Why Chronic Disease May Begin Before Birth

As functional medicine clinicians, we often spend our careers helping patients reverse years, sometimes decades, of accumulated dysfunction. But what if some of the most powerful opportunities to influence lifelong health occur long before symptoms ever appear? What if they begin before pregnancy, or even before conception?

That’s what makes this conversation so exciting. I sat down with Emily Stone Rydbom, Dr. Leslie Stone, and Dr. Kalea Wattles to explore the rapidly evolving science connecting preconception health, epigenetics, precision nutrition, and the Developmental Origins of Health and Disease framework. Together, we discuss why fertility is about so much more than achieving pregnancy. It’s a unique biological window with the potential to influence metabolic health, immune function, neurodevelopment, and chronic disease risk across generations.

This conversation will challenge us to think differently about prevention. Functional medicine has always emphasized identifying root causes before disease develops. Preconception care may represent one of the earliest and most impactful opportunities to do exactly that.

Whether you work in reproductive health or simply want to better understand where lifelong health truly begins, I think you’ll find this discussion both thought-provoking and clinically inspiring. ~DrKF

Why Chronic Disease May Begin Before Birth | Leslie Stone, Kalea Wattles & Emily Stone Rydbom

In this episode of New Frontiers in Functional Medicine, Dr. Kara Fitzgerald sits down with Emily Stone Rydbom, Dr. Leslie Stone, and Dr. Kalea Wattles to explore one of the most overlooked opportunities in preventive medicine: the preconception period. Together, they examine how nutrition, metabolism, mitochondrial function, inflammation, and environmental exposures before and during pregnancy may shape lifelong health through epigenetic programming and developmental biology. The conversation moves beyond fertility alone to discuss the Developmental Origins of Health and Disease (DOHaD) theory, precision maternal nutrition, unexplained infertility, recurrent pregnancy loss, mitochondrial health, AI-assisted clinical care, and the emerging science supporting earlier intervention to improve outcomes for both mother and child.

In this episode of New Frontiers, learn about:

This transcript was edited with the assistance of AI and may contain errors. Please refer to the audio or video recording for the most accurate version of this conversation.

Dr. Kara Fitzgerald: Hi, everybody, welcome to New Frontiers in Functional Medicine, where we are interviewing the best minds in functional medicine. And today is no exception. We have the best of the best today. We have three incredible leaders who are helping reshape how we think about fertility, pregnancy, maternal health, and actually health across the lifespan and intergenerationally.

Dr. Kara Fitzgerald: Dr. Leslie Stone and Emily Stone Rydbom are the co-founders of Grow Baby, an innovative care model bringing functional and precision nutrition directly into obstetric care. Joining them is Dr. Kalea Wattles. She is the founder of Functional Fertility, whose work focuses on helping patients optimize fertility through a systems-based, root-cause approach. They are challenging the idea that pregnancy begins with a positive pregnancy test.

Dr. Kara Fitzgerald: They’re making the case that preconception care may be one of the most important opportunities we have to influence the health of mother and baby. So in this conversation, we’re going to be looking at preconception, fertility, pregnancy, postpartum, all of it through a functional systems lens, and how we can profoundly influence maternal and infant outcomes.

Dr. Kara Fitzgerald: And we’re going to be talking about some of the extraordinary research that Grow Baby is doing. We’re also going to be talking about Dr. Wattles’ new book, The Functional Fertility Blueprint — just an elegant, clean, functional model outlining fertility through systems thinking, and how you, as a clinician, can immediately start using this in your practice. It will resonate with you if you’re trained in functional medicine. And if you’re a person on the journey of conception, wherever you are in the conversation, this book is accessible for you as well. So join me in what was just a fabulous conversation.

Dr. Kara Fitzgerald: First of all, just thank you so much, you brilliant women, for making time to talk to me today on this incredibly relevant topic. As I was reflecting on our conversation, thinking about the rise in infertility rates — not just in the US, but really around the world.

Dr. Kara Fitzgerald: Despite technology, despite the heroic interventions we have, fundamental infertility is on the rise. Maternal morbidity and mortality, preterm births, low birth weight, large for gestational age — all across the board, we’re seeing these challenges increase. And so I wanted to start with Grow Baby, maybe with you, Leslie, and then with Emily. What’s going on? Here we are, so wildly sophisticated, and yet we’re facing a reversal. And then we can see this on the other side of the lifespan, with changes there and chronic diseases and so forth. We’ll loop back and bring that into the conversation as well. But yeah, what’s going on?

Leslie Stone, MD: Well, I think we have to loop it right in from the very beginning. What about these chronic diseases? How do they implicate our outcomes in the fertility realm and in our ability to create healthy pregnancies and healthy offspring? Because we are in the midst of a dramatic feed-forward cycle. For example, chronic hypertension in pregnancy has doubled in the last fifteen years or so. Those with chronic hypertension during pregnancy are more likely to have adverse effects that severely threaten their pregnancy, increasing risk for preterm birth and small for gestational age — which in turn increases risk for childhood adverse developmental outcomes and projects right into adult life. Those people are more likely to struggle with hypertension, and that next generation is now at increased risk for all of these adverse maternal outcomes.

Leslie Stone, MD: And infant outcomes. So it is probably of no surprise that as we experience an increased incidence of non-communicable diseases, we also find that this contributes to adverse maternal and neonatal outcomes, feeding forward continuously. The good news is that these are all in a modifiable space. We have great tools now to interrogate, investigate, and optimize the health and resilience of the preconceptual and conceptual female, and minimize and mitigate those risks.

Dr. Kara Fitzgerald: Emily, do you have anything from the Grow Baby team you want to add to what Leslie has said? I really want to drill into what the problem is. Of course, we’re going to spend the lion’s share of our time discussing the solution. But go ahead, Emily.

Emily Stone Rydbom, MDH: I think to paint an even more complete picture — when we think about maternal morbidities and neonatal complications, sometimes we relegate the conversation to low- and middle-income countries. But the truth is, the United States holds the very unfortunate record of the highest rate of preterm birth in the world, even above Malawi, in a specific county in the state of Mississippi.

Dr. Kara Fitzgerald: Yeah.

Emily Stone Rydbom, MDH: Which just happens to correspond with Cancer Alley in the southern part of the United States. So this is not a far-fetched idea. We’re talking about a sophisticated, highly resourced country, yet we’re still seeing this disparity hit us squarely in the face. We are winning on some levels of maternal mortality, but we’re seeing acceleration in the very unfortunate statistics associated with severe maternal morbidities — which, to Leslie’s point, is the feed-forward component of what is getting us into these highly vulnerable spaces as an entire populace.

