Boost sperm health naturally

Photo by Franci Strümpfer

Originally published on MindBodyGreen in 2013.

Want to make a baby - but can’t? You’re not alone. Infertility affects 10-15% of couples in the US, and that percentage is steadily rising. When the cause of infertility lies with the male partner (about 30% of cases), it is usually due to poor sperm health. But there’s good news - sperm health can be drastically improved with simple diet & lifestyle changes.

Sperm count & motility are affected by heat, toxins, hormones, stress, sleep, weight - even cellphone use and TV watching have been implicated as factors in declining sperm health. But most of these factors can be remedied by diet & lifestyle changes.

Toxins are one of the toughest categories of sperm-blockers to avoid, because they are hidden everywhere - from pesticides & heavy metals in your food to plastics to prescription drugs. Eliminating them all may not be possible or realistic, so just control whatever you can: eat organic to avoid pesticides, and increase your intake of fruits, vegetables, nuts, and seeds, which contain antioxidants that help fight free radical damage. Aim to consume low-mercury seafood like lobster, oysters, and salmon. Don’t forget that avoiding toxins also means cutting out those that we willingly choose to consume, such as alcohol, tobacco, and over-the-counter or recreational drugs.

Testosterone, the hormone that drives sperm production & health, can be compromised by too much estrogen in the system. Hormones in meat & dairy foods, drinking water, plastics and even the phytoestrogenic effects of soy foods may contribute to an excess of estrogen in men. Eating organic or hormone-free animal products, filtering your tap water, and using glass containers for water & leftovers may help men avoid the hormone imbalance that can lead to sperm degeneration.

In addition to following the above guidelines, men may be able to improve sperm health in the following ways:

• Using relaxation techniques such as deep breathing or meditation to combat stress
• Sleeping at least 8 hours a night in complete darkness
• Limiting cell phone use and carrying your cell phone away from your body
• Exercising
• Avoiding excessive heat in the pelvic region (hot tubs, tight underwear or tight pants)

The importance of nutrition in fertility preparation program is also paramount. Foods containing Vitamins A, C, and E, selenium and zinc can be of great benefit to naturally boost sperm quality. Giving the body a 6-12 month period to detoxify & restock vital nutrients through a whole food diet is crucial to sperm health, and will help increase the odds of conception.

Men don’t have to overhaul their lives in order to improve their fertility - small changes can make a big difference over time. By taking these baby steps towards better sperm health, men may soon witness baby steps of another kind.

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

Eating for Mental Health

This is part 4 of a 4-part series designed for Bend + Bloom Yoga's May Challenge. Click to read Part 1, Part 2, or Part 3.

Just as the final limbs of yoga highlight the unity of the Self & the Divine, there is a very close link between your gut and your brain. Supporting your gut through proper nutrition can improve general mental health, and may facilitate the mental fortitude necessary to explore these advanced yogic techniques.

Probiotics are "friendly" gut bacteria that help nourish our gastrointestinal tract and protect against the bad bacteria that comes from excess consumption of sugar, processed foods, alcohol, or medications. Probiotics are found in naturally fermented foods like real pickles, kimchi, kombucha, or real sauerkraut (not the fake stuff with vinegar).

Homemade Sauerkraut

1 head green cabbage

1.5 T. salt

1 T. pickling spices (optional)

Large glass jar

A weight that fits inside your glass jar (e.g., a smaller jar filled with pie weights)

Cheesecloth & rubber band

Chop cabbage into thin slices. Mix the cabbage and salt together in a big mixing bowl and massage it together with your hands until it wilts & gets juicy, about 5 minutes. Fold in optional pickling spices and transfer cabbage (and its juices) to a large glass container, pushing it down as you go. Place a weight on top of the cabbage. Place cheesecloth over the mouth of the glass container and secure it with a rubber band.

Over the next 24 hours, press down on the weight every so often until you end up with a layer of liquid on top of the cabbage, completely submerging it.

Keep the cabbage on a countertop away from direct sunlight. After 5 days, taste the sauerkraut. You’ll know when it’s done by how it tastes - it could take 10 days or more. Once it’s done, pop a lid on the glass container and transfer it to the fridge.

