Latest / Radically Genuine / 127. Fueling for Fertility: Nutrition to Conceive and Carry w/ Lily Nichols RDN
Transcript
- Welcome to the Radically Genuine Podcast. I'm Dr. Roger McFillin. In 1950, women were having an average of 4.7 children in their lifetime. Researchers at the University of Washington's Institute for Health Metrics and Evaluation showed the global fertility rate was cut in half to 2.4 in 2017. And their study published in The Lancet projects it will fall below 1.7 by the year 2100. The media will discuss this as a success story of improved contraception and more thoughtful decisions around family planning. What is untold is our rapidly declining health and the number of women who want to get pregnant naturally but cannot. Since the late 1980s, testosterone levels in men have been plummeting at a rate of 1% per year. Sperm count too has dropped 50 to 60%. in the past 40 years. Not only do today's men produce less sperm, but the quality of the sperm they produce is lower. A 2022 meta-analysis suggests a decline in sperm counts may be accelerating. Proposed explanations include lifestyle factors such as changes in diet and physical activity levels, increased exposure to endocrine disrupting chemicals such as those found in plastics and pesticides. On the female side of the equation, miscarriage rates are also increasing by about 1% per year in the US and so is the rate of gestational surrogacy. Meanwhile, the total fertility rate worldwide has dropped by nearly 1% per year since 1960. There is an increasing distrust in the medical authority and government recommendations. Many of the standard food and healthcare advice is implicated into the decline of our physical and mental health. What foods are actually healthy? How much? The degree of contradictory health advice is absolutely frustrating to the average person. When it comes to fertility and pregnancy, the stakes are obviously much higher. With declining fertility... Sean (02:25.918) increases in miscarriage and a range of concerns around birth defects, autism and neurocognitive disorders, women are now understandably vigilant and even stressed when trying to get pregnant and when they do become pregnant. So we are grateful to have one of the world's foremost fertility and pregnancy nutrition experts join the show today. I've started following her work and her grasp of the scientific literature is unparalleled. Lily Nichols is a registered dietician nutritionist, certified diabetes educator, researcher, and author with a passion for evidence-based nutrition. She's the author of two bestselling books, Real Food for Pregnancy and Real Food for Gestational Diabetes. And she just released her new book, Real Food for Fertility, co-authored with fertility expert, Lisa Hendrickson-Jack. The book has over 2,600 scientific citations and is a comprehensive resource on optimizing preconception nutrition for both partners to improve outcomes in fertility, pregnancy, and beyond. We're often asking, what is the optimal human diet here? We're focusing on areas around wellbeing, quality of life, mental health. And she is a great resource to come on to the program. She's also a founder of the Institute for prenatal nutrition, where she mentors other practitioners on perinatal nutrition, and is the co founder of Women's Health Nutrition Academy, which offers individual webinars on a variety of women's health topics. Her Instagram is absolutely phenomenal. Any woman of childbearing age, you know, I would be on that, especially if you're interested in conceiving. or you're pregnant. Lily Nichols, welcome to the Radically Genuine Podcast. Lily (04:24.683) Thank you. That was an epic introduction. Sean (04:29.415) Lily, I've been following your work. And what you don't do is regurgitate the standard nutritional advice that many mainstream nutritionists kind of regurgitate. What I am kind of interested before we get into the weeds about specific recommendations, I'm a little bit interested in the standard academic curriculum for nutritionists. And what is the path that you took to become independent? Like specifically, if I always create these questions around like the biases that exist around saturated fat, I think is a great one that exists in your field. So I am interested in you, the person and how you kind of got off that standard track. Lily (05:12.727) Well, I feel like it kind of got off the standard track from the get-go because I decided I wanted to go into this field when I was a teenager and actually entered with a nutritionist who is not a dietician. And she's the one who introduced me to the work of Dr. Weston Price. And like at the time I was vegetarian, I mean. So I already had this introduction to ancestral nutrition before I even did my formal training. I did end up doing my formal training as a dietician. So I went through a very conventional program at the University of Massachusetts Amherst and did my dietetic internship at LA County USC Medical Center. So like both, you know, kind of established institutions very much following the guidelines. But I think that difference is that I sort of knew what I was getting out of this sort of a program, right? I think you get the science base, which is helpful. You have access to all the medical journals. So I was like cross-checking things that I was being taught in my classes and being like, huh, that's weird. They didn't bring up this nutrient, which I know, you know, Dr. Price writes about, and is there anything else to learn about, you know, vitamin K2 or... They didn't talk about phytic acid. Why not that they're presenting artificial sweeteners is beneficial. Let me look into the research on Splenda, which at the time was like a new sweetener and look into the aspartame research. So I kind of took it as an opportunity for digging deeper on my own, but I was very tangibly aware of the limitations of that education and the purpose of those programs, which are to create. practitioners, dieticians who work within the medical system as it currently exists. And don't get me wrong, a lot of conventional dieticians do amazing work. I think you can see really how incredible the work is when you're in an ICU setting, or when I was in the burn unit at County USC Medical Center. I mean like... Lily (07:27.403) There's a reason we like do all these nitty-gritty calculations once you're calculating, you know, TPN recommendations for a person who's had 40% of their body burned. Like, wow. But where I feel it often falls short is that, I mean, it's very clear, even when you're in the program itself, that the dietary guidelines are very much influenced by the food industry. When you do look at things through the lens of ancestral nutrition, you can see just the gaps, like the things that don't make logical sense. So I kind of started from the get-go, I wasn't fully bought into everything I'm being taught is necessarily true, but it serves a purpose within this larger system. So I made the choice to kind of move outside of that system. And I certainly worked within it as a dietician, I worked as a clinical dietician in a perinatology. office for many years. That's where I like developed my differing approach to gestational diabetes, but I kind of took it from the angle of like can we improve upon these guidelines and having worked in the public policy sphere, at least on a very small scale with the California Diabetes and Pregnancy Program, I saw firsthand how difficult it is to try to move the needle on guidelines. And so I was like, okay. trying to go about this from a policy angle isn't going to work. I think I have to go about this from a grassroots level. So I happen to really enjoy reading research and writing about it and making sense of it for the general population. Practitioners are really hungry for that information. And so that's how I kind of moved in the direction of writing books, educating practitioners, just where are the gaps in the guidelines? How were they set in the first place? and can we do better? And oftentimes, we can, we don't have perfect research on every single thing, nutrition tends to be, and the questions I really want answers to are often understudied, but we can at least kind of like get in the right direction and start moving away from these industry funded, super outdated guidelines, which often themselves weren't really based on the greatest evidence. Lily (09:47.859) But it seems to take like an insurmountable amount of new evidence for anybody in positions of power to be willing to change them So we're in this like Standstill I'm just trying to fill in fill in the gaps because I don't think we should be Leaving a generation or two behind on optimizing their health their fertility their pregnancy outcomes the health of that future generation Just because we're forced to follow these old guidelines. Sean (10:19.574) Before we get into some of the science that supports this, let's just get a definition for incestoral nutrition. What does that mean to you? How is it defined? Lily (10:28.935) Good question. I don't have an answer written out for this in my head, but to me, when I'm thinking of ancestral nutrition, I'm thinking of what did human beings consume when they were living in small tribal or indigenous communities before the advent of industrialized Lily (10:56.803) foods of modern commerce is how Dr. Price puts it, but before