blog posts

Thyroid health in fertility, pregnancy and postpartum healing.

Thyroid health affects everything from fertility to post partum healing. But testing the thyroid preconception or during the first trimester is not standard for most care providers yet. Neither are the correct things being tested for.

We suggest having your thyroid hormones tested before, during and after pregnancy due to epidemiological data showing the significance of maternal thyroid hormone in fetal neurologic development and maternal health.

Supporting the thyroid can be as easy as learning how to avoid toxicity to the gland and supporting it with specific antioxidants and anti-inflammatory functional foods or neutraceuticals. But we need to know how much support the thyroid needs during this important time especially.

The thyroid is responsible for a few crucial functions of the body:

Thyroid hormone (TH) regulates the metabolic processes essential for normal growth and development  in the adult (). It is well established that thyroid hormone status correlates with body weight and energy expenditure.

TH influences key metabolic pathways that control energy balance by regulating energy storage and expenditure ()

Fertility relies on thyroid health . In one study, the rate of fetal loss was 60% in women with overt, untreated hypothyroidism. [ref]. 

Another reason to have your thyroid tested prior to pregnancy is because researchers note that the “vast majority of women who develop postpartum thyroiditis are thyroid antibody positive prior to pregnancy.”[ref] If thyroid antibodies can be detected prior to pregnancy, then more focus can be on supporting the thyroid in the postpartum period.

In pregnancy, thyroid hormone needs increase due to the increase in Thyroid binding globulin, the stimulatory effect of HCG on TSH receptors, and increased peripheral thyroid hormone requirements. [ref]

Maternal thyroid dysfunction is associated with increased risk for early abortion, preterm delivery, neonatal morbidity and other obstetrical complications.[ref]

It’s estimated that 10-17% of women have thyroid autoimmune disease during pregnancy  without showing any symptoms.

If you know you have an under active thyroid and you are on thyroid hormone medication, make sure to discuss this with your primary provider in order to adjust your dose accordingly.

Thyroid health impacts postpartum healing.

As said above, many women have athyroid anti bodies even before pregnancy, they then go through pregnancy with an underlying thyroid disease (without symptoms), and it has been shown that  one third  of these women will develop postpartum thyroid problems within the first year after delivery. [ref]

Even if your thyroid test came back fine before and during pregnancy, it may be good to have them tested after birth as well as thyroid abnormalities that appear within a year of giving birth, collectively known as “postpartum thyroiditis,” are surprisingly common. In fact, “up to 23% of all new mothers experiences thyroid dysfunction postpartum, compared with a prevalence of 3-4% in the general population.” [ref]

Postpartum thyroididtis{PPT) is one imbalance that contributes to postpartum mood disorders that can be avoided with proper nutrition or adjusting thyroid medications.

For example, Nutraceuticals (such as selenium) or omega-3-fatty acid supplements seem to have a role in prevention of PPT. In a recent study on pregnant women with stable dietary habits, we found that the fish consumers had lower rates of the condition compared to meat eaters. [ref]

What tests to ask for?

Most doctors will only test TSH and T4. this is no comprehensive or helpful since it doesnt even include testing for any antibodies. Ask your doctor or a functional medicine practitioner to test for the following:

Thyroid Stimulating Hormone (TSH)
Free T4
Free T3
Reverse T3
Thyroid Peroxidase Antibodies (TPOAb)
Thyroglobulin Antibodies (TgAb)

You may need to ask a functional medicine practitioner/dietitian/doctor to help you interpret the results.

 

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Liver consumption in pregnancy

 

By Y.Rademeyer

Prenatal, functional R.D

 

The controversy of liver consumption during pregnancy was raised by a study that linked high doses of  synthetic vitamin A to birth defects.[ref]

However we now know that naturally occurring vitamin A does not have a teratogenic effect, especially when consumed with adequate vitamin D and K2.[ref]

 

liver and supplements are not of equivalent teratogenic potential. Advice to pregnant women on the consumption of liver based on the reported teratogenicity of vitamin A supplements should be reconsidered.” [ref]

 

Yes. Liver is high in natural vitamin A called Beta carotene (as opposed to synthetic vitamin A in most supplements).

Screening studies have shown that ONE THIRD of pregnant women are borderline deficient in vitamin A despite having access to vitamin A rich foods [ref]

Plant sources (sweet potatoes and carrots and kale} contain whats called provitamin A that needs conversion to active vitamin A and the conversion of this is highly variable in individuals due to factors such as genetics and therefore plant sources are not a reliable source of vitamin A [ref], especially when facing a vitamin A deficiency during pregnancy.

