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If you want to listen to the full episode, head over to: www.wellspringnutrition.co/healing-in-fertility

Transcript:

Hey, everyone. I’m Anabelle Clebenar, registered dietitian, functional nutritionist and your new fertility bestie. In this episode, I’m going to cover why some of the things you’ve tried in the past haven’t been working for you, what a conventional approach to fertility looks like, and why you need to start thinking about a different approach to your reproductive health. All right, let’s dive in. So if you’re like many of my clients, you’ve probably tried a whole bunch of different things on your fertility journey. I’m guessing you probably started tracking your cycles. Maybe you’ve used ovulation predictor kits. Maybe you cut out some of your favorite foods.

Maybe you cut out sugar, alcohol, gluten, dairy, grains. Maybe you’ve tried a whole bunch of different supplements because you saw an influencer talk about them. Or maybe you got an Instagram ad and you thought, hey, why not try it out? And maybe you even went to your doctor and you were met with some really terrible advice like lose some weight, or just wait another six to twelve months and then come back. So let’s break down why some of these things are not working for you, and also why this approach to fertility doesn’t make that much sense. Okay, first let’s talk about period tracking apps and ovulation predictor kits. The issue with period tracking apps is that they use an algorithm to determine when you’re ovulating. So if you’re simply entering data into an app and it’s going to tell you when you ovulate again, that’s based off of a typical 28 day cycle with ovulation happening on day 14. And if you veer away from that, which many women do, then you’re missing your timing, right? So if you’re relying solely on a period tracker algorithm, you may be missing out on the cues that your body is giving you.

So every cycle, our body has certain hormonal cues and signs that it gives you to let you know when ovulation is coming. And you can also confirm ovulation by tracking your temperatures. If you’ve gone up one step and you’re using ovulation predictor kits, this can be helpful for many women, but for others, it’s not. So, for example, if you have PCOS, ovulation predictor kits are not a good use of your money because ovulation predictor kits measure luteinizing hormone or LH. And in women with PCOS, they have higher levels of LH throughout their entire cycle. So if you have PCOS and you’re using an OPK or ovulation predictor kit, you’re likely getting a positive test. But that doesn’t necessarily mean that it’s a positive LH surge that’s associated with ovulation. And if you don’t have PCOS and you’re using ovulation predictor kits and you’re timing things accordingly and you’re still not getting pregnant, there’s likely something else going on that needs further investigation.

The Balancing Act of Elimination Diets: Navigating Health, Social Life, and Fertility

Now, if you’re like many of my clients, you’ve probably tried a bunch of different elimination diets. Maybe you tried going gluten free or dairy free, sugar free, grain free, or maybe you tried all of those all at once. You may have felt a little bit better, you may have even lost some weight. But the issue with cutting out all of these different foods is that you’re depriving yourself of enjoyment, of experiences with your friends and your family. You’re depriving yourself of entire food groups, and you may actually be putting more stress on your body than actually necessary. So, for example, dairy products have a lot of nutrients that are needed and beneficial for fertility. So things like vitamin D, vitamin A, magnesium, and calcium, these are all necessary for fertility to occur. And often these nutrients are depleted in women who are struggling with infertility.

I had one client who had to eliminate fruit because she was told that fruit has too much sugar in it and she had PCOS. And when I told her that she could actually eat fruit, the smile and the joy that came to her was so amazing, because I have seen so many women depriving themselves of healthy foods, things like fruit or oatmeal or dairy products, that it’s just not necessary. So if you’ve been doing that to yourself, I want to give you the permission right now to scale back and start to incorporate some of those foods that you love and enjoy and are actually healthy and beneficial for you. All right, now let’s shift gears and talk a little bit about what a conventional approach to fertility looks like, especially if you’ve already gone to your doctor or to your OB. And you were told to just keep trying for another six to twelve months before any lab work could be done, and you felt like it was either dismissive or just not good enough. I totally get it. Let’s talk about what this approach is and the reasoning behind it. So first, if you go to your OB and you’re over the age of 35, they’re going to tell you to keep trying for another six months.

And if you’re under the age of 35, they’re going to tell you to keep trying for another twelve months. Now, if you are trying to get pregnant ASAP, which I feel like for many people, once they decide they want a baby, they’re like, it’s go time, and you don’t want to wait that full twelve months. Wait till the end of the episode, because I’m going to share a little bit more about what you can do to be proactive during this time. So in a typical conventional fertility setting, they’ll first do an initial evaluation with a thorough medical exam, physical exam, and look at the health of both partners. They’ll ask you about ovulation, about your cycle history, any previous pregnancies or miscarriages, and hopefully they’ll also talk about lifestyle factors like smoking, alcohol, and exercise. Then a semen analysis will typically be done to assess sperm count, motility, and morphology. So this is to help determine male fertility potential, which about one third of all infertility cases are male factor, and then they’ll do an ovulation assessment. So for the female partner, ovulation is assessed through blood tests to measure hormone levels like progesterone and ultrasound monitoring.

Fertility Tracking and Treatment Options

To track follicle development, you may do an HSG, which is an X ray procedure to check for blockages or abnormalities in the fallopian tubes and uterus. There may be testing to check ovarian reserve. So this is a blood test to evaluate the quantity and quality of a woman’s remaining egg supply or ovarian reserve. They may look into some underlying causes. So any additional tests that are needed for hormonal imbalances like PCOS, endometriosis or structural issues, and then typically what is recommended is to start on ovulation induction medicine. So typically clomid or letrozole are prescribed and those are used to induce ovulation. If that doesn’t work on its own, the next step is to do an IUI or intrauterine insemination, which involves placing a specially prepared sperm directly into the uterus around the time of ovulation to increase the chances of fertilization. And then IUI is typically done anywhere between three to six times or three to six rounds.

