What you need to watch out for if you’re following a dairy-free diet – Anna Nicholson (Nutritionist)

The trend for going to a dairy-free diet has been increasing in popularity over the past few years, whether it be due to a genuine lactose intolerance or allergy or just health concerns. It’s no wonder, given that the consumption of dairy has been linked to:

• Digestive issues (lactose or casein-sensitivities);
• Bloating;
• Respiratory issues (increased mucus production and asthma);
• Exacerbating skin issues (acne and eczema);
• Inflammation and oxidative stress (due to the D-galactose content);
• Increased risk of prostate cancer (promotes the production of IGF 1, which cancer cells love); and
• Increased exposure to pesticides, antibiotics and hormones used in the dairy industry.

However, there are some risks in eliminating dairy from your diet, which you should be aware of! Dairy is an important source of calcium, vitamin D, protein, riboflavin, potassium and magnesium, as well as other nutrients. This is a concern given that the 2011 – 2012 Australian Health Survey identified that that majority of Australian women are not getting adequate calcium in their diets.

Calcium

Calcium is essential for strong, healthy bones and for the healthy functioning of the heart, muscles, blood and nerves. Almost 99% of the body’s calcium is found in the bones and your bones act like a calcium bank so if you don’t get enough calcium from your diet, the body takes it from your bones for use elsewhere in the body. If this continues, bone density (strength) will gradually decrease and risk of developing osteoporosis (brittle bones) increases. Osteoporosis is a serious issue in older age as broken bones take longer to heal and can lead to significant loss of mobility and independence.

The amount of calcium you need depends on your age and sex, with teenagers (growth spurt), women over the age of 50 (menopause causes more rapid bone loss) and men over the age of 70 (calcium is absorbed less efficiently from the intestine and lost increasingly through urine in older adults) having greater calcium requirements. Unfortunately, we lay down most of our calcium reserves during the first 30 years of our lives (especially during puberty), so maximising calcium intake during those early years is important for achieving and maintaining optimum bone health throughout life. After the age of 30 it is just about managing that calcium bone bank so that your dietary intake is equal to or greater than any losses.

Vitamin D

Vitamin D has a crucial role in maintaining bone health as it improves the absorption of calcium from the intestine and helps control calcium levels in the blood. Food is generally not a great source of vitamin D but luckily, we can get plenty of vitamin D from the sun so making sure you get out for at least 20 minutes a day (especially during the winter months!) will really help support your bones. Other sources of vitamin D include oily fish (salmon and mackerel), eggs and liver. Some milk and dairy-free alternatives are also fortified with vitamin D.

Alternative Sources of Calcium

The Australian Dietary Guidelines recommend that you should include 2.5 serves of milk, yoghurt, cheese and/or alternatives (mostly reduced fat) in your diet each day. This increases to 4 serves per day for post-menopausal women. So, if you’re not eating dairy, what are the most calcium-rich alternatives?

There are sooo many dairy-free alternatives available in the supermarkets these days, but not all of them will provide you with calcium you need. It should be noted that whilst some plants provide calcium, not all of this is in a form that is available for our bodies to absorb. This means that we would need to eat large quantities of these foods in order to achieve the recommended daily intake. For example:

• 1 cup of cooked spinach contains 100 mg of calcium but only 5% of this might be absorbed so you would need to eat 60 cups in order to obtain the same amount of calcium as in a glass of milk!
• 1 cup of broccoli contains approximately 45 mg of calcium but only around 50-60% is absorbed so you would need to eat around 13 cups of broccoli to get the same amount of calcium as in a glass of milk.
• 15 almonds contain around 40 mg of calcium, so you’d need to consume around 375 almonds to match a glass of milk. This may not sound that bad but also means that you’re consuming approximately 225 g of fat and 2,625 calories – ouch!

Adding to this, we also need to consider the calcium losses from the body through urine. These losses are increased with increase salt, caffeine and alcohol consumption, so it is important to reduce our intake of these to ensure that we’re not undoing all the good work of increasing consumption of calcium-rich foods! Diets high in animal protein and nuts and seeds can also lead to increased excretion of calcium through urine so this is also something to consider.

Tips for getting more calcium

If you are avoiding dairy products, try including some of the following foods in your diet to increase your calcium intake:

• Try to eat the bones in salmon and sardines as this is where most of the calcium is concentrated;
• Green leafy veg, especially broccoli, bok choy, silverbeet, kale and spinach;
• Almonds (maybe not 375 but even a few will help!);
• Dried figs and dried apricots;
• Chickpeas;
• Eggs;
• Tahini;
• Fortified foods such as calcium-set (firm) tofu and some soy milk – calcium from these is easily absorbed as it is from other foods that naturally contain calcium;

If you’re unsure, this Online Calcium calculator can help you work out if you need to up your calcium intake!

