The Lister Fertility Clinic talk nutrition

Our live Instagram Q&A on nutrition with Lister Fertility Clinic

Last Thursday we asked Senior Specialist Dietitian Komal Kumar from The Lister Fertility Clinic to take part in a live Q&A on our Instagram. For those of you who aren’t on Instagram, we wanted to share with you some of the questions and answers.

Q: I have heard nutrition can aid fertility. As a man, what should I be eating? 

A: Food and fertility is linked for both men and women. Nutrition can influence sperm quality and motility. A normal balanced diet is the baseline for any diet recommended. I would never recommend men to go on low carb diets as whole grains have shown strong evidence to improve fertility in men probably owing to the protein sparing effect of carbs, antioxidants and good dose of fibre. There is some evidence behind using antioxidants such as selenium, zinc and lycopene but it won’t be effective unless you meet your normal requirements.

Dark green vegetables like broccoli and spinach and dried legumes such as chickpeas, beans and lentils are naturally good sources of folate. For selenium, most common sources are nuts especially Brazil nuts, dairy, fish, poultry, meat, whole grains and lentils. Having a handful of Brazil nuts every few days is an easier way to get the requirement. Lycopene becomes highly available when tomato is processed so canned, bottled and juice of tomato are dense source apart from fruits with a red to pink colour such as pink grapefruit, red carrots, watermelons and papayas.

Q: Is there a super food that really stands out from the rest? 

A: Good question! I wish there was one food which I could recommend to all. Ensuring you have good carbohydrates from whole grains, a diet rich in fruits and vegetables, adequate protein, monounsaturated fats, adequate hydration, exercise and sleep! But based on each patients assessment when we find key nutrients missing we allocate a superfood for them. That again is not the same for all!

Q: Is there any truth to concerns about eating soya (at the amount found in a fairly standard western diet)?

A:  For Her: Evidence from clinical trials is conflicting on the effect of soy protein supplements on hormone levels in premenopausal women that may affect fertility. When taken in amounts found commonly found in foods, soy is likely safe to take during pregnancy.

Soy protein or isoflavone supplements are not recommended during pregnancy as a high intake of isoflavones are mildly estrogenic and could potentially adversely affect fetal development.

For Him:  Results from evidence-based reviews found no statistically significant effect of soy consumption from several different sources (including isolated soy protein, soy flour, soy milk, tofu and pure soy isoflavones) on levels of follicle-stimulating hormone (FSH) (a measure of infertility in men), testosterone (high levels are a risk factor for prostate cancer; low levels are associated with conditions causing infertility) and other reproductive indicators.

So the verdict is you could safely have up to 60 g of soy protein per day (natural form rather than isolate protein supplements)

Q: I have pretty severe lean PCOS and have cut out gluten, dairy and refined sugar to try to reduce any inflammation. I’m due to have IVF next month. I’m naturally very slim and struggle to maintain a healthy BMI. What foods do you recommend I take that might help me maintain a suitable weight in order to give myself the best chance of conceiving.

A: Thank you for raising this! There is no evidence of restrictive diets help improve PCOS. But undernutrition and low BMI does impact on lower pregnancy rates and higher risk of miscarriage. If you find it difficult to gain weight with food fortification please do consult a dietitian for supplementation.

Q: I’m starting IVF this month and am mostly vegetarian and I don’t eat eggs. Can you please suggest a protein supplement/ powder?

A: There are a lot of vegetarian protein sources such as sprouts, soy, milk and dairy products, whey, nuts and seeds. If you want to add on protein in powder form, an easy way is to add milk powder or whey protein in milkshakes, soups or smoothies. It’s quite possible to meet your requirements without supplements. It would be advisable to get individually assessed to check your need for supplementation.

Q: I have a histamine sensitivity and am increasingly getting reactions (urticia and angioedema) and am about to start a histamine intolerance specific diet, and wondered if it might help with my sporadic ovulation?

A: I understand you are concerned about food allergies. There are some useful diagnostic tests that can be used in conjunction with clinical history including allergen specific IgE blood tests and Skin Prick Tests. For any suspected food allergy, specialist input is required for diagnosis and management.

Q: Do you have any tips for a vegan undergoing IVF? 

A: Being Vegan throughout IVF and Pregnancy, please ensure you meet your requirements for protein, iron, calcium, vitamin d, vitamin B12, omega 3, zinc and selenium and iodine. Rather than supplementation, choosing whole foods would help you prevent toxicities. Please do get your diet analysed to consider alternate food sources or supplements.

Q: What supplements would you recommend (his & hers) or is a healthy diet enough?

A: A healthy balanced diet as per eat well guidelines rich in whole grains, fruits veg and adequate pro + 400 mcg of Folic acid supplementation for Her along with folic acid rich foods for her is generally adequate. If there is any other concern such as coeliac, diabetes, food intolerances, GI diseases or malabsorption, or strict dietary preferences, then need of supplements are assessed on individual basis. At Lister Fertility Clinic we do a detailed screening of over 64 nutrients and tell you why you should supplement based on need.

Q: Any dietary tips for someone doing IVF with subclinical hyperthyroidism with positive thyroid antibodies and endometriosis?

A: There are no specific foods or dietary supplements that are helpful in treating thyroid disorders. But it is important to look into calcium, vitamin D, weight management, soy and iodine intake. But that again is individualised from case to case basis. Also endometriosis symptoms can be better managed as per a new study in 2017. Please refer to our blog https://ivf.org.uk/about/blog/fertility-treatment-for-those-with-endometriosis/

Q: I’ve heard lots of milk is great. Do you recommended whole milk opposed to semi-skimmed?

