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Test Don't Guess is the podcast unlicensed health practitioners interested in functional lab testing have been searching for! If you're anything like the host, Jensen, you had no idea you had access to all kinds of different functional labs when you graduated with your nutrition certification. Through interviews with practitioners, lab experts, and course creators, you'll learn how your colleagues are using gut, hormone, mold, mineral testing and more to confidently work with clients and grow your practice!
If you've been working with clients as a functional practitioner for really any amount of time, I'd venture to bet that you've come across a client or two who's in the perinatal time frame, whether they are preconception and taking the steps to have a healthy pregnancy. They might already be pregnant and wanting to feel as good as possible and give their baby everything that they can, or they are postpartum and realizing that they may need to support their body differently than before, working with clients during this time is obviously incredibly rewarding. But it can also be a little daunting because we know we need to approach these clients differently when it comes to our recommendations. But it's hard to know where to find the right information, And that's exactly where our guest today, Mary Anne Marks and Sarah Russell come in. Even for myself, I actually haven't publicly announced this yet, but I thought now would be a perfect and fun time to share that I had my second little girl in 2023.
Speaker 1:I absolutely adore my midwife. I loved working with her. And when I got lab results back throughout my pregnancy, it was always so helpful and reassuring to hear that it's normal for certain markers to be higher or lower due to pregnancy. So in today's episode, I'm honored to get the opportunity to talk with Mary Anne and Sarah about interpreting blood work during preconception, pregnancy, and postpartum. Mary Anne is the founder and CEO of LabSmarts, a bio individual blood work interpretation software.
Speaker 1:So, obviously, we have a lot in common when it comes to our love of automating functional lab analysis. And she's also a holistic nutrition consultant and functional medicine practitioner widely regarded by her peers as the go to source for blood chemistry analysis. Mary Anne has combined the skills from her 20 years in the tech industry with the skills from her 9 years in holistic health to create a tool that helps practitioners be more effective and efficient at interpreting blood work to improve client outcomes. Sarah has run an active nutritional therapy practice for close to a decade, offered mentoring to other entrepreneurial nutritionists, and authored 3 robust family building courses, the feed your body, grow your family series. She holds a PhD in Italian studies from UC Berkeley and is a certified functional nutritional therapy practitioner.
Speaker 1:She and her son live in Tuscany on a thriving farm of olive trees, kiwis, and rabbit. Now Mary Anne and Sarah work together teaching practitioners specifically how to interpret blood work in preconception, pregnancy, and postpartum. I am so excited to share this episode with you. Let's get into it. I wanted to introduce both of you.
Speaker 1:So I have Mary Anne and Sarah Mary Anne Marks and Sarah Russell joining me today. And so if you guys could just do a quick introduction of yourselves, and we can get into all the conversation about the perinatal time frame and lab work.
Speaker 2:Yeah. Sure. Mary Anne Marks. I'm the founder and CEO of a company called LabSmart. It's a blood work interpretation software.
Speaker 2:I left my corporate job job in the tech world in 2014, got into nutrition school, and just love blood work analysis. So I thought, well, you know, maybe I should turn my automated spreadsheet into some software, and I've been working on this software since 2018 I started and and, you know, that that we can talk more about that after.
Speaker 3:Yeah. So I a nutritional therapy practitioner. I I I finished my certification in 2,000 13 when I was still living in the US, and then I moved after having a a one on one practice for 2 years in in Berkeley. I moved to the Tuscan countryside in 2015 and have been running a remote practice with clients worldwide in addition to mentoring practitioners
Speaker 2:I I'll take this. We connected through a mutual, friend and and colleague of ours, Victoria Lafont Jackson. She's amazing. And she's she does our she was doing our marketing separately at the time, and and she said you 2 have to meet because Sarah's doing a lot of work with pregnancy. And and in your software, you have some pregnancy reference ranges.
Speaker 2:And so Sarah and I met, and Sarah became a user of my software. And she's like, well, you you need to add more reference ranges for all these different markers in for different trimesters of pregnancy because they changed drastically. And so Sarah and I just started as I started to do research, we said, let's just there's so much here. Let's let's turn this into a core. So we started doing research together.
