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

First off, I am not one for giving things up, especially when it comes to food.  Thankfully I do not have the digestive issues, weight issues or other symptoms of allergy that are associated with wheat gluten sensitivity and, frankly, I adore bread.   Yet, last Tuesday I decided that I was going to experience a week without wheat (W3).

So why, on earth would I do that?  First, while I try not to be swayed by media, I have to admit that one of the precipitating factors was an article I read in the Huffington Post entitled “Three Hidden Ways Wheat Makes You Fat.” Written by Functional Medicine guru Mark Hyman, a man who clearly does not like wheat one little bit, the article outlines did introduce some facts about wheat that caught my attention.  Like the fact that the wheat we eat today is different from that eaten by our ancestors.  Modern wheat, called dwarf wheat, has been genetically altered over the years to be starchier and contain stronger gluten.  More dramatic is Hyman’s description of how dwarf wheat prompts the creation of “gluteomorphins and gliadorphins,” brain- and behavior-altering chemicals similar to the endorphins created in response to pleasure and strong exercise.  This, according to Hyman, prompts craving and bingeing.

Now that’s alarming. My quick Pubmed search, however, did not reveal any clinical data about gluteomorphins (Hyman calls it gluten-morphine) or gliadorphins, apart from one study looking at gluten and autism symptoms.  Yet, the basic premise of Hyman’s article, that the wheat we eat now is not our grandparent’s wheat, rings true to me.  I also know that if I were to binge on anything it would be crusty bread and butter.  In my world of moderation, bread is my siren song.  Could I be “addicted” to gluten morphine?

The second, and more sensible reason I decided to go W3, is that reducing wheat consumption is a component of our new Lifestyle & Weight Loss Program, First Line Therapy for Fertility – more about this program soon!  And, like everything we recommend at the Moon, I wanted to make sure that I could do it myself before I recommended it to another.

I don’t want to bore you with a daily food-frequency or play-by-play of my W3, but I did notice a few interesting things when I chose to eliminate this source of calories from my diet. What follows is a short and sweet summary of the kernels of wisdom I gleaned  from a week without wheat:

• Kernel #1:  Wheat consumption is a habit.  When I was faced with a week  without wheat none of my go-to foods were available.  I had to find different choices for breakfast (steel cut oats), re-think my “side” of bread and butter at Panera (choose an apple), and stretch for a different side dish at dinner instead of buttered noodles (try amaranth).  All in all, the process felt more like an exercise in breaking food ruts than giving up a staple.
• Kernel #2:  The results were subtle.  After a week off wheat, I cannot report any particularly striking changes in my overall health.  However, as I look back at the past week I am sure a nutrition analysis would reveal a healthier, more varied and nutritious diet than my habitual eating pattern.  I became painfully aware that I could point to “lazy choices” I made every day – chicken wraps at Whole Foods, pasta or noodles with dinner, dried cereal and breakfast breads  as well as lunchtime sandwiches – that kept me from better choices.  This was an empowering insight.
• Kernel #3:  I can see how cutting back on wheat would make a diet more fertility-friendly.  If used intelligently, limiting wheat frees up calories for healthy fats, encourages the consumption of more nutrient rich foods and discourages the consumption of processed foods.  If used unwisely it could also be a disaster.  Gummy bears are gluten free.
• Kernel #4:  This last point, that processed foods rely heavily on wheat, is a no-brainer.  Think of all the crackers, dried cereals, low-fat cookies, cakes and frozen meals on offer at your local supermarket.  When wheat is out you have to find a new pasture  to graze.  Also, when shopping this week I realized that there are plenty of gluten-free foods that are highly processed.
• Kernel #5:  Addicted?  In my case I would argue that I’m just plain lazy.  I learned this week that I rely heavily on processed grains to the exclusion of other nutritious foods.

When Tuesday came around and I was done with my W3 I was surprised that I didn’t rush to the coffee shop for a muffin. Maybe I’m strange, but I enjoyed this process of diversifying my diet. I think I’ll let it ride for a bit until some of my newer, healthier choices become habitual.  I know that a lot of women out there are going gluten-free for fertility.  For some it’s a therapeutic decision because they are dealing with the very real impact of gluten sensitivity and allergy.  For others, the goal might be weight loss. Whatever the reason, there’s one piece of advice I can give anyone making dietary changes:   Make your changes from a place of exploration and inquiry. Empower yourself to know what is right for you.  It’s helpful, too, to work with a nutritionist to maximize nutrients that support fertility.

Have you made dietary changes as part of your fertility journey?  Have they felt empowering or onerous?  We’d love to hear your experiences.

For more information about nutrition and fertility, check out Tami and my book The Infertility Cleanse:  Detox, Diet and  Dharma for Fertility.  We have fabulous nutritionists at Pulling Down the Moon who are available in-person or by phone for an empowering consult to help you optimize your diet for health and fertility.  Visit www.pullingdownthemoon.com for more information!

