By Beth Heller, MS

The word “diet” can mean “food or drink regularly consumed,” or “a regimen of eating and drinking sparsely so as to reduce one’s weight.” The latter definition is one that inspires fear in the hearts of many who have tried unsuccessfully to lose weight by “going on a diet.”One of the most common questions we get at Pulling Down the Moon is “how do general diet programs like Weight Watchers stack up for fertility?”   How diet impacts fertility was also the subject of a daylong symposium at the most recent meeting of the American Society for Reproductive Medicine.  Clearly, overweight is a challenge to fertility and can also block women from access to advanced medical fertility treatments like IVF.  But are diets the answer?

How Do Diets Measure Up?

In our view, for a diet to be fertility-friendly it must a) help women to attain and maintain a healthy weight for fertility b) target the specific ways in which overweight negatively impacts fertility:  poor blood sugar regulation, inflammation and the negative hormonal impact of excess body fat  c) eliminate overly-processed foods and encourage the consumption of minimally processed foods.  So how do “diets” stack up?

A) Help women to attain and maintain a healthy weight for fertility

While it may sound ridiculous, dieting does not seem to be the best way to lose weight.  An extensive 2007 review of weight-loss programs published in American Psychologist concluded that:

Dieters were not able to maintain their weight losses in the long term, and there was not consistent evidence that the diets resulted in significant improvements in their health. In the few cases in which health benefits were shown, it could not be demonstrated that they resulted from dieting, rather than exercise, medication use, or other lifestyle changes. It appears that dieters who manage to sustain a weight loss are the rare exception, rather than the rule. Dieters who gain back more weight than they lost may very well be the norm, rather than an unlucky minority.

Even well established programs like Weight Watchers struggle when we take a closer look at success and maintenance.  There is recent clinical data suggesting that Weight Watchers may be more effective than other diet programs at helping people lose weight and keep it off.   A 2008 study published in The British Journal of Nutrition reported looked at a sample of 976 “lifetime members”(defined as people who met and maintained their goal weight for at least 6 weeks) to see how many remained below their goal weight at 1 (26%), 2 (20.5%) and 5 (16%) years after they successfully completed the program.  On the surface this sounds encouraging but a closer look reveals this study has significant biases that make it next to impossible to generalize the findings.  Only about 6% of people who try Weight Watchers successfully attain and maintain their goal weight and meet the criteria to become lifetime members.  This study looked only at their most successful dieters and only 16% of that already small minority kept the weight off for 5 years.

The other problem with assessing the efficacy of WW is that we do not know what’s happening to the other 94% people who try the program and fail.  Are they experiencing the clinically relevant negative effects of dieting, including gaining back more than the weight they lost after a failed diet?

With these numbers in mind, there is a very good chance that many women who are told they need to lose weight in order to increase their odds of pregnancy have already failed at Weight Watchers.  Diets, it seems, are not the answer.

B) Provide ample amounts of nutrients that are important for good nutrition function and target the specific ways in which overweight negatively impacts fertility:  poor blood sugar regulation, inflammation and the negative hormonal impact of excess body fat

Major components of commercial diet programs – eating “low fat,” using artificial sweeteners, mass-prepared processed foods to support portion control and optimize convenience and emphasis on low fat dairy and “diet” foods – fly in the face of what we believe lie at the heart of healthy eating in general.  For women to find true success and optimal health they need to “un-learn” many of the dieting habits they have picked up over the years.  This means that frozen processed diet meals are out, as are the sugar-free and low-fat processed snacks.  Diet soda and artificial sweeteners are another crutch that needs to be discarded.  These overly processed food products may conveniently cut calories and “soothe the sweet tooth” (unfortunately artificial sweeteners may actually sharpen a sweet tooth in the long term) but they do not address the underlying causes of infertility – inflammation and poor blood sugar control – associated with overweight.

You can review a head-to-head comparison of a “healthy” low-fat diet versus a fertility-friendly menu in our blog A Tale of Two Diets to learn more about our contention that many of the “healthy” eating habits that have become conventional diet wisdom are simply wrong.   In our estimation an ideal fertility-friendly diet contains about 10% more fat and 10% less carbohydrates than a “typical” healthy diet.  The fats come from foods that naturally have fat in nature – full fat dairy in small amounts, fats from nuts, seeds and oils, as well as fats from grass raised meats and fish in small quantities.  Many of the fat-soluble nutrients and essential oils needed for optimal health are found in these natural fats.

