Topics
- News and updates from Diane & Liz [2:19]
- Fourth segment with Dr. Jolene Brighten: thyroid and adrenals [4:24]
- Baby Making and Beyond researcher Amanda Torres: Vitamin A [21:16]
- Folic acid, folate, and MTHFR [35:00]
- Protein aversion in pregnancy [42:55]
- Sleep and melatonin [50:07]
- Amanda's motivation for working on Baby Making and Beyond [59:08]
The episodes are also available in iTunes, Spotify & Stitcher.
Show sponsors:
You’re listening to the Balanced Bites podcast episode 385.
Liz Wolfe: Welcome to the Balanced Bites podcast. I’m Liz; a nutritional therapy practitioner, and author of the Wall Street Journal bestseller Eat the Yolks; The Purely Primal Skincare Guide; and the online program Baby Making and Beyond. I live on a lake in the mystical land of the Midwest, outside of Kansas City.
My usual partner in podcast, Diane; a certified nutrition consultant, and the New York Times bestselling author of Practical Paleo and the 21-Day Sugar Detox. Her newest book, Keto Quick Start, that released on January 1, 2019. She lives in San Francisco with her husband and fur kids.
We’re the co-creators of the Balanced Bites Master Class, and we’ve been bringing you this award-winning podcast for more than 7 years. We’re here to share our take on modern healthy living, answer your questions, and chat with leading health and wellness experts. Enjoy this week’s episode, and submit your questions at http://blog.balancedbites.com or watch the Balanced Bites podcast Instagram account for our weekly calls for questions. You can ask us anything in the comments.
Remember our disclaimer: The materials and content within this podcast are intended as general information only, and are not to be considered a substitute for professional medical advice, diagnosis, or treatment. Before we get started, let’s hear from one of our sponsors.
Liz Wolfe: The Balanced Bites podcast is sponsored in part by the Nutritional Therapy Association. The NTA trains and certifies nutritional therapy practitioners and consultants (including me; I’m an NTP), emphasizing bio-individuality and the range of dietary strategies that support wellness. The NTA emphasizes local, whole, properly prepared nutrient dense foods as the key to restoring balance and enhancing the body’s ability to heal.
The NTA’s nutritional therapy practitioner program and fully online nutritional therapy consultant program empower graduates with the education and skills needed to launch a successful, fulfilling career in holistic nutrition. Registration is now open for February class, and you can learn more and save your seat by going to http://www.NutritionalTherapy.com. Don’t forget to check out the NTA’s annual conference, Roots, happening March 1 through 3 in Portland, Oregon. It’s one of the most empowering and educational holistic nutritional events of the year, and all are welcome.
1. News and updates from Diane & Liz [2:19]
Liz Wolfe: Ok, friends! Liz here, just with a few quick updates on Diane’s behalf. Diane is on tour right now, so go see her. Plus some special guests, like myself, if you come to Kansas City. You can go to www.blog.balancedbites.com/tour for all the details, and to RSVP. She is in Seattle tonight, I believe, then Portland, Oregon; Washington DC; Charlotte, North Carolina; Las Vegas, Nevada; Denver, Colorado; and then Kansas City with me; and Phoenix, Arizona.
Also, very exciting stuff. Diane launched her Balanced Bites meals. The meals are keto friendly, and they’re available in packs of 10. So check out her website for all the details on how to order those.
Finally, just a quick reminder on the Body Awareness Project. Diane and I both have been involved with this project, and are really proud of our contributions. Part one focuses on skin care, which you know is one of my original passions. And part two focuses on adrenal fatigue and cortisol dysfunction. So you can check that out at theBodyAwarenessProject.com. And stay tuned for part three, which will focus on the gut.
Before I jump into my interview today, we have Dr. Jolene Brighten back again for the fourth installment of our five-part series. So make sure you go back and listen to the previous podcast episodes to hear the first three segments. First, a quick word from one of our sponsors.
Liz Wolfe: Today’s podcast is sponsored by Perfect Keto. Dr. Anthony Gustin and his teams have created a line of supplements that are super clean and effective, no matter what your dietary needs. I know Diane has been blending their MCT oil powder into her matcha latte lately. Not only are MCTs; medium chain triglycerides; a premium source of your body’s preferred type of energy, they help to fuel your brain and body, but there’s also no added taste. It makes your coffee or matcha wonderfully creamy. Check them out at PerfectKeto.com and use the code BALANCED for 20% off at Perfect Keto; and their sister site, Equip Foods.
2. Fourth segment with Dr. Jolene Brighten: thyroid and adrenals [4:24]
Diane Sanfilippo: Alright, this is our fourth installment of this five-part series with Dr. Jolene Brighten. Don’t get too sad that this is the second to last one; I know you guys absolutely love hearing from Dr. Jolene. But make sure you go back and listen to the previous clips in our previous episodes, as well as the full episodes that Dr. Jolene was on. Some of our most popular episodes over the last seven-plus years. We absolutely love having her on here.
So today I would love to hear you talk a bit about how the pill can affect your thyroid and adrenals. Both of these are such major topics for women. So let’s hear a little bit about that.
Dr. Jolene Brighten: Oh gosh. And it is so major; there’s an entire chapter in my book on adrenal and thyroid health. And the big reason is that we all need to be more educated about our adrenals and our thyroid. But we also need to understand that hormonal birth control also affects these systems.
So there’s this story in women’s medicine that your ovaries; they just stick to themselves. These hormones are not all interplaying and interacting with one another. Now, there are really smart docs out there who get that your estrogen, your progesterone, your testosterone absolutely do influence what is going on with the adrenals and thyroid, and vice versa.
Whenever I explain hormones, and really my approach to helping women balance their hormones, I like to think about a pyramid. At the very base of the pyramid is our adrenal glands. And then comes thyroid. And at the very tippy top, there is your sex hormones. And in my book, I actually say; your sex hormones are just a bunch of followers. They’re like those teenage kids. Your mom would say; if everybody else was jumping off a bridge, would you? Yeah, your sex hormones would. Because if your adrenals; your foundation of your adrenals and your thyroid are not right, you're going to struggle with your periods. You're going to struggle with your mood. You're going to struggle with your weight. Every system can be impacted.
