Kelly LeVeque: The Fertility Crisis: Why it’s Happening and How to Fix it

Coming up on this week's episode of the Doctor's Pharmacy.

So that can be overwhelming because you hear the word endocrine disrupting chemicals forever chemicals, they're omnipresent. If someone removes these endocrine disrupting chemicals, they can see the decrease of the urine excretion of puffs by half within a few days or a week. So we have so much power in our ability to make decisions around these forever chemicals that cause oxidative stress to our body and the DNA that we'd be passing down for future children. So when it comes to these types of chemicals, there are so many any things you can do.

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On the Doctor's Pharmacy Podcast. Welcome. Hey, thanks Mark. I mean, you've been a guest on.

My podcast a few times and it's nice to return the favor. Yeah, it's great to see you. You know, your work is really important because you're addressing something that is an epidemic in the world and in America particularly. And I've seen this so much in my own practice, which is this increasing incidence of infertility. you know, one in seven couples is infertile, and it's becoming more and more of a crisis globally. Fertility rates have dropped 50% in the last 50 years, and it's not getting any better. And, and the question is why we have better food, we have better health care, we have better everything, and yet we're seeing it's not just birth rates decline, because that could be people having less kids, but actual fertility. so can you kind of give us some insight into the real root causes of why we're seeing this decline in fertility?

Yeah, I mean, there are three buckets that I talk about with my clients, and that's age. So we're having children later than our parents did on average between our 30s and 40s, where our parents might have had them younger between their 20s and 30s. And fertility rates do decline as we age. But I think the bigger levers that we have the ability to pull on are our own health status, and then oxidative stress. And so when you think about what causes chromosomal abnormalities and what causes this oxidative stress, it's a number of things. It's going to be endocrine disrupting chemicals, it's going to be things like pesticides, PUFAs, BPA, things that you've talked about on this podcast a lot.

Yeah, yeah. All the petrochemical toxins that we're just exposed to in crazy amounts, right? Right.

So you look at those three buckets. And like you said earlier, I mean, the WHO had a really jarring stat earlier this year in April that said one in six people globally are going to be dealing with infertility at least once in their life. And when we look at men, men's sperm has dropped 62% since the early 70s. And women today who are 20, their fertility is less than their grandmother was at 35. So there's something here. What's causing all of these chromosomal abnormalities and it's the stress that our body is going under.

But is infertility just about the chromosomal stuff or is there other reasons for infertility, right?

There are other reasons for infertility as well. You can go through undiagnosed issues like polycystic ovarian syndrome, endometriosis, hypothyroidism, you have Hashimoto's, you have anemia, low iron status, high iron status, untreated undiagnosed oral infections and untreated and undiagnosed autoimmunity. So when you think about it, your body needs to be in a place of abundance and vitality. You have to have high nutrient status to get pregnant. And it was interesting that the Journal of Clinical Nutrition showed that women who are pregnant, 90% of us aren't getting the nutrients we need from food alone. So there's a nutrient status issue and a health issue that we need to look at. And then it's the oxidative stress and it's coming from both sides. men and women, right? We think that for a long time it was just us women, but men play a role in this and we're both passing on our DNA for the child. Yeah, it's so true. I mean, I've seen this so much.

In my practice and, you know, I just co-founded a company called Function Health where we're doing, you know, wide scale screening of over 180 biomarkers for people that they can access directly from functionhealth.com without going through their doctor. And, we started analyzing the data. We have over 20,000 people gone through it over a million data points and was shocking for me to find this is a health forward population. There's not people leading McDonald's, and these be like, I'm going to be proactive. I take care of myself. I exercise, I eat healthy. You know, we saw dramatic amounts of nutritional deficiencies, particularly methylation, which is really critical for fertility and for, for preventing miscarriages, you know, B12, folate, B6. And people were really deficient in these. We saw very low levels of vitamin D, very low levels of iron. And these are things that are easily detected and treatable. So, I mean, I think there's, there's a lot of things that have to do with our, our poor nutritional quality, with insulin resistance, with just you know, stress and things that we can actually do something about. But then there's these, like you mentioned, these environmental chemicals, which are so disturbing. I remember when I was working at Canyon Ranch as a doctor, I was reading this book called Our Stolen Future by Theo Colborn. You know that book? Have you ever heard of that book? It was, it blew my mind. It was basically a book about the roles of environmental chemicals in causing all these hormonal dysregulation issues, hormonal chaos. And, and essentially the hormone disruptors are these petrochemicals. They're, we call them xenoestrogens or xenobiotics. They, they're in very infinitesimally small amounts. They're toxic. When you add them together, it's not like adding one plus one equals two. It's like one plus one equals a thousand. And they're ubiquitous. They're in all of our tissues and all of our organs. Our bodies store them in the fat. And, and this is driving huge problems with fertility. So I, I think there's so many issues that are out there, and, and the good news is that people don't have to just sit there and be passive acceptors of this infertility issue. And it's not just about getting IVF or getting fertility treatments. It's about dealing with these root causes. And most fertility doctors don't actually do this. And so that's why functional medicine is so important. What you do is so important because it helps us to think about it. So, you know, tell us more about how, how these toxins and forever chemicals impact fertility for men and women. I touched on a little bit, but maybe you can give us a little deeper understanding of how that works.

