PRECONCEPTION

023: Gut Health During Preconception w/ Katie Morra, MS, RD, LDN, IFMCP

023

023: Gut Health During Preconception w/ Katie Morra, MS, RD, LDN, IFMCP

Welcome to the Hey Mami podcast!

Katie Morra, our guest, is an Institute for Functional Medicine Certified Practitioner and Registered Dietitian specializing in gut health and nutrition.

Katie is the founder of a virtual functional medicine practice, Gut Honest Truth, that focuses on the root causes of inflammation, autoimmune disease, irritable bowel syndrome, hormone imbalances and skin conditions, amongst other chronic disease states. 

She is also the host of the Gut Honest Truth Podcast available for iTunes and Spotify listeners worldwide where she has interviewed some of the most prominent individuals in the field.

Katie is also a new mom to a beautiful baby boy!

Or listen on Apple Podcasts | Spotify | Stitcher | TuneIn | YouTube

In today’s episode we are talking about gut health during preconception.

Highlights:

  • Katie’s story
  • How gut health and gut infections can impact the preconception period
  • How the gut can affect sex hormones
  • Gut and thyroid

Important Links

Find Katie online

Check out Katie’s FREE Detox 101 webinar

Find Katie on Instagram | Facebook

023: Gut Health During Preconception w/ Katie Morra, MS, RD, LDN, IFMCP TRANSCRIPT

Dr. Maren:                          Welcome back to the Hey Mami podcast. In today’s episode, we’re talking about gut health. In particular, how it’s connected to preconception health. Our guest today is Katie Mora. She’s known for her work in gut health, in particular, acid reflux, IBS, and SIBO. Katie is an Institute for Functional Medicine certified practitioner and registered dietician specializing in gut health and nutrition. Katie’s the founder of a virtual functional medicine practice called Gut Honest Truth that focuses on root causes of inflammation, autoimmune disease, irritable bowel syndrome, hormone imbalances and skin conditions, amongst other chronic disease states. Katie’s also the host of Gut Honest Truth podcast, available for iTunes and Spotify listeners worldwide, where she’s interviewed some of the most prominent individuals in the field. She is also a new mom to a beautiful baby boy and just two months postpartum, so we’re super grateful for her time today, and also love that this is just all really fresh. Welcome.

Katie:                                    Thank you. I’m so glad to be here. I’m really excited and it is really fresh. It’s all in the memory right now.

Dr. Maren:                          Totally. We know how that feels. So Alex and I just like to start by asking all our guests, tell us about why you do what you do and what brought you to this field.

Katie:                                    Sure. So I feel like I always say this, I’m like, “I don’t have a cool story.” I feel like everyone in functional medicine has like the aha moment in their own health. But I kind of grew up in a world where I feel like functional medicine was sort of being whispered in my ear. My mom is, or was, she’s now retired, a pharmacist in a functional medicine pharmacy. And my father is a dentist. I’m very much in, like my whole family’s in healthcare, so I kind of always knew I would be in some form of healthcare. And it wasn’t until after I did degrees in psychology and I kind of went on the educational route that I started shadowing people and I shadowed mark Heiman’s nutritionist and everything, and it sort of just fit. It just hit me. It was like my aha moment where I was like, “Everything finally makes sense.”And when I went to the IFM and I did my first GI module, I remember sitting there and being like, I felt like clinical work sort of never really made sense to me, and I was sitting there, I was like, “Gosh, everything.” It’s like the stars aligned. And I was like, “I need to be doing gut health. All of this is the epicenter of health. And it makes so much sense to me.” And from that day forward, I started specializing in learning everything I could.

Dr. Maren:                          That’s awesome. I didn’t know that about you.

Katie:                                    Yeah. I feel like I have a really random collection of degrees, but they all really fit nicely. Like I have a psych degree, a bio degree. Went to be a biology teacher and then I was like, “No, I think I’m going to go the nutrition route, and kind of mesh it all together.

Dr. Maren:                          Yeah. I come from a family of an accountant and a flight attendant. So like, you know.

Katie:                                    I know, I got psychologist, psychiatrists all in the immediate family, so just blend it all, you know?

Dr. Maren:                          Yeah totally. All right. Well, let’s just start by talking about how gut health and gut infections can impact the preconception period.

