PODCAST: Optimizing Diet And Lifestyle For Healthy Pregnancy With Ayla Barmmer

Kelsey Kinney

Thanks for joining us for episode 136 of The Ancestral RDs podcast. If you want to keep up with our podcasts, subscribe in iTunes and never miss an episode! Remember, please send us your question if you’d like us to answer it on the show.

Today we are thrilled to have Ayla Barmmer back with us!

Ayla Barmmer, formerly Withee, is a Registered Dietitian Nutritionist, CEO and owner of Boston Functional Nutrition, an integrative and functional nutrition practice based in Concord, Massachusetts. Her practice is known for its big picture approach which starts with a thorough whole person assessment and uses cutting edge research to help individuals create effective, meaningful change even with the most complex of cases.

Ayla’s primary specialty is women’s health with a special emphasis on fertility nutrition. Through simple tailored diet and lifestyle interventions she has helped 90 percent of the women she’s worked with conceive and go on to have healthy pregnancies. She is also the co-host of Real Food Radio which relays practical information about how to support your health naturally and live a life you love.

In addition to her nutrition work, Ayla is also a mom to her one year old son and enjoys biking and hiking with him and her husband. You can learn more about Ayla at BostonFunctionalNutrition.com.

Diet and lifestyle are key to a healthy pregnancy. While many of us know this, it can be overwhelming to decide what to follow among the array of conventional and alternative recommendations.

Ayla Barmmer is back with us today to share an overview of diet and lifestyle factors both women and men should focus on during preconception. If you are already are pregnant, we still have you covered as Ayla shares her insight into optimizing diet and lifestyle for healthy pregnancy.

Just some of what Ayla will be sharing is key nutrients that optimize egg and sperm quality, how gut health affects pregnancy, and the importance of minimizing environmental endocrine disruptors.

You also won’t want to miss hearing the benefits of a natural approach as Ayla disproves the long held belief that infertility necessitates medical intervention.

This episode is sure to take the guesswork out of prepping for healthy pregnancy as Ayla provides practical tips and busts some myths along the way.

Here is some of what we discussed with Ayla:

• [00:04:33] Areas of health Ayla focuses on for preconception
• [00:07:13] How far ahead before pregnancy you should begin optimizing reproductive health
• [00:08:20] Addressing nutrient deficiencies before pregnancy
• [00:15:14] Stressors that affects fertility and pregnancy
• [00:18:50] Ways to reduce stress levels when preparing for pregnancy
• [00:22:48] How gut health affects fertility and pregnancy
• [00:28:50] How weight loss before conception can affect fertility and pregnancy
• [00:34:57] The importance of minimizing environmental endocrine disruptors
• [00:39:33] Nutrients that optimize egg and sperm quality
• [00:44:19] Benefits of the natural approach to infertility versus medical interventions
• [00:49:15] Tips you can start implementing for a healthy pregnancy if you already are pregnant
• [00:53:12] Information about the Nourish Your Fertility online program

Links Discussed:

• DrCowansGarden.com – Use the code “ancestralrds” for 20% off your order!
• Nourish Your Fertility online program and private Facebook group
• Real Food Radio Episode 23: Plastics, Pesticides, Pollution, Personal Care Products And Your Health
• The Ancestral RDs Podcast Episode 47: Nutrition For Fertility With Ayla Withee
• The Ancestral RDs Podcast Episode 133: Genetic Variants And Your Health With Dr. Benjamin Lynch
• Kelsey Kinney – The Role Of Gut Bacteria In Fertility And Estrogen Dominance
• “Association Between Pesticide Residue Intake From Consumption Of Fruits And Vegetables And Pregnancy Outcomes Among Women Undergoing Infertility Treatment With Assisted Reproductive Technology”

TRANSCRIPT:

Laura: Hi everyone! Welcome to Episode 136 of The Ancestral RDs podcast. I’m Laura Schoenfeld and with me as always is my co-host Kelsey Kinney.

Kelsey: Hey guys!

Laura: We’re Registered Dietitians with a passion for ancestral health, real food nutrition, and sharing evidence based guidance that combines science with common sense. You can find me at LauraSchoenfeldRD.com, and Kelsey over at KelseyKinney.com.

We have a great guest on our show today who’s going to be sharing her insight into optimizing your diet and lifestyle for a healthy pregnancy. We’re so glad Ayla Barmmer is joining us and we think you’ll really enjoy this episode.

Kelsey: If you’re enjoying the show, subscribe on iTunes so that you never miss an episode. And while you’re there, leave us a positive review so that others can discover the show as well!

And remember, we want to answer your question, so head over to TheAncestralRDs.com to submit a health related question that we can answer on an upcoming show.

Laura: Before we get into our interview for today, here’s a quick word from our sponsor:

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Laura: Welcome back, everyone! We’re so pleased to have Ayla Barmmer here with us today. Ayla Barmmer, formerly Withee, is a Registered Dietitian Nutritionist, CEO and owner of Boston Functional Nutrition, an integrative and functional nutrition practice based in Concord, Massachusetts. Her practice is known for its big picture approach which starts with a thorough whole person assessment and uses cutting edge research to help individuals create effective, meaningful change even with the most complex of cases.

