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February 19, 2017 by Leanne Vogel December 14, 2018
Interview with Lily Nichols, a real food-focused registered dietitian and diabetes educator, chatting about the ins and outs of balancing a ketogenic diet while pregnant. Strategies for amenorrhea and other fertility issues, when to go low-carb during pregnancy, breastfeeding tips, and more.
For podcast transcript, scroll down.
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Leanne Vogel: You’re listening to episode number 21 of The Keto Diet Podcast. Hey I’m Leanne from Healthfulpursuit.com and this is The Keto Diet Podcast where we’re busting through the restrictive mentality of a traditional ketogenic diet to uncover the life you crave. What’s keto? Keto is a low-carb/high fat diet where we’re switching from a sugar-burning state to a becoming fat burning machines. If you’re in need of keto recipe food prep inspiration, I’ve prepped a free seven day keto meal plan exclusive for podcast listeners. The plan is complete with a shopping list and everything you need to chow down on keto for seven whole days. Download your free copy at Healthfulpursuit.com/ketomeal. Let’s get this party started.Hey guys, I hope you’re having a wonderful weekend, and if you celebrated Valentine’s Day I hope you had a great time with your significant other. Kevin and I have never really celebrated Valentine’s Day. We have celebrated our love anniversary every year. That was the day that Kevin told me that he loved me. It’s always been a special day. I guess you could say that that is our Valentine’s Day, and it’s on November 11th which is also my community manager, Katie’s, birthday. I never forget her birthday every year. It’s so great. Then we just celebrate our wedding anniversary. If you were the lucky few that celebrated Valentine’s Day I hope you had a great time. We have an awesome podcast for this week. I must say that every time just because I love it so much. I love chatting with all of these cool people about keto things.
Hey guys, I hope you’re having a wonderful weekend, and if you celebrated Valentine’s Day I hope you had a great time with your significant other. Kevin and I have never really celebrated Valentine’s Day. We have celebrated our love anniversary every year. That was the day that Kevin told me that he loved me. It’s always been a special day. I guess you could say that that is our Valentine’s Day, and it’s on November 11th which is also my community manager, Katie’s, birthday. I never forget her birthday every year. It’s so great. Then we just celebrate our wedding anniversary. If you were the lucky few that celebrated Valentine’s Day I hope you had a great time. We have an awesome podcast for this week. I must say that every time just because I love it so much. I love chatting with all of these cool people about keto things.
I have an awesome thing to share with you this week. That is Zen Sweet mixes. Zen Sweet are the makers of monk fruit sweetener which is the only all natural, zero calorie, zero glycemic sweetener on the market that measures and tastes like sugar. One cup of Zen Sweet equals exactly one cup of sugar. It makes the conversion really easy for people that aren’t like me and don’t have an internal calculator of how to calculate out recipes in my head. I don’t know if it makes me weird, but it’s a really cool party trick. They actually sent me a couple of their mixes. It was a chocolate chip cookie one and a brownie one. What I loved about the mixes is that first off, they’re sweetened with monk fruit, and they have no sugar in them. They’re also gluten-free, grain-free, non-GMO, and they’re paleo, and diabetic friendly, and they were so good.
They’re a base of almond flour with a couple extra ingredients. The chocolate chip cookies I only got half of one, because Kevin ate all of them. He’s known in our family as the cookie monster. Guys, he loves cookies. You cannot keep cookies around the house. He will just eat all of the cookies. You won’t even know that you had cookies in the house, because they’ll be gone. I set aside two cookies for my sister. I put them in the back of the fridge. When I got up the next morning they were gone. He didn’t even know that I put them back there, so that is the cookie monster. It is for real. He ate the cookies, he loved the cookies, and the brownies were pretty good too. If you want to learn more about Zen Sweet you can go to ZenSweet.com, and they actually have a Kickstarter campaign for their new mixes. I think they’re really cool, and it’s a really interesting way of going about mixes for the low-carb community. I really appreciated it, so I wanted to share it with you guys.
What we’re covering off in this episode is all about keto and pregnancy. Many of you have been asking for this episode. I’m so happy to be sharing my thoughts and having a really awesome guest on the show. We’re going to be talking about how to accept the changes to your diet when you’re pregnant, whether keto is safe when you’re expecting, whether carbs are required for pregnancy, and some keto breastfeeding tips. The show notes and full transcript for today’s episode can be found at Healthfulpursuit.com/podcast/21. The transcript will be added to the post about three to five days following the initial air date of this episode. Definitely check back in a couple of days if you’re looking for the transcript. Let’s hear from one of our awesome partners.
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We have a couple of announcements for today’s show. The first one is that if you don’t already know, I’m going on a book tour. It’s going to be epic. We’re adding dates constantly to the schedule. Right now, I am going to be visiting New York, Atlanta, Houston, Austin, Chicago, San Francisco, Seattle, Vancouver BC, Edmonton, Calgary, Toronto, and like I said, more dates are being added. If you are interested in visiting with me at any of those places, I’d definitely recommend that you RSVP by going to Ketodietbook.com/tour. I’ll include a link in the show notes for today’s episode. If you’re close to those cities, I’d love to see you. I know that a couple of people are flying in. I think that that’s just crazy amazing. The events are going to be about two hours and we’re just going to straight chill. We’ll take some selfies, I’ll sign your book, we’ll chat about keto. I’ll probably do a little talk as well. It’s just really amazing that I’m going to be getting to meet some of you, and I’m really excited for it.
