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Preconception care offers support to couples with fertility problems and also for those who simply want their child to have the healthiest start to life. Our aim is not only to improve the chances of conception, but to also improve the chances of a natural and healthy pregnancy, birth and baby.  Starting by providing you and your partner’s bodies with nutritional ‘building blocks’ necessary for a healthy embryo we then work through the following:

• Toxicity and detoxification
• Healthy ovulation and charting the menstrual cycle
• Male fertility
• Reproduction dietary guidelines
• Stress management
• Optimizing conception- timing and techniques

At present it is estimated that 1 in 6 couples are infertile. This statistics are staggering, and unfortunately on the rise each year. It is thought that many of these issues are related to a Western lifestyle that has deteriorated rapidly. We live in a ‘toxic’ society. Environmental pollution, polluted water, toxic farming methods, chemicals, radiation, heavy metals are frequent problems. Nutrient levels in the soil are poor, we live sedentary lifestyle and don’t compensate with adequate exercise. Sugar, caffeine, alcohol and food additives are high in our diets. Add onto this the stress of progress and it becomes obvious as to why our modern lifestyle is affecting fertility levels. The approach is quite obvious- we simply want to bring prospective parents health back to optimal before conception takes place thereby giving your child the best chance of health and start to life!

The program consists of a monthly appointment for 4 months prior to conception. The reason that we advise on at least 4 months of preconception health care is to ensure optimal health of the sperm and egg. Sperm can take 116 days to generate and during this time are easily susceptible to damage. Similarly, the egg is vulnerable during maturation for around 100 days leading up to ovulation.

Fertility complications

 It is becoming more and more common for couples to experience difficulty conceiving a healthy child.

 Factors which can affect fertility health include but are not limited to:

• Environmental and lifestyle toxicity
• Nutritional deficiencies
• Age
• Stress
• Infection
• Immune problems

The same problems which lead to increased rates of infertility in developed nations also lead to increased rate of chronic health problems in our children, and the adults they become.

Conditions that natural medicine can be of assistance to which affect fertility include but are not limited to:

• Endometriosis
• PCOS
• Hormone imbalances
• Thyroid disease
• Blood sugar levels problems
• Obesity
• Immune problems
• Fibroids
• Amenorrhoea
• Problems with sperm (e.g. motility, morphology, count, etc)
• Varioceles
• Stress

Preconception Care

Preconception care involves the promotion of optimal health of ideally both partners in the time before conception.  This may include detoxification, nutritional and herbal supplementation, acupuncture and diet and lifestyle changes.

There is research showing the benefits of a good preconception care program in chances of conceiving, reduction of complications during pregnancy and birth and promotion of excellent health in the fetus and child, which continues into adulthood.

Preconception care aims to:

• Prevent congenital defects
• Prevent chronic health conditions such as asthma, allergy, immune dysfunction
• Support a healthy robust immune syndrome
• Support your child’s ability to resist damage from environmental and lifestyle toxicity
• Support the nutritional health of your child
• Ensure good fertility of your child

Couples are having children later and later (for various reasons) and a consequence of this is an increased difficulty conceiving, and increased risks of pregnancy complications and health problems in the child.  The good news is that the factors that cause this can be reduced with a good preconception care program.

Epigenetics

Diet and lifestyle has a big role to play in fertility.  Not just for you, but for your children and grandchildren’s fertility.  What you eat, drink and do in the 4 months leading up to conceiving affects the genetics of your offspring and their fertility health.

It can be pretty scary to think about, but what your grandparents ate and were exposed to can have an affect on the DNA of your offspring. There isn’t much you can do about that, but now we have the awareness of epigenetics it’s ideal to take steps to do everything to can to set up a good environment for conception.

For a bit of extra reading on epigenetics check out my previous article here.

If you are thinking of having a baby and you want to give yourself the best chances and give your child the best start in life, contact us today to start a preconception program.

Preconception Care Frequently Asked Questions

What is preconception care?

Put simply, preconception care is to ensure, as much as possible for any given couple the presence of all the factors required for fertility and creation of the healthy fetus and the absence of all the factors detrimental to fertility and for formation of a healthy fetus

Preconception care aims for the optimum general and reproductive health of both partners to ensure good fertility and the health of the egg, sperm and the womb.