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What to Look For in a Prenatal Multivitamin

Original photo by Melissa Ramirez

This is one of the first things I work on with my perinatal clients, as it’s often overlooked. Many doctors don’t specify what kinds of nutrients are necessary to supplement, which forms of these nutrients are most absorbable, or the recommended dosage of each. 

Supplements are unregulated, and can vary wildly in terms of their content, so it’s important to ensure you’re getting high-quality, bioavailable nutrients so that you’re not wasting your money.

In addition, many of my clients get incorrect information about what they need during this unique time in their lives. For example, contrary to popular belief, the RDA for calcium does not increase during pregnancy, but stays constant at 1,000mg for all women aged 19-30, regardless of whether they are pregnant or lactating.

It’s also important to note that the Recommended Daily Allowance (RDA) is not necessarily what you think it is. The Recommended Daily Allowance is defined as “the average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%-98%) healthy people.” 

What this means is that the RDA isn’t necessarily what’s recommended for optimal health; it’s more like the minimum recommended for your body to function properly. A separate chart, Upper Tolerable Limits (UL), notes the “maximum daily intake unlikely to cause adverse health effects.”

Of course, theoretically, we should be able to get all our nutrition from our food. And if you’re eating lots of clean, whole foods like organic vegetables and pastured meats, a supplement may feel redundant. However, I still recommend that all my perinatal clients take one (see why here).

That said, the healthier you eat, the more flexibility you may have in terms of the dosage of your supplement (perhaps you may feel safe taking half the recommended dose).

With that in mind, here is my guide to ingredients and dosages, as well as a recommendation for my favorite prenatal supplement (and where to buy it).


B-complex

Perhaps the single most important nutrient for moms-to-be, folate requirements nearly double when you become pregnant1. Supplementation pre-conception prevents spina bifida2 and, potentially, autism3. For this reason, it’s important to start taking a supplement well before you get pregnant.

However, there are some very important distinctions between the natural form of Vitamin B9 (folate) and the synthetic form that’s commonly found in fortified foods & supplements (folic acid). Up to 50% of the population has a genetic mutation preventing them from metabolizing folic acid. In addition, folic acid has been associated with cancer, maternal infection, and abnormally slow fetal heart rate (4). Therefore, you must look for the L-5-MTHF form.

(The USDA alludes to this differentiation in their table of Tolerable Upper Intake Levels. A note at the bottom of the table explains that the UL for folate only applies to synthetic forms “obtained from supplements, fortified foods, or a combination of the two.”)

If you’d like to get more folate from your food, you can add more green leafy vegetables, black-eyed peas, brewer’s yeast, liver, and beans to your diet.

Supplementing with folate can obscure a B12 deficiency, so if you’re going to take folate, I highly recommend supplementing with B12 as well. Look for the methylcobalamin form, which is more easily absorbed and used than the cyanocobalamin form. In foods, Vitamin B12 is only found in animal products.

B-vitamins work in concert with one another, and the Daily Recommended Intakes for almost all of them rise during pregnancy, so the best option is to choose a multivitamin that provides all of them together.

In terms of dosages, B vitamins are water soluble, which means that they flow easily throughout the body. Most B vitamins do not have an upper limit due to lack of evidence of adverse health effects.

Insufficient B vitamins may be associated with morning sickness, so supplementing may help alleviate symptoms.

B-vitamin food sources include nutritional yeast, yogurt, peanuts, and organ meats.


Magnesium

The Recommended Daily Allowance for magnesium increases to 350mg per day when you’re pregnant, depending on your age (if you’re over 30, you require 360mg). Look for a chelated form, such as magnesium citrate or glycinate.

Magnesium helps build & repair tissues and is necessary for protein formation & cellular replication. Deficiency is associated with preeclampsia and poor fetal growth. Excess calcium intake can also reduce the absorption of magnesium, since they are mineral partners that need to be balanced1.

To increase magnesium in your diet, eat pumpkin seeds, sea vegetables, almonds, cashews, brewer’s yeast, and leafy greens.


