*SE10 Learn more about prenatal vitamins with Julie Sawaya + Needed

We have a very special guest on the podcast today, Julie Sawaya, who is one of the co-founders of Needed, a company that focuses on providing women with the highest quality of vitamins needed during the entire perinatal period. Julie shares with Meagan the research behind Needed's prenatal vitamins and supplements. She talks about why you need a prenatal vitamin in the first place, the optimal dosage and forms of specific vitamins in pregnancy, how supplementing proper nutrition in the best ways can positively impact your entire birth experience, and so much more! Use the code VBAC20 to receive 20% off at www.thisisneeded.com Additional Links Needed Website What to Look for in a Prenatal Vitamin Folate vs Folic Acid. What's the Difference? Ryann Kipping: The Prenatal Nutritionist Real Food for Pregnancy: The Science and Wisdom of Optimal Prenatal Nutrition How to VBAC: The Ultimate Prep Course for Parents Full Transcript under Episode Details Meagan: Hello, Women of Strength. We have a very, very special episode for you today. We have our friend, Julie Sawaya, and she is the co-founder of Needed. If you haven’t heard us talking about Needed yet, go listen to the other episodes and get on Instagram. You guys, Needed is incredible. She is a mama of two young girls. We were just talking before the episode and her youngest is nine months. She is a lifelong nutrition nerd. I love that she calls herself this, a nutrition nerd. I’m a birth nerd. When we find ourselves passionate about something, we just nerd out, right? It’s so amazing. Julie grew up in a family of medical doctors and learned at a young age the power of nutrition and how it can influence or help. Julie went on to study the issue of nutritional access in college and got her Master’s in business from Stanford where she met her Needed co-founder, Ryan Of the most nutritionally aware of their friends, Julie and Ryan were shocked to realize that through nutrient testing, they were seriously major deficient in key nutrients. We don’t think about it, Julie. We just don’t think about this, I think, enough. We think we’re taking something and we think that we’re good. They found out that there was really much more needed for a healthy pregnancy. They dug into the research and they realized that they were not alone. 97% of women take a prenatal, yet 95% have nutrient deficiencies. Let me just say that again. 97% of women take a prenatal, yet 95% have nutrient deficiencies. Most prenatal vitamins just weren’t cutting it and Julie and Brian started Needed to create a new, higher standard for perinatal health. Working alongside a collective of more than 3,000 perinatal nutrition and health experts, together they have redesigned the products, education, expertise, and experience that women need. Welcome to the show, Julie. I seriously am reading this and I’m like, “Oh my gosh.” This is amazing because like I was saying when I was pregnant years ago, I did not pay attention to anything. I got the bottle. I took it. Check mark. Julie: Yeah. No, I mean, I think it’s a problem. The core underlying problem that we’re solving at Needed is that women are nutritionally deficient in this life stage. It’s a problem both with the products that are available. Most prenatal vitamins are designed to meet just the bare minimum nutrient needs, not to set you up for optimal health, and it’s also an awareness or an education problem because, in some way, it’s a problem that you don’t know you have until you feel the effects of it. We’re told it’s normal to feel depleted, that it’s normal to not feel your best, to feel like yourself during pregnancy or postpartum. So many of the complications of pregnancy have a nutritional root to it whether it’s gestational diabetes or preeclampsia or hypertension or nausea even, or more severe nausea like hyperemesis. There is a nutritional component to it. Not to say that nutrition is a cure-all, but it’s a reasonable first step in supporting your body optimally. Meagan: It’s huge. Julie: What Ryan and I found when prior to starting the company is that despite how important nutrition is and yes, I am a lifelong nutrition nerd. Ryan and I are also trained nutritionists. It was truly and utterly shocking to us that we had these deficiencies but what we realized once we looked under the hood is that this problem is widespread and part of the problem stems from the fact that it’s so common for women in the U.S. to see an OB. I come from a family of MDs and I have huge respect for the medical profession. But most doctors aren’t trained in nutrition. It’s actually not a requirement in most med schools. I think somewhere in the range of 50% of med schools don’t require one nutrition course. The average OB appointment time in the US is 7 minutes long so even if an OB is trained in nutrition and has the intention to help educate their patients. OBs are generally very well-meaning. They’re just people who are constrained on time and with the curriculum as we like to say, the curriculum is flawed, not the people. But even if all of the stars align in 7 minutes, you can’t get all of your nutrition questions answered. What we hear again and again, the most common recommendation is, “Take a prenatal vitamin,” and then you ask, “What kind?” and then they say, “It doesn’t matter. They’re all the same.” Meagan: Just take one, yeah. Julie: “Just take one. Make sure it has folic acid in it,” which I’m sure we’ll get into. That particular nutrient and nutrient form. But there is so much more to prenatal nutrition than vitamins and minerals. But even if you just focus on vitamins and minerals, it’s really hard to pick a prenatal. There are over 100 on the market. There is a vast difference when it comes to quality. The quality of the nutrients, the quality of the nutrient forms, and dosages. We spent over three years formulating our first products with a collective of health and wellness practitioners that study perinatal nutrition and looking at all of the available clinical research on nutrient dosages and forms, and what pregnant and lactating women need. The reality is that there are a lot of nutritional gaps. That’s where this collective of practitioners that are testing women’s nutrient and hormone levels every single day really, really matters to understand in practice what does it take to dose? What dosing of Vitamin D do you need to give your patients to be in optimal nutrient ranges? It seems like such a basic question, but no prenatal company had done that legwork to understand what’s actually optimal. Meagan: That is what I was