More than 2,500 years ago, Hippocrates said: “Let food be thy medicine and medicine be thy food.”

Now that we’re facing COVID, optimal nutrition is more important than ever.

Which nutrients support the immune system?

Micronutrients are dietary components that may contribute substantially to a robust immune system.¹ Essential micronutrients like vitamins A, D, E, C, B₆, B₁₂, and folate and trace elements such as iron, zinc, and selenium, available in a variety of fresh animal- and plant-based foods, aid the body’s ability to fight infections.² Health and survival are increasingly dependent on the functioning of the immune system.

Optimal nutrition impacts the immune system through gene expression, cell activation, and signaling molecules modification. In addition, what we eat determines our gut microbiome and subsequently shapes the immune responses in our body.3

What is optimal nutrition when in comes to preventing COVID?

Certain factors such as lifestyle, age, health status, sex, and medications affect the nutritional status of an individual.4  Several studies have confirmed that micronutrient deficiencies are associated with a weakened immune system that predisposes individuals to increased vulnerability to infections.^24,25

Recently, Calder et al⁶ reviewed the association between optimal nutrition and the immune system in providing better protection against viral infections. They suggested that essential micronutrients and the omega-3 fatty acids have the capacity to boost immunity against viral infections. Similarly, Chaturvedi et al⁴⁶ described the complex relationship between trace elements and viral infections, highlighting the immunomodulatory properties and antiviral activities of certain micronutrients such as iron, zinc, selenium, and copper. Apart from functioning as antioxidants, these trace elements were shown to inhibit viral replication in host cells.

The role of optimal nutrition for managing the current COVID-19 pandemic cannot be underestimated. Nutrition has a demonstrable role in the prevention and treatment of moderate to severe respiratory and non-respiratory infections. Adequate nutrition is even more essential for marginalized communities and in low- and middle-income countries, where deficiencies in key vitamins and minerals expose individuals to greater morbidity and mortality.

Each meal brings thousands of different substances into the body, affecting thousands of different biological processes, all the way to the cellular and subcellular level. Scientists are only beginning to grasp this enormous universe of food and nutrition effects on the body. Among these substances are nutrients, both macronutrients and micronutrients for which reference daily intakes have been defined, as well as upper levels for safe intake for many.16 17 However, a plethora of other bioactive substances found in foods, such as polyphenols and carotenioids, that seem to be important for health and wellness, are also brought along. The importance of these are bluntly reflected in food-based dietary guidelines (FBDGs), represented as recommendations for a variety and diversity of:

• whole vegetables, fruits
• berries
• nuts
• seeds
• grains and pulses
• along with some meats, eggs, dairy products and fish, if selected, as discussed in the paper by Calder.4

This type of healthy diet is a tactical approach to build a healthy body and a strong immune system, as emphasised by the WHO and other organisations during the pandemic,18 especially when eaten at the expense of more ultra-processed food items.19

However, with advancing age and for high-risk groups, a nutrient-rich diet is not always enough to meet needs for micronutrients.4 14 While high intakes should be avoided, there may be a a role for immune-targeted supplements that might be necessary to achieve the intake of nutrients needed for an optimally functioning immune system.4

Furthermore, there is one thing to enhance the public health nutritional status, through preventive actions, while the clinical situation of an active disease is another situation altogether.

Overall, older people are harder hit, and while fighting an infection, the nutrient needs of patients might be increased.14 This might warrant special nutrition therapy, potentially with higher doses of supplements and functional foods,11 as quality care also involves quality nutritional care.

