Stephanie Fein MD [00:00:00]:
Hello, fabulous Dr. Stephanie Fein here with weight loss for fertility. And today we are talking about fertility foods. Wouldn't it be nice if there was a fertility food? We would all totally be telling people to eat it and everyone would eat it and it would be amazing. It doesn't work that way. And it's such an important point to make because our brains and our hearts want there to be an answer, a simple answer. And, and it's not quite that simple. And to me that's the good news because it's not.
Stephanie Fein MD [00:00:35]:
It's avocados. So eat 12,000 avocados. Really, the bottom line is it's more of a pattern of eating that is helpful and this is not going to be news to you. And again, I think that's good news also. There's nothing earth shattering, there's nothing you're missing, there's nothing you don't know. There may be slight nuances that make maybe slight differences, but there's nothing that you're totally blind to. There's patterns that could be helpful and we're going to talk about that. But it's not a new pattern.
Stephanie Fein MD [00:01:13]:
It's not anything you don't already know. And to me that's the most important thing. And when you see I don't know things on like social media or people saying something that can feel scary because they're saying this is the answer, it's not that simple. It really never is. And I want your heart and your nervous system to remember that as much as it can. It won't always, but that you really do know common sense in general works really well when it comes to how diet impacts. And by diet I mean what you eat impacts fertility and outcomes. And remember how I always think about it, here we do weight loss for fertility because the idea is that metabolism, that metabolic health is the driver that helps fertility in ways that metabolic issues can.
Stephanie Fein MD [00:02:26]:
And what I mean by that is sometimes infertility is something with your tubes and that has nothing to do with diet. So it depends on the reason. Really what we're talking about and what can be a very uncertain place to be is unexplained. Infertility and metabolic issues may impact that with a big question mark. Because if we don't know what's causing the infertility, we don't know what necessarily would impact it. But that is one idea that we want to improve metabolic health. We do that with weight loss. If your BMI is over 30 in particular, some studies show that 26 is the number.
Stephanie Fein MD [00:03:10]:
Anyway, the point is that if it's around 30, weight loss may impact pregnancy retention, getting pregnant, and in particular with ivf, we can't guarantee anything. I wish I could. Oh, my goodness. If I could guarantee anything for you, I would do it in a heartbeat. The best we can do is the best we can do, and that's really good. So your efforts are supported and helpful, but also not to be used like a bat to beat yourself over the head with. So I want that to be the message of this podcast. There's not one food that will be the magic thing.
Stephanie Fein MD [00:04:01]:
You generally know what to do and you're doing it. If you're here and connecting to this and thinking about weight loss and what's the best foods to nourish your body, you're already there. It's like preaching to the choir kind of thing. So let's get into a little bit of the research. You may have heard of the fertility diet book that came out in 2007. And, and that had to do with anovulation and fertility and improving ovulation with the diet they outlined there. Now, since then, which was 2007, almost 20 years ago, they changed their stance on dairy, which they said that whole fat dairy was better than low fat dairy. That doesn't look like that pans out anymore.
Stephanie Fein MD [00:05:01]:
So if you like low fat dairy, please have it. The two bigger studies that came out later are one called the earth study in 2019, and that was specifically about dietary patterns and outcomes of assisted reproduction. And there's some interesting things there that I'm going to talk to you about. And then in 2023, there was a systematic review about Mediterranean diet and its association with improved life, birth and pregnancy rates with assisted reproductive technology. So there are studies out there that directly address this issue, which is nice. It turned out that the Earth Study, the one that did in 2019, they called it the pro Fertility diet, and it looked like it performed better, had an impact on live birth rates even more than just the Mediterranean diet. And the Mediterranean diet had impact on art rates, assisted reproductive technology rates. And in looking at this now, no one will say 100%.
Stephanie Fein MD [00:06:20]:
Exactly. Anything. That's usually true with studies. Right. We can show associations. It's usually not causations, especially when it comes to food and eating and diet. Right. Because it has to be over time and you're not with the people all the time, all that sort of stuff.
Stephanie Fein MD [00:06:33]:
But what it looks like is there's a lot of overlap between the Earth Study diet and the Mediterranean diet. And I'm going To go into that even more in detail, just so you have that information. But it really looks like the difference between the Earth and Mediterranean, which again, the earth had better outcomes, has to do with supplementation of vitamins and the fact that they looked at pesticides. So to me, that is what's making the difference. So it's not the foods like Kale versus, I don't know, Twinkies, which of course we're going to go into that in a minute now. There was no support in what I'm saying. I'm just. This is in reading this and looking at it and what makes sense to me.
