by Breea Johnson, MS RD LDN

I’m sure you have heard the saying “You are what you eat” but have you ever heard the saying “you are what you drink?” Beverages are everywhere – especially when the temperature increases in the summer time! The average American adult consumes about 28 ounces of sugar-sweetened beverages per day, equal to about 350 extra calories per day. While our typical client is much more health conscious than the “average American” I’m always surprised to see what people are drinking. Top on the list (other than water) is almost always diet sodas, skim milk and coffee, followed by artificially-sweetened ice teas and lemonades (like Crystal Light), fruit juice, herbal teas, sometimes sports drinks and alcohol.

Fluids – like food – are necessary in the diet. We know our bodies are about 78% water – found inside and in between cells and our brain is almost all water- thus explaining why even minor dehydration leads to difficulty thinking. We know that we need fluid for hydration (especially in times of increased fluid loss like exercise). We need fluid for detoxification – both from internal toxic by-products of metabolism to external toxins like chemicals that are converted to water-soluble compounds and eliminated. We need it for digestion and metabolism of food. And we know that without water, we would die within days. There’s no doubt that fluids are just as essential as food to our lives — and to our fertility – as fluids are needed for lubrication, cervical fluid production, detoxification, and overall metabolic support.

We tend to think of fluids as just added calories and not having any specific nutrients in them. But there are lots of nutrient rich beverages to enjoy.  Fertility-friendly fluids are naturally nutrient and electrolyte-rich and have no added sugar or artificial sweeteners.  Here are some Fertility-Friendly beverages to get some extra vitamins, minerals and phytochemicals into your body:

• Coconut water
• Water infused with sliced citrus fruits, cucumbers and herbs
• Nettle Tea infusion
• Cucumber lemon water – Slice a cucumber and lemon and place in pitcher of water and let chill for 2 hours.
• Seltzer water (8oz) with unsweetened fruit juice (1oz)
• Kombucha Tea
• Cranberry-infused Water (8oz water plus 2 oz unsweetened cranberry juice)
• Watermelon water – Blend 4 cups fresh watermelon, add to 6 cups water and add juice of 2 fresh limes.  Serve over ice.
• Herbal Teas like PDtM’s Nourish ARTea.

For more information on fertility-friendly fluids and our Nutrition Program, please contact Pulling Down the Moon or go to www.pullingdownthemoon.com and schedule an online appointment.

Summer is the season for cookouts, al fresco dining and steaks on the barbie.  Yet, all that charred animal flesh may not be the best for you favorite guy’s fertility.  Read more here.

Kimberly Wong, RD, LDN

Spring, in unbroken tradition, has long been a celebration of the fertility of the earth. Similarly, this glowing season marks a time of renewal and revitalization in one’s fertility journey. Thus, in new hope and anticipation, what better way to welcome the coming months than by improving your fertile body with the natural nutrients of Mother Nature.

While it seems like the path to parenthood may at time be paved with difficult words upon deeply scientific concepts, the movement for local foods, dubbed with the endearing, folksy name “locavorism,” is much less esoteric and was spawned in the mid-2000s in an effort to promote sustainability and eco-consciousness.

Fertility vocab 101: locavore, (\ˈlō-kə-ˌvȯr\, noun), one who eats foods grown locally whenever possible.

Repeat. Memorize. Embrace.

Here’s the 411 on why becoming a locavore can aid in optimizing your preconception nutrition status. In short, locally farmed foods a) provide more vitamins and minerals per serving than do their grocery store counterparts b) encourage increased consumption of fresh fruits and vegetables and c) frequently boast a pesticide-free label.

Local foods travel far fewer miles than your average megastore produce. While it seems convenient to run to the corner store and buy a pint of strawberries to meet our daily quota for our 9-A-Day, what we end up with in hand is quite the reverse of nutritious and fresh. In fact, a food is only considered local if it is grown within 100 miles of where it is sold. Conversely, the average carrot will travel 1,838 miles from farm to table.

While this particular carrot travels the rough equivalent of DC to Mexico City, greater than 50% and up to 90% of its vitamin C content will be lost within the first day of travel. Other essential nutrients fall prey to time-, temperature-, and light-sensitivity: the vital B vitamins, particularly folate, and vitamin E. These particular nutrients are all antioxidants that not only protect from an array of disease, but also help prevent harmful oxidative stress that has been linked to both male and female infertility.

Next, shopping for local foods is a calming, rewarding, and positive experience. Sifting through the wagons of crisp kale, chatting with its grower, and breathing fresh air may be considered so pleasurable that it increases the frequency of fresh fruits and vegetables, and grass-fed/cage-free proteins in one’s diet. Even without a drastic increase in servings per day, the mere substitution of local foods decrease the amount of commercialized foods in the diet. This, in turn, essentially cuts back the amount of processed foods, refined carbohydrates, saturated fats and preservatives in the diet. Just think—a mere trip to a local market can bring you one step closer to an anti-inflammatory, lower-glycemic, fertility-friendly diet!