Speaker 2:I implemented the ranges in the software. And as as throughout our research, we started we started to create this this course together to teach practitioners on how to interpret blood work throughout the the different trimesters of pregnancy.
Speaker 1:It's such important work because, I I mean, as you guys know, we'll get the blood work back for our clients. And if they're pregnant, there are certain things that it's like, oh, no. But that's supposed to be high, or that's supposed to be low right now. And so tell me more about the research process that went into, you know, creating all these reference ranges and all the information that's available?
Speaker 2:I mean, the re I can take this real quick because it started with me within the software trying to do this research for each of the markers that that I have in the software on, you know, how those markers change throughout pregnancy. So Sarah and I were just devouring different, blood work in pregnancy books and scouring PubMed, and we had this huge document that we would go through and and look through different markers and and see how they change. And then, you know, it's it's just it took us about a about a year to come up with all those those different ranges and and really vet them through different processes. And I don't know if you have any more to say on on the research process, Sarah.
Speaker 3:I do. Yeah. You know, it's interesting because I I started researching years ago just on the clinical side as needed when people would come to me with their pregnancy lab work, and there are very few markers that are actually adjusted for pregnancy on lab reports. So whenever something would come up, like, weird, I would just go on to PubMed. But every single time, it was very time consuming to PubMed or to the Teets book of clinical chemistry to look at how things shifted during pregnancy and if there was a trimester by trimester change, because what I realized is it was really easy to assume that somebody's, you know, health was poor or something very wrong happening with them.
Speaker 3:Like, you know, why are their white blood cells so high? Do they have an infection? They feel fine. Like, what is going on with that? So I it was an incredibly time consuming process, and it was hard for me.
Speaker 3:I'm not like Mary Anne. I'm not really a spreadsheet person. I'm a notebook person. I can't sound pen. So I had all these handwritten notes and different notebooks just scattered all over my house on how things change in pregnancy, and it was so nice to be able to connect with Mary Anne so that I didn't have to reinvent the wheel and do the research every single time all over again.
Speaker 1:Yeah. I feel like there's no other resource out there like this. Like, when as you guys put this out, I mean, there's nothing else that really does this. Right?
Speaker 3:Yeah. Yeah.
Speaker 2:Right. Yeah. We we've looked. We there's nothing else out there that that is has the the with the course and how we teach people and then in in the software, which is which is nice for me that nobody else has the automated adjustments of different reference ranges throughout each trimester.
Speaker 1:Right. Right. Can you maybe each of you can take one. Can you give me an example or 2 of specific markers that must be assessed differently? I know you mentioned white blood cells.
Speaker 3:Yeah. Yeah. So white blood cells go up drastically mainly because of how much neutrophils rise. They increase by almost, you know, by over 200% compared to nonpregnancy ranges and how much they increase compared to nonpregnancy changes from trimester to trimester, but it's really amazing. And then we we look at the neutrophil to lymphocyte ratio and how that increases because the neutrophil to lymphocyte ratio is known to indicate specific risk factors for adverse pregnancy outcomes.
Speaker 3:So looking at that number, if it's, you know, if it goes up past 5 point 8, then then we know that certain risks are increased during that pregnancy, and we keep a closer eye on the person and work on them more functionally.
Speaker 2:Yeah. I mean, I didn't know when we were doing this research that neutrophil the the body creates more neutrophils to help with the placenta development and the the remodeling of the arteries that feed the placenta. And it it I didn't know that neutrophils were a big part of that whole process, and that's the the main reason why those increase. There's another one that's pretty pretty neat that the kit also, the kidneys enlarge throughout pregnancy and that to increase its filtration rate to try to get rid of toxins. So those toxins that the mother has from who knows where don't go to the the fetus.
