Maggie McKay (Host): If you're struggling with fertility issues, you may not be aware of something that could be hampering your efforts. It's sugar. So today, we're going to talk about how it could impact the chance of getting pregnant with our guests, Dr. Mary Hinckley, Medical Director of Reproductive Science Center of the San Francisco Bay Area; and Bonnie Burgess, Fertility Nutritionist and Founder of Burgess Wellness.

Welcome to Fertile Edge, a podcast from Reproductive Science Center of the San Francisco Bay Area. I'm your host, Maggie McKay. Thank you both for joining us today. Dr. Hinckley, and Bonnie, would you please introduce yourselves?

Mary 'Ramie' Hinckley: Yes, it's so nice to be here. I love getting a chance to do these podcasts with you, to be able to educate our audience. And I'm one of the Physicians and Reproductive Endocrinologists at the Reproductive Science Center of the San Francisco Bay Area.

Bonnie Burgess: And I'm Bonnie. Thank you so much for having me on. I usually work with people one on one to figure out their personalized nutrition for fertility or perinatal health, and it's great to educate on a larger scale.

Host: Well, I can't wait to hear more about this. So, let's get into it because I remember when I was pregnant, and I am a sugar fiend. It's the only time in my whole life I gave it up. Probably the best time to do that. But I had no idea sugar played such a part. So, let's talk about sugar and fertility. Bonnie, how can a patient's diet affect their ability to get pregnant?

Bonnie Burgess: Just to lay the scene, age is number one, the thing that's going to affect fertility. But then, close second and the thing that you can actually control, is diet and lifestyle. So, the food that you eat provides the building block for hormones. The nutrients affect how the egg and sperm mature and then affects their egg quality. It can also affect the health of the endometrial lining and how the embryo develops and the embryo's quality as well.

Host: And Dr. Hinckley, would you like to add anything?

Mary 'Ramie' Hinckley: Well, the other thing to add to that, which was perfect, was just that a woman's diet, and even a man's diet, can affect whether the woman's having normal cycles, whether she's even ovulating. I mean, it can be that basic. So without a proper diet, we really can't even begin to address their fertility. So, taking care of this even before you step foot into a reproductive endocrinologist, IVF center is a great idea because like Bonnie said, it's something you can control.

Host: So Dr. Hinckley, how does dietary sugar affect fertility, eggs, and sperm?

Mary 'Ramie' Hinckley: Well, we're still really trying to understand that and there's been a lot of research and a lot of interest even more and more recently. But I think we really feel that glucose, although essential to running our bodies, can actually result in harm when it's not maintained in the ideal levels. And sometimes that's through insulin. And so, people have heard of diabetes, people might have heard of insulin resistance or glucose intolerance. And so, a lot of the research has actually looked at that. It's looked at the effects of insulin resistance on mature eggs, mature oocytes, and the blastocysts, which are embryos, formation and the quality. It's looked at immunity through B cells. It's looked at diseases like polycystic ovarian syndrome, and it's evaluated how glucose may be playing a role, perhaps mostly through insulin, in affecting the quality of eggs, the quality of sperm and even the ability of the uterus to land and hold on to an embryo. So, it can really affect all three of those, not to mention the growth and health of the baby throughout the pregnancy. But today, we're mostly speaking about fertility.

Host: Bonnie?

Bonnie Burgess: Well said. The research is really interesting and something that I like to share with people is that when people are even in the pre-diabetic range, so you don't have to be a diabetic to see effects of sugar impacting fertility. And the way that it might affect would be causing some inflammation in the body that can affect, like Dr. Hinckley talked about earlier, hormone balance and just having a regular cycle at all. It's hugely impactful on regular ovulation. Sugar affects the microbiome. And then, at a basic level, it displaces key nutrients. You know, we have only so much we can eat in a day. And if you're having lots of sugar, you're probably missing out on really important key nutrients.

Host: Does that mean if, let's say, you have a green smoothie with, you know, kale and spinach and everything, and then you have sugar later in the day, does the sugar cancel it out?

