What if the future of maternal healthcare began before conception?
In this episode of The Evolution of Medicine , James Maskell and Emily Rydbom explore how nutrition, systems biology, and integrated care models are transforming pregnancy outcomes.
You’ll learn how a “standard of care plus” approach; combining trimester-specific nutrition, biomarker testing, and virtual care models, has improved outcomes across multiple cohorts, including Medicaid populations.
This conversation explores how early nutritional intervention may reduce preterm birth, gestational diabetes, and other complications, while also reshaping how we think about prevention in medicine.
About the Guest:
Emily Rydbom is a board-certified holistic nutritionist and clinical researcher working within the Grow Baby initiative, a 13–15 year program focused on improving maternal and infant health through nutrition-first, systems-based care models. She has worked extensively on integrating nutrition into obstetric care across clinical, virtual, and hybrid healthcare systems.
– – – – –
About the Host:
James Maskell is a healthcare entrepreneur and founder of The Evolution of Medicine. For over 20 years, he has worked to scale functional medicine through community-driven models, group visits, and practitioner infrastructure. His work focuses on moving medicine upstream – toward prevention, lifestyle intervention, and systems-based care.
Website: https://www.jamesmaskell.com/
X: https://x.com/mrjamesmaskell
Instagram: https://www.instagram.com/mrjamesmaskell
Facebook: https://www.facebook.com/jamesedwardmaskell/
LinkedIn: https://www.linkedin.com/in/jamesmaskell
Youtube: https://www.youtube.com/FunctionalForum
Evolution of Medicine™ Mission Partners:
TrueNeura: https://goevomed.com/truneura
Fullscript: https://goevomed.com/fullscript
– – – – –
Thank you for listening.
Please subscribe and share.
This podcast is produced by DrTalks.com
https://drtalks.com/podcast-service/
Listen wherever you listen to your podcast or watch the full episode on our YouTube channel.
Transcript:
The first healthcare system that anyone enters into is the Intrauterine environment. So the Intrauterine environment is the first healthcare system that we all experience. It is the most powerful tone setting. Stage that we have. Hello and welcome to the podcast. This week we interview Emily Rydbom. She is one of the co-founders of Grow Baby.
This is a 15 year project to understand the role of nutrition in preconception, in conception, in uh, in birth, in pediatrics. And they have been on an incredible journey to prove. The impact of nutrition in early childhood outcomes to prove, uh, that this can be delivered in a Medicaid population. And what you’re gonna hear is a new study, um, that they have put out and what the impact is and how it’s giving them momentum.
There is so much to learn from this podcast, but one of the big things I wanna get across is what does it take to make a real impact in medicine with the tools that we have here in functional medicine? And this is a masterclass in that. Enjoy. So a warm welcome to the podcast, I think actually for the first time, Emily Rydbom.
Welcome, Emily. Thank you so much, James. I’m thrilled to be here all these years and we’ve never jammed. I know, I have. We’ve known each other for like a decade plus. It’s been a minute. Well, look, I’m super excited today and, and the purpose of, of why this came around is I’ve been following on social media and I’ve been following the Grow Baby, you know, project for a long time because I think, you know, I think.
Everyone, uh, involved in functional medicine, uh, recognizes that the best time to intervene is like at the first possible moment, or even before, because you just see the thing, the things that happened at the very beginning have an effect all the way through. And so that’s, that’s the area that you are playing.
And I, I, what I’m excited about is just to. Uh, uh, help the audience understand a little bit more about your work and you know, what some of the implications are for our industry and for healthcare and for the evolution of medicine. So why don’t we just start sort of for the right now and, and share a little bit about the study and, and what we’ve learned and what you’ve learned and, um, why you think it’s important.
All right. Thank you, James. Well, so we, as, as you know, we were able to publish at the end of February through the Journal of Personalized Medicine. And really that study represents the culmination of about. 13 to 14 years of our work where we were iterating on really this applied perinatal nutrition model, the grow baby model within an insurance-based clinical setting and family practice integrated care in a rural part of the United States.
