‘I’ve been doing this for the last 12 years, I’ve studied at the Institute for Optimum Nutrition in London and also at the Institute For Functional Medicine in the US. I founded the fertility nutrition centre limited, which is a place where you can find science-backed information about fertility nutrition, and lifestyle strategies to improve your fertility. It is also a place where you can find a directory of qualified nutritionists who have trained in fertility specifically to help support you on your journey.’In terms of the prevalence of infertility, Sandra emphasized that she doesn’t like to call it infertility, she prefers the term subfertility because most people are not infertile, they’re just a little less fertile than they would like to be. We want to boost them into the fertile range, but the number of people that this is affecting could be up to about 15%, particularly, in industrialized nations. 1 in 4 pregnancies end in miscarriage as well, it’s quite common. Sandra talked about the factors that you have the power to change or modify, and those are your nutrition, your weight management, exercise, your stress levels and coping mechanisms with smoking, drug use, medications, alcohol, caffeine and environmental exposure, those are the main kind of areas where you have the power to make a big difference. Food and nutrition affect your fertility, your lifestyle affects it, the toxins that you come into contact with. A balanced diet is a myth because if you look at the research:
‘Only a third of men and women are achieving a five a day fruit and vegetable target.’That is the official guideline in the UK, depending on where you are, the guidelines may be different, but actually, it’s better to aim a little higher than five a day. People tend to think they have a fairly healthy diet, there is often room for improvement. Another thing that was illustrated is that everything that you come into contact with through the food that you eat, the air you breathe, everything that touches your skin affects egg and sperm development, it takes roughly 3 months to mature a batch of sperm or to mature an egg ready to be released for ovulation. That time is critical in terms of affecting the health of those cells because as they are maturing, they come into contact with everything that you put on your plate and everything that you come into contact with, so it is quite important to think about this.
‘Obese men are three times more likely to have reduced semen quality compared with men of a normal weight, and overweight men have also been found to have increased DNA damage in sperm.’
For women, being too slim is also not particularly helpful. If the BMI is close to 19, that’s when ovulation can start to become affected. On the other hand, IVF clinics, at least in the UK, won’t take women who have a higher BMI than 30 because of the added risks and lower success rates. It’s worth working with nutritional therapists to lose weight safely and slowly.
‘Men eating fruit and vegetables with the highest pesticide residue had a 49% lower sperm count and 32% fewer morphologically normally shaped sperm than those who are eating less food with fewer pesticides.’Unfortunately, you can’t just wash it off with water because they tend to be petrochemicals, and also they tend to penetrate the fruit and vegetables. Ideally, if you can get organic, that is a really good strategy, and some studies show that couples who eat organic food have better IVF outcomes. It can be more expensive, but you can Google it, and you’ll get a list of the things that it’s better to buy organic and the least important ones. That way, you can start implementing some changes.
‘There is strong evidence that complementary treatment with an appropriate nutraceutical improves the natural conception rate of infertile couples and increases the success rate of assisted reproductive techniques.’This is well known, but supplementation is a real mind field. There’s no training or supplementation for any doctors or consultants that work in fertility unless they’ve taken specialist nutritionist training. Sandra always encourages patients to work with a nutritionist to tailor supplements to their needs. Supplements and food, lifestyle can turn genes on and off. What you supplement within the three months running up to conception has long-term effects on your offspring’s health into later life as well. Women who take multivitamins may have fewer ovulation problems, supplements improve pregnancy rates, but when you’re choosing supplements, you want to look at the ingredients. Most nutrients come in many different forms, and some are cheaper and more easily formulated into a supplement, which will go into the cheaper brands. If you get a really good quality brand, you’re getting better absorption, better efficacy and potentially higher doses as well or therapeutic doses. What you also want to avoid is certain fillers and excipients, which are detrimental potentially as well. The cheaper supplements tend to be filled with all sorts of things that shouldn’t be eaten. You also need to be aware that supplements, nutrients and herbs are very powerful substances, and they interact with each other. They also interact with any potential drugs that you might be prescribed or take over-the-counter, so you have to be very careful when you’re taking a supplement that you’re not inadvertently actually harming your own health.
