Culture Apothecary with Alex Clark - “Drinking Wine & Eating Sushi While Pregnant?!” - Prenatal Dietician Lily Nichols, RDN

Episode Date: August 11, 2023

What if the things we THINK pregnant women should and shouldn’t eat are completely made up? “Don’t eat deli meat, raw sushi, or egg yolks that are too runny!” How trustworthy are the "studies"? Is a glass of wine while pregnant really that bad? Is it ever okay to add salt to a baby's food? What’s the deal with postpartum hair loss? What solid food is best to give your baby first? All of your prenatal and postpartum questions are answered this week by certified prenatal dietician, ...

Are the things we think pregnant women should and shouldn't eat completely made up? Don't eat deli meat, raw sushi, or egg yolks that are too runny. Is a glass of wine while pregnant really that bad? Is it ever okay to add salt to a baby's food? What is the deal with postpartum hair loss? Does the standard American diet have anything to do with how many women struggle with breastfeeding in our country? Look, I scoured the mommy blogs, the parenting forums, and I asked all my mom friends for their burning questions on diet, fertility, and pregnancy

in preparation for this interview today. If you're attracted to nutrition, the real food movement, and all things pregnancy, you probably know my guest. Her forte is nutrition during pregnancy, and she's a registered prenatal and postpartum dietitian. She's the author of Real Food for Pregnancy, the Science and Wisdom of Optimal Prenatal Nutrition, and Real Food for Gestational Diabetes. One of my most popular guest, Dr. Courtney Kayla, you guys loved her. She's a huge fan of my guest today.

Her books and research have actually influenced international prenatal nutrition policy, been used in research studies and even become required reading in university-level maternal nutrition classes, aka explaining to me like Mali 5. She's like super, super, super, super, super smart. Like way smarter than me, way smarter than you. And that's why I like having people like this on. And the best part is, even though she is super, super, super, super, super smart, she's known. for her evidence-based yet sensible tips that even a non-scientist like you and me can understand. Whether you're currently pregnant just had a baby or you want to in the future, this is a heavy educational episode that will teach you a lot. It's a notebooker. Please welcome prenatal

and postpartum dietician and author Lily Nichols to the spillover. First question, right out the gate, Lily. A glass of wine while pregnant. Worse mom of the year. year, she's just doing what she's got to do. You're going to be with a tough question right at the start. So it's nuanced. It really depends. You know, at the end of the day, alcohol doesn't offer any nutritional benefit. The question is whether it is overtly harmful.

And there's been wild debate across the literature about what thresholds, fold of alcohol is problematic, right? We know that too much alcohol is associated with fetal alcohol spectrum disorder or fetal alcohol syndrome. And they still have not come up with a consensus on how much is safe. I can tell you that some of the data shows like a glass of wine, a night, or an occasional drink is not necessarily associated with harm. They can't say it's perfectly safe and a good idea. But the biggest problems with alcohol are with heavier drink. And drinking than, you know, a sip here or there. So I can't really condone it. You know, it's not offering you any benefits. How risky is it? Probably not super risky to have a small glass here or

there. When should you, when is it safe to consume alcohol post birth? Whenever you want. When you want? Very little alcohol passes into breast milk. So you would have to be like drinking pretty heavily. You certainly, the bigger risk with drinking while breastfeeding is that you become, you know, inebriated and can't care for your baby well. Like that's the bigger concern. But like a beer, glass of wine, whatever, it's totally fine. No need to like pump and dump the milk or anything like that. There's very, very little alcohol that transfers into the breast milk. All of the talk and feeling around pregnancy in the West is just very fear-based. Why do you think that we've allowed that to happen?

Good question. It seems like most of the advice given in pregnancy, I mean, you go in for, say, your first prenatal visit, and they might give you a pamphlet on prenatal nutrition, and most of it centers around foods to avoid. Very little is on what you should. eat more of or what foods you want to emphasize to optimize your outcomes. I think as a whole, there's just very little emphasis on how nutrition impacts your overall well-being, your general health and in pregnancy, the health of you and your baby. It's very much like reactionary. So I think

that does need to shift because, you know, the relative risk of, you know, food poisoning or getting sick from various foods that are typically off limits is actually really slim. And it actually results in women avoiding a whole array of healthy foods that they otherwise should be eating. And instead, eating like, well, the foods that aren't at risk for giving me food poisoning are like packaged processed foods, right? But you're scared away from eating, you know, certain meats and sushi and soft cheeses and all sorts of things that have pretty low. rates of actually causing food poisoning. Yeah, let me just be 100% transparent with you. My gut instinct tells me that these rules about raw sushi and runny egg yolks and deli meat, limiting fish,

no bagged veggies and all this, I think it's BS. And I know that it took you years to get the courage to teach based on current research, even though it conflicted with these so-called guidelines for pregnancy. And I'm going to be honest, the guidelines that everybody's talking about all the time, sometimes they seem to me like the adult version of the boogeyman. Yeah. They're pretty simplistic and, I don't know, they're so distilled down that they lose all of the nuance. So even if there is an ounce of truth to some of it, like, yes, you are more at risk for getting sick from bacteria, viruses or other things that can contaminate foods during pregnancy, the chances of it happening are still statistically very low. And then the chances of it harming your baby are

statistically even way lower than that. And yet it's presented as, if you eat this, you will get sick, you know, don't eat this or else something horrible will happen. It's like chances of something bad happening from, you know, a piece of sushi is actually pretty slim. like most of the sushi we get, it depends on where you're purchasing your sushi. And like, do you leave it in a hot car for three hours? Yeah, if you're getting your sushi at a gas station and you're pregnant, I would say, you know what, maybe don't eat that. But if you're going to like a five-star sushi restaurant, I mean, to me, I'm just like,

I really don't think that that's a problem. No, and in other parts of the world, it's not. It's recommended in parts of Asia, especially Japan. you're encouraged to consume raw fish in pregnancy. In the UK, even in the NHS guidelines, they say sushi's okay, raw fish sushi. Because sushi-grade fish has been frozen for a period of time and at a temperature that kills parasites.

