E55. Busting Myths to Empower Reproductive Health with Registered Dietitian Rachelle Mallik and Health Coach Heather Sayers Lehman

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
All of these phases come with their own stressors.
Right Preconception, if you'renot having trouble, may not be
super stressful, but dealingwith fertility challenges is
super stressful and really takesover your thoughts and your day
to day.
If you're going throughfertility treatments and testing
and pregnancy right, there'salways worries about like is

(00:20):
baby kicking enough?
Did I eat something I shouldn'thave?
There is already inherent fearand worries and anxiety that
might come along with pregnancy.
There's just so many uniquechallenges and stressors that
come with each phase that I wantto make nutrition a form of
self-care and to reduce stress.

Speaker 2 (00:38):
Hi and welcome to the Air we Breathe, finding
well-being that works for you.
I'm your host, heatherSayers-Layman.
I'm a National Board CertifiedHealth and Wellness Coach,
certified Intuitive EatingCounselor and Certified Personal
Trainer.
I help you get organized andconsistent with healthy habits,
without rules, obsession orexhaustion.
This podcast may contain talkabout eating disorders and

(01:02):
disordered eating.
There could also be some adultlanguage here.
Choose wisely if those areproblematic for you.
Hi and welcome to this episode.
Today I'm chatting with RachelMalik and she's a registered
dietitian, founder of the FoodTherapist, and she focuses on

(01:26):
reproductive health and hownutrition impacts.
That.
I find it fascinating because,as somebody who is 150 years old
and really only read a coupleof books and nutrition was not
even on the table thank goodnessthe internet was not available
then and nutrition was not evenon the table Thank goodness the

(01:48):
internet was not available then.
But I really wanted someevidence-based answers from
Rachel on all of these differenttopics 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 Ilive, works in my building.

(02:12):
So I am on the seventh floor.
Her sister works on the 14thfloor.
How bananas is that?

(02:32):
Anyway, I thought it was nuts.
This world is small.
You got to watch your P's andQ's out there people.
Anyway, here's what we wentthrough.
I wanted Rachel to really talkabout how we can try to suss out
who is credible withinformation for this time of
life and who is just aninfluencer trying to sell some
stuff.
And another big question I haveis when we look at nutrition
throughout this whole cycle,basically from fertility to,
like childbirth, lactation,postnatal, like, are there

(02:54):
different things we're supposedto do, like different things are
supposed to eat?
But I wanted some really um,succinct information from her on
that.
And then, finally, we talkedabout PCOS.
If you're not familiar, it'spolycystic ovarian syndrome and
I see it a lot in my clients andI will say the healthcare space

(03:17):
doesn't seem to have a lot ofgood answers for them.
So I wanted to get Rachel'stake on the evidence and how
that can be supportednutritionally.
So tune in.
I really enjoyed talking toRachel.
I feel like she is so nuancedand evidence-based, which
hopefully that's who we're allfollowing.

(03:38):
But it's really beneficial Evenif you're done with that stage
of life.
You certainly know other peoplethat may be coming up on it,
and it's always great toreiterate good, sound practices.
Anyway, enjoy the episode.
All right, I am really excitedto have this episode today
because I think this topic is,you know, it's past.

(04:02):
I'm past this topic, but formyself.
But for others, I'm sointerested in what Rachel has to
say because we're going to talkabout some reproductive
nutrition bits and pieces, so Iwill let Rachel Malik go ahead
and introduce yourself.

Speaker 1 (04:20):
Hi, thanks for having me, Heather.
My name is Rachel Lacroix-Malik.
I am a registered dieticianspecializing in reproductive
nutrition, so I primarily workwith folks who are trying to
conceive, pregnant postpartum.
I also work with folks who haveendocrine or reproductive
conditions like PCOS,endometriosis, hypothalamic
amenorrhea.

(04:41):
So I definitely work withpeople who are supporting their
reproductive health, even whenthey're not actively trying to
reproduce.
I've had my private practicethe 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 onstate licensure laws, and I've
had this practice for six, sevenyears.
I started in 2017.

(05:02):
And essentially like do youwant me to give a little bit of
my background?
Sure.

Speaker 2 (05:07):
I, because that was going to be one of my questions,
because I was curious aboutwhat drew you to it.

Speaker 1 (05:12):
Yeah, so without giving you my entire life story,
essentially we were talkingbefore we started recording
about how I went to ArizonaState undergrad and that was
back in the early 2000s.
I graduated in 2006.
I had a degree in nutrition andwas a pre-med student.
So essentially I was trying toget some experience before
considering going in the medschool route of getting

(05:32):
experience in the medical world,and moved back to New York,
where I'm from, and got a job asan IVF patient coordinator at
the Weill Cornell Center forReproductive Medicine.
So here I am 22.
I think I just turned 23 when Istarted working there.
I don't think I'd ever heard ofa reproductive endocrinologist
before.
Definitely was at the age whereI was not considering trying to
get pregnant or really hadnever really given much thought

(05:54):
to my fertility, except ofpreventing pregnancy.
Right, and you're a young woman, that's what we're often
thinking about is preventingpregnancy, not trying to become
pregnant.
So I worked there for aboutfive years and during my time
there as a patient coordinator Iworked with probably thousands
of patients.
It's a really busy practice inNew York that sees patients from

(06:14):
literally all of the countryand all of the world because
it's a really well-renowned,world-renowned center.
So they would get really hardcases, really complex cases it
wasn't just people in their late30s and 40s trying to conceive,
you'd see like primary ovarianinsufficiency, like young people
dealing with issues aroundtheir reproductive health or