I’m thinking it’s possibly something like a slim fat something like that, so I’m, unfortunately, not a fan of shakes. I think we need the act of chewing and sitting down and eating a meal, that’s just that part of it is important. Having a shake, having a drink doesn’t satisfy us mentally and emotionally, we do have a connection with what we eat.
As you are preparing for egg donation, I would work with a nutritionist who can help you get those whole foods back in your diet, and it’s about helping you properly move. Walking is an excellent way to lose weight, swimming if possible. Also, building a little muscle can help to kick-start weight loss because those muscles use more energy. When you’re resting, you’re still increasing your metabolic function.
I would recommend that you also get a good thyroid screen, not just the standard thyroid screen, where your doctor will look at TSH and T4 without going into too much more kind of in-depth about the thyroid. There are many other markers that we also need to look at to make sure that the thyroid problem isn’t playing into your problems with losing weight and also PCOS, so it’s about balancing your hormones to support your body to do what it wants to do, what it’s supposed to be doing because I think that having a diet of shakes and maybe over-exercising is ultimately going to push your body into a state that it’s not going to be necessarily particularly happy, and it’s increasing your stress levels, so I would recommend working with somebody who can help support you to lose the weight safely and healthily as well.
Again, it’s about not starving yourself. We need to eat properly because if we’re starving ourselves, our body will just immediately go, okay let’s down-regulate everything. If you have hypothyroidism, and you may be medicated, potentially if your levels are all normal, there may be something playing in, so again having a proper full thyroid panel would probably be helpful. Also, there could be something else going on such, as PCOS connected to that. Boosting metabolism, it’s about movement. Moving and doing some weight training, and you don’t need to buy weights or go to a gym, you can just do squats, and as long as you’re building some muscle, that should help as well.
I would agree that most, yes. I mean, I hope you’re eating something. You do need your healthy fats, your healthy protein. I’m not a big fan of trying to be perfect because it’s just incredibly stressful, nobody can live out and not have anything that has touched any plastic ever, and it’s not possible. I would say it’s very individual, a little sugar is fine as long as you’re not diabetic or having it every day, gluten, some people do need to cut it out, not everyone does. A little meat is quite important because it does have nutrients that you can’t get from vegetables or vegetarian food. I wouldn’t say to cut meat out completely, dairy again is very individual, some people can tolerate it, some people can’t. Tofu I mentioned vegetarian forms of protein are quite beneficial, so is soy unless you’re intolerant. I wouldn’t avoid it necessarily, but I certainly wouldn’t be having soy yoghurts or soy milk, which are not the traditional way of having soy. I would say go for tofu for sure, we just don’t want to overdo anything but a little tofu or tempeh can be quite beneficial. Alcohol again, if you have a glass of wine once a month, twice a month, it’s okay to enjoy a glass of wine with a friend, just don’t have a bottle.
Again, a little coffee is fine, look for organic, maybe a decaf. If you want to get a better coffee option, you can go for the Swiss water decaffeinated coffee, which has slightly fewer toxins added to it. I think a little chocolate is fine, it contains a little caffeine, but cacao is a very potent antioxidant, so it makes your guts very happy, it contains a bit of magnesium, so a little of chocolate, but I would go for the dark, high quality, not the kind of cheap stuff, which is just sugar. Cans again, one or two things out of a can isn’t going to kill you. Plastic, you can’t avoid all plastic, but we don’t want to be so perfect, then we end up being stressed about what we’re doing because then it’s just counterproductive, so it’s about finding a balance and finding what works for you.
I work with people all over the world, and in some countries, it’s hard to find better alternatives, and then we do what we can do, and we don’t worry about the things that we can’t do. Fruit contains a bit of sugar, I would say go for the lower sugar options like berries, apples and pears rather than the tropical fruits like bananas and mangoes and pineapples because they are higher in sugar. Two fruit are probably about right, and then try and get your antioxidants from vegetables on top of that.
