Tag Archives: Fertility Diet

Apples, Pears and Fertility – How Shape Impacts Our Ability to Conceive

Posted on March 11, 2012

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

 

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Chronic Negative Energy Balance and Fertility: Is Your Exercise Program Affecting Your Ability to Conceive?

Posted on February 22, 2012

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.

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Fertility Friendly Eating on Budget

Posted on February 7, 2012

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.

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“Nourishing Up” for Fertility

Posted on November 6, 2011

Healthy Dinner by Beth Heller, M.S.

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

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

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

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

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

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

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

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Fat: Fertility Friend or Foe?

Posted on October 24, 2011

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

by Margaret Wertheim, MS, RD, LDN

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

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

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

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

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

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Should You Go Gluten-Free for Fertility?

Posted on September 22, 2011

by Beth Heller M.S.

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

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

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

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

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

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

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

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

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

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


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2 Responses to Should You Go Gluten-Free for Fertility?

  1. Amanda says:
    September 28, 2011 at 7:21 am

    I have been reading your book ‘Fully Fertile’ and working through the programme, which has re-ignited my passion for yoga, nutrition and a calm lifestyle. I wanted to ask advice (my doctor is very dismissive) about my ‘unexplained sub-fertility’ (being trying for a baby since Jan 2010 and I am 36) with a mountain bike accident I had in Dec 2007, when I fell and broke my back in 3 places. Do you think there could be a link? Any advice would be great. I start taking Clomid next month and very anxious about its side-effects….

    Thanks,

    Mandie (in England) :)

  2. admin says:
    September 28, 2011 at 9:29 am

    Mandie,
    Thanks so much for this comment. I am so glad our book has sparked your passion for the holistic path again. Regarding your back injury and fertility, we cannot say there is a direct link but, as you know, a holistic approach looks at all possible contributing factors when considering a woman’s fertility. Conceivably (no pun intended) a back injury could result in scar tissue and/or postural changes that could be impacting your pelvic organs. Whether or not there is a concrete link between your accident and your fertility is hard to say but from the perspective of yoga it’s definitely important to regain strength and flexibility in the spinal column. I would suggest you work with a physical therapist and a skilled yoga teacher to find a gentle yoga practice that suits your needs. You may also want to try reiki work to see if you can connect with any possible emotional trauma that may be lingering from the accident.

    Best of luck with your upcoming clomid cycle – it’s not pleasant but it does have the potential to work. Have you considered trying acupuncture in addition? It can be very helpful with the side-effects and may combat the thinning of the uterine lining that can be associated with clomid. I took clomid for my son, Jackson so I have a soft spot for that drug :-) Peace, Beth

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ART Recovery (or Prep) – Case Study

Posted on August 10, 2011

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

At Pulling Down the Moon we will often recommend a “cleanse” diet following a miscarriage or failed ART cycle.  While a cleanse can, at times, entail the elimination of one or more common food allergens like dairy, wheat and soy, elimination is not the basis of our program.  More often than not our cleanse consists of limiting processed sugar and other processed foods, artificial additives and colors while focusing on foods that support our body’s anti-inflammatory and detoxification processes.  The cleanse program at Pulling Down the Moon is individualized and takes into consideration a woman (or man’s) past and present digestive function, hormonal and other symptoms, medical history and current lifestyle.

One key element of our program is supporting hormone balance.  After a failed ART cycle or a miscarriage, a woman’s body must re-establish hormonal balance and function.  It may have been months since her last natural menstrual cycle. Weight gain during treatment may also impact hormone balance.  Yet another common symptom reported by our patients post-ART is anxiety and a lasting case of “the blues.”   It’s very easy to attribute these emotional side-effects to disappointment but there may also be a physical component.   The hormone medications used during the stimulation phase of an ART cycle, and the progesterone supplementation post-IUI and ET, can cause emotional side effects and these hormones can be slow to leave the body.  The liver is charged with processing these steroids before they can be excreted.  To do this it requires ample amounts of amino acids (in particular sulphur-containing amino acids), as well as the vitamins and minerals that work as co-factors in detoxification pathways.