Ayla’s primary specialty is women’s health with a special emphasis on fertility nutrition. Through simple tailored diet and lifestyle interventions she has helped 90 percent of the women she’s worked with conceive and go on to have healthy pregnancies. She is also the cohost of Real Food Radio which relays practical information about how to support your health naturally and live a life you love.

In addition to her nutrition work, Ayla is also a mom to her one year old son and enjoys biking and hiking with him and her husband. You can learn more about Ayla at BostonFunctionalNutrition.com.

Welcome back to the show, Ayla! I know we had you here I think it was a couple of years ago at this point.

Ayla: Hey Laura and Kelsey! Thanks for having me back.

Kelsey: I’m always excited to have a fellow Massachusetts person on the show even though I don’t live there anymore. You’re super close to where I grew up. I grew up in Harvard, Mass. It’s just a couple of towns over.

Ayla: For sure. Yeah, I live right near Harvard. It’s beautiful there. I’m born and raised here.

Kelsey: Nice. We’re really excited to have you here. I think for today we’re going to kind of take a little bit of a different approach than we did last time with you on the show and talk a bit about just general pregnancy prep and how women and men actually can prepare for pregnancy in the near future.

We have a lot of first of all clients that I think both Laura and I work with one on one that are kind of going through this process. But also our listeners too are people who are thinking about becoming pregnant soon and they’re not sure how far in advance to start working on any of this stuff or if they can just start trying right away.

We’d love to hear from you in terms of how that works in your practice and just your thoughts on that in general.

Ayla: I love to talk about that.

Kelsey: I guess a good place to start is just some of the areas that people can focus on and sort of optimize to basically make their chance of conceiving a healthy child as good as possible. Are there some favorite areas that you tend to work on with your clients that are considering becoming pregnant in the near future?

Ayla: I should say it is it is ideal if you have…and I could talk about a few of the reasons why, but if you’ve got at least at a minimum three months prior to trying to conceive, but ideally six or more. That’s when you ought to start thinking about some of the changes you can make and doing some of this prep work ahead of time.

It’s ideal when I have clients coming who have been longer term clients that I’m working with and they’re telling me that that’s in their future, or I have someone who is saying three, six, nine months down the road we’re thinking about a pregnancy and we can start working on balancing things, optimizing reproductive health, all of that. That’s ideal.

The kinds of things that we’re going to look depending on the timeline will be things like gut health, nutrient, vitamin and mineral deficiencies, nutrient deficiencies, how balanced the diet is. I definitely also take really an integrated approach. I mean I really think probably similar to you guys, health requires a whole body approach. We’ll look at sleep, stress, all of those areas and how they influence reproductive health and ultimately pregnancy outcomes as well.

Kelsey: Before we jump into those a little bit more deeply, you mentioned the timing of things. At least three months, but ideally more like six or nine months prior to becoming pregnant is when you start this. Can you tell us a little bit more about why that is?

Ayla: One thing that’s important to know is that both our eggs as well as sperm develop fully in about three month cycles. From a cell to a fully formed sperm, egg ready for ovulation, that takes about three months, so it’s 85-ish days. That’s why I like that the bare minimum, but we can really influence chances of conceiving as well as the health of the embryo, and the health of the baby, and ultimately the health of the pregnancy if we have about that amount of time.

I’d also say that nutrient deficiencies take time to replete, too. If we discover some of those, then we’re going to want to come up with a targeted approach to make sure you’re in the best place possible for conceiving. There’s some very common nutrient deficiencies that I see as a result of medication use, environmental factors, genetics. A couple good examples would be key fertility and pregnancy nutrients like folic acid, folate, and B12, just to name a couple.

Kelsey: I guess let’s start there then because this is something that is definitely something I work on with my clients who are thinking about becoming pregnant because to me it’s like one of the most obvious places to begin. If we can make sure that somebody has proper nutrient stores of things that they should have for general health, never mind pregnancy, I think that’s a great place to begin.

Do you use any sort of functional medicine type testing to take a look at somebody’s nutrients? Or are you basing this off of symptoms that you see in that person, or medications you know they’ve been on, things like that?

Ayla: Sometimes it has to do with timing and budget I will say. Ideally speaking if I have enough time with someone, so someone is going to see me at least three months, but ideally six, nine months ahead of time, then I’m going to be running a functional lab testing so we can get a lot more targeted. Actually even if you’ve got a shorter timeline, sometimes that can be a faster road like targeting what needs to be repleted. It’s just a test for it so that you’re not guessing and you know.

It’s important because if you’re truly deficient or even borderline deficient in a nutrient, you’re not going to replete it in my opinion just by diet alone. This is where I think you really do need to kind of pull in some supplements. Maybe even a basic prenatal or basic multivitamin is not going to cut it either if you’re really deficient in something.

I run things like either SpectraCell Micronutrient or there’s a great new test by Vibrant America. They’ve got one that looks at extracellular and intracellular vitamin and mineral status, so a really complete picture of what’s going on.

