#315 | The Preeclampsia Puzzle: Misdiagnoses, Misconceptions and Prevention with Author Sarah Thompson

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Well, first off, thanks for having me on again today, guys, I'm really excited to jump on and talk about this topic. And I know we had, we had discussed talking about this understanding pre eclampsia, because I feel like there is a lot of information out there on preeclampsia, but it's also very confusing, because preeclampsia is complicated, and there isn't just one cause, and everybody's journey to preeclampsia looks very different, which is why there isn't just one protocol for prevention or treatment, either, and and so it's something that I'm passionate about. It's something that I've been working with a group of physicians on with the idea of creating, you know, maybe some better research studies on understanding preeclampsia, and coming up with some game plans that and some protocols that maybe help more people with management and prevention. And you are, yes. Sarah Thompson, I am a functional medicine provider who specializes in maternity care, and you are so excited to talk about pre eclampsia that you completely neglected to introduce your fabulous self.

I'm horrible at introducing myself on things. It's okay. Unfortunately, another thing about preeclampsia that I think is really important that we're having this discussion today is because women are getting diagnosed with it when they often don't really have it. There's actually, like, a diagnosis out there and a treatment. It's it's not a technical diagnosis, but it's being used, and it's called pre pre eclampsia, which is not a thing. So, you know, women's birth plans are being completely derailed for this pre, pre eclamptic condition. Like, oh, you're probably going to develop pre eclampsia. So we're just going to take you in now, as if you had it, and treat you. And that's a real problem, and it's based off fear and less understanding of the mechanisms of action, and I feel like a less a lack of respect on the physiology of pregnancy and then the role of nutrition and and this whole kind of functional medicine idea, because in the conventional model of care, they don't Have another way of treating preeclampsia outside of delivery, so that's their default. It ah, this might become that let's just default to delivering a baby ASAP so that we can prevent it from happening. What? That's not true prevention. That's That's just reactionary care versus actually looking into what's going on with this person, and you know, to what you were saying, there's a lot of nutritional deficiencies and a lot of other things that mimic preeclampsia, because of the mechanisms of action that go into pre eclampsia, and the kind of overlap on this dysfunction That presents, like preeclampsia and the dysfunction that is preeclampsia, yeah, and you can really alter a woman's birth experience, and in the care provider's mind, it's basically just having your baby early. I mean, why not? Why not avoid a preeclampsia diagnosis and get your baby out sooner? And they don't even consider what that means for the mother and the baby and the risk of induction. So it's just like another reason to get these moms induced and get these babies born early. And it seems like it's just providers are just running with it. So we are very enthusiastic about, you know, trying to understand when what preeclampsia is, where is it coming from? What is the new science? What are you learning? And how can mothers understand if they actually have it or not? People are constantly asking us, did I have it? This is what my blood pressure was. This is what my protein in my urine was. I didn't even have blood work done. I got diagnosed with preeclampsia. They don't even know, yeah, and there I see it all the time in my practice as well, because a lot of what I do is working with moms who probably had a preeclampsia diagnosis that threw off their birth plans in a previous pregnancy, or even multiple previous pregnancies, with the idea of, let's make sure this doesn't happen again, so that we have better outcomes right again? That's always my goal. Let's improve pregnancy and childbirth outcomes, because it's so much bigger than just that single birth experience. We're talking about, the long term health of the mother we're working with and the long term health of the child involved here, outside of just being born and surviving birth. The game is so much bigger. It's, it's why I think, personally, that maternity care is probably the most important functional medicine or any medical specialty, is because we're, we can be changing the course of health for these two individuals for the rest of their lives, and setting the foundation for that next generation as far as. Preventative care right off the bat. So you know, going into pre eclampsia and etiological causes, there is no one cause, right? We will read studies that say, oh, preeclampsia is a disease of endothelial dysfunction. To me, that's like getting an IBS diagnosis. Oh, you have irritable bowels. Oh, the cells are sad, is really what we're saying here, and it needs to become the why? Well, why are the cells sad? Sarah, what is preeclampsia? How do you define it? Because everything I've ever read about it always comes down to the diagnostics. It's like, Oh, why do this excess protein in your urine and you have a spike in your blood pressure, especially over 140 or whatever they're going to say at the time. What is it? We know what it we know the diagnostics. We know what it can mean to if it's not treated, or if they don't, if the baby, if the mother doesn't deliver the baby. But I never hear anyone doubt what it actually is.

It's like a disease of toxicity. So it's the placenta, the baby, the mom, everything becomes toxic, is really what it is. And it's the why to how we got there, which is very different than somebody who just has gestational hypertension or something else. But it's, it's basically this idea that the the cells of the placenta, the cells within the mom start to build up inflammation and toxicity, and eventually it's, it's, yeah, toxicity is really what the idea comes down to. So preeclampsia becomes this disease that is found in pregnancy or postpartum, like I think a lot of people have this, this the belief that preeclampsia is only a pregnancy disease, but it can be a postpartum disease as well, which is super interesting, because the placenta and the baby are gone then. So what causes preeclampsia at that point? It's an element of toxicity. The mom's body has build up all of these toxins. And when we say toxins, we're not just talking about, you know, environmental toxins. We're talking about the toxins and the inflammation of just life and cellular metabolism and all of these byproducts of chemistry in the body. You know, everything we're talking about when it comes to preeclampsia is biochemistry is really what it is, what happening inside of an individual cell on a massive scale, and how is the mother's body capable of balancing this act. For some people, preeclampsia is a straight disease of the placenta and how the placenta developed. For other people, it's how mom is processing the natural oxidative stress and chemicals of pregnancy. So we have all of these different patterns of pre eclampsia, which is why there's no true definition of preeclampsia outside of we have hypertension, and we might have some elevated liver enzymes that so the liver involvement, we might have some protein urea that shows kidney damage, right? There's a lot of mites in that scenario, but classically, it's hypertension with proteinuria, and, you know, on extreme levels, we can get to what's called Help syndrome, which is a hemolysis type pattern where we're seeing cell death in the body. And that's what we're seeing on that basically on paper, is the elevated liver enzymes, hemolysis, elevated or low platelet counts. I apologize, where we're seeing the death of platelets in the system. So it's a toxicity pattern. It's just, how did we get to toxic levels?

