Nutrition plays an important role in all women’s life, with differing requirements at different stages in the lifecycle. This week we will be discussing nutrition for fertility; pregnancy; post-pregnancy; menopause; and over 65 years of age.
Nutrition and Fertility
Current evidence suggests that both partners in a relationship play an important part in conception and fertility. However, in terms of the female’s role in fertility there are a number of nutrients of interest including fats; protein; vitamin D; iron; zinc; and folate. Similar to the NHS Eatwell guide, it is recommended that women switch saturated fats for monounsaturated fats, such as olive oil, avocado and nuts. This is because evidence has shown that higher fertility rates are seen in women who incorporate plenty of monounsaturated fats in their diet.
For protein, it is suggested that women consume more plant-based sources of protein and less animal sources. This is supported by research that showed that women who ate more plant protein reduced their risk of ovulatory infertility by 50%. Some examples of plant-based protein sources are beans, lentils, chickpeas, tofu, and nuts and seeds.
Regarding vitamin D, more positive pregnancy tests, pregnancies and births were associated with sufficient vitamin D levels in the body. Many people are at risk of vitamin D deficiency, so it is important to incorporate it in the diet by eating foods such as oily fish, egg yolks and products fortified with vitamin D. A supplement may be suggested if you are at particular risk of vitamin D deficiency.
Iron deficiency is another common deficiency that can lead to fertility problems. There is an increased risk for women of reproductive age as iron is lost during menstruation. Women should try to eat plenty of non-haem iron, such as grains, legumes, dried fruit, tofu, and nuts.
Finally, for zinc and folate, an adequate intake can have numerous benefits. Folate deficiency can increase the risk of neural tube defects in women, therefore, for women trying to conceive, a supplement of 400mcg of folic acid is recommended. Zinc plays an important role in hormone balance and ovulation, some good sources include beans, wholegrains, oysters, lean red meat, and seeds and nuts [1].
Nutrition in Pregnancy
Nutrition for pregnancy follows general guidelines for a healthy, balanced diet. You should aim to eat a variety of foods from each food group and drink plenty of water. There is a lot of misinformation surrounding “eating for two” during pregnancy, as even though energy requirements increase during the third trimester by around 200 kcal, your energy requirements stay similar to those pre-pregnancy during the first and second trimester. However, it is important to make sure you are not losing weight during pregnancy and if you have any concerns about your weight to consult with your doctor. If you need to eat more, try to incorporate more protein and wholegrain carbohydrates into your diet.
It is also important to consider how much caffeine and vitamin A you’re consuming when pregnant. It is advised to have no more than 200mg of caffeine a day. This is equivalent to around three cups of tea or two mugs of instant coffee daily. Caffeine can also be found in chocolate, energy drinks and fizzy drinks. Vitamin A can cause harm to a foetus therefore it is essential that you check any multivitamins that you normally take for vitamin A, often in the form of retinol.
In terms of supplements whilst pregnant, it may be a good idea to take folic acid and vitamin D. Folic acid can reduce the risk of neural tube defects developing in your baby. The recommended supplement dose of folic acid is 400 mcg a day, until 12 weeks of pregnancy. Vitamin D is important in preventing rickets in your baby as it helps with calcium absorption and to promote bone health. The recommended supplement dose of vitamin D is 10 micrograms, but you may need more if you’re at risk of vitamin D deficiency.
Vegans or vegetarians may be at risk of iodine deficiency as most sources of iodine are from animals. An iodine supplement may be recommended in this case [2].
Post-pregnancy Nutrition
For post-pregnancy nutrition, eating well should be a priority. A healthy, balanced diet can improve mood and help to lose any excess weight you have gained during pregnancy. You might want to try cooking in bulk; trying frozen or tinned vegetables which are quick to prepare; and finding healthy snacks that don’t need to be cooked, to promote healthy whilst caring for a new baby.
If you choose to breastfeed ensure that you are drinking plenty of fluids, eating a varied diet and getting plenty of rest. A vitamin D supplement is also recommended when breastfeeding, and you should continue to limit your caffeine intake to 200mg a day [3,4].
Menopausal Nutrition
The menopause is the time when a woman’s periods stop, and they are no longer able to get pregnant. This usually occurs between the ages of 45-55. Muscle mass declines during the menopause, meaning that you may not need as many calories as you think. Ensure that you are eating a healthy, balanced diet and incorporate physical activity into your routine to prevent weight gain.
Osteoporosis can also become a problem when we reach menopausal age. This is because as we age, we slowly lose calcium from our bones. Try to incorporate two or three portions of calcium-rich foods into your diet everyday to decrease the risk of developing osteoporosis. Some good sources of calcium include a matchbox size piece of cheese; a small yoghurt; 2 large slices of wholemeal bread; 100g boiled kale; 1 medium orange; 100g of tofu; 100ml cow’s milk; and 100ml calcium-fortified plant-based dairy alternative. Vitamin D is also important for bone health, so a supplement may be a good idea at this age.
Finally, it is important to promote good heart health at menopausal age, this is because menopause can increase the risk of developing heart disease. A heart healthy diet can be used to combat this. For example, try switching from saturated fats to unsaturated fats; eat plenty of seeds, nuts, and legumes during the week; reduce your intake of refined sugars and salt; eat two portions of fish per week; swap to wholegrain carbohydrate sources; and incorporate beans and pulses into your diet [5,6].
Nutrition for Over 65’s
You may think that you need to eat less at an older age due to inactivity but the decrease in energy requirements is only minimal, meaning it’s important to eat well at all ages. A healthy, balanced diet is recommended for women over 65 but there are several considerations that need to be made for nutrition for over 65’s.
Reduced appetite is a problem that may arise as you age but there are some techniques you can implement to ensure that you are meeting your nutrient requirements. Try making your regular meals and snacks with more calorific alternatives, such as by using full fat milk, eating crackers with cheese and butter, and eating full fat yoghurt. You should also try to make sure you are eating three small meals a day, with three small snacks alongside.
Protein is also a concern for women over 65. Muscle mass decreases with age but ensuring that you eat plenty of protein at each meal can prevent excess muscle loss. Some good protein sources are fish, eggs, lean meat, beans, lentils, chickpeas, tofu, and nuts. You should aim to eat around 25g of protein at each meal.
Similarly, to menopausal age, calcium and vitamin D are important for bone health in women over 65. Vitamin D supplements can be taken at this age, as well as including sources of vitamin D in the diet, such as oily fish, cod liver oil, egg yolk and fortified breakfast cereals. Vitamin D can improve the absorption of calcium into bones and teeth to prevent rickets, falls and to improve muscle strength.
Finally, vitamin B is an important micronutrient for women over 65. It promotes the health of red blood cells, metabolism, healthy skin, good vision, and reduces tiredness. Some good sources of vitamin B are green vegetables; fortified grains; fortified cereals; poultry; fish; vegetables; milk; eggs; and fortified dairy alternatives [7].
Summary
There are a number of significant periods in a woman’s life where nutrition can support changes that are occurring. Nutrition can be used to promote beneficial change such as managing weight change, managing symptoms and reducing the risk of associated health conditions.
If you are looking for support with your nutrition and diet, please contact me at caroline@carolinehillnutrition so we discuss how I can help you.
References
[1] https://www.bda.uk.com/resource/a-clinical-update-on-diet-and-fertility.html
[2] https://www.bda.uk.com/resource/pregnancy-diet.html
[3] https://www.nhs.uk/conditions/baby/support-and-services/keeping-fit-and-healthy-with-a-baby/
[5] https://www.bda.uk.com/resource/menopause-diet.html
[6] https://www.bda.uk.com/resourceDetail/printPdf/?resource=calcium
Caroline Hill is a specialist menopause dietitian supporting women making dietary change. Caroline uses her extensive knowledge, skills and expertise of food and nutrition to help women manage their symptoms and weight during menopause. Caroline believes in providing sustainable, individualised, evidence-based advice to women making dietary change.