The Air We Breathe: Finding Well-Being That Works for You
The Air We Breathe: Finding Well-Being that Works for You is a podcast created to help you establish a trusted foundation of doable healthy habits and smart self-care skills that can endure every season and last you a lifetime. I'm your host, Heather Sayers Lehman, and my guests and I will share ways that you can focus on your physical and mental health with purpose, flexibility, and ease. The Air We Breathe is here to help you find out what’s most doable, frictionless, and effective for you and release everything that’s not. Find more information at HeatherSayersLehman.com or @HeatherSayersLehman on IG.
The Air We Breathe: Finding Well-Being That Works for You
E55. Busting Myths to Empower Reproductive Health with Registered Dietitian Rachelle Mallik and Health Coach Heather Sayers Lehman
Fertility health is an area rife with nutrition misinformation and opportunistic influencers. 💸💸💸
I have registered dietitian Rachelle Mallik on the pod, and she is here to share her vast knowledge of nutrition and reproductive health!
Rachelle’s experience while pregnant left her wishing there was more support and information on nutrition for pregnant people.
She shares the journey that led her to start her private practice focusing on reproductive health.
In this episode, we discuss:
- How to spot misinformation and who to seek information from
- Differences and similarities in nutrition for pregnancy and postpartum
- Uncoupling weight and pregnancy
- Areas to focus on during pregnancy that are not weight-centric
- Busting some of the myths around PCOS
Whether the topic we cover today directly relates to you, you will appreciate how well-versed Rachelle is in her field of work!
Rachelle’s bio: Rachelle (Rachel) LaCroix (LaCwa) Mallik (Mal-ick), MA, RD, LDN is a dietitian and founder of The Food Therapist, a virtual private practice specializing in nutrition counseling and education for reproductive health. Rachelle supports clients who are trying to conceive, pregnant, postpartum, breastfeeding, or managing conditions like PCOS and endometriosis with a weight-inclusive approach that focuses on nourishment rather than restriction.
Rachelle’s website: https://www.rachellemallik.com/
Find various articles on Rachelle’s work here: https://www.rachellemallik.com/media
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All of these phases come with their own stressors. Right Preconception, if you're not having trouble, may not be super stressful, but dealing with fertility challenges is super stressful and really takes over your thoughts and your day to day. If you're going through fertility treatments and testing and pregnancy right, there's always worries about like is baby kicking enough? Did I eat something I shouldn't have? There is already inherent fear and worries and anxiety that might come along with pregnancy. There's just so many unique challenges and stressors that come with each phase that I want to make nutrition a form of self-care and to reduce stress.
Speaker 2:Hi and welcome to the Air we Breathe, finding well-being that works for you. I'm your host, heather Sayers-Layman. I'm a National Board Certified Health and Wellness Coach, certified Intuitive Eating Counselor and Certified Personal Trainer. I help you get organized and consistent with healthy habits, without rules, obsession or exhaustion. This podcast may contain talk about eating disorders and disordered eating. There could also be some adult language here. Choose wisely if those are problematic for you. Hi and welcome to this episode.
Speaker 2:Today I'm chatting with Rachel Malik and she's a registered dietitian, founder of the Food Therapist, and she focuses on reproductive health and how nutrition impacts. That. I find it fascinating because, as somebody who is 150 years old and really only read a couple of books and nutrition was not even on the table thank goodness the internet was not available then and nutrition was not even on the table Thank goodness the internet was not available then. But I really wanted some evidence-based answers from Rachel on all of these different topics that pertain to reproductive health. Also hang on to your hat, because you're not going to believe this. So Rachel is from New York, lives in Chicago. So Rachel is from New York, lives in Chicago, and her sister, who lives in Arizona, where I live, works in my building. So I am on the seventh floor. Her sister works on the 14th floor. How bananas is that? Anyway, I thought it was nuts. This world is small. You got to watch your P's and Q's out there people.
Speaker 2:Anyway, here's what we went through. I wanted Rachel to really talk about how we can try to suss out who is credible with information for this time of life and who is just an influencer trying to sell some stuff. And another big question I have is when we look at nutrition throughout this whole cycle, basically from fertility to, like childbirth, lactation, postnatal, like, are there different things we're supposed to do, like different things are supposed to eat? But I wanted some really um, succinct information from her on that. And then, finally, we talked about PCOS. If you're not familiar, it's polycystic ovarian syndrome and I see it a lot in my clients and I will say the healthcare space doesn't seem to have a lot of good answers for them. So I wanted to get Rachel's take on the evidence and how that can be supported nutritionally. So tune in.
Speaker 2:I really enjoyed talking to Rachel. I feel like she is so nuanced and evidence-based, which hopefully that's who we're all following. But it's really beneficial Even if you're done with that stage of life. You certainly know other people that may be coming up on it, and it's always great to reiterate good, sound practices. Anyway, enjoy the episode. All right, I am really excited to have this episode today because I think this topic is, you know, it's past. I'm past this topic, but for myself. But for others, I'm so interested in what Rachel has to say because we're going to talk about some reproductive nutrition bits and pieces, so I will let Rachel Malik go ahead and introduce yourself.
