Friday, March 16, 2018

Vitamin D and Fertlity

As we move into Spring and in the UK, with temps raising the mercury in the summer ( heres hoping!), I thought it was time I talked about how important the sun is in terms of how it creates the right environment for this specific hormone to work its magic in the body.  The reason I’m talking about this now is that the rays you gathered from when the clocks go forward, will have the desired effect you need to help all sorts of processes in your body come Autumn and Winter.
Can I get vitamin D all year, even if it’s a sunny day? – In a word no. The further away you are from the equator, the less chance you will get (past the clocks going back to when they go forward again) when the sun is further away you get way less UVB, which is what you need for you to produce vitamin D. So I wouldn’t bother getting you kit off in the cold for such a miniscule amount!
Over the years vitamin D has hit the headlines many times, and with empirical data evidencing the importance of it in the body, and it has widely been accepted and embraced by the medical community and as such it’s no coincidence that in the UK GPs are now testing routinely for this and prescribing it to everyone from little ones to the elderly. Vitamin D is also on my mind as headlines last year look at how the right levels can help asthma.

Our main source of Vitamin D comes from our absorption of sunlight that mixes with saturated fats in our bodies, to create Vitamin D.

As the year progresses and we enter into spring, the sun gets higher in the sky and therefore produces more intense UV rays, and its the UVBs that we all need!

With more intense sunlight we get more exposure to the rays, and therefore more opportunity to manufacture this important nutrient.

For those of us in northern hemisphere we are often plunged into often up to 8 months of the year of low rays, making it almost impossible to get enough sunlight, something we all need. Sunlight is so important for us a species and as UK peeps wait and watch, many summers in the past just haven’t cut it, and due to this there have been huge health consequences. This has promoted scientists to look into issues with long term health – a few summers ago there were children presenting in doctors surgeries with aches and pain and getting all sorts of illness, this was also linked to cases of rickets,  which is shocking to hear, but just shows how important it is to get outdoors when we have any sun and sop covering kids up with sun factor 50 in the summer!

It amazes me every summer when I start to feel the heat of the sun on my body, just how far away it is and yet it can make a huge impact on us and even cause sun burn! Sadly as the ozone layer began to thin and places like Australia and New Zealand were reporting cases of sun cancer as early as 1980s the campaign and worldwide demonization of the sun began. I understand with skin cancer on the rise why the sun is so vilified to some extent. But we could not have evolved past single cells organisms without it - we’ve forgotten that photosynthesis supports most of the food chain on this planet.  And as mammals we use photosynthesis to make vit D as our first stop, instead of ‘fortified foods’.  The message has been loud and clear, and has hit parents hugely. Even in places like the UK parents are slapping factor 50 on their little ones ( don’t get me started on parents using what can only be described as ‘ scuba suits’ for kids when they actually do go to hotter climates ( apart from Australia where you do need this!) No wonder there is a childhood epidemic of low vitamin D levels and Doctors force feeding drops down poor kids neck!  As much as I like supplements, the real deal is so much better!

More relevantly and as I get to the point  - the sun is vital for fertility.  Studies have looked into peak conception rates and this can be traced back to the summer month, not surprisingly when the sun is in full force!

There are many reasons for this, but new research highlights vitamin D as a key to higher conception rates.

Vitamin D is often referred to as a vitamin, it is in fact a steroid hormone and is important for good overall health and particularly to help build strong and healthy bones. It’s also an important factor in making sure your muscles, heart, lungs and brain work well and that your body can fight infection. We have vitamin D receptors in loads of areas of our bodies and some of us even have mutations on these receptor ( I’m one of them and I found this out by looking into my genes at 23andme )

Recent research has alluded to ways in which Vitamin D can cause issues with our health including a role in chronic diseases like diabetes, obesity and autoimmune conditions as well as cardiovascular disease and cancer.

Vitamin D status affects different cells in our body and more specifically organs. It does this as it actively turns on and off genes, which can mean cell growth or death.

Your body can make its own vitamin D from sunlight. You can also get vitamin D from supplements and a very small amount comes from a few foods you eat, which I will talk about later on.

