“When we talk about a healthy pregnancy, especially for PCOS women, if we do the things to prepare even before getting pregnant, then we lower our chances for miscarriage and increase our chances for a healthier pregnancy and a healthier baby.” – Dr. Aumatma
Dr. Aumatma Shah, ND is a naturopathic doctor, nutritionist, and author. She specializes in helping women naturally boost their fertility and stay pregnant and healthy. Miscarriage is a difficult topic, and her practical and compassionate approach to not only getting pregnant, but maintaining a healthy pregnancy, even after prior miscarriage will resonate with many of us. Listen in (or read the transcript) as we discuss:
- Managing underlying health conditions: IR, hypothyroid, hormonal imbalance, MTHFR mutation, & blood clotting
- How to advocate for tests (including genetic factors) and progesterone therapy
- Folate v. folic acid and the risks of supplements with folic acid
- Tips to prepare for a successful pregnancy
- Natural thyroid hormone replacement suggestions
- Weight loss factors and tips
- Metformin in pre-pregnancy and pregnancy
Mentioned in this podcast:
- Fertility Secrets: What Your Doctor Didn’t Tell You About Baby-Making
- More PCOS Diva content on pregnancy & miscarriage
- Folate v. Folic Acid
- PCOS Diva Perfect Prenatal
- PCOS Diva Essentials Multivitamin
- WP Thyroid
- Sparkle Cleanse
- holisticfertilitycenter.com “the fertility insight session”
- Aumatma on Instagram
Amy: Today, I’m talking to Dr. Aumatma. She is a naturopathic doctor and a nutritionist and has been in practice for over 12 years and she’s also a good friend. I had her, or asked her to come on today to the PCOS Diva podcast because I’ve been getting lots of questions lately in my private Facebook community. If you’re not a member of that community, it’s really a great place for like-minded PCOS Divas to share our health journeys with PCOS.
But there’s been many questions about PCOS and miscarriage. It’s a tough topic, but it’s very important to be empowered as a PCOS Diva. Dr. Aumatma, she is a Women’s Health Specialist and she is the bestselling author of Fertility Secrets: What Your Doctor Didn’t Tell You About Baby-Making. She’s the host of The Egg Meets Sperm podcast and she supports couples through private one-on-one care and online group programs. I thought that she would be an ideal expert to talk to us today about what to do after miscarriage and how to support healthier pregnancies.
Amy: Welcome to the PCOS Diva podcast, Dr Aumatma.
Dr. Aumatma: Thank you so much for having me, Amy. I’m so excited to be talking to you today.
Amy: I wanted to kind of just jump right into it. I’ve done some articles and have had some other expert guests talk about miscarriage and PCOS in terms of the connection, are the two connected. In my own research, it seems that the evidence is somewhat inconclusive. I was wondering what you’re seeing in terms of a connection between miscarriage and PCOS.
Dr. Aumatma: Yeah, it’s a little unclear from the research you know? I feel like there is, there’s definitely evidence that says PCOS is going to increase the likelihood of a miscarriage. One in three women have miscarriages in general. Increasing the chances is definitely like putting PCOS women at a disadvantage when they do get pregnant. I think that what a lot of people, or a lot of researchers haven’t been considering is how much of the underlying cause is playing a role in how well that pregnancy develops and how well the baby develops and the health of that overall pregnancy. I definitely think that the underlying factors do make a difference. When we talk about a healthy pregnancy, especially for PCOS woman, but in general, if we do the things to prepare even before getting pregnant then we lower our chances for miscarriage and way increase our chances for a healthier pregnancy and a healthier baby.
Amy: Well, let’s talk about some of those underlying health conditions. Women with PCOS tend to have insulin resistance. If the insulin resistance kind of down the road gets worse and worse it can lead to type two diabetes. Women with PCOS tend to be hypothyroid. We have hormonal imbalance, like low progesterone related to estrogen. You know, I’m wondering if some of those underlying conditions are adding to miscarriage rates.
