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Microchimerism and Mitochondrial Health in Reproductive Competence with Leah Hechtman

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Microchimerism and Mitochondrial Health in Reproductive Competence with Leah Hechtman

Have you heard of microchimerism?

Today we are joined by Leah Hechtman to give us an insight into the topics she is lecturing on at the forthcoming Mindd Forum Conference 2019 in Sydney on the 23rd - 24th March.

Leah talks us through the various forms of microchimerism and why it really highlights the significance that pre and post conception care play in the health of future generations. Leah shares the immunological consequences that are just starting to be understood in microchimerism and the possible connection to autoimmunity as well as the role of mitochondrial health in reproductive competence.

As always Leah brings the wow-factor to her discussion with Andrew, you'll be able to hear his jaw hitting the floor. 

Covered in this episode

[00:58] Welcoming back Leah Hechtman
[01:48] Preparing for Mindd Conference 2019
[04:07] What is microchimerism?
[08:12] Immunological compatibility affecting fertility
[11:55] Microchimerism and autoimmunity links?
[14:47] Is this a scientific rationale for spirituality?
[18:02] Maternal vs. paternal DNA influencers
[21:38] Nutritional & Herbal considerations
[30:14] Blood quality: investigate beyond iron deficiency anaemia
[33:38] Investigate and understand methylation
[38:07] Nourishing through diet
[39:58] Supporting the broken, worn out couples


Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook. Joining us on the line today is Leah Hechtman, who's a very experienced and respected clinician, who specialises in fertility, pregnancy, and reproductive health for men and women. Her primary passion is her clinical practice, where she is inspired and humbled by her patients. She's completed extensive advanced training, and is a university lecturer, keynote speaker, author and educator to her peers. 

Leah is currently completing her PhD through the School of Women's and Children's Health, Faculty of Medicine at the University of New South Wales. And as I said previously, she's the author of Clinical Naturopathic Medicine and the forthcoming Advanced Clinical Naturopathic Medicine

Welcome to FX Medicine, Leah. How're you going?

Leah: I'm really well, Andrew. How are you?

Andrew: Good, thank you. Now, we're going to be talking today about something which you know, dare I say the word ‘intimately,’ and I am, I...do I say the word noob, or novice? We're talking about microchimerism, maternal RNA, and parental wisdom. Wow! Now, you're talking about this at the MINDD conference, 2019, correct? 

Leah: Yes.

Andrew: Okay. Can you, I guess first, explain a little bit about what you'll be covering at the MINDD, or the MINDD conference in general?

Leah: Okay. So, the MINDD conference is coming up March 23rd and 24th, in Sydney. And the focus for the year, the mandate that I was given, or the instruction I was given was talk about something to do with mitochondrial health. And so I sat with that, and I went I am absolutely fascinated by the concept of microchimerism. So for me, people that know me know that I'm really passionate about preconception care, and fertility and, you know, really improving the health of the next generation. 

And so I thought, well, microchimerism, to me, is where science is progressing to try to understand how we actually really influence our kids. And the mitochondria, well, let's look at mitochondrial RNA, mitochondrial DNA, and really what is transferred between parents, both father, mother, and to their child. And then sometimes there's third parties, but we'll talk about that later. 

Andrew: Yeah. 

Leah: And then the principal wisdom is, you know, I practice meditation, and I've got a really strong spiritual underpinning focus for my own life. And the spiritual transformation for me as a parent has been nothing short of remarkable, as I know it is for many. But I love how science and spirituality find a common language. 

Andrew: Yes. 

Leah: And so I really wanted to sort of put it all together, and go, this is where we're at, and this is what we can do, and really educate and motivate and inspire everyone to sort of go, there's so much that we can do before we get to conception, once were pregnant, and then afterwards. 

And the concept of microchimerism is this how we still connect to our kids, how we talk to them, even when they're not in our bodies. And it fascinates me, no end.

Andrew: I was just going to make a glib comment about, "I'm constantly talking to my kids." 

Leah: Well, you know, on that energetic level, where we know what our kids are doing, you know? Yeah.

Andrew: I know, I know. But I guess first we've got to start off with the definition. Now, chimera is monster. So, microchimerism, what's that?

Leah: Well, microchimerism is essentially when cells from another are found in another. There are two main types of microchimerism, and there's what's called vertical and horizontal. And vertical is what happens from gestation, and you basically trans-placental trafficking of cells between a mother and it's foetus. And then horizontal is something else, but that's from medical intervention, like organ transplantation, or blood transfusion, or things like that. 

So it's the idea that the cells from another person enter your body, or the other individual's body, and how long do they hang around? What do they do? How do they transform that person? And what is the crosslink of communication between the two? 

So, you can take that concept of microchimerism, and you can go, well, there is so much that we can do. And these cells hang around, so how can we consistently influence in a positive capacity?

Andrew: So, how is that different from, you know, having a maternal and paternal gamete, so that we are, you know, the offspring of both of our parents? Are you talking about whole cells?

Leah: Yeah. We're talking about whole cells, and I mean, the research...obviously, I've done a lot of research when I've been putting together the talk. And some of the research is pretty phenomenal, where there's...you divide microchimerism up into maternal microchimerism and foetal microchimerism. 

And they look at a number of populations where the fetal microchimerism, so the transfer from the baby to the mother, influences her tendency towards diseases. And they quantified it.

Andrew: Wow. 

