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Five important things to consider when becoming pregnant after weight loss surgery.

What is bariatric surgery?

Bariatric surgery, also known as weight-loss surgery, is a type of surgery that involves making changes to your digestive system to help you lose weight. It is designed to make the stomach much smaller, which causes you to feel full after eating only a small amount of food.

The most common types in Australia are gastric bypass (called Roux-en-Y gastric bypass) and gastric sleeve surgery (called sleeve gastrectomy). Lap band surgery (called gastric banding) is also a type of bariatric surgery.

 

How does bariatric surgery help fertility problems?

Bariatric surgery can help you lose significant amounts of weight and improve your overall health. Being above your most comfortable or healthy weight may trigger hormone imbalances that can affect your ovulation cycles and make it harder to get pregnant. Moving towards a healthier weight can help address these issues. Improved fertility results from promoting more predictable ovulation cycles and reducing insulin resistance.

Significant weight loss can lead to dramatic fertility improvements. As such, it is important to consider contraception following this type of surgery and not to try to become pregnant straight away. This is for a number of reasons. The first is that it  gives your body time to lose weight (and importantly, stabilise) before conceiving. Secondly, delaying conception also allows your body’s vitamin levels to stabilize, which reduces the risk for fetal malnutrition as well as complications like premature birth and low birth weight.

Here are five important tips for women who want to fall pregnant after bariatric surgery:

  1. Wait at least 12 to 18 months after surgery before trying to conceive. This will give your body time to heal and adjust to the changes caused by surgery.
  2. Reach and maintain your most comfortable or healthy weight before getting pregnant. This will help to reduce the risks of complications during pregnancy. You should not be actively trying to lose weight.
  3. Eat a nourishing diet and take an appropriate multivitamin. This will help to ensure that you are getting all the nutrients that you and your baby need. Bariatric surgery causes malabsorption, a significant reduction in nutritional intake, or both. Following this type of surgery you need lifelong multivitamin supplementation. A “pregnancy multivitamin” will not be enough.
  4. Be as physically active as possible. Prioritising movement, reducing sitting time and finding activities that you enjoy all support your health and wellbeing. Think bone, heart, and mental health as well as helping to manage your weight and metabolic and reproductive health.
  5. See your health care professional team regularly for antenatal care. This will help to ensure that your pregnancy is progressing normally.

How can a dietitian help?

At a minimum, a pregnant person who has had bariatric surgery should see a dietitian in early pregnancy and then approximately every trimester. Bariatric surgery can change the way your body absorbs nutrients, so you can be at increased risk of developing nutrient deficiencies.

Once you become pregnant you have the additional issues of juggling:

  • increased requirements for protein and most micronutrients,
  • the pregnancy symptoms that can further affect your intake (nausea, vomiting, reflux, constipation, food aversions), and
  • the need to monitor your weight gain closely, especially in the second and third trimesters.

It is important to talk to your bariatric surgery team and a maternal health accredited practising dietitian about your specific needs and to develop a plan to make sure that you are getting all the nutrients that you and your baby need and that this is monitored through blood tests.

The dietitians at Lifestyle Maternity are expert maternity dietitian who have also worked with bariatric surgeons, providing care to their patients. For further information book an appointment with a Lifestyle Maternity Dietitian.

References:

Queensland Clinical Guidelines. Obesity and pregnancy (including post bariatric surgery). Guideline No. MN21.14-V6-R26. Queensland Health. 2021.

 

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Is what and how you eat working for you…or against you?

We think ‘diet’ is a four-letter word.

Food restriction or “dieting” means intentionally depriving yourself. Ongoing deprivation is generally only ‘successful’ for a certain amount of time before we ‘fall off the wagon’ and start eating for comfort or to rebel against the ‘diet’.

Initially we might feel temporarily better before we inevitably become disappointed or frustrated with ourselves that we ‘failed’ and decide to “diet” again.

Why does the diet industry thrive? Repeat business!

Does this cycle sound familiar?

The majority of clients that we see for weight management are already aware of what an ‘everyday’ food and a ‘sometimes’ food is, yet struggle to reach or maintain their most comfortable weight. Why is that?

When working towards your weight loss goals it is imperative to not only look at what you eat but also why you eat, how you eat and where you eat.

We are all capable of eating when we are not physically hungry and it is quite normal to do this on occasion. This is called ‘non-hungry eating’. Do it too often however and this type of eating behaviour can result in unwanted weight gain or difficulty losing weight.

If we can reduce the amount we are eating when we don’t really want it, as well as reduce the amount we are eating when we don’t really enjoy it, it will make reaching a healthy, comfortable weight easier without relying on extreme diet restrictions.

Experience tells us that in many situations, a particular type of food might taste great initially, but if we pay attention to the taste, texture and flavour, surprisingly quickly the food becomes less pleasurable.

