At Pulling Down the Moon we will often recommend a “cleanse” diet following a miscarriage or failed ART cycle.  While a cleanse can, at times, entail the elimination of one or more common food allergens like dairy, wheat and soy, elimination is not the basis of our program.  More often than not our cleanse consists of limiting processed sugar and other processed foods, artificial additives and colors while focusing on foods that support our body’s anti-inflammatory and detoxification processes.  The cleanse program at Pulling Down the Moon is individualized and takes into consideration a woman (or man’s) past and present digestive function, hormonal and other symptoms, medical history and current lifestyle.

One key element of our program is supporting hormone balance.  After a failed ART cycle or a miscarriage, a woman’s body must re-establish hormonal balance and function.  It may have been months since her last natural menstrual cycle. Weight gain during treatment may also impact hormone balance.  Yet another common symptom reported by our patients post-ART is anxiety and a lasting case of “the blues.”   It’s very easy to attribute these emotional side-effects to disappointment but there may also be a physical component.   The hormone medications used during the stimulation phase of an ART cycle, and the progesterone supplementation post-IUI and ET, can cause emotional side effects and these hormones can be slow to leave the body.  The liver is charged with processing these steroids before they can be excreted.  To do this it requires ample amounts of amino acids (in particular sulphur-containing amino acids), as well as the vitamins and minerals that work as co-factors in detoxification pathways.

Our ART Recovery/Prep Program focuses on limiting sources of external hormones by discouraging foods that contain hormones and hormone-like substances.  Chief offenders in this area include factory-farmed dairy and meat products which contain the hormones and growth factors used in production.  There are also hormone-like chemicals in pesticides and plastics.  By limiting these external sources of hormone-like substances and increasing the intake of foods that support good hormone function (fiber, lignans and lignins, a range of whole grains – not just wheat! – , healthy fats, cruciferous vegetables, antioxidant rich fruits and veg and added-hormone-free protein) we have the potential to bolster our body’s ability to metabolize and excrete excess hormones and restore balance in the reproductive cycle.

Our Rockville nutritionists Laura Dubrule, R.D. recently  shared a case with me that drove this message home.

My patient is 43 and had experienced two failed IVF cycles in quick succession (6 months time).  Her physician had noted several potential factors contributing to failure including egg quality and endometrial lining quality.  In addition, the patient had recently been diagnosed with PCOS.  Since her last IVF the patient was unable to lose the 8 pounds gained during IVF treatment despite eating a healthy diet and working out four times per week.

We discussed the impact of IVF medications on hormone levels as well as the impact of various dietary choices on her body’s ability to break down and clear excess hormones. We focused especially on tweaking her already health-supporting diet to include significant amounts of cruciferous vegetables and berries every day as well as a daily serving  of legumes.  I suggested she add two supplements, RePro Cleanse and FlowPro, to her regimen as well as vitamin D.

I was very surprised when the patient returned for follow-up having lost 8 lbs over the preceding two weeks.  At Pulling Down the Moon we are extremely careful not to encourage rapid weight loss but upon review of my patient’s diet it was clear that a reduction in calories was not a major factor in her weight loss. The patient reported feeling that the weight came off her abdominal area, that she had lost a bloated feeling, and that her clothes fit the way they used to.

The patient also told me about the resolution of another symptom she hadn’t mentioned in our initial consult. She had been experiencing high levels of anxiety while driving, especially on the highway.  This was not her experience historically, but had been a recent development.  Over the course of the two-week cleanse, this driving anxiety completely disappeared.

While we can’t be certain, we suspect that this rapid loss of water weight and alleviation of anxiety may have been due to an increased clearance of excess steroid hormones that had been circulating in her system.   Whatever the reason, the result was excellent.  While there is still work ahead, my patient is very pleased with the results of her cleanse and feels more like herself than she has in months.  We both agreed that anything we could do to reduce the lingering effects of ART would only help her feel more prepared for her next round of treatment.

We believe that a nutritional consultation can make a big difference in the fertility journey.   Our consultations are available in person in Chicago and the DC Metro area and by phone from almost anywhere else.  Call 312-321-0004 (Chicago) or 301-610-7755 (Rockville) for information.