The vitamin D that you get in your skin from sunlight, and the vitamin D from supplements, has to be changed by your body a number of times before it can be used. Once it’s been converted the vitamin D receptors (VDR) in your body use it to manage the amount of calcium in your blood, bones and gut and to help cells all over your body to communicate properly.

Vitamin D is linked to so many issues:

Vitamin D is a natural antibiotic that assists White Blood Cells in clearing infections. It does this by stimulating immune cells.  This does not happen well in our gut, but works really well in our skin with UV rays as the catalyst. Many of my clients have issues with Natural Killer Cells, and I could almost bet their Vitamin D levels are low in this instance, which is what maybe the ‘ heightened’ immune response is all about!

There is also a school of though that looks at vitamin D and chronic inflammation and illness. There are some clinicians studying Vitamin D and as mentioned above its always best to look at both markers of active and stored vitamin D as systemic inflammation may cause an alteration in that dynamic.

Age will decrease your skin’s ability to make vitamin D3 from sunlight and cholesterol. As we go from 20 to 60 years old, we lose the ability to convert Vitamin D hugely. So as we age, we need more sun or supplementation.

If we have  autoimmune diseases, we need much higher levels of Vitamin D from sunshine. Autoimmune conditions that are often associated with vitamin D deficiencies. Issues like endometriosis, PCOS  and thyroid issues, which in these cases  will mean  you need a higher amount of Vitamin D, for your bones, muscles, oestrogen and immunity to work in the way it was designed to do.

A report in the European Journal of Endocrinology mentioned a few key facts in relation to vitamin Ds importance in women..

One that is often overlooked by many IVF clinics is that vitamin D has an  impact in terms of Invitro fertilization (IVF) outcome and a quick scout around pubmed typing in IVF and Vitamin D will show up lots of published studies on this!

Anecdotally I haven’t ever had a client with PCOS without dangerously low levels of Vitamin D. In terms of the endocrine system and hormones, the root of all fertility, vitamin D is important to boost levels of progesterone and oestrogen, which regulate menstrual cycles and improve chances of conception.

Both genders require Vitamin D for different things in the body. In men, vitamin D is essential for the healthy development of the nucleus of the sperm cell, and it supports semen quality and count. Vitamin D also increases levels of testosterone needed for sperm development and sex drive.

Vitamin D is always hitting the headlines for all sorts of issues. In 2008, Australian fertility specialist Dr. Anne Clark found almost one-third of the 800 infertile men included in her study had lower than normal levels of vitamin D. She also looked at folate levels in conjunction with Vitamin D. When men made adjustments to lifestyle with dietary and supplement changes, fertility markers were dramatically improved.

If you’re Struggling with Infertility, it may not be the overall reason for fertility issues, as it is never just one things as we are complex beings, however it won’t harm you to do some checking under the hood, so I would speak to a practitioner to  get Your Vitamin D Levels checked.

Vitamin D is so crucial to health that as a practitioner its in all my initial test grade panel! Doctors commonly use vitamin D which in clinical terms is  25(OH)D  However, this is not the final picture, and a truly knowledgeable physician would look at the Parathyroid Hormone level ( PTH) and  25(OH)D, together with  1,25(OH)2D  to get a true picture, as well as bone density as a third marker of how well the sunshine vitamin is being utilized in your body.

Vitamin D and skin colour

Many practitioners will tell you vitamin D is often seen as more important the darker your skin. However if you do live in a sunny climate ( and get out in the sun) you need to be careful drawing conclusions about a simple lab test that only show 25(oh) d levels.  Tribally when tested many massai warriors in African had a borderline level of 25(OH)D and great bone density. Showing possibly that its not as black and white as just looking at one marker, as living with so many hours of sunlight, logically we would assume a higher amount of Vitamin D! This may mean that that ethnicity and where we live may also change this picture and we naturally adjust to what levels we need when living in sunny climates and outdoors a lot.

What will show a true picture of this important hormone?

