Leslie P. Stone, MD, IFMCP, is board certified in family practice with a fellowship in surgical obstetrics. She is a published researcher and international lecturer on developmental programming of health and disease and the application of individualized functional medicine care during pregnancy. Her passion is helping parents capture the miraculous during pregnancy by changing their habits, changing their lives, and empowering life in and out of the womb. She has been delivering babies since 1982 and has delivered over 5,000 children. She is owner of Ashland’s Comprehensive Family Medicine, Stone Medical, where she continues to practice.
Emily Rydbom, CN, HN, CNP, is a certified nutrition consultant, board certified holistic nutritionist, and certified nutrition professional. She is a published researcher, has been practicing the functional nutrition approach to pregnancy since 2010, and is an international lecturer on practice implementation to improve transgenerational health. She is owner and CEO of GrowBaby, LLC, and board president of GrowBaby Life Project (501c3)—research in pursuit of health and resilience for a lifetime. She has an active clinical practice working beside Dr. Stone to help women reach their nutrition and pregnancy health goals. Her passions include empowering women during the preconception, pregnancy, and postnatal time period and teaching families about healthy nutrition and lifestyle balance.
Kalea Wattles, ND: IFM’s Annual International Conference is coming up soon. Learn about the latest advancements in functional medicine research and what they mean for your practice. Join us June 4th and 5th for a reimagined online experience. I’ll see you there. Visit aic.ifm.org for more information.
On this episode of Pathways to Well-Being, we’ll discuss a topic that’s close to my own heart and practice—that’s functional fertility and preconception. Dr. Leslie Stone and Emily Rydbom are joining us today to explore new ways to support fertility, preconception health, and a healthy pregnancy. Emily and Leslie, we’re thrilled to have you today to talk about the intersection of functional medicine and preconception, and also your work on the GrowBaby Life Project. Welcome to the show.
Emily Rydbom, CN, HN, CNP: Thank you.
Leslie Stone, MD, IFMCP: Happy to be here.
Kalea Wattles, ND: It’s such a delight to be able to talk to you about this topic. And I know that so many of my patients are wondering, how can they reduce any risk that they might have trouble getting pregnant later? I’d love to ask, what are some common conditions or risk factors you’re seeing in your patient population that seem to impact fertility potential, subfertility, the ability to get pregnant when you want to?
Leslie Stone, MD, IFMCP: Should we just pitch in? Okay. We view fertility as an event, the emphasis on fertility is an event that should begin right out of the womb, basically, right? Because what we’re trying to do is create the most resilient and healthful environment from the get-go.
So, what that means is, in contradistinction, that is, look at how our own environment, our whole US national statistics, look at obesity, our exposure to toxins, our insulin resistance, our sedentary lifestyles, our infection rates, inflammatory rates, autoimmune disorders, things that we have complete management capability over, we just need to take that moment to do it. One of the important pieces that we recognize is knowing where to look and when to look.
The first piece that we think about is, it’s not just women’s fertility, it’s male fertility and their health as well. It has, in our population, in the US population, it’s about age too, because that poses a potential risk factor. We think about the social determinants of health. Where do you live and what are your toxic exposures like? And then, of course, the environment in which you’ve been raised, what kind of food practices do you have? What kind of nearness to good, healthy foods do you experience? Or are you in the midst of a food desert as well? We think widely too, even broader as we get more technological support for these concepts, we think too, what are your particular personalized issues? Could it be that we should be looking at your genomics, as we are able to do so, so that we can personalize? Perhaps you might have a particular need that needs support nutritionally and in a lifestyle manner?
Emily Rydbom, CN, HN, CNP: Thank you, Leslie, and I think that it’s very easy for females, particularly, to bear the brunt of this burden. Male factor infertility is not a diagnosable disease or a condition to this day, it’s not. Yet we know that male factor infertility can impact pregnancy rates anywhere from 20 to 70%, depending on where you are on the globe. So, I think this idea of the vacuum conversation that has emphasized primarily in the female court, really, we need to broaden that topic and broaden the conditions that are associated and the factors that do impact this time period so prevalently. So, beyond the diagnosable concerns that are rising in female infertility and can impact female infertility, those like endometriosis and PCOS, we also have to consider the high prevalency rate of things like birth control pills (BCPs). Any type of conception protection or conception control, you have to consider the commonality of nutrients that become deplete in those situations where when, say you’re not diagnosed with a condition that we know will directly impact fertility, so to say or so to speak, we know that just simply the use of things like BCPs are dramatically impacting these micronutrient needs that really impact whether or not somebody can become pregnant.