C) Discourage overly processed foods and encourage the consumption of minimally processed foods.

We all seek convenience in our meal preparation but often to the detriment of the food we put in our bodies.  While Jenny Craig, Nutrisystem and Weight Watchers all provide recipes, they  also do a brisk trade in maximally processed meals and snack foods, none of which we feel we could endorse as fertility-friendly.  Processed, packaged in potentially toxic plastics and “fortified” with added vitamins and minerals – they aren’t true foods.  Read the ingredients of any of them for a tongue-twisting array of chemicals, preservatives and colorings.

Furthermore, we encourage women who are trying to conceive to eat organic and hormone-free as much as possible. The cardboard, plastic and Styrofoam packaging that wrap up convenience foods and snack-size packs are not good for our environment, either, and may be contributing to the chemical stew that is negatively impacting fertility in the first place.

What’s the Solution?

As we mentioned above, most women who have been told they need to lose weight in order to conceive or undergo IVF have likely tried dieting in almost every form possible and do not want to try another one.  So what to do?

Our answer lies in the concept of “nourishing up.” Nourishing up is the process of learning how to feed our bodies with real food that includes healthy fats and does not rely on processed low fat, sugar free or diet foods.  With nourishment come satiety, great digestion and optimal nutrition.  In obese and overweight women weight loss is not the goal of nourishing up but it is almost always a by-product.

Our therapeutic intervention for overweight and obesity, First Line Therapy for Fertility, introduces women to highly nutritious and satisfying eating guidelines based on the Mediterranean dietary pattern, which several studies have associated with potential protection against infertility (3, 4).  This dietary pattern emphasizes low-glycemic load, minimally processed foods and healthy oils from vegetable and fish sources.  Refined sugars and treats play a minimal role in this dietary pattern as do “diet foods” like processed low-fat dairy, and sugar free or fat free foods.  First Line Therapy has been shown to promote weight loss as well as improve markers of metabolic syndrome, such as decreasing LDL (bad) cholesterol, in women (5).

Dietitians who have received additional training in fertility nutrition and are up to speed on ART treatments lead the FLTF Program.  We educate women about Fertility Go (eat lots every day), Whoa (okay in moderation) and No (let’s skip these) foods, making it easy for women to customize their program to optimize sources of essential fertility nutrients (iron, omega-3 fats, B-vitamins and antioxidants).   In addition there is education and emphasis on foods and supplements that limit inflammation, which is implicated in many different infertility conditions including endometriosis, Polycystic Ovarian Syndrome (PCOS) and poor egg quality. With FLTF, we will help women choose foods that will nourish their bodies with the vitamins and minerals needed to maximize their fertility and help them feel satisfied, while at the same time helping them achieve a healthy weight.

Currently we have two groups of 5 women, one group in Chicago and one in DC Metro, who are participating in the FLTF program.  Stay tuned to our site for more information about their progress, to share their stories, challenges and successes, and to learn more about First Line Therapy for Fertility.

Sources

1.  Mann et al.  Medicare’s search for effective obesity treatments:  diets are not the answer. American Psychologist (2007), 62: pp 220 –233.

2.  Lowe et al. Weight-loss maintenance 1, 2 and 5 years after successful completion of a weight-loss programme.  British Journal of Nutrition (2008), 99: pp 925-930.

3.  Toledo et al. Dietary patterns and difficulty conceiving: a nested case–control study.  Fertility & Sterility (2011), 96: 1149-53.

4.  Vujkovich et al. The preconception Mediterranean dietary pattern in couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment increases the chance of pregnancy.  Fertility & Sterility (2010), 94: pp 2096-101.

5.  Jones et al. A Mediterranean-style low-glycemic-load diet improves variables of metabolic syndrome in women, and addition of a phytochemical-rich medical food enhances benefits on lipoprotein metabolism.  Journal of Clinical Lipidology (2011) , 5: pp. 188-96.

Cathleen McCauley L.M.T.

By Cathy McCauley, LMT, NCTMB

Spring has officially sprung and a multitude of signs show the season is upon us. Take a walk through your neighborhood and you see crocuses blooming and green buds taking shape. The earth is fertile and bursting with life.