 

“The American Pediatrics Association cites vitamin A as one of the most critical vitamins during pregnancy and the breastfeeding period, especially in terms of lung function and maturation. If the vitamin A supply of the mother is inadequate, her supply to the fetus will also be inadequate, as will later be her milk”[ref]

 

Other than Vitamin A, liver is also a great source of other crucial nutrients:

  • Other than eggs, liver is the only other major source of choline, a nutrient that is in high demand in pregnancy for neurodevelopment of the fetus

Pregnancy and lactation are times when demand for choline is especially high; transport of choline from mother to fetus [ref] [ref]) depletes maternal plasma choline in humans (78). Thus, despite enhanced capacity to synthesize choline, the demand for this nutrient is so high that stores are depleted.”

  • Liver contains iron in a very absorbable form (heme iron) that does not cause constipation.

Pregnancy calls for up to 60 mg of  iron daily in late pregnancy. This is not an easy task to manage via diet alone if you look at a 300g steak supplying 7-10mg or iron, a 100g lamb chop providing 3.3mg and an egg providing 1.6 mg.

For provitamin A , 1 cup of cooked spinach providing 6.4mg, ½ cup cashews providing 6mg, ½ cup pumpkin seeds providing 1-15 mg.

With animal liver containing roughly 1.2 mg for every 10g of liver, 200-300g of liver spread through the week can help contribute to more bioavailable iron intake.

  • Liver is one of the riches sources of natural folate and B 12 which is needed to prevent maternal anaemia. 50% of women are not able to convert synthetic “folic acid” found in supplements to active folate in the body. One way to bypass this is to either consume already active folate (called methyl folate) or to consume liver.

 

How often to consume liver?

If regular consumption of carotene rich vegetables are consumed, a 6 to 8 ounce portion of liver once or twice a week provides a huge contribution to prenatal nutrition.

Other dietary sources of animal derived vitamin A should be included as well such as

  • Butter from grass fed animals
  • Egg yolks from free range chickens

 

How to include liver in the diet if you don’t like the farm style pan fried liver with eggs?:)

Liver is easy to hide in other dishes like meatloaf , meatballs, shepherd’s pie, slow cooked carnitas or other slow cooked meats on the bone cooked or a simple liver pate.

 

Important to note: liver from organic  grass fed/ pasture raised animals definitely are recommended above liver from grain fed/non free range animals.

Restoring Iron Levels

Replenishing Iron Stores

Yolandi Rademeyer R.D

For women 18 years and up the recommended daily intake is 27 mg – 32 mg /day

During pregnancy the recommended daily intake is 27 mg / day remains the same [1][2]

Iron comes in two forms, heme iron and non heme iron. Generally, heme iron is better absorbed than non heme iron.

Animal products = 40% heme + 60% non heme [3]

Plant foods = 100 % non heme

 

Absorption:

Heme iron and non-haem iron are both absorbed in the small intestine, but via different mechanisms. Because we have a limited ability to excrete excess iron, the body has prevention mechanisms for iron overload: Haem iron is absorbed through the gut wall in an intact form, regardless of how much we need. Non-haem iron absorption is more carefully controlled, as it is more readily absorbed when the body has need for iron.[4]

 

  • With non heme iron, the  absorption is regulated according to how much the body needs iron
  • Non-haem iron is nearly as well absorbed as haem iron by people with very low iron stores[4]
  • In pregnant women, who need the most iron, absorption can increase by 60% relative to normal [5][6]

 

There are three levels of iron deficiency, in increasing order of severity:

  1. Depleted iron stores
  2. Early functional iron deficiency
  • limits oxygen delivery to cells
  • resulting in weakness, fatigue,
  • reduced immunity
  • shortness of breath
  • sensitivity to cold
  • heart palpitations
  1. Iron deficiency anaemia (most common nutritional deficiency in the world)

           In pregnant women can result in: 

  • premature delivery
  • low birth weight in infants and higher infant mortality
  • delayed psychomotor development in infants and impaired cognitive function [7]

 

Causes of iron deficiency :

  • Other than the fact that as women we loose blood on a regular basis?
  • Gastrointestinal inflammation (eg, in Crohn’s disease or coeliac disease)
  • Gastrointestinal blood loss (eg, associated with colorectal cancer, aspirin use or genitourinary diseases)
  • Excessive intake of zinc (due to zinc supplementation)
  • There is a higher prevalence of iron deficiency in obese people
    • inadequate iron intake
    • higher blood volume
    • Chronic inflammation in obese people is associated with higher levels of hepcidin, which  downregulates intestinal iron absorption

 

Foods:

Heme iron table1

non Heme iron table[8][9][10]

Spices:

herb-spice-iron-content.jpg[10][11]

 

Habits to remember when trying to replenish iron levels:

  • Cooking in cast iron skillets (the longer the cooking process the higher the iron content of the meal will be)
  • Combining citrus / Vit C rich foods and iron foods
  • Taking Vit C supplements with meals high in iron

 

Habits that Inhibit iron absorption:

  • Tannins
    • Tea
    • Red wine
    • Coffee
    • Some berries (cranberries)
    • cacao
  • Calcium
    • Not combing dairy and iron foods
    • Not taking calcium supplements close to meals that are high in iron
  • Excess Zinc supplementation
    • Not taking high doses of zinc with meals high in iron

 

Supplements:

Iron supplements may be prescribed and should be taken according to the directions of the healthcare professional.

