vegan diet

Episode 20: Concerns with a Vegetarian Diet in Pregnancy with Lily Nichols, RDN

In this episode, Dr. Mark and Anisa dive deep with Lily Nichols, RDN into the true concerns for mamas and babies when a woman chooses to follow a vegetarian (or even limited animal protein) diet. Though there is so much to be discussed on this topic, we covered the key concerns of what true protein needs are in pregnancy, essential pregnancy micronutrients often deficient on a vegetarian diet, the differences between animal and plant forms of nutrients, and the challenge of balancing blood sugar on a limited protein diet.

Lily Nichols is a Registered Dietitian/Nutritionist, Certified Diabetes Educator, researcher, and author with a passion for evidence-based prenatal nutrition. Her work is known for being research-focused, thorough, and unapologetically critical of outdated dietary guidelines. She is the author of two bestselling books, Real Food for Pregnancy and Real Food for Gestational Diabetes. You can find her work at LilyNicholsRDN.com and follow her on Instagram: @lilynicholsrdn

We fully understand that this is a controversial topic and ask that each person listening does so with an open mind and accepting the information we discuss from a place of curiosity and in the best interest of mama and babe.

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Show notes

2:45: Anisa’s personal challenges following a vegetarian diet

3:20: How protein needs vary for women in pregnancy and other common concerns with protein in pregnancy

RDA is arguably too low even outside of pregnancy

  • Current RDA: 0.8 g/kg (about 10% of caloric intake). After `13 weeks goes up to 1.1 g/kg

  • Other recommendations: 70g in last 2 trimesters

9:30: 2015 first study on estimating protein needs in pregnancy for Estimated Average Requirements (EARs: meets 50% of group’s needs)

  • Estimated that protein needs in early pregnancy are 39% higher than conventionally recommended and 73% higher than current recommendations for late pregnancy.

  • Downside of not getting enough protein: elevated blood sugar (Gestational Diabetes)

  • Study showed that recommendations should be at least 1.22 g/kg for early pregnancy and 1.52 g/kg in late pregnancy. Study referenced: Stephens TV, Payne M, Ball RO, Pencharz PB, Elango R. Protein requirements of healthy pregnant women during early and late gestation are higher than current recommendations. J Nutr. 2015;145(1):73-78.

  • “There’s a lot of evidence that suggests the RDA is way underestimated when it comes to protein…Based on what we know about nutrient needs in these stages of pregnancy, the goal may even be 1.5 g/kg protein in early or 1.8-2 g/kg in late pregnancy.”

  • For a 134 lb woman (61 kg) current recommendations would suggest 48g of protein needed but if we were to use this study’s recommendation 92g would be needed (almost double!)

12:30: Micronutrients found in protein-rich foods and common protein-rich pregnancy “superfoods”

27:45: Differences between forms of nutrients of animal-based vs plant-based foods

  • 29:00:Omega 3 fats

    • Needed for optimal brain and vision development - another example of a nutrient that when deficient can have irreversible effects. When a mother is not consuming adequate amounts in pregnancy, there are irreversible vision deficits in childhood

    • Forms of omega-3s: DHA + EPA are found together in food sources and they work synergistically together and with choline. DHA is not found in plants (ALA is plant sourced). Some plant sources of ALA: flax, chia, walnuts

    • Our bodies have the capability of converting some ALA to DHA but this is very inefficient. At best the conversion rate is 3.8%. Plus, if your diet is high in omega-6 (concentrated in seeds, nuts and vegetable oils and other plant based omega 3 sources) then this conversion rate drops to 1.9%.

    • When you supplement breastfeeding women with flaxseed oil and measure DHA levels in breastmilk, the levels are no different.

    • The only plant-based source that is significant enough is an algae-based DHA supplement. Like this one.

    • You can get plenty of DHA if you eat 12-16 oz/week of high omega 3 seafood sources (like salmon and sardines)

    • Concerns about heavy metal (like mercury) toxicity: Do benefits outweigh the risks? Avoid larger fish that bioaccumulate mercury like swordfish, mackerel, tuna, shark.

