Dr. Jolene Brighten: Navigating Autoimmune Disease Through Pregnancy

Welcome to Episode #9 of the Healing Pain Podcast with Dr. Jolene Brighten!

Today we are joined by Dr. Jolene Brighten, ND.

Pregnancy has both short-term effects and long-term consequences. For women who have an autoimmune disease and subsequently become pregnant, pregnancy can reduce symptoms of the mother’s disease, such as in rheumatoid arthritis, while exacerbating or having no effect on other autoimmune diseases like systemic lupus erythematosus.

Hashimoto’s is the most common autoimmune disease in the United States often developing in the post partum period. Many people do not know that thyroid hormones can also affect the hormones that are responsible for fertility and successful pregnancies. According to the American Thyroid Association, up to 20% of all pregnant women in the first trimester of pregnancy are positive for Hashimoto’s antibodies.

In This Episode You Will Learn:

How to recognize the signs and symptoms of autoimmunity in the pre and postpartum period.
Which autoimmune diseases may worsen or improve while pregnant.
Why pregnancy that affects the immune system so significantly.
The delicate balance of our immune system and hormones.
Lab testing that can be done to detect autoimmune disease before pregnancy.
How a woman can prepare and strengthen her body before pregnancy and lesson her chance for autoimmunity.
How to boost your energy and vitality while negotiating the postpartum transition.

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Welcome to the Healing Pain Podcast. I am your host, Dr. Joe Tatta. It’s great to be here with you today. Thank you for joining me.

On the podcast today, we are discussing how to navigate autoimmune disease through pregnancy. My guest today is Dr. Jolene Brighten. Dr. Brighten received a bachelors degree in nutrition, and then later went on to receive her doctorate degree in naturopathic medicine. She has extensive training in integrative women’s health, as well as autoimmune disease treatment. After developing Hashimoto’s after the birth of her son, she’s become an advocate for the Hashimoto’s community, with a special emphasis on fertility, pregnancy, and postpartum thyroiditis. She’s the bestselling author of the book “Healing Your Body Naturally After Childbirth: The New Mom’s Guide to Navigating The Fourth Trimester.”

Dr. Jolene Brighten, thank you for joining us on the Healing Pain Podcast. It’s great to have you here.

Thanks so much having me. I’m really excited to dive on in and get to chatting about this really important topic today.

Yes, and you know, it’s great to have you here, because I really love the niche you have, talking about autoimmune disease in the pre- to post-partum period. It’s so important and it’s not very easy to find a specialist like you, so thanks for joining us.

Yeah, definitely. Well, I’m really honored to be here. Thank you for having me.

I know you have your own unique story about your struggle with autoimmunity while you were pregnant. Can you share that with us to get started?

Yeah. I actually didn’t develop my autoimmune disease until after pregnancy, which is actually quite common and something that no one talks about. For myself, I actually found that in the postpartum period, I started to really struggle. It started with things, you know, really subtle. My energy was going down, my mood was going down, something was not feeling right in my body, and I actually had a lot of pain as well. I would go to doctor after doctor who would tell me, “You need to sleep and you need to exercise,” which is the worst thing that you can tell a new mom, because we’re not getting any sleep; there’s a small human that has to be fed, and that’s just the way it works, but that’s what I kept being met with.

I love the work that you’re doing, because it wasn’t until I had that experience that I realized, I would go to do something like a squat and I would do about five of them and I would be exhausted, totally wiped out, and then to be feeling it days later, and being like, “Okay, I did five squats.” I used to be a group fitness instructor. I used to do 15 to 25 classes a week, and now I can’t even walk up a hill without feeling like I was completely inflamed and in pain.

I struggled for a long time to get the answer and really the defining moment, the moment that I really woke up to what was going on is when I would be so fatigued, I had come out of sleeping probably about a 15-hour night in bed – That’s how much I was sleeping back then – I was gaining weight, all these things were going on and I fell asleep at the breakfast table. My husband had woke me up. We were taking shifts. He was like, “All right. You slept in. Your turn to get up with the kid. I’m going to go back to bed,” and I got with my son and I just fell asleep, laid down on the table and went right to sleep and didn’t even think anything about it. I woke up to my son screaming. He’s complaining, he’s a small child, cannot use his voice yet. And my husband came into the kitchen, he’s like, “What is going on?”