I’m often asked this and as mentioned above, its never one marker that determines the truth in the body, as we just aren’t as simple as this! As a practitioner I recommend working with someone more closely, who can work through your bio individual situation. They should test initially 25(OH)D and with  1,25(OH)2D  to get a true picture.  if the 25(OH)D  is lower than 50, then you need to look at Parathyroid levels PTH. If PTH is less than 30, you may not need to supplement as the Parathyroid gland is adequately using vitamin D in the body.  If PTH is under 20 then by all means all systems go for higher supplementation and UV exposure!  ( or splash out on a holiday! ( practitioners orders! ;)

If your levels of the stored Vitamin D are over 50 then then you don’t need extra vit D supplement. If your Test shows a 25(OH)D  of over 70, adjust diet take out supplements with over 1000Ius and stay indoors a little! Too high a levels is just as damaging as too low!  Also another word of caution - I would be vary of blindly going out and buying supplements with over 3000ius as vitamin d, as it can build up, so it's only wise to supplement if your know the true picture.  

Speaking for supplements can I get Vitamin D from a supplement, or is it better to get it from food?

There are very few foods that actually have therapeutic levels of vitamin D naturally and even fortified foods don’t contain enough vitamin D to support your body. However for those in areas like Australia where the ozone layer is very thin, its vital you do make sure your skin is not exposed for even a short time. Even 5 mins in the 11am sun can do harm. I experienced this myself in 2004 when I visited. Its funny as it really is a totally different experience in regards to the sun in the Southern Hemisphere.   My flight arrived early in February the height of their summer, and my room wasn’t ready. So I sat on Manley Beach in Sydney and the only thing that wasn’t covered was one foot! Ouch! 5 mins in and my foot was burnt for the full 3 week holiday! My advice here is that its good to build up your vitamin D levels in spring in this part of the world and only for a short amount of time and not in the full swing of summer!

How long you need to stay in the sun varies massively  depending on the factors below:
  • Antioxidant level and diet
  • Age
  • Skin Colour/ tan level
  • Latitude and altitude
  • Ozone Layer
  • Use of sunscreen
  • Season
  • Cloud Cover
  • Surface reflexion

Sun cream is also another tricky one… What to go for?

In the UK factor 50 isn’t necessary despite it going up to 30 degrees c this year. With a  SP factor as high as 50 you are blocking your ability to get any vitamin D. I would opt for a sun screen that ranges from 15 – 30 SPF. There are some amazing ranges out there at present, including ranges for children such as Oganii, Biosolis and Green People as these are some camps that argue that the chemicals in the sun cream are a contributing factor to disease, including hormone disruption! The above are free from all sorts of nasties, so at least you know you aren’t going down this route.

Diet is an interesting one, If you can’t get access to the sun then diet is the only option. Here are some sources

  • Cod liver oil
  • Tuna.
  • Sardines
  • Beef or calf liver.
  • Egg yolks

But if you have low levels, to get them up quickly - you only really only have one option if you want to raise your levels and that is to take a vitamin D supplement. As a general guideline,  after testing – if  your levels are 50ng/ml then I would take 1000-3000 IUs for one month and see what your levels are like after 1-2 months of this level. I’m not a fan of huge 1 week 20,000IU doses. Its also likely that if you have issues digesting food, or are overweight and have had a gall bladder removed, you may have issues with fat and assimilating it, so this type of approach won’t help, and in the long term could possibly lead to kidney stones as your parathyroid tries to cope with this amount!  If you do opt for a vitamin D supplement, please remember that you also need to boost your intake of  vitamin K2 through food and/or a supplement, as well as Magnesium. If you’re getting your vitamin D from the sun, this isn’t necessary. ( however its always good to get some leafy greens in right?)

Like anything all vitamins need  to be balanced out (as they would in nature)  so if you are getting less than optimal sun and have to resort to supplements, make sure you are supplying your body with the means to self regulate with enough vitamin A, K and other minerals’ such as calcium and magnesium, zinc, boron.

That way you will be winning in the Vitamin D stakes and have one less thing to worry about in regards to fertility.