The above habits to avoid still applies for iron supplementation

Iron supplementation often cause constipation and can be taken with one of the following:

  • Prune juice (100%, no sugar)
  • Prunes

The following may be used to relieve constipation 

  • 2 tablespoons Ground flax & psyllium husk mixed in water
  • Magnesium citrate supplement

 

References:

[1]ods.od.NIH.gov

[2]National Health and Medical Research Council and New Zealand Ministry of Health. Nutrient reference values for Australia and New Zealand including recommended dietary intakes. Canberra: NHMRC, 2006. http://www.nhmrc.gov.au/guidelines/publications/n35-n36-n37 (accessed Apr 2012)

[3] Hurrell R, Egli I. Iron bioavailability and dietary reference values. Am J Clin Nutr 2010; 91: 1461S-1467S.

[4]Hunt JR. Bioavailability of iron, zinc, and other trace minerals from vegetarian diets. Am J Clin Nutr 2003; 78 (3 Suppl): 633S-639S.

[5] Hunt JR, Roughead ZK. Nonheme-iron absorption, fecal ferritin excretion, and blood indexes of iron status in women consuming controlled lacto ovo vegetarian diets for 8 wk. Am J Clin Nutr 1999; 69: 944-952.

[6] Whittaker PG, Barrett JF, Lind T. The erythrocyte incorporation of absorbed non-haem iron in pregnant women. Br J Nutr 2001; 86: 323-329

[7]Expert Rev Gastroenterol Hepatol 2008; 2: 287-290. 3 Food and Nutrition Board and Institute of Medicine. Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington, DC: National Academy Press, 2001. http://www.nap. edu/openbook.php?record_id=10026&page=R1 (accessed Apr 2012).

[8] ndb.usda.gov

[9]Food Standards Australia New Zealand. NUTTAB 2010 online searchable database. http://www.foodstandards.gov.au/ consumer information/nuttab 2010/nuttab 2010 online searchable database/online version.cfm (accessed Jun 2011)

[10] nutrition.self.com

[11] http://www.ferralet.com

Saunders et al . Iron and vegetarian diets. MJA Open 2012; 1 Suppl 2: 11–16 doi: 10.5694/mjao11.11494

 

 

 

 

 

Avocados & Fertility

aviary-image-1540052251748

The Role of Avocados In Fertility & Maternal Health

Research Review.

Yolandi Rademeyer R.D

Maternal nutrition plays a crucial role in influencing fertility, fetal development, birth outcomes, and breast milk composition. During the critical window of time from conception through the initiation of complementary feeding, the nutrition of the mother is the nutrition of the offspring—and a mother’s dietary choices can affect both the early health status and lifelong disease risk of the offspring. 

For pregnant women there is a whole list of nutrients that are needed in a higher (some more than double) quantity than when not pregnant. However pregnant women in the U.S. are known to lack in more than half of this list of nutrients that their bodies require or that’s recommended to sustain a healthy pregnancy and make a healthy baby[1]

The most heavily researched nutrients for fetal health can be narrowed down to a few different groups:

  1. Micronutrients that regulate DNA synthesis, cell division, and growth.
  • Folate
  • B-12
  • vitamin A
  • vitamin D
  • Iron
  • zinc
  1. Nutrients that assist with brain development.
  • Iodine
  • specific fatty acids
  1. Antioxidant nutrients which protect against free radical damage and DNA mutation
  • vitamin A and carotenoids
  • vitamin C
  • vitamin E
  1. Another important class of nutrients for fetal health not currently recognized is regulatory nutrients—such as
  • Fiber
  • potassium

—which may improve maternal health status (i.e., reduce the risk of diseases such as hypertension, dyslipidemia, and gestational diabetes)

When it comes to the fourth trimester, postpartum, maternal intake of vitamin A, vitamin B6, and vitamin B12 as well as iodine and fatty acids directly influence the composition of breast milk.

Few fruits or vegetables are rich in both vitamins and fatty acids, with the exception of oil-containing fruits such as avocados, which contain mono unsaturated fatty acids (MUFA).

A look at an average California avocado:

Nutrient Requirement in pregnancy Amount in 1 Avocado (California,136g)
Folate 600-800 mcg higher than a serving of most fruits, tree nuts, and seeds 121 mcg
B12 2.6 mcg
Total Vit A 770 mcg (1300 lactation) 10 mcg

    Beta carotene

900 mcg from suppl
90 mcg from food
Avocado in salads improve carotenoid absorption by 5–15 times [12] 90 mcg

    lutein + zeaxanthin

Absorbed better from avocados than other fruits & veg 360 mcg
Vit D 15 mcg
Iron 27 mg 0.8 mg
Zinc 9-11 mg Plays a crucial part in fertility 0.9 mg
Iodine 220 mcg
Fatty acids : MUFA 13.3 g
Vit C 60-85mg 12 mg
Vit E 10 mg 2.7 mg
Fiber 25-30g According to the 2015 DGAC report, only 8% of women who were pregnant had adequate intake of fiber  9 g
Potassium 2800 mg gestational hypertension decreased significantly with roughly 250–300 mg higher intakes of potassium
Avocados have more potassium by weight than most other common fruits and vegetables
690 mg

DRI reference intakes(National Academic press 2006)/ WHO RDA

 

Reasons why avocados are an ideal fruit for maternal diet:

  • Avocados contain some of the most crucial vitamins  that are vastly under-consumed by most women according to their daily requirements ; vitamin E, folate, and vitamin C [1][2] ,as well as multiple shortfall nutrients, without significantly contributing to any of the 2015 DGA nutrients of concern for overconsumption (i.e., sodium and saturated fat), or to empty calories from added sugars

 

  • Avocados are a source of several non-essential compounds, such as monounsaturated fats (MUFA), lipid-soluble antioxidants, and various phytosterols that are the components of the mediterranean diet that has been scientifically proven :
    • To increase fertility the most as well as improving ovulatory disorders by 70% [3].
      • The researchers found that consuming just 2% of energy from unprocessed MUFA instead of hydrogenated trans fats was associated with less than half of the risk of ovulatory infertility[3]
    • To reduce the chances of preterm delivery by 90%[4]
    • The researchers found that greater intakes of MUFA were related to nearly three and half times higher odds of live birth after embryo transfer, compared to lower intakes of MUFA[5]
    • (Maternal lipid intake is the single most influential factor contributing to breast milk fatty acid composition[6])

They found that MUFA made up approximately 29% of the blood fatty acids of pregnant mothers, 18% of the umbilical cord blood, and 23% of the blood of a newborn infant [7]

 

  • Low GI. Low Glycemic index diets have been proven to increase fertility [8][9], reduce the incidence of birth defects [10], produce a better birth weight and decrease the risk for conditions such as insulin resistance later in life[11]

 

  • Lutein: Lutein is the most abundant carotenoid in avocados [12]; and it is absorbed in greater quantities from avocados relative to other fruits and vegetables with low or no lipid content [13]. Lutein Represents roughly 25% of the carotenoids in breast milk in the first few days of breastfeeding and actually increases to nearly 50% by the end of the first month .

 

Conclusion:  Avocados are a unique nutrient-rich plant-based food that contain many of the critical nutrients for fetal and infant health and development. They fit within the guidelines for a Mediterranean-style diet (i.e., they contain MUFA, fiber, antioxidants, and are low-glycemic), which is known to be beneficial for disease reduction in most populations including pregnant and lactating populations. Based on this review, avocados offer a range of beneficial nutrients that can make a substantial contribution to a nutrient-rich diet when offered as a staple food for the periconceptional period, as well as during Nutrients pregnancy and lactation.

 

How to incorporate more avocados into your diet:

  • Choose fresh avocado over mayonnaise on a sandwich to reduce saturated fats while adding numerous other essential nutrients, potentially bioactive compounds (e.g., lipophilic antioxidants and phytosterols), and fiber.
  • Use an avocado- and yogurt-based dressing in place of many nutrient-poor commercial options in order to avoid added sugars and saturated fats while adding protein, fiber, and fat-soluble vitamins
  • Make avocado & eggs & salmon a staple for breakfast
  • Incorporate avocados into a berry smoothie
  • Make avocado chocolate mousse
  • Pinterest has many creative avocado dishes 🙂

 

Reference:

The Role of Avocados in Maternal Diets during the Periconceptional Period, Pregnancy, and Lactation, Kevin B. Comerford, 2016

 

[1]Otten, J.J.; Hellwig, J.P.; Meyers, L.D. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements; The National Academies Press: Washington, DC, USA, 2006.

