Diet and lifestyle

12


Diet and lifestyle




Introduction


In this chapter, we will consider the effect of diet and lifestyle on fertility. Here we combine Chinese medicine advice which has evolved over many hundreds of years with that which medical research has uncovered in just the last few years. The infertility patients who consult a Chinese medicine doctor are often well educated and may have a lot of questions. In the interests of trying to cover all the relevant areas related to infertility and preparing to conceive, I have included information in this chapter that is not part of traditional Chinese medicine, but should help the clinical specialist be as informed as possible.


There is a dizzying amount of information and misinformation handed out to prospective parents: what they should eat – what they shouldn’t eat – which pills they should swallow – which they should not – what activities they should do – and not do. Attempts to follow all of this advice is enough to make any couple trying to conceive tense and miserable! However, being sensible and responsible about one’s diet and lifestyle not only safeguards health but can pay large dividends in gamete and embryo quality. Additionally, it is now recognized that mother’s nutritional status at the time of conception can have significant implications on the health of the future baby and the adult it will grow into.1



A Chinese Medicine Perspective



Jing


Jing is considered to be very precious; it is the life spring sourced in our deepest origins, a substance or energy inherited from our parents. In that sense, it is a finite bundle which must be conserved because it is not so easy to replenish it once spent. Healthy Kidney Jing is vitally important for fertility.


Previous generations of Chinese people were very aware of conserving their energy reserves. They were taught early in life to pace themselves, to move gently through life, not rush at it all at once, as we tend to do in the West. For Chinese people a long life is a desired goal and something they actively foster. This means they must look after their Jing and use it sensibly like a steady drip feed, which gets topped up on a regular basis. In so many parts of modern Western culture we adopt the philosophy of ‘live hard and die young,’ rather than thinking and planning, while we are still in our 20s, to be well and healthy in our 80s or 90s. Observing patients in the clinic of a well-known, elderly and wise Chinese doctor in New York in the 1980s, I had the opportunity to see these differing approaches to life. Every day, New Yorkers, driven by ambition and circumstance, would come to the clinic complaining of myriad different disorders. They were often young people who were working 70 or 80 h a week just to keep their feet on the bottom rung of the Big Apple ladder. The old Chinese doctor would look at their faces carefully, take their pulses and say ‘can’t you rest a little more?’ Usually, he was met with squawks of protest or looks of blank incomprehension. Slowing down or resting was just not part of the script for success. But if such a lifestyle persists, then the price is paid – in Jing and Yin currency.


It is the balanced path through life which helps to conserve Jing. Life doesn’t have to be quiet externally if our internal environment is quiet, i.e. if the mind can remain stable and still, but for most of us this is difficult when living in the midst of so much stimulation and stress. Likewise, rushing all the time doesn’t just make us stressed, it exhausts us. And if we keep going on an empty tank, the Jing is consumed.


Jing can also be depleted in a more sudden and dramatic way if there is a major crisis, e.g., recovery from an accident or serious illness draws deeply on life reserves. People in terrifying and dangerous situations like war and famine may also need to drain Jing supplies rapidly just to survive.


There are many ways that Jing is used up in the normal course of living and this is, of course, the nature of life. Jing is intimately related to reproductive processes and one of the more obvious expenditures of Jing is the semen and sperm spent with every ejaculation. The Chinese were strong believers in conserving the Jing by practicing semen conservation techniques, i.e. having sex without ejaculation. However, this book is about achieving pregnancy, so further discussion of semen conservation techniques will have to be sought elsewhere. In a man with poor Jing and low Kidney energy, however, it is always wise to limit sexual activity (including masturbation) and focus on spending Jing reserves only at the fertile time of his partner.


The sexual secretions of women are not considered to be so depleting to the Jing as is the loss of semen. Since these secretions do not contain gametes, they do not have such a direct connection to the Jing. Rather, they reflect Kidney Yin reserves; these too can be drained somewhat by excessive sexual activity. However, every menstrual cycle in which an ovulation occurs requires contribution from the Jing. It is when no more Jing contributions can be made (i.e., there are no more viable eggs) that menstrual cycles cease and menopause has arrived. Thus, women spend their Jing too in the normal processes of the menstrual cycle during the reproductive years. Celibacy in a woman cannot preserve Jing in the same way it can for a man. Stopping ovulation altogether, as happens, e.g., in women taking the oral contraceptive pill, may preserve some aspects of Jing, although it does so at a price.


