Motherhood is all consuming.

Having babies, nursing, feeling the fear of loving someone that much, and there's this baby on your chest, and boom, your entire life has changed.

It's a privilege of being your child's safest space and watching your heart walk around outside of your body.

The truth is, I can be having the best time being a mom one minute.

And then the next, I'm questioning all my life choices.

I'm Lo Mansfield, your host of the Lo and Behold podcast, mama of four Littles, former labor and postpartum RN, CLC, and your new best friend in the messy middle space of all the choices you are making in pregnancy, birth, and motherhood.

If there is one thing I know after years of delivering babies at the bedside and then having, and now raising those four of my own, it is that there is no such thing as a best way to do any of this.

And we're leaning into that truth here with the mix of real life and what the textbook says, expert Insights and practical applications.

Each week we're making our way towards stories that we participate in, stories that we are honest about, and stories that are ours.

This is the lo and behold podcast.

I have to be honest with you, I sought out today's podcast guests who talk about a specific postpartum topic, and then we ended up not getting into it today because I was loving the conversation that we were having and I didn't wanna divert.

So when.

I have this guest come back 'cause I'm going to, you'll wanna tune in for that conversation as well.

Lily Nichols is here with me today.

She is a registered dietician nutritionist, a certified diabetes educator, researcher, and author with a passion for evidence-based nutrition.

Her work is known for being research.

Thorough and very sensible, which I can affirm from the books that I've read.

She is the founder of the Institute of Prenatal Nutrition, co-founder of the Women's Health Nutrition Academy, and the author of three books.

She has Real Food for Fertility, which was co-authored with Lisa Hendrickson Jack.

She has real food for pregnancy and then she has real food for gestational diabetes.

These bestselling books, they have helped 10 thousands of mamas and babies.

They're used in university level maternal nutrition and midwifery courses, and she has even influenced prenatal nutrition policy internationally, which I think is so cool.

When Lily does step away from writing, you can find her spending time with her husband and her two children, most likely outside or in the kitchen.

We will talk about that in today's episode.

So let's get into this combo with Lily.

Lily, thank you so much for being here with me today.

Why don't you go ahead and introduce yourself or share kind of who you are with us and then we'll just kind of get into our conversation.

Yeah, sure thing.

So first of all, thank you for having me.

I'm a registered dietician nutritionist.

Diabetes educator and I focus on women's health through the lifespan.

So preconception and fertility through pregnancy, pregnancy complications like gestational diabetes as well as postpartum and breastfeeding.

So I think a lot of people know my work for being, you know, research focused.

Mm-hmm.

And looking at, you know, where are the gaps in our current guidelines.

Because they, they missed the mark in many ways.

Yeah.

And like, what can we learn from the more recent research that's out there?

So I'm just trying to bridge that gap.

There's about a 17 year gap between new research, making it into Wow.

Guidelines and policies.

And so, we, you know, I try to help to, to shorten that lag time.

So we actually are, you know, getting women proper information for optimal nutrition and optimal development for their babies.

Yeah.

Rather than like, you know, letting about 20 years go by before that information hits the mainstream.

Is that 17 year, 20 year thing you're talking about, is that kind of a universally true thing for any research to policy?

Or is that more just nutrition, you're saying that's not specific to policy?

I mean, I'm assuming it's everything.

There's, there's

literally a research paper that's like, what is the gap between, you know, research and.

Clinical practice, I think is what it's called, and they looked at this like huge body of evidence and found that on average it was about 17 years between new information coming out and it actually being incorporated into practice.

You could argue that for public policy, there's even a longer.

Gap in that 17 years, like oftentimes for policies to change, there has to be an uprising of clinicians who are pushing for this change because they're using this information and getting better clinical outcomes.

Mm-hmm.

And then that pushes like the policy.

You know, o over the line to a, to a new, new way of approaching it.

So yeah, 17 years I think is conservative.

Yeah.

Well, I mean, I'm listening going.

I bet the birth world is the same.

That's why I was wondering if that's a universal kind of truth, if you could say that.

Because I feel similar when we're talking about birth stuff and when I'm teaching about birth stuff is there's so often like this is what the policy is.

But this is literally the more recent evidence and things that show that the policy like shouldn't be that way.

But it takes, well, it feels like decades if ever, sometimes for some of those birth policies to catch up to what is very clearly in the research, like right in front of us.

So that doesn't surprise me, but I've never heard that actual number of that, you know, two decades they sort of catch up.

So anyway.

That's why people like you are bridging the gap.

Okay, so I brought you on and I told you before we started, there are some different little things that I want you to talk to us about because I just think it's stuff that is being.

Kind of like misinformation out there in pregnancy or stuff that's lacking in pregnancy or postpartum about nutrition.

But I wanted to kind of start with just like a very fundamental, if you could make some really simple recommendations for all of us to follow, like.

We find out we're pregnant and you say, okay, I want you to start drinking 10 glasses of water and eat six eggs, or whatever.

But if you have some kind of really general stuff for the people who are like, I'm so overwhelmed already, because here comes all this, this is what you should be doing now that you're growing a baby.

And really, I know preconception might be a separate conversation too, but what, where do you start with someone who's feeling that overwhelm but is like, alright, I wanna make sure I'm checking some boxes here.

That's a great question.

And my response or guidance may be different based on what sort of symptoms that women may be presenting with.

Right?

So somebody who's coming in and they're, you know, seven weeks pregnant and like the nauseas started to set in, right.

You know, there's like, we can paint this optimal picture for like nutrient intake.

But that would be unfeasible when you're in the throes of Exactly.

Of nausea and food aversions that are so common in the first trimester.

So it depends on, on when I'm catching somebody and what's going on.

Mm-hmm.

So speaking from like an optimal perspective, like we wanna make sure mom and baby are getting optimal nutrition and we're just going to ignore the nausea part of the equation for right now.

One of the things I would first focus on is getting an optimal amount of protein.

Mm-hmm.

And your protein needs will shift at different phases of pregnancy.

Technically, early on in the first trimester, your protein needs may not be all that much different than preconception, but as you get further along, those needs will increase.

