Caitlin Johnson, RDN is a Registered Dietitian Nutritionist who specializes in PCOS and Fertility. She has a private practiced focused on women and conception. Check her out on Instagram @PCOSFERTILITYNUTRITION and subscribe to her podcast Food Freedom Fertility at www.foodfreedomfertility.com.
What is Ovulation?
A cornerstone of improving conception chances is to improve factors that lead to a healthy ovulation and frequent enough ovulation. Ovulation is when an egg is sent from the ovary into the fallopian tube to meet sperm. There are a few reasons ovulation may not occur in a cycle; conditions like PCOS and Hypothalamic Amenorrhea(HA). In order for ovulation to occur a delicate cascade of reproductive hormones are made and circulated to signal to the ovary to develop and release an egg.
It’s important to understand, even though in a normal length menstrual cycle an egg is released about every 30 days (somewhere between day 12 and 18 of a regular length cycle), this egg has been developing for 90-120 days, and have been in existence in the ovary since a woman was in her mother’s belly. So, while women trying to conceive are always focused on the next ovulation, it’s important to understand interventions made now may not show up until 2-3 cycles down the road.
Hormones that can Affect Ovulation
In conditions like PCOS and HA women either do not ovulate or ovulate very infrequently. Getting to the bottom of what hormonal abnormalities are present helps to tailor interventions more specifically to each women’s physiologic needs.
Two specific hormones that play an important role in ovulation are LH (luteinizing hormone) and FSH (follicle stimulating hormone). These are both made by produced in the pituitary gland and act on the ovary. FSH tells the ovary to help an egg mature to the point of ovulation. LH helps the ovary to know that it is time to expel the egg out of the follicle in the ovary to be released in the fallopian tube where (hopefully) it meets sperm. Supporting balance in these hormones and others that play a role in ovulation is important.
Women with PCOS also may have higher levels of androgens like testosterone. These levels can be high everywhere in the body and specifically locally in the ovary. This local testosterone can interrupt ovulation. It’s important to not only focus on the production levels of certain hormones, but may also be necessary to suppress the actions of other hormones that stand in the way of ovulation.
Dietary Approaches for Specific Conditions that cause Anovulation
Many recall learning in elementary school that some women don’t get periods when they are athletes like the Olympic gymnasts, because they don’t have sufficient body fat. Similar scenarios occur when the body does not feel safe enough to ovulate due to under-eating or chronic over-exercising. Sometimes the answer is as simple as more nourishment for the body to help encourage ovulation to occur at all. Simple answer however, for some this is difficult to implement if the HA condition has resulted from unrealistic body expectations, eating disorders or other conditions that affect appetite and dietary intake.
PCOS is a syndrome that affects an estimated 15% of the population. According to this review of literature, 75% of women with PCOS are reported to have menstrual dysfunction and even 20% of women who have appear to have normal periods still do not ovulate in these cycles. With more than 3 out or 4 women with PCOS with a menstrual cycle related abnormality, it is important to take a step back and look at what hormonal cascades may be affecting this and what dietary approaches me do to help solve these consequences.
For many with PCOS insulin is a hormone that is all too often under discussed. Insulin resistance is estimated to affect 70% of the PCOS population. High levels of insulin can cause weight gain, increased metabolic inefficiencies and abnormalities in the ovary. Why? While many organs and tissues of the body become insulin resistant, the ovary does not. What does that mean for follicles and tissue in the ovary? It is bombarded by insulin and blood sugar. These high levels of insulin and energy available at the cellular level in the ovary may explain why local testosterone levels are increased. I’ve seen in many of my patients, as we bring blood sugar, and insulin levels into balance, testosterone levels decrease and frequency of ovulation increases. The encouraging thing about this display of events is diet is a first-line treatment for insulin resistance and obtaining more frequent ovulation.
Carbohydrates are the main macronutrient that causes quick increases in blood sugar and insulin. So many people believe if you just cut the carbs out of your diet, you have a solution. The issue with this approach is it is very short-sighted. No one wants to cut carbs out forever, so it is not a very sustainable approach. Also, carbohydrates are the only source of fiber in our diets, cut carbs means also cutting fiber, which is important in many digestive processes in our body. Perhaps my biggest concern with cutting carbs is you then cut key nutrients that are essential for nutrient stores pre-pregnancy. Think about never eating fruit, veggies, beans and many other foods again. That is what we are talking about when we talk about cutting carbs.
There is a better way.
1) Choose high quality carbs.
Carbohydrates as close to nature provided is best. What does that mean, less processed, less stripped down, something a two year old could pronounce. Apple, berries, beans, brown rice, etc. Skip the foods that are full of white flour, refined grains, and high in sugar. If you can find it on the outside borders of a grocery store it is going to be better for you.
2) Combine it with a protein rich food.
Protein comes from meat, dairy products (if trying to conceive choose full-fat dairy), seafood, nuts, seeds, beans, and processed products like protein powder isolates. Sure grains have some protein, but so little compared to it’s carb content, it won’t count for this category. Literally every time you eat carbohydrates, look for some protein to help balance blood sugar.
3) Don’t skip fat and fiber.
Fat always seems to get a bad rap. It’s very helpful for blood sugar balance and will support the feelings of fullness between meals and snacks. Fiber is similar, it slows down your bodies ability to get to the carbohydrate calories, leading to more level blood sugar and increased satiety between eating.
These are helpful suggestions not only if you have PCOS. Balanced blood sugar helps sustain hormone balance in the body as insulin levels can affect so many other hormones.
Dietary Approaches for Everyone Trying to Conceive
Supporting healthy ovulation in the general population is something that should be looked at from the lens of obtaining hormonal balance in the body and increasing nutrient stores. Here are dietary approaches that will improve hormonal balance throughout the body.
1. Focus on getting 4-5 different colors of fruits and vegetables per day. How could you do that? Blueberries in your Greek yogurt at breakfast. And orange with some almonds at a snack. Spinach in a side salad at lunch with some strawberries on top. Roasted eggplant with dinner and tomato’s on a side salad. This day there are fice different colors represented.
2. Include shellfish and nuts and seeds in your diet. Important minerals like zinc and selenium are crucial for the development of healthy eggs, but also play a role in hormone balance. Many studies have shown zinc to be important in lowering testosterone levels in women. Including a serving of nuts or seeds every day is a great (and easy) way to increase these levels in your diet.
3. Eat cruciferous veggies daily. These are broccoli, cauliflower, brussels sprouts, bok choy, rutabaga, watercress, arugula, cabbage and kale. This can assist with proper levels of estrogen.
4. Eat fish and other healthy omega-3 rich foods. This can help to provide critical nutrients and help support and balance against too much inflammation in the body. Eating foods fatty fish like salmon, nuts and seeds, and healthy oils like olive oil can help promote balance. Avoiding foods like industrial seed oils (cotton, rapeseed, peanut, sunflower seed, and more) can help combat levels of inflammation in the body.
5. Balance your blood sugar. Don’t forget to choose quality carbohydrates paired with protein, fat and fiber(see above).
6. Spice up your life! Spices like curcumin, spearmint, cayenne pepper, garlic, ginger, cinnamon, nettles among others have been used for millennia by various cultures to support women during her fertile years. Spices and flavorings like spearmint and cinnamon have direct benefits in blood sugar levels and testosterone levels. You can see how identifying underlying hormonal imbalances can help direct you to a more clear route to ovulation.
7. Limit alcohol. Don’t shoot the messenger on this one: In a study of 259 women, alcohol consumption significantly increased estradiol levels. Each drink increased estradiol by more than 5%, and consuming more than 4 drinks in one period of time increased it by 60%. This has the ability to throw off your cycle.
8. Caffeine. Caffeine in moderation is my most balanced suggestion. If you feel that caffeine makes you anxious or is affecting sleep quality, it is imperative to decrease your intake. I also find it’s not so much the caffeine that impacts women, but their form of drinking it with 6 pumps of sugary vanilla syrup and whipped cream on top. If you don’t like a good old-fashioned cup of joe with a splash of cream in it, you just may not like coffee, and better to kick the habit than be drinking it in the form of a milkshake every morning. There are some forms of caffeine with great health benefits like green tea, full of antioxidants and L-theanine which can help with relaxation (an important thing in the trying to conceive journey).
My main recommendation is to try and improve one to two parts of your diet at a time. Find an area that feels like it may be making the most impact and work on improvements (not perfection) for 1-2 weeks, and when you feel stable with those changes, attack another area.
If you feel like you need more help, enlist the support of a professional! My fertility journey was riddled with areas that small improvements could have impacted my frequency of ovulation much sooner. Armed with the right information you can vastly improve your health and the health of your cycle – and be baby ready.
Caitlin Johnson is an integrative and functional medicine dietitian who takes a holistic approach to women’s health. Her strong belief in the healing power of food paired with positive lifestyle changes has fueled her ability to help women through various hormonal struggles. Caitlin struggled with infertility secondary to PCOS and years of combatting weight and insulin resistance. This experience gives her a unique understanding and empathy regarding what her clients struggle with daily. She devotes her practice to helping women manage PCOS and learn to conceive naturally. Having graduated from California Polytechnic University with a degree in Nutrition and Biology, her many years serving in church ministry, Caitlin’s science based and compassionate approach have nourished client’s menus and souls.