So this is, you know, it would qualify in many instances as a paternal care desert in some instances for some folks that walk through the doors. A food desert, certainly associated with vulnerabilities. In and around equity, social determinants of health. So this population that we’re speaking to in our paper and that we continue to work with, these are not folks that typically have a ton of resources to them.
So one of my favorite things about what functional medicine and systems biology does is that allows us to find creativity where otherwise maybe it feels that we may get stonewalled. Um, but of course that requires integration of different. Professionals within care models, like a nutritionist, as an example.
Yeah. And so Grow Baby’s work has put nutrition at the forefront of the conversation around biology and really finding, um, physiological patterns that emerge as nutritional, insufficiencies and deficiencies far before, sometimes even biomarker status changes, um, through nutrition, physical exam findings, you know, through symptoms and challenges.
And you, you know this, you’re a dad. You know, there’s, there’s a lot of challenges that can come just simply with, with being pregnant because of the amazing amount of life giving force that this maternal body has to, has to pass along to their kiddo. And so our work has now spanned across kind of really three key care models.
So we started actually with group medical visits. Yeah. Um, as you know, community co cure there, there’s a big component of healing that happens when you integrate community. Um, number two, we, because of the COVID time period, we had to utilize the up and coming telemedicine, telehealth concept and virtual, um, visits.
And then the third was a fully hybrid model, or excuse me, a fully virtual model. So we had the group medical, we had the hybrid where we had in-person the single visits with. With the virtual and then the virtual care model. And that virtual care model was actually applied, albeit in our small but mighty cohort in Nevada, was applied in a 100% Medicaid population and it was funded with preventative dollars by a Medicaid care organization.
And our the, what is, I think. Pivotal about the work that we continue to do is, although in our study, the majority of that cohort came from our organ population, so those folks who walked through our own clinical doors, um, the, the next iteration was really represented in, in a completely different population and one that showed equal vulnerability to our organ population in terms of obesity rates, drug use rates, alcohol use rates, and, and really just what we are starting to understand.
The set point of vulnerability of most women’s wa women walking through the door with their pregnancy. You know, we’re, we’re seeing that even with diet, even with supplementation, we’re seeing really big deficiencies and, and main, key micron macronutrients that are setting the stage for complications, where otherwise, if there was a nutritionist in the loop, if there was someone sitting there as an.
Standard to the obstetric care that is being given in the United States now that many of those patterns would emerge as as preventative and we could anticipate them. And so I think for us, what we continue to be so thrilled about is that no matter how we apply this work, um, we seem to get rates of preterm birth that are.
Far lower than anything that we see in the United States. Same thing with GDM. Same thing with preeclampsia. Hypertensive disorders of pregnancy, and then babies that are born too large and too small. So, so both large for gestational age and small for gestational age. And I think it’s because we’ve focused on, on limiting its and, and ameliorating that gap of nutritional deficiencies with using.
Parts of the system that we, that, that exists for us now, James. So the, the parts we can get labs covered with the insurance model, where we can utilize more referral networks to registered dieticians and nutritional professionals. And so that’s what makes us so excited. It’s not an indictment of the system as it stands, it’s leveraging the creativity that the system actually affords us now and really trying to bring more power to, to all care providers who can tap into it.
How did you decide what the intervention was gonna be in those cohorts and, and what was the sort of diagnosed diagnostic process to understand like what was gonna be for everyone, what was gonna be individualized depending on the information that came in? That’s a great question. So the way that the Grow Baby model works, or in this case is called standard of Care plus within the papers, just so we can orient with language there.
Um, but the way that the Grow Baby Care model works is that actually the very first. Tenant of what we did. The, the, the very first structuring of our nutrition program was what changes occur by trimester, both for the fetus and the mother that require heightened micro and macronutrient interventions, right?
So it’s not just what’s happening with fetal development and growth all the way from. Organogenesis in the first trimester to really the components of neuroplasticity and, and neuronal growth in the third trimester to simplify it, right? But also what’s happening with the mom that impacts her resilience, that changes her ability to be able to engage in the lifestyle measurer that helps optimize this time period.
