How to Choose the Right Prenatal Vitamins

You may associate pregnancy with the idea of “eating for two” and craving unusual foods as the baby grows. This may be a popular adage, but keep in mind the best source of health for you and your developing baby is a nutrient-rich diet. While it’s possible to obtain adequate amounts of vitamins and minerals from eating a variety of fruits, vegetables, and lean proteins, many people do not. Legumes are rich in  protein, iron, folate, and calcium. Dark, leafy greens contain ample amounts of vitamin C, vitamin K, vitamin A, calcium, iron, folate, and potassium. Berries are high in antioxidants, while foods like salmon provide fatty acids for brain health.  If these foods aren’t staples in our diet, you may consider supplementation.

 

Taking prenatal vitamins in preparation of your pregnancy is like an insurance plan. The eggs that are ovulated start on their development journey about three months prior to the cycle. Before you begin trying to conceive, you may want to speak with your doctor about the best prenatal supplement for you.  Prenatal vitamins are recommended if you are not using birth control methods to prevent pregnancy, just in the event a pregnancy occurs you will want to ensure optimal nutrients are available for the fetus’s development. 

What to Look for In a Prenatal Vitamin

 

A good prenatal should have various vitamins and minerals to support the health of the mother and the baby. While supplements vary in their ingredients, key items to look for include 

 

  • Vitamin A with the majority as beta carotene – extremely important for fetal vision development and immune function

 

  • Vitamin B12 – important for maintaining the health of the nervous system

 

  • Choline – supports the development of the baby’s brain and neural tube

 

  • Iron – needed to make hemoglobin, a substance in red blood cells that transports oxygen throughout your body

 

  • Methylfolate (instead of folic acid) – decreases the risk of preterm birth and congenital heart disease

 

  • Calcium – necessary for skeletal formation and growth as well as muscle, heart, and nerve development
  • Magnesium – enables the growth of strong bones and teeth in the baby and also supports the mother by reducing blood pressure levels and reducing the risk of premature contractions

 

  • Selenium –  supports thyroid hormone metabolism, DNA synthesis and acts as an antioxidant protecting cells from damage and infection

 

  • Zinc – needed for cell division and tissue growth during baby’s development

 

  • Iodine – maintains normal thyroid function for both mother and baby

 

  • Biotin – required for the metabolism of glucose and amino acids and is essential in liver, skin, and nervous system healthy

 

Your doctor will be able to assist you in choosing the right dosage for you, as they will take into account your health, current diet, and any concerns that may warrant additional supplementation. 

 

Many prenatal vitamins also contain Vitamin D and/or DHA. Sufficient levels of vitamin D help ensure proper calcium absorption. DHA, or Docosahexaenoic acid, is an omega-3 fatty acid essential for brain development during pregnancy.  While these two ingredients are beneficial, most supplements do not contain adequate amounts.  You will want to consult with your doctor to determine if you need an additional supplement. 

What to Avoid in Your Prenatal Vitamins

 

A good rule of thumb when choosing supplements is to look for those as natural as possible. Avoid those that have food colorings or dyes which are unnecessary and petrochemicals, hydrocarbon derivatives, and coal tar. These may act as endocrine disrupting chemicals and affect fertility along with having adverse effects on the immune system. 

 

Other ingredients in supplements you’ll want to avoid are hydrogenated oils like soybean, canola, and rapeseed.  These are sometimes added to supplements to preserve shelf life and save costs. The hydrogenated oils are considered trans fats and have been shown to cause health concerns such as heart disease, stroke, diabetes, and possibly infertility. 

 

Folic acid is added to some brands of prenatal supplements. You may be aware folate is important for prenatal health and the baby’s growth and development, but folic acid is the synthetic form of folate. The body has a more difficult time breaking down the folic acid (the synthetic version of the vitamin), and unmetabolized folic acid (UMFA) can build up in the blood and cause health concerns. It’s recommended instead to seek out supplements which provide methylfolate as a source of folate.  

 

Your doctor will be able to recommend brands that are appropriate for you as they take into consideration your health history and nutritional needs. If you are local to the southern California area, I see patients in my offices in Los Angeles, Orange, and Riverside Counties where I offer comprehensive integrative fertility treatments. You can contact us for an appointment here.

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How Eating Organic Can Impact Fertility

Taking initiative around your health when you want to become a parent is a responsible choice.  It’s wise to mind your health and set a good foundation for the little one you are helping to create. The list of what to eat and what not to eat during pre-pregnancy and while expecting can be overwhelming, but it doesn’t have to be. 

Why Does Organic Matter?

