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Omega-3, pregnancy and preterm birth

Omega-3, pregnancy and preterm birth

Preterm birth (birth before 37 weeks gestation) is leading cause of neonatal mortality. Infants born preterm generally require care in neonatal intensive care, and can have an increased risk of a number of potentially serious complications such as cerebral palsy, respiratory distress syndrome, intraventricular haemorrhage, necrotising enterocolitis and blindness. Preterm birth cannot be easily predicted, however we can do everything in our power to prevent it.

Nutritional status during and prior to pregnancy is an important determinant of fetal health through pregnancy. Observations of populations with higher fish consumption found increased lengths in gestation. So what does fish have that potentially decreases risk of preterm birth? Fish is high in an essential fatty acid, omega-3. Omega-3 is hard to come by in any other food source, so our friends in the sea are one of the only places we can find it. There are a few omega-3’s:

  • Eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and docosapentaenoic acid (DPA): found almost exclusively in oily fish and seafood.
  • A-linoleic acid (ALA): found in some nuts, linseed and canola oil, legumes and small amounts in leafy greens. ALA is generally inactive until converted to EPA and DHA, of which it only converts very small amounts.

Omega-3’s, specifically EPA and DHA play key roles in the development of the fetus, modulating inflammation and the synthesises of prostaglandins. Prostaglandins are substances that play a role in blood flow, the induction of labour and gestational length through reducing the inflammatory pathway which is linked to spontaneous preterm birth. During labour omega-3’s play a crucial role in the inflammatory cascade, blood flow and cervical ripening.

In fetal development, omega-3’s have been shown to impact the fetal brain, retina and respiratory system. Higher near-birth DHA levels in the fetus are associated with increases in brain volume that correlate with increased language and motor scores in preschool age children. Supplementation during pregnancy reduces the incidence of asthma and improves heart rate variability, with low levels of omega-3 through childhood being postulated to be a risk factor for autism spectrum disorder.

So how do I get omega 3?

  • Intake of fatty fish – especially sustainably wild sourced and of a good quality.
  • Supplement a good quality fish oil, that is rich in DHA. Poor quality fish oils can be contaminated with heavy metals, come from low quality processing facilities and may even be rancid. Quality is everything with omega-3 supplementation.
  • Some omega-3 can be from a marine algal source, which can also be excellent – just ensure that this is a high EPA/DHA marine algae.

How much do I take?

There have been a lot of studies on supplementation in pregnant women with doses of 750-1000mg/day shown to be safe and effective.

Although there are studies on omega-3 and fish oil supplements being safe and effective for most pregnant women, always consult with your healthcare professional before starting any new supplements. There can never be a guarantee that any one supplement will prevent preterm birth for your specific situation. There is no one size fits all approach to pregnancy care, always have a team of professionals assessing your nutrition, supplements and lifestyle.

Further reading:

