Franziska Haydanek: Like there's no one single food that's going to make or break your ability to get pregnant. It's patterns over time and nervous system support and so many other factors that go into it that where just adding something in is not going to be that like magic solution. Welcome back to I Did My Own Research. I'm Dr. Fran, and today I'm joined by Dr. Jessica Monroe. Dr. Monroe attended the University of New Hampshire for her both her undergraduate degree in nutrition as well as her master's degree in nutritional biochemistry. She then earned her PhD in nutrition at the University of Rhode Island, as well as completing her dietitian internship there. She now posts online at the prenatal RD where she discusses how nutrition and fertility intersect. Dr. Monroe, thank you for being here. Thank you, Dr. Fran. I'm so honored. I have loved following you because as I think most doctors should acknowledge we are not experts in nutrition and the food that we put into our body makes a big difference in how our body functions. And especially obviously as an OBGYN, I'm very interested in how nutrition can impact my patients, both when it comes to their fertility as well as supporting them through pregnancy and after. I think there's a lot to be learned outside of pregnancy, of course, as well. But for you, your job really focuses on really pregnancy and all parts of that. I'd love for you to share just a little bit about your educational background. How did you get into this? What was your interest in nutrition? And then how did you kind of like get into where what you're doing now? Sure. First of all, thank you for having me. And you are you've always been such a champion and a cheerleader for dietitians. And so I just adore you so much. I love all my RDs. I love you guys. And we love you back. So I fell in love with nutrition in my undergrad and I decided to I declared it as my major and basically made it my entire personality. And then I stayed on to get my master's degree and I fell in love with teaching. I had the opportunity to be a teaching assistant. And so then I decided to stay on and get my doctorate thinking I was gonna go into academia. And I got some exposure to clinical while getting my doctorate and was like, Well, I don't ⁓ I'm not gonna close the door on that either and therefore followed through with a dietetic internship. And I love my favorite rotation was with WIC, Women, Infants and Children. And it was only a week long, but I was like this is my calling. I want to do this. And I was so fortunate after my dietetic internship that my first job was working as an RD in a gynecologist's office. So my first exposure to working with patients was a full focus on women's health. And I saw the whole gauntlet of teenagers who were just starting to get their periods all the way up through postmenopausal women who were like, What happened? I need help. And my favorite patients were the ones coming in with PCOS and the ones who were trying to get pregnant and my pregnant patients. And so then I decided to open my private practice and focus solely on those patients. So that's incredible. I am so fortunate that I have a registered dietitian who works in my office. And let me tell you, when I started this job, no one told me that this was a perk of my job that I was signing up for and I got there and I was like, Pardon me, there's someone who sits 10 feet down from me and I can send all my patients to her and offer the thing that we all complain about in the American healthcare system that we don't do a good job about, but I can offer that to my patient. I like it is such a gift. And if anyone here listening has the ability to bring in a registered dietitian into your office in one way or another, please find the funding to do so. It is life changing. I a bias take because I am a registered dietitian, but I love when my doctors have registered dietitian in the office. I mean I served as that role and I not only were the patients so grateful, but the doctors, the nurses, everyone was like, we have someone for that. Let me introduce you to our dietitian. And I was able to fill a gap that not a lot of offices have. And so I fully stand with you that every doctor's office should have a registered dietitian in office. It's so useful. It is so nice to have, especially because there's like another option that I can offer my patients, right? Especially when it comes to like PCOS. Especially online, I see a lot of patients be very upset that they're offered one thing and one thing only. Here's your birth control pills. And then if you need to get pregnant, I'll give you some lechazol. And it's not a fully comprehensive offering of all the options. And for me, that conversation always starts with lifestyle changes. And I say, I can have you see my registered dietitian and she will look for opportunities in your day to day nutrition about how to optimize things to get fit whatever goal it is that we have with your PCOS. And like, what a gift to my patients to. For me to be able to offer that because like I know many can't. And I think many p patients, like you said, are appreciative that they even have the option to see an expert and