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

Natalie: 0:49

On today's podcast. I chat with Lilly Nichols about preconception nutrition, how the common recommendations are outdated and even potentially harmful, and we take a deeper look at folate and how folic acid supplementation isn't all it's chalked up to be. We also answer some questions you submitted on Instagram. Welcome to the Resource Doula podcast. I'm Natalie, your host, and my goal is to equip you with the tools and information you need to make informed healthcare decisions while having some fun along the way through engaging interviews with experts, personal stories, and insightful commentary. I'll save you the time and effort of sifting through countless sources on the internet. Consider me your personal resource dealer because if I don't know the answer, I can connect you with someone who probably does. So whether you're a seasoned health guru or just starting your journey, I hope this show inspires and encourages you every step of the way. I have the pleasure of introducing my guest today, Lily Nichols. She's a registered dietician nutritionist, certified diabetes educator, researcher, and author with a passion for evidenced based. Prenatal nutrition. Her work is known for being research focused, thorough and critical of outdated dietary guidelines. She is co-founder of the Women's Health Nutrition Academy and the author of two books, real Food for Pregnancy and Real Food for Gestational Diabetes. Lilly's bestselling books have helped tens of thousands of mamas and babies and are used in university level. Maternal nutrition and midwifery courses and have even influenced prenatal nutrition policy internationally. She writes@lillynicholsrdn.com. Hey Lily, welcome to the Resource Doula

Lily: 2:41

podcast. Thanks so much for having me. Happy to

Natalie: 2:44

be here. Yeah, I'm happy to have you. I've been recommending your book to basically every single client and those who are not my clients also. And so I talk about you all the time 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 talking about preconception nutrition because oftentimes we hear people just say like, oh, eat healthy exercise, get ready for having a baby. But there's no specific instructions, and a lot of the common recommendations are outdated as we know. So where would you start if you were counseling somebody who's, who's looking to have a baby soon?

Lily: 3:27

Yeah. Where do you start? There's so many things to think about. Um, so ultimately the, the things that you do, just to circle back to like, you know, my, my books are on pregnancy. The things that you do for supporting your health during pregnancy very often are just about the same things, or very similar things that you do to prepare your body for conception, to optimize your egg quality, to improve your, uh, menstrual cycle regularity, to improve your hormone balance. There's a lot of overlap, so you know, first and foremost, the more nutrient dense foods you consume, the better off your micronutrient stores are going to be leading into pregnancy, which ultimately helps support, um, you know, healthy ovulation, healthy egg quality, um, supporting implantation, supporting the development of the placenta, and of course applying all the nutrients so that your baby can develop, um, properly, right? Um, so nutrient dense foods for sure are a big, big focus. Um, There's a wide variety of foods that are, you know, overall beneficial to us. But when it comes to the ones that are the most nutrient dense, um, particularly the ones that are supplying these micronutrients that are often, um, commonly in low supply for a lot of women or, um, under consumed or where deficiency can develop most frequently are actually our protein rich foods. And so that's an area that I really recommend that people focus on, um, in the months leading up to pregnancy as, as large of a variety of protein rich foods as you can. Cuz there's different, um, levels of certain amino acids, like the small components that make up protein. Those all have specific roles in our body. So you get a different balance of amino acids in different foods. Um, so in an ideal world, including some both animal and plant sources of protein is optimal. Um, And then also specifically looking at some of the most nutrient dense protein foods. So, um, organ meats such as liver are particularly concentrated in vitamins and minerals. Um, shellfish are really high in vitamins and minerals. Um, egg yolks, uh, meat that's on the bone or from like, you know, a whole animal. Say you take a whole chicken and cook it down and then save the bones and all the leftover bits to make broth like that has a specific amino acid balance. Um, definitely incorporating some 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 of these things generally are supportive of, you know, egg quality. Um, and also, you know, sperm quality as well. It takes, takes two to make a baby. So we gotta include the partner in the conversation as well. That would be, Probably one of the major places that I would focus. Um, and then from there, and this all kind of intertwines focus on, uh, blood sugar balance as much as possible. Now by eating a sufficient amount of protein, which has a lot of these micronutrients, you also are supporting your, your blood sugar balance significantly. Cuz protein foods tend not to spike our blood sugar. Um, they also tend to be very filling and satiating, so there's less. Room and less desire in your life for the foods that spike your blood sugar the most and have the least amount of vitamins and minerals in them, which are primarily your refined carbohydrates, your, your added sugars, your white flour, your white rice, um, anything where, you know, the, the goodness has been taken out of that whole food, original whole food source of carbohydrates. So a lot of these things, it's like they intertwine cuz it's all, it's all related, but those would be the top three areas. The nutrient dense foods, protein rich foods, and then focusing on, on blood sugar balance. And oftentimes those foods are simply displaced by, by eating more protein and eating more healthy foods.

Natalie: 7:51

It's like it was meant to be that we eat real whole food. Yeah. Right. Uh, so, okay, we did have a question too, like, since you already mentioned it, sperm quality. Is it, I mean, your, your books are primarily focused at women and prenatal nutrition, but were a man to eat the same, same kind of diet. Would that be what they're aiming for? Is there any specific nutrients that they need to add?

Lily: 8:18

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, pretty strong research on involvement of vitamin A for, uh, the whole process of, of generating sperm. Um, f folate is important to sperm health and reducing something called D fragmentation where 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 studied for sperm quality. Uh, vitamin D deficiency can affect sperm quality. So yes, there's a lot of overlap. Um, But a big one for, for men especially, is avoiding the, the not, the not so great foods, um, and alcohol and smoking, um, and avoiding, uh, toxin exposure as well. Um, you know, men of course create a lot more sperm or have a lot more sperm than, than women have eggs, right? Um, so you can kind of get away with a higher proportion of, you know, not all of your sperm is super healthy, and it, it's still fine. The body has ways of kind of, the egg actually sort of self-selects the, the healthiest sperm. Um, however, like chances of conception are, are highest when you have a, you know, a healthier ratio of sperm, like fewer damaged sperm. Um, and toxins play a really big role in like, The having, it has detrimental effects, um, on sperm health. So, um, again, like in real food for pregnancy, after that whole chapter on toxins, you argue arguably could write very similar things. But all the research citations were, would be for sperm, like the same things that are detrimental to pregnancy, uh, the health of, of your baby, and pregnancy outcomes. Um, you also equally have a ton of research on like egg quality, ovulation, um, spur quality, uh, yeah, that it's all, there's a lot of overlap. So avoiding the non-stick pans when you're cooking, for example, switch to stainless steel cast iron, glass, uh, cookware. Um, Avoiding exposure to toxins as much as possible, including things like smoking, vaping, um, exposure to high pollution areas, if at all possible. Um, think about toxin exposure on the job. Like does your partner work in construction and have a lot of toxin exposure there? Could they wear one of those like legit crazy masks or open the windows or find a way for more air ventilation or, um, do their painting, you know, they're refinishing cabinets, refinish them outside or in like an outdoor open air, um, uh, covered areas so that they're not inhaling as many of those, those toxins. Things like that do, do have a really big effect. Um, and of course the more toxins you're exposed to, the more of a drain that puts on your system to. Detoxify those things. And yes, we have built-in systems for detoxification. Um, our liver and kidneys especially are, are really good at doing so, but when we like, are overflowing with exposures, you at least have to take a look at the ones that are within your control and, uh, reduce your exposures as much as possible. So for men with high toxin exposure, they might wanna be focusing, um, well even more on the nutrient dense foods, but specifically on nutrients that support their body's detoxification systems, like production of the enzyme glutathione, which is so, so important for, uh, or antioxidant glutathione, which is so important for detoxifying. Um, a number of. Of these chemical exposures. So foods rich in selenium. Um, our seafood, for example, is really good organ meats. Uh, you could throw in Brazil nets there as well. Um, but a lot of our protein rich foods have a lot of selenium. Um, your foods that are rich in glycine, 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 a couple more that are involved in glutathione production, but um, those are some of the major ones that you do wanna be looking at.