  1. Olsen SF, Halldorsson TI, Thorne-Lyman AL, Strøm M, Gørtz S, Granstrøm C, et. al, Plasma  Concentrations of Long Chain N-3 Fatty Acids in Early and Mid-Pregnancy and Risk of Early Preterm Birth, 2018, eBioMedicine, 2018 Sep 01, 35(2018);325-333, DOI:https://doi.org/10.1016/j.ebiom.2018.07.009.
  2. Lizewska B,  Teul J,  Kuc P, Lemancewicz A, Charkiewicz A, Goscik J, et al., Maternal Plasma Metabolomic Profiles in Spontaneous Preterm Birth: Preliminary Results, Mediators of inflammation, 2018; 1-13, https://doi.org/10.1155/2018/936282
  3. Makrides M, Best K: Docosahexaenoic Acid and Preterm Birth. Ann Nutr Metab, 2016 Nov 01, 69(suppl 1);29-34. https://doi.org/10.1159/000448263
  4. Ramakrishnan U, Stein AD, Parra-Cabrera S, et al. Effects of Docosahexaenoic Acid Supplementation During Pregnancy on Gestational Age and Size at Birth: Randomized, Double-Blind, Placebo-Controlled Trial in Mexico. Food and Nutrition Bulletin. 2010;31(2_suppl2):S108-S116. doi:10.1177/15648265100312S203
  5. National Health and Medical Research Council, Australian Government Department of Health and Ageing, New Zealand Ministry of Health. Nutrient Reference Values for Australia and New Zealand. Canberra: 2006 National Health and Medical Research Council; (cited 2021 April 4); 31p. Available from: https://www.nhmrc.gov.au/health-advice/nutrition
  6. Imhoff‐Kunsch B, Briggs V, Goldenberg T, Ramakrishnan U, Effect of n‐3 Long‐chain Polyunsaturated Fatty Acid Intake during Pregnancy on Maternal, Infant, and Child Health Outcomes: A Systematic Review. Paediatric and Perinatal Epidemiology, 2012(26); 91-107. https://doi.org/10.1111/j.1365-3016.2012.01292.x
  7. Makrides M, Gibson RA, McPhee AJ, et al. Effect of DHA Supplementation During Pregnancy on Maternal Depression and Neurodevelopment of Young Children: A Randomized Controlled Trial. JAMA. 2010;304(15):1675–1683. doi:10.1001/jama.2010.1507
  8. Carlson SE, Gajewski BJ, Valentine CJ et al. Assessment of DHA on reducing early preterm birth: the ADORE randomized controlled trial protocol. BMC Pregnancy Childbirth 2017, 17(62):1-16, https://doi.org/10.1186/s12884-017-1244-5
  9. Kamino D, Studholme C, Liu M, Chau V, Miller SP, Synnes A, et al., Postnatal polyunsaturated fatty acids associated with larger preterm brain tissue volumes and better outcomes. Pediatr Res. 2018 Jan;83(1-1):93-101. doi: 10.1038/pr.2017.230.
  10. Carlson SE, Colombo J, Gajewski BJ, Gustafson KM, Mundy D, Yeast J, et al., DHA supplementation and pregnancy outcomes, The American Journal of Clinical Nutrition, 2013 Apr; 97(4):808–815, https://doi.org/10.3945/ajcn.112.050021
  11. Olsen SF, Secher NJ, Tabor A, Weber T, Walker JJ, Gluud C. Randomised clinical trials of fish oil supplementation in high risk pregnancies. Fish Oil Trials In Pregnancy (FOTIP) Team. BJOG. 2000 Mar;107(3):382-95. doi: 10.1111/j.1471-0528.2000.tb13235.x. PMID: 10740336.
  12. Oken E, Kleinman KP, Olsen SF, Rich-Edwards JW, Gillman MW, Associations of Seafood and Elongated n-3 Fatty Acid Intake with Fetal Growth and Length of Gestation: Results from a US Pregnancy Cohort, American Journal of Epidemiology, 2004 Oct 15;160(8):774–783, https://doi.org/10.1093/aje/kwh282
  13. Harper M, Thom E, Klebanoff MA, Thorp J Jr, Sorokin Y, Varner MW, National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Omega-3 fatty acid supplementation to prevent recurrent preterm birth: a randomized controlled trial. Obstet Gynecol. 2010 Feb;115(2 Pt 1):234-242. doi: 10.1097/AOG.0b013e3181cbd60e
  14. Middleton  P, Gomersall  JC, Gould  JF, Shepherd  E, Olsen  SF, Makrides  M. Omega‐3 fatty acid addition during pregnancy. Cochrane Database of Systematic Reviews 2018, Issue 11. DOI: 10.1002/14651858.CD003402.pub3.
  15. Ahmed S, Middleton P, Gomersall JC, Gould JF, Shepherd E, Olsen SF, Makrides M. Omega-3 fatty acid addition during pregnancy. Cochrane Database Syst Rev. 2018 Nov 15;11(11):CD003402. doi: 10.1002/14651858.CD003402.
  16. Leventakou V, Roumeliotaki T, Martinez D, Barros H, Brantsaeter A-L, Casas M, et al., Fish intake during pregnancy, fetal growth, and gestational length in 19 European birth cohort studies, The American Journal of Clinical Nutrition, 2014 Mar, 99(3):506–516, https://doi.org/10.3945/ajcn.113.067421

Collagen: Is it really going to make me beautiful?

Everyone seems to be taking a collagen supplement, but do they work?  Is it the miracle cure-all for aging we have been looking for?  Collagen is the primary protein in skin connective tissue, acting like a scaffold to hold tissues in place.  So sure, it’s important, but eating more brains doesn’t make us just have more brain in our skull, so does eating more collagen automatically make our skin structurally better?

