The New Yorker

Big news this week: my letter to the editor was published in the New Yorker. If you're like me, you get sucked into reading The Mail every week, so by the time the next issue arrives, you've barely made it to Talk of the Town. When I heard that my letter might be included, I was over the moon - especially because it's such an important topic.

My original letter was heavily edited, so I've included the first draft below.

In case you're wondering what prompted my response, here's the original article. The author is thisclose to hitting the nail on the head, especially when she's quoting Tom Wadden and William Dietz, but never quite gets to what I think is the crux of the matter; namely, that we have created a society where weight loss is nearly impossible - and more importantly, that we have the power to change that!

The problem starts at the highest echelons of government and trickles down through conventional medical education all the way to the obesity epidemic. All is not lost yet, but without change on every level, the article's hypothesis may very well come to pass.

I think we can do much, much better. And I'm committed to doing my part to see it through.

xo
E

***************************

from: emily wade
to: themail@newyorker.com
date: Tue, Oct 4, 2016 at 9:30 PM
subject: Letter to the Editor re: "Bariatric Surgery: The Solution to Obesity?"

Before we all rush off to get bariatric surgery, it would be smart to examine exactly why diets and exercise don't work for obese patients.

First is a systemic problem with medical education. Many doctors are trained to treat symptoms instead of uncover the root cause of disease, and nutrition education in medical school is often minimal. 

Second, patients need more support in making these tough lifestyle changes. Doctors might advise their patients to eat right and exercise, but without any follow-up or a clear plan of action, success is unlikely. 

In addition, patients need more tests, and insurance needs to cover those. Obese patients are often battling dysbiosis, psychological issues, food sensitivities or addictions, or hormonal imbalances, all of which can contribute to the inability to lose weight. Without diagnosing and addressing these contributing factors, patients are more likely to struggle. 

Finally, the biggest hurdle: the food system in the US. People are eating foods that contribute to obesity because these foods are accessible, cheap, easy to prepare, tasty, addictive, and because people are largely misinformed about what's healthy (the low-fat movement discussed in the article is just one such example). 

Obese patients need a holistic, personalized program in conjunction with ongoing support so they can make lasting behavioral change without feeling overwhelmed or giving up. Diets & exercise do work, but there is not a one size fits all solution, and we need to provide patients with not only a strategy, but also the support to help them see it through.

-Emily Adams, Certified Nutrition Consultant

The Most Important Nutrients for Fertility

In Priming the Bump, my 14-day fertility prep program, meals are tailored to include nutrients that are known to improve fertility: Protein; Vitamins A, B, C, D, and E; Zinc & Selenium; carnitine & arginine; omega-3 fatty acids; probiotic foods, and antioxidants. 

Want to know exactly how these fertility super-nutrients support your reproductive system? Here is the rundown:

Vitamins

• Vitamin A: Necessary for the production of estrogen, progesterone & testosterone. Vitamin A also protects against environmental toxins & aids sperm production.
• B-vitamins (especially folate & B12): Folate is crucial upon conception and many women are deficient. B vitamins (especially folate & B12) are responsible for protecting the DNA within sperm.
• Choline: Choline is usually grouped with the B-complex vitamins. It is critical for brain & nervous system development.
• Vitamin C: Vitamin C improves all semen variables. Vitamin C deficiency has been linked to declines in sperm count, motility and vitality and to an upswing in abnormal sperm.
• Vitamin D: Balances Vitamin A, supports the production of estrogen in men & women, and can help correct PCOS. Infertility is associated w/ low levels of D.
• Vitamin E: A powerful tool to improve male & female fertility, Vitamin E also increases male potency, regulates menstrual flows, and may prevent miscarriage.

Antioxidants
Antioxidants are essential for everyone during this age of high free radical damage, but they're especially important for anyone struggling with fertility. They help protect your delicate reproductive cells and systems from oxidation and degeneration. In fact, high antioxidant intake is known to improve fertility. Antioxidant consumption is associated with an increase in pregnancy rates, and it may also aid fertility in older women.

Many nutrients have antioxidant capabilities, but some of the most potent antioxidants are Vitamins A, C, and E, Selenium and Zinc.

Minerals

• Selenium: Selenium is considered essential for male fertility because of its role in testosterone synthesis, normal sperm maturation, and sperm motility.
• Zinc: Another critical mineral for male sexual function, Zn is involved in virtually every aspect of male reproduction. But it's not just for men. Zinc is also required for estrogen, progesterone & sperm production. Impotence, infertility or sterility can occur from Zn deficiency, and deficiency during pregnancy can cause birth defects.
• Bone broth contains minerals like calcium. It also supplies nutrients that help build healthy cartilage, detoxify, and heal the digestive tract. It's an excellent tonic for immunity as well as development.

Brazil nuts are an excellent food source of Selenium, and oysters are the best dietary source of Zinc. It's no wonder oysters are considered an aphrodisiac!

