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Join us for Part II of our enlightening journey into fertility, folate, and autoimmune disorders with the esteemed clinical nutritionist, Sonia Savage.

Building upon the foundations laid in our previous episode, we delve deeper into the intricacies of methylation and its pivotal role in reproductive health. Together, we unravel the mysteries of optimal preconception care and empower couples embarking on their fertility journey.

Episode Highlights:

  1. Essential Assessments: Sonia guides us through the crucial blood tests and assessments recommended for both partners at the onset of their fertility exploration.
  2. Nutritional Compass: Discover the transformative potential of tailored nutrition and supplementation in fueling your fertility voyage. Sonia shares insights on the significance of folate, vitamin B12, and genetic variations, equipping listeners with practical know-how in selecting the right supplements and addressing broader health issues like gut health.
  3. Managing Pregnancy Symptoms: We navigate the delicate realm of pregnancy symptom management. Learn effective strategies to counteract challenges such as nausea and the role of specific nutrients in facilitating a smoother pregnancy journey.
  4. Male Subfertility: Delve into the tide of male subfertility and autoimmune disorders with Sonia and explore the profound impact of lifestyle changes on sperm quality and conception. We emphasize the importance of a collaborative approach in the fertility equation, offering guidance to both healthcare professionals and individuals alike.


Genetic Discrimination:

Genetic discrimination and insurance underwriting (mentions Eugenics):

Partial moratorium on disclosure of genetic testing for health insurance:

About Sonia
Sonia has worked with Carolyn Ledowsky (founder of MTHFR Support) for the past 6 years, she also works part-time in her own practice Balanced Life Nutritional Therapy. Six years with MTHFR has given Sonia a specialised knowledge in the area of genetics and epigenetics and she has a keen interest in fertility,  auto-immunity, gut health and children’s wellness. Sonia works with clients all over the world.

Having grown up just outside Tamworth,  Sonia has a down-to-earth approach and appreciates that regional clients don’t always have access to the same range of food, supplements and healthcare services as city folk.  She strives to support her clients wherever they are and whatever budget they are on.

Sonia is based in the Northern Beaches and holds an Advanced Diploma in Nutritional Medicine from Nature Care College and a Bachelor of Health Science – Complementary Medicine (with Distinctions) from Charles Sturt.

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DISCLAIMER: The Information provided in the Wellness by Designs podcast is for educational purposes only; the information presented is not intended to be used as medical advice; please seek the advice of a qualified healthcare professional if what you have heard here today raises questions or concerns relating to your health



Andrew: This is “Wellness by Designs,” and I’m your host, Andrew Whitfield-Cook. Joining us again today is Sonia Savage, clinical nutritionist who specializes in methylation issues, fertility, and autoimmunity. And today we’re doing part two of exactly that topic. Welcome to “Wellness by Designs,” again, Sonia. How are you?

Sonia: Hi, Andrew. Good morning. Thanks for having me. Pleased to be here.

Andrew: Great to have you on. Now, today we’re going to be doing a lot of the pointy end, if you like, of methylation, fertility, and autoimmune disorders. We’re going to be talking about dosages, and exactly what you use in clinic to help people. So, I guess to start off with, can you take us through what assessments, blood tests and maybe other test you do to see if an initial fertility appointment, in an initial fertility appointment for both partners?

Sonia: Yeah, sure. Thanks, Andrew. So I guess, as I’ve chatted about before, I work, lucky enough to work in two clinics. So, I work for MTHFR Support Australia, and I also work Under Balanced Life Nutrition. So, sometimes it depends which clinic they sort of see me through, I guess, because MTHFR, often, people have sort of been on a long journey to get to us. So, what I guess they present with at MTHFR is a lot. So, often, it’s, you know, four, five, six years of trying to conceive. So, often, that comes with a lot of, you know, blood, semen analysis, really good work-ups. At Balanced Life, they might be just starting out, so, potentially, I’ve sort of gotta get, you know, full bloods, you know, a semen analysis, depending on where they’re at in the journey. Sometimes that’s a bit tricky to get, off the bat. You know, unfortunately, you know, you’re sort of getting from clients, two to three losses doesn’t count as a reason to do, you know, to look at the male subfertility, which I think is a little bit disappointing, especially if you’re the female going through it.

