Functional Fertility – with Dr. Kalea Wattles

Hi and welcome. I am so happy to be talking today about fertility with Dr. Kalia Wattles. She's a naturopathic physician, also graduate of Bastyr, like me and functional medicine practitioner and she is in the Seattle area joining me here to talk all about fertility, how we can help women who are planning to get pregnant or maybe struggling to get pregnant or somewhere along the the journey of getting pregnant. Thank you so much for joining me, Clea. I'm so happy to be here with you.

Such a pleasure to join you. I just am so honored. Thank you for having me.

You're welcome. So talk us through first, like what inspired you to become a naturopathic doctor and do what you do, helping women with their fertility?

Yeah, well, it was a long road, but I think it started just to make this long story more abbreviated that I moved when I was at 18 years old, I moved down the street from Bastyr University in Washington. And as you know, it's set back in the forest and I would drive by the sign every day and just wonder what is going on back there. It seems so magical what is happening back there. And then I seeing a naturopathic doctor for the first time and it was so life changing, unlike anything I had ever experienced. Where I think many of us go into medicine because of our own healing journey. Right. Really encouraged me to first do the nutrition program there. So I enrolled and I got my bachelor's in nutrition at Bastyr and then stayed on to do the doctorate program. And during my naturopathic doctorate, I had my first baby in my second of the program. And becoming a mother was such a transformational experience that I really felt called, you know, whoever wants this, I want that for them so bad. So I started learning, taking all of the classes that I could take on the subject of kind of an integrative approach to fertility. And then I talked my way in. I kind of cold called all of my local fertility clinics and said, I know that this is not traditional, I'm a naturopathic student, but can I shadow can I come and see what you do so that I can understand how my modalities will fit into that. I rotated through three of the biggest fertility clinics here in the Seattle area and really I think got a deep understanding of how an integrative approach can, number one, maybe make it so that you don't need assisted reproduction. But sometimes IVF is necessary. So getting a great foundation of what can I do to set patients up for success so that their IVF works, that their outcomes are Better. I really realized that there's this beautiful collaborative approach that we can take and that patients ultimately benefit when they get the functional medicine, the naturopathic medicine, and then have access to those, you know, the advanced technologies as well.

Oh, it's such a. It's such a good point. And I've really observed that over the years, too, for, you know, over the 21 years that I've been in practice and helping women, because I'm. I did the midwifery program at Bastyr, and so I was really right in with the birth. But it also, like you, it made me very inspired to help women more, to be able to achieve that and to get there. And so often what I observed was a lot of pregnancy loss, you know, a lot of women who would be having miscarriages and not maybe sometimes not just one miscarriage, multiple miscarriages, and not getting support to make it through that early stage of pregnancy. Whereas I felt really comfortable at that point because that's what I, you know, that's where my focus was with, you know, even though midwives were especially focused on when the baby's coming out, we are also there at the beginning, too. So as a naturopathic doctor and midwife, that really was something I really found rewarding to help with. I'm sure for you, too, it's just, how do we help pregnancy happen, but also how do we help women through that first trimester without having a miscarriage? And thank you so much for sharing your story. I was mentioning, too, that I lived a lot of my life right in that area where you are in Seattle, Bellevue, you know, the east side. And, oh, my gosh, I have such good memories of being there. So it's fun just to get to talk to you. Thinking of. That's where I did a lot of my midwifery training, doing a lot of home births and birth center births in the Seattle area. And I'm with you. It is. It's like when you see that you just want that for someone else, too. And my daughter was actually born after I graduated from Nature Public Medical School and. And my midwife retraining, and she was born at home in New York. But it also, you know, just, again, just really, you learn so much when you go through it yourself, right? And you're just like, okay, where are women supposed to learn all of this and what's going on in your body and how we can support the body? And, you know, it's just that not to be, you know, I'm not critical at all. Of obstetrician, gynecologists or reproductive endocrinologists because they're doing amazing work. But it's good to know that their work is very focused and it doesn't necessarily include diet or nutrients or exercise or any of the other things that as naturopathic doctors, we focus on. You just have to know that when you're going through this process, have a reality of, here's what these doctors focus on and here's what they don't focus on. A lot of times I find. I don't know for you, too. I find that my patients will have, of course, they're specialists, but then they have me as someone to guide them alongside.

Absolutely. And I think it's beautiful how you said it doesn't have to be either or, it can be both. And, and oftentimes it's best if it's both. And, and what I find you touched on the recurrent pregnancy loss piece, and this is something with recurrent pregnancy loss with unexplained infertility. It's kind of, you know, in the conventional world, it's. Well, I don't know, it's probably a lot of things, but that's where naturopathic and functional medicine really shines, because it's already part of our philosophy to consider patients as whole, complex entities and to think about a variety of body systems working together. We know, of course, it's one thing, that's how we were trained. We already coach patients that way. So I really think that naturopathic medicine is uniquely suited to meet the needs of those patients who have these conditions where other modalities are kind of like, well, I don't know.

