Welcome to the Hey Mami podcast!

Our guest today is Sarah Morgan, MS. Sarah is a modern-day inventor. Known for her innovative ideas that connect science to everyday life, she delivers impactful, science-based solutions for common health problems.

Sarah created Even, the first wellness company focused on providing nutrient support for those taking prescription medications to minimize side effects caused by nutrient depletions. Even believes individuals can get the benefits of their medications without compromising their quality of life.  

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This week, we’ll be talking to Sarah about prenatal vitamins: a really hot topic! We’ll be discussing how to find a good prenatal, how to find one you can actually stomach, and things to be aware of when choosing one.

Highlights:

• Why does Sarah care about high-quality supplements?
• Why are prenatals important?
• When is the best time to start taking a prenatal vitamin?
• What is methylation?
• The difference between folate and folic acid
• Important nutrients that help support a healthy pregnancy
• How to find a prenatal that best fits your body

Important Links

Find Sarah online

Vitamin IQ Whole Food Prenatal Vitamin

Quotes

“There’s so many things that are really important about a prenatal, and what you’re doing is you’re basically preparing your body with the nutrients and all these different biochemical pathways, which are kind of like your metabolic freeway systems, that are going to help develop your placenta, the baby, and also keep the mom healthy throughout pregnancy.”

“A lot of times, women will do better taking their prenatal if they’ve had something in their stomach.”

 

002: What To Look For In A Prenatal Vitamin w/ Sarah Morgan, MS TRANSCRIPT

Dr. Maren:                          Welcome to the Hey Mami podcast. I’m your host, Dr. Christine Maren, here with my cohost, Dr. Alex Carrasco, and one of our favorite people, Sarah Morgan. So Sarah is a modern day inventor known for innovative ideas that connect science to everyday life. She delivers impactful, science-based solutions for common health problems. Sarah created Even, the first wellness company focused on providing nutrient support for those taking prescription medications to minimize side effects caused by nutrient depletions. Even believes individuals can get the benefits of their medications without compromising their quality of life. If you want to learn more, check her out at feeleven.com. We’re here to talk with Sarah today about one of our favorite things, which is prenatal vitamins. Big deal.

Dr. Carrasco:                      Yes.

Sarah:                                   Big deal.

Dr. Carrasco:                      Thank you so much for being here.

Sarah:                                   Yeah. Thanks for having me. I love this topic. It’s so fun.

Dr. Maren:                          Yeah, and all of us are kind of interested in it, because we’ve all searched for prenatal vitamins in our own path as mothers and practitioners and everything like that. So it’s near and dear to our heart, and I’m super excited for kind of kicking off our podcast with this topic.

Dr. Carrasco:                      Yeah. I think something that I think about when I talk to patients, but also when I remember my two pregnancies is some prenatal vitamins, you have to take like 40 of them to get the dosages that you need.

Sarah:                                   (laughing). Yeah.

Dr. Carrasco:                      Then sometimes they’re compacted in these tablets that are hard to swallow, and patients feel really sick after they take them. Then there’s gummies, and there’s just so many choices out there. Then a lot of times, people don’t even take a prenatal, because they’re hard to palate. So I think beyond just what to find in a good prenatal, it’s great to talk about how do you also find one that you can kind of handle?

Sarah:                                   Yeah. (laughing). The practicality, right?

Dr. Carrasco:                      Yeah.

Sarah:                                   I’m big on that myself, being pragmatic about things.

Dr. Maren:                          Yeah, for sure. So Sarah, just tell us a little bit about yourself, besides Even. Just give us a little snippet of why you care about quality supplements.

Sarah:                                   Yeah, that’s a great … So I guess a really quick background on me is I’m totally a biochemical geek at heart that loves to create things that improve people’s health. Being a mom myself, digging into all of the latest research, that’s just kind of my favorite thing to do, is open a can of worms and dig. I saw there are some products out there that are doing a decent job, but at the end of 2018, the FDA really changed a lot of things, and kind of the American Medical Association made some more firm stances about prenatal nutrients that I thought were really interesting. I was like, “Nobody’s really doing this yet.”

Sarah:                                   When we look at research going to clinical practice, it’s like a 15 to 17-year lag time. I’m like, “That’s not fair for people who are pregnant now or they have different issues now that they need help with or they need support on.” I really believe that nutrients are really powerful, and that’s what I studied in my education. When we use them properly, they have the potential to alter our biochemistry in a really positive way. So I’m a big fan, and nutrients are extremely powerful. I wanted to create something that I could really stand behind and believe in with a team of other healthcare professionals that helped put this together.