It's a toxicity pattern with end organ dysfunction, right, mainly the liver and the kidneys. So this toxic buildup for whatever the etiology, wherever it comes from, targets the liver targets the kidneys, which obviously, then the body goes into crisis. The reason it gets targeted in the liver and the kidneys is because those are our detox organs, right? Every toxin in the body is going to go through there. And so if there is damage to the liver or damage to the kidneys because of the toxins or dysfunction whatever pathway we're looking at, then they start to malfunction, and they start to shut down, and eventually the whole system shuts down, right? It's it's basically like slowly being poisoned.

What about pregnancy tends to exacerbate whatever toxicity is happening in that particular woman.

It's revved up Metabolism is the simplest way to say that every time you and I take calories and turn it into energy, we're talking basic cribs, cycle stuff. Here we get pollution. We get byproducts of pollution. You can't I mean, even on an electric vehicle, you can't run make energy without reducing waste in some way, shape or form, and our body is the exact same in pregnancy that is revved. We have a lot of toxicity get that gets produced because we're taking single cells and rapidly developing it. That's a lot of metabolic process. We also have tissue damage that's happening. Add that placenta is embedding itself into the. Endometrial tissue, we have tissue damage, tissue damage, we have to clean up, right? So that is an element of toxicity, right? And so all of these things are increased exponentially throughout pregnancy, peaking, of course, in third trimester, when most women are going to get their preeclampsia diagnosis or symptomology. So that's just, it's, it's that build up, and so mom's body has to compensate for that. We have to make sure those cells are nice and healthy and they can detox and they have enough oxygen and they're healthy, and we have to clean out all the the byproducts in and of themselves. This is so interesting, because nobody, this is the first time I've actually ever heard anybody talk about preeclampsia as not just a problem of lack of something, lack in the body, lack of blood volume expansion, lack of magnesium, lack of calcium, whatever, this is also a disease of poor detoxification in a body prior to getting pregnant and during pregnancy, which, of course, is going to be harder if you already have trouble with detox pathways prior to pregnancy. But nobody talks about that.

Oh, and I think it's because we're trying to find one, one cause, right? And deficiency tends to be where we go, right? Oh, you must be deficient in vitamin D. Oh, you must be low in something. That's why we're dysfunctional. But I find that there's just as much excess as there is deficient patterns, if not more. And you can, they can go both ways, because you can have oxidative stress in this excess pattern of toxicity because we have a deficiency in something, vice versa, you can have an excess in something that causes dysfunction or a decrease in function at a cellular level, right? Lots of things, right? When we're looking at that ideology of preeclampsia, so far, we find that there are lots of different things that can cause this increased cellular toxicity or increased cellular dysfunction, you know, I think everybody wants to chalk it up to genetics. Well, genetics might play a little bit into it. For sure, I think you have a genetic predisposition, but that doesn't mean inevitability. You know, take I think blood clotting factors, for example, right? People with blood clotting factors are more likely to have preeclampsia, but you can find a blood clotting factor than 20% of controls as well when you're looking at these statistics. So just because you have it doesn't mean it's going to be there, and that's not the cause. Other genetics we see associated with preeclampsia are like growth factors. There's one called VEGF. Placental insulin growth factor falls into that category. It's out now, one of the biggest markers of early onset preeclampsia is testing this ratio between an inflammatory compound and this placental insulin growth factor, and it's been shown to predict early onset preeclampsia, because if we have low placental insulin growth factor, we know that placenta isn't growing the way it was supposed to in early pregnancy, and now we have dysfunction. Right? Genetically, the genetic issues in the VEGF and ve GF receptors are associated with higher rates of preeclampsia. Progesterone regulates the production of VEGF, so there is a connection there with progesterone in early pregnancy as well. Other what can I ask a quick question on that? What that might potentially mean that women who have trouble with progesterone or low progesterone in early pregnancy or just in their menstrual cycle, in general, in their life in general, which is extremely common, they're going to be more prone to have this lack of the insulin growth factor for their placenta. So it's that combination. It's that combination. And currently, there's no, I mean, currently there's not enough research to say that using progesterone in early pregnancy mitigates and helps with preeclampsia. But theoretically, in the right scenario, it could be beneficial, right? So it's just understanding that mechanism of action, and that's not for everybody, right? That's not the mechanism for everybody. That's just for some people in the right scenario, other genetic things that we've seen with preeclampthia are issues with what's called glutathione s transferase, right, which goes into how glutathione binds to toxins and neutralizes them in the body. Glutathione is our most potent antioxidant, and its job is to clean out a lot of this damage and inflammation that happens just from normal pregnancy. So people who have genetic issues with their ability to use glutathione are going to be at a higher rate of oxidative stress. They're going to have issues with their ability to clean out that natural pollution. Then we have some other ones, like, there's genes within the tumor necrosis family that have been researched, and there's some evidence that there might be a connection there. So the genetic side of it is so much bigger than, Oh, look. Found a gene associated with preeclampsia. There's a lot of different ones that have now been associated. But just because you have it doesn't mean that you're going to get preeclampsia. It means you might have a slightly higher risk based off of the physiology of pregnancy and how this gene works in the body. So that's one aspect, right? It all kind of comes down to how did that place into form in early pregnancy, right? And there's a lot of stuff that goes into that, whether it's the hormonal components, oxygenation of the cells themselves, nourishment of the cells themselves, the immune system responses on mom's side, environmental factors, microbiome is something that's been researched lately that's been super interesting to to see some of that research coming out, because the microbiome is just fascinating, and something that is another topic I would be more than happy to discuss at any point, but there's a lot of not misconceptions, but a lot of lack of knowledge around how the microbiome changes throughout pregnancy, and so, like, the microbiome in the first trimester is very different than the microbiome in the third trimester. And sometimes, like our probiotic supplements and those sorts of things, aren't right for each one of those phases, because the hormones change the microbiome to be specific patterns. We have to have to have a specific microbiome at conception to support or the placental development in that early phase, and then as we get towards the end of pregnancy, we need a completely different microbiome for labor and delivery and how that how that placenta is working towards the end of pregnancy.

Has there ever been any research done on the occurrence or rate of preeclampsia for women who have had antibiotics recently or many times in their life or at a young age, anything like that? Any correlation there?

