douglas 6:41
Awesome. And it’s so interesting, because we kind of take, like, take it at face value, a lot of the advice that we’re giving, but when you actually think about, you know, diabetes, being a state where you are finding it difficult to actually handle carbohydrates, it sounds like the stupidest thing in the world. I’ll just, I’ll just give you more and more regularly, and then that’ll so whatever thing because we again, in Australia, both Kate and I are dietitians as well. So we went through, you know, I guess the the kind of conventional training over here and had the similar like, it’s the same in Australia, that those kind of like that kind of advice, and I remember being in, in a diabetes education clinic when I was actually still in uni as part of our clinical placement, and having to educate the people who were coming in on a healthy diet for gestational diabetes. And I can tell you now it’s so not what I’d say now. It’s just, it’s really interesting that.

Lily Nichols 7:45
Well, the same, the same here, it kind of like, hurts my heart a little bit to know that I could have helped some of these women more than I did. But you you I mean, we all want to be doing our best at all times. I think there’s a lot of of pushback against dietitians these days because our training is so conventionally minded that it’s kind of like, you know, you’re kind of stuck in a box. But there’s a lot of fear around going outside of that box. And for everything that I had heard. It wasn’t until I researched to find that most of the warnings were actually not evidence-based to begin with. But what I had heard was that it could be dangerous for a baby’s brain development if a mom went lower carb. So of course, I didn’t want to recommend lower carb if it was unsafe.

Kate Callaghan 8:33
Yeah.

Lily Nichols 8:35
The baby’s brain development for God’s sake. That’s why you’re doing all this, and that’s why you’re doing the work you do.

Natalie K. Douglas
Yeah, totally.

Kate Callaghan 8:41
Did you, did you get pushback from your colleagues and from your governing body?

Lily Nichols 8:50
No, which really surprised me. And I think the reason for it is that the way I went about it was so careful and methodical and and backed by science, that there was kind of not, there wasn’t as much room to rebut, I guess, I’ve actually been very surprised that it’s been overwhelmingly well received. And I mean, there’s even a company in the US that like offers continuing education credits for real food for gestational diabetes, I was like, shocked that they reached out and wanted to do that. I was like, what, really?

Kate Callaghan
That’s so good. That’s so good.

Lily Nichols
And the Czech Republic, the country itself changed their gestational diabetes guidelines, to drop the minimum mandatory requirement of carbohydrates, which for their country was set at 200 grams per day, in the US, it’s 175 grams per day. But they dropped a mandatory minimum of carbs whatsoever from their guidelines, and they’re reporting better outcomes less need for insulin medication. I mean, it just just kind of obvious at the end of the day like, if you were diagnosed with gestational diabetes, usually it’s with a glucose tolerance test of somewhere between 50 to 100 grams of glucose if the treatment for that is to provide a similar amount of carbohydrates at meals, why would we expect you to have normal blood sugar after having a meal with 50 grams of carbs, or 75 grams of carbs, when you failed a glucose tolerance test with 50 to 75 grams of carbs. It’s just kind of mind-numbingly simple.

Natalie K. Douglas
I know.

Lily Nichols
And then also just really frustrating, because we’ve just been given so much misinformation. And so I don’t know, it’s been interesting. I feel like in a lot of ways, I’m just sort of like the voice of reason, and then pointing people to the science. And usually when people, you know, take in all that information, they kind of come around and go hmm, yeah.

Natalie K. Douglas 10:57
Sounds sensible. I know, you kind of don’t know whether to laugh or cry, when like some of this, you like to see some of the way chronic disease is treated, or, you know, in this case, not necessarily chronic disease, but gestational diabetes, it just like, I just you, I get that everyone’s doing their best. But I also think like, you know, clearly use all the research there. And it’s available for practitioners for governing bodies to look into. It’s not like it’s not there, and they have to go and create it. It’s actually already there. So good on you for going doing the hard yards of finding all of that research and putting it into something digestible for for listeners and fellow practitioners. And I’m so glad that the it’s getting so much attention and that it’s well-received. Kate and I definitely haven’t had the same response of well-received over here with our governing bodies. And yes, we, Kate, I don’t know if want to expand on on that.

Kate Callaghan
We probably don’t have time. My governing body don’t like me.

Lily Nichols
Because? Look, can I ask? Because of the carb issue or because you’re recommending higher fat or what?

Kate Callaghan
Yeah, everything, because I’ve supported basically an ancestral health real food way of having out grains. And no, I’m not always low carb. I support carbs in in some situations, but more of real food, carbohydrates.

Lily Nichols 12:27
Yeah, same, same here.

Natalie K. Douglas
So, irresponsible of you two. Gosh.

Lily Nichols
I mean, that’s the part that’s so confusing to me is just, we have to look at what is preferred. What’s preferred by the body? What’s physiologically normal? What’s a physiologically normal metabolic response to whatever situation is going on? And then how do we provide the most nutrient-dense diet possible, and a lot of that does end up pointing back to more of an ancestral approach. And just getting back to basics with food and less reliance on I don’t know like process.

Kate Callaghan
Processed crap.

Lily Nichols
Grain-based products. I mean, you just look at trying to get a lower glycemic index, more nutrient-dense diet, and it just points you away from grains, because they’re not super nutrient-dense. The whole grain argument is very interesting. And, you know, I’m not even fully anti grain, I do eat some grains, just not in like massive quantities. I just don’t see them being I don’t see the logic behind them being a staple in the diet. It’s really never made sense to me, but you know, yeah.