So they even say it's okay. The U.S. hasn't really caught up to that. So what can you do, right? I think there's a lot of, you know, you can take the smile and not approach and just like, okay, that advice is outdated and I'm just going to do my thing or you can try to educate your providers. But I really don't think the evidence on avoiding a lengthy list of food is warranted. And actually to play devil's advocate, the foods most likely

to give you food poisoning are actually raw fruits and vegetables. Like 46% of foodborne illness outbreaks in the U.S. are from raw fruits and vegetables. But nowhere in the guidelines does it say don't eat raw fruits and vegetables. Now, see, why is that? Some other countries have guidelines on that, though. But is that because... But is that because the guidelines provided to pregnant women in America are like profit-driven predominantly?

Like, why are they saying, oh, don't eat this, but eat this? It's a good question. I do not know how they decided which foods ended up on the do not eat list and the these are totally fine. list. I wasn't at that like committee meeting or whoever made the decision because the stats don't line up. It's totally arbitrary. Literally any food can become contaminated at any point in production. I mean, we have like, you know, recalls on almonds for being contaminated with salmonella. It's not like almonds typically harvests salmonella. They were contaminated at some point, some step in the processing

or distribution, right? So anything has a chance of being contaminated. So it's kind of unfair to even have a list whatsoever. It's like you need to practice like safe food handling, use your common sense, like use your nose. Your sense of smell is incredibly heightened during pregnancy. Anything that's even the slightest bit off is completely inedible. But, you know, I experienced this during both of my pregnancies. It was like, oh, salami is like I felt fine eating salami. Chances that deli meat has listerias, one in 83,000 servings. Okay. It's very, very slim that you're going to get sick from deli meat. But if that pact of salami had been opened for like multiple days, it was like completely off-putting to me. Yeah, you could tell. It had to be super fresh. So, you know, I also think there is something to that. Like, I don't have evidence to prove it.

But I certainly know for myself and others, your sense of smell and senses are so tuned in. Like, you really don't eat things that you're even a little bit. questionable when you're pregnant. I am 100% the clingy, annoying girlfriend and the DMs of Nimi Skin Care. About every two months I send a new message, it goes

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That's MimiSkinkare.com with code Alex Clark for 10% off or click the link in the show notes. But when women are avoiding these certain foods while pregnant because they're scared, are they unknowingly setting their baby up to have nutrient deficiencies? It depends on the food they're avoiding. So like eggs are a perfect example. So eggs with runny yulks or raw eggs are recommended to be avoided by the guide. lines. The chances though that an egg contains salmonella is anywhere from one in 12,000 to one in 30,000 eggs. So very, very rare that an egg is contaminated whatsoever. Um, but eggs,

this, this advice, by the way, it's not always like communicated super clearly from the provider to the woman. So they might say, don't eat eggs instead of like, don't eat eggs with runny yelks, or maybe you just sort of like bypass it on the pamphlet. It says eggs with runny yelks, but you're like, oh, eggs, I can't have eggs. Okay, I want to have eggs. Or maybe the only way you want to have eggs is over easy or over medium or soft boiled or something where the yoke is still a little bit runny. And then like eggs are otherwise totally off putting to you. Whatever it is, if it results in you eating fewer eggs or fewer egg yelks specifically, your risk of certain nutrient deficiencies does go way up. The major one being coline, which is a really vital B vitamin-like

compound that's very helpful for your baby's brain development, for your brain development, for your liver function, for the prevention of preeclampsia. It's a really vital nutrient. And eggs are the number one source in the diet, but it's specifically in the yolk. So if you are not eating eggs whatsoever or taking out the yolk because you're afraid of food poisoning issues, you're going to be, you know, trading that idea of safety for a very known harmful consequence, which is coline deficiency, resulting in, you know, poor infant brain development. And we have really, really strong data on coline in pregnancy, specifically, like randomized controlled trials, testing higher colonel intake and pregnancy to better childhood brain development

all the way now until age seven. Like, these kids have very much. better brain development, regardless of what they ate in childhood, just linked back to higher maternal colonel intake in pregnancy. And again, like the number one food source of chlorine for us is at yokes. Why is it misleading or inaccurate to advise a pregnant woman to make sure she's eating for two? It's ill-advised because I think it is misunderstood what that means. So the interpretation of that is often, I need to eat double the amount of food or double portions in order to get enough food for myself and baby. And that's actually not the case. So energy needs only increase maybe

three to 500 calories a day. So there's one researcher who says instead of eating for two, we should say eating for 1.1, it was like 10% more, maybe like 20% more depending on, you know, your overall energy needs. But it's not double portions. Are women gaining too much weight while they're pregnant, like more than they should be? In some cases, I mean, I don't think most women are able to actually follow through with eating double the amount of food. But I think sometimes instead of it being interpretive, like, I need more nutrients, more like vitamins and minerals during pregnancy, which is true. It's like, I just need more food, more calories, period, which is true to an extent, but it's not a double. as to like gaining too much weight, it totally depends on the individual.

There are probably the majority of pregnant women are gaining above the guidelines, but there's been a lot of debate on whether those guidelines are evidence-based too. So that's kind of a tricky, it's a tricky conversation. That's a tricky question to answer because it really depends. Okay, so this is what I don't understand about these guidelines for pregnant women that they're given at the doctor. if there's so much contention about what is true and what isn't and what even has any evidence backing it up at this point after years and years and years, why aren't they going back and looking at them and doing new studies and changing these up? Yeah. They are doing those studies in some cases. So with the weight gain guidelines, there have been a lot of studies reanalyzing the data. I mean, when they came up the weight gain guidelines for pregnancy back in the 1980s, that's when the first ones came out.

This was in response to the bigger concern at the time was that they had observed that in women who did not gain enough weight, their babies were smaller than average and less robustly healthy. And they're like, oh, we need to have guidelines to encourage women to gain adequate amounts of weight during pregnancy for the health of their baby. Now, over time, as like the demographics of the U.S. has shifted, of course, the 80s is when we put out our high-carb low-fat debt. dietary guidelines too, and the processed food intake just ramped way, way, way up in response. Yeah. We now have the majority gaining more weight than needed. And so this has kind of led to a lot of research looking at, you know, huge data sets, millions of pregnant women, and looking at the chances of certain outcomes based on how much weight was gained during pregnancy,

you know, stratified by a woman's body mass index or BMI. And there's still, there's contention, I will say. They haven't updated those guidelines, but it appears that the general guidance for women who fall into the so-called normal or overweight BMI categories is pretty on point. We could maybe give them a wider range of what's healthy or not. Women who fall into a lower weight category benefit from higher weight gain than what the guidelines say. And women who are in the higher BMI category over 30, they actually better.

benefit from lower weight gain, don't the guidelines say. We'll see if that's ever reflected, like they ever actually go back and change the guidelines, but like the concerns as a country have shifted entirely. Like now three quarters of American or Americans are overweight or obese, right? So now it's like, okay, it's less of an issue of people aren't getting enough food. Maybe it's an issue of they're not getting the right food or they're getting too much of certain types of foods and maybe we don't need to be like encouraging so much more so much focus on gaining enough weight. Maybe we need to like shift our like messaging a little bit. So we'll see. Like the challenges with all of these guidelines are set with, you know,

it's a specific time period and there's like a limited amount of evidence available. And then in order to change those guidelines, it takes like an insurmountable number of studies. Yeah. for people to agree upon and these like, you know, committees and bureaucracy to get change put through. So that's, it's a challenge. It is. Word on the street right now is that prenatals are a scam that your diet should ideally be enough and that we don't really need to be recommending prenatal vitamins. What do you say, Lily Nichols? I, I don't know that I've heard that exact message, But I will say there's a wide range of nutrient deficiencies that are actually pretty prevalent in our population.

And women of childbearing age specifically have higher nutrient demands than the rest of the population. Like you need high, you need good nutrient stores going into pregnancy and you need to like replete those nutrients after pregnancy when you're breastfeeding and particularly in between pregnancies, you know, around half of women in the U.S. are deficient in at least one micronutrient. Which one that is, like your doctor run comprehensive micronutrient analysis to like check on your levels. Probably not. It's pretty rare outside of like selects, you know, functional medicine practitioners. So I look at prenatal vitamins as an insurance policy.

on top of trying to be really diligent about hitting all of your nutrient requirements for food. Okay, so it's a little bit of both, ideally. It's a little of both. Like a prenatal does not make up for a nutrient deficient diet. It'll fill in some gaps, but by no means of replacement. There are some nutrients that aren't in prenatal vitamins, for example, right? So I look at it as an insurance policy. Let's like fill in the gaps of the diet.

If you're taking a comprehensive prenatal, regardless of what the nutrient deficiency is that you have, or maybe you have more than one, lots of people do. You're like covering your bases there. But we can't look at it as like the one and done solution. You still need to be eating a healthful diet on top of that. Like a baby is not built out of only vitamins and minerals. like the structural things that make up a human being are like your macronutrients,

particularly your protein. So like you've got to still be eating a good amount of food. And it also just so happens your protein rich foods are the foods richest and vitamins and minerals. So, you know, you need both. How much are you recommending organ meats while pregnant, the heart, the liver? Well, I highly encourage consumption of those during pregnancy. pregnancy, you know, they are some of our most nutrient-dense foods. I write about them extensively in Real Food for Pregnancy. I have a whole separate article on my website on liver and organ

meats in pregnancy. Because they are so nutrient-dense, and they often have like a particular flavor profile, right? Liver in particular. It's like it has a very strong flavor for, I mean, most people would say it has a strong flavor. It depends on if you grew up eating it a lot or not. you don't need to eat organ meats every single day. They don't need to be your like default and only protein source. They're something that I almost look at as kind of in the same realm as like a vitamin supplement in a way. It doesn't have everything that a prenatal vitamin does. So I don't want to like throw that out there because that is something that I'm actually hearing a lot is people taking liver for example instead of a prenatal. You're not going to cover all your nutrient bases with liver. But it does, like, fortify your diet with higher amounts of certain nutrients. See, and I'm getting my liver. I'm doing beef liver in a supplement form. So some people are getting it at the store and then they're, you know, cutting it up into teeny tiny pieces, wrapping them up, putting them in the freezer.

And then they are taking them like a pill because, you know, if you don't want to actually eat raw liver. And then some people are doing supplements. And is there a difference in the nutrients if you eat it like that, like when it's been frozen versus a supplement? I don't believe, so the supplements of desicated liver are like freeze dried. And I don't believe there's a significant reduction in nutrients in the freeze drying process because it's done at super cold temperatures. Usually nutrients dissipate with like heat, light, and exposure to oxygen. And as far as I understand, the freeze drying process does preserve most nutrients.

So it just comes down to a matter of preference. Like, I personally usually eat my liver and I make paté or puree it and mix it into ground meat dishes, what I call hidden liver. And that's my way of getting it in. Not everybody likes it that way. I think it hides the flavor pretty well. Yeah. Or, like, dilutes the liver flavor pretty well. But that's still like a no-go for a lot of people.

I think, you know, a freeze-dried option is okay. People, like, will mix their, if their organ meat into ground meat, like, ground beef, sorry, like what you're. saying and then, you know, make a hamburger and give it to your kids. So they're getting that and they have no idea that they're eating it. Yep, yep. That is an option. You worked with low-income women early on in your career. What is your advice for food sourcing, reducing food waste, buying real food on a budget? Because, you know, I think is all the, I wonder, like, is all the food offered on WIC or food stamps absolutely atrocious? Yes, I've had a lot of experience working with that population, and I've been pleasantly surprised, actually, that a number of WIC organizations have brought me in to speak on this exact topic for their state WIC conferences. There's limitations on WIC. You know, WIC is like, by default, since it has to follow the government guidelines, they're not providing vouchers for. all categories of food. You know, one of the biggest deficits is like they don't give you vouchers for like meat

and you have like a limited provision for eggs. Depending on the state, they may or may not cover canned fish, for example. You might have limitations on whether the dairy you get is low fat or full fat, depending on if you have young kids or, you know, there's all sorts of like different rules and they vary slightly by state. So I think ultimately we have to improve the guy. guidelines for like the things that they're covering to improve because I mean there is and it's it's widely like within the WIC community a lot of people working there actively working to

try to like reduce the amount of cereal and reduce the amount of juice that like provide more whole foods but you have to remember I mean there's lots of conflicts of interests and funders and the people who sponsor the conferences are oftentimes some of the companies benefiting from where the vouchers go. So I do think on some level, regardless of if you are receiving food assistance, you have to kind of take matters into your own hands. Like take advantage of the vouchers on the best quality food that you can get with them. But your discretionary money, I think, should be going primarily to your protein rich foods and your produce where you have less provisions for that. and like, you know, how much you get all nitpicky about quality and stuff.

Like, this kind of goes into like a bigger conversation about like, you know, your hierarchy of needs, right? Right. At the very base level, we need to like eat, right? And so like I'm not going to talk about grass fed organic, blah, blah, blah, when it's just a matter of eating. Like conventional beef, conventional eggs, conventional dairy is still nutrient does. Even if we want to nitpick about little different things about how.

they're raised and, you know, possible contaminants or whatever, like, we're talking about just meeting your basic nitrate needs, your protein needs, getting enough calories. That, by default, is always going to be healthier than the alternative of processed food, fast food, whatever. So I really recommend, like, yeah, kind of using your discretionary funds for those foods, and there will probably be tradeoffs, you know, like you may not be able to afford, you know, getting most of your protein from animal foods and you may want to be building in, you know, beans and legumes to fill in the gaps, which don't have quite as high quality protein, but they're still nutritious foods, you know what I mean? So I do have actually, by the way,

a full article in my website on like real food on a budget for pregnancy, which people can read for more detail on like some, you know, strategies and considerations because we're all, We all have like, you know, different, different situations economically and different priorities, you know. Now, are you on the anti-seed oil train, especially when it comes to pregnancy? Generally speaking, yes, I do have a section all about, you know, the problems with seed oils or most people used to call them vegetable oils in pregnancy. I do recommend swapping out for healthier oils when you can. Okay. and it's particularly like oils you're cooking with at home and like checking things like,

you know, mayonnaise, salad dressing and cutting down on the process snacks that are made with seed oils. That, yes, I'm in agreement with and fried foods and whatnot. But when it comes to getting like really bent out of shape about like there's sunflower oil at like the very bottom of an ingredient list and the food has like one gram of fat person, Like you're getting so little seed oils in that. I would not like, I would not nitpicked the degree that some, some people are. So like what you're talking about, I saw you post this on your Instagram. It was like a tin of oyster, smoked oysters or something like that.

And you were saying how this is such a, it technically has seed oils in it, whatever it's sitting in. But it is like this teeny tiny bite. If you're talking about, you know, oyster and you're like, The benefits outweigh the seed oils in this instance. Oysters are like crazy nutrient dense. So, yes, I prefer the crown prince oysters. No, they don't sponsor me or anything. I like them because they're canned and olive oil.

Not every store has those. What if you're somebody like you were just talking about who's, you know, struggling with food and they're at, you know, a dollar store, which often has canned oysters, by the way, a dollar for something very nutrient dense, but it's canned and soybean oil. I would actually still get it and I would drain the oil and like, you know, get as much oil off of there as possible. I wouldn't be like actively trying to consume more soybean oil. But the benefits of the nutrients in that oyster are going to outweigh the handful of grams of fat that you're going to get in that.

Whereas something like, I feel like having a focus on, okay, if you're going out to eat and you have the option of something fried and you know they fry in vegetable oil, unless they tell you. otherwise it's vegetable oil. Oreo is something that's a not-fried option. Like, I would take the burger, okay, probably lettuce-wrapped would be my preference. I might actually get some French fries, but maybe not eat, like, the whole thing of French fries. So a little bit of fried food. But I'd take that over a fried chicken sandwich with a whole plate of fries where you eat

the whole thing and then, like, polish it off with a donut at the end. Like, you know, you can, like, be aware that, okay, too many. seed oils are a problem, you can still kind of pick and choose and live your life and not like get completely bent out of shit over little bits of seed oils sneaking in or like genuine enjoyment. Like I actually really like French fries. I mean, I think most people do. Probably not going to eat like the whole portion they give me, but I'm going to have some and I'm getting less seed oils by, you know, doing that than I probably would with a salad with conventional salad dressing that's made with seed oils. Like, you know, like, pick your battles, you know.

Should women who have the MTHFR gene mutation take prenatals with higher levels of folate? And could it have any effect on the development of the baby or is that a myth? So just coming in with a hard question. Is that hard? No, it's not a hard question. It's just complex. I'm trying to give you like a short answer. Oh, yes. Give us layman's terms for sure. MTHFR is a genetic variation in. in one of the enzymes that's involved in how your body metabolizes folate, okay?

The major thing with MTHFR is that you have a bigger struggle metabolizing a specific type of folate called folic acid. So folic acid is a man-made compound that you don't find in nature. There's like 150 different types of folate found in nature. folic acid is not one of them that is synthesized in a lab and your body has to go through extra steps to make it useful in your system. So oftentimes if you have somebody who has MTSHFR, I'm actually one of those people, 40 to 60% of the population falls into this category. I can't process synthetic folic acid very well. So like the folic acid that's fortified and refined grains, I can't process well. The folic acid in a conventional

low quality prenatal, I can't process well. If it is methylfolate, my body has no problem processing it, because that's what the MTSHFR enzyme would do anyways. So it's already in the biologically active form. And so if you have MTFR, check that your prenatal has methyl folate. Another form is called folinicic acid. It's not folinic acid. Is also fine, also metabolically active in your system. I wouldn't I would definitely take, you know, a pre-needle, but I would make sure that the type of folate in there specifically says methylfolate or folinic acid. Sometimes they're a combo. I would avoid a folic acid supplement that actually will make your folate deficiency worse, by the way. You have MT to FAR and you take folic acid, you're making the situation worse. It actually blocks your body's ability to

use folate properly. So yeah, it's a tricky. It's a little bit of a tricky conversation. And by the way, you don't have MTHHFR. Your body can also use methylfolate. So just everybody can do a methylfolate prenatal and your body uses it because already 95 to 98% of the folate in your body is methylfolate. So just use the form your body can recognize. feeling about the carnivore diet. I'm definitely more for it than against it, although I love too many foods to literally eat meat and nothing else. I mean, pasta, am I right?

Although, let me tell you, speaking of what to eat while pregnant, I watched the coolest short documentary on YouTube the other day. It's called Nourished. Have you seen this? They compare a placenta of a vegetarian versus the placenta of a meat eater woman. and I was so shook, it was like seeing the lung of a smoker versus a non-smoker. Eating meat exclusively is up for debate, but the benefits of eating meat a lot, especially while pregnant, is not.

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What can we be doing with our job? diet to help prevent nausea at the beginning of pregnancy? I wish there was a great answer to this because I went into this with rose-colored glasses in my first pregnancy. Like, I'm going to be so nutrient replete. I've been eating well, real food for like over a decade. I'm good to go. I won't have nausea.

My magnesium levels will be in check. And my, what's the other one? A B6 will be in check. and my liver function is really good, and it's just going to be grand. I'm going to have no nausea. Yeah, I still had nausea. Okay, both times. Not severe and debilitating, and I wasn't throwing up constantly,

so arguably very mild compared to the average person. But it's still there. The vast majority, like 90% of pregnant women, are going to have some degree of nausea, which can range from kind of this, like, low-level queasiness. Like, did I eat the wrong thing? Am I see sick, motion sickness? Like, just feeling kind of low energy and off to like everything makesy barfing.

You can't keep anything down. Not good news for the nauseous people. Not good news for the nauseous people. It's tough. So I don't know that there's a great way to prevent it. I think we can do our part in coming into pregnancy with as good of nutrient stores as possible, understanding that you might be nauseous and you might not be able to eat as well as you want for a period of time. And at the very least, I could feel reassured that I did my part to come into

this pregnancy as healthy as possible. Because really, at the end of the day, like, that early embryo development is actually growing from the stored nutrients in your endometrium before the placenta is formed. So, like, the work that your body is doing, like, that's from stored nutrients for very early pregnancy. So you can, like, be at ease if, like, the only things you can keep down is, like, sourdough bread with butter on it or something like that. It'll be okay and it'll pass. You know, B6 and magnesium can often help. Sometimes having essential oils around like diffusing in your room like peppermint or lavender or lemon, like sometimes that can help. Getting little bits of protein in throughout the day. I know a lot of people have aversions to protein in pregnancy or at least the early part,

but get creative with whatever proteins you can keep down, whether that's nuts or yogurt or cheese or whatever it is, even if it's not your usual, that can help stabilize your blood sugar, which can often really help decrease the severity of nausea. But it really comes down to like, it's a little bit different every day. It truly is. Something that's a trigger for you one day won't be a trigger the next day. Smells can be really heightened. So it's about just kind of responding in the moment.

You're kind of walking on eggshells with what sounds good, what you think you can keep down, and just do the best you can. It is a phase, and for the vast majority of cases, it does ease up significantly after the first trimester, and most cases have resolved almost entirely by about the halfway mark. It usually kind of gradually declines in severity over time. How much caffeine is safe during pregnancy and is one Diet Coke a day really going to hurt the baby?

Okay. We'll start with the caffeine. This is still up for debate, by the way, but the vast consensus is that 200 milligrams of caffeine is safe. So that's the equivalent in one large or two small cups of coffee. A cup of coffee being like six ounces of coffee, okay, is about six to eight ounces is about 100 milligrams, depending on how strong you brew your coffee, okay? So throwing that out there, you're probably not going to overdo caffeine from black, green or white tea or chocolate unless you're eating a ton. It's mainly caffeine or if you're

like an energy drink person or you have soda that has caffeine, keep an eye on the caffeine in there. But you know, your cup of coffee, your 12 ounce Starbucks or something would generally be considered fine. That said, some people like metabolize caffeine differently. So if you feel better with less, no harm, no foul, but I would not exceed 200 milligrams. As to the Diet Coke, does that have caffeine? I don't know offhand, does it? I don't know. Okay. Well, if it asks caffeine, we don't think. Okay, we don't think Diet Coke has caffeine. I don't know offhand. But if it does, factor it in. The bigger question there is the artificial sweeteners. Like how bad are the artificial sweeteners? And that too is up for debate. You know, I write about them in Chapter 4 of Real Food for Pregnancy. My opinion,

is to keep artificial sweetener intake as low as possible during pregnancy. It does seem to stimulate our preference for sweet foods, even though it doesn't have any calories in it, our taste preferences become wired for wanting more sweet things. So even though you had a zero calorie sweet beverage, later on, you're probably more likely to want something sweet later in the day. Okay, well, speaking of beverages, what is this controversy around raspberry leaf tea? I had so many people ask me to tell me you've got to ask her about raspberry leaf tea. Okay.

Do you know, do you get this question? I've never heard of it. Okay, it's a pregnancy thing. So red raspberry leaf tea is like a traditionally consumed tea. You take the leaves of red raspberry plants. That's it. And you brew a tea from it. It's really rich in minerals and certain antioxidants.

and it actually has been shown in studies to help improve uterine tone. So like how well your uterus can contract, which of course when it comes time for birth, your uterus needs to do a lot of contracting to help you birth the baby. So it's pretty common, especially in midwifery circles, to recommend red raspberry leaf tea starting in the second or third trimester to, yeah, improve your, you know, mineral intake, but also generally to help with the health of your uterus and hopefully improve how well it's able to contract when it comes time for labor.

What is more important? Meal prepping and planning what you're going to eat after baby or getting the nursery finished. Meal prepping, postpartum prep, hands down. Why? Your nutrient demands postpartum are actually higher than they are during pregnancy. So all this like talk about, you need to get your baby body back, free baby body back, lose the baby weight, whatever. I call BS. You need during that time, fire amounts of nutrients, calories, proteins,

vitamins and minerals than any other time in your entire life, including pregnancy. Okay. So more food. You need more food. You need more food. And by fueling yourself well in those early months postpartum and recovering well, you're actually going to support your metabolism later on. Like the baby weight will come off over time. You need to give yourself a reasonable time frame. And when should you start? Nine months off.

When should you start after baby trying to lose that baby weight? I don't think you ever need to really actively try. I think your emphasis should be on fueling yourself, first and foremost, again, especially those first few months when nutrient and energy demands are so high. They've actually checked there was a recent study that looked at three to six months postpartum, what are the protein needs in breastfeeding women?

They're higher than an average female athlete. Okay, let that sink in. Protein needs. Even after, like, the early part after you have a baby, the first month, six weeks, two months, that's like very heavy. Like, you're very hungry. You're figuring out nursing.

