205 – GESTATIONAL DIABETES & PCOS DURING PREGNANCY [Podcast with Lily Nicholas]

“Pure carbohydrates set you up for a blood sugar spike and crash and this triggers your hunger hormones to go wild for the rest of the day and you’ll just be eating eating eating on this blood sugar roller coster”

In this episode, registered dietitian, nutritionist, and certified diabetes educator Lily Nichols discusses with PCOS Diva Podcast host Dr. Vinu about PCOS and gestational diabetes. Lily explains how eating protein is extremely beneficial to manage blood sugar in pregnancy. She explains what gestational diabetes is and how to manage it with having PCOS.

 

Tune in as they discuss:

 

Resources Mentioned:

Lily Nicholas Website
Pregnancy Weight Gain Article
Real Food for Fertility Book
Real Food for Pregnancy Book
Lily Nicholas Instagram

 

Lily Nichols is a Registered Dietitian/Nutritionist, Certified Diabetes Educator, researcher, and author with a passion for evidence-based nutrition. Drawing from the current scientific literature and the wisdom of traditional cultures, her work is known for being research-focused, thorough, and sensible. Lily’s clinical expertise and extensive background in prenatal nutrition have made her a highly sought after consultant and speaker in the field.

 

 

 

 

 

 

TRANSCRIPT 

 

Dr. Vinu:
I’m really excited to talk to you. I’ve been going over the book and I have some questions ready here. And I just wanted to, you know, give you a little bit of idea what it’s going to be like, the session would probably be for about 3035 minutes. Okay. Have questions here. Mostly, it is going to be about nutrition, and gestational diabetes, I’m going to go a little more in depth on how any of this would impact PCOS women, especially us women who get pregnant and how it’s a little more different for them maybe in some aspects from the, you know, regular population. And, you know, at the end, I will just, you know, round it up with where our listeners can find more information about you or get interested how they can contact you.

Lily Nicholas:
Okay, sounds great. And can you remind me when this is planning to be published?

Dr. Vinu:
Um, I am not exactly sure at this moment, should be within the month. And when it does, we can keep you posted.

Lily Nicholas:
Okay, sounds good. I do have a third book coming out in February on on fertility, there’s like a whole chapter on PCOS. So, oh, yeah, that under I can either keep that under wraps and not really talk about it or not mentioned the title, since they won’t be able to buy it yet. Or if the episode could be published in like, after February 14, we could do that. And then I could mention it, but either way, I’m fine. Like it’s a, I want it to be a benefit to your audience. So if you need to get this January or whatever, that’s fine. And I’ll just keep the extra information out of it, you know,

Dr. Vinu:
Oh, yeah. No, we could, you know, we could have you back if you’re interested. Because that is a whole topic, you know, fertility and PCOS is like, you know, be so beneficial to our audience, you know, hear what you have to say on that. So, either, if you if you prefer, I could just include it in the introduction and say that you’re working on a third book, or, or you could do that at the very end, you know, that you’re working on a third book about fertility. So we were requested, you know, they can kind of follow up on it. That sounds great. Sure. Yeah. Okay. That sounds like a good plan then. And let me let me start off then. Okay, so I think the recording is in process. And by the way, just the audio is getting recorded, not the video. And if at any time you wanted to like pause or something, you know, just let me know. And we can always edit this after so we can just remove the parts that we need to edit anyway. Sounds good. Okey doke. So let’s get started then. I know everyone, I am Vinod Jyoti, preventive medicine specialist, and one of the members of the PCOS diva team, and I’m really excited to have with me today Lily Nichols. Lily is a registered dietician nutritionist. She is a certified diabetes educator, researcher and an author with a passion for evidence based prenatal nutrition. Her best selling book real food for gestational diabetes presents a revolutionary nutrient dense, low carb approach for managing gestational diabetes. Lily has a second book real food for pregnancy that outlines the problems with current prenatal nutrition guidelines and provide the evidence. Her work has not only Help 10s and 1000s of women manage the gestational diabetes, but it was also influenced nutrition policies internationally. I’m really, really excited to have Lily with us today. Hey, Lily, welcome to this podcast.

Lily Nicholas:
Thanks so much for having me.

