EP 288 Real Food for Fertility | Lily Nichols

The Wholesome Fertility Podcast

Lily Nichols is a Registered Dietitian/Nutritionist, Certified Diabetes Educator, researcher, and author with a passion for evidence-based prenatal nutrition. Drawing from the current scientific literature and the wisdom of traditional cultures, her work is known for being research-focused, thorough, and sensible. Her bestselling book, Real Food for Gestational Diabetes (and online course of the same name), presents a revolutionary nutrient-dense, lower carb approach for managing gestational diabetes. Her work has not only helped tens of thousands of women manage their gestational diabetes (most without the need for blood sugar-lowering medication), but has also influenced nutrition policies internationally. Lily’s clinical expertise and extensive background in prenatal nutrition have made her a highly sought after consultant and speaker in the field. Lily’s second book, Real Food for Pregnancy, is an evidence-based look at the gap between conventional prenatal nutrition guidelines and what's optimal for mother and baby. With over 930 citations, this is the most comprehensive text on prenatal nutrition to date. Lily is also creator of the popular blog, www.LilyNicholsRDN.com, which explores a variety of topics related to real food, mindful eating, and pregnancy nutrition. Website & Social media links (Facebook, instagram, twitter) https://lilynicholsrdn.com/ Instagram: https://www.instagram.com/lilynicholsrdn/ Facebook: https://www.facebook.com/PilatesNutritionist Twitter: https://twitter.com/LilyNicholsRDN Book: https://realfoodforfertility.com/ Takeaways

• Optimizing health prior to conception is crucial for a healthy pregnancy.
• Balancing macronutrients, such as carbohydrates and protein, is important for fertility.
• Including organ meats, like liver, in the diet can provide essential nutrients for fertility.
• Concerns about toxins in liver are unfounded, as the liver does not store toxins.
• Vitamin A toxicity is rare and usually associated with synthetic supplements, not whole food sources like liver.

Click here to find out how to get the first chapter of "The Way of Fertility" for free. For more information about Michelle, visit www.michelleoravitz.com The Wholesome FertilityFacebook group is where you can find free resources and support: https://www.facebook.com/groups/2149554308396504/ Instagram: @thewholesomelotusfertility Facebook: https://www.facebook.com/thewholesomelotus/ Transcript: Michelle (00:00) Welcome to the podcast, Lily. Lily (00:01) Thanks for having me. Michelle (00:02) I'm definitely excited to talk to you a lot about your book that just came out, which by the way, congratulations, it looks like it's doing phenomenal as I knew it would. it just has so many great tips and information and research. So, before we get started, I'd love for you to introduce yourself, your background, how you got into this work, and also what inspired you to write the book with Lisa. Lily (00:24) Yeah, sure. So first of all, thank you for the kind words in the book. We're very excited that it's been welcomed with open arms. My work, my professional background is as a registered dietitian nutritionist and also a diabetes educator. And I've really spent the majority of my career working in the women's health space, spanning the whole childbearing years from preconception through pregnancy, postpartum recovery, breastfeeding. Also focusing on certain pregnancy complications, especially gestational diabetes. So that's really what I found working in many different areas in the prenatal space from clinical practice to public policy to training other practitioners to not just like conventional clinical practice, but my own private practice is that. There's often a significant difference between what actually works well for helping to maintain optimal health and healthy pregnancies versus what the guidelines recommend that we do. And so a lot of the whole reason I even started writing books was that it became kind of frustrating to me hearing from clients who, or from other practitioners who were kind of dutifully following the guidelines and their clients were not getting. Michelle (01:16) Mm-hmm. Lily (01:36) good results. And I happen to love reading research and writing about it and having kind of worked through some of these issues myself already in practice, I decided to take to writing about it to get it to a wider audience outside of just my own clinical practice. So yeah, we now have three books. I have Real Food for Gestational Diabetes, my first one, Real Food for Pregnancy and now Real Food for Fertility. And the whole reason that I thought adding this third book to the lineup would be helpful and why Lisa and I decided to do it together is that the whole issue of trying to have a healthy pregnancy, avoid complications, optimize your baby's development and all that, while what you eat during pregnancy certainly does matter, otherwise I wouldn't have written about it and wouldn't advocate for it. Technically, if we really want to optimize outcomes, you want to be looking in advance of the pregnancy. You want to have a healthy lead up to that pregnancy, because a lot of the very sensitive periods of babies' development are in those