Skin is the largest organ in the human body.  We can sometimes think skin is simply a superficial layer to keep us looking beautiful, but it has a lot more important functions than that: skin has a sensory role, it provides a physical barrier against environmental factors, vitamin D is synthesis happens in the skin, absorption of topical applications, as well as playing a role in regulating body temperature. 

Collagen isn’t just for beauty, collagen-derived peptides control lots of functions in our cells – such as cell shape, differentiation (differentiation is when cells change from one type to another) and synthesis of proteins throughout the body.

Skin

One study with supplementation of 50ml of collagen a day for 60 days showed noticeable reduction in skin dryness, wrinkles and nasolabial fold depth. In addition, a significant increase in collagen density and skin firmness was observed after just 12 weeks. The data from this study suggests that collagen can counteract some of the signs of natural ageing.  Another study with 10g supplementation over 6 weeks had improvements in skin hydration, decreased formation of deep wrinkles and improved skin elasticity. This study noted that the anti-aging effect was more obvious in women aged more than 30 years.

As well as providing improved structural integrity of the skin, hydrolysed collagen has been found to enhance the activity of antioxidants in the body, which in themselves act as anti-aging molecules by reducing free radical damage. 

Other cool points that are beyond superficial anti-aging:

  • Osteoarthritis: Studies show that collagen supplementation reduces pain in patients suffering from osteoarthritis, due to its role in cartilage matrix synthesis.
  • Wound healing: Collagen has been shown to accelerates wound healing.
  • Brain function: Hydrolysed collagen has the ability to cross the blood brain barrier, and promote neurogenesis
  • Type 2 diabetes: A study showed that over a 3 month period, collagen supplementation had a significant reduction in fasting blood glucose and HbA1C, as well as improved insulin sensitivity.
  • Bone mineral density: Collagen supplementation was shown in one study to increase bone mineral density in post-menopausal women with primary, age-related reduction of bone mineral density. Additionally, supplementation was associated with a favourable shift in bone markers, indicating increased bone formation and reduced bone degradation.
  • Skin tear: One study looked at elderly populations prone to skin tears and found improvement over an 8 week period in the skin elasticity.

Read the label

The most common sources of collagen production are bovine hide, bone, fish and pigskin. This means our vegan and vego friends (or those who find this information gross) need to carefully read the labels.

The lower molecular weight hydrolysed collagen have been shown to have better results in studies on skin aging and appearance.  Hydrolysed collagen has smaller molecules and has been found to cross the gastrointestinal wall easier better than earlier collagen supplements.

Beauty begins in the gut

For collagen to be able to be active in the skin and provide it’s benefits, we need to be able to absorb it, meaning it needs to cross through the intestines and reach blood circulation.  If you experience issues with digestion (bloating, gas, IBS, constipation, diarrhoea etc.) you may not be getting all the benefits of collagen (or from really any supplements).  If you want the benefits, try working on your digestion with a naturopath. 

My take on collagen

As we age, our skin is bombarded with sun damage, varying diets and nutrients (or lack of nutrients), hormones, chemicals and just the regular decline in our body’s ability to repair with normal ageing.  Studies on nutrition and skin appearance are everywhere, with diets higher in vitamin C and linoleic acid and lower intakes of carbohydrates and fats showing improvements in skin appearance (wrinkled appearance, senile dryness and skin atrophy).

Eating a better diet overall has a more significant effect than any supplement or topical application.  Fill your plate with antioxidant colourful vegetables, drink more water and wear sunscreen to see the biggest improvements in anti-ageing outcomes. Even more important for me is knowing that ageing is a natural part of our life, with wrinkles and spots not making us less beautiful.

If you are interested in reading where any of this info came from, here are the super interesting studies I found the info at.