RePro Cleanse includes kudzu, flax, rice protein and other micronutrients that support the liver’s detoxification processes. Because it contains plant estrogens and is designed to help balance and promote clearance of excess reproductive hormones, we do not use RePro Cleanse when a woman is on fertility medications or birth control.  We often recommend supplementation with Re Pro Cleanse when women are recovering from a failed cycle or miscarriage, or in cases of hormone-related conditions like fibroids or endometriosis.  We will also use RePro Cleanse when a woman’s IVF cycle is cancelled/postponed due to high baseline estrogen levels.   Used as directed over a period of 2-4 weeks we feel that this supplement can help jump start a woman’s recovery process in preparation for a subsequent cycle, be it ART or natural.  Of course we recommend that our patients clear any/all supplements with their physicians.

About Laura Dubrule

Laura brings an eclectic mix of passions to her nutrition counseling. Her years studying acting in New York taught her the importance of connecting with our bodies; this deep sense is fundamental to her understanding of diet and nutrition. Laura completed the program in Nutrition and Food Science at Hunter College in New York, and then went on to complete her dietetic internship at Stony Brook University, a program with an integrative and functional approach. She returned to the city and practiced in a worksite wellness program, delivering individualized nutrition counseling to bank employees in Manhattan and Brooklyn. Her vision for her clients could be called “whole foods meet real world.” She believes that food is meant to be enjoyed and works with her clients to find healthful approaches to eating that are satisfying and enjoyable.

Laura is thrilled to be working in concert with acupuncture, yoga and massage professionals because she believes that the nourishment and care of our hearts and souls is integral to the nourishment of our bodies. She considers it a privilege to be a resource to men and women on their fertility journeys and to celebrate every step long that path as an act of love and creation.

To fully comprehend the latest research on omega-3 fatty acids and embryo quality it’s important to understand that the goal of medicated fertility cycles is not simply to make a lot of eggs.   In fact mild ovarian stimulation that results in fewer follicles seems to provide the best results.  This approach allows only the healthiest follicles and oocytes to develop.  Since developing follicles produce estrogen, fewer developing follicles also mean lower estrogen levels during the cycle.  This is also potentially beneficial as higher estrogen levels may negatively impact uterine receptivity and deter embryo implantation.

New research suggests that a higher intake of omega-3 fatty acids ALA, DHA and EPA may support this objective (1).  In 225 women undergoing IVF diet data was collected using a food frequency questionnaire.   Intake of  the omega-3 fatty acids ALA,EPA and DHA were calculated, as well as omega-6 (LA) intake and the ratio of omega-6 to omega-3 fats in the diet.

In this study, the women with the highest dietary intake of omega-3’s had lower estrogen response, developed fewer follicles and had better quality embryos, even after controlling for confounders like age and BMI.  A higher omega-6 to omega-3 ratio was associated with higher numbers of follicles.  If the goal of fertility treatment is to help women produce fewer, higher-quality eggs, this research suggests that women undergoing ART  should strive to increase consumption of omega-3 fatty acids and decrease the amount of omega-6 they consume.

As a result of these findings, the research team recommends that twice-weekly fish intake should be encouraged in women during fertility treatment.  While generally useful, this recommendation does not take into consideration the risk of toxicity from fish consumption – especially in the perinatal period.  In fact,  the fish richest in omega-3 fatty acids are the ones most likely to contain mercury and other contaminants.  For this reason, our recommendation at Pulling Down the Moon is that women work to lower their intake of omega-6 fats (found in snack and fast foods, factory/grain-fed red meat and processed oils), increase  their intake of leafy greens, nuts and seeds and supplement their diet with a high quality, purity tested fish oil supplement.

Supplements are only a small part of fertility nutrition, however.  For more information about fish oil, diet and egg/embryo quality, schedule a consultation with one of our nutrition specialists. Learn more about omega-3 fatty acids here.