With spring here, it’s the time for rejuvenation and cleansing. The longer days bring a renewed boost of energy. With spring, you receive the opportunity to release any stagnation that has accumulated during the winter and start fresh in mind and body. You can look ahead and make plans for the coming year.

A Chinese proverb says, “Make your whole year’s plans in the spring, and your day’s plans early in the morning.”  The proverb comes from the fact that farmers sow their seeds in early spring to ensure a good harvest and highlights the importance of being proactive.  Applying this concept to fertility, you can see the importance of starting early in taking care of your reproductive health. When you begin to pay attention to your bodies’ rhythms, cycles, signs and symptoms, your chances can increase in creating a fertile environment.

If you haven’t been as proactive about fertility as you’d like, spring is the perfect time to make plans for the future. It might be time to talk to your doctor about a fertility blood work up to determine what’s really going on with your hormones. You could make an appointment with a nutritionist to overhaul your eating habits to be more fertility friendly or take a yoga class to learn some breathing and relaxation techniques for stress reduction.

Click here to learn about the Fertility Awareness Check-Up available from Fertility Centers of Illinois for just $90

Also, the concept of spring cleaning our bodies can become an important ritual. You need to clear out the toxins and rejuvenate any stagnate energy in the body to boost immunity and increase fertility health. Since spring is the time for new beginnings, it’s a good opportunity to experience something new. Acupuncture helps balance the energy in the body and stabilize the organs and bodily functions. Reiki, a gentle form of vibrational energy healing, helps restore harmony in the body, mind and soul and clears emotional blockages. Fertility massage focuses on opening up the abdominal and reproductive organs to promote the immune system and assist in blood flow. Massage also greatly reduces tension and helps you feel great.

In the spring, people begin to feel better as the temperatures increase, the sunlight shines and the world turns green. Pour some of that warmth and light into your reproductive health to invigorate and rejuvenate your personal fertility journey.

We’re here to guide you along your path and hope to see you soon!

 by Beth Heller, MS RYT

Chicago has had an amazing winter and a very early spring.  This past week has found us meditating on flip-flops…in March!

 While it’s super fun to slip on a pair of summery wedges and paint our toenails pink, open toed shoes and flip-flops aren’t the only reason to pay attention to our piggies.  When it comes to the holistic view of fertility  feet occupy a place of honor.  If you’ve ever had fertility acupuncture you know that many of the points that support the reproductive system are located in the feet and ankles.  Reflexologists assert that the feet literally provide a map of the body and that we can use foot manipulation to impact different physical organs.  Yoga, too, teaches that healthy feet are important for better menstrual function, dispelling toxins and improving immunity.

So what’s so special about our feet?  In yoga, the feet are seen as the foundation of our being that is connected with the earth.  The most basic of yoga poses, mountain pose, challenges us to simply stand and find balance from our feet to the top of our head.  If we close our eyes in mountain pose, we can visualize the outlines of our feet on our yoga mat…literally our footprint in the world.  One of the strangest things for the new yoga practitioner is exercising in bare feet rather than sneakers.   Postures are practiced barefoot to maximize our awareness of our feet.  Yoga postures also stretch and stimulate different points on the feet that are associated with different organ systems in the body.

Symbolically, the challenges of fertility lead us away from our feet into our head as we spin our mental wheels searching for the silver bullet that will blast us past “trying” time into mommy time.  Our feet, particularly when we practice yoga asana, bring us home from our imaginings and projections to the here and now.

On an energetic level, the feet are associated with our first chakra.  Chakras are energy wheels located along our spine and each chakra is associated with both physiological functions and spiritual life-lessons.  On a psycho-spiritual level the first chakra is associated with security, trust and our sense of belonging.  Physically, the first chakra governs our immune system, gut health and lower back.  The feet are also very important for the flow of apana energy, the energy current in our body that moves downward from the pelvis to the soles of the feet, governs the menstrual cycle and the ability for our body to dispel toxins.

