How To Be WellnStrong

94: What to Eat for a Healthy Pregnancy | Lily Nichols, RDN

• Jacqueline Genova • Episode 95

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Join me as I sit down with Lily Nichols, a renowned Registered Dietitian and author, to explore the essential nutrients for fertility, preconception, and pregnancy. Drawing from her books, "Real Food for Pregnancy" and "Real Food for Gestational Diabetes," Lily debunks common nutrition myths and highlights the importance of protein, organ meats, and key vitamins for embryo development. We discuss how to optimize fertility, especially for women with PCOS, and why managing blood sugar is vital for a healthy pregnancy. Lily also shares the ideal nutrition plan for preconception and pregnancy, how modern diets are affecting fertility, and offers her thoughts on how to choose the best prenatal supplements. We also discuss the crucial differences between folic acid and folate, and which one you should be taking. If maximizing fertility is your goal, this episode is for you!

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*Unedited Transcript*


Jac: [00:00:00] Welcome to the podcast, how to Be Well and Strong. I'm your host, Jacqueline and Genova, and I'm excited to have you join me as I speak with some of the leading figures in the fields of wellness, integrative medicine, and mental health, as we discover what it truly means to be well and strong in both body and mind.

Get ready to be empowered, inspired, and motivated about being an advocate for your own health.

Join me as I sit down with Lily Nichols. A renowned registered dietician and author to explore the essential nutrients for fertility, preconception, and pregnancy, drawing from her books, real Food for Pregnancy and Real Food for Gestational Diabetes. Lilly Debunks Common Nutrition Myths and highlights, the importance of protein, organ meats, and key vitamins for embryo development.

We discuss how to optimize fertility, especially for women with PCOS and why managing blood sugar is vital for a healthy pregnancy. Lily also shares the ideal nutrition plan for [00:01:00] preconception in pregnancy and offers her thoughts on how to choose the best prenatal supplement. We also discuss the crucial differences between folic acid and folate and which one you should be taking if maximizing fertility is your goal.

This episode is for you. Let's get into it. I have heard your name, um, come up multiple times in podcast and I dove into your work. I was beyond impressed and I realized that I have not had an episode dedicated to prenatal nutrition, you know, nutrition during pregnancy. And this is such an important topic.

But just to kick things off, I always love to start by asking, how did you find yourself in this space? Great question.

Lily: It was kind of a roundabout, um, journey to get here. I mean, I knew really early on I wanted to study nutrition, so I was one of the few people who didn't change my major in the middle of college.

Um, I was first like really drawn to nutrition because I wanted to improve childhood health. It was like we had this childhood obesity and diabetes [00:02:00] epidemic. Could we like reform the school lunch policy and make a dent in that. Um, and in a roundabout way, I somehow found myself in the, the prenatal space.

So some opportunities arose pretty early in my career to work with the California Diabetes and Pregnancy Program. It's also known as Sweet Success Focuses purely on. Diabetes and pregnancy as the name suggests, and then, um, clinical work in a perinatology office in gestational diabetes. And it was, yeah, really in those roles that I learned so much about how maternal metabolism and blood sugar affects the development of the baby and then their propensity for diabetes or obesity later in their life.

And it's, it's substantial. Like if a mom's blood sugar is not well controlled for the majority of her pregnancy, that child's risk of developing type two diabetes can be anywhere from like a six to 19 fold. Wow. Increased risk compared to somebody who has normal blood sugar in pregnancy. It was like, whoa, okay.

We have like a whole generation or multiple [00:03:00] generations now of children being born with like the cards stacked against 'em metabolically, and how unfair, you know, it's, it's more than just taking the sodas out of schools and providing better food and getting enough, you know, activity for kids. Those are all important too.

But it, it's like, what is their. You know, pancreas program to handle when it comes to food, how functional are their mitochondria for burning energy? It's like that, those things are to some degree, um, predetermined or pre-programmed during pregnancy. So that's really what, what lit me up. Um, and then of course, working in those spaces and being able to put the current guidelines to the test in actual clients, it was like, wow, these guidelines are missing the mark for blood sugar management.

So, um, you know, after kind of coming up with my own way of managing the condition, and of course doing a [00:04:00] ton of research to see whether or not doing anything different than the guidelines would even be safe in pregnancy. 'cause first and foremost, safety is of utmost important. You don't wanna do anything that could be harmful to mom or baby.

So once those like, you know. Boxes were checked. It was like, okay, we can, we can implement this. We saw a dramatic improvement. Um, and that's ultimately what led me to write my first book, real Food for Gestational Diabetes. And the other two have kind of come via audience request of like, okay, can you dive into this?

Right. My own experiences and my two pregnancies as well, um, have really played a role in my work.

Jac: I was gonna ask if you had kids, so you have two children? Two kids, yeah. Um, five and nine. Those are funny ages, I'm sure. Yeah. Yeah. Well I definitely wanna get into the blood sugar, um, component, Lily, but you mentioned, um, your book Real Food for Pregnancy, and while I know we can't cover the entire contents of that book, I would love to just maybe start by asking what key nutrients should [00:05:00] women be prioritizing in a prenatal diet?

Yeah, that's

Lily: surprisingly complicated question to answer. Uh, 'cause you can make the case for. Like any nutrient, like take your pick. Um, so like to start from kind of a like broader, top down kind of like dietary components in terms of fat, protein and carbohydrates. You definitely wanna be prioritizing protein during pregnancy.

We do know that needs increase quite a bit and the guidelines missed the mark on this one entirely. Um. The guidelines weren't even written with any pregnancy specific data in place. We do now have that data as of 2015. That still has not been incorporated into the guidelines, but suffice it to say you need a lot more, um, than what the recommendations currently are at.

So, um, more protein and your protein needs will progress as the pregnancy progresses. [00:06:00] When you're approaching eating protein, you don't want to take the fat out of all of your protein. You'll notice a lot of your protein-rich foods naturally contain fat, right? Eggs have the yolks, your chicken has the skin, your steak has fatty streaks in it.

Dairy naturally comes with fat in it unless you take it out. Nuts naturally contain fat, right? Some of the plant proteins are some of the few exceptions, like beans and legumes are fairly low in fat, generally speaking, but they still have some, right? If you start obsessively taking the fat out of everything, you screw up the like nutritional content, um, of that food, the, a lot of the nutrients become less bioavailable and you also need some fat for hormone hormone production, and there is an amped up hormone production, of course, during pregnancy.