So with hormonal birth control, in particular, it’s inflammatory. So that’s one thing we have to recognize. They’ve done studies. It raises your CRP; C-reactive protein. This is measurable. We can measure this data, and you can understand if it’s true for you. And whose job is it to keep inflammation at bay? Your adrenal glands. So your adrenal glands are going to kick out cortisol. That’s all in an attempt to save you. {laughs} I want to say that; that’s one of the villain hormones in some people’s stories. “It’s causing this belly fat.” But it’s also trying to keep that inflammation down and regulate your immune system.
With that, it can kick out some epinephrine, norepinephrine as well. Now we’re not sleeping, now we’re anxious. We’re having all these symptoms come up.
The other things is that hormonal birth control is depleting nutrients. Nutrients that your adrenals and your thyroid need to make their hormones and to do their job. Vitamin C is actually very important in adrenal health. It is depleted by hormonal birth control. And if you're anyone who is like; eh, adrenals, thyroid. I doubt that; your audience is so smart. But you can also know that vitamin C getting depleted and vitamin E getting depleted means that your skin is going to age a lot fast. So let that one wake you up there for a minute.
So that’s one issue that we see. The other thing that happens with hormonal birth control is it raises binding protein. So we see this with sex hormone binding globulin. When they do studies, and they want to know; is that woman really taking the pill? They measure these binding proteins. Sex hormone binding globulin, cortisol binding globulin, and thyroid binding globulin all go up.
So with that, if you are making cortisol, or you are making thyroid hormones, you're going to bind it up. So you're going to grab onto it. If you are inflamed, you are less likely to use your hormones at the receptor level. So actually docking them onto the cell, and talking to the cell; that’s not really happening the way that it should. In a natural, physiological process.
Now, the other issue that we see in terms of with the thyroid specifically is that your thyroid pretty much makes inactive thyroid hormones. That’s the main juice you're going to get; T4. And then you require other tissues to convert that T4 to T3, along with nutrients. Yes, the very nutrients the pill depletes. {laughs}
But your liver and your gut are major conversion sites of getting T4 to T3. And if you don’t have T3; that’s your mood, your metabolism, your menses. This is why women start losing their hair. They have dry skin. They cannot poop. They don’t want to get out of bed in the morning. They’re super, super fatigued. They’re gaining weight for no reason. And then you see some people out there being like; just eat less. And it’s like; hold up! {laughs} There’s something else going on here. So I just want to say that. If you're nodding your head with any of those things, you need to go get a lab test.
With that; if we can’t get T4 into T3, we are going to have those hypothyroid issues. And if your doctor is only looking at your TSH, which is thyroid stimulating hormone, they may not catch that. And if they read that one study that came out; everybody loves to send me this study. Where the researchers concluded that your thyroid levels were actually higher. So you had more thyroid hormone while you were on hormonal birth control, as if it was a good thing.
But what they were measuring was total. And in fact what they found is the free hormones were low. But the total was elevated. Because it was bound to these proteins. You can’t use that! That’s not how the hormones work, here! If it’s bound, you can’t use it.
So, in all of those ways, we’ve got the nutrient depletions. We’ve got the havoc it wreaks on your gut and on your liver. We also have the issues with the inflammation. And we have the issues with not being able to actually produce or use at the cellular level the hormones were making. Due to that inflammation and those binding proteins.
Diane Sanfilippo: So helpful to know that. Because I think getting basic lab work done is really common, and women will get some preliminary thyroid readings; thyroid measures, and the doc says; this all looks normal.
So you were talking about T3 obviously being the active form, not T4. And even within that, it’s free T3 that’s really important for people to get measured. What are the markers that typically get measured, and what are the additional markers that women need to be asking for and really advocate for having pulled in their labs?
Dr. Jolene Brighten: What I see clinically; TSH, thyroid stimulating hormone. What your brain says to your thyroid, that’s the number one, tried and true that doctors will measure. Now, let’s recognize it’s a brain hormone. It’s an indirect measurement of what’s happening in your thyroid. Certainly, if it goes high, that warrants further investigation.
I would argue that every woman should have a full thyroid screening panel. Because you’ve got to know this information about yourself. But it’s also not as simple as just what the brain is saying to your thyroid. So sometimes will also measure a total T4 or a free T4. And that’s a measurement of; what is your thyroid producing? I’ve seen women with normal TSH, normal free T4, and then when we check that free T3, it’s less than 2. And I’m like; well no wonder you're fatigued. You're not making that conversion. Which might be due to nutrients, it might be due to inflammation. It could be gut infections. There are a lot of reasons.
And I just want to say that, because I see this mistake made clinically, where clinicians will then just give thyroid hormone. But your body is so smart. So smart. What will happen sometimes is that it makes reverse T3, preferentially, over free T3. And you can also measure this in the blood. And if that’s happening, that’s your body putting the brakes on you. Time to slow down. And I call it the hibernation hormone, because you're going to get cranky. You just gain weight and go to bed. You're going to be like a bear in winter. That is your body’s way of protecting you.
There have been studies that show if you get in a car accident and you have elevations in your reverse T3, it’s not looking good for you. Your body is trying to shut you down so you can heal and repair. This is also something we can see; just a gut infection. Just something as simple as having candida overgrowth or small intestine bacterial overgrowth. Maybe you have a parasite. Your body will shift. And it does that so that you slow down, and you heal.
So, from the top. We have TSH, free T4, free T3, reverse T3. And then everybody needs to have their antibodies screened. Anti-TPO and anti-thyroglobulin antibodies. Those are measurements of Hashimoto’s. They can help you understand. And if you're working with a good functional doc, or naturopathic doc, they can actually help you understand if that’s what’s coming down the pipeline, and then prevent that so you don’t develop that condition.
But, it’s something that I will often hear from doctors who will say; well I measured her TPO antibodies like 6 years ago, and they were normal. And I’m like; ok. Like autoimmune disease cares? It can be turned on at any time. We see with women there are different triggering events. One can be going on birth control, coming off of birth control, getting pregnant, having a miscarriage. Having a baby. These big shifts. Starting your period. Perimenopause. Shifts in our hormones can trigger autoimmune disease. So if you ever feel like something’s not right, get that investigated.
Now, in my clinical practice, I also run total T4 and total T3. The first I’m seeing someone. Because I want to understand. Do we have ample T4 and T3? And our issue is that it’s all bound up. And we’re not able to use that. And that just gives me a more clear picture of what is happening there.
