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Choosing Your Perfect Prenatal Multivitamin

September 16, 2020

As you begin your preconception journey, it’s important to start taking a prenatal multivitamin. Here’s the thing – there are SO many to choose from. You’ve got your pick at your pharmacy, at health food stores, and online – and some of them with the most beautiful branding.

Choosing your perfect prenatal can be difficult, and oftentimes people will simply choose the cheapest option, or one recommended by a friend. When it comes to a supplement that you’ll likely be taking until you stop chest/breastfeeding – you want to ensure you’re taking something that has quality ingredients and sufficient dosages.

Forms of Vitamins and Minerals

Active vs. Inactive

The B vitamins in many prenatals are in their inactive forms. While they can be converted to the active form, it can be difficult for some people. Moreover, active B vitamins are often better absorbed and therefore better utilized by the body.

Look for these ingredients:

  • Vitamin B2 – choose riboflavin-5-phosphate
  • Vitamin B6 – choose pyridoxal-5-phosphate
  • Folic acid – choose methylfolate (more below)
  • Vitamin B12 – choose methylcobalamin

Folate vs. Folic Acid

As you probably know, one of the most important vitamins to take during preconception is folate. This important B vitamin is needed for neural tube defects. In addition, studies have shown that taking folate in the preconception period may increase chances of becoming pregnant and hopefully result in a live birth.

Methylfolate is the active form of folic acid, and while it does the same thing as folic acid, the active form may be better absorbed and used. When choosing a prenatal, look for about 600 mcg in folate levels, although in some cases such as a neural tube defect in a prior pregnancy, a higher dose of folate is required.

Iron

During pregnancy some people will stop taking their prenatal because it causes nausea and/or vomiting, constipation, and stomach pain. This isn’t great because as seen above a prenatal (especially the folate) is important during early embryonic development.

The form of iron in prenatals is typically the reason why people stop taking them – usually it’s in the ferrous sulphate form which is poorly absorbed. Look for iron glycinate instead which is easier on the digestive system. Iron is also better absorbed with vitamin C – another common ingredient in your prenatal.

Iron is really important in pregnancy as blood volume increases during the second and third trimester, thus leading to a decrease in iron. A deficiency results in low energy, cold hands and feet, hair loss, and restless leg syndrome.

Oxide vs. Citrate

When taking a look at the ingredients list, look for citrate forms of vitamins and minerals if possible. Most ingredients are found in the oxide form, but this form isn’t always absorbed well.

Dosage

Because there are tons of prenatal multivitamins on the market, the dosage of vitamins and minerals vary greatly. At the end of the day, they all provide the amount that you need throughout preconception and pregnancy.

However in professional brands you may see a larger amount of B vitamins, important because these are needed for energy (you will be/are growing a baby!), developing brain and nervous system of your baby.

Some brands contain more vitamin B6, which is a first line treatment for nausea and vomiting in pregnancy. Taking too much vitamin B6 is possible, so be aware of the following symptoms: change in sensations to fingers and toes, rashes, walking, reflexes, nervousness, insomnia, feeling ‘wired.’ Before adding more vitamin B6 to your first trimester supplements, speak to your doctor. Or even consider other first line treatments like ginger or acupuncture.

Additional Ingredients

A simple multivitamin with only vitamins and minerals will do the trick. Some brands, particularly those inexpensive formulas found at the pharmacy contain additives. These may not matter to you, but they may have negative effects on the body. A common endocrine disruptor, BHT is found in some brands. Moreover unnecessary colours are also found in some prenatals like: FD&C Red #40 Aluminum Lake, FD&C Blue #1 Aluminum Lake, FD&C Yellow #6 Aluminum Lake, D&C Red #27 Aluminum Lake, FD&C Blue #2 Aluminum Lake.

Some prenatals found at health food stores contain proprietary herbal blends. While a good thought, these are also unnecessary because it doesn’t outline how much of a particular herb you’re getting.