Yeah, well, you hit the nail on the head. They can act like xenoestrogens in the body, but there was actually a recent published study out of Mount Sinai that looked at over a thousand women and it researched blood levels of PUFAs between 2015 and 2017, and they found up to a 40% decrease in fertility. And so that can be overwhelming because you hear the word endocrine-disrupting chemicals, forever chemicals, they're omnipresent, and everything from your nonstick cookware, waterproof clothing, the Lycra, food packaging, the lining in inside your coffee cup, coatings on your carpet, upholstery, you're like, wait, my whole life is covered in this stuff. But what I always like to give is a promise of hope, and that is when we look at urine excretions of PUFAs, if someone removes these endocrine-disrupting chemicals, they can see the decrease of the urine excretion of PUFAs by half within a few days or a week. So we have so much power in our ability to make decisions around these forever chemicals that cause oxidative stress to our body and our, you know, future, the DNA that we'd be passing down for future children. So when it comes to these types of chemicals, there are so many things you can do from using storing your food in glass, swapping out nonstick cookware, even just taking a stainless steel coffee mug to your coffee shop or sitting down and having it in instead of in a to-go mug in a to-go cup, have it at the coffee shop, avoiding those plastic water bottles. A lot of these like pufas these are made to make things resistant to water, oil and grease, whereas phthalates make plastic malleable. Free things you can do, open your windows, take your shoes off at your door. All of these are going to lower a lot of those forever chemicals that are making their way into our house. You know, it is critical in those three months or four months prior to conception to really think about, well, where would I be coming in contact with these things the most? and how do I lower my exposure to them? Because we do have so much power in the decisions we're making every single day. It's true.

You know, it's, it's what we're eating. It's what we're, we're eating from, like the containers. Right. It's our household cleaning products, and it's our body care products. And, and those things we have control. And, you know, I don't know if you know this, but I'm on the board of the environmental working group, and there you go. Skin deep. Yeah, skin deep. And you go to ewg.org, and they have guides on body care products, household cleaning products, what foods, vegetables, fruits, animal products, how to reduce your exposures from every potential source of environmental chemicals. And so you can't be perfect, but it's something you can actually have a fair bit of impact in. Like you say, if you reduce these consciously, you see a drop in the urine levels very quickly. Kelly, you know, most of the fertility doctors focus on women, but the truth is, it takes two. And, and even no matter 50% of the equation, they're not really often considered. Even 25% of the men in infertility couples are not even evaluated as part of dealing with infertility. So, you know, what are, what are your thoughts for how men need to think about fertility, too, and how, how they need to think about improving their likelihood of, of conceiving a baby with their partner?

Yeah, well, men are 50% of the equation and how their lifestyle factors, how they're taking care of themselves, their nutrient status, their health is going to have an epigenetic effect on the DNA that they're passing down. And so it's critically important that they take care of themselves, especially during that spermatogenesis period, which is around 74 days on average to produce sperm. And so for men, fertility does drop and it drops about 52% in their early to mid 30s. and so just like women, they're experiencing a drop in fertility around the same amount of time. And what we've seen in studies over and over and over again is that introducing antioxidants into the diet, these are leafy greens, things that are gonna provide vitamin C, your wild fish, your lean pasture-raised meats, all the things you talk about, even when you think about your book Forever Young.

A lot of those steps- Young Forever, Young Forever. That was Bob Dylan. That was Bob Dylan.

About all of the ways that we are protecting our own health, we're protecting our men are protecting their sperm's health. And so when we look at it, we can see that vitamin C, vitamin E, L-carnitine, zinc, all of these nutrients are critical in producing sperm. And when we look at sperm, we're looking at quantity, we're looking at morphology, we're looking at DNA, and their lifestyle is impacting it. You know, we look at the research and we can find that men who walk over 4,000 steps a day versus those who have less than 4,000 steps a day have an increase in their testosterone levels. But what's so interesting is 1,000 more steps a day on top of that 4,000 increases testosterone 7 nanograms per milliliter. And when you look at that, that's pretty powerful. Like getting out there and getting active increases the quality of your sperm that you're passing on to your children. And testosterone does that, which is so great because we have power to make these healthy choices to increase the nutrients and antioxidants on our plate to move our bodies to sleep to decrease stress. You know, I think we forget that stress doesn't just come in the form of endocrine disrupting chemicals and in the form of our lifestyle choices or undiagnosed issues. It's coming psychologically too and sleep and activity really combat that and it is just equally as equally as important for the man and the woman to get active and get healthy together prior to conception. it.