Bonnie Burgess: Not necessarily. You're still getting good nutrients, for sure, from that green smoothie. It might dysregulate your blood sugar and cause more insulin resistance. One of my favorite tricks in terms of how to incorporate sugar in a least damaging way is having the sugar paired with some healthy food, something that has good fiber like that green juice, depending on how it's made. Some fat and some protein, and then you might not get such a glucose spike and lead to insulin resistance and some of the things that we were talking about. So, the green juice can be helpful in that way too, not just for its nutrients.

Host: Bonnie, how should patients think about sugar intake as a part of their daily diet? I mean, you touched on it a little bit just now, but how should they change their thinking on that for when they're trying to get pregnant?

Bonnie Burgess: I think being more rigorous about the sugar that you want to have in your diet. There's a lot of sneaky sugar, I call it, out there. So, sugar that is in a lot of prepared foods and processed savory food that you might not even appreciate. So first off, just be really rigorous with what type of sugar you have and make sure that you're enjoying it for the sake of sugar and it's not just all over your diet and you're not even aware of it.

And then, the second is when you have it, pair it well. So, not having that sugar on an empty stomach. A lot of times I hear of people, they need an energy boost. You know, it's mid-afternoon, they're feeling a slump, and they reach for the sugar because they know that's going to give them a sugar high. That's exactly when you don't want to have the sugar. You need something that's going to sustain your energy. Like I said earlier, some good protein, some good fat, some good fiber, and not just a sugar boost. So when you have your sugar, pair it well. Dessert is a great concept.

Host: How about a banana instead of a cookie in the afternoon?

Bonnie Burgess: It depends on the person. For some, people that's too much sugar. But bananas do have fiber, and so that's absolutely a better choice than the cookie, for sure.

Host: What foods have a lot of sugar and how can patients reduce eating that or at least learn about it?

Bonnie Burgess: Yeah. So, like I alluded to earlier, there's some sneaky sugar in savory foods, so take a look at your packages. Things like sauces, condiments, soups are big ones. And then, there's the obvious sugar, cookies, pastries, candy. And then, there's the quote unquote healthy foods that pack a lot of sugar in them, so things like kombucha and smoothies and dried fruit. Those have a lot of sugar. So for context, I usually recommend that people try to keep added sugar in their diet under about 30 grams, depends on the person. So, that gives you a bit of context when you're looking at a package of soup that has 15 grams of sugar in it. That savory thing just smashed half your sugar intake for the day.

In terms of how to go about reducing it, I think first just bringing awareness to the sources of sugar in your diet, and then also awareness to how it's affecting you, how it's making you feel. For a lot of people, it gives you an energy crash and maybe even some anxiety after that burst of sugar has worn off. And that can be really effective to curbing sugar cravings if you know that it's going to get worse after.

Host: And how else can lowering sugar help patients? What about substituting artificial sugars also?

Bonnie Burgess: So, like we talked about earlier, pregnancy is a really important thing to think about, right? Your journey doesn't end at fertility. The high intakes of sugar and insulin resistance can cause complications in pregnancy, so you can prepare early for that. You also just feel better when you reduce your sugar intake. You usually have better energy, better moods, better sleep, so there's lots of even short term reasons to consider reduction in sugar.

Artificial sugars are a common replacement. There's an interesting study that looked at both regular soda and diet soda, so diet having artificial sugars, and both negatively impacted egg quality. So, you don't get a free pass necessarily with artificial sugars. They can also contribute to inflammation, certain ones impair thyroid function. There's better artificial sweeteners than other. Better might be stevia and monk fruit, but the jury's still out in terms of how that might affect you. So, I don't think it's a free pass to have artificial sugars.

Host: I think it's shocking how much sugar is in certain coffee drinks, won't mention which chain, but I wonder if people know. Like I'm not a coffee drinker, but I did try a chai latte and then I got hooked. And then, I thought, this is way too good. It's got to have a lot of sugar. It had like a ton, like not 50%, but close. And I thought, oh my gosh, unless you looked it up, you'd never know. So, should you avoid things like that? I'm guessing.

Bonnie Burgess: I would say if that is a really difficult change to give up that sugar, and that's the only sugar in your diet, and you pair it well, so you have it, say, with breakfast that has some eggs and greens and avocado, you know, you have a really substantial meal so that you're not digesting that sugar on an empty stomach, maybe it's okay, but that is a lot of sugar.

