What to eat during pregnancy - Lily Nichols on Prenatal Nutrition, Paleo Magazine Radio

Contributed by: Stella, @dirtygirlscleaneats 

“What should I eat when pregnant? When trying to conceive? Why do I want to eat ALL of the carbs? Why am I having so many food aversions? What supplements should I take? Can I still workout?”

If you have ever been pregnant, are trying to conceive, or have been in the company of another pregnant person, you are sure to have wondered or heard of at least one, if not all of these questions! 

The very subject of prenatal nutrition is a delicate one, as there is no “one size fits all” approach. It is also challenging to develop new evidence-based practices in a rigorously scientific way (aka randomized control trials), as it would involve subjecting pregnant women to more desirable versus less desirable situations, and then comparing fetal development between the two, something you can clearly see would not be very ethical…

Yet, despite these difficulties, new research is emerging every day, challenging some of the ways we have thought about prenatal nutrition, as well as some of the nutritional “standards” that have been prescribed for so long.

Once such person advocating for new prenatal guidelines based on modern research findings is Lily Nichols, a Registered Dietitian/Nutritionist, Certified Diabetes Educator, specialist in prenatal nutrition, and author of the bestselling book “Real Food for Gestational Diabetes: An Effective Alternative to the Conventional Nutrition Approach” as well as the recently published “Real Food for Pregnancy: The Science and Wisdom of Optimal Prenatal Nutrition”  (pssst… I have personally devoured this book and have used it to guide my own pregnancy!)

TOP 5 TAKEAWAYS

In case you do not have time to listen to the full podcast at this point (although you will want to!), here are the key points I personally took away from it.

• Lily is a registered dietitian and diabetes specialist by trade
• In her role, she witnessed first hand the drawbacks of conventional prenatal diets and how poorly traditional recommendations treated gestational diabetes and blood sugar levels
• This experience led to her establishing her own practice based on real food principles and guided by current research findings (there are actually over 900 research citations in the book!)
• Most prenatal recommendations are based on outdated guidelines and do not reflect the state of current research
• Lily has to do a lot of “deprogramming” and “re-education” in her work
• Although her food prescriptions can be considered ancestral, paleo, or low carb, Lily stays away from using any diet labels. Why?
• Prefers to focus on the foods, as opposed to the labels
• Wants to bypass resistance from other practitioners, who may equate labels with the idea of “fad” diets
• Prefers the “real food” label, as it is more inclusive and not limited by type of food or macronutrient quantity

• Why so many carb cravings in early pregnancy?
• There is actually a physiological basis for increased carbohydrate cravings during the first trimester
• In early pregnancy your body is in anabolic state (that is, your body is in a state in which it is building or repairing tissue)
• You are trying to build up tissues stores, your blood volume is increasing rapidly, and you are growing a whole new organ (the placenta), as well as a tiny embryo
• As part of this anabolic state, your pancreas is also changing and you are producing more insulin, meaning you are in a very insulin sensitive state
• So during this period where your blood sugar is lower, it is to be expected that you are craving a higher carbohydrate intake!
• Also, if  you are experiencing nausea, which so many women are, the quickest digestible foods are carbohydrates, which also helps explain increased cravings
  
• What happens after the first trimester?
• By the second and third trimesters, your body switches from an anabolic to a catabolic state
• At this point, your body is more likely to become insulin resistant, rather than sensitive
• This phenomenon also helps explain why some women will develop gestational diabetes during the second trimester
• It is therefore important to inverse and actually lower carbohydrate intake during this pregnancy period, and keep blood sugar levels stable
  
• So… how many carbs?
• Not all women need to decrease carbohydrate intake during pregnancy
• Depends on other factors such as health and fitness level pre pregnancy - there is no one size fits all!
• In general however, most women should be aiming below 45% of calories coming from carbohydrates
• This is different than the standard recommendation of up to 65% of calories coming from carbs!
• In gestational diabetes, carbohydrate levels should be lowered even further, to  around 15% - 22 % of daily calories coming from carbohydrate
  
• What sources of carbohydrates are best?
• Try to keep it to unprocessed, whole foods sources, such as sweet potatoes and fruit
• Just keep it as REAL as you can
  
  
  

• Should I really be “eating for two"?
• Lily doesn’t fully disagree with this idea, as nutrient needs do go up during pregnancy
• However CALORIES or QUANTITY of foods does not increase that  dramatically - actually only about 70 to 300 extra calories a day. Think of it more like eating for 1.1
  