Yeah, definitely exercise helps, but watching sports may not because one, one study actually showed that if your team won, your testosterone level went up. But if your team lost in the sports game, your testosterone level went down. So better exercise. Yeah. Now, one, one of the things that, that's important is, is sperm quality. and, and, you know, I think, you know, people think, oh, you know, men don't really have a time clock, right? They're not, they don't have a biological clock, but they do. And, and yet men can conceive. I think the oldest man ever to conceive was 96, which I think is pretty impressive. But, but it's, it's not the same as men get older in terms of the quality of the sperm, their fertility rates or the consequences for their Offspring. I mean, I think we see more autism rates with older fathers, so. Can you tell us more about man sperm health and why we see this decline and what do we know about how to address it?

Yeah, well, one study looked at the genetic changes in sperm health from young men to older men. And what we see is you are going to see the DNA involved there is going to have an increased risk of autism, Alzheimer's, type 2 diabetes, even heart disease. And when those genes are implicated based on the a man's lifestyle choices, they're actually passing that down to their children. And if they end up having a baby girl, they're actually passing those genetic changes down to their grandchildren. And so what we really want to do for men is to increase the antioxidant status. When we look at men who increase their antioxidant status by taking things like L-carnitine, vitamin C, zinc, all of those nutrients of concern that I talked about, even CoQ10. CoQ10 is shown to improve sperm concentration, quality, motility and morphology. And when you pair that with B12, it actually improves DNA, lowers the rate of DNA damage, which is also really impressive because we have this control. We can add NAC to our diet. We can look at our vitamin D status in the same way women will prior to pregnancy. It's equally as important. And I think this research is building and building. And that's why you see companies like we natal, which I know, you know, both of that both of us love very much coming out with prenatal for men because we can protect sperm quality, we can protect the morphology, and we can increase the chances that someone gets pregnant. And actually, men on antioxidants, they have a four times higher rate of getting their wife pregnant and a five times higher rate of that woman having a live birth when they're taking antioxidants prior to conception. Yeah, I think that's a very important point.

And in fact, just full disclosure, I'm an advisor to We Need I really believe in this. And I became an advisor because I really understood this from my own practice as a functional medicine doctor and treating infertile couples. And I would treat both the men and the women, and I would see really much greater results. So I think it's very important. And I think, you know, what you're seeing also is important to emphasize, which is that it's these simple things, just simple nutrients that are safe and well tolerated and inexpensive, can have a profound effect on sperm quality, sperm health, and the outcome of, of, of a pregnancy, which is just remarkable to me. And, and, and people think, oh, vitamins, minerals, how powerful are they? I just, I just want to share a little story here because I think it kind of speaks to the power really digging into learning how to take the right nutrients for you. I was in a film called Fed Up years ago, about a decade ago. And, in the filmmaker, the director of the film was a woman who had recurrent miscarriages. She had recurrent miscarriages, not only that she'd had stillbirth, she had an anencephalic birth which is really a horrible experience where there's a baby, but there's no brain. So it's, it's was pretty traumatic for her. And she read this article that I wrote on methylation. Now, for those of you listening, you know what that is. It's essentially a chemical process that requires B12, folate and B6. And it's involved in everything from Gene expression and regulation to neurotransmitter function to energy production to detoxification. So it's, it's a critical process in the body. And, and so she read this article, and she went to her doctor and said, hey, can you test me for something called homocysteine, which Dr. Hyman says is the way to best test for this. And he did. And she had a very high level. And he's, he's, she said, well, can you test me for the gene that regulates my homocysteine level? And he did. And she had the abnormal Gene that made it hard for her to do this chemical process. And he says, okay, I'll just give you some folic acid. And she's like, no, no, no. Dr. Hyman says, I need this special kind of folic acid and this form of B12 and this form of B6. And, and so she took it. And during the promotion of the film, as we were driving around in New York in the, in the taxis and going to the different events, she had a healthy baby that she was nursing in the taxis. And it was result of, of actually simply taking the right nutrients that were for her that helped optimize her chance of having a healthy baby. So people don't even realize that frequent miscarriages can be just simple as that. Just take the right B vitamins, take the right nutrients, and, and you'll prevent So it's such a dramatic story, but it's very compelling.

Well, I have to chime in here because this is one of the biggest red flags for me when I'm working with a client who's taking a prenatal that is using folic acid because 50% of us don't have the ability to take that folic acid and make it the methylated active form. And what you're talking about is her experience. And unfortunately, even research now is showing that babies are being born with unmethylated folic acid in their bloodstream. And if this isn't, if we're not able to use this, it's going to have implications on health and it's showing up in research in that way. And so, and your point on homocysteine, I mean, that's going to create an imbalance in hormones and increases chances of, of, of miscarriage. So it's, you're pointing right to the source. And this is as simple as turn that prenatal around and look, do you have a methylated form of folic acid or using folic acid and if you're using folic acid, you have to switch.

