• Choline: An Update on a Vital Fertility and Pregnancy Nutrient

    By Margaret Eich, MS, RDN

    Choline is little talked about essential nutrient for fertility and pregnancy. It is not technically considered a vitamin, as our bodies can synthesize choline though not enough to meet our daily needs.  Choline is a major component of all cell membranes and is a precursor to the neurotransmitter acetylcholine, which is involved in muscle control and memory. Choline is also converted to betaine, which prevents homocysteine levels from becoming elevated. Elevated homocysteine has been associated with increased risk for cardiovascular disease and miscarriage. Choline deficiency may also play a role in the development of fatty liver, as choline is necessary to transport fat from the liver to other tissues in the body.

    Choline also has important functions during pregnancy. Choline is essential for baby’s brain development and for DNA methylation, meaning that choline deficiency can have epigenetic effects on the developing baby. There is also evidence that adequate choline intake helps prevent neural tube defects like spinal bifida, which most people associate only with folate/folic acid intake. 

    Several studies have compared intakes of 480 mg choline daily to 930 mg choline daily at varying times during pregnancy and found a variety of outcomes. For example, supplementation with 930 mg choline compared to 480 mg throughout the 3rd trimester resulted in faster information processing in 4-13 month old infants. In a similar study, children whose mothers took in 930 mg choline daily performed better with a color location memory task compared to children whose mothers who had only taken in 480 mg choline daily. Another study reported reduced attention and behavior problems and social withdrawal in children at 40 months of age in the group of mothers supplemented with 900 mg choline from the 2nd trimester through delivery in addition to baby being supplemented with 100 mg choline daily through 3 months of age compared to controls.

    The daily requirement for choline for non-pregnant women of childbearing age is 425 mg. This goes up 450 mg during pregnancy and further increases to 550 mg during breastfeeding. Less than 10% of pregnant women are meeting their daily requirement for choline, underscoring the importance of focusing on this nutrient.

    The impact of choline during pregnancy is an emerging area of research, and currently it seems that 450 mg choline at a minimum is needed to support a healthy pregnancy, but up 900-930 mg is safe and may have long-term benefits to the baby. Animal products are better sources of choline than plant foods–with liver and egg yolks being the best sources–followed by meat and fish and cruciferous vegetables.

    Because so few women are meeting even basic daily choline needs during pregnancy, taking a prenatal vitamin that contains choline is a good idea, especially if you are a vegetarian or vegan. Pulling Down the Moon carries two prenatal vitamins, both of which contain choline. TheraNatal OvaVite contains 100 mg choline, and PlusOne contains 450 mg choline. Do you have more questions about optimal choline intake prior to and during a pregnancy? Book a nutrition appointment today!

     

      

     

  • Magnesium: An Essential Mineral for Fertility and Pregnancy

    By Margaret Eich, MS, RDN

    Magnesium is an essential mineral in hundreds of reactions in the body involved in a variety of processes including deriving energy from food, DNA synthesis, and blood sugar regulation. In addition, magnesium is a mineral component of bone along with calcium and phosphorus. Along with these important functions, did you know that magnesium may play a role in fertility and pregnancy as well?

    Magnesium’s Role in Fertility and Pregnancy

    In a study of 33 women with polycystic ovarian syndrome (PCOS), 23% of women did not meet their daily magnesium needs. (1) In another study comparing women with and without PCOS, women with PCOS consumed less magnesium than women without PCOS. In women with PCOS, lower magnesium intake was correlated with higher risk for insulin resistance and elevated testosterone, key hallmarks of PCOS. (2) There have been many studies investigating the impact of magnesium levels and magnesium supplementation on insulin resistance and type 2 diabetes. These studies point to a significant role for magnesium for blood sugar regulation. (3)

    Magnesium supplementation may also help prevent muscle cramps in pregnancy, and may also be helpful for headache prevention. Research is ongoing around magnesium and its impact on risk for gestational diabetes and gestational hypertension.

    How much Magnesium do we need?