going to say. There are so many things about Needed that I love. Honestly, one of them is how this company came about. It’s two women that found that there was something lacking out there and had a passion from themselves and had passion to share it with the world. That’s how The VBAC Link started. Myself and my old partner, Julie, same thing. We just found this passion so I love the heart that comes behind this company and then really what you guys have done. You’ve built it from somewhere where it was really mediocre if you could even call it that is incredible. Like you said, not only getting ingredients but the optimal amount. As I have compared in the past, there are so many out there that are even recommended on Amazon or wherever and they don’t even have the ingredients at all let alone that optimal amount. I am so excited and honored for you to be here today and be talking to our community because I think that it is so important. Like you were saying, it’s not that my provider had any ill intent to not give me that information, but it really was as I was walking out, he goes, “Oh, and by the way. Make sure to start a prenatal right now.” I was like, “Oh, okay.” That was it. That was it. I did. I found myself Googling it and found one. I was like, “Okay, cool. That one has some okay reviews.” I got it and I really didn’t know the impact that it was leaving or lack thereof. Julie: Yeah, totally. I think some of that comes from there is misunderstanding that a prenatal vitamin is for the baby. By and large, unless you have massive nutrient deficiencies, the baby’s going to get what he or she needs to develop properly, but often at the expense of your own nutrient reserves. As a mom of multiples, you know that oftentimes, women experience and understand the pain point more as a second-time or third-time mom than as a first-time mom because once you’ve been through pregnancy and birth and if you choose to breastfeed or pump, you can feel it viscerally how depleting that experience is maybe more so than a first-time mom that hasn’t yet been through it all. In some ways, it’s an experience that has to be lived to fully appreciate the problem probably much like the topic of VBACs. You go into a first birth maybe not fully understanding how one birth choice or one birth outcome will impact the second birth choice or birth outcome. What we’re really trying to do at Needed is to raise awareness so that you can make the best choices possible with the information that you have. That’s all that it’s about. It’s not about what I would have done differently with one pregnancy versus another. It’s not at all. Any of the information we share is not in any way meant to shame or add guilt. There is so much of that mom guilt, so much of that fear-mongering out there. That is the antithesis of who we are as a company. But we find that when you’re empowered with the right information, you can make better-informed decisions so that’s a huge part of what our mission is here at Needed. Meagan: Yeah. Yeah, I mean we can relate to so much of that over here. I didn’t know what I didn’t know when I had through perinatal care to birth to recovering after a C-section. We grow from our journeys. Yeah. There’s never any more shame. Mom guilt is way too thick. We lay it on way too thick, especially with social media. So here we are today to have this episode so you can start learning and growing and finding that information so you can make the best choice for you and your growing baby or maybe through your fertility journey or nursing journey or whatever part of the journey that you are in, Needed has so many incredible things, really it all. I’m sorry, but you kind of have it all out there. It’s just amazing. So thank you so much. Yeah, let’s get into some of these questions. Julie: Yeah, I’m excited. Meagan: Me too. Okay, so one of the questions is what is the importance of a prenatal vitamin? Really, why? We’re being told to take these prenatal vitamins and we were just a little bit talking about how there are a lot of things that we need, but why do we really need them and does it matter if we don’t take them? Julie: Yeah, that’s a great question. I like to answer it with a look back at context from nature because first and foremost, I think people are right to have skepticism about supplements in general. Do I need them? Why do I need them? Is it just snake oil in general? I think something that was an aha moment for me as someone who was a little bit of a, “Food is my medicine, not supplements.” That’s the perspective I came into before starting Needed. I think it’s really helpful to understand that one of the main reasons we need supplements generally and then specifically at the life stage of pregnancy or the perinatal stage is because our soil is depleted. Food isn’t as nutritious as it once was and it tends to take a lot longer to reach us than it used to. We’re not generally growing our own food. We don’t necessarily know who is growing our own food. Even if you shop at the farmers market as Ryan and I did at the time. We were testing our nutrients way back 6 years ago when we started Needed. Your food can still be depleted because the soil quietly is depleted. We’re also subject to a lot more environmental toxins which that toxic load increases baseline nutrient requirements. Your body has to consume more nutrients to operate at homeostasis because of the burden of toxins it’s trying to process effectively. Meagan: Yeah. Julie: We have a great book posted on our website. The title is “Why Your Grandmother Didn’t Take Prenatal Vitamins But You Should.” It’s really talking about these factors that are an evolution of modern life. We also now know as we didn’t previously how important some nutrients are, especially nutrients like folate which is vitamin B9. It’s really critical for babies’ brain and neural tube formation. Folate’s sister nutrient is choline. It’s a super important nutrient for many of the same reasons– brain development, cognitive function, neural tube formation. Those are nutrients you don’t want to skip out on in that even with your best intentions, you might be deficient it. 95% of women are deficient in– sorry about that. I have a rowdy dog. 95% of women are deficient in the nutrient choline. It’s most abundant in eggs, liver, and foods like that but in the first trimester, many women have a food aversion to eggs. I certainly was not consuming any liver in my first trimester. Meagan: Yeah, I was going to say that liver never crossed the path of my pregnancy, unfortunately, or fortunately. Julie: Yeah, not at all. Yeah, but in any event, at a high level, prenatal vitamins are there to fill the gaps in your diet. I think that a misunderstanding and the way that prenatal vitamins have been formulated historically is that they’re dosing around a concept called the RDA level which is basically a dosage framework that came out of World War II when the government was trying to determine how to set nutrient levels to avoid serious diseases like scurvy, like a significant deficiency of vitamin C. The entire concept of an RDA is rooted in this idea of, what’s the bare minimum amount of a nutrient I need to give someone to avoid a disease or worse like famine or starvation. Minimalistic, not optimal. There’s a big order of magnitude of difference of what amount of vitamin C your body needs to avoid scurvy versus what it needs to support postpartum tissue healing and repair and optimal immune health during pregnancy or optimal reference ranges. But at a high level, basically, prenatal vitamins are there to fill in the gaps in your diet. They are, unfortunately, a necessity because of our modern food system and they are especially important at a life stage like pregnancy and breastfeeding when your body will never have higher nutrient needs than it does in these life stages. It’s really, really critical that you’re getting the right nutrients. As I said earlier, it’s not just for the baby. It’s for you too. I think that a concept that we’re really passionate about is centering women in this journey because ultimately, your baby is most likely going to get what they need but you might be left depleted and that depletion can have long-term impacts. If you want to have two kids or three kids or ten kids, your body has fewer nutrient reserves to give to the next baby with each sequential baby unless you are replenishing those nutrient stores. If your family feels complete, it’s still important to supplement throughout the postpartum and a time period thereafter to support your hormone health and your thyroid health. Just general vitality and overall well-being. I think it’s super common for women to say that it took them several years to feel like themselves post-pregnancy and a lot of that can be tied back to nutrient deficiencies. Meagan: Yeah, something that you said that resonated with me is that through each pregnancy, my life became busier because I had little toddlers and newborns. You know, all of these things around. So like you were saying at the beginning, you were like, “I can get it through my food. I can get it through my food.” Yes. Food definitely is impactful but obviously, as we know, is not as great as it used to be. Not only was it not as great as it used to be, but when I was really, really busy running around, I’m going to tell you right now that I was not eating correctly. I wasn’t even getting enough calories at the time let alone the right foods. I was like, “Oh. There’s a Nutrigrain bar. Let me just grab that because I’m hungry.” I wasn’t grabbing the right things or enough. It just goes to show that as we keep going on too, it’s so important. Julie: Yeah. That’s absolutely the reality. I think where it’s almost more important to take supplements with each subsequent pregnancy for that reason or even in the postpartum period because when you’re pregnant with your first, you generally speaking have more time than you do in postpartum with your first. And in postpartum with your first, you generally have more time than pregnancy with your second or third or fourth so that’s absolutely right. Meagan: Yeah. I would also remember breastfeeding my baby even in the middle of the day and just feeling sucked. Literally dry of energy and everything. Julie: Hydration and nutrients. Meagan: Hydration, yep. My mouth was getting dry. It just goes to show that you are feeling it. You are literally feeling your body change right there. Okay, so now we know it’s definitely important to take prenatal vitamins in the perinatal/postpartum stage and everything. But what ingredients should we focus on? We talked a little bit about folate and choline. What should we be looking at when it comes to the back of our bottle? Are those really the two main ones or are there more ingredients that are like, “Hey, we really need to be focusing on these and if we don’t see them on the back of our prenatal, we should have our alarms going off”? Julie: Yeah. There are really 24 vitamins and minerals that Needed has chosen to include in our prenatal vitamins because they are the ones that have the most clinically validated need for them. Choline and folate are two really important ones. I think they are really easy ones to scan a bottle for or a supplement facts panel and see not only does this have choline in it, but what’s the dosage? The most common dosage of choline– it’s a nutrient that has had an RDA. We talked about RDAs. It’s a minimum amount. It’s at an RDA of 450mg in pregnancy for 20+ years, 550 for lactation. The most common dosage of choline in a prenatal vitamin is 0, followed by 55mg which is 1/10 of the breastfeeding RDA. RDAs are the minimum. They’re taking 1/10th of that in most prenatal vitamins. The reason for that isn’t because you’re getting all of the extra from your diet. It’s because choline is a bulky nutrient that is hard to fit into a one-a-day prenatal. It’s hard to fit into a gummy. You just really can’t effectively do so. To dose it optimally, you need to include it in multiple capsules or in a powdered form like we offer. One of our options for a prenatal vitamin is a powder which is really, really great, especially for those bulkier nutrients like choline. The other bulky nutrients that are really important are calcium and magnesium. I would look for dosages of at least 200mg of those two ingredients. Ideally, magnesium and other minerals are in the glycinate form. Sometimes that’s on a label as magnesium bis-glycinate or magnesium bound to glycine. Glycine is an essential amino acid that just helps with absorption, keylation basically, the usability of that nutrient in the body so that’s a really important one. Other nutrients I suggest scanning a panel to see if they are in there– vitamin D is a telling one. I think nearly every prenatal vitamin will have vitamin D in it but the dosage matters and the form. Some prenatal use a less-absorbed form called vitamin D2. We recommend the D3 form. We also suggest looking for at least 2000 international units, IUs or more optimally would be 4000. Our prenatal vitamin capsules and multi-powder have 4000 and then our essentials multi which is a paired-down version in only three capsules has 2000. Those are the ranges that we typically like to see for