And I do want to say; I’m not shaking my finger on anyone who uses a thyroid medication. I developed postpartum thyroiditis. I had a baby, I developed Hashimoto’s. By the time it was caught, there was enough damage to my thyroid that I now require medication. I’ve been doing some really cool things, that I’ve been able to come down off of the original dose of the medication, but I have to say. I hear from women who will say to me; I wish I didn’t have to take a medication every day. Or, I’m just not going to take my thyroid medication.
Please. If you’ve been prescribed it; understand that every single cell in your body needs that. And when we don’t take our thyroid medication, or we don’t have ample thyroid hormone; that’s like congestive heart failure in the future. You could die. This is not a good thing to be messing around with.
But I also want to frame it; how lucky are we to live in a country where we can have access to a medication like that. Once upon a time, we just struggled. We didn’t have these amazing tools at our disposal. So for any woman; and I know this happens in the natural health space, where women feel ashamed because they have to take a medication and they couldn’t heal their thyroid naturally. Don’t give up hope. There is new research coming out all the time. It is fascinating. But I also want to say; you need to be gentle with yourself. Also; it’s so much more powerful if we come from a place of gratitude.
I’m sure you hear this; whenever patients tell me; I don’t want to have to go gluten free, I hate that. I hate the idea of that. I always laugh and say; but you get to go gluten free. You actually live somewhere where you have a choice. And you have the means to choose differently when it comes to your food supply. I think it’s just a really important thing to stand back and to do that reframe with yourself. And know; when you're taking thyroid medication; that’s a non-negotiable. You were born needing thyroid. You were born needing that. It’s not the same as taking an aspirin or Advil. You were not born needing those. And yay that we have those for when we do need them. But you need thyroid hormone. You were absolutely designed and you absolutely do require that.
Diane Sanfilippo: I love that. We always get questions about advocating for getting these additional markers tested. And the one thing I want to say to all of our listeners; the way that I would personally approach this is just save your doctor. I honestly think you have to be willing to pay for it just in case, who knows how they’re going to write it up. I haven’t been to a general practitioner in a long time. Or had some tests like this where I’ve had to demand more than I was already asking for. But I think if you're ready to say; I’ll pay the bit extra for it. Because you might not even have to. I don’t know what everyone’s insurance will cover.
Just saying; prove me wrong. You know? What’s the worst that happens? We get these things measured, and then you're right, and wont you be happy? Because there are people; we always tell people to find a doctor who is willing to work with you. But I understand that sometimes you're a little bit stuck. Maybe there’s not another doctor close by. Maybe this is the one you’ve gone to for forever. There are a lot of reasons why sometimes it’s hard to move. And I think this point of advocating for yourself. The least you could do; while they’re already grabbing all this blood. Say; can you please measure these extra items. And if I’m wrong, I’m wrong. I have a right to this information. And I just want to have it. And that’s it.
There really doesn’t need to be this crazy back and forth. And I think if it becomes like a battle of wills; if the doctor is really that crazy about it. I think then maybe there’s a time to find another doctor. Or ask them; why are you so insistent that I not just have this additional information. Is it so crazy that I just want to know, just for curiosity’s sake. And that’s kind of it. I don’t know.
I think sometimes what happens are ego problems when a doctor feels questioned, or they haven’t had the last say. So if you're dealing with that, I just think it’s important to kind of, I don’t know. I don’t want to say come at it in a manipulative way, but almost just say; listen. You're probably right. But just humor me. And let’s get them, and we’ll see from there. Because I just need to rule this out. And then just move on. It will be fine.
Dr. Jolene Brighten: The other thing I’ll say, too, is that unless you're in medicine, you don’t know this. I remember when I learned it I was shaking my head. Some medical groups will actually dock the pay of doctors if they order these extra labs, saying they’re being frivolous. Or they’re running up the cost of medicine. And I see this argument, where providers will say; this extra lab testing is why healthcare is so expensive. No. Delayed lab testing and onset of disease is why healthcare is so expensive.
Sometimes your doctor’s hands are tied. They’ll get their pay docked. Or some systems, some of their EHR systems won’t even have those labs in there as an option. It can’t even be ordered. So some of this stuff is coming from hospital administrators and the higher ups that are tying your doctors’ hands. I’ve talked with doctors who have left these medical groups, because they were like; I was sick of being told by somebody who did not have a medical degree what was and was not indicated for my patient.
And thankfully, some states you cannot get your own data. And I really take issue with that, because you're absolutely right. You have the right to know. But these days, there’s a lot of ways where you can actually self-order your own lab work at a discounted price, and get all of that. And I really want to encourage…
Don’t wait until you have symptoms to get a thyroid panel. Get that baseline. Because then if anything changes in the future, you’ve already got that data, and you can advocate so much stronger. Whereas if suddenly your TSH is now 4, which some conventional docs are like; that’s fine. They might leave you and say, we’ll test again in a year. But if you can show; no. Once upon a time, it was at 2 and now it’s at 4, and these are the things that have changed, and these are my symptoms. It makes a stronger case. If you speak data, your doctor gets data. They get that.
When you come in and you're like; I listened to Dr. Brighten on Balanced Bites and I just want this thing. But if you actually have; I’ve been tracking my symptoms. This is what I’m seeing. This is what I understand. Would you be willing to work with me so that I can get this lab testing? I really want to know. And most doctors would be open to that.
And that’s especially true with your period problems, as I call it in my book. If you can track your data of your menstrual cycle, you are less likely to get brushed off. And it’s just the way doctors think. It’s not because they don’t like you, or they’re not trying to help you. It’s because if you come in and you're like; I’m having some heavy bleeding, and they’re like ok maybe birth control pills. But if you’re like; hey. I’m having 8 days; this is how many tampons I’m changing or how often I take out my diva cup. And here are the mood symptoms that come up, and this is the time that it happened, and this is what’s going on.
When you have that data, that’s their language. When you can speak in their language, it is going to be so much easier for you to advocate for yourself.
