34. Lily Nichols on Fueling Fertility: Demystifying Preconception Nutrition with Real Food

Episode Transcript
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Natalie (00:00):
On today's podcast.
I chat with Lilly Nichols aboutpreconception nutrition, how the
common recommendations areoutdated and even potentially
harmful, and we take a deeperlook at folate and how folic
acid supplementation isn't allit's chalked up to be.
We also answer some questionsyou submitted on Instagram.
Welcome to the Resource Doulapodcast.

(00:20):
I'm Natalie, your host, and mygoal is to equip you with the
tools and information you needto make informed healthcare
decisions while having some funalong the way through engaging
interviews with experts,personal stories, and insightful
commentary.
I'll save you the time andeffort of sifting through
countless sources on theinternet.
Consider me your personalresource dealer because if I

(00:42):
don't know the answer, I canconnect you with someone who
probably does.
So whether you're a seasonedhealth guru or just starting
your journey, I hope this showinspires and encourages you
every step of the way.
I have the pleasure ofintroducing my guest today, Lily
Nichols.
She's a registered dieticiannutritionist, certified diabetes
educator, researcher, and authorwith a passion for evidenced

(01:05):
based.
Prenatal nutrition.
Her work is known for beingresearch focused, thorough and
critical of outdated dietaryguidelines.
She is co-founder of the Women'sHealth Nutrition Academy and the
author of two books, real Foodfor Pregnancy and Real Food for
Gestational Diabetes.
Lilly's bestselling books havehelped tens of thousands of
mamas and babies and are used inuniversity level.

(01:28):
Maternal nutrition and midwiferycourses and have even influenced
prenatal nutrition policyinternationally.
She writes@lillynicholsrdn.com.

(01:50):
Hey Lily, welcome to theResource Doula

Lily (01:52):
podcast.
Thanks so much for having me.
Happy to

Natalie (01:55):
be here.
Yeah, I'm happy to have you.
I've been recommending your bookto basically every single client
and those who are not my clientsalso.
And so I talk about you all thetime and I'm just, I'm excited
to actually talk with you today.
So welcome.
Thanks so much.
Yeah.
Yeah.
So I'd like to start talkingabout preconception nutrition

(02:17):
because oftentimes we hearpeople just say like, oh, eat
healthy exercise, get ready forhaving a baby.
But there's no specificinstructions, and a lot of the
common recommendations areoutdated as we know.
So where would you start if youwere counseling somebody who's,
who's looking to have a babysoon?

Lily (02:38):
Yeah.
Where do you start?
There's so many things to thinkabout.
Um, so ultimately the, thethings that you do, just to
circle back to like, you know,my, my books are on pregnancy.
The things that you do forsupporting your health during
pregnancy very often are justabout the same things, or very

(03:02):
similar things that you do toprepare your body for
conception, to optimize your eggquality, to improve your, uh,
menstrual cycle regularity, toimprove your hormone balance.
There's a lot of overlap, so youknow, first and foremost, the
more nutrient dense foods youconsume, the better off your

(03:23):
micronutrient stores are goingto be leading into pregnancy,
which ultimately helps support,um, you know, healthy ovulation,
healthy egg quality, um,supporting implantation,
supporting the development ofthe placenta, and of course
applying all the nutrients sothat your baby can develop, um,

(03:43):
properly, right?
Um, so nutrient dense foods forsure are a big, big focus.
Um, There's a wide variety offoods that are, you know,
overall beneficial to us.
But when it comes to the onesthat are the most nutrient
dense, um, particularly the onesthat are supplying these
micronutrients that are often,um, commonly in low supply for a

(04:07):
lot of women or, um, underconsumed or where deficiency can
develop most frequently areactually our protein rich foods.
And so that's an area that Ireally recommend that people
focus on, um, in the monthsleading up to pregnancy as, as
large of a variety of proteinrich foods as you can.
Cuz there's different, um,levels of certain amino acids,

(04:31):
like the small components thatmake up protein.
Those all have specific roles inour body.
So you get a different balanceof amino acids in different
foods.
Um, so in an ideal world,including some both animal and
plant sources of protein isoptimal.
Um, And then also specificallylooking at some of the most
nutrient dense protein foods.

(04:52):
So, um, organ meats such asliver are particularly
concentrated in vitamins andminerals.
Um, shellfish are really high invitamins and minerals.
Um, egg yolks, uh, meat that'son the bone or from like, you
know, a whole animal.
Say you take a whole chicken andcook it down and then save the
bones and all the leftover bitsto make broth like that has a

(05:16):
specific amino acid balance.
Um, definitely incorporatingsome of those types of foods in
is, is optimal.
Um, and beyond the shellfish,other like fatty seafood that's
rich in omega-3 fats, all ofthese things generally are
supportive of, you know, eggquality.
Um, and also, you know, spermquality as well.

(05:37):
It takes, takes two to make ababy.
So we gotta include the partnerin the conversation as well.
That would be, Probably one ofthe major places that I would
focus.
Um, and then from there, andthis all kind of intertwines
focus on, uh, blood sugarbalance as much as possible.
Now by eating a sufficientamount of protein, which has a

(06:00):
lot of these micronutrients, youalso are supporting your, your
blood sugar balancesignificantly.
Cuz protein foods tend not tospike our blood sugar.
Um, they also tend to be veryfilling and satiating, so
there's less.
Room and less desire in yourlife for the foods that spike
your blood sugar the most andhave the least amount of

(06:24):
vitamins and minerals in them,which are primarily your refined
carbohydrates, your, your addedsugars, your white flour, your
white rice, um, anything where,you know, the, the goodness has
been taken out of that wholefood, original whole food source
of carbohydrates.
So a lot of these things, it'slike they intertwine cuz it's

(06:45):
all, it's all related, but thosewould be the top three areas.
The nutrient dense foods,protein rich foods, and then
focusing on, on blood sugarbalance.
And oftentimes those foods aresimply displaced by, by eating
more protein and eating morehealthy foods.

Natalie (07:02):
It's like it was meant to be that we eat real whole
food.
Yeah.
Right.
Uh, so, okay, we did have aquestion too, like, since you
already mentioned it, spermquality.
Is it, I mean, your, your booksare primarily focused at women
and prenatal nutrition, but werea man to eat the same, same kind

(07:22):
of diet.
Would that be what they'reaiming for?
Is there any specific nutrientsthat they need to add?

Lily (07:29):
Um, I mean, for, for sure the same foods that are
beneficial for female fertility,there's also overlap for male
fertility.
Okay.
So there's, you know, prettystrong research on involvement
of vitamin A for, uh, the wholeprocess of, of generating sperm.
Um, f folate is important tosperm health and reducing

(07:50):
something called D fragmentationwhere the sperm are actually
damaged.
Um, a variety of antioxidants.
Coq 10, um, number of minerals,selenium, zinc are some of the
big ones that have been studiedfor sperm quality.
Uh, vitamin D deficiency canaffect sperm quality.
So yes, there's a lot ofoverlap.

(08:11):
Um, But a big one for, for menespecially, is avoiding the, the
not, the not so great foods, um,and alcohol and smoking, um, and
avoiding, uh, toxin exposure aswell.
Um, you know, men of coursecreate a lot more sperm or have

(08:32):
a lot more sperm than, thanwomen have eggs, right?
Um, so you can kind of get awaywith a higher proportion of, you
know, not all of your sperm issuper healthy, and it, it's
still fine.
The body has ways of kind of,the egg actually sort of
self-selects the, the healthiestsperm.
Um, however, like chances ofconception are, are highest when

(08:54):
you have a, you know, ahealthier ratio of sperm, like
fewer damaged sperm.
Um, and toxins play a really bigrole in like, The having, it has
detrimental effects, um, onsperm health.
So, um, again, like in real foodfor pregnancy, after that whole

(09:16):
chapter on toxins, you arguearguably could write very
similar things.
But all the research citationswere, would be for sperm, like
the same things that aredetrimental to pregnancy, uh,
the health of, of your baby, andpregnancy outcomes.
Um, you also equally have a tonof research on like egg quality,

(09:36):
ovulation, um, spur quality, uh,yeah, that it's all, there's a
lot of overlap.
So avoiding the non-stick panswhen you're cooking, for
example, switch to stainlesssteel cast iron, glass, uh,
cookware.
Um, Avoiding exposure to toxinsas much as possible, including