Being more aware of whether or not we are enjoying the food we are eating is an important step in reducing the overall amount of food we eat.

Do you start off enjoying something but then just keep eating to finish it off?

The If not dieting© ‘Law of Diminishing Pleasure’ is a concept that can assist us to eat less, while at the same time increase our enjoyment from food. It can show us that if we eat with awareness, the more we eat of a particular food the less pleasure we receive as we continue to eat that particular food. It applies to all types of food that we eat although the rate of decrease will vary for various types of foods.

By being more mindful of this decrease in pleasure we can continue to eat all types of foods (everyday and sometimes foods), however learn to eat less by stopping earlier – when our enjoyment has diminished.

Lifestyle Maternity Dietitians specialise in dietary counselling methods that focus on the behaviour of eating. We use a coaching approach to weight management and healthy eating that draws on evidence based strategies to promote a ‘life-skills’ focus to facilitate lifestyle change to assist our clients achieve a more comfortable and healthy weight.

For further information or advice on being a healthier you, make an appointment here.

 

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Controlling Non Hungry Eating: one piece of the puzzle for achieving your most comfortable weight

One of the most common techniques our Lifestyle Maternity Dietitians use with clients is a range of strategies to help them identify their patterns of Non Hungry Eating, also known as NHE.

WHAT IS NHE?

 Non hungry eating is eating when you aren’t physically hungry for food.

HOW CAN I TELL IF I DO ANY NHE?

 Ask yourself the following questions:

  • Do I usually eat a piece of cake that someone has baked for me even if I am not hungry, because I don’t want to offend them?
  • Do I finish what is on my plate when I am eating out, even if I feel full before all the food is finished, so that I don’t waste it?
  • Do I ever overeat a food because it is really delicious? (E.g. sometimes it is hard to eat just one Tim Tam!)
  • Do I ever eat something like a chocolate bar or have a few glasses of wine after a really long, stressful day to make myself feel better?

These are just some examples of NHE – and there are many more!! Some NHE is normal and many people do it. When we end up doing a lot of NHE it can be hard to maintain a comfortable weight and it may also contribute to weight gain.

WHAT ARE SOME TIPS I CAN USE TO REDUCE MY NHE?

  • Question your hunger levels before eating. Do your best to only eat when you are physically hungry.
  • Don’t restrict foods; tell yourself, “I can have it if I want it, but am I really hungry for it?
  • Avoid eating when you are distracted (E.g. in the car, in front of the TV, when you are working) as it is hard to really assess hunger levels when you are doing other things.
  • Eat off a plate. Don’t eat out of packets as you can’t see the volume you are eating when you do this. This will help increase your awareness of how much you are eating.
  • Keep a food diary and also record your hunger levels before and after meals and snacks.
  • If you are consuming high calorie foods and fluids to comfort yourself (E.g. after a bad day) consider other options other than eating to comfort yourself such a going for a walk, taking a hot shower or long bath, talking to a friend or streaming an episode of your favourite show.

If you would like to learn more about identifying your NHE triggers, strategies to reduce NHE episodes or how to eat mindfully make an appointment here.

To read more about NHE and other techniques to help you be the healthiest you can be, resulting in achieving and maintaining a comfortable and healthy weight without being deprived of food or losing quality of life AND to enjoy food without feeling guilty, visit Dr Rick Kausman’s website.

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Can what I eat and how I move help my Polycystic Ovary Syndrome?

What is PCOS?

Polycystic Ovary Syndrome (PCOS) affects around 10% of Australian women in their reproductive years. This is due to hormonal changes.

This ‘syndrome’ is linked to a range of health issues for affected women, trans or non-binary people. In the short term, those with PCOS may have reduced fertility and difficulty conceiving. In the longer-term obesity, diabetes and cardiovascular disease are more likely for people with PCOS.

Normally the ovaries produce large amounts of the female hormone oestrogen, lesser amounts of the male hormone testosterone, and the pregnancy hormone progesterone (which is only produced in greater amounts after ovulation and during pregnancy). In PCOS, testosterone levels are often mildly increased.

The causes of PCOS are unknown. In some cases, it seems to run in the family whereas for other women the condition only occurs when they are above their most healthy weight.

Women who have PCOS may experience:

  • Irregular menstrual cycles – menstruation may be less frequent due to less frequent ovulation, and may be either heavier or lighter than average.
  • Amenorrhoea – some women with PCOS do not menstruate, in some cases for many years.
  • Infertility – related to less frequent, incomplete or absent ovulation.
  • Increased body hair (hirsuitism)
  • Obesity
  • Acne

There may also be long-term health risks. Recent research suggests that PCOS is related to insulin resistance and the development of type 2 diabetes. Some women with PCOS develop type 2 diabetes, especially if they are overweight.