    According to NHANES data, the majority of Americans do not get enough magnesium in their diet. The daily requirement for magnesium is 310-320 mg for non-pregnant women. During pregnancy, magnesium requirements increase to 350-360 mg daily. 

    Food sources of Magnesium

    The best food sources of magnesium include: nuts and seeds especially Brazil nuts, cashews, and almonds; seaweed, leafy greens, legumes, whole grains, and dairy products.

    Magnesium Supplements

    Adding a magnesium supplement can be a helpful way to ensure you’re getting enough magnesium on a daily basis. Magnesium glycinate is the preferred form of magnesium, as it’s very well-absorbed and unlikely to cause digestive issues or loose stools like other forms of magnesium that are less well-absorbed like magnesium oxide.

    Unsure if you’re meeting your daily magnesium needs? Schedule a nutrition consultation for a comprehensive review of your diet and supplement regimen.  Supplements are available in Chicago, Highland Park, and via our online shop for your convenience!

    References

    1. Szczuko M, et al. Quantitative assessment of nutrition in patients with polycystic ovarian syndrome (PCOS). Rocz Panstw Zakl Hig. 2016;67(4):419-426.
    2. Cutler DA, et al. Low intakes of dietary fiber and magnesium are associated with insulin resistance and hyperandrogenism in polycystic ovarian syndrome: a cohort study. Food Sci Nutr. 2019;7(4):1426-1437.
    3. Linus Pauling Institute at Oregon State University: Magnesium

     

     

  • Choline: Are You Getting Enough?

    By Margaret Eich, MS, RDN

    Are you getting enough choline in your diet? Most women are not, and most women may not have even heard of choline. Choline plays an important role in fetal development, including brain development. Most people have heard they need to get enough folic acid (or folate) before and during pregnancy to prevent neural tube defects, but did you know that choline may also play a role in preventing neural tube defects, like spina bifida? Research has produced conflicting results in this area, but ensuring adequate choline intake makes sense while the research sorts itself out, especially given choline’s other benefits.

    In addition to a potential role in preventing neural tube defects, choline deficiency may also play a role in the development of fatty liver. Choline is also a precursor to the neurotransmitter acetylcholine, which is involved in muscle control and memory. 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.

    Choline is not technically considered a vitamin, since our bodies make small amounts, but our bodies don’t make enough to meet our daily choline needs. Therefore, we need to get choline in our diet. Non-pregnant women need 425 mg choline daily, and this goes up to 450 mg during pregnancy, and 550 mg while breastfeeding. In the US, average choline intake is well below this recommended level with women on average only taking in 260 mg choline per day!

    The best food sources of choline include liver, eggs, meat, seafood, legumes, and cruciferous vegetables like Brussels sprouts, and broccoli. One egg provides almost 150 mg choline, which underscores how helpful eggs are in meeting your choline needs. Not only are eggs rich in choline, but they are also just a very nutrient dense food to support your overall health, fertility, and pregnancy. Because choline is most concentrated in animal foods, vegans or vegetarians who eat limited eggs and dairy products are at highest risk for choline deficiency. Since so many US women struggle with getting enough choline, it’s a good idea to take a prenatal vitamin that contains choline, especially if you are vegan or vegetarian with limited intake of eggs.

    Looking for more information about nutrition for fertility and pregnancy? Book a nutrition consult today!

    References:

    1. Linus Pauling Institute at Oregon State University: Choline
    2. Caudill, et al. Pre- and Postnatal Health: Evidence of Increased Choline Needs. J Acad Nutr Diet. 2010; 110:1198-1206

     

  • Vitamin A: Are you getting the right amount?

    By Margaret Eich, MS, RDN

    Vitamin A is a fat-soluble vitamin that is essential for reproduction, vision, immune system function, and embryo and fetal development. There are two main types of vitamin A: preformed vitamin A known as retinoids, which are found in animal products, and are converted to retinoic acid, which regulates transcription of a number of genes. The second type of vitamin A is called carotenoids, which includes beta-carotene and hundreds of others. Only about 10% of carotenoids are capable of being converted to retinol and further to retinoic acid. Beta-carotene, alpha-carotene, and beta-cryptoxanthin are all capable of being converted to retinoic acid, though only small amounts are converted.