Natalie: 14:01

Perfect. And that, I mean, there's so much overlap, like you said, I think the concept of nutritionism, that's what you call it, right? Where it's like hyper focused on isolating each individual nutrient and like overthinking supplementation versus like, let's just have whole foods and nutrient dense foods. Um, yeah. So could you give like a couple examples of where there's a very synergistic, um, relationship with a couple nutrients in, in specific foods? Sure. Yeah.

Lily: 14:35

Does that make sense? No, I, I, I cover. Yeah. So a, a lot, um, a lot of nutrients work together in their functions, in your body, and then in foods, a lot of times, well, there's no food that only contains one nutrient, right? They all, all foods contain an array of nutrients. And oftentimes there are, um, qualities where these, these, uh, nutrients kind of like co function and our metabolism in some way. Um, with regards to pregnancy, for example, we know that, uh, choline and DHA seem to work together. Um, choline is often in the form of a phospholipid, which helps to transport d n A across. The placenta to baby and also help incorporate that DHA into baby's brain. Mm-hmm. So, um, you know, when either one is supplemented solo, that doesn't have the same beneficial effects as when they're supplemented together, but our food sources of d h a really all have choline in them as well. Our, our seafood, our salmon, um, our egg yolks, for example, they all have both, uh, nutrients together. We know that, um, you know, the production of red blood cells, people are always worried about anemia. Mm-hmm. Anemia, um, can happen when you have, you know, too few or dysfunctional red blood cells that aren't able to carry oxygen properly through your system as they should. And, uh, Everybody thinks of iron and anemia as if that is the only cause of anemia and it's not. Um, iron is iron deficiency. Anemia is one subtype, but you can have anemia related to a variety of other, uh, nutrient deficiencies. Most, most commonly, uh, folate or vitamin b12. Usually B12 over folate cuz our food supply is, is fortified with a whole bunch of folic acid that rarely in fortified countries are people falling short on that one. Um, but there's even, you know, vitamin A, um, glycine, b6, uh, and then the B12 and folate as well as the iron, uh, copper as well. A mineral that kind of co functions with with iron. Deficiencies in any of those things can reduce red blood cell production and also reduce the production of the heme protein, which carries the iron in our system. Right? We have our hemoglobin, um, that everybody is, is talking about, and in foods we have heme iron found in animal foods and non-heme iron. And the one that's bound to heme is, is much more bioavailable, right? That's the same type that our body uses to carry iron through our system. So when you start looking at all the things involved in anemia and you look to food and you look historically what was used to treat anemia, they use liver or liver extract. Or some of the older studies refer to liver juice, which sounds particularly appetizing, right? Um, as a, like a traditional treatment for anemia. And you look at liver, it has all those nutrients that I just just mentioned, um, in abundance, right? So there's many different things that. Work together in our system that, 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 supplement with iron, for example, you might not actually be addressing the underlying cause of the anemia, right? If it's not iron, but also iron is metabolized. Well, if it doesn't have all these other co-factors. So that's where, that's where yourself, right? In some ways you could be shooting yourself in the foot or just not fully addressing the problem and wondering why your condition is not appro improving. Hmm. Um, and this isn't to throw supplements under the bus. There's definitely a time and a place for supplements. I'm not antis supplements, but I definitely am pro, um, food first for addressing things and, and still prioritizing food, even if and when supplementation, uh, is needed to fill in certain gaps.

Natalie: 18:53

Okay. Yeah. So how would someone find out like what supplements they might need? Like are there specific labs that you recommend? Um, specifically I guess in the preconception time, like should they get a whole, a whole panel of blood work ahead of time? What should they be looking for?

Lily: 19:11

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 care and medical testing and ability to afford it. Cuz a lot of these sort of advanced functional medicine kind of panels, uh, are not always covered by insurance, right. So, From, from just like the standpoint of what can we get through, uh, just a regular old doctor who doesn't really know a whole lot about nutrition, but maybe 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 the preconception phase, I think it is a good idea to, um, get like a, a, C, B, C, a complete blood count and see if there's any anemia present. And if so, you can do follow up work to check on your iron, uh, folate and B12 to see what's going on there. Um, and see if anything needs to be optimized ahead of time. It really is ideal to come into pregnancy, not anemic, because it is so much more likely to occur during pregnancy. So coming in with like a solid, solid baseline is helpful. Um, beyond that, I mean there are other labs that I would test that. Wouldn't necessarily be nutrition related. Um, so I'll skip those. But, uh, as far as like a micronutrient panel, that is certainly a possibility. And there's a wide variety of like comprehensive micronutrient panels on the market where you can see where your levels are at, um, for a variety of different vitamins. Um, certain minerals, though not all minerals are best tested via blood work. Sometimes those are tested via hair instead. Um, and that's kind of a controversial area of testing. Some people have, you know, believe there's more or less validity to that. But certainly with a a blood work panel, um, there are comprehensive options, both blood work and, and some urinary markers that can be used. Like Genova has a nutrient eval that's sometimes really helpful. Um, vibrant America has a good panel, um, that can be used to assess a variety of, of other micronutrients, not just some of those major ones, but you can also just. Only if you're limited with what's out there, only test a handful. Um, and those are usually ones that any conventional provider can test for you.

