Ep 191: A Personalized Approach to Prenatal Vitamins with Doreen Bloch and Dr. Nathan S. Fox of Ellement

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This is the first time I’m having more than one guest on at a time and I’m super excited to have both. Today I’m joined by Doreen Bloch and Dr. Nathan S. Fox. Doreen is the CEO and founder of Ellement, the first personalized prenatal supplement system. And Nathan is a board-certified Obstetrician/Gynecologist and an advisor at Ellement.

Ellement was actually a sponsor of the podcast last year and I invited them to come back because what they’re doing with prenatal supplements is pretty cool. The short story is that, unlike most prenatals, these supplements are made specifically for each individual person based on their unique needs or dietary preferences. I love the idea of things being more personalized and less one size fits all; I think that’s the future of where supplements and healthcare overall are headed.

Please know that I have no financial interest here. They are no longer sponsoring the podcast - I just want to share things with you that I think are important and useful.

In this Episode, You’ll Learn About:

  • Why we recommend prenatal vitamins
  • When you should start taking them
  • What the difference is between folic acid and methylfolate
  • What role supplements should serve in pregnancy nutrition
  • How prenatals can be deficient
  • Why individualized care is important
  • How Doreen’s personal experience with pregnancy and birth inspired her to start Ellement
  • How the cost of Ellement stacks up against other prenatals or mixing and matching vitamins

Links Mentioned in the Episode

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Dr. Nicole (00:00): In this episode, you're going to learn about prenatal vitamins with Doreen Bloch, CEO, and founder of Ellement and Dr. Nathan Fox, maternal fetal medicine specialist and Ellement advisor. Welcome to the All About Pregnancy & Birth podcast. I'm Dr. Nicole Calloway Rankins, a board certified OBGYN, who's been in practice for nearly 15 years. I've had the privilege of helping over 1000 babies into this world, and I'm here to help you be calm, confident, and empowered to have a beautiful pregnancy and birth. Quick note, this podcast is for educational purposes only and is not a substitute for medical advice. Check out the full disclaimer at drnicolerankins.com/disclaimer. Now let's get to it.

(00:56): Hello, there welcome to another episode of the podcast. This is episode number 191. So glad you're spending some of your time with me today. Well, today's episode of the podcast is the first time that I'm having more than one guest on this show at a time, and I'm super excited to have both. We have Doreen Bloch, she's the CEO and founder of Ellement, which is the first personalized prenatal supplement system, and you're going to learn what that means in the episode. Prior to Ellement, Doreen was the founder of a data analytics company. She received her undergraduate degree from the University of California Berkeley, and she is certified in nutrition science from Stanford University School of Medicine. And Dr. Nathan Fox is a board certified OB G Y N with subspecialty certification in maternal fetal medicine or high-risk pregnancy. As it's also known, he completed medical school and residency in obstetrics and gynecology at Mount Sinai School of Medicine.

(01:52): His fellowship in maternal fetal medicine was at Cornell. He's currently a clinical professor in the department of OBGYN and reproductive Science at the School of Medicine at Mount Sinai. He's also the founder and host of Healthful Woman Podcast. It's a great resource for accurate, reliable, helpful information about all areas of women's health, and he is an advisor for Ellement as well. Now I'm super excited to have both of them come on to talk about this unique prenatal supplement system that Ellement has. Ellement was actually a sponsor on the podcast last year, and I invited them to come back because what they're doing with prenatal supplements is really pretty cool, and I think it really is the future of how supplements will be made or perhaps should be made. So the short story is that unlike most prenatal vitamins, Ellement supplements are made specifically for each individual person based on a detailed intake questionnaire.

(03:01): And it takes into account your unique needs, your unique dietary preferences. It can be customized to include things like a baby aspirin if you're at risk for preeclampsia, even extra iron if you're carrying twins. It's just really, really cool and a not like cookie cutter approach to prenatal vitamins or prenatal supplements. So we're going to get into more details of how that works into the episode or we're going to start off with some general information where you'll learn about prenatal vitamins, including why we even recommend a prenatal vitamin in the first place. When you should start taking it, we'll touch upon the difference between folic acid and methyl folate. I see a lot of information or arguments really online about that back and forth and whether or not it should be included in prenatal vitamins, spoiler alert Ellement supplements actually include both. And then we'll also talk a bit about Ellement's specifically in deeper into their four principles, that it's scientifically sound, it's conscious and responsible.

