Pregnancy

Lily Nichols is a Registered Dietitian/Nutritionist, Certified Diabetes Educator, researcher, and author with a passion for evidence-based prenatal nutrition and exercise. Drawing from the current scientific literature and the wisdom of traditional cultures, her work is known for being research-focused, thorough, and sensible. Her bestselling book, Real Food for Gestational Diabetes (and 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 has 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 prenatal nutrition to date.

Lily is also creator of the popular blog, www.LilyNicholsRDN.com, which explores a variety of topics related to real food, mindful eating, and pregnancy nutrition.

Mathea Ford: [00:00:26] Hi there it’s Mathea. Welcome back to the Nutrition Experts Podcast. The podcast featuring nutrition experts who are leading the way using food starts today, right now with our next guest. It’s great to have Lily Nichols on the show today. Lily, welcome to Nutrition Experts. I’m excited to have you on the show and share your expertise with my tribe.

Lily Nichols: [00:00:49] Hey thank you for having me appreciate the invite.

Mathea Ford: [00:00:52] Great! So, you’re on this show to talk about Pregnancy Nutrition and that’s such a valuable important topic because it’s you know taking care of two or three maybe sometimes but so can you tell our listeners a little more about you and what you do?

Lily Nichols: [00:01:09] Sure thing! Yeah. I have specialized in prenatal nutrition for most of my career as a dietitian and diabetes educator. A lot of my work actually focuses on gestational diabetes as well. I first got interested in it quite a long time ago but didn’t come to professionally start working in the area until after I was a dietitian and working for the California Diabetes in Pregnancy Program which is known more commonly a Sweet Success. And it was there that I was able to see you know how we set our nutrition guidelines, how they work. I also worked clinically for a perinatalogist and our practice was almost entirely focused on gestational diabetes. So having seen the prenatal nutrition world and gestational diabetes world from different vantage points, the public policy level, the clinical level, I also do a lot of speaking and teaching for other professionals and really opened my eyes to the areas of improvement that we could look at for prenatal nutrition and have kind of led me to where I am today with you know two books on the topic.

Mathea Ford: [00:02:14] Can you talk about how a mother’s eating habits during pregnancy affects her baby?

Lily Nichols: [00:02:20] Absolutely! So, there is a whole field of study called epigenetics which is how our environment affects our genes. A lot of people think that your health or risk of disease is entirely inherited and it’s partly inherited and partly the environment that you’re exposed to. Meaning what you eat and drink, how you sleep, your exercise, your stress levels and all of those things. And we now know there is a whole subset of epigenetics that surrounds a woman’s health during pregnancy called fetal programming or intrauterine programming. There is a bunch of other different names that researchers will use for it but essentially the environment that a baby is exposed to from their mother can affect their lifelong risk of disease. So, for example when it comes to gestational diabetes we know that babies who are exposed to high blood sugar levels during pregnancy meaning not well controlled gestational diabetes they face a sixfold higher risk of obesity or type 2 diabetes by the time they turn 13 which is crazy. Right?

Lily Nichols: [00:03:27] So it really gets you thinking about you know we see all these disparities in children’s health these days with obesity on the rise and type 2 diabetes being diagnosed and even in toddlerhood sometimes. And we’re now seeing that it’s not just what these kids are exposed to now it actually could even go all the way back to their in-utero environment. So what a mom eats like the quality of her diet meaning the level of micronutrients which are vitamins and minerals, antioxidants, other compounds and food can really affect development. We could go into details but that’s sort of like the overarching theme is that it does matter the amount of nutrition you’re getting during pregnancy, your exercise levels during pregnancy, your stress management, your toxin exposure. All that stuff can play a role in your baby’s development. So, I’m really about trying to help women make the most proactive choices possible based on the latest scientific evidence that we have.

Mathea Ford: [00:04:28] Obviously, when you’re pregnant anything that you do is concerning. So, how do you kind of balance what they should do with not being you know emotionally stressed or concerned or trying to eat perfect?

