fertilityArticles of Interest

Healthy Eating & Exercise

Healthy Eating and Exercise

Eating

Eating a healthy diet and obtaining regular exercise can be a big part of helping you achieve your goals, whether they are physical fitness, weight loss, or hormonal/fertility improvement.  Although persons who modify their diet and begin regular exercise programs generally lose weight, even in the absence of any weight loss, a regular exercise program will significantly improve a woman’s hormones and cardiovascular health.   There are beneficial changes to your heart as well as your blood sugar and insulin levels, and also to your reproductive hormones.  Many women who are not ovulating will begin ovulating.

While it may be true that some people with a weight a problem “don’t eat much at all”, the fact is that they still  have excessive food intake compared to what their bodies require.  Remember that everyone’s metabolism and calorie usage differs.   Unfortunately, many individuals are overweight because they burn and require very few calories compared to an average person.

In the end, it is a very simple formula that no one can deviate from.  If you consume more calories than you burn, you will gain weight.   If you burn more calories than you consume, you will lose weight. 

Achieving an “ideal” body weight is not necessary! Research has shown that significant hormonal improvements occur with as little as 8-10% body weight loss. However, all calories

are not equal! For example complex carbohydrates ( whole grain bread, pasta, etc.) cause less weight gain than a similar number of calories from simple carbohydrates( candy, sugar, soda, etc).

There are a few general points to be made regarding diet and eating habits:

  • Don’t skip breakfast.  If you skip breakfast, this will prolong your body’s “fasting mode” and decrease your calorie usage.
       
  • Drink water instead of other options.  Diet drinks are also okay, but some researchers think these may stimulate appetite.
       
  • Keep a water bottle with you and try to drink water frequently throughout the day, especially when you are hungry.  Distention of the stomach, although brief, can help decrease your appetite.
       
  • Don’t eat after supper, since there is no way to utilize these calories before you go to bed.
       
  • Eat and drink dairy products! Research has shown that you can lose 60% more weight if you consume a diet with 1200 – 1500 mg of Calcium from dairy products.  A glass of skim milk has 300 mg of Calcium but only 100 calories.  Yogurt, cheeses, and some flavored ice milks are also good sources of low fat calcium.  Calcium supplements are not as effective as dairy products for reasons that are not completely understood, but they are still helpful.  If you are lactose intolerant, try taking “Lactaid” or other similar lactase supplements, available without a prescription at any pharmacy or most grocery stores.

The best option for “dieting”, and the one that needs to be made a regular part of your life at some point, is simply what can be termed ‘sensible eating’.  Here are a few basic principles to live by:

  • No fast food  -  fast foods are almost invariably high in calories and fat. A notable exception would be the low-carb menus (offered by some chains) if you are on the Atkins diet.
       
  • Don’t eat candy or foods with concentrated sugars – even a chocolate addict can find low fat, sugar substitute alternatives.
       
  • Important !!!   Minimize your ‘simple’ carbohydrates, such as potatoes, white bread, and white rice.  Instead, eat whole grain bread and brown or wild rice.
       
  • Pizza, fried foods, and fatty meats should be kept to a bare minimum or avoided completely.  However, a little fat is NOT a bad thing, and in fact helps you to feel less hungry for longer periods of time.  The best fats to eat are the mono- and poly-unsaturated fats, such as those found in nuts, salmon, avocados, and olive oil.
       
  • Cut out snacking between meals, or if you can’t do this, try snacking on celery,  carrots, etc.  Try not to eat after 7:00 p.m.
       
  • Eat more Fruits and Vegetables.  Try to increase your fiber intake in any way possible.  This helps prevent ‘spikes’ in your blood sugar and insulin levels.
       
  • Eat more lean proteins.  Instead of having an extra serving of carbohydrate if you are still hungry, eat more chicken, fish, or lean pork or beef instead.
       
  • If you cook, add more water than the recipe calls for.  If  possible, add wheat germ/ wheat bran to your recipes.  This decreases the density of the food and helps you feel satisfied after eating fewer calories.

If you prefer to start on a more regimented diet:

  • Weight Watcher’s is an excellent group that has a scientific and effective approach to weight loss.
       
  • Low carbohydrate diets are especially effective for women with insulin resistance, but are also effective in other individuals.  The Atkin’s Diet (Dr. Atkin’s Diet Revolution, etc.),  “Sugar Busters”, and other books on low carbohydrate diets can be found in any bookstore and even Wal-Mart.  The bad press that low carb diets have received is unwarranted. Research has shown that these diets are more effective than many traditional diets, and actually cause improvements in blood lipids (cholesterol levels).

Let us know if you would like to have a formal consultation with a dietitian who can provide you with a personalized diet plan.  Be aware that there may be some fees involved with this as insurance does not always cover dietary services.

Exercise

Regular exercise can provide two huge benefits:

  1. First it can help you achieve weight loss. This weight loss then causes favorable hormonal changes. Importantly, THE GREAT MAJORITY OF SUCCESSFUL’ WEIGHT LOSERS HAVE MAINTAINED THEIR WEIGHT LOSS DUE TO A REGULAR EXERCISE PROGRAM.
       
  2. Even in the absence of weight loss, adequate weekly exercise regimens will cause significant and favorable hormonal changes.  These are beneficial from a cardiovascular standpoint as well as a reproductive standpoint.

You should  exercise for approximately 3 to 3 ½  hours per week to achieve optimal benefits.  Ideally, exercise is performed in the morning.  This helps to increase your metabolic rate and calorie burning throughout the day.

Brisk walking is a type of exercise that almost anyone can perform.  We generally prefer this to bike riding, swimming or other forms of exercise because it is more sustainable and does not require significant skill or coordination.  However, weightlifting is an excellent addition to your aerobic (walking) exercise program, as it can increase your muscle mass, which causes increased calorie burning even at rest.

It is ideal to exercise with a slightly elevated heart rate in the 100 to 110 BPM range for the entire period.  Exercise at a higher heart rate is more difficult to sustain and is not ecessary to achieve hormonal benefits, but it would increase your fitness level and help you lose weight at a more rapid rate. 

A few caveats about exercise and walking in general:

  1. Walking on a treadmill is fine, but it is not equivalent to walking outside unless you put the treadmill on at least a 2% incline.
       
  2. It is not necessary to achieve all your daily walking at the same time.  For example, in order to achieve 3 to 3 ½ hours per week, you must walk about 25 to 30 minutes per day, on average.  This can be done in three 10 minute sessions daily.  It can also be accomplished in three one hour sessions weekly.  Do whatever best fits your schedule and lifestyle.
       
  3. Make certain you have a good pair of walking or running shoes.  These in general should be replaced twice a year if you are doing the prescribed amount of exercise.
       
  4. Leg weights or “heavy hands” type dumbbells may be used while walking, but it is easier to trip or fall if you use them.

One very good and new alternative to the above approach is the “10,000 step” plan.  This has been found in recent studies to be an excellent way to increase calorie expenditure and improve hormonal profiles.  It can also help you achieve weight loss.  In this plan, you will need to purchase a pedometer.  These can be found at running or sporting goods stores. They can also be found on the Internet at many places including www.new-lifestyles.com or www.digiwalker.com.  An individual typically walks 4,000 to 5,000 steps per day.  If you can increase your walking to 10,000 steps per day, this will provide substantial hormonal and cardiovascular benefits.  Many women find that this is a little more fun and somewhat of a challenge, as you are able to assess your progress throughout the day and weeks.

Don’t be afraid to start exercising!  Even if you are in very poor condition, you can begin a modest program that you can be proud of and that can become a regular part of your life with surprisingly little effort! 

Finally, pharmacologic agents can be useful in helping to achieve weight loss. Unfortunately, the vast majority  of women and men who use these typically regain the lost weight after stopping these supplements or medications.  This is because they have not committed to the significant lifestyle changes that are necessary in order to maintain a stable body weight.  Nevertheless, over-the-counter aids such as Dexatrim and Metabolife can be helpful in the short term and are generally safe if you do not have difficulties with your heart, blood pressure, etc.  We do occasionally use prescription medications.  If you would like more information about these alternatives, please ask.

Often, your ability to assist in dietary and exercise regimens such as noted above are instrumental in helping you achieve your desired goals.  If you have other suggestions or require further information or assistance, please don’t hesitate to contact us at any time.

Jeffrey A. Keenan, M.D., F.A.C.O.G.
Associate Professor
Director, Division of Reproductive
Endocrinology & Infertility
Department of Obstetrics & Gynecology
University of Tennessee Medical Center, Knoxville