Listen to our interview on the podcast:
Dr. Alex Carrasco is joining me today on the Egg Whisperer Show to answer our questions about the gut and fertility connection. These are two topics that come up often with fertility patients, and she is an expert.
Dr. Carrasco is board certified in both family medicine and integrative and holistic medicine. She is a certified practitioner by The Institute of Functional Medicine and has spent the last decade studying nutrition, integrative, preventative, and functional medicine.
She’s married to another doctor, a local dermatologist, and they have three children. Outside of medicine, she loves to garden and read.
Dr. Aimee: Thank you so much for joining us today, Alex! You’re a busy mom and more than that. Share with us about your blog, your book, all that kind of stuff.
Dr. Alex Carrasco: Thank you. When I started medical school, I had an interest in indigenous wellness. In my Latino upbringing, there was just a lot of folk medicine that was passed down, so I had a lot of interest in herbal medicine and in other types of healing that already existed.
When I was halfway through medical school, I suddenly developed panic attacks, and fainting episodes, and irritable bowel syndrome, and migraines. I had a great medical team that did amazing million-dollar workups just to find that nothing was wrong and that I was probably just stressed. They said maybe you just need to go on anti-anxiety medicine, IBS medicine, migraine medicine, and go on your merry way. I felt like there was more to explore, but no one could give me answers.
I took a year off between medical school and residency, and I found functional medicine during that time. I went to a CME course and it was all about food as medicine. It blew my mind, because here were physicians that were presenting studies about food sensitivities, inflammatory markers, the role in the gut, migraines and food and the gut.
I just was like, “How is this possible that I didn’t learn any of this in medical school?” I knew I needed to learn more about it. It really changed my life. I threw myself into that study the year that I was in between my medical school and residency.
Then I went to residency and did family medicine. In residency I got pregnant with my first child. As I’m sure happened with many healthcare providers working 80 hours a week, taking COQ3-Q4, I had a terrible case of preeclampsia at the end of my pregnancy. I developed it on call and had to leave to go to another hospital. I was bedbound for a couple of weeks and then I was induced 22 days early. My daughter was healthy, but I had postpartum hemorrhage and had to have a blood transfusion, and then I had a transfusion reaction.
After that experience, I got really passionate about preconception health, pregnancy health, postpartum health. I think that everything that I experienced drove me to wanting to help people have not just status quo outcomes, I wanted exceptional outcomes. I wanted better outcomes, I wanted better for myself and better for my patients and better for women.
So, I started a practice in 2012, pooling together all of the information that I had studied over the years with an integrative medicine and functional medicine approach. Then in 2017, I wrote a book because I felt like I wanted to have a roadmap available for people that couldn’t come and see me that laid out for them the way in which I see health and the way in which I try to help people cultivate health.
Dr. Aimee: What’s the name of your book?
Dr. Alex Carrasco: My book is called Bloom: 7 Steps to Reclaim Your Health, Cultivate Your Desires, and Reignite Your Spark.
Dr. Aimee: Awesome. And, you also have a podcast?
Dr. Alex Carrasco: I do. After I had my third child, my best friend (who is also a functional medicine physician) and I started a company called Hey Mami. We wanted to support women through the whole motherhood experience, from preconception all the way through motherhood. We were seeing people through the whole spectrum in our private practices and just wanted to have a resource for people that wanted a more holistic experience, a more nutritionally guided experience, and we wanted to be a bridge between two worlds.
We’re very proud to be allopathic physicians trained in medicine, but also feel like there is space for more holistically minded therapies, so we kind of created that, we were kind of standing in that bridge space.
Dr. Aimee: I love it. Tell us about gut health. What is it, for someone who has no idea what it means?
Dr. Alex Carrasco: Gut health is a very buzzy topic right now. Let’s just start with the fundamentals. We all have a microbiome, which is basically all of the bacteria that live on and inside of our bodies. In the digestive system alone, there are over a hundred trillion bacteria that live within us. We’ve barely just started researching and understanding just the tip of the iceberg as far as microbiome goes.