So as long as you're just like eating a protein forward diet and not obsessively taking fat out of everything. You're gonna hit the marks for most things. You'll be [00:07:00] getting enough protein, you'll be getting enough fat. Our protein-rich foods have a lot of the key micronutrients and we can dive into that, um, that are required in higher amounts in pregnancy.

So when it comes to avoiding anemia, for example, you need not only iron, which you'll get in the most bioavailable form in animal foods, but you also need vitamin A from animal foods. You need B12, you need riboflavin. You need folate. A lot of these nutrients are highly concentrated in your protein rich foods.

So when it comes to ticking off all those boxes, that's like the simplest way of, of kind of explaining where to focus. Um, then of course, we also wanna consider the other macronutrient I didn't talk about, which is carbohydrates. And you wanna focus on the highest quality, least processed carbohydrates that you can.

So whole food, plant foods that haven't had. All the fiber taken out of it haven't been like ultra processed from, you know, a whole wheat berry into white flour, for [00:08:00] example. Um, if you're eating more of those whole carbohydrates, another example would be eating whole fruit instead of juice, or you haven't macerated it, extracted all the fiber, and then you're just left essentially with pure sugar.

Um, that's better overall for your body. So protein forward without taking out all the fat. And then whole food carbohydrates is like a, a very good combo where you're most likely going to hit most of your micronutrient needs from food alone, and you will be, um, pretty unlikely to face severe deficiencies.

Jac: Yeah. On the topic of protein too, Lilly, obviously the market is saturated with protein powders, right? From collagen to hemp and other different plant protein sources. Do you have a favorite, um, and do you actually like, encourage women to include a protein powder in their diet? Or are you more of a, let's depend upon, you know, whole food sources for that.

Lily: So I, I prefer people get most of their protein from Whole [00:09:00] Foods because then you're getting the full micronutrient component. Um, and you're also getting some of that fat that's naturally meant to come with your protein foods. I also find they're a lot more satiating. Just having like a savory meal that you have to chew.

You might be getting, you know, 30 grams of protein in that meal and your protein shake might have 30 grams of protein, but the satiety factor is often a lot different. Just, just notice when you have, you know, smoothie or protein shake. Um, that said, I'm not anti protein powders. I think they can be incorporated.

I probably wouldn't have them replace more than maybe one or two. Servings of protein in a day. It depends. Like sometimes we have situations where protein needs are really quite high, like in twin pregnancy, where it gets pretty difficult to meet the protein needs from food alone. It certainly can be done, but protein powders can be helpful.

Or sometimes there's periods of like food aversions, especially in the first trimester where maybe meat or fish is kind of [00:10:00] offputting and protein powders can fill that gap. Um, a, a key factor here to look at those, the quality of the protein powder you're consuming. I would check with the company for a certificate of analysis on their heavy metal and contaminant testing.

A lot of the plant proteins in particular tend to be high in, uh, heavy metals like arsenic or lead or cadmium. Um. So those would be ones that you'd want to check on. Um, I personally prefer like a beef protein isolate. Um, I do also like collagen proteins. They're technically not a complete protein. I have a whole, whole article on my website and how it fits into your diet.

It's really gonna be a non-issue, unless that's your only protein source. But assuming you have a serving of collagen or two along with whatever you're eating, you're not gonna run into any issues there. Um, those tend to be some of my favorites. And then just again, watch for other ingredients in the protein powders.

Some of them add. Herbs, some of [00:11:00] which may not be safe in pregnancy. Some add a whole bunch of extra nutrients and if you're already taking a prenatal, you may be getting too much of certain things. So I just prefer like a, a really simple formula. Usually like a pure protein I. Possibly with a, a sweetener that's safe in pregnancy or, you know, vanilla extract or something.

But try to be careful with all the additives that can be in there.

Jac: Yeah, no, that makes complete sense. I am curious too, Lily, what's like the equation for determining how much protein a woman needs during pregnancy? Is that a factor of weight? And obviously if she's carrying one or two children, like what does that look like?

Lily: Yeah, it's a factor of weight. So based on that newer data that I alluded to from 2015, uh, they looked at what they call the estimated average requirement of protein or an EAR level. That's, that's different than an RDA. It's actually set much lower than an RDA. This study did not define the RDA, so I can't speak to that.

But if we use an EAR level, we're looking [00:12:00] at bare minimum. Okay. So I'm gonna say that because a lot of people will calculate it out and they're like. Oh, I actually feel better eating more. That's totally fine. This is bare minimum. It's just to say that the bare minimum that I'm recommending is still a lot more than the current recommendations.

So they split it up by early pregnancy and late pregnancy, which early pregnancy in this study was defined as before 20 weeks. And late pregnancy is pretty much anything beyond that. So in early pregnancy it was 1.22 grams per kilogram of pre-pregnancy body weight. You always use pre-pregnancy body weight when calculating these, or for late pregnancy, one, 1.5, two grams per kilo.

Jac: Interesting. And also too Lily, so I mean, for the woman who's looking to get pregnant, right, at what point in time should she change her diet? If her diet is probably currently not the best, um, you know, in order to improve her fertility and, and, you know, boost chances for conception.

Lily: So it [00:13:00] depends. Um, there's, there's a number of different ways that you can look at this.

Um, first and foremost, there's no downside to having good nutrition for a longer runup period into pregnancy. Um, however, uh, we do know that the time that an egg is maturing, leading up to ovulation is the time that it's, it is most sensitive to nutrition changes. So at minimum, about three months leading up to when you're trying to conceive, technically, if you really wanna get specific, like the full time period for the recruitment of an underdeveloped follicle in your ovary to the development of a fully developed egg, that's going to be ovulated in that cycle, that's 220 days or like seven to eight months.

So in an even more ideal world, we might give ourselves that eight months. Now, if somebody has cycle issues or underlying health condition conditions that we know play a role in fertility or maybe a risk factor for early miscarriage or adverse pregnancy [00:14:00] outcomes, uh, we might wanna look at a longer runup period and nobody wants to hear that, right?

But, um, for some individuals, they'd be better off giving themselves a year or sometimes even two years to get their thyroid. Um, in a good place to work on their polycystic ovarian syndrome to, you know, optimize their low nutrient stores to improve their blood sugar levels. Like some people really do better off with more time.

Um, and don't leave your partner out of the equation either because their sperm quality is also influenced by their diet and lifestyle and, and overall metabolic health. So it can be something that you and your partner are actually doing together.

Jac: Yeah. And does everything you say, nutrition-wise hold true for men as well?