You know, I think it’s very easy to focus so much as a parent and as a system on the baby, right? Because. That child is growing, it’s developing, it’s vulnerable, and so we have to ensure that we’re doing everything we can for that baby. But in the meantime, if we’re not, if we’re, if the measurement of our success is only in the outcome of the birth, and we’re not measuring the success of how we’re supporting a mother too, then I believe that’s a failing of how we’re approaching this.
And so what we utilized was what’s happening with fetal development, what’s happening with maternal complication, symptoms and challenges that are common but don’t, aren’t inevitable. Right, just because, just because of the physiological process of growth in pregnancy doesn’t mean that we can’t anticipate the needs.
And so that’s the basis of how we approached it first by trimester. So every plan changes by trimester. So every mom gets a good base plan of low glycemic index macronutrient ratios, so that 40% carbohydrate, 30% protein. 30% fat and 25 to 30 grams of fiber. So that’s a big significant change over really what we know.
Most Americans are maybe getting eight grams if on a good day, probably less than that. And so the fiber, a big key modulator of that microbiome. Right. And then of course, on the top of that, focusing on micronutrients that we know become more and more depleted over the course of pregnancy. And not just to point a finger at Hemodilution, because I think that in some ways is an easy excuse, and it’s actually what some of the limitations of the research are showing is that we don’t necessarily have great reference range values for some of these micronutrients.
And so it’s easy to just chalk it up to, oh, well, it’s just. The deficiency exists because of hemodilution, when really we have a mom who’s just really struggling and, and needs more support. And so we emphasize food first. Of course, in all things we layer on top with micronutrients, um, needs based on symptoms and challenges, nutrition, physical exam findings, but also biomarkers.
So we do utilize kind of a key set of biomarkers for everybody being the CBC with auto differential, A CMP. Um, 25 Hydroxy D zinc total and free carnitine, and also maternal DHA. So not an Omega-3 index, but specifically kind of measuring maternal DHA, which isn’t going to give us quite as much of that Omega index.
Similar to the way that when you measure hemoglobin A1C, it gives you kind of that three month average glucose. Representation. An Omega, um, index would do the same thing. It gives us a little more longitudinal leverage to understand, but the maternal DHA gives us a good understanding of compliance and sufficiency in real time.
So maybe over weeks. Um. Then we utilized in the organ cohort, we primarily utilized he two key SNPs, um, associated in three, in some instances, um, associated with methylation. One, carbon metabolism being M-T-H-F-R-C 6 7 70 T, and A 1 2 98 C. And then, and then the, the haplotypes of of COMT. So that CaTECH methyl transferase.
In the Nevada cohort, we brought in a much larger n nutrigenomic array, and that allowed us to tailor interventions even further. And you know what James, what was so cool about that is that these moms were floored to learn this information about themselves In many ways. It reinforced like, oh my gosh.
That explains why I feel X when I get stressed, or that explains why I feel X when you know, I don’t have enough vitamin D. You know? So I think for these moms it was, um, not as similar from, from like, you know, reading an astrology calendar or Zodiac, I’m getting some in, into themselves that allowed them to say, okay, this gives me a reason to implement this information about myself.
’cause I really do need it. So it takes this concept of like. General nutrition support and really makes it precise and personal and therefore drives cognitive behavioral theory, which is I feel competent enough. I feel like the opportunity is given to me and I feel motivated enough to really make this change, let alone the fact that.
I would say the pregnant population is maybe one of the most motivated populations of Yeah. Of folks I’ve ever worked with in, you know, being a, a board certified holistic nutritionist for 15 years and I’ve, I’ve worked across chronic disease, you know, across the gambit and in many ways, and so it’s a pretty ex, it’s exciting time to think about how this model of using food first, layering in nutrients, utilizing existing biomarkers, bringing in precision omics.
On top of and integrated into allopathic care because it’s not meant to replace where you serve. It’s meant to live in parallel, to extend and create that compassionate care model. And, you know, for, for us it’s just, it’s, it’s exciting. There’s limitations to it, of course, too. I mean, I think it’s important to recognize that, um, you know, we, we’ve not run a principle component analysis with this, you know, meaning that, which part of which part of the Grow baby model drives these outcomes?
