Meet the amazing Lily Nichols! Lily is a Registered Dietitian/Nutritionist, Certified Diabetes Educator, Researcher, and Author with a passion for evidence-based prenatal nutrition and exercise. Drawing from the current scientific literature and the wisdom of traditional cultures, her work is known for being research-focused, thorough, and sensible.
EVERY MAMA-TO-BE NEEDS TO READ THIS!!!
1. What is the most common food myth you hear related to pregnancy?
I often hear lengthy lists of foods to avoid. Often due to food safety concerns that are overstated, such as eating eggs with runny yolks, or concerns about mercury in fish, which leaves many women to conclude that they should eat no fish while pregnant.
Another myth is that you need to “eat for two”, when in reality, energy needs don’t increase much (certain nutrient needs do, but the solution is not double portions; it’s more nutrient-dense foods!). There’s a lot of nuance around prenatal nutrition, so I find that most guidelines end up watering down the information or leaving out complex discussions entirely. This, in my opinion, does a disservice to women who want to get the full scoop on controversial topics.
2. Can you outline what you recommend as far as meal composition for pregnant women? (i.e. frequency and macronutrients of meals)
I find that most women benefit from 3 meals and several snacks per day. This helps a women never get too hungry or too full and mitigates common pregnancy complaints (like nausea, early satiety, heartburn, and elevated blood sugar). That said, I fully embrace that every woman’s needs are different, so I try to avoid super prescriptive advice with too many nutritional “shoulds”.
As far as macronutrients, emphasizing a source of protein, fat, and non-starchy vegetables at each meal is paramount to satiety, prevention of cravings, inclusion of enough nutrient-dense foods, and leveling out blood sugar levels. Carb needs are very individual and I see a wide range of carbohydrate tolerance in practice. Typically ½ to 1 cup of a more carb-dense option, such as sweet potato or fruit, works well at meal times (can be less if a woman has gestational diabetes or another complication that is affected by high blood sugar).
3. What are your thoughts on carbohydrate consumption in pregnancy, and do you have any healthy alternatives that satisfy carb cravings instead of white/processed carbohydrates?
Our current guidelines are very high in carbs (45-65% of calories) and when women eat at that level, it is often at the expense of more nutrient-dense foods. Micronutrient intake (vitamins, minerals etc.) is inversely linked to carb consumption, so my recommendation is to look at carbs more like condiments rather than the mainstay at meals. It’s helpful to work with a real food-focused registered dietitian/nutritionist if a person is struggling to find the right carb balance.
Always, always choose the highest quality carbs available to you. There are micronutrients in foods like butternut squash, berries, legumes, fruit, and dairy products, but the same can’t be said for products made from white flour. In the US, 85% of carbohydrates eaten are refined carbs and I find that when women hear that they need “more carbs because they are pregnant” the go-to is processed foods, like cereals, not an extra serving of lentils. It’s a matter of both quantity AND quality.
4. What are specific foods/nutrients pregnant women need to eat more of?
Protein, vitamin B12, iron, choline, iodine, DHA, glycine, folate, vitamin A… Foods that help meet these needs are meat, fish, poultry (particularly tough cuts of meat, meat on the bone, bone broth, or poultry eaten with the skin specifically for glycine), eggs (with the yolks!), liver and organ meats, leafy green vegetables, and grass-fed dairy products (full fat).
5. What lifestyle changes should women make if diagnosed with Gestational Diabetes?
First and foremost, start monitoring your blood sugar, so you can start to identify which foods/combinations of foods spike your blood sugar. Then familiarize yourself with what foods are highest in carbohydrates (those are the ones that spike your blood sugar the most) and which foods aren’t. Depending on your familiarity with nutrition/food, you can start piecing together meals/snacks that leave your blood sugar at a healthy level.
Working with a dietitian that specializes in this area can be helpful, or you can check out my book, Real Food for Gestational Diabetes (or online gestational diabetes course of the same name) for further guidance. I also have a free video series that walks through the basics of GD for anyone who’s newly diagnosed.
6. Do you have an opinion on the use of collagen peptides in pregnancy?
I’m a big fan of gelatin and collagen during pregnancy, as these are the most concentrated sources of glycine. Glycine is a conditionally essential amino acid during pregnancy, meaning that you must consume enough of it in your diet to meet your body’s needs.
The role of glycine in pregnancy includes: development of your baby’s skeleton, teeth, internal organs, skin and nails; support of your stretching skin, growing uterus and placenta, and helping your circulatory system adapt to the demands of pregnancy.
For women who don’t have much glycine in their diet already (fairly common since eating top food sources has become rare), a gelatin or collagen powder makes a lot of sense. Just ensure that it’s sourced from grass-fed animals.
7. There are varying recommendations on maternal weight gain in the literature. How much weight gain do you believe to be healthy for women who are classified as being a healthy/normal weight pre-pregnancy (healthy BMI)?
The research on weight gain during pregnancy as well as the recommendations from countries across the globe shows us that there’s a wide range of “healthy” weight gain for pregnancy. Per the Institute of Medicine standards, it’s 11-16 kgs (25-35 pounds) for women at a healthy BMI. When looking at data from other countries, “normal” ranges anywhere from 8-15 kgs (18-33 pounds).
I think more than knit picking the exact number, we should be focusing on the habits that underlie low/normal/high weight gain in pregnancy so women can be proactive about that instead of obsessing about the scale. If a woman’s weight is trending up more than anticipated, I’ve found in practice the #1 cause is excessive intake of refined carbohydrates and sugars. Even women who have previously reported gaining 27 kgs (60 pounds) with their pregnancy find that their weight gain is normalized when following my real food approach.
Lily’s bestselling book, Real Food for Gestational Diabetes (and online course of the same name), presents a revolutionary nutrient-dense, lower carb diet for managing gestational diabetes. Her unique approach has not only helped tens of thousands of women manage their gestational diabetes (most without the need for blood sugar-lowering medication), but has also influenced nutrition policies internationally.
Her second book, Real Food for Pregnancy, is an evidence-based look at the gap between conventional prenatal nutrition guidelines and what’s optimal for mother and baby. With over 930 citations, this is the most comprehensive text on prenatal nutrition to date.
Lily is also creator of the popular blog, www.LilyNicholsRDN.com, which explores a variety of topics related to real food, mindful eating, and pregnancy nutrition.
Tell me in the comments below – what other questions do you have around prenatal nutrition?