Office Hours: AMA Pregnancy & Postpartum

Dr. Mark Hyman
Welcome to Office Hours. This is our dedicated one on one space to go deeper, get clear, and explore what truly moves the needle for your health. I'm doctor Mark Hyman, and each week, we're gonna pull back the curtain and share the insights, the research, the lessons that don't always make it into our conversations with guests. Because at the end of the day, you are the CEO of your own health. And for many of you, your family's health too.

And you might not feel it all the time, but you have far more power and agency than you realize. I'm glad you're here. Once you conceive, the questions don't stop, they just multiply. Pregnancy is a time of profound transformation. Your hormones shift, your metabolism changes, your nutritional needs increase, your nervous system adapts in ways that most women are not really prepared for.

And postpartum, well, that may be one of the most misunderstood and underserved stages of a woman's life. So in this office hours, we're slowing things down and answering your most common real work questions about how to support your body during pregnancy and afterwards. We're gonna talk about things like choosing the right prenatal vitamins and understanding the difference between folate and folic acid. We're gonna talk about managing nausea in pregnancy, acne, heartburn, which is common, and needs many other common pregnancy discomforts. We're going to talk about supporting mental health during pregnancy, and why it matters for your well-being postpartum.

We're going to talk about reducing the risk of complications in pregnancy like preeclampsia, which is high blood pressure in pregnancy. And we'll talk about nourishing your body in the third trimester to prepare for labor and recovery. And then we're going to move into postpartum. What happens with your hormonal shifts? Thyroid shifts.

What happens in your pelvic floor? How do you heal that? How do you support your immune system? How do you deal with some of the mood changes that happen with all these shifts in hormones? What about hair loss?

And how do you recover after a c section? This isn't about doing everything perfectly. It's about understanding what your body is going through and learning how to support it with clarity, with some compassion, and a few evidence based tools. So whether you're pregnant now or you're planning ahead in the postpartum phase or supporting someone you love, my goal is to walk you through a process to walk away feeling informed, to feel empowered, to not feel so alone. So let's talk about what happens once you conceive and how to support your body through pregnancy and postpartum.

Alright. Let's start with pregnancy and prenatal vitamins and the whole difference between folate or even methylfolate versus folic acid. And the question is, can prenatal vitamins be harmful if I can't process folate? Well, And it's important to take the right forms of these nutrients, especially when you're pregnant. Something called methylated folate is a very important form of this vitamin, also known as vitamin b nine.

It's different than folic acid, which is what's in most prenatal vitamins, which is often somewhat effective, but not always very effective. And there's a lot of genetics that play a role here. The form of the nutrient matters. You want to have the right product. So quality is so important, and I would avoid anything with aesthetic fillers, colors, dyes, excipients.

And there's some great brands out there. I I like Weenatal. It's actually a prenatal for men and women, and we've done some shows on the podcast on male infertility. But guess what, folks? Men are half the equation in conception, so they matter.

And then their health matters, and they actually need prenatal too. Before, it doesn't matter once you get pregnant, obviously, what the guy takes, but before for sure. So I like WeNatal. There's many other brands like Pure Encapsulations has prenatal vitamins. Thorne has them.

There are there are many other companies to do, but you wanna use the best quality you possibly can. Alright. What about question around nausea? This is a big thing. A lot of women get it.

Some women don't, but morning sickness, nausea, acne, these are big things. So we're gonna talk about them. Now if you're nauseous, there's some real simple practical things you can do. One is making sure your blood sugar is is balanced. So you wanna eat, you know, often smaller, more frequent meals.

Don't eat a lot of carbs and sugar. There's certain herbs that can be helped, like ginger tea. You can just slice up some ginger, boil it. Vitamins matter. B six, very important.

Magnesium really matters. And and there's actually, you know, some some studies that show that if you take, you know, the b six and magnesium, it can really help. And there's even some sometimes medication like Bendectin, which is a weird drug that's used for insomnia, often known as Unisom. And I don't like prescribing drugs that often, but sometimes for women who really have intractable nausea, it can be very helpful in the early period with with the b six at higher levels. And you need probably like fifty milligrams, and you probably need pyridoxal five phosphate, again, a very special form of b six.