Leah: Where they looked at the percentages of the foetal cells still present in the mother, and in this particular paper, having a higher incidence of thyroid disorders. It's really fascinating, you know? And it's looking at tendencies or, you know, aversions towards having cancers, autoimmune conditions... It's mind-blowing. 

And it's, you know, the concept of, well, if I transfer from mum to bub, how I can protect my child, how I can give them antigens and immune complexes, and help them actually to fight against things. But am I actually then giving them cells to give them, you know, tendency towards diseases? Can I move those cells? What influences whether or not those cells stay, and the volume? And that's what they're really looking at now.

Andrew: Okay, so I guess on a different level, my mind is sort of a little bit stuck on the rhesus factor. You know, if it goes to the baby, that's one thing. But if it comes back into the mother, you've got a real issue. When we're talking about a double-edged sword here, I guess, with affording some lesser chance or lesser risk of some diseases, but a preponderance for others, do we tend towards immune-mediated, maybe, protection in the baby, and autoimmune in the parent? Like, how does that work, sort of thing? Are we talking about certain cells being primed?

Leah: Yeah, and what they're thinking is that, you know, all the research nowadays is looking at that we know that the maternal immune system is extremely unique, you know? 

So, she has to down-regulate itself to accept foreign cells. And they're trying to understand what actually happens in that capacity, and why the uterus has such a propensity towards certain particular cells, and how does that regulate things? And they're discovering that that seems to be the biggest variable. 

So we know that the maternal and the foetal cells are predominantly detected in hematopoietic cells. So T cells, B cells, monocytes, natural killer cells, things like that. And so we know that if there is an influx, for example, of those cells, the body protects against having a conception, or has a higher chance of miscarriage. And so they're trying to understand the regulation of that in a mother, then how does that determine how much of the foetal cells come over and how many don't?

Andrew: Right.

Leah: And they're thinking that that is the...it's the normalising piece, there.

Andrew: As in the dose, the number of cells that come across is the thing that will determine whether an immune reaction is mediated or not?

Leah: Yes.

Andrew: Right, okay. So therefore, are we sort of lending along the lines that microchimerism is just a thing? Not necessarily a bad thing or a good thing, it's just a thing. 

Leah: Yep, it’s just a process. 

Andrew: And the terrain in which it's placed into is the deciding factor on whether it goes on...sorry, a normal response, or a pathological response? 

Leah: Yes, Definitely.  

Andrew: Is that right?

Leah: Yes. And what's really fascinating was also what was the maternal immunological response to the sperm, and then that influenced her immunological capacity, which then determined what happened to her reactivity to the foetus, as well. 

So, that harmonisation between the mother and the father…

Andrew: Yep. 

Leah: For want of a better term, really influenced the consecutive patterning that happened.

Andrew: Okay. So, let's say there was an immunological reaction happening there with the sperm, as happens. Can that be normalised?

Leah: Theoretically, yes. And so if you look at the community, or you look at the IVF community, and that's where they do some of these very...well, how should I put this delicately? Some of these very bold IVF treatments where they give women, you know, phenomenal doses. 

And I've got, like, a patient at the moment who's been put on immunosuppressive drugs to, you know...like organ transplant rejection types of drugs. And they're using the drugs at higher and higher levels, but they are getting the reaction that they're able to get implantation, and then it's going to be interesting to see what happens with the mother and the child after. 

And we don't have any long term studies, because it's all quite new at the moment. But we're certainly seeing corticosteroid usage, and blood thinning usage for a number of years, now. So we know that corticosteroid usage certainly increases risks of gestational diabetes and PCOS in the next generation, and all that.

Andrew: Yeah. 

Leah: I don't think we know what's going to happen to the immune system. Like, it's all very well that you get pregnant, but then what? 

And please, I'm going to put my caveat in here, I want to support everyone to have a baby, and there's no judgment. But I just don't know that we know what we're doing.

Andrew: That's bordering on Brave New World stuff, isn't it?

Leah: Yes. I mean, we're in CRISPR gene territory, do you know what I mean? 

Andrew: Yeah. 

Leah: Like, we're just doing it in a different capacity. But I think the more we understand the immune response in the female, and perhaps is that like... Let's go into it in a spiritual context, perhaps she just doesn't like him and doesn't want to have kids with him. And the amount of couples that I see where they have these immunological reactions within the couple, and then with the children, and then they divorce shortly after. You've got to be thinking, you know, mind/body connection and what's going on? 

But certainly, when they have these children and they're on the triad, and they're highly allergic and anaphylactic to everything, what are we doing? 

Andrew: What about conversely? What about, you know, loving parents that are obviously in love with each other, dedicated to having a child, and frustrated by their bodies just not giving them the outcome that they wish? Do you find that?

Leah: Yeah, no, absolutely.

Andrew: Yeah, so it's interesting that people who don't like each other, if they're really honest with each other, end up divorcing and all that sort of thing. Does the converse also happen? ie., are we looking at a real issue here, or just an artifactual issue?

Leah: No, I think it's a real issue. But I do think that you'll always have the couples where it's a very loving, spiritual connection, and they are wanting to have children and it's difficult for them. And it's not necessarily a reflection of their relationship. 

Andrew: Yeah. 

Leah: You know, there'll be other things at play. 

But yeah, there's a lot to be said for really, you know, working with patients to get them to sort of be honest about where they're at and what they want. 