(06:35):
early menopause kind of symptoms, cancer treatments, like
preserving their fertility ifthey were needing to go through
cancer treatments, all kinds ofthings.
And during that experience,what I decided was or what I
became more curious in havingthat degree in nutrition I was
like, well, how does nutritionplay a role in fertility?
Because we talk a lot whenyou're in school to become a

(06:57):
dietitian or learning aboutnutrition, you talk a lot about
disease management, but alsoprevention, right?
And so I was like, all right,how does nutrition play a role
in this?
And that was something thatpatients would ask me about.
Now, in this role I was not adietician but because of being
the liaison between the patients, like they would see the doctor
.
Their plan was to go to IVF andthey would say go talk to

(07:18):
Rachel, she'll walk you throughall the next steps.
So basically, they'd come to meand I would pull out a calendar
.
We talked about their lastmenstrual period, what kind of
testing they needed to get doneHSDs and SIS and semen analysis
and for people who aren't in thefertility space, I can explain
all those acronyms, but allthese things that are can be
really overwhelming for patientslike, okay, this is a big deal,

(07:41):
we're trying to get pregnant,we're having trouble and we have
to go through all this testingand all this treatment.
And they would ask, like, whatcan I do?
So that planted the seed, punintended, of like how I wanted
to go in the direction of mycareer.
So I went back to school.
I stayed working at Cornell, Iwent to NYU for grad school, got
my degree in food studiesbecause I already had a degree

(08:02):
in nutrition.
I needed to finish my DPDrequirements.
The audience doesn'tnecessarily need to know about
that, but it's essentially thetraining or the classes that are
required to do your dieteticinternship, which is required
before you can then take the RDexam and become a registered
dietitian.
So I went to NYU and did foodstudies masters and my DPD there

(08:25):
.
And what I loved about the foodstudies program this is a
little bit ancillary to my mainpractice and reproductive health
, but you learn about foodsystems, food history, food
culture, food policy, all thesedifferent things that shape how
we eat, outside of the nutritionscience you, you know.
So it was really, reallyinteresting for me.

(08:45):
I got to study abroad, inMexico in.
China just really, I think,helped me become a really
well-rounded dietitian and Ijust have always been interested
in food, food culture and foodhistory and how that shows up in
the work we do as dietitians.
You know.
Um so flash forward to likeskip a couple of years.
I graduated in 2012, became adietitian then and then in 2016,

(09:08):
my son was born, and so nowalways go back to different
parts of that if you're curious,but essentially like this,
experiences that I'd had workingat the fertility clinic, then

(09:30):
working in private practice withpatients who are trying to get
pregnant postpartum but I hadn'tbeen through those experiences
myself, right of like trying toget pregnant, being pregnant,
giving birth, lactating, healingpostpartum, and then in that,
when I was pregnant with my son.
You know I'm a dietician, sothere's a lot of information
that I had about nutrition inthe life cycle and my experience
working in the fertility clinic.

(09:51):
So there's a lot of things Iknew.
But in terms of nutrition advicethat I was given, it was like
take a prenatal vitamin and thatwas it Right and it's very it's
not bad advice, but it'sdefinitely not comprehensive
advice, and I always think abouthow there's no standardization
for prenatal vitamins.
They're all across the board.
Some don't have iron, somedon't have choline, some are

(10:13):
gummies, some are tablets, somehave eight, some have one per
day.
So this is kind of all over theplace.
And I just did a little bit ofmarket research and was like I
don't really see many dietitiansspecializing in fertility and
pregnancy outside of likegestational diabetes, outside of
kind of addressing issues thatcome up in pregnancy versus more
of like what can we do to maybereduce some of those risks?

(10:34):
And why would you see adietitian 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 workedat, so for another day, but, I,
decided that I was like okay, Iwant to start a private practice

(10:55):
.
I wanted to be reallyintentional about focusing on
reproductive health and servingthat population who is trying to
get pregnant, postpartum, withcredible information from a
dietitian with experiencepersonal and professional and
that could really help peoplethrive in their pregnancy
journeys and, you know, haveenjoy food along the way to not
just like there's such a focuson what you shouldn't eat both

(11:18):
infertility, whether that's trueor not.
There's a lot of things don'tavoid this, don't have that in
pregnancy, because of foodsafety.
That comes up a lot, you know,like you can't have alcohol, you
can't have deli meats, youcan't have sushi, like all these
things that people are toldthat they can't have.
So, really coming out of place,like what can we add in?
What are things that are goingto help you feel nourished and
enjoy this experience as bestyou can, because each phase of

(11:40):
the reproductive journey comeswith its own set of challenges.
That's a long winded answer,but that's essentially how.

Speaker 2 (11:45):
I think it's so interesting because, you know,
certainly for me, you know, mykids are 21 and 23.
But you know, and I had had acouple of miscarriages before I
had them, and so this is liketeetering, teetering on the
internet era.
So I read, like what to expectwhen you're expecting like we

(12:06):
Googling stuff was not really athing then, Thank goodness.
So one thing that I perceivethat people are up against is
the internet and this like glutof misinformation and
disinformation, because I feellike through each of these
stages, people are so vulnerableand then it's so easy for

(12:32):
people to take advantage ofsomebody who's desperate,
because I feel like I'm tryingto conceive, so concerned about
the fact, like now I am pregnant, I want this to be, you know,
successful.
Like that people get takenadvantage.
So much in that piece.
So can you speak a little bitto, I guess, like I mean, I know

(12:58):
you've seen everything likethis, the different pieces about
misinformation and how people Imean I assume they just come in
overwhelmed and confused whenthey talk to you.