(10:00):
things like smoking, vaping, um,exposure to high pollution
areas, if at all possible.
Um, think about toxin exposureon the job.
Like does your partner work inconstruction and have a lot of
toxin exposure there?
Could they wear one of thoselike legit crazy masks or open
the windows or find a way formore air ventilation or, um, do

(10:22):
their painting, you know,they're refinishing cabinets,
refinish them outside or in likean outdoor open air, um, uh,
covered areas so that they'renot inhaling as many of those,
those toxins.
Things like that do, do have areally big effect.
Um, and of course the moretoxins you're exposed to, the

(10:43):
more of a drain that puts onyour system to.
Detoxify those things.
And yes, we have built-insystems for detoxification.
Um, our liver and kidneysespecially are, are really good
at doing so, but when we like,are overflowing with exposures,
you at least have to take a lookat the ones that are within your

(11:05):
control and, uh, reduce yourexposures as much as possible.
So for men with high toxinexposure, they might wanna be
focusing, um, well even more onthe nutrient dense foods, but
specifically on nutrients thatsupport their body's
detoxification systems, likeproduction of the enzyme

(11:25):
glutathione, which is so, soimportant for, uh, or
antioxidant glutathione, whichis so important for detoxifying.
Um, a number of.
Of these chemical exposures.
So foods rich in selenium.
Um, our seafood, for example, isreally good organ meats.
Uh, you could throw in Brazilnets there as well.
Um, but a lot of our proteinrich foods have a lot of

(11:47):
selenium.
Um, your foods that are rich inglycine, in cystine, those are
both amino acids.
Again, protein rich foods,especially the meat on the bone
for the glycine.
Um, I know I'm forgetting acouple more that are involved in
glutathione production, but um,those are some of the major ones
that you do wanna be looking at.

Natalie (12:08):
Perfect.
And that, I mean, there's somuch overlap, like you said, I
think the concept ofnutritionism, that's what you
call it, right?
Where it's like hyper focused onisolating each individual
nutrient and like overthinkingsupplementation versus like,
let's just have whole foods andnutrient dense foods.

(12:28):
Um, yeah.
So could you give like a coupleexamples of where there's a very
synergistic, um, relationshipwith a couple nutrients in, in
specific foods?
Sure.
Yeah.

Lily (12:42):
Does that make sense?
No, I, I, I cover.
Yeah.
So a, a lot, um, a lot ofnutrients work together in their
functions, in your body, andthen in foods, a lot of times,
well, there's no food that onlycontains one nutrient, right?
They all, all foods contain anarray of nutrients.
And oftentimes there are, um,qualities where these, these,

(13:05):
uh, nutrients kind of like cofunction and our metabolism in
some way.
Um, with regards to pregnancy,for example, we know that, uh,
choline and DHA seem to worktogether.
Um, choline is often in the formof a phospholipid, which helps
to transport d n A across.

(13:26):
The placenta to baby and alsohelp incorporate that DHA into
baby's brain.
Mm-hmm.
So, um, you know, when eitherone is supplemented solo, that
doesn't have the same beneficialeffects as when they're
supplemented together, but ourfood sources of d h a really all
have choline in them as well.
Our, our seafood, our salmon,um, our egg yolks, for example,

(13:51):
they all have both, uh,nutrients together.
We know that, um, you know, theproduction of red blood cells,
people are always worried aboutanemia.
Mm-hmm.
Anemia, um, can happen when youhave, you know, too few or
dysfunctional red blood cellsthat aren't able to carry oxygen
properly through your system asthey should.

(14:12):
And, uh, Everybody thinks ofiron and anemia as if that is
the only cause of anemia andit's not.
Um, iron is iron deficiency.
Anemia is one subtype, but youcan have anemia related to a
variety of other, uh, nutrientdeficiencies.
Most, most commonly, uh, folateor vitamin b12.
Usually B12 over folate cuz ourfood supply is, is fortified

(14:36):
with a whole bunch of folic acidthat rarely in fortified
countries are people fallingshort on that one.
Um, but there's even, you know,vitamin A, um, glycine, b6, uh,
and then the B12 and folate aswell as the iron, uh, copper as
well.

(14:57):
A mineral that kind of cofunctions with with iron.
Deficiencies in any of thosethings can reduce red blood cell
production and also reduce theproduction of the heme protein,
which carries the iron in oursystem.
Right?
We have our hemoglobin, um, thateverybody is, is talking about,
and in foods we have heme ironfound in animal foods and

(15:18):
non-heme iron.
And the one that's bound to hemeis, is much more bioavailable,
right?
That's the same type that ourbody uses to carry iron through
our system.
So when you start looking at allthe things involved in anemia
and you look to food and youlook historically what was used
to treat anemia, they use liveror liver extract.

(15:39):
Or some of the older studiesrefer to liver juice, which
sounds particularly appetizing,right?
Um, as a, like a traditionaltreatment for anemia.
And you look at liver, it hasall those nutrients that I just
just mentioned, um, inabundance, right?
So there's many different thingsthat.

(16:00):
Work together in our systemthat, um, unless you have a
really carefully formulated, uh,prenatal vitamin, um, oftentimes
you don't get those exact same,uh, synergies.
Or if you're only to supplementwith iron, for example, you
might not actually be addressingthe underlying cause of the

(16:21):
anemia, right?
If it's not iron, but also ironis metabolized.
Well, if it doesn't have allthese other co-factors.
So that's where, that's whereyourself, right?
In some ways you could beshooting yourself in the foot or
just not fully addressing theproblem and wondering why your
condition is not approimproving.
Hmm.
Um, and this isn't to throwsupplements under the bus.

(16:43):
There's definitely a time and aplace for supplements.
I'm not antis supplements, but Idefinitely am pro, um, food
first for addressing things and,and still prioritizing food,
even if and whensupplementation, uh, is needed
to fill in certain gaps.

Natalie (17:00):
Okay.
Yeah.
So how would someone find outlike what supplements they might
need?
Like are there specific labsthat you recommend?
Um, specifically I guess in thepreconception time, like should
they get a whole, a whole panelof blood work ahead of time?
What should they be looking for?

Lily (17:18):
Yeah, so I mean there's all sorts of differences of
opinion, um, on this.
Yes.
And there's also, uh,differences in, you know, access
to certain kinds of medical careand medical testing and ability
to afford it.
Cuz a lot of these sort ofadvanced functional medicine
kind of panels, uh, are notalways covered by insurance,

(17:41):
right.
So, From, from just like thestandpoint of what can we get
through, uh, just a regular olddoctor who doesn't really know a
whole lot about nutrition, butmaybe you can convince them to
order a couple of labs.
I think it's a really good idea.
Um, for example, to get your,uh, vitamin D levels tested in

(18:02):
the preconception phase, I thinkit is a good idea to, um, get
like a, a, C, B, C, a completeblood count and see if there's
any anemia present.
And if so, you can do follow upwork to check on your iron, uh,
folate and B12 to see what'sgoing on there.
Um, and see if anything needs tobe optimized ahead of time.

(18:23):
It really is ideal to come intopregnancy, not anemic, because
it is so much more likely tooccur during pregnancy.
So coming in with like a solid,solid baseline is helpful.
Um, beyond that, I mean thereare other labs that I would test
that.
Wouldn't necessarily benutrition related.

(18:44):
Um, so I'll skip those.
But, uh, as far as like amicronutrient panel, that is
certainly a possibility.
And there's a wide variety oflike comprehensive micronutrient
panels on the market where youcan see where your levels are
at, um, for a variety ofdifferent vitamins.
Um, certain minerals, though notall minerals are best tested via

(19:05):
blood work.
Sometimes those are tested viahair instead.
Um, and that's kind of acontroversial area of testing.
Some people have, you know,believe there's more or less
validity to that.
But certainly with a a bloodwork panel, um, there are
comprehensive options, bothblood work and, and some urinary
markers that can be used.

(19:25):
Like Genova has a nutrient evalthat's sometimes really helpful.
Um, vibrant America has a goodpanel, um, that can be used to
assess a variety of, of othermicronutrients, not just some of
those major ones, but you canalso just.
Only if you're limited withwhat's out there, only test a
handful.
Um, and those are usually onesthat any conventional provider

(19:46):
can test for you.