So trying to hit a minimum of about 80 grams of protein per day in the first trimester is a good goal.

And that may be a bit more challenging.

Mm-hmm.

If you're having nausea, and that amount of protein may vary based on your body size.

So somebody who's very small, they're like, you know, five.

Five feet tall and, and a hundred pounds or something.

Mm-hmm.

They won't need as much protein as a woman who's like five 11 and also like a powerlifter who's mm-hmm.

You know, has a lot of muscle repair that needs to happen.

Right.

So there's, there's room to adjust that up or down.

But as a general rule, about 80 grams is like a good, good starting point.

And so that may look like trying to get.

20 or so grams of protein per meal, 25 grams of protein per meal, plus the additional that might come in with snacks.

And I'm, I'm harping on the protein first and foremost.

Mm-hmm.

Because your protein rich foods are often your most nutrient dense foods.

Right.

So a lot of like the key micronutrients that we're thinking about for your health and baby's development and pregnancy.

They are found in those foods.

So things like vitamin B12 and iron and zinc and choline and vitamin A, these are all found in especially your protein rich animal foods.

So that's really helpful to like set a standard for that because you're kind of like checking a lot of boxes at the same time.

Mm-hmm.

And then I would say in addition to that.

As much variety of whole plant foods as possible.

So yes, your fruits and vegetables, but also your legumes, maybe whole grains, if those agree with your system.

These will provide you with a lot of other complimentary nutrients that might not be in the animal foods.

Plus fiber, which is helpful for gut health and healthy microbiome, which you also pass on to your baby.

Mm-hmm.

And some other key micronutrients like vitamin C is, is highest in plant foods relative to animal foods.

So a good like balance, just focusing on whole foods as much as possible, especially when you're getting that protein in.

It often helps you achieve satiety after meals instead of.

Being instantly hungry after that meal ends.

So you can experiment with this a little bit yourself.

Like say you have a, a breakfast, that's.

Just like oatmeal and a banana.

So essentially all carbs.

Compare that to a morning when you have some eggs at your breakfast, and how do you feel in the hours after that meal?

On one meal, you're gonna feel ravenous pretty soon after the meal because your body didn't really get a lot of protein and fat.

It digests relatively quickly.

You get a blood sugar spike and crash and the other meal, you're gonna feel much more.

Satiated for a longer period of time.

So you can play around with this, you know, sort of macronutrient balance, on your own.

But it's, it's nice when you hit that satiety point by getting enough protein, because naturally you'll find that your cravings for processed foods and, you know, the less healthy things in our, in our world, decline dramatically because you're.

Blood sugar is more stable and therefore your hunger, fullness cues are, are, you

know, on point.

Right.

Okay.

Thank you for that.

I'm listening to it thinking I am a mom of four, so I have the classic baby cliche sometimes of like, I can't make myself like a three egg breakfast or whatever every morning.

So where do you insert like supplements or what if I use protein powders and things like that to kind of hit some of the like 80 grams of protein and I'm five 10, so I would need probably like upper limits.

Not a weightlifter, but probably need more than, you know, the woman who's five foot that we're talking about.

And I like protein for me pregnant or not, is always.

Feels hard for me to get that much.

So to me, I'm like, oh, I can take a protein powder, I can eat protein bars, things like that to help me.

Where or how do you like to kind of insert some of that kind of supplementation in to help people hit some of the ideal goals?

Whatever they are for them when it comes to Yeah.

Preconception pregnancy, wherever we're at in this part of the story.

Yeah.

So.

Especially as you get to like the latter parts of pregnancy.

Mm-hmm.

Where protein needs are a lot higher, and by the way, in postpartum they're even higher.

Mm-hmm.

Early postpartum, when you're exclusively breastfeeding, they're even higher than third trimester of p.

Crazy.

That's crazy.

That's like fairly, fairly new research that has come out.

Okay.

So.

I would say try to get as, as much of your protein through Whole Foods as you can, because you're not just getting the protein, but you're also getting the micronutrients that are mm-hmm.

In there as well.

So the vitamins and minerals, you're also getting it packaged with the appropriate ratio of fat.

Right.

Most of our protein rich foods have fat.

The eggs have a yolk.

The dairy, if you're not taking it out, has.

Dairy fat with it.

The cream, your steak has, you know, streaks of fat on it, your chicken skin, all of it has some fat with it, which also plays a role in the micronutrient intake for fat-soluble vitamins, A, D, E, and K.

And also helps with the satiety factor.

So I do like to get as much from food as possible.

I'm not antis supplementation by any means.

I have protein powders on hand in my own house.

And sometimes there's mornings where something like a. Smoothie with protein powder is, is the easier ticket.

Or maybe you're making some sort of a baked good or pancakes for the kids or something and, and you can add protein powder to that and, and boost their intake.

We probably both know that getting protein in kids sometimes because Not easy too, so, yeah.

But I look forward to protein powder.

And this especially applies to pregnancy and breastfeeding where.

You know, you don't want a bunch of additives that maybe are, you're, you know, it's a protein powder that has added vitamins and minerals.

Mm-hmm.

Well, if you're already taking a prenatal, you might not want or need the extra.

Maybe it has like some herbs in it that haven't been studied sufficiently for pregnancy or breastfeeding.

Maybe there's caffeine added to it, which you wouldn't wanna overdo.

So just get a clean protein supplement that doesn't have.

Anything else in it, like I like a pure protein, I might get one that has, you know, a chocolate or vanilla flavor.

Yeah, that's fine.

And maybe some sort of sweetener.

That's, that's not questionable.

So like check the sugar content.

Some of them have a ton of sugar check whether it has artificial sweeteners.

Those are not my favorite, but I'm okay with things like stevia or monk fruit, or.

Erythritol or mm-hmm.

Even, even allulose, it's a bit understudied in pregnancy, but the, you know, the data we have on lab animals is pretty reassuring.

Mm-hmm.

I would go for those sweeteners versus like an aspartame or a sucralose sweetened mm-hmm.

One, and I do like, you know, a, a protein powder that's a complete protein, so those would be animal sourced protein powders like.

A grass fed beef protein isolate, or a grass fed whey protein.