Not only is it bacteria, it’s viruses, it’s fungi, it’s protozoa that live within us. It’s the interaction of these things within our body that then can either drive health or it can drive disease. We know, for example, that microbiome plays a big role in chronic illness, developing allergies, mood, and many other things.
If you are wondering if you have gut issues, a lot of times people come in complaining about having gas or being bloated, or having constipation, or having diarrhea, or swinging between the two. We know that there is an interaction between the microbiome and weight gain or obesity. We know that there is an interaction between the microbiome and energy levels, risk of autoimmune disease, immune system function. Chronic skin diseases can be a reflection of microbiome status, and inflammatory diseases as well.
It guess it can feel a little bit like a rabbit hole. Taking care of gut health is so important because it really is the seat of health, it’s a foundational aspect of how interactions and inflammatory reactions happen in our body.
Dr. Aimee: How do people know if they have poor gut health and should get help with this problem?
Dr. Alex Carrasco: I think probably the main symptoms that I see are that they get super bloated after they eat, or they struggle with constipation, they struggle with diarrhea, where they feel like they can’t make it to the bathroom in time. Constant gas. Even reflux can be a symptom.
Then there are other issues that people can have that are not necessarily GI related. Sometimes some of the more malaise like symptoms of fatigue, headache, and skin rashes can also be a reflection of what’s happening in the microbiome of the gut.
Dr. Aimee: How about its effect on fertility? Is there any evidence that they’re connected?
Dr. Alex Carrasco: I wouldn’t say that there is an exact correlation, but we know that there can be an issue between the gut microbiome and inflammation. We know that sometimes infertility can be caused by inflammatory processes. In my perspective, the more that we can do to decrease inflammation within a patient, the less that they have to fight that issue and then their body’s resources can go towards fertility.
Dr. Aimee: What about getting pregnant and having a healthy pregnancy? You mentioned your own story with preeclampsia. Why would it be important to address gut health before pregnancy and even in pregnancy?
Dr. Alex Carrasco: We know that the microbiome or gut health can play a role in pregnancy outcomes. We know that there is an increased risk of preterm birth when there are excesses of dysbiosis or bad kinds of bacteria. We know that there is an increased risk of preeclampsia. We also know that there is an increased risk of gestational diabetes. We also know that there is an increased risk of weight gain during pregnancy. All of this can be related to microbiome effects.
My stance has always been that if we can build the microbiome up in the preconception period, you have a much better chance of having an outcome that is positive throughout pregnancy.
For multiple reasons, I think it’s really important to build up the microbiome as much as possible in a healthy way before pregnancy.
There are definitely things that happen that you can’t control. Some people have Group B strep infections and that has to be treated before you deliver. Some people have to have a C-section, and that can be distressing to people, especially because then your baby is not necessarily getting that microbiome.
Dr. Aimee: For people who don’t know what microbiome actually means, what is it?
Dr. Alex Carrasco: It’s basically the trillions of bacteria, fungi, viruses, and protozoa that live within the gut. They also live on our skin, but we talk about it mainly as the whole symphony of creatures that live within us.
Dr. Aimee: How can you restore gut health for someone who is not necessarily trying to get pregnant, for someone who is trying to get pregnant, and for someone who is already pregnant?
Dr. Alex Carrasco: I would say that probably nutritional approaches are the best ways to do this. Number one, I would say you want to eat probiotic rich foods. Things like sauerkraut, yogurt, kimchi, lacto-fermented vegetables beyond sauerkraut. You can also make this at home.
It’s good to eat prebiotic rich foods, things like onions, leeks, garlic, jicama, dandelion greens. These are foods that have fibers that can act as a food source for probiotic bacteria, for the healthy bacteria in the gut.
You can also eat foods that are fiber rich and that have resistant starch. These are things like beans, nuts, seeds, and whole grains. Then there are foods like potatoes, cold yuca, or green bananas which have resistant starch and they also feed the friendly bacteria in your gut.
One thing that I want to mention is kind of a hypothesis that I have. When I think about my grandparents’ generation, my grandmother lived to be 103 years old and never “exercised” a day in her life. Her generation didn’t think about health in the way that we do, but there were so many traditional foods that were eaten culturally in her time. I think that we’ve lost these old methods of cooking, which were beneficial to gut health.
