MAY 2012        Foods for Fertility and Beyond    RECIPES        Apple-Cranberry Tuna Salad        Spinach, Cheese and Mushroom Strata        Warm Lentil Salad    DOWNLOAD THE NEWSLETTER        CLICK HERE to Download the PDF               This requires Adobe Acrobat

etting pregnant and having a healthy pregnancy can be an exciting chapter in a woman’s life. However, it can also be fraught with fertility struggles and anxiety over how to best nourish the life growing inside you. No matter how easy or difficult a time you have in your reproductive efforts, research shows that upgrading your diet at least three months prior to conception can help you achieve the best possible outcome for you and your baby. Eating well during your reproductive years not only can improve your chances of getting pregnant, it can also help nourish a healthier baby with fewer risks of birth defects.

Although the connection between diet and fertility has not been studied extensively, health researchers at Harvard have found evidence that certain dietary and lifestyle practices can make a difference for women who are trying to get pregnant. It seems that practicing at least five of the eight fertility factors that they identified decreased ovulation-related infertility in healthy women by 69% (as compared to healthy women who practiced none of the fertility behaviors).

According to the results of the Nurse's Health Study, there are eight specific factors that improved women's chances of ovulating. If you are thinking of getting pregnant, try to practice at least five of the following in order to prime your body for optimal fertility:

Eliminate trans fats and emphasize monounsaturated fats and omega-3 fats. Trans fats (called "partially hydrogenated oil" on ingredient lists) are not only bad for your heart and your brain, but they interfere with ovulation, too. Eliminating from your diet all partially hydrogenated oils — which are usually found in commercial baked goods, fast food, fried food, margarine, shortening, cookies, crackers, some cereals, breads, energy bars and candy bars — is important for boosting fertility. Minimizing saturated fat to less than 17 grams a day is also recommended.

Most Americans eat about 10 times more polyunsaturated fat than they do monounsaturated fat, but the researchers recommend that women eat roughly equal amounts of monounsaturated fat and polyunsaturated fat. It's easy to get plenty of polyunsaturated fat in your diet, since it's in most processed and prepared foods, but women should minimize those foods and instead focus on their intake of the most important polyunsaturated fat, omega 3 fatty acid, which only comes from sources like salmon, anchovies, black cod, white fish, sardines, tuna, herring, halibut, and, to a lesser extent, walnuts, chia seeds, flax seeds and some omega 3-fortified foods. Eating more monounsaturated fat also takes some effort, since it is found mostly in extra virgin first cold pressed olive oil, avocados, seeds and nuts (not peanuts).

Get dietary protein mostly from plant foods instead of animal foods. In the study, the nurses who ate most of their protein from animal sources had 39% more ovulatory infertility than women who ate most of their protein from plant sources. Eating two vegetarian meals a day would be a good way to execute this suggestion. Examples of plant-based proteins are soy beans, soy nuts, tofu, soy milk, tempeh, textured vegetable protein (TVP), lentils, garbanzo beans, black beans, kidney beans, cannellini beans, pinto beans, split peas, almonds, walnuts, pecans, cashews, pistachios, sunflower seeds, pumpkin seeds, sesame seeds and tahini, but they recommend limiting soy products to one serving a day. When you do choose animal proteins, your best bets are fish and eggs with poultry eaten occasionally. Try to minimize your intake of beef, lamb and pork as much as possible since they are associated with increased risk of ovulatory infertility.

Replace simple and refined carbohydrates with slow-digesting carbohydrates. Whole intact grains, starchy vegetables, beans, legumes, non-starchy vegetables and fruit all help control the level of women's blood sugar, insulin, and other reproductive hormones related to ovulation. This is another good reason to minimize processed food, since women who ate the lowest quality carbohydrates were 92% more likely to have ovulatory problems than women who ate the highest quality carbohydrates. Instead of fast-digesting carbs like refined breakfast cereals, white breads, white rice, pasta, mature potatoes and crackers, try oatmeal (not instant), muesli, granola, barley, quinoa, flourless whole grain bread, brown rice, wild rice, whole wheat pasta (slightly undercooked), baby potatoes, orange sweet potatoes, peas, corn and winter squash.

