Friday, 7 March 2008

Becoming a father Chapter 4 : Nutrition

Everyone seems to know that women should take folic acid while they are trying to conceive so that the baby’s brain develops properly. Many people even know that it makes conception that bit more likely. What no one mentions is that nutrition can have a major effect on men too. Below, after a quick explanation of why good nutrition matters for men I discuss the requirements for a man who is ‘trying’ and how to ensure that you fill those requirements. There are also a few asides on your partner’s nutrition and how to avoid this becoming andissue.

Nutrients, How Sperm Are Made And What Can Be Wrong.
A sperm takes around 100 days to make and is clearly important in the conception process. When the sperm enters your partner it has only around six hours in the vagina before the acidity there will kill it. It is important that it is a healthy sperm for it to even have a chance of getting to the egg, let alone being in a condition fertilize an egg upon arrival.

A sperm measures around 1/20th of a millimetre and swims at around 3mm an hour. That means each sperm is swimming around 60 times its own body length an hour, which does not seem that much until you think that it has to swish its tail around 8000 times to move only ten centimetres.

Fortunately a strong female orgasm can cause muscle contractions to suck the sperm to the safety of the more alkaline cervical mucus. This means that most sperm reach the fallopian tubes within an hour, rather than getting too damaged by the acidity.

Possible problems with sperm include:

• Cannot swim in a straight line.
Sperm can suffer from a tendency to zigzag or even to swim around in circles. Not good news if you are a sperm in a hurry to get out of an acid environment.

• Deformed heads. Sperm can suffer from the heads being too big, too small, the wrong shape or even from having more than one head. This can affect ability to swim as well as ability to conceive upon arrival at the egg.

• Deformed tails. Sperm tails are made of two central tails surrounded by two rings of nine fibrils. These must taper to give the sperm proper motility. Again sperm can have these poorly formed or even have two tails.

• Lethargic sperm. If the sperm are not whipping their well formed tails behind their well formed heads they are not going to be moving fast enough to survive the whole journey.

• Not enough sperm. As most sperm never make it close to an egg it is clearly essential to have enough sperm or there will be very little chance of a successful conception.

• Sperm not ‘motile’. If the sperm are stuck together (agglutinating) or otherwise not able to move properly they will not make it to the egg while they are still viable.

More About Sperm
Some sperm facts:

• When you orgasm you ejaculate around 2-5ml of sperm (up to around a heaped teaspoonful). This contains around 90 million sperm per millilitre. Depositing between 150 million and 500 million sperm.

• Sperm can survive for up to around 6 hours in the vagina though most will die within the first hour or less.

• Sperm can live for 3-5 days or even longer in your partner‘s cervix if there is fertile mucus there.

• When your partner is not in her fertile phase her mucus blocks entry to the cervix keeping the sperm out.
Sperm are therefore stuck in the vagina and killed by the acidity of the vaginal secretions.

• Around 8% of couples of who use anal sex as a method of birth control have pregnancies each year.

• Your testicles are always making sperm, so you are potentially fertile all the time, rather than in phases like your partner.

• The natural lubricant produced before orgasm, sometimes known as pre-come can contain sperm, and so can cause pregnancy even without ejaculation.

What Our Bodies Need
To make healthy sperm our bodies need a whole variety of nutrients. To protect the sperm during their journey from where they are made to where they are stored before sex they need other nutrients such as antioxidants. A variety of governmental and other organisations produce recommendations for how much of each nutrient a person need and these are listed on packaging in terms of the Recommended Daily Amount (RDA).

The RDA for vitamins and minerals references the average person. Talking about the average person assumes that you are a healthy adult below 60 with normal digestion, not overweight, leading a relatively stress-free life. It also assumes no medical problems and a good diet. Under this definition very few people are average.

Few adult men consume the RDA for zinc. Zinc is one of the major constituents of sperm. Fewer than 29% of people eat the recommended 5 fresh fruits and vegetables a day . With the way that vegetables have been watered down, in some cases literally, there are grave doubts as to whether the recommended 5 portions a day are still sufficient. If you want to conceive then a healthy diet is very important and supplementing it with one or two tablets is not a bad idea at all.

