By Beth Heller, MS

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

How Do Diets Measure Up?

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

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

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

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

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

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

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

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

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

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

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

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

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

What’s the Solution?

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

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

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

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

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

Sources

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

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

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

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

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

by Beth Heller MS, RYT

Seasonality is a concept that went out of vogue with the advent of super-stores and refrigerated shipping.  I remember seasonality from my childhood growing up in Michigan when I could guess the month from the fruit my mom placed on the breakfast table.  If she served cantaloupe or watermelon I could put money on the fact that school was out for the summer.  Oranges and grapefruit were winter fruits, which we would occasionally pack home with us from our winter break trips to Florida for a sunny treat on short winter days.  Berries were an early summer thing, although Michigan raspberries were available through October if the weather was warm…and if there was homemade apple sauce on the table it was late September.  Ditto vegetables.  We simply didn’t eat tomatoes when they weren’t growing in our garden.  And when summer ended and the garden turned brown there was squash – lots of it – to be stored for stews and soups during the cold winter months.

But as I got older, stores got bigger.  Suddenly cantaloupe was available in January…pale, crunchy cantaloupe but cantaloupe.  Tomatoes, too, and disturbingly large red apples began to appear.  My mom got a job and had less time for gardening.  So the food on our table changed.

I often wonder how much of our obesity, infertility and chronic health problems arise from the simple fact that we’ve allen out of rhythm with our food source.  For optimal health and fertility, traditional medical teachings recommend eating seasonally and locally.  In keeping with the ancient belief that we are healthier and happier when our bodies are in tune with the cycles of nature, it follows we should eat foods that grow in our geographical area while they are in season.  Traditional systems teach that foods and people in the same geographical area have “similar energy.”  This may be true in the sense that plants and the people living as neighbors share the same weather, air, soil and “roots.”  Whether indigenous or adoptive species, plants that thrive in particular areas are there because they are well-suited and have established harmony with their surroundings.  When we eat foods that exist in harmony with our surroundings, it’s believed we take some of that harmony into our own bodies.

So, what’s “in” for April?  The light flavors of spring are in right now and are full of fertility-supporting nutrients.  Many stores now state the origin of their produce so for an added bonus choose fruits and vegetables grown nearby.  Seasonal spring choices contain antioxidants and anti-inflammatory compounds.  Since many conditions that cause infertility – PCOS, endometriosis, fibroids and poor egg quality – are associated with oxidative stress and inflammation, increasing your intake of these fruits and veg are a great idea!

• Arugula – looks and acts like a green but is classified as a cruciferous vegetable and may help healthy hormone metabolism. Arugula is also lower in oxalates, chemicals in leafy greens like spinach, which interfere with calcium absorption.  You can stir a handful of arugula into a delicious Spring Minestrone soup for a delicious satisfying meal.
• Artichokes – an excellent source of Vitamin C and believed by some cultures to be an aphrodisiac.
• Asparagus -great source of potassium,  vitamin A and folate and is naturally low in sodium.  Also believed to be an aphrodisiac…
• Beets – contain betelains, antioxidant and anti-inflammatory compounds.  Eat beets lightly steamed or grate them raw into salads to because the benefits of betelains are thought to diminish with heat.
• Leeks – while not as extensively studied as its cousin garlic, leeks are an allium vegetable and have many of the same beneficial sulfur-containing compounds as garlic.
• Morel mushrooms – a great source of the antioxidant compound selenium.  Morels have also been studied for their natural blood sugar balancing action.
• Strawberries (if you live in the South) – strawberries are a fertility superfood filled with antioxidant vitamins and lignins, fiber that has been shown to lower cholesterol.  Lignins are also a favorite food of beneficial gut bacteria and has been called a “pre-biotic” because it promotes a healthy intestinal flora.

by Margaret Wertheim, MS, RD, LDN

There is clear evidence that a healthy body weight maximizes fertility and IVF success rates, but when it comes to specific foods or vitamins and minerals, the evidence gets a little murkier. There are a number of reasons for that, but perhaps the most important reason is that diet changes don’t happen in a vacuum; you can’t change one thing in a person’s diet without something else changing. For example, you decrease the carbs while keeping the calories the same and the fat and/or protein in the diet must increase.  In the era of evidence-based medicine, nutrition recommendations to support fertility aren’t always clear-cut. I can’t say “eat almonds, and you’ll definitely get pregnant,” but I do know if you eat healthier you’ll probably feel better, have more energy, and it may help you get pregnant.