The next thing you can do is support your liver and your gut health because that plays a role also by helping your microbiome, by supporting with probiotics, and there's also ways to support your liver with healthy food and nutrients. So all that's really important. What about sciatica, men'sotic pain, heartburn? These are all the things that women get. We got several questions about that.

For example, why do you get sciatica? Well, it's usually caused by the uterus expanding, and you've got this giant nerve that comes off of your spinal cord and goes down through your butt. And as your uterus expands and there's shifts in your posture and there's ligaments that get kind of loose because of hormones called relaxin that your body makes when you're pregnant, you end up, you know, often getting back pain. So there's some just simple things you can do. Pelvic tilts, cat cow stretch, really great.

Prenatal yoga, hip opener is really great. Just moving helps. Heat and ice rotating can be very helpful. Physical therapy, massage is great. Myofascial release, learning how to properly sleep so you don't get in bad positions, and just walking, moving.

The more you move, better you're gonna be. I know I have back issues. The more I move, the better I feel. So sitting here doing this podcast is probably the worst thing for me, actually. Heartburn is often very common too.

Why does that happen? Well, there's there's hormones that change, and you get the esophagus relaxing a little bit. So the sphincter, which is a little kind of valve at the top of your esophagus, kind of loosens, and then you've got this big uterus pushing up, and then abdominal pressure grows, and then it kind of pushes food up. So how do you address that? Well, eat smaller meals, more frequent meals.

If you have a big meal, going to make it worse. Try four to six small ones instead of two to three big ones. Watch the trigger foods for reflux, tomato based foods, citrus based foods, chocolate, fried foods. I mean, listen, if I eat fried foods, get heartburn. I don't get heartburn.

Caffeine, coffee, which you shouldn't probably drink anyway while you're pregnant. Carbonated drinks may be an issue. Peppermint, which sounds good if you like peppermint tea, but that can make the sphincter even worse. So watch out for that. Make sure you just kind of keep a log of food you're eating and see, like, well, what did I eat and do I get reflux?

So that can help. Also, don't lie down after eating. That's just a general recommendation for reflux and heartburn, but give yourself two or three hours at least, ideally three hours so you can digest rather than, you know, laying down after a meal. You can also elevate the head of your bed at night. You know, there's ways to do that with blocks, or you can there's different even beds that do that.

That can be helpful. Certain digestive aids can help, like aloe vera juice can help. It's pregnancy safe. Little ginger tea can be helpful. Making sure you chew your food so you don't, like, have a lot of undigested food in there.

Don't wear tight clothing, you know, obviously, you're pregnant, your belly's grown, but get pregnancy clothes so you're kind of have loose clothing. If you have a waistband around your belly, that can increase the pressure. Also, make sure you're hydrating, but but not during a meal, in between meals is really bad. So also don't chug a lot of water, just just keep a steady flow going. Certain things are great.

Magnesium can be really helpful. It relaxes your system. Calcium carbonate or Tums can be helpful, but you want to talk to your OB about that. I like magnesium glycinate, often very helpful. A lot of times people are magnesium deficient, and that can make reflux worse.

And then, you know, if you're stressed, that makes a problem with your digestion. It slows everything down, and it makes heartburn worse. So simple stress techniques like breathing slow through your nose, five breath in, five breaths out, really slow, Really simple, takes a couple minutes or less, and it can make a big difference in your nervous system. My favorite massage, you can get a prenatal massage, that helps with stress. Gentle stretching, movement, being in nature, just simple things, doing things you love, all help.

What about the mental health stuff in pregnancy? That that's something people talk about a lot. And you know, you got to manage all that, anxiety, depression, it's a thing. And everybody's different, some of them do great, some of have all kinds of mood issues. But there's some really foundational things around lifestyle that make a big difference in mental health.