And then if that’s unsuccessful, typically the next step is IVF or in vitro fertilization. So this involves retrieving in eggs from the woman’s ovaries, fertilizing them with sperm in a laboratory, and then transferring the resulting embryos into the uterus. It’s important to note that infertility treatments can be complex and not always successful. So the approach taken between different fertility clinics, between different couples is going to be different depending on unique circumstances and decisions made by the doctors and by you as a couple. So to recap, you would go from doing initial tests to being prescribed ovulation induction meds to trying IUI, and then if that didn’t work, to try IVF. So let’s look at some stats on IVF for a moment. One round of IVF typically costs anywhere between $10,000 to $25,000, depending on the state you live in. This is for the United States, and IVF success rates really vary from clinic to clinic.

But the most recent stats that I pulled up was that the overall success rate was between 25% to 30%. So this changes depending on the age of the woman. So if we’re looking at women under the age of 35, for the first embryo transfer, the success rate is 41.4%. And for women between the ages of 35 to 37, the first embryo transfer success rate is 31.6%. I don’t know about you, but if I was spending upward of $25,000, I would want something that had a higher success rate than 41%. In the best case scenario, that’s less than a 50 50 shot if you think about it. And I know for many couples, IVF is truly their only option. Whether you have a blocked fallopian tube, if your partner has a history of testicular cancer, or any of the other hundreds of situations that would lead a couple to doing IVF.

The Power of Functional Medicine and Addressing Root Causes

But it’s certainly not the answer for all couples, which what the current conventional medical model directs couples to. So for many people, addressing underlying factors like hormone imbalances, blood sugar imbalances, nutrient deficiencies, gut health all of that has a profound effect on their fertility. And I know this because this is the work that I do and I see it firsthand every single day. So if you’re thinking, okay, if it’s not IVF, what other way is there? Well, Functional Nutrition or Functional Medicine is the approach that I’m going to talk about because it’s what I use with my one on one clients as well as inside my group program, the Holistic Fertility Method. So, Functional Medicine is a holistic approach to healthcare that aims to identify and address the root causes of health issues rather than just treating symptoms. So it focuses on understanding the underlying imbalances and dysfunctions within a body that could be contributing to disease or a health condition. And while specific root causes can vary depending on each person, there are some common root causes that are typically addressed in functional medicine. So, the first is poor diet.

Nutrient poor diets that are high in processed foods, sugar, unhealthy fats, and artificial additives can lead to nutritional deficiencies and imbalances. And this contributes to various different health problems, including infertility. The second is chronic inflammation. So, prolonged inflammation caused by things like poor diet, stress, lack of exercise, environmental toxins, gut health this can all disrupt the body’s natural balance and lead to chronic disease and impair reproductive function. Third is gut health imbalances. So an unhealthy gut with an imbalance of beneficial and harmful bacteria can lead to digestive issues, immune system dysfunction, and systemic inflammation, which also leads to fertility struggles. Fourth is stress and adrenal dysfunction. So chronic stress can impact the adrenal glands, which leads to imbalances in stress hormones like cortisol, adrenaline, epinephrine, norepinephrine.

And these directly affect sex hormones like lowering progesterone, which is needed in adequate amounts to sustain a pregnancy. Fifth is hormonal imbalances. So think about disruptions in hormone levels like your thyroid hormone or sex hormones. Estrogen, progesterone, testosterone, insulin and others can lead to a range of health issues. So it’s estimated that one in eight women will develop thyroid problems during her lifetime. And having poor thyroid function can interfere with the release of an egg from your ovary, which is ovulation, and it impairs fertility. In many fertility cases, subclinical hypothyroid has been found to be a root cause. The 6th root cause is toxin exposure.

Unraveling Fertility Challenges: Toxins, Infections, and Immune System Factors

So exposure to environmental toxins, heavy metals and pollutants can accumulate in the body and cause harm to organs and tissues, including reproductive organs and tissues. The 7th root cause is chronic infections. So, hidden or recurring infections can trigger chronic inflammation and disrupt the immune system function, which makes the body feel unsafe for pregnancy. We have a few more to cover. So the next one is immune system dysregulation, an overactive or underactive immune system can contribute to autoimmune conditions and increase susceptibility to infections, which then leads to fertility problems. Mitochondrial Dysfunction so, mitochondria are the energy producing organelles inside of your cells. Think of it as like the battery or the powerhouse of the cell. This is what creates energy.

Dysfunction here can lead to decreased cellular energy and impact overall health, including fertility. Sleep disturbances, so, poor sleep quality inefficient sleep, not being able to fall asleep, having a wired but tired brain at night, these can all negatively impact your overall health and contribute to a range of health issues that will impact fertility as well. And then there’s also psychological and emotional factors. So mental and emotional well being can influence your physical health. So any unresolved trauma or chronic stress can actually contribute to fertility struggles. So, functional medicine practitioners use all of this comprehensive data, patient history, in depth functional lab testing, and a personalized treatment plan to help you address these root causes and promote optimal health and well being. And the focus is often on lifestyle changes like nutrition supplements, stress reduction, and other therapeutic interventions to support your body’s natural healing mechanisms, restore balance, and make your body feel safe for pregnancy. So, as you can see, a functional approach to fertility is very different from the conventional approach.

In a conventional approach, it’s basically taking some pills to try to induce ovulation, and then if that doesn’t work, IUI or IVF. And in a functional approach, we’re looking at underlying factors to help get your body into a healthy pregnancy state. And while making these changes to your diet and tracking your cycle are all important first steps to take, if you’re currently struggling to get pregnant, it’s probably time you look into some of these deeper root causes and work with a practitioner who can help guide you through this. So, that’s all for this episode. In the next episode, we’re going to dive deeper into some of these root causes, and specifically which tests you can take so that you know what is contributing to your fertility problems. If you enjoyed this episode, tag me on Instagram at TTC dietitian or send me an email. Let me know what you thought of this episode. If you found this helpful, please share it with a friend.

And thank you so much for listening. I’ll see you soon.