Dr. Carrasco:                      That’s amazing.

Dr. Maren:                          For sure. So let’s just start with why are prenatal vitamins important? I mean, all of us know, right, that spina bifida and folic acid maybe is important, but fill us in on what else. What other reasons do we need a good prenatal?

Sarah:                                   Yeah. So if we think about a prenatal, it’s basically like, okay, so your retirement plan, right? Most of us know, “Oh my gosh.” We should set up our 401k and have this plan for our future. Well, your nutrient status and your prenatal’s basically your 401k for your child’s future. So there’s so many things that are really important about a prenatal, and what you’re doing is you’re basically preparing your body with the nutrients and all these different biochemical pathways, which are kind of like your metabolic freeway systems, that are going to help develop your placenta, the baby, and also keep the mom healthy throughout pregnancy. So there’s so many reasons that a prenatal is really important, I mean, things like gene expression. Having nutrients in these proper forms and levels, which we can dive into, allows for proper gene expression that’s setting up not only your child’s future, but we could even argue maybe your grandchildren’s future.

Sarah:                                   Then cell health, organs, tissues, it goes beyond just the heart and, yeah, like you mentioned, that neural tube that is the spinal cord, skeletal system. There are so many important things that happen. Then one for me, I’m a mom, too. I think it’s really important. We think so much about a prenatal for our baby, but also for us, right? We know that if a woman gets the proper prenatal nutrients that they’re set up better for things like their mood, their energy levels, going through the postpartum phase. I think it allows them to just be in a much better place with things like that.

Dr. Carrasco:                      Yeah. [crosstalk 00:05:32]. One thing that kind of shocks me still when I see patients in my practice for kind of preconception visits is that they want to get pregnant now, but there’s no prenatal onboard, and there’s been no prenatal onboard. So from my perspective, I think that you need to be on a prenatal ideally for three to six months. What’s your opinion?

Sarah:                                   100%. I would say I love to see six months, unless I would say maybe if a woman was really doing some proactive care and supplementing with different nutrients ahead of time or drinking green smoothies, getting lots of good folate levels ahead of time. But it’s like you literally are setting up their future, and we know that a woman’s status in pregnancy, before pregnancy, these nutrient levels have an impact on a child’s long-term health. If we dig through the scientific literature, it’s pretty clear on that. So I think the American College of Obstetrics and Gynecology recommends folate one month ahead of time, which it’s like, “Hey, at least it’s ahead of time.”

Dr. Carrasco:                      (laughing).

Sarah:                                   But I think we can do better, right? I think three to six months is fabulous.

Dr. Maren:                          Yeah, and one of the things I love about you, Sarah, is how you simplify things. So can you just kind of run through methylation? We mentioned briefly gene expression.

Sarah:                                   Yeah.

Dr. Maren:                          But tell us, we talk about methylation and neural tube defects. How do you tell people? How do you describe methylation?

Sarah:                                   Yeah. So methylation is this really complex system. It’s kind of like the metabolic economy for our body, right? If we think about money and cash flow is really important for our economy to flow not only in the US, but the world. So methylation is kind of one of those core activities to our whole metabolic system, and it’s like the central circle of a spiderweb, right? Where all these things branch out for it, and to simply put it, it’s just this little thing that kind of goes … and it spins. It kicks off these little methyl groups, and they’re a simple molecule, kind of like a water molecule. It’s a carbon, three hydrogens, but it has a profound impact on our body as a whole, because it activates all these other important things that are happening, from the way that we make our neurotransmitters, how our liver functions, how we detoxify, how we balance our immune system function, our cell membrane integrity, which allows things to come in and out of ourselves.

Sarah:                                   It’s kind of a big deal, right? Electrolyte balance, toxins. Can they get inside of the cell or not? The better your cell membrane integrity, the healthier you are as a person. So it’s kind of this central hub, and what I like to say is if we get that right, we get so many of these other things that branch out from it right as well. What happens in pregnancy is this methylation cycle has a higher demand on it or it’s being used more, because you’re literally growing a new life. A lot of these methyl groups are used for things that allow your baby to develop properly. Yeah, I don’t know. Is that good?

Dr. Maren:                          Totally. It’s amazing. I love that. I love that analogy, and it leads to this big topic, which is we’ll talk about other methylation nutrients, but let’s start with folate or methylfolate versus folic acid.

Sarah:                                   Yes.

Dr. Maren:                          So what’s the difference, and what should people look for?

Sarah:                                   Yeah, that’s a great question. So I have this 30-second test for a supplement. If you’re like, “Oh my gosh. This is all overwhelming. How can I tell if something is quality or not?,” so flip it around to the back when you look at the supplement facts, and you want to look at vitamin B9, which is folate, and folate is this umbrella term for all these different forms of folate or vitamin B9. Folic acid, if you see that on a label when you’re reading it, it’s garbage. Toss it. Ugh. I don’t like it. Okay? So it’s an oxidized form of vitamin B9. It’s synthetic. It’s made in a lab. It’s not found in nature, and our bodies can’t use it as is, right?

Sarah:                                   When we get that form, we have to convert it in these different pathways, and about 50% of the population has what are called SNPs. They’re single-nucleotide polymorphisms. You don’t have to remember that. But what it means is that conversion is slow. It doesn’t happen properly, and the form that your body really loves, about 90% of what’s floating around in your bloodstream is something called methylfolate. That’s the form that is like the gold standard for our body. So if you’re taking folic acid, you have to convert it to methylfolate, which remember, some of us don’t do very well.

Sarah:                                   The other thing that’s really interesting between these two forms is folic acid can actually act like a troll on the bridge of our cell membranes, like these little receptors that allow folate to come in. It’s like, “You shall not enter” to the active forms of folate. So what’s really fascinating is we’re telling women to take a form of folate, folic acid, that actually blocks active folate from getting inside of the cells, where it works to do things like make healthy DNA, and we need to make new red blood cells. We need to make neurotransmitters. All these things that feed into that methylation cycle, folate is kind of the launching pad that kind of kicks that cycle into gear.

Sarah:                                   So what I say is look at folate. The other one that’s really important to look at is vitamin B12, because a lot of manufacturers use cyanocobalamin. Cobalamine is another word for B12, and if you look and you see that, that’s a super cheap garbage form that has to be converted several different times into active vitamin B12, kind of like the folate, and it uses nutrients to do that. So literally when you take these cheap synthetics, you’re sucking up nutrients to make the active forms. It’s way better to just take the active forms. Your body can take it, use it, and move on with life, right? You’re getting the nutrients your baby needs and you need in the process of pregnancy, and your demands are up, right?

Sarah:                                   So that’s another thing about folate. You have higher demands in pregnancy, and it’s really important that you get those. Those needs start very early in pregnancy, before a lot of women even know they’re pregnant, which is why we have these recommendations of if you’re going to even try, prepare, right? Build up your status, because your body is going to suck up a lot of that folate and start using it right away.

Dr. Maren:                          Yeah, brilliant. We’re on the same page. I mean, that’s like our quick cheat sheet. If you see folic acid, move on. Put it down. Move on.

Dr. Carrasco:                      But I think the other thing of note is thinking about the troll on the bridge, right? Because if you’re eating enriched foods, which some people might be doing unknowingly, and you’re getting folic acid from an enriched food, perhaps there’s also some challenge there best avoided.

Sarah:                                   Yeah, absolutely. Yeah, and it’s very interesting. If we look at the data about autism and folic acid, and this gets into what’s called unmetabolized folic acid, but there’s a bell-shaped curve, right? So we don’t want too much. We don’t want too little. On either side, it’s this beautiful piece in the middle of where we want it. If you get a lot of folic acid, the way your body actually kind of plucks it off of the receptors is more active folate.

Dr. Carrasco:                      Wow. That’s very interesting. Yeah, it’s very interesting.

Sarah:                                   Too much unmetabolized folic acid, not to geek out too much, but there’s association with some fertility. There’s some very good literature about those folate receptors being blocked and women having a hard time getting pregnant or it takes them longer to get pregnant, which I think is another reason why loading folate, the active forms of folate three to six months ahead of time is a really good idea.

Dr. Carrasco:                      Right.

Dr. Maren:                          So when we talk about methylation, folate and B12, what are the other big nutrients we need to methylate?