Zinc

Zinc is an antioxidant mineral and is important for protein & DNA synthesis. Deficiency is associated with miscarriage and low birth weight.

Food sources include oysters, steak, and pumpkin seeds.

The RDA for Zn increases from 8mg to 11mg when you’re pregnant. In supplements, look for chelated zinc, such as zinc glycinate, zinc picolinate, and zinc citrate.

Zinc’s mineral partner is copper, so they must be in balance. Therefore, it is often recommended to take supplemental copper (at a ratio of 1 to 10) if you take supplemental zinc4. The RDA for copper increases to 1000mcg/day when you’re pregnant, so that's another good reason to look for copper in your prenatal multi.


Selenium

Selenium is a powerful antioxidant that can be found naturally in Brazil nuts. The RDA increases from 55mcg to 60mcg during pregnancy.

When it comes to minerals, chelated forms are often the best, so look for something ending in -ate, such as selenium glycinate or aspartate.


Chromium:

The Adequate Intake (AI) for chromium rises from 25 to 30 mcg/day when you’re pregnant. While the RDAs for some other trace minerals also increase during pregnancy (like molybdenum and manganese), chromium is the only one that you may not be able to get sufficiently from your diet. Therefore, selecting a multivitamin that includes chromium is a good idea.


Vitamin A

Vitamin A is tricky. Vitamin A deficiency can cause maternal death5, but excessive amounts are not easily excreted and can cause birth defects6. Therefore, getting just the right amount is crucial.

Whole foods are by far the best way to get your daily requirements of Vitamin A, as it’s less likely that you will consume toxic levels of Vitamin A through your diet. In addition, the natural forms of Vitamin A found in foods are more likely to be safe than synthetic versions found in some supplements.

Carotenoids, the plant-based precursors to Vitamin A, are water soluble and do not cause Vitamin A toxicity. For this reason, when it comes to your supplement, mixed carotenoids are the best choice to avoid toxicity. The RDA for Vitamin A rises from 700 to 770 mcg/day when you’re pregnant.

Beta carotene, the best known carotenoid, is found in orange plant foods like sweet potatoes and carrots, as well as dark green leafy vegetables like spinach and lettuce.

However, carotenoids can be problematic, as not all beta carotene is converted into Vitamin A7. In addition, it appears that some people aren’t good at converting any beta carotene into Vitamin A8. Mixed carotenoids are a better choice, but they are still not as bioavailable as preformed Vitamin A, because they require conversion.

Preformed Vitamin A is found in animal foods like liver, fish oils, milk, eggs, and butter. Adding these foods to your diet in moderation - along with your orange veggies and a supplement containing mixed carotenoids - is what I recommend in order to reach a healthy Vitamin A intake.


Vitamin C

The RDA for Vitamin C increases to 85mg/day when you’re pregnant. Vitamin C is another great antioxidant, and it’s water soluble so toxic buildup is unlikely. That said, excessive amounts of Vitamin C (> 2,000mg/day) “may contribute to the formation of kidney stones, as well as cause severe diarrhea, nausea, and gastritis”9.

While most of us think of citrus fruits when we think of Vitamin C food sources, bell peppers, broccoli, and brussels sprouts have even higher concentrations of Vitamin C.


Omega-3 fatty acids

There is no recommended daily amount for these nutrients, but studies show that they are crucial for baby’s health. Most experts recommend intake of 400-650mg DHA and 650-1200mg EPA11. You can get this through eating fish, or you can take a purified supplement like OmegaGenics or OmegAvail, both available in my store.


A word about iron

Iron requirements rise from 18mg to 27mg per day during pregnancy, as it’s required for the production of red blood cells and DNA. Even slight iron deficiency can lead to learning disabilities in your developing child.

However, iron is not easily excreted, and can contribute to free radical activity. For this reason, I don’t recommend supplementing with iron unless your doctor deems it medically necessary. Instead, try to get heme iron (the most efficiently absorbed type) from animal food sources like clams, steak, shrimp, turkey, and chicken. Lentils are a good non-heme iron source for vegetarians.