It is the ultimate preventative medicine.  By undertaking preconception care you are reducing your risks of complications and promoting the health of your future child.

Who should do preconception care?

• Anyone planning to conceive can benefit, whether there have fertility issues or not.
• Both prospective parents (see below)
• Older parents
• Those who are overweight or obese
• Those with a history of environmental toxin exposure
• Those with a history of fertility problems, miscarriage or still births
• Those with a history of genetic defects, physical or mental health problems in their previously conceived children.
• Women who have previously been on medications which can cause nutritional deficiencies such as the oral contraceptive pill or methotrexate.
• Those undergoing IVF. Couples undergoing IVF are often having problems with egg and/or sperm quality, older in age, or have other factors affecting fertility health.  IVF is also associated with increased risks of genetic problems, pregnancy complications and miscarriage rate –  preconception care can help to reduce these.  Preconception care can also improve the success rates of IVF (saving you time, anguish and money).

What are the benefits of preconception care?

It can reduce risks of fertility, miscarriage, fetal defect, and unhealthy children.

It can also improve the chance of healthy conception, a healthy and full-term pregnancy, a natural, intervention free birth, reduce problems post birth such as post natal depression, and support long-term breastfeeding.

Comprehensive preconception care may reduce the risk of age-related sub fertility, miscarriage and fetal defects.

Diet and nutritional supplementation can affect genetics, reducing the rate of genetic conditions.  Essentially this means that good preconception care can switch off faulty genes in the developing fetus (like a light switch) and this benefit is passed onto their offspring as well.

By providing an optimally healthy environment, your child’s genetic blueprint will be strong and robust.  Not only will they be healthy children but that health continues into adulthood.  What a great gift for your child.

How long should I do preconception care for?

Preconception care should begin well before conception (minimum of 4 months) and continue through pregnancy and breastfeeding.

It takes 100 for eggs to mature and 116 for sperm to generate, so it is recommended that preconception care be undertaken for at least 4 months before you attempt to conceive.

The instant that egg and sperm combine an irreversible blueprint is formed for the development of the baby.  This blueprint is reflective of the health and toxicity levels of the egg and sperm in the 4 months prior to conception.

It is enough to just take Folic acid?

No.  Folic acid (the synthetic form of folate)  is well known for its ability to prevent neural tube defects – however folate is important for much more than this and it is NOT THE ONLY nutrient required during preconception and pregnancy. There are many other nutrients that have such as many important effects in preconcetion and pregnancy and are often forgotten – Vitamin B3 (Niacin), Iodine, Iron.

Additionally, too much folate taken without the rest of the other B vitamins can actually mask a deficiency of vitamin B12 – this can actually cause spinal development problems as well!

Some people have a genetic problem called MTHFR which affects their ability to convert folic acid to its activated form.  These people need folinic acid (the activated form available in Australia) and folate found in food (the naturally occuring form, not synthetic added form found in some packaged foods) and again this must still be taken with the other B vitamins.

While folate is very important, we require COMPREHENSIVE preconception care.

Should my partner do it too?

YES!  Sadly, many women incorrectly blame themselves for fertility problems and/or miscarriage.  Poor sperm health can contribute to miscarriage, genetic defects and fertility issues.  Problems related to sperm health do not end at conception.

• Sperm are more vulnerable than eggs because they are smaller, more exposed and are developed entirely within the present environment.
• Some studies have found that 75% of infertility is due to male factors.
• Sperm is at least 50% responsible for the health of the baby and the pregnancy.
• Studies have found certain conditions are linked to the health of the sperm such as leukemia, asthma, bronchial/respiratory system and mental development/disease.
• Not only does it affect fertility, miscarriage rate and the health of the baby, but poor sperm health can also affect the health of the mother during pregnancy. Partners of older males have been found to have an increased rate of pre-eclampsia, regardless of the age of the mother. So just because you have fallen pregnant in the past doesn’t mean the guy doesn’t have to help out too.

What is my partner doesn’t want to come to the appointment?

Ideally preconception care involves both partners.  However if for some reason the male partner cannot or will not undergo preconception care…  One partner is better than none.

What is I’ve already fallen pregnant?