3. Baby Making and Beyond researcher Amanda Torres: Vitamin A [21:16]
Liz Wolfe: I’m so happy to welcome my friend, Amanda Torres to the show today, to complete our three-part series on our Baby Making and Beyond program. Amanda has been on the show once before, where we discussed her passion for science and Chinese medicine. And her healing journey through autoimmunity, which she discusses more on her website, TheCuriousCoconut.com. and in her book, Latin American Paleo Cooking, which is awesome.
And since then, I’ve been so fortunate to work with her as our Baby Making and Beyond lead researcher. Today we’ll focus our conversation on some of the really compelling and interesting tidbits she discovered while diving into the research questions we had while building the program.
Amanda is a neuroscientist. She earned her Bachelor’s and Master’s degrees in neuroscience from Tulane University in New Orleans. She has worked in laboratories conducting biomedical research since 2007. She’s published papers, and she understands how to dissect scientific journal articles and examine evidence with a critical mind.
Almost anybody can read and summarize a study that they find on the internet; not everybody knows whether that study was conducted properly, whether it’s in a reputable journal, and what the actual responses from the scientific community are. And Amanda does, so she is an absolute asset to Baby Making and Beyond. And I highly recommend that you check out her work at the Curious Coconut.
Welcome, Amanda, and thanks for joining us on the show!
Amanda Torres: Thank you so much for having me! I always love having conversations with you.
Liz Wolfe: You know, when we were booking this, I remember being like; you’ve been on the show recently, right? And you were like, no we just talk all the time. {laughs}
Amanda Torres: Yeah, it seems like I should have been on the show multiple times as much as we talk.
Liz Wolfe: Oh my gosh, yes. And everybody; I was thinking about this earlier today. Everybody needs an Amanda to reach out to and ask ridiculously nerdy questions at all hours of the day. We were having a really interesting conversation about some research you were looking at on folic acid, vitamin B12, and autism spectrum disorder. And I was just shooting you all these random questions about; what were they looking at blood? You were like, they were looking at plasma. And I was like; well did they look at this? And you were like, well yeah. It’s just the best thing. I love this.
Amanda Torres: {laughs}
Liz Wolfe: That was the point of Baby Making and Beyond, was having experts on call. I just love it so much. Thank you for all your hard work with that.
Amanda Torres: Oh, absolutely. I’ve very thoroughly enjoyed the work that we do. And I just so appreciate your intention and mission behind Baby Making and Beyond. To just make it; everything is triple verified. Question everything. Don’t take dogma as gospel. It’s just been a real pleasure and an honor to be that research gopher for all these interesting questions. It’s just been so fantastic, and I think it’s made the resource so valuable.
Liz Wolfe: I hope so. {laughs}
Amanda Torres: {laughs}
Liz Wolfe: I really, really hope so. And we’ve talked about this before. It’s taken us a long time to get some of this out. But the reason it’s taken a long time is because, as you just said, we’ve questioned everything. Even the things that we kind of held dear as real food ancestral health paleo types. And why don’t we just jump right into that, actually. Because we very easily could have just repeated what is generally said amongst experts in our community with regards to, in particular, how much liver we think people should be eating. Particularly in pregnancy and reproduction and all of that. But we decided to go ahead and look into it and see if what we were repeating was actually supported by the evidence. And we found some really interesting stuff. And we don’t want to give everything away, but we’re going to give a little bit away in this podcast.
So do you want to speak a little bit to what we discovered about vitamin A and liver? This, folks, would be why our recommendations for vitamin A are pretty different from what most people in this community are recommending.
Amanda Torres: Yeah. Well the whole topic of vitamin A and pregnancy and teratogenicity; so ability to cause birth defects. It’s such a complicated and convoluted topic. It’s very controversial, too. Still, just among scientists. Just to give a little…
Liz Wolfe: I should have said, by the way, for anyone who is new to us. Sorry to interrupt, but before; vitamin A is kind of controversial in pregnancy because it is known to cause birth defects at certain levels. And paleo folks; real food folks, are very enthusiastic about eating liver, which is our richest source of vitamin A. Just to get that out of the way.
Amanda Torres: Yes. So basically all of the vitamin A risk during pregnancy kind of started in the mid-90s with this kind of famous Rothman paper where they looked at; wasn’t it 200,000? No, not 200. 22. I added a zero. It was like 20,000 pregnancies. And they found, basically, their conclusion in the paper is that for women who were taking more than 10,000 IUs of preformed vitamin A from supplements, they would estimate one out of ever 57 babies would have a birth defect attributable to that high vitamin A intake.
But, it gets really; this full text is available online. You can see that there were so many letters to the editor prompted by this study. Critics, and questions. But because this paper was published, then we can’t ever ethically run a proper study to determine what is that threshold in humans that’s going to lead to causing birth defects. A high threshold. We also know that too little vitamin A will cause birth defects. I know in Baby Making and Beyond, we call it a Goldilocks nutrient. You need just the right amount.
And what’s interesting and what’s relative to the paleo ancestral health community, is that there is some recent evidence, in the last decade or so, that eating liver; getting vitamin A from liver can uniquely increase levels of the downstream metabolites. So you eat vitamin A, and your body processes it and turns it into all these other compounds. Some of those downstream metabolites are what are known to cause the birth defects. And liver can raise those more than the same amount of retinol from a supplement.
So, that’s interesting. That there’s some unique detrimental effect of vitamin A in liver. They don’t know why. There’s not an explanation; an answer of why does that happen. It’s just been observed in some very well controlled studies, where they made sure. It was comparable, based on the type of retinol in the supplement, and the delivery vehicle, and all of that stuff. So it just kind of should give us all some pause as to whether; because there are some recommendations out there in this community that it’s fine to eat lots of liver every week. Huge doses of vitamin A are going to be ok. They’re going to be safe. But we just don’t know for sure. And it’s going to be hard to know for sure.
The recommendations that we have now are based on very careful analysis. This has been so thoroughly scrutinized. {laughs}
Liz Wolfe: Mm-hmm.
Amanda Torres: And we thoroughly scrutinized it also. So it’s just interesting. Once I started diving into the scientific literature, it made me go; oh man. If I were going to get pregnant, I would not want to be eating liver multiple times a week, following some of these recommendations that clearly go against the government recommendations. But anyway. That’s what I love about this program. We aren’t afraid to question the dogma. Whether that dogma is coming from conventional wisdom or now the dogma in this ancestral paleo community, right?