Obviously, eating a whole food real diet, moving regularly makes a big impact on mental health, managing stress that we just talked about with meditation, yoga, breath work, sleep, making sure you prioritize sleep, emotional support, friends, therapists, whatever. And then of course, keeping your blood sugar even, your nutrient levels optimized, all that matters. Omega threes, baby needs a lot of omega threes to make its brain, because about 60% of the brain is made up of omega threes. So it's going to take all yours, so you're going get potentially low. So you want to make sure you get omega threes as well during pregnancy.

If you're depressed during pregnancy, there may be an increased risk of getting postpartum depression, which is a real thing, and that's kind of a drag. But there's a lot of ways to prevent that, just doing all the things I said. Okay, well there's another big problem we've been asking about, which is this thing called preeclampsia, which is quite a serious problem in pregnancy. You get fluid retention, you get high blood pressure, it can even lead to seizures. And there's a lot of good literature that shows that generally getting your metabolic health straight will help.

That means balancing your blood sugar. And again, you've heard me talk about this forever, but you know, eating whole foods, not eating a lot of sugar and starch, you know, having lots of fiber, protein, good fats, all common sense stuff. And that works for high blood pressure. The biggest driver of blood pressure issues is insulin resistance. So if you're eating a lot of sugar, you're eating a lot of starch, it's going to drive up your blood pressure, and you want to be really, you know, careful about that.

And, you know, I don't like the idea. Like, just whatever you want. Have much ice cream or cake or cookies. I'm pregnant. I could eat.

Doesn't don't do that. It's not good for you. It's not good for the baby. You want to still stay on a really optimally healthy diet. Have make sure you have adequate protein, lots of minerals, all that's really important.

And I omega threes, like, you know, you want to be careful with fish during pregnancy, but you can have the small fish, sardines, herring, mackerel, anchovies, small wild salmon can be helpful. All that really helps. Now sometimes aspirin can help, so there's plus and minuses on that. If you have a high risk of preeclampsia, if you've had it before, if you have really if you're overweight, if you have a lot of insulin resistance, metabolic issues, you know, you might want to take a baby aspirin, but you want to check with your obstetrician about that before taking any drugs during pregnancy. Alright.

What about food? What should you be eating? Well, it's the same thing you wanna be eating anyway because to create a healthy you is the same thing you need to create a healthy baby. But there's a few things that are particularly important. One is making sure you have adequate protein because you're growing a whole new being.

Two is lots of good healthy fats, particularly omega three. As I mentioned, a lot of your neurologic tissue, your brain and nervous systems all made up of omega threes. Choline, which is really important, also important for brain development. And again, it's very low in in many Americans' diets, and it's important in neurotransmitter function. And you can get it from eggs, particularly egg yolks, so no egg white omelets, please.

Making sure you stay hydrated and get adequate electrolytes, all that's important. So I think just common sense, but again, don't overeat, don't just eat whatever you want. You know, not like, know, it's okay to gain a 100 pounds in pregnancy, it's not. You're affecting the epigenetic programming of the baby, you're affecting your own health, and you want to just stay, you know, following the principles of of a healthy diet, which I've written about a lot in the pagan diet or food, what the heck should I eat? Okay.

So how do I pick a formula? That's another question we got. Well, first of all, ideally, you want to breastfeed for at least six months or longer a year. Sometimes it's not possible. I understand that.

And so then the question is how do you figure out what's going on with formula? And in America, formula is just crap. It's the average formula has the equivalent of a Coke or two a day that the baby's consuming. Now you wouldn't give your baby a can of Coke, but you basically are giving it a can of Coke if you're giving it the traditional formula. You don't want the corn syrup solids.

You don't want all these additives. You want really clean ingredients. And there are good brands out there. Bobbi is one. There's a new thing that happened you should know about.

The FDA released a ban. Can you believe this? There was a ban on importing formula from Europe, which is way better formula. It actually has omega threes in it. They do a lot of really good things with it.

Much better designed. We banned it. Why? To protect the American companies that were making formula, but who was paying the price? The babies and the mothers.

Who was, you know, going to the bank all day? The company's making the formula. So that's a good thing. The new FDA rule that lifted the ban on importing foreign formula is a good thing. And there's some great brands out there from Germany and other places, so I just kind of check around on that.

