Prenatal Vitamins are Kind of a Hot Mess with Helena Bottemiller Evich

Katie Ferraro (0s):

Before we get started, I just wanted to drop a Happy Father's Day to all the dads out there who are doing Baby-Led Weaning. I totally get that. The vast majority of our audience are moms, but there are a lot of dads who are actively involved in helping their babies learn how to start solid foods safely. I remember when our twins, Guss and Hannah were starting solid foods. They were our sixth and seventh babies. I'd been teaching Baby-Led Weaning full time for a number of years before this. My husband would still roll into the kitchen and be like, are you sure the babies can eat that? Are they gonna choke? And I'd be like, oh my gosh, yes they can. They're safe. But I loved that he would get into it and he was so proud of all of the foods that his babies were learning how to eat. So I just wanted to wish all of the dads out there a very Happy Father's Day, especially if it's your first Father's Day.

Katie Ferraro (42s):

So thank you for helping your baby learn how to eat, and I hope you have a wonderful Father's Day

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Helena Bottemiller Evich (2m 33s):

The prenatal vitamins that they tested, the vast majority of them had at least one nutrient that was like not at the levels it said it was like they were just not very accurately labeled. And that kind of got my wheels turning like, you know, prenatals are just for such a vulnerable population. Like I just kind of thought there would be a little bit more guardrails around them. And the more I dug into it, the more I was like, oh, not only is there not very much regulation, there's also not guidance on what needs to be in them.

Katie Ferraro (3m 3s):

Hey there, I'm Katie Ferraro, registered dietitian, college nutrition professor and mom of seven specializing in Baby-Led Weaning. Here on the Baby-Led Weaning with Katie Ferraro podcast. I help you strip out all of the noise and nonsense about feeding, giving you the confidence and knowledge you need to give your baby a safe start to solid foods using Baby-Led Weaning. How did you choose your prenatal vitamin? Was it the branding or a doctor's recommendation? Was it based on price or maybe was available at the store the day you were there? Or maybe you did your research and you looked it up to see exactly, you know, how many micrograms of folic acid are recommended and then what brand comes closest to delivering on that?

Katie Ferraro (3m 47s):

Although I doubt it, right, because most pregnant women pick a prenatal and trust that it will do the job. But what are the guidelines for nutrients in prenatal vitamins and who sets those standards? Does anyone really like checking? Is there oversight on this? Well, the GAO, the Government Accountability Office recently did a report on prenatal vitamins and this report and their testing showed that 11 of the 12 prenatal supplements that were tested had at least one nutrient that was above or below the levels noted on the labels. And this could result in a person consuming too much or too little of some really important nutrients when you're pregnant. And this GAO report caught the eye of Helena Bottemiller Evich.

Katie Ferraro (4m 27s):

So Helena is our guest today. She's a journalist who focuses on food safety and food technology. She's the founder in editor-in-chief of one of my favorite email newsletters called Food Fix. I first started following Helena when she was in her previous job, so she was the senior food and agriculture reporter for Politico. And so she has a very impressive professional resume. But Helena is also the mom of a 4-year-old. And at the time that we just recorded this interview, she was also 35 weeks pregnant with her second baby. So the whole idea of inconsistencies in prenatal vitamins is of interest to Helena as a journalist, but of course also as a pregnant mom. And I love that intersection of her work. She's always reporting on issues that are of interest to us as consumers, but also in many veins as parents.

Katie Ferraro (5m 13s):

So Helena was previously on this podcast to talk first about the formula shortage and then the formula recall that was happening simultaneously. She actually broke a really important part of that recall story. And then more recently she came on to talk about lead contamination in the cinnamon and applesauce pouches story that she was researching. And I'll link to both of those previous episodes if you want to learn more about her work. But I'm personally a huge fan and I can't recommend her newsletter called Food Fix enough. I kind of recently went through and canceled a lot of my paid newsletter subscriptions. They were either ones that I wasn't reading or weren't relevant or I was like, this is not worth the money. And one of the very few that I did keep was the Food Fix newsletter. So if you are interested in food policy or food safety, food technology or you don't have time to read and research GAO reports on your own, Helena definitely can.

