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SuperFeast is bringing you another epic episode of the Women's Series today as Tahnee sits down for an insightful conversation with Lily Nichols, registered dietician, nutritionist, accomplished diabetes educator, author, comprehensive researcher, and mother.
Her books Real Food for Gestational Diabetes and Real Food for Pregnancy hone in on evidence-based nutrition for prenatal/pregnancy health and are thoroughly researched assets to the field of maternal wellbeing. Her work stands out for the grounded approach it takes and has not only helped tens of thousands of women manage gestational diabetes but has also influenced nutrition policies internationally. For all women and men currently expecting or thinking about having children in the future, you don't want to miss this episode!
Tahnee and Lily discuss:
- Gut and microbiome health.
- The evolution of prenatal and pregnancy nutrition.
- Gestational Diabetes and how to manage it through diet.
- Glycine and the crucial role it plays in all aspects of pregnancy.
- Postpartum thyroid issues, iodine, and other nutrients to support this gland.
- A micronutrient-forward approach to nourishing the body when pregnant.
- Current Dietary guidelines for pregnant women; are they doing more harm than good?
- Blood sugar levels during pregnancy; the subsequent effects they can have on the hormonal system, weight gain, and postpartum period.
- Different variables that can influence nutritional research and intern misinform people.
- Epigenetics; how our health is determining the genes of the future generation and their risk of disease.
- Carb cravings in the first trimester, why we get them, and why mothers can allow themselves some grace.
- Nutritional research; the benefits to be gained when moving away from a reductionist approach to the observation of traditional cultures who are still thriving.
- Methylation; methylfolate, folic acid, folinic acid, and looking to the other groups involved in methylation (Vitamin B12, B6, choline, glycine, betaine, riboflavin, copper, and magnesium).
Who is Lily Nichols?
Lily Nichols is a Registered Dietitian/Nutritionist, Certified Diabetes Educator, researcher, and author with a passion for evidence-based prenatal nutrition. 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 approach for managing gestational diabetes. Her work 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. Her clinical expertise and extensive background in prenatal nutrition have made her a highly sought after consultant and speaker in the field.
Her second book, Real Food For Pregnancy, is an evidence-based book that addresses the gap between conventional prenatal nutrition guidelines and what is optimal for mother and baby. With over 930 citations, this is the most comprehensive text on prenatal nutrition to date.
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.
Check Out The Transcript Below:
Hi, everybody, and welcome to the SuperFeast podcast. Today, I'm joined by Lily Nichols, and I'm really excited to have her here. She's a registered dietician and nutritionist as well as a diabetes educator. But more importantly, I think she's a researcher and a mom herself, and she kind of has created these incredible books that talk about evidence-based nutrition, especially prenatal and during pregnancy.
So, I'm just so excited to share her work because I think it's something we haven't spoken about much on the podcast, and there's so much information out there. It's really hard to wade through the studies. It's really hard to understand what's going to be right for you as an individual and for your baby especially during pregnancy, so this is really exciting.
Lily's blog is excellent. She's got a really amazing blog that we'll link to in the show notes, and her book, Real Food for Gestational Diabetes and Real Food for Pregnancy, both, well, I've only read Real Food for Pregnancy so far, but it's excellent. It's so readable, which is really good. And also, yeah, just a really dense and interesting read on maternal wellbeing.
So, she's also been able to get her work into university. She's been influencing policy. There's people doing studies based on her work, so I'm just really stoked to have her here. So, thank you, Lily.
Lily Nichols: (01:21)
Thank you for having me.
Yeah. We're really, really lucky. I always like to sort of understand how people got to be where they are, and I'm really curious how you ended up being a dietician. I did hear you on another podcast actually saying that you'd sort of been exposed to alternative ideas around nutrition before you studied dietetics, and one of my most traumatising moments as a pregnant mom was opening up on of my old nutrition and dietetics textbooks and reading the recommended diet which was like fortified cereal and low-fat milk and orange juice and crackers. And I was kind of like, "Ugh," and I just shut the book and put it back on the shelf.
Lily Nichols: (02:04)
But, yeah, I'm curious how you actually kind of came to want to study dietetics and how you've ended up here.
Lily Nichols: (02:10)
Sure. You want the long story, so-
Lily Nichols: (02:14)
Yes. I have been interested in nutrition for a long time. I grew up in a fairly health-conscious home and really started to dive into nutrition in my teen years. Unfortunately, probably a little bit misguided because our dietary guidelines are so backwards, but nonetheless, made the connection that how I feel is definitely related to the type and quality of food I eat. So, that was beneficial.
Lily Nichols: (02:47)
It was during that time that I sort of mentored with a nutritionist who was not a dietitian, and that was probably all for the better actually, who recommended I read the book Nourishing Traditions by Sally Fallon. She, goes into a lot of the work of Dr. Weston Price, and that was a really important book for me to read because at the time, I was vegetarian and was not feeling very well. And so, to read this book that was really suggesting that animal foods, particularly fatty animal foods, could be an important but also healthful part of the diet was like completely mind blowing to me. And it took me many years to actually fully buy into that way of eating so to speak. It was just so very different from what I thought as healthy at the time.
Lily Nichols: (03:44)
But by the time I went to university, I knew I wanted to study nutrition. I did not change my major, obviously, because here I am, and I used that as an opportunity to sort of see what our textbooks were teaching and then see what the research was saying and to sort of see if there was any overlap with what I had read from these other sources. And by that time, I had changed my diet and eating fairly liberal amounts of animal foods. For most people, probably a fairly high fat diet, but that kept me feeling really quite well with very stable energy levels and good mental health and all that. So, I knew it worked for me, but I was like "Does the research support this?"
Lily Nichols: (04:28)
And I can't say I can unequivocally sort of prove that every claim that was in Nourishing Traditions is backed by science, but certainly, a lot of it is. And that definitely coloured my view of nutrition early on, and there was quite a bit. I mean, it was just at the time when studies started coming out on Vitamin K2. I had a professor very involved in research on Vitamin D. So, all this work around fat-soluble vitamins was really, really interesting to me.
Lily Nichols: (05:05)
And once I actually became a dietitian, did my internship, and all the boring stuff, I ended up working in the prenatal space a little bit by accident, specifically working with gestational diabetes and California State public policy on gestational diabetes but, also, clinical work. And it was really there that all of the ... It's sort of like everything came together.
Lily Nichols: (05:31)
I understood from the work of Dr. Price that cultures living isolated from modern, civilised foods as they would call them or foods of modern commerce I believe he refers to them, were far healthier. And when they started incorporating more processed foods, their health declined, including the health in the next generation. So, there was poorer pregnancy outcomes, higher rates of birth defects, and increased incidents of infection and other issues. And understanding the gestational diabetes component was really pivotal to me because I'd learned that children born to mothers with poorly controlled blood sugar can face upwards of a six-fold higher risk of developing Type 2 diabetes or becoming obese by the time they're 13.
Lily Nichols: (06:22)
And that risk, actually, in some studies, is upwards of 19-fold higher risk, and yet we can pretty much negate that risk if we can maintain well-balanced blood sugar levels in pregnancy. And it was like, "Wow." So, this work of Dr. Price actually, there's a lot to this whole idea of epigenetics and how we can ... The quality of our genes or which genes are turned on and off can, in fact, be influenced by a mother's health. Also, father's health. We can't forget him as well. That was really big for me.