we started shipping in foods that were like unnatural to that region or that season, how did humans eat? And you do of course find that that's going to vary significantly based on what's available in that local area and for that climate, right? So I think ancestral nutrition is a bit, what I like about it is it's a bit broad and that it doesn't. It doesn't point to just one way of eating as being appropriate for all populations. It's what's natural and local to you. And by default, of course, before all this industrial processing, your diet really is based on whole foods. So, simple enough. Sean (11:43.21) Do you believe we are either experiencing a fertility crisis or going to be facing one? Lily (11:50.111) I mean, I think we're in it right now. As it stands, approximately one in six couples are facing fertility challenges. If you see like in the sperm quality chapter we have in real food for fertility, we go through the declining sperm counts and sperm quality that's being seen. And then of course the guidelines for normal are also declining in lockstep with what's seen in the average decline. So I think we are in that situation. I mean, the number of couples that I hear from that are having challenges conceiving is just through the roof. Sean (12:30.402) And what do you account for? What variables do you think are influencing it? Lily (12:34.939) Oh man, dozens. First of all, I think our lifestyles are a mismatch for fertility. Uh, we're not spending as much time outside. We're not connected to nature. We're not getting enough, uh, sun exposure. That's not covered up with, with sunscreen, which will block some of the benefits of that sun exposure, including your vitamin D production. Our sleep cycles are all wonky from. work stress, artificial lights, use of technology late at night, and just not getting that daytime sun exposure like completely throws off the circadian rhythms. Dietary quality is way down. So not just not even just people trying to eat you know ancestrally or not or base their diet around whole foods or not but just the overall food quality is down. I mean we're growing food on depleted soils with just... The amount of agricultural chemicals sprayed on crops is wild. I have conventional crops growing nearby and you see the planes flying over, the giant combines. I mean, it's wild, right? But when you watch the fields right before they go to harvest the soy, for example, and they kill spray everything with glyphosate right before harvest, I mean, you see it firsthand. So I think our food supply is low quality contaminated. Even if you're trying to eat high quality, it takes a lot of work and a lot of extra time and money, honestly, to eat well. Gosh, what can you add to the list? Low activity levels. I mean, there's so many potential factors that are all working together, which is unfortunate and also points to... There's also a lot of areas we can work to improve as well. You know, it doesn't have to be super doomsday scenario. Sean (14:34.158) I think that's also compounded by starting later in life to actually start a family, maybe economically driven. We should probably be trying to conceive in our early to mid 20s, but a lot of people are waiting until their early 30s because they feel like they can't support a family until they've made enough money to allow that to happen. That's definitely part of it. Yeah, Lily, this might be outside your areas of expertise, but I'm gonna ask it anyway. Lily (14:39.38) Yes. Sean (15:03.586) hormonal birth control, do you think in any way that might be a factor? Lily (15:07.807) Yes. And I was actually just going to follow up with what Sean said there is that in the delay to start families until later, where we do see legitimate declines in egg quality over time, particularly as you get over age 35, you also see declines in sperm quality over time. Although, you know, men can keep producing sperm for a very long time, whereas women have, you know, a period of menopause where they're just no longer ovulating, right? But women delaying families for longer and being on hormonal birth control for many years, as is often the case. I mean, some women are started on it as teenagers. That completely shuts off your ovarian hormone production. It also results in several nutrient deficiencies as well. So when you have these women who have had their, you know, normal hormonal production just turned off, and they have this influx of synthetic hormones, the longer that you're on hormonal birth control, the greater the likelihood there's gonna be challenges when you come off of it. On top of that, a lot of women are started on hormonal birth control because they're told this lie that it's going to fix their period problems or whatever symptoms they're dealing with. When... it might make them go away, but it's not because it's fixing it, it's just masking it. So then when you compound the nutrient deficiencies that you have now developed over all of these years and you come off of it, well, what are you going to notice? Like the same cycle issues you were having before are probably going to be there. They might actually be more severe because now you're dealing with, you know, the fallout of coming off all of these hormones and those nutrient deficiencies. And it does... take a while for the cycle to normalize after coming off hormonal contraception. Sometimes 12 cycles and your cycles aren't always exactly a month. So that sometimes is like an 18 month period of time before we start seeing like ovulatory function resume to what we would expect for a woman of your age. So absolutely that plays a big role and I'm glad that you brought that up because I was missing from my list. Sean (17:28.77) That's very familiar. I was out in Los Angeles and I'll be honest, my wife and I, we tried to conceive, it took us eight years before we were lucky enough to have our child. But in her circle of friends, a lot of them were working. They were on birth control mostly because they were afraid of getting pregnant at a time when they thought that they weren't ready for a family or if they had like an irregular period. And the irregular period, once they met their partner, wanted to start to conceive, they went off their birth control. And some of them, you know, wouldn't ovulate or have a period for like three months, maybe it was diet related. And then they had to optimize that to try and get back to a regular cycle. And that took months and months and months and a lot of dietary changes. So it actually ties in very nicely with today's conversation because I'm learning a lot and I wish I knew more when we were trying to conceive for those eight years. Yeah. I think Lily (18:25.473) Yeah. Sean (18:26.146) The segue here is into just opening the discussion on fertility boosting foods. And I would imagine that if these foods are fertility boosting, then they're in all likelihood, like the optimal human diet, because it is going to, in order for a woman to become pregnant and to carry a baby through term and for that baby to be healthy. Imagine what is required from nature in order to do that. And that kind of gives us, I would imagine, some window into how to optimize the human condition through nutrition. So let's start talking about that. Are there such things as fertility boosting foods? Lily (19:07.943) Yes and no, right? My opinion is that I'm in full agreement with you on foods for optimal human function being foods that also optimize fertility. Because when we look at what's required for a human being to survive, fertility is one of those optional functions of the body. You can survive. for a very long time and be like completely infertile, right? And if nutrition is not optimal, one of the first places your body is going to metabolically pull back from is on fertility. You see it at a slower rate with men, with women, it's very obvious because we have this feedback from our monthly cycles relaying information to us, time and time again, whereas a man might not necessarily know unless they're doing like a semen analysis on a regular basis. But you see ovulation slow or even stop when a caloric deficit of only like 25% of calories is put into place. And that happens within a period of just a couple of months. In addition, there's a number of micronutrients that are absolutely vital to ovarian function, to ovulation, to maintaining healthy, building up a healthy endometrium each cycle, which of course is shed during the months. monthly period. And so when I'm looking at, you know, what is optimal for fertility, you're really looking at what is optimal for general human health and metabolism, because our fertility, our hormone balance is just a reflection of that. So are these special foods that are like not helpful for you outside of the context of fertility? No. But I can highlight in specific ways why they're beneficial to fertility. So one of the first things that I consider is not just the micronutrient balance, but also the macronutrient levels, your fat, carbohydrate, and protein. Goes against the conventional wisdom on fertility, but really protein at its core is one of our most important macronutrients for maintaining human health, but also the health of the menstrual cycle, healthy sperm production, and our protein-rich foods are also by default, often our highest. Lily (21:29.863) most nutrient dense micronutrient rich