Transcript: EP 277 – Everything to Know About Prenatals with Julie Sawaya

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Dr. Taz: Welcome back, everyone. Welcome back to another episode of Superwoman Wellness, where we are determined to bring you back to your superpower itself. Again, a topic I wish I had my hands on when I was having my children, who now, by the way, are 13 and 14. That dates me, but we won’t get too much into that. Joining me today is Julie Sawaya. She is the co-founder of Needed, a perinatal nutrition company focused on optimal nourishment before, during and after pregnancy. Julie and her co-founder Ryan, both lifelong nutrition nerds met on their preconception journeys and were shot to realize through nutrient testing that they were hugely deficient and key prenatal nutrients. They dug into the research and realized that they were far from alone. And, I can attest to that just from practice as well.

Dr. Taz: 97% of women take a prenatal. Yet 95% are deficient. We’ve got to break that stat down in just a minute. Most prenatal vitamins are designed to meet bare minimum needs, leaving mama deficient after giving so much to grow a healthy baby. The two teamed up with a group of perinatal nutrition and health practitioners to redesign the perinatal vitamin from the ground up and deliver quality nutrition information to all families in the perinatal stage. Welcome to the show, Julie, so glad to have you here.

Julie Sawaya: Yeah. Thank you so much for having me. I’m excited.

Dr. Taz: Well, and I wasn’t lying I was just starting out my integrated medicine journey really because of my own health when the children were conceived, quite honestly, everything was started at the same time, the practice and the two kids. And, I was nutritionally very deficient so much so that it impacted my mental health. Probably their health indirectly. And, that’s a story for another time. But didn’t know, I felt like I knew a lot back then and looking back, I’m like if I had only known all the things I could have done could have taken to really optimize my own personal nutrition. I wonder if the whole experience of having children and being so stressed in their early years would’ve been completely different. So, I’m assuming that something that you found too, you talked about the statistics in the intro here. Tell me about what and sort of intrigued both of you to go into this field and really dig into perinatal nutrition?

Julie Sawaya: Yeah, well, I come from a family of MDs and I’m sort of the nutritional black sheep in the family. I’ve had a passion for nutrition my entire life. And, truly, it’s not an understatement to say that I was shocked when I realized that I had huge nutritional deficiencies and at this time, and this is back probably about five years ago. Many of my friends and Ryan, my co-founder’s friends were starting their families. And, a lot of them were having what I would call sub-optimal experiences. Not feeling well during pregnancy fertility challenges, high incidents of miscarriage, postpartum, depletion and all of the impacts that can come with that.

Julie Sawaya: And, it was really, really surprising to us, both that we were really deficient given how much care and attention we put in our diets and also how much nutrition was lacking from the entire conversation around how to set up a woman and her family for optimal health in this, what is really the most I view, as a pivotal life stage.

Dr. Taz: Oh, totally.

Julie Sawaya: Where you have the ability to impact not only a mom’s wellbeing, not just during pregnancy, but for the years thereafter, but also a baby’s wellbeing. And, those of us who have had daughters, it’s kind of a fascinating step, but it’s true that the follicles that will someday become your grandchildren are formed when your baby is in utero. So, it is an intergenerational time where nutrition as a backbone of optimal well being comes into the picture. And unfortunately, it’s also just so common for women to hear, “Take any prenatal. It doesn’t matter, they’re all the same.”

Dr. Taz: Right?

Julie Sawaya: And, if you get any nutritional advice at all, it’s probably that you should look for a prenatal and yeah, quality doesn’t matter and here is a short list of foods to avoid. And, that’s where the conversation ends. And, it’s not for lack of well intended practitioners, but it’s simply a function of the fact that the average, most women in the US are seeing an OB. The average OB visit is seven minutes long and there’s so much to cover in that appointment. It’s really difficult to get into a robust conversation around nutrition, not to mention many MDs and again, I say this from a place of utmost respect for MD profession, but many MDs aren’t trained in nutrition to the extent that a registered dietician or an integrative medicine practitioner has been.