If I didn’t just say your city, definitely still check at Ketodietbook.com/tour, because like I said we’re adding dates all the time. By the time this episode airs there may be more locations. Definitely check back. We’re trying to make sure that I visit as many places as we can. I’m very excited for that, and there’s a new partner that is joining the podcast; Manitoba Harvest. If you guys have been following me for a while you guys know how much I love Manitoba Harvest. They’re in this exclusive group of companies and products that I really, really love. They’ve agreed to come on the podcast for a couple of times this year. We’re going to be sharing new products with you guys and some exclusive things I’m pretty excited about, so listen for it next week.
In episode 18 a couple of weeks ago, I mentioned that Keto OS was a pyramid scheme and I’ve since learned that that is wrong. I actually didn’t know the difference between a pyramid scheme and multi-level marketing. I didn’t know this, so one of our listeners actually emailed me and explained that it was different. I then googled it, and read a bunch of stuff on Wikipedia. I love learning and I also love admitting when I’m wrong. I’m totally always open to different ideas and different ways of looking at things. From what I understand, a pyramid scheme requires the customer to actually buy into the company before they can actually get the products. They need to become a member. Whereas people that are in a multi-level marketing, which happens to be Keto OS, and I know that I was part of Stampin’ Up which is also a multi-level marketing with my crafting, basically customers can buy product from a person that represents the company. Whereas with a pyramid scheme, in order for a customer to buy a product, they have to become a member and a seller themselves. That’s the difference. I’m sorry that I confused the two. Thank you so much for continuing to be open and educating me. I always love learning, like I said, so I really appreciate it. If you have an idea for a podcast episode, or you want to submit praise over and above the review which you can leave by going to Healthfulpursuit.com/review you can reach me at email@example.com.
Today’s guest is Lily Nichols and she’s a real food focused registered dietitian, diabetes educator, and researcher with expertise in prenatal nutrition and gestational diabetes. Her book, Real Food for Gestational Diabetes, and online course of the same name is the first to advocate for a nutrient dense, lower carb diet for managing gestational diabetes. Her book and course have helped thousands of women have healthy babies and most without the need for blood sugar lowering medication. Her blog, Pilates Nutritionist, explores a variety of topics related to real food nutrition, mindful eating, digestive health, pregnancy, and of course, gestational diabetes. My community manager, Katie, and I were at Paleo Effects last year, I don’t even remember when that happened, like May-ish. Yeah, it must have been May. We saw that Lily was going to be talking about a low-carb diet for pregnancy, and we were all over that talk. I was so excited to hear what she had to say and I was nodding my head the whole time. I was so excited to have her on the show. It just took this long for us to figure out a time to sit down and chat. As she mentions in the call, she just had a baby last year, so really busy time for her. She’s super knowledgeable. I’m so happy we got to chat all things pregnancy. I made a pregnancy video on keto, which I’ll link to in the show notes and my take on pregnancy with keto, and we align on so many pieces. It was really cool to have her on the show and talk about breastfeeding which is something that I know very little about, so it was really cool. Without further ado, let’s cut over to the interview. Hey Lily, how’s it going?
Lily Nichols: I’m doing well. How are you Leanne?
Leanne Vogel: I’m doing really well. I’m so happy to have you on the show. We have lots of questions and lots of details to go through, but before we get started, for listeners that may not be familiar with your work, why don’t you start off by telling us a little bit about yourself?
Lily Nichols: By trade I’m a registered dietician and certified diabetes educator. I think most people either know me from my blog, Pilates Nutritionist, or from my book Real Food for Gestational Diabetes. A lot of my work these days has been around prenatal nutrition and specifically gestational diabetes, the diabetes that is either first recognized or develops during pregnancy. After a lot of work in the field and seeing how the conventional gestational diabetes works, or maybe doesn’t work, in practice, I realized that a lot of women get the diagnosis of gestational diabetes. They try to follow the conventional diet advice, and sometimes their blood sugar goes up. A lot of times it just doesn’t get better.
That led me to question what’s up with our prenatal nutrition guidelines. Especially around pregnancy diabetes. I had to wonder, for every woman that I’d see who would try this diet and her blood sugar not get better the way that doctor’s prescribe it, is that they failed diet therapy. I was always left wondering did they fail diet therapy or did diet therapy fail them? A lot of my work has been around revamping our gestational diabetes guidelines. I developed my real food approach for managing gestational diabetes, which is the first advocate for a lower carbohydrate diet and a nutrient-dense real food diet during pregnancy that has really, really good results.
We have much fewer women requiring insulin and medication to manage their blood sugars. It’s managed naturally with food, and really good outcomes for babies, so a lot less of the negative side effects when they’re born. Like hypoglycemia and needing to go to the neonatal intensive care unit and stuff like that. That’s the gist of my work. I know today you wanted to talk a little more about low carb, and pregnancy, and ketosis, and all of the controversy that surrounds that. I’ll let you take it away.
