PDF Summary:Real Food for Pregnancy, by Lily Nichols

In Real Food for Pregnancy, Lily Nichols challenges conventional prenatal nutrition advice and advocates for a nutrient-dense, low-carbohydrate diet focused on whole foods. This guide details the benefits of prioritizing nutrient-rich foods and moderating carbohydrate intake to maintain stable blood sugar levels for the health of both mother and baby.

Nichols covers important nutrients like choline, vitamin A, glycine, and DHA, and provides diet strategies tailored for vegetarians. She also offers insight on managing common pregnancy issues like nausea and constipation through diet, and underscores the importance of postpartum recovery—from rebuilding strength to mental health—before considering subsequent pregnancies.

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Nichols emphasizes the necessity of dietary modifications, which encompass a range of adjustments including a commitment to consuming at least three eggs each day, integrating seaweed into meals for its abundant content of iodine and iron, preparing beans and grains by soaking them to reduce phytic acid and boost the uptake of minerals, choosing dairy products with low carbohydrates from grass-fed sources like aged cheese and Greek yogurt over those high in sugar, utilizing nuts, seeds, and legumes as substitutes for grains to increase protein intake, and thoughtfully combining certain foods to enhance the assimilation of nutrients that are typically difficult to obtain, such as consuming vitamin C-rich foods alongside those high in iron. She underscores the necessity of daily supplementation with a premium prenatal vitamin that compensates for the nutritional deficiencies often found in vegetarian diets. For women who choose a vegetarian diet purely for animal welfare reasons, she suggests that oysters may be a good way to get some of these problematic nutrients as they are naturally abundant in Vitamin B12, iron, zinc, DHA, selenium, and iodine.

Other Perspectives

• While liver is nutrient-dense, some health professionals caution against its consumption during pregnancy due to the risk of vitamin A toxicity, which can be harmful in high doses.
• The recommendation to consume full-fat dairy may not be suitable for all pregnant women, especially those with lactose intolerance, dairy allergies, or those following a vegan diet.
• The emphasis on animal-based sources of nutrients may overlook the potential of a well-planned plant-based diet to provide all necessary nutrients, with the exception of Vitamin B12, which would require supplementation.
• The suggestion to consume eggs daily for choline may not be appropriate for individuals with egg allergies or those who avoid eggs for ethical or health reasons.
• The advice to eat meats prepared on the bone and slow-cooked dishes may not consider the dietary preferences or restrictions of certain cultures or religions.
• The recommendation to increase seafood intake, even with low-mercury fish like salmon, may not account for the environmental and sustainability concerns associated with overfishing.
• The focus on specific nutrients like Vitamin K2 in fermented dairy products may not acknowledge the potential for these nutrients to be obtained from other food sources or supplements.
• The assertion that plant-based proteins often do not contain adequate amounts of glycine may not consider the ability to combine plant-based foods to create complete protein profiles.
• The strategies for optimizing a plant-based diet may not fully address the complexity and individual variability in nutrient absorption and dietary habits among vegetarians and vegans.
• The suggestion to consume oysters for those on a vegetarian diet for ethical reasons may not align with the ethical stance of all vegetarians, as oysters are still living organisms.

Employing dietary tactics to control symptoms, health issues, and external factors during the entire gestation period.

Nichols emphasizes the importance of acknowledging common pregnancy-related discomforts and, where possible, addressing them through dietary strategies rather than accepting them as unavoidable elements that require no intervention.

Numerous natural remedies for health issues that are often encountered throughout pregnancy.

Nichols provides advice on how to mitigate typical symptoms associated with pregnancy through dietary changes, the addition of certain supplements, and adjustments to one's way of living.

Approaches for managing nausea and vomiting include altering one's diet, modifying daily habits, and incorporating nutritional supplements.

Nichols offers a range of strategies for coping with nausea and the urge to vomit, emphasizing the importance of keeping blood sugar levels stable, avoiding strong odors or an overly full stomach, and ensuring the intake of specific nutrients.

