Eat Your (Leafy) Greens
By Emily Hahn APD
While dark green leafy vegetables may not always be a favourite at the dinner table, there is no denying the ‘eat your greens’ mealtime mantra is spoken as a gesture of love and good intention, founded in the wisdom that dark green and leafy vegetables are a rich source of body-loving nutrients. Let’s look at the humble vegetable group we call ‘dark green & leafy’ to see what all the fuss is about.
Dark Green and Leafy Vegetables
This group of vegetables includes arugula (rocket), Bok choy (Chinese chard), collard greens (a variety of cabbage that produces long leaves instead of a head), dandelion greens, kale, mustard greens, rapini (broccoli raab), Swiss chard, turnip greens and spinach.
It also includes the brassica vegetables since there are many nutritional overlaps. Brassicas (also called cruciferous vegetables) are broccoli, cauliflower, broccolini, turnip, Brussels sprouts, and cabbage. This short list is limited to those most cultivated in the West, but Mother Nature’s generosity in producing edible green plants the globe over means that many cultures have leafy greens native to their geographical location, and thus include them in their dietary pattern.
Nutritionally, dark green and leafy vegetables are rich in:
Preparing for Pregnancy
While dark green and leafy vegetable consumption and fertility has not been heavily studied, research is consistent when it comes to the protective effects of dark green and leafy vegetables for positive birth outcomes and all-round health.
Zerfu and colleagues (3) found that poor or inconsistent consumption of dark green leafy vegetables was associated with a 92% higher risk of experiencing an adverse pregnancy outcome compared to those with a higher or more consistent intake. Low or no green leafy vegetables consumption has also been identified as a risk factor for small for gestational age (4; 5), spontaneous preterm birth (4; 6), and gestational diabetes mellitus (4; 7).
Low dark green and leafy vegetable intake has also been positively associated with anaemia during pregnancy, particularly in those with a low red meat consumption (8; 9). Finally, as rich sources of magnesium, dark green and leafy vegetables are important for preventing hypomagnesemia during pregnancy, which is associated with pre-eclampsia and pre-term birth (6).
Adding Dark Green Leafy Vegetables to Your Week
Some nutrients in dark green leafy vegetables cannot be absorbed by the body in the absence of fat, so pairing these vegetables with a source of fat is a great way to ensure you’re getting all the nutritional benefits.
Stuetz and colleagues (10) write about this beautifully in discussion of their findings that women in Tanzania who cooked their leafy vegetables with peanuts (a source of fat) were found to have higher levels of fat-soluble vitamin A in their blood.
Here are some ideas for including dark green and leafy vegetables in your week:
Preparing for conception is a wonderful time to care for your body with the health-protective powers of dark green and leafy vegetables. If you’re looking for some further guidance on your fertility journey, we’d love to support you in clinic or via telehealth.
You can book a complimentary phone call with us here or check out our science backed approach to get pregnant sooner in Create a Fertile Gut!
Abundance for Your Fertility
In her absolute genius, mother nature has connected all non-essential bodily functions to physiological energy balance so in periods of famine non-essential physiological activity (such as reproduction) can be paused. While reproduction is of course necessary for survival of the species, the body prioritises individual survival… for the same reason flight attendants tell us to put on our own oxygen masks before we help others… that is… we’re no good to anyone, or our species, if we’re not functioning.
Now, I appreciate that for many of us famine is a rare occurrence… I mean, how many of us live within a five-minute drive of at least 1 supermarket? Not to mention the abundance of corner shops and fast-food joints we pass on the way to aforementioned supermarket. Oh, and who has Uber Eats on their Smartphone?
Yet, while we intellectually understand that we are not living in famine, our bodies and gut microbes base their definition of ‘famine’ on what passes through the gastrointestinal tract, and the regularity and consistency with which it arrives. So, on those weeks when we find ourselves too busy to schedule in regular times to eat, and it’s grab ‘n’ go at varying opportunistic times of the day (often making up for it in excess in the late evening) … the body is registering that we’re living in times of famine, and food is neither a predictable nor dependable commodity.