Yeah, that's exactly right. And in function health, one of the things we measured was homocysteine, which your doctor should have checked. And about 15% of the population had elevated homocysteine, which is one in seven people, which is about the amount of people are infertile. Now, that's not saying that that's the cause, but it was just shocking to see that for me. I was like, wow, this is a lot of people. who are having this and are not being treated. Hey everyone. Eating well is a critical part of reaching my health goals, but something as simple as getting to the store can be challenging with my schedule. And that's why Thrive Market is my go-to for all of my organic grocery and household essentials. The convenience of getting it all quickly shipped to my doorstep is a huge time saver and helps keep me from just grabbing whatever is fast, which usually means bad for you. I especially love stocking up on snacks from Thrive Market, and some of my favorite include Chomps free-range turkey sticks, Hugh mint chocolate snacking gems. Gimme Organic Olive Oil and Seaweed Snacks. Yeah, I love that actually. They're private label pitted green olives and they even have a price match guarantee so you know you're getting the best prices on your favorite brands. You can join Thrive Market with my exclusive offer and get 30% off your first order plus a free $60 gift. Head over to thrivemarket.com/hymen today. Plus, orders over $49 are shipped free and delivered with carbon neutral shipping from their zero waste warehouse houses. That's thrivemarket.com forward slash hymen. Protein is a foundational component of many health diets, including my own Pegan diet. But too often, the meat and seafood you get at the store has been raised unsustainably and contains harmful compounds that should never have been there in the first place. So if you're looking for quality proteins that are better for you and the environment, my friends at butcher box can help. Butcher box makes it super easy to get humanely raised meat that you can trust by delivering right to your doorstep. Butcher box has everything you could want, like 100 grass-fed and grass finished beef and shipping is always ButcherBox is committed to humanely raised animals that are never given antibiotics or added hormones. And since they take out the middleman, you get the extra savings. There is a major stipulation I always tell my patients about when it comes to animal protein. Quality needs to be a priority. And with ButcherBox, you can feel good knowing you're getting the highest quality meat and seafood that will help you thrive. For a limited time, new subscribers to ButcherBox will receive ground beef for life. When you sign up today, ButcherBox will send you two pounds of 100% grass finished beef free in in every box for the life of your subscription and $20 off. To receive this offer, go to butcherbox.com/pharmacy, F-A-R-M-A-C-Y. That's butcherbox.com/pharmacy. And now let's get back to this week's episode of the Doctor's Pharmacy. So in terms of preparing for pregnancy and preconception, you know, people don't often think about that. They think about, oh, getting pregnant and then what happens after. But actually it's just as important to understand how to prepare yourself to be pregnant. And I think about like preparing the garden. When you want to grow a garden, you've got to prepare the soil. You want to make sure it's got the right compost in it and the right nutrients in it and it's watered properly and everything's ready to plant the seed. We don't do that in medicine. We just like, okay, get pregnant and then take your multivitamin. And well, it should not be that way. And I think this is really important to think about. So can you talk about the whole concept of preconception and how we prepare for pregnancy? Right.

Well, it's now a big buzz term, trimester zero, preconception, your primetime, it's the three months prior to conception. Three months prior to conception. But I actually take it a step further and I take it back six months. And I say this from actual personal experience. I've had four pregnancies and three healthy little boys. And my first pregnancy happened actually on my first book tour, you know, a lot of travel, a lot of stress, eating out, but excited, you know, a lot of us have big, we want to have big careers and we extended education and then get married and then have babies. The day you want to have a baby, you want to be pregnant. And, but there is something to putting in the time to ensure the highest quality outcomes. And so six months out, this is the time to take inventory over your own health. This is, you know, I love your company function. You can go on there, I would say get a thyroid panel. Make sure any form of low thyroid is going to increase your chances of a miscarriage. Check your iron levels. look at your female sex hormones. We're going to look at follicle stimulating hormone to see if there's any, you know, chance of PCOS. You want to look at prolactin. Prolactin causes an imbalance and can create infertility. You want to look at homocysteine levels. You want to look inflammatory markers. This is blood test is that is a great place to start for both parties. and understanding like where do we stand? Where is our health? And if there are any autoimmune antibodies to try and work and lowering them by working on your gut health and cleaning up your diet, incorporating things that are supportive of healing leaky gut and pulling out the things that break our body down. Because if we can go into pregnancy strong, whether that's, you know, what you eat and lifting heavy and sleeping well, you, you're going to do and have the best outcomes. But six months out is good because then we're getting those blood tests, we're understanding where we are and we can take some active steps towards those three months prior to conception because it's the three months prior to conception, 100 days for an egg, 74 days on average for sperm where we're able to increase those nutrient levels.