Julie Sawaya: And, so it’s often not emphasized as part of the kind of what to do during preconception prep during pregnancy, during postpartum, simply because the knowledge may not be there to the full extent that it can be utilized based on what we know from the clinical research and from those who test nutrient and hormone levels day in and day out.

Dr. Taz: I agree wholeheartedly. And, it’s interesting. It sounds like you found out your own nutrient deficiency from just going and getting tested, correct?

Julie Sawaya: Yeah. So, through at home nutrient testing, kind of at the beginning of that being a wellness trend, and since then, I’ve fortunately found a practitioner who is totally on board with testing nutrient and hormone levels regularly, but it can be hard to come by. Sometimes women really have to advocate for themselves or go through an alternate channel than more of the mainstream healthcare system to get that testing, even something as ubiquitous as vitamin D testing can be hard to come by with a primary care provider.

Dr. Taz: Yeah. And that’s the experience that I think, with our practice, I’ve been in practice in the integrative world for about 14 years now. And, that’s been the experience over and over again, still to this day that there’s not a conversation around nutrition. There’s no education around nutrition for us as doctors. Most of us know we’ve had to go out personally and pursue it and try to understand it, or we’ve had our own stories of things and that’s why we know about it. But, I will tell you just from practice, looking at these numbers and levels day in and day out on so many women, in a percentage of them being in those sort of perinatal preconception post concept phase, there are some pretty significant deficiencies and those deficiencies contribute a lot to what we’re calling postpartum depression and what we’re calling pregnancy related nausea.

Dr. Taz: And, like all these conditions that we see over and over again, and associated with pregnancy in the postpartum period can be rooted in nutrition. And, I think that’s what’s so frustrating is that we just need a lot more conversation around it. We need a lot more delivery, we need a lot more awareness, which is why I was excited to bring you onto the show. So, for anyone out there listening, who has someone thinking about getting pregnant, or you might be pregnant yourself or planning your family, wherever you are. We have so many different viewers on the show that I think it’s important to spread this message that it’s really important pre conceptually, to understand where your nutrient levels are. Not just for you, by the way, but also for your partner. And, it’s also very important to understand and track those through pregnancy and in the postpartum period to bring you back up to your optimal self.

Dr. Taz: And, this is not some brand new novel idea, right? Chinese medicine, aggravated medicine, they were incredibly insistent on the quality of nutrition in the preconception period, in the pregnancy period. They have broths and soups and teas and potions and all the stuff that they use to really bring a woman into her nutritional fullness, so to speak. What inspired you or what have you found would be a better question? What have you found are the most common deficiencies that women today are facing when they’re getting ready to have a child? And they’re thinking about their overall new nutrition?

Julie Sawaya: Yeah. So, that’s a great question and I’ll try to distill it down. The short answer is nearly every nutrient that is critical for pregnancy, we are not getting enough through our diet. And, the primary reason for that is that our soil quality isn’t what it used to be. Food takes longer to reach our plates than it used to be. So, the food that we’re consuming starts out more depleted than it once was. Many of us aren’t eating a completely optimal diet during pregnancy. And, then there’s also the real challenge of many of the foods that you’re told to avoid during pregnancy are those that are richest in some of the key nutrients that are actually really necessary. So, it’s a confounding problem, but some of the nutrients I would highlight are vitamin D is a really important one.

Julie Sawaya: The clinical research is pretty clear that upwards of 90% of women are deficient in vitamin D. We actually offer an at home nutrient testing kit to test your vitamin D levels. And, we find through the data of women in the perinatal stage, who’ve tested their levels that this is very much true, even among health conscious consumers with a skew towards those living in California, where we have abundant sunshine, much of the year, many of us are not needing our need for vitamin D. So, that’s a really critical nutrient vitamin D is commonly found in prenatals, but you’ll often find it dosed very, very low. The latest clinical research suggests that 4,000 international units is an optimal dose. That’s the amount that is needed as a baseline to avoid deficiencies. So it’s really, you can think of that as like a minimum optimal dosage. There are some that will require more than that, especially if you start out very depleted.