Leanne Vogel: Yeah, and there’s a lot of it. Maybe starting even before one is pregnant. I know that a lot of women in our community have amenorrhea or issues with fertility. When you were looking at your gestational diabetes piece and looking at the nutrition for that, did you also look a little bit into fertility, and know a lot of women will say that their doctors have said that they’re post-menopausal in their 20’s?
Lily Nichols: Yeah.
Leanne Vogel: They’ll go on a ketogenic diet in order to boost fertility or a low carb diet in order to boost fertility. Have you seen that in your own practice?
Lily Nichols: Yes, I have. What’s interesting with menstrual cycles and fertility in general, is your fertility is highest is when your body is healthiest. When something’s not going well, a lot of times the body refuses to ovulate. Sometimes you don’t have a menstrual cycle to go along with it. For women who are overweight, or struggle in some sense with some degree of insulin resistance, I see a lot of benefits from reducing carbohydrate intake. It doesn’t necessarily have to be super, super low-carb, but reducing their carb intake, especially getting refined carbohydrates and sugars out of the diet, a lot of times insulin resistance improves. They lose a little bit of weight and lo and behold they get pregnant.
In fact, there are a lot of women that I would see in prenatal practice who maybe weren’t even trying to get pregnant or they thought they could never get pregnant. Then they’d come in and they’re like, “Gosh, I just lost 20 or 30 pounds in this past year doing low carb and I’m pregnant. I’m not ready to be pregnant.” It’s like your fertility goes up as your body gets healthy and your physiology starts regulating.
Leanne Vogel: I guess on the opposite side to that, I know in my case, I was actually underweight and I needed to gain quite a lot of weight to get my period back and to get over amenorrhea. Eating low-carb/high fat initially helped me lose a bunch of weight and helped me get my hormones back, but I still didn’t menstruate until I gained weight. It was an opposite way of doing things. You know, losing weight and then gaining some back in order to get my period. In my case, it was the fat that helped boost my cholesterol so that I could make hormones, and then gaining weight back. It’s kind of the opposite of that experience of…
Lily Nichols: You bring up a good point. There’s actually something called functional hypothalamic amenorrhea, which is probably what you had, which can be related to weight loss, or stress, or exercise related to lack of having your period. A lot of times there’s insufficient estrogen in your body, as opposed to the opposite case where maybe your estrogen levels are too high. Yeah, you’re right, it can go on either side of the spectrum for sure.
Leanne Vogel: If a woman is having difficulty conceiving, like some of the individuals you’ve spoken with I’m sure, how long would you recommend that they go on more of low-carb eating style? How long would they do a certain protocol?
Lily Nichols: Well, I think it depends on the woman. I would want to be looking at where her weight’s at, where her body fat is, what her activity levels are like, what her stress levels are like. Are there other underlying issues – potentially digestive, or adrenal, or thyroid issues? I would want to get all those things figured out, because there can be a variety of potential causes of fertility issues. I’d be looking at the big picture before automatically going low-carb. For example; If I had somebody who was very underweight, and not having their cycle, I probably wouldn’t have them go really low-carb. I’d probably have them go a little more moderate-carb, but still get plenty of healthy fats in their diet.
Whereas, somebody who maybe is starting out very overweight I’d be more inclined to go low carb. Oftentimes, it’s accompanied by insulin resistance and high blood sugar, which we need to get in line. Naturally, the body doesn’t want you to get pregnant usually when your blood sugar is elevated. It’s a known cause of birth defects. Especially in the first trimester. The first eight weeks of pregnancy is when all the organs are being formed, so the body’s pretty obsessive about trying to maintain normal blood sugar. If your blood sugar’s already high then you’re probably not going to be able to maintain a pregnancy early on. Again, I’d be looking at what is going on with the individual woman before giving a blanket recommendation.
Leanne Vogel: Yeah, and I had no idea about the blood sugar irregularities and holding pregnancy. That is really cool. I didn’t know that.
Lily Nichols: Yeah, it’s a big, big deal. Super high blood sugar is a known teratogen, something that causes birth defects, and can be just as harmful as taking the wrong medications in early pregnancy. It can lead to very severe birth defects, which is why a lot of times the miscarriage rate, especially early miscarriage rate, is very high in people who have unknown or uncontrolled diabetes or out of control blood sugars.
Leanne Vogel: Wow, that’s really interesting. I couldn’t agree with you more. I say that every time. It’s like, let’s get to the bottom of things. If you’re having issues with fertility, like you said, if it’s more of an underweight/over-exercise type of problem, you’re super stressed out, you’re probably going to want moderate carbohydrate, and still a bunch of fats. For those listening who are familiar with my program, “daily fat burner” is what she’s talking about. It’s that good combination of moderate carbohydrates and a good amount of fat. Then you’re saying for people with imbalanced blood sugar, and maybe body weight that’s not really set where they “should be” for their body, perhaps more of low carbohydrate thing. Which would, in my program, translate to a full “keto fat-fueled” profile, for those listening and are curious how that aligns. Let’s get into the meat of the conversation, and something I know very little about, is pregnancy. You spoke at the beginning at about gestational diabetes and the protocol that you’ve come up with from that. I’m assuming that that protocol spans further than just gestational diabetes. Is that fair?
Lily Nichols: Meaning that it can benefit women who don’t have diabetes…
Leanne Vogel: Exactly.
Lily Nichols: …in pregnancy. Yes, absolutely.