The body feels safe shunting energy to fuel reproductive physiology when it knows there’s enough energy and sufficient nutritional diversity, delivered consistently. Let’s explore each of these…
A reproductive cycle (from cultivating a viable egg, through pregnancy, to eventually weaning the offspring) is the most energetically costly activity female mammals undertake in their lifetime. Thus, the body has safe-keeping mechanisms in place to prevent risk to a mother or any potential offspring in times of caloric deficiency. In short – your beautiful body has totally got your back.
Eating sufficient energy to match your metabolic activity is a must for fertility. Importantly, research suggests that it is not the absolute energy consumed that matters but that energy intake matches energy expenditure (1). Consuming insufficient energy for your needs may manifest as a lack of libido (suspected to be the result of disruption to ovarian steroid release, as well as reduced responsiveness to oestradiol by the part of the brain that controls female sexual behaviour), or manifest as suppressed ovulatory cycles (nil ovulation during your cycle or missing periods), due to a forebrain-controlled dampening of the luteinizing hormone (LH) surge that needs to occur for successful ovulation. This is why we often witness amenorrhea in females who are not meeting their energy expenditure requirements in the context of calorie restriction (e.g. dieting) or exercising without properly nutritionally replenishing themselves.
An important caveat of energy abundance is that energy must be available for cells to use. For example, in the case of untreated diabetes, where there is an abundance of glucose trapped in the blood unable to be used as cellular energy, both sexual behaviours and ovulation are suppressed (1). If there is a risk that you may be living with untreated diabetes, getting help to manage blood glucose levels is important for your overall health, and will also increase your chances of falling pregnant. Similarly, in metabolic syndrome fatty acids are trapped in storage unable to be used for energy, hence infertility is a commonly observed side effect.
The importance of diversity in the diet for fertility cannot be understated. Diversity (particularly of plants) not only ensures the availability of sufficient nutrients to help keep our human body functioning properly, it also ensures we are delivering a broad diversity of foods to our health-promoting gut microbes, who we know play an important role in supporting healthy sperm and egg development and uterine receptivity.
A dietary pattern rich in different fruits, vegetables, fish, dairy, wholegrains, legumes, nuts, seeds, fish, poultry, and monounsaturated fats increases the probability of pregnancy following IVF (2, 3) and lowers the risk of ovulatory disorders and infertility due to other causes (4). If you would like to know if you are ovulating you can read here.
Dietary patterns containing an abundance of different foods, rather than restrictive diets, positively correlate with biochemical pregnancy, clinical pregnancy, and probability of live birth (5). On the other hand, a Western Style Dietary pattern (low in plant diversity and healthy fats, while high in refined carbohydrates, vegetable oils, and processed meats) is associated with increased inflammation in follicular fluid and less blastocysts, as well as an increase in time to pregnancy, and delays in the female ovulatory cycle (6).
Consistent nourishment is a powerful signal to the body that the environment is conducive to reproduction. Indeed luteinizing hormone secretion (needed for ovulation) is tightly regulated by the forebrain (hypothalamus), which responds very rapidly to changes in availability of fuel (glucose or fatty acids) (1).
Another note about consistency is the finding by Bavani and colleagues (7) that showed meal irregularity associated with irritable bowel syndrome prevalence. This is an interesting finding for fertility, since we know that IBS aligns with gut dysbiosis, which correlates with increased inflammation and oxidative stress, both of which negatively impact fertility.
Consistently nourishing your body with a diverse array of foods sufficient in carbohydrate, protein, and health-promoting fats, rich in vitamins, minerals, phytochemicals, and antioxidants, is a wonderful first step when looking to conceive. If you are looking for support in cultivating nourishing practices for fertility, we would love to be there for you.
Book in for a complementary call to see if we are the right support for you here.
Blog Written by Emily Hahn APD
1. Wade, GN & Jones, JE (2004) Neuroendocrinology of nutritional infertility. Am J Physiol Regul Integr Comp Physiol 287: R1277–R1296, doi:10.1152/ajpregu.00475.2004.