 

Choosing organic foods can limit your exposure to pesticides, which can act as endocrine disruptors and carcinogens within the body. Higher levels of pesticides can also be linked to lower pregnancy rates and/or lower birth weights. 

 

Conventionally grown produce is sprayed with multiple types of pesticides many of which have been implicated in causing things like cancer and influencing infertility.   In 2017 The EARTH (environment and reproductive health study) showed eating higher pesticide residue vegetables and fruits was associated with lower rates of pregnancy and live birth following infertility treatment. These findings were consistent with prior animal studies displaying a similar result.  

What is the Dirty Dozen and Clean 15?

 

A simple guideline to follow is using what’s called the “Dirty Dozen” and “Clean 15” lists. Every year the Environmental Working Group releases Dirty Dozen and Clean Fifteen guides. In 2020 EWG analyzed 47 items and compiled their list. 

 

The dirty dozen were the top 12 fruits and vegetables with the highest pesticide content in the analysis. 

  1. Strawberry – rich in antioxidants
  2. Spinach – packed with iron, folate, and zinc
  3. Kale – high in iron, folate, calcium, and manganese 
  4. Nectarines – rich in selenium and vitamin C
  5. Apples –  high in vitamin C and fiber
  6. Grapes – packed with vitamins C and K and rich in antioxidants
  7. Peaches – rich in selenium and vitamin C
  8. Cherries – excellent source of vitamin C, zinc, calcium, iron, magnesium and vitamin B6.
  9. Pears – high in vitamin C and fiber
  10. Tomatoes – an excellent source of lycopene
  11. Celery – high in anti-inflammatories and fiber
  12. Potatoes – sweet potatoes are high in vitamin C, zinc, calcium, iron, magnesium and vitamin B6 as well as antioxidants
  13. Hot peppers ( an extra item on the list this year)  – rich in vitamins A, B, C, and E and some studies suggest capsaicin acts as an antioxidant to protect your cells and helps tamp down inflammation

 

The “Clean 15” conversely had the lowest levels of pesticides. ⁠

  1. Avocado – great source of vitamin E, antioxidants, and monounsaturated fats
  2. Sweet corn – contains folic acid, zeaxanthin, and pathogenic acid
  3. Pineapple – high in bromelain, an anti-inflammatory and anti-coagulation
  4. Onions – high in sulfur which helps promote the antioxidant glutathione
  5. Papaya – contains folate, vitamin A, magnesium, copper, and pantothenic acid
  6. Sweet peas frozen – rich in magnesium, potassium, and calcium
  7. Eggplant – high in fiber, potassium, vitamin C, vitamin B-6, and antioxidants
  8. Asparagus – rich in folate 
  9. Cauliflower – high in vitamins C, K, B6, and folate
  10. Cantaloupe – an excellent source of beta carotene, vitamin C, and folate
  11. Broccoli – rich in iron and folate
  12. Mushrooms – source of vitamin D
  13. Cabbage – an excellent source of beta carotene, vitamin E, and folic acid
  14. Honeydew melon – contains a high amount of vitamin C
  15. Kiwi – rich in vitamin C and folate

 

Don’t misunderstand that the Clean 15 is free from pesticide use. Why is the Clean 15 somewhat “safer” then? It’s because many, although not all, of these fruits and vegetables have a layer of protection in the outer layer of their skin. Others, such as cabbage and asparagus, contain naturally occurring enzymes that help to protect against pests and therefore require fewer pesticides to protect them during commercial growing. 

How to Make Organic Food More Affordable

 

Many of my patients have expressed concern about the increased cost of shopping organic.  One thing I would like to stress is not to let the list prevent you from adding a variety of vegetables and fruits to your diet. There are ways you can cut costs without cutting out these important sources of nutrients from your diet. 

 

  • Visit farmers’ markets or get to know local farms or farmers  Many farms do not have the organic label but do in fact use organic practices.  

 

  • Buy seasonal produce as its typically less expensive when in-season.

 

  • Look for frozen organic fruits and vegetables.  Frozen produce tends to be lower in cost but still high in nutrients because they are flash-frozen. 

 

  • Look for store brand organic produce or budget-friendly stores. Certain stores are known to be more expensive (Whole Foods, for example)  or more affordable (such as Aldi or Trader Joes). While in the stores shop the sales and look for in-season produce. When you purchase out of season, that will typically mean a higher price tag because of the cost in transportation to get the items to your local market.

