by Beth Heller, M.S., R.Y.T.

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

By Beth Heller, M.S.

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 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.

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!

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.

By Breea Johnson, MS RD

DHEA and DHA are two supplements that are often confused by people trying to conceive. While their abbreviations may look similar they are in fact very different – one is a fatty acid while the other is a hormone and one should be taken during pregnancy while the other should be avoided during pregnancy.

DHA stands for Docosahexaenoic acid, which is an omega-3 fatty acid and found in conjunction with EPA (Eicosapentaenoic acid). DHA is beneficial for neurological health and is added to prenatal vitamins for the central nervous system and optical development of a fetus. While it’s not always included in prenatal supplements, it is highly recommended that both pregnant and breastfeeding women take a DHA supplement. Consider this research:

• A 2004 study published in Child Development found that babies whose mothers had high blood levels of DHA at delivery had advanced attention spans into their second year of life. During the first six months of life these infants were two months ahead of babies whose mothers had lower DHA levels.
• A 2003 study published in the journal Pediatrics showed children whose mothers took a DHA supplement during pregnancy scored higher on intelligence tests at four years of age than children of mothers not taking DHA supplements.
• In a 2011 review article, researchers concluded that decreased brain DHA represented an important potential risk factor for depression generally, and postpartum depression in particular as research has found low levels of DHA in mother’s milk and in the red blood cells of women with postpartum depression (Journal of Affective Disorders, 2002).
• In a trial of women receiving DHA supplementation during the third trimester, the average length of gestation increased six days (Obstetrics & Gynecology, 2003).

DHA is beneficial not only for the health of a growing baby but also for the health of a mother, and thus it’s a critical supplement to take while pregnant and breastfeeding. But, while DHA is an important omega-3 fatty acid, EPA is left out of almost all prenatal supplements. EPA is the anti-inflammatory omega-3 fatty acid and is most beneficial when trying to conceive. Research has shown many studies that men and women with higher levels of blood omega-3 fatty acids have increased fertility rates compared to people with lower levels of blood omega-3 fatty acids.

So, now switching to DHEA, which stands for Dehydroepiandrosterone. Unlike DHA, which is a fatty acid, DHEA is a hormone, one of the most abundant circulating hormones in the human body. DHEA has recently garnered a lot of attention in the world of fertility for helping women with Decreased Ovarian Reserve (DOR) and Premature Ovarian Failure (POF) as it is a precursor to hormones such as testosterone and estrogens and may help increase follicular stimulation. It is also known to sharply decline with age. DHEA has been shown in some small studies to improve IVF outcomes in women that are poor responders to IVF. Some research also points to DHEA as possibly reducing aneuploidy chromosomal abnormalities) in embryos and thereby decreasing miscarriage rates.

A few things should be noted about utilizing DHEA when trying to conceive. First, it should not be taken in high doses for long term as it may cause undesirable fluctuations in hormone levels and may also cause liver damage. Also, before beginning DHEA it is advisable to get DHEA-S levels tested to make sure they are within range before supplementation. It is also highly encouraged to notify your Reproductive Endocrinologist before beginning a DHEA supplement. Unlike DHA, DHEA is not to be used if pregnant and should be discontinued as soon as a positive pregnancy test is achieved. DHEA should also not be used if you have PCOS, as this hormone may make this condition worsen.

DHA and DHEA are very different supplements – while both have important roles in trying to conceive it’s vital to know the difference between the two. If you have additional questions, please ask your reproductive endocrinologist or one of our nutritionists at Pulling Down the Moon. To book a nutrition appointment, please call (312) 321-0004 or visit www.pullingdownthemoon.com to book online.

By Beth Heller M.S.

New research is pointing to some unexpected “soldiers” in the battle for good blood sugar and hormone health.