Episode 2: Things You Think Are Working…but May Actually Be Hurting You

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If you want to listen to the full episode head over to: www.wellspringnutrition.co/healing-in-fertility

Transcript:

Welcome to the Healing infertility Podcast. I’m your host, Anabelle Clebenar, registered dietitian, functional nutritionist, and your new fertility bestie. Today in our first episode, we’re going to explore the reasons why you may be struggling to conceive and take a look at some of the causes that I typically see when it comes to clients struggling to conceive naturally. Now, for some, getting ready to start a family is this really easy dragon process. But for many, many couples, the challenges of trying to conceive take a huge mental and physical and emotional toll. And today, I really want to cover some of those contributing factors that I tend to see with clients and hope that this can give you some insight and to take some proactive steps to addressing these things and hopefully improve your chances of conceiving naturally. Now, obviously, there’s many reasons why a couple may be struggling to conceive. There could be things like chronic diseases.

There could be issues with sperm quality, structural issues like a tilted uterus or blocked fallopian tube. And today, I’m going to cover some of the most common things that I see with clients when it comes to not being able to successfully conceive naturally. So the first contributing factor that I want to talk about is excess stress. This is the type A girlies, the women who thrive off intense exercises like Barry’s Boot camp or Orange Theory. Five to six times a week, these women need their morning coffee, an afternoon coffee. They tend to worry a lot about the future and possibly have anxious tendencies. These women are expert multitaskers. They have their work piled high, they strive for perfection, and they tend to put a ton of pressure on themselves.

So if you’re nodding your head yes to this, definitely continue to listen on. So being in a constant state of stress actually triggers the release of cortisol, which is a hormone that can suppress other essential reproductive hormones, specifically progesterone. So with these women, I see a lot of imbalance in cortisol, whether that means that their cortisol is sky high or it’s actually tanked low because it’s been so high for such a long time that now the body is not responding to that signal. And they have chronically low cortisol. So these stressors can come from a variety of things like over exercising, undereating mental stress, the stress of high expectations. All of these can be contributing factors to infertility. So why does this happen when we push ourselves too hard in the gym? Or if we’re not giving our bodies enough fuel that can actually throw off our balance of hormones? So this can impact your menstrual cycle? It can affect when we push ourselves too hard in the gym or not giving our bodies enough fuel. This can mess with our menstrual cycles and throw off the delicate hormone balance.

How Do Intense Workouts Impact Fertility?

So intense exercise like Orange Theory without proper rest can disrupt hormone production and our menstrual cycle. And the same thing with not consuming enough calories or essential nutrients. This can also lead to irregular ovulation, your period going Mia, having a short luteal phase, or just periods that absolutely suck because they’re so freaking painful. And all of this comes back to stress. So it’s been shown in research that chronic stress can impact everything from your digestion, your immune system, detox systems, hormones, memory. It can cause brain inflammation, and it can also impact your gut health. So stress really touches all parts of our health, which is why this is one of those main contributing factors that I tend to see come up over and over again for so many women. So addressing that chronic stress is going to be so important for not only conceiving, but also maintaining a healthy pregnancy and preventing early loss.

The second contributing factor to infertility that I see quite often is poor blood sugar management. So if you’ve ever experienced a sugar high after having too much soda or candy or cookies or anything like that, you know exactly what I’m talking about. So unstable blood sugar can cause things like insulin resistance, delayed ovulation, irregular periods, and it can even affect egg quality. So for women with unmanaged diabetes or insulin resistance, they’re particularly at risk for fertility challenges because of this reason. This is also true for women with polycystic ovarian syndrome or PCOS, because their body has a harder time digesting and breaking down carbohydrates, and that leads to more insulin resistance. This is often a root cause to a lot of fertility struggles, even in women who don’t have PCOS or insulin resistance. Because the way that we tend to eat in general, making a generalization here, but the way that we’re taught to eat isn’t necessarily the best way to improve our metabolic health. So for many women, they’re undereating protein and overeating carbohydrates or overeating fats.

And not having a proper grasp on how to eat for blood sugar management can cause a cascade of events that will make it harder for your body to conceive. This also causes inflammation, and blood sugar imbalances are so pervasive. That’s why it’s so important to make sure that you’re eating a real good balance of macronutrients and not relying on your carbs. Scratch that last part. Okay, so not only does blood sugar imbalances lead to inflammation, but it also impacts egg quality, increases your testosterone, and delays ovulation. The third contributing factor to infertility that I run into a lot with clients is excess inflammation. Inflammation is the body’s natural response to injury, infection, or any harmful stimuli. So, for example, when we get a cut or an infection, inflammation is your body’s way of sending healing agents to the affected area to fight off those invaders and initiate the repair process.

Unraveling the Impact of Chronic Inflammation

It’s like an alarm going off and then someone coming in to address the person trying to invade. What happens when we have chronic inflammation that persists for a long time? Is it can cause health issues, including those related to fertility. So we have good biomarkers to be able to tell when someone has high inflammation. So, for example, Creactive protein, or CRP, this is a marker of inflammation. However, if someone comes back with high CRP, we need to figure out where that inflammation is coming from. For some clients, this can be inflammation from a parasite in the gut. It could be from bacterial overgrowth, or it could also be from not having enough beneficial bacteria. So, especially for women who have had multiple rounds of antibiotics, I often see their gut results being really low.

And having low beneficial bacteria can also cause inflammation. So, how does this impact fertility? So, when we have inflammation that’s chronic, it disrupts our hormone balance, which, again, is crucial for ovulation and conception. Chronic inflammation can also affect the health of egg quality and sperm quality, making it harder for fertilization to occur. Inflammation in reproductive organs can lead to scarring and damage, which can also further complicate things. And when we’re thinking about a functional approach to fertility, we’re always looking for the root cause. So, why is there inflammation and where is it coming from? That way, we can address it, calm down the inflammation, and make our bodies a safe place for reproduction to occur. The last bucket of a possible the last category that I want to talk about is micronutrient deficiencies. I tend to see this a lot with my mamas, with secondary infertility, after going through pregnancy, birth, breastfeeding, there tends to be a lot of nutrient and mineral deficiencies.

