EP. 02: Prenatal Vitamins
In light of my big news during my first episode, we focus on prenatal care and vitamin regiments in this episode. Unfortunately, our food is nutritionally depleted so even if we're not growing a baby, some of this information is great for any woman of childbearing years. Additionally, we discuss Hashimoto's Disease and a little bit about autoimmune disorders. There are some key symptoms to keep an eye on. As always, I'll bring in some research as well as my own experience as I discuss how we should monitor and supplement our nutritional needs. The question is, are you metabolizing what you should be and are you absorbing what you should be? Also, what if your own care can result in optimal health for your babies, too?
Show Notes
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Hi everybody, welcome to Holistic Health with Dr. Heather Heck and welcome to another week at least in Ohio here we have a little bit of sun so I think spring is finally on the way. So I just wanted to follow up yesterday I had my 15 week prenatal visit and basically they just you know do a pap if you if you're due for a pap which the recommendation now is every three years and then they'll just do some 12 to 15 week labs. So I wanted to talk about labs, what to ask your provider to get checked, if it's not already being checked, and then I want to talk about prenatal vitamins. This is something that I feel like does not get discussed enough and not only are you providing the nutrients for baby, but yourself, of course, right? If you have any other little ones at home and you're making a baby, you need as much help as you can get. And unfortunately with today's food supply, our food is nutritionally depleted. It comes from trucks and planes. And so we really just want to optimize nutrition as much as we can. So with the lab work that was drawn yesterday, for me, and this is kind of standard routine care, they just do ST checking with every pregnancy just to make sure everything's good for baby. They check some antibodies. They do a complete blood count just to see how hemoglobin is looking, see if there's any iron deficiency, platelets, white blood cells. They obviously check the thyroid because thyroid is the conductor for all the hormones. So they typically run TSH and T4. I always ask for T3 as well. There's many more labs to get checked for thyroid, especially if you have a thyroid condition. Hashimoto's is one that has really escalated, especially in the last couple of years post-COVID. That's something that I myself have, and I've diagnosed a lot of patients with it. So with that, with Hashimoto's, you can go undiagnosed for many, many years because unless you get your antibodies checked, which are TPOAB and TGAB, those are specific antibodies that tell us if your thyroid is attacking itself. So it's an autoimmune condition. It is the only autoimmune condition that will not show up on routine autoimmune blood work. So in the autoimmune world there's something called an ANA, which is an anti-nuclear antibody lab, and that just tells us if there's any attacking going on in the body. With autoimmunes we can attack our own skin, we can attack the mucous membranes, the joint tissue, there's so many different auto-immunes out there. With Hashimoto's, that'll show up negative. So that's kind of the sleeper auto-immune that unless you're getting those antibodies checked, we just don't know that it's there. And you have a higher incidence of having Hashimoto's if you've had Epstein-Barr virus, mono, and now COVID. So that's something just to get checked, especially if you have chronic infections, if you're chronically fatigued, if your hair is thinning, if your skin is dry, dry eyes, joint pain, any of those symptoms. So that's something just to kind of keep an eye on. So with the thyroid of course, thyroid regulates hormones. It, like I said, it's kind of the conductor for the endocrine system. So it's super important, especially super important for baby's health and development so they always check that and then the other ones that I always ask to get checked are vitamin D I want to talk about vitamin D and then B12 and B9 sometimes I can get checked so those are two that I two or three that I like to get get added on so vitamin D with that it isn't a lot of multivitamins. However, what we're finding now the dose in multivitamins and now we're finding out the dose of prenatal vitamins is just not enough. So 400 maybe a thousand international units is the standard dose. Now we're seeing what the research shows recommendations of about 5,000 units. I always tell my patients it's always the best to get checked in the fall and in the spring. And the reason for that, in a perfect world, and I'm going to say perfect, we're outside all summer, elbows down exposed, knees down exposed, no sunscreen, making vitamin D. And it's kind of funny because they've done research where the sun's rays have to hit your skin at a certain angle to make enough vitamin D and those are between the hours of 12 and 2 which is when we try to avoid the sun the most. So what I always tell patients in the summer months try to be out between 12 and 2 just for 15 minutes no sunscreen just for a little aromathemic reaction so you want that little pinkish reddening of the skin and then if you want to use a mineral-based sunscreen you can go for that. We'll talk about sunscreens and all of that on another episode but that's ideal to make vitamin D. So in a perfect world we're making vitamin D in the summer, vitamin D is made, it's stored in our fat and then since we don't see the sun during the winter we pull it out of our fat and we use it. And so in theory, we're going to be the lowest coming out of winter, and that's when we want to get rechecked. Now, if you're fortunate enough to go on vacation or you're outside during the winter months, you might not have that many issues. However, I've had patients go on cruises to Jamaica, come back super, super tan and dark, and they're still deficient in vitamin D. So you have to almost get the blood tests to see. Vitamin D is one of those fat soluble vitamins along with A, D, E and K. So those are the four. It's nice to get the blood work checked because you can potentially get too