Solutions for Postpartum Depletion with Dr. Lauren Davis: Rational Wellness Podcast 447
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Solutions for Postpartum Depletion with Dr. Lauren Davis and host Dr. Ben Weitz.
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Podcast Highlights
Dr. Lauren Davis is a Doctor of Osteopathy, a Dual Board-Certified Physician: Family Medicine and Osteopathic Neuromusculoskeletal Medicine, the founder of Latched Nourished Thriving, a Functional Medicine Certified Practitioner, and a Postpartum Wellness Expert. Dr. Lauren describes herself as a Functional Medicine physician, a human milk advocate, and a holistic minded mama of two. Dr. Davis has written two books, Thrive, Mama! The Ultimate Postpartum Blueprint and Nourishing Beginnings: An Integrative Physician’s Guide to Successful Lactation.
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure. Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.
Podcast Transcript
Dr. Weitz: Hey, this is Dr. Ben Weitz host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast.
Hello, rational Wellness Podcasters Today our topic is Postpartum Wellness with Dr. Lauren Davis. Dr. Lauren Davis is a Dr. Osteopathy and she’s Bo Board certified in both family medicine and osteopathic neuro musculoskeletal medicine. She’s the founder of Latch, nourish, thriving, a functional medicine certified practitioner. A postpartum wellness expert, Dr. Lauren, describes herself as a [00:01:00] functional medicine physician, a human milk advocate, and a holistic minded mama of two. Dr. Davis has written two books, thrive Mama, the Ultimate Postpartum Blueprint and Nourishing Beginnings. An Integrative Physician’s Guide to Successful Lactation. She’s helped hundreds of women restore their energy and hormones after birth. But her passion for this work began after she faced her own postpartum health crisis, which she describes as postpartum depletion, which meant that she felt exhausted, anxious, foggy, and disconnected from herself while trying to care for a newborn. Dr. Lauren Davis, thank you so much for joining us.
Dr. Davis: Thank you for having me.
Dr. Weitz: So, it’s interesting that you’re an osteopath and you do osteopathic manipulation. ’cause these days I think most osteopaths actually don’t, I myself am a [00:02:00] chiropractor, so we do plenty of manipulation.
Dr. Davis: Yeah. And my favorite, how I got into the space was doing cranial on infants long before I became a mom.
Dr. Weitz: So, oh, wow. Do you know Dr. Stefan Hagopian?
Dr. Davis: I do.
Dr. Weitz: Oh, okay. He was, I was on the same hallway in the same building with him for years. Really? So he’s a friend of mine.
Dr. Davis: Dr. Hagopian is wonderful.
Dr. Weitz: Yeah. He’s considered a real expert on sacral and osteopathic manipulation. So, in your practice you’ve decided to focus on a niche that is really very neglected in medicine, the postpartum period. Yes. In American culture, there’s almost no focus on the health of the mother. It seems to be all about the baby, but in your book, thrive Mama, you note that other cultures such as in China, Latin America, Korea, and India, there’s a big focus on the health of a mother for at least the first month or so after giving birth,
Dr. Davis: at least, right?
Dr. Weitz: Yeah.
Dr. Davis: Most cultures have at least a four to six week period where mom is supposed to do nothing but feed the baby. Everything else is taken care of by someone in the family. Someone in the community comes and does all the meal prep, all of the things. And in America, we have this period where we say we don’t want visitors over to help care for us and care for the baby safety, but most of the focus is not on us.
Dr. Weitz: How did we end up without any focus on the mother?
Dr. Davis: Well, I mean, I think that is a longstanding issue that’s been going on in America when it comes to healthcare, right? We focus on mom through the pregnancy, but what most people don’t realize is that about 50% of the [00:04:00] complications related to pregnancies happen in the first year after birth. So we give moms 16, sometimes 18 visits with their OB and one postpartum visit, but most of those complications we’re gonna see happen long after the birth. We get baby out safely, and then we don’t think about what’s happening to mom.
Dr. Weitz: It’s is that because we have this male dominated culture, women are supposed to just drop the baby out and get back to plowing the field?
Dr. Davis: Well, I think that’s how we used to think of it, right? Once the baby is out, okay, mom should be back to normal, but. Now we know there are all these changes in women’s physiology that happens and moms are still re rewiring their brain for two years. There’s some evidence that it takes five to seven years to replenish the nutrient stores lost. And there’s some evidence that shows that, you know, our hormones take two to five years to level back out, especially if we’re [00:05:00] breastfeeding. So it’s this whole cascade of things that happen that we just don’t pay attention to.
Dr. Weitz: Wow. And we put so much attention on the prenatal period, and mothers going to their doctor and getting prenatal visits and taking prenatal vitamins and focus on working with the mother to make sure everything’s right, to improve to improve the pregnancy, to improve fertility. There’s, you know, so many books on fertility and yet. After the baby’s born, that’s, they just forget about it. So we Right. And it’s great that you’re focusing on this ’cause this is something that we really need. It’s a shame that we haven’t focused on this period before.
Dr. Davis: And for me, right. I was diagnosed with celiac disease in medical school. I had been an NCAA athlete in college.
Dr. Weitz: Right.
Dr. Davis: And I knew what it felt like when I didn’t prepare myself nutritionally, mentally for a task and postpartum was this huge influx of all, of these stressors that reminded me so much of when I’d be absolutely depleted after a weekend where there was competition after competition. And I simply didn’t recover.
Dr. Weitz: In your own case, what were some of the keys to recovering.
Dr. Davis: So one was making sure that I met my nutrient needs. One of the things that we didn’t discover until 2022, where a researcher took breastfeeding women into the lab and actually measured the amount of protein that they burn, we found out that women actually need 1.7 to 1.9 grams per kilogram of protein just to provide milk for their baby.
Dr. Weitz: Wow.
Dr. Davis: So if you’re an athlete, if you’re going back into the gym, if you’re doing anything [00:07:00] else besides making milk, you’re probably up at two to 2.2. You and I both know that those numbers mean you are a competition athlete on leg day trying to bulk up muscle. Right. Not a woman who is postpartum, who is Right. Looking at regaining birth weight.
Dr. Weitz: Right.
Dr. Davis: Right. Getting back to their healthy state.