But even if you aren’t dealing with secondary infertility, the way that our food system is set up, the way that our medical system is set up, there’s so many ways that this can cause nutrient and mineral deficiencies in our bodies. Whether you’re taking certain medications or coming off of birth control, all these things impact our nutrient levels. So I’m sure you know that our bodies require a wide range of vitamins and minerals to function optimally, and fertility is no exception. So, micronutrient deficiencies like folic acid, zinc, iron, vitamin D, vitamin A, magnesium these can all impact reproductive health. And these nutrients play a critical role in supporting the development of a healthy fetus and a successful pregnancy. Mineral imbalances also impact fertility. So, for example, when we’re thinking about zinc, an excess of copper in the body can interfere with zinc absorption, which leads to hormone imbalances. So we’re always trying to see what the possible root cause can be.

And for some women, it can be all four of these things together. For some, it’s just one thing. But we’re always trying to figure out what is the cause of someone struggling to conceive and how can we address it? So, as a functional dietitian, I often recommend these comprehensive tests, whether it’s a stool test or a mineral test, a micronutrient test to really tailor personalized nutrition plans to support women on their preconception journey. And the upside to all these causes of infertility is that there’s a way to address them naturally using a combination of functional lab testing, supplements and nutrition protocols. So I’m really excited to share more with you in the coming episodes. And if you found this episode to be helpful, please share it with a friend who’s also on the road to Motherhood. I’ll see you in the next episode. Bye.

Episode 1: Reasons Behind Struggling with TTC – Causes of Infertility

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As an expecting mother, despite all the excitement and the anticipation, there are indeed many things to worry about and proper nutrition during pregnancy might be one of them. Aspiring to give your baby a strong healthy start to life and to ensure their flourishing growth, you might be wondering what types of food or nutrients to actively incorporate in your diet throughout the duration of your pregnancy.  

If this is your situation, you have come to the right blog post! Wellspring Nutrition is here to clear up any confusion and steer you to the right path of healthy eating for you and your baby.     

While doing your research, you have likely come across recommendations regarding the different B vitamins, vitamin D &C , calcium, omega 3 fatty acids, iodine, iron, folate, choline and so on…  

Some of these may sound familiar while for the others not so much. This might become a bit overwhelming. 

Thus, in today’s blog post, we will specifically breakdown the importance and the purpose of choline, a potentially overlooked but critical nutrient that pregnant women are highly encouraged to consume adequate amounts of and how you can add them to your prenatal nutrition repertoire.   

What is choline?

Choline is a nutrient that plays an essential role in the physiological process of living organisms, as it supports metabolic functions, maintains the structural integrity of cells, and aids the activities of the brain and nervous system. They are present in many of the foods that we are already familiar with (more on this later in this article!), although they are also naturally produced in the human liver. Despite this, many people, including pregnant women, do not reach the recommended intake of choline set by the Institute of Medicine (IOM). As a matter of fact, the National Institute of Health (NIH) reports that 90-95 percent of pregnant women do not consume the adequate intake (AI) of choline. For pregnant women, this AI is set to be 450 milligrams per day, while for lactating women, it is 550 milligrams per day. This is because lactation further increases the bodily demand of choline due to the rich source of choline in human breast milk, making choline a crucial nutrient postpartum as well.   

Why is choline intake during pregnancy so important?

Choline assists the anatomical development of the fetus, and consuming the sufficient intake level is associated with decreasing the likelihood of certain birth defects. Several studies also link adequate choline consumption to an improved cognitive function and development for the fetus. Let’s look at these one by one.

Development

Choline plays a crucial role in the overall physical growth of the fetus, particularly for the establishment of the spinal cord as well as the proper brain and neural pathways development especially in the hippocampal region, where its core features involve attention, learning and memory. Choline also supports cellular growth, transportation of macronutrients from the mother to the baby and provides anti-inflammatory benefits during pregnancy. Because certain  neurodevelopmental processes of the baby are completed within the duration of the pregnancy, it is important to be conscious of not being deficient in such key nutrients.

Healthy Birth

Research suggests that choline deficiency during pregnancy is linked to the increased risk of Neural Tube Defects (NTD) while the risk decreases with higher choline consumption. NTD is a serious condition where the neural tube, which is responsible for the initial development of the brain and the spine, does not go through proper closure. The Center for Disease Control and Prevention (CDC) reports that a spinal cord defect and a brain defect are the two most common forms of NTD.  

Additionally, choline supplementation may help prevent premature birth. This is because docosapentaenoic acid (DHA), a type of omega 3 fatty acid, has recently been found to be associated with decreasing the likelihood of a preterm birth, and studies have shown that choline supplementation could be a effective approach to increase the availability of DHA in our body. 

Cognitive Function 

Maternal choline intake during pregnancy is also potentially associated with the improved long-term cognitive function of the child although further research is needed to support this claim for humans (Many of the previous studies are done on rats and mice…). 

There are however several human studies that indicate a strong connection between improved cognitive outcomes such as for information processing speed, memory and learning ability of the child and higher prenatal intake of choline. This may be unsurprising considering how as discussed earlier, adequate choline intake provides the foundation for the healthy neurodevelopment of the fetus.  

What food should I eat for choline? 

So, how can we achieve this 450~550 milligram-a-day goal? 

Here are some foods that are excellent sources of choline:

  • chicken
  • salmon
  • eggs
  • beef
  • milk
  • legumes
  • quinoa
  • pork
  • wheat germ
  • tree nuts such as almonds and pecans
  • cruciferous vegetables

For more information, we suggest checking out the USDA Database for the Choline Content of Common Foods to make more informed food consumption decisions!

Should I take supplements? 

Animal food products such as whole eggs, meat and seafood contain the most concentrated amount of choline.  If you are on a vegan or a vegetarian diet and are concerned about not hitting the daily choline intake goal, the Dietary Guidelines for Americans 2020-2025 (chapter 5 covers all of the basics of nutrition during pregnancy) recommend consulting a healthcare specialist for guidance of whether or not taking choline supplements would be suitable for you. It is important to note that many prenatal supplements contain an insufficient amount of choline if any at all. Thus, it is recommended to seek out dietary supplements that consist only of choline, or a combination of choline and B-complex vitamins. These usually contain somewhere between 10 milligrams to 250 milligrams of choline per dose.   

