Fertility Foundations: Functional blood testing and analysis for fertility with Milena Mastroianni

Welcome to the latest series of Fertility Foundations, where we speak in depth with expert guests about how to prepare the foundations for healthy pregnancy. This week Sandra Greenbank is talking to Milena Mastroianni, Registered Nutritional Therapist, about blood testing and analysis and which tests are important as part of a fertility workup. 

Milena always knew she wanted to support women and couples in the space of fertility as nutrition and blood testing were a game changer for her own fertility and parenthood journey. Not only is she a passionate advocate of the incredible power of real food to transform our health and fertility, but she’s proud to be her clients go-to for support when fertility feels like a puzzle. 

Milena enjoys supporting those who are trying to conceive through proactively optimising the whole couple’s nutrition and lifestyle. Using the functional medicine tools of advanced testing, her ultimate goal is to unveil the root causes of fertility issues or hormonal imbalances and together build a strong foundation for conception and a healthy pregnancy. She’s passionate about guiding her clients with personalised recommendations so that they can feel fully supported and more empowered than they’ve ever been in the knowledge that every action they take, and every mouthful, can bring them closer to their family dreams.

Find Milena here: www.rootandleafnutrition.com
and on Instagram here: www.instagram.com/rootandleaf.nutrition

Milena has produced a free guide to blood tests for fertility. You can download a copy here: https://www.rootandleafnutrition.com/freebloodtestguide-fertiilityfoundations

Our sponsors for this episode of Fertility Foundations are NeoVos, a UK-based lab that provide at-home health tests and cutting edge analysis. Knowledge is power and in my opinion, you need to always check not guess your levels of Omega 3 and vitamin D so that you can supplement correctly if you need it. I found the novice test really easy to use and affordable. The team at NeoVos have kindly offered Fertility Foundations listeners a 10% discount by using the code FERTILITY at the checkout. Visit the NeoVos website for more information.

Podcast transcript

Sandra Greenbank  00:04 

Hello and welcome to the Fertility Foundations podcast, where we go into detail about how to prepare the foundations for healthy pregnancy. We dive deep into the underlying root causes for fertility issues and natural solutions. I want you to know that you’re not alone and you’re not broken. I hope that by sharing these episodes this will help you move from feeling overwhelmed and lost to feeling hopeful and empowered to take charge of your own path to parenthood, because there are actually lots of things that you can do to help rewrite your own story. 

I’m Sandra Greenbank, nutritional therapist, functional medicine practitioner, coach and educator, specialising in fertility, pregnancy and postpartum health. I’m also the founder of the Fertility Nutrition Centre, where you can find fully trained experts in nutrition, lifestyle and functional approaches to a healthy fertility and pregnancy. You can find more information over at www.fertilitynutritioncentre.org and also book in a free strategy call with one of our experts.

Today I’m speaking to Milena Mastroianni all about blood testing and analysis and which tests are important as part of a fertility workup. Milena always knew she wanted to support women and couples in the space of fertility as nutrition and blood testing were a game changer for her own fertility and parenthood journey. Not only is she a passionate advocate of the incredible power of real food to transform our health and fertility, but she’s proud to be her clients go-to support when fertility feels like a puzzle. Milena enjoys supporting those who are trying to conceive through proactively optimising the whole couple’s nutrition and lifestyle. Using the functional medicine tools of advanced testing, her ultimate goal is to unveil the root causes of fertility issues or hormonal imbalances and together build a strong foundation for conception and a healthy pregnancy. She’s passionate about guiding her clients with personalised recommendations so that they can feel fully supported and more empowered than they’ve ever been in the knowledge that every action they take, and every mouthful can bring them closer to their family dreams. 

Before we get into the interview, I wanted to talk a little bit about our podcast sponsors, NeoVos. They’re a UK lab that provide at home health tests and cutting edge analysis. I personally like the vitamin D and Omega three tests, which are absolutely crucial to get right for anyone trying for a baby. Knowledge is power. In my opinion, you need to always check not guess your levels of Omega three and vitamin D so that you can supplement correctly if you need it. I found the novice test really easy to use and affordable so the NeoVos team have kindly offered our listeners a 10% discount on their website using the code FERTILITY at the checkout. Their website is simply www.neovos.com. All of these details are also in the show notes for you.

Now let’s get into today’s interview with Milena. Hi, Milena, thanks so much for joining me on the podcast. 

Milena  02:58

Hi, Sandra, thank you for having me.

Sandra  03:01

Just for those who don’t know you. Could you tell us a little bit about how you got into nutritional therapy and why you decided to work in fertility nutrition specifically.

Milena  03:13

Yeah. So so my, I always think that I kind of subconsciously and consciously prepared for my fertility journey. When I started to kind of think about conceiving way later in my life, like I was way past the age of 35. And I always feel that that kind of proactive approach to trying to conceive on our fertility journey really helped us kind of with the boys we had later later. And I decided to specialise in fertility because I thought, like as I was going through that a lot of information was so hard to get. It was still a so much confusing advice, you know, whether following one day or another diet, and I had actually basically gone into studying nutrition to find out more about the body in general and health. And then obviously, that helped me a lot along my fertility journey as well. So yeah, I definitely felt that the nutrition really helped from my point of view, and then all the other tools that you learned along the way of, of having a nutrition practice. Like testing, which we’ll talk about a little bit today as well.

Sandra  04:39

That’s great. Yeah, I mean, I think it’s, it’s so important for the health of the family as well, you know, and I remember when we were in ION or when I was there, there were a lot of people actually who were struggling with fertility at the time and loads of them got pregnant in their 40s which is you know, people were so surprised. And the lecturers were like, Why are you surprised? We told you before? Because they actually warned us to say, you know, your fertility is going to increase. Of course. Now I remember just thinking, This is so amazing, like there’s something in us. Yeah, I

Milena  05:14

mean, definitely was a platinum way in my cohort as well. Over the last years, we kind of delayed a little bit because it’s funny.

