Your Body in Balance

CHAPTER 1

Foods for Fertility

I have good news and bad news,” Elsa said. She was going to leave our research study, and I could tell she wasn’t the slightest bit sad about it.

When she volunteered for our research, she did not imagine that it would change her life forever. The study was a test of how foods could reduce menstrual cramps. It followed up on my observations that a menu tune-up sometimes makes cramps go away. (More about that here.) Elsa had suffered with menstrual pain for years and was eager to see how a diet change might help.

Like all the volunteers, she was asked not to use birth control pills during the study, because birth control pills are hormones that could obscure the effects of the diet change. That was not an issue for her, she told us. She didn’t actually need birth control at all; she and her husband had long since given up the idea of having a baby. They had been evaluated medically, and the problem was hers. She was infertile.

Joining the study, she followed our advice on how to choose foods, which you will read about shortly. It was not especially complicated. And soon, something unexpected happened.

“Good news and bad news?” I asked. “Tell me! What is it?”

“Well, the bad news is that I have to drop out of the study,” she said. “I’m sorry about that, but the good news is that I am pregnant!”

Yes, her so-called infertility was over. She was indeed pregnant and soon gave birth to a beautiful, healthy baby. She never imagined, after all the medical tests, monitoring, and treatments she and her husband had been through, that a simple diet change would set things right.

Years later, I was giving a lecture in the Midwest, and I was surprised to see Elsa in the audience. She had heard that I was coming to town and wanted to let me know how she was doing and to introduce me to her three children.

Katherine

Katherine grew up in Louisiana. As an aerospace engineer for the Air Force, she was one of the first to be deployed to Iraq in 2003.

In the war, government rations were limited, to say the least. And when Katherine’s tour of duty ended and she went back home to Louisiana, her friends were eager to reunite her with her old favorite foods: cheeseburgers, macaroni and cheese, shrimp, and gumbo.

Not surprisingly, she gained weight. And as time went on, she experienced something else—pain in her abdomen. The pain gradually worsened and came in waves, waxing and waning with her menstrual cycle, returning month after month.

She saw her doctor to try to find out what was wrong. After several tests, her gynecologist recommended a laparoscopy. He made a small incision in her abdomen, inserted a scope, and looked around. And he spotted the cause of her pain. She had endometriosis, a condition in which cells that normally line the uterus have migrated to other parts of the abdomen, where they implant and cause pain that can be excruciating. Because the out-of-place cells become inflamed and can disrupt the anatomy of the ovaries and fallopian tubes, endometriosis can also lead to infertility.

Finding the cause of her pain was one thing. Curing it was another. Typical treatments include painkillers, hormone treatments, and laparoscopic surgery. They may or may not work. When all else fails, doctors can perform a hysterectomy.

Things were not going well for Katherine. The pain worsened over time to the point where she was essentially out of commission for a day or two every month. None of the treatments helped. Eventually she had to make a decision. Although she and her husband had hoped to raise a family, she could not live like this, and she scheduled a hysterectomy.

But before she had the surgery, a friend made a helpful suggestion. Why not try a diet change? After all, foods can influence the body’s hormones, which is why many women with breast cancer change their diets. Maybe it would work for endometriosis, too. So, she made an appointment for some nutrition guidance and revamped her diet. Following her nutritionist’s advice, she eliminated animal products and explored the world of vegetables, grains, beans, and fruits and all the meals they turn into.

Her new foods turned out to be tasty. But more importantly, she started feeling better. She lost weight, her energy improved, and the pain started to loosen its grip. With each passing week, she felt more like her old self.

Six weeks later, her doctor repeated the laparoscopy. Again, he made a small incision in her abdomen, inserted the scope, and carefully looked around. He then sewed up the incision, sent Katherine into the recovery room, and walked out to the waiting room to find her husband. The doctor explained that, to his surprise, her endometriosis was practically gone. So much so, in fact, she no longer needed a hysterectomy at all.

Her husband was not so surprised. He told the doctor about how Katherine had revamped her diet and how it had helped her enormously. She had been feeling better and better.

The doctor was having none of this. Foods do not cause endometriosis, he explained. And there is no way that a diet change could make it go away. There was only one possible explanation, the doctor said. This was a miracle!

Katherine laughs about that today. But it did feel pretty miraculous. She lost fifty-five pounds in six months, her pain went away completely, and her emotional ups and downs smoothed out, too. Most miraculous of all, she never had the hysterectomy. She and her husband now have three children.