Leanne Vogel: What does that look like? Which trimester is it best to switch over, how do you know, is it safe to switch over to this eating style where you’re eating less carbohydrates when you’re pregnant?
Lily Nichols: I like these questions. I like these questions specifically because when I wrote my book on gestational diabetes most women are diagnosed in the second half of their pregnancy, not at the beginning. Although that’s changing thankfully. We should be screening women earlier, but that’s a whole other conversation. My book is from the standpoint that you’ve already been diagnosed with high blood sugar and this is what you need to do, right? In early pregnancy, if somebody’s been following low-carb and then they get pregnant and then they’re wondering, “Can I continue to eat low-carb during my pregnancy?” it’s a very good question. We have less clear information on first trimester – what’s ideal and what’s not – than we do for later pregnancy. If I can leave you with anything, a lot of women, myself included, (I just had a baby last year so I can relate to the challenges of early pregnancy) the first trimester is very challenging. There are a ton of hormonal shifts. You often times have food aversions or nausea or vomiting, or what people classically call “morning sickness”. I don’t even know why it’s called morning sickness, because…
Leanne Vogel: It happens all day.
Lily Nichols: For a lot of people it’s not a thing like you wake up in the morning and you’re sick for a little while, and then you’re all good. A lot of times it can last all day or come at different times of day. A lot of times you don’t feel as good eating low-carb. I myself was very curious to see how my body would respond when I was pregnant and how I’d feel, because I thrive on a moderately low-carb diet and have for a long time. I was very curious, went into it open-minded like, “Okay, I know there can be benefits to low-carb in later pregnancy, but what is it like early on?”
I found that my body actually wanted a little more carbohydrates when I was feeling the morning sickness or the nausea coming on. You want things that digest quickly and leave your stomach quickly, so if you do have to throw up you aren’t throwing up a whole meal. You know what I mean? For a lot of people, that ends up being eating a little more starchy foods. I don’t think everybody needs to go, or stay low-carb in the first trimester. I think it’s really important to still attempt to get some protein and fat in your world. I found that I didn’t feel good staying really strict. I think there’s some women who still do. From a metabolic standpoint is it ideal to remain low-carb? Not necessarily.
In early pregnancy, your insulin levels are increasing. Your pancreas actually gets larger during pregnancy, and by the 10th week of pregnancy your body is producing three to three-and-a-half times more insulin than it is outside of pregnancy. It’s doing this to gear up for later pregnancy where insulin resistance goes up like crazy. Women are 50 to 70% more insulin resistant in the second half of pregnancy. In the early part, you have a lot more insulin on board, no more insulin resistance that you came into pregnancy with. You can decide, depending on how insulin resistant you were before, how well you’ve done on low-carb, where your blood sugar levels are at, whether or not you want to stay low-carb for that time period. There’s less of a need for it, I guess is what I want to say, in early pregnancy.
Whereas in later pregnancy, your insulin resistance is so high that a lot of times that’s when we start seeing the blood sugar go up a little more. Sometimes women have less wiggle room for carbohydrates the further along they go in pregnancy, oddly enough. Oftentimes your food aversions aren’t as bad at that point. Personally, I found that I felt better eating low-carb towards the end of my pregnancy, where early on I felt good having a little bit of potatoes and stuff like that. That was an interesting observation for me personally, but also the metabolic information, I think, is new for a lot of women.
Leanne Vogel: I had no idea that our insulin bumped up that much in the first…
Lily Nichols: Yeah, it’s huge.
Leanne Vogel: Wow. Well, that even in and of itself tells you maybe carbs are a good thing to have during this time. Whereas that second half not so much.
Lily Nichols: Exactly. I hear so many women beating themselves up trying to eat low carb, but they feel terrible. It’s like, listen, of any metabolic thing that we don’t know a lot about, pregnancy tops the list. There are things that are changing on a weekly, day-to-day…sometimes there’s huge shifts going on. We don’t have this completely, perfectly mapped out, in literature when certain changes are happening, and why, and what nutrients we need. We have pieces of the puzzle. I’m obsessed with digging up those pieces and making sense of all of it. There’s a certain mystery to it all.
I think at the end of the day, we have to do a lot more mindful eating in pregnancy than prescriptive eating. Since there are differences from women to women, at the end of the day, I have to fall back on, “How do you feel, what’s going on this week, what can you do with your food to keep yourself feeling well?” You can go overboard on the carbs early in pregnancy too. I’ve heard women just give up, eat whatever, and then halfway through the pregnancy they’ve already exceeded their weight gain goals for the whole pregnancy. They feel terrible, and their blood pressure’s high, and all this stuff is going on. We have to find a middle ground between eating well and also keeping yourself in good shape and listening to your body.
Leanne Vogel: Yeah, and to go back to the feeling terrible. I can understand, and I’m sure that there are a lot of women listening that are maybe thinking about being pregnant and they’re like, “What if I just crave carbs every day? I love being ketogenic, and I love being low-carb.” How does one deal with that feeling, like you said, of just letting it go, listening to your body, knowing that in a lot of cases it’s not like keto is gone forever. It’s not like low-carb is gone forever, but if what’s standing between you and another day of morning sickness is having a sweet potato with dinner why wouldn’t you just do that to avoid that feeling?
Lily Nichols: Right.