She recommends that women who are dealing with nausea should eat smaller, frequent meals and snacks, ensuring that each one, regardless of size, contains elements of protein and fat, and to eat mindfully to keep their diet well-rounded. When experiencing nausea, she recommends opting for carbohydrates that are simple to digest, such as white rice or a blended fruit drink. To help stabilize blood sugar fluctuations that can lead to nausea, she recommends balancing carbohydrate intake with an equivalent amount of protein or fat. She also explores the combination of magnesium with ginger and B-vitamins as a method to alleviate nausea symptoms.

People can handle their food preferences and dislikes by deliberately selecting their meals to maintain a balanced diet.

Nichols explores the mental and physical factors that result in the common food cravings and aversions experienced by expectant mothers. While acknowledging that cravings during pregnancy could be signals of the body's protective mechanisms or a sign of nutrient deficiencies, she recommends resisting the temptation to indulge in less nutritious foods, which might result in excessive weight gain and fluctuating blood sugar levels.

Nichols explains that the hormonal fluctuations occurring at the beginning of pregnancy typically lead to an increased craving for carbohydrates, which is attributed to lower blood sugar levels and a more rapid build-up of fat. She proposes that a craving for sushi could signal a need for omega-3 fatty acids or iodine, and similarly, an inclination towards dairy products could suggest a shortfall in iodine. Some food aversions that manifest in the early stages of pregnancy may act as protective mechanisms to deter the consumption of substances that could be harmful or toxic. For instance, you might develop a distaste for certain meats or vegetables with a bitter flavor, an instinctive repulsion that historically could have signaled possible spoilage or the risk of sickness from food prior to the advent of modern techniques for maintaining food freshness and hygiene.

To reduce discomfort and lessen the unpleasant feelings, individuals can alter their everyday habits and select foods that help manage heartburn.

Nichols delves into the common causes of heartburn and underscores that changes in one's eating patterns and lifestyle can alleviate such discomforts.

She counters the common practice of using antacids to suppress stomach acid, explaining how this can interfere with nutrient absorption and make you more susceptible to food poisoning (iron gut or not!). She recommends that individuals explore any personal food sensitivities they may possess, particularly to foods high in sugar and items with strong flavors, as well as eating habits that could worsen their health issues. She recommends a conscious eating strategy aimed at avoiding undue stomach enlargement. Lily Nichols advises cutting back on carbohydrate-heavy meals, spacing out the times when you eat, staying hydrated between meals, and using apple cider vinegar before meals to help maintain ideal stomach acid levels and potentially alleviate discomfort.

Addressing Particular Health Concerns

Nichols offers advice on adopting a whole food-based nutritional regimen that helps alleviate common pregnancy-related problems like constipation and supports the management of weight gain, while also stabilizing blood pressure and blood sugar.

To alleviate issues like constipation and hemorrhoids, it's important to consume a diet rich in fiber, drink plenty of fluids, include beneficial fats in your meals, and establish regular bowel routines.

Nichols addresses the frequent issue of constipation that occurs during pregnancy, discussing dietary choices and changes in lifestyle that can help maintain regular bowel movements.

She underscores the importance of combining fiber-rich foods with adequate water intake, warning that a sudden uptick in fiber intake without increasing hydration can lead to worsened digestive issues. Lily Nichols recommends opting for foods like berries and vegetables with minimal starch content, as well as avocados and seeds rich in omega-3, due to their higher fiber relative to carbohydrates, aiding in nutrient absorption and moderating blood sugar levels. The author argues that the belief in grains as the best source of fiber is misguided due to their less-than-ideal fiber-to-carbohydrate ratio and because their consumption can often displace other foods that are richer in nutrients. She emphasizes the importance of enhancing one's diet with a higher consumption of fats, a recommendation that goes against popular opinion but is essential for supporting digestive health. She emphasizes the advantages of a squatting posture as opposed to sitting on a toilet, which can improve the alignment of pelvic muscles and promote easier bowel movements. To enhance digestive efficiency and encourage consistent bowel movements, Nichols recommends adding a magnesium supplement or starting a probiotic regimen. She cautions that the use of calcium supplements frequently worsens constipation problems.

Understanding the subtleties of weight management and the impact of various dietary selections on weight variation.

Nichols delves into how the mother's weight gain affects the health of both the mother and the baby, underscoring the necessity of weight gain during pregnancy, while also noting that the amount should be adjusted based on the mother's pre-pregnancy BMI.