Speaker 1:Hi, thanks for having me, Heather. My name is Rachel Lacroix-Malik. I am a registered dietician specializing in reproductive nutrition, so I primarily work with folks who are trying to conceive, pregnant postpartum. I also work with folks who have endocrine or reproductive conditions like PCOS, endometriosis, hypothalamic amenorrhea. So I definitely work with people who are supporting their reproductive health, even when they're not actively trying to reproduce. I've had my private practice the food therapist. I'm based in the Chicago area. It's a fully virtual practice, so I do work with people all over the country, depending on state licensure laws, and I've had this practice for six, seven years. I started in 2017. And essentially like do you want me to give a little bit of my background? Sure.
Speaker 2:I, because that was going to be one of my questions, because I was curious about what drew you to it.
Speaker 1:Yeah, so without giving you my entire life story, essentially we were talking before we started recording about how I went to Arizona State undergrad and that was back in the early 2000s.
Speaker 1:I graduated in 2006. I had a degree in nutrition and was a pre-med student. So essentially I was trying to get some experience before considering going in the med school route of getting experience in the medical world, and moved back to New York, where I'm from, and got a job as an IVF patient coordinator at the Weill Cornell Center for Reproductive Medicine. So here I am 22. I think I just turned 23 when I started working there. I don't think I'd ever heard of a reproductive endocrinologist before. Definitely was at the age where I was not considering trying to get pregnant or really had never really given much thought to my fertility, except of preventing pregnancy. Right, and you're a young woman, that's what we're often thinking about is preventing pregnancy, not trying to become pregnant. So I worked there for about five years and during my time there as a patient coordinator I worked with probably thousands of patients. It's a really busy practice in New York that sees patients from literally all of the country and all of the world because it's a really well-renowned, world-renowned center. So they would get really hard cases, really complex cases it wasn't just people in their late 30s and 40s trying to conceive, you'd see like primary ovarian insufficiency, like young people dealing with issues around their reproductive health or early menopause kind of symptoms, cancer treatments, like preserving their fertility if they were needing to go through cancer treatments, all kinds of things. And during that experience, what I decided was or what I became more curious in having that degree in nutrition I was like, well, how does nutrition play a role in fertility? Because we talk a lot when you're in school to become a dietitian or learning about nutrition, you talk a lot about disease management, but also prevention, right? And so I was like, all right, how does nutrition play a role in this? And that was something that patients would ask me about.
Speaker 1:Now, in this role I was not a dietician but because of being the liaison between the patients, like they would see the doctor. Their plan was to go to IVF and they would say go talk to Rachel, she'll walk you through all the next steps. So basically, they'd come to me and I would pull out a calendar. We talked about their last menstrual period, what kind of testing they needed to get done HSDs and SIS and semen analysis and for people who aren't in the fertility space, I can explain all those acronyms, but all these things that are can be really overwhelming for patients like, okay, this is a big deal, we're trying to get pregnant, we're having trouble and we have to go through all this testing and all this treatment. And they would ask, like, what can I do? So that planted the seed, pun intended, of like how I wanted to go in the direction of my career.
Speaker 1:So I went back to school. I stayed working at Cornell, I went to NYU for grad school, got my degree in food studies because I already had a degree in nutrition. I needed to finish my DPD requirements. The audience doesn't necessarily need to know about that, but it's essentially the training or the classes that are required to do your dietetic internship, which is required before you can then take the RD exam and become a registered dietitian. So I went to NYU and did food studies masters and my DPD there. And what I loved about the food studies program this is a little bit ancillary to my main practice and reproductive health, but you learn about food systems, food history, food culture, food policy, all these different things that shape how we eat, outside of the nutrition science you, you know. So it was really, really interesting for me. I got to study abroad, in Mexico in.
Speaker 1:China just really, I think, helped me become a really well-rounded dietitian and I just have always been interested in food, food culture and food history and how that shows up in the work we do as dietitians. You know. Um so flash forward to like skip a couple of years. I graduated in 2012, became a dietitian then and then in 2016, my son was born, and so now always go back to different parts of that if you're curious, but essentially like this, experiences that I'd had working at the fertility clinic, then working in private practice with patients who are trying to get pregnant postpartum but I hadn't been through those experiences myself, right of like trying to get pregnant, being pregnant, giving birth, lactating, healing postpartum, and then in that, when I was pregnant with my son. You know I'm a dietician, so there's a lot of information that I had about nutrition in the life cycle and my experience working in the fertility clinic. So there's a lot of things I knew.
Speaker 1:But in terms of nutrition advice that I was given, it was like take a prenatal vitamin and that was it Right and it's very it's not bad advice, but it's definitely not comprehensive advice, and I always think about how there's no standardization for prenatal vitamins.
Speaker 1:They're all across the board. Some don't have iron, some don't have choline, some are gummies, some are tablets, some have eight, some have one per day. So this is kind of all over the place. And I just did a little bit of market research and was like I don't really see many dietitians specializing in fertility and pregnancy outside of like gestational diabetes, outside of kind of addressing issues that come up in pregnancy versus more of like what can we do to maybe reduce some of those risks? And why would you see a dietitian before getting pregnant or while being pregnant, even if you're not having quote unquote problems, right? And then after my son was born, I had no paid maternity leave from the hospital that I worked at, so for another day, but, I, decided that I was like okay, I want to start a private practice.