Dr. Weitz: Right. Trying to lose weight, hard, heavy, and
Dr. Davis: therefore
Dr. Weitz: cutting your and
Dr. Davis: cut protein.
Dr. Weitz: Yeah.
Dr. Davis: And we look at, if we look at the numbers of what actually happens for breastfeeding women, milk is on average 21 calories per ounce. And a baby needs 24 to 30 calories per day, or 24 to 30 ounces per day of milk. So it comes out that women need somewhere around 650 to 750 calories just to make milk. That doesn’t mean her increased metabolic demands, that doesn’t mean making up for decreased sleep. Anything [00:08:00] else?
Dr. Weitz: Wow.
Dr. Davis: Women need that extra. And we go and we calculate and we say three to 500 calories, not knowing in medicine that when we calculated that back in the day, and that became common knowledge, that was already lower than women needed. That was to get them back to their healthy pre-pregnancy weight. So when women say three to 500, oh, I’ll cut an extra 200 and maybe I’ll lose the weight faster. They’re really 500 plus calories under their body’s needs, and then they’re not. Getting anything that they need when it comes to their brain health, when it comes to their hormone health. We see all of these women who blame it on postpartum, when really if we support our body’s postpartum, we feel completely different.
Dr. Weitz: Wow. That’s a shocker. So in your book you start off by, in one of the beginning chapters talking about the cell danger response.
Dr. Davis: Yes.
Dr. Weitz: So that’s a [00:09:00] well known concept in the functional medicine world, though I’m not sure. Most of us really understand it. And my, and even me, myself, I’m a little bit murky about it, but I know it’s based on this paper that Robert Naviaux wrote.
Can you explain what is the cell danger response, why you started with this and how this is applicable in this context?
Dr. Davis: Yeah, so the cell danger response is really our mitochondria, right? Those energy powerhouses of the cell giving a signal back to the body that something is wrong. So it starts locally from tissue damage. So during birth, that’s any vaginal tearing, that’s all of the rearrangement that’s happening in the uterus, inside the organs. All of that triggers this signal that something is happening, something is going on. It can also be signaled from increased stress, which happens postpartum. It can also [00:10:00] be signaled from nutrient depletion. So all of these hits come along and our mitochondria in the long run slow down, how fast they’re turning over and how fast they’re producing energy. Essentially it’s a signal that’s saying, I need more resource. I don’t have what I need. There’s something going on that’s damaged this cell, and we need to switch into repair mode. But I need all of those building blocks in place before I can repair this body.
Dr. Weitz: Huh?
Dr. Davis: So it turns on this danger signal. And then we need to stop that danger signal with all of the right pieces in place, which means that we need the nutrients there, especially vitamins and minerals. We need enough protein, we need enough safety felt within the body that all of this can relax and turn off and re-sign back.
So it’s [00:11:00] a complex system that involves both the signaling locally. Then if it goes on long enough, it spreads globally throughout the body. And that’s what I really think is what most women are experiencing when they start feeling that fatigue, when they feel the brain fog, when they feel everything else that comes along with being a new mom, that we just contribute
Dr. Weitz: right
Dr. Davis: to the lack of sleep or the hormone imbalances that women experience after birth.
Dr. Weitz: So how do we calculate how many calories, how much food a postpartum woman should eat if she wants to lose the weight that she’s gained, but yet she doesn’t want to deplete herself of nutrients and make sure she has all the protein and other calories she needs for breastfeeding and everything else.
Dr. Davis: So there is a free calculator on the website that you can go to that women providers, anyone can use website
Dr. Weitz: and
Dr. Davis: give you website to get the macro [00:12:00] balance and give the exact amount. So it’s latchednourishthriving.com.
Dr. Weitz: Okay.
Dr. Davis: And what you’ll put in is your age, weight, and if you know from an app or a wearable device what your basal metabolic rate is, how much you’re burning in a day, you put all of that in. You say whether you’re breastfeeding, whether you’re just postpartum, or whether you’re still pregnant. And it will automatically calculate how many grams of each of your macros you need a day.
Dr. Weitz: Oh wow.
Dr. Davis: The other thing that we need to focus on is also the micronutrients, right? So we know that across the board there’s a 25 to 55% increase for breastfeeding women that they need to hit. So getting enough, especially potassium, vitamin E, vitamin K, and magnesium are the main ones that when we look at the data from the N-A-H-N-E-S studies and when we look at what women are reporting, they’re [00:13:00] actually getting in their daily diet that over 90% of women are short on one of those nutrients for their postpartum body.
Dr. Weitz: We do micronutrient testing.
Dr. Davis: I do.
Dr. Weitz: Which micronutrient panel do you like? Or do you just use individual tests from LabCorp Quest?
Dr. Davis: Yeah, so I really like metabolomics because it gives us a good idea of where we’re at across the board, what the detox pathways are doing, how that energy is responding. And the other component to postpartum health is gut health because of all of the stress, because of what happens to make our microbiome. And it gives a really good overview of what’s going on behind the scenes.
Dr. Weitz: Who offers the metabolomics panel?
Dr. Davis: Genova.
Dr. Weitz: Okay.
Dr. Davis: So it’s similar to the Nutraeval. Neutraeval is blood,
Dr. Weitz: right?
Dr. Davis: Metabolomics is one that women can do at home. That’s just a urine study test.
Dr. Weitz: Oh, okay. With a fingerprint. Is that the same thing as the [00:14:00] omics?
Dr. Davis: It’s similar,
Dr. Weitz: yeah. Okay,
Dr. Davis: cool. And for moms who have small babies, it’s hard to get out of the house. So some of these convenient at home tests give really good data that allow us to tailor it to their needs.
Dr. Weitz: Cool. Yeah, we’ve been using Vibrant micronutrient test.
Dr. Davis: Yeah.
Dr. Weitz: So, what other testing do you like to do when you see women with postpartum, with some of these symptoms?
Dr. Davis: Yeah. So nutrients are key, right? Getting. They’re nutrients up first. The other thing we think about is the gut. So during pregnancy, we develop the breast milk microbiome by creating leaky gut syndrome. Essentially, we open up the pathways between the cells. We allow for microbes to pass from the gut even to the lymphatic channels. And then we get entero lymphatic [00:15:00] translocation. So we get movement from the gut to the breast that makes up the breast microbiome. And we get all of these big changes in the gut microbiome that happen during pregnancy where woman’s microbiome resembles that of metabolic syndrome. So when we combine that with nutrient deficiencies, usually we have some gut repair work to do, and gut testing is another big one that I do.
Dr. Weitz: Right. Yeah, I heard you talk about that on Yusef’s podcast and that’s fascinating. So what you’re saying is that the gut microbiome of the mother gets transmitted to the baby through breast milk.
Dr. Davis: Yes.
Dr. Weitz: Fascinating. So if you don’t breastfeed, that’s another reason why not breastfeeding is less than optimal.
Dr. Davis: Right. And when we think about it in functional medicine terms, we ask a lot if someone was breastfed from the beginning of [00:16:00] their life. Right? ’cause it transmits so many signals. It also transmits cortisol signaling. It transmits a lot of our immunoglobulin globulins for how we develop our immune system. And we know for babies that. That doesn’t fully develop. We don’t fully develop a full autoimmune or a full immune system until between ages three and seven.
Dr. Weitz: Wow. So, what other testing do you like to do for these women? Do you test cortisol?
Dr. Davis: I test cortisol. We know it’s going to be off because of the difference in sleep wake cycles postpartum. Women naturally have lower peaks of cortisol in the morning and then maintain higher levels of cortisol to be in a more awake state overnight to help respond to the baby.
Dr. Weitz: Oh wow.
Dr. Davis: So are you’re breastfeeding or not?
Dr. Weitz: Oh, interesting.
Dr. Davis: If cortisol is already dysregulated, ah, and long term, that can [00:17:00] lead to issues. If it’s not reversed or if women were going into pregnancy already with cortisol pathways that are a little off, it gets worse postpartum. That’s why we see some of the insomnia, some of the difficulty falling asleep that leads to decreased. Deep sleep, and that’s normal postpartum, unfortunately.
Dr. Weitz: Interesting. I noticed that Dutch testing, which offers salivary and urinary cortisol testing has an extra tube you can use at night to test if there’s a spike of cortisol. Is that something that makes sense in this context?
Dr. Davis: It is. But as practitioners, we also have to kind of be aware. It’s going to be a little bit off to begin with. And working towards that perfection in the first year of life is not really the goal.
Dr. Weitz: Okay.
Dr. Davis: It’s getting regulated a little bit more and getting moms the opportunity to sleep, that is way more important than getting that curve regulated back [00:18:00] out.
Dr. Weitz: Right.
Dr. Davis: Especially in that first, you know, six month period if not the first year.
Dr. Weitz: So if it has that sort of shape that you just described, where it’s lower in the morning, but higher in the afternoon or evening, you want to maybe moderate it in the afternoon and evening and see if you can bolster it in the morning.
Dr. Davis: Right.
Dr. Weitz: Okay. Do you look at hormones?
Dr. Davis: I do. And I look at it in a very specific way.
Dr. Weitz: Okay.
Dr. Davis: So
Dr. Weitz: how,
Dr. Davis: so what happens in the postpartum period? We’ve done a few studies now that look at how women’s hormone shifts after birth.
Dr. Weitz: Okay.
Dr. Davis: And what we find is that overall they’re higher, but they should be in certain ratios. And when the ratios are skewed, we get a 70 to 80% increase in postpartum anxiety and depression. We get a 70% increase in women with sleep disruption, and we get about a [00:19:00] 50% increase in women who report brain fog, fatigue, low energy when those hormone balances are off. So we’re not looking for perfection, but we’re looking for certain ratios in the hormones, and that’s the more important part of those tests.
Dr. Weitz: So you’re saying the estrogen and the progesterone are both higher than they were? Previously. Right. Okay.
Dr. Davis: So during pregnancy, right, we get somewhere between a hundred and a thousand fold increase in some of the estrogens,
Dr. Weitz: right?
Dr. Davis: And the placenta makes a different form of estrogen that we normally don’t have in the body,
Dr. Weitz: right?
Dr. Davis: So postpartum, getting rid of that overwhelms the detox systems.
Dr. Weitz: Okay?
Dr. Davis: And when that detox system is overwhelmed, so that’s the estriol. That’s the estriol, right? So we may get decreases in the different hormones, in different variants because the different detox pathways that some of these are being pushed down.
And when those are in balance. So if we have women [00:20:00] with like COMT gene mutations, we see a huge imbalance. And that’s why these women have much higher symptoms and are more likely to have anxiety, depression, postpartum.
Dr. Weitz: Interesting. So women who have issues with methylation won’t be able to detoxify some of these estrogens.
Dr. Davis: Correct.
Dr. Weitz: So what’s the significance of having higher estriol levels? What sorts of effects result from that? So there’s three different forms of estrogen and estriol. It tends to be secreted during pregnancy rather than at other times, right?
Dr. Davis: Right. So Estriol takes up mostly I believe it’s the 16 alpha pathway, right? Which is the pathway that we need more detoxification to get the better ratios of estrogens as they break down. So estriol is preferentially broken down during, in that pathway. So what [00:21:00] then happens is we get a lot more breakdown of Estriol postpartum. The microbiome has shifted. We get estrogen receptor or estrogen recycling from the estrobolome.
And then we have this whole cycle that continues on where we’re getting overwhelmed with the detox pathways. We know that during pregnancy, glutathione levels in the liver drop by 40% and they don’t fully recover until 10 years postpartum if they recover all 10
Dr. Weitz: years.
Dr. Davis: 10 years.
Dr. Weitz: Wow.
Dr. Davis: 10 years to recover intra hepatic glutathione levels.
Dr. Weitz: Wow. And we need them having glutathione to detoxify the estriol.
Dr. Davis: Yes. And if we’re having back to back pregnancies, we’re decreasing that glutathione level further.
Dr. Weitz: Huh.
Dr. Davis: It’s why we think that increased risk of death for women in the first 18 months, if they have a second pregnancy within 18 months, higher risk of death during labor, unfortunately.
Dr. Weitz: Wow. [00:22:00] What does this say about we’ve had a lot of discussions about hormones on the podcast and functional medicine practitioners. Have had a tendency to recommend estrogen in a compounded topical form that includes estriol and estradiol. And if estriol is something that’s normally only seen in higher levels during pregnancy and afterwards can have negative effects, that probably has implications on whether or not we should be doing that,
Dr. Davis: right?