Dr. Taz: Mm-hmm (affirmative).

Julie Sawaya: But, our prenatal includes the full 4,000 IU dosage. And, that’s roughly four to five times what you’ll find in a standard prenatal vitamin.

Dr. Taz: Got you.

Julie Sawaya: Another key nutrient I would focus on is Choline. So, many of us know the importance of a nutrient called foliate. Sometimes it’s referred to by its synthetic form, folic acid, and folate is really important for a baby’s neural tube development and brain development. Choline plays a really critical role in exactly the same functions. And, there’s been an established recommended amount of Choline since the nineties. Those recommended amounts are usually referred to as RDA levels. And, I think of RDA levels as being the minimum amount that’s needed to avoid disease condition. That’s really what the paradigm is all about. Like, what amount of vitamin C is needed to avoid scurvy? What amount of Choline is needed to avoid a serious deficiency, et cetera.

Julie Sawaya: So, the RDA for Choline in pregnancy is 450 milligrams. For breastfeeding it’s 550 milligrams. And this RDA has been established for, as I said, about 20, 30 years now. We have the first prenatal vitamin on the market, which is rather shocking, 30 years after the RDA was established. Our prenatal was the first one to dose at the full RDA level. And, you might wonder why that is and really it comes down to how many prenatal vitamins are dosed to meet just the very bare minimum needs. They’re designed to be palatable enough for a consumer to take one, one pill a day, maybe two or a gummy vitamin. And, some of the more important nutrients for a prenatal like Choline, which has deficiency rates in the perinatal population of 95%. It’s a bulky nutrient.

Julie Sawaya: So it’s really, really difficult to fit a meaningful amount of Choline into a one a day prenatal or a handful of gummy vitamins. So, if you find Choline on a prenatal vitamin label, it’s often dosed at one 10th of the RDA or even less, that’s so low that it’s effectively not meaningful. It’s less than about a third of one egg yolk, it’s 55 milligrams of Choline so a very, very small amount. Of course, any is better than none at all, but we’re talking orders of magnitude of difference between what the optimal level is and what is found in most prenatal vitamins.

Dr. Taz: And, I think it’s really a good argument in general, right? Like with supplementation, the standard thing is like, “Oh, well, we don’t need to supplement our food is good enough,” but our food no longer has the quality due to the soil content of what it used to have. And, so you do need to supplement and then supplementing at the bare minimum, doesn’t really cut it. And, for those who might be listening and who don’t really understand Choline, why would you say Choline’s important in this sort of perinatal, preconception and pregnancy phase?

Julie Sawaya: It’s really, really important for a baby’s brain development. That’s the primary function. That having adequate Choline levels is proven to impact things like children’s attention span years later. It’s one of those super nutrients, along with folate, along with Omega three, that is just fundamentally important to the neuro development of a developing baby. And, it’s so important that it’s just not one that you want to mess around with. And, I think it’s one of the most shocking ones when you look at prenatal vitamins and we’ve looked at just about everyone on the market, it’s just one of those that’s particularly disappointing because of how important it is.

Dr. Taz: Goodness gracious. Okay. So vitamin D, Choline. What other, maybe give us two more that we’re missing when it comes to good nutrition in those early years of preconception and pregnancy?

Julie Sawaya: Sure. So, another one I love to focus on is B12. B12 is important for so many different functions. It’s important for baby’s DNA synthesis. It has a huge impact on maternal energy, which is such a challenge during pregnancy and postpartum. And, so much of what contributes to that feeling of depletion is a lack of energy, a lack of B vitamins. So the RDA, this is one where the RDA level is set very, very low it’s set at 2.8 micrograms. It’s well established through clinical research that RDA is at least three times too low. So, there’s clinical research showing that 10 micrograms would be more sufficient than the current RDA so we know the RDA is wrong.