Emily Stone Rydbom, MDH: And it actually feeds into some of Kalea’s work in the fertility space. If we can anticipate and see these problems early enough, we can work toward personalizing and improving outcomes. But the truth is that almost every single state in the United States has a worsening preterm birth rate. We’re seeing higher rates of severe maternal morbidities, marked disparities among certain ethnicities and populations, and social determinants of health driving a larger chasm between the haves and the have-nots. We’re recognizing more than ever that where we live highly influences our health outcomes. And, unfortunately, where this is landing is right in the middle of this phenomenally vulnerable but opportunistic place within preconception and pregnancy — where you can meaningfully change the trajectory of health during this time.

Emily Stone Rydbom, MDH: You know, Leslie brings up chronic hypertension and hypertensive disorders of pregnancy. If a mother who has a female fetus is exposed to a hypertensive disorder of pregnancy, that female has a 70% increased risk of a hypertensive disorder of pregnancy in her own pregnancy, and a 90% increased risk of preeclampsia. So when we’re looking at a reactive cardiometabolic and cardiovascular vulnerability in a female, we have to consider what her exposure story was — and that begins in preconception and in utero.

Emily Stone Rydbom, MDH: We have to push this timeline way back to the beginning to really consider moving ourselves out of a reactive space with the conversation around chronic disease states.

Dr. Kara Fitzgerald: And this is if we actually get pregnant. I mean, can I just say — sitting and preparing for this conversation, pulling this all together, the meteoric rise in infertility rates, again, globally but concentrated in the US, and then everything happening during pregnancy, postpartum, and with offspring — it’s just really tough to face what’s happening. Kalea, what’s going on with infertility?

Kalea Wattles, ND: I’d like to loop back to some things my colleagues have said here, thinking about the timeline and how we tell this health story that starts in utero. When I first started doing that in practice, I had to choose my words carefully, because if I’m not careful in the storytelling, it can almost sound like: “Well, this happened to your mom, so it’s going to happen to you.” And so it’s so beautiful that we have these functional medicine tools so that we can tell the story in a way that highlights all of the things that are modifiable. That just came to mind as Emily was talking — this wonderful opportunity to do storytelling and to help reassure our patients that their health isn’t just happening to them, that it’s not up to luck, that we can really intervene.

Kalea Wattles, ND: I have such an interesting vantage point doing preconception care because I get to catch the things that predispose us to chronic illness way before they’re manifesting, at a time when the patient is highly motivated to make a change because there’s a really clear outcome they’re hoping for. And so thinking about what Leslie and Emily described — hypertension and cardiometabolic disease during pregnancy — I feel extra committed to doing the screening work in the preconception timeframe that looks at things like chronic systemic inflammation, vascular function, and even markers like uric acid — all of these inflammatory and metabolic markers I can act on right now, when we’re still so upstream of chronic disease.

Kalea Wattles, ND: My call to action is really using fertility concerns as an invitation to do a deeper dive, because the things that impact oocyte maturation, endometrial thickening, and the immense energetic requirement of early embryogenesis all relate back to our functional medicine matrix — and we can powerfully act on them in the 90 days, the six months, or, in a dream scenario, the twelve months before someone wants to get pregnant, so that they get pregnant more easily, have a healthy pregnancy, a smoother postpartum, and the longevity to enjoy the family they’ve worked for.

Dr. Kara Fitzgerald: Yeah. I want to spend the lion’s share of our time dialoguing about what we’re going to do and how we’re going to get there. What are the fundamental issues prompting infertility?

Kalea Wattles, ND: In my practice, it’s largely ovulatory disorders — anovulation. And that could mean many different things, which is why we utilize all of our lab tools, nutrition-oriented physical exam, and history collection. Androgen excess is probably the leading cause, but also thyroid dysfunction — if we think about thyroid hormone activating our granulosa cells, those helper cells that nourish our developing egg cells. So androgen excess, thyroid disorders. We also know that even things like low antioxidant capacity can impact the way that our follicles — our egg sacs — are developing. So there’s a whole tour of the functional medicine matrix we could do just to narrow in on ovulatory dysfunction.

Leslie Stone, MD: Yeah.

Dr. Kara Fitzgerald: Can I pull the thread a little further and ask why androgen excess? You could speak from a mechanistic level and also more broadly about the drivers that might prompt that bias.

Kalea Wattles, ND: Well, I think it’s no secret that we are in something of a metabolic crisis. So many of our patients have hyperinsulinemia. If we look at this diagnosis of unexplained infertility, maybe 15% to 30% of patients who present for fertility concerns are diagnosed with unexplained infertility. And I always — I joke with my patients, but I’m not really joking — when I tell them: if you have insulin resistance, you don’t have unexplained infertility. That is a clear mechanistic explanation, because hyperinsulinemia causes the theca cells in our ovaries to pump out more and more testosterone. That elevation in androgens can impact the way our egg cells are developing — it really can inhibit folliculogenesis. And if we take that even further, insulin is upregulating our aromatase enzyme. We have all of this testosterone, all of this substrate being irreversibly converted to estrogen. So patients who have fibroids and endometriosis will ask: “How do I have both a testosterone excess and an estrogen excess?” This is why. The underlying driver of the anovulatory cycles is often a metabolic component.

Dr. Kara Fitzgerald: Right. And the drivers of that metabolic dysfunction would be what?

Kalea Wattles, ND: Everything we’re exposed to in our world — endocrine disruption, sleep disruption, light pollution, energy excess inside our cells that prevents us from utilizing available energy, leptin dysregulation. In our modern world, there are so many contributors to this metabolic dysfunction for the modern woman.

Dr. Kara Fitzgerald: Yes. And so it comes back to leaning on a systems lens, a functional medicine lens, and really teasing out the individual’s unique imbalances — the androgen and estrogen dominance, the inflammation, and so forth.

Dr. Kara Fitzgerald: So let’s bring it over to Grow Baby. Leslie, maybe define what Grow Baby is, and then Emily can talk about some of your research and how you’re implementing the program. And you can also riff on some of what Kalea just said.

Leslie Stone, MD: Well, I want to wholeheartedly agree with Kalea. And I’m imagining you would also include the male component in your discussion of why we’re infertile — men are struggling with the same systemic attacks: exposures, stressors, poor sleep, and intentionally delayed fertility. Those factors all come into a base systemic view that has to be teased apart. The emphasis is always that this brings us back to what Grow Baby is.

Leslie Stone, MD: I think we were all raised — I will say, I started doing obstetrics forty-four years ago now — with the idea that these morbidities and mortalities associated with pregnancy were sort of inevitable. You do good work and you’re rewarded by relatively low rates of adverse outcomes. But you do it as long as I have and you start to ask: why am I not getting better? And so you realize: maybe it’s the way we’re looking at this. We’re now applying tools that interrogate the individual, not just the population. The individual is the one who is going to react differently to a given exposure, and our job is to figure out who’s not going to be vulnerable — strengthen them — and for those who are, shore them up. We can do that in multiple ways. Standard of care looks at a very small set of nutrients and exposures and tells you there’s not a whole lot you can do. So here’s where Grow Baby comes in: it says there’s actually a great deal we can do by recognizing that our macro and micronutriture is highly disordered and highly related to these adverse outcomes.

