#371 Preconception & Fertility Nutrition with Lily Nichols, RDN, CDE

This week on The Less Stressed Life Podcast, I’m thrilled to have Lily Nichols, RDN, CDE, back with us! In this episode, Lily gives us the scoop on her latest book, Real Food for Fertility, co-authored with Lisa Hendrickson-Jack, which focuses on preconception nutrition for both women and men. We cover everything from improving sperm quality to the crucial role of nutrient-dense foods for both partners. Lily is all about breaking down myths, especially when it comes to avoiding fats and animal proteins, which are actually key players in healthy pregnancies. I love Lily’s no-nonsense, research-backed approach, and I think you will too!

Check out Lily's other books Real Food for Gestational Diabetes and Real Food for Pregnancy here: https://lilynicholsrdn.com/books/

KEY TAKEAWAYS:

• Why conventional guidelines for gestational diabetes often fail, and what actually helps with blood sugar control
• How preconception nutrition for both men and women affects fertility and pregnancy
• The benefits of nutrient-dense foods like liver, meat, and seafood for hormone health and egg/sperm quality
• The role of environmental toxins in fertility and simple steps to minimize exposure
• Why fats and animal proteins are essential for healthy pregnancies
• How myths around prenatal nutrition can hurt rather than help

Lily's other episodes on the LSL:
#031 Do you really need to eat for 2? 3 myths in prenatal nutrition & how to have a healthy pregnancy and postpartum experience with Real Food for Pregnancy Lily Nichols, RDN, CDE
#204 Gestational Diabetes with Lily Nichols, RDN

ABOUT GUEST:
Lily Nichols is a Registered Dietitian/Nutritionist, Certified Diabetes Educator, researcher, and author with a passion for evidence-based prenatal nutrition. Her work is known for being research-focused, thorough, and critical of outdated dietary guidelines. She is the founder of the Institute for Prenatal Nutrition™, co-founder of the Women’s Health Nutrition Academy, and the author of three books: Real Food for Fertility (co-authored with Lisa Hendrickson-Jack), Real Food for Pregnancy and Real Food for Gestational Diabetes. Lily’s bestselling books have helped tens of thousands of mamas (and babies!), are used in university-level maternal nutrition and midwifery courses, and have even influenced prenatal nutrition policy internationally. She writes at https://lilynicholsrdn.com. 

WHERE TO FIND:
Website: https://lilynicholsrdn.com/
Instagram: https://www.instagram.com/lilynicholsrdn/

WHERE TO FIND CHRISTA:
Website: https://www.christabiegler.com/
Instagram: @anti.inflammatory.nutritionist
Podcast Instagram: @lessstressedlife
YouTube: https://www.youtube.com/@lessstressedlife
Leave a review, submit a questions for the podcast or take one of my quizzes here: ****https://www.christabiegler.com/links

NUTRITION PHILOSOPHY:

• Over restriction is dead
• Whole food is soul food and fed is best
• Sustainable, synergistic nutrition is in (the opposite of whack-a-mole supplementation & supplement graveyards)
• You don’t have to figure it out alone
• Do your best and leave the rest

Transcript

[00:00:00] Lily Nichols, RDN, CDE: when, anytime you start talking about fertility, everybody thinks of the woman and they don't think about the man, Oh, if there's delays in getting pregnant, Oh, it must be something going on with her, where male factor and fertility. Is a component of at least 50 percent of infertility cases.

[00:00:17] Christa Biegler, RD: I'm your host, Christa Biegler, and I'm going to guess we have at least one thing in common that we're both in pursuit of a less stressed life. On this show, I'll be interviewing experts and sharing clinical pearls from my years of practice to support high performing health savvy women in pursuit of abundance and a less stressed life.

[00:00:47] Christa Biegler, RD: One of my beliefs is that we always have options for getting the results we want. So let's see what's out there together.

[00:01:05] Christa Biegler, RD: All right, today on The Less Stressed Life, I have Lily Nichols back, maybe for the second, maybe for the third time, we're pretty sure the third time. She is on episode 31, do you really need to eat for two? Myths in prenatal and how to have a healthy pregnancy and postpartum experience.

[00:01:19] Christa Biegler, RD: But if you don't know Lily, She's a registered dietitian nutritionist. She's a certified diabetes educator. And she's honestly like the person who writes the books on prenatal fertility and gestational diabetes. It all started with gestational diabetes. We'll talk a little bit about that, but her work specifically is known for being this very research focused, thorough and critical review of outdated dietary guidelines.

[00:01:42] Christa Biegler, RD: So she's like a cycle breaker of let's get to it. quit giving people the same outdated crap that actually has nothing to do with the research. She is the founder of the Institute for Nutrition, co founder of the Women's Health Nutrition Academy, and the author of these three books, both Real Food for Fertility, which was her most recent book that came out in February, co authored with Lisa Hendrickson Jack, who has a very popular podcast.

[00:02:06] Christa Biegler, RD: She's been on our podcast before, I want to say 

[00:02:09] Lily Nichols, RDN, CDE: Fertility friday. 

[00:02:10] Christa Biegler, RD: Thank you. Fertility Friday. Also, the author is, I think something about your period is a vital sign. I think 

[00:02:15] Lily Nichols, RDN, CDE: it's the fifth vital sign. 

[00:02:17] Christa Biegler, RD: Thank you. Real food for pregnancy is also Lily's second book, a very, I would say like a blockbuster hit.

[00:02:24] Christa Biegler, RD: She could tell us like how long it was Amazon top, whatever, and real food for gestational diabetes. So thanks for coming back, Lily. We're talking a little bit about conception, preconception nutrition today, based on your most recent book. So I'm thrilled to have you back. 

[00:02:40] Lily Nichols, RDN, CDE: Hey, I'm happy to be here. Always appreciate a re invite. 

[00:02:43] Christa Biegler, RD: Yeah, exactly. It gets more fun the more you do it. All let's talk like for a few minutes about the beginning of this, because your origins were at California WIC, I think. I think you were working in WIC nutrition. You can correct me. 

[00:02:56] Lily Nichols, RDN, CDE: California 

[00:02:57] Lily Nichols, RDN, CDE: Diabetes and Pregnancy Program. 

[00:02:59] Christa Biegler, RD: All right.

[00:03:00] Christa Biegler, RD: Close. Close. And you were finding that the information you were supposed to be providing to your women just was not. There was an issue, there was a conundrum. So tell us about how this all began for you. 

[00:03:15] Lily Nichols, RDN, CDE: Yeah. So depends on how far you want me to rewind, but if I'm putting myself at that time of working in that program, I was also working clinically with women trying at first to be a good little dietitian and follow the guidelines.

[00:03:29] Lily Nichols, RDN, CDE: I found that when I implemented the conventional dietary advice for gestational diabetes, it did not help my clients. blood sugar levels, and oftentimes actually made their blood sugar levels worse. And this kind of started the whole thing, because it's okay, everybody's telling me we have to follow these guidelines for these reasons.