Leanne Vogel: Do you have any tips or strategies or thoughts on how one would go about being okay with putting that behind them?
Lily Nichols: Yeah. A lot of times I think it’s more than just having a sweet potato with dinner. It’s like, “I can’t eat dinner and if I eat this low-carb thing I’m going to be sick. The only thing I can eat is some of these roasted sweet potatoes.” It’s like, by all means, eat some roasted sweet potatoes my friend. Don’t starve yourself for the sake of being compliant with low-carb, or whatever. I feel like pregnancy is such a chance to surrender. It’s a good preparation for motherhood. As a mom of a child less than a year old there are so many … what’s the word I want to use? You make so many amends being a mom. You have to get less serious about yourself. There’s going to be so much that’s out of your control. All you can do is do the best that you can at the time.
Honestly, I didn’t have morning sickness or nausea as bad as some people I know, but there were days when it was like, okay I’m feeling so ill and tired. Your body is just rapidly producing all of these cells for this growing being. Your hormone levels are all crazy. There’s so many things going on that you just need to do what you can to get through the day. What I did, was I attempted to eat as whole foods as possible. I chose not to keep junk food in the house minus salt and vinegar chips. I will say salt and vinegar chips were my saving grace some days. Early on there’s something about starchy, salty, and sour that really helped with my nausea. That was just me. I don’t know, everybody has their thing. I kept good quality, good ingredient, salt and vinegar chips in the house.
I tried not to let candy – beyond dark chocolate – and a bunch of other junk in there so I wouldn’t be tempted to eat those foods. I tried to eat whole foods, meaning the carbs that I was having were coming mainly from things like sweet potatoes or fruit, or yogurt. Dairy products for some reason tasted really good to me in the early part. I think there’s a lot of potential reasons for that. They tend to be a pretty good source of iodine for people who don’t eat a lot of seafood. Which is really important for your thyroid which is going through major changes early on, and also important for fetal brain development. That may be a reason why so many women crave dairy products.
As long as you’re getting good quality carbohydrates in your world then you’re also getting all the other micronutrients that come with it. That was one way that I made peace with it, but I was also open to the possibility that later in the pregnancy I might feel better eating less carbs again. Sure enough, I did. I just naturally felt like, oh wow, I want to eat more vegetables again. Meats and fish and eggs taste good to me again. I could tolerate more than a couple bites here and there. Just be open to things shifting. Whatever you’re doing right now, just to get through the day, it might not be that way tomorrow, or next week, or next month.
Leanne Vogel: That’s really good advice, really good advice. The fact that it shadows your experience pregnant and going through all that really shadows your experience with being a mom and setting you up for all the changes to come, so that’s really neat.
Lily Nichols: I will say one thing though it’s super, super helpful to have a taste for healthy food going into pregnancy. Sometimes early on, you’re relying on your nutrient stores. Some days you’re not eating the best. In the back of my mind I’m thinking, “I need to be eating my eggs for the choline, and I need to be having salmon for the Omega 3s, and it’s just not happening.” I’m like, well, this is why I was eating so well for all these months or years prior to getting pregnant. We do have nutrient stores on board. Sometimes you have to have faith in that. Have faith in the system working, and have faith in the fact that so many women have had healthy babies despite having morning sickness, or even worse like Hyperemesis gravidarum where you’re very, very, very ill. It’s like, okay I know this has worked in the past. I have to trust the system. I have to trust that I have nutrient stores on board that are going to supply this baby for the time being. I will eventually get back to eating well.
Leanne Vogel: I’m really glad you mentioned that, because I think that what I’ve seen in my practice is a lot of people who will be like, “Well, I’m planning to be pregnant, so I’ll just eat whatever. Then I’ll have the baby and then I’ll care about what I’m eating.”
Lily Nichols: Oh my gosh.
Leanne Vogel: Do you see that as well?
Lily Nichols: Yes, and I’m telling you you’re probably not going to magically switch to being a vegetable lover while you’re pregnant, nor is there any chance you’re going to want to, or be able to, continue that postpartum when you have zero time to yourself, and zero time to cook. The time to eat healthy is now. Get it in your bones. Learn to make vegetables taste good. Learn to cook, learn to enjoy healthy foods, and then you’ll figure out how to make it work during and after pregnancy. I think it would be exponentially harder to go into pregnancy not being a healthy eater and then try to convince yourself to eat vegetables. It’s hard to eat enough vegetables at certain points in pregnancy. For me at least, once the nausea and food aversions let up a little bit, I was able to go back to eating pretty healthy, but that early part was no chance.
Leanne Vogel: Yeah, totally. More on my interview with Lily Nichols after this message from one of our podcast partners.
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Leanne Vogel: It sounds like whatever food you can surround yourself with in your house is definitely better, but really being open to the fact that your diet may change during that first half of your pregnancy once you get over that hump. I know there’s been a lot of questions of how low-carb can you go in a pregnancy? Is it safe, is it not safe? Do I need carbohydrates to make my baby grow? How would you answer that question?