He started to list my symptoms to me, saying, “Look, you’re sleeping all these hours and you’re always freezing cold,” and as he actually relayed the symptoms back to me and he laid them out, much like patients do for me in my practice, it was so clear in that moment. I was like, “I have Hashimoto’s. That’s what’s going on.”

I promptly ordered my own labs and got a bunch of testing done, and lo and behold, there it was. I had Hashimoto’s, a condition I am very well versed in, had been treating multiple cases, but in myself, it was so easy to fall into the story that the doctors were giving me that, “You’re a new mom. You’re fatigued. Maybe you’re just depressed. That’s common,” and when I really stopped and saw the whole picture, it was so obvious what was happening, and in that moment, I was able to advocate for myself and really turn myself around, turn my health around.

It’s funny. I tell this story and people get to see me now. I’m a very energetic individual and people will say to me, “I can’t ever imagine you sleeping that much or you not being able to get through your days,” and it’s like, “Yeah, but it all started so slowly and I didn’t even recognize that my life was being robbed from me.” I went on to do further testing, which is what I recommend to my practice patients, so yes, I had that thyroid issue, I had autoimmune thyroid disease, what’s called Hashimoto’s thyroiditis, which is an autoimmune disease that causes destruction of the thyroid, but I also had antibodies to other tissues as well, so I had developed multiple conditions.

One of the big ones that made me have to slow my roll, put the brakes on, and re-evaluate my life, is that I actually had antibodies to my adrenal glands, which is something called Addison’s disease. What we know about this condition … A lot of times in conventional medicine, the doctors won’t test for this until there’s overt symptoms and what overt symptoms look like is … JFK actually had this, so that’s why he had that beautiful tanned skin. That’s one of the things you see in Addison’s. You see fatigue and you see a lot of pain in the body. The problem is that when we wait that long, conventional medicine actually isn’t catching Addison’s disease until there’s about 90% destruction of the adrenal glands. At that point, there’s no coming back from that. At that point, you’re only going to be offered hydrocortisone and it’s not pretty. Once you start, and I’m sure you talk about this on the podcast, but once you start taking those things, the body, it’s a big decline after that.

What we know, and it’s there in the literature, we’ve seen it in the research time and again, if we see these antibodies early, we catch them early, before there’s the symptoms, we actually can intervene. These people who have these antibodies, 90% of them within 10 years will have full-blown Addison’s, will have that tissue destruction, and that to me is a golden opportunity why we should be testing these antibodies early and screening all people, but especially women who are in their reproductive years.

Autoimmunity is really a spectrum in that you start with the antibodies, then you have the antibodies and the tissue destruction, and then it goes on to full-blown symptoms. You’re not going to reverse it; you’re deep in the trenches of autoimmunity, which is where conventional medicine does a beautiful job of stepping in and meeting you with medications, but I want to get every patient upstream because it’s reversible. It’s not curable, but it’s reversible, and I’ve done this in myself and I’ve done this with countless numbers of patients.

That’s a great introduction. You’ve said so much already, my functional-medicine brain is kind of starting to go a little crazy. We obviously have clinicians as well as patients that listen to this podcast and watch the podcast, so when you’re talking about antibody testing, and this is mostly for people who may be interested, you’re talking about predictive antibody testing, correct?

Yes.

Can you explain what that is a little bit?

Yeah. That’s a great question, and this is what I do in my practice. I don’t practice in primary care anymore, but when I did, every woman’s annual exam included thyroid antibodies, because that’s the most common that we’re going to see, so getting those screenings … There’s really great labs out there. I love Cyrex Array 5. There’s a lot we can get done through our traditional labs like LabCorp and Quest, that I can look for, but what’s different about the Cyrex panel is that I can see what antibodies are definitely present, and then what are the equivocal antibodies, which is the guys that are waiting in the wing.

