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What should women eat for fertility?

December 17, 2018
female fertility diet, toronto naturopath, naturopathic doctor toronto, fertility naturopath

It might come as a surprise that few people think about preconception health. And to be honest, when they do, it’s usually because of fertility struggles. Diet plays a huge role in how we feel and function, and provides the necessary building blocks to support conception.

Carbs and Fertility

Carbs might make up a significant part of your diet. When it comes to nutritional science, there’s a lot of learn about carbs, but I want to focus on 2 things: the glycemic index and glycemic load. 

The glycemic index is a value assigned to a particular food on how fast or slow it causes an increase in your blood glucose level.

The glycemic load combined quality and quantity of carbohydrates. It’s calculated by the amount of food you eat and the glycemic index of the particular food.The glycemic load is also associated with higher risks of ovulatory infertility.

In PCOS, it’s been found that women will often consume foods with a higher glycemic index. When women reduce their carb intake (or perhaps choose carbs with a lower index and load), their insulin sensitivity will improve, testosterone will decrease, and ovulation will occur (this is important, because anovulation is a key symptom in PCOS).

Fats and Fertility

Let’s clear something up. Fat isn’t bad. Yes, some are better than others and there are some you should avoid completely. But you need fat to make hormones, help your eggs mature and to get that tiny blastocyst to implant! 

Unsurprisingly, you should be avoiding trans fats. They increase insulin resistance, may prevent ovulation from happening, and decrease your chance of getting pregnant.

To get into specifics, omega 3 fatty acids are associated with progesterone production in the luteal phase (this is important!) and a reduced risk of anovulation. In women undergoing IVF, omega 3 fatty acid intake was associated with better embryo morphology. 

Protein and Fertility

You should be eating at least 1g of protein per kg of body weight (more if you’re active). Protein comes in different forms: animal and vegetable. One study showed that ovulation was negatively affected by increased animal protein. While another study showed that although fish, eggs, and processed meats didn’t have an effect on ovulation, vegetable protein intake decreased anovulation. Blastocyst formation in assisted reproductive technology decreased in patients consuming more red meat. But it was positively affected by fish consumption.

Now before you head on off to the local fish monger, you want to pay attention to fish and mercury content (as it may interfere with hormones and fertility). Fish to avoid would be bigeye tuna, king mackerel and swordfish.

Soy protein often gets a bad rap, but can actually be beneficial in women seeking fertility treatments. Soy isoflavone supplements were associated with improvement in reproductive outcomes, increased live birth after clomiphene administration, and higher endometrial thickness and ongoing pregnancy rates after IVF and ICSI. 

A couple things to consider before ordering your soy latte – choose organic, non-GMO soy. And if you have a thyroid condition, it’s best to avoid dietary soy altogether.

Next Steps

It might be obvious that a diet that leans towards fast food/processed foods and few fruits and vegetables is probably not the best. And when it comes to a diet in particular, adopting a Mediterranean diet (which basically has a foundation of vegetable and fruit, whole grains and fish) has shown to be effective in a few studies. 

Pesticides and other chemicals in our foods may also affect reproductive success, so if possible, choose organic when you can. Basically, if any of the fruits and vegetables that you eat appear on the Dirty Dozen, eat the organic version instead. 

When choosing meats, aim to get your meats from local farms if possible. And grass-fed and antibiotic-free are great options too. 

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References

Chiu, Y., Chavarro, J. and Souter, I. (2018). Diet and female fertility: doctor, what should I eat?. Fertility and Sterility, 110(4), pp.560-569.

Endometriosis in Teens

December 10, 2018
endometriosis in teens, toronto naturopath, naturopathic doctor toronto, teen naturopath, danforth naturopath

It’s time to listen to your body. 

Especially if you’re experiencing period pain. 

You might’ve been told that period pain is normal. But that’s not exactly true. Period pain is a common symptom, but isn’t always normal.

Cramping in your lower pelvis or back is normal around the start of your period, but experiencing severe pain isn’t. If you feel a stabbing, burning, or throbbing pain that doesn’t go away with pain killers, and is causing you to miss school or work, and affecting your quality of life – you need to figure out what’s going on.

One of the emerging causes of period pain in teens is endometriosis. Endometriosis happens in about 10% of women who menstruate (likely more!). It was previously thought that teens didn’t have endometriosis because research only looked at older women who were having trouble getting pregnant.

What is endometriosis?