Is it the access to the nutritionist? Is it the tailored nutrient supplementation? Is it the testing? Um, you know, but I think in many ways, just like systems biology, the, the secret in the sauce is that it’s probably all of it. Yeah. It’s likely. That holistic approach that allows this to be so powerful, um, but also overwhelming to people when they hear this, like, how in the heck do I do this?
So you asked another question, how do you go about diag? How, how do you go about doing this? Right? And so I think, um, Leslie has to answer this question a lot. Dr. Leslie Stone, who is the, the obstetric side of the Grow Baby model, um, because. Not everyone is going to have a nutritionist at their fingertips.
Right? So how do you create, how does an obstetrician. Or any provider who is working in this population, how did they go about establishing an a, a referral establishing the diagnosis to get the referral done right? And so that’s where, um, that’s where I think our core, kind of the core next step of our work needs to live is really showing people how to do this in their own, in their own care practices, because.
It’s, it’s utilizing things like I said, the CDC with auto differential, the CMP and a select set of biomarkers to begin the process of being able to attach a nutrient diagnosis to get that referral to the registered dietician or nutrition professional. Um, so, you know, that’s kind of the next iterative step of this, I would say.
It seems like, you know, if you, if you didn’t do this, you get the outcomes that you get across the rest of America and Medicaid populations. Right? And, and those are measurable in terms of the costs of all those conditions that you mentioned. Um, what is the process of showcasing the value of these kind of interventions in a context of things that you are avoiding, like the, these downstream consequences?
Because surely it makes sense to me that this would be. You know, the, the, the greatest way to measure the success is like avoiding all of these, at least near term com complications. Nevermind the autoimmune disease when you’re 35 because you didn’t get the right nutrients when you were minus two months.
Just wanted to take a moment to thank our mission partners for helping bring this podcast to you. As you know, we are in the business of building a network of clinics that can reverse cognitive decline and our partners in that. Are organizations you can find out more if you go to goevomed.com and look at the mission partners.
But first and foremost, Truneura, if you go to truneura.com, you can get a demo. Um, this is the underlying software that will connect this network of clinics. And we have an incredible mastermind session. A lot of cool stuff coming out of that company. Um, you can see here. Uh, Fullscript thanks to Fullscript with Fullscript where we’re gonna help you take advantage of the tools that they have, um, to compete with things like ChatGPT, and Function Health.
It’s gonna be awesome. Go to goevomed.com/fullscript. Uh, bigboost.marketing. If you need patients for your clinic, uh, or if you have any marketing needs, goevomed.com/bigboost is, uh. Premier, uh, supporter in that world. And then please, uh, also check out Freedom Practice Coaching Built and scaled a very successful brain health practice and has been instrumental in helping practitioners with the nonclinical aspects of running a practice doing this.
These are our mission partners. These are people that I know well. These people are the top of their sphere and really excited to bring you, uh, the rest of the podcast. Enjoy. Yeah. It’s a, it’s a great, it’s a great concept to, to speak to, right? Because I think the, the problem exists across MCOs, it exists across government entities, it exists across hospital systems.
Meaning the problem being these is that there’s deleterious neonatal outcomes and maternal outcomes in this country. And we’re very, very well aware of them, and they were getting worse. And it, this is, um. There is more urgency than ever to solve for this problem because we are seeing largely preventable occurrences increase.
In fact, I, in fact, I think this, this statistic came from the CDC, 80% of all maternal deaths are preventable. 80. We have some of the highest rates of maternal mortality in this country. Same thing with infant mortality, and the infant mortality and vulnerability comes from those neonatal experiences and those neo neonatal outcomes that are setting the stage.
And you know, I’ll repeat myself because I said this to you in the beginning, but the. First healthcare system that anyone enters into is the Interuterine environment. So the Intrauterine environment is the first healthcare system that we all experience. It is the most powerful tone setting stage that we have, and I think.