Speaker 1 (13:08):
Yeah, it's such a good question and even from when
I started my practice in 2017to now right, because back then,
social media existed for sure.
I mean, I had Instagram withall the filters on it, like the
early 2010s, right, and but itwasn't such a place that people
turn to for nutrition advice.

(13:29):
It wasn't the search enginethat it has become.
Tiktok didn't exist to myknowledge.
So now there's not only likethe endless internets of where
you're getting information, butthen there's social media and
it's really hard to know who totrust, because people come off
with such conviction, even whenthey have no idea what they're
talking about, which is reallyscary and have huge audiences,

(13:53):
right, so we assume trust basedon that, or at least I think
people can like oh, they havesuch a huge following, they must
know what they're talking about.
So it's tricky because I thinkpeople not always.

(14:17):
There are definitely dieticians,you know, and people and REIs,
you know, fertility doctors,obgyns that haveredit their
experiences, but then they'll belike this is what I did and it
worked for me, and then they'rejust kind of evangelizing that
when that's not necessarily whatthe research shows or is
helpful for everyone and canmake it more stressful.
Right, Because a lot of timesthat does involve.

(14:38):
What worked for me was I did ahundred different things and I
also cut out a hundred differentthings, and that's super
overwhelming.
So I really try to get down towhat does the evidence show?
And evidence, as dieticians, isnot just the research that's
available, but the body ofresearch right, looking at it
holistically, not just one studythat had 12 people for four

(15:00):
weeks yeah, we can all find onestudy that showed x, but we want
to look like take, zoom out,look at the larger body of
evidence, but also our clinicalexperience working with patients
.
Right, seeing what can help orharm.
And you know, in the medicalworld, in the healthcare world,
we're always taught to likefirst, do no harm.
And when it comes to nutritionnutrition I think I used to

(15:23):
think of was always like oh, itcan't hurt, but it can in some
scenarios and I think youunderstand that as a weight
inclusive provider as well likehow, how we approach nutrition
can be harmful for some people.

Speaker 2 (15:39):
Do you feel like the do it yourself approach to
improving your healthy habitsdoes nothing except feel
overwhelming, guilt-inducing anddefeating?
You don't need more rules,influencers or structured
programs.
Let me help you discover whatyou want, what works for you and
how to maintain healthy habitsduring the ever-changing
circumstances of your life.

(16:00):
If you're ready to createsystems that stick head to
heathersayerslaymancom backslashhealth dash coaching and click,
let's do it.
Certainly, somebody who hadorthorexia who you know, which
is an eating disorder that isextreme clean eating, and was

(16:23):
petrified to eat a lot of thingsbecause I was diagnosed with
thyroid disease and you know Iwanted to cure that with
nutrition which plot twist, youdon't?

Speaker 1 (16:36):
So there are things that we can eat to support our
thyroid health, but you stillprobably need some levothyroxine
, or it depends what your yourthought.

Speaker 2 (16:45):
Yeah.
So I think that, um, you know,I see the other end, and that's
what my perception is, it'speople really promoting extreme
clean eating.
To what you were saying of,like, yeah, you got to cut this
out, you definitely have to cutthis out.
And, oh, this is toxic, this,this is poison.
I always, certainly, warnpeople against the end of one.

(17:07):
So this person that had thisexperience and now is an expert
which I also love your termevangelize because I was like,
oh, I'm gonna steal that one forsure, but, but you know, they
become then their own industrybecause they went through it and
, yes, you went through it, andit doesn't make you an expert.
Like, other than looking outfor the influencers who are the

(17:30):
end of one, like, are therethings that you see that you
think other people that mightnot know should tune into that?
This is not a credible sourceof information.

Speaker 1 (17:43):
Yeah, it's a great question.
It's a tricky one to answerbecause there's not, like always
, a simple way, but I'd say thefirst step is, if you're getting
health care information, makingsure you're getting it from a
health care provider that theyare an MD, right, or a DO, so
they're a medical doctor, eitherspecializing in obstetrics and
gynecology, or maybe they're amidwife again, if you're looking

(18:04):
into the prenatal space orpostpartum, or that they're a
registered dietitian or aphysical therapist right,
there's different, it dependswhat kind of things we're
looking at, but I'd saygenerally, from a nutrition in
the fertility space, you wantsomeone to be a registered
dietitian that has experience inthat space.
The tricky thing is here thatthere's not a fertility training

(18:28):
specifically.
There's sports dietitians, likea CSSD, I think is the acronym
or there's people who arespecialists in nutrition support
.
There's a board exam for that.
There isn't at this point forfertility.
So really want to dig into thatperson's experience because
there can be that n equals one,two of like.
They are healthcare providersthat had a fertility experience.

Speaker 2 (18:49):
Again it doesn't.

Speaker 1 (18:50):
I don't mean to discredit that, but is like okay
, have they also gone in to domore research on this?
I'm a member of the AmericanSociety for Reproductive
Medicine, so I attendconferences.
I'm active in the nutritionspecial interest group that they
have within that, so I speak toREIs on this topic.
I've spoken at the conference,so I'm really as involved as I

(19:13):
can be in understanding againthat body of evidence and
working with, like okay, what iswhat is fertility treatment
actually involve versus?
You know, kind of just againtaking a big picture, look at
what someone going throughinfertility treatments is
actually dealing with.
And then what does thenutrition research say about

(19:33):
what can support their chancesof conceiving and of having a
healthy pregnancy?
So, again, there's no specifictraining, but I've been working
in the space since 2006 becauseI started in a fertility clinic.
So I had five years of like theins and outs of IUI, ivf, donor
egg and really understandingeverything that's involved in
that.