Lily Nichols: (07:00)
I mean I can keep going, but ultimately a lot of my work led me to be rather critical of the current dietary guidelines because I was not seeing the gestational diabetes guidelines work very well in practise. A lot of clients' blood sugar would either not improve or get worse following the conventional recommendations, and certainly, I, myself thrived on a real food, moderately lower carb diet with adequate amounts of fat and certainly not like the margarine and other just garbage food that they recommended. And so, that led me to develop an alternative approach for managing gestational diabetes and led to my first book, Real Food for Gestational Diabetes.
Lily Nichols: (07:48)
And then several years later, after a lot of pestering for a book on prenatal nutrition and having my first child, somehow, I managed in the midst of baby toddlerhood to get Real Food for Pregnancy out into the world. So, here I am.
That was very impressive when I read that you were writing it when your child was one, so I think I was-
Lily Nichols: (08:12)
I know. I look back. I don't know how I accomplished that.
I think you just got through it, but, yeah.
Lily Nichols: (08:17)
It's definitely, definitely wild.
Lily Nichols: (08:19)
I mean I guess that's such an interesting ... I mean I didn't end up studying dietetics, but I was going to. So, I have some of the textbooks and things, and I ... It's such a modern food kind of promoting field, and it feels to me like there's so much focus on kind of these specific nutrients or kind of fortified iron and duh, duh, duh, duh, duh, instead of really looking at, "Well, what did humans eat forever until recent industrialisation, and how would traditional cultures.
utilised foods? What would they prioritise? What was a traditional pregnancy diet?" I mean all of these things I studied to the end.
Lily Nichols: (09:03)
So, you know?
Lily Nichols: (09:03)
Lily Nichols: (09:07)
I think that's actually where a lot of the magic lives, actually, in the nutrition field is just as the field evolves, moving away from this let's try to isolate the nutrient in this that is responsible for this outcome, now we understand so much more about nutrient synergy and how different nutrients work together.
Lily Nichols: (09:30)
And it's very hard to study that because the more you can just take this reductionist approach of isolating the one variable that's responsible for the one outcome and try to prove causality, right?
Lily Nichols: (09:42)
That's like an easier model for scientific research, but I think there's a lot of value in that observation of what cultures who are thriving and have great fertility and great reproductive outcomes like, "What are they doing, and/or what did they do before they changed their diet and those outcomes started getting worse?"
Lily Nichols: (10:09)
I mean that's why I think the work of Dr. Price is just so very important, but sometimes, it takes a lot of work to sort of unpack what those observations were and try to unpack from-
For sure, yeah.
Lily Nichols: (10:26)
... modern nutrition research what are the factors that are so crucial? So, in my stance, I feel like I almost reverse engineer in a way a prenatal diet that is nutrient dense and going to promote optimal pregnancy outcomes by taking all of those little studies and individual variables like, "Okay. Selenium is associated with a lower risk of pre-eclampsia. Okay. Where do we find selenium in food? Oh, look. That happened to be a food that was really prized in some of these cultures."
Lily Nichols: (11:00)
"What else is in that food? Oh, wait. It has that nutrient. Hey. We have these like 10 studies showing that iodine is really good to-"
Lily Nichols: (11:11)
... fertility and pregnancy and sort of trying to make those connections for people because there is just so much wisdom in those traditional foods. But I think, I mean as a lover of research myself and as somebody who's always been kind of sceptical of when people claim to have-
Lily Nichols: (11:32)
It's just people have so many random dietary claims and superfoods and whatever. To really look at it from like a grounded perspective and take a micronutrient-forward approach versus this reductionist, "Well, the guidelines say we need X, Y, Z percentage of carb, fats, and proteins, so let's build a meal plan about around that. And then, just like fortify our way out of the nutrient deficiencies that will result from such a poorly planned diet." You know what I mean? I'm like, "Let's go micronutrient-forward and just see where the macros ended up," right? And I think that's so much more important.
Yeah. Well, that's what I really loved about your Real Food for Pregnancy book is that as you chat a little bit about the macronutrients and just give some context for what the current guidelines say. 40 to 60% carbs, and you're going, "Well, we don't really have proof that that's actually valuable. It actually could be detrimental." You've got this information in there about the protein requirements of pregnant women and how it's much higher than probably what we think and fats. Everyone's so afraid of fat, and again, you're looking at all of these vitamins that are required for a healthy brain and a healthy pregnancy and a healthy spinal cord and a healthy bone system to be developed. Well, they're all fat-soluble, so there's this real sort of ease in your just presentation of that information.
But then, this focus on, yeah, really looking for kind of the food sources of these things before we go and take a pill or take a supplement. And I think that's always been an approach I've really respected, and it's difficult to kind of find, I think, in prenatal nutrition because it's, yeah, everything you read about like, "Oh, if you're deficient in this, just take a supplement or this and this. Take one of these."
Lily Nichols: (13:21)
Yep. [crosstalk 00:13:22]
And I mean I can see that being useful sometimes, but not, yeah, not always.
Lily Nichols: (13:25)
Yeah. 100% and in addition to that, people are really afraid to challenge the status quo on pregnancy. I've heard many times like, "I don't touch pregnant women or prenatal nutrition with like a 10-foot pole. I'm not going to mess with it." Because if something goes wrong, if your recommendations are bad and actually causing harm like, "Whoa. That's a major problem," and I think that's one of the reasons that I do rely so heavily on research. I mean, I guess some people might consider my stance extreme, but I feel like I take a very moderate approach to this as well where I'm not jumping to really crazy extremes.
Lily Nichols: (14:12)
If anything, I think some of our dietary guidelines are a bit extreme in say like the recommendations on carbs. Like upwards of 65% of your diet on carbs? If you do that and then you have the remaining part of your diet, you're what? 35%, if my math is right, coming from fat and protein, given what we know now about the protein requirements being 73% higher than the current estimated average requirement in late pregnancy and what we understand about the importance of specific nutrients, micronutrients found in foods that have a lot of fat and protein like choline, for example.
Lily Nichols: (14:58)
If you eat a diet that's 65% carbs, you are pretty much guaranteed to be micronutrient deficient, and you are probably almost guaranteed to be eating a diet deficient in choline as well as like a huge number of other micronutrients. So, if anything, I would argue that some of our dietary guidelines are actually doing more harm than good if you really take to the extreme of the macronutrient proportions.
Lily Nichols: (15:32)
That they are. Yeah, yeah.
And I mean, I guess when you're working with women, I'm sure there's a lot of unravelling of our, I guess, cultural kind of assumptions, or you mentioned like eating for two in the book. And I mean, I even have spoken to women who just, yeah, they're like still afraid to really nourish themselves because they have a hang up around eating disorders and those kinds of things. And I mean are there things that you say that you kind of find help women kind of get to the core of what's really ... I mean the epigenetic stuff for me, I guess, is one of the big things where it's like you're influencing not only your child but all the way down the line multiple generations.
Lily Nichols: (16:16)
Is there anything you find really convincing for people to kind of focus on this macronutrient approach instead of their mom?
Lily Nichols: (16:23)
Yeah. Really convincing. That's always tricky because I think somebody who's done just so much individual but also group client work, what's motivating for somebody is not motivating for somebody else. So, on one hand, I think taking things from a mindful eating perspective and really driving home the point that you can feel well, have a more positive pregnancy experience when you're better nourished, you'll just you'll feel you just feel better, right? You won't have the crazy blood sugar swings that leave you low energy. That impacts your hormonal balance, so maybe you won't be as snippety at your partner.