The acknowledgement that the Grow Baby Standard of Care Plus model is trying to bring forward is this, is that this isn’t just about the prevention of these outcomes, although James, to your point, that is what. Peaks the interest of MCOs. Yeah. It’s what peaks the interest of hospital systems. They say, well, if I can decrease these outcomes, then ultimately I’m talking about an economic impact that is of interest to us.
Right? Yeah. You come for the economic impact and you stay for the network sufficiency throughout your life. That’s right. That that’s, that’s right. And you know, it was so funny because for so long, James, you know, our story for so long, we were really beating the mission drum as much as possible. And then we had, you know, really powerful insight from our work in Nevada and really from really some close colleagues that said, you know, emphasizing the economic model, the cost effective analysis ratio, the qualities and data, so the, the quality adjusted life you’re saved, the disability adjusted life, you’re saved.
That is not. An abandonment of mission. It’s actually using the language to speak to the stakeholders so that they can hear it. And so that’s really what this is about. This is the, the same solution exists for all the stakeholders who care. You just have to change the languaging of it. Yeah. That to allow them to sit up and listen.
Because to your point. A preterm in the United States, $65,000, and that is the singular event. That’s not talking about the implications of the cost of the preterm birth over the course of even the, the child’s first year of life, let alone the emotional, spiritual, and mental. Um. Strain challenge that can happen from having a preterm birth, um, child within a family unit or in, within the mother or within the whomever.
It is the caregiver. And so I think it’s important to recognize too that that singular economic event, uh, is the tip of the proverbial iceberg, right? It’s this is, this is not just about preterm birth. It really is talking about changing the entirety. Entirety of the trajectory of the health of that person and the system as a whole, because.
I, I often actually, I understand the utility of utilizing something like a randomized control trial. I, I really do. I understand the value of it, except for in this type of care, um, we unfortunately have a long history of seeing, uh. How well we do it when we are just applying kind of current standard of care and we’re not, we are not touching the needs of this maternal population in this country in the least.
And so, yeah, you know, this, this is pro, this is for me trying to bring some of the highlight forward into like, how can this system work for us? How can we utilize and pull on the, the tangible parts of the system that can bring this type of care forward? Yeah, no, that’s a great point. And I think we, you know, we got plenty of data about what the standard of care does.
One thing that you might find interesting, so I, I was, I put in an event last year and I had two pediatrician friends who have a practice down the road, um, trained in functional medicine, like, have an incredible practice. They do a lot of, um, they work with a lot of chronically ill kids, but they also have this sort of like, trusted patient.
Direct primary care population. And one of the graphs that they put up when they were doing their presentation was, you know, what is the, what is the percentage of people, what is the percentage of kids that have these chronic illnesses in the country? What are the percentage of kids that have these conditions in California?
And then what are the percentage of kids that have these conditions in this practice? And ultimately it’s, you know, the eye-opening thing is that. That third bar graph does not exist because all the kids are healthy and that’s what it looks like. And they do things there like, you know, one of the innovations that they came up with was what they call the bambino visit, which was essentially like a group visit for the first 18 month of care where you’d actually meet a cohort of other parents and do this healthy stuff along the way.
And, you know, there’s not, not so much prenatal just because it’s a pediatric practice, but, you know, it’s, it’s, it’s incredible. I think, I think you’re right to say that just, um. It’s. At the beginning, you need the mission because you want to get people engaged. You don’t have resources. You need to gather resources, you want to get people moving.
But there comes a certain point where you have to sell the people who hold the purse strings and they need to understand that this is gonna help them. And ultimately, I guess that’s what I wanted to just dive into here, because this is a, a life’s work for you, right? You have, you know, your father and mother.
Functional medicine royalty. You are sort of birthed into this, you know, this milieu. You, uh, take on this, this project that now is over a decade old and I just, I’d love for you to speak to what it takes to actually change something significant because you could, you know, you’ve got this. This Oregon cohort, now you’ve got this Nevada cohort, you’ve got a new North Carolina cohort, right?
Where there’s gonna be even more, um, engagement into the system as it is you sort of have this like virtual delivery system, right? With the, the plus that could be prescribed by all of those OB gn, ob g OBGYNs that don’t have a nutritionist friend and they haven’t developed that relationship. So like.
