Outcome SACE ID: T. Question: To what extent can dietary factors be addressed to optimise healthy female fertility?

Transcription

1 SACE ID: T Outcome Question: To what extent can dietary factors be addressed to optimise healthy female fertility? - Word Count: A2 poster and a magazine article

2

3 What is the ideal diet to optimise Introduction What is the ideal diet to optimal female fertility? The optimal diet and supplementation of vitamins and minerals for female fertility is a controversial topic. A wide range of opinions were sought and all experts came from the respective fields of fertility including specialist doctor, naturopaths, dieticians and GPs. The following recommendations are the result of extensive research. Recommended diet part of a healthy diet 227,228. Should I go organic? Becoming organic costs a lot more. Herrmann sates that [It s] not needed, it s expensive. It may be a bit better, [with fewer toxins and chemicals and greater vitamins and minerals] 229. Naturopaths, on the other the body s proteins to overstimulate the immune system or resemble reproductive hormones leading to oestrogen, progesterone and testosterone imbalances 233,234,235. What carbohydrates should I eat? All the experts believe moderate believe in having some vegetarian days 283,284 carbohydrate proportions are fundamental and GP Griscti believes only in vegetarian, to to optimize fertility and quantities should be optimize fertility as it minimizes synthetic Across the board, if a diet was individualized to the hormone intake 285,. However, too much recommended, experts advise a female 236,237,238,239,240,241,242,243,244,245,246. protein has been discovered to lead to Mediterranean type diet 198,199,200,201,202,203. However, in saying that, all experts believe infertility risks which was shown in the Experts recommend wholegrains as they are Nurse s health study (The Fertility Diet) 286, that any diet is not a good way to achieve optimal fertility, but rather females should focus on a diversity in their food intake made up of predominantly wholefoods 204,205,206,207,208,209,210,211,212,213 lower in GI 247,248,249,250,251,252,253,254,255,256, reducing blood sugar spikes 257,258,259,260,261,262,263,264. Wholegrains are also higher in fiber which helps keep females full. Examples include brown rice, but protein helps decrease cravings and balance weight to stabilize hormone levels 287,288. Fertility expert Angela McLean and Karia including antioxidants and anti-inflammation wholemeal pasta and buckwheat. Sides recommends some red meat for iron 289,290, foods 214,215,216,217,218,219,220,221,222. Fertility expert states that white carbohydrates lead to which is important for hemoglobin Nicole Sides recommends eating foods weight gain as they are not metabolized production because it transports oxygen which our grandparents would have eaten well 265, however Karia maintains that white around the body 291,292,293. Due to monthly and avoid packaged or processed foods carbohydrates are fine as long as it is paired bleeds or during pregnancy, low iron levels 223. Dietician Kerri Abbott and Kate Gallasch with vegetables and meat 266. may interrupt baby development or leave individuals feeling weak and and general practitioner (GP) Adrian Griscti tired strongly believe that food should be bright. Chicken, fish and eggs are also identified as other great meat and colorful 224,225,226. GP Mark Herrmann and sources FE Sonal Karia also declare that sweets and. For vegetarians, it s fundamental to consume beans, legumes, naughty foods enjoyed everyday can be nuts and seeds 305,306. Small quantities of soy What proteins should I eat? hand, strongly recommend organic produce to optimize fertility, maintaining that toxins The advice on the consumption of protein interfere with micronutrients intake varies Griscti recommends a daily absorption 230,231. Griscti however, is more intake of.7-.8 grams of protein per kilo of concerned about the hormone levels in nonorganic food, particularly meat and milk 232. increase for active females who require more body weight 267. However, this amount may These synthetic hormones can interfere with protein, which contains amino acids, the building blocks of all body cells; this topic was explored extensively in The Fertility Diet (2007) and Fertility foods (2006) 268,269,270,271. Naturopath and Nutritionist Kerri Abbott said protein is important for healthy ova cellular membranes 272. The majority of the experts recommend meat daily 273,274,275,276,277,278,279,280,281, consuming up to 150g per meal 282. Dietician, Kate Gallasch and Naturopath, Henrietta Flannagan are also fine 307,308,309.