Tailored nutritional advice and prescription for the prevention and treatment of COVID-19 is complex. The best way to navigate this is via professional advice from nutrition-trained professionals. Thankfully, we have 3 of them at Freedom Chinese Medicine; Dr. Jessie Fayers, Dr. Leoni Zakarias & Dr. Laura Thiveos.  Telehealth consultations to discuss your nutritional status and get advice or prescriptions are inexpensive and easy to book via: www.freedomchinesemedicine.com/booking

Written by Dr. Elaine Hickman

References

https://pubmed.ncbi.nlm.nih.gov/33982105/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7306972/

1. Annual Research Review: Improved nutrition–pathway to resilience.  Yousafzai AK, Rasheed MA, Bhutta ZA

There’s a bunch of fertility diet advice on the internet, but most of the advice has no evidence to support it. Most claims have not been tried and tested. Or, it’s general nutritional advice, not tailored for fertility.

And fertility advice is not a one size fits all approach. Shouldn’t be anyway. Some women’s fertility issues are related to their lining, some to their hormones, some to their eggs. And 50% of the time, it’s a male fertility issue.¹

The dietary recommendations below are to help improve a woman’s hormonal balance, egg quality and reduce miscarriage risk.

High blood sugar and insulin levels are a big problem for fertility because it disrupts the balance of other hormones that regulate the reproductive system. They also compromise egg quality². And increase the risk of miscarriage³.

The first step is to slightly reduce overall carbohydrate intake. And increase protein intake. A good ratio appears to be around 40% of calories from carbohydrates, 30% from protein, and 30% from fat. This represents a healthy, balanced diet and most people will be able to reach these ratios simply by changing just one meal per day. Such as having eggs for breakfast, rather than toast or cereal.

An even lower carbohydrate diet is likely helpful for those who are very overweight, or have PCOS, insulin resistance, or diabetes. For most women though, it is probably not beneficial to adopt a very low carbohydrate diet. In some cases, it may even have negative consequences for fertility, by elevating cortisol levels, and suppressing thyroid function. 4

• Avoid refined carbohydrates: the white flours, pastries, potatoes, white bread. Swap out for lower GI carbs such as brown rice, wild rice, steel-cut oats, quinoa or buckwheat. There are many pastas available these days made out of quinoa or buckwheat. This will help to balance your blood sugar and insulin levels. 

• Avoid refined cane sugar, in all it’s forms. There is clear evidence that excess sugar consumption compromises fertility.5   Minimise all types of sweeteners, and foods with significant amounts of added sugar. Whole fruit is OK in moderation (2 serves daily).  If you find yourself craving a sweet treat, and fruit won’t cut it, a small amount of dark chocolate is a good choice. Also keep in mind that it is long term daily habits that matter most. The occasional indulgence is not worth feeling guilty about. 

• Have lots of different vegetables. Aim for 4 different colours each day.

  

• Include legumes

• Eats nuts and seeds

• Include olive oil in your diet

  

• Eat fish twice per week

• Avoid saturated fats – typically found in butter, red meat, coconut oil. Appear to negatively impact egg development. A higher intake of red meat has been associated with lower embryo quality.

What about gluten and dairy?

There is some concern that both gluten and dairy can contribute to autoimmunity and inflammation in those with a sensitivity, even in the absence of celiac disease. For those with endometriosis, a history of recurrent miscarriage driven by immune factors, it does make sense to avoid gluten and diary. For everyone else, these foods may not be problematic. One option is to eliminate them from your diet for 2 weeks, and see how you feel. If you feel better, it may indicate that you do have a sensitivity and will benefit from avoiding gluten and/or dairy longer term.

What about alcohol?

Numerous studies have indicated that drinking regularly during pregnancy can increase the risk of miscarriage. However, low to moderate alcohol consumption ( 6 drinks per week or less) before you become pregnant is not an issue. The safest option is avoiding alcohol after ovulation, in case you become early pregnant without realising, or before testing.

What about caffeine?

Unfortunately, caffeine can increase miscarriage risk. Even caffeine intake before pregnancy. Studies indicate that miscarriage risk begins to rise with just one cup of tea or less than half a cup of coffee per day.