Natalie (19:47):
Okay.
Okay, cool.
Yeah.
Um, I was thinking about all ofthat in terms of like, okay,
people are, they're gettinginstruction to just blindly
supplement oftentimes.
And I, I definitely have a lotof questions for you about
folate and folic acid becauseit's a huge topic.
Um, and I know you have a wholearticle on your blog about it,

(20:10):
but, um, so the conventionalprenatal vitamin oftentimes has
a lot of folic acid in it, andthat mm-hmm.
Has been historically like arecommendation for
preconception.
Can you talk about, um mm-hmm.
The differences between folateand folic acid and kind of maybe
some of the, the main issueswith excessive folic acid
supplementation?

(20:31):
Yeah.

Lily (20:32):
Yeah.
So, um, the reason theyrecommend folate.
I'm just gonna use the wordfolate for right now.
I'll, I'll explain in a minute.
The reason they recommend folatein the preconception timeframe,
um, is primarily because a lackof folate, a folate deficiency
in the mother very early inpregnancy at the time when the

(20:57):
embryo is just beginning to likeform what's called the neural
tube, which like connects up toyour brain.
So the various early brain andspinal cord development, which
takes place like, gosh, withinthree weeks post concept, it's
in like the first, what'sconsidered the first five weeks

(21:18):
of pregnancy, but the way wedate pregnancies, throws
everything off.
So, okay, so within a couple ofweeks after fertilization, um,
That neural tube is closing anda deficiency in folate can
prevent that process fromhappening properly, leading to a
very serious defect called aneural tube defect, which can be

(21:39):
of, you know, varying degrees ofseverity, but some of them are,
you know, make it so that, thatthat baby cannot survive and the
pregnancy is non-viable, right?
Mm-hmm.
Um, or they can be severelydisabled.
And so, um, once we learned thatin some cases, uh,

(21:59):
supplementation with folate orcorrecting a folate deficiency,
and the mother could fix this,there was, you know, widespread
effort to improve folate statusat a population level.
And since most pregnancies, orat least half of pregnancies in
the US are unplanned, it waslike we need to address this at
a population wide level toprevent, because by the time.

(22:23):
You're pregnant.
This process of the neural tubeclosing is already taking place.
Right?
So if you like intervene withfolate supplementation at week
six of pregnancy, you are toolate.
Mm.
So, yes.
Um, so this is, this is reallyultimately why, cuz most women
aren't thinking about takingprenatal vitamins for better,
for worse until they're alreadypregnant.

Natalie (22:42):
Right.
Um,

Lily (22:43):
That's the why.
Okay.
The, the reason folic acid, it'skind of perplexing why folic
acid is even used, but I thinkthat the reason is when they
originally found it.
So, folic acid is, uh, syntheticversion, manmade form of folate.
Folate is an umbrella term.

(23:04):
There's at least 150 differenttypes of naturally occurring
folate.
Um, oftentimes with very complexstructures of, of, uh, things
attached to like the central.
Part of that compound that wecall folate, or when you isolate
it and oxidize it, and it's thismanmade form, it's folic acid.

(23:29):
Now, folic acid is veryinexpensive to produce a lot of
the early studies onsupplementation, used folic
acid.
Um, because it is oxidized, itis very stable when it is added
to fortified foods.
So it doesn't like break down.
Um, and it is, it is absorbed inthe GI tract because of its very

(23:52):
simple structure.
It is absorbed very well.
Whereas your body has to gothrough a couple enzymatic steps
involving zinc to remove allthis extra stuff on the natural
folates to absorb it into yoursystem.
Hmm.
Folic acid doesn't have thatstuff added onto it.
Okay?
Problem is, uh, what is absorbedist necessarily well utilized by

(24:17):
your body.
Okay.
So, Synthetic folic acid doesn'tparticipate well in all of the
things that a natural folatewould do in your system, your
body actually has to alter thestructure of it just a little
bit through a process calledmethylation.

(24:38):
It has to turn it intomethylfolate in order for it to
work in your system, to work inthe folate cycle, to work in all
these cycles that involve, it'scalled methylation, which when
you have rapidly dividing cells,um, as you do in pregnancy, when
you're growing a brand new humanbeing from scratch and your
body, there's a lot ofmethylation going on.

(25:00):
Um, your body has to do thisextra legwork to make it
metabolically active in yoursystem and the majority of of
folate, despite there being 150plus different types in our
foods, the majority of it wellover 90% is in the form of.
Methylfolate, the type of folatethat circulates in your body,

(25:21):
that's in your bloodstream,that's in your red blood cells,
that's in fetal cord blood.
So what the baby is, is takingin 95 to 98% of that is in the
form of methylfolate.
Hmm.
So it begs the question, why arewe not supplementing with
methylfolate?
Right.
Which doesn't need your body todo any of this work in order to

(25:45):
make it metabolically useful,um, to your system.
Instead, we're putting in thissynthetic folic acid that your
body has to do all this extralegwork to make it helpful.
Yes.
Your body absorbs it well.
Yes.
It's not the same as itparticipating well in what your
body actually needs it to do.

(26:05):
And so there's been a lot ofquestions raised about, uh,
whether we might wanna.
Switch over.
Yeah.
From doing full fromsupplementing everybody with
folic acid, um, or fortifyingall the foods with folic acid.
Um, when it's now been revealedthat the vast majority of these

(26:28):
populations that have foodfortification programs
polluting, most pregnant women,women and most newborn babies
have high levels of what'scalled unmetabolized folic acid.
So it's like the folic acid thatyou absorb super well that can't
do anything useful in your bodyjust kind of builds up in our

(26:48):
bloodstream and we don't fullyunderstand what that's actually
doing to our system.
Interesting.
That's actually why there's likean upper limit for folic acid,
the upper limit set by thegovernment.
The government's so afraid of,of setting like.
They set our nutrient standardslike so, um, I don't know.

(27:11):
So conservatively.
Mm-hmm.
Um, and even their upper limits.
So there's only an upper limitfor folic acid.
There's not an upper limit setfor methylfolate or natural food
folates.
Okay.
Um, for folic acid, it's set at1000 micrograms per day.
And a lot of times you haveprenatal vitamins that have 1000
micrograms per day.
Sometimes women are supplementedwith 5,000 micrograms per day of

(27:36):
folic acid, which is five timesthe upper limit.
Um, and that's not evenconsidering what you're taking
in from fortified foods.
So they've actually looked atlike, how much folic acid can we
all metabolize?
And it's somewhere between like200 to 280 micrograms of folic
acid.
That's like the limit to howmuch your body can metabolize

(27:59):
beyond that.
You actually start screwing upthe folate cycle and your body
like, it, it, it blocks theenzymes that are involved in
actually, you know, utilizing,uh, folate.
So you can actually have asyndrome where you're folate
deficient, but you have anexcessive intake of folic acid.

(28:20):
I don't know if that makessense.
It totally does.
Yeah.
Um,

Natalie (28:23):
that's

Lily (28:23):
so fascinating.
And that's, and that's in peoplewho genetically have fully
functioning enzymes in their Fcycle.
Okay.
So now we have this very widelydiscussed genetic mutation or
genetic variation called Mt hffr.
Mm-hmm.
And mt h FFR is the enzyme thatadds the, the methyl group on,

(28:51):
um, So if you have a geneticvariation in that and your body
is anywhere from 30 to 70% lessefficient at methylating folate,
and you take in a whole bunch offolic acid, your body can't do
anything with it.
So you end up folate deficient.

(29:13):
And there's a lot of things thatare reliant on this methylation
cycle and this full late cycle.
So it can have many downstreamnegative consequences.
Um, some of them are relevant tofertility.
So there have actually been casestudies, um, even in women
without an M T H F R variationwhere you take a woman who was
given a very high dose of folicacid to supposedly promote her

(29:37):
fertility.
So like a 5,000 microgram dose.
Okay.
And her lab markers, uh, of likehow well her folate cycle and
methylation are working.
Namely something calledhomocysteine.
It's an inflammatory compound.
You don't want it.
High, high levels are associatedwith a high rate of miscarriage
and a variety of pregnancycomplications.

