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On this episode on the podcast, we are taking another deep dive into the importance of nutrition for fertility and pregnancy. While women often shoulder the responsibility of all things related to preconception and birth, my guest today, Ayla Barmmer, MS, RDN, LDN says that nutrition in men during this time is just as critical.
For over 15 years, Ayla has been advancing the health and empowerment of thousands of clients, patients, peers, and mentees, at the intersection of nutritional science, functional medicine, and evidence-based holistic solutions.
Ayla and I have a special connection in that as I was completing my dietetic internship, she was one of my preceptors. And I continue to be impressed with all that she has accomplished in her career as a registered dietitian.
Ayla owns and operates Boston Functional Nutrition, an integrative and functional nutrition multi-clinician practice that specializes in women’s health and infertility. She is also the founder of FullWell, a fertility wellness brand, widely endorsed by a diversity of health practitioners for its quality and education.
And that’s not all! Ayla founded the Women’s Health Nutrition Practice Group and co-founded the Women’s Health Nutrition Academy with recent podcast guest, Lily Nichols, RD.
Despite her very busy professional life, she has taken time out to chat about all things “real-food” as it relates to pregnancy and fertility. Her passion truly shows as we cover:
- Why preconception nutrition is so important
- The importance of men’s fertility health in preconception
- How oxidative stress impacts men’s fertility health
- Why Ayla started making supplements and how they are different from other supplements on the market
- Important nutrients to look out for during preconception and pregnancy
- The difference in available nutrient forms
Even if this isn’t the phase of life you are in or simply not interested in becoming pregnant, this episode still has important takeaways for anyone who uses supplements. Plus, fertility is a sign of health so it’s important to have it even if you don’t use it.
Resources:
Sustainable Dish Episode 179: Ty Beal, PhD
Sustainable Dish Episode 178: Lily Nichols, RD
Urban Moonshine Calm Tummy Bitters
Real Food for Pregnancy by Lily Nichols, RD
Connect with Ayla:
Website: FullWell Fertility and Boston Functional Nutrition
Instagram: @fullwellfertility and @aylabarmmer_rd
LinkedIn: Ayla Barmmer, MS, RD, LDN
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Episode Credits:
Thank you to all who’ve made this show possible. Our hosts are Diana Rodgers and James Connelly. Our producer is Emily Soape. And of course, we are grateful for our sponsors, Patreon supporters, and listeners.
This episode is sponsored by Levels, a continuous glucose monitor that gives you individualized insight into your metabolism. This is a tool I personally use and recommend to people I work with. It’s helped me figure out what foods spike my blood sugar and which ones keep me level. I can also see how certain tricks like walks after a meal affect my body. Right now Levels has a waiting list of over 150,000 but they are allowing my listeners to skip the line if you go to sustainabledish.com/levels and sign up. Try it out to see how food you eat affects your metabolism. This is a must-have tool for anyone interested in personalizing their nutrition.
Quotes:
“For men, one of the things that we’re really looking to do is minimize oxidative stress. And one of the reasons why we are seeing generally, higher rates of infertility in the research, we’re tracing it back to increase levels of oxidative stress.” – Ayla Barmmer, RD
“Zinc is a big one for men. It supports sperm DNA, it boosts sperm motility, and improves testosterone levels.” – Ayla Barmmer, RD
“The supplement industry, I mean, there’s a reason why they’ve been labeled sort of snake oil salesmen because a lot of it is very overpriced garbage.” – Diana Rodgers, RD
Transcript:
(Intro) Diana Rodgers, RD 0:01
Welcome to the Sustainable Dish Podcast. I’m Diana Rodgers, a real food registered dietitian, author, and sustainability advocate. I co-host this podcast with James Connelly who was a producer on my film Sacred Cow. I also founded the Global Food Justice Alliance an initiative advocating for the inclusion of animal source foods like meat, dairy, and eggs for a more nutritious, sustainable, and equitable worldwide food system. You can check it out and join me at global food justice.org. Thanks again for listening. And now onto our show.
Diana Rodgers, RD 0:39
Welcome back to the podcast everyone. Today I have with me, my good friend Ayla, who I actually met when I was an RD student and did my internship under Ayla. And it was such an honor and I was a fan then and I’m blown away with where her career has taken her. And so it’s so nice to have you with me.
Ayla Barmmer, RD 1:03
Oh, thanks for having me on. Yeah, I remember that years ago, and you taught me a lot in turn too, I remember you coming with your books, you know, that you had published and all these introduced me to all kinds of new products to use with clients. So it was mutually beneficial.
Diana Rodgers, RD 1:18
So we live near each other, we’ve shared an office for many years, and we both, at the moment, are not taking on nutrition clients, because we’re so busy with our other work and we’ve gone in, you know, very different directions, but I think a lot of dietitians, after some period of time, end up not taking on clients and doing other work. Lily Nichols is the same as well. And you work a lot with her so so why don’t you kind of talk about the evolution of your career as a dietitian?
Ayla Barmmer, RD 1:49
Yeah, so and you know, not taking new clients and really doing one on one work is a very, very recent thing. In fact, I’m really just kind of winding things down a bit over this… over the past few months. And so it hasn’t even fully kind of come to fruition. But I started out, I knew early on that I wanted to be an RD, you know, graduated out of a coordinated program and then kind of went into doing some community work. I, similar to you, sort of knew from the get-go that a clinical hospital, clinical job was not for me, I saw the limitations there and didn’t feel like I’d be as effective. You know, there’s a whole host of reasons but…
Diana Rodgers, RD 2:27
It was still a cool experience. Right? Like, I’m still really glad. And you know, people come to me and they talk… I don’t mean to interrupt you, I just get excited. I’m sorry. But people talk about the RD program. And I actually think that’s one of the benefits of the program is to have that clinical experience just being… just to see it and experience it.