I appreciate that this advice could be alarming for some of you. It could suggest that a big diet overall is needed. If so, I suggest you start at the top of the list, and slowly make your way through, once you’ve got a handle on each.  A more tailored dietary approach is often useful, taking into account your history, your microbiome and your genetics. So it’s best to ask your practitioner at Freedom Chinese Medicine for specific advice or to help guide you through any changes needed. Most of us have nutritional training and have lots of experience with healthy diets.

Written by:

References

1 Esteves SC, Agarwal A. Novel concepts in male infertility. Int Braz J Urol. 2011 Jan-Feb;37(1):5-15. doi: 10.1590/s1677-55382011000100002. PMID: 21385475.

2 Jinno M, Takeuchi M, Watanabe A, Teruya K, Hirohama J, Eguchi N, Miyazaki A. Advanced glycation end-products accumulation compromises embryonic development and achievement of pregnancy by assisted reproductive technology. Hum Reprod. 2011 Mar;26(3):604-10. doi: 10.1093/humrep/deq388. Epub 2011 Jan 12. PMID: 21233108.

3 Tian L, Shen H, Lu Q, Norman RJ, Wang J. Insulin resistance increases the risk of spontaneous abortion after assisted reproduction technology treatment. J Clin Endocrinol Metab. 2007 Apr;92(4):1430-3. doi: 10.1210/jc.2006-1123. Epub 2007 Jan 23. PMID: 17244790.

4  Kose E, Guzel O, Demir K, Arslan N. Changes of thyroid hormonal status in patients receiving ketogenic diet due to intractable epilepsy. J Pediatr Endocrinol Metab. 2017 Apr 1;30(4):411-416. doi: 10.1515/jpem-2016-0281. PMID: 28076316.

5 Machtinger R, Gaskins AJ, Mansur A, Adir M, Racowsky C, Baccarelli AA, Hauser R, Chavarro JE. Association between preconception maternal beverage intake and in vitro fertilization outcomes. Fertil Steril. 2017 Dec;108(6):1026-1033. doi: 10.1016/j.fertnstert.2017.09.007. Epub 2017 Oct 3. PMID: 28985907; PMCID: PMC5716855.

Hjollund NH, Jensen TK, Bonde JP, Henriksen TB, Andersson AM, Skakkebaek NE. Is glycosylated haemoglobin a marker of fertility? A follow-up study of first-pregnancy planners. Hum Reprod. 1999 Jun;14(6):1478-82. doi: 10.1093/humrep/14.6.1478. PMID: 10357963.

Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. A prospective study of dietary carbohydrate quantity and quality in relation to risk of ovulatory infertility. Eur J Clin Nutr. 2009 Jan;63(1):78-86. doi: 10.1038/sj.ejcn.1602904. Epub 2007 Sep 19. PMID: 17882137; PMCID: PMC3066074.

Karayiannis D, Kontogianni MD, Mendorou C, Mastrominas M, Yiannakouris N. Adherence to the Mediterranean diet and IVF success rate among non-obese women attempting fertility. Hum Reprod. 2018 Mar 1;33(3):494-502. doi: 10.1093/humrep/dey003. PMID: 29390148.

Mirabi P, Chaichi MJ, Esmaeilzadeh S, et al. The role of fatty acids on ICSI outcomes: a prospective cohort study. Lipids Health Dis. 2017;16(1):18. Published 2017 Jan 21. doi:10.1186/s12944-016-0396-z

Moran LJ, Tsagareli V, Noakes M, Norman R. Altered Preconception Fatty Acid Intake Is Associated with Improved Pregnancy Rates in Overweight and Obese Women Undertaking in Vitro Fertilisation. Nutrients. 2016 Jan 4;8(1):10. doi: 10.3390/nu8010010. PMID: 26742065; PMCID: PMC4728624.

Chen LW, Wu Y, Neelakantan N, Chong MF, Pan A, van Dam RM. Maternal caffeine intake during pregnancy and risk of pregnancy loss: a categorical and dose-response meta-analysis of prospective studies. Public Health Nutr. 2016 May;19(7):1233-44. doi: 10.1017/S1368980015002463. Epub 2015 Sep 2. PMID: 26329421.

Huang H, Hansen KR, Factor-Litvak P, Carson SA, Guzick DS, Santoro N, Diamond MP, Eisenberg E, Zhang H; National Institute of Child Health and Human Development Cooperative Reproductive Medicine Network. Predictors of pregnancy and live birth after insemination in couples with unexplained or male-factor infertility. Fertil Steril. 2012 Apr;97(4):959-67. doi: 10.1016/j.fertnstert.2012.01.090. Epub 2012 Jan 23. PMID: 22270557; PMCID: PMC3319287.

There are a bunch of toxins in our environment that have been proven to reduce our fertility and increase the chance of miscarriage. Yes, we can’t avoid all of them. Yes, our grandparents did OK without this knowledge. But they didn’t live with the multitude of endocrine disrupters that we now do. There are a few main offenders. Let’s focus on them. And the simple steps we can take to reduce our exposure.

BPA – stands for bisphenol A, an industrial chemical that has been used to make certain plastics and resins since the 1950s. BPA is a known endocrine disrupter. Which means that it messes with our hormones. Hormones that are essential for normal ovarian function, follicle maturation, ovulation and fertilisation. And for sperm production. These normal processes are complex, there are lots of ways that things can go wrong. BPA has been found to be more frequently detected in infertile women thus leading to hypothesize a possible effect of BPA on natural conception. In addition, in procedures of medically assisted reproduction (such as IVF/IUI), BPA exposure has been found to reduce estradiol levels during gonadotropin stimulation, number of retrieved oocytes, number of normally fertilized oocytes and implantation¹.

So, where do we start to reduce our BPA exposure? BPA reacts/ leaks from hard plastics when exposed to:

• Liquid
• Heat
• Acid
• UV light

So the main things to look at are:

1. Drinking water. Get rid of your plastic drinking water bottle. Even if listed as BPA-free, other plastics probably contain other endocrine disrupters. We just don’t know about them yet. Best to go with glass or stainless steel.

2. Boiling water. Swap your plastic kettle for a stainless steel one.

3. Storing left-overs. Especially wet ones. Swap over your hard plastic food containers for glass or stainless steel ones. IKEA has some good glass ones with lids that don’t leak and stand the test of time.

4. Swapping plastic colanders for stainless steel ones.

5. Avoiding use of coffee machines with plastic components, using a stainless steel French press at home instead.

6. Canned food. BPA is often found in the lining of tin cans. Reduce your use of canned food as much as possible. Ie. Buy passata in glass bottles rather than cans. I’m aware that somethings are only found in cans ie. Coconut milk so let’s focus on reduce, not eliminate.

7. BPA is also found on printed receipts, such as receipts from EFTPOS transactions. So you can wash your hands after handling such receipts or try to avoid touching them often.

Interestingly, research has shown that folate-rich foods reduce the effects of BPA. The folate found in most supplements, doesn’t do the same thing. That may be because most supplements contain synthetic folic acid, whereas the folate present in fruits and vegetables is usually in the form of biologically active methylfolate or other forms that are readily converted to methylfolate. Folate-foods are berries, oranges, spinach, broccoli, cauliflower, kale, asparagus, avocado and lentils.

Even though high levels of BPA are linked to higher miscarriage risk. It is important to keep in mind that it is the highest BPA levels that are linked. To increase your odds of conceiving and preventing miscarriage, the main goal is simply to get out of that highest range; to lower your overall exposure rather than to avoid all possible sources of BPA.

Phthalates – Are also endocrine disrupters. Phthalates are found in many products made of plastics, but especially in synthetic fragrances. Such as:

• Perfumed cosmetics/ moisturisers
• Perfume
• Hair spray
• Scented fabric softener
• Nail polish
• Air fresheners

Before you freak out about all these products that you may use on the regular, remember it’s about reducing your exposure. Try to focus on one product at a time and swap it over for a natural, non-fragranced product. Maybe start with your body lotion/ moisturiser, as this covers a large part of your body. And when looking for alternatives, avoid items with fragrance listed in the ingredients. As these often contain Phthalates. And manufacturers can label products as phthalate-free but be aware – there is a labelling loophole in which the products may actually contain phthalates. It’s best to find products made from all natural ingredients or labelled fragrance-free. That way your reducing your exposure to other toxic chemicals such as parabens also.

