Today I am so excited to have registered dietitian and real food advocate Lily Nichols!
Lily, who blogs over at www.pilatesnutritionist.com, is an expert with heaps of experience counseling women on their diets throughout gestational diabetes. She recently published a book earlier this year, Real Food For Gestational Diabetes, and is on a self-declared mad mission to evolve the medical communities archaic approach to caring for women with gestational diabetes and bring it more up to date with the current scienctific research and understanding. Below is a transcribed interview I had with her a few weeks back. It is a must read for anyone diagnosed with gestational diabetes!
SSB: So Lily let's start off by going over what you think are the top 3 most notorious myths concerning gestational diabetes?
Lily: I would say that a lot of women have been told that they need to eat a very specific level of carbohydrates and they cannot go lower than this level of carbohydrates without harming their baby. That is a huge myth, and that is one of the things that I tackle pretty in depth in my book, Real Food For Gestational Diabetes, because it simply just doesn’t hold up to the science, doesn’t hold up to the research.
Another one is that baby will be big no matter what. So a lot of women have been told that when you have gestational diabetes the chances of having a “big baby”, a macrosomic baby, are higher- and that’s true, it is higher- however statistics, you know it’s statistics, and yes statistically your chances of having a large baby go up but that doesn’t mean that you have to be a statistic, right? So the chances of you having a larger baby correlate very strongly to blood sugar control during pregnancy. So if you know what to do to keep your blood sugar under control your risk of having a big baby goes way way way down and if your blood sugar stays at pretty much normal levels you have no higher risk of a big baby than somebody who doesn’t even have the diagnosis. So that’s a big one.
It’s hard to choose just three but I’d say the final one is that a lot of women believe that they will require insulin and that there is nothing that they can do to reduce the chances of requiring insulin and that is also not true.
The conventional diet therapy for gestational diabetes, which I kind of eluded to earlier, is pretty high in carbohydrates, a minimum of 175 grams per day and women who follow that advice- again from the research- shows that there is about a 40% chance that you’re not going to be able to control your blood sugar through that diet alone. But they have also shown that if we change up the way we think about the diet for gestational diabetes and instead think of a low glycemic diet and one that is a little lower in carbohydrates we can reduce the likelihood that a woman will need insulin by fifty percent (italics mine), which is huge!
"...We can reduce the likelihood that a woman will need insulin by 50%, which is huge!"
So I’m into giving women all the information they need to make better choices and reducing those chance because I believe that- and I think most doctors agree- that the goal is to control this as naturally as possible. As always there are going to be some women that no matter how hard they try, you can do everything right, and you will still need insulin. But we can put your odds in your favor by giving you better dietary information.
SSB: So if a woman finds herself diagnosed with gestational diabetes, what are the most important first three steps she should take?
Lily: Number one is you want to start monitoring your blood sugar. Knowledge is power! If you don’t know where your blood sugar is at you are pretty much helpless. You will have no idea what to eat, a lot of women feel like they have to starve themselves, they just don’t know what’s going on. If you don’t check your blood sugar you will never have the information to change up your diet or lifestyle to get your blood sugar under control. It’s kind of like see no evil, hear no evil kind of thing. You want to be able to see clearly what’s going on and observe patterns in your blood sugar so you know what changes to make.
So for example some women will notice that their blood sugar will go high after breakfast and at lunch and dinner it’s ok. So that might give them a clue, ok maybe I need to take a closer look at what I’m eating for breakfast and experiment a little to find something that is going to work better. So monitoring the numbers is huge, you can notice trends, and then you adjust and be proactive.
Number two is I would suggest they pay attention to the foods that raise their blood sugar the most, and that, in general, is the foods that are high in carbohydrates. Start to get comfortable with which foods contain carbohydrates and which ones contain more or less of them, so you can kind of see “oh I can eat a much larger volume of vegetables versus rice” and still keep the carbohydrates under control. Especially be cautious of the foods that are high in processed or refined carbohydrates because those tend to digest much quicker, spike the blood sugar much more, lead to unstable blood sugar and insulin levels- which then just further fuel those cravings for more of those foods- it’s kind of like this vicious cycle thing. So just get comfortable with where your carbohydrates are coming in, what sources, and again, tying it into number one, seeing how it affects your blood sugar because carbohydrate tolerance, how well your blood sugar responds to any given amount of carbohydrates, is different woman to woman. Some people can handle a lot more and still have normal blood sugar and other people have to be super super strict- and you only know if you test your blood sugar and see!
Number three is to listen to your body. And that is kind of a weird one to choose for gestational diabetes but gestational diabetes tends to medicalize pregnancy, right, you have to be monitored and you have to follow a certain meal plan, so they say, and you have to eat this many grams of carbohydrates and you have to check your blood sugar at this hour after eating, it kind of puts you in this very regimented schedule, and even though some of those things need to happen, it’s important, but there’s still room within any of these plans or regimens to customize it based on what is going on in your body. So how are you feeling after you eat whatever recommended amount of food that was on your meal plan? Are you completely stuffed? Are you starving? Are you just right? You know that’ll give you different information. So instead of trying to meet a certain goal of your meal plan, you’re meeting your body’s needs instead. How do you feel when you move or exercise a little more? How do your blood sugars respond? All these things, these mindful practices, really go a long way in helping you become a master of gestational diabetes and getting your blood sugar under control, and thus making sure your pregnancy is as healthy as possible.