The Dietary Guidelines for Americans 2020-2025 reports that many Americans including pregnant women are failing to meet the recommendations for the consumption of different food groups and subgroups such as vegetables, fruits, grains, and proteins. These are food groups/sub groups that contain choline and other essential nutrients that aids a healthy pregnancy.    

We will be releasing more articles to spread increased awareness of the importance of prenatal nutrition so please stay tuned and we look forward to seeing you again! 

References 

  1. Caudill MA, Strupp BJ, Muscalu L, Nevins JEH, Canfield RL. “Maternal choline supplementation during the third trimester of pregnancy improves infant information processing speed: a randomized, double-blind, controlled feeding study.” FASEB J. 2018;Apr;32(4):2172-2180. doi: 10.1096/fj.201700692RR. Epub 2018 Jan 5. PMID: 29217669 PMCID: PMC6988845
  2. Choline.” https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/
  3. Dietary Guidelines for Americans.” 2020-2025, https://www.dietaryguidelines.gov/food-sources-calcium
  4. Facts About Neural Tube Defects.https://www.cdc.gov/ncbddd/birthdefects/facts-about-neural-tube-defects.html#:~:text=NTDs%20occur%20when%20the%20neural,anencephaly%20(a%20brain%20defect).
  5. Irvine N, England-Mason G, Field CJ, Dewey D, Aghajafari F. “Prenatal Folate and Choline Levels and Brain and Cognitive Development in Children: A Critical Narrative Review.”  Nutrients. 2022 Jan; 14(2): 364. doi: 10.3390/nu14020364 PMCID: PMC8778665 PMID: 35057545
  6. Korsmo HW, Jiang X, Caudill MA. “Choline: Exploring the Growing Science on Its Benefits for Moms and Babies.Nutrients. 2019 Aug; 11(8): 1823. doi: 10.3390/nu11081823 PMCID: PMC6722688 PMID: 31394787
  7. “Science Update: High-dose DHA influences immune responses during pregnancy, may reduce risk of preterm birth.”

https://www.nichd.nih.gov/newsroom/news/012122-DHA#:~:text=longer%20being%20updated.-,Science%20Update%3A%20High%2Ddose%20DHA%20influences%20immune%20responses%20during%20pregnancy,reduce%20risk%20of%20preterm%20birth&text=Taking%20supplemental%20docosahexaenoic%20acid%20(DHA,the%20risk%20of%20preterm%20birth.

  1. Zeisel SH, da Costa KA. “Choline: An Essential Nutrient for Public Health.” Nutr Rev.  2009 Nov;67(11):615-23. doi: 10.1111/j.1753-4887.2009.00246.x. PMID: 19906248 PMCID: PMC2782876

Benefits of Choline in Pregnancy 

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If you are currently pregnant you are most likely encountering quite a lot of surprising changes to your body. It is normal for your body to experience certain levels of discomfort, as the mother’s organs, especially the lungs, kidneys and heart get strained due to the fetus’ need for oxygen and nutrients, and the elimination of waste products.   

Thinking about the health of you and your baby during pregnancy can be overwhelming. There are numerous health complications that may occur and thus maintaining your well being can be a challenging endeavor. 

Today, we will specifically discuss gestational diabetes, a health condition during pregnancy that has been on the rise, and tips on how to manage it.  

What is Gestational Diabetes? 

Gestational diabetes is diabetes (excessively high blood glucose/sugar levels) that may occur during pregnancy. 

An organ called placenta that supports the growth and development of the baby forms in the mother’s uterus during pregnancy. The placenta synthesizes hormones that reduce the effectiveness of insulin, a type of hormone that is secreted by the pancreas. 

When food is consumed, insulin controls the storage and the usage of the blood sugar. Therefore, because insulin is less effective during pregnancy, a modest increase in blood sugar levels is common and a normal part of pregnancy. However gestational diabetes is detected when this increase in blood sugar becomes excessive. 

This type of diabetes usually goes away once the pregnancy is over but it has potential long term consequences for both the mother and the baby. Having gestational diabetes increases the likelihood of the mother developing type 2 diabetes later in life. It is also linked to the development of obesity and type 2 diabetes for the child.  

Wellspring Nutrition has compiled a list of five tips that can help you get through your pregnancy in the most healthful way possible, especially if you are struggling with gestational diabetes or have risk factors.   

Tip #1: Exercise

Research suggests that consistent physical activity during pregnancy reduces the risk of gestational diabetes by 50 percent.  

The recommended amount and level of physical activity depends on how active you were prior to pregnancy, but the general recommendation is 150 minutes of low to moderate intensity physical activity per week. Here are some examples of activities that are generally safe to do: 

  • Walking
  • Swimming 
  • Light aerobics 
  • Cycling
  • Yoga
  • Pilates
  • Light jogging 

If you were very active before pregnancy, you should be able to maintain the same level of activeness but it is best to consult with a health care specialist first.  

Other than lowering the risk for gestational diabetes, there are many benefits to staying active during pregnancy for both you and the baby. For the mother, physical activity can also lower the risk for gestational hypertension, high blood pressure during pregnancy. Staying active also boosts cardiovascular function, decreases back pain, contributes to better sleep, minimizes the loss of bone density due to pregnancy, and reduces edema (swelling caused by pregnancy) of legs and feet. For the baby, an appropriate amount of exercise leads to longer gestation (prevention of preterm birth), potential improvement for their brain development, and an increased likelihood of them having a healthy BMI during childhood.  

Please keep in mind, however, that there are certain types of physical activities that pregnant women should avoid. Activities that could lead to abdominal trauma must be avoided. These are few examples of physical activities that you should avoid: 

  • Contact sports (soccer, wrestling, basketball, football etc.)
  • Downhill skiing 
  • Scuba diving 
  • Horseback riding
  • Heavy weightlifting 
  • Hot yoga

Regardless of your background or your specific condition, if you are looking to stay active during your pregnancy, you should speak with your health care provider to ensure the safety of you and the baby.  