[00:03:50] Lily Nichols, RDN, CDE: Why are these guidelines what they are? Where did this come from? What's the evidence behind this? What's the truth about the warning about? deviating from those guidelines, especially thinking about going lower carb, for example. And yeah, would it be safe? Would it be safe to do so that kind of set me off on a very long path of researching an alternative approach to managing gestational diabetes which kind of flips the macro nutrient ratios on their head.

[00:04:20] Lily Nichols, RDN, CDE: but works far better for blood sugar control. And that is ultimately like the results that we got in clinical practice is what led me to write real food for gestational diabetes, which was my first book. It was too frustrating to keep hearing from clients, women on the internet other dieticians, just people rehashing the same old guidelines, which I had now uncovered A, didn't work, B, were not evidence based, and C, were actually harming women overtly, if you are creating more blood sugar spikes and you are necessitating medication and insulin, which, by the way, is It's like they're great tools.

[00:04:59] Lily Nichols, RDN, CDE: You need them in some cases, but it's not a perfect scenario. You want to like interrupt the blood sugar spike before it happens, if at all possible, rather than trying to cover it with medication because that can give you inconsistent results. Anyways, I was tired of hearing the same old, and I was like, I gotta write this up because trying to argue with people over the internet and repeating myself again and again, I'm not going to write like a thesis paper for every single comment in a gestational diabetes Facebook group Claiming, that you're incorrect and I'm right, like this needs to be written.

[00:05:31] Lily Nichols, RDN, CDE: So that's really what led me to write my first book, Real Food for Gestational Diabetes, and kind of everything from there. I don't know if you want me to keep going, but it's kept me on the path of, why are our guidelines what they are? What is the evidence for or against them?

[00:05:49] Lily Nichols, RDN, CDE: How can we do better to optimize? people's health. And I do that via my writing because I feel like that is the place that I can be the most clear, the most articulate and I can cite all my sources in one place. And it also just bypasses all of the bureaucratic nonsense with public policy stuff, since I have at least any amount of experience with that, with the California Diabetes and Pregnancy Program.

[00:06:16] Lily Nichols, RDN, CDE: Try changing national guidelines good luck. It takes, especially in a country as large as ours, that takes insurmountable amount of work, time, and dealing with all the conflicts of interest. So I just take it from the grassroots level. It's educate the public, educate the health professionals who want to do better and change it from like the inside out rather than the top down. 

[00:06:38] Christa Biegler, RD: I love that. People don't usually come here and talk about that really. And you're one of, I think you self published and I don't know if you've self published all three or just the first two. Is that right? Correct, did you say? 

[00:06:49] Lily Nichols, RDN, CDE: Yes, I've self 

[00:06:50] Lily Nichols, RDN, CDE: published all three. 

[00:06:51] Christa Biegler, RD: Okay, you're one of the most, and I don't know everything about everyone.

[00:06:55] Christa Biegler, RD: I do interview a lot of authors because podcasts are a really great way for authors to get their work out. Not that you really need my help with it, but it's always nice. My goal here is to incite intrigue and show people that there's always another way, like you're never out of options, or there's probably a better way that maybe you don't know about yet, so filling knowledge gaps.

[00:07:16] Christa Biegler, RD: But, I don't know, everyone who self publishes, but I feel that you're one of the most successful self publishers I've ever known because I've known who you are since you were in private practice, and I believe that your publishing journey allowed you to just focus on research. And actually, what I would consider, I don't know if you feel this way, do you feel like writing and doing this research work is your zone of genius, like you could enjoy doing this all the time? 

[00:07:41] Lily Nichols, RDN, CDE: Yes, totally. Yeah. All the time the books keep getting more and more like meaty as time goes on. So I don't want to do it all the time. 

[00:07:50] Christa Biegler, RD: Yeah. How many citations were in Real Food for Pregnancy? 

[00:07:54] Lily Nichols, RDN, CDE: Real Food for Pregnancy had 934, which I thought was like huge. And Real Food for Fertility has over 2, 300 citations.

[00:08:04] Lily Nichols, RDN, CDE: And that was, 

[00:08:04] Christa Biegler, RD: Oh, wow. 

[00:08:05] Lily Nichols, RDN, CDE: three years. We, let me put it this way. We couldn't put the citations in the back of Real Food for Fertility, which was already 500 pages because it would have added another 200 pages. So it's an additional PDF download. People can get it for free at realfoodforfertility. com. But also I want to, like, share a, just an interesting thing on like the publishing space.

[00:08:30] Lily Nichols, RDN, CDE: The choice to self publish is not because I can't get a book deal. I have, the biggest name publisher is trying to buy out my book rights. Every week. Okay. The reason I like self publishing is you have total control. If my books would not be what they were, what they are. If I had a publisher telling me how to do it, because you know what?

[00:08:54] Lily Nichols, RDN, CDE: They put you on these ridiculous timelines. You get like barely any money. Even if your advance is excellent, highest industry. It is peanuts compared to self publishing, but you get a lower quality product. It might be better edited depending on if you're going to hire a good editor or not. You have that choice as a self publisher but they're going to force you to ditch most of the citations because they believe people don't want the citations.

[00:09:22] Lily Nichols, RDN, CDE: They don't want to pay the money with the printing costs to put those citations in the book. They want the book out at a certain date, so if I had ever signed on with a publisher, my books would have flopped, actually, because they would have changed it from the intention of what they are, and they're much different than most health books on the market, most health books like it.

[00:09:48] Lily Nichols, RDN, CDE: Talk down to a little bit, right? They, simplify things more than necessary. They expect that people aren't smart enough to read between the lines. They expect that people don't want the research citations. And I think I've proven that. That's not true. My books aren't for everybody, but they are under the assumption that you are smart, you want to learn more, you want to fact check me, here's my sources, 

[00:10:10] Christa Biegler, RD: I think we're pretty aligned that way. It's that was something I actually, I often tell people this, I had to recalibrate when I left working in conventional health and I was in dialysis and, anytime you're in a hospital or very normal clinical setting, you're seeing a lot of people who are frequent flyers.

[00:10:27] Christa Biegler, RD: And I will tell you that health professionals become very disillusioned after a while just because they are not seeing the people who want the best in that case. Whereas now in private practice, I see the opposite. I see the people who want the best, which are the people who are reading your books, right?

[00:10:39] Christa Biegler, RD: And so that took a recalibration in my brain. I was, it's like you only know what you're immersed in sometimes and to your point, I did as a very hard Enneagram three achiever, I wanted to check the box of a book thing. So when I was asked to do a eczema cookbook, the publishing thing, it was funny because when you write a book, you want to solve everyone's problem.

[00:11:04] Christa Biegler, RD: I don't know if everyone feels that way, but that's what I would guess. I think that's like the nature of it. of a lot of helpers, right? Like they want to just solve everyone's problems. And I remember they were like, this is not a science book. None of this is relevant, but out all of these words.