much vitamin D because it's stored in the fat. So you have to watch out for toxicity. The water soluble ones like B's and C, you don't really have to worry about because you just pee out the excess. So vitamin D is always a good one. The range is huge with this and it depends on the lab. The range is anywhere from 30 to 100. Now I've had patients get their labs drawn and they're at 31 and their provider is like, okay, you're good, you're good to go. Now from a functional perspective perspective and based on the research I always like patients to be at that higher end 80 to 90 just to kind of combat any disease. So vitamin D is huge for cancer prevention, autoimmune prevention, immune health and of course mood. So we want to be at those higher levels and with that we just want to make sure that we supplement and then recheck the labs just to make sure that you're metabolizing what you should be and then absorbing what you should be. With vitamin D I always like to do a liquid because in my opinion liquid is automatically absorbed. If you're taking a soft gel you have to depend on your gut's mobility and motility and health to break it down. And sometimes that can affect absorption levels. So a liquid dropper, you just drop it under your tongue and you're good to go, just depending on what your labs show. And that's an easy one to supplement with. Depending on what your labs show, you might need a separate vitamin D versus just one that's in a prenatal or a multivitamin. So vitamin D is really, really important. And I just wanted to bring up, I was doing some research last night, and when I do my research, I always like to look at research within the last year or two, not to say that research isn't good from five years ago, ten years ago, twenty years ago, but nutrition changes, advances change, and what we notice is that we discover new things. A recent study that came out last year that shows it was a 15 year study and it showed that prenatal vitamin D supplements prevented childhood asthma. I don't know about you but I have had many kids in my practice with asthma and allergies on the rise getting allergy shots. If we can make the effort to maybe prevent this, not that I think that there's one cause, but if we can just give the babies and our children the best option for optimal health, I think that's a good place to start. So with that study, they actually recommended that 400 units of what is in most vitamins is not enough. They were using 4 to 5,000 units. So again, it's always nice to get the blood work, but that's just one study. Um, there was an other study from this year actually from the nutritional biochemistry journal. And that showed that low vitamin D during pregnancy is associated with infantile eczema. So how many babies have you seen, or maybe you've had this experience. I know I've had so many in my practice with eczema. So vitamin D can be a big contributor to that. One of the many factors, sometimes a dairy allergy or soy allergy can factor into that too, but low vitamin D is a big one. And then one more showed that fish oil and vitamin D supplementation in pregnancy protected children against croup. So with all the viruses going around, with RSV on the rise, croup, I know there's research that just came out, at least in Ohio, that measles is on the rise. Why don't we just boost up our own nutritional reserves, give our babies the best chance, and boost up our children's health through proper vitamin D and fish oil. Now for fish oil, the company that I like the best, and there's so many companies out there, what I like to do is look at the different companies and kind of choose good, better, and best. There's some that have a really good mix of one but maybe not the best mix of another one so I'll go to another company. In general, the company that I like the best for fish oils is Nordic Naturals. That's the one I give my babies the liquid in their formula starting from birth. They have a great postnatal one to prevent baby blues after giving birth. And that's a huge, there's a huge amount of research out there that show low fish oil and low vitamin D can affect postpartum depression, which we can talk about in another episode. But Nordic Naturals, they also make really good, I give my three-year-old gummies. They make them out of fish, you know, shaped like a fish. And then they make little gumdrop ones. They do have sugar in them, but they have really good amounts of fish oil. And I don't know if you've ever tried to take some fish oils yourself and you have that aftertaste, that burping aftertaste that just doesn't go away. These do not have that. So I always check them out myself before I give them to my children and they're very clean. They are well sourced fish oils. They don't have any pesticides. They don't have any parabens. They are clean, they're wild caught, they're processed as best as they can be, and they're third party assessed. So Nordic Naturals is the company that I like the best for fish oils. And then as I said, for vitamin D, when you're looking for vitamin D, liquid is best. And there is a difference. A lot of times they've, they've for the most part phased out vitamin D2. D2 if you see that is not the most bioavailable. You want D3. Most of the time now on shelves, it's just vitamin D3. So liquid vitamin D3. And then the other thing I wanted to talk about, so B12, if you get your B12 checked, the range is very big on that. It's 180 to about 914, 950, depending on the labs. Again, if you're a mom, if you're working, if you maybe don't have the best diet, if you're stressed, if you have any alcohol or any medications, if you've been on birth control in the past, those all deplete B vitamins from our bodies. So, making sure you're at that higher end of B, around like 700 to 800 for B12 is ideal. And I always like a liquid B12. There's some really good companies out there that I can always give you guys resources for. But that's an easy one for energy, good metabolism. and metabolism, and for babies, when we're developing babies, it's important for neurological development as well. Now, the one that's probably one of the most important ones is benign. So with prenatals, they always ask, at least at my doctor's appointment, are you on a prenatal? Yes.