4 What fats should I eat? Fat will not make you fat and should be consumed daily, however intake should be individulised 310,311,312,313,314,315,316,317,318. The fatty acids within fat are impotant for a successful contraception and healthy pregnacy 319,320,321,322,323,324,325,326, especially, as Gallasch points out, because these fatty acids are anti-inflammatory with beneficial To improve infertility, limit or avoid cardiovascular properties 327. A 2003 study alcohol 352,353,354,355,356,357,358. Sides declares identified that 18-weeks pregnant mothers that alcohol is empty calories and lacks nutrients 359 and Flannagan says that alcohol who consumed very-long-chain n-3 interrupts the menstrual cycle 360. Herrmann polyunsaturated fatty acids (ie. cod liver oil) recommends to avoid compared to long-chain n-6 polyunsaturated alcohol altogether 361.Sides exclaims that fatty acids (ie. corn oil) had children who caffeine intake should be no more than 2 later achieved higher intellectal scores at cups (or equivant) 362,363,364,365 as the age Flannagan declares that low fat breakdown and its effect on the body is still diets are higher in artificil sweeteners, unknown 366,367,368,369. Flannagan declares that therefore more insulin is excreted as the caffeine may affect the pancreas raising pancreas is tricked 329. Abbott sates that fats insulin leading to irregular menstrual aid in cellular growth l ke ovum 330. cycles 370. Controversially Griscti suggests oil is not needed in a diet and good fats like olive oil are a marketing tool 331. Across the board, the majority of experts recommends that fat sources should be unsaturated. This includes olive oil, nuts, avocados and fish 332,333,334,335,336,337,338,339. Saturated fats should be limited including animal meats 340,341,342,343,344,345,346. Should I consume dairy? one serve of full fat dairy was linked to increased fertility, potentially because fat stores proteins, therefore full fat stored hormones for fertility 351. What Should I drink? Cochrane Pregancy and Childbirth group of the University of Liverpool s systematic review analysed if folate supplements preconceptionally reduced congenital abnormalities such as neural tube defects. They discovered a strong link with a dosage (pure or multivitamin) of 0.4mg or higher, reduced neural tube defects especially in those with past history 384. Gallasch declares that folate is most important 28 days after conception when the neural tube closes 385. Iron Iron is important for oxygen transport around the body for successuful pregnancy and foetus development 386,387,388. Iron is a much needed mineral 389,390,391,392,393,394,395,396,397,398,399, mg may be a good supplement amount 401,402,403 especially for vegetarins or vegans, however Flannagan declares that people are genetically anemic 404. A diverse diet may prevent supplementation, Naturopath and author of the Natural Fertility, Francessca Naish believes meat, nuts, seeds, beans, greens, seaweed, eggs and wholegrains are great sources 405. A study with 438 participants by the Nutrition and Epidemiology Harvard School of Public Health in Boston found that iron supplements (and multivitamins) containing non-heme-iron were linked to higher infertility, while heme-iron had no link 406. They also announced that iron food sources (heme and nonheme) may be associated with increased fertility 407. Abbott and Griscti recommends that females struggling with infertility should avoid dairy to reduce inflammation which interferes with the thyroid and therefore unbalances female hormone production 347,348,349. Herrmann controversially said limiting dairy restricts calcium absorption, which is important for female bones and fetus bone development during pregnancy 350. In the nurse s health study, So, should I take supplements? Folate Folate appears to be the most important vitamin to achieve optimal fertility due to its properties of decreasing neural tube defects in babies by 40-70% 371,372,373,374,375,376,377,378,379,380,381,382,383. A

5 Vitamin D A systematic review, including 15 studies found that 58-91% of people do not have enough Vitamin D. Vitamin D receptors present in pituitary, hypothalamus, ovary, uterus and placenta signal the excretion of anti-mu llerian (ovary reserve), a follicle stimulating hormone, estradiol (oestrogen type) and progesterone which are all involved with fertility 408. Flannagan maintains that deficiency s interfere with the Digestion and absorption is fundamental to menstruation cycles and succession rates of obtain vitamins and minerals, however embryos embedding into the uterus by across the board experts did not seem 25% 409. Sides says that deficiencies lead to concerned about this impacting fertility osteoporosis due to lack of ovulation 410. directly, but suggest it could be improved Karia believes vitamin D during pregnancy is by avoiding intolerants or allergies, ie important for calcium absorption, coeliac 458,459,460,461,462,463,464. decreased autism and increased IQ rates in children s development 411. Experts like Vitamin D for different reasons (sun) 412,413,414,415,416,417,418,419, Abbott believes Vitamin D balances female hormones 420. Zinc Zinc was recommended for hormone balance and improved foetus development, limiting retardation 421,422,423,424,425,426,427,428. An intake of 25-60mg is adequate, fresh oyster, poultry, fish, nuts, seeds, wholegrains, legumes and milk are all sources. 429,430 Iodine Iodine, an important mineral 431,432,433,434,435,436,437 is not stored in the body 438,439,440, it must be supplemented or consumed via diet (Mackerel, cod, seaweed, miso, ocean fish, shellfish and iodised salt 441 ). Sides and Karia says that iodine improves healthy thyroid function during pregnancy and must be increased by 50% to decrease fetus implications, ie brain development 442,443,444. The general conclusion is that, In a balanced diet, supplementation is not needed as the body should have the right amounts of micronutrients for healthy function, therefore increasing fertility. However if vitamin or mineral supplementation is required, no matter what micronutients it is, it should be specific to the individual and their needs 445,446,447,448,449,450,451,452,453,454,455,456,457. Is good digestion and absorption important? Should I be concerned about my weight? The biggest concern regarding female infertility is obesity, McLean maintains that a BMI of 35 (class 2 obesity 465 ) is beginning to become socially acceptable, this decreases fertility. She also highlighted that it was important for a female to eat enough to maintain energy needs 466,467. Flannagan says that overweight people give birth to premature or smaller children. However, experts agrees that an adequate diet is needed for optimal fertility and regular menstral cycles. In many cases thin females need to gain weight and large people need to lose weight, but in a non restrictive healthy manner which improves insulin resistance, improving homeostasis and therefore weight 468,469,470,471,472,473,474,475,476. The Nurse s health study discovered a BMI between optimizes fertility 477. Essentially, healthy weight decreases disease and illnesses and encourages balanced hormones for fertility 478,479,480,481,482,483,484,485.