Natalie K. Douglas 13:38
Totally, totally, no, like, it’s it’s funny, we could probably, we could also probably banter on all of it for hours but I will jump back in and just take us back to the gestational diabetes side of things. So could you briefly tell our listeners what gestational diabetes actually is, and why it’s an issue for mothers and their babies?

Lily Nichols 14:00
Yeah. So, gestational diabetes simply means that woman’s blood sugar is elevated during pregnancy. And there are a couple of different ways to define it. So it can be diabetes that is first diagnosed during pregnancy, or that first develops during pregnancy, which could be two different things because it could be something that is having is happening because of changes going on in the pregnant body like placental hormones, and natural insulin resistance, and weight gain and all that, or it could have been going on before and it just hasn’t been diagnosed, which is actually a pretty high percentage of this, quote, gestational diabetes that we’re seeing right now. I mean, in the US, we have like 49 to 52% of the US adult population has some form of diabetes, or pre-diabetes, mostly undiagnosed. And of course, that carries over for women because half the population-ish is women. So it’s it’s the identification of a blood sugar problem in pregnancy period. Another way to define it is carbohydrate intolerance during pregnancy, so your body is unable to handle large amount of carbohydrates without having high blood sugar. The reason that we care is that the carryover effects from having high blood sugar can impact a baby’s development, some of them could be very severe, like birth defects, and then others can be seemingly maybe arguably less severe, such as having a large baby, having a birth injury, like shoulder dystocia, a baby being born and going hypoglycemic rather quickly, jaundice, higher rates of for mama c-sections, preeclampsia. And I think the most concerning of all is that consistent exposure to high blood sugar over the course of the pregnancy can change the development of a baby’s pancreas, so that they hyper secrete insulin, and in a way become a bit insulin resistant themselves. And this actually sets them up for a higher risk of developing type 2 diabetes, or obesity, or other metabolic problems later in life. In fact, there’s a 6-fold higher risk of developing type 2 diabetes by the time they turned 13 of children born to mothers who had uncontrolled gestational diabetes, and some of the stats actually put it at a higher amount than that. But for me, that’s the most concerning of all, because we can make a dent in some of the, you know, childhood obesity epidemic and other things that are going on by helping mothers have maintained normal blood sugar levels.

Natalie K. Douglas 16:43
Yeah, and so, so interesting, because I think that it’s, it sounds scary when you say all those things, and it definitely is scary. But also, in like, there’s a lot that you can do, as you kind of just alluded to this, there’s actually so much you can do to mitigate those damages and to prevent gestational diabetes and even manage it, if it does, if it does present. And now, I just wanted to ask about the glucose tolerance test, because you kind of mentioned it in the beginning, relating to that 50 grams of glucose drink given, but could you explain what like what the glucose tolerance test is? And is it that, do you actually think that it’s essential for women to be getting in? And are there any alternatives if people actually don’t want to do that test?

Lily Nichols 17:34
Yeah. So, I think having some form of screening for gestational diabetes is really smart. If we take on the diagnostic guidelines that most of the world uses outside of the US, first world are behind on this. We would diagnose upwards of 18% of pregnant women with a blood sugar issue with gestational diabetes. So I think it’s important to have some form of screening. I’m a bit rogue and my stance in that. I don’t believe that it has to be the glucose tolerance test or the glucola. That is the gold standard, that is the most accepted way to test for it. But there can be many reasons that people don’t want to do it. And I think we, you know, it’s a matter of informed consent, we need to honor that and give alternatives. So you know, it may be that you don’t usually eat a lot of sugar, and you don’t want to drink 50 or 75, or 100 grams of sugar at a time, you might not like the other ingredients that are in it, you might be eating a pretty low carb diet to begin with. And that’s the results can be skewed, that skews you to have a potential for a false positive doesn’t always happen. But there are cases of that happening. So I do think it’s important to offer different tests. One of the ones that I am partial to, is using hemoglobin A1c to help screen in the first trimester. Essentially, what you’re, what you’re getting a measure of is average blood sugar over the last 2 to 3 months, which if you’re doing it first trimester, you’re getting an idea of pre-pregnancy, average blood sugar levels. So if those are ranging in the pre-diabetic range, you can treat it as if the person has gestational diabetes. That’s what most people in the state of California do. They follow the sweet success guidelines, I’m partial to it because that’s what we did when I worked in a, you know, very busy obstetric clinic in Los Angeles. So we were able to diagnose people early, give them you know, two-thirds of their pregnancy to make a dent in their blood sugar levels to be proactive about it versus diagnosing, you know, when the glucola is usually done, which is 24 to 28 weeks. And we have really good outcomes. So I think that is a smart one for providers to incorporate, but a lot of people you know, are against it, I will throw out one statistic, which is that if an A1c is elevated in the first trimester above 5.9%, the chances that that woman would also fail a glucose tolerance test is 98.4%.

Kate Callaghan
Wow.

Lily Nichols
So it’s very useful. You’re identifying blood sugar issues very early on. Anyways, another alternative would be to test your blood sugar at home. And I’m also partial to this because I believe it gives you a lot of information about how your body responds to food. But it does require that a person you know gets a glucometer, gets test strips, knows how to use it, knows when to test, how to test, is willing to do it. Because you have to like you know, test your blood sugar four times a day, you have to like set alarms to make sure you do it at the right time, you have to log everything. But at the same time, you got a lot of information out of it. So for the really, and I find that a lot of people who don’t want to do the glucola, they tend to be really proactive about their health to begin with, and have no problem doing something like that. So I think that’s, you know, a great option. And essentially, you take the data and compare it to blood sugar level levels observed in non-diabetic pregnancies and your gestational diabetes targets and sort of make a call on whether or not it counts as GD or doesn’t. It’s tricky, because you don’t have like a exact cut point, where with the glucola, you have like, okay, if it’s any number over this, it’s a positive diagnosis. If it’s any number under this, it’s negative, like with home blood sugar monitoring, monitoring, it’s a little more wishy-washy, and I think that can be frustrating for Mamas and providers. Sometimes it’s like, what do we do with this information? So in that case, you know, maybe a glucola does make sense or maybe that would give you more peace of mind, I don’t know, I just think it’s helpful to have have options.