Julie Sawaya: What we find in clinical practice through a vast network of perinatal nutrition and health practitioners that actually test B12 levels regularly is that it takes about 70 to a hundred times the RDA to get to sufficient levels of B12. So, what we’re talking about in terms of dosage is around 200 micrograms. So that is very, very different from what you’ll find in most prenatal vitamins. What we look for when it comes to B12 is usable forms that your body can readily utilize. The most common form of B12 found in supplements is Cyanocobalamin. So, it’s a form that’s literally attached to a cyanide molecule. It’s not something that we necessarily want to be consuming during pregnancy, if we can avoid it.

Julie Sawaya: And, the more usable forms of Methylcobalamin and Adenosylcobalamin, these are two forms that we love to see in a one-to-one ratio, because the Methylcobalamin is excellent for, especially for of those who have trouble processing nutrients. If you have the MPHFR genetic variation, that’s the form that you want to be including to make sure that your body can actually absorb the B vitamins that you’re consuming. And then the Adenosyl form is awesome for energy. So, we use a combination of the two, and I would say that this is probably the number one reason why when people switch from a generic prenatal to Needed, they notice immediate and energy but-

Dr. Taz: Wow.

Julie Sawaya: It’s just so noticeable because you’re going from taking almost no B12 to taking a really meaningful amount and the effects are really quite rapid.

Dr. Taz: That’s amazing. So D, Choline, B12. Did I miss one? What was the fourth?

Julie Sawaya: Yeah, so a fourth one, I would say active vitamin A, and this one can be a little bit controversial. There’s two forms of vitamin A, and this is true for most nutrients. There’s usually an inactive form and an active form of most nutrients. Some nutrients have many more forms than that, but in the case of vitamin A, we typically look at it in terms of the inactive form, which is Beta Carotene. That’s the kind of vitamin A you’d find in carrots or sweet potatoes. It’s usually pretty abundant in a plant-based diet. And, then there’s an active form of vitamin A that’s known as retinyl palmitate. Retinyl palmitate it’s related to retinol. A lot of women know to avoid retinol in pregnancy. There are concerns with any fat soluble, nutrient vitamin A, D, K, vitamin E Omega threes. There is a potential worry with the way your body stores these nutrients that you can overdo the amounts.

Julie Sawaya: So, and there are valid concerns about super high levels of vitamin A in the active form, but what that’s led to is the industry largely moving entirely away from active forms of vitamin A and the conversion from the inactive form of vitamin A to the active form is so, so, so low that if not consuming active, vitamin A from your diet through things like beef liver, that’s a really high quality source of active vitamin A. Other animal food based products can have active vitamin A in it. If you’re not consuming many of those in pregnancy, which most women are not.

Dr. Taz: Right.

Julie Sawaya: Who are very likely to be deficient.

Dr. Taz: Hmm.

Julie Sawaya: So, when it comes to vitamin A, we suggest looking for a mix of the Beta Carotene inactive form, and the active form of Retinyl Palmitate. The dosage amounts are small. So, we’re talking 750 micrograms of both of them. We use a 50/50 mix of the two to avoid overdosing on the active form, but just to ensure that you’re getting enough. So, we’re always looking for sufficiency or an optimal amount and avoiding it entirely is not optimal, but that’s the most common thing that you’ll see in a prenatal is just the Beta Carotene form so that’s one to focus on.

Julie Sawaya: There’s a lot of literature showing the importance of vitamin A for pregnancy, especially the active form. It’s really, really important. And, one that unfortunately most of us are just not getting, through either our prenatal or diet.

Dr. Taz: Is the research, yeah because I haven’t checked more recently, but is the research catching up with pregnancy related symptoms and postpartum related symptoms and nutrient status? Is there any… In practice, I can tell you methyl folate deficiency, methylB12 deficiency, Omega three deficiency directly correlates to postpartum depression and fatigue and all that other stuff. The nausea, the vomiting kind of, some of that really does correlate a lot again to vitamin A deficiency, B deficiency we see that. What about magnesium? I don’t know if you’re seeing much with magnesium, but is there any new research? I haven’t looked critically in the last year or two, but is there any new research tying nutrition to the state of pregnancy and the state of postpartum health?