Liz Wolfe: Yes, absolutely. And my brain kind of exploded multiple times while we were figuring out all this vitamin A stuff. What’s really interesting and fun to me. As I remember when we first started; and I say we. You. {laughs} When you first started looking into this for Baby Making and Beyond, I think the first pool of literature that you looked at was saying; the Rothman paper is saying vitamin A is prone to cause birth defects over a certain threshold. And then you saw the letters to the editor, that you referred to previously, about people saying; gosh, this is dangerous. Basically, people are throwing the baby out with the bathwater. People were really furious and saying; you're going to make people make no vitamin A. And we know that vitamin A is important.
So we were kind of at first, it was almost a little bit of a confirmation bias. Where we were like; ok, yeah. I think we’re pretty good to go on these recommendations that everybody is kind of repeating in this community. And then we kept going. And this is what we do. You just kept pushing a little bit, and kept looking for more; either corroborating or, what’s the opposite of corroborating evidence?
Amanda Torres: Contradictory.
Liz Wolfe: Contradictory evidence. We kept going, and then it was like; ok. I can’t remember what the next step in the journey was. But there were a couple of stepping stones between there and where we came to find that evidence about vitamin A from liver having a unique effect in that it generated those downstream, potentially teratogenic metabolites compared to the same amount of retinol from non-liver source. But we really kind of went around and around with this for quite some time, trying to figure out what the best conclusion would be. And I’m really happy with where we landed. Where we’ve got that kind of Goldilocks level that we recommend.
And I’m proud of us, also, for starting to look at this with more of a bird’s eye view. Where we kind of took this information that you had come up with, and distilled for the program. And then we started to say; ok, it actually does make sense that we’re not recommending people eat a certain amount of liver every week. Because first, we need to look at; how much liver have you been eating over time? It’s a fat-soluble nutrient. So it is stored in the body. This actually led me to get my vitamin A levels tested. And I am fully sufficient, which was really interesting news.
We also thought to ourselves; well, liver is kind of a rare food. I mean, if ancestral people were eating it, it was probably rarely and not 3-4 ounces per week evert week forever.
Amanda Torres: Right.
Liz Wolfe: So there were a lot of things we kind of took into consideration and making our recommendations to make sure people get enough; not too little, and not too much.
Amanda Torres: Yeah. And you mentioned about throwing the baby out with the bath water. That’s kind of what happened. When this Rothman paper was published, supplement maker stopped putting pre-formed vitamin A in prenatal supplements. They just turned it all to beta carotene. And when we kept digging in the literature, we found that that’s not really sufficient to get adequate vitamin A levels. Because there are so many steps and so many variables that affect conversion. And just how bioavailable it’s going to be. So multiple experts; scientists say that you really need to have both. You need to have both sources, and in pregnancy, to have sufficient A levels. Because you just really can’t predict accurately how much you're going to convert from plant sources. Beta carotene. Precursors.
Liz Wolfe: Yes. Maybe that was the stepping stone I was thinking about. Because we kind of lingered in that place where; yes, we really know that preformed vitamin A; retinol, which is what you would find in liver, is important. But we were working to dismantle the conventional wisdom, which is avoid it entirely and only use beta carotene for your vitamin A. Because your body will make all the vitamin A it needs out of beta carotene. Which is completely false, and not a reliable blanket statement you can make for any and all pregnant people.
Amanda Torres: Right. At least, the reasoning is; at least you're not going to produce too much. Your body won’t let you produce excess retinol from beta carotene, because there’s a negative feedback look there. But it definitely is not sufficient for adequate retinol levels.
Liz Wolfe: Such good stuff. Let’s hear from our final sponsor.
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4. Folic acid, folate, and MTHFR [35:00]
Liz Wolfe: OK, another topic that we looked at that I think is a little bit more of a hot topic; both in the ancestral health community and the conventional health community, is folic acid. And I think for the most part, people in our community understand that there’s a difference between folic acid and folate. Folic acid is the synthetic form of folate that is put into supplements and fortified into foods. Part of the reason they use folic acid is because it’s very stable. So, you couldn’t necessarily just throw folate from vegetables into supplements, because it’s unstable and vulnerable to; I think cooking, and potentially even freezing, I think after a certain amount of time in frozen storage, folate will decline in leafy greens.
But we kind of wanted to dig into that even a little bit more. I think a lot of folks who are familiar with the genetic SNP; it’s a genetic polymorphism. Not a true genetic mutation, but it is a genetic polymorphism where your body does not produce enzymes that operate at full capacity that help to convert folate into active folate. I think I got that correctly. And that would be the MTHFR enzyme, which is the methylenetetrahydrofolate reductase enzyme. And it’s really important I think that folks know that folic acid is not treated the same in the body as actual natural folate, or methylated folate. Which you can get from supplements.
One thing I want to clear up, though. And this was one of the early, early questions that I asked you, Amanda. Does MTHFR have anything to do with the body not being good at using folic acid? And those two things, correct me if I’m wrong, are two separate issues. You see a lot of folks saying; if you have MTHFR your body can’t process folic acid. I think the truth is, everybody’s body is crappy at processing folic acid. {laughs} And there is an enzyme that has to convert that. And then it has to be converted again with the MTHFR enzyme. Am I right, here?
Amanda Torres: Yes. That’s pretty good. And kind of what you said about the folic acid. We all have trouble with it. Some of the really large scale nutrition analysis studies that; gosh, I forget the exact acronym, but it’s like national; Nhans is how I pronounce it in my head. We can maybe put that in the show notes of what that study is. But it’s just basically a very widespread population look at nutrient status, basically. They found it pretty much ubiquitous across all ages, every level of socioeconomic status. Everybody has unmetabolized folic acid in their blood stream because of the widespread fortification.
And probably people that are following a real food, ancestral paleo lifestyle will have less, because we’re not eating processed foods. It’s mostly added to grains. But, there’s just a lot. Researchers are starting to question whether it’s a good thing to fortify the food supply. There’s one quote from this one paper that was particularly interesting. Several hundred thousand people are exposed to an increased intake of folic acid for every neural tube defect pregnancy that is prevented.
And their questioning whether the benefits to helping prevent the birth defects of pregnancy outweigh the risks the rest of the population is facing. We’re looking at links to certain types of cancer. Especially colorectal cancer. What else does it do? That’s one of the big things. Alterations to the immune system. But the cancer link is something that’s concerning.
