One of the most frequently asked question in, likely, every fertility center is this: Doctor, should I change my diet? For the longest time there was really no good answer to this question because there were, simply, no reliable studies in the literature that address the connection between diet and fertility. Over the last decade, something almost miraculous happened, however, to medicine in general: We discovered a new “organ” in our body that not only affected its own physiological functions but, secondarily, affects most, if not all, other organs in the body. This organ is now called the microbiome and its biggest component is the gut microbiome. The microbiome is defined as the aggregate of all microbiota within a human being in human tissues and biofluids and includes the anatomical locations where those microbiomes are housed, including the skin.
The study of the microbiome is in the process of revolutionizing all of medicine because the huge amounts of different bacteria that populate our gastro-intestinal tract (and other bodily cavities), as we are just learning to understand, greatly affect health as well as disease. Several studies recently, for example, revealed a gut-brain axis through which gut microbiota influence brain activities. In other studies, differences in gut microbiota were demonstrated to affect the effectiveness of chemotherapies in cancer patients. And we could go on and on with many more examples. Because the gut microbiome to a significant degree is affected by what we eat, it appears increasingly obvious that what we eat also to significant degrees must affect female as well as male fertility. Studies trying to investigate such connections are still rare but CHR recently got approval by the center’s Institutional Review Board (IRB) for a study of gut and vaginal microbiotas in all kinds of female infertility patients. This study will initiate enrollment any day now and will lead the CHR into a brand-new area of research.
What Is Already Known
Not much is really known yet, but interesting data have been published in a handful of recent studies principally in three areas: In female infertility, investigators, for example, have started looking at the gut microbiome in women with polycystic ovary syndrome (PCOS). Though clinically valuable conclusions have not been achieved so far, they are just a matter of time. It appears increasingly likely that over the next decade, medicine will learn to manipulate distinct disease entities via specific diets and changes in gut microbiome they will induce. Though we are not there yet, we venture to predict that these developments will also significantly affect the fertility field, one of the major reasons why CHR has decided to engage in research in this arena. Similar studies are also being initiated in male infertility.
Likely the most concrete data of the impact of diet on female and male fertility so far come from studies where the impact of different diets on infertility treatment success was investigated. Both, in female and male infertility, considerable evidence has accumulated suggesting a beneficial effect on treatment outcomes in patients who followed a Mediterranean diet.
One of the most interesting findings in the field has been the recognition of how the gut microbiome affects the immune system and, especially, inflammation. Here at CHR, we do not like inflammation in women who are trying to conceive. The reason is that inflammation creates a hyperactive immune system and such hyperactive immune systems are closely associated with poorer implantation rates and more miscarriages. CHR, therefore, is very proactive in diagnosing and treating inflammation in our patients.
As some of our readers may recall from a few years back, we, in these pages extensively discussed a paper by a group of California investigators from Santa Barbara University in SCIENCE which demonstrated that certain helminths (worms) induced immunological tolerance that benefitted establishment of pregnancies. In investigations of the effect of helminths on the gut microbiome, investigators recently determined that helminths, at least in part did this by having anti-inflammatory effects on the gut microbiome. By reducing inflammation and, thereby, by diminishing the immune system’s hyperactivity, the evolution of tolerance pathways improves, resulting in easier implantation and fewer miscarriages.
What CHR Does
Being very conscious of the adverse effects on fertility inflammation can exercise, CHR in recent years has also become much more aware of the importance of gut health for fertility treatments. While CHR in general recommends against changes in lifestyle and habits during infertility treatments because we consider any such changes stress-inducing, we do advise patients to stay away from foods that may be inflammatory for them. This, of course, raises the question: how do we know when that is the case
There is no easy answer to this question but food that is inflammatory usually causes symptoms. CHR, therefore, recommends that patients in fertility treatments stay away from foods that make them bloated, cause flatus, abdominal cramping or other signs of indigestion since these symptoms can suggest a “leaky gut” and that is an inflammation-inducing condition. A large variety of foods can cause these symptoms but especially gluten (wheat) and dairy (lactose) can be strongly inflammatory. If laboratory investigations detect inflammatory markers, like an elevated erythrocyte sedimentation rate (ESR), high C-reactive protein (CRP) or elevated interleukin-6 (IL-6), CHR, often, recommends an anti-inflammatory diet, excluding gluten and dairy, even in the absence of clear gastrointestinal symptoms. Moreover, patients often are treated with anti-inflammatory supplements (CONFLAM-Forte, Fertility Nutraceuticals, LLC*) or drugs (Plaquenil).
*Conflict Statement: Dr. Gleicher is a shareholder of Fertility Nutraceuticals, LLC.
This is part of November 2020 CHR VOICE.