In my work as a nutritionist at Pulling Down the Moon, I’ve worked with women that are at a completely normal weight and outwardly look healthy, but they’re overwhelmed and exhausted, and using sugar and caffeine to make it through the day. They are filling their bodies with low-calorie pre-packaged “stuff” masquerading as food in order to avoid weight gain. I would argue that just because they have a normal BMI doesn’t mean they are “healthier” or more likely to conceive than a woman who is somewhat overweight, but eats really well. There are overweight women who eat very healthfully and normal weight women who don’t and vice versa. Does weight matter – absolutely, but I would argue there is much more to it than that. Dietary quality needs to be considered in all women and men, regardless of weight. Here are three ways to improve the quality of your diet to improve your overall health and vitality, and they just may also help you conceive:

1. Follow a Mediterranean diet pattern. Following a Mediterranean diet pattern may increase chance of pregnancy when undergoing IVF, according a 2010 study in the journal Fertility and Sterility. The Mediterranean diet pattern is characterized by high intake of vegetables and plant oils like olive oil, fish and legumes. In this study, women who were most adherent to a Mediterranean diet pattern were 40% more likely to become pregnant via IVF than women who were less adherent to this pattern. The authors suggest that the higher intakes of folate and vitamin B6 in the more adherent group may explain the benefit of the Mediterranean diet on pregnancy.

2. Focus on Nutrient Density. Nutrient density means that you want to try to get as many vitamins and minerals as you can from the food you’re eating. This means the grains you eat should be whole grains. For example, experiment with different types of bread. “Whole wheat” bread that is really soft and spongy is probably not made from 100% whole grains, and thus isn’t as nutrient dense. The refining process in taking whole wheat to white flour strips the wheat of valuable fiber, protein, vitamin E, and B-vitamins like folate. Try sprouted or 100% whole grain bread as well as other whole grains like brown rice, quinoa, millet and oats. Other nutrient dense foods are legumes, nuts and seeds, fruits, and vegetables along with appropriate portions of high quality meat, fish and dairy. The idea is to minimize empty calories found in sodas, sweetened beverages and desserts. They offer only calories and sugar, which may cause unwanted weight gain, low energy levels, and also may negatively affect your mood.
3. Eat a wide variety of different colors. Research indicates that oxidative stress may play a role in endometriosis, PCOS, male factor and unexplained infertility. Increasing dietary antioxidants may help to offset this increased oxidative stress. Many vitamins and minerals have antioxidant functions including vitamins A, C and E and minerals like zinc and selenium. Does this mean you should start popping supplements of these vitamins and minerals? Not without the recommendation of a qualified nutritionist or healthcare professional, who understands when it’s appropriate to supplement and when it’s not. More is not always better when it comes to supplements. Instead focus on food.

Eating a varied diet is essential. In addition to antioxidant vitamins and minerals, phytonutrients, which are naturally-occurring compounds found in plants, also function as antioxidants. Certain phytonutrients give color to plants, and many have additional benefits beyond their antioxidant value, such as anti-inflammatory actions. Eating a varied diet that includes a wide variety of different colored fruits and vegetables is essential. Leafy green vegetables are incredibly healthy, but if you eat leafy greens at the exclusion of other vegetables, you miss out on the nutrients provided by yellow, orange, red, blue, and purple fruits and vegetables. We all get stuck in ruts where we feel like we’re eating the same things day after day. Let the changing season inspire you to start visiting your local farmer’s market or branch out at the grocery store by trying some new vegetables. Buy a new cookbook and try out some new recipes.

While I can’t tell you that eating specific foods is absolutely going to improve your fertility, a nutrient poor diet is definitely not going to help. I’ve worked with many people who expressed their initial reluctance to schedule a nutrition appointment, and then had a change of heart. One woman told me, “What’s the worst thing that’s going to happen from my changing my diet? I’m going to feel a lot better? That works for me!” This attitude always makes me smile. I find it inspiring to work with women who are really trying and succeeding in improving their fertility by hitting it from all angles – exercise, nutrition, acupuncture, stress management and relaxation in order to really maximize their chances of natural conception or success with ART.

 Click here to schedule a phone or in-person consultation with Margaret.  