Katie Ferraro (5m 58s):

And I really enjoyed this conversation because she opened my eyes to these gaping holes in prenatal vitamin regulation. I know it's relevant to all of you because you are either a pregnant person taking a prenatal vitamin right now, or you're perhaps still taking your prenatal vitamin if you're postpartum on the recommendation of your own doctor. Or you will be taking prenatals again for future pregnancies. So this is important information to hear. And if you're not already subscribed to this podcast, I would encourage you to do so. Hit the follow button so that you can get notified each week when both of the episodes that I do drop. I do a mini solo Baby-Led Weaning training episode on Mondays and a longer interview episode like this one every Thursday.

Katie Ferraro (6m 38s):

To follow the show or follow us online, we're at blwpodcast.com. And with no further ado, I want to invite Helena Bottemiller Evich, the founder and editor-in-chief of the Food Fix newsletter, on to talk about prenatal vitamins and why they're kind of a hot mess.

Helena Bottemiller Evich (6m 57s):

Thanks for having me. I'm glad to be back.

Katie Ferraro (7m 0s):

Okay, I know you usually focus on food your newsletter, which I'm a huge fan of. Sorry. I always write back to your newsletter like I love this one today. And you're like, you're probably making this response.

Helena Bottemiller Evich (7m 9s):

I love getting your notes.

Katie Ferraro (7m 10s):

Okay, I, It's called Food Fix, so like I get it. Your focus is food and food journalism and food technology. And I was kinda surprised because like, oh god, Helena doesn't normally cover supplements. And I was interested when I saw your article, it had very catchy headline, which was, Prenatal vitamins are kind of a hot hess. Does anyone care? So what stoked your interest in this story other than at the time of this recorded year, 35 weeks pregnant? So there's a personal interest level, but like what caused you to, you know, maybe make that jump from food to supplements in this case?

Helena Bottemiller Evich (7m 39s):

Yeah, it's a great question. I mean certainly I do have a personal interest because I am pregnant and right now and when this, the Government Accountability Office put out a report that had done testing on prenatals, it came out a couple months ago and I saw it and was like, oh that's relevant to me. I'm gonna read it. And you know what they largely found is that the supplements that, or the prenatal vitamins that they tested, the vast majority of them had at least one nutrient that was like not at the levels it said it was like they were just not very accurately labeled. And that kind of got my wheels turning like, wait a minute, how could that be the case? Right? Like prenatals must have some level of oversight that's a little bit more than, you know, we, I think there is some general awareness that supplements are not as regulated as other products but you know, prenatals are just for such a a vulnerable population.

Helena Bottemiller Evich (8m 27s):

Like I just kind of thought there would be a little bit more guardrails around them and the more I dug into it, the more I was like, oh, not only is there not very much regulation, there's also not guidance on what needs to be in them. And so I just started calling around and asking people about prenatals and it kind of turned into, yeah, it turned into this newsletter. And I think I even wrote in the newsletter like, I avoid covering supplements because it is so different than food. They have a really different set of issues and it is kind of this, I think, unwieldy sort of separate industry that I personally, I'm personally kept plenty busy covering food policy and you know what's going on in food world. So I do tend to stay out of it, but because I am currently pregnant, I also have a 4-year-old.

Helena Bottemiller Evich (9m 12s):

So I took prenatal vitamins years ago. So you know, I've been consuming these products on and off for like several years now. And so yeah, there's a personal interest there and it's, it's been interesting to dive into. I'm still getting so many emails about this too.

Katie Ferraro (9m 26s):

It's so interesting because it's like.

Helena Bottemiller Evich (9m 27s):

It's moms, dads, grandparents.