review and like personalize their plan for themselves. So I just again shout out to all the RDs. Love you guys so much. It's really like nutrition is at the core of so many things. And with conditions like PCOS or even endometriosis, nutrition can play such a cohesive role in managing those conditions. I'm fully here for it. Yeah, and I love that. I want to talk a little bit about how what your day to day looks like with patients then. When patients come in or they work with you, I assume they come in with some kind of goal in mind and you work towards that. What is like the like what's an appointment with a registered dietitian look like? I love that. So I was when I first opened my private practice, I was in person. I had my own cute little office and everything was hunky dory and then COVID hit and I went just one hundred percent virtual. So it's really like this. We're just having a conversation. My initial appointments with patients or clients are is over an hour. And we cover everything from what they eat in a day, work days versus weekend days, how they're sleeping, how they're exercising. And we cover really like the nitty-gritty details that they don't really get an opportunity to do in other appointments. And from there we make small goals based on whatever their overarching goal is. Like if they've been struggling to get pregnant, we're looking at patterns of where we can make additions to what they're already eating to try and enhance whatever's happening. And so it's it's really detail oriented in their everyday habits. And I'm not trying to make drastic overhauling changes with people because that's not sustainable. And so I always try and figure out how we can enhance what you're already doing so it can be just become part of that day to day. Yeah. I love that two things about that. One that you're a lot of it is how do we add things rather than how do we take away. I think that's very helpful language because it feels better. Like I get to add something that's going to benefit me versus I'm restricting this thing that I enjoy previously. So I think that's a wonderful way to think about it. And two, I also really like the that you've always been very that's stable is not the right word, but very just understanding that like extreme does not do well. Except for online. Extreme online does great, but extreme in real life when treating patients is not typically the best way to go. So to say like you should never ever have pasta again, you should never have a n a glass of wine ever again, right? That is not sustainable. And like Understanding that humans are humans and we like some things that okay are ⁓ maybe not for the best of my health, but are good for me to be happy. And it brings you joy and joy is important. I think it's really important to talk about that. But it it does kind of bring me to the point of like the extremeness does do well online. And I think we both have seen a lot of that online when people come to like get to the place of making content around fertility and nutrition. And I've seen a lot of things about saying like you should absolutely never have another cheeseburger again. Absolutely always eat, I don't know, a Brazil nut every single day. Are you seeing those kind of things too? ⁓ a hundred percent. And it's probably my feed, but like I'm getting fed all that based on fertility all of the time. And I just a lot of it I just have to like scroll or turn the app off because I get fired up about it. And if I were to try and call out everything that I saw that I would become my full-time job. The fertility space I think is it's rampant with that because it's such a vulnerable place to be. These people want to get pregnant more than anything and especially if they've been struggling for a while, they're like looking for that magical thing that's gonna change their scenario. And that's just that's not how fertility works. And especially when you take it to extremes, that can borderline on disordered eating or orthorexia and then you're just causing more problems that compound after that. And so yeah, the extremes get me fired up. I think the other problem when it comes to like fertility is that many people who have gone through infertility things now themselves feel because like maybe they did change something in their diet that they now themselves are experts and maybe they got like an online nutrition certificate and now they can market themselves as a prenatal nutritionist. And that sounds fancy and educated, and the reality is, and I've had several other registered dietitians on to explain that. Registered dietitian actually means something. You went through very vigorous training and a cer like you get a certificate, your is it board a board certification? It's not considered I mean it's it's nationally recognized. It's not can it's not necessarily called board certified, but it is a national board. Yes, it means something versus a nutritionist can be anyone, but because many people ⁓ everyone eats every single day and has to eat food, and maybe someone did make some great changes in their own life that did benefit them. when it comes came to their own fertility. Now they feel they are experts