 

[2]U.S. Department of Agriculture; U.S. Department of Health and Human Services. Scientific Report of the 2015 Dietary Guidelines Advisory Committee—Advisory Report to the Secretary of Health and Human Services and the Secretary of Agriculture. Available online: http://health.gov/dietaryguidelines/2015- scientific-report/pdfs/scientific-report-of-the-2015-dietary-guidelines-advisory-committee.pdf (accessed on 13 January 2016)

 

[3]Chavarro, J.E.; Rich-Edwards, J.W.; Rosner, B.A.; Willett, W.C. Dietary fatty acid intakes and the risk of ovulatory infertility. Am. J. Clin. Nutr. 2007, 85, 231–237. [PubMed]

 

[4]Khoury, J.; Henriksen, T.; Christophersen, B.; Tonstad, S. Effect of a cholesterol-lowering diet on maternal, cord, and neonatal lipids, and pregnancy outcome: A randomized clinical trial. Am. J. Obstet. Gynecol. 2005, 193, 1292–1301. [CrossRef] [PubMed]

 

[5]Chavarro, J.E.; Colaci, D.S.; Afeiche, M.; Gaskins, A.J.; Wright, D.; Toth, T.L.; Hauser, R. Dietary Fat Intake and in-vitro Fertilization Outcomes: Saturated Fat Intake is Associated with Fewer Metaphase 2 Oocytes. Available online: http://humrep.oxfordjournals.org/content/27/suppl_2/ii78.abstract (accessed on 17 August 2015)

 

[6]Innis, S.M. Impact of maternal diet on human milk composition and neurological development of infants. Am. J. Clin. Nutr. 2014, 99, 734S–741S. [CrossRef] [PubMed]

 

[7]Agostoni, C.; Marangoni, F.; Stival, G.; Gatelli, I.; Pinto, F.; Rise, P.; Giovannini, M.; Galli, C.; Riva, E. Whole blood fatty acid composition differs in term versus mildly preterm infants: Small versus matched appropriate for gestational age. Pediatr. Res. 2008, 64, 298–302. [CrossRef] [PubMed]

 

[8]Sinska, B.; Kucharska, A.; Dmoch-Gajzler Skate. The Diet in improving fertility in women. Pol. Merkur. Lekarski. 2014, 36, 400–402. [PubMed]

 

[9]Becker, G.F.; Passos, E.P.; Moulin, C.C. Short-term effects of a hypocaloric diet with low glycemic index and low glycemic load on body adiposity, metabolic variables, ghrelin, leptin, and pregnancy rate in overweight and obese infertile women: A randomized controlled trial. Am. J. Clin. Nutr. 2015, 102, 1365–1372. [CrossRef] [PubMed]]

 

[10]Parker, S.E.; Werler, M.M.; Shaw, G.M.; Anderka, M.; Yazdy, M.M.; National Birth Defects Prevention Study. Dietary Glycemic Index and the risk of birth defects. Am. J. Epidemiol. 2012, 176, 1110–1120. [CrossRef] [PubMed]]

 

[11]Danielsen, I.; Granstrom, C.; Haldorsson, T.; Rytter, D.; Hammer Bech, B.; Henriksen, T.B.; Vaag, A.A.; Olsen, S.F. Dietary glycemic index during pregnancy is associated with biomarkers of the metabolic syndrome in offspring at age 20 years. PLoS ONE 2013, 8, e64887. [CrossRef]

 

[12]Ashton, O.B.; Wong, M.; McGhie, T.K.; Vather, R.; Wang, Y.; Requejo-Jackman, C.; Ramankutty, P.; Woolf, A.B. Pigments in avocado tissue and oil. J. Agric. Food Chem. 2006, 54, 10151–10158. [CrossRef] [PubMed]

 

[13]Unlu, N.Z.; Bohn, T.; Clinton, S.K.; Schwartz, S.J. Carotenoid absorption from salad and salsa by humans is enhanced by the addition of avocado or avocado oil. J. Nutr. 2005, 135, 431–436. [PubMed]

 

Omega 6 : Omega 3

 

Omega 6 omega 3

Omega 6 vs Omega 3

By Yolandi Rademeyer R.D

Omega-6 and omega-3 polyunsaturated fatty acids (PUFAs) are essential fatty acids that must be derived from the diet and cannot be made by humans or other mammals.

Due to modern agricultural changes, the intake of omega-6 fatty acid has increased and the omega-3 fatty acid decreased, resulting in a large increase in the omega-6/omega-3 ratio from 1:1 (during evolution/ paleolithic times) to 20:1 today or even higher.

This shift in ratio parallels a significant increase in inflammation and the prevalence of overweight and obesity as well as inflammatory diseases / condition states such as:

• Alzheimer’s disease
• Asthma
• Cancer
• Chronic obstructive lung diseases
(emphysema and bronchitis)
• Chronic pain
• Type 2 diabetes
• Heart disease
• Inflammatory bowel disease (Crohn’s or ulcerative colitis)
• Stroke
• Diseases where the immune system attacks the body, such as rheumatoid arthritis, lupus,or scleroderma

•PCOS, endometriosis, subfertility etc

Prospective studies clearly show an increase in the risk of obesity as the level of omega-6 fatty acids and the omega-6/omega-3 ratio increase ,whereas high omega-3  decrease the risk of obesity.

Omega 3 and Omega 6 must be consumed from food as there is no way for the body to produce either of them and they are not interchangeable (Omega 6 can not be converted to Omega 3 or vise versa)

(Having a look at the diagram)

  • LA is plentiful in nature and is found in the seeds of most plants except for coconut, cocoa, and palm
  • ALA, on the other hand, is found in the chloroplasts of green leafy vegetables, and in the seeds of flax, rape, chia, perilla and walnuts.
  • AA is found predominantly in the phospholipids of grain-fed animals, dairy and eggs.
  • EPA and DHA are best sourced from fatty , wild caught fish as ALA has a very slow conversion to EPA and DHA

In paleothic times , almost all animal products were a great source of Omega 3, however, as agriculture has changed, so has the Omega 3 content of animal products;

  • Changing animal feeds  to grain (as a result of its emphasis on production) has decreased the omega-3 fatty acid content in many foods: animal meats, eggs, and even fish [1, 2, 34].
  • Foods from edible wild plants contain a good balance of omega-6 and omega-3 fatty acids. Purslane, a wild plant, in comparison to spinach, red leaf lettuce, butter crunch lettuce and mustard greens, has eight times more ALA than the cultivated plants [5].
  • Modern aquaculture produces fish that contain less omega-3 fatty acids than do fish wild caught fish in the ocean, rivers and lakes [3].
  • The fatty acid composition of egg yolk from free-ranging chicken has an omega-6:omega-3 ratio of 1;3 whereas the United States Department of Agriculture (USDA) egg has a ratio of 19;9 [4].
  • By enriching the chicken feed with fishmeal or flaxseed, the ratio of omega-6:omega-3 decreased to 6;6 and 1;6 respectively.

How to incorporate more Omega 3 and less Omega 6?

Om6;Om3

for more information on fish intake please read this blog

For more examples on trans fats click here

Other foods that counteract chronic inflammation:

  • Leafy green vegetables 
  • Foods high in antioxidants
    • Yellow, orange, and red vegetables (peppers, carrots)
    • Dark leafy greens (spinach, Romaine lettuce)
    • Citrus fruits
    • Black and green teas
    • Allium vegetables (onions, garlic)
  • Foods high in fiber (aim for 30g/day)
  • Spices that contain anti-inflammatory compounds
    • Ginger
    • Rosemary
    • Turmeric
    • Oregano
    • Cayenne
    • Clove
    • Nutmeg
  • Herbs that have anti-inflammatory properties
    • Boswellia
    • Willow bark
    • Feverfew

Other foods that contribute to inflammation:

  • Foods high in simple carbohydrates (That is, foods with a high glycemic load. Foods
    that cause rapid rises and drops in insulin levels seem to cause more inflammation.)
    • White breads or bagels
    • English muffins
    • Instant rice
    • Rice and corn cereals
  • Foods more likely to trigger intolerance reactions (these vary from person to person)
    • Dairy
    • Wheat
    • Eggs
    • Artificial flavors and colours (Aspartame, FD&C dyes)

 

Additional references

An Increase in the Omega-6/Omega-3 Fatty Acid Ratio Increases the Risk for Obesity. Nutrients. 2016;8(3):128. Published 2016 Mar 2. doi:10.3390/nu8030128

Schisterman, E.F.; Mumford, S.L.; Browne, R.W.; Barr, D.B.; Chen, Z.; Louis, G.M. Lipid concentrations and couple fecundity: The life study. J. Clin. Endocrinol. Metab. 2014, 99, 2786–2794. [CrossRef] [PubMed]

Facts About Calcium In Female Health/ Pregnancy/ Labour

 

calcium

The recommended daily intake of calcium for women is 1000mg/day (1300mg/d if you are 19 or younger)[1].

Reports shows that the general population at large is not meeting their Calcium needs as it is, Asia has a <400mg Ca/day dietary intake and  countries in Africa and South America 400-700 mg/d. Women in America consume 600-800 mg/day of dietary Ca [2]. Only Northern Europe has an average 1000mg/d intake[3].

  • Calcium and magnesium deficiency has been linked to PMS symptoms[4]. Ovarian hormones influence calcium, magnesium and vitamin D metabolism. The similarity between the symptoms of PMS and hypocalcemia is remarkable. Clinical trials in women with PMS have found that calcium supplementation effectively alleviates the majority of mood and somatic symptoms.

