Real Food for Gestational Diabetes: An Effective Alternative to the Conventional Nutrition Approach

by Lily Nichols

Getting diagnosed with gestational diabetes is scary, but it doesn't have to stay that way. Imagine easily managing your blood sugar, effortlessly gaining the right amount of weight during your pregnancy, and giving birth to a beautiful, healthy baby. This can be you! Real Food for Gestational Diabetes offers an alternative to the conventional nutrition approach that embraces nutrient-dense and delicious foods that nourish you and baby without causing high blood sugar. With the wrong information (or no information at all), far too many women are left alone struggling with erratic blood sugar and excessive weight gain, often leading them to high doses of insulin or medications and difficult births. Sadly, this often happens despite these moms dutifully following the dietary advice given to them by well--meaning clinicians; a restrictive diet that leaves them feeling unsatisfied, unhappy, and confused about ever- increasing blood sugars. In Real Food for Gestational Diabetes, prenatal nutritionist and diabetes educator, Lily Nichols, RDN, CDE, CLT, sets the record straight, offering revamped carbohydrate recommendations and exercise guidelines based on the latest clinical research. You can have gestational diabetes and have a healthy baby. Lily will show you how. With this book, you have the tools to turn this diagnosis into a blessing in disguise. You'll learn: Why conventional diet therapy often fails and what to do instead How the right prenatal nutrition can reduce the likelihood you'll need insulin by 50% Exactly which foods raise your blood sugar (and more importantly, which foods DON'T raise your blood sugar) How to customize a meal plan with the right amount of carbohydrates for YOU (there's no one-size-fits-all plan, despite what you may have been told) The truth about ketosis during pregnancy (and why checking urine ketones isn't useful) Information on insulin and blood sugar-lowering medications used in pregnancy Which foods to emphasize to provide your baby with the right nutrients for optimal development (these real foods have a long history of producing strong, healthy babies) The best prenatal exercises to control your blood sugar and prepare for labor What to do after delivery to prevent type 2 diabetes

Genres: Nonfiction, Health, Parenting, Nutrition, Food, Self Help, Cookbooks

190 pages, Paperback

First published January 9, 2015

About the author

Lily Nichols is a Registered Dietitian/Nutritionist, Certified Diabetes Educator, researcher, and author with a passion for evidence-based prenatal nutrition and exercise. 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 diet for managing gestational diabetes. Her unique approach 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 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.PilatesNutritionist.com, which explores a variety of topics related to real food, mindful eating, and pregnancy nutrition.

Reviews

[RLV · Rating 5 out of 5]

My first reaction when I was diagnosed with GD was “what the heck”?

My first reaction when I was told by my educator and dietitian that I would need to eat a minimum of 175g of carbs daily was, I believe, “what the friggin he*l”?!?!

I don’t have the typical GD profile: I gained very little weight despite starting at a healthy though lowish weight (11 lbs in 30 weeks, without restricting of course), don’t pee all the time, am not thirsty, baby is in the 25th percentile (so not chubby!) and don’t crave nor consume crazy amounts of sugary foods.

Getting diagnosed was a total shock. Being told about the guidelines for women with GD was even more of a shock. Maybe for someone who eats bread thrice a day, pasta for lunch and rice for dinner, dropping to 175g of carbs daily might help. For someone who doesn’t, it makes no sense to suddenly add that amount of carbs to her diet.

So I went on a hunt for information and was so very glad to find this book! It is very informative and i love that the author cites studies (means more ammunition in case my educator, dietitian or endocrinologist gives me hell over the fact that I’m not eating their 175g of carbs daily!).

Sure she goes into some subjective stuff here and there but overall this book was a great read. I wish there were more recipes but apart from that it is awesome!

[Ashley · Rating 3 out of 5]

The principles here are super helpful, especially the first few chapters, and especially if you've gotten bad advice on managing GD. I have never heard the recommendation that women with GD consume 175 carbs per day. That sounds crazy to me. But apparently it's out there.

I'm hesitant about two things. 1. Reading some of her advice can make it seem like you should probably take 5-10 supplements a day, eat only grass-fed, organic (read: expensive) foods, and never eat anything processed. Otherwise, your baby will definitely be overweight, someday develop Type 2 diabetes, and might even be schizophrenic. This just isn't realistic or even necessary for most people. I had to keep reminding myself that her best is not necessarily attainable for me.

2. I'm always a little hesitant when people are calling out all of modern medicine in one fell-swoop. I worry that the results of one study might be taken to override years of medical research. I'm not knowledgeable enough to confirm or deny that's what's going on here. But I do think we should be careful before we buck all our practitioners' recommendations after reading one book.