A word about iodine

Iodine deficiency used to be a problem in the US, and was largely rectified by iodizing salt. Nowadays, supplementation isn’t usually necessary, and due to complexities surrounding the effects of iodine intake, it also usually isn’t recommended.

That said, when you’re pregnant, your RDA for iodine rises from 150 to 220mcg/day, so you do need to be aware of your intake.

In addition to iodized salt, the ocean is an excellent source of iodine, so sea vegetables and seafoods are a great way to get iodine through your diet. Dairy products are also a good way to get sufficient iodine through your diet.


A word about Vitamin D

The RDA for Vitamin D doesn’t increase during pregnancy, but since deficiency is common, it’s often included in multivitamins. Look for the cholecalciferol form (D3), as D2 isn’t nearly as absorbable or beneficial10.


A word about Vitamin E

Your need for Vitamin E doesn’t increase when you’re pregnant, but most multivitamins include it in some form nonetheless. The best form is mixed tocopherols, although I rarely see that in supplements.

1. Murray, M., Pizzorno, J., & Pizzorno, L. (2005). The Encyclopedia of Healing Foods. New York: Atria.
2. http://en.wikipedia.org/wiki/Spina_bifida
3. http://www.ncbi.nlm.nih.gov/pubmed/22648721
4. http://www.drweil.com/drw/u/ART02871/copper.html
5. http://www.who.int/nutrition/topics/vad/en/
6. http://www.teratology.org/pubs/vitamina.htm
7. http://www.ncbi.nlm.nih.gov/pubmed/12001013
8. http://ajcn.nutrition.org/content/75/5/900.long
9. http://www.drweil.com/drw/u/ART02811/facts-on-vitamin-c
10. http://ajcn.nutrition.org/content/84/4/694.full
11. Hudson, T. (2008). Women’s Encyclopedia of Natural Medicine. McGraw Hill: New York.

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.

Are You Folate-Deficient?

Last week, I had my blood drawn. (We just moved to New York so we're setting up all our baseline
preventative appointments here. It took me a while, but I finally found a MD trained in functional medicine who accepts our insurance.)

I had been feeling a bit sluggish and down since our cross-country move. At first, I thought it was diet-related - it's not as easy to get fresh, healthy food on the East Coast as it was in San Francisco. But after a few months of clean eating, I felt only marginally better. I started exercising more, but that didn't help much either. So, it was off to the doctor's office to see if we could figure out what was up.

I got my results back and was jaw-droppingly shocked to find out that I had hyperhomocysteinemia (too much homocysteine). Homocysteine is a byproduct of protein metabolism that can wreak total havoc on our health. Symptoms of high homocysteine range from depression to Alzheimer's Disease to serious cardiovascular issues to osteoporosis to Down's Syndrome and more. It typically results from diets too high in animal protein and too low in B vitamins (found in legumes and dark green, leafy veggies).

Now, considering that I had just finished a fertility program designed to be particularly high in folate and other B vitamins, and leafy greens are a part of my everyday diet, that seemed impossible.

But there's a catch! (And this is where it gets super-important for YOU!)

Up to 50% of people have a genetic mutation that limits or prevents their absorption of folic acid (MTHFR).

This is one of the reasons why I recommend against supplements that use folic acid instead of folate.  

But if you have the genetic mutation, even if you're eating a folate-rich diet, additional supplementation with the naturally absorbable form of folate (5-MTHF) is needed.

You all probably already know how important folate status is during pregnancy. Deficiency in the early stages of pregnancy can cause neural tube defects like spina bifida. That's why it's essential to get enough folate before you conceive.

How much is enough? It is difficult to consume too much folate. In fact, one of the only concerns about excessive folate intake is that it can mask a B12 deficiency. If you're already taking a good prenatal multi that includes the methylcobalamin form of B12 (as found in the prenatal supplements that I carry), you shouldn't need to worry about that.

With that in mind, I just added L-5-MTHF capsules to my dispensary on Emerson Ecologics. Head on over to pick some up along with your prenatal multi. To set up your account, you'll just need the code natal3 and my zip code, 11201. Click here to buy products.