Lily Nichols: (17:16)
Your blood sugar levels definitely can influence your weight gain. Different foods you eat might change your odds of experiencing heartburn or the severity of heartburn.
Lily Nichols: (17:30)
It might lower your odds of certain pregnancy complications, and certain pregnancy complications have this other carryover effect of sure not only affecting baby but also can have profound differences in the way you're treated within the medical system and what options you're provided with for your birth. It can carry all the way over to your postpartum experience as well and how well you heal and how well just, yeah. Your just general wellness and postpartum definitely has can go all the way back to your preconception health.
Lily Nichols: (18:11)
So, I think some of those factors can be convincing for people. For some people who have a history of disordered eating, I think the points about the epigenetics and sort of this imprinting on your child's future risk of disease is really crucial. I think there's also a lot of unpacking. I tend to find a lot of people with disordered eating also have just kind of messed up blood sugar balance, usually because they've been convinced to really restrict their fat intake because, "Oh, my gosh. Fat has so many calories," right?
Lily Nichols: (18:56)
And once we kind of unpack and sort of reframe the role of fats and protein and their influence on your blood sugar levels and your hunger and cravings, so many of these things balance themselves out when you just have stabilised your blood sugar levels by not overly restricting your fat and protein intake.
Lily Nichols: (19:22)
Which I think that a lot of women do because of fear around fat or fear around eating meat or fear around eating eggs with the yolks. So, some of these things just fix themselves over time. But, yeah, I really think it depends on the client. What is the most motivating factor to them? Because it's so personal.
Yeah, for sure. And I think once ... I mean the feeling good factor, I think is such a big part of it because I mean I was a vegetarian for a long time for about 14 years, and I kind of started eating meat just before I got pregnant because I was unwell and it was sort of only thing that I actually could tolerate. And then, I sort of had this vision of my life always being a vegetarian mom, and then my pregnancy, I remember walking down the street being like, "I would kill someone for chicken drumstick right now." I just wanted to attack anybody who had a chicken drumstick.
Lily Nichols: (20:23)
And it was such a strange ... And obviously, I respect my body more than I respect my ideology, and I kind of ended up eating meat through the later stages of my pregnancy. And it was interesting in your book because talk about towards those last trimesters really needing more protein, and that was something that I had a kind of anecdotal experience of. It's just this huge demand all of a sudden for protein foods.
Lily Nichols: (20:50)
Yeah. But I mean I think it's something that now I eat all these foods that you talk about in the book, and I feel so much more nourished on so many more levels. And I just think that's, yeah, as much as there can be this kind of belief maybe that your diet plan or whatever is working, it's like until you've really felt how good you can feel when you have I mineral rich and kind of high micronutrient rich body, it's a really different experience I think. So, yeah.
Lily Nichols: (21:19)
I think you're right, yeah. There's so much to be said for experiencing it first-hand, and, yeah.
And so, I mean I'm curious when because one of the things I've always struggled with with nutrition is just how poor ... You touched on this a little bit before with this focus on one particular reductionist kind of thing in order to get a "good study" that can be published in a journal and whatever.
But when we're talking about nutrition, we're talking about individuals eating foods from such a variety of different qualities and sources like I could eat meat from an organic grass-fed cow in Byron Bay or I could eat meat from a feedlot. That's two very different propositions.
So, how do you kind of troll through the research and find validation? I mean one of the studies I remember that really jumped out for me that you mentioned in the book was the one on feeding rats soybean oil and saying that fat was bad. Well, it's like, well, that's to me just ridiculous because we all know that that's one of the worst types of oil you could possibly eat. So, how do you kind of, yeah, you troll through all of this and find what's a good study?
Lily Nichols: (22:29)
Lily Nichols: (22:31)
Well, in a way, it's hard because so much research is I feel like the researchers behind it are coming into it with certain biases, certainly if they're funded by a certain industry. That can happen as well. But I actually used to work for a research institute in Los Angeles, and there was a lot of people doing rat studies there. And so, they'd have these lunch and learn sessions where the researchers would present on what was happening in their studies, and most of them were like had nothing to do with pregnancy by the way, but I went because I just find it just it was interesting. It was a nice way to spend my lunch break, and what was what I found so frustrating is that a lot of our dietary ideologies find their way into people doing rat studies who have literally no understanding of nutrition. But they're like, "Fat is bad."
Lily Nichols: (23:32)
"So, our hypothesis is that feeding rats a diet that's high in fat is going to cause this problem." So, that's the angle that they take when they're going into the study.
Lily Nichols: (23:46)
Honestly, these researchers are they're like rapt biologists. I don't know what you'd call them, but they're not people who have a deep understanding of nutrition. So, there is almost no thought to the quality of the fat that they would be feeding the rats. What should rats eat?
Lily Nichols: (24:06)
Like an ancestral-
Lily Nichols: (24:08)
... where they're definitely-
Biologically appropriate diet for a rat.
Lily Nichols: (24:11)
Lily Nichols: (24:12)
So, it's like, "Okay. We're going to start with the standard route chow," which is probably to some degree crap already.
Lily Nichols: (24:20)
"But we're going to enrich this rat chow with a lot of soybean oil," or a lot of pick your poison, whatever fat they want to do. And I've actually really dove into some of these rats feeding studies, particular the ones where they're looking at pregnant rats. And sometimes, when they make these adjustments to the rat chow, they don't adjust the micronutrients supplementation to match it. So, it's like, "Okay. You gave these rats high-fat diet." It was also a horrible source of fat, like soybean oil, you know?
Mm-hmm (affirmative), mm-hmm (affirmative).
Lily Nichols: (24:57)
So inflammatory, Omega 6 fats no like shown to cause all sorts of pregnancy complications, and I go into that in Chapter 4 of Real Food for Pregnancy.
Lily Nichols: (25:11)
But on top of that, because their diet is now what, I don't know, 60% fat or something that's fairly high, and you're not supplementing the micronutrients that would otherwise be in the regular rat chow. You now have micronutrient deficient rats as well.
Lily Nichols: (25:27)
And there's no discussion of this in the papers whatsoever. We definitely have to have animal studies to learn things about human pregnancy because there's all sorts of ethical issues, obviously, on subjecting human pregnancies to certain deficiencies that we know are going to cause adverse outcomes. That's not ethical. So, we have to rely on rat studies, but a lot of them are poorly designed. And so, I'm just very critical when I'm looking at research, so usually when I approach looking up a certain topic, I have some sort of a hypothesis in my head, or I'm just looking for what is the latest update on choline and pregnancy. So, I'll sometimes use some generic search terms and then see what's out there. And I am very, very critical of the methods that studies use.
Lily Nichols: (26:29)
I'm also critical of the funding sources, and I'm also critical of the way that they explain their results in their discussion section. So, I always try to go back to the actual data, and it depends on how much of that actual data they're able to present on in the study which can be frustrating.
Lily Nichols: (26:50)
Because sometimes there's holes that they don't address. But my long answer or short answer for this long explanation is I'm just very critical of everything that I read. And I find there's often quite a few holes in research studies, unfortunately, and what's interesting is if you go back to studies from like the 1940s and look at how they present their data and how they discuss their data, they are much less likely to explain away a certain finding.