Natalie: 21:40

Okay. Okay, cool. Yeah. Um, I was thinking about all of that in terms of like, okay, people are, they're getting instruction to just blindly supplement oftentimes. And I, I definitely have a lot of questions for you about folate and folic acid because it's a huge topic. Um, and I know you have a whole article on your blog about it, but, um, so the conventional prenatal vitamin oftentimes has a lot of folic acid in it, and that mm-hmm. Has been historically like a recommendation for preconception. Can you talk about, um mm-hmm. The differences between folate and folic acid and kind of maybe some of the, the main issues with excessive folic acid supplementation? Yeah.

Lily: 22:25

Yeah. So, um, the reason they recommend folate. I'm just gonna use the word folate for right now. I'll, I'll explain in a minute. The reason they recommend folate in the preconception timeframe, um, is primarily because a lack of folate, a folate deficiency in the mother very early in pregnancy at the time when the embryo is just beginning to like form what's called the neural tube, which like connects up to your brain. So the various early brain and spinal cord development, which takes place like, gosh, within three weeks post concept, it's in like the first, what's considered the first five weeks of pregnancy, but the way we date pregnancies, throws everything off. So, okay, so within a couple of weeks after fertilization, um, That neural tube is closing and a deficiency in folate can prevent that process from happening properly, leading to a very serious defect called a neural tube defect, which can be of, you know, varying degrees of severity, but some of them are, you know, make it so that, that that baby cannot survive and the pregnancy is non-viable, right? Mm-hmm. Um, or they can be severely disabled. And so, um, once we learned that in some cases, uh, supplementation with folate or correcting a folate deficiency, and the mother could fix this, there was, you know, widespread effort to improve folate status at a population level. And since most pregnancies, or at least half of pregnancies in the US are unplanned, it was like we need to address this at a population wide level to prevent, because by the time. You're pregnant. This process of the neural tube closing is already taking place. Right? So if you like intervene with folate supplementation at week six of pregnancy, you are too late. Mm. So, yes. Um, so this is, this is really ultimately why, cuz most women aren't thinking about taking prenatal vitamins for better, for worse until they're already pregnant.

Natalie: 24:35

Right. Um,

Lily: 24:36

That's the why. Okay. The, the reason folic acid, it's kind of perplexing why folic acid is even used, but I think that the reason is when they originally found it. So, folic acid is, uh, synthetic version, manmade form of folate. Folate is an umbrella term. There's at least 150 different types of naturally occurring folate. Um, oftentimes with very complex structures of, of, uh, things attached to like the central. Part of that compound that we call folate, or when you isolate it and oxidize it, and it's this manmade form, it's folic acid. Now, folic acid is very inexpensive to produce a lot of the early studies on supplementation, used folic acid. Um, because it is oxidized, it is very stable when it is added to fortified foods. So it doesn't like break down. Um, and it is, it is absorbed in the GI tract because of its very simple structure. It is absorbed very well. Whereas your body has to go through a couple enzymatic steps involving zinc to remove all this extra stuff on the natural folates to absorb it into your system. Hmm. Folic acid doesn't have that stuff added onto it. Okay? Problem is, uh, what is absorbed ist necessarily well utilized by your body. Okay. So, Synthetic folic acid doesn't participate well in all of the things that a natural folate would do in your system, your body actually has to alter the structure of it just a little bit through a process called methylation. It has to turn it into methylfolate in order for it to work in your system, to work in the folate cycle, to work in all these cycles that involve, it's called methylation, which when you have rapidly dividing cells, um, as you do in pregnancy, when you're growing a brand new human being from scratch and your body, there's a lot of methylation going on. Um, your body has to do this extra legwork to make it metabolically active in your system and the majority of of folate, despite there being 150 plus different types in our foods, the majority of it well over 90% is in the form of. Methylfolate, the type of folate that circulates in your body, that's in your bloodstream, that's in your red blood cells, that's in fetal cord blood. So what the baby is, is taking in 95 to 98% of that is in the form of methylfolate. Hmm. So it begs the question, why are we not supplementing with methylfolate? Right. Which doesn't need your body to do any of this work in order to make it metabolically useful, um, to your system. Instead, we're putting in this synthetic folic acid that your body has to do all this extra legwork to make it helpful. Yes. Your body absorbs it well. Yes. It's not the same as it participating well in what your body actually needs it to do. And so there's been a lot of questions raised about, uh, whether we might wanna. Switch over. Yeah. From doing full from supplementing everybody with folic acid, um, or fortifying all the foods with folic acid. Um, when it's now been revealed that the vast majority of these populations that have food fortification programs polluting, most pregnant women, women and most newborn babies have high levels of what's called unmetabolized folic acid. So it's like the folic acid that you absorb super well that can't do anything useful in your body just kind of builds up in our bloodstream and we don't fully understand what that's actually doing to our system. Interesting. That's actually why there's like an upper limit for folic acid, the upper limit set by the government. The government's so afraid of, of setting like. They set our nutrient standards like so, um, I don't know. So conservatively. Mm-hmm. Um, and even their upper limits. So there's only an upper limit for folic acid. There's not an upper limit set for methylfolate or natural food folates. Okay. Um, for folic acid, it's set at 1000 micrograms per day. And a lot of times you have prenatal vitamins that have 1000 micrograms per day. Sometimes women are supplemented with 5,000 micrograms per day of folic acid, which is five times the upper limit. Um, and that's not even considering what you're taking in from fortified foods. So they've actually looked at like, how much folic acid can we all metabolize? And it's somewhere between like 200 to 280 micrograms of folic acid. That's like the limit to how much your body can metabolize beyond that. You actually start screwing up the folate cycle and your body like, it, it, it blocks the enzymes that are involved in actually, you know, utilizing, uh, folate. So you can actually have a syndrome where you're folate deficient, but you have an excessive intake of folic acid. I don't know if that makes sense. It totally does. Yeah. Um,