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 Margaret Wertheim MS RD

When it comes to fertility and pregnancy, folic acid, iron and calcium are the vitamins and minerals that tend to get much of the attention. We would argue that there are quite a few other nutrients that don’t get nearly enough attention, and one of these is choline. Choline is an essential nutrient that your body can synthesize in small amounts, but the majority must be obtained in your diet. While you may constantly hear about the importance of folic acid for the prevention of neural tube defects like spina bifida, research indicates that higher choline intake during pregnancy is associated with lower risk of neural tube defects as well. In addition, choline is converted to betaine in your body, which assists in the conversion of homocysteine to methionine, thus preventing homocysteine levels from becoming elevated. Elevated homocysteine is associated with increased risk for cardiovascular disease and miscarriage, and in one study was associated with poorer egg and embryo quality in women with PCOS undergoing IVF. Furthermore, choline is a precursor to the neurotransmitter, acetylcholine, which is involved in memory and muscle control. In a study in rodents, when mothers consumed higher levels of choline, their offspring had significantly better memory throughout their lives. Thus choline intake during pregnancy may have a very long-term impact on memory and brain function from infancy into adulthood.

According to the National Health and Nutrition Examination Survey, the average choline intake in pregnant women is only about 338 mg/day, while the daily requirement during pregnancy is 450 mg. Daily choline needs increase to 550 mg while breastfeeding, as breast milk is a rich source of choline. Good food sources of choline include eggs, meat and fish, dairy, legumes, and certain whole grains, nuts and seeds. Vegans and vegetarians with limited intake of eggs and dairy products are at increased risk of having a choline-deficient diet. Very few prenatal vitamins contain any choline at all, and those that do usually contain only very small amounts. Luckily, Prenate Pro and Prenatal Plus both contain 200 mg choline, which can give you the extra boost you need to ensure you’re meeting your daily choline requirement. That being said, it’s also absolutely essential to include choline-rich foods in your diet on a daily basis.

References:
Linus Pauling Institute at Oregon State University: Choline

Caudill, et al. Pre- and Postnatal Health: Evidence of Increased Choline Needs. J Am Diet Assoc. 2010; 110:1198-1206

Berker, et al. Homocysteine concentrations in follicular fluid are associated with poor oocyte and embryo qualities in polycystic ovary syndrome patients undergoing assisted reproduction. Reproductive Endocrinology. 2009; 24(9):2293-2302.

Zeisel, et al. Importance of methyl donors during reproduction. Am J Clin Nutr. 2009; 89( suppl):673S-677S.

If you have been reading our blog regularly, you know that a fertility-friendly diet is nutrient dense.  Put another way, good fertility nutrition means eschewing empty calories and choosing foods that pack a nutritional wallop.   This can be particularly challenging in the morning when we’re pressed for time, and later in the afternoon, when our body is craving something sweet to pick us up and carry us through the rest of the day.   These are times when we are particularly vulnerable to the caffeine and sugar rush provided by treats the coffee shop and/or the vending machine.

Enter the smoothie.  Like the “salvage stew” that many of our moms created out of the produce drawer, a smoothie is a place where we can chuck in lots of nutritious ingredients, press a button and, presto!  A satisfying treat that is quick, nourishing and satisfying.

With these challenges in mind our Pulling Down the Moon nutritionist Margaret Wertheim has created some smoothie recipes that are not only nutritious, they are filled with nutrients that support fertility.  In the recipes below, Margaret experiments with almond milk and coconut water as the base of her smoothies and suggests add-ins like probiotic powder, antioxidant and fiber-rich Organic Superfood and our delicious hypo-allergenic rice protein powder, ProMeal. Please note, too, that these smoothies do not use crushed ice.  According to Traditional Chinese Medicine and Ayurveda, a fertility diet does not emphasize cold foods.

Basic Shake
2 scoops vanilla or chocolate ProMeal
1 cup water, almond milk, or coconut milk

Almond Fruit Smoothie
2 scoops vanilla ProMeal
1 cup almond milk
¾ cup mixed berries or peaches
optional: ½ banana

Coconut Fruit Smoothie
2 scoops vanilla ProMeal
1 cup coconut milk OR ½ cup coconut milk and ½ cup water
¾ cup mixed berries or peaches
optional: ½ banana

Yogurt Fruit Smoothie
2 scoops vanilla ProMeal
½ cup full-fat plain yogurt
¾ cup mixed berries or peaches (a splash of addition liquid may be needed, depending on the kind of berries/fruit used)
optional: ½ banana

Weight Gain Shake
2 scoops vanilla or chocolate ProMeal
1 cup coconut milk
2 tablespoons natural peanut butter or almond butter
optional: ½ banana or berries

Mango Kale Smoothie
2 scoops vanilla Promeal
1 cup coconut water
1 tablespoon almond butter
1 leaf of kale
¾ to 1 cup mango
Dash of cinnamon

Other healthy additions: Probiotic powder, nuts (walnuts, almonds, Brazilnuts), oranges, organic spinach or Swiss chard for greens you won’t even taste.

*To maximize nutrient and antioxidant content of any of these shakes, add 1 scoop of Organic Superfood*