00:00:02
I mean, are there things that people
00:00:03
should eat and not eat,
00:00:05
things that people should
supplement and not supplement
00:00:07
in order to optimize their fertility?
00:00:11
I mean, this is definitely
an interest of mine, right?
00:00:13
All my fellowship research
cycles around fecundability
00:00:15
and natural fertility.
00:00:17
And I think we really do a disservice
00:00:19
by how medicine really is
categorized by organ systems
00:00:23
because we act like things in one place
00:00:25
don't impact the other.
00:00:27
As if, right?
00:00:28
But you have a body and your body
00:00:30
and especially your hormones
change and fluctuate
00:00:32
and they're meant to.
00:00:34
They are meant to be a dynamic system.
00:00:36
But the world and the environment of which
00:00:40
you are subjecting your body to
00:00:42
has proven changes on
both hormonal function
00:00:47
and also when it comes
to egg and sperm quality.
00:00:50
And so if you are somebody who just wants
00:00:51
to live your healthiest life
00:00:53
and have your most regular periods
00:00:56
and have your hormones as
well balanced as they can be,
00:00:59
for a lack of a better word,
we'll just say that that means
00:01:02
that they are functioning normally.
00:01:03
Then paying attention to the things
00:01:05
that you do are really important.
00:01:06
And so, I know this is a big one for you.
00:01:08
Sleep is probably the number
one thing that people don't do
00:01:11
that does impact their
reproductive hormone system
00:01:13
and therefore can impact
again, sperm quality
00:01:16
because sleep is when
you have cellular repair
00:01:18
and when you can drop
your inflammation levels.
00:01:21
We know that inflammation is just toxic
00:01:24
to eggs and sperm, it is.
00:01:27
The inflammatory environment
is not ideal for conception.
00:01:31
And then for a female, you
have to deal with the fact
00:01:34
that you have your egg quality,
00:01:36
but you also have how inflammation
00:01:39
or what you're exposed to
impacts your uterine environment.
00:01:42
So you have a a twofold situation here.
00:01:45
So none of this should be shocking news
00:01:48
when it comes to nutrition,
00:01:50
but it is not talked
about enough you're right.
00:01:53
Decreasing inflammation by the
foods that we put in our body
00:01:56
is consistently shown with an
improvement in fecundability,
00:02:01
an improvement in ovulation,
00:02:03
an improvement in success with IVF
00:02:05
and a decrease in miscarriage, right?
00:02:08
Huge studies have looked at these.
00:02:10
Now, the big caveat is that
nutrition studies are super hard
00:02:15
because people who
consume flax, for example,
00:02:19
tend to have other good health behaviors
00:02:21
that sometimes make it hard
to identify what flax did
00:02:25
versus their general
health versus somebody
00:02:27
who eats fast food every day.
00:02:30
So nutrition studies
tend to be observational.
00:02:33
And fertility studies are really hard too,
00:02:35
because what endpoint are you using?
00:02:38
Is it getting pregnant?
00:02:39
Is it live birth?
00:02:40
Are you looking at IVF?
00:02:41
Are you looking at natural fertility?
00:02:43
And we have a lot of
different overlap that makes
00:02:46
both of these a little bit difficult.
00:02:48
And so they are all cohort based
00:02:50
or population-based
studies where you analyze
00:02:53
how people perform when it
comes to fertility treatments
00:02:56
or getting pregnant naturally
00:02:58
based on their exposures
to certain things.
00:03:02
Diets high in fruits and
vegetables are good for you, right?
00:03:04
Fiber, antioxidants, fruit is not bad.
00:03:07
Fruit got this really bad reputation.
00:03:09
I love fruit.
00:03:10
I love fruit too but people
think that it has sugar
00:03:12
and that it's bad for you.
00:03:13
Well, it has fructose.
00:03:15
That type of sugar is not bad for you.
00:03:17
If we can just agree
on the fact that fruit
00:03:19
has a lot of nutritional benefit,
00:03:21
especially when it comes to
vitamins and antioxidants,
00:03:24
that can be extremely beneficial
in decreasing inflammation.
00:03:28
Grains, so whole grains
especially that your body
00:03:31
provide a lot of great fiber.