Finally, local foods tend to offer pesticide-free and organic varieties. The upside to directly dealing with the foods’ producer ensures the elimination of any confusion. Pesticide-residues on fruits and vegetables and hormone/antibiotic-residues in meats and their by-products are of concern to fertility because of the accumulation of such toxins has been linked to reproductive damage.  

The Environmental Working Group has developed the infamous “Dirty Dozen,” which notes the foods that are likely to be highest in pesticide residuals. Do try to buy these foods organic and locally when possible. Conversely, they have released the “Cleanest Twelve” which indicates the produce lowest in pesticides.

Words of caution: the label “organic” does not mean that the produce was grown locally. While it may lack harmful toxic chemicals, it may have travelled several days to arrive to your location and thus also lacking in vital nutrients.

Although the warm summer-like weather donned upon us this year with as much surprise as our back-to-back blizzards, take this opportunity to explore new grounds in your fertility journey and tune into your inner locavore and enjoy the one predictable mainstay this spring: the flood of fertility-friendly, nutrient-rich produce into our fresh markets.

Check out http://www.rawdc.org/dc/fruitDC.html, an excellent online resource with more details and links to local farmers’ markets, CSAs, and organic retailers scattered across Northern Virginia, Washington, DC, and Maryland. For nationwide information, check out http://www.localharvest.org/.

Click here to schedule a fertility nutrition consultation with Kimberly Wong at Pulling Down the Moon in Rockville.  For more information about nutrition counseling visit our website at www.pullingdownthemoon.com.

Pulling Down the Moon nutritionist Breea Johnson guest-posts on Beth and Tami’s Fertility Authority blog this week.  For more information about fertility nutrition and supplements, you can visit our e-tail fertility boutique.   Our supplement line is “PDtM Approved” and adheres to the standards Breea discusses here.  Of course, nutrition is a highly individualized subject, so we recommend a consult with a fertility nutrition specialist to make sure your program suits your needs and diagnosis.  Check out Breea’s must-read post here.

Perhaps the most common question we get at the Moon is “where should I start?”  Women and couples are interested in doing everything they can to increase their odds of conceiving.  But among all the services available – nutrition counseling, acupuncture, yoga for fertility and massage – where to begin?  For the answer to this question, stay tuned to our blog this week as we discuss the different treatments we offer at Pulling Down the Moon and who will best benefit from these treatments.

The most important thing to recognize, though, is that using holistic treatment for fertility requires your participation.  Unlike a medical regimen, where you simply follow the directions your doctor provides, holistic treatment asks you to become involved in identifying and correcting physical, mental and emotional imbalances in your life.  In a sense, these treatments require you to be part of the treatment team.  This is true even if you are also using medical fertility treatments in addition to holistics.

The other point to make about holistic therapy is that it can take some time to work.  Treatments like acupuncture have shown short-term benefit (as few as two acupuncture treatments have been shown to increase IVF success rates), but studies using a longer treatment time frame actually have much more impressive results.  Nutrition changes can also be effective immediately, especially in terms of improving gut function, but other more long-term effects (potential improvement in egg or sperm quality, reduced inflammation, ovulation induction in PCOS) can take several months to achieve.   We feel great for a few hours after yoga or a massage – but longer term practice of these modalities actually leads to a lasting calm in which our body and mind can begin to heal themselves. 

So what’s right for you?  Stay tuned to our blog this week for a deeper exploration of what holistic fertility techniqes are right for you.   Also, feel free to post your questions.  We’ve got experts standing by. 

Be present, be positive!  Paige

By Breea Johnson, MS RD LDN

Fish oil with Omega-3s (that supply DHA and EPA) are a class of supplements commonly recommended for women with infertility. While nutritionists stress the importance of quality when choosing supplements, many people buy fish oil from their local store for convenience or to save money. This past week a lawsuit was filed in California against fish oil manufacturers [CVS Pharmacy Inc.; General Nutrition Corp. (GNC); Now Health Group Inc.; Omega Protein Inc.; Pharmavite LLC (Nature Made brand); Rite Aid Corp.; Solgar Inc., and TwinLab Corp]. The lawsuit charges that these companies sold fish oil that contained “undisclosed and unnecessarily high levels of contamination with polycholorinated biphenyl (PCB) compounds.”