It should however be emphasised that taking vitamin tablets is never going to be a substitute for a healthy diet. Do make the effort to eat healthily while you are trying to conceive, and to help your partner to eat good food throughout the pregnancy and you may find it has more effect on your sex life, your relationship and your general happiness than you would have believed possible.
Where the symbol is used in the table it means that the given item can be bad under some circumstances, but under others can actively be helpful. Each of these is covered in more detail elsewhere in the book, but in summary Vitamin E is useful up to the RDA, but check with a doctor before going over. Caffeine is generally okay in moderation, but cutting out altogether may be better. The exception to this is that there are some possible good side effects on sperm straight before sex under the right circumstances.

Details of Individual Nutrients
Folic Acid RDA 400ug
Folic acid is a B vitamin found in many fruits and vegetables. Men do not need to take as much of it as women, but they should be consuming it during the 100 day run up to conception. A finding of the Western Human Nutrition Research Center with UC Berkley was published in the journal of Fertility and Sterility; it suggests that low levels of folic acid correlate with decreased sperm count and low sperm density.
Your folic acid could be in the form of green leafy vegetables like spinach or it could be in the form of vitamin pills, but you do need to make sure there is enough of it in your diet.

The same study suggests that where there is a lack of folic acid there is more likely to be chromosome damage in the sperm which may contribute to an increased risk of childhood cancer.

A supplement containing the RDA of 400 micrograms per day wouldn't hurt. While too little sperm may be caused by lack of folate, over-consumption will not cause men to produce excessively high amounts of sperm.

Folate is commonly found in leafy greens, orange juice, legumes and fortified grain products. In the UK there is currently investigation into the idea that all white sliced bread should be required to be enriched with folic acid to prevent birth defects. As of January 1998, all uncooked cereal grain products in the United States were fortified at a concentration of 140ug of folate per 100 g of grain for the same reason.
NB: Too much folate in the diet can hide the anaemia associated with a lack of vitamin B-12. If you are taking a supplement then this is unlikely to be a problem, but if you are not then you may want to be sure you are eating enough meat and dairy produce (see Vitamin B12 below)

Folic acid in women
Even though this book is aimed primarily at men I feel that this can make such a significant difference to the future of the child and hence to the whole family that it deserves a proper mention. The CDC estimates that two-thirds of women in the United States do not consume adequate amounts of folic acid. I have not been able to obtain good figures for the UK but I would expect that more than one third of us do get enough folate. While the UK as a country are probably doing better than the United States, it would be very surprising if overall either were consuming enough.

In women, too little folic acid has been found to correlate with a higher risk of having children with birth defects such as spina bifida Previous research has shown that it is important for a woman to have enough folic acid in her body both before and during pregnancy to ensure correct brain development.
Adequate amounts of the vitamin are very critical for women, particularly during the period before conception and during early foetal development (the first three months or so). Folic acid taken by the woman before conception is also supposed to improve the chances of successfully conceiving.

Essential Fatty Acids (EFAs) RDA not yet issued
Essential fatty acid supplements are a good idea because semen is rich in prostaglandins which are produced from these fats. Men with poor sperm quality, abnormal sperm, poor motility or low count, generally have inadequate levels of beneficial EFAs or prostaglandins.

In addition essential fats have a major effect on the reproductive system (along with every other system of the body) as they are crucial for healthy hormone functioning. Omega-3s are fatty acids which are particularly linked to brain development and preventing depression.

In terms of ensuring the welfare of your child their brain development is clearly important, and lack of the right ingredients in your sperm are believed to be able to make a significant difference. Like all these things it will not make as large a difference as a long term lack in your partner during pregnancy, so you will want to help her with her nutrition as soon as you are able to stop taking care of yours.

EFAs and Female Depression During Pregnancy

If your partner is not getting enough EFAs then the foetus will take the lion’s share of what she is consuming. This lack can cause depression in your partner. If your partner is suffering from depressive symptoms during pregnancy check she is getting enough EFAs.