Katie:                                    Yes. So I don’t know if it’s a passion because I’m a new mom and all this stuff I kind of went through, but I think just a message for all of your listeners, and I know you guys kind of preach this, but there is just so much, especially with gut health, that you can do preconception period and before you’re even thinking preconception, like a year before just being like, “I better get this all in check so everything just flows and is so much easier.” So I think that’s really great that we have more power than we think we do. But gut health impacts everything in our body, every single thing. So you can go from as basic as about an inflammatory response that the gut, that diet that the pathogens and bacteria in our gut have and play a role, to where are those levels and how are you able to absorb and digest your food, your supplements that you take your prenatal, if you will? If you don’t have a healthy microbiome or the bugs in your gut, you’re going to have a hard time having proper micronutrient status.

Katie:                                    So in my opinion, a lot of women that don’t do all the education themselves or see a good functional medicine provider, they start out at a depleted level. When they get pregnant, through pregnancy, and pregnancy is a depleting thing on its own. So the ability to have proper micronutrients to have a proper fertility, proper pregnancy, is really important. And then it can affect things from your hormones, if people have heard of the estrobolome or how your estrogen can be too high, you can have imbalances in your hormones. That’s obviously we all are aware as females that are hormones can affect our fertility and conception period. So I think that’s just basically saying how well our gut bugs can influence how well we detox or have hormonal balances. And if you don’t have a healthy gut, you’re not going to have healthy hormones. It’s going to be an uphill battle trying to get pregnant and keep a pregnancy.

Katie:                                    So that’s two really big ways, in my opinion. And then this one I always think of, I believe it was Dr. Carrie Jones on my podcast said this quote stuck with her, and now it’s always stuck with me, but she always says that you can only have one infection at a time. And so technically calling a pregnancy an infection, so you can either have a gut infection or you can have a pregnancy, a healthy pregnancy. So there’s an imbalance that can happen in your TH1 and TH2 immune system, as you guys obviously know, when you are pregnant versus, let’s say, you have SIBO. They can shift your necessary balances of which level. So when you’re pregnant, you’re going to shift over to TH2 and a more anti-inflammatory process that’s happening. So if you don’t clear or work on these infections that you have prior, like if you have small intestinal bacterial overgrowth, you might be setting yourself up for a harder time to carry a pregnancy. So those are probably the top three things I can think of, but there’s probably about 20 other ways that your gut impacts fertility, in my opinion.

Dr. Maren:                          Yeah, totally. Well, I want to dive in a little bit more about sex hormones. Tell our listeners how the gut can affect sex hormones.

Katie:                                    Yeah. So many ways. So that whole micronutrient thing is part of it. If we don’t have the proper building blocks to what we need, we are not going to have proper hormone levels. And that also starts with a lot of people who are just following potentially even fad diets of low cholesterol, cholesterol is the building block of all our hormones. So if you’re low in that, you’re going to be low in everything. All the way down to the there’s a term called dysbiosis, which is just an imbalance of good and bad bacteria. And when you have this imbalance, which lord, I feel like everybody does in America, but when you have this imbalance, you potentially are going to have this enzyme in your gut due to bad bacteria, called Beta-glucuronidase. And when Beta-glucuronidase is increased, you’re actually going to recycle your estrogen. So all the estrogen that you’re supposed to be tightly packing up and pooping out, for lack of a better word there, and have these healthy estrogen and progesterone levels going on in your body as a female, trying to conceive, this can be a problem because you can become more estrogen dominant.

Katie:                                    So even if you’re not producing too much, you can be recycling it and having estrogen dominant issues. And there’s a lot of research behind estrogen dominant related conditions, if you will, that can impact your fertility in a negative way. So this is simple. This is something simple that you can work on from diet and lifestyle, like your stressors to you potentially, I guess, simple way you could think like eating less junk food, eating more probiotic and prebiotic rich foods, to working with a provider that can work on antimicrobial herbs that can cleanse out some of that bad bacteria and rebalance. So actually, it’s not tons of effort. It’s pretty usually fairly easy and quick to resolve in a natural way, in my opinion.

Dr. Carrasco:                      And even just adding some mag in so you poop everyday.

Katie:                                    Yeah, exactly. And that’s a huge, like right there, people who don’t know it’s not normal to poop every day, or have a complete evacuation of what they feels like a good poop. But if you’re not doing that, you are going to become estrogen dominant. So being able to go to the bathroom, produce fiber, have magnesium, lots of water, physical movement, whatever you need. But that is a cause right there.