Leslie Stone, MD, IFMCP: Particularly the B vitamins.
Emily Rydbom, CN, HN, CNP: Yeah.
Leslie Stone, MD, IFMCP: Interesting.
Emily Rydbom, CN, HN, CNP: Yeah, and so I think the willingness to throw a larger blanket over this topic that is going to open up not only the conversation for a solution and finding answers, which I think is really what we are all aiming for in this period is to relieve that feeling of guilt, to relieve the feeling of desperation, because it’s not just an emotional conversation and an emotional taxing, but it’s also financial tax associated with the use of things like IVF clinics and infertility services that we have to consider is part of this picture as well.
Leslie Stone, MD, IFMCP: And I think the other piece I was thinking about is, yes, we need to start earlier, because almost 50% of people are pregnant before they know it. And so we need to have that kind of, we also know that there’s huge impact that can be achieved in the preconception time period. It doesn’t have to be enduring your entire life. So this also puts it firmly into the court of those persons who are in the healthcare fields of lifestyle and coaching and nutrition and in a collaborative model with their other healthcare providers. It is definitely a primary care emphasis that’s gonna get us the best fertility basis, and we can solve an awful lot by taking care of those basic needs, the micronutrient that’s missing, the genomics that might have some vulnerabilities, the microbiomics, just an understanding of how they’re going to be doing, their lifestyle, environmental exposures. There’s a lot that can be ticked off and are modifiable. I mean, it’s an optimistic, forward-leaning experience, the more information we gather.
Kalea Wattles, ND: Yeah, well I have to admit, I’ve been so inspired by your work as a primary care doctor who works mostly with women who are trying to get pregnant, and a message that I’ve been saying for a long time is, we should really plan for preconception like we plan for our wedding. I mean, isn’t that funny that we’ll take a year or two to plan for our wedding, but when we decide we want to get pregnant, we wanted to get pregnant yesterday?
Emily Rydbom, CN, HN, CNP: Right.
Kalea Wattles, ND: It makes these conversations pretty tough about, well, you know we have this periconception timeframe where we’re most susceptible to things like protein malnutrition and methyl donor deficiencies and environmental toxicant exposure. Selfishly, I guess I’m wondering how you have that conversation with patients when they want to get pregnant and they wanna get pregnant right away. How do you frame that discussion about, well, this actually is something we should approach with mindfulness and thoughtfulness and maybe a little patience?
Emily Rydbom, CN, HN, CNP: A good question.
Leslie Stone, MD, IFMCP: As always, these conversations are so individuated. If we have somebody who is rushing at it, who just cannot be dissuaded, then we will accommodate that. But if we have the opportunity, we will take the moment and get ourselves some real, personalized care. As you know, we have this GrowBaby project that we’ve been working on for a while. And so that is what we do is we will analyze them in all of those different systems and then personalize that as we can. But yeah.
Emily Rydbom, CN, HN, CNP: Well, I think so much of this is bringing awareness to the fact that to decrease these common birth outcomes that have some adverse association with short and long-term health outcomes, or to decrease the prevalency or the risk of some of the maternal conditions that we’re so worried about that do help predict some of these birth outcomes, we actually have to talk about this. You ask the question, what is that origin story? It’s in the preconception time period, primarily. There is lots that we can continue to do that’s modifiable in the pregnancy time period, however, and I think it was a very recent multi-country study that’s cited that in order to decrease things like low birth weight, stunting, fetal growth restriction, we have to consider the nutritional status and the preconception or maternal pre-pregnancy weight and BMI. And those have the most impact on those birth outcomes that now we now know have really long-term adverse vulnerability association. And so, so much of this is bringing awareness to that conversation. I don’t think we know yet that we have to think about pregnancy health, childhood health, adolescent, adulthood health as a preconception conversation.
Leslie Stone, MD, IFMCP: Having said that, we also know that interventions that are instituted have a genetic effect, have a genetically modifying transcription effect within hours of implementation. So comparing saturated versus unsaturated fat diets and looking at the different shifts that occur in the inflammasome, and that genetic piece of it, we can shift those within about six hours. We know that a microbiome shifts within hours as well. And so that gives us great hope and optimism that if we are starting, we are starting now, we will have a, a positive trajectory. We also know that that plasticity time period extends for years after birth. And so we have an opportunity to have a post-transcriptional epigenetic effect as well. It’s all quite optimistic.