[00:11:18] Christa Biegler, RD: And so it's funny when people tell me, they're like, Oh, I bought your cookbook. And I'm like, yes, that is not the book that we would have wanted. And that's okay. That's okay. Everything is an experience and my life is not. Massively better or worse. I am encouraged when people say that was very helpful.

[00:11:34] Christa Biegler, RD: I'm like, oh, imagine you could have gotten the book. I would have liked to write. 

[00:11:36] Lily Nichols, RDN, CDE: Exactly. 

[00:11:41] Lily Nichols, RDN, CDE: Yeah. sure if I had gone with a publisher for any of them, they still would have been, useful resources, but I think I would have had imagine if I had. They had their team of experts review it and you had an OBGYN who is on the folic acid is the only solution train.

[00:12:00] Lily Nichols, RDN, CDE: They would have been like, oh we can't put this to print. There's liability issues here. It just never would have, would have gone out. Yeah, it was, with my first book, I wasn't even thinking like it was going to make a splash in any way. I was just like, I have to get this out of my brain because I need to have a place to send people the information in a concise, cited way.

[00:12:20] Lily Nichols, RDN, CDE: So I didn't even think whether I'd go with a publisher or not. It was like, this is the quickest path to get this out here. And let's just do it, make it a resource available the end. And then once that one became quite successful, I was like, all right, I think that wasn't that bad. I think I could do it again.

[00:12:37] Lily Nichols, RDN, CDE: And I had enough friends who had gone with traditional publishers that it was like, that's not the path that I want to take. So I've turned down quite a few book deals, including cookbook deals and stuff like that. It's just Not aligned, at least not right now. I'm not saying that I'll never be aligned, but yeah, for anybody who's like considering authorship, you have options, you don't have to do it the way that everybody does it.

[00:13:01] Lily Nichols, RDN, CDE: Yeah, clearly. 

[00:13:02] Christa Biegler, RD: I love it. We were talking offline. How many times has someone reached out and said, we use real food for pregnancy as a textbook and programs. And on this note know you're feeling, we also talked a little bit about how, prenatal nutrition is not necessarily taught in school and dietetic program.

 It just depends on the program probably, right? 

[00:13:21] Lily Nichols, RDN, CDE: Totally. Yeah. So yeah, at this point, I've heard from a lot of people, probably in the multiple dozens, but there's a lot of overlap in the programs that they're mentioning. So I'd say we're probably at maybe 10 schools that I've heard of that use it as a textbook, like the midwifery program at Best Year, which is a sort of naturopathic alternative medicine.

[00:13:42] Lily Nichols, RDN, CDE: Maybe they call it integrative functional medicine now up there. I don't know, but it's a sort of forward thinking natural health school up in Washington state. They use it as the textbook for their prenatal nutrition class. There's a number of dietetics programs that have incorporated it into their curriculum too.

[00:13:59] Christa Biegler, RD: Let's talk about why preconception nutrition needed to be the next book. Was this a conversation between you and Lisa? Was this something you were really, this is something I see a lot in practice. This is like the main thing I'm doing in fertility nutrition is preconception nutrition. And I will say my clients who are very smart people are still undernourished women who don't necessarily think that they would be undernourished.

[00:14:20] Christa Biegler, RD: So what are the risks? of a woman who is not fully, completely nourished getting pregnant or what are some of, what, where did this come from? Why was this such a need? 

[00:14:32] Lily Nichols, RDN, CDE: Yeah, so this was definitely a conversation that Lisa and I had considered together for a long time. Many years, a lot of people don't know, but we were like bookwriting buddies when I wrote for pregnancy, she was writing the fifth vital sign and we'd meet on a regular basis.

[00:14:49] Lily Nichols, RDN, CDE: So we know our, writing and research styles are pretty aligned. The type of book that we want to, would want to put out would be really similar, which is important if you're co authoring anything. For us, I feel like there's not really many up to date preconception or fertility nutrition resources out there.

[00:15:06] Lily Nichols, RDN, CDE: I think most of what's out there panders to this concept of the Mediterranean diet, and I actually go into that and have a whole section on that in the book itself, speaking to why it's not really like an accurate description of the diet in the region in the first place, but also what are some of the consequences if you do implement a Mediterranean diet by the Western conventional definition?

[00:15:30] Lily Nichols, RDN, CDE: it can leave some nutritional gaps and sometimes can have some adverse effects on fertility, which nobody seems to address. So we want to set the record straight on that. It also feels like a lot of the resources on fertility are just from the standpoint of let's get you pregnant as quick as possible.

[00:15:48] Lily Nichols, RDN, CDE: Not let's improve your overall health. So that we're having a healthier, low risk, low complication, pregnancy, a healthier birth, healthier postpartum recovery, of course, a healthier baby. But a lot of the resources are just like, they focus on the conception part so much. And to me having worked in the prenatal space so much, a lot of the pregnancy complications and issues that can occur in pregnancy happen really early in the pregnancy.

[00:16:17] Lily Nichols, RDN, CDE: Like you look at congenital birth defects, everybody knows neural tube defects, right? Those are happening in the first five to six weeks of pregnancy. All the organs, internal organs are fully formed by, not fully formed, but they have differentiated, the cell types have all differentiated into their organs by eight weeks of pregnancy.

[00:16:37] Lily Nichols, RDN, CDE: So like any major defects, like a heart defect, a congenital diaphragmatic hernia, any of those things, those are set really early in pregnancy. And a lot of women aren't thinking about their nutrition until you've gotten that positive pregnancy test. Based on how pregnancy is dated, that's already four weeks of your pregnancy.

[00:16:58] Lily Nichols, RDN, CDE: Are we really going to be able to intervene with enough time in another two to four weeks to improve your nutrient status to avoid some of these things from happening? The other thing is with the gestational diabetes work that I've done a lot of what lights me up about that work is we're setting up the next generation for potentially better health by improving mom's blood sugar control, because that impacts the baby's pancreas, their insulin resistance, their metabolic function.

[00:17:26] Lily Nichols, RDN, CDE: It goes beyond that, though, because the baby inherits their mitochondrial function their ability to utilize energy, create energy from food they're taking in and other things from their mom. paternal mitochondria is destroyed after fertilization. So you're inheriting your mom's metabolic health essentially.

[00:17:47] Lily Nichols, RDN, CDE: And we need to have mothers starting their pregnancies with better metabolic health. The majority of gestational diabetes cases, which I've spoken about ad nauseum for like well over a decade, really stem back to a pre pregnancy blood sugar or insulin regulation issue. And it's, yes, we can do things to improve outcomes.

[00:18:09] Lily Nichols, RDN, CDE: Obviously, I've written about that at length, but could we even improve the blood sugar and insulin regulation and all of that ahead of time? So we avoid the diagnosis entirely. That starts preconception and then like just one more thing, cause I could go on forever is we also wanted to talk about the male factor as well.

