Motherhood: PCOS, Prenatal Nutrition On A Budget, Postpartum Depression And Overwhelm

Infertility is on the rise. Polycystic Ovarian Syndrome (PCOS) and postpartum depression is, too. Can diet help address these issues? And what’s the best diet to enhance fertility? Lily Nichols is a Registered Dietitian/Nutritionist and the author of Real Food for Fertility, Real Food for Pregnancy and Real Food for Gestational Diabetes. Today, Lily offers practical advice for tackling the issues mentioned above and more.

Lily covers how to maximize micronutrients for mothers and mothers-to-be, even when on a budget. She gets specific about foods to include in the diet that enhance fertility and combat insulin resistance (a central factor in PCOS). She also goes over why a protein-rich diet is critical for nourishment pre- and post-partum for better energy, satiety and to combat nutritional deficiencies. Finally, she offers insights on breastfeeding and how to deal with overwhelm in the first few months following giving birth.

Visit Lily’s website: lilynicholsrdn.com

Go to Nourishing Our Children

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Episode Transcript

Within the below transcript the bolded text is Hilda Labrada Gore and the regular text is Lily Nichols.

Infertility is on the rise, polycystic ovarian syndrome, and postpartum depression too. Can diet help address these issues? What’s the best way to enhance fertility? This is episode 503, and our guest is Lily Nichols. Lily is a registered dietitian nutritionist and the author of Real Food for Fertility, Real Food for Pregnancy, and Real Food for Gestational Diabetes.

Lily offers practical advice for tackling pregnancy issues with diet from PCOS to fertility issues and more. Lily is an unconventional dietitian focusing more on nutrient density than most conventional dietitians might. She addresses the gamut and offers concrete and ancestral advice for maximizing micronutrients for mothers and mothers-to-be, even when on a budget.

She gets specific about foods to enhance fertility and combat insulin resistance, a central factor in PCOS. She also goes over why a protein-rich diet is critical for nourishment pre- and postpartum, for better energy, and satiety, and to combat nutritional deficiencies. Lily offers insights on breastfeeding and how to deal with overwhelm in the first few months following giving birth.

This is the third episode released in our motherhood series. Before we get into the conversation, Nourishing Our Children. Do you know that Nourishing Our Children is a project of The Weston A. Price Foundation? Launched in 2005, it has a focus on timeless principles for supporting learning, behavior, and health through optimal nutrition. Nourishing Our Children has an active online group for parents, would-be parents, grandparents, and adults interested in children’s health. If you are looking for support on how to nourish your children and yourself, join the Facebook group, Nourished Children 2.0. You’ll also have complimentary access to the Nourished 2.0 group focused on adults, for one donation of only $5 for the calendar year. The moderators ensure that no question goes unanswered. Go to Nourished Children Groups to learn how to join.

Here is a testimonial from one of the community members. “I have been a part of the Nourishing Our Children closed group on Facebook for many years and find that the communal support is invaluable. First, when I joined, we had struggled with unexplained infertility. Back then, nine doctors from Dartmouth to Harvard had no idea what was wrong and how to help us.

We have drastically changed the way we eat, and by God’s grace, now have two happy, healthy children. Thanks to all the knowledge I have gained through the group, my children have had no medical interventions, have never taken any drugs, and are very happy, vibrant, and easy. We are expecting another miracle baby any day now. I want you to know that everything you are doing matters so much. It’s made a huge difference for our family.” That’s from Olga. Again, check out Nourishing Our Children Groups for more information. Coming up, Lily addresses issues with breastfeeding and dealing with overwhelm as a new mom.

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Our guest was Lily Nichols. Visit her website, Lily Nichols RDN, to learn more. Remember to follow the Wise Traditions on any podcast app, or you can follow it on the Wise Traditions app. Put that into your browser on the Apple applications, and you will find us. That way, you don’t miss a thing when the new episodes are released, and you can share your favorite interviews quickly with your friends. This helps us get the word out in a more personal way. Thank you so much for reading, my friend. Stay well, and remember to keep your feet on the ground and your face to the sun.

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Welcome, Lily.

Thanks so much for having me.

Real Food And Health

Some people might come to this show with a little healthy skepticism because most dieticians have dietary recommendations that people who are all about real food would look at with a lot of skepticism. Can you tell us your story and how you came to the approach to real food and good health?