Kate Callaghan 22:02
I did the the glucose strips. So I had a carb-containing meal and did the strips after and my doctor supported me through that because I had the I had the glucola in university in physiology and someone else is meant to have but everyone else messed up. And then I was the only one left to have the bloody glucola.

Natalie K. Douglas
Oh, you’re okay with that?

Kate Callaghan
And this was when I was following a really low carb diet. And then I had this friggin glucola. I swear, I felt like I was coming off heroin or something if your, I was shaking and sweating, it was a horrible.

Lily Nichols 22:34
Yeah, I know, I had a similar reaction to the glucola too. So I feel you.

Kate Callaghan 22:40
So if someone’s going to do that testing, they’re going to do the test of themselves. When in their pregnancy would you recommend they do it? So I think the glucose test, tolerance test is usually recommend around 27 28 weeks, is that the same for the US?

Lily Nichols 22:53
Yeah, and the US they have a window of 24 to 28 weeks. So yeah, I would do the same. You can technically test at anytime. You can do it, you know, they can perform a glucola earlier in the pregnancy, if there’s any risk factors or like if a woman had gestational diabetes in a previous pregnancy or something, they can always do it early. So you could always do the home blood sugar monitoring early. I think it makes sense to just occasionally for a couple of weeks, you know, check in on your sugar, make sure it’s okay. There is a fair number of cases of people, you know, passing a glucola 24 to 20 weeks, but then maybe their insulin resistance spikes at 30 weeks or 32 weeks, and they might be totally missed because they’re testing window was early, right? So, I think the proactive approach is to like have a glucometer and test every once in a while. But that’s something that not everybody wants to do. Understandably.

Kate Callaghan 23:49
Understandably. Yes, I guess. Alright, so let’s backtrack a little bit and talk about prenatal nutrition because that’s what you specialized in your new book, Real Food for Pregnancy. So that’s more, more broad scope for everyone. So not just women with gestational diabetes. Right?

Lily Nichols 24:07
Right. Correct.

Kate Callaghan 24:09
Okay, so in your opinion, when do you think someone should start thinking about eating for conception or pregnancy and why? Should they wait until they’re pregnant or should they prepare before?

Lily Nichols 24:20
I like this question because it turns out that we can influence both egg and sperm quality by making sure the diet contains enough essential nutrients early on. There’s about a 3 to 4-month window preconception where you can play a role in the development of the whole, like the sperm cycle, and I’m talking mom and dad here because everybody always puts all that on us women, but you know, men, men are providing half the DNA for this baby, right? So 3 to 4 months would be would be minimal. I think there’s never a bad time to be eating really well. But definitely getting more serious about it. And like the 6 5 4 3 months leading up to conception, for sure makes a sense to up the nutrient density of the diet, and potentially to to start supplementing with some nutrients that are commonly lacking or that you might be deficient in. By the time that a woman finds out that she’s pregnant, and you’re technically based on how they date pregnancies, you’re already like four weeks pregnant, by the time you’re at, like your next missed menstrual period. So and most of the embryonic development is happening really early, the risk for really serious birth defects, all that stuff is like in the first 8 weeks of pregnancy. So if you can, you know, preload with a lot of the nutrients involved in like the closure of the neural to like choline, and folate, and vitamin B12, and vitamin B6, and glycine, like, if you can preload with those ahead of time and make sure your intake is good leading up to it, you’ll have a much lower risk of having any of those issues during your pregnancy.

Natalie K. Douglas 26:12
I totally concur. And I think I love that you said this kind of never a time we’re eating a really nutrient-dense whole foods diet isn’t a good idea. And I, I really like that, as well, because I think that, you know, it’s like eating for pregnancy, like the way that we’re talking about it now is really just an extremely nutrient-dense way to eat. And it’s going to make you feel good, whether you want to fall pregnant, or you don’t. So I love that. I love that you said that. And you did just touch on a few of the key nutrients there that people should be mindful of when preparing for pregnancy. So you mentioned, you actually mentioned choline, which I want to explore a little bit further, can you tell us a little bit more about choline, kind of what it is and why is it so important during pregnancy? Because I think it’s something that doesn’t get as much as as much attention in the conventional world as it should?