Dr. Vinu:
Absolutely. So, I’m gonna start off with, you know, all of us have heard about how important nutrition is, especially during pregnancy. And I’m gonna start off with the term we usually hear, start eating for two, you know, so I would love to hear your take on that. Yeah,

Lily Nicholas:
that’s a that’s a really common one, I hear it all the time. You know, it’s not, it’s not wrong, of course, you are nourishing yourself and your baby and pregnancy. So, of course, you’re you’re eating for two. But I think the way that people interpret that is sometimes you need to eat like double the amount of food maybe. Or, Oh, you’re eating for two. So don’t worry about, you know, indulging in X, Y, or Z food. And really like there, there is an increase in energy requirements and pregnancy, but it’s certainly not a doubling of energy intake, you don’t need to eat twice the amount of calories. But you do need to eat a lot more of our nutrient dense foods, because your requirements for vitamins and minerals do go up pretty substantially. So I would say, eating for two, in terms of energy is really more like eating for 1.1, you need like an extra snack per day or slightly larger portions that your meal and not double the amount of food. And then you want to be focusing on improving your nutrient intake as best you can. So focusing on maximizing the nutrient density of what you’re eating? Not necessarily the portions being substantially larger. Yeah,

Dr. Vinu:
no, that’s good. And, you know, in your experience, what are some of the most common nutritional concerns that you encounter with pregnant women?

Lily Nicholas:
Well, I get a lot of questions. A lot of times, you know, people are not really given a whole lot of information about eating well during pregnancy. So, you know, they’re usually just given a list of don’t eat these foods, and maybe not given a list on foods you should emphasize. So a lot of my work is focusing on where are the areas in your diet, we can optimize to improve your nutrient intake and reduce your risk of various pregnancy complications. And what I often see lacking is protein intake, that is a nutrient that increases in requirements over the course of pregnancy. And a lot of women just are not getting enough. So that’s one area that I often focus on. And then again, as I mentioned, some nutrient dense foods, I’m often trying to help people improve their the quality of their diet, vast majority of Americans, including pregnant women, are eating a lot of what’s called Ultra processed foods. So things with a lot of like added sugar, or just based on white flour. And then, of course, all the things they add to it to make it taste good or look good. Like the colors and flavors and preservatives and everything else that goes in it, that actually makes up about 60% of the American caloric intake is ultra processed foods. So I’m usually trying to shift people away, you know, from those foods, eat less of those eat more of your whole foods that are more nutrient dense. By default, if you focus on protein that helps to displace a lot of the processed foods because it helps so much with your satiety as well.

Dr. Vinu:
Right. Yes. And, and, you know, nutrition, you know, we’re really concerned about that. But then 1/3 of your pregnancy and for some women, the whole of your pregnancy, they have nausea and vomiting, and you know, the ins and, you know, so how would you, you know, be eat nutritious food and the same time combat all of the symptoms that you’re having, you know, yeah,

Lily Nicholas:
the first trimester is usually when the nausea and aversions are at their height, and it’s a real challenge. You can have the best of intentions to eat super well. And when the nausea hits, sometimes you’re just trying to make the best of a really challenging situation. I wish I had advice that would work across the board for everybody to just, you know, eliminate that nausea. And unfortunately, that does not exist. There’s a wide array of tips that you can apply. I talk about it in real food for pregnancy. I have a blog article on first trimester tips on my website. And a lot of it is trial and error. And some of it even varies like day to day so some some basics though, so I’m not leaving you completely empty handed. Sometimes paying attention to the things that trigger your nausea can help you do lead to the things to avoid to, you know, avoid it getting worse. And one of those that’s pretty common is either under eating or eating and balanced meals or snacks, you’re very prone to actually having blood sugar drop a little too low, early in pregnancy, just based on how our blood sugar and insulin and everything changes, starting quite early in pregnancy. And that can trigger nausea. So if you eat small frequent meals, and try to get just a little bit of protein in there with whatever you’re able to keep down, because usually the thing that settles your stomach the quickest is carbohydrates. But unfortunately, they don’t keep you full for very long. And they trigger a blood sugar spike and a crash. So you go low blood sugar, again, very quickly, and your nausea returns, like even stronger than it was before. So I often recommend you know, eat a little bit of something to settle your stomach and then try to follow up with something that has protein. That can be really anything but sometimes like nuts or seeds, peanut butter, dairy products, cottage cheese, sometimes those settle your stomach a little easier. A lot of people do seem to have aversions to meat and and fish in the first trimester. And that that’s tricky when that’s like a great protein source. Sometimes eggs are a little easier tolerated. So you just kind of have to see what your symptoms have thrown at you for the day and try to make the best of it and know that it’s usually in most cases, just a phase that does tend to resolve as you get further in pregnancy.