(19:53):
And then now seven plus yearsworking specifically as a
dietician only in this space,really attending conferences,
focusing my continuing educationon reproductive health, like in
terms of webinars and ces youknow, continuing education that
I get and being involved in theorganizations that are doing

(20:15):
most of this work, so somebodythat is as qualified as you is
going to be speaking to thosethings also.

Speaker 2 (20:22):
So those are good things like to listen for, like
oh, okay, that they are involvedand I always think, involved in
the academic side of it, whichsometimes I feel like it sounds
a little snooty, but for me,like I'll be snooty all day long
.
That is important because I dothink those things matter, and

(20:47):
the anecdotal pieces or theinfluencer pieces tend to kind
of spit out the same sort ofclean eating information that I
feel like they're just hearingfrom each other and then kind of
regurgitating the same thing.
Echo chamber, yeah, and in like,when we look at again, like

(21:09):
this, um, which is interestingto be in the field for over 30
some years, you know, in healthand wellness, because it things
have changed, because I startedin low fat era, um, and so clean
eating seems snackwells eradelicious.
Even taco Bell had a light menuback in the day.
We, you know, now clean eatingis like has a real grip and a

(21:35):
staying power when you're tryingto work with someone you know
that's living and hearing all ofthose things.
And then you're talking about,like nutrition for fertility.
Well, I guess first do youreally differentiate nutrition
for fertility and then foractual gestational times?

Speaker 1 (21:56):
It's a good question.
I mean, for the most partthings are going to be
supportive of fertility, arealso going to be supportive of
pregnancy, because when we lookat fertility research,
specifically research on peopleundergoing IVF so if they'll
look at a cohort of patientsthat are undergoing in vitro
fertilization and they'll lookat these dietary patterns among
these people, undergoing IVF waslinked to higher rates of

(22:18):
implantation, higher rates ofclinical pregnancy, higher rates
of live birth.
The really goal outcome of allof these studies is live birth.
We can look at theseintermediates of like egg
quality, sperm quality, but atthe end of the day the patient
wants to come home with a baby.
So and I say this becausethings that are happening at
preconception may be linked tothe live birth outcomes.

(22:40):
Now it's association, notcausation.
But a lot of nutrition researchis that kind of observational
cohort studies, so it's kind ofthe best that we have.
It's really hard to dorandomized, controlled trial
studies and especially inpregnancy, they're not often.
There's a lot of limitationsthere and a lot of red tape.
Challenges that come up inpregnancy are very different

(23:02):
than someone's preconception oreven going through IVF
treatments the amount of nauseaand aversions and quote unquote
morning sickness you know thatcan happen any time of day makes
it so that a lot of thenutrient dense foods that maybe
you were focusing on prior toconception are now not
appetizing whatsoever.
So I really do like workingwith people preconception,

(23:29):
because it's so common to dealwith those challenges in the
first trimester that can last 16weeks.
Even I did for me in both of mypregnancies.
It does for a lot of my clients.
It doesn't just end at thefirst trimester, it can linger
into the beginning of the second.
What can you do ahead of time tobuild a good foundation of
healthier dietary and lifestylehabits?
Build up some good nutritionstores, have a good quality
prenatal to fill in the gaps andoptimize your intake of certain
vitamins and minerals.

(23:50):
That when you're dealing withmorning sickness like I still
work with clients to adjustright.
Like, okay, if you can only eatbagels, can we get some peanut
butter on that bagel.
Or, you know, can we get asmoothie in.
Like what are some things thatmaybe you could tolerate,
whereas like a big old piece ofsalmon with broccoli may sound
disgusting.
You know.
Like, okay, how could we?
Would you like some salmontacos?

(24:12):
Would you like little salmonnuggets, you know or different
ways of eating it, and ifsalmon's off the table, let's
make sure you got a DHAsupplement and let's focus on
some other foods that you cantolerate.
So I guess where I'm going withthis is we can always modify in
the first trimester, but I likeworking with people
preconception or duringfertility treatment so that we

(24:32):
can really help them feel goodabout their nutrition and their
habits leading into pregnancyand then, as they are able to
move past some of the challengesof first trimester, they can
bring some of those things backin the second trimester.

Speaker 2 (24:42):
Sounds like such an important time.
I had the same.
I have 15 weeks and 16 weeks ofnausea and um, and I also
remember um waiting for a littleCaesars to open so that I could
go get some crazy bread.
Um, because it just like ifthere was something about the
bread and the grease that waslike oh, okay, I feel so much

(25:04):
better.

Speaker 1 (25:04):
Um, like if there was something about the bread and
the grease.
It was like oh okay, I feel somuch better, uh-huh, like so.
Oh yeah, I was big into Frenchfries and Caesar salad dressing
Like bottled, so it was likepasteurized.
But I worked in the hospital soI had like access to the salad
bar and that and then the Frenchfries every day.

Speaker 2 (25:19):
And that was my jam.

Speaker 1 (25:19):
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 (25:28):
It's funny how amplified it is that that I I
have a like a visceral memory ofhaving 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 itsince, and I was like this is
pretty good, I'm not gonna lie,but I think that I think I kind

(25:48):
of lost my train of thought, butI know that I wanted to ask oh,
preconception, yeah, I think.
Oh, I was just gonna say itseems like such an important
time to see a dietitian becausewhen you're on your own and
you're kind of like wafflingaround of like I don't know, I
know I'm supposed to eat, sortof this way, but this is
disgusting, this is disgusting.