But if I don’t do functional lab testing, there’s definitely signs that point to potential issues. I almost always with all my clients these days are running genetics to take a look at their ability to metabolize, convert, and utilize nutrients, important ones like for example folic acid, folate. I’ll look at that. If you’re compromised there, then that’s a good sign that you’re probably going to need more of certain nutrients.

And then also medication use. I’m sure we’ll get into talking about a kind of a favorite topic of mine, hormonal birth control. If you have been on that for any length of time and also another whole handful of medications, there’s a good chance that you need more of certain nutrients as well.

Kelsey: Got it. You mentioned a couple important ones like folate. Can you talk a tiny bit about why those certain nutrients are really, really important when it comes to pregnancy in particular?

Ayla: I think folate gets pointed to a lot because of its critical role in preventing neural tube defects. We’ve known that for a long time. It’s why historically they started fortifying the food supply with folic acid, particularly your processed grains and things like that. That fortification in that synthetic kind of folic acid is different than the natural form of folate that’s just in your spinach, for example.

It can be problematic for people that are compromised in converting, that have the MTHFR enzyme mutation. That’s a common mutation. It decreases your ability to convert synthetic folic acid into its usable form. It doesn’t just relate to neural tube defects, folate is a critical component to the health of follicular fluid and also to egg quality. You definitely see with deficiencies in that, I’ve noticed this in practice and it’s also in the research, you definitely see impaired fertility with higher rates of infertility with folate deficiencies.

Kelsey: If people didn’t listen to our fairly recent episode with Dr. Ben Lynch, definitely go back and take a listen to that because it goes a little bit more into depth than what Ayla is talking about here. It’s really good to get a baseline understanding of all of this genetic stuff, which I know can be a little bit complicated.

That’s absolutely something I’ve seen as well. You really have to pay attention to that stuff especially when it comes to fertility and pregnancy and all of that.

Okay, so folate…any other common ones that really play a huge role in pregnancy, and egg quality, sperm quality, all of that kind of stuff?

Ayla: This is kind of a collective group, but antioxidants, particularly coenzyme Q10. Coenzyme Q10 is largely generated by our body. We produce that, but sometimes in the cases of fertility and pregnancy prep, supplementing with it makes sense.

Just big picture wise, this is a really common group of nutrients that I see deficient or inadequate, usually really quite deficient when I run testing despite maybe having a diet that’s fairly rich in antioxidants.

It can be because of chronic stressors. That’s a big bucket that can include a lot of things, but chronic stress is just blowing through those antioxidants. Our body has to prioritize really functioning right and reproductive health always gets kind of the last priority really. If there’s somewhere else in the body that’s really in need of lots of good antioxidants and all that kind of support, it’s going to take resources away from reproductive functioning.

I focus a lot on folate and I actually focus a ton on antioxidants. Particularly the ones in the research that are really helpful for prepping for pregnancy is coenzyme Q10, vitamin C, bioflavonoids, things like that.

Kelsey: Interesting. That makes a whole lot of sense.

I think we can probably jump into this next topic of stress which you mentioned as one of those things that’s a really, really great topic to focus on when you’re starting to think about getting pregnant. Because like you said, if your body is stressed out with other things going on, that becomes the priority and fertility is definitely the last thing the body wants to focus on in that case. Let’s talk a little bit more about stress. How does that play a role in fertility and pregnancy?

Ayla: Again kind of broadly speaking, I mean another reason why you may want to give yourself a little bit of time to prep before you try to conceive is, I see it all the time in practice, it is extremely stressful just mentally and physically to have cycles keep going by where you’re not conceiving. You were ready and you wanted a baby like yesterday and it’s not happening. That’s an added pressure. Another good reason to try to see if you could plan a bit and do a little prep work prior to trying to conceive.

The issue with stress is that it takes resources away from reproductive functioning. That’s kind of the broad theme here I guess is to make sure that reproductive function is not turned down to prioritize other areas of the body, other needs in the body.

Chronic stressors, the biggies that I see, the big ones are blood sugar management. Even if you have a normal A1C, you have a normal fasting blood sugar…although a lot of people have kind of like functionally abnormal levels there. Even if you don’t have diabetes you don’t have it in your family, we’re just talking about basic blood sugar management throughout your day, like balanced meals, not being on kind of a blood sugar roller coaster. That’s a real underlying chronic stressor that can drive hormonal imbalances and you see things like elevated testosterone levels. That’s typical with that. But without going down that rabbit hole too much, I would say blood sugar management is a big one.

Gut health is a big one, so microbial imbalances, that can be a real chronic stressor. We can talk about that. And then ongoing nutrient deficiencies as well as what we classically perceive of stress which are lifestyle kinds of thing, too little sleep and just stressors in your life.

Kelsey: It’s kind of funny because I was like we’re moving onto other topics. But you’re right, all of those fit into the category of overall stress. Most of us think of stress as like just this psychological piece, but really it’s anything going on in or outside of the body that causes some kind of dysfunction and therefore becomes a stressor on your body.

