Real Food for Pregnancy: The Science and Wisdom of Optimal Prenatal Nutrition

Have you ever been jealous of the author of a book because you wish you had written it? That’s exactly how I feel about this amazing new resource from RDN Lily Nichols called Real Food for Pregnancy: The Science and Wisdom of Optimal Prenatal Nutrition. Thankfully I had the opportunity to not only receive and read Ms. Nichols’ book earlier this spring, but to also ask her some follow-up questions that I get to share with you all today. Scroll down below for the full interview!


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In Real Food for Pregnancy, Lily Nichols, takes prenatal nutrition advice out of the dark ages and provides an easy-to-follow guide for making the best food and lifestyle choices during pregnancy. 

Short version of what is covered in the book:

• Most prenatal nutrition advice is either outdated or not evidenced-based. In Real Food for Pregnancy, Lily Nichol’s debunks a LOT of prenatal nutrition myths. Misconceptions of conventional prenatal nutrition: macronutrients, salt, “foods to avoid,” fish, etc.  

• Foods to emphasize, lab tests, supplements

• Testing for gestational diabetes—pros/cons of all the methods

• Nutritional management of preeclampsia, gestational diabetes, nausea, heartburn & more

• Mindfulness, stress management, exercise, avoidance of toxins

• Traditional postpartum care, impact of nutrients on breast milk quality, etc.

In Real Food for Pregnancy, you’ll get clear answers on what to eat and why, with research to back up every recommendation. Lily Nichols has taken a long and hard look at the science and lays out the evidence—930 citations and counting—on the benefits of real food, why certain foods are essential (and others are detrimental), and countless lifestyle tweaks you can make to have a smooth, healthy pregnancy. There has never been a more comprehensive and well-referenced resource on prenatal nutrition. With Real Food for Pregnancy as your guide, you can be confident that your food and lifestyle choices support a smooth, healthy pregnancy.


If a newly pregnant woman was only willing to take one supplement, what one supplement would you recommend?

I’d had to say a high-quality prenatal vitamin. It would be better to have your bases covered on a broad spectrum than to just pick one. Most supplemental nutrients can be supplied by a nutrient-dense, real food diet, however it can get tricky with dietary restrictions, certain food preferences (such as a vegetarian diet), or food aversions/nausea.

I often come across women who feel too sick or have too strong of a gag reflex during pregnancy to take supplements or consume the best real food. What are your suggestions here?

I can relate to that! I wasn’t able to swallow pills for most of my first trimester due to the combo of nausea and that super strong gag reflex you mention. If possible, taking a prenatal and eating really health preconception can boost your nutrients stores, so you can more easily weather this rocky time without becoming nutritionally depleted. For mamas who are in the midst of it already, you can look into taking some of your supplements in the form of a smoothie, such as using a prenatal vitamin that comes in capsules and emptying the contents into a smoothie. There are also some companies that offer protein shakes that include all the nutrients of a prenatal vitamin or gummy prenatal. If none of those options work out, you have to trust that you’re doing your best with whatever symptoms are coming your way right now. Millions of women have gone through what you’re going through and have still had healthy babies, so trust that you’ll be ok.

If women know they are dealing with liver or detox issues, how far in advance before trying to get pregnant should these be dealt with?

Ideally, 3-6 months preconception is best to handle any detoxing and I recommend working with an experienced functional medicine practitioner to do so. It takes careful planning, lab testing, and usually some supplementation to properly address detoxifying.

Where do you stand when it comes to consuming certain trusted and nutrient-dense raw foods during pregnancy? (i.e. raw cream, raw cheese, raw ACV, etc...)

With anything related to food safety, you have to consider the nutritional benefit versus the food safety risk. For something like raw apple cider vinegar, the risks are extremely low for getting sick; it’s far to acidic for pathogenic microorganisms to grow. For raw dairy, I like to look at the data behind food borne illness outbreaks and also how the cows are raised. When you do, you see most of the dairy-related outbreaks are actually from pasteurized milk and from products from large farms that are stored improperly. Smaller dairy operations that allow their cows to graze have fewer pathogens thanks to healthier cows and less crowded conditions. These days, raw dairy farmers are held to such stringent food safety standards, that they often have no detectable pathogenic bacteria in their raw milk. So, if you know your farmer, can assure that they follow grass-based/pasture-raised practices, and follow good handling practices yourself, raw dairy doesn’t necessarily have to be off the menu. Ultimately, that’s a decision to be made on a case by case basis.

Do you think the glucose screening during pregnancy is necessary if one is monitoring their own blood sugar at home?

Author Lily Nichols, RDN/CDE

Author Lily Nichols, RDN/CDE

Not necessarily. Home blood sugar monitoring is a viable alternative to rule out gestational diabetes for those who opt out of a glucose tolerance test (glucola) or other types of screenings. Women just need to be aware of what numbers to compare their results to, since there’s a lot of mixed opinions on the interwebs. I’d first recommend talking over this option with your healthcare team to make sure everyone is on the same page, then discuss what target blood sugar levels, when they want you to test your blood sugar, and for how long. You’ll also want to make sure you know how to properly test your blood sugar at home, including how often to change lancets, proper cleaning of your hands before checking, timing your blood sugar checks after meals, etc. As a specialist in this area, I have a lengthy discussion of my recommendations on this matter and the pros/cons of all screening methods for gestational diabetes in Real Food for Pregnancy.

What are your favorite recommendations for curbing morning sickness and pregnancy nausea?

It’s tricky to navigate for sure. Sometimes it’s just a matter of waiting it out, but there are some general guidelines that can help. For one, eating small, frequent meals/snacks is helpful. Avoiding large quantities of food or water at one time seems to help, since an over-full sensation in your stomach is a nausea trigger for some women. Having a snack at your bedside (if your nausea starts first thing in the morning or with sudden movement when getting out of bed) can lessen those symptoms. For me, that was salted cashews and some dried cherries. Salty, sour, and cold foods are good options when you’re feeling especially sick (think orange juice popsicles, lemon water, pickles, olives, smoothies, etc). Finally, ginger as a tea, ginger chew, or supplement is one of the few research-backed interventions for nausea. There are plenty more strategies to try, which I cover in Chapter 7 of Real Food for Pregnancy, but these would be some of my first recommendations.

Madeline GivenComment