Mediterranean diet ‘a straightforward approach’ among many nutritional options for improving the chance of success in IVF
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HART - NUTRITIONAL SUPPLEMENTS AND IVF (RBMONLINE, 2023)
view moreCREDIT: REPRODUCTIVE BIOMEDICINE ONLINE, 2023
Adjuvant therapies to help infertile women conceive by IVF - especially those whose treatments have been unsuccessful in the past - are now a common feature both before and during the treatment cycle. Now, a new analysis of the evidence for many nutritional supplements and diets thought to improve outcome in IVF has concluded that adopting a Mediterranean diet during treatment would offer a single ‘straightforward approach’ with good evidence of benefit in contrast to that of a Western diet.
Evidence from studies of nine commonly used nutritional supplements was found to be inconsistent and not always of good quality. The analysis, by Professor Roger Hart, University of Western Australia and City Fertility, Perth, Australia, is published today in the peer-reviewed journal Reproductive Biomedicine Online.
He explained that the extent to which nutritional supplements are used in IVF is largely unknown. ‘Nutritional supplements are usually not prescribed,’ explained Professor Hart, ‘but bought online or over-the-counter. They’re self-medicated and solid data on usage is impossible to determine. Our information is largely anecdotal but it’s quite clear from online IVF discussion forums that they are widely used and of great public interest.’
The nutritional supplements analysed in the study were dehydroepiandrosterone (DHEA), melatonin, co-enzyme Q10 (CoQ1O), carnitine, selenium, Vitamin D, myo-inositol, Omega-3, Chinese herbs and several diets (as well as weight loss). Many were reviewed as adjuvants for poor response to previous IVF treatment, of which DHEA and COQ10 appeared in studies to have more benefit than control therapies. Similarly, there was some evidence of benefit from melatonin, but it remains unclear which patient groups might benefit, nor at which dose.
However, the evidence in favour of a Mediterranean diet is much stronger and includes several well designed randomised clinical trials, showing benefits in both embryo development and pregnancy outcome (even from a six-week intervention programme). Professor Hart explained that the common features of these favourable diets were those with high intakes of fruits and vegetables, whole grains, legumes, nuts, fish, and monounsaturated or polyunsaturated oils, but with a limited intake of highly processed foods. ‘These diets are high in B-vitamins, antioxidants, omega-3 poly-unsaturated fatty acids and fibre and are low in saturated fat, sugar and sodium,’ he said. Omega-3 fatty acids, often taken as combined preparations, are the most studied dietary fatty acids in the IVF literature, largely, said Professor Hart, because of their perceived benefits in general health and reproduction. The evidence suggests that omega-3 fatty acids ‘may be beneficial’ in improving IVF clinical outcomes and embryo quality.
Similarly, antioxidants are usually taken as combinations of supplements but evidence from one major review (of 63 antioxidant studies in reproduction) described them as of low quality and was unable to demonstrate any benefit in terms of live birth rate.
Thus, from this mass of evidence Professor Hart advised that a simple nutritional approach to assist conception via IVF would be the adoption of a Mediterranean diet. The use of COQ-10 and DHEA before starting IVF may be a useful adjunct for women who had a previously poor response to ovarian stimulation, while supplementation with omega-3 free-fatty acids may indeed improve some clinical and embryological outcomes.
Professor Hart also advised that all women attempting to conceive should be taking adequate folate supplementation and should seek the advice of their general practitioner or specialist to ensure they are in their best general health for conception.
* This press release is in support of
Hart RJ, Nutritional supplements and IVF: an evidence based approach. Reproductive Biomedicine Online 2023; doi; https://doi.org/10.1016/j.rbmo.2023.103770
* For more information on this press release, the published paper and interview opportunities, please contact:
Duncan Nicholas, RBM Online Development Editor, dev.editor@rbmonline.com
JOURNAL
Reproductive BioMedicine Online
METHOD OF RESEARCH
Literature review
SUBJECT OF RESEARCH
Human embryos
ARTICLE TITLE
Nutritional supplements and IVF: an evidence based approach
ARTICLE PUBLICATION DATE
20-Dec-2023
Slimming significantly alters your microbiome and brain activity
Weight loss via intermittent energy restriction results in synchronized changes throughout brain-gut microbiome axis
Worldwide, more than one billion people are obese. Obesity is a risk factor for cardiovascular disease, diabetes, and some cancers. But permanently losing weight isn’t easy: complex interactions between body systems such as gut physiology, hormones, and the brain are known to work against it. One method for weight loss is intermittent energy restriction (IER), where days of relative fasting alternate with days of eating normally.
“Here we show that an IER diet changes the human brain-gut-microbiome axis. The observed changes in the gut microbiome and in the activity in addition-related brain regions during and after weight loss are highly dynamic and coupled over time,” said last author Dr Qiang Zeng, a researcher at the Health Management Institute of the PLA General Hospital in Beijing.
The fast track to weight loss
The authors used metagenomics on stool samples, blood measurements, and functional magnetic resonance imaging (fMRI) to study changes in the composition of the gut microbiome, physiological parameters and serum composition, and brain activity in 25 obese Chinese women and men on an IER diet. Participants were on average 27 years old, with a BMI between 28 and 45.