(26:10):
But to have somebody who iswell-versed to give suggestions
versus checking on chat, gpt,like what helps with nausea
during pregnancy, right, right.

Speaker 1 (26:24):
Yeah, yeah, I mean I think you know there can be some
helpful crowdsourcedinformation on social media, or
you know I've been interviewedfor articles on this topic.
There's one, I think it's in mylink tree or it's on my website
.
I have all the like mediaarticles that I've been quoted
with linked on my website.
So I was interviewed onerecently for morning sickness,

(26:44):
so there's.
So there is some solidinformation out there, but it's
also very different to getgeneral information versus
personalized information,because within that you might
have people that are vegan orthat don't eat fish or that have
nut allergies.
So, really tailoring it to theindividual and exploring like,
what are some safe options, whathas helped a lot of my clients
what do you like and what's alsogoing to help give you the

(27:06):
nutrition you need to support apregnancy Because that's really
why people are coming to me, youknow, is that they want to make
sure that they're doing whatthey can to improve their chance
of getting pregnant and supporttheir chance of staying
pregnant and having a healthypregnancy and a baby.

Speaker 2 (27:18):
Well, I assume you get a lot of people that have
had the directive because Iheard personally it was let's
just keep an eye on the weightwas how it was always phrased to
me, because I think also kindof you know, looking back I know
that I was restrictive with myeating.

(27:38):
So then when I was pregnant Iwas like wheels off, like let's
go because I could.
I gave myself sort ofpermission, but that was how my
OBGYN would always phrased it.
You know it's like let's keepan eye on the weight.
So I assume you have peoplecoming to you and they're like
oh, I'm supposed to watch myweight.
Like how do you help themtransition to a different

(28:00):
mindset about nutrition, takingaway the weight aspect?

Speaker 1 (28:05):
Yeah, right, it's so.
It's hard to challenge thatwhen it's such the norm of, like
weight centric care, right, Iwork with other providers that
aren't so focused on weight andit's really refreshing that,
like I've had patients,especially patients in larger
bodies, who have their weighthas been blamed for their
problems their whole life, thatwhen they work with an OB that

(28:26):
is like you're doing greatbaby's, great, all your numbers
look good.
You know, from their glucosetest, you know glucose tolerance
test to test for gestationaldiabetes or the heartbeat, the
fundal height, like there's somany other ways to measure
health and pregnant baby'shealth and the mother's health
and pregnancy, their bloodpressure, um, their, if they,
you know, is there protein inurine?
Like there's so many other waysto assess things like

(28:47):
preeclampsia besides weight.
So I think it's really helpfulwhen patients are able to have
access to both dietitians aswell as OBs or midwives that
aren't hyper focused on weightand at the same time, I mean the
first thing you see on so manyarticles that you Google is like
get to a healthy weight.
You know it's ACOG talks aboutit.
Different things from ASRM talkabout it.

(29:10):
Asrm is the American Societyfor Reproductive Medicine that I
was mentioning earlier thatorganization I'm a member of,
acog, is obstetrics andgynecology.
So it's something that peoplehear or read all the time and
that providers are reinforcedlike, okay, healthy weight,
healthy weight and I'm puttingair quotes around healthy weight
or quote, unquote, normalweight, which can be really
pathologizing, like if someone'sbody is meant to be a higher

(29:33):
weight, that doesn't make themunhealthy.
So really trying to help themunderstand what a weight
inclusive approach is, it'sreally.
It's not not focusing on theirhealth.
It's actually more focused ontheir health rather than just
their weight, um, as a metric ofhealth.
So you know, we considervarious factors that affect
health.
Right, things aren't always inour control when we think about

(29:53):
social determinants of healthbut 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 andyou were talking about that
before we hopped online of like,okay, what are things that you
can, that are actionable, thatyou can work on, that can
support your health and apotential pregnancy or current
pregnancy.

(30:14):
So, really focusing on allthose behaviors because weight
is not a behavior.
So and understanding thatweight is going to change, but
we don't necessarily know howit's going to change because you
know there's like weight gainguidelines and those are based
on BMI alone.
So if BMI is problematic anddoesn't indicate someone's

(30:35):
individual health and we'reassuming that they should gain X
amount of weight based on BMIalone, I don't think that's very
helpful.
And if someone is gaining a lotof 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 usea scale to check it.
But like there's usually otherthings going on, you know that

(30:56):
are other ways to identify thatthere's something wrong.
If someone is gaining or losinga significant amount in a short
period of time, like they'rehaving significant water
retention, that may beindicative of um, like
preeclampsia, or um weight loss,because I don't know,
something's not not workingproperly in their lose.
Like it's normal to lose acouple of pounds potentially in
the first trimester.
It's also normal to gain weightand people are like I'm not

(31:17):
supposed to gain any weight, butthere you mentioned, like it's
also I don't want to say common,but sometimes people come into
pregnancy restricted, right, andmaybe their weight is a little
bit suppressed prior topregnancy because of restricted
behaviors that are no longeraccessible in pregnancy.
You don't have the energy towork out, you can't avoid these
certain foods because all youcan tolerate is the bagels and

(31:39):
the ginger ale and the body'sjust kind of restoring its
weight because it's it's beennot had access to those
carbohydrates potentially, andthen it is going to gain weight
in the first trimester.
Other people lose weightbecause their nausea is so bad
they can't eat anything, youknow, and then we try to support
them in there.
I'm going on.
There's so many things, so I'm.
I could continue talking aboutthis, but I'll stop.