Andrew: Yeah.

Sonia: But, yeah, it’s really… Then that’s the general stance that I’m getting, “It’s only two miscarriages.” Usually by three, they’ll do it, but I find that’s a bit disappointing.

Andrew: Is that because of cost?

Sonia: I think so, and through Balanced Life, I see a lot of country-based clients, so it could be a bit more of a country versus, sort of, city thing as well. But I do find that, especially, you know, one person comes to mind. They were, you know, 10-week miscarriage, 10 and 11 weeks, you know. They’re not talking about four weeks. And the GP’s answer was, “Oh, yeah, we’ll look at your partner if you have another one,” which I find is, you know, is pretty traumatic.

But, yeah. So, full bloods is great to see. So, you know, full blood counts, zinc, vitamin D, sort of, biochemistry. Love to see iron for both parties, generally. And then anything extra on top of that, I love. So, you know, any sort of work-ups or functional tests they may have done elsewhere. Anything I can get my hands on, I love, because that just helps, sort of, you really work out where we go, and we then check for, often, I do have genetics, even if it is just MTHFR, to start with, right from the beginning.

Andrew: Right. Okay. So, just going back to the blood tests, do you order those yourself? Do you find that it’s just easier to bypass the GP and get them done? You know, there’s a couple of people that I’ve used. How do you accomplish that?

Sonia: Yeah, yeah. Sure. And I often ask, sort of, request it before the first consult, so we can really get into the nitty gritty. I mean, there’s always a lot to do with diet, but having those bloods really helps you with diet as well. So, in the lead-up to the consult, I’ll be recommending a list that the GP may be happy to do. And I don’t even, you know, put any pressure on GPs to do things they’re not comfortable with. So, that might be homocysteine. Zinc is kind of sometimes in, sometimes out. Copper’s normally out. But I’m encouraging, sort of, instant scripts. So, $20, do one of the general blood panels, or the “why am I tired all the time?” blood panels. You can get one of those a year. And then I’ll just send them a pathology request for the three, you know, maybe the three extra that we need. That might be vitamin D, zinc maybe homocysteine. So, I normally do that before I actually meet with the client, and then I’ve got all that worked up, and I know, sort of, where to go. Sometimes it isn’t done, but generally, I like to see it, you know, right, you know, right from the beginning.

Andrew: Yeah. Okay. And, can I ask, do you get any kickback, like, for instance, if you asked for, say… Well, you said homocysteine. Are you getting a lot of kickback with this? I think it was…was it taken off the screening availability?

Sonia: Yeah. And it’s quite a, it’s a tricky one. Like, forgive me, I’m not exactly sure about all the ins and outs of how they do it, but I believe it has to be packed onto ice, so it’s tricky. So, it is a bit more of an expensive test, I think, to pay for. It’s about $60 or something, you know, rather than just the $25 to $35. So, but I’ll have some GPs that are very, very happy to do it. But, you know, I’m cognizant of not, you know, that they’re working within their lane, and if it’s not something they’re comfortable to do, I’ll sort of explain that to the client, and minimize the cost for the client to do it as best we can, utilizing, you know, what they can under Medicare. But, being realistic, I often say, “Look, you know, it’s a meal out. Let’s just get it done. We probably won’t have to do it again.” You know, just try to get a really good work-up to start with. And homocysteine’s a handy one to have, especially going into pregnancy, because if it’s too high, like, you really, it can have some risks of, you know, affecting miscarriage and so forth. So, I do. And for the male, it can kind of really show where he’s at with methylation, and potentially heart health even, if, depending on where he’s at. So, I do like it if I can get it. Yeah.

Andrew: Right. Even B12, though. B12 was taken off the Medicare list of screening tests, I think with vitamin D. So, that was way back in, gosh, 2016, something like that?

Sonia: Yeah.

Andrew: So, do…

Sonia: Yeah, that’s a definite. I’m sorry. I probably put a… It’s too early for me, Andrew. I didn’t think of B12, but it is sort of the main leading one that I’d go for. So, an active B12, if I can get it. So, you know, B12, and active B12, or holotranscobalamin. And also folate. So, they would be the leaders of the pack of what you really need, what I would see you need going into it.

Andrew: So, asking a GP to do those tests, because you’re not screening. You’re suspecting. Do you find there’s any issues with getting those tests done?

Sonia: Not really. No.

Andrew: Do you just get them done yourself?

Sonia: Yeah, no, I find B12, generally, the GPs are happy to do it, and sometimes happy to do both. So, I haven’t found as many issues, sort of, with clients getting B12 through their GP as with the other tests, like zinc and vitamin D. I think Vitamin D’s now, what, once every three years or something under Medicare? Yeah.

Andrew: Yeah, yeah. What about other tests, of course? Using, it may be more expensive, but methylmalonate? Do you use other, any other surrogate markers?

Sonia: Love them. Love them. Yeah, love them if I can get my hands on them. And so, I tend to sort of, rather than just doing methylmalonic acid, if it’s in the budget, do a full organic acids test, because then you’re getting just so much more. I think methylmalonic acid’s about $70 or something, just to do on its own, and if you can kind of get the whole organic acids test, that sort of really is helpful. And I think for people who’ve had, you know, multiple losses, or have been trying for you know, five, six, seven years, it just can show us, you know, could it be yeast? Other oxalates? Or what’s happening, you know, with nutrition in the cells? I think it’s a great one. And then, depending on where the female’s at with her cycle and so forth, love a DUTCH too. I love DUTCH. So, I’d love to have all of them, but obviously, you know, it’s an expensive process, so you gotta pick and choose, and if the client can only afford bloods and change their diet, I’m happy to work with that as well.

Andrew: It’s one of those horrible choices, you know, sometimes. They’re expensive tests, we’re in a tightening economy, but, to do, for instance, a cycle of fertility, you then gotta look at value…

Sonia: Totally. And it’s

Andrew: …versus, you know, disappointment and the emotional pain that couples go through. So, it’s kind of like, “ahh.”

Sonia: Yes. That’s correct. Yes.

Andrew: Okay. So, let’s move on to supplements. What are the main supplements that you use for fertility clients? How do you start them, how do you initiate them, and how long do you recommend that they use these before they start trying

Sonia: Yes. So, ideally, I’m loving to see people at least four months before they wanna start to try to conceive, and that often isn’t always the case. I get people who are two weeks pregnant, or they wanna start IVF in two weeks, or, but realistically, to get the folate into, whether it’s, for both female and male, it’s important to do, you know, to start that process minimum six weeks out, but ideally longer. And if there’s a lot going on, you know, if there’s a lot of inflammation, if diet’s terrible, if there’s autoimmune involved, like, probably sometimes six months is what you need. But, you know, it depends where they’re at. It’s often very hard if someone’s been trying, and actively, through the fertility, kind of, you know, up-and-down journey, to ask them to wait for six months, but you can normally get three months, or at least, you know, two to three months. But that would be ideal.

And, you know, spermiogenesis takes, I think it’s 70 days. I sort of explain things like that. What you’re doing 70 days before is what counts. You can’t just start the multivitamin a week before you wanna start trying to conceive. And it makes a huge difference. So, as far as supplements go, the first thing I always look at is B12. Poor old B12. Left it off my blood list, but that’s where I would start, and look into it a bit further. So, sometimes, you know, B12 might look really good in the blood, and if you’re lucky to have genetics as well, I might see their TCN2, and I’d be questioning whether the B12 in the blood is actually what you see is what you get. So, that could actually mean, you know, you do an organic acids, and the methylmalonic is not good. So, you might wanna look at some subcutaneous injections, particularly if they’re presenting with B12 deficiency-type, you know, fatigue, and, you know, lots of other things that go with B12.

So, I guess, starting with B12. And in the sort of methylation side of things, I find, then, I’d work in the folate, and the folate will be dependent on a lot of things, but, you know, ideally, methylfolate is generally what you’d go for. But once again, that can be genetics of why that doesn’t work. So, get the B12 in first, because people will react to methylfolate if they’re low in B12, so you’ve gotta get the B12 in first, even if it’s just a week or two. You’d start with B12, and then I’d look at whether that’s methyl B12 or hydroxy B12. There are a few reasons for that, whether I think they’re going to react. If their homocysteine is really high, then I definitely want methyl. If it’s on the lower side, I’d probably go hydroxy. Then, working in the folate.

So, I’d start really low if I think they’re going to react. If I’ve got genetics, and they’re COMP +/+, I’d be really careful with methylfolate, because it’s going to increase dopamine, and then that could cause anxiety. And by the time they’ve got to me, often they’ve said, “I’ve tried methylfolate, and I felt terrible,” so I’ve, sometimes already know that, without even genetics, that we have to be careful. And that’s not always the reason someone’s going to react to methylfolate. It could be yeast in the gut, it could be poor detox pathways, so, inflammation can affect your ability to utilize methylfolate. So, there’s a few different reasons. It’s not always genetic. But I put in the B12. Then I’d probably get in a prenatal, which is probably going to have either folinic acid and methyl, or just methylfolate. If they react to that, then I’d be looking at a methyl-free prenatal. So, sometimes that can be, you know, through, that sometimes, that there is, not that we’re mentioning any names, but there is one that you can kind of get already done, or you might have to compound it. So, you might, you know, because there aren’t actually many at all on the market that are methyl-free. So, then that would be using folinic acid, but working up the dose, and using magnesium to make sure they can actually utilize the folate.

So, get B12 in. I’d get prenatal in. And then I’d be correcting things. So, looking at vitamin D. And this is for both, like a prenatal for the man, B12 for the man. This is both sides of the coin here. Looking at, generally, men are okay in iron, but I have a number of clients who have vegan partners, so, you know, we’ve gotta look at their iron just like we have to look at the female’s iron. Then we’d be looking at correcting things. So, I’d really like to know zinc, particularly for the male. So, looking at optimizing zinc, optimizing copper, balancing that out, looking at inflammation markers, and working on antioxidant and liver support, like, in that three months. Looking at reducing inflammation, reducing free radicals. So, then, you might… The beauty of the prenatal is, often, there’s so much in it that, you know, you’re ticking quite a few boxes. But, then looking at things like maybe Saint Mary’s Thistle, alpha-lipoic acid, you know, some extra things that are gonna help that detox process, which is then gonna help, obviously, the quality of the sperm. Yeah.

Andrew: Sonia, can I just go back a little bit to where we were discussing how people flip, if you like, and they get bad reactions from taking a methyl supplement? Obviously, the five MTHFR… Sorry. Forgive me. The 5-MTHF is the form that’s found in vegetables. So, do these people react adversely to foods as well, do you find? And then, obviously, we bring in that whole gut thing. So, it’s kind of like the naturopathic axiom. You know, we go back to healing the gut.

Sonia: Yeah, that’s right. So, in question, generally, if there’s a lot of reactions to food, that’s gonna be reactions to vegetables, obviously, your leafy greens and things, which I would see as that wouldn’t happen, generally, because of folate, but it could happen for a number of different reasons with food sensitivities and things, potentially low molybdenum and things like that, which I would see as something you have to fix before you fall pregnant, because I don’t think you should be going through pregnancy

Andrew: enzymes.

Sonia: vegetables. Yeah. I think, yeah. Or, you know, digestive. And so, working it out, because that’s usually something else going on. I feel like, for some people with MTHFR, you know, I guess with the C667T polymorphism, if it’s homozygous, I think folic acid in food can be causing some dramas for those people who’ve got 70% downregulation in your methylation folate pathway, and you’re eating the standard Australian diet, I think… And, you know, they probably don’t realize how that’s coming out, that that’s, you know, driving inflammation and so forth. So, I’d see that as a problem. I wouldn’t see, generally, people tolerate folate from food really well. But once you’re actually getting it in as a supplement, that’s when you might…

And look, I have got one client, to be honest, who does react to vegetables. And she is about to sort of go through IVF, and but we’ve done our best. Like, we’ve got her eating, you know, so much more than she was, but it’s still not easy for her, for lots of reasons. But I think, as far as methylfolate goes, it’s usually, as I said, one of those reasons why. So, genetics, inflammation, poor detox pathways. And then I would start, if I feel that’s gonna happen, would start with niacinamide. So, I’d start with a little niacin trial. So, before I even gave someone methylfolate, I might say, “Okay, for two days, every couple of hours, take 250 milligrams of niacinamide, and see how you feel. Do you feel less anxious? Do you feel nothing? Do you feel worse?” You know, and I get a little bit of a handle on, from that little trial, how they might actually react to the methylfolate. And then I drop dose in, like, very slowly. I might, you know, just use a tiny little bit, or break open a capsule or something, to get them, once B12 is in place. But that is sort of how you would also deal with a methylfolate reaction if you didn’t feel great. B3 helps you utilize your methyl groups, so that will generally give you a little indication of how they’re gonna go, but be really, really helpful for people that have got some sort of a methyl block.

Andrew: I actually wonder if… This is me wondering. Forgive me. I actually wonder if part of the issues that we blame wheat for might be the folic acid in the wheat products, or indeed the glyphosate, but anyway, that’s another podcast. But I wonder if we might be blaming the food for how the food is made, or what’s added to that food in preparation for, you know, being on the shelf in the supermarket.

Sonia: There’s a can of worms, Andrew.

Andrew: Total can of worms.

Sonia: But I do feel there could be a lot to that, because…

Andrew: Way too early in the morning.

Sonia: Oh, my goodness. clients that will report, you know, they feel terrible for eating any sort of bread here, go for a trip around Europe, can eat some bread and feel okay. You know, I do… And Australia’s are… You know, I’m from the country. I totally empathize. It’s hard to grow wheat in Australia. But it’s, you know, we’re a tough country, but it’s very highly sprayed. We’re adding folic acid to everything. I just, you know… And if you’re 70% downregulating your ability to break it down, why wouldn’t it affect you somehow? Like, I just feel… You know, and not everyone has as high a MTHFR SNPs as that, but I feel that there has to be something to it. And if you really wanna be on the pregnancy journey, people are really prepared to probably cut that out, at least whilst they get, you know, get to the result they need. But I agree. There has to be something in it.

Andrew: So, I think you just might just have answered my next question, that is, can you, because of the intake of folic acid, rather than the natural form, methylfolate, can you upregulate methylfolate so that it basically pushes folic acid out? Like, it’s basically gets the cogs turning?

Sonia: Yeah. Yeah, I believe yes, the answer to that is yes. Ideally, you’d minimize it, or cut it out at the same time, for this…

Andrew: Sure.

Sonia: …you know, very reason of… Because usually, with fertility, people are very invested to do whatever it takes. So, I think, you know, if you got a little bit of sourdough couple of times a week, good-quality, fermented, probably…some has folic acid, some doesn’t, I think, you know, that might be as, you know, a bigger deal, but it sort of depends on your genetics, would be my answer to that. Yeah.

Andrew: Yeah. Aha. Aha. Thank you. Salient point. Okay. So, moving further into, you know, we’ve been discussing when things go wrong. What about, say, nausea, in early pregnancy, for instance? What do we do here when people have already been on their supplements, and then things go wrong?