• Is sushi that bad during pregnancy?
• Women tend to crave sushi in pregnancy, which is against conventional pregnancy recommendations of not to eat raw fish
• The reason for advocating to abstain from raw fish is to try to protect women against food poisoning and bacterial infections
• BUT, if smart about food safety, maybe not as risky..,
• Seafood that is marketed for consumption is flash frozen, which is an effective way to counter parasites
• Assuming you are getting your sushi from a reputable source and following good food safety practices (look for a clean place that has been regulated, look for fresh fish, try to avoid grocery store sushi), sushi can be okay
• In fact, in other countries such as Japan and the UK, consumption of raw fish is not discouraged, but rather encouraged, for optimal fetal development
  
• Why so many food aversions?
• Meat aversion usually shows up in the first trimester, when embryo is most susceptible to outside toxins and pathogens
• From an evolutionary perspective, meat aversions may represent a carry over effect from the pre-refrigeration era. Meat is susceptible to spoilage and growing unwanted organisms that make us sick, and before refrigeration, this was more likely
  
• What to do when can't stand the sight of meat?
• Be mindful of what you are replacing your aversions with and try to keep it as close to whole foods as possible
• Know that aversions can change daily and that just because you don't want it one day, doesn't mean you won't want it later. Trust that food aversions will subside and you will be able to get back to your more typical way of eating
  
  
  

• Plate method for prenatal nutrition
• Fill  ½ your plate with lots of veggies (mostly non starchy), prepared with some fat
• Have some protein and fat at each meal
• Not all fats are “bad”! Don't throw out egg yolks and don't need to go for skinless chicken
• Examples: cheese, greek yogourt, beef, poultry, eggs, nuts, avocado...
• Add some carbohydrates:
• Add ½ to 1 cup of starch or carbohydrate rich foods at each meal (like starchy veggies or fruit)
• Keep in mind there is a range of optimal carbohydrates, depending on person and based on pre pregnancy health (see Takeaway #2)
  
• What supplements should I take?
• Prenatal vitamin always a good idea
• Vitamin D
• about 4 000 IU/day
• Fish oil (Omega 3)
• Can take it on days when not eating fish (for example, skip on days when having salmon)
• There are more supplements you can take, based on whether or not you are getting certain foods in your diet
  
• Fermented Foods
• Contain good bacteria (probiotics) and can be a great addition to your prenatal nutrition
• Also helps to set up baby’s microbiome and immune system
• Research shows that women that don’t have great bacterial balance are more prone to certain pregnancy complications, such preterm labour, preeclampsia, and even gestational diabetes
• Examples of fermented foods: kefir, yogurt, aged cheese, kimchi, sauerkraut, natural pickles, kombucha …
• Mindful Eating
• Check in with yourself after you eat a meal: how do you feel in body when macronutrients are more appropriately balanced?
• For example, how do you feel after a meal of oatmeal, low fat milk, and strawberries versus eggs, bacon, and veggies? Usually difference is outstanding!
• How are certain foods affecting pregnancy symptoms such as nausea, cravings, and aversions?
• Mindful eating is key to figuring out what is best for you and YOUR pregnancy!
  
  
  

• To work out or not work out?
• Overall, benefits of exercise outweigh the risks
• In the first trimester, don't have to make a huge number of changes other than avoiding activities with bouncing, jerking, or risk of abdominal injury
• Later in pregnancy
• Avoid exercises that involve lying on back
• Be careful with stretching, lunges etc, as center of gravity changes as well as joint stability
• Gentle, pilate-type exercises can be most helpful during this time
• Overall, be mindful of any physical changes in body
• Always be aware of temperature, and avoid overheating
  
  
  

WHERE TO GET MORE

1. Listen to the Paleo Magazine Radio podcast here! Paleo Magazine Radio is the official podcast of Paleo Magazine, an awesome publication of all things paleo! Check out their website  for awesome articles, recipes, paleo expo, and more!

2. Ashley VanHouten is the host of Paleo Magazine Radio Podcast - follow her on Instagram at @themusclemaven  

3. More About Lily Nichols: Be sure to check out Lily's new book “Real Food for Pregnancy: The Science and Wisdom of Optimal Prenatal Nutrition”

4. Follow Lily on Instagram, Facebook and check out her website! 

Disclosures from SwitchGrocery:

• We have not received any compensation from Paleo Magazine or Lily Nichols for this post! We genuinely liked this awesome interview! 
• We are a fan of Ashleigh (host of the Paleo Magazine Radio Podcast) and have been recommending some of our amazing suppliers and stories to her! She did not ask us to feature this particular podcast - we feel like this can provide awesome insights for our Customer Friends who are contemplating pregnancy, who are pregnant or have friends and family who are pregnant!!
• SwitchGrocery is an online retail store for food products and this blog under SwitchDiaries is intended for informational purposes only. The information provided is not a substitute for medical advice, diagnosis, or treatment nor is it to be construed as such. Information is provided without any representations or warranties of any kind. Please consult a qualified physician for medical advice, and always seek the advice of a qualified healthcare provider with any questions you may have regarding your health and nutrition program.