Tip #2: Being aware of optimal weight gain during pregnancy

Gaining weight during pregnancy is a natural and normal process. This is absolutely not the time to be attempting any kind of weight loss. It is also important to be mindful of what a healthy weight gain should look like during this critical period. 

During the first trimester, mothers should be consuming around the same amount of calories as prior to pregnancy and should be expecting around 2 to 4 pounds of weight gain. After the first trimester, gaining around 0.8 to 1 pound per week is considered to be ideal. During the second and third trimester, mothers should be consuming about 350 to 450 additional calories compared to their pre-pregnancy days. 

The optimal total weight gain is around 25 to 35 pounds for someone with a BMI in the normal range. If you are carrying twins, however, the optimal range is between 37 to 54 pounds.  

Tip #3: Eating quality carbohydrates

Controlling your blood sugar levels is essential for managing gestational diabetes. Choosing the right type and amount of carbohydrates to consume is a great place to start. 

Although skipping carbohydrates might sound tempting if you are worried about your blood sugar levels, this is never recommended. Carbohydrates supply energy for the placenta and it supports the healthy growth of your baby. There is no evidence for the effectiveness of a low carbohydrate diet for managing gestational diabetes and the general recommendation is a minimum of 175 grams a day, although it may depend on the individual.   

When consuming carbohydrates, choosing the type with a low glycemic index is highly recommended. The glycemic index of a food indicates how rapidly it causes the blood sugar level to rise.  Low glycemic index foods raise the blood sugar level much more slowly compared to high glycemic index foods, due to its slower rate of absorption.    

Mothers with gestational diabetes should avoid refined grains such as white rice, white bread, white pasta, and white flour as well as foods containing a lot of added sugars since they usually have higher glycemic index. 

The recommended carbohydrates on the other hand are starchy foods with high dietary fiber content such as whole/unprocessed grains, beans/legumes, vegetables, and fruits. 

Additionally, carbohydrate consumption should be spread out throughout the day- instead of eating a few big meals a day, having smaller meals distributed within a day helps control major blood sugar fluctuations.  

Tip #4: Watching your diet

Although pregnant women should consume more calories during their second and third trimester, the quality of your food should be prioritized over quantity. 

Other than carbohydrates, there are several macro and micro nutrients that you should be actively incorporating in your diet during your pregnancy especially if you are dealing with gestational diabetes.

Research suggests that consuming protein from lean meat (unprocessed), fish, and plants are favorable for the treatment of gestational diabetes. In fact, women with gestational diabetes are recommended to consume 350 grams of fish per week. Check out our blog about high protein foods here as well, as we talk about safe types of fish to consume during pregnancy. 

The overall fat intake for women with gestational diabetes should be around 20 to 35 percent of total energy intake and the consumption of saturated fat should be restricted.  

There are several vitamins and minerals that play an important role during pregnancy. Iron, calcium, folic acid (Vitamin B9), and 25-Hydroxyvitamin D are a few examples. 

Here are the Institute of Medicine (IOM) recommendations for these micronutrients:

  • Iron: 27 milligram/day
  • Calcium: 1000 milligram/day
  • Folic acid: 600 microgram/day
  • 25-Hydroxyvitamin D: 5 microgram/day

These dietary advice are not just specific to women with gestational diabetes but apply to all pregnant women to ensure a healthy pregnancy with the best possible outcomes.

Tip #5: Screening 

This is especially important if diabetes runs in your family or you are considered to be overweight prior to pregnancy. 

Although lifestyle modification is key for gestational diabetes management, visiting your healthcare provider and receiving nutritional guidance or possible clinical treatment tailored to your individual needs should be a priority as well.

It is recommended that all women regardless of a history of type 2 diabetes be screened between 24 and 28 weeks of pregnancy. If you have risk factors for type 2 diabetes, getting screened at your first prenatal visit is advised. Regardless of your health history, receiving prenatal care, especially during the first trimester is crucial as that is the most critical time for the baby’s development.

Looking for more support? 

Whether it is guidance regarding hormonal imbalances like PCOS, or any fertility or pregnancy concerns, Wellspring Nutrition has your back! Our fertility dietician is available for consultation. 

References: 

  1. “Exercise During Pregnancy: Safe And Beneficial.” https://newsnetwork.mayoclinic.org/discussion/exercise-during-pregnancy-safe-and-beneficial-too/
  2. “Insulin Basics”, https://diabetes.org/healthy-living/medication-treatments/insulin-other-injectables/insulin-basics
  3. Rasmussen L, Poulsen CW, Kampmann U, Smedegaard SB, Ovesen PG, Fuglsang J. “Diet and Healthy Lifestyle in the Management of Gestational Diabetes Mellitus.” Nutrients 2020 Oct 6;12(10):3050. doi: 10.3390/nu12103050. PMID: 33036170

 PMCID: PMC7599681

  1. Smith A, Colleen A, Spees C. “Wardlaw’s Contemporary Nutrition, 12th Edition.” McGraw Hill, 2022. 
  1. “What Is Glycemic Index.” https://www.eatright.org/health/wellness/diet-trends/what-is-glycemic-index

5 Tips for Gestational Diabetes

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If you are currently pregnant, the journey of sustaining a whole other life in your body probably feels like an extraordinary experience but at the same time, a great deal of responsibility ( in a positive way of course! ) 

Although there are many aspects relating to the healthy growth and development of the fetus that are beyond our control, one of the main factors that we do have control over is our lifestyle choices- namely our diet. 

There are a handful of nutrients that you do not want to be missing out on during your pregnancy to ensure the best possible health outcome for your baby. These include choline, iron, calcium, Vitamin D, iodine, and folate to name a few. 

If you recently found out that you are pregnant or are planning on conceiving, you are in luck! Today, Wellspring Nutrition is specifically going to highlight the importance of folate, and how this nutrient can be a powerful ally for preventing a common type of birth defect- the neural tube defect.     

What is a Neural Tube Defect?