New research indicates that the main way that Phthalates gets into our body’s is through food. In particular, fast food and highly processed food². One study suggests that simply making more meals at home is one of the most powerful ways to reduce exposure to the phthalates of greatest concern.

Have you already taken the above steps? Here’s some more you can do (only when you’re ready though, otherwise it can be overwhelming):

A provocative new study finds that women who have trouble getting pregnant are more likely to have high concentrations of certain non-stick chemical pollutants circulating in their blood than are those who become pregnant within the first month of trying. The suspect compounds — generally known as PFOA and PFOS —found in Teflon and Scotchguard products. 

Today, the chemicals are present on non-stick pans and in carpeting, upholstery and clothing that has been treated with stain-guard chemicals. They’ve also been used for years to treat popcorn bags and other packaging that might make contact with grease. Yet tests of these products show minimal release of PFOA and PFOS. Meanwhile, these compounds are showing up in the water entering municipal treatment plants long distances from manufacturing facilities — not to mention in animals and people around the globe. So what can we do?

• Filter your drinking water

• Install a shower or bath filter

• Ditch your old non-stick pans for ones made of cast iron, stainless steel, pyrex glass baking dishes and/or ceramic non-stick cookware

Whether you are trying to conceive naturally, going through IVF or trying again after a miscarriage, it is worthwhile doing what you can to improve egg (& sperm) quality. It takes 3-5 months for an immature egg to develop into a mature egg ready for ovulation. So it is worth making positive changes three months before trying to conceive (or now if you’ve already started).

Remember, one step at a time. When I was trying to conceive, I decided to focus on a new project each month. That is, each time my period came and I got over the disappointment, I then focused on what new thing I could do next to improve my chances.

Written by:

Elaine is available Mondays & Tuesdays at Freedom Chinese Medicine in Ivanhoe, Melbourne or via video chat. Click here to book.

References

1. Pivonello, C., Muscogiuri, G., Nardone, A. et al. Bisphenol A: an emerging threat to female fertility. Reprod Biol Endocrinol 18, 22 (2020). https://doi.org/10.1186/s12958-019-0558-8

Bisphenol-A and Female Infertility: A Possible Role of Gene-Environment Interactions. Xiaona Huo, Dan Chen, Yonghua He, Wenting Zhu, Wei Zhou, and Jun Zhang. Int J Environ Res Public Health. 2015 Sep; 12(9): 11101–11116. Bisphenol-A and Female Infertility: A Possible Role of Gene-Environment Interactions

Fei, C., . . . and J. Olsen. 2009. Maternal Levels of Perfluorinated Chemicals and Subfecundity. Human Reproduction 24(in press). DOI:10.1093/humrep/den490

Fei, C., . . . and J. Olsen. 2008. Prenatal Exposure to Perfluoroocanoate (PFOA) and Perfluorooctanesulfonate (PFOS) and Maternally Reported Developmental Milestones in Infancy. Environmental Health Perspectives 116(October):1391. [Go to]

Fei, C., . . . and J. Olsen. Perfluorinated Chemicals and Fetal Growth: A Study within the Danish National Birth Cohort. Environmental Health Perspectives 115(November):1677

When a woman or couple is trying to conceive, many tests may be done. It can be difficult to understand what these results mean. In my experience, most patients don’t understand them, even after seeing a fertility specialist. I think knowledge is power. And you wanna be empowered in your fertility journey right? So here is a basic outline of what tests may be done and what they indicate..

