Dr. Amy Nett: You’re saying she’s been on HCl for three years? That seems like kind of a long time. In pregnancy, you can have some smooth muscle relaxation, so there could be some relaxation in the lower esophageal sphincter, which could potentially increase some gastroesophageal reflux, so I would be inclined to see if you can decrease that HCl. I’m very cautious in pregnancy. Which supplements I’m cautious with? Pretty much all of them. Generally when my patients are pregnant, I keep them on a multivitamin, generally a prenatal. Again, we’ve had the multivitamin discussion many times, so I won’t go into that in great detail, but I like the Seeking Health prenatal multivitamin. The full dose is eight capsules per day. A lot of my patients are like, “There is no way I’m taking eight of these capsules a day.” That’s fine. I just tell them to take four to eight depending on how they feel and what they can tolerate.
I keep people on a prenatal, and then that has methylation support in it. I don’t know if your question here is have I seen overmethylation specifically in pregnancy or in general. So, I would say that I’ve seen issues with overmethylation in general. I haven’t seen it in pregnancy, but again, that’s probably because I’m very, very cautious with supplements. Overmethylation in general, mostly the patients tell me, “Oh, I started these methylation support supplements, and I feel really anxious or irritable, or my temper was flaring, or I feel really fatigued.” All of those things I’m going to say, okay, back off. This is too much. Let’s decrease the doses, take it every other day. Let’s find something that works for you. Overmethylation is a real issue, absolutely. Is it a real issue in pregnancy? Probably. Does it affect fetal development? I don’t know.
I always sort of back off on B vitamins. I don’t like to go too much over. Like, I won’t do our methylation protocol on top of a prenatal vitamin, sort of one or the other. The Seeking Health prenatal has pretty good doses of active forms of B vitamins. What else I’ll keep patients on during pregnancy is cod liver oil, you know, maybe a teaspoon of cod liver oil daily; butter oil if they tolerate that; and/or maybe a little bit of vitamin K2 depending on what their intake of fermented foods looks like. Magnesium might be something because, again, in pregnancy you can see more constipation and motility issues, so maybe magnesium glycinate.
I will keep patients on prebiotics, probiotics. I think those are very safe, so depending where we are in terms of treating the gut, I might do PHGG, FiberMend, any of those that we talked about, BiotaGen. Any of those are fine. As much variety in fruits and vegetables. You know we love food sources of nutrients, so I’m definitely going to talk to patients about a nutrient-dense diet, but, of course, during that first trimester, they might be wanting nothing but crackers, so there I’m going to be a little bit more liberal in terms of, okay, then let’s just get these prebiotics in, make sure there is a lot of variety in prebiotics and that sort of thing. Prebiotics, probiotics, a prenatal, cod liver oil, maybe some magnesium, and maybe some vitamin K2.
Then it will depend what else we’ve worked on. Do they need iodine or something like that? So, in regard to the HCl, I would be cautious because I think you might have to worry a little bit more about gastroesophageal reflux with some relaxation of that lower esophageal sphincter that can happen. I would just caution her on that and see if she can get off the HCl. I don’t love that she’s been on it for three years. That might be a little bit long, and the question would be why does she still need it? If that is what helps her, then, yes, just talk about really lowering the dose, but just give her the heads-up. If she feels some burning sensation, she just might need to lower the dose during pregnancy. I don’t think it’s specifically going to be harmful, but I just worry about adverse effects given some of the physiologic changes we see in pregnancy.