So, be kind to your feet.   Try not to cram them into uncomfortable shoes and make sure they  are frequently touched or nurtured.   Here are some tips for fertility-friendly feet:

1.  Shake hands with your feet once a day.  To do this, take your fingers and thread them between your toes (pinky finger between pinky and second toe, ring finger between second and middle toe, etc.).  Once your fingers are threaded, gently squeeze and massage the ball of the foot.   Repeat on the other side.
2. Keep your feet warm.  Cold feet mean decreased circulation.  With summer coming we face “air conditioner freeze syndrome.”  Keep a pair of fuzzy socks in your bag or desk for the days when you feel like you work in a refrigerator!
3. Experiment with reflexology, the science of foot massage.  Either see a professional reflexologist or try out “reflexology socks,” that actually outline the different areas of the foot and their associated organ system.
4. Try yoga.  If you’re a runner or walker, your feet may need a good stretch.  Time spent in yoga class in bare feet can help feet become more flexible and improve circulation to these important fertility “organs.”  Click here to view our upcoming Yoga for Fertility schedule for DC Metro and Chicagoland.

by Anna Pyne LAc FABORM

One aspect of medical theory in Traditional Chinese Medicine (TCM) includes the system of the five elements; wood, fire, earth, metal, and water. They can be used to differentiate TCM physiology, pathology, and treatment plan.  Each element corresponds to a specific emotion and an individual TCM organ.  The Earth element is affiliated with the worry or rumination emotion.  When our minds are busy over-thinking it hinders us from being grounded and impairs harmony between the mind-body connection.  The earth element is also associated with the spleen (not the same as Western medical spleen), which has to do in part with the digestive system.  A person with a poor digestive system usually cannot think clearly, hence the importance of a well functioning spleen.   When the spleen is working properly it means the earth element is being sufficiently nourished so that the mind can remain grounded.   This enables us to reduce stress, keep life in perspective when it gets tough, and can help maintain optimal physical health.

At Pulling Down the Moon we have numerous treatment modalities to ensure that the earth element comes into and stays in balance.  The therapies offered are acupuncture, herbal therapy, yoga, meditation, diaphragmatic breathing exercises, reiki, massage, and nutrition all of which can be used either individually or in combination.  If you have any questions regarding the earth element according to TCM, feel free to contact me via email (anna@pullingdownthemoon.com) or make an appointment for acupuncture/herbal therapy by calling the office.

A new study compared the effect of electro-acupuncture (EA), physical exercise and no intervention on testosterone levels, menstrual frequency, acne and hirsutism in women with PCOS.  After 16 weeks of treatment, the researchers found both EA  and exercise lowered testosterone and increased menstrual frequency, with EA having a significantly greater impact than exercise.  After a further 16 weeks of EA treatment or exercise,  improvement was noted in hirsutism and acne symptoms, again with electro-acupuncture having a greater impact than exercise.

Lifestyle treatment including diet, exercise, stress reduction and Traditional Chinese Medicine for PCOS makes sense.  If you have been diagnosed with PCOS, we encourage you to come in for a consultation and work with our expert practitioners.  Our comprehensive and targeted approach to PCOS includes specific dietary recommendations and supplementation, yoga and relaxation for stress reduction  and Traditional Chinese Medicine acupuncture treatment.  You do not need to be struggling to conceive to benefit from our expertise.  In fact, getting a handle on PCOS before you are “trying” is essential. PCOS is often under-diagnosed in teenage girls and the acne, irregular periods and weight gain are chalked up to puberty.

For more information about PDtM’s comprehensive approach to PCOS, call 312-321-0004 to book a complimentary face-to-face or phone session with our Patient Advocate.

Anna Pyne, LAc, MSOM, FABORM

A question I frequently get asked in my acupuncture practice is “Can acupuncture help improve egg quality?”  From my own clinical experience the answer is, it can.   Acupuncture and herbal therapy help improve the environment of the ovary enabling it to function optimally and properly, therein allowing it to make good quality eggs.  An example of this is with Polycystic Ovarian Syndrome (PCOS) where the problem is a functional disorder of the entire system that is affecting the ovary.  In other words, the issue is not with that single organ alone.  Since the body systemically is not working properly it is not able to nourish the ovary.  Therefore many immature follicles develop within the ovary impeding the process to fully grow one or two healthy quality eggs, as is the case in a normal cycle.  There are many treatment strategies that traditional Chinese medicine (TCM) offers to help regulate the body’s functioning in PCOS, so that the ovary is being supplied the energy and blood it needs to be able to produce an exceptional egg.