 

  • Stick to basics. You will do better with your grocery budget purchasing organic, whole foods instead of splurging on organic snack chips, organic cookies, and so on. These items tend to be expensive, and even though they may be organic, they tend to have unnecessary sugars and ingredients that should be enjoyed on rare occasions.  Remember, we are looking to nourish the body with food. It’s best to learn to satisfy your sweet tooth with fruits (one of my favorites is fresh organic berries tossed with some high-quality balsamic vinegar for about 10 minutes to draw out the extra sweetness and then served with organic, full-fat, grass-fed Greek yogurt or coconut milk or nut milk of you are dairy-free and a small amount of farm-fresh honey. Be sure to choose yogurt that is free of added sugars.)

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Remember each little step to reduce your exposure, is a step in the right direction. Check out the Dirty Dozen and Clean fifteen on www.ewg.org for more information. If you would like additional support around your own fertility journey and how integrative medicine might support you, contact me. 

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Yoga for Fertility

The journey through infertility can be filled with stress, anxiety, sadness, frustration, and loneliness. I have heard from couples that they feel like their bodies are broken or aren’t good enough because of their fertility struggles or have tried to find ways to detach themselves from the disappointments of unsuccessful attempts at trying to conceive on their own. Yoga is an excellent tool to facilitate calm and help support patients on their fertility journey. The practice of yoga may allow people to reconnect to themselves, to each other, and to find a sense of community.  

 

Many women who are experiencing infertility feel stress and disconnectedness from their body. Yoga is a way to reduce stress and rebuild the mind-body connection.  Our emotions don’t just exist in our minds, we can also carry them with us in our bodies.  This can show up as muscle tension, physical pain, digestive issues, or fatigue.  You helps you to avoid holding un-processed emotion in your body. 

Asanas Allow Reconnection and Physical Benefits

 

Researchers have found our minds may cope with difficult emotions by disconnecting from a sense of self-awareness and body-awareness. A goal of healing and wholeness becomes reconnecting with your body in a safe, comfortable, healthy way. Yoga is excellent at filling this need. The physical poses, or asanas, in yoga, allow you to connect to your body through movement and breath. 

 

The yoga asanas also help to strengthen the body and improve blood flow to the reproductive organs. Some research has shown improved blood flow and circulation as it relates to a higher abdominal temperature that may correlate to enhanced fertility. 

 

Some asanas particularly helpful for fertility include those that are hip openers, such as lunges, butterfly pose, and the reclining bound angle pose, and those that bring calming energy to the pelvis such as the legs up the wall pose, the seated forward bend, and the standing forward bend. 

 

Similarly, some yoga poses are also beneficial for stimulating the endocrine system and restoring hormonal balance where needed. This applies to men as well as women. Choosing yoga poses that target specific trigger points may help to regulate monthly cycles, improve libido, rebalance thyroid function, stabilize blood sugar, and support fertility health. To help support hormone balance, you might select poses such as fish pose, sun salutations, garland pose, mariachi’s pose, and the bound angle pose. Illustrations of these can be found here. 

Yogic Breathing and Stress 

 

Yoga’s role in stress reduction is well documented. Yoga is a multidimensional system that includes physical poses, breathing, and meditation. Yogic breathing is also known as pranayama and translates from the Sanskrit ‘to control life force.’ Essentially, this refers to breathing in certain patterns that require you to inhale and exhale in ways that draw greater awareness to your breath. There are many different types of pranayama, and each has a specific role, such as restoring balance or focusing energy. 

 

Deep breathing allows us to reduce stress and manage body functions like blood pressure, immune health, and concentration.  Ujjayi breath is probably the most common type of pranayama used in foundational yoga classes and helps to bring focus to your mind and breath. This is also used to calm your mind during meditative practices. 

Yoga as a Sense of Community

 

While yoga can be practiced on your own, you may benefit from practicing in a class setting where you can connect with a supportive community of others sharing similar experiences. You may choose to seek out classes designed for restorative or gentle hatha yoga, as these would be most supportive of the asanas, breathwork, and meditations supporting stress release.  Sometimes knowing you are not alone in your journey is helpful, While your experiences are unique to you, connecting with others who may be sharing a common story.  

 

Research has shown that women who practice emotion-focused coping skills, such as reducing stress, may experience improved results when participating in fertility treatments. Sometimes the problem itself cannot be immediately resolved the way we want; instead, we need to examine the way we respond to the situation. Having resources such as yoga, breathing, and mediation available for stress reduction may be valuable. 

 

Resources for incorporating yoga and meditation into your habits can be found on my website along with this beginner’s yoga sequence. I encourage you to find a non-toxic yoga mat, made from biodegradable natural tree rubber, manufactured with zero waste and no harmful plasticizers. Manduka mats are free of toxic chemicals, dyes, and phthalates. If you would like to read more about the impact of environmental toxins on fertility, an article can be found here on the blog. 