Or should men be focusing on different. You know, food groups than, than women in terms of fertility.

Lily: So there's a lot of overlap for men and women. Um, we have, you know, there's a whole chapter on sperm quality and real food for fertility. There's a whole chapter on egg quality and real [00:15:00] food for fertility.

And, you know, we, we go through the research on a number of different nutrients and there is a lot of overlap. Um, men still benefit from a protein forward diet. It's not great for men if their fat drops below about 40% of calories, likewise for women 'cause it impairs hormone production for men. Of course, we're looking at markers like testosterone levels, um, and their sperm quality parameters.

But likewise, you see similar issues with hormone production in women. When their fat drops too low, that's a consideration. Um, likewise, carbohydrate quality is important. The more refined carbohydrates and the more added sugars that are in the diet. Have similar detrimental effects on things like semen quality and also in women egg quality or ovulatory, uh, regularity.

Like are you ovulating? Is your cycle normal, essentially? Um, so there's a lot of overlap on the basics. Obviously, men need a lot more protein than women. There's [00:16:00] also, I'd say, stronger data on certain micronutrients for men than there are for women, even if that data exists. We have like a lot more studies on men for things like selenium and zinc, um, than we do for women, even though we have some of those.

That's because sperm quality is a lot easier to study than egg quality. With sperm quality, you could very easily get a sample with egg quality. For the most part, we're looking at like tertiary markers of, um, of egg quality. You can't take an egg sample if you have somebody undergoing IVF or have done, um, some type of fertility treatment where there is egg retrieval, you can have some of those markers.

So a lot of the data we do have is from women undergoing assisted reproductive technology. Um, however, it's it's, it's a lot more limited, um Right. Per what we can study just, just based on biology at this point in time.

Jac: Yeah, no, that makes sense. Here's another question too for you Lily. So I know, [00:17:00] you know, you've been mentioning the importance of protein and saturated fat and whatnot in a diet and, you know, the more I I research into the wellness space and nutrition and whatnot, I feel like the less I know, right.

And there's constantly like differing opinions and controversial issues, but you know. One diet is not necessarily the best, like across the board, right? Like it works for one person, doesn't work for another person. And I've seen a lot more on like, you know, test for nutritional deficiencies and test to see, you know, what your body might be more inclined to absorb and not absorb.

Um, and also too like sensitivity to things like saturated fats and a OB levels and all that to say. I guess my question for you is, do you recommend any type of like nutrition testing prior to adjusting your diet either before or during pregnancy? So for a woman example who may have like a high a OB level, right?

Who also recognizes the importance of having, you know, a lot of protein in her diet. I guess my question is how do you like mitigate the [00:18:00] risk with cardiovascular issues down the road, but also like wanting to prioritize protein for the healthy development of your child? Does that make sense? It does

Lily: make sense and.

I mean, I don't have all the answers to this either, I'll say straight up, but there have been some interesting intervention trials looking at A POB and it's not across the board that saturated fat in and of itself is going to raise a POB or even raise cholesterol levels. Um, some of it has to do with like, you have to look at the entire dietary pattern.

'cause some of these trials have tested out, you know, with protein levels fixed playing with the fat and, and um, carbohydrate ratios. And when you get the carbohydrate levels lower and the fat higher keeping protein consistent, you actually see better A POB levels and reduced inflammation and improvement on the whole lipid panel.

Um, but again, [00:19:00] there's individual variations on things. And so one of the tricky things about any sort of nutrition stuff, and this is why I think it's important to always consider like. Where you're getting your information. 'cause if you're working with somebody who has, who's interested in research but also has a clinical background working with actual humans, you can put to test what you see in studies.

Right? And you know, it's not like we have an intervention trial and a hundred percent of participants have this dramatic improvement. You might have 60% of participants have significant improvement in overall that is, you know, showing that the intervention was successful. But there's probably some people who had a neutral response and some people who might have even had a negative response.

And so I think that's something that clinicians need to take into account. Um, yeah, sometimes you do have people where if their saturated fat intake is too high, you start seeing abnormalities in their lipid panel. And is that truly fine and [00:20:00] physiologically normal for them? Or do we need to adjust things like there are some people who respond kind of negatively to an excessive amount.

Of saturated fat and something like a ketogenic diet that's high in saturated fat doesn't work for them. So you can, right, you can play with the ratios without taking foods that contain saturated fat entirely out of the diet. But maybe we don't need to be having like six fat bombs a day made with butter.

And you don't need to have butter in your coffee. Like we need to be, you know, thinking a little more ancestrally about how we're approaching nutrition and maybe that individual does better, getting a bit more of their fat from avocados and olives, um, and what's naturally occurring in their protein foods versus all the added fats coming in.

Like, we need to be willing to look at the individual and adjust. Um, but as to the lab question. Yeah, you can look at a number of labs, preconception, even more so than a lipid panel. I'm [00:21:00] interested in blood sugar and insulin levels. Those have a dramatically profound effect, um, on fertility and also pregnancy outcomes.

And a lot of times when we bring insulin levels down, we're seeing improvements in their lipid parameters as well. And, and usually that's gonna come down to. Prioritizing protein, better quality carbohydrates, matching their carb levels to their personal glucose and insulin, um, levels, building in more physical activity so they have more metabolically active tissue, like muscle that's gonna boost their metabolism.

And like all in around about way you naturally improve, you know, the lipid levels. Um, but that would be one thing I would check on. Certainly inflammation levels can be helpful. Like with a c-reactive protein, um, you can check on some nutrient levels. Vitamin D plays a really vital role in fertility, so that's a, a really key one to check.

If you have it available, you could do a full micronutrient panel, but usually you're going outside of the [00:22:00] conventional healthcare system for that. Right? And a lot of times that's on your own dime, so, yep. It gets, it's like you can, you can keep adding on things. It's like how much is

Jac: too much? I guess that's always the question,

Lily: right?

Like a thyroid panel, that would be really helpful. A lot of times you come up against resistance for checking a full thyroid panel, right? But without the full panel, it's hard to interpret just t, SH and T four. If you get those checked, you might see a red flag and look deeper, but sometimes there's not a red flag on that.

But there's significant issues going on with the thyroid and that plays a role in right conception and and miscarriage risk. So, yeah. Yeah, it gets complex with fertility, since it really is a reflection of our overall health. You can almost pick and choose virtually any test and make the case for it being helpful.