Leslie Stone, MD: Modifiable. The key piece is empowerment — these things are modifiable. But then why do some people with micronutrient deficiencies not end up with the problem while others do? There’s a genomic piece that needs to be explored and layered in on top. And why might those two things not fully explain the same result? Then maybe we need to look at the microbiome. And if that isn’t a sufficient answer, maybe we should be looking at the exposome. What is it about their unique environment — given that Jackson County, Mississippi has a terrible preterm birth rate and also happens to be one of the most toxic regions in our nation, and has an interesting gene variant pattern? All of those pieces together. So Grow Baby is a 360-degree view of pregnancy and preconception.

Leslie Stone, MD: When do we consider preconception? As soon as that person becomes reproductive. So we’re thinking way ahead. The people perfectly positioned for this are pediatricians, parents — most importantly parents — and all of the additional healthcare workers who are going to be touching these people. And we recognize this is a totally empowering story: when we tease apart our five areas, we can come up with great results.

Dr. Kara Fitzgerald: And you worked on this in your own clinical practice. You refined the Grow Baby structure — this multifaceted intervention. Both in Grow Baby’s and Kalea’s work, you’re looking at it through a functional and systems lens. So you’re individualizing your interventions. You [Leslie and Emily] started it in your own practice, you published on birth outcomes there. You followed children in your practice for a number of years. And it showed outrageous outcomes, how healthy and strong and vibrant both moms and babies were. That was your original impetus for developing Grow Baby. And now you’ve taken it beyond that. You’ve just gotten IRB approval and you’re going to start recruiting for a much larger study I want to hear about. And I think what’s also wildly important is that, even while doing systems medicine, you’ve made this model doable. Not only doable but affordable. The soul of Grow Baby is really getting into the underserved populations Emily mentioned. So dig in, Emily.

Emily Stone Rydbom, MDH: Leslie, do you want to speak to our original study, and then I can take it into the study we just published?

Leslie Stone, MD: Sure. So we investigated this originally. It came on the heels of recognizing that one cause and one disease was not going to be enough — it needed to be a multiplicity of things. We tried a single intervention — one vitamin C supplement — and saw no difference. But when we took a functional approach and recognized that these concepts were modifiable, we had multiple micronutrient deficiencies and macronutrient imbalances. When we could address them all at once, combined with select gene variant analysis, we could drop our preterm birth rates. Compared to the national rate of about 10.4%, or regionally in Oregon at 8.7%, we dropped to about 2% — a 75 to 80% reduction. Hypertensive disorders of pregnancy showed about the same reduction. Gestational diabetes mellitus was an almost 90% reduction. It was jaw-dropping. We followed up longitudinally over the next seven years, and the results held.

Leslie Stone, MD: We then took it to a small group in Nevada in a very different demographic — 100% Medicaid compared to our 50% Medicaid, mostly multi-ethnic in Nevada versus mostly Caucasian in Oregon — and we still had the same results. They also had the same micronutrient deficiencies and the same patterns in gene variants.

Emily Stone Rydbom, MDH: Yes. In our original cohort of just about 110, our preterm birth rate was actually zero percent. Our first published study cohort was zero percent; our small for gestational age rate was also zero percent. And then our published cohort grew to about 402. Leslie reflected those percentage reductions. But the other thing you were mentioning, Kara, was the F1 longitudinal, generational follow-up period.

Dr. Kara Fitzgerald: Okay.

Emily Stone Rydbom, MDH: This data is not yet published because we are a family practice integrated care clinic. We were able to see these mothers and their babies on a continuum, which is so powerful and fruitful for data collection. What we found was that in our group of just over 400 moms, we had one case of autism out of 400 — while the average rate of autism in California is currently about one in 33. We had less than a 1% risk of allergies, atopy, eczema, and any type of dermatitis. So it really does look like a resiliency set point — not just for the mother, but for the F1 generation — with this type of multimodal, precise approach. And importantly, we’re talking about a 50 to 100% Medicaid population across four different care models in four different states, and we’ve been able to reproduce and replicate the results. So is at this point, we I think we can confidently say this is not a one-off necessarily.

Emily Stone Rydbom, MDH: What is really exciting to us now is the ROOT Study, which is going to be happening in North Carolina. That’s a five-hundred-pregnancy study with a five-year longitudinal arm of exploratory outcomes where we get to look at pediatric outcomes at a five-year level. We are totally blown away by the level of stakeholder engagement. This is 100% MCO-funded with Department of Health and Human Services dollars — so we’re using taxpayer money to support a group of women who are covered by insurance, have Medicaid, or in certain instances may not even have access to insurance. The single clinical recruiting site has about forty-five percent of moms on Medicaid, about fifty percent being Caucasian, about thirty percent being Black, and the rest Hispanic or of other ethnicities. It’s a true snapshot of this country’s diversity. And you’re looking at parallel integrated nutrition care right alongside obstetric allopathic care in a hospital setting.

Emily Stone Rydbom, MDH: So this is very much looking at the stakeholders who are paying for the problems and the complications, and flipping it to ask: how about we pay for the prevention? To then see what happens and the resiliency set point for this population. And so we’re very, very excited. And it’s a culmination, Kara, of many years of work — you’re very familiar with it, and you were unbelievably gracious and wrote about Grow Baby in your Younger You book.

Dr. Kara Fitzgerald: Yes.

Emily Stone Rydbom, MDH: Sitting right behind me. We utilized components of the methylation diet and lifestyle to support those moms who needed nutrigenomic support for one-carbon metabolism. We used all of your work, Kara. Kalea, I’ve been speaking for years about preconception fertility optimization and how to make this information accessible. I call Grow Baby a group project.

Dr. Kara Fitzgerald: Maybe it’s our turn.

Leslie Stone, MD: Let me clarify one other piece important to understanding what we’re doing here. We’re not giving away standard of care medicine. We are parallel — bringing along all the good things standard of care allows us to do, particularly in the acute care setting, while bringing in this other piece to build up and fortify it and build resilience.

Dr. Kara Fitzgerald: That’s clear.

Dr. Kara Fitzgerald: I’m going to circle back and talk about the program and adherence in a minute, but first I have two things. One question for you, and then I want to talk to Kalea about her program. How difficult was it to get funding for prevention?

Dr. Kara Fitzgerald: I’ve just witnessed you over so many years of collegial friendship, convincing people — did you just finally have enough data where they had to say yes? I mean, how did you make that happen? It seems obvious to some people — of course you’d get funding for prevention. But in fact, it’s more uphill than people realize.

Emily Stone Rydbom, MDH: Yeah.

Leslie Stone, MD: Maybe I could start with what we did initially, and then Emily can speak to how it progressed. Initially, we tried to pay for it within our clinic by not charging for group medical visits — group nutritional counseling visits. Then the Affordable Care Act allowed delegated services reimbursement, so we were able to pick up diagnostic codes that could be billed to a degree and pay for it that way. It was a little bit hook-in-the-crook — certainly not something you could sell and say, “Here’s the way to build your practice and make it rich.” But it was enough to get it done. Then with provocative data, and Emily codifying this whole thing…

Emily Stone Rydbom, MDH: Leslie, you’re also speaking to utilizing things like CPT and ICD-10 codes within the insurance reimbursement system to get micronutrients covered. So it was very much creative focus. But going back to how we got this funded — all fresh and new ideas ultimately need early adopters. One of our earliest adopters was Molina Healthcare out of Nevada. Part of the reason Molina Healthcare ultimately signed off on paying for prevention is that the state Medicaid system of Nevada put out an RFP specifically calling on MCOs and private insurance companies to address maternal health care in that state. So the state Medicaid system, at least in Nevada, was the impetus and spark for an MCO to say: what type of program could help us fulfill this RFP and bring services into Nevada? So much of it has to do with timing. And it was also the willingness of the MCO and the local OB-GYN clinics to say, yes, we will take this risk with you. But the reason it felt less risky, Kara, is because there wasn’t a dearth of data on the program. This had been done for many, many years. And so we were able to present first and foremost with the data.

Emily Stone Rydbom, MDH: Fast forward to the ROOT Study — so much of this has to do with timing, the right people, and advocacy. I want to give a shout-out to Dr. Chris Magrita, who actually heard about Grow Baby at one of the AICs. He was speaking at the AIC conference in Florida and literally changed his entire talk to include Grow Baby, hours before he was speaking, because as a pediatrician he was seeing it from the F1 space: How come my kids are so sick? How come my moms are so vulnerable? And so North Carolina — tipping my hat to them — funded for, I believe, three years something called the Healthy Equal Opportunities Program.

Emily Stone Rydbom, MDH: This was an opportunity for MCOs to find programs that could bring forward innovative ways to really help vulnerable populations using functional medicine systems thinking, nutrition, and lifestyle. At the time, North Carolina was specifically focused on anything related to type 2 diabetes support. Well, gestational diabetes mellitus fits really nicely into that. And so we were able to lean heavily on the statistical analysis and the percent reduction and numbers needed to treat around our GDM outcomes — because our GDM rate in our cohort is actually 0.49%. So from a metabolic standpoint, going back into the hyperinsulinemia conversation with Kalea, we’re talking about the fact that an insulin-resistant state is somewhat synonymous with pregnancy physiologically. How do we ensure there’s flexibility within that metabolic state?

Leslie Stone, MD: It’s amazing.

Emily Stone Rydbom, MDH: The immune system state, the vascular state — we need to ensure we’re not pushing and pulling on the tethers at the wrong time. The big arc of our story is that it’s not just about proving mission-oriented outcomes; those outcomes happen to be tied to massive amounts of savings. When you’re talking about a healthcare system spending massive amounts of money on reactivity and poor outcomes, all of a sudden this feels less risky.

Leslie Stone, MD: Molina, for example — they’re a managed care organization covering Medicaid that wanted to get into Nevada. They were convinced this was a “pay it forward” idea: spend a little up front, which is not how insurance is built — they want to collect money and not spend it — and then significantly reduce expenditures on the other end.

Dr. Kara Fitzgerald: Right. Yeah.

Leslie Stone, MD: It does require that a managed care organization or insurance carrier is going to see a year-upon-year effect. It’s a policy-based approach, but it certainly makes complete sense. It’s very persuasive. Emily is spot on.

Dr. Kara Fitzgerald: And of course, the evidence is there — because you’ve got the funding to do an extraordinary study, and I’m so excited about it. I know it’s been hard. Moving into larger research models has been the barrier for so many of us in this space. We just submitted a big NIH grant as well — multiarm — so we’re holding the energy there. That would be very exciting.

Dr. Kara Fitzgerald: So Kalea, you’ve developed this really cool Fertility Focus Zone calculator. I’m hoping you’re gleaning some data from it, and maybe you already have. You’ve refined this systems model for fertility in such a beautiful, clear, empowering way. The calculator will make it doable for clinicians, but also for the regular couple working on conception who can start to use these tools themselves. Being the research geek that I am, I’m definitely hoping you will or already have crunched some data. But talk to me about the program you designed and how you’re implementing it — and maybe some of the nodes that you’re looking at. I’m curious if you’re seeing patterns and standout nodes.

Leslie Stone, MD: Well…

Kalea Wattles, ND: Such a question I could talk about for hours. And listening to Emily and Leslie — what a clinician’s dream, to see a problem, figure out a solution, and then track it and see that your interventions worked. That has to be the most satisfying, rewarding feeling. It has my wheels turning, because

Dr. Kara Fitzgerald: Yeah.

Kalea Wattles, ND: Emily has heard this story before — we were just together — so sorry, Emily, you’re going to hear it again. Part of my origin story in the functional medicine reproductive health world is that when I was a naturopathic student, I spent time rotating through my local IVF clinics. I begged them to take me in as a non-traditional resident. And they did. I was able to sit with them through new patient intakes, egg retrievals, IUI, IVF — the whole process, start to finish. And I remember sitting in on a new patient intake with one of the reproductive endocrinologists, looking over his shoulder at the patient’s lab results, and seeing low vitamin D, an elevated hemoglobin A1C, and a really low ferritin. I was a lowly student at that point, so I wasn’t going to say a word. But in my mind I was thinking: I wonder what would happen if I had three or six months to work with these patients before they entered this room. Not necessarily to say they wouldn’t need this intervention, but I felt confident that the outcome would be improved if I could set the scene. So this has been such a long dream of mine — to show how this systems approach to fertility really works, so I could foster those bridges and relationships with the reproductive endocrinologists in my area.

Dr. Kara Fitzgerald: I love it. It’s beautiful.

Leslie Stone, MD: Yeah.

Kalea Wattles, ND: Thank you. One of the ways we do that is the Fertility Focus Zone calculator. It all stems back to my great love for the functional fertility matrix. Over time, it’s evolved to be more fertility-specific in my practice. For me, it’s the gut-fertility axis, cellular energy — which we know is so important for both sperm and egg — inflammation and immune function, the flow network (which represents circulation, oxygenation, and cervical fluid production), fertility hormones, metabolic health, nervous system restoration, and preconception detoxification.