Probiotics may also be found in prenatal vitamins, which can be unnecessary. They may be added in to promote gut health and prevent group B strep (a bacteria tested for in the 3rd trimester). But the strains often aren’t protective or used to help prevent GBS in pregnancy. In which case, you may want to consider taking a separate probiotic supplement in the second or third trimester depending on your history of vaginal/urinary tract infections or a previous positive GBS test.

Final Thoughts

As you can probably see, there’s a lot more involved in choosing a prenatal than picking the lowest-price option. However, if that’s all you can manage at this point that’s okay because it will have all the recommended dosages of what you need.

If you can opt for a professional brand which has better absorbed forms of ingredients and limits any unnecessary ones, that would be a great option. Typically these would be a 2 or 3 capsules per day product, which isn’t as convenient as a 1 capsule per day, but you can likely take all 3 capsules at once.

If you have any questions about the right prenatal supplement for you, or any questions in general about vitamins and minerals during your pregnancy, reach out to a Naturopathic Doctor. We can help you figure out what would be the best supplements for you to take during your pregnancy.

References

Kominiarek, M. and Rajan, P. (2016). Nutrition Recommendations in Pregnancy and Lactation. Medical Clinics of North America, 100(6), pp.1199-1215.

Sebastiani, G., Herranz Barbero, A., Borrás-Novell, C., Alsina Casanova, M., Aldecoa-Bilbao, V., Andreu-Fernández, V., Pascual Tutusaus, M., Ferrero Martínez, S., Gómez Roig, M. and García-Algar, O. (2019). The Effects of Vegetarian and Vegan Diet during Pregnancy on the Health of Mothers and Offspring. Nutrients, 11(3), p.557.

Basic Fertility Testing in Your 30s

July 27, 2020
basic fertility testing naturopathic doctor toronto

If you’re approaching your mid 30s and are starting to think about kids, you may want to consider getting some of your hormones tested. You might be thinking, “My periods are like clockwork, isn’t that good enough?” Maybe – but having regular periods doesn’t truly give us a glimpse of your hormones.

As we age, our hormones begin to change, and it can take longer to become pregnant. Normally it’s recommended that people under 35 seek care (ie. go to a fertility clinic) if they’ve been trying for about 12 months without a live birth. If you’re over 35, then it’s recommended that you seek care if you’ve been trying for 6 months without a live birth.

It’s been my experience in practise where couples under 35 don’t want to wait out that full year before they begin to seek out help. Measuring basal body temperature, assessing cervical fluid, using ovulation predictor kits, timing sex, and the two week wait can be really stressful – and after a few months of unsuccess, people are ready for answers.

Many people think that fancy tests need to be done to get an assessment about fertility – and that isn’t true. I like looking at blood work because it gives us an idea of what’s going on upstream (aka. in the brain). Whereas urinary metabolites looks at the downstream products. Ideally, we want to see how the pituitary gland is functioning, not the different types of estrogen metabolites (which won’t really tell us anything about what’s going on fertility-wise). Not to mention, fertility clinics aren’t using urine tests to guide their treatments, they’re using serum (aka. blood).

Basic Fertility Assessment

If you’re wanting to get some basic tests done potentially before visiting a fertility clinic, here’s what you should consider. All of these tests can be ordered by Naturopathic Doctors.

FSH (Follicle Stimulating Hormone)

FSH is a hormone that stimulates ovarian follicles to grow and develop. In some women, the pituitary secretes a lot of FSH to encourage the ovary to respond. When this begins to happen, it’s usually due to a decline in ovarian reserve (the total number of gonadotropin-responsive follicles and oocytes within a person’s ovaries at any given time), and we would typically start to suspect this when the FSH is over 10mIU/mL.

FSH should be tested on day 3 of your menstrual cycle.

Estradiol

This is a form of estrogen that is typically measured early on in your cycle in conjunction with FSH and AMH as a means to assess your ovarian reserve.