Experimental evidence has shown that diets enhanced with probiotics (beneficial gut bacteria) have a beneficial effect on glucose metabolism in mice.  Recently, randomized controlled research in women has also found that probiotics supplementation plus dietary counseling improved glucose metabolism better than dietary counseling alone during pregnancy.  The mechanism of action is not yet well understood, but researchers hypothesize that beneficial gut bugs:

• Limit the proliferation of other “bad bugs” that can break down polysaccharides (starches) in the large intestine which would otherwise be excreted.  The breakdown of these starches by the bad (“saccharolytic” bugs) into sugars increases the glucose load to our body.
• Improve gut immunity and limit inflammatory action which has been associated with insulin resistance and obesity.

It turns out that the beneficial bacteria in our gut also play an important role in the excretion of estrogen metabolites and hormone-like environmental toxins.  When “beneficial bugs” are in good supply, the elimination of waste is speedy and regular and estrogen is excreted quickly.  However, when good gut bacteria is compromised due to inflammation, allergy, antibiotics or other conditions, pathogenic intestinal bacteria begin to thrive.  These less friendly critters secrete the enzyme β-glucuronidase, which re-digests estrogens in the large intestines, releasing estrogen back into the body.  High levels of β-glucuronidase are associated with breast and colon cancer and may contribute to hormone imbalances associated with infertility.

Stay tuned to our blog for more tips on improving gut health!

Sources: Friebe et al. 2008, Verstraelen  et al 2005

By Breea Johnson, MS RD

It’s the end of the holiday season and most people are already looking towards next year saying to themselves “This will be the year that I _______.” Whatever it is that this next year will be about, cleansing on an emotional, physical and nutritional level is a great way to clear your head and start working towards achieving your goal. Because being in your best health in your best body with your best mind opens you up to achieving anything you set out to accomplish.

Over the past year I have gotten many requests for us to do our ART Recovery/Prep cleanse as a group cleanse as many women like the peer and emotional support that group meetings provide. So, for the New Year, yoga teacher Jenilyn Gilbert and I are working together to offer a joint nutrition and Kundalini yoga cleanse for 4 weeks starting in January 2011. The nutritional cleanse will be a slightly modified version of our ART Recovery/Prep Cleanse which is sure to move your diet to a more clean and green fertility-friendly place. Every week we will split our time between an interactive nutrition lecture and a yoga class that focuses on cleansing a specific area of our body.

What you need to know:

Start the New Year with a special yoga and nutrition combo cleanse! This cleanse will combine nutrition guidelines and Kundalini yoga to focus on restoring digestion, supporting liver detoxification and cleansing both physically and emotionally. Peer support will help you find greater success and even enjoy the process of cleaning up body, mind and spirit!

This class is not for women currently on a medicated fertility cycle or who are pregnant. No prior yoga experience required. The class fee of $200 includes four combined nutrition and yoga sessions, teas and snacks. Any related nutrition supplements are extra.

Co-taught by senior PDtM yoga instructor Jenilyn Gilbert and nutritionist Breea Johnson at the Chicago River North location this is the right class to help you meet your goals for health and wellbeing in 2011!

To sign up or if you have any questions, call Pulling Down the Moon at (312) 321-0004 or visit our web registration page.

We love tea. From the earliest conception (pun intended) of Pulling Down the Moon, we knew that we wanted a cozy tea room where people could sit back, relax, and let their troubles dissolve in a cup of hot tea. We soon realized that we could make our tea rooms even more special by giving our guests tea that was delicious, relaxing, and—most importantly—fertility friendly. So, we called on the expertise of our acupuncturists and designed our ARTeas that use the principles of Chinese medicine to promote fertility at different phases of your cycle. Nourish tea is great for the first part of the cycle, Ovulation Support is helpful during ART stimulation or the follicular phase, and Implantation provides uterine support and calming herbs after ovulation, insemination, or embryo transfer.* All of that and fabulous flavor, too! We’d write more about it, but it’s time for a tea break…

Click here to view our Tea Package and other holiday gift ideas from Pulling Down the Moon…

*These statements have not been evaluated by the Food and Drug Administration.  These products are not intended to diagnose, treat, cure or prevent any disease.