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Friend and fellow dietitian, Lily Nichols is back to catch us up on what she’s been up to and fill us in on the latest in nutrition research. Since our first episode together, Lily has been busy advocating for updated dietary guidelines, especially as they relate to pregnancy and postpartum. She is the author of two books: Real Food for Pregnancy and Real Food for Gestational Diabetes. Lily is also a co-founder of Women’s Health Nutrition Academy, an organization dedicated to providing continuing education in women’s health.
In this episode, Lily and I take a deep dive into all things protein. There is a long-held belief in dietetics that as long as you are getting enough total protein in your diet then your amino acid requirements will be met too. Lily sets the record straight by pointing to new evidence that shows this simply isn’t true. In fact, the need for the full array of amino acids for children is so important, that deficiencies during certain development periods can cause irreversible problems.
There’s so much to cover in this episode that we actually ran out of time so stay tuned as I’m sure to have Lily on the show again.
Even if you are not pregnant or considering getting pregnant, you’re sure to find something interesting in this episode. Listen in to hear us rant about the need for protein and so much more including:
- Why the RDA (recommended dietary allowance) for protein needs an update
- All things B12
- Cheap nutrient-dense food options
- The need for culturally appropriate nutrition recommendations
- A thought experiment about the environmental cost of being unhealthy
- Why meat does not have to be grass-fed to be healthy
- Why nutrition professionals need real world perspective
- Our personal results from continuous glucose monitoring and why everyone should try it
Resources:
Women’s Health Nutrition Academy
Research Paper: Animal Source Foods, Rich in Amino Acids Important for Linear Growth and Development of Young Children in Low- and Middle-Income Countries
US News and World Report “Best” Diets
Lily’s books:
Lily’s Articles
- Protein Requirements in Pregnancy are Higher Than Previously Thought
- Vegetarian Diet in Pregnancy: Nutrients of Concern
- Choline in Pregnancy: Folate’s Long-Lost Cousin
- Budget-Friendly Prenatal Nutrition Following Real Food for Pregnancy Principles
- Why Prenatal Nutrition Guidelines Needs to be Updated
- Liver and Organ Meat: Nutritional Benefits & How to Make it Palatable
Connect with Lily:
Website: Lily Nichols, RDN
Instagram: @lilynicholsrdn
Twitter: @LilyNicholsRDN
Facebook: Lily Nichols, RDN
LinkedIn: Lily Nichols, RDN
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Episode Credits:
Thank you to all who’ve made this show possible. Our hosts are Diana Rodgers and James Connelly. Our producer is Emily Soape. And of course, we are grateful for our sponsors, Patreon supporters, and listeners.
This episode was brought to you by my new Sustainavore Course! Are you confused about which diet is best for your health and the planet? Are you feeling frustrated with quick-fix diets and conflicting nutrition information? Check out Sustainavore. You will learn how to feel confidant that the food you’re buying is the right choice for your health and the environment. The course includes over 7 hours of video instruction from me and 60 daily emails full of tips, tricks, and motivation to keep you going – plus lots of bonus material. For a limited time, I am offering special discount pricing so head over to The Sustainavore Course now!
This episode is also being sponsored by Levels, a continuous glucose monitor that gives you individualized insight into your metabolism. This is a tool I personally use and recommend to people I work with. It’s helped me figure out what foods spike my blood sugar and which ones keep me level. I can also see how certain tricks like walks after a meal affect my body. Right now Levels has a waiting list of over 150,000 but they are allowing my listeners to skip the line if you go to sustainabledish.com/levels and sign up. Try it out to see how the food you eat affects your metabolism. This is a must-have tool for anyone interested in personalizing their nutrition.
Quotes:
“Not only are we telling people that all of these nutrients are unsustainable, unethical, and unhealthy, but then we also have a food justice issue with telling people that their traditional culturally appropriate foods are actually unethical because us dietitians don’t like the idea of animals being slaughtered.” – Diana Rodgers, RD
“Essentially, your body actually requires a full array of amino acids to be functioning properly, especially to be functioning optimally. Can you survive on a protein-deficient, amino acid-deficient diet? Yes, but body systems start to break down and you start to have metabolic dysfunction.” – Lily Nichols, RD
“At the end of the day, meat is a nutrient-dense food, end of story, wherever it is sourced from.” – Lily Nichols, RD
“We would have such a nicer society of calm people who weren’t honking their horns and trying to rip someone’s head off if they were just blood sugar regulated people.” – Diana Rodgers, RD
“Fix breakfast, and then almost everything else falls into place. And the number one thing that is usually missing from people’s breakfast is sufficient amounts of protein.” – Lily Nichols, RD
Transcript:
(Intro) Diana Rodgers, RD
Welcome to the Sustainable Dish Podcast. I’m Diana Rodgers, a real food registered dietitian, author, and sustainability advocate. I co-host this podcast with James Connelly who was a producer on my film Sacred Cow. I also founded the Global Food Justice Alliance and initiative advocating for the inclusion of animal source foods like meat, dairy, and eggs for a more nutritious, sustainable, and equitable worldwide food system. You can check it out and join me at global food justice.org. Thanks again for listening. And now onto our show.
(Ad for The Sustainavore Course) Diana Rodgers, RD
Hi Everyone. I wanted to let you know that I am launching a really cool new nutrition and sustainable eating course. I’m calling it Sustainavore, and it is going to teach you how to feel confidant that the food you’re buying is the right choice for your health and the environment. You’ll learn the root cause of why you’re so sick, which foods to optimize and which to avoid, how to optimize your protein intake to balance your blood sugar, and which carbs and fat are ideal. I’ll also share my favorite tools for tracking your progress, and you’ll get 60 days full of helpful emails to keep you on track. So if you’re looking to make a change in the way you eat but have been let down in the past give Sustainavore a try. Head over to Sustainavore.com to learn more. Check out all of the cook bonuses I am including and take advantage of the special discount pricing I’m offering right now to my followers.