(04:04): It's made to change over the course of your pregnancy and tailored to your unique needs. So you'll learn all about that in the episode. I do want you to know that I have no financial interest here. They're no longer sponsoring the podcast. I just again, wanted them to come back because I wanna share things with you that I think are important and useful and potentially helpful to help you have your best pregnancy journey. All right. Now before we get into the episode, on Tuesday, January 17th, guess what I'm doing? I'm teaching a live class on how to make a birth plan the right way. I'm so, so excited to be teaching this class live. I'll be doing it twice that day. 1:00 PM Eastern Standard Time and 7:00 PM Eastern Standard Time. In this class, you're going to learn the right way to make a birth plan. A birth plan is important, can really help you, can really be essential to help you have the birth that you want.

(04:54): But those templates and online forms that you see, don't cut it because if you show up to the hospital with that and you haven't actually discussed what's in the birth plan and make sure that your doctor actually supports what's in it, you're potentially setting yourself up for disaster. So in my class, I teach you a step by step easy to understand process where you will learn how to approach making a birth plan the right way, which involves answering some sp or asking rather some specific questions of your doctor during the prenatal period so that you know that they're on your side or they're not on your side and you should change. So in the class, you get the class itself, of course, you get access to the replay video forever. You get a birth plan workbook that you can use to take with you to your doctor's office in order to discuss your birth plan.

(05:41): And you also get as a bonus membership into my private Facebook community, the Inner Circle community. This is the only place that I do Q and A's anymore. It's where you can connect with me, tag me on questions, you can connect with other pregnant mamas as they go through their pregnancy, their postpartum childbirth journey. So really, really great information, group, class, all of that good, great stuff. So sign up for the class at drnicolerankins.com/register. I also forgot to say that the class is only, I'm only teaching it live four times a year. So if you are due in January, February, March or April, then you definitely wanna sign up for this class because I'm not going to teach it again for a few months. Again, that's drnicolerankins.com/register. All right, let's get into the conversation with Doreen and Dr. Fox, Doreen and Nathan, Dr. Nathan Fox. Thank you so much for agreeing to come onto the podcast. I'm so excited to be here and talk about prenatal vitamins and supplements.

Doreen (06:49): Thank you so much for having us today.

Dr. Nicole (06:51): Yeah, and this is the first time I recorded with two different people, so this is a little bit of an experiment for me. So hopefully it is all going to turn out well. But I thought it was important to have both of you here.

Dr. Nathan (07:02): It takes you to the next level of podcasting.

Dr. Nicole (07:08): So why don't you start off by telling us whoever wants to go first about yourself, your work and your family. If you'd like

Dr. Nathan (07:14): Doreen, you start.

Doreen (07:15): Hello everyone, my name is Doreen Bloch and I am the founder and CEO of Ellement, the first personalized prenatal supplement company. I studied nutrition science at Stanford University and my background prior to founding Ellement was in data science. So I am a numbers person who is obsessed with health and wellness. I am also a mom to an amazing four-year-old son, Ethan.

Dr. Nathan (07:39): Hello. Hi Nate Fox. I'm an OB GYN and maternal fetal medicine specialist in New York City. I also have four kids, but they're old, so we're replacing them with dogs as they move out of the house. And that got connected a couple of years ago and we started talking about this project and I've been involved since as a medical advisor and as a friend of Doreen and real excited to be here.

Dr. Nicole (08:07): Yeah, awesome. Super excited to have you both. So why don't we hop right in and talk about why are prenatal vitamins even important?

Dr. Nathan (08:15): Yeah, I mean it's interesting. I think all of us know in our hearts that having a well-balanced nutritious diet with all sorts of minerals and nutrients and vitamins is the way to go. But we also know that probably not everyone does that. And so the idea behind a prenatal vitamin is during the time of pregnancy which is sort of next level importance cuz not only are we talking about the health of the mom, but the health of the baby, people feel maybe I should take a supplement, I should take a vitamin just to make sure I'm getting all the vitamins that I need and I might not be getting in my diet. And that's sort of conceptually why a prenatal vitamin has a bunch of stuff in it. There's for each individual component of the prenatal, as some of them have more evidence that they're helpful and some of them have less evidence that they're helpful. And so there's some components that are mandatory like folic acid or folate. It's just one of the things that's pretty much in every prenatal, but the rest of them are made a little bit differently just because no one agrees exactly what should be in, it's because it's hard to make a one size fits all vitamin for every pregnant person in the world.

Dr. Nicole (09:29): And we like to think that we can get everything from our diet, but also our food is grown in nutritionally deficient soil and things like that. So we have to kind of supplement. When should someone start taking a prenatal vitamin?