Natalie: 30:16

that's

Lily: 30:16

so fascinating. And that's, and that's in people who genetically have fully functioning enzymes in their F cycle. Okay. So now we have this very widely discussed genetic mutation or genetic variation called Mt h ffr. Mm-hmm. And mt h FFR is the enzyme that adds the, the methyl group on, um, So if you have a genetic variation in that and your body is anywhere from 30 to 70% less efficient at methylating folate, and you take in a whole bunch of folic acid, your body can't do anything with it. So you end up folate deficient. And there's a lot of things that are reliant on this methylation cycle and this full late cycle. So it can have many downstream negative consequences. Um, some of them are relevant to fertility. So there have actually been case studies, um, even in women without an M T H F R variation where you take a woman who was given a very high dose of folic acid to supposedly promote her fertility. So like a 5,000 microgram dose. Okay. And her lab markers, uh, of like how well her folate cycle and methylation are working. Namely something called homocysteine. It's an inflammatory compound. You don't want it. High, high levels are associated with a high rate of miscarriage and a variety of pregnancy complications. Her homocysteine shot way up on the high folic acid supplementation. They instead discontinued the folic acid supplementation, gave her a dose of methylfolate of only 500 micrograms, so tenfold lower dose than what the folic acid was. Yeah. And her, in a matter of days, her homocysteine normalized and 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 and my. Of course our guidelines are saying very different things to what I'm saying because I think they ignore the biochemistry of it. Um, and it's just what we've always done. So if you ignore the biochemistry of it, then you know, ultimately our body can use some folic acid. This is true. We can use some of it. Okay. Um, we observe it at least, right? And so it, it can be of some level of benefit, but there also can be some level of harm or some level of it not really doing anything for us. And if, if bolic acid supplementation and fortification was the intervention that prevented all neural tube defects, I, I wouldn't have any qualms, but at, at least anywhere from fif 30 to 50% of neural tube defects are what's called folic acid resistance. So despite these women having sufficient intakes, their, their idea sufficient intakes right, of folic acid, still there is a level of, of neural tube defects that have not been prevented. Hmm. We don't even know the mechanism why folate, um, can help to prevent neural tube defects, by the way. But we do know that when you have sufficient concurrent intake of a number of other nutrients that function in the folate cycle, b12, B six, glycine, choline, and acetol, uh, and a number of others, you can actually reduce at least by half the, the rates of neural tube defects. So it's more than just folate and it's certainly more than just. Folic acid. Mm-hmm. But to go back to your use of the term nutritionism, we got so siloed in our view that okay, folic acid is the solution to all of this, that we're missing everything else. Everything else is, yeah. Wow.

Natalie: 34:38

Okay. So if I'm hearing you correctly, in the case study, when she was taking the, the methylfolate, it actually lowered her levels of the, like built up folic acid in her system.

Lily: 34:49

Does that, I don't know that they checked her unmetabolized folic acid. Okay. Um, I'd have to look at the case study, but they did check her ho homocysteine levels. Okay. So her homocysteine levels are, um, levels, it's generally considered like an inflammatory compound. Mm-hmm. And if your folate cycle isn't functioning normally, you'll have a buildup of homocysteine in your system. Got it. Um, and so with the high, high folic acid supplementation, that's. What occurred for her. Okay. There was an excessive level of homocysteine when they switched her to the methylfolate, her homocysteine levels normalized, which is an indication that that whole nutrient metabolism cycle is actually working properly. Mm-hmm.

Natalie: 35:33

Okay. Yeah. So yeah, I guess I'm thinking like, is there a worry if you have unmetabolized folic acid in your blood? Like do you need to get that out somehow? Or like by just eating nutrient dense foods, you're supporting your detox pathways? Like

Lily: 35:48

is that I think just by we, so we don't fully know the effects of unmetabolized fo folic acid. Okay. There's been all sorts of studies that have looked into whether or not this is a bad thing. We simply know it is occurring and it is now occurring at a very high rate since we started fortifying the food supply. And we know that particularly in pregnant women, it happens at a very high rate because most are taking supplemental bull acid. Some are taking supplemental folic acid on top of a prenatal that already has plenty of folic acid in it. So they're getting like the double dose because they heard that they need to get enough folic acid to prevent neural tube defects. They didn't hear that like beyond the first, you know, first little chunk of pregnancy that'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 defect window is long gone and now you're starting supplementation in the second trimester. It's like, yeah. So you have some women who are just taking like tons and tons and tons. So it's a phenomenon that's been observed population-wide. We have very high, uh, percentage of the population that has unmetabolized folic acid in their system. What effect is that happening? Is that having rather, um, we don't know for sure. There's been. A variety of, of people suggesting that it might have something to do with potentially neurological issues. Um, high folic acid can, you know, block the function of vitamin B12 in the body. So maybe it's contributing to B12 deficiency, which of course affects our brain function. There have been some studies suggesting it might have something to do with the rising rates of certain cancers because generally folate helps with cell division and, and replication. So could we be contributing to say you have pre-cancerous lesion and then you have a whole bunch of folic acid in the system. Is that like perpetuating the growth of this pre-cancerous thing that you wouldn't want to, like We don't know. And I'm not saying any of this is for sure. Right. Um, that's still genuinely up for debate. And this has been up for debate for like. 20 plus years. Okay. So it's, it's an ongoing, it's an ongoing area of study.

Natalie: 38:09

Wow. That's a lot to consider. So I guess thinking through, like if somebody is preconception, they're thinking through their, their folic acid folate supplementation, maybe they back off the prenatal vitamins, potentially if they're eating a sufficient nutrient dense diet. Well, I

Lily: 38:28

personally would recommend switching to a prenatal that has methylfolate. There you go. Then there's no it there, there is no unmetabolized folic acid that builds up in your body when you take methylfolate. And we do have to genuinely talk about the benefits of folate, right? I mean, like you, you do absolutely need sufficient folate. I wouldn't want anybody going into pregnancy, uh, folate deficient. Right? So if the only thing you've got is folic acid, I still think that's better than nothing. Okay. Okay. Um. But, uh, you know, your, your body maxes out how much of it it can utilize after like 200 to 280 micrograms a day. Um, and if you're taking in any fortified foods whatsoever, all of our refined grains sold across state lines anyways, our fortified with folic acid. You're, you may be getting a lot from food that you didn't realize, but I recommend switching to a prenatal that has methylfolate. I recommend increasing the amount of folate rich foods you're taking in. And if you have one of these genetic variations like Mt. H F R, many of us don't know we have it unless we get tested. But regardless, you know, it's still a benefit for all of us to eat the natural forms of folate and the biologically useful forms of folate like methylfolate. Um, But especially in those individuals, like you wanna really be emphasizing your intake of fully rich foods. So liver is our number one source. Um, then it's like leafy greens, legumes, um, certain seeds, uh, avocado, asparagus, beets. I have a whole list of all the folate rich foods and their concentration of folate per serving size in that article on folate that you alluded to, and probably a much more, uh, succinct discussion, uh, logical, you know, discussion of all the points on, on folate since my, you know, default form of communication, clearest form of communication is writing. So I can really like put everything in, uh, logical order so you can follow my train of thought in all my tangents. Um, that's all, all in that article. So I would look there and look at building in the number of servings of folate rich foods that you can. Ahead of time, ahead of pregnancy, and of course throughout pregnancy still of benefit. Okay.

Natalie: 41:03

I feel like hearing you talk about it in real time and reading the article really puts some things together for me. So Good. I needed both, which is great. Yeah. Yes. Um, so with all of the folate conversation and the rise, potential rise in tongue ties showing up in lots of babies, how is that related? Is there any new research on that As of recent?

