Overview

Taking a high-quality prenatal vitamin is one of the easiest things you can do to ensure you have all of the vitamins and nutrients you and your baby need during pregnancy. You have an increased need for specific nutrients during pregnancy, and it is challenging to meet these requirements with your diet alone. There are many choices when it comes to selecting a prenatal vitamin. How do you know which ones are high-quality? What should you look for on the ingredient label? What ingredients should you avoid? All of these questions, and more, are answered in this episode.

This episode features Kenn Israel, a formulator and an expert resource on prenatal vitamins. He brings decades of expertise and talks about what to look for in a prenatal vitamin and why it is crucial to get all of the vitamins and minerals you need during pregnancy.

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Transcript and Resources

Vanessa: Kenn, thank you for joining me on the pregnancy podcast today. I wanted to give my listeners a little bit of your background to have some context on your expertise in the vitamin world. Would you mind kind of telling us a bit of how you got into this industry and your role there?

Kenn: I would be delighted, Vanessa, and I appreciate you welcoming me to the show. I’ve been involved in the dietary supplements industry for about 30 years. I started as an herbalist and nutritionist. I initially wanted to be an economist and got into organic agriculture as a senior research thesis project. That introduced me to health food stores and met an herbalist, and my path started there along the way. I’ve worked in contract manufacturing of supplements as a product developer, and I’ve had an active consulting career alongside this for about 20 years. I’ve been doing work specifically for Advanced Nutrition by Zahler for almost a decade. And one of the first big projects that they invited me to work on was their prenatal project. And this was a fabulous opportunity to innovate and change the discussion in the space and do something special.

How a Prenatal Vitamin Differs from a Multivitamin and When to Switch

Vanessa: Thank you for filling us in on how you got involved in all of this stuff. I’ve done some episodes on the podcast on specific ingredients like folate and iron, and I thought it would be helpful to do more of a comprehensive episode just on prenatal vitamins. I want to pick your brain and sort out what people should be looking for or paying attention to. I want to start by talking about why it’s important to take a prenatal vitamin and how that differs from a regular multivitamin.

Kenn: Absolutely, and let me also add to the background. This project became intensely interesting to me in that we did an early version of the product. And then Zahler asked me, you know, let’s try harder. This coincided with my wife becoming pregnant and me taking a really keen interest for very personal reasons in this space. I looked at the landscape of the prenatal vitamins and women’s multivitamins that were available, and I was not delighted. I wasn’t delighted for a couple of reasons. There were either the usual suspect choices from the physicians, which just focused on a few key ingredients in not terribly innovative or bioavailable or bioactive forms. Or there were formulas that had, from my perspective, too much of some things, not enough of others. A woman, ideally, should be starting with a prenatal vitamin months before conception. If you are planning on getting pregnant, that’s the time to start with prenatal nutrition. You want to build up the body’s stores of a number of key nutrients. You also want to make sure that the body is nutritionally replete. Most of us live in a constant state of depletion in nutrition. I’m not talking about frank deficiency, but certainly not optimal levels.

Vanessa: Especially when you’re talking about pregnancy, ideally, you want to be as healthy as possible before you conceive. Then you have a human that is going to be pulling from any stores that you do have of vitamins for all the growing that they’re doing.

Folic Acid vs. Folate

Kenn: You mentioned some of the important nutrients for pregnancy. It used to be thought that folic acid was the correct solution. I’m going to be very specific and say, it’s not folic that you want, it’s folate. Folic acid is a synthetic material that can be can, in fact, be problematic. Not everybody can convert folic acid into its active format. So providing folate, which is in its biologically active form, is really important. This is really important in the earliest stages of pregnancy. When you start forming the neural tube, the brain, the spinal cord, in fact, if there’s a deficiency, there can be terrible problems. That’s why the FDA and the USDA mandated supplementing grain products, flour, cereals with folic acid to reduce the risk of neural tube defects. I think it was a good effort, but it was a little bit misguided, and the industry got involved, and I don’t think the best possible solution was implemented. Folate is real important. Iron is important.

Omega 3s and DHA

Kenn: Of course, fatty acids, and this is really where we stepped out in a very different way and said, you know, fatty acid nutrition’s absolutely critical. And that should be part of a prenatal strategy.

Vanessa: I’m almost surprised how few have it, it’s very rare that a prenatal vitamin includes DHA.

Kenn: Well, it’s tough. It’s challenging. It’s a fatty acid. It increases the cost of manufacturing. It increases the challenges of stability, and quite frankly, it’s expensive stuff. A lot of the products that need really high multiples and high margins don’t want to go there with the premium ingredients. It’s unfortunate, but it’s been rationalized out of a lot of approaches. That said, it’s doing much better. Some of the big guys have followed our lead, and you can actually see some of the big prenatal companies adding an extra DHA product. We decided to put our entire formula in a base of DHA or docosahexaenoic acid, the key fatty acid for eye and brain development in the growing baby.

