The nutritional status of couples who are trying to conceive

Dian Shepperson Mills, MA & Stephen Kennedy, MD
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Dr Stephen Kennedy, MD: Good afternoon. I’m Stephen Kennedy, a gynaecologist working at the University of Oxford.

Dian Shepperson Mills: I’m Dian Shepperson Mills, a clinical nutritionist working at the Endometriosis and Fertility Clinic based in Sussex in England.

Dr Stephen Kennedy, MD: The aim of this interview is to ask Dian about the nutritional status of couples who are trying to conceive. Dian, tell us why is it so important for couples, who are trying to conceive, to think about their nutritional status?

Dian Shepperson Mills: It would seem from literature that there are major problems if people are nutrient-deficient or eating a poor diet and not obtaining enough good nutrition in food in that the egg and the sperm require nutrients in order to mature. 

The blood supply into the ovary carries the nutrients into the ova and the graafian ovarian follicles help to mature the ova using those nutrients. You also have the endometrium, which has to be nutrient-rich in order for the blastocysts to implant and grow. In fact, the latest research is showing that the blastocysts actually roll down through the endometrium to find a spot to attach where it is rich in nutrients. The attachment enzyme requires zinc and vitamin E. 

We know that, in order to mature and produce healthy ova, we need sound nutrition. I have just worked with a woman of 42 years and she has had six failed IVFs eight years ago and was told her eggs were very poor quality. I worked with her for five months and she has gone back and done IVF, as she had her fallopian tubes removed, and she was told her eggs were the quality of a twenty-year-old and she is now pregnant with twins. So there is obviously a mechanism whereby the nutrients for maturing egg and sperm are crucial to fertility.

Dr Stephen Kennedy, MD: Are there any particular foods the couples should avoid and are there are any particular foods that people should be encouraged to take?

Dian Shepperson Mills: Foods, I think, from research, using Mormon women as controls because they do not drink, they do not have alcohol, they do not have coffee, they avoid smoking. It would appear that caffeine has a detrimental effect on ovarian function, so caffeine in strong coffee, chocolate and strong tea and fizzy-cola-type products should be kept at a low level. 

Certainly, you need to ensure if you have digestive problems, the main two gut irritants would be caffeine and citrus because they do irritate the gut membrane. So, if you have digestive problems, which could be compromising your absorption of nutrients, those would be the first two foods to avoid. 

There is some research now showing that wheat can be a problem - wheat gluten or the gliadin factor in wheat. It used to be felt that one in 2,500 people have what is known as coeliac disease, but there is now a category known as non-coeliac dysfunction and that is finding that one in 100 to 1 in 200 people have problems with gliadin and gluten digestion and it can impact on fertility. 

The main research looking at that is in America and they are finding that you can get all sorts of problems with this and it can impact on thyroid function. So, in certain people, there may be a gene, and you need to look at this, Sir, which proposes that you have sensitivity to gluten. The people affected by this are Jewish people, people from Scandinavian countries and the Irish - they carry the gene for gluten sensitivity. This is another area that needs looking into. 

Other foods you need to be careful with: there is some research on aspartame interfering with the hypothalamus and pituitary functions. People who are drinking eight cans of fizzy diet whatever a day, could be having problems because it could be interfering with digestion and fertility. 

The other area is people who are dieting. When I was doing my MA, I worked with 50 couples in Denmark and 50 couples in Britain, who were undergoing IVF, and they had to fill in a food diary for seven days so that I could track what they were eating. It was very obvious that I had to hunt vegetables and hunt protein – and you need the oils and vitamins and proteins to help hormone function. 

The other problem was that, while they were undergoing IVF, a lot of the women who were taking Clomid,, Gonal-F and Perganol because of the action of the drug, they were bloating and retaining fluid and these women were dieting because they did not want to put weight on. There is a point in time when you are desperately trying to get pregnant that you need sound nutrition. In animals, there is a system known as flushing where before you put an animal into the fertility zone, as it were, you actually flush the animal with nutrients and animals always get pregnant, from veterinary research, on a rising body weight, never on a falling body weight. 

Dieting at the very moment you are trying to conceive is a very, very bad idea. A), you are not taking in the nutrients you need and b) you are upsetting pituitary function because there is research showing that if you skip a meal, it can impact on the pituitary, which then does not send the right message to the ovaries for the next 24 hours. 

There are lots of things you need to eat to be healthy. They would be fresh fruit and fresh vegetables, the fresher the better. Organic if you can get them but I do not like people being paranoid because we cannot always get organic, so if you can’t get organic then peel, and do the best you can with the money you have. 

Fresh deep-water fish: there is pollution in shallow seas so trying to avoid oily fish from shallow seas would make sense because we know dioxins and PCBs are in that food, but certainly deep-sea oily fish - fish oils seem to help fertility. Two-thirds of the brain is oil, every cell membrane is oil, and it seems to be crucial in the ovary and testes and sperm. So eat fish oils, lean meat, nuts and seeds because the oils in the nuts and seeds are also very important; berry fruits because they contain proanthacyanadins, which are anti-oxidant in function, and peas, beans and lentils. Again, you have to be careful not to have too many legumes because in peas there is a chemical which can cause sterility if eaten to excess. This research was looking at Tibetan men, who only, on average, fathered two children and they wanted to know why. Because they have high pea content in their diet, they found it was a phyto chemical. So peas, beans and lentils are fine in moderation but not in excess. 

There were also two pieces of research looking at wild cats in the Cincinnati and Auckland zoos. They did not get pregnant, whatever they did, the fertility was compromised and it was only when they looked at the diet in these wild cats and found that 50% of their diet was soy protein. They took the soy protein out and put chicken in and the wild cats got pregnant immediately. 

There is all this research we have to look at and it is not looked at. Elsevier produced a CD-ROM called, “Food and Human Nutrition,” and this research data is from universities around the world, the nutrition departments, and it is done by nutritionists and it is not always found on Medline.

Dr Stephen Kennedy, MD: So, tell me, some cynics would say everything that you are proposing is common sense. That one should try to be as healthy as possible if you are trying to conceive. But is there evidence to suggest that if you are nutritionally deprived and you eat healthily, you are more likely to conceive?

Dian Shepperson Mills: Say that again: if you eat healthily and you are nutritionally deprived?

Dr Stephen Kennedy, MD: If you nutritionally-deprived and infertile, is there evidence to suggest that improving your diet will actually improve your chances of conceiving?

Dian Shepperson Mills: Well, there is a lot of research showing that people who are dieting and people with amenorrhea, who are amenorrheic because they are not eating well enough to support the reproductive system, and that includes men as well as women, it compromises fertility. The optimal body mass index for fertility is 23.5 and people below 19 and people above 30 find it very difficult to get pregnant.

Dr Stephen Kennedy, MD: I meant, more specifically, if you are short of specific nutrients.

Dian Shepperson Mills: There is a lot of different research that needs pulling together. There is the folic acid research looking at spina bifida. There is iodine: we have all this research on iodine looking at cretinism. There is research on iron. But apart from those three nutrients, nobody has done enough definitive research on specific nutrients. There is some research on B1 and B2 with cleft palate and club foot. But it is only common sense that all nutrients must be crucial to human life. It is looking at this research and the need to optimise research and make sure more is being done.

Dr Stephen Kennedy, MD: Dian, I think that is a very nice way to end this interview. Thank you very much indeed.

Dian Shepperson Mills: Thank you.

Endometriosis: A Key to Healing Through Nutrition 
by Michael Vernon and Dian Shepperson Mills

See also Dietary modification to alleviate endometriosis symptoms and selected food intake and risk of endometriosis