Our ART Recovery/Prep Program focuses on limiting sources of external hormones by discouraging foods that contain hormones and hormone-like substances.  Chief offenders in this area include factory-farmed dairy and meat products which contain the hormones and growth factors used in production.  There are also hormone-like chemicals in pesticides and plastics.  By limiting these external sources of hormone-like substances and increasing the intake of foods that support good hormone function (fiber, lignans and lignins, a range of whole grains – not just wheat! – , healthy fats, cruciferous vegetables, antioxidant rich fruits and veg and added-hormone-free protein) we have the potential to bolster our body’s ability to metabolize and excrete excess hormones and restore balance in the reproductive cycle.

Our Rockville nutritionists Laura Dubrule, R.D. recently  shared a case with me that drove this message home.

My patient is 43 and had experienced two failed IVF cycles in quick succession (6 months time).  Her physician had noted several potential factors contributing to failure including egg quality and endometrial lining quality.  In addition, the patient had recently been diagnosed with PCOS.  Since her last IVF the patient was unable to lose the 8 pounds gained during IVF treatment despite eating a healthy diet and working out four times per week.

We discussed the impact of IVF medications on hormone levels as well as the impact of various dietary choices on her body’s ability to break down and clear excess hormones. We focused especially on tweaking her already health-supporting diet to include significant amounts of cruciferous vegetables and berries every day as well as a daily serving  of legumes.  I suggested she add two supplements, RePro Cleanse and FlowPro, to her regimen as well as vitamin D.

I was very surprised when the patient returned for follow-up having lost 8 lbs over the preceding two weeks.  At Pulling Down the Moon we are extremely careful not to encourage rapid weight loss but upon review of my patient’s diet it was clear that a reduction in calories was not a major factor in her weight loss. The patient reported feeling that the weight came off her abdominal area, that she had lost a bloated feeling, and that her clothes fit the way they used to.

The patient also told me about the resolution of another symptom she hadn’t mentioned in our initial consult. She had been experiencing high levels of anxiety while driving, especially on the highway.  This was not her experience historically, but had been a recent development.  Over the course of the two-week cleanse, this driving anxiety completely disappeared.

While we can’t be certain, we suspect that this rapid loss of water weight and alleviation of anxiety may have been due to an increased clearance of excess steroid hormones that had been circulating in her system.   Whatever the reason, the result was excellent.  While there is still work ahead, my patient is very pleased with the results of her cleanse and feels more like herself than she has in months.  We both agreed that anything we could do to reduce the lingering effects of ART would only help her feel more prepared for her next round of treatment.

We believe that a nutritional consultation can make a big difference in the fertility journey.   Our consultations are available in person in Chicago and the DC Metro area and by phone from almost anywhere else.  Call 312-321-0004 (Chicago) or 301-610-7755 (Rockville) for information.

RePro Cleanse includes kudzu, flax, rice protein and other micronutrients that support the liver’s detoxification processes. Because it contains plant estrogens and is designed to help balance and promote clearance of excess reproductive hormones, we do not use RePro Cleanse when a woman is on fertility medications or birth control.  We often recommend supplementation with Re Pro Cleanse when women are recovering from a failed cycle or miscarriage, or in cases of hormone-related conditions like fibroids or endometriosis.  We will also use RePro Cleanse when a woman’s IVF cycle is cancelled/postponed due to high baseline estrogen levels.   Used as directed over a period of 2-4 weeks we feel that this supplement can help jump start a woman’s recovery process in preparation for a subsequent cycle, be it ART or natural.  Of course we recommend that our patients clear any/all supplements with their physicians.