Ayla Barmmer, RD 2:49
Oh Yeah. Absolutely. I mean, I think about rotations on the burn unit and various critical care settings. It was really, I mean, still there’s applicable things that I bring into my work. And I really did a lot. I mean, I’ve hustled most of my career. So I’ve done a lot of different things, but I have a… I have an entrepreneurial kind of heart. And so I’ve always done various business ventures and endeavors. And I started a private practice work 12 to 15 years. I mean, I’ve been a dietitian over 15 years. And it wasn’t shortly after that, that I started private practice work. So it’s been a long time. And I really if I added up I mean I have worked within individual and group settings, 1000s of people and I love it, I think you know, over the pandemic, I’m looking for a little break to kind of use my skills elsewhere, though, because it’s a lot of energy. And now I’m really enjoying, teaching, educating, and doing a lot for that for both health practitioners, and also the lay public and most passionate about really influencing the way that we talk and treat fertility, you know, in this country and abroad. And so that’s where I’ve landed now and found my sweet spot with the work I’m doing.
Diana Rodgers, RD 3:58
Yeah, and it’s a place where there’s a lot of opportunity because people will really do anything to have a baby. I mean, even I had some issues conceiving, and I remember just thinking, oh my gosh, I’ve spent my whole life you know, trying not to get pregnant and you just assume that the minute you actually intend to get pregnant that you’re going to get pregnant. And it took me many years. I ended up having an ectopic pregnancy and had to take methotrexate which drains your folic acid. And then I was very concerned and this is way before I became a dietitian but I was very concerned about birth defects because folic acid is something that you need. And so you have really taken a deep dive into the needs of pregnancy and preconception, not only in women but also in men. So can you talk about that a little bit like? What, you know… we’re coming into this depleted, just from our modern diets?
Ayla Barmmer, RD 5:03
Yeah, yeah, it’s it… This is something I’m just so passionate about talking about because there’s so much that we can do. And we can influence. Not only to influence fertilization, like conception and getting that positive pregnancy test but really the health of the pregnancy, the health of baby over the long term. And so to me, that’s… there’s just a really big impact that we can have in what I call… what is called really the preconception period. So back when I started getting into this work, there was no one really, it didn’t feel like there was anybody talking about nutrition and lifestyle for fertility. I mean, this is a while ago, and now there’s more, but there’s still not enough. We’re kind of mostly in conventional settings really funneled into treatments before, the whole picture is really looked at. And so I just think we can get ahead of a lot of issues by focusing on the preconception window. And what that really is, is I mean, it’s… there is no “too soon to start”, but three to six months is a great time to start thinking about, you know, for both women and men, you know, the nutrient status, what needs to be addressed, and getting things in good supply. Not once you’ve conceived, and once you’ve gotten pregnant, there’s a lot of reasons for that. I mean, one big one for women is neural tube defects. So you mentioned birth defects. And you know, that is that’s a big one. And we hear a lot about folate and it’s the main reason why the food supply was fortified with folic acid, you know, starting years ago now and which is problematic and we could talk about. But, you know, the neural tube closes like week five-ish of pregnancies. So that’s like a week, after a missed period, maybe right? So you may not even know you know, that you’re pregnant at that point. And so, and folate is just one of many nutrients involved in neural tube defects and general pregnancy complication avoidance, right, you know, so like, we have a lot of nutrients that we’ve got to really kind of get up and good supply to avoid that. And choline is one. 95% of women are not even meeting the adequate intake level, which we know is is set way too low, based on more current research. So there’s a lot of reasons and then for men, I’m most excited about some of the most recent research that’s tying men’s preconception health to pregnancy complications, Like, you know, preeclampsia, gestational diabetes, preterm birth, miscarriage, you know, pregnancy loss, where really all that burden has been historically, you know, until very recently, and still is, you know, put squarely on women’s shoulders when we now know that there’s, regardless of past pregnancies a male may have had with previous partners or a clean semen analysis, there’s still… that preconception period still influences pregnancy, health and outcomes, and baby over the long term.
Diana Rodgers, RD 7:53
Yeah, so let’s talk specifically nutrients and, you know, food sources for them. I recently did a podcast with Ty Beal, where we looked at global nutrient deficiencies, and some are less common in high-income countries like the US, but we still have a huge prevalence of things like iron deficiency, and then you mentioned choline, which is not even on anyone’s radar, and something that you can’t get on a diet that doesn’t have animal source foods in it. So let’s talk about the food, the best food sources for some of the most common nutrient deficiencies that are particularly important when we’re considering fertility health.
Ayla Barmmer, RD 8:31
Yeah, actually, you mentioned iron, and I think it’s worth pointing out, I mean, so I do now in my current work, you know, run Full Well and I have formulated… created a prenatal multivitamin, along with a men’s product and the prenatal by design actually does not contain iron. And I actually, that’s important, not because it’s not needed, because we know it is by many, but that’s a nutrient that really needs to be taken separately so it’s not… doesn’t compromise, you know, absorption of the other minerals, nutrients in the formula, right? Because that’s it does impact the absorption of those other important nutrients, but it also needs to be really customized to your labs, you know, to make sure you’re getting appropriate doses. I mean, it’s a tough one to tolerate. And ideally, you’re running lab work and we’ve got on our site, I tried to do a blog post really covering the best ways to assess iron status so that you can hopefully get ahead of it and shoot for dietary sources first, you know because there are… that it is possible to meet your iron needs through diet.