Dr. Aumatma: Absolutely. Of course like blood sugar and insulin resistance may not directly correlate to miscarriage, but there is evidence that having dysregulated blood sugar and insulin will potentially cause intrauterine growth restriction possibilities, as well as increasing the chances of gestational diabetes in pregnancy. It definitely creates, already that alone creates the basis for an overall not as healthy pregnancy as we would like.
I don’t like to use negative terms for pregnancy. Like it’s amazing that women are pregnant to begin with. But I think that we want to optimize that pregnancy as much as we can and having and helping support that insulin and blood sugar balance way before getting pregnant is going to make a huge difference in the health of that pregnancy. Additionally, there is lots of evidence that says women with hypothyroidism as well as women with Hashimoto’s are way likelier to have miscarriage and those women are also way likelier to have PCOS.
There’s a little bit of an overlap with the thyroid diseases and then I think there was … Oh, the relative estrogen to progesterone. If we’re talking about women with estrogen dominance, absolutely like those women are going to have a harder chance getting pregnant. But in that early phase of pregnancy, really that whole first trimester, if the woman isn’t able to produce progesterone and the baby doesn’t actually take over the production of progesterone until the second trimester. That first whole trimester she has to be able to support the development of that baby with optimal levels of progesterone production. But if she has lots of estrogen and isn’t able to compensate with the progesterone production, it’s going to be really challenging to have a healthy, sustained pregnancy.
Amy: The other things that I’m wondering about in terms of underlying conditions are things like the MTHFR mutation or you know, issues with blood clotting factors. Is that something that you see, as well?
Dr. Aumatma: Yes. You know, from what I’ve read in the research, it’s a little bit tricky with the MTHFR mutations. I know that we talk about them a lot, and really the research suggests that there’s only one type of MTHFR mutation that’s been linked to miscarriage. The other MTHFR mutations are probably not linked to miscarriage, but in my belief, it’s really ideal to have not only MTHFR, but the whole host of methylation genes to really be functioning. So that one, we’re ensuring that we as the mama can get optimal levels of nutrition and then be able to provide that nutrition to the baby for optimal growth. When we have those mutations, that makes it much more difficult and our needs for let’s say folate for one, but Magnesium, B vitamins, there’s a whole host of vitamins that is really an increased need if we have methylation issues.
In a broader sense, I think it’s really ideal to have optimal methylation, and there’s that one MTHFR gene that is linked to miscarriage. If we have that gene, really we can, it’s really easy to be able to adapt our bodies and give the extra nutrient support that one would need if they had this gene defect. It’s not a huge deal, it’s just important to know. Important to be aware of what your profile looks like and then to be able to adapt for it and make sure that you’re supporting your additional need for nutrients in addition to what you would generally take in a prenatal or something like that.
Amy: Now, you being a naturopath doctor and really looking to get kind of to the root cause of why a woman’s having PCOS would of course do some of these tests. But women listening today that maybe go to a regular OB/GYN or even a reproductive endocrinologist, how can they advocate for those? For tests to test their genetic factors for methylation or even to advocate for progesterone therapy possibly in early pregnancy. I’m finding, or what I’m hearing is that doctors aren’t always that willing to work with women on those things.
Dr. Aumatma: Yeah, I agree. I think I’ve had equal difficulty having patients, especially like even patients that I work with generally want to tend to cover a lot of what they can through their insurance and we’re not covered by insurance. In general, we have similar challenges in terms of like what are you going to go and say to this doctor that’s going to convince them to think outside of the box? Oftentimes, we run into a wall.
In my experience, I always tell women like our first approach is for you to go to your doctor and be educated. Right? You know what to ask for. Often, the doctor will say, but why? Why do you want to do this test? What is it going to tell us? In that moment be able to give an educated response of, well there’s this connection of MTHFR that could be related to my folate absorption and I want to make sure that I can absorb folate. Something simple, like a quick one sentence thing that you can say in response to their “why” is really super helpful.
If at that point they say, “Nope, that’s a no go. We’re not doing that,” then so maybe not stop there, right? Take it a step further and say, “Okay, then if you’re not going to do this, I’m going to find someone who will,” and that might be a local naturopathic doctor. That might be someone just getting online and ordering their own tests. I’m actually in the process of developing a fertility genetics panel, so this will be like anybody can go and request this test on their own. It will be out of pocket, but it’s going to be really affordable and they can get a whole host of genetic overview of genes specifically related to fertility. Instead of the overwhelm of, “Oh my God, now I have 200 genes to look at,” it’s going to narrow it down and really focus in on the ones that are important and then to have the education behind it to say, “Okay, if you have these genes you probably want to support your fertility by supporting these XYZ nutrients.”