foods. Of course, in my dietetics training, it was all fruits and vegetables, fruits and vegetables, you know, over and over. Those are our most nutritious foods. And I've actually got nothing against fruits and vegetables. I think they're also part of a healthy diet. But if we're really looking at the key micronutrients required for optimal fertility, this points you in the direction of primarily protein rich foods with some specific other micronutrient rich foods on the side. So you're looking at red meat and animal foods, all foods of animal origin, particularly meat on the bone or slow cooked meat that are richer in collagen. There's a number of reasons that the amino acids within there are vital for fertility, also absolutely vital during pregnancy as you're growing this brand new human being. Eating those animal foods nose to tail. So also including the organ meats Organ meats are just particularly micronutrient dense I mean they have like 200 times more of vitamin b12 per ounce than an equivalent portion of Muscle meat they're also just uniquely concentrated in some nutrients that might not be in large Concentrations in the muscle meat or might not really be in there At all, so definitely some organ meats in there fatty fish and seafood, a lot of the micronutrients in there like iodine, DHA, they can be a little bit tricky to get in the diet in sufficient quantities if seafood is missing. It can be done, but it takes a lot of extra legwork to get there. And when you start to analyze some of the writing of Dr. Price, which some people write off because it's all anecdotal. He really did document some very interesting things in a period of time that we can't recreate those studies now because a lot of these communities are no longer eating their traditional diet or may not even exist anymore, right? But in some of those communities, when you'd have tribes, for example, where one tribe lived more in the mountains and one was in the coast, even if they were warring tribes, they would set up like drop points for sharing food. Lily (23:47.115) where the coastal tribes would bring fish and shellfish up to a certain area to trade with that tribe and the mountain people would bring other foods down. And it's like, they knew that their population needed to have seafood at least every approximately three months for them to maintain fertility. Again, an interesting historical anecdote, but when you look at the roles of Iodine in maintaining ovulatory function, for example, is huge. And we're in a situation now in the US where about half of women actually have insufficient iodine status. Everyone thinks we're fine because we iodize our salt. We're not fine. And when your iodine status is suboptimal, you see significant delays in conception, likely related to issues with thyroid function, but it could be other factors as well. So. Seafood key, I'm just highlighting one micronutrient in there and its role. Minimally processed and full fat dairy products. Not all populations consume dairy, but in those that do, it does really serve as a very valuable source of many micronutrients. Everyone thinks calcium and vitamin D, for example, but it also provides riboflavin and B12. vitamin A in its retinal form. It's actually the major source of preformed vitamin A in the US diet. And if you deprive people of vitamin A, fertility goes down the tubes. Testosterone production goes down, ovulation ceases. In animal studies, they can initiate, like they can completely halt sperm production. They can also halt ovulation by depriving animals of iodine. And in like the farm world where you wanna keep, dairy cows for example, getting pregnant and having babies so they continue lactating, you actually give them iodine supplementation so they maintain their fertility and you give them vitamin A supplementation as well so they maintain their fertility. Fermented foods also valuable for maintaining the microbiome. Healthy gut determines whether or not we're going to be absorbing and utilizing nutrients well. Lily (26:06.495) And that really is the original probiotic before we add all these supplements. And of course, there's a place for vegetables and fruit as well for their many antioxidants, their fiber, and really most communities worldwide you do see eating an omnivorous diet to some degree. Of course, this varies based on their latitude and what's available in the far North. You have significantly less plant foods and the equatorial populations have a lot more. but I do believe they also have a place. Sean (26:40.214) Sean, what does this remind you of this discussion? We've had a lot of discussions. You're gonna have to be more specific. So we've been talking about the optimal diet for mental health. You've asked that question. Almost every professional that's come in here that is in the field of health and diet, you asked the question, is there an optimal human diet? And then I did my own research and I created a sub-stacked article around it. And you and I had a conversation on the optimal mental health diet. And it's just so much about what she's. speaking about. Lily, I do have a question about protein intake. And that seems to be I have a question that might come from that also. So go ahead. Yeah, I mean, that's where there's more contradictory advice right about how much protein we should be eating daily. And I know like the recommended daily allowance just seems like frightening low, like really low. What do you recommend as far as the daily allowance of protein? Lily (27:38.295) So I'm in agreement with you that the RDA is set too low and there's actually a number of protein researchers who have been writing about precisely that in recent years, that the basis of our evidence used to set the RDA is incomplete and they really chose a level that's at a bare minimum to prevent overt protein deficiency and death as a result. but not at a level that's helpful for optimal health. So my opinion is that, so the RDA is set at like a grams per kilogram ratio, so 0.8 grams per kilogram of body weight. So for, if we're gonna use like an example, woman who is about 150 pounds, that equates to 55 grams of protein per day. I mean, I like to put the numbers to it because sometimes people don't realize like, what we're up against here, but it's really low. This is a bare minimum, about 10% or so percent of calories coming from protein. My opinion, and this is all based on some of these game-changing protein researchers, is that we should have a bare minimum of no less than 1.2 grams per kilogram of body weight. It's arguable that optimal is more like 1.5 to 2.2 grams per kilogram. So for that woman who weighs 150 pounds, instead of eating 55 grams of protein, bare minimum would be 80 grams of protein. Optimal may very well be in the range of like 100 to 150 grams of protein a day. Sean (29:25.55) And that's hard. Like if you're just eating a normal diet of like maybe eggs in the morning, a normal lunch, and then. Well, what would be a normal lunch? Let's say like a normal lunch for most people might be like a salad with grilled chicken or like a protein on there or a sandwich, but then at dinnertime, it might be a starch, a vegetable, and a protein. So even if those are whole foods, you add those together, it's difficult to get that many grams of protein. And I think those who are in the space and are aware of some of those numbers, they might supplement in the morning with making a smoothie. So my question is, are those whey isolate proteins or pea proteins, are those sufficient enough to give you the nutrients that you need to offset what you're not consuming as whole food? Lily (30:18.615) I mean, it would certainly fill the gap for just protein requirements. If you're just looking at like grams of protein and trying to get it in. Um, my concern when people are too reliant on protein powders, again, I see no problem with them being used as an adjunct to otherwise the majority of their protein is coming in from whole foods, but, um, my concern when it's taking the place of whole foods is. They're. protein isolate. So they don't, they're not necessarily going to be maintaining the micronutrient makeup that was in the original food. You're also not getting the fat that was in the original food. So you just want to make sure that you're also getting some of those other things on the side. Again, I mean I sometimes use protein powders to like a beef protein isolate or I'm a big fan of we're not getting the level of collagen in our diet than we ancestrally used to, right? You know this if any of you have done like a, you know, an animal share, like a pig or a cow share, and you get all the parts of the animal with it, it's like, holy cow, the majority of this meat is not tender steak and pork chops. Like the majority of it is meat that is connected to bones with a significant amount of connective tissue, right? So if you're really eating ancestrally. we were getting a lot more collagen than we used to. But I do like to emphasize or encourage people to get as much protein as they can from the whole food. So they're also getting that full micronutrient component and the fat that is designed to be there with the food, with the protein. We do need some of those micronutrients to help with utilization of that protein. So. I'm neither anti or pro, I'm in between. I think it can be a useful supplement. Sean (32:18.634) Understood. Uh, focusing on the area of trying to conceive. Um, I made a list of some of the things that my wife and I tried that friends had told us, and there is some components within those that may be beneficial, I just wanted to pick your brain on a few, can I throw them out to you? Okay. So going back to what a lot of our, maybe fertility doctors said is Lily (32:35.563) Yeah. Sean (32:42.882) You know, the woman at this stage, when you're trying to conceive, you want to have a nice warm uterus, pillowy sticky. So all those things were kind of repeated to us, but something like pineapple core, which is high in bromelain, that was something that stuck with me. Is there anything in pineapple core consuming it, eating it, putting into a smoothie or even eating it raw that actually could be beneficial to help conceive? Lily (33:09.643) That's a good question. I have not seen research on that specifically. I mean, I can think through it maybe from the perspective of, you know, bromelain being like a proteolytic enzyme and you're trying to break up, you know, get clean, clean up the dead old cells and get rid of them. I could, I could maybe see it through that angle. Sean (33:14.263) Well, when you... Lily (33:33.739) Do I know of any research that specifically used that as an intervention for fertility? Not off the top of my head. So that's an interesting one. Sean (33:41.098) I've done some reading on it and I can't find anything so I was curious. Here's another one. Royal jelly. Consuming royal jelly for the female to help with fertility. Lily (33:43.304) Okay. Lily (33:48.267) Yeah. Lily (33:54.519) I have heard this one as well. You know, it is uniquely high in certain B vitamins. So thinking of it through that perspective as like sort of a supplemental source of B vitamins, I could see it potentially being helpful. We didn't feel that evidence was strong enough to make the cut to put it into writing and real food for fertility, but I certainly don't think it could cause any harm. Sean (34:22.89) It was also expensive because it comes from the queen day. Lily (34:24.991) It's expensive and yeah, and I kind of feel bad for the bees a little bit. I mean, that's like the queen bee's food. So there's all sorts of like, you know, ethical conversations in the bee world about like taking away queen bee's source of food. I don't know. That's beyond. Sean (34:32.831) Exactly. Sean (34:42.222) I'm with you there. We got enough B problems also. This is something that I did while we were getting, you know, if we were in that window of being able to conceive, which is only like a couple days a month, I would carry around Brazil nuts and I would just eat Brazil nuts as a snack just to, you know, maybe increase the sperm count. Is there any connection there? Lily (35:07.307) Well, I mean, Brazil nuts are uniquely high in selenium. I believe they have a decent amount of zinc in there as well. You'd be getting vitamin E. So I could see from that angle, sperm quality really is heavily influenced by like the oxidative stress that the man is experiencing. And selenium. of course, improves your antioxidant defenses, boost your glutathione production. So that would seem to offer some potential protection from toxins. And they have done studies where they supplement with an antioxidant mix that includes selenium, zinc, vitamin E, vitamin C, that does seem to improve sperm quality. So I'd give that a nod of approval there. Sean (35:54.398) Okay, all right. I want to go back to protein intake. What would somebody experience symptom wise if they were not getting enough protein? How would they know? Lily (36:08.003) So a number of things. You may feel very tired. So of all of our macronutrients and their roles in energy production and blood sugar balance, carbohydrates give us a really quick spike and crash in blood sugar. Protein and fat tend to be very satiating and stabilizing for our blood sugar levels. So what I often see with clients who are under eating protein. is that they are tired. Their meals don't stick with them for very long because usually the makeup is primarily carbohydrate and so they're getting a blood sugar crash and energy dip. That often is also paired with cravings usually like carbohydrate, junk food, caffeine, sugar kind of cravings which is just it's not a willpower thing that's like the f*** physiological response to a dip in blood sugar is your body's going to seek out something that will give you quick energy. Little do you know the thing you should be seeking out is probably something that has more protein so it can stabilize you for a little longer rather than just you know pure carbohydrate, but that's definitely something I see. Difficulty maintaining lean body mass is another one. We do need protein for maintaining our muscle mass. I would also say headaches. That's another one I see in people who are not eating a lot of protein. And I'll throw in one more, and this is for women who might be tracking their fertile signs or using fertility awareness method, but low basal body temperature is, I see that very commonly in women who are under consuming protein. Protein out of all of the macronutrients produces the most heat when it's digested. It's like, approximately something like 30% of the calories you get from protein is actually wasted, so to speak, in the production of just expended or expelled as excess heat. And so when you have women who have low basal body temperature, often usually coincides with low thyroid function, one of the first places I look is protein. Lily (38:25.519) and increasing protein intake often does help support the thyroid as well. You just need it to keep your metabolic function up. Sean (38:34.602) Okay, Lily, I know that you're practical and reasonable. And I do appreciate that when just kind of listening to you on podcasts and following your Instagram, but I'm going to ask you to be rigid for a second. Okay. So you wanted to optimize your fertility and your pregnancy. Okay. And you are going to adhere strictly to what you believe is the optimal human diet for you and your child. for that extended period. I wanna get an idea of what foods, what like a typical day is going to look like for you morning till night in order to optimize that. Lily (39:17.123) Okay, great question. Well, I would probably start with eggs in the morning, maybe eggs sauteed with veggies or like an egg and veggie quiche, maybe even a side of some sort of extra protein in there, you already acknowledged that sometimes eggs are at least the quantity that most people consume in the morning. doesn't always give them sufficient protein, right? An egg has maybe six, seven grams of protein a piece. So if you're trying to get to, let's just throw out like 100 grams as a ballpark a day, you may very well wanna be aiming for like 30 grams of protein, right? That would be more than four eggs, right? That's kind of a lot. So I would say eggs and maybe like a side of some like breakfast meat, like breakfast sausage or even bacon, I know like. The food police are going to come after me with that, but truly it's fine. I might have a piece of fruit or something on the side, maybe like an orange or some grapefruit or something. I would try to have, again we're talking optimal, I would try to have a meal that includes some organ meat, not necessarily a massive quantity, but I do have like a grass-fed beef meatloaf recipe that has some liver. Sean (40:06.638) I'm sorry. Lily (40:31.787) like ground up liver in it or liver pate hidden in it. Highly, highly, highly nutrient dense. So I would probably throw in one of those at a meal, maybe with a side of like, you know, roast some potatoes or roast some other vegetables, Brussels sprouts along with it. Again, we're talking optimal. Maybe have a snack that's like some oysters on the side, highly nutrient dense. or maybe another seafood item that day, like maybe salmon or cod, again, alongside a vegetable and maybe a starch if that works well for a person's physiology. And then because we all need dessert, I'd probably do some sort of like a low sugar but still nutritious dessert. So maybe a yogurt or even a homemade whipped cream with the berries or some fruit. someone's still hungry, maybe a snack that has some, I don't know, some nuts or like half an avocado, you know. Yeah, I would just be emphasizing all these nutrient-dense foods we just covered and then like throw it all into one day. Whether that's realistic for somebody to pull off every single day, you know, is a separate conversation, but I would definitely be trying to hit those nutrient-dense foods as much as you can. Sean (41:54.802) Okay, I think that's great. There's a lot of fear mongering out there and I'm not sure sometimes what's true and what's false. Let's just start with the liver. Is there any potential concern for vitamin A overload? Like I know how much vitamin A exists in liver. Can people overdo it? And then what about those recommendations for pregnancy where they kind of steer women away from it? Lily (42:21.867) Yeah, I get into like all of those points in my books. Is it possible to overdo vitamin A from liver? Yes, I actually believe that it is possible to overdo. Is it realistic that many people are going to overdo it? If you asked me this five years ago, I'd say no. But nowadays, since so many people are actually on board with eating