Things like the health of your gut, your microbial balance like you mentioned, and nutrient deficiencies, of course those are super stressful for the body to have to deal with. If it’s dealing with that like we said, there’s just way less resources available for fertility and reproductive health at that point.

Ayla: Yes, exactly.

Kelsey: Let’s just say you’re kind of preparing your body for pregnancy and thinking about stress, what are some of the ways in your practice that you are helping women and potentially men…I’m not sure how much you work with men, or the women you work with, their partners. But what kind of things are you recommending to them to help to reduce their stress level as they’re prepping?

Ayla: If we talk about just more like classic stress that we think of, like just everyday sort of things versus internal stressors, sources of inflammation, I love small strategies that can be used throughout the day and start to be integrated as well as like big strategies. I often will have people pick a little thing and a big thing.

The little things I think of as really effective are breathing techniques. There is a fantastic, simple technique that is just unbelievable at activating your parasympathetic nervous system and just calming down that cortisol production. It’s called 4-7-8 breathing. You guys may have heard of that.

It’s basically a very simple technique. You inhale to a count of 4, you hold it for 7, or maybe just couple of seconds. People don’t love holding it that long. And then you exhale slowly about twice the length. So 4-7-8. It becomes really like second nature and you can incorporate that while you’re driving and in just various situations. I love that kind of method.

I do a lot of looking at the different buckets in your life and what needs more attention and reprioritizing rather than just trying to fit in healthy behaviors. A theme that came out last week as I was just talking to clients was how do I make breakfast work on the go? What can I take with me in my car? That kind of thing. But what we end up talking a lot about is how can we make breakfast not happen in the car? How can we take that out as a stressor? I think it’s looking at all of those big buckets and reprioritizing a little bit.

Kelsey: It makes sense. Obviously this is something that Laura and I talk a lot about in our Paleo Rehab program with people. Even though that’s not necessarily a fertility program by any means, but it really feeds into that just because stress is such a big piece of it. And Laura, I know you just had your Get Your Period Back program start and I’m sure you talk a whole lot about stress in there, right?

Laura: Yeah. I mean I have a whole week dedicated to it and I feel like I just scratched the surface on it. It’s one of those things where it’s like it could be its own program for sure.

Kelsey: Yeah, easily. Let’s talk a little bit about gut health because you’ve mentioned it a couple times here. Obviously this is a topic I’m very intrigued by and I work a lot with in my own practice. It’s been something I’ve been looking into a little bit more in terms of how it actually connects to both fertility, and pregnancy, and hormone health.

It’s kind of amazing how big of a role it plays. I feel like it’s hard to be surprised these days with what gut health feeds into. But it was actually a little bit surprising to me to learn about all of the different ways that the microbiome actually changes throughout pregnancy.

Talk to us a bit about how you are working with your clients in terms of gut health to help them prepare for a healthy pregnancy.

Ayla: This is huge. I agree, I think it’s really astounding when you really look into it what got health really does to fertility and pregnancy outcomes. I think the biggest one area to highlight that people may not realize is the role that gut bacteria play in hormonal balance specifically. I’ll give one example. The most common thing that I see in practice is estrogen dominance. That is heavy periods, a lot of bloating before your period, it’s like tender breasts.

This estrogen dominance is something that happens very frequently in men as well. We can talk about some of the reasons, the environmental reasons why if we get into that, and detox. But there’s a lot of factors that come into play. Estrogen dominance is super common. We usually discover that on a DUTCH Complete test. I love that test. But you can go based on symptoms as well, some of the ones I mentioned.

With estrogen… its safe removal from the body, it has to be packaged up, it has to be detoxified partially by our liver, partially by our gut. In our gut, this is a key area where our beneficial probiotics, gut bacteria will help package up and assist kind of in the removal of conjugated estrogen, the estrogens that have been packaged up neatly by our liver and are ready to be gotten rid of through our stool because that’s really where they’re ultimately excreted, the excess of what we don’t need.

Our bacteria are responsible for that. But when there is unhealthy bacteria, and there’s a large range of that. I’ll see that on stool tests and also just again based on symptoms. That impairs estrogen metabolism. That impairs that step. Some unhealthy bacteria actually make the enzyme beta-glucuronidase which de-conjugates, like breaks estrogen back out of that nice little package and then reactivates it and gets recirculated.

This is one of the reasons why women and men can be estrogen dominant. It’s because of their gut health and that impairs fertility because it messes with the ratio to progesterone and will impair conception and ultimately pregnancy. It really does put you at a higher risk for miscarriage, frankly.

Kelsey: Yeah. This is something that I have an article about if anybody wants to dive a little bit deeper into the mechanisms that we were just talking briefly about in terms of how that actually works to elevate your estrogen levels. I’ll link to that in the show notes if you guys want to read it.

But that is huge. This is something that I see a lot. Laura, I assume you see it a lot. I mean estrogen dominance is one of those things that I just think is so, so common. Like you mentioned Ayla, it’s just one of those things that just puts you at such a higher risk of having all sorts of fertility issues.