Sandra  05:28

But anyway, we’re going to talk about blood testing today. And this is something that I think, you know, everyone has had a blood test in their life. And they’re just think that the test you get from your doctor is like, the test you need. But actually, there’s so much more to blood testing. And it’s a really technical area, as well. And so I think we’re going to focus more more on sort of the general, you know, whoever’s listening now and thinking, you know, have I had the test that I need to have? And, you know, what, what should I be thinking about? So, but I wanted to start by asking you about standard reference ranges that we sort of, you know, you’re kind of looking at your blood test results. And then it says, you know, this is the reference range, and you’re within that, therefore, everything is fine. So what, what have you got?

Milena  06:25

Ya know, we hear this a lot, don’t we? Yeah, when clients come to us, and, and the problem they have, they may have done some blood testing before, and there’s no, but everything was normal. Everything was fine. So. So yeah, there’s, there’s a lot. There’s a lot to just unpack there in terms of like, I mean, first of all, the fact that we, I mean, obviously, everyone understands blood testing anyway. So it’s important that we we start with some blood testing anyway, because obviously, is the is the most recognised type of testing with worldwide as well, and GPS, and doctors will all recognise that. And then the other thing is, obviously, is that that reference, though, all those markers have been studied for a very long time. So there’s a lot of research on them, where the reference standard ranges that we see they are based on statistics, mostly in this based on the Hawaii wide populations, and often they don’t know do not necessarily kind of match with kind of good health or optimal kind of physiological function, basically. So then the kind of the out of range kind of markers are based on kind of overt symptoms, but not necessarily, you know, before you kind of start feeling unwell, and you go to say, a doctor and say, I’m not, I’m not feeling great kind of thing, and then everything comes back normal, but actually, it there has something has started like a process has started in, in the background to to get to make unbalanced things. So like,

Sandra  08:18

yeah, so I suppose what, what they, what they would have done is say, take 100 people, and they might have just stopped them in the street and said, Do you feel well, and they go, yeah, yeah, feel well, and then immediately you’re thinking, but how many of us are truly, truly well, like really well. So then you’re starting with a group of people, and there’s, they will all these people feel feel good. And, you know, we don’t know that they’ve got any particular disease, and you know, they don’t have and then so the range that they get is sort of that’s deemed to be normal. So that’s one way of looking at it, you know, each marker in there on their own and you’re looking at, you know, it’s that sort, I mean, in a very simplified way, at the end, looking at how reference readers come about, but it’s kind of pretty much it, isn’t it?

Milena  09:12

Yeah, it is. It’s just very, they’re very wide, as you say. And that’s the what, it’s a wide range of population as well as Yeah, not overt symptoms kind of being detected yet. And, and that’s, that’s when we’re using that kind of big curve of for the reference range. Yeah, and, and there’s a lot of statistics, as well in them to make them that makes reference ranges. They can also change from lab to lab sometimes or from country to country I find as well. So it’s quite interesting how, yeah. It kind of being tight with those reference ranges. It’s actually more important for us into If you’re looking at optimal health,

Sandra  10:02

and actually, it can take a really long time for data to be incorporated into the NICE guidelines into WHO guidelines. And then once that has changed, once those guidelines change, each hospital then has to change their guidelines. And I remember, during pregnancy, there were a couple of test results that I had, that were out of range. And I looked up the WHO guidelines, and they were different from my hospital, because they had been updated. And they said, well, we don’t go, you know, these, this is our policy. We haven’t updated ours yet. So therefore, you’re outside of the range, whereas actually the so this is where it becomes really kind of, you have to you have to sort of know where to look and what to look at as well. And I think also some ranges are based on the male population. And they are applied to women. But we are not small man. We are not met.

Milena  10:58

Indeed, indeed. Yes. Yeah, there’s a set like it’s kind of a wider, yeah, what a generalisation of of health. Right from from those reference ranges. And, and also, I think, also, what I find is that some slightly abnormal results, if they, you know, they’re not, like overly abnormal that sometimes also not looked at properly they, they consider just borderline and it’s okay. And then you know, what we want to know is why that borderline word there I end up in kind of state? What’s what’s pushing that trend? Yeah.

Sandra  11:42

And is it getting worse? Yes. Yeah. Or is it changing? Yeah. So. So with that in mind that what do you think? I mean, how do you approach us? Say someone’s been to the GP? And they’ve said, yes, what often what I find is people come to me, and they say, I’ve been to the GP, I’ve told everything’s fine. And then you go, have you got a copy of results? No, I’d seen them. Yeah. Yeah, Indeed,

Milena  12:05

indeed. So yeah, first of all, definitely getting get your, your records, your data, you know, from from your GP as much as possible. And then the mark is one, when we look at those results, then we we have another set of markers, we have a set of optimal markers that we will look at, and we kind of like, you know, we hope we want to do it, but actually, we can use spreadsheets or whatever to kind of plug those those values in. And we can start seeing from, you know, the normal reference ranges, which one’s actually really, really normal or optimal, or which ones actually slightly out of out of range from an optimal point of view so that we can call them sub optimal, or from that point of view, yeah, so under optimal, yeah. So so it’s, that’s why then it’s also important to look at then, from an optimal kind of optimal reference ranges point of view, what are the different markers that are popping up as sub optimal? And what kind of patterns we want to recognise with them? Yeah,

Sandra  13:19

yeah. So that’s the second thing as soon as you’re looking at each marker individually, but then also, you can look at a trend, the trends were watch, you know, say your irons off, and your thyroid results are a little bit borderline normal. And you’re thinking, you know,

Milena  13:40

what do we need to iron is needed for thyroid, thyroid hormone conversion, so that there is definitely like, a connection there. And then iron is definitely one of the ones that we see a lot where it’s not in the optimal ranges, you know, if it’s even like, towards the start of the reference range, when it’s really pretty low, it’s considered normal. And that that is definitely one of the ones that we want to look at, we want to definitely address because we know it’s implicated in so many different things. But also, like, from a metabolic point of view, you start seeing things being off a little bit from a, you know, liver point of view or cholesterol point of view, you know, we know that we know there is a trend there we can we can talk about this as well. Definitely started looking at where the the the sub optimal value is, is super crucial. And important. Yeah. Yeah.

