For many women who have gone through pregnancy, their experience with gestational diabetes (GD) begins and ends with the infamous glucose tolerance test, where they drink the sickly sweet “glucola” and get their blood glucose levels tested. But for the roughly one-in-ten pregnant woman who’s given a GD diagnosis, the process of tracking blood sugar and understanding how food affects insulin levels becomes a central part of her pregnancy.
Real Food for Gestational Diabetes is a short volume from dietician Lily Nichols that takes a new approach to controlling GD through diet and exercise. With a mountain of research supporting her, Nichols helps readers understand their gestational diabetes diagnoses by giving them the tools to take their pregnancy health into their own hands. In our Real Food for Gestational Diabetes book review, we share the strengths and limitations of Nichols’ book and our recommendation on whether to buy, borrow, or pass.
Lily Nichols is a Registered Dietician and Nutritionist and certified Diabetes educator. She has also written Real Food for Pregnancy, which is a more general approach to pregnancy nutrition, and Real Food for Fertility, intended for those trying to conceive and co-written with fertility awareness expert Lisa Hendrickson-Jack.
Nichols has clinical experience working with pregnant patients with GD, which led her to develop her lower-carb and nutrient-dense approach to GD nutrition. She also founded the Institute for Prenatal Nutrition, which educates health practitioners on pregnancy nutrition. Nichols’ blog also has a variety of posts on prenatal nutrition, where she often takes an in-depth look at pregnancy-related nutrition research. Diving deep into the research and making the evidence accessible for the average reader is what Nichols does best, and her blog posts and books stand on long lists of scientific references.
Who is the intended audience of Real Food for Gestational Diabetes?
Real Food for GD is meant to be a companion for the pregnant woman who has been diagnosed with gestational diabetes and wants to fully understand her diagnosis. The book is helpful for women with GD who also wish to lessen their chances of needing medication or suffering GD-related problems (either for themselves or their babies). Nichols has said that any pregnant woman can follow the information given in this book, regardless of GD status, but you might prefer Real Food for Pregnancy if you’re looking for more general pregnancy nutrition advice.
Women who had gestational diabetes in a previous pregnancy and are looking to conceive again might also benefit from this book, as around half of women who had GD in one pregnancy will be diagnosed with the condition again in future pregnancies [1].
What are the main content areas of Real Food for Gestational Diabetes?
The book can be roughly divided into four sections: what gestational diabetes is, and its connection to Type 2 diabetes, blood sugar-balancing diet and lifestyle choices during pregnancy, medications for GD and why she doesn’t recommend the conventional approach, plus how to stay healthy postpartum.
What gestational diabetes is and its connection to Type 2 diabetes later on
Nichols begins by giving two definitions of gestational diabetes.
Definition 1: Gestational diabetes is a type of diabetes that develops during pregnancy.
Definition 2: Gestational diabetes is a type of diabetes that is first diagnosed during pregnancy.
(Source: pg. 3 of Real Food for Gestational Diabetes)
Although these two ways of defining GD might sound similar, they are each pointing to different truths of the diagnosis. GD is a phenomenon of pregnancy in some ways, as insulin resistance (i.e., your body’s inability to process insulin, which is the hormone that lowers blood sugar) increases when you are pregnant. This is why a woman might have gestational diabetes without ever having challenges managing her blood sugar pre-pregnancy. However, Nichols argues that it’s more common for a GD diagnosis to be the first time that a woman comes to know of her already-existent insulin resistance. The evidence for this is found in the shocking statistic that within 5 years of giving birth, 70% of women who had GD will receive a type 2 diabetes diagnosis (pg. 3).
Within 5 years of giving birth, 70% of women who had GD will receive a type 2 diabetes diagnosis (pg. 3).
How to avoid Gestational Diabetes risks by controlling blood sugar
With this statistic as the starting point for her research, Nichols explores the main risk factors that can come with GD, and how they are largely avoidable with good control of blood sugar. She gives the nitty gritty details of how to test your blood sugar and understand what foods will cause spikes, with helpful tips on building a GD-friendly plate and eating mindfully.
Nichols then gives a five-day meal plan at three different carb portions: 90 grams, 120 grams, and 150 grams per day. She explains how to decide which amount of carbs is right for you, as these numbers all fall below the conventional recommendations of 175 grams per day [2]. The daily meal plans include three full meals, three snacks, and an optional dessert, and are full of foods aimed at not only controlling your blood sugar, but also packing in as many nutrients as possible.
In Chapter 5, Nichols discusses which foods are best in creating a healthy pregnancy. Rather than focusing on individual nutrients, she instead orders her list around the foods themselves. Nichols also gives us some tips on supplementation and exercise during pregnancy, with specific attention towards what is most helpful for women with gestational diabetes. She points out how exercise can even reduce the risk of having GD by 49-78% (pg. 87).
Nichols’ take on medications for GD and critique of the conventional treatment approach
Following the book’s sections on diet and lifestyle is an explainer on the different kinds of medications prescribed for GD. Nichols concedes that not every woman will be able to control her GD through diet (pg. 101), though she has seen the need for insulin and medication “drop significantly” with her protocol (pg. 102). She also knows that many women want to do whatever they can to avoid going on insulin or other medications, especially while pregnant.
For those who still require medication to control their GD, Nichols has this to say:
“… for the women who do require a little medical intervention, know this: Normalizing your blood sugar with medication is far safer than ‘going natural’ and having blood sugar outside the natural and safe range” (pg. 102-103).
With this in mind, Nichols gives readers tips for success when using each GD drug, as well as their potential side effects. She provides this information so women can make informed decisions when discussing possible GD medications with their doctors. Finally, she discusses why her approach to gestational diabetes differs from the conventional guidelines, and gives guidance on how to continue living a healthy lifestyle postpartum.
Strengths of Real Food for Gestational Diabetes
The place where Nichols’ work shines is her in-depth take on research surrounding real food nutrition. She separates fact from fiction on such fraught topics as vitamin A toxicity (pg. 59-60), eggs and cholesterol (pg. 58), and the benefits of real sugar over artificial sweeteners (pg. 37). Her takes are balanced and evidence-based, with lengthy explanations for why she makes her food recommendations.
I personally loved the book’s meal plans, which were full of delicious-sounding recipes like low-carb shepherd’s pie and coconut macaroons. Nichols breaks down the carb content of each meal in an easy-to-understand way that helps you feel more in control of what you’re eating, with ways to increase or decrease carbs as needed.
The other aspect of Real Food for Gestational Diabetes that stands out is Nichols’ commitment to looking at all aspects of the evidence before giving her thoughtful recommendations. In chapter 11, “Questioning the Conventional Dietary Approach to Gestational Diabetes,” Nicholz explains why so many women “fail” the diet therapy prescribed by their doctors, and why a lower-carb approach is a better option. She also discusses the issue of ketosis in pregnancy, which is vital to understand for any woman hoping to control her GD through diet.
Limitations or blindspots
Because Nichols’ plan for managing GD differs from the typical recommendations, I would have liked to see her advise women on how to talk to their doctors about their choice to take a different approach. I deeply appreciated her message that your health choices are ultimately your own, and that the best thing to do is have a thorough understanding of your diagnosis (pg. 144). However, she doesn’t give clear-cut answers on what to do if your doctor dissuades you from going low(er) carb, or if you receive pushback on having low levels of ketones in your urine due to your dietary changes. It can be difficult to talk to your doctor, especially if you are going “against the grain” when it comes to certain protocols, so more encouragement and advice on that front would have been a helpful addition to the book.
Many of Nichols’ critics often point out that she offers a lot of negative statistics, and they say that she can be a bit “doomsday” in her outlook. While it’s true that Nichols does not shy away from giving you the truth on the dangers of unchecked GD (which can indeed be serious) (pg. 5-6), I did not personally find this information to be overly negative.
Beyond the overall empowering message to women with GD that they do have agency in their health, there are also great anecdotes about choices like breastfeeding (pg. 122), which can further help improve maternal and infant outcomes after a GD pregnancy.
The verdict: To buy, borrow, or skip Real Food for Gestational Diabetes?
If you’re a woman navigating a gestational diabetes diagnosis or you’ve experienced GD in the past and are looking to get pregnant again, I would say that Real Food for Gestational Diabetes is an absolute must-buy. The information presented in the book is vital to understanding GD, and how real food can improve your and your baby’s health outcomes. Plus, the book has great information on exercise, supplements, and postpartum choices. The book’s realistic meal plans and recipes will also teach new skills to help you on your health journey–even beyond pregnancy. Lily Nichols’ entire body of work is a wonderful guide for moms looking to have healthy pregnancies, and the deep knowledge on gestational diabetes she provides readers in Real Food for Gestational Diabetes truly makes this book a must-have for women with GD.
Additional Reading:
Natural Womanhood Book Review: Real Food for Fertility
References:
[1] Egan AM, Enninga EAL, Alrahmani L, Weaver AL, Sarras MP, Ruano R. Recurrent Gestational Diabetes Mellitus: A Narrative Review and Single-Center Experience. J Clin Med. 2021 Feb 3;10(4):569. doi: 10.3390/jcm10040569. PMID: 33546259; PMCID: PMC7913262. [2] Mustad VA, Huynh DTT, López-Pedrosa JM, Campoy C, Rueda R. The Role of Dietary Carbohydrates in Gestational Diabetes. Nutrients. 2020 Jan 31;12(2):385. doi: 10.3390/nu12020385. PMID: 32024026; PMCID: PMC7071246.
