Dr Harriet: Really the only downside of organic food is the cost. And if that's something that you can afford, then certainly while you're trying for a baby and the cellular changes matter, just for three months or while you're trying, if you could swap over to an organic diet, I think that would be helpful. And certainly if you can't, wash your fruit and vegetables really well.
Dr Rupy: Welcome to the Doctor's Kitchen podcast. The show about food, lifestyle, medicine and how to improve your health today. I'm Dr Rupy, your host. I'm a medical doctor, I study nutrition and I'm a firm believer in the power of food and lifestyle as medicine. Join me and my expert guests while we discuss the multiple determinants of what allows you to lead your best life. On the show today, we are talking about everything to do with eating for fertility with a colleague of mine, Dr Harriet Holmes. She's also a regular contributor to the Doctor's Kitchen website. She is a registered nutritionist and an experienced paediatrician in the NHS. After studying at Cambridge University, Dr Harriet worked in the NHS for over a decade, specialising in paediatric oncology. And I'm a firm believer that it's this experience that gives nutrition advocates like myself and Dr Harriet a unique perspective of the landscape and the interplay between nutrition and medicine. Dr Harriet has authored two books, one eating during pregnancy that she wrote to provide mums with credible information on pregnancy nutrition, and another postpartum nutrition and expert's guide to eating after a baby, again written to support new mums and their journey through motherhood and weaning. Dr Harriet also has a number of virtual courses on her website. The links to which are all on the podcast show notes. Today, this is a topic I'm asked about a lot, so I'm delighted that we can actually talk about this. We're going to be chatting about foods and supplements that may support your fertility. This isn't a cure all, this is looking at the evidence base and providing you with credible, reasonable suggestions of ways in which to eat to improve fertility. And this is not just for women, this is very much a both male and female consideration. You need to, everyone needs to be listening to this kind of information. We talk about carbohydrates and the types that are more beneficial, the importance of sperm nourishment and lifestyle, dairy and soy and their links with fertility, as well as fats and the importance of omega-3, and even the environmental impact on fertility with particular reference to pesticides and pollution. And we do dive into alcohol at a societal level as well as a mechanistic level as to why that's not such a good idea from the perspective of improving your chances of conception, as well as the supplements that you might want to consider. There's also an article to support today's podcast that you can find on the Doctor's Kitchen website which lists the evidence base used for the recommendations and the foundation for our conversation today. And I hope you find it a useful resource for you and your loved ones. Here is my conversation all to do about eating for fertility with Dr Harriet Holmes. Harriet, thanks so much for joining me on the show. Super excited to talk about this subject with you. How are you doing?
Dr Harriet: I'm great. Thank you so much for inviting me. It's a real pleasure to be here. Thank you.
Dr Rupy: Oh no, no worries. I mean, you've written some incredible articles for the website and stuff and I love sort of your work and a bit about your story as well about how you worked in the NHS, continue to work clinically and to sort of found nutrition. So I wonder if we could start actually by just exploring your story a bit more and how you became the healthy eating doctor, which is your brand now.
Dr Harriet: Sure. So I studied medicine at Cambridge. It feels a very long time ago now. And and then I did my clinical at UCL and I've stayed in London really ever since. So I trained as first of all as a paediatric, was a paediatric trainee and then I became a paediatric oncology trainee. And and then I took some time out to do a PhD on the genetics of osteosarcoma, a rare bone tumour. And I really loved that. And and then I think it was sort of probably a combination of sort of noticing more about the importance of nutrition with the paediatric oncology patients and and how tough that is. And also then just really expanding my knowledge of genetics during my PhD and the emerging research on the microbiota and the microbiome. And I think that was the sort of those the things that sort of fuelled my interest in nutrition. And the sort of I really like the science side of it, how how it's really possible I think to to to actually get some evidence-based studies that are replicated in animals and humans and that although there's a lot of sort of myths around nutrition, there is actually some, you know, fundamental science in there that if you can drill down to that, then you can actually, you know, really work that out and make a positive difference to your life. And I think it's it's that really, the sort of combination of being a doctor and seeing the importance of long-term health and also realising how you can alter that and how you can really moderate that with nutrition and then looking at the science behind it, the science of the microbiota, the science of the microbiome, I find all that really fascinating. So then I stepped aside from medicine and I then lectured in nutrition. First of all, I became a registered nutritionist and then I lectured in nutrition.
Dr Rupy: Important step there, yeah.
Dr Harriet: And then I was commissioned to write a degree on nutrition, which combines culinary skills. I didn't do that bit, but I did the nutrition and the health side. And it's the first of its type in the country. And it's really aimed at a lot of chefs. Because I think it's how are they meant to know what nutritious food is if they don't learn about it and learn the importance and why things are nutritious and not and and some of those myths. So I was really proud of that. And now I've written two books on what to eat during pregnancy and then what to eat after you've had your baby and breastfeeding. And I write for you and I write for a lot of other people and that's a bit about me. I really like science-based nutrition.