I’ve read so many papers on this topic, and I kind of have a hunch that we’re on the cusp of seeing a change. I mean, there are papers where their conclusion is we need to stop recommending folic acid and shift to recommending the methylated version; the 5-MTHF as the optimal way for pregnant women to get this nutrient.
But as you said, you can’t fortify the food supply with that. It’s going to have to come from a supplement. And unfortunately, it’s more expensive. So, kind of after going through all of this, sorting through all of these papers, reading all of these opinions from all of these scientists, and seeing what the risks of long-term exposure to excess levels of folic acid, having high levels of unmetabolized folic acid in the blood stream. Kind of what the conclusion that we came to is that; you know what? You need it when you're pregnant. And if you're supplementing with folic acid, preconception and during pregnancy, that is much better than not supplementing because you can’t afford the 5-MTHF version. At least during preconception and during pregnancy. It’s absolutely better to supplement with folic acid. Even if you have one of the SNPs.
I think there’s a lot of shaming that can happen, and guilt. Like you said about; there’s all of this information out there on the internet that you should avoid it if you have one of the MTHFR SNPs. And yes, I agree, long-term you should avoid folic acid supplementation. But if that’s the best you can do while you're pregnant and preconception, then do it. Please do it. It will help you prevent devastating potential birth defect.
Liz Wolfe: Yeah. That was kind of a wakeup call for me. This is something that we talked about fairly early on, where I think one of the questions you asked me is; how are you going to make this accessible to people everywhere? People that can’t necessarily spring for a $99 prenatal. It’s unfortunate that this is where we are. But I feel like, at a certain point, you do have to; what’s the word? Progress, not perfection.
We are trying to keep things realistic for people. And if you legitimately need to spring for a prenatal or preconception vitamin with folic acid in it instead of folate, then that’s ok. We don’t want people to freak out, and have paralysis by analysis and not do anything because they’re scared of doing something wrong. But we still wanted to bring the information that people needed about long-term folic acid intake. And the potential consequences of that over time.
Pregnancy, and pre-pregnancy, and immediately post pregnancy, this is a relative. I mean, it drags on. It feels like a really long period of time. {laughs} But in the scheme of things, you're going to be ok if you're doing folic acid, if you have to take folic acid instead of methyl folate. And what you would look for on a label is 5-MTHF, or L5-MTHF. That’s the form of folate that is optimal for prenatal nutrients.
And of course, we still want people eating folate rich foods. So leafy greens and legumes are both included in our food recommendations and meal plans. We have some recipes, including legumes, which are an excellent source of folate from food. So we want people to be doing both.
5. Protein aversion in pregnancy [42:55]
Liz Wolfe: Ok. Let’s talk about another favorite tidbit of mine that you came up with for us that you found and dug out of the literature. Let’s talk about morning sickness.
Amanda Torres: {laughs} Yeah.
Liz Wolfe: This is kind of my favorite. I think that the chatter in the community in the past has been; oh, the body doesn’t process protein appropriately when you're pregnant. Or something like that; I don’t even remember what it is. But it’s actually much more simple and much more interesting than that.
Amanda Torres: Right. And it actually has an ancestral explanation, so it’s kind of odd to me that within this ancestral health community, that this kind of myth about the body not being able to process protein effectively. I think it had to do with urea and the kidneys.
Liz Wolfe: Oh, and I should have said protein aversion, not morning sickness.
Amanda Torres: Yeah, well there’s interesting tidbits about the morning sickness, also. But really, it’s super simple and so interesting. And I did a lot of reading just to try to see what is the current consensus about why do women experience food aversions during pregnancy. And very specifically, meat aversion is so, so common.
Pregnancy is actually considered an immunocompromised state. I read that exact phrase in papers. Because of progesterone, and because you have to have. In order for the pregnancy to be successful, the immune system has to calm down, and not reject the baby. Because if you think about it; it is foreign material. The sperm that created the baby is foreign material that the immune system should try to attack normally, right? But for pregnancy to occur, the immune system has to be suppressed so that the pregnancy isn’t rejected. And progesterone is a known immune suppressant. It lowers immune function.
Liz Wolfe: So crazy.
Amanda Torres: So that’s a long-winded way of saying your immune system isn’t up to par when you're pregnant, because it has to be for the pregnancy to be successful in the early stages. And meat historically is one of the riskiest foods we can eat. Modern preservation methods; refrigeration, it’s so recent in our history. And especially in warmer climates, meat was much more likely to spoil easily, to have parasites. And pregnant women are the most susceptible to getting ill. And if you suffer from some kind of very severe illness, it can have really horrible, negative impacts. And sometimes even result in a miscarriage if you get sick enough.
It’s actually a very simple explanation that your immune system is lower. Meat is, through all of human history except for very recently, is one of the riskiest foods that you can eat, and so it’s a protective mechanism to kind of be like; ok mama. You should chill out and eat some other things that aren’t going to be such a high risk thing for you. It’s just interesting.
Liz Wolfe: It is. It’s pretty amazing. This is why I love that we have you heading up the research team, and that we have researchers on board that are excited to look into these things. Because this seems like such a simple, small thing. But even the fact that it had actually been written about in the literature; it was just the coolest discovery to me. And I was just so excited when you found this, and started distilling it for me.
And yet, at the same time, you also did a ton of research for us on protein and how critical it is during pregnancy. And that’s where we crafted our recommendations, right, with the understanding that it’s sometimes difficult to take in adequate protein, and that’s a very normal, natural, evolutionary response to pregnancy. And yet we know folks need pregnancy. So little old me, who was so prejudice against shakes and smoothies, has now totally come around. Because I’ve found it’s actually one of the easiest ways to help make sure during those times you get adequate protein for fetal development, and for all of the different changes that are going on in the body during pregnancy.
Amanda Torres: Right. And also, too, just within the paleo community. I know a lot of people avoid legumes, and beans. But, you know what; don’t let dogma get in the way of eating the foods that are going to supply the protein, and the folate, and all of that. You know what I mean? As long as they don’t make you sick. So that’s just another interesting kind of perspective, too.
