By Beth Heller, M.S.

So, you think you eat healthy?  Read on and you might be surprised.  The low-fat dietary pattern that is generally touted as healthy is actually low in nutrients that have been shown to be important for fertility.  To illustrate this point, we charged Pulling Down the Moon nutritionist Margaret Wertheim, R.D. to run a nutritional comparison of two diets 1) a typical low-fat diet taken directly from the practice manual of the American Dietetic Association and 2) a fertility-friendly meal plan based on Pulling Down the Moon’s nutrition program.  The results were  striking.

Here’s the low-fat diet based on recommendations from the American Dietetic Association:

Typical Low Fat Diet - Click to enlarge

And here’s the fertility-friendly eating plan per Margaret’s recommendations:

Fertility-friendly Diet - Click to enlarge

At first glance, both diets look pretty healthy.  The calorie content is the same – just around 1830 calories.  Yet, a nutrient comparison reveals a different story.   Head-to-head the Pulling Down the Moon plan blows the typical low fat diet pattern away in key fertility nutrients.  The low fat diet proved deficient in  iron, vitamin E, vitamin D and very low in the omega-3 fatty acids EPA and DHA – all nutrients that are linked to optimal fertility and healthy ovulation.  The difference?  The fertility-friendly diet derives about 10% more of its calories from healthy fats at the expense of carbohydrates.   Foods in the fertility-friendly diet are also less processed – note the absence of  ”diet” dressings,  as well as”low fat” and “sugar free” foods.

Dietary Comparison LF vs. FF - Click to enlarge

This exercise illustrates a central concept of Pulling Down the Moon fertility-friendly eating that we call “nourishing up.”  In short, nourishing up means that even at your perfect body weight you may still be getting insufficient nutrients for optimal health and fertility (read more about nourishing up in a previous post here).  Remember that current dietary guidelines are based on the idea of preventing deficiency (helping us survive), rather than promoting wellness (helping us thrive).  Even  ”healthy” diets such as the low fat diet above are missing the mark.   Note that this low fat diet doesn’t even include guilty pleasures and convenience foods like McDonalds, Starbucks and Lean Cuisine. Also note that the fertility-friendly diet is rich and satisfying, and doesn’t feel like “diet food.”  Our belief is that many women end up starving themselves of important nutrients in order to lose or even maintain their weight.

For this reason we recommend that women who are trying to conceive seek out a nutritionist who specializes in fertility to learn important steps they can take to optimize their diets for fertility.  In addition we also offer the Pulling Down the Moon Pregnancy Prep Program, a three part program of nutritional supplementation that includes Prenatal Plus, a prenatal vitamin that has been optimized to include nutrients like CoQ10, extra B-vitamins, omega-3′s and choline, Probiotic Powder to support digestion, elimination and the immune system, and our Organic Superfood a 100% certified organic fruit and vegetable drink to provide antioxidants their most effective form – that of whole food.*

Have we convinced you that diet is important?  Click here to book an appointment with a Pulling Down the Moon nutritionist or call 312-321-0004 (Chicago)/301-610-7755 (Rockville) for more information.

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

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.

Kimberly Wong, RD, LDN

Spring, in unbroken tradition, has long been a celebration of the fertility of the earth. Similarly, this glowing season marks a time of renewal and revitalization in one’s fertility journey. Thus, in new hope and anticipation, what better way to welcome the coming months than by improving your fertile body with the natural nutrients of Mother Nature.

While it seems like the path to parenthood may at time be paved with difficult words upon deeply scientific concepts, the movement for local foods, dubbed with the endearing, folksy name “locavorism,” is much less esoteric and was spawned in the mid-2000s in an effort to promote sustainability and eco-consciousness.

Fertility vocab 101: locavore, (\ˈlō-kə-ˌvȯr\, noun), one who eats foods grown locally whenever possible.

Repeat. Memorize. Embrace.

Here’s the 411 on why becoming a locavore can aid in optimizing your preconception nutrition status. In short, locally farmed foods a) provide more vitamins and minerals per serving than do their grocery store counterparts b) encourage increased consumption of fresh fruits and vegetables and c) frequently boast a pesticide-free label.

Local foods travel far fewer miles than your average megastore produce. While it seems convenient to run to the corner store and buy a pint of strawberries to meet our daily quota for our 9-A-Day, what we end up with in hand is quite the reverse of nutritious and fresh. In fact, a food is only considered local if it is grown within 100 miles of where it is sold. Conversely, the average carrot will travel 1,838 miles from farm to table.

While this particular carrot travels the rough equivalent of DC to Mexico City, greater than 50% and up to 90% of its vitamin C content will be lost within the first day of travel. Other essential nutrients fall prey to time-, temperature-, and light-sensitivity: the vital B vitamins, particularly folate, and vitamin E. These particular nutrients are all antioxidants that not only protect from an array of disease, but also help prevent harmful oxidative stress that has been linked to both male and female infertility.