Julie Sawaya: Yeah. That’s a great question. I would answer this by saying there is an abundance of research that shows the importance of nutrition when it comes to pregnancy outcomes, but there’s also such a lack of focus on research generally in women’s health, but also for pregnancy. There’s obvious potential ethical questions when it comes to studying pregnant women. So, while the research is robust, we find it so important to supplement that research, the clinical research that’s available, with in-practice experience. And, that is what I think most companies do. It’s great if companies are just looking at the clinical research, not just relying on an RDA level, that’s going to get them so much further ahead than the current state of prenatal vitamins. But, the next level on top of that is really layering in what is the in practice clinical research showing or clinical experience rather showing that women need?

Dr. Taz: Yeah.

Julie Sawaya: And, then generally what’s lacking in the space is the combination of the two.

Dr. Taz: Mm-hmm (affirmative).

Julie Sawaya: We’re really excited later this year to kick off a clinical study that’s looking at a cross section of women all throughout the US who are taking a range of different prenatal vitamins to really, in a consolidated way, look at nutrient status in a pregnant population. You are likely familiar with a lot of the research it’s often done on one nutrient at a time.

Dr. Taz: Yeah.

Julie Sawaya: So, let’s look at, in isolation, vitamin D status. Let’s look at Choline status in isolation. A lot of the data sets people are using are 30 years old. So, it’s not as contemporary as we would wish it to be. And, that’s true, even of the new clinical research that’s coming out, oftentimes it’s of populations that may not be truly representative of today’s modern woman. So, we’re really excited to help to close that clinical research gap through contributing to clinical research. And then we do so every day when we’re formulating products, by tapping into the expertise of our practitioner collective.

Dr. Taz: I feel like I haven’t given you a chance to really talk about Needed very much, because we’ve been very focused on prenatal and prenatal supplementation, but you guys are not just doing supplementation, right? You’re also talking a lot about nutrition in general, for young families and new families. Can you touch on that and what Needed is doing and give us a sense of what that looks like?

Julie Sawaya: Yeah. So, we really think of Needed as being a platform for nutritional products. Most of which are dietary supplements. Education, which is so important because that is, that’s really I think for trying to solve the need and why we started the company Needed really is because we want women to feel empowered and making decisions about their nutrition during this critical life stage. We want to help close the gap between what you’re hearing from your doctor and what we know through clinical research and in-practice experience is actually optimal. And, we want to help women get access to that information in a way that doesn’t require you to have a PhD. Doesn’t require you to spend dozens of hours to get to the research and so the average woman doesn’t have to spend time on PubMed in the clinical data.

Julie Sawaya: And, so today what Needed is really a kind of destination to really meet your full perinatal nutrition needs. So, we have… We’ve been talking a lot about vitamins and minerals that appear in our prenatal vitamin, but beyond a prenatal vitamin. I think this is a really important point because even the most nutritionally complete prenatal vitamin alone isn’t going to give you every single thing that you need to have your needs met in this stage.

Dr. Taz: Right.

Julie Sawaya: As we need more than vitamins and minerals, we need Omega three fatty acids. We need microbiome support in the form of prebiotics and probiotics. We need protein. There are other things beyond kind of a core baseline need that can pop up for women. So, recently we launched additional targeted support for hydration, for stress, for sleep, extra fertility support. And, then we have products for women and for men, because as you alluded to earlier, men’s nutritional status during the preconception phase impacts sperm health. It impacts pregnancy and fertility parameters. And it’s, I think it’s kind of a… For men it’s especially a short window where your nutritional status can make a big difference. It’s usually the 90 to a hundred days leading up to sperm maturation where nutrient status and other lifestyle factors can really play a role.

Julie Sawaya: So, getting men into the preconception prep equation is really, really important and a lot of that ultimately circles back to education and helping families understand the why behind every single thing that we know to be optimal is what we’re really focused on. And, to do that, to design products and to put together super high quality educational information, we partner very closely with our practitioner collective. It’s a cross section of perinatal nutrition and health practitioners. So OBS, midwives, doulas, naturopathic doctors, registered dieticians, integrative doctors, really kind of spanning the entire gamut of what optimal care would look like if we all had access to that here in the US. It really… It’s about bringing together more collective voices rather than fewer, because none of us has all of the answers when it comes to what women need or what’s best for you in your pregnancy.