Fermented foods were a staple of many cultural diets. People also consumed a lot of gelatin rich broths which were very good for the gut mucosa. I really believe that there might be a correlation between this incidence of increased gut issues with this change of traditional foods that we just don’t consume anymore.
Dr. Aimee: Interesting. In essence, it’s a lot more than just “take a probiotic?”
Dr. Alex Carrasco: Yes. I think taking a probiotic is great. And, there are so many other things that we can do. Taking a probiotic will be useful, but you also have to feed those healthy bacteria in the gut.
The other thing is supporting a healthy stress response. If you’re going through infertility treatments and releasing inflammatory stress hormones and chemicals such as norepinephrine, cortisol, and cytokines — those can play a role in upregulating inflammation. We know that high cortisol plays a role in the microbiome and you can get increased expression of pathogenic or dysbiotic bacteria when there is high cortisol present.
Also, avoid antibiotics as much as possible. They’re absolutely useful if you need them, but a lot of times people will take them gratuitously. Be sure and have a conversation with your physician about the necessity of antibiotics in your situation.
Then I think taking a high-quality probiotic is very good insurance, but it’s not just that one thing, in my experience and in my opinion.
Dr. Aimee: Patients ask me all the time what brand I recommend. Is there a particular brand that you recommend to your patients?
Dr. Alex Carrasco: There are many different ones. I really like Ortho Biotic. Ortho Molecular is the brand, but the Ortho Biotic Probiotic has Lactobacillus, and Bifidobacterium. We know that those two strains of probiotics are very important for longevity, vaginal health, and baby health. That’s my go-to.
Dr. Aimee: What about during pregnancy as well, are they the same probiotics that a pregnant woman could take?
Dr. Alex Carrasco: I think so. There is controversy with probiotics during pregnancy, so be sure to ask your OB. They’re generally well tolerated as long as you have a healthy immune system. And remember to have a diverse diet as well, so that you can feed those good guys.
Dr. Aimee: What testing do you do on your patients to study their gut health to see if there is improvement over time? Are there tests like that available?
Dr. Alex Carrasco: There are different kinds of testing. There is testing that looks at the DNA, a stool study that looks at the DNA within the gut and gives you a broad idea of what is overgrown and what pathogens exist. There’s also stool cultures. There’s also ova parasite testing that can be done with microscopy. It really depends on the patient. There’s also testing that can look at if there is an overgrowth of yeast. There’s also testing that can look at if there is SIBO, which is small intestinal bacterial overgrowth.
It really depends on symptomatology, but yes, it can be assessed, and it can be tracked and followed over time.
Dr. Aimee: I imagine that you’re talking about an area of health that a lot of people haven’t even thought about. For patients who don’t live in your state, would they still be able to benefit from your expertise?
Dr. Alex Carrasco: Well, they can read my book, and I have a great chapter in there about the gut. I’m practicing in Texas, but if you go to The Institute for Functional Medicine website, you can find doctors within your state that are practicing functional medicine or that are licensed in your state.
I think that there are things that everyone can do that don’t necessarily require working with an expert. I think there are very basic things, like many of the things that we discussed today. Also, I have a lot of that outlined in my book as well.
Dr. Aimee: I love it. The name of your book again?
Dr. Alex Carrasco: It’s called Bloom. You can look it up on Amazon with my name, feel free to download it or to purchase it.
Dr. Aimee: What’s the most important thing you’d want someone to know about their gut health who is trying to conceive right now?
Dr. Alex Carrasco: The more that you can do before you get pregnant to support your gut health is helping to set yourself up for success. There are many things that we can’t control in a pregnancy, but I think that building up your microbiome beforehand just sets the stage for a very healthy gut so that then your baby, if you have a vaginal birth or even if you have a C-section birth, your baby can get your gut microbiome and also benefit from that work that you’ve done.
Dr. Aimee: I agree. Thank you, Alex, for coming on. I really appreciate all of the information you’ve shared with us.
Dr. Alex Carrasco: Thank you.
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