[00:18:30] Lily Nichols, RDN, CDE: So we have a whole chapter on sperm quality because when, anytime you start talking about fertility, everybody thinks of the woman and they don't think about the man, Oh, if there's delays in getting pregnant, Oh, it must be something going on with her, where male factor and fertility. Is a component of at least 50 percent of infertility cases.

[00:18:50] Lily Nichols, RDN, CDE: So we need to be looking at the man's health as well. So this is the first of any of my resources that brings in the partner into the conversation. That's not just, women's health focus solely. 

[00:19:03] Christa Biegler, RD: I think this is a perfect three bullets. It's exactly where I want it to go. And so we'll actually start in reverse a little bit with the male factor, because I feel that while it is very important, you just said that only at preconception, conception, and then it's not after that.

[00:19:17] Christa Biegler, RD: So it's the shortest conversation, I feel, compared to the next two conversations, which are going to be a little bit about egg quality and then a little bit about that metabolic health in the mother. So we'll figure out which one we want to go to, but let's talk a little bit about male factor fertility.

[00:19:31] Christa Biegler, RD: How do recommendations change for males versus females? How do we want to think about them and the preconception?

[00:19:39] Christa Biegler, RD: Also, how early do we want to talk about preconception? I always tell people at least three months before preconception, but that's after working on all of their other core stuff for a handful of months, right? And I bring this up, I think there's such a line to toe a little bit. As you would know the numbers better than I do about I think I have to be careful about how I talk about this or even you talk about it, because when we are projecting stressful concepts on women, we're not helping, right?

[00:20:11] Christa Biegler, RD: I think that's the opposite of everything. I think that a lot of the issues I see with conception, This is my opinion. The issues I see with conception around sluggish thyroid, sluggish progesterone are at a core stress issues overall. And therefore, anything that, and I generally apply this to most things in practice.

[00:20:30] Christa Biegler, RD: Generally, if this is increasing stress, it may be circumventing the out, the goal or outcome. I guess I want to bring that up because anything we talk about here is meant to be just science. It's just. to be useful, to be helpful, not to be stressful that if you weren't planning, a year in advance or six months or three months in advance before you got pregnant that you should be stressed during your pregnancy.

[00:20:53] Christa Biegler, RD: So right out there as well. Yeah. And 

[00:20:55] Lily Nichols, RDN, CDE: Our recommendations. No, I think those are all like really important disclaimers and our recommendations give a range, a span of time. Part of because the book ended up so long, and I found that kind of stressful. I was like, this is too long.

[00:21:12] Lily Nichols, RDN, CDE: Maybe we went into too much detail, right? We all of the feedback I'm getting from people is they like the details. It is what it is. We put in like a preconception planning checklist, we call it a chapter but it's a very short like literal checklist where an entire chapter boils down to a bullet point, and there we go into some of the more detail on like, when you might want to consider like when a shorter. And I think that, when you're planning to conceive, like interval is fine. And when there are times when you maybe want to have a little more time on the clock so that honestly you take the stress off, you take the pressure off of yourself.

[00:21:50] Lily Nichols, RDN, CDE: Because Our fertility is like the first, it's an optional function in our body. Like you can survive. if you have infertility, right? You're not going to die. You won't be able to reproduce, but you're not going to die. Because your body pulls back any resources from your hormone production, from ovulation, whatever, when it senses, like you're saying, some sort of stress or scarcity.

[00:22:20] Lily Nichols, RDN, CDE: And so we need to like, be, cognizant of supporting really taking this from the angle of supporting our body's functions, nourishing. Yes, we're going to provide some education that might sound a little scary, like the stuff on toxins, for example, but we want to give you like ample time for your body to reach homeostasis to the point that it does start like ramping up hormone production more.

[00:22:45] Lily Nichols, RDN, CDE: It does start ovulating again. Sperm quality does improve These things are changeable. They respond to your lifestyle and environment in real time. So with that disclaimer out of the way, three to six months, I think is adequate for most individuals. If somebody is. Pretty healthy. You have no overt issues.

[00:23:05] Lily Nichols, RDN, CDE: You're speaking to women. You're cycling regularly. You have if you're noting your fertility signs, which is something we go through in the book and those seem to be adequate, like that's all in a good place. It's a pretty good reflection that your hormones are good. And maybe like you're already eating a pretty nutrient dense diet.

[00:23:24] Lily Nichols, RDN, CDE: You don't really have to change anything. You've been on this train for a long time. Great. And then for other women, where there might be some cycle irregularities, maybe they've more recently come off of hormonal contraception, the longer you've been on hormonal birth control, the longer of a lead up you may need, simply because it takes there's a delay in Your body returning to, regular ovulation and normalizing all your cycle parameters.

[00:23:51] Lily Nichols, RDN, CDE: So we want to give ourselves that sort of runway. But just speaking from here's the time point at which like nutrition makes the biggest impact. We are really looking at that three to six month window. We look at sperm production. You're going back a little over 70 days for the full creation of sperm for egg quality.

[00:24:13] Lily Nichols, RDN, CDE: Technically, if you go all the way back to the undeveloped follicle that's going back 220 days, selecting that follicle and it going through its full development cycle until it is ovulated. But in that, I'd say, 70 or so days prior to ovulation, that's where your Micronutrient intake, for example, your protein intake, your inflammation, your toxin exposure, those have the biggest impact in that last three months or so.

[00:24:43] Lily Nichols, RDN, CDE: So you can if you need specifics, we have specifics for figuring out, like, How much time do you think I need? There's plenty of people who, get pregnant without doing any planning whatsoever. And if you're, eating pretty well and these things are dialed in, you might not need to make like this.

[00:25:01] Lily Nichols, RDN, CDE: Do this total dietary lifestyle overhaul in preparation for conception. But as we know in fertility being on the rise, there are some individuals who can benefit from a little bit, more comfortable timeline instead of stressing about it happening right away. We have to get like realistic, 

[00:25:20] Christa Biegler, RD: This makes me want to go off on a tangent about advanced maternal age, but we'll see if we have time.

[00:25:24] Christa Biegler, RD: And if not, maybe next time back to male factor fertility. I usually talk about after anatomical issues are addressed antioxidants and oxidative stress use of toxins, et cetera, can affect sperm quality, anything else big that I'm missing? Because I'm keeping male factor fertility kind of short, the long versions in the book, but anything else that is really good to just notate here when you're thinking about male factor. 

[00:25:48] Lily Nichols, RDN, CDE: Yeah, there's, there's a lot of overlap with the factors that affect both egg and sperm quality. You could probably apply pretty much everything I say here also to egg quality. Elevated blood sugar is an issue. That, of course, is going to drive up oxidative stress, so that can affect sperm quality.