And you know, you can find so many weird papers on so many bizarre topics. Like, the fact that they’ve written papers that give explanation and rationale for why women have meat/protein aversion during pregnancy is no where near the weirdest thing you can find. {laughs}
Liz Wolfe: So, another reason I’m so grateful to have you, because I love looking at stuff like this. But quite frankly, unless somebody I really trust passes a paper along to me, I would have a much lower ability to discern whether it was a legitimately well written paper. Whether it was in a reputable journal. What the responses and letters to the editors were about it after the fact. And that’s just something that you just know how to do from your many years in academia. So another reason it is so awesome to have you looking through all of this stuff.
Amanda Torres: Yes. It’s good to just kind of question everything. And it is so widespread that people that don’t have any kind of formal scientific training whatsoever will talk about research, share tidbits, they’ll cherry-pick information, and try to just kind of misconstrue what the science actually says. And we all have to do our due diligence, I think.
But people that are buying Baby Making and Beyond can rest assured that we have done all of that for you. {laughs}
Liz Wolfe: All of that and more. So much fact checking. Even, you know, we have sort of fact checked some of the more popular scientists. Popular Instagram scientists. We’ve actually had trouble, a couple of times, verifying the information that is coming out of those resources. Which has been a huge bummer. It was kind of a disappointing moment. But also a moment where we’re like; we continue to do the right thing and just double checking and fact checking anything and everything that goes in here.
Amanda Torres: Yeah.
Liz Wolfe: You think people get the point that we double check and fact check everything?
Amanda Torres: {laughing}
6. Sleep and melatonin [50:07]
Liz Wolfe: Alright, so let’s move on because I only have you for a few more minutes. I wanted to talk about; we talk a ton about nutrition in Baby Making and Beyond. But our core four, which are the things that are important for everyone, no matter what phase you're in. Whether it’s just general hormonal health and you're not even thinking about getting pregnant, or you are trying to get pregnant, or want to get pregnant soon. You are pregnant, or you are post-pregnancy. The core four is for everybody.
So the core four involves proper nutrition, smart exercise and movement, and sleep, and stress reduction. So one of the challenges we’ve had with the core four is that people are really excited about the nutrition and the exercise stuff, but they get less excited and less committed to the sleep and stress reduction stuff. Even though, I think we know now, that it is even more the bread and butter of this whole thing than even perhaps nutrition. I think most people know how to eat reasonably well. Most people know how to select a good prenatal. We give that information. But in all, if we could get people sleeping and reducing their stress, it might give more mileage than any amount of extra salmon in the diet could do.
So, one of the topics that you researched pretty extensively was sleep, and also sleep and melatonin. So I was hoping you could give folks a little tidbit, or several tid bites about what you discovered around sleep and melatonin that was just so fascinating.
Amanda Torres: Yeah. So it’s definitely hard to get people on board. Doesn’t matter if they’re trying to get pregnant or not to just manage stress and sleep better. I think it’s just not fun. We have faced so many challenges with our modern lifestyle. But I think that when you understand, at least for me, understanding the mechanisms and the reasons why it’s so important, kind of helps you say; oh. Ok, I really need to take this seriously.
So something interesting that I learned in doing this research is that the follicles in the ovaries. The follicles are what hold the maturing egg before ovulation. The follicles in the ovary have two to three times more melatonin than we have in our blood stream. That totally blew my mind. I didn’t realize that melatonin is actually synthesized in several parts of the reproductive system; including the placenta. And it’s a very potent and strong free radical scavenger, and antioxidant.
The reason why they think it is found in such high concentrations in the follicle is because the act of ovulation is a very violent act. And it’s kind of thought to be there to help protect the egg from getting damaged from the act of ovulation. It is also thought to just help preserve the integrity of the developing fetus, also.
What’s interesting, too, is that melatonin is secreted by our bodies in response to darkness. That’s why we secrete it. So hello; we all have screens that we’re staring at at night after dark. We probably all have lots of little blippy lights and stuff throughout the house that can create this dim light exposure. And dim light exposure, at least in some animal models. I don’t think I found anything that was specifically for humans with this. But something that was really interesting was that chronic dim light exposure will disrupt melatonin production. And it can cause epigenetic changes.
This was in hamsters, I think. But they looked at both the males and the females having this chronic exposure. I think they did it for 9 weeks. So before pregnancy even happened. And then they get pregnant, and then you see these changes passed off into the offspring. Some dysregulation in the immune system function. Dysregulation in the endocrine function. Really fascinating stuff.
And also just goes to show; I think we’re getting better culturally to realize that everything doesn’t fall on the woman to be healthy and have good habits to have a healthy pregnancy. That what the father does, and eats, and all that stuff matters too. But it was very interesting to me to see that the father, in hamsters at least, could have this chronic dim light exposure, and that could lead to detrimental changes in the offspring because of some epigenetic changes. Isn’t that so crazy? {laughs}
Liz Wolfe: So crazy. And it’s funny to me; this word. It is a violent; the releasing of an egg from the ovary is a violent act. It’s like; I’m thinking, beautiful, wise women, gently taking the egg from, what, the corpus luteum or whatever it is, and rolling it down the fallopian tube for its calm little journey into the uterus. But it’s like, no. It’s ejected, and it flies down the fallopian tube!
Amanda Torres: {laughs}
Liz Wolfe: I don’t know. It’s just an image that’s funny to me. But I thought that was so fascinating. And you think that melatonin; we know that melatonin is the sleepy substance. We think about it, not in regards to how it’s going to effect ovulation, or egg quality, or reproduction. And just connect those dots was so profound to me. And definitely kind of put some ants in my pants to get people on board with sleep hygiene.
Even making small changes that can make a big difference. Like, blacking out your room. Covering up the little lights in your room with electric tape. Really protecting your sleep the way you protect your body from crappy foods.
Amanda Torres: Yeah. The other thing that was very interesting is that there’s a link with melatonin and progesterone production from the corpus luteum. After ovulation, you need that progesterone. The reason it’s producing the progesterone is because your body is thinking; hopefully we’re going to get pregnant. Right? And you need the progesterone. So the melatonin is thought to aid that. So if you're not getting good sleep. If you're having chronic light exposure, and you're not producing enough melatonin, it could potentially impact progesterone levels and successful pregnancy. So it’s a big deal. {laughs}
Liz Wolfe: Huge deal. And we talk about; not just this stuff. Not the nerdy stuff with the melatonin and all of that. We talk about basic sleep hygiene and ways to optimize that when you're in the fertility time period when your pregnant. And also when you're getting up late at night to feed a baby. There are different ways that you can address light exposure during those time periods. And many of these things are well within our control. Which is really good news.