Yes, that's such an important point because think about the egg and the sperm that you're delivering. to be the baby, right? That is determined by what you ate, by your stress levels, by your nutritional status, all of it. And if you don't have good sperm and egg, then it's less likely to have a healthy baby. So 100% agreement. Again, something I never learned in medical school we don't talk about, but it's actually really important. And, you know, you mentioned about the testing and it, you know, what we found was 12% of people have elevated thyroid antibodies, which people are walking around 12% with an autoimmune thyroid issue that can actually affect fertility. And even if your quote, other thyroid tests are normal, if your antibodies are high, there's something nasty going on and it could have an impact. And I actually have had many women I've helped get pregnant by giving them thyroid hormone. It's really quite amazing. You give them a thyroid hormone and boom, they're pregnant. So I think, I think we really, in fact, it's one of the things for fertility doctors do. They often give T3 hormones. So I think it's such an critical thing to think about and to think about this preconception period and get the right testing to look at your health and upgrade your health in every way. So You mentioned a few of the labs, but I think, you know, the Functional Health Panel is an easy way to get pretty much everything you need from your vitamin D to your hormone levels to your thyroid antibodies, autoimmune markers, to nutritional levels, and all the things we talked about.

People can go to functionhealth.com youm make a good point because I don't think people, what you've given people with function health is the ability to almost see a functional MD and get all of these tests without seeing, you know, a lot of times it's overwhelming for someone to walk into their OB, and I can say this personally, I have a wonderful OB, but to go into a doctor with a laundry list of tests that you want on top of a regular Quest Health panel. And that, it also can aggravate the relationship a little bit because the doctor thinks that you're questioning their expertise in that specific area. Yeah, you don't need that test.

So that's not necessary. Or why do you want that? Or that's going to be extra money. Or, you know, or I, the other thing is, I don't know what that means and I'm embarrassed because I won't know how to interpret it.

So I'm not going to order anything. Right, right. And this is a great way to stand up and say, you know, you can take care of it yourself with that type of a panel.

Yeah, that's amazing. In terms of the diet and lifestyle that the parents have, you know, how does that influence the genetics that they pass on to their baby? Because we think genes are pretty fixed, but can you talk a little bit about this concept of epigenetics and pregnancy and why this matters and why we need to think carefully about what we're doing while we're pregnant or before we get pregnant that regulates our epigenome and how that affects fertility and the health of the baby.

Yes. You know, as a mom who's delivered three babies, I've been through pregnancy. I know it can be really difficult in the first trimester. You can have food aversions, you can have cravings, but unfortunately, the epigenetics of what we do prior to conception and during conception is actually such a vulnerable period of time. It's probably the most powerful time we have of influencing our child's life. And it's the most delicate time in which our epigenetics decisions have the most powerful effect. And so, for example, I work with clients to regulate their blood sugar during pregnancy, and I wrote an entire course on how to kind of get through those food aversions and to increase nutrient status and to check in with yourself when the first trimester is over and make sure everything is good because we know elevated blood sugar during pregnancy increases your child's chances of metabolic syndrome and type 2 diabetes in their lifetime. And so it isn't this free-for-all free period to make unhealthy choices and not check in with yourself. Now, being that I'm a woman who's been through it, I know what it feels like to not want to look at protein and I'm in my kitchen cooking for my family a lot of the times here, but That's why the preconception period is so critically important because you can work your stores, your nutrients up, you can protect the DNA. And, you know, when studies do look at how our sperm DNA and egg DNA is impacted by our epigenetics, I mean, it is linked to everything. Like I said, risk of autism, Alzheimer's, OCD, obesity, type 2 diabetes. and these are, we're giving our child the chance at their best life, and we're already in contact with all these endocrine disrupting chemicals and things that are stressful on our own DNA. So it's really, really important that we're trying our best. You know, one of the things, depending on the person's relationship with health tech, like I love an Oura ring as a way to motivate someone to get into bed earlier to track their movement. It's also a great investment you can make prior to conception because you can use an aura ring and natural cycles to understand when you're ovulating and a change in basal, you know, basal temperature and all of that. So there are ways that we can protect our the DNA we're passing down to our child and then protect their their DNA through our epigenetic, through our lifestyle choices, which impact our epigenetics and thus their epigenetics. Yeah.