Dr. Vinu:
Right. Yes, no, I hear you on that. There’s no one standard solution, right. It’s what works for you know, what works for you is what works for you. So you just need to figure that out. And it’s, you know, do you. So overall, we talk about nutrition, it’s kind of similar for all pregnant women. But is there specifically things that you know, you know, some of us we have to see how that fits us? Or is there things that we need to focus on? And I’m asking this from, you know, someone who’s had PCOS, from their perspective, what nutrition to the day follows it can be different from what a regular woman without PCOS would follow?

Lily Nicholas:
Yeah, it’s a good question. So, you know, there’s, as I’m sure you’re well aware, you know, a couple different subtypes of PCOS. However, the majority of cases have some level of insulin resistance going on elevated insulin levels. And with my specialty and gestational diabetes, of course, I’m well versed in both because having PCOS is a risk factor for gestational diabetes, because coming into pregnancy with insulin resistance already present is is a risk factor. By default, essentially, gestational diabetes is simply insulin resistance during pregnancy. So when you have it pre existing, and just by the physiology of pregnancy, we expect that insulin resistance is going to get worse, there’s a very good chance that over the course of your pregnancy, you’re just more likely for your blood sugar to exceed that threshold and put you in the category of gestational diabetes. So what I would say is some of the best things to focus on are things that help to improve how your body responds to insulin, so improves your your blood sugar response, and that may help lessen your chances of the insulin resistance getting so bad later in pregnancy that you do either end up with a formal diagnosis of gestational diabetes, or might help lessen the chance that you require medication or insulin to keep your blood sugar in check. So that would be prioritizing protein is a huge one, I mean, of all of our are three macronutrients are fats or carbohydrates and protein. Protein is the most satiating, it’s very good at stabilizing your blood sugar levels. It doesn’t, doesn’t trigger them to go up. In fact, usually the opposite. And especially when you’re careful about pairing your protein. With carbohydrates, you can lessen how much those carbohydrates spike your blood sugar. So that’s a huge one definitely needs a good focus. And more so in women with PCOS. Increasing the amount of fiber you consume. So non starchy vegetables for example would be a good example. Let’s see berries are pretty high in fiber coconut chia seeds. Fiber helps to kind of create a almost like a mesh in your stomach and your digestive system that slows down how quickly carbohydrates are broken down into glucose and raise your blood sugar levels. So that that is often really helpful because a lot of combating insulin resistance is just trying to minimize how frequently and how high your blood sugar spikes. And so fiber, both fiber and protein tend to be really, really helpful for that. Outside of the dietary component, exercise has been shown to reduce the chances of gestational diabetes by quite a lot. Generally, it tends to improve your insulin resistance. And then one other one I’ll throw in, I mean, there’s this, this answer could go on forever. But there is a pretty good amount of research now on supplementing with inositol. A lot of people in the PCOS community are already very familiar with inositol. But it is a nutrient that is also safe during pregnancy. So if you’ve been taking inositol, to help with your insulin resistance and PCOS beforehand, it can be safely continued throughout pregnancy. And there have been a lot of trials now looking at what it does to insulin resistance over the course of pregnancy, rates of gestational diabetes, or if you get diagnosed severity of gestational diabetes, and pretty much across the board, it’s beneficial. In a lot of ways, some of the mechanisms that works by are pretty similar to Metformin. But there’s less controversy, I guess, around using it in pregnancy. Even though of course, Metformin is also commonly used in pregnancy as well. So that is something that you could consider supplementing with even before you get pregnant and continue during the pregnancy, usually, they most of the studies are dosing around four grams a day of inositol. And yeah, it’s been highly, highly beneficial.

