Common Nutrient Deficiencies In Postnatal Depletion
During my time in clinic working with Dr Serrallach and treating mothers with Postnatal depletion, I learnt that the first step in the repletion plan is rebuilding your micronutrients. This will involve blood tests to check your levels and then possibly a six week course of oral supplements followed by retesting. Supplements are often needed because there is a loss of mineral and vitamin density in food due to poor soil mineral content and long term storage of foods. So foods are good at maintaining levels but can be poor at replacing levels of vitamins and minerals. Once your depletion is on its way to being cured, you’ll be able to get the micronutrients you need from nutrient dense foods.
Micronutrients are the vitamins and minerals that help regulate our metabolism. They are needed for healthy growth and development and are found in the foods we eat and with vitamin D, in the rays from the sun. They are called micronutrients because you only need a very small amount of them.
Dr Serrallach believes that to rebuild, repair and replace, we need these micronutrients not just in adequate amounts but also in a good balance in relation to one another. Prenatal multivitamins aren’t enough because they are all about ensuring the baby is healthy, they don’t provide enough for the mother’s optimal functioning.
When you have Postnatal depletion, these are the important micronutrients you need to restore, in descending order of importance (from The Postnatal Depletion Cure, p.57);
Iron
Zinc
Vitamin B12
Vitamin D
Copper
Magnesium
Trace elements including iodine, selenium, molybdenum and manganese
Other B vitamins
Vitamin C
Fat soluble vitamins, especially vitamins A, E and K2
In the book The Postnatal Depletion Cure, there are assessments listing various different symptoms associated with particular nutrient deficiencies and you can also see your doctor and ask for the recommended tests to check your levels.
Blood tests should include full blood count, iron studies, electrolytes including corrected calcium and liver function tests, thyroid function tests including free T3, free T4, TSH, reverse T3 and thyroid antibodies, vitamin B12, 25-OH vitamin D levels, plasma zinc, serum copper, ceruloplasmin, homocysteine and whole blood histamine. Urine tests should include morning spot iodine and 24 hour urinary magnesium.
With your provider you can work out an appropriate treatment plan incorporating supplements based on your test results.
“Postnatal repletion is all about improving the internal environment of your body so you can restore what went missing when you became depleted. When you look at the process of pregnancy, childbirth and breastfeeding, your body’s demand for micronutrients — vitamins and minerals — is huge. Add the stress of sleep deprivation, which through hormonal reasons can add to your depleted load, and you will have a big “debt” of micronutrients to pay back. The placenta seems to show preferential treatment to the developing foetus when it comes to micronutrients and macronutrients. Whatever the baby needs, the mother supplies ... often leaving her lacking enough for herself.”
Common supplements recommended include —
1. Iron
Intravenous iron infusion only for severe iron deficiency if clinically indicated. Afterwards, switch to oral supplementation such as iron glycinate. The new generation of iron supplements are easily absorbed throughout the digestive tract and do not have the typical side effects of constipation, dark stools and nausea.
2. Zinc
For patients with low levels of zinc, a baseline dose of 25 mg zinc picolinate or zinc citrate is recommended as a replacement dose. Recheck zinc levels every 3 months. The only long term downside of zinc supplementation is the potential for reducing copper stores (which is not such a bad outcome as most postnatally depleted mothers have excess free copper in their systems).
3. Vitamin B12
If vitamin B12 is low, a single intramuscular injection of methyl B12 (10mg) can be given, or a sublingual spray of liposomal methyl B12 (1000 micrograms) daily for one month. Once your stores of vitamin B12 are restored, your body can remain topped up for up to 2 years.
4. Vitamin D
For vitamin D deficiency, Dr Serrallach recommends a much higher replacement dose at 5,000 (IU) of vitamin D for 6 weeks and then a retest. For women who are severely deficient (50nmol/L) should talk to a doctor about the possibility of an intramuscular injection of 600,000 IU of vitamin D, which usually lasts for a year. For women with only mild deficiency or low normal levels of vitamin D, I recommend 15-20 minutes of morning sun with the face protected and the belly and thighs exposed, 3 times per week. You can make 20,000 IU of vitamin D this way. After those 15 - 20 minutes, cover up or apply a high SPF sunscreen. Do not get into water or shower for at least 10 minutes after your sun exposure, as you can literally wash off the vitamin D that has just formed on the surface of your skin. If you burn easily, then supplements are a better source of vitamin D than the sun.
5. Copper
Copper deficiency, like iron deficiency, classically causes anaemia and is related to malabsorption, but this is rare. More commonly in Postnatal women there is excess copper which can contribute to overwhelm, anxiety and depression postnatally as well as causing inflammation. It also indirectly reduces iron absorption, contributing to fatigue, and impacts the efficacy of zinc and magnesium. Treatment for copper excess typically consists of 6 weeks of zinc loading then, while continuing the zinc, adding the trace element molybdenum.
6. Magnesium
One of the most important nutrients for mamas — it makes sure everything works properly. The proper functioning of calcium, iron, zinc and copper all depend on magnesium doing its job. If women are depleted, 400-500mg of elemental magnesium (citrate, malate or glycinate) daily can help rebalance levels and help with sleep, muscle tension, agitation, poor concentration and memory and fuzzy brain function. Retest levels every 3 months. Using magnesium sulfate as bath salts or a foot soak can also be a fantastic way for mamas to relax.
7. Trace Elements
The 4 most common trace elements that are depleted in the postnatal period are iodine, selenium, molybdenum and manganese. Typical treatment protocols include 100-200 micrograms iodine daily, 100-200 micrograms selenium daily, 200-300 micrograms molybdenum daily and 5-10 mg manganese daily. This may come as an over the counter multi mineral supplement or an individualised script through a compounding pharmacy. Levels are retested in 3 months.
8. Other B Vitamins
B vitamins are involved in energy production and maintaining a healthy mood. To be useful, these vitamins need to be activated inside the cells and the only way they can get there is if you have adequate levels of zinc and all the other trace elements. Usually recommended is a general, activated B-complex supplement. Look for one that has vitamin B9 (folate) as folinic acid or 5-MTHF.
9. Vitamin C
In postnatally depleted women, usually doses of 1000-2000 mg vitamin C daily for 6-12 weeks is recommended depending on symptoms. Liposomal vitamin C which is absorbed orally is wonderful for getting such high doses. Ideally, patients transition from vitamin C oral supplements to foods that are high in vitamin C. If you take too much vitamin C, the only side effects you get are gurgling intestines and loose stools.
10. Fat Soluble Vitamins A, E, K2
Vitamins A and E can be easily measured with a blood test, measuring vitamin K2 is not easily available. When a patient is depleted, recommended doses are 5000 - 10000 IU vitamin A daily for 6 weeks, vitamin E dosage range is huge and needs to be individualised, and the minimum RDA for vitamin K2 is 60 micrograms daily for a pregnant or breastfeeding mother. It’s usually easy to reach these amounts in the food you eat if you include free range eggs, aged cheeses and fermented foods. Nattō, or Japanese fermented soybeans, are particularly high in vitamin K2.
Closing thought..
Obviously, every woman is different and every case of Postnatal Depletion needs to be approached individually. Appropriate testing can allow personalised formulation of treatment protocols and follow up testing with your doctor. Addressing micronutrient deficiency is just the first step in postnatal repletion and will help women feel less overwhelmed with more energy to face the diet and lifestyle changes which are recommended to treat Postnatal Depletion.
Camilla x