Dr Rupy: Yeah, yeah. I mean, I mean, that's like kind of a whistle stop tour through like a really expansive career thus far. You kind of skipped over the registered nutritionist bit and I just want to explore that a little bit more because, you know, you're registered with the AfN, it's sort of the benchmark for nutritionists in the UK. It demonstrates a clear understanding of the nutrition world. And I think that's a very, very unique proposition that you offer as both someone who has hardline frontline clinical experience with the understanding of nutrition. So I wonder how did you become registered and what was your what was your educational experience there?
Dr Harriet: So for most people, I think the vast majority of people to register with the AfN have to do a specific degree which then entitles them to become registered with the AfN. But for me, I had a portfolio of evidence, various, it was about 50 pages I think I had to to do a large portfolio and and references that all showed that I had the same knowledge as someone that had had done that. So that was through, you know, sort of learning what I'd learned at Cambridge with the sort of the basic science stuff, the physiology, you know, metabolism, biochemistry, a lot of that. And then what I'd learned on my way through, stuff for my PhD, a sort of a wide portfolio of of evidence really and that that entitled me to to be registered with the AfN. So yes, I think they're probably not many people that have got a medical degree registered with the AfN and have got a PhD in genetics. So I guess I'm a little unusual, but it's a nice combination. I feel it kind of gives me the science helps me to understand all of those studies, you know, I think before I did my, I was an academic clinical fellow, an ACF on the NIHR pathway and I'd done quite a bit of research on my way through as an academic trainee. And I think although I'd, you know, published in in blood and, you know, found novel genes, I didn't really understand about the difference between animal models, cellular models, how that translates. And I think it was really only doing my PhD that enabled me to really understand in detail the pros and cons of all those things. And I think as a just a probably a routine, you know, normal medical trainee without the ACF, I probably would have had even less understanding of that. So I think it puts me in a a really privileged position to be able to understand, you know, when I read those papers, what are they actually doing? Does it matter? Why have they chosen this model? Can you extrapolate anything from this model? And and then with my clinical training, I can think, oh well, actually, they've done this in animals, but it doesn't make any difference in in humans or how can we translate it into humans? And then they've got the, you know, obviously also nutrition based, so that's, you know, the AfN and and and my field now is, you know, concentrating on nutrition and and health together.
Dr Rupy: Yeah. I mean, it's a fascinating and really interesting perspective that you're able to glean by looking at those studies. And I don't want to digress too much because I want to get to the topic of eating to improve fertility. But I wonder given your perspective, where do you think the biggest pitfalls are within nutritional science and the hierarchy of evidence that we have available to us as clinicians that look at nutrition and and where do you think we should be concentrating our efforts if we were to design more nutrition trials that could actually offer us a way of of helping people live healthy, happy lives?
Dr Harriet: I think if you have animal and cellular models, they're quite easy to control and and you can you can easily get, you know, sort of answers from them. Obviously, they're limited by the fact they're cellular and animal models. But human models for nutrition are so difficult. So I think, you know, clinical trials in nutrition are confounded and biased by so many different things. You know, if you eat organic food, you're probably more likely to go to the gym, you live in a bigger house, you have a bigger garden, you know, all of those things versus someone who eats, you know, regularly eats processed meat. And it's very stereotypical, but it's probably very true. And how do you get over that? And and how do you how do you, you know, make a placebo? How do you do it sort of blind it? How do you double blind it? How do you, you know, you can easily randomize things, but how do you how do you really work out what's going on? And I think that the problem is with a lot of this is it's not a quick intervention. And this is lifestyle changes and these are changes that you're only really going to reap the benefit of many, many years later. And so just an intervention of a dietary change for a month or two or six months or even a couple of years, how do you look at the out point? You know, what's the outcome measure? And they're either very subjective outcome measures or they're objective outcome measures which will take years into the future. If you sort of look at, you know, cardiovascular risk, you're going to have to wait, you know, quite a long time and so I think I think it's really difficult to do these studies that are powered enough to understand them that that you know, and and that they're costly as well. You know, it's going to be a huge cost. Who's going to do them? Is it going to be a clinical, you know, research group which is going to cost them a lot of money? They're going to have to get charitable funding to do it. Or or is it going to be a company looking to see if they can find an association? And then of course, you've got the whole problem of, you know, negative results aren't published, are they? No one knows, you know, it's difficult enough to get a publication, let alone negative results. No one's interested in negative results. So then you have that bias. So I think it's the clinical studies that are really challenging, really challenging.
Dr Rupy: Yeah, definitely. I mean, like, I'm often sort of met with this sort of cynical view of big pharma and how everything is a corporate conspiracy to dampen down nutrition and actually promote pharmaceuticals or or nutraceuticals even. But it's like you said, it's inherently very difficult to do nutrition studies. You can't blind someone's diet compared to another one. It's very expensive. And the mechanisms are are multifactorial as well. So when you're eating food or eating according to a dietary pattern, you're you're having an influence on multiple different biological pathways, which is great on the surface of it because it means, you know, it can explain a whole bunch of observations that we see, but on the crux of it, it's very hard to explain and go into depth of the the mechanisms. It's it's much easier to, you know, give someone a placebo and then a pharmaceutical pill and test those because it maintains sort of the highest standard of research according to the gold standard.