Sonia: Yes. And it is tricky. So, first thing would be, obviously, to try to just keep in the minimum of what you can manage, and hopefully, we’ve had some good time to get in some really good nutrients before that, and hopefully, fingers crossed, it doesn’t last more than, you know, that sort of 14-week mark. In some people, it does. But I always think, you know, if we’ve had time to prep, we’ve got some good nutrients in, we should be able to, you know, drop a few things out for the poor female going through the nausea. But putting the supplements in the fridge can sometimes work, but you might have to drop back to doing, you know, what you can in liquid form, and drop-dosing it. You might have to open the capsule and put it into a smoothie. And I would generally just pick out the basics of what we need, and I would see that as B12. Ideally, a prenatal, but, you know, at least B12 and some folate, to keep that in, and anything else on top of that is sort of a win, and then, just trying to do as much as we can through food. So, working out whether that’s smoothies, if that’s all they can manage, if it needs to be dry things, maybe making some seed crackers, or, you know, some good things like that, that are still really nutritious, and working really closely with whatever we can get in. And also, potentially looking at what else can we do there to minimize the nausea. So, potentially, some liver support. So, Saint Mary’s Thistle, you know, to deal with the hormones. Maybe some extra B6 can work. Sometimes some ginger or ginger chews could work. So, we try all of that sort of thing, but there has to be that little bit of wiggle room in that sort of 12 to 14 weeks. Some people fly through it, but not everyone.

Andrew: I’ve got a question which I’ve never investigated, and I’m just, again, wondering if there may be some tie-in to methylation. The super-sensitivity that women, many women get, I’ve gotta say, during pregnancy. You know, they can get sensitive to, for instance, raw meat, or tea and coffee, where they get a metallic taste in their mouth. But they get super sensitive to foods. Raw chicken is, “ehh.” But also supplements. So, for instance, the B3, because it’s based on tryptophan, there’s that real, what do you say? It’s a B vitamin smell. It’s, like, a yeasty smell, if you like, but do you find that women with methylation issues tend to have a preponderance for this increased sensitivity, or is it just pregnancy?

Sonia: Look, it’s an interesting question, and I’m sure… I think methylation, if it’s not… And not all of us with MTHFR SNPs aren’t methylating properly, but we’ve done some work to get there. But I absolutely think it would have to have an effect, because it really does downregulate your hormones and your detoxification if you’re not methylating properly. So, I think, in general, it would have to have some effect, and I don’t…I’ve never sort of thought about it about who… Because most people I see, I guess, do have an MTHFR SNP, so I’m a bit of a, I guess I’m probably not a level playing field here, but just…

Andrew: Biased sample.

Sonia: Yeah, exactly. But a true-life, I think, that is so true. You know, whether it’s alcohol, whether it’s, you know, hormones, I think, if you’re not methylating properly… And you could still be not methylating properly and have no MTHFR SNP. If you’re really depleted in B vitamins, like, that’s still going to affect anyone’s ability to handle, you know, that sort of detox process. So, I’m sure there’d be something to it. Not an exact answer, but I would think yes, because methylation, the end result is detox, you know, of hormones, or detoxication in general.

Andrew: Yeah. Got it.

Sonia: Yeah, so… Mm-hmm.

Andrew: And you were also mentioning earlier how some patients, when they start a methyl supplement, they feel terrible. Take us through how that looks. What do they feel? What do they report?

Sonia: Yeah. And look, it can be quite an adverse reaction. So, it could be, it generally is going to be… Look, as I said, it’s that, sort of, group: genetics, inflammation, or detox pathways. So, it could be huge anxiety. It could be headaches. It could be… And they’d be the main two, I would say. Like, it can definitely affect mood adversely. And, you know, I’ll never forget, I was a fairly new practitioner, and one of the practitioners had a client call to say she’d actually had suicidal thoughts taking methylfolate. I haven’t come across that again, thankfully…

Andrew: Whoa.

Sonia: …but it stuck with me. It stuck with me. That was probably in my first couple of months consulting. So, you know, that’s what…it can be quite extreme, so you do have to be careful. Like, you don’t just sort of say to someone, “Go and get 5 grams of methylfolate and go,” because it just isn’t right, yeah.

Andrew: You know what? That also may be an example of something actually working. I’ll segue back to this. I’ve known about a patient who, previous history of suicidal thoughts, quite severe depression, multiple medications. But, in this instance, he started a new medication for anxiety. And prior to that, he was anxious about having suicidal ideations again. The drug worked. The drug was successful. It took away his anxiety. So therefore, he merely had his suicidal ideation, without any anxiety associated with it. In other words, he was now going to suicide. So, the drug effect was successful. The outcome for the patient was not. Now, thankfully, this patient was saved. But it’s just interesting how we can get a disconnect with what we want and what the patient needs.

