#85 Lily Nichols | Real Food Strategies for Maternal and Infant Health

AUTOGENERATED TRANSCRIPT

00:00 - Jesper Conrad (Host)
So today we're together with the Lili and Nikos. First of all, thank you for sharing your time with us. It's wonderful to see you.

00:08 - Lily Nichols (Guest)
Likewise. Thank you for the invite.

00:10 - Jesper Conrad (Host)
And our podcast is called Self-Directed and it's about choosing and taking a direction in life, and sometimes it's also just me being super curious on different subjects where I'm like I would love to talk about that. So today I would love to talk about real food and babies and wonderful stuff. So can we start out with what is real food?

00:37 - Lily Nichols (Guest)
Sure. Well, there's all sorts of different definitions about real food. I have my own, as I've written about in my books. So for me, real food is food that has not been processed in a way that has removed nutrients from it. This isn't to bash all sorts of processing, because even traditional methods of processing, like fermentation, for example, it's a type of processing, but that doesn't remove nutrients. You actually in many ways enhance the nutritional value of the food.

01:10
But a lot of the ways in which we process foods nowadays is in a way to make it, you know, taste better, or the texture better, or to remove a nutrient that you know some governing body has said is not good for you, right? So a lot of the ways that we're processing foods say taking all the fat out of dairy and then not consuming it in other ways. We're not talking about a skimmed yogurt and then saving the cream for butter. No, people eat like all low fat or non fat dairy products. It's not.

01:41
To me that does not qualify as a real food, because you're not consuming the full nutritional component of the food, or taking in only egg whites but throwing away the yolks, eating boneless, skinless chicken breast but not consuming the rest of the animal, not using the bones for broth, not eating the yummy crispy skin, not consuming the dark meat of the chicken, not consuming the organs that changes your overall intake of nutrients.

02:04
Crispy skin, not consuming the dark meat of the chicken, not consuming the organs that changes your overall intake of nutrients. So I take my definition just a little bit beyond. Like the typical, eat foods as you find them in nature and you know we really need to take that like very literally. Then don't take out parts of the food that you know the government told us we shouldn't eat, such as saturated fat or cholesterol, because that ultimately has an impact on our micronutrient intake. So, yes, it means eating you know foods as we find them in nature, but also not processing them in a way that takes away all of their original nutritional value, but it still means processing them in the good way.

02:47
Like cooking, is processing right, processing right. Fermenting? Is processing soaking sprouting grains? Yeah right, but that's not reducing the nutritional value of it, right?

02:58 - Jesper Conrad (Host)
so yeah, what brought you on this path in your life?

03:04 - Lily Nichols (Guest)
talking about real food so much. I mean, I've had a, you know, a lifelong interest in food and health. I mean, it was raised in a fairly health conscious household and, uh, I decided from a very young age, you know, I'm going to go to school and study nutrition. It was between nutrition or art. I ended up studying both technically, but my major was in nutrition and I actually was thinking that I would work in reformulating the school lunch program in the United States, which is just abysmal because we were seeing this skyrocketing childhood obesity and diabetes and it was like, wow, we have to do something about this.

03:49
But years into my career, you know, I'd become a dietician, gone through all the conventional training, you know, did a lot of like smile and nodding because I had already been introduced and incorporating more ancestral nutrition principles into my life since I was a teenager.

04:07
It was there that I started working in the gestational diabetes field and learned that a mother's metabolic health and blood sugar levels can impact her baby's risk for things like diabetes and obesity quite substantially. We're talking like a six to 19 fold increased risk of developing those conditions later in life when mom's metabolic health and blood sugar is not in a good place during pregnancy and that's that's really what lit me up and has kept me in the field is seeing like how can we optimize mom's health so that we not only have, you know, healthy, healthier, easier, more comfortable pregnancy, but also this child is set up for success? You know healthier, easier, more comfortable pregnancy, but also this child is set up for success. You know, their epigenetics are such that they are at a lower risk for all these chronic conditions that kids now commonly face.

