On today’s episode, I’m chatting with Lily Nichols about Prenatal Nutrition!

Fed and Fit podcast graphic, episode 146 prenatal nutrition with Lily Nichols with Cassy Joy

We’re back with our 146th episode of the Fed+Fit Podcast! Remember to check back every Monday for a new episode and be sure to subscribe on iTunes!

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Episode 146 Links

  • Visit Lily’s website, Pilates Nutrition, HERE

Episode 146 Transcription

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Cassy Joy: Welcome back to another episode of the Fed and Fit podcast. I am your host, Cassy Joy Garcia. And today I am thrilled to bring you a really wonderful guest. Her name is Lily Nichols. She’s a registered dietician/nutritionist. A certified diabetes educator, researcher, and author with a passion for evidence-based prenatal nutrition and exercise. Her bestselling book, Real Food for Gestational Diabetes, and online course of the same name, presents a revolutionary, nutrient dense, lower-carb diet for managing gestational diabetes. Her unique approach has not only helped tens of thousands of women manage their gestational diabetes, without the need for blood sugar lowering medication, but has also influenced nutrition policies internationally. It’s very cool.

Lily’s second book, Real Food for Pregnancy, outlines the problems with current prenatal nutrition guidelines, and provides the evidence; 920 citations and counting; that’s wonderful. That supports a real food diet to optimize maternal and fetal health. It’s what we all want to learn about. Especially those of us that are currently pregnant, planning to get pregnant, or maybe we’re just generally curious!

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

Lily Nichols: Thank you for having me, Cassy.

Cassy Joy: Thanks for coming on! This is so exciting! I would love it if you could share a little bit more about your story, your background. What led you to this profession in particular. And with this brand-new book, why are you focusing now on prenatal nutrition?

Lily Nichols: Yes. I’ll start from the top. I got interested in nutrition from a young age. I’m one of those rare people who decided in high school; I am going to study nutrition! And then stuck with it. Everyone’s like; you’ll change your major! You’ll change your mind. And I was really into it from the beginning.

Pretty soon after I finished my training; my academic training and clinic training, I started working more in gestational diabetes and prenatal nutrition. I worked with the state of California for their diabetes and pregnancy program, which is called Sweet Success. And it was there that I was able to see both clinically and at the public policy level really more in-depth of why and what all the dietary recommendations are in pregnancy. And then what works and what doesn’t work.

And what was kind of disappointing for me was, when I was working clinically and implementing the guidelines that I had helped create at the state level, a lot of my patients’ blood sugars were getting worse. And that was really; it set off a lot of red flags in my mind, and really made me question the current recommendations. And eventually that led to me developing my real food approach for managing gestational diabetes, which is much higher in nutrients. It’s also lower in carbs, of course, because we know carbohydrates are what raises blood sugar.

But I was really the first dietician to at least publicly speak out about the problems with those recommendations. Which eventually led to me writing my book. And then once I released the book on gestational diabetes, it really kind of took on a mind of its own. I got so many requests from doctors, and midwives, and OB/GYNs who were recommending my book to their non-diabetic clients. Non-diabetic pregnant women.

So imagine you’re a pregnant woman, and your doctor is like; here, read this book. And they’re like; do I have gestational diabetes? What’s going on here? So that really started making it clear I needed to write a book on prenatal nutrition more generally. And between writing the first, and now the second book, I had a baby myself, so I learned a lot just personally going through that process, and all the frustrations of what’s true and what’s not true about prenatal nutrition.

I found myself in this sort of space of; you either follow the guidelines at face value and trust that what they say is accurate. Or you follow some other popular book that’s just the author’s opinion, but it’s not backed with any evidence. So you really don’t know who to trust. I personally approached nutrition from more of an ancestral, paleo-ish approach, and I like to learn from what traditional cultures have done for thousands of years to have healthy pregnancies and stay healthy without chronic disease. And so that really colors the lens through which I view nutrition information. But I also want to have things backed by evidence. So that’s really what I’ve tried to do in my forthcoming book. Hence why it has so many citations; a lot. {laughs} Was that I want people to have a trustworthy source of information that’s also accurate and up to date. So that’s where I’m at.

Cassy Joy: That’s wonderful. Wow. What a really cool undertaking! And profession to pursue. I’m just curious; what have been some of your; I’m blindsiding Lily with this question. But what have been some of your favorite client success stories? I would just love if you could pick one that maybe floats to the top of your mind?