Speaker 2:So the eGFR, that's a marker of kidney filtration estimated, that that range increases dramatically, I don't know, maybe 50, 70%, which then in turn, if you'll see on the blood work, like, some of the waste products like BUN, creatinine, uric acid, those should all decrease throughout pregnancy because the kidneys are filtering out those those even more. I mean, there's there's so many different ones. I mean, alkaline phosphatase increases dramatically in the 2nd and third trimester because the because of the placenta is creating more of that enzyme. There I mean, I don't know. More than 50 different markers change pretty drastically throughout pregnancy.
Speaker 1:Yeah. Wow. And so you guys recommend testing preconception and then throughout pregnancy. Is that right? And then postpartum as well.
Speaker 1:How frequently would you say?
Speaker 3:Well, every 3 months, it's good to run some labs. So, you know, preconception, typically, you know, people will will come to me 3 to 6 months prior to their target conception timeline. Sometimes people will come to me where they've already been trying to conceive for a long time, so they might conceive right away. But, typically, I'll have people run lab work about every 3 months. Sometimes preconception, it could be a little bit longer.
Speaker 3:Say, you know, if the couple is healthy and and it just takes them a little longer than, say, 3 months to conceive, they might then do their next labs in the first trimester of pregnancy, and it might be a little longer than 3 months. But, yeah, it's it's good to run specific markers before both male and female patients should run specific nutrient markers and additional metabolic markers prior to conceiving because that can help increase their pregnancy and and and the epigenetic outcomes, so that they are fertile and having a healthy baby with with a greater epigenetic potential. So versus, you know, once the woman is already pregnant, then we want to keep an eye on specific metabolic markers and depending on what is going on in in in her nutrition, what we saw preconception. Or, you know, if somebody comes to me who didn't work with me in the preconception period, then I would want to look at certain baseline nutrition markers as well. And, of course, we look at thyroid function before conception.
Speaker 3:And then in people who have issues with thyroid, it's important to keep an eye on that in in during pregnancy as well. Otherwise, it's it's a good idea even in in people who are healthy to look at it, a full thyroid panel again in the 3rd trimester before heading into postpartum just to identify people who are at higher risk of having, say, postpartum thyroiditis, which can be associated with a a rise in, adverse outcomes of all kinds in the postpartum period.
Speaker 1:Yeah. We've Absolutely.
Speaker 2:We've found some other, you know, specific areas around plea preeclampsia. So you would want you wanna make sure you would test uric acid, GGT, and l lactate dehydrogenase in the 1st trimester. So those are markers of preeclampsia. Like and like Sarah said, I mean, the the basic c c b c, CMP, iron panel, and preconception. But then iron gets a little bit wonky in the 1st trimester, so you might wanna you don't need to really test it then, but maybe, you know, 2nd and third, you wanna check to make sure thing things are alright there.
Speaker 2:Yeah.
Speaker 1:So with with the information that you can get from the lab work, are you able to customize supplementation? What is the I mean, I know supplementation during pregnancy is another whole, you know, big conversation, big topic. But what are you able to influence with the lab work with a, let's say, pregnant patient or client?
Speaker 3:Lots. Yeah. Lots. I mean, even starting with preconception, we can support male and female fertility. We can identify specific areas that could be holding them back from conceiving if they have been struggling with infertility.
Speaker 3:We can help people go on on the proper prenatal multinutrient for them based on specific levels of nutrients that range from, you know, b 6 and retinol, just forgotten nutrients and making sure that people are getting just enough vitamin d, not too much, that if somebody needs iron supplementation that they're taking it. But if they don't, they absolutely are not because it can be quite detrimental to take iron if it's not necessary. And, actually, looking at the, a, looking at the full panel of iron markers, not just not just ferritin or, you know, ferritin and hemoglobin, like a lot of people just look at those 2, max, is really important because then you can see exactly what's going on with iron metabolism, iron storage. It's the context around it because sometimes the person doesn't need an iron supplement. They just need to increase the iron in their food or, you know, other things that can support and scaffold proper metabolism of iron versus, like, throwing more iron at the person.
Speaker 3:Yeah. Do you like
Speaker 2:like to look at b 6? Right?