If you and your partner are trying to conceive, I do think that first of all, a DUTCH Complete, that kind of test which looks at your adrenals and your hormones is a great test to get. It will just give you an overview of kind of how your stress levels are, and how much cortisol you’re producing, and your overall hormonal…I don’t want to say breakdown, but it kind of shows you how your hormones are going through their normal….What is the word I’m looking for?

Ayla: Kind of metabolic pathway and how they’re metabolized.

Kelsey: Yes, exactly.

Ayla: The DUTCH test really measures metabolites and it’s so helpful for figuring out if you are actually using the proper channels. There’s ways to push the right estrogen detox channels short term and long term. Obviously the longer term or even shorter term is to help repair your gut.

Kelsey: Yeah, exactly. Another cool way that gut health feeds into this is that basically any sort of dysbiosis or imbalance of gut bacteria that you have at the beginning or prior to pregnancy basically just gets worse because the natural cycle of microbial balance in pregnancy is actually for the bacteria to become slightly dysbiotic towards the end of pregnancy. If you start off with already dysbiotic flora, it basically just gets even worse than it would normally in pregnancy. There’s been a lot of research that kind of shows that obviously this is not what we want and it has some detrimental effects on pregnancy outcomes.

One of the biggest things that actually tends to kind of correlate with dysbiotic flora is being overweight or obese prior to pregnancy, too. That’s another reason why your starting weight is actually quite important. It’s sort of like a chicken or the egg kind of question. Does obesity or overweight come first and that’s what makes the gut bacteria imbalance, or the other way around? But the end goal here of course is to get balanced flora and be at a healthy weight prior to pregnancy which will then make sure that your gut bacteria doesn’t get to dysbiotic as you go into pregnancy.

That was something I learned recently that was one of the things I was like, wow! My mind was kind of blown by that. I didn’t know that bacterial colonies change so much naturally during pregnancy, but also of course that if you start off in a dysbiotic place it’s only going to get worse over that time.

Ayla: I completely agree with you. But just one note about the weight piece. This is just one of my own little sort of pet peeves. But the one kind of nutrition recommendation it seems that a lot of practitioners are giving their clients in terms of pre pregnancy prep is weight loss. I just would caution listeners, you’re going to really hurt your chances of conceiving as well as put the pregnancy at jeopardy, you could definitely get into nutrient deficiency issues and various things if you try to be too aggressive with weight loss. I just see so many women kind of crash dieting in that pre pregnancy prep that I would avoid that.

Kelsey: Right. Because oftentimes there’s that that idea of a time crunch, too. They’re like I really want to start trying in three months, so I need to lose X amount of pounds by then. You’re right, it’s kind of basically the opposite of what we’re trying to do otherwise, which is to really nourish a woman before she conceives. Basically losing weight tends to be the opposite of that where you’re just taking things away, you’re restricting and that goes against a lot of the things that we’re really trying to do in that time period.

Ayla: Right. Losing weight to fast, that can be a more contributor to that chronic stress that we were talking about earlier.

Kelsey: Right. Let’s say a woman does have to lose some weight or feels like she would like to before she conceives what. Obviously this depends on how much weight somebody has to lose, but I would imagine that that of course extends the time period in which you would like to kind of do this preparation period.

Ayla: Yeah. It does because I like to see changes in body composition. In my practice I have an InBody body composition machine. Those you can sometimes see at gyms and things like that. I really prefer to monitor composition and make sure that muscle is not being broken down, it’s actual body fat that’s lost. You can only go so fast and continue to lose body fat while preserving lean body mass. There just is kind of a limit to that.

If I am working with someone on that, we’re going to kind of work on it in two methods. It’ll be changing body composition through blood sugar management and balance nutrient dense meals. So kind of achieving multiple things at once.

Kelsey: Makes sense. I think this also feeds into another area that people start to get concerned about when they’re thinking of getting pregnant, which is detoxification and kind of the environmental factors.

Just from what I know about weight loss, I would think, and you can correct me if I’m wrong, that when you’re losing body fat, potentially you’re kind of mobilizing stored toxins that usually are stored in our fat stores. Is that necessarily going to be an issue for somebody who wants to get pregnant imminently?

Ayla: Yeah, it definitely can be. I was wondering how deep I wanted to go want to go to bring that up. But yes, almost whenever I have somebody who is losing weight, then we’re kind of supporting the detoxification pathways as well.

I mean our body as a protective mechanism will package up toxins and store it in the fat if it can’t keep up with the demands. If your liver and your gut are not keeping up with the demands on it, then it’s going to store it. When it gets recirculated, any of these toxins from heavy metals to organic pesticides, and chemicals, and things like that, that recirculation is what’s damaging. It is proven in the research to affect both male fertility as well as female fertility.

Some of these things do cross the placenta. Whenever you’re thinking about pregnancy health, it’s kind of the health of the mom as well as what crosses the placenta, so it’s a risk to the fetus as well.

It’s a time where if you’re losing weight, lots of antioxidants, binders. I use some of that kind of stuff in practice, like an activated charcoal. Sometimes it just depends on the situation. That’s short term, by the way. Chlorella or greens, things like that.