 

Integrative fertility may be a choice for you if you would like to combine natural and modern therapies in your fertility journey. If you are interested in a consultation to see if integrative techniques can further support your fertility journey, contact me at Shala Salem, MD.

 

 

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October is pregnancy and infant loss awareness month

Losing a pregnancy or child is one of the most painful experiences a person can go through in life.  Pregnancy loss is often followed by a period of grief where a range of emotions can be felt, including guilt, anger, or even depression.

If you or someone you know has experienced the loss of a child, know that you are not alone.  Here are some statistics that show how common loss is:

  • 1 in 4 mothers report experiencing perinatal loss, however, the number may be as high as 50%  (Jaffe& Diamond, 2011)  
  • Approximately 24,000  mothers will experience a stillborn, or  loss after 20 weeks gestation. 
  • According to the CDC,  an additional 23,000 mothers  a year will experience infant loss during the first 28 days of their child’s life (MacDorman &Gregory, 2015).  

There are no  clear steps on how to navigate a loss, as each woman’s journey to healing is unique. Losing a child brings about difficult feelings and there is no right or wrong way to grieve. There is no typical time period that it takes, it’s different for every family. It’s important to allow yourself or anyone who is experiencing a loss time to feel the loss and go through the grieving process.  Often family members will grieve in different ways and it’s important to honor each person’s way of grieving, without judgement or expectation.  

Moving forward after the loss of a child can feel impossible. Often mothers and partners may feel stuck with no end in sight to their pain.   Couples should be supported in their choices to start trying for a baby again, or choosing to take some time before trying. Some couples may want to try to conceive soon after their loss.  For them, it may be a way of helping them ease the pain or shorten the grief period.  While other couples may choose not to try. 

Regardless of how the couple processes their loss, it’s important to acknowledge that some form of support is necessary to facilitate healing.  Most people will find comfort in getting support to cope with the emotions that accompany the grieving process.  Support can come in many forms.  It may be seeking help from a mental health professional, a support group, a spiritual community or a trusted friend.  Professional help is a proven way to work through the emotions that come with pregnancy loss.  For those that are hesitant to get professional help, it’s recommended they talk to someone in their life and find comfort in sharing what they are experiencing.

Here are some examples of those you can turn to for help and support after a loss

  • A close friend
  • Partner/ spouse
  • Family member
  • Spiritual leader
  • Counselor 
  • Psychologist 
  • Therapist 
  • Support Groups

It is common for mothers to blame themselves for the loss.  They may experience feelings of guilt and shame for not doing things that could have “prevented” the loss from happening.  These feelings may cause the mother or family member to retreat, isolate, and not seek support from others around them.  This will likely intensify the feelings of loss and grief, by spending time alone without support it may be more difficult to process your pain or find comfort.  

Seeking help and sharing your pain is not easy to do.  But the path toward healing includes working through your emotions and learning to process your grief in a healthy way.  For some people, family, cultural norms, or your beliefs may prevent you from asking for help. However, seeking help is the best step you can take in coping with your loss and grief.  Speaking to someone about your emotions may help in making sense of the loss and having your feelings validated.  Support during this time will help lessen the feelings of guilt and help to comfort you.  Remembering that you do not have to face the loss alone allows you to open up to receive support.

When working through loss and grief it is so important to prioritize self care.  Taking care of your body is as important as taking care of your mental and emotional health.   A healthy body can help promote balanced emotions and a healthy mind. Taking care of yourself does not mean that you are forgetting about the loss of your child.  You are healing yourself and the memory of your child will always live within your heart. 

Here are some examples to support your self care:

  • Eating a healthy, nutrient-dense diet
  • Exercising
  • Going for a walk outside
  • Meditation 
  • Yoga
  • Getting enough sleep

For those supporting a family member or loved one who has experienced loss there are many ways that you can help.  Here are a few tips:

  • Arrange for a meal delivery 
  • Refer to them as parents (acknowledge them on Mother’s Day and Father’s day)
  • Ask them if they want to tell you their story
  • Be present sit with them and listen 
  • Ask them what you can do to be helpful or to help them heal
  • If they have living children ask if you can help babysit or take them on an outing.
  • When they feel ready, join them in one of their favorite activities

Looking for help may be challenging when you may not know where to begin.

Here’s a list of resources:

This October, reach out to a mother or family that has experienced loss. Ask how you can support them in their healing. If you personally find yourself grieving the loss of your child, please know that you are not alone in this journey. Help is available all around you and you will heal on your own time.

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