I’m really excited about it. I think that we are living in an age where I often feel like patients are more educated than their doctors, and there’s just so much education available, but there aren’t resources to be able to put that education into practice. Often that stopping point is the doctor. We are moving towards an age where customers and patients are going to be more encouraged to just take their health into their own hands and to be able to self-direct their care rather than wait for the doctor to jump onboard and support them with it.
Amy: Yeah. I love the idea that you’re doing this specialized lab panel. I know I direct a lot of PCOS Diva’s to yourlabworks.com for different PCOS panels and I know that they, I think they do have a MTHFR genetic panel if you’re interested in that now. But you know what, while we were talking about folates and the importance of being able to metabolize folate. I want to just, maybe you could give us a quick explanation why prenatals with folic acid is really not, maybe what’s problematic about those versus prenatals with more of a natural folate.
Dr. Aumatma: Yeah, so traditionally doctors have said folic acid is the same as folate. But, what we aren’t being told is that folic acid is made in a lab and folate comes from green leafy vegetables. Just for example, it comes from a lot of things, but green leafy vegetables is my favorite source. We often like collapse the difference between folic acid and folate, but there’s quite a huge difference. Folic acid needs to go through extra steps to actually be absorbed into our body and be utilized. Whereas, folate is more readily available. More “bioavailable” to be able to be utilized. Even folate still has steps to go through to be able to be utilized. People with the MTHFR mutation for example, or there’s another one called MTRR, when they are given folate it’s still, if that gene, if those set of genes is not optimally functioning, it still may be challenging to take that folate and utilize it in the body, which is where we get to the more “progressive supplementation” that has five MTHF, which is … I was saying it to a patient this morning, it’s “pre-processed”. You know, like it’s just easier for your body to utilize that form. Especially if you have particular genetic mutations that don’t allow the processing of the folate in the body.
So folic acid, probably the worst thing we could be taking. There is evidence that folic acid is detrimental to people with the MTHFR mutations. Not only is it not equivalent, it’s actually doing more harm than offering benefit. Folic acid, if you’re a prenatal has folic acid, please stop taking it. Like just stop. Find a different prenatal. If it has folate, that’s a good step. It’s awesome. Like it’s probably okay if everything’s functioning well. Then if you know that you have an MTHFR mutation, you should really be getting a five MTHF form of folate.
Amy: I want everybody listening. If you are on a prenatal or even a multivitamin, pause the podcast or when you get off of the podcast, take a look at if it’s folic acid, as Dr. Aumatma said, please get rid of it. If you’re looking for a new multi or prenatal, the PCOS Diva prenatal or the PCOS Diva essentials both have a folate and in the perfect prenatal. It’s actually provided as five MTHF in my perfect prenatal. Just wanting you to be aware of that.
Dr. Aumatma: That’s awesome.
Amy: We talked about underlying conditions. Now I would really love to shift to how a woman with PCOS can really prepare to have a successful pregnancy. Maybe you could give us your top tips.
Dr. Aumatma: Yeah, absolutely. I would start with the foundations, right? Optimal body weight for one. Then move to blood sugar insulin imbalance. Let’s make sure that that’s optimal.
Amy: Let’s back up to the optimal body weight. For so many of us, it’s just such a challenge to get to an optimal body weight. What if that’s just not happening? How do you work with your PCOS patients?
Dr. Aumatma: Yeah. You know, the thing that I have found to be most beneficial, like I think I almost feel like all of these kind of interrelate, so spending all of your time losing, trying to lose weight if you have a suboptimal thyroid function is going to be not efficient. Right? It’s kind of like they all rely and piggy back off of each other. If you have good blood sugar regulation and good insulin, you’re going to have better success with losing weight.
We kind of have to look at all of these things together and optimal body weight or optimal BMI is one of the things that a lot of PCOS women struggle with. What’s interesting, and I’ll just throw this little caveat in there, is like so many of the women that I have worked with have this of what a lot of us naturopathic or natural practitioners are considering soft PCOS, which is where they don’t have the typical like weight gain of PCOS. They look like very normal BMI women who have PCOS physiology.
If you don’t have the BMI issue, this is not for you. Right? But for the women who have difficulty losing weight, I think making sure that thyroid is functioning is number one. If it’s not, I tend towards using bioidentical thyroid as a solution because it’s faster and more efficient than trying to do the herbal approach, which you know, there’s a lot of the herbs that are for thyroid support are actually contraindicated in pregnancy. I usually give women the option, but a lot of women will end up choosing being on thyroid hormone just because it’s easier, it’s faster. We don’t have, it’s not contraindicated in pregnancy. It’s a little bit safer in this particular time period where women are trying to conceive.
Amy: Could you just mention a couple of those brands just so that they’d be familiar to someone if they heard them for natural thyroid hormone replacement.
Dr. Aumatma: Oh yeah, yeah. The way that we, like the bioidentical thyroid that we use tends to be like through a pharmacy that would make a particular dosage of it. There’s also like Armour thyroid or WP thyroid. Those are probably, if we were to go towards one of those, I would tend towards the WP thyroid. It’s the most regulated and the most stable, and it has what it says in terms of dosage. Armour thyroid used to be really popular. It’s kind of fallen out of favor. They’re not regulating it as well. West thyroid or, like the way that we have it is WP thyroid. I think maybe I’ll do a post or something to follow up. As far as like the brand name, I can’t remember.
Amy: Nature-Throid? I know that’s another one.
Dr. Aumatma: Nature-Throid that’s another one. Nature-Throid and WP are actually manufactured from the same company, and now it’s going to bug me why I can’t remember the name of the company.
Amy: Tell me and we’ll add it to the show notes.
Dr. Aumatma: Okay, perfect. I will. Oh yes, I’ll do that. I’ll just get you the name. They’re made by the same company. But even between those, I have been told by one of my favorite people who is an awesome thyroid expert, Dr. Alan Christianson that the WP thyroid is just more consistent. You’re going to get a better quality and a better dosage with less excipients than the Nature-Throid. It’s slightly like, Oh, I found the name of the lab. It’s called RLC labs. They make both WP thyroid and Nature-Throid and yeah, the Nature-Throid. Yeah, the Nature-Throid just has a little bit extra excipients, which are like things that are not active ingredients that are added into this medication. WP thyroid is free of that, so we use the WP thyroid.
Amy: Great. Okay.
Dr. Aumatma: Yep, so either that the bioidentical and then there is a company that makes a really great thyroid support supplement. Again, like I said, it is contraindicated in pregnancy. If you are trying to conceive, please do take this supplement. But if you’re not trying to conceive and you have PCOS with thyroid issues, it can be really helpful. It’s Restorative Formulations, Thyroid PX.
Dr. Aumatma: Thyroid PX. Those are like my three favorite thyroid support things and, of course, if someone has Hashimoto’s then we’re going down a whole different path of why that might be going on. Circling back to weight loss, we really want to support the weight loss with a good diet and nutrition. I really have found that an initial detox that is somewhat intense will stimulate weight loss and help to potentially reset metabolism so that that weight can continue to decrease faster.
Amy: I’ve found that, as well. I run, I call it the sparkle cleanse and it’s a functional food-based detox and a lot of women who are like on a plateau or struggling two weeks of doing the detox shakes twice a day and really cleaning up their diet. It really jump starts weight loss.
Dr. Aumatma: Yes, exactly, exactly. Then I think in addition to doing something like that, making sure that we’re supporting the liver so that the liver can help support getting rid of toxins as well as excess hormones can be really helpful and will help support resetting the metabolism as well as making sure that that weight loss continues even after you finish a cleanse like that.
Amy: Yeah, and just preparing for a healthy pregnancy, right? Getting rid of those toxins.
Dr. Aumatma: Yes, absolutely. I think I like have this quote that someone started quoting me about, which was basically if you have toxins in your body, it’s going to be really hard for you to lose weight. Your fat cells are helping to store toxins out of your system so that you can survive. The fat in a sense is helping to support your survival on this planet and they’re doing you a service. Right? The more toxins we accumulate, the more we have to create fat cells in our body to like store all of these toxins away. I think that, that’s a little bit less, less popular. You know, it just doesn’t sound as fun. But in reality it’s like these fat cells are a huge component or a huge service to our survival on this planet. When I’m supporting people with detox, I’m like, Hey, remember to thank your fat cells. Like they’re doing this huge thing. You know? Having that gratitude for like, thank you so much for protecting me. Thank you for like letting me find a way to deal with all the toxins that I had to deal with, and I’m releasing these toxins now. Thank you for your service. We don’t need you anymore.
Amy: Oh, I love that. That’s really powerful.
Dr. Aumatma: Yeah, so just like remembering to have that gratitude for what these, what the physiology is, is setting you up for survival, right? Like your body’s doing everything in its power to take care of you so that you can live a long life. It’s not always a healthy life or it’s not always in the most wisdom. As you’re learning about it, you can say like, “Hey, cool. This was awesome. Now we know better. Thank you for your service. Good bye.”
Yeah, so we talked about like helping support detoxification and helping support liver pathways so that detoxification and reset could happen easier. Once you jumpstart that weight loss, really sustaining it with a healthy lifestyle and exercise is essential. It’s kind of like kickstart and then keep going. A lot of times people aren’t thinking, Oh, I’m going to do this two week thing and I’m going to lose 50 pounds and that’ll be it. But I know that I’ve heard you say this before, it’s like PCOS is a forever thing. Like it’s not going away. It’s more like you’re shifting into a new state of balance and then you’re doing the lifestyle and supportive things that are going to help keep you there and keep you healthy. Because it’s a metabolic thing that you want to make sure that you don’t fall back into the trap that got you there to begin with.
Amy: We’re talking about pregnancy and having children. For me, my PCOS, you know I talk about it being a blessing, but not just for me but for my children because I’ve been able to teach them how to eat and cook and really fuel their body with nutrient-rich food and understand what it feels like when you’re low blood sugar and hangry. I’ve got three kids that are healthy, thank God and athletic and doing well in school. But so much of that is based on how they’re feeding themselves. It’s important to get this right for yourself so that then you can teach your kids the same thing because it’s, I think it’s one of the greatest gifts you can give your kids.
Dr. Aumatma: Absolutely. Absolutely. I feel like all the fertility people that I work with, it’s like you go forward with this new state of understanding that you can, we are changing the lives of the future babies that y’all are going to have. Right? Like we want this to be a new state of our being rather than like, Oh yeah, I did this thing; it helped me get pregnant. Goodbye. Now I get to go back to eating the crap that I was eating and the amount of sugar that the average American intakes, which is crazy to me. Mind boggling.
Amy: I got a question today on our private Facebook community about Metformin and pre pregnancy and pregnancy. You know there’s I think a lot of different opinions in the medical community, whether a woman with PCOS should stay on Metformin throughout her pregnancy if she’s already on it. I know with my second child I was on it in order to try to get pregnant. What is your thought on Metformin, PCOS, and preparing for pregnancy?
Dr. Aumatma: Yeah, I think that that is a very case-by-case thing. It really has to depend on like the full picture, right? Is this woman, what is her blood sugar like? What is her insulin like? What is her BMI? What are the changes that she’s already made, and what is her lifestyle like? Is there more changes to go that could potentially be helpful? Or is she living this like optimal lifestyle and eating the best food and doing all the things and yet there’s this insulin blood sugar dysregulation.
I think that those are really important questions to have before saying it’s good or it’s bad. I will say that there are studies that show that there are natural things that work just as well as Metformin. Chromium, for example. They’ve done double blind studies with Chromium and Metformin and found that Chromium works just as well. There are things that are in the natural world that could help and potentially work to a benefit. It really has to be in the context of the patient. I think it would be hard for me to say, Oh no, you can get off of your Metformin. Like, whoa.