Congratulations! Now take a deep breath, relax: just because I’ve been talking about how I think it is important for couples to undergo preconception care if they have the opportunity it does not mean that NOT doing it will mean you have an unhealthy baby or terrible pregnancy. There are plenty of healthy babies out there that were conceived accidentally or under non-ideal health situations, the human body is amazing!

Remember that preconception care is about doing the best you can do, and if you’ve already conceived then take the steps now to work on your health, read more about naturopathic support in pregnancy here.

If you are thinking of having a baby and you want to give yourself the best chances and give your child the best start in life, contact us today to start a preconception program.  

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In the Media:

Published in Australian Natural Health: Eat Yourself Happy

If you’ve noticed your mood hasn’t been as vibrant as usual lately, one of the first things to consider is tweaking your diet. It never ceases to amaze me what amazing results can be produced with small dietary changes.

Pick up a copy of Australian Natural Health this month to have a read!

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The link between MTHFR and Thyroid health

MTHFR is a gene that has been known for several decades now, but the implications that this gene can have on our health are only becoming well known recently.

If you’ve tested positive for the MTHFR gene, you’re probably still learning about all the impacts it can have on your health. If you haven’t been tested for it, but have some concerns about your health, then I definitely recommend learning more about it and consider getting yourself and your loved ones tested.

MTHFR is just one type of gene that we can have issues with and certainly it’s not the be all and end all of our health (nothing is) but it is showing to be a very important one with some wide ranging health implications such as mental health, heart disease, digestive health, fertility issues and more. MTHFR is also linked to the health of our thyroid, and the health of our thyroid has an impact on the activity of our MTHFR gene.

I know I tend to get a little carried away when writing these articles, so for those of you have are in a hurry, I introduce my new addition to my articles, a TLDR summary (TLDR = too long; didn’t read).

TLDR:

• The MTHFR gene produces an enzyme which is responsible for the conversion of methylfolate, the activated form of folate, folinic acid and the synthetic, not good for us form, folic acid.
• A fairly large proportion of the population has some form of mutation in this gene which causes underactivity of certain chemical pathways in the body (known as methylation) à which causes methylfolate deficiency à which causes lots of health problems because it’s a very important nutrient in our biochemistry.
• Our thyroid status affects the expression of the MTHFR gene, regardless of whether you have the polymorphism (gene mutation) or not.
• MTHFR polymorphism can reduce detoxification of chemicals and also affects immune health, which can contribute to the presence of autoimmune thyroid disorders such as Graves and Hashimotos disease.
• If you don’t have methylation working properly, you’re not turning your genes on and off properly, and this can be linked to cancer, in particular thyroid cancer. There is an increased risk of thyroid cancer in those who with homozygous C677T MTHFR.

Still reading? Cool!

Here’s a bit of a summary about what MTHFR is and its impact on your health.

The MTHFR gene produces an enzyme in the body called methylenetetrahydrofolate reductase which is responsible for converting folate, folic acid or folinic acid into a form that the body can use – methyltetrahydrofolate, or commonly shortened as methylfolate.

Some people have a genetic mutation in the MTHFR gene which affects this pathway, and as a result causes a lot of other issues in our health.  This methylation pathway is central to our biochemistry, so defects in this gene cause wide ranging implications and are associated with a huge amount of conditions, including but definitely not limited to:

There are two main MTHFR genes we are currently aware of (there are some other types but these are rarely tested or implicated in conditions), and your combination of these genes, as well as you diet and lifestyle, affects how much of an impact this gene has on your health. If you have the MTHFR gene mutation and you are consuming synthetic folic acid such as from fortified foods and certain supplements(*cough*most supplements out there), this can worsen your health as well, by blocking up the methylation pathways and your blood can accumulate with unmetabolised folic acid (UMFA). Accumulation of UMFA has been linked with inhibition of part of your immune system, particularly suppression of your natural killer cells (1).

MTHFR and Thyroid Health

If you have hypothyroidism, it’s likely your MTHFR gene is sluggish

And this can be whether you have the polymorphism or not.

If your thyroid is underactive then you have lower levels of a thyroid hormone thyroxine (T4) in the body. Our body converts T4 to T3, and those who have an underactive thyroid are mostly prescribed T3 medication, bypassing the T4 deficiency.

