Maggie McKay (Host): When getting pregnant is the goal, it's good to have all the information possible to make that a reality. So, how does diet factor in? Do you need to follow an anti-inflammatory diet for fertility? Today, we're going to find out with Dr. Mary Hinckley and Bonnie Burgess.

Host: This is Fertile Edge, a podcast from the Reproductive Science Center of the San Francisco Bay Area. I'm your host, Maggie McKay. Thank you both so much for being here. Dr. Hinckley and Bonnie, could you please introduce yourselves?

Dr Mary Hinckley: Yes. Maggie, thank you so much for having me. I love getting a chance to talk with you and to share information that pertains to fertility and other lifestyle choices to patients and other curious listeners. So, I'm Dr. Mary "Ramie" Hinckley, and I'm a practitioner here at Reproductive Science Center. I've been practicing medicine and infertility, also known as reproductive endocrinology for over 20 years. And I love taking care of all types of patients who are hoping to build a family, either now or in the future.

Host: That's great. And Bonnie?

Bonnie Burgess: Hi. Thank you so much for having me. I am a fertility and perinatal nutritionist. So when it comes to fertility, whether somebody's trying to conceive on their own or with assistance, like with Dr. Hinckley, I will help them find personalized diet and lifestyle changes to help mitigate modifiable risk factors for infertility.

Host: And let's just dive right in. Dr. Hinckley, when do you find yourself talking to patients about diet and nutrition?

Dr Mary Hinckley: I find myself talking to almost every patient about it. You know, luckily, our initial visits are usually about an hour long. And so, that affords me the opportunity to really dive deep into someone's history, their medical history, but also the exposures and toxins and chemicals and diet and exercise. And I actually love that part because I really think that food is the first medicine and how we take care of ourselves will influence our outcomes for fertility. So, I try to make that a part of every new patient visit to ask a little bit about their diet, weight loss or weight gain and what they do for exercise so that we can then address it if I see anything that could be optimized.

Host: When it comes to anti-inflammatory diets, it's being talked about a lot in social media and the news. What fertility issues might make you mention this to a patient?

Dr Mary Hinckley: Well, that's a good question and it is something that is very timely. I do find that often patients, in this last year or so, maybe even post-COVID, seem to be asking me a lot more about anti-inflammatory diets. You know, "What is that, Dr. Hinckley? What would you recommend? Do you think that's going to help me?" And it seems to come up more often when I have patients that have irregular menstrual cycles. Maybe they're not ovulating or maybe they're patients that have implantation failure, success with IVF has not come easy, they're struggling to try to get pregnant. I see it with men who have male factor infertility and their sperm counts may not be ideal. And so, they're asking whether the diet or exercise or lifestyle might play a role. And then, of course, it comes up with people who have other, what we doctors refer to as, comorbidities, which means they have other diseases that may be complicating or causing some of their infertility, which includes diabetes, high blood pressure, autoimmune diseases. Even things like endometriosis would fall into this category. Because more and more, our medical literature is starting to show that what you put in your mouth may affect your health and may be able to drive outcomes, either for better or for worse.

And so, patients that are savvy about this, even if they're just on TikTok, they may have seen that there's something called an anti-inflammatory diet. And so, they ask me about it. But, you know, Maggie, this is not my specialty, and so that's one of the reasons I'm so happy to have Bonnie here to go into greater detail about the diet, so that maybe I can bring it to the awareness of the patient or discuss a little bit about the role it might play in fertility, but that they could really get more information about that diet and changing their lifestyle and their diet and their nutrition with the help of someone like Bonnie.

Host: Right. And so Bonnie, what are the fertility benefits of an anti-inflammatory diet? Who can benefit from that kind of a diet when it comes to fertility?

Bonnie Burgess: And just to kind of go deeper onto the biology of what's happening, so for a lot of the types of people that Dr. Hinckley mentioned, conditions that Dr. Hinckley mentioned, that high inflammation in the body causes oxidative stress, which directly affects both egg and sperm quality. So when she says she talks to nearly everybody about it, that's no wonder. There's either going to be male factor, female factor, egg or sperm quality at play there. And then also, high inflammation increases cortisol, which has really direct effects on the fertility process. So, implantation is affected, egg maturation, hormone balance. So with an anti-inflammatory diet, we can decrease the oxidative stress by -- there's antioxidants in food. We'll go into some of the specifics, I'm sure I would love to share specific details, but mitigating the oxidative stress, mitigating the inflammation can have really profound downstream effects that really do affect fertility.

Host: So, Bonnie, what foods are anti-inflammatory? Dying to hear this.

