Tracking Macros for Fertility: More Fat and Protein, less Carbs for TTC!

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Whether you have just started trying to conceive naturally, or you have been diagnosed with “infertility” and are considering assisted reproductive technology like IUI, IVF, or other options, research shows that maintaining a healthy fertility diet can dramatically up your chances of pregnancy success.  In this post I talk about the research on the fertility diet, including a very exciting study that gives us some actual numbers to work with!

The Number Game

If you are as Type-A obsessive-compulsive as I am about your fertility journey (and everything else in life), you probably go crazy when you read about perfect fertility diets but there are no NUMBERS to help you figure out EXACTLY what you are supposed to eat.  I’m guilty of writing in generics myself, because neither the research I’ve done previously, nor the diet I used to get pregnant with my first miracle included any kind of counting of calories or tracking of carbs, etc.  So I just give general advice- eat this, don’t eat this, eat this in limitation, etc.  

The problem with this approach is that it turns out that no matter how much we try and how much we think we are eating “healthy,” we are probably eating WAY TOO MANY CARBS for optimal fertility. Luckily we finally have some new guidance to help us figure out how many of each macronutrient- carbohydrates, protein, and fat – we should be eating.

The Major Fertility Diet Research- The Harvard Nurses Study

When I was first trying to conceive I followed the basic guidelines of the only major and well-respected fertility diet research study- the Harvard Nurses Study.  Their research studied only women with anovulatory infertility (meaning the patients were having a hard time getting pregnant because they weren’t ovulating).  Their results were the general fertility diet you see in most books, blogs, etc.: eat more plant protein (lentils, beans, nuts, etc.), and less animal protein, avoid trans fats, choose slow carbs (brown rice, quinoa, etc.), limit quick/simple carbs (sugar, white rice, juice, pasta, white bread), choose high fat dairy over low-fat, and limit alcohol and caffeine. They even wrote a book about it- you can get it at Amazon here: The Fertility Diet. I find it funny that they have peas in a pod on the front cover- yes, it’s cute, because it is a metaphor for pregnancy, but also peas hurts fertility, so, you know– haha.  Sorry, I digress.

Back to the story-

Unfortunately for me, this diet didn’t work at all.  After several early losses (chemical pregnancies and early miscarriages), the diagnoses started rolling in- endometriosis, High FSH, low AMH, Diminished Ovarian Reserve, and MTHFR mutation. I seriously needed to UP MY DIET GAME to get pregnant.

I started researching, reading, consulting with fertility gurus like Julia Indichova, and getting advice from my Traditional Chinese Medicine practitioner (aka, my acupuncturist).  I cobbled together a diet that was perfectly tailored for me, and in under three months I was pregnant with my miracle child. I stopped doing the “limit” nonsense and completely eliminated caffeine, alcohol, sugar, sweeteners, quick/white carbs, trans fats, soy, and all processed food.  I also eliminated dairy and all raw/cold foods per my chinese medicine diagnoses and personal dietary needs.  I consumed lots of organic veggies, eggs, legumes, whole grains, seaweeds, and healthy fats, and a moderate amount of organic meat. You can read all about the diet I followed here, and about how you can tailor a perfect diet for you here.  I also did many other things during those three months, and you can read about all of them here.

I got pregnant, with extreme discipline to this extreme diet.  

And, then again in 2017 I repeated these efforts and got successfully pregnant in three months again. Although this time I incorporated the changes suggested by the research from Dr. Russell I talk about below.

The “New” Research:

Dr. Jeffrey Russell of the Delaware Institute for Reproductive Medicine noticed something interesting.  He had plenty of young, healthy, fit women who had great BMIs (body-mass index), and yet had recurring failed IVFs because of poor egg and embryo quality. Although they seemed healthy- they were making terrible eggs.  They reported eating “healthy,” but he asked them to track their diets.  It turns out that most of them were MOSTLY eating carbs- oatmeal for breakfast, a sandwich or pasta for lunch, then rice for dinner with some meat and veggies.  Many of these women were eating 60% carbs for their diet, and less than 10% protein.  

So, they decided to ask them to eat more protein and fewer carbs and continue to track their diets.  What they found was astounding– once women hit the threshold of 30% or more protein, and 40% or less carbohydrates, they had FOUR TIMES the pregnancy success rates of those who ate more carbs and less protein.  FOUR TIMES.  

The change actually started at 25% protein consumption- that is when a reversal in egg quality and embryo development.  Once they reached 35% or above for protein they saw a peak in blastocyst development and pregnancy rate. So, going over 35% protein produced no further positive results.

If that doesn’t blow your mind, I don’t know what else will.  Here is his research published in the journey Fertility & Sterility.  Here is a great podcast with him where he explains his study and findings.  Dr. Russell now REQUIRES his patients to eat 25% to 35% protein and less than 40% carbs for THREE months before he will even allow them to begin their IVF cycles.

So, we’ve learned something very, very clear here- make sure you are eating between 25% and 35% protein.  You can get this from organic meat, organic eggs, wild-caught salmon, gelatin, organic organ meat, beans, nuts, lentils, etc.

Here’s the thing- When I do the calculations for the diet I was following when I got pregnant the first time- I was just about hitting that ratio exactly (hovered around 25% protein)!  To get to 35% protein the second time I had to up my meat intake, and add in daily bone broth.

What about FAT?

So, the whole time I am listening to Dr. Russell’s podcast and he keeps talking about the importance of protein, I keep waiting for him to talk about fats.  Why? Because there are only three “macronutrients” that make up our diets- carbohydrates, protein, and fats.  Many people who are trying to lose weight decide to count these instead of calories.  These three “macros” add up to 100% of your diet.  So, for Dr. Russell’s report he forgot to mention that component- >25% protein, <40% carbs, ~35% FATS.  

So, no matter what you want to be ensuring that around 35% of your diet is from healthy fats- AVOCADO (I eat one a day!), organic meat, organic eggs, wild-caught salmon, gelatin, ghee, coconut oil, coconut butter, nuts, extra virgin olive oil,  organic organ meat (like liver), and organic olives.

Here’s the thing- Dr. Russell’s research didn’t play at all with varying those protein and fat levels- nor with dropping carbs below the 40% mark. So, should you actually be eating FEWER carbs and MORE fat? 

Dr. Kiltz of CNY Fertility Center thinks you should. In fact he thinks you should eat 80% fat, 15-20% protein, and only 0-5% carbohydrates.  Crazy, huh?  Well it certainly sounds crazy, until you start listening to him.

Dr. Kiltz asks his fertility patients to stick to a “Bacon, Eggs, Butter, and Beef” diet.  Sounds delightful, doesn’t it?  It is basically an extreme version of the ketogenic (or “keto”) diet that has been found to help a number of health conditions including multiple sclerosis and PCOS.  In fact Dr. Kiltz shares the whole study on keto improving polycystic ovarian syndrome on his website here. Here’s Dr. Kiltz’s written explanation of why Keto works for fertility and overall well-being, and here is a terrific interview with him talking about it.  

Carbohydrates, all of them, stimulate fat production, insulin and inflammation that’s primarily the cause of metabolic disorders like PCOS, diabetes, and all the other chronic diseases.  Infertility is just an inflammatory chronic disease. The only way to reduce it is to cut out carbohydrates.  Your body requires fat and protein and it doesn’t require any carbohydrates.”

Dr. Kiltz believes that inflammation from our foods- and primarily carbohydrates- is literally killing us.  He also believes the DNA damage is reversible by switching from a high carb to a high fat diet.  He thinks that this diet is the most important for women with a history of miscarriage, chemical pregnancies, or failed IVF cycles.  In addition to bacon, eggs, butter, organic grass-fed meat, coconut oil, fish oil, and your daily avocado, he recommends taking MCT oil (Medium Chain Triglycerides). If you are interested, here is the only MCT oil available that is fully organic.

So, what are we supposed to do?

Okay, we know for sure we need to reduce carbs to under 40% of our diets AND those carbs NEED to be good, healthy, slow, complex carbs– brown rice, quinoa, lentils, and carbs from high-nutrient veggies and low-sugar fruits like berries.  

AND we should PROBABLY be hitting a solid amount of protein- 25-35%.  The rest my friend, how much further you reduce your carbs and up your fats– the rest is up to you!

Here’s what I’m doing–  I am basically sticking to my original diet plan (the one that got me pregnant three years ago), but I am gently upping my fats and reducing my carbs.  For example, I’m not cutting out any green veggies or berries, but I am reducing the amount of brown rice and quinoa I’m eating.  I’m not cutting out lentils, beans, or nuts, because they have all been shown to be great fertility foods, and more importantly THEY MAKE ME FEEL GOOD.  The most important thing is that you feel good.  I’m also continuing to avoid all dairy, because despite Dr. Kiltz’s persuasive talks (he advocates for some dairy), I know that dairy makes ME sick, so its just not worth it.  

Based on this research, what are YOU going to do?

HOW DO I COUNT MACROS?

Okay, okay, you’ve reached your limit of information and want an action plan!  Here is is in 5 simple steps.

1. Decide what macros you are going to try to hit.  To start, try Dr. Russell’s recommendation-25% protein, 40% carbs, 35% fats.  If you’re feeling fancy go with 35% protein, 30% carbs, 35% fats.
2. Get some kind of an app that tracks macros. If you have a Fitbit (and I hope you do) then you can actually track your macros right in the Fitbit app. If you don’t have a Fitbit you can download the free MyFitnessPal app or just use their website.  They will try to trick you into thinking that you need the paid version for macros, but you don’t, you can do it in the FREE version.
3. Start inputting every single thing you eat.   Both Fitbit and MyFitnessPal have a wide range of foods and recipes that have already been input so it should be easy to search and put add it to you daily food diary.
4. Before dinner, go and check your macros.  Are you where you need to be? If not, what do you need to eat for dinner to get into your perfect macro zone?
5. Do this for at least a few days before you figure out what foods you need to eat- and not eat to hit your macros.  If you are like me and you hate tracking things, you can then stop and just keep up that general diet.  If you NEED TO KNOW and keep track of EVERYTHING, however, you can actually do this every day to make sure you are hitting the right ratios.

Have I blown your mind?  I hope so, because all of this totally blows my mind. Let’s go, eat, and get pregnant, ladies!

Citations

Does changing a patient’s dietary consumption of proteins and carbohydrates impact blastocyst development and clinical pregnancy rates from one cycle to the next? Russell, J.B. et al. Fertility and Sterility , Volume 98 , Issue 3 , S47