I haven't read one on that. Doesn't mean there isn't one out there. I just haven't seen it personally.

Yeah, Sarah, you mentioned earlier that preeclampsia doesn't only affect women late in pregnancy. I guess if it's an extreme case, it could happen in mid pregnancy. But you said it isn't only pregnancy specific, but I assume you mean it does only affect women, and it does only affect the perinatal period of life, is that a correct assumption?

Correct? I just mean that you can have, I mean, pre eclampsia can show weeks after delivery, right? For some women, right? And again, it's in this element of tissue damage from the birth experience, and it's they were just on that verge, probably before delivery, where they've just been building up all that own tissue damage and toxicity and birth was the straw that broke the camel's back, but it's not until weeks later, as the body is processing all of that tissue damage, not to mention you have a massive drop in progesterone right after birth. And that's probably some unknown trigger in some women. Possibly it could be. I think one of the other big triggers that nobody talks about is thyroid. I think thyroid is a really big one for prevention and acute hypertension. Particularly, I think that falls into the category of like you were talking you have this potential for pre eclampsia, but you're actually pre eclamptic. And I think a lot of those cases are subclinical hypothyroidism in the third trimester that are getting misdiagnosed because people don't test thyroid, and if they do, they don't have the additional training in endocrinology to understand the physiological changes in thyroid function that happen in the third trimester. There's a lot of controversy. There's a lot of back and forth between, you know, The Endocrine Society, the American thyroid Association, and ACOG on what normal thyroid function is in pregnancy. And most OB, GYN know very little about how the thyroid works in pregnancy. And if you have any sort of thyroid wonkiness, they're going to refer you to endocrinology, right? But sometimes they miss it because they're looking at that range that is very, very not associated with pregnancy. In somebody who's pregnant, I don't think it's standard practice if a woman comes in with hypertension in the third pregnancy to go get a thyroid panel. It sure wasn't. It sure wasn't when I, you know, in my experience, but, yeah, I haven't heard people talking about that either. No, I had one patient in particular, who was just a couple months ago actually, who was medically managed for her thyroid and her blood pressure started to creep up at 36 weeks. And I looked at her blood work and I said, I think it's your thyroid. She was like, Well, I just got it two weeks ago, and it was fine. I said, Let's recheck it right. Things happen that fast. And sure enough, her TSH was higher than it should have been. Her endocrinologist booked her medication and her hypertension went away, but they were already planning for to do an induction, because her blood. Pressure was creeping up, and they were like, Yep, you're gonna get preeclampsia. Let's just go ahead and schedule that induction, because we don't want you to go past that. And all it was was her thyroid meds needed to be adjusted.

Wow. This is part of the problem that we always see, that everyone is very siloed, and there's very little holistic approach to anything. And I think that that's one thing that you're pointing out right now with respect to how a thyroid condition is identified and then addressed. They're not looking at it holistically as it relates to pregnancy. I'd love to back up a little bit, because I really have tried so hard to understand preeclampsia for so many years. And you are not only one of the most intellectual women I've ever known in this industry, you're also the most curious, which I think is your superpower. I think it's your curiosity that gets you to the bottom of all these things. And I just love that about you, and this is why I want to learn all I can whenever I'm with you. So if we can back up a little bit, so what I understand you two have said so far is preeclampsia is a result of toxicity in the body. You went out of your way to specify that it isn't only a matter of environmental toxins, which is something Trisha and I care a lot about, and we've talked a lot about, and we've done like special events on the topic, on our Patreon platform. So I'm assuming that it a first good step is to be aware of environmental toxins. But then the next point that I heard you make is it can be a host of many known and probably still many unknown genetic components, which won't necessarily indicate that preeclampsia will ever happen, but it does potentially increase the likelihood of it. Am I on track so far? Yes. Okay, now, if it's not a genetic factor for a woman, and because we, you know, I don't want women to think, Oh, now I have to get tested and see if I'm at risk. We just want them to empower themselves to manage this. So if only one component is the environmental factors and another one is the genetic factors, is there another component we haven't discussed yet, and what I want to get into is, what can we control to reduce the likelihood of developing this? Everything in functional medicine, I always tell my clients, you know, our goal is control what we can let go of what we can't control, right? There's going to be aspects of things that are out of our control, environmental chemicals. We can get rid of some of those in our world, but there's some of those that no matter how hard you try to get them out, you're not going to get them all out, and that's okay. So we're going to try to control what we can right? And so yes, there are things that we can do, like you were saying, What can we control? Well, nutritional components are something we can control by testing it, looking at things, making sure the body is functioning where it is so, yeah, outside of genetics and, you know, environmental toxins, it's making sure that the body itself is functioning and we have our detox capacities where they need to be, and we're not adding other things, right? And I get like I was saying before, I find that I'm seeing more people doing excess than not doing enough, because we have such availability to these really potent supplements. Everybody's on supplements, and I find that it's probably 5050 let's be honest, what I see 5050 of people not getting the right things, and they're nutritionally deficient in something that's playing into their pattern, or they're overdosing on supplements. Wow, that's interesting. Okay, so can you comment on that? Well, I don't want you to lose your track, yeah, but please make sure to comment more on what it means to overdose on supplements, yeah, water soluble supplements like tell us about that, which you can right? And that part of it comes from the fact that we have done a really good job of making bio available supplements. Bio available means they work directly in a cell. We bypass the rate limiting steps. Do not pass go, do not collect $200 right? We're going right into the cells to do a job. That means we don't have a stop on how much gets into that cell. Therefore it becomes easier to overdose on those, even if they're the water solubles, and we kick them out if you're taking high dose every single day, all day long. Well, eventually you're just going to get overloaded, and you have to stop them to clean it out, right? You're still going to be building on top of that. Other ones we see, you know, and there is a little bit of research on this one is the iron component. Again, this is one of those ebbs and flows where you see almost like both sides, and we've got to really get iron levels Goldilocks before and during pregnancy, because look iron. Yeah, anemia is associated with higher rates of preeclampsia. If we have malnourished blood, we can't get enough oxygen to the cells, therefore, the cells are malnourished and dysfunction happens. Hypoxia is one of the big driving factors of preeclampsia, whether it's this deficiency game not enough blood flow to the cells themselves, we have blood clotting issues, whatever, we have malnourishment on the flip. Side, excess iron is also associated with preeclampsia. So if we go too far on our iron levels, we cause basically iron associated cell death, baroptosis. Iron is toxic, and nobody talks about the toxicity of iron. Everybody talks about iron deficiency, and this idea that iron levels need to be really high for our bodies to function. And I don't agree with that, based off of what I read in the research, pregnancy being a state of inflammation actually seems to perform better at slightly lower ferritin levels. And it's interesting. And when I say that, I'm not meaning less than 30 here, right? And you'll see that and depends on where you are in pregnancy, and if you are, you know less than 30 on a ferritin at 12 weeks, we can pretty much predict you're going to be anemic in the third trimester. But if you're greater than 80, we start to see dysfunction and cell damage. So whether it's gestational diabetes and we're starting to see iron associated pancreatic issues, or do we start to see increased preeclampsia and placental issues? Yes, can I ask a question about, yeah, anemia in the third trimester? I mean, some of that is physiologic. You are actually meant to be slightly anemic in the third trimester. So are we potentially, really over treating women in the third trimester, pushing iron excessively and possibly triggering some of this?