Foods and Fertility

This may not be a time of life when fertility is an issue for you. And these days, many people are opting not to have children anyway, because of time, finances, concerns about overpopulation, or other reasons, and the days when people were pressured to have children have mostly gone. Nonetheless, let me encourage you to read this chapter, as its lessons extend to many other conditions as well.

In theory, fertility is simple. An egg from Mom meets a sperm from Dad, and they cozy up in a place where they can unite and grow. But things can go wrong, both for Mom and for Dad.

For about 10 to 15 percent of couples trying to conceive, it just does not happen after more than a year of trying. Many spend a fortune on medical evaluations and treatments of all kinds. Beyond the financial cost is the burden of medical visits, examinations, treatments, and the risk that romance will turn into a sterile medical exercise.

The most common reason for infertility in women is a lack of ovulation. The ovaries are stubbornly refusing to release an egg. For men, abnormalities of the testes, the hormones that control them, or the ducts that carry sperm along can all limit fertility.

There can also be problems with bringing the egg and sperm together: At the bottom of the uterus, the cervix admits sperm while, at the top, the fallopian tubes are where the egg is fertilized. Sometimes these structures do not form properly. Other times, infections interfere. Or perhaps trauma or other abdominal problems intervene. Yet foods have surprising effects on fertility for both men and women. And if food choices are causing the problem, the solution can be straightforward. Let’s start with ovulation.

Foods and Ovulation

The ovary is an amazing structure. One of the most amazing things about it is that, by the time you were born, your ovaries were already developed, with millions of eggs just about ready to go. That’s right. While you were still a baby in your mother’s womb, your own tiny ovaries had already developed the eggs that could become your babies. That means that things your mother was exposed to during pregnancy could easily have affected you, your ovaries, and your eggs.

During your reproductive years, your ovaries are ready to release an egg each month. But that process is easily derailed. If your hormones are out of balance, ovulation may not occur at all.

Millions of Hormone Factories

Pinch a bit of flesh on your thigh. If you could reach into your thigh and pull out one single fat cell and examine it, what would it look like? We tend to think of fat cells as lifeless little bags of stored calories. The truth is very different. Fat cells are busy hormone factories. Every minute of every day, they crank out hormones. Starting with hormones produced by your ovaries and adrenal glands, fat cells turn these raw materials into the male hormones and female hormones that control your basic biology.^*

The more body fat you have, the more hormones they produce. That can get your hormone balance out of kilter and interfere with your fertility.

Having extra body fat will not help your fertility one bit. In Harvard’s Nurses’ Health Study II, researchers examined fertility in a large group of women, based on their body weight.¹

Fertility was greatest for those who were a bit on the thin side of the normal weight range. At even slightly higher weights—even for women within what we would consider a healthy body weight—infertility was more common. For seriously overweight women, fertility problems were nearly three times more common.^†

The reason, we believe, is that fat cells cause hormones to go haywire. They actually do this in two ways:

First, as we have seen, fat cells produce extra female sex hormones (estrogens) and also extra male sex hormones (androgens) and send them into a woman’s bloodstream.

Rich-Edwards JW, Goldman MB, Willett WC, et al. Adolescent body mass index and infertility caused by ovulatory disorder. Am J Obstet Gynecol. 1994;171(1):171–177.

Second, body fat reduces the amount of sex hormone–binding globulin, or SHBG, in the bloodstream. SHBG is a very helpful protein molecule. It circulates in your bloodstream and holds on to sex hormones, keeping them inactive until they are needed. Think of SHBG as a fleet of microscopic aircraft carriers and estrogens as tiny fighter planes. So long as the “planes” stay on the “carrier,” they remain inactive. If you have plenty of SHBG in your bloodstream, your sex hormones will not be overactive, and that is good.

So if your fat cells are producing extra hormones and, at the same time, are reducing the amount of SHBG that would rein those hormones in, you’ll end up with too much hormonal activity. So carrying extra weight can reduce fertility.

That said, thinner is better only up to a point. Below a BMI of about 18 kg/m² (i.e., 108 pounds for a woman who is five-five), infertility starts to creep upward again. Being overly lean can lower estrogen levels too much and can shut down ovary function. So for optimal fertility, it helps for heavier women to lose weight and for overly thin women to gain weight.

Getting your body weight into the right zone will help fertility. Here, I will show you how to do it.

Fiber for Fertility

If excess hormones cause problems, can you get rid of them? The answer is yes. In fact, your liver is trying to do that for you right now. All day long, your liver filters your blood, removing things that do not belong there: toxins, medications, and other things, including hormones. Your liver sends them into a small tube, called the bile duct, which leads to the intestinal tract. There, fiber soaks them up and carries them out with the wastes. You are literally flushing away unwanted hormones.