So there’s a natural balance that happens, and it’s different when we look at postpartum women than if we’re looking at the perimenopause and menopausal women.
Dr. Weitz: Okay?
Dr. Davis: So both are going down in perimenopause and menopause, [00:23:00] and overall we should be in that ratio balance between E one E two.
Dr. Weitz: What should the ratio be?
Dr. Davis: So usually I look for a 20 to 30 to one ratio when I’m looking at the fractionated estrogens
Dr. Weitz: of estradiol to Estriol?
Dr. Davis: Yes.
Dr. Weitz: Okay. Interesting. So probably not ideal for post-menopausal women to be taking estriol to estradiol in a 80 to 20 ratio of estriol to estradiol, right. Like by cream.
Dr. Davis: Right. So some of the newer information that’s come out for perimenopause is that, you know, we really should just replace with estradiol,
Dr. Weitz: right?
Dr. Davis: And even smaller amounts of estriol if we’re adding it on.
Dr. Weitz: Yeah, I’m friends with Felice Gersh [00:24:00] and yeah. You know, she is a. Huge proponent of recommending estradiol and not recommending estriol.
Dr. Davis: And it, what I look at is how women are doing, how they’re functioning. Okay. And then what is that ratio on replacement?
Dr. Weitz: Right.
Dr. Davis: You only need small amounts of estriol. So if we’re looking at balances and we’re looking at what their body is doing with the estradiol that we’re giving,
Dr. Weitz: okay.
Dr. Davis: If the imbalance is skewed in that particular woman, if that’s her physiology, right? And that usually has to do with those detox pathways in the liver.
Okay. Then I consider adding a small amount on into the compounded formulation. Okay. Otherwise, I start with E two and I see where that gets us.
Dr. Weitz: Okay. Interesting. So you’re recommending hormones to postpartum women in some cases,
Dr. Davis: not necessarily in women who’ve had births over the age of 35 or 40.[00:25:00]
Who are in that window, where they’re in early perimenopause, where they may benefit from hormone replacement therapy.
Oh,
Dr. Davis: okay. What I talk to them about is doing some estrogen replacement. So most of the time when we’re dealing with breastfeeding women, it’s vaginal dryness and irritation. That is the main symptom that they’re experiencing. And low libido.
Dr. Weitz: Okay.
Dr. Davis: So replacing locally with an intravaginal estrogen works really well for them.
Dr. Weitz: Okay.
Dr. Davis: To enjoy sex again, and that’s a completely different thing than giving oral or giving topical for systemic estrogen absorption.
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Dr. Davis: Now, once again, I often hear that intravaginal, estrogen is often recommended in an estriol form, but in this case, you’re probably gonna be recommending an estradiol form, right?
Dr. Davis: I do because it’s perimenopause. We haven’t hit the total decrease in the hormone imbalances yet that come closer to menopause.
Dr. Weitz: Right,
Dr. Davis: and to do symptom relief for women because breastfeeding is a natural low estrogen state. I think of it as the washout period after pregnancy. Pregnancy was really high. Now we need to get rid of those hormones and get you back to normal. Breastfeeding is naturally low in estrogen. We create prolactin and oxytocin, which is a completely different physiologic state than a woman experiences at any other point. So we [00:28:00] should be lower in estrogen, we should be lower in progesterone, postpartum, and if those are higher or imbalanced, it leads to low milk supply. So that’s some of the discussion that needs to happen is if we put you on systemic hormones, we may tank your milk supply. And that’s a common experience in women who go back on oral contraceptives or go back on even an IUD at low levels, huh? That have their milk supply tank and people don’t understand why, but it’s related to the hormones.
Dr. Weitz: So let me get this straight. I, because I thought you were saying initially that the postpartum period is a period of higher estrogen and progesterone.
Dr. Davis: So we get ultra high levels of estrogen and progesterone during pregnancy.
Dr. Weitz: Right.
Dr. Davis: That drops about 90% back down towards normal in the first 48 hours postpartum.
Dr. Weitz: Oh really? Wow. Okay.
Dr. Davis: When the placenta’s [00:29:00] gone, those hormone levels drop really quickly. What stays around is intracellular levels of estrogen and progesterone. And what also stays around is the imbalance in the ratios. If we compare pre-pregnancy to postpartum.
Dr. Weitz: Okay.
Dr. Davis: So we’re still higher relatively than we were pre-pregnancy, but there’s a 90% drop that happens as soon as the baby’s delivered, and soon as the placenta is fully out.
Dr. Weitz: Okay.
Dr. Davis: Right. One of the big reasons why women don’t make milk supply is because of retained pieces of the placenta. So we need to make sure placenta’s completely gone. If a woman’s having issues with low milk supply,
Dr. Weitz: huh? Well, how do you work that up?
Dr. Davis: Usually an ultrasound.
Dr. Weitz: Okay. So if a woman doesn’t have good breast milk supply
Dr. Davis: mm-hmm.
Dr. Weitz: It could be part of the during pregnancy leftover. Yep. Interesting.
Dr. Davis: The first thing we look for [00:30:00] in breastfeeding medicine.
Dr. Weitz: Huh. And then they get a surgical procedure to get that removed.
Dr. Davis: Mm-hmm.
Dr. Weitz: Okay. Are there other reasons why women might not have a good breast milk supply?
Dr. Davis: Yep. So we look at, if the first question is did the breast grow during pregnancy, we should see a one to two cup increase in size,
Dr. Weitz: okay.
Dr. Davis: In someone’s breast volume, meaning that they are turning on the genic cells and that they are making the tissue needed. Huh. If that happens, a women should be able to breastfeed.
Dr. Weitz: And how often does that happen?
Dr. Davis: So that’s about a two to 3% risk where women have what’s called tubular or tubular breasts.
Okay. And have an anatomic difference where they did not actually turn on the first part of Lac agenesis and the anatomic tissue to make milk didn’t happen for them.
Dr. Weitz: Interesting.
Dr. Davis: So other than that, women [00:31:00] should be able to produce some amount of breast milk.
Dr. Weitz: Okay.