And even an egg white protein.

If, if you're averse to having beef, that can be an option, although it's not a complete protein.

I also like collagen.

As long as you're eating other sources of protein, you're gonna fill the gap on the one little amino acid tryptophan that's not found in collagen.

Okay.

So collagen protein is also also a great choice.

And I would just keep it to like maybe one or two servings per day.

So again, it's like helping you meet your protein goals but is not completely replacing mm-hmm.

All the other protein that may be coming in, in your diet.

So maybe you're getting, you know, 20, 30, 40 grams of protein from a protein powder or bar or shake or something, but the rest of your protein is coming in from, from Whole Foods.

So I've got.

I've got no issue with that.

And one more thing I wanna add is like, yeah, make sure you're purchasing from a brand that does third party testing because protein powders can be contaminated.

With things like heavy metals, this is less common in the animal-based proteins, whereas things like rice protein and pea protein tend to be pretty high in some contaminants, like possibly lead or arsenic or cadmium.

The animal ones are a little less likely to be contaminated, but you still wanna be going for a brand that is doing their due diligence on, contaminants.

Okay.

And that's something that's usually pretty readily available in the information, right?

The third party testing.

I feel like I've seen that in places, seen it on websites.

How obvious is that for a consumer to find?

It's

becoming more commonly available.

Okay.

I think brands are feeling more pressure to mm-hmm.

Provide that.

So what you can ask for is a certificate of analysis or.

You know, purity, quality testing, third party testing, independent lab testing, and, and see what they do.

Mm-hmm.

It's a bit of a red flag if they're doing this testing in-house.

You know, it's nice to have a third party doing the testing.

So you can,

you can verify that.

Yeah.

Okay.

And I'm assuming we can talk about where people can find you later, but I'm assuming you have some recommendation.

I know you have your book, obviously with a ton of information about what we can be eating and how to do all of this.

Well, and then.

On your website as well.

Do you have recommendations of brands, products, things that you do feel good about or that you consider, let's say, quote unquote clean, kind of some of the stuff that meets some of the guidelines that you've kind of just laid out for us that they could find?

I do

so over at lily nichols r dn.com/codes, or you could just go to my website and search codes and mm-hmm.

The page will, will pop up in the search results.

Okay.

Yeah, that has, that has a number of options, so.

I also have a blog article on collagen specifically.

Okay.

Where I link out to some good options.

So, yeah, it's, it's on my site.

Okay.

We'll share that too.

I'm a collagen lover.

Collagen user.

So I think it was interesting to have you add that in about that little bit about tryptophan and all that.

'cause to me, I'm like, oh, I actually didn't know that.

So what does that mean for me?

So I'm like, yeah.

Well, the reassuring thing, if I, if

I can summarize very briefly that blog article that I have, they've actually done.

Research on collagen, like how much collagen can replace the protein in your diet without disrupting the balance of your amino acids.

Mm-hmm.

So like our, all of our proteins are made up of individual amino acids and.

You know, you need, you need them in relative balance to one another for your body to then use those amino acids to build other proteins in your body.

So to build your enzymes and your blood vessels and repair your organs and muscles and all the things, right?

So there's been a lot of chatter about, oh, collagen is no good because it's not a complete protein.

Well.

Mm-hmm.

They did a study on this and they had, people consuming fairly low amount of protein, like the RDA for protein, which for.

Men and men, I think it's like 55 grams a day.

Like it's really low.

Yeah.

For women it's about 45 grams a day.

So they had them eating a fairly low amount of protein.

They replaced 15 grams of that with collagen and we're checking the seed.

Did it disrupt amino acid balance in the body and it didn't.

Okay.

So assuming you're, even if you're getting like.

Bare bones, amounts of protein.

'cause the RDA is like 10% of calories from protein.

It is.

Mm-hmm.

It is nowhere close to optimal.

Even if you're doing that, replacing a third of your protein with collagen, you're fine.

Right.

Because youre filling the gap.

So you're getting, you know, 80 grams or a hundred grams or a hun 120 grams of protein a day, or maybe even more.

You should have.

Zero concern about mm-hmm.

Having a serving or two of collagen per day, it's not gonna mess anything up.

Mm-hmm.

And it's kind of ironic that that even comes up as an issue because plant proteins are also lacking amino acids and nobody's like, oh, the protein you're getting, calling them out doesn't count.

Like nobody calls that out.

But with collagen, suddenly there's like an uproar and everybody's concerned that is, it's, it's really less of a concern.

Then we think it's just like, don't get all of your protein from collagen, like don't have a no protein diet and then take a whole bunch of collagen.

Like that's not gonna be any good.

But assuming you're eating like a normal human and not taking things to extreme, and collagen is additive.

To what you're consuming, you're fine.

Okay.

So basically that little bit that collagen is missing, which other plant-based protein are missing, you're saying as well, can, the gap is filled when we just eat regular protein and like put it all together.

Right.

Plant proteins are missing a different amino acid, but Right.

Yes.

Like you're getting plenty of tryptophan from other things in your diet.

The proteins that it's that I eat.

Mm-hmm.

Okay.

It's no concern.

Yeah, it's perfect.

It's a good summary of that.

'cause I was like, hmm, what to do with that information.

Yeah.

Okay.

I wanna zero in on choline specifically, in pregnancy and then I, this trickles into postpartum as well, so we can let it take us there.

But I really love the way that you teach and educate about choline and I feel like it is not something that everybody recognizes as a need in pregnancy and postpartum and in breastfeeding.

So I was.

Hoping you could kind of just give us an overview about choline, why we need it, why our babies need it, why it matters, and kind of give us this foundational, Hey, this is about how much you should be trying to get in your pregnancy, some ways to get it, stuff like that.

Because I, as you do as well, think like people need to be getting choline when they're growing babies, feeding babies, raising his babies, so.

Yes, so choline is an interesting nutrient when you're looking at all the other nutrients we consider essential things you have to get from your diet.

Choline is actually the most recent one to have been added to our, our guidelines.

There's not since been an another nutrient that has been previously considered non-essential and then suddenly considered essential, and it's.