Bonnie Burgess: So TikTok, for better or for worse, promotes some of the buzzy ones. So, I'm sure a lot of people know that berries are anti-inflammatory. And really, a lot of the colorful produce that you see probably has flavonoids, anti-inflammatory, antioxidant flavonoids. So, that's a really good shorthand way to think about diet, is getting colorful, diverse produce and herbs. Those are hugely packed with good flavonoids. Also, some of the vitamins act as antioxidants in the body, would love to see them from food. Your body can not only absorb them really well in food, but they come with complimentary other flavonoids that help. So, the antioxidant vitamins, ACES is the acronym, so vitamin A, C, E, zinc and selenium.

And just to give you a sense of what foods might be covered by those, I'll give you a favorite of each. So, vitamin C, a lot of people think about oranges, but actually citrus zest is one that's super potent, so that's kind of a super food from the anti-inflammatory perspective. Eggs and if you eat it, liver, if you can find a way to get it in, I have lots of ideas to get it in, but a ton of good antioxidants. Whole grains, shellfish and Brazil nuts, that's my favorite for selenium. But really, a diversity of colorful plants, high quality animal foods. So, you not only want to think about what you're eating, but the quality that you're eating. So if you can get organic and either way, wash your produce, just so you're not getting harmful herbicides and pesticides that might counteract some of the beneficial stuff that you're trying to get in, and good quality, maybe grass-fed or pasture-raised meats.

And then just one more to mention, just some foods that have the plant foods that have special anti-inflammatory properties. So, a lot of people might hear of turmeric with regards to this. And you can get turmeric in your diet normal food quantities. You know, you don't have to eat pounds of turmeric a day to actually get really profound benefits. Likewise with ginger, the allium family, so garlic, onions, and shallots. Those seem like just flavor additions to food, but they're really powerful. And then, cruciferous vegetables, so that's the broccoli family. And I love to tell people about sprouts or microgreens from the cruciferous family. Just because in a small amount of microgreens, you can get a ton of nutritional power, a ton of anti-inflammatory power.

Host: And what herbs? You touched on it, but what specific herbs?

Bonnie Burgess: Honestly, all of them. The fresh ones, over dried, just say you get the maximum nutritional potential as opposed to maybe an older spice that's been in your cabinet for years. So, some fresh parsley, fresh cilantro, fresh dill, those ones of particular that come to mind. So again, not just for flavor, potent nutritionally.

Host: And on the other end of the spectrum, what foods promote inflammation? What do we want to avoid?

Bonnie Burgess: So, I think about the things that are going to increase oxidative stress, we're trying to reduce oxidative stress in the body. And they're kind of the things that you think of with the foods that are not typically good for you. So, processed food, there's a lot of additives, preservatives, artificial colors and excess of sugar and an excess of saturated fats. Fats are kind of an interesting one because they can be hugely anti-inflammatory. This is one that I didn't mention, but omega-3 fats, really great in wild caught fish. Or you can have inflammatory fats, so trans fats often in a lot of packaged foods or damaged fats. This is one that I educate my clients on a lot. You could have a typically good fat, so say like a grass-fed organic butter. You're heating it to too high of a point, you might have heard of the smoke point of oils. That's stretching a fat past its ability to be heated, gets rendered damaging and pro-inflammatory. So, generally tryng not to deep fry things or super high heat things can prevent you from having damage for inflammatory fats.

Alcohol, another good one to mention, promoting more inflammation. And then, it also gets individualized and personalized in terms of what you might react to in an inflammatory way versus somebody else. So, a specific allergy or even a sensitivity to a specific food can increase inflammation in the body.

Host: So, is there anything else I can do to live an anti-inflammatory lifestyle? I mean, those are great. That's great to have like a pro and con list. But what else factors into anti-inflammatory lifestyle, Bonnie?

Bonnie Burgess: Well, actually, I wanted to say one more thing on diet because there's the list of foods to eat and not to eat. But also on the macro level how you're eating, I talk a lot about blood sugar stability. And so, Dr. Hinckley mentioned diabetes, for example. Another common condition that comes up with regards to fertility is PCOS, polycystic ovarian syndrome. So if somebody has insulin resistance and you don't even need to have a label of either of those conditions to have some level of insulin resistance, that can cause inflammation in the body. So, we could probably have a whole podcast just on trying to eat for good blood sugar stability. But a way to wet your feet, eating a balanced meal with lots of good fiber, so you can get those colorful produce items and high quality protein and fat. All of those combined into one meal will help to keep your blood sugar steady.

Host: How do you counsel somebody struggling with either obesity or somebody who's underweight when it comes to an anti-inflammatory diet?