Dr. Maren:                          Yeah. And I think testing too, I think all of us do probably run the Dutch test. And so it’s just nice to know specific interventions that you need to make, because sometimes I see people who put themselves on a bunch of dim and maybe they don’t actually need them. Or maybe calcium-D-glucarate is really what they need, or maybe it’s really magnesium. Like is it phase one, phase two phase three? So we can get in the weeds with that, but the reality is there are some really safe ones. And we’ll talk more about supplements down toward the end when it comes to that. But it is always nice to test and kind know where you’re at.

Katie:                                    That is great. And I know it can be expensive for people, which is a default. But you can do such a disservice to yourself, like you just said, with dim and causing low levels versus increasing the sulforaphane and making things [crosstalk 00:08:57]

Dr. Carrasco:                      I think just number one is just pooping. Start there. If you can’t test, just figure out how to have a bowel movement every day. And then maybe test to see if you need to bind, but I think a lot of people can come on dim and it’s like, “Well, why? You didn’t need that support.”

Katie:                                    Yeah, it’s a good point. It’s like magnesium and pooping every day, like you said.

Dr. Carrasco:                      Yeah. Vitamin C, magnesium, a little bit of fat, a little bit of fiber.

Dr. Maren:                          Yeah. It’s not going to hurt anyone, right? Well maybe a few, but most people not. Okay. So let’s talk a little bit about thyroid hormones as well, as we know there’s a huge connection between the gut and the thyroid and the thyroid and the gut. So explain that a little bit.

Katie:                                    Yeah. So chicken or the egg. Which one causes which one? And it’s both. So first of all, you can think of gut infections, like for example, I know you guys probably work with SIBO a lot, the small intestinal bacterial overgrowth. Over 50% of people with SIBO also have a hypothyroid issue. So that’s a really big percentage and it’s probably underdiagnosed still, the hypothyroid component to this, but this can greatly, your thyroid is one of, and I love following Dr. Maren, I love following you on this for thyroid, especially for women in conception. So if you’re not following her on that, follow her. But it controls everything in your body, your thyroid. And so if that’s low functioning, that’s always one of the first things I want to look for in somebody who is having fertility issues, because there’s a lot you can do with this or support, even if it’s just general like micronutrient support.

Katie:                                    But there’s a lot of people too, like connections with thyroid medication and gut issues as well with levothyroxine. So that’s another thing I like to talk about with people. But getting your thyroid in control, I keep circling back to micronutrients too. If you don’t have the proper micronutrients to convert your thyroid hormones, that can be a problem. So making sure you’re eating them, first of all, and then supplementing if needed, but being able to actually absorb them is the biggest concern. And that’s really hard to do if your gut isn’t functioning properly. So that’s a huge one for people, as well as diet, stress, and inflammation in the gut can really mess up people’s reverse T3 on their thyroid and really put them in kind of like this alternate state of a hypothyroidism, if you will, causing other issues downstream for preconception. So there’s like a million ways, you guys know, that can do this. And also of course, autoimmune components with gut health and thyroid is a whole other, you could have a whole podcast right now on that.

Dr. Maren:                          Well, let’s just dive in. Because I think that’s such a relevant thing with gut health. Of course there’s sex hormones, thyroid, nutrients, but tell us how it affects auto immunity.

Katie:                                    Yeah. So the way I was taught, and I’m sure you guys were taught in the functional medicine world, is you need three things for the development of auto immunity. You need a genetic predisposition, you need triggers of some sort. There could be one, there could be multiple, which could be your gut infections that we’re talking about. And then usually you need some kind of leaky gut thing to be going on, meaning there’s some kind of permeability. So if you can, in a perfect world, remove the triggers or minimize the triggers, you can potentially put that leaky gut component back together the most it should be into a semipermeable membrane. And when you can do that, you can help people in autoimmune states.

Katie:                                    But lots of things, there’s a lot of connection with gut infections being a trigger for autoimmune development and people. So that’s SIBO, that’s yeast overgrowth, H. Pylori is really big for hypothyroidism, and that’s founded over 50% of the population worldwide. So that’s something I check in pretty much everyone. So that’s a really big component. But H. Pylori doesn’t mean you’re going to get rid of the hypothyroidism issue necessarily, like the autoimmune genetic component. But if you have H. Pylori, that can actually be a really quick fix that you can help someone in like two to four weeks. So checking for that, being able to heal that, can really put somebody into a better place for trying to have a good fertility process, if you will. And there’s a lot of, you guys tell me what you want to know more, what else you want to dive in on, but there’s such a connection with the gut and leaky gut and having thyroid issues or autoimmune issues as a whole.