[Annie Bruza · Rating 4 out of 5]

Lily Nichols has good advice for pregnant moms dealing with Gestational Diabetes. She takes a diet and exercise first approach when it comes to controlling blood sugars but emphasizes the need for medication if that isn't enough. I enjoyed her chapter on trouble-shooting particular problems, as GD can effect people differently. She's always very data driven in what she writes and this book is no exception. As in Real Food For Pregnancy, the recipes she's chosen to include are very helpful as well. I highly recommend this for anyone dealing with GD or who wants more information on this specific complication of pregnancy.

[Victoria Prince · Rating 5 out of 5]

Any one in pregnancy should read this book!

After facing a surprise diagnosis of GDM I had to dig deep to find any information with studies done earlier then 1969. After feeling on my own and lost even with my providers help this book has been eye opening. All of the facts I had researched were in here in an easy to read down to earth way. I feel confident that I have all of the materials and the facts to face GDM and stay off of medication for as long as possible. Honestly so grateful I found this I’ll definitely be giving a copy to my midwife and my dietitian to help other Mom’s out of the confusion.

[Meghan Hughes · Rating 5 out of 5]

This book was recommended to me by a mom friend & I appreciated the knowledge in it SO much! It felt like one of those books I wish I had read before pregnancy just so I was equipped with this knowledge for my full term, but alas! Third trimester knowledge is good too! Lily Nichols details a low carb diet in this as a measure to lower your body’s glucose production to prevent gestational diabetes or manage it if you have it. She sited many sources, gave recipes, talked about what to specifically avoid (white bread, white rice, white potatoes, fruit first thing in the morning, etc.) to avoid huge glucose spikes showing up on your GD test with your provider. Legendary info!

[Margaret Fogarty · Rating 5 out of 5]

Super informative and helpful! I read this right after getting diagnosed, but before meeting with the diabetes counselor at the hospital - she was pleased with how much I knew about GD and agreed that the suggestions in the book will be good to follow. I really appreciated the personal stories sprinkled throughout the book! I wish the recipes came with nutritional values, but it's not too hard to calculate them on your own.

[Rebekah · Rating 4 out of 5]

Helpful and insightful! The first several chapters were incredibly interesting to me and I read them quickly. I wish I had read this book during my first pregnancy!

I appreciated the diet recommendations in the book, however, I personally feel as though I need MORE carbs than what she recommends. Everyone’s body responds differently and I am grateful she brought that out in the book. Learning how your body and blood sugars respond to food while pregnant (and not pregnant) is so KEY!

Overall, I found the book to be interesting and helpful - it was also encouraging as she reminded the reader quite often that developing gestational diabetes is not always our fault but we do have a lot of control over how we manage it!

[Lauren · Rating 5 out of 5]

I first read Real Food for Pregnancy; I started tracking my blood glucose daily as laid out in the book around 25w. I just was feeling off, had some GD symptoms and had that feeling. Though my numbers aren’t horrible, they’re not awesome; my doctor wants me to manage through diet and exercise.

This book lays it out in a straightforward, scientific and easy to understand way, as well as well cited studies and information to back it. GD doesn’t have to be a death sentence; if anything, it’s helped me be more in tune with what foods makes my body function best. There is a five day sample plan, snack ideas and recipes, too.

Highly recommend this book to those with GD!

[Karrah X · Rating 5 out of 5]

This is a great resource for understanding GD and pregnancy nutrition, from someone who is thinking outside the box and not just recommending things because "it's always been that way". It should be noted that this book is produced in America; if you are reading it outside of the USA, some measurements and nutrition standards may differ from your country. I am Australian, but still found it very helpful and brimming with useful information. There is also a handful of recipes included to help you on your way!

[Dallas Ganschow · Rating 5 out of 5]

Was diagnosed with GD after opting to track my own blood sugar instead of do the glucose test. After reading this book (and ignoring the advice of the diabetes dietitian who wanted me to eat extremely high carb) I changed my diet according to this book and my gestational diabetes went away, to the point where I no longer was considered as having it. By 34/35 weeks I no longer needed to meet with maternal fetal medicine and I delivered a perfectly healthy baby 7 lb baby at 39 weeks with no blood sugar issues. All of Lily’s books are a MUST read for all women but especially during child bearing years.

[Shannon Hall · Rating 4 out of 5]

I learned so much from this! And have learned so much about food and carbs/sugar from having gestational diabetes in general. I was already doing a lot of the advice in this book based on my TikTok research (lol), but have definitely experienced some of the pressure to eat more carbs from my doctor’s office even though my blood sugar has been perfectly diet controlled. Glad this book was recommended to me and it helped a lot with the overwhelm after diagnosis.

