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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.

5 Ways to Prepare for the Postpartum

May 15, 2020
prepare postpartum naturopathic doctor toronto

When people are pregnant, they often think about what life will be like with baby. However, the immediate postpartum sometimes get overlooked. Today, I’m discussing 5 simple ways how you can prepare for the postpartum.

Create Your Nest

It’s likely that most of your time in the immediate postpartum will be feeding baby and getting rest. Many people believe they need to ‘get back to it’ days after birth – but the truth is that your body has done A LOT over the past 9 months, and some people liken birth to participating in a marathon.

In Traditional Chinese Medicine, there’s a huge emphasis on resting for the first 40 days after birth in order to replenish your energy stores. So, if you’re going to be recuperating in your home for the next little while, you may want to consider purchasing some items to cultivate some comfort.

This may include:

  • Comfortable chair that can glide back and forth
  • Side table to hold your water, phone, etc.

You essentially want to make your space as nice and cozy as possible so you can enjoy the immediate postpartum as much as you can.

Stock Your Pantry & Freezer

Oftentimes when you’re caring for a newborn, cooking isn’t top of mind. But eating well is important to you may want to replenish iron and blood, repair tissues and support hormones, enrich breastmilk and support mood.

When my clients begin maternity leave, they usually start preparing meals that can be frozen and easily warmed up when needed. Traditional Chinese Medicine emphasizes simple yet nourishing meals to support your body in the postpartum. This includes soups, stews, and broths (even during those warmer months!).

Soft and simple meals (read: easily digestible) are recommended because your digestive system was displaced during pregnancy and needs time to return to its original position and function. Eating a meal that takes a lot of energy to digest, may upset your system.

Ideally all your meals should contain some type of protein and fat to nourish your body and help with repair and recovery. Hydration is also quite important as you likely need to replenish fluids lost at birth. Moreover, if you choose to chest/breastfeed, water is needed for milk production.

Lastly, many wise people recommended adding gift cards your registry – specifically to grocery stores/local restaurants. Basically, if you’re able to purchase ready-made food, it will save you lots of time and energy (not to mention, washing dishes!).

Stock-up on Your Supplements

I often get questions from patients asking which (if any) supplements they should take in the postpartum. Obviously this depends person-to-person, but for the most part there are a few to consider having in your cabinet.

These include:

  • Prenatal Vitamin: You won’t be done with this one yet! If you’re chest/breastfeeding, your baby is getting many of their nutrients from you. So it’s necessary for you to continuously replenish that store for their needs as well as yours!
  • Fish oil with EPA and DHA: Fish oil in general is a great supplement to have on hand for your overall health and mood, and the DHA specifically will help with your baby’s neurological development.
  • Probiotics: If you ended up testing positive for Group B Strep, you will most likely get antibiotics during your birth. Supplementing with healthy bacteria will aid in replenishing your gut – which will not only benefit your immune system, but will support baby’s too. There are specific strains for the vaginal microbiome as well.
  • Vitamin D: Generally, most of us are low in vitamin D. Low levels have been shown to contribute to postpartum mood disorders. To determine how much you need (because this is one of those vitamins where dose does matter), a simple blood test can be done.
  • Iron: Low ferritin levels (the iron storage form), can also contribute to postpartum mood disorders. While iron is present in prenatal vitamins, sometimes more is needed. Again, a blood test would tell you how much is needed – test, don’t guess!
  • Lactation Herbs: There are tons of these – so speak to your ND before buying a particular brand. Goats Rue is an herb that works universally – supporting prolactin, milk production, insulin sensitivity, and the nervous system. But something to keep in mind is that if you’re experiencing milk production issues – it’s usually best to consult with a lactation consultant first before using herbs. Sometimes the latch is the issue!

When determining what exactly you’ll need in the postpartum, it’s important to work with someone who can provide you with the correct information, safe products and dosing.

Catch Your Zzzs

Your sleep quality and quantity may likely change in the postpartum. So if you have an opportunity, rest up before baby comes! Like I mentioned earlier, pregnancy can be like a marathon and preparing your body is important. Whether you’re taking naps throughout the day or going to bed a few hours early – every last bit counts.

When baby arrives and when it’s safe to do so (this article was written as we’re all physical distancing), don’t be afraid to ask for help! Whatever task that can be taken off your hands, and placed into the hands of family and friends will save you time and energy, ad hopefully allow you to get some rest.

Build Your Community

When people say it takes a village – it’s true! Your village doesn’t need to be made up of just family and friends though – healthcare providers can also provide support! The following are some professionals that you may want to seek out. Some clinics (like the one I work at) are tailored towards pregnancy and the postpartum, and usually have most of these services all under one roof (and many provide virtual visits as well).

  • Lactation Consultant (In person & virtual): A lactation consultant can be helpful for chest/breastfeeding support, especially promoting a flow and a healthy latch. Usually the first person you should talk to when it comes to feeding.
  • Postpartum Doula: A postpartum doula may be helpful at providing support for both you and your newborn. This may include chest/breastfeeding support, completing small tasks around your house (ie. laundry, tidying up), and providing a wealth of knowledge about the postpartum period.
  • Therapist (In person & virtual): Sometimes birth doesn’t as expected. You may want to consider adding a therapist to your postpartum team, to help process your delivery and your new role as a parent.
  • Pelvic Floor Physiotherapist (In person & virtual): It’s a common misconception that you don’t need to seek a pelvic floor physiotherapist if you’ve had a c-section. Your pelvic floor may still need support! Especially if you experience pelvic girdle pain and diastasis recti abdominus (DRA). Typically, you would see a pelvic floor physiotherapist around 6 weeks after birth.
  • Massage Therapist: A massage therapist can be helpful at helping to mobilize scar tissue, especially if there have been any adhesions.
  • Naturopathic Doctor (In person & virtual): A naturopathic doctor may be helpful for any postpartum depletion that you may be experiencing (diet-wise, energy/fatigue), and using acupuncture or herbs to help promote healing.
  • Acupuncturist: An acupuncturist may be helpful at promoting a general feeling of well being as well as helping with healing.
  • Chiropractor (In person & virtual): A chiropractic doctor may be helpful as reducing any aches and pains that you may be feeling, especially neck and pelvic pain.

Be sure to contact these specific healthcare providers to determine when would be the appropriate time to come and see them – especially if you’re noticing physical issues.

Final Thoughts

Now that you’ve gone through this list and hopefully picked up something new – you may consider checking in with a Naturopathic Doctor like myself to tailor some of these suggestions.

I’m offering virtual appointments during this time to support pregnant people throughout each trimester and the postpartum.