Endometriosis is a gynecologic disease that occurs when endometrial tissue grows outside your uterus. This tissue can grow anywhere in your body (it’s even been found on the lungs and brain), but it’s most commonly found on the ovaries, fallopian tubes, uterine surface, bowel and the lining of the pelvic cavity.

When you experience your monthly period, you also experience internal bleeding and ultimately scar tissue will form. Sounds great, right? #noway

Common endometriosis symptoms in adults

Some of the common symptoms associated with endometriosis are:

Other symptoms include:

How does endometriosis present in teens?

You might notice pain that doesn’t quite sync with your period (aka. noncyclic pelvic pain). Also, if your mom or sister have endometriosis, or if you have a history of atopic disease (ex. eczema, asthma) – you should be checked!

Endometrial lesions might be found between your ovaries, peritoneum, pouch of Douglas, uterosacral ligaments and rectovaginal septum. Typically, the lesions may present differently than they would in adults. Yours might be more red and clear. 

Because of these differences, this may contribute to your delay in diagnosis, and ultimately treatment. Obviously this lag may negatively impact your quality of life. 

Warning signs in teens

Pay attention to these signs:

  • Extended use of anti-inflammatory drugs (ex. NSAIDs)

  • Family history of endometriosis (ex. mom and sister)

  • Frequent absence from school during your period, and skipping exercise because of pain or a heavy flow

  • Birth control prescription before you turn 18 because of pain

How is endometriosis diagnosed?

You can’t diagnose endometriosis through a blood test. Instead, the gold standard of testing is a laparoscopic exam. This is considered a minimally-invasive surgery where small incisions are made in the abdomen to both confirm the presence of and remove endometrial lesions.

Doctors may suggest ultrasounds to see if you have endo, but that test can’t completely rule endo out. 

Conventional Treatment of Endometriosis

Unfortunately there’s no cure for endometriosis. But treatment should include controlling pain and preventing lesion progression. 

The first line treatment in endometriosis is birth control (usually a combined pill). This may actually be worthwhile to try if the pain is incredibly severe, and not responding to regular painkillers. Nevertheless, there are a few things to consider if you plan on taking birth control: 

A huge study in 2016 investigated different types of birth control and how they were associated with antidepressants and a diagnosis of depression. Researchers found that teens (between 15 to 19) are more sensitive to depressive symptoms and antidepressants than adults. This was seen in teens using the combined pill or progestin-only pill. The study did show that the incidence of depression and antidepressants use decreased with age. 

Teens with endometriosis report impaired physical and mental health quality of life. As well as physical pain, difficulty in participating in daily activities, physical activities, and social events. Therefore all of these factors must be considered when determining the best treatment route, or adjunctive supportive therapies. 

Naturopathic Treatment of Endometriosis

Once again there isn’t a cure for endometriosis, but you can do a couple of things to manage the pain and improve quality of life. There are some supplements that you can take, but it should really be done under the supervision of a health practitioner like a Naturopathic Doctor. 

You may want to consider:

  • FODMAPs diet or an anti-inflammatory diet

  • Curcumin

  • N-acetyl cysteine

  • EPA/DHA

  • Selenium

  • Vitamin E

Next Steps

If you’ve been experiencing any of the warning signs, it may be time to talk to your doctor about endometriosis. 

If you found this information helpful, I would encourage you to download my 
FREE EndoDiet meal guide and plan. It goes through everything we discussed: foods that are safe and that should be avoided, and a 7 day meal plan and preparation guide!

References

Dowlut-McElroy, T. and Strickland, J. (2017). Endometriosis in adolescents. Current Opinion in Obstetrics and Gynecology, 29(5), pp.306-309.

Gallagher, J., DiVasta, A., Vitonis, A., Sarda, V., Laufer, M. and Missmer, S. (2018). The Impact of Endometriosis on Quality of Life in Adolescents. Journal of Adolescent Health, 63(6), pp.766-772.

Reid, R., Steel, A., Wardle, J. and Adams, J. (2018). Naturopathic Medicine for the Management of Endometriosis, Dysmenorrhea, and Menorrhagia: A Content Analysis. The Journal of Alternative and Complementary Medicine.

Zannoni, L., Forno, S., Paradisi, R. and Seracchioli, R. (2016). Endometriosis in Adolescence: Practical Rules for an Earlier Diagnosis. Pediatric Annals, 45(9), pp.e332-e335.