NB while pregnancy depression should not be confused with ‘Post-natal Depression’ it is possible that the two may be related, so care should be taken. Post-natal depression is covered later in the section entitled ‘The Birth’.

The best sources of EFAs within a healthy diet are fish, wild game and Flaxseed. In fact Mahatma Ghandi is quoted as saying “Wherever flaxseed becomes a regular food item among the people, there will be better health”. While Ghandi was no nutritionist he seems to have been right on this one, which along with the other sources near the end of this section is good news for vegetarians or the more adventurous omnivores.

In terms of fish the more fatty the better, so cold water fish (who need the insulation fat supplies) are ideal. Good examples of these are herring, sardines, halibut, mackerel and blue fin tuna. Do not forget that your partner has to be careful about how much tuna she eats because of the heavy metals, so this may be one to have on your own.

Buffalo and venison are also good sources of EFAs and have at various times been sold in most major supermarket chains including Sainsbury and Tesco. Marks and Spencer quite often has venison in a variety of forms that can conveniently be put into sandwiches as well as the sausages and cold cuts you will usually find in most places. If you do have difficulty finding these they are also available mail order from (Buffalo)

and (Venison)

For vegetarians canola oil, flaxseed, flaxseed oil, walnuts, and leafy green vegetables such as spinach are all good sources of alpha-linolenic acid (ALA or sometimes LNA). ALA is the plant-based omega-3. Weight for weight walnuts have about three times the ALA content of salmon, so being vegetarian is not an excuse to skimp on the fatty acids.

Some people find that fish oil supplements give them unpleasant fishy burps or indigestion. If you are not one of these people, or if you can cope with the burps, then the supplements are worth taking while trying to cause a conception. Other ways, for those who cannot cope with the more standard supplements include omega-3 enriched eggs and enhanced breads.

Some research has indicated that certain types of DNA damage in the sperm can make it difficult to conceive, and can cause an increased risk of miscarriage if conception does take place. If DNA is damaged, there may be a chromosomal problem in the baby, should the pregnancy proceed. It has been suggested that his sort of damage is linked to some childhood illnesses.

Whether or not DNA damage does have these effects has not been conclusively proven, but to my mind the research makes it seem likely. It certainly seems worth taking vitamin C and the other antioxidants just in case. The same is true for your partner. The good news is it is possible for you to get pretty much all you need out of one or maybe two tablets, or out of a careful, healthy diet. Of the two I have to recommend having the healthy diet, and adding supplements so that you do not have to spend time worrying about how healthy you have managed.

Selenium RDA 55ug
Selenium is an antioxidant that helps to protect your body, your sperm and your partner’s eggs from free radicals. Low selenium in the blood is associated with low sperm counts. By protecting against free radicals selenium can prevent chromosome breakage, which is known to be a cause of birth defects and miscarriages.

Some good sources of selenium include red meat, tuna, chicken, and enriched pasta and whole grain breads.

Vitamin B12 RDA 1000 µg = 1mg
Vitamin B12, also known as cobalamin (from cobalt vitamin) is a complex compound containing cobalt which is important in the synthesis of RNA and DNA. B12 deficiency has been linked with anaemia, low sperm count, malformed sperm leading to poor sperm motility and with a failure to absorb folic acid. B12 supplements are one of the things sometimes prescribed for men with fertility problems, so getting enough in a normal healthy diet can sometimes avoid having problems in the first place.

Good sources of b12 include liver and kidneys, yogurt and dairy products, fish, clams, oysters, non-fat dried milk, salmon, and sardines.

Vitamin E RDA 10mg
Vitamin E is another powerful antioxidant; it increases fertility for both men and women. It may make the sperm themselves more fertile. Vitamin E given to men who are going for IVF treatment with their partners causes a 10% rise in the couple’s overall fertility. It has been suggested that the antioxidant activity might be responsible for this rise, but no one really knows.

WARNING: Vitamin E should not be taken if you are using anticoagulants. Always check with a doctor before exceeding the RDA of Vitamin E.