Kalea Wattles, ND: I have a whole series of questions designed to assess patients’ signs, symptoms, and symptom severity, similar to how the Medical Symptoms Questionnaire does, but hyper-focused on fertility findings. It’s now in a digital format, which makes it really easy to share with other clinicians. How I use this in practice: I’m able to give this assessment to patients to create a clinical hierarchy. We have a clear entry point and know exactly what we need to focus on first.

Kalea Wattles, ND: I’m also able to share it with other clinicians so they can create this body systems map for their fertility patients. And I do online programs that are fairly asynchronous — I pop in to support the learners, but they’re going through educational material developed to help them understand what all of those imbalance areas mean. It’s such an exciting model that allows clinicians to add precision to their treatment plan, and patients to more deeply understand their body.

Leslie Stone, MD: Very good.

Dr. Kara Fitzgerald: Yeah. By the way, I just want to say to the listeners that we’re going to link everything in the show notes — the whole transcript is free to access. The citations that have been mentioned, information about the ROOT Study that Grow Baby is working on, we’ll link to Kalea’s site and her book. And if the calculator is available in some capacity, we’ll link to that too. We’ll even do an acronym glossary, because we’ve been throwing some acronyms around and probably not everyone knows them all. Kalea, what prompted you to get into reproductive endocrinology offices and pursue this direction during school and your residency?

Kalea Wattles, ND: Well, I was in my second year of my naturopathic program and I decided — which is a whole other story — I decided I want to have a baby. I’m ready, and I’d like to get pregnant. And I realized that even with a nutrition degree, even halfway through a doctorate, I didn’t know where to start. None of my friends were talking about it. None of my classes were covering it. It just wasn’t anywhere in my curriculum or training. So I had to figure it out on my own.

Kalea Wattles, ND: And that led me to really connecting with other women — not clinicians, but other women who were teaching me what I needed to do. And I knew I had to operationalize this because I had to make it accessible in a way that my own patients would benefit, but also my colleagues and friends who would need to get this information out to others. So I went on a whole fertility journey personally and realized how much there was a need for this type of care. Luckily, in the Seattle area, we have such a vibrant community of reproductive health care, and I had all of these clinics at my disposal to cold call and beg to take me on.

Kalea Wattles, ND: And it was the most brilliant learning experience — to realize how much naturopathic and functional medicine could set the scene, as I think is the best term — set the scene for even patients who are going to utilize therapies like IVF and IUI, but also for those who simply want to get their body in the best shape possible for preconception so we can avoid some of the comorbidities Leslie and Emily are talking about. That’s really functional medicine’s time to shine there. So I just saw the opportunity.

Emily Stone Rydbom, MDH: Mm.

Kalea Wattles, ND: I had a personal motivation and went for it.

Dr. Kara Fitzgerald: That’s awesome. And so the way opened before you, as my mom used to say. It’s amazing how it unfolded, and that you thought to operationalize and codify it in this very elegant way.

Dr. Kara Fitzgerald: I have to say your work has resonated with me quite a bit. Maybe just walk us through the zones you’ve outlined — the fertility matrix — and then I’m curious about some unexpected patterns that have jumped up, or patterns that are always predictable, always there. I’m just curious to glean a little from your clinical experience using this model.

Kalea Wattles, ND: Excellent. What I love about functional medicine in general is that it often uncovers things that were unexpected. And unexplained infertility is a great use case here — because so many people receive this diagnosis. When you get unexplained infertility as a diagnosis, it means the patient is ovulatory, that they have at least one fallopian tube that is open — because technically you only need one — and that a semen analysis has been normal. Not optimal, but normal enough that conception could be possible. That could all be true, and we could still have suboptimal thyroid function or elevated thyroid antibodies.

Kalea Wattles, ND: Even elevated TPO antibodies can create what the literature calls a “hostile environment” in the ovarian follicle — and that language can be tough to swallow, but it definitely can disrupt folliculogenesis. That could all be true, and we could still have tons of oxidative stress damaging our follicles, or chronic systemic inflammation — which, once in the bloodstream, travels everywhere. It can travel to the ovarian tissue where it disrupts folliculogenesis; it can travel to the endometrium where it impairs endometrial receptivity. We could have celiac disease, or a disrupted vaginal microbiome, or periodontal disease causing inflammation throughout our reproductive organs.

Kalea Wattles, ND: There’s just a whole spectrum of things that could be happening, even if someone is ovulatory, has one open fallopian tube, and there’s enough sperm. I love that we’re able to move the conversation from “unexplained infertility” — which feels uncertain, scary, and defeating — to “metabolic dysfunction with chronic systemic inflammation,” which we know what to do about in functional medicine. That is our bread and butter.

Dr. Kara Fitzgerald: Yeah.

Kalea Wattles, ND: So that’s so much more empowering. And that’s why my preconception panel — as we work through all of the Fertility Focus Zones — has things like hsCRP, fasting insulin, GGT, and uric acid. These are biomarkers that are perhaps unexpected at times, but help me understand what the underlying drivers of reproductive dysfunction are.

Dr. Kara Fitzgerald: Do you do any specialty lab testing?

Kalea Wattles, ND: Yeah, you mean

Dr. Kara Fitzgerald: In a baseline workup? Like stool testing, or looking at the microbiome?

Kalea Wattles, ND: Yeah.

Kalea Wattles, ND: My first tier is going to be blood work. It’s so accessible. I can bill insurance for it. Even when patients pay cash for what I think is now a 33-biomarker panel, it’s about $250 — so relatively affordable. That’s my first tier. And then based on the Fertility Focus Zones, I’m able to use their funds wisely.

Kalea Wattles, ND: For example, if they take the Fertility Focus Zone calculator and the gut-fertility axis comes back as their highest area of dysfunction, it makes sense to do a stool analysis or breath testing. Or if reproductive hormones or the nervous system come back as their highest imbalanced zone, we might think about an adrenal stress profile or a nutrient evaluation.

Dr. Kara Fitzgerald: That’s right.

Kalea Wattles, ND: That’s where I love the precision of the Fertility Focus Zone calculator — because we know how to spend our time, our money, our energy, and our mental, emotional, and spiritual capacity on interventions that are targeted for that individual’s body, rather than just trying everything we read on the internet.

Dr. Kara Fitzgerald: A hundred percent. I love it. And one day you’re going to crunch your data, and it’s going to be rich with really important information that could direct how we think about preconception care, and have a broad impact across the health span and the lifespan. I do want to circle back to that later. But first, I want to understand Grow Baby’s program. Emily, give me an idea of what it is. You had to have made it accessible enough to be adopted broadly. It’s systems medicine, and you’re doing wildly sophisticated work. But you’ve crunched some serious concepts into the key touch points you need to affect the outcomes you’ve sustained. What is it? What are the core aspects of the program? How do you individualize it for the populations you’re working with? And how’s adherence?