So I think what you said was just so important. I want to recap a little bit because people may not understand what epigenetics fix is. I wrote a lot about it in Young Forever, but essentially, you know, your genes are fixed. You can't really change those. But which genes are expressed, turned on or off, is regulated by everything you do. What you eat, what you think, your activity levels, environmental toxins, your microbiome, your nutrient status, et cetera, et cetera. And it's something you have control over for the most part. It's what we call the exposome. Everything your genes are exposed to, which determines about 90 of your health. And what happens is when you look at the data around pregnancy and epigenetics, it's actually quite terrifying as I've looked into it. When women are unhealthy going into pregnancy, when they're obese or when they have diabetes or when they have various kinds of inflammatory issues, when their diet's crappy, they end up causing epigenetic marks or tags on on the genes of their infants in utero, and then that affects them developmentally and throughout their health and their long-term risk of disease. So what that means is, you know, you, you, the epigenetics are like the piano player, that your genes are like your piano keys. So, you know, you can play an infinite variety of songs with piano keys from all kinds of different types of music, but, but that's what your epigenome does. So, you know, it can code for for optimal health and robust metabolism, or it can code for genes and turn on the genes that are going to make you obese and diabetic and have your risk, risk of heart disease or cancer or Alzheimer's, as you mentioned. So it's really important. And I think kind of preparing the oven for the baby is really key and keeping the oven good while, while the baby's in there is really important. It's not trivial. And I think, you know, it's, it's heartbreaking for me because I see, you know, the, the incredible amount of illnesses and suffering our kids have now. We see obesity go up. It's 75 of the population is overweight, 42 obese, and 40 of our kids are overweight now. And their mortality rate is high. If you're obese as a kid, your risk of death is, you know, is much higher. Your life expectancy is 13 years less. That's a lot. And, and, and so we, we have an influence over that. It's not to shame people into getting healthy, but it's important to understand that if you're going to have children and you don't want to kids who are sick or who have ADD or autism or who have allergies or autoimmunity or obesity or worse, you need to think about how to actually optimize your health before the baby's born and before you get pregnant and optimize your own health first. And that's why I think we need we natal is so important because it kind of brings in the concept of how do we actually optimize our health? It's not just taking the special optimize prenatal and I don't know what you call, what you call them now, pre-prenatal vitamins, you know, antenatal vitamins. But basically, you need to think about optimizing your health through diet and lifestyle, through the right supplements, through getting the right tests, as we mentioned, and, you know, checking things that maybe you're not getting checked by your doctor, like your thyroid antibodies, like your homocysteine level, like vitamin D levels. other nutrient status and basically making sure that everything is in balance before you try. And by the way, when you do these things, if you're having infertility problems, it's likely to fix them. Right.

Well, and I think that that is what can be so discouraging for people who are on an infertility journey or having a hard time conceiving. You know, I've walked alongside friends and clients who've dealt with that and have been, you know, had a miscarriage myself. And it is overwhelming. And when you go down to a traditional route, I mean, there's, you know, there's pharmaceuticals that can help with ovulation. And then you have IUI and IVF, but no one's addressing those root cause issues that may be imbalancing hormones that may have, you know, implications on DNA. And you might make a really good point that It's it is that it is that time prior to conception. But also for men, if if if your partner, if you can just get your partner to commit to that period of time when their sperm is being developed, those 74 days prior to when you want to try. So think three months prior to when you want to try. There was a really amazing study, not just on women, but for men, when you're talking about turning the volume down on these genes, if a man exercises twice a week, high intensity exercise, only twice a week, they have the ability to silence the genes that pass down type 2 diabetes, obesity, and Alzheimer's. So, that's powerful stuff right there. And if they may not want to eat this the way you want to eat throughout your whole pregnancy, but get them on board for that preconception period of time because it is pretty critical. And I remember when Chris and I were first trying to get pregnant, you know, I had him on a high dose Omega-3, I had him on NAC, I had him antioxidants, a functional multivitamin. I didn't have access to a men's prenatal. I joke that it's a he natal and a she natal. But it is important to protect that DNA integrity prior to conception.

Yeah, totally. And that's why thinking about this holistically is really important rather than just saying I need IVF or I can't you know, so I think it's really cool. So what have you learned in terms of the supplementation Market? Like, how do we, how do we know which is a good and bad prenatal vitamin? Because I've been dealing with this for, for decades with my patients, and my, I used to be, you know, well, I'm still a family doctor, but I usually deliver a lot of babies. I deliver over 500 babies. I, I loved OB, and I, and I, I was very involved in this, and I, and I help, and then subsequently, a lot of women deal with with figuring out what to take. And so part of it's testing and figuring out what you need and what's right for you. But there are real quality differences and there's real differences in the ingredients. And like you said, you know, before, if you don't take the right type of folic acid, then it may not work and it may even cause more problems for the baby or for you. So how do you kind of navigate this and how do you determine, you know, how to tell good ones from bad Right.

So first and foremost, the supplement industry is not regulated. So you want to look for something that has third party testing. I think that that's really important. You want to guarantee that what you're taking is in your multivitamin or your prenatal. Second, you want to look for methylated forms. We talked about this. So you're looking for five, the for the active form of folate versus folic acid. So methyl tetrahydrofolate versus folic acid. So that should be one thing to look for. Next, you want to look for the number and quantity of nutrients. So another thing that I have clients look for, it's almost like a little checklist. Is it third party tested? Do you have methylated B vitamins in there? Look for B6 because we talked about it earlier. It helps to balance female sex hormones and ensure that there isn't excess homocysteine in the body. You also want to look for choline. You know, there are a number of prenataLs on the market that still don't include choline and choline is critical. for neural development for a baby and yeah, for the brain, exactly. And a lot of prenatals don't even have choline, but what we found in the latest research is that for pregnant women it's 450 milligrams and for lactating women it's 550 milligrams. And if you look at breast milk two years after birth, choline levels stay high. They don't drop over time. And the majority of women between the ages of 20 and 40 are getting less than 300 milligrams of choline a day and choline is really only coming from eggs and pastured meat, specifically things like liver, where a lot of us aren't eating that type of thing.