A: Ideally 3 portions of milk are necessary for calcium requirements. Evidence proves whole milk is better for fertility compare to semi- skimmed and skimmed milk. If you have weight loss goals then your dietitian will help you to ensure you can fit this in your day without impacting on the weight.

Q: Is there anything in particular that helps sperm motility? And equally egg quality?

A: Nutritional adequacy, weight management and having a good diet plan are the key to managing fertility issues for both him and her. We all know that fertility treatments can be very stressful and having a plan to fall back on helps you to maintain good nutrition when you don’t have the time to think about it.

Generally, I would advise all women to follow the ‘eat well plate’ principle. This is based on consuming a balanced diet of carbohydrates, fats and proteins. Making some healthy choices such as whole grains over refined flours, including omega 3 rich fats such fish, walnuts and flax seeds, at least 5 fruits and vegetables per day.

It is also advised you take 400mg of folic acid per day, in addition to consuming folate rich foods such as green leafy vegetables, beans, avocados and seeds and nuts.

Gradually reducing weight if you are overweight will help improve the hormonal balance thereby helping regularize your menstrual cycle. Finally adequate sleep, exercise and hydration can never be understated!

The aspects needed to be looked into for male fertility are discussed in one of the previous questions.

Q: Is there any truth in having certain things at certain points of the cycle? Pom juice, Brazil nuts, etc. Just starting out and there’s lots of myths out there. Any advice welcome. 

A: Thank you for this question, there is no evidence to back statements like these. Rightly pointed out there are a lot of myths in this area. Following a good diet through the month is necessary, however if you do notice cravings or fluctuations or symptoms that can be predicted we can create a plan so that you are proactive rather than reactive!

Q: Are you allowed to eat peas?? I’ve heard peas are bad for fertility! Also protein during IVF… how much should we be having? 

A: There is no evidence to support peas are bad for you. Peas are a great source vegetarian protein, swapping 50% of your protein requirements to vegetarian sources helps improve fertility in women. Protein requirements are based on BMI, age, disease conditions, activity and protein losses. So you will get an estimated requirement that can be a reference point for yourself from your dietitian who will consider all of the above.

Q: I had 3 bouts of food poisoning in 12 months a few years ago. I had a lot of bloating and intolerances after it – I was put on a FODMAPS diet. I am intolerant to onions, garlic and find eating a lot of gluten doesn’t agree with me. What long term effects might this have had on my fertility? Also, as a side question would you recommend taking a probiotic as part of a healthy diet if you do experience bloating. 

A: Any insults to the gut can increase sensitivity and produce IBS type symptoms. I am hoping you were assessed for Coeliac and were given the low FODMAP advice by a trained dietitian. Low FODMAP is a three staged process which helps identify foods you are intolerant to. If you have already tried reintroducing which is an important step to pregnancy planning as this diet is not suitable for pregnancy; your dietitian should be considering providing you with alternatives so, that in a restrictive diet, you don’t develop deficiencies.

Long term effects of low FODMAP are not well researched, however there is evidence of probiotics in the field of IBS management. There are a lot of different strains and the duration and type will be suggested to yourself after careful consideration of your symptoms and current diet. But it can be managed so please do check with your dietitian

Q: Is there any truth in adding maca root to your diet?

A: There is no strong research to back up use of maca roots. I would rather advise a wholesome diet to achieve the nutritional adequacy for fertility.

Q: Is there any natural remedy to increase AMH level?

A: The right BMI and good nutrition can influence female hormones thereby optimize the menstrual cycle. If weight management or deficiencies are suspected please ensure it’s looked into by a specialist so that you have that covered.

Q: Is it recommended though to cut back on caffeine? 

A: Having caffeine in moderation helps. Have no more than 200mg caffeine daily. Limit coffee, tea, cola, high energy drinks and chocolate. So go ahead and enjoy your two mugs of coffee or three cups of tea a day (Taken from British Dietetic Association)

Q: I am starting my first cycle in the next couple of weeks and have DOR. What should I be eating/drinking for egg quantity and quality. Also, should I be avoiding dairy and carbs?? I know whole milk is good but what about cheese?

A: You need to look into nutrition factors for both in the couple. 5-10% inching towards the right BMI if that is a concern is a strong aspect to be considered. A balanced diet with whole grains, 5-7 servings of fruits of vegetables, protein from both vegetarian and animal sources, adequate hydration and good exercise and sleep is important.

Having a plan of action around the days you are undergoing IVF so that the rush and anxiety doesn’t make you skip meals helps. Also supplementation on a basic ground would be 400 mcg of Folic acid. It would be worth getting checked individually if more input is needed.

There is no evidence to avoid dairy and carbs, the diet would be inadequate without it so please don’t do that unless there is a medical need. Whole dairy products such as cheese are the same as milk so it’s a yes!

Q: Some people say to avoid pineapple but others say it helps implantation does it aid? I normally eat pineapple but was worried about effects. Also green tea or herbal teas I was told by a friend who had had ivf to avoid.

A: Pineapples are safe and great sources of antioxidants and help you absorb protein better so enjoy them! You could have tea and coffee in moderation as per a previous question on Caffeine.

 

To find out more about The Lister Fertility Dietetic Clinic, please click here or email komal.kumar@hcahealthcare.co.uk

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