Benadiba, M., Serruya, R. & Maor, Y (2018). Bioaccessibility of Shore Magic® collagen, a low-molecular-weight collagen supplement, in different in vitro barrier models. Heliyon, 4(9), https://doi.org/10.1016/j.heliyon.2018.e00821

Borumand, M., & Sibilla, S. (2014). Daily consumption of the collagen supplement Pure Gold Collagen® reduces visible signs of aging, Clinical Interventions in Aging, 2014(9), 1747–1758. https://doi.org/10.2147/CIA.S65939

Borumand, M., & Sibilla, S. (2015). Effects of a nutritional supplement containing collagen peptides on skin elasticity, hydration and wrinkles. J Med Nutr Nutraceut, 4(1), 47-53. https://doi.org/10.4103/2278-019X.146161

Miyab, K.B., Alipoor, E., Vaghardoost, R., Isfeedvajani, M.S., Yaseri, M., Djafarian, K., Hosseinzadeh-Attar, M.J. (2020). The effect of a hydrolyzed collagen-based supplement on wound healing in patients with burn: A randomized double-blind pilot clinical trial, Burns, 46(1), 156-163. https://doi.org/10.1016/j.burns.2019.02.015

König, D., Oesser, S., Scharla, S., Zdzieblik, D., & Gollhofer, A. (2018) Specific Collagen Peptides Improve Bone Mineral Density and Bone Markers in Postmenopausal Women—A Randomized Controlled Study, Nutrients, 10(97), 1-11. https://doi.org/10.3390/nu10010097

Hongdong, S. & Bo, Li. (2017). Beneficial Effects of Collagen Hydrolysate: A Review on Recent Developments, Biomed J Sci & Tech Res, 1(2), 1-4. https://doi.org/10.26717/BJSTR.2017.01.000217

Tatsuya, N. & Shinji, I. (2020). Effect of an Oral Nutrition Supplement Containing Collagen Peptides on Stratum Corneum Hydration and Skin Elasticity in Hospitalized Older Adults: A Multicenter Open-label Randomized Controlled Study, Advances in Skin & Wound Care, 33(4) 186-191. https://doi.org/10.1097/01.ASW.0000655492.40898.55

How stress affects your hormones

Stress and fertility

Is stress contributing to your infertility and hormonal problems?

The short answer is that if stress is a major factor in your life, it is most likely having an effect on your hormones.

Our body adapts to stress very quickly, adaptability is what has ensured human survival. However long-term adaptation to stress tells our monkey brain “hey, it’s not a good time to reproduce, I’m too busy running away from a woolly mammoth” (were we alive at the same time as woolly mammoths?  Look, I’m a naturopath, not a historypath).  This “quick, run from the mammoth” is called the fight or flight response. Our body is meant to be in fight or flight for short periods of time, however modern day stress has us in this state more frequently than we are programmed for.  When we are constantly in fight or flight instead of rest and digest, our body increases stress hormones that block hormonal release from our reproductive system.

Stress is more than just long days and deadlines to meet at work.  Over-training at the gym, under-nutrition, chronic illness, and psychological stress all contribute to hormonal dysfunction and infertility.  We are constantly challenged with stressors in daily life from big things like the death of a family member, a relationship break up, not being able to cover rent, living through a pandemic (hello 2020), to smaller issues like being caught in traffic or queueing in line for too long.  Our bodies cannot tell the difference between physical and psychological stress and the stress hormone release (adrenaline and cortisol) is the same for a break-up as it is for a run from a lion.

How does it work?

The hypothalamic-pituitary-adrenal (HPA) axis (how our brain and adrenal glands talk) directly inhibits the hypothalamic-pituitary-ovarian (HPO) axis (how our brain and ovaries talk to each other).  So basically when we are stressed our body pumps out excess stress hormone, and this inhibits our reproductive hormones.  Long-term stress suppresses luteinizing hormone (LH) release from the brain.  LH is the trigger that releases the egg from the ovaries during ovulation.  When LH is suppressed, ovulation is thrown out of whack, or sometimes doesn’t happen at all.

Everyone’s response to stress is different, depending on the type and duration of stress, personality type, stress coping mechanisms and their genetics (even depending on how stressed your parents where while you were in the womb can affect your HPA axis!).  Ovulation, sexual behaviour and embryo implantation are the areas most effected by stress.

Acute stress is a stress that only lasts a few hours, but if this carries on for months, even at low levels, it’s called chronic stress.  Acute stress impairs reproduction if it happens during critical times in the menstrual/ovulatory cycles, whereas chronic stress impairs reproduction in general. 

Chronic stress can progressively lead to decreased lean muscle mass, decreased wound healing, increased visceral fat (the bad fat around your organs) and insulin resistance.  There is a big link between chronic stress and PCOS due to the insulin resistance, anovulatory cycles and increased body mass.