What is the latest research on PCOS and lifestyle changes?

Recently, new international evidence-based guidelines for the assessment and management of PCOS were released. This large body of work documented results from studies around the world and gives direction for the best treatment steps to take.

A take home message from these guidelines is the important role of ‘lifestyle management’ as the first line of therapy for PCOS and outline the clear benefits that result from a very achievable weight loss and increase in physical activity.

Do I have to get back to my ‘healthy’ BMI range for me to see improvements in my health?

No, the good news is that research shows that achieving a loss of just five to ten percent of your body weight, whatever weight you are at now, has significant effects for fertility and symptom management in women with PCOS. What might this look like? For most women, it is a loss of only 4 to 5 kg. Further health benefits come from greater losses, and are enhanced by increasing physical activity.

How active do I have to be to get health benefits?

A good goal is at least half an hour of moderate-intensity physical activity on most, preferably, all days. You do not have to do it all at once. Your exercise can be spread over the day, in ten minute blocks. Try three ten minute walks, or two fifteen-minute periods of activity.

What does moderate-intensity activity mean? Moderate-intensity means you are exercising at a comfortable pace. A good guideline is the “talk test” – you should be able to maintain a conversation easily without being short of breath.

What happens if I am already in my healthy BMI range?

Maintaining your weight in the healthy range can help prevent symptoms and longer term health risks for women with PCOS. Being a healthy weight is a balancing act: having a good knowledge of nutrition is important, but we also need to understand the reasons for why we eat, how we eat, what we eat, who we eat with and where we choose to eat. Believe it or not, there is a lot more to reaching and maintaining a comfortable weight than counting up kilojoules!

Dietitians are trained to take a key role in assisting women with PCOS to manage their symptoms. Here at Lifestyle Maternity, specialist women’s health dietitians are able to tailor a program to support you to adapt guideline recommendations to your lifestyle and preferences. We look forward to supporting you on your journey to better health and quality of life. For further information book an appointment with a Lifestyle Maternity Dietitian or enrol in an online, self-paced course.

 

Interested in the new PCOS app that was produced to accompany these guidelines? Check it out here

 

 Figure 1. The Lifestyle and PCOS infographic produced to accompany the new PCOS guidelines.

 

 

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The Ultimate Guide to Supplements and Fertility: What Works, What Doesn’t, and What to Avoid. (Hint: it’s probably not what you think…)

If you are trying to conceive, you may wonder if taking supplements can improve your chances of falling pregnant. After all, nutrition plays an important role in reproductive health, and some vitamins and minerals may support fertility in various ways.

However, before you rush to the nearest health store, pharmacy, or order online, there are some things you need to know about supplements and fertility.

What are the best supplements for fertility?

Despite some very clever marketing trying to convince us of otherwise, there are no specific supplements that will help you fall pregnant. However, there ARE some vitamins, minerals and other nutrients that are worth considering for their impact on your fertility.

The following has PROVEN links to improved pregnancy outcomes.

FOLIC ACID. This is the most important supplement to take when trying to conceive, as it helps prevent neural tube defects in the developing baby. Most women need  to take a supplement that contains at least 400 micrograms (mcg; µg) of folic acid per day, starting at least one month before conception and during the first trimester (at least). Some women need higher amounts – these include women with diabetes, a higher body mass index, those with a family history of neural tube defects, or who are taking certain medications.

Additionally, while iodine  is not directly related to improving fertility it is essential to take during all of pregnancy and while breastfeeding. Iodine is involved in growth and development, especially for a baby’s brain. Studies show that the Australian population is mildly iodine deficient.  Pregnant women need 220 micrograms of iodine per day. All women should take a daily supplement with 150 micrograms during pregnancy and breastfeeding.

In the MAYBE group we have a handful of supplements that MAY improve fertility OR have links to better health IF an IDENTIFIED DEFICIENCY has been detected.

VITAMIN D. This vitamin is essential for many functions in the body, including immunity, bone health, and hormone production. Some studies have suggested that vitamin D deficiency may be associated with infertility, miscarriage, and poor pregnancy outcomes. A blood test will tell you if you do not have enough Vitamin D in your blood. Vitamin D comes from the sun, supplements, and a small amount from food.

Most of the Vitamin D your body needs comes from the action of sun on your skin. Do not get sunburnt as this will increase your risk of skin cancer. If you are low in Vitamin D you will require an additional Vitamin D supplement of at least 1000IU.

 

IRON: Iron deficiency anaemia affects over one in three women of childbearing age. An iron supplement could be useful and may be recommended by your doctor or dietitian if your stores are low. If this is the case, a separate iron supplement is recommended (rather than relying on it from a multivitamin – some have a little (e.g. many of the preconception and pregnancy ones), and some have more (e.g. Elevit), but none have ENOUGH to correct a deficiency).