The production of a whole new baby human during pregnancy draws heavily on the Qi, Blood and Jing resources of the mother. Anything which damages the DNA in the chromosomes (such as X-rays and mutagenic chemicals) is said to be damaging to the Jing. Some of the epigenetic effects of assisted reproduction technology (see Ch. 10) could also be of concern as far as Jing is concerned.


There are some ways Jing can be nourished, although clearly even the most careful lifestyle and nourishing diet cannot replace the Jing that must necessarily be spent in living. Some Taoist and Qi Gong practices can protect and nurture the Jing; similarly, there are Ayurvedic and Buddhist practices that aim to do the same.



Jing and food


Food substances which are designed by nature to nourish offspring can enhance many different levels of energy, including the Jing. Substances, e.g. royal jelly, which is produced by bees to nourish their larvae, offer this type of nourishment.


Eggs of birds, such as chickens or ducks, are one of nature’s most complete protein food packages and represent a type of Jing themselves, containing as they do the gametes of the female of the species. Similarly, fish eggs or roe are a form of Jing themselves and provide useful food if we wish to nourish our own Jing. Caviar may be precious not just because it is so rare and expensive but also because it is such a marvelous Jing tonic.


Seeds and nuts contain not only fertilized germ cells but also supplies for the immediate nutritional requirements of the potential new plant; hence, they are useful sources of Jing nourishment. In fact eating a handful of walnuts a day for 3 months has been shown to improve all sperm parameters. Pollen, which is made up of plant germ cells, is also a form of Jing and therefore a potentially useful supplement for Jing deficiency.


Some animal organs and tissues nourish the Jing. For example, bone marrow (especially that from pig spine) can be used to make a particularly good Jing-strengthening soup. Brains fall into a similar category to bone marrow. Animal organs such as kidneys also provide the sort of nourishment which can support the Jing. Oysters, with their aphrodisiac reputation, bolster Jing by delivering essential minerals like zinc to the sperm-manufacturing cells.


Other plant products which nourish Jing are seaweeds and algae. These plants provide trace elements which are necessary for many processes in the body, including the production of the gametes and the hormones which control their development.


Additional foods reported to have a special effect on the Jing are: artichoke leaf, nettles, oats, and raw milk.2



Yin


Yin cannot exist or be described except with reference to Yang, its opposite force. The Yin energy of the body is the internal, quiescent, restorative, and moistening force to balance Yang’s more outward, active, stimulating, and warming force. When we try and make parallels with our understanding of physiology from the Western point of view, it is sometimes said that Yin reflects anabolic activities (synthesizing and storing) and Yang reflects catabolic (energy-producing) activities. Or that Yin reflects the function of the parasympathetic nervous system that controls internal homeostasis, whereas Yang reflects the activity of the sympathetic nervous system that controls our responses to stimuli.


Yin is essentially an internal and quiet energy. An overly stimulating and rushed lifestyle damages it by not allowing time for rest and regeneration. It is such a lifestyle which turns up our slow drip feed of Jing, draining it more rapidly than is healthy and at the same time creating an imbalance between Yin and Yang by indulging in more Yang active times than Yin ‘resting’ times. Such a lifestyle depletes both Jing and Yin, which spells doom for fertility. Those fortunate people born with plentiful and strong Jing energy may sustain quite some Yin deficiency without the Jing being depleted but eventually a frantic life catches up with everyone – lucky are those for whom it doesn’t happen until old age, when fertility is no longer an issue! Yin deficiency in the absence of Jing deficiency can still compromise fertility. Restoring damaged Yin energy, although not quite so difficult as dealing with deficient Jing, is still not an easy clinical task. Yin-deficient women, especially older ones (speaking from the ovary’s perspective) find getting and staying pregnant a challenge. Their juices are dried up, i.e., they have little fertile mucus to carry the sperm safely into the uterus, and the lining of the uterus can be thin. The development of the egg too is compromised if the Yin is inadequate. And men are not immune from the damaging effects of the Yin-hungry lifestyle; internal Heat which develops as a result of Yin deficiency can have very dire repercussions for the development and maturation of sperm.


Yin can be nourished and rebuilt by attention to inner calm. Meditation, Tai Chi, and regular walks in serene natural environments recharge Yin. Modifying those habits or behavior patterns which increase mental stimulation excessively and heat or dry the body will also help Yin. For example, trying to fit too much into one day and skimping on sleep and meal times undermines the Yin and should be avoided or limited in those with a tendency to be Yin-deficient or in those wishing to preserve their Yin.


Modern work places may be hazardous for the Yin. Long hours in front of computer screens, or around other electrical machinery such as photocopiers, drains and dries the body, as does the stale air in the air conditioning of large sealed office blocks. Antidotes to such influences need to be sought out on a regular basis in areas of naturally high negative ions such as rainforests, river banks, and the ocean.