Dr. Maren:                          Yeah, for sure. We talk about that all day every day, right?

Dr. Carrasco:                      Yep.

Dr. Maren:                          It’s a big deal. And I think a lot of patients just don’t understand, and of course they don’t because nobody’s talking about it. If they go and see their conventional doctor, it’s just not a central focus when they have some autoimmune disease. But there’s a lot we can do about it, certainly if we just start with gut health. And as we know, it’s a big deal preconception.

Katie:                                    Yeah, I think a big problem too is gut symptoms don’t always appear as gut symptoms. Gut imbalances can appear as skin issues, they can appear as headaches, they can appear as infertility, they can appear so many different things. And so if you are not somebody who has chronic diarrhea and constantly looking six months pregnant bloated, you might be like, “Well, why am I going to spend money or energy or change all my diet, change all this to work on my gut,” if that’s not the symptoms that you’re experiencing? But there’s almost always some sort of imbalance that you can be improving upon in your gut if you know what you’re looking for. So I think that’s a challenge.

Dr. Maren:                          Yeah, for sure. So let’s talk a little bit more about detox/ and I’m always really careful about talking about detox and preconception because it’s like sometimes if women are trying to get pregnant, it’s like now it’s not the time to detox, keep this stuff where it is. But if you’ve got the time in the foresight, healthy gut and detox go hand in hand. So tell us what that looks like.

Katie:                                    Yes. So you and I did a whole podcast on this. I hadn’t divulged yet that I was pregnant while we were doing that, but that was really near and dear to my heart. And so detox is huge for people. And when we say detox, we’re talking about not your three day juice cleanse, we’re not talking about things you’re buying over the counter, we’re talking about lifestyle change, minimal exposure in your household, in your day to day, how can you decrease the amount of toxic burden coming in while also potentially promoting the amount that is coming out of the body through sweat, urination, bowel movements, all of that. So there’s a lot you can do with that. And in a perfect world, you’re doing this at least six months prior to preconception. You’re getting this taken care of.

Katie:                                    And there’s a lot of studies and research. I think EWG has some stats out where it’s almost 300 chemicals were found in the umbilical cords of newborns. That’s really high. These are humans that have yet to step foot a day in their lives into the world, and they’re already at like 300 toxicity levels in their umbilical cord coming from the mom. And I actually wrote some of this stats down, but it was like 180 are known to cause cancer, 217 are neurotoxic, and 208 in animal studies cause birth defects. So this is wild, the amount that is getting transferred from the body of the mother to the baby is outrageous. So we can do a lot as the mom. You’re not going to get rid of everything, but to get some of those toxins out of our body prior to conception, as well as just minimizing, like picking up receipts every day and getting BPA. That’s a simple thing that people can do. Like email me the receipt. Let’s save the earth, save the baby.

Katie:                                    So there’s just a lot of things that you can do from detox support diets, like increasing cruciferous vegetables, increasing water, increasing all this stuff, going to the bathroom. To actually taking things with a provider that up-regulate your phases, phase one, phase two of detox. So I think it’s great for anyone. It’s such a simple kind of thing that you can work on, I think, six months plus prior. You don’t want to do it around conception in case you’re making everything mobile and it’s going to go more easily to the baby, but you’ll be okay.

Dr. Maren:                          Although cruciferous veggies and increasing your, like right, people can do that all the time. Yeah.

Dr. Carrasco:                      We don’t start infrared saunaing when you’re pregnant. After you’re pregnant, you just have to wait, keep everything where it is.

Dr. Maren:                          And when you’re breastfeeding too.

Dr. Carrasco:                      And when you’re breastfeeding too.

Dr. Maren:                          For those people listening. There is so much you can do. And I think it’s like avoidance, avoidance, avoidance, detox. So it’s like anytime’s a great time to take some toxins out of your life, whether that’s in your food or your water or your air, whatever it might be. And there’s probably no more important time than when you’re pregnant.