Sonia: That’s exactly right. And methylfolate does work. You can see the first couple of cycles after you’ve got it in. The cycle might be a bit different. And it might not be great, the first one. But you can see it starting to affect. And, you know, they’ve brought out, for a very short time, the antidepressant that was just methylfolate, which, I think it was 12…12 milligrams, I think it was? And it worked for a lot of people. So, you know, really high dose. So, for some people, methylfolate is fabulous. It’s just not fabulous for everyone to start with. And often, you can get someone to 500, maybe only 250. But with, you know, jumping back to dosage, I would say, if you’ve got, you know, depending on your MTHFR SNP, you wanna be up to probably at least 1000, 1500, maybe 2000, with autoimmunity. Like, that’s the level you need to get to, I would see, for the good outcomes we see in clinic. So, you’ve gotta work the person up. And if you can’t do it with methylfolate, you’d look into how you can. You’d try to clear the pathways, and do all the work that needs to be done, but if that isn’t possible, then you’ve gotta do it, you know, with folinic acid.

Andrew: Sonia, just as a last question, we tend to focus on female subfertility and female supplementation. What about taking us through, maybe, the issues of male subfertility? Where do you start? Do you always look at their work environment, for instance?

Sonia: So, with a fertility consult, generally, I’ll do a two-hour consult as the first opening gamut, which, obviously, is quite long, but we get a lot done. It’s both the female and the male, and quite a lot will have been filled out before they come in. So, you know, what are they both eating? How are they, you know, how’s sleep? How’s going to the bathroom? What their jobs are. So, I generally know, and I will check with that, are they cycling 150 kilometers a morning?. Are they landscape gardeners? So, I’ll know all that information coming in, which I see as really important. And generally speaking, I’ll have bloods from both as well, so… And it’s a big deal. You know, they sort of think that we’re on track by 2050 that, you know, fertility’s gonna be a huge, huge deal because of men’s subfertility. So, you know, we really need to… You can’t sort of, you know, put the responsibility on the female. That’s gone. They think, you know, potentially, it’s edging over the 50% more, the male subfertility.

And the good news is there’s so much that can be done. So, all the things that we’ve spoken about. We’d be looking at, you know, B12, vitamin D, zinc and copper. Be looking at reducing inflammation. What’s the fasting glucose like? What’s cholesterol look like? Do a really big work-up. And the amazing thing is, with males, once they’re on the right sort of track, they would generally be super compliant. And it’s amazing what you can do to turn around, you know, especially if you’ve got a sperm analysis to start with. And, you know, an example might be some wonderful clients I’m dealing with at the moment. The gentleman, we had an analysis done, sort of, mid-last year. And, you know, he’s gone from sperm concentration of 10.7 to 45, like that. It’s in about a six-month period. His normal forms went from 4 to 10. His progressive motility, 13 to 47, I think he is now. Like, unbelievable. But that was a big change with diet. That’s just not supplements. The main thing, I would say, with him was diet. He’s highly stressed at work. His diet was terrible. His sleep wasn’t great. But, you know, they’ve got such a better chance now of conceiving, and before that, they’d been trying for quite a long time. And they were never gonna get there, probably, because no one had really looked into it from the male side. So, I think it’s so important, especially for people who’ve been trying a long time.

Andrew: Takes two people to tango, as they say. Well, what about frequency of sex, for instance? Couple of people I’ve spoken to them about, maybe it’s worthwhile trying to abstain for a little bit, rather than going bull at a gate, forget the pun.

Sonia: Yeah. Look, I think, generally speaking, like, it’s a very busy world we live in. So, I guess it’s another thing to think about, right? We’ve gotta leave it. I sort of, you know, a very old GP of mine once said, you know, “I generally just give the advice of try every second day between day 10 and day 20.” You can’t really go wrong. I know. Like, I’m like, “Who has the time to do that?” But I do think, depending on what the quality is, I’m not 100% sure of the ins and outs of waiting, but I think definitely, every day, you know, that’s probably not going to be useful. Every two to three days, during that, sort of, ovulation window, I would think, you know… I think working on the quality of the sperm, and seeing it in an analysis, you know, it’s probably better than just saying, you know, wait three days, or… I think, just have the quality there. But, yeah. I’m not 100% sure of the difference it would make between two and three days.