Yeah. And it's a standard of care to, you know, usually it's only after at least three miscarriages that they even look a little closer. And even then they might not be looking at things that we look at. And so, and to some degree, it's, I would say, similar to. Even if you're. Say you're starting to think of getting pregnant, you're like, okay, I'm. I'm now thinking in the next, you know, And I think a lot of times women even think they only think, I'm going to start getting pregnant this month. But I think you and I probably would agree that it's, you know, if you, if you even start to think about it and you can give yourself even six months to get ready, or sometimes longer. Right. Like, just because the healthier you are, the healthier your whole body is, not just your Menstrual cycle. Yes, your menstrual cycle is important because that's when where ovulation happens and pregnancy happens. But we want to have your digestion healthy, your nutrient levels balanced, your neurotransmitters, everything in your body balanced and as healthy as can be. Because then you're being much more likely to get pregnant and maintain that pregnancy. But yeah, tell me your perspective. How do you like to talk about that?

That's exactly right. And I think there's two things you made me think of. So number one, preconception care in my mind is really about cultivating whole organism resiliency. A healthy body is a fertile body. In the preconception phase, yes, we're working to support a pregnancy, but oftentimes it's just building up the reserves and the fortitude of that human in general, making them in the best health possible. Then the second thing that you made me think of is I always tell patients we plan for our wedding for a year. But then when you want to get pregnant, you wanted to get pregnant yesterday. You have to approach our pregnancy planning like we would other big event because it is a big event. That is a huge event. And so I always have the conversation, as I'm sure you've had a million times, that when we have a little baby developing follicle, which is essentially an egg sac, where our egg that can become our baby is growing and maturing, that starts roughly 120 days. It starts getting big. And so 120 days, that's when our little baby follicle is really starting to grow and emerge. And so if we can give at least 120 days to really de dedicated support, that's going to make a huge difference. But of course, in a perfect world, if we can have six or 12 months, then ultimately that's going to set us up for the best healthiest egg possible and the healthiest parent to be. And I always want to reframe just as you did so beautifully. It's not just, you know, are your menstrual cycles normal? It's what is also going on in your relationships, in your finances, your mental, emotional, spiritual health. I think those are things that are forgotten about. But that's where we can really step in and say let's look at all aspects of how your health is, is persevering as a human.

Oh, I love that. Exactly. Yeah. Like really look at the big picture. What I find is because I help a lot of women with HPV and abnormal pap smears and some of Those women are in the age group where they're planning also to have a pregnancy soon, or maybe they just had a pregnancy and they're wanting another one. And so the thing I find is that as I'm helping them to fend off HPV and heal their cervix, they end up way more likely to get pregnant. In fact, some of them get pregnant out of nowhere. They're like, oh my gosh, I got pregnant. Because like as you said, when your body's healthier overall, you're way more likely to get pregnant. The ovulation is going to be more successful, the progesterone production is going to be better. You know, like your body's, your nutrient level is going to be better. Your body's just more receptive to pregnancy. Because a lot of what I do with resolving HPV is help women to recover from stress, which is I think what you're pointing to. You know, when we're, when we're under stress, whether it's physical, emotional, whatever kind of stress, even toxins as a stress, it's a signal in our bodies to turn off our fertility. So if, and sometimes it's even stress, being stressed seems familiar or normal. Right. We're just so used to, used to being stressed all the time. We're like, isn't my body supposed to be able to get pregnant? Well, no, because it's the wrong signaling. When our bodies are in like go, go, go survival mode, it's turning off the ovaries and ovulation and fertility. And so we need to really go, how do we shift even on a day to day daily routine. Right. Our self care, how do we shift so that you can integrate in different signals for your system so your body actually has some time. Not in survival mode. Yeah.

And when we look in the literature thinking about things like chronic stress, and I always tell patients it's not just you have your inboxes loaded and that kind of stress. It's also stress that your body perceives from poor sleep quality and poor nutrition and even being exposed to fluorescent lighting all the time. All these inputs that our body is perceiving as stress. And when we read the literature about it, it calls it predation risk.

Right.

How, how, What a startling way to phrase that is. Your body feels like you are being chased by a predator. So of course it's not going to say, yeah, now is the best time to have a baby, let's do it.

Right, Right. It makes sense. Our bodies are trying to do what we want them to do. And we, if we want them to be ovulating, then we need to give a different signal. We need to give it the sort of calm and. Yeah. Turning down the lights at night and getting enough sleep and. And eating right. In regular intervals through the day. Because that's another. I find a common kind of stress to the system. As if we're going long times without eating. That is basically. I mean, in some ways we call it fasting, but when it comes to the body and pregnancy, the body can consider that a stress. So then it ends up turning off the ovaries in the midst of us either fasting too long or even exercising too much, Right?

Yeah, definitely. We are building and cultivating a sense of safety in the body and the nervous system. That is all a very important part of a preconception plan. You just reminded me when you said sometimes we are so ingrained in the stress response, we don't even realize that we are doing it anymore. It reminds me of, I use this example sometimes that When I was 13, I got contact lenses for the first time in my life and I didn't even realize my eyesight was so bad. Then I got contact lenses and we were driving away from the eye doctor and I told my mom, I said, I can see the leaves on the trees now. And I didn't even realize that before. I was just looking at this green blur. But now I can see all of the individual leaves. It's like you don't even know what you don't even know.