Lily Nichols: Oh gosh. Well, I’ll have to float back to gestational diabetes, because that’s so much of my focus and my practice. Typically with gestational diabetes, if a woman requires medication or insulin to manage her blood sugar in one pregnancy, it’s likely that she’ll need it again.

I’ll back up. If you have gestational diabetes in one pregnancy, odds are that you’ll have gestational diabetes in your second pregnancy, and third pregnancy, and so on. If medication or insulin is needed, typically those will be required again, and usually in higher doses. It’s assumed that it just gets; it snowballs over time.

Cassy Joy: Gotcha.

Lily Nichols: I had a gal who had had three pregnancies, all of which had required insulin to manage her blood sugar. She was now on her fourth. So I’m like; ok. All of the odds are stacked against you for managing this with diet alone. So I was very up front with her that we can do a lot with food, but we still might need some insulin or medication. Totally ok.

Anyway. She ended up going through her entire pregnancy without needing any medication. Her blood sugar was spot on the entire time. All of her other babies had been born on the bigger side, which is one of the risk factors with gestational diabetes, and this one was an even 8 pounds, 1 ounce. She didn’t have the swelling. She didn’t have the blood sugar as high. Her baby didn’t grow too big. She was able to have a beautiful vaginal delivery. It was just great. So that’s one of the biggest one that sticks out in my mind. Because it goes opposite what all the statistics and all the research will tell you is possible.

Cassy Joy: That’s very exciting. Wonderful. What a neat way to touch somebody’s life. I’m curious now. I get a lot of questions. At this point, by the time this show airs, in complete transparency. Lily and I are chatting in late December. And this show will air in late February when your brand-new book is available. So by now, I’ll have a baby on the ground and life will be very different. But through this pregnancy. She’s not here yet, while you and I are chatting. She’s due in a couple of weeks. But through this pregnancy I’ve gotten a lot of questions.

I’m a certified nutrition consultant, and I have my own professional opinions. And also, of course, what I call my Perfect You Plan as part of my online food and fitness, essentially lifestyle design that I help walk folks through to figure out what works for them to kind of individualize thoughtful nutrition and healthy lifestyle habits.

So folks are watching what I’m eating and putting in my body during pregnancy. I’ve gotten a lot of questions about; what are the important foods to focus on? So I would love it if you could share your thoughts on the foods to prioritize most during pregnancy. And let’s say if somebody is newly pregnant, or thinking about it, what are the top three or four that you think they should start focusing on including in their diet?

Lily Nichols: Absolutely. That’s a great question. And I’ve been stalking your Instagram account, so I approve of what you’ve been putting in your body to nourish you and baby right now.

I’ll give my answer, but I’ll give a caveat for early pregnancy. Because early pregnancy is sometimes the trickiest time to switch over to some of these nutrient dense foods. Because often times food aversions and nausea and stuff creep in. But with that said, and we can go into how to manage those things, or why those things happen. Because there is a reason for those things to come up.

I will talk about some of the foods that are really important for providing you and your baby with the nourishment needed to have a healthy pregnancy and to encourage normal or optimal development of your baby.

So a lot of women feel that they should be eating certain foods during pregnancy, and a lot of traditional cultures actually prize certain foods before, during, and after pregnancy. And I found that really interesting when I started looking at, especially the conventional nutrition guidelines and seeing the foods that recommended. Like the sample meal plan that I’ve seen is like; oatmeal, skim milk, and strawberries. And that’s breakfast. Which is kind of opposite of what I recommend, because there’s no protein in there, very little fat. Not very satisfying. And if you look at a micronutrient breakdown of what’s in there, you’re not going to get barely any vitamin B12, barely any choline. All these nutrients that are important for brain development.

So when you start breaking it down, and sort of what I call reverse engineering a perfect prenatal diet, we look at the nutrients that are most needed for fetal development. The ones that are most lacking in our diet. And the look at the foods that provide those. So eggs definitely top of my list. Most women can stomach them, too. Again, depending on if the food aversions have really crept in. But eggs are fantastic. They’re really rich in B vitamins, or a relative of the B vitamin. So it’s identified after all the B vitamins were set early on in the 1900s. But it’s called choline.