[00:26:06] Lily Nichols, RDN, CDE: Definitely thinking about the refined carbohydrate, added sugars, That whole component, excessive amounts of alcohol can also damage sperm quality. If fat intake is too low, that can compromise testosterone production and sperm quality, especially if fat intake that provides nutrients like vitamin a and omega three fats is too low.

[00:26:30] Lily Nichols, RDN, CDE: Those again, can compromise sperm quality. Let's see I'd even add like too low in protein. There's a lot of individual amino acids that are supportive of sperm quality. Some of which actually have antioxidant functions in their own right. Like taurine, for example, which is highly concentrated in semen.

[00:26:48] Lily Nichols, RDN, CDE: You get that from animal protein creatine carnitine. Like these are some other amino acids again from animal protein. that support sperm quality, sperm motility and fighting off oxidative stress. So those are like a handful off the top of my head. You mentioned antioxidants. So of course, like the fresh produce conversation also needs to be had as well.

[00:27:09] Lily Nichols, RDN, CDE: Honestly just moving towards displacing more of the processed with more whole foods. targets all of these things that I just mentioned without overcomplicating it with the nuance. 

[00:27:24] Christa Biegler, RD: And if I was going to add any nuance here, I will say just as a person who sees humans still, as a clinician. If your partner or even you deal with heartburn or reflux or indigestion, this all could be pieces of not digesting the protein.

[00:27:41] Christa Biegler, RD: I do think to underline something that Lili said is that Fat intake could be too low. Fat metabolism can be a huge issue. And I think this brings us to egg quality very beautifully because when I think of egg quality, I think of cell membrane status. I think of mitochondria, I think of all of those rich antioxidants that are really necessary.

[00:27:59] Christa Biegler, RD: Three to six months, as you said, you use the days in advance and everything you said there could be applied to. I'm always thinking about egg quality when I'm thinking about preconception nutrition. And I know you brought up toxic burden. I've heard Ayla, our mutual friend speak on this.

[00:28:18] Christa Biegler, RD: I actually had her come out to our state to speak on it years ago, and people were just in awe. The research around it is wow. It's actually quite comforting to know that there was so much research for you to choose from in this topic, as a side note. 

[00:28:34] Lily Nichols, RDN, CDE: Oh my gosh, of all the chapters, of course, since this is co authored, we had to split up the writing, who took the bulk of the work on different sections.

[00:28:42] Lily Nichols, RDN, CDE: And I wrote the toxins chapter, and I can tell you I could have cited

[00:28:46] Christa Biegler, RD: That's crazy. 

[00:28:47] Lily Nichols, RDN, CDE: 10, 20, 

[00:28:47] Lily Nichols, RDN, CDE: 30, 40, 50 times more studies than I did. It gets to the point where you're like, okay, which study was more recent? Which one's a more reputable journal? Okay, I'm gonna pick to cite this one and not these 20 other ones because this gets too overwhelming.

[00:29:05] Lily Nichols, RDN, CDE: There's just an enormous amount of research on The effects of environmental toxins on both male and female fertility. leave it at that, and we do cover that in a lot of detail, and yes, that's another factor that would be absolutely vital to keep in mind. So not just the alcohol, which arguably is also a toxin but the cigarette smoking, the cooking in nonstick pans, plastic exposure, even EMF exposure.

[00:29:33] Lily Nichols, RDN, CDE: Which we talk about just briefly in the sperm section. So 

[00:29:35] Christa Biegler, RD: smelly stuff 

[00:29:36] Christa Biegler, RD: in your house, coffee quality, just offering some basics. 

[00:29:39] Lily Nichols, RDN, CDE: All that stuff does make a difference. So anywhere where you can just clean up the lifestyle a little bit to be less fragranced, less plasticky, stop spraying your yard with Roundup, my gosh you're going to have dramatic improvements on both egg and sperm quality. 

[00:29:57] Christa Biegler, RD: Yeah, I will say this is a topic I love and talk about and has impacted my life so dramatically because I'm a person with skin stuff and so the skin is a place where your body gets rid of crap it can't get rid of and genetically I am not blessed in drainage and detoxification. 

[00:30:15] Lily Nichols, RDN, CDE: Me 

[00:30:15] Lily Nichols, RDN, CDE: neither. 

[00:30:16] Christa Biegler, RD: Like for me, if I cannot pop out of bed in the morning, I know that my bucket has gotten.

[00:30:22] Christa Biegler, RD: And I'm just a human living. A really pretty low process life with natural products in my home, and I'm not perfect I know that if I drink poor quality coffee for a week, I will feel worse. Like know these things after years of experimentation on self. And I bring this up because not everyone knows that about themselves yet.

[00:30:41] Christa Biegler, RD: And You can't be massively mobilizing toxic burden on the inside during pregnancy. I think we could probably both agree that's not intelligent, but you can reduce over the things that are filling your bucket from the outside always. And so we don't have to be crazy about it, but there's so many basics, like how are you breathing and what are you drinking?

[00:30:59] Christa Biegler, RD: And what are you eating, and what are you touching all day long, or what's touching your skin all day long, 

[00:31:03] Lily Nichols, RDN, CDE: for 

[00:31:04] Lily Nichols, RDN, CDE: all the controllables. 

[00:31:05] Christa Biegler, RD: Yeah, simple things, they're just little things, and they take a little bit of time right your body is trying to clean up naturally.

[00:31:12] Christa Biegler, RD: But our world is not, it's not the way that we were created anymore. And so it's just where we are. It's just where we are. But every little step you make could be a big deal. So I'll just leave it at that. 

[00:31:25] Lily Nichols, RDN, CDE: Yeah. 

[00:31:25] Christa Biegler, RD: Okay. So that's toxic exposure and burden. Egg quality. We've danced around a little bit.

[00:31:31] Christa Biegler, RD: I'll underline again. Fatty acids, I think, are huge for hormone production in general, which low hormone production, I would say, is quite epidemic, I think, personally. I don't know if you think that way, at least progesterone wise. And I think, when people bring up hormones, I'm like, which ones would you like to talk about?

[00:31:48] Christa Biegler, RD: Adrenals? Thyroid? Sex hormones? I know when people say that, they're like, Every, I just feel off. But I want to bring up you brought up congenital defects earlier. You talked about how these happen in the first five to six weeks. And my question is there research around egg quality And what we're doing preconception impacting is the egg quality potentially impacting or what is impacting those congenital defects at five to six weeks that we could potentially intervene with that we know for sure.

[00:32:15] Christa Biegler, RD: Does that make sense? That was a rambling question. 

[00:32:17] Lily Nichols, RDN, CDE: That makes sense. I might answer it in a bit of a roundabout way, but It depends on which congenital anomaly you're looking at. For heart defects, for example, there is an association similar to neural tube defects with low folate status.

[00:32:33] Lily Nichols, RDN, CDE: Also elevated maternal blood sugar levels are associated with a fivefold higher risk of congenital heart defects. So people hear the term congenital, and they assume that it is genetically inherited or something, or oh, this was defective and there was no bearing on yeah, anything in my lifestyle or environment that could have played a role in it.