Like people with digestive issues can have fertility issues, different genetic variations, can have fertility issues. And it's like how far down the rabbit hole do you. Go. [00:23:00] Um, that that is something that we go into in the lab test chapter of real food for fertility, though, if people wanna have a bit more of like a roadmap of what to consider, but, you know, work with your clinician to see, to see whether, whether and what testing you might need.

Jac: Right. Would you say that the best place to start though, is ensuring that you're not insulin resistant and really trying to manage your blood sugar levels across the board? For the most

Lily: part, yes. Um, with a caveat that if you fall into the category of somebody who doesn't have a cycle at all, like you have hypothalamic amenorrhea, um, or you're kind of on that spectrum where your, your period is really light and short, maybe you have a short luteal phase.

The time between periods is. Pretty short. Um, those individuals might not need to have quite as much focus on the blood sugar and insulin like in a roundabout way you will. Right? Because a lot of the things we're gonna prioritize are gonna be similar, [00:24:00] but typically the type of pattern that we see in that type of client is they need to be nourished.

So that wouldn't be a client where I wanna like give them a continuous glucose monitor and have them hyper obsess about any little blip in their blood sugar. 'cause it's just gonna further the restrictive behaviors. And a lot of times these individuals actually need to like liberalize their diet and maybe even gain some weight and like lay off the gym a little bit.

Right? Um, so when those individuals, maybe not virtually everybody else. Can benefit from, from focusing a

Jac: little more on blood sugar. Yeah. Yeah. No, that makes sense. And this Lilly could be a whole episode dedicated to itself, but women with PCOS right. A majority of them have insulin resistance. Yeah. What is your approach to optimizing fertility in A-P-C-O-S patient?

Lily: So a lot of things we've talked about also apply to PCOS. 'cause again, globally for the most part, we, we are focusing on optimizing your, your [00:25:00] blood sugar and insulin levels. Um, that said some particular adjustments for someone with insulin resistant PCOS. I really highly recommend some blood sugar monitoring to see what spikes your blood sugar and eat in accordance to what your observations are with that testing.

Um, generally speaking, when we're looking at our macronutrients, fat and protein aren't really spiking your blood sugar insulin is a separate conversation. Um, but carbohydrates are the macronutrient that really spikes your blood sugar the most. So you wanna be especially considerate of the quantity and also the quality of the carbohydrates you're consuming really, you know, get honest with yourself.

Like are there added sugars and ultra processed carbohydrates sneaking in? Is there a lot of refined white flower products? Sometimes we even have people eating like, what would be a really. Good quality diet, but there's like multiple, like, like there's [00:26:00] a slice of sourdough bread with breakfast. There's a sandwich at lunch, and then there's, you know, a large side of potatoes and sweet potatoes at the dinner.

And it's just too many carbohydrates for that person's metabolism at this particular period of time. So they really need to lean into more protein, um, lean into more low starch plant foods. So your non starchy vegetables, your low sugar fruits, you can play around with the order in which you consume foods to mitigate the blood sugar spikes, like leading with your protein and vegetables at the start of the meal, leaving the carbohydrates for the end of the meal.

That could be really helpful. Even playing with meal timing can be helpful. So we have really limited data on intermittent fasting in women and that generally, I'm not a huge fan of it. We have a whole section outlining the whys and how to go about it carefully if you want to approach that in real food for fertility.

But the small amount of data that we do have [00:27:00] that is positive is in women with insulin resistant PCOS, who would benefit from some weight loss. And it's not a calorie restricted, intermittent fasting protocol. It is sufficient calories, no calorie cutting, but simply eating front, loading your food in the early part of the day, eating a large breakfast, a moderate lunch, a smaller dinner, and then stopping eating.

Earlier in the day, so you have a longer fasting window overnight. Right. Even if it's just stopping dinner. In the study, they stopped at 4:00 PM they ate all their food from 8:00 AM to 4:00 PM but we have other studies that didn't necessarily do an intermittent fast, but just gave a large breakfast, moderate lunch, small dinner versus the opposite, small breakfast, moderate lunch, large dinner.

And they saw dramatic improvements in the PCOS symptoms. So don't skip breakfast, have a smaller and earlier dinner, can be a really simple and, and and beneficial approach for, um, for PCOS.

Jac: Yeah, no, [00:28:00] that makes sense. And for the listener out there, Lily, who has never heard of the term insulin resistance, what markers should they be looking at to determine if they are indeed insulin resistant?

Lily: So you can look at both your blood sugar levels, especially your fasting blood sugar levels give you a lot of information on the likelihood that your insulin resistant. So as your blood sugar levels get. Higher than you can even go down to like 90. But by, by our current diagnostic standards for pre-diabetes, that cut off as 100 milligrams per deciliter.

If your fasting blood sugar is higher than that, that pretty much guaranteed there's some insulin resistance going on. Um, you can get a fasting insulin level checked. Uh, you have to be aware of the, um, the lab reference ranges because the cutoff that most labs will give you is 25. But we start seeing insulin resistance issues even above like nine in some studies or even in some studies above five.

So if you're [00:29:00] fasting, insulin is running high. That's another red flag. Um. There are different lab markers that they can calculate from blood sugar and insulin that can give you like a level of your insulin resistance. Like Homa IR is one of them. Some people can see it on a continuous glucose monitor, um, where you're seeing your blood sugar, you know, have a, have a little sensor in the side of your arm and you see 24 7 blood sugar patterns.

If we're not seeing your blood sugar dip to essentially close to, or fasting levels between meals or overnight, like your blood sugar just persistently is like the baseline is a lot higher. 'cause the baseline should really probably be definitely below 90. Yeah. But sometimes even in the seventies. Um, that would likely be what most people would consider optimal in the research space, although I'm sure that's still up for debate.

But if you're seeing your baseline lowest [00:30:00] blood sugar is not dropping below 90 at any time point during the day or night. That's a pretty good sign. There's some insulin resistance going on. If you see pretty dramatic spikes in blood sugar to a not very large serving of carbohydrates, and then your blood sugar kind of like plateaus and doesn't come down, um, that's another potential sign of insulin resistance.

Yeah. But, you know, interpreting CGM takes a lot of clinical skill. Yes. And so I, I just caution people from trying to go at it at their own. I mean, I've been a diabetes educator for a long time, um, well over what, 10, 12 years now. And it's a different skillset than even a typical dietician has, or a typical doctor or nurse.

