EBB 194 – Nutrition and Real Food in Pregnancy with Lily Nichols RDN

• Read the Evidence Based Birth article on Diagnosing Gestational Diabetes here
• Visit Lily Nichols’ website here: https://lilynicholsrdn.com
• Find the books “Real Food for Pregnancy” and “Real Food for Gestational Diabetes” on Amazon or wherever books are sold!
• You can also buy “Real Food for Pregnancy” at Lily’s shop here
• Read Lily’s article about protein in pregnancy here: https://lilynicholsrdn.com/protein-requirements-pregnancy/
• Read Lily’s article about 9 Myths about Gestational Diabetes: https://lilynicholsrdn.com/9-gestational-diabetes-myths/
• Visit the Women’s Health Nutritional Academy here: https://whnacademy.com/
• Join Lily’s Gestational Diabetes course here: http://realfoodforgd.com/online-course/
• Follow Lily on Instagram @lilynicholsrdn

Rebecca Dekker:

Hi everyone, on today’s podcast we’re going to talk with Lily Nichols about nutrition and real food in pregnancy. Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Dekker and I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer, for more details.

Hi everyone, and welcome to today’s episode of the Evidence Based Birth® Podcast. My name is Rebecca Dekker, pronouns, she, her. I’ll be your host for today’s episode. We are so excited to welcome our guests, Lily Nichols. Lily Nichols pronouns she, her, is a registered dietician nutritionist, certified diabetes educator, researcher, and author with a passion for evidence-based prenatal nutrition. Lily’s work is known for being research focused, thorough and critical of outdated dietary guidelines. She is co-founder of the Women’s Health Nutrition Academy and the author of two books that I personally have read and love, Real Food for Pregnancy and Real Food for Gestational Diabetes. Lily’s best-selling books have helped tens of thousands of families, are used in university level maternal nutrition and midwifery courses, and have even influenced prenatal nutrition policy, internationally. Lily writes at lilynicholsrdn.com and also is on Instagram @LilyNicholsRDN. We’re so thrilled that you’re here Lily, welcome to the Evidence Based Birth® podcast.

Lily Nichols:

Thanks for having me, Rebecca.

Rebecca Dekker:

It’s so nice to see you again. Lily and I have collaborated before in years past for quite a while now, and I’m so excited that this is your first time on the Evidence Based Birth Podcast®. I was wondering if you could tell us a little bit about how you started your journey as a registered dietician?

Lily Nichols:

Sure. I’ve been interested in nutrition from a pretty young age, so I’m one of those people that decided my teenage years that I wanted to specialize in nutrition. Didn’t necessarily know it would be pregnancy, but after all my university training and clinical internship, I kind of got thrown in the ring, working with the California Diabetes and Pregnancy Program… Sort of at the public policy level, working on gestational diabetes, or any type of diabetes and pregnancy, nutrition and exercise guidelines. Then also worked clinically in a perinatal, perinatology practice, mainly with gestational diabetes and high-risk pregnancies. It was really there in both of those settings that I got really passionate about continuing my work and specializing in prenatal nutrition and gestational diabetes, because I just saw it as a really unique time that you can make change in a person’s life, and then influence their baby’s health, lifelong health as well. So just like a little stat that I throw out is that in those who have poorly controlled gestational diabetes, their children face a higher risk of Type 2 diabetes and obesity later in their life.

Some research puts that at anywhere from like a six fold to 19 fold, increased risk for those complications later in their life. So there’re actual things that you can do. The primary intervention for gestational diabetes is nutrition, and with better nutrition and different lifestyle choices oftentimes we are able to really well manage blood sugar and avoid these sorts of… It’s called fetal programming or intrauterine programming, but change the way that the baby’s pancreas develops, and their insulin responsiveness, and their propensity for blood sugar issues and metabolic issues later in life. So that was really powerful for me to learn about. Then as my work has continued on, I continue to just uncover new things like, “Oh my gosh, we have new research on this nutrient showing that it can influence baby’s brain development, and have a positive effect on their literally lifelong brain health during this very important nine month window of pregnancy.” So that’s really why I do the work that I do.

Rebecca Dekker:

You became interested in this before you had your own children as well, correct?