2. Vujkovic M, de Vries JH, Lindemans J, et al. (2010) The preconception Mediterranean dietary pattern in couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment increases the chance of pregnancy. Fertil Steril. 94:2096–101. [PubMed: 20189169]
3. Twigt JM, Bolhuis ME, Steegers EA, et al. (2012) The preconception diet is associated with the chance of ongoing pregnancy in women undergoing IVF/ICSI treatment. Hum Reprod. 27:2526–31. [PubMed: 22593431]
4. Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. (2007) Diet and lifestyle in the prevention of ovulatory disorder infertility. Obstetrics and gynecology. 110:1050–8. [PubMed: 17978119]
5. Sanderman, EA Willis, SK & Wise, LA (2022) Female dietary patterns and outcomes of in vitro fertilization (IVF): a systematic literature review, Nutrition Journal 21:5, https://doi.org/10.1186/s12937-021-00757-7
6. Skoracka, K Ratajczak, AE Rychter, AM Dobrowolska, A & Krela-Kazmlerczak (2021) Female Fertility and the Nutritional Approach: The Most Essential Aspects. Adv Nutr 2021;12:2372–2386; doi: https://doi.org/10.1093/advances/nmab068
7. Bavani, N.G., Hajhashemy, Z., Saneei, P. et al. (2022) The relationship between meal regularity with Irritable Bowel Syndrome (IBS) in adults. Eur J Clin Nutr 76, 1315–1322. https://doi.org/10.1038/s41430-022-01108-3
Your Mind-Body Connection and IVF
Your mental health impacts how your body functions. Short term stress can be beneficial for heightening your brain function, mounting immune responses to fight off colds and flu and to help you build resilience. It promotes positive adaptations.
On the other hand, chronic stress can have negative consequences for your health and wellbeing, including your fertility.
Psychosocial interventions to reduce stress and support individuals through fertility treatment have been found to double the chance of pregnancy (19). Let’s look at a practice that may help bring you calm, and support balance for a positive mind body connection.
What is Mindfulness?
Mindfulness is “paying attention to the present moment with openness, curiosity and without judgement” (1).
Mindful awareness allows thoughts and experiences, often viewed through the lens of our opinions, preferences, and judgments, to simply be there. Some benefits of practising mindful awareness include:
his all sounds very nice, I hear you say, but what does this have to do fertility?
Mindfulness Benefits Fertility and IVF
Dealing with infertility brings emotional and physical challenges. Mindfulness can help foster mental and emotional resilience, helping us to cope with feelings of anxiety, depression, distress, and worry (10).
Research shows a correlation between mindfulness-based therapies and quality of life among women experiencing infertility (11-13), as well reduced rates of psychological distress, anxiety, and depression (13, 14).
Li and colleagues (10) found that women who received mindfulness-based interventions alongside IVF treatments reported increased quality of life, self-compassion, and coping strategies for stress. They also found that these women had greater pregnancy rates compared to the group of women who did not receive the mindfulness-based intervention.
How Do I Practice Mindfulness?
There are two main types of mindfulness practice: formal mindfulness and informal mindfulness.
Formal mindfulness meditation involves sitting or lying, with eyes closed, focusing the attention on one single thing. This could be the sensation of breathing, or focusing on sensations within the body (1).
Daily formal mindfulness meditation has been correlated with decreased depression scores and enhanced sleep quality of women undergoing infertility treatments (15). Mindfulness apps, such as Smiling Mind, make it accessible to cultivate a regular mindful practice, offering free guided meditations that you can listen to at a time and place that suits you.
You can also learn mindfulness from therapists trained in mindfulness-based therapies or attend classes where you can learn mindfulness practices as part of a group.
As with any skill, the more we practice mindfulness the more automatic it becomes. Informal mindfulness is about bringing the same level of focus and attention of formal mindfulness to aspects of your everyday life (1).