1.  Hammiche et al. Fertility and Sterility. Vol. 95, No. 5, April 2011 1820-23

At the Moon we are constantly striving to increase our E.Q.I.Q. (Egg Quality I.Q.) and for years we have believed that nutrition can play a role in eqq quality.  However, until recently there were few studies to support this claim so we needed to temper our recommendations with the phrase “but there isn’t any clinical evidence for this yet.”   Now, several new investigations have shown that, yes, certain nutritional supplements may make a difference in egg quality.  The goal of this blog is to summarize the latest clinical news,  discuss the substances that are now showing potential benefits for women with poor egg quality and help you make choices about which supplements may be right for you.  As with any supplement protocol, you should always consult your physician before starting.

1.  Myo-inositol (MI)

Very recently two clinical trials were published that clarified a lot of the unknowns about myo-inositol, a product we use at PDtM under the name of FlowPro.   Myo-inositol (MI) is a part of the B vitamin complex and is a known insulin-sensitizer.  It has also been shown to improve both physical (hirsutism and acne) and reproductive (anovulation and amenorrhea) manifestations of Polycystic Ovarian Syndrome (PCOS).  In addition, myo-inositol plays a role in cell growth and early studies indicated that higher levels of MI in the follicular fluid was associated with better egg quality.

Several exciting new studies have emerged that have shed new light on MI and its role in fertility, particularly Assisted Reproductive Technology.  The latest study of interest demonstrated that treatment with 4 g per day of MI for three months prior to IVF improved egg quality in women who had failed a previous IVF due to poor egg quality. In this study the treatment also included 3g per day of melatonin, which I will talk about next.

But first, a note about inositol.  For some time there has been a debate as to the efficacy of d-chiro vs. myo-inositol for fertility.  We have chosen to use MI in our products because a) this is the form that has been used in all the clinical research we have seen to date on PCOS, egg and embryo quality and b) it is less expensive than the d- form.  Now, a new study confirms that myo-inositol seems to be more effective than d-chiro for egg and embryo-quality. On another happy note, MI  has also been shown to have a positive therapeutic effect on mood disorders that are responsive to SSRI’s (serotonin selective reuptake inhibitors) including depression, panic and OCD – a potential plus for the anxious, depressed fertility patient!

2.  Melatonin

Melatonin is a hormone that is secreted by the pineal gland.  It regulates our sleep/wake cycle as well as other hormones, in particular the hormones of the female reproductive cycle.  New studies like the one above suggest that melatonin supplementation at a level of 3 mg per day may help to improve egg quality when taken with MI for several months prior to IVF.

There are caveats to the use of melatonin.  Side-effects may include exacerbation of depression symptoms and patients who struggle with depression should make sure to  discuss this side-effect with their physician.  Melatonin should not be used with patients using thyroid medication as it can impact thyroid hormone levels.  It can also suppress ovulation at high doses so in general we only recommend this supplement for women who will be using ART and a trigger shot to stimulate ovulation and/or retrieval.

Finally, melatonin should NOT be taken while pregnant or nursing.  In general we do not recommend melatonin use for longer than 3 months without taking a break.  It can also cause marked drowsiness and is best taken just before bedtime.

3.  DHEA

DHEA (not to be confused with the omega-3 fatty acid DHA) is a hormone that serves as a precursor of steroid hormones testosterone and estrogen.  Research indicates it may also stimulate follicular development.  Several studies have shown supplementation with 75 mg of DHEA daily to improve egg quality and pregnancy outcome in women who were “poor responders” to IVF stimulation medication. Another study suggests that DHEA supplementation may reduce the risk of aneupoloidy.

DHEA should be used with caution as it is a pretty powerful hormone and when used at high levels and over a long term it may damage the liver.  Women who are pregnant or nursing should not take DHEA, nor should women with PCOS as this could exacerbate the condition.  Like melatonin, we recommend a three month treatment period.

4.  CoQ10

CoQ10 is a naturally occurring fat-soluble nutrient that is essential for energy production. CoQ10 has potent antioxidant properties and cell membrane stabilizing effects that make it beneficial for egg and sperm quality, specifically sperm motility. CoQ10 works within the mitochondria (the cellular power stations) in the cells and is essential for energy production. Until recently, CoQ10 was not thought to be a nutrient that required supplementation, as all normal tissue manufactures its own CoQ10; however, this production decreases naturally with age and is also lowered by certain drugs, including statins. When CoQ10 levels in the cells are low, energy production may be reduced and oxidative stress increased as a result.