Lily Nichols:

Yeah. Yeah. So I actually wrote my first book, Real Food for Gestational Diabetes before I had my first child, got pregnant actually pretty soon after the release of that book. I didn’t have any intention of writing another book to be honest, but people kept asking for one on prenatal nutrition. So I started working on that at about 10 months postpartum, and since the release of that, I have another child as well. So I think when you go through that sort of postpartum transition and have just… I mean you have multiple children just the complete overwhelm and postpartum recovery, and that you just see firsthand how important taking care of yourself is, it really has continued to inspire me to do this work.

Rebecca Dekker:

Yeah. That makes me think it must have been really fascinating to have been writing about this and doing the research and then practicing it on yourself as well-

Lily Nichols:

For sure.

Rebecca Dekker:

… when you were working on a second book. Which is one of the most popular books for prenatal nutrition, correct?

Lily Nichols:

Yeah. As far as I know. Most books are sold on Amazon, and by Amazon ratings it’s the number one best-selling prenatal nutrition book. Which was a total shocker to me because I didn’t really intend to write a book for a mass audience. So it was kind of targeting the type of person who’s really interested in nutrition, that’s why I kind of go into a lot of detail-

Rebecca Dekker:

It’s very detailed oriented.

Lily Nichols:

It’s very detailed oriented, there’s like 930 something citations in there. I kind of wanted to do double duty of hitting like the really nutrition nerdy kind of person, and also including professionals who work in the prenatal space. So it’s pretty surprising to me that it’s grown in popularity so much. But I’m really glad too, because what I hear is that it’s, people feel really empowered. They want to know more information, I think from like having worked in sort of the public health sector and community health world, I think the general approach to prenatal nutrition is to simplify things as much as possible and sort of put things in bite sized pamphlet style pieces of information. So it’s like, do this, don’t do that.

This has made me realize that, no in fact, I think we’ve been… arguably there’s some sexism in there. There’s like a “oh, we know better than women so we just tell them what to do, instead of giving them all the information and letting them make choice for themselves.” Which is arguably what your work does as well, is inform you on all sides of specific, pregnancy and birth interventions. You make the call, you come up with a decision yourself. So yeah, it’s been kind of a surprise that it’s taken off the way that it has, but I’m also happy that it’s been able to affect so many people.

Rebecca Dekker:

It has been very powerful and information is power, so-

Lily Nichols:

Right.

Rebecca Dekker:

Going back to kind of the beginning of your career and your credentials, can you explain the difference between a registered dietician and a nutritionist?

Lily Nichols:

Sure. So there are two terms that can kind of overlap in some ways and in other ways there’s very specific distinctions. So a registered dietician has gone through a four year, typically a four year degree in nutrition and undergrads. Some people go do a graduate degree after they already have an undergrad in something else, and fulfill specific dietetics related requirements. Then you also need to do a dietetic internship for the most part is usually about a year, and includes rotations in clinical care, typically in a hospital community settings, like an outpatient setting. So maybe like a WIC organization or some other areas. Then food service management as well, so managing a hospital kitchen and things like that. Then after that, you have to pass a registration exam, so it’s a nationally recognized registration in nutrition. Then some states also have licensure laws.

As for a nutritionist, technically anybody can call themselves a nutritionist. So there isn’t one universal agreed upon standard. Although I will say for registered dieticians, you can choose to call yourself either an RD or RDN, registered dietician, or registered dietician nutritionist. Those are the same things, it’s up to the professional to choose which one they want to use. I use RDN but others just use RD. But just nutritionist in and of itself is not a regulated term. So you could call yourself a nutritionist. You could take a weekend class and call yourself a nutritionist. There are also higher level certification programs, some of which are great. Some of which aren’t super great, that are like sort of privately maintained with specific organizations come out with their own certification or credential. But if you’re going to work in a conventional healthcare system, typically they’re looking for the RD or the RDN because they know you have at least five years of education with a really heavy focus on sciences. You have your biology, chemistry, microbiology, organic chemistry, biochemistry… I already said that, microbiology, a lot of food science.

Then also, they know that you have a certain skill set with clinical skills, so it’s just a different designation. There are some really great nutritionists out there who are PhD level scientists who simply did not go through the dietetics specific courses, or a dietetic internship that do really excellent work. There are also some people out there who have barely any training and put out information that is not always scientifically sound. So you have to do a little more work on the consumer side if you don’t know if somebody has an RD credential.

Rebecca Dekker:

Okay. That makes sense. Thank you for clearing that up. You also have a certified diabetes educator. Can you tell us a little bit about how you get that credential?