Bonnie Burgess: So, there's an interesting overlap that not everybody is aware of between obesity and high levels of inflammation, that fat cells do produce inflammatory cytokines. And so, there are strategies to help somebody get into a mid-range BMI that has been shown to be helpful for fertility outcomes and also improve their levels of inflammation with an anti-inflammatory diet. So, that might be the approach for somebody who is struggling with obesity. And likewise, somebody who is underweight under a normal BMI might struggle with infertility. Now, the root cause might be a little bit different. Like for obesity, I'm thinking inflammation. For underweight, I might be thinking high stress. Obviously, there can be different types of people that fit into these categories. But high stress is also a huge promoter of inflammation. And so, I might be thinking about an anti-inflammatory diet, also trying to pack in those healthy good fats, make sure they're getting enough good fat and protein, but also thinking about anti-inflammatory lifestyle.

Host: Speaking of that, is there anything else someone can do to live an anti-inflammatory lifestyle?

Bonnie Burgess: I would say there's so many things. I mean, we're living in a modern world with stress around every corner, environmental stress. So, environmental toxins are huge, both for female and male fertility. BPA, one of the chemicals and plastic is a really big one. We talked about some exposures through food, trying to mitigate those through organic produce or well raised meats. But through your personal care products, cleaning products around the house, the water that you're drinking, if it's filtered or not, and what it's filtered for, obviously if you smoke or not. So, environmental toxins.

We talked about stress. Hugely important mitigating stress, trying to find stress reduction in your life. Exercise is a great, not only stress reducer, but anti-inflammatory tool. And I talk about sleep a lot too. Good sleep hygiene. If you've heard of melatonin, a supplement that's often recommended for fertility, it has benefits on egg quality, for example. But melatonin is an antioxidant in the body. It has lots of anti-inflammatory properties.

Host: Dr. Hinckley, how do you feel about other lifestyle modifications for patients thinking about fertility treatment or pregnancy?

Dr Mary Hinckley: Well, I love the ones that Bonnie just mentioned, and those are ones that I also find that I tell patients about when they ask about what else they could do. You know, I'm going to take care of the medical part. I'm going to take care of any fertility shots or surgery they might need. But they say, "But what can I do so that we can be in partnership with this?" And I totally agree. Sleep, stress reduction, whether that's through meditation, prayer, deep breathing, yoga, making sure they're getting enough water. And keeping a really regular schedule. You know, our lives are so busy and we can't control it perfectly, but there are choices we can make to try to go to bed at the same time, wake up at the same time. When our body feels that rhythm, we can relax a bit. And I do think all of those things will not only make life more enjoyable, but also may promote fertility.

And there's more and more articles coming out within the medical literature that support this, that look at antioxidants and oxidative stress, that look at inflammation and different markers from a very scientific level. Many of these studies are still observational. They may have some bias in them. But I do think bit by bit we are uncovering that this is sort of a hidden secret, another way to help improve the outcomes for fertility treatment. And so, I love being able to work with patients who are really taking charge of what they can do and taking charge of their nutrition and their exercise, whether that is just daily walking or if it's doing something a little more rigorous, I can help them tailor that to be safe during fertility treatment.

Host: That's great. I mean, just trying to get pregnant if you're going through IVF, et cetera, is stressful enough, but it's good to be conscious of it. And like you said, yoga and exercise, that all helps. Are there any foods that should be avoided during IVF? And what about during early pregnancy?

Dr Mary Hinckley: That's a good question too, one that I get asked quite often, especially in terms of IVF. There really aren't any foods that we say you absolutely need to avoid. There are some things that might be helpful, like we've mentioned in terms of being more anti-inflammatory or having oxidative benefits. But in terms of things that might harm you or negatively affect that two weeks while you're doing stimulation, there's nothing that patients are going to do that are going to dramatically change the outcomes we have. However, in early pregnancy, there are. There are definitely recommendations that we make for that. Bonnie, I'm sure you can give a little bit of information on this too, since you also cover early pregnancy care for patients in their diet. But ours are really avoiding things that could be contaminated with bacteria, making sure things are pasteurized, making sure things are well cooked and washed, like Bonnie said earlier. Those are some of the most important things that I recommend in early pregnancy.

Host: I have to tell you, when I was pregnant, I avoided everything just to be on the safe side. I wouldn't eat meat or raw fish or shellfish. Oh my gosh, I was so over the top. And I didn't even know any of this. I just thought, "That can't be good. I have to be careful." But it's good to know the facts and what you should be avoiding.

Bonnie, what other groups of patients do you see frequently who have fertility needs that diet and nutrition might help with?

Bonnie Burgess: Yeah. Interesting piggyback off of your comment, Maggie, "I wasn't sure, so I just avoided it all." And I do think that people tend to overstress about food. And so, that can be a reason somebody talks to me to figure out, "Okay, here's some clarity. Here's what you can control." And to Dr. Hinckley's point, you're not going to ruin things by your diet. It's a bit more subtle than that, but there's a lot that you can do to help, at least, during fertility. Yes, you want to be careful of a few buckets of things in early pregnancy.