Lily Nichols: [00:04:44] Well, I’m big on mindful eating which is listen to your body as you know hunger and fullness cues, your feelings about food like what you’re in the mood to eat or not in the mood to eat, the signals your body sends you around food outside of hunger and fullness like this upsets my stomach. This gives me good energy. This didn’t keep me energized for very long at all and I’m starving again. Like all of those cues are helpful and I think that’s primarily like the most important thing to focus on. First and foremost is mindful eating then aside from that you have to kind of make the decision that you’re going to do the best that you can during pregnancy given whatever knowledge you have that time or whatever your body he is allowing you to eat at the time for example if you have nausea or food aversions. Sometimes that makes it really tough to make healthy choices. So, I think it’s kind of a combination of being informed but also giving yourself some grace certainly I don’t expect anyone to eat 100 percent perfectly. So like in the meal plans section of my book Real Food for Pregnancy I talk about it very straight up you know it’s not about being 100 percent perfect it’s just trying to maximize the nutrient density of your diet as best you can given whatever circumstances you’re under at the time. But you certainly don’t want food to become an additional stressor. I think it can be depending on the quality of your diet previously. I mean if you’ve been eating a pretty good diet for years and years and years then coming into pregnancy it really won’t be that much of a shift but if you’re coming from not a very good quality diet and suddenly trying to make your eating habits a little healthier it can be a big shift because you may be mourning the loss of some of your favorite foods or not eating as much of those foods. So, it’s really about gradual changes, mindful eating and just doing the best you can given whatever circumstances you’re in.

Mathea Ford: [00:06:43] What are some ways moms can eat better during pregnancy? And is there a anything specific related to trimesters or is one trimester more important than others?

Lily Nichols: [00:06:57] You would think that that is super well studied and it’s totally not. Anyone that’s telling you that there is like a specific food that you have to eat at this point in pregnancy, they’re kind of making it up. I will say there are certain nutrients that we know are really important at certain points in pregnancy. So, for example in early pregnancy all the organs are being formed. That all happens before week 8 of pregnancy. So, this kind of overlaps with preconception nutrition but we know that nutrients like Choline, Folate, Inositol – all these things are involved in the closure of the neural tube. And since that’s all being formed really early on then we want to make sure we’re having enough of those foods. So, we’re getting it or getting enough of those nutrients through the foods in our diet or possibly through supplements as well to make sure that we don’t have a neural tube defect or Spina Bifida or something like that. We also know especially in early pregnancy that blood sugar levels that are too high can also impact the rates of certain birth defects including neuro defects and also congenital heart defects. And those have been linked to elevated blood sugar even below the diagnostic threshold of gestational diabetes so I think everyone taking a common sense approach to eating for better blood sugar is a good idea. Which means like less sugar, less refined carbohydrates first and foremost and making sure your diet has adequate amounts of fat and protein both of which don’t cause the blood sugar to go up. And then in later pregnancy and this is not to say all this stuff I just said doesn’t apply to later pregnancy but I will say this. In later pregnancy we know that the fetal brain starts cumulating omega 3 fats such as DHA really rapid pace like we think it’s around 67 milligrams per day. So, we want to make sure we’re getting enough DHA from the diet especially in the latter part of pregnancy. So fatty fish and seafood, fish oil or algae oils supplements would be great. And then you get a little bit like pasteurized eggs, grass-fed meat. Those are a couple examples.

Mathea Ford: [00:09:09] So just thinking though overall for pregnancy, are there any things that mom should really focus on eating?