Speaker 1:I wanted to be really intentional about focusing on reproductive health and serving that population who is trying to get pregnant, postpartum, with credible information from a dietitian with experience personal and professional and that could really help people thrive in their pregnancy journeys and, you know, have enjoy food along the way to not just like there's such a focus on what you shouldn't eat both infertility, whether that's true or not. There's a lot of things don't avoid this, don't have that in pregnancy, because of food safety. That comes up a lot, you know, like you can't have alcohol, you can't have deli meats, you can't have sushi, like all these things that people are told that they can't have. So, really coming out of place, like what can we add in? What are things that are going to help you feel nourished and enjoy this experience as best you can, because each phase of the reproductive journey comes with its own set of challenges. That's a long winded answer, but that's essentially how.
Speaker 2:I think it's so interesting because, you know, certainly for me, you know, my kids are 21 and 23. But you know, and I had had a couple of miscarriages before I had them, and so this is like teetering, teetering on the internet era. So I read, like what to expect when you're expecting like we Googling stuff was not really a thing then, Thank goodness. So one thing that I perceive that people are up against is the internet and this like glut of misinformation and disinformation, because I feel like through each of these stages, people are so vulnerable and then it's so easy for people to take advantage of somebody who's desperate, because I feel like I'm trying to conceive, so concerned about the fact, like now I am pregnant, I want this to be, you know, successful. Like that people get taken advantage. So much in that piece. So can you speak a little bit to, I guess, like I mean, I know you've seen everything like this, the different pieces about misinformation and how people I mean I assume they just come in overwhelmed and confused when they talk to you.
Speaker 1:Yeah, it's such a good question and even from when I started my practice in 2017 to now right, because back then, social media existed for sure. I mean, I had Instagram with all the filters on it, like the early 2010s, right, and but it wasn't such a place that people turn to for nutrition advice. It wasn't the search engine that it has become. Tiktok didn't exist to my knowledge. So now there's not only like the endless internets of where you're getting information, but then there's social media and it's really hard to know who to trust, because people come off with such conviction, even when they have no idea what they're talking about, which is really scary and have huge audiences, right, so we assume trust based on that, or at least I think people can like oh, they have such a huge following, they must know what they're talking about. So it's tricky because I think people not always.
Speaker 1:There are definitely dieticians, you know, and people and REIs, you know, fertility doctors, obgyns that haveredit their experiences, but then they'll be like this is what I did and it worked for me, and then they're just kind of evangelizing that when that's not necessarily what the research shows or is helpful for everyone and can make it more stressful.
Speaker 1:Right, Because a lot of times that does involve. What worked for me was I did a hundred different things and I also cut out a hundred different things, and that's super overwhelming. So I really try to get down to what does the evidence show? And evidence, as dieticians, is not just the research that's available, but the body of research right, looking at it holistically, not just one study that had 12 people for four weeks yeah, we can all find one study that showed x, but we want to look like take, zoom out, look at the larger body of evidence, but also our clinical experience working with patients. Right, seeing what can help or harm. And you know, in the medical world, in the healthcare world, we're always taught to like first, do no harm. And when it comes to nutrition nutrition I think I used to think of was always like oh, it can't hurt, but it can in some scenarios and I think you understand that as a weight inclusive provider as well like how, how we approach nutrition can be harmful for some people.
Speaker 2:Do you feel like the do it yourself approach to improving your healthy habits does nothing except feel overwhelming, guilt-inducing and defeating? You don't need more rules, influencers or structured programs. Let me help you discover what you want, what works for you and how to maintain healthy habits during the ever-changing circumstances of your life. If you're ready to create systems that stick head to heathersayerslaymancom backslash health dash coaching and click, let's do it. Certainly, somebody who had orthorexia who you know, which is an eating disorder that is extreme clean eating, and was petrified to eat a lot of things because I was diagnosed with thyroid disease and you know I wanted to cure that with nutrition which plot twist, you don't?
Speaker 1:So there are things that we can eat to support our thyroid health, but you still probably need some levothyroxine, or it depends what your your thought.
Speaker 2:Yeah. So I think that, um, you know, I see the other end, and that's what my perception is, it's people really promoting extreme clean eating. To what you were saying of, like, yeah, you got to cut this out, you definitely have to cut this out. And, oh, this is toxic, this, this is poison. I always, certainly, warn people against the end of one. So this person that had this experience and now is an expert which I also love your term evangelize because I was like, oh, I'm gonna steal that one for sure, but, but you know, they become then their own industry because they went through it and, yes, you went through it, and it doesn't make you an expert. Like, other than looking out for the influencers who are the end of one, like, are there things that you see that you think other people that might not know should tune into that? This is not a credible source of information.
Speaker 1:Yeah, it's a great question. It's a tricky one to answer because there's not, like always, a simple way, but I'd say the first step is, if you're getting health care information, making sure you're getting it from a health care provider that they are an MD, right, or a DO, so they're a medical doctor, either specializing in obstetrics and gynecology, or maybe they're a midwife again, if you're looking into the prenatal space or postpartum, or that they're a registered dietitian or a physical therapist right, there's different, it depends what kind of things we're looking at, but I'd say generally, from a nutrition in the fertility space, you want someone to be a registered dietitian that has experience in that space. The tricky thing is here that there's not a fertility training specifically. There's sports dietitians, like a CSSD, I think is the acronym or there's people who are specialists in nutrition support. There's a board exam for that. There isn't at this point for fertility. So really want to dig into that person's experience because there can be that n equals one, two of like. They are healthcare providers that had a fertility experience.