But beyond general female health, calcium plays a crucial role in pregnancy & labour

Calcium is obviously an important mineral during pregnancy , not only for optimal fetal development but decreasing the risk of hypertention and preeclampsia and the body does everything it can to optimise calcium absorption during the last few months of pregnancy.

  • During gestation the average fetus requires about 30 g of calcium to mineralize its skeleton and maintain normal physiological processes. About 80% of the calcium present in the fetal skeleton at the end of gestation crossed the placenta during the third trimester and is mostly derived from dietary absorption of calcium during pregnancy[5]

 

  • Oxytocin and uterine cells make use of calcium stores for uterine contractions and therefore low calcium stores may have consequences on the initiation of labour and the strength of contractions[6].

 

  • Vit D is needed for the absorption of Calcium. Your body can not utilise your calcium intake efficiently if your Vit D stores are low. When specific indications were examined, Vit D deficiency has been linked to doubling the risk of cesarean due to prolonged labour[7].

 

  • The body is aware of its need for calcium leading up to labour and delivery so much so that Intestinal calcium absorption doubles during pregnancy, and this appears to be the main adaptation through which women meet the calcium demands of pregnancy[5]. Even  women who are generally lactose intolerant (dairy being the best source of calcium) will become tolerant by term as calcium tolerance improves with gestation. One study found that out of 114 women who were lactose intolerant before 15 weeks, 44% had become tolerant by term[8].

 

  • Low fat yogurt contains more calcium than greek yogurt. Hard cheeses (Parmesan being the highest) are higher in calcium, and soft cheeses are avoided during pregnancy anyway.[9]

 

  • Supplements: Calcium carbonate may be cheaper, but calcium citrate is more easily absorbed.
  • Look for a supplement with USP on the label (adequate Ca, dissolves well, free of lead and toxic metals). no supplement with dolomite, bone meal, oyster shell or coral. and dont overdo it on the Ca supplement.

 

IMPORTANT TO NOTE: Dairy is one of the absolute best sources of calcium and Id like to just point out a few things here. The way our dairy is processed these days make for it to be a very controversial food, but it does still contain so many nutritional benefits if we are determined to source our dairy ORGANICALLY, hormone free and from GRASS FED cows instead of grain fed.

Also, Many women who are vegan or full on vegetarian start craving animal products during pregnancy and feel extremely guilty about this.  Id like to encourage you to listen to your body as it knows what it needs…. Food is medicine, and animal products can be honoured in reverence for its medicinal contribution to our health. This is a life-cycle where intuition and  maternal instincts are not to be underestimated.

 

[1]ACOG
[2] NHANES 1999-2000
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5684325
[4]Micronutrients and the premenstrual syndrome: the case for calcium. Thys-Jacobs S1. 2000 Apr;19(2):220-7.
[5]Calcium Metabolism during Pregnancy and Lactation. Christopher S Kovacs, MDFaculty of Medicine – Endocrinology, Health Sciences Centre, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John’s, Newfoundland, A1B 3V6, Canada
[6]Eur J Obstet Gynecol Reprod Biol. 2004 Jul 15;115(1):17-22
[7]Maternal Vitamin D Status and Delivery by Cesarean
Theresa O. Scholl, Xinhua Chen, and Peter Stein
[8] Improved lactose digestion during pregnancy: a case of physiologic adaptation?Obstet Gynecol. 1988 May;71(5):697-700. Villar J1, Kestler E, Castillo P, Juarez A, Menendez R, Solomons NW.
[9] http://www.nutritiondata.self.com

The Role Of Folate in Recurrent Miscarriage

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Folate & Recurrent Miscarriage

By Yolandi Rademeyer R.D(S.A)

 

Plain text summary.

Folate deficiency in the body contributes to high levels of inflammation that have been linked to recurrent early pregnancy loss.

There could be numerous reasons for folate deficiency and the most common way to increase folate in the body is by supplementing with folic acid. However, folic acid needs activation in the body and 50% of people can not convert folic acid to active folate therefore they remain deficient in folate regardless of supplementation.

One way to overcome this is to supplement with an already active folate (Methyl folate) to normalise inflammation in the body and create a healthier environment for a healthier conception.

……………………

Infertility affects 15-20% of couples, and keeping in mind that infertility is not only a female issue, since in infertility, 50% of cases are due to male factors[1]

Spontaneous miscarriage occurs in 12% to 15% of all pregnancies. 30% pregnancies are lost between implantation and sixth week[2].

Folate metabolism affects ovarian function, implantation, embryogenesis and the entire process of pregnancy[3].