Kind of acts like a B vitamin.

It was just named after the B vitamins were named, so they didn't give it like a vitamin B 13 or something uhhuh.

They didn't give it a number, but it really acts in, in tandem with nutrients like folate and vitamin B six and vitamin B12.

And riboflavin, like a lot of these same key metabolic pathways are, are using many of the same nutrients.

So choline is right.

Right in the mix.

Choline is, you know, something that is found mostly in animal foods.

You find it most concentrated in liver, egg yolks.

Those are by far the top two sources.

Mm-hmm.

Other organ meats, meat, fish, poultry, slightly smaller amounts in dairy products, and then you find it in fairly sparse concentrations in plant foods.

The richest sources being.

Beans and legumes, nuts and seeds, cruciferous vegetables like broccoli or Brussels sprouts and, and, did I say nuts and seeds?

Nuts and seeds?

Mm-hmm.

And shiitake mushrooms.

But like, as you start looking at the relative concentrations of it, you'd need like two cups of cooked beans to equal the choline concentration in a single egg yolk.

Okay.

So it's gets really difficult to hit the mark for choline if you're cutting out animal foods.

Mm-hmm.

Which ironically.

The high cholesterol animal foods tend to be the ones with the most choline, and those were the ones that we were told to avoid for so long.

Right?

Yeah.

So like more than half of our intake of choline comes from egg yolks specifically.

Thankfully I feel like the tides have turned a little bit on eggs and people are less afraid of the yolks now as they were in the eighties and nineties.

But when you talk about delays in nutrition information, making it into the masses.

You know, the egg yield shift and the choline recommendations are certainly, one of them.

Yeah.

So why is it important to, pregnancy?

We know that, choline plays a role in neural tube development, so just like folate can help prevent neural tube, defects.

Likewise, the same goes for choline.

It does help improve brain development.

So we have.

Pretty strong data.

We're talking randomized controlled trials in pregnant women, supplemented with different levels of choline, and the ones who were supplemented with higher amounts of choline, which are more than double our current recommended intake.

Mm-hmm.

By the way, their babies have better brain development, problem solving skills, reaction time.

Not only in toddlerhood, but this, this study has now published data up to age seven.

Mm-hmm.

On this same cohort of mothers and children.

And the same held true at age seven, and that's regardless of what the kids consumed in infancy and childhood, or whether they were breastfed or not.

Mm-hmm.

There was a substantial improvement in their brain development when the mothers consumed.

Double the amount of choline of what our recommendations are during their pregnancy.

Mm-hmm.

So it's pretty cool.

Mm-hmm.

So speaking of like amounts, and there's there's other benefits of choline that I can circle back to, but speaking of amounts, our current recommendations in pregnancy are 450 milligrams per day and not study supplemented the treatment group.

That had the better brain development mm-hmm.

With 930 milligrams per day.

Okay.

In breastfeeding, the recommendation is 550 milligrams per day.

So you could see an increase of a hundred grams relative, a hundred milligrams rather relative to pregnancy.

However, we also have research using that 930 milligram amount showing.

Improvements and, and better choline transfer in the, into breast milk and whatnot.

So I think the 930 milligrams is a good goal.

Mm-hmm.

You'll see if you tally up your choline intake, you can use a free app like Chronometer.

To do this, you have to toggle on choline in the settings.

It doesn't always show up on the dashboard unless they've very recently updated that.

But if you track your choline intake to be like, oh, how much am I getting?

You may hit, you know, four or 500 milligrams per day.

It does get pretty tricky to get beyond that.

Mm-hmm.

Unless you're a pretty heavy consumer of things like eggs or you regularly have organ meats and rotation, or you eat just a high amount of, of animal protein in general, but you can tally it up and see where you're at.

I still think it's great.

Like if you're exceeding.

The recommended intake of 450 milligrams in pregnancy, you're, you're still doing pretty good, right?

You're doing much better than the average woman who's getting less than 300 or, you know, 250, milligrams per day, and certainly better than vegans and vegetarians have the lowest intake by far, because they're, the food sources are far less concentrated in choline, right.

So especially in, in the individuals who don't consume eggs, that's, that's a, a dramatic, shift in the choline intake for sure.

So, okay.

That would

be, remind me, remind us how much choline about is in one egg.

I don't know if you've said that yet, and I can't remember.

So

it depends on the size of the yolk.

So it can be, you know, 115, 120 milligrams.

Okay.

Upwards of, for maybe like a jumbo egg with a really big ylk, 150 milligrams.

Okay.

So, yeah, it varies on the size of the egg and then,

but obviously pretty significant.

Like two large eggs gets you up to 2 50, 300, so that's pretty good.

Exactly.

Yeah.

So like pit right

there.

Okay.

Exactly.

If you're getting a couple eggs a day, you are well on your way to meeting.

Mm-hmm.

Your choline needs, good quality prenatal vitamins will include some choline, right?

It does, it does an expensive ingredient and it's also.

A bulky ingredient, it takes up a lot of capsule space.

Mm-hmm.

And it also tends to have kind of a strong smell.

Some types, like choline by Tartrate has a strong smell.

Mm-hmm.

And so it's tricky to get supple supplement manufacturers to want to include.

A, a reasonable amount of choline, like a lot of them will be like 20 milligrams or 20 milligrams because they don't wanna add to the capsule count.

And customers already are like, I don't wanna take so many capsules.

Like, I get it.

Mm-hmm.

Like, I, I hate swallowing pills too.

However, like, it, it may, it may be beneficial to just like, suck it up and take the capsules.

Yeah.

If you're not, hitting the mark and it is something you could supplement with.

Separately as well, separate from a prenatal if you wanted to, to, you know, double up on, on your intake if you happen to be particularly low in choline intake.

I was looking at a few different prenatals a while ago that do say, Hey, we have choline now, which.

Stood out to me because I don't remember seeing those options.

Like when I had my first eight years ago, I don't remember seeing choline being noted, you know, kind of on labels and stuff like that.

And I'm seeing it more now, but looking at the values, a lot of them are like, you know, 50 milligrams or something.

They are small.