Dr. Nathan (09:49): I mean we generally recommend at least for the folic acid component before getting pregnant so that the stores are filled in your body before. Cuz the folic acid is particularly important for early pregnancy to help the baby develop what's called the neural tube, which ends up being sort of the back and the spine. And so it's something that if you wait until you realize you're pregnant or you see her obstetrician or midwife, it may be too late so to speak. So the thought is to have it earlier. As far as the other vitamins, it's not entirely clear if they need to be started before pregnancy, but probably if you're not getting a well-balanced diet and you need vitamins, probably better to start with them on board.

Dr. Nicole (10:30): And let's go ahead and tackle the folic acid issues. Since you brought it up. I hear a lot of folate versus methyl folate, that whole debate in prenatal vitamins. Can you talk about that, what the debate is and what your thoughts are?

Dr. Nathan (10:47): I, I'll start then I'm going to kick it to Doreen. Basically, folic acid and folate or methyl folate are terms that are frequently used interchangeably. They're not the exact same thing. Folate is the natural occurring form of the vitamin or methyl fold. It's those are pretty much synonymous. And folic acid is the synthetic form that's made and put in vitamins. The reason there's a lot of confusion is number one, they sound similar. Number two, there is debate out there which one is quote unquote better. The people on the side of folate will say, well, it's the naturally occurring one. It's the one you get from foods and leafy green vegetables. And that's probably the better way to go. And the people on the side of folic acid will say, all right, that's great. But all the studies that looked at the benefits of supplementation were getting folic acid, they weren't getting folate. And so I think each one's right, it's not that one is right and one is wrong. And most of the data shows it probably doesn't matter which one you get but no one's entirely. Sure. And I know that Doreen's going to be very excited to say how Ellement has addressed the folic acid folate debate. We are the first people to bridge the gap in this country between those who argue.

Dr. Nicole (12:03): That's right. All right, yes.

Doreen (12:04): Yes, we're here to unify. This is exactly why Ellement includes both. We have the requisite 400 MCG of synthetic folic acid, which is the recommended level and an additional 600 CG of the methyl folate. So debate no longer just get both.

Dr. Nicole (12:24): Yeah, I have seen some straight up ugly on social media people really fighting hardcore over this issue. And I'm like, everybody take a deep breath. Calm down.

Dr. Nathan (12:36): Yeah, you thought politics was bad? Wait till you get into prenatal vitamins. Yes. That's when people really go nuts.

Dr. Nicole (12:41): Yes, exactly. Exactly. So I do have to ask for folks, I think sometimes people are like, I can kind of eat what I want and the prenatal vitamins will make up for any dietary deficiencies. What are your thoughts on that?

Doreen (12:57): I think as Dr. Fox was saying, supplements really should be just that, it's a supplement to a healthy and balanced diet. But as we were talking about the challenges that most Americans do not necessarily get a fully balanced diet each day. And the other important thing to note is that some people have dietary preferences or maybe medical needs which are impacting them in different ways. For example, being vegan or gluten free or having a low dairy diet that might lead to lower levels of certain nutrients like V12 or folic acid. If someone is not getting the fortification from the wheat supply in the United States or low calcium. And so a prenatal supplement can make up for some of those deficiencies.

Dr. Nathan (13:44): Yeah, I think it's also important that people realize that nutrition and dietary science is very advanced and very complex and there's people who spend years and years studying it. And vitamins and minerals are only one small component of that. I mean, vitamins and supplements are not going to address, are you getting the right amount of fatty acids and protein and carbohydrates and are you getting enough water in your diet? And there's all these different components that go into it. And so the vitamin might be enough to make sure you get enough folic acid or to make sure you get enough calcium, but it's not going to address the rest of the importance of diet obviously.

Dr. Nicole (14:22): So it's really like a holistic a approach. You need to do all of the things in order to have the most optimal health. I think that's a really important point that this is an advanced science. It's not just flyby night kind of stuff. And I know you're going to talk about how that impacts what you do with Ellement as well. So why, I know part of the reason why you started Ellement, and we'll get to that is because you felt like what was out there wasn't optimal. But why do you think most prenatal vitamins are not optimal?

Doreen (14:58): There are three issues with typical prenatal vitamins and the first, and I would argue most important is that typical prenatals are cramming 20 to 30 different ingredients into the same set of pills taken at the same time, which is problematic for optimal bioavailability. I think the classic example is combining iron and calcium together. Those are not absorbed properly when taken at the same time. There are also fat soluble vitamins like vitamin D, vitamin E, which are best taken with food as opposed to water soluble vitamins like your B vitamins and vitamin C, which are best taken just with water on an empty stomach. And so at Ellement, we developed the first ever twice daily packet to optimize for bioavailability and to separate out ingredients by time of day. And second, prenatals are also not made to change by stage of pregnancy. This is the other really important insight and difference when it comes to using Ellement's.

(16:00): It's known from the medical literature that calcium, for example, becomes more important in the second and third trimesters as the skeletal system of the baby is developing. Or that blood volume doubles by the third trimester. So iron deficiency becomes more common. And with Ellement, we're adjusting the dosages to be optimal by stage. And I would say finally, prenatals are very transactional today. The brands basically just sell the product and they don't check in to see how it's actually performing for each pregnant mama. And so with Ellement, we check in with our customers every few weeks as we prepare that next shipment and ask about changes in diet and lifestyle and update the prenatal accordingly.

Dr. Nicole (16:45): So I love the fact that it's an individualized approach. And I'll be honest, I'm the first to say I'm a really great obstetrician and I can do things with delivering babies and taking care of pregnant folks, but I don't know much. I'm also good to say what I'm not, I'm comfortable saying what I'm not good at. And prenatal vitamins was always just like, I don't know, start a prenatal vitamin. We don't get a lot of nutrition training in obstetrics so that you expect that your OB is going to give you that advice, but it's not something that we necessarily know about. What would you say to that, Dr. Fox?

Dr. Nathan (17:26): So I would say that you and I are exactly alike. And when Doreen first reached out to me, I said, I don't know if I'm the right guy for this. Cuz honestly I just tell people, take whatever, just find a prenatal, get a multivitamin, get one, and you get the cheapest one you can get because there's no difference. And I think it is true that there's probably very little difference between all of the existing prenatal vitamins because they're basically the same and they're same as a multivitamin. Again, they're just assuring that they have folic acid and that's fine. But what's never really been attempted is true individualization customization. And it's not like we're customizing it cuz we're being nice to the customer type of customizing. It's the same thing we do in medicine. You would never manage two people's labors exactly the same way. You would never recommend how to treat someone's blood pressure the exact same way as someone else.

(18:24): You have to do it based on where they are or how bad is it, how severe is it? What's good for them, what's not good for them, what do they tolerate, what do they not tolerate. There's all these nuances that we do every day and no one's ever tried it with vitamins in pregnancy really. And so when Doreen got to speak about it, I was like, this is so cool. Oh my God, wait, you're going to actually ask people what they eat and then tailor their prenatals, or if they're gluten free, we're going to change it. I was like, that's crazy. Who can do that? I can't do that. I don't have the time. Or no, no OB has the time to do that properly. And so either everyone's gotta see a nutritionist their whole pregnancy and follow it, and this is an easier way to do that. So I got really excited about it.

Dr. Nicole (19:06): That is the exact same reason why I wanted Doreen to come on to the podcast. Although, you know, sponsored a few episodes, a few episodes back, I asked you to come back because for that very reason I thought it was so forward thinking and really centering pregnant people in their needs in a way that is not typically done that I just wanted people to know. So I don't have any interest or financial whatever. I just wanted you all as listeners to hear you deserve to have somebody who's looking out for your specific individual needs and tailoring things that are important to you. And that sounds like what is done at Ellement. Is that fair to say?

Doreen (19:54): Yes, absolutely. Well, thank you both so much. And I would say this really echoes what we hear from other practitioners who we are talking with. We've had such great outreach from OBGYNs, from MFMs, dieticians, doulas, and really lots of different practitioners throughout the prenatal care system saying this has been a gap. And they're really enthusiastic about Ellement almost becoming an extension of the care team as it relates to nutrition and supplementation.

Dr. Nicole (20:25): Nice, nice. So I would love to hear a little bit more of your story about how you started this company, why you started this company, that journey.

Doreen (20:36): Five years ago when I became pregnant, I honestly knew very little about pregnancy and birth, which is why I am so grateful for podcasts, the ones, ones that you both host. Being a data-driven person, I tried to learn as much as I could about this life-changing milestone, and I knew that I needed to use a prenatal supplement due to the folic acid. But the conversation with my doctor left me very confused. My doctor told me, just as Dr. Fox was saying, that it didn't matter what product I used that they're all the same. But I would look at the labels and I would see different ingredients, different dosages, different form factors, and ultimately so many moms to be, I had to cobble together my own supplement routine and I wondered why there wasn't a better and more personalized solution. So I think, and this is common for founders and entrepreneurs, my journey to start Ellement was based on first trying to solve my own problem and feeling like there just needed to be a better way. And so after three years of research and development with OBGYNs, maternal fetal medicine specialists like Dr. Fox, we were able to create a product that is vastly superior for bioavailability, simplicity, and overall wellness. And I just truly believe that you shouldn't need a PhD to have the best possible prenatal supplement experience. And so I wanted to create a product that was simple and it's just been great to have such incredible validation from doctors and expectant families. That's what they want as well.

