216. Dr. Labib Ghulmiyyah: On How To Prepare Your Body for Pregnancy, Fertility Decline, and Preconception Health

0:00Dr. Labib Ghulmiyyah:One thing I tell patients before they get pregnant is to prepare for the pregnancy as much as they prepare for their wedding. And I think also one area that we forget to talk about is the preparation of the men for the pregnancy.

0:12Gary Brecka:I love what you say about preparing the husband along with the wife because I think that spousal support is so critical.

0:18Dr. Labib Ghulmiyyah:It's a two-player game. It can be one person. And I think we throw pregnancy on women and men should play a role. And being supportive, and when you have this support, you will make a difference.

0:27Gary Brecka:Pregnancy is also a time when women are supposed to be elated and joyful. The pregnancy glow, it's really supposed to be a time that they enjoy.

0:35Dr. Labib Ghulmiyyah:So that's how I imagine a perfect pregnancy, preparing the men, preparing the women on all those important pillars. From their nutrition, their movement, their sleep, their stress, their family support, which is extremely important. There's so much advice for women that are pregnant, but there's so little medical advice for them. That's why, you know, I got into more the functional medicine and started asking why and why. So pregnancy is a miracle. It's another human comes out of a human and then instinctively they can raise them.

1:05Gary Brecka:Once a woman is pregnant, what does an ideal healthy pregnancy look like?

1:11Dr. Labib Ghulmiyyah:To answer you as far as the pregnancy is concerned, I think...

1:26Gary Brecka:hey guys welcome back to the ultimate human podcast i'm your host human biologist gary brecca where we go down the road of everything anti-aging biohacking longevity and everything in between and today's guest is going to have special appeal to my staff because i've got a lot of pregnant women on my staff and you know he is a board certified in obstetrics and gynecology he's also additional certifications in functional medicine and nutritional medicine. I cannot wait to unpack this podcast because it's so germane to the conversation we've been having here in Saudi Arabia so far. Just a lot around diet, lifestyle, spiritual well-being, and the aspects of health that are non-pharmaceutical, non-chemical, and non-synthetic.

2:13Gary Brecka:And so this is going to be an amazing, amazing discussion. I'm really excited about this. Welcome to the podcast, Dr.

2:18Dr. Labib Ghulmiyyah:Labib

2:19Gary Brecka:Kumaya. Correct. Excellent. I got it right. From the first trial. All right. For the first trial. Dr. Labib, I'm so excited to get into this topic because just jumping right into pregnancy with women, there's so much advice for women that are pregnant, but there's so little medical advice for them. I mean, we don't do randomized clinical trials on pregnant women because nobody wants to mess with a woman while she has a fetus in the womb. I constantly am asked the question, can I take this during pregnancy? Can I take that during pregnancy? And there's very little evidence for us to fall back on.

3:00Gary Brecka:We have clinical trials on just about everything, but we rarely do them on women while they're in the process of bearing children. Right. So what does a healthy pregnancy lifestyle look like? You know, most women are so stressed about getting pregnant. And then when they conceive, now the stress shifts to, am I doing everything right to care for this, you know, fetus while it's in the womb?

3:27Dr. Labib Ghulmiyyah:Well, you know, one thing I tell pregnant patients or ideally before they get pregnant to prepare for the pregnancy as much as they prepare for their wedding. Wow. You know, sometimes weddings take six months to prepare. You have to do the same thing for pregnancy, but a lot of times, unfortunately, they come in already pregnant.

3:44Gary Brecka:Well, what does that look like? Let's back that up a little bit. What does it look like ideally moving into healthy pregnancy?

3:49Dr. Labib Ghulmiyyah:Ideally, of course, we touch on all the pillars of health, from their nutrition, their movement, their sleep, their stress, their family support, which is extremely important, their connection. So we try to get into all of those pillars and to be honest you know even me being an ob gyn and i did the fellowship in maternal fetal medicine which you know involves only high-risk pregnant patients we were never trained in you know addressing all these pillars but of course you know with time you know i learned that these are so important so basic and there's no doubt that they make a difference in the outcome of the pregnancy prevention preparation because you know i you know maybe I'm biased but because most of my pregnant patients are high risk so we see a lot of preeclampsia preterm labor gestation diabetes and I can tell you from the patients who prepare for the pregnancy they have less of those of course this is not a randomized trial because you know it's difficult to do randomized trials in pregnancy but no doubt preparing like you're preparing for a marathon like you're preparing for an exam you have to be ready and I think also one area that we forget to talk about is the preparation of the men for the pregnancy.

5:02Dr. Labib Ghulmiyyah:Wow. Because, you know, we assume. Yeah, let's talk about us. Yeah. We got to go through this too. We assume that, you know, she's carrying the pregnancy. Yes, of course. But again, he's giving half of the genetic material and this genetic material can epigenetically change in the womb. I know you talk a lot about epigenetics and during my fellowship, I did a lot of animal studies on epigenetics, on mouse models that were hypertensive and not hypertensive. and you would see the offsprings and their outcomes. And we see this going from one generation to another of mice. Of course, we assume the same thing happens in pregnancy and humans.