So in my head I'm reading it and I knew some of these more current recommendations.

I was thinking, well that still doesn't really get me that much closer.

I should just like eat another egg, essentially.

Yeah.

So I think it's nice to see it's in there.

But then nice for all of us to know, sitting here, listening to you that we still might need a little more, we wanna focus on it better with our diet, or we need a fuller supplement that's just choline or something like that.

Like you can't just say, oh good, my prenatal has choline.

Check the box.

Like, look at that number.

It might not be as big as you think or want it to be.

To meet the recommendations or to really go past them like it sounds like is obviously really beneficial too.

So.

Yeah, and I'm, you know, to set, set kind of a standard.

When you look at how much choline women are consuming in the us, like 90 to 94% are not even hitting that 450 milligrams per day.

And we're seeing this decline as plant-based diets have kind of come in vogue.

It seems like that's.

Kind of on the way out.

I don't know.

Mm-hmm.

At least from what I'm seeing, I see a lot of people transitioning back to including animal foods, but that, that is one of the challenges, like when you have, I mean, our guidelines really promote going more plant-based, more plant protein.

One of the challenges is that you start to run into issues with certain, certain micronutrients that you're not getting enough of.

Right.

Choline is a major one.

B12 is a major one.

Iron and zinc are major ones, DHA, there, there's many, but choline specifically, it's like your animal foods are so much more concentrated that you really do run into an issue here and, and it's not one that I see.

Again, it's gaining steam, but I've been teaching on this for like more than 15 years and I remember I, you know, 15 years ago I taught at a conference on gestational diabetes, and I think I had a. A few lectures, but one of them was on breastfeeding and I was talking about choline and I asked the audience, this was all health professionals, about a third of 'em were dieticians, a couple hundred people in the room.

And I asked like, Hey, show of hands, how many of you are familiar with choline?

Mm-hmm.

And its importance in, in pregnancy and breastfeeding.

And I swear I had like 10, 20 hands out of a group of hundreds of health professionals.

I think if I asked this today.

More than half would raise their hands, especially among the dieticians.

There's just so much research on it now, but it's really been slow, right?

Mm-hmm.

And that was already, what, a decade or more, right after the guidelines had come out saying this was an essential nutrient and setting a standard.

And yet that standard that was set, that four 50 milligrams, sorry to keep like going on this, but I think this is interesting for people to know.

It's that level was based solely on data from adult men of course.

So they put men on a low choline diet and then saw what happened because the assumption was, well, our body can make some choline, so therefore it's probably not essential.

Well, you put men on a choline deficient diet and what happens choline is so important for liver health that they develop liver issues, they develop fatty liver disease.

It is, it is actually, and this is rare in the medical world, like it is a cause and effect situation.

You put people on a low choline diet and it will cause them, it's not associated with fatty liver disease.

It will cause them.

To develop fatty liver disease.

That's wild.

And so the, and then they repleted them with choline.

They saw how much was needed to fix their liver function.

And then they, they make the adjustments, you know, the, they set the standards for women and for pregnancy just based on changes in body weight.

Right.

And a couple like mathematical estimates, but it wasn't based on any data in women and certainly no data in pregnancy.

Mm-hmm.

So it's new that we now have that data.

And randomized control trials at that.

It's really high quality data.

We absolutely should be changing the standard for.

A higher amount of choline and, and, you know, what would that look like on a population-wide scale?

Like maybe there would be requirements for prenatal vitamins to contain mm-hmm.

A minimum amount of choline.

Or maybe we would revise our guidance on, vegetarian or certainly vegan diets in pregnancy.

Or at least have separate recommendations on higher choline supplementation for those groups.

Right, right, right.

But it's like.

We're not there yet.

Like it'll, it'll take some more time maybe in

50 years.

Yeah.

This is helpful though because I feel like this was something I randomly came across in my breastfeeding education, about choline bean and Sunflower ethen being like an active ingredient and talk, and we can speak to this actually, like, and what.

How it plays a role in clogs and, and well less the thin and choline be and less thin, all that.

That's where I really came across it and almost like tracked backwards and realized, oh my gosh, we need a lot more of this than I realized in postpartum breastfeeding.

Oh wait, we actually need a lot of choline in pregnancy.

So I got almost made.

To me it feels like I worked backwards 'cause it came more from breastfeeding education.

And so I think.

I am grateful to be able to talk about it or know that there are people talking about it.

It is coming, coming more to the forefront.

Again, you're probably like, I've been talking about this for 15 years, but the rest of us haven't been.

Because it does seem like incredibly valuable, important, necessary, and it has just been a little bit.

To me on my side of things feels still like pretty quiet.

And this, I don't wanna say it's an easy thing to do, right?

It, it can be hard to get all that we need of any of these things that we're talking about, but certainly not that complicated to, to add in to kind of, Hey, I wanna get my protein, I wanna get my cho.

And really going back to where you started of, if we eat Whole Foods more than just hitting a supplement.

We're getting, I was thinking about eggs, right?

We're getting protein and we're getting choline or the dairy, the different things you listed.

Like that's obviously why there's so much value when we can in eating the whole food, because it's not giving us just protein.

It's like, oh, my egg's gonna give me multiple things, and that is always going to serve me better than just the protein powder or whatever supplement we're talking about.

So I.

Yeah.

I guess just going back to that maybe 50 years from now though, it's so good.

I think that it is being talked about and shared in these channels, in these ways until we maybe get that policy change or that recommendation change that we now know to be very slow in coming, even though it's, yeah, necessary it should be coming.

Yeah.

Yeah.

And yeah, on the, on the breastfeeding, front, yeah.

We, we don't know for sure like the mechanism by which supplementing sunflower eth than helps reduce clogs.

And for some women that can reduce the risk of mastitis, of course.

Mm-hmm.

Because if you have a clog, you're gonna probably develop mastitis unless you could clear it right.

But, you know, eth than emulsifies fats.

Right?

So the idea is maybe the lesser thin is helping to emulsify the fats, in the breast milk to help it pass.

The choline may be just like a, a side benefit.

Mm-hmm.

Ethin is really high in a type of choline called phosphatidylcholine.