Lily Nichols 27:09
Yes, I agree with you, it doesn’t and it’s kind of perplexing because it’s so important. So everybody was always talking about folate or folic acid, which is which is good, you know, it’s a good. Folate is like an important nutrient. It’s very important for the prevention of neural tube defects. It’s involved in sort of with the transcription of DNA, like the passing on of genetics from one to another, and making sure that process goes smoothly, folate does involved in that, but it’s not the only nutrient involved in that. And that’s where you have the choline, and the B12, and the glycine, the B6, and these other nutrients coming in as well. There’s always some level of synergy in nutrition, which is always really cool when you look at the nutrient breakdown of food and find like oh, that food that’s high in this it’s also high in this. For choline specifically, it is a B-vitamin like compound that was identified after our other B vitamins were named and given numbers associated with them. So it could be like vitamin B, pick a number but they just call it choline. It is required for fetal brain development, placental function, as I mentioned, the prevention of neural tube defects. You find choline primarily in two foods, at least in high concentrations in two foods is found widely in the diet and fairly low amounts, but it’s most concentrated in egg yolks and liver. So for moms who don’t consume either of those, and a lot of people don’t eat much liver, so it really mostly comes down to eggs. For people who don’t eat eggs they consume about half the quantity of choline as egg eaters do and the choline is in the yolks, by the way, so if you’re following like 80s nutritional advice to have egg whites like you’re missing out on the choline, eat the egg yolks too, but you find really high concentrations of choline in an egg yolk like one egg yolk provides 115 milligrams, whereas like the next highest food, other than beef liver, which has a similar amount of choline for one ounce, you see, like, you know, 30 milligrams in half cup of pinto beans, or 30 milligrams in half cup of broccoli, you see 20 milligrams, and two tablespoons of peanut butter, you just see like tiny little amounts read throughout things. And those are actually some of the most choline dense of our non-egg items. So usually see, like, you know, five milligrams, eight milligrams, and in pregnancy, you need a minimum of 450 milligrams per day. And there’s even some research to suggest that double that quantity is better. There was like a really interesting, very well designed trial where they to like for the research people like a randomized controlled trial. And they provided half the mamas, these were pregnant women with 480 milligrams per day and the other group with 930 milligrams per day. So like a little more than the recommendation, and then like, double it. And they tested neurological outcomes in the infants like reaction time and other test measures. Later on in when when after the baby was born and in toddlerhood, and the high choline group consistently, and significantly scored better on all the tests at all time points compared to the baby’s born who, to mamas who essentially just met the recommendation. So I think there’s, this is just one of many areas in prenatal nutrition, where we’re uncovering that maybe optimal levels of the nutrient might be higher than what our recommendation is, but also just how important some specific foods are to optimal prenatal health because most prenatal vitamins don’t include choline so.

Natalie K. Douglas 31:12
Yeah, and it’s it’s so it’s interesting, actually, that it’s, this is a slight sidestep. But as part of my job at another, I kind of worked two jobs. So as part of one of my jobs, I’m at the moment going through, and I’m actually doing a lot of DNA, like genetic interpretation, and a lot of the people have coming because they have fertility issues. And one of the biggest snips or like genetic variations that I’m seeing is a lot of people have an impaired ability to actually synthesize choline in the body. And so, again, it’s and I mean, that’s, that’s definitely I have no statistics on that. It’s just what I’m seeing as a common thing in a lot of people that are having difficulty falling pregnant, amongst many other things, but I thought was just interesting. And I, I am, I definitely don’t think that most people get enough choline in their diet. Because, again, you know, some people are eating eggs every day. But even if you are eating a couple of eggs, most days, there’s still going to be a gap there. So you kind of touched on supplementation there a little bit. So do you actually recommend people to use any, any supplements during pregnancy? Like whether it’s isolated nutrients like choline or a prenatal? What should people kind of be looking for?

Lily Nichols 32:38
Yeah, there’s a number of possible supplements that can be helpful. And I think a lot of it depends on a person’s diet too. What they should supplement with, and how much you can get a little more specific if you have some of that information. But as a general, as the general rule, I think a prenatal vitamin makes a lot of sense. There are some prenatal vitamins that do incorporate choline, it is a kind of a just physically bulky nutrient, it takes up a lot of space. And so the supplements that have decent amounts of choline tend to be lots and lots of capsules for getting getting all your nutrients and plus the choline. So keep that in mind. It can be supplemented separately for for somebody who’s not consuming eggs, or just doesn’t have a great choline intake to begin with. I also think there’s a place for I mean, there’s a whole chapter on supplements and real food for pregnancy. So I’ll try not to like just rehash the whole the whole thing. But just just briefly, I think there’s definitely a place for additional vitamin D supplementation. The needs for pregnancy are way higher than our conventional recommendations that we have a lot of really good supplementation trials on pregnant women. And it shows that 4000 IUs per day is far better at maintaining vitamin D levels in the normal range than the current recommendation. I don’t know where it is where you guys are at, but in the US it’s 600 IUs per day. So 4000 is considerably more than that. Most prenatals don’t provide 4000. An omega-3 supplement that provides DHA would also be really important. Most people are really diligent about consuming, frequently consuming cold-water fatty fish like salmon, sardines, herring, then you’re going to want to you’re just going to want to do some sort of fish oil or they even make an algae-based DHA supplement that is very wise because DHA plays an irreversibly important role in brain and vision development in utero and also beyond that. So when you’re breastfeeding, you pass DHA and other nutrients into your milk. So it’s something you if you’re going to breastfeed you want to consider long term to make sure your milk is sufficient. Beyond that, it kind of gets into you know, the nitty-gritty like, you know, how’s your diet with magnesium? You might need more of that. How’s your iron status? You might need that. How’s your like, are there any holes, any gaps in your diet that would make it likely that you might be deficient in something else? That’s not also provided in your prenatal vitamin like, that’s where it can be helpful to work one on one with a practitioner to help you find to not hopefully and nutrition-focused one because you know, most doctors don’t have much training on on prenatal nutrition. So unless they’re really personally interested and up to speed on the research, you’re probably going to want to work with the you know, a real food focus dietitian nutritionist kind of a person.

Kate Callaghan 35:51
Definitely, I was just thinking how much bigger and better my brain could have been if egg yolks and liver were supported in the ’80s.

Lily Nichols
Right?

Kate Callaghan
Because, I was born in the ’80s and you know, ’80s and ’90s, egg yolks were really shunned and no one ate liver and choline wasn’t even thought us so.

Lily Nichols 36:16
Yeah, we didn’t have a recommended intake for choline until 1998, and yeah.

Kate Callaghan 36:22
Oh, goodness, I missed out.

Natalie K. Douglas 36:27
But you’re already so intelligent. So it’s okay.

Lily Nichols 36:34
You know, my mom did not like fish and seafood like still doesn’t. And so I’m like, how did we, my sister and I like how did we develop decent brains? Like we didn’t have almost any DHA coming in? I don’t know, it’s a miracle.

Kate Callaghan 36:51
So on that, so an egg yolks and liver not bleeding a bit there. What are your top three superfoods for pregnant women to consume and why? I also got a question through from a listener. And she said, can I ask about non-fancy superfoods that give you your biggest bang for your buck when you’re not up for eating a lot or can’t eat large meals?

Lily Nichols 37:12
Non-fancy?

Kate Callaghan
I think she may not acai berries and goji berries.

Lily Nichols
Oh, okay. Gotcha, gotcha. Um, well, you said egg yolks and liver. So yeah, obviously those are non-fancy ones. Another one said only three but I’ll list a couple more since you already lead.

Kate Callaghan
Yeah, sorry.

Natalie K. Douglas 37:35
We try to contain it. But it’s hard. Sorry.

Lily Nichols 37:38
So well, we kind of came up to seafood, the fatty fish in seafood. So I actually just posted this on about this on Instagram today. So seafood is just such a valuable food source of many different nutrients that are kind of tough to get in our diet if we don’t eat it. So, iodine and DHA would probably be the big ones that you’re most likely not going to get enough if you’re not eating any fish or seafood. And those are very important for brain development. Iodine is huge for brain development. It sounds this sounds crazy, but I’ll read you this quote and then tell you where the quote was from. Iodine deficiency remains the leading cause of preventable intellectual disability worldwide.

Kate Callaghan
Wow.

Lily Nichols
That quote comes from the Journal of the American Medical Association. So, iodine is vital. Absolutely, along with all these other nutrients, but it plays a very important role in thyroid health, which was under a lot of strain during pregnancy has to pump out like 50% more of thyroid hormones and thyroid hormones play a direct role in the brain development. So absolutely fish and seafood are going to be providing you with DHA. And iodine, they also have a lot of selenium. And they provide you know, vitamin B12, B6, zinc, iron, other nutrients that are very important in pregnancy for a variety of reasons. So that’s definitely a big one. I’ll throw in one more because we can’t we can’t only talk about animal foods we have to throw bone to to vegetables here. So your leafy green vegetables are going to be a major source of folate in the diet. The word folate comes from foliage, meaning green leafy plants. So they’re they’re they’re very important nutrient source and I think they kind of get it maybe it’s just in recent years is everybody so like pro low carb, pro keto, and we’re kind of like forgetting about plant foods as well. They are a valuable source of nutrition. You have a lot of magnesium and trace minerals, antioxidants, vitamin K1, carotenoids, and of course that folate. So, I think they’re really necessary useful food in the diet. We just need to pay a little more attention about making them taste good. Cooking them with enough fat and salt so they’re palatable. Well, squeezed lemon never hurts. But you know, your kale, your you know, the beet greens I had this morning, spinach, dark leafy lettuce like those are all really, really valuable food sources.

Kate Callaghan 40:16
Excellent. Add butter and salt and it makes anything better.

Lily Nichols
Yeah for sure.

Kate Callaghan
So on that on the whole plants thing, I did get a question through about, she said, I’d like to know more about how to do it pregnancy? Well, on a plant-based diet or mostly plant-based, there seem to be so many animal products recommended. And maybe I’ve just missed the alternatives. What are your thoughts on a vegetarian or vegan diet for pregnancy and breastfeeding?

Lily Nichols 40:43
Yeah, so it’s it’s a very good question. And it’s a very sensitive topic because there can be many different reasons that go into choosing to to not consume any animal foods. I think from from a nutritional perspective, it’s a bit of a conundrum to try to meet the increased nutrient demands that pregnancy and breastfeeding put on your body solely through a plant-based diet. I think it can be possible with a vegetarian diet that includes eggs, definitely eggs, and some like full-fat fermented dairy products that also tend to fill in a lot of gaps. Just the iodine part, for example. Now granted, that wouldn’t that’s not one that’s like huge on my list with plant-based diets because you can get it from seaweed. But if you don’t eat seaweed, and you don’t need any other types of seafood, the other major two dietary sources are our eggs and dairy products. So like, the more the more groups of foods you start to cut out, the more you have to just just be careful about planning around the potential deficiencies that would be there. So just to list out the possible nutrients that can be challenging to obtain on a vegetarian diet. We have vitamin B12, choline, glycine, preformed vitamin A or retinol, vitamin K2, DHA, iron, and zinc because some of those nutrients are only found in animal foods, or only found you’d only be able to get them in sufficient quantities, or easily absorbable forms from animal foods. I personally ethically can’t recommend the vegan diet during pregnancy. That is the stance that I’m pretty sure the Academy of Nutrition and Dietetics would fight me on. But there is a very long, all fully evidence-based section in chapter three of Real Food for Pregnancy called the challenge of a vegetarian diet during pregnancy that outlines nutrient by nutrient, why we would be concerned and what would be sort of a stopgap approach if you’re not willing to consume the foods that have it. And I think for a lot of them, there are supplements that can take the place of it like vitamin B12 for example, choline, for example. And then there are some nutrients where the supplements are animal-sourced, anyway, so there’s kind of no way around it that would especially be like the glycine that you find mostly in gelatin, and collagen, which are animal-sourced foods. So just think it’s definitely something to consider the trade-offs and read the section in there. I have tips to optimize the vegetarian diet, it’s all bullet-pointed out with specific recommendations based on the nutrients that might be lacking or different preparation methods you could take to up your chances of meeting your nutrient needs like with grains, beans, legumes, nuts, and seeds. For example, if they’re soaked, sprouted, or fermented before you consume them, you greatly enhance your ability to absorb the iron and zinc in them, right. So that’s something that might be helpful. With iron, like if you eat it, eat iron-rich, plant-based iron-rich foods with a source of acid or vitamin C and separate from coffee and tea, separate from any dairy products, separate from high calcium foods, separate from high tannin foods, you can optimize your absorption of of iron. So just just thinking about some of that stuff can be can be helpful.

Natalie K. Douglas 44:13
Yeah, I would 100% agree with everything you’ve said, just there. So thank you for approaching that very diplomatically. And I yeah, I think that it’s such a blessing that you’ve written the book that you’ve had, that you have, and that that’s now a resource because it is important not to ignore the fact that for pregnancy, it is more difficult to reach the nutrient levels that we need to while following a plant-based diet. And I think that it’s important that people have resources to go to. And also, I would encourage people that if they are feeling overwhelmed, and or unsure about even after reading your book, or still unsure about well, am I getting enough, then I think that’s where working one on one with someone can be really, really beneficial both from a physically looking after you but also from an emotional, reassuring perspective as well so.

Lily Nichols
Absolutely.

Natalie K. Douglas
Yeah.

Lily Nichols
It’s, you know, it’s a really sticky conversation, I used to be a vegetarian, I have some people very close to me in my life who choose to be vegan for animal rights reasons. And so I get it, I totally get all the reasons that people do it. And I think there’s there’s just a lot to think about, because it’s so multifactorial, the reasons that people might choose to eat one way or another. I do think there’s some, definitely, some supplements that become absolutely non-negotiable in these instances, definitely the vitamin B12, for example, and the algae-based DHA, but it still has the potential to leave some, some gaps. And I think part of, I think part of the reason that our conventional guidelines are, so they’re actually kind of supportive of vegetarian diet during pregnancy. And I think the reason they might be is that they haven’t looked at some of the newer data. Some of this isn’t actually newer data, but they haven’t considered that like, for example, glycine is an amino acid that becomes conditionally essential during pregnancy. It’s a really important nutrient. And it’s like not even mentioned in our conventional guidelines. But when you look back at what traditional cultures emphasize before, during, and after pregnancy, for optimal healing, for a good supply of breast milk for preventing stretch marks, for supporting the integrity of the amniotic sac for, you know, helping with skeletal development, they were recommending, like food that included, you know, bone, skin, and connective tissue of animal foods. Kind of make sense those would help protect your bones, skin, and connective tissue as well, if you think about it, but if we don’t have that thought process going into it, or we don’t even have certain nutrients on our radar, then like, why would we expect our guidelines to be suggesting that or like the recent date on B12, they found in order to maintain adequate vitamin B12 levels during pregnancy, you actually need triple what the current RDA is. So as a vegetarian woman, if you’re relying on say, your nutritional yeast to meet your B12 needs, or maybe let’s make it simpler than that or you’re relying on your prenatal vitamin that provides 100% of your daily value for B12. Well, if that’s the only B12 in your diet, and you actually need triple that amount, then you’re going to become deficient in B12. And potentially, if somebody has been following a plant-based diet for many, many years, particularly without very careful supplementation, or they’ve never had their micronutrient levels tested, you might be going into pregnancy deficient, then you become further depleted during pregnancy and then further depleted postpartum. I mean, even as an omnivorous woman eating like a very nutrient-dense diet, you know, pregnancy is really nutritionally demanding on your body, holy cow, and then postpartum throws it through another loop, especially when you breastfeed for a long time. That’s like sucking you dry of nutrients. And there’s like, I mean, that’s part of the reason I have a chapter on the fourth trimester in healing is like, you know, with breast milk, especially, everybody’s always saying breast milk is best. And I, you know, I, I kind of don’t like that statement, but I, I do, I agree, it’s like the best food for a baby if it’s, you know, feasible to do so. But the nutrient levels in breast milk are reflective of a mother’s nutrient intake, a nutrient status, and that is not talked about conventionally, I think because it’s a little taboo to talk about how potentially, your nutrient intake might affect your breast milk. It does. And like, I don’t know why this is a secret. And we have a lot of very worrying case studies on severe vitamin B12 deficiency and infants of vegan mothers. Some of the effects are irreversible in like 40% of cases, by the way. And this is something that like, why isn’t that discussed when we’re talking about the adequate adequacy of vegetarian diets? We just want to make sure everybody is covered. And I think it’s possible, we just have to be like, very, very, very on top of supplementation, and very aware of what the potential trade-offs are.

Kate Callaghan 49:39
Yeah, I’ve always found it so interesting that traditional dietetics have often taken so much offense to a paleo or ancestral diet and their potential nutrient deficiencies there. But yet, they don’t have an issue promoting a vegan diet. It just.

Lily Nichols 49:57
Yeah. Right. Because we can’t take out greens, but you can take out all these other groups of gonna complain about taking out those food groups. It’s really kind of weird. It is.

Kate Callaghan 50:06
Yeah. And I see, I saw in your book that you have a testimonial from Diana Rodgers, and she is such a wealth of information for the sustainability and ethical side of all of this business around eating meat.

Lily Nichols 50:18
Yes, yes. And the environmental stuff and the benefits of regenerative agriculture. And yes, her stuff is great, really good, good place for people to look.

Kate Callaghan
Definitely.

Natalie K. Douglas 50:28
And I just wanted to we don’t have too much longer left. But I wanted to make sure we quickly gave a couple of suggestions on any suggestions you have basically on women who are struggling with nausea and food aversions in pregnancy because that’s a common question that we get that I thought I’d get your two cents on.

Lily Nichols 50:52
Yeah, it’s tricky, isn’t it? Because you want to be doing everything you can to provide optimal nourishment for your baby. And maybe you’ve read through my book or some other resources, and you’re like, okay, these are the things I have to eat. And then you’re everything in your body says no, it’s like, it’s hard. So the first trimester, I actually just received a message on social media from another dietitian who was saying, oh, my gosh, what am I doing I’m feel like I’m doing a terrible job. I’m in my first trimester and the nausea and the food aversions. And I went from eating vegetables and eggs in the morning to eating like, you know, the only thing that I can have is like, toast with butter, and like I’m messing this up. I was like, oh, my gosh, we got a way, like, take a step back. And like cut ourselves some slack in the first trimester. It is very tricky. There’s a lot of things going on that sort of hijack your food tolerance, your taste buds, your sense of smell, your propensity to have nausea, it’s just it can be challenging and all you can do is the best that you can do. So, if the only thing that your body will allow you to eat is carbohydrates, which is often the case, eat carbohydrates, like it’s better to eat the food than to starve yourself first of all. If you have wiggle room, within your choices of carbohydrates, I recommend like the most nutrient-dense things that you can possibly handle. So you know, roasted winter squash is going to be better than like cinnamon toast crunch cereal, right. So try to make the best choices with with what your body can tolerate. And once you get over like the really difficult hump of whatever wave of queasiness is coming your way, try to follow up with something that has a little more sustenance, so that you’re not just living on carbs, if you can, I mean, there’s a time and a place for just surviving. But we also need to be like consistently trying to introduce healthy foods into our rotation as much as possible. So like, can you have a small handful of cashews that would at least give you some protein and fat a little more sustenance? Could you, can you get down a couple bites of egg in the morning? It doesn’t have to be the whole thing, just like a little bit. So we’re not on this crazy blood sugar roller coaster in the morning. It’s tricky. So my best advice is kind of to write it out. I do have a section on nausea and vomiting and food aversions in, I think it’s chapter seven in the book to sort of walk you through it. And also walking through some of the possible causes for it. I mean, there’s actually research suggesting that nausea in the first trimester is a sign that you, your the embryo development is, is working appropriately, your hormonal response to getting and staying pregnant is happening as expected. And so it’s actually kind of a good sign of embryo viability to have some nausea. So sometimes that’s reassuring to people that said, there’s always the people who avoid it entirely, and they have totally healthy pregnancies. So now all of a sudden freak out that you’re not nauseous because I’ll hear that too but you just gotta try. I don’t know, it’s like survive, just like lower your expectations, survive, try to get in some bites of nutrient-dense foods whenever the nausea is like at a low and then start again the next day. And then, you know, take some, what’s the word I want to use like, accept that it’s a temporary thing and it usually goes away. So most women their nausea fades after the first trimester and gradually usually disappears. There are cases where it can stick around or it can be very severe. But for the majority of women, it does go away after or soon after the first trimester.

Kate Callaghan 55:00
I would agree day by day and I also emphasize if people are trying to conceive that’s another reason for optimizing nutrient status before pregnancy because, in the first trimester, you often feel like not eating much at all, like just having potato and butter.

Lily Nichols 55:13
Absolutely. You can you can take solace in the fact that you up to your nutrient stores leading up to it, that’s really important. Even taking your prenatal because some people can’t be like swallowing capsules or tablets during that time, either. Like I couldn’t really swallow pills during my first trimester was like really made the nausea worse. I’d like gag on it. It was terrible. So there are companies that have like, mixed in a prenatal vitamin into like a protein shake, sometimes a smoothie can you can get that down. Yeah, seeking health there, they have a shake, that has their optimal prenatal built into it. So that sometimes is helpful. You’re like, it’s like, cold and doesn’t smell really strong. And you know, it’s like, and you’re getting some protein in there like sometimes you just have to, not huge on protein shakes. Like as a whole I like people to get their nutrients from real food as much as possible. But the first trimester is like however, you can get whatever you need to get as much, try that.

Kate Callaghan
It’s it’s survival, that’s for sure.

Lily Nichols
It is.

Kate Callaghan 56:23
Nat, are you excited about having babies in the future?

Natalie K. Douglas 56:25
Yeah, guys. I’ve gone through ups and downs so far. Yeah, I’m going to be so prepared, the next minute I’m like, oh, my God.

Kate Callaghan
It’s temporary.

Natalie K. Douglas
I’ll just have both of you on speed dial now. Thanks, guys.

Lily Nichols
There you go.

Kate Callaghan 56:41
Thank you for that Lily. So now, can you quickly tell us about your books most. So we’ve gone a little bit about the gestational diabetes. So tell us more about your real food for pregnancy because it’s not just about food. You cover a whole lot of stuff in there.

Lily Nichols 56:54
Yeah. So you know, what’s funny about real food for pregnancy is I I only decided to take on another book project because I was getting asked by other people who liked real food for gestational diabetes. Hey, do you have a recommendation on a premium nutrition book for non blood sugar stuff? I was like, I mean, the more I looked, the more I was disappointed by what was on the market. So I wanted to write one that was evidence-based. And from the same like real food ancestral angle, as I did with real food for gestational diabetes. So the what I had intended to be like a really simple project turned into like this monster because there’s so many rabbit holes to go in for pregnancy nutrition, like, you know, the foods to avoid, you really need to avoid those, like what foods do you emphasize or the macronutrient levels like really evidence-based or not? What about salt? Should you lower that? Should you eat more of it? Like there’s just so much to research so it turned into this gigantic project. So I not only talk about food in it, I talk about supplements, there’s a whole chapter on that. I talked about pregnancy expectations, and common complaints like what to expect with weight gain, how to handle like constipation, heartburn, the nausea, what to do with high blood pressure, preeclampsia, and high blood sugar. There’s a bunch on exercise during pregnancy, lab test, to ask your provider about if you want to be really proactive and making sure your nutrient levels are good, and your thyroids functioning and all that stuff. Toxins to avoid because those can affect fetal development, the mental health side of things, and then also postpartum healing. So how can you optimize your healing? You know, successfully, breastfeed, have nutrient-dense breast milk. How do you take care of yourself postpartum really, what do you do? What do you not do? What did traditional cultures do? And what can we learn from them? So, there’s a lot and then I throw in some recipes at the end, just so you can make sense of the meal plans. I kind of hate meal plans and recipes, but they’re sort of necessary to convey a message. So there’s some of those in there too.

Kate Callaghan
Awesome.

Natalie K. Douglas 59:17
Thank you so much.

Kate Callaghan 59:19
And you got. You got a section on weight loss and loving your body, which is fantastic and needed.

Lily Nichols 59:23
I have that in there too.

Kate Callaghan
Yes.

Lily Nichols
So the postpartum chapter kind of turned into, I had some early reviewers were like that can be its own book in and of itself. And I was like, but I have to put it in here because people aren’t picking up books on postpartum, they’re picking up books on pregnancy. And I’ll sneak this in here. And then they’ll learn about it. I don’t want it to separate book

Kate Callaghan 59:42
We will learn about this.

Natalie K. Douglas 59:46
And on that note, any plans to write another one perhaps one on introducing solids or anything around kids nutrition or any plans in the in the works.

Lily Nichols 59:57
So, not at this moment. Hands are hands are full with the toddler. I’m still not really sure how I wrote this with a less than two-year-old in the house. But it somehow it happened. I’ve got to take a little bit of a break before I think about writing another book. There are have been many requests, there have been requests on the kids’ stuff and feeding baby. There have been requests on a separate book on postpartum I thought I addressed it fully in here. But people want that too. There’s been a lot of suggestions. So just you know, keep them coming. Eventually, I’ll find one that I jive with, and maybe in another year to finally take the plunge and write another book.

Natalie K. Douglas 1:00:37
I love it. It does sound like you deserve some some downtime. It I’ve I’ve seen how like your books is so well written and so well referenced. And I think sometimes people underestimate how difficult it is to write a book if you’ve never written one. And also to go through and find all of that research. And actually make sure that’s good research because it’s not just a matter of, you know, I heard about a study here. It’s actually, no, this is the study, and this is what happened, and here is the reference so.

Lily Nichols 1:01:09
Yeah.

Natalie K. Douglas
Well done to you.

Lily Nichols
It takes about 10 times longer to write a book that is referenced because in order to find like one good research article, you’re probably going to be looking through like 15. So yeah, it’s it’s a lot. And so now I’ve like set the standard, the bar, like too high. I’m like, gosh, that’s so much work I don’t want to do it again, but I know I’ll probably do it again. So stay tuned.

Natalie K. Douglas 1:01:35
We definitely will. And on that note, where can people actually find you and connected you and buy your books. Keep up to date with anything that you put out or doing?

Lily Nichols 1:01:47
Yeah, so my main website is LilyNicholsRDN.com. I have separate websites for both of the books that have extra information on them. So I have RealFoodForPregnancy.com and RealFoodForGD.com. I’m on the typical social channels, but I’m most active on Instagram, and my handle is Lily Nichols RDN.

Natalie K. Douglas 1:02:09
Amazing. And we will definitely put all of those in the show notes. And I would strongly encourage everyone that’s listening, whether you are wanting to get pregnant now or in the future, or even just want to know how to eat a really nutrient-dense diet to grab your book or either of your books, really, because they’re both just so well written. So thank you so much for spending this hour with us and sharing all of your wonderful wonderful knowledge and tips and in a really easy to understand and accessible, non-judgmental way we really, really resonate with with your approach and just appreciate your time. So thank you so much.

Lily Nichols
Thank you.

Kate Callaghan
Thank you so much, Lily.

Lily Nichols 1:02:50
Before we hang up that anybody who wants to just get a taste of real food for pregnancy without buying, I give away the first chapter for free on my website, so.

Natalie K. Douglas 1:03:01
Amazing.

Kate Callaghan
Awesome.

Lily Nichols
Go check that out. Yep.

Natalie K. Douglas
Thank you and have a lovely lovely day or night. I don’t know what time it is, but we’ll definitely speak to you soon.

Lily Nichols
Thank you, take care.

Kate Callaghan
Thanks so much, Lily.

Outro 1:03:14
Thanks for tuning in to The Holistic Nutritionists Podcast. Remember, we love to make the show relevant to you. If you have any questions or topics you’d like us to discuss, just submit them to [email protected] and we’ll get them answered for you. Also, don’t forget to subscribe, rate, and review the podcast on iTunes and share it with your friend. And if you’re looking for more info about how we can accelerate your journey to your optimal health, you can find me, Nat, over at NatalieKDouglas.com and Kate at TheHolisticNutritionist.com. See you next time!