Beth Heller, MS, RYT

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.

By Beth Heller, M.S.

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

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.

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 Breea Johnson, MS RD LDN

Eating out at restaurants can be especially challenging when you are trying to eat well for fertility. Try these three easy tips to make better choices at restaurants.

1. Review the menu ahead of time (if possible) and decide what you are going to eat so you make the best “nutrition decision” when you order. If you leave your decision to the last minute and are “starving” by the time you have to order you are more likely to order the less nutritious option.

2. Don’t be afraid to ask for changes when you eat out. Do you want broccoli instead of French fries? Or tomato slices instead of hash browns? Greens instead of bread? You can add vegetables to almost anything and most restaurants are happy to accommodate you.  A Pulling Down the Moon nutritionist can help you learn which foods are best for your fertility so you can even optimize your meal with a fertility-friendly choice.

3. Avoid the salad trap – a lot of salads aren’t very nutritious and instead of loaded with lots of high calorie and low nutrition toppings. Does it have chopped vegetables? Protein? Nutrient dense toppings? An olive-oil based dressing? Make sure to check first.  In addition, salads can be “cold” and in many traditional medicine systems (Traditional Chinese Medicine and Ayurveda), eating cold foods are thought to dampen the digestive fire and potentially decrease fertility.

by Breea Johnson, MS RD LDN

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

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

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

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

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

Guest Blogger:  Kimberly Wong, RD, LDN

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

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

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

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

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

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

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

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

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

Sea vegetables are nutrient powerhouses, especially for fertility.  These humble ocean plants (well, technically they’re algae which is neither plant nor animal – but that may be T.M.I.) are full of antioxidant vitamins like carotenoids (A), and C, the B-vitamin folate and minerals that are essential for reproduction like iron, calcium and iodine.   Iodine is particularly important for fertility, since iodine is a key component the thyroid hormones T3 and T4.  Thyroid hormones play a role in almost every body function, from metabolism and weight management to the proper function of our reproductive system.  Many foods in our diet (like soy, caffeine, raw peanuts) can suppress thyroid function so having a good source of dietary iodine on the plate is a good idea.   Sea veggies also contain lignins, which are a fave food of the beneficial bacteria that live in our gut and support digestion and immunity.

Admittedly there can be a bit of a “fear factor” that comes into play when we first begin to explore sea vegetables.  For that reason we suggest baby steps.  Here are two ways to “dip your toe into sea veggies:”

1.  Make dashi.  Dashi is a flavorful broth that can be sipped alone or used as a base for clear or thicker soups.    This recipe from Whole Foods Market will help you get started.  Please note that this recipe includes bonito flakes.  Because bonito is a type of tuna we investigated the mercury content of bonito and were pleased to learn that this quick growing fish is not a high mercury risk.   Some other ways to use dashi:

• Season with fresh ginger and mirin and pour over cooked brown rice for a more hearty soup
• Add cooked protein (chicken, free-range beef strips, shrimp or fish) and some lightly steamed veggies and you’ve got a great one-bowl meal

2.  Try nori (flat sheets of pressed sea vegetable that you’ve probably seen on the outside of sushi rolls) as a condiment.  Toast it over the flame of your gas range until it turns from emerald green to blackish green (but not burnt) and then cut into strips or crush into flakes.  This will add crunch and savory flavor to salads, grains and casseroles.

As with anything related to fertility nutrition, do not overdo.  Several servings of sea vegetables per week is a great start.  Regardless of whether you’re adding sea veggies to your diet, if you’re trying to conceive and not sure about your thyroid function (women can have both overactive and underactive thyroid) you should speak to your doctor about having it tested.

Be Present, Be Positive…Be Adventurous in the Kitchen, Paige

To soy or not to soy is a common question in the world of fertility nutrition and the answer to receive depends on which nutritionist you consult. Don’t laugh…the question of soy is polarizing in the nutrition world and most nutritionists have a “soy philosophy.” On the one hand, there are holistic advocates like Christiane Northrup (read about the Oprah/Soy/Thyroid story), who recommend soy for general health and menopausal symptoms. On the other hand, any internet search will turn up scads of articles which attest to the negative impact soy can have on health. So, what’s a fertile gal to do?