And you find that also in, in eggs.

By the way, most eggs are, egg yolks are very high in ethin and therefore very high in phosphatidylcholine.

So the choline you're getting from eggs is coming in that form primarily.

But it is, it is.

An association that many lactation educators have.

Have noticed.

Yeah.

And so it's become kind of a common recommendation and I think it's arguably to everybody's benefit.

'cause the mom needs high amounts of choline.

Right.

Not only for, you know, liver health.

Your liver's doing a lot in early postpartum as you're transitioning from the hormones of pregnancy mm-hmm.

To the hormones of lactation.

Your brain, of course, has gone through all sorts of changes, and, and choline is really vital to brain function.

And then also that higher choline intake translates to higher breast milk choline concentrations, which would benefit mm-hmm.

Baby's brain development.

So I think there's, you know, multiple ways in which it's, it's beneficial.

I don't think everybody has to supplement Sunflower ethen.

I, I actually didn't with either of my, with either of my babies, but I was eating a pretty high amount of choline, just from food sources and it was also, in my prenatal, at the time as well.

Mm-hmm.

So, I think it's optional, but for somebody who's prone to clogs and prone to mastitis, it might be a good kind of insurance policy.

Mm-hmm.

To, to add that in.

Yeah, and that's actually where the education stuff that I was learning was saying There's nothing wrong with sunflower lessen.

It's been really helpful for a lot of people, but one of the side effects of it sometimes is GI upset, I guess, for some people.

I've never actually taken it either.

I've not needed to for breastfeeding stuff and get choline in a lot of other ways.

But in what I was learning, it was saying there's nothing wrong with taking ethin, but why aren't we talking about choline more because it's such a. That's something that actually is really valuable with the breastfeeding scenario.

And, and this might not be true, so you can correct me if I'm wrong, but actually can be valuable with what's going on with plug ducts and stuff like that as well.

And so before you jump to ethen, actually make sure you're getting enough choline and that way you could potentially then avoid even less assistance, side effects, potential side effect of like GI and stomach upset.

And so that's kind of what.

I had been learning and that's where I started.

That was what led me to the like, whoa, what is this choline specific conversation of this?

Because essentially when you have it plugged up, the wreck is often, or if you get them frequently, I would say you should be taking lesser than, but then it was, yeah, when you pick that apart, it was like, could you, you fix it with choline alone versus lesin?

And are you are, are you low in choline but you're taking Leshan?

Well, you should correct.

Your choline intake as well, like that That is actually, I'm not gonna say more important or more vital, but like kind of a foundational root thing that gets ignored and we jump like to less than specific to breastfeeding and helping with plug ducts and stuff like that.

So anyway, that was, I mean,

yeah, where I'd started with that mean, I would argue that since our protein needs are so high, I mean the data that we have is in women three to six months postpartum who are exclusively breastfeeding.

Their protein requirements were higher than a typical female athlete, and that's crazy.

That's already three months out after birth.

Mm-hmm.

When really, well, you know, you've done this four times, like you've gone through.

The really hardest part of your healing typically, yeah.

By three months out, unless something has gone terribly awry.

It's not to say you're not sleep deprive, deprived, and tired and you know, it's very physically demanding having a baby.

However, like you have healed from birth typically mm-hmm.

By three months out and still.

The protein needs were quite high.

So crazy.

Mm-hmm.

So if you are actually meeting those protein needs, which for, you know, a breastfeeding woman probably could be, you know, a hundred twenty, a hundred thirty, a hundred fifty, so crazy.

180 even grams of protein, you know, it's based on, on body weight, the calculations, your choline intake would be substantially higher.

Yeah.

If you're actually hitting those and, and you would probably very easily hit.

930 milligrams or more from diet alone.

Mm-hmm.

So I think if that was happening, you may not, it's true, you may not need an additional supplement, but I mean, I look at, so often what I see breastfeeding, women eating, and especially in our culture, which does a terrible job of supporting new mothers and nourishing new mothers, is that they're living off of like lactation cookies and just.

Easy to grab things.

Mm-hmm.

And they heard oatmeals, a lactic gog.

So even if they don't really like oatmeal, they're having oatmeal for breakfast and they're just on this, this blood sugar rollercoaster, hungry, hangry anxiety like this.

Mm-hmm.

This undernourished state and.

You won't find this sense of like equilibrium and calm and control over the crazy hunger that can come with breastfeeding if you're not getting enough protein.

And I, I would really emphasize in this case, like enough whole food protein.

'cause you also need those fats as well.

Mm-hmm.

And when you're getting those things, you're also gonna be getting.

Choline, like a lot, a lot of issues are simply solved when women get enough protein, when we eat whole food protein.

I'm, I'm just such a broken record on it, and I, you know, to circle back to some of the earlier part of the conversation of like, that's the most challenging thing for you.

I mean, I'm right there with you because protein requires.

Planning and meal prep.

Yeah, exactly.

Like, it, it, it, it requires advanced planning where something like just grabbing some potato chips or some oatmeal or, you know, some cereal, like it's, it's there on demand.

Like the carbs are so easy to hit.

Most of us don't have to go out of our way to get the carbs.

Most of them are grab and go, but the protein option requires we actually prep something.

It's like, okay, I'm gonna have.

Tuna salad or salmon salad.

That might be a bit more grab and go, but like, okay, I have to get the can or cook the fish and use the leftovers to make the salmon salad.

It requires I chop some celery and mix some stuff in it.

I wanna have, you know, chicken for dinner.

Okay.

It requires you like buy the packages chicken or defrost it at the right time so it's ready to go for dinner time.

And so for me.

I find that with my meal prep and grocery shopping, I'm mostly planning around getting enough protein.

Mm-hmm.

Because like filling in the gaps is not hard.

It's not hard to throw on some rice or pasta or beans as a side.

It's not hard to like throw in a vegetable side or make some cole slaw, but like.

Planning that.

Okay, we are going to have pot roast for this meal.

Mm-hmm.

And we are going to have pulled pork for that meal.

Mm-hmm.

And we are going to have chicken, you know, drumsticks for this meal that requires that.