Giving T3 in isolation may address the thyroid function, but T4 is involved in the process of making vitamin B2 into its active form, flavin adeninde dinucleotide (FAD) (2). If you don’t have enough T4, you can’t covert Vitamin B2 to FAD properly, and your supply will be reduced.

If you don’t have enough FAD, your MTHFR enzyme slows down, causing low methyfolate levels, and subsequently can mimic the issues caused by having the MTHFR polymorphism (3).

“But my thyroid is normal.”

It’s important to be aware that the standard test for thyroid health is TSH, and if this is within normal range most people are brushed off, being told that their thyroid is ‘fine’.

I believe that solely testing TSH levels gives an incomplete understanding of thyroid function. The current ‘normal’ range of TSH 0.5-5.0 debatable, and in addition to this, other factors such as the presence of reverse T3 (which competes with natural free form T3) and the ratio of T4:T3 (which I recommend to be 3.3:1) is rarely considered.

It’s not uncommon that even if T3 and T4 are added to a test request that they will not be performed is TSH is within normal range. This is due to the restrictions placed on doctors and labs regarding what can be covered by Medicare. If you suspect that you have an underactive thyroid and your TSH is greater than 2, it may be worthwhile discussing whether you would benefit from seeking deeper investigations with your health practitioner, and it is likely that further testing will have to be paid for yourself.

MTHFR impact on thyroid

Conversely, if you have the MTHFR polymorphism then it can impact thyroid health. MTHFR polymorphisms can cause issues with detoxification of chemicals and immune health, factors which can contribute to the development of autoimmune conditions such as Grave’s disease and Hashimotos. Chemicals such as organophosphates and those in the halide group (fluoride, chlorine and bromide) can interfere with iodine levels, an essential mineral for thyroid health. We are exposed to these chemicals on a regular basis, and unless we are making steps to minimise our exposure they can often be in harmful amounts. People with MTHFR polymorphisms have a much harder time detoxifying these chemicals, and so their effect on the thyroid function is greater.

As impaired methylation causes lower levels of methyfolate, which is involved in the production of biopterin (BH4) (1) (4). This is needed to convert tyrosine into its active form and tyrosine is needed for formation of the thyroid hormones.

Some research has found that the MTHFR genotype C677T (homozygous) can increase the risk of developing thyroid cancer in caucasians (5) (6) (7). This is a pretty scary thing to hear, but rather than view it in a negative light we should embrace this knowledge and make the steps to reduce our risk factors. Also remember that the genes don’t cause problems in themselves, rather it is our diet and lifestyle that influences the expression of these genes – we have a lot of power over our health.

It is a good idea to make steps to avoid the harmful halide chemicals and other toxins, and ensure we are getting adequate nutrients necessary for our thyroid health (you can read more about this here). Ensure you’re getting the right nutrients for methylation through your diet, and definitely avoid synthetic folic acid. If you are homozygous for C677T it may be a good idea to get baseline thyroid ultrasound, and repeat this every year or so.

If you would like to learn more you can watch a presentation by Dr Ben Lynch here.

Works Cited

1. Lynch B. [Video Presentation].; 2013 [cited 2014 November 23. Available from: http://mthfr.net/mthfr-and-thyroid-disorders/2013/07/18/.
2. Cimino JA, Jhangiani S, Schwartz E, Cooperman JM. Riboflavin metabolism in the hypothyroid human adult. Proceedings of the Society for Experimental Biology and Medicine. 1987 Feb; 184(2).
3. Hustad S, Nedrebø BG, Ueland PM, Schneede J, Vollset SE, Ulvik A, et al. Phenotypic expression of the methylenetetrahydrofolate reductase 677C–>T polymorphism and flavin cofactor availability in thyroid dysfunction. The American Journal of Clinical Nutrition. 2004 October; 80(4).
4. Miller AL. The methylation, neurotransmitter, and antioxidant connections between folate and depression. Alternative Medicine Review: a journal of clinical therapeutic. 2008 Sep; 13(3).
5. Yang YM, Zhang TT, Yuan L, Ren Y. The association between the C677T polymorphism in MTHFR gene and the risk of thyroid cancer: a meta-analysis. European review for medical and pharmacological sciences. 2014; 18(5).
6. Chen Y, Wang B, Yan S, Wang YG. Significant association between MTHFR C677T polymorphism and thyroid cancer risk: evidence from a meta-analysis. Genetic testing and molecular biomarkers. 2014 Oct; 18(10).
7. Ozdemir S, Silan F, Uludag A, Atik S, Erscelcan T, Ozdemir O. Increased T-allele frequency of 677 C>T polymorphism in the methylenetetrahydrofolate reductase gene in differentiated thyroid carcinoma. Genetic testing and molecular biomarkers. 2012 July; 16(7).
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It’s no new news that you should eat well while you’re pregnant. But what a lot of people don’t realize is the importance of eating well BEFORE you fall pregnant – during the preconception period. I try to teach my patients the importance of a healthy preconception care diet for both mother and father for at least 4 months before they are going to try to conceive.