(30:00):
Her homocysteine shot way up onthe high folic acid
supplementation.
They instead discontinued thefolic acid supplementation, gave
her a dose of methylfolate ofonly 500 micrograms, so tenfold
lower dose than what the folicacid was.
Yeah.
And her, in a matter of days,her homocysteine normalized and

(30:23):
her folate levels normalized.
Wow.
So again, it's a matter of like,what can your body actually
utilize?
Mm-hmm.
I, I don't know why it's like,so there's so much pushback with
the, with this conversation andmy.

(30:44):
Of course our guidelines aresaying very different things to
what I'm saying because I thinkthey ignore the biochemistry of
it.
Um, and it's just what we'vealways done.
So if you ignore thebiochemistry of it, then you
know, ultimately our body canuse some folic acid.
This is true.
We can use some of it.

(31:04):
Okay.
Um, we observe it at least,right?
And so it, it can be of somelevel of benefit, but there also
can be some level of harm orsome level of it not really
doing anything for us.
And if, if bolic acidsupplementation and
fortification was theintervention that prevented all

(31:25):
neural tube defects, I, Iwouldn't have any qualms, but
at, at least anywhere from fif30 to 50% of neural tube defects
are what's called folic acidresistance.
So despite these women havingsufficient intakes, their, their
idea sufficient intakes right,of folic acid, still there is a

(31:50):
level of, of neural tube defectsthat have not been prevented.
Hmm.
We don't even know the mechanismwhy folate, um, can help to
prevent neural tube defects, bythe way.
But we do know that when youhave sufficient concurrent
intake of a number of othernutrients that function in the
folate cycle, b12, B six,glycine, choline, and acetol,

(32:17):
uh, and a number of others, youcan actually reduce at least by
half the, the rates of neuraltube defects.
So it's more than just folateand it's certainly more than
just.
Folic acid.
Mm-hmm.
But to go back to your use ofthe term nutritionism, we got so
siloed in our view that okay,folic acid is the solution to

(32:37):
all of this, that we're missingeverything else.
Everything else is, yeah.
Wow.

Natalie (32:45):
Okay.
So if I'm hearing you correctly,in the case study, when she was
taking the, the methylfolate, itactually lowered her levels of
the, like built up folic acid inher system.

Lily (32:56):
Does that, I don't know that they checked her
unmetabolized folic acid.
Okay.
Um, I'd have to look at the casestudy, but they did check her ho
homocysteine levels.
Okay.
So her homocysteine levels are,um, levels, it's generally
considered like an inflammatorycompound.
Mm-hmm.
And if your folate cycle isn'tfunctioning normally, you'll

(33:16):
have a buildup of homocysteinein your system.
Got it.
Um, and so with the high, highfolic acid supplementation,
that's.
What occurred for her.
Okay.
There was an excessive level ofhomocysteine when they switched
her to the methylfolate, herhomocysteine levels normalized,
which is an indication that thatwhole nutrient metabolism cycle

(33:37):
is actually working properly.
Mm-hmm.

Natalie (33:40):
Okay.
Yeah.
So yeah, I guess I'm thinkinglike, is there a worry if you
have unmetabolized folic acid inyour blood?
Like do you need to get that outsomehow?
Or like by just eating nutrientdense foods, you're supporting
your detox pathways?
Like

Lily (33:55):
is that I think just by we, so we don't fully know the
effects of unmetabolized fofolic acid.
Okay.
There's been all sorts ofstudies that have looked into
whether or not this is a badthing.
We simply know it is occurringand it is now occurring at a
very high rate since we startedfortifying the food supply.
And we know that particularly inpregnant women, it happens at a

(34:17):
very high rate because most aretaking supplemental bull acid.
Some are taking supplementalfolic acid on top of a prenatal
that already has plenty of folicacid in it.
So they're getting like thedouble dose because they heard
that they need to get enoughfolic acid to prevent neural
tube defects.
They didn't hear that likebeyond the first, you know,

(34:37):
first little chunk of pregnancythat's not ure pass past the
point of neural tube closure.
And now it's just, yes,sufficient folate is important,
but the neural tube defectwindow is long gone and now
you're starting supplementationin the second trimester.
It's like, yeah.
So you have some women who arejust taking like tons and tons
and tons.

(34:58):
So it's a phenomenon that's beenobserved population-wide.
We have very high, uh,percentage of the population
that has unmetabolized folicacid in their system.
What effect is that happening?
Is that having rather, um, wedon't know for sure.
There's been.
A variety of, of peoplesuggesting that it might have

(35:19):
something to do with potentiallyneurological issues.
Um, high folic acid can, youknow, block the function of
vitamin B12 in the body.
So maybe it's contributing toB12 deficiency, which of course
affects our brain function.
There have been some studiessuggesting it might have
something to do with the risingrates of certain cancers because

(35:40):
generally folate helps with celldivision and, and replication.
So could we be contributing tosay you have pre-cancerous
lesion and then you have a wholebunch of folic acid in the
system.
Is that like perpetuating thegrowth of this pre-cancerous
thing that you wouldn't want to,like We don't know.

(36:01):
And I'm not saying any of thisis for sure.
Right.
Um, that's still genuinely upfor debate.
And this has been up for debatefor like.
20 plus years.
Okay.
So it's, it's an ongoing, it'san ongoing area of study.

Natalie (36:16):
Wow.
That's a lot to consider.
So I guess thinking through,like if somebody is
preconception, they're thinkingthrough their, their folic acid
folate supplementation, maybethey back off the prenatal
vitamins, potentially if they'reeating a sufficient nutrient
dense diet.
Well, I

Lily (36:36):
personally would recommend switching to a prenatal that has
methylfolate.
There you go.
Then there's no it there, thereis no unmetabolized folic acid
that builds up in your body whenyou take methylfolate.
And we do have to genuinely talkabout the benefits of folate,
right?
I mean, like you, you doabsolutely need sufficient

(36:58):
folate.
I wouldn't want anybody goinginto pregnancy, uh, folate
deficient.
Right?
So if the only thing you've gotis folic acid, I still think
that's better than nothing.
Okay.
Okay.
Um.
But, uh, you know, your, yourbody maxes out how much of it it
can utilize after like 200 to280 micrograms a day.

(37:19):
Um, and if you're taking in anyfortified foods whatsoever, all
of our refined grains soldacross state lines anyways, our
fortified with folic acid.
You're, you may be getting a lotfrom food that you didn't
realize, but I recommendswitching to a prenatal that has
methylfolate.
I recommend increasing theamount of folate rich foods

(37:43):
you're taking in.
And if you have one of thesegenetic variations like Mt.
H F R, many of us don't know wehave it unless we get tested.
But regardless, you know, it'sstill a benefit for all of us to
eat the natural forms of folateand the biologically useful
forms of folate likemethylfolate.

(38:04):
Um, But especially in thoseindividuals, like you wanna
really be emphasizing yourintake of fully rich foods.
So liver is our number onesource.
Um, then it's like leafy greens,legumes, um, certain seeds, uh,
avocado, asparagus, beets.

(38:25):
I have a whole list of all thefolate rich foods and their
concentration of folate perserving size in that article on
folate that you alluded to, andprobably a much more, uh,
succinct discussion, uh,logical, you know, discussion of
all the points on, on folatesince my, you know, default form
of communication, clearest formof communication is writing.

(38:47):
So I can really like puteverything in, uh, logical order
so you can follow my train ofthought in all my tangents.
Um, that's all, all in thatarticle.
So I would look there and lookat building in the number of
servings of folate rich foodsthat you can.
Ahead of time, ahead ofpregnancy, and of course

(39:07):
throughout pregnancy still ofbenefit.
Okay.

Natalie (39:10):
I feel like hearing you talk about it in real time and
reading the article really putssome things together for me.
So Good.
I needed both, which is great.
Yeah.
Yes.
Um, so with all of the folateconversation and the rise,
potential rise in tongue tiesshowing up in lots of babies,
how is that related?

(39:31):
Is there any new research onthat As of recent?

Lily (39:35):
Yeah.
So I, so not, not super as ofrecent, um, I did write about
the, um, I did write about themost, the really the most recent
and the only paper to date thatI'm aware of, um, on the topic
on my Instagram page.
So on my Instagram page, I have,um, I put in.