I like, plan it out, have it ready at this time.

Yeah.

And you know, not spoiled yet, right?

There's like a shelf life on fresh proteins.

That's the part that takes.

The effort and the planning, and I can't say that I've figured it out for myself, but I, I do find, I kind of plan my shopping and pulling things from the freezer around what are the main proteins I'm gonna have?

Can I make enough that there's at least one meal of leftovers leftover of it?

Yeah, yeah.

You know, build in some slow cooker or instant pot proteins to make it easy.

But I'm right there with you.

Like it's hard.

It's hard in weeks.

It's really hard.

You know, I don't hit the mark as much and, and I could tell with my energy levels and yeah, and my mood.

Patients, you know, it, it just, it affects everything.

It makes me think like meal trains bringing food to postpartum moms love it.

Like I will do that.

Yes.

Until I am no longer able to cook food for someone.

But how often we do like.

The rice, the pasta, the heavy stuff.

And I'm like, I'm gonna start bringing people a pot roast and be like, you need to eat this pot roast.

Because again, it's like, it's not totally what you think about sometimes this really protein heavy thing to bring to someone if that's like your gifting and what you wanna do.

And then, like you said in your own home too, it is, it requires.

Much more thought.

Sometimes in some of these simpler, quicker meals, you add kids into the mix who don't love protein.

So then it's like, how do I balance doing the work of making this baked chicken, but my kids won't eat it or whatever.

And so it does it, it just starts to feel like this constant balance of this would be easy.

This would, and for me, sometimes I'm like, this would allow me to like, I'll say, serve more people.

Like what if I made this quickly for a friend and my kids and myself?

But there's that balance of like, but we're not also all really.

Totally getting as much of what our body needs, and so trying to balance that.

Sometimes I think whether it be in your own home or for someone else or whatever, it can feel a little bit, I guess frustrating would be the word because frustrating.

It's like I wanna do the right thing, but it is more complicated.

I know it.

It does take some planning and.

Yeah, I, I mean, I've been there.

I have one kid who's kind of a picky eater right now.

You know, it goes through phases.

You've probably seen it with your own kids, where my older one is completely grown out of it, thank goodness, and will eat anything.

Yeah, it's great.

But my younger one is still kind of in that, you know, they push their like independence and it's almost like, not even that they don't like the food, it's just part of.

Yes.

Bring growth and development, you know, like asserting yourself and boundaries and it is what it is, right?

We, we roll with the punches on it, but, I still do try to simply make the protein option whether or not they're going to eat it.

Sometimes it's not worth the battle or we find an alternative, but, you know, in terms of prepping, I, I do find things like the slow cooker and instant pot options make it really easy.

So like a pot roast?

Mm-hmm.

Or pulled pork, you just throw the meat in.

Yep.

Maybe with some veggies and your seasonings and whatever.

Little bit of liquid in there and like it's good to go.

Yeah.

Like I, we literally did that last night.

I got like a chuck roast and we did like a beef fur, like a Mexican shredded pork Yep.

Sort of thing.

And I put that in the instant pot at like three 30 and it was, you know, ready by four 30, I mean.

It was, it was easy.

Then we made rice on the side and some cole slaw and you know, called it a day and the leftovers were going to tacos or something like that tonight.

And those are the sorts of things that can work really well for postpartum meal prep as well.

So like.

In my second pregnancy when I had learned the hard way that like, wow, it's really hard to cook when you have a baby and you have to Yeah.

Plan ahead or accept a lot more help.

Right.

We all learned the hard way.

We do.

I started at about halfway through the pregnancy, just making a double batch of one meal per week.

That would be kind of a freezer friendly option.

Yeah, so the soups and the stews and the pulled pork and the casseroles and things like that.

I would just cook double and then freeze one.

Granted, you have to have the freezer space, but you do.

We, we had, we had done that, we had room in our deep freeze for it.

And so by the end of it, I had approximately 20 Yeah.

Full meals, pre-prepped, many of them serving more than one meal's worth of food.

Right, right.

You make the whole lasagna or something.

We got Right.

Maybe two meals for the whole family.

So that can, that can simplify it a little bit, for some people.

'cause I, I couldn't.

Figure out, like at the time with a toddler, how to set aside like, okay, you're gonna have this whole week or Sunday or something of like meal prepping, multiple things.

And like, I can't, can't, that's impossible.

Like where I was at at that stage in life.

Yeah.

And so that was one way that I made it work.

But it can also work well for bringing something to a friend, make a double batch of pulled pork.

Yeah, bring half to the friend for their postpartum.

You got the other half for your family and it doesn't really take all that much more time.

Yeah.

You just double your seasonings and maybe set a sep separate, you know, crockpot on.

But yeah.

I'm with you.

Like it's tricky.

I don't have it figured out.

I know.

And then I listened to you though, and I'm like, but she's right.

Like, here's what I took away today.

Eat a lot of protein.

Buy a crockpot.

You can do this.

Like at the end of the day, some of it's complicated, but it's also not, we just need to be, yeah, just.

I think maybe be a little more thoughtful or be willing to give a few minutes to the meal prepping part of it, or how we buy our groceries so that these things are available to us, and then we can just throw them in the crockpot because we took the time to snag them at the grocery store, you know, and give it.

So, yeah, it asks some time of you, but it, it doesn't have to, you don't have to feel like you're changing your entire diet to meet some needs.

Like we can do.

Some simple things like you just described, and those have really good impacts on our, our health.

And then when we are pregnant, the baby's health and growing that baby well and all of that stuff.

Yeah.

So, yeah.

And the future protein people at day,

sometimes it takes, in a way like less work.

Yeah.

Because when you're buying things that are prepackaged, pre-made.

You get such a smaller quantity than when you're making like a big, a full pot of something for the whole family or whole, like sheet pan dinner mm-hmm.

Or something.

Mm-hmm.

You get this box of a pre-made thing and it's like usually expensive too for what really expensive, how

much food you're getting.

Yep.

And it's like the flavor isn't good and the texture isn't right.

It's like I've tried all the different things to like hack the meal time.

Right.

So I don't have to spend as much time in the kitchen.