I mean, the classic couple that saw me that said, "Oh, no. We don't want to have sex, we just want to do IVF." And you're kind of like, "Okay, you want to have kids together. All right."

Andrew: Righty-oh!

Leah: So there's extremes, and I think by the time you've seen as many couples as I have, you'll see all sorts of options. 

Andrew: Wow. Okay.

Leah: Yeah.

Andrew: That's a really interesting one. So, when we're talking about autoimmune, are there any sort of classes of autoimmune diseases that tend to affect the mother? You mentioned thyroid, what about things like arthralgias and skin disorders? 

Leah: Yeah, most of the research that I've seen are around connective tissue disorders and thyroid, they seem to be the biggest one. And there's a huge cohort where they looked at scleroderma patients, which I found really interesting. 

Andrew: Wow. 

Leah: And so yeah, it's interesting, the types of generational impact. And when you go really deep into the research, they start looking at four, five, six generations and, you know, they start getting into really cryptic scientific territory, where, you know, the first sibling will then have microchimerism with the second sibling through the mother, and then the third sibling, and how they have, like, a triple-whammy of everybody's cells.

Andrew: Oh, gosh.

Leah: And the inheritance patterns, yeah, the inheritance patterns get worse, and the inheritance patterns...sorry, the impact patterns to the mother get worse after multiple children. 

And I think that's something for us to think about when we have women, you know, when they're on they're on their third or fourth child, and very depleted. But they also are at greater risk of developing their autoimmune conditions from microchimerism impact. 

I know myself, you know, I've had plenty of women come in, and the third child is when they turn into, like, a thyroiditis crisis after delivery.

Andrew: Right. That's really interesting to me. Because, you know, my thinking at the moment is sort of oh, you know, advanced stress and, you know, prolongation of stress and raised cortisol, and there's a preponderance of genetic preponderance in there, and bang, suddenly you get symptomatology. But there may be, actually, this just sort of genetic, or certainly, RNA component that's passed on that's causing this. 

What about animal studies? Like, what do they show, with regards to this other, a preponderance to multiparous mothers having a preponderance for, you know, autoimmunity? Or, you know, what about in animals that are prolific in their generations?

Leah: They've done a lot of research in my studies, and they've tried to replicate human conditions and all that sort of stuff. And that's where they're getting the understanding… where it's still...because it's animal research, we can't take it entirely, but they're looking at cell trafficking, and trying to understand it. You know, the cell trafficking between the foetus and the mother, but in the mice studies, they're trying to see what's actually influencing things. And it's from those studies that they've started seeing the generational impact. 

And it was the original mice studies that showed that it was then, you know, sibling to...had cells from sibling one, and had cells from the mother, and, you know, the implications. And then the mother starting to crash. But it's mainly that they've been looking at it generationally because, obviously, the life span is shorter…

Andrew: Yeah. 

Leah: And... Yeah, that's mainly where we're getting it from, and then they're doing some human studies from there.

Andrew: This is really kind of like Prometheus, isn't it? Like, it's almost scary, if you wonder about it too much sort of thing. But it seems to happen as part of human evolution. 

Leah: Yep. 

Andrew: I'm just wondering about...me, sort of tending towards being a functionalist, I wonder what the function is of it, then? If it, in a normal role where there's no, you know, disease or progression, in either the mother or the child, what's the function of it? What's the current thinking there?

Leah: I think this is where we can look at the spiritual lens in the context of science. Because if we look at various cultures and tribal influences and religions and all that sort of stuff, it's the genetic sharing of energetic patterns, and it's the genetic sharing of information. And I think that in a healthy context, it's how a mother can be in another state or another country, and know that her child needs to be breastfed. 

Andrew: Whoa.

Leah: Because she will have the sensation in her body when her child needs it. I mean, I had it. I was presenting at uni, and I was in a completely different state to my son. And I called my husband after and I was like, "Yep, he needed a feed, didn't he," and he was like, "Yeah. How'd you know?" 

Because that's what mothers experience. I mean, you know when your child needs you, and this is giving us the scientific understanding. So I think it's a very clever survival mechanism, and it's a way for us to ensure, you know, from the Darwinian perspective that the healthiest genes are passing through, and we're developing immunity against things that are problematic. 

But I think that it can get out of hand, and that's where the concept of preconception care and the work that we do with clinicians is absolutely vital. And the work that we do around having a very healthy and robust immune system for the mother before she conceives, during her pregnancy, and certainly post. And I'm finding more and more that clinicians aren't as vigilant with their postnatal care for women. And I think it's really important that we really support them in that capacity because that's when things go haywire. 

You know, like whenever I speak to other clinicians, I'm like, "No, no. You do bloods two weeks after baby's delivered, and then six weeks after," because weird things happen from this microchimerism perspective.

Andrew: How many times have we said this, you know? The antenatal classes, sure. Where are your postnatal classes? I've heard it, like, once or twice.

Leah: Yeah.

Andrew: I'm in a bit of a wow situation here, Leah, because I'm just sort of waking up as to this connectedness.

Leah: Yeah. 

Andrew: And like, I tend to try and explain any sort of spiritual aspect in a physiological way. And this may be a way in which that explains at least some part of the connectedness. I mean, obviously, there's other things like habits and all that sort of thing, but...

Leah: Of course. No, of course. Yeah. And that's why I love it so much. Because I think, you know, for me, the spiritual component in who I am as a person, I love it when I can find the science to back it up. 

Andrew: Yep. 