04:57 - Jesper Conrad (Host)
Yeah, I remember with our first baby we talked about breastfeeding and back then I was a more nine to five kind of guy also in my mindset and and when my wife started talking about long-term breastfeeding I was like that's weird. Well, it's my, it's my breast, that's my titsits. What is going on here? The whole stupid man version of thinking. It's a little weird that what you have found so interesting now is going to the baby, and for so long time. And it took me some time to understand it. And I remember Cecilia talking about the value about breastfeeding for whole cycles of a year, so a fair year.

05:50
No, no, no, no, no. But how the breast milk is providing the babies with all it needs and also helping the immune system and I just remember how I didn't understand it back then and also looking at what does a mom need for the sake of the baby. It wasn't in my mind back then. So I think a lot of us men are a little behind still. Do you meet that in your work that the moms might be further ahead, or how is that?

06:23 - Lily Nichols (Guest)
Well, I mean, I think in general I don't know it's that like mama bear instinct You're usually the one who's going to be more into researching what, what's going to be best for your baby and there's also just this very strong, uh, maternal intuition and instinct that you can't, that you can't deny, um, but I think it's also a cultural thing. I'm sure this is different in different parts of the world. If it's not like I call it, full-term breastfeeding, like breastfeeding until essentially, toddlerhood and the child self weans, or maybe you have to give them a little nudge to wean at that age, that's. I mean across the world you look globally at the you know length of breastfeeding and it often is in cultures that have not sort of I don't know, put an arbitrary limits on it. It often is into toddlerhood, ages two, three, four, sometimes beyond, depending on the culture that you're studying, depending on the culture that you're studying. So I think that moms typically maybe have just done a little more homework or you're just driven more by that maternal intuition.

07:33
I mean, the first couple months can be kind of rough with nursing or at least for my two it was especially the first month like takes a big adjustment and then, once your milk supply is established, it's incredibly convenient to be able to just nurse when baby's hungry or upset. There's no like washing bottles. I mean, if you're, of course, if you're pumping and whatnot, you might use bottles. But if you're like going out for a day trip, you don't have to plan the formula and the bottle warmer and the. How are you going to sanitize the bottles and do you have the right clean water to mix it up, like it? In a lot of ways it complicates things a bit. So I think for many moms it just becomes a convenience in some ways. If breastfeeding has been able to become established, it's almost harder to stop than it is to just continue. Usually, once babies have like gotten the hang of it, they would like to continue for a while.

08:30 - Cecilie Conrad (Host)
I I felt you kind of skipped there from the whole food I mean yeah, breastfeeding and I, I enjoy both conversations, but I'm just curious what happened to your, to your mid school lunch? I think it's a very important issue for the americans maybe not so much for us, but I don't know. Um, also, it's a hard one. I mean, did you enter that battle? Did you fight that dragon? How did you have you worked with it?

09:10 - Lily Nichols (Guest)
And what happened? Yeah, so what happened is I did not work on school lunch directly. No, what happened is when I started working for an organization in California called the California Diabetes and Pregnancy Program, which does a lot of work with gestational diabetes. So I was among a team of dieticians who were at the state public policy level working on these guidelines, and I saw there how difficult it was to make changes to even very subtle little things in the guidelines because you have all this interagency overlap. You know we need to switch from this graphic depiction of a diet for gestational diabetes to a different one, but oh, it has to align with the other state graphic that's already used and oh, it has to also align with the one that's used nationwide. And like just the tiniest little things.

10:09
I'm giving one example, but there were so many more trying to elicit change in guidelines and in policies. You come up against so much bureaucratic red tape that, yeah, any interest in working in any sort of public policy sector was, yeah, pretty much eliminated. I also saw in even in, like the hospital systems you have to work in in the hospital, like kitchens systems you have to work in in the hospital, like kitchens when you do your dietetics training. I mean a lot of this stuff just comes down to money and funding and compliance with the guidelines, and then there are so many, uh, special interests that influence what those guidelines are. You have all these different lobbies for these different food products and whatever. It's almost impossible to elicit change. There have been dozens, probably many dozens, of dieticians trying to change this for years and years, unsuccessfully. So, to me, working in gestational diabetes gave me a glimpse into like.