(39:58):
What I call research briefs,where it's a little summary of
studies that can fit in mylittle very limited caption.
It's a, uh, it's an exercise inbrevity for me.
Um, but we do have one study.
It was from 2020.
I've pulled it up so I can giveyou the actual exact
information.
Awesome.
They looked at 85 infants withtongue ties versus 140 infants

(40:21):
who did not have tongue ties.
And then they looked back at thefolic acid intake of their
mother's.
Um, so when they looked at folicacid intake at any intake level,
they found a slight butinsignificant increased
frequency of tongue ties.
When they looked at women whopreconception took folic acid on

(40:42):
a regular basis, they found thatthe rate of tongue ties was
significantly higher among thebabies who were exposed to folic
acid.
So they found a rate of tongueties of 51.4%.
In the babies of mothers whoregularly took folic acid
preconception versus a rate of25.7% in those who did not take

(41:04):
folic acid on a regular basispreconception.
So in other words, it was abouttwice the rate.
Um, still there were stillbabies in the group of moms who
did not take folic acidregularly, who still experienced
tongue ties.
Um, the idea that this might bea link is that one of the many

(41:28):
roles that, you know, folateplays in cell division
replication, all the things, isin the formation of what they
call midline structures.
So things, structures thatdevelop down the middle part of
our body, um, that would includethe, the.
Frenulum, um, underneath ourtongue.
And also the ones that attachour lips to our gum gumline, cuz

(41:49):
you can also have lip ties.
Um, so the thought is that ifyou have too much folic acid,
potentially you might make like,midline structures that are too
thick, too robust, hence, hencethe tongue tie.
Mm-hmm.
Um, I think it's probably like,it's probably a variety of

(42:11):
factors that contribute.
I've even heard from some oldermidwives that, you know, when
babies were born, they used tojust have a, a sharp fingernail
and they just like, eh, rightunder the, oh my gosh.
Right under the tongue.
And they, you know, they, theysnip that tongue tie.
Right on, right after birth, youknow, um, so what, what is it?

(42:33):
We, we don't really know.
I think it could be acontributing factor for some
people.
Um, I do wanna point out that inthis study, you know, the
average intake of folic acidwasn't that high.
It was only 400 micrograms perday.
Okay.
Um, but in the US average intakeof, of synthetic folic acid from

(42:53):
fortified foods in women isabout 300 micrograms per day.
Right?
So you're already almost hittingthat limit, just, you're already
almost hitting that limit.
Supplementing, and most of yoursupplements are gonna have at
least 400 micrograms, often 6,8, 600, 800 or 1000 micrograms
of folic acid.
So it is possible that we have,you know, a large proportion of

(43:17):
the population taking in morethan their body.
Can utilize, but I don't thinkwe have perfect answers on this.
You know, whenever I put stufflike this out there, you know, I
hear from, from women, like, Idon't, haven't taken any bull
acid, I don't eat any fortifiedfoods, I supplement with, with
methyl methylfolate only, and mybaby still has a tongue tie.

(43:39):
Like, I don't think it explainsall cases.
I think it might be acontributing factor for some,
and maybe there's some geneticsusceptibility or environmental
susceptibility that we don'tknow about that could be
contributing as well.
I don't

Natalie (43:54):
know.
Yeah, it's fascinating.
I know I've heard lots and lotsof stories of tongue ties
recently, and it, it seems justlike my own experience in
talking to clients, it seems tobe on the rise.
So, um, yeah.
Hopefully there's more researchsoon about it.
That would be great.

Lily (44:11):
Yeah.
I, I hope so.

Natalie (44:13):
Yeah.
Um, okay.
I had a couple, um, Audiencesubmitted questions that I
wanted to go into.
Um, so the first, well the firstone was, do you think there will
ever be proper nutritioneducation for expectant moms?
How are we doing on that?

Lily (44:31):
I mean, define the avenue of, uh, nutrition, ev education.
Uh, yeah, I If you're expectingthat your, you know, healthcare
provider is going to be up todate on all of the current
research on pregnancy nutrition,I mean, don't hold your breath.

(44:55):
Yeah.
Cause just on average, the, thequantity of hours of nutrition
education in medical schools isvery limited.
And, and the majority of themdon't have.
Really anything on nutrition orthey have a single three credit
course on nutrition.
And of course that class wouldbe, I could guarantee you just

(45:17):
rehashing whatever the dietaryguidelines are.
Mm-hmm.
Uh, which, you know, a lot of mywork is pointing out where those
guidelines are flawed and oroutdated.
So from that standpoint, youknow, I don't know that we can
expect that from providers.
And I also don't know that it'sfair because, you know, even as,

(45:39):
as a dietician, you know, Ispent four years studying
nutrition, not, not counting allthe work I did ahead of time.
I mean, nutrition was a passionof mine from a really young age.
So I already came in prettynutrition literate.
Yeah.
And then I, you know, four yearsof formal education, four years
of, or not four years, one yearin, you know, primarily a

(46:01):
hospital setting, doing likeinpatient clinical care sort of
stuff.
And then the years and years of.
Work with clients, work inpublic policy guidelines on
gestational diabetes, um, worktraining, other professionals,
work in private practice, allthe additional training.
And of course, for mepersonally, just thousands upon
thousands of hours of reading.

(46:23):
Yeah.
Research studies.
I don't know that we can expectthat from like a busy clinician
who has their, their practice,you know?
So I think, I think some of thisstuff we just kind of have to
take matters into our own hands.
If we wanna be educated on atopic, we need to find the
information ourself.
And I mean, my hope is that likewith, with my books, especially

(46:45):
with Real Food for Pregnancy,um, I've done some of the
legwork.
For you, um, you know, nutritionresearch compared to just about
anything else is so fraughtwith, um, you know, just flaws
in the methodology and thestudies study design, who funded
it, like what are the comcompeting interests and the

(47:08):
results of the study?
How did they like rig themethods to make a certain
dietary intervention or anutrient like, you know, come,
have the results come out acertain way?
How do they present theinformation?
Like, does, does the results anddiscussion section actually

(47:30):
match.
The data, because sometimes, Imean, if the study even includes
the data itself, like in atable, you'll be reading these
conclusions.
You're like, oh gosh, thissounds so dire.
And then you look at the, theodds ratios, risk ratios and the
data, and you're like, what inthe world?

(47:51):
I would never, I would nevercome up with that conclusion
from this same data.
Um, so interesting.
The longer that I do this typeof work where I'm like basically
full-time, like translatingresearch into something
actionable and useful, the moreI'm like, the quality of some of

(48:14):
these studies is, um, not good.
Yeah, not good.
Wow.
I'll just say that.
So, um, so I don't know howlong, how long it'll take, but I
think you just have to beproactive about seeking out the
information.
That you want.
Um, and I think there's justlike any profession, you will
have people from many, manydifferent professions that have

(48:39):
varying degrees of, of expertisein a topic, regardless of the
letters behind your name.
So there's a lot of people whoare not even nutrition
professionals in, in any mannerwho are just geniuses in this
field.
And on the flip side, you havepeople with all the so-called
appropriate designations, andthey're just, they're just

(49:02):
talking heads for the outdatedguidelines.
You know, it's, it's like, youknow, a plumber, you have really
good plumbers and you havereally terrible plumbers.
It's, you know, any profession,really great lawyers, really
terrible lawyers.
Um, so I think it takes just anindividual actually having an
interest in taking it uponthemselves to, to dig deeper, to

(49:23):
educate themselves.
I just don't think we can expectthat from.
From just any old provider.
You'll find it with some, you'llfind those, you know, needles in
a haystack, but it, it's notevery single one.