early weeks. Many of us are aware of the conversation around folate and preventing neural tube defects, for example, and how you want to optimize your intake preconception. I mean, public. Public health only calls out one nutrient, but you can extend that same logic for a number of different nutrients. And if we can optimize health prior to conception, and ideally in both partners, not just mom, but also for dad, then we can optimize the chances of a healthy pregnancy. Part of why I really wanted Lisa on board for this project, I mean, we had been talking about doing this for years. Michelle (03:01) Yeah. Lily (03:13) was with her expertise in the menstrual cycle and hormonal health. I mean, she works with helping couples both conceive and also prevent pregnancy using fertility awareness. It's also an important part of the conversation to get your menstrual cycle in check, which reflects that your hormones are in check and your menstrual cycle is only in a good place when your nutrient status is in check. And if you wanna achieve pregnancy, you could be doing everything perfectly right, but if you're not getting the timing right. Michelle (03:34) Mm-hmm. Lily (03:40) for sex, you're not going to conceive if you're not, you know, doing this in your fertile window. If you're not in your fertile window, pregnancy isn't going to happen, right? So bringing in that conversation around hormones and the menstrual cycle, kind of using your cycle as a reflection of what might be going on health-wise, which can sort of steer you in the direction of areas that need some attention, and also building in the conversation around male health and sperm quality. Michelle (03:41) Mm-hmm. Bye. Lily (04:05) That's really where Lisa shines. So I think we really, you know, brought our heads together to bring you the best of both worlds so we can optimize fertility, optimize your chances of conception, and then also pave the way for a healthier pregnancy ahead. Michelle (04:18) Yeah, I mean, it is very important to definitely start early because obviously the quality that you'll get from the sperm and the egg is going to make a huge difference in the pregnancy. So it is something that like, I remember this is way back when I was getting, when I was trying, and people were talking to me about folic acid at the time, it was folic acid, not folate. That's kind of what they were talking about a lot. And people were saying, you have to do this way before you even start, because obviously it's such an important part, that early section. And you can't just have your body ready with all the nutrients when you give it to the body right at that point. You have to do it ahead of time, because obviously your body needs to process and it has to translate. And I remember you talking about sperm and egg. really like the food being similar for both. And I thought that was really cool because sometimes it seems kind of like this two separate thing, but it really is ultimately like us humans, our bodies need nutrients and those nutrients help reproductive health. And it's nice to know that, you know, it's nice to look at it that way, that it really is like the quality is impacted. similarly for men and women with very similar foods. So I wanted, I mean, I know this is a long range, but if you could just talk about like the basics, the macros, that people should be focusing on when it comes to sperm and egg quality. Lily (05:36) Sure. Yes, there is thankfully a lot of overlap between male and female health, although there are some differences as well. But the kind of take home point is that doing a lot of the same health practices has carry over benefits for both. You don't need to be cooking separate meals for your partner just because, yeah. So Michelle (05:53) Yeah. Lily (05:55) Some of the things that are really key for both male and female fertility are keeping your blood sugar in a healthy range. And so when it comes to carbohydrates, for example, finding a level of carbohydrates that your body can process without experiencing significant hyperglycemia, like high blood sugar after meals, is optimal. A lot of that comes down to the quality of carbohydrates Michelle (06:16) Mm-hmm. Lily (06:18) less processed whole food carbohydrates, you know, your fruits, your vegetables, even a little bit of whole grains or fermented grains like sourdough, beans, legumes, like those sorts of things have much, although they do impact blood sugar levels, they have a much lesser effect on blood sugar levels than if most of your carbohydrates are coming from sugar, white flour, all the refined grains and the processed foods. In the U.S. we're in a situation where 58% of calories on the average American diet are coming from ultra processed foods. And those are usually foods that have a base of some type of refined sugar, like corn syrup, some type of a refined starch, like white flour, low quality, like vegetable oil, seed oils, and then all the other ingredients that you can't even pronounce. that are in there to make this food-like substance actually appeal. And so if we just shift the balance over to whole foods, massive benefits, not just for blood sugar levels, but nutrient intake. Another key one is getting your protein in check. Protein does not raise your blood