Choline, an Overlooked Nutrient for Fertility and Pregnancy

by Margaret Wertheim MS RD


When it comes to fertility and pregnancy, folic acid, iron and calcium are the vitamins and minerals that tend to get much of the attention. We would argue that there are quite a few other nutrients that don’t get nearly enough attention, and one of these is choline. Choline is an essential nutrient that your body can synthesize in small amounts, but the majority must be obtained in your diet. While you may constantly hear about the importance of folic acid for the prevention of neural tube defects like spina bifida, research indicates that higher choline intake during pregnancy is associated with lower risk of neural tube defects as well. In addition, choline is converted to betaine in your body, which assists in the conversion of homocysteine to methionine, thus preventing homocysteine levels from becoming elevated. Elevated homocysteine is associated with increased risk for cardiovascular disease and miscarriage, and in one study was associated with poorer egg and embryo quality in women with PCOS undergoing IVF. Furthermore, choline is a precursor to the neurotransmitter, acetylcholine, which is involved in memory and muscle control. In a study in rodents, when mothers consumed higher levels of choline, their offspring had significantly better memory throughout their lives. Thus choline intake during pregnancy may have a very long-term impact on memory and brain function from infancy into adulthood.

According to the National Health and Nutrition Examination Survey, the average choline intake in pregnant women is only about 338 mg/day, while the daily requirement during pregnancy is 450 mg. Daily choline needs increase to 550 mg while breastfeeding, as breast milk is a rich source of choline. Good food sources of choline include eggs, meat and fish, dairy, legumes, and certain whole grains, nuts and seeds. Vegans and vegetarians with limited intake of eggs and dairy products are at increased risk of having a choline-deficient diet. Very few prenatal vitamins contain any choline at all, and those that do usually contain only very small amounts. Luckily, Prenate Pro and Prenatal Plus both contain 200 mg choline, which can give you the extra boost you need to ensure you’re meeting your daily choline requirement. That being said, it’s also absolutely essential to include choline-rich foods in your diet on a daily basis.

References:
Linus Pauling Institute at Oregon State University: Choline

Caudill, et al. Pre- and Postnatal Health: Evidence of Increased Choline Needs. J Am Diet Assoc . 2010; 110:1198-1206

Berker, et al. Homocysteine concentrations in follicular fluid are associated with poor oocyte and embryo qualities in polycystic ovary syndrome patients undergoing assisted reproduction. Reproductive Endocrinology . 2009; 24(9):2293-2302.

Zeisel, et al. Importance of methyl donors during reproduction. Am J Clin Nutr. 2009; 89( suppl):673S-677S.

Fabulous Fertility Smoothie Recipes!

If you have been reading our blog regularly, you know that a fertility-friendly diet is nutrient dense.  Put another way, good fertility nutrition means eschewing empty calories and choosing foods that pack a nutritional wallop.   This can be particularly challenging in the morning when we’re pressed for time, and later in the afternoon, when our body is craving something sweet to pick us up and carry us through the rest of the day.   These are times when we are particularly vulnerable to the caffeine and sugar rush provided by treats the coffee shop and/or the vending machine.

Enter the smoothie.  Like the “salvage stew” that many of our moms created out of the produce drawer, a smoothie is a place where we can chuck in lots of nutritious ingredients, press a button and, presto!  A satisfying treat that is quick, nourishing and satisfying.

With these challenges in mind our Pulling Down the Moon nutritionist Margaret Wertheim has created some smoothie recipes that are not only nutritious, they are filled with nutrients that support fertility.  In the recipes below, Margaret experiments with almond milk and coconut water as the base of her smoothies and suggests add-ins like probiotic powder , antioxidant and fiber-rich  Organic Superfood and our delicious hypo-allergenic rice protein powder, ProMeal. Please note, too, that these smoothies do not use crushed ice.  According to Traditional Chinese Medicine and Ayurveda, a fertility diet does not emphasize cold foods.

Basic Shake
2 scoops vanilla or chocolate ProMeal
1 cup water, almond milk, or coconut milk

Almond Fruit Smoothie
2 scoops vanilla ProMeal
1 cup almond milk
¾ cup mixed berries or peaches
optional: ½ banana

Coconut Fruit Smoothie
2 scoops vanilla ProMeal
1 cup coconut milk OR ½ cup coconut milk and ½ cup water
¾ cup mixed berries or peaches
optional: ½ banana

Yogurt Fruit Smoothie
2 scoops vanilla ProMeal
½ cup full-fat plain yogurt
¾ cup mixed berries or peaches (a splash of addition liquid may be needed, depending on the kind of berries/fruit used)
optional: ½ banana

Weight Gain Shake
2 scoops vanilla or chocolate ProMeal
1 cup coconut milk
2 tablespoons natural peanut butter or almond butter
optional: ½ banana or berries

Mango Kale Smoothie
2 scoops vanilla Promeal
1 cup coconut water
1 tablespoon almond butter
1 leaf of kale
¾ to 1 cup mango
Dash of cinnamon

Other healthy additions: Probiotic powder, nuts (walnuts, almonds, Brazilnuts), oranges, organic spinach or Swiss chard for greens you won’t even taste.

*To maximize nutrient and antioxidant content of any of these shakes, add 1 scoop of Organic Superfood*

Nutrition Is Key for Fertility – A Tale of Two Diets

By Beth Heller, M.S.

So, you think you eat healthy?  Read on and you might be surprised.  The low-fat dietary pattern that is generally touted as healthy is actually low in nutrients that have been shown to be important for fertility.  To illustrate this point, we charged Pulling Down the Moon nutritionist Margaret Wertheim, R.D. to run a nutritional comparison of two diets 1) a typical low-fat diet taken directly from the practice manual of the American Dietetic Association and 2) a fertility-friendly meal plan based on Pulling Down the Moon’s nutrition program.  The results were  striking.

Here’s the low-fat diet based on recommendations from the American Dietetic Association:

Typical Low-Fat Diet info

Typical Low Fat Diet – Click to enlarge

And here’s the fertility-friendly eating plan per Margaret’s recommendations:

Fertility Friendly Diet Info

Fertility-friendly Diet – Click to enlarge

At first glance, both diets look pretty healthy.  The calorie content is the same – just around 1830 calories.  Yet, a nutrient comparison reveals a different story.   Head-to-head the Pulling Down the Moon plan blows the typical low fat diet pattern away in key fertility nutrients.  The low fat diet proved deficient in  iron, vitamin E, vitamin D and very low in the omega-3 fatty acids EPA and DHA – all nutrients that are linked to optimal fertility and healthy ovulation.  The difference?  The fertility-friendly diet derives about 10% more of its calories from healthy fats at the expense of carbohydrates.   Foods in the fertility-friendly diet are also less processed – note the absence of  ”diet” dressings,  as well as”low fat” and “sugar free” foods.

Dietary Comparison LF vs. FF – Click to enlarge

This exercise illustrates a central concept of Pulling Down the Moon fertility-friendly eating that we call “nourishing up.”  In short, nourishing up means that even at your perfect body weight you may still be getting insufficient nutrients for optimal health and fertility ( read more about nourishing up in a previous post here ).  Remember that current dietary guidelines are based on the idea of preventing deficiency (helping us survive), rather than promoting wellness (helping us thrive).  Even  ”healthy” diets such as the low fat diet above are missing the mark.   Note that this low fat diet doesn’t even include guilty pleasures and convenience foods like McDonalds, Starbucks and Lean Cuisine. Also note that the fertility-friendly diet is rich and satisfying, and doesn’t feel like “diet food.”  Our belief is that many women end up starving themselves of important nutrients in order to lose or even maintain their weight.

For this reason we recommend that women who are trying to conceive seek out a nutritionist who specializes in fertility to learn important steps they can take to optimize their diets for fertility.  In addition we also offer the Pulling Down the Moon Nutritional Program,  a three part program of nutritional supplementation that includes the Pulling Down the Moon Supplement Packet, a prenatal vitamin that has been optimized to include nutrients like CoQ10, extra B-vitamins, omega-3′s and choline, Probiotic Powder to support digestion, elimination and the immune system, and our PhytoNutrient Powder, a 100% certified organic fruit and vegetable drink to provide antioxidants their most effective form – that of whole food.*

Have we convinced you that diet is important?   Click here to book an appointment with a Pulling Down the Moon nutritionist or call 312-321-0004 (Chicago)/301-610-7755 (Rockville) for more information.

*These statements have not been evaluated by the Food and Drug Administration.  These products are not intended to diagnose, treat, cure or prevent any disease.

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