Sandra  14:37

And I think one of the other things that actually you can probably do yourself if you get a full blood count, which is like the standard tests that the GP would run and they would look at, you know, iron ore ferritin, folate, B 12. And if you see across the board, they are low. Then you’re thinking why am I not you know, my think why am I not absorbing these nutrients in your diet is if you believe you have a good diet, maybe you’re even taking supplements, those values shouldn’t be low. And so you know, is there an absorption issue? Is it pretend potentially celiac. And this is something that I always always always want to keep an eye out for? Because some people, for some people, that only symptom of Celiac disease is infertility? Yeah, yeah. And one clue could be that your nutrients are quite low on your blood test. And it’s unexplained. If you have a terrible diet, we wouldn’t expect you to have good values as teachers anyway. But absolutely,

Milena  15:44

I mean, there’s so many kind of markers that like that we ideally want to have right to to have a full picture. And then the kind of see like screen is definitely one of them. In the list of all the markers that we try to look at it from a fertility point of view, a list. If it hasn’t been done before, for sure. And then it’s

Sandra  16:06

very unlikely that you’ll get it done unless you’ve got significant gut issues. And even then, it’s very rarely checked, isn’t it?

Milena  16:15

Yeah, well, I mean, I find it in practice, if you do have a justification for it, then that’s why also that obviously helps to work with a practitioner that, you know, if you can write a letter and justify why you do want to have a particular blood tests done, I find that often, it’s a yes, and it works. So yeah.

Sandra  16:38

That’s it and actually, can, you know, you can you can really help advocate then for that test to be done on the NHS to save you a little bit of money? Yeah,

Milena  16:47

absolutely. Yeah.

Sandra  16:49

So So let’s talk a little bit more about pattern recognition, then and what your, what else you’re looking for, when it specifically when it comes to fertility, so talked about nutrient absorption.

Milena  17:05

Yeah, so I mean, the nice thing is to, first of all, start from some specific kind of panels, or from a from a kind of blood markers point of view. So obviously, start from a really lovely food blog, because that already can give us a lot of information. So some of the patterns that you would get from a full block count, for example, are whether you may be low in iron, which is you then want to check in your iron markers, whether you may be low and folate already be 12. Summer so if you look very specifically, we can also look at things like B six, as well, some markets can give us an indication whether, you know, sometimes we can’t test B six, so it’s a nice to kind of get a gist of what may be going on. So those markets are really important for like, you know, full eight, B 12. The very important for methylation. And this process of methylation that happens all the time in our body, but it’s super important when it comes to fertility, because it’s the foundation of reproduction of cells and repairing yourselves. So it’s super important from, you know, sperm health to, you know, to, to egg quality, and as well as kind of reproduction, kind of mitochondria and everything else. So that’s already like a positive thing. And then in the full blood count, you also get some information about white blood cells. And again, you know, this is where sometimes little slightly abnormal results come up. And they’re not necessarily looked at because there’s no symptoms or anything like that. And that’s where, again, we potentially want to look at what’s happening with iron, because we know that kind of bacteria viruses, parasites use kind of iron. So, if there is some kind of change in the white blood cells, then potentially some change also in the iron markers as well and that can give us indication of what else may be going on what else do we need to go look out for? From Yeah, from immunity point of view or, or infection point of view, which ultimately can cause kind of inflammation. And then there are you know, the profiles that I always call kind of metabolic that you know, there to do with die for example, liver or blood glucose. It’d be one see, for example, or cholesterol, they they can give us an indication about what’s going on in terms of your metabolic health and, you know, insulin, insulin sensitivity or insulin resistance whether there is already a trend there going around there also some information about bile flow you can get from some liver markers, which is is like GGT, for example, which is quite, you know, it’s quite good to have an In the whole picture, and which can then impact cholesterol as well. And what else obviously, like you know, other important, I like to also look at minerals when we can when we’ve got things like sodium, potassium, calcium, obviously, hydration is super important. And we know that it’s important for fertility. Also, like in terms of like cervical mucus, and from that point of view as well, but also I mean it for energy. And also for cellular health, we know that, you know, the sodium potassium kind of pump around our cell membrane is quite important for getting nutrients in. Right. So that’s another one that I also like, really like looking at as well.

Sandra  20:50

You’ve got your hormones as well, the whole with all of these that we’re talking about, these are kind of generally done via the GP unless they’re particularly unhelpful. Yeah, usually.

Milena  21:03

Yeah. But I mean, from hormones, because stuff from the thyroid, obviously, you get, like a limited amount of information from the GP. But the end kind of like standard kind of a female hormones of male hormones can also be tested with GPS as well, yes. And ideally, that’s the other thing, I find that really, you want to be able to do them on the right days, on the days. You know, day three for certain hormones and for progesterone, which is kind of the hormones of ovulation that we want to kind of look at in terms of how what a stronger ovulation we may have had, that is normally done seven days post ovulation, and that can be, you know, considered day 21 For some people, but it could be used to treat people for other people. So that’s another kind of important nuance to keep in mind when it comes to hormone testing. And again, yes, looking at them from a kind of optimal reference range as well is really important.