sugar levels unlike carbohydrates, and so having plenty of protein with every single time you're eating, having some form of protein. whether it's a meal or a snack, can do a lot to help blunt the elevation in blood sugar that we experience naturally from carbohydrate foods. So especially starting your morning with a protein-rich breakfast for both male and female clients is hugely important to setting the stage for healthy blood sugar and insulin levels, healthy cortisol levels, healthy hormone balance for the rest of the day. And then... Since most of our whole food protein sources naturally come with fat. So think like eggs come with the yolk, chicken has skin, steak has fat on it, right? Like nuts and seeds have fat. If we're not taking out the fat out of our whole protein rich foods obsessively, we kind of don't even have to like really worry all that much about the fat conversation. But if you leave the fat intact in the whole food, Michelle (08:11) Yeah. Lily (08:16) Those foods are going to be more satiating. They fill you up, they keep you fuller for longer. They help sustain healthier blood sugar levels, and they have a number of nutrients in them that are important for our health, especially our fat-soluble vitamins. Absolutely vital that you have enough of those for fertility. Michelle (08:30) second. Another thing that I do notice actually with a lot of my patients, and I've seen this more recently, it doesn't always happen, but people skipping breakfast. And I wanna talk about that because I know that there's been a lot of research on intermittent fasting and it was beneficial for men and it was researched really for men. It wasn't researched as much for women. And I just, I also know and heard that like cortisol can rise from skipping breakfast and that can throw off hormones. And I wanted to get your take on that and why it's important really to eat breakfast and have protein rich foods, especially in good healthy fats. Lily (09:04) Yeah. Yeah, we do have a section on intermittent fasting in the book because we're asked about it all the time. So ultimately, yeah, most of the research on intermittent fasting has been done in men. There's been a little bit of work in women and in very specific instances, which I can talk about, it can be a tool that's beneficial. But for the most part, intermittent fasting for women raises some red flags. Primary reason is that our menstrual cycle is very sensitive to disruptions in energy intake. And not just energy intake over the whole day, but like even periods of time within the day where your body senses what we'd refer to as low energy availability. So you're not eating for certain periods of time during the day, long spans of time during the day, particularly in those who are exercising a lot. When your body senses that there's not fuel there, the response is a reduction in your hormone levels. And so we see in women who under eat, and we even have like controlled feeding trials on this where they can measure precisely the level of caloric deficit that results in menstrual cycle disturbances. If your calorie intake dips below about 25%, so you're eating a, quarter less food than you, your body actually needs, you see hormonal changes. Um, and within a couple of months that typically results in an issue with the menstrual cycle. Um, oftentimes it starts with like a short luteal phase or premenstrual spotting or more PMS or something like that. Um, and then ends up with ultimately complete anovulation. You stop ovulating and eventually stop cycling altogether. Um, so. you essentially set up a situation of hypothalamic amenorrhea. So if we're restricting our food intake too low, this is going to happen. When most people do intermittent fasting, they're doing it in a way where they skip a meal. Oftentimes it is breakfast. And what we know from the research on skipping breakfast is these people are not making up the caloric deficit at their other meals. So they still over the course of the day, end up eating less food. you couple that with the sort of mindset that most people go into intermittent fasting with. Most people who are attempting intermittent fasting are doing it with the goal of weight loss. And so there's not really an approach of, oh, I'm just gonna eat all the same amount of food in a shorter eating window. It's like, oh no, I'm going to shorten my eating window and also eat less. So the trials that have shown Michelle (11:27) Bye. Lily (11:29) benefits for intermittent fasting for women. And these are very small studies by the way. So, you know, take it for what it is, but these are in women who have polycystic ovarian syndrome. They were overweight or obese. And so, you know, likely have some insulin resistance going on and may benefit their hormonal profile, may actually benefit from a little bit of weight loss. It can benefit from. reducing levels of insulin resistance. The way they implemented intermittent fasting was they consumed all of their meals between 8 a.m. And 4 p.m. They didn't skip meals and they also didn't do it in a caloric deficit They simply ate their food at an early eating window in the day and in that trial they specifically had them continue to consume the same amount of calories. Now Michelle (12:09) Mm-hmm. Lily (12:16) This