All right. What happens after you give birth? Postpartum period is really misunderstood by many people. It's an underserved part of medicine. I didn't learn anything about it in medical school, and it's a really important stage of a mother's life.

So you've got to know what happens. The question is you get all this hormonal imbalance. Right? You're out of all this flood of hormones when you're pregnant, and you give birth, the placenta's gone, all these hormones are gone. What happens?

So the question is how long until your hormones get back into balance? Well, it can it can take a minute. It can take a minute, and and some women are more affected by it than others. But usually, things come into back into balance after about, you know, four to six weeks. There is a there is a thing that happens often after and I don't think we exactly know why, but a shift in thyroid function.

And women get postpartum autoimmune disease of their thyroid called Hashimoto's, and about ten percent of women do this. And that can cause depression. It's it can cause lots of things, but depression is one of the key features of low thyroid function. So now depression, but fatigue, you can get weight gain. That is very psychological.

It's hormonal. And you want to make sure you do the right tests. Function health, we do full panel of tests. Really important to get the right test because most doctors don't check the right thyroid test. They just don't.

They check TSH, and they leave it at that. But you want to check the free t three, free t four, thyroid antibodies, and function health. We see over almost fifteen percent of our members, five hundred almost five hundred thousand people now have an autoimmune thyroid problem, and most of them have never been diagnosed before, and it's affecting the quality of their life. So you want to make sure you check the right test. Next question is about what happens to your pelvic floor.

You give birth. It's a big thing. This big head goes through your pelvic floor. You can get a lot of tissue stretching and lots of vaginal issues. What what do you do after pregnancy to help with that?

Well, there's lots of things. Physical therapy can help, and there's pelvic floor therapy that can help, breath work, Kegel exercises, strengthening your core, your abdomen, your abdominal muscles, all really important, and that can help a lot. It's really important both both after vaginal birth and even after a c section. Also, women report getting sick a lot after pregnancy, and the question is why am I sick so much after having a baby? Well, I hate to say this folks, but the baby's a parasite.

It steals all your nutrients. It takes everything out of you, and you got to put it back in. So hopefully, you're doing that during pregnancy. Hopefully, you're taking the right multivitamin, fish oil, vitamin d, and so forth. But you want to make sure your nutrient levels are optimized.

And again, at Function Health, we test all your nutrients. You can do the basic function panel, which has a lot, or you can even add the extended nutrient panel, and you can go to functionhealth.com to learn more. The other thing that can make you sick a lot is you're not sleeping because the baby's up all night or you're, you know, breastfeeding at night. And so sleep deprivation does affect immune function. Microbiome changes also happen during pregnancy, and that can affect you.

So there's a lot of reasons, but as long as you make sure your vitamin D's levels are good, you're you're getting the right vitamins and minerals, you've got omega three fats, you're learning some you know, how to do some gentle stress reduction because stress suppresses your immune system too, get some help with the baby, do some general exercise, all that really can be helpful in supporting your immune system. Alright. Next question was about postpartum depression. What can we do to prevent it? Well, the key is to do the things that work for depression for anything, which is getting your metabolic health straight.

So balancing your blood sugar, because insulin resistance, prediabetes, blood sugar issues, all those cause depression. Making sure your thyroid's right. And those tests I just mentioned are really important. Checking for inflammation. You know, lots of inflammation in your body can cause depression, and you can use that test that we do at Function Health, CRP, which is a measure of inflammation.

There's other tests you can do as well. You can check your omega three status. Again, you can do that with Function Health. Low omega threes will lead to more inflammation in the body. So all that's really important, and there's some simple things around making sure you're getting exercise, getting your sleep sorted, that's tricky, but getting support, maybe your husband can take the baby, or maybe you get a support from a family member or even help from a nanny.

All that can be helpful, getting time with friends, therapy if you need it. If you, you know, had trauma in your life, sometimes trauma informed therapy can be really helpful. What about postpartum hair loss? There's another question about that. Is there a way to prevent so much hair loss after pregnancy?