[Umm Abdurahman · Rating 5 out of 5]

Got diagnosed at 31 weeks, and this book was recommended a many times when I was researching more about gestational diabetes. I found it really helpful and very much beginner friendly. It definitely opened my eyes to what the future outcomes of this diagnosis looked like.

[Lindsey]

Hard to rate, as I suppose the proof will be in the pudding (or rather, in the kiddo/Greek yogurt).

[Laurissa · Rating 5 out of 5]

So insightful and practical!

[Blake Randolph]

Helpful and straightforward

[Sarah Burton · Rating 5 out of 5]

Super helpful and encouraging, I am able to feel empowered with some new strategies and not feel shame. So glad I purchased this book.

[Christina · Rating 4 out of 5]

I don’t have it (at least not for now lol) but still a helpful read with tips that I want to implement regardless!

[Katherine · Rating 5 out of 5]

Mandatory reading for anyone at risk for or diagnosed with gestational diabetes, imo. Be forewarned that there may be a lot of recommendations that go against current conventional advice for managing GD by American dieticians and MDs, but it seems very logical and evidence-based.

[Elise Temme · Rating 5 out of 5]

As a recent recipient of the GD diagnosis, I am so glad I read this. The book is full of recipes, nutritional advice, and guidelines for keeping blood sugar levels under control. It is also quite short and easy to read quickly. Although there is no guarantee that diet and exercise alone will prevent a pregnant woman with GD from needing medication or insulin down the road, the strategies presented here can help give her a good chance at avoiding that. I highly recommend this book for good prenatal nutrition, with or without having gestational diabetes.

[Jamie · Rating 3 out of 5]

It was fine. I hate the elitist suggestion that you "source" all your meat and dairy (you know, in your free time with your spare hand) and it falls into the trap of talking about avoiding "obesity" as a goal in and of itself. Helpful in explaining that some people with GD will find that their blood sugars are more stable with a lower-carb diet AND that it's normal to find that keeping your blood sugar in range gets harder and harder as your pregnancy progresses.

[Natalie]

Didn't have GD, but wanted to read it anyway. At least someone out there is speaking sense about gestational diabetes diet.

[Jen · Rating 5 out of 5]

I was in shock when I failed both of the tests to determine if I had Gestational Diabetes. Could it be so? Or could my pancreas just be used to outputting a lower level of insulin because my regular diet due to a food allergy was already low on the glycemic index? Regardless, no shame in the data gathering game, so I jumped in to the 4x/day finger pricks with my trusty little glucometer and I joined a GDM support group.

They welcomed me and then immediately gave me the preview link to what they claimed was the holy grail: Real Food for Gestational Diabetes: An Effective Alternative to the Conventional Nutrition Approach by Lily Nichols. I read through the preview - was hooked when the first thing she predicted we'd be thinking is that the test was wrong - and then went and bought the whole book.

My doctor's practice already sent me a 15 page diabetes diet document which summarized the main points of the dietary advice given in this book, so I did not find the book to be valuable on those fronts. Lily Nichols is one of the key minds behind the California GDM program called "Sweet Success" which apparently has made its way over to North Carolina where I live. Sweet Success will tell you the bulk of the nutrition information contained in this book, but for free.

However, what this book had that my doctors didn't, was information on ketosis and the three types, plus references to studies about fetal growth with ketones present in the body. It gave me something to discuss with my medical team, as I found that the biggest challenge they faced was trying to control my overnight/fasting blood sugar so that I didn't enter ketosis but also didn't have high levels of blood glucose ... a very fine needle to thread. But if we weren't worried about ketosis, then the task becomes much easier. So it led me to a conversation about how worried we were about ketosis and if we had to weigh high blood glucose vs ketosis, which would we pick. If you have GDM, for no reason other than the ketosis chapter, pick up this book. It will lead to conversations you would never have otherwise, and an easing of the stress of fasting blood sugar as a result.

My other complaint, aside from the fact that this book is selling nutritional information that Sweet Success gives for free; I know some of you are gestating on a budget -- is that this book doesn't take into account those of us who are already on specialty diets due to food allergies or the like. The sample menus, the suggestions, etc, don't help. My diet is largely vegetarian and this book doesn't make allowances for the fact that beans are both a protein, yes, and also a low glycemic index carbohydrate. The book wants to look at pure examples of proteins, fats, and carbohydrates which are then lumped into starchy and non-starchy. We on the specialty diets tend to exist in the overlap blended foods areas. I hope to find a different book that is perhaps written for the vegetarian diet which is still GDM compatible. But I also don't expect I'll need it ... eating my regular diet has resulted in below-concern blood glucose every time.

I can also tell that this book is a bit dated. It rails against GDM dietician advice that it presumes one would get to go on a low carbohydrate diet. In fact, my dieticians were pushing me to increase my carbohydrates, specifically my high glycemic index ones, because "baby needs carbohydrates" which when I tested their advice had my blood sugar over the threshold for concern. Apparently that's the new thing as I met with two different dieticians across two different agencies who had no reason to collaborate or collude. Hear ye hear ye GDM patient ... baby does need carbohydrates but they can be low glycemic index (bell pepper, olives, green beans, etc), they don't have to be breads or pastas or fruits which is antithetical to Lily Nichols's "plate method" where 1/4 of your plate is supposed to be high glycemic index carbs. And you definitely don't need 175g of carbs if you aren't used to eating even so much as 175g of carbs. (if you are used to eating more carbs, though, def drop down)

[Kate · Rating 5 out of 5]

This was a reread as I did read and love this with my first GD pregnancyin 2017. I skipped the book but still armed with the info for my next two GD pregnancies, but figured it was about time for a good review of it again as I was struggling to remember some of the finer details I needed. The information is still great and relevant, even nearly a decade later. Unfortunately research on pregnancy women are slow and based on observational studies rather than double blind because the latter would be unethical if something didn't work when they had a solution, or caused worse effects. Nichols provides a no nonsense and easy to utilize approach, which focuses on eating whole foods that are lower in carbs and balancing said carbs with protein and fat to help keep glucose levels steady. She provides the science and also bravely shows how the idea that a low carb diet is dangerous for baby is not based on anything scientifically and is more tradition of a number they pulled from an irrelated study. Thus, she advocates for a lower carb diet (the level each person needs can vary a lot because we all react differently and need to eat to the meter), though it is still much, much higher in carbs than the keto diet. She dispels the common myth that ketones from nutritional ketosis (which the body naturally hangs out in pregnancy at certain points anyways) is the same as keto acidosis or dangerous in any way. That being said, she also doesn't villianize medication if it is needed. She provides a very balanced and sensible perspective. There are many other questions answered in the book as well as great info one may not consider. The appendix provides around 20 recipes that are easy to make. Not surprisingly, I love this book just as much as I did the first time I did and am so glad she has provided the info to help expecting women take control of their health and diet and be empowered with the the knowledge to make positive changes. Perhaps my only complaint is that I could read about this for ages, so the book comes to an end way too quickly for me! I actually only read a chapter at a time this go around to make it feel longer. Either way you read it though, I definitley recommend if you or a partner has gestational diabetes!

[Tabitha Kirkland · Rating 5 out of 5]

Very helpful! This is my second pregnancy with gestational diabetes and I thought I already knew what to do, but I got a lot of useful information from this to guide my decision making in the next 3 months.

I had read the author’s other book, Real Food for Pregnancy, before this one, so there was quite a bit of overlap since the author recommends a low carb diet in both.

From both books: I love her “plate method” for determining proportions (1/2 of your plate is non-starchy veggies, 1/4 protein, 1/4 carbs including grains and fruit); tips for foods that can slow the processing of carbs if you eat them before a meal (chia seeds and apple cider vinegar!); and the insight that eating a carb alone (“naked”) will cause a bigger blood sugar spike than eating it alongside a fat/protein (e.g., apple + nuts) 🤯.

Insights unique to this book: guidelines for how much of a food counts as a 15g serving of carbs (beans and lentils were a surprise), the idea that you can subtract the amount of fiber from the total carbs in a serving to get the net carbs (since fiber slows absorption of carbs), that berries are lower in sugar than apples or other whole fruits, satisfying low carb snack ideas. Other gems: lower target blood sugar thresholds than my last doctor recommended (apparently I should aim for 110 mg/dl an hour post meal, not just <140); the idea that exercise around each meal time can decrease blood sugar (um hello 10 minute walks, I see you and I’m coming for you); small frequent meals to decrease portion size / blood sugar impact at any one meal; bedtime snacks can lower fasting blood sugar the next day; and generally the idea that each person’s carbohydrate sensitivity during pregnancy will differ so it’s worth doing some personal experimentation rather than stopping at the one size fits all guidelines.

Feeling empowered and hopeful that my second gestational diabetes pregnancy experience will go even more smoothly than the first!