Katie Ferraro (9m 27s):

Yeah, I think if you're a food person, like I'm a dietitian, right? I'm a practitioner of food, I'm food first all the time. It's most of the supplements save your money. They don't do what they say they're gonna do. It's the wild wild west of marketing. Unless they like literally kill you, there's never gonna be a recall and like you and I could spit in a capsule and sell it at Costco tomorrow and it, that's totally legit. Like most people get, supplements are bogus except they kind of have you by the, you know what, when it's like wait a minute, but I'm pregnant and there's no way you could physiologically like eat the amount of iron that your body needs when you have 50% increase in blood volume. Like you do have to rely on these supplements. And I think especially for moms, like it's very eyeopening. Like I thought prenatals were like pretty run of the mill and like hang on, they're all standardized and there's at least a baseline of what "should be in there".

Katie Ferraro (10m 11s):

So what'd you find out? Like I know you were talking to ACOG, tell us who they are, what they told you about, like what are the requirements for what should be in supplements for pregnant moms if there are any?

Helena Bottemiller Evich (10m 22s):

Yeah, I mean I think those are all, you know, such great points like prenatal vitamins are really the only supplement that is like fully embraced by the medical establishment, right? Like there you generally are not gonna have doctors recommending, you know, maybe they'd recommend like a vitamin D or something, but you know, there isn't a big focus on it except for when you are trying to get pregnant or you're pregnant and then look, the only question you get is are you taking a prenatal? So it is one of those places where the medical establishment is very much recommending and encouraging you to take it. And I think that's the big difference. So for prenatal vitamins, what I learned is that the American College of Obstetrics and Gynecology, which is a group we refer to as ACOG, they really only very specifically recommend that a prenatal vitamin should contain folic acid.

Helena Bottemiller Evich (11m 14s):

So that you need to have at least, I think it's 400 micrograms of folic acid supplemented every day. And that is actually important before you are trying to get pregnant. And it's more important before than it is actually during pregnancy. And that is because there's very clear evidence that it dramatically reduces neural tube defects. So these are really serious birth defects and there we've had a dramatic reduction in the US since we also fortify a lot of foods with folic acid to try to encourage more consumption. So folic acid's really important. Then from there, from there it gets really variable. Your, your prenatal vitamin might contain iron, it might not, it might contain choline, it might not.

Helena Bottemiller Evich (11m 56s):

What I was just so surprised by was how much variation there is and there really isn't anyone writing guidelines about what should be included. Like here are the five things right. And that just sort of surprised me. I just figured there was a little more standardization and there's really not.

Katie Ferraro (12m 17s):

Hey, we're gonna take a quick break but I'll be right back.

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Katie Ferraro (12m 54s):

So I wanna just clarify too with the folic acid, in case people, I know a lot of our audience who's like usually parents of baby six to 12 months of age, like they always have iron on the brain. So like yes of course your prenatal could include iron and we'll talk about why many of them don't these days. But the catch there with the folic acid is that neural tubes usually close somewhere between like 15 to 28 days following conception. And a lot of times that's before you even know you're pregnant, right? So the general guideline is especially if like you're on birth control, as soon as you go off of birth control, if you're trying to conceive, start taking your prenatal vitamin because again, if you wait till you're first missed period that these more than 30 days in many cases following conception and that really, really important window of preventing anencephaly and spina bifida, like it's already closed.

Katie Ferraro (13m 39s):

So folic acid is of so much importance and yes we can get some from the diet, it's

Helena Bottemiller Evich (13m 47s):

A preconception intervention. Exactly.

Katie Ferraro (13m 48s):

They should be called like preconception pills not prenatal.

Helena Bottemiller Evich (13m 51s):

Yeah and like there's, there's probably a lot more that could be done in Medicaid and other health programs to just look at anyone who's maybe trying to get pregnant or of childbearing age should probably be more of the target. Because you're exactly right, a lot of times you don't know you're pregnant by the time.

Katie Ferraro (14m 7s):

Yeah and I know we both do a lot of work with WIC that covers you from the time you're pregnant. There's no preconception unless you have another child who's five and under you still qualify. You know that's a huge catchment population too that and as far as like public health campaigns go, like it is very well established that fortifying the food supply and recommending supplements, prenatal vitamins with folic acid has done wonders to reduce neural tube defects. Now neural tube defects were never like rampant public health, you know, disaster. But if you talk to anyone with the baby's spina bifida even you know, the fact that even one life can be saved but there really is a market decrease with this. So this is something like.

Helena Bottemiller Evich (14m 46s):

It's been a dramatic decrease in the US since particularly we started fortifying food and actually in the UK right now they're debating whether or not to fortify certain foods over there because they didn't and they still have higher rates of neural 2D. Interesting really quick. In Europe prenatal vitamins are way less of a thing. So just in researching this I kind of learned that like it's much more likely for there to be emphasis on folic acid preconception like we were just talking about. And there is much less emphasis on taking a supplement while you're pregnant, which I just found interesting that it's like a very different approach.

Katie Ferraro (15m 20s):

Well, you know Americans love to fix things with a pill, right? Like oh I'll just have a crappy diet and take a pill. It's kind of your insurance policy. And I know a lot of moms who think like that, like especially first trimester, right? You have nausea, you don't feel like eating or you can't keep stuff down, right? Exactly. Like hey, but the toast is fortified with folic acid in this country as well as some other B vitamins. So that's an interesting finding. What'd you find out about with regards to iron? Because we know there's many different formulations of prenatal vitamins, some that have iron and some that don't. So what's, what are the recommendations from I ACOG regarding iron?

Helena Bottemiller Evich (15m 54s):

ACOG doesn't actually say that you need iron in your prenatal, but they have some really good resources on their website about consuming enough iron. You need 27 milligrams a day, that's their recommendation. And you could get that from lean red meat, poultry, fish, dried beans, peas, iron fortified cereals, prune juice, I don't know how many.

Katie Ferraro (16m 15s):

Hey if you're constipated you'd definitely be on it.

Helena Bottemiller Evich (16m 17s):

Yeah. So they focus a lot on getting your key nutrients that you need when you're pregnant from foods. Which I found interesting because my care team personally did not really talk about that. And I, I think that's a common experience is that.

Katie Ferraro (16m 28s):

Its also impossible, just so you know, like as a dietitian to eat 27 milligrams of iron, like to put it in context, an eight ounce chicken breast, two times the palm of your hand only has three milligrams of iron. Like you're gonna eat nine of those, you're gonna eat 72 ounces of chicken.

Helena Bottemiller Evich (16m 40s):

This is why you always have to be friends with or get your insurance to cover a dietitian. I didn't know that but yes, 27 milligrams is the recommendation for every day.

Katie Ferraro (16m 50s):

So when you're pregnant, which is wild 'cause we actually one of the most downloaded episodes of our podcast 'cause for babies it's 11 milligrams. Like babies don't even eat like 11 milligrams of actual food, let alone iron when they're starting. And like the podcast episode is called, does my baby really need to eat 11 milligrams of iron? Because parents will look it up and be like, oh my gosh I meant to feed them so much. You start with.

Helena Bottemiller Evich (17m 8s):

A map and they're like.

Katie Ferraro (17m 9s):

Yeah. And then there's so many different things like with regards to absorption rates, right? Like if you have a lot of vitamin C, then your body is more inclined to absorb that iron or the iron from animal foods is better absorbed than plant. But like at the end of the day, even as a dietitian who's always gonna recommend food first, don't even try to get 27 milligrams from food, you have to take a supplemental source of iron. And I wanna ask you, 'cause you just, you're doing this like does the iron nauseate you, constipate you? Like are you personally seeking out a prenatal without iron because it's problematic for you or were you looking for one that had it in there and did your search change when you saw this report?

Helena Bottemiller Evich (17m 45s):

Yeah, really, really good question. So personally, I always make sure any prenatal I'm taking or any multivitamin, anything I'm taking has iron. 'Cause I know that I can get low iron and it's horrible, horrible, right? Like your energy's level and especially when you're, or your energy's really low, especially when you're pregnant can be really hard to recover from low iron. So mine does contain iron but I, the iron doesn't bother me. I know a lot of, a lot of moms who can't who just get really bad like constipation or heartburn or I mean they, they just can't tolerate it. So I think if you can tolerate it, it makes sense 'cause it's hard to get that much iron from your diet. But if you look at what's actually recommended, I mean a lot of prenatals don't contain iron, a lot of them don't contain choline or different, I mean it's just variable.

Helena Bottemiller Evich (18m 31s):

So I think looking at your, you know, whatever you're taking and sort of thinking critically about like does this seem like it's meeting what I need is good. You also do get tested for your, you get your iron tested when you're pregnant a few times. So you should have some sense of like whether or not your iron levels are stinks steady. And actually I got kind of lazy about taking mine every day because.

Katie Ferraro (18m 52s):

You're supposed to do it on an empty stomach too and it's like that's rough.

Helena Bottemiller Evich (18m 56s):

I did go down a little bit, yeah it didn't precipitously drop off but I thought oh you know what that may, that may have been doing something. So I've gone back to taking it much more regularly. But it's just an interesting thing where, I mean I think this whole area probably needs more attention, more oversight, more standardization just because the more we're learning about how crucial this time is, you know we talk about the first thousand days which includes pregnancy, right? And or you know the early years of what you're feeding your kid. And so it just seems like an area that could use more attention.

Katie Ferraro (19m 31s):

I wanna ask you about the actual.

Helena Bottemiller Evich (19m 33s):

Yeah. Un impressed with the level of attention.

Katie Ferraro (19m 35s):

Yeah. Well I, oh, I also love that you're just like cruising ga like what's the GAO put out this week? Like I mean that doesn't sound interesting to me until it's like okay prenatals, that's about, that's interesting but like what you read in this report, part of my ignorance but I don't read these reports anymore 'cause I just read your newsletter which summarizes all this stuff. But like what's the problem if they tested samples and 11 out of 12 of 'em I guess had nutrient levels that were outside of the acceptable deviation from levels printed on the label. Which I think is awesome. Like you are allowed to lie on your labels but like you might've lied too much the label and so now we're gonna report on you.

Helena Bottemiller Evich (16m 26s):

It's also that means the.

Katie Ferraro (20m 7s):

Labels. Yeah because all the supplements can just, they all hide behind proprietary blends, right? So that they don't have to like actually tell you what's in the supplements. Like supplement labels are a joke to begin with. So I think this is funny that the government's like did you know that the stuff on supplement labels is wrong? Like of course it is. But was it problematic in the sense that they were like shorting you on the nutrients or were we airing on the other side like possible issues of toxicity and nearing the upper limit which is a level that scientists have found. Like if you go above that value from a supplemental source of a micronutrient it could be potentially harmful to you in your fetus. Like some of this crosses the placental barrier. Like was that some of the concern about this report?

Helena Bottemiller Evich (20m 42s):

Yeah, I mean all really good questions. I think the overall message is that there was, they didn't find anything that was like dangerous or unsafe or that or that you know would suggest that people should stop taking their prenatal. So that's a really key message here. But to me what this suggests is like there just isn't as much kind of control over the processes and sort of the manufacturing to have that much variability in what's in the product compared to what's in the label. And one of the things I learned is that one of the few requirements that there are on supplement makers is that they do need to be, I think it's close to or over the a hundred percent level or a hundred percent of whatever the level they do have on there.

Helena Bottemiller Evich (21m 26s):

So a lot of them are overshooting. So in gummies in particular, this is a big issue because certain nutrients are not as stable in the gummy form and gummies are really popular or growing in popularity, especially for prenatals. And a lot of times those don't contain iron either because I think iron tastes kind of bad. So what they're doing is they're overshooting the folic acids sometimes by like two or three times the amount listed on the label. And I don't know that there's any health issue with that. Like I couldn't really find anything that would suggest that it is a health issue. But as a consumer knowing that something you buy could have like double or triple the amount.Yeah, what's on the label and for water sort of like a, a red flag to me for.

Katie Ferraro (22m 7s):

A water soluble vitamin, right? Your body excretes it. Like we always tell patients like hey you're just gonna have expensive you buy these expensive supplements with a bunch of water soluble vitamins, you're gonna have expensive urine 'cause your body will excrete it, right? It's water acid

Helena Bottemiller Evich (22m 17s):

Soluble acid water soluble, I don't even.

Katie Ferraro (22m 19s):

Know yes fo 'cause folic acid is a B vitamin and B vitamins are water soluble. But if we're talking about fat soluble vitamins, for example vitamin A, which everyone know like plays a role in the development of your baby's, you know, vision system and their immune, those are the fat soluble vitamins like your liver retains those. Like they can build up to potentially toxic levels because the body does not excrete them as readily. So I think there's this, you know, the common concept like well this is an over the counter product, like I don't even need a prescription to buy this. It can't possibly be harmful. Well it is if you don't go above the upper limit. Well how am I supposed to know what the upper limit is? Well it it's posted on the Supplement Facts panel. But if that information is wrong, like sorry not not to be, what can you really trust because the information you're being provided is wrong.

Katie Ferraro (23m 4s):

And again, if you know the history of dietary supplement regulation, that's also a hot mess.

Helena Bottemiller Evich (23m 9s):

Yeah it, I think for me coming back to just like being a parent and someone who covers like regulatory issues, we just kind of have this assumption I think and and maybe it's sometimes wrong that certain things are just, they have a little bit more oversight, right? Because, and actually there's good examples of this like cribs are regulated like what you, what paint you can use. Yeah. Also car seats are pretty tightly regulated. So there are examples.

Katie Ferraro (23m 35s):

But You know what's not high chairs, all they have to do is pass the tip test. There's no requirement that the back be flat babies falling backwards, opening their airway, no foot rest requirement, baby's feet resting flat which stabilizes them when they're gagging so they don't choke like, and parents get pissed like how could you possibly have sold me a hiter that's unsafe. It's like, it's wild. It makes parents mad. I and rightly so because you would think like, dude I just bought this $300 high chair, guess what? Some of the most expensive ones are actually the most dangerous.

Helena Bottemiller Evich (24m 2s):

Really? Okay. So I didn't, I didn't know that. But it does feel like kind of a classic American story to like peel back and you'll be like, some things are super tightly regulated and some of them are like not regulated at all and it's, it's hard to tell as a parent and also like it feels like it requires a lot of legwork And I think, you know, one of the things I was hoping when I was looking, you know, researching prenatals was will I find some great guide or come up with some like great advice on just like how to, you know, how to pick a prenatal, here's some like here, here here are how the experts pick prenatal vitamins, right? And what I found is that everyone had a different set of advice like look for third party certification but then like I found the experts kind of disagreed about which third party certification was the best.

Helena Bottemiller Evich (24m 48s):

And there's, there's just so much variability that I didn't feel like I came to kind of a consensus on like how you would do the homework to sort of pick the best prenatal which.

Katie Ferraro (24m 57s):

And that's saying a lot like you spent way more time researching it than any parent ever would and you still kind of come up with something and I want like how did it then inform your decision?

Helena Bottemiller Evich (25m 7s):

I didn't change the prenatal I'm taking but I also, I do think it's really important. I also did not come away thinking like, oh prenatals are dangerous, I'm gonna stop taking mine. I did not, which is good but it was more of a, it was more of a realization of like, huh, like I said in the headline, does anyone care about this? Right? Like I know is this area that we're really looking closely at and making sure is properly labeled and you know that it's not having safety issues. We don't see evidence of that. But one of the things that was so interesting is the, one of the supplement trade groups really came out strongly against this report. They called it alarmist. They were like, you know, arguing or basically saying that you know, maybe GAO didn't have the best testing methods and and so on.

Helena Bottemiller Evich (25m 53s):

But what I came to realize is there has been no independent analysis.

Katie Ferraro (25m 57s):

Even consumer reports hasn't done it.

Helena Bottemiller Evich (25m 58s):

No. Of how accurately labeled this, you know, this sector is, it would be great if Consumer Reports did that. Yeah

Katie Ferraro (26m 3s):

They should. They're chief scientist. He's so awesome. He comes on all the time. He's so interested in parents' feedback 'cause you know they, they've done tuna and obviously the heavy metals and the baby food but like I would love to see their hot take on this too.

Helena Bottemiller Evich (26m 15s):

Yeah, I think it's just be good to have some independent analysis because you are really relying on, you know, companies to do the right thing. And thankfully I think most of them like don't wanna have an issue with a prenatal vitamin. And I especially I think if they have a brand, like a brand name behind them, like they're gonna be paying really close attention to like what their sourcing is. You know, maybe they're gonna be doing more quality testing. Like I, it's not like I think the industry's like reckless but it's the question of is there independent oversight? And I think that's, that's what we don't have.

Katie Ferraro (26m 53s):

Hey, we're gonna take a quick break but I'll be right back.

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Katie Ferraro (27m 28s):

I think what's so interesting historically, like I used to be an adult nutrition all the time. Okay if you absolutely need to take a supplement 'cause like you just feel like you want to, right? But it's, it's in order to supplement your diet. So I would like to look as a dietitian at your, the base of your diet and most of your nutrition is coming from food and the supplement is intended to supplement it, not fix it. But in that case a lot of times the recommendation was go for the generic brands like a Walgreens and a Target and a Walmart brand Kirkland. And I know Consumer Reports has done supplement studies in the past where Kirkland comes out like tip top like you're gonna buy fish oil just like they've got more to lose basically. And they've got.

Helena Bottemiller Evich (28m 5s):

Is a lot of, they have a lot of in-house requirements that are not.

Katie Ferraro (28m 10s):

Perhaps more stringent.

Helena Bottemiller Evich (28m 10s):

Are known to be more strict. I can't speak to the supplement specifically but on food safety they are known to be quite strict on that stuff.

Katie Ferraro (28m 18s):

And that's a good recommendation to parents like if you don't care but, but sometimes parents think, especially in adult nutrition, older adults, a lot of the supplement manufacturers that they, they're they so unscrupulously market to older adults on limited fixed incomes, their perception is if it's more expensive it must be better for me. And we know with supplements that's certainly not the case. And so I think, you know, I would love to see your guide on like how to buy a prenatal because it doesn't need to be the most expensive, a big national brand that perhaps has more stringent oversight than the non-existent prenatal oversight. I guess that I didn't even know we didn't have this either so I appreciate you looking at the source documents too 'cause just like looking at the way you handle this versus like your typical mom influencer on TikTok would be like prenatal vitamins are the worst thing ever.

Katie Ferraro (28m 58s):

It's like that's not what you're saying. You're just saying like wow even as a person taking this and a fairly educated person in food and supplements, like I had no idea there was no standardization and should there be just starting that discussion like that's interesting.

Helena Bottemiller Evich (29m 13s):

Yeah and there are some government agencies that are I think this summer going to have a meeting about prenatals. I'm not sure if it was sort of sparked by the GAO report. I would guess it has something to do with it. And so there is gonna be a little bit more conversation here in Washington just about that class of products, which I think is a good thing. I mean I don't know what the answer is here. I just, I, yeah like you said, I was just surprised to learn about sort of the lack of standardization and talking to friends too about like what are they taking? I just found it was all over the map. Like what you know, what was included versus not. Which is just interesting And I personally think that like parents shouldn't be expected to do research on this kind of stuff.

Helena Bottemiller Evich (29m 57s):

Like oh my gosh you're right, less time you should just sort of be baseline just standardization. Like you are not wondering whether or not your car seat is up to code. Right.

Katie Ferraro (30m 7s):

Absolutely. You're right. You there should be some basic levels, especially when there's upper limits that are set based on science. There's RDAs and ais for pregnant women set that are based on science. There's average like household consumption level data that we can get from the USDA about what the average person is eating. Like do the subtraction, right, what you should be getting minus what you're probably eating and then like let's make a range and put 'em in prenatal vitamins. Like it, it's probably not that simple but your question or your statement about, okay there's other agencies maybe getting together led me to my next question was, 'cause normally as a dietitian for consumers who are looking to learn about supplement safety, I usually recommend go to the office of dietary supplements. Has ODS changed any of their guidance in response to this GAO report or what if any, fallout do you think this report will have on the government's ability to make safety recommendation about products that ostensibly are benign like prenatal vitamins but apparently are not?

Helena Bottemiller Evich (30m 57s):

Yeah. I don't know if they've changed at all. But FDA actually was, so I think ODS is under NIH so they do a lot of the research on, you know, what do we know versus not know about like supplement evidence and efficacy. But GAO actually recommended one of their recommendations was that that FDA be given like information about what supplements are on the market. So right now FDA doesn't often know like you know, what certain products contain or don't and they do pretty limited inspections generally on the supplement industry. But GAO is like basically FDA needs more oversight, more authority to conduct oversight over dietary supplements and FDA like agreed with that.

Helena Bottemiller Evich (31m 42s):

But I haven't seen any like movement on Capitol Hill to be like, hey congress should specifically direct, you know, FDAI.

Katie Ferraro (31m 47s):

Can't imagine it's not like a top priority point for them right now.

Helena Bottemiller Evich (31m 51s):

Don don't know if how much your, your listeners have been paying attention but like we're having trouble keeping the lights on, right? Or keeping the government funded. There's just a lot of dysfunction in turmoil here generally that has nothing to do with prenatals but it makes getting anything done really hard. So I don't foresee there being like a big move on this, but it certainly got folks attention. I think the GAO report did cause some folks across the government to go, okay, like do we need to look at this? don don't know if anything will come of it, but I, I am hearing certainly more like attention on on the issue.

Katie Ferraro (32m 25s):

So we need consumer reports on the job. I mean one, once they're done with their Lunchables take down, then we'll see if they can get on prenatal items. Lunchables.

Helena Bottemiller Evich (32m 36s):

Wow, totally Blown up.

Katie Ferraro (32m 38s):

Thank you for bringing your personal take on the prenatal vitamin. Just to kind of summarize, we should keep taking prenatal vitamins but just be aware that there's no set standard for what should be in them or what might be in them.

Helena Bottemiller Evich (32m 50s):

Yeah and I think pay special attention to whether or not you need iron in yours. 'Cause a lot of them don't contain iron and the gummies are often overshooting. So just keep that in mind. Not that it's a safety issue to my knowledge at all, but just I think it's good to know that. And if you can tolerate other types that are not gummies, those are probably gonna be a little bit more accurately labeled. And so just, I think that's a good thing to know.

Katie Ferraro (33m 13s):

And at the end of the day, would you say the benefits of prenatal still outweigh the risks?

Helena Bottemiller Evich (33m 18s):

Yeah, that was my takeaway from talking to all the experts is like there's no evidence that we need to be moving away from these products. It's just a question of like, can we do better on making sure they're accurately labeled? Can we maybe standardize what's supposed to be in them? But, but yeah, I mean ACOG, you know, talk to any doctor, talk to CDC, they're all pretty across the board on particularly making sure you're taking a folic acid, especially in that early preconception time in the first trimester.

Katie Ferraro (33m 44s):

I always appreciate your opinions and your insight and thank you so much for taking the time to come to talk about prenatal vitamins and good luck to you in the tail end of your pregnancy. I know I probably won't see you for a while, so good luck with everything.

Helena Bottemiller Evich (33m 54s):

Thank you so much.

Katie Ferraro (33m 55s):

I better see you when the baby turns six months of age for Baby-Led Weaning.

Helena Bottemiller Evich (33m 60s):

Yeah. Oh yeah. And actually I was just talking to a friend and they'd like raving about your hundred foods to try. Everyone thinks that's so fun. So

Katie Ferraro (34m 8s):

Thank you.

Helena Bottemiller Evich (34m 10s):

Thanks for having me.

Katie Ferraro (34m 12s):

Well, I hope you guys enjoyed that interview with Helena Bottemiller Evich. She's the founder and editor-in-chief of the Food Fix Newsletter. You can find that online at foodfix.co. She's got a lot of great reporting on issues that pertain to us both as consumers and as parents. I'll put everything that she mentioned in the show notes page for this episode, which you can find at blwpodcast.com/440 and a special thank you to our partners at AirWave Media. If you like podcasts that feature food and science and using your brain, check out some of the podcasts from AirWave.

Katie Ferraro (34m 53s):

Again, we're online blwpodcast.com. Thank you so much for listening and I'll see you next time.

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