Well, why did this happen? It's something called telogen effluvium, which is a big medical word. It's really common. It peaks around three to five months after birth, and it's mostly caused by hormonal swings, especially estrogen after you give birth. And it also can be from nutrient depletion because you're you're like I said, the baby's a parasite.

It's taking all your nutrients. So making sure you're on a healthy diet, adequate protein, hair is made of protein. Things like biotin can be really important. And also just making sure you have omega threes, which are important per hair hair health, and your thyroid's okay. All that can affect your hair loss.

And it can really be from nutrient depletion, not just in pregnancy and and the birth, but breastfeeding also. So you're you're still feeding another human, and you need to make sure you're getting yourself enough quality nutrition. Stress, you know, people say, you know, I'm so stressed. My hair's falling out. Well, that's a thing.

So I know it's hard if you're a new mother or new family, it's sometimes tricky, but do the best you can to find ways to kind of reset your nervous system, whether it's a yoga nidra. You can listen on Spotify or breath work or meditation or yoga or hot bath. Just simple things make a big difference. And sleep disruption also, again, something sometimes hard to avoid, also can be a big factor in in stress and causing more hair follicles to go into the shedding phase. Like I said, thyroid, you want to check that.

Very common. A big cause of hair loss. And you know, there's a lot of ways to support regrowth of your hair even if you totally can't prevent all the hormones. Right? So you need a lot of nutrients for hair growth.

And and pregnancy can deplete a lot of these, iron. For example, if your ferritin is low, because women lose a lot of blood, again, you had to have a ferritin. Even if you're not anemic, if your ferritin, which is the iron stores, like the money in the bank as opposed to in your pocket, if your iron stores are low with low ferritin, that can cause hair loss. And if it's under 45, it's a problem. And most lab reference ranges are like 16 is normal.

That's not normal. That's opt that's not optimal. It's quote normal because people are low. So you want to make sure you check that. And again, on function health, can check iron, and you can check ferritin levels.

You can check for zinc, also really important for follicle repair. Biotin, really important for keratin production. Omega threes, we check that at function health. Vitamin D, we also check that. That vitamin D can if it's not adequate, can lead to thinning of your hair.

Omega three fats also really critical for hair. I mean, they give race horses omega three fats to make their coat shiny. And protein. You know, hair is made up of protein and made up of amino acids. So you need at least eighty to a hundred grams a day, especially if you're breastfeeding.

So how do you do all this? Well, stay on your prenatal vitamin, not just for when you're pregnant, but at least six to twelve months after. Eat a lot of iron rich foods. I was talking to this nanny service because my my daughter's gonna have a baby soon. And and they're like, well, do they she eat liver, does she eat kidneys?

And I'm like, so all that stuff. Liver is probably one of the richest source of iron in the diet. I love liver, but you can also get it from grass fed beef, from lentils, from spinach. You want a lot of zinc rich foods, pumpkin seeds, oysters, beans, and you want protein in every meal. So chicken, fish, meat, nut seeds, beans, all that's really important.

Make sure you check your labs, folks. You gotta check your labs. You you if you don't know what's going on in your body, you can't manage it. You know, I think some tech guy said what doesn't get measured can't be managed. So you need to know what's going on.

It's like your dashboard in your car. I mean, imagine you didn't know how fast you're going, how much gas in the tank, like you need to know that stuff. The thyroid's really key, as I mentioned, around postpartum depression, hair loss, and many other things. And this thyroid thing is a big thing. You know, a lot of it's really common, as I said, and it can cause anxiety, depression, exhaustion, fatigue, hair loss, fluid retention, prevent you from losing the pregnancy weight.

And you want to get the right test. Like I said, you don't just want the TSH, you want the free t three, the free t four, the thyroid antibodies. There's even something called reverse t three, which can be very helpful sometimes if there's stress that can go up, it's like a blocking thyroid hormone. So until you fix those, your hair loss isn't going to get better. So you've got to make sure you check that.

What about c sections and recovery from c sections? Well, what are tips for recovering? And I delivered 500 babies. I used to do lots of c sections. It's a big surgery.