Dr Harriet: And also that, you know, most most clinical studies are now so biomarker driven. And if you've got a drug and it acts on target A and you know what the biomarker is, it's it's really, it's so much easier to give the intervention, measure the biomarker, and you've got a really nice quick, easy, well, it's not cheap, but it's an awful lot cheaper, quicker study where you can power it for far fewer people than, you know, if you're if you're doing this and you don't know what the biomarkers are, or there are a range of biomarkers, you don't know quite how the biomarkers relate. And then you've also got now, you know, think of the sort of the microbiota is even changing or, you know, is now thought to have an effect on um, chemotherapy therapeutic sensitivity. You know, how do you account for that as well? Do you give everyone a course of antibiotics, wipe the microbiota out, and then, you know, repopulate them with a fecal transplant to know? So there are just so many factors. I think it's so difficult.
Dr Rupy: Yeah, exactly. You've got to just stick to first principles, I think, when it comes to nutrition, which is exactly kind of what we're going to be talking about today, um, when talking about eating to improve fertility. I wonder, so my first question is, where did your interest sort of lie when it comes to fertility and postpartum nutrition? Is it is it from your own experience? Is it from colleagues? Or is it just something that you naturally gravitated toward?
Dr Harriet: Um, I think, I think probably a bit of both, a bit of the fact that I'm female and have been through all of these things myself. And also, um, I still, I guess sort of a gravity towards women's health in in that regard. But I think mainly as a mum and a, um, you know, mum of two children now, an awful lot of this information, I just didn't feel it was available when I was going through it. And, um, I didn't have problems conceiving, but I certainly didn't conceive, you know, on the on the, you know, first try. And I did look into all of this at the time and I found it, you know, really, even, even with all of those sort of, you know, skills set, I found it not easy to navigate. And I thought, well, if I'm finding that, then then I'm sure an awful lot of other people are as well. And the same things, you know, when I had my children, I kind of thought, um, you know, I'd have a fairly good understanding being a, you know, paediatrician, but, um, there's so much more to it. And there's so much, you know, I didn't realise at the time about, you know, needing more, um, you know, calcium when you're breastfeeding, you know, those sort of things about looking after your long-term, you know, health as a mum. Um, and so it's only really now I feel I'm in a position to help other people and to give them that information, um, so that they they're empowered to, you know, look after themselves. And also, there's there's just so much, um, there's so many myths. You know, I know in Australia at the moment, um, bone broth is being touted as better than breast milk.
Dr Rupy: Oh, really? Wow.
Dr Harriet: Yes. I mean, I find it astonishing. Yes. So,
Dr Rupy: Oh my word. That is really worrying.
Dr Harriet: Yeah. And, um, so I just think I really, I really just come back to I want to just to provide science-backed, you know, evidence-based information for people so that they've got, they can just look through it and it's not biased. I'm not trying to to sell them a supplement or, you know, I'm just giving them the information so they can choose then whether they want to follow it or which bits they want to follow and and, uh, yes, I just I feel I feel there needs to be more evidence base in the world, you know, there needs to be.
Dr Rupy: Well, I think, you know, partly, and to turn the lens on ourselves, it's kind of like, well, we're not taught nutrition to a significant, um, uh, degree during our medical school training. And when patients sort of look for information, you have this huge vacuum and unfortunately, that's filled by a lot of erroneous players that will spread information. I mean, I I was I'm a bit still in a bit of shock about the whole bone broth versus breast milk stuff, given how nutritious breast milk is. It's, uh, it's incredible. But,
Dr Harriet: But also that breast bone broth is, bone broth is not in part special features. It hasn't, you know, the immune cells from the bone marrow are all killed and denatured when you cook it and it's got risk of toxins leaching out of the bones because you cook it for so long. I just, I just find it astonishing and, um, yeah, so,
Dr Rupy: Yeah, exactly.
Dr Harriet: But also, I think it's those people that, you know, if you're struggling to breastfeed and you're, you know, you're going, you're desperate, you're going to look for answers. If you're trying to have a baby, you'll do anything, you know, you're desperate. And I think almost people play on those, you know, those fears and worries about it. And I find that really sad, actually. I find it, you know, a sad state of affairs.
Dr Rupy: When there's, when there's money to be made, um, people will stoop to levels, uh, to sell a product. So, unfortunately, um, but that's our job today to rectify the situation. So, um, I wonder if we could start off with the landscape of fertility as it stands at the moment. Um, what are the sort of success rates for a couple, um, and are there any features of our sort of Western landscape, both from an environmental point of view and a food point of view that might be having an impact on fertility rates?