Emily Stone Rydbom, MDH: I think of something Mark Hyman often says: our bodies are complex but not complicated. Meaning, once we understand what the driver of dysfunction or homeostasis is, we can try to create the proverbial recipe. I’m using recipe as a pun because we are literally going to talk a lot about the nutritional aspect of Grow Baby. So we try to keep simplification centered around the core tenant, which is food. I like to remind everybody that we have about two thousand pounds, on average, of opportunity to make decisions for our health — that’s how much food we consume annually as adults. So our bodies are not failed by the occasional slip. This really is about flipping the script and saying: look at how much opportunity there is here.

Dr. Kara Fitzgerald: Right.

Emily Stone Rydbom, MDH: We can pull out statistics that feel absolutely demoralizing, and in the same breath say: and look at what you can do about it. First and foremost, nutrition is the most underutilized leverage and tool we all share. Making sure we are addressing nutritional needs from a macro and micronutrient standpoint first is what brings so much robustness to what Grow Baby has done. We do that on a trimester-by-trimester basis with food plans based largely in a cardiometabolic approach to health — what I’d call a modified pregnancy Mediterranean diet. Not Mediterranean diet strictly, but the parts we want to emphasize: high phytochemical diversity, excellent sources of monounsaturated and polyunsaturated fats, selected choices of animal protein, and fiber enrichment. It changes by trimester and is driven first by what the mother’s needs are.

Emily Stone Rydbom, MDH: So that’s a big part of what we believe brings Grow Baby resilience and its ability to really shift the well-being and the vitality of the mother is because so much of societal emphasis is on making sure the baby’s okay. And certainly we need to do that. But if the mom isn’t well, that baby isn’t going to be okay. We physiologically look at what challenges arise by trimester for these moms. What happens in the first trimester? We’re going to be managing mood shifts, managing nausea likely, and managing fatigue.

Dr. Kara Fitzgerald: Yeah.

Emily Stone Rydbom, MDH: So those three core tenets are what we go after first with the core food plan. A lot of solutions to mood disruption and fatigue have to do with adequacy of macronutrients — specifically protein. Hard to do when you’re feeling nauseous. So we take the time to adjust these needs to the mother based on her symptoms first. Moving into the second trimester, moms typically start to feel better — but now gut motility may be altered, there may be diarrhea or constipation, headaches, insomnia, or restless legs. So we do a good assessment around what the mother’s needs are.

Emily Stone Rydbom, MDH: That pattern continues into the third and fourth trimesters. And we look at fetal development — what are the needs during these key trimester windows where we have to make sure the mother’s vitality is intact and that we’re meeting the physiological needs of the developing fetus? This is when we often have to layer in a personalized or tailored approach to nutrient supplementation, because one of the exposures we experience as a society is a state of nutrient depletion. Over 90% of our moms are going to be deficient in choline, DHA, and at least one B vitamin. 83% by the time they’re in their third trimester will be deficient in iron. Vitamin D is up there too.

Emily Stone Rydbom, MDH: So all of a sudden — let’s anticipate what we know from hemodilutive physiological changes, but also teasing out through nutrition integration: if we can’t get 15 to 20 minutes with the OB, the nutrition piece can come in and piggyback on that allopathic care to make sure the physiology of the mother and the baby are supported first with nutrition and then nutrients as the focus — knowing that because of the time we’ve spent establishing patterns toward deficiency, we can anticipate what those needs are and act on them very quickly.

Emily Stone Rydbom, MDH: So much of this is also empowering the mother. I used this term with Kalea when we were speaking: it’s a “choose your own adventure.” There is nothing more powerful than really listening to the mom in front of you and hearing what matters most to her. Because we may feel like we have the answers from a Grow Baby perspective, but if the most important thing for her is to be able to sleep, that’s the door we enter through. If it’s most important that she feels like she’s eating well, that’s the door we go in.

Emily Stone Rydbom, MDH: We also have to ascertain what is driving the allostatic load this mother is experiencing, and how do we relieve it? Because we know a mother experiencing high allostatic load has impaired mitochondrial function. And you cannot maintain epigenetic instructions, biochemical instructions, in an energetically unstable environment. So if we’re not really looking at what is driving physiology from a mitochondrial standpoint, and making sure these nutrients are intact for this mother while she and the baby are in this massive period of growth, then we are not taking care of that mother and baby.

Dr. Kara Fitzgerald: Are you delivering this level of sophistication primarily through an app? What kind of contact is involved in the Grow Baby program?

Emily Stone Rydbom, MDH: It’s been iterative. We did group medical visits first, then a hybrid of group medical and one-on-one, and then one-on-one face-to-face. Then the global pandemic forced the issue into virtual. And every single model appears to generate the same results. But scaling has always been the challenge. That’s where the technology solution has come in. Over the past two years, we’ve spent time developing Grow Health, which is the scalable technology platform for Grow Baby — and that’s what will be used in the ROOT Study. It will be me providing nutritional care support via this technology platform, improving efficiency to see more moms with that same level of personalized care, without burdening the provider.

Dr. Kara Fitzgerald: And through that, will you be getting labs? Does the local provider manage that? And are there supplements you’re prescribing through that structure?

Emily Stone Rydbom, MDH: Because it’s collaborative, we will be able to use LabCorp, and the provider will be able to draw the Grow Baby labs, covered by insurance. We have lab partners EVI and DNA Life — we’ll be doing vaginal microbiome testing on select numbers of these moms, and everyone will be doing the DNA Life Grow Baby test. Our product partners Needed and Pure are going to be offering their solutions for free. So this again costs the mother zero dollars.

Dr. Kara Fitzgerald: Wow. Interesting. And the dietary pattern they’ll be adopting — which I like, the “choose your own adventure” structure — supports adherence because they’re buying into it. Is it relatively accessible? You don’t need to go to a Whole Foods somewhere. Is that true?

Emily Stone Rydbom, MDH: One of my favorite things we’ve done over the course of the Grow Baby program is adopt everything we’ve ever put forward to both WIC and SNAP. We’ve incorporated seasonality into every food list based on region as well. So food accessibility is really, really important to us. In fact, it’s critical — it’s why people stay compliant.

Dr. Kara Fitzgerald: Yes.

Emily Stone Rydbom, MDH: And I’m very sensitive to saying “Mediterranean diet,” because I’m not going to ask a Hispanic mother to eat a Mediterranean diet. I’m going to ask a Hispanic mother to eat her cultural foods. I’m just going to make sure we’re adjusting based on a 40% carbohydrate, 30% protein, 30% fat macro target — emphasizing low glycemic index, 28 to 35 grams of fiber — and finding it in ways that fit that mom’s life. We’re pulling on tenets from the methylation diet and lifestyle, the Mediterranean diet, the Healthy Eating Index, and more. At the end of the day, the mom has to feel — Leslie says this all the time — that it’s doable. They have to feel like this one thing is within their control.