The pathway towards solving this problem exists, and we’re about the same age, I think. Right. You still got some, uh, some juice in the locker, right? So this could happen in one lifetime, but like, you know, you are, you’re in the middle of it now. So I’d love for you to share just your thoughts on that, because I feel the same passion from you that I feel when I go to functional medicine conferences.
See people operating at, I feel it right now with the doctors that are involved with reversing cognitive decline. Right. Another, at the other end of the spectrum, but another example of where, um, you know, the, the economic savings are potentially, you know. So significant because of the cost of one extra month of, of, uh, of memory care.
Right? Um, uh, but like ultimately, in order to get the people to play ball, there has to be a moment where you put it into dollars and cents and represent that this is a, this is a healthy investment all the way around. Absolutely. Well, and I’ll just divulge my age because I actually find the irony of the parallel path of developmental programming at health and disease to, um, actually coordinate exactly with my lifespan time, which is, so in 1986, David Barker and some of his colleagues of course published the, the, uh, the Dutch famine studies, right?
Which really was the impetus of this concept of developmental programming of health and disease or. Transgenerational programming of resilience is kind of how I think I would, I, I like to think of it. Um, so I am as old as D-O-H-A-D, so I am almost 40 and. I started this pathway really having grown up in it, right?
Um, but functional medicine and the con really systems biology, um, entered into my parents’ working ethos very, very early as family practice physicians, Leslie, my mom being a family practice obstetrician Michael, though Dr. Michael Stone, also having delivered babies too earlier in his career. So both of them have kind of this touchpoint of this womb.
The wo magic in them a bit. Um, but over the, kind of the course of, of their clinical practice, when they started integrating nutrition very early in their practice, um, I, I realized that I wanted to become a nutritionist because of the time I got to spend with people. And also understanding that NU Nutrition is the one thing all of us share in common, no matter who you are across the world.
And. I, I use this line a lot, but on average an adult human eats about 2000 pounds of food in a year, and that means we get 2000 pounds of opportunity to try to optimize ourselves. Like that’s a lot and there’s a lot of grace in that statement, and I really wanted to push back against the societal pressure that having to be perfect, especially during a time period when pregnancy, when you know, nausea is a bummer.
Right, and fatigue is intense and it just feels like no matter what you do, you are failing. This baby and failing yourself within this pregnancy time period, because societal pressures, the messaging is discordant, it’s misunderstood, it’s not valued, it’s reactive, it’s triggering. And so for me, I realized that that is really where I wanted to put my time and my heart was how do I create empowerment around the pregnancy time period, but really the preconception, postpartum pediatrics.
So I laugh a lot too. I work in the PS because it’s all about prevention. I like preconception, I like pregnancy, postpartum, pediatrics, puberty and perimenopause. Like those are my favorite piece because they’re all about prevention. Yeah. And so, um, but I think to your point. The, there, there is a well-known concept from the, the genesis of an idea to a full, to full acceptance and of kind of clinical implementation.
Not even implementation, but full clinical acceptance. Um, takes about 17 years. So from the time someone has a good idea. That’s founded in systems biology or in science to the time where there’s some acceptable notion. It takes about 17 years. So we’re about, we’re about 14 years into this, so by my account, we’re ahead of the game, which makes me feel pretty good.
So, so, but to your point. The momentum is starting, it’s starting to snowball. You know, the, the North Carolina, um, work that we are about to embark on in about, in, in July is, is, I don’t get to use names yet, but I get to talk about big WAN’S concepts. It is fully funded by an MCO. Our cohort size is 500 pregnancies.
We just follow those kids for five years. So back to your pediatrician, model two showing that when you change care within the pediatric care model two you, you get better outcomes. But what we’re gonna be measuring is the exploratory association between when you intervene during this time period in pregnancy, are these kids more resilient in terms of their health as it pertains to.
Allergy, the, the allergy triad allergies, atopy eczema. We will be, um, walking into the world of autism spectrum disorder too. And then we’ll also be looking at pediatric obesity up to the age of five. Um, and it will be not only funded by an MCO, it’s supported by a major four state hospital system. And, and then our recruitment will be at a single site with a fully OB GYN allopathic care team.