If I see something that’s like, “Okay, we’ve got these equivocal antibodies, this is what’s waiting in the wing,” we know what’s coming downstream, we know what’s coming down the pipeline, and that’s where we can start to intervene. We can look and say, “Okay, what’s the root cause of these things? What infections do we see that are commonly associated with this, and what tissues do I need to feed, what systems do I need to support. A lot of times when you get these predictive antibody screening tests, you can show the patients, “Hey look, you have antibodies going on right now.”

This is the way I describe it, and if there’s any environmentalists out there, they might hate this analogy. I grew up in the mountains. I grew up in a town where there was a mill, so tree cutting was part of my childhood. There’s the guy who goes out and he tags the tree, he puts that big X on the tree with spray paint and he says, “This is the tree we’re going to cut down.” He doesn’t actually cut down the tree; it takes the guy with the equipment to come through and he cuts it down. There’s women, too, I’m sure doing this, but this is just my analogy. Those antibodies are flagging; they’re that X on the tree. They’re saying, “This should be destroyed,” but they’re not doing the destruction; those are the cells tagging. It’s the T-cells that come in, that aspect of the immune system that comes in and actually does the destroying.

It’s something that we can take a look at. “You’re being flagged. Maybe you don’t have symptoms yet, maybe we’re not seeing the pathological changes in the blood work, but it’s tagged, so the potential for the destruction is definitely there.”

Basically what you’re saying is that there’s a period where you may have these predictive auto-antibodies, so you’re positive or you’re equivocal, which means they’re there, but you’re not quite symptomatic just yet.

Absolutely.

That’s also a really important time for you to kind of start to work with someone.

Absolutely, yeah. I would like to get everybody before they even ever want to get pregnant and before they ever have an autoimmune disease. I like to joke that I like to work with the diseases that you can’t name, like we don’t have a name for it yet. Because the moment you can name an autoimmune disease, that’s really the moment that you’ve had that extensive tissue destruction, but until then when it’s like, “Oh, you have all these kind of iffy symptoms and we’re seeing these antibodies,” that’s a good place to be at because that’s where we can really start to reverse things.

Functional medicine and naturopathic medicine, where I really see it thriving is on that spectrum of, “You have antibodies, you antibodies with some symptoms.” That’s where we can really work and we can reverse it. My goal is you never get into the rheumatologist’s or the endocrinologist’s office to get that diagnosis and start those pharmaceuticals. I want to get you way before then, and even if you are there, we can still work on all of those root causes.

If someone goes to their average rheumatologist, they’re probably not going to get tests done for predictive auto-antibodies.

Oh, no. So often I will send patients … I like to collaborate with a lot of conventional medicine doctors; there’s no dig on that. They have their place where they shine, absolutely. Everyone has a place in healthcare, but often patients will say, “Well, my rheumatologist told me until my joints are swollen or I’m having pain, these major symptoms, there’s no real reason to test,” and from their perspective, it’s true. In medicine, you should only really run a lab test if it’s going to impact the treatment that you’re going to offer a patient, and if it has an impact on those treatment outcomes. From their perspective, if they test for those antibodies and they’re present, but you don’t have these extreme symptoms, they only have a medication to offer you, so that makes complete sense.

They’re not in the wrong in doing that, but I just think that what preventative medicine is is not about just like, “Oh, give a flu vaccine.” Preventative medicine is understanding your family history, understanding your genes, understanding how you’re interacting with your environment and seeing through those lab tests, through the functional-medicine lens, we can actually say, “Yeah, these markers may not be disease.” I don’t disagree in what’s the absence of disease or what’s disease; where I disagree is where the functional place is, and that’s where we want to be. We want to be in the most optimal place for our body.

Excellent. It’s a great option for people. If this is new information, you can see a functional-medicine practitioner and get your predictive auto-antibodies tested before you’re pregnant.

Explain to us, what is the shift that starts to happen after pregnancy. I know some autoimmune diseases get better during pregnancy and some actually get worse or can start to show up later on.