Protein

• Clean protein: Reproductive hormones are made from proteins, some of which are only obtainable through diet (aka "essential"). Protein also provides a feeling of satiety that helps us stay on track and avoid a doughnut binge.
• Carnitine: Carnitine is an amino acid - one of protein's building blocks. Low carnitine levels may be indicative of infertility. Carnitine can help men improve their sperm count & motility. It also provides energy to testicles and sperm.
• Arginine: An amino acid that is essential for sperm formation. Arginine can strengthen sperm count & motility. It can also improve fertilization rates in women who had previously failed IVF.

Fat

• High-fat dairy products: Studies show that high-fat dairy reduces the risk of infertility due to lack of ovulation by more than 50% in contrast to low-fat dairy foods, which can actually reduce the risk of successful conception.
• Omega-3 fatty acids: Sperm motility directly correlates with omega-3 fatty acid levels, especially DHA. Too few omega-3 fatty acids in relation to omega-6 fatty acids can decrease sperm concentration, motility & morphology. Plus, omega-3s are crucial for baby's brain development.

Probiotics

• Probiotic foods: Changes in vaginal flora & subsequent genital & intrauterine infections have been linked to reproductive failure. Probiotic foods help restore bacterial balance. In addition, since probiotics help us digest & assimilate food, they help ensure that the body can use all the nutrients we eat. Probiotics can also detoxify & strengthen the immune system, which is especially important during the early stages of pregnancy.

Now that you know which nutrients are important for fertility (and why), you can begin to choose foods that supply these nutrients and begin boosting your fertility naturally.

Eat more, weigh less

When it comes to weight loss, cutting back on calories has been the go-to strategy for decades. In order to lose weight, you just need to eat less and exercise more, right?

Well, not really.

If you’ve ever tried counting calories yourself, you know that it’s nearly impossible to maintain. And the proof is in the pudding: the US is now facing an obesity epidemic, despite these well-known recommendations.

It seems to make sense on the surface: eat less, weigh less. So why doesn’t it work?

Well, when it comes to eating, not all calories are created equal. Our bodies digest different foods in different ways, some of which are more prone to fat storage.

In addition, calories aren’t usually the problem in the first place. Nearly all of the clients I coach for weight loss are already eating fewer calories than their Basal Metabolic Rate (BMR) when adjusted for activity level. According to the conventional recommendations, this means they should be losing weight - but they’re not.

Finally, calorie restriction doesn’t take your satiety into account. If you’re hungry and you don’t eat enough, your body will do what it needs to do to protect against starvation - it’s a simple survival mechanism. Hunger will win every time.

In many cases, the most effective weight loss strategy may actually require you to consume more calories. But instead of focusing on the quantity of calories, it’s important to focus on their quality.

For example, refined carbohydrates spike blood sugar and insulin levels, signaling the body to store the excess blood sugar as fat. Complex carbohydrates, clean proteins, and healthy fats, however, don’t provoke a dramatic insulin response, and therefore the body has a better ability to convert them into energy or muscle. When we shift our diet accordingly, we can eat more calories and still lose lots of weight.

In addition, snacking is crucial to weight loss. If you’re hungry, your blood sugar is lowered, and your body craves quick energy that will raise blood sugar immediately - like refined carbs. Snacking helps stabilize your blood sugar throughout the day so you don’t reach for that cupcake at 3pm.

When we approach eating this way, we have more energy and better control over our mealtime decisions. It’s a more delicious, satisfying, and enjoyable dining experience than portion control and restriction.

And better yet, we have a better chance at keeping the weight off for good.

Need help changing your diet and balancing your blood sugar? Check out The Last Diet, or work with me one-on-one.

Low Progesterone? Do This.

Photo by Liz West

Progesterone works in partnership with estrogen throughout a woman’s cycle to prepare the uterus for conception. Estrogen is the dominant hormone during the first part of a woman’s cycle (the follicular phase), while progesterone is the dominant hormone during the last part (the luteal phase). The two hormones must be in balance to achieve optimal health.

If you’ve been charting your cycles, you can see where progesterone takes over - it’s responsible for the rise in your temperature.

Not sure if you have low progesterone? Check out Katie Singer’s book The Garden of Fertility for tips on how to read your charts to find out whether they might indicate low progesterone levels.

Low progesterone is quite common. It’s actually not surprising when you consider that estrogenic compounds are everywhere nowadays - in our environment, food, plastics, personal care products, and more. And the higher estrogen is, the more progesterone we need to be in balance.

If you’d like to avoid synthetic progesterone shots & creams, there are some natural alternatives you can try to boost your progesterone level (and/or reduce your estrogen level):

• Cut out dairy. One Harvard scientist & physician found that dairy accounts for 60-80% of estrogens consumed!
• Go organic. Minimizing pesticides and hormones in your food can help avoid estrogen overload.
• Eliminate other estrogenic compounds. Stop eating phytoestrogens like soy (click here for food sources), and stop using plastics and personal care products that could leach xenoestrogens (click here to find out where they’re lurking and how to avoid them).
• Stop eating sugar and refined carbohydrates. Consumption of refined carbohydrates can indirectly exhaust your adrenals, suppressing progesterone1.

If further supplementation is required, you might ask your doctor about natural or bio-identical progesterone from a compounding pharmacy.

1. Singer, K. (2004). The Garden of Fertility. New York: Avery.