Dr Harriet: Um, so about 80% of of couples will conceive within a year. Um, and and if you haven't, then that's a good time to speak to your doctor. If you've got, you know, known problems already, then maybe speak to them a bit earlier. Um, but about 10 to 25% of couples who are trying for a baby will have some difficulty and those subfertility factors are spread pretty evenly between men and women. So men are just as important as this. I think a lot of the time they get forgotten. Um, and, uh, you know, what they're eating and their diet, you know, will play just as a huge role on gamete, you know, healthy gamete quality, gamete production as it does for women. Um, but I think certainly it's a time when it's really stressful and you might be more inclined to, um, to therefore eat those, you know, hyper palatable foods, um, that are high in sugar, high in fat, that maybe aren't quite so good for you. So, um, and it's totally understandable if you're feeling stressed, you have that cortisol release that drives you to eat those hyper palatable foods, you know, inhibits your, uh, satiety feelings, so you eat more. And that, you know, but, um, then it's, you know, how can you try to contain that and then eat, eat healthily to support your, your fertility. And I'm certainly not saying this is going to, you know, get everyone pregnant by any means. This is just about supporting you trying as opposed to a cure. So, um, but there are a number of things you can do. So, um, uh, carbohydrates,
Dr Rupy: Before we get onto carbs actually, I just want to clarify what we mean by gamete production because I can imagine there's a few listeners who are not privy to the medical terminology. So I'm going to stop you every time I feel there's some medical jargon and I'm going to clarify it, if not for my own benefit, then for the listeners.
Dr Harriet: So gametes are are your the sperm and the the eggs and that's what, um, that's what I'm talking about when you're gamete production. So obviously men are producing many, many more and women are producing, you know, one, maybe two or sometimes more a month. But, um, gametes for women take a lot longer to produce, um, or to to mature, whereas, um, they mature quicker in, um, in males. But probably a diet for three months is what you need to be thinking about, um, changing. So changing your diet for about a three month period in order to see any benefit really. It's not a quick fix.
Dr Rupy: Brilliant. Yeah, absolutely. And I think just to reiterate what you already said, you know, this isn't a list of cure all foods that is going to make everyone super fertile, but it's definitely giving, uh, couples the best chance at laying the foundation for improved fertility as guided by the evidence that we'll we'll dive into. And just with my GP hat on, um, uh, I just want to remind listeners that, you know, 80% after a year, um, those are good numbers, but you have to be having regular sexual intercourse for this to happen. I've had a number of instances where, you know, unfortunately couples have come in after a year, but they haven't been having sex as often as they should be, which is a couple of times a week, if not more. Um, so yeah, just to clarify that.
Dr Harriet: Yeah, absolutely.
Dr Rupy: So you were talking about carbs. So this is a common thing that I'm asked about in terms of the quality of carbs and and the amount of carbs and stuff. How does that impact fertility?
Dr Harriet: So carbohydrates, when they're broken down, they're broken down into saccharides, the little tiny rings and those are your, you know, your glucose and your sucrose. And the bigger the carbohydrate molecule, the harder it is to break it down. So the the longer it is, um, the the sort of lower and slower the rise in glucose and that puts less pressure on your body and that um is your sort of marker of insulin sensitivity or resistance. And um, and that may influence ovarian function. And certainly in women with PCOS, they've got, um, when you improve their insulin sensitivity and they have a lower carbohydrate diet that can help them to ovulate. So if you can change, you know, this is really the basis of a healthy diet anyway, if you can change from refined carbohydrates to whole grain carbohydrates, you know, that's that's going to really support your body anyway. And um, not just the fact that you've got that insulin sensitivity, but also they've got, you know, nutrients in them and and that as they, you know, harder to break down, some of them more of them make it to the colon where they, you know, feed and, you know, support your, uh, your microbiota as those prebiotics. So they're good from a number of of points really. And that, um, that antioxidant, anti-inflammatory, you know, um, microbiota supporting effect has been shown to have beneficial effects on glucose metabolism. And there was one um study, the Earth study that showed that if you have a higher level of those whole grains in a preconception diet, it was actually associated with a higher probability of live birth.
Dr Rupy: Oh, wow. And was there any, um, explanation other than what you've, uh, just brought up there about why whole grains in particular might have that beneficial effect? Is it something to do with the sort of extra antioxidant load or the extra sort of phytonutrients that you find in the the high fiber whole grains?
Dr Harriet: I think it's a combination of those that I the extra anti-nutrients, the and the fact that, um, when we know that refined sugars can irritate and and don't support or help your microbiota and that if your microbiota is not happy, that increases your risk of chronic inflammation. So you can see then how it has sort of wider role. If you've got the antioxidant features, the prebiotics, you've got a healthy microbiota, lower levels of inflammation, that that's going to help.
Dr Rupy: Yeah, absolutely. I mean, there's so many different ways in which this diet is going to be supporting overall well-being, um, which is why I find these kind of conversations so validating for, you know, just changing your your diet overall. Not only is it going to impact potentially your, uh, your ability to conceive, but also, you know, your cardiovascular health, your risk of dementia, etc. Um, I wonder if, um, there there are sort of, um, that there's overlapping features with those who are down the path of assisted reproductive technologies and and assistance with with conception. Is there a is there a certain sort of dietary pattern or do the things that we've talked about already also, uh, play a role for for those couples?
Dr Harriet: So I think that a lot of the research that we've got for for just couples trying in general has come from those assisted reproduction therapies. So that's where a lot, it's much easier to get those outcome measures to measure live birth, to, you know, do an interventional study, um, if you're, if you're doing that, it's a lot more controlled. So a lot of this evidence does come from that. And certainly if you're going through those techniques, um, at the moment, that, you know, these things will will support that.