Speaker 2:Again it doesn't.
Speaker 1:I don't mean to discredit that, but is like okay, have they also gone in to do more research on this? I'm a member of the American Society for Reproductive Medicine, so I attend conferences. I'm active in the nutrition special interest group that they have within that, so I speak to REIs on this topic. I've spoken at the conference, so I'm really as involved as I can be in understanding again that body of evidence and working with, like okay, what is what is fertility treatment actually involve versus? You know, kind of just again taking a big picture, look at what someone going through infertility treatments is actually dealing with. And then what does the nutrition research say about what can support their chances of conceiving and of having a healthy pregnancy?
Speaker 1:So, again, there's no specific training, but I've been working in the space since 2006 because I started in a fertility clinic. So I had five years of like the ins and outs of IUI, ivf, donor egg and really understanding everything that's involved in that. And then now seven plus years working specifically as a dietician only in this space, really attending conferences, focusing my continuing education on reproductive health, like in terms of webinars and ces you know, continuing education that I get and being involved in the organizations that are doing most of this work, so somebody that is as qualified as you is going to be speaking to those things also.
Speaker 2:So those are good things like to listen for, like oh, okay, that they are involved and I always think, involved in the academic side of it, which sometimes I feel like it sounds a little snooty, but for me, like I'll be snooty all day long. That is important because I do think those things matter, and the anecdotal pieces or the influencer pieces tend to kind of spit out the same sort of clean eating information that I feel like they're just hearing from each other and then kind of regurgitating the same thing.
Speaker 2:Echo chamber, yeah, and in like, when we look at again, like this, um, which is interesting to be in the field for over 30 some years, you know, in health and wellness, because it things have changed, because I started in low fat era, um, and so clean eating seems snackwells era delicious. Even taco Bell had a light menu back in the day. We, you know, now clean eating is like has a real grip and a staying power when you're trying to work with someone you know that's living and hearing all of those things. And then you're talking about, like nutrition for fertility. Well, I guess first do you really differentiate nutrition for fertility and then for actual gestational times?
Speaker 1:It's a good question. I mean, for the most part things are going to be supportive of fertility, are also going to be supportive of pregnancy, because when we look at fertility research, specifically research on people undergoing IVF so if they'll look at a cohort of patients that are undergoing in vitro fertilization and they'll look at these dietary patterns among these people, undergoing IVF was linked to higher rates of implantation, higher rates of clinical pregnancy, higher rates of live birth. The really goal outcome of all of these studies is live birth. We can look at these intermediates of like egg quality, sperm quality, but at the end of the day the patient wants to come home with a baby. So and I say this because things that are happening at preconception may be linked to the live birth outcomes. Now it's association, not causation. But a lot of nutrition research is that kind of observational cohort studies, so it's kind of the best that we have.
Speaker 1:It's really hard to do randomized, controlled trial studies and especially in pregnancy, they're not often. There's a lot of limitations there and a lot of red tape. Challenges that come up in pregnancy are very different than someone's preconception or even going through IVF treatments the amount of nausea and aversions and quote unquote morning sickness you know that can happen any time of day makes it so that a lot of the nutrient dense foods that maybe you were focusing on prior to conception are now not appetizing whatsoever. So I really do like working with people preconception, because it's so common to deal with those challenges in the first trimester that can last 16 weeks. Even I did for me in both of my pregnancies. It does for a lot of my clients. It doesn't just end at the first trimester, it can linger into the beginning of the second.
Speaker 1:What can you do ahead of time to build a good foundation of healthier dietary and lifestyle habits? Build up some good nutrition stores, have a good quality prenatal to fill in the gaps and optimize your intake of certain vitamins and minerals. That when you're dealing with morning sickness like I still work with clients to adjust right. Like, okay, if you can only eat bagels, can we get some peanut butter on that bagel. Or, you know, can we get a smoothie in.
Speaker 1:Like what are some things that maybe you could tolerate, whereas like a big old piece of salmon with broccoli may sound disgusting. You know. Like, okay, how could we? Would you like some salmon tacos? Would you like little salmon nuggets, you know or different ways of eating it, and if salmon's off the table, let's make sure you got a DHA supplement and let's focus on some other foods that you can tolerate. So I guess where I'm going with this is we can always modify in the first trimester, but I like working with people preconception or during fertility treatment so that we can really help them feel good about their nutrition and their habits leading into pregnancy and then, as they are able to move past some of the challenges of first trimester, they can bring some of those things back in the second trimester.
Speaker 2:Sounds like such an important time. I had the same. I have 15 weeks and 16 weeks of nausea and um, and I also remember um waiting for a little Caesars to open so that I could go get some crazy bread. Um, because it just like if there was something about the bread and the grease that was like oh, okay, I feel so much better.