Lily Nichols cautions expectant mothers that gaining too much or too little weight can increase the chances of experiencing complications, which might lead to premature birth, necessitate a cesarean section, cause hypertension, result in blood sugar problems, or result in the birth of babies who are either too small or too large. Nichols outlines the updated prenatal weight gain recommendations from the Institute of Medicine for women in the underweight, normal weight, overweight, and obese categories and explains how these can be further fine-tuned based on an individual’s height and other considerations. She underscores the importance for women with excess weight to limit or entirely prevent further weight gain during pregnancy to enhance their chances of a healthier outcome, given the potential complications linked to substantial weight increase in this stage.

Dispelling myths regarding

Nichols explores the root factors contributing to heightened blood pressure and the emergence of preeclampsia, scrutinizes the common advice to decrease salt intake, and emphasizes the significance of vital nutrients in preserving vascular health and regulating blood pressure.

She challenges the widely held belief that reducing salt consumption while pregnant is a reliable method for controlling or decreasing hypertension, emphasizing that this idea is not backed by scientific evidence. In fact, she underscores that while a portion of individuals might react to salt with fluctuations in blood pressure, for the majority, including pregnant women, reducing salt consumption does not affect the measurements of blood pressure. The author underscores the significance of salt in maintaining electrolyte balance, ensuring the right volume of blood fluid, and supporting the development of the fetus as well as encouraging the production of adequate stomach acid. She highlights research suggesting that a diet low in carbohydrates, as opposed to one with less salt, is generally more effective at lowering blood pressure for people, regardless of their pregnancy status. The consumption of sugars, particularly fructose, has frequently been associated with higher blood pressure levels. To combat preeclampsia, characterized by elevated blood pressure in pregnant women, Nichols advocates for a dietary regimen that incorporates an increased intake of salt, potassium-rich foods, and adequate levels of protein and fats, with a particular focus on glycine-dense foods like slow-cooked meats and bone broth.

Understanding the notion of increased sugar concentrations in the blood: It is crucial to emphasize the significance of a nutritional regimen that prioritizes the consumption of foods that have minimal impact on blood sugar levels and limits carbohydrates to manage glucose effectively and avert gestational diabetes.

Nichols addresses the widespread misunderstandings regarding the impact of pregnancy on blood sugar levels, explaining that a decrease is a normal occurrence, that an excessive intake of carbohydrates, especially processed ones, can elevate blood sugar and increase the risk of complications, and that entering a state of nutritional ketosis is a typical physiological reaction during pregnancy and is not a cause for alarm.

Lily Nichols explores the increasing occurrence of gestational diabetes, which is characterized by a pregnant person's reduced ability to process carbohydrates and is part of a larger trend that includes the escalation of prediabetes, type 2 diabetes, and the overconsumption of carbohydrates, impacting as many as 18% of pregnant individuals. She argues that current dietary advice for pregnant women that emphasizes high-carbohydrate foods is misguided and goes against the known effects of carbohydrates on the body. Instead, she encourages all women—regardless of their diagnosis—to eat a diet that prioritizes low-glycemic carbohydrates, such as those found in non-starchy vegetables, legumes, and high-fiber fruits, especially if their fasting blood sugar is high or their blood sugar runs higher than average after meals. Lily Nichols underscores the importance of sufficient protein intake for preserving pancreatic well-being and enhancing blood sugar stability.

Other Perspectives

• While dietary strategies can help manage pregnancy-related discomforts, they may not be effective for all individuals, and some conditions may require medical intervention.
• Natural remedies and dietary changes may not be sufficient for managing all health issues during pregnancy, and there is a risk of overlooking serious conditions that require conventional medical treatment.
• The advice on managing nausea with dietary changes and supplements may not consider individual differences in women's responses to these interventions, and some may find little to no relief with these methods.
• Food preferences and aversions during pregnancy can be strong and sometimes uncontrollable, making it challenging for some women to maintain a balanced diet despite their best efforts.
• Lifestyle and dietary changes for managing heartburn may not work for everyone, and some individuals may still require medication to control their symptoms effectively.
• A whole food-based nutritional regimen may not be accessible or affordable for all pregnant individuals, potentially leading to feelings of inadequacy or stress.
• The emphasis on a fiber-rich diet for constipation may not address the underlying causes of constipation for every individual, and some may require additional treatments.
• Recommendations for weight management based on pre-pregnancy BMI may not account for individual metabolic differences or the needs of the fetus and could potentially lead to undue stress or unhealthy dieting practices.
• The advice against reducing salt intake to control hypertension may not be appropriate for all pregnant women, particularly those with pre-existing hypertension or preeclampsia, who may require a more nuanced approach.
• The focus on limiting carbohydrates to manage blood sugar levels and prevent gestational diabetes may not consider the complex nature of gestational diabetes, which can also be influenced by genetic factors, and may not be preventable through diet alone.