What you can do to reduce stress, and normalise reproductive hormones:

  • Nutrition – Eat healthy, high fibre, balanced meals and avoid processed, high sugar foods.
  • Avoid stimulants – Coffee and energy drinks will automatically increase your cortisol.
  • Sleep – Aim for at least 7 hours a day to reduce stress and ensure adequate rest.  Hormones are released during sleep that help our body to repair and recover.
  • Exercise – Exercise moderately at least 5 days a week, for half an hour a day.  Alternate exercise types and challenge your body.
  • Deep breathing – This is my favourite, breath in for 5 seconds, imagining a balloon inflating under your diaphragm, and then out for 10 seconds.  Repeat this whenever you are feeling stressed, or at least twice a day for 2 minutes. This actively brings your body out of fight or flight and into rest and digest.
  • Grounding – Basically this involves taking your shoes off, walking in nature and letting our feet touch real soil/grass (it surprisingly doesn’t happen much unless you take the time to connect with nature and the earth in this way).
  • Speak to a professional – This one is close to my heart.  Please don’t bottle up your feelings, and let them swish around in your head and fill it up, call Lifeline 24 hours a day on 131114.
  • Bring joy into your life – do one thing before lunch every day that you actually enjoy.  Write a list of things you enjoy and do them!  Here are some things on my list: gardening, face-masks (the pampering type), yoga, reading, patting my cat, kissing my baby, phone free time talking to my fiancé over breakfast.
  • Herbal medicines that help you adapt to stress such as Withania, Schisandra and Rehmannia
  • Calming herbal tea, baths, aromatherapy with essential oils such as lavender, meditation, journalling… Find the things that specifically calm you, and incorporate them into your life.

This study was the basis for much of my research, click here for further science-y talk on the topic

Click here to book in with me for help on your fertility journey.

Who am I?

I am here on my laptop while my 10 month old is eating a tiny piece of old cheese she found under the fridge. I guess that’s what being an adult is all about: deciding that your baby can eat cheese scraps while you try to learn how to use WordPress. Just like my mother did for me, and my grandmother did for her.

Before I get into a multi-generation lecture on eating old cheese, here is a little about me and why I choose naturopathy for my health and career (to heal my gut from years of old cheese scraps?).

I was raised in a huge, old Queenslander in Toowoomba, with an abundant vegetable garden and a flock of happy chickens. My parents were health-conscious and made sure we ate a varied diet. My mum was a nurse and homebirth midwife, and utilised both her background in conventional medicine, and natural medicine to grow and heal us.

In my teen years I got my first job and money… and access to Red Rooster. My late teens consisted of alcohol, partying and late nights, followed by early mornings and long days at my managerial job in retail. And so the spiral went. Lack of sleep and poor nutrition was having an affect on me I wasn’t yet aware of. Through my 20s my skin was breaking out,  I became overweight and was frequently sick. I had dandruff, a huge list of gastrointestinal complaints and periods that were unbearably painful. At 22 I got Ross River Fever, and could barely get out of bed. My health was spiralling.

I had been going to so many doctors, but no one seemed to be able to get to the root cause of why I was so fatigued, depressed, overweight, with skin that just would not quit (not in a good way).

At 26 years old, I was at the end of my tether when a good friend recommended I went to see her Naturopath. They took a super thorough health history and connected the dots of diet, lifestyle and my previous health complaints. Here she created a super simple, wholefoods diet plan, and prescribed a herbal formula.

This naturopath changed my life. I cannot overstate how much of an impact this amazing woman had on me. My skin cleared up, my energy returned, and I was feeling radiant for the first time in years. I ranted about my naturopath to anyone that would listen. Within a year I was at Endeavour College to study a naturopathy degree so I could help people in the same way she helped me. 

What I’ve learned in the subsequent 7 years of study was the huge range of ways naturopathy can be life changing, and how treating the root cause of an issue is the only way to resolve it. Just giving paracetamol for period pain doesn’t solve the reason why the pain is there, and treating the underlying hormonal dysregulation is the long-term solution.

One of the foundations of naturopathy is “Doctor as teacher”, meaning that I don’t just hand my clients a herbal and dietary prescription, I teach them why their health is disrupted, exactly how to get back on a path to health, and why these herbs will help them. Most importantly, how to achieve real change and not be on a prescription forever.

This brings me to the present day, a fruitful, happy life lived with intention and meaning, with a real excitement to help others.