Dr. Taz: Well, I love the platform and I love the information. Before I let you go, though, male fertility we know is on the decline. I have my theories a lot with the environment, the microbiome, hormone shifting and all this other stuff. But, what are you seeing on your end when you guys dive into that field?

Julie Sawaya: Yeah. So, 40 to 50% of fertility challenges are male factors. It’s absolutely the case that all, all parameters of sperm health. So, motility, morphology really looking at all different ways is that it’s on the decline. That’s not to be doom and gloom. That’s really just a level set with where we’re at and understanding that doesn’t have to be the continued downward trajectory. And, that nutritional support and when we’re talking about male fertility, we’re really wanting to focus on things like antioxidant support. I love that you mentioned the microbiome because the male microbiome actually impacts not only male fertility, so hormone functioning, things like testosterone, et cetera, all of that hormone function starts with gut health.

Julie Sawaya: But, also sperm have their own biome.

Dr. Taz: Right.

Julie Sawaya: And, what we find in both the male and female body is that the gut microbiome impacts the reproductive microbiome. For women, that’s like the uterus has a biome. Breast milk has a biome. The vagina has a biome. All of that can be impacted through targeted support. And, that is I think something that is totally under-appreciated when it comes to the fertility equation. So, our pre and probiotic that’s tailored for women is highly, highly important. If you were going to pick two products focused on fertility for women, I would suggest prenatal vitamin that’s really comprehensive and pre and probiotic that’s targeted to support the maternal microbiome.

Julie Sawaya: And for men, it would be the same. It would be a comprehensive multivitamin and mineral blend that has added antioxidants. Antioxidants are so important when we’re trying to protect those sperm from environmental damages, from toxins, from the cell phone in the pocket, all of that comes down to antioxidant support. And, then microbiome support in a targeted way. And, so we… Our complete plan for women’s actually four products and our complete plan for men is three. But, if you’re focusing just on the bare minimum, those are the two that I would focus on as a really awesome starting place.

Dr. Taz: I love it. I love it. If anyone watching or listening today wants to learn more about just this preconception concept and even about the products that Needed offers, where’s the best place for them to go?

Julie Sawaya: Yeah. So, our website is ThisisNeeded.com. So, it’s pretty easy to remember. ThisisNeeded.com. Instagram we are @Needed, which is awesome. We got the one word Instagram handle, which is hard to do. And, then I would suggest on our website, two really awesome places to start your search around what to look for in a prenatal vitamin and also just if you’re curious about a brand. Maybe you’ve heard of a brand? Maybe your friend took one, maybe you’ve been taking one. We have the most comprehensive, to our knowledge, review of over 75 prenatal vitamins on the market. It’s looking at the pros, cons and the overall takeaways of all of these products. This actually came about through kind of a user generated series where women would write to us on Instagram with the name of their prenatal vitamin and we had our perinatal nutrition expert review them.

Julie Sawaya: We got to such a high volume that we ended up turning it into a guide, but it’s a really awesome place to start. And, it’s really quite objective. We’re not always saying Needed is the best. We’re giving you the pros and cons. If you’re happy with your prenatal, here’s a couple modifications to make. Make sure you’re focusing on Choline or Magnesium or whatever your prenatal might be lacking in. So, look for that guide, it’s called prenatal vitamin reviews on our website, and then we have another guide called what to look for in a prenatal. So, those are two really great places to start if you’re starting from kind of square one or wherever you are in your journey. Would highly recommend those two educational resources.

Dr. Taz: Awesome. Well, thank you for taking time out today to join me and talk about this very important concept. I think it’s one that Eastern and Chinese aggravated medicine, they knew about 5,000 years ago, and we’re just now starting to dip our toe in the water. So, we have some definite catching up to do, thanks again for your time. And, for everybody else watching and listening to this episode of Superwoman Wellness, remember you can rate and review it and share it with your friends. And, I will see you guys next time.