Podcast

Episode 4- Finding the Best Pre-natal Supplements with Ayla Barmmer

Ayla Barmmer, MS, RD, LDN is a Registered Dietitian trained in integrative and functional medicine, who specializes in women's health and infertility. Ayla owns and operates Boston Functional Nutrition, an integrative and functional nutrition practice. She is the co-founder of the Women's Health Nutrition Academy, an online academy delivering cutting edge, evidence-based continuing education for healthcare practitioners. She is also the owner and creator of Full Circle Prenatal which includes Full Circle Prenatal Multivitamin, a high-quality prenatal multivitamin delivering optimal nutrients before, during and after pregnancy and now also, Full Circle Fish Oil with highly concentrated DHA.

Episode 2 of our podcast scratched the surface on the importance of preconception nutrition but with Ayla, we take a deeper dive into some of the key nutrients for fertility, compromises made in common prenatal supplements and why she decided to take the leap into starting her own prenatal supplement company.

You can find Ayla on Instagram as Aylabarmmer_RD or @Fullcircleprenatal bostonfunctionalnutrition.com   & fullcircleprenatal.com

For 10% off the Full Circle Prenatal use Coupon code-

WOODALLWELLNESS10

Topics

  • Taking a Whole body approach to Fertility.

  • Important Lab testing in Fertility

  • Importance of Glycine

  • 3rd Party Testing of Supplements

  • Is MTHFR the only type of folate to think about during pregnacy

  • Holistic pre-natal nutrition

Episode 3- Iron- THE MOST COMMON Nutrient deficiency people don't talk enough about

Functions of Iron in the body? 

  • Oxygen transport, and use,

  • Amino acid metabolism,

  • CARNITINE synthesis

  • COLLAGEN synthesis,

  • THYROID hormone Synthesis

  • Some Enzymes that iron is involved in

    • Catalase (anti-oxidant defense)

    • Cytochromes (mitochondria for ENERGY)

    • myeloperoxidase,

    • thryopeproxidase,

    • lysine/proline dioxygenases,

    • PEPCk

Symptoms

●Fatigue

●Restless legs syndrome

●Headache

●Exercise intolerance

●Exertional dyspnea

●Weakness

●Dry or rough skin

IRON FACTS

Absorbed in Small intestine- Duodenum

Things that cause us to be deficient

  • #1 heavy menstrual bleeding

  • Pregnancy

  • Gut issues- Celiac, PPIs, Gastritis, H. pylori, SIBO

  • Exercise induced loss - (probably causing a GI issue)

Q: Sources of Iron nutritionally- 

  • Top 3-5 Animal (Clams, Oysters, Liver, Red Meat, Dark Chicken)

  • Top Plant Sources- (Spirulina, Molasses, Chickpeas, lentils, Spinach,)

Q: Who's at risk for Iron Deficiency? 

Q: How do we define Iron Deficiency?

  • Lavs vs. optimal Reference range

    • Iron expert Dr. Michael Auerbach MD uses a cutoff of 30 ng/mL. 

    • Normal ferritin concentration ranges from 30 to 200 mcg/L

Iron Deficiency on Labs

  • Serum ferritin <30 ng/mL

  • Transferrin saturation <19 percent

  • Different Reference ranges in different countries, 

  • Also different clinics have different ranges, ie GI clinic.

Problems w/ Insurance

  • Iron Infusions

Supplements we love and WHY? 

IV Infusions

Enhancers of absorption:

  • Acids (ascorbic acid/vitamin C) - brush-border enzyme DCYTB (duodenal cytochrome B) reduces ferric to ferrous iron

  • Meat, fish, poultry (MFP) – cys residues bind and help solubilize ferric iron, amino acids and peptides improve iron bioavailability and absorption  Nutrients 2017 PMID: 28617327

  • Iron deficiency (low iron status)

Inhibitors:

Competitors for transport

  • Zinc, manganese, calcium

  • " zinc-DMT1/FPN1 axis is a critical determinant of zinc-deficiency-induced changes in iron homeostasis and helps understand the mechanism of iron and zinc interactions.” 2019 Nutrients, PMID: 31412634

  • Mechanism of calcium inhibition is more short-term and no long term effects, don’t eat in same meal

Formers of insoluble complexes

  • oxalic acid (dark leafy greens like spinach and chard, nuts, grains, legumes)

  • phytic acid (unsprouted/unfermented grains, legumes and nuts) Phytic acid, an abundant secondary metabolite of plant foods, chelates dietary iron, and limits its intestinal absorption. Since phytic acid also inhibits the zinc absorption, higher risk of zinc deficiency is expected in populations with high prevalence of anemia

  • tannins (teas, wines, beer, chocolate, berries, legumes, nuts, grains)

Physiological states

  • Reduced stomach acidity

To support healthy iron levels:

Animal sources of (heme) iron are bio-available whereas plant sources (non-heme) are extremely hard to convert and absorb.

  • Include red meats (beef, bison, lamb, game meat) at least 3x/wk. Preferably from grass-fed sources.

  • If possible include liver 1-2x/wk: either in capsule form (Vital Proteins Liver Capsules or Paleovalley Organ Complex) or hidden into ground meats. Use a 4:1 ratio (1lb ground meat to 1/4 lb ground liver) when making meatloafs, meatballs, patties, or meat sauce.

Plant sources include 1 tbsp molasses, spinach, spirulina, dried apricots or lentils. Though portions necessary to reverse deficiency or maintain levels are difficult to obtain solely from plants so supplementation may be necessary.

Other tips:

  • Cook your food in a cast iron skillet or use the "lucky iron fish" in your cooking

  • Always pair your plant-based-iron foods with vitamin C foods to help enhance absorption, such as bell pepper, citrus, kale, strawberries, or rosehip tea.