vitamin D. Vitamin D is best absorbed with vitamin K. Make sure that vitamin K is on that supplement facts panel and 90 is the dosage that we tend to look for vitamin K. It should be in the K2 form. That’s the best-absorbed one. Those are some key ones. The other things to look for are– I think we’ll probably get into the question of what form of folate so let’s have that’s conversation. Meagan: Yeah. Julie: If you’re told nothing else about prenatal nutrition, you’re probably told to take folic acid which is the manmade synthetic form of the nutrient folate. Folate is naturally occurring in food. It’s an essential nutrient. We talked about its use in the body. It’s really important for babies’ neural tube formation so for spina bifida. That’s why it’s emphasized usually in the first trimester because the neural tube fully closes during the first trimester. It’s a nutrient that is so, so important and many women don’t know they’re pregnant until well into the first trimester so it’s pretty common to hear that you should start taking it preconception which we definitely agree with, with one caveat which is that the synthetic form of folic acid is not readily used by the body. Many women have a genetic variation, MTHFR which makes it impossible for their bodies to convert synthetic folic acid into the usable form of folate. Instead, Needed uses methylfolate which is a naturally occurring form of folate. It’s the active form meaning it doesn’t have to go through the conversion process. It’s been shown in clinical research to be better utilized by the body, especially for those with the MTHFR. There is controversy out there of folic acid versus methylfolate. Primarily what the controvery stems from is the fact that the clinical studies on folate for neural tube defects was done with folic acid. That’s because the research is old. It’s 30 years old. Now that we know how important folate is to neural tube defects, it would be unethical to do a clinical study with a double-blind placebo controlled study where you’re putting women on a placebo that has no folate in it versus one that has folate in it. We know the risk factors. We don’t want to induce spinal cord issues or neural defects. So a lot of those who are pro-folic acid are relying on stale research. Really, this argument is that all of the clinical research around neural tube formation is on folic acid. We’re not arguing with that. That’s actually a true statement. But there’s a huge wealth of research showing that head-to-head comparing methylfolate versus folic acid, methylfolate is better absorbed by the body. 96% of the circulating folate in your body is methylfolate so that’s pretty clear evidence in support of it. Mechanistically, in the body, how we’re preventing neural tube formations is the serum folate status of mom. There is research showing that methylfolate raises serum folate status in mom in the same way or better than folic acid does. We have a really well-researched blog post on this topic on our website. It’s dense. Maybe we can link to it in the show notes for those who want to learn more, but there is a reason why many of the higher-quality prenatal vitamins are including methylfolate, not folic acid. I would tend to distrust– there are some out there who are saying, “Oh, it’s a designer prenatal vitamin. They’re just trying to charge you more.” The reality is that methylfolate is so much more expensive than folic acid. You could make a lot higher profit margin if you used folic acid than methylfolate. I think it’s around 100 times more expensive which is also why most of the clinical research is relying on folic acid. Folic acid is a nutrient that is often fortified in cereals and bread, so there’s also a food lobby that has an interest in keeping folic acid in things and not methylfolate because it would be cost-prohibitive to include methylfolate in a $3.00 box of cereal. Meagan: Interesting. Julie: Yeah, there are a lot of factors. I don’t want to bog listeners down in all of this information, but this is a really good nutrient to highlight how much information and nuance and research goes into selecting optimal nutrient forms and optimal nutrient dosages. It’s a quick way of saying that we did a tremendous amount of research and there is a lot of evidence behind what we’re including in the Needed prenatal. We include references for every single nutrient that we use for those who are, like me, nutrition nerds that want to go many layers deep. For those of you who are like, “Oh my god. This is over my head,” I would say that the core message is that we’ve done extensive research and these nutrients have been utilized in practice with perinatal nutrition and health experts for decades. This isn’t newly redesigned. We did design our prenatal vitamin from the ground up, but the insights, expertise, and recommendations behind it have been put into practice for many, many decades. Really, what Needed did was bring together all of this inside of a single product instead of previously how practitioners were having to say, “Okay, go take this magnesium and this vitamin D and this prenatal and this amount of choline,” because no prenatal had everything that you needed in one package. Meagan: Right. That is another reason why I love and trust you guys so much. Literally, it’s all of the research that has gone into creating such a solid product for the birth community so I love that. Thank you so much for explaining that because yeah, it definitely is a hot debate sometimes. Julie: Yeah. I think it’s good to have that. We love a healthy debate. We work with practitioners. We actually have now almost 4000 practitioners in our community. It includes OBs. It includes reproductive endocrinologists but it also includes a lot of registered dieticians and naturopathic doctors and functionally-trained practitioners. We’re collaborating with all of them when designing products. We appreciate that some people come from different training backgrounds. Some people might have different skepticism and all voices are welcome. We want to have a construction conversation on this specific topic of folate versus folic acid, sometimes, the status quo argument is unwilling to hear the other side. It’s nuanced and that’s why we have a great blog post on the topic. Also, if you’re just early in your research and want a basic primer on what to look for in a prenatal vitamin, we also have that free resource available on our website as well as a review of over 75 of the prenatal vitamins on the market. It compares the pros, the cons, and overall recommendations. So if you love your prenatal, but it doesn’t have choline