Eat one to two servings of full-fat dairy products a day. This may be the most surprising recommendation of all, since it is so contradictory to our belief that nonfat dairy is generally the healthiest choice. The researchers found that women who chose nonfat and low-fat dairy products had much higher rates of ovulatory problems than the women who ate full-fat dairy. The reason for this, in short, is that all dairy products contain both male and female sex hormones, but most of the female-type hormones in milk (such as estrogen) bind to fat; therefore, when the fat is removed or reduced, then the majority of hormones that remain are the male type hormones, like testosterone, as well as other hormones that suppress ovulation. The full-fat dairy products, on the other hand, contain the full gamut of sex hormones. Whole milk seemed to have the best results in terms of increasing ovulation, and the authors recommend one to two daily servings of full-fat dairy, ideally one glass of whole milk each day plus two half-cup servings of ice cream a week.

Take a prenatal multi-vitamin that includes plenty of folic acid and iron. Folic acid and iron are especially important for increasing ovulation, but the multivitamin as a whole is also important for improving fertility and growing a healthy fetus. A prenatal vitamin that contains at least 400 micrograms of folic acid and 40 milligrams of iron is recommended. Additionally, a diet that is rich in these nutrients is imperative. Folate (the food form of folic acid) is found in lentils, black-eyed peas, pinto beans, garbanzo beans, romaine lettuce, asparagus, okra, spinach, Brussels sprouts, broccoli and other vegetables and whole grains. Iron is best consumed from plant sources, such as tofu, pumpkin seeds, blackstrap molasses, lentils, kidney beans, fortified breakfast cereals, artichokes, edamame, barley and nuts. Some research suggests that male partners could benefit from taking a standard multivitamin (not a prenatal one) since folic acid may boost sperm production.

Drink mostly water and consume coffee, tea and sodas in moderation, if at all. Being well hydrated is an important factor in fertility, and water is the healthiest way to hydrate. Coffee and tea (caffeinated or decaf) seem to have no effect on fertility when consumed in moderation (one to three cups a day), and the same goes for alcohol when it is consumed at a rate of one glass daily. However, the consumption of any of these beverages beyond moderation will probably negatively affect fertility and the practice of drinking alcohol and/or caffeine during pregnancy and preconception is controversial, so it may be best to take a break from these beverages.

Soft drinks, diet and regular, were also shown to diminish fertility. Women in the study who drank two or more caffeinated sodas a day had 50% more ovulatory infertility than women who drank soda less than once a week. Sodas with and without caffeine affect blood sugar and contribute many extra calories to the diet, both of which contribute to ovulatory infertility. Male partners may want to consider giving up caffeine and alcohol to promote successful conception, too.

Both female and male partners should get their weight into the healthy range, a.k.a. the "fertility zone." The researchers explain that this is a range of weights for your height that maximizes fertility by regulating ovulation. For women, that optimum range is defined as a Body Mass Index (BMI) between 20 and 24. BMI is a quick and dirty way of estimating if your weight is right for your height and a BMI of 19-24 is considered healthiest. Here is the equation to use to calculate your BMI: BMI=your weight in pounds x 703 divided by (your height in inches)2. If your BMI is above 24, they recommend lowering it to be as close to 24 as possible, but they found that losing just 7.5% of your current weight can be enough to improve fertility. For those with BMI under 20, they recommend trying to gain five to ten pounds. Additional research shows that a healthy pre-pregnancy weight is also important for preventing birth complications and poor child health outcomes, including obesity and its related risk factors. Although researchers weren't able to define a fertility zone for men, they do emphasize that being overweight affects men's hormones, too, and overweight men seem to produce sperm that are less robust. Therefore, overweight male partners should aim to lose 7.5% of their body weight or get as close to a BMI of 24 as possible. Although losing weight is not always easy, the reward of conceiving a healthy baby is an excellent motivator.