Katie:                                    Yeah. And these are things that I, every patient, every friend I have, is they don’t think this pertains to them or they don’t know enough because we aren’t talking about it enough that there’s so much they can do prior, like we mentioned in the beginning, that they get to a point where they’re having to seek out IVF or they’re having to seek out something costly and invasive and not fun to their body. And it just bring my heart a little bit that it’s like if we had been able to access them and talk to them a year before, there’s a lot of this stuff that we could have done to increase their chances of having a healthy fertility and pregnancy experience.

Dr. Carrasco:                      I think that’s a really good point. And I think that a lot of times, sometimes lifestyle medicine doesn’t always get you to that end point. But at least doing that work where you can create a really healthy reservoir for yourself, it can a lot of times reverse fertility issues. And on top of that, it will set you up for a healthier pregnancy if you have to use intervention.

Katie:                                    Yeah. And I think on top of it, the worst thing in my mind that really makes my heart cringe and sad for people is when they finally find that functional provider, that’s like, “I can help you with all these aspects we’re talking about.” They maybe are on IVF and they have a very short time restraint and they’re like, “I need to have this done in the next three months.” And you’re like, “I can’t help you with this because I don’t feel comfortable detoxing you outside of diet this early and close to getting implanted,” or something. So it is definitely if you’re considering it or you’re nervous about it, just lots of people can help through diet, through anything.

Dr. Carrasco:                      Yeah. And I think that’s why we always try to tell, at least in my practice, I think Kristen does the same thing, where we tell our patients, “Give us six months, give us a year. Let’s just start with the most time. Even two years, three years. Let’s try and set this up now so that when it comes to deciding that you’re ready for conception, we’ve had this framework in place.” And of course there’s patients that come to us that are like, “I’m ready to get pregnant now, so what can we do?” And then that’s a little bit different. But something that I wanted to touch on was, tell us a little bit about how specific diets and food can play a role in preconceptions. So people on elimination diets, what about the moms doing keto, et cetera?

Katie:                                    Yeah. So there’s there’s no one size fits all. And I do think there probably needs to be more research out there on all of this. But there’s probably the three diets like you just named are the three I think of with my patients that might be the biggest bang for our buck when we’re talking about healthy fertility and preconception periods. So elimination diets are such a powerful tool for so many reasons, but the main thing is getting inflammation down, getting your gut in check and your immune system in check through food, but finding what fuels your body and your gut the best. So if you are having an issue with gluten or with dairy and you’re constantly eating it, you’re kind of doing yourself a disservice in the process, that’s just, potentially, I’m going to say simple, it’s not always simple, but a simple thing that you can tweak and it’s free. It’s just [crosstalk 00:21:03].

Dr. Carrasco:                      It’s just not easy, but it’s simple.

Katie:                                    Yeah, exactly. I like that. It’s easy, but it’s simple. So the elimination diet is something that can take even as short of like six weeks of a month of elimination in a couple weeks of reintroduction to just try to find what foods work best for you. And so you’re not having this perpetual cycle of inflammatory responses going on. Detox is huge, but that is something we kind of should always be leaning towards in how we eat with the different vegetables and just everything we do. But that can be really a helpful tool in helping use food as medicine to promote your detox system, especially if you are going on supplements or saunas, things that you can kind of use as a whole program for some somebody. So there’s a lot of things from just food as medicine to detox diets the Metagenics cleanses and stuff out there that have been really helpful for my patients.

Katie:                                    And keto, keto gets a bad rap, but keto can be really good for fertility for a lot of people. And I’m not talking long term. So I don’t know if you use that in practice. That’s not thing I push upon people, by any means. But I actually used a ketogenic diet myself when I got pregnant. And it’s really great because it can help, not for everyone, but it can help sort of resituate and rebalance a lot of your hormones. So it can reduce insulin, help obviously your sex hormones balance. And it can actually help with your follicle stimulating hormone, your luteinizing hormone. And to me it’s a pretty delicious diet and if you’re doing it right, [crosstalk 00:22:38]

Dr. Carrasco:                      You don’t have cravings, yeah. Honestly, I do use it in practice a lot, because even in my patients who are veteran moms and moms of big kids, like with insulin resistance and weight loss resistance, it can really help as well. So I kind of use it in all phases if appropriate.