Lily Nichols:

Sure. Gosh, I’ll have to remember all the specifics. In a way it’s a little bit similar to an IBCLC because you need… I believe it’s 2000 clinical hours, maybe it’s 1000. It’s been a while since I first got certified, so I can’t remember the exact requirements, but you need to first have a recognized health credential, like be a dietician, or registered nurse, or physical therapist, or something, and then have direct clinical experience in diabetes care. Then there’s a national registration exam as well. Then you maintain that credential. Similar to the dietician world, you have a certain number of continuing education units that you have to complete every five years to maintain that credential. Or you can choose to retake the exam every five years, which you’d be silly to do because it’s a very long, difficult exam.

Rebecca Dekker:

Okay. So that makes sense. I never knew that about the becoming a certified diabetes educator. So when you finish school and you’re out there practicing, what are some of the challenges you face towards the beginning of your career?

Lily Nichols:

Well, I think from the beginning one of the hardest things for me, both in my university training, but then also working clinically is a lot of times I found that the guidelines in place didn’t always work really well in clinical practice. Or taking this from like the prenatal perspective with gestational diabetes, more than half of my clients would “fail diet therapy”, meaning they weren’t able to manage their blood sugar with food and lifestyle interventions alone and would need to go on medicine or insulin. Not that those are bad things, but the clients wanted to do it with food. They were like really highly motivated to do it with food-

Rebecca Dekker:

They were following the rules and following the guidelines.

Lily Nichols:

They were following all the rules, following all the guidelines. You don’t want to mess with anything pregnancy-related right? Because the consequences could be dire if you give bad advice, you know what I mean? So I was really careful about following the guidelines until it was just so clear to me that it wasn’t working. That’s really what ultimately led to me developing like the Real Food for Gestational Diabetes approach. Then eventually writing that book after using that approach in clinical practice for years, was that we could cut in half the number of clients who required medication or insulin with dietary changes. So that works for a couple of different reasons, some of it is like the macro nutrient ratios, the conventional guidelines are unnecessarily high in carbohydrates and gestational diabetes-

Rebecca Dekker:

For gestational diabetes the conventional guidelines were telling people to eat too many carbs.

Lily Nichols:

Too many carbs. Yep and carbs are the primary macro-nutrient that raises your blood sugar levels, but it was very controversial to recommend lower carb.So I did really extensive research to make sure that that was indeed safe to do. That research is all presented in Real Food for Gestational Diabetes. They’re also too low in protein, their first ever study in 2015 was performed on checking protein requirements in pregnant women directly and found that it was a significant underestimate of true protein requirements in pregnancy. So in late pregnancy they are an underestimate by 73%. So it’s not like “Oh it was like maybe 10% too low, just add a little bit.” No, it was way too low. Protein is very important for blood sugar management, it very much stabilizes your blood sugar levels. Of course, when you’re growing a baby or growing a brand new human, which requires a lot of protein.

So just some of the shifts in macronutrients and then focusing more on whole food sources of nutrition, which gives you a greater nutrient density in the diet. So higher levels of your micronutrients, like your vitamins and minerals, many of which affect your blood sugar metabolism and insulin resistance. We just had really fabulous results. In fact, as you read out in the intro, my work has influenced nutrition guidelines elsewhere. So the Czech Republic updated their Gestational Diabetes National Nutrition Guidelines in 2016. They have since reported that the percentage of pregnant clients who require blood sugar medicine or insulin has dropped from about half of pregnancy is similar to how it is in the U.S. down to about 10%. So it just makes it much easier to manage when you’re not… Gestational diabetes, one way of describing it as carbohydrate intolerance of pregnancy. So if we just match the level of carbohydrates to that person’s own blood sugar tolerance, then you don’t always need the additional medical interventions. Sometimes you do, and that’s okay there’s always going to be cases where with that, but we can reduce the percentage of clients who will require that.

Rebecca Dekker:

That can have a real impact on people, not just serve people who want to avoid medications but when it comes to birth, a lot of your birth plan choices depend on whether or not you’re taking medication for your blood sugar. So once you start medication for-

Lily Nichols:

Exactly.

Rebecca Dekker:

… blood sugar, that can eliminate some of your choices that you might want to make when it comes to birthing.