Tuesday, June 20, 2017

Tracking your cycles using OvuSense

Tracking your cycle is a vital tool I use as a practitioner. I started using it in 2008 and it has been invaluable over the last 9 years. I do this for so many reasons as your cycle can show you not only key shifts that indicate ovulation has occurred but it can also show stress, how sleep or lack of it can impact your body’s ability to be and stay fertile and how well you may be responding to lifestyle changes.  It has also been a real insight into subtle changes in my body from my early thirties to my mid forties.

As a practitioner I'm always shocked how little ladies know about their cycle, and am super exited to tell them about how certain phases in their cycle can suggest better times to exercise and socialise, how motivation is high at certain points and when to 'chill down' and spend time reflecting and relaxing . When this is known it can be hugely empowering! So its not just about tracking your fertility!

Back in 2008 I got 'intimately' involved in fertility tracking. I was into 'biohacking' back then ie looking at how technology could help us to better understand our body and hormones. There were very few monitors and 'apps' didn't exist. In the UK there were also even fewer Fertility monitors. I remember getting Ovaque a fertility monitor I really liked to ship to me from America and having to convince them that it was ok!

In the last two years the market has literally exploded with fertility apps, Daisy, fertility cycle, duo fertility, Eva bracelet.  With most of these newer generation trackers, they are wearable or rely on taking a temp on skin or orally which is fab when you are well, but doesn't work if you are ill a few days before ovulation ( it happened to me a few times and was v frustrating)

In November 2015 I stumbled on a new fertility monitor at the London Fertility Show called OvuSense - OvuSense had overcome the issue of using the method of oral or skin temping by using a monitor that is inserted overnight like a tampon and records only 'core' body temps. By doing this it builds up algorithms which will then present a pattern and show when your body moves from one phase of the cycle - The Follicular to the Luteal phase, past ovulation to progesterone production ( when the ovum has burst out of the follicle and progesterone is making the body a little hotter) . When the sensor is worn overnight it takes temps every 5 mins.

OvuSense has been around a few years now and was recently named one of the top fertility apps in the Times Newspaper. I’m all about the evidence and a recent study stated, that if used correctly the device proved to be 99% accurately. Fertility Road magazine talk more about the history and trials.It has since moved on from this by now offering an app instead of a monitor, so adapting to market needs. 

I have been banging on about how great OvuSense is for so long they decided to give me access via the app ( hurrah to the lovely people at ovuSense) I have been using the new app for a few month now. Its very nifty, as links to your phone via an adaptor. And I have to say it's pretty darn good. I've even confirmed ovulation and checked progesterone via a blood test in this time so I know it works!

It's really easy to use also and in the morning after at least 7 hours of use you take out the sensor  ( wash it) and place the sensor on the adaptor which goes into your phone headphones port. The device then picks up the signal and transfers the data to the app on your phone. 

The device has also been a real support system for ladies with PCOS who are unaware if ovulating, and has an amazing Facebook page to support ladies using it for this reason and it has over 15,000 users. I dip into the group now and again and have given advice on supplements and diet which has been well received by the group.

Missing your fertile window is frustrating. As a practitioner tracking and looking at the health of your cycle is at the heart of what I do. I would be bold enough to say its also something that about 70% get wrong during the fertility journey unless given proper guidance.  It is important to know this as every woman's cycle is different and there is no room for error with a 24 hour window! I also use it to identify an unbalanced cycle that needs some support and when this is evident functional testing is where I go next. 

Using OvuSense to help identify this in my view has been a real game changer and as a practitioner has been a huge asset to my practice, as once diet and lifestyle suggestions are in place you can see a real difference in the charts, and in most cases predict early pregnancy!

Tuesday, October 4, 2016

Bridget Jones’s Baby – is having a baby over 40 good or bad?

I’m quite excited Bridget Jones is about again and she’s having a Baby; more importantly it’s a hatrick for me adding to the 2 other films, plus it’s the best one yet and ‘bang on’ so to speak in terms of what is happening right now with women in the UK who want to have babies.

Hopefully having a baby over 40 is going to be the hottest thing in town soon  (maybe I’m exaggerating this a little). I’m not sure if Bridget’s surprise conception was down to the fact that she thought she wasn’t capable of having a child over 40, so stopped trying with contraception,  or something else.