Start an exercise program if you haven't already and keep exercising if you already have started. In the study, nurses who exercised vigorously for at least five hours a week had the lowest risk of ovulatory infertility. Exercise can help improve fertility when you exercise within a certain range of time and intensity that is right for your body since it helps to moderate hormone levels. Women who are at a healthy weight should aim for about 30 minutes of vigorous exercise a day. Women who have a BMI above 25 should try to get 60 minutes of exercise daily to help them get their weight into the "fertility zone." Underweight women should be more moderate in both the time and intensity of their workouts, since over-exercising can impede ovulation and prevent weight gain. In addition to your everyday activities, the researchers recommend a combination of aerobic exercise, strength training and stretching, with aerobic exercise being the cornerstone of your program.

Getting pregnant is easier for some couples than it is for others; age, genetics, weight, diet and lifestyle are all contributing factors to fertility. While you can't control all of these risk factors, you can make some healthful alterations to your diet and lifestyle and the eight factors I outline here are a great starting point. Remember that your goal should be to practice at least five of these eight factors, but you are certainly encouraged to aim for all eight. Few if any of the nurses in the study were able to achieve all eight elements, but the researchers speculate that the more of them you are able to achieve, the more successful you will be in boosting your fertility.

Once you are pregnant, you don't have to eat in any special way (though there are foods and beverages that should be avoided since they have the potential to harm your developing fetus; see chart). It would be great if you could continue to practice the fertility factors discussed above since they are healthful habits that promote health throughout the lifecycle. More than anything, your job in pregnancy is to start feeding yourself and your baby well in order to achieve the best possible outcome: a full-term pregnancy with a healthy baby.

Eating for two is a myth; you need very few extra calories (about 300 per day) in the second and third trimesters to support optimal weight gain. Only women pregnant with multiples should gain more than 40 pounds (talk to your doctor about your optimal weight gain range, since goals are based on pre-pregnancy weight). That being said, any woman who has ever been pregnant will tell you that it is very difficult to control weight gain at this time. During pregnancy, our bodies become more efficient at extracting nutrients (and calories) from foods, so weight gain happens easily (unless nausea and vomiting prevent you from eating). Furthermore, weight gain patterns are different for every woman with each pregnancy. Some women gain a lot at the beginning, while others gain nothing; other women gain steadily or in short bursts every few weeks. More important than trying to force or restrict your weight gain is to put your energy into nourishing your body and your baby.

Pregnancy is a good time to start practicing nurturing a healthy family, since you will be responsible for feeding another person once your baby arrives. If you have a strained relationship with food or are not good at feeding yourself reliably, now is the time to start making positive changes to cultivate a healthier relationship with food. Important eating practices to consider during pregnancy include:

Start learning how to prepare and cook easy, healthy meals. If you don't know much about planning meals and what constitutes a balanced, healthful meal, now is the time to learn and experiment. These are skills that don't happen naturally; you must find ways to cultivate them. Feeding your family (especially a toddler) will be a much more pleasant experience when you have meal planning and cooking skills under your belt. For easy, healthful recipes and menu planning information, visit the "healthy living resources" section.

I believe that how you eat is just as important as what you eat. Having a healthy relationship with food is an essential part of enjoying your pregnancy and parenting your child. Children notice everything, so if you have some eating habits that you don't want them to adopt, now is the time to make changes. Make peace with food now by practicing mindful eating, listening to and trusting your body, eating when you are hungry and stopping when you are full and not attaching judgment to food. If you don't enjoy vegetables, push yourself to try new ones and experiment with different preparation and cooking methods that make them taste good to you (visit the "cookbook" section for my simple and tasty recipes).