Yeah. All of that is really tied into what the immune system is doing in pregnancy, and it’s a common misconception that the immune system is shut down in pregnancy. I even hear this sometimes from other healthcare practitioners. It’s kind of true, but not so much. What is actually happening in pregnancy is that – We’re going to oversimplify the immune system here – But you have this aspect of the immune system called Th1 and Th1’s job is to go out and survey the land and say, “Is this me or is this not me?” It’s the self versus non-self. If it’s not you, then the immune system wants to know, “Is this dangerous and does it need to be destroyed?” That Th1, its primary job is to fight viruses and bacteria, except that baby is genetically unique; baby is non-self, it’s not you, so if that Th1 is doing its thing and going around and surveying, it would find baby and it would actually say, “This isn’t us and we probably should get rid of it. We probably should destroy it because there’s a lot of foreign protein here.”

Your body, being very wise, actually down-regulates Th1, and as it down-regulates Th1, baby’s protected, and at the same time, that’s why pregnant women are more susceptible to illness. We don’t want to be sick around a pregnant woman, or food-borne illness. That’s really something that in America you can go a little overboard with it in our fear of food and women getting food poisoning during pregnancy. The diseases and the outcomes from that can be very detrimental, so it’s definitely something that we want to be cautious with because we don’t have that aspect of our immune system really protecting us while we’re pregnant.

What we do have is Th2. That’s the other part of the immune system, for these purposes I should say. Th2 is all about … It developed for parasites, but it’s also allergies, asthma, and eczema, so we’ll see that’s higher in pregnant women. It’s still helping defend things, but it’s not going to quite do the job of Th1. We actually have this shift happening in the immune system, and then we have everything that’s going on with the hormones as well.

You basically have kind of an imbalance that’s happening, because your Th1 and Th2 should be relatively balanced in most people, but in pregnancy there’s this kind of shift that starts to happen between the two.

Absolutely. It’s that shift that happens that determines does autoimmunity get better or does it get worse. If your autoimmune disease is Th1 dominant, it tends to get better, and it’s not like, “Oh, I’m pregnant, it’s better.” We see that it’s after the first trimester that we really see that shift and then things really start to get better and things improve. But if your autoimmune condition is a Th2-dominant condition, we’re very dependent on female hormones, very effected by that. Lupus is one, for example. Lupus is kind of like a, “It could get better, it could get worse. We don’t really know in pregnancy, we just kind of have to see how it goes.” It’s actually something you can be really successful with if you are supporting the aspect of the immune system that we can think of as the regulatory system, the T-reg cells, but those shifts, while they’re very, very wise, they influence … This is your immune system so it’s influencing what diseases get better.

Predominantly, most autoimmune conditions, especially … In my practice, I hear women saying, “Being pregnant is the best I’ve ever felt,” which is a big clue to me. If a woman says, “I had difficulty conceiving and pregnancy is the best I’ve ever felt and then I was completely wrecked by post-partum,” I am looking for autoimmunity. I’m going to dive in and look for that because that is definitely something that can be taking place, and again it can just be that low level that isn’t enough. These are the women in my practice who often say to me, “I’ve gone to my doctor, I’ve seen all these people, I’m told my labs are normal, I’m fine, it must just be in my head,” and usually it’s a, “Here’s a birth control pill or here’s an SSRI,” some kind of offering like that.

To me, if your doctor’s saying your labs are normal, but you’re saying, “This is not normal,” you know your body way better than anyone else. You’re privy to information your doctor can never gather through a blood test, and that needs to be honored and respected as part of the approach to your case.

I think it’s a great point that you bring up. A lot of people with these slowly-evolving autoimmune conditions are often told they’re hypochondriacs or “it must be in your head,” but in reality, there’s something kind of brewing underneath.

Yeah, definitely. And I’m sure it’s something you see with chronic pain as well where people get told, “It can’t be that bad.”

That’s right. You said something a couple minutes back that I want to kind of circle back to. You mentioned miscarriages. If there are women who are struggling with miscarriages and they can’t find the reason why, could it be that they’re in the reactive phase of an autoimmune disease that’s starting to brew?

