8 things I wish providers knew about nutrition, fertility, and pregnancy
As a registered dietitian nutritionist specializing in fertility and pregnancy nutrition, I come across all sorts of nutrition misinformation every day. Unfortunately, a lot of this incorrect nutrition information actually comes from medical providers. Don’t get me wrong, there are some really fabulous doctors and midwives out there, but even some of the most skilled and compassionate providers haven’t had great education in nutrition, or simply don’t have time to have nuanced conversations with every one of their patients. While this can be really frustrating, I totally get it. You want to give your patients the best, most holistic care that you can, but you have limited knowledge of nutrition (understandably, you got in depth training in your field and that takes up a lot of brain space) and you may only get 15 minutes to chat with each of your patients.
Guess what?? That’s ok! If you’re a medical provider reading this now - I’m so glad I’ve got the opportunity to help you understand a little more about the world of nutrition as it relates to fertility and pregnancy. But also, registered dietitians like myself are here to support your patients. We practice evidence-based medical nutrition therapy, and our whole job is to provide a safe, positive space for patients to explore self-care through health promoting behaviors. Instead of feeling like you have to do it all, providing a referral to a registered dietitian can help your patient get all of the information they need, and get the individualized support they need to implement it.
That said, there are absolutely some common nutrition myths circulating in the world of reproductive health care that need to be cleared up, stat. So, without further ado, here are 8 things I wish medical providers knew about nutrition, fertility and pregnancy.
1. Hypothalamic amenorrhea is possible even for folks with a “normal” or high BMI
Hypothalamic amenorrhea (HA) is the loss of menses due to high levels of psychological or physiological stress, undereating, overexercising, or some combination thereof. A common misconception is that HA occurs only in thin people, or those with a low BMI. While this condition is more common among people with lower levels of adiposity, it is still entirely possible in those with a “normal” or high BMI. In fact, many folks who seek my support do have a BMI above 19.5, or may not regain menses even after weight restoration to a “normal” BMI. Ruling out a diagnosis of HA because of a “normal” or high BMI may lead to a misdiagnosis of PCOS and therefore inappropriate treatment protocols, and/or dangerous disordered eating behaviors being left untreated.
2. Weight loss is not necessary to improve fertility for people in larger bodies
Another misconception is that for people with a BMI over 25, weight loss will improve fertility. This comes from the assumption that people in larger bodies must be overeating or living sedentary lifestyles. In my experience, this is rarely true. In fact, most of the larger-bodied folks in my office have tried multiple times to lose weight. Many are actually undereating, which puts their reproductive system under unnecessary strain and can lead to nutrient depletion. Furthermore, recent research shows that for folks in larger bodies with unexplained infertility, weight loss may not improve fertility outcomes at all. While incorporating health promoting behaviors like increasing fruit and vegetable consumption or engaging in enjoyable exercise may sometimes result in weight loss, it sometimes does not. Regardless, these behaviors are associated with improved fertility and prenatal outcomes, independent of weight loss. Referring patients to a qualified registered dietitian can help them incorporate sustainable healthy eating behaviors instead of crash dieting.
3. Ozempic and Wegovy have their place, but they have big nutrition risks
While semaglutide injections can be extremely helpful for folks with type 2 diabetes, they are not without risks and often leads to compromised nutrition status due to GI distress and low appetite. This may result in weight loss, but as expressed above, that might not actually be healthy weight loss, especially in the absence of insulin resistance which may not indicate extreme medical intervention. If you and your patient decide a semaglutide injection is the right approach for improving insulin resistance-related infertility, ensuring your patient has the support they need to maintain a well-rounded and nutrient dense diet is vital for positive fertility and pregnancy outcomes.
4. Low carb diets do more harm than good, even for people with PCOS or insulin resistance
The vast majority of folks who I work with that have PCOS or insulin resistance have at some point been recommended to try a low carb diet. While this might make sense on the surface, low carb diets are not actually the best approach for folks trying to conceive or pregnant. Low carb diets increase the risk of binge eating behaviors, and are low in fiber, antioxidants, vitamins and minerals that are crucial for fertility in pregnancy. Instead, I recommend balanced meals that pair carbs with protein, fat and fiber to help reduce the incidence of blood glucose spikes.
5. There is no evidence that everyone should eliminate gluten and dairy to improve fertility
While people with Celiac disease or a dairy allergy do need to eliminate gluten or dairy for medical reasons, and will therefore see an improvement in inflammation and fertility outcomes, there is zero evidence to suggest that everyone should eliminate gluten and dairy to improve fertility. In fact, some evidence suggests that full fat dairy may help promote ovulation, satisfaction levels, and blood sugar balance, and whole grains - even ones containing gluten like wheat, barley and rye - are an important source of fiber, antioxidants, vitamins and minerals. For people with lactose intolerance, lactose-free options can still provide great nutrition for fertility without resulting in GI distress.
6. Fear and shame based tactics do not help pregnant people manage gestational diabetes
While providing information about risks of unmanaged disease states is important, people with gestational diabetes more often than not are already scared, and already care deeply about their growing fetus. Shame and fear based tactics can lead to maternal disordered eating and malnutrition, which can increase risk of postpartum mood and anxiety disorders and even possibly cause intrauterine growth restriction of the fetus due to over-restriction of carbohydrates. Instead, providing reassurance, decreasing fear and stigma around diagnosis, and providing a dietitian referral immediately upon diagnosis can help folks with gestational diabetes get the individualized and positive nutrition care they need.
7. Eating disorder risks double in postpartum
Eating disorders affect about 5-7.5% of pregnant people (similar incidence to the general population), but the risk of relapse or new onset of an eating disorder increases to 12.8% in postpartum due to high pressure to “bounce back” coupled with birth trauma and the stress and isolation of caring for a newborn. Eating disorders affect people in all sized bodies, and are associated with a higher risk of perinatal mood and anxiety disorders. Screening postpartum parents for disordered eating behaviors, providing mental health and nutrition referrals, and refraining from encouragement of dieting behaviors can greatly improve postpartum wellbeing.
8. Male factor infertility can be improved through nutrition
Male factor infertility is responsible for up to 50% of infertility cases. While the reproductive endocrinology and infertility fields are modernizing in their realization of this statistic, much of the burden of fertility improvement remains on females in heterosexual partnerships. Just like with female infertility, lifestyle and nutrition factors also impact male factor infertility. Incorporating nutrient dense foods, targeted supplements, and other health promoting behaviors like exercise and stress management can greatly improve sperm count and quality, and should not be discounted.
Summing it up…
A dietitian referral can dramatically improve your patients’ outcomes for fertility and pregnancy. Learn more about what I offer for 1:1 clients here (psst, I accept BCBS insurance and am licensed to practice in multiple states).
For folks who may not need in depth support or are looking for a more affordable out-of-pocket option, I offer group coaching through my programs Fully Nourished Pregnancy and The Insulin Resistance Mini Course.