Natalie (49:35):
Yeah.
Yeah.
I know a lot of midwives now aregiving your book to every client
just because it's the bestsource out there, I feel like.
And thank you.
Yeah.
Yeah.
And I, I truly mean that.
I feel like it's great forprofessionals as well as the
average consumer.
And I think that's, so, um, Idon't know, it speaks volumes

(49:55):
about how you write, but it'salso something you talk about,
like, women aren't dumb.
Yes, yes.
They can learn and research ontheir own and, and come to their
conclusions and, and be smart.
It

Lily (50:09):
doesn't have to be, and we, and we have to approach, um,
pregnancy, birth, and motherhoodthrough, you know, being
knowledgeable and empoweredbecause there's just a lot of, a
lot of things and our wholesociety and medical system and,
and other things that just.
Don't even make common sense.
So, um, yeah, you have to reallybe, be on top of, be on top of

(50:34):
it yourself.
Um, and I really do, I, I don'tsucceed every time, but I do
really try to put in an effortto make information that is
maybe a little too high level, alittle too full of jargon if
you're just gonna go read the,the study, um, into something

(50:57):
that makes sense to the averageperson.
I mean, I think, of course, I'm,I'm writing to an audience that
has at least a high school.
Education or beyond, you know,there, it's a literate
population.
Um, my first book, real Food forGestational Diabetes is, is, uh,
much more simplified and writtenin, in simple terms, but real
food for pregnancy really islike writing to that educated

(51:20):
audience because that, those arethe people that kept asking me
for information because there's,there's plenty of general
information out there aboutpregnancy.
There really isn't a lot of veryspecific information about
pregnancy.
And on top of that, I think mostproviders are really not
comfortable questioning, um,guidelines.

(51:43):
I mean, gosh, the thought thatlike, You could potentially, you
know, do harm to a mother or ababy by like, not following the
guidelines.
I mean, I take that extremelyseriously.
Yeah.
Ultimately, that's why I wroteReal Food for Gestational
Diabetes in the first place,because the guidelines were
harming mothers and babies, andwe do need to, uh, revise those,

(52:07):
at least in regards to, uh, orespecially in regards to
carbohydrate consumption, tooptimize blood sugar levels and
optimize outcomes like it.
Mm-hmm.
It felt like a moral obligationto, to write that.
But the more you dig into moreof these things, it's like, holy
moly are, are we unwittinglyputting women and babies in, in

(52:29):
harm's way or just notoptimizing outcomes by not
talking about, Hey, there's thisresearch showing our.
Protein requirements are set,73% too low in pregnancy.
Like, come on, this isn't, thisisn't a 5% margin of error.
Yeah.
This is a major, this is a majordiscrepancy here.

(52:50):
Um, so anyways, yes, I, I, Iappreciate your feedback.
I, I do know there's some, youknow, midwifery, uh, programs
that, that have real food forpregnancy is required reading.
I do.
Oh yeah, definitely.
Um, appreciate that.
And, and I hope that, you know,it kind of just trickles down to
better advice across the board,maybe given another 20 years and

(53:13):
will have some.
A little more of like a, a levelplaying field here.
Yeah.
Hopefully

Natalie (53:18):
not that long, but maybe, um, speaking of protein,
there was another question aboutprotein.
Um, they wanted to know your toptips for protein aversions.
Um, she said she had onlystomach plant proteins during
her pregnancy, but knew theimportance of animal foods.

Lily (53:36):
Mm-hmm.
So I've, I've seen thisoccasionally, uh, particularly
first trimester and particularlyin women who had a really solid
foundation of nutrition cominginto pregnancy.
Hmm.
So, I've seen both things.
This is totally anecdotal, youcan't quote me on any studies
here, but I have had women whoare vegan, previously vegan have

(54:01):
like undeniable, um, unavoidableurges to eat eggs, specifically
egg yolks, bone broth.
Oysters in their pregnancy.
And then of course the classiccraving for like a burger.
But like you take even thosefirst three foods I mentioned

(54:23):
and that fills in almostentirely all of the potential
nutrient gaps on a vegan diet.
Like that's fascinating.
And I've even had women in theirfirst trimester say that those
were the things they werecramping.
And that is a time that'sclassically a period of meat
aversion for a lot of women.
Um, on the flip side, I havesome women who come in, they're

(54:43):
like paleo or high protein orfull carnivore, and they come
into pregnancy and they're like,mm, you know, I can't, I can't
do it.
Hmm.
So I have to wonder if there'ssomething behind the sort of,
you know, cravings have some, oraversions have something to do
with the nutrient requirementsof the body and your body's

(55:05):
trying to like sort of balanceout where there's gaps.
I really do think that's apotential.
Uh, possibility.
I mean, I myself am very muchlike a mindful intuitive eater,
so I didn't really overthink mycravings or aversions during
either of my two pregnancies.
It was just sort of like, oh, Ireally want citrus this week a

(55:25):
lot.
Okay.
Ooh, salmon sounds really goodthis week.
All right.
Ooh, liver pat on crackers.
Like, I'll have more of that.
Or, you know, oh, I only wantsour gummy worms.
Darn it.
Let me try to find somethingthat'll give me that sweetened
sour without being sour gummyworms.
Yeah.
Um, you know, but maybe there's,maybe there's something to these

(55:48):
cravings that we don't fullyknow about.
Hmm.
So, in the case of somebody, youknow, who has full animal
protein aversions, I mean, Ifeel like what I would try to do
is, well, a, eat what you can,um, maybe the bulk of your
protein intake will be from.

(56:09):
Beans, legumes, nuts, seeds,those sorts of items.
And maybe you can find ways tokind of sneak in a little bit of
these foods from time to time.
Little bites of things here orthere.
Sometimes it can be the way it'sprepared or who is preparing it.

(56:31):
Mm.
So at times when I didn't reallywanna be eating meat, it was
more that I didn't want, thesmell of cooking was just
entirely repulsive at differenttimes in my pregnancy.
So like, I'll happily eat, holdpork, but like, can you prepare
it and stick it in the slowcooker in the garage?
And then I'll eat it when it'sfully done, but I don't wanna

(56:53):
touch it or smell it cooking.
Um, I hear that a lot with likepoultry chicken for example.
So that's, that's a possible wayto get around it.
Um.
Or to buy it pre-prepared, like,again, period of time where like
cooking eggs was like, eh, I'mthe biggest fan of eggs, right?
But like, yeah, the smell of itcooking, ugh.

(57:15):
Um, but like a pre-made eggsalad was like so delicious or
interesting.
You could do eggs in somethinglike make some pancakes where
there's eggs in it.
Or I have like a, a spicedbanana nut muffin recipe in my,
um, e cookbook.

(57:35):
You can find thatover@shop.lilly nichols rdn.com.
That's like, has a lot of eggsin it, actually.
Um, really nutrient dense,well-balanced macronutrients
doesn't spike your blood sugar.
And there's also ginger in it,which often helps with nausea.
Um, maybe that's how you'regonna get your eggs in.
Maybe you wanna just round outyour amino acid profile with

(57:58):
some collagen.
Or gelatin.
You could make like gelatin,gummies with, with fruit juice,
there's a recipe for some andreal food for pregnancy.
There's at least one more in my,um, e cookbook.
Um, or you could add collagen,two different things.
So say you wanna have, you know,everybody talks about collagen

(58:20):
and coffee, tea, cocoa.
Yes, that's the thing.
Oatmeal, whatever.
But you can also add it tosavory foods, which I think in
some ways actually, if it, ithas a subtle flavor, depends on
the brand.
Some brands are, uh, tasteawful.
Other brands don't have superoff flavors.
But, um, say you wanna have, youknow, you want pasta for dinner,
right?

(58:40):
Maybe you could do one of thoseleg yume based pastas so that
you're getting extra protein inthere and extra nutrients in
there.
And maybe you only want redsauce, but you add a couple
scoops of collagen to the redsauce.
There's no meat in there.
But you've added protein to it.
Guarantee you the flavor ismasked in something savory like

(59:02):
that.
Yeah.
Um, you could, you know, I wouldget creative with it, but I
mean, ultimately you have to dowhat you gotta do.
And, um, if, if that were thecase and animal protein is very
limited, I would, I would put,you know, even more of an
emphasis on like a high quality,comprehensive prenatal vitamin
to make sure you're rounding outyour nutrient intake.