And choline is really important for brain development and vision development. And it’s very difficult to get in our diets. The two main places we get it are eggs and liver. And I know you had liver and meatloaf just like I had liver and meatloaf, and that’s definitely on my list of healthy foods. But a lot of women are unfamiliar with how to use it, or don’t like the taste, or whatever. And if that’s you, eggs are really going to be your primary source of choline.

There’s a lot of other good stuff going on in eggs, as well. So you have vitamin B12, and you have omega-3 fatty acids, including the other really important nutrient for brain development, which is DHA. You have vitamin A and E, and vitamin D. There’s a lot of good stuff in eggs. They’re very rich in protein, which is very satisfying to help you manage cravings. So eggs are definitely top of the list. That’s an easy sell for most women, too.

Liver, like I mentioned, is also important if you can get by the; if you’re not used to eating it you have to kind of figure out ways to fit it into your diet. And I usually, like you, hide it into other recipes like meatballs, or meatloaf, or Shepard’s pie or something like that.

Liver is going to be your best source of highly absorbable iron by far. So if you’re prone to anemia or concerned about anemia, iron is really important to get enough of. And unfortunately, most iron supplements, you don’t absorb it very well. So liver ends up being an excellent source.

I have several other foods that I could go into in so many details, so you tell me if you want to hear more of them or if you want to move on. {laughs}

Cassy Joy: No, I love it! This is my chosen career path also {laughs}. And I think most listeners here at Fed and Fit are pretty geeky oriented, so feel free to jump into a couple more.

Lily Nichols: Ok. I’ll share one more. I have 5, 6, or 7 of them that are really my favorites. One that I really want to touch on is cold water fish. Like salmon, fatty fish, and other seafood. This is so important for providing the nutrients for brain development for baby. Especially the omega-3 fat DHA. Also it does have some choline in it, and it has a special amino acid called glycine in it, which is important for the development of connective tissue and the skeleton of the baby. It also has a lot of iodine in it, which is really important to support your thyroid health during pregnancy. Which directly affects your baby’s brain development, as well.

There’s also a quote I include in my book that says, from the Journal of the American Medical Association, “Iodine deficiency remains the leading cause of preventable intellectual disability worldwide.” The leading cause. It’s crazy. It’s a very important nutrient. And food from the ocean or from salt water sources is going to be your best sources of iodine. Which includes fatty fish, but also includes things like seaweed. So I really encourage women to include some of those foods in their diet.

I think a lot of women have been scared away from fish because of this warning about mercury. I don’t know if you heard some of those yourself.

Cassy Joy: Yeah.

Lily Nichols: Yeah. They’ve actually found that, aside from a few fish that are very high in mercury and should be avoided, which is swordfish, king mackerel, and shark, and they also recommend tuna be limited to less than 6 ounces per week. Many other types of fish are perfectly safe to each while pregnant. Even if they contain small amounts of mercury. And that’s because fish contains a certain mineral that binds to mercury and prevents it from being absorbed in your body. That’s called selenium.

So a lot of these fears about mercury have been really overblown. And when you start looking at the studies, the concern about mercury is that it’s a neurotoxin. So on one hand, you have the omega-3s, which is good for brain development. And on the other hand you have the mercury, which is not good for brain development. But when you look at the research on maternal fish consumption and neural development in babies; actually women who eat more fish, their children have better neurological outcomes. Higher IQ, better communication skills. And actually the worst outcomes; the worst cognitive development are among kids whose mothers consumed no seafood during pregnancy at all.

So I think when you start to piece together all these different pieces of information, you can see why A) traditional cultures really prized seafood, but B) we have definitely a margin of safety in here. And one thing that maybe some listeners; some practical advice they can take with them, is that the best way to determine how much mercury a fish has is how big the fish is. So, if you think of sockeye salmon, which weighs maybe about 15 pounds or so. They also don’t live as long, maybe about 7 years. They’re going to be a better choice, a lower mercury choice, than something like albacore tuna, which can weigh up to 130 pounds and live for longer; like 13 years or more.

And then you get down to the even smaller fish. Like sardines are fantastic, if you like them. They’re very tiny. They live a short lifespan. They haven’t lived as long to absorb and accumulate as much mercury as other fish, and they’re also super high in omega-3s. So sometimes that’s enough to ease the fears around mercury.