Emily Stone Rydbom, MDH: And this is also part of what’s really important to me: cognitive behavioral theory. So we do a full Transtheoretical Model assessment where we look at readiness on a one-to-five scale, and then use motivational interviewing tactics — specifically the OARS acronym: Open-ended questions, Affirming, Reflecting, Summarizing. So they feel absolutely part of that therapeutic alliance and are autonomously driving the decisions they’re making. We’re just presenting the options.

Dr. Kara Fitzgerald: I love it. I absolutely appreciate you bringing the branch down and making it doable — looking through the lens of cultural dietary pattern. I think it’s essential. And one of the things we were excited about in our research was that we didn’t require organic. Many people in this space ask why we didn’t. And thank God we didn’t, because we would have omitted quite a few people, yet we still got some pretty exciting published outcomes. And here now doing conferences in Mexico and talking about dietary patterns through the cultural lens — there are just wildly important nutrients across all cultures. I think the macros and micros are readily adoptable.

Emily Stone Rydbom, MDH: Yeah, I do.

Dr. Kara Fitzgerald: So Kalea, we’re heading into the home stretch. I was talking to David Perlmutter for our 2025 Masterclass and I asked him when we need to really start thinking about brain health. And he said: preconception. Immediately. Always. And that was just such a great response from him. We know now that the work you’re doing with parents-to-be will influence their health, the health of their offspring, and it will influence generations to come. Those data are out there. You’re definitively influencing gene expression intergenerationally. It’s exquisitely powerful.

Dr. Kara Fitzgerald: We started our conversation here with the painful broad public health crisis we’re in. But to your point, Kalea, there’s just so much possibility here. So in your work, how do you think about that? How does it inform what you’re doing with your patients? And the other piece I’ll throw out there is that this foundational work will without question improve health span and reduce the chronic disease burden associated with aging. So speak to speak to that big picture.

Kalea Wattles, ND: I love this question, especially having just had an advanced maternal age pregnancy myself and thinking quite a lot about the connection between what I’m calling the “fertile span” and the health span. I just had the opportunity to present on this very topic at IFM’s annual conference. I started my presentation with a poem: “Roses are red, violets are blue; preconception care prevents chronic disease too.” I think it’s so helpful to frame it like that, because it is a big investment to take care of our body in the preconception phase. I absolutely talk to my patients about all the hard work they’re doing now and how it will absolutely play out in their health trajectory in the decades that follow.

Kalea Wattles, ND: Brain health is a great example because we focus so much in the fertility world on mitochondrial health — knowing that ovulation, fertilization, implantation, and early embryo development represent an energetically expensive timeline. All the things we’re doing to support cellular energy production so that we can ovulate regularly and get pregnant — that’s also going to protect our brain when our child is in middle school and all a sudden we can’t remember anything.

Leslie Stone, MD: Yeah.

Kalea Wattles, ND: These are the inputs we make while supporting our fertility so that we can enjoy robust cognitive function later on. And the same is true across so many body systems. When we work on reducing inflammatory burden so that our ovaries and endometrium are healthy, we’re also reducing our cardiovascular disease risk. When we work on restoring intestinal barrier function so that we don’t have metabolic endotoxemia leading to systemic inflammation, we’re reducing risk for a whole slew of chronic diseases now linked to intestinal hyperpermeability. We’re stabilizing blood sugar so that we ovulate regularly, while we’re also preventing type 2 diabetes later on.

Kalea Wattles, ND: The mitochondrial health piece supports our cardiovascular system and slows the aging of our brain. So what a powerful moment to step into someone’s timeline and inform them of all the ways they will personally benefit. And, as you said, Kara, this is intergenerational medicine. Don’t we all wish our own parents had this knowledge so that we could have reaped those benefits? Now we get to be the givers of that knowledge.

Dr. Kara Fitzgerald: Yes, that’s right. It’s super exciting. I love thinking about it through the epigenetic lens. Exercise, for example — we can actually pass down some of that information to our offspring through gene regulation, reducing the risk for diabetes and cancer. Really, across the board, intergenerationally, there is so much we can do at this time.

Kalea Wattles, ND: I’ll just share a really quick funny little blurb: this morning I spent all morning watching videos of what they’re calling “sperm nanobots.” These are little robots that can attach themselves to immotile sperm and transport them to an egg so that they can fertilize — almost a more advanced version of ICSI, intracytoplasmic sperm injection, which is usually done by a clinician.

Kalea Wattles, ND: But this is a remotely powered robotic procedure. And it was so interesting watching the videos on social media and seeing all the comments and robust discussion about: well, if the sperm isn’t moving, then we have to wonder about its cellular energy production, since we know mitochondria power the forward momentum of sperm. Do we want to bypass that biology? I don’t have the answers, but it’s a really interesting question to consider as we look at all the ways our preconception health translates into our children.

Dr. Kara Fitzgerald: Without question. Okay, Grow Baby — as we head into the final stretch — I want to throw that same question to you guys. You’ve published with Randy Jirtle, who has mapped out the imprintome, and there’s a lot to say about defining the future health of the mom, the F1 generation, and subsequent generations with functional medicine interventions. Talk a little bit about that paper. It’s currently under review, actually — we’ll link to the citation. Do you have a preprint? Actually the imprintome paper is out — I’m sorry.

Emily Stone Rydbom, MDH: The imprintome paper is actually out. It was published in Frontiers, and that was an amazing opportunity to work with Dr. Lucia Aronica, Dr. Samantha Fessler, and Dr. Randy Jirtle. It was actually on the imprintome — which, simply speaking, is the biological system that determines which parent’s copy of certain critical genes gets to speak. At the end of the day, one side of the imprintome — paternal or maternal — is either going to be silenced or activated. And the imprintome is highly dependent on methylation — on one-carbon metabolism. So going into the epigenetics of preconception health, not only and this kind of larger conversation in and around epigenetic function, but also of this this set of genes that ultimately has a very distinct window when it is open and then it is closed.

Emily Stone Rydbom, MDH: It’s not dissimilar from the way we think about the neural tube in fetal development — there’s a window that’s open and then closes. And the imprintome is the same way. Ironically, that imprintome — that set of instructions that that single parent copy is either going to be on or off — it almost corresponds directly to that of the neural tube physiology. So you’re talking about within the first eight or so weeks, that imprintome modifiability diminishes because then it sets. And then you move into what is known as kind of this adaptable window.

Emily Stone Rydbom, MDH: But the imprintome, these genes specifically, once they’re set, they establish vulnerability for what we are starting to understand in and around growth very, very early. Some of these imprinted genes also establish vulnerability around psychopathology — including different types of neurodevelopmental issues, even into the autism spectrum.