Iron supplements can be important, but they can have side effects, including: an upset stomach or constipation. Different tablets of timing of tablets can help – discuss with your dietitian or pharmacist if this is the case.

 

ZINC and SELENIUM: The Fertility Society of Australia and New Zealand’s preconception health special interest group provide a fantastic review of how some micronutrients might be linked to improving fertility. This review has focused on zinc and selenium.

This expert group acknowledge that, despite the growing number of studies on the effects of micronutrient supplementation on subfertility, inconsistencies in the literature relating to males and the lack of studies on females, prevent any firm recommendations about doses or duration of treatment. (In simple terms – the studies that have been done have not been done well enough to tell us the answer yet!)

However, the group do point out that none of the studies identified any detrimental effects of zinc or selenium on male or female fertility when administered below the recommended daily intake.

 

OMEGA-3 FATTY ACIDS: Omega-3s are important for brain and eye development as baby grows in the womb, as well as for reducing overall inflammation at a cellular level. In pregnancy, they have been linked to a reduction in the risk of preterm birth and may lengthen pregnancy too.

In a recent study called the “Time to Conceive” cohort, it was found that there was no strong association between serum concentrations of omega-3 fatty acids and the probability of conceiving naturally in a group of over 200 women. However, when this same study team looked at around 900 women undergoing IVF in their cohort, there was an association between omega-3 intake and conceiving. (They note that as this wasn’t the type of high-level study (randomised controlled trial) that allows us to say, ‘doing this caused this to happen’. Being a less controlled ‘cohort study’ they can only say ‘one thing happened at the same time as another thing’.

As these essential fats cannot be made by the body, they must be obtained from food or supplements.  While it seems like this is a green light for omega-3 supplements, we need to stop and consider other studies (as well as sources of omega-3). Omega-3 supplements used to be all the rage for heart health, but recent position papers from the Heart Foundation have shown that it is eating FOOD SOURCES of omega-3 rather than popping the SUPPLEMENTS have the most positive impact on heart health. Perhaps it’s the same for fertility and pregnancy?

The good news is that fish and seafood should be an important part of your diet in pregnancy. It is an excellent source of protein, is low in saturated fat, has high amounts of omega 3 and can be a good source of iodine. Great sources of omega-3 include: canned sardines, salmon (fresh or canned), some canned tuna, as well as mackerel and herrings.

…and what are some good ‘swaps’ for those claims that don’t quite hold true?

COENZYME Q10 (CoQ10): This is a natural antioxidant that helps protect the cells from oxidative stress and supports energy production. It is also known as UBIQUINOL. While many fertility blogs seem to recommend taking a CoQ10 supplement to help improve egg quality in women and sperm quality and motility in men, these parameters and enhance fertility two recent papers have shown this not to be helpful.

When wanting to find information to support your beliefs it can be easy to just read and believe small studies that align with what you are wanting to read. In the ‘how to judge good science’ approach, the studies at the pinnacle of the ‘trust’ pile are ones that have gathered a LOT of studies together, pooling the results AND systematically assessing them for how well they were done AND written up.

One such study by a group of Greek researchers found that oral supplementation of CoQ10 had no effect on live birth rate or miscarriage rate when compared with ‘no treatment’ or a placebo. They did note that CoQ10 may increase a clinical pregnancy rate, but this did not affect the overall pregnancy rate.

Similarly, another clinician-research team from Australia and New Zealand that gathered findings from many studies foundthere was low- to very low-quality evidence to show that taking an antioxidant supplement may benefit subfertile women. They concluded that there was limited evidence in support of supplemental oral antioxidants for subfertile women.

What about nature’s antioxidants? Sorry, bad dietitian joke there. Well, this is something for which there is a LOT of evidence. Antioxidants are found in many fruits and vegetables and may prevent some of the damage caused by free radicals by neutralising them. These include the nutrient antioxidants, vitamins A, C and E (from food and not tablets!), and the minerals copper, zinc and selenium.

Other dietary food compounds, such as the phytochemicals in plants, are believed to have greater antioxidant effects than vitamins or minerals. These are called the non-nutrient antioxidants and include phytochemicals, (such as lycopenes in tomatoes and anthocyanins found in cranberries). 

How much should I take?

The dosage of supplements may vary depending on your age, weight, health status, and fertility goals. It is always advisable to consult with your doctor or specialist maternal health dietitian before taking any supplements, especially if you have any medical conditions or are taking any medications. Your health care provider can help you determine the optimal dosage for your needs and monitor your response.

Are there any side effects or risks?

Most supplements are generally safe and well-tolerated when taken at the recommended doses. However, some supplements may interact with other medications or supplements, or cause allergic reactions or gastrointestinal discomfort in some people.

Some supplements may also have adverse effects on pregnancy or breastfeeding if taken in excess or without medical supervision.

Therefore, it is important to read the labels carefully, follow the instructions, and report any unusual symptoms to your doctor. Taking more than one supplement that contains the same ingredient can increase your risk of toxicity or overdose.

One specific example that has been in the news recently is vitamin B6. This vitamin, present in many multivitamin and mineral supplements, can cause peripheral neuropathy. In response, the TGA (therapeutic goods association) has strengthened labelling requirements so products containing daily doses over 10mg of vitamin B6 must carry a warning about peripheral neuropathy. Check the labels of what you are taking!

Do supplements guarantee pregnancy?

Unfortunately, no. Supplements are not magic pills that can make you pregnant overnight. They are meant to support your overall health and wellness, and possibly enhance your fertility potential. However, there are many other factors that influence your ability to conceive. This can include your age, lifestyle, genetics, timing of intercourse, and underlying medical conditions.

Therefore, taking supplements alone may not be enough to overcome these challenges. You may also need to make some lifestyle changes (such as quitting smoking, reducing stress, eating a balanced diet, exercising regularly) and seek professional help (such as fertility testing or treatment) if you have been trying for more than a year without success (or six months if you are over 35).

The bottom line

Supplements can be a helpful addition to your fertility journey, but they are not a substitute for a healthy lifestyle or medical care. If you are interested in taking supplements for fertility, talk to your doctor first to find out what is best for you and your partner.

Remember that every person is unique and what works for one may not work for another. Be patient and optimistic, and don’t give up on your dream of having a baby.

Vitamins and minerals are important but it is important to think about food and meals to get all the nutrients you need. If you would like further information book an appointment with a Lifestyle Maternity Dietitian or enrol in an online, self-paced course.

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How does diet affect fertility?

What a woman (and her partner) eats before conception plays a significant role in many parts of the pregnancy journey.

This includes how quickly they may fall pregnant, woman’s health through pregnancy, as well as how their baby develops in the womb AND it’s long-term health.

How long before I become pregnant should I be focusing on improving what I eat?

Improvements at any time are beneficial.

However, keep in mind that an egg and sperm can take around 3 months to develop and the quality of someone’s diet in this time influences the processes of producing healthy reproductive cells.

Is there a special diet I should follow to fall pregnant?

The types of food in a woman’s diet can reduce ovulatory infertility (which can occur in PCOS – polycystic ovary syndrome).

Despite some very clever marketing trying to convince us of otherwise, there are no specific foods that will help you fall pregnant. However, we know from big population studies that there is a pattern of eating that may improve your fertility. (Check out the ‘Nurses’ Health Study, if you are interested).

The recommended changes you can make relate to the types of carbs and protein you eat, how you exercise and your weight.

What supplements do I need to take?

Adequate and appropriate folic acid supplementation is essential to prevent neural tube defects (e.g. spina bifida) in your baby.

Women need an extra 400 micrograms (“μg”)/day of folic acid, in the month before conceiving and the first three months of pregnancy. This requirement is higher if your BMI is above 30kg/m2.

Although you don’t need more iodine until you become pregnant, taking a folic acid-iodine supplement is often the best way to take these nutrients.

Unless you have been diagnosed with a nutritional deficiency, you do not need to take vitamin D or iron. A single (nutrient specific) supplement is best for these in each case if you do have a deficiency.

There’s a lot of interest in zinc and selenium supplementation to improve subfertility.

Although there are many research studies in this area, they haven’t all been done well. This means it’s hard to make any firm statements about their benefits. Importantly however, none of the studies showed bad effects of taking them at levels below recommended daily intakes – so they are probably safe to take, if desired.

Want to know more?

Lifestyle Maternity’s Director and Principal Dietitian, Dr Shelley Wilkinson, was recently interviewed by journalist, Jessica Mudditt for this BBC article. Click here for a deeper dive into the links between fertility and nutrition.

 

If you would like further information book an appointment with a Lifestyle Maternity Dietitian or enrol in one of our online, self-paced courses.

 

 

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Alcohol could affect your fertility more than you think

Most people are aware that alcohol should be avoided in pregnancy. But did you know that drinking alcohol can affect fertility?

Drinking any amount of alcohol can make it more difficult to conceive. Despite no definite cut off with alcohol intake and fertility, it is recommended that people do not drink when trying to conceive.

How much is enough?

This advice is supported by recent research from the US that showed the associations between drinking alcohol and decreased chances of successful conception.

It is thought that alcohol consumption disturbs the delicate sequence of hormonal events around ovulation, fertilisation, and implantation. Even light drinking. (What?!)

Aussie, Aussie, Aussie…

Socialising and drinking in Australia tend to go hand in hand. Heavy drinking is seen as acceptable in almost all social situations, from weddings to sports matches, and even at baby showers.

Binge drinking is not uncommon – one in three Australians drink more than they should on a single occasion. (This resource from Your Fertility has a great run down on what a standard drink looks like).

Want more reasons?

Reducing or quitting alcohol can improve your life in many ways. It can:

  • improve your mood and sleep,
  • increase your energy,
  • improve your relationships with your loved ones,
  • help you perform better at work,
  • lower your risk of long-term health problems such as cancer and heart disease, and
  • save you money.

Here are ten top tips from UK’s drinkaware on how to socialise without alcohol.

  1. Plan ahead. If you know you don’t want to drink on a night out, a little bit of planning ahead can make things much easier. Deciding on an alternative drink to have before you go out can also help you avoid stumbling.
  2. Tell people. This can have a few benefits – announcing your intentions can give you the confidence and motivation to stick to them. Friends can also offer support if you need it, and it helps avoid any awkward moments.
  3. Be ready for peer pressure. People will usually move on or respect your decision if you stand firm.
  4. Explore alcohol-free alternatives. Alcohol-free beers, wines and spirits are an easy replacement for your usual tipple.
  5. Organise some alcohol-free activities. Some classic drink-free nights out that never get boring include trips to the cinema, late-night food markets, theatre, or bowling.
  6. Watch your savings grow. Then every month, enjoy putting that money towards a treat or something else you’ve been meaning to get.
  7. Try some new hobbies and grow your network. You might have an old interest you always wanted to pursue or try something completely new.
  8. Get active. Not only will you be getting the health benefits of drinking less, like more energy and better sleep but you’ll be getting fit too.
  9. Have some plans for the morning after. Make sure it’s something you really look forward to and you’ll be more determined to stay alcohol-free the night before.
  10. Celebrate your progress. Drink-free nights are something to be proud of, so celebrate them. You’ve stuck to your goals, saved some money, and made a great step towards improving your health and fertility.

 

If you need more help or support please speak with your GP or try one of the available helplines like Hello Sunday Morning or Counselling Online.

 

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Priming your body for pregnancy

It is well known that nutrition during pregnancy is important. However, many of us forget our habits and dietary patterns before falling pregnant can affect our baby’s health at birth, as well as for their entire lifetime.

Getting it right can be challenging – there is lots of information available about what foods we should and should not be eating to improve fertility, but often this information is misleading or conflicting.

When it comes to dietary advice, how do I know what to believe?

We’ve taken some of the leg work out for you and put together a summary of the latest evidence-based nutrition advice to improve fertility. Read on to find out the important things you can do to improve your reproductive health and prepare your body for conception.

Weight matters

Losing weight, if you are above the healthy weight range, is recommended for good health now (and for increasing your chances of falling pregnant), as well as for a healthier pregnancy. It is important to remember to still focus on a nutritious, balanced meal plan to ensure your nutrient stores are optimised. To kick start your way to a healthier weight, remember:

Folate and folic acid

Folate is needed for healthy growth and development for your baby and reduces the chance of neural tube defects (e.g. spina bifida). Daily supplementation with 400 micrograms (µg or mcg) folic acid is recommended for women one month prior and 3 months post conception (i.e. in the first trimester of pregnancy). A supplement is good, but it is still important to focus on eating a diet rich in folate including green leafy vegetables, fruit, and breads/cereals fortified with folic acid.

Choose the right types of fat

Balancing the types of fats we eat is important. We do know that eating less ‘trans fats’ can improve fertility, whilst adding in healthier unsaturated fats can boost fertility further. We hear a lot about trans fats in the media – especially out of the United States. This is because they have a very different food supply to us. The Australian diet is very low in trans fats – our dietary goal is no more than 1% of energy (we currently consume 0.6% of our energy from trans fats, while Americans eat almost 3%). However, it is still wise to limit foods that contain high amounts of saturated fats, as trans fats usually turn up in these foods. Trans fats can be found in foods such as partially hydrogenated vegetable oils e.g. vegetable shortening, most commercial baked goods such as biscuits, pastries and donuts, and many fried foods.

Unsaturated fats, including mono and polyunsaturated fats, are important structural components of cell membranes, the central nervous system, and retinal cell membranes. It is especially important to make sure to include polyunsaturated fats in your diet as these essential fatty acids cannot be made by our body. Therefore, we must get these through dietary sources including oily fish, flax seeds, walnuts and vegetable oils. The fatty acids from fish are a lot more potent than those in nuts and seeds.