Yes. Anytime there’s a repeat miscarriage … The unfortunate thing is that most of conventional medicine, and we see this with insurance dictates this way as well, it isn’t until after the third miscarriage that women will get a thorough workup. To me, that’s completely heartbreaking. Anyone who’s been through one miscarriage, it’s very hard on the body. That can actually be a trigger for autoimmunity in itself, and it’s a really devastating event in a woman’s life, although it’s very common and sometimes it’s the wisest thing that your body can do. I still think we do a disservice when we don’t work up the woman after one miscarriage.

The first place that I’m going to dig in is definitely looking at all the basic blood work, but I’m going to go exploring autoimmunity as well and going for some of the most obvious ones, which is Hashimoto’s autoimmune thyroiditis. We know that even if you don’t have thyroid symptoms and even if your thyroid’s functioning correctly, just having anti-TPO antibodies circulating is actually correlated with a 2x to 3x increased risk of miscarriage. Autoimmunity, because it’s inherently inflammatory, can cause an increase in miscarriage. Then there’s the nutrient depletions that often exist in these people because when you have autoimmune disease, there’s usually a gut issue underlying that and that gut issue might be leading to inflammation.

Conversely, these autoimmune diseases, like Hashimoto’s for example – not having enough thyroid hormone – actually lowers your hydrochloric acid. You’re not making enough hydrochloric acid, you’re not moving things through your intestines, you’re not absorbing nutrients as well.

We have to look at that as well, what kind of nutrient deficiencies might be playing a role. We see a lot of vitamin D deficiency in autoimmune people.

Talk to me about diseases that might get better or might get worse around pregnancy time.

When you become pregnant, it’s one of these interesting things, if you become pregnant, you get through the first trimester, then you’re usually in the clear for most autoimmunity. We see that lupus, sometimes rheumatoid arthritis, and even Graves’ disease, which is a hyperthyroid autoimmune disease, that can get worse during pregnancy. Most autoimmune diseases we see are getting better in pregnancy and I think that the issue that comes up in medicine is a lot of doctors will be like, “Well great. You’re pregnant, now your autoimmune disease is better.” I’ve had women come to me and their doctor’s like, “Don’t worry about it. You’re pregnant now; now your autoimmune disease is going to get better and then we’ll worry about it post-partum,” but really pregnancy is a great opportunity in time that, as that immune system is kind of down regulated, let’s start to correct some of those other things. Let’s work on that.

I want every mom to completely rock motherhood and feel totally confident and totally vibrant and have as much energy as possible, even though you’re going to take a little bit of a hit; those adrenal glands take a huge hit in post-partum. It’s things like that where we can actually be doing work in that time regardless of what the autoimmune condition is. Now, of course I said, I would love to get women pre-conception, I’d love to work on it there, but even if you are pregnant, there’s steps that you can take to really modulate what’s going to happen when you come out on the other side.

It’s something I say so often, that as women we prep so much for childbirth and there’s always all these birth plans and we have to be really focused on that. But birth might be six hours, it might be 24 hours, it might be three days, it just depends on how you birth, but post-partum, that fourth trimester is definitely three months and the healing it takes for your body to recover after a baby is a good year. This is where we should be focusing. Of course we want a healthy baby, healthy mama, we want birth to be its best, but let’s focus on that post-partum as well so that you can completely thrive and that your autoimmunity doesn’t flare because it does often flare in most women and that post-partum, that birth of the baby, and really what marks the birth of you as a mother, can be the triggering event for developing autoimmune disease.

Let’s talk to the women who may be pregnant right now or who have just given birth. How can they really prepare their body and fortify it and make it strong so that their risk of Hashimoto’s is as low as possible?