Exactly. I think that's exactly. Doesn't have to be. The other thing is you have to be careful because sometimes as soon as we start to notice the stress, then we start to be hard on ourselves and that's just another stress. So just always please hear at any listeners that it's about being gentle with yourself, noticing. Oh, okay. How can I observe myself and my routine and start to get creative about and curious about how I can shift things in a way that are going to just bring in a little more anti stress or you know, just downtime without being hard on yourself. You know, it's just a practice, I think. Right. You just have to bring more awareness and little by little you can create some shifts.

Yeah. And I think when you're trying to get pregnant and you know the stress management piece is really impactful, that can be such a great motivator because I think without that sometimes like, well, I'm faring well, you know, my career is going well or I'm very productive. I'm a good employee. I'm a good partner. Well, then when we actually have some actionable of. I need to work on this because of my goal to get pregnant. That is such a motivating factor.

Yeah.

Little nudge we need sometimes.

It's true. You know, it's so interesting because I think a lot of times we're more motivated by this other human that we have the intention of creating. Or even when women are pregnant, they're way more motivated to make diet changes because we're used to doing things for another person before ourselves. And so sometimes you can use that, you know, to your advantage and be like, okay, this is. This is for me, this is from this other baby that I want to create and for my family that I want to create. And you can start to get. Yeah, like you said, more motivated around that. And. And then. Yeah, just. And that's why it also is nice to be able to have a little time so you. You're not stressed. Like, oh, my gosh, I need to have this pregnancy. This. By this date or by this. Because women, of course, sometimes feel stressed about their age. Right. And they're like, okay, I have to hurry up now. And that's just more stress.

The last thing that I'll say about the stress component is I work with a counseling referral service in my practice, and I think it's such a nice time if you've not been in counseling. A lot of things come up during a fertility journey. Even if it goes, I think it can really stir up a lot of feelings of uncertainty or anxiety. And so I work with a counseling referral service where I can provide them with my patient's information, and then they match them to a counselor. And I think it's a really nice time to start doing some digging if patients are comfortable to do that. And I have a mentor, and she told me she's an OB who's been practicing for 40 years. And she said when she would have patients for infertility, she would do this guided meditation with them where she would have them contact the soul of their future baby and say, what are you waiting for? What are you waiting for that is preventing you from coming? Or, what can I do to shift that so that you're ready? Was like a stress management piece, or, I'm worried about my marriage, or I don't know that my finances are ready. So many things that you could hash it out, you know, if you had one skill to talk it through. And I think that that's such just a powerful image to say, okay, I have energetically reached out and get this signal that. Or a message that this is what I need to work on. And now I have someone to support me through that process.

No, it's. It. I love that. And it's beautiful. It's really beautiful because I think, you know, because it's a process that sometimes we just, it's. We would be tempted to want to control everything. Right. To try to control the date and the time and the everything. But to just have a process that allows you to kind of let go a little bit and put your intention. Here's what my intention is and my desire and my, you know, what I'm envisioning for my life and my family. And at the same time, you know, let it go a little bit and be like, okay, I trust this is going to happen at the time. And what can I do to be. For my. To prepare myself? How can I be most prepared? Because actually, what happens is the more we kind of start living into it, the more likely it's going to happen.

And I love the way you said that. It's just surrendering. I'm sure as a midwife, you have conversation all the time of like, we can plan to the best of our abilities with our pregnancy and our birth plan, but we have to remain dynamic and surrender to the fact that anything can happen.

Yep. We're humans in nature. And the thing too is, like, say patients who are working with it with an re, a reproductive endocrinologist, say you're doing, you know, IUIs, IVF or any other procedures that alone can start to become stressful because there's a lot of, you know, going into the office, getting blood draws, getting, you know, different treatments, what's the next date that I need to check in. And, you know, it's. It can really take over. And so I think the, like you were mentioning having a therapist or counselor having emotional support and having strategies to be able to. To know, hey, this is going to be a stress exposure. What can I do to support myself through it? So that your body's still in its most fertile state in the process, right?

Yeah. And I think that really speaks to the utility of having the collaborative care team like we talked about, because so many of my patients that come to me after they've already done IUI or ivf, they were holding so much of research, what diet is going to be best for me, which supplements should I take, what labs do I need, and really holding that on their own, and it becomes heavy and very cumbersome. What I try to say is your reproductive endocrinologist is going to do their job. I'm going to run all the labs and make sure that have all the nutrients and that your thyroid is well controlled and the inflammation piece. Let me hold that. That will be my job so that you can focus on doing the healing and the restoration work that's going to be best for your fertility. But I'll hold the logistics. And I think that takes off the weight of the world for folks. And that's why I think it's so nice to have someone who's willing to go there with you while you're doing your IVF or your iui.