or it doesn’t have magnesium, we’ll give you those recommendations on how to supplement or how to get more of those nutrients from your diet. Again, we’re really not trying to tell you, “Everything you’re doing is wrong.” It’s really about how you can upgrade what you’re doing or make small changes on the margin that can have a huge benefit for you and your baby. Meagan: Yeah. I was going to say, All I can see is that it’s an improvement. We’re making improvements. We grow and make improvements in everything in our day-to-day lives. This is one that is really important so that’s why we’re doing this today. We’re sharing this so we can make improvements. Sometimes just it’s just small tweaks to benefit ourselves. Okay, so now we’re talking about all of the things that we really should be looking for nutrient-wise during pregnancy. Are there any nutrients we really should be avoiding taking during pregnancy and through your guys’ research, have there been some of those ingredients even in prenatals out there? We were just talking about folic acid and folate, but are there any where you are like, “Okay, if you see this, this is one of those tweaks that you really should make”? Julie: Yeah, it’s a great question. We talked about folic acid. We would suggest avoiding that nutrient. The other very common nutrient form that we suggest avoiding is a form of B12 called cyanocabalamin. It’s easy to remember because it’s actually derived from a cyanide molecule. There is just not research to substantiate. It’s a synthetic nutrient form. It doesn’t exist in nature and there’s not safety data to suggest why you’d want to consume cyanocabalamin. We’re leveraged the two naturally-occuring active forms, methocobalamin and adenosylcobalamin. We use those in a 50-50 ratio. Try to avoid cyanide if you can. Try to avoid synthetic folic acid. We’re always using nutrient forms that exist in nature and we think that that’s the best way to make sure that we’re on the side of safety. It’s often contrary to cost. Those synthetic nutrient forms tend to be cost-effective but they really don’t necessarily perform as nature intended. Meagan: Right. Julie: And then another one that’s maybe a little counterintuitive or nuanced is the nutrient iron. Most prenatal vitamins have iron in them. We chose not to include iron in our prenatal for a few reasons. Iron is absolutely an essential nutrient for pregnancy and postpartum. It supports your blood volume. Your blood volume effectively doubles in pregnancy and you lose blood postpartum. It’s a super important nutrient for avoiding anemia and for just overall blood volume expansion during pregnancy. The reason to not include it in a prenatal is that your needs vary by trimester or by stage. We wanted to make a prenatal vitamin that was safe to take before, during, and after pregnancy and safe for all women to be taking. Iron also competes with calcium and other nutrients for absorption in the body. Oftentimes, prenatals will just include both calcium and iron and you can be pretty well-assured that the calcium that you’re taking isn’t going to be absorbed in that case. Or sometimes they just leave calcium but they don’t tell you that you should take calcium at a different time of day. We’ve kept calcium in our prenatal and we offer iron as a separate add-on. The advantage of that is that you can take exactly what you need. If you’ve done any iron testing, which is pretty common in pregnancy, you can tailor the dosage to your ferritin levels. That’s the type of iron testing we recommend. And then taking it at a different time of day ensures you’re absorbing all of the calcium that you need as well as all of the iron that you need. We like delivering iron in the kelated form bound to glycine. It’s much gentler on the stomach. A lot of prenatals have a really high dose of iron in a form that’s not well-absorbed. It can cause GI issues and then women will stop taking their prenatal because they say it makes them nauseous. Meagan: Yes! Julie: There are many reasons why we think that iron in a prenatal is suboptimal. I think if you don’t know that information, you might scan prenatals like Needed’s and say, “Oh, it doesn’t include iron. That’s a problem,” and it’s actually a really intentional choice so I like to call that nutrient out. Meagan: I love that you talked about that because as a doula, we actually do have a lot of clients who pee on a stick, see it’s positive, and start looking for a prenatal. We have clients that do hire us in that stage and we’re always there for our clients. They’ll be writing us and be like, “We’re just so sick and it seems to be after I take my prenatal,” so they stop taking their prenatal because it makes them sick or their nausea gets so intense when in fact, it’s not what we should be viewing. Again, not to shame anyone if you’ve stopped taking your prenatal. We should be taking our prenatal, but we don’t think about that. I love that you guys have done that. I’ve been sharing it since I learned about this. I’ve been sharing that with my clients really early on because I think it’s really important. Something also I love about your products is that there is a lot that can help with nausea as well. Julie: Yeah. I’m glad you mentioned that because that’s one of the key reasons why it’s really, really beneficial to start taking a prenatal vitamin before you try to conceive. We suggest up to 6-12 months before conception getting on a high-quality prenatal vitamin for a couple of reasons. One is that it can support cycle regularity so ovulation and healthy ovulation. It can also support egg quality. We have now a separate add-on, egg quality support, which is amazing in helping your egg follicles as they mature into egg cells before ovulation which is great. And then it can help you to build up your nutrient stores. Oftentimes, and I’ve been there. I’ve had first-trimester nausea despite all of my best attempts and taking all of the right supplements. Sometimes it just happens. You can minimize nausea by having adequate nutrient stores prior to conceiving. And then if you do find yourself with severe nausea in the first trimester, if your nutrient levels are optimal pre-conception, it’s more tolerable to skip a day or two of your prenatal vitamin because your levels were already in a great range before so your body has enough nutrient stores. I’m not advocating not taking your prenatal in the first trimester, but if life happens and you skip some days, the fact that you started early on means that your body is going to have enough of those nutrients to draw upon to get you through to the second trimester when hopefully you’re feeling much better. Meagan: Right. If we have really bad nausea and vomiting and we’re throwing up all of the time, we’re also losing nutrients, so it’s a whole cycle. It all goes together. Julie: Yep. It sure does. It sure does. Not to push our products, that’s not what this is about, but I would say hydration, hydration, hydration for nausea. We have hydration support if you are interested at all in trying it, I suggest trying it. It has the right nutrient ratios for pregnancy. It’s made without artificial sweeteners. It just has monk fruit which is naturally occurring. It comes in three flavors, three very first-trimester-friendly flavors. They are citrusy so grapefruit, lime, and lemon. But you can also make hydration stuff at home. You can just take a glass of water and put in some sea salt. You can add a squeeze of lemon. You can add in– you probably have your own recipe for a labor aid, but that’s another use of our hydration support during labor. Hydration can really impact. It’s like the chicken and the egg. “I’m nauseous. I don’t want to drink water. Water makes me nauseous,” but also if you’re dehydrated, nausea is worse. I would really recommend trying to stay hydrated during the first trimester if you can. Meagan: Yeah, absolutely. From the first trimester to the end, sometimes we can have early prodromal labor and stuff like that when we’re actually dehydrated. Julie: Exactly. Meagan: It’s just so, so, so important the whole time. Julie: And just to support that blood volume expansion that we were talking about that takes place in the second and third trimester. It has to come from nutrients but largely water. Your amniotic fluid levels increase. Sometimes they decrease too and they risk you out of a VBAC or a home birth and the things that you want for your birth outcome. So yeah. Hydration is key. It’s your mom’s advice, “Make sure you’re drinking enough water,” but it’s really true. Meagan: It really is true. My kids all roll their eyes at me. They’re really big into sports and I’m like, “No, your body, your muscles, and everything needs that hydration.” Okay, so we’ve talked about when it’s good. We’ve talked about taking it before. One of the questions is, “Oh, I’ve had my baby. I’m done with my prenatal vitamin, right?” But we talked a little bit and skimmed the surface about why it is important to take it during breastfeeding. We talked a little bit about how it’s still depleting our bodies, but after having a baby, how long should we be taking these? Then if we want a close baby, is it something that we should just continue? Julie: Yeah. Yeah, great questions. The minimum that we would recommend is 6 months after delivery and that is whether or not you are breastfeeding. So from your choice or from how things turn out and you aren’t lactating, it’s still beneficial to give your body that time to replenish because pregnancy and labor are really depleting events on the body. It just takes time to rebuild those nutrient stores. That’s the minimum. So yes. Please, keep taking a prenatal vitamin postnatally. There are postnatal vitamins on the market. Generally, that is a marketing differentiation, not a product-quality differentiation. Most postnatal vitamins are almost identical to their prenatal counterparts except for a couple of nutrients where they take maybe 25mg more vitamin C which is less than you would get from one strawberry. It’s basically a marketing play. We skipped that step and we just offer one prenatal vitamin that’s appropriate for the entire perinatal, before, during, and after stage. And then if you are breastfeeding or pumping or otherwise producing milk, we recommend staying on a prenatal vitamin for that full duration of time. If you can give your body a couple of months once you stop lactating, that’s really beneficial for the same reasons we just discussed. It gives your body a chance to recuperate. There is a concept known as the recuperative interval when we’re thinking about pregnancy spacing if you’re having multiple kids. I myself did not do this. I breastfed my first daughter basically until the day my second daughter was born. Maybe not optimal– optimal in some ways, not optimal in others. Meagan: Really common, though. Julie: Really common. Yep. Meagan: A lot of people do it and then they want to feed both babies. Julie: Exactly. Or maybe you can breastfeed until you’re pregnant with the second. In any event, that is a reason why you should keep taking your prenatal vitamin because it ensures that your body has enough nutrients to give to your baby. Basically, the order of operations is going to be growing baby gets first, older baby gets second, and mom gets last. So if you are nursing while pregnant, if you are tandem feeding, that’s what your body is going to do. It’s evolutionary. Your body is really smart. Except for in the example that we talked about in the recording about severe postpartum hemorrhaging, your body’s first priority will be surviving but second to that, your body is going to give to baby before it gives to older baby before it gives to itself. Make sure to take your prenatal vitamin all throughout. I think that’s a general misunderstanding. A lot of women are like, “I’m not pregnant anymore.” Men, when looking at the category when Ryan and I were starting the company, they’re like, “It’s 9 months. You’re going to have a customer for a maximum of 9 months.” We were like, “Just frankly, you’re wrong,” because this is a life stage that women are in for five years, or seven years, or ten years. It’s a much longer life stage when you account for trying to conceive, pregnancy, postpartum, breastfeeding, trying again, or preparing to conceive again. That’s why this is a consequential decision and taking care of your body during those five or ten or one or two really intensive nutritional years can set you up for long-term health and your babies up for long-term health for the rest of their life. Meagan: Yeah, absolutely. I was one of those after my first. My provider didn’t say, “Continue taking these vitamins.” That wasn’t even a discussion. It was, “How are you feeling? What birth control would you like?” That’s really the conversation that we had. Again, we’re not shaming the provider for that but that’s just following the script. “Okay. We’re six weeks. This is what we’re doing.” I just needed so much more. Julie: At six weeks, honestly, nutritionally depletion-wise, you are nowhere near recovered even if your scar is healing well from a Cesarean or if your stitches are healing well from a vaginal delivery. Emotionally and physically, we are very much postpartum at that point. Even at the stage I am now at 9 months postpartum, this is still postpartum. We call it the fourth trimester sometimes which at least allows for three months, but in a lot of years, it’s two years after having a baby that your body is still returning to homeostasis, whatever that homeostasis is for you. Meagan: Right, and then by then, we’re kind of entering that prenatal stage again. Julie: You could be. Exactly. Meagan: Right? A lot of people are. I love this. Okay, so a couple more questions. I know we are kind of running out of time, but collagen is a big thing that I never really heard about when I was pregnant. The words didn’t even come out of anyone’s mouth. I honestly didn’t even read it online. You guys have prenatal protein collagen or collagen protein. I think it’s important to talk about that too because it can impact us in a really positive way not only during but especially after healing from surgery or anything. We’ve got tissues that are healing so I don’t know if you’d like to share a little bit about the protein. Julie: I’d love to. I think that this is something that we are super passionate about and something I learned a lot about when we were in the formulation stage. We know that protein requirements increase substantially in pregnancy. You need 80-100g of protein a day. That is the low end of the range. There is newer research showing that you need upwards of 140g of protein a day. That’s a lot to hit when you’re pregnant. Those needs are there because you’re growing a baby obviously. Amino acids are the building blocks of life, the organ that you’re growing, the placenta, and blood sugar regulation. Especially as your blood volume is expanding, protein is really important for stabilizing blood sugar and for a lot of other things. We love collagen proteins specifically because it’s a single ingredient. It’s really cleanly sourced. Plant-based proteins can be high in heavy metals whereas we don’t find that to be the case with collagen protein. The amino acids in collagen protein are specifically really beneficial for pregnancy. Two of them, glycine and proline, are conditionally essential meaning that your body can’t synthesize them on their own. They have to be consumed by food and many of us are not consuming the foods that are high in glycine and proline like the carcasses of animals and the skins and bones. It’s just not very common, especially in pregnancy. We tend to eat boneless, skinless chicken breast. Maybe some even have animal protein aversions during pregnancy. Collagen is an awesome form of glycine and proline and overall meets your protein needs. It’s effectively flavorless. You can blend it into smoothies. It blends really well with our prenatal multivitamin powder. You can mix it, especially for those first-trimester mamas, into mac and cheese. You can mix it into just about anything to get some protein in even when you’re feeling a bit nauseous. Then for postpartum, why it’s beneficial is that your skin tissue stretches. It needs to recover whether that’s because you had a vaginal delivery or a Cesarean. Collagen can be really, really helpful for tissue healing and repair and recovery in that regard. The last thing I should mention is that the placenta is actually comprised of collagen so it really makes a lot of sense to be consuming those building blocks when you’re making your new organ for pregnancy. Meagan: Yeah. I want to share with you guys that I love it in my oatmeal. Julie: Yeah, that’s awesome. Meagan: I put it in my oatmeal. I’ll put some apples and a little bit of cinnamon and it works really well. I actually put a little bit of yogurt. It’s amazing. Julie: I sneak it into my daughter’s oatmeal. She calls it sprinkles. Kids have lower protein requirements than adults of course, but it helps to balance out their blood sugar too in a really beneficial way. Making sure she’s not bouncing off the walls more than necessary. Meagan: I love that. I love that. That’s something too I love. A lot of this is really good for kids. We could go into it. There are so many other products. There are a lot that my kids love as well. Okay, so the last question, we kind of talked about this in the beginning how we can get this through food. It’s hard to get that because we’re not typically eating carcasses and skin and liver, right? Julie: Yep. Meagan: So what are some foods that we can drop for this audience to eat that help us during pregnancy just in general and in postpartum that will help us in addition to Needed and other products? Julie: Well, I would say that in general, we are huge advocates for food. You can’t out-supplement a bad diet. Food should be a critical component of your nutrition plan. It’s just really hard sometimes to eat optimally. But foods to focus on during pregnancy, are lots of organic if you can, leafy greens, vegetables, and fruits. Eat the rainbow. I think some people tend to be afraid of fruits because of the sugar content and gestational diabetes but there is fiber in fruit. Unlike fruit juice, there is actually fiber in fruit. You can pair it with something like nut butter to add a little bit of protein and fat to help with blood sugar stability. Other things to focus on are prebiotics and probiotic-rich foods like kimchi and depending on your stance on it, I drink kombucha during pregnancy. There is a tiny, tiny, tiny amount of alcohol in it but the benefits to me outweigh any potential risk of alcohol content. Sauerkraut is another really great one and fiber. A lot of women during pregnancy have hemorrhoids or they’re constipated so foods that are rich in fiber are generally very good for you and your baby. Probably one of my favorites when I’m pregnant– I tend to fall off the wagon a little bit postpartum because you have a newborn and whatnot, but I’m usually really good at smoothies during pregnancy. Smoothies are a great way. You can put our collagen in it or our prenatal multivitamin powder. If you are not a capsules fan, you can even take our pre-probiotic and add it or vitamin D. You can add in a lot of our capsule products. Just break open the capsule and dump the powder contents into the smoothie. That’s a really great way to put in greens and fruits and whatever else– nuts, seeds. That’s a great way to get in your fat content. That’s definitely one of my favorites as well as depending on the season. If you’re pregnant more in the winter months, you can make soups. Stir the collagen protein into the soup. Try to load it with those other fruits, vegetables, and fiber-type-rich foods. But I think we’re really, really passionate about debunking some of the concerns around pregnancy like pregnancy weight gain. You are eating for two. It doesn’t mean you should go load up on ice cream and pretzels and chips. Some of that in moderation is totally fine, but think about nutrient density. That’s what you’re going for both for you and your baby. It’s going to help you avoid depletion, to feel better. Pregnancy, even if you’re eating well, is pretty uncomfortable so I think eating foods that are going to nourish you and leave you feeling good is definitely the priority. We do share some really great recipe ideas over on our Instagram. A couple of people in our network that you can check out if you’re looking for more food recommendations, the prenatal nutritionist, Ryann Kipping, has a prenatal nutrition library that is full of really great food-based nutrition ideas. We also love the work of Lily Nichols. She’s really popular with midwives and doulas also. She wrote a book called “Real Food for Pregnancy” that has some great, practical tips for nutrient-dense meals. A lot of what she’s recommending is going to sound familiar from this podcast like collagen and eating more meat than you might think you need and eating more. Honestly, I say this coming from the perspective of having been a vegetarian and a vegan for a long time. I think that you can do that during pregnancy but you have to be really intentional about protein and about nutrients like vitamin D and choline. It’s much more difficult but it’s possible. I would not advise undergoing a vegetarian or a vegan pregnancy without working with a dietician or a nutritionist to help you figure out what those nutritional gaps could be. Meagan: That’s a really good point because we do. We know we all eat differently and we all have different allergies and things that have developed so that is really, really important to know. We are going to have all of these links that she is mentioning like the blogs, the recipes, all of this linked in the show notes. So if you want to go and dive in– Julie: Nerd out with us. Meagan: Nerd out and get your teeth sinking into this, then check it out because you guys, Needed is just amazing. Really, it’s such an honor to have had you on today to be talking about this. Julie: Thank you for having me. Meagan: Because it is so important. With my first and second pregnancies, I was healthy-ish but each pregnancy got better because I learned more. Julie: Isn’t that amazing that there is this concept of, “Oh, you’re too old or you’re subsequent.” If I have a third, I’ll be a geriatric mom but it’s so much more about your health span or your health status than it is about age in some ways you can have your healthiest pregnancy at 40 if you’re doing the right things and taking care of your body in the right way. Meagan: Yeah. Yeah. My best pregnancy was the older one. The oldest that I was. I was the oldest in my pregnancy and it was my best pregnancy. It just impacts. I wanted to touch a little bit on what you said that sometimes we hesitate to eat or we are eating the right things. Women of Strength, if you are listening, I know that as a person wanting to have a VBAC and as a mama wanting to have a VBAC, sometimes we get scared of the world out there saying, “Your baby is too big and you can’t have a vaginal birth.” I saw just today three posts in our community, “A doctor said that my baby is too big.” Then we sometimes tend to hold back and not get the right nutrients, right? Not purposely, but purposely because we’re trying not to make too big of a baby because we really want this vaginal birth. It’s all twisted and I don’t love it, but it’s really important to remember like she was saying, get these nutrient-dense foods in you and don’t be scared to supplement. Don’t be scared to supplement because our bodies and babies deserve it. We deserve it. Julie: Yep. And on the other side of birth, I tend to feel that bigger babies sometimes sleep better. They sometimes eat better. My second daughter was almost 9 pounds, but the first daughter was late. She was born almost at 42 weeks. I was so nervous about it, but she was a champion sleeper and feeder. I think there is a lot of natural wisdom in that your body knows how big of a baby to grow and your body knows how long to carry that baby for. But I loved this conversation. I think it’s so important. It might not be immediately intuitive why nutrition and birth outcomes go so hand-in-hand, but they do. Oftentimes, what risks women out of the birth that they want whether it’s a VBAC or just a primary first-time vaginal birth is a factor that can be traced back to nutrition like preterm labor or gestational diabetes or whatnot. We are very aligned on the idea that nutrition for prevention and for optimal outcomes. Meagan: Yeah. Yeah. I had a client during COVID who had pre-eclampsia. She got it at 18 weeks. She had a home birth planned and all of these amazing things planned. She had to completely shift gears. The second one, she was like, “I’m going to start trying soon and I’m going to dive in.” She did. She dove in and changed so many things and had an incredible, incredible home birth with her second. She was like, “I really do feel that because I fed my body and fueled my body, it gave back.” We know that sometimes we do all of the right things, everything, and still, we have undesired outcomes. But if we can do everything within our control, if we can do what we can within our control– Julie: That’s exactly it. Yeah, I’m nodding my head here because we keep saying to ourselves and are starting to say more externally that there is so much on this journey that you can’t control. You can do everything right and still have things not go as you want. That’s just a reality. But nutrition is a big one that you can control so why not focus on the things that you can control and let go of the rest? Meagan: Right. Absolutely. Well, we will end on that note because I think that is such a powerful ending point. I want to share with everybody that we are going to have the link in the show notes, but if you want to go check out Needed and all of the amazing products because we just barely touched on a few today, you can go to thisisneeded.com to learn more about Julie and Ryan and go learn about their partners. There are a lot of partners that we’ve actually had on the show. We just love you guys. We appreciate you so much so thank you for taking the time today. Julie: Absolutely. It was really fun. Closing Would you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com . Congratulations on starting your journey of learning and discovery with The VBAC Link. 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