    • Safecatch Tuna: low mercury tuna

    • Most fish are high in selenium that can help bind mercury, preventing from absorbing much of whats in the fish

    • Studies assessing fish consumption and neurodevelopment in babies show it’s worth it: study out of UK 12,000 mother infant pairs, consumption of more than 12 oz fish/week was strongly linked fish consumption to higher IQ and communication skills as worst cognitive outcomes among children whose mothers consumed no seafood in pregnancy, resulting in issues with fine motor skills, social development and communication skills. Neurodevelopmental outcomes were better despite consuming some seafood containing mercury. Seafood is micronutrient rich (B12, DHA, B6 Choline, Selenium, Iodine)

    • Omegaquant RBC fatty acid profiles omega 3 at home test kit

    • Cochrane: >5% RBC DHA reduces risk of preterm birth, study referenced: Middleton P, Gomersall JC, Gould JF, Shepherd E, Olsen SF, Makrides M. Omega‐3 fatty acid addition during pregnancy. Cochrane Database Syst Rev. 2018;2018(11).

  • 39:30: Vitamin A

47:00 Why is it harder to manage blood glucose when following a vegetarian diet in pregnancy and why is blood sugar regulation so important?

  • Risks of elevated blood sugar in pregnancy: changes in rate of fetal growth, larger than average size, increased insulin resistance,

  • “As a result of [consistently elevated maternal blood sugar] their pancreas is larger than normal, pumps out more insulin than normal, they’re more insulin resistant than normal, and they also can face a higher risk of Type 2 Diabetes and Obesity by the time they’re 13- upwards of 6-19-fold higher risk.”

  • Almost all whole-food vegetarian protein sources are packaged with carbohydrates. Many vegetarian meals are also low fat which further increases glycemic load of meals.

  • Lily’s Continuous Glucose Monitor (CGM) Experiment

54:00 Rapid Fire Questions

What are you excited about or what are you researching currently that keep you interested in your current profession?

  • Just how little we know about nutrition. Current research is extremely lacking - especially when it comes to Recommended Dietary Allowances (RDAs)

  • Interesting study on how non-essential amino acids (like glycine and taurine- both primarily found in animal foods) is a misnomer- “animals and humans cannot adequately synthesize nonessential amino acids to meet optimal metabolic and functional needs ‘under either normal or stressed conditions’ pregnancy would definitely be a stressed condition in my opinion.” Study referenced: Hou Y, Wu G. Nutritionally nonessential amino acids: a misnomer in nutritional sciences. Adv Nutr. 2017;8(1):137-139.

  • Repeated theme: Regardless of if you’re following the “guidelines”, if you still have symptoms or don’t feel optimal, keep digging.

58:30: Common piece of advice that’s incomplete or misinformed

Concept of eating for 2: You need to eat more of certain micronutrients for sure. However, the way people interpret “eating for two” is to eat double or increase the quantity of their food without regard to the quality. But it’s nowhere near double, you add maybe an additional 300-500 kcal depending on activity and body size.

LilyNicholsRDN.com

Books: Real Food for Pregnancy and Real Food for Gestational Diabetes

As a thank you for supporting Lily’s small business, those who purchase a paperback copy of Real Food for Pregnancy **directly from her site** will get a 30-recipe e-cookbook as a FREE gift.


This e-Cookbook is available for purchase separately -OR- you can get it for FREE when you order a paperback copy (details below).

For Lily’s U.S. readers, there are a few reasons you may want to buy paperback copies direct from her shop:

  1. FREE goods! All paperback purchases will come with a FREE copy of the new e-Cookbook! That’s a $19.99 value. Simply add BOTH items to your cart (paperback + e-Cookbook) and use code GIFT at checkout. The cost of the e-Cookbook will be deducted from your order.

  2. Discounts on 5+ copies. A lot of people like to gift Real Food for Pregnancy to their friends or clients, but don’t meet the 15 minimum copy threshold for wholesale orders. Solution: Lily’s BUY4GET5 offer. Add 5 copies of Real Food for Pregnancy to your cart. Use code BUY4GET5 and the cost of one book will be deducted from your order.

  3. FREE shipping on all orders in the continental U.S. Although she can’t beat the expediency of 2-day prime shipping (not quite ready for a personal fleet of delivery vehicles and autonomous warehouse robots, haha), Lily can offer standard shipping for free.

  4. Support Lily’s work more. Direct book sales from the author mean a larger percentage of your purchase goes to support her. More support for her work means she can spend more of her time on freely-available content, like her in-depth blog posts and interviews.