CoQ10 has been shown to improve sperm quality and is now under investigation for potential use with women of advanced reproductive age undergoing ART to improve egg/embryo quality. The oocyte has among the highest concentrations of mitochondria of all body cells and uses immense amounts of energy in the process of maturation and ovulation. Researchers hypothesize that supporting the oocyte with CoQ10 may improve egg quality (Bentov et al. 2010).

The recommended dosage for overall health is 100-300 mg/day, or as directed by a nutritionist. The dosage under investigation in studies looking at egg quality is higher: 600 mg/day. CoQ10 appears to be a safe supplement: Studies have used supplementation of CoQ10 up to levels of 3,000 mg per day without adverse side effects. At present, the only risk to taking CoQ is the cost, as this supplement can be pricy, and no data currently exists on its usage in high doses during pregnancy.

5.  Omega-3 Fatty Acid (EPA/DHA)

There is still no direct clinical evidence that omega-3 fatty acids improve egg quality but we are convinced they are a good bet and include them in our Egg Quality Protocol.  Eicosapentaenoic acid (EPA) forms the backbone of many of the chemicals that halt inflammation in our body and also serves to support the health of our cell membranes.  Docosahexaenoic acid (DHA) (not to be confused with DHEA above) is important for brain health and adequate stores of DHA are thought to be beneficial for the early cognitive development of the fetus.  DHA may also be helpful for depression.   Look for purity-tested products.

This is exciting news indeed but you should always speak with your physician  before beginning a supplementation regimen of any kind. Of course, we would also be remiss if we didn’t mention that providing your body with the highest quality diet is also important for fertility.  If you are specifically seeking to improve your egg quality you should also consider re-thinking your diet to limit inflammation, achieve good blood sugar control and get ample antioxidant nutrients from food sources. Our nutritionists at Pulling Down the Moon are specialists and will tailor their recommendations to your fertility diagnosis.

For more information about any of the supplements or info in this blog, please feel free to contact me at beth@pullingdownthemoon.com.  These supplements and other fertility-related products are available at our online store.

Cauliflower is a fantastic fertility food.  Walnuts, lean protein and berries are terrific too.  But if you do not consume, digest and assimilate these foods effectively they cannot help your fertility.   This process of consumption, digestion and assimilation  (and we’ll also add elimination) is what nutritionists call gut function.  Good gut health is important for many health conditions, including fertility. Let’s take a closer look at these variables:

Consumption: Both Traditional Chinese Medicine and Ayurveda place a great deal of emphasis on how we consume our food.  On the surface this means mindful eating, not eating in the car or standing in front of the microwave.  In addition, choosing food that is locally grown and in season is recommended by these traditional systems.  The taste buds, too, are an important part of the gut.  To be fully satisfying, traditional medicine systems teach a meal should contain six vital tastes:  sweet, sour, salty, pungent, bitter and astringent.  In fact, “western” scientists are now learning that certain tastes convey specific health benefits.  For instance flavonoids, the powerful antioxidants found in red wine, green tea and citrus that are believed to convey important health benefits, are bitter in flavor.   Interestingly, our taste for bitter foods increases with age – as our body’s innate antioxidant systems are losing their efficacy.  Nutrition researchers even hypothesize that a preference for bitter taste in aging animals may be evidence of an evolutionary advantage.  Sadly, our Western diet emphasizes primarily the salty and sweet tastes – leaving the pungent chilis and bitter melons and fruit to other cultures.   Bottom line:  we should consume food mindfully – from eating in a calm environment to paying attention to the range of flavors in the food we eat.

Digestion: In yoga’s sister medical science Ayurveda, we are taught to stoke “agni”  (digestive fire) prior to meals.  This can be done with yoga, exercise and in cases where the digestive fire is weak, an herbal aperitif. The digestive fire is so important that Ayurvedic lore says “if agni is strong we can convert poison into nectar; if agni is weak, we convert nectar into poison.”  Eating too much can also dampen agni, just like throwing a big log on a fire.  Eating too many cold foods can also dampen agni.  Use the Appetite Scale at the end of this blog to help you use agni to your advantage.  For optimal digestive power, eat when you are at a level of 2-3 and stop eating when you are at 7.

