ASRM2011: Improving fertility through nutritional medicine (pre-conceptional care)

Orlando, 19 October 2011 | by Lone Hummelshoj

It was at the 67th Annual Meeting of the ASRM that the Special Interest Group on Nutrition (NutriSIG) held its first Post Graduate Course addressing pre-conceptual care through nutritional medicine, attracting more than 50 delegates.

Kevin Osteen, Dian Shepperson-Mills, Kaylon Bruner-Tran, and Gil Wilshire at the 67th Annual Meeting of the ASRM

Endometriosis.org caught up with the NutriSIG team: Associate Professor Kaylon Bruner-Tran (chair), Dr Gil Wilshire (chair elect), Nutritionist Dian Shepperson-Mills (immediate past chair), and Professor Kevin Osteen (NutriSIG member), who were happy to share the highlights from this PG Course.

The PG Course was designed to demonstrate what science there is available to back-up clinical science when it comes to improving fertility through nutritional medicine.

Key messages included that women with endometriosis, who are trying to conceive, should be trying to eat a diet which reduces inflammation in the body, because inflammation affects fertility (and pain, of course!).

For you to absorb the nutrients from your food to deal with inflammation you must have a healthy digestive tract. Non-steroidal anti-inflammatory drugs can trigger inflammation in susceptible people so discuss this with your physician, who may then prescribe pain killers which do not trigger inflammation at the gut membrane.

Is poor digestion recognisable?

Patient at week 1 and week 17 of the anti-inflammation diet*

Dr Wilshire suggested that just by looking at a woman’s face, he can recognise whether she suffers from inflammation: rounded, puffy, double chin, squinty eyes, and acne are signs he immediately recognises when the woman’s digestive system is not functioning.

However, after 12-16 weeks on an “anti-inflammation diet” to improve digestion the change in the woman’s face alone is noticeable as you can see from the picture above.

Improving digestion and reducing inflammation

The team’s advice was unanimous: get rid of junk food!

If you want to improve your digestion and reduce inflammation you have to eat real food – not processed food. However well you eat, though, it will not correct inflammation already damaging the gut membrane. For that to happen you would have to have some live yoghurt three times a week to heal and correct the damaged tissue.

This is backed up by science, which shows that pro-biobic effects have been associated with a reduction of mucosal inflammation in a variety of animal models of inflammatory bowel disease (IBS) and have even been shown to modify inflammatory processes distant from the gut [1].

In other words: if you have healthy gut flora it helps reduce inflammation in the body [2].

So the use of pro-biotics (live yoghurt), olive oil, nuts and seeds, and oily fish will help reduce internal inflammation [3,4]. Furthermore wild pasture-fed meat contains more omega-3 cis-fatty acid, which reduce inflammation, as opposed to domesticated cereal-fed animals [5].

Food which has been in storage for a long time will also have a reduced nutritional value, so explore how you can source local and regional foods to avoid the loss of nutrients, which happens during the transportation time of fruits and vegetables in particular.

Eating to get pregnant is up to both of you!

If you are trying to get pregnant now’s not the time to diet. You want to be healthy to sustain fertility and to “eat forward” for a healthy baby – but, it is not up to the woman to do this alone.

Sperm needs to be healthy

Diets rich in red meat and processed grains seem to impair the ability of sperm to move about, while diets high in trans fats appear to lower the amount of sperm found in semen, according to Audrey Gaskin, Harvard School of Public Health, who presented results from her study suggesting that a healthy diet composed of a higher intake of fish, fresh fruit, whole grains, legumes, and vegetables seems to improve sperm motility.

Her conclusions are based on work with 188 men between the ages of 18 and 22, who were recruited to complete food questionnaires. Their diets were categorised as being either “Western” in content (including red meat, refined carbs, sweets and energy drinks) or so-called “Prudent” (composed of fish, fruit, vegetables, legumes, and whole grains).

Semen tests were then conducted to assess sperm movement, concentration, and shape, and whereas diet seemed to have no impact on either sperm shape or number, motility was impacted with “Western” diets linked to reduced movement, even after accounting for factors such as race, smoking history, and body-mass index (BMI).

However, Dr Wilshire urged caution in translating these findings into a recommendation to lower red meat consumption, as this remains very controversial with inconclusive data. Dr Wilshire believes most men should eat generous amounts of red meat, which contains carnitine, vitamins, iron, protein, and natural animals fats, all of which are proven to be important for optimal health.

Sperm needs to be able to move

A second study led by Dr Jorge Chavarro, Assistant Professor of Nutrition and Epidemiology at the Harvard School of Public Health, revealed that 100 men, who ate diets that contain a relatively high amount of trans fat, had lower sperm concentration levels, and the amount of trans fat found in their sperm and semen were higher.

Even after adjusting for a wide array of factors such as age, drinking and smoking histories, BMI, caffeine intake and total calories consumed, the authors found that although trans-fat intake appeared to have no impact on sperm movement of shape, the more trans fatty acids consumed the lower an individual’s sperm concentration.

Of mice and men…

One thing is sperm number and motility (movement) but the anti-inflammatory diet mentioned earlier may also help counteract toxicants that we are all exposed to these days (primarily through our diet).

NutriSIG Chair, Kaylon Bruner-Tran, shared research that adult male mice exposed in utero to the environmental toxicant TCDD (dioxin) confer an increased risk of pre-term birth to unexposed females.

Since omega-3 fatty acids exhibit anti-inflammatory activity, she provided TCDD-exposed males with a fish oil-enriched diet prior to mating. Although pre-term birth was common in control females mated to TCDD-exposed males on the standard diet, fish oil supplementation of TCDD-exposed males eliminated pre-term birth in unexposed partners.

Her studies suggest that a paternal pre-conception diet which includes omega-3 fatty acids prevents the toxicant-associated increase in the placental inflammatory response at late gestation, preventing pre-term birth – so don’t forget to include oily fish in your diet!

As you can see: diet is as important for men, as it is for women, when you are trying to conceive!

What do I do when I do get pregnant?

Logic and common sense will have it that you continue to eat healthily!

Do take note, however, that whereas vitamin A is important in pregnancy high doses may lead to ‘floppy baby syndrome’, where the baby is born with very soft bones liable to damage.

During pregnancy vitamin A doses should be kept low and are best taken through a diet which includes two portions a day of red, purple, orange, yellow, and green fruits and vegetables (a rainbow plate).

Who said that eating well couldn’t be pretty also?

Unanswered questions about nutrition

Above you will find suggestions on to how to improve pre-conceptual care through nutrition as learnt at this week’s ASRM meeting. However, the NutriSIG team acknowledged that solutions are not always straight forward.

“It is very difficult to use traditional “Evidence Based Medicine” with controlled trials in nutrition because it is so multi-factorial and inter-dependant”

said Professor Kevin Osteen, and continued:

“To provide guidance on nutrition you need to use logical thinking and common sense. I tend to use the rule of thumb suggested by Michael Pollan: read the labelling on foods, and if your grandmother can’t pronounce it, then don’t eat it”.

Dian Shepperson-Mills chipped in with the final words, also based on a quote by Michael Pollan:

“If it came from a plant, eat it. If it was made in a plant, don’t eat it!”

Looking at it this way, healthy eating really is rather simple to understand, isn’t it?

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References

Sheil B, et al. Probiotic effects on inflammatory bowel disease. J Nutri 2007;137:819-24S
Collier-Hymans LS and Neish AS. Innate immune relationship between commensal flora and the mammalian intestinal epithelium. Cell Mol Life Sci 2005;62-1339-48.
Beauchamp G, et al. Ibuprofen-like activity in extra-virgin olive oil. Nature 2005;437.
Wall R, et al. Fatty acids from fish, the anti-inflammatory potential of long-chain-fatty-acids. Nutri Rev 2010;68:280-9.
Crawford MA, et al. Comparative studies in fatty acid composition of wild and domestic meats. Int J Biochem 1970;1(3):295-300.

For more information

A recording of this session can be purchased directly from the ASRM at: http://www.softconference.com/asrm/