Dr. Vinu:
Oh, yeah. That’s awesome. Yes. And you’re right, a lot of PCOS women, before pregnancy are taking in hospitals, it’s a good idea to keep continuing that it’s good to not save during pregnancy, you know, yeah. That’s awesome. And so you talked about, you know, you kind of touched on it already. And, you know, you said, diet and exercise, you know, they’re kind of the pillars, right, of preventing gestational diabetes. So can you give us a little more in depth view of, you know, why do people end up getting gestational diabetes? And how is it different from, you know, regular, having chronic diabetes?

Lily Nicholas:
Yeah, well, in a lot of ways, it’s not that different. It is really, the physiology of it is very, very similar to pre diabetes and type two diabetes. Long time ago, our understanding of gestational diabetes was really coming from the perspective that it is something that only happens during pregnancy, and is only a response to several factors that are going on changes in maternal physiology, where you have central hormones, of course, you grow up placenta at the same time you grow a baby, and a lot of the placental hormones signal insulin resistance to occur. And this is really a built in mechanism. If you think about like the, the, you know, eras of human history, humans were exposed to famine quite frequently, and having insulin resistance as sort of like a default physiological mechanism that especially kicks in in the latter half of pregnancy when the energy requirements for baby’s growth are a lot higher. If your body is insulin resistant, it’s like you’re not going to be as you’re the maternal tissues are not going to be taking as much of that energy for themselves. And you can shunt that energy and those nutrients to the baby to optimize baby’s growth, even if there is some sort of a famine or food scarcity or it’s like a low harvest season or whatever. The body is always prioritizing the baby’s growth. Nowadays, that sort of adaptation doesn’t really work in our favor when we have an abundance of food, tons of calories, tons of processed foods, which are really high in calories and pretty low in nutrients. So in a way, like our physiology is almost like a mismatch to the modern food supply. But we used to think gestational diabetes was just something that developed during pregnancy. It’s just the insulin resistance caused by the placental hormones combined with you know, insulin resistance as a response to maternal weight gain. And that’s it once baby is born, it goes away. And now our understanding is gestational diabetes really is kind of like the warning light coming on in your car. There is something arise with your like blood sugar and insulin management. And when you have it, yes, it needs to be managed during pregnancy. And yes, it can kind of go away postpartum, but you are at a lifetime higher risk for Developing type two diabetes. And it depends on the research paper you’re you’re reading, but it’s anywhere from like a 30 to 70% chance that you will so called convert to type two diabetes in the five to 10 years after you’ve had your baby. It’s actually the number one predictor of type two diabetes and women if you have a history of gestational diabetes. So that’s what I say it’s like a warning light coming on in your car, it is a sign that like, your body needs some help with your blood sugar and insulin regulation. And it doesn’t, you don’t have to fall into these statistics. It’s not fate or destiny that you’ll for sure, get type two diabetes if you have it. But it is something where you probably want to pay attention lifelong, to your blood sugar and insulin. So pregnancy offers an opportunity where a we identify things because we’re actually checking blood sugar levels, which oftentimes outside of pregnancy, we’re not seeing them. The threshold for diagnosis is a little lower in pregnancy, because your blood sugar levels actually naturally should be trending lower than an average nonpregnant adult. So it’s a little more sensitive to screening for it and catching it. But then you’re also typically pretty highly motivated to take good care of yourself and pregnancy. And so the things that you’re learning about your blood sugar management can carry forward for the rest of your life, you’re going to learn which foods spike your blood sugar, which foods don’t, which foods keep you energized for longer, which foods trigger you to crave more, you know, processed foods. And those are usually pretty tightly correlated to what you’re seeing in your blood sugar readings, as well. So it’s not a diagnosis anybody wants to get. But I think it does offer the opportunity to learn a lot about foods. And then hopefully, maybe once you’re out of the early postpartum phase, when everything’s crazy, you can take some of those lessons that you’ve learned over the course of pregnancy and continue to apply to the way that you and your family eat. And then you don’t have to be a statistic necessarily.