Vanessa: Do you think that we’re going to see more of that in the future? Do you think other companies will start including DHA within their prenatal vitamin? Or do you think it’s just slow?

Kenn: Two answers. I hope so, and yes. It’s already happening. It’s already on-trend. It’s already now required for infant formula. It’s becoming easier to do, and the products are becoming much better. When I say that, we at Zahler started with fish-derived DHA. When we first started producing the product, we recently migrated to a plant-derived DHA. It’s actually from a wild source algae from the Bay of Fundy up in Nova Scotia. It’s naturally fermented and water extracted. There’s no risk of heavy metals, no PCBs, no microplastics, none of the bad guys that you might hear about with some of the other DHA products. So, yes, the industry is following; they’re using fish oil. We’ve already moved on to plant-derived DHA that’s of higher purity, greater stability. Frankly, the people who are producing it are great people. So we like working with them.

Why Take a High-Quality Prenatal Vitamin

Vanessa: I think it’s so critical to be taking a really high-quality prenatal vitamin. I think that there’s a huge spectrum of what’s out there. It’s definitely a worthwhile investment.

Kenn: Totally, you know, everybody should be taking nutrition. Every, everybody should be looking at their diet and saying, you know, how do I fill in the blanks? How do I fill in the areas where I’m not completely replete with the nutrients where I’m not optimal? Most people take a multivitamin, but it’s so important for expecting moms to transition from a regular multi to a prenatal vitamin. Some nutrients just aren’t provided in sufficient levels to make sure that the body’s in the correct status nutritionally for an optimal pregnancy outcome. We’re learning more every day. For instance, iodine was not on the radar ten years ago. Now it’s absolutely on the radar and something really key for the baby to develop a healthy metabolism, actually for the mom to have a healthy metabolism during pregnancy.

Chromium and Iodine

Kenn: Also important for thyroid function in the baby. Chromium is growing in importance. Many women, when they become pregnant, you hear a lot about unstable blood glucose levels even gestational diabetes, you know, the body’s working very, very hard. You’re feeding two humans with one liver and one pancreas; it’s challenging. So making sure that the insulin response system is working properly is key, and there are nutrients that support that specifically.

Vanessa: Interestingly, there’s not a daily recommended value for chromium, right?

Kenn: Well, you know, the FDA and the United States department of agriculture recently did change their requirements for this and, you know, under the old RDA, which is still in effect, there was no requirement. The new and upcoming RDA actually requires a small amount of chromium. That said, the clinically researched level is still about four times the amount recommended by the FDA, even for pregnant women. You will be seeing labels change with increasing amounts of chromium. Also, they increased the amount of iodine quite significantly. If you look at the old recommendations, it was about 150 micrograms. The FDA is up to 290 micrograms. Really giving it the proper attention this time, I have to applaud their work, and I don’t often do that.

Vanessa: I know sometimes it seems like it can take so long for the science to actually make it through to regulation. Absolutely true with government agencies; they don’t always move so quickly.

Kenn: No, I, I think that you know, they get it this time. We live in a different age. We live in an age now where probably one of the most activist populations and most informed populations and internet savvy populations are moms to be. They want the best possible answers, the best results for them from their pregnancy for their child. They are getting informed. I don’t know a single mom or a mom to be who has not consulted Dr. Google with some great results and some questionable results, but certainly out there seeking good quality information. You are providing a massive service by doing the podcast. I hope that we can contribute some truth and some unbiased facts into the space.

Vanessa: Yeah, and that is what is challenging. It’s a tremendous amount of work and hours to really dig through a ton of research and get down to evidence-based information.

Kenn: Well, you know, I have to respect the team at Zahler. In that their mandate for me has always been, what is current scientific thinking on an ingredient? What is current scientific thinking on a formula? It’s not, Hey, we need a product that fits this particular price model, or we want to do an ingredient because it’s hot in the market right now. It’s really more about what should we be doing? What’s the responsible move, what’s the best form. And that those are our guideposts in building products. So they’re really delightful folks to work with. And they’ve given me tremendous freedom from a formulaic perspective, from a dose development perspective, from an ingredient format, selection perspective, to deliver the types of products that I want my wife to use, and she did, or other members of my family to use. So, you know, it’s really liberating, and it’s a good feeling. And I kind of feel like we’re doing the right thing in the world.

MTHFR, Methylation, and Unmetabolized Folic Acid

Vanessa: I think it sounds like you are, and it’s definitely good to hear that. One thing I want to circle back on, you had mentioned using folate over folic acid. I have done an episode where I talk a little bit about if you have an MTHFR mutation. Since I’ve been pregnant and had children, I actually did a DNA test and found out that I do have that mutation, which I think it’s estimated that 50% of the population has.

Kenn: Varying estimates. If you look at 23 and Me’s data set, 20% have a full defect of methylation for methylfolate; you convert folic acid into methylfolate. That said, it’s likely that 50% of the population has other challenges that lead to poor methylation. Just so that the non-scientist understands from many nutrients and many processes in the body, we use methyl groups. These are small molecular structures to make nutrients more sizeable and more bioactive. We also use methylation as part of our detoxification process, and there are genes, little protein structures, that are either turned on or turned off that allow that to happen. Many of us have a challenge in that we don’t have the protein structures in our body. The genes are not in the position to do that important methylation work. Either it doesn’t happen, or we provide the body with nutrients that our body ready.

If you look at the actual form that folate takes in the dark leafy green vegetables and some of the animal-derived foods that are rich in folic acid, it exists as folate. Folic acid is a product of a factory. It’s a fermentation product. It’s okay for some of us, for those of us who can’t convert it, or who take too much. In fact, it can be quite problematic.

You can have unmetabolized folic acid build up in the body. You can have unmetabolized folic acid in the digestive tract. There’s some evidence that this can actually cause some subtle problems in gut flora, in the microbial population, in our gut, or different types of tissue in the colon. There’s actually some work that couples excessive folate exposure to glyphosate, which is a commonly used pesticide compound and carcinogenesis. So this is a real serious issue, not just limited to pregnancy, but I think it affects the larger population as well. It may affect brain health. It affects a lot of different non-cardiovascular wellness. There’s a big growing body of research on this.

Vanessa: I’ve read through quite a bit of that stuff, and I can put some links in the show notes if anyone wants to get into more of the science on that and some of the studies on folic acid.

Q&A: Folate & Folic Acid

Great Article from Chris Kresser with Evidence

Article and Links from Dr. Ben Lynch

Ingredient Costs and Price Differences in Prenatal Vitamins

Vanessa: For somebody that doesn’t have that MTHFR mutation, is there any downside to taking a prenatal vitamin that has folate rather than folic acid?

Kenn: The only one I could think of is that the product costs a little bit more, but you’re not using so much of it. This is an expensive ingredient. It costs over $10,000 a kilogram versus a few hundred dollars a kilogram for regular folic acid. That said, you’re using microgram quantities, maybe a milligram, which is 1/1000000 of those kilogram quantities per dose. It’s worth spending the extra money. The worst thing that happens is your body works a little less hard to make the nutrient active in the body. The nice thing here is that the material that we use is produced by an Italian pharmaceutical company that has invested millions in human clinical research to show that the product, their ingredient is stable, it’s bioactive, it’s safe, and it’s effective. I’d say the extra money you’re spending if you don’t need it, and that’s a small portion of the population, it’s going to improve human wellbeing. Don’t feel bad about it. You’re not just throwing it down the toilet. As some people like to say, you’re actually helping people, and help you’re helping yourself, and you may be helping others. So it’s important.

Vanessa: We are not really talking about a huge cost difference between very inexpensive prenatal. I don’t think Zahler’s prenatal is extremely overpriced by any means.

Kenn: No, you could spend a lot more and get a lot less. I mean, people pay much more attention to the brand of onesie that they’re going to swaddle their newborn, and then they do the micronutrients that they’re building their baby to be out of. I say flip those priorities, spend a little more on the prenatal, get the best possible forms of nutrients, and have a smart, healthy, happy baby.

Iron

Vanessa: That’s definitely the most important thing. One other thing that I wanted to touch on specifically, and something that I think sets prenatal vitamins apart from multivitamins, is iron. Can you talk a little bit about iron?

Kenn: I’d be delighted to, of course. I’ve had the privilege to work with a bunch of different sources of iron in my career and to also formulate a lot of multivitamins and a few prenatal vitamins. For the mom, iron deficiency anemia is one of the most common side effects of pregnancy. It’s one of the biggest causes of early miscarriage. Addressing iron needs is tremendously important. The RDA for everybody is 18 milligrams. The RDA for pregnant women is 27 milligrams. So it’s a 50% increase in the recommended minimum level of iron. There is good evidence that perhaps a little more prior to and during pregnancy is important.

The second thing we look at is the form that the iron takes. If you look at your drug store variety prenatals, many of them use ferrous sulfate. It can cause constipation and stomach aches, and so does pregnancy. You have this double whammy combined with early pregnancy morning sickness. It just creates a mess. Iron is difficult to absorb. Iron is tough on the stomach unless you use some very specific forms of it. For the Zahler prenatal, we selected Albion’s ferrous bisglycinate, which is a very gentle form of iron. It’s very bioactive, easy to assimilate. It’s bioavailable, and it goes to work fast. We were very selective in the iron that we used. We wanted to ensure that we had the gentlest, safest, easy to assimilate, and bioactive iron for the product. Again, it costs a little bit more, but it’s absolutely worth it, especially given the heavy challenges that you face early in pregnancy. I mean, your digestive system is not used to this growing baby in you. Then you get further in pregnancy, and everything’s being moved around to make room for this little guy or girl inside. You have got to be kind to your digestive organs when you’re conceiving,

Vanessa: Right. I’d like to add to iron is so important because when you’re pregnant, your blood volume increases by 50%, which is huge. From a lot of the studies that I have read through, they estimate iron deficiency to be up to almost 30% by the time you’re in the third trimester, which is really high. Is it possible if you’re taking a different prenatal vitamin that has another form of iron that may not be as bioavailable, if it says that it has 27 milligrams of iron, but it’s not as bioavailable, is your body still absorbing the same amount? Does that question make sense?

Kenn: It absolutely makes sense. You’re right on track in that just because the iron that’s elemental iron is in the product. It doesn’t mean that it’s going to get absorbed easily. We have a responsibility as nutritional formulators, as manufacturers, to really be selective and careful about the forms of nutrients that we use to ensure that they are bioactive and bioavailable. It’s not just checking a box and saying it’s in there. It’s really examining the product and saying, yes, it’s in there, and you’re going to be able to absorb it. It’s going to actually go to work in the body. The form we use is one of a couple of outstanding forms in the market. There are some other protein-bound irons that are interesting and useful and not necessarily as challenging on the gut. I don’t say we have the only solution. All too often, you see inferior forms being used. To me, that’s a major fumble on the part of the formulator and the manufacturer.

Vanessa: Is that just a product of wanting to keep costs low?

Kenn: There are two or three drivers there. Iron is a super reactive mineral. The reason why your blood uses iron to carry oxygen as part of hemoglobin is, as I like to say, iron loves to dance at dances with just about everything. This means it induces stability problems in formulas unless you’re really careful how you formulate with it. So there are stability questions. Number two is a size issue. Iron in a chelated form and we use a chelated form, which means it has transporter proteins wrapped around the mineral, that takes up a fair amount of space. You could get ferrous sulfate, which is mostly iron. So it’s really easy to fill the box and fulfill the amount required with a small amount of material. When you use a chelate, it requires a much larger amount of material, which means your formula gets larger. You need more excipients; you have to shield other nutrients more from this. It’s complicated a little bit, but there are three drivers. One is stability, two is size, and three is cost. We make some sacrifices on all three to make sure that we have the most bioactive bioavailable form in the product.

Vanessa: I can’t imagine all of the science, formulation, testing, and everything that goes into formulating a finished product.

Kenn: It’s a fun process. It’s one of discovery every time, and you’ll end up with some unexpected results. At the end of the day, if you’ve done it right, you can really produce a tool that’s meaningful in people’s lives, and that’s our goal.

Vanessa: We certainly appreciate all the hard work that you have done with the Zahler prenatal vitamin. My audience knows I talk about this vitamin all the time. It is definitely my recommendation and the prenatal vitamin that I’m taking. I really appreciate all your time and your expertise today. Kenn, is there anything you would like to add or any other points you wanted to make before you go?

Don’t Overlook the Bigger Picture

Kenn: I think you’ve covered the ground really well. I just encourage everybody to keep learning and to realize that the supplements you use are just that. They’re supplements to a healthy lifestyle. It starts with sleep. It starts with activity. It extends into a state of connectedness with those around us. Also, eating good quality foods, clean foods. It’s not the be-all-end-all. I know my place, so to speak, it’s a fairly small place. It’s an adjunct to the foods we eat. It can be really meaningful but don’t overlook the bigger picture, which is getting adequate rest, getting adequate exercise, being connected to those that you love and the world around you, and making wise choices about what we consume in the form of food.

Vanessa: That is an excellent point. It’s just one piece of the puzzle. Definitely an important, important keystone piece, but you’re right. I think there’s a lot of components that we need to be paying attention to.

Kenn: Absolutely. They all work together, and when they work well, beautiful things happen.

Vanessa: Absolutely. Well, thank you so much, Kenn. I appreciate your time.

Kenn: It’s been a true pleasure. Thank you so much.

Thank you to the amazing companies that have supported this episode.