  • Avoid having plant-based iron with other calcium or zinc-rich foods/supplements (like dairy or grains) or absorption inhibitors like tea or coffee.

Prevalence

For females, iron deficiency anemia was present in nearly one in five!

Women are at a greater risk, so get tested

 Vegan’s/Vegetarians are at a greater risk

Where does Iron go in the body?

●RBCs – Approximately 2 g goes to the RBCs

●Iron proteins (eg, myoglobin, cytochromes, catalase) - 0.4grams

●Plasma iron bound to transferrin – 3 to 7 mg

●Storage iron in the form of ferritin or hemosiderin – about 1 gram for men and 0.5 grams for women

Sources

  • 5mg /3oz Liver

  • 2 mg/3 oz Hamburger,

  • 1 mg/3 oz white turkey chicken, 2 mg for dark meat turkey

  • Clams- 12/3 oz, oysters 8mg/3oz

  • Spinach 3.7mg/cooked per half cup

Avg American gets 10-14mg/per day

RDA-

  • 8mg MEN

  • 18 mg Women

  • 28 mg if Pregnant

SOURCES-

Causes and diagnosis of iron deficiency and iron deficiency anemia in adults

Author:Michael Auerbach, MD, FACP

Literature review current through: Apr 2020. | This topic last updated: Apr 15, 2020.

Episode 2- Before the bump, bump up your nutrition

Is preconception nutrition a new idea?

Traditional cultures prized nutrient dense foods like organ meats, fatty fish, bone-in meats, and eating nose-to-tail. Without even having names for the nutrients found in these foods, they had such strong intuition ( and generations of practice) to know exactly which foods helped young couples conceive. 

Through optimizing your body's digestion, detox capacities, and nutrient status we:

  • directly optimize your womb's ability to release healthy eggs

  • produce fertile cervical fluid

  • implant fertilized eggs

  • develop an embryo

  • increase nutrient absorption and utilization

  • create a favorable epi-genetic environment for your future baby, and manifest healthy pregnancy & birth outcomes.

When to start pre-natal nutrition

In general I recommend 6 months but depending on the woman’s health history it may take more or less time. It takes 4 months for women to see a change in egg quality after implementing diet and lifestyle changes.

SYMPTOMS that may be a clue you need to work on your nutrition before conceiving

  • Period problems: Irregular cycles (long, short or skipped), heavy or light menstrual flow, painful periods, missing ovulation

  • Previous pregnancy complications: miscarriage history or challenges with previous pregnancy (pre-ecclampsia, gestational diabetes, preterm birth, etc.)

  • Severe mood swings

  • Low energy

  • Poor digestion: IBS/SIBO, diarrhea, constipation, gas, bloating, cramping.

  • Known toxin exposures: nail/hair salon frequently, using generic household cleaners, mainstream skincare products, high-mercury seafood intake.

Think “if you don’t do ICF, you might need IVF”

  • Iron- 20-65% of menstruating women have deficient reserves (ferritin)

  • Choline- intake should be between ~400-900mg depending on genetics. 2-3 eggs per day!

  • Folate- Bioavailable folate > folic acid especially for individuals with MTHFR variations.

Anisa’s Favorite Prenatal Vitamin (use code: WOODALLWELLNESS10 for 10% off)

3 Food Groups to be mindful of during pregnancy

  • High glycemic foods- first trimester HbA1c is 98% predictive of Gestational Diabetes.

  • Dirty dozen- EWG.org 

  • High mercury fish- Be mindful of Tuna and halibut especially. Though, DHA-rich seafood is still super important! A 2018 Cochrane review reported DHA intake is associated with 42% reduction in preterm (<34 weeks) birth while also reducing maternal risk such as preeclampsia, GD, PPD, hemorrhage etc. If RBC DHA is >5% then there’s reduced risk of low gestational age. Best sources of low mercury high omega-3 fish include wild-caught salmon and sardines.

Working with Anisa you'll learn:

  • How to listen to your intuitive voice and rebuild your relationship with food while preparing your body to carry life

  • How to use real-food to improve your energy, normalize your periods and fuel the life you want to live

  • The ins-and-outs of your menstrual cycle; learning to shift it to your advantage for fertility and optimizing metabolism.

  • How to prepare your body for a healthy baby, pregnancy, birth and postpartum while preserving your own health and well-being along the way

My Fertility Nutrition Coaching Includes:

  • 6 months of holistic nutrition and lifestyle support

  • 2-  60 minute nutrition consultations in the first month

  • 4- 45 minute monthly nutrition consultations

  • 1- 45 minute Fertility Awareness educational session

  • Preconception laboratory recommendations 

  • Personalized supplement recommendations 

  • 20% discount on professional grade supplements ordered through my dispensary


Books Mentioned in this podcast episode

The Fifth Vital Sign

Real Food For Pregnancy



Studies-

DHA and preterm birth: Middleton P, Gomersall JC, Gould JF, Shepherd E, Olsen SF, Makrides M. Omega-3 fatty acid addition during pregnancy. Cochrane Database Syst Rev. 2018;11(11):CD003402. Published 2018 Nov 15. doi:10.1002/14651858.CD003402.pub3

An Early Pregnancy HbA 1c >5.9% (41 mmol/mol) Is Optimal for Detecting Diabetes and Identifies Women at Increased Risk of Adverse Pregnancy Outcomes. Hughes, R. C.E., Moore M.P., Gullam J., Mohamed K., Rowan J.Diabetes Care 2014;37:2953–2959. DOI: 10.2337/dc14-1312