Dr. Nicole (22:08): Yeah, and I just wanna say, like you said, a lot of people start things out of their own experiences, but not everybody takes that to the next level of starting a whole company. So you should be like pat yourself on the back for that. I think it's impressive. So

(22:24): Thank you.

Dr. Nathan (22:25): Doreen's impressive.

Dr. Nicole (22:27): Yeah. What led you to, well, let's talk about a little about your story, how you got into M F M and then how you got to be connected with Doreen.

Dr. Nathan (22:37): Yeah, so I grew up in the Midwest and I came out east for college. I met my wife, we got married young and then I went off to medical school still in New York, did my residency here and did my fellowship in maternal field medicine. I don't know why, it's hard to articulate why I was drawn specifically to OB gyn and then M F M, I think I always just found pregnancy fascinating. It's just really from a scientific perspective, really fascinating. It's really interesting. There's so much we still need to learn. It's obviously a really exciting field that's great for people who like to do a lot of things as you know. So I've been doing this and seeing patients and I love what I do and honestly I have no idea how Doreen found me, but she shot me an email one day and we started talking.

(23:31): And the crazy thing is, I remember I would always say to patients, man, if I would design a prenatal, I'd put this in it and I always pontificate and whatnot. And then she's like, Hey, let's design a prenatal. I mean, I'll leave you great example. I mean, Nicole you know, that hypertensive disease of pregnancy is a huge problem and it causes a lot of potential morbidity or even mortality in this country, which is crazy. And there's a lot of things that we could potentially do to reduce that risk. And one of the easiest ways is putting people who are very high risk on a baby aspirin, starting early in pregnancy, simple, cheap, safe, easy, well tolerated. But the data shows that most people who qualify for it don't get it. And so I was talking to and say, you know what? We could do this at the same time, when you get your intake on your nutrition, let's add a question. Do you have a history of preeclampsia? Do you have hypertension? What's your age? We could send a baby aspirin to you every day with your vitamin, just throw it in there. And this has never been tried before and I just think it's has so much potential for anything like that where you can get more screening, more involvement, and hopefully really, really help people.

Dr. Nicole (24:48): Absolutely. And just make it easier for people and not quite so complex. So on your website Ellement talks about four different things, and I wanna touch through each one. You talked on 'em a little bit, but we can go into them again. So scientifically sound, conscious and responsible, made to change, and tailored to you. So let's start with the first one cuz I think this is always important, scientifically sound.

Doreen (25:16): What that means to me is that Ellement was designed with doctors and that all of our decisions are backed by the most recent and relevant science. And that's why we created the twice daily packets to separate out the fat soluble in the water soluble ingredients. Because we know from a pharmacology perspective that spreading supplements out over the day allows for more optimal absorption. So that's really what it means to me is about having our decisions driven by science and not by beautiful branding or the latest social media trends. It's really about staying grounded by what our medical advisors advise.

Dr. Nicole (25:55): Gotcha. Was there ever anything where you were like, oh, maybe we should do this, and the advisors were like, eh, maybe not.

Doreen (26:01): I can't think of what the particular examples were for that but it did come into play with dosages specifically. We had some initial drafts where there might have been quite a high dosage. For example, biotin, that's one that comes to mind. There are some brands that have really high levels of biotin, and that was one where the medical advisor said it really doesn't need to be that high for pregnancy. So we really got into the nuances at a dosage level, at a form factor level. And I think that has made all the difference to design something that is palatable easy to comply with day-to-day, and something that customers get excited about as well as doctors.

Dr. Nicole (26:46): Yeah, love it. Love it. So what about conscious and responsible?

Doreen (26:50): That means that we are focused on environmental and social impact. Our products are cruelty free. The daily packaging is 100% biodegradable and BPA free. And we have stringent fair wage practices in place. The products are produced here in the United States in a C G M P certified facility, and they are who sent me, that is one of the main certifications for supplement manufacturers. As you might be aware, supplements and vitamins in the US are not F FDA regulated. So the C CGMP is one of the best in class certifications in terms of manufacturing processes, cleanliness of the facility, et cetera.

Dr. Nicole (27:29): Got it, got it. So you're not just about making this thing for money, you really wanna be socially responsible also. Yes. And then made to change. This is the part that I just absolutely love. I think this is so cool. So what does that mean? Made to change

Doreen (27:46): Ellement customizes each box for each stage of conception, pregnancy, and postpartum, and we're delivering the optimal nutrient levels as bodies change and babies grow.

Dr. Nicole (27:59): So how many times, and maybe we can walk through, what is it like from the moment you start taking Ellement through your pregnancy journey and even postpartum? What is that process like?