What are Fertility Awareness Methods

fertility awareness methods, toronto naturopath

Fertility awareness methods allow the opportunity for people to track their cycle, with the goal of knowing when ovulation occurs. There are a variety of methods (as listed below) and are about 76-88% effective, with a possible increase in effectiveness if you use multiple methods together. 

With most of these methods, it’s wise to track your period and these particular signs for at least 3 months (6 months for calendar methods) to get an idea of your body’s rhythms before you use any of the methods for contraception. 

The Temperature Method

If you’ve been following my blog for a while, you might remember a blog post discussing basal body temperature and fertility.

A quick recap: body temperature changes throughout the menstrual cycle. It’s lower in the follicular phase and slightly higher in the luteal phase. This slight rise in temperature occurs after ovulation, and happens after the formation of the corpus luteum which releases progesterone (the hormone responsible for the temperature change). 

By following this method, you would measure your basal body temperature everyday and chart it (on an app or on paper).  

Days are considered safe once 3 days has passed since the initial rise of temperature, as well as a drop in temperature before the onset of the next menstrual cycle. This is an opportune time to have unprotected vaginal sex (with or without ejaculation). 

During your fertile days, you can avoid sex or use another birth control method. 

The Cervical Fluid Method (The Billings Method)

This method is based on cervical fluid changes, another topic I covered a while back. 

A quick recap: During the follicular phase, increasing estrogen levels will lead to the production of cervical fluid. Cervical fluid will change in colour, texture, and amount during the period, and is considered especially fertile around ovulation. 

Similar to the Temperature Method, cervical fluid needs to be charted everyday, starting from the end of the menstrual cycle. The changes that you may see will give you an idea of when ovulation may occur – which is great if you are hoping for pregnancy (unlike temperature, where it tells you that ovulation has passed).  Record everything daily: your period days, dry days, wet days, sticky days, cloudy days, and slippery days.

There are 3 ways to check your cervical fluid: (1) Before urination, wipe the opening of your vagina with white toilet paper or tissue. Observe the colour and feel of the fluid. (2) Look at your underwear for any discharge – note the colour and texture. (3) Insert your clean fingers into your vagina, and note the colour and texture of cervical fluid on your fingers. The best way to feel the consistency of your fluid is to rub it and stretch it between your thumb and index finger.

This fertility awareness method may not be best for people who don’t generally produce any cervical fluid. 

Source https://pregprep.com/wp-content/uploads/2013/08/131107_pregprep_chart1.jpg

The Symptothermal Method

This method combines cervical fluid, cervix changes, basal body temperature, and calculation to determine the beginning and the end of the fertile period. At the very least, you should be tracking cervical fluid and basal body temperature to determine when to avoid or engage in sex (depending on your goals, obviously). 

The Calendar Method (The Rhythm Method)

This is one of the methods that need at least 6 months of charting your period. 

Mark the first day of your cycle on an app or on a calendar. Remember, the first day is when you notice significant bleeding – not spotting. Mark the first day of your next cycle. Count the number of days in between your period. You’ll find the fertile part of your cycle, once you subtract 18-21 days from the shortest cycle (of the 6 cycles that you have tracked). You would find the end of the fertile part of your cycle by subtracting 9-11 days from your longest menstrual cycle. 

A real life example:

Dec – Jan = 30 days
Jan – Feb = 33 days
Feb – Mar = 28 days
Mar – April = 26 days
April – May = 32 days
May – June = 27 days

My shortest cycle was 26 days 
My longest cycle was 33 days

Start of my fertile phase is (26 days – 21 days) and (26 days – 18 days) = Days 5 to 8
End of my fertile phase is (33 days – 11 days) and (33 days – 9 days) = Days 22 to 24

Therefore, I would be considered fertile between days 5 to 24 of my period. Many couples may find this way a bit constricting, and may need to have another means of contraception if they still want to engage in vaginal sex. 

This method may be unreliable if you experience irregular menstrual cycles. 

The Standard Days Method

This fertility awareness method identifies a standard window in which someone may be fertile. You can only use this method if your cycle is really regular and is never shorter than 26 days and never longer than 32 days. You must also be cool with not having vaginal sex or using another contraceptive method between days 8 and 19 of your cycle – as they are considered the most fertile. 

Final Thoughts

There are at least 5 ways of practicing fertility awareness. Your best bet is paying attention to your basal body temperature and cervical mucus, and doing so for at least 3 cycles if you’re choosing this as your primary method of birth control. Speak to your Naturopathic or Medical Doctor to determine if these methods are right for you.