Cinnamon is a very healthy spice. All spices are good, it makes our gut bugs very happy. Any spices and herbs that you can add to your foods are going to be beneficial. I’ve never heard of cinnamon being problematic, it can help balance your blood sugar, so I certainly use it a lot. Sparkling water, it’s better to drink still water, but again if you have a glass of sparkling water once in a while, that is not going to be a problem. Canned sweet drinks or pops like Pepsi, Coke, that kind of thing is detrimental. With sparkling water, I wouldn’t be worried about it.
It’s trickier for sure, so you do need to look at your protein sources, your legumes, nuts and seeds, tofu, you are going to have to rely on those types of sources of protein. You can also get the hemp protein powders, pea protein powders, I’m not a massive fan of protein powders, but if you’ve been told that you’re not getting enough protein, maybe that’s what you need to do. Fish oil, you can get vegetarian sources of fish oil now in supplement form. There are two or three brands available now in the market of non-fish vegan fish oil products.
Vegan diets are deficient in or potentially deficient in many nutrients, which is specifically important for fertility, so we’re looking at iodine, B12 potentially iron, calcium. Most of them you can get from a vegan diet, but you have to be very specific about how you eat and what you eat to meet your needs. The other thing about vegan proteins is that the amino acids that make up those proteins do tend to be lacking a couple of the amino acids. I think that unfortunately, it’s difficult to get everything that you need before and during pregnancy as a vegan. There isn’t food or a specific thing that you need to eat that’s going to make up for the lack of what an omnivore would be getting from their diet. I would recommend that you work with a nutritional therapist specifically skilled in working with vegan diets, you may need some testing actually to make sure that there aren’t some very important amino acids missing and B vitamins, iodine for your thyroid and all the other nutrients as well.
This is why you’re advised not to eat oily fish more than twice a week during pregnancy, and I think that’s a good rule of thumb in a run-up to pregnancy as well. I advocate a food-first kind of strategy, I think food is most important, we shouldn’t be relying on pills for our nutrients, but fish oils are one of the things that I would say take a pill and don’t try to get your need met through your diet by eating so much oily fish because then you will end up with toxic levels of mercury and dioxins and all sorts of toxins that are leaked into the food chain and our seas and our waters, unfortunately, and you need to get a really good quality, not a fish or a cotton liver oil because the liver is where the toxins are processed, you need the oil from the skin of the fish, and it needs to be independently batch tested for contaminants.
A nutritionist can advise you on which ones to get, it’s about the forms of the oils as well but fish also you know contains iodine, it’s a very good source of protein, so I would say still do have some in your diet, and so if you want to start to avoid toxins, the Alaskan salmon is the more healthy forms, they are the least toxic ones, of course, they’re transported across halfway across the world. Farmed fish, unfortunately, is not particularly good for you, prawns, again they’re bottom dwellers, so they tend to consume what’s at the bottom of the seas, and of course, toxins are heavy. Some heavy metals sink. Farming practices are just not very pleasant at all when it comes to shellfish, so again that should be potentially an occasional treat.
The smaller the fish, the less toxic there will be because if you’re looking at the tuna, for example, or a salmon they’re eating other fish all the time, and the toxins accumulate in their body, but if you’re taking smaller fish, then they haven’t had that time, or they just don’t accumulate so many toxins. For example, sardines are good. We want to avoid the most toxic fish, so are the swordfish, tuna and sea bass is also particularly toxic, so they should be like special treats, and it’s a reality that we have to live with. It’s a bit of a minefield out there, but omega-3 oils fish oils are ones that I would recommend that you get a very good quality brand, and it is important not to be missing. This is also going back to the question about vegan diets, that’s another thing, that’s very commonly lacking in a vegan diet. Although you can get omega-3 from flax and walnuts, we need the DHA form for healthy neurological development and brain development for the baby, and you don’t get any of that from those sources. Most of us are very poor converters, so it’s about taking the DHA and the EPA in a pill, unfortunately, I hate to say it, but that’s true.