The first place is to get tested. Like we were saying, before you even want to become pregnant, you should definitely have a full workup looking at nutrient status. I like to look at nutrient status and mitochondrial function because here’s a little secret: If you want to have the most superhuman baby ever, support your mitochondria because everything you do to support your mitochondria which, as mamas that’s what we pass on; we pass on that genetic material to baby, which is so cool to think that. The mitochondria … For people who don’t know what I’m talking about, I should back up and say they’re these little powerhouses in the cell and their job is to create energy. We actually pass that on; that’s our lineage that we pass on to our children. When you take care of your mitochondria, that makes your egg so rocking, one of the best eggs possible. It makes you at your most optimal, and it’s going to make this total superhuman baby. It’s a great way to approach it.

Definitely I’m wanting to look at that and looking at ways like, “How do we support the mitochondria?” Which when we’re doing preconception care, we’re usually using things like Co-Q10. You can supplement Co-Q10 at 200-300 mg a day or – I’m a big fan of food as medicine – you can start eating some beef heart, and I do have patients do this where I’m like, “Get some ground beef heart and get some ground beef and make a 50/50 burger.” Everybody gets a little, “Oh, gross. Dr. Brighten’s asking me to do that first,” but when they have it they’re like, “You’re right, that was the most tasty burger ever.” I’m like, “Yeah, it’s incredible.” And it’s so nutrient dense. There’s definitely ways to start feeding your mitochondria and supporting them and then getting the preconception lab testing to understand where you’re at.

We definitely want to do a full thyroid panel. Something that I really take issue with in conventional medicine is their approach to thyroid health in women, and it goes like this: If your TSH, which is thyroid stimulating hormone, what your brain says to your thyroid … That’s often the only lab they’re running and so I want to make sure people know you should also get a T4, which is how your thyroid responds, and then you should get a T3, which is the conversion. You want to full picture of thyroid health, along with your antithyroglobulin, anti-TPO antibodies.

The thing about the TSH is if your your TSH is 2.5 or higher, but you’re not quite at that 4.5, 5 mark, the doctors often say to women, “Are you wanting to become pregnant? Are you thinking about becoming pregnant?” And if the answer is no, it’s like, “Okay, well go about your way. I know you’re having symptoms, but your TSH isn’t high enough,” but if the answer is yes, it’s immediately start them on a medication, specifically synthetic T4, which is Synthroid or levothyroxine. My issue with that is why are we only doing this if a woman wants to become pregnant when we’re recognizing that there’s an issue with the thyroid, but nothing’s being treated, nothing’s being done until she says, “Yes, I want to become pregnant.”

The reason why it’s so crucial, and this is important. What’s important about this – Sometimes I think in the space of functional and naturopathic medicine we get people who are like, “I don’t want to go on a medication for any reason,” but here’s a really important thing to understand: If your TSH is 2.5 or higher, that’s correlated with an increased risk of miscarriage and infertility and usually irregular menses as well, so that’s definitely got to get corrected. Does it have to be a medication right away? That depends on your root cause and really getting down to the deep issue. Sometimes we can support with tyrosine and selenium and iodine and B vitamins and that can correct a thyroid dysfunction, but it’s all about understanding where that thyroid dysfunction is coming from.

If you do want to become pregnant or you are pregnant, yes you do need to start a medication right away because that T4, that synthetic T4, even though nobody wants to take synthetic most of the time, they want natural thyroid hormone – you can definitely do that as well, but most OB-GYNs and midwives are actually referring to me to manage thyroid medication because they don’t want to do anything but Synthroid. Synthroid is where the research is at, that T4 is where the research is at. That is the only thing that will cross the placenta and cross baby’s blood-brain barrier, so baby has to have the T4. The T3 makes mama feel good, but T4 is essential for baby’s development. There’s been amazing studies done where they’ve actually followed children and cohorts to see where are they at developmentally and what they found is that if women didn’t have sufficient T4 during pregnancy, those children are cognitively very far behind their cohorts. It’s very important for baby, but very important in preventing miscarriage as well.

I’m definitely looking at a full thyroid picture. If there’s auto-antibodies present, I’m going to be asking the question of, “Do we have gut infections? Do we have a vitamin D deficiency? What’s going on with that Th1 and Th2 balance?” Three great ways to get Th1 and Th2 back into balance, one is correct the gut, so probiotics and proper cellular signaling to the immune system is fantastic with that, the vitamin D deficiency that I mentioned, and then definitely fish oils, omega-3 fatty acids. Whether you’re eating more fish oils, most of the time I’m putting women on really quality fish oil that have been screened, no heavy metals or anything like that, to help balance that immune system.