That is, directing full, non-judgmental curiosity and attention to whatever it is you are doing in the present moment – be this commuting to work, vacuuming the house, eating, etc. Bringing mindful awareness to mealtimes can be a great way to cultivate regular mindful practice, providing opportunities to connect with your body and experience more deeply the sensory pleasure of appetite and eating.
This increased attunement to the body puts us in a better position to nourish our body in a way that is aligned with what it needs in that moment. Because eating includes all 5 of our senses – seeing, smelling, tasting, touching, and hearing – it is a sensory rich context for focusing the attention.
Next time you are eating a food, try bringing attention to how the food looks (colours, textures, shape), smells, the sound of picking it up with your utensil, and the mouth feel. Notice, without judgment, your response to the food, and how it feels in your body. Bring awareness to how this eating experience differs from the experience of, say, eating your lunch while checking your email, or snacking while in the car? Does your level of satisfaction improve?
Yoga and Fertility
Yoga is a form of physical movement that marries up formal and informal mindfulness; the physical postures and breathing techniques of yoga are designed to bring mindful awareness to the body.
A recent review found that anxiety scores were improved by yoga as an adjuvant during infertility treatment (16). Gaitzsch et al (17) also conducted a review of studies exploring the effectiveness of mind-body therapies (yoga and mindfulness-based therapies) during infertility treatment and found associations with lower anxiety and depression scores.
Ready to Nurture Your Mind and Body?
Cultivating a practice of mindfulness can help build resilience to life stress and enhance fulfilment in everyday experiences. Research suggests that incorporating mindfulness into your fertility journey can help reduce anxiety, depression, and distress, while also helping improve sleep and quality of life.
If you would like to know more about incorporating mindful awareness in your everyday life, we would love to support you at The IVF Project.
1. Smiling Mind (2022) What is mindfulness? https://www.smilingmind.com.au/mindfulness.
2. Chambers, R., Gullone, E., & Allen, N. B. (2009). Mindful emotion regulation: An integrative review. Clinical Psychology Review, 29(6), 560–572. https://doi.org/10.1016/j.cpr.2009.06.005
3. Lancaster, S., Klein, L., & Knightly, K. (2016). Mindfulness and Relaxation: a Comparison of Brief, Laboratory-Based Interventions. Mindfulness, 7(3), 614–621. https://doi.org/10.1007/s12671-016-0496-x
4. Luberto, C., Shinday, M., Song, N., Philpotts, R., Park, L., Fricchione, L., & Yeh, E. (2018). A Systematic Review and Meta-analysis of the Effects of Meditation on Empathy, Compassion, and Prosocial Behaviors. Mindfulness, 9(3), 708–724. https://doi.org/10.1007/s12671-017-0841-8
5. Rusch, H. L., Rosario, M., Levison, L. M., Olivera, A., Livingston, W. S., Wu, T., & Gill, J. M. (2019). The effect of mindfulness meditation on sleep quality: a systematic review and meta‐analysis of randomized controlled trials. Annals of the New York Academy of Sciences, 1445(1), 5–16. https://doi.org/10.1111/nyas.13996
6. Bartlett, L., Amanda, M A., Memish, N., Otahal, P & Kilpatrick M (2019). A Systematic Review and Meta-Analysis of Workplace Mindfulness Training Randomized Controlled Trials,.Journal of Occupational Health Psychology 24(1).
7. Dane, E., B. J. Brummel (2014). Examining workplace mindfulness and its relations to job performance and turnover intention. Human Relations, 67 (1), 105 - 128.
8. Blanck, P., Perleth, S., Heidenreich, T., Kröger, P., Ditzen, B., Bents, H., & Mander, J. (2018). Effects of mindfulness exercises as stand-alone intervention on symptoms of anxiety and depression: Systematic review and meta-analysis. Behaviour Research and Therapy, 102, 25–35. https://doi.org/10.1016/j.brat.2017.12.002.
9. Keng, S. L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: A review of empirical studies. Clinical psychology review, 31(6), 1041-1056.