Lily Nichols:

Exactly. Yeah. That depends on where you live in the world or in the country. In some places going on medication, even if it’s just for fasting blood sugar, like a low dose of insulin or Metformin or something, that can quote “Risk you out of midwifery care, or risk you out of a birth center.” It depends on their policies, and of course can lead to a lot of additional medical recommendations on like increased monitoring and things. I think providers, because they rarely see really well-managed gestational diabetes their brain goes to worst case scenario. So I think a lot of these interventions are done with the best of intent because they are like, “Oh my God, what if baby’s big? And we have shoulder dystocia, we need to induce at 39 weeks. Or we need to plan a C-section or”… and I think they’re done with the best of intentions, but it does subject you to increase monitoring and an increased likelihood of interventions that in some cases, of course are necessary, but not always.

Rebecca Dekker:

Can you talk a little bit more, you’ve mentioned real food a couple of times and using whole food. Can you tell us more about what that means? The real food nutrition for pregnancy or for gestational diabetes? Either one.

Lily Nichols:

Sure. Yeah. So for me the way that I look at prenatal nutrition is like, reverse engineering the best possible diet to meet all the requirements of pregnancy. It’s really very recent that we’ve even had isolated vitamin and mineral supplements to fill in the gaps. Before, how did we do it? 100 years ago we didn’t have these isolated nutrients. We didn’t have prenatal vitamins. So clearly we’re still here as a species, so people were able to reproduce and how did they do it? So I like to look from a micronutrient perspective first, and look for the most nutrient dense foods. I call them real food, but people could call them whole foods or other things. Essentially it means eating as much of your diet as possible from unprocessed foods, and unprocessed from a perspective of the foods have not been processed in a way to reduce the levels of micronutrients in them.

Certainly some types of processing do not reduce nutrients or can be beneficial, like taking milk and turning it into yogurt. You increase the probiotic content and the vitamin K2 content of the yogurt, it doesn’t reduce the nutrient concentrations of the food. But when you start taking whole grains and turning them into refined grains, or taking whole corn and turning it into corn syrup, or taking a whole potato and turning it into potato starch, or taking a whole egg and only eating the egg whites, this will branch out into other food types. Instead of eating the whole animal, we only eat the boneless skinless chicken breasts, we don’t use the bones, we don’t make broth with it. We don’t eat the organs anymore. Right? all of those things end up reducing the nutrient content of your diet, especially the micronutrient density.

So my approach is to build sort of from the ground up, most of your diet around unprocessed whole foods. Then I sort of see where the cards fall with the macronutrients. It just so happens that they end up meeting that 2015 identified higher protein requirement of pregnancy. It just sort of ends up that you get a sufficient amount of carbohydrates, but not so much that your blood sugar gets totally out of whack. Just so happens that you have the micronutrients that help with your blood sugar balance. You have sufficient amounts of iron, and zinc, and choline, and vitamin B12, and vitamin A. So that’s really my focus is seeing how much can we do with food? I’m certainly not anti-supplements, but I do like for people to try to get as many of their nutrients from food as possible, because a lot of them work synergistically together.

So like choline and DHA, just to give an interesting example. Choline helps with the transport of DHA and its incorporation into the fetal brain. Both of these nutrients are associated with better brain development in baby. It just so happens the way they show up in real food, like egg yolks and salmon, for example, they coexist, they’re packaged together. You can give literally dozens of examples like this. So I like to remind people that nutrition is really a young science. We think we know a lot and we do know a lot, but we also have to admit how much we don’t know. We have nutrients that don’t have a name yet. Not everything was identified when we named all the vitamins. Choline is a perfect example. They call it a B vitamin-like compound. We didn’t even have a recommended intake for it until 1998. Okay?

Now we know it’s absolutely essential for liver health, brain health, placental health, nutrient transfer across the placenta, prevention of preeclampsia, optimizing baby’s brain development. We have some new data showing that our recommended intake for it is probably set about 50% too low because we didn’t have the studies specifically in the population of pregnant women, we had extrapolated from data on men. So these are the sorts of things that light me up because, it just so happens when you do a nutrient analysis on a real food meal plan that I create you meet that higher choline requirement.

Rebecca Dekker:

Yeah. Not only does it seem like we are behind in nutrition science, but it seems like things got messed up.

Lily Nichols:

Yeah.

Rebecca Dekker:

We kind of mess stuff up with the mass factory produced processed foods. Does that sound about right?