And I keep coming full circle to like, mm-hmm.

You know what?

Even as much as I don't wanna do it, some days, that time spent in the kitchen pays back in dividends because you get, yeah, many more meals out of it.

Everybody feels better and more satisfied.

You can flavor things exactly how you want.

It's just like, you know what I mean?

I still have my, my last minute options, you know, that are not perfect, but we just, we do what we gotta do.

Yeah.

But the more of those meals that I can fit in, even if you're starting slow, like you're like, I'm gonna make one home cooked meal this week.

Mm-hmm.

And you're like, just dipping your toe in the waters like.

You just, there's a trade off when you don't spend that time in the kitchen.

And I, I haven't figured out how to remove myself from the kitchen.

Like yeah, I don't, I dunno that we

can fully, I mean, yeah, I think that's, yeah.

Part of being human and and caring about the bodies that, that we've been given truly.

Yeah.

So, yeah.

Lily, this is great.

There were other things I wanted to talk to you about, but we'll save those for another conversation, I think.

Why don't you let people know where they can find you.

I know we mentioned your website.

I know you have a really, helpful book as well, so kind of where people can find those, I'm assuming maybe in one place and social media accounts as well.

Yeah, for sure.

So, my website is sort of the main hub links out to mm-hmm.

Everything.

So, we talked about choline today.

If you go to the little search bar.

Type choline.

C-H-O-L-I-N-E, and you'll find an article on that.

We talked about, protein requirements.

There's an article on protein.

Yep.

We talked about postpartum.

There's a. It's called Real Food, postpartum Recovery Meals or something like that.

There's a whole article links out to a whole bunch of different recipes for filling your freezer with healthy food or giving those recipes to family members or friends.

Yeah, to, to stock your meal train.

There's just a ton on there.

There's no paywall on my site.

I'm allergic to moving over to Substack or anything, so my site has hundreds of articles.

Free for the taking.

There's also a link on my site to books, and that'll link out to my three books.

I have Real Food for Fertility, real Food for Pregnancy, and Real Food for Gestational Diabetes.

And those are all linked on the books tab.

Let's see, as for social media, yeah, land, I'm most active on Instagram, but I'm on some of the other platforms as well.

So you can find me, Lily Nichols, RDN, and I post.

You know, random foods that I'm making at home, usually, like meals that don't take a whole lot of my time in the kitchen.

New research, just musings on pregnancy, fertility, postpartum nutrition research typically.

And yeah, you can grab the first chapter of, some of my books over on my site, so check that out.

First chapter, real Food for Pregnancy.

Is up on my site on the freebies tab.

So if you're curious to like dive in in a little more detail.

I think, you know, my, my favorite way in expressing myself is writing because I can do it really like clearly and thoughtfully.

Yeah.

And non repetitively.

And sometimes I love, I mean, I love doing podcast episodes, but I feel like sometimes.

The order in which I cover things is not quite as logical and maybe a little harder to follow.

So I really do try to put in the effort with my writing to make things really clear and straightforward.

Yeah, because I know the nutrition space is overwhelming and you can kind of end up down these rabbit holes of research where you're going in circles around things.

There's just a lot of incorrect information.

Yeah.

Floating out there as well, which adds to the confusion, so mm-hmm.

I try to clarify everything in my writing as much as possible.

Okay, that's perfect.

And I just wanna, in case you guys miss that, if you were in the like preconception, fertility, pre baby phase, that she does have her real food, for fertility, what is it, fertility, right?

Yes.

And then the gestational diabetes one as well.

I found you also from the pregnancy one 'cause.

A lot of people I feel like love that one or had heard about that one.

But want you guys to know Yeah, that's, if you're in the other stages, you have those kind of specific ones for you and where you're at too.

Yeah.

If that's where you're at.

And if I can clarify, because I, I thought it would be fairly obvious with the book titles, like which book is for you, but which one for me?

Yeah.

I have so many questions.

If you are not currently pregnant.

You wanna have the fertility one because the pregnancy one is very specific to pregnancy to be pregnant.

Yeah.

There's also a chapter on the fourth trimester, so if you're in early postpartum and also breastfeeding, whether or not you're breastfeeding, that's covered in that postpartum mm-hmm.

Chapter.

But if you're anywhere, like I'd say a year out, like a year postpartum or beyond.

Thinking about having another baby, or even if you've decided I'm kind of done with babies.

No more babies.

Mm-hmm.

Real food for fertility is like kind of a women's health bible on okay.

Nutrition because perfect, you know, optimal fertility and hormone levels, just the ability to get pregnant is a reflection of having.

Good health, right?

Like you will have hormonal balance when your health is in a good place and when your health is not in a good place, you're gonna have hormone issues as well, right?

It's all interconnected.

Okay?

So if you're not pregnant, get the fertility book.

If you are pregnant, get the pregnancy book.

You only need real food for gestational diabetes.

If you get diagnosed with gestational diabetes.

It is additive to the pregnancy content.

And it is very specific to blood sugar management during pregnancy, so that's perfect.

That helps least likely chance that you'll need the GD book, but it's, it's there if you need it.

Okay, perfect.

One last question, doesn't have to be related to anything we just talked about.

What's one thing in your life right now that's just sparking a ton of joy for you?

Ooh, that's a great question.

Probably my garden.

Mm-hmm.

So we're in the, the heat of the summer, so the tomatoes are popping.

We got okra, we got hopefully some watermelons coming soon.

Certainly some herbs, some, some peppers.

So.

That definitely sparks joy.

I love spending time outside and in my garden and in the sun on the not, not too hot days.

Yeah,

I like it.

Especially as we slowly start to creep.

Present day, we're about to creep back towards school starting, so I feel like, oh, I already feel that.

Like the holidays are coming, like summers ending.

So these summer gardens I do think are like exploding right now as they kind of do through this August month and I already feel like the fall coming.

So it's yes.

Yes, get that garden joy before we're back into winter.

For sure.

Well, thank you so much, Lily, for your time.

This was, thank you, helpful for me even in my own day to day and I know it will be for everyone else too.

So thank you.

It was fun.

Appreciate it.

Bye.

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