(59:25):
Cuz with very low animal foodintake, you might run into
issues with, um, like vitaminB12 deficiency or zinc
deficiency or iron deficiencyand a number of other things.
So a, a prenatal to round itout.
Um, I don't think we mentioneddairy, I don't know if dairy's
included in the animal proteinaversion, but dairy can fill in

(59:46):
a lot of, a lot of nutrientgaps, including pro, um, in the
diet.
So maybe you wanna focus alittle more heavily there, but.
I would also say like, I don'tknow if this person is writing
in at the end of their pregnancyor if they're in the middle,
things change.
Yeah.
You know?
Yeah.
True.
It could ha it could be thewhole pregnancy, but if it was

(01:00:09):
just like you're writing in at17 weeks, like you very well
could still have those, thecarryover of those early
pregnancy aversions, or youmight have different aversions
come up at different times andjust roll with it and things
kind of even out over the weeks.
Like I, I don't always get superconcerned over, you know, short
term food aversions, especiallyif there's supplementation on

(01:00:30):
the side to kind of fill in thegaps

Natalie (01:00:33):
a little.
Right.
And I guess if you're going intopregnancy with a really solid
foundation as well, then mm-hmm.
You could worry less.
Mm-hmm.
Yeah.
Yep.
Um, okay.
Uh, last question from theaudience was, How much of your
book translates to life afterpregnancy and postpartum, and
they were assuming that, youknow, if it's good for growing a

(01:00:55):
human, it's probably good foradult life too.
Um,

Lily (01:00:58):
yeah, yeah.
Uh, vast majority of it does.
Um, and the last chapter,chapter 12, is all about the
fourth trimester.
So it's all about postpartumnutrition, nutrient repletion,
um, nutrition for breastfeeding.
So ultimately the sameprinciples hold true across the

(01:01:22):
board.
You certainly don't have any,shouldn't have any remaining
fears about beyond the generalsense, but like food safety or
certain foods need to beavoided.
Even though some of that is notentirely true.
Read chapter four.
Yes.
Um, that part of it no longerapplies postpartum, so you don't
have to be as, as concernedabout that.

(01:01:44):
Um, but the same nutrient densefoods that you emphasize during
pregnancy Yes.
Continue to emphasize thosepostpartum for sure.
Um, especially protein.
So I talk about protein in realfood for pregnancy.
Um, in regards to your intakewhile you're pregnant, since,
since the book was published,there actually has been a study

(01:02:06):
looking at protein needs inpostpartum.
Um, they looked at women atthree to six months postpartum
who are breastfeeding, and theirprotein requirements are
actually higher than pregnancy.
Okay.
They're at, they're at the levelof, at the level, at or beyond
what a typical female athleteconsumes.
Okay.
So, Lot of protein.

(01:02:27):
Yeah.
So my, it doesn't surprisethough, my biggest
recommendation for postpartum isto be over the top in
emphasizing protein,particularly the nutrient dense
ones that we already talkedabout earlier in the interview.
Um, and in higher portions thanyou had in pregnancy.

(01:02:47):
That solves like 99% ofeverybody's problems.
Seriously get enough protein,um, but also expect that your,
your appetite typically is goingto be a lot higher cuz your cal
caloric demands like energyneeds, protein needs, and then a
number of differentmicronutrient needs are much

(01:03:08):
higher.
During postpartum.
Hmm.
So I would emphasize all thesame things you were doing in
pregnancy, just larger portions.
I typically recommend continuinga prenatal vitamin, uh, during
at least the first six monthspostpartum.
If you're nursing, you mightwanna continue that longer, um,
and really focus your effortson, you know, rest and recovery

(01:03:32):
and who's gonna help supportthat for you because you can't
do it alone.
So definitely read that chapter.
I do have, um, as kind of afollow up resource, I'll have a
number of resources onpostpartum, but I do have a free
blog post on my website that'scalled something like Real Food,
postpartum Recovery Meals.

(01:03:52):
I link out to 50 plus recipes.
I give you some of therationale.
I talk about freezer tips and,and options for building in
support and encouraging yourcommunity to bring you meals,
things like that.
Um, that's definitely a reallypractical.
Guide thousands of people readthat specific article on my
website every single day.
Okay.
Yeah.
So it's like, it is a goodresource to have and it's

(01:04:14):
totally free, it's just on mysite.
Um, I do also have, um, this isa little higher level more for
professionals, but anybody iswelcome to view.
I do have a postpartum recoveryand nutrient repletion webinar
over at the Women's HealthNutrition Academy.
Um, and that's roughly a twohour webinar going through all

(01:04:35):
of like, you know, what toexpect at different timelines,
sort of the trajectory ofhealing your postpartum body lab
tests, um, thyroid issues,postpartum mental health.
It goes through like, just sortof a wider gamut of things.
Okay.
Um, and I actually have aseparate approximately two hour
webinar all about, um,breastfeeding, nutrition and

(01:04:56):
nutrient transfer into breastmilk.
Cuz what you eat also impactsfor some nutrients, not all the,
um, vitamin and mineral contentof.
Your breast milk.
So you also wanna look at thisas like a two birds with one
stone situation, right?
Mm-hmm.
Like the better nourished youare for some nutrients, the more

(01:05:17):
nutrient replete your breastmilk will be as well.
For example, if your B12 levelsare low and your B12 intake is
low, your breast milk will alsobe low in b12, and that has
potential consequences for yourbaby's development.
So while I think a lot of peoplehave the focus for postpartum
just being on, you know, weightloss, oh, I just wanna lose the

(01:05:38):
baby weight and get my bodyback, whatever that means.
Yeah.
It's a, you know, that's a lie.
Yeah.
Yeah.
Your body's just changes and notnecessarily in negative ways.
Your body just goes throughchanges and these are all good.
Um, but we really need to havethe focus on, um, nourishing

(01:05:58):
the, the mother, um, and, andbuilding in that community
village support to make that apossibility.
And I won't get all politicalhere, but you know, it's a train
wreck that we don't havematernity leave as like a
default in the US like othercountries do.
Cuz you really do simply needtime.

(01:06:20):
You need yeah, time.
And in other cultures there is abig emphasis on allowing that
time.
But also there is just abuilt-in cultural support
network and support practicesand, and nutrition practices,
um, to support those mothers.
And I, I do talk about a bunchof those different cultural

(01:06:40):
practices in, um, chapter 12 ofReal Food for Pregnancy.
I think there's a lot that wecan learn from them.
Um, if you're just trying tolook at like the published
research, there's very littleresearch done on postpartum.
It is a very understudied timefor human nutrition, for animal

(01:07:00):
husbandry, for, uh, farmanimals.
Where there's a financialinterest in these animals
recovering well and being ableto have more babies or making
sufficient milk for the dairyindustry or whatever.
There's a ton of research onfarm animals, and that's pretty
consistent, that like thenutrient demands are way higher
in postpartum.

(01:07:21):
We don't have that strength ofdata for, um, for humans, but
it's, it's pretty obvious foranyone who's had a baby, like,
holy cow, my appetite is higher.
Oh my gosh, I need a lot morefood.
Ooh, on the days when Iundereat, especially protein, I
feel like garbage and my mentalhealth is a disaster and my
energy levels are tanked and Ijust feel completely zapped and

(01:07:43):
wow.
On the days when I get enough, Ifeel actually semi human again.
You know, like these are, we, wedon't, almost don't even need a
study to say what is.
What is obvious, right?
But a lot of it is, do we havethe support to make that happen?
Do you have the time off to makethat happen?

(01:08:04):
Have you allowed yourself torest?
We very uncomfortable in Americawith like quiet time and time
off and not being busy and notbeing what we think of as
productive, right?
Um, but this is just the time tonot be productive.
Like y you know, I had to liketalk myself off the ledge in my

(01:08:25):
first postpartum.
Like, this is all too much.
I can't do all this.
I'm like, okay, my only jobtoday is like to feed myself and
feed the baby.
Okay?
If I can get that done, the daywas a success, right?
Mm-hmm.
Mm-hmm.
You know, it's like that'sreally, that's the level you
need to simplify, simplify,simplify, and then simplify some
more.
Yeah.
Uh, especially in that firstmonth to two months, it's like

(01:08:47):
you just, yeah.
Pair it down.
Eat, eat, lay down.
Yeah.
Yeah.
Yeah.
I

Natalie (01:08:57):
think, I think maternal mental health, I think childhood
health, I think just in general,we'd have a better system in our
entire country if we focused oneating good foods, preconception
and then resting in postpartum,like, you know, a

Lily (01:09:13):
hundred percent.
Yeah.
Yeah.

Natalie (01:09:16):
It's crazy.
Yeah, it's big.
Um, okay.
I have a couple questions that Iask every guest and I wanna
know.
So this one you can expand ifyou need to, but I want to know
your number one piece of advicefor our listeners.
So what do you want every personto know?

Lily (01:09:34):
Hmm.
I mean, I have to go withprotein, uh, eat enough protein.
Yes.
Especially at breakfast, andjust observe how your life and
whole day is vastly better whenyou do that one thing.
Yeah.

