b vitamins & pcos

b vitamins & pcos

Today I’m really excited to talk to you about a group of vitamins really vital for female health useful for ladies particularly with hormone dysregulation, PCOS and weight issues.

The B vitamins are very important in helping to improve the symptoms of PCOS. In nature if we get a balanced diet we get lots of the B vitamins in things like Meat, Fish, Eggs, Milk and green leafy veggies. If you want to have them in one source ie a vitamin, Its really important to make sure you have these vitamins in a combined formula as they all work together on different elements!
 
Vitamins B2, B3, B5 and B6 are particularly useful for weight and maintaining and managing it. One of the B vitamins – Vitamin B2( riboflavin) helps to turn the food you eat via fat, sugar and protein to the energy we need to survive(its also the one that turns your wee bright yellow!)  B3 another vitamin, s an important co-factor in supporting glucose tolerance factor (GTF), GTF is something  that allows your body to keep an eye on blood sugar . It needs vitamin B3 to help this process, almost like food for your GTF! Vitamin B5 is also important as it helps your body metabolises fat, so important if you are overweight and need to lose weight to qualify for fertility support!  B6 is also marvellous as it supports proper hormonal balance and may be one deficiency present if you suffer from PMT. It helps to maintain blood sugar, oestrogen and also progesterone and helps in mood regulation via serotonin. Many women with PCOS have deficiencies in this and also low progesterone, so worth topping up your levels with B6 in this case. B6 is also part of a ‘gang’ with B2 and B3, that will help your body to make and move thyroxine, needed for normal thyroid hormone production.

Let’s not forget folate B9! Many of you maybe on folic acid for your fertility as this is the basic component of many B complex vitamins. However I like to super charge my ladies and always go for the superior version of folate called Methlyfolate. Folate is such an important substance, its not just needed for helping to prevent Spina Bifida and Neural tube defects, its needed for all our cells to replicate which happens hundreds of thousands of times a second in our bodies, so vital for health, not just to get it in supplement form but in natural forms through leafy greens!

Folate works in conjunction with B12 also a co-factor and together they help to reduce a substance or by-product of methylation called homocysteine. This can have implications of cardiovascular issues if too high and homocysteine can creep up if taking metformin, without replacing both B12 and folate in the diet.

Deficiencies in these vitamins can happen easily if you have an inflammatory condition like PCOS, so having a great combined  B vitamin will enable the body to maintain balance more easily so it can do its job!

B12 is an important vitamin and many people are deficient in this mineral. It is found in lots of foods such as Meats, fish and dairy, so often vegetarians can become deficient in this vitamin,  particularly people who don’t eat a healthy diet. B12 together with folate is really needed by the body to help cell replication and DNA, which we need constantly as cells die and are replenished. When we eat protein B12 is released and is then further broken down by something called intrinsic factor which helps B12 to get absorbed into the blood stream. You need good levels of Hydrochloric acid for B12 to be released so for many this may be the issue of constant low B12 despite supplementation. So taking some cider vinegar in war water before food helps with stomach acid support.  B12 becomes deficient in the body by using metformin, so it really important to take this to help red blood cells and oxygenated blood travel round the body. Thorne Research Basic B has a super absorbable B12 called Methylcobalamin in it, which is an excellent version of B12, and one of only 2 I recommend together with Adenosyl cobalamin and Hydroxocobalamin. I’m not a fan of the standard  B12 forms you see in most supplements – Cyanocobalamin. I’ll be honest it isn’t my favourite form as it uses cyanide as a binding factor instead of more natural forms. It is a very small amount and we do have naturally occurring cyanide in some food, however I like my B12 without a side order of poison personally!  So if you, like me, are not into this, always read the labels of supplements to see what’s in them and if possible go for active b Methylfolate.

The B vitamins are also essential for the liver , which has 2 phases. The first one processes substances such as hormones and toxins and metabolises them – B vitamins particular B2, B3, B6, B9 and B12, are important at this stage. The second stage is where these substances are ‘ conjugated’ . B vitamins do their thing at this stage also and help the liver to get rid of  excess and old hormones so they can be eliminated by the body. If you have PCOS its more than likely you have an excess of oestrogen, so this is where B vitamins can really help your liver!

Here a diagram to show how well absorbed methylfolate is in the body compared to folic acid as well as where B12 and Homocysteine come into things as we break the vitamins down via food and supplements for the body to use.

Many ladies with PCOS I’m working with are having great results combining this supplement with Inositol which also helps regulate blood sugar via the insulin receptors. It also works on the liver to support its function and in trial has supported reducing higher FSH and reducing oestrogen. In trails particularly for IVF this has helped egg quality and also improved outcome in IVF. There are also loads of studies on using Inositol for PCOS.

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1.    http://www.ncbi.nlm.nih.gov/pubmed/15644580

2.    http://www.obgyn.net/polycystic-ovary-syndrome-pcos/hormone-levels-and-pcos

3.    http://www.naturalnews.com/027045_vitamin_B12_cyanocobalamin_methylcobalamin.html#  
4.    http://www.ncbi.nlm.nih.gov/pubmed/11304860 B12  

5.    http://ajcn.nutrition.org/content/85/1/265S.full 

6.    http://pubget.com/paper/17952759/myo-inositol-in-patients-with-polycystic-ovary-syndrome-a-novel-method-for-ovulation-induction 

7.    http://www.ncbi.nlm.nih.gov/pubmed/21300338

8.    http://www.ncbi.nlm.nih.gov/pubmed/21463230 

9.    http://www.nejm.org/doi/full/10.1056/NEJM199904293401703 

10.  http://www.ncbi.nlm.nih.gov/pubmed/18854115 

11.  http://www.ncbi.nlm.nih.gov/pubmed/18854115 

12.  http://www.ncbi.nlm.nih.gov/pubmed/18854115

insulin resistance PCOS diet

insulin resistance PCOS diet

Many women diagnosed with Poly Cystic Ovarian Syndrome( PCOS), suffer from insulin resistance ( approximately 50-70%) and it effects 1 in 15 women worldwide.  Lets bring it right back to basics and go into a little physiology to understand what this is all about and how this impacts your fertility.

What is Insulin and why do we need it?

Insulin is used in the body to maintain the levels of glucose. In the body glucose is a key energy source primarily for the brain and blood cells. Many other tissues can use fat and protein to gain energy but red blood cells and the brain really need glucose.  The liver is the main storage unit for glucose.

Insulin  is the helper hormone directly tied to glucose that allows you to maintain some sort of normality in energy and metabolism management. You get glucose in the body when you break down and eat carbohydrates. Insulins total role is to pull glucose from the blood or store it for later. As a crude analysis it does this by  ‘ dip testing’  to see if levels are dropping to hyperglycaemia,  and it then pulls glucose out of the stores in the liver, or if its too high it will grab all the glucose floating free and store it. When you become insulin resistant it’s almost like the hormone insulin forgets how to do its job and it doesn’t know when to store or pull glucose from the blood, as it gets overwhelmed by the amount of glucose being poured into the blood and therefore becomes less effective at lowering blood sugar. Over time this will have an effect on the endocrine system. With ladies who are polycystic the endocrine function, ie the key organs that support and produce hormones, that regulate metabolism, growth and development, tissue function, sexual function, reproduction, sleep, and mood are sending the wrong signals and over time can create an imbalance. This will happen from the very beginning of the cycle and can cause mild to severe hormonal imbalance, this result s in issues with all the above, ie low libido, or higher and inability to lose weight, hirsutism ( excess hair growth), weight gain, cystic acne,  mood swings, sleep issues and anovulation  (absent menstrual periods)  to name a few.

How does having insulin resistance or PCOS effect fertility?

The body is always working to balance things and is a finely tuned system or almost an orchestra of all sorts of instruments that come together to bring on ovulation. If one of these hormones is ‘out of kilter’ the endocrine system will step in to send out another hormone to correct this. This is exactly what happens with Insulin. The body detects something isn’t working and has repeatedly not listened to the key command, so it sends in another hormone in the view that higher levels of this will tip the other levels to the right function. However this causes all sorts of issues if this goes on for a while.

A woman’s cycles

At the beginning of a woman’s cycle on day one the tag team will be in place to send out hormones to prime her for ovulation. This goes from Gonadotropin Releasing Hormone (GnRH), to Follicle Stimulating Hormone (FSH), to Luteinising Hormone (LH), to Oestrogen then Progesterone. ( you will be tested for the majority of these when going to the GP for blood work)

In women with PCOS and insulin resistance, the GnRH will detect higher Insulin and pulse out more GnRH than normal to balance, this then sets the tone for the rest of the cycle as LH will then rise too high, too early,  (this is the hormone that indicates the egg must be released from the follicle and should in most cases be a short lived hormone)  Having a high level of this gives the indication that follicles are now ready to pop and reduces FSH almost before it has had time to do its thing. This then leads to excessive production of the big players oestrogen, and then androgens  ( Testosterone and  androstenedione) and then oestrogen dominance becomes a fixture.  The ‘poly’ in the diagnosis comes from the fact that lots of follicles will try to develop but not fully mature. In a normal pattern, follicles develop then die away where one to two become dominate and this releases the egg. This will also have an effect on progesterone the hormone that maintains pregnancy and womb lining and in many situation women with PCOS will have low progesterone levels.  In most cases ovulation falls short as the egg won’t have been able to grow sufficiently to produce a viable oocyte.  Women with PCOS will have a very real indication the cycle isn’t working as there is no period to speak of for many months or a very long cycle over 35 days. A normal cycle is a  process where lining is broken down and built up as the hormones come to play throughout the month and is usually between 26- 33 days.

Managing my insulin, looks like the key that unlocks this problem, so how can I help improve insulin resistance?

A huge way to help improve insulin resistance, is through most probably the very source of this issue in the first place, – diet!  I’m not normally a calorie counter, or a believer in ‘ group weigh ins and slimming clubs’  or foods you can buy that tell you how many points you have, its all a gimmick to me especially after watching ‘ the men who made us fat’  Our ancestors never lived like this. What I do believe in is following traditional wisdom.  Why break what thousands of years have honed?  instinctively our ancestors just knew what worked and ensured fertility year on year!  I believe based on the old model emphatically in  reducing our reliance on processed white/baked and ‘pants’ foods that give us zero nutrients but provide the massive ‘ deafening’ effect on our poor old insulin to the point that it is now causing the hormonal epidemic in our modern lives.

So what is the diet you talk about?

In order to ‘reeboot’ your bodies ability to ovulate we need to go back to basics and cut out starchy carbohydrates to a large degree and focus on protein and fat. Remember what I said at the start of this article about the brain and the red blood cells being the only ones needing glucose? All other tissue can work on protein and fat as fuel, so what we need to do is trick your body back into line by maintaining a blood sugar level that is primarily fuelled by  some very basic ingredients: Protein/legumes and veg and very simply cooking like your Great grandparent made!

Foods to Help Balance Blood Sugar Levels

Here is a list of  a few of my seasonal choices of food for winter. The trick is also to have 3 protein balanced meals. Starting off with to set the blood sugar at least 20-30g of protein in the morning.

Protein – I would generally get clients to go organic  (as the conventional ones will only exacerbate your oestrogen burden as the animals are pumped full of this to overproduce) so buy more protein from animals and if veggie vegetable sources. If you eat animal products choose grass-fed, organic and free range animal products. A woman needs to consume 60-70g grams of protein per day while trying to conceive.

  • Free-range organic chicken, lamb beef ( pork can contain some contaminants, so avoid for now) make sure its all fresh cuts and not processed!
  • legumes/beans like chickpeas, lentils and black beans
  • Nut and seed butters: Sunflower seeds, sesame seeds, pumpkin seeds, almonds, walnuts, chia and hemp seeds, and Brazil nuts.
  • Cold-water fish, Free range organic eggs and chicken, grass-fed beef and grass fed dairy (go for sheep yogurt as this seems to be less inflammatory) If in the UK you can get this in Waitrose
  • Carbohydrates – All veggies are carbs, so when you say ‘ I’m on a no carb diet, not strictly true!  Choose fresh not frozen too. Some people think that eating carbohydrates will make them gain weight, but the fact is that eating too many of the wrong carbohydrates (pastries, crackers, white pasta, white rice, etc.) is what results in weight gain as they have zero nutrients. Also starches and fibre feed your gut bacteria which can also help you with weight. Whole food sources of carbohydrates contain important nutrients that can help you feel full longer and give your body energy.
  • Whole Grains – bread/crackers/rye/pasta  – limit these for now,   (ie oats once a week) as they will breakdown in the body to glucose, you can introduce them once things are balanced again!
  • Fruits –again as this breaks down to fructose and then eventually glucose limit fruit to 2 servings daily in season at mo are apples, pears and blackberries
  • Vegetables –carrots, Brussel sprouts, greens, sweet potatoes (not white potatoes) and artichokes, cabbage, turnips, kale, chard, leeks, onion, garlic, turnips, parsnips broccoli, cauliflower, Kale
  • High fibre foods – Fibre helps remove excess oestrogen from the body which can be helpful for some reproductive imbalances. Dark leafy greens, brassica vegetables like broccoli and cauliflower, quinoa and beans and lentils.
  • Spices – Horseradish (fresh root as opposed to a prepared sauce), garlic, onions, cinnamon, fenugreek, tarragon, coriander and allspice.

Women living with PCOS who educate themselves about healthy nutrition for PCOS are more likely to be successful at changing their health.

Changing your diet will have a huge effect on your ability to balance your hormones and I have had many success stories. Taking out gluten is one of the first things you can do, which will really help you to lose weight, I’ve had ladies drop so much weight in 3 weeks who did this! ( and that doesn’t mean replacing it with ‘ gluten free options/ as these are starchy carbs also!  )

Start being a health detective and go right back to basics. Maybe even investing in a slow cooker? These changes will start to take hold after around 1 month and you will need to follow this for at least 3-6 months to see changes.

While it may seem daunting to have to change your diet, it is one of the best ways you can improve insulin resistance and your overall health, with the added benefit is increased in fertility.

The sheet to the right is an example of  the diet I honed after many years as I also suffer from PCOS to a mild degree due to genetic issues with insulin

Supplements for PCOS

I’m always asked about supplements as a nutritionist and many of the ladies I see with PCOS are at the stage that they are chucking in anything they have seen working on forums all over the net.  As a practitioner I like to ‘ Heal with food’ as add too many supplements in the mix and you really don’t know what is working and what isn’t. Undoubtable like many ladies diagnosed with PCOS who are trying to conceive, you may be on a raft of medication that will ‘ mug’ you of a lot of your vital nutrients. The basic approach I like to suggest is only the bare minimum until I can really see if the food is healing and if not working as fast and needs a jolt after the first month, that’s when I add more supplements.   Also I’m a  trained professional and can only advise on things based on a consultation where I go through specifics. Many of you have been asking each other for advice recently on specifically things like maca and vitex which are herbal medications. This is very personal and can be very powerful ( after all its where all out modern medicine comes from in the first place) so be careful ‘ self prescribing’ as it can interfere with your hormonal balance and any medically prescribed medication.  

References:
1. http://www.ncbi.nlm.nih.gov/pubmed/9467578

http://www.ncbi.nlm.nih.gov/pubmed/11397835

2.Philip M. Sarrel, MD. Androgen. HealthyWomen.org.http://www.healthywomen.org/condition/androgen
3. The National Diabetes Information Clearinghouse is a service of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. Insulin Resistance and Prediabetes. http://diabetes.niddk.nih.gov/dm/pubs/insulinresistance/#metabolic NIH Publication No. 14–4893 (June 2014)
4. About Polycystic Ovarian Syndrome: Types of Medical Treatment.http://www.pcosfoundation.org/types-of-treatment
5. PCOS Nutrition Center. What’s Your Protein-To-Carb Ratio?http://www.pcosnutrition.com/links/blogs/whats-your-protein-to-carb-ratio.html

6. Anna-Marija Helt, Ph.D. CH, personal communication, May 2014.

7. Chris Kresser ‘ The right and wrong way to balance hormones http://chriskresser.com/the-right-and-wrong-way-to-treat-hormone-imbalance

8. Effects of Myo-inositol supplement on oocyte quality in PCOS patients

9.The rationale of the Myo-Inositol and D-chiro-Inositol combined treatment for Polycystic Ovary Syndrome.http://www.researchgate.net/publication/263858485_The_rationale_of_the_Myo-Inositol_and_D-chiro-Inositol_combined_treatment_for_Polycystic_Ovary_Syndrome

bridget jones’s baby – is having a baby over 40 good or bad?

bridget jones’s baby – is having a baby over 40 good or bad?

Bridget Jones is a well known figure in popular culture, and I’m a huge fan! If you haven’t seen the most current 3rd instalment of the films based loosely around the Bridget Jones Diary I urge you to as its ‘bang on’ so to speak in terms of what is happening right now with women in the UK who want to have babies.

For me having a baby over 40 is always something I celebrate in my line of work! As a fertility Nutritionist I’m inside an ‘ older mum bubble’ , where anything is possible, however when I venture out and meet people ( which I occasionally do!)  its almost whispered that its ‘not right’ or that ‘it’s a bit of a worry isn’t it?’ In fact having a baby at 40  seems almost as taboo as a teen pregnancy according to ‘ word on the street’!  Thankfully this is beginning to change, and lets hope in some small way Bridget will have helped in this quest!

The message that you are almost irresponsible even trying over 35 is plastered everywhere. It is even worse if you are over 40 as when you start trying it all seems to become more scary as are the messages about potential birth defects, miscarriages, and if by some miracle you have the child,  then there is the issue that they might have development issues and there is more chance of autism. The list goes on, and the stories I have heard about how it’s not a good idea to try after 37, are enough to age your eggs overnight and sew your own bits up! If it’s not enough hearing this from GPs or IVF clinics, the media coverage on this is certainly relentless, something that is repeated almost weekly in the many columns of broadsheets and tabloids. 

As a Nutritionist this whole issue of  ‘ old eggs’ and the ‘geriatric mother’ (as was mentioned in Bridget Jones’s baby)  gets me very riled up as its one of the fastest growing age group of women I have coming through my door in the last 2 years and its one I’m getting results with, despite the fact they are ‘ past it’ according to those in the know! This is anecdotal to my practice, but lets take a look at this more closely…

For the first time in decades women over 40 have now taken over the teen pregnancy rate. How’s that for a statistic? A more sombre statistic that ‘its not safe to have a baby over 35’ seems to be hitting home as this age group accounts for the largest amounts of abortions of any other more recently.

Also if we look back a few decades to the 1920s, being an older mum was more accepted. Many were even giving birth when grandmothers and 42 years old was a time when many stopped adding to their families.
 
Today,  an interesting statistic is  that many women in their 40s are also first time mums.  The UK Office for National Statistics figures show that pregnancy rates for over-40s are doubling and in the last years,  this has gone from  only a mere six per 1,000 to now
14 conceptions per 1,000.

Only recently an article in the London Standard mentioned that London is leading the charge for women giving birth to babies over 45. So there is definitely something going on out there with women not giving up or even coming into motherhood later on in life.

In fact, the true statistics about female fertility are far less scary than we are led to believe. Women do lose a lot of their eggs by 30, but that still leaves them with many tens of thousands, when only one is needed to make a baby. Something many ladies are not told in IVF clinics where  egg donation is offered if over 37, or if they have been trying for over 6 months.
 
Other scaremoungering comes from of all places the  journal Human Reproduction. But if you take a closer look at this article in 2004 the  statistic were drawn not from modern day but from birth records from 1790-1830.  When correct me if I’m wrong, there was no access to modern health care or nutrition and many were possibly only living to 45 anyway, so actively avoiding Sex. So no…. ‘Bridget Jones, wanton sex goddess, with a very bad man between her thighs!’ there!
 
The truth is everyone is different and if you  put in the work and follow a healthy lifestyle, diet and stress levels are managed appropriately, you just may well have the fertility of a 20 something!

In my view Fertility isn’t always age specific and there might actually be some truth in what I talk about daily that diet and tailored intervention  improves fertility at any age. A study in 1995 conducted by Surrey University and Foresight with over 300  couples ranging from 25-45 years old gave couples with previous infertility and miscarriages a tailored dietary and supplement programme over 2 years. During this time 81% of them went on to have healthy babies http://www.zestnaturalhealth.co.nz/preconception-care-and-fertility/how-effective-is-preconceptive-care/  similar studies are also being conducted by Foresight and also the University of New England.

Lord Robert Winston seen as a one of the grandads of modern fertility talked recently in a daily mail article about women’s fertility being sound until around 45, which might have raised a few eyebrows. I can’t corroborate this empirically but share his view, as do see a heck of a lot of women who are getting pregnant these days over 40.

I believe in fertility in older women wholeheartedly, as my own grandmother was part of this ‘gang’ and had my mum when she was 37. This isn’t an isolated incident and its shown to happen time and time again, defying the naysayers. Thankfully many I work with don’t give up, but to be honest with all the media attention about ‘Britain facing an infertility time bomb’ it can be very hard to cut through the negativity.

As always Bridget Jones is ‘On trend’ as it has been right from the first film! Let’s hope it starts a ripple effect, where ladies feel they don’t have to feel old and ‘past their sell by date’ when trying over 35,  or worry about the issues with their ‘ageing eggs’ Hoorah for Bridget is what I say and as Daniel Cleaver would say ‘ Hello Mummy’!

vitamin d and fertility

vitamin d and fertility

As we move into Spring and in the UK, with temps raising the mercury in the summer ( heres hoping!), I thought it was time I talked about how important the sun is in terms of how it creates the right environment for this specific hormone to work its magic in the body.  The reason I’m talking about this now is that the rays you gathered from when the clocks go forward, will have the desired effect you need to help all sorts of processes in your body come Autumn and Winter.

Can I get vitamin D all year, even if it’s a sunny day? – In a word no. The further away you are from the equator, the less chance for your body to feel the rays.  When the clocks go back, the sun is further away and you get way less UVB, which is what you need for you to produce vitamin D. In this situation even on what feels like a sunny day,  I wouldn’t bother getting you kit off in the cold for such a miniscule amount!

Over the years vitamin D has hit the headlines many times, and with empirical data evidencing the importance of it in the body, it has widely been accepted and embraced by the medical community and as such it’s no coincidence that in the UK GPs are now testing routinely for this and prescribing it to everyone from little ones to the elderly. Vitamin D is also on my mind as headlines last year look at how the right levels can help asthma.

Our main source of Vitamin D comes from our absorption of sunlight that mixes with saturated fats in our bodies, to create Vitamin D.

As the year progresses and we enter spring, the sun gets higher in the sky and therefore produces more intense UV rays, and its the UVBs that we all need!

With more intense sunlight we get more exposure to the rays, and therefore more opportunity to manufacture this important nutrient.

For those of us in northern hemisphere we are often plunged into often up to 8 months of the year of low rays, making it almost impossible to get enough sunlight, something we all need. Sunlight is so important for us a species and as UK peeps wait and watch, many summers in the past just haven’t cut it, and due to this there have been huge health consequences. This has promoted scientists to look into issues with long term health – a few summers ago there were children presenting in doctors surgeries with aches and pain and getting all sorts of illness, this was also linked to cases of rickets, https://www.theguardian.com/society/2017/dec/23/poorer-children-disproportionately-need-hospital-treatment  which is shocking to hear, but just shows how important it is to get outdoors when we have any sun and stop covering kids up with sun factor 50 in the summer!

It amazes me every summer when I start to feel the heat of the sun on my body, just how far away it is and yet it can make a huge impact on us and even cause sun burn! Sadly as the ozone layer began to thin and places like Australia and New Zealand were reporting cases of sun cancer as early as 1980s the campaign and worldwide demonization of the sun began.

I understand with skin cancer on the rise why the sun is so vilified to some extent. But we could not have evolved past single cells organisms without it – we’ve forgotten that photosynthesis supports most of the food chain on this planet.  And as mammals we use photosynthesis to make vit D as our first stop, instead of ‘fortified foods’.  The ‘skin Cancer’  message has been loud and clear, and has hit parents hugely. Even in places like the UK parents are slapping factor 50 on their little ones ( don’t get me started on parents using what can only be described as ‘ scuba suits’ for kids when they actually do go to hotter climates ( apart from Australia where you do need this!) No wonder there is a childhood epidemic of low vitamin D levels and Doctors force feeding drops down poor kids neck!  As much as I like supplements, the real deal is so much better!

More relevantly and as I get to the point  – the sun is vital for fertility.  Studies have looked into peak conception rates and this can be traced back to the summer month, not surprisingly when the sun is in full force! https://www.sciencedaily.com/releases/2017/05/170523084302.htm

There are many reasons for this, but new research highlights vitamin D as a key to higher conception rates.

Vitamin D is often referred to as a vitamin, it is in fact a steroid hormone and is important for good overall health and particularly to help build strong and healthy bones. It’s also an important factor in making sure your muscles, heart, lungs and brain work well and that your body can fight infection. We have vitamin D receptors in loads of areas of our bodies and some of us even have mutations on these receptor ( I’m one of them and I found this out by looking into my genes at 23andme )

Recent research has alluded to ways in which Vitamin D can cause issues with our health including a role in chronic diseases like diabetes, obesity and autoimmune conditions as well as cardiovascular disease and cancer.  https://www.ncbi.nlm.nih.gov/pubmed/26068917

Vitamin D status affects different cells in our body and more specifically organs. It does this as it actively turns on and off genes, which can mean cell growth or death.

Your body can make its own vitamin D from sunlight. You can also get vitamin D from supplements and a very small amount comes from a few foods you eat.

The vitamin D that you get in your skin from sunlight, and the vitamin D from supplements, has to be changed by your body a number of times before it can be used. Once it’s been converted the vitamin D receptors (VDR) in your body use it to manage the amount of calcium in your blood, bones and gut and to help cells all over your body to communicate properly.

Vitamin D is linked to so many issues:

Vitamin D is a natural antibiotic that assists White Blood Cells in clearing infections. It does this by stimulating immune cells.  This does not happen well in our gut, but works really well in our skin with UV rays as the catalyst. Many of my clients have issues with Natural Killer Cells, and I could almost bet their Vitamin D levels are low in this instance, which is what maybe the ‘ heightened’ immune response is all about!

There is also a school of though that looks at vitamin D and chronic inflammation and illness. There are some clinicians studying Vitamin D and as mentioned above its always best to look at both markers of active and stored vitamin D as systemic inflammation may cause an alteration in that dynamic. https://link.springer.com/article/10.1007%2Fs00011-014-0755-z

Age will decrease your skin’s ability to make vitamin D3 from sunlight and cholesterol. As we go from 20 to 60 years old, we lose the ability to convert Vitamin D hugely. So as we age, we need more sun or supplementation.

If we have  autoimmune diseases, we need much higher levels of Vitamin D from sunshine. Autoimmune conditions that are often associated with vitamin D deficiencies. Issues like endometriosis, PCOS https://www.ncbi.nlm.nih.gov/pubmed/?term=vitamin+D+and+PCOS  and thyroid issues, which in these cases will mean  you need a higher amount of Vitamin D, for your bones, muscles, oestrogen and immunity to work in the way it was designed to do. https://www.ncbi.nlm.nih.gov/pubmed/25407646

A report in the European Journal of Endocrinology mentioned a few key facts in relation to vitamin Ds importance in women.

One that is often overlooked by many IVF clinics is that vitamin D has an impact in terms of Invitro fertiliation (IVF) outcome and a quick scout around pubmed typing in IVF and Vitamin D will show up lots of published studies on this!

Anecdotally I haven’t ever had a client with PCOS without dangerously low levels of Vitamin D. In terms of the endocrine system and hormones, the root of all fertility, vitamin D is important to boost levels of progesterone and oestrogen, which regulate menstrual cycles and improve chances of conception.

Both genders require Vitamin D for different things in the body. In men, vitamin D is essential for the healthy development of the nucleus of the sperm cell, and it supports semen quality and count. Vitamin D also increases levels of testosterone needed for sperm development and sex drive.

Vitamin D is always hitting the headlines for all sorts of issues. In 2008, Australian fertility specialist Dr. Anne Clark found almost one-third of the 800 infertile men included in her study had lower than normal levels of vitamin D. She also looked at folate levels in conjunction with Vitamin D. When men made adjustments to lifestyle with dietary and supplement changes, fertility markers were dramatically improved.

If you’re Struggling with Infertility, it may not be the overall reason for fertility issues, as it is never just one things as we are complex beings, however it won’t harm you to do some checking under the hood, so I would speak to a practitioner to get Your Vitamin D Levels checked.

Vitamin D is so crucial to health that as a practitioner its in all my initial test grade panel! Doctors commonly use vitamin D which in clinical terms is  25(OH)D  However, this is not the final picture, and a truly knowledgeable physician would look at the Parathyroid Hormone level ( PTH) and  25(OH)D, together with  1,25(OH)2D  to get a true picture, as well as bone density as a third marker of how well the sunshine vitamin is being utilized in your body.

Vitamin D and skin colour

Many practitioners will tell you vitamin D is often seen as more important the darker your skin. However if you do live in a sunny climate ( and get out in the sun) you need to be careful drawing conclusions about a simple lab test that only show 25(oh) d levels.  Tribally when tested many massai warriors in African had a borderline level of 25(OH)D and great bone density. Showing possibly that its not as black and white as just looking at one marker, as living with so many hours of sunlight, logically we would assume a higher amount of Vitamin D! This may mean that that ethnicity and where we live may also change this picture and we naturally adjust to what levels we need when living in sunny climates and outdoors a lot.

What will show a true picture of this important hormone?

I’m often asked this and as mentioned above, its never one marker that determines the truth in the body, as we just aren’t as simple as this! As a practitioner I recommend working with someone more closely, who can work through your bio individual situation. They should test initially 25(OH)D and with  1,25(OH)2D  to get a true picture.  if the 25(OH)D  is lower than 50, then you need to look at Parathyroid levels PTH. If PTH is less than 30, you may not need to supplement as the Parathyroid gland is adequately using vitamin D in the body.  If PTH is under 20 then by all means all systems go for higher supplementation and UV exposure!  ( or splash out on a holiday! ( practitioners orders! 😉

If your levels of the stored Vitamin D are over 60 then then you don’t need extra vit D supplement. If your Test shows a 25(OH)D  of over 70, adjust diet take out supplements with over 1000Ius and stay indoors a little! Too high a levels is just as damaging as too low!  Also another word of caution – I would be vary of blindly going out and buying supplements with over 3000ius as vitamin d, as it can build up, so it’s only wise to supplement if your know the true picture.

Speaking for supplements can I get Vitamin D from a supplement, or is it better to get it from food?

There are very few foods that actually have therapeutic levels of vitamin D naturally and even fortified foods don’t contain enough vitamin D to support your body. However for those in areas like Australia where the ozone layer is very thin, its vital you do make sure your skin is not exposed for even a short time. Even 5 mins in the 11am sun can do harm. I experienced this myself in 2004 when I visited. Its funny as it really is a totally different experience in regards to the sun in Over in Aus and NZ.   My flight arrived early in February the height of their summer, and my room wasn’t ready. So I sat on Manley Beach in Sydney and the only thing that wasn’t covered was one foot! Ouch! 5 mins in and my foot was burnt for the full 3 week holiday! My advice here is that its good to build up your vitamin D levels in spring in this part of the world and only for a short amount of time and not in the full swing of summer!

How long you need to stay in the sun varies massively  depending on the factors below:
Antioxidant level and diet
Age
Skin Colour/ tan level
Latitude and altitude
Ozone Layer
Use of sunscreen
Season
Cloud Cover
Surface reflexion

Sun cream is also another tricky one… What to go for?

In the UK factor 50 isn’t necessary despite it going up to 30 degrees c this year. With a  SP factor as high as 50 you are blocking your ability to get any vitamin D. I would opt for a sun screen that ranges from 15 – 30 SPF. There are some amazing ranges out there at present, including ranges for children such as Oganii, Biosolis and Green People as these are some camps that argue that the chemicals in the sun cream are a contributing factor to disease, including hormone disruption! The above are free from all sorts of nasties, so at least you know you aren’t going down this route.

Diet is an interesting one, If you can’t get access to the sun then diet is the only option. Here are some sources

Cod liver oil
Tuna.
Sardines
Beef or calf liver.
Egg yolks

But if you have low levels, to get them up quickly – you only really only have one option if you want to raise your levels and that is to take a vitamin D supplement. As a general guideline,  after testing – if  your levels are 50ng/ml then I would take 1000-3000 IUs for one month and see what your levels are like after 1-2 months of this level. I’m not a fan of huge 1 week 20,000IU doses. Its also likely that if you have issues digesting food, or are overweight and have had a gall bladder removed, you may have issues with fat and assimilating it, so this type of approach won’t help, and in the long term could possibly lead to kidney stones as your parathyroid tries to cope with this amount!  If you do opt for a vitamin D supplement, please remember that you also need to boost your intake of  vitamin K2 through food and/or a supplement, as well as Magnesium. If you’re getting your vitamin D from the sun, this isn’t necessary. ( however its always good to get some leafy greens in right?)

Like anything all vitamins need  to be balanced out (as they would in nature)  so if you are getting less than optimal sun and have to resort to supplements, make sure you are supplying your body with the means to self regulate with enough vitamin A, K and other minerals’ such as calcium and magnesium, zinc, boron.

That way you will be winning in the Vitamin D stakes and have one less thing to worry about in regards to fertility.

 

vitamin a – is it safe in pregnancy?

vitamin a – is it safe in pregnancy?

The new year has started off with a bang! Lots of clients who have been working with me for 3 months or more are now pregnant – Yay! As most are new mums a few have got in touch about Midwives and Drs misconceptions and concerns about vitamins and minerals, as this is where the medical community start to get involved. One of the concerns is about Vitamin A and its ability to cause birth defects; so let me respond and shed some light on this..

 

I have looked into this issues myself quite thoroughly and the research links I have cited below mention that the research is over 30 years old in regards to the potential causes of birth defects. I will say that again…. In time frame only 18 cases have been cited where this has caused deformities. 

I’m sure you are aware that any adverse reaction to drugs need to be reported.  All medicines are reported under the medical misuse category.

Drugs cause death and other health conditions by the hundreds of thousands annually. vitamins don’t cause death http://bit.ly/1Ogey41  We don’t have anything for supplements to report on this, but as always if anything does show ‘Teratogenicity ie potential for birth defects it has to be reported as such.

A basic look into drugs commonly used to help women conceive and to help those with sticky platelet, such as Aspirin have far more potential to cause birth defects, http://www.mayoclinic.org/drugs-supplements/analgesic-combination-acetaminophen-salicylate-oral-route/before-using/drg-20069948 and not to mention fertility drugs that many use unwittingly without looking into the small print, that can also cause deformities and also death. http://www.drugs.com/pro/clomid.html  My point here, is many of my clients are getting all wound up about something, without looking into the issues more closely, and colleagues in the medical profession are making a point of issuing notice on Vitamin A without also mentioning that drugs, many of them used in fertility circles, have far more of a chance of giving ladies birth defects,  And those were taken at the correct dosage!

Of the 18 reported cases over the last 30 years who had babies with deformities all of the women in regards to Vitamin A took over 25,000IUs of Vitamin A, which exceeds the RDA on this by an exponential amount. As always the devil is in the detail. Most  supplements will show 2 forms of Vitamin A – the one that can cause more damaging effects at high levels  is retinol only and not a mixed between Retinol and beta carotene,  which is what most supplements have in them.

It is worth noting also in this instance that Natural Vitamin A ( retinol) is found in high doses in organ meat, such as liver. Which up until the 1970s was consumed and readily available. Many children, like our parents who, were born after the war were given cod liver oil daily, to ensure they didn’t have deficiencies. This form of fish oil has a much higher form of Vitamin A.

One of the sources of this information is NHS choices website. In this website, which I find extremely unhelpful and very uniformed it says things like ‘ you should be able to get all you need nutrients from your diet and don’t need any extra vitamin A’. Also rather unhelpfully in the article they put the measurement in Mgs not IUs, which is the standard international unit used to measure Vitamin A, so right from the start shows a fundamental misunderstanding about vitamin A.  http://www.nhs.uk/Conditions/vitamins-minerals/Pages/Vitamin-A.aspx

In terms of its use in pregnancy it is vital and essential nutrient and the most important and well known role of vitamin A is in relation to eye function. Vitamin A is necessary to prevent drying of the eye ( Xerophthalmia) and corneal changes. It is also used for retina function. 500,000 people lose their site each year due to vitamin A deficiency. Vitamin A levels are also inportant in thyroid health as it is needed for the uptake of idone and is required for thyroid hormone triiodothyroxine (T3) to bind to intracellular receptors. 

Vitamin A is needed in pregnancy for:  – Growth, Immunity, epithelial tissue maintenance and during cell proliferation, ie foetal growth!
http://ajcn.nutrition.org/content/71/5/1325s.full

I work with many clients and look into deeper analysis of fertility issues and pregnancy complications and one area I am fascinated in is Epigenetics. Many people who have polymorphisms in their BCMO1 gene have an issue converting beta carotene into retinol. So I welcome the use of mixed vitamin A for them in a retinol base, as they will have a problem converting Beta Carotene in the body http://www.ion.ac.uk/blog/anonymous/tue-2014-06-17-0954/are-you-converting-enough-beta-carotene-vitamin-55-people-may-not  Many of the studies on the populations in the human genome project also had the potential for poor eye sight also so were really in need of vitamin A, should the gene express.

I ask questions about eyesight as part of my consultations and also look at this from a family health position, as there is the potential here also to pass this on to off spring! One anecdotal thing I’m noticing much more than when I was a child is that there seems to be a huge amount of kids with glasses at a young age. I only remember a few in my whole school growing up, so I’m wondering if reduced amounts of vitamin A in pregnancy are a result of this?

WHO recommendations. More recent than 1995 http://www.who.int/elena/titles/vitamina_pregnancy/en/
American Teratology Society information on Vitamin A http://www.teratology.org/pubs/vitamina.htm

Further information on Vitamin A http://lpi.oregonstate.edu/mic/vitamins/vitamin-A#safety

On a personal note. I have used many American supplements for the last 8  years of working with women all of which have mixed vitamin A around 5000IUs and I have confidence on these levels of Vitamin A.  I have worked with hundreds of ladies and so far no issues with this, with my recommendations!

I hope this helps you to make a more informed decision about vitamin A and its use in pregnancy and preconception.

References

1.http://www.teratology.org/pubs/vitamina.htm 
2.Teratogenicity of high vitamin A intake. N Engl J Med. 1995 Nov 23 ;333(21):1369-73 
Wiegand, et al. 
3.Safety of vitamin A: recent results. Int J Vitam Nutr Res. 1998;68(6):411-6. Rothman, et al. 
4.Teratogenicity of high vitamin A intake. NEJM. 1995 Nov 23;333(21)1369-73. 3. Miller, et al.
5.Preconceptional vitamin A use. Reprod Toxicol. 1998 Jan-Feb; 12(1)75-88 
6.Tolerable levels of 10,000IUs https://umm.edu/health/medical/altmed/supplement/vitamin-a-retinol

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