resulted in dramatic improvement in their PCOS. You saw improvement in their insulin, their blood sugar levels, their androgens, their just the whole hormonal profile also resulted in weight loss. But these are in women who can benefit from a little bit of weight loss. They're specifically not under eating and they're also not skipping breakfast. Breakfast is a time when your body is actually expecting. Michelle (12:35) Right. Lily (12:38) the most amount of food. Like we have trials for women with PCOS that are not intermittent fasting trials where they test out a same diet, but a different like breakdown of when you're having your calories. So they've done like large breakfast, moderate lunch, small dinner, or the reverse, small breakfast, moderate lunch, large dinner. And when you front load your food with a greater caloric intake at breakfast, tapering down over the day, even when the calories are matched, you see greater improvement. in their metabolic health when you're front loading your food. And so this, essentially this intermittent fasting trial kind of did the same thing. Um, by default, by stopping eating at 4 PM, you are tapering down your, you know, caloric intake fairly early in the day. That may not be realistic or achievable for a lot of people, especially if you're a working person or you have, you know, a family and they're eating dinner at like six o'clock and you're missing out. Right. But just to say there's different ways of achieving the same thing without having to cut off your eating window so early. But the greatest importance and what I've seen the most in practice benefiting my clients' metabolic health, whether or not they're trying to conceive or pregnant or postpartum, well whatever, male or female, is getting a sufficient protein-rich breakfast in. really sets the stage for better regulation of your appetite and hunger and fullness cues throughout the day. Less like mindless eating and overeating and just better nutrient intake as a whole. And I think any of this, any of us can very easily experiment with this, right? Notice how you feel on the days when you skip breakfast. Notice how you feel in the days when you have an imbalanced, super high carb breakfast like bagel or cereal or oatmeal and then notice the difference on the days when you're starting your morning with like eggs or maybe like Greek yogurt or cottage cheese like or leftover dinner that has protein in it some protein rich breakfast and notice how you feel through the morning at Your appetite at lunchtime whether you get an afternoon slump It's pretty easy within a couple days to like feel the difference for this. So Michelle (14:19) Right. Lily (14:41) I always am like trying to bring people back to their own body. Like how do you feel when you do this? Because my experience with clients really across the board is most feel better when they're getting that balanced breakfast in versus skipping it. Michelle (14:56) it's true. I love that you kind of get people to tune in with themselves. Like, how does this feel for you? Because ultimately, I think that that's the best experiment you can feel it from the inside out. You can really experience the feeling that it gives you. And also, Ayurvedic medicine, they always talk about Agni, which comes out, it increases, it's your own digestifier and your own digestifier is very much responsive to nature. and when the sun comes out and during the day. And at breakfast and at lunch, our Agni is the highest because of the way the sun is up. And during that time to take advantage of eating, because that's when our bodies are gonna be able to process and digest food the most. And we should actually taper it down towards the end of the day when the sun goes down, our digestive system goes down, our metabolism slows down, and we're ready. Our bodies are preparing for bed. And so it's very intuitive, you know, what you're saying. Lily (15:48) Yeah, it makes perfect sense. Yeah. Michelle (15:50) Yeah, let's talk about maybe the phases, the follicular phase and the luteal phase, anything that you can contribute. I'm sure there's just so much. So I'm going to be asking you questions where I'm sure that you can go really into detail and you're not going to be able to. But just to get like more of a general for people short follicular phase. I know that a lot of attention is not really put on that. Most people are focusing on like luteal phase defect. as far as food, is there anything that you think about when it comes to a short follicular Lily (16:18) I mean the follicular phase is naturally going to be shortening over time as women approach menopause. So even starting in the late 30s, you can women just start sort of prepping for ovulation like earlier, like even maybe when they're you know, towards the end of their last cycle. And so some of that may just be an age thing. I will say, under-eating as a whole does tend to shorten the cycle length, and that would probably also carry over into the follicular phase a little bit, although we usually are focusing on the luteal phase defect, where it's getting shorter, you start having other symptoms of low progesterone levels and all of that. So I would say... take a look at your overall caloric intake. Like are you overdoing it with the exercise and then under fueling with food as a whole? We see lower hormone levels in women who are not only under eating but specifically under eating fat. And... Michelle (17:17) Mm-hmm. Lily (17:18) So if that's going on, there's a possibility that your hormone levels across the board, not just progesterone, but also estrogen could be lower. I mean, we have trials where they have specifically assigned women to a low fat diet for the purpose of lowering estrogen levels because we thought maybe that would be, you know, preventative for estrogen driven breast cancers later in life, right? And it works, you put people on a low. diet their estrogen levels plummet as well as their progesterone. So I would take a look at your macro balance are you being too restrictive on fat? Like I said since fat goes hand-in-hand with protein like other than what you're adding separate to food if you're under eating protein you're probably also under eating more likely to be under eating fat as well because they often come packaged together. Addressing the low fat issue may also involve addressing a low protein intake as a whole. And for those who are really like aware of calories from food, you know that fat is a more concentrated source of calories. So oftentimes for people who are calorie counting and dieting, that's the nutrient that they try to eliminate the most. So I would have some awareness on that. You may want to like dial down. the exercise a little bit as well. Typically, when we think of nutrient changes over the cycle, the luteal phase, it's a little bit mixed in the research, but generally, we expect a slight increase in calorie requirements in the luteal phase. It seems to be that the desire for more food and specific cravings are more common in those who have hormonal issues like low progesterone levels, maybe your body's trying to like make up for it, eat a little more so we can keep that hormone production going. But if that egg was not in the best quality because it wasn't, you were undernourished during the follicular phase, you're gonna have that show up in the luteal phase as well, right? So I think it kind of comes full circle, but I would say focusing on nutrient adequacy. Michelle (18:52) Yeah, right. Lily (19:11) would be where I would target it. While also acknowledging the follicular phase is likely just going to get shorter over time, the closer you get to menopause. And that's not necessarily something you have to like super stress about if everything else seems to be okay. Michelle (19:25) Another thing that I actually noticed as you were talking, it's something that I've noticed like maybe once or twice, like that there's a link for me that I've seen with vegan diets impacting a shorter follicular phase. two cases that I'm kind of like thinking in my mind. And I'm wondering if it's because you're not, you're not really getting the animal fat. Lily (19:35) Mmm. Yeah. Michelle (19:45) you're not getting the same kind of protein as you would from animal protein. It's just, and there's a lot of nutrients that you're also not able to really get with a vegan diet. Lily (19:45) and protein. Yes, and that's definitely an area worth mentioning for sure. We have a whole chapter on vegetarian diets that goes into quite a bit of detail. So vegans in particular tend to eat fewer calories, less protein, and less fat than their omnivorous counterparts. And we do see a significantly higher rate of hypothalamic amenorrhea. in vegetarians and vegans, likely for that reason. There also tends to be, it's not always, but there's a higher prevalence of eating disorders among that group. In a way, it kind of gives you like the perfect cover for your eating disorder. Actually, I was just doing an interview with another podcast recently where the host was talking about that being part of her history, that she did use a vegetarian diet and a vegan diet to sort of cover. for the eating disorder. Oh, I can't have any, is it vegan? Oh no, no thanks, right? Like you could just decline food across the board because it doesn't meet whatever standards or restrictions are part of the diet. So that can be another reason where it's like, yes, there are legitimate concerns about nutrient adequacy, but also some people are doing it as a way to restrict their caloric intake as well, which. regardless of which foods are or are not in your diet, a caloric deficit is gonna create problems. But I do see significantly higher rate of cycle issues in vegetarian and vegan clients. And this is not just my practice, not just your practice. This is like per all the documented research as well. Is that a statistically higher rate on average, even if it's not gonna affect every single person who's on such a diet. Michelle (21:27) Yeah, I see it quite a bit. some people really take it like religiously. It's something that they really feel ethically very connected to. So depending on how people feel, and then some people just don't like the taste of meat in which I'll... offer beef liver pills and things like that to get around that. And we talked about Oregon meats actually last time, and I loved our conversation on that. I would love to get your take again on Oregon meats and why Oregon meats are superior really. And they're so nutrient dense and supportive for overall health, fertility health, Lily (21:44) Yeah. Michelle (22:01) We'd love to get your thoughts on that because I thought that was such an interesting topic we spoke about. Lily (22:03) Sure. Yeah, so I mean, cross-culturally, there has often been an emphasis on including certain nutrient-rich foods in the diet prior to conception and during pregnancy, kind of prioritizing them for the child-bearing future parents in the tribe, male or female. And that's kind of for good reason, if you look at the micronutrient content of them. Each organ has different nutrients that are particularly high in this organ versus that organ. Liver tends to be the most nutrient dense. There's a few exceptions for some micronutrients that are higher in like heart or spleen or kidney or some of these other organs. They certainly have their place, even if they're maybe less commonly consumed in our current Western diet. But we see... vastly higher rates of things like higher levels of nutrients like vitamin b12, choline, iron, zinc, vitamin a certainly and liver, and many different minerals in there as well. Both the big ones like iron and zinc and some of the like minerals we need in slightly smaller amounts like selenium and whatnot copper. So Those foods, even when eaten in fairly small quantities, kind of act as like, uh, almost like a way to fortify your diet with extra nutrients. So if anybody has ever done like a cow share, for example, where you're buying the meat from a whole animal, you can also choose to get organs, which I always do, but you get, you know, hundreds of pounds of meat, maybe from a single cow and you get one liver, right? Which might be like, Michelle (23:35) Mm-hmm. Lily (23:36) the biggest liver I've ever gotten was like eight pounds. Must have been a big cow. But like you you're not getting like a huge amount relative to the rest of the meat that you're getting, but by including it in your diet, it doesn't have to be every day. We're talking maybe once a week or once every other week. Having a little bit of organ meats in there really does fortify your diet with a lot of these nutrients that are in lesser quantities in muscle meat. So B12 for example, it's like 200 times more concentrated in organ meats than it is in muscle meats. If you were to calculate out the vitamin A for liver versus muscle meats, it'd be crazy because liver is the by far the richest source of vitamin A in our diets, like bar none. So these nutrients are really vitally important to the processes of ovulation, for the formation of sperm, for the liver and organ meats have cholesterol in them and all of our steroid hormones are built on a backbone of cholesterol. So they're giving us kind of the raw materials necessary for our fertility. So huge fan of including some organ meats every once in a while in your diet. I have to give those qualifiers because sometimes when people hear me talking about organ meats, they think that I'm eating liver like three times a day or something. And I'm like, no, maybe like once a week, but. Michelle (24:49) Yeah. Lily (24:49) having it as part of the diet and it often does need to be specifically something you focus on because many of us do not have the taste for including liver. It's something we have to go out of our way to find because oftentimes it's not at the regular grocery store. Like I talk about it because of its nutrient density but I also have to like you know clarify quantity and frequency of consumption. So for those who do not want to or don't have access to or do not enjoy the flavor of eating liver or organ meats, there are yes, desiccated organ supplements on the market. And yes, I've seen those provide huge benefits for clients who aren't consuming animal foods otherwise. That and also shellfish, like oysters or clams are very nutrient dense. And sometimes I'll have vegan clients who are willing to consume those, but not organ meats, right? So whatever gets it, gets the nutrients down the hatches, you know, whatever works. Michelle (25:40) Yeah, for sure. And so I actually wanted to talk about two common concerns that people have with liver. They think that because it cleans out toxins, that And then also the vitamin A content, because they think about vitamin A toxicity, which is different in food versus just taking vitamin A pills. So I'd love your take on that. Lily (26:01) Yes, so yeah, we'll cover the toxin conversation. People are often very concerned about the toxin levels in liver. If you look at the data we have on like analyzing the levels of toxins and heavy metals and other things in different parts of an animal, the liver is not particularly higher in those contaminants than other parts of the animal. So I always find it kind of weird that people want to zero in on I'm not going to eat that because it might be higher in contaminants when it doesn't even hold true. But be the quantity of liver you're consuming relative to muscle meats. You'd probably be getting more toxins overall from the muscle meats, but also you can find a reason to make any food like evil, right? You can find a reason to avoid anything. We're not gonna eat rice because the arsenic. We're not gonna have Michelle (26:35) Yeah, but also... It's true. Lily (26:49) I don't know, we're not going to have