11:17
Of course, what kids are eating matters, and of course the school lunch program still needs to be reformed. But it's not just that. What these kids are eating in childhood is increasing the risk of diabetes or obesity, pancreatic function, their glucose and insulin levels, their levels of insulin resistance, their mitochondrial function, their ability to burn energy that has already been compromised in utero if their mom's blood sugar and metabolic health was not dialed in. So that, to me, let me up more than being in a futile fight against policies and bureaucratic things that are just so difficult to change. And even with that, I've taken my own path for trying to elicit change in these guidelines, which is not directly trying to change the guidelines but educating the masses, educating health professionals and women themselves on how to do better. We have a lot of clinics and hospitals that have changed their policy.

12:29
The Czech Republic changed their guidelines on gestational diabetes after my first book, real Food for Gestational Diabetes, outlined a different approach. The change will come in a roundabout way, but I go about it at a grassroots level because I've just kind of lost faith in how quickly we're going to be able to change the actual guidelines. We already have like a 17-year gap between new research making it into clinical practice, and that gap for changing guidelines is even greater. So it's like, do I just sit by, burn myself into the ground working trying to change guidelines and leave behind like a generation or two of kids, or do I just put the information out there in a way that I think would be helpful now?

13:20 - Cecilie Conrad (Host)
just put the information out there in a way that I think would be helpful now Makes a lot of sense, lily.

13:22 - Jesper Conrad (Host)
Just to understand the 17-year gap. So is that the advice you would get on going to a doctor Is more or less based on, depending on the doctor of course, but in general based on 17 year?

13:40 - Lily Nichols (Guest)
old knowledge. Yes, there is actually a research paper that came out looking specific. I could send you the link after the talk if you'd like, but it was like how long, what is the gap between research making it into clinical practice? Like the title of the paper was something of that nature and they did this whole analysis and landed on 17 years. Yeah, so it depends how up to date your clinician is or not. Of course, there's lots of great clinicians who are really up to speed on the research and they're practicing in that way, but so many others just if they're just following whatever the policy is for their place of work or whatever the governing body's policy is, it's often quite outdated.

14:25 - Jesper Conrad (Host)
There's some different subjects I would dive down to and I would love to go to the prenatal nutrition. But first part of me I mean I the last couple of years have done what I could to improve my health. It's gotten a lot better. I'm generally quite healthy, but I carry too much weight. I'm turning 50 this year working on it, but a bag of crisp is just so nice sometimes, and sometimes it's chocolate and it would be so easy if the reason I'm a little fat is someone else's fault than what I put in my mouth and how little I exercise. So where to start if you want to change your life around Because I know it's hard and I'm doing quite good. It's quite fit for my age, but still it's hard Eat a lot of supplements, but it's a big task. What do you advise people when they want to start making a change?

15:30 - Lily Nichols (Guest)
Yeah, so my advice on this has actually shifted over the years. I used to really go heavy on the these are the things to avoid angle and now I take it from the opposite approach, which is eat more of these things. So I have found over and over again that if people under consume protein specifically and particularly at breakfast, they're more likely to have blood sugar highs and lows throughout the day, which then drives cravings and he's like, when their blood sugar drops low, you get hungry and of course the first thing you want to go to is something like a bag of crisps or chocolate or something sweet or caffeinated to like boost your energy up quickly. And it's not a willpower thing, it's like a physiological response. Of course our modern food environment doesn't help. It's not like the carb source available is, you know, wild berries in the forest or whatever Like. It's all this process stuff which they engineer to drive our cravings and boost our dopamine and give us that immediate high. But we can interrupt that like whole physiological process by just eating a sufficient amount of protein, especially at breakfast, as I said, which sets the stage for like a whole day's worth of better balanced blood sugar levels and that keeps the cravings and the like extreme hunger pangs in check.

17:02
Instead of being hungry, you know, an hour or two after breakfast you may be able to go three, four or five hours before you start to feel like, oh, I'm a little bit hungry. And even when you do have something that's a treat or a sweet or some chips or whatever I mean, I'm no saint, I also eat those things sometimes as well You're not going to have as big of a spike and crash when you have some protein already in your system. So that's how I go about it usually and that's an easier one for people to take on. It feels a lot more positive to be like, oh, eat more of this instead of eat less of this. Because I found that sometimes when you go from the angle of telling people to eat less of something, then they just under eat, which perpetuates this same cycle of crazy hunger and cravings and that fight against what they feel is their willpower. But again, it's just that physiological response to blood sugar imbalances. So sufficient protein absolutely key.

18:08
I would also say keeping less of the treats in the house, of course, sets you up for more success, because then when you are hungry, there just isn't the option of that processed, tasty treat or snack available and you're like well, I guess I have to look in the refrigerator for something boring, like you know, the cheese or the yogurt, or the hard boiled egg, or the leftover dinner, or the carrot or the apple or the, you know it just doesn't give you the option to be consistently indulging, you know. So like setting yourself up for success, where it is created to be an occasional thing versus every day. Because I'm the same. If there's like potato chips in my pantry and I'm hungry, of course, the first thing I think of is the potato chips. Like they give you that instant reward. Doesn't matter how long you've been doing this, they're still delicious and craveable, you know.

19:06 - Cecilie Conrad (Host)
I actually find that it's easier if I don't have all the rules, all the don'ts. I very much agree with that mindset. It's about making sure you get all the nutrients and then if I want something on top, I'm okay giving myself that, especially because if it's not a don't, then I had a tendency when I was thinking, oh, I can't have this and I can't have that too. If I finally have it, I'll have a lot, because I wouldn't allow myself, you know, the next day. So now I've just let go of all those rules and I don't really want it anymore. It's not that interesting. It's like you know the things that are illegal, you really want to try them and and if everything is legal, then it doesn't matter so much. Yeah, for sure. So that's one thing.

20:02
And another thing I was thinking was uh, you talk about blood sugar and I'm just wondering do you use with your work, like technical ways of measuring blood sugar, or do you let your clients just feel it out? Or you know, I find I mean I can feel my own, but I'm also feeding for teenagers and another way to make sure they don't live off processed food is just to be ready with food. You know. You know they'll be hungry in two hours. So how about throw something in the input and turn it on, so that when they ask for all the snacks, I can say you can have snacks, but could you have food first? And and? Uh, that's one way, but sometimes I'm just wondering if we should consider measuring it. How, how is this? How is it going with the sugar? Is this kind of breakfast better for you? Because we're not all the same? Yeah, so I so do.

21:04 - Lily Nichols (Guest)
How do you go around. It depends on the client, right? So you know, not everybody needs to have a glucometer or a continuous glucose monitor or something like that to measure their glucose levels. Some people who are more in tune with their body can actually feel a blood sugar spike. I know I can and I've confirmed in the times that I've worn a continuous glucose monitor and I've written about I call them CGM experiments. You can find two blog articles on my website where I talk about my experience.

21:40
I found that I could actually kind of feel the blood sugar spikes. I couldn't feel the degree to which my blood sugar was spiking though, like you know, I could feel my blood sugar was a little high, but the difference of, you know, 40 milligrams per deciliter I would not be able to like pick up on that with. You know, just my own mindfulness about my body's symptoms. But a lot of people will feel it almost like a, like a racing in their heart. Um, some people feel it by feeling very tired. Some people feel it by getting like hyperactive. You know a blood sugar spike in a young child. Often they talk about kids getting hyperactive after birthday cake or something like that. Sometimes it can be felt in that way.

22:21
So there's a whole array of symptoms but in order to actually quantify, like what the spike is, how high your blood sugar has gone, you would want to monitor it Now.

22:33
You don't have to check it all the time or for a super long period of time.

22:38
So if somebody just wants to spot check, for like a week you know your blood sugar upon waking and then an hour or two after each meal an hour would usually catch the blood sugar spike better. Often by two hours your blood sugar has gone back down that can be used. Or if you want a much more precise way to like measure how quickly and how high you're spiking, how quickly you come down, a continuous glucose monitor gives you real time feedback. You know over 200 time points in the day where it's checking your blood sugar so you can see. You know some foods, for example like a really high sugar food for me can give me a blood sugar spike within 30 minutes. So by the one hour mark my blood sugar has already come back down, and so if I was just checking at a single time point, I wouldn't have caught the spike. Other people have a delay in their blood sugar spiking and so they might not see it until 90 minutes after the fact. A CGM would be better able to pick that up.

23:40 - Jesper Conrad (Host)
So let's talk about pregnancy and all those cravings and all the myths about the dick. You can't say it, I can't say it. I will let my wife help me. Not going to.

23:55 - Cecilie Conrad (Host)
Just a moment, I cannot say it, I can't say it.

23:56 - Jesper Conrad (Host)
I will let my wife help me, not going to Just a little, I cannot say it. The diabetes you can get when you're pregnant, that's the workaround. So how big a problem is it? How many percent get it and how dangerous is it?

24:15 - Lily Nichols (Guest)
Yeah, so you're talking about gestational diabetes. I'll say the word for you. It is by far the most common pregnancy complication. So it's more common than preeclampsia and other pregnancy issues. It affects up to 18% of pregnant women. It depends on how it is diagnosed. There are slight differences in the diagnostic standards in different countries. Even within the US there's like a couple different options available, which complicates things in terms of like standardizing. You know who truly has it, who doesn't. But nonetheless, yeah, about 18% of pregnancies are affected.

25:02
The whether or not it can, you know, severely compromise the health of the pregnancy depends on how it's presenting. Not all cases are the same. Some are very mild. The elevated blood sugar is pretty mild and pretty easy to manage. In other cases blood sugar is very elevated. Maybe it is not caught early enough or maybe it's not managed well, and that can lead to a greater risk of complications.

25:34
So typically, in the case when it's uncontrolled or poorly managed, we're worried about baby growing larger than expected. Not because they're exuberantly healthy, but because they're literally storing more body fat. When their blood sugar levels and insulin levels are elevated, they store more fat in their tissue, so they're not as metabolically healthy even from birth. It also affects the development of their pancreas, so they're typically born with high insulin levels and in a state of relative insulin resistance. This is why there's that higher risk at a younger age of type 2 diabetes in these children. It can affect lung development.

26:17
There's a risk of their blood sugar dropping too low shortly after birth, so there's a number of things that can potentially go wrong. There's also a higher risk of other complications in the pregnancy as well. So higher risk of preeclampsia, preterm birth and other issues when it's not well managed. On the flip side, when it's well managed, it's really not all that risky to the mom or her baby and it definitely can be managed, and most cases can be managed with diet and lifestyle changes. How well it can be managed depends on the type of advice that they're given, though. So you have to take that into consideration. A lot of the current guidelines. The advice doesn't really help improve their blood sugar levels much, and sometimes it can make it worse, and so that kind of complicates things a little bit when you start talking about dietary interventions. It absolutely depends on what type of advice that they're getting.

27:15 - Jesper Conrad (Host)
I'm just thinking oh, so much work goes into being a mom and now you even have to worry before you get the baby with all what can I eat this and this and this, and I have all these cravings. What are some of the easy advices to pregnant women about how to go through it?

27:39 - Lily Nichols (Guest)
yeah, so I mean with with gestational diabetes specifically, or about managing cravings hopefully not getting the thing you can't say that I can't say it, I follow I follow is there anything you can do to like prevent it potentially um yes, that would be advisable.

28:05 - Jesper Conrad (Host)
I think yeah yeah, yeah.

28:07 - Lily Nichols (Guest)
So I mean your, your health going into pregnancy plays a big role in this um. So if there were any blood sugar and insulin issues happening ahead of time, before pregnancy, the better you can get those in a healthy place before conception, the lower your chances of developing this condition during pregnancy. Actually, the majority of gestational diabetes cases these women had some level of insulin resistance preconception. So, and of course what you do to whether to prevent or to manage is often kind of the same right. So a better balance of your macronutrient intake your fat, protein and carbohydrate can help a lot with your blood sugar levels and your insulin resistance. So, really prioritizing protein when you're eating your protein, don't obsessively take all the fat off of it. So leave the fat on your steak, the skin on your chicken, the fat in your milk, the yolks in your eggs and whatnot. Those two macronutrients really don't raise your blood sugar. It's the carbohydrates that raise your blood sugar and when you're consuming a sufficient amount of protein, that comes with its naturally occurring fat you're not as hungry for all the carbs. So it kind of works in your favor for a better macronutrient balance when you're really prioritizing your protein. Also, including more vegetables in your diet gives you a lot of fiber, they have a low concentration of carbohydrates and they also fill you up, so they'll give you kind of that volume at the meal without the blood sugar spike and, of course, all the different vitamins and minerals that you get in your vegetables. So prioritizing the protein and your vegetables is huge. You can still have some carbs, but just don't have it as the absolute center of the meal. Here in the US, for example, a lot of people have like a pasta dish for their dinner, like just noodles, right, and there might be a little bit of meat in there, maybe a small salad on the side, but the majority of the plate is this big bowl of noodles. That's like a huge blood sugar spike. But if instead you had some you know meat and salad making up the majority of your plate and maybe a small portion of it as noodles or some other carbohydrate, you may be perfectly fine, right? So some of it comes down to like the balance of what's consumed. That plays a big role of it comes down to like the balance of what's consumed. That plays a big role.

30:39
Going into pregnancy with good nutrient status plays a role as well, because our blood sugar regulation is not just all about carbs spiking our blood sugar. There's also different micronutrients that help your insulin work better. So vitamin D, magnesium, inositol, thiamine, even sodium, having a sufficient amount of sodium, potassium there's a lot of these different nutrients that work to improve our blood sugar balance, and when you're eating a mostly whole foods, real food, you know unprocessed diet, you're often hitting the marks for a number of those nutrients as well. Processed diet, you're often hitting the marks for a number of those nutrients as well. There's many more, but I'll just add one. More would be movement, some sort of movement or exercise. We can't discount how much of a difference that makes in our blood sugar levels. So we know that women who have exercised pre-pregnancy and continue through early pregnancy, pre-pregnancy and continue through early pregnancy, their risk of developing gestational diabetes is something like 79% lower. So it really does dramatically improve your blood sugar levels and reduce your chances of developing the condition.

31:49 - Cecilie Conrad (Host)
So it's actually just live healthily? Yeah, just like you would always. I was thinking when you asked the question before. You know it's so hard to be pregnant and then you have to also think about to be a mom.

31:59
And then so you phrased that and you know I'm the mom here and I think in many ways for me it was more like a nice chance to clear the, the slate, sort of thing. Okay, now I have the responsibility for someone else. Now I I, I have to get my act together. It's, it's an it's not an annoying oh. Now I have to be healthy.

32:27 - Jesper Conrad (Host)
It's more like now I have one more very good reason to take good care of myself and and I think I mean we women should just cherish that option it's, it's a great motivator to to want to become pregnant or to be pregnant, to to stay healthy and fit yeah, absolutely I just wanted to put that in there, because you phrased it as if it's a problem and if I all you, you know I don't know, but from my wonderful male mind I'm like man that's a lot of work, but I can see it as the gift as you present it, you might as well flip it. Yeah, I love it. So, Lily. So people who want to know more about your work and your books and how you help people how do they find you and and if you can share that with us please?

33:20 - Lily Nichols (Guest)
yeah, sure, so you can find my work at my website, lilynicholsrdncom. That'll link out to my books. There's three of them now real food for fertility, real food for pregnancy and Real Food for Gestational Diabetes. Those are all linked up on my site. You can also find them on Amazon. My blog is up there. There's 250 plus articles. If you wanted to read more about the CGM experiments that we alluded to, you can find those there. There's a handy little search bar, so just type in any keyword you're interested in. There's a good chance there's an article on it or, mentioning that topic, I do give away the first chapter for free of Real Food for Pregnancy up on my site. So if you want to get kind of more information on what is this real food thing or how would my recommendations compare to like a conventional meal plan, that's actually all included in that free download. And yeah, as far as social media, I am most active these days on Instagram, so my handle is the same as my website. It's LilyNicholsRDN.

34:31 - Cecilie Conrad (Host)
We will put all the links in the show notes. Absolutely, and if you send us the articles, we can put them too.

34:37 - Jesper Conrad (Host)
Yes, sounds good. Thanks a lot for your time. It was wonderful learning more about this word. I still cannot pronounce it. I will work on it, thank you.

34:50 - Cecilie Conrad (Host)
Thank you, it's been a nice chat, thank you.

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