10. Jing Li, Ling Long, Yu Liu, Wei He, Min Li, Effects of a mindfulness-based intervention on fertility quality of life and pregnancy rates among women subjected to first in vitro fertilization treatment, Behaviour Research and Therapy, Volume 77, 2016, Pages 96-104, ISSN 0005-7967, https://doi.org/10.1016/j.brat.2015.12.010.
11. Li, G., Jiang, Z., Han, X. et al. A moderated mediation model of perceived stress, negative emotions and mindfulness on fertility quality of life in women with recurrent pregnancy loss. Qual Life Res 29, 1775–1787 (2020). https://doi.org/10.1007/s11136-020-02460-2
12. Masoumeh Sadat Hosseini, Parvaneh Mousavi, Khadijeh Hekmat, Mohammad Hossein Haghighyzadeh, Reza Johari Fard, Razieh Mohammad Jafari. Effects of a short-term mindfulness-based stress reduction program on the quality of life of women with infertility: A randomized controlled clinical trial, Complementary Therapies in Medicine, Volume 50, 2020, 102403, ISSN 0965-2299, https://doi.org/10.1016/j.ctim.2020.102403.
13. Sherratt KA, Lunn S. Evaluation of a group programme of mindfulness-based cognitive therapy for women with fertility problems. J Obstet Gynaecol. 2013 Jul;33(5):499-501. doi: 10.3109/01443615.2013.786031. PMID: 23815205.
14. Xiaoran Wang & Yunxia Wang (2022) The Effectiveness of Mindfulness-Based Intervention on Emotional States of Women Undergoing Fertility Treatment: A Meta-Analysis, Journal of Sex & Marital Therapy, DOI: 10.1080/0092623X.2022.2109542
15. Cai-Feng Bai1,2, Nai-Xue Cui1, Xian Xu3, Guang-li Mi4, Ji-Wei Sun1, Di Shao5, Jie Li1, Yin-Zhi Jiang3, Qian-Qian Yang1, Xuan Zhang1, and Feng-Lin Cao1 Effectiveness of two guided self-administered interventions for psychological distress among women with infertility: a three-armed, randomized controlled trial. Human Reproduction, Vol.34, No.7, pp. 1235–1248, 2019 Advance Access Publication on June 26, 2019 doi:10.1093/humrep/dez066
16. Dumbala S, Bhargav H, Satyanarayana V, Arasappa R, Varambally S, Desai G, et al. Effect of yoga on psychological distress among women receiving treatment for infertility. Int J Yoga 2020;13:115-9.
17. Gaitzsch, H., Benard, J., Hugon-Rodin, J. et al. The effect of mind-body interventions on psychological and pregnancy outcomes in infertile women: a systematic review. Arch Womens Ment Health 23, 479–491 (2020). https://doi.org/10.1007/s00737-019-01009-8
18. Colleran, E (n.d.) What is mindfulness? https://blog.smilingmind.com.au/what-is-mindfulness.
19. Santa-Cruz, D.C., et al., Hair Cortisol Concentrations as a Biomarker to Predict a Clinical Pregnancy Outcome after an IVF Cycle: A Pilot Feasibility Study. Int J Environ Res Public Health, 2020. 17(9).
Fuel Your Fertility
There is one key diet component that is essential to fuel your fertility: carbohydrates!
This may surprise you, as carbohydrates often get a bad rap. Reminiscent of the ‘low fat’ diets of the 80s and 90s, low carbohydrate diets such as Keto, Whole-30 and Paleo are touted as the panacea of health, promising to reduce inflammation and metabolic disruption.
Reducing inflammation is positive for fertility, but is lowering carbohydrate the answer?
What is Carbohydrate?
Before we go any further, let’s just clear up what we mean by carbohydrate.
Lots of the confusion surrounding carbohydrate stems from the fact that carbohydrates can be many different things. Carbohydrates are sugars, fibre and starches that can be found in a variety of foods from fruits and wholegrains to lollies.
Carbohydrates are the preferred source of energy for your brain and muscles, and without them your gut microbes don’t have a food source to ferment to provide you with fertility loving metabolites like butyrate.
The fine print: not all carbohydrates are created equal!