Leah: So for me, this is...I think it's definitely a "watch this space" area, but it's such an empowering opportunity if we understand it, and we use it to really motivate ourselves as clinicians and as people. 

Andrew: Yeah. 

Leah: And then if we can change... Like, think about the opportunities that we've got here. It's amazing. 

Andrew: This is what I love about you. It's… you'll take science, and you'll bring it back to that patient in front of you. 

Leah: Thank you.

Andrew: I've got to ask, though, we talk about maternal RNA, and obviously, that's half of the gamete. There's a paternal part, as well.

Leah: Yes. 

Andrew: I was interested in a paper I glanced at. I'm not claiming that I'm an expert in this at all. But I was very interested that there's a normal delay in the...do I say the word "balance?" That basically, the first few divisions of a cell are controlled by the maternal DNA, and then the paternal DNA comes in and sort of, they work as a team. 

Leah: Yes. 

Andrew: And there's certain instances where that aspect of the paternal DNA coming in to further the cellular replication can actually be delayed by certain outside influencers.

Leah: Yes. And what I found most fascinating myself with that was just that the maternity DNA can kick out the paternal line, if she feels like it.

Andrew: So, not just sperm, not just with coitus, with intercourse, where, you know, we've read previously with, you know, a female that, let's say, has multiple partners in one...do I say the word "sitting?" In one sitting...standing line, bending, whatever. But...

Leah: She could be sitting next to you.

Andrew: Yeah, that it basically kicked...the female's body kicks out the previous sperm..

Leah: Yes. 

Andrew: And accepts the subsequent sperm as, basically, a, you know, a more suitable suitor, more suitable mate, if you like. 

Leah: Yes. 

Andrew: Now, what you're saying is not just then, but she might go, "Yeah, no. That was a wrong decision."

Leah: Exactly. Yep, yes. And that's where we're sort of looking at, you know, the mitochondrial health, and the material transfer of mitochondria and mitochondrial diseases. And the maternal line chooses most of it. 

There were two cases that came out, and they were case reports that came out last year that showed some paternal carrying of mitochondrial health. But we're sort of in a "watch this space" area. But at the moment, science is believing that it's all maternally controlled.

Andrew: Wow. So, we're all kangaroos. Sorry.

Leah: Okay, maybe? It's an interesting area. Look, I mean, when I was studying my master's, I had a wonderful lecturer, and her analogy that she gave to men...so, if a man came in, and he had high DNA fragmentation in his sperm, she'd basically sit him down and go, "Right, this is how it all works. So, you've got the egg and you've got the sperm, and if you come over to the egg with all of your garbage in the head of the sperm, the egg then stops everything, tries to clean you up, and then she cleans her own egg up, and then she enables fertilisation to occur. So if you come over with lots of garbage, she's going to run out of energy to be able to do everything." 

Andrew: Right. 

Leah: And so that always motivates guys to go, okay, I'd better do some of these things. But what we're now realising is not only does she do that, but she can actually selectively choose whether or not she accepts some of the DNA from the paternal line. That's pretty amazing.

Andrew: Yeah. So...that's pretty amazing, but also a big call-out for not just treating the female, and treating the male.

Leah: Yes.

Andrew: I mean, that's the biggest call-out I've heard, basically. Because if you want a successful pregnancy in the wife, you better not give garbage. 

Leah: Basically. And if you give garbage, you make for a more difficult pregnancy. So it all comes down to, you know, the mitochondrial health within the egg itself. The older she gets, the older the mitochondria get, unfortunately, and the lower the CoQ10 concentration, etc. 

Andrew: Yep. 

Leah: And so then she's used up so much energy to clean up all the sperm, then you've obviously got a weaker embryo, which makes for a more difficult pregnancy, which then makes your child less healthy.

Andrew: I've just tagged on to something you said then, CoQ10. 

Leah: Yes. 

Andrew: And I'll always remember, I think it was Ruth Trickey I heard it from first. 

Leah: Yes. 

Andrew: And my memory of her words were on the basis of one in-vitro study, and she used it on the basis of results that she got, that she routinely used, I think she said 100 milligrams of coenzyme Q10, as ubiquinone. And you know, it was just this bang statement. What's your call on that now, and with the ubiquinone, ubiquinol, do you care? Like, what's your call on that now? Where are we at?

Leah: So, when I've looked at the latest research, the papers even published this year, go figure...it's only March, but I found a couple. 

Andrew: Right. 

Leah: So, 600 milligrams is the recommendation. 

Andrew: Yep. 

Leah: And it's ubiquinol form, over ubiquinone form. And look, I mean, in clinical practice I'll sometimes still do a combination, but I do try and use the ubiquinol, if I can. 

Andrew: Yeah. 

Leah: But if I can get a woman to 600 milligrams, I do think that there's a much better impact, and the older she is, the higher I go. 

Basically, mitochondrial activity is all about CoQ10. So if you want that older woman's eggs to actually function, you need to give her reasonable doses. So it's interesting, you know, even mainstream CREI fertility specialists who are giving CoQ10 and melatonin. It's pretty much accepted. Probably about 10...8 -10 years ago we were all relying on very small cohort studies that were all pretty insignificant, but we've got really good data now.

Andrew: Okay. You mentioned melatonin there...

Leah: Yeah, melatonin is very, very efficient and very effective, more so for...they don't really understand how it works from a mainstream medical perspective. My lens looks at it as an antioxidant. And I think that if you do melatonin in synergy with CoQ10, you do get really powerful mitochondrial response. I do think it works really, really well. Yeah. And you only need about three milligrams a day.