Dr. Vinu:
Right. So So you know, let’s say PCOS women who do have insulin resistance, you know, they becoming pregnant. So is there a way to prevent gestational diabetes? Can you do anything you know, in your first trimester or later, that will prevent you from going in there? Or is it is it something that whatever you do, it’s still going to proceed. That’s the route it’s going to go in.

Lily Nicholas:
I have experienced with lots of clients who have avoided it and subsequent pregnancies or avoided it despite having a history of PCOS. So it can be avoided. There is no magic bullet where I could say for sure you do these things, and you won’t get the diagnosis because at some point, the way in which your physiology changes in pregnancy is not always entirely up to you. If you’re coming into pregnancy, at with your PCOS, pretty well managed, your blood sugar and insulin level have come down to a good level, your cycles have normalized a bit. If you’re maintaining a healthy weight or close to a healthy weight, if you’re physically active, all of those things work in your favor to reduce the risk of developing gestational diabetes, the inositol that we spoke about, there’s a number of other nutrients, vitamin D, magnesium, for example, that play a role in blood sugar and insulin regulation. Those things can all help. And while you’re pregnant, as best as you can, despite the nausea phase, eating healthy does help it when you eat healthy, and you kind of moderate your gestational weight gain. So you’re gaining like an appropriate amount of weight over the course of pregnancy. That also dramatically reduces your risk of developing gestational diabetes during that pregnancy. So there’s, there’s a lot and a lot of it. You can, you can do can move the needle a little bit. At the same time. There’s all sorts of risk factors that aren’t within our control, like our family history of type two diabetes, if our mom had gestational diabetes when she was pregnant with us. Age, you tend to get more insulin resistant as you get older. You know, there’s a couple other examples but there are things where you do sometimes have the deck stacked against you and you can try to like slip that as much as you can with Lifestyle, but there’s never a guarantee that you for sure will avoid a diagnosis. That said even with a diagnosis, you can manage it well where your adverse risk factors even when You have a diagnosis can be almost down to baseline if you keep your blood sugar in a healthy range over the course of pregnancy, so I do want to throw in kind of the silver lining side of it, people get so worried about avoiding a diagnosis, and sometimes, sometimes you can’t avoid it, but you can manage it really well.

Dr. Vinu:
Now, I hear you on that all that you were saying, you know, if you cannot avoid it your case controlling it in the best way possible. So, you know, hear you on that. So we discussed, you know, nutrition and exercise and you know, things to do during pregnancy. Is there any kind of foods that you would say you should completely avoid? Or keep it to the bare minimum? You know, in the in the Twitter messages?

Lily Nicholas:
Yeah, well, it’s especially when they’re speaking about the blood sugar aspects. I don’t know about avoid completely, but keep minimal. For special occasions, I would say the refined carbohydrates are some of the biggest contributors to blood sugar spikes, which of course spikes your insulin levels as well. And over time, that kind of feeds this insulin resistance that we’ve been talking about. So refined carbohydrates being any, any whole food carbohydrates that have been processed to remove things from them, like remove the fiber, so you take a whole grain, and then you refine it down into white flour, or you take corn and you refine it down into corn starch, or corn syrup. Those are refined carbohydrates, they really don’t have any nutritional benefits. What’s left behind is either pure starch or pure sugar, which either way your body digests it into sugar, and it spikes your blood sugar. So those are the foods that you’d want to be really cautious with how much and how frequently you’re consuming them. It almost like doesn’t even matter what dietary type you’re following. If you’re like reducing the amount of refined carbohydrates, by default, you’re improving your micronutrient intake, your protein intake, your fiber intake, these things just kind of are they’re like filler foods, they take up a lot of space and a lot of calories, but they’re not really providing our body with the nourishment that it really needs for growing healthy baby. Those would be definitely like, the number one thing when you’re concerned with blood sugar, about trying to keep to a minimum. And so I’m not saying don’t have cake, you’re at your baby shower, some things. Certainly you should be having some treats now and again, but just trying to make sure they’re not like a daily staple.