We can categorise carbohydrates into two broad groups: simple and complex.
Simple carbohydrates (also called simple sugars) are easily broken down by the body and the glucose is rapidly absorbed into the bloodstream. This produces a rapid and large blood sugar spike upon digestion. What goes up must come down, however, so following a blood sugar spike your body will also go through a relative low. A lot of these roller coaster peaks and troughs in blood sugar is correlated with inflammation in the body and the brain (1-3).
Processed sources of simple carbohydrates often have the nutrients such as fibre, vitamins and minerals removed or reduced. You will recognise foods with this type of carbohydrate as they are high in energy, high in refined sugars (like white sugar, honey and fruit juice), high in refined grains (white flour), low in nutrients, low in fibre, high in sodium content and could be high in saturated fat, cholesterol and trans fats. Essentially you get less nutritional bang for your buck with simple carbohydrates.
Examples of simple carbohydrates are sugar, honey, agave nectar, maple syrup, high fructose corn syrup, rice malt syrup, refined (white) flour, fruit juice, soft drinks, biscuits, lollies, cakes, chips, sugary breakfast cereals, white bread and wraps.
Reducing your intake of refined sources of simple carbohydrate is a win for your fertility.
Complex carbohydrates are made up of more complex sugars strung together in long chains. Compared to simple carbohydrates, foods with complex carbohydrates are packed with more nutrients, vitamins, minerals and fibre.
This beneficial carbohydrate is often found in whole foods - foods that have not been overly processed or turned into something that you don’t recognise anymore. Whole foods with complex carbohydrates (fibre and starches) include: wholegrains, brown rice, vegetables, fruit, nuts and seeds, beans and legumes. You will recognise them as they contain low to moderate energy, have a high nutrient content, have no refined sugars or grains, are naturally high in fibre, low in sodium (salt) and have low to no saturated and trans fats.
Fibre and starch are two types of complex carbohydrates. Starches are naturally occurring in breads, cereals, starchy vegetables (peas, corn, beans, and potatoes), legumes and wholegrains. Starches will be found with fibre, although some foods have more fibre than starch. Fibre is naturally found in fruits, vegetables, legumes, nuts, seeds and wholegrains.
Complex carbohydrates feed beneficial bacteria in your gut microbiota that can enhance your fertility by lowering inflammation, increasing your gut diversity, and reducing dysbiosis. To achieve a fertile gut you need to include complex carbohydrates in your diet that will feed those bacteria who are responsible for looking after you. They can’t do it without you!
Wholegrains – a Whole Lotta Goodness
Wholegrains are one of the most important carbohydrates for fertility. In Australia, wholegrains are grain foods that have not been processed or refined. Wholegrains have not had their outer bran or germ layers removed, and therefore contain an abundance of nutrients that support fertility.
They contain more fibre, vitamins, minerals and antioxidants than their refined versions (e.g. white bread).
Wholegrain intake has been associated with better antioxidant defenses and reductions in inflammation, as well as better blood glucose regulation (good news for polycystic ovarian syndrome (PCOS)-related insulin resistance) (4).
Wholegrain consumption has also been shown to increase the production of fertility-promoting compounds by the gut microbiota (5) and a higher preconception intake of wholegrains has been associated with thicker endometrium for implantation and increased live birth rates following IVF (4).
Wholegrain examples include wholewheat, rice (brown, black), corn (including popcorn), oats, barley, spelt, rye, sorghum, millet and pseudo grains such as buckwheat, quinoa, wild rice and amaranth.
Wholegrains Reduce Inflammation
Wholegrain foods are not only great for fertility. They have a positive impact on reduced risk of developing type 2 diabetes, certain type of cancers and cardiovascular diseases.
Wholegrain intake is associated with a reduction in circulating inflammatory markers like CRP (6). Higher CRP levels can be detrimental to the outcome of assisted reproductive treatments (7) while reducing inflammation improves egg and sperm health and uterine receptivity.
Are you Eating Enough Wholegrains?
How many servings of wholegrains are you getting per day? One serve of wholegrains might look like: