Functional Maternity with Dr. Sarah Thompson: Rational Wellness Podcast 245
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Dr. Sarah Thompson discusses Functional Maternity with Dr. Ben Weitz.
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1:38 Dr. Thompson started out treating musculoskeletal pain as an acupuncturist until she became pregnant with her first child. She felt that there was a need for better nutritional prenatal care and dedicated herself to being able to provide that care. Dr. Thompson also found Functional Medicine and pulled that into her maternity care.
4:28 Dr. Thompson calls her book, Functional Maternity because she puts the focus on the care of the mother and not just on the care of the baby. Conventional prenatal care may end up with a healthy baby and a sick mom, which can lead to postpartum dysfunction that affect the mother adversely for the rest of her life. If we have a healthy mom, we’re going to have a healthy baby.
5:36 The US has a shockingly high maternal mortality rate for an advanced country and that rate has gone up in 2020 by 18%.
7:05 Dr. Thompson often jokes that we are failing women before they even know that they are women through the standard American Diet and through childhood nutrition. One in five children are now overweight in the US and the food served in the school breakfast and lunch programs is not healthy and these children are 30% more likely to be obese. “We have poor nutrition education in childhood, and then we have the lunch systems that teach kids to eat shitty food.”
8:28 NHANES studies show us that 80-90% of women aren’t consuming the minimum vegetables per day and we see that young women who are eating poor nutrition have lowered reproductive powers.
9:00 There are a lot of nutrients that support maternal physiology both before pregnancy and then during pregnancy. Vitamins B12, folate, vitamin D, etc are very important for maternal health during conception and pregnancy. AMH, Anti-Malarial Hormone is associated with egg quality and low B vitamins, low zinc, and low vitamin D are all associated with low AMH levels. This can create poor quality eggs, which can lead to poor quality embryos, which can lead to poor placentas, which can lead to pre-eclampsia and gestational diabetes. While Dr. Thompson sometimes does run nutrition panels preconception, there is also a lot you can tell just from a CBC. For example, if the MCV is little high, this may indicate a B12 or folate deficiency. Homocysteine levels can confirm this.
17:10 There is no prenatal vitamin that is right all the way through pregnancy, since the need for different nutrients changes in each trimester. Plus, it would be better to call it a maternal vitamin, rather than a prenatal. For example, in the first trimester, women often have up to 15 times more insulin being produced, so certain vitamins, including thiamine, magnesium, and vitamin D that can help with that.
18:50 The reason that there is up to 15 times more insulin being produced in the first trimester is because of the need for glucose to facilitate the cellular development of the placenta in the uterus and this is stimulated by the production of HCG. One of the primary causes of morning sickness in the first trimester is due to low blood sugar, so it is important to increase the consumption of low glycemic carbs during this time. Of course, these carbs should be paired with good fats and proteins and this is why following a low carb diet during pregnancy is not optimal.
22:02 Women who have PCOS and existing blood sugar dysregulation going into pregnancy have more trouble balancing their blood sugar. It is important that their blood sugar does not drop below 80 or 75 at the lowest. Gestational diabetes is more placenta related than mom related. The placenta produces a lot of hormones, including lactogen, which tends to be increased in the third trimester. Lactogen’s role is to block the maternal physiology from bringing sugar into her cells to raise blood sugar levels to give baby sugar to help stimulate fetal growth in those last months of pregnancy. There is a metabolic shift in moms where they actually burn their own body fat to fuel their energy, so all of their glucose in their diet goes to baby. What happens in gestational diabetes is that you have an excessive production of lactogen, so no dietary glucose gets into mom and her blood sugar rockets.
Dr. Sarah Thompson is the founder of Sacred Vessel Acupuncture & Functional Medicine, the creator of the website www.functionalmaternity.com, and the writer of Functional Maternity Using Functional Medicine and Nutrition to Improve Pregnancy and Childbirth Outcomes. She is a certified functional medicine practitioner, licensed acupuncturist, board-certified herbalist, birth doula, and educator with a passion for pregnancy care.
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss and also athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest and cutting-edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast.
Hello, Rational Wellness Podcasters. Today we have an interview with Dr. Sarah Thompson on functional maternity. Dr. Sarah Thompson is the founder of Sacred Vessel Acupuncture and Functional Medicine. She’s the creator of the functionalmaternity.com website. She wrote a book called Functional Maternity: Using Functional Medicine and Nutrition to Improve Pregnancy and Child Outcomes. She’s a certified functional medicine practitioner, a licensed acupuncturist, a board-certified herbalist, a birth doula, and an educator with a passion for pregnancy care. Dr. Thompson, thank you so much for joining us today.
Dr. Thompson: Thanks for having me.
Dr. Weitz: Great. Tell us a little bit about your journey. How did you go from becoming an acupuncturist? And were you treating patients with acupuncture for a number of years before you changed your focus towards helping women with their nutrition from fertility to birthing and beyond?
Dr. Thompson: Yeah. So, I started out I think like most acupuncturists, when I graduated school, wanting to do sports medicine, pain management, those things. I spent the beginning of my career working for an interventional pain management specialist. I trained with some of the best orthopedic acupuncturists in the world. And that was my focus. Now, as far as nutrition and functional medicine, my undergraduate is in nutrition. And I’ve always known that nutrition played a very important role in treatment success, whether it’s conventional medicine treatment, acupuncture treatment, chiropractic treatment, you name it. You have to have a solid foundation. And that foundation is nutrition. So, even with my orthopedic patients that I had way back when I first started practicing, over 16 years ago, we always talked about diet and nutrition and how certain things they were doing in their diet could be increasing their inflammation affecting how their neurology was working and trying to improve their pain responses and improving their treatment success.
It wasn’t until I became pregnant with my own first child that I discovered how cool pregnancy was. Up until that point, and people who knew me from childhood and my early adulthood, as soon as I told them I’m pregnant, they were like, “Excuse me, what? You weren’t going to have kids.” And I was like, “I know, but this happened.” And here we are, and we’re having a kid. And it’s the coolest thing I’ve ever done. And why didn’t anybody tell me that this would be so fun? And I completely changed my focus. And I changed my focus through my own experiences and the experience or lack of experiences really that I had in my own prenatal maternal care. And I felt that there was a very substantial need that wasn’t being met with pregnant moms across the board, whether they’re in midwifery care, OB care, home birth care. There was this lack of education and a little bit of a lack of focus on the importance that nutrition played into these pregnancy and childbirth outcomes. And that’s when I really changed my focus in my practice with acupuncture and found functional medicine and did the certification programs and pulled that all into the practice in maternity care.
Dr. Weitz: Yeah, absolutely. I think traditional care for pregnant women basically consists of taking your prescription prenatal and that’s it.
Dr. Thompson: And we know that prescription prenatals are really subpar when it comes to even prenatal care, let alone maternity care.
Dr. Weitz: Right. So, you call your book Functional Maternity, rather than a functional medicine approach to fertility or pregnancy. Why is that?
Dr. Thompson: My goal is to bring the care of women back into the care of pregnancy. Pregnant women who become lost in this system of baby-
Dr. Weitz: Instead of the whole focus being on the baby.
Dr. Thompson: Exactly. When we look at the actual medical definitions, we look at what does prenatal means. Well, it means the care of pregnancy. What does maternal mean? It means the care of the mother. And the goal here is to bring the care of the mother back to the care of pregnancy. There’s so much that happens in maternal physiology that gets left to the wayside as long as baby looks good, and you can have a healthy baby, but you can have a really sick mom because that baby is taking everything from her and leaving her very dysfunctional. And she’ll end up having a cascade of postpartum dysfunction that can transfer throughout the rest of her life. Well, if we focus on mom, we’re going to have a healthy baby if mom is healthy, and we can prevent these issues in mom later on down the road.
Dr. Weitz: Yeah. That’s super important. I think that’s great that you’re doing that. And let’s not forget that even in an advanced country like the United States, you might be shocked to learn what some of the maternal mortality rates are, especially in certain populations, in certain parts of the country, it’s really shockingly high.
Dr. Thompson: It is, sadly. As far as first-world developed countries go, we have arguably the worst maternal statistics. And that’s very disheartening for any mother coming into a maternal program of any sort because her risk of complications is significantly higher than a mother who’s having a baby in Spain, or a mother who’s having a baby in Iceland.
Dr. Weitz: Right. And that probably goes with the ability of the average American to be able to handle any health challenge, whether it be pregnancy, a virus, or any other thing that might challenge our health if we already have a whole series of what are being called now comorbidities I would call chronic diseases like obesity, and diabetes, and hypertension, and on and on and on, which you and I and most of our audience know is directly related to our standard American diet, our sedentary lifestyle, our stress levels, or our lack of good sleep, et cetera, et cetera.
Dr. Thompson: Oh, absolutely. One of the things I jokingly say, but not jokingly at the same time is we’re failing women before they even know they’re women. And we’re doing that through the standard American diet, and more importantly, childhood nutrition. One in five children is now considered overweight. That’s a problem. That is already setting these-
Dr. Weitz: It’s crazy. It’s completely insane. Right.
Dr. Thompson: Absolutely. There’s a lot of things that go into that. Definitely, the standard American diet. Big, big part of that is a lot of the childhood nutrition programs themselves. We have poor nutrition education in childhood, and then we have the lunch systems that teach kids to eat shitty food.
Dr. Weitz: Right. And that ketchup is a vegetable, and let’s bring fast food and some of this garbage into the school system. So, kids are used to eating that.
Dr. Thompson: Yeah, there was a study done by the University of Michigan that actually showed a direct correlation between kids who ate school breakfast and lunch programs and a 30% increase in their risk of obesity in childhood.
Dr. Weitz: Wow. Yeah. We got to start early with educating our population on how to be healthy if we really want to be healthy as we age.
Dr. Thompson: Yeah, we look at, again, NHANES studies, those sorts of things from the CDC and everything show that 80% to 90% of Americans aren’t consuming the minimum vegetables per day. Again, that starts in childhood, and we see that young women who are eating poor nutrition from just before puberty through their high school years is very indicative of their reproductive prowess later in life.
Dr. Weitz: Right. So, how do we determine which nutrients a woman needs for optimal health, especially when wanting to get pregnant and bring a healthy baby to term?
Dr. Thompson: Yeah, and there’s a lot of nutrients that go into supporting the maternal physiology, even before pregnancy ever happens. I always say preconception nutrition is more important than anything a mother does in pregnancy.
Dr. Weitz: Do you recommend nutritional testing?
Dr. Thompson: Sometimes. It depends. Preconception. There’s some definitely serum vitamin panels that we can do that assess certain nutritional profiles. I do definitely a lot more testing preconception than I do in pregnancy it seems like because that’s the foundation. And it’s amazing what you can find in just basic panels as you’re aware. You look at a CBC very differently than how a Western doc looks at a CBC where they’re looking for overt anemia. And we’re looking for function where we can say, “Ooh, that MCV is a little high. Maybe that’s a B12 deficient folate issue. Let’s check that homocysteine and see if we have some components that could lead into methylation issues in the early pregnancy phase.”
We’re always looking at Vitamin D. Vitamin D is crucial to anything pregnancy-related and you could definitely dive into all the cool biochemical components there that’s a pretty fun one. There’s definitely a number of tests that we do. I always do if I have patients who may have been on long-term birth control use, we always run a day three lab panel where we’re looking at their anti-malarial hormone and their LH to FSH ratio, because that’s very telling of the quality of eggs that she has and sometimes the quantity too. There was a study done. The researcher on it was Sharon Briggs. And it came out in 2020, I believe, and it was one of the first studies that actually showed a direct link between chronic birth control use and lower AMH levels. And for those of you who don’t know what AMH is, it’s that anti-malarial hormone that is produced by the tiny little follicles in the ovary pre-ovulatory follicles. And we use those to measure the quantity of eggs. Right? If you don’t have very many eggs in your ovaries, we don’t get a high amount of that hormone because there’s just not eggs to make that hormone.
But the other thing we see is that it also represents quality of the eggs if we have lots of oxidative stress. If we have low B vitamins in there, low zinc levels, low vitamin D, all of those are associated with low AMH levels. And interestingly, birth control tends to deplete the body of these B vitamins and zinc above the body over the course of time and thus we create poor quality eggs. And if we have poor quality eggs, we have poor quality embryos. If we have poor-quality embryos, we can have poor placentas. If we have placentas, then we can have preeclampsia and gestational diabetes, and all these things being at an increased risk.
Dr. Weitz: And obviously having a high-quality sperm as well.
Dr. Thompson: Absolutely, yeah. Male factor fertility accounts for 50% of infertility issues, miscarriages, and there are studies that now link male factor, nutritional deficiencies basically with the increased risk of preeclampsia.
Dr. Weitz: Right. Interesting. What about running a NutrEval or one of these more extensive nutrition panels?
Dr. Thompson: I don’t do that as a general rule. But yes, if we have people who are we’re doing all this fertility work, we’re not getting where we need to go, definitely, we would run something like that to look for maybe some of those more obscure nutrient deficiencies that can be dominoing through the system. All the vitamins-
Dr. Weitz: Serum levels of nutrients for some nutrients, like vitamin D are very helpful. But when looking at serum levels for other vitamins, they’re not so helpful.
Dr. Thompson: No, not at all. Not at all. I tend to run more functional tests than, definitely, the NutrEval tests are great. But I do a lot more like the homocysteine, methylmalonic acids. I look at the comprehensive metabolic panels. If alkaline phosphatase is low, that’s usually indicative of a zinc deficiency. If protein is low, too, we add in all these factors together to look at that overall body function to get a clue of that, versus this is how much is in your blood. And it’s like, “Well, that doesn’t help us that much.”
Dr. Weitz: What about genetic testing like MTHFR, which you mentioned in your book? Is that something that’s helpful?
Dr. Thompson: It can be. It very well can be. I run it in specific cases, but not as a general rule of thumb. I tend to, again, look at that functional relationship. Is homocysteine elevated? Is the MCV in the CBC elevated? Right. All indicative of that folate B12 dysfunction. If those are showing some signs of, Oh, yeah, no, you’re maybe having issues with breaking down that oh, like, let’s definitely run more than just MTHFR. Seeking health has a great panel now, where they look at all the different genetics that go into methylation because there’s so much more than MTHFR out there.
Dr. Weitz: Of course. I just mentioned one that’s always in-
Dr. Thompson: Oh, I know. We tend to focus on that MTHFR quite a bit because there’s a lot of research on it. It’s been the one that most of the research has been based on since they found it. But I think there’s now more and more studies starting to pop up with all these different components and how… I’m sure you’re aware there’s changing school of thought on MTHFR, versus do we up methylated folate or do we pump choline instead? Right? Do we use may be the pathway that’s a little more functional, and just go, “Well, that one’s broken. Let’s move on.” Right?
Dr. Weitz: And, of course, what does this say about folic acid versus folate?
Dr. Thompson: Oh, yeah. Yeah, I have a whole section, a little mini-nutrient highlight on folic acid versus folate, because there is a lot of debate over it. And when you look at the idea of folic acid, it totally makes sense, theoretically, that folic acid should be better. But it’s not.
Dr. Weitz: And unfortunately, a lot of the older studies on preventing neural tube defects and things like that were done with folic acid, not with folate.
Dr. Thompson: Yeah, it’s very interesting. There’s definitely a lot of back and forth on that.
Dr. Weitz: Well, it’s too bad that folic acid isn’t a billion-dollar drug because then all those studies would be repeated with folate, but of course, it’s not. We don’t have that advantage.
Dr. Thompson: Right. And there was a couple of studies I referenced in my book, too, that talk about the difference between folate and folic acid and how… Really, natural folate has these little proteins attached to it. And we have to break those down in the gut in order to absorb folate. Folic acid, they’ve done it for you. And they just said, “We broke it down.” We’ve got one protein attached to it. You can easily absorb it. And you see those studies. When you compare the two on absorption, folic acid is significantly more absorbable through the gut when you look at serum levels. But when you start, again, looking at those functional values, how is this folate and folic acid getting used in the system once it’s in the bloodstream? That’s where it changes, right? Or if you just look at what happens to the serum, yeah, folic acid raises those levels significantly more than dietary folate.
Dr. Weitz: Right. But if it doesn’t get properly metabolized, and we know that unmetabolized folic acid can be a risk factor for a number of things.
Dr. Thompson: Exactly. Certain studies have linked higher levels of unmetabolized folic acid with autism with some of these neurological components because it can get into the brain.
Dr. Weitz: And estrogen-related cancers as well.
Dr. Thompson: Exactly, exactly.
Dr. Weitz: So, you write that no prenatal vitamin is right all the way through pregnancy, because the needs for nutrients change during the different trimesters. I’m sure they change for each woman, depending upon a lot of other factors too, or diet or stress, whether or not she’s exercising, et cetera. So, what’s a woman to do?
Dr. Thompson: I would love to say, and I know, godly, there is a brand of prenatal that just came out that has trimester-specific prenatals. And I haven’t done my due diligence and really looked into what’s in them.
Dr. Weitz: Yeah, there was one company that had three different ones that didn’t sell so they stopped it.
Dr. Thompson: Right. Because women are like, “I don’t want to do that.” And a lot of women, they choose the one a days, right? Because who wants to take eight pills a day? That’s hard.
Dr. Weitz: I hear that all the time. Yeah. I can’t swallow a bunch of pills. I’m feeling nauseous. What can I do?
Dr. Thompson: Yeah. And-
Dr. Weitz: Open up the capsule and put in the shake.
Dr. Thompson: Exactly. When you look at the material physiology, it is true. There isn’t a prenatal out there that follows all of the maternal needs because a prenatal is designed to help that baby grow. A maternal vitamin would be definitely more of a better nomenclature. We look at first trimester for example. There’s so many metabolic changes that happen. Women have oftentimes up to 15 times the amount of insulin being produced in the first trimester. Certain vitamins like thiamine, magnesium, vitamin D, those become super essential in that first trimester to help for that.
Dr. Weitz: It’s interesting. Can you talk about why there’s 15 times more insulin being produced?
Dr. Thompson: Let’s thank HCG for that. And the need of glucose to facilitate cellular development of the placenta in the uterus. That takes a lot of really quick energy. And sugar is our best source of really quick fast energy and cellular development. And so, when HCG, so it’s the embryo as it develops its little trophoblast cells that become the placenta, we get that production of HCG, which is what we measure in, say, pregnancy tests. HCG in that first trimester completely hijacks the maternal physiology. The first thing it does is it wants to get a lot of sugar to that uterus to help grow that baby and that placenta primarily. And it does that by stimulating the pancreas to increase a lot of insulin. And some studies measure up to 15 times normal levels of insulin production. It’s one of the reasons that women have a lot of morning sickness. To me, it seems like just a horrible biological mechanism that when your blood sugar drops, you get nauseous. Why would your body want to vomit when you actually need more food? But that’s what it does. People who get hypoglycemic, they get a little shocky and they get nauseous. And we see that in that first trimester, is one of the primary causes of morning sickness is low blood sugar.
Dr. Weitz: So, does that tell us what we can do to decrease the likelihood of morning sickness?
Dr. Thompson: It’s one of the things. One of the things is, there’s a reason that women crave carbohydrates in that first trimester. It’s because they need them. Now they don’t need Snickers, right? They don’t need that. But they can totally get away with some good white potatoes, sweet potatoes, whole grains, starchy vegetables, those things go a long way.
Dr. Weitz: So, increasing carbs in the first trimester might be helpful in decreasing that nausea that a lot of women feel.
Dr. Thompson: Absolutely, and pairing it with some good fats and proteins so we don’t get that quick up and down of blood sugar, right? So, it’s nice and sustained.
Dr. Weitz: Slow carbs. And this is why perhaps, it might not be optimal to follow, say, a ketogenic diet during pregnancy.
Dr. Thompson: Right. I have a lot of moms that I work with who did a really strong keto or a paleo diet before they got pregnant. And they’re beating themselves up in the first trimester because really all they want is something like mashed potatoes. And you have to go, “It’s okay.” By all means, eat the mashed potatoes, right? Your body needs that. It’s craving it for a reason. Don’t deny it.
Dr. Weitz: Yeah, on the other hand, we know that in our society, rates of diabetes, pre-diabetes, insulin resistance are sky-high. And those things actually make it more difficult to get pregnant.
Dr. Thompson: Absolutely, yeah.
Dr. Weitz: So, it’s not unusual that there’s going to be a percentage of women who are following perhaps a lower carb diet to get pregnant.
Dr. Thompson: Yeah. And I’ve definitely worked with fertility patients who, that’s what we recommend. Women who do have insulin resistance, PCOS, those conditions do significantly better.
Dr. Weitz: Exactly, exactly. PCOS goes hand in hand, right.
Dr. Thompson: Yeah. And those are the women who actually tend to have that higher insulin production, closer to that 15 times production, is seen a lot of those women who do have insulin resistance. So, it becomes a fun balancing game to make sure their blood sugar stays and more of that mid-range, and they don’t drop too low and they don’t jump too high. And that’s a lot of coaching.
Dr. Weitz: Is there a functional blood sugar range you might want to see during the first trimester, for example?
Dr. Thompson: I don’t like to see fasting glucose that drops below 80, 75 in moms. We don’t run them very often, but sometimes we’ll have midwives, sometimes I’ll run things like a comprehensive metabolic panel that has that. If it’s dropping lower than that, then we’re getting hypoglycemic.
Dr. Weitz: Well, we know that sometimes there are blood sugar problems during pregnancy. We certainly want to prevent those.
Dr. Thompson: Yeah. And when we look at gestational diabetes, that’s more placental-related than it is mom-related. Now, if mom has type two diabetes coming into pregnancy, that’s a completely different pattern. Right? That’s typically not “actual gestational diabetes.” That’s pre-existing type two diabetes that has now turned into pregnancy-related type two diabetes, very different pattern.
Dr. Weitz: So, what causes gestational diabetes?
Dr. Thompson: So, it has to do with really a lot of this hormonal work and more of a placental dysfunction issue. And one of the things that we see-
Dr. Weitz: So, what do we mean by placental dysfunction?
Dr. Thompson: Yeah, so the placenta produces some different hormones. One of those hormones is lactogen. Now lactogen increases in more that third-trimester range, which is typically when we test for gestational diabetes. Lactogen’s job is to block the maternal physiology from bringing sugar into her cells to raise blood sugar levels to give baby sugar to help stimulate fetal growth in those last months of pregnancy. Baby has to put on a lot of body fat. Baby has to stimulate a lot of growth in that last phase. And so, we see a metabolic shift in moms where they go, and they actually burn their own body fat to fuel their own energy and most of the glucose in their diet goes to baby. What we see in gestational diabetes is excessive production of lactogen. So, that, really, no blood sugar gets into mom, and their blood sugar skyrocket. Does that make sense?
Dr. Weitz: Yeah.
Dr. Thompson: And so, when we’re looking at dietary management for gestational diabetes, it’s very different than when we’re looking at type two diabetes dietary management.
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Dr. Weitz: So, what do we do for gestational diabetes?
Dr. Thompson: It varies on the woman. We do a lot of blood sugar watching, and it’s fun to help moms through that sometimes, because some of the foods that they think would be good or would be bad are actually very beneficial, like sweet potatoes, for example. Oftentimes, I have a mom doing a lot of sweet potatoes, even though they’re high glycemic because they also have a lot of nutrients in there that help to regulate a lot of it.
Dr. Weitz: Sweet potatoes are not necessarily high glycemic.
Dr. Thompson: I know, but if you look at a type two diabetes type thing, they’ll tell you, “Don’t do sweet potatoes because they’re high in sugar.”
Dr. Weitz: Well, if you look on the glycemic index, they’re much lower than white potatoes.
Dr. Thompson: Absolutely, absolutely. Usually, white potatoes are something that we’ll consume them, but we pair them, right? We’re going to put a lot of fat with them. We’re going to change the glycemic load of what’s happening. So, usually, we’re monitoring glycemic load over glycemic index, basically. How foods pair together in a meal to balance blood sugars, because we do need those sugars. We just don’t need a lot of the processed sugars. It’s a lot removing of those things. Women who are eating a lot of cereal for breakfast, have cereal, right? It’s a lot of just bringing them back to that whole foods-based diet that they’re probably struggling with to begin with.
Dr. Weitz: It’s amazing. The women I speak to think that eating the cereals are beneficial because of all the advertising and all the things on the boxes that talk about all these health benefits of eating those packaged cereals. It’s incredible.
Dr. Thompson: Yeah, we’ve been sold on that for generations, right? It’s low fat. It’s whole grain. We’ve added vitamins to it. It’s good for you. Pair it with some skim milk. Right?
Dr. Weitz: Exactly.
Dr. Thompson: That’s a great meal. And we wonder why everybody’s sick.
Dr. Weitz: Exactly. Let’s talk about the importance of thyroid function for pregnancy.
Dr. Thompson: Yeah, so going back to that first-trimester aspect, that HCG hijacking the maternal physiology. One of the things that we see is that HCG mimics thyroid-stimulating hormone. It’s structurally very similar and it can bind to the TSH receptors on the thyroid. And what happens is it then hyperstimulates the thyroid to produce more T4 and T3. And so, we’ll see a natural dip if we’re doing lab work, right? You’ll see a drop in TSH, and you’ll see an upswing and reverse T3. And what’s happening is that HCG is basically throwing mom into a borderline hyperthyroid pattern, because we need thyroid hormone to grow placental tissue.
Dr. Weitz: So, let me just stop you for a second. What level are you seeing on TSH and reverse T3 so we have an idea of what we’re talking about?
Dr. Thompson: So, several studies will show that if you have a TSH over a 2.5, you’re at a high risk of miscarriage. You want that TSH to drop to closer to one. Some people drop below one and they’re in the 0.8 range. Okay? Some women dropped even lower and they’re full hyperthyroid, that can get into a little bit of a hyperemesis type pattern. So, we do see that the lower TSH goes to, the more likely we are to have a little bit of a hyperemesis, so severe morning sickness type pattern. Really cool studies that talk about excess iodine in the blood causing, maybe being a cause of some of that hyperemesis.
Dr. Weitz: Okay, so if we have a patient with hyperthyroid during pregnancy, we might want to look at iodine intake.
Dr. Thompson: Exactly, yeah. We may want to lower that intake. And what happens is, T4 comes down to the placenta. We have the deionized enzymes, which are zinc-based enzymes that break down T4 into T3. Some of that T3 stays in the placenta to grow placental tissue, then we have reverse T3 that goes up. And usually, we’re seeing that in right around 23, 25, somewhere in that range. It’s usually above the reference range. And I’ve had homebirth midwives, for example, do full thyroid panels, and I do mentorship and different things, and coach practitioners as well, who send me these labs, and they’re like, “What’s wrong? What do I do? “I’m like, “That’s normal, it’s good. Don’t touch it. It’s fine.” And then, what you’ll also see is you’ll see iodine levels in the blood that pop up as we break that iodine off of T4 to make T3. And so, that elevated reverse T3 and that elevated extra iodine in the blood, there’s a couple of studies that are associating that, again, like I said, with a higher morning sickness type pattern.
Dr. Weitz: What about the women where you see hypothyroid?
Dr. Thompson: Yeah, that gets concerning. I can’t tell you how many recurrent miscarriage patients that we look, and their thyroid looks beautiful before conception, and within four weeks of conception, that TSH is going up, not down, and it hits that 2.5, 2.6, 2.8, 3. And they lose their baby, and it gets missed, and these physicians are running it. Fertility doctors tend to know this. I have 10s of fertility doctors who will see that creeping up and immediately give a level thyroxin. But I think general OBs, midwives, for sure, aren’t typically trained in seeing that. And you will see that creep up and that’s a sign that that thyroid just cannot keep up with the demand of pregnancy. And when that happens, you go back and you have to go, “Okay, well, what’s the underlying cause? Is it autoimmune? Is it Hashimoto’s? Is that what’s happening? Or are we looking at something closer to like an iodine deficiency, a zinc deficiency, selenium,” something along those lines.
Dr. Weitz: Yeah, I was just going to ask about that outside of giving thyroid hormone. What about making sure they have enough iodine, making sure that maybe some of the halogens, bromine, chlorine, fluoride, which are on the same pathway as iodine if you look at the periodic chart, those can block iodine. Do we need to make sure the woman is not consuming a bunch of those? I know, for example, in Los Angeles where we are, chlorine is put into the water to kill bacteria.
Dr. Thompson: Yeah, those are definitely things that we look at and-
Dr. Weitz: And they throw fluoride in there, too.
Dr. Thompson: Yeah, absolutely. Sadly, these are things that we don’t even start looking at until someone’s probably had a couple of miscarriages and that’s sad to me. I hear somebody who has a miscarriage especially if it’s a later first-trimester miscarriage, second-trimester miscarriage, and I automatically want to hug that woman and try to help her not have that happen again because that is physical and emotional loss. It’s a toll and it’s something that we shouldn’t expect moms to have to do three times before the medical system starts to treat it seriously.
Dr. Weitz: Anemia during pregnancy, you touched on that a little bit. I’d like to go into that a little more. You mentioned if you see an elevated MCV, that might show the need for B vitamins. What else do we want to look at as far as preventing or helping to manage anemia?
Dr. Thompson: Yeah, so, anemia. We look at anemia. And of course, we focus a lot on iron. Right? Iron deficient anemia. It is very important. And when you look at classical-
Dr. Weitz: What do you actually consider the best marker for iron? Is it serum iron? Is it TIBC? Is it ferritin levels? Is it a combination?
Dr. Thompson: Yeah, in pregnancy, we look at ferritin mostly, because we have to have a store of ferritin. And there are studies that show that low ferritin levels in the first trimester are indicative of anemia later on.
Dr. Weitz: And what level of ferritin makes you concerned?
Dr. Thompson: Anything below 40. If we’re coming into the third trimester and it’s low, we’re going to have some problems. And it has to do with how, again, changes in maternal physiology. We focus so much on iron, but once a mom hits about mid-third trimester, she is not going to be able to change those ferritin levels. So, part of what happens in second trimester when we are doubling down, we say doubling down, it’s really a 35% increase in red blood cells and a 50% increase in plasma, doubling down on these red blood cells, is she’s storing iron. And I always, again, I joke, everything in pregnancy is preparing for preparing, and what’s happening in this trimester really is to support the mom’s body in the third trimester when everything shifts. And iron is a perfect example of that. A mom’s body accumulates iron, yes, to double down and make that 35% increase in her red blood cells, but more importantly, to store ferritin for the third trimester, where her body actually breaks down ferritin to support the iron needs of both her and her baby.
Because what happens, the same thing, we see a shift just like we did in insulin and blood sugar, and it all gets diverted to baby in that third trimester. Same thing happens with iron. Babies have to accumulate just under 400 mg of iron in their own ferritin stores before birth, because in the fourth trimester, the postpartum period, they can’t absorb iron out of their breast milk, and they are living off of their ferritin reserves. So, in that second trimester, we focus so much on the iron component of anemia, not because it’s the primary cause of anemia, but because if we get to third trimester and a mother doesn’t have her ferritin stores, she is going to struggle and then she’s going to struggle postpartum recovery. Does that make sense?
Dr. Weitz: Absolutely.
Dr. Thompson: And so, ferritin to me is way more important. If I see somebody who’s got a hemoglobin level that’s hitting that 11-mark, yeah, we’re going to run a ferritin and we’re going to see, are you making ferritin? Is that why you’re a little low? Because your body is really focusing on this. We need that to be at a certain level. When we look at the studies in reality, iron deficiency anemia only accounts for about 30% of all pregnancy anemia cases. We look at the function of red blood cells, how they’re made, well, there’s a lot of things that go into it, right? We have to have vitamin C to pull the iron into the cells. Vitamin C deficiency is surprisingly common in pregnancy. It’s one of the things that we see associated with preterm labor, early cervical remodeling can be associated with not enough vitamin C.
Dr. Weitz: Let’s not forget vitamin C. In this age when we have all these exotic nutrients, we sometimes tend to forget the basics like vitamin C.
Dr. Thompson: Yeah, it’s so true. It’s so true. And it is a very crucial nutrient as the water-soluble antioxidant. It helps with the collagen. What is the cervix? It’s a big chunk of collagen, and it needs vitamin C and vitamin E to be stable during the remodeling process. And for those that don’t know, remodeling of the cervix actually begins around 25 to 28 weeks. By that time, the mom’s body is already starting to prepare for childbirth. And we have to have a high amount of antioxidants in the system to negate the inflammation that is occurring in the body so we don’t go into labor too soon.
Dr. Weitz: What’s the best way to get iron?
Dr. Thompson: Well, everybody’s favorite food, liver. I’m a big proponent of liver in pregnancy, but I also have a lot of plant-based patients who do really well just doing a bunch of legumes. Interestingly, again, in pregnancy, so outside of pregnancy, we see that heme-based iron is significantly more absorbed the non-heme iron. So, heme iron is the animal-based iron, non-heme plant-based. In pregnancy, the absorption rate is the same.
Dr. Weitz: Okay. But if we’re going to consume a bunch of legumes, we might be consuming lectins.
Dr. Thompson: That’s right. So then, we go into preparation methods. Right? And that’s where diet culture comes in. I’m not anti-legumes. I think we’ve just lost our innate knowledge of how to prepare so many different foods because we’ve lost our connection to culture and history. There’s markings on walls and Aztec buildings of food preparation methods. And one of them is soaking legumes, and not just doing a quick overnight soak. That’s not what we’re talking about. We’re talking about sprouting these legumes, right? Here in Colorado if I’m going to sprout my grains or legumes or nuts and seeds or any of the high lectin, oxalate, phytate type things, I’m not just going to do it overnight. I’m doing it, especially now in the winter, like 20 degrees out right now. I’m going to be doing it for three or four days. And I’m looking for the chemical reaction.
Dr. Weitz: I can’t even remember to do it overnight.
Dr. Thompson: I know, right? I’m waiting for that chemical reaction. And anybody who’s done that will notice that the water gets bubbly. Right? There’s gases that come out of those legumes. That’s what you’re looking for. You’re looking for a breakdown in these anti-nutrients. And in that process, they release gas. And that’s what you’re looking for. And then, you know you’ve really broken those legumes down and now they’re more like-
Dr. Weitz: What about using a pressure cooker?
Dr. Thompson: Pressure cookers can work.
Dr. Weitz: Need shortcuts.
Dr. Thompson: They’re not my favorites because they don’t allow for the germination aspect. Right? They just pressure and it does break down some of it, absolutely. But to really get the full nutritional benefit, soaking those legumes is the best way. And I’ve soaked them before and I’ve done big batches at my house and then taking them and froze them. And then, pull them out when I’m ready to use them.
Dr. Weitz: Right. So, for vegetarians, it’s legumes. We can’t eat the livers from plants. [crosstalk 00:40:26] So, another problematic condition during pregnancy is hypertension. We call it preeclampsia. What can we do to prevent and or help with this condition?
Dr. Thompson: So, study after study links dietary patterns with an increased risk of preeclampsia, preconception and during pregnancy. And the most causative or correlated factor in diet was the consumption of vegetables. So, those who consume more vegetables in their diet have a decreased risk of preeclampsia. And if you remember again, 80% of Americans are consuming the minimum vegetable intake. And we know that that’s probably really subpar anyways. So, let me even up that number a little.
Dr. Weitz: Yeah, especially since potatoes are considered vegetables. So, French fries qualify as vegetables in there. And the ketchup they put on is the second vegetable.
Dr. Thompson: That’s right. That’s right.
Dr. Weitz: And even then they’re not making minimum.
Dr. Thompson: Preeclampsia is a very complicated condition. But what seems to be the primary connecting factor between all the different theories as to the progression of preeclampsia is placental dysfunction. And the placenta really develops a lot of health, its functionality in the first trimester in the beginning of the second trimester. And so, a lot of preeclamptic conditions develop before the mom even knows she’s pregnant. And really, that first-trimester phase is highly dependent on what the mom and dad, the egg and the sperm, brought to that pregnancy in that initial development of those trophoblast cells that become the placenta. Almost every vitamin and mineral deficiency is associated with preeclampsia. It used to be way back, decades ago, they talked about preeclampsia being a disease of B vitamin deficiency. They didn’t know why at the time. Now, we know things like methylation, right? B vitamins are really important for that. We know how B vitamins play into the Krebs cycle, and energy production, and oxidative stress and all those things.
Oxidative stress is a primary driver of preeclampsia. There’s a lot of things that go into that. Coenzyme Q10, antioxidants associated with oxidative stress. Very interesting studies in… Enrique A. Teran from Ecuador, he has done so many studies on linking Coenzyme Q10 with placental dysfunction and preeclampsia, and they’re fascinating. And links that show things like high elevation, age-related, dietary-related, associations with CoQ10. And this increased risk of preeclampsia.
We see in the body that the need for preeclampsia increases throughout pregnancy. As estrogen levels go up in pregnancy, as cortisol levels go up in pregnancy, we see a rise in LDL in the body. And with that rise, we also see a rise of CoQ10. Now, as we age, we don’t produce as much CoQ10 as we used to, right? And there’s interesting correlations with this low CoQ10 level and preeclampsia. And so, it goes back to oxidative stress as the driving factor, whether it’s B vitamin deficiencies, whether it’s antioxidant issues like CoQ10 or superoxide dismutase. There was a study from 2020 that linked manganese deficiency and superoxide dismutase deficiency with an increased risk of preeclampsia. So, when we’re looking at-
Dr. Weitz: I’ve even seen a few papers with L-carnitine as being beneficial as well.
Dr. Thompson: Yeah, absolutely. And that goes into some of that metabolic factor stuff, and when the mom is really super catabolic and she’s breaking down her own body fat. And the acetyl L-carnitine or L-carnitine, in general, helps her break down those fatty acids into energy.
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Dr. Weitz: In the last 10 minutes, let’s focus on some of the most important nutrients, a number of which we’ve already talked about but maybe we need to talk a little more about. So, Vitamin D. I know you mentioned that the amount of vitamin D in the typical prescription prenatal is still like a joke compared to what we really know is needed. It’s still recommended that people get 400 or 100s of mg. All the data that I’ve seen working with patients for a number of years with functional medicine, actually decades, is they need 1000s or sometimes even 10,000. So, taking 400 is like a joke.
Dr. Thompson: No. Yeah, the current RDA for pregnancy on vitamin D is 600 international units, 400, preconception. Now, there was a study in 2011. And this is 10 years, I mean, 12, so 11 years ago now. Right? I can do math. It was a decade ago. And we’re just now starting to take the study seriously. Right? What this study did is, the whole premise was to see how much vitamin D supplementally a mother needed to maintain, 32 was their magic number, 32 ng/mL of vitamin D in the serum throughout pregnancy. Okay? Now, for those who know reference ranges, the reference range of Vitamin D is between 30 and 100. Studies now show, really, it should be more like 40 and above. This study was looking to keep it at 32. And they needed a minimum of 4000 international units per day to maintain that level throughout pregnancy. That’s a lot. That’s way more than 600 that we’re currently telling women they need. And vitamin D is essential for almost every function of pregnancy
Dr. Weitz: So, what do you do? You give them a prenatal and then you give them extra vitamin D?
Dr. Thompson: That’s what we do.
Dr. Weitz: And then, they freak out and say, “Oh, my God”, and the medical doctor says, “Oh, I don’t know. It sounds like a lot.”
Dr. Thompson: It sounds like a lot, right? They’re worried about increasing calcium buildup in the placenta and all these things. This study at 4000 international units per day found zero negative side effects, zero. No negative implications were associated with that 4000.
Dr. Weitz: Has anybody looked at vitamin K, making sure there’s no calcium buildup in the placenta?
Dr. Thompson: Not that I’m aware of. But that’ll give me something to look for. You gave me something I need to research. I love it.
Dr. Weitz: Because that’s what we do in the functional medicine world when we prescribe vitamin D, is make sure we prescribed vitamin K2 because that reduces arterial calcification. It makes sure that the calcium that gets upregulated doesn’t end up in the soft tissues.
Dr. Thompson: Right, right. And that’s what we do, too. Every vitamin D supplement I give has K2 in it, and we have to have it. K2 is essential for so many other things in pregnancy too. And again, it’s a forgotten nutrient, especially in maternal care. It’s one of those primary drivers of regulating blood clotting. And when you go into labor, it is a very important part about not dying in childbirth, is the ability to clot. And they take care of babies, like, “Oh, well give him a vitamin K injection,” because historically, they found that that was an issue because moms were deficient. But instead of treating moms, they just said, “Well, we’ll fix babies. It’s fine.”
Dr. Weitz: Exactly. Forget about the mom.
Dr. Thompson: They don’t care about mom. But back to vitamin D, vitamin D, again, does a number of things in the body. One of the things it does and why it’s really this important gateway nutrient to a number of different complications in pregnancy, is that it regulates the P450 enzymes that go into steroidogenesis. So, these enzymes that help to make estrogen, progesterone, cortisol, testosterone, all these hormones that are skyrocketing throughout pregnancy.
Dr. Weitz: It’s hard to find a system or physiological process in the body that vitamin D doesn’t have some role.
Dr. Thompson: It’s so true. So true. And the most nutritionally deficient nutrient in the diet.
Dr. Weitz: So, my next most favorite nutrient besides vitamin K and D is omega-3. And this is another reason why that prescription prenatal that’s just that one a day, there’s no way you can pack any substantial amount of omega-3 in that tablet or capsule. And yet we know that omega-3 especially DHA is super important. Can you talk about that?
Dr. Thompson: Yeah, and DHA is really important, so I have a whole section in my book on this because it’s something that, again, I don’t have a study that really solidifies this idea that I have, but a lot of studies that link to a possible complication if we isolate DHA in prenatal supplementation. So, the studies who look at the beneficial effects of DHA on brain development, on all these things we talked about in prenatal care, they used a combination of EPA and DHA in the studies and found high amounts of DHA in the brain and said, “Oh, we got to do DHA.” But we also know that DHA if it’s isolated, we see that in cardiovascular studies, blocks the ability of thromboxane A2 to work in the body. Now, what is thromboxane A2? Thromboxane A2 is the primary coagulant in childbirth. So, when we go into labor, our body produces a large amount of this blood-clotting agent. It’s the primary driver that makes the uterus and the placenta as they detach caught, right? DHA blocks that. It prevents that thromboxane A2, in studies, from doing its job of clotting the blood. If you add EPA to it, that doesn’t happen. EPA becomes prostacyclin. Prostacyclin and thromboxane A2 balance each other’s effects. So, if we remove that EPA aspect, all we have is an anticoagulant.
Dr. Weitz: So, make sure we take EPA and DHA together.
Dr. Thompson: Yes. And EPA helps bring DHA into the fetal brain. The whole reason that moms are trying to take DHA. Without EPA, that DHA doesn’t get into the fetal brain.
Dr. Weitz: Okay, now, what about the ratio? Is the ratio of EPA and DHA that’s found in fish oil, is that optimal? Or would it be better, say, to have instead of this range to have maybe EPA and DHA together and then some extra DHA?
Dr. Thompson: I lean towards what is the natural balance found in fish? The original study was done on Inuit women, and how much fish they consumed. And looking at that ratio of EPA and DHA in their blood, and comparing that to cord blood. Right? Nature isn’t dumb. And sometimes we try to over science nature. And I feel like the fish oil, EPA, DHA, omega-3 world is really trying to outsmart nature. So, what I do with my patients is I push just straight fish oil.
Dr. Weitz: Right. But this will also say to those vegetarian patients that they’re algae-based DHA supplement is not optimal.
Dr. Thompson: Right. I dislike the algae-based DHA supplements for a number of reasons. I just don’t like them. I don’t see any studies that show that they are better. I see more studies that show that there might be more of a risk.
Dr. Weitz: Right. And you certainly don’t want to eat tuna every day while you’re pregnant.
Dr. Thompson: And that gets complicated too.
Dr. Weitz: Right. Consider mercury. So, I think we’re just about out of time. We did not say anything about a lot of stuff. But one thing is calcium. So, I just want to touch on calcium, which is yet another controversial mineral.
Dr. Thompson: Yeah, well, we talked about preeclampsia earlier. Calcium supplementation is the only nutrient so far in research that has been shown to have an acute effect on preeclamptic symptoms, meaning calcium supplementation reduces the symptoms of preeclampsia. And it’s the only nutrients that we know in research has that actual effect, but yet it’s one of those ones that we just go back and forth on.
Dr. Weitz: So, how much calcium should women during pregnancy consume, supplemental?
Dr. Thompson: I think it depends on the individual, their diets, all those things. I don’t do additional calcium supplements.
Dr. Weitz: You don’t?
Dr. Thompson: No. Nothing outside of basic prenatal-
Dr. Weitz: Well, some prenatals have a lot of calcium, some have a little bit.
Dr. Thompson: That’s true.
Dr. Weitz: And once they have multiple pills, they’re going to have separate calcium magnesium supplements. The one a day is only going to have a little bit. So, is 50 mg enough, 500 mg? What’s optimal?
Dr. Thompson: I tend to aim for 1000.
Dr. Weitz: A thousand?
Dr. Thompson: Yeah. We’re aiming high. And the goal again is to get it in diet. Anywhere we can get it in diet is going to be better.
Dr. Weitz: But then, you have problems with consuming dairy. Right? Because the proteins in dairy that are allergenic.
Dr. Thompson: And it depends on the person. I’m not opposed to dairy. I’m not. In pregnancy, sometimes we use dairy high diets, specifically in cases of preeclampsia. I will have women, I will have them try to drink half a gallon of milk a day. Good quality, full fat, grass-fed milk.
Dr. Weitz: Wow. A half a gallon of milk per day.
Dr. Thompson: Yes. And we’re talking severe preeclamptic situations where they’re spilling proteins. And we know we need to keep that protein level elevated, plus we need the calcium, the vitamin D, conjugated linoleic acid in the milk also helps. The other thing is milk contains insulin-like growth factors, right? One of the things that we worry about today, people with PCOS.
Dr. Weitz: Right, because it’s added, right?
Dr. Thompson: Exactly. But in cases of preeclampsia, the placenta itself produces insulin-like growth factors. And in preeclampsia, they don’t. And you have to have that insulin-like growth factor to stimulate a number of different functions in the physiology of both the baby and the mother. And the milk facilitates that. We’re supplementing insulin-like growth factor that the placenta should be making that it isn’t making.
Dr. Weitz: Interesting Wow. This conversation had a lot of clinical pearls. I want to thank you for that.
Dr. Thompson: Yeah, of course. My pleasure.
Dr. Weitz: I really enjoyed this. How can our listeners find out more about you and how to contact you?
Dr. Thompson: Yeah, absolutely. So, my website-
Dr. Weitz: And how to get your book as well.
Dr. Thompson: Yeah. My website is www.functionalmaternity.com. People can find the book there. They can link my clinic there. I have patients all over the world that I follow through pregnancy, whether it’s just general health, specific complication management. I also offer practitioner mentorship programs. We’re working on a group mentorship thing that we should be doing the summer, mostly case study review. So, all of that will be found on that website. Social media-wise, we are at functional.maternity on everything. And then, currently, the book is on Amazon. And it should be in some retailers here before too long as well.
Dr. Weitz: Barnes & Noble as well.
Dr. Thompson: Hopefully. You can request it from them. They don’t carry it yet. But it’s in their system. They can order it.
Dr. Weitz: Okay, I’ll do that. Thank you so much, Dr. Thompson.
Dr. Thompson: Thank you.
Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness Podcast. And if you enjoyed this podcast, please go to Apple podcasts and give us five-star ratings and review. That way, more people will be able to find this Rational Wellness Podcast when they’re searching for health podcasts. And I wanted to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica Weitz Sports Chiropractic and Nutrition Clinic. So, if you’re interested, please call my office, 310-395-3111 and sign up for one of the few remaining slots for a comprehensive nutritional consultation with Dr. Ben Weitz. Thank you and see you next week.
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