And if there's any sardines, who don't forget sardines.

Don't forget sardines. But these are these, you know, I don't want to say, but there might, they might just be more prevalent in a really health focused person who knows the nutrient density of sardines, beef liver, egg yolks, and they're not afraid of eating those things. for, but we see when we look at the stats, it's less than 300 milligrams. And this is, you know, choline is, I always tell my clients it's like the Uber driver that drives DHA to the brain for your child. And those two nutrients are so critical for neurodevelopment in utero. And when you think about that, and another thing to think about is like iron levels, does it have you know, iron by glycinate in it because iron, suboptimal iron levels in utero and when a child is developing in the first year of life, that's why we prick a child at their one year birthday checkup with a pediatrician to check their iron status because we know it has irreversible IQ decline issues. So, like, these are so important for their, for the future of this world and, and their ability to have the best life that they can have. And we can, we can take a nutrient or a prenatal that supports that.

Yeah, I think that's really important. You mentioned a few things that are not typically in prenatals, right? So fish oil is not typically in prenatal, although there's some now that are recognizing and adding that and particularly with levels of DHA that are important for brain development in kids. And, and you said you gave it to your husband and you took it before and you should take it during and your kidneys sit after and, you know, it's the old cod liver oil thing, which is actually a great idea. usually get vitamin D, get vitamin A, you get the Omega-3s. But the right levels usually are not in the prenats and choline is usually not in there and the right form of methylated vitamins is not in there. And these are really essential if you want to have a healthy baby. And often, as a doctor, I learned to prescribe the usual prescription multivitamin which basically insurance pays for. But the ones that insurance pays for are generally pretty poor in terms of their quality ingredients. And it's not just the, you know, the, whether it's, you know, the right form, it's also, you know, how they're manufactured. Are they tabletted and so thick that they don't digest in your belly? Are, are the blood levels right? Are the forms of the nutrients the right? And if you take magnesium oxide, that doesn't get absorbed. Certain forms of iron don't get absorbed as well as others. The right forms of methylated new vitamins into B vitamins, all this really matters. And, and you want to make sure there's no colors and dyes. And if there's a blue vitamin. Like, why is there a blue vitamin? It's no blue vitamin, naturally. So you don't want to be taking all that stuff, and, and you want to be really smart about it. And I think it's, it's really important to find the right products and to, to, unfortunately, it's not typically something that most doctors weren't much about. It's like, oh, get a prenatal vitamin. Just, here's a prescription one. This is why I learned in medical school, and that's it.

And it's kind of how I did it when I first started practicing until I started learning about. I'm like, oh, this is not all same. Right. I think, you know, you make a good point about, like, a big tablet or, you know, that's one of the things, too, is I'll work with clients and they have a really, you know, they may have a hard time taking their prenatal, and so they don't take it, or they pick something that is maybe two pills, and we look at the composition of that prenatal, and it's half the nutrients and at lower doses, and yes, that's going to get you somewhere. But when we look at blood levels of women who are unsupplemented during their pregnancy, you're going to see blood levels drop in vitamin A, C, D, K, all the B vitamins. And that's, you know, you're giving it all away. All of your nutrient stores, everything that you're eating to the baby. And we're seeing that show up in your blood, which doesn't leave you in a good place when it comes to postpartum, especially because some of us, a lot of us are, when we do decide to have children, maybe we're having them a little bit later and we're having multiples. And we know that, you know, for me, at least personally, I've had three babies in less than five years between the ages of 35 and 40. And they've been back to back followed by 18 months to 22 months of breastfeeding. And that's like being an athlete. You have to take your nutrition seriously, your supplementation seriously, your sleep seriously. I have been on the other side of postpartum depletion. It does not feel good.

That'S different than depression, right? Depletion is different than depression. Because people heard postpartum depression, which by the way is often caused by Omega-3 deficiency because your Omega-3, you know, your baby's a parasite essentially, so it'll suck everything out of you. And, and breast milk is one of the highest sources of Omega-3 fats. But if you haven't been eating the right Omega-3s and you're low, it's going to suck yours out. And that's really critical for mood. So we do know that fish oil can be a really great treatment for postpartum depression. question. But tell me more about this postpartum depletion thing because I think that's a concept most people have not heard about.