A lot of people don’t know that I was introduced to ancestral nutrition and Western Price’s work even before I went through my formal dietetics training, my undergraduate nutrition, my internship, and all that. I had already read Dr. Price’s book Nutrition and Physical Degeneration. I had already read Sally Fallon’s book Nourishing Traditions and had already seen my health improve from the time I was vegetarian and incorporated more animal foods.

I already had exposure to that dietary philosophy and was already you could already feel it in my body that when I went through my schooling, even when we did I remember an assignment where we had to track everything we ate and calculate everything out and my fat consumption you look at the percentage of calories from different macronutrients my dietary fat consumption was over 50%.

I remember my professor’s jaw was on the floor. “How are you so lean and healthy and everything seems fine?” They couldn’t get out of the dogma. I used my undergrad like I went into it with eyes wide open. I knew that it was a means to an end of getting the necessary science education, but also, I knew that what I was going to be learning was government dietary guidelines and so I used it to my advantage to have access to all the medical journals, read all the things, fact-check some of the concepts that are around in different dietary philosophies because I do keep an open mind. There is value in a lot of different philosophies.

Let me fact-check this like, what’s the research on vitamin K2? What about phytic acid and fermenting grains and all of that? It worked to my advantage. I did have to do a lot of smiling and nodding to get through it, but I do appreciate the science background and how it got me attuned to looking at research critically.

Real Food For Gestational Diabetes

Your first book had to do with gestational diabetes, and you were talking about the power of real food to address it. Can you touch on that briefly before we get into some other stuff?

Wise Traditions | Lily Nichols | PCOS — Real Food for Gestational Diabetes: An Effective Alternative to the Conventional Nutrition Approach

Some of my early work in my career was in the gestational diabetes space. It was a good way to get my foot in the door in the prenatal nutrition arena and mirrors a lot of the principles that Dr. Price talks about with you inheriting certain things from your parents, and that’s not genetic. You are inheriting how well they were eating and their environment and all of that. With gestational diabetes, that’s right at the forefront because when blood sugars are not very well controlled in pregnancy, that child’s risk of obesity and type 2 diabetes are dramatically higher, anywhere from a 6 to 19-fold increase and you can pretty much avoid that even with the gestational diabetes diagnosis when blood sugars are kept in a healthier range.

It’s a very direct impact on the next generation. I worked in a number of different capacities in that space. I worked at the policy level with the California Diabetes and Pregnancy Program, which some people call Sweet Success. I worked clinically with perinatologists, and I’ve done a lot of work in private practice and consulting, and now training other professionals as well.

I remember a couple of my pregnancies. I have four grown kids now, but I’m so thankful. A couple of times, they suspected I might have gestational diabetes or be inclined toward it, predisposed. They had me drink like this huge jug, probably a quart, of some sappy, syrupy, sickeningly sweet drink to measure how my body was responding to glucose and how it was working with the insulin but I never got any guidance on what I could do with my diet to change things as opposed to taking these drinks and doing the test.

The unfortunate part is, that even if you did get guidance, it probably wouldn’t help the matter very much. One way of looking at gestational diabetes is carbohydrate intolerance in pregnancy or insulin resistance in pregnancy. Your body cannot tolerate a large quantity of carbohydrates at one sitting without having high blood sugar as a result, and everybody’s carbohydrate tolerance is different. We need to fine-tune what our body handles well.

For an individual with gestational diabetes or borderline, you don’t want to be eating a whole lot of carbohydrates. You want to be getting more of your calories from fat, protein, fiber-rich vegetables, and things that don’t spike your blood sugar, and yet when you get a diagnosis, they usually give you a high-carb diet. That’s the whole reason that I even wrote Real Food for Gestational Diabetes because what I was seeing in clinical care was that the conventional dietary advice didn’t work. It was way too high in carbs, way too low in protein and fat, too restrictive, and none of it made any sense. It didn’t work well in clinical practice. That’s the whole reason that I even went about writing that book.

I’m about to move on to another book you’ve written, but I’m curious. What percentage of pregnant women have issues with gestational diabetes in the USA?

It depends on which diagnostic criteria are applied, so you’ll see all the different stats all over the map. Some say it’s like 5% to 7% percent of pregnancies. If we are using the most stringent diagnostic criteria, which is what all other countries in the world use except the United States. It’s about 18% of pregnancies. It is the most common pregnancy complication by far, more than preeclampsia.

Real Food For Fertility

Speaking of pregnancy complications, that might not sound bad to someone who wants to get pregnant, and I’m thinking about the other book you wrote, Real Food for Fertility. Talk to us a little bit about what’s the issue with fertility in the US and around the world and some real foods you’d recommend to enhance our fertility.