No, I love that and it's so true and I love how you're touching. Let's go into that a little bit. What are some of. Let's talk about some of the common.

Scenarios or things that we pick up on in patients that maybe they haven't already been hearing about so they can get a sense of what we're paying attention to that would help with fertility. And you mentioned nutrients. So maybe let's start there and talk about some of the important nutrients that women might not be as familiar with.

Sure. Well, I'll go for what I consider to be low hanging fruit. And I always mention this because vitamin D, we always think of vitamin D, I think especially in the integrative medicine world where everybody's pretty aware, aware of vitamin D. But what I will say is when I was rotating through the fertility clinics, I saw a lot of really low vitamin D. I mean really low. And I think that it's probably because once you're already at that point where you're going to do ivf, they have other things to focus on. Right. Vitamin D can get a little bit pushed to the back burner, but we see that when there's adequate vitamin D levels, we have more positive pregnancy tests just when folks are trying on their own to get pregnant and then much better outcomes with IVF cycles as well. So I always am looking at vitamin D right away. I mean, first visit, we're ordering a vitamin D. And the other, the nutrient consideration that I see all the time, and I'm sure you see all the time in menstruating women is really low iron.

Yes, it's so common.

And this is something that I really want to think about whether someone's getting pregnant on their own or they're doing ivf. Because we know that iron is really responsible for helping our little follicles, our little developing egg sacs grow when we have a low iron, that growth gets really disrupted and then we have less ovulation, anovulatory cycles. We see that.

Even when the follicle is ovulated, it's just less robust, it's less healthy, less likely to fertilize. Then the other piece that I always think about with iron is our red blood cells contain iron. And our red blood cells are responsible for delivering oxygen to our entire body, including our ovaries and our endometrium, which is that inner lining of the uterus. And so if we don't have adequate iron, our red blood cells are really going to suffer. And there's been some interesting research. I've been reading that in the setting of low ferritin, which is an important storage form of iron, that we see that the egg cells are actually wasting away because they're deprived. And so especially for our patients who have a lower ovarian reserve, or what we call premature ovarian insufficiency, so they're younger women, but have less viable eggs. I just want to know, are you getting enough nutrients and oxygen into those reproductive organs?

Those are two nutrients that I think a lot about. But then I love to do micronutrient analysis in my practice. So I use a test called the Nutrival that looks at a ton of different nutrients, antioxidants, amino acids. And I love, especially in my fertility patients, to look at antioxidants because we know that that's important for egg health. And I think it's great if we can, number one, understand how we can change the diet, but then to really be targeted with our supplementation. I know that sometimes in that preconception phase, we're taking just so many supplements and that it becomes really overwhelming. So if we can add a layer of specificity and say, well, based on your unique body, this is what I see that you need. Oh, I think that's so helpful.

No, it's so true. And I love how, like you were mentioning first, vitamin D and iron, which those can be tested even just from a regular lab. Like you could ask the doctor and measure my. Now with. With the iron. I would, like you mentioned, I would ask to measure the ferritin because sometimes you might not have anemia and your regular iron level might be fine, but if the ferritin is under 50, it needs attention. And we need to start thinking about iron sources in your diet. Right. Or supplements to get the levels up. And it's going to be important during pregnancy, too, because during pregnancy there's dilution of the blood and just a natural anemia that happens. So you're going to want your iron up for all of those reasons. And so I love those points. And then, yeah, the micronutrient panels can be so helpful. And I love, like, what you're pointing out from the research when they. And this is, I would say I'm seeing in the research more recent, I guess, maybe over the past more like 10 years, is this focus on oxidative stress in the ovaries. And it's not something we paid attention to before. But then we started to go, wait a minute, if there's oxidative stress, which is when basically, usually our bodies naturally make oxidative stress, but then we have antioxidants to counterbalance it. And so there's this constant process of oxidative stress and antioxidants. But when the oxidative stress outweighs the antioxidants, that's when there can be damage to the cells, but also to the DNA. That's why Kalia and I are thinking, hey, how do we. How can we measure that? I mean, right now, one of the best ways, I think, is probably with a urine 8.0hdg. Right. So we can get a sense of oxidative stress. But you need a specialty test to do that. That's not going to happen in the regular doctor's office.

It sure isn't. And yes, I love that you brought up this oxidative stress piece, because the research that's coming out is using this term, which I think is so perfect. And it's inflammating inflammation within the ovary, which is this combination of inflammation and oxidative stress that causes our ovarian tissue to age more rapidly. And we know that the things that we can do are stop smoking, eat more antioxidants. And it's so comforting because these are actionables, right? These are modifiable lifestyle factors, and they're very actionable. And we have a number of dietary. I mean, just even if we said we're going to eat a rainbow of fruits and vegetables every day, that's already going to start combating inflammaging again. Going back to if we can do targeted supplementation with things like curcumin and melatonin and green tea and alpha lipoic acid. These are all such powerful stimulators of our antioxidant capacity that I love.

To say, whatever we can do to support our antioxidant capacity and our mitochondrial health, that's ultimately going to prolong our Fertility potential. Such conversations to have. And then if we have a year to act on it, how wonderful.