Slow not low (or no!) carbohydrates

Successful conception requires a balance of the right hormones, at the right levels, at the right time. It is known that higher levels of circulating insulin can have a negative impact on a woman’s hormone cycles – specifically ovulation. Low GI carbohydrates are absorbed slowly in our bodies and lead to a gentle rise in blood glucose levels, thus minimising insulin spikes. This, in turn, can improve fertility. Simple ways to include low GI carbohydrates are:

  • Choose wholegrain bread in place of high GI options such as white and wholemeal.
  • Opt for doongara or basmati rice in place of jasmine rice (also labelled as ‘Low GI Rice’)
  • Eat sweet potato instead of white potato
  • Select whole grain crackers in place of highly processed crackers and biscuits

Caffeine

Some evidence suggests that the consumption of caffeine may prolong the time to pregnancy and affect the health of your developing baby, most likely in a “dose-dependent” way (the more you drink, the longer it might take). This is thought to be due to the affect caffeine has on ovulation and corpus luteum function (secretion of hormones to maintain early pregnancy) through alterations to hormone levels. It is recommended that women trying to conceive limit their caffeine intake to the equivalent of 1-2 cups coffee per day.

Be a flexitarian!

You need protein every day. Protein comes from either animal or plant sources. Research shows that fertility is enhanced when you aim to get your daily protein from as many sources as you can. Aim for at least half of your protein intake from plants – beans, lentils and legumes, nuts, peanut butter, whole grains and seeds. Choose fish, eggs, and poultry for most of the rest, while limiting red meat to once or twice a week.

Putting it all together – the ‘Fertility Diet’

Unfortunately, there is no one food that you can eat that will improve your fertility. Each different food group has a role in helping you conceive and priming your body for pregnancy. Similarly, by following diets that cut out entire food groups you are potentially restricting your intake of essential nutrients that may cause nutrient deficiencies that alter your body’s ability to conceive and the growth and development of your baby.

  • Choose foods from all food groups in line with the Australian dietary guidelines. This includes cereals/grains, fruits and vegetables, dairy and dairy alternatives, and meat and meat alternatives
  • Include a folic acid supplement with at least 400 µg of folate
  • Include unsaturated fats such as vegetable oils (olive, sunflower, canola), avocado, nuts, and oily fish, whilst limiting trans fats such as biscuits, pastries, fried foods (as well as other ultra-processed foods)
  • Choose low GI carbohydrates
  • Limit your caffeine intake to1-2 caffeine containing drinks per day
  • Choose half your protein from animal sources, half from plants

If you would like further information book an appointment with a Lifestyle Maternity Dietitian or enrol in one of our online, self-paced courses.

 

 

IMAGE CREDIT: Unsplash/Thought Catalog 62

IMAGE DESCRIPTION: Half an avocado with seed in the centre on a pink background

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Why “2 & 5”? – understanding the science that supports our dietary guideline goals for fruit and vegetables

The Australian Dietary Guidelines recommend we ‘Go for 2&5’ … in other words, to enjoy two serves of fruit and five serves of vegetables every day.

Where does the recommendation for ‘2&5’ come from?

The benefits of eating fruit and vegetables have long been reported (by doctors, scientists and of course, our mothers!). Not only do they make for a colourful and tasty meal experience, but they also provide lots of nutrients that can help to keep us healthy and protect us from disease.

Scientists are beginning to discover more about how certain foods can protect us from disease. Vegetables and fruit contain phytochemicals, or plant chemicals, as well as a variety of vitamins and minerals. These ‘biologically-active’ substances have been linked to a reduced risk of cardiovascular disease, stroke and some cancers.

How much extra do I have to eat for health benefits?

Did you know that each additional serve of vegetables you eat each day reduces your risk of coronary heart disease?1 And that consumption of at least one and a half serves of fruit each day is associated with a reduced risk of stroke?1 Additionally, researchers have found that overall risk of mortality (dying) decreased by 5% for each additional serving of fruit and vegetables consumed per day (up to five serves per day, beyond which no further reduction in risk was seen).2

Different fruits and vegetables contain different nutrients and can therefore help protect our bodies in different ways. For this reason, it is a good idea to include a variety of fruits and vegetables in your diet – colour your meals and snacks with fruit and vegetables.

Fruit and vegetables may also help prevent excessive weight gain. They are low in energy (kilojoules) and high in fibre relative to other foods and help to ‘fill us up’.1 This reduces the risk of overeating which can cause weight gain.

After some practical (and yummy) tips to help? Read on…

If you’re finding it hard to get enough vegetables, you could try:

  • Aiming to fill half your plate (or meal) with salad or cooked vegetables at lunch and dinner,
  • Having grilled tomatoes, mushrooms, spinach or baked beans at breakfast (yes, legumes count as a vegetable too!), or
  • Including vegetable based dips like hummus or salsa with vegie sticks or crackers as a snack.