Speaker 2 (32:00):
I just I always like another voice that's saying like
this, like yes, there's a chartthat they're following of like
okay, in this week of yourpregnancy, it would be
acceptable to gain, you know,one to two pounds, which is also
so mind boggling given that youcould be four foot 10 or six

(32:20):
foot five.
It's like how do we land on thisas an okay number and just
helping people see also kind ofthe absurdity of it?
You know that as a and I meaneven the interesting thing of
like that they're prescribinglike a healthy weight and it's
like define that Like you know,because again, it's different

(32:46):
for everyone.

Speaker 1 (32:48):
Like if people have to do super restrictive eating
disorder type behaviors to getto a healthy weight.
I would not define that as ahealthy weight.
The thing that I was thinkingabout is like excessive
gestational weight gain.
Ewg is something that you knowthey'll talk about, like
avoiding excessive weight gainin pregnancy, and while I think
it's it can be helpful to atleast consider what's you know

(33:10):
that that's happening is likewhat is going on there that may
be contributing to this, becauseexcessive weight gain may be
correlated with or associatedwith higher rates of gestational
diabetes or macrosomia or likelarge for gestational age babies
, but they're not necessarilycausing that right.
So it kind of goes back to thatlike weight is not a behavior

(33:30):
and like association is notcausation.
So what are things that we canmodify?
Because weight is not abehavior?
So like weight we can't alwaysmodify, even when we're quote,
unquote doing the right things.

Speaker 2 (33:42):
And then I think just as kind of like a good
definition when you're talkingabout health sustaining
behaviors and health promotingbehaviors, like what do you feel
, like you know and the thingsthat are in your control, like
what do you usually talk aboutwith clients?

Speaker 1 (34:00):
Yeah, it's a great question.
I mean, again, I'm always goingto tailor it to like where
they're starting from right,like what are your current
behaviors like and what are wetrying to work towards?
But I would say, eatingconsistently throughout the day,
like when I think of the firstcouple things I'll tend to work
with New York clients on, islike eating consistently
throughout the day, which maylook a little different in the
first trimester and the thirdtrimester than it does, and
maybe pre pregnancy or thesecond trimester right when,

(34:23):
like first and third, you mightneed to eat like every two hours
because you are nauseated ifyou eat too much and you're
nauseated if you get too hungry.
The third trimester because theuterus and the baby are so big
it's really squishing up yourinternal organs and your stomach
gets really kind of pushedaround there and then you get
higher, you can get heartburnmore easily and get full more

(34:46):
quickly.
So, again, you might need toeat more frequently, but just
that frequent mealtime.
That's not like you'reconstantly snacking but you're
having like some solid meals ornutrient dense snacks, you know,
every three to four hours prepregnancy and maybe the second
trimester, and probably everytwo to to three first trimester.
Second and the third, againadjusting for the individual,

(35:07):
focusing on like.
I use the plate method.
It's just like a high levelframework often of like okay,
are we getting some good qualitycarbohydrates and protein rich
foods and produce on your plateor in the meal in some capacity
and fat to kind of tie it alltogether and add flavor and help
you absorb some of the vitamins.
I'll talk about getting adequatesleep.

(35:31):
I'll talk about movement.
I think it's kind of all overthe place, but the foundational
stuff is often like frequency ofmeals, what's going on the
plate, making sure they'regetting adequate carbs, fat and
protein.
And then micronutrients right,because there are ones that are
important for pregnancy, likeiron and choline and iodine,
like how are we getting thatfrom the diet?
And or supplements, folic acidso how do we get those vitamins

(35:57):
in different foods on your plate?
You know so like.
That plate method is kind ofthis high level framework for
ratios of food and then likespecific foods that we might
want to put within thosecategories to get those variety
of micronutrients and then thesupplements to fill in the gaps,
and then like the movement andregular bowel movements, like
what can we do?

Speaker 2 (36:16):
to support a regular bowel movements.

Speaker 1 (36:17):
They're not super constipated and then super
bloated and gassy because youhaven't pooped, like those are
things that we can address too,so there's kind of this general
healthy things, you know, healthpromoting behaviors, and then
there's kind of strategic, basedon what some of their
challenges might be.

Speaker 2 (36:33):
Well, I really love that, almost as a litmus test
when I'm listening to you.
It's informative and it'scomforting because you have
details and information and Ithink, people being able to step
back and hear some other voicesthat are totally fear-mongering

(36:57):
and they're making peopleafraid, that, like, that voice
may maybe no, but you know yourentire, the way that you address
it is really like, yeah, hereare some things that you can do
and they're not overwhelming andyou know I'm not hearing
counting and tracking and all ofthese pieces but really very

(37:21):
sustainable practices, verysustainable practices.
But it's just so juxtaposedagainst the fear mongering that
I think is, you know, withinkind of like clean eating,
whatever is so prevalent thatyou need to be afraid, which I I
mean.
I know that's part of kind ofthe indoctrination of following

(37:41):
someone of like, oh my gosh, nowI'm afraid and I've got to look
at this person because they'regoing 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 somuch better to me than any of

(38:05):
the other alarmists that I hear.