Lily Nichols:

Yeah, that’s accurate as well, we did. So again, you can kind of take these to different levels. So I think from the highest level view of like, how do we really optimize nutrient density? You start looking into how your food was grown or raised, and that does influence the nutritional value of the end product. So this isn’t accessible for everybody, so I don’t want people to get too bogged down with like, “Oh my God, I can’t afford that or I can’t find that.” But if we’re really going to get nitpicky about it, technically if you buy your vegetables from a farmer who composts and has ruminant animals on the land, so the animals’ poop is fertilizing the soil, you grow better quality plants. They have higher nutrient density because the soil is healthier. There’s microbial diversity in the soil, which enhances the nutrient content in the soil and the mineral uptake by the plant.

I mean, you can really go to that level and it’s true. It’s the same thing with pasture-raised eggs, chickens that are raised on pasture and are allowed to peck in the grass and eat bugs and worms and greens, they have different nutrient levels in the resulting egg. You can expand that to virtually every possible food. Again, that’s not accessible to everyone, but if you have the means or are able to get connected with local farmers, certainly that’s an added bonus for sure.

Rebecca Dekker:

Yeah. Can you tell us what are some of the most important points people should be aware of regarding nutrition when they’re pregnant?

Lily Nichols:

Well, first of all, go easy on yourself because there’s a lot of changes that happen in your body metabolically in pregnancy that can symptom-wise change your ability to eat super healthy food, right? So I just want to give a shout out to anyone in the first trimester who’s dealing with nausea, who might be listening to this and was like, “I can’t eat anything but like crackers and grilled cheese right now. Ah!” There’s going to be different phases of pregnancy that are probably going to throw you for some loops. But from a generalized perspective, one of the most important things is to get enough protein. The protein thing is a bit of a two birds with one stone situation. Not only do A, we know now that you need more protein than we thought before. So you calculate protein requirements based on pre-pregnancy body weight, by the way. For, so for somebody who weighs 150 pounds, pre-pregnancy, you’re looking at about 80 grams minimum of protein in the first half of pregnancy, and 100 grams of protein in the latter half of pregnancy.

For people who are familiar with Dr. Brewer’s work, interestingly, this aligns with his recommendations, which is pretty interesting. But it’s not just about the protein needs… yes, that that will influence your satiety, your propensity for having cravings, your blood sugar management and so on. But also when you are consuming most of your protein from whole food sources, you’re also almost guaranteeing that you’re getting enough of a lot of different micronutrients that are of importance in pregnancy. So choline tends to be richest in our protein, rich foods. Eggs are the number one source it’s found in the yolks, liver is also really rich in it. Pretty much any of your animal products, meat, seafood, dairy are also good sources. There’s a couple low protein sources that also have it like cruciferous vegetables, nuts, and beans. Those are also sources, but most concentrated in egg yolk specifically. So if you’re getting like eggs for breakfast, you’re probably going to be much more likely to hit your choline intake. You’re going to be more likely to hit your vitamin B12 intake.

Also, our protein rich foods tend to be the richest sources of iron and zinc. So those nutrients become less of a concern about getting enough of. Our vitamin A and its most bioavailable form is in our protein rich animal foods, specifically your DHA really important to mega three fat for baby’s brain development. If some of your protein is coming from seafood, seafood is your richest source of DHA. If some of your protein is coming from beans and legumes, they’re a really rich source of folate, and of course, fiber and other nutrients as well. So if we just hit the protein goals alone and eat from a variety of protein sources, it’s really unlikely you’re going to have a major, major nutrient deficiency in pregnancy. So I have tended to move my work away from talking about like, “Don’t eat too many refined carbs” to “Eat more protein.” By default it kind of displaces the refined carbs, it takes care of it helps sort of balance out the carbohydrate intake. So you don’t have as many blood sugar spikes just it’s a really important one for people to think about.

Rebecca Dekker:

How can blood sugar spikes and drops effect people during pregnancy. Because you’ve mentioned about stabilizing the blood sugar, what are some symptoms people experience when their blood sugar is spiking or dropping?