What you eat is important, as the foods you eat are incorporated into your baby as he or she grows and develops in the womb. It is more important now than ever to choose the best quality foods for yourself and your baby. Research has shown that following the Mediterranean Diet produces some of the best pregnancy outcomes. The Mediterranean Diet is a plant-based diet that emphasizes two vegetarian meals a day, consisting mainly of vegetables, whole grains, olive oil, beans, eggs and nuts. The dietary recommendations for improving fertility easily fit within the framework of the Mediterranean Diet. Of course, diet does not determine all health outcomes, but it is one of the few factors that we can control.

Drink plenty of water. Being well-hydrated is essential for producing adequate amniotic fluid, supporting increased blood volume and preventing constipation, water retention and urinary tract infections. Filtered water (NOT vitamin-enhanced waters) is the best beverage choice for you and your baby, since water carries important nutrients throughout the body and contains no calories or sugar. Aim for at least 64-80 ounces a day, plus an additional eight ounces for every hour of exercise.

Iron and calcium are two very important nutrients in pregnancy, but they are not compatible with one another. They actually compete for binding sites inside the body, so in order to maximize your absorption of both nutrients be sure to keep them separate. That involves choosing a prenatal vitamin with as little calcium as possible. Most prenatal vitamins contain adequate iron, but calcium supplements should be taken separately to maximize absorption of both nutrients. Furthermore, prenatal vitamins should not be taken with a high calcium meal (milk, yogurt, cheese and calcium-fortified foods are good sources of calcium) and calcium supplements should not be taken with a high iron meal (see factor #5 above for sources of iron).

Omega-3 fatty acids are essential for the development of the central nervous system, brain and eyes of a developing fetus. Adequate omega-3 intake in pregnancy can increase pregnancy length and result in optimal visual and cognitive performance in children. Pregnant women should aim to consume at least 300 milligrams of EPA + DHA each day (with at least 200 milligrams coming from DHA). This is a difficult goal to achieve, even if you follow the recommendation to eat just two six-ounce servings of low-mercury fish each week, since fatty fish is the main dietary source of omega-3s. Talk to your doctor about adding a high-quality fish oil supplement that c ontains both EPA + DHA to your supplement routine. Note that many prenatal vitamin supplements come with algae-derived DHA, but no EPA. A fish oil supplement such as Nordic Naturals Ultimate Omega contains both of these essential fatty acids.

Once you give birth, you need to continue to think about your nutritional needs. If circumstances allow for it, consider breastfeeding, as there are tremendous long-term health benefits for both you and your baby. Breastfeeding requires an additional 500 calories a day (more than pregnancy!) in order to maintain an adequate, nutritious milk supply. Continue to eat high-quality foods like you did when you were pregnant, since the foods that you eat put nutrients into your milk that nourish your baby and replenish the nutrient stores in your body. Maintain your prenatal vitamin and omega-3 routine (even if you don't breastfeed, omega-3s can help ward off post-partum depression). If possible, cook and freeze some meals before your baby comes so that you can easily defrost and eat healthful foods in the first few weeks of your newborn haze (trust me, you won't even remember how to write your own name, let alone remember how to cook a meal from scratch in those first few weeks). Furthermore, don't even think about trying to lose your pregnancy weight right away. It is important to return to your pre-pregnancy weight, but don't put too much pressure on yourself to lose weight quickly as it can affect your milk supply and result in muscle loss instead of fat loss. Keep in mind that it took ten months to gain the weight, so give yourself at least that amount of time to lose your pregnancy weight.

Healthier mothers produce healthier children. If you are thinking of trying to conceive in the next year, now is the time to start making healthful changes to your diet. It is never too soon to start eating healthfully and building up your nutrient stores in order to prepare for your healthiest possible pregnancy.

Gelson’s registered dietitian, Jessica Siegel, has a Masters in Public Health. However, she is not a doctor and her nutritional recommendations are not tailored to specific health problems. Consult your physician before beginning any nutritional program. To contact Jessica, please call her at 1-800-GELSONS (435-7667).