Kelsey: Got it. Would you recommend that a woman stops losing weight at a certain point before she actually starts trying to get pregnant? Or do you have some clients who tend to still sort of be losing weight when they get pregnant?

Ayla: Sometimes there’s a bit of overlap, but I do. I say let’s put the stop on the weight loss about a month or two prior, although there’s a good argument to be made that three months prior. We don’t want to be affecting the quality of eggs, the quality of sperm.

If you are losing weight and that’s releasing toxins, that’s using resources. That’s using antioxidants to process those. That can be taking away from protecting the egg and protecting the sperm. They’re both very sensitive to oxidative stress. That’s a real theme that I would drive home with clients is that we’re trying to protect them and keep them as healthy as possible. It prevents the risk of miscarriage and also just increases the chances of actually conceiving.

Kelsey: With environmental factors and these toxins that we’re talking about, are there any specific ones that you’re either testing for or basically just assuming that people are overloaded with that you are focusing on detoxifying?

Ayla: Yeah. It’s tough here because a lot goes into play. First of all, no matter what, I am talking about these environmental toxins with all my clients. This is something that if we’re talking like pre pregnancy prep, you can start doing now and is very wise to do is to clean up the environmental endocrine disruptors. Those are the primary ones.

I would say the big areas to do that would be looking at personal care products. In our podcast as well as my fertility work, I call it the 4 Ps. It’s plastics, pesticides, pollution, and personal care products. Kind of the four big buckets that you can focus on.

While you cannot insulate yourself from everything and it’ll be overwhelming to try to do too much, you can kind of hit the big low hanging fruit in each of those areas. Actually we did a podcast just on the 4 Ps, like the big things that you can really focus on in each of those areas.

It’s amazing how little the industry is regulated. It’s like 13 chemicals, additives to personal care products that are actually banned in the U.S. I think it’s 1500 or more in the EU. Nothing’s been changed since the early 1940s. It’s like a one page document.

There’s this feeling that if the product is on the market it, should be safe. It’s not necessarily so. There was there was a big study that I can also send you the link to that looked at just how profoundly pesticides in produce are really affecting fertility as well.

Again talking pre pregnancy prep here, at least focusing on the Dirty Dozen, the Environmental Working Group’s Dirty Dozen and avoiding those, but ideally speaking trying to eliminate as many sources of pesticides as you can from produce primarily.

Kelsey: Awesome. Well we’ll definitely link to that. Not only the pesticide study, but also the episode you guys did on that topic. I think that’s something that obviously you can go down this like crazy rabbit hole of driving yourself insane trying to avoid these things. But I think there is a happy medium that avoids the big stuff and you can still kind of use products and things that you like, not just things that are completely natural and whatever. I think there’s a happy medium that people can find that really keeps them as safe as possible while still not driving themselves crazy. So we’ll link to that.

I think it’s a really important topic to cover because it’s one of those things that plays a huge role and I think some people actually probably underestimate the role that it plays and maybe other people overestimate it. So it’s good to find that that line that kind of gives you the best of both worlds.

Ayla: Yeah. Just to kind of summarize so that I think it’s clear how this all kind of connects is you’re trying to minimize the inputs from your environment. And again, perfection is not possible or necessary. But in combination with minimizing inputs, you also optimize your gut function. Take a look at that pre pregnancy. What’s going on there and what can you do to optimize your gut function? Can you increase the antioxidants in your diet and other good liver and gut supporting foods to help with dealing with what is coming in? And sweating, too. Getting in some good sweat whether it’s sauna therapy, or obviously exercising, that’s another way that our body detoxifies.

Trying to just make sure your systems are getting rid of what they need to properly so that it’s not a stressor that’s affecting your reproductive function.

Kelsey: Awesome. You mentioned egg quality and sperm quality a couple of times already. I want to just dive a little bit deeper into that. We’ll throw the guys in here too because obviously we’re talking sperm quality here as well as a quality. What kind of like dietary and lifestyle changes are you typically recommending to just optimize the quality of egg and sperm?

Ayla: Actually it’s pretty straightforward. For sperm, some of the biggest nutrients are zinc, selenium, vitamin E, and other antioxidant. But zinc and selenium seem to be really key as well as omega 3 fatty acids, so that fatty acid balance.

There’s been some good research, albeit it was funded I think primarily by the walnut industry, but it was looking at walnuts which have a nice fatty acid balance to them in a handful of those daily. Which I like that concept because in addition to seafood, that’s a really easy thing to do. Honestly based on what I’ve seen in the research and everything, I’m having a lot of the men that I’m working with do that.

So more fatty acids, more selenium and zinc rich foods. Definitely I’m prescribing that couples go out and have a date night with oysters. That’s an awesome thing to do and those are great for both men and women. And reducing alcohol consumption as well. That’s key. You just can’t get around it. I’m never anyone’s favorite with that.

Kelsey: Right. If you’re prepping for pregnancy, hopefully they’re kind of at least knowing that that’s in the cards, that the alcohol is about to come out.

Ayla: I’d say for men though too, the alcohol. It just has a big impact.

Kelsey: Right. They’re not necessarily expecting it, unfortunately. Got it. That really helps.

I’m not at the point right now where I’m considering getting pregnant in the near future really. For me I’m like, oh yeah, I guess I never really thought that much about the actual egg quality. It’s like I know you can do all these things obviously to optimize your chances of conceiving in the first place, but then you do obviously have to think about the quality because that’s the thing that’s going to going to end up as your baby. You need to think about that right from the beginning too, which I think is something that maybe obviously me and possibly other people don’t necessarily think as much about as we’re starting to consider pregnancy.

Ayla: I think there’s kind of this notion, like I know I thought before I really got into this, you’re told like you are just born with all of the eggs that you have throughout a lifespan in your ovaries. You just sort of imagine these eggs that are formed and there’s nothing you can do. And the reality of our eggs, actually it’s a journey to become an egg that’s actually ovulated and ready for conception. It starts really as like an ovocyte in the ovary and it goes through this journey where it gets to the follicle. All along that it’s subject to assaults along the way. There’s things that can impact the quality of it in the actual development of it.

There’s a lot of women who struggle with knowing they ovulate, but they’re still not getting pregnant. It may be very early miscarriages, unfortunately, or just not have a conception occur. That could be why.

I mentioned just zinc, selenium, reducing alcohol. There’s actually some herbal approaches for men. Ashwagandha is really effective for improving sperm health and morphology, things like that. But then for women, Vitamin E, coenzyme Q10, those are two real key ones. Folate as I mentioned for the follicular fluid, and vitamin C. I’d say those are my top ones.

Kelsey: Nice. That helps. Is there any specific product that kind of combines all those things? Or are you tending to really just prescribe them individually?

Ayla: Honestly you do of need to do it individually. Because for example with vitamin E, you often see d-alpha-tocopherol only used in products. But I always recommend looking for something that includes full spectrum vitamin E, so the mixed tocopherols in addition to the d-alpha. It’s a little hard and sometimes you have to piecemeal some of these things together to get the dose, like the quantity that you’re looking for. Like for vitamin E, it could be 800 to 1,000 IUs of the mixed tocopherols. It’s hard to get it all in one.

Kelsey: You just busted a myth here about the fact that we’re kind of just born with our eggs and that’s basically what they are and what we’re dealing with for the rest of our lives so any other myths you can think of that women or men hear about pregnancy or fertility that you would like to bust for us?

Ayla: Yeah, I think just broadly speaking is that infertility requires a medical intervention. That if you’re not ovulating, you need Clomid. If you can’t conceive, you need IVF or IUI. And the reality is, and I really like to drive this home for people, is that across the board, and there’s research to this and not just only what I see in my practice, a natural approach and getting to the underlying issue doesn’t take longer than some of the medical interventions. My 90 percent success rate is within six months.

Kelsey: Awesome.

Ayla: That’s compared to IVF success rate which hovers around 40 percent and it’s not clear as to whether or not that’s actually to a healthy baby or just conception. You haven’t gotten to the underlying issue, you’re at an increased risk of miscarriage and that kind of thing.

I think the misconception is that a natural approach will take forever and that you don’t have control. Even though there’s a lot of possibilities for what could be going on with you individually, the interventions once you kind of figure that out are really straightforward. A lot of this is not really complicated or difficult things to attain or do. It sometimes could be just minor tweaks. I hate to see people just invest the type of money, and mental, and physical, and emotional health sacrificed to some of these medical interventions.

Kelsey: Plus if you’re working on your own health, these root causes that are leading you to not be able to conceive in the first place, it’s not like you aren’t doing anything for yourself at that point. It just kind of a drain, like IVF and all these things, I just I hear it’s no fun to go through that process first of all. It’s stressful in and of itself. Whereas with the natural approach, you’re actually improving your own health throughout this process which is something that’s going to stick with you for the rest of your life, never mind your child’s life too, which I think is a really cool aspect of doing it the natural way.

Ayla: Absolutely. I’m sure that Laura maybe has seen or heard this too, but I can’t tell you how many women with hypothalamic amenorrhea and anovulatory cycles that are being funneled right into IVF. It’s just so unfortunate because their bodies are not ready for a pregnancy and that’s the reality of it. But with some minor tweaks really, some basic interventions, you can be.

Laura: That’s something that I talk to my ladies in my Get Your Period Back program a lot. There’s a lot of impatience a lot of the time because for some of them they haven’t been getting a period for maybe it’s been years at this point. It can be really challenging to say I know that you want to go do, like you said, the Clomid, or I’ve even had people ask me about like getting leptin injections, that kind of thing.

I almost feel like you can’t try to sidestep all the nutritional stuff and expect that you’re just going to have like a normal, healthy pregnancy and that there’s no long term impact of skipping the nutrient replenishment phase of the approach. Because like you said, maybe 90 percent of people will get it back, and get their fertility, and have a healthy pregnancy with the natural approach. And for that 10 percent who need the medical approach, they probably still needed the natural approach on top of that as well.