Katie:                                    Yeah. It’s really great. And if you’re someone who’s like, “I don’t think I can commit to that kind of thing,” it can be really helpful if you are somewhat planning your pregnancy and being like, “I know I’m going to try in December and I know around when I’m ovulating,” that month or two prior, you can sort of get onto the keto plan and see if that is helpful around the few months prior as well. So definitely doesn’t need to be a forever long term thing. It shouldn’t be. But the diets themselves have been really helpful for both myself and for my patients.

Dr. Carrasco:                      Yeah, same here. Same here.

Katie:                                    And I think a lot of fertility clinics use the keto diet now, too.

Dr. Carrasco:                      That’s interesting how it’s gone from … And there’s so many different ways to do it, it’s not just eat bacon all day. It’s like we can do keto with lots of amazing plant-based fats, olives and avocado and. My favorite way to do it is to use a lot of the SMASH fish. So I think that there’s some really smart ways to do it where you’re not just eating bacon all day.

Katie:                                    Definitely go see a functional nutritionist if you need help with that. But it really can be another very, not easy, but simple thing to shift to.

Dr. Carrasco:                      Yeah, once you learn it, totally.

Katie:                                    Yeah. And I enjoy that diet when I’m on it.

Dr. Carrasco:                      Well, something that a lot of our pregnant patients deal with is indigestion and GI issues during pregnancy. And we’re pretty limited with what we can take. So can we talk about a few supplements that are useful that can help?

Katie:                                    Yeah. So I do sadly, and correct me if you think I’m wrong, both an experience of my own and with my patients, to a degree, we have to expect some of it. And some of it is just the hormonal changes loosening everything. You’re going to get the reflux. There’s some stuff that you can try both lifestyle-wise and obviously diet is one of those, don’t eat things that, potentially limit the things that make you feel lousy. But there’s probably three supplements that I feel are most helpful and safe for pregnancy. Not kind of, they are safe for pregnancy, as opposed to there’s not enough research on other things. So ginger is great. I love it in all forms and it’s so easy. So it’s stuff like if you like tea. Or if you’re someone who’s not doing coffee while you’re pregnant, that’s okay too. You can get ginger tea and have that during the day. And that can really help. So ginger is great for literally everything, but it’s anti-inflammatory, it’s a great prokinetic, meaning if you’re not going to the bathroom regularly, which happens [crosstalk 00:25:30]

Dr. Carrasco:                      Which happens, absolutely the second you get pregnant.

Katie:                                    The second you get pregnant it’s like what is going on. But eating ginger, putting it in smoothies or juices. Like I, my first trimester, was like, “How can I have as much ginger in a juice?” It’s all I wanted. Ginger, apple and carrots. So that can be a game changer is getting fresh gingers broken down for you. Or just get ginger root supplements and kind of rely on that. And you can take it multiple times a day if needed and use it as [inaudible 00:25:59] going to the bathroom, calming reflux, soothing your stomach. So that’s a really good one. My favorite, which I am obsessed with you guys talking about this all the time, by the way, because no one talks about it, but is your need for choline. No one’s even heard of choline.

Dr. Carrasco:                      Yeah. And like 99% of Americans are deficient.

Katie:                                    Yeah. I don’t think I even really knew the needs and then I followed you guys, I think before I was pregnant, and I was like, “Oh my God.” And I immediately like bought it [crosstalk 00:26:27] every day. And I still use it, I love it. But it helps with so many things that are important for the baby’s growth and development, but it helps you with your liver and gallbladder function and your gut, it can help with leaky gut, it can help with all these different issues. So it’s a super key component for bile, but it helps, bile helps you absorb your fat. And your number one macronutrient that you need for baby development is fat, and people don’t realize that. So it’s so important, and so many people are deficient and all of the prenatals that people are commonly grabbing are deficient as well, very deficient.

Dr. Carrasco:                      Very efficient. And the ACOG didn’t even come out with recommendations until recent years. So I think the market is still catching up. And I don’t know, I’m not sure, but it seems like it might be hard to formulate a vitamin that has a large enough amount of choline. It might be that they need vitamin packs with a choline pill just like the DHA.

Katie:                                    Mm-hmm (affirmative). That’s a great idea. Yeah. And then I actually just learned this from the Hey Mami Instagram, I didn’t realize the needs went up even more in lactation.

Dr. Carrasco:                      Yeah, yeah.

Katie:                                    I was out here before talking to my husband and I’m like, “We need to increase my choline.”