Toxic fumes associated with some trades and professions (e.g. manufacturers of glues, paints and solvents, photographers who develop their own photos in darkrooms, cleaners and dry cleaners) appear to have a damaging effect on the Jing and Yin. Under these conditions, the developing eggs or sperm become less able to create viable embryos (see Environmental pollutants, below, and Ch. 8).


Severe or recurrent febrile illnesses or the loss of large quantities of blood can deplete and damage Yin.



Yin and food


Attention to lifestyle habits and avoiding stimulating drinks and foods has more impact on conserving or recovering the Yin than does making specific additions to the diet. In general, diets composed of foods which are rich in nutrients and not overly stimulating are those which nourish the Yin. A diet of fruits and vegetables and adequate protein (especially tofu, fish, and milk) is one which fortifies the Yin. On the other hand, drinking too much coffee and eating very spicy food can consume Yin. Some texts recommend the following specific foods: barley and millet; string beans; asparagus; all dark-colored beans; dark fruits like blackberry, mulberry, and blueberry; seaweeds; and animal products, including fish eggs, dairy produce, duck, and pork.3


One word about soy before recommending it as a good addition to the diet of Yin-deficient men with poor sperm counts – it has been found that men who eat even moderate quantities of soy-based foods regularly produce a third less sperm per milliliter than men who consume no soy-based foods.4 One cup of soy milk or one serving of tofu, tempeh, or soy burgers every other day provides enough isoflavone content to affect the sperm. It is thought that the phytoestrogens may interfere with hormonal signals that govern sperm production.


Including soy-based foods in the diet won’t affect most men, but if there is also obesity (fat also produces estrogens) and if a man’s sperm count is low, or even low-to-normal, soy foods could tip the estrogen/testosterone balance in the wrong direction and reduce sperm count further.


Ensuring that the body is well hydrated is also important. Yin-deficient people are often thirsty and dry. Drinking a lot, however, will not necessarily hydrate the tissues if the fluid passes straight through the body and is excreted (see Fluid intake, below).


Yin can be damaged by chronic dieting (to the point where the body is malnourished) and by the use of recreational drugs.



Yang


Yang deficiency often develops out of a Yin deficiency, but can also be provoked by certain environments, behavior, and diet. Living and working in icy climates or even damp cold ones can damage the Yang. The external Cold can enter the body, through specific channels or organs and inhibit or weaken the inner Fire of Yang. If the Yang of the body (and therefore its Wei Qi or natural defences) is weakened, Cold can enter even more easily. For example, in the first days of a woman’s period, her body is slightly Yang deficient (because she is losing body heat with the blood loss) and is more vulnerable to direct attack of Cold to the Uterus because the Chong channel is open. It is for this reason that Chinese women (and Asian women in general) are advised not to swim in cold water during their periods. If the Cold restricts or inhibits the rapid and easy flow of the blood it can ‘stagnate’, setting the stage for many gynecological problems later, including infertility.


When Kidney Yang is damaged, so is fertility in both men and women. Libido will be poor in both sexes, and in women, the function of the corpus luteum and the processes of implantation of a newly fertilized embryo into the uterine lining will be compromised. Kidney Yang deficiency in men can lead to impotence and/or low sperm counts and motility.


A Yang-deficient body is one without enough driving or warming energy, so that metabolism and mental processes become sluggish. The body and limbs easily feel cold and lethargic, and motivation and assertiveness diminish. As much as Yin needs rest and a quiet mind to regenerate itself, Yang needs movement and stimulation to feed it. Providing there is a good Yin base, and activity and stimulation are appropriate for the circumstances, Yang will benefit from activity and physical exercise. When the Yang is already weak and motivation is very low, the first few steps are difficult. In cases like this, the use of strong Yang tonics (like deerhorn and ginseng capsules) and the appropriate diet will help to motivate a Yang-deficient person into initiating the appropriate changes in their life. This may be as simple as beginning a gentle exercise program, or it may be as challenging as being assertive in an unfavorable work situation.



Yang and food


Yang benefits from a diet that is warming. This means eating foods which are nutrient or calorie-rich such as protein or carbohydrate and eating foods which have been cooked. It also means avoiding ice-cold drinks and foods like ice cream. Methods of cooking such as long slow baking or simmering will increase the Yang Qi in foods. Cooking foods like fruits can reduce their cooling nature and addition of some spices like ginger, shallots, or cinnamon can increase Yang Qi in foods. Very hot spices like cayenne and chilli certainly add Heat to food and in moderation can be helpful in raising a sluggish metabolism. When very pungent spices are eaten a lot (as they are in some very hot and tropical climates), they can have the opposite effect, i.e. become cooling, because they provoke sweating. Stimulants like coffee are favored by Yang-deficient people because the adrenaline (epinephrine) they provoke creates an impression of internal Heat and activity. However, it is false Yang, and eventually consumes reserves rather than stimulating them.


The organs most commonly affected by Yang deficiency are the Spleen and the Kidney. For the person with weak Yang Qi, a diet of raw and Cold foods can quickly douse the inner Fire, creating problems of Spleen and Kidney Yang deficiency. This will manifest first, as digestive symptoms such as bloating and loose stools. If this situation continues, it can start to mimic a chronic food allergy picture, where many foods become difficult to digest and stamina and mental concentration are affected. Fluid is not metabolized efficiently and edema or puffiness may occur in some parts of the body.


Texts of Chinese dietetics recommend the following additions to the diet: garlic, onion, chicken, lamb, trout, salmon, lobster, shrimp, prawn, mussel, black beans, walnuts, chestnut, pistachio, raspberry, and quinoa.5



Qi and Blood


The vitality and actions of the internal organs can be described not only in terms of Jing, Yin, and Yang but also in terms of their Qi and Blood. While Qi is an immaterial substance which we translate as energy, the TCM concept of Blood includes the material substance we can see (the red stuff in our veins) and many aspects of nourishment of the body. Plentiful Blood and Qi makes us more substantial and resilient in both physical and emotional ways. When the Blood and Qi is adequate and moves well, all the tissues are well nourished and the complexion appears to be a good color. A pale tongue is a sure sign that the Blood reserves are low.


Healthy Qi requires rest, movement and flexibility. Exercise builds Qi and the capacity for producing Qi, providing it is done in an appropriate way. For some people this means aerobic workouts or athletic training. For people at the other end of the spectrum, this means gently stretching the limbs or walking slowly around the block. For most of us, an exercise program somewhere in the middle is appropriate. As the lungs work more, so does the Qi. The nature of work in the city, often sedentary, often stressful, combined with eating too much or in a rush does not help the Qi move smoothly; rather, a regular routine plus a sensible exercise program will help the Qi build and move.


Spleen Qi is important for the absorption and metabolism of food and the production of Blood. Just as important is the patency of the Liver and Heart Qi (see also Stress, below).



Qi and food


A diet of varied fresh and tasty food eaten in an unhurried and regular daily routine will benefit the Spleen Qi and ensure its capacity to transform the nutrients in food into the myriad molecules that are required for all the thousands of biochemical processes which occur every moment in every organ and tissue.


When Qi (especially Spleen Qi) is weak or is obstructed, there will be bloating after eating, and other digestive symptoms. The judicious use of herbs and spices in cooking can be helpful, as can foods which specifically help to maintain circulation of Liver Qi. Drinking warm water with a little lemon or lime juice to add a sour flavor is a useful Liver Qi invigorating start to the day. To support the Spleen Qi, foods should be lightly cooked and balanced in flavor and nature. The diet should include some with sweet, some with bitter, and some with pungent flavors. The sweet flavor is found in root vegetables and grains and these usually form the base of a meal. If eaten in excess, however, they can create stagnation. Bitter leaves like arugula (rocket) or watercress help digestion and pungent foods like onions, garlic, coriander or chives (even small amounts of chilli) also help digestion and Qi movement.


Chinese people sip green teas during meals to facilitate digestion (especially of fats) and the custom of French and Mediterranean people of drinking wine during the meal has now become an international habit. In careful moderation, wine can be a useful tool in regulating Qi and helping digestion. Spirits, likewise, can move the Qi. Because spirits add a lot of Heat to the system, however, they must be taken sparingly.


There are many aspects of the menstrual cycle which depend on plentiful Blood. Liver Blood is an important component of menstruation and is one way we can describe the Blood-storing function of the Uterus in TCM terms. When periods become very scanty, it is said that Liver Blood is deficient. This means the uterine lining is thin and lacks nourishment. Blood deficiency can contribute to poor semen quality.



Blood and food


Diet and the way we digest foods is very important if we are trying to build up the Blood. In Western medicine, a severely Blood-deficient person might be called anemic, and iron would be prescribed so that more hemoglobin could be manufactured. The way TCM doctors see it, is that although iron is very important, equally important are the cofactors and the process itself which makes hemoglobin from iron. Adequate cofactors are ensured by using whole foods as the source of iron and the process of making hemoglobin happens efficiently if the Spleen Qi is strong.



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Foods which build Blood best are meats and poultry, and especially stocks and soups made from bones. Such stocks provide Blood-fortifying bone marrow and also calcium from the bones (if a little vinegar is added to leach it out). Small amounts of meats which have been marinated before cooking, or stewed in casseroles for a long time, will provide rapid nourishment to the Blood. Egg yolk and legumes also help to nourish the Blood, as do grains, green leafy vegetables, beetroots, red wine, and stout. Substances which build the Blood after menstruation are an important component of diet and herbal prescriptions. With this in mind, Chinese and other Asian women commonly eat special soups made with chicken and herbs after the period. For example, post-menstrual soup is made by boiling a whole chicken with a selection of herbs and vegetables. These include carrots, mushrooms, shallots, and sweet potato. Herbs which are often added include Shan Yao (yam), Gou Qi Zi (Lycium berries), Long Yan Rou (Longan fruit), and Sheng Jiang (ginger). The resulting stock makes a nutritious post-menstrual soup – some chicken meat can be added if desired.


Heat in the Blood is a condition which develops from internal imbalance or from external factors like excess consumption of Heating foods. Foods which are obviously heating and stimulating, like chilli, pepper, and coffee, can contribute to Heat in the Blood, as can alcohol, especially spirits. If Heat in the Blood is manifesting in the form of heavy periods or skin rashes, then such foods should be avoided. In general, Heat is not conducive to the development of good-quality sperm or eggs or a thick endometrium.


To allow the Blood to flow freely during the period, sour, astringent foods should be avoided. If consumed in excess, such foods can inhibit or temporarily stop the flow. For example, during the period, vinegar and pickles, some sour fruits like grapefruits and gooseberries and sour yogurt should be limited or avoided. In general, very fatty foods are not advisable because they slow the blood and make it thicker and easier to stagnate.



Phlegm-Damp


When we discussed the various TCM patterns of infertility, we mentioned three categories other than Kidney weakness, these were: Liver and Heart Qi stagnation, Blood stagnation, and Phlegm-Damp accumulation. Of these three, it is Phlegm-Damp accumulation which is most related to diet.


Phlegm-Damp creates an internal environment of congested and stagnant fluids. Excess mucus forms in the gastrointestinal tract and bowel movements become sluggish and unformed. The lungs and other parts of the respiratory tract can also become congested with fluid or mucus. The urine becomes cloudy if the bladder is affected. Obesity, diabetes, and heart disease can develop. In terms of fertility, we are concerned mostly with congested or stagnant fluids blocking the cervix (pathologic vaginal discharges or inflammation), or the tubes (mucus and inflammation), or affecting the ovaries (cysts), or the uterine lining (excess secretions). Damp in men can contribute to impotence, prostatitis, discharges from the penis or thick congealed semen – all of which have an affect on sperm. Phlegm-Damp in both men and women can manifest as fatty deposits around the abdominal organs. If a person has a tendency to Damp or already manifests pathologic manifestations of it, then Damp-clearing herbs will be prescribed. Such therapy must be supported by the appropriate diet.



Phlegm-Damp and food


Poor eating habits or poor digestive function allows accumulation of Phlegm-Damp. A diet which is unlikely to create Damp is one which has few fatty rich foods and includes foods which help to mobilize fluids and break up congestion. Herbal digestives are often taken by Chinese people after a meal to help to avoid Damp accumulating, e.g., hawthorn flakes after eating heavy meats. Where there is already evidence of internal Phlegm-Damp (weight gain), reducing intake of fatty meats, dairy products, sweets (especially chocolate and ice cream), bread, and fried foods is important. Dairy products are one of the main dietary culprits for many Westerners, milk and cheese being such a popular part of the diet in countries like Australia, New Zealand, UK, France, and America. It is well known by nutritionists that adult Caucasians often lose the capacity to digest the components of dairy (specifically lactose) as they mature, and in the case of many Asians, that capacity was not there even in childhood. Some studies relate the inability to digest dairy products (or galactose, a sugar found only in milk) or overconsumption of dairy products, to impaired ovarian function.6 High levels of galactose appear to be toxic to ovarian germ cells and trials have been done to examine its association with premature ovarian failure.7


However, for women who can digest lactose and galactose and who do not have a tendency to Phlegm-Damp, then milk or dairy products can be an important source of protein and calcium.


In a case where infertility is related to Phlegm-Damp in the lower Jiao, a diet based on aromatic rice (and some millet and barley) with the addition of broad beans, chick peas and, especially, adzuki beans, will support the Spleen and drain Damp.8


The Clinical Handbook of Internal Medicine, Vol. 2, Chapter 26, provides more in depth discussion of diets for different constitutions with appropriate food inclusions or exclusions.9



Fluid Intake


Drinking enough fluid is an important part of a good diet. Water is the major component of the human body. Every system in the body depends on water. Blood is 83% water; muscles are 75% water; the brain is 74% water, and even bone is 22% water. Water lubricates every joint in the body. Water is used in the digestion and absorption of food and nutrients and the elimination of digestive wastes.


Not everyone, however, is able to make effective use of the fluid they drink. People with Yin deficiency tend to have tissues which are less well hydrated and lubricated. They often feel dry and thirsty and may have dry skin and hair, especially if their condition is complicated with Yin-deficient Heat. But no matter how much they drink, the tissues remain somewhat dehydrated and liquid tends to pass straight through them. From the point of view of the nourishing fluid around the egg in the follicle, the fluid in the fallopian tubes and the fluid levels in the endometrium as it prepares to sustain a fetus, keeping moisture levels up is obviously very important. This is why such emphasis is placed on clearing Heat and reinforcing Yin in the follicular phase of the menstrual cycle. In men, the quality and quantity of the semen which nourishes the sperm is dependent on healthy Yin and moisture levels. TCM doctors use Yin tonic herbs (such as Mai Dong and Tian Dong) to encourage tissues in the body to hold more fluid. A daily fluid intake of eight or more glasses of liquid which does not contain sugar, salt, or caffeine should be advised.


Interestingly, people with Damp constitutions also make poor use of the fluid they imbibe. Unlike the Yin-deficient types who can’t hold liquid in their tissues, Damp people hold too much fluid in their tissues, which become boggy and congested. The lack of easy fluid movement in and out of the cells means that as a vehicle for nutritional factors and wastes, it is most inefficient. In the case of constitutional Damp, herbs are given which help to alter the osmotic balance between the intra- and extracellular fluids such that liquid moves out of the tissues and into the bloodstream, from where it can be drained from the body via the kidneys and bladder. Damp people should not drink large quantities of water until this process is happening efficiently.


One last reason why adequate water intake is important, is to keep the blood circulating well. You will know by now that Blood stagnation is a pathology that crops up frequently in infertility and other gynecological disorders. While Blood stagnation is a TCM term which covers a lot of complex pathologic changes in different tissues, it is a process which actually starts at the level of the circulation of blood in the capillary. When the body is dehydrated (even mildly and even before much thirst is registered), the blood becomes thicker and circulation in the far reaches of the tiniest capillaries is retarded. If this situation is repeated over and over, day after day, month after month, then Blood stagnation develops.



Preconception Diets


So what does in fact constitute a healthy diet for those preparing to conceive (who don’t need to lose or gain weight), one that will maximize their nutritional status and their fertility? This will vary enormously depending on the country, the culture, urban or rural environs, economic status, and individual constitutions and preferences. In the USA, one large study tried to define some of the parameters of a diet which promoted fertility.10


The Nurses Health Study followed nearly 20 000 women over several years and correlated pregnancy attempts with diet and lifestyle factors. They recorded higher pregnancy rates when women had what they defined as a ‘fertility diet.’ Their findings were summarized with this advice:11










We could summarize general diet advice even further with the words of esteemed author Michael Pollan, who writes extensively about our modern food production and eating habits.12 His mantra is Eat food. Not too much. Mostly plants.


To this we would add, Enjoy! And we would add an artful TCM touch emphasizing balance, taste, flavor, appeal and ease of digestion, alongside an awareness of the season and an individual’s constitution.9


We know that nutritional status at the time of conception can be critical in determining the health of the baby and future adult (particularly in terms of cardiovascular disease and diabetes),13–15 hence it is important that women take steps to ensure their diet includes sufficient nutrients. In general, a diet that includes plenty of fresh fruit and vegetables and sufficient protein, will provide the nutrition needed to create a healthy environment for the new embryo. However, it may be wise to add supplements to ensure intake of certain essential vitamins (such as folate) particularly where the diet is not ideal.