Andrew: Yeah, so that's the...so, what, in Australia, the circadian, I think, is two milligrams? Is that right, the prolonged release?

Leah: Usually they do, yes.

Andrew: Okay, so what other nutrients? Are we talking about, you know methylation here, as well, which is, obviously, the favourite, iodine? You know, let's talk about maternally famous nutrients, and then we'll talk about others.

Leah: The one that I'm going to focus on next, if that's okay, is glutathione.

Andrew: Ah, yeah.

Leah: I think...because everyone kind of boxes glutathione as an antioxidant, and then they forget about it.

Andrew: Yep. 

Leah: And they sort of don't think about it. But it's...I mean, I don't think I have a patient that I don't give glutathione to, I have to be honest. 

All of the redox buffering network is all glutathione-mediated. So all the nutrient metabolism, all the quenching of the reactive oxygen species, all of the restoration of the embryo, all that sort of stuff is all glutathione-based. And it helps the mitochondria to be as healthy as it can be. And I do think that we need to give reasonable doses, you know, 400 milligrams a day is my standard dose. And as I've said plenty of times before, I do find dermal delivery probably the fastest, clinically.

Andrew: Oh, dermal delivery?

Leah: Dermal delivery, yeah.

Andrew: Oh, this is cool.

Leah: So through a compound pharmacy? I do find it's the fastest, and it's the most stable. And within two, three days a patient will tell you that they're having deep, restful sleep and they're not waking up with, like, a liver hangover, and you know that you've got the right dose. 

Andrew: Yeah.

Leah: A couple patients, you know, like if they're homozygous to CBS gene, or something like that, I'll give them a bit higher. 600, 800 milligrams, depending on weight. But big doses of that, with CoQ10 and melatonin, is the foundation of what everyone has to get, I think.

Andrew: Yeah. I remember a paper years ago now, the author was Le Maestro, and basically he was just laughing at the people who were saying that glutathione doesn't work because you're giving oral doses of two grams, and he said, "Well, you're measuring it, like, four hours after you've given the bolus dose of two grams to a rat," or something like that. And he said, "It's not there. It's not in the serum." 

So this issue of dermal dosing, however, is really interesting because...forgive me, I should explain. So, my previous thoughts were, if your gut needs glutathione because you've got a rubbish gut, it's going to be used up in the gut before any gets absorbed. 

Leah: Exactly. 

Andrew: And then it's going to be redoxed out, it's going to be taken out into the cells. So why are you measuring the serum? Dermal delivery...and I would say, therefore, obviously, and hopefully, liposomal delivery would be really interesting to look at for elevation of the enzymes. See, people always measure the glutathione. Why aren't they measuring glutathione peroxidase, that sort of thing? Like, the activity.

Leah: Yeah, totally agree. Totally agree. For me, I always feel that the clinical evidence is enough for me, I'll be honest. So, I'd love to see the paper, don't misunderstand me. But I mean, you just see the change so dramatically.

Andrew: Wow.

Leah: So, it's really...it's amazing. And people's mood is better. 

Andrew: Yeah. 

Leah: Like, I don't know if you've ever tried, like, a good glutathione, you just feel great. So I think that it's definitely worth giving. 

Andrew: Glutathione transdermally, what dose do you use? How do you apply it?

Leah: Yes. Any venous area, so inner wrists is usually the most opportune space for people. And they put it on before bed, a dose of 400 milligrams a day, the standard dose, and go higher if they're sort of homozygous to CBS, or something like that. Or if they've got really poor SNPs, for phase II detox, etc. 

Andrew: And do you tend to... Let's say you were going to apply it in the cubital area, do you have, like, an area that you use? Like a five-centimetre-squared, or three-centimetre-squared?

Leah: It comes out of syringes as mils, and so it ends up being...the pharmacy that I use, it ends up being a mil equals 400 milligrams. So that's quite a fair amount of cream.

Andrew: Yeah. 

Leah: So they end up rubbing it all on their inner wrists and up their inner arm. But as long as they get it in, I'm fine.

Andrew: Gotcha. So from the wrist to the elbow, basically, on the inner surfaces.

Leah: Yeah, yeah. Yeah. You can do behind to behind the knees, and inner thighs, if you preferred.

Andrew: Wow, that's really interesting that.

Leah: Yeah. It works really, really well, too. Yeah.

Andrew: Okay. Other nutrients, other herbs? I know that you have a definite, keen interest in traditional Chinese medicine.

Leah: Yep. I’ll pause on Chinese medicine for one tick, I think we've got to get all the methylation right.

Andrew: Yep.

Leah: So, definitely all the SNP testing for all the patients, SAM/SAH ratio to really see where their methylation's at. Understanding of folate conversion, all of that sort of information needs to be acquired. Because if methylation's not working, you can give them all this wonderful support and I don't think it will get through, and I don't think it'll work properly. 

So, you know, some patients will have, you know, five-milligram doses of B12, it's just going to be dependent on the person. But making sure that all of that is accurate so the cellular replication is stable within the parent, and you know, all the mitochondrial health around that is really, really important. 

You know, a couple other nutrients, just to sort of jog people's memory around, is obviously things like resveratrol and any of the NAD carriers, curcumin has some really, really good research that's come out.

Andrew: Yep. 