shellfish because it might have cadmium or lead, even though you don't absorb most of what's in there. We're not going to have fish because of mercury, likewise, you don't absorb most of what's in there. If you really want to take it to that level, you are going to find something wrong with every single food. With liver though, it functions more as a... Michelle (27:06) It's true. Lily (27:10) It's somewhat of a filter because it filters your blood, of course. It's not holding on to all the toxins, but it also transforms the toxins. But a lot of what the liver does is there's different stages of detoxification and part of what it does is attach molecules and things to the toxins to make them easier for your body to excrete. and then they're excreted in the bile, or maybe they go through the bloodstream and are excreted through the kidneys, or maybe you sweat and you sweat it out through your skin, or maybe it grows out through your hair, but it's not holding onto the toxins. It's trying to make them less toxic so your body can excrete them through your pathways of detoxification. So I think it's silly to think of the liver as a storehouse of toxins that actually isn't really true. It is a storehouse of nutrients Michelle (27:43) Right. Lily (27:57) process of all the things the liver does, detoxification is just one of many, many functions. Those are highly nutrient dependent activities. So it does hold on to nutrients because you need these nutrients as cofactors for all these different liver enzymes that are actively doing so many jobs to keep you alive. So if anything the liver is a storehouse of nutrients, not toxins. is a storehouse for vitamin A. It really is. It has more vitamin A than any other food and it is also a storehouse for a number of other nutrients as well. Whether the vitamin A and liver is particularly toxic, A, I think we have to be speaking about the quantity. As I said, I'm not recommending people consume massive quantities of liver. I'm talking three to six ounces a week, which provides less vitamin A than the so-called tolerable upper limit. The concerns over toxicity I think are twofold. A lot of people are worried about pregnancy specifically. You have to understand the studies they use to show that an intake of vitamin A was potentially toxic to the fetus was from synthetic supplemental vitamin A. Michelle (29:03) Right. Lily (29:03) So you can measure the metabolites in the blood after consuming vitamin A from different sources and you do not see the spikes in the harmful metabolites of vitamin A to the same degree from whole food sources like liver as you do from isolated synthetic vitamin A supplements. That said, I still don't recommend people consume so much liver that you're exceeding the tolerable upper limit, which again, three to six ounces of liver a week is perfectly fine. There's a caveat, if you're up in the Arctic, don't eat polar bear liver because it is ridiculously concentrated in vitamin A. You can legitimately get toxicity, but you're not getting that level of vitamin A from beef liver, chicken liver, something like that. The case studies we have on vitamin A toxicity, which by the way usually self-resolves anyways, even if it is encountered, but nonetheless. These are in people... Michelle (29:36) Mm-hmm. Right. Lily (29:53) I haven't seen one documented other than there was one case study in small children who were given like four ounces of chicken liver every day. They're infants. That's too much. That's too much liver. So yeah, exactly. I'm like what? But that again in that case study that self-resolved on its own. All the other case studies I've seen Michelle (30:04) Yeah, it's too much. It's like, how do they even eat it? Lily (30:15) Um, we're either there's two I can think of that were polar bear liver. I've never seen one from chicken or beef liver. All the rest of the case studies on vitamin A toxicity are synthetic supplemental vitamin A, and they're usually people taking mega doses, like hundreds of thousands of I use a vitamin A per day daily for years, which if you equate that to liver would be like. Multiple pounds of liver per day, every single day for years, like Michelle (30:37) That's crazy. Wow. Yeah, yeah, yeah. Right. Lily (30:39) something that you simply don't see in clinical practice. So I do recommend that people do keep an eye on their total vitamin A intake if they're big fans of liver or if they're doing liver capsules. And particularly if you're also taking like a multivitamin or a prenatal vitamin that has that preformed vitamin A, we don't wanna go crazy overboard. I used to never need to give this caveat, but now that everybody's talking about organ needs and so many people are supplementing, I have had people come in where they're taking like a multi-organ supplement, a liver, desiccated liver supplement, and they're taking like the highest potency prenatal on the market that already has a decent amount of vitamin A. And I'm like, okay, well, we can probably cool it on some of these. Like the risk of overtly something terrible happening is quite slim. Michelle (31:19) Right. Somewhere. Lily (31:25) But I do think we're at a point where I'm like, okay, if you're consuming more than about the equivalent of like six ounces of liver per week, you