Sarah:                                   Yeah, so there’s lots of different nutrients. Some of the big ones are going to be on top of that will also be riboflavin, which is one that’s vitamin B2 that I feel like doesn’t get a lot of credit. It’s the one that makes your pee really yellow if you take a lot of it in a supplement, but it’s the helper for your main enzyme, MTHFR, that converts this folate into that active form of methylfolate. So that’s a really important one. Then you have some other nutrients, like zinc, that’s really important in your methylation cycle. If we get further along into that, we have magnesium. We also have something called SAMe, though I don’t recommend really supplementing with SAMe. It’s a lot better for your body to make it. Then there’s some amino acids like methionine that are really good to get from your diet that are going to kind of drive this cycle forward, some of those other things.

Sarah:                                   So, again, in a prenatal, you want to have all of those, because they work as a family. So you really want to see all of those together in this kind of beautiful symphony of all these different nutrients working as a family to make more of these methyl groups to drive all these processes for a healthy baby.

Dr. Maren:                          Awesome. So let’s dive into one of our favorite nutrients that is the underrepresented superstar, which is choline. So tell us about choline and why most prenatals don’t have it or at least have enough of it.

Sarah:                                   Yeah. So choline is kind of like riboflavin. It’s one that we just don’t really talk about, right? With folate, we miss riboflavin in terms of those two together. Choline was one of the biggest changes we saw with the FDA’s recommendations at the end of 2018. They basically kind of said, “Ooh, choline’s actually needed in pregnancy.” So they increased the amount to about 450 milligrams. So you can argue based off of genetics that women have very … There’s kind of a spectrum of need, but they made this really hard stance that … Even the American Medical Association basically said, “Hey, folate is at the same place as choline in terms of needs. We need to view them equally, even for the prevention of birth defects.”

Sarah:                                   It’s because choline is one of the major methyl donors as well in terms of how it’s used. It kind of is like a backup with folate when we’re using all these methyl groups. When we look at choline, it’s basically a B vitamin derivative that’s used in a lot of different places. One of them is our brain as moms (laughing), which is important, and the baby’s brain development, as well as we’ve even seen connections with neural tube, the heart, because of this higher methyl use, and then also cells and cell membranes. So the way I tell people this is think about this. We have trillions of cells, right? When you’re building a new life, you’re building trillions of these new cells and that the surrounding little wall that protects the cell, allows it to thrive and function properly is that cell membrane.

Sarah:                                   One of the main components, the building blocks of that cell membrane, is something called phosphatidylcholine. You have to have a enough choline to make this to be used in your cell membranes, as well as liver, gallbladder function, which gets into another thing that a lot of women in pregnancy and then after pregnancy have issues with, is eating fat or they’re eating food and they’re like, “Oh, I just feel nauseous. I feel horrible,” and their liver, gallbladder can get sluggish. Then they can have a lot of issues. Sometimes they get gallstones, and we have all these other things.

Sarah:                                   So I think there’s this whole train of topics of why choline needs to be kind of the superstar for prenatals now. I love that there’s some big organizations that basically got behind the data and said about 95% of pregnant women are deficient in choline, which is pretty alarming, right, when we think about what it’s being used for. When you mentioned not a lot of prenatals have it in there, this was one of the biggest things I looked, and I’m like, “Okay, so some companies are on this train,” right? Where they’re like, “Oh, choline. People are starting to talk about it. It’s important. Women are catching on. So we’ll put 12 milligrams”-

Dr. Maren:                          Right.

Sarah:                                   … “in our formula,” right? I was looking at one of the top selling prenatals has 12 milligrams. I’m like, “Are you kidding me?” That doesn’t even put a dent in the 450 milligrams that you need in a day. Now, I don’t know if you guys want to talk about some of the caveats with choline, but it’s very interesting. How I decided to put our formula together, we did not put a full dose of choline in there. We actually use something called trimethylglycine that is also part of the methylation cycle. It’s kind of like the shortcut, like the freeways are jammed. Use the back roads to get to where you need to go to get home and make your methyl groups. So we used a combo of two of those, and there was a reason why we did that. But yeah, choline is something that you have absolutely need to look for in a prenatal, and it should be a decently high dose with several hundred milligrams.

Dr. Carrasco:                      Yeah. I was going to just say, interesting fact, though, it’s true that people didn’t even realize choline existed as a nutrient until the late nineties.

Sarah:                                   Yeah, yeah. It’s kind of like one of those like, “Oh. Oh, this is new, and it actually is incredibly important.”

Dr. Carrasco:                      Yeah. (laughing).