Yes. Anyone who doesn't familiar with mitochondria, those are those little energy producers in our cells, but they're really important in the ovaries. So we like, yes, anytime you're taking nutrients, it's going to feed all the cells in your body, but some amount is going to get to your ovaries. And we actually see that when we use, as you're mentioning, sometimes simple nutrients. Vitamin C, for example, antioxidant using vitamin C and some of the others that you mentioned, we can actually see a difference and see that 8, oh, DG level come down and we see fertility increase. And so it's super exciting to us that what you're swallowing and what you're doing in terms of your food too, and your lifestyle is actually making a difference in your ovaries. I know it's sometimes hard to believe, but it actually works.

Yeah, it is a little bit not intuitive to make that connection. But mitochondria, it's such a fun topic to discuss. And I always think I can always hear my 10th grade biology teacher's voice in my head, like it's the powerhouse of the cell and that oocytes, so egg cells, they're that most highest, you know, it's the highest concentration of mitochondria in the human body is our little something.

Concentration. Wow. Yeah. So I think if I'm remembering the statistics, it's. There's roughly 200,000 copies of mitochondrial DNA per little tiny egg cell, which couple of ordered orders of magnitude higher than other cells that we think about, like nerves or skeletal cells that we think are, oh, those are very energetically dependent. But really our little egg cells are so they need so much energy. And now there's all of this research coming out because in the IVF setting, they're able to watch this happen. You fertilize eggs and you watch it grow. What they have found is that the ability of an egg cell to grow into an embryo is really dependent on whether its mitochondria is producing enough energy to fuel that growth and fuel that replication. And so I think whether you're going through an IVF cycle or not, the mitochondria need some love.

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Yes, and the amazing thing is there's so many even simple things that do kind of give love to the mitochondria. Things we've been talking about already, the sleep, the, you know, and actually you reminded me I spent put my, because these glasses are my reading glasses but they have blue light blocking in them. So you know, you realize like oh my gosh, we're exposed to so much blue light, you know, during the day, especially when it's dark out, you don't want that blue light because it then it's inhibiting melatonin. It's an interesting one. Melatonin, like you mentioned is considered an antioxidant, but it also has signaling to the ovaries. This is why I always like to mention the cool thing where.

Our human bodies respond to the moonlight. When the full moon is out and we have more light exposure at night, it turns down the melatonin on those days and that makes it more likely that the ovaries are going to ovulate. But you don't want to have light all the time because then the body is not going to know. There was a contrast from darkness at night to these couple days right at the time of ovulation. That's when you can use a little bit of light exposure to promote ovulation, but then you want to go back to darkness again.

We're really not separate from this earth, are we? We're really just part of it and all interfacing together. And you just reminded me thinking about the bright lights and wearing blue light blockers is I have a, you know, a group of women in my practice that have secondary infertility. So they had a baby and now they're having such a hard time getting pregnant again. And we are always looking for patterns in medicine pattern recognition is so important and I see that oftentimes I have moms of small children who are Working. And so they wait to do a lot of work until after baby is in bed. And then they're working like from 8 to midnight and there's all blue light exposure and their circadian rhythm is all messed up. And then that really rolls into more irregular ovulation and irregular menses. And so sometimes it's really returning to the basics and just truly looking at how we're interacting with those light and dark cycles.

Yeah, it really reminds us, okay, I'm a human, I'm not a robot, I gotta like, look at how what my human body is responding to. And it also. This conversation reminds me that just this topic of what we often refer to as epigenetics, which is that the more we take these steps to help ourselves recover from stress and help our mitochondria and lower oxidative stress, all that good stuff, it also can shift our gene expression. This is really exciting too in terms of even thinking about not only how your gene expression is in your body, like how to decrease your health risks and optimize your.

Cell production and so on, but also it can have an influence on your baby that when you have optimal gene expression, then your baby's going to have more optimal health throughout their lives.

I think that something that's so important about preconception planning and preconception care is that it's really generational health that we are making. And I have some friends who are doing group prenatal classes or group preconception classes. And so there's this community aspect. It's building community and then fostering this generational health, which, wow, how impactful. That makes me feel like I'm such a small piece of this whole, whole thing where it's generations that are going to inherit this planet that are healthier. That's stunning.

Yeah. Does it? Gives me goosebumps.

Me too.