Dr Rupy: Yeah, absolutely. And you know, um, we talked a bit about the environment, um, in terms of, uh, pollution, perhaps exposure to, uh, agricultural chemicals, um, pesticides, etc. Do we have any sort of knowledge or understanding about the role that they could be playing in a negative role with with fertility?
Dr Harriet: Yes, so, um, there is, there is emerging evidence actually about the role of pesticides. And, um, I think that's why a lot of people if you go, um, for IVF, you're advised to eat an organic diet. And while the chemicals are safe or thought to be safe for us and are small levels, um, there is sort of, there is some evidence which is quite difficult to ignore that they, you know, in small quantities, pesticides can, um, can have an effect. So there was a study that looked at, um, men who ate the highest amount of fruit and vegetables because that they're often, you know, the ones that have got pesticides on them. And that those who ate more, um, more fruit and vegetables were associated with a higher percentage of abnormal sperm. Now, there may well be, you know, confounders in that and and bias. Um, if you're eating more fruit and vegetables, maybe you'll be eating a, you know, a healthier diet in general, um, but then you shouldn't have abnormal sperm. So, um, so I think it's quite hard to ignore that. Um, and I think it's an easy change to make. Really the only downside of organic food is the cost. Um, there isn't really an, you know, a downside otherwise. And if that's something that, you know, you can afford, then certainly while you're trying for a baby and the sort of, you know, the cellular changes matter, you know, more important than ever when you're having a baby, you know, that that one sperm, that one egg are the key, you know, are what's going to get you a baby or not that, you know, that just for three months or while you're trying, if you could swap over to an organic diet, I think that would would be helpful. And certainly if you can't, wash your fruit and vegetables really well, because, you know, they they're going to be mainly on the outside of them and give them a good scrub.
Dr Rupy: Yeah, yeah, absolutely. I there's there's a whole bunch of like DIY, uh, fruit and veg scrubbing mixtures and rubs that you can get. I think with like a bit of vinegar or something like that, um, to to really scrub your vegetables. And I think you're right, you know, it's getting harder to ignore the growing concerns, I think around pesticide use on fruits and vegetables, um, to the point where, I mean, I don't get too caught up about, um, organic versus conventional, like when I'm out or when we used to go to restaurants, let's say. Uh, but, uh, but if possible and where possible, I try and choose organic, um, because like you said, the only downside is the cost and there are certainly environmental gains to to be had from, uh, organic produce as well. Um, which is kind of shifting my my own personal consumer habits.
Dr Harriet: And also with, um, milk now, the sort of the IGF-1 seen in in milk. So that's the, um, insulin-like growth factor, which is seen more in, um, in non-organic milk. There are, you know, emerging studies that it may well be linked with, you know, like prostate cancer. Um, so I just think, um, if you can have organic, it, you know, while there's no difference probably in the nutritional value of it, you know, a, um, an organic carrot is no different or has marginal difference to a non-organic carrot. It's those added bits that come with it, those, you know, the pesticide residue or the IGF-1 in in milk that, um, but maybe long-term, you know, we there's a, there's a huge difference as well, I think between, you know, absolute safety in a general population or, you know, at a population level versus, you know, an individual level, especially if you're trying to get pregnant. Um, and I think there's still a lot more to to, there's still a lot more research to be done and a lot more information to know really.
Dr Rupy: Yeah, yeah. Alcohol, I'm I'm probably speaking more to the male audience when talking about alcohol and fertility, but as they sort of tend to sideline themselves or perhaps they're sidelined by their partner when it comes to changes to to support fertility. Uh, is there any sort of, um, evidence to suggest that we should be certainly drinking less or maybe not at all?
Dr Harriet: Yes. So, you know, alcohol, in general, we should really be drinking less. You know, alcohol is the number one risk factor for breast cancer, um, other than genetics, obviously. Um, but, you know, in general, we should all be drinking less and certainly when you're trying to conceive, there's there's evidence that it reduces your fertility, reduces your time to conception, reduces your quality of those gametes, you know, those and, um, and and reduces the quality of embryo quality as well. So even once they've fertilized and you've got your your embryo that it it decreases implantation in people going through IVF. So there's good evidence that, um, you should try and avoid it if if you're able to.
Dr Rupy: Yeah, yeah. It's definitely one of those subjects, I think that perhaps in 50 years time, we're probably going to look back at our current society and the way we sort of with in perpetuity allow alcohol advertising, uh, across, you know, things like the Premier League, um, in in supermarkets and all the rest of it and be like, oh my god, how on earth did we allow this to happen considering the associations with not just physical and mental problems, but also the wider implications of things like abuse and, you know, poverty and addiction, you know, it's it's a hugely, hugely problematic substance that we allow in society without many restrictions.
Dr Harriet: I think it will be the new, I agree entirely. I think we'll look back on it in the same way that we did with smoking. And, um, and and now, you know, how lovely is it to be able to go out to a restaurant and, you know, you choose if you want, you know, you're not, you don't have to put up with other people's smoke. You know, if you want to smoke, go outside. I think that that's really refreshing for the the non-smokers of the world. Um, I wonder, I wonder if alcohol will ever get to that stage. I don't think we will. I think alcohol will probably always be a social thing. I think certainly in the way, you know, the vegan trend has has come in from the cold and is now really mainstream. I think that probably a lot more people will be, um, you know, alcohol-free. I certainly remember, uh, so I had meningitis 20 years ago when I was a student.
Dr Rupy: Oh, really? Wow.
Dr Harriet: Yeah, I did. Yeah. And, uh, so I gave up alcohol for a year afterwards. I had, you know, issues afterwards. And it was such a sort of, you know, a difficult thing socially 20 years ago, you know, not to go on a night out at, you know, medical school and not to drink. Um, but now I think that's probably a lot more socially acceptable if you don't drink and, you know, I think that's great. I think, you know, you know, so I think I think the world's that's changing for a better.
Dr Rupy: I I definitely see similarities with the smoking industry. You know, you're seeing a lot of consolidation around big, um, smoking corporations like Philip Morris and the likes, hoovering up, uh, those electronic cigarette companies because they see the trend towards non-smoking. And I think the same thing is happening within the drinks industry, which is why you have big giants like Diageo, um, buying up smaller companies that are doing non-alcoholic spirits. Um, some of which I I really like actually, the non-spirit, the the the zero alcohol spirits because they give you that feeling of, uh, socializing when you're out, but not the hangover the next day. And and actually, I I've admitted this on the podcast recently about how I was drinking definitely a lot more last year, um, during 2020 when I was coming back from work as a way to sort of unwind. And, um, I mean, that that definitely had negative connotations for me, the way I felt the next day, my weight definitely fluctuated, my mood was definitely, you know, up and down and stuff. So I think there's definitely that trend towards, uh, massively reducing or completely removing alcohol in its entirety that, um, that I welcome when you when you look at like the the grander impacts of alcohol in society.
Dr Harriet: No, I agree entirely. I think it's a, it's a great direction that we're traveling in with alcohol.
Dr Rupy: Yeah. And the trends as well, that they're pretty cool to see like, you know, zero beer and all this kind of stuff. So, yeah. Anyway, we digress.
Dr Harriet: But if you, yeah, no, absolutely. I, um, I don't drink very much and I couldn't tolerate a hangover anymore. You know, I just, that's my main thing. I've got two, you know, my kids are enough of, you know, I couldn't be up with them and up in the morning and, you know, have a hangover as well. I just,
Dr Rupy: Yeah. Exactly, yeah. Maybe it's just the trend that that happens when you go into your late 30s and 40s that, you know,
Dr Harriet: But there's so much advertising that sort of, you know, mum, mum, it's wine o'clock time and, you know, those things. I get that, you know, after a, you know, a long day, you might want to have a glass of wine or, you know, a beer or whatever. But, um, yeah, I guess it's, but there's so many other different, different, I guess not, different ways of relaxing now that I think that maybe, you know, we're, we're a bit more tuned into, which is good.
Dr Rupy: Definitely. We're we're sport for choice, I think, in terms of activities of things that we can do. Maybe not right now, uh, during a lockdown period, but you know, there are a whole bunch of other activities that we should be encouraging to sort of wind down rather than looking at the bottom of a bottle. Um, or the top of the bottle that turns into the bottom of the bottle. Anyway, so, uh, we talked a bit about omega-3, um, and the the interesting, uh, fact about the Earth study finding that, you know, omega-3 supplementation was was related to an increase of, um, of live birth rate. Um, are there supplements that you think are worth considering for for for couples, um, who are who are trying to conceive?
Dr Harriet: So certainly, um, folate, every woman should be on, you know, preconception folate from as soon as you're thinking about trying to get pregnant, um, right up until 12 weeks. And most people should be on, um, you know, 400 milligrams of of folate. If you've got, um, uh, epilepsy or you're, um, have special risk factors, then you might need to be on, you know, a higher dose. Um, but there's good evidence as well that maybe folate might help men actually. And, um, it's increased their, um, sperm count, um, and sperm quality. So I think, um, maybe if you're struggling, um, might be something to try, you know, it's obviously really safe. Um, it's safe enough for women to take during pregnancy. It reduces their risk of, um, spina bifida. So that's neural tube defects where the the neural tube, um, doesn't form completely at the base of the spine. So, um, you know, if it's safe enough for women to take, it will, it's safe enough for men to take as well. And, um, it might actually help you. Equally, you know, as as a male, you could also just, you know, uh, increase folate in your diet. So it's like broccoli, green leafy vegetables, kidney beans, uh, fortified foods, chickpeas. So they're those kind of, um, things. Um, so certainly folate, definitely for women, um, consider it for men. And then, um, vitamin D, everyone should, you know, the sort of NHS guidance is everyone should be taking, uh, vitamin D during the autumn and winter months to try and keep it in the normal range. And then, um, there's sort of lots of other different supplements. And I think the evidence for these is a lot more sketchy. Um, so the antioxidants, um, so that's like things like coenzyme Q10 and vitamin E. Um, they've been shown that they may help male infertility, um, but much less positive effect in women. And I think, um, the sort of, there's some, some evidence to support them, but I think really a lot more, more research, I think is really needed because a lot of the the studies are are quite low quality. Um, so I personally would would, you know, I wouldn't be rushing to to supplement with those. I think if you can increase your antioxidant levels within your diet, um, so that's, you know, fruit, vegetables, whole grains, and that that is, you know, is certainly the first step. Um, and then, you know, maybe further down the line, um, then maybe consider those depending on on, you know, your position.
Dr Rupy: Yeah, yeah, absolutely. So those are, um, vitamin, I mean, I take, I take 2,000 international units of vitamin D3 every day. Um, I I struggle to push my vitamin D levels high and it's most likely because of the, um, the the my my skin colour and my ability to convert, uh, to vitamin D3 in in the in the skin. Um, but I'm no longer surprised when I see vitamin D levels in in the low 20s these days. Um, and I try and get people to get that sweet spot of of at least around 40 to 50. It's a there's a bit of a controversy around what is the optimal level for vitamin D, but, you know, my sort of pragmatic thinking is that it's very hard to push your vitamin D levels up to a toxic level unless you're literally taking like 10,000 IU a day, um, which would be very expensive to do. Um, so, yeah, do do you have any ideas about like or any suggestions on the the amounts that people should supplement with?
Dr Harriet: So I think, um, vitamin D is not straightforward to be honest, because I think, um, it's quite hard to know how much you should be taking without a blood test because you don't really know whether you how much you need. So without sort of swamping the NHS and everyone clamoring to get an, you know, a vitamin D test, I think, you know, for most people, probably 400 international units, which is the recommended dose, will be enough. But there will be people like you and me. So I've got totally different complexion to you, but I know that I'm a poor metabolizer and transporter of vitamin D. So I have to take 10,000 units a day.
Dr Rupy: Oh, really? Yeah.
Dr Harriet: So, um, so I'm one of those people. Um, and so are my children. Um, so, and we know that vitamin D is a really important, you know, co-factor in many genes. It's even been, um, been associated with lung function. If you look at patients with COPD and cystic fibrosis and an independent marker of lung function is vitamin D status. And if you, so I, you know, I think it's, um, it's really, it is important and it's important that we get enough. So how do you know if you're one of those people? The only way you can tell if you've got low vitamin D, despite what you're doing, is really to have a blood test and then you can titrate and know, well, you know, okay, I'm taking 400 units, but my, you know, vitamin D levels are low, you'll know that you need to take a bit more. Um, so I don't think it's, I think otherwise we're just treating it blind a lot of the time. And that's, that's not easy. And also, I think, you know, maybe a few years ago, if I'd seen someone with low vitamin D levels and they'd said that they were taking them, I might have wondered how much they took them, whereas now I think I'd think, oh, right, you're taking them, but probably you're a poor transporter and metabolizer, so you need to take more. So, um, and while I'm certainly not saying with fertility that if you supplement, you're more likely to get pregnant, I think, you know, everyone should really be keeping their vitamin D level in the normal range, you know, for long-term health and that will support, you know, all of the other parameters of health including fertility.
Dr Rupy: Do you have any opinion on sort of the home blood testing kits that are again more available these days? Because I'm conscious that people who don't want to, um, waste to for for one of a better term, uh, NHS time by going in to check their levels just so they're in the optimal range when they don't actually have symptoms suggestive of severe vitamin D deficiency. Do do you think there's a role for for those companies in a in a private manner?
Dr Harriet: So I think I think they probably is, but again, there's a huge variety of them and a huge difference not in the quality of the blood tests, which I think is, you know, pretty standardized and good. It's it's who's supplying it and what is their their reason? Are they are they doing it so that they can, you know, not just test vitamin D, but they can test a whole panel of things, most of which, you know, potentially meaningless or, um, you know, when I was a doctor, I lived very much by the sort of philosophy of, um, of of only really doing investigations that would change my management, not just out of interest, but to change the management. You know, if a child came in and they were sick, are they clinically sick? So do I don't why am I doing blood tests on them? I can tell they're sick. I don't need a blood test to tell me they're sick. I might need a blood test to tell me something else. So in the same way that, um, you know, you could measure all manner of things in your body and have an interesting result. Um, might be of interest to know all of those things, but it's not actually going to change management. So I think if it's vitamin D and, you know, there's some sensible reasoning behind it or, you know, you're just doing that and you've got someone that can help support you with knowing what dose to take, that's great. If you're being sold a whole panel of meaningless blood tests, then I'd be cautious about it to be honest. It's back to those balancing hormones, you know, or find out all about your body. Do you probably don't really need to know any of that information. But vitamin just knowing your vitamin D, having someone, you know, registered nutritionist or a doctor that can help, you know, titrate those levels with you and tell you how much you should probably be taking. I think is is helpful and there is a role for it. Certainly, I think, you know, the NHS probably needs, you know, it's only a finite resource and needs to be focusing on those people with, you know, symptomatic levels of, you know, vitamin D or, you know, other other things. But, um, and then I should caveat it and say that vitamin D is a fat soluble vitamin. It so your body stores it. It is 100% possible to take too much and get vitamin D toxicity. So if you, if you, if you don't know that you're a poor transporter of it, you 100% should not be taking 10,000 units a day. You should be on, you know, a much lower, you should be on 400. So, you know, there's there's caution with all of that as well.
Dr Rupy: It's it's definitely a difficult topic, isn't it? And and I, you know, I think again, you've exemplified why it's, um, really advantageous to have that clinical perspective, that NHS perspective combined with nutrition and sort of delving into the private world of of testing and investigations because it's been drilled into my head from day one, if it doesn't change management, why on earth are you doing that test? And there are definitely cost saving, um, advantages with that methodology, but it's also saving unnecessary investigation, unnecessary pain and inconvenience to the patient and focusing on what really changes and pushes the needle. So, you know, I think we we could all learn from that experience and and that's definitely something that has stayed with me whenever, you know, giving out, uh, information online because it's very easy to dive into that biohacking, optimization at any cost, uh, kind of field, which, um, again, has a lot of erroneous players and can spread misinformation about what we should really be looking at when it comes to our our bodies.
Dr Harriet: Absolutely. And then also, I think you sort of end up with, um, you know, you get this sort of panel of blood tests and one of them might be slightly abnormal and then you're kind of, well, well, what do I do with that now? There weren't any symptoms, you know, it's not, it's not abnormal enough to do anything about it. It's just, you know, and it it's you probably didn't ever needed that worry, you never needed that blood test, you never needed any of that information. So I I agree with you entirely and I think probably doing it more from a paediatric, you know, child's perspective, you 100% wouldn't be just doing some blood tests on someone just to have some interesting answers. Um, but you might be more likely to do that, I think on, you know, an adult in A&E or back when I was training, you know, in A&E, probably nearly 20 years ago, not quite 15 years ago, you might have been more, you know, everyone had that needle in, everyone had those baseline bloods and, you know, I think it's, um, things are changing, it's, you know, it's really great. You've got that, you know, evidence base, what's the management decisions. So I think it's, it's good and we should, you know, use that through all walks of life really, not just medicine.
Dr Rupy: I think definitely, you know, lending on your paediatric experience, you are much less likely to stick a needle into a child and, you know, cause massive aggravation to to a kid. So you're going to be a lot more sort of reliant on your your clinical skills, looking at symptoms, taking a good history, um, than we are with patients, you know, as soon as people come to A&E, they they expect a blood test almost, which is, you know, sometimes, you know, it takes a bit of explaining as to why we're not just taking blood. It's not because we're trying to save money, it's because we're trying to save you time. And yes, we are trying to save the NHS at the same time as well. So, um, I I want to just touch on, um, some of the foods because, you know, like I said earlier, it just kind of matches perfectly over a very well-balanced Mediterranean style way of eating when you're trying to eat for, you know, adequate levels of zinc and omega-3 and and iron and all the rest of it. Um, but particularly from folate, you you mentioned a few ingredients. What what what what were the ones that you would say that are particularly important from that perspective?
Dr Harriet: So folate is like green leafy vegetables, um, chickpeas, uh, broccoli, kidney beans. And then, um, uh, foods fortified with, uh, folate. So breakfast cereals are, you know, a good example of that. So, um, they've got, they're fortified with folate normally. So they're those are some examples.
Dr Rupy: And you've got some, um, like, uh, some examples of of, uh, quality fats like, um, certain nuts and seeds. Are there any ones that that stick out to you?
Dr Harriet: Um, so like walnuts is high in omega-3, they're, you know, good. But I think this comes down to, you know, not just having like a fixed diet. I'm only going to eat walnuts because they're the highest in omega-3. I think I'm going to have, you know, a range of different things because otherwise it's restrictive, it's boring, and you need, you need all those different things in the same way that we say to eat the rainbow, all of those different colours are different antioxidant compounds and that's why we say it because they've all got slightly different properties. So, um, I think eat a range and, you know, have have different nuts, have different seeds, you know, mix it up, keep it interesting, otherwise you'll get very, very bored and that's not what you want. And then you'll, you know, go back and, you know, that's the basis of a diet really, isn't it? Where you restrict, it's difficult to restrict, you get bored, you get fed up, you crave the things you can't have, and then you, you know, you just abandon it. And I think this is really more about long-term, sustainable, lifetime, you know, long-term lifetime changes where you're changing your diet for life and you're you're not bored, you're not restricting anything, you're just trying to make those healthy choices and eating a range of different foods and and, um, and doing that.
Dr Rupy: Yeah, absolutely. I mean, like my sort of, um, suggestions for people is to use diversity as your as your go-to strategy because if you diversify your diet across different categories of food that include things like quality fats from nuts and seeds and even, you know, cold pressed oils, lots of different colours from from different plant-based materials, you have a largely plant-based diet, you have a lot of fiber from beans and nuts and legumes, you're going to be getting a whole range of those different, uh, micronutrients, macronutrients and phytonutrients that are so pivotal for, yes, fertility, but also a whole bunch of other, um, uh, risk reduction, um, strategies for for other conditions.
Dr Harriet: Absolutely. And if you restrict and you cut food groups out, you're a lot less likely to meet your micronutrient and macronutrient needs. So I think, um, yeah, the key is diversity and choice and healthy choice and and long-term, you know, enjoyment of food.