Estradiol should be tested on day 3 of your menstrual cycle.

AMH (Anti-Mullerian Hormone)

AMH is produced by the granulosa cells surrounding each oocyte in developing ovaries, and serves as a marker of ovarian reserve as it reflects the size of the follicle pool. An AMH greater than 0.8-1.0 ng/mL is suggestive of a normal ovarian reserve.

It’s important to be mindful that AMH does not accurately predict the chance of pregnancy in people who are not infertile. A single test will not predict time to pregnancy – meaning you could have an optimal level, and it can still take a few months to become pregnant.

Moreover, studies have been done in women with low serum AMH, and the monthly ability of pregnancy compared to women with normal AMH levels did not differ. That said, this test is commonly run in women considered to be infertile as it is useful for prediction of the ovarian response to ovulation induction and controlled ovarian hyperstimulation.

Some docs will run this test right away, and some will wait. In people with PCOS, this number may be high. If we find that it’s low, however, sometimes prompted treatment is warranted. There does appear to be a seasonal variability with AMH, where low levels of vitamin D may be one of the reasons for low AMH.

While AMH can be tested anytime during your cycle, it’s best to run it at the same time with FSH and estradiol.

TSH (Thyroid Stimulating Hormone)

An association between thyroid health and fertility exists. Thyroid conditions like hypothyroidism and Hashimotos can contribute to a wide array of fertility issues like no period, recurrent miscarriage and prolonged spotting.

Ideally, getting a WHOLE thyroid panel done would be ideal – this includes, TSH, T3, T4 and thyroid antibodies. But sometimes only TSH should be run. The target for TSH should be between 1-2.

If you think IVF may be part of your family plan, a study has shown that hypothyroid women are less responsive to ovarian stimulation and have a lower rate of embryo transfer.

Thyroid hormones can be tested anytime during your cycle.

What About Egg Quality?

The important thing to remember about these tests is that while they provide some good information, they don’t tell you about egg quality. A reproductive endocrinologist on a podcast I listened to used an example of keeping eggs in the fridge – the longer they’re kept inside, the less fresh they are.

This isn’t to say at 30 your eggs aren’t ‘fresh’, but egg quality starts to play a factor. Luckily, there are some lifestyle modifications you can adopt to help maintain egg quality – I’ll be discussing that in a future post.

References

Obstetrics & Gynecology, 2019. ACOG Committee Opinion No. 773. 133(4), pp.e274-e278.

Can Sleep Deprivation Affect Fertility?

April 22, 2020
fertility sleep naturopathic doctor toronto

As many of us are practicing physical distancing and working from home, it’s a great time to focus on sleep – especially if you’re hoping to become pregnant in the near future! This is because sleep deprivation can affect fertility – no matter if you’re a man or a woman.

Sleep deprivation happens when there’s a decrease in your total amount of sleep over a certain period of time, or when there’s a shortage of sleep per night. It can also happen during shift work or from jet-lag.

Sleep deprivation can contribute to many adverse health conditions (ex. high blood pressure, depression and anxiety disorders, glucose dysregulation, etc.). Studies in humans who experienced a shorter duration of sleep experienced with high cases of mortality. Unfortunately in animal studies, long-term sleep deprivation lead to death!

Today I’m going to tell you how your sleep routine might be impacting your fertility and what you can start to do to get back on track!

Female Fertility and Sleep

In women, sleep affects many reproductive hormones.

TSH and Sleep

With respect to the thyroid, thyroid stimulating hormone (TSH) has a significant increase in women experiencing acute sleep deprivation. This can lead to anovulation, amenorrhea (no period), and recurrent miscarriages.

Prolactin and Sleep

Prolactin is a hormone that plays a role in reproduction, and in the postpartum, it stimulates milk production (for chest or breastfeeding). In sleep deprivation, prolactin levels may increase causing hyperprolactinemia which is associated with anovulation, PCOS, and endometriosis.