It's so exciting. Another nutrient that I was thinking of that I'm always. I pay a lot of attention and a lot of women contact me related to MTHFR and methylfolate because it's, you know, now I think sometimes more likely, when women sometimes get to even the stage of ivf, then they might finally get tested for MTHFR and then find out, oh, I have an MTHFR gene variation. Now what do I do? Because even if your doctor does the test, they might not really know how to manage it. There's no protocol yet established that I know of an obsage for OB GYNs or for endocrinologists even. And so I've really, over the years, developed protocol to help women with MTHFR related to pregnancy and, well, even preconception and pregnancy and so on. And the key, I like to mention is to once you know you have an MTHFR gene variation, and even if you don't, even if you haven't had that test done in your standard blood work, you can ask for a test called a homocysteine. And a homocysteine they can run at the regular lab from a regular SST tube. They don't need anything fancy on. Your insurance should cover it, but it's going to tell you how you're dosing your current dosing of folate, but not just folate, but Also, of course, B6 and B12. All three of those nutrients or B vitamins influence the homocysteine and you want it to be right. About a 7 is what I'm aiming for, but I find a lot of times when we hear about MTHFR and homocysteine, most information you'll find out there is talking about having a homocysteine that's too high, which, when the homocysteine is high, it means a person needs more, more of those B vitamins. But what I see much more often in the fertility audience and patients is they have a low homocysteine. And so it's a whole different treatment approach because we still do need adequate folate and the other B vitamins, but we also need to be able to support the homocysteine as much as possible. And so I find it's a careful balancing act with the nutrients that, again, I think most practitioners are not looking at that or knowing how to do that. Sometimes they'll even give you a really high dose of folate. They'll see MTHFR and say, okay, you need 10 milligrams, and that might be way too much for your body.

Yeah. I'm so glad you brought this up because I would love to get your perspective on this of. Sometimes I'll have patients who may have recurrent pregnancy loss and they'll get some testing and they'll find that they have an MTHFR polymorphism. There's a mutation and it causes so much fear. Try to have the conversation that your genes are not your destiny. There's things that we can do to modify these things, but if you'd be willing, I'd love to hear. How do you frame this to patients when it causes so much anxiety and fear once they get testing?

Well, especially for women who've been through, say, Pregnancy loss and a lot of ivf and then they find out about mthfr. Sometimes it's like you feel like, oh my gosh, I wish I would have known how come this wasn't tested earlier? And so first that conversation should just know this isn't yet part of standard care. And so it's not something that's usually tested. And usually practitioners aren't even thinking of it. And so they're also practitioners are not trained in how to address it. And so just knowing, hey, this is a common scenario where you find out somewhere through the process. Now, if you're earlier on the process of fertility you may want to do, you can get an MTHFR gene test through the regular labs. Now, sometimes insurance doesn't cover it, so you have to be prepared to pay out of pocket. Or you can just do one of the other gene panels that gives you a bunch of gene information, MTHFR and more. And that's what a lot of patients I work with we end up doing because I end up wanting to know MTHFR as well as other genes, MTR and CBS and so on.

We can more proactively test for your genetics. So if you're already working on fertility and maybe having pregnancy loss, I would say let's find out what your genes are and then we can start addressing it. And then the other thing I'll say to women is now that we know we can be proactive, now that we know if you have an MTHFR gene variation, then I can help you. But what we then need is the blood test for homocysteine. And sometimes then we even will do other tests. You had mentioned organic acid panels and there's more specific methylation panels we can do. But I've found that even just if I have a homocysteine and then what I do is I recommend checking it through.

Even on a regular basis. If someone's working on getting pregnant, we will recheck their homocysteine every couple months and definitely if we have any dosage changes or we're trying to shift that homocysteine level, we'll check it more often. I also recheck it as soon as they find out they're pregnant and a couple times during pregnancy and postpartum because I want to make sure sometimes the doses will shift and I'd rather monitor it and make sure that their dosing is good because it can really vary for one woman. I mean, this is the thing is, of course, research from way back talked about folic acid, right? And we learned, okay, you should have 800 IUs of folic acid. And so you want to look at your vitamins. You know, that's the other thing is I would say for everyone really, because at least 40% of women have an MTHFR gene variation. That's quite a lot. I just feel like any prenatal or even multivitamin out there, sorry, my cat is right behind the computer, so you see his hair. But any prenatal really should be methylfolate, not folic acid. So I encourage any listeners look at your multi or your prenatal and if it says folic acid, I would replace it and make sure you're getting methylfolate. Because that's the whole thing with the MTHFR genes. People think, you know, in that, like you were mentioning that, oh, no, what do I do now? State the real key is to know that it really comes down to this simple B vitamin, vitamin B9 called folate or methylfolate, and that you have a decreased ability to turn folic acid or you could have a decreased ability to turn folic acid into methylfolate. And so what we want to do is just use methylfolate. Now you detoured around the traffic jam and you don't have to, you fixed it. You know, you essentially said, okay, I'm going to take methylfolate. But the key is, well, how much methylfolate. And this is, I think, again, where a lot of the confusion happens because some practitioners end up assuming they need a lot like 5 milligrams, 10 milligrams or more of methylfolate in it. And it may not be the case. That might actually be flooding the system. And some women will feel worse or do worse if they have too much methylfolate. So it's not a matter of just throwing a whole bunch of it into your body. It's a matter of, okay, we know we need methylfolate. Now, how much does your body need? And the other thing that I think is so interesting is as you do these other things you and I were talking about, right, as a person does more sleep and self care and dietary changes and addressing any toxins that might be present as they do, that methylation actually improves. So then the requirement for folate can actually decrease as you improve your health. That's pretty cool to be like, hey, you can actually help your methylation just by doing some of these steps we've talked about to be healthier. And then we just do the amount of folate. We need what's adequate, like say at least, I would say at least probably 1 milligram or 800 micrograms. And then if we need a little bit more to keep your homocysteine optimal, great. If your homocysteine is low, we need to do some other strategies to support the homocysteine at the same time.