Diana Rodgers, RD
Welcome back to the podcast everybody I have with me a returning friend and colleague, Lily Nichols, dietitian who focuses on pregnancy and optimal health. I refer your book to everyone who comes to me who is pregnant. You know a lot about blood sugar control for gestational diabetes. So welcome back.
Lily Nichols, RD
Thanks for having me, Diana.
Diana Rodgers, RD
So, what’s new in your world? I know I’ve had you on before we may be repeating things, but I’ll bet it’s been a while. And so yeah, what’s new?
Lily Nichols, RD
Yeah, well, I mean, I feel like I’m just hammering away at the same stuff that I’ve been doing for years and years, which is calling out the areas in the dietary guidelines that could use an update, especially in regards to pregnancy, fertility, postpartum breastfeeding, and just continuing to put out information on that. So what have I been doing? I don’t know. You know, I have the Women’s Health Nutrition Academy that I run with fellow dietitian and friend of yours as well, Ayla Barmmer. So we put out a webinar last fall on folate metabolism and how that relates to pregnancy and fertility, kind of unraveling all of the controversy on forms of folate and if folic acid is better, or if it’s harmful, and all of that. So I certainly have like the, you know, professional training, like on one hand, and then just keeping up with writing for, you know, the general public, on my blog, and Instagram on new research that is coming out and making us rethink a lot of things that we previously thought. Like, what we think about protein and so-called nonessential amino acids, which I think we’ll get into today.
Diana Rodgers, RD
Yeah, there’s a bunch of stuff I’d love to chat with you about. And so let’s, let’s talk about protein. There was a paper that came out recently, and it’s made me… it’s what made me reach out to you. Talking about how in many places, especially low and middle-income countries, children may be getting the protein, the total protein they need, but not all the essential amino acids that they need. And so they’re still having growth issues and learning issues, which in many cases are irreversible. And so it’s a lot of what I talk about on the Global Food Justice channel, is just making sure that people have access to nutrient-dense foods. So let’s talk about the specific needs of amino acids and how that’s different from total protein. A lot of people don’t know this.
Lily Nichols, RD
Yeah, so it’s actually kind of confusing. And some of the research that’s come out now is making us question everything that we thought we knew about these so-called essential amino acids and the nonessential amino acids. So in… certainly we have needs for a specific amount of protein. I know you’ve written about this in Sacred Cow. So there’s like the RDA, which is based on a gram per kilogram of body weight.
Diana Rodgers, RD
Which is way too low and based on really bad research.
Lily Nichols, RD
Oh yeah. It’s set at like a very bare minimum level. And the RDA needs to be completely revamped for pregnancy as well as postpartum by the way, and we can talk about some of that research if you’d like. But there’s also another way of looking at protein requirements, which is the macronutrient distribution range. And so you can get anywhere from like 10 to 35% of your calories for protein like that is bonafide approved by the dietary guidelines. And yet, what we focus on is the RDA, which is maybe at best, like the 10% of calories range.
Diana Rodgers, RD
Yeah, I did that calculation in Sacred Cow. And so um, you know, so the average person, I think, when I looked at it is only getting about 16% of their calories from protein. And the AMDR is 10 to 35%. And when you calculate out the RDA, which is .8 grams per kilogram of body weight, and you look at the average weight of women and men in the US, the RDA is actually less than 10% of total calories.
Lily Nichols, RD
It’s way too low. And then you look at the average protein intake among vegetarians and vegans, and it tends to be 11 to 12% of calories. So it’s really quite low. And this is US ranges. So arguably, probably be less in places with poorer access and distribution of food. So first of all, the RDA is like bare minimum, so there’s like a need for total protein, but there’s also individual amino acids that we also need. Some of them we call essential. Some of them we call nonessential. The ones that are essential our bodies cannot create by themselves, the nonessential ones, supposedly, as long as we’re getting a sufficient amount of total protein we can create as much of the nonessential amino acids as we need for everything to work properly in our body. That actually has turned out to not be true. So there is actually no scientific basis for the concept of nonessential amino acids. I write about this research in my protein requirements and pregnancy blog post. Essentially, your body actually requires a full array of amino acids to be functioning properly, especially to be functioning optimally. Can you survive on a protein-deficient, amino acid-deficient diet? Yes, but body systems start to break down and you start to have metabolic dysfunction, you start to have disease. And you see people’s health decline rather rapidly. When you go to the children side of things and like optimal development, what I think is hard to tease out… So our… the way that our nutrition research is set up is very reductionist, where we’re trying to look at these individual components and pull it out from the overall diet. So we can reduce confounders and come to some kind of exciting conclusion with good statistics that we can spit out to the media, right, but protein intake and amino acid intake is very much wrapped in and micronutrient intake as well. So if you have people eating lower protein diets, especially low-quality protein diets, meaning mostly plant proteins, you’re also automatically unless there’s supplementation happening, going to be a situation of micronutrient deficiency, as well. So you’re going to have low intakes of choline, B12, iron, zinc, copper, vitamin A, in the retinol form, I could go on and on. But those are some of the top ones that you’re also going to be low in that also play really vital roles in growth and development, brain development. And some of those specific time periods are literally irreversible. I mean, there are specific times in our development, you could start all the way back from preconception then through pregnancy, and particularly through the first two years of life where there are processes happening that are not going to happen again in the future. And if you miss that window of opportunity to provide the nutrients needed for those processes, you end up with lifelong deficits. We see this with choline inadequacy. Low choline intakes permanently affects brain and vision development, and can and you can actually predict like memory problems in later life with low choline intake from pregnancy and infancy. So our most choline-rich foods or animal foods, especially liver and organ meats and egg yolks. Yeah, you get a little bit in your plant foods, but you do the calculations. I mean, a single egg yolk has the same amount of choline as two cups of cooked beans. Okay, it’s easy to get two or even three eggs down the hatch in the morning, you’ve pretty much met your choline requirements for the day if we’re assuming the recommended intake is optimal, which it’s not. But still, as a benchmark, that’s a good place to at least start. Most people don’t even reach that. 94% of women don’t even reach that. So if you get three eggs in, you’re good, right? But are you going to be able to fit six cups of beans in during the day? You’re not going to have room for any other food and you’re gonna end up with other nutritional as well as digestive problems if that’s what you’re doing to meet your choline requirements. So it’s just a matter of what happens when people eat different foods, you know, like half the choline intake is from egg yolks specifically. So you take out that food, you end up with other problems.