Lily Nichols: (27:29)
They're like, "We observed this," and just they leave it as is. Where if you're looking at say, we'll go back to the rat study studying fat, they might say, "We were surprised to find that the rats fed the soybean oil, although there this happened, they actually had this really advantageous thing happen," or really terrible thing happen that they can't possibly explain because it goes against their hypothesis. So then, they'll spend whole paragraph-
What the finding mean.
Lily Nichols: (28:08)
... trying to explain away why that result was because of confounding variables and not from the thing that they tested. So-
It's almost editorialising their kind of own-
Lily Nichols: (28:18)
Lily Nichols: (28:21)
So, I'm just ... I do a lot of reading of scientific studies, but I probably only out of every 10 studies, I might find like one that's really good. It's slim pickings.
Yeah, and I think like you said ethically, and I mean even practically, it's very difficult to study human nutrition on a kind of large scale because people aren't reliable really, you know?
Lily Nichols: (28:52)
And you can't lock someone in the room and force feed them. That would be naughty, so, yeah. It's a tricky area I think, and that's why I think I've always been drawn to the ancestral kind of ideas, especially as I've gotten older because it makes a lot of sense to me to look at, well, we got pretty far through nature providing.
Lily Nichols: (29:11)
And like, "Okay. So, maybe the last couple hundred years haven't been so good for us," but-
Lily Nichols: (29:18)
But, yeah. One thing I found super interesting, which I mean I ... This is a little, I guess, off to the side of it, but similar just thinking about epigenetics. And one thing we hear a lot of in our work is kids with eczema, and I noticed that you made a point of in Real Food for Pregnancy of saying like, "Glycine needs really increase during pregnancy."
And one of the things I know is quite effective in treating kids after they've been born is glycine supplementation, and I was curious if you've seen things like that where there's kind of a correlation between the deficiency in pregnancy and then a popular ... I know this is going to be tricky to answer, but I'm going to try. Like a population kind of change in terms of more common because we know we see more ADHD now. We see all these different types of things becoming way more common. Do you think that that's in part due to this kind of prenatal nutrition and even just women's general health as they're bringing the babies in, or is it more to do with what the kids are eating once they're born? Or do you have any thoughts on that?
Lily Nichols: (30:22)
I think particularly after having my two kids and knowing how tricky feeding kids gets into later toddlerhood. You have a three-year-old, right? So-
I do, yes. I do.
Lily Nichols: (30:40)
All these real foodie moms, myself included, sort of smugly-
Lily Nichols: (30:45)
... go into early motherhood with like, "My child is going to eat so well, and they're not going to go through a picky eating phase because I'm being really intentional about which foods I'm introducing when. And I'm not exposing them to this processed stuff." And then, just by default, the development, I just have to say it. It is a developmentally normal stage in brain development of exerting independence that you're probably going to go through some degree of picky eating. It'll happen. Just prepare yourself. You didn't do anything wrong, right?
Lily Nichols: (31:21)
And so, knowing that, knowing that there's probably going to be times where their nutrient intake is not that great, I think so much of it comes back to at least I know. I'm like, "Well, at least in pregnancy and at least-
They sure had a good time.
Lily Nichols: (31:38)
... early infancy, you had really nutrient-dense foods, and you had your breast milk and your ..." Because they just go through those funny food phases where they only want certain things, and you know they're not getting well-balanced nutrition. So, that's just a little aside to start out.
Lily Nichols: (31:59)
I think it is certainly both. Obviously, if a child has a propensity towards food sensitivities or allergies, then, yes, you're definitely going to notice a reaction to certain foods. But there's a lot of things that come back to pregnancy nutrition. I can't say offhand I know something where glycine has any relation to a risk of children's risk of allergies. I have not seen that study, but glycine is an amino acid that I give a lot of big nod to in the book because it's something that becomes very important to provide in pregnancy.
Lily Nichols: (32:49)
And because glycine is a major component of collagen and makes up so many of our bodily structures, so like a third of the protein in our body is collagen.
Lily Nichols: (33:01)
A third of the amino acids in collagen are glycine, so you can kind of use glycine and collagen somewhat interchangeably in that if you're eating collagen, you're going to be getting a lot glycine. Of course, you could supplement separately with it, but in terms of what you get from food, you would be getting it usually in the form of gelatin or collagen.
Lily Nichols: (33:23)
And those amino acids are very important for the formation of organs, for the transcription of foetal DNA, for the development of the gastrointestinal tract, so maybe it plays a role there. For the skin, hair, nails, connective tissue, bones, the entire skeletal system, your liver's ability to detoxify because you require glycine the form of glutathione, one of your major detoxification enzymes. So, you could probably circumstantially make the case that it does play a role in immune system development.
Lily Nichols: (34:04)
I can't say we have direct data on that specifically at this moment. Some of the things we do have pretty decent data on in terms of risk of child allergies would be Vitamin D.
Lily Nichols: (34:18)
Vitamin A very important for the immune system. Probiotics and the health of the maternal microbiome to a large degree affects the baby's microbiome, and some of those bacteria and microbes are transferred throughout pregnancy, although the greatest seeding of the microbiome happens at birth.
Lily Nichols: (34:43)
So, if there are interventions in pregnancy that affect the maternal microbiome, like the use of antibiotics, or if there is antibiotics used during labour or shortly after postpartum because that also affects the breast milk, if baby is born vaginally versus born via C-section, that can impact the microbiome. Whether they're breastfed or formula fed can affect the microbiome, and that is really your immune system is like some estimates say 70% or 80% located in your gut.
Lily Nichols: (35:21)
So, all of these factors that affect gut health and the microbiome I think are just huge, and I have actually been asked before like, "What do you think is the greatest gift you've passed along to your children?" And I think it's my microbiome. I'm not kidding. If it's not my prenatal nutrition, it is the microbiome. It sets the stage for their immune system for their entire life, and I'm grateful for my mom who birthed me at home and didn't jump to giving us antibiotics a whole bunch as kids and practised full-term breastfeeding, breastfed us into toddlerhood.
Lily Nichols: (36:11)
And so, I know I had a strong microbiome, and I think that is literally the greatest gift that we can pass to our children, which is kind of probably a weird thing for some people to think. But once you dive into the research, it's just so fascinating.
Yeah. I mean I completely agree, and I mean one thing that I'm curious about. We have a colleague who is a functional naturopath, and he has been recently kind of ... He used to recommend quite an ancestral style diet. And he's been sort of recently doing a lot of research on the microbiome and saying that maybe a higher fat diet is less beneficial for the microbiome. I'm curious if you've come across any of that, or if you know. I haven't actually gone quite deep on it yet. He just, he spoke to my partner about it the other day, but, yeah. It was something that was a bit of a surprise for me.
Lily Nichols: (37:01)
Yeah. So, I think, first of all, that we're still in our infancy of understanding the microbiome.
Lily Nichols: (37:10)
And so, I think there's a lot of, kind of like those rat studies, there's a lot of assumptions that are made, right?
Lily Nichols: (37:15)
So, there are assumptions made that the greater diversity of bacteria that we have in the gut, then the better.
Lily Nichols: (37:26)
And I don't think that is always true. Now, you will have a greater diversity of bacteria if you're eating a diet with a greater diversity of plant foods, especially fibres, because those will feed certain microbes in the gut. But you can shift the microbiome based on what we're eating.