Dr. Vinu:
Yeah. Right. Okay. Yeah, no, that’s good. And, you know, pregnancy, you know, it is common that you would gain weight during pregnancy, you know, that is the, you know, aspect of it. So how do you make sure you’re gaining a healthy amount of weight? And then, especially for women that do have PCOS, where weight gain? And you know, you have all of these weight related issues? How do you make sure you’re gaining a healthy weight, and then you preventing all of the other complications that might arise? Because you’re gaining more than needed, you know, more than the healthy weight is? Right,

Lily Nicholas:
right. Yeah. And it’s a sensitive topic, right? Because not not everything in pregnancy really is in our control. And sometimes your weight just does things that you don’t expect in pregnancy. I would say first and foremost, to work with your provider to determine what’s a healthy amount of weight gain for you. There really aren’t. There’s not one standard, there are like ranges that are recommended based on your pre pregnancy weight and BMI. And I will also add, there’s a lot of new research, it’s kind of questioning if those conventionally accepted ranges are still accurate, maybe they need to be adjusted a little bit. I do have an article on my website on weight gain and pregnancy that that people can go to for more information that has some the specifics and how new research is maybe starting to redefine where we should go. For example, women of size, especially BMI greater than 30 or greater than 40. There’s some research suggesting that the recommended weight gain range is maybe too large for those women and maybe it can be a little bit smaller than what we’ve recommended in the past. And that’s based on looking at like the chances of adverse pregnancy outcomes, including complications like gestational diabetes, preeclampsia, preterm birth, having a baby that’s like significantly lower larger than we’d expect, which is called macros OMYA. And then looking at what were the weight gain ranges for those women based on their BMI. In terms of like trying to control that weight gain, again, I’m gonna go back to that protein recommendation, it really does make a very big difference in your blood sugar levels and your satiety if you’re getting a sufficient amount of protein. So if you feel like whoa, the scales going up a little faster than I expected. Oftentimes, the first place that I look is like where’s your protein intake at, particularly at breakfast, because that really does set up your blood sugar control for the whole day. And breakfast is often when our protein intake is the lowest because you think about popular breakfast. So things like oatmeal, or fruit, or fruit smoothie, or cereal and milk, glass of orange juice, like these things are all just pure carbohydrates, and they set you up for a blood sugar spike and crash. And this triggers your hunger hormones to go wild for the rest of the day. And you’ll just be eating, eating, eating on this blood sugar roller coaster. It sounds too simple to work. But it really is important that you get that protein in first thing in the morning. Women especially often do well with 25 or 30 grams of protein at their breakfast. And that often sets you up at a good place just for the rest of the day. Like here, we are recommending you eat like a good amount of food in the morning. But it actually really does help to prevent potentially excessive weight gain and pregnancy and also sets you up for really good blood sugar levels for that whole day.

Dr. Vinu:
That sounds good. So as a follow up to that, you know, there’s a lot of people who are vegetarians or vegans. And a huge challenge with that is finding foods that are protein dense, right? So do you have any recommendations for you know, vegetarians or vegans on what they can take, that will give them the needed amount of protein in the diet?

Lily Nicholas:
Yeah, it’s a big, it’s a big challenge. Because if you look at all of our whole whole foods, at least vegetarian sources of protein, they do pretty much all come packaged with carbohydrates as well. Our nuts and seeds will have a lot less carbohydrates. They’re packaged with more fat than carbohydrates, but your legumes all have a significant amount of carbohydrates, your high protein grains like quinoa, you know, you’d maybe have like eight grams of protein in there, but that’s packaged with 40 Something grams of carbohydrates. I will say that focusing on more legumes and beans tends to be helpful and products that are made from legumes and beans. So like tempeh, and tofu, for example, will have more higher density of protein and lower density of carbohydrates. They do have, you know, protein powders made from all sorts of vegetarian sources that you could potentially look at. incorporating more nuts and seeds can be helpful. Sometimes you just have to get a little bit creative, but it definitely is. It’s especially from a blood sugar perspective, trickier when you’re trying to keep your carbohydrate intake in check. And that’s where I think sometimes there is a time and a place for bringing in like a protein powder. Now for like lacto ovo vegetarians who consume dairy and eggs, that’s a lot easier because eggs are no carbohydrates. So that’s easy. And lots of dairy foods also have no or very little carbohydrates like Greek yogurt, cottage cheese, cheese paneer, you can incorporate more of those alongside with the legumes and other vegetarian sources at your meal. That makes it a lot easier to hit the protein targets without exceeding your carbohydrate levels. So really just kind of have to play around with it. And see I would definitely say for vegetarians who are managing PCOS to pick up a blood sugar meter and start to observe your blood sugar patterns after different meals and combinations and you might be able to find some that work better. And there’s also like something to be said for, you know, some of these extra strategies that can help like incorporating vinegar into your meals or having some vinegar before you have eat your meal can really lessen the blood sugar spike. And so vegetarians might be more inclined to use some of those strategies to help with their post meal blood sugar readings.