Natalie (01:09:51):
I have started like in the last year and a half eating
breakfast.
I used to be like a coffee firstand like maybe a granola bar or
something as I Yeah.
Ran out the door and Yep.
Yeah.
It's made loads of difference inmy life.
So

Lily (01:10:05):
transforms your life.
Mm-hmm.
It's especially important forhormone balance and fertility,
by the way, too, not just, notjust pregnancy.
I mean, it's important foreverybody across the board.
Yeah.
But makes a big difference in,in menstrual cycle regularity
and ovulatory function and bloodsugar balance and stress

(01:10:25):
hormones and all that.
So, yes, please eat breakfastand eat, make sure there's
protein there as well.
It'll, yeah, really help youfeel better.
Awesome.

Natalie (01:10:35):
Okay.
Second question is, what is yourcurrent favorite daily wellness
habit that you're incorporatinginto your own life?
Hmm.

Lily (01:10:45):
Current favorite.
Let's see.
Um, well, it's June, so a lot ofthings in my garden are hopping.
So, um, I guess my favoritewellness habit is going outside
barefoot and picking somethingfrom the garden, whether it's,
uh, you know, snap peas or plumsor tomatoes or zucchini or

(01:11:09):
something.
Just being outside and gettingyour feet in the dirt.

Natalie (01:11:13):
I love that.
I don't know if you know thisabout me, but I'm a huge
barefoot advocate and minimalfootwear wearer,

Lily (01:11:20):
so it makes me very happy.
Likewise, likewise.
I'm so bad.
Likewise, yes.
I, I prefer to be barefoot overmy earth.
Runners.
I mean, the earth runners aregood and all, but yeah.
No, Barefoot's better.
Yeah.
Awesome.

Natalie (01:11:31):
I have an earth runner, tan, tan line, so I feel like
that's a successful summer

Lily (01:11:36):
so far.
That's tricky in Alaska, right?
Yes.
The, yeah.
Yeah.
Although I do have a pair ofbarefoot boots, so you know,
they're out there, the minimalflat and everything, but yeah,
you can't go barefoot when it's,uh, below zero.
That's, I know.
That's not a good idea.
It's tricky.
It's really tricky.
Tricky long.

(01:11:56):
Yeah.

Natalie (01:11:58):
Oh, okay.
Um, so can you tell us where canpeople find you online?
Um, and then maybe talk a littlebit about the Women's Health
Nutrition Academy as well forthe practitioners listening.

Lily (01:12:10):
Yeah, so you can find me on my website, which is lilly
nichols, r d n.com.
Um, I'm also on Instagram, same,same username.
So it's Lilly Nichols, r d n.
Uh, let's see, over on my sitethere's 250 plus blog articles.
Use the search function to pullup whatever is of interest to

(01:12:33):
you.
There's a lot of freebies.
You can get the first chapter ofreal food for pregnancy for
free.
I have a free video series ongestational diabetes.
Um, there's a bunch of littlefreebies on that page, so grab
that when you grab a freebie.
You also get my, uh, not veryfrequent newsletter anymore cuz
I have so much on my plate.
I'm not sending as many emailsas I once did.

(01:12:55):
Um, but yeah, there's a ton ofinformation over on my website.
So, That also links out to mybookshop.
So if you want either of mybooks, I have Real Food for
Pregnancy, real Food forGestational Diabetes.
Um, those are on the sidebar.
There's also a books tab on thetop.
You can see where to purchasethose, if those are of interest.
And yeah, for the uh, women'sHealth Nutrition Academy, that

(01:13:18):
is a, uh, resource that I puttogether with my colleague Ala
Barer, who's also a, adietician.
And we have pretty in depth.
Practitioner level webinars anda variety of women's health
specific topics.

(01:13:39):
Um, most of our webinars areabout 90 minutes to two hours
long.
Um, really, I don't think any ofthem are less than 90 minutes,
so they're at least 90 minuteslong so you can kind of get a
feel for the depth of content.
They come with a full referencelist for all the studies that
we're speaking to, um, in ourpresentations.
So yeah, there's a wide varietyof topics.

(01:14:02):
There's, uh, some that are onpregnancy.
I've done most of thosegestational diabetes, uh,
postpartum recovery and nutrientrepletion, nutrition for
breastfeeding.
Uh, we have a whole two hourwebinar on folate, right.
That gigantic article on mysite.
Apparently is not in depthenough.
And so if you're a practitionerwho has any questions about

(01:14:25):
folate or methylation as itrelates to fertility and and
pregnancy, that is the webinarto go listen to.
Um, it's very in depth.
You will, no stone is leftunturned on the folate
conversation.
Um, yeah, there's just a ton onthere.
There's a bunch on fertility.
Um, we started a series on P C OS.

(01:14:46):
The first one of those is upthere, so just browse those.
Um, awesome.
It's definitely a usefulresource there.
Uh, yeah, buy one, buy'em all.
And, um, in addition to that,just this year I launched the
Institute for PrenatalNutrition, which is a full, um,
At the time, the first time Iran it, it's 13 weeks.

(01:15:08):
I'll probably do it a little bitlonger the second time, but
it's, um, a comprehensiveprenatal nutrition mentorship
program.
So if anybody wants to betrained as a prenatal
nutritionist, um, I'm going tobe running that again in 2024.
So, um, yeah, stay tuned forthat.
If you Cool.

(01:15:28):
Don't wanna just do one-offwebinars, but you want like a
full walk you through all thethings.
Uh, mentorship with q and acalls every single week.
Case study sessions, like areally good community.
Um, there that's also will,again, be an option in 2024 when
I run that again.

(01:15:49):
Okay.

Natalie (01:15:49):
And are there prerequisites for that?
Do, do people have to have acertain degree or things like
that before they enroll?
I do

Lily (01:15:56):
require that people have some sort, there's some health
professional of some kind.
Okay.
Um, You know, if you just have adegree in nutrition but no
professional designation, that'stotally fine.
Um, I accept Allied Healthcareprofessionals, not just
dieticians.
I accept non dieticiannutritionists, assume assuming

(01:16:17):
you have a solid background innutrition, but like this round,
we had, um, mostly nutritionistsand dieticians, but we also had
a midwife.
We also had a physicianassistant.
So if there's any sort of, um,you really need kind of a
medical science or nutritionbackground just for the level of
the content.
Um, the level of the content islike way far above, uh, real

(01:16:41):
food for pregnancy level.
Um, and, and much of it is aboveWomen's Health Nutrition Academy
level as well, although there isa little bit of overlap, of
course.
Um, so I, I do need it to be amedical professional.
I do, I do have plans to createsomething, um, smaller and a
little more, you know,Reasonable, uh, level of detail,

(01:17:05):
um, for people who are likedoulas or childbirth workers or
even medical professionals whodon't wanna do a full on huge
lengthy, um, mentorship programas well.
So that'll be in the works.
I don't know if that will belaunched in 2024, but at some
point, I know I've been askedmany, many times for that.
So I'll be working on that aswell.

Natalie (01:17:27):
Cool.
Oh, man.
Awesome.
Well, thank you.
Thank you for being here andsharing your time.
Thank you.
Thank you.
And energy with me today andproviding so much information
for people.

Lily (01:17:38):
You bet.
Yeah.
Happy to do it.
Great questions.

Natalie (01:17:41):
I'm glad.
I so enjoyed my chat with Lily,and I hope you did too.
I've been a big fan of her workfor a number of years now, and I
am so happy she's doing the workto educate us all on nourishing
our bodies for the bestoutcomes, not only for
ourselves, but our children too.
I've listed all the resourcesshe mentioned in the show notes
for this episode for your easyreference.

(01:18:03):
And if you have not read RealFood for Pregnancy yet, Put it
at the top of your list.
Please remember that what youhear on this podcast is not
medical advice, but remember toalways be an active participant
in your care and talk to yourhealthcare team before making
important decisions.
If you found this podcasthelpful, please consider leaving
a five star rating on Spotify orwriting a review on Apple

(01:18:25):
Podcasts, as that really helpsother people find the show.
Thanks so much for listening.
I'll catch you next time.

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34. Lily Nichols on Fueling Fertility: Demystifying Preconception Nutrition with Real Food

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