Sandra  22:06

And the range can be so wide for the specifically for the hormones can’t do as well. And I think that, you know, it’s important to say that it’s not just women who needs all of these tests as men as well. Absolutely. And making sure that they have a hormone panel to looking at. You know, testosterone, a sh BG prolactin, LH FSH, oestrogen, I mean, you know, both direct Of course, yeah. So, you know, it might be a little bit trickier for the male partner to get this, but they should, I think now, in this day and age should get a semen analysis and a blood test from the GP. Yeah,

Milena  22:50

I mean, I try to always try to write it in my letter, and obviously give us give a reason for it. And let’s see, like, 60 80% of the time out of the times I send letters they they say, Yes, we know. So, as you say, it’s about the guidelines, right, and knowing how to play around them as well. We know that, you know, for example, GPS, one test. Again, if the mark markers, we’re not out of range the last year, so it’s about knowing what was tested before, if for similar, nice has never been done before, there’s no reason why the GP may not be able to do it, if, you know, half has not been done before. And it’s obviously for a good reason. So it’s always important to know when when it’s possible or when we can ask and when we you know, when it’s within the guidelines, is this kind of a lower risk for to get a no basically from from requesting tests.

Sandra  23:50

One of the ones that I always think people should test and it just never gets done by the GP because they the guidelines, the GP guidelines are that it’s assumed that it’s low. So therefore we don’t test and it’s vitamin D. We assume that everybody, the entire population is low, and therefore we don’t test but I just think it’s so important to test and to know your levels so that you know how much to take.

Milena  24:15

Absolutely, absolutely. Otherwise, yes. Supplement vitamin D. Where do you go from there? Like, you know, you can you could be supplementing maintenance stores, but if you love that maintenance dose, it’s not gonna get you anywhere, are you You know, you could be over supplementing awfully not but you know, that’s also a bit dangerous. So it’s really important to know what your actual number is on those markers to be able to know how much you can use do you need to supplement? Yeah, and the same, I mean, it’s the same for folate and B 12. How many times do we see that being either on the floor or, you know, being too high potentially from over supplementing? That we need to then want to readjust because We know that obviously, as we said, they’re implicated in methylation, or you don’t want to potentially cause over methylation, right? And that even everything needs to be kind of what I call the long kind of range. We like it to be. Like that, right? Because yeah, there’s never too much or too little is still.

Sandra  25:20

Yeah. And actually, that’s another point, isn’t it? That, you know, just because it’s high on a blood test, that doesn’t actually mean that you’ve just absorbed loads, but really well, actually, it can mean that, you know, depending on what’s tested, for example, B 12, if it’s testing what’s in the red blood cell, or within the serum, you know, and it’s not even often clear on the test result, what’s been tested, but you know, you might have really high p 12. And you think, Oh, this is good, you know, but actually, if the, if it’s high in the serum, it might be mean that it’s not being taken into the cell properly. Absolutely. Yeah. And so again, you need to know what you’re looking at.

Milena  25:58

Yeah. And this is where kind of then the kind of following steps in terms of research and looking into what else may be going on, you know, it could be gut tissue, it could be, yeah, like cellular membrane health issue that we need to look into. There are often patterns that you can start looking at from the blood tests anyway, that that, then that’s, that’s why it’s so important to have a starting point of blood testing, because then you then know which direction to go afterwards. Yeah, better or which, which other areas to prioritise as well. And

Sandra  26:35

so say, I’ve had a blood test by the GP, and I’ve been told that everything’s fine. But I’m feeling a bit, like maybe deep down, I don’t feel like I am fine. What should I do?

Milena  26:49

Well, I that’s the, that’s when the optimal reference ranges come in. Right? That’s when we’re looking at those tests. From an optimal range point of view, it’s nice first step to do, because it would allow to just start looking at those buttons. And if there is something slightly off, in which area that may be, we can see that often with thyroid testing, can we like when, unfortunately, then we can only have maybe one or two markers with the NHS or the GP. But then those two markers don’t necessarily give us the full picture of what may be going on, in terms of like thyroid hormones, whether they’re actually being converted into the active hormone, d3, which is not tested often. What else may be going on as well, from a thyroid health or inflammation point of view. Right. So so first of all, looking at those kind of markers, again, from a optimal level, and then also seeing what else? What hasn’t been tested? What is what’s missing, that we could obtain, potentially somewhere else, that that can give us further clues as to what may be going on?

Sandra  28:07

Yeah, so this is where the private testing comes in. Obviously, we have access to lots of different labs, depending on what we need to look at. But yeah, for sure, the thyroid, you know, establishing whether there’s an autoimmune component, which just doesn’t, you know,

Milena  28:25

regardless, we want to do anyway don’t Yes, I mean, sometimes we don’t see the changes in some of those thyroid markers until later, right then until after the autoimmune side of things has kicked in. So it’s from a fertility point of view, definitely want to make sure that’s ruled out because we know that it has got an impact on many things, including implantation. So in the reactivity of your immune system anyway, and obviously thyroid a kind of integrity, as well. So yeah, so there’s there are there are, there are various, we’re kind of lucky in a way in the UK, I guess. There’s, there’s so many labs that we can go to for private testing, we tend to work mostly like, you know, labs that can be either, you know, available to the public, or also pop labs that, you know, that work with practitioners only I quite like those to start with as well, because sometimes we can also kind of customise the panels or we can, you know, we know which ones which areas to look into a little bit more. And but there’s so many other Mark kind of labs that do any kind of publicity here, but yeah, there’s so many labs that the private labs that anyone can kind of buy a nice full blood panel from and have that analysed. Ideally by a practitioner looking at these optimal reference ranges. Yeah, for sure. Also, yes, kind of at least starting to do the work there of looking because that’s, that’s, that’s what I also find. It’s often that maybe when you as you were when you mentioned the male side of things, maybe they’ve never had a blood test before. Yeah, so it’s good to be starting somewhere. And definitely, and there’s so many private options now that we can that are available to everyone. Yeah,