Speaker 1:Um, like if there was something about the bread and the grease. It was like oh okay, I feel so much better, uh-huh, like so. Oh yeah, I was big into French fries and Caesar salad dressing Like bottled, so it was like pasteurized. But I worked in the hospital so I had like access to the salad bar and that and then the French fries every day.
Speaker 2:And that was my jam.
Speaker 1:I haven't tried that combo anyway, uh, but I think that that's salty, that crunchy, you know a little sour from the acid of the dressing.
Speaker 2:It's funny how amplified it is that that I I have a like a visceral memory of having um, crazy bread and the deliciousness that that was, which I have had it since, and I was like this is pretty good, I'm not gonna lie, but I think that um, I, which I have had it since, and I was like this is pretty good, I'm not gonna lie, but I think that I think I kind of lost my train of thought, but I know that I wanted to ask oh, preconception, yeah, I think. Oh, I was just gonna say it seems like such an important time to see a dietitian because when you're on your own and you're kind of like waffling around of like I don't know, I know I'm supposed to eat, sort of this way, but this is disgusting, this is disgusting. But to have somebody who is well-versed to give suggestions versus checking on chat, gpt, like what helps with nausea during pregnancy, right, right.
Speaker 1:Yeah, yeah, I mean I think you know there can be some helpful crowdsourced information on social media, or you know I've been interviewed for articles on this topic. There's one, I think it's in my link tree or it's on my website.
Speaker 1:I have all the like media articles that I've been quoted with linked on my website. So I was interviewed one recently for morning sickness, so there's. So there is some solid information out there, but it's also very different to get general information versus personalized information, because within that you might have people that are vegan or that don't eat fish or that have nut allergies. So, really tailoring it to the individual and exploring like, what are some safe options, what has helped a lot of my clients what do you like and what's also going to help give you the nutrition you need to support a pregnancy Because that's really why people are coming to me, you know, is that they want to make sure that they're doing what they can to improve their chance of getting pregnant and support their chance of staying pregnant and having a healthy pregnancy and a baby.
Speaker 2:Well, I assume you get a lot of people that have had the directive because I heard personally it was let's just keep an eye on the weight was how it was always phrased to me, because I think also kind of you know, looking back I know that I was restrictive with my eating. So then when I was pregnant I was like wheels off, like let's go because I could. I gave myself sort of permission, but that was how my OBGYN would always phrased it. You know it's like let's keep an eye on the weight. So I assume you have people coming to you and they're like oh, I'm supposed to watch my weight. Like how do you help them transition to a different mindset about nutrition, taking away the weight aspect?
Speaker 1:Yeah, right, it's so. It's hard to challenge that when it's such the norm of, like weight centric care, right, I work with other providers that aren't so focused on weight and it's really refreshing that, like I've had patients, especially patients in larger bodies, who have their weight has been blamed for their problems their whole life, that when they work with an OB that is like you're doing great baby's, great, all your numbers look good. You know, from their glucose test, you know glucose tolerance test to test for gestational diabetes or the heartbeat, the fundal height, like there's so many other ways to measure health and pregnant baby's health and the mother's health and pregnancy, their blood pressure, um, their, if they, you know, is there protein in urine? Like there's so many other ways to assess things like preeclampsia besides weight. So I think it's really helpful when patients are able to have access to both dietitians as well as OBs or midwives that aren't hyper focused on weight and at the same time, I mean the first thing you see on so many articles that you Google is like get to a healthy weight.
Speaker 1:You know it's ACOG talks about it. Different things from ASRM talk about it. Asrm is the American Society for Reproductive Medicine that I was mentioning earlier that organization I'm a member of, acog, is obstetrics and gynecology. So it's something that people hear or read all the time and that providers are reinforced like, okay, healthy weight, healthy weight and I'm putting air quotes around healthy weight or quote, unquote, normal weight, which can be really pathologizing, like if someone's body is meant to be a higher weight, that doesn't make them unhealthy. So really trying to help them understand what a weight inclusive approach is, it's really. It's not not focusing on their health. It's actually more focused on their health rather than just their weight, um, as a metric of health. So you know, we consider various factors that affect health.
Speaker 1:Right, things aren't always in our control when we think about social determinants of health but when I'm working with an individual, we're focusing on, like, what behaviors are realistic and accessible to them, that they can work on, those health promoting behaviors and you were talking about that before we hopped online of like, okay, what are things that you can, that are actionable, that you can work on, that can support your health and a potential pregnancy or current pregnancy. So, really focusing on all those behaviors because weight is not a behavior. So and understanding that weight is going to change, but we don't necessarily know how it's going to change because you know there's like weight gain guidelines and those are based on BMI alone. So if BMI is problematic and doesn't indicate someone's individual health and we're assuming that they should gain X amount of weight based on BMI alone, I don't think that's very helpful. And if someone is gaining a lot of weight or losing a lot of weight in a short amount of time, you don't usually need a scale to tell that, but you could use a scale to check it. But like there's usually other things going on, you know that are other ways to identify that there's something wrong.
Speaker 1:If someone is gaining or losing a significant amount in a short period of time, like they're having significant water retention, that may be indicative of um, like preeclampsia, or um weight loss, because I don't know, something's not not working properly in their lose. Like it's normal to lose a couple of pounds potentially in the first trimester. It's also normal to gain weight and people are like I'm not supposed to gain any weight, but there you mentioned, like it's also I don't want to say common, but sometimes people come into pregnancy restricted, right, and maybe their weight is a little bit suppressed prior to pregnancy because of restricted behaviors that are no longer accessible in pregnancy. You don't have the energy to work out, you can't avoid these certain foods because all you can tolerate is the bagels and the ginger ale and the body's just kind of restoring its weight because it's it's been not had access to those carbohydrates potentially, and then it is going to gain weight in the first trimester. Other people lose weight because their nausea is so bad they can't eat anything, you know, and then we try to support them in there.
Speaker 1:I'm going on. There's so many things, so I'm. I could continue talking about this, but I'll stop.
Speaker 2:I just I always like another voice that's saying like this, like yes, there's a chart that they're following of like okay, in this week of your pregnancy, it would be acceptable to gain, you know, one to two pounds, which is also so mind boggling given that you could be four foot 10 or six foot five.
Speaker 2:It's like how do we land on this as an okay number and just helping people see also kind of the absurdity of it? You know that as a and I mean even the interesting thing of like that they're prescribing like a healthy weight and it's like define that Like you know, because again, it's different for everyone.
Speaker 1:Like if people have to do super restrictive eating disorder type behaviors to get to a healthy weight. I would not define that as a healthy weight. The thing that I was thinking about is like excessive gestational weight gain. Ewg is something that you know they'll talk about, like avoiding excessive weight gain in pregnancy, and while I think it's it can be helpful to at least consider what's you know that that's happening is like what is going on there that may be contributing to this, because excessive weight gain may be correlated with or associated with higher rates of gestational diabetes or macrosomia or like large for gestational age babies, but they're not necessarily causing that right. So it kind of goes back to that like weight is not a behavior and like association is not causation. So what are things that we can modify? Because weight is not a behavior? So like weight we can't always modify, even when we're quote, unquote doing the right things.
Speaker 2:And then I think just as kind of like a good definition when you're talking about health sustaining behaviors and health promoting behaviors, like what do you feel, like you know and the things that are in your control, like what do you usually talk about with clients?
Speaker 1:Yeah, it's a great question. I mean, again, I'm always going to tailor it to like where they're starting from right, like what are your current behaviors like and what are we trying to work towards? But I would say, eating consistently throughout the day, like when I think of the first couple things I'll tend to work with New York clients on, is like eating consistently throughout the day, which may look a little different in the first trimester and the third trimester than it does, and maybe pre pregnancy or the second trimester right when, like first and third, you might need to eat like every two hours because you are nauseated if you eat too much and you're nauseated if you get too hungry. The third trimester because the uterus and the baby are so big it's really squishing up your internal organs and your stomach gets really kind of pushed around there and then you get higher, you can get heartburn more easily and get full more quickly. So, again, you might need to eat more frequently, but just that frequent mealtime. That's not like you're constantly snacking but you're having like some solid meals or nutrient dense snacks, you know, every three to four hours pre pregnancy and maybe the second trimester, and probably every two to to three first trimester. Second and the third, again adjusting for the individual, focusing on like.
Speaker 1:I use the plate method.
Speaker 1:It's just like a high level framework often of like okay, are we getting some good quality carbohydrates and protein rich foods and produce on your plate or in the meal in some capacity and fat to kind of tie it all together and add flavor and help you absorb some of the vitamins.
Speaker 1:I'll talk about getting adequate sleep. I'll talk about movement. I think it's kind of all over the place, but the foundational stuff is often like frequency of meals, what's going on the plate, making sure they're getting adequate carbs, fat and protein. And then micronutrients right, because there are ones that are important for pregnancy, like iron and choline and iodine, like how are we getting that from the diet? And or supplements, folic acid so how do we get those vitamins in different foods on your plate? You know so like. That plate method is kind of this high level framework for ratios of food and then like specific foods that we might want to put within those categories to get those variety of micronutrients and then the supplements to fill in the gaps, and then like the movement and regular bowel movements, like what can we do?
Speaker 2:to support a regular bowel movements.
Speaker 1:They're not super constipated and then super bloated and gassy because you haven't pooped, like those are things that we can address too, so there's kind of this general healthy things, you know, health promoting behaviors, and then there's kind of strategic, based on what some of their challenges might be.
Speaker 2:Well, I really love that, almost as a litmus test when I'm listening to you.
Speaker 2:It's informative and it's comforting because you have details and information and I think, people being able to step back and hear some other voices that are totally fear-mongering and they're making people afraid, that, like, that voice may maybe no, but you know your entire, the way that you address it is really like, yeah, here are some things that you can do and they're not overwhelming and you know I'm not hearing counting and tracking and all of these pieces but really very sustainable practices, very sustainable practices.
Speaker 2:But it's just so juxtaposed against the fear mongering that I think is, you know, within kind of like clean eating, whatever is so prevalent that you need to be afraid, which I I mean. I know that's part of kind of the indoctrination of following someone of like, oh my gosh, now I'm afraid and I've got to look at this person because they're going to be a savior and help me. That's a whole other episode, but I think that it makes sense, like what you're saying is, again, it's information and it's beneficial and that feels so much better to me than any of the other alarmists that I hear.
Speaker 1:I appreciate that. I mean, that's the approach I want to take too, because all of these phases come with their own stressors. Right, preconception, if you're not having trouble, may not be super stressful, but dealing with fertility challenges is super stressful and really takes over your thoughts and your day-to-day. If you're going through fertility treatments and testing and pregnancy right, there's always worries about like is baby kicking enough? Did I eat something I shouldn't have? You know, there's just all these. They're like pregnancy is not health neutral, like their pregnancy can be risky and like women and babies lives can be at risk, right, so there is already inherent fear and worries and anxiety that might come along with pregnancy and then postpartum. You would now have the baby on the outside that you have to keep alive and you're trying to transition to motherhood, even if it's not your, especially when it's your first baby, but even if it's a second or third. Each time is a whole different experience Because you are older, you have more kids or another kid or more kids, just like everything changes. So like there's just so many unique challenges and stressors that come with each phase that I want to make nutrition a form of self care and to reduce stress. Right, and, yes, there are things that you have to be mindful of in pregnancy, especially of foods that may be less likely to be safe.
Speaker 1:Right, I do like that the language has changed more to like high risk versus low risk foods on, like the FDA food safety guide. I'm pretty sure it used to say like avoid. You know it was just like eat, slash, avoid, and now it's like low risk. High risk because no food is without any risk, and then some are higher risk. It doesn't mean you're guaranteed to get listeriosis, but are you willing to take that risk with some of these higher risk foods? So I try to come at it from a place of just like again what can you eat? Instead of focusing on all the things you can't, let's add in all these other foods that are very low risk and are high nutrient, dense foods. And or just for pleasure, like a bag of Doritos in the Target aisle, like when I was in my first trimester Delicious Love that salty food?
Speaker 2:And, as my last question, which is probably too long of a question for the last question, you had mentioned PCOS before and I know it's so problematic for so many people and it feels very misunderstood and again, another vulnerable population that people really like glom onto with, like oh, here's the PCOS plan and I assume it's the same kind of like metered approach. But when you're working with somebody with PCOS, like you know, is there a more evidence-based framework that you approach with?
Speaker 1:Yeah, great question. So I don't think I might. It's in my bio, but one of my roles it's a volunteer role is I'm the Nutrition Care Manual Board of Editors Reproductive Nutrition Content Editor. So let me rephrase that For the Nutrition Care Manual I'm on the Board of Editors, specifically the Reproductive Nutrition Content, so I'm sure you have. You actually actually I don't know, would you have used Nutrition Care Manual before in any capacity Like you're working in a hospital.
Speaker 1:Okay. So like I think every dietitian because we all have to do clinical rotations as part of our dietetic internship have heard of NCM. So nutrition care manual anyone can have access to it. It's a paid subscription but basically any hospital has access to it. So if you work in a hospital you want to look up, you know you get a referral for someone with diabetes. You can go in the nutrition care manual, get patient education materials and information like that.
Speaker 1:So my role in the reproductive nutrition content is like updating things related to PCOS, pregnancy, lactation, so it's. You know we do things kind of in order, so it's not all updated at one time, but I was recently working on the PCOS one and there is, you know. So I was going through like a literature review of like all right, what does the evidence say? And I have a lot of experience in this and then in this role I was also okay, let's be really fine tuned like combing through the literature. Just going back to like your question about the evidence is like there isn't a specific diet for PCOS at this time. A lot of the recommendations essentially are just like what are the dietary guidelines for Americans? Like what is general healthy eating look like and movement. There are specific supplements that can help people with PCOS. So my approach with supplements is like how's the evidence? Is it decent enough to warrant that you might want to take it? At the very least, is it can't hurt, might help. You know, ideally we have good quality evidence, kind of the second tier in my own work with clients, not necessarily in like the, the um, the content for the nutrition care manual, but when I'm working with clients is like all right, what does the evidence say? And then if it can't hurt, might help with like the supplements piece and you can afford it and it's realistic and we can fit it into. You know you're you're able to take it consistently. We'll look into that.
Speaker 1:But one of the papers that I looked into a lot of detail on when um working on some of the updates is a paper that was on like low carb diets and PCOS, because that gets talked about a lot. It's like all right, do we need to eat low carb to improve PCOS? Because with PCOS there's often underlying inflammation and or insulin resistance. Typically both are happening and insulin resistance can make us more likely to have issues like blood sugar management right. So this one it was a meta-analysis, so generally that's considered higher quality research because it's multiple studies looking at the same thing that are evaluated.
Speaker 1:But the problem was that the studies included were extremely heterogeneous, meaning that they weren't studying the same length of time, the same percentage of carbohydrates providing energy right, like was it 5% of their diet or 50% of their diet. There's a huge difference between carbs providing 50 or 45% of your energy intake than 5%, like a keto diet. And then, like studies lasted I think the shortest was like two weeks and the longest I can't remember if it was like 30 weeks Again, huge difference between more than half a year or two weeks. So, like when we think about long term outcomes and sustainability of being able to stick with a certain dietary or nutrition intervention, like how long can this patient do it for, how long do they need to do it for to have the desired outcome? And, like in this case they were looking at like does a low carb diet improve insulin resistance in people with PCOS? And essentially the takeaway was a lower carb diet where calories are coming from 50% 50% of your calories or less are coming from carbohydrates can improve insulin resistance in people with severe insulin resistance.