Wheat germ oil, almonds, sunflower seeds and sunflower oil are all excellent sources of vitamin E. Some vitamin E can also be found in Broccoli and spinach.

Vitamin C RDA 60mg
Vitamin C is yet another antioxidant. Studies show that vitamin C enhances sperm quality, protecting sperm and the DNA within it from damage. Vitamin C also seems to keep sperm from agglutinating, making them more motile.

Good sources of Vitamin C include citrus fruits - especially kiwi fruit, berries, tomatoes, cauliflower, potatoes, green leafy vegetables, peppers.

Poisoning: Large doses can cause diarrhoea and nausea.
Vitamin C is relatively quite delicate and often destroyed during food preparation, so raw or lightly steamed is best. It is destroyed by: boiling food, too much chopping, light, smoking and heat.

Calcium RDA 100mg=1g / Vitamin D RDA 5ug
It is worth ensuring that you are getting enough Calcium and Vitamin D. I am classing them together because the one is absorbed better in conjunction with the other. Research suggests that 1g of calcium and 10 micrograms (ug) of vitamin D each day may together improve a men's fertility. Sources of calcium include low-fat milk (an average milk glass has about 400mg) and yoghurt (one individual pot has around 300 mg of calcium). You'll find vitamin D in milk (the same size glass has 2ug) and salmon (a 100g has just under 10ug)

Zinc RDA 18mg
Zinc has been the subject of a huge variety of studies in both men and women.
Lack of zinc can cause changes to your genetic material and the same is true for your partner. This is associated with a low sperm count in men as the sperm tails and their outer layer are heavily dependant on sufficient zinc. Excess zinc can interfere with Copper and Calcium absorption, so while it is imperative that you get enough zinc it is not a good thing to go to far in that direction.

Clearly as I have said before, the less sperm there are out there, the less chance of conception. As well as lower sperm counts zinc affects the motility of sperm. Even if low zinc does not prevent conception in a particular case it can have an effect on the health of the baby.

Zinc is equally important for your partner’s body to use oestrogen and progesterone. Lack of zinc in women can lead to reduced fertility and an increased risk of miscarriage.

Most meats are good sources, particularly liver, as are most types of seafood, particularly herring along with eggs, nuts, peas and beans. Grains contain a fair amount of zinc, but have been shown to contain acids which bind to zinc making it harder to absorb. It is possible to overdose on zinc, so do not take more tablets than are recommended on the packet. As most of our zinc comes from animal proteins vegetarians need to be particularly careful to ensure they eat enough.

The first thing that has to be said here is that supplements are never a substitute for healthy eating. What supplements are good for is avoiding worrying about whether your healthy diet includes absolutely everything that it should. If you cannot guarantee to eat five fruit or vegetables and a sufficient quantity of each of the different nutrient sources then I would personally recommend two of the ‘Soft and Chewy’ multivitamins from Bassets. The Blackcurrant flavour does not contain any artificial sweeteners or other nasties and is actually very pleasant to eat (as you might imagine being made by Bassets). In addition to these I would suggest occasional zinc, selenium and vitamin C tablets. These need not be as regular. What I found was that a single Bassets would be juicy enough to swallow a zinc or selenium tablet, so I alternated which I took on a day and then followed up with the second bassets chewy vitamin. The Vitamin C tablets I took were interesting and high dose, but not so pleasant that I always remembered or bothered with them.

Are supplements expensive?
Supplements for men are not expensive as you can use standard supplements that are not specific to pregnancy. Supplements for women are expensive as they have to avoid vitamin A and so the supplement companies know it is pregnancy related. For leaving out that vitamin they charge a large premium. The excuse is that extracting it from the fish oils is a cost, but as vegetarian supplements are not made with fish oil I have my doubts. In any case pregnancy vitamins are expensive where normal ones are not. I have included a few sample costs below. They will be out of date by the time this goes to press, but they are good indications.