Yes, I think that that is a potential, in some cases now, is that iron supplementation with that ferritin and levels are a little lower in the third trimester, going to cause preeclampsia at that phase. No could it be a straw that breaks the camel's back? Maybe in the right scenario, but it depends on each individual. And I think the biggest thing we see is that first trimester right? There's a reason that iron metabolism shifts so much throughout pregnancy, and it's because iron is toxic. High blood levels of iron create that the opposite that cell death, and first trimester is a really good example of that. Whole game is iron absorption drops to like 2% in the first trimester. So we want low serum iron levels in the first trimester, particularly at that week eight to week 1011, 12 range, when the spiral arteries of the placenta open up and we get this huge burst of blood to our baby, that iron, if we have a ton of iron in that blood as it gets to baby, it can cause toxicity in our Babies, because they can't process that. We need a thinner blood with less iron in it, with more glucose and more calories and other things that that baby is going to need iron isn't one of them, right? Then iron absorption shifts back into normal metabolic rates in the second trimester. In the third trimester, things shift again. And when we're looking at this iron metabolic shift and ferritin levels, and I think that is a good indicator of iron stores, there's a lot of mechanisms at play here, like when we go to third trimester, everybody freaks out about iron levels less when it because it had less to do with mom at that point, because mom should have made the red blood cells that she needed to get her through the third trimester when she was in the second trimester, is that ferritin is going to start getting broken down with heme based iron to give to baby, because baby is going to have to store ferritin for those months postpartum, when they can't absorb iron from breast Milk, they have to have a reserve, usually, like 350 to 400 milligrams, something like that, a stored iron in the third trimester. So we find that heme based iron literally goes directly to the baby, as does the breakdown of ferritin to compensate for the demand of the baby, and or a plant based iron so that not heme iron kind of goes to mom, and we see that mom uses that plant based iron more readily than heme based iron, and in fact, non heme iron absorption increases to about 66% of the third trimester, more than animal based iron, but it goes to mom, and heme based goes directly to baby. So when we're looking at those ferritin levels, and we're trying to maintain these ferritin levels, because they're on that lower side, for some people, we see this interesting shift where if we're pushing a ton of heme based iron, it's not that he based iron is going into storage for ferritin. It's that we're pushing so much to baby that we don't have to break down the stored ferritin to give it to baby, but if we want to change mom's ferritin stores, she's going to do better off of that plant based iron. Does that make sense processing it? I think,

I think if I understood it correctly, what you're saying is, she'll do better on that plant based iron. But in part because what you were saying was, if two. Much goes directly to the baby. The mother's body won't go through the process it needs to in order to metabolize it. And is that linked to the release of the toxins you were talking about?

It would be like iron. True iron overload would be too much iron into that placental cavity, then, therefore calling causing some of that iron base to cell death. And again, it goes back and forth, like when we look at the studies that talk about ferritin as a marker of the inflammation, or in that pre eclampsia game, it's that which comes first the chicken or the egg. Do we have high ferritin because somebody really was hemochromatosis, iron overload, whatever it was, or are we seeing elevated ferritin because of cell death? So as we see cell death, we see that ferritin getting kicked off into the bloodstream, and so it raises those ferritin levels. So it can be a false elevation to some degree. With that, we hear of many mothers getting iron infusions in the third trimester. Is this helpful? Is this harmful? What should they be looking at?

I think it depends on the scenario for some women, and iron infusion is the right choice, because their iron levels are so so low, and we're seeing it systemically. It's not just low ferritin. And we can see ferritin levels dropping to a 10 by the end of their trimester, and that being completely normal for pregnancy, right by the time we're 36 weeks. And then we see a shift as we get prepared for labor and delivery, our baby should have that nice stored iron, and then our body goes back into storing ferritin for mom in preparation for labor and delivery. So at 36 weeks, we should be going up from there, right, going back into that storage mode. But third trimester, it's a breakdown. And I wonder sometimes is we have this, this idea that our body needs to be static, right? Oh, we need our vitamin D levels, for example, to be here all the time. I think we, our body loves these ups and downs, and we have there's all these ebbs and flows that happen in pregnancy. And I think there's an element of normality to some of these ups and downs, right? There's a variation. I think sometimes we need to be here. We don't need to be here, but we need to be right here for some of these nutrient levels. And there's a reason. There's a drop in these things, and I think that this drop in iron levels, to some degree, may be a normal process of the third trimester that we're just not respecting because we really want them here, because we're measuring blood right at the start of the third trimester, when you're saying that they're going to be typically lower, and that's how it should be. At the end of the third trimester, we would expect them to be lower the beginning of the third trimester, we want to have a good reserve that we're going to pull from knowing it's going to drop. The problem is, there's not enough research to say, what did the normal drop like? Unlike some things where, if you look at platelet counts, well, we expect there to be a 20% drop in platelets from the beginning of pregnancy to the end of pregnancy, that's normal, right? But we don't have good measures. Unfortunately, within the nutrition world, of what a normal drop is based off utilization and physiology the time frame. Again, just to make sure everybody understands, because you know, if you're getting 28 week blood draw, your iron levels should be good at that point. If you're getting your blood draw again at what 3536 weeks, that's when you're going to kind of see your lowest point, and then it goes up from there.

Yes, that would be normal physiology, right? Which is why we go as long as if that ferritin is low, but we see that everything else is functioning, okay, then that's the norm. It's okay. That's not bad.

What you were saying about levels being high and low and just respecting the body's need, and we don't have to. We don't have any of the answers yet, compared to what we're gonna know decades from now, just that whole concept of respecting this biofeedback system, like maybe there's a wisdom to why it needs to get low and then whatever it takes for the body to build it up again, is the very beneficial part for us, rather than, you know, the arrogance of the limited knowledge we have today, saying this is where levels should be. I can't help, and I'm not trying to derail the conversation, but I cannot help but think about vitamin K and how newborns are born with, quote, low vitamin K levels. And we've all decided they're just too darn low, but the body has a way of building them up in that first week or so.

Super interesting. Vitamin K doesn't get transferred very well through the placenta to baby, but what does is the blood clotting factors from mom, right? So mom, in the third trimester, should be using all of her great vitamin K to make tons of blood clotting factors, which then she will give to her baby, who her baby will use postpartum as needed to clot their blood as necessary. It's if babies are vitamin K deficient. It's because mom was vitamin K deficient in the third trimester. And it's not true. Vitamin K deficiency, it would be a blood clotting factor deficiency.

So let's go back, because I'm always afraid when we re listen to the episode we're going. All realize we never finished a train of thought, and this is obviously such a rich conversation, we're at high risk of doing that no matter what. But going back, we were making the point about controlling what's in our control and letting go of what isn't. And you made that comment about oding on even water soluble vitamins, which got Trisha and me all excited, and we started asking you a bunch of asking you a bunch of questions. So if we can go back to what your point was about limiting toxic environmental factors, letting go of potential genetic things, where were you going with that point about the risk of oding on vitamins and what we can control?

Yeah, yeah. So I think there's an element of what you can control depends on the individual. And I think it's really important, if somebody did have a pre eclampsia case, to work with somebody who really understands preeclampsia and help them determine, was their case actually true preeclampsia? Did we miss something? I have a COVID lion the other day who got diagnosed with preeclampsia at 16 weeks because she had protein in her urine. She had a kidney stone. Oh, my God, the whole thing. With a case, she had hypertension and she had proteinuria, but she had a kidney stone.

What about liver function? Isn't that an essential component to this, they didn't run the labs. What should they have run Sarah? What should they have looked at next before diagnosing her with preeclampsia and missing a kidney stone?

So, I mean, it was actually quite clear as day in her 12 week panel, she had had it for a while, because it was her white blood cell counts were, what, 1615, so she actually had, I mean, you could see infection in her blood work all day long. But for my clients, you know, it's, it's individualized, that's, that's what sucks. And I always hate when I get this, you know, question like, how do we prevent it? Well, it depends, it really depends on the individual, unfortunately and optimization. And I hate that term, I know it's like the key functional medicine term, but it's all about balance, right? Not too high, not too low, just right. And supplementation is great, but I feel like we're relying so much on supplementation that we're missing the low hanging fruits of diet and lifestyle, you know? I think those are huge, and I think those are more important than supplementing. You're not going to supplement your way out of it, per se, right? So it's making sure you're eating a mix of things, right? We need antioxidants. Antioxidants are our friends, and our antioxidants are going to come from fruits and vegetables for the most part, I think that sleep is really important for prevention of preeclampsia. There's a lot of studies that talk about people with sleep apnea, asthma, a lot of these conditions that regular that affect their ability to detox at night, keep them from getting into deep sleep, or have this element of hypoxia while they sleep, have higher rates of preeclampsia. So that's something I'm always looking for in my clients, is, how is your sleep? Are you able to even clean out the pollution of everyday life outside pregnancy, let alone when we ask your body to do more? So that's something we think about. Exercise again. This is another one of those games of, are you doing too little or are you doing too much? And I think we're starting to see this rate of preeclampsia about in some of our healthy individuals who don't fit the classic preeclampsia pattern, because they're doing too much, they're over exercising. They're not eating a balance. They're doing maybe more high low carb, high protein, and they're over exercising. And that is a recipe for tissue damage, right? Every time we do a big, intense cardio workout or really heavy weights, we're creating tissue damage, and we have to recover from that. If we don't allow the recovery, if we're going every single day for an hour or more a day with intensity, we're going to just continue to build up oxidative stress and tissue damage. And then you add pregnancy on top of that, and you're asking your body to do more. And it's really interesting, because there was a study 2324 when was that published recently, where they looked at women in the military. Women in the military have the highest rates of pre eclampsia at 12% oh my gosh, that's so interesting. Why is that lifestyle? What about the lifestyle? Is it? We don't lifestyle, right? The exercise, the lack of sleep, high stress, it's just high stress, right, emotional stress and physical stress. Diet wise, they have a very standard diet, right? They're getting commissary food. It's the same stuff. So what's lacking? That's the next step after that study. What's the difference? Difference, I think that there is a big stress component to it. Personally, probably some diet. I'm sure they're missing some things in that diet. I'm sure it's not the greatest diet, but yes, ma'am, and are there studies in like professional athletes? Because that would be sort of an interesting comparison. There's a lot more rigor and restriction in the military. And then, what about professional athletes? Are we seeing preeclampsia more in those cases?

So there have been a ton of studies on professional athletes and preeclampsia per se, but there are stories we have, the anecdotal stories of professional athletes who have had preeclampsia or have died from pre eclampsia. We do know that endocrine disrupting, or disrupting endocrine issues are more common in professional athletes. So we do see that it's, you know, a lot of times it's that functional hypothalamic, amen area, PCOS type patterning that we're seeing from that survival is more important than reproduction mindset, where the body is like, Oh my God, we are overworked and underpaid here, so we're just not going to ovulate, because that's just too much word.

What about the male component?

So there are some studies that do link male factor to pre eclampsia, but it's it would go back into that early, early development, maybe the genetic standpoint, and it would be an oxidative stress, inflammation based, DNA base, right? Which goes into oxidative stress, right? How is our body methylating? And how is it detoxing?

And why would the rate be higher for women with a new partner?