Estrogen and Sleep

Estrogen, specifically estradiol, is needed for the development and maintenance of female sex characteristics. In sleep deprivation, estradiol increases and is associated with poorer sleep quality.

Melatonin and Sleep

Interestingly enough, melatonin is a hormone and is quite important when it comes to fertility! Melatonin is secreted at night, basically telling your body that it’s time to go to sleep. As the night progresses and it turns into morning, melatonin production decreases until it’s shut off completely.

With fertility, melatonin enhances reproductive function by syncing your sexual behaviour with the appropriate season and timing for mating and conception.

When you’re ovulating, melatonin protects your eggs from stress. But if your melatonin level is low, it’s associated with stress which can ultimately impact the quality of your eggs.

If you’re undergoing IVF, taking melatonin may actually help improve your outcomes – like the number of eggs retrieved, egg quality and maturation, and fertilization rate. This is also seen in women with PCOS. Before placing melatonin in an online shopping cart, consult with your ND to determine if melatonin as a supplement is right for you.

Shift Work and Female Fertility

In women working shift work, studies showed an increased odds of abnormal menstrual cycles and infertility was also seen – however no early spontaneous pregnancy loss was noted. Nevertheless, a study looking at female flight attendants (when work coincided with sleep), there was an increased risk of first-trimester miscarriages.

Male Fertility and Sleep

Sleep deprivation in men can affect their sexual behaviour (even if they had previously excellent sexual behaviour). It specifically affects the time to initiate sex as well as a decreased rate of penetration and ejaculation.

Testosterone and Sleep

Sleep deprivation can lead to increased stress levels which can contribute to lower testosterone production in males. Moreover, low testosterone may cause men to feel tired during the day, find it difficult to concentrate and focus on tasks.

In a rat study, sleep deprivation also led to lower testosterone production. Sleep deprivation also affected rat’s sperm too! Sperm motility, which is the ability of the sperm to move properly, was also significantly reduced.

Simple Sleep Tips

Fertility Sleep National Sleep Foundation Sleep Duration Recommendations

Around 39% of people who responded to the National Sleep Foundation’s survey reported getting less than 7 hours of sleep on weeknights! Because many of us are currently working from home, improving our sleep habits may be possible. Here are a couple of tips to help get you started:

  1. Stick to a schedule. Ideally you want to be going to bed and waking up around the same time each day including weekends. Aim for at least 8 hours per night.
  2. Avoid a few things right before bed like coffee, alcohol, smoking and large meals.
  3. Avoid exercising late into the night, ideally you should not exercise any later than 2-3 hours before bed.
  4. Aim to designate your bedroom for sleep and sex. If it happens to be your makeshift office right now, consider setting a bed-time alarm so you’re able to put everything away at a consistent time. This way, you can stick to your sleep schedule.
  5. Let’s face it, most of us are using some type of device before bed. If you have the option, consider turning on night mode, reducing the amount of blue light that you’re being exposed to.
  6. Your bedroom should also be dark and cool – which means that those cute, fuzzy pj’s may not be the best option for sleep.
  7. In the mornings, expose yourself to bright light! I like to open the blinds once I make my way to my living-room office (it gives me a great view of my tree ad neighbourhood birds). Or you can even consider a sunrise alarm, where you’re woken up to gradual to bright sunlight in the morning.

These are all great options to start with before considering supplements like melatonin – which undoubtedly can be helpful, but fixing your routine is foundational.

If you have any tried and true sleep tips that have worked for you, please share them below!

Reference

Lateef, O., & Akintubosun, M. (2020). Sleep and Reproductive Health. Journal Of Circadian Rhythms18(1). doi: 10.5334/jcr.190

Walker, M. (2017). Why We Sleep: Unlocking the Power of Sleep and Dreams (1st ed.). Scribner.