Yeah. Well, I think keep going back to this really cultivating whole person health. And I love how you mentioned that you can actually affect your nutrient needs. And it reminded me as we're thinking about B vitamins, it's also. Well, we can affect the way that you're digesting your food, even with stress management alone, even with being your food distracted, and you're going to absorb more of your B vitamins in the first place. And it's just incredible when we think about the way that we interface with the world through our gut. That's just. I wanted to highlight the importance of gut health as well.

Yes.

Oh, in your preconception, care for your. Just your nutrient absorption.

Yes. It's so true. And of course, with stress and toxin exposure, leaky gut is so common and imbalanced gut bacteria. And that's another area. I mean, we. Yes. Focusing on gut health, I agree. Is so important. And then that crosses over to the microbiome vaginally and even in the ovaries. Right. That's another cool new research area is, you know.

What are these bacteria and other microbes that live in our digestion, but also other areas of our body that can have a positive or negative influence depending on how they're doing? Yeah.

Leaky gut is something that I think about all of the time, especially in patients with pcos. There's all of emerging research all of the time about this connection between our gut bacteria and the. The generation or the origin of pcos. And I think one of the light bulb moments I had when I was learning functional medicine was this connection between leaky gut and having poor ovulation, because leaky gut and things that are inside your intestinal tract, they can start to traverse that intestinal wall and enter your systemic circulation, where they basically activate alarm signals and an inflammatory cascade, and that includes inside the ovary. And so there's these studies looking at increased intestinal permeability and then the resulting ovarian inflammation and then lower ovulation rates and lower progesterone production. And I thought, wow, I have so many patients in my practice who have low progesterone, all of these gut symptoms, and it was such a profound moment of connecting those dots for me.

Yeah. It really is true. I mean, it's. And I mean, I always love to really start with the gut healing. True to naturopathic medicine.

Right.

It's like, okay, how are you digesting? And as you mentioned, even just by eating in a way that's less stressful, because just like the ovaries turn off when we're stressed, the digestion gets turned off when we're stressed. So if we want to be able to digest our food and absorb our nutrients and have a healthy gut lining, we need to set aside time for eating and chewing and digesting so that that process can work optimally. And, of course, there's so many other things we can do to help with leaky gut healing. Oh, my gosh. It also makes me think of gluten, and I found way back many years ago, you know, the connection between gluten, not just celiac disease, but gluten sensitivity and infertility. Because gluten, of course, is one major cause of leaky gut. So for many people, it's causing the leaky gut and inflammation, and it can definitely be associated with decreased fertility. So it's like, okay, let's figure out your food sensitivities. Let's figure out if there's leaky gut. Let's start using the nutrients and herbs to heal it and address the bacteria and just really be able to. That's a big piece of helping the body get ready for pregnancy.

Yeah. I always joke that an elimination diet. I'll put someone on an elimination diet for their eczema or their migraine, they will end up pregnant at the end. Once you start removing those food triggers and focusing on organic foods and letting your liver actually do some detox and removing all of the processed, the trans fatty acids and all of the advanced glycation end products, which is a whole other conversation that we could have once we start those things. It's like, oh, now every. All of our body systems are working more optimally and we're more fertile.

Yes. It's so exciting. And I. Oh, my gosh. I know you and I could go on and on. We didn't even talk much about thyroid yet, which is another. So, you know there's the other hormones in the body, right? Like, you're mentioning insulin, glucose balance, but also there's thyroid function and thyroid hormone levels, which is another. Like, a lot of times these might look normal on the blood work. Like your. Your glucose and your. Even your human globin. A1C might look normal, or your TSH might be. Be in the range. But for you and I, I know that's like, nope, that's not good enough. We need to, like, we want it really optimized. We want to have optimal thyroid. We want to have optimal insulin function because we know that those hormones affect fertility and affect the ovaries. And as you mentioned, when we, when we ovulate our. The ovaries make progesterone. And we need that progesterone to maintain the pregnancy. So it's.

That's key.

Anything that can help the ovaries not only ovulate, but make plenty of progesterone. Or we can a lot of times fill in and support the progesterone if there's not enough. But it's so important. Right? Yeah.

I can't believe we didn't even talk about thyroid. That is such a big topic. This is the biggest place where I always say normal does not mean optimal. The biggest thing with thyroid labs that we're really looking for a specific range. And then also for anyone who's listening, if you have your thyroid plant, your thyroid labs, they're coming up and they're planned. I always get thyroid antibodies. I think this is forgotten.

Emphasized part of a thyroid panel. We have to see what's going on with those thyroid antibodies because we know that even in the setting of nice thyroid hormones, nice free thyroid hormone and a TSH that looks okay. Even when there's, when there's elevated antibodies, we see higher rates of pregnancy loss, preeclampsia, gestational hypertension. So these are things that we want to know about while we can still make a move.

Yeah. And say there are thyroid autoantibodies, which is considered. It's Hashimoto's or autoimmune condition. There's so much there, again, that we can do from a naturopathic perspective to help turn off the autoimmunity. I do see a lot of that in fertility cases, whether it's Hashimoto's or other forms of autoimmunity. And the more we can help the immune system come back to balance, then that's going to make a big difference too. So. It's such a good point. You know, when you get blood work, you can ask for when you. When they. Some. They'll do the TSH usually, but the range, they'll, you know, they'll say even up to four is okay, but I would want it definitely under 2.5 or, you know, close to one as possible, essentially. Right. And then we want to look at free T3 and free T4, because this tells us the actual thyroid hormone levels, not just what your brain thinks of your thyroid. We want to know what your thyroid's up to.

Yeah. I always tell patients I want to know that your brain is talking to your thyroid, but then that your thyroid actually cares and is responding to that message.

Exactly. So we can look at this and then there's so much we can do to help fine tune it and address it in the studies. Definitely. It's so cool. I love it when a stage study actually documents what we've already were paying attention to. Right. I mean, I remember paying attention to thyroid way back, and then the study came out and said, hey, we should be paying more attention to the thyroid when it comes to fertility. And it was like, yes, definitely. And same with the insulin and blood sugar levels. Right. It's the ovaries are so responsive, amazingly, to insulin and blood sugar. And like you mentioned, PCOS is a classic case, but a woman might not have a diagnosis of PCOS or diabetes or anything. And still if there's a blood sugar fluctuations, even sometimes hypoglycemia, then it's. The ovaries are going to pick up on it. Yeah.

The body wants to be in a homeostasis. As we've been talking about. What do we need? What information do we need for our body to say it is safe here, really, just to have that balance kind of hormonally and nutritionally and in our circadian rhythm, in all ways, we're just looking to be balanced.

Yeah. And then it comes back to checking cortisol and adrenaline levels, which is, of course, how we see how that stress is affecting you. Like you're saying, like, if I want to know how has stress affected this person, how close to balance are they? We can look at cortisol, adrenaline and get a good sense and address that too.

It's just as people can hear from us talking, we get so excited because there's so many things we can do to help.

So please don't feel like it's hopeless or you're out of options because we even just touched on some of the common ones. There's so much more, too, that we can do to help.

There's so much more. And I think that's a nice way to kind of tie this all together is that when patients come into our office and they're exhausted and they feel like every stone has been turned over and there's no hope, and then we can say, actually there's all of this information that we haven't looked at yet. Right. Your, your glucose regulation, your inflammation, your adrenal stress, your micronutrients in the organic acids and the oxidative stress markers and the methylation. Actually probably nobody has looked at that stuff yet. And there's so many more information that we can collect to help you. And I think that it's just, you know, it can be a message of hope that there's more, there's more to look at.

There definitely is. It definitely is so much more. And so definitely. Thank you so much for this conversation. And if people want to reach out to you and because this is the thing is, as nature biologic doctors, we can help you with these tests and interpreting the test and then putting it into a program that makes sense so you don't have to stress about it. Like sometimes I think, think people will be like, oh, well, even if I get that info, what am I going to do with it? Well, that's exactly what we specialize in, is how to, you know, what do you do with that information in a systematic way, individualized for your body in a way that doesn't have to be stressful. We can, it can match your pace and really, you know, we can prioritize in a way that, so you can actually get the results from it.

Yeah, that's what we do. That's part of our philosophy is to do that education and to have it be patient centered and valuable and actionable. Yeah, that's at the core of who we are.

Oh, I love that. So your website is your name, right, Dr. Dr. Kalia Wattles.

That's right, yep. So doctorkaliawatles.com and then on Instagram at Functional Fertility, those are the best places to keep tabs on where I'm up to.

I love it. Okay, that's great. So I'll put links to this down below too, so everybody can find you and be in touch if they have questions. Now, do you work with people mostly in your office or virtually or how do you people.

Yeah, so I've been doing kind of a both in person and virtual visits, but I think the future is really moving towards a lot of virtual visits. And so that's where I'm headed as well. So I think moving forward it'll likely be a lot of virtual. It just works. So in this day and age.

Yeah, it's true. Me, me as well. And especially when it comes to, you know, usually a person will have their, their ob, their reproductive endocrinologist, they have, you know, the person who they see in person and for what we do. A lot of it doesn't have to be in person and we can. A lot of these tests we've mentioned you can do from home, you don't have to be in the office to do them. So it's really doable, you know.

So just I'm hoping we gave people a lot of hope. I think we did. And thank you again so much for joining me. Oh my gosh, this was so much fun to get this, talk this all through with you. And I'm so happy for all of your patients who are getting to work with you and get to their, their, their dream pregnancy.

Well, thank you so much. It's such a pleasure and it's always nice to connect with others who are so excited about topics that I'm excited about and it's just been so fun to talk with you. Thanks so much for having me on.

Thanks for listening to how humans heal.

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