For me having a baby over 40 is always something I celebrate in my line of work! As a fertility Nutritionist I’m inside an ‘ older mum bubble’ , where anything is possible, however when I venture out and meet people ( which I occasionally do!)  its almost whispered that its ‘not right’ or that ‘it’s a bit of a worry isn’t it?’ In fact having a baby at 40  seems almost as taboo as a teen pregnancy according to ‘ word on the street’!  Thankfully this is beginning to change, and lets hope in some small way Bridget will have helped in this quest!

The message that you are almost irresponsible even trying over 35 is plastered everywhere. It is even worse if you are over 40 as when you start trying it all seems to become more scary as are the messages about potential birth defects, miscarriages, and if by some miracle you have the child,  then there is the issue that they might have development issues and there is more chance of autism. The list goes on, and the stories I have heard about how it’s not a good idea to try after 37, are enough to age your eggs overnight and sew your own bits up! If it’s not enough hearing this from GPs or IVF clinics, the media coverage on this is certainly relentless, something that is repeated almost weekly in the many columns of broadsheets and tabloids. 

As a Nutritionist this whole issue of  ‘ old eggs’ and the ‘geriatric mother’ (as was mentioned in Bridget Jones’s baby)  gets me very riled up as its one of the fastest growing age group of women I have coming through my door in the last 2 years and its one I’m getting results with, despite the fact they are ‘ past it’ according to those in the know! This is anecdotal to my practice, but lets take a look at this more closely…

For the first time in decades women over 40 have now taken over the teen pregnancy rate. How’s that for a statistic? A more sombre statistic that ‘its not safe to have a baby over 35’ seems to be hitting home as this age group accounts for the largest amounts of abortions of any other more recently.

Also if we look back a few decades to the 1920s, being an older mum was more accepted. Many were even giving birth when grandmothers and 42 years old was a time when many stopped adding to their families.
Today,  an interesting statistic is  that many women in their 40s are also first time mums.  The UK Office for National Statistics figures show that pregnancy rates for over-40s are doubling and in the last years,  this has gone from  only a mere six per 1,000 to now
14 conceptions per 1,000.

Only recently an article in the London Standard mentioned that London is leading the charge for women giving birth to babies over 45. So there is definitely something going on out there with women not giving up or even coming into motherhood later on in life.

In fact, the true statistics about female fertility are far less scary than we are led to believe. Women do lose a lot of their eggs by 30, but that still leaves them with many tens of thousands, when only one is needed to make a baby. Something many ladies are not told in IVF clinics where  egg donation is offered if over 37, or if they have been trying for over 6 months.
Other scaremoungering comes from of all places the  journal Human Reproduction. But if you take a closer look at this article in 2004 the  statistic were drawn not from modern day but from birth records from 1790-1830.  When correct me if I’m wrong, there was no access to modern health care or nutrition and many were possibly only living to 45 anyway, so actively avoiding Sex. So no…. ‘
Bridget Jones, wanton sex goddess, with a very bad man between her thighs!’ there!
The truth is everyone is different and if you  put in the work and follow a healthy lifestyle, diet and stress levels are managed appropriately, you just may well have the fertility of a 20 something!

In my view Fertility isn’t always age specific and there might actually be some truth in what I talk about daily that diet and tailored intervention  improves fertility at any age. A study in 1995 conducted by Surrey University and Foresight with over 300  couples ranging from 25-45 years old gave couples with previous infertility and miscarriages a tailored dietary and supplement programme over 2 years. During this time 81% of them went on to have healthy babies  similar studies are also being conducted by Foresight and also the University of New England.

Lord Robert Winston seen as a one of the grandads of modern fertility talked recently in a daily mail article about women’s
fertility being sound until around 45, which might have raised a few eyebrows. I can’t corroborate this empirically but share his view, as do see a heck of a lot of women who are getting pregnant these days over 40.

I believe in fertility in older women wholeheartedly, as my own grandmother was part of this ‘gang’ and had my mum when she was 37. This isn't an isolated incident and its shown to happen time and time again, defying the naysayers. Thankfully many I work with don’t give up, but to be honest with all the media attention about ‘Britain facing an infertility time bomb’ it can be very hard to cut through the negativity.

As always Bridget Jones is ‘On trend’ as it has been right from the first film! Let's hope it starts a ripple effect, where ladies feel they don’t have to feel old and ‘past their sell by date’ when trying over 35,  or worry about the issues with their ‘ageing eggs’ Hoorah for Bridget is what I say and as Daniel Cleaver would say ‘ Hello Mummy’!

Monday, September 5, 2016

Back to school – another reminder of your empty house, or the start of deficiencies that lead to fertility issues?

Yes its that time of year again when all the offers and retail are uber hell bent on selling stuff to parents to equip them for school/nursery/ college etc. However like the new year and Christmas it’s a time of year that makes many who are on a difficult fertility journey sad. Another reminder that you are years behind on this happy moment of taking a photo of your little one against the door in their new school uniform and another time where you can’t get involved with all your friends who are now pushed into a whole new routine and change of life.

When it comes to food it’s a time I normally become a ranting nutritionist (don’t get me started on Halloween and Christmas) as it is a time where ‘ packed lunches’ become king, and a hoard of vile candies, chocolates, flapjack like concoctions, waxed small processed cheeses and flabby white bread ham sandwiches are thrown at you, which will leave anyone nutrient deficient let alone a child!( I know some of you make healthier choices, but sadly its hard with retailers making it oh so easy to eat crap!)

My point is, that the deficiencies start as early as preteens. I’m seeing so many ladies now who were overweight and showing signs of hormonal dysregulation at as young as 10 when we went through a detailed consultation.

I see fertility issues as a deficiency in most cases, where there isn’t enough ‘raw ingredients’ to make good hormones, or at worse too many high processed carbohydrates that have caused the hormonal issues, and I can almost pinpoint when it started to happen. With teens this can present when the body starts to show dysregulation with acne, painful periods, putting on weight and having mood swings. Which contrary to popular belief aren’t a normal part of life when your hormones start to show their face!  Like menopause hormones need at least 10 years to regulate when they start, so that means if a girl starts her period at 12 it won’t be until 22 that she is really normalising and coming out the other side! This is exactly the same for menopause. Sadly in the medicalised and ‘ fix it’ society we live in we see things like heavy periods, acne and pain as something to ‘ turn off’ rather than look at the root  cause and this( ie poor diet and environmental stressors)  So many of the ladies I support are put on the hormonal contraceptive pill to ‘ regulate the period’ Newsflash – the pill doesn’t ‘Regulate’ your period, it mimics pregnancy hormones, and invariably  puts your body to sleep in terms of hormones. Many are even unaware that the ‘ bleed’ they have isn’t actually a period, its is a withrwawal from the hormone bleed! When many of these ladies  start to think about babies that is when  they come off the pill and find they have oestrogen dominance and the same issue comes back again they had at 16!

PCOS is the number 1 cause of infertility now. This is something new I’m seeing in the last 4 years. Prior to that it wasn’t top of the list. There is a genetic predisposition to PCOS, but as the saying goes ‘ genetics loads the gun and the environment pulls the trigger’ ie it may be in the family but you can exacerbate this by the choices you make food wise and stress also makes this worse.

Its not all doom and gloom though, as this can be fixed. I see this time of year always as a new beginning. You may not have a child right now, but why not start to look at September as the start of your new term or semester? Add in some changes to your diet and seek out someone who can guide you. I really don’t know what I would do if I wasn’t a nutritionist, as the food isles and marketing behind food is so relentless.  This makes it nigh on impossible to make these ‘ healthy choices’ yourself. Worse still its made even more impossible to attain by the rise of the ‘ Green smoothie goddesses’ on places like Instagram!  With correct guidance and support your body might just be back on the right tracks for Christmas!  

Friday, June 10, 2016

Natural Killer Cells - are we being pulled into the hype?

I see a lot of clients and have over the past few years been increasingly aware of the area of reproductive immunology. Like most the starting point for this was the book ‘ Is your body baby friendly’ by Dr Alan. Dr Alan Beer is the man behind the whole area of reproductive immunology and the originator of the ‘Chicago protocol’. He set up his clinic as a pioneer and he was instrumental in the fertility world with regards to looking into the immune system as a causative factor to multiple miscarriage and failed implantation. As a result, many IVF clinics started looking at Cytokines, the bodies ‘war’ machine and as I like to call them the ‘ Special forces’ or more commonly know - Natural Killer Cells.
What are NK cells and how are they relevant to pregnancy?
Natural killer cells are under normal circumstances a natural and healthy part of the immune system. They are there to eliminate anything harmful that could cause a threat to your body. They are a type of white blood cell that provides a rapid response to infected cells and go to task particularly if they are needed in the case of tumours that start to form but equally get in there with viruses, parasites and bacteria.
When we get pregnant, NK cells need to get the signal to ‘ power down’ - after all although it is the most natural thing in the world  to be pregnant, it is essentially 50% foreign DNA. At the time of pregnancy (and normally the first 12 weeks) the brain needs to give the signal to lower the natural defences of the body, a situation that can understandidly confuse things. It must be really hard for the body's immune system to ignore what looks like a pathogen starting to develop, via the uterus, as during this early time - implantation starts a whole chain reaction where it then starts to establish its own blood supply!
What should happen before an expensive blood test for NK cells
If you have had multiple miscarriages or grade A eggs at IVF and your partners sperm has also been verified as good with no DNA fragmentation, then the next step for me is always a hysteroscopy. This procedure involves taking a biopsy of your uterine lining and the results will show if there is unusually high NK cells. For me this is the most effective way to establish if NK cells are invasive and could be causing miscarriage.
What normally happens…
If you are working with a progressive IVF centre, they may after 3 or more failed IVFs or miscarriages, send off for a raft of blood tests, which cost a pretty penny!
What you need to know before ordering or letting your reproductive specialist lead on some very expensive tests is the difference between blood NK cells and uterine  NK cells. Another thing to keep in mind which takes it a little deeper is you should know is that NK Cells are deemed Bright NK, Super Bright and Dim NK cells
..’During implantation, CD56bright NK cells are reputed to play an important role whereas CD56dim NK cells are mostly negatively associated with reproduction'.
In a few studies they found that the proportion of the uterine CD56dimCD16+ NK cells was significantly lower in IVF patients as compared to the controls (6.9 and 13.7% ) The proportion of CD56bright NK cells  was no different between IVF patients and controls in the uterus (28.8 and 33.5%) This data indicated a shift in the ratio towards the beneficial CD56bright NK cells and away from the harmful CD56dim NK cells…’
In peripheral blood there is no shift in the CD56dim/CD56bright ratio
Blood NK cells are very different to uterine NK cells leading some experts to conclude that “measuring any parameter of NK cells in blood is not useful in trying to understand the cause of reproductive failure”
The important thing to keep in mind when you have had multiple miscarriages is that the you need to know a little more about these new tests before proceeding to the next stage and what inevitably can then involve more costs. It is my view that a biopsy is the only way to confirm high NK cells which may be causing some issues with implantation and growth of the baby.

Wednesday, February 17, 2016

Vitamin A ~ is is safe in pregnancy?

The new year has started off with a bang! Lots of clients who have been working with me for 3 months or more are now pregnant – Yay! As most are new mums a few have got in touch about Midwives and Drs misconceptions and concerns about vitamins and minerals, as this is where the medical community start to get involved. One of the concerns is about Vitamin A and its ability to cause birth defects; so let me respond and shed some light on this.

I have looked into this issues myself quite thoroughly and the research links I have cited below mention that the research is over 30 years old in regards to the potential causes of birth defects. I will say that again.... In time frame only 18 cases have been cited where this has caused deformities. 

I’m sure you are aware that any adverse reaction to drugs need to be reported.  All medicines are reported under the medical misuse category.

Drugs cause death and other health conditions by the hundreds of thousands annually. vitamins don't cause death  We don’t have anything for supplements to report on this, but as always if anything does show ‘Teratogenicity ie potential for birth defects it has to be reported as such.

A basic look into drugs commonly used to help women conceive and to help those with sticky platelet, such as Aspirin have far more potential to cause birth defects, and not to mention fertility drugs that many use unwittingly without looking into the small print, that can also cause deformities and also death.  My point here, is many of my clients are getting all wound up about something, without looking into the issues more closely, and colleagues in the medical profession are making a point of issuing notice on Vitamin A without also mentioning that drugs, many of them used in fertility circles, have far more of a chance of giving ladies birth defects,  And those were taken at the correct dosage!

Of the 18 reported cases over the last 30 years who had babies with deformities all of the women in regards to Vitamin A took over 25,000IUs of Vitamin A, which exceeds the RDA on this by an exponential amount. As always the devil is in the detail. Most  supplements will show 2 forms of Vitamin A – the one that can cause more damaging effects at high levels  is retinol only and not a mixed between Retinol and beta carotene,  which is what most supplements have in them.

It is worth noting also in this instance that Natural Vitamin A ( retinol) is found in high doses in organ meat, such as liver. Which up until the 1970s was consumed and readily available. Many children, like our parents who, were born after the war were given cod liver oil daily, to ensure they didn't have deficiencies. This form of fish oil has a much higher form of Vitamin A.

One of the sources of this information is NHS choices website. In this website, which I find extremely unhelpful and very uniformed it says things like ‘ you should be able to get all you need nutrients from your diet and don’t need any extra vitamin A’. Also rather unhelpfully in the article they put the measurement in Mgs not IUs, which is the standard international unit used to measure Vitamin A, so right from the start shows a fundamental misunderstanding about vitamin A.

In terms of its use in pregnancy it is vital and essential nutrient and the most important and well known role of vitamin A is in relation to eye function. Vitamin A is necessary to prevent drying of the eye ( Xerophthalmia) and corneal changes. It is also used for retina function. 500,000 people lose their site each year due to vitamin A deficiency. Vitamin A levels are also inportant in thyroid health as it is needed for the uptake of idone and is required for thyroid hormone triiodothyroxine (T3) to bind to intracellular receptors. 

Vitamin A is needed in pregnancy for:  - Growth, Immunity, epithelial tissue maintenance and during cell proliferation, ie foetal growth!

I work with many clients and look into deeper analysis of fertility issues and pregnancy complications and one area I am fascinated in is Epigenetics. Many people who have polymorphisms in their BCMO1 gene have an issue converting beta carotene into retinol. So I welcome the use of mixed vitamin A for them in a retinol base, as they will have a problem converting Beta Carotene in the body  Many of the studies on the populations in the human genome project also had the potential for poor eye sight also so were really in need of vitamin A, should the gene express.

I ask questions about eyesight as part of my consultations and also look at this from a family health position, as there is the potential here also to pass this on to off spring! One anecdotal thing I’m noticing much more than when I was a child is that there seems to be a huge amount of kids with glasses at a young age. I only remember a few in my whole school growing up, so I’m wondering if reduced amounts of vitamin A in pregnancy are a result of this?

WHO recommendations. More recent than 1995
American Teratology Society information on Vitamin A

On a personal note. I have used many American supplements for the last 8  years of working with women all of which have mixed vitamin A around 5000IUs and I have confidence on these levels of Vitamin A.  I have worked with hundreds of ladies and so far no issues with this, with my recommendations!

I hope this helps you to make a more informed decision about vitamin A and its use in pregnancy and preconception.


2.Teratogenicity of high vitamin A intake. N Engl J Med. 1995 Nov 23 ;333(21):1369-73 
Wiegand, et al. 
3.Safety of vitamin A: recent results. Int J Vitam Nutr Res. 1998;68(6):411-6. Rothman, et al. 
4.Teratogenicity of high vitamin A intake. NEJM. 1995 Nov 23;333(21)1369-73. 3. Miller, et al.
5.Preconceptional vitamin A use. Reprod Toxicol. 1998 Jan-Feb; 12(1)75-88