Speaker 3:Yeah. Yeah. That marker. B 6 is such an interesting marker because different people need different levels. And I see people all over the map in their preconception b 6 levels, and and the top quality prenatal vitamins go from 2 milligrams all the way to 50 milligrams in a daily dose.
Speaker 3:So you don't want to put somebody on 50 milligrams of b 6 if they are already kind of off the charts in their b 6 levels. So just making sure that that everybody's getting the right amount for them of the nutrients is is really, really helpful. I mean, every vitamin has epigenetic, functions. Even, you know, specific minerals have specific epigenetic functions as well, like iodine. And optimizing nutrient levels in both parents' preconception and in the mother during pregnancy can really help improve the epigenetic outcomes for, you know, for this baby before they're even conceived and born.
Speaker 3:It's it's an it's an amazing time to leverage this potential.
Speaker 1:Yeah. Absolutely. And I know b 6 is one of the things that's recommended if you have morning sickness Yeah. Or all day sickness for many people. And so I guess knowing those numbers too will help with that.
Speaker 1:Have you seen anything specific come up with someone in their 1st trimester that is typically linked with morning sickness? Any, like, clinical pearls there?
Speaker 3:Well, you know, it's interesting. I would say that working with somebody preconception and optimizing their b 6 levels before they even conceive tends to to make it so that people don't have severe severe morning sickness. Now it is also true that, you know, that some people have a genetic tendency towards hyperemesis gravidarum in there. I mean, just working on b 6 is not even going to be enough for those individuals. There has to be a much bigger plan in place.
Speaker 3:But I would say by and large, optimizing someone's b 6 before they conceive really does help lower the the incidence and severity of of nausea during during that 1st trimester of pregnancy.
Speaker 1:That's amazing. The clients that you both work with, are they typically working with midwives or conventional OBGYNs? What does that relationship look like?
Speaker 3:It depends. I would say about 60% of my clients are working with the conventional OBGYN, and about 40% of my clients are working with midwives. Many of whom are very conventional and and rather, you know, out of date in terms of research on lab markers and things like that. So a lot of them it doesn't really make a huge difference in terms of the approach that their that their practitioner has.
Speaker 1:Yeah. So they're they're right. The practitioner's running the lab work. And then do you feel like they are getting, you know, opposite advice to what you would be recommending based on possibly not interpreting the labs, you know, the way that you've learned?
Speaker 3:Yeah. It depends. So, I mean, a a lot of the time, the practitioner isn't running all the markers that I am. So whatever their practitioner is running, then I'm suggesting additional markers that the OB GYN or midwife may actually be adding on as an add on or they may not. But then when I interpret the lab work, I I actually print up, you know, or I use I I create a PDF from LabSmarts with the report that that graphs out the the optimal ranges for some you know, that are individualized for that patient from a functional perspective.
Speaker 3:And so they get that report, and it's a terrific tool to start a conversation with their physician or midwife, and to you know, then I can provide all the, you know, the research, the bibliography to help the physician or midwife understand that the person actually maybe doesn't need iron supplementation at all because their iron is actually optimal for that trimester of pregnancy. You just send them the bibliography, and and it's you know, it really helps everybody. I don't see it as being a conflictual issue or you know? Yeah. I mean, the the patient may initially get some conflicting pieces of information, but the but using this method of lab work interpretation, which is we can talk about how lab smarts goes into individual characteristics, like, you know, age and altitude, not just whether a person is pregnant and what trimester they're in.
Speaker 3:But because it is such a strongly evidence based and extraordinarily well referenced software, It's it's a really helpful tool for patients and their and their more allopathic trained medical or or nonmedical providers like midwives to to actually reenter and reassess the world of functional lab testing during pregnancy so that so that everybody's on the same page. And I I've actually seen this be, you know, not only the reference ranges that we worked so hard to to dig up from the research, but also the implementation of those within the framework of the LabSmart software. These are terrific ways of of helping update doctors and mid midwives so that the patients' outcomes are actually improving. People patients have been incredibly satisfied with with the work that we've done together and how it helps improve what they get out of their work with their with their providers. Yeah.