Considering how hard it is to eat a healthy, nutrient dense diet when you have morning sickness, it makes the 4 month preconception care period all the more important (although I don’t think there’s a period of life when you shouldn’t eat well).

The reason for this time frame is because sperm can take 116 days to generate and during this time they are easily susceptible to damage. Similarly, the egg is vulnerable during maturation for around 100 days leading up to ovulation.

The damage that I’m referring to is of the genes of the sperm and the egg. If the genes of either are altered, then the foetus is more likely to develop a stronger tendency to genetic conditions such as autism, schizophrenia, genetic cancers, physical malformations and can increase general ill-health.

The thing about DNA is that some genes can be turned on and off like a light switch. Our environment i.e. the food that we eat and the chemicals that we’re exposed to control these switches – this concept is referred to as epigenetics. Methylation is another player in this whole process – it is a chemical ‘tagging’ process which aids in activating certain proteins in our body and silencing some genes.  This process is dependent on healthy levels of certain B vitamins – deficiencies in these vitamins can lead to an increase in DNA damage and when methylation isn’t working properly it can also cause problems in adults as well, such as heart disease, mood disorders and more.

Epigenetics research

While the research in this field is still in its infancy (haha, get it?) the research that we do have available is certainly interesting.

Most of the research that has been done in this field has been on mice. Any information that we get from animal research can never be fully extrapolated into recommendations for humans because mice and human metabolisms are worlds apart. It is a starting point however.

The human research that has been done has mostly been on the mother, and until recently it has mostly been during pregnancy. I believe the diet and supplements for the preconception period are just as important for the father however, and while there is some research in this area it is minimal in comparison.

The most well known study is that of the agouti mice. A selection of mice that were genetically identical were exposed to certain chemicals or dietary changes during their pregnancies that triggered gene changes in their pups, which was displayed as the production of the agouti protein, which turned their hair yellow. This same protein also prevented the mice from being able to feel full, and they developed obesity and were more prone to cancer and diabetes.  Some of the mice did not express this gene and so remained of normal weight and brown and some mice developed a mottled yellow-brown colour, only having partial gene expression. They were all genetically identical, however their gene expression was different.

Figure 1 The Yellow Agouti Mouse Model

Diet during pregnancy

Another study found that mice fed a high fat diet during pregnancy produced mice with altered metabolisms and also had brain changes which resulted in an impaired ability to feel when they were full. The third trimester and breastfeeding period were most important in this aspect.   Something to note is that the ‘high fat’ diet that these mice are fed is actually a concoction of hydrogenated vegetable fats, mixed with sugar. This is a far cry from what is commonly understood to be ‘fats’, as the production of these fats turns them into rather toxic substances. Your everyday, whole-food sort of fat found in avocadoes, nuts and seeds, fish and meat are not going to cause the same issue but hydrogenated fat found in fast food and processed food are going to cause problems.

A human study compared the amount of weight a mother gained in each of her pregnancies, and found that if the mother gained too much weight during a pregnancy the child was more likely to develop obesity, even more than 10 years later, compared to when the mother kept to a healthy weight range during her pregnancy. There are a lot of factors which could influence this, but a possible mechanism is that methylation can be reduced in those who are overweight.

This study looked at a group of women in Gambia and analyzed their diet and nutrient status during the preconception period. There were two groups of women analyzed – one who had conceived at the peak of the rainy season, and one who had conceived at the peak of the dry season. The women who had conceived at the peak of the rainy season had greater nutrient levels, notably the B vitamins essential for healthy methylation, and their babies were found to have greater amounts of DNA methylation. The study also found a correlation between the mothers BMI and methylation levels.