Sarah:                                   So it’s been fun to look at, and what’s neat that I see is a lot of the scientific literature is pushing towards choline in a way that it’s like, “Oh, wow, we really do need this. We need more of an emphasis on this, and get it out there to the population.” Some of the OB GYNs that we’ve worked with are aware of this, but it’s not really common yet, even in terms of that practice as a whole.

Dr. Carrasco:                      Right. It definitely wasn’t part of my medical school curriculum.

Sarah:                                   Yeah, yeah. We’re catching up. Nutrients are like, “Oh, wow.” Now we’re realizing they’re so powerful, and I feel like the science is catching up. Then now we’re catching on as healthcare professionals of like, “Oh, this is one of the key foundational pieces of our health. We have to focus on what these specific needs are in different stages of our life.” Pregnancy and preparing for pregnancy is one of those that’s crucial to get right.

Dr. Maren:                          Right. For sure. All right. Let’s talk, too. I want to pick your brain on a big one, which is vitamin A.

Sarah:                                   Ooh, [crosstalk 00:20:22].

Dr. Maren:                          I think this one is pretty controversial.

Sarah:                                   Controversial. Yeah.

Dr. Maren:                          Yeah. I mean, you look on the back of a vitamin bottle, and that’s my that’s kind of my next step, is like, “Well, look at vitamin A. Does it say vitamin A as beta carotene?,” because that’s not vitamin A. That’s actually beta carotene, which is a provitamin to vitamin A. So walk us through vitamin A in pregnancy, why it’s important, and what to look for in a prenatal when we’re looking for vitamin A.

Sarah:                                   Yeah, absolutely. So vitamin A, I love what you said. So basically, when we think about beta carotene, right, that would be things from carrots, butternut squash, all the things that are orangy, yellowy, and a lot of the greens have it, too. They’re kind of hidden under the green color. So beta carotene is an antioxidant. It does a lot of really cool things, but it gets converted into this retinol form of vitamin A, which is the active form of vitamin A. It’s actually how our body uses vitamin A for all these different functions, which we’ll talk about.

Sarah:                                   So there’s a gene called BCML1 that converts beta carotene to this pre-formed vitamin A. So I always tell people, I’m like, “You know how you hear carrots are good for your eyes?” I’m like, “Only if your gene works well,” because what’s actually being used by your eyes is that vitamin A in its retinol form. So what’s really fascinating, because I look at a lot of genetics, and especially in women, BCML1 is a common gene that’s very slow in women across the board, anywhere from like 35 to 70% reduced function, which means you can’t rely solely on beta carotene to get your vitamin A needs. Okay?

Sarah:                                   So this is a big one for women. Now, if you do a Google search, like what you’re talking about, it’s kind of like, “Oh my gosh. It can be so scary to think about vitamin A.” Well, those are all very old studies. That’s actually one that was designed very poorly and looking at pretty high dosing of vitamin A. So vitamin A is a fat-soluble nutrient, meaning you can store it in your liver. So it’s not one like a B vitamin where you take it in, pee it out through your kidneys, right? You’re going to store some of it, which is why you want to be careful. Again, it’s a bell-shaped curve. Too little, too much, not good. Right in the middle is awesome.

Sarah:                                   So what are some of the things that vitamin A does? Well, vitamin A actually helps the baby’s eye develop. Vitamin A is really important for iron metabolism and transport. So we think about iron levels in women. I think one of the things we really miss is actually how vitamin A is so important for that status, like, “Oh my gosh. I’m taking iron. What’s happening? Why am I not responding?” Well, have you had a serum retinol level tested? This is something that’s really interesting, and we’ve found a lot of women in third trimester, the data shows a lot of pregnant women are deficient in retinol, this active form of vitamin A.

Sarah:                                   It’s also used for DNA production for all the mucus membranes, so like mouth, gut, right? I think vitamin A, we forget how important vitamin A is for gut health, for the lungs, right? Babies that are born prematurely, one of the biggest things is their lungs are underdeveloped. I’m not saying vitamin A progresses that more than the time they need to develop, but it’s really important. Then we have vision, which is also really important. I think a great test is vitamin A’s in breast milk. You can look at it in breast milk, which means that baby needs it, right? So not only in pregnancy, but also while you’re nursing, it’s a very important nutrient.

Sarah:                                   So there’s all kinds of more recent literature that shows benefit of vitamin A to the lungs, to just overall functionality of mom and baby that are really important. So, again, you don’t want to get too much, but you don’t want to get too little. I would say the risk of getting not enough and relying solely on beta carotene, there’s more risk there than getting some vitamin A.

Sarah:                                   Now, where do you find it in food, right? Because this is another thing I’m a big fan of. A supplementation should be an addition to a great foundational health, even while you’re pregnant, eating high-nutrient foods. Liver is a great source. Not everybody eats liver. I don’t really like liver. Pasture-raised butter, egg yolks from chickens that are eating bugs and they’re super happy and roaming around, cod liver oil, those are some places, but it’s mostly animal where you’re going to find these preformed, active retinol versions of vitamin A.

Sarah:                                   So yeah, I take a very interesting stance, and this is something I ran by Dr. Jamie Seeman, who’s on our scientific team. She’s a board-certified OB GYN, and she’s like, “Yeah, vitamin A’s so important.” The message that it’s dangerous for pregnant women is very outdated, and now we want to get it right, which is why in our formula that we put together, we have 50% of beta carotene and 50% of the retinol form of vitamin A in very responsible doses.

Dr. Maren:                          Yeah, I love that. I think it’s great. I mean, and I think the responsible dosing is important. So don’t walk away from this and go buy some vitamin A off the shelf that’s really high-dose, because that’s not the idea, either. It’s sort of maybe like iodine. I have a lot of respect for these nutrients. Too little is not good, but too much isn’t, either.

Sarah:                                   Yep. No, exactly.

Dr. Carrasco:                      [crosstalk 00:26:07] a Goldilocks nutrient.

Sarah:                                   Yeah. Yeah, it is. It really is. But it’s like I come back to it’s needed for healthy DNA production. In pregnancy, that is such a crucial function. So to me, just that connection alone is huge.

Dr. Maren:                          Yeah, totally. We’re with you. Let’s kind of transition a little bit into healthy bones and skeletal formation. So what kind of nutrients do pregnant women need to support baby’s bone formation?

Sarah:                                   Yeah. So we hear a lot calcium, right? Calcium is really important, which it is. I’m a fan of get some calcium in your prenatal, but also from your diet. I think it’s important. Your needs are high, and calcium is really bulky. So, I mean, you can take a calcium supplement alone. It’s this big, huge tablet. It’s a big molecule. So we have some calcium in our formula, but, again, I’m a big fan of you’ve got to really track it in your diet as well while you’re pregnant, make sure you’re getting that.

Sarah:                                   But the other thing we want to think about is bone health and the skeleton is not just calcium, right? I think we have this message of bones equal calcium. Well, they’re a very active tissue, right? They do a lot of really cool things, even secrete hormones and all this stuff that I’m blown away by. But some of the other nutrients that are really important would be things like vitamin D3, which is really important for bone health. Vitamin K2 kind of tells calcium where to go. So we don’t want to take a bunch of calcium without some of these other helper nutrients with it, because we could drive calcium, let’s say, into soft tissue, like our arteries, like inner ear bones. I’ve seen some weird things when people just dose up on calcium or too much vitamin D without enough K2.

Sarah:                                   So, again, just like the methylation nutrients, there’s this family of nutrients that are really important for bone health, and we want to get those together. Magnesium’s also really important for bone health, calcium magnesium ratios, which is something we really looked at for healthy skeletal development. So those are some of the big ones. You guys have any more that you like or that you consider?

Dr. Maren:                          No, I love that. I think what you said is perfect. I think it’s interesting just to go through pregnancy. One of my weird cravings was milk.

Dr. Carrasco:                      Me, too.

Dr. Maren:                          I don’t even drink milk, and now I’m dairy-free, but this was with my first. Now in retrospect, I’m like, “Oh, I needed more calcium.” I was in my third trimester, and I was literally bringing a Mason jar of milk to work.

Sarah:                                   (laughing).

Dr. Maren:                          My husband was like, “You are so weird. What is that about?”

Dr. Carrasco:                      I drank so much milk my first trimester of my first pregnancy.

Sarah:                                   Interesting.

Dr. Carrasco:                      [crosstalk 00:28:55] craving.

Dr. Maren:                          Yeah. I don’t think any of us believe that milk is your best source of calcium, anyways, but it was just like this sort of caveat. My other big craving in my second pregnancy was egg. So I’m like, “Oh, choline.”

Sarah:                                   Yes.

Dr. Maren:                          I needed more choline. All I wanted was egg all the time.

Sarah:                                   Yeah, yeah. Very fascinating. Yeah. It’s really interesting to hear that from women, what they want and why. This is kind of a little bit off from what’s in a traditional prenatal, but I felt kind of ashamed about this forever, but I was like, “Oh my gosh.” I just craved gummies, like, “I can’t eat enough gummies.” I realized, I like, “Oh my gosh. It’s the collagen and gelatin.” I needed more of that, and I wasn’t really getting that in my diet. I didn’t understand that. Then when I looked at my genetics, I was like, “I need more collagen.” That’s a need that I have, and that made sense that I needed more when I was pregnant. So I was like, “Oh, I explained the gummies.”

Dr. Maren:                          Yes.

Sarah:                                   I maybe ate a little too much sugar, but we have to balance life, right?

Dr. Carrasco:                      Right.

Dr. Maren:                          That’s super interesting, and I love that you’re bringing up some of the genetics. We’ll do a future podcast, probably. Hopefully we’ll get Alex on here to talk about MTHFR and PEMT-

Sarah:                                   Yes.

Dr. Maren:                          … and BCML1 and all of those, because I love that. I think it’s so important for preconception health that we really understand sort of that background programming, like what kind of vulnerabilities or nutritional needs we might have.

Sarah:                                   Totally. Yeah. It’s fascinating stuff, and it allows you to personalize it even a little bit more. I think that’s where a little bit of the inspiration of, “Let’s put together this prenatal with the latest data,” and then even what I’ve seen in working in clinical practice for 13 years of patterns with some of these genetic SNPs that we can see and how do we optimize it in a way that really meets the needs of a lot of women and kind of those patterns?

Dr. Maren:                          For sure.

Dr. Carrasco:                      Yeah. That’s amazing.

Dr. Maren:                          So I want to talk about one more kind of family of nutrients, which is minerals. So iron is sort of the primary one, but can you tell us a little bit about what are your favorite forms? What are we looking for in the back of our bottle to make sure it’s more tolerated and better absorbed?

Sarah:                                   Oh, that’s a great question. So minerals are so incredibly important, right? So we’re talking about things like you mentioned. Iron, zinc, magnesium, calcium are just a few of them, and minerals are kind of sometimes the nutrients when you take a prenatal that can bother your tummy. So one of the best forms of these minerals is if they’re chelated so they’re bound to an amino acid. My favorite is bisglycinate for a lot of the different minerals. So we used iron bisglycinate. We have zinc bisglycinate. We have magnesium malate, citrate, and glycinate and depending on what are using it for, because magnesium depending on the form and the use is variant.

Sarah:                                   But yeah, that’s really important, because it’s a lot gentler on the system and on your tummy when it hits your GI tract, and then it also is better in terms of absorption for those minerals, yeah, because it’s like it’s never fun to take a prenatal and you’re like, “Ugh.” You feel so horrible with it, right? It hits your stomach, which is challenging, because some of us are just more sensitive than others. But that’s one thing that you can do with the minerals to help.

Sarah:                                   Then iron, for us, we didn’t put a huge dose of iron into our formula. We put enough iron that you should also be getting some from your diet to marry that together. Then remember, vitamin A is really important in terms of your iron metabolism. It’s not just iron in and of itself, but we didn’t want to do too much iron, because some women don’t have as much need for iron. That’s a really personalized one that your doctor should really track throughout your pregnancy, because too much iron, it’s pretty inflammatory, but you need it, right? Your blood volume increases in pregnancy. You’ve got to make more red blood cells. You’ve got to have the little taxi cab called hemoglobin to transport oxygen. Otherwise, you’re … You feel so tired. It’s like, “Oh my gosh. What’s happening?,” beyond just normal pregnancy tired. So those were some of the considerations. We were a little bit more conservative with iron, because I’ve seen higher dose cause some problems for someone. Have you noticed that? Including constipation (laughing), right?

Dr. Carrasco:                      Yeah.

Sarah:                                   Which is never [inaudible 00:33:43].

Dr. Carrasco:                      Definitely. Yeah, totally.

Dr. Maren:                          Yeah. I think iron, I mean, Alex and I both really subscribe to the philosophy it’s better to test and not guess. So we’re usually tracking these kinds of things in our patients. So for people who are listening, if you’re anemic, make sure you also check an iron panel, because it’s not always iron. You can look at something called MCV, which is the size of your red blood cells, and if you see that’s small, typically that needs iron. If you see it’s really large, sometimes that can lead to folate or B12 or even vitamin C. So there’s a lot of different things we can check that are quite simple labs, right? They’re just not always thought about.