Nutritional Supplements


The British Association for the Promotion of Preconception Care, called Foresight, has for many years dispensed information about diet and lifestyle to prospective parents. They have sponsored research which supports the notion that healthy, well-nourished parents have healthy pregnancies and make healthy babies.16 Their advice includes a sound, well-balanced, and ‘clean’ (i.e., no junk food or added chemicals) diet and the optimum intake of many vitamins and minerals, namely: zinc, selenium, manganese, potassium, magnesium, iron, iodine, calcium, chromium, boron, vitamins A, B complex, C, D, E, folic acid, and essential fatty acids.17


It has long been recognized that nutrients such as calcium and iron are important for the health of the pregnant woman and her baby. We now know that lack of folic acid can have dire consequences on the early development of the nervous system of the fetus, causing neural tube defects such as spina bifida. As more research is carried out on different nutrients, their role in fetal development will be elucidated. The above-mentioned nurses study found that women who took supplemental vitamins had a better chance of conceiving.18


Finding a good prenatal supplement which incorporates essential vitamins and minerals is important and consultation with a local naturopath or nutritionist for guidance may be advisable. A full discussion of the roles and dosage requirements of all these supplemental nutrients is outside the scope of this text, however it is worth noting that there are some nutrients that modern diets seem to be lacking, and which may be the cause of some disturbances in fetal development. Consumption of iodine has dropped in many countries (except those where a lot of seaweed is eaten), to levels that have caused concern for infant brain development. Iodine deficiency in the mothers’ diet can lead to miscarriage, premature birth and significant developmental delays in affected children.19 Hence, it is important that women take a vitamin preparation containing 150 μg iodine daily, in preparation for and during pregnancy and lactation to supplement iodine intake from the diet;20,21 the total daily intake should be 250 μg.22 Dietary sources are seafood, dairy and eggs, and some vegetables. In some countries, foods like bread are fortified with iodine to prevent a public health problem. However, the amount of iodine in dietary sources is inadequate for pregnant and breast-feeding women.


Similarly, vitamin D levels are inadequate in a large number of women who are pregnant or preparing to conceive. Very few foods (other than some fatty fish) have significant amounts of vitamin D in them and the primary source, the action of sunshine on the skin, is limited in the lives of many modern women who work inside and seldom see the sun. Vitamin D deficiency adversely affects bone health and brain development of the baby, but also increases risk of heart disease, type 1 diabetes and cancer as the baby grows into an adult.23


In summary, women preparing to conceive should take a prenatal multivitamin supplement and should check this for inclusion of adequate folate (500–1000 μg), Vitamin D and iodine. Women are often recommended to add Fish oil and CoQ10 capsules to a preconception vitamin preparation if it is not included.


Many patients who have had a poor response to IVF or who have been diagnosed with poor ovarian reserve are recommended by their specialist to take DHEA (dehydroepiandrosterone). This is a hormone that is produced by the ovaries and the adrenal glands and is an essential prerequisite for ovarian follicular steroidogenesis, specifically follicular testosterone.24 However, DHEA levels decline with age. Some clinical studies on small numbers of IVF patients classified as poor responders, have shown promising effects of DHEA supplementation (75 mg/day for 6–12 weeks) on outcomes such as number of mature oocytes, embryos, pregnancies, and live births.25,26


Other supplements sometimes suggested by clinics to their IVF patients who have not responded well include:



Arginine – supplementation with this amino acid has been examined in several small studies which show conflicting results, arginine supplementation being associated with both better IVF outcomes in earlier trials but worse outcomes in more recent studies.27–29


Melatonin (N-acetyl-5-methoxytryptamine) – this hormone is secreted during the night by the pineal gland to regulate a variety of pathways related to circadian rhythms and reproduction. It has been shown in one study to reduce intra-follicular oxidative damage, and increase fertilization and pregnancy rates in IVF poor responders at a dose of 3 mg per night for 5–6 weeks leading up to egg retrieval.30,31


Inositol – a naturally occurring carbohydrate that is found in phospholipids which function as cellular mediators of signal transduction in metabolic regulation and growth. One recent trial claimed that using Inositol 4 g/day, and Melatonin 3 mg/day together, improved oocyte quality and pregnancy rates.32


Men who are preparing to have a child and who do not have an ideal diet are recommended to take a general vitamin supplement and fish oils. A high intake of omega-3 fats such as those found in fish oils is associated with better sperm morphology.33


Men whose sperm have a high degree of DNA fragmentation are recommended to take antioxidants, such as Vitamins C and E.34


Drinking Rooibos tea or green tea also benefits men with a high degree of DNA fragmentation.35



Weight


Does weight matter? Body weight that varies from a defined norm in either direction can affect fertility. Restriction of calorie intake has an immediate effect on the pituitary hormones acting on the ovary36 and a loss of even 10% of body weight below the standard can cause ovulatory problems and reduced fertility. More extreme weight loss (as in anorexia nervosa) can inhibit ovulation altogether. Even in women with regular weight, low body fat can negatively affect ovulation. This is observed in women who train seriously for athletic and sporting events and stop ovulating until such time as their exercise regimen is reduced and their body fat builds up again. If infertility is the result of the body deciding it cannot support the huge caloric requirements of pregnancy and breast-feeding because it does not have enough adipose tissue, the remedy may be as simple as consuming more calories. For some women who have very low appetites or who have difficulty eating enough or digesting larger quantities of food, some work may need to be done to invigorate Spleen Qi. For women who cannot put on weight no matter what they eat, then treatment to build the Yin, cool internal Heat and calm the Shen must accompany a good diet. Both herbal tonics and acupuncture can invigorate the Spleen Qi, supplement the Yin, or clear internal Heat and thus encourage less sympathetic nervous system activity and more weight gain.