There is plenty of fiber in beans, vegetables, fruits, and whole grains, and this healthy fiber escorts unwanted hormones out of your body. But animal products do not have fiber. If chicken, fish, dairy products, and eggs are a prominent part of your diet, you may not have enough fiber to soak up and remove unwanted hormones. That means hormones end up being reabsorbed back into your bloodstream. This process is called enterohepatic circulation (entero refers to the digestive tract, and hepatic refers to the liver). Hormones are ejected from the liver into the intestine, but then pass into the bloodstream and eventually back to the liver, where the whole process repeats, several times a day. Instead of flushing away unwanted hormones, your body keeps “recycling” them, leaving you with more hormones than you need.

What is the answer? Chuck out the animal products and bring in the vegetables, fruits, beans, and whole grains. Their fiber will capture the hormones in the digestive tract and carry them away once and for all. Instead of recycling unwanted hormones in your bloodstream, you will send them down the toilet. You will still have enough hormones for normal functioning, and getting rid of the excess is a big help.

Fiber does the same for cholesterol, as you may have heard from television commercials for breakfast cereals made from oats. The oat fiber carries cholesterol out with the wastes, gently lowering your blood cholesterol levels.

Would this really work? The answer came from studies at Tufts University, UCLA, and the American Health Foundation. Women volunteers changed the fat and fiber content of their meals under controlled conditions and, yes, high-fiber, low-fat diets trimmed estradiol levels by anywhere from 10 to 25 percent. Estrone was tamed to about the same degree, and testosterone was reduced, too.^3,4,5

Fiber is not all there is to it, though. Researchers have long taken an interest in the “Mediterranean diet” of southern Italy, emphasizing fruits and vegetables and favoring olive oil when oils were to be used, while de-emphasizing meats and dairy products. In 2006, Sicilian researchers bemoaned the influx of meat, dairy products, and animal fat into the region’s diet, a phenomenon they called “Northernization.” They decided to see what a return to a more traditional diet would do. Inviting 115 postmenopausal women to join a research study, 58 women were asked to cut back on meats, dairy products, and animal fat and favor plant-based foods, while the remaining women were asked to stick with their usual diets. Neither group increased their fiber intake. But, measuring estrogens excreted in urine samples, the researchers found that the women who cut back on animal products reduced estrogen levels by 40 percent.⁶

So the evidence is in: A higher-fiber, lower-fat diet brings a woman’s hormones to a healthier level. While researchers are most excited about the reduction in breast cancer risk these changes can bring, they also help women struggling with other hormone-related issues.

Go Dairy-Free

Another threat to fertility may come from dairy products. This is not entirely surprising, because milk and cheese have plenty of unnecessary calories and lots of fat. Typical cheeses are 70 percent fat, as a percentage of calories. So, as these products bring on extra weight, those growing fat cells contribute to hormone haywire. And, of course, dairy products are not plants, so they have zero fiber.

But dairy products have two more attributes that could aggravate hormone problems. First, in order to maximize their milk production, dairy cows are artificially inseminated every year. During their nine-month pregnancy, cows produce estrogens that get into milk. When milk is turned into cheese, these estrogen traces are more concentrated.

Second, the milk sugar, lactose, may be harmful to the ovaries. In 1994, Dr. Daniel Cramer at Boston’s Brigham and Women’s Hospital reported that the more milk women drink, the faster their decline in fertility as the years go by.

Normally, fertility declines bit by bit as women get older. In Thailand, where milk is not a traditional part of the diet, fertility declined by only about 25 percent as women passed from their late twenties to their late thirties.⁷ In Finland, however, where dairy products are a major part of the diet, women had a much greater decline in fertility—around 80 percent—during the same age range. Statistics for New Zealand were similar, and Denmark, the United States, and the UK were not far behind.

Dr. Cramer reasoned that the problem may be lactose. During digestion, lactose breaks apart, releasing two smaller sugar molecules, glucose and galactose. It turns out that galactose can be toxic to the ovaries, damaging the germ cells that turn into eggs. There is plenty of lactose in milk and ice cream, ready to release galactose into your bloodstream.

You will find “lactose-free” cow’s milk in stores, but that does not solve the problem. The fact is, it has just been treated so as to break the lactose into glucose and galactose in advance, so galactose is waiting for you right in the carton. Skip it. Plant milks are free of lactose naturally and are much better choices: soymilk, rice milk, oat milk, almond milk, hemp milk, and other varieties are now widely available. Most other plants are galactose-free, although traces do show up in dates, papayas, bell peppers, tomatoes, and watermelon.⁸