A really big one is the stress component. There is nothing like stress to drive autoimmunity and drive infertility. I can’t even tell you how many times in my practice it’s really a matter of shifting mindset, shifting priorities, and finding good stress decompression techniques, and then when you’re in the thick of it, how you actually deal with your stress. Stress will drive an aspect of the immune system know as TH17. I like to call TH17 the “seek and destroy.” I literally hear Metallica in my head blaring and just see a mosh pit going with your immune system.

[crosstalk 00:27:25]

Right? There’s just like this mosh pit of the immune system going. Stress is going to drive that. This is a bad guy, you don’t want him all up in arms and going crazy. So definitely stress is a really big piece of the preconception and the autoimmune care.

You mentioned a couple of great supplements to support your immune system. Vitamin D, obviously you would run a test, of course, to see what people’s vitamin D levels are, but vitamin D can be slow to rise. What do you recommend to people as far as starting out if they’re going to supplement vitamin D?

That’s a great question. It’s across the board what people recommend. Generally I’m looking at someone’s vitamin D; if they’re in the 30s, I’m probably … I want to see vitamin like 70, and if they’re in the 30s-ish, I’m probably going to do about 5,000 IU every day and then I’m going to retest in six weeks. I like to retest at the six-week mark to make sure we’re on target because vitamin D is awesome, it is so great for everything, your brain, your hormones, your gut health, your autoimmunity … Such a phenomenal vitamin, but almost hormone. We’re just learning so much about and it’s really fascinating. But vitamin D, too much of it, and I see this often where patients are, “Vitamin D’s great, so I’m just going to take tons of it,” it can actually pull calcium into your arteries and then they become rigid. There is a very … It’s one of the golden rules of life and that is that rigid organisms do not survive. You have to be adaptable and you have to be flexible and that’s true of your arteries as well.

If somebody’s vitamin D is really low, in the teens, I’m probably going to do about 10,000 IU in divided doses, again retesting at the six-week mark to make sure that we’re on target, but also that it’s rising. I treat a lot of small intestinal bacterial overgrowth, or what’s more commonly known as SIBO, and I’ll see a vitamin and a mineral, vitamin D and iron, and most pertinent is ferratin which is the stored form of iron, I’ll actually see we’ll have a really hard time getting those to rise. That’s because what’s going on in the gut is actually affecting small intestine absorption. It’s also affecting leaky gut and inflammation and helping drive autoimmunity and create food sensitivities as well. It’s definitely an important thing to factor in that if your doctor is having you supplement but things aren’t really changing, you’ve got to dig deeper and you have to ask the question, “Why is the gut not doing its job? What is going on here?”

A lot of the times people do supplement and it gets better, but if it’s not, again that’s not that you’re doing anything wrong, it’s that you’ve got to partner with your doctor. They have to dig a little deeper.

What about omega-3s? There’s some really good research up to 5,000, but for someone who, let’s say, is pregnant, is that safe? That’s my first question.

Yeah. Omega-3s are safe in pregnancy. We tend to get, a soon as we figure out that something in food can be used medicinally as the supplement and then we start studying it, then we start to get scared of it. I see this with turmeric as well. Turmeric is awesome. You could eat it every day, but people are like, “Whoa, now it has all these effects so maybe we shouldn’t use it in pregnancy,” and it’s like, “If it’s food, that’s a different story.” It’s a big debate where people are like, “Oh, well fish has mercury. Should we be eating this?” Sardines are not going to … We’re looking at swordfish has mercury. Think, “Big fish, mercury.” Sardines, they’re going to be loaded with your omegas and they’re going to be really low in those things. Always starting from a place of food as medicine.