6 Will exercise play a role in my fertility journey? Excessive exersise leads to infertility, an important factor for fertility specalists and general practitioners when determining optimal fertility 486,487,488,489,490,491,492. However, moderate exercise will help balance hormones and improve fertility exclaims McLean and Abbotte 493,494. Herrmann and Sides maintain that many gymnasts and marathon runners do not ovulate due to unbalanced hormones, Sides also states that this can be easily fixed for conception 495,496. To optimise fertility, listen to your body and move daily without going to any extremes. Summary Optimisng fertility is more than a diet. It come down to individuals and their body. A perfect fertility diet for females should avoid diets and include moderate exercise with a healthy weight. Experts do agree that wholefoods, all macronutrient groups and vegetables in a diet instead of supplements, will increase fertility. However, some females may have deficiencies and therefore, folate, iron, vitamin D, iodine and/or zinc may help achieve optimal fertility. Fertility doctors believe mediterranean diet principles, lean meats, unsaturated fats and no alcohol or sugary drinks increases fertility. Naturopaths recommend organic produce, eating the organs and glands from animals and unsaturated fats, along with good digestion for fertility. Dieticians advise a Mediterranean diet and good digestion, however, they also suggest to avoid gluten and dairy and to improve insulin resistance. GPs recommend to avoid alcohol, gluten and dairy and where possible, promote organic. Foods to optimise fertility is a controversial subject because of the developing knowledge in this field and it appears experts still do not know exactly how many biological mechanisms work. Regardless, females should experiment and find what works for them.

7 1 Chavarro, P. J. (2007). The Fertility Diet. New York, United States: McGraw-Hill Steicke, Interviewer) Angaston, South Australia, Australia Steicke, Interviewer) South Australia, Steicke, Interviewer) Angaston, South Australia, Australia Ingrid B. Helland, L. S. (2003, Jan). Maternal Supplementation With Very-Long-Chain n-3 Fatty Acids During Pregnancy and Lactation Augments Children s IQ at 4 Years of Age, Volume 111. (Pediatrics) Retrieved 24, Feb 2018, from American Academy of Pediatrics: aacaeb77f7a401f5f9.pdf Epidemiolog, Department of Nutrition and. (2006, Nov). Iron intake and risk of ovulatory infertility. Retrieved 5, Feb 2018, from ncbi: 70 Sollis, S. S. (2015, Aug 11). Vitamin D De ciency and Infertility: A Systematic Review. Retrieved 6, Feb 2018, from Brigham Young University: tent.cgi?article=1142&context=studentpub Luz Maria De-Regil, J. P.-R.-G.-S. (2015, Dec 14). Effects and safety of periconceptional oral folate supplementation for preventing birth defects. (Cochrane Pregnancy and Childbirth Group) Retrieved Feb 20, 2018, from Cochrane Library: Ingrid B. Helland, L. S. (2003, Jan). Maternal Supplementation With Very-Long-Chain n-3 Fatty Acids During Pregnancy and Lactation Augments Children s IQ at 4 Years of Age, Volume 111. (Pediatrics) Retrieved 24, Feb 2018, from American Academy of Pediatrics: aacaeb77f7a401f5f9.pdf 79 Tarjan, E. Z. (2017, Aug 31). Effect of Magnesium Supplement on Pregnancy Outcomes: A Randomized Control Trial. (Department of Obstetrics and Gynecology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran ) Retrieved Feb 26, 2018, from NCBI: Luz Maria De-Regil, J. P.-R.-G.-S. (2015, Dec 14). Effects and safety of periconceptional oral folate supplementation for preventing birth defects. (Cochrane Pregnancy and Childbirth Group) Retrieved Feb 20, 2018, from Cochrane Library: Epidemiolog, Department of Nutrition and. (2006, Nov). Iron intake and risk of ovulatory infertility. Retrieved 5, Feb 2018, from ncbi: (A

