Food & Diet Part 2

So this is the slide that Marlene Merritt LAc. DOM (NM), ACN of Merritt Wellness Center started her lecture with. And the info below is my summarizing and expounding on the concepts she covered. What I especially liked about her talk is that it appealed to both my logical brain and the sense of honoring and trusting what history and experience can reveal (something that is a BIG part of Traditional Chinese medicine). 

To understand the basic lifestyle and dietary changes Marlene's lecture was ultimately advocating please see my first post, which contains links to her youtube videos where she explains the concepts herself. This post is about more support and follow-up info: historical evidence and modern scientific support.

I'd like to start by acknowledging that this is a departure from my previous recommendations, because it is NOT entirely based on chinese medicine food therapy. And while I still do advocate for many of the concepts in TCM food theory (namely focusing on increasing your food's ability to be cooked down by your digestive kettle by doing things like eating more cooked foods, chewing well, slowing down, eating smaller meals more frequently, enjoying food mindfully, being moderate, eating seasonally and locally). This post definitely represents a shift from a purely TCM recommendation to more of a hybrid. 

Why, you ask?  Because one of the very interesting things Marlene pointed out is that different populations have evolved to eat different foods (in our digestive tracts). Yes, in Asia there is a lot of rice and soy and no dairy and yes, eating this way is what TCM food therapy recommends, but most of my patients are not of Asian descent and so our guts have evolved to eat what was traditional in the places we came from. In European countries for example, dairy was much more common (especially Scandinavian ones), in Africa it was not.  So this really puts some perspective on everyone eating the same foods... it just doesn't make sense from an evolutionary perspective. We have different guts and different abilities. This does still go with the TCM concept of listening to your own body above any one rule.

The History

There was a man named Weston Price who has been called the Isaac Newton of Nutrition. He was a dentist and a vegetarian and in the 1930s he went and searched the world to find a healthy vegetarian culture. He went to cultures all over the world and used the powers of observation to come up with basic assertions. Although he did not find any healthy vegetarian cultures, he did find indigenous cultures that had much higher levels of health (when you took away illnesses and accidents that would be readily preventable and treatable in the west), fertility and ultimately nutrition. 

These traditional diets were much more like our own ancestors and included:

Foods grown in nutrient rich/fertile soil 

ALL the parts of animals including organ meats, marrow)

Animal fats

Animals on pasture

dairy products that were raw and/or fermented

grains and legumes that were soaked or fermented 

and bone broth

only real foods found in nature

Our modern diets includes:

Foods grown in depleted soil

muscle meats (which are the least nutritious parts of animals) 

vegetable oils

Low Fat

Animals raised in confinement

pasteurized dairy

refined and or extruded grains 

WAY more grains than would have traditionally been available

lots of artificial and synthetic foods

So basically, as time went on and we had the luxury of not having to worry about starving and had more science, agriculture and politics enter into our food arena. Much of the traditional diet went out the window.

In the 1800s people averaged 18 lbs of sugar per year

In the 1900s it went to 90 lbs per year

In 2010 the average american consumed 120-150 lbs of sugar per year and 50% of americans consume a half a pound of sugar per day.

see USDA Agricultural fact book, profiling food consumption in america, pg. 20. www.usda.gov/factbook/chapter2.pdf

Yet, the FDA has NO recommendations on sugar intake, it has it for fat (especially saturated fat).

Since the 1950s the US food pyramid has advocated for less fat and more carbs (but, carbs are ultimately sugars: so simple and complex grains, fruits, legumes and actual sugar all are increasing our blood sugar)

And the typical american eats between 300-600 grams of carbohydrates per day... The American diabetic association recommends the reduction down to 45-60g PER MEAL. But the human body can only actually possibly use and process about 60-100 grams of carbs per day.

So the body is resilient and amazing and can make it look like it is coping for a long time even though it is in stressed out, coping mode day in and day out... really, the human body is AMAZING!  The things we can do to it and that it will tolerate for YEARS!  (that's not to say they won't catch up with us, individually and culturally)... 

By the time we are 65, 77% of people are diabetic or pre-diabetic 

us centeres for disease control and prevention 2011 

US dept. of health and human services, national diabetes information clearinghouse, fast facts about diabetes, 

http://diabetes.niddk.nih.gov/dm/pubs/statistics/#fast, 2011

American's are getting fatter and fatter... for years the statistic was 1 in 7 americans was obese and this statistic was stable for decades and decades... but with modern diets the rates are quickly jumping up... so that in 2012 most of the US was one out of 3 or 4 and the projected rates for 2030 are that most of the states in the US will have at least 1 out of every 2 people categorized as obese (NOT overweight, but obese!)

Clearly, cutting out fat isn't the answer. Weston Price showed lots of healthy indigenous cultures who ate lots of foods that we look at as unhealthy but they were actually healthy. AND the actual statistics show that despite eating less and less fat, we are getting fatter and more unhealthy.

If you want more big picture evidence, look at the lower rates of heart disease associated with higher levels of saturated fat in the diet in the modern french, swiss, dutch, icelandic, belgium, finnish and austrian cultures!

european cardiovascular disease statistics

And for those of you who like the research based approach check out these: 

The Framingham Study (Archives of internal medicine, jul 1992, 152(7), 1371-1372)

showed that the more saturated fat and cholesterol one ate, the more calories one ate, the lower people's serum cholesterol was.

And the follow up 30 years later which concluded that lower cholesterol equaled a greater risk of death. "For each 1% ml/dl drop of cholesterol there was an 11% increase in coronary and total mortality." Anderson, leaven M., William P. Castelli, and Daniel Levy. "Cholesterol and mortality: 30 years of follow-up from the Framingham Study." Jama 257.16(1987):2176-2180 l

And it doesn't get much more clear and damning than this: "Those individuals with a low serum cholesterol maintained over a 20 year period will have the worst outlook for all-cause mortality."

Schatz, Irwin J., et.al. "Cholesterol and all cause mortality in elderly people from the honolulu heart program: a cohort study." the lancet 358.9279 (2001): 351-355

But those are just on cholesterol, how about this:

"In studies conducted over 20 years, the Harvard School of Public Health showed that total fat intake bore no significant relation to coronary Artery Disease risk... epidemiological studies have shown no evidence that men who eat less fat live longer or have fewer myocardial infarctions"

Hooper, L., et. al. "Reduced or modified dietary fat for prevention of cardiovascular disease." Cochrane Database Syst. Rev 2 (2000)

Mozaffarian, Dariush, Renata Micha, and Sarah Wallase. "Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and mata-analysis of randomized controlled trials." PLos medicine 7.3 (2010): e1000253

or for Women:

"In women and in the elderly, no appreciable difference in coronary heart disease rate for any level of cholesterol. In fact, for women of all ages and the elderly, higher cholesterol is associated with longer lifespan.

Circulation medical journal 86, 1026-1029, 1992

And this one has been in the news, because it was just released 2 weeks ago: in over 500,000 subjects the conclusion was that decreasing saturated fats should not be encouraged!

Chowdhury R. et al. Annals of Int. Med. 2014, March 160(6) 398-406

So why is cholesterol actually not so bad?

In addition to being a basic building block for many of our cells (it is part of cell membranes), It acts as a bandaid to fix up cellular damage and if we don't have enough our cells can't repair. Leaving our bodies more prone to damaged cells turning into problems. 

Cholesterol is also a precursor to many hormones and Vitamin D, so when you decrease it, you mess with those. 

It helps fight infection and it protects against depression and helps your nervous system deal with stress. So much so, that one study showed people who relaxed prior to blood draws had lower cholesterol than they did on days when they were stressed prior to blood draws.

So, there is SOOOO much more I got from these talks and more I will definitely be discussing with patients, friends and family, but for now, I'll give a few closing tidbits:

If you want more information on the diet changes Marlene Merritt suggests it is basically the Weston Price approach Which you can read about at length here PLUS specifically limiting your carbs to under 100g/day ideally more around 60 is the goal... Remember, doing what you can and making some changes is better than doing none and sticking with the low fat, high carb approach. 

A thought provoking article from the Atlantic about medical research and the fads/bad info they can result in.

A book about the food industry and modern American diet

Some notes from a western MD on saturated fats

and if you've made it this far... way to stick with it!  Thank You...

for you, some Julia Child :)

on McDonalds French Fries, Saturated Fat and Flavor!

PS. For those who are vegetarian or vegan and may site the China Study (Book, not actual study). There were shown to be over 8000 correlations in that study and one of the authors of the actual study went on to publish several other papers stating animal protein is not harmful. Here is the Weston A Price foundation's page on info for you

Holistic Views on Clomid - is it right for YOU?

I am not a Reproductive Endocrinologist or an OBGYN. I am a holistic practitioner with 10 years of clinical experience and 7 years of exclusive fertility experience. The information I am giving you here is based on holism and looking at women as a whole (body mind and spirit). It is a different way of looking at fertility and one I am passionate about. What I tell you may or may not agree with what your western practitioner advises you to do. I am simply giving you my way of thinking and what my clinical experience leads me to believe is the most whole person and holistic approach to using Clomid treatments to conceive a baby! As with so many things on this journey, you will get conflicting opinions and you ultimately have to choose what feels right in your heart and body and as a couple. I hope this will help you choose the route that is easiest on you and most likely to really work :)

Clomid is the very first line in many fertility treatments. It is often prescribed with little education or monitoring and here are the things I wish more women and doctors would consider before deciding if it is right for them...

Clomid is a very hot drug from a Traditional Chinese Medicine (TCM) energetic perspective. It is like putting fuel on a fire... which is good if what you are lacking is fire, not so much if you have plenty of fire, but are lacking coolant or blood, or are just too stuck for things to circulate smoothly.

So if you are considering Clomid, here's the type of people who (holistically) do well on it:

If you are chilly more often than overheating (not just your hands and feet, but your whole body-chilled) then clomid might be a good fit for you.
If you tend to be lethargic or fatigued then clomid might be a good fit for you.
If your main emotions tend to be anxious, sad and weepy, or fearful, then Clomid might be a good fit for you.
Some women with PCOS or cystic ovaries will answer yes to the above questions, but due to their higher than average risk of producing extra follicles and developing OHSS (a serious problem) they really need to be monitored EXTREMELY closely to avoid OHSS (as well as super-multiple pregnancies which are unhealthy for both mom and babies) but Clomid still might be okay for them in some situations.

Overall, for most women with the above symptoms, Clomid feels fine (no big side effects). These women get a little boost of energy, feel more comfortable, feel more even emotionally and even like Clomid (in moderation - read on about this).

The following characteristics will tell you if Clomid is NOT a good holistic fit for you... if you are these things, then I'd highly recommend talking to your doctor about skipping the Clomid and try injectables if you are wanting to do fertility treatments or trying holistic methods to correct these things first (which might help you get pregnant and avoid Clomid altogether!)

If you already tend to overheat, have hot flashes or have night sweats avoid Clomid.
If you tend to have high or nervous energy then Clomid is probably not a good fit for you.
If you already have issues with your lining being too thin (uterine lining) then skip Clomid.
If your main emotions tend to be irritated, angry or frustrated, then Clomid probably won't be a good fit.
If you already have migraines that are worse with stress or exercise a lot/very vigorously because it actually makes you feel better (as opposed to because you think you should), Clomid likely isn't for you.

For the women with the above symptoms PRIOR to taking Clomid, Clomid will likely make these things worse. These are the types of women you see blogging about how taking Clomid turned them into raging crazy maniacs, gave them horrible migraines, sent them into 6 months of horrible night sweats that were so bad they had to get up and change the sheets... you've read the blogs I'm sure... it's not so good.

Now, I know Clomid is inexpensive, and I know many doctors prescribe it like it's no big deal. So if you do decide to use Clomid, then you should know this!

Clomid has a long half life... the half life is 5-7 days which means if you take 50mg (a normal fertility dose) in 5-7 days 25mg is still present in your body. 5-7 more days later you are down to 12.5mg. 5-7 more days you are down to 6.25mg. 5-7 more days you are down to 3mg. 5-7 more days 1.5mg. 5-7more days a tiny amount 5-7 more days it's pretty much gone... so that's nearly 2 months.  If your dose is higher, it takes longer!  Women will often remark how they can't believe they are still having side effects from Clomid 2-3 months after they've taken it. This is why that can occur.

Because Clomid has a long half life, doing back to back cycles of it build on each other. This can be good in some cases (if it is agreeing with the woman), but bad in others (when it is causing side effects and not good results). Side effects can get worse and worse with each subsequent cycle (especially when there is no break in between and women are in the don't take Clomid holistic category I listed above).

Also, holistically Clomid is like putting fuel on a fire. This can be okay for a short amount of time, but eventually, even with women who don't start out overheating and irritable it WILL burn up their good coolant (yin). So even after the drug is out of their system, they may be left with really horrible NEW imbalances that have been induced by using Clomid for too long. This is heartbreaking, because perhaps they start out in category A above and Clomid is good for a while, but if they keep it up they end up adding the symptoms of category B above to their category A symptoms and now they are even more of a mess and still not pregnant. This is super hard holistically and takes a long time to fix.

Numerous studies have shown that if pregnancy will occur with Clomid, 75% will occur within the first 3-4 cycles. Doing more cycles causes more side effects, creates increased risk of ongoing hormonal imbalance and will not likely result in a baby. In all my years working with women using clomid, I have seen exactly 1 patient who has gotten pregnant on a round of Clomid that was beyond her 3rd (and it was her 4th).

Clomid makes the fluids in your body "burn up" so it tends to make uterine linings thinner (fine if you have some to spare) and cervical mucus cooked down and thicker (fine if you are using IUI to bypass the sperm needing to swim through the mucus). If you are using Clomid with sex you REALLY need to do something to help insure that the sperm can make it through the cervical mucus.  You have some options... Here is a nice article about natural options (the supplement FertileCM is good if you have it on had ahead of time... you have to order it online). You can buy preseed and pre (sperm friendly lubes) at walgreens, CVS, target etc. and should NOT use any other lubes when you are TTC and doing clomid.

You may have read about taking cough syrup to enhance your fertility. That's actually misleading. You can take cough syrup to thin your cervical mucus which can help with sperm getting to their destination. So if that's your issue (and it likely will be if you take Clomid) then it's something to consider. But for most women it's not needed. But, you're here because you're thinking of or on Clomid right!?  So here's the scoop on doing that... which is good if you aren't doing IUI with your CLomid.

And last but not least! The ultimate goal of Clomid is to make you ovulate if you are not ovulating and make more than one follicle/egg to ovulate and increase your odds of conceiving. It is VERY important to realize that if you are not being monitored via ultrasound during your cycle you have NO IDEA how many follicles/eggs you are making and potentially fertilizing. This is one of the main situations that leads to the stories of women pregnant with multiples, and not just twins... triplets, quads and more. I know you are thinking if I haven't had a baby or gotten pregnant yet, I doubt that will happen (and I get that logic), but it is a real risk and one you need to be aware of. I am a BIG fan of monitoring. (not to mention you want to know how your body responds so you can know if it's worth repeating again or moving on to something else if it doesn't work). Selective reduction or high risk pregnancies for mom and babies are no joke. Both are situations I wouldn't wish on anyone. Especially someone who has already gone through the heartache of fertility struggles.  So ask for monitoring or go to someone who monitors these cycles. It's important!

That's my two cents (okay, maybe more) on Clomid. I hope it is helpful to you on your journey!

Best Wishes,
Nicole

PS:

If you want some layperson info on Clomid and how it works here's a good article from Fertility Today

And here's the official FDA page about Clomid with lots of good information including some absolute contraindications (which I didn't go over because your doctor should know them and they aren't super common!) listed as well as lots of other info on the technical mechanisms of Clomid.

DHEA and what you should consider before going on it for fertility!

Yes, DHEA can be associated with improved egg quality and decreased chromosomal abnormalities (and recent research support this so all the sudden fertility clinics are recommending it left and right!) but it is worth looking more in depth...

DHEA is a hormone secreted by the adrenal glands and is a precursor for testosterone, estrogen and the stress hormone cortisol (as well as others). In instances where a woman is lacking in these things it can be good (in instances of premature ovarian decline when estrogen is lacking for example)

In instances where a woman is NOT lacking these things it can be bad (masculinizing, feeding into estrogen excesses, fueling growths that are dependent on extra estrogen like some sorts of tumors/masses, increasing stress hormones...)

Also, it is important to note that because hormones work on feedback loops if one hormone changes then others adjust accordingly so again, this can be good or bad, depending on if adding the hormone is really needed or not. When adding a hormone puts the body back into balance the other hormones will benefit from this, when adding a hormone puts the body out of balance the other hormones will be more likely to become out of balance too.  

The best way to really tell if a person could use DHEA is to test their current levels, if it is low, go for it, if not just say NO (a study is not reason enough for everyone to do something!)

In loo of having the basic blood test, secondary ways to tell if DHEA is a good idea include going on it and see how you feel… if you feel worse or have side effects, holistically this is a good indication that it is NOT a good fit for you, alternatively, if you feel great on it, then it might be good for you (I'd still suggest bloodwork!)

Another secondary way to tell would be to go based on other hormonal signs… like with POF and high FSH then you might infer that going on it would be good because those hormones that are made from it are low. This would be inferring that DHEA is a good match.

But why shouldn't everyone just try it?  Who can it really hurt!?

It is a known fact that growths like fibroids and endometriosis are fueled by extra estrogen, so I would strongly suggest that if endometriosis, fibroids, cysts, etc. are a known or possible issue taking DHEA is not a good idea at all!  Even if there is POF/POD, or a past medicated cycle suggests "age related" ovarian decline, if there are growths, DHEA is only going to make those worse so at best it's helping one area and making another worse.  

I feel a bit frustrated with western clinics at times (though overall they do a TON of good and have their hearts in the right place most of the time) because they often absolutely discourage their patient from doing most supplements, but then all the sudden there will be a big study or trend to use a supplement and all the sudden the same clinic will be telling their patients to take the same supplement that just a year ago the clinic would have poopoo-d.  I wish they would leave the supplements and alternative/holistic stuff to those of us who actually understand the holistic way of diagnosing and dosing, recommending.  The truth is DHEA can be really great for some and really detrimental for others and if you look at the big picture you're more likely to get it right.  

And since I know western science often seals the deal for choices, here is what a few western websites have to say which will back me up:

WebMD says: Hormone-sensitive conditions such as breast cancer, uterine cancer, ovarian cancer, endometriosis, or uterine fibroids: DHEA is a hormone that can affect how estrogen works in the body. If you have any condition that might be made worse by exposure to estrogen, don’t use DHEA.

Depression and mood disorders: There is some concern that patients with a history of depression and bipolar disorder might have some mental side effects if they use DHEA. DHEA can cause mania (excitability and impulsiveness), irritability, and sexual inappropriateness in people with mood disorders. If you have a mood disorder, be sure to discuss DHEA with your healthcare provider before you start taking it. Also, pay attention to any changes in how you feel.

Polycystic ovary syndrome (PCOS): Taking DHEA might make this condition worse. Don’t use DHEA if you have PCOS.

And Mayo Clinic.com says:

Side Effects and Warnings

Few side effects are reported when DHEA supplements are taken by mouth in recommended doses. Side effects may include fatigue, nasal congestion, headache, acne, or rapid/irregular heartbeats. In women, the most common side effects are abnormal menses, emotional changes, headache, and insomnia. Individuals with a history of abnormal heart rhythms, blood clots or hypercoagulability, and those with a history of liver disease, should avoid DHEA supplements.

Because DHEA is a hormone related to other male and female hormones, there may be side effects related to its hormonal activities. For example, masculinization may occur in women, including acne, greasy skin, facial hair, hair loss, increased sweating, weight gain around the waist, or a deeper voice. Likewise, men may develop more prominent breasts (gynecomastia), breast tenderness, increased blood pressure, testicular wasting, or increased aggressiveness. Other hormonal-related side effects may include increased blood sugar levels, insulin resistance, altered cholesterol levels, altered thyroid hormone levels, and altered adrenal function. Caution is advised in patients with diabetes or hyperglycemia, high cholesterol, thyroid disorders, or other endocrine (hormonal) abnormalities. Serum glucose, cholesterol and thyroid levels may need to be monitored by a healthcare professional, and medication adjustments may be necessary.

National Institute of Health mimics webMD:

Hormone-sensitive conditions such as breast cancer, uterine cancer, ovarian cancer, endometriosis, or uterine fibroids: DHEA is a hormone that can affect how estrogen works in the body. If you have any condition that might be made worse by exposure to estrogen, don’t use DHEA.

That's my 2 cents… okay, it's at least a dollars worth, but I think it's worth shedding some light in an area that can make a big difference to make the best call on an individual level instead of blindly following the crowd.  .  

My Take on Nutritional Supplements (for fertility and otherwise)

Here is the post where I will say the exact opposite of what many of you may expect (or perhaps if you know me or have worked with me I'll say exactly what you've heard me say oh.... about a thousand times!)

My take on nutritional supplements, by me, Nicole Lange (fertility acupuncturist & patient centered care advocate)

I guess you could distill my feelings on nutritional supplements into one easy sentence and it would go something like this, "I'd rather [you, me, whoever we're discussing] eat well."

But it just isn't my style to stick with just one sentence, when 10 paragraphs can suffice :P

I'll start with a little story.  A colleague of mine who I think the world of and respect greatly as a practitioner was sharing with me how much she was advocating for a certain type of fish oil.  (unless you've been under a rock somewhere you've probably heard at least a snippet or two about the benefits of fish oil... anti-inflammatory etc. etc. etc.). I told her I totally agreed that fish oil was great and that my recommendations for taking it as a supplement were in line with how I prescribe pretty much any western dietary supplement, low doses, not everyday.  (more on this below, don't worry!)

She of course, pointed out that by administering things in this way I was never getting anyone onto a "therapeutic dose" of the nutrient in question, so why bother.

This conversation has stuck in my mind because it helped me distill exactly why I do bother and why I feel good about my less than therapeutic dosing.  The bottom line for me is, "Well, if I were counting on X (in this case fish oil) to be the one thing that is going to "fix" the concern I'm working on, well then, yes, of course a therapeutic dose would be essential!  But I'm NOT!"  I believe this is too neat, too magic bullet, too easy an approach for something as complicated as holistic health and a person's body/mind/spirit.

What I do want to do is this... I want to help a person find a constellation of options, all capable of moving them in the right direction, towards a more balanced, healthy, more fertile, happy and sane version of themselves and NOT count on them having to do or not do any one thing (supplement or otherwise). For example, if the fish oil is one part of a menu of say 20 different options and I'd like them to thoughtfully examine their goals, time, energy, money, etc. and pick a few and trust that those make the most sense for them, are sustainable and will combined get them to their goal I think I'm doing my job as a truly HOLISTIC practitioner and keeping the focus on them as whole people!

Never mind the fact that dosing fish oil in therapeutic dosages would involve taking the equivalent of eating BUCKETS full of fish and in my gut I just don't think that makes sense.  Should we have to eat buckets of fish every single day to get the benefits when that isn't anything that would occur if we were relying solely on a healthy diet?

AND, if I might throw in an added bonus to my method of thinking how about this... how many times have we seen the old, "THIS IS THE BEST SUPPLEMENT EVER, EVERYONE SHOULD TAKE IT!"  only to have something 6 months, 1 year, ten years later linking the very same supplement to some ill effect?  If you take high doses and rely on one thing being the magic ticket to fixing everything, not only will you probably a) not stick with it and b) not actually see those results you c) run the risk of it being extra bad should it not be the right choice!

So you see, just because I'm an acupuncturist and do fertility work, two things that would commonly make me waaaay into supplements, I'm not!  I'd rather you take low doses of things that you REALLY think you need extra of and eat well on top of making other choices with your life that will really get you to where you want to be.  Trust me, although the thought of doing less can be terrifying, especially with fertility where you want a magic answer so badly, my results are fantastic - I promise!

For more "food for thought" on food vs. nutrients I highly recommend you read this article by Michael Pollan and his other varied works!

Specific Nutrition for Fertility & Pregnancy Concerns- Chromium

Chromium (PCOS, metabolic syndrome, diabetes, gestational diabetes)

Chromium is a mineral that helps the body break down and store fats, carbohydrates, and protein. It also works with the hormone insulin to maintain normal levels of glucose (sugar) in the body – an important consideration, for fertility concerns where blood sugar or metabolic syndrome play a roll (PCOS) especially if you're diabetic or become diabetic during pregnancy. Chromium has also been studied for its ability to increase sperm count.

How much chromium you need

TTC/Pregnant women: About 25-30 micrograms (mcg) a day (29 mcg if you're 18 or younger).

Breastfeeding moms: 45 mcg a day (44 if you're 18 or younger)

Men: About 35mcg

Brewer's yeast is a concentrated source of chromium, containing as much as 60 mcg per tablespoon. Other good sources include:

• 1 tablespoon peanut butter: 41 mcg
• 1 cup boiled spinach: 36 mcg
• 3 ounces broiled skinless chicken: 22 mcg
• 1 cup button mushrooms: 20 mcg
• 1 medium apple: 15 mcg
• 1/2 cup broccoli: 11 mcg
• 3 ounces turkey ham (processed): 10.4 mcg
• 1 cup grape juice: 8 mcg
• 1 cup romaine lettuce: 7.34 mcg
• 1 waffle (about 2.5 ounces): 6.7 mcg
• 1 whole wheat English muffin: 4 mcg

Click HERE to see MUCH more info on Chromium from the NIH Office of Dietary Supplements 

Specific Nutrition for Fertility & Pregnancy Concerns - Iodine

Iodine (for sub-clinical thyroid issues that may effect fertility)

Iodine is a mineral found in some foods. The body needs iodine to make thyroid hormones and without it (even if the body wants to make thyroid hormones) it cannot.  Because current research for fertility specifically suggests that the healthy range of TSH should ideally be between .5 and 3 for optimal fertility, but most general practitioners are still operating on the more broad recommendations of TSH being under 5, some women who are struggling with infertility are being considered "normal" but may actually benefit from lowering their TSH (to do this, you need to increase your actual thyroid hormones). For a nice summary of this please click HERE

The body also needs thyroid hormones for proper bone and brain development during pregnancy and infancy. Getting enough iodine is important for everyone, especially women who are pregnant.

How much iodine do you need

Adults150 mcg

Pregnant/TTC women 220 mcg

Breastfeeding women 290 mcg

In general: 

Iodine is found naturally in some foods and is also added to salt that is labeled as "iodized". You can get recommended amounts of iodine by eating a variety of foods, including the 

• Fish (such as cod and tuna), seaweed, shrimp, and other seafood, which are generally rich in iodine.
• Dairy products (such as milk, yogurt, and cheese) and products made from grains (like breads and cereals), which are the major sources of iodine in American diets.
• Fruits and vegetables, which contain iodine, although the amount depends on the iodine in the soil where they grew and in any fertilizer that was used.
• Iodized salt, which is readily available in the United States and many other countries. Processed foods, however, such as canned soups, almost never contain iodized salt.

Click HERE to see a chart with specific foods and the amount of Iodine they contain as well as MUCH more info on Iodine from the NIH Office of Dietary Supplements