Emily Rydbom, CN, HN, CNP: It is, and if we are able, and honestly, it’s the education and the support and the continued touchpoints of care that allow this conversation to happen in an empowered way. I think if we just plop a single topic on someone’s lap to say, “You really should have been thinking about this three to six months ago,” that just immediately and instantaneously feels disempowering, just like the conversation in pregnancy of, don’t gain too much weight and your BMI is too high, but yet there’s not a solution or a roadmap to how to go about solving those that is standardized, let alone able to be implemented because of the time constraints associated with the nuances that this conversation requires.
And so it is really, Leslie and I over the course of the past decade together have really come to understand that if we want to start shifting the trajectory of this conversation toward preventative measures to improve pregnancy health for a lifetime, pregnancy and reproductive health for a lifetime, it’s gonna require more than one primary care provider, it’s going to require nutrition professionals, health coaches, many people, a community approach. Just like we understand community-based group medical visits are powerful, community touch points, community connection is so powerful as we’ve really come to understand over the past two years of this pandemic is that, the community really in and of itself changes frequency. And so if we can give another solution or suggest another solution, which integrates a hybrid model, a hybrid care model, we have found that those results appear to be durable and long-lasting. And we see better results, we see better lifestyle, behavioral changes, more consistent changes, because there’s more people checking in on you saying, “Hey, I care about you.” So that’s what we’re hoping.
Leslie Stone, MD, IFMCP: And we, we all know that, right? We all know that. What I think happens, I’m thinking back to the question of, why is it that people don’t show up before? They plan their wedding, but they don’t plan their pregnancy, and I think their conception, and I think it’s because they are laboring under the misconception that there’s nothing they can do about it, that this is what they’ve got. Well, we couldn’t be farther from the truth. And it’s that nugget of information that gives us such optimism is that, if we know that we have modifiable issues here that can change their fertility, and the quality of their pregnancy, and trajectory and the health of their offspring for generations, that’s a powerful message that we need to hear a little earlier, yeah. So policy needs to be shifted that way. Grassroots reach needs to be shifted that way. This is an optimistic modifiable empowering message.
Emily Rydbom, CN, HN, CNP: And the conversation of the “teamness” of it really needs to sit at the forefront of that conversation. I don’t mean team just by providers. I also mean teamness as in a couple and a significant other. I mean, the male partner needs to be a part of this if there’s a traditional couple involved. We have to have a full scope conversation.
I was able, with Dr. Michael Stone, to do a deep dive into male preconception health and male infertility, and I was shocked at how quickly sperm DNA fragmentation can change with simple lifestyle changes. I mean, it is a 400-fold improvement just simply by adopting yoga practice. I mean, yet at the same time, if you’re over 35 as a male, you are gonna directly impact whether or not your partner has things like an increased or gestational hypertension. So knowing your age and its impact on not only your baby, but also the impact that you’re gonna have directly on your spouse or your significant other, so much of this has to do with awareness and education. And then a roadmap to a solution, right? Because I think, I say this all the time, Leslie probably gets annoyed with me saying it, but we have to be good stewards of information. It’s simply knowing information is not going to get to a place where we can act upon it. We have to have those people or those tools in place that help support along the way and integrate along the way as personalized and individuated as possible. But it’s a hopeful conversation.
This all sounds so, it’s really a hopeful conversation, because there’s so much that we can do about this. But it requires a different set of eyes and ears and a willingness amongst all of us to shift how we are having this conversation and when we are having it. Leslie alarms everybody when she says we should be thinking about reproductive health at puberty at the age of menstruation, which shocks everybody’s socks off. But the truth of it is is that she’s not wrong, because when we think about the significant hormonal changes that happen, the significant needs of a teenage pregnancy versus those of an adult woman, right? Those are dramatically different. And so I have grown to welcome that statement, it just alarmed everybody at first when she said it.
Kalea Wattles, ND: Well, this is definitely a message of empowerment. That’s what I’m taking away. And Emily, I’ve actually heard you say before, when you were speaking about birth outcomes, that we’re at this place where we no longer need to accept this notion that there’s nothing we can do. We know better than that. And I feel the same exact way about fertility, and I’ve even, in the last couple years, have shifted away, in most cases, from using the term infertility to subfertility, because I think that better reflects what I really see in my practice of fertility being a continuum and there being multiple factors that are influencing that spectrum. And oftentimes, we can shift that. So I really appreciate the way that you’re framing this of, we can assemble this collaborative care team. And really, this is a message of hope and encouragement and empowerment.
Emily Rydbom, CN, HN, CNP: It is.
Leslie Stone, MD, IFMCP: That’s exactly right.