Sample costs
MumOmega, 90 capsules £12.99
ClearBlue Pregnancy
Vitamins 28 capsules £4.99

Folic Acid 360 tablets £3.95

Pregnacare, 90 capsules £10.69
Bassetts Soft & Chewy Multivitamins, 30 sweets £1.49

Are supplements worthwhile? I know all the doctors I have spoken to about it recommend them. I also know that the reassurance that her supplements provide for my partner, when the hormones try to make her worry needlessly, is worth the price. Are they worthwhile for you? I think they probably are, but it is a personal choice. I recommend them, but do not feel they are so necessary that if the cost is a big issue you should stress yourselves out to get them into the budget.

As this is not a book for women I do not have the difficult job of trying to evaluate all the different supplements that your partner might want to consider. Certainly I was happy for my pregnant wife to take Pregnacare and MumOmega, but there could have been a more efficient way that would have let her off with just one tablet. It was not a big problem for her to have both, just a mild inconvenience.

In terms of practicality the best time to take your supplements is when you will reliably remember to take them. That is the reason I had mine first thing, and used supplements I enjoyed taking. In terms of efficiency the best time to take supplement seems to be with your biggest meal as the food helps you to absorb the supplement and lowers the chances that they will upset your stomach. Don’t take lots of different supplements at the same time because they can interact with each other and be less effective, for example, zinc interferes with how copper and iron are absorbed.

Taking supplements discretely.
As stated elsewhere, if people realise you are trying they will inevitably put more pressure on you both. For this reason you may well want to decide to keep it quiet. As some of the supplements can be a give away discretion about taking them may be required. Men can offer round the bassets supplements as delicious and no one will think any more about it. Also being chewy and not needing water these can be shoved in with food without even noticing.

Your partners will be much more likely to generate suspicion that they are trying if they start taking them openly and you may want to offer advice and help. This is in part because the supplements for women, being restricted to avoiding vitamin A, are recognisable as pregnancy related and have names like MumOmega and Pregnacare. Using a pill box or similar for taking them with meals hides this as well as making the packet small enough to be a bit more discreet. Nipping off to the toilet during a communal meal is another way of avoiding anyone noticing your partner taking her supplements. Also as supplements are not strictly necessary she could skip them on the days when having a meal with the mother or whoever else needs to be kept in the dark.

If they are not taken properly, supplements are flushed through your body without being absorbed. Ladies pretty much need to take supplements with water at room temperature – hot or chilled drinks can damage them. They should not drink tea or coffee 15 minutes before or after taking supplements because they interfere with nutrient absorption. Make sure you read the label on the bottle, and that your partner takes supplements with or after food as directed.

What Our Bodies Do Not Need

Why to reduce your intake
While an occasional drink is generally considered safe, studies show that daily consumption of wine, beer or spirits can decrease testosterone levels and sperm counts and increase the number of abnormal sperm in semen. Cut out or cut back on alcohol.

The same is true of your partner as Danish research has shown that a woman's alcohol intake is associated with decreased fecundability even among women with a weekly alcohol intake corresponding to five or fewer drinks.

It is worth noting that your partner is going to be being careful about alcohol for a lot longer than you are, so making he know you are making every effort at the start is good for both of you in the long run. Earn your brownie points while they are easy to get.

Tips for reducing your intake
Much alcohol consumption is related to peer pressure. It is not easy to avoid having a Guinness on Saint Patrick ’s Day or a whisky on Burn’s Night. If you are not strong enough to say no, or if you do not want to give away the fact you are trying to have a child then there are still a few things you can do. These really come down to (1) avoiding situations where drinking will be expected, (2) having a good excuse ready, (3) pretending to drink without actually consuming much alcohol.

Avoiding situations where it is necessary to drink
This is really just about planning. Look at all invitations and see whether you will have to drink. If you will invent a prior engagement or arrange to go to a less alcoholic do at the same time. Most men seem to let their partners keep hold of the diary, so producing engagements you have to get to should not be hard.
Below are a few good reasons why you are not drinking.

• I am driving
• I have felt a little dodgy today
hates it when I come home smelling of alcohol, and she has been a bit down lately so I thought I would surprise her
• We are thinking of trying for a baby, so I thought I would see how long I could give up for. Once sees how hard it is/how much it would cost/other reason not to try it will probably come to nothing.
• My doctor told me to cut down for a while.
• I have had too much already.
• I had too much last night.