Dr. Vinu:
Yeah, that’s a great tip. Yep. And and, you know, for everyone, I know you know, you’re taking energy dense foods and Oh, You know, you’re you’re trying to have a good diet. But would you need some kind of supplements in addition to your regular diet? And I know early trimester, you know, they always prescribed iron and folic acid, you know, for baby’s growth. But in addition to that, would you need like vitamins or minerals that you would recommend, you know, people take along with regular nutrition? Yeah,

Lily Nicholas:
I mean, for most individuals, I do recommend a prenatal vitamin, it really does help to fill in any potential nutrient gaps. And it goes beyond just filling in, like you said, supplementing with like two nutrients. There’s, it’s just the rates of micronutrient deficiencies are surprisingly high, it’s about half of women of childbearing age, have some sort of micronutrient deficiency. And it’s not always something like iron, and fully it might be like for vegetarians might be 12. If they’re not already supplementing. Sometimes it’s vitamin A, sometimes it’s iodine. Other countries, iodine supplementation is pretty much standard for pregnant women, and it’s not in the US. And maybe it should be because like half of women are too low in iodine, right. And you wouldn’t get that if you were only supplementing with those two nutrients you mentioned. So I do think a prenatal vitamin is a good idea. There are some instances where extra supplementation is needed. Really, depending on the case, Vitamin D deficiency is really, really common. So if you screen low for that, then depending on your prenatal, you might need a higher dose than what’s included in the prenatal vitamin.

Dr. Vinu:
Right? Okay. So any final words of encouragement or advice that you have for, you know, prenatal, women, especially, you know, PCOS women who were trying to get pregnant or gotten pregnant?

Lily Nicholas:
Well, I would say we I don’t think we really got into it a whole lot in this interview. But moderating your blood sugar levels, like getting those into a good place before you conceive really is ideal, it often does improve your menstrual cycle. And it also improves it improves your chances of conception in any given menstrual cycle as well. And then, when you think about all the changes that will be taking place during pregnancy, having your blood sugar in a healthy range ahead of time will lessen your chances of developing something like gestational diabetes, or potentially even some other complications. And a lot of these effects really are impacted by your diet and lifestyle choices. So you know, we don’t have a crystal ball for eliminating, you know, the risk of pregnancy complications, but we can stack the deck in our favor. So just do your best. A lot of the same things that you’re doing for managing your PCOS are also things that work for reducing the risk of pregnancy complications, like gestational diabetes, so it’s, it’s kind of one in the same.

Dr. Vinu:
Awesome, thanks, Lily. This has been really enlightening. And this has been a lot of great information. And for our listeners who want to know more about, you know, whatever you’re speaking about today, or would like to reach you. Can you tell us, where would be a good place to get in contact with you?

Lily Nicholas:
Definitely, yeah, so you can check out my website, which is Lilly Nichols, RD, n.com. On there, you can find my books. So the real food for pregnancy and also real food for gestational diabetes. And I do have a third book coming out on fertility. There’s a whole chapter on PCOS that will be coming out February 14, so keep an eye on that. Also, on my site, there’s a whole library with hundreds of blog articles, many of which are quite in depth. So if you wanted to read more about weight gain and pregnancy, for example, just search type YT into the search bar, and it’ll come right up. And yeah, you can find me on social media also. I’m usually on Instagram and my handles the same as my website. So it’s Lily Nichols, RDN.

Dr. Vinu:
Awesome. Thank you, Lily, thank you so much for joining us today and for sharing your expertise with us.

Lily Nicholas:
Thank you.