Emily Rydbom, CN, HN, CNP: It absolutely is. However, I don’t know if you found this, Kalea, but we still do not have, I mean, well, actually, as of 2020, but in 2020, we still did not have a standardized way that we approached nutrition for pregnancy in this country, 2020. It was just made, this preventative task force guide was just made. I mean, and how long have we been getting pregnant in this country? I mean, oh my gosh, I just went… It feels, to use a sports analogy or a sports metaphor, excuse me, it’s like we were swinging off our back foot a little bit here.
It’s not for lack of caring, and I think that that really needs to be heard. It’s not because people don’t want to help, it’s because there’s a fear associated with it or a time constraint associated with this conversation, or like I said, there’s not a standard way to enter this conversation across the board, across many associations where we’ve all agreed. We still cannot agree about how to approach pregnancy the best way, because guess what we figured out in our decade of doing this, and I realize we’re a very small entity here, but we’ve been doing it consistently for a long time, is that it’s because it is going to be the nutrigenomics conversation, the metabolomics conversation, all the omics conversation of personalization that is going to launch us into that space where we can find a better standardization of this very nuanced but important detail with how do we approach nutrition? How do we individualize nutrients? How do we individualize lifestyle? And it’s all gonna change depending on things that we do talk about, but we’re not quite sure how to just shift it toward the right answer for the person sitting in front of us.
And so, over the course of this time period, where we’ve been doing this, we’ve personalized based on yes, pre-pregnancy BMI, yes, gestational weight gain, but even gestational weight gain is not a standardized measurement tool in pregnancy. Is that interesting? Because it requires more time. And then it requires, oh, I’m watching you gain more weight than you ought to, or not enough, and I don’t know what to do about it. So then we stop measuring, we stop asking. We contract versus open up to what are the possibilities and options here in how do I best help you? So the pre-pregnancy BMI, gestational weight gain, but it’s also whether or not that person has, what’s their medical history? What are their current medical conditions and vulnerabilities? And so we start individualizing, and all of a sudden, it feels so big. But I think that that is where we have to start personalizing using these tools as much as possible. And this is where functional medicine thrives.
Leslie Stone, MD, IFMCP: That’s right, the systems approach.
Emily Rydbom, CN, HN, CNP: It’s that systems approach that is interconnected and that when you pull on one tether, or when you pull on one string of the puppet, you are gonna have a different level of expression, and that’s a good thing, we don’t have to be scared of that. But it does mean that these single intervention and these single nutrient interventions are powerful, but what happens when we have a multifactorial systems approach or the multifactorial interventions that we know are, have shown us, right Leslie? Time and time again that it’s not the single nutrient intervention that is most powerful, it’s when we approach it at the same time in a continuum…
Leslie Stone, MD, IFMCP: That’s right.
Emily Rydbom, CN, HN, CNP: In a symbiosis and in that balanced way.
Leslie Stone, MD, IFMCP: That’s exactly right. We don’t have to get everything right. We just have to get some of it right. And that’s generally, we get great results that way.
Emily Rydbom, CN, HN, CNP: And physiological redundancy is a very inspiring thing.
Leslie Stone, MD, IFMCP: Useful.
Emily Rydbom, CN, HN, CNP: I love that our bodies are one big biochemical reaction because the cofactors don’t really change that much, do they? No, those cofactors impact what the enzymes are doing, what the substrates, what the requirements are. Those all have a recipe.
Leslie Stone, MD, IFMCP: They do, so we focus on a few key micronutrients, a few key gene variants. We can’t wait till we can focus on a little bit of more advanced genomics, but we’re not quite there yet. We use history and story to give us an idea about the microbiome, and we do some epidemiology. For example, recognizing that bacterial vaginosis is an issue for 40% generally, but like 60% of Black and Hispanic women in the US, it’s the outcome from the US as it turns out. And so we know that those persons are more likely to struggle with infertility or miscarriages or preterm birth if they actually got pregnant. And that there are some modifiable things we can do anticipating that issue or we can test for it if they fit that in a demographic, and then be able to intervene with targeted probiotic interventions. If they have a recurrent miscarriage history, we can look at particular genes, the pro-gene receptor. We can look at TCN2, and we can have specific interventions for those as well. We can pick a nutrient and lifestyle intervention that can reach around to that. We can find stories in their PCOS and their endometriosis, and recognizing that there are toxic manipulations there, there is weight and inflammatory manipulation that can take place, and it’s all very nicely successful. I mean, very.