Lily Nichols: (37:46)
I always kind of come back to the ancestral thing. Would you have taken that microbiome research? So, say we were at that point where we were studying that in the 1920s, and you were visiting an Inuit population in Northern Canada or Alaska or Greenland. And you were like, "Okay. So, those people be generally a ketogenic diet," particularly in the winter when probably-
They may be more.
Lily Nichols: (38:19)
... some of the only plant foods they have are, and I've lived in Alaska, so I can attest to this, probably some of the only plant foods that you have managed to preserve over the winter. Traditionally, they gathered lingonberries and blueberries, and the wild ones are not very sweet.
Lily Nichols: (38:37)
And some berries called crowberries, which are not sweet at all, and they preserved them in seal oil, okay? So, there's isn't-
Lily Nichols: (38:46)
You're not going to find a lot of plant matter in the tundra. Maybe if you're eating the contents of like a moose's gut, then maybe you'd get some of the things that they were eating. But for the most part, they were eating a lot of fat and protein.
Lily Nichols: (39:01)
And I would argue that their microbiome is adapted appropriately to-
With their diet, mm-hmm (affirmative).
Lily Nichols: (39:07)
... break down the foods that are in their diet. I don't think we can unequivocally show that having a more diverse microbiome is always better. However, I think with certainly with a modern diet, if you're comparing the microbiome of somebody eating the so-called standard American or Western diet, which has like a whole bunch of white flour and refined oils and just very low in micronutrients, also low in fibre, probably their animal products are from animals raised on feedlots who are treated with a bunch of antibiotics, eating glyphosate-sprayed, genetically-modified corn and soy.
Lily Nichols: (39:48)
Certainly, you're not going to see a very diverse microbiota, and it's not going to be a very healthy microbiota because a lot of their bacteria have been negatively-
Lily Nichols: (40:00)
... affected by their diet of processed foods and things that are killing the microbiome like the antibiotic residues and the glyphosate residues.
Lily Nichols: (40:10)
So, I think it's the bit tricky for us to draw super strong conclusions.
Lily Nichols: (40:17)
I think a lot of people ... I think you have to find your sweet spot. I think there are some people who really who thrive with differing levels of plant versus animal foods, and you find that in the research, too. When they've looked at modern hunter-gatherer diets, they find that the carbohydrate range ... I hope I don't butcher this, but I do cite this in the book.
Lily Nichols: (40:41)
... range anywhere from 3 to like 34%, I believe, of their diet coming from carbs.
Lily Nichols: (40:50)
There might be some groups actually that eat a little higher, but I think the median quartile or whatever was somewhere between, gosh, in the teens up to 34%. So, like probably around a quarter, give or take, of your diet coming from carbohydrates. That would be most of your plant foods since that's where you find your carbs.
Lily Nichols: (41:11)
And then, the remainder was your fat and protein, and I think people need to sort of find their own sweet spot with that. And some people do well with a lot more. Some people do well with a lot less, and I think there's also different stages of life where you can tweak that. And if there's certain health conditions you're dealing with for a period of time, sometimes, people do better with a short period of time eating keto. And then, they resolve that health issue, and they can start incorporating a more liberal amount of carbohydrates into their diet. And they feel great.
Lily Nichols: (41:50)
But if they'd done that two years ago, they would have felt really awful.
Lily Nichols: (41:54)
So, I think, I don't know, as a whole, I think we need to be much less dogmatic about nutrition and much more adaptive.
Yeah. Well, I think that actually made me think of there's a guy called Jack Kruse. Are you familiar with him?
Lily Nichols: (42:09)
Yeah. He's interesting, but I read his book. And probably the biggest thing I took away from that was he sort of discussed how if you think about a seasonal diet, you might get a lot more carbohydrates and be more insulin resistant during say, summertime.
Lily Nichols: (42:25)
But then, you're going to naturally have a stage of ketosis every year when it's wintertime, and this kind of dance between the two states might actually be beneficial for humans. And I mean there's not really any evidence for this. But it made sense to me that we wouldn't be in ketosis all the time, and we wouldn't be in a state of insulin resistance all the time, and-
Lily Nichols: (42:47)
I completely agree.
Yeah. And I just, that for me was a really big takeaway that perhaps it's a little bit of both, you know?
Lily Nichols: (42:56)
And I mean probably other things as well, but that was something you'd mentioned in your book about carbohydrate cravings because of the amount women who've written who are really conscious of nutrition who are like, "All I want to eat is toast," you know?
Lily Nichols: (43:09)
For the kind of three months of their pregnancy or whatever.
Lily Nichols: (43:13)
And then, you were sort of saying, "Well, there's naturally this this change in the pancreas." Can you tell us a little bit about that and why maybe it's not the end of the world if you eat a lot of carbs?
Lily Nichols: (43:23)
Oh, yeah. Yeah. There're so many, I mean, I've thought a lot about this, of course, because I also experienced that during my two pregnancies, so, yeah. The first trimester is a time of incredible change and adaptation, and the more you dive into the weeds, the more incredible it is that we can pull off this complex feat.
Lily Nichols: (43:50)
But also, the more reassurance I feel around giving people permission to not be super freaked out about their carb cravings in the first trimester, so, yeah. There's a lot happening not only with the pancreas, but also, all of the major internal organs and organ systems of baby are formed by eight weeks of pregnancy. Pretty much all the cells have differentiated to their like, "I'm going to grow into a liver, and I'm going to grow into a brain. And I'm going to be a bone," and all of that has-
Be expecting that.
Lily Nichols: (44:29)
Yeah. All of that has pretty much taken place by week eight, which is insane.
It's so crazy. Yeah.
Lily Nichols: (44:35)
During that time as well, the embryo has implanted into the endometrium, and actually, there's glands in the endometrium that serve as nourishment for the early embryo before the placenta forms. And ultimately, when the placenta forms, which is end of first trimester, beginning of second trimester, that then takes over in supplying nutrients to the foetus. And but until that time point, your baby's actually being nourished by the lining of the uterus. The lining of the uterus that builds itself up, and then in case that you are not pregnant that month is expelled via your menstrual cycle. So, a healthy menstrual cycle really sets the stage for a healthy pregnancy, and I think we can give ourselves a whole bunch of grace in that first trimester when your body might have food aversions or only wants to eat carbs because the endometrium kind of has it covered.
Lily Nichols: (45:43)
In the meantime, your body is working crazy overtime to build a whole new organ, a very complex organ known as the placenta, and that takes a lot of energy. So, the amount of mitochondria being produced and actively those are like the energy producing parts of the cell, but they do a whole bunch of other stuff. It is exponentially higher compared to really any other life stage, and so there's a reason you feel like tired and worn down and just wanting carbs.
Lily Nichols: (46:17)
On top of that, insulin sensitivity changes throughout your pregnancy, so in early pregnancy, people tend to be more prone to hypoglycemia. So, your insulin resistance tends to be a little bit less, but also, your insulin production increases a bit. This is going to shift a lot towards the end of pregnancy where your insulin production can be double or triple but also is matched with a pretty high level of insulin resistance. So, in early pregnancy, your body actually kind of can handle more carbs.
Lily Nichols: (46:54)
But also, if it's the only thing you can eat, and you're like, "Oh, my gosh, I'm not eating all these nutrient-dense things," technically, and particularly for people who did a little bit of prep work ahead of time or have eaten a generally nutritious diet, doesn't have to be perfect, in the months and years leading up to pregnancy, you can really just rest assured that your body is taking care of it. It's really relying on your nutrient stores early on more than anything.