There are theories that our immune system is as women in you'll find that there's an element of, how do I say that, like the immune system recognition of the DNA of semen, right, right? And that the longer you've been with a partner, the rate of pre eclampsia actually goes down. If you have a fresh new partner, the rate of preeclampsia goes up. And it's because, and the same thing you'll see the earlier people you know try to conceive in marriage, in a way, if they've waited like the more likely they are to have preeclampsia. This is fascinating, and this is also, this is also why women get bacterial vaginosis with a new partner, because the immune system is responding to that different DNA, the different spur, exactly right? It's a new something in the system, and we have to figure out, Is this friend or foe, and the more they're exposed to it, we see less of an immune system reaction. And you're going to be if you're going to be married for a short interval of time before you decide to conceive, have a ton of sex, like every day, so that you get lots of exposure Trisha.

Trisha, the whole takeaway of the episode was balanced. That's it. It's all about That's right, remember balance, okay, but not when it comes to new sperm. It's not about balance. It's about, well, guess yes, funny. That was a joke. It is. It is a joke. And I'm my response was a joke too. That's very interesting. Sarah, did you complete your point about the things we can control? Because that was ultimately what this was about. And I just want your your whether you did or didn't, so that we can make sure, yeah.

So the things that we can control become diet, lifestyle, right? Those are the things that we have the most control over in our lives, right? So, so that's where I tend to start, right? Supplements, again, to me, supplements are just that. They're supplements. We're not meant to rely on them. You're not going to supplement your way out of generally, a lot of things, right? If the foundation is broken. So we have to work on that aspect of things.

People are going to want to know diet and lifestyle and exercise. A few specifics on like, how many hours of sleep does a woman need? How much exercise should be doing? An upping I know it's about balance, but can you give any guidelines? Yes, but I would say again that depends. Like some people need more sleep than others, but man, you've gotta get that minimum of eight hours of sleep a night. Great. That's a minimum. Women tend to need more sleep than that's just something we see, which is kind of crazy, partly because we have so much to go through. We got a lot of hormones, right? There's a lot of ups and downs in us, and bigger brains and bigger mood. More connections, well anyway, more connections. And it's those neurological connections produce a lot of oxidative stress. That's why the neurological system is one of our most sensitive systems to toxic overload, right? You die because of the lack of sleep, because of toxic buildup, right? That's because you didn't ever pull out that natural oxidative stress, and eventually your organs fell to me, okay? You just convinced me that sleep is the most important modifiable factor in the prevention of preeclampsia, right there?

Yep, it is one of the biggest ones, in my opinion. And it gets to be a really hard one in pregnancy, because some people have insomnia in pregnancy, and then we're seeing that buildup of toxicity slowly because they cannot sleep to save their lives. Yes, so then we have to fix the sleep. Well, why aren't you staying right? Pregnancy is stressful, right? There's a 500% increase in cortisol throughout the course of pregnancy, at the end of pregnancy, right through, through labor and delivery, our body shouldn't know this is happening thanks to elevated other hormone levels, right? Things like DHEA and progesterone, right? Those should help balance and let us not even know that these things are happening. So if we have insomnia, insomnia, for a lot of people, is their body saying, hey, time out. I'm feeling the stress. Why am I feeling this stress? I can't sleep. I gotta be on alert. Something is wrong. So if somebody is coming in with insomnia, and it's not just I'm restless because my hips hurt and I can't get comfortable, and it's more of an anxiety based insomnia, something we have to remedy, because now that person is already showing signs of toxicity, showing signs of that physical anxiety, and we can't even recover from it because we can't sleep. How do you help those women? Sometimes we look at progesterone, sometimes we're looking at other aspects. Sometimes we're looking at antioxidant support for them, there are some interesting studies on antioxidant support in the treatment of preeclampsia. Now, again, none of it's definitive, right, but it's really interesting work that we're seeing when we're looking at like an acetyl cysteine, Alpha Lipoic Acid, some of these antioxidants, and using those to start to reverse some of that preeclampsia, inflammation.

Can I ask about glutathione? Because I hear women talking about taking glutathione, and my understanding of that is it's very poorly absorbed. You can't really take a pill and get glutathione that way. So, and that's a very powerful one of the most powerful antioxidants. How do you get more glutathione in your life? So this is an interesting one, and this is where I say I think we're overdosing on our B vitamins a lot for some of these people, because not everybody needs methylfolate. And I am going to be one of those people in the functional medicine world, who kind of poo? Poos methylfolate? I'm sorry, okay, we need a whole other episode. Now I know, I know, because it's all about homocysteine to me, and homocysteine is what becomes our glutathione. And with methyl folate, we are bypassing the rate limiting steps and going right directly to bioavailable. Throw it into the cell. Let's turn homocysteine into methionine into Sami and go that way. So if we have two pathways of homocysteine going this way into SAM e and this way into glutathione, if we just keep pumping methylfolate in here and we're just revving this cycle. We don't leave enough to make glutathione. And interestingly enough, the studies that we see on low homocysteine, which there aren't many of them, but I tell you what, I talk to a lot of my functional medicine colleagues, and we're starting to see hypo homocysteinemia More and more in clinic. They're neurological, they're oxidative stress type symptoms, and I'm wondering if we have over thought MTHFR, because not everybody needs methylfolate support. Some people do, but not everybody. And if we blanket statement people with super vitamins, because that's what we're doing, right? We've, we've synthetically made a vitamin that bypasses rate limiting steps, so it just goes directly to work, which is fantastic for people who need it, but not for people who don't remember just giving it to everybody, and we're doing it long term, but I think what we're seeing is a reduction in the production of glutathione in people who are on it long term.

So would you recommend that maybe women take their B vitamins A little less regularly, maybe three times a week instead of daily or shorter term. Or it's specific to the individual, of course, so specific, so specific. And I think that the best way to look at that is to test the homocysteine. Is it too high, or is it too low? And if we look at this, is another one of those. You know, Goldilocks thing. Things is we see high homocysteine associated with higher rates of preeclampsia, right? So there is a group of people who, if we have high homocysteine and we do need that methyl folate or choline, I think choline is more important for preeclampsia prevention than folate is then, yes, there's a group of people who would benefit from doing a methylation support because they have high homocysteine. But with that high homocysteine, is it really a methyl folate issue, or do we have other issues that are causing that homocysteine to sit heavy in the system? Do we have a CBS issue that's preventing it from going into the first step of making glutathione, and that's why the homocysteine is elevated? It's not a folate issue. It's not true. Mt. HFR or other issues that might slow the pathway. So there's a lot of lot of moving pieces there, but to me, homocys, if you run a homocysteine, that's one of the easiest ways to know where you fall, ish in that in that realm. So glutathione, going back to glutathione, glutathione is one of these supplements, like you said, that isn't very well absorbed, so the best way to support it is to help your body make it in whatever way that is an acetyl cysteine is a precursor to glutathione, and acetyl cysteine is very well absorbed. It's got about a 12 hour half life, and the body, you know, usually taking it twice a day, gets you a little bit more effectiveness, but it is very well absorbed, and a portion of that will become glutathione. NAC also works as a little bit of a chelating agent, so it can help to bind to toxins in the body and help maybe pull those out a little bit. So there's a lot of benefits to the NAC that theoretically may help with preeclampsia at an acute level, other things that go into glutathione is the amino acid l cysteine. L cysteine is, and has been shown in in studies, that taking l cysteine helps to boost natural glutathione production because it's part of the structural compound of glutathione. And then, if we're talking about the gene, the GST gene, that was associated with preeclampsia, which is how glutathione functions, and in the body, that requires selenium. So selenium could have a huge connection to the function of glutathione. So making sure we're getting and b6 b6 when it comes to homocysteine, breakdown into the next stage, steps into glutathione production. We need b6 to do that, and it's really interesting. If you look at studies on like miscarriage, for example, we find that, you know, 40% of miscarriages can be related to folate issues. Well, another 40% can be associated with b6 issues. And if you have both, the risk of miscarriage is 310% because we're hitting both sides of that homocysteine pathway. Right? We're we're deficient in our ability to regulate Sammy, but then we're also possibly deficient in our ability to make glutathione, so we can't even clean up the oxidative stress from the the function of Sammy. So we have a double whammy.

And would homocysteine be the test to determine that it's one of them. Yeah, if we have somebody who's having miscarriages, I run it all. I'll look at a homocysteine I look at there'd be 12, there'd be six. Usually I'm running, possibly some genetic testing too, to make sure I'm not missing something. Sarah, if we can come back to Trisha question that we got into this interesting conversation about sleep and glutathione, but you were starting to list some of the basic things we all have to make sure we're doing for optimal health. And what, where were you going after sleep? What were you going to say next that everyone could be empowered to do?

Yeah, I think diet becomes one of our biggest things that we can control, and currently, the studies tend to show a specific dietary pattern to be more protective against preeclampsia, and that tends to be the Mediterranean diet. And I think the Mediterranean diet works well because it fits so many different aspects, and there's a lot of factors of the Mediterranean diet that I think help with preeclampsia, but and there's a lot of different variations of the Mediterranean diet, obviously, but I think it's a good base for people to start with, because it's going to be high in things like monounsaturated fats. And there's some really cool studies on fatty acid balance and endothelial dysfunction. And I totally recommend everybody go read the studies by Nancy Hart on this where she really talks about fatty acid balance and how we may be doing too much polyunsaturated fats, not enough cholesterol in the diet as a precursor to preeclampsia, and balancing that with monounsaturated fats. Mediterranean diet is also high mineral and antioxidant, really, and and a lot of these trace minerals that we talk about, manganese, molybdenum, selenium, they all play into different antioxidants, whether it's glutathione or superoxide dismutase. Is another one that we didn't touch on. But I think the Mediterranean diet is a sneaky way to get a lot of these minerals through legumes, nooks and seeds and then seafood. Right? Typically, the Mediterranean diet is high seafood, and other diets that we see being beneficial for preeclampsia prevention. There's another one called like the new Nordic diet, which is high seafood and vegetables. Again, we're reducing inflammation from a cardiovascular perspective, but we're also hugging the thyroid in a indirect way by eating a lot more seafood, because that's where we're going to get our you know, iron, iodine, selenium, all of these great mineral zinc, that copper that go into Floyd supported thyroid is a connector here, to some degree, and other things we see in these diets are going to be high, like vitamin E, vitamin A, some of these. Other antioxidants that are more fat soluble, that really play into progesterone production. So Mediterranean diet, to me, is an easy base and it's, it's a moderate diet, right? It's not like going low carb, high high protein, like a carnivore diet. You're not going vegan. It's, it's really a balanced midway diet. So I think diet is a big, big, controllable factor, like you guys talk about a lot, the environmental chemical exposure. That's something somebody can control to some degree, kicking out ones like the phthalates, kicking out parabens. You know, those guys get out of your system within a couple of weeks. They have a really short half life. So once you remove them, they're kind of good to go. Other ones are going to be harder. So work with the ones you can control and let go the ones you cannot control, right? So those are kind of my big things. Exercise, to me, is another one. We want people exercising, right? It's a it's a goldilock. Not exercising enough increases that risk of preeclampsia, but not giving yourself recovery between your workouts. It also, to me, just as detrimental. So if you're somebody who really fuels off of exercise, take your high intensity exercises and do those a couple times a week, and fill in the gap with low intensity. Do some more yoga in between. Give yourself some more recovery exercises, preparing for pregnancy from that exercise perspective, is very different than maybe what you're used to, right? For people who are really into bodybuilding and kind of those more intense patterns of workout. So balancing the workout aspect is something people can control a little bit too. So those would be my top ones. Those are great.

Okay, before we wrap there's just two things that I must ask, because the first one is around aspirin. Mothers are, every day told that they should take aspirin to prevent preeclampsia. This is a big topic, and we don't need to go into a lot of detail. We can save for another episode, but just give us your your quick skinny on aspirin for the prevention of preeclampsia. And the last question would be, for a new mom going to a traditional OB practice or midwifery practice, can you give them a few lab tests that they absolutely need to ask for that are going to be outside the standard OB panel?