Diana Rodgers, RD
You know, and choline is one of the things that we never hear about. I don’t remember really learning about it much when I went through my RD training. We don’t hear about it, it’s you know… you do hear about iron and B12 as it relates to vegan and vegetarian diets. And most vegans and vegetarians, at least are aware that they might need to supplement a B12. Although they say that it just comes from soil and so it’s not really coming from…
Lily Nichols, RD
Or algae which is also a false statement.
Diana Rodgers, RD
Let’s talk about that and let’s talk about the soil idea and how like when you eat it in an animal form. I don’t know why people comment often on my social media that B12 is only injected in animals and it comes from soil and what? Do you know where that comes from?.
Lily Nichols, RD
I am also perplexed by this. So I think like avoidance of super severe B12 deficiency say in areas where vegetarianism is quite common and veganism is quite common, like in areas of India, which actually is more so vegetarian than it is vegan, it’s kind of newfangled that more and more people are vegan in India. I’ve been reading up a lot on this. If you have ruminant animals… if you have like a truly regenerative system where there’s ruminant animals and chickens and stuff pooping on your fields, then you’re going to have some B12 coming in from the animal manure and probably a little bit from the microbes in the soil. So if things are not like super well cleaned, then you’ll get a little bit, maybe enough to prevent a severe deficiency problem. Arguably, I don’t know if that’s actually the case. But India has some of the highest intakes of dairy products per capita of anywhere on the planet. The majority of vegetarians in India are not vegan, so they’re getting quite a bit of B12 from their dairy products. And if they eggs, their eggs as well. The other one I hear is the seaweed. And I’ve looked into this a lot too, it does seem like there’s certain types of seaweed that’ll have some B12. But the majority of the B12, that’s in these different types of seaweed and algae are B12 analogs. So they structurally look very similar to B12. And when we had like poor laboratory analyses of things we couldn’t look quite as closely at the structure. They thought that they were really high in B12. But it turns out that they’re actually high in B12 analogs. And B12 analogs can block your uptake of vitamin B12. So your body thinks it’s actual B12. But it doesn’t function like B12. And it actually worsens B12 deficiency. So I was reading a study recently that looked at rates of B12 deficiency and vegetarians and vegans dependent on like, where they were getting their B12. So some people were supplementing, some people are doing fortified foods, some people were relying entirely on seaweed, fermented foods, I think it was mostly seaweed and fermented foods, thinking that those would be sources. So most of them… all of them were B12. deficient minus the people supplementing. However, the ones with the most severe B12 deficiency were the ones who are relying on fermented foods like kombucha and kimchi, and algae and seaweed as what they thought was a good source of B12. It’s just, it’s just simply not true.
Diana Rodgers, RD
It’s amazing, because in other countries, like Germany, I’m trying to remember the other countries and you probably know them, the government does not recommend a vegan or vegetarian diet for anyone other than a healthy adult. But then you always hear people saying, well, the Academy of Nutrition and Dietetics, says a properly planned vegan or vegetarian diet is perfectly adequate, you know, for all stages of life here, with not much other guidance on how you need to supplement and be so so, so careful.
Lily Nichols, RD
And have you looked… I don’t know if you’ve looked at those practice papers. So I’ve certainly ripped apart the practice paper on that with regards to pregnancy. But I recently pulled up the general vegetarian diets for like all life stages practice paper. And first of all, there are very few references. A lot of nutrients of concern are not specifically called out. I’d have to pull it up to look at which ones they do call out. They call out some of the important ones. They call out like iron and zinc and DHA, calcium, vitamin D. Vitamin D is ironic because it’s like a concern for everybody. And most of your intake is going to be sun exposure. So that one’s kind of silly, but they do point out some important ones, but they also leave out a lot of other ones that really should have made their list. I’m trying to remember I don’t think they call out choline. I think they mentioned iodine. They mentioned that there’s higher rates of iodine deficiency, but then they don’t give specific enough guidance on how to avoid these things. So all of the like conclusions of well, a well planned vegetarian or vegan diet can meet your needs. I have never seen a fully nutrient-replete sample meal plan that’s vegetarian or vegan without any supplements or fortified foods that meets all the needs and does so better than a similar omnivorous sample meal plan. Now, their omnivorous sample meal plan is also pretty terrible. So when I’m talking about like an optimal omnivorous diet, I mean, I’m talking about not one that’s endorsed by a dietetics organization. But I haven’t seen that done. I’ve never seen a sample vegan meal plan that provides sufficient amounts of choline, even from some of these bigger organizations like the Vegetarian Research Group, think they’re called VRG. Nope, their meal plans fall short on choline as well. And so they might call out the nutrients of concern, but they actually don’t show you in real-world food terms how you actually accomplish this so-called well-balanced meal plan. It’s similar with the protein research, I was reading through an article that was suggesting that you can meet all the amino acid needs on a vegetarian diet without any problem. Ironically, the author was a consultant for a plant protein and vegetable oil company or organization. And having done a lot of reading on these so-called nonessential amino acids like carnitine, and creatine and taurine and whatnot, I was like, let me just… I read through the whole article. And I was like, I don’t recall seeing him talk about carnitine, or creatine, or carnosine, or any of these other so-called nonessential ones that actually have really important roles for growth and development, and particularly during times of stress, like during pregnancy or postpartum recovery. So I searched the document for all these amino acids, not a single mention of any of these. So if all of our like basis of this is adequate, is like wrong, because that was built on a really shaky foundation, to begin with, then like, we need to go back and really critically analyze, are you going to be getting… like, what are you going to do? How is your body going to cope? If you don’t have enough glycine? Why do vegetarians and vegans have higher markers of glycine insufficiency that ultimately is going to affect many different parts of your body, the least of which is your liver function, because you need glycine to make glutathione? And clearly, even if they’re getting so-called enough protein, they have markers of lysine insufficiency. So what’s going on there? I mean, you can start to poke holes that like so many different places in this argument, and I’ve done so in many different places. But it’s like a very shaky foundation, I’ll just say that much.
Diana Rodgers, RD
And I think when I looked at the authors of the position paper from the Academy, every single one of them was either a religious, vegetarian or a practicing vegan. So why isn’t? Why is the science so bad? Proper development during childhood is a predictor of GDP. Like why isn’t anyone looking at this from a like, okay, we need optimal children’s health in order to have healthy functioning humans that can withstand a virus or something like that?
Lily Nichols, RD
Right, right. It’s a very good question. I don’t know, I think a lot of things in the nutrition and dietetics space are built on assumptions. And you start looking… once you start looking at like, the original assumptions, instead of getting lost in the research that’s just talking heads. You know, actually, it’s fine, because this is this and this, and they’re like, wait, what’s the basis for us calling these nonessential amino acids? Does that actually stand? Then you kind of see underneath all of the noise. Who’s to say what the reason is behind any of it? I don’t know, maybe people just aren’t asking the right questions. I think a lot of researchers are very, like siloed in their individual area of expertise, and then they don’t branch out into these other areas of expertise. But even like a good example is taurine, and I’ve written about this one. This is a so-called nonessential amino acid. It is only found in animal foods. They’ve done lots of different analyses on plant foods, and there’s literally none detected in your plant foods. So it’s mostly meat and seafood is going to be your top sources of taurine. But almost all animal foods will have a little. It turns out that taurine is really vital to bone development. And the assumption that your body can make enough taurine on its own is questionable because guess what’s a cofactor for your liver to produce taurine? Vitamin B12. So if you have vitamin B12 deficiency, on top of not any dietary taurine coming in, which would be the case if you’re vegan. You have really serious problems. So I think this stuff is like very tip of the iceberg. Maybe we see it a little more like globally, you might see like lower growth, shorter stature, delays in hitting developmental milestones, but to know that this could be permanently affecting their bone development is kind of a big deal. And then again, it comes down to teasing out what is the causative factor? Well, all of your taurine-rich foods are vitamin B12 rich foods, which are your choline-rich foods, which are your iron and zinc-rich foods, which are your vitamin A-rich foods. They’re all connected because it’s all in the same foods. And what’s crazy about this to me and talking about this from like a food justice standpoint, is you don’t have to be like a full-on carnivore to get access to some of these nutrients if you focus on some of the most nutrient-dense animal foods even if your diet is relatively low in animal foods, but you have some type of bivalve shellfish coming in like oysters clams or mussels, which are both inexpensive, readily available in coastal regions. They can be purchased in cans, like smoked oysters, for example. And they’re still nutrient-dense. They’re also extremely environmentally friendly, very sustainable. You’re going to be hitting your marks for B12, iron, zinc, iodine, selenium. You’re also getting some choline, some DHA in there. You’re getting a ton of nutrients for like a really small dosage of animal foods. Likewise, same goes for liver and other organ meats. Really, really nutrient-dense, if you could just fit in a tiny bit of liver a week. Even if a kid is getting like an ounce of liver a week, that is huge for supplying them with nutrients required for their optimal growth and development. And liver is very inexpensive, relative to other animal foods. So you can almost think of it like a you know, sort of like a vitamin supplement in a way.
Diana Rodgers, RD
Speaking of children… (sounds of kid noises in the background). Yeah, I mean, other than Serenity Kids, which is an awesome baby food company, I don’t see any education or any other like food companies throwing a little liver into something and promoting that as something healthy for babies. Or even putting a little clam… I mean, oysters, smoked oysters might be kind of intense to somebody who doesn’t normally eat them. But certainly, clam chowder is awesome. And you can’t really taste the clams very much in it.
Lily Nichols, RD
Yeah, clam chowder is like a really easy one, you know, you throw in like potato and some clams and some cream or milk and salt and pepper, like it doesn’t take a lot to make a really delicious clam chowder. Highly, highly nutrient-dense. Likewise, with liver, you know, I do like hidden liver recipes, where I’ll make like a liver pate or pureed liver and then add it to ground meat recipes. So you could make a pretty and I actually do this cost breakdown in a blog post I wrote on budget-friendly prenatal nutrition. There is a recipe, a very basic recipe for chili. I didn’t put hidden liver in there, but you could – showing the cost breakdown per ounce. I should have put a nutrient analysis because it hit the mark. It met like a quarter or more of the daily value for an adult in a single serving for like probably six or eight different nutrients. And so it doesn’t have to cost a lot. That’s also like the other point. I think people think that like, you know, any animal foods are going to be expensive. And it depends on the type of animal foods. And I think our dietetics system has done a really poor job of creating like culturally appropriate nutrient recommendations because in a lot of these cultures, nonwestern, non-American cultures because I’ve worked with a lot of these people who are new immigrants all over the world, they eat nose to tail naturally. That is just the way they eat. If you’re going to have chicken, you just buy a whole chicken, you make use of all the organs. You save all the bones and skin and other bits to make broth, that’s normal. You get the tripe to make soup, you get the liver to make pate you use the tongue and turn that into tacos or some other type of dish. Like they use all parts of the animal naturally. And when we tell them that you can’t eat those because they’re high in cholesterol and saturated fat, we have done such a disservice. And if people are actually… this is what really irks me. If we really had dietitians, like running nutrient analyses like micronutrient analyses on people’s diets, you would see that the diet quality declined significantly when people take out these foods and replace them with – what does everyone recommend? Grains.