in fertility because they themselves figured it out for them or own body. And I think it really pries on people's vulnerabilities when it comes to infertility because the that patient population of I would say, at least in the field that I obviously work in, is so vulnerable. They just wish it would work and they will do anything to make that happen. And people online see that and they take advantage. ⁓ yeah. They're preying on that. And that's where it's It's so disheartening to see people taking advantage of that. And you wanna have faith that like they wanna help people, but are you really helping people or are you just doing like if you really wanted to help people you take the appropriate avenue to get the degree and the certification and it's that three to six month nutrition course online and they can call themselves nutritionists because that's not a protected term. Whereas I had Ten years of education before I even sat down with my first patient. So there's a big difference in understanding. And it's also like the more you learn, the more you realize what you don't know. And so you you have almost like a humility or a humbleness about you where these other people just don't. The audacity to think that they can just come in and start helping people with like medical conditions is just mind blowing. I I think some people maybe mean well and don't realize how destructive destructive they are when they do these things. And I think some people just see this as a money making scheme to ⁓ get money from people and I think that's really sad. Speaking though of your education, I was talking Dr. Clatt a couple of weeks ago and he was talking about how nutrition research is actually really difficult to do. And that the it's really hard because every you can't just make people not eat. And it's really hard to determine like what works, what doesn't, and how do you restrict people from eating certain th you know, nutrition and research is difficult. When it comes to the research on fertility and nutrition, do we have anything where we can say like, yes, these are changes that you can make that are evidence based? There are. It's really all very nuanced still though, because of I there's so many factors that go into someone's individual fertility. I know I'm preaching the choir with you here, but like the the individuality when it comes to fertility is, I mean, it's based on your anatomy, your nutrition habits, lifestyle, sleep quality, egg quality, sperm quality. Like it's not even just you, it's you and your partner. And so when you factor in nutrition where there are preferences and allergies and cultural aspects. It's hard to say like black and white, yes, this is something that you should do versus maybe something you don't necessarily have to do. One example I'm thinking of is incorporating seafood. Seafood has very strong research of supporting fertility outcomes. A lot of the research we have are in couples who are undergoing IVF. And so it's that subset population who are struggling to get pregnant, and so they're pursuing this avenue. And it show a seafood has been shown to shorten your time to pregnancy and to improve pregnancy outcomes. Of course, there's gonna be people like, I don't like seafood or I'm allergic to seafood. And so it's not like if you don't eat seafood, you're gonna struggle and not be able to see these positive outcomes either. So it's and even with nutrition research, it it's a lot of it is reliant on self reporting because you're not gonna be like hovering over someone seeing like, What are you eating? and how much of that did you have? And Estimating portion sizes and so there's a lot of, like I said, nuance to it. And it's going back to those extremes, nothing is black and white with nutrition. You just you there the blanketed statements of you need to cut hell gluten or you need to stop having dairy. And it's just like that doesn't apply to every single person. That is really and like, you know, if the condition that you n if someone has a known condition. PCOS versus endometriosis are gonna be two different recommendations for people to follow. And like, you know, obviously I have done a lot of like deep dives on PCOS and like I want to offer like advice when it comes to lifestyle management. Like, like, do we change to a low inflammatory diet? Do you do no gluten? Those kind of things. And it's just unfortunate in some ways that I almost wish it was easier. I almost wish it was that I could just say, just do the Mediterranean diet. This decreases your time to pregnancy by three months. Like just eat some tomatoes and feta and you're good to go. I'm I yeah, I wish. That sounds great. I think that's so hard for people to understand, right? That us as clinicians, dietitians, that it's not so easy. But the internet has made it seem like it's so easy. Just do this thing and then that's that. And then in reality it's not just that. Yeah. And that's where I think the extremes come back into play where if y it's being marketed to you as this like quick fix, this easy addition and you're gonna be good to go. Like I saw something a couple of weeks ago that was like, have your partner eat beets and you'll