Lily Nichols: [00:09:16] One of the big things that I think is important for everyone to pay attention to pregnant or not but especially during pregnancy is to look at the quality of carbohydrates you’re consuming. Carbohydrates are in many many different categories of food and they tend to be really convenient easy and delicious. And there is some research looking at micronutrient intake among pregnant women and women who consume a higher level of refined carbohydrates or high glycaemic carbohydrates meaning like refined grains and white flour and white rice and stuff like that they actually have lower micronutrient intake than women who are eating more low glycemic carbohydrates such as non starchy vegetables, nuts and seeds, fruit and its whole form that hasn’t been juiced. So, I think it’s important for women to look at the quality of carbs they’re eating and making sure they’re choosing real food less refined sources which tend to have less of an impact on your blood sugar levels. They tend to be a little more satiating and they’re packed with more nutrition. I would also say, protein wise we have some new research as of 2015. It’s kind of amazing how behind the times prenatal nutrition is as a field as a whole because this 2015 study was the first ever to directly measure protein needs during pregnancy and they found that protein needs were significantly higher in both early and late pregnancy as there were 37 percent higher in early pregnancy 73 percent higher in late pregnancy compared to our current recommendations. So, this actually puts you know optimal protein intake at the latter half of pregnancy above 100 grams a day and our current recommendations are only like they are less than that. So that’s important for women to know just to make sure you’re consuming an adequate amount of protein, doesn’t need to be like a massive quantity just enough. And it might be more than you were eating before. I also think women don’t need to be fearful of fat. Fat is very satiating. It comes with a lot of different nutrients if you start cutting way way back on fat. You also put yourself at risk for a number of nutrient deficiencies such as choline or vitamin A, vitamin E, vitamin K. So if you start looking from sort of a real food perspective on fat when you start omitting it you actually start omitting whole categories or types of foods that are also have other nutrients that you need. Some of it is quality of fat as well. We can’t just be like eat all the fat you want but it’s like a low quality vegetable oils or shortening or margarine it needs to be really high quality fats as well because that can actually influence your baby’s development also. So, like for example, I can’t give information without going into details. Women who consume a lot of vegetable oils consume a large amount of omega 6 fats and they’ve shown that that can actually influence the amount of DHA that’s incorporated into the fetal brain and has also been linked to developmental and motor delays in babies has also been linked to a higher risk of developing preeclampsia. So, I think we need to be really smart about the types of fat we’re recommending to pregnant women.

Mathea Ford: [00:12:38] When you’re talking about those recommendations you’re talking about just a single birth, right? So, does anything change with multiples or how does the recommendation change when you may be pregnant with twins or triplets or more?

Lily Nichols: [00:12:54] You know it’s interesting with that is it’s not super well studied. So what we do recognize is that calorie needs likely go up, protein needs likely go up and then virtually everything else we don’t know for sure how much it goes up. There’s not a ton of studies on twin pregnancy. You think about how hard it is to do even nutrient studies on singleton pregnancy or women pregnant with one baby. But you start trying to do interventions on women pregnant with two babies? It’s like you just don’t have a large pool of people to choose from and you wouldn’t even get statistical significance. So, it’s kind of a guessing game beyond knowing you need more calories, you need more protein. It’s pretty much a matter of just eating a larger quantity of whatever nutrient dense foods you recommend for a singleton pregnant women and then I would just recommend that the woman eats to satiety. So, following those mindful eating, hunger fullness cues and that’s the best you can do.

Mathea Ford: [00:13:58] So when you’re thinking about mindfulness, eating till your full eating when you’re getting hungry and the real food concept which maybe you can talk a little bit more about what you mean by real food for pregnancy your book. But how do you mesh those together? Because I mean how do you build them mindful eating to also incorporate more of the real foods? So talk a little bit about what you mean by real food and then talk about how mindfulness and real food go together?

Lily Nichols: [00:14:28] Real food is something that a lot of people have different definitions for but for my purposes, real food is made with simple ingredients that are as close to nature as possible and not processed in a way that removes nutrients. So, for example, for time match vegetables like vegetables will be more packed with nutrition if they’re in season, if they’re eaten soon after harvest and then also grown without the use of pesticides and those would be more nutritious than something eaten out out of season or eaten in like a canned or processed form. Another example would be like dairy products. So, what are cows naturally meant to eat? They naturally are meant to graze on grass, their milk naturally contains fat. So, from a real food perspective I would want full fat dairy from grass fed cows versus low fatter non-fat dairy from cows that never ate grass in their life and are just inside of a confined barn eating feed but feed of soy and corn. So it’s a bit of a nebulous term but I’m always looking at what is the least processed version and closest nature version of a particular food. So, for me like well-balanced real food diet would include vegetables, fruit, meat, poultry, fish, seafood, nuts, seeds, legumes, healthy fats and then depending on how a woman does digestive wise nutritionally for all the food sensitivities, allergies all that would also maybe include whole fat dairy products and maybe some whole grains for blood sugar can handle the grains. So it’s kind of that’s it in a nutshell. Hopefully that wasn’t too confusing as far as the Mindful Eating part goes I feel like real food and mindful eating go hand in hand. Because when you’re eating food that’s full of nutrients and especially when you’re not overloading yourself on refined carbs and sugars that leave your blood sugar and hormone regulation all over the map.

Lily Nichols: [00:16:38] You naturally tune in to your hunger and satiety cues really well. So I think the two of them go together really well. I think a lot of people the argument that I hear against mindful eating is that you sort of don’t need to pay attention to general nutrition advice because your body’s just going to tell you what to eat and how much and it’s fine. Or maybe you get sometimes mindful eaters will just like give a pass on not healthy food because as long as you eat it mindfully it’s fine. And I just feel like there’s a little more nuance to the topic and I think it’s easier to be a mindful eating when your diet is composed of less processed foods. So I think there’s sort of a balance between the two not getting so wrapped up in nutrition that you have to calculate every single thing or super measure your portion sizes. I mean unless it’s medically necessary versus I mean a mindful it with this sort of free for all attitude about food and not worry about nutrition. You know there’s somewhere in between.

Mathea Ford: [00:17:41] Can you talk about optimizing your diet when you’re pregnant for health or the baby’s health? Kind of what you would use food to help optimize that pregnancy?

Lily Nichols: [00:17:54] I’m going to talk in food terms. I like talking in food terms then breaking it down into nutrients because I think that just makes sense for more people outside of dietitians. So one of the most important foods to consider is eggs. And the reason for this is while it’s many many fold but what are the nutrients I want to focus on with eggs is that they are the number one source of choline in the diet. Aside from liver however not many people consume much liver. So really eggs are eggs are it. People who consume eggs consume about double the amount of choline as people who don’t consume eggs. And when it comes to pregnant women specifically 94 percent of pregnant women don’t meet the recommended amount for choline intake. So if you take eggs out of the diet or don’t consume them very often it’s pretty likely you’ll be deficient in choline. Why does this matter? We have a huge body of data on how choline impacts pregnancy outcomes and a mother’s health during pregnancy. We know that adequate amounts of choline can reduce the risk of developing preeclampsia, seems to play a role in nutrient delivery across the placenta. We also know that brain development is impacted by choline intake and we have both rat studies and also human studies that have shown this to be the case. And there was one fairly recent study, that was a randomized controlled trial on pregnant women supplemented with choline and they split them into two groups where they had one that consumed a little over the current recommended amount. So they had 480 milligrams per day versus the recommendation is 450 milligrams per day. And this second group had 930 milligrams per day more than double the current recommendation. They couldn’t have a group that they gave them no choline because that would be unethical. That didn’t pass the IRB. So they looked at how the infants fared after being exposed to these differing amounts of Choline and they specifically looked at reaction time in infants and some other intellectual tests at different time points in infancy. And they found that of the infants who were from mothers who had the high choline intake the 930 milligrams per day they scored better across all of the tests significantly better on reaction time. So, we know it plays a really important role in brain development and we know it’s a big nutrient of concern in pregnancy and unfortunately it’s something that isn’t on many clinicians radars. And it’s also not in many prenatal vitamins. So, it’s something you do want to look at from your diet and if your diet doesn’t have enough or you can’t consume eggs maybe for an allergy reason or food intolerance or food preferences it actually seems like a choline supplement might be might be warranted. So that’s important food source and also nutrient to take into consideration. As I mentioned earlier when it comes to early pregnancy we also know that choline plays a role in the closure of the neural tube so prevention of neural tube defects so it’s important across the entirety of pregnancy not just at the end. Another food that I want to point out is salmon, fatty fish and other seafood. I could go on to a bunch of different foods but I know we’re so short on time so I don’t want to waste too much of it right now. But when it comes to seafood this is going to be the number one dietary source of DHA that really important Omega 3 that’s also involved in brain development. It’s also going to be a major source of iodine, that’s a nutrient that is known to be the leading cause of preventable intellectual disability across the globe. And that quote comes straight from the American Medical Association. So it’s something that is recognized as a really vital nutrient. Pretty much across the board iodine needs go up by about 50 percent in pregnancy. And it’s something that a lot of us don’t really have on our radar as well. And new prenatal vitamin may or may not contain it. Some other things that are found in fish include vitamin D, selenium, zinc, of course it’s a good source of protein. Certain types of seafood can be a really good source of iron and B12. So oysters for example are extremely high in both iron and B12. I do recommend them cooked just because they’re the cause of a lot of foodborne illness outbreaks. So I think it’s a wise idea to do them cooked. You could do like canned oysters or something like that but they’re really really valuable source of nutrition.

Lily Nichols: [00:22:51] All different types of seafood not just the animal ones even the algae is going to be a rich source of a lot of minerals and iodine as well.

Mathea Ford: [00:22:58] Isn’t just taking the prenatal vitamin I’m going to make up for any deficiencies that I have with my eating while I’m pregnant?

Lily Nichols: [00:23:07] I wish it would. And there’s some better quality prenatal vitamins in the market that can probably do more of that than some other ones. But there is a lot in food that we need. I mean that’s kind of its not the whole point. It’s part of the point of me writing the book real food for pregnancy is that we need to be looking at food sources. We have so much developing in the field of prenatal nutrition. I know we were chatting earlier before we started the call about like well how much has changed in the field since you started? And just in the prenatal nutrition research I mean the fact that as of three years ago we identified that we got protein needs wrong. We’re looking at choline and maybe the amount needed for pregnancy is double the amount that we previously thought. I mean when they first set the recommendations on choline that was actually really recently that was 1998. They didn’t even have a recommendation before that and they set those levels based on the amount needed to prevent fatty liver disease in adult men. So they tried to factor in pregnancy but they didn’t know for sure how much to set to that. We even have another study on vitamin B12 where they recently shown that the amount of vitamin B12 needed to maintain adequate blood levels is triple the current RDA. So I think prenatal vitamins are a good idea. It is an insurance policy. I don’t think we can fully trust that all the recommendations are perfect because we just don’t have enough research to vet every single one. A lot of times they are best guesses. They are not bad. They are a good starting point. But if you can make sure you’re getting a really nutrient dense diet on top of your prenatal then you have much more of an insurance policy that you’re covering your bases.

Mathea Ford: [00:25:03] Do you think that there are foods we’ve talked about foods mom should include or nutrients. Are there foods moms should avoid during pregnancy?

Lily Nichols: [00:25:11] There’s you know alcohol is something that you should avoid or if you’re going to consume it consume it in very small quantities. It’s something that I go into all the research and controversy about in the book. Same goes of caffeine seems wise to keep caffeine under 200 milligrams per day. There are studies that look at both sides of the coin on that one just like on alcohol so it’s something to look into if you’re if you’re interested in all the nuance. But as a general rule, best people to those low. Refined carbohydrates and sugars are another thing that is beneficial to keep extremely low in your diet as well. And that’s because they a. Don’t contain much nutrition and b. They cause their blood sugar to go up. The latest data shows that about 50 percent of Americans have some form of diabetes whether diagnosed or undiagnosed. Full blown diabetes or prediabetes and depending on how we diagnose for gestational diabetes were looking at around 18 percent of pregnant women facing high blood sugar and pregnancy if we’re talking about a. Foods that are going to maintain healthy blood sugar levels which is important forever on regardless of a diabetes diagnosis or not and b. Provide the maximum amount of nutrition for baby meaning like micronutrients, vitamins, minerals those sorts of things. Refined carbohydrates and sugars don’t do that. They just leave our blood sugar high and don’t give us much nutrition. So that’s why I talked about you know quality of carbohydrates early on. I don’t think anything needs to. These things need to be entirely avoided. I just don’t think they should make up a very large part of the diet. I mean I know I certainly consumed a little bit of sugar during pregnancy but I was trying to keep it low so it’s like you know you have this super dark chocolate that doesn’t have that much sugar. You know just being smart about it is important. We know that with sugar in particular we see higher rates of gestational weight gain, higher blood sugar levels, higher rates of preeclampsia among women who consume a lot of sugars. So, not that great for you. There are plenty of other real food, lower sugar alternatives that you can go to. I also don’t think artificial sweeteners have much place in pregnancy. I have a whole big section on this in the book that goes through all the research. First of all artificial sweeteners make you crave more sweet foods. This has been documented in rat studies and also human studies. And then they’ve also shown that among women who consume artificial sweeteners on a daily basis in pregnancy their children are actually more likely to be born large even if the other group was consuming sugar sweetened beverages. There’s something about artificial sweeteners that seemed to change our insulin or change something epigenetically with baby. And so I think it’s something that we should not consume a massive quantity of. Probably the last most important one would just be related to quality of fat. So, I think I already mentioned the omega 6 and vegetable oil issue. Omega 6 fats are not great to consume in large quantities for a variety of reasons and the number one source we’re going to find them in our diet is vegetable oils and so those are things that are usually used in salad dressings, they’re used for frying oils at fast food restaurants. They’re often used in making like chips and crackers and other things like that which usually have the double whammy of being a refined carbohydrate that’s fried in that food and fried in that oil. So those are not great. And then probably the worst of the worst would be trans fats which are when they take a liquid vegetable oil and turn it into a solid via a process called partial hydrogenation and that’s what they used to make a lot of different spreads, shortenings. Those are sometimes used in frying oil although it’s being phased out in a lot of the food industry and processed foods. But we know that those can impair nutrient transport across the placenta. They can up rates of preeclampsia and they also tend to mess up insulin sensitivity which can be an issue for anyone whose blood sugar is already just regulated such as in the case of gestational diabetes. So trans fats. No way no.

Mathea Ford: [00:29:43] Can you talk about the fourth trimester that you referred to in your book what it is and how it affects mom and baby?

Lily Nichols: [00:29:50] Oh of course. I love this topic actually. I don’t know how you felt after having your kiddo kiddos. But the healing time the recovery time it takes is just incredible. Your body goes through just massive transformations in every possible way physically, mentally, emotionally. There’s so much that shifts and our bodies really require a lot of time to heal. And this is something that is not there’s not enough like reverence for it maybe in Western culture but if you look across the globe between a month and six weeks or around 40 days is very common of having a special recovery time for mothers where they are they are mothered by others. They are taking care of their food is made for them. Your entire job is to rest and recover and feed your baby. And in Western culture it’s just like “all right you had your baby. Okay. That entire pre pregnancy genes like drop your kid off at daycare, somehow figure out how to breastfeed while going back to work.” Like super early and it’s just really challenging and really stressful for mothers. So the fourth trimester refers to there’s different definitions but it usually refers to the first three or so months postpartum that really early recovery time. Some people will let it extend into the entire first year or even even beyond maybe you could call it trimester 5 and 6 or something. Essentially it’s allowing yourself some time to heal. So there is traditionally, there are specific foods that are beneficial for healing. Incidentally, a lot of them overlap with the foods that are beneficial during pregnancy. There are certain things that you can do to take care of your mental, emotional health, a lot of self care practices, allowing help from other people resting not jumping in to exercise right away. And when you do return to activity levels being really cognizant of your form, your alignment, the sensations in your public floor just being really gentle with yourself during this whole time period. I can go into detail on any of it but that’s that’s sort of in a nutshell.

Mathea Ford: [00:32:16] Yeah I think that’s very interesting. I had a couple c section so I was kind of forced to have that downtime for a period of time because you can’t do a lot with that but I can understand other moms it seems like it’s just like you said just get right back into it. Can you mention a few of the healing foods that you think are important in that fourth trimester?

Lily Nichols: [00:32:39] Yeah absolutely. So a lot of these foods I’ll say are things that contain nutrients that are beneficial for healing tissues. So things have been stretched, torn or maybe like surgically cut. These things require a lot of protein, a lot of specific amino acids that are important for your body to make collagen that’s important for your skin and tissue and joint integrity. And those are the amino acids glycine and proline. There’s also specific foods that can be more beneficial for like electrolytes and fluids that could have been lost during labor. And then also if you lost blood during labor and most of us do. And also you continue bleeding postpartum for several weeks maybe so could be up to six weeks or even more than that. Things that help build up your blood again. So like Iron and vitamin B12 rich foods and then especially if you’re nursing but even if you’re not nursing foods that are going to replenish nutrients that have been transferred rapidly to your baby during pregnancy. So like I mentioned DHA for example like when they look at rat brains they haven’t looked at human brains because they’re not going to sacrifice a new mom right? Rat brains post pregnancy, they’re actually depleted of vitamin sorry DHA. So that rapid transfer of of Omega 3 is to the baby could leave you depleted like your body will sacrifice its nutrient stores for the baby. It’s sort of just built into our design so being really intentional about replenishing those things. So some of the foods that will fit the bill for all those things I just mentioned for the building up of your you know your collagen and your skin integrity that source of the amino acid glycine we’re looking at stews, slow cooked meats especially in glycine as found in highest concentrations in the bones, skin and connective tissue of animal foods. And what’s interesting is when you look at traditional cultures the recommendations on postpartum foods are often soups and stews and curries which have a lot of this nutrient in it. They’re also very warming from like a temperature perspective which before the advent of like you know modern housing and shelter and heat and cool control like having a heater in the house like that was really important to maternal survival is like keeping you and baby warm. So those foods would also fit that bill. High iron foods would be things like the meats I already mentioned a lot of traditional cultures actually focus on organ meats like liver kidney and heart. I mentioned oysters already extremely high in iron. All those above foods are also high in B12. You could look at plant foods as well. The Iron is just not as as absorbable of a form that you could look at things like black beans and spinach and stuff like that as well. Higher fat foods can be really helpful because your energy needs go up postpartum. Actually across the board your nutrient needs go up postpartum even more so than pregnancy. So you’re choline needs are higher like your energy needs are higher, your protein needs are higher. All these things ramp up in this recovery period particularly for breastfeeding women your calorie needs are about 500 calories more than when your pre-pregnancy. Enough food period is helpful. But making sure you’re getting enough calories in one of the easiest ways to boost up your calories without getting super overstuffed is with higher fat foods. Some of those will also be really high and vitamin A that’s very important for breast milk. You pass by a minute through your breast milk along with many other nutrients and then I could go on forever but I’ll choose a couple others. Iodine rich foods would be really important. So traditionally in Korea they do like a seaweed infused broth and that is going to be superhigh in iodine. That’s usually also meeting the needs for the glycine if they’ve made it with some sort of an animal animal bones. But that iodine is really important for post-partum thyroid health and also for passing iodine through your breast milk. Your breasts actually are more reliant on iodine than even your thyroid gland and going through all the crazy changes that happen to your breasts when you’re breast feeding, iodine demands are much higher. So, that’s a really important thing as well. I don’t want to leave out anything but there are more foods. I’m just sort of highlighting the ones that are that are frequently left off. I feel like some of the other ones are kind of obvious so.

Mathea Ford: [00:37:27] Well. So knowing that the audience is dietitians, doctors, nurses, medical people or people that are specifically interested in this topic but usually people that are working at different medical things. What are ways that you think the listeners could use the information we’ve talked about today to improve their practice or information in their daily life?

Lily Nichols: [00:37:49] Well I think sort of understanding that there is a benefit in looking to meet your nutrient needs from food and not just sole reliance on a supplement. I think that is important to recognize. I think it’s important to recognize the signals that your body sends you around foods so see how you feel after eating certain things and don’t eat the things that leave you feeling like garbage. That’s fairly obvious that that goes on the Mindful Eating side of things. How do you feel after you have a soda? Like how long do you feel energized? How long, how soon until you crash? What kinds of foods you crave when you’re hungry again? That sort of introspection kind of leads you to really valuable answers surrounding food. I would also say you know your care of your body during pregnancy extends into the postpartum period. I think a lot of people sort of assume like the hard work is done with pregnancy. I mean I’ve worked with hundreds and hundreds of pregnant women. So I see this shift where it’s like you know you want to do everything you can to have the healthiest pregnancy possible and then of a postpartum like “Alright now I get a break now I don’t need to eat as well because you know baby’s out. I’ve already done my job.” And actually your nutrients are higher during that time and it’s not a matter of stressing yourself out or doing it perfectly or anything but it’s a it’s a matter of self care and recovery. I’ve observed in practice a significant difference in women’s recovery postpartum based on the quality of their diet. So just recognizing that care of yourself extends beyond pregnancy and that your nutrition matters a lot beyond pregnancy. I think it’s really important and I think sort of address a lot of the issues we see women have with postpartum recovery can be rough and a lot of different ways. And so that extra health care and help from others really pays off.