Emily Stone Rydbom, MDH: So I’d really encourage everybody who wants a good review paper on the imprintome to take a look at that. What it reminds us of, more than anything, is how important methylation is in the physiological process of the body on so many levels — including, of course, at its mother source: the mitochondria. So we couldn’t agree more with Kalea, with Dr. Perlmutter, and I know you would agree too, Kara, that the preconception window is the time to be thinking about this. But Leslie would very quickly course-correct a little and say: well, puberty might be an even more appropriate preconceptional window.

Emily Stone Rydbom, MDH: The idea here is that preconception, for us, is not ultimately a three- to four-month window. It really is a decade. And sometimes providers say, “Well, I don’t work with preconception folks, I don’t work with pregnancy.” But if you are seeing anyone of reproductive age, then you work in preconception. Whether you feel like it or not. What an opportunity to have a frame shift around that concept. If you bring in the right tools at the right timing in this preventative fashion — around the gut-fertility axis, the gut-placental axis, the gut-mitochondria axis — you can do such powerful work. Even reframing your patient population as preconceptive by the time they’re twelve. Not that they’re going to reproduce, but preconception doesn’t necessarily mean reproduction.

Emily Stone Rydbom, MDH: And irrespective of becoming pregnant or having a family, we’re talking about imbuing the concept of physiological resilience at the exact point of care when that person is sitting in front of you, no matter their age — but as early as possible.

Dr. Kara Fitzgerald: Right. And even as we outline the importance of methylation for gene expression, it isn’t a case where more is better. There’s the matter of form, food-based versus supplemental, and much more to one-carbon metabolism than just folate intake — there’s dietary intake and supplementation later and all sorts of extremely important stuff to support balanced methylation. The polyphenols — the phytochemical influence on how methylation happens — I think is equally important and essential.

Dr. Kara Fitzgerald: There’s an interesting idea that has taken a lot of my attention — which is that there are now biological age clocks, and careful explorations of the aging phenomena looking at Polycomb Repressive Complex proteins. These proteins are key in reproduction and building a baby, key in the very earliest developmental phases, and they slowly turn off over time. This occurs via methylation — not just DNA methylation, but histone methylation and other marks. They reproducibly go through this phenomenon of change, not just in humans, but across mammals. This is why we care about preconception so much — because we’re starting to map out very clearly the connection from the earliest point of reproduction on through the experience of aging.

Dr. Kara Fitzgerald: This is something that’s really gotten our attention in our work, and something we hope to explore in our research — what nutrients and what interventions might influence these proteins, and therefore influence not only preconception but the aging journey very directly. Any final words?

Emily Stone Rydbom, MDH: I was just going to say, Kara, you’re speaking our language. What was it Leslie — about four years ago now — we built a whole deck called “Developmental Programming of Health and Disease and Aging,” because there are very identified mechanisms: leukocyte telomere length, mitochondrial DNA —

Leslie Stone, MD: mitochondrial DNA copy number.

Emily Stone Rydbom, MDH: and methylation patterns across tissue and cell types. It’s important to start having this conversation around longevity as early as possible. And science is starting to present itself to say this matters during this time.

Dr. Kara Fitzgerald: It matters. And it matters more deeply than we can yet conceive. No pun intended. And you know, when I was looking at Kalea’s zone calculator, the first thing that came to mind was the hallmarks of aging. If you’re sufficiently geeky, you could do that exercise — take the hallmarks of aging and map them to the nodes Kalea’s looking at in her work, which we teach in functional medicine. There’s a very full-circle experience here that makes this a continually satisfying medicine to practice.

Leslie Stone, MD: I certainly have found there’s a remarkably redundant set of nutrients and a remarkably redundant set of systems that work to optimize function throughout every aspect of human nature. And they are not restricted to fertility or aging or preterm birth — they are all at once.

Leslie Stone, MD: All root causes ultimately end up at the energetic level. We’re talking about electron particles, protons. We know we’re ultimately going to get there. Right now we’re circling at the atomic level. We’ll be subatomic soon.

Dr. Kara Fitzgerald: I have no doubt you’re already talking about that in your world. Listen, all of you — thank you so so much for joining me today. This was just a really juicy and fun conversation, and I think an important one. I support you all from the deepest place.

Emily Stone Rydbom, MDH: Thank you, Kara.

Leslie Stone, MD: Thank you.

Dr. Kara Fitzgerald: I hope you enjoyed that conversation with Dr. Leslie Stone, Emily Stone Rydbom, and Dr. Kalea Wattles as much as I did. It was impactful, informative. And yes, there are some grim statistics — but the upside is that functional medicine really, really works. I’m thrilled with Grow Baby being adopted in the research setting and with the tireless work of the Stones. And of course, I spent some time off-air encouraging Dr. Wattles to jump into some research and do a little data dive into what would be a fruitful investigation of outcomes in her practice. There’s just much we can do through the functional lens to influence not only birth outcomes and the health of the mother, but health outcomes throughout the lifespan — entering into the preconception conversation at any stage.

Dr. Kara Fitzgerald: As always, thank you, thank you, thank you for listening to New Frontiers. If you enjoyed this conversation, if you’ve got any thoughts, definitely let me know. I would love to hear from you. This community is an important part of what keeps this work evolving — that is you and your thoughts. Again, thanks for coming to New Frontiers, and I look forward to seeing you on our next episode.

Leslie Stone is a Board Certified Family Practice Obstetrician with fellowship training in Surgical Obstetrics, a published researcher, and an internationally recognized lecturer known for integrating functional medicine into evidence-based, insurance-reimbursed obstetric care. She is a co-founder of the GrowBaby model and principal investigator of the ROOT Study, a 500 mother–baby dyad trial launching in North Carolina in 2026. Over a career spanning more than 5,000 deliveries, she has spent over a decade, alongside Emily, implementing GrowBaby in high-Medicaid obstetric settings across four states and delivery systems.

Emily Stone Rydbom is a nationally recognized Board Certified Holistic Nutritionist and clinical nutrition consultant who holds a Master of Digital Health and specializes in functional and precision nutrition across maternal, pediatric, and chronic disease care. She’s a co-founder of GrowBaby, a clinically validated, integrated OB–nutrition care model, an author on multiple peer-reviewed publications, and a sub-investigator on three clinical studies. Her work partners with Medicaid managed care organizations, hospital systems, and OB-GYN clinics to deliver biomarker- and genomics-informed maternal health pathways with demonstrated reductions in maternal and neonatal adverse outcomes.

Kalea Wattles is a naturopathic physician, certified functional medicine practitioner, and founder of Functional Fertility, where she specializes in unexplained infertility, preconception optimization, and fertility over 35. Her clinical work is rooted in a systems medicine — evaluating how the gut, metabolism, hormones, immune function, inflammation, and mitochondrial health converge to shape reproductive outcomes. She is the author of The Functional Fertility Blueprint, a clinical framework that translates current research in reproductive medicine into actionable preconception care.

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