Fertility has become a major concern. We see sperm quality declining globally, and of course, the WHO keeps lowering the threshold of what’s considered infertile to a ridiculously low level. Egg quality is declining. Pregnancy rates are declining. Anywhere from 1 in 6 to 1 in 7 couples now have some fertility challenges, and at least half of those cases have some male-factor involvement. It’s not just female fertility that’s affected again, there’s the male component as well.

It’s become a major issue, and we are seeing it grow even more as a result of a decline in overall metabolic health and overall nutritional status of the population. If you tie it back to the gestational diabetes conversation, a lot of the point that I try to make about that condition is that there’s some underlying, in most cases, there’s underlying insulin resistance that was their preconception. We are catching it in pregnancy because this is a time when we are testing blood sugar levels and have slightly more stringent diagnostic criteria because blood sugar is supposed to trend a little lower in pregnancy.

If you have women with the most common fertility challenge among women, which is polycystic ovarian syndrome, the majority of PCOS cases have an insulin-resistant component, and they are very prone to develop so-called additional diabetes but is it something that developed as a result of all the physiological changes in pregnancy, or was it a pre-existing long-standing blood sugar metabolism issue that we are seeing come to light in that stage?

We also see delays in conception among women who have blood sugar dysregulation. There’s a very large study out of Singapore that came out, and they were tracking couples who were actively trying to conceive, conception rates relative to where their blood sugar levels were at. Even in women whose blood sugar was on the higher end of normal but not quite in the pre-diabetic range, it took longer for them to conceive than women who had blood sugar right in the healthy range or the lower end of the healthy range.

It does make a difference in egg quality, conception rates, and fertilization rates. It affects the implantation. It affects the development of the placenta. It can affect the risk of certain birth defects. It is something that we need. We need people to be having a conversation about improving overall fertility, in my opinion. From the title of my book, is that food is the major place that we need to be focusing. The second part of your question was about foods to emphasize.

I’m a huge proponent of people optimizing their protein intake prior to conception. From the blood sugar metabolism side of things, you have better blood sugar management when people consume more protein. Our RDAs for protein are woefully too low, like arguably at least they need to be at least double. You know what they are for some individuals, even higher. We also need to consider that our protein-rich foods, protein-rich animal foods, are the richest in micronutrients.

This isn’t my opinion. Even though I came to the same conclusion from looking at nutrient analyses, there was a study that looked at what are the most nutrient-dense foods worldwide for these keys. They looked at six key micronutrient indicators. It’s funny. I have a post way in my archives on my Instagram about this study but you look at the identified, and it’s like liver, organ meats, bivalve shellfish like oysters, clams, mussels, small fish like sardines and anchovies, red meat, dairy products, eggs, and then the only one that was a plant food was dark leafy greens.

All the sorts of things that I have been preaching about emphasizing in pregnancy, lots of overlap with the recommendations of the Weston A. Price Foundation as well. These are our most nutrient-rich foods. You get two birds with one stone, you get better blood sugar control, and you have better satiety and better energy levels. You are also filling those depleted nutrient stores that so many people have from eating a highly processed standard American diet.

What you are saying resonates with me, because I was exactly on the standard American diet, the SAD diet, without my realizing it. I’m certain I had some insulin resistance or insulin sensitivity before I got pregnant, and as you are suggesting, I didn’t get diabetes. I never received that diagnosis, but my body was exhibiting symptoms of that, but it was a precursor.

I love this idea also of preparing our bodies for pregnancy by stabilizing that blood sugar, by eating foods that are going to make our womb an inviting place. It’s so fun to see that science is catching up to traditional wisdom. The things that you did research, in fact-checking on, kind of support the work of Dr. Price and what the foundation has been promoting for some time.

I draw parallels to Price’s work throughout my books because it’s important that we have to look at anthropology as well. A lot of these communities could figure it out though, I don’t know, many years of trial and error or ancestral wisdom being passed down generation after generation. You need to consume more of these foods in advance of conception which is so super interesting I don’t recall that Price talks about this but I found some research that I wrote about in Real Food for Fertility, talking about how in some communities, when it wasn’t a good time for the tribe or community to have more babies, they would withhold specific foods. The same ones that they would emphasize when they wanted to help a couple conceive because it wasn’t a good time for them to have babies.