Like it really is a skillset to interpret CGM readings. And sometimes I feel like people will use, they'll use CGMs as. Uh, [00:31:00] they'll interpret like any variation in blood sugar as problematic. Yeah. And that's not always the case. It's normal for your blood sugar to do little dips. Right. What we don't wanna see as dramatic spikes and crashes, and we don't wanna see super prolonged ties without them coming back down.

So somebody who's like blood sugar goes up to one 40 or one 50 and then it's hanging out there for many hours before coming down. It's a pretty clear sign of insulin resistance. But I don't want somebody who has an apple and goes to one 20 and then comes back down within an hour to like, freak out that something's wrong.

That's, that's a normal blood sugar response.

Jac: Yeah. Yeah. That was me last year. I experimented with CGMs just for the, the fun of it. And that's initially what I thought. You know, if I saw a spike that was 30 or 40 points, I'd freak out. But then realizing that, you know, obviously if you have something with natural sugar in it, that's what's gonna happen.

Um, yeah. So interpretation is definitely key there. Yeah, definitely. And in terms of non dietary interventions, Lily, like [00:32:00] supplement wise for managing blood sugar, I mean, there's a lot of research on like berberine or an anatol. Are those, like, are you a fan of either of those for, again, specifically women with PCOS in, in terms of trying to manage those levels?

I'm a bigger fan of anatol

Lily: than Berberine. Um, if you use Berberine, you'd have to stop ideally before you even tried to conceive, but certainly at the time of your first pregnancy test because it is not safe in pregnancy. So that, that is one that's a little bit tricky with the fertility equation. Like when in your.

Um, plans for actually trying to get pregnant? Are you taking it? If it's a while out, it's probably fine, but right in that interim it becomes a little bit tricky. Whereas in Acetol is a, you know, it's a nutrient, it's a b vitamin like compound. It has literally zero studies showing any sort [00:33:00] of teratogenicity, which means your risk of birth defects.

And in fact, there's many trials that use it during pregnancy for the prevention of gestational diabetes or the management of, of gestational diabetes. Um, so it's, it's one that you can continue taking through the whole pregnancy. And we have head-to-head trials on anatol supplementation compared to another really common intervention in PCOS, which is the medication.

Metformin, Metformin. And a lot of times Anatol performs similarly. Sometimes it performs better than Metformin, um, in those trials. So it's. It's a really useful one. Most of the studies are using about four grams per day. That's 4,000 milligrams usually in split dosages. Um, I use it very commonly in gestational diabetes as well.

Um, for some women it's, it's the, the, that little added kick that helps 'em avoid insulin or medication with their blood sugar management. So I'm, I'm a huge fan of [00:34:00] acetol, um, that depending on how PCOS is presenting their. Can be a number of other supplements that could also be beneficial. But many times if you're taking a comprehensive prenatal vitamin, many of your micronutrient levels are, are met already.

Um, but Ceal is usually not one that's going to be included in sufficient quantities to give you a therapeutic dose for, for PCOS.

Jac: Right. That makes sense. On the topic of prenatal vitamins, what should women be looking for when they're looking for a prenatal vitamin? And I don't know if you could recommend a brand or you know, something like one that you like, uh, in particular.

Yeah,

Lily: absolutely. It's has super complicated these days. There are, it feels like every other week there's a new prenatal coming out on the market. Um, it's kind of hard to keep up with, honestly. I mean, I, I do, I'm always following it and everybody's always asking me, so I'm always looking at the new formulas.

Um. But yeah, a number of things [00:35:00] to keep in mind. So you wanna look for one that is comprehensive, like covers, covers your bases on a wide array of micronutrients. There are some that just sort of cherry pick a handful of nutrients that they think are important and then leave out the rest. So it's like, okay, maybe some of the things in the formula look okay, but you've left out choline or you've left out iodine, or you've left out zinc, and like, why did you pick and choose those ones?

So look for ones that have an array, um, when you're looking at all the micronutrients, it's at least like 23 different nutrients. You wanna look at the nutrient forms to make sure they're bioavailable. So you might be looking at the types of folate in them. The types of vitamin, a super common, um, problem with a lot of prenatals is they don't include any preformed vitamin A, they only include betacarotene.

And while we have to be careful about the amount. Of preformed vitamin A. You do need some, at least half of people don't have the genetics to [00:36:00] convert betacarotene into vitamin A in their body. And this becomes a problem. I've written about this at length in my books and on my blog if you wanna look into this.

Um, you know whether, whether the formula by default includes iron as a red flag for me. Not everybody needs iron supplementation. And if you put iron in it, you're going to compromise your absorption of the calcium that also might be in there. Hopefully it has calcium. A lot of them leave it out because it's a bulky nutrient.

Takes up a lot of space. I'm also looking for choline. Does it have, have some choline in like a decent concentration? That's another both expensive and bulky nutrient, which takes up capsule space. So if you're looking at something like a prenatal that only has a couple of capsules a day, as the dosage is not gonna be.

Very good potency. Simply. Yeah. Because you need the capsule space to fit those bulky nutrients. So those are a handful of things I could keep going. Um, [00:37:00] quality control is huge and so many supplement companies completely skip that.

Jac: Yeah.

Lily: And a lot of the brands, and I'm not naming names who have a lot of, of money, investor money usually.

Mm-hmm. Going into affiliate marketing are some of the worst, honestly. So I'll just leave it at that. Um, there's two brands I really like. Um, Falwell and Seeking Health are both really good quality. They're practitioner founded supplement companies, so they didn't like pay to get somebody's name and likeness on their website.

They're actually formulated by a clinician. And this I find brings up a much different like ethical standard to the company than somebody founded by a business person or investors. Yeah. Where they're just looking to try to turn a profit. 'cause guess what? Hitting all the marks on a number of different things I've just mentioned is very expensive.

Having a company that tests every single batch for [00:38:00] quantity, consistency, purity is very expensive. And that's not what most companies do. Um, and so those are the two that I have like full trust that, that do all the things right. Um. And they also have, you know, other, other supplements available to fill in the gaps.

So both of them leave out iron, but you can take an extra iron supplement if your labs indicate both of them leave out omega threes. This is intentional. You don't want omega threes packaged with your iron and B vitamins. It's gonna oxidize your omega threes and make them essentially like inflammatory to your system instead of providing benefits.

So that's built into the formulas intentionally, and you can add those things on the side. Um, but I have really good results clinically with them. I get feedback from thousands of people on supplements, consistently positive feedback on them. So yeah, those, those would be the ones I'd consider.

Jac: All right.

Good to know. I was making a note of those as you were discussing them. Um, another question too for you, Lily. So I've read that women with the M-T-H-F-R-G mutation, [00:39:00] which is actually a lot more than we otherwise think it is, should not be supplementing with synthetic folic acid. Um, and instead like opt from methylated forms of folate.

And that, you know, perhaps even taking a prenatal might be detrimental in that situation. Like what are your thoughts on that?

Lily: The M-T-H-F-R con conversation is pretty complicated, so I'll say that to start, and I've tried to address this in a number of different ways to make it as, as clear to people as possible.

I have a whole article on my website on folate versus folic acid. I talk about M-T-H-F-R there, I have like a two hour webinar on it with the Women's Health Nutrition Academy looking all that whole section. Yeah, there's a whole section on M-T-H-F-R and fertility in real food for fertility as well. Um, chapter 13, if you specifically wanna dive into the fertility research.

So the, the issue in a nutshell, and I'll try to keep this brief, it's hard to. Is folate is an umbrella term and there's many different things that fall under [00:40:00] the umbrella of folate. You have the folate that naturally occurs in food. There's over a hundred and diff 150 different forms that naturally occur in the world, in nature, in plants and animals.

Um, you have the supplemental forms of folate. Some of them would be forms that are more easily metabolized, like you mentioned, methylated folate. There's others. Um, and then you have folic acid. And folic acid doesn't occur in nature at all. This is a manmade version of folate. Folate comes in so many different forms 'cause the molecule is complex and it can have all these different things attached to like the core structure that is, you could call it the folic acid, um, but the folic acid is synthetic.

You never find it like that in nature. It's an oxidized form of folate and. While it's really easy for your body to absorb from your intestines, and it's a very stable molecule that can be fortified into [00:41:00] refined grains and then made into bread and baked in an oven, and the folic acid still like is stable enough to exist and, and be a sort of nutrient for your body, even though it's absorbed well, your body doesn't utilize it well because it turns out that it's not metabolically active until it has been methylated.

So your body has to go through several different steps to convert folic acid into methylfolate before it can function in your body the way that we need folate to function to do all these very important metabolic processes. Now, this is why 90 to 95, 90, sorry, 95 to 98%. The folate in your body, in your bloodstream, in your red blood cells, even in umbilical cord blood.

So fetal blood supply is in the form of methylfolate? Mm-hmm. Okay. 'cause that's what your body needs. [00:42:00] Some people, the enzyme that is needed to methylate folate is called M-T-H-F-R, and about half of us have some type of genetic variation in how this enzyme functions. It doesn't mean that you can't use folate folic acid at all, but you have a reduced ability to to convert it, methylate it.

Therefore make folic acid be of benefit to your body. And depending on which type of M-T-H-F-R variation you have, and this is where it gets all complex and I I go through all those different versions in real food for fertility and also that webinar. Um, some people have like a 70% reduced ability to methylate it.

And so then you have a buildup of what's called unmethylated folic acid, UMFA. You can look it up in the medical literature circulating in your body. And that can actually block some of your other folate enzymes, folate dependent enzymes, where now you have a functional deficiency in [00:43:00] full folate, but you have high levels of unmetabolized folic acid.

'cause again, it isn't a biologically useful compound until it's been methylated. So, um, given that not everybody is tested for M-T-H-F-R, right, um, I think it's important to point out that everybody can metabolize. Methylfolate. And there's another version of folate that's really easy for your body to metabolize.

That's called folinic acid, not folic folinic acid. You'll see it in supplements under the name calcium foliate. They just bind the folinic acid to a calcium. Um, that one also is very easy to metabolize even if you have an M-T-H-F-R variation. So, um, anybody can metabolize them as well, even if you don't have one of these things.

So from a standpoint of like being proactive about this and making sure your folate status is good, going into [00:44:00] pregnancy and throughout pregnancy, I think it is wise to simply. Optimize your intake of folate from folate rich foods. Yeah, there's a whole list of those with concentrations in that folate blog I just mentioned.

Um, and then also to supplement with a form of folate that everybody's metabolism can handle regardless of any genetic variations. So methylfolate or folinic acid will do that. People who are just an average American is already taking in pretty much as much folic acid as they can metabolize from refined grains.

Like we can only metabolize about 300 or so micrograms per day, and that's already what most people are eating from refined grains. Of course, if your diet doesn't have any refined grains, maybe that's, you know, not even a, a consideration for you. But, um, I think a lot of people are just taking a lot, and it's a, it's very, very common among reproductive endocrinologists to put people on really high dose folic acid.

Jac: [00:45:00] Yeah. Um,

Lily: and there's been some interesting studies where they've like. Looked at individuals who are put on high dose folic acid. It's usually like a 5,000 microgram per day dosage. And note that the tolerable upper limit defined by the Institute of Medicine is a thousand micrograms. Okay? So you put 'em on 5,000 micrograms and you start seeing more metabolic issues.

You see a rise in their homocysteine levels. You, you see a rise in unmetabolized folic acid. You see delays in conception, and then you switch them over to methylfolate, even at a much lower dose, like 500 micrograms. And then suddenly their homocysteine levels come down, their red blood cell folate levels normalize.

Wow. And they're able to get pregnant. So we just need to like take a step back from all the noise about flic acid in this world and just look at the biochemistry. Like it's really straightforward and it's kind of wild how this has become so controversial.

Jac: Yeah. Wow. That was incredibly helpful. That was that like five minute synopsis, Lily was like more helpful [00:46:00] than the hour conversations I've heard on M-T-H-F-R because there is so much noise.

Yeah. And again, it's just a matter of Yeah. Sifting through through the noise. Um, one other question too for you on supplements. I know we're, we're nearing our time, but aside from a prenatal, are there any other supplements that you suggest women include in their diet? Preconception and also during pregnancy.

Okay.

Lily: And preconception. There can be some differences. Um. Just, just as like a, a overarching theme. You have like so much more wiggle room outside of pregnancy to be experimental with things. And then during pregnancy, we are kind of limited by what we have the research on. Uh, so I'll just say that like we, yeah, we wanna be a little more careful during pregnancy itself, but some that definitely overlap between both preconception and pregnancy would be a comprehensive prenatal that we've already talked about.

Usually, like the two formulas I mentioned have enough vitamin D for most individuals, [00:47:00] but if your lab tests show that you're still deficient, you might need some extra vitamin D and possibly also some extra magnesium, which helps with vitamin D metabolism. Magnesium for many other reasons is also very helpful and is on my list.

Um, some women need extra iodine, so that's a possibility. Um, a fish oil supplement, if you are someone who's not. Uh, eating at least 12 to 16 ounces of high Omega-3 seafood per week, which my experience is outside of individuals who are living in like Alaska, where they're fishing all the time and eating a whole bunch of wild cut salmon.

Most individuals are really not consuming that level of seafood. The average US woman is eating only about three ounces per week. Um, so a fish oil supplement or an LG based DHA supplement, if you're not consuming, um, sea animals would be really helpful. Um, then you start to get into a bunch of extras, right?

So like probiotics [00:48:00] and different formulas of probiotics could be considered either preconception or in pregnancy, for example. Mm-hmm. Um, you have somebody who's tested for iron deficiency anemia, you know, it's an iron issue. You can supplement with extra iron. I do also highly recommend prioritizing your food sources of iron, especially the ones that are really easily absorbed.

I have a whole article on my site on that if you wanna look that up. Um, sometimes if you have an individual who's not consuming dairy products, it does indeed get tricky to hit your calcium needs. And so a calcium supplement could be an option. Um, again, it's, it, it's kind of up to like taking into account the full clinical picture here.

I don't really love putting people on calcium unless it's truly necessary, but there is a time and a place for that. Uh, and then in the fertility realm, there's like an whole array of supplements that can be possibly utilized. We talked about in Acetol for PCOS. [00:49:00] Even just general fertility, it can be beneficial.

You don't have to have a known blood sugar or insulin issue. Um, it's something that I personally take even though my blood sugar and insulin levels are good. There's a number of different antioxidant type compounds that can be really helpful. Um, alpha lipoic acid, coq 10 or or a handful of those.

There's some amino acids. Um, that can be really helpful. Like a carnitine is a really helpful one, especially in PCOS. There's even some data on hypothalamic amenorrhea. Um, uh, I didn't mention collagen, but collagen I find is also really helpful 'cause a lot of people are not consuming collagen rich foods in the way in which we did ancestrally.

So that's another one that, that can be of benefit. It's probably the shortest

Jac: list I can give you. Yeah, no, that's, I mean, that's pretty comprehensive still. One other thing that came to mind when you mentioned calcium, and I know this is dependent upon the individual in the clinical picture, but. A lot of people or a [00:50:00] lot of the research or whatnot, the noise out there has said that women with PCOS should avoid inflammatory foods.

And within that group of inflammatory foods, I've seen dairy grouped as well as the gluten, and I know dairy, this is a whole other complex issue, the difference between a one and a two case in protein and, and what's inflammatory and what's not. But are there any foods that you are like a strong believer that should not be omitted from someone's diet during pregnancy that should not

Lily: be omitted?

Yes. You know, dairy's a tricky one 'cause people have such individual responses to it. Um, in, in all of my books, I am ProAir, like pro high quality dairy and you know, the level of detail I get into high quality dairy like differs depending on the book. Real Food For Fertility, we go into the most. Detail on it.

We talk about A one and a two. We talk about raw milk and unhomogenized, right? All the different various options and goat [00:51:00] and sheep's milk and whatever as a whole. I tend to see benefit with including dairy in the diet. It can leave a lot of nutritional holes. Calcium is just one of them, but it can leave holes in your riboflavin intake, vitamin B, B two, um, your B12, if you're not eating a lot of animal foods.

Your iodine, especially if you're not eating a lot of C. Um, there's just a whole number of new, your vitamin K two. Yeah, vitamin D. There's a lot of things that we wanna consider with dairy where if it's possible to include some type of dairy. Even if it's sheep or goat's milk, dairy. And even if it's like only a low lactose version, like a yogurt or a goat cheese or something, yeah.

It still tends to fill a lot of nutritional gaps. So I try to keep it in the diet if we can. There are of course times where that's not the case. There's an overt allergy or symptoms or such that it doesn't work out. Um, but I think most often the adverse outcomes people have from including dairy [00:52:00] are from conventional dairy, like not super great quality dairy that's, that's pasteurized.

Um, so, you know, take, take with it when you will. I do, you know, at the end of the day, animal foods do provide a lot of different nutrients that are highly be beneficial, both for fertility and hormone balance and also for pregnancy outcomes, fetal development. So I am a proponent of an omnivorous diet with as much variety as you can get.

So. There's again, always gonna be people where for whatever reason they don't wanna include those things. And there's a lot of nutritional gaps you need to consider. But generally speaking, if you can con consume animal foods from an array of sources and also plant proteins as well, like beans and legumes have their own benefits, um, that's where I think you're most likely and not where I think, where I know you're most likely to hit your micronutrient [00:53:00] needs.

'cause one of my little like side projects is running sample meal plans through micronutrient analyses and see where the holes are. Like, I don't know why more people don't do this, but you, you notice when you do that. Okay, we came up with a pescatarian meal plan. So fish and seafood also includes dairy and eggs, but no, no red meat.

No chicken or whatever. And unless you're including bivalve, shellfish, like oysters, clams, and muss, virtually every day, you see pretty significant nutritional gaps. Right. And like seafood every day, right? Yeah. And most. Pescatarians are vegetarian and they eat seafood once or twice a week, right? Yeah.

Right. Then you have more nutritional gaps that you need to consider. So if people are including some red meat, including the organs every once in a while, including meat on the bone, like roast a whole chicken and then making use of the bone from making bone broth, right? You're getting a much better mix of nutrients than if your, your food choices are much more limited.[00:54:00]

Right. Um, I do also think it's highly beneficial for people to include some plant foods as well. So a lot of people take my words and then they're like, oh, she's pro pro carnivore. Yeah. You could be pro an animal forward diet or a diet that includes some animal protein as part of the overall protein intake and still be like, there's benefits to eating vegetables and fruit and legumes and many times whole grains.

Right. We have, we have, again, exceptions to that with some individuals, but the more variety as a whole. The better. Like it, it is what it is. And, and you know, I've, I've experimented with my. Range of different restrictive diets over the years, out of curiosity. Yeah, and it also comes down to what's sustainable too.

And to me, the most sustainable is one that has the most variety, um, for what your individual physiology can tolerate. And it's also the one that hits the micronutrient marks.

Jac: Yeah, yeah, that makes sense. For your two pregnancies, Lily, did you experiment in terms of different eating [00:55:00] patterns or were you pretty consistent across both of them?

Lily: I ate pretty similar to how I describe in my books. Um, with that said, of course, first trimester has, its, has its ups and downs of food intake. So yeah, I wouldn't say, as is probably the case for like 90% of pregnant women that I was eating super optimally in that stage where I was kind of queasy and just like, eh, I don't wanna eat that.