just, your body simply doesn't need that much. And so if you have a case like that where they're taking in liver in many different forms plus like a high potency multivitamin, or even if they're taking, you know, a separate all that much all on top of it. I still out of an abundance of caution keep my recommended intake below the tolerable upper limit. Even if you know that level it's set very conservatively but again from the most conservative angle I try to keep it under the tolerable upper limit just to be safe. Michelle (32:03) Yes. And then also, yeah, I mean, a lot of this is obviously common sense because like, people aren't going to eat like ridiculous amounts or shouldn't, you know, eat ridiculous amounts of anything. So it's just a matter of really balancing things out. As far as beef versus chicken liver, what are your thoughts on that? Lily (32:20) I mean, both are nutrient dense. There's a handful of things that may be higher in chicken liver off the top of my head without looking at a nutrient analysis. And I'm pretty sure I have a table of this in my article on liver and organ meats on my website. But off the top of my head, chicken liver is higher in folate. It's a little higher in iron. Beef liver is a little higher in... vitamin A, for example. So you'll see slight differences in the nutritional profile. They're both ridiculously nutrient dense. You will certainly have differences in the flavor. So the liver from larger animals has a richer flavor than the liver from smaller animals like chickens. So, and also the texture is different. The liver from beef is a little more tough. versus the liver from chicken tends to be very tender. So if somebody's brand new to consuming liver, I'm probably gonna have them opt for something like chicken liver and maybe try beef liver a little later. Some of it has to do with how you cook it too. If you look at like traditional recipes for cooking liver, it's usually kind of marinated or soaked in something for a while ahead of time that eases the flavor a bit. And then it is... pan-fried at a kind of slightly lower temp and for a short period of time. You're not overcooking it. The longer you cook it, the more that kind of metallic iron flavor comes out and the tougher that it gets. So that's my only caveat there. I think chicken liver is an easier gateway into consuming liver than beef. But you could see what... Michelle (33:36) Bye. Lily (33:50) what you like. You can also do, you mentioned talking about other organ meats. So heart is a very, a much more mild flavor than liver. I mean, liver has a stronger, more metallic kind of flavor. So you can also do heart. Chicken hearts are like a delicacy in many countries and South America, they're often like skewered and grilled over the fire. You can even do like I have a recipe for Thai chili beef heart skewers on my website. Those can be like It's much larger, so it has to be sliced up and everything, but when it's marinated, I mean, it's like a more flavorful steak. Heart is a very lean meat because it's a muscle, so it really has more of a steak kind of texture. You can slow cook it. We have like a beef heart stew recipe in real food for fertility that you could make. So that's an easier one for people to try. Michelle (34:33) Mm-hmm. Lily (34:34) even though the nutritional profile is a little different. Like there's no concerns about the vitamin A and in beef heart, for example, but it's really rich in iron, it's rich in CoQ10, it's rich in zinc, B12, many other things. It's like a slightly more robust, very lean muscle meat kind of a flavor. Michelle (34:39) Bye. of course I could pick your brain for hours because you're just so well fed for information. I really enjoy talking to you. But I know that you have to go. And I would love for you to share with the listeners how they can find you and how they can find food for fertility. And basically, do you work with people online or do you offer any? Lily (35:10) I'm not taking one-on-one clients anymore, but I do have referrals to the practitioners I train via the Institute for prenatal nutrition, many of which also specialize in fertility as well. But yeah, you can find me on my website, lillynicholsrdn.com. As I mentioned, there's, you know, when I refer to articles, those are all on my website. There's no paywall on my website. So just click the blog tab. You can search in the search bar for whatever search terms there are. hundreds of articles up there. So definitely take advantage of that free resource. As for my books, you can find those on my site as well. Just go to the Books tab. Real Food for Fertility has its own website, real You can download the first chapter for free from that site and also check out the book on Amazon. And as far as social media, you can find me at Lily Nichols RDN over on Instagram. That's usually where I am. I'm also on the other platforms. I just don't spend a whole lot of my time on social media as a whole these days. Michelle (36:08) Awesome. Well, Lily, it was such a pleasure talking to you. I love all of the information you shared, and I know that it's going to be so valuable. And you guys got to check out the book. It's amazing, Real Food for Fertility. Thank you so for coming on today. Lily (36:22) Thank you for having me.