Margaret Wertheim, MS, RD, LDN is a Nutritionist at Pulling Down the Moon, Integrative Care for Fertility, Inc.

References:

1. Vujkovic, et al. The preconception Mediterranean dietary pattern in couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment increases the chance of pregnancy. Fertility and Sterility. 2010;94(6):2096-2101.
2. Ruder, et al. Oxidative stress and antioxidants. Human Reproduction Update. 2008;14(4):345-357.
3. Mendiola, et al. A low intake of antioxidant nutrients is associated with poor semen quality in patients attending fertility clinics. Fertility and Sterility. 2010;93(4):1128-1133.

by Beth Heller, MS RYT

Increasing evidence suggests that the way in which fat is distributed on a woman’s body may impact fertility.  While body fat is essential for reproduction  (a range of about 17-22% body fat is necessary for menstruation) too much body fat impairs a woman’s ability to conceive.

Body shape also predicts fertility.  Pregnancy rates, in both natural and assisted reproduction, go down with fat accumulation around the waist and trunk independent of overall body weight (1).  As opposed to the tush and thigh fat associated with the pear pattern, apple fat is more metabolically active.  It produces cytokines, chemicals that promote insulin resistance and low-level chronic inflammation.  These factors may lead to other disturbances in reproductive function.  The apple shape is also characteristic of women with Polycystic Ovarian Syndrome (PCOS), a condition associated with infertility.

Click here to access your waist/hip ratio and determine your relative health risk.

If your waist-to-hip ratio is in the less healthy range, don’t despair.  There are effective steps you can take to change your body fat profile.

• Exercise:  All forms of exercise, but particularly resistance training, has been shown to help decrease abdominal fat.  Strength training increases lean muscle mass throughout the body and this increased lean tissue boosts metabolism in a lasting way.  Spot training (hundreds of ab crunches) has not been shown to be effective.
• Weight loss is helpful for decreasing abdominal adiposity but this loss is greater when exercise is added.
• Relaxation training:  Stress has been shown to promote the accumulation of abdominal fat.  Yoga, meditation and breathing practices can help to lower the circulating stress hormones that promote the formation of abdominal fat deposits.  Massage can also help you learn to relax.

Making lasting changes is more effective with support and expert advice.  Our nutrition and other holistic programs including massage, fertility yoga and acupuncture can help you meet your goals and are available in person and by phone.  Call 312-321-0004 (Chicago) or 301-610-7755 (DC Metro) for more information!

1.  Kuchenbecker et al.  The Subcutaneous Abdominal Fat and Not the Intraabdominal Fat Compartment Is Associated with Anovulation in Women with Obesity and Infertility.  J Clin Endocrinol Metab, May 2010, 95(5):2107–2112

by Beth Heller, MS, RYT

Research published in the journal Obstetrics and Gynecology reports that women who exercised 4 hours or more times per week for 1-9 years were 40% less likely to have a live birth and were almost three times more likely to experience IVF cycle cancellation.  They were also twice as likely to have an implantation failure or pregnancy loss than women who did not report exercise.  This research reinforces previous data showing that strenuous exercise can disrupt reproductive hormone regulation.

A common question that arises at Pulling Down the Moon is whether or not women should give up exercise when trying to conceive (ttc) and/or undergoing A.R.T.  For many, exercise is an important tool for relieving depression, controlling stress and regulating body weight.  Putting the message out there that women who are “ttc” should abstain from exercise could be dangerous – we’re already a highly sedentary society – but data such as the study referenced above suggest that we should look closer at the ways in which exercise can interact with our reproductive system.  An understanding of the mechanisms at work may help us make more intelligent exercise choices.

Another recent study dove into this question by comparing the menstrual cycles of sedentary and exercising women who were matched for age, body weight, BMI and age of menarch.  The results were astounding.  In the sedentary group, only 4% of women had menstrual dysfunction.  In the exercise group only 50% of cycles were ovulatory and 50% were abnormal.  Within the abnormal cycles,  29% demonstrated Luteal Phase Defect (a short luteal phase) and 20% were anovulatry.  In a further study of this same sample of women, the researchers found a correlation with “high-DT “(high drive for thinness) and menstrual dysfunction and found that REE (resting energy expenditure) was decreased in these women, a sign that they were experiencing negative metabolic effects of chronic negative energy balance.