Lily: 41:28

Yeah. So I, so not, not super as of recent, um, I did write about the, um, I did write about the most, the really the most recent and the only paper to date that I'm aware of, um, on the topic on my Instagram page. So on my Instagram page, I have, um, I put in. What I call research briefs, where it's a little summary of studies that can fit in my little very limited caption. It's a, uh, it's an exercise in brevity for me. Um, but we do have one study. It was from 2020. I've pulled it up so I can give you the actual exact information. Awesome. They looked at 85 infants with tongue ties versus 140 infants who did not have tongue ties. And then they looked back at the folic acid intake of their mother's. Um, so when they looked at folic acid intake at any intake level, they found a slight but insignificant increased frequency of tongue ties. When they looked at women who preconception took folic acid on a regular basis, they found that the rate of tongue ties was significantly higher among the babies who were exposed to folic acid. So they found a rate of tongue ties of 51.4%. In the babies of mothers who regularly took folic acid preconception versus a rate of 25.7% in those who did not take folic acid on a regular basis preconception. So in other words, it was about twice the rate. Um, still there were still babies in the group of moms who did not take folic acid regularly, who still experienced tongue ties. Um, the idea that this might be a link is that one of the many roles that, you know, folate plays in cell division replication, all the things, is in the formation of what they call midline structures. So things, structures that develop down the middle part of our body, um, that would include the, the. Frenulum, um, underneath our tongue. And also the ones that attach our lips to our gum gumline, cuz you can also have lip ties. Um, so the thought is that if you have too much folic acid, potentially you might make like, midline structures that are too thick, too robust, hence, hence the tongue tie. Mm-hmm. Um, I think it's probably like, it's probably a variety of factors that contribute. I've even heard from some older midwives that, you know, when babies were born, they used to just have a, a sharp fingernail and they just like, eh, right under the, oh my gosh. Right under the tongue. And they, you know, they, they snip that tongue tie. Right on, right after birth, you know, um, so what, what is it? We, we don't really know. I think it could be a contributing factor for some people. Um, I do wanna point out that in this study, you know, the average intake of folic acid wasn't that high. It was only 400 micrograms per day. Okay. Um, but in the US average intake of, of synthetic folic acid from fortified foods in women is about 300 micrograms per day. Right? So you're already almost hitting that limit, just, you're already almost hitting that limit. Supplementing, and most of your supplements 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 the population taking in more than their body. Can utilize, but I don't think we have perfect answers on this. You know, whenever I put stuff like this out there, you know, I hear from, from women, like, I don't, haven't taken any bull acid, I don't eat any fortified foods, I supplement with, with methyl methylfolate only, and my baby still has a tongue tie. Like, I don't think it explains all cases. I think it might be a contributing factor for some, and maybe there's some genetic susceptibility or environmental susceptibility that we don't know about that could be contributing as well. I don't

Natalie: 45:47

know. Yeah, it's fascinating. I know I've heard lots and lots of stories of tongue ties recently, and it, it seems just like my own experience in talking to clients, it seems to be on the rise. So, um, yeah. Hopefully there's more research soon about it. That would be great.

Lily: 46:04

Yeah. I, I hope so.

Natalie: 46:06

Yeah. Um, okay. I had a couple, um, Audience submitted questions that I wanted to go into. Um, so the first, well the first one was, do you think there will ever be proper nutrition education for expectant moms? How are we doing on that?

Lily: 46:24

I mean, define the avenue of, uh, nutrition, ev education. Uh, yeah, I If you're expecting that your, you know, healthcare provider is going to be up to date on all of the current research on pregnancy nutrition, I mean, don't hold your breath. Yeah. Cause just on average, the, the quantity of hours of nutrition education in medical schools is very limited. And, and the majority of them don't have. Really anything on nutrition or they have a single three credit course on nutrition. And of course that class would be, I could guarantee you just rehashing whatever the dietary guidelines are. Mm-hmm. Uh, which, you know, a lot of my work is pointing out where those guidelines are flawed and or outdated. So from that standpoint, you know, I don't know that we can expect that from providers. And I also don't know that it's fair because, you know, even as, as a dietician, you know, I spent four years studying nutrition, not, not counting all the work I did ahead of time. I mean, nutrition was a passion of mine from a really young age. So I already came in pretty nutrition literate. Yeah. And then I, you know, four years of formal education, four years of, or not four years, one year in, you know, primarily a hospital setting, doing like inpatient clinical care sort of stuff. And then the years and years of. Work with clients, work in public policy guidelines on gestational diabetes, um, work training, other professionals, work in private practice, all the additional training. And of course, for me personally, just thousands upon thousands of hours of reading. Yeah. Research studies. I don't know that we can expect that from like a busy clinician who has their, their practice, you know? So I think, I think some of this stuff we just kind of have to take matters into our own hands. If we wanna be educated on a topic, we need to find the information ourself. And I mean, my hope is that like with, with my books, especially with Real Food for Pregnancy, um, I've done some of the legwork. For you, um, you know, nutrition research compared to just about anything else is so fraught with, um, you know, just flaws in the methodology and the studies study design, who funded it, like what are the com competing interests and the results of the study? How did they like rig the methods to make a certain dietary intervention or a nutrient like, you know, come, have the results come out a certain way? How do they present the information? Like, does, does the results and discussion section actually match. The data, because sometimes, I mean, if the study even includes the data itself, like in a table, you'll be reading these conclusions. You're like, oh gosh, this sounds so dire. And then you look at the, the odds ratios, risk ratios and the data, and you're like, what in the world? I would never, I would never come up with that conclusion from this same data. Um, so interesting. The longer that I do this type of work where I'm like basically full-time, like translating research into something actionable and useful, the more I'm like, the quality of some of these studies is, um, not good. Yeah, not good. Wow. I'll just say that. So, um, so I don't know how long, how long it'll take, but I think you just have to be proactive about seeking out the information. That you want. Um, and I think there's just like any profession, you will have people from many, many different professions that have varying degrees of, of expertise in a topic, regardless of the letters behind your name. So there's a lot of people who are not even nutrition professionals in, in any manner who are just geniuses in this field. And on the flip side, you have people with all the so-called appropriate designations, and they're just, they're just talking heads for the outdated guidelines. You know, it's, it's like, you know, a plumber, you have really good plumbers and you have really terrible plumbers. It's, you know, any profession, really great lawyers, really terrible lawyers. Um, so I think it takes just an individual actually having an interest in taking it upon themselves to, to dig deeper, to educate themselves. I just don't think we can expect that from. From just any old provider. You'll find it with some, you'll find those, you know, needles in a haystack, but it, it's not every single one.