Tactics for appearing to drink without drinking

• Raise a wine glass (or any other glass) to your lips without drinking, so it never needs refilling. I have gone a whole evening without drinking anything by getting a big drink and any time I am offered saying “no thanks I was just bought one” as I show my full glass.
• Pick up the bottle and refill everyone yourself, so they do not notice your refill is only a splash.
• Gin and Tonic without the tonic, or better still mineral water masquerading as G&T.
• Alcohol free beer
• Virgin Mary
• Take your drink with you and pour it away when you are out of site.
• Iced coffee (with no milk) can look like dark spirits such as whisky
• Arrange to pour drinks for your partner and for her to pour for you. This can range from weak or completely alcohol free drinks to simply giving you stingy portions.
• Finally, tactic one of the list above can be supplemented by taking away the occasional full glass and ostentatiously replacing it with another big one.

It is worth noting that drinking and then throwing it up is not a good idea for a variety of reasons. The most important being that alcohol is absorbed through a variety of membranes from your tongue (mucus membrane) to your stomach wall, so even if you empty your stomach it may be too late to stop the alcohol getting into your system. Next most important is that your digestive juices which come up will not be good for you and their loss will be bad for your digestion.

There are good reasons for you to either give up caffeine or at least to reduce your intake. That said it is not always a bad thing for a man to have caffeine before conception. For women the only side effects are negative ones, for men the story is a little more complex. Below, as well as tips on cutting down I have included a brief explanation of the side effects as well as the myth that coffee wakes you up. Once you have read this you should have a reasonable idea of how much you want or need to cut down, and if you do need to then of how to do it.

The myth that coffee wakes you up.
Everyone thinks that coffee wakes you up, and most of us have even experienced it. Remember when you had your first cup of coffee? You suddenly felt very, very alert. The same for that evening when you discovered a local place that served double espressos. Well what you felt was not just the placebo affect, and yet coffee does not really wake you up. How can this be?

It is actually pretty simple. We know caffeine is addictive, that is why people are dying for their first cup to wake them up in the morning. Well the problem is that our body is not really designed to be hyper alert all the time but it is adaptable. After having coffee each day for a couple of days our body becomes accustomed to it. It puts you in a down state and the coffee brings you back to normal. You can think of it as coffee withdrawal symptoms. No coffee no alertness at all. Stop taking coffee for a few days, maybe a week, and your body starts waking up as normal. Suddenly you do not need coffee to wake you up, you have better mornings and are overall more alert.

It sounds odd but switching to decaf actually makes you more awake on average.

When caffeine is a good thing and when it is bad.
Strangely caffeine seems to have a similar effect on sperm to the effect it has on people. A cup shortly before sex that you want to result in conception gives the sperm a sort of undirected turbo charge. They move further and faster, though their sense of direction may not be as good. Clearly this only works if you have not been having coffee for a few days prior, otherwise the boost is gone, but the negative effects are still there. If your sperm are not suffering from a tendency to zigzag then abstinence followed by a cup of coffee at the strategic time can actually be beneficial. Taking coffee regularly will only have a small negative impact in most cases, certainly less than becoming very stressed by giving it up. I would suggest changing to decaf straight after the fertile time and sticking with it until she is fertile if you like the taste.

Reducing your caffeine intake
If rather than give up you simply want to reduce your caffeine intake there are a few ways you can try and do this:

• Substitute Decaf for every second cup. Try a blind test as if you get good coffee you will find decaf has a placebo effect just as good as the real thing. If you normally drink instant try buying single cup filters for the caffeine free drinks. This will mean you actually look forward to the better tasting coffee.
• Look at when you regularly have coffee and see if you can change the circumstances, e.g. if you have it with each meeting try and combine meetings to lower the number.
• Try different drinks such as water or tea when you might otherwise have coffee .
• Get your partner to help you, just as you will be helping her.

Rufus Evison

1 comment:

Maryam said...

Indeed worthy stuff.