Sandra  30:30

so I think privately, what we would always, always try to do with the vitamin D, you know, if we can’t get that done a full thyroid panel, which you simply can’t get it from your GP. And usually, it’s not done by the any fertility clinics, either full iron panel, I think I n is so complicated, or complex, because it doesn’t just come down to the ferritin it’s about the carrier mechanism. And it’s about, you know, the size of the red blood cells, and whether they’re actually you know, they’re too big to cat to be carried carrying nutrients through to the placenta, which is teeny, teeny, teeny, tiny capillaries, for example, and, you know, there’s so many things that can be impacted. And, yeah,

Milena  31:24

and we know also, you know, ferritin as a markers, you know, it can be such a crucial, it’s so important, but equally can can give us so much information about what else may be going on, because we know that ferritin is elevated, it’s not it’s not because you’ve been having necessarily a lot of like red meat or because you’re in a lot of iron sources ferritin is elevated sometimes when there is inflammation in the body and the the body’s kind of restoring retaining iron so that it doesn’t go into circulation again, that’s, you know, similar to what we were seeing before when there’s some kind of immune activation and what else might be going on. So the full kind of panel iron panel, looking at all of them together, you know, ferritin when the serum iron and what else is going on and the transfer and everything else is really quite important give us real clues as to whether there is real deficiencies or times or functional deficiency where iron is potentially not good at getting into the cells for a particular reason.

Sandra  32:28

Yeah, so this strategy isn’t then to put more iron in is to actually fix what’s going on whether it’s inflammation or infection or you know, something else but also I think iron is one of those that you definitely don’t want to be taking if you don’t need it because it’d be inflammatory and absolutely quite damaging is certainly for a man you know, we see him comatose quite a lot as well where they actually have an iron overload and which is the genetic

Milena  32:56

Yeah, yeah. There’s at least a question mark and then we need to obviously want to rule that out and up and check definitely yeah, yeah. And yeah, you can’t get that just from simply one full block cow and test it you need to have that extra information about what’s going on which you know, I mean, happens with fertility happens with pregnancy as well. I see quite a lot if only one test only one we know one panel was had to test done like the full blood count and haemoglobin is going down and often iron is dispensed. And it’s not necessarily the right option at that particular time if we don’t know if we don’t know for sure.

Sandra  33:34

Oh, yeah. And let’s talk about the iron that you get prescribed. Yeah, there are better options for sure. Yeah. Very low cost really. So there’s no reason why you should have to put up with the prescribed iron that you get.

Milena  33:54

And the symptoms and the episode effects are it Yeah,

Sandra  33:58

yeah, I mean, it’s just poorly absorbed. It’s constipating

Milena  34:04

I find it some clients just can’t get along with it as well not for nausea point of view like you know, just in general upsets their stomach. So it’s quite interesting on but then again, I also like yeah, again, looking at everything else in in blood panels, what else may be going on if we have more information about the know, even like electrolytes, you know, sodium, potassium, calcium, or magnesium as well we know what maybe we we know all those kind of like an even even some liver markers, for example, give us some information about zinc. And we know that all of those minerals kind of work together for iron metabolism, iron absorption, and so it’s important to have a fuller picture, having like as many markers as possible to kind of before even supplementing just with iron and having a clue what else may be going on? From a mineral point of view mirror absorption point of view.

Sandra  35:07

Yeah, mineral panel is great to have, isn’t it? But it does tend to come with what depending on what once you try, you have to get the centrifuge sample, and then it becomes more and more complicated. But yeah, definitely, definitely something that I think it’s important to, instead of just going out and ordering all of these even I mean, I’m not even sure you could get all of the sort of more complex tests on your own. But in a rather than spending the money, I think it’s worth asking somebody like yourself, what are the important tests for me to focus on? And so you, you know, because you can go out and buy so many tests, can’t you? And actually, they might not be necessary for you either?

Milena  35:51

Yeah, it all depends what hasn’t been done before, whether it was done recently or not. You know, what else nurses do? If you’ve been kind of supplementing for a while, and you’ve been working on certain things and some deficiencies, for example, then you can’t really retest, you know, very quickly, like, you need to wait at least couple of months to see three months or so to see what else what, you know, what, what has changed? So, yeah, there’s definitely and this the also different labs, I find, right, depending on what you know, what you know about you, for example, thyroid, right thyroid health, then you know, which labs to go to, to get specific information that you’re missing, as opposed to? Yeah, retesting something that you’ve already tested again.

Sandra  36:41

So what if someone’s had a blood test? And they think, you know, I wonder if I should ask for a new one. Like, how if someone brings a blood test you how recent Do you would you prefer it to be?

Milena  36:53

I say, the lead, like, I mean, the latest last six months, but even that is three months, ideally, the last few months, ideally, that will give us a better picture. Yeah, but I rarely get that I rarely get again, more clients that unfortunately, have come and haven’t tested in a long while. And we tend to kind of just write a letter, I write a letter to GP and ask for more based on their symptoms based on history based on medical history, as well, and, you know, parental familial history. And then based on on what we get, then we can see, okay, what’s missing? What else can we get outside of that? With a with a with a private lab?