8 (A Sollis, S. S. (2015, Aug 11). Vitamin D De ciency and Infertility: A Systematic Review. Retrieved 6, Feb 2018, from Brigham Young University: tent.cgi?article=1142&context=studentpub 125 (A (A (A. 160 (A (A (A (A. 173 (A (A. Steicke, Interviewer) Angaston, South Australia, Australia

9 215 (A (A (A (A (A (A (A Epidemiolog, Department of Nutrition and. (2006, Nov). Iron intake and risk of ovulatory infertility. Retrieved 5, Feb 2018, from ncbi: (A (A. Steicke, Interviewer) Angaston, South Australia, Australia Ingrid B. Helland, L. S. (2003, Jan). Maternal Supplementation With Very-Long-Chain n-3 Fatty Acids During Pregnancy and Lactation Augments Children s IQ at 4 Years of Age, Volume 111. (Pediatrics) Retrieved 24, Feb 2018, from American Academy of Pediatrics: aacaeb77f7a401f5f9.pdf

10 328 Ingrid B. Helland, L. S. (2003, Jan). Maternal Supplementation With Very-Long-Chain n-3 Fatty Acids During Pregnancy and Lactation Augments Children s IQ at 4 Years of Age, Volume 111. (Pediatrics) Retrieved 24, Feb 2018, from American Academy of Pediatrics: aacaeb77f7a401f5f9.pdf 329 (A (A (A (A (A (A (A (A Luz Maria De-Regil, J. P.-R.-G.-S. (2015, Dec 14). Effects and safety of periconceptional oral folate supplementation for preventing birth defects. (Cochrane Pregnancy and Childbirth Group) Retrieved Feb 20, 2018, from Cochrane Library: Luz Maria De-Regil, J. P.-R.-G.-S. (2015, Dec 14). Effects and safety of periconceptional oral folate supplementation for preventing birth defects. (Cochrane Pregnancy and Childbirth Group) Retrieved Feb 20, 2018, from Cochrane Library: Epidemiolog, Department of Nutrition and. (2006, Nov). Iron intake and risk of ovulatory infertility. Retrieved 5, Feb 2018, from ncbi: (A (A Epidemiolog, Department of Nutrition and. (2006, Nov). Iron intake and risk of ovulatory infertility. Retrieved 5, Feb 2018, from ncbi: Epidemiolog, Department of Nutrition and. (2006, Nov). Iron intake and risk of ovulatory infertility. Retrieved 5, Feb 2018, from ncbi: Sollis, S. S. (2015, Aug 11). Vitamin D De ciency and Infertility: A Systematic Review. Retrieved 6, Feb 2018, from Brigham Young University: tent.cgi?article=1142&context=studentpub 409 (A Sollis, S. S. (2015, Aug 11). Vitamin D De ciency and Infertility: A Systematic Review. Retrieved 6, Feb 2018, from Brigham Young University: tent.cgi?article=1142&context=studentpub 413 (A (A

11 (A (A (A. 472 Steicke, Interviewer) Barton, Australian Capital Territory, (A (A Steicke, Interviewer) Barton, Australian Capital Territory,.

12 What is the ideal diet to Bibliography Books Interviews Steicke, Interviewer) Angaston, South Australia, Seminars Websites Websites (scientific studies) Epidemiolog, Department of Nutrition and. (2006, Nov). Iron intake and risk of ovulatory infertility. Retrieved 5, Feb 2018, from ncbi: Ingrid B. Helland, L. S. (2003, Jan). Maternal Supplementation With Very-Long-Chain n-3 Fatty Acids During Pregnancy and Lactation Augments Children s IQ at 4 Years of Age, Volume 111. (Pediatrics) Retrieved 24, Feb 2018, from American Academy of Pediatrics: Sollis, S. S. (2015, Aug 11). Vitamin D De ciency and Infertility: A Systematic Review. Retrieved 6, Feb 2018, from Brigham Young University: tent.cgi?article=1142&context=studentpub Tarjan, E. Z. (2017, Aug 31). Effect of Magnesium Supplement on Pregnancy Outcomes: A Randomized Control Trial. (Department of Obstetrics and Gynecology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran ) Retrieved Feb 26, 2018, from NCBI: Luz Maria De-Regil, J. P.-R.-G.-S. (2015, Dec 14). Effects and safety of periconceptional oral folate supplementation for preventing birth defects. (Cochrane Pregnancy and Childbirth Group) Retrieved Feb 20, 2018, from Cochrane Library: