What To Look For In A Prenatal Vitamin with FullWell founder Ayla Barmmer

Oct 23, 2023 | Let's Hear From The Experts

For almost 20 years, Ayla Barmmer, MS, RDN, LDN, has advanced the health and empowerment of thousands of clients, patients, peers, and mentees by fusing her expertise in nutritional science, functional medicine, and evidence-based holistic solutions. While currently on sabbatical from private practice work, Ayla owns and serves as the practice director of Boston Functional Nutrition, an integrative, functional nutrition practice specializing in women’s health and infertility. She is also a co-founder of the Women’s Health Nutrition Academy, leading the way in providing continuing education to healthcare practitioners. Most notably, Ayla is the founder and CEO of FullWell, a fertility wellness brand widely endorsed by top practitioners for its high quality, evidence-based supplements and educational efforts. On a mission to make the most current science accessible to the public, you can always find Ayla sharing through the Knowledge Well, FullWell’s informational hub, supporting families with expert information and the power of choice.

In This Episode:

  • When to starting taking a prenatal 
  • The dangers of supplement industry 
  • The top nutrients most prenatals come up short on 
  • The importance of Vitamin D for fertility and and pregnancy 
  • Best supplements for regaining and regulating your cycle with HA 

Podcast Transcript

Lindsey Lusson  00:00

Tell us a little bit more about what vitamin D does for preconception, for fertility, how people can know if they need more. What are the sources? Can we get into that a little bit. 

Ayla Barmmer  00:10

Vitamin D really has almost like a hormone-like action and plays a role in a number of different ways with ovulation and egg quality. And so vitamin D deficiency I think, is one of the easiest, more standard tests you can really get done even through insurance from your provider to see where you’re at. And I love to see for fertility vitamin D, like be at least above 40, if not 50. And really kind of get it in that 50 to 80 range is ideal for both women and men. 

Lindsey Lusson  00:40

Welcome to the period recovery and fertility podcast. Here we discuss the challenging, warning and life changing process of recovering your period and finding freedom with food and exercise. Whether you’re hoping to regain your cycle to get your health back on track where you’re ready to become a mama, this podcast is for you. While the recovery process isn’t always rainbows and butterflies, it’s my hope to bring you both information and inspiration during your own recovery journey. I’m your host, registered dietitian and fellow HA woman Lindsey Lusson. 

Lindsey Lusson  01:12

Okay everyone. Welcome back to the Period Recovery and Fertility Podcast. I am so excited to bring on the person that I’m interviewing, Ayla Barmmer. For almost 20 years, Ayla has advanced health and empowerment of thousands of clients, patients, peers and mentees by focusing her expertise in Nutritional Science, functional medicine and evidence based holistic solutions. While currently on sabbatical from her private practice work, Ayla owns and serves as the practice director of Boston Functional Medicine and integrative functional nutrition practice specializing in women’s health and infertility. She is also the co-founder of the Women’s Health Nutrition Academy leading the way in providing continuing education to health care practitioners. Most notably, Ayla is the CEO of FullWell, a fertility wellness brand widely endorsed by top practitioners for its quality, evidence based supplements and educational efforts. On a mission to make the most current science accessible to the public, you can always find Ayla sharing through Knowledge Well, Fullwell’s informational hub, supporting families with expert information and the power of choice. 

Lindsey Lusson  02:23

Welcome Ayla. How are you? 

Ayla Barmmer  02:24

Oh, thank you for having me. And thanks for reading through that long intro. I should probably shorten that a little. 

Lindsey Lusson  02:29

No, I mean, it needs to be like all encompassing of all that you have done and all that you are currently doing. So it’s super exciting. And like just like the knowledge will have, it’s just like wealth of information, like I’ve learned so much. And I’m just so excited to have you on and let you share some things with us. So let’s get into it. Tell us a little bit about FullWell and kind of like how this came to be and how this is like your brand now.

Ayla Barmmer  02:55

Yeah, so FullWell is truly a major pivot in my career that I didn’t anticipate getting into. I had worked for most of my career really building my private practice, you know, and that was always my end goal, a multi clinician private practice that really served people globally, you know, who were struggling with fertility. So I was working with women and men in practice for years and really enjoyed that work and got so much experience working with individuals and groups and couples, but the needs that I saw as I started to incorporate and integrate dietary supplements into client protocols was first and foremost, I think a lot of the formulas I was looking at didn’t really match the evidence. I saw a disconnect between what we really needed to fill the gaps with with supplements versus diet and what was actually in formulas. So I didn’t find the specific formula that I wanted us to get what I would feel would be the best outcomes with my clients. Even using myself or with recommending to family members, you know, and so there was that. And then second, there’s this curtain, or wall really, when it comes to the dietary supplement industry that’s hard to get behind and I wanted behind that curtain to understand how are these supplements made? How can we trust the quality? This is such a critical stage of life? I mean, arguably, we should always be concerned with what we’re putting in our body. But I really wasn’t happy with the lack of transparency and not really fully getting my questions answered by even some of the health professional lines that are really working with health practitioners and supposed to be kind of a step above. And so for me, the goal was to design exactly the formula that I wanted, that I knew would be most effective with my clients. And that really started with a prenatal multivitamin, first and foremost, and then two, get behind the curtain and have full control over the quality, the testing we were