be able to like he'll be able to get you pregnant. And I was like, what that's not it doesn't work that way. Like there's no one single food that's going to make or break your ability to get pregnant. It's over it patterns over time and nervous system support and so many other factors that go into it that where just adding something in is not going to be that like magic solution. I will say I do appreciate that people are at least having the conversations more that male factor is very important when it comes to the infertility of a couple. And I tell my patients this all the time and they're a little surprised by it. ⁓ That I'll say, you know, if we've reached that definition of infertility, a third of the time it's female factor, a third of the time it's male factor, and a third of the time it's both or neither. And so that really means half the time it's the dudes that we need to be looking at. Right. So the dudes need to participate. And first of all, it's not fair that actually that the dudes can so easily participate by giving us one singular sample and we learn all this about them. It's one thing he has to do and you have to do these seven invasive things. And why they're all invasive. And he has to just provide a sample. Like we're getting ultrasounded and poked and prodded and And tubes are flushed and ⁓ yeah, all the things. So it's not fair that he we can find so much out about the man with one singular little test, but it is nice. But when it comes to people who have male factor infertility, are there nutritional things that can be done other than apparently eating beets? Apparently eating beets. It's a lot a lot of things actually overlap. Between men and women in supporting and improving fertility. Lots of colorful fruits and vegetables where people are probably gonna roll their eyes at that, because like that's what dietitians recommend to everyone. But it's true because of fiber content, antioxidant content, and then essentially making sure that he's eating enough, eating enough protein, being hydrated, like all of the foundational health things are going to be what help you. support and improve sperm quality. And there's a f there's a lot of lifestyle things as well. We want to keep that it's located outside of the body for a reason. We want to keep that area fairly cool. And so we don't want to have overexposure to saunas or hot tubs or even like compression shorts. We want it we want that area to be loose. Supported but loose and cool. And it's like you mentioned, it's a shame that Really when there are fertility struggles, it's automatically assumed that it's the woman. I've had clients come to me who have been struggling for months, years, they've gone to their doctor and their doctor just dismissed their husband as being a factor at all. Like, ⁓ he's gotten you pregnant before. Meanwhile, they've had recurrent pregnancy losses. Or like, ⁓ I literally quote unquote, ⁓ he could impregnate the entire state. with his sperm. And she's sitting there like, What what? Like, yeah, what is that comment? And so I love that the conversation is, or at least we're trying to shift that conversation to include their role in it, because it is not just a women's issue. And the man plays a I mean, he's 50% of the DNA. So we need to make sure he's in tip top shape. And I, you know, obviously seeing a registered dietitian to have that conversation is important because it's it can't just be eat more meat, ⁓ eat more beets. It makes a great Instagram reel, right? You can just say like a if there's one thing I knew that you that your male partner should do and then like you have to go down and scroll, read the caption and says eat beets and you know, now that person got like four million views and never had to cite a single study and now everyone's buying beats for their husbands. Yeah. And ⁓ like not a harmful thing, sure. Include some beats, but like it's not going to be I keep saying it, but like this magical thing that's gonna help you get pregnant. But yeah, it's those it's that extreme, those easy fixes. That's what gets the views, that's what gets the attention. And then you're ⁓ you and me were in the background like, Well, yeah, but no. So Yeah, but also I mean, do you have who come to you who say, like, hey, I saw I've been doing this diet, I've been taking this supplement, it's still not working. I was told it would work and now it's not and I'm sad. I I assume those are things that you are hearing in real life. Yes, ⁓ daily. And it's there's a lot of like, well, this worked for me, so it has to work for you in the fertility space. And I I love the community of trying to conceive women. They're all very supportive and they they're cheering each other on. But there's also like the Well, what did you do when you got like what was different about the month that you got pregnant? And like, that's it may have worked for her, but that doesn't necessarily mean that it's gonna apply to you. And it's just there's so much hope to heartbreak and it's it's just tricky. And so when people come in, they're like, Well, so I saw this online and then I'm going through all these supplements that they're taking, and there's a lot of overlap