Lily Nichols: (47:26)
And I don't want to give like a complete like, "Oh, nutrition doesn't matter at all in the first trimester." Of course, it matters, but when you're in the throes of nausea and you really kind of don't have a choice, you have to do what you got to do just to get through the day or get through the hour. And so, we can sort of try to make choices with more nutrient dense carbs. I just recently did an Instagram Live on this if people want to dive in a little more.
Lily Nichols: (47:53)
But don't get super hung up on like, "The whole the sky is falling." There's so much hormonally going on. I didn't even talk about the thyroid being hijacked by HCG, which also supposedly contributes to the nausea and the hyperness.
And that was something. That was like a wow for me when I read that.
Lily Nichols: (48:13)
That morning sickness could mean that the thyroid is actually really healthy.
Lily Nichols: (48:19)
I'd never heard that before. Can you tell us-
Lily Nichols: (48:21)
No, it's just it's so complex, and so this is one of the fun things about doing the research is you can go into it with a hypothesis, and then you come out with all these random theories that you're like, "Wow." And then looking at everything and that's happening in early embryonic development all the way back to the development of the egg and implantation. It's just incredible. Can we just take a step back and be like, "Wow"?
I'll do it.
Lily Nichols: (48:50)
Hold this up.
Lily Nichols: (48:51)
Well, sometimes, I look at my daughter, and then I look at me, and I'm like, "How did ..." you know? You're like, "How did that?"
Lily Nichols: (48:59)
Yeah. You made that.
Yeah, and but-
Lily Nichols: (49:01)
Yeah, woo. And I mean on the kind of thyroidy thing, because that's something a lot of women experience postpartum and thyroid issues. Do you have any ... Is there anything we can do nutritionally to support the thyroid? I mean, iodine and selenium obviously are big ones.
Lily Nichols: (49:20)
Is there anything you have to say about that?
Lily Nichols: (49:23)
Yeah. Well, the thyroid is just a very sensitive gland, and it's sensitive to all sorts of stressors not only nutritional but life stress as well. And it is under a significant amount of stress in a pregnancy where it has to pump out 50% more thyroid hormone than it usually does, and a lot of that ramping up, going back to the first trimester, happens really early on as well.
Lily Nichols: (49:50)
And so, once you have your baby and you're postpartum and you have this sudden crazy drop in hormones, pretty much once you birth the placenta, and you don't have this hormone producing organ hanging out telling your body that you're pregnant, you see a very sudden crash in hormones. And the thyroid has to pretty much completely remodel back to a non-pregnant thyroid that isn't producing as much thyroid hormones.
Lily Nichols: (50:23)
So, it goes through a lot of adaptations in that first year postpartum, but especially in the first three to six months. And so, if there was any underlying stressors on the thyroid prior to pregnancy or during pregnancy, sometimes, you see those amplified in postpartum. Most often it's postpartum thyroiditis usually in the form of a hypothyroid state, although some people have an overactive thyroid. So, usually, there's ... And then, it gets complicated because sometimes, it presents in a, they call it a triphasic pattern, where you can experience often a period of hyperthyroidism early on. So, like excessive thyroid hormones early on followed by either a normal thyroid or a hypothyroid state later on in that first year.
Lily Nichols: (51:17)
And so, it's really tricky to toy out even as a clinician in trying to decide what you're working with clinically, so I think as a mom, you want to be really aware of your symptoms so if you need follow up testing because something has changed, to beware. You may have swung to the other side of the thyroid spectrum.
Lily Nichols: (51:42)
As far as nutrition to support the thyroid, absolutely iodine is so key. I think way under emphasised in our prenatal and postpartum breastfeeding nutrition guidelines. You need more iodine when you're breastfeeding than you do when you're pregnant and more than any other life stage, by the way.
Lily Nichols: (52:08)
And I think our iodine recommendations are very, very conservative. You transfer quite a bit of iodine via your breast milk, and so that's sort of like a just ... It's like a bucket with a hole in the bottom. You take it in. It goes right out.
Lily Nichols: (52:23)
And so, I think in some cases, of course, there's a lot of things that are preferentially transferred to baby, and that continues to be the case when you're breastfeeding. And I think that might be the case with iodine. Definitely a nutrient to consider, so look and see if your prenatal has any iodine. Hopefully, it does, and hopefully, it has enough. And then, continue that postpartum, but also, seaweed and seafood are going to be your major iodine sources. And next to that but in much lesser amounts, dairy products and eggs.
Lily Nichols: (53:00)
So, yeah. Postpartum would be a good time to have seaweed snacks as a snack and have your fish and your mussels and oysters and all those nutrient dense foods. And then, the cool thing about those nutrient dense foods is that because things work in synergy, when you're getting your seafood, you're also getting a lot of other nutrients that are supportive of the thyroid so a number of trace minerals, especially selenium. That is a really important one to have in balance with your iodine. You have your Vitamin D. You'll have your Vitamin B12. You have your zinc and copper and a bunch of other nutrients in your seafood products. That's so important for thyroid health.
Lily Nichols: (53:42)
And then, I would also emphasise Vitamin A and iron for the thyroid. And again, if you're eating those seafoods, but you're also including nutrient-dense animal foods, especially the organ meats, you're going to get pretty much all of those nutrients you need in the right proportions to support your thyroid health.
Lily Nichols: (54:08)
But on the other side of the non-nutrition side of things, postpartum is often very stressful for people and especially if there's not a big community of support.
Lily Nichols: (54:20)
It's just it's a lot for your body to go through and for you to emotionally go through, and in the midst of perpetually interrupted sleep. And I mean, all of it is really a recipe for stress on the thyroid. So, if you can find a way to simply get enough to eat first of all, focus on quality as second. Get enough to eat, very important for your thyroid, and have some sort of community or family support there to help you in the moment, ground level with baby, bringing you food so you can just rest as much as possible. That is X. That's just so important and probably just as important as the nutrients I just mentioned. I think that community aspect in a supported postpartum, the importance of that cannot be understated.
Yeah. We talk about that a lot on this podcast because, yeah, I completely agree. It's just it's so essential. I'm in a meal train right now for a friend who just had a little one.
I wanted to jump a little bit across to methylation because one thing that I remember reading about when I was pregnant was about folate and how most of the ways in which we supplement it are really not that beneficial because our bodies have to work really hard if they can even absorb it at all. And you recently did a post on your blog about MT. I always get this wrong, MTHFR. I always want to say the dirty word.
Lily Nichols: (55:54)
You got it right.
You got to spell it out, and how that sort of influences folate absorption in the body as well, especially for people that have that sort of predisposition to poor methylation. So, obviously, I can link to the blog post, but could you give us a quick summary of folate and kind of why it's important and then what we might need to look out for if we are concerned about our ability to methylate?
Lily Nichols: (56:23)
Sure. Yeah. I'll try to give you the short version-
Lily Nichols: (56:26)
... because that blog post is quite long.
Lily Nichols: (56:29)
So, folate is one of our B vitamins, and in terms of pregnancy health, it's most famous for its role in the prevention of neural tube defects and other birth defects. And it does this because it's very involved in the transcription of DNA, making sure that all of that goes properly. And when you're lacking in certain micronutrients, folate being one of them, you can have problems with that process. And one of the really devastating outcomes when that happens in early pregnancy is something like a structural birth defect. Of course, folate is important for a lot of other things, but that's where it gets its fame for its role in a healthy pregnancy.