Ayla Barmmer  04:59

doing and sharing those results with customers. So really what I wanted to see, in any dietary supplement I aim to create. And when I launched FullWell, it was originally full circle prenatal and it was two weeks before I gave birth to my second baby, which I always say is just like not what you do, right. But I had been working on it for easily five years prior to that. And I finally had something that I could launch with, I wanted to put it out to the world and over the course of my maternity leave, I remember coming back in the fall, I just had had a lot of colleagues, a lot of people really interested, appreciate the formula, having test results in their hand to really evaluate and feel confident in. And it kind of has, it’s grown really organically and also strategically since then. So now, I feel like FullWell really with our mission to educate  as well really fills both of my buckets. I can educate and communicate on something I’m so passionate about, which is fertility health and also put out really, I feel exceptional products.

Lindsey Lusson  06:09

Well and for those who aren’t aware, like the supplement industry is a little shady. It’s not as regulated the way food is. And so for you to be able to create a product that, you as a registered dietician, as someone in the health and wellness space that can kind of put your stamp of approval on something. I personally find just really encouraging and really comforting to know, like, “okay, like I trust the person who’s making the supplement.” “This is quality.” And this is helpful, especially as you mentioned, we should always be careful about what we’re putting in our bodies, but especially when we start thinking about having our bodies in the right place for growing a little human. So I love them.

Ayla Barmmer  06:53

Yeah, and to that point too, there’s actually very few when you get into it. There’s actually very few health practitioners behind dietary supplement companies. A lot of companies are run by marketing professionals, entrepreneurs. A lot of prenatal vitamins are just frankly, made by middle aged white men who are looking at industry data and in what’s going to sell and what’s going to be most economical. And that’s not how we want our formula is made. Even qualifying the health practitioner who’s behind it too, right. I think, we might get into this a little bit, but it’ll be GYN who generally might say, you can go pick up anything off of the pharmacy shelf. For a prenatal is not necessarily the subject matter expert that you want behind your nutrition formulas, your dietary supplements. So registered dieticians like you and I, we’ve got five to seven/eight years of specific training in this. And so I think that it’s important to know, too, that marketing professionals are behind a lot of dietary supplement companies, and I really think it ought to be nutrition professionals. 

Lindsey Lusson  08:00

Yes. And let’s get into that even because I don’t like to drag people’s name and the dirt. But there’s one prenatal that is very well marketed and I even took it during my second pregnancy because it tastes good and it’s better than some, and I felt good about it at the time. But now learning what I know now I’m like, oh, that is lacking in so many areas. And it’s obvious when you look up the RDA for pregnant women and then you look at what’s on your bottle, and it’s like, okay, there is this huge gap here. So tell us a little bit more about why OBs are like, yep, just take whatever you want. Like, they’re basically saying that, a target brand prenatal is the same as FullWell prenatal, like, why do they feel that way? Where’s the gap?

Ayla Barmmer  08:53

Yeah, so I think first and foremost, OBGYN is your doctors, like, they’re absolutely part of your team, right? I mean, they’ve got their zone of genius, and they’ve got their scope of practice which is absolutely critical to a healthy pregnancy. But it doesn’t include nutrition. It just, that’s not something that they’ve ever gotten, unless they’ve gone and sought out additional certifications and training on, it’s not part of a standard MD training. I think it’s on average, 19, you know, maybe 20 hours that any doctor will get in their entire medical program, including residency in nutrition, right. And so, on a day to day, again, that’s not really their scope of practice. So are they embedded in it like, we are, like registered dieticians? I mean, no, right. And we all have our scope of practice, right? I mean, there’s things that I certainly can’t do or wouldn’t do as an RND. So I think first and foremost, we’re looking to OBGYN is to do too much to be everything and provide all the things when in reality, the best scenario is the collaboration, you know. Referring out to subject matter experts in nutrition and sO

Ayla Barmmer  10:00

I think that’s what I would love to see. And I hope we’re making some strides in that way to bridge that gap between conventional providers, OB GYN and dieticians, through some things that we’ve got coming up with FullWell that I’m excited about. But, really, I think that the key is referring out, making sure that you’ve got a subject matter expert really making those those recommendations. And the probably the biggest reason is that there’s just a lack of really knowledge and awareness among a lot of providers.They cannot stay on top of what the differences are, and are probably using very well we know, based on data, that they’re using out outdated research and outdated guidelines on nutrition, when we do have really good evidence, but it doesn’t always make its way to conventional practice. I think there was a research study that it takes like 18 years, I think, between 15 and 20 years for research to make it to practice. So, to me that’s really telling and it’s like, Alright, we’re gonna, we’re gonna wait 15 to 20 years are we going to just use the best available evidence to create the formula? So obviously, I believe it’s the latter,