Lily Nichols: Yes. Okay, so complicated question. What you’ll hear from a lot of people is that you need carbohydrates for a healthy baby. You need a minimum, this is the conventional recommendations, of 175 grams of carbs in the latter half of pregnancy. What I found in my research was really interesting. Nobody could tell me where that 175 gram number came from. I finally dug it up from the institute of medicine report on macronutrients, which is a 1,300 plus page document, so it took a lot of digging. They assume that there’s an estimated average requirement for non-pregnant women of about 100 grams of carbohydrates. Then they add additional carbohydrates to account for the increase calorie needs of pregnancy, which is estimated to be 300 calories.
They assume you need 45% of your calories coming from carbohydrates, so that gives you an additional 35 grams. Then we know there’s some carbohydrates, or rather there’s some glucose that’s required for the fetal brain every day, which is approximately 33 grams. Some estimates are less. You would add this all together and that gives you, with a little bit of a buffer, about 175 grams per day. What’s very interesting, and as you know, being somebody who’s done a lot of research on low-carb, this estimated average requirement of 100 grams of carbohydrates per day is kind of bunk, because…
Leanne Vogel: Yeah, no. Right.
Lily Nichols: In the same document, they say the lower limit of dietary carbohydrate compatible with life is apparently zero provided that adequate amounts of protein and fat are consumed. Our bodies are really metabolically efficient. If there are not a lot of carbohydrates coming in we can actually make glucose for our body from fat and protein if you’re getting enough calories. The same thing is true in pregnancy. In pregnancy, your body actually tends to favor a state of ketosis, especially in the second half of pregnancy. It becomes very efficient and always supplying the baby with some form of nutrition. Given that the baby’s brain development actually relies on a certain amount of ketones, about 30% of fetal brain energy comes directly from ketones, your body relies on a mix of both glucose and ketones.
When it comes to how low you can go in carbohydrates, I think you can go as low in carbohydrates as you are still able to get enough micronutrients, enough essential fatty acids, enough amino acids which are separate from carbohydrates, enough vitamins and minerals which may be coming from your carbohydrate foods, enough antioxidants potentially. I think as long as you’re planning a diet that contains enough of those for a pregnancy than you can cater your carbohydrate level to that. I think the lower carb you go sometimes your sources of other nutrients might be a little more limited, unless you’re eating a lot of non-starchy vegetables, which still are going to give you carbohydrates by the way.
Leanne Vogel: Totally. I love that. Eat as low-carb as you can without it affecting your intake of essential nutrients. That’s always been my approach. Well, after I totally failed on keto the first time and I lost a ton of weight, but I felt like absolute garbage, I was like wait a minute I’m counting my spinach and that’s not cool. I love that approach. To step back a little bit, you were talking about how the developing brain of your child needs a bit of glucose in order to function and continue to grow. Do you know, or have you seen, research that baby can be provided with the glucose it needs from the mom through gluconeogenesis, the creation of glucose? Like you were saying through the protein or the fat. Have you seen that that’s enough to supply to the baby?
Lily Nichols: Yeah, that’s actually a good question. That’s one thing that is left unclear in that Institute of Medicine thing. There’s this need for glucose, but it doesn’t say whether it’s exogenous or endogenous, right? What’s interesting with pregnancy is women become about 30% more efficient at creating glucose from alternate fuels, in other words gluconeogenesis, in the later stages of pregnancy. Combined with your body naturally goes into ketosis very easily in later pregnancy. Even if you have a more moderate carbohydrate intake. They’ve looked at women after a 12 to 18 hour fast, pregnant nondiabetic women, and compared to their ketone levels to nonpregnant women and their ketone levels are about three-fold higher. You very easily slip into ketosis in pregnancy. It’s just a fact of life. It’s not bad.
Leanne Vogel: That is so cool.Lily Nichols: Humans have lived over thousands of years and periods of starvation and famine, which may not be ideal, but if every time you weren’t able to eat for … If you had to go 12 to 18 hours or maybe a day or day-and-a-half without having a significant amount of food, if that caused you to miscarry we wouldn’t be as populated on this planet as we are. Let’s put it that way. Our body has very specific metabolic mechanisms in there, like fail-safes in there, to make sure that baby still gets nutrients. Your body’s just very efficient at shunting nutrients from your body to the baby. There’s a reason you get a little pudgy in the first part of pregnancy. Everyone’s like, oh my God I already feel fat, and bloated, and whatever. It’s like your body is specifically putting on some fat in early pregnancy, because it is expecting in late pregnancy to break it down and send that fuel to the baby, which it does. A lot of times you feel in a way leaner…
Leanne Vogel: Leaned out.
Lily Nichols: …at the end.
Leanne Vogel: Yeah, I noticed that.
Lily Nichols: You’re bigger, but you’re leaner. It’s hard to explain. Where early on you just feel puffy…
Leanne Vogel: Puffy.
Lily Nichols: …and pudgy. That’s by design. That is nature doing its thing the way it is supposed to. I guess to answer your question, we don’t know for sure if the glucose is required to be from outside sources or from inside the body. What’s the number I gave you, 33 grams?
Leanne Vogel: 33, yeah.
Lily Nichols: I don’t think you could eat less than 33 grams of carbohydrates in a day and still supply your body with enough micronutrients for the baby. If you truly track your food in MyFitnessPal or whatever, you’re going to be getting a couple grams of carbs from those nuts, and you’re going to be getting a couple grams of carbs from that spinach and a couple grams of carbs from that cabbage. It adds up. If we’re talking bread carbohydrates, certainly you can survive without 33 grams of bread carbohydrates. When we’re looking at your diet in total I think yeah, you’re probably going to need at least that or more just to get enough of your micronutrients for you and the baby.
