Nutrition for Fertility in Eating Disorders
Co-written by Talia Cecchele and Stefanie Valakas
Pregnancy is a wonderful and challenging time for women both physically, emotionally and psychologically. During preconception and pregnancy, nutrition and wellbeing play a critical role in the development and health of your baby. If nutrition is insufficient both baby and mother's health can be adversely affected.
If you have lived with an eating disorder or are recovering from one, you can read more about how an eating disorder can impact your reproductive system and your fertility in a blog post I wrote with Stefanie Valakas (also known as The Dietologist) who is a leading women’s health and fertility Dietitian & Nutritionist in Australia. We wanted to write another blog together to give you the best advice on how to optimise your fertility through nutrition when recovering from an eating disorder.
How can nutrition play a role?
There are several key nutrients that are vital for a healthy reproductive system which could be at risk if an eating disorder is present. For preconception it is important to consume regular balanced meals to get a variety of these nutrients, but strict food rules can interfere with adequate consumption of these. Nutritional requirements for preconception don't differ if you have a history of an eating disorder or not, but if you are restricting your diet or engaging in eating disorder behaviours it is best to speak to your GP or Dietitian for individualised advice.
Ensuring that you give your body enough energy is vital for regular menstruation and production of fertility hormones. Energy requirements don’t increase until the second and third trimesters when additional carbohydrate, protein and vitamins C and D are needed to support development of the baby. You will need additional energy if you are underweight to help with weight restoration and support the growth of the baby. If you are struggling with volume of food, try spreading your food over 6-8 meals a day. You do not need to "eat for two” but you need to be eating enough to nourish you and your growing baby.
Dietary fats are needed to build reproductive hormones like estrogen and progesterone. Sources of healthy fats include extra virgin olive oil, avocado, oily fish, nuts and seeds and dairy foods. Aim to include about 1 tablespoon (the size of your thumb) with every main meal and add them to your snacks!
If there isn’t enough calcium coming from your diet, your body will withdraw calcium from your bones to use in other parts of the body. This can result in reduced bone strength and increase risk of osteoporosis and fractures. If your period is absent due to low estrogen levels, this directly impacts your bone health as estrogen promotes bone growth. In anorexia nervosa, calcium requirements may be as high as 1500mg per day (which is equivalent to 5 serves of dairy foods) so ensuring you have enough calcium in your diet is important as your baby will also use calcium from your stores to build healthy bones and teeth if there isn’t enough in your diet.
Iron requirements increase by approximately 30% during pregnancy. In restrictive eating disorders, ensuring that you are receiving enough iron to support your health and the development of your baby can be difficult and anemia is common. Speak to your GP or Dietitian about how to best support your intake of iron-rich foods or to talk about iron supplements.
Folic acid is a key nutrient in reducing the chance of neural tube defects such as spina bifida. It is recommended that all women supplement with folic acid and iodine at least 1-3 months before conceiving to boost stores before pregnancy. If you are weight restoring with the goal of getting your period back and falling pregnant, it might be worth taking a pregnancy supplement during this process just in case. You can read more about how to choose a prenatal vitamin here.
Other micronutrients Depending on your dieting history, current intake and physical health status, there may be other vitamins and minerals that are deficient or at risk of being deficient which are needed for preconception and pregnancy. You might need a nutritional supplement if you are unable to eat enough food or a achieve dietary variety. Please speak to your GP and/or Dietitian for further advice.
Remember, just because you don’t have a period, doesn’t mean you have zero chance of conceiving - please use appropriate contraception if you intend to avoid pregnancy
Disordered & Compensatory Behaviours
Whether you are actively engaging in disordered & compensatory behaviours or not, pregnancy can trigger a relapse due to changes in body shape, increasing weight, cravings, morning sickness or a limitation in physical activity. If you are trying to conceive and engaging in behaviours such as purging, over-exercise or laxative use please speak to a qualified eating disorder specialist to help overcome these before falling pregnant as these behaviours can increase risk of side effects like electrolyte derangement, dehydration or raised blood pressure which can lead to adverse effects for you and your baby.
What can I expect will happen to my weight during pregnancy?
During pregnancy your body is going to change physically, and for some women with a history of an eating disorder, it can be quite distressing. Weight gain during pregnancy is necessary and is made up of the weight of your baby, increase in blood volume, fluid retention, increase in uterine muscles and breast tissues and placenta. Depending on the weight you were at conception, there are guidelines about how much weight gain is expected:
If you have a:
BMI <18.5 the expected weight gain is approximately 12.5kg-18kg
BMI 18.5-25 the expected weight gain is approximately 11.5kg-16kg
BMI 25-30 the expected weight gain is approximately 7kg-11.5kg
BMI >30 the expected weight gain is approximately 5kg-9kg
It is important to remember that these are guidelines. If you find yourself worried about your weight talk to your healthcare professional or ask not to share your weight with you.
If you are able to get your eating disorder under control, you will have a better chance of conceiving and more likely to have a normal, healthy pregnancy. If you are trying to conceive or are pregnant and have an eating disorder, it is important to access support to prepare for any challenges or triggering situations that may present during and after pregnancy. Speak to your GP or contact The Butterfly Foundation (Australia) or Beat (UK) for advice on who to speak to.
If you would like to enquire about a private nutrition consultation, please contact me here
You can find Stefanie on Instagram @the_dietologist, Facebook and visit her website to learn more about Stef and the amazing resources and programs she has available to help you and your partner on their fertility journey!
Talia is a registered dietitian working in private practice and as an eating disorder specialist dietitian in London's leading private mental health hospital. As a freelance dietitian, Talia not only offers 1:1 consultations but can present at your workplace, create recipes or articles or host a cooking demonstration. To enquire please fill out a contact form.