Amy: I appreciate that outlook because we have to remember that there’s no one size fits all approach. You’re right, it’s multifactored and you really need to look at it as a case by case. I think that’s important, especially when you’re on Facebook groups and listening to other women’s testimonials. You know, you’re a unique individual and what works for somebody or what’s been prescribed to somebody doesn’t necessarily mean it’s the best thing for you.
Dr. Aumatma: Yeah. It’s so true, and I see so often with Facebook groups, Instagram, like people are sharing from the aspect of like they’re excited about like, “Hey, this really worked for me.” But we’re losing the context of the person and all of it. Yeah.
Amy: Yeah, and there’s no magic pill. You have to do the hard work of changing your lifestyle factors. Any other tips that you can give our listeners about preparing for healthy pregnancy after miscarriage?
Dr. Aumatma: You know, I think that what we didn’t maybe mention is like a lot of women come after having like two, three miscarriages. Sometimes they come and seek out our help and there is this fine balance of, “Hey, this is not your fault” and “there’s still so much that you can do that’s in your power to not have the same outcome again.” I feel like that’s a hard line to walk, right? It’s that place of like, Hey, I have tons of compassion, and I don’t think at all that this is anybody’s fault. But at the same time, we can be empowered to make shifts that are going to support the next positive pregnancy. How do we do that with grace? Right? I really feel like we try to walk that line and a lot of people get offended because miscarriage is never a fun thing to talk about or look at.
It’s like such an emotional journey filled with so much shame and grief and all of that. But all I can say is that from my experience, when women do the work of resetting their bodies, rebalancing their hormones, their detoxification, like all of the things that we’ve been talking about doing them sounds very simple. A lot of women come and say, Oh yeah, I’ve already done those things. Our process is like, okay, let’s just make sure we dot all the I’s, cross all the T’s and then the next pregnancy they have a much different experience. Often that experience is met, like we’ve had one woman have a miscarriage ever in my practice. It didn’t have to do with, it was mostly because she got on a really long flight that she shouldn’t have. But everybody else who’s come in with miscarriage leaves with a healthy pregnancy and they ended up having a baby. I think that part of that is just the, the holding of like, yes, you didn’t do anything wrong and yes, there’s so much that we can do.
Amy: Well, hope is a powerful thing, isn’t it? When you hold that space for somebody.
Dr. Aumatma: Yeah.
Amy: And that’s a great outcome and great story, Dr Aumatma. I was hoping that you could tell us more about your resources that you have available for women who are trying to conceive.
Dr. Aumatma: Absolutely. We offer consultations. We have a one hour consultation that we’ll charge you $1 to book that consultation, but it is one hour with me. I will sit down with you and kind of review all of the history hormones, all of that and then put together a plan of like what is the next best step for you to take to be able to get pregnant and have a healthy baby.
That is on our website. Our website is www.holisticfertilitycenter.com and the appointment is called the fertility insight session. That’s a really great resource if you want to talk to me directly or if you just want more information and want to be part of the tribe. We have a really vibrant Instagram page and our handle is holistic_fertility_specialist and I feel like it’s become my little micro blogging. We share a lot of content. We are reading research papers all the time, so we tend to like summarize these papers into something that’s digestible and usable for the average woman. You could find me on Instagram.
Amy: We will put those links in our show notes and also in our show notes is a complete transcription of this podcast. If you need to reference it, please go to pcosdiva.com and you can access all of those resources.
Dr. Aumatma: Can I just share that Amy, you are just so amazing. Like I direct so many women to you because I feel like PCOS is this lifestyle thing, and it’s really important to have community around you to be able to be supported and hence the work that you’re doing is just so amazing. I really value you as a friend, as a colleague, all of it.
Amy: Oh, well I really appreciate it. That’s really sweet. I love highlighting experts like yourself on this podcast and on my blog. Thank you for really sharing your wisdom with us because it really helps empower us to take our health into our own hands and you know, be the Diva at the doctor and ask for what we need. If it wasn’t for doctors, you know, like you, I don’t know if we could do that, so thank you.
Dr. Aumatma: Oh, yeah. Thanks for having me.
Amy: Well, I thank you everyone for listening. I look forward to being with you again very soon. Bye-Bye.