Sandra  37:42

Yeah. And actually, you mentioned family history. And I think that’s really important, because if you have a strong family history of something, yeah. Whether it’s heart disease, celiac disease, diabetes, thyroid, you know, any. And even if they are, even if you have a family history of lots of different things, it’s really important to tell your practitioner because, you know, type one diabetes, and celiac and thyroid Hashimotos disease, for example, they’re all autoimmune diseases. So they are all linked, but you wouldn’t necessarily know that, but we wouldn’t know what to look for in that case. Or, you know, you’ve got lots and lots of cancer in the family, then we might look at, we might decide to I mean, this is not a blood test, but we would then potentially look more at methylation and what’s going on with your genetic, you know, epigenetics, for example, but you know, that that’s sort of moving away from from blood tests. But yeah, I think that’s really important as well to consider family history. And also, if someone’s entered the menopause early. I think it’s really important, actually, because you don’t want to miss that information. If this is something that’s potential potential for you.

Milena  38:59

Yeah, absolutely. With hormone testing, yes. It’s ideally one of the part of the workup anyway when it comes to fertility. But yeah, fun times. I also see like, we don’t want to necessarily wait until a referral to a clinic. You know, we want to do it more proactively with the way before and start looking at those trends, you know, of when it comes to FSH, LH, what’s going on? And sometimes even kind of oestrogen. Right? If it’s kind of on the low side, we want to know why. Why maybe law and what else can we do to kind of because obviously, oestrogen is quite important for triggering ovulation as well. And so yeah, so looking at those trends soon, is quite important if we need to act fast as well. Yeah,

Sandra  39:51

definitely. I think that this is all investigations that need to be done. Where if not before then, as soon as you get told that you need help to try and To see where you’ve been told that you’ve got unexplained infertility? Or certainly, as you’re starting to look for a clinic and finding out your options, you definitely need to be doing this concurrently. So you know, we don’t it’s not, instead of necessarily but you know, you’re, as you’re getting your ducks in a row, this is one of the ducks absolutely needs to be lined up, you know, and like you said, it could take three months, it could take, you could take a while because we want to test to try and fix the underlying issues, retest make sure. You know, it’s working, because it doesn’t, you know, it doesn’t always work how we hope, hope is going to work. Absolutely.

Milena  40:39

Yeah. And I mean, it’s also connected to supplementing, I guess, because if you think about that, as well, like, you know, we tend to work on a three month basis when it comes to supplementing, and then we want to retest to see what’s going on. And if the supplements that you’re taking may have corrected some deficiencies, then you definitely want to kind of re re adapt, adjust, then switch up things a little bit to make sure that you’re not going over again, like, again, keeping those kind of optimal levels in the Goldilocks range, as opposed to taking the same supplement for very, very long time, which sometimes get doesn’t serve you anymore. Right. So there’s something else

Sandra  41:21

out then, especially, especially if they’re minerals, if you’ve taken one mineral, yeah, absolutely. All worthless energy. Yeah, especially

Milena  41:27

like with iron is, as he said, as well, and really wanting to know, let him maybe diet as adjusted in the meantime, maybe in the meantime, also got absorption as improved. Because all the work we did together anyway. So there’s definitely time for readjusting. That is that’s important to consider as well. And that’s why retesting is so important. Yeah.

Sandra  41:49

And what about if someone’s had a loss? For whatever reason? How long do you think we should wait to run these tests?

Milena  42:01

So I think I think that in terms of kind of nutrients, you can still run quite a few tests, like in terms of like, full blood count, folate, bit of vitamin D. Some markers, kind of with pregnancy, depending on how far into the pregnancy, you are kind of still kind of get out of range, like in the labour market, sometimes cholesterol as well, it depends off our end. But yeah, we still Yeah, I think there’s still kind of a good amount of them, that you we can still test from a nutrient point of view. And then when it comes to hormones as well, then you probably want to wait at least a couple cycles to get things back into kind of a normal kind of state, again, and then potentially any other markets that we missed up before. But it’s so important, then, I guess, also at that stage to do test nutrient levels, because we know even the first trimester, obviously they match. Exactly. There’s a lot of nutrients, utilisation, we know that goes to baby that obviously, mom can easily and depleted. And so yeah, it’s correcting those nutrient deficiencies early on, obviously can put you in good stead when it comes to then the preparation phase afterwards as well. And it’s put on what to consider if there have been like several losses as well. And yeah, yeah,

Sandra  43:46

it does become much more important to make sure that you’re not depleted because you know, it does have an impact not only on the baby’s health, but mom’s health and also risk of postnatal prenatal depression as well as trends that can can be so because the early Concet oily concepts conception stage is such a huge need for methylation nutrients, for energy for for you for everything that you’ve been storing up, and you just need to make sure that it’s not taken out to you more than you know more that you need to obviously emotionally physically, you know, emotionally physically, it’s harder anyway. But we just have to make sure that you’re supported as much as humanly possible. So that, you know, you can you can be healthy and happy during your next pregnancy.

Milena  44:42

Absolutely. Yeah.

Sandra  44:43

And so, there’s lots of actually when you’re looking online, kind of, you know, I’m sure people have Googled kind of blood tests online and there’s lots of finger prick tests available as well. And there’s different types of finger prick tests. There’s the ones that you can I’ve just blocked on a piece of paper, you just have a drop, and you sort of put it on a vitamin D tests are often like that. Yeah. And then there’s the ones that look like mini vials, you sort of have to, like, fill in your own fingers to death to like, get enough out. And then, you know, and I’ve had so many clients actually just faint at home, trying to because there’s just even though it doesn’t seem that much, it’s just too much for them to do. But what is I mean, are they are they useful? Are they a good idea is that it was the money? What do you think?

Milena  45:37

So I always say that, when is when possible, tried to do a blood draw instead of instead of a finger prick test? For many reasons, one of them first of all, is that, you know, we’ll obviously, there’s less of the hassle, when you’re less than the hassle weed having to do it yourself at home, especially if you’re not very comfortable with that type of things. Also, you know, it’s gonna be done properly. But it’s obviously a phlebotomist. And then the third, if there is anything out of range, then it’s more likely that your GP will kind of another doctor will kind of look at it in a more favourable eyes and kind of want it to retest and look at it properly. Whereas maybe with a finger prick test, it’s not always considered as as accurate. Or is, you know, you may still be get a retest if post if something is out of range. But if it’s not out of range, then and again, remembering the reference ranges are quite wide, then you may be having the value that is not necessarily reflective of that particular marker. Yeah,

Sandra  46:50

I think, yeah, so I was gonna say one of the reasons this because your fingers are in the on the periphery of your body, so actually, you’re not necessarily having the exact same circulation of nutrients into your fingers, as you would have pumping through your arms. Yeah.

Milena  47:06

Yeah, and I think is also, another thing to consider is how many markers then these blood panels with finger prick tests are trying to catch, right? If, if it’s too many, we often see that either them, some of them are missed, or some of them may not be completely accurate. And then the other thing is really kind of, you know, the variability that may happen when it comes to, as you say, preparation and trying to get that kind of blood out, right. Where you know, what you do need to really warm up your hands, you really need to make some movements as well to get circulation going into your fingers. And having be really, really hydrated, again, is super important. So because there’s so much variability, you know, between different people for how they do it in terms of taking their blood from a finger prick, then it can be, it can be an extra kind of variable in that you don’t want to that may kind of give us skewed results when it comes to blood testing. So yeah, I always say if it’s a marker or two, and they’re not necessarily cannot like, for example, vitamin D potentially is not, you know, it’s not a major issue, like to try and do with a finger prick. or small markers B to our full aid, if you want to have that little kind of fill the gap for some things, then you can ideally fingerprick it’s not it’s not, you know, an issue. But if it’s something important that you’re monitoring, like even like your thyroid, TSH, and things like that, then I would definitely go for a blood draw. And if it’s a bigger panel, definitely with blood draws well.

Sandra  48:51

Yeah, I agree. And also, you know, that oversee gets sent lots of these tests all the time. And I always do them, because I just think, you know, why not, you know, I’m going to retest this thing. And the number of times it’s been sent back, and I know the importance of actually making sure those filled to the line. And then the number of times that come back comes back and said you didn’t fill in enough. And I’m like, I know I did. But there’s obviously something about this vital thing that I’m supposed to fill that home. Because, you know, it actually often gets sent back and then you’re thinking, you know, by the time you’ve had a new test and a new you know, is your set back in time, aren’t you? Yeah. Three weeks? Yeah, it’s really upsetting because you’re thinking I don’t have three weeks to waste because that’s the cycle. Yeah, in the you know, it’s nearly a host I call. So that’s another consideration. Is it worth just paying that 25 pounds or whatever to go and get the test? You know, the blood drawn? Yeah, so

Milena  49:53

it’s so much easier, isn’t it? It’s the drug for example, offer blood draws or you know, with In certain private labs, they already offer a different kind of Kleenex that you can go to depending depending where you are. And then another thing that like, yeah, like you were saying, you know, if when the finger prick tests, and another thing that often happen is that is squeezing the finger actually can ruin the blood, the cells themselves. So like, it’s another risk of you know, of potential. Yeah, things going wrong. So yeah, when possible blood draws is the, the option is the best option. Yeah.

Sandra  50:37

And so, so blood testing, I think we’ve established that it’s really, really important to test and, you know, it’s kind of universal language that’s spoken between doctors, nutritionists, healthcare practitioners, all around the world. And, you know, we can understand, you know, I mean, I’ve had a number of clients from Germany, or, you know, obviously, you work with clients in Italy, or, you know, we can Europe, we can, we can understand what it means. And you can take a private lab test to your GP and say, Listen, you know, I’ve had this test, can you help me? And they understand that, and that’s great, but there are limitations as well, obviously, you know, it’s a snapshot in time. Yeah. You know, especially with some of the hormones that can really fluctuate even day, you know, within a day, let alone day to day, then a, you know, there are some limitations as well. And then, you know, the blood test can inform us what else we might want to look at as well.

Milena  51:36

Yeah, absolutely. In

Sandra  51:37

terms of other tests, you know, we used to live that we use still, we might use hair tests. What else do we use?

Milena  51:44

Yeah. Yeah. I mean, testing like, testing for hormones. Yeah. Because then you with Yeah, with a with obviously, blood testing, you know, there’s e to the oestrogen but there’s other estrogens as well in our body. And what happens to that oestrogen afterwards in terms of methylation and there’s the you can’t get that information from a blood test, unfortunately, so he can other levels, but you cannot what happens to that oestrogen, for example? So you can do dry urine testing, like Dutch testing, or even I find kind of nutrigenomics can can help for that knowing what trends or trends you have, from a hormonal point of view that this Yeah, that’s quite nice. An addition. Yeah. And then obviously, as you said, there is you know, then all that extra digging when it comes to, you know, for example, finding potential when it comes to immunity or when it comes to Yeah, infections, for example, then we can go into gut testing, stool testing, we could go into vaginal microbiome testing, which obviously, it’s important for fertility, regardless of blood testing. Anyway, we want to do that. Yeah,

Sandra  53:00

definitely. But that you know, and that’s heavily impacted by oestrogen levels in your body. So you sort of you know, it’s good to have all these tests. Reading them together as well.

Milena  53:11

Absolutely. Yeah. The more the better.

Sandra  53:15


Milena  53:16

But you know, but obviously, as I said, starting with a blood test is was a really good start. Anyway, yeah.

Sandra  53:23

So just as just final question, someone’s going I haven’t got any money. I want to go to the GP and what should I ask for? So we’re looking at full blood count for sure. And that’s a problem generally to get

Milena  53:33

know, if I can find that you’d normally can get easily a full block count, you get a liver profile easily renal kidney profile easily. Cholesterol lipids that would do normally as well, again, it can give an HB one C, which is the marker for blood glucose the last three months. That’s something that normally quite happy to do. Yeah, brilliant. And, yeah, I mean, there’s sometimes deliver profile. There’s also proteins as well like things like globulin, orbelian. And even it can also give us an indication of protein absorption, for example. They don’t always do the minerals, the calcium disodium mlsu. kind of ask them sometimes they do sometimes they don’t. And then the iron is iron is the iron panels is obviously sometimes just serum iron and ferritin. And sometimes it’s just ferritin. It’s yet another roid thyroid, they do just normally just TC, TSH, or we feel like a TSH a D four. And then hormones, it’s important to know to ask them to test them on the right days. So for women, females, like day three hormones and then progesterone to be done on a separate that says hi, yeah,

Sandra  54:53

and we haven’t mentioned CRP, but I think this is one that should be cleared. just filed because again, it’s Yeah,

Milena  55:01

I was thinking about it now as well. Yeah. Yeah, that’s true. I mean, obviously, the CRP just sort of climbed to the issue where they have very high CRP. But yeah, CRP is a marker for inflammation. It was the one that you get from the GP is just a standard CRP is not a sensitive high sensitivity, CRP, which is slightly different. But do you can get that more privately. But even that can give us an indication in terms of like, you know, general inflammation, and whether that kind of confirms the pattern to myrcene. And maybe like, the high ferritin, for example, or the high cholesterol and potential kind of liver markers being a bit off. So that that is that is a good one to keep. And also GP wouldn’t normally be happy to do that. And if it’s really elevated, we know something is definitely going on. And it’s suddenly something acute. Most of the time, if it’s really high, and to keep an eye on it, for sure. retest would it be?

Sandra  56:01

Yeah, so CRP is a marker of nonspecific marker inflammation. So it’s just a saying that’s inflammation in your body. We don’t know what it is, but it gives us a clue as to what’s going on. It’s worth saying, though, that, you know, don’t freak out if it’s high. And you’ve recently had a cold, for example, because it’s normal. That’s what the body does, it creates, it makes your pain response so cold. Also, when we get pregnant, it tends to go up, you know, it’s it’s a normal, but inflammation generally is not good for you. So that’s why we want to check CRP, and again, you know, the normal range is generally up to five, isn’t it? But we want to see it below one below one, you know, for somebody who’s supposedly well. So that’s something to look out for, as well, I think and if it’s ever come up higher than that does need to be retested. Just to make sure it’s coming down, even if you think you know, why, why it was high? Yeah. So I think that, you know, anyone who’s listening is thinking, oh, you know, I haven’t had, you know, six months since my last test, or I have not been offered all these things. For sure. Go and have a chat with a GP and just say, please can have these tests as a starting point. Because I you know, it’s great to have these from the very start when you’re working with somebody, isn’t it?

Milena  57:19

Yeah, definitely.

Sandra  57:24

ordered them when you start. Yeah,

Milena  57:26

sometimes I also work with, you know, when I start working with clients, even before we’ve had our first appointment, I try to see what’s going on. And potentially if they have never had tests before, we can request them and see what happens. And then we have a much clearer picture on that first appointment going in. Yeah.

Sandra  57:45

So if anyone wants to know more about you, and how to get ahold of you, and I think you’ve got you have a free download as well, that we’re,

Milena  57:52

yeah, yeah. So this kind of markers that we just talked about. I’ve had like a little document with them that I’m really happy to share. So I will be giving it to you. So the notes as people can download them and know which which markers to ask for. And yeah, and then I hopefully will be useful.

Sandra  58:18

Yeah, and if people want to get ahold of you, what’s the best way to contact you?

Milena  58:22

So my websites, what through my website is the best way, my name is Milena Mastriani. But my reps that my website is called root and leaf nutrition.com. I’m on Instagram with at is root and leaf dot nutrition as well. So available there as well. But yeah, normally my websites, you go there and you can book a nice of chat discovery call we call them or 30 minutes and we can we can we can talk more if you want to.

Sandra  58:58

Yeah, so it’s always worth having a you know, booking that free chat just to find out if there’s anything that Milena feels that you could you know you could help or you know because I think this is gonna be course a really important as well to establish whether actually maybe you don’t need to work with us right now. Maybe you need to actually go and see somebody else or you know, a different professional, you know, or whatever it might be so those discovery calls have free non obligation getting to know you getting to know your petitioner.

Milena  59:29

Yeah, I find like people always get kind of a couple of tips from them any kind of worthwhile to Jota and you always get at least at least sometimes get direction of what what next to do what to do next if you’re not ready to practitioner yet, because

Sandra  59:46

your strategy Yeah, for sure. Yeah, highly recommended. Get booking chats with Molina and thank you so much. It’s been really useful. No

Milena  59:55

pleasure. Thank you for having me, Sandra.

Sandra  1:00:02

I really enjoyed this chat with Milena and I hope you enjoyed listening to this episode. Please like, save, share and rate this podcast if you found that useful, as it helps us reach more people. Also, don’t forget your 10% discount on tests with Neovos using the code FERTILITY at the checkout. And if you’re looking for a fertility specialist to support you, all practitioners can all be contacted over at www.fertilitynutritioncentre.org And they all offer a free strategy call to help you decide on your next steps on your journey. Thank you for listening.

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The Fertility Nutrition Centre was founded by Sandra Greenbank, an expert in proven nutrition strategies to help couples conceive naturally. After 12 years of helping hundreds of couples successfully conceive naturally, she is making it possible for more couples to receive nutrition consulting by creating a network of nutrition expertswho have committed to a unique and in-depth training program in the field of fertility.