Like, you're just starving and ravenous. you're recovering from birth, uterus shrinking down, maybe there's a tear or episiotomy or C-section scar or something. Like, there's a lot of healing going on. So even after that phase has passed, because we don't have a study looking at protein needs during that time, three to six months out still, levels of requirements for protein are more than a female athlete. So you really need to be thinking about like your long-term health here. Um, natural. for some women, like the rate of, you know, weight loss post birth is different for everybody. I can tell you, like, my first baby, I lost the weight fairly quickly, but I did not feel as

healthy and energized and, like, able to take on the day as I did with my second when the weight came off slower. And I was actually, oh, thank God, the weight is coming on slower because I have, like, the resources and the energy to, like, make breast milk and, like, keep up with my toddler. I was actually appreciated that the weight came off at a slower rate because I was more with it. I was more functional. So I think the whole focus on like body and weight loss and all this stuff is like it's like gibberish. I think it's irrelevant. I think you should focus on your nourishment.

When your body feels safe to let go of that baby weight, it will come off. And yes, after you've established breastfeeding, say you're like three to six months out and you're like, man, haven't lost as much weight as I thought, you can start becoming more conscious of like, oh, you know what? I'm realizing when I'm stressed. I'm like going over to the pantry to have a snack and I'm not actually hungry right now. It's like a stressed like response. Those little things often are all that it really takes. But the big one that I find is under eating protein as a lot of moms do just sets you up on a crazy blood sugar roller coaster that leads to cravings and overeating throughout the day. So that's the big one. I believe when when you hit the protein needs first and foremost, a lot of times your

cravings and appetite for other foods, you just end up not overeating by default. So that's why I kind of focus my energy on like, eat enough of these things and then most of the rest of the things end up falling into place. Okay, I'm going to do quick hit a few more prenatal questions. Then I'm going to go through our postnatal questions. Harmful or harmless, skipping breakfast while pregnant. Harmful. Okay. How can we prevent or cope with constipation? Generally, more fluids, more salt and electrolytes, and more fruit and vegetable sourced fibers. How does diet affect acid reflux while pregnant or does it? It can. Overeating at a particular meal time or overeating. combined with having a bunch of fluid at that meal time and eating too many processed foods.

So if they're high and refined carbohydrates or low quality oils like fried food or, you know, the seed oils you were talking about, oftentimes that can be a trigger. Top thing they're not telling us about gestational diabetes. I know this is your whole thing. Now this is hard. Now this is hard for me because I have a whole book on gestational diabetes. So I'm trying to distill down my main point. Or give me, what about top three?

Is that better? Top three? Okay. My opinion is that they make it out to seem that all gestational diabetes cases are the same, that you're automatically high risk and you're going to have terrible outcomes, which is not true at all. But then sadly, the dietary advice they give you that supposedly is supposed to improve your blood sugar often makes them worse.

and predisposes you to needing unnecessarily insulin and medication. There are cases where those are needed, but we can reduce by half the number of women who need insulin and medication just by dialing in their nutrition appropriately, which the guidelines just fail at. So I'll give you those two things. Perfect. What is the most underrated mineral when it comes to pregnancy and fertility? Magnesium? I would say magnesium. We need it for both. Because there's all those different types of magnesium. So two of my favorite forms are magnesium glycinate and magnesium malate.

Okay. Story time. Before the spillover, I created a different show. It was called or is called Poplitics. the first ever daily pop culture show with a conservative perspective. I launched that in 2019, and throughout the years we've grown and gone through some changes. Recently, I've done something new, which is going live on the Real Alex Clark YouTube channel on Wednesdays and talking about the top entertainment news stories of the week and then interacting live with you, the viewers. It's been really unique and fun, so I think we're going to keep doing it, which is why you should subscribe to Real Alex Clark on YouTube. But I tell you all this to say, I say, I say, I see. start to get really thirsty talking that fast by myself for over an hour, which is why I asked my

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You're looking good today. All right. Postnatal questions. What should our first meal after birth be? A lot of women, they like to get the celebration meal while they're in the hospital, you know, fast food or whatever that they've been going without. But what is quick and ideal and still healthy for that mom? after labor. So that's tricky for me because I had my babies at home, so I just could take, I could just eat whatever was in the refrigerator. If you have to pack, though, I will tell you,

like, both times I really wanted, I have a recipe for grass-fed beef meatloaf in real food for pregnancy that has hidden liver in it. And I craved that both times postpartum, right? Protein needs are high, iron needs, vitamin A, tons of nutrients in there. So that, Like, if you can make that ahead of time and bring it to the hospital and reheat it, that would be great. I personally think that like a single meal is not going to make or break your postpartum recovery. I would just go for whatever sounds good, whatever you're craving in the moment. And it's really like what you eat over the long term day in and day out of your recovery that's going to make the difference. So just eat what you want.

You just did, you know, a superhero thing. of birthing a baby, eat whatever you want. And then circle back to like what's healthiest or whatever in the days ahead. Okay. Well, speaking of eating what you want, does eating your placenta postpartum have anything to do with recovery, mood, hormone imbalance, or even breast milk production? So there's mixed opinions on this and there's barely limited research on it as well. So just a very interesting side note, I find this very fascinating. Like most mammals, most non-human mammals, consume their placenta.

But when you look at indigenous cultures, at least from what we know is documented, there's not a culture that traditionally consume human culture that consumes their placenta post-birth. There's usually some sort of like a ceremony around it instead, like it's buried or, stored for a period of time or there's even like lotus birth where you leave the placenta attached the baby for a period of time. It's kind of like the ceremonial thing. That said, you know, consuming the placenta, there's a little bit of research on it.

What did you do? It does appear I did try it. You did? I did try it my first time and then I didn't my second time. So my opinion, so your placenta can provide, you know, iron and minerals and all sorts of things. Like, a placenta is essentially a temporary liver that you're growing for the baby, okay? And it does have, they have looked at it in studies. It does genuinely contain, you know, a lot of iron, for example.