Stephanie Fein MD [00:07:28]:
And again, I'm going to tell you what that is. The other thing that ended up being important in terms of the better outcomes for the Earth study is the fact that the increased live birth rates were mainly from the fact that there were fewer failed cycles. So they got eggs more often on the people who were doing the profertility diet even before the embryo transfer. And there were lower miscarriage rates. And that's an important thing to note. We don't know exactly what the reason for that is, but, but certainly we know that metabolic health and weight impacts pregnancy in things like preeclampsia, gestational diabetes. And so there may be that aspect in it. We don't know exactly because that study could not possibly look at all these factors.
Stephanie Fein MD [00:08:36]:
But it's interesting that it led to that. Also, weight loss in general will also positively impact miscarriage rates. And so we can make assumptions. It's never safe to make assumptions, but we can see that's likely has something to do with it. And certainly around here that makes sense to me because that's what I see and that's what we're doing is we're losing weight to have better outcomes with our egg retrievals, our transfers and, and carrying the pregnancy. Okay, so let's get into it a little bit more the difference. So here's in the Earth study, the profertility diet had higher intake of supplemental folic acid. So the high intake meant 800 micrograms likely.
Stephanie Fein MD [00:09:29]:
You're doing this, but now you'll know about this B12, they had higher B12 intake and that was up to 16 micrograms a day. Vitamin D supplementation, and that had to do with their own if they were deficient and then replacing it low pesticide. Fruits and vegetables, whole grains, seafood, dairy and soy. That was the Earth study. And in the Mediterranean diet, the core components of that are eat vegetables, fruits, legumes, whole grains, nuts and seeds Olive oils, herbs and spices, fish and seafood, eggs, and then a smaller amount of poultry, dairy, and then rarely. Meaning? Yeah, rarely. Red meat, processed meat, sweets and added sugars, refined grains like white bread, white pasta, white rice, butter and saturated fats. And so essentially absent from the Mediterranean diet are ultra processed foods, sugar, sweetened beverages and fast foods.
Stephanie Fein MD [00:10:48]:
So the Mediterranean diet in general goes with that. Can't remember the guy's name now, but eat food, mostly plants, not too much. That's what I think of when I think of the Mediterranean diet. Fruits and vegetables, whole grains, olive oils, fish, eggs, dairy, poultry, a little bit of red meat, processed meat, sweets and added sugars, refined grains. And that is the Mediterranean diet that's mainly whole foods. I think in general, when we think of healthy foods or nutritious foods, that's what we think of the issue about how much red meat might be something that's cultural or we may not know, but I think most of us have heard to reduce red meat. So again, I don't think any of these things are surprising. And when we eat more towards this way of eating, the Mediterranean diet, we're doing stuff that's really good for our bodies in ways we may not even know the full extent of.
Stephanie Fein MD [00:11:59]:
Here we're concentrating on fertility outcomes, on reproductive technology outcomes. But in general, the way we think about it around here is the healthier your body is, the better functioning it is, the better it will take to pregnancy, reproductive technologies, all that sort of thing. So this is what also they've done studies, but I have not looked into them, but studies on dementia and heart disease and all the rest of that stuff with this Mediterranean diet, it does look like this Mediterranean diet leads to generally good health. That will also mean better outcomes for fertility interventions. That makes common sense, and I bet you've heard of it. So when we're talking about fertility foods, this is what we're talking about, whole foods. And when we can, decreasing fast foods, sugar, sweetened beverages and ultra processed foods. And we talk about that here.
Stephanie Fein MD [00:13:05]:
But the way that I think about it is we don't have to go from all or nothing. If one's diet is 100% processed foods, then we ease into whole foods as we like it. Because remember, the most important thing is that you do this forever, not for three months. Right? And the way we get to forever is if we're willing, if we want to do it. And I don't mean for three months, I mean if we genuinely want to change our diet, meaning the foods that we eat down the road and we can do that little by little. What happens is, and this is so interesting is as we shift from ultra processed to more whole foods, we start to the whole foods better. So we don't have to do it all or nothing. Because then we go from foods that we think are palatable to foods we hate and have to choke down and can't wait till the day we get to go back to our ultra processed foods, our highly palatable foods.
Stephanie Fein MD [00:14:12]:
Instead, we start slowly incorporating. When we do that, our taste buds change and we don't enjoy the highly palatable foods quite as much. They don't feel the same in our body, they don't taste the same as they used to. It's like we get on a moving train and it goes faster and faster as we work with ourselves, with our palate, with our desires, then we can move from one way of eating to another and have it last forever. That is always where I'm going with this. So fertility foods, I guess if I had to say anywhere, fertility foods are whole foods. And when the more we can ease into that and get into that, the better it is for everything. Not just fertility, but everything down the road.