Lily Nichols:

Yeah. So people don’t always experience overt noticeable symptoms, especially because what’s considered a blood sugar spike in the context of pregnancy is actually lower than outside of pregnancy. Because your blood sugar, naturally, your body’s trying to keep it at about 20% lower than normal during pregnancy specifically. Your body is really obsessed with glycemic control in pregnancy. There’s a number of different issues that can arise from it being too high. First of all, if blood sugar is elevated in the first trimester… and this is particularly true for undiagnosed diabetes or mismanaged, maybe it doesn’t have a proper dose of insulin and medication. Like someone with pre-existing diabetes going into pregnancy, and the very early stages that can disrupt some important steps in early embryonic and fetal development, and at super high levels actually can influence the risk of birth defects.

So people think about folic acid or folate for neural tube defects, elevated blood sugar is a significant risk factor for neural tube defects. In later pregnancy, we start worrying more about how it’s impacting the baby’s metabolism. So when you get to the point in pregnancy where baby’s pancreas is developed enough to produce its own insulin, your blood sugar levels and baby’s blood sugar levels are like a mirror image of each other. Then the baby’s pancreas will be tasked with producing additional insulin to keep those blood sugar levels within range as much as possible. So if you’re having frequent spikes or your blood sugar is consistently high, then you end up with a situation where the baby essentially has developed hyperinsulinemia. So high insulin levels and some degree of insulin resistance in utero. So these babies actually are born with like a larger than normal pancreas and are at that greater propensity for diabetes and blood sugar issues later in their life.

It can also interfere with fetal lung development. So that can be a challenge with, that’s why there tends to be a higher rate of NICU admissions for breathing or lung problems in infants of diabetic mothers who did not have sufficient blood sugar management and pregnancy. I just want to highlight that these risks are sort of on a spectrum of severity of blood sugar levels. So the higher you spike, the more frequently you spike or the longer your blood sugar stays above an optimal level, the more likely that things will happen. But a transient single high blood sugar from having cake on your baby shower or something, it’s really not going to do any harm. It’s when it’s consistent or repeated over and over and over and over and over again throughout the pregnancy.

Rebecca Dekker:

Okay. Yeah, that makes sense that it’s on a spectrum. We do have articles about diagnosing gestational diabetes, so if any of our listeners want to read that, just go to ebbirth.com/diagnosinggdm, and we also have one on inducing labor for gestational diabetes, it’s also linked there. I think you raised some good points so about for people who are having blood sugar issues, high blood sugar issues, there’s a spectrum-

Lily Nichols:

Exactly. Yeah. I think in that article, I’m pretty sure I reviewed that for you guys. You linked to the HAPPO Study, the hyperglycemia and adverse pregnancy outcome study. Which is a little bit older now it was in the earlier two thousands, I think somewhere between like 2004 and 2008 or something if memory serves me, but it was a really large study with over 23,000 women from 11 countries. So we do have some pretty significant data from that subset, and it did show like increased risk of certain complications based on… really it’s a progressive increase in blood sugar issues.

For the most part, for most of the outcomes they were looking at were worse as you went higher up that spectrum. So it does have definitely some degree of considering like the clinical scenario in front of you. Because sometimes a mild case of gestational diabetes and depending what diagnostic criteria were use, sometimes you catch really mild cases and we don’t need to be so hypervigilant about absolute perfection in all blood sugar numbers. To have a positive outcome a lot of it really is related to the severity of the blood sugar challenges.

Rebecca Dekker:

It’s funny because there’s a spectrum of opinions on it too. I remember when I first started Evidence Based Birth®, literally people told me that they thought gestational diabetes was not a real thing. So that’s why I wrote that article to show actually there are real health consequences to not treating gestational diabetes, but the good news is there are treatments and it’s manageable. Every time I have a friend or family member who gets diagnosed, I immediately bring your book over to them.

Lily Nichols:

Aw! Thank you.

Rebecca Dekker:

Real Food for Gestational Diabetes.

Lily Nichols:

Yeah.

Rebecca Dekker:

It’s very empowering to know that there are ways to manage it.

Lily Nichols:

Absolutely. I’ve had the same thing brought up, especially I think in some midwifery circles as well. Nothing against midwives I had home births with my babies, I love midwives. But I think there is more of an idea that gestational diabetes is over diagnosed. Really, I think the issue is not identifying the blood sugar problem, the issue is that I think it leads to a bunch of unnecessary interventions. We can manage it and make it a really low risk pregnancy, but we can also be aware that yes, blood sugar issues do play a role in pregnancy outcomes and babies outcomes.