liver, I do think some people are going overboard. I like to think of liver consumption in the context of, again, if you do like an animal share or you're harvesting an animal or you hunt a deer or something, you get one set of organs. When you have a cow, like you may be getting hundreds of pounds of muscle meat and again, you're getting one set of organs. We've done cow share for like over a decade now. The largest liver we've ever gotten was eight pounds. Most of the time they're like four or five pounds, depends on the size and breed of the cow, right? But like relative to hundreds of pounds of muscle meat. So when I see people doing lots and lots and lots of liver, like liver every day or liver supplements every single day, and they're not making sure that their dosage is not overboard, yes, I think some people actually are overdoing it. So I recommend an intake of about three to six ounces of liver per week. That is a safe range for both outside of pregnancy and a safe range during pregnancy. You're not going to get vitamin A toxicity from that level. If we go back to the studies that originally identified an issue potentially with excessive vitamin A intake during pregnancy and birth defects, this goes back to the early 1990s. and they were supplementing with 10,000 IUs or higher of synthetic vitamin A. Now we do, our body does process synthetic vitamin A different from the type of retinol that's found naturally in liver. And we don't see the same teratogenic potential from liver as you do from those supplements. They can actually like monitor the blood levels of the particular vitamin A metabolites that are associated with these. Lily (44:40.131) birth defects and you don't have a spike in those in the same way from liver as you do from Synthetic vitamin A supplements. So overall my opinion is liver is far safer than a high dose vitamin A supplement, but it's also worth saying that the They've done follow-up studies on higher doses of vitamin A and they don't always reliably predict situation of birth defects Some research suggests that it's not typically a cutoff of 10,000 IUs as given, but some don't see an increase in birth defects until you get up to 30,000 IUs or more. So we have to have some context, I think, when having those discussions. We also need to talk about realistically how common our, what's our issue with vitamin A sufficiency? Even looking in the US, 80% of women are not hitting the RDA for vitamin A. If you take out liver, that's the number one food source, most concentrated food source of liver, and there is data from the Netherlands that found that women who avoided liver, approximately 70% of them did not hit the recommended intake for vitamin A per day. So if we take out liver, we're almost guaranteeing a situation of vitamin A insufficiency, which we already are seeing. Second to that, when you look at the rates of potential birth defects from vitamin A over consumption, there have been only 20 cases identified worldwide over the last 30 years. Whereas again, although the conversation usually centers around vitamin A being potentially teratogenic, it also prevents certain birth defects. We need vitamin A for proper formation of the eyes, the brain, the kidneys, number of different internal organs, the immune system, like so many other things are reliant upon sufficient vitamin A stores. So if we're coming into this situation of 80% of women not getting enough vitamin A, what we're seeing now is a surge in a birth defect called congenital diaphragmatic hernia. Lily (47:01.163) You look over that same time period, about 30 years, and there have been over a million cases of CDH. This is a situation where the diaphragm doesn't fully form. So instead of the digestive organs forming where they should in the abdominal cavity, they start moving up into the chest cavity where the lungs should be forming, and that can create an issue where the lungs don't properly form, they don't have the space to form, and it can range in severity, you know, 30% of cases are fatal and the ones that aren't fatal require surgery, typically, to repair that hole, bring the digestive organs where they should be. It's a very severe situation. And when I say that vitamin A is related to that, it's not just like animal models that we have. We do have a range of animal research showing this, but we also have human data showing that babies born with CDH. are pretty reliably almost always retinol deficient. Mothers who consume low amounts of retinol are at a higher risk for having babies that have CDH. Like we have a large range of evidence showing that it's connected. Sean (48:15.706) That actually leads to a question I was hoping to ask. While my wife was pregnant, she either had a book or stumbled upon a recommendation for specific types of food to eat during where she was in that stage of the pregnancy, either, you know, eight to 12 weeks along, that coincided with maybe fetal organ development. And I remember I was still working in the office. So it was, we got pregnant in January of 20 right around that time is when we found so I was still working in the office was before everything kind of shut Down in California and she drove about 45 minutes outside of where we were to go to a restaurant Because there was a Chinese stew that used lots of organ meats and it was very well spiced and she was craving it So was in that month three period. So was there anything there that is beneficial for mother and baby that you're eating those specific things that's going to help with that baby to develop, depending on where they are on their stage. Lily (49:17.439) You know, I wish it would be so great if there was like tons of research that said precisely at this stage of pregnancy, you need XYZ and then this shifts at this stage of pregnancy and you need XYZ. Really most of our nutrient recommendations are our best guesses. So if I could write a book that had all of those things, I've actually been contacted by a publisher that wanted me to write such a thing. You write this cookbook that has the trimester by trimester recipes. I was like, I... I can't do it, there's just not the evidence base to do that. You can make an argument for any of these foods at any stage of pregnancy, arguably. But I mean, absolutely an organ meat stew at any stage of pregnancy would be chock full of nutrients. You got your B12, your choline, vitamin A, selenium, zinc, iron, copper. I mean, the full gamut of... Sean (49:52.863) Uh-huh. Lily (50:12.287) micronutrients really. I mean, many of them refer to organ meats, especially liver as nature's multivitamin. It's not like a one-to-one replacement for, you know, comprehensive prenatal vitamin, but it does hit the marks for a number of different micronutrients. So anytime like a pregnant woman is craving something highly nutrient dense, I'm like, yes, go for it. Like I had a stage in one of my pregnancies where I really wanted clams of all things. And Sean (50:33.515) Yeah. Lily (50:41.203) I didn't think much of it at the time other than like, well, I think that's pretty nutritious. But later looking at the micronutrient content of shellfish, clams are one of the richest sources of iron, copper, B12, zinc. So maybe my body needed some of those things at that stage. Who knows? Sean (51:02.235) Is there anything to that specific cravings that a woman would have during pregnancy? Is that some built-in mechanism through evolution to be able to crave the foods that are just needed at that time? Lily (51:14.591) I think in some instances, yes. Certainly I've heard of a lot of women who crave citrus like crazy. Could be the vitamin C, could be the folate, could be some of the bioflavonoids, could be the potassium. You do need a lot more potassium during pregnancy. You hear of women craving dairy. Even women who may have been completely intolerant to dairy beforehand, but they really, really want dairy. Is it the calcium? potassium, is it the B12, is it the vitamin D, the vitamin A, the K2, could it be the riboflavin? You need riboflavin for your folate metabolism and other than organ meats, dairy is the best source of riboflavin. I think there's something to it, but I will say I do look at cravings with like a bit of curiosity and caution, and that I find there can be things other than nutrient needs that are driving cravings. Sometimes it's like an emotional thing where you really want something your mom used to make, like your mom's mac and cheese and only your mom's mac and cheese and maybe that's feeling like an emotional need. If the craving is for really highly processed foods, like that can be an emotional thing where you're going back to a certain time in your life. It can also simply be that ultra-processed foods are literally engineered to make us crave more of them. And so Do you really have a nutritional need being met by hot Cheetos? Or is it just that hot Cheetos are highly craveable and you used to have them when you were 15? So I do look at them with curiosity, though. If there is a craving for highly processed foods, is it the fat or the starch or the salt or the sugar you're seeking? And maybe there's a way to fill that void with something that isn't. quite as processed. Like I remember my first trimester and one of my pregnancies, I was at the grocery store and I was like, oh man, sour gummy worms sound so good right now. And I remember picking up the package and looking on the back and you know, I can like write off a little high fructose corn syrup now and again, like it's really, it's not gonna kill you. But I'm like, I really can't justify, like I may be able to justify a little added sugars here and again, but. Lily (53:37.163) can't justify like red dye number 40 and blue dye number whatever. And I found that tart dried cherries were a perfect replacement. What my body needed and what helped me a lot with the nausea was sour, that kind of like sour sweet flavor combination, also salty foods, but like dried tart cherries could fill that. craving. It wasn't really the sour gummy worms. It was the sweet and sour combination. So again, looking at them through the lens of curiosity might sort of guide you towards like what's actually underlying this. Sean (54:21.182) I do want to stay on that this fear mongering kind of aspect, because I do have a few more questions about some other foods. When my wife was pregnant with our kids, I remember that she was kind of steered away from fish, definitely like sushi, like couldn't eat sushi. But there was a concern for mercury. And one of the things you're hearing out there constantly is the mercury levels in our in our fish. So How do you reconcile with that? What are your recommendations? Lily (54:53.787) Yes, I'm very familiar with this whole controversial area. I talked about fish on another podcast and the reel went viral and people were really attacking me over the Mercury conversation. So, and that actually has shifted my take a little bit. So let me get into it, cause I actually wrote a blog rebuttal to the concerns and it kind of... clarified my stance on fish and seafood. So the concern over mercury is that mercury is a known neurotoxin. There's certain developmental issues, neurodevelopmental issues that can result from mercury toxicity. So there's long been this recommendation to maybe limit or avoid certain types of seafood. Now, I've kind of sided with that in that I typically recommend alignment with what the FDA recommends, which is about 12 ounces of high omega-3 fish or seafood per week for pregnant women. And I do think it's just logically wise to limit your intakes of the types that are high in mercury. Like why overexpose yourself when you have the option for something that's lower in mercury? There are compounds in most types of seafood, most types of fish with the exception of certain things like shark and whale. where they have high concentrations of selenium that seems to offset the mercury exposure, helps the body excrete the mercury or make the mercury potentially less toxic in your system. And so that gives you like a little bit of coverage for potential mercury exposure. But I do want to point you in the direction of a study that was... Let me find it really quick here so I could speak... specifically to their findings. So this was a 2022 study from the journal neurotoxicity. Oh Sorry, let me it's the other one. Sorry prost it's from its 2019 study from the journal prostaglandins Leukotrienes and essential fatty acids and the title is relationships between seafood consumption during pregnancy and childhood and Neurocognitive development. So this was actually a paper that did two systematic reviews they looked at Lily (57:19.051) fish consumption, fish and seafood consumption in pregnancy and outcomes on the child, and then fish and seafood consumption during childhood and the outcomes on the child. So this was a huge review. It had over 100,000 mother offspring pairs, and they were specifically looking, can we find the level of seafood consumption during pregnancy where it benefits neurocognitive development in babies, and can we find a level where seafood intake might cause... more risks than benefit potentially due to the mercury exposure. So they found as little as four ounces of seafood intake per week was beneficial, but there was greater benefits to child cognition as that seafood intake went up. And interestingly, they found no upper limit where seafood intake resulted in adverse neurodevelopmental outcomes. Even when they were looking at women who consumed an average of 100 ounces of fish and seafood per week. And it actually didn't matter if it was the fatty fish and seafood or the high mercury seafood or not. And these benefits to child cognition persisted even if the women had higher mercury exposure due to the seafood intake. If their mercury exposure was not related to the seafood intake, mercury was reliably correlated with poorer neurocognitive development. but one that mercury was from seafood intake specifically, no association with harm there. So this has shifted my recommendations to be not as concerned with like an upper limit on seafood intake and reaffirmed that, and again, maybe this has to do with the selenium content, but that the benefits of seafood intake outweigh the risks. You wanna get into the sushi conversation that's a bit of a separate. that's not on the mercury, that's on like the food safety part, but as a whole, I'm pro seafood consumption. Sean (59:22.514) Well said, that's important to know. One other question here around fear mongering. So I originally, and Sean knows this, I'm someone who can get obsessively focused with this type of stuff. And I do treat eating disorders in a female population, adolescents and adults. And I've done experimentation with different diets. I was on carnivore diet for quite some time. And then I kind of transitioned to, I guess would be considered more of an animal based diet, Paul Saladino, uh, it's kind of recommendations. So, you know, probably have a, you know, a lot of, a lot of red meat eggs, typical carnivore, but I add in organic fruit, some honey, locally sourced honey and raw dairy. And so this is my, my questions about raw dairy. There's a lot of fear mongering about raw dairy. We've completely transitioned our family over to. raw milk. And I love it. I think it's so much better. I think I'm also like fermenting it into raw milk of fear. But I want to get your thoughts on raw dairy for, you know, conception, for fertilization, optimizing fertility and also pregnancy, which I think it's, I think the recommendations are for women to steer away from any raw milk and maybe that's around food safety too. Lily (01:00:42.847) Yeah, the food safety stuff really gets people crazy in pregnancy land. And yeah, I've faced a lot of criticism. I do include a section in Real Food for Pregnancy, chapter four, all about food safety, where it's like, my opinion is you need to weigh the risks and the benefits, not just overtly cut out all of these foods due to a very, very small risk that you might get sick from them, right? So the concerns over raw milk have stemmed primarily from food safety, and that's population-wide, but especially, you know, emphasized in pregnancy. And my opinion is that those risks have been pretty exaggerated. If you look at the majority of foodborne illness cases associated with dairy, they're mostly from pasteurized dairy products. You know, if a dairy operation is not that clean, if you have... pasteurization in place, they can just pasteurize it. I mean, you're just gonna kill everything in the milk anyways, so why worry about it? Since raw dairy producers nowadays are under such strict scrutiny, as long as they're following good hygiene practices, oftentimes their, you know, so-called harmful bacterial counts come in lower than what you find in pasteurized dairy. Plus you've maintained the original microbiome. of that milk, that microbial makeup of the milk. You've maintained the enzyme activity in there. So you have lactase and other enzymes, you have enzymes that enhance the calcium absorption from it. So, you know, I I'm personally okay with raw milk. I personally drink it myself. I do think it's if you have a clean source and you've kind of vetted where you're getting your supply, you're good to go. Like any food anything can become contaminated So if people really want to play devil's advocate on food safety Which I do often the majority of foodborne illness outbreaks actually come from raw fruits and vegetables about 46% of cases across the country And yet we're you know, so concerned about the raw milk or so concerned about the you know Raw eggs or whatever it is So I would say just know your source Lily (01:03:06.015) and you're probably okay. I do know that a lot of, for a lot of people, it's much better tolerated when they're getting raw dairy versus pasteurized. Like my husband, for example, can't do normal pasteurized milk, but he can digest raw milk just fine because you have, you know, the lactase enzyme hasn't been destroyed by pasteurization, so you can break everything down. The proteins haven't been altered by... heat, the fats haven't been damaged by being highly heated and homogenized. So there's a number of reasons that it can be better tolerated. So know your source and honestly, you do you. Sean (01:03:49.388) I want to transition to after the birth of a child. We've had conversations in this room about diet. And I think the United States is a country that struggles with diet. And I have a hypothesis that because we're a nation of immigrants, we came here and we lost out on a lot of that, maybe generational wisdom that maybe a grandmother used to guide us on the foods that we need to eat what's going on in our lives. And we just kind of ate what we can get. Uh, after my wife was born, my mother-in-law is Taiwanese and she stressed the importance of eating a specific diet for those first, basically like six weeks after the birth. So my question to you is once you've got pregnant, you went through the pregnancy, what's important for the woman to adjust in her diet, the way she's consuming and the type of food she's consuming, that's going to help with the recovery and then also for feeding the baby. Lily (01:04:45.251) Great question. So assuming she's already consuming a relatively nutrient-dense diet, we've been talking about this whole past hour. Not that much needs to be adjusted outside of quantity of food. So when you're postpartum. your nutrient requirements are actually, and this is even by conventional standards, are higher than at any other time point in a woman's life, higher than during pregnancy. Calorie needs, now we have new research on protein needs being higher. Micronutrient requirements are higher. And in cultures outside of the West, as you've mentioned where we've lost touch with these traditional practices, there is often a... standalone period of time, about six weeks or 40 days, where extra care and attention is provided to that mother and usually special foods are prepared for her. Her job is to rest and recover and receive support and that food is brought to her, which is lovely. So certainly more food. Don't be surprised if you need a lot more calories than you previously thought. The conventional standard is that you need about 500 calories per day alone for breast milk production on top of your baseline needs. My opinion is that is actually higher because that's only accounting for the energy lost through the milk production itself. It's not accounting for what you went through in labor, delivery, and recovery. And labor and delivery can go different with every pregnancy, right? much more exhausting than others. Sometimes it's a surgical birth and you're not only recovering from pregnancy and rebuilding your nutrient stores, but you're also recovering from major abdominal surgery. I mean, by any means, we would be providing you with plenty of rest and good food to nourish and recover. Lily (01:06:52.687) I'd say the biggest thing that I would zero in on is the protein and specifically emphasizing our whole food sources of protein. So you're also getting all those micronutrients and the fats that should come with them. And that's because we do have finally new data that protein requirements are a lot higher postpartum. So to date, really the only human data we have, which is wild, and this is only from the last couple of years. Lily (01:07:21.955) three to six months postpartum who were exclusively breastfeeding and their protein requirements, and this is a, they gave a level called an estimated average requirement, which I don't really need to get into the weeds, but this is lower than what we'd assume would be the optimal RDA if we were to set one for them. But nonetheless, the protein requirements were 1.7 to 1.9 grams per kilogram. If you were to adjust that to an RDA, it very well may be higher than 2.2 grams per kilo, which would be higher than a gram per pound of body weight. Lots of protein. And this is at three to six months postpartum. You've already gone through that initial three month period where you're recovering from the birth. So what's the protein requirements for immediately after labor? Probably a heck of a lot higher, I can say for my own two postpartum recoveries. Sean (01:08:14.254) Mm-hmm. Lily (01:08:17.915) I was like out eating my husband easily for weeks on end. You do need a lot of food. You need a lot of protein. You need a lot of energy and you need somebody to cook it for you. You need that help. So lots of food, lots of nutrient dense food is the short answer. Sean (01:08:20.135) Yeah. Sean (01:08:34.678) Yeah. Sean (01:08:38.214) One question that comes from there. So based on my mother-in-law, what are your thoughts on, especially when it comes to that Chinese culture, the warm elements versus the cold elements of food? What value do you give to that? Lily (01:08:53.387) Yeah, and you know what's interesting about this, and I write about this in the postpartum chapter of Real Food for Pregnancy, is that you see that theme globally. It's not just the Chinese tradition. There are areas in Southeast Asia where you're supposed to stay in a hammock for a certain amount of time, and there's a small smoldering fire under the hammock. They call it mother warming or mother roasting. even when you go to areas of the world where the climate is much more mild or even semi-tropical, there's recommendations to stay warm, stay out of breezes, don't get cold, don't get wet. So I think some of those traditions, of course, like now we have, you know, some traditions are going back to an era when we didn't have, you know, central heat and air to climate control in our houses. Where if you think about if you're in a vulnerable state, like maybe somebody is sick or injured or recovering, you do keep them warm. Like the default is to keep them warm versus them getting cold. So I think that just logically makes sense. Sometimes this expands into certain foods that are believed to be warming or cooling as well, and not just temperature warm, but warming spices like ginger and cinnamon and galangal. Again, you see this across. Sean (01:10:06.582) Mm-hmm. Lily (01:10:15.743) really all cultures where I have seen written documentation of their postpartum practices. Whether or not there's, you know, white paper scientific research to back it, I haven't seen other than the anecdotes being all written up, but seems to me wise to do so. Doesn't hurt, it's easier on your digestion too. So you have to think when you're postpartum, your uterus was the size of a watermelon. all of your digestive organs were like smushed to the side. And then everything has to reorient, right? As your uterus is shrinking down and all your digestive organs are sort of like finding their place again, if we just think logically from a perspective of how easy certain foods are to digest, like cold raw vegetables and salads are like much harder to digest than a warm cooked stew with bone broth and like super soft rice and soft. Sean (01:11:08.046) Mm-hmm. Lily (01:11:10.179) cooked vegetables. So just from that perspective, from supporting the digestive system reorienting, it also makes sense. Sean (01:11:19.306) Okay, we are in the down stretch air, the final stretch of this, I know we've kept you a while, but there's two separate areas that I just have to ask before we let go. The first is, I know that there is about more than 50% of the American population is magnesium deficient. And then when it comes to also like fear mongering around salt, you know, and with women who are pregnant increase in obviously like hydration and the amount of they're supposed to be drinking too. Lily (01:11:35.178) Oh yeah. Sean (01:11:47.778) How important are electrolytes as these fluid requirements increase? What are the recommendations for salt intake? And just how do we help women become magnesium, at least have the minimum amounts of magnesium? Lily (01:12:04.819) Yeah, this is a great question. I think it's been under-focused on conventionally. I mean, conventional guidelines still tell you to limit your salt intake during pregnancy, which is wild. Just to give you kind of like a toddler level metaphor here, if you're dehydrated and you go into a hospital to get fluid replacement, they give you IVs, they don't. They're not giving you distilled water with nothing in it. At the very least, they're giving you salt water, right? There's sodium in it because it's acknowledged that any fluids in your system also come along with these electrolytes. So when you're in a state of pregnancy and your fluid volume has gone up 50%, how is it logical that we're telling women to restrict their sodium intake? It's insane. So you should not be restricting your sodium intake. And in fact, that can lead to a lot of problems with the fluid balance in your system with maintaining proper, you know, amniotic fluid levels and actually can predispose you to preeclampsia, which is the opposite of what everybody has been told. Way back in the 1950s they were treating preeclampsia, which at the time they called toxinia, with salt supplementation. They would give women four heaped teaspoons of salt per day and that would resolve the toxinia. in all cases unless the woman stopped the salt supplementation. So salt your foods, if you're craving salty foods, eat the salt and you may even want to like add more salt via supplementation as well. So definitely a big fan of salt. As to what amount is optimal, I haven't seen good research suggesting precisely for pregnancy how much is needed. My opinion, so of course conventionally they say you know eat you know 1500 to 2300 milligrams of salt, way too low. Globally, population-wide, we see lowest rates of mortality and other health issues among people eating about 3000 to 5000 milligrams of sodium per day. So I would probably aim in that range, maybe even higher. It's so hard to like monitor and measure your sodium intake that I'm a much bigger fan of just salt and season your foods liberally. And if your body is craving more salt. Lily (01:14:29.267) eat it. If you have any concern that you might be eating too little, try eating a little more and see if your symptoms improve. Like just keep it simple. We don't need to be obsessively measuring, you know, every single milligram. As for the, um, uh, magnesium conversation, that is a really, really tricky one. Lily (01:14:53.475) The soils are so depleted in magnesium from these decades of industrial farming, especially with all the spraying of glyphosate, which is a mineral chelator. So like your plants aren't even taking up what magnesium might be in the soil. I think it's a situation where the majority of us do benefit from some magnesium supplementation. So although I am a fan of food sources and food sources would include like... pumpkin seeds, flax seeds, Brazil nuts as you mentioned, sunflower seeds, chia, all the seeds really, which I know gets controversial. Leafy greens, all of our culinary herbs, things that are deeply pigmented green, rich in chlorophyll, tend to be high, magnesium, cocoa, seaweed, and then you do have magnesium in some types of animal foods as well, lots of seafood, caviar, fish eggs, cod, salmon, halibut. So whatever you can get from food. but I am also a fan of supplementing with extra, like a magnesium glycinate, magnesium malate tends to be pretty well tolerated, well absorbed without causing significant digestive distress. Yeah. Sean (01:16:03.314) Okay, final question. I am a clinical psychologist who has been outspoken against the harms of various psychiatric drugs, specifically SSRIs, and there's still recommendations out there by the medical professionals for women who have experienced postpartum depression to stay on an SSRI while they are pregnant and even while they're breastfeeding. We know that this crosses the placenta. It's present in breast milk. It is associated with so many neurocognitive conditions, autism, um, uh, just a number of problems, a lot of which we haven't even like thoroughly studied and you're, you're going to be giving birth to a baby who is in withdrawal then from it, from an SSRI. And the question that I always do get is, well, then, uh, how do we prevent or how do we treat or support? women who experience postpartum depression or who might be vulnerable to postpartum depression. And one of the first areas I always go to is I don't think we do enough to support a woman postpartum. Especially, you know, when you talk about sleep deprivation and hormonal changes and a number of other stressors, it's almost insane. You know how we just kind of allow a woman to be just on their own and you know, don't even in our culture have the same degree of like community and family support as we used to. But I am interested to know from a nutritional perspective, what might contribute to postpartum depression that you are aware of in the literature and what do you recommend? And we've talked a lot about the optimal human diet. So I don't know if we have to get into specifics. But you know, just your thoughts on some other nutritional factors that could influence postpartum depression. Lily (01:17:53.747) Yeah, I mean, as you've pointed to, before I get into the nutrition side, it's multi-factorial, right? That's like population-wide, systemic-wide, lack of maternity leave, lack of support, lack of awareness in our culture of what it takes to recover postpartum and also to raise a baby. And just dealing with this whole medical system is enough to ruin your mental health, especially when you're navigating it in this very... vulnerable state postpartum with this brand new baby and you know you want to trust that other people know Better than you and yet you have this like maternal Intuition that's so very strong Which listen to it by the way, but um on the nutritional side I do believe there's a nutritional component to it as well And that's actually not just my opinion too. There is quite a bit of research now, thankfully looking at maternal nutrition and how it can affect mental health. I mean there's a lot of research you know population wide on mental health and nutrition and there's a lot of carryover for postpartum as well. We do have like a unique hormonal situation but it doesn't mean it's entirely separate from all that other research on nutrition for mental health. There was actually a study in the Journal of Nutrition Science in, I believe it was 2017. It was a review paper of over 24 other papers, a total of over 14,000 subjects, and they acknowledged that pregnancy and lactation deplete nutrients essential to the neurotransmission system and that may be one reason for the increased risk of depression during this time period. So which nutrients would be... most important. I mean, certainly there's a lot of minerals that have been depleted over the course of pregnancy. Iron, selenium, zinc, calcium, magnesium are some big ones. A lot of B vitamins, of course, have also been depleted. Folate is a big one. B12. Didn't talk about B12 a whole lot in this conversation, but this is actually like really, really common in pregnancy. Lily (01:20:12.379) and has a major effect not only on mom's mental health, but also baby's neurological development, especially as more and more women are opting for plant-based diets and aren't adequately supplementing. So B12, absolutely vital. I would also add choline and DHA to that list. We know choline is absolutely vital for cognitive function. We know DHA is depleted over the course of pregnancy. I mean, just in the last, three months of pregnancy alone, every day the baby is accumulating about 67 milligrams of DHA per day. And when you look at average intake of DHA among most pregnant women, or really women of childbearing age, I think that data is outside of pregnancy as well. Average intake is like in the range of 60 to 70 milligrams per day. So if you are even eating any of it, it's basically all going to the baby. And when you look at rat studies where they can actually like, you know, they can look at the amount of DHA in the rat's brain because, you know, it's an animal study, not a human study. We can't ethically do these things. When they examine the postpartum rat's brain, it's depleted in DHA. So there does need to be a period of repletion that happens in that postpartum stage. I would also say just one separate thing from the micronutrient consideration. is blood sugar balance. So in postpartum, your body is so focused on, well continuing to focus, I guess, on transferring nutrients through the baby. Now it's happening via breast milk. Your body is very like it's on like metabolic overdrive and insulin sensitivity goes way, way up. which we would think metabolically is a great thing. What it means is your body is like actively accessing as many fuel resources as it can via breast milk production. This makes you really prone to hypoglycemia postpartum. We see this a lot when people are way under eating and specifically way under eating their protein. So a nod back to the protein situation, but also a nod to the importance of really tuning into those hunger cues and Lily (01:22:37.395) eating enough and it's hard to eat enough unless you have support providing you food, food at the ready, warm on a plate or in a bowl for you to eat while you're also like on the couch and nursing that baby. Because by the time you realize sometimes that you're hungry and you can even manage to set the baby down or negotiate getting up to the kitchen to go get something with baby in arms, you're already completely famished. And as your blood sugar. Sean (01:23:04.674) Mm-hmm. Lily (01:23:06.555) I mean, you know this from just general psychology, people with crazy blood sugar swings, their mental health is a wreck, depression, anxiety, you can't get your feet under you, you know what I mean? And I see this definitely amplified in postpartum as well. So just that general blood sugar balance, sufficient protein, you're kind of hitting two birds with one stone, you're getting, or three birds, you're getting the protein needs met. you're keeping your blood sugar stable, and you're also hitting the mark for a number of those micronutrients I mentioned. Sean (01:23:39.022) Great. What an informative podcast. You are a wealth of knowledge and we are so grateful for you coming on to the show. I want to, again, just reiterate how important her work is. Real food for pregnancy, real food for gestational diabetes and her new book, Real Food for Fertility. Lily, where can our listeners get in touch with you find out more about your work? Where can you direct them? Lily (01:24:09.835) Yeah, you can find more about my work over at lillynicholsrdn.com. That's my main website. It'll link out to my books, links out to my blog. There's 250 plus articles up there, many of which tack on to the conversations we were having today. So use the search bar for like postpartum recovery or protein in pregnancy or fish. You'll find resources, detailed resources going through all of that. You can find more information about the webinars I teach or the Institute for Prenatal Nutrition on there as well. And then as far as social media, you can find me primarily on Instagram, although I'm also a little bit on the other platforms. And my handle is the same as my website. So it's Lily Nichols RDN. Sean (01:25:01.262) Right? Lily Nichols, we want to thank you for a radically genuine conversation. Lily (01:25:07.831) Thank you, it was fun.