Kalea Wattles, ND: Well, I think that was the perfect lead in to my next question. You talked about, sometimes, we really wanna take this individualized approach, but there’s so much going on and we have complex cases, and I mean, humans are complex, and it’s easy to get overwhelmed at times. And that’s when I feel so fortunate that we have functional medicine tools like the timeline and the matrix that allow us to map out what is happening with these body systems. So when you’re using the functional medicine timeline or the matrix, and you’re looking at someone’s health trajectory, that really starts in their preconception timeframe, which lifestyle factors, what we call the personalized modifiable lifestyle factors, which I think in and of itself is such an empowering term, they’re modifiable, right? We can do something about it. Which of those modifiable lifestyle factors do you see as being really important for women who are at higher risk for gestational hypertension and preeclampsia and pregnancy loss? I would love to hear. You’ve talked a little bit about lifestyle factors already, but I think it’s so important. I wanted to capture that a little bit more intentionally.
Emily Rydbom, CN, HN, CNP: There was an excellent expert review that was published just this year. And I think it’s important for us to say that that research does not point to one specific diet that does the best job at decreasing things like gestational hypertension or preeclampsia or gestational diabetes. However, there are some very excellent general nutrition pieces of advice that we have all come to understand as the Mediterranean diet.
But I think it’s also important to say that when we are considering lifestyle choices associated with these maternal conditions, such as gestational hypertension, preeclampsia, gestational diabetes, that we have to consider other things besides nutrition, such as smoking, drug use, alcohol use, and these all, Leslie, you can correct me if I’m wrong, these all take a lot of time with people to ensure that we are not just taking away something that they have come to use as a comfort measure most often. And I think we have to really obliterate the judgment associated with a lifestyle choice that might not be conducive to a goal or might put somebody at an increased vulnerability, because it’s the why behind somebody choosing that, we have to get to that question. Why are they doing it? Why are the nutrient needs or the nutrition needs not being met? Is it the food desert? Is it the geographical location?
So if you start to look at what are the other lifestyle factors, we have to consider also zip code. I think we are starting to understand that vulnerability of disease or vulnerability of poor health outcomes is associated with where you live. And it’s really hard to go about approaching a detoxification lifestyle or a food plan when we’re not able to mitigate the exposure risks to begin with, where the toxic exposure was to begin with.
I’m gonna come back around to your question and answering what are some things that we look for to decrease maternal conditions. It really is using a low glycemic Mediterranean diet style approach. There is good data to suggest things like paleo diet. Does it meet some of the vitamin D, calcium needs that pregnancy requires? A vegan diet, there’s significant nutrient needs that are not present in that diet where we have to ensure that if someone is a vegetarian, that we meet adequate protein needs aside from dairy sources as much as possible. And then talking about the quality of those foods that come into their life versus the quantity of those foods. So this is where the individualization really reigns clear for me is that, in fact, I really push against the notion that a food is good or bad. It’s how does it interact with you, and what are your needs at the time? And so Mediterranean diet, low glycemic index, higher fiber as much as possible. But then what do you do about it when you can’t afford those foods or you don’t have access to those foods?
And so one of the biggest reasons why we have created all the tools that we use is because we meet with a 50% Medicaid population. So we meet with women who are utilizing SNAP benefits, WIC benefits, and so we’ve had to adopt everything and adapt everything that we’ve done and talk about to the resources that are available, the financial resources that are available for the person or the family as much as possible, because that is, again, that’s another layer of empowerment to ensure. It does no good to say, “Oh, you should eat a Mediterranean diet,” and people are going, “I can only buy tuna when I’m pregnant and not even when I’m breastfeeding with WIC benefits.”
Leslie Stone, MD, IFMCP: Exactly.
Emily Rydbom, CN, HN, CNP: So the idea that, I’m supposed to eat 8 to 12 ounces of low mercury fish in pregnancy, and that’s the recommendation, you might as well just tell me, I gotta shoot for the moon. So as we go about, how do we solve for that? What are the other sources of omega-3 fatty acids that allow us to help meet those needs? Can we meet those needs in nutrient supplementation or prenatal vitamins? And then it brings the conversation into the quality of those, right? Because what we do know is, although there’s not a standardized way to manage things like gestational hypertension, preeclampsia, and gestational diabetes, there’s really good, strong data, the quality of evidence, I think for researchers and scientists, they may tell me that the quality of evidence is not quite there, and they’re not wrong. But what we do know is that, from other data, the emphasis of this Mediterranean diet, low GI approach really does the best job at meeting the macro and micronutrient needs of pregnancy, or at least putting us on a similar playing field to begin with.