Leah: Activating the NAPK signalling pathway and antioxidant activity, and being really powerful in a very reasonable dose, obviously, as well. And preferably, I like it in a lipophilic base, get a really good dose in there and that can make some really positive changes.

Andrew: Yep.

Leah: In more of the herbal context, I think it's important to, you know, from a Chinese medicine perspective, I think it's looking at the energetics of the patient and trying to understand where they're at. 

But I think a lot of the heart warmers work really well, a lot of the blood builders work really well. I've been experimenting with a few patients, with giving them lots of moving herbs through the day to just sort of nourish the body quite a lot. And, you know, some of the ginseng families, just to get the energy and vitality of the body moving, and then at night doing lots of heart, spirit-nourishing types of formulas. You know, herbs like Zizyphus work beautifully for that, as well. And then that nourishes them and builds their energy reserves up at night, and I'm finding that it's stabilising their immune reactivity at night, as well. So the movement through the day, and the stabilisation at night can work beautifully, too. 

And then more in a Western herbal context, I think it's really important to stabilise the immune function and have really powerful antioxidant types of herbs, as well. But really making sure that, you know, you do a really good screen of any bugs, and you know, underlying viruses, and anything along those lines.

Andrew: Yep. 

Leah: So that nothing rears its head at an inopportune moment. And then that can really stabilise things beautifully, too.

Andrew: Okay. Now, just going back, I know that we're sort of going backwards and forwards with nutrients. 

But what about...you've got between complex 1 and complex 2, where CoQ10 comes in, in the respiration train, mitochondrial respiration chain, even iron. So, when you've got, like what is it, 12% of women being either anaemic or at least below the RDA of iron, how often do you use iron? Do you always test if they need iron, just to make sure there's no haemochromatosis?

Leah: I’ll always test for it. So, I'm a big believer in making sure that with women you look at their full blood count really comprehensively, and you do all the calculations, and don't ignore, like, lower levels of platelets or higher levels of platelets. 

I mean, the amount of fertility patients, unfortunately, or fortunately, just depending how you look at it, that I've met that have been not diagnosed with having a platelet disorder astounds me. And it astounds me that I'm the one that flags it. 

Andrew: Wow, yeah.

Leah: You know, just the quality of their blood, yeah? Like, so let's get down to the fundamental basics of it. If she's got excessive platelets, there's going to be a problem.

Andrew: Yeah.

Leah: So there's that aspect, and then looking at the anaemias with iron, as well. 

But I've got a few clinical things that I see that I don't have papers or science to back me up yet. Really happy to share them, but just flagging that it's my experience only, at this point. 

I'll have a lot of women where they won't increase their ferritin levels. They may even have abnormalities in their saturation and their TIBC and in iron studies. 

Andrew: Yeah, yep. 

Leah: And I'm finding that they're heterozygous for haemochromatosis, but the H gene, not the C gene. 

Andrew: Yeah. 

Leah: And my understanding, the way I justify it is that I think that the C gene produces the disease, we know if they're homozygous for it, or if they're a compound heterozygous. But I think that what the body does is if it's heterozygous for that H gene in isolation, it stops them from actually moving iron into storage. 

Andrew: Yeah. 

Leah: And so I see that all the time with women when I can't get their iron levels right, so I treat them in an over-capacity, and I give them multiple forms of iron, in multiple delivery methods, and blood building support, and then I can bypass all that. But I like to know what's really going on. 

Andrew: Yeah.

Leah: And I also have another trend of women that are coming through a lot in the last 12 months, where they've got saturation levels of like, 50%, 60% and no iron supplementation whatsoever, for years. And I'm finding that that's a diagnostic of an underlying virus.

Andrew: Ahh, right, okay. Yep, Yep.

Leah: Yeah. And it's just that the virus..

Andrew: Robbing them…

Leah: ..Has interfered with their replication and conversion of iron. So what I'm seeing is that I don't give iron routinely, I get very cautious with women that are on multis that have iron in it, even five milligrams because there could be other things going on that we need to understand a bit more definitively. 

Andrew: Yep. 

Leah: And if a woman has a virus that is, you know, inside her DNA and it's replicating for all it's worth, you go give her iron, you're just going to increase the replication. And for microchimerism, you give it back to the child.

Andrew: Yeah, it's...like, I totally agree with you. It's the one nutrient that I'm just paranoid about knowing with a blood test what's going on before supplementing with it. Just because of the damage. And it can be catastrophic. It's not just oh, a little bit overdose, it's not just a little bit over the RDA and say, "big deal..."

Leah: Yeah. And then, of course, there's some of the research around, you know, earlier incidence of Alzheimer's if you give too much, as well. So it's like…

Andrew: Yeah, that’s right, what are we doing?

Leah: You know, what are you doing? Please be careful. Yeah.

Andrew: Yeah, that's right. Yeah, what indeed. 

B vitamins? we've mentioned the methylation. Like, I still...I've gone back to the fence with this, I really have. 

You know, I was like, oh, can we please have, can we please have? You know, we haven't got it, can we please have? And in years gone by, I've normalised, let's say, homocysteine. And you know, I've seen drops with when you use just folic acid and added B12 and, and I'm not a fan of just folic acid, ever. 

So I've seen drops in that from, you know, I think it was 13, 18, can't remember now, and it got down to still high, but it got down. And then the lynch pin...sorry, then I either doubled or trebled the folic acid dose. So, we're giving five milligrams, three times a day. 15 milligrams. 

Leah: Right. 

Andrew: That's the S3, pharmacist-only version of folic acid in Australia. That budged it a little a little bit more, but not much. And then the linchpin to bring it down was actually betaine hydrochloride. 

Leah: Yes. 

Andrew: Now, of course, we've gone, oh, no, no, we don't use that bad form of folic acid because it's bad, and then what we want is the good form of folic acid. But I was recently watching... looking at a paper that showed no difference, if you used MTHF or folic acid. 

So, my question is, can you use this good old, cheap form and just barge your way through? And, is there leaving behind some bad thing that our body can't utilise in 40%-odd, 60%-odd of the population? You know, which may be causing an issue, even though it's not a devastating issue? So, should we thenfore be preferring MTHF? 

Leah: I think...the first thing that I think of with this is that every patient that I see I do SNP testing. I do that, I do a methylation profile for everybody. I want to see what their body's actually doing before I give anything. 

Because the amount of times where I've had someone sitting in front of me, and yes, they may have a high fasting homocysteine, or it might be something else. And unless I know what's going on sometimes I'm surprised, you know? Sometimes the body is doing something else that I didn't anticipate. I like it when I'm surprised because it makes the tests more warranted. 

Andrew: Yeah. 

Leah: But I'm a big believer that...and I speak to clinicians about this all the time, my treatment, my time to get to the outcome that I want has shortened by at least six months, since I've done more testing.

Andrew: Right.

Leah: So I talk to the patient about it and I say to them, "We either do the testing and we shorten the treatment by six months and we get there faster, or we ignore the testing, don't spend $1,000 or whatever it comes to, but in nine months time we may not have nailed it." 

Andrew: Yep.

Leah: Every single person wants to nail it straightaway. So if any clinician is out there and they're apprehensive about the patient paying that amount of money, trust me, it works. Your treatments are all going to improve so much faster, it's worth the money. And so then I don't have a problem where I'm looking at a patient, going, "I've just given you high doses of folic acid without it's co-factors." You know, sometimes I wouldn't have expected how much B3 they needed. Or sometimes I wouldn't have expected how much magnesium they needed, or betaine, or TMG, or whatever it might be. But I wouldn't have the confidence without the testing.

Andrew: Yeah. 

Leah: And something that I...I mean, I always think of myself when I say to patients, as I talk to them about methylation, there's a big chunk of methylation that we don't have the science around yet. 

There are a couple of pieces that I've got big question marks around, but we just don't have the science. I've got enough knowledge that I can get medical/clinical outcomes, but I think there are a couple of cases that we still don't know. 

So, without having someone's THF, folinic acid, methylated folate levels in front of me, I'm not confident to go, "I'm just going to give you methylated folate." Does that make sense?

Andrew: So, you know... Yes, it does. And indeed, you know what, maybe the problem with the paper was that they were looking at one nutrient rather than a cycle, rather than biochemistry.

Leah: They're not looking at the biochemistry of it. And they're not looking at the co-factors that go with it, and they're not looking at...

Andrew: Yeah. They're looking at a medicine. Yep.

Leah: They just going folic acid, this worked, methylated... Well, maybe the methylated would have worked if you'd actually fixed the fact that they, you know, are homozygous for MTR and MTRR, and do you know what I mean? Like, all these other B12 variables that you hadn't addressed. They're just looking at it purely as substance – dose. And there's merit in that. Please, science...God, it takes forever to do papers, and…

Andrew: Yes, I think you know that. 

Leah: Yeah, my God, I do. But I just think that, you know, we've got these opportunities to really do individualised medicine justice, let's use them. 

Andrew: Yeah. 

Leah: And trust me, clinically, you get the response so much faster. And I feel more confident. And if I'm confident, the patient's confident. And then it's a win-win.

Andrew: You mentioned a few things in the... a few Chinese medicine herbs, and you know, heart warmers and blood builders. But what about nutritional goals for diet? Like, do you tend to use more warming foods, more nourishing...you know, one might even think stodgy type foods? More soups, more you know, hearty sort of meals for women in need? And do you tend to sort of vary that, with regards to what their treatment needs are?

Leah: I'm... Absolutely. I'm a big believer in seasonal eating, and where the person is at. 

Andrew: Yep. 

Leah: And so I feed in where they're at emotionally, as well. So if someone's going through a period where they're feeling very depleted, and they don't have the, as I put it, the ‘muscle’ to get through something that they're working through.

Andrew: Right. 

Leah: You know, maybe they've gone through 10 failed IVF cycles, and they're really just beaten down. They'll need nourishing foods. So it might be a cup of bone broth every day, and it might be warm stews, and it might be, you know, fiery teas and things to warm their body up and build their blood up so that they have the energy to be able to go, "I can do this, and I can make this baby." Because a woman has to be blood-rich and blood-nourished to be able to hold a child. 

Andrew: Right. 

Leah: But similarly, you know, they may have gone through something and they need to shed, you know? And that's where I reduce protein intake, and I won't be pushing protein, and I'll be saying things like, "Okay, let's lighten it up, let's do some time-fasting, let's do juices, let's do cooler food," whatever it might be. 

Andrew: Yeah. 

Leah: "Your body just wants to shed now because that's what you're emotionally at, and then let's work through it that way." And for me, you know, I don't think anyone has a fixed diet, and I don't think anyone has a fixed diet every day. And it's about really attuning yourself to where the person is at, what their needs are, what their life goals are? What their support is around them emotionally, practically, etc., and going, "Okay, I'm going to tailor that food for you, to meet that goal, to achieve it. And then we'll go to the next stage together." 

Andrew: Yeah. 

Leah: I think it's a beautiful thing to do when you're seeing a couple, as well, you know? Like, so they come to you, and they're usually quite broken. Well, I tend to see the broken ones more than not, I think, because of waitlist, and all the stuff that I have. 

And they're quite broken, and the unification of the food choice and the nourishment choice can be so powerful for them as a couple, to just sort of go, you know, I'm going to make the bone broth today, you can make the stew. Or, we're going to nourish each other because we're going to nourish the energy to bring a child in. We're going to nourish that feeling between us to go and rebuild ourselves and be able to create something from ourselves. 

You know, by the time they get to me sometimes, they've been through so many cycles and so much heartache, they're just broken. And it's crazy, you know, but the shared meal, the shared cooking, the shared experience around the energetic of the food makes so much difference.

Andrew: Yeah, absolutely. And that was my next question, about you see patients when they've been through all of these cycles, and they're indeed, they're devastated, they're broken. Not just their body, but their mind has now broken. 

Leah: Yep. 

Andrew: So, how much emphasis do you place on...when we're talking about microchimerism, transfer of mum to bub, of bub to mum, and everything encompassing that, how much work do you do with just regenerating their resilience, their emotional resilience?

Leah: I think the most important thing that I do, and this is bringing the spiritual in again…

Andrew: Yep.

Leah: Is we talk about firstly, do you still see yourselves as parents? Do you still have a "yes" in you to keep doing this? And secondly, do you feel a child with you? 

Andrew: Ooh, wow. 

Leah: And that always evokes a lot of tears and a lot of emotional discussion. I have a rule of thumb myself that I find it very hard to support couples if I don't feel a child with them. That's certainly not a skill that we learn in our training, that's just something else that a lot of people have, as clinicians. It's rare for me to not be able to see it, but if I don't see it, then I move them a little bit quicker to maybe something like the donor cycle, or I move them a bit quicker to being open to other options and choices. 

Andrew: Yep. 

Leah: And I'm always conscious that things can change, and, you know, I can just help them, and then a baby goes, "Yeah, I want to be there." But I remind them that they feel a child with them. They may be dreaming about them, they may just have a sense of them, you know, the sex that they might be, whatever it is. But that just brings them comfort and reminds them that there's a bigger thing that's going on here. 

You know, and I crack jokes like, you know, well, maybe your child just wants to be a Leo, or something like that, you know. Just that the child has an idea of when they want to come. And I spend a lot of time counselling patients around that idea of spiritual preconception, which is your child wants you to be a certain person, to be able to be the best parent for them. And that might mean that you have to go through this hardship before you can actually carry them and be that parent. And it might be a humbling experience, it might mean that you need more humility. You might need to let go of more crap, you might need to do all sorts of things. But then you're going to be the parent that this child needs, so that they can be the best that they can in their life. Which means it's all been worth it, you know? It gives them a sense and a lens of meaning for the hardship that they've experienced, and it helps them realise that when they meet that child, that they're at the right place and the right time. 

Andrew: Yeah. Wow.

Leah: Yeah. And that, you know, and I stretch that with them, which is, you know, each pregnancy will be different, and it will tell you about the child. And each labour is more about the child than it is about you. And you know, a woman can have five kids, and she'll have five different labours, but it tells you about the personality of that child. 

And, you know, bringing it back to the microchimerism, which is such a gift to be able to carry these children because you get this insight, you have their cells in your body, which is the insight of who they are so you know...you know how to guide them. You know how to be their parent. So that that sort of ties you, in that microchimerism, so that they understand. Science has a bit of a language for it now.

Andrew: Yeah. 

Leah: And then they can do it.

Andrew: Yeah. So, not only are we now scientifically allowed to call our offspring ‘little monsters,’ but that that can be a good thing, not necessarily a derogatory thing.

Leah: It can be. We hope so.

Andrew: This is really amazing. I've got to say, Leah, you know, we really need to be attending MINDD. Not just for your talk, I have to say, MINDD, the MINDD forum, and Leslie Embersits. Wow, what an incredible job she's done in helping parents, families, practitioners to help families with people with neuro-developmental issues. 

But I really think, you know, if you want to understand more about this microchimerism issue and how it can be both good and bad, you've really got to be attending The MINDD Forum 2019

So... And thank you, just for being you. Because you don't just talk science. I know you've finished your masters, you're now doing your PhD, you're totally immersed in this. Yet you retain your humility and humanity, always, for your patients. And I really do admire you for that. 

Leah, thank you so much for joining us on FX Medicine.

Leah: Thank you, Andrew. Really appreciate it.

Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook.

Additional Resources

Leah Hechtman
Mindd Forum International
Book: Clinical Naturopathic Medicine by Leah Hechtman

Research explored in this episode

**Coming soon.. please check back. 


Other podcasts with Leah include:


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FX Medicine Podcast
FX Medicine is at the forefront of ensuring functional and integrative medicine gains the recognition it deserves and ultimately establishes itself as an integral part of standard medical practice. Hosted by Andrew Whitfield-Cook, our podcasts are designed to promote research and evidence-based therapeutic practises, acting as a progressive force for change and improvement in patient health and wellbeing.