    Most women hear about vitamin A in terms of toxicity – that you shouldn’t take too much vitamin A prior to and during pregnancy, as it may cause birth defects, which is true. We recommend limiting the amount of preformed vitamin A from supplements to no more than 5000 IU (which is equivalent to 1500 mcg RAE). RAE stands for Retinol Activity Equivalents and is the standard way of expressing vitamin A requirements and amounts in food, as it accounts for the differential bioavailability of preformed vitamin A and carotenoids. Supplement labels usually use International Units (IU) to list vitamin A doses, which can sometimes make sorting out your vitamin A intake confusing! There is no limit for carotenoids like beta-carotene, as they haven’t been shown to be capable of causing vitamin A toxicity or birth defects. Some prenatal vitamins do contain preformed vitamin A, such as retinal palmitate, which is fine and maybe helpful if you struggle to meet your vitamin A needs, as long as the preformed vitamin A is less than 5000 IU. Make sure to check all of your supplements for vitamin A, as other combination formulas aside from your prenatal vitamin may contain vitamin A.

    The daily recommendation for vitamin A is 700 mcg RAE and increases to 770 mcg RAE in pregnancy. In the US, women are getting on average only 580 mcg per day – in other words, US women are not getting enough vitamin A. So while it’s important to make sure you’re not taking in excess vitamin A from supplements, it’s also important to make sure you’re getting enough vitamin A due to its essential role in reproduction, embryo development, and organ formation during fetal development.

    Your best sources of preformed vitamin A include liver, fish, dairy, kidneys, eggs, poultry skin, butter, and dark meat chicken. Your best (plant) sources of carotenoids include: sweet potato, pumpkin, carrots, cantaloupe, spinach, kale, collards, and butternut squash. Absorption and conversion of carotenoids to active vitamin A is variable based on the food it’s contained in, and an individual’s ability to digest and absorb it. Because of the variable in absorption, it makes sense to include a mix of preformed vitamin A and carotenoids to meet your vitamin A needs.

    Need some help sorting out your vitamin A intake. Book a nutrition consult today!

     

  • Supplements for Immune Support: Separating the Research from the Hype

    By Margaret Eich, MS, RDN

    It’s January, which means it’s officially cold and flu season. When you’re trying to conceive or pregnant, you have to be extra conscious of what you’re putting in your body. Certain over-the-counter medicines may not be appropriate during this time; so it’s important do what you can to stay healthy. Hand washing, getting plenty of sleep, eating healthy, and managing stress are all helpful ways to do that. What about supplements? There’s plenty of info online about miracle immune support supplements, but what does the research really show? Here’s a quick summary of some popular immune support supplements and the ins and outs of what you should know while trying to conceive or pregnant:

    Vitamin D: Vitamin D supplementation may help prevent upper respiratory infections, though the evidence is mixed. Vitamin D plays an important role in the immune system, so you definitely want to avoid vitamin D deficiency as this may impair immune system function. Vitamin D also may affect fertility, so it’s a good idea to have your vitamin D level tested, so you can supplement at an appropriate level. Vitamin D is a fat-soluble vitamin that can be toxic at very high doses, so make sure to discuss an appropriate dose with your healthcare practitioner.

    Vitamin C: While there is currently no evidence that taking vitamin C once a cold starts helps reduce severity, people who take vitamin C regularly tend to have colds that don’t last as long as people who don’t take vitamin C. Also people who take vitamin C regularly and are under lots of physical stress (marathon runners, skiers, etc.) had lower incidence of colds in one study. Vitamin C is generally well tolerated and safe to take while try to conceive or pregnant, though high doses of vitamin C may cause diarrhea. Vitamin C supplementation is not recommended in people with a history of oxalate-containing kidney stones.