Assimilation:  The old adage is true.   The best way to get optimal amounts of vital nutrients is to eat a balanced diet filled with minimally processed fresh foods.  This is because the macronutrients (fat, protein and carbohydrates) as well as the micronutrients (vitamins, minerals and other beneficial chemicals) in food work best in combination with each other. Food sensitivities, health conditions and even chronic stress can impact how we assimilate nutrients.   For instance, when we are very nervous we may find that food just “sits” in our stomach like a rock.  This is because the flight or flight stress response has down-regulated the digest/nest body functions and is shunting blood to the skeletal muscles rather than the stomach.

Elimination:  When food rushes through the digestive tract (diarrhea) or stagnates there (constipation) we experience discomfort.  Poor digestion may also put us at risk for disease.  Diarrhea may speed food through the gut too quickly for vital nutrients to be absorbed.  It can also wreak havoc on the beneficial bacteria in our gut.  Constipation, on the other hand, allows for potentially toxic substances (including hormones and carcinogens) to be “re-digested” from fecal matter and returned to the body.  Imbalances in the intestinal and vaginal flora can also make women vulnerable to conditions like bacterial vaginosis that are associated with infertility and early pregnancy loss.  We can support gut bacteria by eating sources of soluble fiber (oats, lentils and beans) that support “good” bacteria and limiting the consumption of refined sugar and saturated fat, that nourish “bad” bacteria.

So, this week as you fill your refrigerator and your plate with fertility-friendly foods, notice  how you are consuming your food and  pay attention to your gut function.  Eat when you are hungry, stop when you are full.  Enjoy a full range of flavors at every meal – searching beyond your habits for pungent, sour and bitter flavors.  Finally, pay attention to how your body is eliminating waste and strive for the Goldilocks’ approach of “not too fast, not too slow.”   These actions can be truly transformative.

Working with an integrative nutrition specialist trained in fertility can be very helpful for resolving issues related to menstrual and reproductive function.  Call 312-321-0004 to learn more about Pulling Down the Moon’s nutrition specialists.

Agni Gauge:

0 Starving

1 Hunger Pains

2 Very Hungry

3 Hungry

4 Could Eat

5 Neutral

6 Could Stop

7 Full

8 Uncomfortable

9 Over-Filled

10 Stuffed

You may have noticed signs at your local Whole Foods Market promoting the ANDI score of different foods.  ANDI, in case you missed it, stands the for Average Nutrient Density Index, a rating scale that compares the amount of nutrients per calorie in particular foods.  The ANDI is the creation of Eat Right for America founder Dr. Joel Fuhrman M.D.

The ANDI score rates foods on the inclusion of many different nutrients including:

Calcium, Carotenoids: Beta Carotene, Alpha Carotene, Lutein & Zeaxanthin, Lycopene, Fiber, Folate, Glucosinolates, Iron, Magnesium, Niacin, Selenium, Vitamin B1 (Thiamin) Vitamin B2 (Riboflavin), Vitamin B6, Vitamin B12, Vitamin C, Vitamin E and Zinc.  It also factors in the ORAC score X2 (Oxygen Radical Absorbance Capacity) which is a method of measuring the antioxidant or radical scavenging capacity of food.

The upshot of this is that a food like kale has a score of 1000 on the ANDI and a food like cola has a score of 0.6.  In other words, kale provides far more nutrients per calorie than soda.  At first blush, the ANDI seems like it could be the Rosetta Stone of nutrition.  It makes quantitatively clear what most of us already intuitively know – and might tip the balance in our decision between, say, and orange (ANDI = 109) and a banana (ANDI = 30).

But there are places where this scale gets murky.