We do not have any evidence to indicate that low BMI affects men’s fertility in the same way. Very thin men with poor sperm counts will likely be Yin deficient and will need to be treated for this and any internal Heat over some time.


On the other side of the coin, it is well known that overweight women can have difficulty conceiving. This difficulty is sometimes related to polycystic ovary syndrome (PCOS), sufferers of which often experience weight gain. (We have discussed the relationship between polycystic ovaries and the condition called Phlegm-Damp accumulation and impaired fertility in Ch. 5.) With an excess of Damp accumulation (with or without PCOS), ovulation frequency and egg quality may be reduced. The follicular fluid surrounding the eggs of obese women is different to that of moderate weight women and maturation within this environment is detrimental to the eggs.37,38 It has been shown that overweight women do less well with IVF39 and suffer more risks during pregnancy.


Researchers who have examined the effect of obesity on placental function in animal models advise women that in order to make a good functioning placenta they should lose weight well before conceiving and not just switch to a good diet once they are pregnant. They describe fat deposit patterns in placentas of the obese rats in their trial, such that the nutrient supply region is just half the size of that of a normal-weight mother, even when both were eating the same healthy diet. As a result, obese mothers gave birth to babies that were 17% smaller than they should have been, risking lifelong consequences.40


But it is not only excess weight in women that we must concern us. Although not all reports agree, there is growing evidence that excess weight in men also has a negative effect on ability to reproduce; sperm counts reduce significantly as BMI and abdominal fat increase41 and men who are overweight are more likely to suffer erectile dysfunction.42


When the embryos of overweight men doing IVF are examined at Day 4 or 5 (when paternal genetic influence comes into play) there is evidence of impaired development. Overall studies show there is decreased blastocyst development, and fewer conceptions when the male partner is overweight.43


There is certainly enough compelling evidence to persuade both partners in a couple to try and reach a reasonable BMI before trying to conceive or do IVF.


It is not only the increased chance of achieving a healthy pregnancy but the health of the child may also be affected by the weight of the parents.


Mice studies have shown that obese fathers can have offspring (especially daughters) that are prone to obesity and insulin resistance. Obesity can actually change the microRNA of the sperm revealing that a man’s diet can affect the epigenome of his sperm, a non-genetic mechanism to inform the next generation of environmental change. Another compelling reason to lose weight before conception.44



Losing weight


A Damp condition often causes weight gain or even obesity because the body’s metabolism is severely hampered by the congestion of stagnant fluids. Treatment consists of clearing Damp generally, so that metabolism improves and specifically so that ovulation proceeds. The weight loss that follows is usually accompanied by a return of fertility.


It is encouraging for your overweight patients to know that a little bit of weight loss goes a long way to improving fertility. Losing just 5 kg is a manageable target for most and once the Damp starts to mobilize reproductive health quickly responds. Just moving the metabolism a little bit in the direction of burning off fat stores can stimulate ovarian activity, improve egg and sperm quality, and increase fertility.


Chinese herbs are often prescribed to help weight loss. They regulate bowel transit time, reduce fluid retention, encourage efficient metabolism and increase energy levels. Herbs which specifically boost the function of the Spleen in transforming and transporting foods and clearing Damp are a good support to metabolism.


Formulas such as Xiang Sha Liu Jun Zi tang whose function is to Harmonize the Digestion, are a good basis from which to start.



For poor sleep add:








Suan Zao Ren 9 g Semen Ziziphi Spinosae

For poor digestion from overeating or food stagnation add:








Chao Mai Ya 12 g Fructus Hordei

For fluid retention add:








Ze Xie 9 g Rhizoma Alismatis
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Related posts:

  1. A tale of two clinics — the treatment of infertility with Chinese medicine or Western medicine
  2. Assisted reproduction technology and in vitro fertilization
  3. Gynecologic disorders which can cause infertility
  4. Traditional Chinese medicine treatment of the IVF patient

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Jul 11, 2016 | Posted by in PEDIATRICS | Comments Off on Diet and lifestyle

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