MTFHR mutation

50% of the caucasian population have an MTFHR mutation that affects folate metabolism and potentially leads to folate deficiency [3] .

MTFHR is the gene responsible for coding the enzyme that converts natural folate or folic acid supplements to active folate. Without active folate in the body, numerous pathways are affected.

MTFHR deficiency in both men and women are associated with infertility[ 4]. Many women with recurrent miscarriage test positive for the MTFHR mutation[5], and the association between MTHFR mutation in both men and women  (from a meta analysis study of 57 global articles) and recurrent miscarriage has been confirmed[6].

Other reasons for folate deficiency

  • Recent use of oral contraceptives
  • Anti blood clotting medications
  • Other meds: Phenytoin(Dilantin)/ Trimethoprim-sulfamethoxazole/methotrexate/ sulfasalazine
  • Excessive alcohol intake
  • Gut disorders preventing absorption of folate
  • Diet : low in fresh food & veg & fortified cereals / overcooking.

The proposed reasons why low folate levels are causing miscarriage/infertility:

  1. Homocysteine (inflammatory marker) levels are too high. The theory is that due to high levels of homocysteine, small blood clots cut off the blood supply to the placenta triggering recurrent spontaneous abortions [7]. High homocysteine also negatively affects healthy sperm formation[4].
  1. Methionine (antioxidant) levels are too low leading to decreased detoxification and epigenetic processes (DNA synthesis, protein synthesis and cell division = fetal implantation & growth)[3].

How much?

In recent studies, patients with recurrent spontaneous abortion (RSA) show a normalisation of initially elevated homocysteine concentrations within a few weeks after starting supplementation with at least 0.8 mg/d (800mcg) folic acid [3]

But since folic acid still needs activation, supplementing with an already active form (methyl folate) is an easy way to bypass the possible MTHFR mutation issue. And always try your best to consume meals that are high in natural folate.

FOODS high in folate?

  • Organic, grass-fed beef liver (pan fried) 80g  = 211 mcg (yes you can have liver during pregnancy 🙂
  • Lentils 1 cup = 180 mcg
  • Spinach 1 cup = 109 mcg
  • Broccoli 1 cup = 104 mcg
  • Avocado 1 cup = 90 mcg
  • Sunflower seeds 1 ounce = 82 mcg  
  • Asparagus 1 cup = 79 mcg
  • Orange 1 large = 55 mcg
  • Tomato juice 1 cup = 48 mcg

Other names for methyl folate supplements:

  • Methylfolate
  • L-Methylfolate calcium (refers to the calcium salt molecule it is attached to)
  • Metafolin and Deplin
  • 5-MTHF and L-5-MTHF (in this article 5-MTHF refers to L-5-MTHF)
  • Levomefolic acid
  • 5-methyltetrahydrofolate
  • (6S)-5-methyltetrahydrofolate and Quatrefolic.

To get tested for MTHFR mutation: 23&me . Darwin Dietitians.

References:

[1]O’Flynn O’Brien KL, Varghese AC, Agarwal A. The genetic causes of male factor infertility: a review. Fertil Steril. 2010;93: 1–12.

[2]Spontaneous miscarriage occurs in 12% to 15% of all pregnancies. Thirty percent pregnancies are lost between implantation and sixth week.

[3]Folate Metabolism and Human Reproduction C. J. Thaler. Geburtshilfe Frauenheilkd. 2014 Sep; 74(9): 845–851

[4]MTHFR 677C>T Polymorphism Increases the Male Infertility Risk: A Meta-Analysis Involving 26 Studies. Mancheng Gong, Wenjing Dong, […], and Runqiang Yuan. PLoS One. 2015; 10(3): e0121147

[5] Archives of Gynecology and Obstetrics June 2016, Volume 293, Issue 6, pp 1197–1211| Association between maternal, fetal and paternal MTHFR gene C677T and A1298C polymorphisms and risk of recurrent pregnancy loss: a comprehensive evaluation. Yi Yang et al

[6]Minerva Ginecol. 2004 Oct;56(5):379-83. [Recurrent spontaneous miscarriages and hyperhomocysteinemia] Del Bianco A1, Maruotti G, Fulgieri AM, Celeste T, Lombardi L, Amato NA, Pietropaolo F.

[7]  Steegers-Theunissen RPM, Boers GHJ, Trijbels JMF, Eskes TKAB. Hyperhomocysteinemia and recurrent abortion or abruptio placentae. Lancet 1992;339:122–3.

[8]Quéré I, Mercier E, Bellet H et al. Vitamin supplementation and pregnancy outcome in women with recurrent early pregnancy loss and hyperhomocysteinemia. Fertil Steril 2001; 75: 823–825