Heal Endo Interview with Lily Nichols


First of all, if you haven't read Real Food for Pregnancy by Lily Nichols, stop what you're doing and buy it here!! This is a one-stop-shop on how women should be approaching pregnancy, eating while pregnant, and even staying nourished postpartum. I would even say you could sub in "start to heal endo" everywhere she says pregnancy, because this nutrient dense diet will really start to fill up those depleted nutrient coffers.


 Lily talks real food - grass-fed meats, cold water fish, low to moderate carbohydrate, raw dairy, and deep nutrition - basically everything I preach about here at Heal Endo. She's a fan of nutrient replenishment, saturated fats and cholesterol, and has a lot to say about how your "average" governmental diet recommendations can get you into much more health trouble than you may realize.

I'm a big fan of Lily's work, and if you have endo, want to think about fertility, pregnancy, or beyond, you should be too. Lucky for us, Lily was excited to answer a few questions while you wait for that book to arrive in the mail :)

First off, as a registered dietition you were taught the governmental guidelines on what constitutes “healthy” nutrition, yet wrote a book showing how the governmental nutrition guidelines are no where near enough nutrients for fertility, pregnancy, or post partum. When did you have that realization? Was it hard for you to change your perspective?

I was actually introduced to an ancestral nutrition/real food perspective before I went to school to become a dietitian, so I have always naturally been one to research beyond what I was taught in dietetics. It never made sense to me to try to replace the nutrients found in real food with fortified foods or to forcibly remove nutrients from real food to make them “better” (think low-fat dairy or meat with the fat cut off or chicken without the skin or artificial sweeteners instead of the real thing).

It didn’t hit critical mass until after working clinically with gestational diabetes, where I saw time and time again that the conventional guidelines failed to control my clients’ blood sugar. That got me really questioning the carbohydrate recommendations for gestational diabetes (and thus all pregnant women) and then led me to really dig into all other aspects of conventional prenatal nutrition guidelines.

From Lily's book, she breaks down real food sample meal versus a conventional nutrition sample meal to show you just how little you may be getting (conventional) versus how much you need

From Lily's book, she breaks down real food sample meal versus a conventional nutrition sample meal to show you just how little you may be getting (conventional) versus how much you need

The same meal from the picture on the left, broken down to micro nutrients. See how incredibly more nutrient dense real food is?! Now imagine how good you'll feel if you eat like this everyday.

The same meal from the picture on the left, broken down to micro nutrients. See how incredibly more nutrient dense real food is?! Now imagine how good you'll feel if you eat like this everyday.

You believe you can prevent a lot of pregnancy woes - and even greatly work to prevent pregnancy traumas such as pre-eclampia and gestational diabetes - through a deeply nutritious pre-conception and pregnancy diet. This is not often what women wanting children are told by doctors. Can you help us understand a little why these issues are on the rise and how nutrition can help?

Yes, many pregnancy complications have a nutritional component. It’s not that we can prevent all cases or that all cases will be “fixed” with nutrition, but we may as well “stack the deck” in our favor by eating a diet nutrient-dense diet. For example:

  • Both gestational diabetes and preeclampsia are affected by a woman’s vitamin D status (major sources: sunlight, whole fat dairy, animal fats rather than supplements).

  • Choline plays a role in placental function and seems to prevent some of the inflammation that precedes the development of preeclampsia (major sources: eggs, liver).

  • Magnesium affects both blood sugar and blood pressure regulation (major sources: dark leafy greens, nuts, seeds, seaweed).

  • Intake of sugar, refined carbohydrates, and trans fats are linked to a higher risk of preeclampsia and gestational diabetes (major sources: processed food, desserts).

As to why these complications are increasing, one of the biggest factors is a mother’s preconception health and weight, both of which are directly influenced by her diet. As a whole, our population is suffering from a poor quality diet: 50% of adults in the US have some form of blood sugar dysregulation (often undiagnosed) and since pregnancy increases the stresses on your body, some of these unrecognized health problems are either first noticed or become more severe.

Lily's cover of her book is a perfect assortment of real food: red meat, cold-water fish, fruit, veggies, fats, nuts, cheese, and some beans!

Lily's cover of her book is a perfect assortment of real food: red meat, cold-water fish, fruit, veggies, fats, nuts, cheese, and some beans!

In your experience, how much has a pregnancy prep diet that manages blood sugar helped women who are experiencing unexplained infertility?

It is a huge factor, particularly in women who have PCOS, which is often characterized by some degree of insulin resistance. Better blood sugar balance ultimately helps balance stress hormones and reproductive hormones. Sometimes it’s as simple as removing processed carbohydrates and sugar from the diet, which not only balanced blood sugar, but increases the micronutrient content (vitamins, minerals, antioxidants, etc.) of the diet as real food starts displacing processed foods.

[Heal Endo note: nearly all of my clients with endo have extreme - not moderate - blood sugar regulation issues, so even if you don't have PCOS please start to look into this :)]

What advice would you give to a woman with endometriosis who wants children but told by medical professionals they may deal with infertility - even before they’ve started trying?

Not all women with endo with have trouble conceiving, although it is more common. Like any woman looking to conceive, I’d recommend focusing on what lifestyle factors are within your control to optimize your chances.

  • Are you getting enough quality sleep?

  • Are you managing your stress levels?

  • Are you eating nutrient-dense foods?

  • Are you minimising your intake of added sugar?

  • Are you taking a prenatal vitamin and DHA supplement?

I always start with the basics and expand to other areas if more support is necessary.

What are the top 1 or 2 issues you see most often with women experiencing infertility? When addressed through diet, have you notice these issues tend to fade away?

There can be so many issues underlying infertility that it’s hard to choose! I will say blood sugar dysregulation is extremely common, so focusing on a real food diet that provides adequate protein, healthy fats, lots of fresh produce, and minimizes refined carbohydrates/sugars is paramount.


Another one is nutrient deficiencies, which could be from over-restricting their diet (sometimes in an effort to improve their fertility, sadly), such as eating a diet with inadequate animal foods (necessary for certain nutrients, like preformed vitamin A, adequate intake of choline, absorbable iron and zinc, glycine, and much more), a too-low-calorie diet in an attempt to lose weight (which results in HPA-axis issues, aka “adrenal fatigue”), or a too-low-fat diet (which limits intake of fat-soluble vitamins, which are vital to ovulation and fertility)... I could go on and on. It really helps to work with a well-trained practitioner who’s familiar with the science of real food, nutrients, and functional medicine to find the root cause of your health challenges.

When we hear about fertility today, it's often in a somewhat frightening framework of infertility and IVF or from the perspective of increased rates of children with birth defects, ADHD or autism. Your book, however, inspires hope that we can take the power back into our own hands to have a healthy pregnancy and healthy child through real food - and lots of it. Based on this hope, what has been your greatest takeaway from working one on one with women and fertility? Is there any 1-2  inspiring stories that stand out?

The biggest takeaway I want women to have is that your body is your friend, not your enemy. When you give it the nutrients it needs to function optimally, your fertility improves and your odds of having a healthy pregnancy and healthy baby also improve. You also need to balance all the rigid nutritional information you hear with mindfulness, meaning that the signals your body sends you are there to help you refine the “perfect” diet for you. One person’s fertility journey may involve an elimination diet for resolving digestive issues while another person’s will involve a low carb diet to help address insulin resistance; that’s the beauty of personalized nutrition.

As far as inspiring stories, I hear many about gestational diabetes, since that’s one of my specialties. I heard from one woman who had just had her 4th baby. This pregnancy was super smooth, she was diet-controlled (meaning did not need insulin or medication) thanks to my “real food approach” for gestational diabetes, and she had an uncomplicated birth & very healthy, normal weight baby. This was the opposite of her first 3 pregnancies, where her blood sugar was very difficult to control, she required high doses of insulin, she had birth injuries with all, and her babies were “macrosomic” (meaning bigger than average) and required care in the neonatal intensive care unit. If you follow the medical research, outcomes like her 4th pregnancy are considered rare after having 3 challenging pregnancies and births. She proved that with better nutrition and proactive lifestyle choices, she didn’t have to be another statistic. My goal with both of my books is to help women feel empowered in their diet and lifestyle choices so they can put the odds in their favor for easier pregnancies and healthier babies.

Feeling inspired? Want to learn more? Buy Lily's book today and take the time to read it cover to cover.

NourishHester Aba