Lily Nichols: (57:24)
So, folate is an umbrella term that includes all the different types of folate that we get from food. There is over 150 different types of folate in food, the most common being methylfolate, and methylfolate also accounts for at least 95%. Some estimates say 98% of the folate that's in our bloodstream, but there is also a synthetic version of folate that was developed called folic acid. And for some reason, this one got all the fame, is then is the one used in a lot of research studies. It's interesting in that in the gut, it is actually better absorbed than food folate because food folate has this whole food matrix going along with it.
Lily Nichols: (58:19)
So, the isolated synthetic folic acid is absorbed quite well, but that doesn't mean that it is utilised well because folic acid has to be converted via several steps into methylfolate for your body to be able to metabolise it. So, this poses a problem for people who have ... It can be a problem for everyone, and I make that case in the folate article, so I recommend people do give that a read. But it's especially problematic for people who have certain genetic variations in the genes that control the enzymes that metabolise folate. So, MTHFR is one of those genes, and there's a couple different mutations that people can have on their MTHFR. I call it MTFHR variations because it's just all of these gene mutations that sound all scary. They're all a variation of normal. 40 to 60% of the population have as a variation of their MTHFR gene and thus has a reduced ability to process synthetic folic acid. So, it's definitely worth talking about.
No, well, that's pretty good I'd say. I think what I guess your point in the article was really that we're looking for real food sources, or if we're supplementing, we're looking for folinic acid or methylfolate instead of straight up folic acid. So, was that addition of the folinic that was the difference? Would that be an accurate kind of-
Lily Nichols: (59:55)
Yes. That would be an accurate takeaway. So, I mean most supplements will use, if they're going to use "good quality" of folate, they'll use methylfolate instead of folic acid. There is also a form of folate called folinic acid, so it has a little extra IN in there. And that is like in if you look at the biochemistry pathways, and I made a choice not to include that in the article but maybe I should, folinic acid is like one step behind methylfolate. So, your body would still have to convert it into methylfolate, but it doesn't have to do near the amount of work as if you were to take folic acid.
Lily Nichols: (01:00:42)
So, yeah. So, there's a lot of really not a lot. There are several good quality prenatal vitamins, for example, that'll use a combination of methylfolate and folinic acid. I think with a lot of people becoming more aware of this MTHFR issue, everyone's like all of a sudden obsessed with methylation, and so they're like, "I need my methylfolate and my methyl B12 and methyl this and methyl that." And some people don't do well with too many methyl groups, especially in supplemental form. So, I think that's why some companies have decided to kind of pull back a little bit on all the methylfolate and do a combination. But it really entirely depends on the person.
Lily Nichols: (01:01:28)
And then, I'd say the other point, take home point, that I wanted to make in that article was that folate doesn't function in isolation just like so many other nutrients. There is essentially we're talking about this whole methylation cycle or this whole folate cycle, and there are a lot of nutrients that participate in it. And so, I think we need to look beyond just supplementing with methylfolate and particularly supplementing with really high doses without balancing that out with all these other groups that are involved in methylation, like your Vitamin B12 and your Vitamin B6 and your choline and your glycine, which we talked about earlier, and your betaine and your riboflavin and your copper and your magnesium. I mean there's so many things.
Lily Nichols: (01:02:20)
And that's why what's so cool about it is that if you look at what are our most nutrient-dense sources of folate in our diet, and I have a list of those foods and the amount of folate in each of them, liver is top of the list. Sorry to keep talking about liver, but with liver you're also going to get pretty much all of those micronutrients that help your body process folate properly.
I think it's one of the only other food sources of choline, too, right? Like-
Lily Nichols: (01:02:48)
Yeah. Eggs and liver are by far your top two sources of choline in the diet.
Lily Nichols: (01:02:55)
So, yep. And choline is huge. Choline is arguably just as important, possibly more important, than folate for the prevention of neural tube defects. It's just we hadn't identified just how important it was until like the 1990s. The U.S. didn't have a recommended intake for choline until 1998.
Lily Nichols: (01:03:18)
So, it wasn't on the research radar. So, if we go back to our earlier conversation about looking at research studies, I mean there's a lot of things I wish were researched that they weren't or should have been researched like 30 years ago, but we didn't know about them yet, right? So, how many things are in our food right now, like our whole foods that we don't know about because we haven't isolated them and named them? I mean-
Well, that's one of our pet peeves, isolating a standardisation of a herb. It's like, "Well, we've taken herbs in their whole form forever."
Lily Nichols: (01:03:53)
Now, we suddenly look for like one little aspect of them and we-
Lily Nichols: (01:03:58)
... standardise that. It just doesn't make any sense.
Lily Nichols: (01:04:01)
So, the last thing I kind of really wanted to touch on was gestational diabetes, and obviously, that's a huge topic. But I guess what I really wanted to touch on was for the pregnant women because it's just something that's come up a lot for me lately with friends and people in the community that I talk to where they're getting diagnosed with this based on usually that horrific drinking lots of sugar test. And then, they're-
Lily Nichols: (01:04:29)
... a lot of time kind of asymptomatic in that they feel really healthy. The baby comes out really healthy. They don't seem to really notice that it's affecting them so much, but they're then being treated as kind of a risk factor. And I'm kind of curious because when I was reading your book and you mentioned it before when we were chatting about how toward the end of pregnancy, we do become more insulin resistant. I'm just, yeah, I'm kind of curious about how it all fits together.
Lily Nichols: (01:04:55)
When someone is pregnant, what would you recommend as the best way to kind of get to the bottom of the edge?
Lily Nichols: (01:05:01)
Okay, and sort of the idea of like, "Well, isn't it physiologically normal to ..."
Well, I didn't want to like ... Because you know, I think it's, like you say, it's risky to sort of say these things, but I've come across that in my research that actually that's kind of what happens when you pregnant and just to chill out with it. And after baby's born, it'll-
Lily Nichols: (01:05:19)
... go away on its own so ...
Lily Nichols: (01:05:22)
It is really fascinating. I think in the context of human history and ancestral eating, the adaptation to be more insulin resistant in pregnancy made a lot of sense because there needed to be some degree of buffering for times of nutritional stress and famine and food scarcity. So, this would kind of ensure that you're shuttling as many nutrients to baby as possible, and I think this adaptation is a little bit maladaptive perhaps for our modern food environment, where aside-
Lily Nichols: (01:06:05)
... from people who literally have ... Some people are exposed to starvation. There's a lot of food scarcity across the world, but if we're talking like an industrialised Western country and somebody in middle-class income level, they're not going to experience food scarcity, caloric scarcity.
Lily Nichols: (01:06:30)
And so, then you can end up with an issue where there's just nutrient excess, for sure. What is interesting though is that I want to clarify that the presence of insulin resistance in pregnancy, although that is adaptive and normal, blood sugar levels actually trend down in pregnancy naturally.
Lily Nichols: (01:06:56)
So, you'll find that average blood sugar levels in pregnant women, and if you're looking at ... So, I think, if I'm thinking of the study is like average of 32 week's gestation, average 24-hour blood sugar levels were in the 80s.
Lily Nichols: (01:07:15)
And you might use different units. You have to divide by 18 to take that for milligrammes per deciliter to millimoles per litre, but nonetheless, it's lower than somebody outside of pregnancy. And the gestational diabetes targets are lower than non-pregnant diabetic levels for that reason.