Natalie: 51:28

Yeah. Yeah. I know a lot of midwives now are giving your book to every client just because it's the best source out there, I feel like. And thank you. Yeah. Yeah. And I, I truly mean that. I feel like it's great for professionals as well as the average consumer. And I think that's, so, um, I don't know, it speaks volumes about how you write, but it's also something you talk about, like, women aren't dumb. Yes, yes. They can learn and research on their own and, and come to their conclusions and, and be smart. It

Lily: 52:02

doesn't have to be, and we, and we have to approach, um, pregnancy, birth, and motherhood through, you know, being knowledgeable and empowered because there's just a lot of, a lot of things and our whole society and medical system and, and other things that just. Don't even make common sense. So, um, yeah, you have to really be, be on top of, be on top of it yourself. Um, and I really do, I, I don't succeed every time, but I do really try to put in an effort to make information that is maybe a little too high level, a little too full of jargon if you're just gonna go read the, the study, um, into something that makes sense to the average person. 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 for Gestational Diabetes is, is, uh, much more simplified and written in, in simple terms, but real food for pregnancy really is like writing to that educated audience because that, those are the people that kept asking me for information because there's, there's plenty of general information out there about pregnancy. There really isn't a lot of very specific information about pregnancy. And on top of that, I think most providers are really not comfortable questioning, um, guidelines. I mean, gosh, the thought that like, You could potentially, you know, do harm to a mother or a baby by like, not following the guidelines. I mean, I take that extremely seriously. Yeah. Ultimately, that's why I wrote Real Food for Gestational Diabetes in the first place, because the guidelines were harming mothers and babies, and we do need to, uh, revise those, at least in regards to, uh, or especially in regards to carbohydrate consumption, to optimize blood sugar levels and optimize outcomes like it. Mm-hmm. It felt like a moral obligation to, to write that. But the more you dig into more of these things, it's like, holy moly are, are we unwittingly putting women and babies in, in harm's way or just not optimizing outcomes by not talking about, Hey, there's this research showing our. Protein requirements are set, 73% too low in pregnancy. Like, come on, this isn't, this isn't a 5% margin of error. Yeah. This is a major, this is a major discrepancy here. Um, so anyways, yes, I, I, I appreciate your feedback. I, I do know there's some, you know, midwifery, uh, programs that, that have real food for pregnancy 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 will have some. A little more of like a, a level playing field here. Yeah. Hopefully

Natalie: 55:11

not that long, but maybe, um, speaking of protein, there was another question about protein. Um, they wanted to know your top tips for protein aversions. Um, she said she had only stomach plant proteins during her pregnancy, but knew the importance of animal foods.

Lily: 55:28

Mm-hmm. So I've, I've seen this occasionally, uh, particularly first trimester and particularly in women who had a really solid foundation of nutrition coming into pregnancy. Hmm. So, I've seen both things. This is totally anecdotal, you can't quote me on any studies here, but I have had women who are vegan, previously vegan have like undeniable, um, unavoidable urges to eat eggs, specifically egg yolks, bone broth. Oysters in their pregnancy. And then of course the classic craving for like a burger. But like you take even those first three foods I mentioned and that fills in almost entirely all of the potential nutrient gaps on a vegan diet. Like that's fascinating. And I've even had women in their first trimester say that those were the things they were cramping. And that is a time that's classically a period of meat aversion for a lot of women. Um, on the flip side, I have some women who come in, they're like paleo or high protein or full 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's something behind the sort of, you know, cravings have some, or aversions have something to do with the nutrient requirements of the body and your body's trying to like sort of balance out where there's gaps. I really do think that's a potential. Uh, possibility. I mean, I myself am very much like a mindful intuitive eater, so I didn't really overthink my cravings or aversions during either of my two pregnancies. It was just sort of like, oh, I really want citrus this week a lot. Okay. Ooh, salmon sounds really good this week. All right. Ooh, liver pat on crackers. Like, I'll have more of that. Or, you know, oh, I only want sour gummy worms. Darn it. Let me try to find something that'll give me that sweetened sour without being sour gummy worms. Yeah. Um, you know, but maybe there's, maybe there's something to these cravings that we don't fully know about. Hmm. So, in the case of somebody, you know, who has full animal protein aversions, I mean, I feel 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. Beans, legumes, nuts, seeds, those sorts of items. And maybe you can find ways to kind of sneak in a little bit of these foods from time to time. Little bites of things here or there. Sometimes it can be the way it's prepared or who is preparing it. Mm. So at times when I didn't really wanna be eating meat, it was more that I didn't want, the smell of cooking was just entirely repulsive at different times in my pregnancy. So like, I'll happily eat, hold pork, but like, can you prepare it and stick it in the slow cooker in the garage? And then I'll eat it when it's fully done, but I don't wanna touch it or smell it cooking. Um, I hear that a lot with like poultry chicken for example. So that's, that's a possible way to get around it. Um. Or to buy it pre-prepared, like, again, period of time where like cooking eggs was like, eh, I'm the biggest fan of eggs, right? But like, yeah, the smell of it cooking, ugh. Um, but like a pre-made egg salad was like so delicious or interesting. You could do eggs in something like make some pancakes where there's eggs in it. Or I have like a, a spiced banana nut muffin recipe in my, um, e cookbook. You can find that over@shop.lilly nichols rdn.com. That's like, has a lot of eggs in 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're gonna get your eggs in. Maybe you wanna just round out your amino acid profile with some collagen. Or gelatin. You could make like gelatin, gummies with, with fruit juice, there's a recipe for some and real 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 and coffee, tea, cocoa. Yes, that's the thing. Oatmeal, whatever. But you can also add it to savory foods, which I think in some ways actually, if it, it has a subtle flavor, depends on the brand. Some brands are, uh, taste awful. Other brands don't have super off flavors. But, um, say you wanna have, you know, you want pasta for dinner, right? Maybe you could do one of those leg yume based pastas so that you're getting extra protein in there and extra nutrients in there. And maybe you only want red sauce, but you add a couple scoops of collagen to the red sauce. There's no meat in there. But you've added protein to it. Guarantee you the flavor is masked in something savory like that. Yeah. Um, you could, you know, I would get creative with it, but I mean, ultimately you have to do what you gotta do. And, um, if, if that were the case 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 out your nutrient intake. Cuz with very low animal food intake, you might run into issues with, um, like vitamin B12 deficiency or zinc deficiency or iron deficiency and a number of other things. So a, a prenatal to round it out. Um, I don't think we mentioned dairy, I don't know if dairy's included in the animal protein aversion, but dairy can fill in a lot of, a lot of nutrient gaps, including pro, um, in the diet. So maybe you wanna focus a little more heavily there, but. I would also say like, I don't know if this person is writing in at the end of their pregnancy or if they're in the middle, things change. Yeah. You know? Yeah. True. It could ha it could be the whole pregnancy, but if it was just like you're writing in at 17 weeks, like you very well could still have those, the carryover of those early pregnancy aversions, or you might have different aversions come up at different times and just roll with it and things kind of even out over the weeks. Like I, I don't always get super concerned over, you know, short term food aversions, especially if there's supplementation on the side to kind of fill in the gaps