Yeah, so real quick on the aspirin game. So if we look at statistics, we'll find that aspirin seems to be effective at reducing pre eclampsia in about 18 by eight to 14% that's not that much, right? But it's kind of the best they got. And if we look at the number of cases that are associated with, maybe, like hypoxia and blood clotting. I think it's more hitting probably some of those people with blood clotting disorders that are undiagnosed. It's probably about the same, right? That's those are the people we're helping there. But that's not everybody. That's a small, small percentage. Everything is a risk versus benefit analysis, and I can't tell anybody not to do something that their doctor told them to do, right? But I do think that it is important, and this is why I'm a huge proponent of non blanket treatments, right? Is because you can give everybody aspirin, but that aspirin isn't going to help everybody number one, and maybe it actually harms them, right? Maybe it actually causes them to bleed more because they didn't have a blood clotting disorder, and now we've got other issues, sub chorionic hematomas, I don't know, other blood bleeding issues, because we gave somebody aspirin and it didn't fit pattern, but it's going to fit the pattern, and maybe about 14% of people, so that's not that much. So that's my take on aspirin. I think there's other things we find that adding calcium to aspirin actually makes does better. We also find that alpha lipoic acid, adding that with the baby aspirin, tends to also be more beneficial, right? Are there other things that we can use? I have, I get this question a lot. Are there alternatives to baby aspirin that are natural, not really, right? We have nothing in research that says, yes, if you do white willow bark, that's going to be just like aspirin. So you can do that instead. No, we don't, right? So it's the best they have in a conventional medicine world. Does it really do magic? Not really. It's, again, about eight to 14% is what we see it statistically. But if you are somebody with a known blood clotting disorder who potentially had preeclampsia in a previous pregnancy, might be a good idea. Otherwise, probably not. And I would say, if you're somebody who had preeclampsia and a true preeclampsia in a previous pregnancy, get tested for blood clotting disorders. Factor five Laden is a big one for this, and that can be a genetic test for the f5 genetic mutation.

I have a lot of opposition to the blanket recommendation for women to be on aspirin every day. It just sounds insane to me. I pull my HypnoBirthing classes, and sometimes 40% of the women raise their hands that they. Put on it, they were just put on it. And I resent that all of them are told there's just no risk to it. I mean, there's no way there's zero risk. Whether that risk has been appropriately tested is another question, but to just do this blanket approach of having women on a daily aspirin for almost a year just sounds absolutely insane to me, yeah. And there was a research article that did say being on baby aspirin increases the risk of postpartum hemorrhage. There you go. How could not, if it has an effect on the blood? How could it not in great doses have an effect? It's just common sense. So the way, they're just recommending it to women now, almost like, let's not take any chances. This is what I don't like. Let's not take any chances. Let's just put you on daily aspirin. To me, is just like, let's not take any chances. Let's just induce you with Pitocin. Now, let's not take any chances. Let's just give you a C section to ignore that there are chances being taken is where I think the injustice is happening. And it's not just in preeclampsia. It's now for miscarriage, it's now if you're age over 35 it's just keeps expanding what they're using baby aspirin for, blanket recommendation for everyone. Okay, so final thing can you please just give us some labs that women can ask for if they're going to their traditional provider who is not going to be running these what should they ask for?

So good basics, I always say with that 12 week OB panel, have them run a comprehensive metabolic panel, ferritin, iron and binding capacity. It's the basics, thyroid stimulating hormone and a total t4 not a free t4 we could talk about thyroid all day long, but we find that total t4 is more accurate in pregnancy than a free t4 let's see here, vitamin D would be another one to check. And then progesterone. Now most OBS are not going to know what to do with the progesterone level, so it's making sure that you have that information. Like again, as always, what are you going to do with that information? Is always what I tell people, right? How do OBS not know what to do with progesterone levels when it is like the main player, the number one hormone of pregnancy? How do they not know that? Because they haven't been told what to do with it. And there, again, there's not a lot of research evidence to guide them into what to do and what is normal for those different areas, or those different to gestational ages, for those progesterone levels. So there's a lack of knowledge in their world because there's a lack of supportive research for them. If we look at the studies that talk about progesterone, most of them don't even measure progesterone. They just say, well, we gave them this and you it didn't do anything well, we didn't know what their progesterone level was. Maybe they didn't need progesterone. Maybe you actually caused more harm than good because you gave them progesterone and they didn't need it. Everything's a balance. So that's part of the problem when it comes to progesterone within the the OB world, they're doing the best they can with what they've been given, and they haven't been given much. You know, I think when we think about pre eclampsia, it does seem all doom and gloom, right? And like, oh God, there's so much going on here. I don't know what to do, or maybe I can't even prevent this. But, you know, all of the organizations tend to agree that 80% of all preeclampsia cases could be preventable. That's a lot of cases that we could prevent by looking at diet and lifestyle, whether it's the sleep, whether it's their stress levels, whether it's the diet that they're consuming, those things alone may reduce the risk of preeclampsia significantly, and those are controllable factors. So that's, to me, a positive thing, right? And I think my goal when I talk about preeclampsia, or I coach people on preeclampsia, is to help them differentiate each individual so that we can get more people in that 80% reduction category by focusing on their specific needs and what they need and how their body is functioning versus, here's my blanket protocol, maybe I'll get 50% of you. Maybe I won't. So the more people who kind of fall into maybe, I mean, again, I think functional medicine is the future of medicine, because the idea is to connect all these dots, not just find that one cause and do one treatment for everybody, it's, how does your sleep pattern change your risk? How do your How does your dietary pattern reduce your risk? Right? All of these things together. So for people who are out there looking, you know, try to find a functional medicine provider in your area that has a has a focus on pregnancy, does have some fertility, and there's a lot more popping up. I know when I started 20 years ago, there was no one, right? I do free phone calls. So if people are interested in knowing Hey, like this is how my case went, what do you think I should look. At I do free phone calls. I will do a free 15 minute phone call. I can't give medical advice on that call, but I can say, here's the area I would start looking based off of your history. Or I don't even think you had preeclampsia. I think you had a beach 12 deficiency, and B 12 deficiency mimics help syndrome. So I can do that right. And again, I'm sometimes limited, but we try right to get everybody in who wants to do a call. And if you had pre eclampsia in a previous pregnancy, you might need a couple years to recover and get your body in a place before you try to conceive again. It's not a quick fix. You didn't get to that point overnight, and so it doesn't it doesn't happen overnight, but it's possible.

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