Neural tube defect is a birth defect that affects the central nervous system of the baby. In a developing embryo, the neural tube is the precursor to their brain and the spinal cord. Neural tube defect occurs when the neural tube does not properly go through the closure process to complete its formation. The two common types of neural tube defect include: 

  • Spina bifida (swelling or protrusion of spinal cord or fluid in the back) 
  • Anencephaly (exclusion of a major segment of the brain) 

What is folate?

Folate, otherwise known as vitamin B-9, is found in various foods. As they play an important role in the nucleic acid (DNA and RNA) production and amino acid (the building blocks of protein) metabolism, they are crucial to the functioning of cells.    

Folic acid is its synthetic form- meaning folate that is found in dietary supplements and fortified foods. 

Why folate is important

The need for folate significantly increases during pregnancy especially because the event of a neural tube defect is closely linked to maternal folate deficiency. Inadequate folate intake can lead to a high homocysteine level in the blood, which is considered to be a risk factor for neural tube defect. Homocysteine is an amino acid and as it is broken down by the vitamin B-complexes, having a high level of this usually indicates deficiency in vitamins. 

According to a recent study, another risk factor for neural tube development is the lack of DNA repair function. Since folate is crucial to DNA synthesis, folate deficiency can lead to a loss in the integrity of DNA. Thus, the mechanism for DNA repair is going to be negatively impacted. Genome stability is an important aspect of neural development for the embryo, and adequate folate intake is necessary for a properly functioning DNA repair mechanism. 

The timing of sufficient folate intake is important to consider. Neural tube formation of an embryo is completed around three to four weeks after conception. This means that anyone trying to conceive should ideally start incorporating folate in their diet as soon as possible, even if pregnancy is yet to be confirmed. 

Even if you are reading this much further into your pregnancy, there are still reasons to consume an adequate amount of folate.  

Other than lowering the risks of neural tube defects, research shows that sufficient folate intake during pregnancy is beneficial for the neurodevelopment of the child. There is a study that links prenatal folic acid supplementation to a lowering of the risk of Autism Spectrum Disorder (ASD), and advancements to the cognitive, motor and intellectual functions of the child.     

What food should I eat for folate?

Although the general recommendation is about 400 micrograms a day, pregnant women are advised to consume about 600 micrograms of folate every day.   

Here are some food items that are good sources of folate to help meet this target:

  • Beef Liver 
  • Spinach
  • Black-eyed peas
  • Chickpeas 
  • Asparagus
  • Brussel sprouts
  • Romaine Lettuce
  • Broccoli
  • Eggs

As you can see, leafy greens, legumes, and liver are the best sources.  

Moreover, it is important to note that folate tends to be sensitive to heat and oxygen.  Especially for the leafy greens, it is advised to eat them fresh or have them lightly cooked. In a study that compared the folate retention for different food products, for spinach, boiling led to only 49 percent retention of folate. On the other hand, steaming proved to be the best way to preserve folate in vegetables. Another good news is that the same study found that grilling beef for an extended period of time did not result in much loss of folate as well. 

Other than foods naturally present with folate, consuming grain products may be helpful as well. This is because starting in 1998, the U.S Food and Drug Administration (FDA) mandated a folate fortification of grain products such as bread, rice, cereal, flour, and pasta.

However, consumption of refined grain products should be limited during pregnancy to prevent significant spikes in your blood sugar levels.  

Looking for more support? 

Our fertility dietician Anabelle is available for one-on-one consultation and can help you address any of your concerns regarding fertility, pregnancy or hormonal imbalances like PCOS! 

References

  1. “Chickpeas (garbanzo beans, bengal gram), mature seeds, cooked, boiled, without salt.” https://fdc.nal.usda.gov/fdc-app.html#/food-details/173757/nutrients
  1. “Embryology, Neural Tube.”  https://www.ncbi.nlm.nih.gov/books/NBK542285/
  1. “Folate.” https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/
  1. “Folate and Folic Acid on the Nutrition and Supplement Facts Labels.”https://www.fda.gov/food/new-nutrition-facts-label/folate-and-folic-acid-nutrition-and-supplement-facts-labels#:~:text=For%20folate%2C%20the%20DV%20is,consume%20500%20mcg%20DFE%20daily.
  1. Gao Y, Sheng C, Xie RH, Sun W, Asztalos E, Moddemann D, Zwaigenbaum L, Walker M, Wen SW. “New Perspective on Impact of Folic Acid Supplementation during Pregnancy on Neurodevelopment/Autism in the Offspring Children – A Systematic Review”PLoS One. 2016 Nov 22;11(11):e0165626. doi: 10.1371/journal.pone.0165626. eCollection 2016.PMID: 27875541 PMCID: PMC5119728 https://pubmed.ncbi.nlm.nih.gov/27875541/
  1. “Homocysteine” https://my.clevelandclinic.org/health/articles/21527-homocysteine
  1. McKillop DJ, Pentieva K, Daly D, McPartlin JM, Hughes J, Strain JJ, Scott JM, McNulty H.“The effect of different cooking methods on folate retention in various foods that are amongst the major contributors to folate intake in the UK diet.” Br J Nutr. 2002 Dec;88(6):681-8. doi: 10.1079/BJN2002733. PMID: 12493090 https://pubmed.ncbi.nlm.nih.gov/12493090/
  1. “Pregnancy diet: Focus on these essential nutrients.”https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy-nutrition/art-20045082
  1. Smith A, Colleen A, Spees C. “Wardlaw’s Contemporary Nutrition, 12th Edition.” McGraw Hill, 2022. 
  1. Wang X, Yu J, Wang J.“Neural Tube Defects and Folate Deficiency: Is DNA Repair Defective?” Int J Mol Sci. 2023 Jan 22;24(3):2220. doi:10.3390/ijms24032220. PMID: 36768542 PMCID: PMC9916799 https://pubmed.ncbi.nlm.nih.gov/36768542/

Folate Intake to Prevent Neural Tube Defects in Pregnancy

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Apple cider vinegarー the name surely gives it a cozy fall vibe doesn’t it? 

Vinegar in general has demonstrated numerous health benefits but apple cider vinegar (ACV) , which is made from fermented apples, in particular has been gaining attention from many health experts in recent years (And no, ACV is not seasonalー thankfully it is around all year).