Cassy Joy: I love it. That’s wonderful. And I actually just did a show; let me see if I can remember the name of it correctly. We just did a podcast on wild seafood. So for those of you who are curious, and want to hear a little bit more about the mercury-selenium balance, I go into it a little bit there.

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Cassy Joy: Awesome. That was so great. So those are wonderful foods to include. And those are all things that I definitely enroll in my diet. The sardines, the liver, the eggs. A lot of fruit to replace some of those more refined carbohydrates.

I would love it if you could share maybe some of the foods that you would recommend women start to avoid. Maybe they’re brand new to a real food lifestyle. Or maybe they’ve kind of been dabbling in the somewhat real food, somewhat we’re going just kind of go where the wind blows us. Are there any foods; maybe a top three or four, that you would recommend staying away from at the beginning?

Lily Nichols: Yes.

Cassy Joy: For someone who is relatively healthy, I guess I should qualify that. Someone going into pregnancy already considering themselves a relatively healthy person and not needing any sort of special consideration at this point.

Lily Nichols: For everyone, healthy or less than healthy, definitely as you kind of pointed out already the refined carbohydrates. Those are really important to keep at a minimum during pregnancy, as much as you can. Again, first trimester is challenging with the nausea and food aversions. And there’s actually a physiological basis for increasing your carbohydrate intake. At least during that timeframe. If that helps keep your nausea at bay. Some women can stay fairly low carb and they feel fine. Other’s that’s all you can tolerate. And I know with my pregnancy, I went through a time period where you needed carbs.

Again, it’s ok to eat more carbs during that time. But you just want to choose the least processed as possible. Because generally the more refined carbohydrates get. Which is typically refined carbohydrates are those that have been processed pretty heavily. Usually to remove the fiber, or maybe be turned into a flour or starch. So whole wheat can be refined into white flour. Whole corn can be refined into corn starch. And then even further refined into corn syrup. The more steps that it goes through to be broken down, the less nutrients you have. And the more pretty much you have pure carbohydrate in there.

And we know, there’s a lot of studies actually looking at carbohydrate intake on pregnancy outcomes, and especially refined carbs. And it’s associated with higher rates of weight gain, more likelihood of developing gestational diabetes or preeclampsia. Blood sugar and blood pressure tend to go hand in hand. It’s linked to a higher chance of the baby being born too large. And generally the more refined carbohydrates you eat, the less nutrient dense your diet is as a whole.

Which makes sense. If you’re filling up on white bread and cookies and cereal, you’re going to have less room for vegetables and meat and fish and eggs and nuts and seeds and fruit and other things that have more micronutrients. So definitely watch the refined carbohydrates. Just really try to find alternatives to having things like white bread and pastas and crackers and puffed grains like rice cakes. Anything that’s instant; like instant rice, instant noodles, instant potato. I always joke that those raise your blood sugar instantly. Because you do work with diabetes, you can see it on the blood sugar readings pretty clearly what happens when you eat those foods.

So refined carbohydrates, I almost consider in the same category as sugar. You just; there’s not much in there other than pure sugar, pure carbohydrates. Very little micronutrients.

Another one that I would recommend avoiding is artificial sweeteners. Sometimes women want to use these in place of regular sweeteners because supposedly it’s sugar free so it’s not going to raise your blood sugar, it’s not going to cause any issues. It doesn’t have any calories, so you’re not going to gain weight. And actually you start looking a little closer at the research, and that doesn’t actually pan out.

So they’ve actually found higher blood sugar levels in people who eat more artificial sweeteners. Which they believe is related to changes in the gut microbiome. So the good bacteria that live in your gut can be harmed by some of these sweeteners. Splenda is especially bad, because it contains chlorine. And if you know you use chlorine to disinfect things, like bleach. Splenda is especially bad. It also has some adverse effects on thyroid function. Again, because it contains chlorine. So it can compete with iodine.

And they’ve also shown that in women who drink artificially sweetened drinks during pregnancy in place of sugar sweetened drinks. So we’re talking about women who drink diet soda instead of regular soda. Again, not great. High sugar intake versus artificial sweetened soda. They actually found that their children are at increased risk of obesity at age 7. Which was opposite of what the research expected. Because they thought that the women who drank artificial sweeteners, and didn’t have the refined sugar coming in would have children that fared better. And it was the opposite of what they expected.