So my opinion is that if you have a case where somebody is fairly nutrient deficient, and they're not willing to eat the really nutrient-dense foods like organ meats, then maybe that might make sense in that person's particular situation, or they might feel really, you know, wonderful benefit from it. I think for women who are more nutrient-replete and are also consuming organ meats and shellfish and other really nutrient-dense foods in their diet, I feel like it's a little more take it or leave it. I don't have a super strong opinion either way. I think like some women like want to do it. And again, if it's the biggest concern is that it's not handled hygienically. There have been cases where like maybe the woman had a uterine infection or it wasn't handled properly. And then you're like consuming essentially it's like a spoiled food, right? The same consideration with like food poisoning, you know. But aside from that, I think it's just a personal preference thing. So, Either way, your call.

Is it significantly more difficult for American women to breastfeed compared to women in other developed countries? Like, are we having more problems here with this? I'm not sure the statistics on that. Now, as a culture, so we have a couple things working against us with the breastfeeding. Yeah, what are we doing wrong in the U.S. department? A whole bunch of birth interventions are a major problem. lack of community support. Everybody's so afraid about having their breast out or their nipple out.

Like it's not, it's like kind of frowned upon in cultures where, in our culture, where you go to other countries and there's women nursing all over the place at the table with, you know, their whole family or a whole group of people, including, oh my gosh, men at the table. And it's like no big deal. I think we like way over sexualized breasts. And so it makes it like taboo. I think we're coming off of like, you know, a whole generation or two or three of women who are told formula is better. And so they don't have experience and you don't have the community support, you know, like.

Okay. So I have to, I have to ask, is fed best? Well, of course, you need to feed your baby. So however you need to feed your baby, you need to feed your baby. But there are very well documented benefits of breastfeeding. So, you know, it is biologically, you know, what our species does. Yeah. Whether or not it works out is not a personal attack on any individual woman.

Sometimes it really genuinely doesn't work out despite trying all the things. So of course, like, you have to feed your baby however you're going to feed your baby. But we have very well documented benefits of breastfeeding. So. And is there any foods? Is there foods that help breastfeeding become easier for mom, like that help produce milk? There are a subset of foods and herbs called galactagogues, which do support the production of breast milk. And some women feel that it makes a huge difference in their supply. That said, it honestly has more to do with, like, is baby have a good latch? Do they have access to the breast? Are they being fed on demand or on a schedule? like a lot of it has to do with the dynamics of the relationship, which I did want to mention a major reason the U.S. fails at breastfeeding is no maternity leave policy or poor maternity leave policies.

Oh, yes. Like when I was pregnant with my second, I was visiting a friend in Canada who doesn't even have at the time, didn't have children herself. And she's like, so how long are you planning to take off for your baby? 12 months or the full 18 months? I was like, I'm sorry, what? because you get 12 months off or you can choose to take your 12 months of pay over 18 months and something like that. We're like, I'm like, whoa, hello.

Like, A, I'm self-employed. So, like, I am not working for a period of time and not necessarily actively making as much money when I'm off on maternity leave. But B, like, what are you even talking about? Like, my friends who are employed at best maybe get three months. Yeah. And that really is just barely enough to establish. your breastfeeding relationship. Oh, it's such a keep up with your supply as nursing frequently. And not all

of us respond well to the pump. Me and the pump did not get along. So it was just like, you know what? I was very fortunate to be able to be at home where I could just a baby on demand right from the breast. And if I was working, I had, you know, a babysitter here to help. And I would just nurse during breaks and give the baby back because pumping was such a pain, right? But everybody has a different experience with it. I have some friends who have no issues with the pump. They went back to work. They pumped plenty. It didn't interrupt their breastfeeding relationship.

But there's just no guarantees in how it's going to pan out. So when you don't have that time, that dedicated time off, there's just a greater likelihood that if anything goes awry, it's like it's probably the nursing relationship that's going to take the hit. What is the truth about postpartum hair loss? you do lose hair postpartum, and it is a natural hormonally driven phenomenon. So your hair cycles change during pregnancy where you don't shed as much hair. And then postpartum, all those hairs that should have been lost as your hormones kind of recalibrate, they get the signal that, oh, time for this hair to fall out. So you have a bunch of hairs that haven't fallen out, and a lot of those will fall out.

in a fairly short period of time. I mean, over the period of a couple of months. So it does often happen how noticeable it is depends on the woman, how thick her hair was, where the hair loss happens to be. Like some of us get more hair loss like right around our temples and it's very noticeable. Some it's more diffuse and they don't notice a difference. But it does grow back. So as long as you're seeing regrowth in like the couple months following the beginning of the hair loss, phase, you're good to go. If you're not seeing regrossed, it might be assigned to go see your doctor, get your, you know, iron and anemia labs and thyroid checked. And again, focus even more on your nutrient-dense foods because you do need sufficient nutrients to grow new hair. Okay, so let's talk

about baby's food when your baby finally starts eating stuff other than breast milk. Is there a right or wrong first solid for a baby? And is this something else that's controversial? It is something else that's controversial. I have a whole blog post on my site called starting solids going through all this sort of controversy. I think people obsess too much about the perfect first food, just focusing on a single thing. Like, what's the first bite that my baby gets. You know, you might have intentions for it. Like, I remember when my son was young, I had intentions of a certain food, and then I'm baby wearing out picking black or blackberries or raspberries. I can't remember which one. And he plucked on off the plant and ate it. And I was like, well, I guess that's

your first food, you know? I think we should be focusing more on like a group of first foods. You know, conventionally, everybody recommends like an iron fortified infant cereal, like infant rice cereal. I would argue, and actually there's quite a few organizations that support me on this in choosing a protein-rich animal food, an iron-rich animal food. So meat, liver patte, something like that as the first food, because one of the nutrients we're worried about baby getting enough of is iron as well as zinc, 12, coline. These are all things that are found in meat. So my opinion is that meat would be a good first choice, but of course you have your like, you know, appropriate textured or shapes if you're doing puree or baby lead waning, you know, your call on that. But your,

you know, vegetables, fruits and those sorts of foods are all perfectly fine as well. Egg yolks are a good choice for a lot of babies as well. I am not sponsored, never talking to the brand in my life. I also personally don't have kids, but all of my best friends have at least three kids and married and all that. So, I mean, I talk to them a lot and my audience a lot. I love the brand, my Serenity Kids, for baby food. Are you familiar with them? And what do you think about them? Yeah, absolutely. They make a great product. So there's, they do, I mean, when we're talking about babies at the age of starting solids, the product that would be appropriate for that age is their puree. So they have little puree similar to like the baby or kid applesauce pouches.

that are primarily made with, you know, grass-fed meats or wild cut fish, vegetables, and some kind of a healthy fat, like avocado oil. So those are a great option for something like on the go or if you're doing purees. That's a really, really great option. Just in case anyone knows those people, they are like a dream duo. It's a husband and wife that created it, and I would love to interview them. But yeah, I'm obsessed with their brand. I just think they're doing everything right.