Dr. Carrasco:                      The baby ate my brain. I need to replete that and the baby needs choline for their cells that are growing.

Katie:                                    Yeah. I use choline for all my nonpregnant patients too that have low immune systems in the gut, bladder issues.

Dr. Carrasco:                      It’s, I use it for a lot of memory issues too, or cognition. It’s incredible, like within a couple of weeks, I see a lot of times memory issues improve with the right dose.

Katie:                                    Yeah’s especially first trimester when majority of people are getting nausea and don’t want to eat and they can’t look at eggs or anything that carries choline and protein. Yeah, get some choline and throw it into your diet every day because that and your supplement rotation. And the last thing would be probiotics. So whether that’s through food, might be harder during pregnancy and the foods probably aren’t so appealing, if you will. But the good bacteria and eating or putting in prebiotics into your diet to feed that good bacteria can really help you kind of maintain regular bowel movements as well as just stopping any kind of overgrowth that might cause nausea, indigestion worsening. But it’s hard. There’s not too many supplements and things you can do. So it’s kind of like eating, figure out what your body does best, eating smaller meals, not eating really heavy greasy things that sit and that fat’s going to sit in your gut and make everything else come upward more easily.

Dr. Carrasco:                      It’s just brutal. It’s brutal especially at the end, I think. I think you can have very bad indigestion all the time, [crosstalk 00:29:12]

Katie:                                    [crosstalk 00:29:12] experience first and third trimester.

Dr. Carrasco:                      But first and third seem to be the worst.

Katie:                                    I know. And I feel bad. I see a lot of people, they come to me and they’re like, “I’m pregnant, what can I do?” And I’m like, “Sadly, there’s nothing you’re doing wrong, it’s just –

Dr. Carrasco:                      Just structural.

Katie:                                    Yeah. I feel for you people out there having that issue. And there’s other things people take, but I wouldn’t recommend them unless you’re working with somebody.

Dr. Carrasco:                      Yeah. I hear that. Do you have any tips about lifestyle measures that people can take for gut health that are kind of simple?

Katie:                                    For preconception period?

Dr. Carrasco:                      Yeah. Preconception period. Yeah.

Katie:                                    There’s so many. First of all, something I’ve just been noticing, not noticing, but preaching on lately, is eat. A lot of people don’t eat enough and they don’t eat variety, eat enough, try to get different variety, especially vegetables and keep processed things as minimal as you can. But one of the biggest things I always say is the stress around food is worse than the food itself. So there’s so many people that social media and doctors and everything they listen to drive people neurotic over food.

Dr. Carrasco:                      The orthorexia is real. Yeah.

Katie:                                    Yeah. Food is meant to be enjoyed and part of community. So make sure you’re eating, make sure you’re eating a variety, but not too much food, but a variety and enjoy it. And really just kind of keep processed things to a minimum. And something I always think is big is working on your stomach acid levels. So that’s something pretty simple people can work with their providers on or work with bitters and things like that if they need to, digested bitters. But I have like a thousand. I have lots of blogs out there that are free too if people want tips. And I have [crosstalk 00:30:59] it’s on my website, guthonesttruth.com. But there’s just so many things. Finding the right foods and diet for you will [crosstalk 00:31:08] a lot of the need. If you have food sensitivities, you get low gut immune function. And when you get low immune function, that’s when bacteria and everything can have its like field day and overgrow. So it’s sort of sometimes that simple of finding what foods [crosstalk 00:31:24]

Dr. Carrasco:                      And agreed, having the time and space to do that, not like the week before you want to get pregnant.

Katie:                                    No, I know. I wish there was a way to just like publicly announce-

Dr. Carrasco:                      Billboards everywhere.

Katie:                                    A year or two before when you’re really being like, “I think I want to start thinking about having kids at age 30,” at 28 start just, it becomes more stressful and like not as cost effective when you do it all at once. Which is still great, but you can slowly dive into things like running a thyroid panel and just saying, “This is part of my problem or it’s not.” Checking it off the list. And you can slowly get there and then it just makes preconception way easier and less stressful, in my opinion. That’s sort of the route I chose to take, but I feel bad for everyone I see and my friends that it does become stressful and they are down that path where they’ve been struggling and then that time crunch happens in their mind and just being like, “Fix your diet and do this,” adds just way more stress.

Dr. Carrasco:                      Yeah. And then you already feel like you can’t or you’re not getting the result that you want, you’re not getting pregnant. And so it’s managing all that. Yeah, it’s really hard.

Katie:                                    Yeah. There’s a lot of power we have. But obviously, there are many times there’s more going on that this won’t fix. But like you said, when it does work, even if it is the IVF path, this is going to help support a healthy pregnancy.

Dr. Carrasco:                      Exactly. Yeah. Irrespective of if the outcome is a natural pregnancy, I think that you will have so much strength, resilience and good nutrition for your baby because you need all those building blocks. And most Americans are micronutrient deficient, I think like all of them.

Katie:                                    Everybody. Literally, I make everyone I look at run an advanced micronutrient panel [crosstalk 00:33:09]

Dr. Carrasco:                      Exactly. Like everyone.

Katie:                                    And you guys just posted the whole postpartum depletion and how you know and starting out depleted is one of the biggest things, honestly. And I was just reading it and I was happy that I could say, “I don’t feel like I hit this checklist and I don’t feel like I’m super depleted.” But I was like, it’s because I was put into a fortunate position where I was able to put this effort in with the idea I would get pregnant and just sort of slow start checking off and work on diet and movement and all those things.

Dr. Carrasco:                      Yeah, if you go depleted, if the bank account’s pretty empty going in, that baby is going to take all of it from you. That’s just the way that it works. And then if you’re nursing that baby, it’s still going to take everything from you. And then all those buckets are going to be empty and then it’s going to take a while to refill the buckets and get them to a place where all of those nutrients are working at capacity.

Katie:                                    Yeah. So there’s a lot you can do. And it really is, it’s like filling up your cup and ruling out bigger issues. Anyone I have them, if they’ve never had a full thyroid panel, we keep kind of going back to thyroid and gut, but let’s just do one to see if this is a part of your puzzle. And if it’s not, amazing, we can move on, but pealing that layer.

Dr. Carrasco:                      That’s how I do a lot of things like that. Like let’s rule things in and rule things out.

Katie:                                    Yeah. Because it’s not worth the stress of two months before you decide you want to get pregnant, finding out that you have Hashimoto’s and there’s a lot that needs to be done there, potentially, for healthy pregnancy. So start early, if you can.

Dr. Carrasco:                      Or even not even knowing you have a subclinical hypothyroid issue or you’re not within optimal range.

Katie:                                    Yeah. And there’s so much you can do for that. There’s so much.

Dr. Carrasco:                      So tell us where people can find you.

Katie:                                    Yeah. So my website is guthonesttruth.com. We are probably most sought after on the Instagram. So it’s just @guthonesttruth. But we have a Facebook, and like we mentioned, we have a podcast and some eBooks and stuff on all things gut and thyroid. So just head on over to Gut Honest Truth and that will kind of link you out towards things if you’re interested. And we actually are coming out soon with a supporting female fertility program. So I’m really excited about that. So that will be coming in the new year. But my heart feels like it’s ready to just help more women because I just see the struggle every day. And I’m sure you guys do too obviously. [crosstalk 00:35:36]

Dr. Carrasco:                      Yeah. And I think probably since it’s still very, very, I guess, strong in your mind since your baby’s still so tiny, you realize the good you can do. When you’ve gone through it yourself and you realize what the whole experience is like.

Katie:                                    Yeah. So I hope everyone can find what works for them and they have healthy pregnancies and positive experiences as much as you can getting pregnant and enjoying that baby. But I think the biggest thing I’ve thought about is just there’s so much more power we have over our own bodies and our health that we don’t realize. We sort of think it’s hormones and hormones only and this the path. And even with hormones, there’s so much we can do.

Dr. Carrasco:                      Yeah. That’s so true. Well thank you so, so much. I appreciate that you came on. Christine and I are happy that you joined us and shared your knowledge. Yeah.

Katie:                                    Yeah, I appreciate it. You guys are great. Keep doing your message. And I loved being here today, so thank you.

Alejandra Carrasco M.D. and Christine Maren D.O.

Hello! We are Alejandra Carrasco M.D. and Christine Maren D.O. We founded Hey Mami because we felt a lack of support for fellow mamis. As physicians, we see women every day who struggle with fertility, are forgotten about postpartum, and have put their health on hold for years while they raise a family. We’re here to change that.

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