The Importance of a Pre-Pregnancy Detox—Plus, Fertility Boosters
Our concern for a growing baby often starts when we get pregnant, but given the toxic load most of us carry around, we should be thinking about detox if/as we think about getting ready to conceive. There are a number of fairly easy pre-steps that are beneficial for all women to check off first, like starting a prenatal vitamin and supplement regimen (check our doctor-designed version here), detoxing your personal care routine, and eating organic as possible (in just a few days, many pesticides and herbicides from food leave the body).
It’s worth the effort: Babies today are born pre-polluted. One Environmental Working Group study found a total of 232 toxic chemicals in umbilical cord blood; another found 287 different industrial chemicals and pollutants—180 of which are known to cause cancer in humans and 217 of which are toxic to the brain and nervous system.
Dr. Aviva Romm, a board-certified family physician who specializes in women’s health and obstetrics—who spent twenty-five years as a midwife and had four children before getting her M.D. at Yale (she’s also an herbalist)—explains that many health conditions that are adversely affecting children today can be traced back to environmental toxin exposure. Here, she offers practical tips for helping moms-to-be lessen toxic load—while also increasing fertility, to make conceiving when you’re ready all the easier. (Stay tuned for more help from Romm on goop re: how to support a healthy pregnancy once you’re there, post-birth hormone recovery, plus health-defining advice on conditions like PCOS and endometriosis. And in the meantime, see her book, The Adrenal Thyroid Revolution.)
A Q&A with Dr. Aviva Romm
Q
Why do you believe that detoxing is important pre-conception?
A
If you had asked me ten years ago if I thought women needed to detox before pregnancy, my answer likely would have been no: Eating a healthy diet and making sure you’re taking an appropriate dose of methylfolate was enough. But in the past decade we’ve seen a continued escalation in health conditions affecting kids, from allergies (including food and environmental) to asthma, eczema, autoimmune diseases (I’ve had kids as young as two years old in my practice for autoimmune disease treatment), and also a massive rise in the number of kids with autism. Many of these conditions can be traced back to environmental toxin exposure. These exposures also affect our fertility and genetics, and we pass the impact down to our babies at conception. Then we download more toxins during pregnancy. In fact, several studies have shown that at the time of birth, babies already have nearly 300 different environmental chemicals detectable in their blood. Heavy metals are a problem, too. A study done in New York State showed that Asian women of childbearing years had blood levels of mercury that exceed federal safety standards, and that most of this mercury can be traced back to high levels of fish consumption. Also, the study that shed light on the problem with arsenic in rice some years ago was actually done on pregnant women in New Hampshire. Those consuming high levels of concentrated rice products (i.e., energy bars that contained rice syrup) had the highest levels.
The toxic load we’ve built up prior to pregnancy can have an impact on our children. We also know from “washout” studies (which look at what happens when someone switches from conventional to organic food), that just in the span of a few days, we can eliminate significant amounts of toxins from our bodies, particularly herbicides and pesticides we consume with our foods, and thus lower systemic toxic levels. So it’s worth it to spend a few months, ideally, “cleaning up” our toxin exposure and levels before conception whenever possible. That said, 40 percent of all pregnancies are reported as unintended, which is why it’s optimal to go clean and green and limit toxic exposures overall.
I really want to emphasize that none of this is meant to mom-blame or shame, or to frighten people. The problems we’re seeing in kids are, though, a wakeup call to the fact that things need to change—and women are the force of nature that can make the positive change for the next generation. It’s about learning the real risks and getting fierce about protecting ourselves and our kids. What’s going on in the environment has to do with big industries: pharma, agriculture, and energy. Just to give you an example: In 2016 scientists found that salmon in Puget Sound were contaminated with over eighty chemicals and toxins, many of them pharmaceuticals. These are ending up in water systems due to industrial runoff, and human runoff—what we pee out. Water decontamination plants in the US have used one loophole after another for decades to avoid being more stringently federally regulated and well-paid industry lobbyists make sure it stays that way—while we pay the price with our health.
Q
What kind of detox do you recommend?
A
First, it’s important to mention that women shouldn’t do a deep intentional detox within six weeks of getting pregnant, or a provoked heavy metal detox within three months of getting pregnant (ideally), because if you do release a lot of toxins and get pregnant during that time, the baby is potentially getting a big download into his or her developing body. In my practice, I work with women on three- and six-month preconception plans to optimize health and nutrition, as well as dive into detox.
STEP ONE: GO ORGANIC
If a woman is generally healthy, then making sure her diet is as organic as possible is the first step. Ditto on cosmetics, body products, personal care products, and household cleaners—you want to to clean up any everyday sources of toxins. Before leaving for work in the morning, most women are inadvertently applying dozens of chemicals that disrupt their endocrine systems and alter their hormones. BPA is another classic example. For the past decade, it’s been getting into our food through almost all the plastic packaging we use, plus the linings of cans (even those that contain organic foods).
These endocrine disruptors have been shown to cause congenital abnormalities in babies; most notably, penis malformations because the chemicals act as strong estrogens in the body. The impact on pregnant women has led several states to ban them in paper receipts and airline tickets, which are disproportionately handled by women in their childbearing years, working as airline personnel and store clerks! It may sound expensive to go clean and green in your diet and cosmetics, but it doesn’t have to be; and if you do have the choice to pay now for healthier food and products, or pay later with your/your family’s health, the upfront cost is of course the easier one to bear than the long-term one.
STEP TWO: SUPPORT YOUR BODY’S BUILT-IN DETOX SYSTEM
The next thing is to make sure that the diet contains a wide range of foods that support our own natural detoxification processes, and to make sure you’re taking out the garbage every day, meaning having a daily bowel movement. Leafy greens (like kale and broccoli), good quality proteins and fats (like salmon, avocado, and extra virgin olive oil), fresh or frozen berries, lacto-fermented foods (like sauerkraut), and if you tolerate dairy, full-fat yogurt or kefir with live active cultures, all support natural detox—the work your liver does, for example, to break down and eliminate toxins.
Then it’s the job of your intestines to clear a lot of these, including the environmental hormones, which is why a daily poop is so important, and addressing constipation before getting pregnant is a big health plus. If extra help is needed to get things moving, you could add more fiber to your diet in the form of fresh vegetables and ground flax seeds daily, or take 400-600 mg magnesium citrate.
In general, taking a multivitamin/multi-mineral supplement daily is beneficial because they usually contain the nutrients your body needs to specifically enhance or repair natural detoxification, for example, B vitamins and magnesium.
STEP THREE: CHECK YOUR NEEDS
Depending on your personal health and/or medical problems, detox steps may include:
Evaluating for heavy metals with a practitioner (particularly if you have an autoimmune disease)
Clearing inflammation, which itself acts as a toxin to the baby in utero), by: avoiding sugar and processed foods, and taking a fish oil (or equivalent algae-based product) to get a healthy dose of essential fatty acids. This is important for both keeping inflammation down and then for supporting the baby’s brain and nervous system development.
One of the biggest causes of inflammation during pregnancy? Blood sugar imbalances. In fact, gestational diabetes can lead to lifelong problems in the baby as a result of this early exposure to inflammation in mom. The biggest culprits are usually a high sugar diet and “empty calories.” Even natural sugars like honey and maple syrup, or fresh fruit juices, which can contain as many as 30 grams of sugar per serving, can really bump up your sugar load. All foods that contain processed fats, processed flour, and pack in more calories than they do nutrients are a problem. The diet below, along with eating regularly throughout the day to avoid getting overly hungry, helps keep your blood sugar steady.
Q
Can some foods adversely affect fertility?
A
Absolutely. For example:
Gluten intolerance is a known cause of fertility problems.
Women who use low-fat milk products may have more trouble conceiving than women who use full-fat dairy. Full-fat dairy foods convey the female hormones estrogen and progesterone. Skimming the fat from dairy removes these hormones, which are attached to fat. Left behind are male hormones. Also, once the fat is removed from dairy, you have a higher sugar ratio in the remaining product and this contributes to insulin problems.
Low protein intake and lack of adequate, good quality, dietary fats have both been shown to reduce conception; again, because these essential nutrients provide the building blocks we need for healthy hormones. Further, poor quality fats have been shown to cause inflammation and high insulin levels, both of which can interfere with fertility.
Nutrient deficiencies—even insufficiency, where you’re not flat-out deficient but have a lower than optimal nutritional status—can interfere with conception, too. Our bodies require a host of nutrients for ovulation to occur; for example, women who have been found to be low in folic acid have lower rates of natural ovulation.
Skipping meals and having low blood sugar on a regular basis is also a red flag for conception. When your blood sugar is low, it triggers your brain to go into survival mode. When this happens too often, it affects your cortisol levels in a way that can start to have an impact on your hormones and your fertility.