I'm sure they'd come on. Yeah, they're great people. Okay, so speaking of giving your kids meat, though, I have a friend who started his nine-month-old giving him solid grass-fed steak, nine-month-old, little teeny pieces. He didn't even know how any teeth. This baby would just gum it down, and you're like, that's okay to do. Yeah, the, well, sort of.

The baby-led weaning thing gets into all sort of controversy about the sizes and shapes and things that are appropriate to different age babies. So typically at like that age, they, I'm trying to think at nine months. So it was a little outside of my forte. My kids are three and seven now, so it's been a while. But younger babies, they usually recommend like bigger sort of finger-shaped piece of food so that they can grasp with their hands and kind of gum on. So a piece of steak would be an example of that.

Or a meat or food that's a texture that they could smoke. by pushing their tongue against the roof of their mouth. Like, they often don't have many teeth, but they can break down foods in that way. So like a bean, a cooked bean, like smashes. Yeah. If you have like super like a slow cooked, pulled pork and it kind of just like kind of mushes apart, that would be an appropriate texture. Sometimes that the bigger pieces or the tougher cuts of meat, they might recommend a bigger

finger-shaped piece that they can gum on, but not necessarily get pieces. off that could be a choking hazard. Or you can cut them really, really tiny, but they need to have, for baby-led weaning purposes, enough of a pincer grass to like pick them up and get them to their mouth, which maybe at nine and a half months the baby might have. It depends on the baby. But just to throw out a little piece of like, because everybody gets worried about choking, like it is a genuine concern and that's something kind of built into the appropriate sizes and textures of foods of baby-led weaning. When should we be introducing allergens?

So this is another thing I talk about my starting solids article. There's been debate on this because they used to say wait longer to introduce allergens. And now it's kind of shifted to actually maybe we should introduce them a little bit earlier, expose the baby to the allergen. And then hopefully they'll like build up tolerance to it over time. So now it's shifted to introducing allergens fairly early into your starting solids journey. Now, typically starting solids begins at around six months of age. I believe that's the, you know, we have the strongest evidence for starting at that age. So I would say after a baby has been tolerating okay, you know, a couple different foods.

Maybe you're a week in, you could start incorporating some of the allergens. I mean, some people start with like, you know, cooked egg ill because baby's first food. Technically, that falls into the allergen category, right? And then you watch for their reaction and see how they do. You know, I was fortunate that my children don't have allergies. So it was fairly straightforward to me. But I did start introducing them fairly early, like within the first month or two of starting solids. We were building in, building in allergens.

All right. So you wrote real food for pregnancy five years ago. What is not in the book that you wish was? Well, by default, I mean, it's a very research-heavy book. There's over 930-something citations in it. And so by default, new research comes out that I wish was out by the time I wrote it, right? Eventually there will be a second edition. I'd say the majority of those research studies center around some specific benefit of a nutrient

that we didn't know about at the time. So like I have information about coline in the book. At the time, the trial that gave mothers high or moderate chlorine intake and looked at their baby's brain outcomes, that only went into toddlerhood. Well, now we have the data going all the way to age seven, showing that it persists. that's something, that's like an example of like, oh man, I wish I had that data point in the book, even though it doesn't change my recommendation per se. So yeah. Okay, so you have two books. Tell us again, remind them what they are, where they can get them and where to follow you on Instagram. They're real food for pregnancy and real food for gestational diabetes. I link out to where to buy those on my website. So it's Lily Nichols-RDN.com. They're real food for pregnancy and real food for gestational diabetes. I link out to where to buy those on my website. So it's Lily Nichols-R-DN.com. there is a little tab for books that links out to them. You can read the first chapter for free of Real Food for Pregnancy.

There's a download link over on my site as well. But as far as Instagram, I handles the same as my website. So Lily Nichols, RDN. I have a ton of information on my Instagram and also, you know, 250 plus blog articles on my website. So lots and lots of free information, even if you don't happen to pick up a copy of my books. Lily, thank you for coming on the Spillow.

over. Thank you. Send this episode to all the moms or soon to be moms that you know. I would like to know your personal story, how you approach your diet if you've ever been pregnant. You know, were you the eat whatever I want prego lady and you think you were too lenient or were you too strict and you wish you would have had more of this information. I'd like to see your story. You can share it in the cute service as Facebook group. I'm very active in there. I respond to you guys. I see everything that you post. I have two other great baby episodes of the spillover. If you're new and you just kind of stumbled upon this podcast, first of all, welcome. This is called the cute servitive movement. And every week I interview somebody that has a different expertise or personal jaw-dropping story or

something like that. So I've done two other episodes on the like the baby realm. One of them was the dark side of the birthing business with Ali Beth Stucky. We talked about the cascade of interventions with a lot of hospital births, how a lot of moms don't feel as supported in labor as they should in the traditional hospital setting, and then the truth about C-sections. That's season two, episode one.

And then there's my interview with Karen Walton from Pain Free Birth, where we talk home birth and well having pain-free birth. That's her thing. I didn't even know that was possible until I talked to her. That's Season 2, Episode 8.

Next Thursday is a guest who may be the most cinnamon rolly of all the guests I've ever had. She is the host of one of the biggest parenting podcasts on the planet, which also happens to be one of my favorite podcasts ever. I cannot say anything else because you'll totally figure out who it is, but oh my gosh, it is so good. Subscribe right now. Leave a five-star review.

Tell me something that you've changed your mind on since listening to this podcast. Watch every episode by subscribing to Real Alex Clark on YouTube where you'll find a myriad of content from me. We're back next Thursday at 9 p.m. Pacific, midnight Eastern with my very special guest, anywhere you get your podcast. I'm Alex Clark, and this is The Spillover. Love you mean it. Bye.