“A healthy, balanced gut microbiome is critical for energy homeostasis and maintaining normal weight. In contrast, an abnormal gut microbiome can change our eating behavior by affecting certain brain area involved in addiction,” explained coauthor Dr Yongli Li from the Department of Health Management of Henan Provincial People’s Hospital in Henan, China.
First, the participants underwent a ‘high-controlled fasting phase’ of 32 days where they received personalized meals designed by a dietician, with a caloric value decreasing stepwise to one quarter of their basic energy intake. They then spent 30 days in a ‘low-controlled fasting phase’, where they were given a list of recommended foods: participants who adhered perfectly to this diet would receive 500 calories per day for women and 600 calories per day for men.
Synchronous changes in brain activity and gut microbiome
By the end of the study, their body weight had decreased by an average of 7.6kg, or 7.8%. As expected, they had undergone reductions in body fat and waist circumference.
Likewise, their blood pressure and serum levels of fasting plasma glucose, total cholesterol, HDL and LDL had decreased, and the activity of key liver enzymes. These suggest that IER helps to reduce obesity-related comorbidities like hypertension, hyperlipidemia, and liver dysfunction.
The authors observed decreases after IER in the activity of brain regions implicated in the regulation of appetite and addiction. Within the gut microbiome, the abundance of the bacteria Faecalibacterium prausnitzii, Parabacteroides distasonis, and Bacterokles uniformis increased sharply, while that of Escherichia coli fell.
Further analyses showed that the abundance of E. coli, Coprococcus comes, and Eubacterium hallii bacteria were negatively associated with the activity of the brain’s left orbital inferior frontal gyrus – known to play a key role in executive function, including our will to lose weight. In contrast, the abundance of the bacteria P. distasonis and Flavonifractor plautii were positively correlated with the activity brain regions associated with attention, motor inhibition, emotion, and learning.
Weighing the evidence
These results suggest that changes in the brain and microbiome during and after weight loss are linked – either because they cause each other, or because an unknown other factor causes both. Because the study is correlational, it can’t resolve the direction of the underlying causality.
“The gut microbiome is thought to communicate with the brain in a complex, two-directional way. The microbiome produces neurotransmitters and neurotoxins which access the brain through nerves and the blood circulation. In return the brain controls eating behavior, while nutrients from our diet change the composition of the gut microbiome,” said coauthor Dr Xiaoning Wang from the Institute of Geriatrics of the PLA General Hospital.
Coauthor Dr Liming Wang, likewise from the Health Management Institute in Beijing, said: “The next question to be answered is the precise mechanism by which the gut microbiome and the brain communicate in obese people, including during weight loss. What specific gut microbiome and brain regions are critical for successful weight loss and maintaining a healthy weight?”
JOURNAL
Frontiers in Cellular and Infection Microbiology
METHOD OF RESEARCH
Experimental study
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Dynamical alterations of brain function and gut microbiome in weight loss
ARTICLE PUBLICATION DATE
20-Dec-2023
How does the inability to burp affect daily life?
The inability to burp—called retrograde cricopharyngeus dysfunction (R-CPD)—is caused by failure of the throat’s cricopharyngeal muscle to relax to allow the outward passage of gas. An interview-based study in Neurogastroenterology & Motility that included 199 adults affected by the condition reveals the impact of R-CPD on quality of life.
Most participants reported abdominal bloating, socially awkward gurgling noises, excessive flatulence, and difficulty vomiting. Only half discussed their symptoms with their primary care clinician, and 90% felt they did not receive adequate help. Participants also reported embarrassment, anxiety/depression, negative impacts on relationships, and work disruption due to R-CPD.
“R-CPD encompasses more than just the physical challenge of being unable to burp; it also significantly impacts people’s daily lives, relationships, and mental well-being,” said corresponding author Jason N. Chen, a medical student at Texas Tech University Health Sciences Center. Future efforts should concentrate on raising awareness about R-CPD, which can help increase identification and treatment rates.”
URL upon publication: https://onlinelibrary.wiley.com/doi/10.1111/nmo.14721
Additional Information
NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout, newsroom@wiley.com.
About the Journal
The field of gastrointestinal motility has undergone phenomenal growth and change in the past three decades since it emerged as a distinct speciality. Neurogastroenterology & Motility provides a forum where current issues and advances relating to the motor function of the GI tract can be presented and discussed. It is of interest to both clinicians and researchers.
About Wiley
Wiley is a knowledge company and a global leader in research, publishing, and knowledge solutions. Dedicated to the creation and application of knowledge, Wiley serves the world’s researchers, learners, innovators, and leaders, helping them achieve their goals and solve the world's most important challenges. For more than two centuries, Wiley has been delivering on its timeless mission to unlock human potential. Visit us at Wiley.com. Follow us on Facebook, Twitter, LinkedIn and Instagram.
JOURNAL
Neurogastroenterology & Motility
ARTICLE TITLE
Retrograde Cricopharyngeus Dysfunction: How does the inability to burp affect daily life?
ARTICLE PUBLICATION DATE
20-Dec-2023
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