Dr. Davis: If we’re looking at why women are having a low supply, they’ve had some milk come in.
The first thing we’re looking at is insulin resistance.
Dr. Weitz: Okay?
Dr. Davis: The second is thyroid imbalances and hypothyroidism. And then the third is looking at hormone imbalances. So looking at estrogen, progesterone still leftover from the placenta. We make sure all of that is okay. Then we’re down to nutrients as the main cause of low milk.
Dr. Weitz: Okay. So how would you work this up?
Dr. Davis: So usually I look and make sure that their prolactin is peaking. Okay. So we should have a doubling in prolactin 30 minutes after a feed,
Dr. Weitz: okay?
Dr. Davis: If that is happening, there is no reason that a woman shouldn’t be able to get in a full milk supply. We make sure then that they’re feeding enough.
Dr. Weitz: So how do you check [00:32:00] prolactin? 30 minutes after a feed. That’s not that easy.
Dr. Davis: So you have them take baby with them to the appointment? They check in, they feed the baby. I see. They tell ’em this is a time test. Okay. And then they draw that 30 minutes after.
Dr. Weitz: Okay. So
Dr. Davis: that’s step one. And if that’s happening, then they should be able to make milk.
They’re getting the hormone signal that needs to happen. So then we look at is it an issue with baby? Are they tongue tied? Can they not pull the milk from the breasts or are they not stimulating it enough?
Dr. Weitz: Huh?
Dr. Davis: Or is it not happening enough to begin with? Right. Is mom trying to schedule feeds? Is she trying to not put baby on the breast when they’re signaling because it hasn’t been three hours since the last feed?
That’s pretty common to hear.
Dr. Weitz: Ah,
Dr. Davis: you know, oh, they only need to feed every two to three hours. Well, in those first four weeks, they might feed every 30 minutes, and that’s normal newborn behavior.
Dr. Weitz: I see.
Dr. Davis: They’re bringing that milk in like they should, huh? So if that is taking care of, and mom is doing all of those things, [00:33:00] what we’ve shown is that no amount of increase in milk removal, so no amount of pumping that increases nothing that goes above and beyond what she’s making right then and there is going to happen.
Well, until we get all of the other issues. Straightened out. So they had women who were having low milk supply go from pumping every two hours during the day and every three overnight to pumping every hour while they were awake, getting 18 to 24 different times during the day when they were pumping.
They only increased the amount of output by one and a half ounces.
Dr. Weitz: Wow.
Dr. Davis: So there’s something that happens where at some point milk removal is not the only thing going on where mom is not making more milk. Okay. So, to me that’s saying we either have an issue with the hormone imbalance that’s not allowing milk supply to happen.
We’re having insulin resistance because we know women with PCOS [00:34:00] have low milk supply at a 30 to 40% increased risk.
Dr. Weitz: Okay.
Dr. Davis: Or we’re dealing with functional low thyroid, which is easily. Fixed when we actually check and when we actually interpret the numbers. Right.
Dr. Weitz: Okay. So how do you work ’em up for insulin resistance?
You do a fasting glucose, insulin, hemoglobin, and A1C.
Dr. Davis: Yep.
Dr. Weitz: And then what numbers do you like to see?
Dr. Davis: So for women who are having low milk supply, my goal is between 4.8 and five on their A1C.
Dr. Weitz: Oh, wow. That’s low.
Dr. Davis: It’s right. We wanna get it down because we don’t want, in the natural insulin resistance that happens during pregnancy, we wanna wash that out as fast as we can to bring in the milk supply.
So we’re pulling a lot of refined sugars, or at least I do, I pull a lot of refined sugars outta the diet. I get [00:35:00] them eating. Consistently so they’re not having glucose spikes throughout the day to try to lower as
Dr. Weitz: fast. So what do you consider eating consistently mean? What does that mean? Three meals, more than five meals,
Dr. Davis: usually I do about five for breastfeeding women to get all of the nutrients in that they need.
Okay. And then we’re removing fi refined sugars and getting their micronutrients built back up. And we’re getting in the system things to, to help with the insulin resistance.
Dr. Weitz: What about other carbs?
Dr. Davis: Slow burn carbs are fine. Sometimes I’ll even slap a CGM on them, a continuous glucose monitor so that we can see what foods are affecting the most and pull out the things that are spiking their glucose.
Dr. Weitz: Okay. And do you use any supplements in that regard?
Dr. Davis: Mm-hmm. So one of the best studied ones is GOAT through. That’s safe when breastfeeding,
Dr. Weitz: what is it called?
Dr. Davis: Goat through.
Dr. Weitz: Huh? Never heard of that one. Go
Dr. Davis: through. So sometimes we’ll prescribe [00:36:00] metformin but go through is another herbal that is safe for breastfeeding women who especially don’t wanna take prescribed medications.
That’s the one I’ll go to for insulin resistance.
Dr. Weitz: Is berberine acceptable for breastfeeding women? Berberine
Dr. Davis: is not, especially in the first four weeks. Okay. Because some of the compounds in berberine pass highly through breast milk can actually be concentrated. Okay. So berberine isn’t considered safe until baby’s liver has developed more and that’s after six months of age.
Dr. Weitz: What about cinnamon?
Dr. Davis: Cinnamon is fine.
Dr. Weitz: Okay.
I guess chromium is another one.
Dr. Davis: Chromium is another one. Yeah. We can go with chromium. I usually am doing diet, go through and getting them shifted as fast as I can out of that insulin resistance to build milk supply. ’cause we. Only have a certain amount of time.
Dr. Weitz: Right.
Dr. Davis: And I don’t wanna, just in their mind, right, it’s hard enough already [00:37:00] to make the dietary changes.
I wanna make their life as simple as possible. And we know insulin resistance is highly linked to refined sugar intake. So we’re, I’m already asking them to pull out sugars, which they’ve probably been reliant on most of the time through pregnancy.
Dr. Weitz: Right.
Dr. Davis: But most are willing to do it because they want to be able to provide milk, they wanna bring in that full milk supply.
Dr. Weitz: Right.
Dr. Davis: And that’s one of the things I’ve even recorded a course for women to be able to do this on their own and help pick out the supplements that may work for them. But time is milk when it comes to breastfeeding.
Dr. Weitz: So do you have a favorite product with, for go through?
Dr. Davis: Yeah, so usually I just get an organic go through capsule.
There’s a few from like Organic India that. That are easy to do. Okay. And then the only supplement we’ve studied that increases milk supply is moringa. Okay. So I’ll have them incorporate moringa powder into all the smoothies, into, you know, it’s a traditional food in [00:38:00] Indonesia. Sometimes soups or other things that are made out of it.
We just get moringa into the diet because that’s the only one that’s been shown to actually make a difference.
Dr. Weitz: Interesting. So, you were talking about nutrients that you often recommend for postpartum women. Yeah. Can you go over those and I noticed from one of your other discussions that you often will recommend calcium supplements among others.
So let’s talk about what supplements you think are beneficial, and then maybe after that we can talk about what herbs or other supplements or contraindicated.
Dr. Davis: Okay. So some of the different supplements that I use depend on what’s going on for a woman.
Dr. Weitz: Sure.
Dr. Davis: But if we’re looking at nutrients across the board, the big four that we know we need to get in are potassium, vitamin E, calcium, magnesium. So what I will have moms do is I will have them [00:39:00] take a good multivitamin with a good mineral base to replenish some of that. Okay. We know that calcium is pulled from the bones because of the hormone that we make. So we make something called P-T-H-R-P, parathyroid Hormone Related Hormone, while we are breastfeeding at higher levels, that pulls calcium from the bones, and we lose somewhere between three and 5% of the bone mass when we are breastfeeding simply because that hormone is present. We slow down that reabsorption. If we keep the calcium levels in the blood high, and we can actually, for women who are at risk for osteoporosis, help prevent some of that bone loss. It does reverse when women are done breastfeeding, if we give calcium and keep calcium at the higher end of the normal range.
Dr. Weitz: Okay,
Dr. Davis: the other thing that women lose is magnesium, and we know that it’s involved in over 300 [00:40:00] different enzyme processes in the body. One of them is actually turning on the cells that produce milk, so calcium across the board. I recommend supplementing for postpartum women. The other thing that I always give is vitamin D.
There was a great study that showed if a woman takes 6,400 international units of D while she is breastfeeding, there’s no reason to give it to the baby. So sometimes it’s easier for moms to just stick it in their supplement stack if they’re taking prenatals and make sure they’re getting that 6,400 units.
That way they don’t have to remember one more thing to give the baby.
Dr. Weitz: Okay, cool. And and then vitamin K goes with vitamin D and vitamin D, calcium vitamin,
Dr. Davis: so K two and D and we just put that in combo and make sure that they’re on that.
Dr. Weitz: Okay. And then you said vitamin E. Do you like alpha Tocopherol, mixed Tocopherols, tocotrienols.
Dr. Davis: I usually use mixed tocopherols. Okay. Only because we’re [00:41:00] both addressing gut health with it. Right. We’re giving an antioxidant, we’re giving a few different things. And across the board for breastfeeding, we don’t know exactly what is the best. So I look at what would naturally be found in diets, and if we give that at slightly higher levels, that’s usually safe for breastfeeding women.
Dr. Weitz: Okay. And what other herbs are safe for pregnant women? And then what herbs are not safe?
Dr. Davis: Yep. So we have a whole bunch that we can use for breastfeeding moms. We can use moringa, the one that, we’ve, we see in a lot of postpartum supplements is venue Greek. Okay. But venue Greek can actually, in some women at a high enough level, at low levels, it’s safe.
At a high enough level, it actually decreases breast milk. Okay. So there’s a large area where women take it to try to help with milk and it doesn’t work as well.
Dr. Weitz: Okay.
Dr. Davis: We know that go through is safe. [00:42:00] We can use berberine at low doses. We can also use ashwagandha at
Dr. Weitz: lows.
What’s a low dose of berberine?
Dr. Davis: So two 50, twice a day would be the highest. I would go on Berberine. After three to six months, we do see passage into breast milk, but at that point, baby’s liver is developed enough that baby can u that baby can detoxify berberine as well.
Dr. Weitz: Okay. So after three months?
Dr. Davis: Yep.
Dr. Weitz: And then what else?
Dr. Davis: There’s a whole bunch of them.
Dr. Weitz: Okay. So
Dr. Davis: I made a whole course on what is safe and what is not safe for herbals when it comes to breastfeeding moms. And that’s actually a free course that’s on the website.
Dr. Weitz: Okay. Now when it comes to, go ahead.
Dr. Davis: Yeah. There’s also a website called ELAC tenia that is a sp Spanish website, but it’s translated into English really well.
And there’s a pediatrician that looks at all of the latest [00:43:00] studies and gives recommendations whether it’s safe or not. That’s my go-to because that has the most up-to-date information to see if there have been new studies that come out that show risk or benefit because they’re coming out all the time.
Dr. Weitz: Okay. And when it comes to hormones you, you said that sometimes you will use hormones for postpartum women.
Dr. Davis: I’m basing it on their testing.
Dr. Weitz: Right.
Dr. Davis: And what’s going on with their hormone balance. Okay. So if they are imbalanced,
Dr. Weitz: so what are some of the imbalance patterns you see and how do you correct those?
Dr. Davis: Yeah, so we’re looking at, right, we usually look at cortisol to DHEA, make sure that they are not in cortisol, steel, and that they’re getting plenty of hormones into the steroidogenic pathway for testosterone and estrogen.
Dr. Weitz: Okay.
Dr. Davis: That I look at E two.
Dr. Weitz: So what if the cortisol to DHEA ratio is off? How will you correct that?
Dr. Davis: I will [00:44:00] sometimes supplement DHEA while I am doing work with them on their nervous system and getting the physiologic signals that are keeping the cortisol elevated back down. Okay.
Dr. Weitz: 10 milligrams or what kind of dosage?
Dr. Davis: Yep. Usually I start, well, I start with about 10 milligrams. Okay. And I test it a week or two later and I see where they’re at because I wanna make sure that we’re keeping them in the normal ranges.
That’s my goal is to get to that optimal range so that they’re feeling their best.
Dr. Weitz: And what do you consider the optimal or normal range for D-H-E-A-S?
Dr. Davis: So D-H-E-A-S for breastfeeding women, I will keep a little bit higher.