Diana Rodgers, RD 9:34
Although it’s hard.
Ayla Barmmer, RD 9:36
Yeah, it’s hard to do. It’s hard to do and it takes a real concerted effort and I think it also requires making sure your iron status is good preconception because we all… those of us who have experienced pregnancy know that the first trimester is like not maybe when you’re hitting the liver hard and it can be tough, so to help you kind of get through that. And then after first trimester iron needs increase further, you know, that can really help. So, you know, I mean, we’re really talking about animal source foods, you know, for that heme iron. And I know in my practice, I know you’ve seen this to women especially are just not eating, you know, red meat, organ meats, animal source foods as much and it seems to me over the past few years, I’ve seen it even declined further, you know? So that’s big. And of course, we find in those foods, the other key nutrients coupled in there, so the choline, folate B12, you know, I see in the research and generally prescribed like the Mediterranean diet, you know, for fertility. That came out of like Harvard’s research Walter Willett, you know, that crew and there’s some good data in there, but it’s limited because if we actually look at the nutrients that are needed for egg quality, follicles development, early embryo development, implantation, pregnancy, it really does come from more your red meats and organ meats and things like that. So yeah, so that’s important. And for men too, because these same nutrients like the folate, the B12, the choline… they contribute to sperm quality and overall semen quality. So the motility, the morphology, the overall structure, you know, whether or not it’s got damage, you know, to it. And so there’s that piece, as well as for both women and men – its role in methylation. So that kind of I’m now I’m kind of going down the rabbit hole. But methylation is really interesting, and it’s very nutrient intensive. And it’s it comes into play big time with fertility.
Diana Rodgers, RD 11:35
But so we know with women, you mentioned choline, B12. Iron take that separately, if you need to supplement with it, I know that the standard prenatal that you would get from your doctor contains a ton of iron, which you mentioned, not everyone can tolerate. It’s been a long time since I’ve been pregnant. But I seem to remember, it makes you constipated. When you take too much iron. Is that the problem? Yeah. And actually this… here’s another reason why you should talk… if you’re going to talk to a dietitian, talk to a specialist in this area. Because it’s been a long time. I mean, I could certainly look up what you need for pregnancy. But talking to someone like you or Lilly is or, you know, or someone else that specializes in this is really the best because you guys are so up to date on all the latest research. And although I’m a little bit of a generalist, I tend to just focus on, you know, more gut health and metabolic health, which is just a different set of skills. Right?
Ayla Barmmer, RD 12:35
Yeah, it is a unique stage of life. It is and I often argue to you know, especially for now, I know your audience isn’t necessarily comprised of probably a ton of vegan or vegetarians, I would imagine, but…
Diana Rodgers, RD 12:47
A lot of recovering ones that are probably very depleted. And also, I’d love to chat too about what happens when you get pregnant with number two, too soon, because there is an optimal time, and you can be very depleted going, especially going into second pregnancy. So and I do have a lot of followers that are ex vegetarians or vegans, and in this stage of life right now.
Ayla Barmmer, RD 13:14
Yeah, yeah, I would say, kind of tracing back to… it’s really like preconception period, even I think I’ve seen over the years here with practice clients, and in general that, you know, they may get through a first pregnancy on their stores. But having gone through a pregnancy or postpartum healing, you know, experience maybe breastfeeding, you know, caring for a toddler, you know, baby and a toddler, and then going into a second pregnancy, you’re depleted. I mean, you need more. And it’s usually I would say most often, then, when I’m seeing the actual fertility issues, like the difficulty conceiving, you know, because it’s just that cumulative depletion, that happens. So, you know, I think there is there some data on pregnancy spacing, 18 months seems to be kind of some of the better data that we have, but it really is dependent, right, like on how well you recover and replete with the right nutrients. Yeah.
Diana Rodgers, RD 14:10
And also how much you’re sleeping. Because it’s so exhausting. But I do remember thinking the first one crushed me with a sleep deprivation than the second one, I was already so worn down, that I was like, What was I thinking? This thing’s easy, you know? I don’t know if you had the same experience.
Ayla Barmmer, RD 14:30
I think I’ve only just started recently sleeping. My youngest, my second is like two and a half. Yeah. And it feels good. But I’m like, I feel like I’m still recovering in some ways, you know?
Diana Rodgers, RD 14:44
So what are some of the nutrients that men, in particular, should be focusing on? And what foods should they be? Maybe eating a little more of? Because iron deficiency in men, because they’re not menstruating, is less common.
Ayla Barmmer, RD 14:59
Yeah. That’s right. So iron tends to be less of an issue. But some… there are very, there’s a lot of overlap in some of the other nutrients. So vitamin D is a big one for both women and men. But for men, you know, it’s supporting not just their immune cells, what we’re really… and sorry, just to back it up. I mean, for men, one of the things that we’re really looking to do is minimize oxidative stress. You know, and one of the reasons why we are seeing generally, higher rates of infertility in the research, we’re tracing it back to increase levels of oxidative stress. I mean, we’re living in a modern environment, with things… environmental exposures, we can’t avoid, some of which we can definitely mitigate with changes. But we’ve just got a lot more stress a lot more environmental exposures that we have to deal with. And so for men, it comes down to really mitigating oxidative stress with lots of antioxidants.