What are PCBs? PCBs are a class of chemicals that are now illegal. However, they were utilized for many different purposes in industrial manufacturing – such as in coolants, PVC piping, pesticides and paints among other things. They are now considered one of the POPs (Persistent Organic Pollutants), a group of the most toxic compounds that still exist in our food and bodies despite being outlawed years ago. According to the EPA, PCBs have been shown to cause cancer in animals, and negatively affect the immune system, reproductive system, nervous system, and endocrine system, amongst other ill health effects. Here is an excerpt from the EPA’s website about the effect of PCBs on reproduction in animals and humans:

“PCB exposures were found to reduce the birth weight, conception rates and live birth rates of monkeys and other species and PCB exposure reduced sperm counts in rats. Effects in monkeys were long-lasting and were observed long after the dosing with PCBs occurred.

Studies of reproductive effects have also been carried out in human populations exposed to PCBs. Children born to women who worked with PCBs in factories showed decreased birth weight and a significant decrease in gestational age with increasing exposures to PCBs. Studies in fishing populations believed to have high exposures to PCBs also suggest similar decreases. This same effect was seen in multiple species of animals exposed to PCBs, and suggests that reproductive effects may be important in humans following exposures to PCBs.”

According to the Environmental Working Group, one of the highest food sources of PCBs include farm-raised (or Atlantic Salmon), with 16 times the amount of PCBs as wild salmon. Thus, supplementing your diet with a fish oil that contains PCBs or eating farm-raised salmon to obtain omega-3s may do more harm than good. It’s important to know where your supplements (and food) are sourced from, and how the companies treat and process it to form a supplement. There are many companies that sell high-quality fish oil. Read more about the quality of our fish oil here. Please consult with a Pulling Down the Moon nutritionist if you have more questions concerning this matter.

For more information:

www.fishoilsafety.com

www.ewg.org

If you build it, they will come. Co-Founders Beth Heller and Tami Quinn share their story on why they decided to create Pulling Down the Moon.

Here’s a good new/bad news situation.  The bad news is that more women are likely to receive a diagnosis of  Gestational Diabetes Mellitus (GDM) in the coming months.   The good news is that if you’re in the trying to conceive process and eating a fertility-friendly diet like the one we use at Pulling Down the Moon you are well on your way to preventing this condition which can be dangerous to mother and baby. 

Previously, a diagnosis of GDM was based on blood sugar measurements that identified women at higher risk for developing diabetes later in life.  The new standards take into consideration risks to the mother and baby, including overweight babies, early delivery, c-section delivery and pre-eclampsia (a life threatening rise in blood pressure that endagers health of mom and baby).  When these outcomes were added to the equation, experts found they needed to make the diagnostic criteria more stringent.  With the new guidelines, it’s estimated 16% of pregnant women will be found to have GDM instead of the 4-6% who currently get diagnosed.

Just in case you needed a bit more motivation to either get started or keep going with your fertility-friendly diet, do it for diabetes prevention and the health of your future child!

Guest Blogger:  Kimberly Wong, RD, LDN

Stress. There’s work stress, family stress, fertility stress…but now oxidative stress? Oxidative stress is natural body process that is essential to physiological function. As we breathe, our cells produce energy, and our body uses oxygen in the process. As a result of these normal metabolic actions, Reactive Oxygen Species (also called free radicals) are produced. In layman’s terms, we can understand ROS’s as highly-reactive molecules that have lost an electron during a chemical reaction and roam around “stealing” electrons from other molecules. While this doesn’t sound particularly scary, this chain reaction actually causes a tremendous amount of trouble on a chemical level. Enter antioxidants.

Antioxidants are chemical compounds that happily give electrons to free radicals in order to keep chemical peace. Antioxidants are present inside the body and also come from food. Antioxidant vitamins include Vitamin E, A and C, alpha-lipoic acid (ALA) and other compounds found in fruits and vegetables. As long as our body’s antioxidant capacity is adequate to manage ROS production, all is well. But when the balance tips, and ROS production outstrips our antioxidant ability, free radicals begin to wreak havoc on DNA, cell membranes and tissues. This condition is called Oxidative Stress (OS). Oxidative Stress can cause damage to our cell membranes, alter protein and DNA and cause cell death. OS is implicated in chronic diseases like cancer and heart disease…and now fertility.

So, what about oxidative damage does a girlfriend need to know? In general, our body knows what to do with free radicals. The body has abundant antioxidant systems that involve antioxidant substances like vitamins C and E, and their cofactors, selenium, zinc, and copper, which swoop through the body and dispose, scavenge, and/or suppress the formation of ROS. Yet it’s a delicate balance that our modern lifestyle with its pollution, over-processed/nutrient-bare foods and stressful pace is likely to upset.