So there are a lot of little things that get disrupted in our metabolism by artificial sweeteners, and you really want to avoid them during pregnancy. And I’ll just point out one more; there’s several on my list. But just to keep to time. Vegetable oils.

So, vegetable oils are the oils that are extracted from seed crops. Like canola, soy, corn, safflower, cottonseed. There are a few others. But up until the last century, humans didn’t even have the ability to eat a significant quantity of vegetable oils, because it takes intensive modern farming and all sorts of sophisticated machinery to extract, refine, and deodorize oils from these seed crops.

The reason I recommend avoiding these is that they’re high in a specific type of unsaturated fat called omega-6. And in general, omega-6 fats tend to be proinflammatory, especially when they are consumed in larger quantities compared to omega-3 intake. And this is virtually guaranteed if you consume vegetable oils regularly.

They’ve found that women who consume too many omega-6 and not enough omega-3 end up with more problems with their pregnancies. So there’s higher risk of things like preeclampsia. Blood sugar balance gets thrown off because they mess up your insulin sensitivity. So they cause you to be more insulin resistant. They also found that it displaces omega-3 fats in cells, which can affect neurodevelopment of babies. So women who consume the most omega-3 fats, their infants have delayed fine and gross motor skills.

So it’s just really important that we prioritize; fat is important during pregnancy, don’t get me wrong. It should make up a pretty significant portion of your macronutrient intake while you’re pregnant. But you want to focus on quality fats. So skip the refined vegetable oils. Those that I already listed when I first introduced this topic. And do more fats that are from more natural sources. So animal fats like lard – pork fat, tallow – beef fat. Enjoying the skin on your chicken. Dairy fat if you do dairy. Butter, ghee, heavy cream. Those are all good.

And then plant fats that are less refined and less high in omega-6. So olive oil, coconut oil, avocados, nuts, seeds, and any unprocessed oils derived from those foods. Like extra virgin almond oil, or something. Those are all fine. We just don’t want to consume a huge amount of vegetable oils.

Cassy Joy: Awesome, I love it. And I’d like to throw in there in a special, I like to highlight, double underline transfats.

Lily Nichols: Yes.

Cassy Joy: As another, usually derived from vegetable sources, but that’s another one to avoid. We want to build healthy lipid bilayers for baby and ourselves.

Lily Nichols: Yeah, quadruple underline transfats.

Cassy Joy: {laughs}

Lily Nichols: That’s another one on my list, as well. That one is actually; even at really low levels of intake, transfats are associated with placental dysfunction, which impairs the nutrient transfer to baby. Which is linked to both lower birth weight and a higher risk of preeclampsia, and a higher risk of miscarriage or fetal loss. So they are hugely, hugely problematic.

I kind of assume most people listening to your show would be like; no, yeah, I don’t eat transfats. But yeah, if you’re still having any transfats sneaking in in your diet, really double check those ingredient labels and avoid anything that says partially hydrogenated oil. They are the worst of the worst. Like 10 times worse than the vegetable oils, for sure.

Cassy Joy: Mm-hmm. Absolutely. And just so you guys know, a quick cheat sheet of where those might be found. And this is, I bring it up because in that first trimester, like you’ve already talked about. If your hit; blindsided. And we’re going to talk about this next. If you’re blindsided by this barrage of pregnancy symptoms. A lot of women are, some women aren’t. Right? And it’s different for every person. But if all of a sudden you’re blindsided, and you kind of lose your wits a little bit. Right? You’re like; I know I need to get some kind of food in me.

The ones to just avoid if you can are going to be the ones that have those transfats. Those are going to be those prebaked, shelf stable, baked goods. Even if they are gluten free. Read the labels, like she said, and avoid anything that has the words “partially hydrogenated.” Those are the cookies, and pizzas, and donuts, and crusts, and biscuits. Those kinds of things; those are the most likely ones that are going to have those partially hydrogenated transfat oils in them. Which goes, again, hand in hand with the refined carbohydrate mix.

Lily Nichols: Exactly. Exactly. It’s like a double whammy.

Cassy Joy: It is.

Lily Nichols: And the baked goods that they sell at grocery stores. Those almost always have transfats. A lot of companies have taken transfats out of their cookies and whatever because they want to have no transfats on the label. And as we’re talking, we should actually say that there’s a labeling loophole that the FDA allows products to have up to half a gram of transfats per serving on a product and advertise transfat free. So we need to read the ingredient label for partially hydrogenated oils.

But that said. I’ve observed at the grocery store, since transfat labeling went mandatory in 2006, a lot of companies have voluntarily removed them from products. But these grocery store in-house baked goods, they don’t have nutrition fact labels on them. They do have ingredients listed. But I feel like because they don’t have to put any advertising on it of transfat free or whatever, they hide so many transfats in those. Especially frosted baked goods. They almost always put it in the frosting, because it doesn’t melt when it has transfats in it.

Cassy Joy: Mm-hmm. Think Crisco. You know. If you’re looking for a mental visual. That’s so true. What a great tip, Lily.

OK, so. We are getting close to time but I can’t let you go. It’s ok; I hope you guys listening. If you’re in this still, then you probably want to hear these next couple of questions. I would love it if you could address a question I get a lot from readers and listeners who email me. They are pregnant, and they are experiencing some pregnancy symptoms. And they want to know two things. They want to know; whether it’s morning sickness, headaches, which is what I had. I had migraines in my first trimester.

Morning sickness, headaches, gosh what are some of the other ones? Extreme exhaustion. All of these. Some of these are going to just; your body chemistry is changing significantly in these first few weeks and months. So don’t be hard on yourself. But people want to troubleshoot. Is there something I can be doing better? And, if I’m having this morning sickness and these severe food aversions, what can I eat? You know. What do you recommend that I eat to get down, just to focus on. And I would love it if you could share your take on some advice on A) how to troubleshoot some of these common pregnancy symptoms. If it’s something nutritionally related from a holistic nutrition perspective. And then B) for folks who are having trouble really getting anything down. What do you recommend that they focus on?

Lily Nichols: Sure. Those are really great questions, and I get a lot of those in my practice, too. I was kind of blindsided by how serious the exhaustion was. My nausea was sort of moderate, I wasn’t throwing up all day. But man, I was so tired in the first trimester! {laughs} It was crazy.

So first and foremost, pregnancy is a really important time to start being really mindful about the cues your body is sending you. And also being really kind to yourself. Because I think there’s maybe a misconception in the media that makes it seem like; oh, you’re pregnant but you’re fine. You can do anything still. You’re a woman, you can do it all. Run a business, and be pregnant, or have a baby, do all these things and never slow down. It’s ok to slow down. It’s ok to take things off your plate when you’re really tired or nauseous or whatever is going on in your pregnancy.

So self-care first and foremost. Nutritionally, yes, there’s a ton that’s changing just on a physiologic basis in your body that can be the underlying reason why food aversions and nausea and some of these things crop up. One that’s big that’s going on is your blood volume is increasing. So, you’ll have a lot more fluids in your body in total between the extra fluids in your blood stream, and the extra amniotic fluid while you’re pregnant.

And a lot of those symptoms that are gearing up for the major changes that happen in the second and third trimester are actually happening in the first trimester as well. You just don’t necessarily feel the symptoms as much. Or you don’t have a basketball in your belly to remind you. {laughs} That it’s ok that you’re feeling that.

But your fluid volume, fluid needs already start to go up pretty early on in pregnancy. And with that, your electrolyte needs go up as well. So a lot of the headaches and even some of the nausea can be related to electrolyte imbalances. A lot of women will drink extra water, but fail to include extra electrolytes. And one of the most important electrolytes is salt.

So, I don’t know if you experienced this. But some women notice they have cravings for sour and salty foods. Or maybe that’s the only thing they can keep down when they’re nauseous. And there’s a really good reason for that. Because the sour and salty foods are also giving you electrolytes. Which is helping you with your fluid balance. So that’s an important thing to keep in mind.

Also, cravings for carbohydrates tend to be higher in the first trimester. Or maybe are the only foods that you can keep down. And this also has a potential physiologic basis. Because your pancreas actually produces more insulin during pregnancy. By the third trimester, it can produce triple the amount of insulin. And the changes that allow that to happen are already taking place in the first trimester. Your insulin production isn’t super, super high yet. But it is a little higher than normal. And your pancreas is going through dramatic changes, and you’re more prone to hypoglycemia.

So when your blood sugar is too low, your body tells you it needs to raise it back up, and it tells you to eat the foods that are going to raise it back up. Which are carbs. It’s tricky because on one hand, too many carbohydrates can cause issues. On the other hand, if you avoid carbohydrates completely, you may feel worse. And again, I think there’s a physiological reason that some of these carb cravings come into play.

The challenge is you want to try, if your aversions or nausea will allow. You want to try to eat more than just carbohydrates by themselves. Because sometimes it can get you in a cycle of boosting your blood sugar for 30 minutes, and then crashing it again. And then the nausea gets even worse, and your exhaustion gets even worse. So if at all possible, if you’re super nauseous, if you can tolerate the lower carbohydrates, great. After you get to that point, you also want to try to incorporate some other items that have fat and protein in there, as well.

I’ll use a not super paleo ancestral example. But say the only thing you can eat is bread. It would be better if you had a piece of bread with butter on it, or peanut butter, or a piece of cheese, or some meat or something than it would be to have the bread by itself. Because at least it will help stabilize your blood sugar a little bit better. Also you’ll get a little more than just pure carbs in your system.

We could do a better example. You could do an apple and almond butter or something if you want to do fruit instead of bread. But really, a lot of women get drawn to grain and starchy carbohydrates early on. And I think there’s probably something to it.

Cassy Joy: I think there is too. And I did; I just, I don’t want folks to think I have this very staunch paleo perspective. I talk about it a lot. But I was blindsided by just my exhaustion as well in that first trimester. And for whatever reason, because I was recipe developing with these gluten free graham crackers. I had too many of them on hand. And that is what my body wanted {laughs}.

Lily Nichols: Yes.

Cassy Joy: And the breads and things like that, of course. And I eventually started to rotate those over to fruit-based sources. But there comes a time and a place for that. And I think just gravitating towards the best option for what you can get down is ok. And to Lily’s point; enrolling some good protein and fat sources I think is really smart. You can really kind of help turn it into a full-blown snack versus then also putting your body through that blood sugar crash.

Lily Nichols: Yes, exactly. And it seems, from what I notice, and maybe you notice this in your practice. Having, if you can. Sometimes the mornings are really challenging. If you can get some protein and fat in your morning, oftentimes that helps set up your blood sugar balance for the rest of the day. I noticed personally I couldn’t have eggs first thing in the morning. What did I do? I think I kept cashews by the side of my bed. Because crackers or something gave me too much of a blood sugar crash.

Cashews, they’re actually kind of higher carbohydrates in the category of nuts. But that was the perfect balance. I already had my fat, carbs, and protein in there. I’d wake up, nosh on some cashews, that would kind of settle my stomach. Get out of bed slowly. Sometimes quick movements make nausea worse. And then after maybe an hour, I don’t know how long, I would then go and have a real breakfast. And for a while, in the first trimester anyway, it was kind of small. But if I could get my egg in in the morning. Literally, one egg. Which is so small, but sometimes that’s all you can do in the first trimester.

If I could get that egg in, I would be pretty good the rest of the day. And I noticed when I did just carbohydrates. Like; oh, I’ll just have this gluten free bread and butter. I was on such a blood sugar roller coaster that my nausea was way worse. Because hunger tends to trigger nausea, as well. So if you can try to squeeze in some protein in the morning, that’s helpful. Some of my clients do well with a good quality protein shake. Normally I’m not huge on protein powders and whatnot, but sometimes it works. I even have clients that can open up their prenatal vitamin capsule into their shake. They get it down. They tolerate it really well. It helps with the rest of the day.

So it’s really just; you have to pick your battles. You have to trust that your body has some nutrient reserves to carry you through. If not eating perfectly in the first trimester was a deal breaker for pregnancy, {laughs} nobody would continue being pregnant, you know. Almost everybody has some bumps in the road in the first trimester, and it’s ok. You just have to do your best to get through it.

Cassy Joy: It’s so true. That’s such a great message, Lily. I really appreciate it. I think that, and this is the nature of the notes that I get. There are a lot of women out there who come from this; I work out, I do all these great things, and then I got pregnant and now I feel like I’m failing at my nutrition plan.

Lily Nichols: Yeah.