    Zinc: Zinc deficiency makes it more likely that you’ll catch a cold or other infection, so ensuring adequate zinc intake is important. Make sure to avoid oversupplementing zinc. The daily upper limit is 40 mg. You should not take more than 40 mg daily except for short time periods as directed by a healthcare practitioner. Make sure to check all supplements for zinc content when determining your daily intake, as some prenatal vitamins have as much as 25 mg zinc.

    Sources

    1. Linus Pauling Institute at Oregon State University: Vitamin D: https://lpi.oregonstate.edu/mic/vitamins/vitamin-D#immunity

     

    1. Linus Pauling Institute at Oregon State University: Vitamin C: https://lpi.oregonstate.edu/mic/vitamins/vitamin-C#common-cold-treatment

     

    1. Linus Pauling Institute at Oregon State University: Zinc: https://lpi.oregonstate.edu/mic/minerals/zinc

     

  • Supplements to Improve Egg Quality?

    Beth Heller, MS, RYT

    Update from 2019:  When we wrote this blog in 2011 we had no idea it would be our most-read and most linked blog of all times – earning an average of 17,000 views per year!   One of the things that I love most about the Moon is that we’re always trying to innovate and we were definitely ahead of the curve with this one.  At the time we wrote this blog, word on the street was that egg quality was immovable and that once a diagnosis of poor egg quality was given, that was it.  Yet the core services we offer (Traditional Chinese Medicine, yoga, nutrition, massage) argue that we can change health outcomes by creating balance in the body, in effect improving the environment in which bodily processes occur.  So, it made perfect sense to us that supplements that support balancing hormones, improving sleep, lowering inflammation and providing better raw materials through healthy food could make an impact.  If you want to read more from our library regarding egg quality, click here!  

    At the Moon we are constantly striving to increase our E.Q.I.Q. (Egg Quality I.Q.) and for years we have believed that nutrition can play a role in eqq quality. However, until recently there were few studies to support this claim so we needed to temper our recommendations with the phrase “but there isn’t any clinical evidence for this yet.” Now, several new investigations have shown that, yes, certain nutritional supplements may make a difference in egg quality. The goal of this blog is to summarize the latest clinical news, discuss the substances that are now showing potential benefits for women with poor egg quality and help you make choices about which supplements may be right for you. As with any supplement protocol, you should always consult your physician before starting.

    1. Myo-inositol

    Very recently two clinical trials were published that clarified a lot of the unknowns about myo-inositol, a product we use at PDtM under the name of Ovasitol. Myo-inositol (MI) is a part of the B vitamin complex and is a known insulin-sensitizer. It has also been shown to improve both physical (hirsutism and acne) and reproductive (anovulation and amenorrhea) manifestations of Polycystic Ovarian Syndrome (PCOS). In addition, myo-inositol plays a role in cell growth and early studies indicated that higher levels of MI in the follicular fluid was associated with better egg quality.

    Several exciting new studies have emerged that have shed new light on MI and its role in fertility, particularly Assisted Reproductive Technology. The latest study of interest demonstrated that treatment with 4 g per day of MI for three months prior to IVF improved egg quality in women who had failed a previous IVF due to poor egg quality. In this study the treatment also included 3mg per day of melatonin, which I will talk about next.

    The supplement we carry at PDtM includes both myo–inositol and d-chiro inositol because clinical research we have seen to date on PCOS, egg and embryo quality suggest a combination approach is most effective.  On another happy note, MI has also been shown to have a positive therapeutic effect on mood disorders that are responsive to SSRI’s (serotonin selective reuptake inhibitors) including depression, panic and OCD – a potential plus for the anxious, depressed fertility patient!

    2. Melatonin

    Melatonin is a hormone that is secreted by the pineal gland. It regulates our sleep/wake cycle as well as other hormones, in particular the hormones of the female reproductive cycle. New studies like the one above suggest that melatonin supplementation at a level of 3 mg per day may help to improve egg quality when taken with MI for several months prior to IVF.