“Oxidative Stress is increasingly recognized as a very important participant in many health disorders, including male and female infertility,” says Dr. Robert Stillman of Shady Grove Fertility.  “Our understanding of oxidative stress and of Reactive Oxygen Species – and their reduction – can improve the overall quality of health of our patients – and their fertility”

In terms of fertility, when the bad stuff (ROS) begins to outpace the good stuff (our antioxidant defenses), our fertility may begin to suffer. Because sperm are basically “DNA torpedoes” with one simple mission (swim fast and fertilize egg), they don’t have extensive antioxidant defense systems and are vulnerable to ROS. In addition, they have a high polyunsaturated fat content, which makes them susceptible to lipid peroxidation (read: damage) in the cell membrane. Various environmental and life-style behaviors can tip the balance of OS for sperm, including STDs, automobile pollution, smoking and potentially diet. OS in sperm has been associated with deceased sperm motility, sperm number, and sperm-oocyte fusion (Desai 2009)

In women, the female ovary is the source of both oocytes (eggs) and the hormones that regulate reproduction. As such, the environment around the ovaries is of particular importance to optimal fertility. The ovaries are also “power houses,” and contain more mitochondria (cellular power plants) than any other cells, including muscles (Bentov 2010).  For this reason, oocytes use lots of energy and oxygen, especially as they are maturing in preparation for ovulation, r oxidative stress. Oxidative stress has been implicated in every stretch of the conception-to-birth cycle imaginable, including endometriosis and miscarriage, yet no direct research has been conducted on the effect of OS on female fertility.  However, studies have shown that women with unexplained infertility show increased free radicals in the peritoneal fluid (the fluid around the egg) and, conversely, lower levels of peritoneal free radicals are associated with successful IVF procedures (Ruder 2008).

The good news is that there are simple strategies for coping with oxidative stress. Here’s the “need to know:”

• Quit smoking and avoid exposure to second-hand smoke. 
• Limit alcohol consumption to < 3 servings per week. Choose red wine for its antioxidant benefits.
• Oxidative stress may also be higher where inflammation is present, so ensuring good digestion and gut health may reduce circulating levels of ROS. If you’re experiencing diarrhea, bloating, constipation, cramping or other digestive symptoms, it may be worthwhile to meet with a nutrition specialist to determine if food sensitivity or other digestive disorder is present.
• Where possible, use organic cleaning products.
• Increase your dietary antioxidant consumption. A diet that is wholesome and rich in fruits, vegetables, tea, and healthy fats will improve our body’s defenses against oxidative stress. Be aware that many sources of healthy fats in the diet (fatty fish, flax seed) should be consumed intelligently to avoid excess intake of environmental toxins (fish) and phytoestrogens (flax).
• Consider an antioxidant supplement or insure your prenatal vitamins have adequate anti-oxidant levels. 
• Avoid high intensity/high impact exercise. The huge aerobic and mechanical demands of strenuous exercise can actually increase oxidative damage to cells in the body. On the flip side, moderate intensity/low impact exercise increases our body’s defenses against oxidative stress.
• Learn to relax, practice yoga or meditate. Life stresses may elevate levels of ROS in the body.

Now, with a firm basis in OS and its effect on fertility, a gal is ready to face the fertility journey. Always at your availability is the advice of a Pulling Down the Moon nutrition specialist who can help you optimize your dietary intake. Our ART Recovery/Prep Nutrition program is specifically designed to reduce inflammation and oxidative stress as well as provide optimal nutrition for fertility.

Most doctors agree that the most effective first-line treatment for Polycystic Ovarian Syndrome is diet and exercise.  Eating a low-glycemic diet that helps regulate blood sugar levels and exercising regularly to improve glucose metabolism can help re-start ovulation in many PCOS patients.  However, at the Moon we think this “prescription” is missing something – and that something is stress reduction.

Interestingly, both overweight and normal weight patients with PCOS show altered cortisol metabolism, with PCOS patients showing an increase in circulating stress hormones likes cortisol.   Higher levels of cortisol are not optimal for either overall health or for fertility.  Cortisol can disrupt our menstrual cycle, increase appetite (particularly for sugary foods), promote weight gain, especially around our middle where it is more harmful to our health and impair our immune function.  While experts cannot yet agree why cortisol is higher in PCOS patients, they should agree that taking steps to lower cortisol is likely to improve overall health of women with PCOS as well as their fertility.

Techniques that have been shown to lower stress include:

Acupuncture:  Recent studies have found that the increased muscle sympathetic nerve activity (a sign of increased stress hormone activity) in PCOS patients can be significantly lowered with acupuncture treatment.

Exercise:  We all recognize the stress reduction component of fertility-friendly workouts.  Exercising regularly controls stress and makes us feel better about ourselves.

Yoga/Relaxation Training:  Yoga has been shown to be as effective as cognitive-behavioural therapy at improving psychological and physiological measures of stress. 

Bottom line:  if you have PCOS, by all means continue with your healthy eating and exercise program but consider adding acupuncture to your regimen and taking at least 15 minutes a day to practice yoga stretches and breathing.