Speaker 1 (38:09):
I appreciate that.
I mean, that's the approach Iwant to take too, because all of
these phases come with theirown stressors.
Right, preconception, if you'renot having trouble, may not be
super stressful, but dealingwith fertility challenges is
super stressful and really takesover your thoughts and your
day-to-day.
If you're going throughfertility treatments and testing

(38:29):
and pregnancy right, there'salways worries about like is
baby kicking enough?
Did I eat something I shouldn'thave?
You know, there's just allthese.
They're like pregnancy is nothealth neutral, like their
pregnancy can be risky and likewomen and babies lives can be at
risk, right, so there isalready inherent fear and

(38:49):
worries and anxiety that mightcome along with pregnancy and
then postpartum.
You would now have the baby onthe outside that you have to
keep alive and you're trying totransition to motherhood, even
if it's not your, especiallywhen it's your first baby, but
even if it's a second or third.
Each time is a whole differentexperience Because you are older
, you have more kids or anotherkid or more kids, just like

(39:11):
everything changes.
So like there's just so manyunique challenges and stressors
that come with each phase that Iwant to make nutrition a form
of self care and to reducestress.
Right, and, yes, there arethings that you have to be
mindful of in pregnancy,especially of foods that may be
less likely to be safe.
Right, I do like that thelanguage has changed more to

(39:32):
like high risk versus low riskfoods on, like the FDA food
safety guide.
I'm pretty sure it used to saylike avoid.
You know it was just like eat,slash, avoid, and now it's like
low risk.
High risk because no food iswithout any risk, and then some
are higher risk.
It doesn't mean you'reguaranteed to get listeriosis,
but are you willing to take thatrisk with some of these higher

(39:52):
risk foods?
So I try to come at it from aplace of just like again what
can you eat?
Instead of focusing on all thethings you can't, let's add in
all these other foods that arevery low risk and are high
nutrient, dense foods.
And or just for pleasure, likea bag of Doritos in the Target
aisle, like when I was in myfirst trimester Delicious Love

(40:16):
that salty food?

Speaker 2 (40:17):
And, as my last question, which is probably too
long of a question for the lastquestion, you had mentioned PCOS
before and I know it's soproblematic for so many people
and it feels very misunderstoodand again, another vulnerable
population that people reallylike glom onto with, like oh,

(40:41):
here's the PCOS plan and Iassume it's the same kind of
like metered approach.
But when you're working withsomebody with PCOS, like you
know, is there a moreevidence-based framework that
you approach with?

Speaker 1 (41:01):
Yeah, great question.
So I don't think I might.
It's in my bio, but one of myroles it's a volunteer role is
I'm the Nutrition Care ManualBoard of Editors Reproductive
Nutrition Content Editor.
So let me rephrase that For theNutrition Care Manual I'm on
the Board of Editors,specifically the Reproductive
Nutrition Content, so I'm sureyou have.

(41:23):
You actually actually I don'tknow, would you have used
Nutrition Care Manual before inany capacity Like you're working
in a hospital.
Okay.
So like I think every dietitianbecause we all have to do
clinical rotations as part ofour dietetic internship have
heard of NCM.
So nutrition care manual anyonecan have access to it.
It's a paid subscription butbasically any hospital has

(41:44):
access to it.
So if you work in a hospitalyou want to look up, you know
you get a referral for someonewith diabetes.
You can go in the nutritioncare manual, get patient
education materials andinformation like that.
So my role in the reproductivenutrition content is like
updating things related to PCOS,pregnancy, lactation, so it's.
You know we do things kind ofin order, so it's not all

(42:07):
updated at one time, but I wasrecently working on the PCOS one
and there is, you know.
So I was going through like aliterature review of like all
right, what does the evidencesay?
And I have a lot of experiencein this and then in this role I
was also okay, let's be reallyfine tuned like combing through
the literature.
Just going back to like yourquestion about the evidence is

(42:27):
like there isn't a specific dietfor PCOS at this time.
A lot of the recommendationsessentially are just like what
are the dietary guidelines forAmericans?
Like what is general healthyeating look like and movement.
There are specific supplementsthat can help people with PCOS.
So my approach with supplementsis like how's the evidence?
Is it decent enough to warrantthat you might want to take it?

(42:49):
At the very least, is it can'thurt, might help.
You know, ideally we have goodquality evidence, kind of the
second tier in my own work withclients, not necessarily in like
the, the um, the content forthe nutrition care manual, but
when I'm working with clients islike all right, what does the
evidence say?
And then if it can't hurt,might help with like the
supplements piece and you canafford it and it's realistic and

(43:10):
we can fit it into.
You know you're you're able totake it consistently.
We'll look into that.
But one of the papers that Ilooked into a lot of detail on
when um working on some of theupdates 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 needto eat low carb to improve PCOS
?
Because with PCOS there's oftenunderlying inflammation and or

(43:33):
insulin resistance.
Typically both are happeningand insulin resistance can make
us more likely to have issueslike blood sugar management
right.
So this one it was ameta-analysis, so generally
that's considered higher qualityresearch because it's multiple
studies looking at the samething that are evaluated.
But the problem was that thestudies included were extremely
heterogeneous, meaning that theyweren't studying the same

(43:57):
length of time, the samepercentage of carbohydrates
providing energy right, like wasit 5% of their diet or 50% of
their diet.
There's a huge differencebetween carbs providing 50 or
45% of your energy intake than5%, like a keto diet.
And then, like studies lasted Ithink the shortest was like two
weeks and the longest I can'tremember if it was like 30 weeks

(44:19):
Again, huge difference betweenmore than half a year or two
weeks.
So, like when we think aboutlong term outcomes and
sustainability of being able tostick with a certain dietary or
nutrition intervention, like howlong can this patient do it for
, how long do they need to do itfor to have the desired outcome
?
And, like in this case theywere looking at like does a low

(44:41):
carb diet improve insulinresistance in people with PCOS?
And essentially the takeawaywas a lower carb diet where
calories are coming from 50% 50%of your calories or less are
coming from carbohydrates canimprove insulin resistance in
people with severe insulinresistance.
So we also don't necessarilystudy everyone's level of

(45:03):
insulin resistance, like it's ahome IR I don't know if you've
heard of the home IR beforecalculation Like I don't usually
have that for patients.
So anyway, there's just likeI'm kind of I'm not rambling but
I'm trying to give someexplanation to like some of this
research or go into detail andlike one study is like okay, we
could take away.
This conclusion is, yes, thatlike a lower carb diet could

(45:25):
improve insulin resistance inpeople with PCOS.
But what we don't really haveinformation is like what
percentage of calories need tobe coming from carbohydrates, or
ideally would be coming fromcarbohydrates?
What is realistic for people todo in a long term way?
And is this helpful for peoplewith moderate insulin resistance
or mild insulin resistanceversus people with severe

(45:45):
insulin resistance?
So there's a lot like I feellike the longer I've been a
dietitian, the more research youcome across like more questions
you have.
I've never feel that way.

