Larissa Telfer Dietitian
A recent study in Australia women of reproductive aged showed less than 1 per cent of women are meeting the current recommended intake of Choline. You are not alone if you have never heard of this nutrient which is required for all adults for memory, mood and muscle control and other brain and nervous system functions.
What is choline?
An essential nutrient that exists in multiple forms in the body. Our liver can produce choline however this is not enough to meet our needs. We require sources of choline from the food we eat, making it an essential nutrient.
Choline has many functions in our body:
Role in early life nutrition
Choline is required for normal development of the neural tube, with inadequate intake of choline being linked to increased risk of neural tube defects. Choline also plays a role in maintaining the health of the placenta and nutrient transport from mum to the baby in the womb.
High intakes of choline in the 3rd trimester of pregnancy has been shown to improve information processing and brain function in children.
After birth, infants require higher levels of choline to support the rapid growth and development that occurs in the early years. Choline levels in newborns have been shown to be 6-7 times higher than that in adulthood.
Despite the growing research about the importance of adequate choline in pregnancy and early life, most Australian pregnancy supplements don’t contain choline.
What foods is a good source of choline?
Animal products contain higher levels of choline, people following vegetarian and vegan diets are more likely to contain inadequate choline.
If you want to check you are eating enough choline, Larissa or your local Nutrition Plus Dietitian will be able to support you with making sure you are getting enough choline.
When it comes to fertility the focus tends to be on women’s health. However sperm is providing half of the DNA and genetic make up of an embryo, and is therefore a crucial part of making a healthy baby.
Type 1 and Type 2 diabetes have been shown to impact men’s fertility. Research looking into the quality of sperm in men with diabetes found that higher amounts of sperm with irregular DNA, this can impact embryo quality, lower implantation rates and in some cases childhood diseases.
Back to Basics
Let’s take a step back to the basics of male reproduction. The process of making sperm is called spermatogenesis. Men produce sperm in the testis where it is stored with seminal fluid until ejaculation.
The process takes around 3 months with testes producing approx. 100 million viable sperm daily. Spermatogenesis is sensitive to changes in the environment such as temperature, dietary deficiencies and oxidative stress, which can lead to DNA damage.
How does diabetes affect male fertility?
Sperm require glucose to provide them with the energy required to reach and implant an egg. Glucose crosses from the bloodstream into the testis, sperm are sensitive to high glucose levels that occur as a result of diabetes. Studies in mice with diabetes showed changes in the way glucose is transported into cells as a result of reduced insulin and high BGLs.
Men with diabetes have higher levels of inflammatory agents in the fluid around the sperm, which is linked to DNA changes in sperm. Optimising BGLs improves pregnancy outcomes by reducing inflammatory agents and therefore DNA damage.
Erectile dysfunction is a complication in men with diabetes long term and occurs as a result of long-term damage that occurs during long periods of high blood glucose levels (BGLs).
Is there a difference between Type 1 and Type 2 diabetes?
Type 1 diabetes is an autoimmune condition that results in the loss of insulin producing beta cells in the pancreas. Onset usually occurs earlier in life although can be diagnosed at any age. Research has shown that high BGLs in men with type 1 diabetes have reduced sperm volume and sperm motility.
Type 2 diabetes is caused by insulin resistance, usually as a result of lifestyle factors such as obesity, dietary habits and lifestyle. This is combined with reduction in insulin production resulting in high blood glucose levels. The chronic inflammation drives changes in sperm DNA and sperm vitality.
What can I do to optimise my chances of falling pregnant?
The first goal for men with any type of diabetes is to engage with your diabetes team to optimise your BGLs. This means checking in with your diabetes specialist and diabetes educator for a check up on your medications, your lifestyle and check you are up to date with the latest technology available for people with diabetes.
It is important to remember that the risk of these factors impacting fertility can be reduced with optimising BGL control.
How can a Dietitian assist men with diabetes and fertility?
A dietitian experienced in fertility and diabetes will be able to provide individualised nutrition plan to optimise your BGL control and nutrition to improve chances of a healthy pregnancy.
The research into the impact of healthy eating on sperm quality continues to build, with higher intakes of nutrients including selenium, zinc, omega-3s and CoQ10 showing benefits. Dietary patterns such as the Mediterranean diet and the DASH diet are also showing benefits for sperm quality.
If you know a man with diabetes please share this article as you just don’t know who might be trying to conceive.
Larissa is available for in person consultations in Geelong, telehealth consultations are available.
Wiebe, J. et. al. Fertility is reduced in women and men with type 1 diabetes: results from type 1 diabetes genetics consortium (T1DGC) Diabetologia, 2014, 57:2501-2504.
Condorelli, R. et. al. Diabetes Mellitus and infertility: different pathophysiology effects in type 1 and type 2 diabetes on sperm function. Froniters in Endocrinology, 2018, 9:1-9.
Salas-Huetos, A. et. al. Diet and sperm quality: Nutrients, foods and dietary patterns. Reproductive Biology, 2019.
This recipe is a delicious and comforting vegetarian meal, it has been a hit in my house. Ideal for freezing for a quick mid-week dinner, or make a batch for workday lunches.
Makes 8 Serves
1/2 cup Yellow Thai curry paste
1.2kg pumpkin, chopped into large chunks
1 onion, diced
3 cloves garlic, finely chopped
1cm piece of ginger
1x chilli (optional)
2x 400g cans of chickpea, drained and rinsed
1 cup (250ml) vegetable stock
1 x 400g can Coconut milk
1 cup roasted cashews
Coriander to serve (optional)
1. Cook onion for around 5 minutes or until golden
2. Add ginger, garlic, chilli and cook for a few minutes, then add curry paste and cook until fragrant
3. Add pumpkin, coconut milk, vegetable stock and chickpeas
4. Simmer for around 30 minutes or until pumpkin tender
5. Prior to serving add roasted cashews and coriander
Nutrition per serve:
Energy 1500kj (360 calories), Protein 12g, Carbohydrate 28g, Fibre 9g.