On the other hand, high blood sugar and metabolic syndrome can throw our hormones out of whack and create massive inflammation, both of which block fertility. Good carbs (those containing fiber, such as vegetables, beans, and whole grains) are digested slowly and have a more gradual effect on blood sugar and insulin. But fast burning sugars like those that come from processed flour products cause high insulin, which has been found to to inhibit ovulation.
And of course, foods that have high levels of herbicides and pesticides that act as toxic estrogens in our body can interfere with fertility.
Q
In your experience, what are the most common factors that make conception difficult?
A
Most common include:
High levels of stress leading to cortisol imbalances
Thyroid problems, especially hypothyroid and Hashimoto’s
PCOS [more coming from Dr. Romm on this topic on goop soon]
Metabolic syndrome, pre-diabetes, diabetes
Microbiome disruption leading to changes in the vaginal microbiome
MTHFR genetic changes
Certain genetic blood disorders
Factors in the partner, i.e., low sperm count or poor motility
And here’s a weird one: being with the wrong partner. I’ve worked with many couples over the years who couldn’t conceive with each other, clearly weren’t happy together, and voila—each got into a new relationship and conceived without a problem! This isn’t one you can test for like all of the above, but perhaps your girlfriends or even a therapist can be the litmus test if you are having trouble facing possible facts for yourself. And really trust your gut on this one.
Q
Are there other important things to do before trying to get pregnant?
A
All women should be on methylfolate, the most absorbable form of folate. Folic acid, the synthetic version of folate, taken by women before and in early pregnancy has undoubtedly reduced neural tube defects in the US. We need more than we get just from dietary folate, and neither dietary folate or folic acid are highly absorbable by women with the MTHFR genetic pattern (which occurs in anywhere from 7 percent to 40 percent of the population, depending on which gene variation you’re looking at). To get enough to protect a baby, 400 mcg methylfolate should be taken starting ideally three months before conception and then continued through the pregnancy. Women with a known MTHFR gene mutation may want to take up to 800 mcg daily.
I also recommend that all women start both a general multivitamin and a probiotic before conception. The former to make sure you’re getting all the nutrients you need, including iodine, which women in the US are often low in and which is essential for healthy thyroid function. The latter because a healthy microbiome can prevent miscarriage, urinary tract infections (which can lead to excessive antibiotic use in pregnancy), preterm labor, and other prenatal problems. Also, probiotics have been shown to help protect babies from developing allergies and asthma, especially if there is a cesarean (which occurs in 34 percent of pregnancies in the US).
If a women has had a history of miscarriage or trouble getting pregnant, or knows she has Hashimoto’s or elevated thyroid (TPO) antibodies, I also recommend getting a full thyroid lab panel. If antibodies are high, I recommend starting 200 mcg of selenium daily, which has been shown to prevent prenatal and postpartum thyroid problems.
Finally, I also recommend women find natural alternatives to medications they are on, whenever possible and safe for you to do so, to minimize potential medication exposure. For example, one in six women is on an antidepressant, some of which may not be optimal for a baby’s development. Most women regularly take tylenol for minor pain like headaches, but tylenol has been shown to increase behavioral risks for babies later on.
Q
How long do you recommend people try to conceive before they seek out help from a specialist?
A
Since 90 percent of women will get pregnant naturally within a year of trying, and most of those who don’t will get pregnant within two years, I go for the long game and encourage women to try for about a year-and-a-half or so before they go for intervention. (Women who have been on the pill may find it takes a year just to get a normal cycle back once they discontinue it). It’s reasonable after about eighteen months of trying naturally to at least get a fertility work-up to make sure everything is normal with both partners.
The exceptions to waiting that long: if there is a known fertility problem that just can’t be overcome naturally, or if a woman’s age when she’s trying pushes her to the edge of her comfort zone in waiting. That said, I’ve been the midwife for women having their first births at forty-four, so it’s partly on an individual basis/choice, because it can happen naturally at almost any (fertile) age.
Aviva Romm, M.D. is a Manhattan-based integrative women and children’s physician, and author of The Adrenal Thyroid Revolution. Romm did her medical training and internship in Internal Medicine at Yale School of Medicine and her residency in Family Medicine with Obstetrics at Tufts Family Medicine Residency. She’s also a midwife and herbalist, and a graduate of the University of Arizona Integrative Medicine Residency program.
The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of goop, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.