Stephanie Fein MD [00:15:02]:
So the main difference with the Mediterranean diet and this pro fertility diet that I told you about with the Earth study were the emphasis or even the acknowledgement of folic acid, B12, vitamin D as in dog, and low pesticides, fruits and vegetables. So when I say that we're talking about organic fruits and vegetables, it does look like if you can, having organic fruits and vegetables makes a difference in terms of how much pesticides you get in. We don't know exactly the levels and all the rest of that stuff. But if it's possible, lower pesticides, fruits and vegetables looks like it has an impact. Washing your fruits and vegetables ends up being important, but it looks like if possible, getting organic works nicely. Now if you cannot, still eating whole fruits and vegetables is going to be really important. The Environmental Working Group always puts out a annual list of the Dirty Dozen and the Clean 15, which can be really helpful. So their Dirty dozen is high pesticides.
Stephanie Fein MD [00:16:23]:
And I'm going to read the list for you now. And of those, if you buy them, it's if you can, buying those organic ones is helpful. There's also the clean 15, which are low pesticides, meaning you can buy the conventional ones and it's not a problem. Okay, so that's helpful. And you can always look up Environmental Working Group and you can get these lists. I don't know that they change all that much. Each year. But I'm going to read them here.
Stephanie Fein MD [00:16:51]:
So the 2026 Dirty Dozen, that means they have high pesticides and if you can buy them organic, would be a good idea. Is spinach, kale, collard and mustard greens, strawberries, grapes, nectarines, peaches, cherries, apples, blackberries, pears, potatoes and blueberries. And the clean 15, which have low pesticides and you can buy them conventionally is not a problem. Are pineapples, sweet corn, avocados, papaya, onions, sweet peas, frozen asparagus, cabbage, cauliflower, watermelon, mangoes, bananas, carrots, mushrooms and kiwis. No problem to buy those conventional if you can. With the Dirty Dozen, buying those organic can lower the pesticide burden that you have. And that would be something that the Earth study showed could be valuable. The other thing, and I don't know how much the pesticide versus the supplements impact the live birth rates, don't know and they don't know either.
Stephanie Fein MD [00:18:01]:
But the supplement then was for folic acid, B12 and vitamin D. And so those are things to maybe consider. What I really would love for you to do is to go talk to your reproductive endocrinologist about the supplements. That is really important to make sure you know what they recommend in terms of how much folic acid for you to have. Obviously you're taking a prenatal vitamin, but if you need extra folic acid and then Talk to your RE about B12 and then have your vitamin D levels checked and supplement as needed. Your Aries may also have a recommendation for how much vitamin D to use, even if your level is appropriate. So definitely do that. The last thing I wanted to talk about is because both the Pro Fertility and the Mediterranean diet recommend fish.
Stephanie Fein MD [00:18:55]:
And really the overlap with the Pro Fertility diet and Mediterranean diet is almost perfect except for these things that I'm talking about, the vitamin supplementation and the recommendations about pesticide stuff. Mediterranean certainly doesn't say anything. It just doesn't say anything about pesticides. The Mediterranean diet so in terms of fish, there is an FDA EPA recommendation about fish because of the mercury. Right. And I'm going to include this in the show notes because there's a really nice table that has the three categories they recommend, which is best choices for fish, good choices and choices to avoid. I'm going to say it here, but there will be the attachment. The best choices, they say two to three servings per week and that's four ounces each.
Stephanie Fein MD [00:19:48]:
And the best choices include, I'm not going to say all of them are salmon, pollock, anchovies herring, shrimp, scallop, tilapia, catfish and then canned light tuna. The light tuna is skipjack. It's a different tuna than the packed in oil. So you can have two to three servings of those ones that I just listed a week. Good choices are one serving per week and this is if you're pregnant, but at this point in preparation for pregnancy, I would say the same thing. So if you have one serving, a four ounce serving, but then no other fishes that week is Chilean sea bass, halibut, carp, rockfish, snapper, yellowfin tuna and albacore tuna. That's the regular other tuna besides the skipjack tuna. If you have one serving per week, you can have that, but then no other fish.
Stephanie Fein MD [00:20:41]:
And then the ones to avoid because they have too high levels of mercury are shark, swordfish, king mackerel, big eye tuna, marlin, orange roughy and tilefish from the Gulf of Mexico. Again, I will include that you now have all the recommendations in terms of fertility foods. I'm putting air quotes around that there is no one fertility food. It looks like the Mediterranean diet with a recommendation for low pesticide foods, fruits and vegetables. I gave you the list of those. Or if there are higher pesticides foods that you buy them organic and that there's supplementation of folic acid, B12 and vitamin D. Ask your re about that. Those are the fertility foods.
Stephanie Fein MD [00:21:38]:
Whole foods, less ultra processed, less highly sweetened and more fruits, vegetables, dairy, soy, chicken, fish. I bet you knew a lot of that and I want to support that. You're doing so well. If you have any questions about this, you know where to find me @StephanieFeinMD on Instagram and LinkedIn or stephaniefeinmd.com, which is my website. You can click the lose weight with me button and we will be connected. I am sending you so much love. Until next week.