• Take foods that contain healthy fats, for instance.  Olive oil scores a 9 on the ANDI, walnuts score a 14 and avocado, one of the most perfect fertility foods, scores a measly 30.  In fact, if we stuck to high ANDI foods we would most definitely consume a diet that is too low in healthy fats like the monounsaturated fats in olive oil and avocado and the omega-3 polyunsaturated fats in walnuts and fatty fish like salmon.
• Low fat dairy products, which have been shown to be associated with ovulatory infertility and may contain high amounts of hormone-like substances like IGF-1 that are suspected to be related to reproductive cancers, have a higher ANDI than the full-fat dairy that at least one study has shown to be protective for fertility.
• Beans and lentils also score relatively low on the ANDI (~100) despite the fact that they provide protein and special forms of fiber that promote friendly GI bacteria and support our body’s ability to eliminate waste.

So what’s the bottom line on the ANDI and fertility?   In our opinion, the best way to use the ANDI is to fine-tune your choices within individual food groups.  For instance, oats and barley top the ANDI for whole grains while white rice and white flour don’t even make the top 10.  The ANDI might make our trips through the produce department easier too, helping us to choose romaine (389) over iceberg (110) for salad.  In terms of overall diet, however, this scale is only one piece of knowledge in a bigger picture of fertility friendly eating that includes lean sources of protein (like organically raised meats, beans and lentils) and healthy fats.

Can I Drink Caffeine When I’m TTC?

Getting off caffeine can be a challenge but we recommend that women lose their dependence on this stimulant when they’re trying to conceive.  While sources are all over the board – some suggesting that a moderate caffeine intake of 400-700 mg per day, about the amount in three cups of coffee – appears not to affect a woman’s fertility, other studies have found that women who consume more than 300 mg of caffeine per day had a 27% lower chance of conceiving each month they “tried.”   One study even found that drinking tea nearly doubled monthly odds of conception!

Clearly the data is all over the board.  However, Pulling Down the Moon’s view of caffeine is that it is not a good choice when you’re trying to conceive.  Artificial stimulants create imbalances in our bodies’ systems.  Drinking caffeinated beverages can also make it harder for us to relax and may exacerbate poor sleeping habits as well as camouflage the effects of sleep deprivation – all conditions that are potentially detrimental to fertility. Furthermore, you’ll have to give it up anyway once you’re pregnant, where repeated studies have linked caffeine consumption of  > 300 mg/day with low birth weight, miscarriage and birth defects like cleft palate.  If you decide to drink caffeine, limit your intake to < 300 mg  (a Starbuck’s Grande coffee has 320 mg).

And while the goose is giving up her daily cup, the gander better not laugh too hard.  Research indicates that men who consume more than three cups of coffee per day had increased DNA damage in their sperm.

There are many different strategies for getting off of caffeine, but one that we like is to first make the transition from coffee to green tea, which is filled with antioxidants and has lower caffeine content than coffee.  Then, gradually, begin to alternate your cups of green tea with herbal teas, until the switch to herbal tea is complete.

What the Literature Says

Research Finding:  Caffeine not associated with ovarian age indicators (FSH, follicle count, estradiol, inhibin B)

Hum Reprod. 2007 Apr;22(4):1175-85. Epub 2007 Jan 29.

Research Finding:  Caffeine intake not associated with endometriosis.

Am J Epidemiol. 2004 Oct 15;160(8):784-96.

Research Finding:  High level of caffeine consumption (> 500 mg per day) associate with decreased fecundity (longer time to conception)

Am J Epidemiol. 1997 Feb 15;145(4):324-34.

Research Finding:  Moderate caffeine intake (400-700 mg/day)associated with improved fecundity, high (>700 mg/day) caffeine intake associated with lowered fecundity.

Prev Med. 1994 Mar;23(2):175-80

Research Finding:  Caffeine intake no effect, but drinking tea doubled monthly odds of conception.

Am J Public Health. 1998 Feb;88(2):270-4

Research Finding:  Women reporting caffeine consumption of > 300 mg per day had a 27% lower chance of conceiving each month.

Am J Epidemiol. 1993 Dec 15;138(12):1082-92.

Research Finding:  Sperm from men who consumed > 3 cups of coffee per day had 20% more DNA damage than men with low caffeine intake.

Hum Reprod. 2007 Jan;22(1):180-7. Epub 2006 Oct 19

Spring is coming and this time of year our minds turn inevitably to swimsuits, sleeveless sundresses and bare skin – when we’re not thinking about babies, that is.  Body conscious times like this can create additional stress for those of us who are trying to conceive.   Many of us have given up exercise during our fertility journey,  the fertility medications and emotional ups and downs that accompany treatment may have helped us gain a few pounds and our body image may be less-than-fabulous.  The good news is that a fit, toned body is not out of the question when we’re trying to conceive.  We just need to be smart about it.

At Pulling Down the Moon we use a sort of decision tree to help women find an exercise regimen that’s right for them:

1.  How close are you to your ideal bodyweight?

Body weight can play a major role in our fertility.   According to the American Society for Reproductive Medicine about 12% of infertility is related to weight – 6% of cases due to underweight, where a woman’s body is too lean for proper hormone function, and 6% due to overweight, where excesses of estrogen-producing adipose tissue (fat) disrupts hormonal balance.  For women who are close to their optimal weight, an exercise program should serve to reduce stress, develop/maintain strength and keep the heart healthy.  Women who need to lose weight should set goals to increase daily activity levels significantly through a program of low impact cardiovascular exercise, strength training and stress reduction activities such as yoga.   If you’re not sure about your ideal weight, a consultation with one of our nutritionists is a great place to start.

2.  What role has exercise played in your life up to this point?

Some women have a less-than-healthy relationship with physical exercise.  Some may hate it and struggle to fit it in to their day.  Chronic under-exercise can make it hard to maintain a healthy body weight or may contribute to sluggishness and depression.  On the flip side, there are those of us who train hard every day, use exercise to maintain an “ideal” body weight or feel anxious when exercise is limited.  Chronic over-exercise can raise levels of the stress hormone cortisol as well as negatively affect the function of the hypothalamic-pituitary-ovarian axis (the hormonal system that governs reproductive function).  Your relationship with exercise will dictate whether you need to slow down or speed up.

Once we know the answers to the questions above, we can begin to make recommendations.   In general, a fertility-friendly exercise program should include cardiovascular exercise that is low-impact and low to medium intensity, which means keeping our heart rate under 60% of max.  Exercise modalities like strength-training are  also fabulous when you’re trying to conceive.  Strength training increases lean muscle mass and helps us keep our bodies strong and shapely (although we need to be careful here – a body fat percentage of at least 22% is generally accepted as necessary for a regular menstrual cycle).  In addition to looking good, lean mass means increases metabolism and builds stronger bones.  Yoga is another must-try for those who are trying to conceive.  The yoga asanas increase strength, improve our flexibility and help to balance our hormones.  Yoga has been proven to reduce levels of the stress hormone cortisol and in yoga physiology its believed that specific yoga postures can be used to increase the flow of blood and life energy (prana) to reproductive organs.

So get out and exercise this spring, but exercise wisely.  For some of us, this will mean increasing our exercise levels, and for others it will mean slowing down – and some of us will find that what we’re doing is just right.  Remember, this is not the time to try and get ripped, drop your body fat percentage to “Hollywood” standards or train for a marathon.  A fertility-friendly exercise program will leave you feeling nourished and relaxed.

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.

Depression, as you likely know, is linked to higher rates of infertility in women.  And, with research showing that women struggling with infertility have anxiety and depression rates equal to women with cancer and HIV, it stands to reason that ANYTHING we can do to help support our emotional well-being is essential when we’re trying to conceive.  One simple step you can take to improve your emotional balance is to make better foods choices.

Research is beginning to support what any chocolate lover has known for years –  food has a profound effect on mood.  Let’s take a closer look at the intersection of food and brain chemistry to learn how our diet can help us manage our state of mind.

Foods, it seems, alter our mood through several different mechanisms:  neurotransmitters, endorphins and satiety.

Neurotransmitters (NTs) are chemicals that communicate information throughout the brain and body.    They affect physical variables like heart rate and blood pressure, as well as sleep, the ability to concentrate and overall mood.  Neurotransmitters can be either excitatory or inhibitory.  Excitatory neurotransmitters stimulate the brain while inhibitory neurotransmitters calm the brain.  In times of stress and agitation, inhibitory neurotransmitters can become depleted as they strive to “keep the peace.”

Three neurotransmitters have been extensively studied in relation to food:  dopamine, norepinephrine and serotonin.  Dopamine and norepinephrine are associated with alertness (excitatory) while serotonin is associated with a calming, anti-anxiety effect (inhibitory).

Inhibitory NTs: Adequate levels of the inhibitory NT serotonin are necessary for a stable mood and to counteract excitatory NTs in times of stress and stimulation.  When brain serotonin levels are stable, our mood is generally balanced.  When serotonin fluctuates, we can experience ups and downs in our emotional state.

Carbohydrates cause a short-term increase in serotonin levels, and a subsequent mood boost, which is one reason many people may crave a sugary or potato-chippy snack when they are feeling stressed out or sad.  The serotonin/carbohydrate relationship is a double-edged sword, however, as reaching for that sugary snack can prompt a sugar crash, and an emotional bummer, later.  Serotonin levels can also be depleted during withdrawal from long-term use of caffeine and stimulants which explains the temporary depression/blues that accompany getting “off the java.”

Excitatory NTs: Protein, on the other hand, may block serotonin production and promote the production of two neurotransmitters that increase our alertness and ability to concentrate.  Dopamine and norepinephrine increase with consumption of protein-rich foods.

Neurotransmitters can become depleted by stress, genetic predisposition, prescription and recreational drugs and even poor diet.  Healthy fats are important building blocks of neurotransmitters and studies have shown  links between low intakes of omega-3 fatty acids and depression.

Endorphins: Endorphins are feel-good chemicals secreted by our brain that block our pain sensors and stimulate a sense of euphoria.  Foods that has been shown to increase endorphins include sweet foods, foods rich in fat and, famously, chocolate.  Other healthier sources of endorphins include spicy foods, in particular foods featuring chili peppers.  Sex and vigorous exercise are also a great way to stimulate the production of these feel-good chemicals.

Satiety:  Finally, satiety – or how satisfied we are by our meal – can impact mood.  After a huge meal, blood is shunted away from the brain to the stomach and digestive organs to aid in digestion.  The result?   The sluggishness that occurs post-feast.  The more fat a a meal (think cheese burger and fried) the longer it takes food to leave the stomach and the longer you may feel drowsy or dopey.   On the flip side, meals that are high in processed carbs aren’t a great idea either.  These sugars leave the digestive system quickly and hit the blood stream like a freight train, followed by an inevitable crash and need for another sweet snack.

So, how can we use this information to help us feel better?  Here are some “Mood Management Munchie” tips for better brain chemistry through eating!

1.  Meals that have a balanced combination of protein, carbohydrate and healthy fat are the best choice for an even keel and balanced mood.

2.  Make sure your diet has ample sources of omega-3 fatty acids as these are chemical building blocks for NTs and other important regulatory hormones.  Sources of omega-3s include fatty fish, walnuts, flax seed, scallops, beans, winter and summer squash and romain lettuce.  Because  women who are trying to conceive are encouraged to limit their consumption of fatty fish, you may also want to consider an omega-3 supplement.

3.  For extra snap before an interview or big presentation eat a moderate sized meal (400-500 calories) that is rich in lean protein and complemented with whole grains or try a salad with avocado, walnuts and lean protein on top.

4. If you’re over-stimulated at bed time and need to calm down, try drinking 8 oz of whole milk sweetened with a small amount (1/2 teaspoon) of honey or agave nectar.  Milk is a good source of tryptophan, an amino acid building block of serotonin, and the small amount of sugar will stimulate the quick absorption of tryptophan into the blood and brain, thus sweeping you away to sleepy land.  Add a shake of cinnamon if you want to improve blood sugar regulation. If you are avoiding dairy, you can use almond milk to make this bedtime treat as almonds do have a healthy amount of tryptophan.

5.  For an endorphin boost, try spicy salsa as a condiment or nibble a piece of 70% cocoa chocolate for dessert.  Then go have sex – tee hee!

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.