and they're over supplementing, and not to mention that it's like a waste of money and so there's a lot of correction. on but the back end of me being like, well, we're gonna take this one away. We're gonna take this one away. That form actually is not gonna do anything because it's not a therapeutic dose. So like having 45 milligrams of choline in something like that, when you need 450 milligrams, that's just it's not gonna make much of a dent. I think I mean it is important and I I talk about supplements both in good and bad ways because I do think it's important for us as clinicians to recognize that there are evidence based supplements on the market. I mean everyone knows like vitamin D and iron and those things, but there are for specific conditions, there are supplements that have shown to make a difference for PCOS. You know, I talk about anacitol a lot and for all sorts of other conditions, there are supplements that can help. So I really encourage any clinician to at least remain open minded to them because they are there are some that are like known to be helpful. But I just get upset when it becomes this like plethora. of you need all of these supplements and only my supplements. And here's my seven links in bio and I will sell you 400 different supplements and you must buy them again next month or it's not gonna work. Anyone can sell you a supplement. You don't have to have a degree. You don't have to have a license. You can just sell it from your shop and anyone and can say that they are a provider of whatever. And I see this all the time online. I actually get really upset about it and start like deep diving people when I see like generic titles that people give themselves online. Like I'm a nutrition provider. I saw the other day, like, I'm a derm provide a fellowship trained derm provider. I'm like, that if you are using a very generic term, you're trying to hide what your actual degree is in. And I find that very frustrating. And I think that's part of how people with like supplement stuff can get away with it is because they give themselves a generic name, like title online, and then they were like, I have the solution for you. It's this supplement in this supplement only. And meanwhile, they're not in the background looking to see what other supplements these people are taking or if there's any interactions with medications. I like I'm trying not to get fired up right now just talking about it. And supplements can be such a powerful addition to what you're already doing. But again, it can be taken to the extreme very quickly and very easily. Then all of a sudden you're getting out a pillbox that's the size of your cabinet and you're spending all this money and you don't even know if it's actually helping. And yes, there are supplements that can help. And we don't want to villainize everything. But again, there's that nuance of like nothing is black and white. And there are supplements that can be great tools in your toolbox to help you get where you want to go. Yeah. You mentioned in the beginning about nutrition and endometriosis. And this was I don't do ⁓ much endometriosis management because my partner at work who sits literally three feet to my right. is a MiG surgeon, so she's a gynecologist who did add additional training. That sounds dreamy. You've got everything there. My office is wonderful. Yeah. So I share at Little Office, like three years feet next to me is my very, very good friend who is a MiG surgeon. So she did additional two years of fellowship to only be an advanced pelvic surgeon. So she does All the endometriosis management. So I send all my patients who I even like am concerned might have endometriosis, want to talk about surgery, they all go right to her because all she does is do this work. So I do a little less, I mean I do a lot less endometriosis work. But I could you just talk a little bit about what the evidence is for nutrition and endometriosis? What should we be like considering when we're trying to change our diet if we do have endometriosis? And that's where I mean the endospace is emerging and it's A shame that it's taking this long to even get basic information about endo. It overlaps a bit with just foundational health, but antioxidants are a really again a powerful tool for endometriosis, whether you're getting that from green tea or matcha or colorful fruits and vegetables or seafoods, omega-3s. ⁓ and it's it depends on. really what symptoms they're having because some people who are experiencing endo have really significant gut issues as well where it's painful to pass a bowel movement. And so you have to kind of navigate, well can they handle more fiber and more colorful fruits and vegetables? Or are we gonna need to take this a little bit slower and try with seafood or even like a fish oil supplement. Again, it's it comes back to like individuality, but I would say one of the stronger evidence based things that we have is with antioxidants and following an anti inflammatory diet and what that looks like is gonna look different for every person, again based on preferences and allergies and cultural aspects. And so the biggest emphasis I have is if you have endo even