Right? It's not a little surgery. Know, recovery isn't just about healing the scar, it's about restoring your strength of your core and your abdominal muscles, getting your gut health back in shape, making sure your nutrient levels are good, making sure your immune system's working and inflammation's down. And so there's some really good foods to help with repair tissue and repair your body. Protein rich foods, which are important.

Probably about a gram of protein per pound of ideal body weight, and then you can just do the math on that. So if you're like, you know, a 120 pounds, that's like a 120, but you can shoot for, you know, 80 to a 120. That helps collagen formation, tissue repair. Vitamin C also really important for recovery of collagen formation. Peppers are real high sources.

Citrus are high sources. All that's really important. Also, zinc for wound healing. Great. Pumpkin seeds, oysters, lentils, taking supplements, also helpful.

Omega three is important for skin repair and healing. Salmon, sardines, walnuts, all that helps. And collagen, can use take collagen bone broth that has amino acids that can help rebuild tissue as well. And then of course, you want to make sure you optimize your microbiome, that helps, especially after antibiotics, which they give you often in pregnancy or c section to prevent infection. And then getting your blood sugar sorted because that'll help reduce the overall inflammation in your body.

You know, if you know diabetics don't heal well, it's no surprise if your blood sugar is out of whack, you're not going to heal well. And you can support your scar tissue repair. Right? So it can be difficult if you don't take care of it. So you want to make sure you can use vitamin E oil, there's silicone gels you can put on your scar, there's many things, but you want to make sure you get your scar sealed.

And you also want to start to rebuild your core and your pelvic floor. So you can work with, you know, a simple exercise or your own, or you can work with a pelvic floor therapist, and they can really help create a good plan for repairing all those things. And you want to support your energy and your hormones. Right? You know, if you're postpartum tired and you have surgery on top of that, I mean, that's a lot.

Right? So having babies is big, but then you had surgery on top of it, it's a lot. So you get more nutrient demand, and you get a lot more hormone imbalances that are going on, but they improve if you optimize your nutritional state, if you get the right nutrients, if your gut is healthy and you, you know, deal with the stress that's going on much as you can. So emotional recovery is important. Healing the nervous system is just important as healing the incision.

And that's that's really important. Like, I do breath work every morning. I do qigong practice every morning. I live a very high paced life, and I need to regulate my nervous system like everybody else. So I encourage you to just find some things that work for you.

In closing, pregnancy and postpartum aren't really separate moments. They're part of this continuous process of hormonal shifts, of metabolic change, and lots of transformation in your life. So no matter where you are on the journey, I want you to remember a few things. You're not powerless. Small, consistent choices can mainly support your hormones.

They can support your energy. They can support your mental health, and they can support your recovery and even your long term health and well-being. Now if this episode brought you clarity, please share it with somebody who might need support during pregnancy or postpartum. I'm gonna send it to my daughter. So many women go through these stages feeling confused or alone, and having the right information can make a real difference.

If you want to go deeper, we've created a free resource to support you. Supplements for a healthy pregnancy, including guidance on nutrition, supplements, and recovery during pregnancy and beyond. You'll find direct links in the show notes wherever you are in the journey of pregnancy or postpartum, whether you're in the early weeks or months in or still healing, remember this. Your body's wise, it's resilient, and it's capable of incredible change. Thanks for joining me for office hours.

I love diving into these topics with you. Remember, you are the CEO of your own health, and every choice you make can move you closer to healing and vitality. I wanna keep these episodes as relevant and useful as possible. So tell me, what do you wanna explore next? What questions are you wrestling with?

What breakthroughs are you chasing? Share your ideas in the comments on social media or through the link in the show notes. I'm listening. Until next time, keep taking charge, keep asking questions, and keep showing up for your health.

Dr. Mark Hyman
If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Doctor Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to The Doctor Hyman Show wherever you get your podcasts.

And don't forget to check out my YouTube channel at Doctor Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on The Doctor Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic, and Function Health where I am chief medical officer. This podcast represents my opinions and my guests' opinions.

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