Speaker 2:And we and we don't put any diagnostic terms in the software because that's what we're not we're not trying to diagnose. We're just trying to point out imbalances, you know, in the end with those optimal ranges. So then they could go back to their doctor and say, well, we you know, this seems looks like I'm okay in this area, or it looks like, you know, I may need to, you know, have some concern in this other area with the the physiology of the body. And and and so we we we try to stay in our lane with with the software and and with what we do in working with with clients.
Speaker 1:That's great. Can you tell me more about this 6 week pregnancy master class? I I saw that it's called what you never learned about blood work in preconception, pregnancy, and postpartum. So it covers all the bases.
Speaker 2:Yeah. I could so we have the first module. So it's a 6 module course. We did it live, in the summer last year, and we're gonna do another live one. I think it I don't know.
Speaker 2:April, I think. We haven't planned it out yet, but we haven't we but we recorded the course that we did in in the summer, and we have that available right now. So it was a 6 week live course of 6 modules, and the first one is around preconception and some of the markers to test during preconceptions, some of the things to consider. And then we go into 4 4 weeks of different groupings of markers throughout the different trimesters of pregnancy. CBC markers is there's a second second week or second module when we talk about the the changes in the immune system, the changes in in all the red blood cell related markers around that hemodilution.
Speaker 2:We go into the physiology. This is the cool stuff that we we like too. I like learning why all these blood markers change throughout pregnancy. We go into, you know, platelets in the coagulation markers. That high estrogen during pregnancy signals that liver to produce more proteins and it has some dramatic effects on coagulation and and those markers there.
Speaker 2:And we go into then iron and and copper and and then all the different other components like liver and and kidney and and all the different changes. And we explain we have tables. So you don't have to have the software because we have I take all the everything that I've done with, you know, with in the tables in the in the software I have, we created tables for the class where you could see in nonpregnant and then each trimester how those ranges we I give you the ranges in the tables and how they change throughout pregnancy. And then we have postpartum, and then we have a whole special section at the end. The 6th module is on thyroid.
Speaker 2:And so we go through the thyroid, and and Sarah brings up some case studies that she has, you know, used in her practice to show people how things change and and what she's done. You know, one of them was, like, how some doctor was recommending high iodine to one of her clients, and it was dramatically impacting her thyroid. And and so
Speaker 3:it's it's pretty cool information. And do you
Speaker 2:have any more info on the on the class, Sarah?
Speaker 3:Not really. You did an an amazing job with, you know, with the rundown. We have a full module just on thyroid function from preconception as as just like, you know, we we talk about preeclampsia prevention, gestational diabetes prevention, and, of course, management of these conditions, they do come up. Mhmm. So, you know, it's just really terrific information that, you know, researching it has really improved the way that I work clinically And the whole way that we framed the the course is really thought of as integrating the clinical practice with this robust evidence based research to to help with the outcomes.
Speaker 1:That's great. It sounds incredibly comprehensive and, very needed, like I said. Do you do either of you offer services outside of your master class if somebody is wanting to work
Speaker 3:with you? Yeah. Yeah. So I have a 1 on 1 nutritional therapy practice where I work with, obviously, preconception, pregnancy, and postpartum in addition to more broadly complex health cases, which has been the area where people have where I've gotten to so many referrals over the years. I actually started my practice thinking of focusing on preconception pregnancy and postpartum, and then somehow I I got nicknamed as the doctor house of nutritional therapy along the way.
Speaker 3:So I get all these, like, mystery cases. It's really fun to to work through them. And then I also have a case study group for clinicians where we talk about, case studies that that people are currently working on in their practice. It's super fun.
Speaker 2:Yeah. That's awesome. I'm Sarah Sarah's brilliant. I'll leave the client work to Sarah. I mean, I used to work with clients maybe 10 years ago or so, but now I'm just focusing on developing this this LabSmart software for practitioners like Sarah to make blood work interpretation easier and more accurate and and try to implement different reference ranges.