Cassy Joy: Additionally, I just want to reiterate that; do your best. This too shall pass. And really, this is a part of the process. And something that we’ve said a lot. I’ve reiterated a lot. I had invited Briana Battles onto the podcast. And she keeps saying she didn’t coin the term, but I really love it. She’s where I heard it first, so that’s where I give credit. That pregnancy is temporary, and postpartum is forever. So just remember that this phase is temporary. Do the best with what you have and the knowledge that you have. We know better, we do better. And then move on.

And to touch one more thing on the electrolyte, just because I want to give folks a quick takeaway. One of the things that I started doing as far as helping to rebalance electrolytes in my second and third trimester. Oh my gosh; we threw everything on the fire in that first trimester. We figured out that wheat gluten was triggering my migraines.

That being said, as blood volume did increase, I could feel, you know when you have those muscle twinges and tweaks, it could be a sign of electrolyte imbalance. We would get coconut water, or gosh, what are they making? Watermelon water now, which both have pretty good sources of potassium and put a pinch of sea salt in it, shake it up, and you essentially have a pretty good electrolyte supplement. So if you’re looking for more of a real food-based electrolyte drink, that’s something that I have kept in my refrigerator this entire pregnancy.

Things that I’ve kept on hand have been fruit, some of those small cold-water fish that you mentioned. The liver, trying to get that in every week in some form or fashion. I’m not a liver hero. I can’t just fry it up and get it down {laughs} but I’ll mix it and mash it. Yeah.

Lily Nichols: The electrolyte thing is great. Keep it on hand when you go into labor too. {laughs} It’s also helpful for that too.

Cassy Joy: Yeah, absolutely. That’s in my little hospital cooler bag plan.

Lily Nichols: Perfect. Yeah, there’s a lot of misconceptions about salt. A lot of women think that the salt is going to make them puffy or make their blood pressure go up. It’s probably too much to discuss in the time we have today, but I have a ton of discussion on the importance of salt in pregnancy and how it actually does not contribute to high blood pressure or preeclampsia. And in fact, may improve those conditions. So inadequate salt and electrolyte imbalance can be associated with these high blood pressure and edema and swelling and those things that women have. It’s an essential nutrient. We need to have it on hand.

Cassy Joy: It is. Oh man, that’s so exciting. I kept you probably too long already. Thank you guys for sticking with us all this time. Thank you so much for coming on the show, Lily. This was an awesome conversation.

Lily Nichols: Yeah, thanks for having me Cassy. Sending all my positive birth vibes out to you.

Cassy Joy: Oh, thank you so much. I really appreciate it. Could you remind folks one more time where they can find you; where they can find your book, as well.

Lily Nichols: Yes. You can find me at www. PilatesNutritionist.com and my forthcoming book, which will be released by the time this goes life is Real Food for Pregnancy, and you can find that at RealFoodForPregnancy.com.

Cassy Joy: Whoo! That’s nice and easy. And if you’re driving and you couldn’t write that down, don’t worry. Because we’ve got all the links provided in the show notes, so that will be there handy for you. Lily, thank you so much for coming on the show. I wish you the best with the upcoming book release. Or the now having happened book release a couple of days ago. {laughs}

Lily Nichols: {laughs}

Cassy Joy: We can time warp.

Lily Nichols: I know.

Cassy Joy: I will continue to cheer you on. If you guys have any questions for Lily, I think a really great way to probably continue this conversation would be to reach out to her directly, of course, but head to the blog post when the show is up and we get the transcript loaded where you can review what we talked about. And go ahead and leave a question there. That would be a great place to kind of start some dialogue, and a reference point.

Thanks again so much for coming on, Lily, I really appreciate it. Everybody else; thanks for dialing in. We’ll be back again next week.

About the Author

Cassy Joy Garcia, NC

Cassy Joy Garcia, a New York Times best-selling author, of Cook Once Dinner Fix, Cook Once Eat All Week, and Fed and Fit as well as the creative force behind the popular food blog Fed & Fit.

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  1. This was a great podcast! I recently found out that I’m pregnant with our second child. This pregnancy is 7 years from our 1st. Since then so much new info has surfaced. I’m curious about caffeine intake. There’s so much information about allowance versus avoidance. Any suggestions for a trimester by trimester caffeine intake?

  2. just LOVE your podcast, but REALLY loved this one. Thanks for all the awesome content you put out!!