About Laura Dubrule

Laura brings an eclectic mix of passions to her nutrition counseling. Her years studying acting in New York taught her the importance of connecting with our bodies; this deep sense is fundamental to her understanding of diet and nutrition. Laura completed the program in Nutrition and Food Science at Hunter College in New York, and then went on to complete her dietetic internship at Stony Brook University, a program with an integrative and functional approach. She returned to the city and practiced in a worksite wellness program, delivering individualized nutrition counseling to bank employees in Manhattan and Brooklyn. Her vision for her clients could be called “whole foods meet real world.” She believes that food is meant to be enjoyed and works with her clients to find healthful approaches to eating that are satisfying and enjoyable.
Laura is thrilled to be working in concert with acupuncture, yoga and massage professionals because she believes that the nourishment and care of our hearts and souls is integral to the nourishment of our bodies. She considers it a privilege to be a resource to men and women on their fertility journeys and to celebrate every step long that path as an act of love and creation.
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Supplements to Improve Egg Quality?

Posted on June 5, 2011

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.

This entry was posted in Fertility, Fertility Diet, Holistic Fertility, Nutrition for Fertility, PCOS and tagged , , , , , . Bookmark the permalink.

16 Responses to Supplements to Improve Egg Quality?

  1. Lashonda Munson says:
    June 8, 2011 at 12:04 pm

    I have more question about the egg controll

  2. admin says:
    June 9, 2011 at 4:40 am

    Lashonda, you can post your general questions here and if you have more specific needs you can contact our office to speak to one of our nutritionists. Thanks!

  3. Faith says:
    July 14, 2011 at 4:09 pm

    Do you recommend these supplements for women who are trying to conceive naturally (without IUI or IVF)?

  4. admin says:
    July 18, 2011 at 5:47 am

    Hi Faith, It would depend on age, diagnosis, etc. Have you seen a doctor or been given a reason why you’re not conceiving? In general we would recommend working with a nutritionist who can guide you to not only to the right supplements but also explain how diet choices can impact fertility. Melatonin should NOT be taken in high doses in women who are “trying naturally” as it may delay ovulation (obviously not great for fertility!). There’s no consensus of how high a dose of melatonin is required to delay ovulation so until there’s more clinical data we proceed with caution in natural cycles. Melatonin should also be avoided if you have depression, thyroid issues or are taking thyroid meds. DHEA should not be taken by women with Polycystic Ovarian Syndrome (PCOS) or by women who are pregnant. Because these supplements have contraindications would recommend that you get screened by a fertility doctor for these conditions before trying either melatonin or DHEA. Myo-inositiol has less potential for side-effects but, again, we recommend that you clear any supplement with your physician first.

  5. Beth says:
    July 22, 2011 at 2:50 pm

    I’m trying naturally after several months of clomid. I’m 40 with secondary infertility. I’m also on synthroid for hypothyroidism. Which supplements would you suggest?

  6. admin says:
    July 25, 2011 at 6:22 am

    Hi Beth, it’s difficult to make a specific recommendation without a full nutrition intake. In general we recommend what we call our “Core Five for Fertility” – a good prenatal (like our Prenate Pro), an omega-3 supplement that has >700 mg EPA and >500 DHA, a probiotic to support the immune system, the gut and detoxification processes, Vitamin D for good hormonal function and CoEnzymeQ10 to support mitochondrial function in the developing eggs. In addition we have specific protocols for Egg Quality, PCOS and hormonal imbalances. Our nutritionists would have to look at your diet, your gut function, symptoms and menstrual cycle before making specific changes. You probably already know to limit soy (especially processed soy) as it can interfere with thyroid function. I highly recommend a nutrition consultation with one of our specialists – they are available in person in Chicago or the DC Metro area or via phone. We offer two tracks. Our Therapeutic Nutrition Track is for women working on a specific issue like egg quality, poor response, endometriosis or PCOS. This may or may not be combined with our ART Recovery/Prep Program, a healing “cleanse” program that we often use in cases of failed cycles, miscarriages and unexplained infertility. I wish you the best of luck and hope #2 comes quickly.
    ! Peace, Beth

  7. Carrie says:
    July 28, 2011 at 10:33 am

    What do you suggest for women who are pre-menopausal (POI, POF) who still ovulate pretty regularly? I do take DHEA and have for awhile. I am going to be 40 soon, and have had 2 successful pregnancies and 3 miscarriages.