Lindsey Lusson  11:15

You made, so many great points in what you just said, I think one of the things that is coming up for me, especially when I think about a lot of women in the HA space, is we’re expecting too much from our OB, like, we go to our OB and we’re like, okay, this is my problem, what do I do to fix it? And because HA is such a nutrition and lifestyle-based condition, your OB is not going to be the person to give you the guidance. And so same to like with your prenatal, and then obviously the lag time in the research and clinicians being able to one know about it, and maybe to feel comfortable with recommending it. So on that note, like for those who are actively trying to conceive listening, or those who are even thinking about it, what should we be looking for in a prenatal? Maybe give us something tangible, like top five things that are typically lacking that are really important.

Ayla Barmmer  12:13

Yes, my favorite question because I feel most passionate and most driven in my work to spread the message that the preconception period is really the most important period. I think that we start thinking about nutrition and taking a prenatal once we’ve confirmed pregnancy, once we know we’re pregnant, maybe after even that first prenatal visit with our OB, and really, we’re missing a key window. And this is not to say that even I did it perfectly right, you know, with my practices are that we can be perfect. But if your listeners are, I think there’s a sweet spot here, right? Like where maybe struggling with HA making the positive changes right now and there’s so much that you can do in order to get pregnant, but so much that you can do to help support the health of the pregnancy, not just getting a positive pregnancy test, but the health of the pregnancy and the health long term health of baby by focusing on some really key nutrients on the preconception period. 

Ayla Barmmer  13:12

So some of the top nutrients I mean, I’ll start with folate, because that’s probably the most well known when it comes to prenatal nutrition. And that’s because there was a huge public health campaign in the 90s. To help prevent neural tube defects, they started fortifying the food supply with a synthetic version of folate, folic acid. And so that was a largely successful public health effort and it did help significantly in infusing that important nutrient into diets of women. The problem is we probably can do well, I know, we can do better than folic acid, you know, in that particular form of the nutrient. It’s not that synthetic nutrients are all bad. I actually did a blog post on talking about that. It’s more about the bioavailability, how well can your body utilize the form of the nutrient that you’re taking. And so when it comes to folate, 80% of the folate that we find in the food supply is actually methyl folate or folinic acid. So that’s the form that I would suggest looking for in a prenatal multivitamin. Really making sure that you’re getting 800 to 1000 micrograms a day of supplemental methyl folate or folinic acid. It’s also called calcium folinate in addition to having folate rich foods, which again, are going to be natural sources of methyl folate. And the reason why other nutrients that I would put in that like top five would be other nutrients that also support neural tube development. So the reason why folate and I don’t know if I mentioned this, the reason why folate was introduced as a public health effort, it really was to prevent neural tube defects which are something that actually occur so early in a pregnancy that It may be before you even know you’re pregnant. So by week five of pregnancy, and remember, that’s actually five weeks from your last period, the first day of your last period. So you’re like a week pregnant, you know, really couple of few weeks pregnant. So the neural tube actually closes week five. And so those nutrients, why preconception is so important as those nutrients that are needed for neural tube development formation, need to be on board preconception, so folate, choline, vitamin D, 12, those are, that’s kind of like a trifecta. And most prenatal vitamins will be lacking in choline specifically, and the reason is, it’s one it’s expensive, two, it’s bulky, it takes up a lot of space in the capsule. And so our needs for choline are actually quite high. They are anywhere from at a minimum 550, 450 to 550 milligrams a day to newer research suggesting closer to 1000 milligrams a day.

Ayla Barmmer  14:55

Which is wild, because so many prenatals have like 25 milligrams.

Ayla Barmmer  16:10

Yeah, they may not have any or they’ll have negligible amounts. And that’s kind of what I call pixie dusting. In the supplement industry, it’s where there’s small amounts of nutrients just to show up on the label to say a checkbox, yes, it has choline in it, but is it anywhere near enough to meet your needs? It’s most people, in fact, 95% of women aren’t even reaching the adequate intake level for choline. And that set below what we actually need to prevent neural tube defects. So choline, folate, vitamin D12, I would also say magnesium is pretty high up there for me, because it’s so vital in every single cellular function, really. And it’s also another bulky nutrient. And so this is where a lot of prenatal vitamins will skim. They’ll do small, very low amounts of magnesium to keep the number of capsules down. And I think that’s a red flag for any prenatal vitamin is if it’s a one or even a two a day, you know, it’s not going to have enough magnesium, choline, calcium, the bulky nutrients that you really do need supplementally. So that’s important. A lot more I could say, but I’ll pause there.

Lindsey Lusson  17:24

I think that that’s great. And that’s such a, like you’re answering some of my questions already, right? It’s like, why are some of these robust prenatals multiple pills per day? And that makes so much sense. But talk to us having been pregnant yourself, talk to us from the seven weeks pregnant nause, I can’t take you know, five to eight pills. Is there, Do you have any recommendations or strategies for how someone can nourish their bodies well, and supplement well, even during this very sensitive time?

Ayla Barmmer  17:59

Yes, yes, I get that question all the time. And yep, I’ve been through it myself, I was not immune to nausea. It was, it’s brutal, it absolutely is brutal. So this is why again, the preconception period is so important because if you can solidly take a comprehensive prenatal vitamin for three, four months, as long as you can, you know, prior to pregnancy, then it’s going to help build up your nutrient stores so that there are those weeks that the weeks that are the worst, right, and usually it’s several it’s not, you know, it can be variable for people, but there’s several where we know it’s like attends to be the worst and you can get by without taking your prenatal or taking what you can have the prenatal and just focusing on what you can eat and what you can do, right. I I think that also setting yourself up by taking enough nutrients, like the B vitamins, including vitamin B6 preconception has been shown to help support the severity of nausea. It might help the severity of nausea in the first trimester if you are not going in depleted. So I think that’s one strategy and not to stress too much about like the days that you feel absolutely awful, and you’re just trying to get in some food and hydration, fine, you know, that may not be a day that you can swallow pills, and that’s okay, or not the full serving, and then you kind of come back to it when you can. I feel you know, for most people, that’s going to be enough there may be certain situations where if you have past pregnancy where there was a neural tube defect if there was you know, if there’s other complications, I mean, always there’s going to be one off situations here where it’s like, we gotta find a way to get like certain things in but for the most part, I think that strategy works.

Lindsey Lusson  19:44

Okay. And I love that and I think that that’s such a great tangible thing that someone can focus on during the fertility journey, when so many things are out of their control is you can focus on almost like storing up nutrients, knowing that there might be a time where we can’t be eating perfectly, we can’t be taking the supplement that we need. So I love that as a strategy. That’s so wonderful.

Ayla Barmmer  20:12

I love it too, if I could just, I think this might be a good opportunity to mention too. I mean, there’s a lot of different delivery formats for prenatals on the market, too. And one of the reasons because if anybody listening is not familiar with FullWell, and they head over to take a look at it, the first thing you’re going to see is, it’s an eight a day. It’s probably worth mentioning that that’s a lot. And I recognize that I think most people do really well with just doing four and four, four with one meal four the another.  You can open up the capsules and put them into things and store them in to cool beverages or smoothies. But the reason why I really chose the capsule format and have not gone down to the powdered format, because in my opinion, it’s very difficult to get,  and I’ve done a lot of RND on this because we get a lot of requests for a powdered format over multi. It’s very difficult to get consistent doses of the nutrients that you claim on your label per serving when you put it into a powdered format. It has to really be in a protein base. And it has to be like in single servings, and it’s still challenging. So one of the things that I like about the capsule delivery format iyou know you’re getting consistent doses of nutrients in each serving. And that’s important b ecause, folate is a vastly different size of choline, which we kind of talked about. And so if there’s a chance we want to make sure that you’re getting both of those key nutrients when you need them and not having folate kind of settled down to the bottom of the canister or like you know, having their their be dispersed. Like there’s different weights and sizes of these nutrients. And so basically, what I’m getting at is that capsules do provide consistent dosing to make sure you’re getting what the label says. And it also helps protect the nutrients too from oxidation and humidity, which are also things that can compromise the nutrients.

Lindsey Lusson  22:05

Okay, I love that. And you’re answering questions before I even ask them because I have been too like in some companies talking about to combat the nausea hears it in a powdered form. There’s so many good points. Another thing that I think I like the capsules for over like a powdered form is travel. Like how easy is it to take your bottle of these perfectly little sized capsules versus the big like canister of the thing? Kind of like practicality of it. Well, we’ve talked about a couple of key nutrients that people should be looking for in a prenatal. If we can, I’d love to just talk about top nutrients, maybe even more from like the food side and in maybe also to supplements because there are going to be some that are just really hard to get from dietary sources. So, vitamin D is one that comes up so often. Tell us a little bit more about what vitamin D does for preconception for fertility, how people can know if they need more, what are the sources. Can we get into that a little bit?