Amanda Torres: Right, yes. I love that you’ve been able to come up with so many practical, actionable steps. Like, we present this information. But it’s not just like; here’s this problem.
Liz Wolfe: Good luck with that! {laughs}
Amanda Torres: No, you’ve given lots and lots of solutions. There is so much helpful information and ways to make steps. And like you said, sometimes little changes can make a big impact.
Liz Wolfe: And to a degree, I think probably we don’t need to be so open and transparent about our process of coming to some of the conclusions that we’ve come to. But I do think it’s important that we include a lot of this stuff, and we talk about this and don’t just say; hey, eat this much vitamin A but not too much. Or, hey, try and sleep better and wear amber glasses or whatever. We don’t want to just tell people what to do. Because everybody is different. Lifestyle is different. And we really feel like people need to know a little bit of extra information to make the best decisions for them. So this process part and how we got here is very important for us to share with everyone.
Amanda Torres: Sure. And you know what; with some of the feedback that you’ve been getting with the beta testers, too. People really enjoy getting this kind of information and understanding these nitty gritty details. Kind of like what I said earlier; when you understand why, then it’s easier to say; ok. Well now I get it. I’ll take it more seriously.
Liz Wolfe: Confidence is pretty key. Because I think at this point, when somebody just tells me something. Like, just do this; it immediately inspires 50 thousand questions and a mountain of distrust. Because I’m like; don’t just tell me that. You need to tell me why. Because we’ve been misled on so many different things so many times in our lives. So it’s important to understand the lead in as much as the conclusion and the advice that we give folks. Not official advice. The recommendations we make for entertainment purposes only.
Amanda Torres: {laughs}
7. Amanda’s motivation for working on Baby Making and Beyond [59:08]
Liz Wolfe: {laughs} Yeah. Ok. That’s most of what I wanted to cover. But before I let you go, I would love for you to give a little bit of your personal story as to why this work is meaningful for you. And in part, I ask you because you're not necessarily trying to have a baby right now. And this program is not necessarily for people that are actively trying to get pregnant. It’s for people who want to understand their bodies better, in particular their hormones. Because fertility is overall health, right?
Amanda Torres: Oh yeah. It’s arguably the deepest measure of your overall health. It’s one of the first things to go when you're not healthy. When you're not taking care of yourself the way you need to. If certain diseases are out of control. It’s a very; what’s the right word? It’s just such a clear marker of your overall health.
I’m happy to speak a little more about my own story. I don’t have plans to have children. But I have dealt with issues that are basically fertility issues. I have uterine fibroids, and endometriosis. When I got those diagnoses a couple of years ago, it was a real kind of wakeup call to me that I need to pay attention to this part of me, and the aspect of fertility and the health of my reproductive system and hormones and all of that. And it doesn’t matter that I don’t plan to have children; it matters for the picture of my overall health and wellness.
So, like you said earlier. Your core four things that everybody needs to follow; yes, it’s absolutely true. And I think that for women, at least I know for me, now I kind of try. I view things through the lens of reproductive health as the first marker. And I’m still doing work. I’ve made huge strides. If you guys listened to the first podcast that I did, we go dive deep into my love of Chinese medicine. How I really kind of treat that as; that’s my healthcare. That’s what keeps me healthy. That’s what’s helped me to avoid needing surgery, and reducing symptoms, and improving my hormonal balance, and improving my cycles. All of that stuff has been through Chinese medicine, herbs, and lifestyle adjustments, guided through Chinese medicine.
Anyway, it’s just; I hope that makes sense. This is why it’s important to me, and I think other women who also don’t necessarily have plans to have children can still benefit tremendously from this information. And taking these steps to just optimize health. That’s what optimizing fertility is. It’s optimizing your health.
Liz Wolfe: Absolutely. And just to add to that, a tiny little tidbit. There are times when women are struggling to get pregnant, or carry a pregnancy, that have nothing to do with the state of their overall health. I know there are many women out there who are working really hard to be healthy, to eat well, to reduce stress. And it’s just not happening.
We by no means want to suggest that those women are not doing enough, or there is something deficient in their lifestyle. There are things that we can’t control. That are completely outside of our control. And we still hope for those people as much as anyone else that you have the tools available to you to be as well as you possibly can wherever that journey is taking you.
Amanda Torres: Right. Thank you for saying that, because I didn’t want anybody to think I was implying any of that that you just cleared up. So thank you.
Liz Wolfe: No, not at all. And you weren’t. Whenever I say fertility health is overall health, my heart always pangs a little bit. Because I think it’s a good soundbite, of course, and I think it’s helpful in understanding that talking about this stuff is applicable, not just to people who are trying to have children, but at the same time I want to recognize there are many mysteries of the human body that cannot be solved with our core four. And that’s just the truth. And I would never pretend that we have the answers for everyone.
Amanda Torres: Right.
Liz Wolfe: So important to say. Ok, I think we’re good. Thank you so much for coming on, and sharing all of these amazing tidbits that you have pulled together for Baby Making and Beyond. We’re just so lucky to have you on the team. And just excited to see where it all goes.
Amanda Torres: Yeah. I feel so lucky to be a part of this team. So thank you so much for having me. This was a real pleasure.
Liz Wolfe: We’ll talk to you again soon!
Amanda Torres: Alright. Bye.
Liz Wolfe: Bye. And that’s it for today. If you haven’t already checked out the other two interviews in our Baby Making and Beyond series, be sure to check out episodes 383 with Meg the Midwife, and 384 with Vanessa Gengler, who is our movement and exercise expert. You can find Amanda at thecuriouscoconut.com. You can find me, Liz, at http://realfoodliz.com/ and Diane at http://dianesanfilippo.com. Don’t’ forget to join our email lists for free goodies and updates that you don’t find anywhere else on our website or even on the podcast. While you’re on the internet, drop over to iTunes or Apple podcast and leave us a review. We would absolutely appreciate it. See you next week.