Diana Rodgers, RD 15:52
Yeah. Will you back up real quick? Just for biology 101 – I do this in my Sustainavore course, where I actually show an atom and show what oxidative stress is and what a free radical is. Would you just briefly remind people what that is, if they don’t remember high school biology?
Ayla Barmmer, RD 16:09
Yeah, I mean, I think one of the easiest analogies to think of, and I swear, you and I did a joint presentation on this and actually showed this image but like, would be like an apple browning. You know, like, that’s oxidation like that can happen at the cellular level, really, I mean, it can happen… Free radicals are coming in from, you know, our external environment. They’re byproducts of just regular metabolic processes in our body there… It’s both normal and then we’ve also got excessive amounts, you know. And so, when I think about oxidative stress, I think about okay, how much of a burden does our body’s own systems that typically deal with these things have? So our liver for one, I mean, we all kind of know, our liver does… has a role in detoxification, I mean, it requires a ton of nutrients just to function properly. It really requires a lot of B vitamins B12, is a big one. We know that animal source foods are where we’re getting B12. It requires a lot of amino acids. Glycine is a big one. That’s one that becomes conditionally essential actually in pregnancy. But you know, so we’ve got to make sure there’s enough resources really to deal with the burden, you know, that any individual is under and that varies.
Diana Rodgers, RD 17:20
So keeping their metabolic health up to date. And especially as we’re seeing people delay pregnancy later and later, and you know, you’re not just concerned about getting pregnant but you know, scrambled DNA and the sperm impacting the development of the baby.
Ayla Barmmer, RD 17:37
Yes, exactly. And, and I, again, I’m really kind of trying to get out there and say to you that a semen analysis, just getting a clear semen analysis is not enough to pick up on all the things. We still need men focusing on their preconception health and you know, nutrients like vitamin D. Like I mentioned, that’s helpful, more from a hormonal perspective, but things like vitamins A, C, and E, those are really important at repairing damage caused by free radicals. You know, big proponent of making sure that both men and women are, are really getting in enough of the retinol, you know, source vitamin A, which is coming from animal source foods. B vitamins, like I said, that plays a role in methylation at a cellular level that’s needed for… if we think at a cellular level that’s needed for mitochondrial health and egg and sperm are just full of mitochondria. In fact, eggs have more mitochondria than most other… any other cell really in the body. And so that’s we’ve got to really feed it, they’re workhorses, you know, they need a lot of energy.
Diana Rodgers, RD 18:39
And why do we care about what… will you describe methylation, please? That’s a word that gets thrown out a lot, and people hear they may not be methylating properly, or whatever. And I don’t think we’ve ever talked about that on the podcast.
Ayla Barmmer, RD 18:52
Yeah, you know, methylation is… it’s a metabolic process that really falls into our realm because there’s so many nutrients involved in it. And it’s required for the metabolism of certain nutrients like B12, folic acid. And, you know, methylation is something that just it happens at, again, a cellular level, like when to give it a more practical example. I mean, when an embryo is developing methylation kind of goes into overdrive, it’s for like that growth and, you know, to happen and so, I think there are… there is quite a bit of misinformation out there and too much emphasis placed on MTHFR, the genetic snip that you can have a variant in that kind of reduces your ability to process certain nutrients, certain forms of nutrients efficiently. But I think my issue with it is that we put so much emphasis on that particular variant and not so much the nutrient sources. So really, the problem comes in when you’re getting excessive amounts of synthetic versions of certain nutrients like folic acid versus folate, so we don’t see folic acid naturally in the food supply, that’s a synthetic nutrient that’s fortified and added in. Our body has to be able to convert. And there’s repercussions to not being able to convert it efficiently. We can get things called unmetabolized folic acid, which we know now does create problems in the body. And so that’s something to kind of focus on is the forms of nutrients, I think more than worrying too much about your MTHFR stuff. So across the board, there’s going to be forms that are better for everybody, you know,
Diana Rodgers, RD 20:29
Right. And the food source forms are usually you know, ideal and when there is a nutrient that’s in plants and animals, the animal form is the one that’s preferred, especially when we’re talking pregnancy and we know from ancient cultures, the pregnant women are the ones that got the fish eggs, and you know, got all those like, the most nutrient-dense foods.
Ayla Barmmer, RD 20:53
Yeah, absolutely. In terms of a couple of other nutrients, though, I mean, like zinc. Zinc is a big one for men. It supports sperm DNA, it boosts sperm motility, and improves testosterone levels. So…
Diana Rodgers, RD 21:07
And that’s not an easy one to get, like if people aren’t eating enough seafood. I mean, I’m thinking clams and other bivalves that are as the best source of zinc. What.. where else are they getting zinc? I know it’s a really common nutrient deficiency worldwide.
Ayla Barmmer, RD 21:21
Yeah, I mean, I’m often recommending shellfish, you know, for that. And, yeah, again, it’s kind of interesting, because I see a lot of recommendations around like nuts and seeds, but really, that just doesn’t compare at all to you know, what you’re going to get and shellfish, you know, so…
Diana Rodgers, RD 21:36
Yeah, I can remember some of the nutrient density charts that I’ve made, and you kind of can’t even… it’s not fair to put oysters on any of them because it tips it so… it skews it so much that oysters are like 10 million times better. Anything else that… then all your other bars look puny, and you can’t even see a difference in them because oysters are just so incredible.