Post, yeah, postnatal depletion is this, it's kind of an epidemic happening in women who are having back-to-back children and breastfeeding who haven't supplemented appropriately or aren't eating nutrient dense foods or have an absorption issue. And what ends up happening is in the postnatal period, those three months prior to giving birth, you have a lot of symptoms, major mood swings. And the thing is, part of it is normal and natural, but I think we're normalizing all of our hair falling out, our nails brittle, our skin dry, major night sweats. Some of it is normal in a specific period of time, but postnatal depletion is is something that I even personally was affected by, and you're going to see low levels of nutrient status on blood tests. I felt like I was eating appropriately and I focus on lean animal meats and nutrient dense. I'm adding liver to my diet. But even so was seeing that my nutrient status and my B vitamins, all of my Omega-3s were low. And I actually had to get to a point where I was taking a high dose close to 5,000 IUs or 6,000 IUs of vitamin D a day on top of eating a vitamin D rich diet and getting some sun exposure. So it's amazing how much they will take from you when they're inside of you and when you're breastfeeding because there are certain nutrients that just don't decline in breast milk and thus you're giving your child all of that nutrition.

Yeah, so it is important, you know, to make sure you take care of yourself, particularly after you have babies, for sure. I think, you know, for those listening, you know, pregnancy, babies, having a family is, is, is really an important thing. And like we said at the beginning, the infertility crisis is getting greater and greater. And, and it's complicated. It's, it's our high sugar process diet. Then, and I think there was, I think there was a great book by Walter Willett called the Fertility Diet, talking about how insulin resistance is a big of infertility, environmental chemicals, nutritional deficiencies, this sort of one in five women have thyroid dysfunction, half of them are not diagnosed. There's so many things that you can do to upgrade your health that will optimize your chance of getting pregnant and having a healthy baby and a healthy pregnancy. And these are just some of the things we talked about. It is obviously a much more potentially deeper subject and longer conversation. But I do think it's important for people to focus on what they have control over and what they have control over is their lifestyle, their diet, exercise, reducing their environmental chemicals, by maybe checking out ewg.org and changing out your household cleaning products, your skincare products, your, your food that you're buying and eating. Obviously, organic clearly matters. And, and also taking the right multivitamin and prenatal vitamins is really key. And I think that's, you know, what Kelly and I both get behind. We natal, which is great. And I think, Kelly, tell us more about how, how people can find out about that and your and where they can find you and a little bit about what you're doing.

Yeah, thanks, Mark. Well, I have a private practice and I work with women who are trying to get pregnant, who are pregnant. I work with women who are preparing for movie roles. I work with women who just want to optimize their health. But basically it comes down to getting a baseline. Those blood tests that we talked about, function is a great place to start. And then taking inventory of your lifestyle choices. And I share easy tips on how to do that at at be well by Kelly on Instagram and all the social platforms. You can head to my website, kellyleveque.com. i have a, a pregnancy nutrition course actually that supports you along the journey from that trimester zero all the way through postpartum. I think it's really important that someone's taking a prenatal three months prior to getting pregnant throughout their pregnancy and through the life of breastfeeding. Also critically important. So don't stop taking your prenatal just because you've delivered your baby, especially if you plan on repleting nutrient stores before another baby or breastfeeding.

Yeah. You got to take it before, during, and after.

After.

Yeah.

I think, you know, one of the.

Things important to mention is that for the podcast listeners, for the Dr. Swamy podcast listeners, if you go to WeNatal, W-E-N-A-T-L, it's like instead of a prenatal, it's men and women's prenatal. That's the point we're making here, is that you don't just need to take it if you're a woman, but you also need to take prenats if you're a man. And, you go to wenatal.com/kelly. and you can get a 30-day supply of the Wee Ndale Omega-3 DHA, which is really critical for the baby's brain. So, check that out. And, Kelly, thanks so much for being on the podcast and doing the work you do and spreading the good word of healing and functional medicine and teaching people what they need to do to stay healthy and fit.

Thanks, Mark. It's been such a pleasure.

It's always good to see you. Yeah, great to see you, too. Thanks for listening today. If you love this podcast, please share it with your and family. We'd love to hear your comments and your questions and please leave us a rating and review and of course subscribe wherever you get your podcasts. You can find me on all social media channels at Dr. Mark Hyman and you can also subscribe to my YouTube channel at Dr. Mark Hyman. I'm always getting questions about my favorite books, podcasts, gadgets, supplements, recipes and lots more and now you can have access to all of this information by signing up for my free Mark's Picks newsletter at drhyman.com/markspicks Mark's Picks. I promise I'll only email you once a week on Fridays and I'll never share your email address or send you anything else besides my recommendations. These are the things that have helped me on my health journey and I hope they'll help you too. Again, that's drhyman.com/MarksPicks. Thank you again and we'll see you next time on the Doctor's Pharmacy. This podcast is separate from my clinical practice at the UltraWellness Center, my work at Cleveland Clinic and Function Health, where I'm the Chief Medical Medical Officer. This podcast represents my opinions and my guests' opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only. It's not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner now. If you're looking for a medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who is trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health. Don't forget, there's a way to listen completely ad free with Hyman plus on Apple podcasts. You can enjoy every episode without any breaks. Just open Apple podcasts and tap try free to start your seven day free trial.