Leslie Stone, MD, IFMCP: And another piece of that personalized modified lifestyle piece is stress management. Everything we have to ask for has to be doable, right? But simple things, so if our goal is to, we live in a high-stress environment, many people do, many people’s cortisol is contributing to their fertility capabilities. And so simple things, music…
Emily Rydbom, CN, HN, CNP: Aromatherapy.
Leslie Stone, MD, IFMCP: Aromatherapy, yes.
Emily Rydbom, CN, HN, CNP: Reflexology.
Leslie Stone, MD, IFMCP: They have great data, Tai Chi, yoga. Those are small things that make a significant reduction in cortisol levels and can contribute to a much more positive fertility hormone balance with those pieces alone.
Activity, yoga and Tai Chi, can act in that space as well. But looking for the sedentary lifestyle. Is this a person who can get out and go for a walk safely? What are our alternatives? Do we need to think of something indoors? Do we need to think of something within a community setting that is a safer event and arrange around that?
Sleep hygiene, a very important restorative moment, right? But those keys to good sleep hygiene are the same pregnant or unpregnant or preconception at all times. And so we reemphasize that even those persons who have some difficulty, there are pieces that can be put together in a plan that makes them have more restorative sleep experience. And all this focuses down to an improved immune function and improved inflammatory balance, improved estrogen-progesterone balances, and avoidance of those toxins, or if we can’t avoid them, because as many people by their zip code cannot avoid them. Then what do we do with our micro-nutriture, our filtration systems within the home, our exposures that we can manipulate, such as what products do we use personally, using those things that are on that website…
Emily Rydbom, CN, HN, CNP: Environmental…
Leslie Stone, MD, IFMCP, and Emily Rydbom, CN, HN, CNP: Environmental Working Group.
Leslie Stone, MD, IFMCP: Yeah, yeah.
Emily Rydbom, CN, HN, CNP: It’s where the bottom of the matrix shines, right? It’s like, there’s so many doors to enter in. And oftentimes, when that idea of a placebo effect comes into play, that is where you’re going to feel the most empowerment when someone can choose what they wish. I think I would best like to enter in on stress, or on food, or on sleep, or on relationships, or on communication. When you create that collaboration and you allow somebody to choose where they think they’re going to be the most successful, and you do this “just one thing” concept, let’s start with just one thing.
Although we know that it’s multifactorial and these interventions become multifactorial, I cannot take away from the fact that when someone can choose one thing to start addressing a change in their health, it builds upon itself exponentially. But you gotta remind them that they can do that one thing, that they have the power to do that one thing. All of my clients just roll their eyes at me when I tell ’em, “Did you do your toothbrush tuneups today?” Because you can brush your teeth and do squats. You can brush your teeth and do wall sits. You can brush your teeth and do leg lifts. You can stand on one leg while you fold laundry. You can take two steps up the stairs versus just one. There’s just so many little things that we can choose to do in reminding people that they have those choices all the time. Man, that’s where the power lies.
Leslie Stone, MD, IFMCP: And if we’re talking about that ongoing modifiability, you all understand this too, that when you get one thing done successfully, the next one’s easier. And the next one after that is easier, and the next one after that, and after you’ve done… When somebody’s aiming to be pregnant, when they want to be fertile, then there’s just no more plastic time period, too, to achieve some really significant lifestyle changes that if maintained over three or four months, they are more likely to happen then they’re not likely to happen. And so it just becomes an empowering thing for that person. And their sense of well-being, as we build on well-being, it’s a great resource, a great source of resilience.
Kalea Wattles, ND: When you were talking about choosing your entry point, it felt like a choose your own adventure.
Emily Rydbom, CN, HN, CNP: Yes.
Kalea Wattles, ND: We’re choosing our entry point and we’re choosing this lifestyle adventure that we’re going on together, it just made me happy to hear you talk about it like that. And thinking about the modifiable lifestyle factors, another piece that I wanted to bring forward again was this concept of community, because relationships, as you mentioned, are at the bottom of the matrix, they’re part of those lifestyle factors. And I think we know that behavior change happens in community. And so that’s an important part that I never wanna forget about when I’m choosing an entry point.
Emily Rydbom, CN, HN, CNP, and Leslie Stone, MD, IFMCP: Yeah, yeah, absolutely.
Emily Rydbom, CN, HN, CNP: We all need cheerleaders. I cannot tell you, it’s like when you watch a little kid and one of the important things you can do is make sure your eyes light up when you see a child. It’s the same thing for an adult, it matters. We can’t take away from these moments. I see you, and I’m smiling, and good job. My husband, he’s like, he went, “Oh my gosh.” But a woman was running up a big hill in Ashland, Oregon, which we’re, we live in a mountain town. And so she was running up this really steep hill with her stroller and obviously a toddler-size person in it. And I rolled my window down, I was like, “Keep going, you’re doing awesome.” Because in that moment, I mean, she’s obviously struggling, but that’s really what we need. All of us intrinsically needs someone to just spontaneously say, “You’re doing a good job.”