Speaker 2 (45:53):
It's like hmm, this just brought up 50 more
questions instead of a clearanswer which I think is the
hallmark of a good, likesomebody who is looking at
research in a meaningful way isyou should walk away with more
questions Because like well,what does this mean, and what
percentage are you talking?
And when people are like, gotit, here's the answer.

(46:16):
Like that's a bad sign.

Speaker 1 (46:19):
Right, right.
Yeah, I agree with you.
I think people want that, butat the same time, for anyone
listening, I hope that you takethis away Like you know that
people who have expertise in anarea do have more questions and
there isn't one right way formanaging any condition, whether
it's trying to get pregnant, youknow dealing with infertility,

(46:39):
or in pregnancy or postpartum,or you know lactating or PCOS or
endometriosis, and that I meanI recently just learned, cause I
started reading Dr Jenny Gunn.

Speaker 2 (46:48):
Do you know who she is?
I have the menopause manifestoManifesto.

Speaker 1 (46:54):
Yeah.
So I borrowed her latest book,Blood, from the library and
literally like second page ofher book, maybe third, she's
like women weren't required tobe in government funded research
until 1993.
I don't think I knew that beforereading that or like hadn't
heard it so explicitly, that Iwas like like I was 10 years old

(47:14):
when women were first required.
Now, it doesn't mean that womenweren't studied, also, people
of color were included in this.
Because I looked up the whitehouse, 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 (47:33):
I'm 40,.

Speaker 1 (47:34):
I'm not 80.
So that goes back to when wetalk about reproductive health,
especially female reproductivehealth, and conditions like PCOS
and endometriosis.
Like people you know, testesdon't have those conditions, so
they're they're not necessarilyas well studied because they
haven't been required to bestudied.

(47:55):
So I think that again opens upmore questions too is like I
think we we can have, we havesome good information we can
work with and support people,but there's still more questions
in terms of, like, besttreatments, best outcomes.
There's always more questions,so I always want to meet people
where they are and put thingsinto practice that again have
good evidence and are unlikelyto cause harm.

Speaker 2 (48:15):
Excellent, excellent advice.
Well, tell me, rachel, wherecan people go to find you?

Speaker 1 (48:22):
Thank you for asking that.
So my website is just my namerachelmalikcom, that's
R-A-C-H-E-L-L-E-M-A-L-L-I-K.
Double L in both names, so thatthrows people off sometimes and
I'm on Instagram at RachelMalik, so I try to keep that
pretty streamlined.
I offer one-to-one nutritioncounseling.
Again, it's kind of statedependent, but I can work with

(48:43):
people all over the country.
So just reach out if you areinterested in one-to-one
counseling.
And I also have a fertilitynutrition course that I launched
last year, that kind of goingto what we were talking about
earlier today aboutindividualized guidance.
So it's not individualizedguidance but it is very credible
information based on my yearsof experience working in this,

(49:03):
my years of experience bothinfertility as well as working
with patients one-on-one.
So I try to take a moremotivational interviewing
approach to it in terms ofrecommendations.
So I try to take a moremotivational interviewing
approach to it of in terms oflike recommendations.
So I provide all the evidenceon various modules.
You can go on the Rachel Malikdot com slash course for more
information about, like, whatexactly I cover.
But essentially with eachmodule I provide some research

(49:27):
and then my takeaways from thatresearch, because I'm a why
person, like why am I doingsomething?
What does the research say, butyou can always skip ahead to
the takeaways if you want toskip that part.
But I like to be a reallyinformed like okay, if I'm going
to do something, why am I doingit?
And I also did that because,going to how we started the
conversation, there's so muchmisinformation and
disinformation.

(49:48):
So you might see arecommendation 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 Imade this recommendation, both
from the research and myexperience as a dietitian.
And then each module ends withlike okay, how could you apply
this into your life?
So I provide a lot of likequestions and thought provoking

(50:10):
ideas, you know.
So I'm really proud of it.
And that's a great resource foranyone trying to conceive,
because you don't have to workwith me in one on one or you can
always do a conjunction inconjunction with one on one.

Speaker 2 (50:20):
Excellent.
What was so nice having you?
I love.

Speaker 1 (50:23):
Yeah, thank you, Heather.

Speaker 2 (50:24):
I love a gal that's just well versed in what she
does.

Speaker 1 (50:29):
I'm very passionate about it and I love what I do,
and it's a privilege to workwith people on the reproductive
journey, so I'd love to help youif you need support.

Speaker 2 (50:38):
Great, All right.
Thanks for being here.
Thank you as always.
Please follow show or you canleave a five-star review on
Apple or Spotify.
That would be fun too.
See you in the next episode.

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E55. Busting Myths to Empower Reproductive Health with Registered Dietitian Rachelle Mallik and Health Coach Heather Sayers Lehman

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