Andrew: What about performance issues? I’ve had a young male who had performance issues, and, you know, there was some sort of data about using ginseng, for instance. Do you tend to favor the herbs here, rather nutrients? Do you tend to focus largely on their psychosocial issues? Tell me how you navigate that one.

Sonia: Yeah, I think, if you can get, you know, actual hormones to have a look at, to see what is actually going on hormonally. So, testosterone, SHBG, free testosterone, you know. Or have a look at that, is it actually a hormone thing, which could be going back to a B12 and a folate thing, because they both are really important for hormones. I would look at it from that angle, and then I would look at, you know, from more the stress level as well. I think, you know, stress plays a really big deal with that. And to support, yes, in answer to your question, I potentially would use some support, but I’d be putting in those building blocks first. Like, you know, just the methylation, nutrients, looking at diet, looking at sleep. You know, potentially looking, does the person need to sort of see a counsellor or a psychologist? You know, what else is going on that is causing that, particularly if it’s a young person, like, there might be…you know, that’s a little bit more unusual, I guess, than a bit of an older gentleman.

Andrew: And, I said last question, but what about male autoimmunity? Do you find that males with autoimmune conditions, like fertility issues, once they have the reason, you just wind them up, let them go, and they’re really compliant? Or do you find that if they’ve got autoimmune conditions that it’s a little bit more of a gotta get them on board? Got, hey, you have to get them motivated?

Sonia: Yeah, I think, with autoimmune, it’s a marathon, not a sprint. So, if it’s an autoimmune condition they’ve got, it’s for life. So, you’re getting a male getting their head around, you know, staying gluten-free, you know, not too much alcohol, all of those sorts of things. Some will be, “I feel so much better, Sonia. I’ll do it.” Other people, you can only get them on board for three to six months, and they’re amazing, and then, you know, the switch gets turned off. But I think explaining to them, and, you know, sort of showing them the data of, “Okay, here’s these autoimmune antibodies before. This is four months after an anti-inflammatory diet. Look at what’s happened. It’s gone from 1000 to 100.” Like, you can bring it down. You’re still gonna have the autoimmune disease, you know, but your body is handling it much better, based on what you’re eating.

Andrew: Yeah. Oftentimes, it takes that falling off the wagon to make people, not just males, make patients realize, “Oh, hell, that really was doing something. That was really working.” And that’s the switch to get them back on?

Sonia: Exactly. Especially if they can feel it. Like, I think with anything we do, you know, there’s gotta be some sort of result. They’ve gotta feel something pretty fast. Otherwise they, you know, you can lose them pretty easily. But often, it’s within days. Like, you know, a diet change can, you can feel different within days, or at least, you know, two weeks. So, I think what we do has a pretty direct, you know, you can get a pretty direct outcome, to a certain extent, that’s enough for the person to invest, to say “Hey, you know, I think she’s onto something,” or I’m onto something by changing my, you know, lifestyle. Which is, you know, really rewarding.

Andrew: Sonia Savage, thank you so much, once again, for taking us through fertility, autoimmunity, and folate, or methylation issues. There’s so much more to learn, obviously, so, you can’t handle, you can’t become expert in one podcast, but you’ve taken us through some real key points in helping our patients, particularly those people that are going through multiple miscarriages or ongoing fertility issues. I really thank you so much for your expertise in this area, and for showing us just how you can help patients with regards to methylation.

Sonia: Pleasure, Andrew. Thanks so much for having me. Lovely to catch up again.

Andrew: And thank you, everyone, for joining us today. Remember, you can find all the other podcasts, and indeed the show notes for this podcast, on the Designs for Health website. I’m Andrew Whitfield-Cook. This is “Wellness by Designs.”

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