Dr. Weitz: So like three,
Dr. Davis: 400 most things, like I have my own cheat sheet of where I like things.
Right. Normally I’m staying somewhere between 300 to three 50. I don’t wanna top them out.
Dr. Weitz: Right.
Dr. Davis: But I also want to make sure that we have some room to play with if we need to go up on dosing.
Dr. Weitz: Okay. Okay. [00:45:00] And then what are some of the other hormone imbalances?
Dr. Davis: So I look at their estrogen to progesterone ratios and I wanna make sure that they are getting back in the normal range, especially after full milk supply is in.
Dr. Weitz: Okay.
Dr. Davis: And we can be a little bit more liberal with getting women feeling better about after that four week postpartum mark so that they can both feel their best and start feeling like, you know, not zombie mom anymore. Right.
Dr. Weitz: So what is the proper ratio of estrogen and progesterone and what do you often see in, how do you correct that?
Dr. Davis: Yeah, so E two to P four, I look somewhere between 30 to 40 to one. And then if we are really off, I will either give pregnenolone or I will prescribe bioidentical progesterone.
Dr. Weitz: Okay.
Dr. Davis: Usually postpartum, it’s high estrogen to low progesterone. [00:46:00] Because of the way that the hormones are circulated. So most of the time I’m giving progesterone and not estrogen because estrogen itself will decrease milk supply.
Dr. Weitz: Interesting. And you’re given that as oral or topical?
Dr. Davis: It mom’s preference. I like to give it topical. I’ll usually give in patches if I can so that women are a little bit more mental load, hands off. Whatever I can do to kind of take some of that mental load away from them postpartum I try to do.
Dr. Weitz: And is there any worry of that passing into the breast milk and getting into baby?
Dr. Davis: We know it passes into breast milk. If it’s bioidentical and normal, it would be passing into milk if mom were making her own.
Dr. Weitz: Right. Okay.
Dr. Davis: I keep it right. I aim for physiological normals,
Dr. Weitz: right.
Dr. Davis: And that’s where I try to keep mom.
I’m not going, you know, super high, super therapeutic. We’re not doing, you know, testosterone or replacement for their sex [00:47:00] drive as in menopause. But I’m looking to keep them in normal physiologic ranges, especially if we’re dealing with other side effects of hormone imbalance, like postpartum anxiety and depression.
Dr. Weitz: Is testosterone something you look at as well?
Dr. Davis: Testosterone, I look at, I usually don’t replace in postpartum women until babies are older because most of the time we are, we’re replacing testosterone in cream form because it’s such a small dose and if that transfers to baby, we can see early puberty and hair development.
So I. Across the board, just like we would tell dads, like, absolutely you can’t do skin to skin contact wherever you put that testosterone. If we think about baby nursing on mom’s lap, rubbing up against her belly or breast while she’s feeding, those are all areas to me that, Hey I feel you. Let’s replace the estrogen portion and we’ll wait on the testosterone until baby’s a little bit older and that you’re not nursing as often.
Dr. Weitz: So you mentioned gut health. What are some of the gut [00:48:00] issues you’ll see with postpartum women?
Dr. Davis: Most of the time it’s leaky gut. It’s disrupted disruption of the barrier. Okay. And both absorbing nutrients becomes an issue. And then how she’s feeling gut health wise. You know, we see sometimes diarrhea, constipation, especially postpartum with the low hormones, and we’re working towards getting that normalized to get all the detox pathways normalized.
Dr. Weitz: So how do you work on doing that?
Dr. Davis: So first I’m an osteopath. I like a lot of manual techniques, so I’ll teach moms to do their own abdominal massage. Okay. I’ll do castor oil packs to help move some of the stuff through the gut.
Dr. Weitz: Okay.
Dr. Davis: And then we’ll start working on keeping hydrated, getting enough fiber and the basics of gut health from the beginning, if that’s still not working.
We’re looking at probiotics, we’re looking at supplements to help with leaky gut syndrome. Okay. If we’re not making any progress. [00:49:00]
Dr. Weitz: What are your favorite supplements for leaky gut? We’re talking about things like glutamine. Yeah. And
Dr. Davis: glutamine. Marshmallow root extract is fine with breastfeeding.
Slippery elm bark is fine with breastfeeding. Most of the muto ENSs are Okay. We
Dr. Weitz: can’t, do you do a combination product or do you use individual products?
Dr. Davis: I will use individual products. Most of the time, if we’re looking at, if we need to do something for the microbiome, like if we’re looking at a combo product like Sedin, wormwood is an absolute no-go PO in breastfeeding women.
Dr. Weitz: Okay?
Dr. Davis: There’s usually one component that makes a combo product not as good for breastfeeding women. And if someone wants to work on getting a one that is safe, then I would be all about that. But most of the time I’m reaching for individual components. So I’m reaching for caprylic acid because I know that’s safe.
I’m reaching for oil of oregano because that’s safe. But a lot of the combos, [00:50:00] you know, wormwood is not safe. There are a few other herbals that are absolute no GOs that are in the combo products for gut health that, you know, it isn’t worth the risk to me, even for a short period of time.
Dr. Weitz: And probiotic wise, what are the best probiotics?
Dr. Davis: So for the gut, if we’re dealing with diarrhea, I really like some of the spore forming probiotics. I reach for Microbiome Labs a lot for their okay. Like a spore biotic.
Dr. Weitz: Okay.
Dr. Davis: We also need a lot of lactobacillus root eye for breastfeeding women. So I’ll reach for, you know, ortho Biotics Women’s Health that has a combination product for lactobacillus Root Eye.
Dr. Weitz: Interesting. A lot of people talk about bifido products for babies especially.
Dr. Davis: Yep. And you know, whether you’re giving to mom or baby, you’re gonna get some of that passage on if a woman is breastfeeding, a big part of the breast microbiome is bifidobacter already. Okay. So it’s not as important to me [00:51:00] to give that to baby or to mom if she’s has a healthy, robust milk supply.
Dr. Weitz: And
Dr. Davis: what, go
Dr. Weitz: ahead.
Dr. Davis: What we do see is women with oversupply. Have high levels of lipopolysaccharide, so either LPS in the breast microbiome or the gut microbiome. So often I will reach for binders if she’s producing, you know, 40, 50, 60 ounces of milk a day to try to decrease the LPS levels.
Dr. Weitz: Can you use SBI protect, or what kind of binders are you using?
Yeah,
Dr. Davis: SBI protect is fine. Sometimes I’ll reach for just doing like chlorella or spirulina. Okay. Because I can have moms put that in a smoothie that she’s having for one of her snacks throughout the day. Okay. And it’s an easy way to get it in and not have to be something else to remember to take separate from food.
Dr. Weitz: That’s cool. And then lactobacillus rooti, what’s the importance of that particular probiotic?
Dr. Davis: It helps produce oxytocin.
Dr. Weitz: Okay.
Dr. Davis: So we know that [00:52:00] oxytocin is the bonding hormone for mom and baby. If mom is feeling depressed, there’s been a connection with low levels of lactobacillus rooti. Huh? So either we can have women have a yogurt that has l rooti in it, or we can reach for other supplements.
And there a lot of the women’s probiotics have it. It increases oxytocin levels. We know that helps bonding and that helps let down for breast milk so we can increase supply just by having more oxytocin present.
Dr. Weitz: Interesting. And when it comes to I’m, I know I’m jumping around a little bit. That’s okay.
The pre the multivitamin, are you using a prenatal or is it something different? And I think there’s one company that has a postnatal, there’s probably more than one, but
Dr. Davis: there’s a lot now that have postnatal vitamins. I know ritual’s a big one that people like right now what I wanna see in a postnatal vitamin is that we’re giving methylated B vitamins, that we have some form of choline and [00:53:00] alpha lipoic acid to help boost the glutathione levels back up.
Dr. Weitz: Okay.
Dr. Davis: And I actually like to give NAC so I will reach for a combo product plus a good omega fatty acid. We need a lot of omegas for breastfeeding women. And I just go for a two gram dose of Omega because we know it’s low across the board.
Dr. Weitz: Yeah. Yeah. You can’t go wrong with omega threes as far as I’m concerned.
Dr. Davis: Yeah.
Dr. Weitz: Great. So I think we’re pretty close to a wrap. Final thoughts or other topics we didn’t mention that you wanna cover quickly?
Dr. Davis: No, I mean, the only thing that comes to mind for me that we didn’t quite cover is that for women who are breastfeeding, in order for us to release prolactin,
Dr. Weitz: okay.
Dr. Davis: The prolactin neuron sits next to a dopamine neuron. We have to stop dopamine release [00:54:00] in order for prolactin release to happen.
Dr. Weitz: Stop dopamine release.
Dr. Davis: So dopamine is being released next to each other, right? The neurons sit side by side. Dopamine is released and that stops prolactin from being released from that neuron.
Dr. Weitz: So you
Dr. Davis: gotta stop having fun. Once dopamine levels drop,
Dr. Weitz: you gotta stop having enjoyment. Right?
Dr. Davis: We release more prolactin.
And I Interesting think one of the things that happens for women is that all of a sudden they’ll feel like they’re not enjoying their day, that they’re not having pleasure, or that they’re getting weird body sensations when they’re breastfeeding their babies.
Dr. Weitz: Huh.
Dr. Davis: I like to tell my moms that is all related to the low dopamine levels.
Dr. Weitz: Huh?
Dr. Davis: And the way we counterbalance that is to increase the oxytocin, to increase the feels and to have moms do pleasurable things for themselves between rounds. [00:55:00] So one of the best ways to actually increase prolactin levels is orgasm. Okay. And that is a weird one that comes up that is a recommendation across the board is one of the best ways to increase milk supply is through pleasure and touch.
Dr. Weitz: Interesting. I know that’s connected with o oxytocin, but I thought dopamine was also the pleasure hormone.
Dr. Davis: It is. So it’s a specific part of the brain called the in fibular pathway. And in order for prolactin levels to be released and high, that shuts off and that’s the signal that feeds back to the brain.
So especially women who are, you know, A DHD or neurodivergent that end up breastfeeding have this increased sensation, what we call demer in the field, dysphoric milk ejection reflex. Ugh. It’s where they get feelings, bad feelings, either internally [00:56:00] or skin crawling, itching, sensations that go along with this low dopamine levels.
Dr. Weitz: Huh.
Dr. Davis: And I feel like if we educated enough women to say that, Hey, this is a normal response to what your brain is doing. There is nothing wrong with you, and there are easy ways to help yourself recover from that, that there would be a much better breastfeeding success rate in our country.
Dr. Weitz: Interesting.
Dr. Davis: I think it’s, I think it’s big enough that enough women experience it.
Dr. Weitz: Huh? So women in the postpartum period need to have more orgasm to stimulate oxytocin, to balance dopamine,
Dr. Davis: to balance out the dopamine.
Dr. Weitz: Interesting
Dr. Davis: sounds. So we say in medicine to wait for that six week period, right. To have penetrative type sex.
Dr. Weitz: Right.
Dr. Davis: That doesn’t mean you shouldn’t be doing ful things before that.
Dr. Weitz: Right.
Dr. Davis: Right. And that’s connection for you and your partner, because [00:57:00] that is still important relationship wise
Dr. Weitz: Sure.
Dr. Davis: And long term for you guys, but also just as important to your milk supply.
Dr. Weitz: Fascinating. All right. So that’s the that’s the clinical pearl for the day. Yes. So how can how can patients and or practitioners get in touch with you? Patients can find out about what you have to offer and then practitioners can find out about your courses and your books, et cetera.
Dr. Davis: Yeah, so it’s all on the website, so you can go to either Lauren Davis.com, and that will link to both websites. Okay. Or the postpartum specific is latchednourishedthriving.com.
Dr. Weitz: Okay. Latch. Latch.
Dr. Davis: Nourished.
Dr. Weitz: Nourished, thriving. Thriving. Great. Awesome. Thank you so much, Dr. Davis.
Dr. Davis: Thank you.
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Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcast or Spotify and give us a five star ratings and review. As you may know, I continue to accept a limited number of new patients per month for functional medicine. If you would like help overcoming a gut or other chronic health condition and want to prevent chronic problems and want to promote longevity, please call my Santa Monica Weitz Sports chiropractic and nutrition office at 310-395-3111 and we can set you up for a consultation for functional medicine. And I will talk to everybody next week.
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