Lily Nichols: (01:07:39)
So, yes, insulin resistance develops, but your insulin production increases to match it. And if that adaptation goes as it is meant to go, blood sugar levels will not be excessively high, will not be in the gestational diabetic range.
Lily Nichols: (01:07:58)
So, for the people who are like, "Gestational diabetes is like a made-up thing," I disagree-
No, no, no, right?
Lily Nichols: (01:08:05)
... from my clinical experience, but I think there's a whole lot of nuance in the diagnosis of gestational diabetes because I think our assumption that a single glucose tolerance test via that sweet drink you're talking about, the glucola, is going to perfectly delineate people who have blood sugar issues and people who don't have blood sugar issues. I think that's pretty absurd.
Lily Nichols: (01:08:36)
So, there are definitely cases of false positives and false negatives with the glucose tolerance tests, and arguably, I think it's a little bit silly that we wait all the way until 2/3 of a pregnancy to screen for gestational diabetes, where technically in the United States, about half of the population, literally, 49 to 52% of the adult U.S. population has some form of blood sugar imbalance in the form of Type 2 diabetes or prediabetes, and most of them are undiagnosed. So, we have just this just rampant issue of blood sugar issues, and we should be identifying those and screening those earlier.
Lily Nichols: (01:09:24)
So, you can request a haemoglobin A1C in your first trimester, which will give you sort of a look at your average pre-pregnancy blood sugar levels, and if those are in the prediabetic range, in the state of California, the guidelines I worked on, they would treat that as gestational diabetes.
Lily Nichols: (01:09:43)
And arguably, there's a lot of gestational diabetes international organisations who argue that that should be used universally as screening in the first trimester and help, too, at least. A1C isn't perfect either, but it gives you a little glimpse, and at least you can have the person monitor their blood sugar for a few weeks at minimum and see what's happening.
Lily Nichols: (01:10:09)
And I would say the same with the glucose tolerance test. Whether you take it or not, because you can also just not take it and choose to monitor your blood sugar at home and see where you average, regardless of the test results or not, it's something that can help you figure out whether, well, A, how severe your blood sugar imbalance is, if in fact, it's an issue, or help you figure out if maybe you had a false positive result on the test. Whereas a false negative, you wouldn't figure out because you wouldn't have blood sugar metre, right?
Lily Nichols: (01:10:50)
Which is why I think it's just such a great learning opportunity for people to use a blood sugar metre for a period of time. And now, we even have continuous glucose monitors which are even more cool. They give you pretty much 24/7 tabs on your blood sugar without having to prick your finger all the time.
Lily Nichols: (01:11:13)
So, if people want to read about my experiment with that, you can look up CGM Experiment on my website, and I go into all the details.
Lily Nichols: (01:11:21)
But, yeah, suffice to say I think the diagnosis of gestational diabetes is complex. I don't think there's one perfect way. I think we should have access to different options. I think people should be aware of the risk of false positive results. I don't think we should be treating a diagnosis of gestational diabetes in the way that we are in that in Western medical care, it's just seen as your pregnancy is now automatically high risk, and there's a tonne of people who are very borderline gestational diabetes, just have very mildly elevated levels, and they just need to reduce their carbs a tiny bit.
Lily Nichols: (01:12:10)
And then, they're good to go. And they're not high risk, and they don't need to have an over-medicalized pregnancy and birth.
Lily Nichols: (01:12:16)
So, I have a lot to say on the topic, but it does, indeed, it is indeed like a phenomenon. It does exist. There are absolutely true cases of gestational diabetes. I've worked with hundreds of hundreds of them, and there are also cases where people have a positive diagnosis, and their blood sugar is totally fine. So, it's, yeah. It's a whole can of worms.
I guess it comes down to sovereignty as well, and really, if you are getting diagnosed with things, understanding what it is and really becoming curious and doing your own research. And I mean that's what your books is so great for, so, yeah. So, I'll definitely link to that. And if you have any interest in gestational diabetes, obviously, Lily's work is amazing, and you should go and check that out and maybe find a practitioner who understands in a bit more of a nuanced way.
Lily Nichols: (01:13:06)
Actually, both. Yeah.
Lily Nichols: (01:13:09)
I will mention one more thing really quickly-
Lily Nichols: (01:13:11)
... on gestational diabetes. I realised I have an article on my site called Nine? I think it's called Nine Myths-
Oh, yeah. We can have that one come up.
Lily Nichols: (01:13:18)
... About Gestational Diabetes.
Lily Nichols: (01:13:20)
That could be a good one for listeners who want to dive in just a little more, so, yeah.
And you also have a video training as well. Is that, right? Am I-
Lily Nichols: (01:13:30)
I do, yep. So, yeah, I know I'm like terrible at marketing myself.
Lily Nichols: (01:13:34)
You're embarrassing me.
You're really good at writing. Well, you're really good at content. I was just like, "How has she written all this stuff?"
Lily Nichols: (01:13:41)
I have the content part down, so I have a whole bunch of freebies on my website/websites, and one of them is a free three-part video series on gestational diabetes. So, you can find that at lilynicholsrdn.com/freebies. It's also in the realfoodforgd.com website. And I mean, that's for people who have been diagnosed with gestational diabetes, so I'm just walking you through the basics and talking you off the ledge because it is just a terrifying experience of being diagnosed for so many people.
Lily Nichols: (01:14:21)
But there's a bunch of other different freebie options on my website as well, including the first chapter of Real Food for Pregnancy.
Lily Nichols: (01:14:29)
So, if people want to just get an idea for what this real food thing is, that is the place to go. That chapter includes a comparative meal plan between mine and the Academy of Nutrition and Dietetics, the American Dietetic Association's new name. It has their sample meal plan for pregnancy and a micronutrient breakdown so you can see which one comes out on top, and I bet you can which one that is.
That was a very impressive little chart, that one. I was-
Lily Nichols: (01:15:05)
That was how I found your website, and I downloaded that. And I read that, and I was like, "Wow."
Lily Nichols: (01:15:09)
Oh, fascinating. Yeah.
Lily Nichols: (01:15:11)
Yeah. It's pretty interesting. Yeah. And then, you can find me on social media. I'm not super active on social media, but if you find me, I'm on Instagram @lilynicholsrdn.
Yep. I'll link to all of your Grammes and all that, so we've got Gramme, Facebook, Twitter, Pinterest, and all those things. You're very good. So, yeah. We'll link to all of that, and anyone who wants to get in touch with the Lily, please feel free. Do you do consultations and things, or are you more in an education space, or?
Lily Nichols: (01:15:41)
I currently am more in an education space, so I'm focusing more of my time on ... I do have a gestational diabetes course that I support women in, and then I've been focusing more on my writing and also creating professional training webinars via the Women's Health Nutrition Academy. So, I'm sort of leaning in that direction right now, so I don't have availability for new clients at the moment.
That's great. I mean I will link to all of that, and I'm sure-
Lily Nichols: (01:16:12)
... there'll be people out there that are practitioners that'll love to learn from you. So, was that the Women's Health Nutrition Academy?
Lily Nichols: (01:16:17)
I've got it. Okay, great. All right, awesome. Well, thanks so much, Lily. I hope you have a beautiful day.
Lily Nichols: (01:16:23)
Thank you. You, too.