Well, it’s important to start by understanding why soy is so controversial. First, soy contains isoflavones, chemicals that are structurally similar enough to the hormone estrogen to be called “phytoestrogens” which can bind to estrogen receptors in our body. Isoflavones, however, are much weaker (about a thousand times weaker) than our body’s estrogen molecules. Isoflavones do not accumulate in the body and are metabolized quickly. For this reason the proponents of soy recommend soy as a remedy for the hot flashes, night sweats and mood swings that accompany lowered estrogen levels in menopause. It is also the reason why soy opponents believe soy may be driving up rates of estrogen related cancers and infertility. So what’s the real scoop?

As far as fertility is concerned, soy is a food we approach cautiously at Pulling Down the Moon.

First of all, soy is a common food allergen and can the cause of digestive upset (they didn’t invent the anti-gas medicine Bean-o for nothing!). At the Moon, we take a “gut first” view of fertility nutrition. If a woman’s digestive tract is upset or inflamed, the result can be disasterous for fertility. Gut trouble can disrupt the absorption of nutrients and chronic inflammation in the gut area can impact the uterus and ovaries. Thus, soy is one of the foods we eliminate in our ART Recovery/Prep Program, in order to ensure that it is not causing digestive problems or allergic response.

Second, soy has been shown to negatively impact thyroid function. This is a major problem for women who are trying to conceive, since hypo-thyroidism is associated with infertility. Additionally, it is our experience at the Moon that thyroid conditions can be overlooked in the infertility work-up. Gals with low thyroid should avoid soy products and other thyroid-lowering foods.

Third, while the action of soy isoflavones is weaker than our endogenous estrogens, women who have a low body weight/and or low levels of body fat metabolize estrogen differently that normal weight women. In lean women, the body up-regulates production of its weaker forms of estrogen (estriol) and down-regulates the production of the stronger form of estrogen, estrodiol. As a result, the estrogen circulating in thin women may be a “weaker” kind, resulting in menstural disruption or anovulatory cycles. It follows that a diet rich in phytoestrogens may further increase the competition for estrogen receptors. This is also why, under specific therapeutic conditions, our nutritionists will use non-soy phytoestrogens to help regulate conditions of estrogen dominance.

Finally, soy contains high levels of phytates, chemicals that can block the absorption of minerals including iron, calcium and zinc. The amount of soy that would need to be eaten to compromise mineral absorption is well beyond two servings per day. However, many vegetarians easily consume this much soy and more.

To boil all this down, here are the general guidelines we use at PDtM:

1. If a woman has digestive issues we recommend an elimination diet that removes soy and then reintroduce soy to see if there is any sensitivity. If sensitivity exists, soy is eliminated permanantly.

2. In women with symptoms of hypothyroidism and/or unexplained infertility, we recommend they get their thyroid tested and eliminate soy if their hormone levels prove to be low.

3. If the thyroid is fine, and there are no digestive issues, our recommendation is to use soy sparingly in the diet, keeping soy consumption to no more than one 8 oz serving of fermented soy per day and to consume soy in a fermented form.

4. In men with poor sperm quality we limit soy consumption to < 3 servings a week and recommend that any soy in the diet be consumed in a fermented form. Because zinc is essential sperm formation, and because the phytates in soy interfere with zinc absorption, we take a cautious apporach. At least one study has shown a correlation between soy consumption and low sperm count in sub-fertile men. The same correlation was not found in normal, healthy young men.

So, there you have it. Smart soy consumption is possible when you’re trying to conceive as long as you tend to your gut, make sure your thyroid is in good working order and don’t overdo. Be aware that soy is often hidden in the foods you eat – frozen dinners, baked goods, energy bars and “veggie” meats – so be smart and read your lables.

Have you made a change to your soy consumption since you tried to conceive? Has a doctor or nutritionist shared their perspective with you? Please join the conversation with us.