Usually when a woman tells her GP that she is trying to get pregnant, they’ll run a bunch of blood tests. The first ones are for STI’s and if the GP is thorough, they’ll include Iron, Vit D and a Thyroid study in the bloods.

Vitamin D is often low, so a good supplement is needed. If they are really low, it’s worth talking to a nutritional medicine practitioner for correct dosage of Vit D, such as Dr. Jessie Fayers at Freedom Chinese Medicine in Ivanhoe, Melbourne.

If you’ve been trying to conceive with no success for 12 months (or 6 months if you’re over 35), then other tests are done:

1. Pelvic Ultrasound – Can show any structural issues, lining thickness and will give a AFC, antral follicle count. This is the number of maturing eggs visible. Usually visible on both sides. You add these together to get the total count.  The AFC is the single most important indicator of your follicular reserve – egg count. An AFC lower than 8 is indicator of a lower reserve. If this is you, try not to despair, there is much that can be done to improve egg quality (it only takes one!) and optimise follicular reserve. Contact us to discuss.

2. Base hormone tests. This is a blood test taken at Day 2 or 3 of your menstrual cycle (day 1 is counted as the first day of  flow- not spotting). Your base hormones should include oestradiol, progesterone, prolactin, testosterone, FSH and LH. These are usually within normal range.

3. Progesterone tests are often overlooked but well worth doing. This is another blood test which should be taken 7 days after your usual ovulation time (if you know it). Often on Day 21, but if you ovulate late or early, this test should be done accordingly, ie. bloods taken on Day 17 if you ovulate on Day 10. The most thorough way to test progesterone is to take two more blood samples every second day after the first. That is, Day 21, 23 and 25. Seem excessive?

I can’t tell you how many women I’ve seen in 22 years of private practice, who have had trouble conceiving or keep miscarrying because of low progesterone. It’s a simple test, and often a simple fix.

12 days of sufficient progesterone levels are necessary to support implantation of a fertilised embryo. So, if you tend to have short cycles, it’s worth working out when you ovulate (via urine test, cervical mucous, BBT, bloods or u/sound). To ensure that there is at least 12 days between when you ovulate and when you bleed.

4. AMH

If your over 35 or if your pelvic ultrasound showed a low AFC, another blood test will be recommended; an AMH test.  This measures a hormone related to your egg count/ follicular reserve. It’s a fairly new test which is only really useful to indicate potential response to IVF and/ or how far you are from menopause.

The graph below shows the change in normal AMH range with age.  The breadth and value of this range reduces with age, which reflects the diminishing ovarian reserve.

However, age is not everything! When I had my AMH tested at 36yo it was 6, at 40 it was 2. Yes, I’ve felt the anguish, worry and tears. I went on to conceive naturally at 41yo. Yes I did a lot of work to improve my health, nutrition & fertility. You can too. Drop me a line to hear what I did and get a fertility plan tailored to you. Also check out the proven fertility diet.

There are no guarantees of course, but there is the satisfaction that comes from knowing you’re doing what you can to improve your chances. Here’s me & my healthy daughter:

5. Semen analysis for him (if there is one).

Been told that his semen is AOK? Do you know that the levels for “normal sperm” have been lowered dramatically in the last 30 years. Now, this doesn’t matter if your going for IVF/ ICSI. However, if you’re trying to conceive naturally or via IUI, read on..

In 1987, the normal levels for sperm morphology, that is sperm shape (- one head, one tail or two heads, missing tail) was 50%. Now it is at 3%. That is, it is considered normal for 97% of the sperm to be misshapen. Once again, this doesn’t matter with IVF as the healthy sperm can be selected. But if not, your partner/ donor’s sperm should be above 15% normal to have a decent chance of natural conception.

Morphology is considered the most significant semen parameter. Research shows that the percent of morphologically normal sperm are significant predictors of time to pregnancy. Even independent of sperm concentration.¹

I hope this helps navigate some of those fertility tests. Of course, they can be more complex if you have PCO or endometriosis. Wherever you’re at, we are experienced in helping every step of the way.