5:37Dr. Labib Ghulmiyyah:But men are important because they're giving the genetic material, they're supporting their partners throughout the pregnancy. And then after delivery, you know, it's stressful too. I mean, they have to, you know, be there, you know, help during, you know, breastfeeding, supporting their partner. So it's a two-game, you know, it's a two-player game. It can be one person. And I think we throw pregnancy on women, and I think men should play a role. And them being supportive, and when you have the support, you will make a difference. And I'm sure physiologically, their physiology will improve when they see support, when they see someone caring for them.

6:16Dr. Labib Ghulmiyyah:So that's how I imagine a perfect pregnancy, preparing the men, preparing the women on all those important pillars. And then, you know, throughout the pregnancy, you will do your prenatal care and, of course, try to fix or optimize any of your nutritional deficiencies and get to those. one area and i know you like this and i love and that's why i follow you is you know the biology of you know our genes and who needs to be tested for genetic mutations and all of that neutrogenomics and all of that these are important but unfortunately it's not easy to do on on everyone and a lot of times they come in already pregnant and um and because of traditional medicine you You know, we're taught not to do those tests.

7:05Dr. Labib Ghulmiyyah:Right. And why? I don't know. And I feel like sometimes we just follow what we were told. Right. And you have no time. Standard of care, we call it. Standard of care, exactly. Evidence-based medicine or, you know, legal medicine. We're worried that, you know, this is going to go into a medical legal thing. So we follow what ACOG or what SMFM tells us and that's it. Yeah. And I think sometimes, I mean, it's good to have guardrails.

7:32Gary Brecka:Yeah, of course. But also the practice of medicine, especially under the, you know, the FDA, is really meant to be in the hands of the practitioner. You know, you don't have to follow FDA guidelines. You have to follow the regulations, but you don't have to follow the guidelines. There is guidelines. I mean, that's why we have off-label medications and off-label use. People wouldn't use Propecia for male pattern baldness if you weren't allowed to practice outside the guidelines. And, but I think there's a prevailing wisdom that there's, in medicine anyway, there's only one way to do everything, right?

8:11Gary Brecka:I mean, in California, your license can be at risk even if you go against the sort of state outlined dogma. And at what point the state was able to decide the practice of medicine when the practitioner is interfacing with the patient, to me, seems pretty myopic.

8:29Dr. Labib Ghulmiyyah:This is assuming everybody's the same and we are not the same. Everybody is genetically different. Everybody, you know, detox their, you know, the endocrine disruptors in a different way. You know, I have a friend actually now, they just moved to a house in Miami and his wife within a few weeks is having allergic reactions. You know, she's worried about, you know, mold toxicity and they found mold. They found mold, but he's not feeling anything and she's having, you know, headaches and, you know, sinus. So people, even living in the same household, will feel differently.

9:01Gary Brecka:There's no question.

9:02Dr. Labib Ghulmiyyah:That's why, like you said, a lot of things we do off-label. And by the way, do you know that when we induce women, we use a product called mesoprostol, which is a prostaglandin to dilate the cervix. And this is not FDA approved for induction of labor. It's off-label use. And I would say maybe most of the inductions in the U.S. are done through mesoprostol or another prostaglandin. And then if you look at the label, it's used off-label. And many, many drugs are used off-label. But yeah, sometimes we have to follow some of the guidelines. And then again, if you drift a little bit from the guidelines, you have to be really, you know, make sure you are doing something not to harm the patient.

9:45Dr. Labib Ghulmiyyah:But a lot of times we don't have the answer to a question because it's difficult to do trials in pregnancy. But as long as you are being reasonable, you're looking at the whole patient as a whole, not just one value from her lab work, then I think it's a good way of practicing. And that's how we're going to learn and change our practice and maybe improve pregnancy outcomes. Because preterm labor, for example, the prevalence or the incidence of preterm labor has not changed over the last 20 years. Actually, it has increased a little bit. And so many places are trying to do research and trials to detect who's at risk for preterm labor, but we have no solution to it.

10:28Dr. Labib Ghulmiyyah:Right. We're seeing more and more babies being born preterm.

10:31Gary Brecka:Yeah. You know, it's fascinating to me that we're so advanced medically in the United States. We definitely don't have a spending problem. We spend$5 trillion a year on healthcare in general. But in the civilized world, we rank among the highest in maternal mortality and infant mortality. Absolutely. Both. What do you attribute that to?

10:56Dr. Labib Ghulmiyyah:Yeah, I think a major, major risk factor that we see is, you know, the demographics and the metabolic diseases that we have and the pandemic of, you know, obesity, which is probably a final sign of inflammatory disease and insulin resistance, plays a major role. And that will increase your risk of preterm labor, preterm delivery of because of preeclampsia and other complications. C-section rates are higher because of obesity. So I think there are multiple factors, but I think it all leads to the unhealthy lifestyle that the U.S. has been getting. And the diet plays a huge role in this. Huge role.

11:39Gary Brecka:I mean, and you as a practitioner, I mean, you have to play with the hand that you're dealt. I mean, when the patient shows up, you don't have a choice over what lifestyle choices they've made to that point. so you're inheriting whatever risk pattern they've developed for themselves and i love the idea of preparing six months out for pregnancy um you know like you were prepared for i'm preparing for 10k and i've been on a program yeah of course otherwise you'll stop in the middle and yeah you won't you

12:06Dr. Labib Ghulmiyyah:can't finish it yeah so i think yeah that preparation is so important um and and that's that's all knowledge i mean you don't have to get pregnant in six months you can maybe prepare even a year or two years before, but at least have the knowledge of what's important to be done. You know, those, you know, lectures and workshops should be given to high school students, to college students, and like sexual health. Like, you know, you're not gonna cause people to be more sexually active if you teach them about it. I think that's what a lot of people fear, especially actually in this part of the world, because I lived in Lebanon also practiced for 12 years.

12:42Dr. Labib Ghulmiyyah:In Lebanon. In Lebanon, which is, you know, part of the Arab world. And a lot of people fear that if you talk about sex or sexual health, people are going to become more sexually active. And actually, it's the other way around. So same thing. Talk about pregnancy, preparation for pregnancy, and definitely the outcomes will be better. Yeah, I couldn't agree with you more.

13:02Gary Brecka:You know, I think, too, that we have a very serious challenge going on in the U.S. I mean, statistically, population-wise, you see fertility rates beginning to decline. And you also see sperm rates beginning to decline about 1 % per year. 1 % per year doesn't sound like a big decline. That's 10 % every decade. And you combine that with infertility rates and women conceiving, and you have a repopulation disaster potentially on your hands, or at least we're heading for one. What do you account for the declining rates of sperm count in men and declining rates of fertility in women?

13:44Dr. Labib Ghulmiyyah:Yeah, I think, you know, they go kind of hand in hand. And when the sperm count is dropping, also the fertility rates will drop. But I think because the sperm and the eggs come from endocrine organs and those endocrine organs are so vital for our, you know, health span and even longevity. We know now the ovaries are so important for that. Same thing for testes, but we are bombarded with toxins. Yeah. And when I say toxins, I don't mean just chemical toxins. That's, you know, financial toxins, social toxins, social media toxins, always bad news. I mean, wars all over the world, hurricanes. I mean, we're always bombarded.

14:24Dr. Labib Ghulmiyyah:I'm sure, you know, our ancestors had also issues, but so many things happening at the same time. I think all this is stressing our body. Cortisol levels are high continuously. And then you have those endocrine disruptors that are constantly invading our bodies and we can't get rid of them easily.

14:41Gary Brecka:I'm so happy to hear you say that. I mean, not happy to hear you talk about these problems, but I mean, I'm happy to hear you say that, that allopathic medicine, traditional medicine is recognizing that the body has frequency and emotion, mood. These have a major impact, stress on our ability to conceive, our sperm counts, terms of healthy pregnancies. So now once a woman is pregnancy, what does an ideal healthy pregnancy look like for you? What are some of the recommendations, the guidelines that you tell your patients to give them the best possible outcome? Because I feel like that is the time when a woman is the most selfless.

15:31I've seen it in the mother of my children.

15:34Gary Brecka:I've seen it in my wife now. She's a phenomenal mother. During that time, their sole concern, almost like it's a genetic programming, is everything is about that fetus. They give up some of the things they love the most, wine, coffee.

15:50Dr. Labib Ghulmiyyah:But you know, sorry to interrupt you, they give up those not because they're obliged to do it. They know it's harmful, but their physiology changes. Their gut microbiome changes, and so they stop having those cravings. So I think it's a lot of the hormones that the placenta secretes makes them, you know, not liking certain smells just to protect their baby. So there is something, you know, like too holistic that happens without us interfering. But of course, sometimes, you know, we have patients that still smoke or use drugs during pregnancy. And that has a lot of, you know, reasons why. But in general, I think the human body knows so well what to fear and what to avoid in preparation for, you know, that pregnancy.

16:39Dr. Labib Ghulmiyyah:But to answer you as far as the pregnancy is concerned, I think, you know, continuing with those pillars, sleeping well, you know, eating, you know, the correct foods and amounts to keep your microbiome healthy, avoid toxins. and of course, you know, lowering your stress. All of these are things that we advise women to do. And I usually, it's so difficult to work on all of them. I try to see where is the weakness where this patient is having issues with and we try to work on that part. The first parts of the pregnancy, the first 12 weeks is when the fetus is developing. So it's a very critical time.

17:16Dr. Labib Ghulmiyyah:But even afterwards, the baby's growing, your brain keeps growing until, you know, later in the pregnancy, even after birth, the brain keeps growing, the lungs. So I think you just have to give advice on, you know, where they are lacking as far as issues with their sleep or with other issues. And then, of course, the regular prenatal care coming to their visits, having, you know, the ultrasounds, make sure the pregnancy is normal. We have multiple testing that we can do to predict if this woman is going to develop preeclampsia, we screen for diabetes. So there are, you know, standard guidelines that so far work well and they do decrease the risk of morbidity and mortality.