Again, it’s the fish oils, they’re omega-3 oils, they’re anti-inflammatory. Avoiding the opposite of that, which is the saturated fats from red meat. You want to be having all of your anti-antioxidants, all the vegetables, lots and lots of colours, avoiding toxins as much as you can. Three months, if you can, six months would be ideal, but lots of people have less time than that when it comes to adenomyosis. We can’t pretend that we can remove any of this just by changing our diet, but we can change pain levels potentially, and we can change that kind of environment to help you improve the inflammation. It certainly is not going to remove any scarring or any anything like that. I’m a huge fan of wind massage as well. I think that it can be very helpful to release adhesions and make sure that everything’s flowing properly around the womb and the pelvic area.
Avoiding environmental toxins is quite important, and also avoiding vaginal infections, we tend to do a vaginal swab looking at the community of bacteria and viruses in the vaginal tract. What’s in the vagina tends to track up further into the womb, but obviously, we don’t want to sort of disturb the womb if we don’t have to. The different types of bacteria can be beneficial or not, and so then after this test, we can start to improve the environment vaginally to again help lower any inflammatory pathways that may be going on there. Other things to include are things like herbs, spices, ginger, turmeric, those are all anti-inflammatories, natural anti-inflammatories that you can start to incorporate in your food as well. Even though I said the Mediterranean diet, I like to sort of taking elements from the Indian and adding them, they’re very helpful, as well, with this sort of anti-inflammatory spices.
We’re looking at pulses, nuts and seeds particularly, hemp, particularly pee, which is pretty much what you’re left with. I mean, all foods contain some protein. You’re looking at rice, and there is some protein in all of those foods, but they come bound with carbohydrates, so they have a different amino acid profile to animal products.
I was referring to high-intensity exercise, so things like spinning. Walking is not high intensity. Walking probably, would be considered low intensity, so that’s completely fine, and we should be doing plenty of the low intensities types of exercise, but it’s the high intensity that’s telling your brain that you’re running away, you’re stressed, you’ve got our brain developed to alert us to something dangerous in our environment, we still have a reptilian brain as opposed to sort of operating in palaeolithic times, and if you’re running like crazy every night, or you’re spinning, you love your biking, and you’re sort of like spinning because you’re trying to lose weight. We’re just telling our brain that we’re stressed, and it’s going to start to put out hormonal information to the rest of your body to adjust the hormones to down-regulate fertility, so it’s about the types of exercise, it’s important to do some.
I am not qualified to prescribe melatonin. I don’t think that melatonin is a good product necessarily for people to just start supplementing. I know you can buy it over the counter in the U.S., and you can get hold of it in the UK, as well, but if you’re trying for a baby naturally taking an additional melatonin supplement can disrupt your ovulation. If you are preparing for an IVF, you could talk to your consultant about whether they’re happy to recommend that you take some melatonin, but what I’m trying to get across is that we want to lower our stress hormone, cortisol, and we want to optimize our body’s own melatonin production by sleeping well, having a proper bedtime routine, avoiding screens late at night and all of those things that are going to help you raise your melatonin naturally, not by taking a pill.
The difference between folate and folic acid is that folate is the form found in nature, it’s what you find in vegetables, especially the dark green leafy vegetables that form is found in nature. Folic acid is a synthetic version, it’s made in a lab. Folic acid has been shown in studies to help prevent birth defects, and therefore every female who is trying, who’s getting ready to try to conceive is recommended to take 400 micrograms of folic acid for 12 weeks before they get pregnant. Since folic acid is in synthetic form, I’m not a huge fan. I believe that we should take food how our body recognizes it because it’s in its natural form, also depending on the genetic makeup, you may or may not be able to utilize the folic acid properly because it requires an extra step of conversion before your body can absorb it. Your body can’t use folic acid as it is, it has to change it first, and between 40 and 60% of the population have an alteration in their genetics, which means that they can’t do this.
There are several of them, and we call them snips, so you can have several snips that affect your ability to use folic acid, and it’s very common. I mean I’ve got two of them myself, and if it’s just safer to take folate because then you know that your body is most likely to be able to utilize it. The other thing about better quality supplements compared to cheaper quality supplements or lower quality supplements is that folate is very difficult to formulate into a product. There’s also a monopoly, there are only two companies that sell folate to companies that are then formulating them into supplements. Those supplements will be more expensive, so you will be automatically paying more because you’re getting a better product and so the cheapest supplements. A lot of them have a lot of money for advertising, and they pay celebrities to say I take the supplement, and they’re very popular, but more and more now, the top-quality supplements are now all starting to contain folate instead, and for a good reason.
Your doctor won’t have heard of this. It’s not something that’s in a kind of conventional realm yet. The snips are called an MTHFR snip, and you can have a genetic test, which will tell you exactly your genetic makeup. I use a lab called life code and also a lab called Nordic, I don’t know if they sell directly to the public. You might have to work with the nutritionist. I think you can also still go to 23 and me but be aware that the results take forever to get back from them. There are lots of genetic test kits on the market, some are better than others, but the markers you’re looking for is MTHFR.
Towards the end of pregnancy to help tone the uterus, yes. I probably wouldn’t recommend it in preparation for pregnancy or an early pregnancy because there is a theoretical risk that it could lead to miscarriage. After all, it tones the uterus to help it contract better.
Ubiquinol is good for egg health, it’s also potent antioxidants, you can take it if you can afford it as it’s expensive, but it’s not detrimental. Vitamin D is essential for everybody, vitamin E helps mature your uterine lining, so if you’ve had a problem with your uterine lining, vitamin E might be beneficial. DHEA is a hormone, we as nutritionists don’t recommend those, certainly, lots of people should not be taking DHEA, you need to have male androgenic hormones tested before you take it, that’s also used for egg health, so certainly no point taking it if you’re using an egg donor. L-carnitine probably is not something that I would necessarily put in, melatonin as well, that’s for egg health, you don’t need to worry about that. I would say for your health and babies health and development omega-3 is still important, a multivitamin for sure. That’s just without knowing anything about you, of course, you need to make sure that any drugs that you’re taking are safe with the supplements that you’re taking.
This is a tricky one. I do sometimes work with the donors to prepare them for the harvesting of those eggs and that is obviously for the three months in the run-up or more. It’s not necessarily that usual, though, I would say. If you can’t help them or affect their diet and supplements, then please don’t worry about that.
Usually, egg donors are younger, which means that we do have a little more leeway when we’re younger, as well and as we get older, unfortunately, that’s when everything starts to go, but our body changes., Of course, the egg recipient, you’re the one that’s probably going through all the stress, and you’re getting injected with lots of hormones, and you want to make sure that your inflammation levels are low and that your endometrium is healthy but also that you’re well-nourished so that you can go through your pregnancy in a healthy state without becoming depleted and nutrients. I certainly can’t say which is more important, but you must look after yourself, and if you do have the opportunity to perhaps, get your donor to work with a nutritionist for a few months, that’s only going to be positive, but please don’t feel hat’s somehow necessary for you to do that because I think it’s probably quite unusual.
Frozen fruit, vegetables, they’re generally frozen at the time of being picked. They’re picked fresh as opposed to picked two weeks before so that they can sit or ripe and survive transport and get to the shops. Frozen fruit and vegetables can be higher in nutrients than what you find in fresh in the shop, so I have no problem with that at all, it’s a great way to get extra nutrition in.
Probably not, it is very unlikely that two weeks of eating off the plan is going to cause such a big effect. When we are changing our diet and lifestyle, it’s about what we do most of the time that’s going to make the most change. So unless you’re eating something that you’re intolerant to, or it made you sick, or you had some illness from eating contaminated food, then certainly, I would expect the reason for that cycle not working probably to be something else.
It’s very individual again, it comes down to your genetics, so without knowing your genetic makeup, I can’t say. The studies are very variable, but I would say for women, unfortunately, we get away with less than men. What you can do, what you can cope with and what you can manage and if coffee a day is something that you need, and you don’t want to negotiate on, I’m sure there are other things that you can put in place that’s going to be beneficial for you. I personally have bought smaller cups, so I’ve got like little cups at home, so I have a smaller amount, I still feel like I have a cup of coffee in the morning, but I have a much smaller amount. You may be able to swap to a decaffeinated version. It comes down to genetics, when you drink coffee, it has a seven-hour half-life, which means that after seven hours, half of the caffeine that you’ve got from your cup of coffee is still circulating in your system roughly.
It depends a little on your genetics, but if you’re somebody who can’t sleep if you’ve had a coffee at two o’clock in the afternoon, you’re probably a slow metabolizer of coffee, so you’re more likely to be affected than somebody who can have three cups of coffee after a night out and sleep all night without any problems. Also, if you get jittery or shaky, or you feel this effect from drinking coffee, you might want to think about cutting down a little.
Coffee is high in antioxidants, it is an antioxidant food, but it also has very high pesticides potentially, so organic coffee I think is important. The other thing about coffee is that it generally contains aflatoxins, which is a type of mould that affects coffee beans. Aflatoxins are toxic to health, and there is no research enough on aflatoxins and fertility specifically, but I believe that again anything that’s not good for your general health is probably not going to be good for your fertility. It’s just becoming aware, and also coffee beans are heated to a high temperature, which again is never a good idea because high temperatures create reactive oxidative species generally that is detrimental to health, but it’s about doing what you can do and not worrying about the things that you just can’t cope with. Perhaps, you’re somebody who doesn’t drink, or you can eat extra antioxidants in the form of lots of fruit and vegetables, in which case, coffee might not be a problem for you.
It can affect implantation, it affects the environment in your vagina. Of course, if you worked with a fertility nutritionist, we would look at the ecology and what’s going on, and we would do a swab, and whether you’ve got the protected bacteria or whether we need to put it back, and sometimes we use pessaries vaginally that puts back the healthy bacteria, and you know you might want to reduce the level of sugar in your diet and things like that. Very often, that isn’t enough, we might use some antimicrobial herbs, but generally, you can try to cut down on sugar and those white sticky fluffy foods, the processed kind of white carbohydrates, because that’s what the candida organism feeds on, but if that is a problem with repeated infections, I would want to know what else is going on in your vagina, why your body’s own flora isn’t able to fight the infection and support it that way.
Yes, it’s fine.
I don’t know whether it’s the same, but certainly, BMI is still important, and I think trying to reduce levels of inflammation, all the things that we’ve talked about movement, vegetables, having a healthy diet, drinking lots of water, all of those things are still important for your health as well as the babies.
Chewing your food is important, your stomach doesn’t have teeth, we begin the eating process when we see the food, and all the digestive juices that you have in your oral cavity starts to prepare the process of digestion further down. You do need to chew your food, a good rule of thumb is if you’re eating a piece of broccoli, you shouldn’t be able to tell the difference between the stem and the top of the broccoli before you swallow it, so you shouldn’t be able to tell the difference, and it should be very well-chewed, making sure that you’ve got adequate levels of stomach acid, which is again how it absorbs minerals from your diet, unfortunately, a lot of us have low levels of stomach acid, it does happen with age, the stomach acid levels go down, but also stress depletes stomach acid because your body is sort of diverting energy away from digestion when we’re stressed because we’re getting ready to run away or defend ourselves from this sort of dangerous animal that supposedly is coming towards us, and the problem with lowering levels of stomach acid is then that we absorb less zinc, and we need zinc to make stomach acid, so sometimes it’s working with a practitioner who can identify whether you do have low stomach acid and give you a supplement that you can take, you can take digestive enzymes as well, but digestion starts with sitting down and having a meal at a table, not at a screen, not reading your emails and having that time and focusing your food, lowering your stress levels. Appreciating the food and chewing it properly is the number one strategy, and it’s the hardest one I think for people to follow, as well.