  8. admin says:
    July 29, 2011 at 5:13 am

    Carrie, thanks for your question. I’m sorry to hear that you’ve experienced so many losses but also heartened to hear of your successes. You don’t specifically mention that you’re trying to conceive again but I’m assuming that is your goal as I respond to your question.

    Without a full history it’s hard to be specific but here are some general thoughts. With POI we usually start with the diet, and work with strategies that improve nutrient intake, limit inflammation and oxidative stress and promote hormonal balance. In some cases that means our nutritionists will eliminate dairy, gluten and soy but that will depend on a patient’s individual case, digestion, medical history, etc. Regarding supplements, we do use DHEA in some cases but we do not like women to take it for longer than 3-6 months at a time. We would definitely take a look at how long/how much DHEA you are using and how you feel it is helping your cycles before deciding whether or not you should continue. Beyond DHEA there is emerging data that myo-inositol may play a role in the maturation process of eggs so this is a supplement you may want to try. We also believe CoQ10 and fish oil (EPA/DHA) may also support the hormonal milieu and eqq quality.

    In some cases we will use a product called Reprocleanse. This is a non-soy phytoestrogen supplement that is NOT appropriate for women using medical fertility treatment. In women trying naturally we will sometimes use it for two weeks to a month after a miscarriage or in cases of high estrogen or other elevated hormones. Anecdotally we have seen benefits. Of course, we recommend you clear all supplements with your physician prior to starting.

    If you want more specific guidelines, our nutrition consultations are available in person in Chicago and Rockville, MD and by phone from anywhere else. It’s an in-depth, personalized process that may not only enhance your fertility but may also improve your general health.

    Best of luck! Peace, Beth

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  11. Shannon J. says:
    November 4, 2011 at 5:53 pm

    Hi there! I am excited to have stumbled onto your site as it seems filled with excellent information!
    I am wondering if you can speak at all to the supplementation of only Myo-inositol? Is it only effective when paired with Melatonin or is there reason to believe that seeking this out independently may offer some improvement as well? Perhaps paired with CoQ10 (with Omega-3)?
    I am 32, have 1 failed IVF (zero fertilization; eggs luteinizing) and 1 ectopic pregnancy (have since had bilaterial tubal removal) and am preparing over the next 4 months for my 2nd IVF. Eqq quality MAY be an issue and I am hoping to do what I can to increase my odds!
    Any advice you can offer would be greatly appreciated! Thank you.

  12. admin says:
    November 5, 2011 at 5:17 pm

    Thanks so much for your comment. We use myo-inositol in several different contexts – in women with PCOS, in women with a history of hyper-stimulation during IUI and IVF and as part of the melatonin/myo protocol described by Unfer et al. Because melatonin can interfere with thyroid meds, we will sometimes use myo-inositol by itself in women who are poor responders and/or have egg quality issues. In fact, we are actually hoping to conduct some research looking at myo-inositol without melatonin to support egg quality. Of course you should always clear any nutritional supplement regimen with your physician.

  13. Jordan says:
    January 12, 2012 at 9:11 am

    What would you suggest for someone who’s eggs are 2 small. I was told my eggs should be bigger at this point of time in my cycle. Is there any vitamins or herbs that can help with the size?
    Thanks.

  14. admin says:
    January 16, 2012 at 8:03 am

    There are no supplements proven to increase egg size/quality, however, there are several protocols under investigation for potential benefit. You may want to ask your Reproductive Endocrinologist about DHEA, myo-inositol, melatonin and CoQ10 with your next cycle if this one is not successful. We do not recommend taking these supplements without doctor’s approval.

    Let’s hope this cycle works, though…Best of luck!

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Why Fertility Nutrition Starts in the Gut

Posted on April 20, 2011

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

This entry was posted in Fertility, Fertility Diet, Holistic Fertility, Infertility, Nutrition for Fertility, Stress and Fertility and tagged , , , , . Bookmark the permalink.

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Is the ANDI Fertility-Friendly?

Posted on March 15, 2011

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.

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