Ayla Barmmer, RD 22:04
Yeah, I know. I always… in the practice, we’ve always recommended couples go date nights with oysters, you know, like, go enjoy them more. You know, if you don’t have access to fresh oysters like canned, smoked. There’s different ways to incorporate them, but they are very nutrient-dense.
Diana Rodgers, RD 22:19
Or clam chowder is easy one Lily and I were talking about. You know, how simple is that? Just clams and boiled potato and there you go.
Ayla Barmmer, RD 22:26
Yeah, pretty much. Absolutely.
Diana Rodgers, RD 22:27
Hey Guys, I wanted to tell you about my experience with using Levels, a continuous blood glucose monitor that I’ve been trying out as one of their early access members, and let you know how you can get an early one too. As you know, I pay close attention to what I eat and where it comes from. I’m one of those people who always wants to know how food impacts my health and I’ve known for a long time that excess carbs have been a big problem for my blood sugar levels. Before I started eating this way, I was on a blood sugar roller coaster and would feel really terrible if I skipped a meal. I constantly felt like I needed a snack and I didn’t understand why. The great thing about wearing a continuous glucose monitor is that you know exactly what’s happening inside your body minutes after you eat a meal. It’s been a huge game-changer for me to learn that certain carbs or food combinations work better than others and the cool thing is, everyone is different when it comes to how certain foods spike your glucose. For example, white rice, even in the context of a meal, will send my glucose soaring. But potatoes with the same amount of carbs keep me pretty level. I also learned that I don’t need to be quite as low carb as I thought I needed to be and certain tricks like eating salad or vegetables first or taking a walk after a meal make a huge difference in my spikes. I’m recommending wearing one for a month or so to everyone I work with. Levels currently has a waitlist of over 150,000 people but they are offering my listeners first come access to their beta program. So just go to sustainabledish.com/levels to get yours without a prescription. That’s sustainabledish.com/levels to jump ahead of the line and try it out for yourself to learn how your individual body reacts to food. I know you’ll think it’s pretty cool.
Diana Rodgers, RD 24:10
So what’s it like to run a supplement company? You developed a supplement, not only for women but also for men.
Ayla Barmmer, RD 24:17
Yeah, I mean, the way it arose was, you know, I was basically working my practice thinking, I need to piece together so many different things to really meet the needs of women and men that I just want to… and me very naively thinking, I’m just going to go and create my own. And so you know, that’s what I did. And what I really wanted, though, was not just to be behind like the formulation of it, but I wanted to be part of every step of the process. And I think that’s what’s really different about what I’m trying to do is that you have a health practitioner, a licensed you know, health practitioner whose trained in the science behind every step of the process where especially, you know, these days with the challenges of the current climate, there’s so many shortcuts that are just being taken because it’s very difficult, it’s really difficult to be in this business right now and consistently produce, like, the quality product that you want. I mean, the first run that I had, I had to throw out completely, and it was really deflating. So…
Diana Rodgers, RD 25:11
And it’s not like you could just taste it and know what’s not right.
Ayla Barmmer, RD 25:15
Yeah, exactly. So, you know, this came out of just me really recognizing that I… just feeling like there was not, there was not the formulas, the evidence-based formulas that I would want to see and use in my practice, and take myself, you know, or recommend to friends and family. So I wanted the formulas, I also wanted really exceptional quality standards, you know, so third-party testing on every single lot. That’s not done in the supplement industry. And so getting and in testing for all the major allergens for identity, for contaminants. So there’s documented you know, it’s real problem in the especially with prenatal supplements, with contaminants. And obviously, that’s the stage of life, we don’t want to be messing around with that sort of thing. And for men’s fertility, there’s very little still, you know, available that’s targeted to men’s reproductive health, and even companies talking or educating on the importance of men’s preconception health on pregnancy outcomes, because it goes so far, again, like I said, beyond just fertilization. So those, those are the reasons but I do… I mean, what we really are trying to do is, is be a fertility wellness and education brand, where we’re going to be moving the needle on how we’re talking and treating fertility. And we’ve got a huge health practitioner network where we’re trying to really help facilitate getting good evidence-based information out there.
Diana Rodgers, RD 26:35
So people can find it… you can just go to sustainabledish.com/ fullwell, and that will take you to check out the supplement. So talk about some of the foods and then maybe some of the other supplements, like you couldn’t get everything in here. And there definitely are brands that as practitioners, you and I, way prefer over other ones you mentioned, I mean, the supplement industry is shady and not regulated, especially in the probiotic realm. I think I read some study that every single one did not have the populations that they said they had in them. So talk about the foods on top of your supplement, what else should they be looking at adding in?
Ayla Barmmer, RD 27:19
Yeah, because I mean, you know me and I am… I would definitely qualify myself as a real food dietitian, you know, so I am always looking to how do we meet our needs with food first. The reason I got into supplements and the stage of life is that you… it’s such a nutrient intense period. And we have so many holes and gaps really in our diets, our modern diets and modern environmental stressors that you know, I just think this is the time where you need to kind of take a supplement.
Diana Rodgers, RD 27:47
Oh, yeah, I mean, why if you could have an insurance policy on protecting… just that extra level of protection? Why wouldn’t you do that?
Ayla Barmmer, RD 27:55
Yeah, exactly. But you know, this is really built on yeah, a good foundational diet, taking this. And so to me, that means we use the most widely recommended, you know, Mediterranean diet, like infertility… in the fertility space that’s recommended, like if it’s even talked about in a fertility clinic or an O.B.’s office, like that’s the diet, they’re going to recommend. I say, we just, you know, we modify that. And we need to add in a lot more animal source foods into the mix as well, you know, with Full Well’s prenatal we were able to fit 300 milligrams of choline in there, which is hard to do. It’s a really big nutrient. And so it drives up the capsule number, you know, and because it just takes up a lot of space, so does magnesium. Those are two really important nutrients that we need extra. We need more than what a typical diet provides. And so that’s one of the reasons why we actually have as many capsules as we do per serving. So I’d like to point that out. But really, the 300 milligrams is not fully meeting your needs for choline. You know, the newer research is pointing to upwards of almost 1000 milligrams a day, you know, being needed. And you’re not going to get that through just like by eating a couple of eggs.
Diana Rodgers, RD 29:06
Yeah, how many? How much do you know off the top of your head? I can look it up while we’re chatting.
Ayla Barmmer, RD 29:10
Yeah, so for choline, it kind of it varies a little bit by egg and I… but it’s only a couple 100 maybe… 100 or so milligrams, you can double-check that on me but I know if you had FullWell’s prenatal plus a couple of eggs every single day really consistently, and some other like fringe kind of sources of choline, then you’d meet your minimum needs, which are set around 500 milligrams, 550 milligrams daily, but to get to those higher levels that we’re seeing better benefit with. And this is really… choline comes into play not just for early neural tube defect prevention and methylation and like embryo development, but also for baby’s brain health.
Diana Rodgers, RD 29:48
That’s what we’re trying to feed right now and what’s growing so rapidly. Oh, I pulled it up. So as you were talking, and I was being all distracted and not looking at you, but I was actually listening. Chronometer doesn’t have choline on it. Well, it didn’t on my phone app. Maybe it does on the desktop. Because I have milligrams per one hard-boiled egg is only 147, which is 27% of your daily value, and that’s for non-pregnant people.
Ayla Barmmer, RD 30:18
Yeah, yep, I was gonna say, I think, you know, it’s around the 100-200 milligram mark for choline. You know, we hear about eggs a lot, you know, the yolk is being a great choline source, it is good compared to like, if you see peanut butter on the list, I mean, you’re getting negligible amounts.
Diana Rodgers, RD 30:35
Yeah. The next one would be beef at 117. And then it goes way down. A chicken breast is 72 milligrams for three ounces, which is only 13% of your daily value.
Ayla Barmmer, RD 30:47
And most prenatal vitamins will have negligible amounts of choline in them, maybe they’re fitting in 50 milligrams, something that I… you know, I just it’s not evidence-based and not really helpful. And that’s again, because it does drive up the capsule space and capsule number. But it’s, it’s a tough one to me, you’ve got to have good dietary intake combined with, you know, supplements to really get their organ meat, you know,
Diana Rodgers, RD 31:12
Well, I was just gonna mention as a parent, I think one of the reasons my kids… my son is like, gigantic now, I don’t know if you’ve seen him lately, but…
Ayla Barmmer, RD 31:22
Every time I see him, he’s grown like a foot. I’m like, yeah,
Diana Rodgers, RD 31:25
Yeah, and what far exceeded anyone in the family. But of course, I’m taking credit for this, I feed my kids eggs, and I have ever since they were little. At least three eggs a day for them. And then the rule in my house, and I know Michelle Tam had the same role. You know, like when I was experimenting with crazy recipes – they just have to try it. And if they don’t like it, they can have eggs.
Ayla Barmmer, RD 31:51
Mm hmm…That’s good. I’m gonna try that at home actually. Yeah, they’re packed. I mean, eggs, including the… I mean, especially with the yolk are packed with a lot of really good nutrients. I think my main point there is you know, that it takes multiple servings of different animal source foods along with a good supplement to really get to your needs with choline. And then vitamin D is just another one for both, you know, women and men that is so hard to keep levels up, especially it depends on the latitude you live at. But we have… I mean, vitamin D, I’ve seen some, you know, and I’m not sure if you’ve seen it, but you know, a little bit of backlash against vitamin D. And it’s… I’ve kind of, you know, it’s a hard one for me to understand, because it’s the most studied nutrient. And while we do have problems with, you know, nutrition research, I mean, we have a lot of randomized clinical controlled trials on vitamin D and the importance of it and the benefit and the functions. And so we know that 4000 IUs, a higher dose than what’s typically being recommended is not only safe, but really shown to be the minimum amount that women need to keep their levels even somewhat adequate throughout pregnancy for babies needs. And that goes into like skeletal development, it’s really important.
Diana Rodgers, RD 33:04
And dependent on calcium intake, which not everyone’s getting enough calcium,
Ayla Barmmer, RD 33:10
Right. Yeah, that’s actually something that we used to see that most people were actually meeting their calcium needs through diet alone. And that’s not the case now and it definitely hasn’t been the case of my client population who maybe are avoiding dairy for a variety of reasons, are having trouble tolerating it, incorporating it in, and things like that, we usually try to get to the root cause of what that is and get it back in but,
Diana Rodgers, RD 33:33
But a lot… but just flat out, a lot of people just are not consuming the levels of milk, or the cans of sardines that we once did. And those are really the main sources of calcium intake in our culture. And soy milk, just because it’s white and called milk actually has a lot of phytates in it and can block calcium absorption. Now I know supplementing with calcium has also been questioned, do you? What’s your… I don’t know much. What’s your status on calcium?
Ayla Barmmer, RD 34:05
Yeah. I think it does… it does come down to the form, you know, you want to be using a highly bioavailable, you know, form of calcium, I mean, we do put… I do put 400 milligrams, you know, in the prenatal which I feel like is judicious but does help meet the needs which there’s a balance, there’s such a delicate balance. And it’s also kind of a matter of being in good ratio relationship with the other nutrients too. So magnesium we have at a higher level too – 300 milligrams. So that’s helping balance that. The vitamin D is higher, so that all really helps, and like I said, again, the form of calcium is also important. There are less bioavailable forms that you can use so I mean, we want to get it in from diet but you know, there is a very safe form like calcium malate, you know, easy to absorb. And I think pregnancy… preconception, pregnancy, postpartum, like that’s the time to do a little extra calcium, for sure.
Diana Rodgers, RD 35:01
Yeah. And magnesium, we see that in a bunch of different forms as well. So will you chat about that? Because it’s so many people are just like, oh, multi, great. Boom, done. And it’s not, it’s not always in the best form.
Ayla Barmmer, RD 35:15
Yeah, you know, there are forms that are easier for our body to absorb, and also to utilize. And then there’s also tolerance that comes into effect, you know, comes into play too. And I think about that a lot with a prenatal because, you know, or really any of these supplements, if someone’s not feeling great on them, they’re not really there, you know, it’s very hard to take consistently, and then you’re risking not getting enough of the things that you really need, you know. So that’s important. When it comes to magnesium. I looked at, you know, back when I was formulating this, most prenatals were using the least expensive form of magnesium, which is also the least bioavailable, most difficult to tolerate – magnesium oxide,
Diana Rodgers, RD 35:57
And which has the opposite effect of taking too much iron.
Ayla Barmmer, RD 36:01
Yes, yes. So definitely can have a laxative effect to it. I just, yeah, I have a real problem with that form of magnesium, I
Diana Rodgers, RD 36:09
I can’t even look at it, it just makes me so sick.
Ayla Barmmer, RD 36:12
And to give you… I just have to mention this too. This is another example of where like, you really want a health practitioner, someone who understands that, like the different forms of magnesium behind the manufacturing process, because there are raw ingredients suppliers that are marketing their magnesium glycinate. And it’s actually quite a high percentage of magnesium oxide, you know, so it’s not, you’ve gotta like… you got to really dig into it all to find what you want. So we have magnesium glycinate, which is a very gentle, easy to absorb, and utilize form of magnesium, and I’m confident in it being magnesium glycinate. That’s also important.
Diana Rodgers, RD 36:49
I’m sure everyone else can tell your passion for quality in all of this, which is really great. And again, the supplement industry, I mean, there’s a reason why there’s been labeled sort of snake oil salesmen out there is because a lot of it is very overpriced garbage. So as people are maybe looking for fatty acid supplements or something else to complement what you’re doing… what are some of the other things people consider and some of the brands that you love?
Ayla Barmmer, RD 37:17
Yeah, well, we are coming out with an essential fatty acid supplement a really sustainably sourced fish oil, not easy to find that these days. That’s good… gonna be good quality and not have contaminants that we’d be concerned about. So that’s taken me a really long time to source and we expect that like late spring 2022. So I’m excited about that one. Because I also, I’m also really focused on with this brand, you know, offering like premium level ingredients and formulas, but trying to make it as affordable as possible. Because I don’t have like investors and not trying to meet like, you know, algorithms for Amazon and like all those things to sell the supplements. So it helps me to kind of keep things controlled, price-wise, but that’s my goal with the fish oil too. Is it’s really something that in addition to a prenatal, you’re gonna want an essential fatty acid supplement that has a minimum 400 milligrams of DHA, 200 to 300 milligrams of EPA. You know, I see there’s a lot of algae-based sourced, essential fatty acid supplements coming out. I’ve dug into that a bit. From a sustainability perspective. I mean, it’s one of those things where I’m wondering, you know… a little bit the conversation, like how accurate it is like you’d be someone to dig into that?
Diana Rodgers, RD 38:30
Well, I did… Yeah, I looked into for the book, Sacred Cow, I looked into these claims of veganic farming, where you have algae-based fertilizer, and the greenhouse gas emissions from the production of that are atrocious, one of the worst producers there were and then you have to consider trucking that everywhere and when you can just use animals to graze. Yeah, so it didn’t make any sense at all. But you’ve got these people, especially that don’t have any experience farming, claiming that the veganic agriculture is the way to go. It makes no sense at all. And we know, you know, DHA, you really need to get that from animal source foods. And yeah, algae supplements just aren’t the same.
Ayla Barmmer, RD 39:18
Yeah. And you know, and that was my assessment as well, you know, with that, and so we are looking at fish oil, and I think that’s, I mean, that’s what I recommend. Ideally, I’d love to see, you know, people eating fish, especially during pregnancy, for fertility, pregnancy, postpartum multiple times a week at a minimum, you know, but including things like sardines and oysters. Like you know, so two good servings of fish plus like sardines and oysters and their diet. And there’s the possibility of meeting your needs, you know, that way through food sources, but it takes a real consistent effort, you know, and it’s hard to do and you’ve got to start preconception.
Diana Rodgers, RD 39:54
Yeah, and I live in New England where fish consumption is actually relatively high compared to the rest of the US. And fish is actually my favorite animal protein more than red meat. And I eat it, not every day but almost every single day. But the reality is people in general, I mean, when I post a fish recipe, it’s the least popular recipe possible. I posted for everybody’s own good. Not for clicks.
Ayla Barmmer, RD 40:24
Yeah, so it’s like, well, you can do it, the reality is, you know, we’re not really. So I think, yeah, fish oil supplements the way to go. I mean, we like and we have been recommending in the interim, Nordic Naturals, I think, some problematic things, but it’s not bad. They’re prenatal DHA I love outside of pregnancy. I really love New Chapters Whole Omega, which has a really nice broad-spectrum, you know, fatty acid, essential fatty acid profile, but it doesn’t… you can’t get there for the DHA content and even the EPA really, but the DHA… EPA actually gets too high. DHA is too low when you do that. So what happens with some of the fish oils that are a little more specialized for this stage of life, is you do concentrate down the essential fatty acids that we’re needing more of, so you can get the ratios that you’re looking for.
Diana Rodgers, RD 41:14
Yeah, it’s interesting. I’ve been working with Dr. Deborah Gordon out in Oregon for my own health and I’m approaching the opposite end of the spectrum from the preconception. And I’ve been feeling so much better taking a really high DHA supplement. Yeah.
Ayla Barmmer, RD 41:30
Yeah great for brain health. And yeah, protecting our brain as we age as well,
Diana Rodgers, RD 41:35
As we age…
Ayla Barmmer, RD 41:38
I’m right there with you. I think when we first met, I was like eight weeks pregnant and super nauseous with my first but I’m beyond that now, too.
Diana Rodgers, RD 41:46
Yeah. What kind of tips do you give? I mean, that’s a common problem, often goes away, right at like clockwork, at 12 weeks, often, but not always. And so when people have aversions, especially to things like organ meats or fish, I mean, I have my own list of foods that I like to eat when I’m feeling nauseous, but what do you recommend?
Ayla Barmmer, RD 42:07
Yeah, this is again way… I mean, it’s a reality that there are some things you can do to mitigate it, like I mean, by having your nutrient status be in a really good place, you know, especially B6 levels and continuing to try to take B6, I mean, that can help with the nausea, but I mean, a lot of it is just the blood volume increases, the hormone changes, it’s stuff that cannot be avoided. And so part of it is trying to build up your stores that you can kind of have some flexibility to deal with not being able to eat the most nutrient-dense diet in the first trimester. That can help you kind of skate through especially if you can try to take your prenatal throughout it but I’m also an herbalist you know, and so I like to employ a lot of herbs in the mix and even just I mean ginger, I mean we can think about even just as more of a food. A ginger juice is my favorite thing to recommend because you really don’t have to… you can just take a chunk of ginger, wash it you don’t even have to peel it you throw it in the blender with some water and make like a slurry you know and then you just strain it through a colander and you can, you know, throw it in ice cube trays and I just found doing that… like, adding that to a little bit of water or having a little bit of that concentrated ginger juice was the most helpful thing for me personally and my clients. So, a good concentrated ginger juice can really help. I mean some part of it is… so same with digestive bitters, because part of it is, I think, is more of a like a motility issue like with all the progesterone and the relaxing hormone being produced you just… things are just not moving, you know and so if you can kind of keep things moving motility wise that also can really help. So, Urban Moonshine I believe last I checked, they’re still making their Calm Tummy bitters which has chamomile and ginger and safe pregnancy herbs. And that’s an awesome one for that first trimester and beyond.
Diana Rodgers, RD 43:53
Yeah, I always like peppermint tea, but I don’t know if that’s safe for pregnant and that’s another reason why you want to be checking with a dietitian that is familiar with pregnancy. Is peppermint safe? I forget.
Ayla Barmmer, RD 44:06
It is. I don’t tend to recommend peppermint essential oil. Definitely not peppermint essential oil internally, like really at any point. But yeah, most things as a tea are safe during pregnancy. It’s a low… pretty low volume of herb overall.
Diana Rodgers, RD 44:18
When I’m nauseous for food, I always find that just like ground beef, rice, and salt. It’s like… that’s the only thing I’m craving when I can’t eat anything else.
Ayla Barmmer, RD 44:30
Yeah, really just keep it really simple and not letting your blood sugars drop too low either, especially in pregnancy from not eating. That just like perpetuates the nausea cycle.
Diana Rodgers, RD 44:41
Yeah, and for folks that didn’t listen to the podcast I did with Lily Nichols she’s got the most amazing book on…
Ayla Barmmer, RD 44:48
She does. Real Food for Pregnancy.
Diana Rodgers, RD 44:50
Real Food for Pregnancy. Right. So Ayla where can people find you?
Ayla Barmmer, RD 44:54
Yeah, so on Instagram, we’re @fullwellfertility and we do a lot there for education. Then fullwellfertility.com is the website. I’m also @aylabarmmer_rd on Instagram and my practice is Boston Functional Nutrition, but we are not, you know, not taking clients right now.
Diana Rodgers, RD 45:15
I know I need to get over there and pick up a few things that are over at the office. So I promise I’ll get over there soon. I think it’s easier for us to even do a podcast than it is for us to get together right now just because of life, and how busy you are with your kids and everything. But it was really nice to see you and I hope this was helpful to anyone thinking about conceiving.
Ayla Barmmer, RD 45:37
Thank you for having me on.
Diana Rodgers, RD 45:39
Thanks so much for joining us on the Sustainable Dish Podcast. If you like the show, please leave us a review on iTunes, and don’t forget to sign up for our newsletter at Sacred Cow dot info. See you next time. Thanks for listening