SSB: And I will also add that they should go out and buy your book! (laughing) Because that one was darn good! The thing that I loved the most about your book was the stories that you included in there of past clientele. I mean it just knocks your socks off to see these women struggle, some for so long, through so many pregnancies, and then just have these, like, miracle stories basically, just by changing their diet! It just was amazing.
Lily: And I could write a whole other book with only those stories now! I have an online program as well, in edition to the book, which offers more support and guidance to make this as easy as possible, and the stories that I am hearing from the program are insane! One of the women had had two previous gestational diabetes pregnancies and this was her third gestational diabetes pregnancy. Both previous times she required insulin. And the statistics are, you know, that if you’ve had gestational diabetes once, you’re going to get it again. And then the odds are if you have to take insulin to control your blood sugar, you’ll likely have to take insulin again. And then as you get older, which you know obviously as time passes and you have a later pregnancy, your older, usually your insulin resistance gets worse and again more likely to require insulin. So this gal was able to avoid insulin in her third gestational diabetes pregnancy. She was completely diet controlled. No complications, baby was born perfectly healthy, I believe close to 8 pounds, no issues. And I mean as a clinician I like people to be proactive about things but I’m also a realist. So you know, I’m like, “given your history, it’s pretty likely that you will require insulin, keep that in mind, it’s not a bad thing, having your blood sugar under control is the number one most important thing and greatly reduces risks for your baby”, right? But lets do everything we can and just see what happens, and it just goes to show that when your given the right information and you’re not overwhelming your body with the wrong foods, and the wrong quantities, and all this garbage, literally miracles can happen.
SSB: Yeah, yeah, it’s the power of food.
Lily: Yeah, super empowering that your body is on your side. You know a lot of women feel like their body has failed them with gestational diabetes. And I’m like, no no, your body is just talking to you my friend. (Laughing) Lets just respond as kindly as we can.
SSB: So protein is of paramount importance in pregnancy but it becomes even more so in gestational diabetes. What are some plant based protein options for vegetarian and vegan mamas or do you think these women should rethink the boundaries of their diet with gestational diabetes?
Lily: Vegetarian protein is a little bit tricky with gestational diabetes because many plant based protein options also contain a high amount of carbohydrates so it makes it a little bit tricky to find the right balance while still giving you enough energy, enough calories. So it kind of becomes a battle between protein versus carbohydrates so sometimes vegetarian women will kind of need to get a little more into the numbers with food to make sure they are balancing things out ok.
As an example beans, like lentils, are a classic staple protein option for vegetarian moms. Half a cup has around 7 grams of protein, which is the amount you would find in an egg, but it has 15-20grams of carbohydrates, while an egg has zero. So if you were to have, say, your complimentary protein matching, making a complete protein, having beans and brown rice at a meal, maybe you’ve hit 15 grams of protein-which in my opinion is a little low for a meal- but for many women you have already exceeded your carbohydrates limit for the meal.
You might be at 30 or 40 grams of carbohydrates, and again, some women can get away with that and for some other women that is far too high to be able to keep their blood sugar under control. So that part is a challenge just from the fact that vegetarian and especially vegan sources of protein often contain carbohydrates.
Nuts happen to be a lot lower in carbs and you have a lot more fat to go along with the protein, so that is a good option. If women are not strictly vegan and are willing to do greek yogurt, cheese or eggs, those are all very high in protein and fairly low in carbohydrates. There are some vegetarian protein powders like pea or rice protein, again a low carb option.
But even beyond meeting a certain protein goal, it’s not just protein that matters, it’s the type of protein and also the other nutrients that go with it. For example needs for certain amino acids go up in pregnancy and protein foods are all made up of amino acids. Some are essential, you have to get them from foods. Some are nonessential, you generally don’t have to get them from foods, your body can make enough from other proteins.
So one example is there is an amino acid called glycine which under normal circumstances is nonessential, but during pregnancy needs go up so drastically because it’s needed to grow a lot of the growing fetal tissues, a lot of the connective tissues needed for the growing uterus- so because your needs go up so drastically your body cannot get enough from other protein sources alone, you have to consume it directly.
The highest sources of glycine are found in the bone, skin, and connective tissues of other animals. So we are talking bone broth, slow cooked tough cuts of meat, pulled pork, or beef roast, chicken with the skin, fish with the skin, those give you a ton of glycine, and that is a really key nutrient for your growing baby and to support your uterus and all the changes that are going on in your own system. In addition to that we have nutrients that we simply can only get from animal foods: vitamin B12- of course you could always do a supplement, the most absorbable forms of iron come from animal foods, DHA- aside from algae, is an animal based omega-3 fat, preformed vitamin A- not the beta-carotene that you get from carrots we only convert a very very tiny percentage of that into true vitamin A….and vitamin A needs to go up during pregnancy…..all those you can only get from animal foods. So if women are willing to rethink the boundaries of their vegetarian/vegan diet, then yes, absolutely, I suggest some animal protein during pregnancy and, I’m trying to remember, I think it’s chapter 5 in my book that I go into all the research behind some of these foods that are super health giving during pregnancy and that provide a lot of these nutrients naturally, and quite a few of them happen to be from animal foods. So I think as along as you are sourcing your animal foods from good places, grass fed beef, pasture raised chickens, wild caught fish, grass fed dairy, you are going to be ensuring that A: the animals are raised with respect but also B: there are higher nutrient levels in them too so it’s kind of a win win.
SSB: Well thank you so much for taking the time to be with us!
Lily: Your welcome!