This study doesn’t mean that we have to wait until it rains to try to conceive, but rather it highlights the importance of eating nutrient dense food.

The moral of the story? If you’re planning to conceive, are pregnant or breastfeeding aim to eat a variety of fresh, whole, seasonal , nutrient dense foods and avoid exposure to environmental chemicals as much as possible.

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Perhaps you’ve heard about one of the latest health buzzes when it comes to mental health – a cheeky enzyme known as MTHFR (methylenetetrahydrofolate reductase).

If you have a mutation in this gene then it can cause your methylation processes to work too much, too little, or not enough at all.  Methylation is essentially a process that occurs where DNA gets tagged with a ‘methyl group’ which lets the rest of the body know not to read that particular bit of DNA.  It’s also involved in the production of neurotransmitters, detoxification of chemicals, nerve health and processing of certain hormones and nutrients, to name just a few.

When the MTHFR genes work properly, you have adequate enzyme activity and that means you can more efficiently make proteins, use antioxidants, metabolize hormones, enjoy more stable brain chemistry, better eliminate toxins and heavy metals, and manage inflammation.  So if you’ve got a problem with this gene, it really can be a bugger.

How does it affect your mood?

Many people with the MTHFR gene experience mood imbalances.  This gene affects your mood in a few ways.

Reduced MTHFR enzyme means that you cannot make and recycle a very important antioxidant, glutathione effectively.  Glutathione is responsible for a vast array of activities in the body and low levels have been associated with conditions such as depression, inflammation, bipolar, chronic fatigue syndrome and autism.

If your body cannot methylate the chemical homocysteine (you can find out if this is too high via a blood test) that results in decreased production of SAMe.  This leads to decreased production of dopamine, serotonin and norepinephrine, neurotransmitters all responsible for mood balance.

If there is a reduced ability to detoxify chemicals and heavy metals (which is a factor for those with the MTHFR gene) this can also affect your mood.  Digestive and liver health can have an indirect affect on your mental health, for several reasons such as the health of your gut flora, increased inflammation and an impact on your neurotransmitters.  Digestive health problems have been linked to mental health problems in several studies.  Click here to read more.

A lot of people with MTHFR gene also have a condition called Pyroluria (also known as Pyrolle disorder, Mauve factor, Kryptopyrrole, Kryptopyrroluria.  People with this condition produce excess amounts of a substance called Pyrolles which bind to certain nutrients such as Vitamin B6, Biotin Zinc and GLA (an essential fatty acid).  There are several conditions associated with this disorder but namely it is involved in several mental health conditions such as Bipolar, Schizophrenia, Manic depression and ADD/ADHD.  This condition is also strongly linked to the state of the digestive system.

MTHFR and Folate

One of the main issues we have come to understand with MTHFR is that people with this gene cannot process folic acid into folate effectively and so cannot handle synthetic forms of the nutrient.  This can become a bit of an issue because synthetic folic acid is in pretty much every multi-vitamin, and a lot of foods are fortified with it.  If you are consuming synthetic folic acid and you can’t process it, it clogs up a lot of the pathways that require folate and as a result a lot of health complications arise.  You can also be prone to problems relating to deficiencies of folate, such as miscarriage and neural tube defects.

Photo by Braňo on Unsplash

People with MTHFR require a special activated form of this nutrient, the type found naturally in some foods.   How much depends on the level of the gene mutations present (there’s a lot of variety that you can have) and your diet and lifestyle can have a big impact on it as well – it’s completely possible to have this gene and be symptom free and healthy if your diet and lifestyle is fine, and the gene hasn’t been ‘switched on’ (usually by stressful events).  In Australia the closest to natural folate that we have available is folinic acid (calcium folinate) supplements, however this may still be difficult to metabolise for those who have very poor methylation.

Getting tested

If you suspect that you have this gene, then you can easily get yourself tested via labs such as Healthscope, Nutripath or 23 and Me.  You may like to get this organized with a health practitioner who is knowledgeable in the realm of MTHFR, so they can guide you with treatment if needed.

Learn more: MTHFR_Related_Health_Problems

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