Calcium Supplements

There has been a lot of controversy surrounding the negative effects of calcium supplements. Some studies suggest that taking calcium supplements may lead to an increased risk of breast and prostate cancer, heart attacks or strokes and kidney stones as well as interfere with the absorption of other minerals like iron, magnesium and zinc. Calcium supplements can also interact with various medications, including antibiotics, thiazide diuretics, digoxin and phenytoin so it’s best to speak to your doctor before taking them. As always, it is better to get your nutrients from actual food!

This article is not intended to substitute for informed medical advice. You should not use this information to diagnose or treat a health problem or condition. Always check in with a medical practitioner before making drastic changes to your diet, taking supplements or starting a new fitness routine.

References

Afeiche, M.C., et al., (2016). Dairy intake in relation to in vitro fertilization outcomes among women from a fertility clinic. Human Reproduction, Vol. 31, No. 3, pp. 563-571, 2016, d.o.i. 10.1093/humrep/dev344.

Australian Bureau of Statistics. 4364.0.55.008 – Australian Health Survey: Usual Nutrient Intakes, 2011-12. http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.008~2011-12~Main%20Features~Calcium~401. Updated 06 March 2015.

Australian Dietary Guidelines. https://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/n55_australian_dietary_guidelines.pdf

Chavarro, J.E., Rich-Edwards, J.W., Rosner, B., Willett, W.C., (2007). A prospective study of dairy foods intake and anovulatory infertility. Human Reproduction, Vol. 22, No.5, pp. 1340-1347, 28 February 2007. D.o.i 10.1093/humrep/dem019.

Feskanich, D., Willet, W.C., Colditz, G.A., (2003). Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Am J Clin Nutr 2003;77:504-11

Dr. Josh Axe, 2018. Dairy-Free Diet Benefits + 6 Alternatives. Online article accessed 23 August 2018. https://draxe.com/dairy-free-diet/

Mannion, C.A., Gray-Donald, K., Koski, K.G., (2006). Association of low intake of milk and vitamin D during pregnancy with decreased birth weight. CMA, 174(9), 25 April 2006.

Osteoporosis Australia. https://www.osteoporosis.org.au/

Sanders, K.M., et al., (2009). Calcium and bone health: position statement for the Australian and New Zealand Bone and Mineral Society, Osteoporosis Australia and the Endocrine Society of Australia. MJA, Vol. 190, No. 6, 16 March 2009.

Thorning T.K., Raben, A., Tholstrup, T., Soedamah-Muthu, S.S., Givens, I., & Astrup, A., (2016). Milk and dairy products: good or bad for human health? An assessment of the totality of scientific evidence. Food and Nutrition Research, 60:1, 32527, DOI: 10.3402/fnr.v60.32527

Victorian Government, 2018. Better Health Channel- Calcium. https://www.betterhealth.vic.gov.au/health/healthyliving/calcium

Weaver, C.M.,  Proulx, W.R., and Heaney, R., (1999). Choices for achieving adequate dietary calcium with a vegetarian diet. The American Journal of Clinical Nutrition, Volume 70, Issue 3, 1 September 1999, Pages 543s–548s, https://doi.org/10.1093/ajcn/70.3.543s

What to do during the two-week wait

OK, so you’ve done all the hard work tracking your ovulation, had sex at the ‘right’ times, or perhaps you’ve just undergone an IVF cycle, and now you are waiting… and waiting to see if implantation has occurred. Implantation is the process whereby the fertilised egg (known as a blastocyst at this point) adheres to the wall of the uterus. This usually occurs 7-10 days after ovulation (or embryo transfer), hence the two-week wait.

That two-week wait before you can take a pregnancy test can feel like forever and the suspense unbearable! Rather than tearing your hair out (and causing unnecessary stress), whether you have been trying naturally or through IVF or insemination, there are still some things that you can be doing to help to encourage implantation.

#1. Diet

There’s no escaping it, diet really is important and whilst there is no ‘special’ implantation diet you should be following (despite what the internet may say), you may like to think about changing your diet to help support your body through the implantation process. If anything, it will be a great head start for if you do become pregnant! Studies have shown that preconception weight is one of the major risk factors for fertility outcomes and that women of a healthy weight are more likely to get pregnant than women with a lower or higher BMI (body mass index). Although now is definitely not the time for a crash diet, focus on including whole grains, lean protein, vegetables, fruits and low-fat dairy and reducing or eliminating processed foods, alcohol and caffeine from your diet.

Eat to support healthy hormone levels and to nourish a healthy uterine lining:

• Inflammation can create an inhospitable environment for sperm and a developing embryo so add omega-3 rich, anti-inflammatory foods such as fatty fish (salmon), flaxseeds, chia seeds and walnuts to your diet. Omega 3 fatty acids have been shown to improve embryo morphology during IVF and not only that these foods are also great sources of protein, zinc and/or fibre to aid growth and digestion.
• Protein is important for growth and there will be a lot of that if your embryo starts to develop! In addition to fatty fish and nuts, eggs and legumes are a fantastic source of protein as well as iron. Studies have shown that improved fertility outcomes are found in women that had a lower intake of animal protein (particularly red meat) and increased vegetable protein intake so take your mind off the wait, get creative and try including a few more vegetarian meals in your diet during this time!
• Carbohydrates are often demonised, but we do need them for fuel. Stick to whole grains (brown rice, wholegrain oats), quinoa, fresh fruit and vegetables and avoid processed foods such as white rice, bread and pasta. Try to include a wide-variety of fresh fruit and vegetables (“eat the rainbow”), especially cooked and fresh dark leafy greens (broccoli, bok choy, kale, kale, chards etc.,) for the folate and dark-berries (blueberries, raspberries, strawberries) for their anti-oxidant properties and vitamin C. Choose organic where possible as organic produce and animal products should be free from hormones and antibiotics and have lower pesticide and herbicide residues.
• Consider eating foods that support warmth – a warm womb is an inviting one! Foods that include ginger, cinnamon and cayenne are great, as are soups and stews.
• Whilst there is no concrete evidence, it is thought that pineapple may be beneficial to implantation due to the high-levels of the antioxidant bromelain. The core of the pineapple contains the highest concentrations so why not add some to a smoothie?

• Lastly, it is best to reduce or eliminate acidic foods such as red meat, coffee, alcohol and processed foods will make your cervical mucous hostile to sperm. Not only that, but alcohol impairs absorption of a number of important nutrients and acts as a diuretic, increasing the excretion of water-soluble nutrients.

#2. Prenatal Supplements

If you’re not taking one already you should definitely start taking a good quality prenatal vitamin in your diet – look for brands, which contain folate (the natural and bioavailable form of vitamin B9) rather than the synthetic form, folic acid. Folate is now considered not only as a nutrient needed to prevent neural tube defects in pregnancy but also as a vitamin essential for reproductive health. Look for a supplement that includes 600 ug for a daily dose.

Check whether the prenatal supplement includes omega 3 fatty acids such as EPA and DHA. If they don’t, it is also a good idea to add in a good quality fish oil or algal oil (for vegetarians or vegans) supplement to cover you for this. Other important nutrients that your prenatal supplement should include are vitamin D and iron.

Choosing a good supplement can be extremely overwhelming so a good resource for checking the quality of a supplement is the website https://labdoor.com , which independently tests supplements and ranks them based on label accuracy, purity, nutritional value, ingredient safety and projected efficacy. Although it’s a U.S. website it does list a number of locally available Australian supplements.

#3. Exercise Vs. Relaxation

Although exercise can be a great stress-release, now is not the time to go all out with your exercise routine! Instead, keep exercise to low impact activities such as walking or sessions on the elliptical trainer or stationary bike. Pilates and yoga are great for nurturing your body but avoid the more strenuous forms such as Bikram / hot yoga or power yoga.

It is advisable to avoid elevating your core body temperature as this can put you at risk of miscarriage. So keep running to a light jog and stay away from baths, jacuzzis, hot tubs, steam rooms and saunas. It is probably best to avoid swimming for a couple of weeks as this could expose you to bacteria, infection and chemicals such as chlorine.

Never underestimate the power of positivity! Mind-body therapies that focussed on development of strategies for coping with stress, social networks and breathing and relaxation techniques were found to improve pregnancy rates in women undergoing their second IVF treatment cycle, so try to meditate, go to a yoga class, get a massage or hang out with your friends and family. There are so many apps that can help you learn how to meditate if you have never tried before such as Headspace, Calm and Insight Timer.

Acupuncture can also be helpful for relaxation but has also been shown to increase chances of getting pregnant by up to 65% (British Medical Journal, 2008), so why not book in for a session at The Fertility Pod?

Giving up your fitness regime can be tough but remember that the potential rewards will be worth it! Your body is already working extremely hard so don’t feel guilty resting and enjoying some quiet time! It’s a great excuse to catch up on that Netflix series or podcast, read a book or even try getting outside for a walk in the sunshine (a bit difficult in the winter I know) to keep those vitamin D levels topped up and help you sleep!

This article is not intended to substitute for informed medical advice. You should not use this information to diagnose or treat a health problem or condition. Always check in with a medical practitioner before making drastic changes to your diet, taking supplements or starting a new fitness routine.

Anna Michael, Nutritionist

References

Afeiche, M.C., et al., (2016). Dairy intake in relation to in vitro fertilization outcomes among women from a fertility clinic. Human Reproduction, Vol. 31, No.3 pp. 563-571, 2016, doi: 10.1093/humrep/dev344.

Australian Government National Health and Medical Research Council, Department of Health and Ageing. Healthy eating during your pregnancy: advice on eating for you and your baby. https://www.eatforhealth.gov.au/sites/default/files/content/The%20Guidelines/n55h_healthy_eating_during_pregnancy.pdf

Australian Government National Health and Medical Research Council, Department of Health and Ageing. Australian Dietary Guidelines 2018. https://www.eatforhealth.gov.au/guidelines

Bailey, L., (2000). New standard for dietary folate intake in pregnant women. The American Journal of Clinical Nutrition, Volume 71, Issue 5, 1 May 2000, Pages 1304S–1307S, https://doi.org/10.1093/ajcn/71.5.1304s

Collins, G.G., and Rossi, B.V., (2015). The impact of lifestyle modifications, diet and vitamin supplementation on natural fertility. Fertility Research and Practice 1:11, doi: 10.1186/s40738-015-0003-4

European Society of Human Reproduction and Embryology, 2018. Mediterranean diet may help women receiving IVF to achieve successful pregnancies. https://www.sciencedaily.com/releases/2018/01/180129223846.htm.

Manheimer, E., Zhang, G., Udoff, L., Haramati, A., Langenberg P., Berman, B.M., Bouter, L.M., (2008). Effects of acupuncture on rates of pregnancy and live birth among woman undergoing in vitro fertilisation: systematic review and meta-analysis. British Medical Journal, 2008 Mar 8;336(7643):545-9. doi: 10.1136/bmj.39471.430451.BE. Epub 2008 Feb 7.

McGrice, M., and Porter, J. (2017). The effect of low crbohydrate diets on fertility hormones and outcomes in overweight and obese women: a systematic review. Nutritents 2017, 9, 204; doi: 10.3390/nu9030204.

National Health and Medical Research Council. Nutrient Reference Values for Australia and New Zealand. https://www.nrv.gov.au/nutrients/

Sangiulliano, J., 2016. Foods to enhance IVF success. https://babybloomers.co/foods-enhance-ivf-success/ Published 15 November 2016.

Southern California Reproductive Centre, 2016. Should I restrict exercise during IVF? https://blog.scrcivf.com/should-i-restrict-exercise-during-ivf. Published 20 September 2016.

Sweet Beet Acupuncture (2017). Foods for implantation. http://www.sweetbeetacupuncture.com/blog/2017/8/30/foods-to-eat-during-implantation. Published 25 September 2017.

Tamura, T and Picciano, M.F., (2006). Folate and human reproduction. American Journal of Clinical Nutrition 2006;83:993–1016.

How confusing is the topic of nutrition and the whole debate re raw vs cooked foods? Some say do this, some say absolutely don’t. The real truth is that there is a lot of chemistry involved in the nutritional values of food some foods need to be heated to a particular temperature in order to maximize their nutritional content. Then there’s other vegetables that lose a proportion of their nutritional value in the process of cooking.

Raw food gurus boast that a raw food diet is higher in nutrients, gives you more energy, helps you sleep, improves your skin, rids you of allergies, strengthens immune system, improves almost every disease, etc. This all sounds very similar to the affects of any diet high in vegetables and other healthy foods. I’m not knocking it because I’m actually a huge fan of raw foods. Getting a good mix of both is the way, and learning a bit about which vegetables are better when cooked or raw.

Cooked foods are definitely less work on the digestive system, so when the weather’s cold I like to keep my food on the warmer side (digestion can be slower in the colder months).

In the summer when digestive fire is alive it’s much easier for most people to consume raw foods.

Here’s a few examples of vegetable’s properties when raw or cooked.

Tomatoes contain Lycopene which in high doses is said to lower the risk of cancer and heart attacks. When cooked the Lycopene levels rise by 35%.

Asparagus, when steamed, ignites its cancer fighting properties.

Mushrooms, when cooked contain more potassium

Spinach when cooked – you will absorb more iron, calcium and magnesium

Carrots have higher beta-carotene levels when cooked.

But then…

Beetroot has 25% more folate when eaten raw.

Broccoli, when eaten raw, contains more of the enzyme Myronaise which helps cleanse the liver of carcinogens.

Red capsicum, when roasted or fried contains a lot less Vit C.

So these just give you an idea of how it all works. Things aren’t as simple as all one way or the other.

What no one in the health industry is in debate about is that eating lots and lots of veggies will help keep the body healthy. Mix it all up a bit and eat lots of it and you’ll be bound to get most of the nutrients you need.

Check out our article on liver health and fertility

So much inflammation comes down when sugar is removed from the diet. Not to mention what happens to your hormonal regulation. Insulin is closely linked to all the other hormones in the body, especially testosterone and estrogen. Don’t forget when talking about sugar I also mean refined carbohydrates.