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What else are you taking?
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Well, nothing right now, but they don't really ask if you're taking any folate versus folic acid. So if you look on, and this is just an example of a bottle, so if you look at the label for B9 it'll say most the time folic acid. So folic acid is one that it's not the most bioavailable form of B9. You really want folate, which is the activated form of B9. And I'll tell you the reason for that. So for some of us, and unless you've been tested, you just don't know. So for me, it's always better to err on the side of we don't have the enzyme to metabolize it. So for some of us, we don't have the enzyme to transition B9 to the activated form. So that's called 5-MTHF deficiency. Maybe you guys have heard of that. I will be honest, I've had quite a few miscarriages. I've had a lot of patients and friends and family members have miscarriages. And until you've had two or three miscarriages, they don't really tell you or test you to see if you're deficient in this enzyme because it affects baby development, right? It affects nerve development, brain health. So if you've had many miscarriages and you've been tested, then you know you might be 5-MTHF deficient and then you're already on the activated form of folate. But if you haven't been tested, number one, maybe get tested, especially if you're struggling with fertility. Um, there's some good companies out there. Genova diagnostics is a good one. And then 23andMe, I know a couple of years ago, my husband and I did that for Christmas, just for giggles. Um, and it was kind of cool to see what came back, but since then, and that's again, been two or three years, they've come out with a methylation test. So a methylation test basically again tells us how well we methylate, so how well we convert bands. If you are low or deficient in methylation, if you have problems of methylation, fatigue is the most common symptom. The other list includes anxiety, depression, irritable bowel syndrome, allergies, headaches, muscle pain, digestive issues, autism, and multiple miscarriages. So if you might fall under any of those categories, it might be worth getting tested. It's a simple blood test. It takes a couple days to come back, but it's well worth it. That way you know. So 5-MTHF is one of those that you just want to err on the side of caution, look at your multivitamin and make sure that it has folate. And it'll say 5-MTHF on it. And the dose now is pretty standard. Most of them have switched from 400 micrograms up to 800 micrograms. So that's something that you want to look for in a prenatal. That can just give you just a better edge. And then the other thing besides the prenatal and supplementing with a B12 if needed, especially if you're vegan or vegetarian, you might need a supplement with that. Make sure you get your blood checked and then with the vitamin D, get your blood checked with that. The other thing, if you have a family history of any postpartum issues or if you have tendencies for anxiety or depression, make sure that you take a fish oil. So that can just, again, err on the side of caution, give you some extra edge, help with baby's development, help with your own cognition, which pregnancy brain is definitely a real thing. So that's something to think about. If you're good about eating fish, that might be a reason that you might not need one. With fish, of course, you have to be careful. Make sure that you're not eating heavy mercury fish. And then my rule of thumb is make sure it is wild, not farm-raised, and you're eliminating that certain types of fish to one to two times a week. So in certain instances like that, it's just sometimes easier, especially with nausea or morning sickness, just to take a fish oil. So those are nice. That's a nice kind of supplement protocol for pregnancy and prenatal care. And just really kind of giving your baby the best head start that you can. I can always link these articles for you guys. And then the only other thing I wanted to mention, and I have to say my office is really good. The OB that I go to doesn't push any vaccines or any testing unnecessary. If I ask why they're doing something or why they might be running something, they always give me a reason. And they can say, well, it's recommended, but at the end of the day, it's your prerogative and we'll work with you, which I always appreciate. So they don't push the flu vaccine, but there is a study that came out that did show that prenatal exposure of methylmercury, which is in many vaccines like the flu vaccine, can be linked to autism-like behaviors. And that was a study from this year. So that's just something to think about if you are pregnant or looking to conceive. Just ask those questions. Do your own research. Many of the vaccines now come with a thimerosal or mercury-free option. So if you do want the vaccine, maybe you can always ask for that option. And then for my patients in the past that do want a vaccine, there's a vaccine protocol that I always put them on about two weeks before, during, and then two weeks after, just to help minimize any side effects from the vaccine that we don't want. And I've done that with patients of all ages, but especially kids and prenatal care. So just things to think about. It's always good to ask questions, do your own research, and then again, try to find the good, better, and best in everything.
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