So I think there’s sort of like a middle ground between them. I actually wrote an article about those several years ago, called 9 Myths About Gestational Diabetes to try to present it at a midwifery conference. There was a lot of sort of uproar over like, “No I’m gestational diabetes isn’t a real thing.” So I wrote that article in response to that because it was like, “No, no, it does exist and it can cause problems, but it doesn’t always cause problems and it doesn’t have to cause problems. And here’s a better way we can keep these pregnancies pretty low risk.”

Rebecca Dekker:

Are there any other important aspects of nutrition? I know you have a very thick entire book with small print on this topic, but is there any other major point you want to get across to our listeners who may be pregnant themselves?

Lily Nichols:

I think I’ll take it from a bit of a general stance. If you’ve met with a provider and the kind of information you received was just take a vitamin and avoid alcohol, and everything else is just like, “What’ll happen is what’ll happen.” I do want to empower you with additional information that there’s actually a lot more you can do to have a smooth, low risk pregnancy. Or at the very least, I like to say “Stack the deck in your favor” to reducing your risk or risk of severity of complications with nutrition. So you can not only just, have a more enjoyable pregnancy with less swelling, and not having to worry about excessive weight gain and a lower risk of certain complications like gestational diabetes and preeclampsia… I do go through which nutrients and lifestyle factors can play a role in those.

But you also just can have that peace of mind, if something does arise in your pregnancy, “Well, I did everything I could, I know I did this and this is just something that happened. I’m going to roll with it.” Either way, whether everything goes super, super smooth, or you have a couple of blips in the road, at least you have the peace of mind that, “Yeah. I really like tried and did everything I could in this pregnancy to make it as smooth as possible.”

Rebecca Dekker:

I think that raises a really important point in that a lot of the traditional obstetric care does not focus on nutrition. It’s more focused on “Do this. Don’t do that. Here’s a list of foods to avoid.” Which I know you cover in a whole chapter in your books.

Lily Nichols:

Yep.

Rebecca Dekker:

We don’t need to go there. But whereas I know the midwifery model of care is more focused on like, “What are you eating and how can we improve nutrition?”

Lily Nichols:

Exactly.

Rebecca Dekker:

It seems like that is a really important aspect of care that everybody should be receiving, not just people who have care from midwives.

Lily Nichols:

Absolutely. Absolutely. I completely agree. I’m definitely heartened to hear from people who said like “My doctor, my midwife recommended your book, or I got it from like the lending library of my doula.” That there’s starting to be more discussion around this because I certainly felt like there wasn’t enough discussion about sort of proactive care. I think a lot of prenatal care is almost like looking for problems, it’s just like waiting for a problem to arise. Like, “Okay, is your blood pressure going to be a problem this visit? Is your blood sugar going to be an issue this visit?” But not really a lot of proactive information about like, “Well, how can I prevent that from being an issue whatsoever?” You know, it’s just like, “If there’s a problem, we’ll intervene.” Instead of “How can we prevent or mitigate those?” So, yeah, I’m happy that it’s a resource for so many.

Rebecca Dekker:

Are there any other projects you’d like to share with our listeners that you’re currently working on?

Lily Nichols:

Oh gosh. There’s always so much going on behind the scenes. So I have some foreign language translations in the works for Real Food for Pregnancy that we’ll be announcing. There’s always new blogs coming out on my website, lilynicholsrdn.com. We also do webinars with the Women’s Health Nutrition Academy. So we have actually one coming this week on folate. So for anyone who’s confused about folate versus folic acid and methylation, how that plays a role in fertility and pregnancy, that’ll be live this Thursday. If this podcast comes up after that, because this is like mid-September that we’re WHNA website as well. Yeah, I’m glad that I can do the work that I do. I support women in my online gestational diabetes course, so for anybody who wants to go sort of beyond what’s in the book or it needs additional support, wants to have my personal insight, I do weigh in during office hours weekly in our private Facebook group. That’s definitely something that’s sort of ongoing.

Rebecca Dekker:

Can birth workers take your classes then? Because we have a lot of people listening who are in the birth work field?

Lily Nichols:

Absolutely. Yep.

Rebecca Dekker:

Yeah.

Lily Nichols:

Everyone’s welcome.

Rebecca Dekker:

Okay. Thank you so much, Lily. We’ll make sure to link to all these resources in the show notes, and we appreciate you coming on to share your insights.

Lily Nichols:

Thank you for having me.