[00:32:54] Lily Nichols, RDN, CDE: And sometimes that is true, right? We do have genetic abnormalities sometimes, like sometimes the genetics quality of the egg is imperfect, or sometimes there's DNA fragmentation in sperm that's imperfect, but these things do have some relation to the environment, the exposures, the nutrient status, right?

[00:33:16] Lily Nichols, RDN, CDE: So folate, maternal blood sugar levels are huge. With congenital diaphragmatic hernia, there's a ridiculously strong link to vitamin A deficiency, specifically retinol deficiency, the animal sourced vitamin A. We have not only animal data, direct animal data, where you like deprive the lab animals of retinol and then their offspring develop congenital diaphragmatic hernia, but we have human data as well, both moms who had babies who had a CDH anomaly or babies with CDH, they are both low in retinol lower than adolescent.

[00:33:55] Lily Nichols, RDN, CDE: Bye. Bye. the healthy babies or the moms who did not have a baby with this type of defect. So retinol's huge. And we're at a place in our country where 80 percent of women are not even meeting the RDA for vitamin A from retinol. So that one is key. When you get to the neural tube defects, it gets into like whole folate status and really any of the nutrients that have anything to do with methylation.

[00:34:22] Lily Nichols, RDN, CDE: There is an association there. So a number of different B vitamins other than folate, such as B12, B6, vitamin B2, or riboflavin zinc, and zinc plays a role in folate metabolism methionine, glycine, choline, and methamphetamine. all of those nutrients are protective against neural tube defects as well.

[00:34:43] Lily Nichols, RDN, CDE: Again, if you're like, if we want to zoom out, like, where do you get all these nutrients and foods? It's a whole food omnivorous diet, something that includes both plant and animal foods. That's really where you get these nutrients in sufficient amounts, and when you're eating more of those foods, you're, generally eating less of the refined carbohydrates and sugar that would drive up maternal blood sugar levels, right?

[00:35:05] Lily Nichols, RDN, CDE: So the more whole food based we are, like the better, especially focusing on sufficient protein and including some variety of different produce in your diet will get you all of those nutrients. 

[00:35:19] Christa Biegler, RD: I'll underline that when your blood sugar is elevated, your body, it's a form of stress in the body, and so our body is using up nutrients.

[00:35:25] Christa Biegler, RD: I think that's the easiest way to talk about stress, is that it simply uses up nutrients that would be used for other purposes. Especially those B vitamins, I would say, if not. It's not almost everything you just brought up. When you brought up deficiency and retinol, which I'll remind everyone what you just said, this is not carrots and orange vegetables.

[00:35:43] Christa Biegler, RD: This is the conversion within the liver from beta carotene plant based vitamin A into animal based vitamin A retinol. It's very different. And as I've been in a little bit of a mineral deep dive in different things over the years, I wonder if you have any thoughts about. individual supplementation of vitamin D competing with vitamin A and almost I feel in the last four years that our haphazard supplementation has been not always in our best interest to just, when people are like I'm low in D, so I just took D.

[00:36:17] Christa Biegler, RD: I'm like, are you considering the other things that it impacts? Conversely with, if you're taking B vitamins, those are water soluble. Not as much risk there, honestly, but when you're doing minerals and fat soluble nutrients, everything has an antagonistic or synergistic relationship. And with A and D in nature, A is found in a much greater amount, maybe three times as much as vitamin D.

[00:36:39] Christa Biegler, RD: If you look at cod liver oil, for example, a beautiful source of vitamin A retinol. But when people are taking individual vitamin D, just because, and here's my other question around vitamin A. No one tests for this. You are barely, if you were tested for vitamin D, you're an exception, to be honest.

[00:36:55] Christa Biegler, RD: We're not really tested on nutrients. Can you go and ask for nutrient testing? When my mother was in the hospital for a month and I asked for vitamin D testing, they couldn't even find it on the computer. So I just share that because it's like I did not think this would be difficult. 

[00:37:11] Lily Nichols, RDN, CDE: Yeah.

[00:37:11] Lily Nichols, RDN, CDE: Yeah, 

[00:37:12] Christa Biegler, RD: it should be basic But 

[00:37:13] Lily Nichols, RDN, CDE: okay, let me try to remember all the things. Yeah, 

[00:37:16] Christa Biegler, RD: can you test for vitamin 

[00:37:17] Christa Biegler, RD: A and then vitamin D in? Individual do you have opinions about that impacting our vitamin A? That's really the two questions. 

[00:37:23] Lily Nichols, RDN, CDE: Yeah, that's like nutrient We definitely have to talk about nutrient synergy always, right?

[00:37:29] Lily Nichols, RDN, CDE: Because every nutrient impacts something else in your system. So yeah, absolutely. Like vitamin A, vitamin D, vitamin K2, there's a bit of a trifecta. They impact each other. They also will impact mineral metabolism, some of the B vitamins, they'll impact like heme synthesis. There's a lot going on in our bodies.

[00:37:49] Lily Nichols, RDN, CDE: We're complex beings. We do have to remember with vitamin D that, we're not living the way that humans used to live, which is a lot of time outside with Sun exposure at least in the warmer months pending where your climate is. And we didn't have sunscreen as an option until what the 1970s.

[00:38:12] Lily Nichols, RDN, CDE: So people are getting a lot less vitamin D than they did before. Like 90%, somebody who's not supplementing 90 percent of your vitamin D status is attributed to sun exposure, not food, really. There's no food source alone. even all the food sources added together, you're not going to get the amount of vitamin D that your body requires.

[00:38:32] Lily Nichols, RDN, CDE: You have to have some coming in from sun exposure. So I think vitamin D supplementation has a place for the individuals who are not able to get enough sun exposure, whether that's, The lifestyle choice or just where they live latitude wise, the farther north you go, the shorter the window of time that you can even make vitamin D from the sun because the sun rays have to be at a specific wavelength to interact with the, cholesterol precursor in your skin to produce vitamin D.

[00:38:58] Lily Nichols, RDN, CDE: Like it's a very complicated and yet also elegant system. Depends on the person, but I think we are at a place where a lot of people are. under consuming vitamin A. Depends on who you talk to in the internet. Some people feel it's the opposite and everybody's vitamin A toxic, but 

[00:39:15] Lily Nichols, RDN, CDE: that's a conversation. 

[00:39:16] Christa Biegler, RD: I don't hang out in those corners. 

[00:39:18] Lily Nichols, RDN, CDE: Oh, that's a conversation for another day. There's all sorts of stuff all over Twitter on this right now, which is really cool. bizarre. But my opinion is a lot of people are supplementing vitamin D, but they're getting insufficient amounts of vitamin A. So I think we need to get both.

[00:39:32] Lily Nichols, RDN, CDE: There's a reason that I'm so gung ho about people having some liver consumption in some form on a relatively regular basis, not massive doses, but enough to like fill the coffers on vitamin A. 

[00:39:47] Christa Biegler, RD: You were ahead of 

[00:39:47] Christa Biegler, RD: the trends on that, by the way. 

[00:39:49] Lily Nichols, RDN, CDE: Yes, right? I know. And now sometimes I have to like, I have to explain myself a little bit because at the time of writing at least my first two books, people were not doing desiccated liver supplements.

[00:40:01] Lily Nichols, RDN, CDE: You had the option of maybe one or two on the market. And now I have people who are like, okay, I'm taking these like 25 desiccated organ supplements. I'm like, and this super comprehensive prenatal. I'm like whoa, slow your roll. Like you might actually be getting a little too much. Let's think ancestrally here.

[00:40:23] Lily Nichols, RDN, CDE: Please go back and consider. I said three to six ounces of liver per week, not three ounces every single day. But anyways yeah, so the organ meats certainly have a component. The other part you asked about was vitamin A testing. And this gets into super nerdy nutrition land because vitamin A status is probably the trickiest nutrient to assess via lab tests.

[00:40:48] Lily Nichols, RDN, CDE: Ooh, 

[00:40:48] Christa Biegler, RD: big statement. 

[00:40:50] Lily Nichols, RDN, CDE: Serum levels are really tightly regulated. It's probably somewhat similar to the conversations around mineral testing, right? You're gonna keep a certain amount in your bloodstream, but you store the excess in other places. With vitamin A, it's not stored in the hair or the bones necessarily, it's stored in your liver.

[00:41:10] Lily Nichols, RDN, CDE: So the most accurate way to assess vitamin A status is a liver biopsy. Which obviously is ridiculously invasive, and it's essentially only done in the context of research studies. What's interesting about it, though, is that when you start looking at vitamin A status and all of our assumptions around vitamin A requirements, They are based on assumptions of an amount of vitamin A in a liver biopsy sample, and there's some indication in the last couple years, some research came out questioning whether that is actually sufficient vitamin A stores.

[00:41:49] Lily Nichols, RDN, CDE: In other words We don't know what the hell to low for like how much vitamin A is supposed to be concentrated in the liver and actually it should be like 30 percent higher than we thought so if you test your vitamin A status unless your liver is completely out of vitamin A, you're probably not going to have low serum levels.

[00:42:09] Lily Nichols, RDN, CDE: So it's a tricky one to test for. 

[00:42:12] Christa Biegler, RD: Yeah, interesting. Interesting. And yeah, a really important topic, maybe an entire episode on vitamin A deep dive, which I just feel is I think we have really popular nutrients. And then I think we're like, what about this guy? Who's actually really important, but you're not giving him any popularity, which I think. 

[00:42:27] Lily Nichols, RDN, CDE: Totally. Yeah. 

[00:42:29] Lily Nichols, RDN, CDE: I have mused about doing a vitamin A webinar for years and it's just, it's never hit the priority list. But it's a fascinating day. Maybe 

[00:42:38] Lily Nichols, RDN, CDE: Someday. Yeah. 

[00:42:39] Christa Biegler, RD: It's nice to have things that you haven't quite accomplished yet. That was one of my last questions.

[00:42:44] Christa Biegler, RD: I have one more, if you have a minute I wanted to just know, I talked to you about this before we got started, but if you could give women something, if you're like, man, women would have such better outcomes in pregnancy if they had this in their preconception? And I'm asking this with loaded with my answer, right?

[00:43:00] Christa Biegler, RD: If I could wave a magic wand and equip women with something, what would you equip them with in their preconception journey to make outcomes better? 

[00:43:08] Lily Nichols, RDN, CDE: Yeah. So I have I'm going to give two different answers. Cause one is from the what do women actually need? Like physically and another one is maybe from like the testing.

[00:43:18] Lily Nichols, RDN, CDE: What would you want them to have on their radar? So I would give free grass fed beef to everybody. You spoke about like the connection with the fat intake and the hormones. We have data where. deprive women, essentially you put women on our dietary guidelines, okay, 30 percent or less of their diet from fat and it plummets estrogen and progesterone levels in their body.

[00:43:49] Lily Nichols, RDN, CDE: You just do not have the resources to make sufficient Hormones and so many women are bought the story about oh meat is bad Or it's not sustainable or it causes heart disease or cancer or whatever like the story is 

[00:44:05] Lily Nichols, RDN, CDE: Yeah 

[00:44:05] Lily Nichols, RDN, CDE: And they're way under consuming protein and they're also way under consuming fat if I was to like pick One thing that would improve my Fertility, improve hormones, improve the menstrual cycle.

[00:44:18] Lily Nichols, RDN, CDE: It would be having women eat more beef. And if that sounds absolutely nuts to everybody, I implore you to read chapters three and five, two, three, and five, actually of real food for fertility to set the record straight. Okay. The next thing I would maybe consider would be to make blood sugar screening routine.

[00:44:42] Lily Nichols, RDN, CDE: Now there's different ways of doing this. I think at minimum, just having, an A1C run on everybody would give you at least some information. It'd be inexpensive. Wouldn't cost a program a lot of money, but if every woman, I don't know that I'd give it to every woman. Cause I don't think women who are on the like eating disorder spectrum benefit from this, but a continuous glucose monitor.

[00:45:04] Lily Nichols, RDN, CDE: For anybody who has any possible concern over, their blood sugar being so too high, like maybe you screen with A1C and anybody in the pre diabetic range gets like a CGM for even just like a two week or one month CGM, it would give them so much actionable data. And what I notice about what, when most people, again, if there's not an eating disorder history going on, when most people are given a CGM.

[00:45:31] Lily Nichols, RDN, CDE: It is a really powerful tool for improving their diet. They can see firsthand, Oh, when I get enough protein at each of my meals, like this happens, Oh, when I have this soda, this happens when I have this smoothie, this happens when I get shitty sleep, this happens when I have a stressful meeting, this happens when I exercise, this happens, it's a really useful like tool for lifestyle change.

[00:45:55] Christa Biegler, RD: People learn the most through getting feedback and results, right? And there's some nuance there. 

[00:45:59] Lily Nichols, RDN, CDE: Real time 

[00:46:00] Lily Nichols, RDN, CDE: feedback, too. 

[00:46:01] Christa Biegler, RD: Something we didn't talk about was pre pregnancy blood sugar and nutrition outcomes, and you have a recent research brief that you just published on that, and if there was a one sentence comment on that, as someone, I'm like child five of seven, my mom had gestational diabetes the last two children, which I feel completely affected by.

[00:46:18] Christa Biegler, RD: did my life. I failed my glucose gradients with pregnancies. And there was a major shift when I started working on my metabolic health where I was like, Whoa, that's what that could look like. And so is there a one sentence statement, I know you should wrap up, but about this pre pregnancy blood sugar.