Natalie: 1:02:25

a little. Right. And I guess if you're going into pregnancy with a really solid foundation as well, then mm-hmm. You could worry less. Mm-hmm. Yeah. Yep. Um, okay. Uh, last question from the audience was, How much of your book translates to life after pregnancy and postpartum, and they were assuming that, you know, if it's good for growing a human, it's probably good for adult life too. Um,

Lily: 1:02:51

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 postpartum nutrition, nutrient repletion, um, nutrition for breastfeeding. So ultimately the same principles hold true across the board. You certainly don't have any, shouldn't have any remaining fears about beyond the general sense, but like food safety or certain foods need to be avoided. Even though some of that is not entirely true. Read chapter four. Yes. Um, that part of it no longer applies postpartum, so you don't have to be as, as concerned about that. Um, but the same nutrient dense foods that you emphasize during pregnancy Yes. Continue to emphasize those postpartum for sure. Um, especially protein. So I talk about protein in real food for pregnancy. Um, in regards to your intake while you're pregnant, since, since the book was published, there actually has been a study looking at protein needs in postpartum. Um, they looked at women at three to six months postpartum who are breastfeeding, and their protein requirements are actually higher than pregnancy. Okay. They're at, they're at the level of, at the level, at or beyond what a typical female athlete consumes. Okay. So, Lot of protein. Yeah. So my, it doesn't surprise though, my biggest recommendation for postpartum is to be over the top in emphasizing protein, particularly the nutrient dense ones that we already talked about earlier in the interview. Um, and in higher portions than you had in pregnancy. That solves like 99% of everybody's problems. Seriously get enough protein, um, but also expect that your, your appetite typically is going to be a lot higher cuz your cal caloric demands like energy needs, protein needs, and then a number of different micronutrient needs are much higher. During postpartum. Hmm. So I would emphasize all the same things you were doing in pregnancy, just larger portions. I typically recommend continuing a prenatal vitamin, uh, during at least the first six months postpartum. If you're nursing, you might wanna continue that longer, um, and really focus your efforts on, you know, rest and recovery and who's gonna help support that for you because you can't do it alone. So definitely read that chapter. I do have, um, as kind of a follow up resource, I'll have a number of resources on postpartum, but I do have a free blog post on my website that's called something like Real Food, postpartum Recovery Meals. I link out to 50 plus recipes. I give you some of the rationale. I talk about freezer tips and, and options for building in support and encouraging your community to bring you meals, things like that. Um, that's definitely a really practical. Guide thousands of people read that specific article on my website every single day. Okay. Yeah. So it's like, it is a good resource to have and it's totally free, it's just on my site. Um, I do also have, um, this is a little higher level more for professionals, but anybody is welcome to view. I do have a postpartum recovery and nutrient repletion webinar over at the Women's Health Nutrition Academy. Um, and that's roughly a two hour webinar going through all of like, you know, what to expect at different timelines, sort of the trajectory of healing your postpartum body lab tests, um, thyroid issues, postpartum mental health. It goes through like, just sort of a wider gamut of things. Okay. Um, and I actually have a separate approximately two hour webinar all about, um, breastfeeding, nutrition and nutrient transfer into breast milk. Cuz what you eat also impacts for some nutrients, not all the, um, vitamin and mineral content of. Your breast milk. So you also wanna look at this as like a two birds with one stone situation, right? Mm-hmm. Like the better nourished you are for some nutrients, the more nutrient replete your breast milk will be as well. For example, if your B12 levels are low and your B12 intake is low, your breast milk will also be low in b12, and that has potential consequences for your baby's development. So while I think a lot of people have the focus for postpartum just being on, you know, weight loss, oh, I just wanna lose the baby weight and get my body back, whatever that means. Yeah. It's a, you know, that's a lie. Yeah. Yeah. Your body's just changes and not necessarily in negative ways. Your body just goes through changes and these are all good. Um, but we really need to have the focus on, um, nourishing the, the mother, um, and, and building in that community village support to make that a possibility. And I won't get all political here, but you know, it's a train wreck that we don't have maternity leave as like a default in the US like other countries do. Cuz you really do simply need time. You need yeah, time. And in other cultures there is a big emphasis on allowing that time. But also there is just a built-in cultural support network and support practices and, and nutrition practices, um, to support those mothers. And I, I do talk about a bunch of those different cultural practices in, um, chapter 12 of Real Food for Pregnancy. I think there's a lot that we can learn from them. Um, if you're just trying to look at like the published research, there's very little research done on postpartum. It is a very understudied time for human nutrition, for animal husbandry, for, uh, farm animals. Where there's a financial interest in these animals recovering well and being able to have more babies or making sufficient milk for the dairy industry or whatever. There's a ton of research on farm animals, and that's pretty consistent, that like the nutrient demands are way higher in postpartum. We don't have that strength of data for, um, for humans, but it's, it's pretty obvious for anyone who's had a baby, like, holy cow, my appetite is higher. Oh my gosh, I need a lot more food. Ooh, on the days when I undereat, especially protein, I feel like garbage and my mental health is a disaster and my energy levels are tanked and I just feel completely zapped and wow. On the days when I get enough, I feel actually semi human again. You know, like these are, we, we don't, almost don't even need a study to say what is. What is obvious, right? But a lot of it is, do we have the support to make that happen? Do you have the time off to make that happen? Have you allowed yourself to rest? We very uncomfortable in America with like quiet time and time off and not being busy and not being what we think of as productive, right? Um, but this is just the time to not be productive. Like y you know, I had to like talk myself off the ledge in my first postpartum. Like, this is all too much. I can't do all this. I'm like, okay, my only job today is like to feed myself and feed the baby. Okay? If I can get that done, the day was a success, right? Mm-hmm. Mm-hmm. You know, it's like that's really, that's the level you need to simplify, simplify, simplify, and then simplify some more. Yeah. Uh, especially in that first month to two months, it's like you just, yeah. Pair it down. Eat, eat, lay down. Yeah. Yeah. Yeah. I

Natalie: 1:10:50

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 on eating good foods, preconception and then resting in postpartum, like, you know, a

Lily: 1:11:06

hundred percent. Yeah. Yeah.

Natalie: 1:11:08

It's crazy. Yeah, it's big. Um, okay. I have a couple questions that I ask every guest and I wanna know. So this one you can expand if you need to, but I want to know your number one piece of advice for our listeners. So what do you want every person to know?

Lily: 1:11:27

Hmm. I mean, I have to go with protein, uh, eat enough protein. Yes. Especially at breakfast, and just observe how your life and whole day is vastly better when you do that one thing. Yeah.

Natalie: 1:11:44

I have started like in the last year and a half eating breakfast. I used to be like a coffee first and like maybe a granola bar or something as I Yeah. Ran out the door and Yep. Yeah. It's made loads of difference in my life. So

Lily: 1:11:57

transforms your life. Mm-hmm. It's especially important for hormone balance and fertility, by the way, too, not just, not just pregnancy. I mean, it's important for everybody across the board. Yeah. But makes a big difference in, in menstrual cycle regularity and ovulatory function and blood sugar balance and stress hormones and all that. So, yes, please eat breakfast and eat, make sure there's protein there as well. It'll, yeah, really help you feel better. Awesome.

Natalie: 1:12:28

Okay. Second question is, what is your current favorite daily wellness habit that you're incorporating into your own life? Hmm.

Lily: 1:12:38

Current favorite. Let's see. Um, well, it's June, so a lot of things in my garden are hopping. So, um, I guess my favorite wellness habit is going outside barefoot and picking something from the garden, whether it's, uh, you know, snap peas or plums or tomatoes or zucchini or something. Just being outside and getting your feet in the dirt.

Natalie: 1:13:06

I love that. I don't know if you know this about me, but I'm a huge barefoot advocate and minimal footwear wearer,

Lily: 1:13:12

so it makes me very happy. Likewise, likewise. I'm so bad. Likewise, yes. I, I prefer to be barefoot over my earth. Runners. I mean, the earth runners are good and all, but yeah. No, Barefoot's better. Yeah. Awesome.

Natalie: 1:13:23

I have an earth runner, tan, tan line, so I feel like that's a successful summer

Lily: 1:13:28

so far. That's tricky in Alaska, right? Yes. The, yeah. Yeah. Although I do have a pair of barefoot boots, so you know, they're out there, the minimal flat 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. Yeah.

Natalie: 1:13:50

Oh, okay. Um, so can you tell us where can people find you online? Um, and then maybe talk a little bit about the Women's Health Nutrition Academy as well for the practitioners listening.

Lily: 1:14:03

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 site there's 250 plus blog articles. Use the search function to pull up whatever is of interest to you. There's a lot of freebies. You can get the first chapter of real food for pregnancy for free. I have a free video series on gestational diabetes. Um, there's a bunch of little freebies on that page, so grab that when you grab a freebie. You also get my, uh, not very frequent newsletter anymore cuz I have so much on my plate. I'm not sending as many emails as I once did. Um, but yeah, there's a ton of information over on my website. So, That also links out to my bookshop. So if you want either of my books, I have Real Food for Pregnancy, real Food for Gestational Diabetes. Um, those are on the sidebar. There's also a books tab on the top. You can see where to purchase those, if those are of interest. And yeah, for the uh, women's Health Nutrition Academy, that is a, uh, resource that I put together with my colleague Ala Barer, who's also a, a dietician. And we have pretty in depth. Practitioner level webinars and a variety of women's health specific topics. Um, most of our webinars are about 90 minutes to two hours long. Um, really, I don't think any of them are less than 90 minutes, so they're at least 90 minutes long so you can kind of get a feel for the depth of content. They come with a full reference list for all the studies that we're speaking to, um, in our presentations. So yeah, there's a wide variety of topics. There's, uh, some that are on pregnancy. I've done most of those gestational diabetes, uh, postpartum recovery and nutrient repletion, nutrition for breastfeeding. Uh, we have a whole two hour webinar on folate, right. That gigantic article on my site. Apparently is not in depth enough. And so if you're a practitioner who has any questions about folate or methylation as it relates to fertility and and pregnancy, that is the webinar to go listen to. Um, it's very in depth. You will, no stone is left unturned on the folate conversation. Um, yeah, there's just a ton on there. There's a bunch on fertility. Um, we started a series on P C O S. The first one of those is up there, so just browse those. Um, awesome. It's definitely a useful resource there. Uh, yeah, buy one, buy'em all. And, um, in addition to that, just this year I launched the Institute for Prenatal Nutrition, which is a full, um, At the time, the first time I ran it, it's 13 weeks. I'll probably do it a little bit longer the second time, but it's, um, a comprehensive prenatal nutrition mentorship program. So if anybody wants to be trained as a prenatal nutritionist, um, I'm going to be running that again in 2024. So, um, yeah, stay tuned for that. If you Cool. Don't wanna just do one-off webinars, but you want like a full walk you through all the things. Uh, mentorship with q and a calls every single week. Case study sessions, like a really good community. Um, there that's also will, again, be an option in 2024 when I run that again. Okay.

Natalie: 1:17:42

And are there prerequisites for that? Do, do people have to have a certain degree or things like that before they enroll? I do

Lily: 1:17:49

require that people have some sort, there's some health professional of some kind. Okay. Um, You know, if you just have a degree in nutrition but no professional designation, that's totally fine. Um, I accept Allied Healthcare professionals, not just dieticians. I accept non dietician nutritionists, assume assuming you have a solid background in nutrition, but like this round, we had, um, mostly nutritionists and dieticians, but we also had a midwife. We also had a physician assistant. So if there's any sort of, um, you really need kind of a medical science or nutrition background just for the level of the content. Um, the level of the content is like way far above, uh, real food for pregnancy level. Um, and, and much of it is above Women's Health Nutrition Academy level as well, although there is a little bit of overlap, of course. Um, so I, I do need it to be a medical professional. I do, I do have plans to create something, um, smaller and a little more, you know, Reasonable, uh, level of detail, um, for people who are like doulas or childbirth workers or even medical professionals who don't wanna do a full on huge lengthy, um, mentorship program as well. So that'll be in the works. I don't know if that will be launched in 2024, but at some point, I know I've been asked many, many times for that. So I'll be working on that as well.

Natalie: 1:19:20

Cool. Oh, man. Awesome. Well, thank you. Thank you for being here and sharing your time. Thank you. Thank you. And energy with me today and providing so much information for people.

Lily: 1:19:30

You bet. Yeah. Happy to do it. Great questions.

Natalie: 1:19:33

I'm glad. I so enjoyed my chat with Lily, and I hope you did too. I've been a big fan of her work for a number of years now, and I am so happy she's doing the work to educate us all on nourishing our bodies for the best outcomes, not only for ourselves, but our children too. I've listed all the resources she mentioned in the show notes for this episode for your easy reference. And if you have not read Real Food for Pregnancy yet, Put it at the top of your list. Please remember that what you hear on this podcast is not medical advice, but remember to always be an active participant in your care and talk to your healthcare team before making important decisions. If you found this podcast helpful, please consider leaving a five star rating on Spotify or writing a review on Apple Podcasts, as that really helps other people find the show. Thanks so much for listening. I'll catch you next time.