Leanne Vogel: That’s so cool. I want to rewind just a touch when you were talking about fasting and pregnant women with that study. More on my interview with Lily Nichols after this message from one of our podcast partners.
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Leanne Vogel: Now, there are a lot of people in the ketogenic community that intermittent fast. What are your thoughts on fasting when you’re pregnant?
Lily Nichols: I don’t think it’s a good idea. You will probably find, for anyone who’s listening who is thinking about pregnancy or is already pregnant, you’ll probably find that you are hungry and consistently hungry while you’re pregnant. A 12-hour fast might be the amount of time you go from going to bed and waking up in the morning, but you’re hungry in pregnancy. A lot of times, especially in late pregnancy, when you have this baby that’s pushing up on your stomach and maybe kicking your stomach, you can’t eat large amounts of food at once. A lot of times, pregnant women end up grazing throughout the day. You’re probably grazing in early pregnancy if you’re feeling nauseous and you’re probably going to continue to graze in later pregnancy when there’s no room in your stomach. There’s no room for a giant meal.
I would not encourage intermittent fasting. A lot of your nutrient needs are higher in pregnancy. Yet sometimes you have less room in your belly for the bulky foods that are going to give you those nutrients. I don’t think there’s any need to fast. I think if you listen to your body, most women are probably going to feel well not fasting. If you happen to be one of those women who feels best eating a lower carb diet you may find that you can go longer between meals without feeling ravenously hungry, and maybe you’re not a snacker. That’s totally fine, but I think for the majority of women you’re going to end up wanting to eat relatively frequently.
Leanne Vogel: Yeah, and I love how that’s tied together. The reason I ask that question is because I know that there are women out there, and I was one of them, if I were pregnant two years ago, I would have totally asked this question. What about fasting? I just heard that ketones are really good for the baby, so if I fast I’m going to create even more ketones and that’s even better, so I wanted to ask you that question.
Lily Nichols: Yeah, no.
Leanne Vogel: You were saying the body can switch over to ketosis quite easily in pregnancy, so don’t sweat the ketones. Just eat when you’re hungry. It’s what I’m hearing from you…
Lily Nichols: Yes, absolutely.
Leanne Vogel: …and you will create them naturally.
Lily Nichols: Yes.
Leanne Vogel: Don’t sweat it.
Lily Nichols: Yes. I don’t think we need to be focused on trying to produce more ketones in pregnancy. Your body will naturally do it. Your body will naturally excrete them unless you are somebody with Type I or Type II diabetes who is entirely dependent on insulin to keep your blood sugar under control. They’ll naturally stay at a safe level in those people who are Type I or Type II diabetic. Take the amount of insulin you need to keep your blood sugar under control, so you don’t go into a dangerous state of diabetic ketoacidosis. By the way, I have to say that.
Leanne Vogel: Yup, totally.
Lily Nichols: As a certified diabetes educator, but for anyone who doesn’t even have to think about insulin and even in women who have gestational diabetes, your ketone levels are probably going to be just fine as long as you’re eating enough food in general.
Leanne Vogel: Cool. Let’s switch over to breastfeeding. I don’t even know what to ask you, because I don’t even understand.
Lily Nichols: Breastfeeding is a crazy, crazy thing I tell ya’.
Leanne Vogel: Right? I know some of my girlfriends have had issues with breastfeeding. Then I tell them to eat a ton more fat. Load on the fat, and all of a sudden there’s tons of milk. It’s crazy. What have you seen and what have you experienced with breastfeeding, and how your nutrients play in line with all of that?
Lily Nichols: What’s interesting about breastfeeding, so you think pregnancy is crazy. You’re growing a whole new human being. Breast feeding is even crazier. With pregnancy, you don’t really need to think about it. You don’t need to consciously do anything when baby’s growing, but then you have a baby. It’s like, “Crap I’m the one who decides when to put the baby to breast, and how long they’re at the breast, and when to switch them from one boob to the other. Oh my gosh when is my milk going to come in? This feels funny. This hurts.” It’s just so complicated, but the crazy thing about pregnancy is there’s still debate about how much extra energy we need during pregnancy, how many extra calories you need.
Breastfeeding, it’s pretty cut and dry. You need extra energy. Most people agree about 500 calories additional per day. You need a lot of extra energy to produce breast milk. It’s just crazy and your body is not dumb. You will probably be ravenously hungry for food postpartum. The nice thing is, for women who have eaten pretty well in their pregnancy, particularly the ones who follow my real food approach, a lot of times they haven’t gained a bunch of additional weight, so they’re not as worried about, “I need to lose the baby weight right away.” A lot of times they’ll lose it with relative ease and they probably will have not exceeded their weight gain recommendations. Early postpartum I think women should focus entirely on listening to their hunger cues. Remember to eat because it’s hard to remember to eat when you’re caring for a newborn. Eating plenty of fat if your body is craving it. Eat more carbohydrates too. That is also totally fine. You’re probably just going to need to eat a lot more food in general.