Speaker 1:So we also don't necessarily study everyone's level of insulin resistance, like it's a home IR I don't know if you've heard of the home IR before calculation Like I don't usually have that for patients. So anyway, there's just like I'm kind of I'm not rambling but I'm trying to give some explanation to like some of this research or go into detail and like one study is like okay, we could take away. This conclusion is, yes, that like a lower carb diet could improve insulin resistance in people with PCOS. But what we don't really have information is like what percentage of calories need to be coming from carbohydrates, or ideally would be coming from carbohydrates? What is realistic for people to do in a long term way? And is this helpful for people with moderate insulin resistance or mild insulin resistance versus people with severe insulin resistance? So there's a lot like I feel like the longer I've been a dietitian, the more research you come across like more questions you have. I've never feel that way.
Speaker 2:It's like hmm, this just brought up 50 more questions instead of a clear answer which I think is the hallmark of a good, like somebody who is looking at research in a meaningful way is you should walk away with more questions Because like well, what does this mean, and what percentage are you talking? And when people are like, got it, here's the answer. Like that's a bad sign.
Speaker 1:Right, right. Yeah, I agree with you. I think people want that, but at the same time, for anyone listening, I hope that you take this away Like you know that people who have expertise in an area do have more questions and there isn't one right way for managing any condition, whether it's trying to get pregnant, you know dealing with infertility, or in pregnancy or postpartum, or you know lactating or PCOS or endometriosis, and that I mean I recently just learned, cause I started reading Dr Jenny Gunn.
Speaker 2:Do you know who she is? I have the menopause manifesto Manifesto.
Speaker 1:Yeah. So I borrowed her latest book, Blood, from the library and literally like second page of her book, maybe third, she's like women weren't required to be in government funded research until 1993.
Speaker 1:I don't think I knew that before reading that or like hadn't heard it so explicitly, that I was like like I was 10 years old when women were first required. Now, it doesn't mean that women weren't studied, also, people of color were included in this. Because I looked up the white house, like thing on it, um, it was basically like until 1993, nih studies, or in 1993, nih studies were required to include, like, women and people of color, and I'm like that's, that's not that long ago.
Speaker 2:I'm 40,.
Speaker 1:I'm not 80. So that goes back to when we talk about reproductive health, especially female reproductive health, and conditions like PCOS and endometriosis. Like people you know, testes don't have those conditions, so they're they're not necessarily as well studied because they haven't been required to be studied. So I think that again opens up more questions too is like I think we we can have, we have some good information we can work with and support people, but there's still more questions in terms of, like, best treatments, best outcomes. There's always more questions, so I always want to meet people where they are and put things into practice that again have good evidence and are unlikely to cause harm.
Speaker 2:Excellent, excellent advice. Well, tell me, rachel, where can people go to find you?
Speaker 1:Thank you for asking that. So my website is just my name rachelmalikcom, that's R-A-C-H-E-L-L-E-M-A-L-L-I-K. Double L in both names, so that throws people off sometimes and I'm on Instagram at Rachel Malik, so I try to keep that pretty streamlined. I offer one-to-one nutrition counseling. Again, it's kind of state dependent, but I can work with people all over the country. So just reach out if you are interested in one-to-one counseling. And I also have a fertility nutrition course that I launched last year, that kind of going to what we were talking about earlier today about individualized guidance. So it's not individualized guidance but it is very credible information based on my years of experience working in this, my years of experience both infertility as well as working with patients one-on-one.
Speaker 1:So I try to take a more motivational interviewing approach to it in terms of recommendations. So I try to take a more motivational interviewing approach to it of in terms of like recommendations. So I provide all the evidence on various modules. You can go on the Rachel Malik dot com slash course for more information about, like, what exactly I cover. But essentially with each module I provide some research and then my takeaways from that research, because I'm a why person, like why am I doing something? What does the research say, but you can always skip ahead to the takeaways if you want to skip that part.
Speaker 1:But I like to be a really informed like okay, if I'm going to do something, why am I doing it? And I also did that because, going to how we started the conversation, there's so much misinformation and disinformation. So you might see a recommendation in my fertility nutrition course. That's like I read the opposite, but I'm providing that evidence based background. So you're like here's why I made this recommendation, both from the research and my experience as a dietitian. And then each module ends with like okay, how could you apply this into your life? So I provide a lot of like questions and thought provoking ideas, you know. So I'm really proud of it. And that's a great resource for anyone trying to conceive, because you don't have to work with me in one on one or you can always do a conjunction in conjunction with one on one.
Speaker 2:Excellent. What was so nice having you? I love.
Speaker 1:Yeah, thank you, Heather.
Speaker 2:I love a gal that's just well versed in what she does.
Speaker 1:I'm very passionate about it and I love what I do, and it's a privilege to work with people on the reproductive journey, so I'd love to help you if you need support.
Speaker 2:Great, All right. Thanks for being here. Thank you as always. Please follow show or you can leave a five-star review on Apple or Spotify. That would be fun too. See you in the next episode.