So What Is Energy Balance?

Energy balance is a simple equation that nutritionists and exercise physiologists use to conceptualize the factors at work in weight loss and weight gain.  The energy balance equation is:

When Energy In = Energy Out, body weight is stable

When Energy In > Energy Out, there is weight gain

When Energy In < Energy Out, there is weight loss

Long-term negative energy balance in females is associated with decreases in circulating metabolic hormones (like thyroid hormone) that regulate overall metabolic rate, and with increases in baseline stress hormone levels like cortisol.  Often, shifts in energy balance can occur without weight loss, especially in long-term exercisers.  Call to mind that trim gal at the health club who spends 60 minutes a day on the elliptical trainer but never gets thinner.  While she may view the exercise session as justification for a candy bar, her body perceives it as a major “fight or flight event.”  Although her weight does not change, hormonal and metabolic shifts like the ones described above can still occur as the body slows down non-essential systems (like reproduction) to preserve energy.  Signs that a woman may be in negative energy balance are anovulatory cycles or the absence of menstrual periods.

Should Women Give Up Exercise when Trying to Conceive?

The answer to this question is a resounding “no!”  Exercise has also been shown to relieve depression, control stress and regulate a healthy body weight – all very important elements for conception.  What women do need to consider, however, is how to exercise in a way that is “fertility friendly.”

Intensity:  When we talk about exercise intensity we are talking about how HARD your body works during a particular exercise activity.  Intensity of an exercise determines its energy requirement, or how many calories you burn while exercising.  Thus, excessive intense exercise can create  a negative energy balance.  This may be a good thing when a woman has significant weight to lose but it is not a good thing when she is at a healthy weight.

Impact:  Exercise can be either low- or high-impact.  High impact activity is and exercise in which both feet leave the ground.  Examples of high impact exercise are running, aerobic dance that involves jumping and jumping rope.  Spinning is also high impact, although this form of cycling exercise does not involve jumping, the intense resistance and sprinting used in spin classes can place enormous impact on joints and muscles.

In general, high impact exercise can be detrimental to fertility in one of two ways.  The first is through the production of endorphins.  Endorphins “natural pain killers” produced by the body in response to strenuous exercise.  While these chemicals serve to mask pain signals and allow us to enjoy long-duration, strenuous exercise, they can also disrupt reproductive hormone regulation.  Second, high impact exercise is generally more intense than low impact exercise, causing the excessive energy drain described above.

What’s the Right Exercise Mix for Fertility?

Fertility-Friendly Exercise: Fertility-friendly exercise is moderate-intensity (heart rate at 60-65% of maximum), low-impact and of medium duration (30-45 minutes, 3-4 times per week).

Good Exercise Modalities:  walking, swimming, recreational bike riding, resistance training and hatha yoga

Relaxation Training: Learning to relax through practices like breathing and meditation are an important part of any fitness program.  Taking 20 minutes a day to meditate or just breathe can help to reduce stress and lower circulating stress hormones.  In addition, cross-training and including rest days where the body can rebuild and restore is also very important.

Nourish Up through Diet: In two recent blogs, Nourishing Up for Fertility and Energy Balance for Fertility – A Holistic View we explore the idea of creating a nourishing lifestyle that changes the paradigm of daily life.

For many women, letting go of an intense exercise program can be difficult.  Services like acupuncture, massage and nutrition counseling available at Pulling Down the Moon can be very helpful in making the transition to a more nourishing and fertile lifestyle.  Click here to learn more/book an appointment.

Sources

1.  Morris SN Obstet Gynecol. 2006 Oct;108(4):938-45.

2.  De Souza MJ Hum Reprod. 2010 Feb;25(2):491-503. Epub 2009 Nov 26.

3.  Gibbs JC Int J Sport Nutr Exerc Metab. 2011 Aug;21(4):280-90.

Margaret Wertheim M.S., R.D., L.D.N.

by Margaret Wertheim, MS RD

Sometimes it can feel like following a fertility friendly diet is expensive, especially when you may have extra costs for fertility treatments and medications. Here are some ways to help keep your food budget in check:

1. Prioritize organic meat and dairy. Due to the use of hormones, pharmaceuticals and pesticides in the production of meat and dairy, these items should be your highest priority to buy organic. If completely organic dairy will put too much of a strain on your budget, buy the rBGH-free (recombinant Bovine Growth Hormone) dairy. While this doesn’t guarantee the animals have been given feed raised without pesticides, at least you know the cows weren’t treated with hormones. Similarly with beef, if organic or grassfed beef is out of your price range, at least make sure to buy beef that is raised without hormones, as estrogen is routinely used in raising conventional beef.
2. Choose lower cost cuts of meat. It’s much less expensive to buy a whole chicken than boneless skinless chicken breasts or any one part of the chicken. Alternatively, buy some grassfed ground beef, which costs less than buying steak. Use it to make some homemade chili, tacos, enchiladas, meatballs or any of your favorite recipes. Serve with plenty of vegetables.
3. Eat eggs. They’re nutrient-rich, and even the most expensive organic eggs don’t cost more than $5 per dozen. A dozen should provide the protein for 6 breakfasts at less than $1 each.
4. Learn about the Dirty Dozen. These 12 fruits and vegetables have the highest pesticide residues, so spend some extra money buying organic spinach and strawberries. When it comes to avocados and onions, it’s ok to buy the conventional version since these are some of the Clean 15, or those fruits and vegetables with the lowest levels of pesticide residues.
5. Buy in bulk. Save money by buying whole grains, beans and nuts and seeds in the bulk section. It’s usually significantly less expensive than buying the prepackaged version.
6. Cook at home instead of eating out. You can serve a delicious home-cooked dinner for 2 at a fraction of the cost of eating out or ordering in. When you have extra time, stock up your freezer with healthy homemade soups and other meals that you can quickly reheat after a long day at work when there isn’t time to cook.
7. Do price comparisons. Some of the major chain grocery stores actually have higher prices in their natural foods section compared to your natural foods grocery store or Whole Foods. The opposite can also be true. Check out fruit and vegetable markets, where they often carry some very reasonably priced organic produce. This may require trips to multiple stores, but it can definitely help to trim your food budget.
8. Eliminate high-cost low-nutrient foods. An excellent example of this is cold cereal. Cold cereals are generally quite expensive, not well-digested and their vitamin and mineral content is generally due to a spray-on multivitamin. Meanwhile you can generally buy 1 pound of organic oats in bulk for less than $2. Cut out other foods like packaged cookies and sweets. These items tend to be pricey and have no fertility benefits.

by Beth Heller, M.S.

Nutrition was a big topic at this year’s American Society for Reproductive Medicine conference.  Concepts under discussion included the potential role of inflammation in both male and female fertility and the possible value of antioxidants like resveratrol and omega-3 fatty acids in reversing damage done by environmental toxins.  Another very simple yet compelling idea was presented by Dr. Gil Wilshire from Missouri.  Dr. Wilshire contends that many women, even obese women, are not getting sufficient nutrition for good fertility.  Put simply, the typical low-fat, USDA Food Guide diet that we have all been programmed to eat, is low in essential nutrients like omega-3 fatty acids and fat-soluble vitamins that are essential for our body’s health and reproduction.

Dr. Wilshire was preaching to the choir on this one.  That the poor quality of our modern diet – from the over consumption of fast foods and overly processed meals, to the belief that “low-fat means healthy” – puts all of us at risk for less than optimal nutritional status  is a cornerstone of our fertility nutrition programming at Pulling Down the Moon.  What was especially compelling, though, was Dr. Gil’s use of the concept of “feeding up” in his discussion.  This idea is old as the hills but almost universally accepted in the medical community:  women get pregnant when they are “feeding up” rather than paring down.

The female body is keenly aware of “energy balance,” an evolutionary mechanism that ensures the survival of the human species.  When calories are scarce, bodies begin to shut down non-essential body functions…like reproduction.  Food, however, is much more than calories.  It is also the way our body gets essential nutrients like vitamins, minerals and fats needed for healthy body function.  If a woman is consuming a diet rich in calories but poor in nutrients, she can become malnourished.  Hence an obese woman who lives on processed foods can have plenty of calories but still be “starving.”  And the slender woman who has been told by her fertility doctor to gain some weight in order to conceive may benefit more from shifting to a highly nutritious diet and lowering the intensity of her activity than from simply packing on pounds.

Rather than “feeding up,” we like to say that women get pregnant when they are “nourishing up.”  Importantly, the process of nourishing up can take place without the gain or loss of a single pound.  It begins with a very healthy diet and  good digestion so that essential nutrients are not only present, they are being absorbed and assimilated.  Calorie counting is secondary to this objective, even for the obese woman who needs to lose weight.  In general we believe that certain nutritional supplements  (including a high-quality prenatal vitamin, a probiotic to support digestion and omega-3 fats) can help support the objective of “nourishing up” but the focus should be a diet rich in fruits, vegetables, lean protein, minimally processed grains and healthy fats.

We also know that nourishment can come in many ways – including the nourishment of true relaxation that comes with yoga practice, nourishment through channeling chi throughout the body during an acupuncture session or the healing touch of massage and reiki.  Changing the intensity and intention of our exercise program from “burning and racing” to “energizing and strengthening” can also make a difference.

At a high-tech conference like ASRM it was encouraging to see nutrition on the table, so to speak.  It was clear, however, that nutrition will never get the attention of research dollars.  Many more people attended the class on Pre-Implantation Genetic Diagnosis (PGD) than the class about nutrition.  Doing nutrition research is complicated and funding is scarce because unlike drug research, where there’s potential to patent and produce a pharmaceutical drug that will make billions of dollars, a healthy diet can’t be patented and won’t make anyone rich.  Conflicts of interest are everywhere.   Governmental agencies that are charged with making nutritional recommendations are also charged with protecting the economic interests of food manufacturers.   Our national nutrition association, the American Dietetic Association, is partnering with companies like Coca Cola to get women to drink more Diet Coke in order to prevent heart disease.  Yikes!

So what are we to do?  In the face of misinformation we must begin to live the truth and spread the word.  Have you made changes to your diet that fly in the face of the Dietary Guidelines for America?  Have you switched to full fat dairy and sworn off fat-free yogurt?  Have you switched to a more nourishing lifestyle through yoga, acupuncture or other practice?  If you have, please share your stories and we will feature them in our blog and on via social media.  Send your storied to beth@pullingdownthemoon.com subject line:  Nourishing Up.  You can include your name or let me know that you’d like to remain anonymous.

Margaret Wertheim M.S., R.D., L.D.N.

by Margaret Wertheim, MS, RD, LDN

There has been much debate about what the ideal diet is for weight loss, optimum health and of course, fertility. After listening to many qualified speakers at the American Society for Reproductive Medicine conference in Orlando last week, I realized that there are quite a few uncertainties. However, there are some things that we know for sure. As humans we are very adaptable and can survive eating just about anything, but that does not mean we are thriving. When you’re trying to conceive, it’s essential that the body’s most basic needs are being met. In other words, adequately nourishing your body and meeting your vitamin and mineral requirements is a must.

Throughout the 1980s, it was drilled into our heads that we should follow a very low-fat and high carb diet, based on the somewhat misguided notion that eating fat makes you fat. This type of diet has fallen out of favor for the most part. The pendulum swung back the other way to the Atkins diet, full of protein and fat with minimal carbs. I think there is a balance to strike somewhere in between.

In my experience, women tend to follow low-fat diets and eat reduced-calorie foods in order to lose weight or maintain their weight. It’s unfortunate that low-fat and reduced-calorie foods, such as artificially-sweetened non-fat yogurt and diet coke have become almost synonymous with “healthy” in certain circles. While we can survive on these types of foods, we don’t thrive. There are 4 fat-soluble vitamins – vitamins A, D, E and K. These vitamins are only found in foods that contain fat. Eat a very low-fat diet, and you won’t get enough of these vitamins that are crucial to your overall health and can play a role in fertility as well. Vitamin A is essential for embryonic development, and in one study of women going through IVF, the group of women with higher vitamin D levels in their blood had higher pregnancy rates. Furthermore, vitamin E is a potent antioxidant and may have a beneficial effect on sperm quality. (That’s right guys, this is for you too!)

When you eat a very low-fat diet, it’s all but impossible to meet your daily requirements for these important fat-soluble vitamins. Remember that when incorporating more fat into your diet, it’s essential to focus on quality fats and steer clear of unhealthy fats like hydrogenated oils. Eating more healthy fat doesn’t have to mean you eat more calories or gain weight. You’re likely to feel more satisfied after eating, which means you’re less likely to be grabbing for unhealthy snacks later on. Also, when you provide your body with the nutrients it needs to be healthy, often cravings fall away and you feel healthier and more vibrant and energetic.

To learn more about the role of healthy fats in your diet and which fats to stay away from, call 312-321-0004 to schedule an appointment with a Pulling Down the Moon nutritionist.

by Beth Heller M.S.

You may be surprised to think of your digestive system as part of your immune system, but our gut actually functions as our body’s first line of defense – eliminating bacteria and other bugs before they can infect our internal environment.   When the digestive system is challenged, by such conditions as stress, illness or food sensitivity, inflammation can result.  Frequent bouts of diarrhea, constipation, intestinal bloating/cramping and heartburn can all be symptoms of an inflamed digestive tract.  Chronic inflammation of the digestive tract can impair our body’s ability to break down and absorb the nutrients in the food we eat.  In addition, gut inflammation may affect other organ systems, including the reproductive organs, which are in close proximity.  These factors, taken together, are why we take a very close look at digestion, and symptoms of food sensitivity, as they relate to fertility.

Celiac disease, a condition in which an individual cannot tolerate gluten (a protein found naturally in wheat and used as an additive in many foods), is the classic example of a food sensitivity that is associated with infertility.  Population studies suggest that about 1 person in 100 has celiac disease, but studies also suggest that celiac is also under-diagnosed and may be 2.5-3.5% more prevalent in women with unexplained infertility (http://www.ncbi.nlm.nih.gov/pubmed/17592443?log$=activity)

In people with celiac disease, dietary intake of gluten (a protein found in many grains) causes a two-fold attack in the small intestine. Antibodies first attack the gluten protein and this attack triggers an autoimmune response in which antibodies attack the endomysium, a smooth muscle component in the small intestine, and damage the tiny, fingerlike protrusions on the wall of the small intestine that serve to absorb nutrients from food called villi. This leads to the most likely link between celiac disease and infertility – the malabsorption of nutrients.

New research is emerging that suggests that there is a spectrum of gluten sensitivity and that celiac disease gluten sensitivity can cause symptoms similar to Inflammatory Bowel Disease which may negatively impact nutrition status and quality of life in ways similar to Celiac Disease.  (http://www.ncbi.nlm.nih.gov/pubmed/19455131?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=21 ) Other common food sensitivities besides gluten sensitivity include eggs, soy, peanuts and dairy. Symptoms of food sensitivity are diverse:  diarrhea, constipation, rashes, gas and bloating and headaches – just to name a few.  At the Moon, in cases of repeated miscarriage, multiple failed ART cycles, unexplained infertility and/or Irritable Bowel Syndrome our nutritionists will often recommend our ART Recovery/Preparation Program, an ultra-healing diet that eliminates common allergens from the diet and track any change in digestive function and other symptoms.

Remember, though, that we do not want to throw the baby out with the bath water.  Potentially allergenic foods, like dairy and soy, are also important sources of vitamins, minerals and dietary protein. They should never be removed from the diet without a solid nutrition plan.  Studies have also shown that one side-effect of a gluten free diet can be a reduction of healthy gut flora (http://www.ncbi.nlm.nih.gov/pubmed/19445821?log$=activity) .  As we’ve written before, healthy gut bacteria is critical for optimal digestive function and hormonal regulation, so any plan to eliminate gluten must support the gut.   Don’t forget that any elimination diet should also include a strategy for reintroduction and symptom assessment as the goal of any elimination diet is to determine which foods are causing problems.

If you suspect food sensitivity may be part of your fertility issues, we highly suggest you seek out treatment with a trained fertility nutritionist.  Eliminating foods from the diet can be hard work, and is not necessary for everyone.   However, at the Moon, we’ve seen that for some patients the potential benefits may indeed be worth the inconvenience.

To learn more about our nutrition programming, call 312-321-0004 (Chicago-Area) or 301-610-7755 (DC Metro).

Evans KE et al.  Be vigilant for patients with coeliac disease. Practitioner. 2009 Oct;253(1722):19-22, 2.

Pellicano R et al. Women and celiac disease:  association with unexplained infertility.  Minerva Med 2007 Jun; 98 (3):217-9.

Verdu et al. Between celiac disease and irritable bowel syndrome:  the “no man’s land” of gluten sensitivity.  Am J Gastroenterol. 2009 Jun;104 (6):1587-94.

by Beth Heller M.S. and Laura Dubrule, R.D., L.D.N.

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.