If your fruit intake is low, you could try:

  • Adding tinned fruit or sultanas to your breakfast cereal,
  • Making a fruit smoothie, or
  • Including fruit in your salads (such as peaches in a green, leafy salad or apple in potato salad or sultanas in a grated carrot salad).

Remember that each additional serve of fruit and vegies you eat each day can have a valuable effect on your health.

For more ideas on how to add extra fruit and vegies to your day make an appointment to see a Lifestyle Maternity dietitian. We can help tailor these recommendations to your individual needs and preferences.

[1] National Health and Medical Research Council. Australian Dietary Guidelines – providing the scientific evidence for healthier Australian diets. Canberra: National Health and Medical Research Council; 2013 Feb.

[2] Wang X, Ouyang Y, Liu J, Zhu M, Zhao G, Bao W, Hu F. Fruit and  vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies. BMJ. 2014; 349: g4490.

 

IMAGE DESCRIPTION: Close up of tomatoes, cucumbers, lettuce and carrots

IMAGE CREDIT:  Scen Scheuermeier/Unsplash

CO-AUTHOR: Elin Donaldson, APD

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Slow carbs, not low carbs – the role of glycemic index in fertility

Carbohydrates or “carbs” are a hot topic of conversation in many different areas of health. Did you know they can play a big role in improving your fertility?

What is the link between carbs and glycemic index?

Carbs are found in many foods including breads and cereals, dairy products, fruit and some vegetables (as well as sweets and sugary foods). The glycemic index or “GI” is a ranking of carbohydrate foods on a scale of 0 to 100 according to the extent to which they raise blood glucose levels after eating.

Low GI foods are those with a lower number (less than 55). They are absorbed slowly, and lead to a gentle rise in blood glucose levels. Moderate and high GI foods have higher rankings and these carbohydrates have faster absorption and quicker rise in blood glucose levels.

The body responds to blood glucose levels by releasing a hormone called insulin.  A larger amount of insulin is required to cope with the higher GI foods (and also larger serves of carbohydrates, in general).

How can GI help with my fertility?

The process of successful conception requires a balance of the right hormones, at the right levels, at the right time. It is known that higher levels of circulating insulin can have a negative impact on a woman’s hormone cycles – specifically ovulation.  Incorporating low GI foods into your diet will assist you keep your blood glucose levels steadier and consistent, thus minimising insulin spikes, and the amount of circulating insulin in general. This, in turn, can improve fertility.

What can I do right now?

Here are some easy food “swaps” that will lower your dietary GI. Choose:

  • Grain or rye bread rather than white or wholemeal;
  • Sweet potato rather than white potato; and
  • Basmati or Doongara rice in place of white or brown rice.

Most dairy foods and many fruit are also low in GI and are good to include in your diet.

How can a Lifestyle Maternity Dietitian help me?

Incorporating low GI foods into your usual eating pattern is just one of many ways you can optimise your diet when planning a pregnancy. Why not see a Lifestyle Maternity dietitian for further advice and a tailored healthy eating plan?

Other topics we can discuss with you include:

  • How to achieve your most comfortable or healthiest weight to assist with conception
  • What the right amount of carbohydrate is to include in your diet each day
  • Which supplements to take when planning a pregnancy
  • The facts about caffeine, alcohol, fish intake and food safety for early pregnancy

To make an appointment book here or enrol in an online, self-paced course.

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Expectant dads’ diet during pregnancy

Expectant dads’ diet during pregnancy has lasting impact on future health of unborn child, study finds

What expectant dads eat during their partner’s pregnancy has a lasting effect on the future health of their unborn children, a Queensland-based study suggests.

This analysis of contemporary Australian pregnant women and partners’ dietary intake patterns shows that a large proportion of dietary intakes are not aligned with recommendations during pregnancy, with a high proportion also experiencing excessive gestational weight gain. The findings suggest that dietary intake of pregnant women is influenced by age, education levels, and pre-pregnancy BMI. An association exists between womens’ and partners’ dietary intake and their likelihood of alignment with national food and nutrient recommendations. This was particularly so in regard to fruit, vegetables, and meat and alternatives food groups which provide essential pregnancy nutrition for mum and bub.

In the cohort of pregnant women and their partners that were involved in the study, sub-optimal intakes of all foods and nutrients were documented, reflecting the wider Australian population and comparable pregnant populations. Around a third of the kilojoules eaten were from junk food from both women and their partners. While these foods are enjoyable to eat, when eaten in these large amounts they replace more nutritious foods that are required for optimal fetal growth as well as for mum’s health.

Lifestyle Maternity’s Principal Dietitian and lead author of the latest Queensland diet-in-pregnancy research, Dr Shelley Wilkinson, spoke to Janelle Miles from the ABC about the study’s findings.

Read more here.

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