The importance of traditional practices for recovery after childbirth.

Nichols underscores the critical need for women to prioritize their well-being and recuperation in the often-neglected yet vital period following childbirth. She explores worldwide postpartum customs that prioritize rest, provide dietary reinforcement, and advocate for a gradual return to physical activity, all with the intention of aiding the mother's recovery and enhancing the infant's health.

The time following childbirth Ensuring personal health and relaxation should be given top priority.

Lily Nichols emphasizes the crucial three-month phase following childbirth, a period marked by substantial physical and emotional transformations that are vital for the well-being of both the mother and the infant.

Embracing age-old practices that emphasize recuperation postpartum through rest, dietary nourishment, and the support of a community.

Nichols explores a range of international traditions aimed at aiding mothers during their postpartum rest and recovery, emphasizing the importance of focusing on the recuperation of the mother.

In a wide array of societies, including those found in China, Korea, Japan, Mexico, Guatemala, India, Jordan, Namibia, and certain Amazonian regions, there exists a custom where new mothers observe a confinement period of at least six weeks, known as resguardo, which means "to protect." During this time, they typically remain indoors, often restricting themselves to bed, avoid strenuous activities that could deplete their strength, including tasks that require significant physical exertion, and focus on recovery, rest, nourishment, and establishing a bond with their newborns. To uphold these traditions, mothers were supported by relatives who cared for the infants and handled the cooking, with the involvement of outsiders kept to a minimum. Nichols underscores that the seemingly strict customs relative to modern methods aim to enhance the health of mothers, ensure the survival of newborns, and foster effective breastfeeding. She advocates for blending these traditions with one's unique cultural heritage and personal situation whenever feasible.

Recognizing the shift in priorities and self-perception that comes with becoming a mother, as well as the recognition that recuperation following childbirth is a gradual process,

Nichols emphasizes the excessive strain that Western society places on new mothers to quickly resume their normal activities, which can hinder their recovery postpartum.

She underscores the significance of focusing on recuperation postpartum, suggesting a gradual resumption of physical activity instead of diving straight into intense workouts. She also acknowledges the profound psychological effects that come with the journey into motherhood. She underscores the importance for new mothers to acknowledge the shift in their priorities and to comprehend the transformation that comes with forming a new bond with their physical selves, which may also include ongoing changes to their body's shape and size. She emphasizes the importance of self-care for mothers, underscoring the need to maintain mental well-being and to seek support in managing the duties associated with motherhood.

Accumulating reserves of essential nutrients to enhance the body's ability to produce milk.

Nichols delves into the critical role that a nutrient-dense, whole-food-based diet plays in a mother's recovery and in improving breastfeeding postpartum.

Consuming foods rich in nutrients is crucial for boosting energy levels and facilitating the repair of tissues, which helps in recuperation and sustains breastfeeding.

The author underscores the significance of a diet rich in nutrients to support physical recuperation and replenish the nutrients depleted during pregnancy and delivery. She emphasizes the necessity of a nutrient-dense diet following childbirth, noting that it is vital due to the continued high caloric needs. Vital for recuperation and the production of breast milk.

She emphasizes the importance of incorporating certain nutrient-dense foods into the diet, such as nutrient-packed soups and stews based on bone broth, which are sources of amino acids essential for collagen production, electrolytes, and micronutrients, as well as meats and organ meats with high iron content to restore the iron depleted during childbirth. Additionally, she advocates for the consumption of foods abundant in vitamins A, D, and K, which are primarily found in animal products like meats, eggs, and full-fat dairy, along with foods high in omega-3 fatty acids, including salmon, sardines, oysters, and grass-fed beef, which are crucial for brain development and may help in lowering the chances of postpartum depression. The inclusion of iodine from seafood and seaweed, as well as properly prepared grains and starches that are consumed with protein and fat, is also recommended to maintain consistent energy levels and stabilize blood sugar.

- Fulfilling the heightened nutritional needs associated with breastfeeding: Prioritizing the selection of vital nutrients to promote the health of the baby and improve the quality of breast milk.

Nichols addresses the common misconception that, when it comes to breastfeeding, “what you eat doesn’t matter,” pointing out that this is only partly true in that the breastfeeding human body is designed to ensure infant survival even when the mother’s diet is not providing adequate levels of all the nutrients needed for optimal health in both of them. However, she argues that consuming foods abundant in vital nutrients is not only important for improving breast milk quality but also plays a significant role in postpartum recovery.

She underscores the significance of the variety of fats ingested, including omega-3, omega-6, trans fats, saturated fats, and monounsaturated fats, because they significantly influence the composition of fats in your breast milk. During this time, it's especially important to avoid processed vegetable oils, trans fats, and synthetically produced fats such as margarine and shortening. She recommends a higher intake of fats, especially those derived from animals, as they enhance the breast milk with beneficial fats that are not only simple to digest and provide quick energy but also play a role in promoting brain calmness and have antimicrobial properties that are essential for the development of an infant's digestive system and gut microbiome. She emphasizes the importance of obtaining sufficient Vitamin A from food sources, as plant-based carotenoids do not reliably serve as substitutes, and it has been observed that women's breast milk often has lower Vitamin A levels when their diets lack animal-derived foods. Lily Nichols highlights the critical need for adequate intake of Vitamin B12, choline, iodine, and DHA for the healthy growth, brain development, and mental well-being of infants.

Tackling the multitude of factors that influence the recovery of both the physical and mental aspects.

Nichols highlights the importance of dedicating attention to healing in body and mind during the first few months following childbirth, recognizing that the demands of new motherhood can substantially deplete one's resources, such as time, vitality, and motivation. She advises deliberately planning for these changes rather than expecting an immediate resumption of one's typical condition.

Consciously participating in exercises aimed at gradually rebuilding strength and function.

Nichols recommends that new mothers gradually increase their physical activity, highlighting that a cautious increase in exercise intensity is a wiser and safer approach to regain muscle tone and control in the pelvic and abdominal areas, and also to minimize the risk of injury or worsening issues like abdominal muscle separation or issues with bladder control.

She underscores the necessity of careful consideration prior to initiating physical activity postpartum, likening it to the recovery needed after surgery, and points out that even if pain or incontinence is not present, proper healing of the abdominal and pelvic areas is crucial. The muscles used during vaginal childbirth are significantly stretched and do not immediately regain their normal tightness or strength. As the pregnancy progresses, activities that were once easy to manage, such as jogging, might start to cause discomfort due to the stretching of ligaments, loosening of joints, and the shift in the body's center of gravity. She emphasizes the importance of heeding the signals their bodies send during physical activity. She recommends consulting with an expert in female health or a pelvic floor therapist who can thoroughly assess the strength of your pelvic floor and core muscles, providing you with specialized exercises to aid in your recovery.

Consulting a healthcare professional is essential when addressing issues including diastasis recti, urinary incontinence, and other pelvic floor-related problems.

Nichols underscores the importance of robust musculature in the lower pelvic region and offers advice on identifying issues such as pelvic organ prolapse and urinary incontinence that may arise postpartum, suggesting that women seek advice from an expert in women's health physiotherapy or a professional trained in pelvic floor rehabilitation for a thorough assessment and tailored rehabilitation strategy.

She explains that due to hormonal changes and increased strain on the pelvic muscles and ligaments, these structures may lose their tightness, which could undermine their ability to provide support and lead to a diminished effectiveness of the pelvic floor. She highlights a commonly neglected condition in which up to half of all women experience a descent of their pelvic organs, which can even extend beyond the vaginal entrance. She recommends that expectant mothers pay close attention to their body's cues, particularly when they feel satiated, notice a protrusion, or have the clear sensation of something round pressing against the pelvic region, since such signs could be indicative of a prolapse. Nichols emphasizes the importance of properly engaging and easing these muscles, noting that the haste to regain a toned abdomen after childbirth can often lead to incorrect use, which might worsen discomfort, pain, or existing ailments.

Adopting a steady and gradual approach to weight loss

Nichols emphasizes the need for a consistent and long-term approach to weight loss postpartum, concentrating on the body's natural healing process instead of rushing to return to one's pre-pregnancy shape.

She underscores the fact that the body undergoes transformations over nine months of pregnancy, and it is logical to anticipate a similar period for recovery and to lose the weight gained throughout that time. She underscores to mothers that although they may lose weight quickly, their bodies may continue to adapt to changes such as stretch marks, an altered belly button, and variations in skin elasticity, along with the pliability of their connective tissues, and the composition of their mammary glands. She notes that the rush to regain one's former physique can sometimes overshadow the incredible ability of women to nurture and give birth to new life. Nichols recommends that new mothers postpone any attempts to lose weight for the first three months postpartum and instead focus on a nourishing diet comprised of unprocessed foods, while being mindful of their dietary patterns rather than strictly regulating their eating or meticulously tracking their caloric intake.

Prioritizing emotional health through the pursuit of communal support and valuing one's psychological state.

Nichols acknowledges the mental and emotional hurdles that come with recuperation post-delivery, highlighting how a shift in attention and a sense of isolation may contribute to the onset of depression and anxiety after giving birth.

She recommends that women prioritize their mental health by connecting with other mothers via online forums or in-person meetings, and by embracing techniques for mindfulness, reducing stress, or seeking professional counseling if needed. Lily Nichols advises expectant mothers that the demanding aspects of pregnancy, combined with hormonal changes and the continuous demands of newborn care, may increase their vulnerability to deficiencies in vital nutrients such as choline, vitamin B12, iron, vitamin D, and DHA, which can influence their emotional well-being.

For the optimal well-being of both mother and offspring.

Nichols underscores the significance of carefully considering the interval between births, noting that research on optimal spacing for future pregnancies can inform family planning choices.

She observes that closely spaced pregnancies may heighten the likelihood of complications for both mother and offspring, owing to the mother's depleted stores of essential nutrients, inadequate recovery time, changes in immune system performance, and hormonal fluctuations. She emphasizes that traditionally, many cultures tended to observe a gap of around two and a half to three years between births, providing mothers with sufficient time to recover, sustain breastfeeding for future children, and improve the chances of survival and health for their subsequent young. Nichols advocates for conventional practices, citing a comprehensive review of 58 studies that established a link between shorter gaps between pregnancies and an increased likelihood of developing preeclampsia. Studies show that the lowest number of complications occur in mothers who space out their pregnancies by at least 18 months, with a significant reduction in risks if they do not conceive again for a minimum of one year. In our current era, where it's not unusual for births to occur in quick succession, especially among those who begin their families at an older age or wish to have numerous children, she emphasizes the importance of recognizing these risks and actively improving one's nutrition and overall health before planning another pregnancy.

Other Perspectives

• While traditional practices can be beneficial, they may not be practical or desirable for all new mothers in modern contexts due to work obligations, personal preferences, or lack of community support.
• The emphasis on rest and dietary nourishment postpartum may not account for the diverse health conditions or recovery needs of individual women, which can vary widely.
• The gradual approach to physical activity may not suit all women, as some may feel capable and prefer to return to their regular exercise routines sooner.
• The focus on nutrient-dense, whole-food-based diets may not consider the socioeconomic barriers that can prevent access to such foods for many women.
• The recommendation to avoid processed foods and certain fats may not acknowledge the complexity of nutritional science and the fact that moderation and a balanced diet can also be effective.
• The advice to consult healthcare professionals for pelvic floor issues assumes access to such resources, which may not be available to all women, particularly in underserved communities.
• The suggestion to space out pregnancies for optimal health may not consider personal or cultural beliefs about family planning, or the fact that some women may not have the luxury of planning their pregnancies due to various factors.
• The idea of prioritizing emotional health through communal support may overlook the reality that not all women have access to supportive communities or the means to seek professional counseling.
• The narrative that the body should take a similar period to recover postpartum as it took to change during pregnancy may not align with the varied experiences of women, where some may recover faster or slower than this timeframe.