If you were curious as to what makes ACV beneficial to our health, you have come to the right place! 

Blood sugar control:

Hyperglycemia, more commonly known as high blood sugar, affects countless people worldwide. This phenomenon is usually attributed to the lack of insulin in the body and is associated with both type 1 and type 2 diabetes. Insulin is a hormone that is secreted by the pancreas that controls what the body does with the energy obtained from food; it determines if it wants to use or store the blood sugar. 

Research suggests that ACV may assist with glycemic control- that is our blood sugar levels. 

Studies have shown that ACV consumption is associated with the overall reduction of blood glucose (sugar) levels. 

Therefore, the consumption of ACV may serve as an ally for diabetes management as well as prevention.     

Preventing cardiovascular diseases:

Now let’s talk cholesterol ー

Cholesterol travels throughout the bloodstream carried by “lipoprotein”, a type of protein. 

There are two types of these lipoproteins: 1) LDL (low-density lipoprotein) cholesterol 2) HDL (high-density lipoprotein).

LDL is commonly referred to as the “bad” cholesterol while HDL is referred to as the “good” cholesterol. Since HDL, along with the liver, helps get rid of the cholesterol in the blood, higher HDL level can contribute to lowering the risk of cardiovascular diseases such as stroke, heart attack and peripheral artery disease. 

ACV consumption was associated with higher levels of HDL for people who do not have diabetes. 

Furthermore, studies have found that for those with type 2 diabetes, ACV consumption was linked to an improved lipid panel- a blood test that serves as a screening for cardiovascular diseases. 

This blood test is based on cholesterol and triglycerides (a type of fat in our blood) levels. The buildup of these fats in the blood will lead to a hardening of the arteries and increase the risks of cardiovascular diseases. A decrease in both triglyceride and cholesterol levels in patients with type 2 diabetes was seen with the consumption of ACV.   

Overall, this suggests a positive association between our heart health and ACV.  

Antioxidative properties and other disease prevention: 

ACV is said to have antioxidative and anti-inflammatory properties. There have been several studies that have linked such properties to the potential prevention and the remedy of kidney/urinary stones.  

The kidney filters our blood, removes wastes from it and produces urine. It plays an important role in the body’s maintenance of the balance of fluid and minerals which is crucial for our physiological functioning.  

Kidney stones are relatively common and may unfortunately lead to chronic kidney diseases. Although ACV should not be relied on as a sole treatment, its therapeutic effect says a lot about its defensive nature against oxidative stress and inflammation in our body.  

Relatedly, ACV contains a phytochemical (compounds found in plants that can yield positive health effects) called flavonoid. Flavonoid have been found to have favorable effects on the following health complications: 

  • angina pectoris
  • cervical lesions 
  • chronic venous insufficiency 
  • dermatopathy
  • gastrointestinal diseases 
  • lymphocytic leukemia 
  • menopausal symptoms 
  • rhinitis 
  • traumatic cerebral infarction      

Looking for more support? 

If you would like to get more inspiration- whether it is about how to specifically incorporate ACV into your meals or anything related to concerns regarding PCOS and/or fertility struggles   please feel free to check out our meal plans or any other services with our fertility dietician. We would love to provide guidance to your wellness journey!

References: 

  1. “Familial Hyperlipidemia.” https://www.upmc.com/services/heart-vascular/conditions-treatments/hyperlipidemia#:~:text=Hyperlipidemia%20defines%20an%20elevated%20level,stroke%2C%20and%20peripheral%20artery%20disease.
  1. Gambaro G,  Croppi E, Bushinsky D f,  Jaeger P g,  Cupisti Ad, Ticinesi A e,  Mazzaferro S c,  D’Addessi A b,  Ferraro PM.  “The Risk of Chronic Kidney Disease Associated with Urolithiasis and its Urological Treatments: A Review.” J Urol. 2017 Aug;198(2):268-273. doi: 10.1016/j.juro.2016.12.135. Epub 2017 Mar 10. PMID: 28286070
  2. Hadi A, Pourmasoumi M, Najafgholizadeh A, Clark CCT, Esmaillzadeh A. “The effect of apple cider vinegar on lipid profiles and glycemic parameters: a systematic review and meta-analysis of randomized clinical trials.” BMC Complement Med Ther 2021 Jun 29;21(1):179. doi: 10.1186/s12906-021-03351-w. PMID: 34187442 PMCID: PMC8243436
  1. “Hyperglycemia (High Blood Glucose)” https://diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hyperglycemia#:~:text=Hyperglycemia%20is%20the%20technical%20term,can’t%20use%20insulin%20properly. 
  1. Kumar A, Nirmal P, Kumar M, Jose A, Tomer V, Oz E, Proestos C, Zeng M, Elobeid T, K S, Oz F. “Major Phytochemicals: Recent Advances in Health Benefits and Extraction Method.” Molecules. 2023 Jan; 28(2): 887. Published online 2023 Jan 16. Doi: 10.3390/molecules28020887 PMCID: PMC9862941 PMID: 36677944
  1. “LDL and HDL Cholesterol and Triglycerides.” https://www.cdc.gov/cholesterol/ldl_hdl.htm
  1. “Lipid Panel” https://my.clevelandclinic.org/health/diagnostics/17176-lipid-panel#:~:text=A%20lipid%20panel%20is%20a,a%20measurement%20of%20your%20triglycerides.
  1. “Phytochemicals.” https://lpi.oregonstate.edu/mic/dietary-factors/phytochemicals
  1. Singh AS, Singh A, Vellapandian C, Ramaswamy R, Thirumal M. “GC–MS based metabolite profiling, antioxidant and antiurolithiatic properties of apple cider vinegar.” Future Sci OA. 2023 Apr; 9(4): FSO855. doi: 10.2144/fsoa-2023-0035 PMCID: PMC10116371 PMID: 37090488
  1. “Your Kidneys & How They Work”https://www.niddk.nih.gov/health-information/kidney-disease/kidneys-how-they-work

Benefits of Apple Cider Vinegar (ACV)

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