Host: It is. And I never knew that you shouldn't eat sugar on an empty stomach. It makes perfect sense. But I can't tell you how many times, you know, like when you're fasting, the intermittent fasting, and sometimes I might have a cookie first thing. And now, I know don't do that. Ah, okay. Dr. Hinckley, does sugar intake affect all people the same?

Mary 'Ramie' Hinckley: Well, probably not. I mean, you can look around at people who eat a lot of sugar next to you and they seem to be doing fine. Their mood doesn't change. They don't get anxious and irritable. You can look at people who eat a lot more just in terms of volume and their metabolism's different. We also know certain people have predispositions genetically. I mean, you can look at families that have a lot more diabetes. You can look at families that have PCOS. And those people are going to probably be more affected in terms of fertility from their diet. And so, I think at the extremes of fertility, when people aren't ovulating, when people are running into diminished ovarian reserve, when sperm count is already low, those are the people that really need to help in every way, with diet, with exercise and with medicine that we provide in our offices. And I think that combination is going to create the greatest effect and help them overcome their infertility.

Host: You mentioned PCOS. For people who don't know what that is, could you explain that briefly? And also DOR?

Mary 'Ramie' Hinckley: Oh, yes. So, PCOS stands for polycystic ovarian syndrome, and it is a common hormonal issue for women. There are women who will never see a doctor and never be diagnosed with it, but the majority of women might run into problems with irregular cycles, acne, maybe hair growth, and then especially if they're in the fertility context and being seen by a practitioner, they maybe have on ultrasound multiple little cysts on their ovaries. And we think that this has a lot to do with insulin and dysregulation, at least in many populations of people with PCOS, although it is a syndrome, which usually means doctors are still trying to figure it out.

DOR refers to diminished ovarian reserve, and those are women whose hormone levels are lower than we would expect at their age. Perhaps their AMH, or antemullarian hormone, is low. Perhaps their antral follicle count, or what it looks like on their ovaries, is less than potential eggs than we would expect at their age, or maybe their FSH, follicle-stimulating hormone, is higher than we expect, indicating that the ovary is more resistant and requiring more hormones from the brain to even get up and do its job of ovulating. So, those two populations probably will benefit more from really looking at their diet and their nutrition.

Host: Bonnie, what do you have to add?

Bonnie Burgess: Dr. Hinckley identified that insulin resistance could run in families. And so, just the fact that insulin resistance varies from person to person, there could be a genetic component to it, there could be a hormonal component to it. But if somebody is okay with their insulin, their pancreas is working well, their cells are responding well to it, they could have that chocolate chip cookie and the body would do what it's supposed to, clear the sugar from the bloodstream, get it to where it needs to go without causing a ton of damage versus somebody, unfortunately, with insulin resistance, the cells are not going to take that sugar as quickly and it's going to wreak a lot of havoc. So, I pay a lot of attention to the degree of insulin resistance that someone has and to be aware that that's not just the diabetics, it's prediabetic and even pre-prediabetic ranges of metrics like hemoglobin A1c is a common metric to test insulin resistance.

Host: Wow. Well, I have learned a lot for one, and I'm sure people listening are going to be so grateful to both of you for sharing your expertise. We really appreciate it. Thank you for being here.

Bonnie Burgess: Thank you so much for having me.

Mary 'Ramie' Hinckley: Yes/ and we've loved doing this. And this is just the tip of the iceberg. So if patients are interested in this, if they're looking for other ways to optimize their fertility, to be able to conceive naturally and have healthy pregnancies, or even to increase their success rates, with fertility treatment like IVF, please check out more podcasts like this on our website. Feel free to ask us, your physicians, when you're having visits with us, or look more into Bonnie's website and having a consultation with a practitioner like Bonnie Burgess, where you can get a really deep dive into your own diet, your fertility, and how that relates to that diet, and then be able to come up with really concrete solutions that might be able to help you towards an improved fertility and an improved quality of life.

Host: Great idea. Again, that's Dr. Mary Hinckley and Bonnie Burgess. To learn more about your fertility and to schedule an appointment with an RSC Bay Fertility Specialist, please call 888-377-4488 or go to rscbayarea.com or burgesswellness.com. That's B-U-R-G-E-S-S wellness. com. And 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. I'm Maggie McKay. Thanks for listening to Fertile Edge, a podcast from Reproductive Science Center of the San Francisco Bay Area.