Dr. Carrasco:                      [crosstalk 00:34:20]. I think every trimester deserves a ferritin check.

Dr. Maren:                          Yeah, and vitamin D. It would be nice to get a vitamin A.

Sarah:                                   I know, right?

Dr. Carrasco:                      And homocysteine, which we’ll dive into.

Sarah:                                   Oh, yeah.

Dr. Maren:                          Yeah. We’ve got a lot. We’ve got a lot on our wishlist, but, I mean, I think most of them are pretty reasonable requests.

Sarah:                                   Yeah, they are. Exactly. They’re not expensive labs. It’s like this tighter care, more comprehensive care throughout your pregnancy to really see where your needs are at.

Dr. Carrasco:                      Yeah, for sure.

Dr. Maren:                          All right. Any other questions we want to ask?

Dr. Carrasco:                      I think circling back to women who have a hard time, kind of who just want a chewable vitamin or a gummy vitamin or they get a pack of prenatals and it’s way overwhelming, they just don’t take anything, what advice would you give women as they’re trying to figure out what kind of fits their body best?

Sarah:                                   Such a good question. One, I feel you, because I was nauseous for the first 20 weeks of my pregnancy. I was like, “Oh, this is so hard.” So it is. It’s a really tough problem to solve. I think while gummies are awesome and easy and it almost feels like this treat reward to have that. I think it’s important to remember you can’t really put good, stable forms of these nutrients in a gummy. I’ve looked at it like I’m a formulator. It’s just kind of tough to do. The stability is not there. So they’re just more inferior, right? As a form. So I’m a big fan of capsules that you have a powder, because you can open up that capsule and put it in some applesauce or put it in your smoothie or do something that it’s like you figured out you can tolerate. Then a lot of times, women will do better taking their prenatal if they’ve had something in their stomach. They’re not doing it on an empty stomach.

Sarah:                                   You find your ideal time. Some women are really nauseous in the morning. Some women are nauseous later in the afternoon, evening. So find that ideal time, and you might have to experiment a little bit. But yeah, gummies, I don’t love. I think tablets, the big, hard horse pills that all of us, I think, want to vomit with a little bit when we go to swallow those, I think those are probably some of the worst in terms of when you’re looking at form of what you want to do. Those tend to have a lot more fillers and other ingredients that are not awesome to have, because they have to do that to make the tablet.

Sarah:                                   So that’s another important thing when you’re looking at a supplement facts. You flip it over. The other really big thing is looking at the other ingredients, and that’s at the bottom, because there’s a lot of junk stuff that they’ll throw in there that you kind of don’t really know to look for. So anything that there’s this long list of other ingredients, of fillers and synthetic things and colorings and all that, those can impact the nutrient absorption. Then also, I would say some of those things could really hurt your GI tract. That could be kind of why you don’t feel so great, too. So you want to look for something clean. We use cellulose, which is like … It’s a plant fiber. It’s like eating some lettuce. To have a little bit in that allows the powder to flow. That’s just something with manufacturing that you kind of have to have, but it’s a very small amount. It’s actually the same thing that our capsule is made out of. It’s just a plant fiber, so it’s really easy on the tummy. That’s a great question.

Dr. Carrasco:                      Awesome.

Dr. Maren:                          Good. Well, I have loved picking your brain.

Dr. Carrasco:                      Yes.

Dr. Maren:                          I think for those people who are interested, we have Sarah’s prenatal that she’s talking about on the website. So go to heymami.com. We’ve sort of tried to curate all of our favorite supplements there to help people and just really lead people toward the right direction so they can figure out what they’re doing without … I mean, it’s quite simple for us, but quite complicated for most people, right?

Dr. Carrasco:                      Right. Yeah.

Dr. Maren:                          So yeah.

Dr. Carrasco:                      We are big fans of it, and our patients have done well on it. Yeah.

Sarah:                                   Oh, that’s awesome. That’s really great. Well, thank you guys for having me on. It’s an honor. What you’re doing to help women is really important, to give them this beacon of light of like, “This is the way to go” and guide them along their journey, because it is. It can be really overwhelming.

Dr. Carrasco:                      Yeah, for sure.

Dr. Maren:                          All right.

Dr. Carrasco:                      Thank you so much.

Sarah:                                   Thanks, guys.