Looking at supplementation from there, I usually have women … If you have autoimmune disease, you have a lot of inflammation, it’s inherently inflammatory, and birth is inherently inflammatory. When you give birth and you come out on the other side and those adrenal glands take the hit, that’s the thing Mother Nature didn’t get right. We have this big athletic event, we go through this big life-changing event for the body, and then we don’t sleep for two to three months, really not great for the adrenal glands.

For the case of autoimmunity, we’re looking at about a total of 2,000 mg of omega-3s a day, and I like to see higher EPA. With fish oil we have two oils, we have EPA and DHA, and usually in the first trimester I’m using a higher EPA. EPA is highly anti-inflammatory and there’s a little bit of blood-thinning effects that happen with fish oil as well. For the most part, what we see in the research and what we see clinically, too, and a really important distinction is we always have to ask the question, “Yes, we see it in the research, but do we see it clinically,” because they don’t always match up. We’re seeing really high doses, like 10 grams a day of fish oil is causing … Of course, if you’re on a blood-thinning medication, it’s going to be a lower dose, but you can go up to like 6,000 mg.

In pregnancy, I’m looking at a higher EPA usually in the first trimester, and then I start to switch over to a higher DHA profile. DHA is the other fish oil that’s in your omegas and it’s super good for brain health. It’s great for mama’s brain and it’s great for baby’s brain and all that nervous system tissue development. Sometimes I’m using both EPA and DHA, and sometimes I’m just using a higher DHA through the second and third trimester, it all depends on where the woman’s at. I practice very individualized medicine. That DHA is actually going to protect mama’s brain because our brains actually shrink in pregnancy; they don’t come back until about six months post-partum. It’s the beautiful mechanism that the body does to get you hyper-focused on baby’s survival; it’s super brilliant, but it’s super inconvenient if you want to multi-task. That DHA actually feeds the brain. I want to keep feeding mom’s brain and doing that through post-partum as well.

Looking at those fish oils is a way to bring down inflammation and also to feed your brain, which you’re going to want that. It’s one way that we can prevent postpartum depression from taking place.

Awesome.

I have been speaking with Dr. Jolene Brighten. She’s a naturopathic medicine in private practice specializing in maternal health and autoimmunity. I’d say this has been an incredible interview and you have given so many take-homes and strategies to my listeners and viewers. I want to thank you for being here.

Can you tell us where we can find you both in practice and online, because they’re both important?

Yeah. It’s been such an honor to be here. Thank you so much for having me.

If people are looking to work with me, they can contact me … One of the best places is jump on my website, which is drbrighten.com. My name’s a little tricky, so it’s D-R-B-R-I-G-H-T-E-N. Someone recently said to me, “Oh, it’s Brighten like the sun,” so I’m starting to use that one. That was pretty clever. You can find me on my website. There’s information all about working with me in my clinic and I also work with a nutritionist so you can find out more about that and schedule an appointment. Then I also have an active blog where I publish information on this, writing articles on these same topics. Then, of course, you can always join the discussion on Facebook; I think that’s where most people jump on to ask me questions. I’m more than happy to answer those, so you can find me there as well.

I want to thank Dr. Brighten for being here with us today. It’s a great interview. Please share it with your friends and family on Facebook, on our YouTube channel, and stay connected to the website at drjoetatta.com for the Healing Pain Podcast.

We will see you next week with more great expert interview around how to heal pain naturally.

About Dr. Jolene Brighten, ND

Dr. Jolene Brighten earned her doctorate in Naturopathic Medicine from the National College of Natural Medicine. She received her BS in Nutrition Science and completed graduate coursework in molecular nutrition at Cal Poly, San Luis Obispo. She has extensive training in Integrative Women’s Health and autoimmune disease management and is a practicing Holistic Pelvic Care(TM) provider. Having developed Hashimoto’s following the birth of her son, Dr. Brighten is a strong advocate for the Hashimoto’s community, with special emphasis in fertility, pregnancy, and postpartum thyroiditis. She is the Best Selling Author of the book, Healing Your Body Naturally After Childbirth: The New Mom’s Guide to Navigating the Fourth Trimester.

To learn more about Dr. Brighten visit https://drbrighten.com.

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