    There are caveats to the use of melatonin. Side-effects may include exacerbation of depression symptoms and patients who struggle with depression should make sure to discuss this side-effect with their physician. Melatonin should not be used with patients using thyroid medication as it can impact thyroid hormone levels. It can also suppress ovulation at high doses so in general we only recommend this supplement for women who will be using ART and a trigger shot to stimulate ovulation and/or retrieval.

    Finally, melatonin should NOT be taken while pregnant or nursing. In general we do not recommend melatonin use for longer than 3 months without taking a break. It can also cause marked drowsiness and is best taken just before bedtime.

    3. DHEA

    DHEA (not to be confused with the omega-3 fatty acid DHA ) is a hormone that serves as a precursor of steroid hormones testosterone and estrogen. Research indicates it may also stimulate follicular development. Several studies have shown supplementation with 75 mg of DHEA daily to improve egg quality and pregnancy outcome in women who were “poor responders” to IVF stimulation medication. Another study suggests that DHEA supplementation may reduce the risk of aneupoloidy.

    DHEA should be used with caution as it is a pretty powerful hormone and when used at high levels and over a long term it may damage the liver. Women who are pregnant or nursing should not take DHEA, nor should women with PCOS as this could exacerbate the condition. Like melatonin, we recommend a three month treatment period.

    4. CoQ10

    CoQ10 is a naturally occurring fat-soluble nutrient that is essential for energy production. CoQ10 has potent antioxidant properties and cell membrane stabilizing effects that make it beneficial for egg and sperm quality, specifically sperm motility. CoQ10 works within the mitochondria (the cellular power stations) in the cells and is essential for energy production. Until recently, CoQ10 was not thought to be a nutrient that required supplementation, as all normal tissue manufactures its own CoQ10; however, this production decreases naturally with age and is also lowered by certain drugs, including statins. When CoQ10 levels in the cells are low, energy production may be reduced and oxidative stress increased as a result.

    CoQ10 has been shown to improve sperm quality and is now under investigation for potential use with women of advanced reproductive age undergoing ART to improve egg/embryo quality. The oocyte has among the highest concentrations of mitochondria of all body cells and uses immense amounts of energy in the process of maturation and ovulation. Researchers hypothesize that supporting the oocyte with CoQ10 may improve egg quality (Bentov et al. 2010).

    The recommended dosage for overall health is 100-300 mg/day, or as directed by a nutritionist. The dosage under investigation in studies looking at egg quality is higher: 600 mg/day. CoQ10 appears to be a safe supplement: Studies have used supplementation of CoQ10 up to levels of 3,000 mg per day without adverse side effects. At present, the only risk to taking CoQ is the cost, as this supplement can be pricey, and no data currently exists on its usage in high doses during pregnancy.

    5. Omega-3 Fatty Acid (EPA/DHA)

    There is still no direct clinical evidence that omega-3 fatty acids improve egg quality but we are convinced they are a good bet and include them in our Egg Quality Protocol. Eicosapentaenoic acid (EPA) forms the backbone of many of the chemicals that halt inflammation in our body and also serves to support the health of our cell membranes. Docosahexaenoic acid (DHA) (not to be confused with DHEA above) is important for brain health and adequate stores of DHA are thought to be beneficial for the early cognitive development of the fetus. DHA may also be helpful for depression. Look for purity-tested products.

    This is exciting news indeed but you should always speak with your physician before beginning a supplementation regimen of any kind. Of course, we would also be remiss if we didn’t mention that providing your body with the highest quality diet is also important for fertility. If you are specifically seeking to improve your egg quality you should also consider re-thinking your diet to limit inflammation, achieve good blood sugar control and get ample antioxidant nutrients from food sources. Our nutritionists at Pulling Down the Moon are specialists and will tailor their recommendations to your fertility diagnosis.

    For more information about any of the supplements or info in this blog, please feel free to contact us at info@pullingdownthemoon.com or call us at: 312-321-0004.  These supplements are available individually at our online store.  We also offer an easy, one-click Egg Quality Supplement Bundle Package.