suspect endo, find I'm gonna I'm gonna represent my my people here, but like find a registr a registered dietitian who knows their stuff. And can help you use nutrition as a tool to help you manage those symptoms, not cure it, because there's no I mean, that would be an extreme saying there's that doesn't exist, but at least help you manage pain symptoms or worsening of symptoms in addition to exploring what you can do with a provider like you have in your office. Yeah. I think again I'd like to just point out the very specific words that you use because I think it's so important for people to hear that. And especially hear that from like experts about the very specific words that people use. So you will have noticed that she just said it's a tool to help manage. It is not a cure. And I think when you consume things online, you have to be very careful and like and really pay attention to the words that people are using. Cause if they're telling you, I have the cure, this is I have re I've resolved. I have reversed, those are all not one correct or and two actually very misleading because you can't cure endo you can't cure PCOS you can manage right these are tools that we use to manage these conditions you can make yourself not have symptoms but that does not mean that you don't have PCOS anymore just because you have managed and found ways to manage your chronic disease it's still there it's just managed some people have used the words in remission and I kind of like that language right My PCOS is in remission because it acknowledges that it's there. It's always there, but it's currently managed. And I have noticed that people who are experts in their field, who have the training, who understand the nuances of these diseased states are very particular about the words that they use on purpose because we don't want to make promises that we can't keep. No, there are no guarantees in I mean, th the world. But especially in fertility, pregnancy, postpartum. And that's yeah, I completely agree that if you know what you do in, your language is gonna reflect that. All right, I wanna go into just a little quick and rapid fire with you, although half the time this turns into not rapid fire. I was gonna say I'm a yapper, so rapid fire is not my strong suit. Okay. This is kind of an unfair question. But what is your what is your favorite supplement for supporting ovarian function? Okay, I have a couple of options based on Cirque C I'm already yapping. Okay, we love the yapping. For infertility, generalized infertility, I'm gonna say vitamin D because we can we don't like to assume, but we can assume that majority of people are going to be insufficient or deficient. And vitamin D plays such a significant role in reproductive health. So vitamin D. For PCOS, ⁓ you mentioned it inocital is just a dreamy addition. Yeah, well we'll go we'll go with that. I love that. Okay, what vegetable is your favorite for fiber content? ⁓ gosh. Like you're making me choose my favorite child. It's technically not a vegetable. ⁓ what is it? Avocado. Avocado is a Technically it's a fruit. Okay and it's got some sneaky fiber in there. Okay. I love that I love avocado. Yeah. If I have to choose a vegetable, it'll be it would be artichokes. Like artichoke hearts. Mm-hmm. Okay, an artichoke. I love that. Okay, what is your favorite place to get blue and white striped shirts? ⁓ my gosh. For those of you who aren't watching us, we are both in blue and white striped shirts and she often wears blue and white striped shirts and so do I. So Uh-huh, you'll see that in all of my videos. What I'm like, what am I wearing right now? I think this is J. Crew. J. Crew's a good one. I mean Banana Republic. ⁓ like a am I I'm not gonna discriminate. If you have a blue, is it cute in blue and white? I'll wear it. Mine's from Z Supply. I like these two. They're a little bit more casual, a little like dropped shoulder here. I love it. I know. I'm like, well, I'm gonna go Google where can I find it? Yeah, so we can match next time. And then who are your three favorite content creators to follow right now? They don't have to be medical. Okay. For food and recipes right now, here's your bite. Her stuff is not only does it look delicious, but it is delicious. I'm obsessed. And her voice is so calming and I just like I want her to read me a bedtime story. I mean, top three. There's so many. A lot of them are medical 'cause that's just who I follow in my feed. Like Jen Hamilton, Beach Jam. I mean, a lot of the women that you've had on your podcast already, I'm like, Yep, check, check. Pelvic Dance Floor, Corey Ruth of the Women's Dietician. I could just chat about it. We'll start there. But I like, I have I have a extensive list of people I love following. You, you're included in there. So many wonderful people to follow and many yes who I have had the honor to interview so far. So I'm just so grateful for all the very smart people out there making amazing content for our followers. For the people who aren't following you, where can everyone find you online? I am same username. I am the dot prenatal dot rd on TikTok and Instagram. Amazing. Thank you so much for being here. Thank you for having me.