And it’s, um. It’s, it’s the exact type of layered stakeholder engagement that’s required to really meaningfully see that this model is not only implementable, it’s scalable. So that’s the next part of this conversation too, James, is like. Is the scaling. And so I think to to your point, I, I would be the most honored person ever if in my lifetime this looked like it meaningfully was going to be an, you know, part of system adoption, system wide adoption.
We are, we are definitely on our way, but I, i, I say this often too, is that this is, this is hard work. You, once you see it, you can’t unsee it. Uh, you know, and I, I would have to my, the, the one piece of advice I would give to anyone, not that anyone’s asking, this is my unsolicited advice moment, um, is get really good at accepting failure.
Failure in the way that it presents as a no, or as a not yet, or as a challenge that feels insurmountable. Um. On the other side of that because failure elicits fear, embarrassment, anger, and working through those feelings and those emotions, like on the other side of it is everything that you ever dreamed of.
So you have a moment, you get a a chance at that very exact time when it feels like you failed to say. Do I get to turn the tide here? Do I continue to walk through it? Do I continue to move through what feels like darkness because it’s the right thing to do and grow? Baby for me has always been the right thing to do, and inevitably the right thing to do is always the hardest.
And so, uh, the acceptance of what feels like failure is actually the most beautiful opportunity that that can be given to anyone. And I just encourage anyone who wants to pioneer a concept or an idea to, to hold on to the other side. ’cause the other side is everything you ever dreamed and hope for and the right doors will open.
Just keep walking through it, you know, and I think that that’s important to remember, um, because after 15 years of doing this. There was many times when, when giving up felt like a really good idea. Yeah. Well, it’s, it’s so needed. And, you know, you mentioned a, a phrase earlier that reminds me of my economics training, the quality adjusted life year, you know, when you’re intervening in preconception, like even a small change in quality means a, a big shift in quality adjusted life years because you can multiply it by 60 or 70 or 80 or or more.
And so I think you’ve got a, you know, a great, uh, segment of the population there. I mean. In the spirit of unqualified advice, like, do you feel like, do you feel like there’s, you know, you’ve spent obviously a lot more time in the functional medicine world, um, than, than anyone because you sort of grew up in it, but it seems like you’ve had to sort of like reposition this in a way to make it more palatable to the people that you wanna work with.
Mm-hmm. And I’d love to get your input on that because I, you know, I see that as well. It’s like, what? You know, how do you. How do you speak in a language that the people who you want to help can understand? And I’d love to get your input on that. Yeah. Well, um, so just to orient those who are listening, who, who may not know this current standard acceptable practice is to evaluate iron and folic acid.
Really, those are kind of the two core micronutrients that most obstetricians feel very comfortable speaking to. Okay. Um, but. The, the problem of course with that is that. They are limited in their scope, right? Meaning that iron and folic acid certainly does not represent the, the myriad of micronutrient deficiencies and insufficiencies that we’re seeing that impact these outcomes.
You know, James, as an example, let me give you a quick example. Just simply supplementing with DHA decreases early preterm birth and preterm birth irrespective of measuring a biomarker, right? And we know that. Choline a critical nutrient for cognitive health, for brain development, um, iq, et cetera, and in, especially in young children.
But if deficiencies in the mother at 90% of insufficiency through diet, let alone through supplementation, we see. Big, a big impact of that on some of these F1 offspring outcomes. Right. But short of coming up with a big, long list of, of stuff that OB obstetricians don’t know, my job is to language this and to teach this and to what are you currently drawing?
What are you currently using in your standard practice and what insights can you find nutritionally within those markers? You know, so let’s use C, D, C with, with auto differential as an example. You can look, albeit it’s not a perfect measure, but you can utilize patterns in hemoglobin. You can look at patterns in hemoglobin, in hematocrit, and get some good insights into iron deficiency.
Those, those thresholds change over each trimester. But A CDC costs $3 and 87 cents. Yeah, you can look equally. You can look at the same patterns for hemoglobin, hematocrit red, um, blood cell distribution with. And mean corpuscular volume and get a good insight into macrocytic anemia. Right? So looking at B12 and folate status in insufficiency, you can look at components of the differential looking at neutrophils.
Lymphocytes, platelets, and you can get composite measures of different impacts of inflammatory cascades, coagulopathies, looking at overall systemic inflammation, and you can get some good insight into patterning that is associated with things like preeclampsia, things like GDM. So with. Less than four bucks very quickly.
A CBC with auto differential becomes the beginning of your nutritional insight, and then with a few additional biomarkers. I always like ACMP and there’s a lot of reasons why obs obstetricians don’t like to to to pull ACMP. But ACMP equally is very cost effective. And what I like about ACMP is within that we can get, get good levels, uh, we can get a good understanding of liver function tests.
Any abnormalities in a ST and a LT within pregnancy are abnormal, and that in itself warrants a good evaluation. We can look at the beginning of glucose levels, we can look at some of these electrolytes. We can look at total protein and irrespective of hemodilution, it gives us a good beginning of dietary understanding of macronutrient sufficiency, you know, and so I think it’s important.
To bring credence to the existing frameworks that it, that, that are available to us within the system that are covered by insurance, where we can amplify the utility of those by centering in around some additional education. And that’s not even discussing, looking at zinc vitamin D carnitine free in total and maternal DDJ.
So what you’ll find in the standard of care plus model is we’re not drawing. 50 to 60 to 70 biomarkers. We’re not pulling, you know, big functional medicine send away kits. We are really trying to utilize the system strengths as they stand. Love that. Yeah. Well, look, I’m super excited to see this, you know, the journey and to capture you at this moment in the journey.
And I know that the journey continues because there’s exciting things on the horizon. And just, yeah, just wanna share my appreciation for the sticktuitiveness that it takes to just be in it and to say yes over and over again, even when it feels hard. And, um, you know, I look forward to following this journey.
And I think that the, you know, the news of. Of the impact hopefully will, uh, accelerate, you know, beyond, uh, your four walls and ripple out into the, into the rest of medicine. And I think it’s really exciting to see functional medicine concepts. This is really the evolution of medicine. I mean, that’s beyond functional medicine.
It’s medicine adapting to its new environment. The environment is nutrient insufficiencies, and so medicine has to adapt to it. So what does it take to do that? Well, you have to prove that sufficiency creates health. And you’ve done that a number of times. Now, it’s like, okay, where are the people that are most needing this and how do we get it to them?
And I think you’ve got some, um, really exciting pieces there. So, uh, and, and a lot of momentum. So. Thank you very much for being part of the Evolution of Medicine podcast. I look forward to seeing you hopefully, um, in San Diego in a few months. And, uh, I’ll be there and we’ll be doing some, uh, podcast recording there, and we’ll put all the details about the study in the show notes.
So if you wanna read more about it, you can see what’s going on. Any other final thoughts about, uh, you know, the evolution of medicine? Seeing this is your first time I used to ask everyone years ago, you know, what does it mean to you? And I’d love to, to get your, your input on that. Oh, thank you. Well, the, the goal for me stays the same, which is the most under leveraged aspect of our health is nutrition.
And that is never as more powerful as it is within pregnancy and that Intrauterine environment. And so for me, the goal stays the same. It’s bringing personalized preventative care into the standard of care model and really gaining momentum so that. All mothers, all folks who want this type of care have access to it.
And that’s, that to me would be the one of the most meaningful things that we could do in the evolution of medicine that has cascading effects generationally than in, than in any area of health. Beautiful. All right, ladies and gentlemen, this has been, uh, the Evolution of Medicine podcast. I’ve been here with Emily Rydbom of Grow Baby.
We’ll put all the details into the, uh, show notes. Uh, thanks everyone for tuning in, and, uh, we’ll speak to you next time. We’ll enjoy that. So that was the podcast, what an epic session. Thank you so much for tuning in to the Evolution of Medicine Podcast. We’ll be back again next week, and thanks so much for tuning in, and we’ll see you next time.
.
Subscribe
Download
Click here to download this podcast
music provided by intomusic.co