Ayla Barmmer  23:10

Yeah, Vitamin D is fascinating. I mean, it has so many functions in the body and it’s just so critical. To the point where, if you just look at conception data, you will see differences in geography, where latitudes and where people live, you’ll see differences in time of year and season of pregnancy rates. When we look at things kind of naturally. And vitamin D deficiency is just so prevalent no matter where you live. And there’s a lot of reasons for that, we’re protecting our skin from the sun, we’re not nomadic tribes, you know, anymore living in tribes that are constantly outside, we’re spending more time inside. So there’s a lot of reasons why we’re generally, throughout the world, lacking in vitamin D. And vitamin D, really has almost like a hormone-like action and plays a role in a number of different ways with ovulation and egg quality. And so vitamin D deficiency, I think, it’s one of the easiest, more standard tests, you can really get done even through insurance from your provider to see where you’re at. And I love to see for fertility, vitamin D, like be at least above 40, if not 50, and really kind of get it in that 50 to 80 kind of range is ideal for both women and men. I mean, because we’re going to be supporting ovulation, egg quality. I’ve actually seen too, you know, there’s a lot of research and we don’t have to get in the mechanism of it, but vitamin D deficiency can make AMH levels look worse than they are. And so I have seen people shuttled in to fertility treatments unnecessarily and I wouldn’t say vitamin D or vitamin D deficiency might be the only reason but I’ve certainly seen it with hypothalamic amenorrhea, my HA clients where things have not been fully investigated that fertility could be restored without going into treatment. So I know we’re getting off of vitamin D there. But those are some of the, I mean, thyroid hormone and vitamin D is really critical for that, for our metabolic health, it plays a role everywhere throughout our body.

Lindsey Lusson  25:27

Yeah. And is it also worth mentioning Ayla, that, above 40, ideally 50, is actually above what some practitioners might say is needed?

Ayla Barmmer  25:40

Yeah, I think it is worth mentioning. It seems to have kind of quieted down now. Because I don’t think there was a lot of real teeth to it. But I had seen sort of a wave of communications, like on social about vitamin D, being something we want to keep low, that we want to avoid supplementation, I don’t agree with that. I think vitamin D is the most well researched nutrient that we have. I mean, it’s like great data that we have on the importance of it, the safety of it and just how important it is for it to be robust in this stage of life, for fertility. I mean, it’s very hard. If you go into pregnancy deficient in vitamin D, it’s almost impossible, in my experience, what I’ve seen with clients to play the catch up game, because there’s so much that vitamin D is needed for. Just the resources, it’s going to continually  filling the bathtub with the drain open. You’re just like, using so much vitamin D to help support baby’s skeletal development. And that’s where you just will wind up more deficient. There actually was the randomized clinical controlled trial that showed on top of sun exposure and dietary intake 4000 IUs vitamin D was the minimum amount needed to be taken throughout pregnancy just for baby and mom to have just sufficient levels at birth. So not robust, not excessive, just sufficient. So that kind of gives you a sense of how depleted we are.

Lindsey Lusson  27:15

Yeah, for sure. And so how do we take our vitamin D? Are we wanting to take that? Can you get enough in a prenatal or retaking that separate from our prenatal?

Ayla Barmmer  27:23

Yeah, so I did put 4000 IUs in FullWell. I have seen some other formulas that also contain that 4000 IUs again, it’s based on this really good study data that we have. I would look for at least 4000. And if you don’t have that in your prenatal, then again, consider supplementing separately with vitamin D3, maybe a little vitamin d3 and a bit more K2, which helps support vitamin D3 absorption and utilization to get up to at least the 4000. But ideally speaking, I like to see and what I did with practice clients or told them to request from their providers was once a trimester preconception, and then once a trimester,  get your Vitamin D and your iron levels fully evaluated and see where you’re at and adjust accordingly.

Lindsey Lusson  28:09

Would you say it’s safe to assume that someone dealing with HA is already depleted, just because of the excessive expenditure and the minimal intake? 

Ayla Barmmer  28:19

Yeah. I would say that that’s fair to say. Genetics play a role, so you might skirt by a little bit with some good genetics around vitamin D. But just based on how prevalent it is, even when dietary sources are good, and even when sun exposure is pretty solid, it’s one of those things that I think is like epidemic level proportions. Like people are so depleted, you can almost assume that you’re low.

Lindsey Lusson  28:46

Yeah, and the stuff like you said, the research on supplementing is so good. It’s like there aren’t necessarily downsides to doing it. So yeah, so why not? On that note of HA and things that people can be doing and you’re not talking a little bit before we hit record today about how like it’s about replenishing through nutrients. And that foundation is going to be dietary.  But are there things that you’ve noticed in your practice, because you said you’ve worked with a number of clients with HA, are there things that you’ve noticed from the supplement side that can be helpful in this kind of this restoration process?

Ayla Barmmer  29:25

Yeah. I just I love, by the way, your content, everything that you put out for education. I think it’s so fantastic for HA, spot on in really how you’re helping women, it’s fantastic. For me I think, above and beyond what you said and what we know are the basics, the foundation for HA, I do really like chaste tree berry which is Vitex I putting on my herbalists hat you know that is a fantastic are for helping restore the communication between the pituitary gland and the ovaries. So that signaling that we need between the brain and the reproductive organs to help restore the proper cascade of hormones that helps our body ovulate, which is really the goal, right? Restoration of ovulation, which really is ultimately leads to your period back is what we’re trying to do with HA and I think that Vitex can be used temporarily to help with that. I like to use it anywhere between 500 milligrams to 1500 milligrams and divide the doses at the higher levels, daily taken over three to four months. I think if we haven’t seen improvement with it by then, then it’s time to just take a break, try to look at other avenues like we haven’t done enough in other areas for that to help. And it’s also not necessarily the first place I would go right. Again, we talked about the foundation. And it’s one of those things that I think you can cycle on and off of you. It’s a great option postpartum for helping to kind of just normalize things. It’s a great option in perimenopause. I mean, Vitex is really like a fantastic female hormone ally for different stages of life.

Ayla Barmmer  31:10

Well talk to me a little bit about Vitex. Because I’ve heard kind of some controversial things about let’s say, someone doesn’t have full blown HA, but their cycles aren’t regular. If we took Vitex throughout her entire cycle could not prevent ovulation even coming on?

Ayla Barmmer  31:27

Yeah. So I totally understand the line of thinking and where that came from. And there was a point where before I really got into my herbalism training, and just worked with the or more where I also believed that because theoretically, it makes a lot of sense. And the idea is that Vitex helps support progesterone production. And the idea is like, could we be supporting the production of a hormone that would then inhibit ovulation? But in reality,  it’s really not how it works? It won’t work in that way. You can take it throughout your cycle. In fact, I think that’s the preferable way to do it versus just in the second part of the cycle. It’s not directly increasing progesterone levels. The way it’s improving progesterone levels is by supporting ovulation, supporting the hormonal balance that supports follicular development, ovulation and then from ovulation, you get progesterone production.

Lindsey Lusson  32:24

That makes so much sense. And when we talk about women who might be struggling with like a luteal phase defect, it makes so much more sense in my mind is how can we support getting a good healthy egg to ovulate? How can we ovulate? Where can we like put a bandaid on this issue and just one part of your cycle. So, okay, I love that. And this is great, like I’m learning so much.  Any others that you’ve used with some of your HA clients, patients, that you would recommend?

Ayla Barmmer  32:58

I would say I’ve always leaned really heavily on adaptogens, that category of herbal supplements. Again, I have a lot of familiarity and comfort level with herbs. And I think I think we all really should, because herbs are really the, just as a side note, I mean, they’re an accessible way to introduce so much good. It’s the kind of food as medicine, you know, and they can be so therapeutic, very easy to integrate into your life in different ways. And I’ve got I’ve got some recommendations there. And, you know, they’re really the basis of really all pharmaceutical medication too. I mean, a lot of constituents of herbs are what are used to create the medicines that we use today. So herbal medicine can be really powerful. And I think adaptogens are great, because to even be called an adaptogen. And I will say I see some herbs mislabeled that way. But to even be called an adaptogen you have to be you have to have a proven track record and evidence of safety. It’s just these are the safest herbs that we can possibly find and use, you know, they’re strengthening, they’re building, they’re usually very nutritive, they help with our stress response and normalizing that.  All of these things are really key foundational pieces to correcting and rebalancing when it comes to HA. I’ve used quite a bit of like Shatavari & Ashwagandha, very similar adaptogens. I think Shatavari is a little bit better, in my opinion for HA because it is so nutritive. And sometimes it’s called like more of the female counterpart to ashwagandha. Both are great, though. So Shatavari is fantastic. I think things like Holy Basil, Eleuthero, I don’t really say Rhodiola as much anymore because that one is becoming endangered. And so I think there are other options and I like to guide people away from any herbs that are approaching that endangered list because we have so many different options that are not. And then  there’s kind of the nutritive herb category and my absolute favorite herb of all time, like this is my number one herbal ally and got me into herbs is Nettle Leaf, which I wouldn’t necessarily say as an adaptogen, but kind of similar. But that’s like anytime where you’ve got you need to rebuild your nutrient stores, whether it be with HA whether it be post illness, you know, or a period of just like depletion, like you’ve just gone through just a stressful time. I think postpartum even throughout pregnancy, that’s a really safe herb, so Nettle infusions have it all.

Ayla Barmmer  34:25

So you’re into it. Do we call them potions? Like whenever you’re like,

Ayla Barmmer  35:43

Yeah, I mean, that’s the retirement plan. I’m gonna have a little hut and just make potions.

Lindsey Lusson  35:50

That it’s so fun. 

Ayla Barmmer  35:51

Yeah, so herbal infusions are a great way to, especially with metal, because with metal like, you can get some of the leaf , dried leaf from something like rose herbs, then you just take a handful and you can put it in even in cold water, let it sit overnight. It infuses really well into even cold, it doesn’t have to be hot. Let it just sit in a jar covered overnight. And in the morning, that is just like mineral rich infusion to start your day with, that I think is just, I love giving people the challenge of for 30 days. Try starting your day with something other than nettle infusion. And you know, see what happens.

Lindsey Lusson  36:29

Yeah, yeah, I love that. So, so helpful. You know, in working with HA clients, are there any other things that you feel like maybe from a stress standpoint can be helpful, whether it’s supplement or even more like lifestyle wise?

Ayla Barmmer  36:49

When it comes to kind of stress management, I find everybody is so different. And the key is finding the thing that really works for you that you’ll do consistently, right? Even having like a toolbox of things. I mean, I know for me, it’s like one thing is I’m not necessarily going to meditate every day, or doing one breathing exercise every day. You know, I can’t call them that all the time, right. But they’re having different tools to do and make sure that you’ve got options, I think is key. I mean, I’ve got a handful of things that I would do with the clients that love the feedback of data to see the technology aspect to like Heart Math, it was fantastic. Because it’s a breathing, mindfulness practice where you can actually have a little device and kind of see what your heart rate variability is doing. And so sometimes I find, when we’ve gotten really disconnected from our body, which can happen, it’s nice to have the feedback of something like an aura ring, or Heart Math, or anything that’s kind of telling you “okay, what’s really working.” What’s helping bring your body back into a parasympathetic response state and then going with that.

Lindsey Lusson  38:00

Yeah, and I think even sometimes you mentioned aura ring like, the wearables can be so helpful for someone who doesn’t really have a cycle. We don’t want to be like, obsessively taking your temperature every day. But if we can have additional insights about like, what is heart rate doing what is our basal body temperature going from like, below 96. It’s like, things are recovering like things are in right direction, and I know a lot of our listeners, like like that data driven stuff too so, that’s awesome.

Ayla Barmmer  38:28

Yeah. And the other thing and I’m guessing you would agree with us too, that I really wish everybody regardless of HA but I think perhaps most importantly with HA and fertility is really the things that you can do to help support your circadian rhythm. So your circadian rhythm is your internal biological clock, and it is just in sync with nature, it drives everything I mean, our internal clock, our circadian rhythm drives essentially all of our hormone production. And so if you want to influence hormones, you can’t discount how important it is to try to get your circadian rhythm more in line with nature as possible. And it’s hard to do in our modern environments, you know, because we are just living with so much artificial light, disruptive schedules, you know, it’s there’s so many things right and so in stress, so I think you know, getting outside for sun exposure first thing in the morning, I mean, I usually have like kids hanging off me and doing different things, but like I walk you know, try to do it for as long as I can. You know, get some of that get some of that sunlight exposure, wait to have you know, coffee, eat your breakfast, try you know, some of these things like reducing blue light at night, things that we can do to get our body a little bit closer and rhythm with the natural light and dark cycles and rhythm of really nature. And when I started working on that myself a little bit more I actually do this that my cycle started to get right in sync with the moon cycle, which I think is really cool made me feel like a goddess.

Lindsey Lusson  40:02

Yeah, that’s amazing. And I know that like just the sleep and the sleep hygiene is like one of the I feel like most basic, but also hardest to do. You want to tell someone to overhaul their whole lifestyle, change everything they’re doing with the way that they’re eating the way that they’re moving. They’re like, Okay, I’ll do that. And we’re like, put your phone away an hour to two before bed? And everyone’s like, nope.

Ayla Barmmer  40:30

Yeah, I know. And it’s right. We want it to be kind of a complicated protocol, when in reality, some things are consistency with the most basic things.

Lindsey Lusson  40:40

That make such a difference. Well, so a question I probably should have led with is like, how did you even get into the infertility space? Like, did you like go to school being like, this is my life. Tell us how you like maybe stumbled into all of it.

Ayla Barmmer  40:54

 I really did kind of stumble into it. I had always been just love nutrition. I think, you know, when I was in school, I knew I wanted to get into the helping medical field, like a helping profession and kind of the medical space. I’ve always loved science. To me nutrition is so practical, it touches every single one of us. And it’s part of our day to day, and I love the concept of food as medicine. And I was definitely always the kid that was making potions in the woods with various things and trying to get people to take them. 

Lindsey Lusson  41:25

Everybody, like everyone’s childhood? 

Ayla Barmmer  41:27

Yes. So you know, and then what kind of happens was I veered around to a lot of different little like, in my early first couple years, a lot of different jobs, trying to figure out where I wanted to land and when I really started getting into fertility, I was doing some consulting at a gym, and the local IVF client was at a local IVF clinic, I should say was referring women over with the goal to lose as much weight as they could before their IVF cycle that they were told that they would, they would get their cycle canceled. And at the time, I mean, this was a while ago. Now, that was the thought, you know that weight was the only nutrition and lifestyle factor that really played a role in fertility, and in assisted reproductive technology. And I just  intuitively knew that that couldn’t be the whole picture. And I saw the stress that it was having that goal and to do it quickly and against all the IVF medications. And I was like this is just not the approach. This has to be a time of building and nourishment.

Ayla Barmmer  42:37

And I don’t believe that weight has as big of a role as we’ve been led to believe. I think it is more about nourishment and signaling to the body. And I’ve always viewed fertility this way. That by design, we’re always going to prioritize our own health and survival over reproduction. And so you know, we’ve got to have enough resources to supply our reproductive systems for fertility to be turned on and robust. And so to me, it was all about finding where the resources were lacking. And so once I started getting into that I didn’t know of any other RDs in the fertility space at all. I remember speaking at a state conference about fertility, and it was kind of like, not well attended. And you know, it just wasn’t an area of practice, really. But it’s fantastic to see how many nutrition professionals now are in the space because I really believe so strongly in not only how profoundly nutrition and lifestyle can play a role in fertility and pregnancy, but how important that is for chronic disease prevention, right? You know, that’s a little bit outside of the scope of this talk. But, really what we’re doing preconception is the best way to ensure the health of our communities, of our families, you know, for future generations. 

Lindsey Lusson  43:52

I’ve heard this said on a couple of different podcasts. And I think you would agree with, your fertility is also kind of a reflection of your health, right? Like, we think about people with HA, it’s like your body isn’t selectively shutting down reproduction, like there are so many body systems that are suffering from stress and undernutrition. And so while it is about being able to bring a healthy little person into the world, it’s about getting yourself healthy and supporting having, longevity essentially. So I love that. Let’s talk a little bit more about FullWell and Knowledge Well, real quick, before we wrap for today. Where can people learn more about you, learn more about what you offer and all the things.

Ayla Barmmer  44:33

Yeah, so I really am spending most of my time these days are at fullwellfertility.com. Right now, we are exclusively offering our products through there. We are launching on Amazon, which has been a very interesting process. But we are we are doing that very soon. Maybe by the time this airs, because it’s happening within this week. So I’m excited about that. The Knowledge Well, this is where we really are different, I think, than other supplement companies and that three out of the seven members of my team are registered dieticians. And we work so hard on the content that we put together. We all have health communication, advanced degrees in health communications, and are just really interested in making really the things that I’ve worked on in practice for years accessible to more people. And so, you know, our knowledge wall is also undergoing like a huge overhaul to make everything easier to find. But we pour a lot of resources into those educational posts and bringing in outside experts with diverse backgrounds to do some education too. So I would I would encourage, like, even if you’ve already settled on, like, if the supplements aren’t your thing, you’ve got something else that works totally fine. But we do have a ton of education just for free.

Lindsey Lusson  45:50

And it’s like so comprehensive. Like it’s so good. Like, it’s not just like a health plan article with a little blurb from a dietitian. They’re like such good articles. So yes, I’d say that’s a great place to start. And then for our listeners who are in the preconception period, where do you recommend starting and when do you recommend starting a good quality prenatal?

Ayla Barmmer  46:10

Yes. So I would absolutely recommend, if you’re even thinking about pregnancy, there’s no, there’s never too soon to start. And I really believe that because there are so many things that deplete us in our modern environments. And it’s hard to overdo it, even though you know, certain marketing claims lead you to believe that you’re going to overdo it. I think a solid prenatal multivitamin, in this stage of life is just a good idea. Three months, you know, prior is probably the minimum I think both you and I know that’s you know, that’s like the development timeline of the follicles that ultimately you’ll ovulate. But if you can do six months, I mean, that’s even better. So a prenatal multivitamin and make sure, I would just say that you have enough essential fatty acids, omega three fatty acids on board too. So I really prefer a fish oil with at least you know, for about the 400 milligrams of DHA mark, you might eat more if you eat zero fish, you know and seafood. But you know, I usually tell people to shoot for that. Make sure it’s not just DHA you need EPA too and that’s why I can’t stand prenatals that just put DHA in them. I think there’s stability issues. But there’s you also need EPA. So a fish oil is a great option. So prenatal fish oil and then I always say iron is its own separate class, like kind of get in if you have HA, you’re more at risk for iron deficiency. And so I know we didn’t talk about that. But that is that something that you don’t necessarily want to blindly supplement with. I would get testing done ask for a ferritin you know, to in addition to your standard panel iron workup, and just make sure that you really need iron and you’re matching your supplementation or dietary intake appropriately with your needs.

Lindsey Lusson  47:58

Yeah, that’s fantastic. Well, thanks again so much for your time. I’ve learned so much. Our listeners are going to also benefit from all this knowledge and so just thank you so much for being here. We appreciate you. 

Ayla Barmmer  48:09

Thank you for having me.

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MEET THE HOST
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I’m a fertility nutritionist and registered dietitian who specializes in hypothalamic amenorrhea. My passion is helping women trying to conceive find freedom with food and exercise, so they can recover their period, and get pregnant naturally.

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EPISODE 1: MY RECOVERY STORY

Jan 19, 2022

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