[Danielle T · Rating 3 out of 5]

I'd actually checked this out from the library a few days prior to meeting with the diabetics counselor and my ob-gyn appointment (where the certified nurse midwife recommended this specific title), so it rose up in my library pile. A lot of recommendations fall in line with what I was told- the plate method (and proportions, light snacks in between meals (which will be a struggle for me because I tend to skip breakfast and I'm not a snacky person), having a light protein snack before bed, etc.

Where Nichols loses me is the suggestion that actually, ketosis is *fine* etc. because my understanding was that that was always more for short term weight loss, and over long term it's not good to be forcing your body to use fats over sugars as fuel (though that's largely because of other recommendations with the way people practice low carb or Atkins style diets). My university biochemistry courses impressed on me that macromolecules aren't inherently bad; it's just about the proportions ingested.

Well cited throughout, though some citations were more like straight quotes from the research papers. I wasn't as big a fan of the mother stories interspersed throughout, though, as anecdote is not evidence (and there was one I felt went to extremes- testing 12 times a day??)

But yeah, gonna eat more eggs and greek yogurt probably.

[Samantha Anderson · Rating 5 out of 5]

I did not read this book cover to cover because I have already consumed a lot of Lily’s content over the years, and a lot of it would be a repeat for me. I read through some of the sections that I thought could offer me new info and they were so helpful. I have been so blessed by Lily’s research throughout all 3 of my pregnancies. Her info has made me so much more diligent in caring for myself and my babies through my rising blood sugar. I think every pregnant woman would benefit from this book as all women’s sugars go up after week 20. I don’t follow everything she says, and I have never had to be as strict as she recommends with the carbs. She also eats a keto diet so just keep that in mind with her recommendations. If keto doesn’t work well for your body you may find yourself wanting to try more carbs than what is recommended. But that is the beauty of actually tracking and having the numbers to know your body, instead of relying on blanket advice from a practitioner! 10/10 recommend

[Mayci McLeod · Rating 3 out of 5]

This book was helpful as I was coping with my gestational diabetes diagnosis and learning about the process moving forward. I really enjoyed the first hand accounts of other moms sharing their stories and helping me not feel so alone.
However, I feel like this book falls into the similar assumption as other GD literature— assuming that the mom is severely overweight and needs a big diet overhaul.
The book also does not mention options for a vegetarian diet, except for in cases when saying this is the wrong choice. I don’t recall even seeing vegetarian protein sources like tofu or tempeh listed as viable options in a low carb diet. Because vegetarian recipes don’t include meat, many fall back on carb substitutes (ie pasta) to complete the dish. Having some fallback veggie friendly choices and meal plans would’ve been a nice addition to be inclusive for pregnant women who are already vegetarian for ethical, environmental, religious, or health reasons.

[Joshua · Rating 5 out of 5]

Wish I had read this as soon as I was diagnosed

I learned more from this book about how to manage my gestational diabetes than I did with just a short zoom call to the educator from my Doctor's office. It's better information than what you get from googling things. I love how she isn't afraid to tell us to eat carbs, like in whole milk. I started drinking whole milk (big no no for GD according to most) at bedtime and that's what finally got my morning fasting numbers under control!!! Just very insightful and glad I read it. This is my last pregnancy, only one with GD. But if any friends I know get diagnosed. I will recommend this book and also will be great for any women who have GD in their subsequent pregnancies.

[Sariah · Rating 5 out of 5]

This book is well written, succinct and evidence based. My favorite trio for science non-fiction.


But also, I found it extremely helpful in understanding my pregnancy, and how food affects our blood sugar. And there are some really yummy looking recipes in looking forward to trying.

I think if you are a birth care provider, a nurse, or certainly a pregnant person with gestational diabetes (or are thinking about becoming pregnant and have pre diabetes or other risk factors for gestational diabetes) this book is a must read. I happen to be all three of the above, and wish I’d read it sooner.

The author, Lily Nichols, has a book called Real Food for Pregnancy, that I have started, but am now very much looking forward to finishing.

[Stephanie Douglass · Rating 2 out of 5]

I felt kind of shamed reading this book. There were stories of people who were able to control their GD, but they all seemed to not be that healthy to begin with. What about people with few/no risk factors who developed GD, like myself? Also, way too many meat suggestions. No mention of tofu, which is a great low-carb source of protein. It's my second time with GD and I was hoping for some more plant-based recipe inspiration. Not every single recipe but at least more than 2. Personally, from going through this twice, eating low-carb just doesn't feel that great and I feel sub-optimal unless I get more grains. Just kind of frustrated there wasn't more variety from what I've already been doing.