Leslie Stone, MD, IFMCP: That’s exactly right, reinforcement.
Emily Rydbom, CN, HN, CNP: I’m gonna keep being here telling you you’re doing a good job, and then let’s adjust when it doesn’t feel like it’s working. It’s like that fixed versus growth mindset, right? We have to be willing to remain flexible. Again, going back to the pandemic, if that is my lesson in this, it’s that. It’s we have the ability to be way more flexible than we ever thought we were, so let’s emphasize that. And so these entry points, yes, choose your own adventure. I know I feel like we need some drumming, cool music to like boop, like a game board or something. I really feel like this is an opportunity to allow someone to feel excited about the changes that they get to make, because they are gonna feel better, and we know that, but they don’t yet. And so they will.
Leslie Stone, MD, IFMCP: They do, yeah. That belief that it will be better. That hope, that’s our power, our super power.
Emily Rydbom, CN, HN, CNP: And we cite this JAMA article a lot. It’s not enough to just give access to health care. Although the Affordable Care Act allowed more women to receive pregnancy health care and to get pregnancy health care, it did not change our outcome significantly in these birth phenotypes, in these maternal conditions. They are continuing to worsen in this nation. Then that, for us, launches our core focus into it. We have to change the care we give, not taking away from the excellent standard of care that exists. I think it’s really, we say this message a lot, standard of care has saved countless lives. Standard of care is excellent. Standard of care in its implementation is not personalized, doesn’t allow the provider to have the time to individuate, even if they desire to do so. The construct of the system makes it less successful when we are looking at a more complex, systems way of thinking.
Leslie Stone, MD, IFMCP: And a collaborative way of thinking.
Emily Rydbom, CN, HN, CNP: And so I just wanna say, we have to change the care we give, not because standard of care is not excellent but because we are still not seeing the results change even though we are still applying standard of care. So that’s where the idea of a collaboration, the idea of more touch points of care, and the idea of integrating community and group medical education becomes so important, because you actually, what you realize is that, as a primary care provider, is that you actually get to expand your compassion and your care and allow other people to help you do that.
Leslie Stone, MD, IFMCP: That building good community again.
Emily Rydbom, CN, HN, CNP: Yeah.
Leslie Stone, MD, IFMCP: A different piece of it, yeah.
Emily Rydbom, CN, HN, CNP: Versus having it lift all on your shoulders or lay ’em all on your shoulders.
Kalea Wattles, ND: As we are feeling so inspired now to be cheerleaders, both in our personal and our professional lives, I wanna make sure that we take a few minutes for you to talk to us about the GrowBaby Life Project and all the advocacy you’ve done for addressing preterm births. This is such important work. Will you tell us about that for a few minutes? Let us know what you’ve been up to.
Emily Rydbom, CN, HN, CNP: Yes. Do you wanna start?
Leslie Stone, MD, IFMCP: Sure. I mean, we’re all very excited about this. As you know, we’ve been doing this GrowBaby focus and a standard of care plus model for an awful long time. And we’ve had, yes, great results in reducing our miscarriage rates, improving our fertility rates, and reducing the concerns that are gonna have generational effects, gestational hypertension, gestational diabetes. We have fewer small term births, or small for gestational age babies, fewer large for gestational age babies, fewer, yeah, preterm births, the very important one that gives us that better health outcome for generations.
And we now have the opportunity to put this into a completely Medicaid population, which people should read as a high risk. We start at a socioeconomically high-risk space and be able to take that standard of care plus but add in all of the lifestyle and dietary components personalized based on genomics, based on micro-nutriture, based on histories that we have taken, based on a good personal history, as well as risks, such as ACE scores, and depression scales, and anxiety scales, and that sort of thing. Targeting down, putting that into a group setting, targeting that down into a population that would have no access to this. And our anticipation is that we will be able to have, again, a very reduced rate. We’re expecting a significant reduction in those preterm births and a great empowerment for those women.