Speaker 2:I have about half of my ranges now have children's ranges. Half of my markers have children's ranges, so I'm hoping to expand that this year and and just add more features to make it easier to, inter for clinicians and practitioners to interpret blood work. And this is what I love. I'm just a blood work analysis nerd.
Speaker 1:I'm in the same boat. I'm I'm just a nerd for all of the automation with the apps and all that. I just love it.
Speaker 2:And so I love what you're doing too. Yeah. Yeah. Thanks. Collaborating.
Speaker 1:Right. Well, so just one last closing question just for fun. What is something that each of you are currently learning in your downtime?
Speaker 2:That I can take one. Just last night, like, I watched this video from Bradley. I forget his name. Bradley Nelson or something on the emotion code. And I started doing the you know, I don't know if you know about it where, you know, you do the muscle testing and you say there's, like, column a and b in different rows.
Speaker 2:And when testing and you say there's, like, column a and b in different rows and where these different stuck emotions are in your body. And I've been, last year, having some pains in my shoulder and stuff, and I've been doing that. I've just released all this stuck energy, and it's just fascinating. So that that's what I've been doing just even yesterday.
Speaker 1:That's so funny because I just started that book within the last week.
Speaker 2:No way.
Speaker 1:Yeah. We're on the same page. Yes.
Speaker 2:It's amazing. It's it's not all physical. It's it's a and a lot of our issues are energy stuck in it. For sure.
Speaker 1:Yeah.
Speaker 3:Yeah.
Speaker 1:What about you, Sarah?
Speaker 3:Yeah. Well, speaking of energy and not physical, I'm I have just a a fun personal interest in quantum physics. I'm reading a book series on different aspects of quantum physics.
Speaker 2:Wow.
Speaker 3:I've been really fascinated by the topic for a few years, and it's been fun to really dig into some of this. And I've also been doing lots and lots of research on bipolar disorder, for my clinical practice. It's been really, really interesting to dive into the the details of different aspects of bipolar disorder and how the disorder itself and the medications that people tend to take for managing bipolar disorder, how that affects all areas of of health at different stages of life, including preconception and pregnancy. You know? So for example, how does how how does the way that kidney function and filtration changes and even, you know, thyroid changes during pregnancy, how those affect people on on lithium and how the medication might affect thyroid function during preconception, pregnancy, and post because there are, you know, there are different areas that that medication really affects, and the 2 organs that lithium affects the most are is the thyroid and the kidneys.
Speaker 3:And so we have to look at how kidney filtration changes in pregnancy affect how lithium is cleared and how that in turn affects the thyroid function and all of that. It's just it's so much interesting information.
Speaker 1:Yeah. So just some light learning is what it's called. Yeah. Totally. Well, I wanted to mention to the listeners that you guys have very generously created a coupon code for the 6 week master class.
Speaker 1:And so if anybody is interested in joining, you can go to the show notes below this episode and type in test don't guess 10 and get 10% off. So thank you so much for providing that to our listeners. And you said that that's gonna be starting in April?
Speaker 3:So our next the coupon code is valid at any time for people who sign up with it. So we have an evergreen course that people can sign up for at any time, and then we have another live course that is going to be starting in April. We still have to the the dates are still to be determined, but it will be on Thursdays. Okay. Starting probably in early to mid April.
Speaker 1:Okay. And then there was also you guys are providing, listeners with a free gift as well, a TSH by trimester pregnancy chart. And so, I'll link to that below the episode as well.
Speaker 2:I put together that graph, and it's just there's so many different reference ranges for TSA for so many different people and labs and I just threw them all on this chart so you could see what our optimal ranges are, where, where you're seeing other experts in thyroid health, what they may say. And it's just pretty cool. And as part of the course, though, Sarah has this is it supplement guide through prenatal or is it
Speaker 3:Yeah. Choose in the right prenatal based on people's lab work.
Speaker 2:Yeah. That's pretty cool. That Oh, that's amazing.
Speaker 3:Of course. Yeah.
Speaker 1:Wow. Very cool. Very cool.