Diana Rodgers, RD
Or chicken, I mean, even just plain chicken meat is one of the lowest “good” sources of protein you can get compared to red meat and seafood and the organ meats and everything. So we’ve got a food justice dilemma, not only with telling people that all of these nutrients are unsustainable, unethical, and unhealthy. But then we also have a food justice issue with telling people that their traditional culturally appropriate foods are actually unethical because us dietitians don’t like the idea of animals being slaughtered. Yeah, which is really what it comes down to and they’re refusing to actually do a nutrient analysis on things.
Lily Nichols, RD
That’s true or the concern about the saturated fat and cholesterol that has been so hammered in but you know, I remember back to when I was in dietetic school and yeah, this was circa like early 2000s. So I guess it’s kind of a while ago, I remember feeling like the education was… I kept like… I felt like there was a lot of meat. You know, I didn’t grow up eating a whole lot of meat. It’s been a transition to me to be more of an omnivore on the carnivore side, although I’m definitely not a carnivore. But you know, omnivore, for sure. I remember thinking like, there’s like always beef at dinner. And there’s these… like, I felt like it was actually like meat was almost always a part of the meal plans. And now when I hear from younger dietitians, and dietetic interns, the whole message has really shifted to be all plant-based. And I just keep wondering, like, what happened to the discussion about amino acids. You go to some of these amino acid researchers, and those are the ones who I really think get it more than anybody else. Because they’re not picking from this is what we always do. They’re like, well, we uncovered this new role for proline and XYZ, and oh, we had no idea that taurine creation is, you know, rate limited by vitamin B12 deficiency like that’s relatively new in the past five or so years. Those are the ones who really kind of see a bigger picture of this whole situation. And then the experts in specific micronutrients of concern like the choline, researchers have been calling out for quite a while that if our guidelines are so anti-cholesterol, dietary cholesterol, we’re going to have a choline deficiency problem. In fact, we already do have a widespread choline deficiency problem. And so we do need to make the case for having choline-rich foods in the diet, which includes, especially your egg yolks, your organ meats, your dairy products, all of your other animal products. And so that’s where it’s like, people start kind of butting heads, I think, in their individual areas of expertise, because then you have the people focused on I don’t know, the greenhouse gases. And if you are only looking at one model of greenhouse measuring greenhouse gases, you might come to the conclusion that we should not produce or eat any animal foods whatsoever. And that butts heads against the people saying no, those provide essential nutrients and human health will decline if we adopt that.
Diana Rodgers, RD
Yeah, yeah. And actually, shellfish, mussels, in particular, are huge methane emitters.
Lily Nichols, RD
Hmm, interesting.
Diana Rodgers, RD
But no one’s… because I think they’re so healthy, and they don’t have big brown eyes. And they’re low in cholesterol. They’re less vilified than cattle, even though I think, per calorie. They’re much higher producers of methane. But it’s not the same as fossil fuels, because it’s a cycle, you know.
Lily Nichols, RD
But they have low inputs to grow like to farm mussels and oysters and clams, that’s low inputs. Right? But I guess you have high methane outputs, is that situation?
Diana Rodgers, RD
They have high – yes. But you know, the same could be said, for cattle grazing on land we can’t crop. That’s pretty low input. And actually, there’s a new paper talking about the net ecosystem benefit we get per pound of beef, like it’s actually a service that these cattle are doing because they’re munching down, you know, fire, you know, if nothing is grazing that grass, then it’s just going to oxidize and burn more quickly. So we can’t just go around mowing everything. And, you know, we could turn…
Lily Nichols, RD
Burning fossil fuels to mow it.
Diana Rodgers, RD
Right. Yeah. So it’s so complicated. And that’s the siloing. I think you referred to before. It’s just so unfortunate because you’ve got all these nutrition experts saying, Well, yeah, but then the planetary boundaries thing, so we probably should meet it without really fully understanding the methodologies. Like with a water argument, cattle take up too much water, it’s like, well, that’s actually most of the water is just rain that is going to fall in that pasture, whether or not a cow is there. It’s not like we’re taking a hose for drinking water and like squirting it at the cow. And then it goes into nothing. And it’s lost forever.
Lily Nichols, RD
Right. And I think you could make the same argument, and I think you have done this on human health if people’s health declines to the level that they require high-level medical care, or even if they become diabetic, I mean, the amount of plastic and fossil fuels used to make all the meters and the test strips and the insulin syringes and all of that stuff, CGM sensors, dialysis tubing, all of this stuff involves a lot of single-use plastic. And I mean, we’ve both seen it, people dramatically improving their blood sugar management with a change in food, which often includes an increase in their animal protein intake. What is the trade-off for that? What’s the net benefit? I think you could, you know, extend the same for pregnancy. I mean, if you have a healthier pregnancy, that your chances that you will be recommended or be in a situation where you have to have a really high intervention birth or have a baby that has a NICU stay. Those are all really high, not only high cost but high single-use plastic and physical resource situations. Whereas you can have like a very low-risk birth, and it’s like couple chucks, pads, and a pair of gloves. Like, it doesn’t require a whole lot of plastic, you know, I think these things have a lot of unseen costs and trade-offs that people don’t even consider.
(Ad for Levels) Diana Rodgers, RD
Hey Guys, I wanted to tell you about my experience with using Levels, a continuous blood glucose monitor that I’ve been trying out as one of their early access members, and let you know how you can get an early one too. As you know, I pay close attention to how I eat and where it comes from. I’m one of those people who always wants to know how food impacts my health and I’ve known for a long time that excess carbs have been a big problem for my blood sugar levels. Before I started eating this way, I was on a blood sugar roller coaster and would feel really terrible if I skipped a meal. I constantly felt like I needed a snack and I didn’t understand why. The great thing about wearing a continuous glucose monitor is that you know exactly what’s happening inside your body minutes after you eat a meal. It’s been a huge game-changer for me to learn that certain carbs or food combinations work better than others and the cool thing is, everyone is different when it comes to how certain foods spike your glucose. For example, white rice, even in the context of a meal, will send my glucose soaring. But potatoes with the same amount of carbs keep me pretty level. I also learned that I don’t need to be quite as low carb as I thought I needed to be and certain tricks like eating salad or vegetables first or taking a walk after a meal make a huge difference in my spikes. I’m recommending wearing one for a month or so to everyone I work with. Levels currently has a waitlist of over 150,000 people but they are offering my listeners first come access to their beta program. So just go to sustainabledish.com/levels to get yours without a prescription. That’s sustainabledish.com/levels to jump ahead of the line and try it out for yourself to learn how your individual body reacts to food. I know you’ll think it’s pretty cool.
Diana Rodgers, RD
And as a fellow dietitian, I think we should also just bring up the point that it doesn’t have to be grass-fed, regenerative, you know, kissed by angels beef, in order for it to be a healthy food. So if people are struggling and feeling uncomfortable, that they, you know, every single meal is not a grass-fed animal, it’s still healthy to eat an egg to eat some liver.
Lily Nichols, RD
For sure, yeah, I tried to make that point in that like, budget-friendly article, because, I mean, like you I have, I feel like a responsibility to help build up small farmers and for people who have the means to support that way of raising animals. But at the end of the day, meat is a nutrient-dense food and of story, wherever it is sourced from so I agree with you. And I think the trade-off in quality of nutrition, if you like, don’t consume any animal foods, or very low amounts of animal foods, the trade-off, and your micronutrient intake is significant. And people forget, like most of the nutrient tables, that’s conventionally raised everything in all the micronutrient tables, you know. We don’t even have the nutrient breakdown on a lot of different foods based on how they were grown and raised. It’s nutrient-dense, it’s still nutrient-dense. So it’s whatever you personally can get ahold of. I think we have to stop this idea that things need to be perfect, you know.
Diana Rodgers, RD
Definitely. But because of that reason, I think that it’s particularly problematic for dietitians, to be sort of implying that you must eat grass-fed. So I always say, you know, a doctor would never say only eat organic vegetables or don’t eat vegetables. Like, duh. No doctor would ever say that. But yet, we have a lot of health experts out there, saying that, you know, conventionally raised beef is toxic and poison and you know, full of hormones, and all this stuff is actually not true at all. And so it’s nutrition experts totally understand that and get it but when I enter the grass-fed beef world, they have a huge problem with that. And I try to let them know that I’m I care about public health, and I care about the environment. And you can do both. And still, you just do your best.
Lily Nichols, RD
Yep, for sure. I think a lot of this and even in some of like the younger dietitians, I feel like a lot of people are kind of skipping over the either like the actual clinical work or like community practice outpatient practice where you’re working with low-income people. You got to have your eyes opened. Not everybody is like living like these nutrition influencers. I swear, I think there’s people who come out of dietetic school, don’t even take on a job, and just become a nutrition influencer on Instagram, or whatever their background is. It’s not all… like, I don’t want to throw all the young dietitians under the bus. Like I support you in your entrepreneurial stuff. But also, you do need to have some perspective. And if you haven’t had those experiences, you simply cannot see the other side of the coin. And when you have not seen firsthand also, the people’s health really declines when they go 100% plant-based, if you have not had that experience, and I, unfortunately, have seen that many, many, many times, especially for women of childbearing age. And especially with young children, you don’t have that worldview to understand what the consequences are of telling everybody to significantly reduce their meat intake.
Diana Rodgers, RD
Right, because like you, I worked in hospitals, and I worked in low-income areas, and for a lot of people, fast food is kind of the majority of their intake. So when you tell them to eat less meat, that just means they’re taking the only nutrient-dense piece of the meal out. And then they end up just, you know, it’s not like they’re trading it for kale salads.
Lily Nichols, RD
Exactly. And that’s, I think I had a post on this recently. I think this is like the elephant in the room. A study came out showing that 59% of calories consumed in the average American diet are from ultra-processed foods. The majority of our intake is coming from foods that have five or more ingredients. For the most part, these are foods that are made of a base of either white flour or some type of sugar with all the other junk in it, okay. And so we don’t have a… like, if we don’t focus on that, because I see all of the arguments coming in from all sides, the plant-based people, the carnivore people, the low carb people, the not low carb people, the pro metabolic health people, the Weston Price people, all of them have their own merits to their own arguments. But if we’re not focusing on the elephant in the room of processed foods, any of your diets are going to be helpful for people if you help them displace the ultra-processed foods for things that provide actual micronutrients in them. And for the most part, all of your ultra-processed foods, by the way, are low protein, it’s all the super-refined sugars, and then refined fats like vegetable oils, hydrogenated oils, that’s what makes up the bulk of the caloric intake from ultra-processed foods. It is only a benefit to displace that with protein.
Diana Rodgers, RD
Yeah, and the great thing about adding more protein, if you do nothing else with these folks if you just try to get them to eat a little more meat, that protein is the most satiating macronutrient, right. So if they eat a little more meat, they’re actually going to be displacing the ultra-processed foods with the protein which naturally will get them to eat more micronutrients, which is what you just said, basically, but…
Lily Nichols, RD
Their hunger and fullness satiety cues will be on point. For anybody who’s worked with people with diabetes, you see it on the blood sugar readings. If we displace the instant oatmeal or cereal breakfast or bagel breakfast, even the smoothie breakfast that people… might be made with better ingredients, but it’s still super high sugar, you displace that, with a couple eggs, and some veggies or even eggs and a god forbid process to beat like bacon. You see the difference on not only that immediate glycaemic reading, but they feel different for the rest of the day. So now they’re no longer falling asleep at like, two or three o’clock in the afternoon. They’re not starving in the morning, going into the break room to get a doughnut or candy or caffeinated sugary beverage, they are satiated until lunchtime. And so you automatically and we’ve seen this in the research, like over and over and over again, you get enough protein and breakfast. And especially if it’s something like a whole food like an egg, it stays with you for so much longer, that your overall caloric intake, markers of your personal ratings of hunger and cravings go down significantly for the rest of the day. And that’s like the biggest… I mean, I feel like a broken record. Because I’ve been doing this with clients and saying this for over a decade now. Fix breakfast, and then almost everything else falls into place. And the number one thing that is usually missing from people’s breakfast is sufficient amounts of protein.
Diana Rodgers, RD
It’s amazing because I just posted…. so the US News and World Report again, just came out with their best diets. And you know, over and over again, it’s the DASH diet. And so I actually posted the recommended breakfast of all of these top diets. And wouldn’t you know, it’s like orange juice, dry wheat toast, low fat, milk, bran cereal, carbs, carbs, carbs, low protein. Amazing. And the great thing about fixing someone’s breakfast is that people are most consistent, like you’re just on autopilot with breakfast, right. And so once you switch that habit, it’s going to be something that you’re going to stick to all the time. And like even my teenage son who is a typical boy, and, you know, has noticed that his attention is not always on point. He knows he feels great and level when he eats a huge protein breakfast. And so I just make these egg muffins. They love them. They’re full of cheese and ham and bacon. I’ll throw a little pepper and some or like red pepper and some like sometimes some spinach or some other green bits in there. But they feel amazing. And that’s the other thing is we would have such a more nice society of calm people who weren’t like honking their horns and trying to rip someone’s head off if they were just blood sugar regulated people.
Lily Nichols, RD
I completely agree. And I will say if we make it more about like, your well being and your energy levels, people are on board with that. Like what motivates people? It’s not getting enough protein and getting enough micronutrients. It’s how they feel. And so if you just set it up, you know, it’s like, Alright, let’s do this breakfast experiment. Are you game? Like we have… let’s try this for like a couple days and then switch back to what you were doing before and see the difference in how you feel and it’s so obvious that most of the time they go right back to doing the protein-rich breakfast. I mean, I’ve even had people who are probably the most difficult cohorts of clientele like that, you know, 50-60-year-old man who’s been doing the same thing forever.
Diana Rodgers, RD
They’re the most resistant, but they’re also the most excited when they see the change.
Lily Nichols, RD
Oh, that’s true. Yeah, I had one that was would pretty much only eat cereal, and coffee, and orange juice for breakfast. And that was the breakfast forever and ever. A person that had always struggled with his weight. He was like, I can eat eggs like that’s okay? You know, so he goes to eating like eggs or eggs and bacon, maybe there’s a piece of toast in there too. As long as it’s balanced with the protein, it’s like a totally different glycemic impact, right. And he’s never looked back. He’s still years later still eating that same breakfast and will comment every once in a while, like I can’t believe that I didn’t do this earlier because like, I can go until one or two o’clock without being hungry. I used to be you know, snacking two or three times in the morning before lunch. That’s what happens when your blood sugar is regulated. It’s not a willpower thing. It’s simply a physiological response. Your body thinks it’s an emergency that your low energy and your low blood sugar and what does it want you to eat? It wants the things that are going to raise your blood sugar as quickly as possible. It has nothing to do with whether you’re dedicated or not.
Diana Rodgers, RD
Yeah and I know we’re going a little bit longer than I promised you but I have to just comment on the fact that I was that way.
Lily Nichols, RD
Me too.
Diana Rodgers, RD
I had… I was like shaking if… I can see right now it’s noon my time. I am so full still from my breakfast today was to eggs with leftover pulled pork that I like seared in the pan. And I had it on some like grain-free tortillas. I feel amazing. I have level energy. I’m not tired. I’m not like dying to get off this call and like sweating. I would feel sweaty.
Lily Nichols, RD
Oh, I remember. I was reactive hypoglycemic for years – years. My default breakfast was you know steel cut oats. And even with doing all the right things, soaking it overnight, doing it with home like Western Price way, slow cooking it and then mixing in all of the supposed things that would lessen my blood sugar spike, the chia seeds, and the nuts, and the collagen powder and cinnamon and whatever else. The butter, coconut oil like all the things that would supposedly help. It’s still a disaster for my blood sugar. Now it’s not a disaster for everyone’s blood sugar. Some people can pair it in that way and it works for them. I’ve seen it real-time and CGM results. For me, oatmeal spikes my blood sugar 60 to 100 points. Whereas I can have a breakfast like what you’re describing, which is a typical breakfast for me. I mean I plaster my Instagram is all full of example breakfast, which are mostly egg or meat-based. And I’m… my blood sugar maybe goes up 10-20 points at most. And then is level for hours and hours and hours and hours just like my energy levels are level. And until people experience that it sounds too good to be true. Or I don’t know, I think some people can’t wrap their mind around like the concept of eating like there’s a disgust factor with animal foods if they’ve not been eating them for a long time. Or there’s like this genuine fear of saturated fat and cholesterol that has been like hammered into us for so long, that they just can’t imagine that this is possibly healthy until they then experience that they feel so good. And it’s like this cognitive dissonance that they need to reconcile like, how could this unhealthy thing make me feel so good?
Diana Rodgers, RD
That is exactly what happened with my preceptor when I worked in my hospital rotation when I was an intern. She was on Weight Watchers, overweight and she’s like, Diana, you’re blowing my mind. She was a dietitian that just you know, and I wasn’t preachy. I just sort of like was there with my lunch every day. And then she asked me and I told her and I was like, Well, you could try it, you know. But I think for me, the biggest benefit was not being food addicted anymore. Like not obsessing about what I was going out for dinner constantly. So food is just whatever meat whatever vegetable I have in the fridge, and that’s the end of it. No more food cravings. It’s amazing. And I do want to make a little plug for Levels, the CGM continuous glucose monitor. You’re the one who turned me on to that. And I know a lot of my followers have been really psyched about that. So I’m going to put a link in the show notes too for folks so they can try Levels because it was so cool to look at the different foods and how it affected me. Just really, really cool tool and I’m glad that people are able to get that on their own without a prescription now
Lily Nichols, RD
Absolutely. It’s a really good option for people so you can see like, exactly how much and how quickly you’re spiking and how quickly your blood sugar comes down after eating different things. It’s been very eye-opening, especially for clients who are kind of like set in their ways of doing some… No, this works for me. Well, let’s just see how it reads. And it’s like, you know what my body really can only handle like, half a piece of toast with my breakfast. So instead of two pieces of bread with one egg, I’m going to have two eggs and half a piece of toast and something else on the side, maybe avocado on the toast and they can see it firsthand. It’s not just this external person advising them to do one thing or another.
Diana Rodgers, RD
Yeah, because high blood glucose actually sometimes feels kind of nice. Like, you don’t really notice it. And you know, and it doesn’t mean you can’t ever eat any… like sometimes I’ll have a tea cup full of oatmeal because I like the texture and taste of oatmeal, but I always make sure that I have it with the eggs. And anyway, it’s really it’s really cool to play around with that kind of stuff and see what works for your body because everyone’s at a different level with carb tolerance and everything.
Lily Nichols, RD
Exactly. Yeah, different carbs affect us differently. So like my homemade sourdough bread is totally fine for my blood sugar, potatoes, sweet potatoes. I mean, this is in the context of a meal that has protein but still, those are fine. But even in a meal that has sufficient protein for me rice is like a huge blood sugar spike
Diana Rodgers, RD
Rice and corn for me, but same.
Lily Nichols, RD
Oh, corn for you. Corn doesn’t spike me almost at all. See, that’s why this is so interesting.
Diana Rodgers, RD
Yeah. Yeah, polenta, off the charts, lentils off the charts. But potatoes for me are totally fine. I can eat a white potato with no issue.
Lily Nichols, RD
Yeah. And then you have this whole group of people who are anti potatoes.
Diana Rodgers, RD
I love how I feel. And I love my digestion when I eat potatoes. So as long as I eat them in the context of a meal. I think they’re great. And they’re nutrient-dense, people. Potatoes are actually healthy.
Lily Nichols, RD
It’s hard for people to wrap their mind around. I know I like my potatoes and root vegetables as well, I find that that’s like a really good complement to a meal in lieu of the rice, you know, because there was that whole group that was really pro white rice, which never made sense to me, because… what? It was like the safe starch thing, whatever it was. No, there’s no anti-nutrients. So this is a better starch source. It’s like, well, if you’re just looking for pure starch, because you don’t get really any micronutrients in it. And for me, it’s a massive blood sugar spike. So yes, I still have rice every once in a while if we’re having like, Indian food or Thai food. I generally if we’re doing takeout or something, I tried to like cook some cauliflower on the side and serve it over cauliflower vegetables with just a little rice because I’ve learned a lot of rice… first of all, not like my favorite food. So I don’t really care eating less of it, but B the spike is so significant. And I really don’t feel good with it too. And that’s the biggest thing. If you don’t feel great, then it’s like why keep doing it?
Diana Rodgers, RD
Well, that was really, really fun. I’m so glad that we were able to record basically a catch-up of just like finding out what’s going on with you and dishing about glucose and everything. So I’ll put a link to Levels so people can give it a try. They have a really long waitlist right now but you can jump ahead of that waitlist if you follow the link that I have. Lily, where can people find you. List off your books, I want everyone to buy your books and or buy them for your friend who’s pregnant or having a baby.
Lily Nichols, RD
Yeah, good for preconception, too, and postpartum. So I have two books Real Food for Pregnancy, and Real Food for Gestational Diabetes. You can find links to those on my website. You can get the first chapter Real Food for Pregnancy for free on my website as well. If you just want to get a taste of what am I talking about when I say the term real food and what is, speaking of micronutrients, what is the comparison on a meal plan that’s real food-based versus the conventional guidelines sample meal plan and you’ll see it in black and white, which one wins that battle. I have my blog up there. Lots of stuff going on my website. We can link out to my article on vegetarian diets and nutrient considerations with the protein and pregnancy article we just barely scratched the surface of that today. And then as far as social media world, I’m most active on Instagram. And my handle is the same as my website, which is Lily Nichols RDN.
Diana Rodgers, RD
Great. All right. Well, thank you so much for being on. Yeah, I want to talk more about pregnancy and we’ll have to have you back on for pregnancy and protein and all of that. So thank you so much for your time. I really appreciate it.
Lily Nichols, RD
You bet.