I don't wanna, you know, cook, uh, somebody cook for me. Yep, yep. Put the food in front of me. Already made. Yeah. Um, my sister is like that. Yeah, that's super, super common. So that, that stage probably not as much. And then just, you know, regionally where you live at the time, that certainly can influence how you eat.

So with my first pregnancy, I was living in Alaska. I ate a lot of seafood because that was what was available. Um, right. And, and inexpensive. You basically get your, when you're a resident, you get your fishing license for like 25 bucks a year and then That's amazing. Fish your limit and [00:56:00] everybody's trying to give away the excess salmon that they've, they've fished right.

So a lot more seafood up there. And of course my son is like super smart. I was gonna ask and he loves fish, so that's kind of, yeah, it's kind of funny. But, um, yeah, for the most part I ate pretty similarly. I mean, you could scroll back. I didn't have Instagram with my, when I was pregnant with my son, but you could scroll back through my super old Instagram, see plenty of examples of what I was eating.

It's, I will, it's pretty consistent with what I'm describing here. And you know, a lot of overlap too with postpartum and fertility nutrition, like the right specific amounts vary and the portion sizes might vary. And the rationale for eating certain foods certainly does vary. Um, but yeah, I did a lot of the experimenting when I was much younger, so Yeah.

You know, tried raw vegan and Really, oh yeah. I last about a week and I was like, even living in southern, Southern Cal, Southern California, this is like completely, [00:57:00] yeah. Uh, this is a mismatch and so difficult and I feel terrible, um, that this doesn't make any sense. So, um, yeah, I did a lot of experimenting without getting like dogmatic or yeah.

Overly restrictive about it, just from like a curiosity standpoint. Right. Um, and yeah, that of course informs, you know, when you watch the different dietary fads come and go, like, exactly. I can be a proponent of moderately low carb, but I've tried out keto many times and my body really, truly does run better when I have some carbs and I don't have.

A metabolic need, right. To be keto. So I'm not going to eat keto, right. But I can still be conscious of the different foods that overly spike my blood sugar compared to other foods with a similar carbohydrate amount. And notice that and make adjustments without being so dogmatic that like, yep, yep.

Everybody needs to eat less than 20 grams of carbs a day. It's like, I've tried that. It really doesn't work [00:58:00] well for me, and that's fine, you know?

Jac: Yeah, no, I hear you. I also like to experiment on myself too. My sister's husband has actually been on the carnivore diet for the past, I don't know, well over five or six years now.

And he thrive, he thrives on it. And that's just, yeah, some people do great on it, you know, so that's why, again, I feel like when someone, you know, tends to find a diet that works for them and they go out and say, everyone should do this, I'm like, no. Yeah, everyone's different. And

Lily: pregnancy also is an interesting, um, it, it, it's.

It's humbling, right? Because you might go into it with this expectation that you're going to eat a certain way. I see it a lot with the people who are keto or carnivore, that they're going to continue on that during pregnancy, and then your body just won't allow it sometimes. I mean, not saying I've never seen it.

I certainly have seen people do it, but especially the first trimester, there's often some bumps in the road, and maybe there's some reasons that your body wants more carbohydrates, like your thyroid is ramping up. Hormone production like crazy. [00:59:00] And, and maybe you need some carbs right now. Maybe that craving for citrus is 'cause you need the extra Yeah.

Potassium or folate or vitamin C, you know, like I, I'm a strong proponent of sort of leaning into those signals, um, instead of trying to like just stick to your guns, like muscle through it. Um, I think there's some, some wisdom there sometimes with cravings.

Jac: Yeah, no, absolutely. Lily, I do wanna be conscious of your time, but this has been such an insightful conversation.

I'm so excited to share it with listeners. But with that, where can they pick up a copy of your awesome books? Um, and you mentioned your Instagram, if you could share that handle with us as well. Yeah, for sure. So,

Lily: um, go over to my website, lily nichols rdn.com, and then click on the books tab. And just scroll down.

There's, shows you all the different ways and formats where you can purchase the book. Um, it has actually come to my attention as of yesterday that there's like counterfeit sellers on eBay. Really highly recommend not trying to buy books on eBay. Okay? Don't buy [01:00:00] books on eBay. Um, for what it's worth, Amazon is often the best place to buy as long as it says ships and sold from Amazon.

I do also carry many of my eBooks over on shop.lilly nichols r dn.com, and I do also, uh, carry the paperback for Real Food for pregnancy there as well. But, um, for the rest of them, paperback, your best option is. Amazon go through the link that I link out, so it's not a fake, there's tons of fake wannabe versions as well as also That's crazy.

The counterfeit versions on eBay, apparently. I know. It's, it's a, it's like whack-a-mole with these, yeah. Criminals. So it is what it is. Um, as for my site also, there's lots of freebies. Theres, if you wanna like, read the first chapter of Real Food for Pregnancy, you can read that there and click on the freebies tab for more.

There's hundreds of articles on my blog. We mentioned a bunch today. Um, so use the search bar for whatever key term and you'll, you'll easily pull up the articles. Uh, as for social [01:01:00] media land, I'm most active on Instagram. My handle is at Lily Nichols rdn. I post a lot of research there, just like, I don't know, random pictures of my food.

I feel like my Instagram is, um. Uh, I, I don't run my Instagram like a typical Instagram account where there's like a million reels or anything. Yeah. So take it or leave it. It's kind of old school Instagram with images and research, but it is what it's, I think that's the best

Jac: kind. So kudos to you. Yeah.

That's awesome. Well, Lily, my last question for you, and this is always my favorite one to ask, and that is, what does being well and strong mean to you? Ooh, being

Lily: well and strong. Um, you know, having the energy to go through the day and, and not, um, not burn out, which is easier said than done when you're a mom and, you know, in entrepreneur land, but yeah.

Uh, yeah, take care of yourself so that you feel good. Yeah.

Jac: With a five and what was it, 9-year-old you said? [01:02:00] Yeah. Yep. I'm sure. Well, Lily, this has been such a fun conversation. I'm so excited to share with listeners, and I hope to have you on again at some point soon. Yeah, thank you.

I hope you enjoyed this episode. If you would like to support the show, please subscribe, leave a rating and review and share it with others. Be sure to visit well and strong.com to access notes from the show and to stay current with new content. I'm so grateful you joined me. Be well and be strong.



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