Doreen (28:12): So it all begins by completing an onboarding form. This is a fairly detailed form. It takes four to five minutes, I would say, to fill out, it covers your age, your stage, a bit of your fertility history, some of those questions as Dr. Fox had mentioned related to preeclampsia risk. And from there, we're able to structure what your kind of initial routine will look like. And we send a specific breakout for each customer of what their prenatal routine will be, what is recommended for them based on Ellement's database and knowledge. From there, every four weeks or so, three to four weeks, we check in with another form to ask you, how have you been feeling these last few months? If you were in the fertility stage, are you now pregnant? And being able to then adjust for trimester one, et cetera. And so we are really staying in close touch with all of our customers every few weeks to understand where they're at in their pregnancy and fertility journey.

Dr. Nicole (29:17): Love it, love it. And then tailor to you, what are some things you can tailor like for dietary preferences or things like that?

Doreen (29:24): Yes, that's right. I mean, this is about not being a one size fits all. We're personalizing each box to fit your specific needs. It gets very granular in terms of we'll have customers who let's say a month goes by and they let us know, oh, I'm dealing with some constipation these last few weeks. We can make some adjustments with their calcium magnesium capsule, for example because magnesium is really beneficial for the anti constipation symptom. There are some more kind of over-the-counter solutions as well that we can kit with the prenatal as Dr. Fox had mentioned, whether it's the low-dose aspirin or some other possible ingredients. And so we are staying in really close touch with the customers to be able to adjust for every single box that arrives to the customer.

Dr. Nicole (30:17): Gotcha. And is it a pill or is it a powder or how capsules, hows folks take a capsule?

Doreen (30:24): Yes. Okay. Series of capsules. So most of our customers are receiving anywhere from four to eight capsules, but it is separated out by time of day. So some of them, they're taking in the morning, some in the evening or afternoon with food.

Dr. Nathan (30:37): It's really very, its very pretty. Doreen sent me a box. I got this beautiful box in the mail, open it up and it has your packs and your PM packs. And there literally used said, take this in the morning, take this at night. Its like the matrix but uh

Doreen (30:53): And it's portable.

Dr. Nathan (30:54): It's amazing. And for me, this box was designed for me for this month. Right,

Dr. Nicole (31:01): Right. Love it, love it, love it. So have you thought about doing any research studies or are there any research studies in progress comparing this to traditional prenatal vitamins?

Doreen (31:12): We conducted a small scale study in 2022 during the r and d process because we wanted to know that Ellement works. And we saw fantastic results in terms of blood work for iron levels, vitamin D, as well as other nutrients. But we are continuing to invest more in clinical studies and we want to expand the sample size of those studies so that we can share results more broadly in the future.

Dr. Nicole (31:37): Okay. Okay. And then I have to ask, how much do the supplements cost?

Doreen (31:42): Most of our customers pay $90 per month or less for Ellement, depending on the number of capsules that they have in their personalized routine. It is more expensive than most off the shelf prenatals because it costs more to produce. And that's due to the very high quality, the personalization and how comprehensive Ellement is. We hear from most of our customers that if they tried to put together a bundle of products to match what they're getting with Ellement, it would actually cost them more than a hundred dollars per month. I think we all know those mamas who are starting with one prenatal and then adding the Omega-3 fish oil and adding in other ingredients. And so most of our customers find that they're actually getting a pricing benefit from using Element because it is so comprehensive. And they also know they're getting the best quality with no harmful fillers or additives. And I also wanna remind people that you can use an FSA or HSA card Prenatals are covered with those as well.

Dr. Nicole (32:40): Oh, I didn't know that.

Doreen (32:41): Yeah. Nice little trick to know about.

Dr. Nicole (32:43): Learn something new every day. All right. So as we wrap up, I ask all guests the same question. So for each of you, what is the most frustrating part of your work?

Doreen (32:55): You go first, Dr. Fox.

Dr. Nathan (32:57): Yeah, I mean, I guess cuz you're going to say working with me, so I guess I should go before you. Hard trying to reach that guy. He's always not doing it. Not answering my emails. Interestingly, the actual work I've been doing with Doreen and with Ellement has not been frustrating and the least frankly, Doreen does all the work. So I'm not remotely frustrated. What what's frustrating to me is how much I am continuing to realize how little we know about this science. And it's just frustrating. That's where we are. The fact that we don't have great studies on nutrition and pregnancy, the fact that we don't have great studies on exactly what the vitamins and we're tailoring it to people and we're using the best data and best evidence available. But that data and evidence is limited, unfortunately. And I think that's really what's been frustrating me, that we're so eager to invest in and to talk about and to study really technologically complex and advanced treatments and biotechnology in nutrition and vitamins. We know nothing about it. Just backwards.

Dr. Nicole (34:08): Yeah, for sure, for sure. What about you, Doreen?

Doreen (34:11): Oh, that's such a good answer. I feel like we touched on before, one of the things that I find most frustrating, which is that I want to support doctors and other prenatal practitioners in changing the narrative that all prenatals are the same and that it doesn't matter which one people take. Historically that was true since brands were just reorganizing the same set of ingredients rather than creating something truly different. But now Ellement has created a significantly better experience, and so we want to scale that information and make sure that doctors have access to those insights.

Dr. Nicole (34:44): Yeah, I know I 100% when I was in the office, I'm a OB hospitalist now, but when I was in the office, I would be like, I don't know, just take a prenatal, just find something I really, I don't know. So totally get that. Totally get that. So on the flip side, what is the most rewarding part of your work?

Dr. Nathan (35:02): Working with Doreen? See now you can't say. I think for me, I spend all day seeing patients and trying to help them and listen to them and take care of them. And it's amazing. It's rewarding. I love what I do. Absolutely love what I do. And what I found really amazing about this project, which again, this is not my day, my day job, this is something I'm doing sort of in addition, it's giving me another avenue to try to make change and positive change for pregnant people in this country and outside obviously this country. And that's just exciting for me to have another avenue to try to do the same things that I've been doing day-to-day with people individually.

Dr. Nicole (35:43): Yeah, it is nice to be able to reach and serve more folks. I feel like these days we have to have a love for this work to continue to do it because it can be stressful and demanding some sometimes, but I totally relate to being able to help people in a different way. So what about you, Doreen? What's the most rewarding part of your work?

Doreen (36:06): Hands down, it's getting to hear feedback from our customers. It's so rewarding. We have a customer who is iron deficient for years, and after 45 days of using Ellement, her blood work was finally at a normal baseline. Or another customer who actually learned about Ellement from All About Pregnancy & Birth. Started using Ellement. This is very recent, actually started using Ellement preconception and within 10 days we got an email from her saying my skin and hair are so healthy and improving and feel so great. So it's just amazing knowing that we're making a positive impact in people's lives, and that's very rewarding for myself and our entire team.

Dr. Nicole (36:48): Yeah. So we'll end with your favorite piece of advice and then I wanna hear where people can find you. I know Dr. Fox, you have a podcast, so you gotta tell us all about that. So why don't we start with what is your favorite piece of advice that you love to give to expectant families?

Dr. Nathan (37:03): So I think the best piece of advice I can give is and this is not going to be a plug for me, but it's a plug for you, is make sure you get your information from good sources. I love Google, I'm a fan of the Google, but it can go wrong. And I think that in the wrong context, it's could be very harmful to people. And I think that finding sources of information that are reliable and that you trust and that are nuanced and explain things in a way that make sense to you is absolutely critical. If you happen to have a really good relationship with a doctor and can ask them questions every day or a midwife, great. But if not, I listen to your podcast. I think it's awesome. And I think that you have a really good perspective on this. I think I have a reasonable perspective on things too, and we try to do that on our podcast, but I think it's really trying to get something better than just some random shot in the dark search for something.

Dr. Nicole (38:00): 100%. 100%. And Doreen, what is your favorite piece of advice to give to expectant families?

Doreen (38:06): Oh my gosh. I feel like I have so much advice to share.

Dr. Nicole (38:10): Okay, you can do two, two

Doreen (38:13): I would say if I had to pick two, it would be advocate for yourself and second, enjoy the simple moments and go easier on yourself

Dr. Nicole (38:23): As well. All great, all great pieces of advice. Love it, love it, love it. And yes Dr. Fox, you mentioned you have a podcast and I agree that we're very similar. I saw you have episodes on OB GYNs who've done home births series on midwives. So you're very centered and providing people that evidence-based information that helps them make the best decisions for themselves as opposed to telling people what to do. So please tell us where folks can listen to your podcast.

Dr. Nathan (38:53): All right, well, we are podcasters separated at birth? I think so, yeah. So my podcast is called Health Full Woman. That's the word Health, f u l, woman in the singular, W O M A N. We're everywhere you find podcasts. Okay. Apple, Spotify, whatever. And we have a website which is health full woman.com.

Dr. Nicole (39:15): Perfect. And then Doreen, where can folks find Ellement?

Doreen (39:18): Our website is hello ellement.com. That's Ellement with two Ls hello element.com. And you can get started by submitting the onboarding form. We'll get back to you with an explanation of your personalized prenatal routine with elements. And you can also email us at support@helloellement.com. We'd love to hear from you. Okay.

Dr. Nicole (39:41): In my head, as you were saying that I was doing the promo from when I did the podcast episodes. I was like, hello ellement.com. So. All right. Well thank you so much for both of you for agreeing to come on. This is really important information and as I said, I'm not invested in this any way other than just wanting people to have the best options and things and know about things that are that're out there. So I appreciate you taking the time today.

Doreen (40:11): Such a pleasure. Thank you, Dr. Rankins.

Dr. Nathan (40:13): Thanks for having us. It's like I feel like we made the big time.

Doreen (40:17): We have.

Dr. Nicole (40:24): All right, wasn't that an interesting episode? I so enjoy chatting with both of them. I'm looking forward to having Dr. Fox back on the podcast to talk about other topics related to pregnancy and birth. And I'll probably hop onto his podcast as well. So stay tuned for that. All right. Now, when I interview someone on the podcast, or in this case two people on the podcast, I do something called Dr. Nicole's Notes where I talk about my top three or four takeaways from the conversation. And here are my Dr. Nicole's Notes from my conversation with Nor Doreen and Dr. Fox. Number one, I just love the idea of things being more personalized and not cookie cutter and not one size fits all. We're all very individual, we're all unique. So to think that one thing can really satisfy everybody when you think about it, it probably doesn't make sense.

(41:16): So I think this is the future of where healthcare is going, where we try to do a more personalized approach to things where you get things that are really based on your specific needs. I do think we're probably many, many years away from that being sort of the standard of care, but I do think that's where we're headed. And I think Ellement is ahead of the game, ahead of the curve in terms of starting to bring this to the prenatal space. And I'm excited about it and I think it's a really great thing to look into. All right, number two, please remember that your doctor got little to no training on nutrition. Just don't like, it's just not a part of our curriculum, if at all. And if it is, and it's very little, and it's not going to be specific to pregnancy pregnancy, nutrition.

(42:07): So you really have to take it upon yourself to get educated about pregnancy nutrition because your doctor just doesn't have that information. And I'll also say that they're also not necessarily comfortable admitting that they don't know that They're just going to say, oh, hey, take a prenatal vitamin, or Hey, here's a pamphlet. Hey, here's information. Without really being clear that I really don't know what in nutrition not, we're not always good with saying what we don't know. So just remember that when you ask your doctor information about anything related to nutrition, we did not get a lot of training on that. So take that with the grain of salt. Now you will find some doctors who have taken it upon themselves to get more education in nutrition. Dr. Ann Canard, she was on the podcast and she talked about nutrition. She was on way earlier on the podcast.

(43:00): She's an OB G Y N, and she talked about nutrition and pregnancy as well. That is episode, hold on, let me look it up. Okay, that was episode 24, way back when. Episode 24. It supplements nutrition environmental toxins with Dr. Ann Canard. So you can get that at drnicolerankins.com/episode24. It may be hard to find the episode in podcast players because I think they only go back like a hundred episodes or so. So at any rate, you can check that episode out. I say all that to say like some doctors do have additional training, but most of us do not. Okay. And the final thing I'll say is because we don't have a lot of training, you should really consider seeing a dietician during pregnancy. That's not something that we refer out routinely enough, and I think we should do it more. I think you should especially consider it if you have food preferences.

(43:56): For example, you're a vegetarian or vegan or you don't eat red meat, things like that. I also think you should consider it if you carry extra weight and you need to be mindful of how much weight you are gaining during your pregnancy or not gaining during your pregnancy. And also, if you're having a lot of trouble with nausea and vomiting and keeping things down, then seeing a dietician can be helpful as well. You can learn some things about prenatal nutrition with pregnancy. I have a dietician episode with Stephanie Laurie, that's episode 1 41. So drnicolerankins.com/episode141. Of course, we'll link both of the episodes I mentioned in the show notes, but do consider seeing a dietician in pregnancy, especially if you have those things that I mentioned. All right. So there you have it. Do me a sola share the podcast with the friend.

(44:40): Sharing is caring and helps me to reach and serve more folks. Also, subscribe to the podcast wherever you're listening to me right now. And let me know what you think about the podcast. Leave me a review on Apple Podcast. Shoot me a dm. I'm on Instagram with Dr. Nicole Rankins. I love to hear what you think. It always makes me smile when I get your messages about the podcast. And do join me for my live class, make a birth plan the right way. That's going to be on Tuesday, January 17th. Check out all the details at drnicolerankins.com/register. So that's it for this episode to come on back next week. And remember that you deserve a beautiful pregnancy and birth.