[00:46:34] Christa Biegler, RD: And one of the tricky things that's requires more nuance. And I was looking to see if we did this in a past episode is that our blood sugar. ranges that are probably conventional are not what you're necessarily talking about, which is the tricky nuance. But anyway, anything to say about pre pregnancy blood sugar nutrition outcomes that, a sentence on that. 

[00:46:55] Lily Nichols, RDN, CDE: Sure. It'll be a, just a few sentences. We see delays in conception among women, Even if they're generally healthy, so no diabetes, no pre diabetes, women whose blood sugar levels average just a little bit higher have delays in conception, natural conception. So we see it affects fertility, definitely affects fertility.

[00:47:16] Lily Nichols, RDN, CDE: The research brief that I was speaking to was looking more in the pregnancy space and they were trying to see what are blood sugar patterns women throughout pregnancy. They gave them continuous glucose monitors to see what would happen. And then later, everybody in the study did their glucose tolerance test to screen for gestational diabetes.

[00:47:34] Lily Nichols, RDN, CDE: And then they went back and were like, Okay, in the women who ended up developing gestational diabetes, were their blood sugar patterns different from the women who did not develop gestational diabetes? And it was significantly different. So their blood sugar, everybody got a CGM prior to 17 weeks. Their blood sugar levels were significantly higher the whole time.

[00:47:57] Lily Nichols, RDN, CDE: way before doing a glucose tolerance test. So my thing, as I've said, along all the time for many years, your blood sugar and insulin levels, a lot of those like blood sugar issues actually start preconception, or they've been going on a long time. And this concept that gestational diabetes is solely, always, something that simply develops during pregnancy as a result of the placental hormones and whatever is not doesn't describe most of the cases most of the cases there is an underlying predisposition and if we could identify it earlier we could provide these women with better dietary And lifestyle advice to improve their blood sugar levels, which then to your point about your health gives improves your, the metabolic health of your child as well, because instead of being exposed to elevated blood sugar for the majority of the pregnancy or gestational diabetes going unchecked for an extra trimester or two, we could identify it early, implement changes to optimize blood sugar levels throughout the pregnancy, and then improve outcomes for.

[00:49:12] Lily Nichols, RDN, CDE: mom and baby, right? You can reduce your risk of a number of different complications, preeclampsia, preterm birth, other things by improving your blood sugar levels. It's not just about avoiding a gestational diabetes diagnosis or something like that. It's about improving the outcomes across the board. 

[00:49:27] Christa Biegler, RD: Yeah, there's a blood sugar mastery is an amazing life altering thing that you could use at any point in life. And the magic wand thing I would say would be, I would wish women could test omegas or fatty acids or DHA specifically, because we know that low DHA can result in preterm birth or early delivery.

[00:49:48] Christa Biegler, RD: And we talk about that in an episode with Christina Harris Jackson, who's a Ph. D. R. D. And co owner of OmegaQuant. So just a really cool topic for a different episode if you're interested in that. Lily, what's next for you? We're three books in. Maybe someday you're going to write something about vitamin A.

[00:50:06] Christa Biegler, RD: Is there anything on the horizon for you that, that's coming up that you want to accomplish? Or that you're excited about. Yeah. asking in the happiness that Real Fruit for Fertility puts out, which is reasonable to do. 

[00:50:17] Lily Nichols, RDN, CDE: Yeah, Lisa and I have joked that we have post traumatic stress disorder, I can't remember what we've called it, but it's just it was a lot of work so I do not know if I will write another book we'll see, time will tell.

[00:50:31] Lily Nichols, RDN, CDE: There's lots of requests. No need to send them to me. There's a long list of requests. What I've been working on lately or what's lighting me up is actually mentoring other professionals. We were talking beforehand about how our training in prenatal nutrition and our undergrad for our dietetics programs were inadequate.

[00:50:53] Lily Nichols, RDN, CDE: And I hear that a lot. And so I'm really having fun mentoring other professionals, which I do via the Institute for prenatal nutrition. I've run a group every year and that's been really fun. That's been like filling the coffers a little bit. It feels good to pass on the knowledge that was so hard to come by in the first place to other individuals and really mentor them through cases and I don't know, nutrition is like a really complex field that there's a lot of psychology going on with it.

[00:51:27] Lily Nichols, RDN, CDE: Like I talk so much about the data, but it's like very psychological. 

[00:51:31] Christa Biegler, RD: 50 

[00:51:32] Christa Biegler, RD: percent or more psychological. 

[00:51:33] Lily Nichols, RDN, CDE: 50 

[00:51:33] Lily Nichols, RDN, CDE: percent so it allows me to bring in some of the counseling things and like the holding space things, which I feel like. You really can only learn that if you've been a clinician for a long period of time nobody teaches you that, no motivational interviewing workshop or webinar is going to help you get there, it's actively doing that work, so that's been fun for me, like helping the next generation of prenatal nutritionists get their feet off the ground, Get into the research, 

[00:52:01] Christa Biegler, RD: and this is how you make, change the world. 

[00:52:03] Christa Biegler, RD: I, this is really fun to hear because I could, I feel very similarly, like this is the natural evolution of someone's work, right? It's oh, I've done this work. Now let me pass it on so it doesn't die. Yeah. 

[00:52:16] Lily Nichols, RDN, CDE: And I can also 

[00:52:17] Lily Nichols, RDN, CDE: like, I'm currently not accepting one on one clients.

[00:52:20] Lily Nichols, RDN, CDE: And so I have a vetted group of individuals, like graduates from the program that I'm like, When people ask, Hey, I want to work with you. It's you can't, but here's some great people that I've personally vetted. I've worked with them for months and months.

[00:52:33] Lily Nichols, RDN, CDE: I know that they know what they're talking about. And that's important when, a lot of these programs are not adequately. Preparing dietitians or nutritionists to really become sort of expert level and prenatal nutrition from the feedback I've gotten a lot of people simply remember that eat more calories and folic acid supplementation and avoid liver due to vitamin A toxicity.

[00:52:59] Lily Nichols, RDN, CDE: Those are the three things that people remember from their life cycle nutrition class. And the section on prenatal nutrition wow, we can do better, right? 

[00:53:07] Christa Biegler, RD: Yeah. We can do better. We can do better. Lily, people can find you at lilynicholsardian. com or realfoodforfertility. com. They can read the first chapter of the book.

[00:53:16] Christa Biegler, RD: Is there anywhere else you'd want to send people?

[00:53:17] Lily Nichols, RDN, CDE: Yeah, those two places would be great. Check out the freebies page check out the blog at lilynickelsrdn. All, everything on my website is all the blog articles are free for the taking. I'm not jumping on like the pay to play to read articles thing.

[00:53:32] Lily Nichols, RDN, CDE: So peruse, there are hundreds there. Social media wise, you can find me on Instagram at lilynickelsrdn. 

[00:53:40] Christa Biegler, RD: Thanks so much for coming on today.