Ayla: Exactly. Really understanding what your cycle is like, I mean back to kind of pre pregnancy prep, if you’re thinking about pregnancy and you’re on hormonal birth control pills and you have been for a long time, pill, or IUD, or whatever, consider getting off those on the earlier side. That’s not a real period – a hormonal birth control period. That’s just a steroidal hormone induced bleed. But understanding what your cycles look like, if you’re actually ovulating. It can take time to get that that signaling between your pituitary gland in your ovaries going again. Give yourself some time to get your natural cycle back.

Kelsey: Yeah, it makes a lot of sense. I want to switch gears slightly here just before we wrap up because I kind of envision that some of our listeners minds might be going here, which is we’ve talked a lot about all these different factors that feed into fertility and reproductive health. I feel for some of the some people listening to this it might feel a bit overwhelming, like holy crap, I didn’t realize there was so much to think about if I even want to consider getting pregnant! For some women, they may be listening to this and they’re already pregnant, or they’re trying already and they haven’t thought about this prep at all.

For people who maybe are pregnant or possibly get pregnant earlier than they were intending to, or it or something like that, should they be stressing about all this stuff that we just talked about today? Or what can they do to at least at this point now that they are pregnant make sure that they have the healthiest pregnancy possible?

Ayla: Yeah that’s a good point. I think it’s just it’s all about prioritizing. Really I mean your body is amazing. Its ability to protect your baby, your fetus, is pretty profound. The number one thing I’d say is make sure you’re eating enough and that you’re getting in some good nutrient density.

The biggest thing that I see and the biggest concern with my pregnant clients is they’re so worried about gaining too much weight during the pregnancy, and those frequent weigh-ins that you get at your checks. It’s even a very common topic that comes amongst RDs in some of our groups that we’re in you guys have probably seen. Just worried about gaining too much.

I think while it can be somewhat of a valid concern and you’ve got to monitor a little bit, it’s way overdone. I mean I’m encouraging a lot of my clients even avoid getting on the scale especially if they have had any sort of history with disordered eating or diet kind of mentality. Not even getting on the scale and just let your body do its thing.

Focus on eating enough nutrient dense foods. You can kind of check in with that by using one of my favorite tools, Cronometer. You can enter in a few days and kind of see what you look like for nutrient density and overall balance. It allows you to plug in if you’re pregnant or not, or breastfeeding, and it kind of accounts for that. That’s one of my biggest strategies.

But I would also say a couple of low hanging fruit things in your environment. If you’ve got the Glade Plug In car scents or candles around, those I might tell you to ditch. Those are a big source of kind of endocrine disrupting chemicals that can be problematic. Take a look at some of your beauty care products. Start with just like your lotion and shampoos, things like that. I often talk to women about that, the things that touch the most surface area on your body.

That’s what I would do. Take a look your environment a little bit, make sure that you’re not overly worrying about the weight gain during pregnancy, and getting in some good nutrient dense foods.

Kelsey: Love it. I love that you mentioned that your body is just so good at protecting your unborn baby. I think it can be very easy to get super stressed about all this stuff that you hear about that maybe you feel like you should have done or something like that prior to getting pregnant. But it is freaking amazing what the body is capable of doing. Trust in that and do the best that you can now that you know you’re already pregnant. I think is a really great approach.

Ayla: Yeah, absolutely.

Kelsey: I know you have a fertility online program. Do you want to tell us a little bit more about that and kind of who that might be a great fit for?

Ayla: Yeah. First and foremost, obviously this is what I do one on one in practice and I have a very specific model that I work with people both locally and abroad, throughout the U.S. and abroad with fertility. That’s pretty much exclusively what I do; women’s health and specifically fertility work now, hormonal balancing, that kind of thing.

I do that and then we also have a program called Nourish Your Fertility. We are launching the second round of that program in the New Year in early 2018. It’s kind of a DIY option. It covers all of these big bucket areas that we talked to briefly about today and it gives you the top priorities and top strategies that both myself and my co-creator Nicole Holovach, she’s also an RD and fertility specialist, that we use with our clients in practice. Basically we walk you through in an eight week module exactly what to prioritize and do so you don’t have to feel overwhelmed and not know what direction to take.

That’s called Nourish Your Fertility and there’s actually a private Facebook group that you can join, too. That’s actually kind of a growing community and a fun one to start learning about some of this pre pregnancy prep stuff.

Kelsey: Awesome. If people want to learn more about you, where can they find you online?

Ayla: You can find me at BostonFunctionalNutrition.com. I know it’s a mouthful. If you’re curious about just talking through your case a little bit, just get a perspective understanding a little bit more about like how I work with clients, or if the Nourish Your Fertility program might be a good fit for you, then I have 30 minute whole health strategy sessions that you can book easily on the site so we could just hop on a call.

Kelsey: Awesome! Well thank you so much for being here, Ayla. I think this was a really great overview of things to start thinking about if you are considering becoming pregnant soon. Hopefully it can help our listeners out there who are thinking about this and are maybe a little bit overwhelmed by all the stuff that you can read online about what you should be doing and shouldn’t be doing. I love your approach. It’s very similar to mine in terms of pregnancy prep. Thank you so much for being here and answering all of our questions today!

Ayla: Thanks for having me, Kelsey and Laura!

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