the pregnancy to postnatal endocrine system · the pregnancy to postnatal endocrine system ......

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The Pregnancy to Postnatal Endocrine System


Topics to be Covered

• Prenatal to Postnatal Hormones

• Key hormones and their impacts on postnatal health

• Nutrition and Lifestyle to Naturally Balance Postpartum Hormone Health

• Maternal-infant bonding and Lactation

• Energy

• Sex drive

• Sleep



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Postnatal Estrogen

• Estrogen: Within 3 hours, estrogen levels drop to 10% of the prenatal value, and reaches its lowest level by day 7 postpartum.

• Very low!

• The equivalent to levels found in postmenopausal women.

• Role in labor and delivery - controls cervical ripening, and increases the receptors for oxytocin for delivery.

http://www.encognitive.com/files/The%20Physical%20and%20Emotional%20Effects%20of%20Postpartum%20Hormone%20Levels.pdf


Postnatal Progesterone

• Progesterone: Also drops dramatically after birth (it’s undetectable by 72 hours after delivery.)

• During pregnancy: quiets the uterus to prevent premature delivery, and inhibits breast milk production.

• Normal (non-pregnant levels) are established during the first postpartum menstrual cycle.

• For many of your clients who breastfeed (WHO recommendation is 2 years of breastfeeding), the re-establishment of normal progesterone levels could take years.



Oxytocin

• Oxytocin: Key for uterine healing, and mother-baby bonding.

• Oxytocin is the hormone responsible for uterine contraction for recovery and prevention of postpartum hemorrhage. If administered artificially in cases of placenta separation, just after the delivery of the baby’s shoulder, it can decrease postpartum hemorrhage (reducing the risk of postnatal death of the mother.)

J Perinat Med. 2014 May 15. pii: /j/jpme.ahead-of-print/jpm-2014-0111/jpm-2014-0111.xml. doi: 10.1515/jpm-2014-0111. [Epub ahead of print] The effect of the use of oxytocin on blood loss during different postpartum periods. Fidan U, Keskin U, Ulubay M, Efendi Karaca R, Burçin Fıratlıgil F, Göksen Kocagöz G, Ergün A.



Maternal-Infant Attachment – What is the biological basis?• Oxytocin is popularly known as the bonding hormone. However,

while it is highest just after delivery, and it is stimulated by newborn sucking and newborn touching the breast, there are many other biological, psychological, and social factors involved in mother-infant bonding.

• Much more to learn in this area.

• Other possible factors… high cortisol may be correlated with mothers being less caring and more aggressive to their infants. But, other studies show that moms with high cortisol are more alert and responsive to their babies’ sounds and smells.

Georgian Med News. 2010 Dec;(189):21-6. Neuroendocrine foundation of maternal-child attachment. Nemsadze K1, Silagava M.

http://www.ncbi.nlm.nih.gov/pubmed/21252405%23

http://www.ncbi.nlm.nih.gov/pubmed?term=Nemsadze%20K%5BAuthor%5D&cauthor=true&cauthor_uid=21252405

http://www.ncbi.nlm.nih.gov/pubmed?term=Silagava%20M%5BAuthor%5D&cauthor=true&cauthor_uid=21252405


Prolactin

• Prolactin: Key hormone for breast milk production.

• Synthesized in and secreted by the anterior pituitary to promote lactation.

• We now know that it has over 300 functions in the human body, and that it’s also produced in the central nervous system, the immune system, the uterus and its associated tissues of conception, and even the mammary gland itself.

• Prolactin can be stimulated by light, sound, scent, and stress in addition to the nursing stimulus.

Physiol Rev. 2000 Oct;80(4):1523-631. Prolactin: structure, function, and regulation of secretion. Freeman ME1, Kanyicska B, Lerant A, Nagy G.


Beginning and Maintaining Milk Production

• The breasts make colostrum in the later part of pregnancy, but high levels of progesterone secreted by the placenta inhibit milk production.

• After placenta delivery, progesterone levels rapidly drop, and prolactin is secreted at high levels, this stimulates milk (colostrum) production with 30-40 hours after birth.

• Women usually feel their milk coming in 50-73 hours after birth.

http://kellymom.com/pregnancy/bf-prep/milkproduction/


Beginning and Maintaining Milk Production

• Once nursing is hormonally established, it is maintained by the fullness (or emptiness) of the breast.

• A protein in milk called Feedback Inhibitor of Lactation (FIL), slows milk production when the breast is full.

• Plus, when the alveolus is full of milk, the walls expand/stretch and alter the shape of prolactin receptors so that prolactin cannot enter via those receptor sites – decreasing the rate of milk synthesis.

http://kellymom.com/pregnancy/bf-prep/milkproduction/


Exercise and Postpartum Hormones

• In a recent study done on 37 lactating women (including a control group), exercise was not found to impact lactation associated hormones.

• The women participated in 50-60 min aerobic, strengthening and stretching exercise, 3 days a week, for 12 weeks

• Prolactin, estradiol, cortisol, TSH, fT3 and fT4 levels were measured as were lipids. – no effect on hormones or lipids

• The women gained endurance (measured by Vo2max), endurance of the upper body and abdominal muscles, they lost body fat, and improved their overall flexibility.

Arch Gynecol Obstet. 2014 Aug 20. [Epub ahead of print] The effect of physical exercise on postpartum fitness, hormone and lipid levels: a randomized controlled trial in primiparous, lactating women. Zourladani A1, Zafrakas M, Chatzigiannis B, Papasozomenou P, Vavilis D, Matziari C.


Nutrition and Lifestyle Support Strategies for Healthy Levels of Postpartum Hormones• Supporting…

• Healthy Lactation

• Healthy Maternal-Infant Bonding

• Healthy Maternal Healing

• Healthy Energy

• Healthy Sex Drive


The Historical Biological Role of Postpartum Women• Bonding with her new infant.

• Caring for her new infant – in the context of tribal or group support.

• Feeding her new infant (lactation and energy to gather and prepare food eventually.)

• Healing her body in preparation for a subsequent pregnancy and/ or to participate in caring for her community.

• After a year or more of infant care (optimum is 3 years between children according to The Weston A Price organization, but not historically common), then a mother would be more concerned with her sex drive.


Modern Expectation of Postpartum Women

• Perfection in parenting.

• Perfection in infant feeding.

• Return to “sexy”, flat belly, fit body within 6-12 weeks.

• Return to energetic sex life within 6-12 weeks.

• Return to full time, productive corporate work within 6-12 weeks.

• Or, if a SAHM – return to full time volunteer and “pinterest” motherhood within 6-12 weeks.

• Plus, she should have the ability to do so with little to no support.


Nourishment to Support Healthy Postpartum Recovery• Eating enough macronutrients to support energy, milk production,

and healthy levels of sex hormones.

• Eating a micronutrient dense diet to support all of the biochemical reactions in the postpartum woman’s body.

• Sleep

• Support

• Work-Life considerations


Eating for Energy and Pain free Sex for Postpartum Women• Supporting the adrenals and thyroid are essential to healthy levels

of sex hormones.



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Nourish the Adrenals – Start with Breakfast to set the stage for all-day, stable blood sugar• To maintain normal cortisol levels postpartum, it’s important to

minimize physical stress as well as emotional stress.

• Check for food sensitivities to minimize gut inflammation (more in gut-brain module.)

• Stay off of The Stress Sugar Roller Coaster.


Formula for Stable Blood Sugar Maintenance

• Clean protein + healthy fat + fiber

• At every meal and snack


Nourishment to Support Healthy Postpartum Recovery• Eating enough macronutrients to support energy, milk production,

and healthy levels of sex hormones.

• Eating a micronutrient dense diet to support all of the biochemical reactions in the postpartum woman’s body.

• Sleep

• Support

• Work-Life considerations


Recipes

• See your handout for recipe ideas…

• Chocolate Cherry, Almond Berry, and Super Green Smoothies


Protein, Fat and Fiber

• Green smoothie = big shot of fiber

• Protein options: Applegate Farms frozen sausage, eggs, leftover burger, smoked salmon, leftover chicken soup, bacon, and more...

• Fat: Avocado, olive oil, coconut oil, nuts, nut butters, and seeds


Optimal Micronutrients to Feed Healthy Postpartum Thyroid Health• Postpartum women are more vulnerable to autoimmune

disease in general, and postpartum thyroiditis specifically. • If your client is experiencing symptoms of either high or low

thyroid (the classic presentation – for about 1/3 of the cases – is high and then, low thyroid symptoms), consider referring for more in-depth thyroid testing.


Common Thyroid Symptoms

• Symptoms of the hyperthyroid stage: • Sudden weight loss • Rapid heartbeat and palpitations • Nervousness, anxiety and irritability • Sweating • More frequent bowel movements • Fatigue • Muscle weakness • Difficulty sleeping


Symptoms of the hypothyroid stage:

• Fatigue • Unexplained weight gain • Constipation • Pale, dry skin • Elevated blood cholesterol level • Puffy face • Increased sensitivity to cold • Muscle aches and weakness (I have seen more and more chatter about this on PT discussion boards… looks like a more generalized joint and muscle pain, not isolated to the pelvis.) • Heavier than normal menstrual periods • Brittle fingernails and hair • Depression (although the relationship between postpartum hypothyroidism and postpartum depression is not consistent in the research.)


Optimal Micronutrients to Feed Healthy Postpartum Thyroid Health• If a woman is found to have positive thyroid antibodies prior to

pregnancy, she can reduce her risk of postpartum and permanent hypothyroidism by approx 50% by adding…

• 200mg daily of selenium to her diet. • Sources: supplement, Brazil nuts, oysters, mushrooms, fish,

sunflower seeds, beef, lamb, and chicken

J Clin Endocrinol Metab. 2007 Apr;92(4):1263-8. Epub 2007 Feb 6. The influence of selenium supplementation on postpartum thyroid status in pregnant women with thyroid peroxidase autoantibodies. Negro R1, Greco G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H.

http://www.ncbi.nlm.nih.gov/pubmed/17284630%23

http://www.ncbi.nlm.nih.gov/pubmed?term=Negro%20R%5BAuthor%5D&cauthor=true&cauthor_uid=17284630

http://www.ncbi.nlm.nih.gov/pubmed?term=Greco%20G%5BAuthor%5D&cauthor=true&cauthor_uid=17284630

http://www.ncbi.nlm.nih.gov/pubmed?term=Greco%20G%5BAuthor%5D&cauthor=true&cauthor_uid=17284630

http://www.ncbi.nlm.nih.gov/pubmed?term=Mangieri%20T%5BAuthor%5D&cauthor=true&cauthor_uid=17284630

http://www.ncbi.nlm.nih.gov/pubmed?term=Mangieri%20T%5BAuthor%5D&cauthor=true&cauthor_uid=17284630

http://www.ncbi.nlm.nih.gov/pubmed?term=Pezzarossa%20A%5BAuthor%5D&cauthor=true&cauthor_uid=17284630

http://www.ncbi.nlm.nih.gov/pubmed?term=Pezzarossa%20A%5BAuthor%5D&cauthor=true&cauthor_uid=17284630

http://www.ncbi.nlm.nih.gov/pubmed?term=Dazzi%20D%5BAuthor%5D&cauthor=true&cauthor_uid=17284630

http://www.ncbi.nlm.nih.gov/pubmed?term=Dazzi%20D%5BAuthor%5D&cauthor=true&cauthor_uid=17284630

http://www.ncbi.nlm.nih.gov/pubmed?term=Hassan%20H%5BAuthor%5D&cauthor=true&cauthor_uid=17284630

http://www.ncbi.nlm.nih.gov/pubmed?term=Hassan%20H%5BAuthor%5D&cauthor=true&cauthor_uid=17284630


Optimal Micronutrients to Support The Postpartum Immune System• Fat soluble vitamins (A, D, E, and K) • Optimal mineral levels: zinc, iron, copper, magnesium,

selenium, and iodine especially. • B-vitamins • Vitamin C • Antioxidants


Optimal Micronutrients to Feed Healthy Postpartum Hormone Balance• Healthy postnatal estrogen levels are essential for mental focus and

postpartum sex drive.

• While postnatal low estrogen is normal, if estrogen is very low, sex will be painful due to vulvovaginal dryness.

• Need vitamins, minerals, and phytonutrients to improve hormone balance and recover postpartum.

• Need even more for postnatal energy and milk supply!


Nutrition for Soft tissue, muscle, and joint healing…


Traditional Foods and Collagen

• Foods containing collagen are essential for rebuilding bones, teeth, skin, joint surfaces, and more.

• Post delivery, pelvic floor muscles, ligaments, tendons, skin and joints have been strained.

• Eating foods high in collagen can help to support their healing.


Good Sources of Collagen for Busy New Moms…

• Bone Broth

• Sneak chopped organ meats (like liver) into meatloaf, tacos, meat sauce

• Bulletproof Collagen protein powder: https://www.bulletproofexec.com/bulletproof-upgraded-collagen/

https://www.bulletproofexec.com/bulletproof-upgraded-collagen/


Amino Acids that Build Collagen

• Lysine

• Proline

• Best food sources... Meat, chicken, fish, and egg whites (for vegetarians: wheat germ and peanuts)

http://www.livestrong.com/article/342620-natural-sources-of-collagen/


Cofactors for Collagen Building and Repair

• Vitamin C - and lots of it!

• For each amino acid conversion in the creation of collagen, a vitamin C molecule is destroyed.

• Foods high in Vitamin C... citrus fruits, strawberries, rose hips, and dark leafy greens.

http://www.vitamincfoundation.org/collagen.html


More Cofactors for Collagen Building and Repair

• Hyaluronic acid - it’s needed to bind collagen to elastic fibers to create bundles. And, it’s likely that there’s a mechanism at play of molecular sliding between the collagen molecules to improve viscosity.

• Best food sources... seaweeds (especially kelp), sweet potato, avocado, mango, and bone soups (use homemade chicken bone broth or whole fish)

http://www.livestrong.com/article/342620-natural-sources-of-collagen/

Matrix Biol. 2012 Mar;31(2):141-9. doi: 10.1016/j.matbio.2011.11.005. Epub 2011 Dec 21. Viscoelastic properties of model segments of collagen molecules. Gautieri A1, Vesentini S, Redaelli A, Buehler MJ.


Even more Cofactors for Collagen Building and Repair• Zinc

• Best food sources... pecans, sesame seeds, cashews, dates, linseed, wheat germ, cocoa, oysters, crab, poppy seeds, beef, blue cheese, and eggs

Nutr Res Pract. 2010 Oct;4(5):356-61. doi: 10.4162/nrp.2010.4.5.356. Epub 2010 Oct 26. Zinc may increase bone formation through stimulating cell proliferation, alkaline phosphatase activity and collagen synthesis in osteoblastic MC3T3-E1 cells. Seo HJ1, Cho YE, Kim T, Shin HI, Kwun IS.

http://www.lead.org.au/lanv10n2/lanv10n2-14.html


Don’t Forget to Build Strong Cell Membranes

• Each cellular membrane is made up of essential fatty acids.

• Postpartum women should be sure to have a healthy ratio of omega-6 to omega-3 fats. (as close to 1:1 as possible vs. the Standard Western Diet of 15-16:1.)


Health Omega-3 Food Sources

• Fish (wild salmon and sardines, and other fatty fish), walnuts, flaxseeds, and the omega-3 to omega-6 fat ratio in grass fed beef (and milk, yogurt, and cheese) is much better than in factory farmed beef. The fat ratio is similar in other grass fed animals like bison.

• Omega-3 enriched or pasture raised eggs are also a great source.


Optimal Micronutrients to Feed Healthy Postpartum Hormone Balance• Healthy postnatal estrogen levels are essential for mental focus and

postpartum sex drive.

• While postnatal low estrogen is normal, if estrogen is very low, sex will be painful due to vulvovaginal dryness.


Health Omega-6 Food Sources

• Linoleic Acid (LA) is converted to gamma-linolenic acid (GLA) which is further broken down into arachidonic acid (AA.)

• GLA can reduce inflammation when converted to DGLA. Having enough magnesium, zinc, and vitamins C, B3, and B6 can help to promote this conversion.

• GLA plant based oils: evening primrose oil, borage oil, and black currant seed oil.

• Spirulina

• BUT...

http://umm.edu/health/medical/altmed/supplement/omega6-fatty-acids


Omega-6 Supplement Precautions

• Avoid omega-6 supplements if you have seizures. Several reports describe seizures in people taking evening primrose oil.

• Some of these seizures developed in people with a previous seizure disorder, or in people taking evening primrose oil in combination with anesthetics. (Stop taking EPO at least 2 weeks before surgery.)



Omega-6 Supplement Precautions

• Borage seed oil, and possibly other sources of gamma-linolenic acid (GLA), should not be taken during pregnancy because they may harm the fetus and induce early labor.

• Avoid doses of GLA greater than 3,000 mg per day. At that level, an increase in inflammation may occur.



Where are Omega-6 Fatty Acids Found?

• Mostly in vegetable oils such as sunflower oil, soybean oil, canola oil or sesame oil.

• But, they are also found in significant amounts in pork, poultry, nuts, eggs, and avocados

http://chriskresser.com/how-too-much-omega-6-and-not-enough-omega-3-is-making-us-sick


Postpartum Detoxification to Optimize Energy

• Detoxification programs are not recommended for women who are nursing.

• Primarily eating organic foods

• Gentle exercise

• Breath work (pranayama) and mindfulness meditation - stress is a significant toxin

Rakel, D (ed.) Integrative Medicine 3rd ed. 2012 Elsevier: Pennsylvania.


Postpartum Detoxification to Optimize Energy

• Support for the liver if a woman used pain medication, pitocin or other pharmaceuticals to support her delivery.

• Milk thistle (Silybum marianum) - 420mg per day standardized to 70%-80% silymarin content.

• Milk thistle has also been shown to be an effective herb for increasing milk supply (by 85.94% vs. 32.09% for the placebo)

Rakel, D (ed.) Integrative Medicine 3rd ed. 2012 Elsevier: Pennsylvania.

ACTA BIOMED 2008; 79: 205-210 Clinical efficacy, safety and tolerability of BIO-C® (micronized Silymarin) as a galactagogue Francesco Di Pierro1, Alberto Callegari1, Domenico Carotenuto2, Marco Mollo Tapia3


Strategies to Improve Postpartum Sleep

• Laptop curfew

• Bright (especially blue) light suppresses melatonin secretion.

• Turning off laptops, phones, e-readers, televisions, and all other screens at least 2 hours before bed is optimal.

• Resist the temptation to get on Facebook or watch a movie when nursing at night.

• To maintain nighttime blood sugar consider having a high protein, low sugar snack before bed. (Example: slice of roast turkey + green apple + almond butter + cinnamon.)


Strategies to Improve Baby Sleep

• See interview with Ingrid Prueher (aka The Baby Sleep Whisperer)


Summary

• To optimize postpartum hormone balance, energy, sleep, and sex, it’s important to take care of the postpartum endocrine system.

• Optimizing adrenal and thyroid health are essential to sex hormone health.

• Balancing blood sugar, having a sleep routine (including a laptop curfew), optimizing micronutrient density of the diet, and gently supporting liver function will help new mothers to more easily return to pre-conception levels of energy, and soft tissue and musculoskeletal healing.

the pregnancy to postnatal endocrine system · the pregnancy to postnatal endocrine system ......

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