Emily Rydbom, CN, HN, CNP: We feel extraordinarily proud of this moment in the GrowBaby Life Project story. Our vision has always been to enact and change or help to change maternal healthcare policy in the United States and in the globe. And it really is as a precedent setting partnership with Molina Healthcare. They’re a managed care organization that exists in 17 different states, and they cover the Medicaid population. And they have basically given us an opportunity in the State of Nevada to apply our systems-based GrowBaby nutrition standard of care plus, or this hybrid pregnancy care model, into a 100% Medicaid population. And so we could not be more thrilled. We have amazing partners. Metagenics is coming into play. dnalife, OmegaQuant Analytics, and Molina Healthcare. And we are honored by people who are starting to understand and to believe that this is the way that we are going to see changes occur. In our own data that we have been collecting since 2011, we do have a peer-reviewed published study in Global Advances in Health and Medicine for our first initial cohort of 110 women. But in our longitudinal data from 2011 to 2017, we do see that our numbers needed to treat for preterm birth is 17. So every 17 births, we can anticipate one less preterm birth. We have a composite score of 24 when you put together small for gestational age, gestational hypertension, and pregnancy-induced gestational diabetes, and gestational hypertension, small for gestational age of 24. So we’re starting to see that these birth outcomes and maternal morbidities that we all care very much about to ensure we decrease the prevalence, we are starting to see a durability with this application model. So we have an opportunity to show that we can scale that, number one, and reproduce it.
Leslie Stone, MD, IFMCP: Yeah, translate it into a different culture, cause it’s all about personalization, right? So we can see, what’s their food sourcing look like? What does their culture dictate? What are their supports in terms of their stress management and all? And then be able to take that into a very codified, personalized way; something doable for them to build their community and end up with better results.
Emily Rydbom, CN, HN, CNP: Yeah, and we anticipate having those study results in 12 to 18 months from now, so stay tuned on that account. It’s pretty exciting. So GrowBabyLifeProject.org is where you can find out more about that and about what we’re doing and to see how you can support. And we’re also starting to upload our educational modules there for providers as well to kind of start learning in this way. And to just explore this option as a way of thinking about developmental programming of health and disease.
Kalea Wattles, ND: I think anybody who’s followed your journey just feels so excited and inspired about what you’ve been doing. I’m like, I’ll be going to the website and signing up for all of the offerings immediately. For someone like me who’s in a primary care setting in an insurance-based model, do you have any advice for how we can start to even slowly implement some of these pillars that you have found in your work and really affect the health of our unique populations we’re working with?
Emily Rydbom, CN, HN, CNP: Yeah, that’s a really great question. Our educational models are a great place to start because they give a very, very excellent foundation. And then what we have been doing for folks that want to implement more is have them reach out to us directly, email@example.com or firstname.lastname@example.org. And that what we do is we help walk them through these intervention tools that we utilize in clinics.
So it’s the intake forms that we utilize, protocols with a small P, as Dr. Kristi Hughes likes to say, because we know that protocols only get us so far, right? We have to individuate even beyond that. So protocols for preconception, male and female health or subfertility, and then what happens in the setting of pregnancy, and we have created, we have 14 different core food plans based off of the IFM Cardiometabolic Core Food Plan of 2010. So I always like to give a nod to IFM for that because it is what we’ve utilized. We’ve adopted parts of the methylation diet and lifestyle per Kara Fitzgerald for our one-carbon metabolism plan. And so we have, I think, about 80 different clinical tools that folks can utilize, and you just have to reach out to us.
And then what we do is we create an individualized plan, just like we individuate for a patient or a client. We individualize for the needs of the clinician as well. And so they may wanna start just with the educational modules, and that’s it. They wanna do educational modules and intervention tools. We also have our own prenatal pack. We utilize our dnalife GrowBaby Genetic Test. There’s lots of education around the dnalife genomic test now, so you can go online and find that as well.
So just honestly reach out to us. We’re pretty accessible people. We try our best. However, I have to say, it’s just Leslie and I, and Dr. Michael Stone, who is somewhere in this building. So we try our best, we’re very busy, but we really do try to reach out no matter what. So if you’re a provider, look at our educational models, if you want more than that, let us know. And then we create a plan based off of what your needs are because we know that when you personalize something, people do better.
Kalea Wattles, ND: And I feel this has been such a wonderful conversation. Thank you so much for spending time with us today. It’s just been a pleasure to talk with you.
Emily Rydbom, CN, HN, CNP: Absolutely.
Emily Rydbom, CN, HN, CNP, and Leslie Stone, MD, IFMCP: Thank you so much.
Leslie Stone, MD, IFMCP: It’s a great opportunity.
Kalea Wattles, ND: IFM’s Annual International Conference is coming up soon. Learn about the latest advancements in functional medicine research and what they mean for your practice. Join us June 4th and 5th for a reimagined online experience. I’ll see you there. Visit aic.ifm.org for more information.