Next, shopping for local foods is a calming, rewarding, and positive experience. Sifting through the wagons of crisp kale, chatting with its grower, and breathing fresh air may be considered so pleasurable that it increases the frequency of fresh fruits and vegetables, and grass-fed/cage-free proteins in one’s diet. Even without a drastic increase in servings per day, the mere substitution of local foods decrease the amount of commercialized foods in the diet. This, in turn, essentially cuts back the amount of processed foods, refined carbohydrates, saturated fats and preservatives in the diet. Just think—a mere trip to a local market can bring you one step closer to an anti-inflammatory, lower-glycemic, fertility-friendly diet!

Finally, local foods tend to offer pesticide-free and organic varieties. The upside to directly dealing with the foods’ producer ensures the elimination of any confusion. Pesticide-residues on fruits and vegetables and hormone/antibiotic-residues in meats and their by-products are of concern to fertility because of the accumulation of such toxins has been linked to reproductive damage.  

The Environmental Working Group has developed the infamous “Dirty Dozen,” which notes the foods that are likely to be highest in pesticide residuals. Do try to buy these foods organic and locally when possible. Conversely, they have released the “Cleanest Twelve” which indicates the produce lowest in pesticides.

Words of caution: the label “organic” does not mean that the produce was grown locally. While it may lack harmful toxic chemicals, it may have travelled several days to arrive to your location and thus also lacking in vital nutrients.

Although the warm summer-like weather donned upon us this year with as much surprise as our back-to-back blizzards, take this opportunity to explore new grounds in your fertility journey and tune into your inner locavore and enjoy the one predictable mainstay this spring: the flood of fertility-friendly, nutrient-rich produce into our fresh markets.

Check out http://www.rawdc.org/dc/fruitDC.html, an excellent online resource with more details and links to local farmers’ markets, CSAs, and organic retailers scattered across Northern Virginia, Washington, DC, and Maryland. For nationwide information, check out http://www.localharvest.org/.

Click here to schedule a fertility nutrition consultation with Kimberly Wong at Pulling Down the Moon in Rockville.  For more information about nutrition counseling visit our website at www.pullingdownthemoon.com.

Pulling Down the Moon nutritionist Breea Johnson guest-posts on Beth and Tami’s Fertility Authority blog this week.  For more information about fertility nutrition and supplements, you can visit our e-tail fertility boutique.   Our supplement line is “PDtM Approved” and adheres to the standards Breea discusses here.  Of course, nutrition is a highly individualized subject, so we recommend a consult with a fertility nutrition specialist to make sure your program suits your needs and diagnosis.  Check out Breea’s must-read post here.

By Breea Johnson, MS RD LDN

Fish oil with Omega-3s (that supply DHA and EPA) are a class of supplements commonly recommended for women with infertility. While nutritionists stress the importance of quality when choosing supplements, many people buy fish oil from their local store for convenience or to save money. This past week a lawsuit was filed in California against fish oil manufacturers [CVS Pharmacy Inc.; General Nutrition Corp. (GNC); Now Health Group Inc.; Omega Protein Inc.; Pharmavite LLC (Nature Made brand); Rite Aid Corp.; Solgar Inc., and TwinLab Corp]. The lawsuit charges that these companies sold fish oil that contained “undisclosed and unnecessarily high levels of contamination with polycholorinated biphenyl (PCB) compounds.”

What are PCBs? PCBs are a class of chemicals that are now illegal. However, they were utilized for many different purposes in industrial manufacturing – such as in coolants, PVC piping, pesticides and paints among other things. They are now considered one of the POPs (Persistent Organic Pollutants), a group of the most toxic compounds that still exist in our food and bodies despite being outlawed years ago. According to the EPA, PCBs have been shown to cause cancer in animals, and negatively affect the immune system, reproductive system, nervous system, and endocrine system, amongst other ill health effects. Here is an excerpt from the EPA’s website about the effect of PCBs on reproduction in animals and humans:

“PCB exposures were found to reduce the birth weight, conception rates and live birth rates of monkeys and other species and PCB exposure reduced sperm counts in rats. Effects in monkeys were long-lasting and were observed long after the dosing with PCBs occurred.

Studies of reproductive effects have also been carried out in human populations exposed to PCBs. Children born to women who worked with PCBs in factories showed decreased birth weight and a significant decrease in gestational age with increasing exposures to PCBs. Studies in fishing populations believed to have high exposures to PCBs also suggest similar decreases. This same effect was seen in multiple species of animals exposed to PCBs, and suggests that reproductive effects may be important in humans following exposures to PCBs.”

According to the Environmental Working Group, one of the highest food sources of PCBs include farm-raised (or Atlantic Salmon), with 16 times the amount of PCBs as wild salmon. Thus, supplementing your diet with a fish oil that contains PCBs or eating farm-raised salmon to obtain omega-3s may do more harm than good. It’s important to know where your supplements (and food) are sourced from, and how the companies treat and process it to form a supplement. There are many companies that sell high-quality fish oil. Read more about the quality of our fish oil here. Please consult with a Pulling Down the Moon nutritionist if you have more questions concerning this matter.

For more information:

www.fishoilsafety.com

www.ewg.org