Interview with nutritonist Lily Nichols, author of Real Food for Gestational Diabetes

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Several months ago, I had the great pleasure and thrill to meet an exceptional woman, Lily Nichols, during an interview over the phone (I was being interviewed to have my story in her book, Real Food for Gestational Diabetes). Lily is a Cetified Diabetes Instructor, a Registered Dietician, and a Certified Pilates Instructor. While listening to her speak, I could tell she has a serious passion for helping others and truly cares about those she helps. She is truly beautiful on the inside and out.

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Months after our interview, I received a package in the mail with her book in it (I was excited to see she had included my story in the book as well!). The book is bigger than I expected it to be, and a WONDERFUL resource that I wish I had had with all of my pregnancies.

It wasn’t until my 4th pregnancy that I was diagnosed with gestational diabetes. I had to seriously modify my diet to stabilize my blood sugar levels and avoid taking insulin. This book would have saved me so much time and energy in the hundreds of hours of research I did during that time!

Real Food for Gestational Diabetes is a very thorough book, which goes into detail to answer so many questions that I remember having myself.  It helps you create your very own meal plan for your particular needs during pregnancy, goes into postpartum care, explains how ketosis works during pregnancy, explains why we have blood sugar spikes, and much more.

Take a look at the first page of the table of contents to get an idea of what kind of topics the book goes into:

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A couple of weeks ago, I asked Lily if I could interview her for a blog post here, and she kindly obliged. You can read our conversation below.

Can you tell me a little about yourself and how you got started as a nutritionist?

I knew I wanted to have a career involving food from very young age – mostly because I loved cooking and gardening! I was also fascinated by the idea that food could be used to treat or prevent certain diseases.

But because I didn’t want to work long hours in a restaurant kitchen, I chose the nutrition path. That led me to pursue a Bachelor’s degree in nutrition, become a registered dietitian/nutritionist, and later, after working in prenatal care and gestational diabetes, train to be a certified diabetes educator. My interest lies heavily in integrative and functional nutrition, the quality of our food (how it’s grown/raised and how that affects nutrient levels & health), prenatal nutrition (how a mom’s diet shapes a health of her child), and mindful eating (listening to our bodies more than a calculator).

What is gestational diabetes, and what percentage of women experience it?

Gestational diabetes is usually defined as diabetes that develops or is first diagnosed during pregnancy. However, it can also be defined as “insulin resistance” or “carbohydrate intolerance” during pregnancy.

I prefer to rely on the latter description because, at the end of the day, gestational diabetes is the result of insulin resistance, which means a woman is unable to tolerate large amounts of carbohydrates without experiencing high blood sugar.

Up to 18% of pregnant women will get diagnosed with gestational diabetes, making it the most common complication of pregnancy.

What made you decide to write a book specifically for women with gestational diabetes?

I’ve specialized in gestational diabetes for most of my career and I helped develop the nutrition guidelines used by the California Diabetes and Pregnancy Program (which many other states have also adopted).

However, once I put those guidelines into practice clinically, they frequently failed to adequately control blood sugar levels. Instead of believing these women had “failed diet therapy”, I realized that diet therapy could have been failing them. Medicine and insulin are useful tools for controlling blood sugar, but I believed we could do more nutritionally before resorting to them.

If gestational diabetes is “carbohydrate intolerance”, why was the gestational diabetes diet so high in carbs? And where did the elusive recommendation for 175g minimum for carbohydrates for pregnant women come from?

No one could tell me, so I spent months researching this in depth and realized this supposed “standard of care” had very little evidence to support it.

But I kept coming across the same argument against reducing carbohydrates in a prenatal diet. The primary reason clinicians are afraid to endorse a lower carbohydrate diet for pregnancy is that they’ve been given outdated information regarding ketosis. This topic is so complex that I devote an entire chapter to in my book, Real Food for Gestational Diabetes. But the short answer is that low-level nutritional ketosis is common during pregnancy, does not carry the same risks as starvation ketosis or diabetic ketoacidosis, and does not negatively impact the brain development of a baby (More on that in this post.)

What makes your diet plan different than the conventional diets offered today?

Well, first off, the carbohydrate recommendations are different. I don’t believe there’s a one-size-fits-all diet for pregnancy, and that includes the whole notion that there’s an “ideal” level of carbohydrates for all women to consume. It should be personalized to the woman and to her blood sugar & activity levels. Often, that will mean a lower carbohydrate diet compared to conventional guidelines, but not always.

Second, I emphasize the importance of quality fats in a prenatal diet, rather than a low-fat diet. There are numerous nutrients found in fatty foods that are key for fetal development. This whole notion that “fat is bad” is extremely outdated. It inadvertently leaves women deficient in a variety of nutrients, including choline, glycine, and fat-soluble vitamins. I cover why these nutrients, and others, are key to a developing baby in Chapter 5 of my book.

Third, I emphasize a real food approach that embraces nutrient-dense foods, including animal foods (from properly-raised animals). It’s not just about eating fewer processed carbohydrates, it’s about replacing those foods with the right things. Inadequate micronutrients can lead to blood sugar issues as well, so we have to focus on food quality.

Have you seen much success with people who have followed your nutritional advice during pregnancy?

YES! If I didn’t see this work clinically, I would not have written a book about it. Not only does a real food diet tend to normalize blood sugar levels, but it often leads to improvements in other issues like swelling, high blood pressure, and excessive weight gain. All of these combined result in less complicated pregnancies, births, and healthier babies.

What are some of your favorite cooking blogs or websites?

I love seeing innovative recipes, so I like to watch what the chefs are up to. Epicurious.com is one of my favorites to hunt for recipes. I actually cook without a recipe 95% of the time and believe cooking is much more about technique anything. I have to force myself to write down a recipe if I plan to share it on my blog!

Who are some people who have inspired you?

There are many, but I’ll choose just one for now. Fellow “real food” dietitian and diabetes educator, Franziska Spritzler, inspired me to not be afraid to speak my mind. She’s an expert in carbohydrate-restricted diets and helped me stay committed to writing my book.

What is your favorite healthy meal?

Oh, this one’s tough. I LOVE food, so I can’t choose just one meal, so I’ll give you a few examples. For breakfast, I love eggs over-easy with bacon, sautéed kale, and avocado (this explains my book cover for Real Food for Gestational Diabetes, right?).

Osso Bucco is one of my favorite dishes, which sounds really fancy, but it’s basically beef shank with the bone, tomatoes, and vegetables slow-cooked. All the really inexpensive and tough cuts of grass-fed beef are my favorite. They make the most delicious (and nutritious) sauces. I prefer it over steak any day.

This will sound trite, but I really love roasted vegetables – bell peppers, cabbage, Brussels sprouts, onions, fennel. Veggies have so much flavor that gets concentrated when roasted. I roast a few half-sheet pans of vegetables every week. They make a great side dish with whatever else I’m having at a meal.

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Do you have anything else you might like to add?

We need to re-frame how we look at gestational diabetes. It’s a unique opportunity for moms to focus on self care, but too often it becomes a source of unnecessary stress. A real food approach is ideal for gestational diabetes, because it emphasizes nutrient-dense foods that provide a baby with all the critical nutrients for growth, while also minimizing blood sugar spikes. This makes it much easier to manage.


You can purchase Lily’s book, Real Food for Gestational Diabetes, in Kindle format or in book form. In my opinion, it is money well spent!

Readers, let me know your thoughts! Have you had gestational diabetes and had success with a low carb diet? I would love to hear you share your experiences.

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