But especially just to call out kind of a few categories that can really benefit from nutrition and in particular an anti-inflammatory diet, I mentioned PCOS, polycystic ovarian syndrome, obesity, endometriosis, autoimmune conditions. And then something that we haven't touched on, but gut health conditions. So, IBS, inflammatory bowel syndrome, as you can imagine, yes, there's an inflammatory component, that there are all these different circles that we've talked about can then affect fertility.

And then also, on a more general level, maybe repeat pregnancy loss. So if it's still undiagnosed what exactly is going on, perhaps because inflammation does affect egg and sperm quality and can cause chromosomal abnormalities, diet's a great way, diet and lifestyle is a great way to just make sure you're stacking the deck in your favor.

Dr Mary Hinckley: Especially with recurrent pregnancy loss, there's a portion of those patients that might have blood sugar problems and insulin problems. And so, I really see some of what Bonnie was mentioning before as being important to uncover which patients might that be a problem for, and how can we optimize that. Because we clearly know that PCOS and diabetes that's associated with an increased chance of miscarriage. And so if someone's having recurrent pregnancy loss or recurrent miscarriage, we need to investigate that medically and then optimize them from not only what foods they're eating, but how and when they're eating.

Host: I didn't hear about caffeine. Does that play any part either way?

Bonnie Burgess: That's a funny one because on one hand, coffee, so a lot of people's main source of caffeine has some antioxidant properties. Likewise green tea, really powerful anti-inflammatory. But then, you've got the caffeine on the flip side, which can raise cortisol, which we talked about promotes inflammation. So, that's a bit of a personalized question. What's their total level of inflammation and is this just like topping the pile and doing more harm than good? How much caffeine are they taking in? Are they pairing it with food? If you take away nothing else from this podcast, please pair caffeine with food. So, that's a tricky one, but a good one to discuss.

Dr Mary Hinckley: We give a little more specific information to patients when they're going through IVF, for example. We'll really advise them to cut back on caffeine, because of blood flow issues to the ovary. There's been some studies that have hinted at possible connection between that. And so, we try to get people down to maybe one cup of coffee a day. And then in early pregnancy, similar, we have some studies that have indicated there are certain milligram levels of caffeine that might be more associated with miscarriage. So, studies have varied a little bit, but we try to get people under about 200 to 300 milligrams of caffeine. And so, that means usually trying to keep it at about one cup a day.

Host: What about decaf?

Bonnie Burgess: If it feels like somebody can tolerate caffeine, and they're not going through excess because, yes, you could have about five cups of decaf coffee and probably top your limits that we're trying to keep them under. Because you're right, even decaffeinated does have caffeine, smaller amounts. When it comes to coffee, and this is definitely relevant to the anti-inflammatory question, there's a few different processes by which it can be decaffeinated because the beans are going to be caffeinated no matter what. So, they could either use chemical processes, which would add to the inflammatory load of that drink or, a good one to look for is water processed or Swiss water processed. So, I highly recommend looking for that process with water over chemicals and also looking for an organically cultivated bean. Coffee is one of the more highly sprayed agricultural products.

Host: And in closing, Dr. Hinckley, is there anything else you'd like to add that you would like people listening to know?

Dr Mary Hinckley: Well, I thank them for taking the time to care about their health and to help us as we take care of them and their fertility needs. So hopefully, this has sparked their interest. I mean, by no means have we covered everything and we haven't gone even very deep into this burgeoning field. So, feel free to ask me about it when you're seeing me for a visit and you call in to rscbayarea.com or reach out to Bonnie. She's a great resource for really helping people dive deep into their fertility and how nutrition may be affecting it.

Host: Thank you so much, Bonnie. Anything else you'd like to add?

Bonnie Burgess: Yeah. Just to piggyback on the point earlier that there's a lot that we covered in this talk, and it can be intimidating, but getting support, whether it's from me or your reproductive endocrinologist that can help clarify the role of diet and lifestyle, not only set you off in the right direction in a personalized way, but with peace too. So, it doesn't have to be scary and intimidating.

Host: That's a good point. Dr. Hinckley and Bonnie, thank you so much for your time today and for talking about this topic and educating us. It's been fascinating and informative and I wish I knew it when I was pregnant. Or before I was pregnant. We appreciate you sharing your knowledge. Again, to find out more, please visit burgesswellness.com or rscbayarea.com or, more specifically, rscbayarea.com/treatments/integrativemedicine/fertilitydietpregnancy.

If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. This has been Fertile Edge, a podcast from the Reproductive Science Center of the San Francisco Bay Area. I'm Maggie McKay. Thanks for listening.