Breastfeeding is draining and you also need to replenish all the … you know you just ran a marathon giving birth. You need to replenish after that gigantic race. I think for a lot of women they need to ease up on being worried about what macronutrients goals they need to hit, and what calorie goals they need to hit postpartum, and just take it easy, try to take care of yourself. Put the baby at the breast often. Nurse, nurse, nurse, nurse, nurse. Drink a ton of water. Worry about the carb thing later on. I think what happens when some women who immediately go to low-carb, is going low-carb naturally helps reduce your hunger levels. Maybe they’re just trying to stick to their macros so specifically that they’re denying themselves food, but if you don’t have enough energy in general from any source, from all sources coming in, meaning fat, protein and carbohydrates, your milk supply’s going to suffer.
The first six, eight weeks or so, your milk supply is hormonally regulated. After that it becomes much more of a supply and demand situation. If you don’t get your milk supply and keep the baby at the breast often in those early weeks and you’re just focused on losing weight, losing weight, losing weight you might dry up early. Which is really unfortunate if your goals are to breastfeed for longer than a couple months. I think early on, women should just let go of the obsession with losing the weight and getting your body back. Your body is different and that is okay. Things are going to be shifting for, gosh, the next year. It’s still crazy how my body is changing. Just focus on caring for and feeding your baby however you’re choosing to do that.
Leanne Vogel: Breastfeeding can also help you lose weight right? I can’t remember what the contractions are called, but there’s some sort of contraction that happens that helps encourage something.
Lily Nichols: Well, it helps the uterus contract. Breast feeding stimulates the release of oxytocin which contracts the uterus, so it shrinks back down to normal. The main reason that it could help with losing weight is that it uses energy. You’re burning an additional 500 calories per day just feeding you baby.
Leanne Vogel: Instead of forcing yourself to go back to the gym quickly just breastfeed more and you’ll get to be closer with your baby, and basically get to do the same thing without sweating and being at a smelly gym.
Lily Nichols: Yes. Take your time, take your time getting back to the gym. Especially got to heal up that pelvic floor that just went through pregnancy and birth. Take it easy with the exercise for a while. Take it easy with getting obsessed about weight loss and carbs. I think later on, once your milk supply’s established, I think women can go back to eating a little bit lower carb and feel fine, but it’s pretty variable what level’s going to work for one woman to another. If anything, if you are going to attempt to go low carb, really make sure you’re eating enough. Do not go on a low calorie any kind of plan, whether that’s low-carb or not low-carb. You need that energy for your milk. Like you said, you absolutely need the fat too big time.
Leanne Vogel: Yeah, it’s a game changer for so many of my girlfriends. It’s like, “Here’s some coconut butter, here’s how to make a really high fat smoothy, enjoy.” What was your go-to high fat thing that you liked when you first started breastfeeding? You have no time, you’re exhausted what was your go to thing?
Lily Nichols: Oh gosh. I remember my husband made me breakfast and I laughed. It was two days postpartum, he makes me breakfast, and brings it to me. It was a breakfast that I would have eaten during pregnancy. I just laughed. I was like, “I’m going to need triple the amount of food. Thank you very much. Just for future reference.” I felt like the first month I was pounding the food. I did lots of eggs, bacon, avocado, lots of vegetables roasted in coconut oil or bacon fat or whatever. Personally, I felt better eating a little more fruit which sounds funny, but smoothies were really easy, so some frozen berries and for me half a banana, coconut milk, collagen powder.
I went pretty hard core on fatty foods and eating a lot of food. Meatloaf was delicious to me. We put ground liver in our meatloaf to really up the nutrient density, the vitamins. You need a lot more nutrients when you’re breastfeeding. Even more than pregnancy and a lot of people don’t know this. Lots of choline which is good for baby’s brain development in liver and egg yolks. I did a lot of those foods as well. Whatever it is, just eat.
Leanne Vogel: Just eat.
Lily Nichols: Ideally have somebody help prep the food. We had some friends that brought us meals and stuff. You’re likely not going to have more than five minutes to yourself for several months and you need help. You need help cooking, you need help cleaning, you need help with people bringing you food and water while you’re sitting there nursing the baby. Whatever help you can get take it.
Leanne Vogel: Take it. Take it. Yes please. Well, thank you so much for being on the show today, Lily. I really enjoyed chatting with you. I know that I learned a whole bunch, and I know that your message will hit home for a lot of women either looking to be pregnant, or pregnant right now, or breastfeeding. I really appreciate you being on the show today.
Lily Nichols: Thank you for having me. I hope it was helpful.
Leanne Vogel: You bet. The show notes and full transcript for today’s episode can be found at Healthfulpursuit.com/podcast/21. That does it for another episode of the Keto Diet Podcast. Thanks for listening in. You can follow me on Instagram by searching Healthful Pursuit where you’ll find daily keto eats and other fun things, and check out all of my keto supportive programs, bundles, guides, and other cool things over at Healthfulpursuit.com/shop and I’ll see you next Sunday. Bye.
This entry was tagged: eating high-fat, eating keto, eating low-carb, fat-adapted, how eat keto, keto basics, keto diet, keto for women, keto life, ketogenic diet, ketogenic for women, ketosis, low-carb paleo, what is keto
HI! I’M LEANNE
Nutrition educator + keto enthusiast. I want to live in a world where every woman loves her body, nourishing fats are enjoyed at every meal, and the word “restriction” isn’t in the dictionary.