00:03:32
So of course if you have celiac
00:03:34
or you are gluten intolerant,
you're a different category.
00:03:37
But there was so much focus on keto
00:03:39
and people eliminating grains
as a food group overall.
00:03:43
And even though that might be
utilized in a dietary strategy
00:03:45
to lose weight, and losing
weight can improve fertility,
00:03:50
likely because of inflammation
being the primary driver.
00:03:54
Because we know that even in
studies where I take donor eggs
00:03:58
and I transfer that embryo into
somebody who is overweight,
00:04:02
they have lower odds of success
00:04:04
than if they were a normal BMI.
00:04:06
So we can't act like that
causation is just on egg quality
00:04:11
from obesity, right?
00:04:12
There's also some inflammation,
some inflammatory changes
00:04:15
that impact the body's ability or desire
00:04:19
to allow an embryo to implant.
00:04:21
So fruits, veggies, whole
grains are all good.
00:04:26
Interestingly, dairy tends
to be okay in most studies
00:04:31
but what we do see is that if
you're going to have dairy,
00:04:34
have the real thing, the
processed dairy, the skim milk,
00:04:39
that actually decreases your fertility.
00:04:42
And likely because the
processing to make it
00:04:44
still look like milk when
you take out the fat,
00:04:47
is adding in things that are unnatural
00:04:50
potentially impacting your fertility.
00:04:52
I don't drink milk anymore
but when I was a teenager
00:04:54
I drank half and half.
00:04:55
I'm not recommending anyone do that.
00:04:56
Remember I was a skiing teenager.
00:04:57
You were trying to bulk up.
00:04:59
Well, no, I just could afford to.
00:05:00
At that age I wasn't trying to at all,
00:05:02
but it was just delicious.
00:05:06
So cheeses, full fat milk,
half and half yogurt.
00:05:13
Yeah, but don't choose the skim one,
00:05:15
choose the actual one that
comes with some of the milk fat.
00:05:19
Fat is not bad for you.
00:05:20
There's also this, hopefully
we're getting away from it
00:05:23
but there's been such a low fat craze
00:05:25
or this real attention that fat is so bad.
00:05:28
But fat comes in so many important forms,
00:05:32
avocados and oils and nuts, dairy, meat.
00:05:37
Fat and cholesterol are the
backbone for all hormones,
00:05:40
so you need that in order for
your body to make the estrogen
00:05:45
and progesterone that it needs
00:05:46
to allow this whole process to happen.
00:05:49
And so there's this idea
that those are bad for you,
00:05:52
that's just really not.
00:05:52
So healthy fats, whole
grains, fruits, veggies.
00:05:55
And what about proteins and meats?
00:05:56
Because I think within those categories,
00:05:59
I'm a big fan of sustainably
like raised meats if possible.
00:06:03
Some people choose not to
eat meat, but fish, eggs.
00:06:07
Love it all.
00:06:08
Okay, so let's just go through the meats
00:06:09
and the myth and the fact.
00:06:11
So we'll do tofu.
00:06:13
So there's this big issue
that like tofu has soy
00:06:15
and that too much soy can be bad
00:06:17
because soy can be a phytoestrogen.
00:06:19
Tofu does not negatively
impact fertility even in men.
00:06:23
In fact, it can improve it
because it does have some
00:06:26
antioxidant like properties, lots of iron.
00:06:28
When it comes to fish,
00:06:29
fish are fantastic sources of healthy fats
00:06:33
and omega-3 fatty acids
which are very crucial
00:06:37
in the reproductive process.
00:06:39
We do worry about if you're
pregnant having too much fish
00:06:42
and over exposure to mercury
and how that can impact
00:06:45
fetal brain development.
00:06:46
So the general recommendation
is three servings per week.
00:06:50
Let me guess, a serving
is like four to six ounces
00:06:52
as opposed to like a real human that eats
00:06:58
six to eight ounces of fish, right?
00:07:00
Yeah, and I think it's important to say,
00:07:02
even though people will tell
you that when you're trying
00:07:04
to get pregnant with the
idea of we don't know
00:07:06
when you're going to be pregnant,
00:07:08
if you're going through things
like egg freezing or IVF
00:07:11
and you know when you're
going to be pregnant,
00:07:13
I wouldn't feel like you
have to restrict yourself
00:07:15
on the consumption of seafood
during those time periods
00:07:19
when you know you're not pregnant yet.
00:07:20
Because really the concern
is about that mercury
00:07:23
and what it could potentially
do to a fetal brain.
00:07:25
And raw seafood, correct?
00:07:26
No sushi, no sashimi.
00:07:27
Well, when you're pregnant correct,
00:07:29
and that's mostly because of
the risk of infectious disease
00:07:32
that can cause severe brain
development and other issues.
00:07:35
What do they do in Japan?
00:07:36
I don't know, I don't live there.
00:07:37
They probably laugh at us.
00:07:38
They probably do laugh at us,
00:07:40
they probably do laugh at us.
00:07:41
Someone who has been pregnant in Japan.
00:07:45
Yeah, reach out, tell us.
00:07:46
Yeah, or conceived in Japan, tell us.
00:07:47
Don't tell us the story of the conception,
00:07:49
but tell us, did you have sashimi?
00:07:53
Overall meat is a really broad category
00:07:57
and studies study it differently.
00:07:58
Like is it all meat?
00:08:00
Are you distinguishing
out red meat and chicken?
00:08:04
Are you putting it all together?
00:08:06
I mean, obviously I think we
can all come to the agreement
00:08:08
that processed meats are not good
00:08:10
for a variety of different reasons.
00:08:12
In addition to being carcinogenic,
00:08:14
those toxins do negatively
impact fertility.
00:08:18
So deli meat, no bueno.
00:08:19
Yeah, but I mean specifically
those things like the bacon
00:08:23
and like the things that are
really highly prostate hotdogs,
00:08:27
sorry, the 4th of July hotdog picnic.
00:08:29
But those things really
do not provide nutritional
00:08:33
advantages and only harm.
00:08:36
Especially then when we have red meat.
00:08:38
For the most part, red meat
when isolated individually
00:08:41
and most circumstances in
moderation tends to be fine,
00:08:46
I usually tell my patients
I want them to eat
00:08:49
a plant forward diet that
doesn't mean no meat.
00:08:52
But I say, look at your meat servings.
00:08:54
I don't want it red meat every single day.
00:08:57
Because there was a study looking at IVF
00:08:59
and looking at embryos,
and the more servings,
00:09:02
a lot of nutritional studies
based things on quartile.
00:09:05
So who eats the lowest and the second most
00:09:07
and the third most and the top most.
00:09:09
And people who ate in that
top quartile of red meat
00:09:13
had lower progression of
embryos through the culture.
00:09:16
So less embryos that developed
00:09:19
less normal embryos and
lower success rates.
00:09:22
Do we know anything about
how that meat was arriving?
00:09:25
No, Unfortunately we don't.
00:09:27
Are we talking about
like hoagie sandwiches
00:09:28
or are we talking about
like grass fed steaks?
00:09:30
These studies are not wonderful
00:09:32
but that doesn't mean
that they don't hold merit
00:09:34
in helping us guide counseling.
00:09:36
But no, that one was how
many servings of red meat
00:09:39
do you eat in a week?
00:09:41
So we don't really know.
00:09:42
Does the really ethically
sourced the grass fed,
00:09:46
this environment which we
feel like is much less toxic
00:09:50
than potentially let's
say like a cattle factory
00:09:53
where the cows are injected
with all sorts of things.
00:09:55
Is there a difference in how
those impact your reproduction?
00:09:59
Probably, right?
00:10:00
If this cow is getting injected
with a lot of hormones,
00:10:02
why are we thinking that
it's not impacting the meat
00:10:05
that you're then ingesting into your body?
00:10:07
I think our audience will certainly
00:10:10
subscribe to that idea.
00:10:12
I think most of them will.
00:10:13
I mean, the notion that like
the pollutants you breathe in
00:10:16
the air somehow are not
the air that you breathe
00:10:19
into your lungs is just
like completely nutty.
00:10:22
And the idea-
00:10:23
But people feel that way
and they hold strongly
00:10:24
to this idea that it can't
be this thing that I love
00:10:29
that is causing this problem, right?
00:10:31
The denial of the association between
00:10:35
what we put in and on our body
00:10:37
and how it impacts our body's function
00:10:40
is really strong in some people.
00:10:41
And I think it's really just
lack of education and awareness
00:10:46
because the medical community for so long
00:10:49
did not address these factors, right?
00:10:51
Your doctor never talked
to you about nutrition.
00:10:54
And so it just became this
idea that it must not matter
00:10:58
otherwise your doctor
would talk to you about it.
00:11:01
I think sugar is the last
thing I just didn't mention,
00:11:03
but added sugar and artificial
sugars are bad for you.
00:11:08
Artificial sugars.
00:11:09
Artificial sugars too.
00:11:10
Including stevias or plant-based
low calorie sweeteners.
00:11:14
Stevia itself hasn't been studied as much
00:11:16
as the other ones things
like sweet and low
00:11:19
and all of those.
00:11:21
But what we do know is that
they cause inflammation
00:11:25
inside the body and
then they also can cause
00:11:28
a stress reaction and they
can cause higher rates
00:11:32
of miscarriage when you intake more sugar
00:11:35
and artificial sugar.
00:11:37
So that's a lot to wrap your head around.
00:11:39
And I say the same thing to every patient,
00:11:42
one cake, one this, one hot dog.
00:11:45
I mean, those things individually are not
00:11:46
going to make a difference, right?
00:11:48
It's the choices that
you make every single day
00:11:51
that are going to set you up
to be your healthy self or not.
00:11:54
And so you should make choices in line
00:11:56
with how you want to treat yourself.
00:11:58
You want to be in your best health,
00:12:00
you want your hormones
functioning the best.
00:12:02
And if that added helps you
get pregnant when you want to,
00:12:06
helps you have a better
chance of success with IVF,
00:12:09
oh my gosh, what a fantastic benefit.
00:12:12
But that doesn't mean you can't enjoy
00:12:13
some of these bad things here and there
00:12:17
as long as you've set
yourself up on the day to day
00:12:20
where you're giving your
body lots of nutritious food
00:12:23
that it needs to make hormones.
00:12:25
Similarly, being very underweight
in calorie restricting
00:12:29
we all know is really terrible
for your reproductive system
00:12:32
and can cause the brain to
totally shut down ovulation
00:12:35
because it's senses that
you can't have a pregnancy.
00:12:39
If people miscarry, excuse me by virtue
00:12:42
of being underweight, does the body,
00:12:44
like I learned some years ago,
I think this is still true,
00:12:49
that one of the signals for
the onset of puberty in females
00:12:52
is that leptin, a hormone
is secreted from body fat
00:12:57
that then signals to the
brain, to the hypothalamus,
00:12:59
like okay, there's enough
reserves to create environmental,
00:13:03
it's a signal about environmental.
00:13:06
There's enough extra fat to have a baby.
00:13:07
And there's presumably
enough food around to sustain
00:13:10
that baby.
00:13:11
Are miscarriages and lack
of body fat correlated?
00:13:15
On both ends of the spectrum, yes.
00:13:17
So lack of body fat and being overweight,
00:13:21
we see decrease in
getting pregnant per month
00:13:24
and we see increase in losing pregnancies.
00:13:28
So certainly there is a healthy medium
00:13:31
where your body has what it needs.
00:13:33
And that makes sense because if you have,
00:13:36
I like to even say
hypothalamic dysfunction.
00:13:38
So maybe your brain is
not totally shut off
00:13:40
where it's sending out no
hormones and you're not ovulating
00:13:43
because you're not getting
pregnant in that circumstance.
00:13:45
But certainly ovulation
disorders are on a spectrum
00:13:48
where you go from a
perfectly synchronized cycle
00:13:51
to one that prolongs it,
gets shorter together,
00:13:54
then prolongs, and then you have nothing.
00:13:56
There's this spectrum of dysfunction
00:13:58
which is representing
your hormones not being
00:14:01
necessarily perfect.
00:14:03
And that can have impacts on the placenta
00:14:05
trying to grow into that uterus.
00:14:07
I mean the placenta is fascinating, right?
00:14:10
An entire talk just on the placenta.
00:14:11
But it does this incredible
job where your body
00:14:14
has to not reject it
yet allow it to eat away
00:14:17
at the side of your uterus and
grow into your blood vessels.
00:14:20
But that requires a very
specific hormonal environment
00:14:23
for it to be done and to be done right.
00:14:26
I think in the same breath of all this
00:14:27
what you're also asking is,
00:14:29
okay, so that's eating healthy,
00:14:31
none of that's really
new news for most people.
00:14:33
A lot of those things I just said.
00:14:35
But I do want to thank you
00:14:36
'cause I think rarely if
ever do we hear a physician
00:14:40
be really direct about like, hey listen,
00:14:42
some red meat, yes.
00:14:43
Not excessive amounts
of red meat ideally from
00:14:47
sustainable sources, whole
fat milk products, grains,
00:14:51
fruits, vegetables, I
mean, those kind of like
00:14:54
to you seem like
straightforward directives
00:14:56
are actually pretty
rare in in the landscape
00:14:58
of public health discussion.
00:14:59
Because more often than not,
people talk about nutrition
00:15:02
and these kind of elimination
diet type things like
00:15:05
eliminate all the grains
or eliminate all the meat,
00:15:07
or eliminate all the milk fats.
00:15:10
When in reality I think people forget that
00:15:13
like most people out there are omnivores.
00:15:15
And they can make better
choices about not deli meat,
00:15:18
less bacon if any bacon, right?
00:15:20
Have some veggies with your lunch, right?
00:15:21
Like you can make better
choices on the day-to-day.
00:15:23
I think that is a great point.
00:15:25
I think there's a place for supplements.
00:15:27
I think the big disclaimer
that everybody is going to say
00:15:29
with supplements is that
they are not regulated
00:15:32
like the way medications are, right?
00:15:35
And I will say supplements and
herbs are different things.
00:15:40
A supplement, but many
companies are adding herbs
00:15:43
to their supplements and that can get into
00:15:45
really murky territory
especially when it comes to how
00:15:48
some of these herbs do have estrogen
00:15:51
and progestin like
properties and can impact
00:15:53
reproduction and hormones
00:15:55
And perhaps even
androgenic properties too.
00:15:57
Yes, so we can't act like
everything is created equal.
00:16:00
So I always tell people,
00:16:01
if I recommend you take a
supplement or your doctor does,
00:16:05
your due diligence is to
look at what is also included
00:16:08
and make sure it doesn't
have these extra added things
00:16:11
that they're unaware of.
00:16:13
Because sometimes they
can have negative impact
00:16:16
at one stage of your life or another
00:16:17
depending on where you are.
00:16:19
Certainly, a prenatal
vitamin which has folic acid,
00:16:22
we all know that folic
acid is really important
00:16:25
to prevent neural tube defects,
00:16:26
but it's also important in cell division
00:16:28
and how the ovary is growing
follicles and growing eggs.
00:16:32
So should people, women, but also men
00:16:36
be taking a vitamin with folic acid
00:16:38
even when they're not trying to conceive?
00:16:40
Yes, there's no harm in having it.
00:16:43
But very often pregnancies occur
00:16:46
when you're not trying to conceive.
00:16:48
And that is a store that
needs to be built up
00:16:50
three months ahead of time.
00:16:51
So we really need you to be taking that
00:16:54
ahead of getting pregnant.
00:16:56
So not just, let's get pregnant right now,
00:16:58
I'm going to start this prenatal vitamin.
00:17:01
So I recommend anybody who is
in their reproductive years,
00:17:04
take a prenatal vitamin.
00:17:05
We also know that many, many
people are vitamin D deficient
00:17:09
and vitamin D does impact reproduction.
00:17:13
And so I usually say a
thousand international units
00:17:16
of vitamin D is not going
to be harmful in anybody.
00:17:19
It's going to be helpful for most people.
00:17:21
Some people definitely need higher levels.
00:17:25
So we screen everybody with a vitamin D
00:17:27
to see who needs to have extra.
00:17:29
But a blanket statement,
that extra vitamin D
00:17:32
is going to be helpful.
00:17:34
Omega-3 fatty acids
also extremely important
00:17:37
in one being anti-inflammatory,
00:17:39
but two, brain development of a fetus.
00:17:42
So most prenatals now actually do have
00:17:45
those omega-3 fatty acids
in them, but if they don't
00:17:48
I recommend a patient take those.
00:17:50
Just a brief question/insertion there.
00:17:54
There's a laboratory up at
00:17:55
the University of California Santa Barbara
00:17:57
that's published some really
interesting data showing that
00:18:00
essentially brain weight which is just
00:18:02
one indirect measure of brain health,
00:18:05
but brain weight at birth
seems to be correlated
00:18:09
at least in some positive
way with the amount
00:18:11
of essential fatty acids that
mom consumed during pregnancy.
00:18:15
Does that hold?
00:18:17
Yeah, I mean that does
hold and there's my studies
00:18:21
about mice are smarter
when they have diets
00:18:24
with omega-3 fatty acids
when they're in utero, right?
00:18:28
So the exposure and the time
period is really important.
00:18:30
And omega-3s have a lot of health benefits
00:18:32
when it comes to their
antioxidant properties,
00:18:35
especially like in endometriosis,
00:18:38
diseases that are very
highly inflammatory,
00:18:41
they can be very beneficial.
00:18:43
We're definitely going to
talk about your work about
00:18:45
after baby has arrived and
impact of essential fatty acids,
00:18:48
but what would you say is the
dosage cutoff on this podcast
00:18:51
before I've sort of
thrown out numbers like
00:18:53
one to two grams per day of the EPA form
00:18:58
of essential fatty acid.
00:18:59
And then we could have
a whole discussion about
00:19:01
omega-3 omega-6 ratios.
00:19:02
But do you think there's a upper limit?
00:19:05
Is it truly that let's say up
to four grams per day of EPA,
00:19:11
would that be advantageous?
00:19:12
Is it better than one gram?
00:19:13
I tell people a gram.
00:19:15
Okay, that's in alignment with pretty much
00:19:16
what we've talked about before.
00:19:18
So that's what I recommend
when I give my handout
00:19:20
to my patients and they're
trying to get pregnant,
00:19:22
it's going to have a prenatal,
a thousand IUs of vitamin D,
00:19:26
a gram of omega-3s and then CoQ10.
00:19:28
So CoQ10 which essentially in general
00:19:33
is trying to help the mitochondria.
00:19:35
That's the whole idea here
00:19:36
that it is helping provide support
00:19:39
across the body in a lot
of different ways, right?
00:19:41
Like CoQ10 is used in a lot
of different areas of the body
00:19:44
but when it comes to reproduction,
when it comes to meiosis
00:19:47
and cell division and
ovulation and egg quality
00:19:51
and even sperm quality,
there's a place for CoQ10
00:19:54
showing benefit without harm.
00:19:57
And so as I said earlier,
00:20:00
nothing's without any
harm or any risk of harm
00:20:01
but very, very little.
00:20:02
So I usually recommend if
you're trying to get pregnant
00:20:05
and you take CoQ10,
00:20:06
a dose of 200 milligrams
three times a day.
00:20:09
So there's kind of a
higher dose than sometimes
00:20:11
people are on.
00:20:12
Often prenatals now have
just like 200 total in it.
00:20:17
The expensive ingredients are usually
00:20:20
the lower concentrations and the blends.
00:20:22
They need just enough so
they can put it on the label.
00:20:24
Right, which includes CoQ10.
00:20:26
Does the form of CoQ10 matter
'cause you'll find them
00:20:28
in gel capsules, you'll also
find them in powdered capsules?
00:20:33
I always say, I mean there might be
00:20:34
for the individual
person, I mean, absorption
00:20:37
of medication is really dependent a lot on
00:20:39
gut health and other factors.
00:20:41
But the number one issue
with supplementation
00:20:42
is that people don't stick to it.
00:20:44
So I always say whichever one you're going
00:20:46
to consistently take is
going to be the better form.
00:20:49
Great.
00:20:50
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