Mathea Ford: [00:39:55] So you can see where it’s just important term minor patients and our people we work with that. It doesn’t stop just because you had gave birth. That is the whole healing process days later, year, months later. My question I try to ask everybody is what’s your favorite food?

Lily Nichols: [00:40:15] Also a couple because I can’t choose just one. I really like eggs. They’re just one of the best breakfasts for me. So really good reality eggs. I love berries. I love avocados. I love dark chocolate. I’ll stop there. I like a lot of different foods.

Mathea Ford: [00:40:34] Can you talk for just a couple minutes that we have left about the process of writing the book? It’s an extensive book and has extensive references in the back. Can you talk about the process?

Lily Nichols: [00:40:45] I mean this is my second book so it was a bit maybe easier this time around because I had done it before. However, it was a lot harder because this time I had a child. So I started writing this book when my son was about 10 months old. So I was still in the first year postpartum but I had been really wanting to write this book for a while so once I got my my brain power back. Talk about fourth trimester takes a long time for your brain power and energy levels to come back enough to take on big projects. I started writing this. I think the most important thing for me was having a really clear outline of where it’s going. What I was going to cover and which chapter. I already have my own method for keeping track of citations and whatnot. But how it looked on a day to day basis was usually while my son was nursing I’d be looking up research on my phone and would find some really interesting studies. Write a little blurb about it and then later when I actually had time when he was napping preferably not on me then I’d spend some time at my computer putting that into context. And again just having a really clear outline helped me put things in the right place so that later when I was in editing and reediting and reediting mode it was easier to know what I had covered and what places and having a system for citations and all that stuff. I mean there’s like 934 references so you have to stay really organized when you’re doing it. It was extremely piecemeal. I mean I was written in like 10 to 15 minute increments across 15 months. So it was a very slow process compared to my first book which I from start to finish the first word on the page to publishing was six months. So that’s the reality of being a mom with very little child care and trying to take on a massive project. But yeah I would say if anyone’s interested in writing a book just get really organized, figure out how you’re gonna do your citations, have a really clear outline and then you just have to keep writing and then understand that the editing process if you want it to be well edited which I do that takes a really long time and a lot of different sets of aides. So there’s just you have to build a lot of time in your timeline for editing, formatting, re-editing, reformatting all of that stuff.

Mathea Ford: [00:43:12] So Lily, thank you so much for being on the podcast today. It was a pleasure to have you on the show. I know my listeners have learned a lot about pregnancy nutrition and the whole gamut of ways we can improve that. And so if listeners want to connect with you what’s the best way to do that?

Lily Nichols: [00:43:30] Yes you can. My main web site is LilyNicholsRDN.com that has my blog and bunch other stuff. If you want to learn specifically about real food for pregnancy you can go to realfoodforpregnancy.Com. I do give away the first chapter for free if you just want to take a peek specifically for nutrition professionals in that chapter I go through a comparison between a conventional prenatal nutrition diet as in like the AND sample diet in their in their guidelines and a real food one and look at the nutrient density between the two. So you could see what’s the whole Why behind this is nutrient density. And I also just got word from CVR that the book has been approved for CEUs and so we’ll be working over the course of the rest of the summer really to try to get those up and ready for people to purchase. So it’s approved for 32 CEUs which is almost half of your five year recertification cycle which is awesome. And I’m also going to be working on continuing education webinars for nutrition professionals as well. So I have my little this recording will be up after my first one is released but we’ll be doing those ongoing webinars and we’re getting all of those approved by CDR as well. So if you’re interested in continuing on prenatal nutrition I really want to fill that gap for you.

Mathea Ford: [00:44:58] Great! So guys, thanks. This has been another great episode of the Nutrition Experts Podcast. The podcast that is all about learning more so you can do more with nutrition in your life.

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