You think about seasonality. We see the deer reproduce at this time of year. In some communities where we didn’t have this grocery store available 24/7, you would want to time when you are having babies when it’s the big growing season when you have an abundance of food to fuel that mom throughout her pregnancy and postpartum. Not at a time when famine and food shortages are likely. It’s very interesting that they would use it as a lever in either direction.

Postpartum Recovery And Well-Being

I don’t remember reading that in his book, though. Indeed, there were communities that were timing marriages so that they could have children at the right season. Probably mostly in the springtime, I’m thinking about particularly the Messiah tribes. It’s fascinating. We are going to have to have more conversations about these other books you’ve written, but I want to focus on what happens after a woman gives birth. The postpartum stage and what we can do to help our bodies recover and stay well. Some of the same principles may apply. What we do during pregnancy is going to help us post-pregnancy or postpartum, but can you speak to that a little bit? How do we keep our bodies well and help our bodies recover from all that they have been doing?

Postpartum always surprises people when I say this, but it is the time of highest nutrient requirements at any time in a woman’s life. More than even the third trimester of pregnancy and this is even acknowledged in our conventional nutrition guidelines. With the first six months, that period where most women are exclusively breastfeeding for those that are choosing to nurse, your body is on overdrive.

The postpartum period is the time of highest nutrient requirements in a woman’s life.

In that immediate postpartum period, you have to think about recovering from birth, which can be an energetic expense, or if you had a C-section, you are healing from major abdominal surgery. It is a huge healing process to heal from birth. That first week and first two weeks are massive, and you have so many ancestral traditions of providing about 40 days of support for the mom. She can rest, and receive nourishment, and food is all cooked for her. There’s a heavy emphasis on protein-rich foods, especially your slow-cooked, bone-in stews. In China, you have pig’s feet soup. In Korea, it’s a very rich beef bone broth with a lot of seaweed in it. In Mexico, you have a whole chicken that’s cooked into a big stew. You have congee and other soups in parts of Asia. Curries in India. You go all over the world, and there’s this bone-in, whole animal foods, organ meats tend to be emphasized, whole eggs with the yolk. In some communities, there are lots of dairy products.

Things that are alarming, comforting, and high-protein and when you think about what your body has been through with pregnancy and birth and now switching to the hormones of lactation, you need a ton of protein. We had the first-ever study on protein requirements in postpartum women only a few years ago. They looked like they were even looking at moms 3 to 6 months out, so we don’t have data yet on 0 to 3 months postpartum. Even at that time, women needed more protein than a typical female athlete. You have to go ham on the protein, pun intended. Lots of protein. It’s a night and day difference as your body is switching over to the hormones of lactation. That’s a huge energetic expense.

You are burning through about 500 calories a day from lactation, and your body is pulling at whatever energetic resources it can to fuel breast milk production yes, there are also, for some micronutrients, an effect on the nutrient density of the breast milk based on what a mom is consuming. That’s a topic that people want to cancel me over sometimes because there’s so much already riding on you as a new mom.

I have two kids that I nursed all. It’s a lot. Breastfeeding is a lot, especially early on but we can’t ignore that. We have all this data on all this effort to make sure dairy cows are properly nourished because we know it affects the milk output and the milk composition. The same is true for humans. I don’t know why it’s such a stretch for people to think you could still produce breast milk when you are pretty nutrient-depleted, but the concentrations of a number of vitamins and minerals, especially your B vitamins in particular, are substantially lower if you are depleted. We see low vitamin B12 levels in breast milk, for example, in vegans and vegetarians who have not been adequately supplementing. That affects the B12 intake of the babies and their B12 status. We do need to think about Mom getting solid nourishment.

I’m a big proponent of an animal food-forward postpartum diet. In a lot of the traditions, the plant foods that we consumed were well-cooked starches, whatever was local to the region. Your energy needs are so high, that you are burning through it, and then when vegetables and fruits are consumed, they are usually cooked or stewed. They are easy to digest. You could probably recall from your baby’s. Everything in your abdomen has been like all your organs have been pushed out of the way by the baby. All those are reorienting, so we want things that are gentle on your digestive system. Something like a big salad is a strain for your body to digest, but a well-cooked stew that has cooked vegetables and cooked meat in it is easy on the stomach and it feels good while you are digesting it.

The warm foods sound so inviting, and a salad does not sound at all appealing but I imagine there are some women who think that that’s the healthier choice, right, Lily??

We have this bounce-back culture, where a lot of women go on restrictive diets postpartum. We don’t honor that time period. We are like, “Our work is done. I was pregnant, and now I need to revert to normal.” This is not a time to revert to whatever you were doing beforehand. You have to fortify your diet with a lot of nutrient-rich foods. I don’t think it’s necessarily bad to have a salad but to think of a giant salad as a whole meal, I don’t think is going to be nourishing enough. Maybe a salad as a side dish, when you are having your big, nice stew, is one thing, but somebody having this anemic salad with sufficient protein and low-fat salad dressing, no, this is not the time. Not, nor is there ever a good time for that as a meal.

When you are talking about bounce-back, especially with social media right now, people are trying to conform to a certain image, and look how quickly I got back into my bikini or whatever it is. People are focused so much on their body image and what they are projecting before they get pregnant that I’m sure after there’s a desire to get right back into that slim dress or jeans or what have you.

You have to give your body some time. This is the time to love your body. Rest, and nourish, especially the first month to six weeks. You’ve got time. This is the time to rest and nourish yourself.

Postpartum recovery is the time to love your body. This is the time to rest and nourish yourself.

What about postpartum depression and your work with clients or interactions with folks? What have you learned about that? Can that also be somewhat alleviated by how we nourish ourselves?

There is a nutritional component for sure. Mental health challenges are multifaceted. There are so many things that can contribute. I would say, arguably, the strength of your support network might be equally as important as how you are nourishing yourself because, “It takes a village,” as they say. That’s true. It does take a lot of help. In the nourishment component, we find that mental health challenges are more common when individuals are having substantial blood sugar swings.

When I speak to the protein and fat aspect, when people are not consuming enough food in the first place, but not enough protein and fat to help stabilize their blood sugar levels, you could be going spike, crash, spike crash all day long if you are subsisting on carbs the whole day. I’m not an anti-carb. You need to have that protein and fat component taken care of and the carbs are like a condiment on the side. We also need to think about what are the nutrients that support our neurotransmitter production and healthy maintenance of healthy fuel levels in our brain.

Those spikes and crashes in blood sugar do affect our brain chemistry as well. We see more symptoms of anxiety in those individuals. We see if vitamin B12 is depleted, or DHA, or vitamin D, or even iron, we see that affecting mental health as well and there’s now a lot more research coming out on the nutrition component playing into postpartum depression. It’s becoming more widely accepted and acknowledged that it could be playing a role. I always tell people the first thing, if your postpartum experience starts going downhill.

The first place I want them to look at is their nourishment. In particular, like starting first thing in the morning, “Are you getting a protein-rich breakfast down the hatch?” One egg is not going to cut it. We are talking about 3 or 4 eggs in an omelet with maybe some sausage or something on the side. You need a lot of protein, arguably easily 40 grams, maybe 50 grams per meal for a lot of women in this early postpartum phase. As I said, your protein needs are more than a typical female athlete, and I have heard from clients that the night-and-day difference that they can feel, even day to day. I got my protein in, and I felt great. I didn’t get there for whatever reason. Life got hectic, and I started to feel myself spiral. We can’t overlook the role that nutrition plays in our brain and mental health.

And Lily, I’m thinking about what you were saying earlier about people wanting to cancel you for saying there’s a relationship between the food we eat and the quality of breast milk we give. It’s because people are concerned for those from lower-income societal strata. Let’s say people were struggling to make ends meet and they can’t afford the very foods that they desperately need to provide good-quality breast milk for their baby.

I’m glad you’ve mentioned eggs and organ meats. These things are not expensive, but they are great sources of protein and the minerals and nutrients that we need to provide the baby with all that it needs.

I have done a lot of professional education on this over the years to give providers the facts, and the newer research. I have a webinar from the Women’s Health Nutrition Academy focusing specifically on nutrient transfer into breast milk related to what a mom is consuming and what her nutritional status is. I go micronutrient by micronutrient. Not all of them are affected by folate and iron, the levels stay relatively stable but for many of them, vitamin A, choline, DHA, and iodine. You go down the list all of those are affected by maternal consumption.

Let’s focus on the mom, and get her as healthy as possible, and yes, there are also going to be carryover benefits for her baby’s nutrient intake as well. Still, breast milk is going to be created by your body and adjusted to suit your baby’s needs, with antibodies responding to what’s in the environment and whatnot. Women, even if they are pretty malnourished, are still going to produce breast milk with sufficient calories, for example, for their babies. When we are talking about the incremental levels of micronutrients and different fatty acid composition, that is affected. We can’t deny it. I do also have resources. I have an article on my website called Prenatal Nutrition on a Budget. Budget-friendly prenatal nutrition goes through different options for prioritizing the most nutritious foods relative to cost.

I have worked very extensively with low-income populations. I first started practicing in Los Angeles. Most of my clients were receiving WIC services and things like that, and working their tails off to try to provide food for their families. There are going to be different levels of people having access to what they can afford, but there’s always an opportunity to optimize. I try to focus on what’s going to meet them where they are financially, but can still be optimal.

You can blow a lot of money on processed foods, which many people do, which are not highly nutritious. If we spend the money on a pound of ground beef and a pound of dried beans that we cook at home and soak and all that, you get way more beans than the canned version. First of all, they are more digestible. Combine it with some beef, and you are optimizing the protein utilization from the beans. There are ways to stretch the budget and still provide good nutrition.

I can’t wait to look at those resources myself and share them. I’m glad you mentioned that. I want to bring this up now since we were talking about breastfeeding and breast milk. Why is breastfeeding so hard? It seems like it should be instinctive, like it is with a calf and her mama cow, or a sow and her piglets. Why is it so hard for us as humans to get it right? What are the issues? There’s a La Leche League and other groups out there trying to help mothers breastfeed. What makes it so hard, do you think?

That’s a hard question to answer. I feel like, on some level, as our families have grown smaller over the years, I feel like a lot of women don’t have exposure to other women who have given birth and to observe the nursing relationship and the latch, how frequently babies nurse. There’s so much stress around how often they are nursing. How long are they nursing? Did I start them on the right side or not? Their weight isn’t exactly changing in this way or that way. I don’t know that people have realistic expectations of how the process goes.

It’s funny talking to some of my mom about it. She had nursed both myself and my sister, and this was a time when she was like, “Breast pumps? I saw one of those one time and it looked weird. I never used a breast pump. I never used a bottle. If your mouth is open, stick a boob in it and nurse.” She was very matter-of-fact you just nurse, I don’t know. Now I wonder if, on some level, we need more information, and then, on another level, there’s information overload where we have overcomplicated it with tracking feeds and pre- and post-weight feeds and counting the number of dirty diapers. There’s a lot of overwhelm, and postpartum.

There are questions about some of our nursing challenges related to latch, maybe the increased prevalence of tongue ties potentially affecting success rates with breastfeeding or willingness to continue because it’s so excruciatingly painful for babies not extracting enough milk. I do think very highly of all the lactation educators and IBCLCs out there working in the field with mothers to help them, especially in those early months, in getting breastfeeding established. That part, for me at least, was the more challenging side of things.

Then you enter into the arena of women having to go back to work, maybe earlier than they might want, and the more you are separated from the baby, your supply adjusts to match the output. If you are separated from your baby for long periods of time, you do have to be pumping them those times, at the same pace that the baby would have been nursing from the breast directly, to maintain your supply. That is a huge under-discussed factor as well.

I remember buying a breast pump and I was like, “This seems like a hassle. I don’t like it. It’s not the baby,” and everyone makes their own choices in this, but I was like, “I’m going to do it the regular way.” I only wanted it in case I went out or whatever. I know there are people who also struggle with a lack of supply, and you suggested that, perhaps, their lack of certain nutrients is leading to that issue. How common is a lack of breast milk or a struggle with quantity in the US population?

I don’t have a statistic off the top of my head on how common supply issues are. There are a lot more women who think they have supply issues that don’t have supply issues, maybe because they are working with a provider who’s weighing their baby and charting it on the CDC formula-fed babies’ growth charts versus the WHO ones for breastfed babies. You want to make sure your baby’s weight trajectory is charted on the appropriate chart. I also feel like interpretations of those charts are used incorrectly and that it’s not a concern if you have a baby at the 15th percentile or the 5th percentile, or even below the chart, but they are staying, they are like gaining at that same trajectory that’s fine.

Like adult humans, you have some people who are smaller than others. The whole point of having the percentiles is that babies are on a bell curve. Yes, about 50% fall in the middle, and then you have the others falling on the side because they are not following a growth chart exactly at the 50th percentile. That does not mean that anything is of concern. My babies were pretty robust when they were born, and then they were very active from a young age, so they both dropped to the 25th-30th percentile but then stayed there over the years. They are growing at a good rate. They are at that percentile, but somebody else might have looked at that chart and freaked out.

There’s a lot of people who, if you can’t see the volume which is, again, a reason a lot of women, some of them prefer to pump because they like seeing the exact output. If you can’t see it, it’s hard to know how much the baby is getting. Motherhood takes a lot of trust that everything is so yeah, supply issues. A lot of times are more in the head, suspected but not confirmed. There are women who have legitimate supply issues that can be a challenge with the latch where the baby is not transferring the milk effectively.

Motherhood takes a lot of trust to know that everything is okay.

There can be differences in the glandular tissue of the breasts that can affect milk production. Somebody low in nourishment affects the quantity of milk production. Even simple things like your intake of fluids and electrolytes can make a dramatic difference. If you are not consuming enough salt, you have to remember you are excreting electrolytes into your milk as well. It’s not just the fluid losses.

Seeing your foods, eat potassium-rich foods. Your produce, your beans, and legumes, and your protein-rich foods, are all high in potassium. Your coconut water, and pand potatoes that’ll be a great way to get enough of that one. That plays a role. There’s a lot of different factors that can play into it. If we focus from the get-go on nourishing mom, we reduce the chances that there is going to be an issue with supply later on.

I also highly recommend anybody who has suspected supply issues. You work with a well-trained lactation consultant, like an IBCLC, to see if they can do a pre- and post-weight feed on your baby so they can get an estimate on how much milk was transferred by the feed. They can assess for latch issues. They can help with the frequency of nursing. Maybe you have to use some pumping at specific times to try to increase supply. They have all sorts of tricks up their sleeves to help. I always recommend people seek out that help as well, not think that food is going to fix everything. Sometimes, we do need other levels of support.

Importance Of Traditional Knowledge And Intuition

Where you started that answer had to do with being cut off a little bit from our traditions, from the intergenerational families, where you could see how the grandmother well, the grandmother’s not going to be nursing but you get handed down, literally, by being close with these people, techniques, and understanding that we have lost touch with and you also alluded to our need to tap into our intuition some as well. I’m bringing this up because,e in an age of a lot of information coming at us, even from the changing table that we have in the home that has a little scale on it, the parents are collecting all the data. Intuition can get lost and set aside when there might be something more important to inform our decisions, having to do with nutrition in the baby.

We have outsourced a lot of our decision-making and our assessment to other individuals and you talk to any tuned-in pediatrician, they always trust the mom. The mom knows she’s usually right and I do think a lot of moms know if there’s legitimately an issue or not with their baby and when to seek that outside support if you are willing to tune into it.

With the ancestral knowledge and stuff even with my mom, she was very, even when things were rocky early on, it was very reassuring. “You girls nursed a ton when you were babies.” You were latched pretty much full-time because you were thinking, “Why is this baby latched for so long?” They said they only need to eat this many times per day, and it seems like my baby’s eating more times per day, or my baby wants to nurse all night.

We have unrealistic, totally like ancestral practices, expectations on babies’ sleep and how babies we expect babies to sleep separate from their parents, and yet both of mine were getting a significant amount of their nutritional needs met overnight, for better or for worse. That’s something that was ancestrally the norm and nowadays, we have a whole industry around trying to fix what is essentially a biologically normal infant sleep, and this, what’s now been termed “Breast Sleeping Relationship,” creates its issues as well. The further we move from all of our ancestral practices, the more things start to fall apart. I don’t know how many examples we need of this.

The further we move from our ancestral practices, the more things start to fall apart.

I should have asked you this but I believe that it’s crossing my mind now. Had you written all your books about gestational diabetes, real food for pregnancy, and real food for fertility before you had your kids, or after, or during?

I wrote Real Food for Gestational Diabetes before having my kids because I had worked in the gestational diabetes field full-time for years at that point. I wrote that book because I was tired of hearing people give the same old outdated, incorrect advice that was making gestational diabetes worse, more difficult to control, and putting women on the path of requiring medication and insulin unnecessarily if they had better nutrition advice. I had my son shortly after that book came out, and I started writing Real Food for Pregnancy when he was about ten months old. There’s a reason that book has a very detailed chapter in the fourth trimester and postpartum and breastfeeding because I was still in the thick of it as I was writing it and then Real Food for Fertility came after I had both my children.

Theory Applied In Practice

I will have to ask you in part two, whenever we get to that, about how much what you learned in theory applied in practice. Maybe you can tell us real quick about that.

I don’t think there’s a replacement for experiencing something first-hand. If you don’t experience it first-hand, having experience with real-life humans, with clients, and clinical practice where you spend time listening to their stories, informs a lot too. For me, a lot of what I’m doing is there’s some sprinkling in of my own experience, certainly. Real Food for Pregnancy is a better book, and a better resource because I have already experienced pregnancy first-hand. If I had written it after having my second, maybe some of the things would be a little different, but for the most part, like the meat of it, holds truth throughout.

I also think since having worked with hundreds of clients by that point before that book, that your experience is not the end-all, be-all because sometimes some resources come out and it’s informed entirely by one person’s experience with the expectation that everybody else had this same experience and no. There are so many different ways in which you can experience a pregnancy or postpartum or the road to conception.

Even personally, I have been very much informed by ancestral nutrition practices, but also a mindful eating, intuitive eating component. That part comes in as I’m thinking through and evaluating research and data that I might cite in the book, and whether that advice would be realistic for somebody to implement in real life. I try to keep things even though there’s a lot of data. I try to keep things at a level that everybody can understand and isn’t too overwhelming. You can go down a lot of health rabbit holes and find yourself almost paralyzed with all the decisions and all the changes you need to make.

I have to think back to when I was first introduced to the ancestral nutrition side of things, and it was like, “It’s okay to eat butter. I don’t have to put this thinnest little smear on here.” It took years for me to be like, “Yes, it’s okay to eat more fat.” It took years to incorporate a sufficient amount of protein into my diet. The programming is very strong on limiting certain foods. I try to have a gentle way of approaching people making any health changes because I have been there too. It’s been a while. I have been eating this way now for over two decades, but I remember being pretty overwhelmed with all the changes and things feeling scary because it’s new.

One Tip To Improve Health

It’s fun that you have this approach because our readership is all over the map. Some people are having their diet super dialed in. They are all about the show and this ancestral way of eating. For some people, it’s brand new. You’ve offered a lot of value. I’m so thankful. I want to conclude with a question I love to pose at the end. If the reader could do one thing to improve their health, or maybe, in this case, we would say to ensure a healthy body pre-during pregnancy and postpartum, what would you recommend that they do?

I feel like I have been talking about protein for a whole interview, so may as well go with that. Something that has come up with literally almost every client I have worked with is, that we have to, what I call, fix breakfast to set the tone for the rest of the day. As a society, we are now coming out of the big trend of intermittent fasting, which I found didn’t work great for a lot of women. I have the data to support why that is, but getting a protein-sufficient breakfast gives you like 2, 3, or 4 days to consider it an experiment. I’m going to change up my morning routine and I’m going to get a sufficient amount of protein at breakfast.

Sufficient might mean different things for different people. Maybe 25 grams, 30 grams. If you are early postpartum, probably 40 grams, maybe more protein at breakfast and pay attention to how you feel the rest of the day. You don’t have to change anything else. Change that, report back in a couple of days, and see what the difference is. The majority of the time, what I hear, and what I experience on a day-to-day basis, because I occasionally step out of my routine and do something where I’m not, maybe have a croissant for breakfast or something like, “How do I feel terrible?” I will get back to it later.

I hear fewer crazy changes in energy levels, fewer blood sugar spikes and crashes fewer after-noon slumps, and less desire for caffeine and sugar because their energy levels are more stable. This also tends to dramatically improve all of our hormones. You are helping keep your cortisol levels at a healthy level, insulin levels in a good place, and reproductive hormones in a good place. You women might even see this change in how your menstrual cycle is for that month if you stick with it. Try this protein experiment at breakfast and report back.

I love it. Thank you so much, on behalf of the Weston A. Price Foundation, Lily. It’s been a pleasure.

Thank you so much.

About Lily Nichols

Lily Nichols is a Registered Dietitian/Nutritionist, Certified Diabetes Educator, researcher, and author with a passion for evidence-based prenatal nutrition. Her work is known for being research-focused, thorough, and critical of outdated dietary guidelines.

She is the founder of the Institute for Prenatal Nutrition™, co-founder of the Women’s Health Nutrition Academy, and the author of three books: Real Food for Fertility (co-authored with Lisa Hendrickson-Jack), Real Food for Pregnancy and Real Food for Gestational Diabetes.

Lily’s bestselling books have helped tens of thousands of mamas (and babies!), are used in university-level maternal nutrition and midwifery courses, and have even influenced prenatal nutrition policy internationally.