Another instance in which I have seen an improvement in egg quality is with endometriosis.  The explanation is a bit simpler to understand than in PCOS.  Generally speaking, with endometriosis the condition is one of blood stasis, a problem that can hinder fresh, oxygenated, nutrient rich blood from reaching the ovary thereby having a negative effect on its function of making a good quality egg.  Here again there are many options in which TCM can help treat blood stasis so that the ovary is being thoroughly supported to produce a good egg.

Though there is no data via research studies presently to support this claim directly, there is much that I have seen in my clinical experience to believe it to be true.  If you have any questions regarding egg quality and how TCM can help please feel free to contact me or book an appointment!

We hope you will take the time to read this wonderful article by Jenny Rough from Bethesda Magazine.   In the article Jenny shares her personal journey, interviews Reproductive Endocrinologists and speaks to women who used techniques like yoga, nutrition and Traditional Chinese Medicine to support their fertility journey.

We’re also excited to share that Jenny will be offering a FREE writing workshop at Pulling Down the Moon in Rockville on Saturday March 26 from 1 to 4 p.m.  Read more about this event here.

by Beth Heller, M.S.

Recurrent Pregnancy Loss (RPL) is one of the most frustrating fertility challenges a woman can experience.   One loss is devastating enough but the cycle of  expectation and disappointment that accompanies RPL can create feelings of despair.  But from both a medical and a holistic perspective, though, couples who experience RPL have plenty of reason to be hopeful.

“In practice we will initiate a work-up for RPL after two losses in a row,” says Reproductive Endocrinologist Dr. Christopher Sipe of Fertility Centers of Illinois.   A medical work-up is important since common conditions such as hyper/hypothyroid, PCOS, luteal phase defect , infection and diabetes can cause RPL.  Once there is a better understanding of the causes of miscarriage, steps can be taken to choose a treatment plan that will optimize the chance of a healthy pregnancy.

There are also holistic strategies for addressing potential root causes of miscarriage.

1.   Acupuncture and Traditional Chinese Medicine

From the Traditional Chinese Medicine perspective much of miscarriage prevention occurs in the months leading up to pregnancy. Regular fertility acupuncture treatment prior to conception can help to manage stress, potentially regulate the menstrual cycle and improve the uterine environment  by increasing blood flow – key elements promoting a healthy uterine environment and pregnancy.   In cases of  threatened abortion, several studies show that treatment with TCM herbs has been shown to be beneficial and may relate to an impact on endocrine hormones and abnormal maternal-fetal immune interaction.  While herbs are NOT appropriate during a medicated fertility cycle,  woman who are not using ART may wish to explore acupuncture and herbal therapy.  However, if you choose to consider this route, we recommend that you check with your OB before beginning any herbal regimen and ALWAYS work with a licensed TCM practitioner who specializes in fertility and pregnancy.

2.  Nutritional Support

Studies have linked conditions like hyper/hypothyroid, obesity, PCOS and oxidative stress to early pregnancy loss and each of these conditions has a nutrition connection.  Assuring that a woman’s diet is rich in antioxidant nutrients like Vitamin A, C, E and selenium can reduce oxidative stress.   In some cases, food allergy or intolerance may be causing gastro-intestinal inflammation which in turn may negatively impact the uterine environment or impair the absorption of nutrients that are vital to reproductive function, as in the case of celiac disease.  RPL is also more prevalent in women with  diabetes and PCOS. Working with a nutritionist to learn how to eat an anti-inflammatory diet that is rich in antioxidant nutrients, and supports good blood sugar regulation and  GI function not only supports overall fertility but may address root causes of pregnancy loss.

3.  Stress Reduction

Giving yourself time to grieve, finding community and surrounding yourself with positive people can make a huge difference for a woman who has experienced RPL and is “trying again.”  Researchers hypothesize a link between stress and poor pregnancy outcomes , so techniques like support groups, yoga and meditation not only help you feel better but may help you stay pregnant.

If you would like more information about holistic support for miscarriage or would like to meet with a Pulling Down the Moon Patient Advocate to discuss your particular experience, please call us at 312-321-0004 (Chicago-Area) or 301-610-7755 (DC Metro) or email us at info@pullingdownthemoon.com.