Ep 31: Male Fertility with Lauren Manaker, RDN
Fertility Forward Episode 31:
Since “it takes two to tango”, this episode focuses on the necessary nutrition and lifestyle information that men who are trying to conceive need, and the role they play in IVF success, and the baby’s health, among other things. Our guest is an award-winning Registered Dietitian turned entrepreneur and author, Lauren Manaker. Lauren launched her business after struggling with infertility and becoming a mother, and her personal experiences shed a spotlight on how much anecdotal and unsupported information is out there. She has made it her mission is to make accurate nutrition information more accessible and easy to understand and, in 2019, she wrote the book Fueling Male Fertility: Nutrition and Lifestyle Guidance for Men Trying to Conceive. In this episode, Lauren shares a bit about what she has learned about male fertility and the best ways she has found to connect with men, as well as some of her recommendations for good, nutritious food, and the foods she suggests eating in moderation or cutting out of your diet.
Rena: Hi everyone! We are Rena and Dara and welcome to Fertility Forward. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our Fertility Forward podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients because knowledge is power and you are your own best advocate.
Dara: Lauren Manaker is an award-winning registered dietician turned entrepreneur and author. She has been featured in numerous publications, herself, a freelance writer and author. Her expertise lies in women's health. However, Lauren is proficient in all nutrition-related matters. She is best known for translating complicated data for the lay- person. She too consults with small food companies to create programs that engage with specific audiences and create messaging surrounding evidence-based information. Lauren's mission is to bridge the gap between registered dietician-nutritionist and the community at large making accurate nutrition information more accessible and easily understood. Laura Manaker currently lives in Charleston, South Carolina, with her husband and her five-year-old daughter. Lauren, I am so thrilled to have you on our podcast today. Thank you so much for being here.
Lauren: Thank you for having me. I was so excited when you reached out.
Dara: So I'm not sure for the audience if they know how we, I believe originally connected. I was told that I had to meet you at last year's big fancy nutrition conference. It's our big, big annual conference. It was held in Philadelphia last year. And it was just, I feel like we were meant to meet at that moment. It was like perfect timing.
Lauren: Yes. Yeah . And we connected through a mutual friend and we just all seem to have similar interests and focus and we all seem to work very similar too. So I was very glad to meet you in person.
Rena: Well I’m so glad that you guys met, and we're so happy to have you on because I love bringing something for the males for our podcast, you know, and I think male infertility is so important, but so underlooked and so hush hush, so I'm so happy we have you on, an expert who can really tell our listeners more about it and really bring more awareness and help other people.
Lauren: Thank you. Yeah, I'm happy to be here.
Dara: Lauren , I feel like you really have, you've kind of spanned the gamut in terms of fertility and fertility in both men and women. How did this all begin? When you kind of finished schooling, you became an RD, was this something that you started off thinking - Hmm, there's a gap in what dieticians can offer or was it something of a personal experience that kind of brought you into this realm?
Lauren: Yeah, it was definitely a personal experience. I never learned any of this in school. I went through IVF myself for almost five years and went through that whole journey, you know, tried naturally, IUI... Throughout the whole process, no one talked to me about nutrition. The extent of nutrition information that I received was eat healthy, like eat peanut butter crackers. Peanut butter crackers aren't going to cut it. And I knew so little that even as a dietician, I never really took the step forward to learn more. It wasn't until after I had my baby that I learned how impactful nutrition can be. And especially in South Carolina how the resources seem to prey on the vulnerable population of women that were struggling myself included. Like, I can't tell you how many things I did that were a fortune and made absolutely no sense. So there was certainly a gap in South Carolina. So when I went off on my own, I felt like I needed to bridge that gap with evidence-based information, hoping to tackle the big picture. And I found that the men weren't as excited to speak to me as the women were, which I understand. That started my exploration into the male side of things, but really what did it was, I have a five-year-old now. When she was four, I was trying to get my husband to pick my daughter up from school one day. And he somehow alluded to the fact that I'm the primary parent and I carried her and I was like, hold up, dude. I carried her. Yes. I breastfed her. But you know, we did this together. And then it brought me back to when we were trying and I was trying all these things and he was like living life. And I felt like it started from there. And I'm like, you know what? These men need to understand. It's both of us from even before the baby's born. So I was mad at my husband that one day and I'm like, I'm writing a book to show all these men that they need to be partners from even before the baby's born. And it's actually, there's evidence highlighting the fact that men play such a large role. So from there I just anger-researched and found all the information. And that's where my, my book came into play to give men the tools to support their fertility as well,
Rena: You know I love that you give men something concrete because in my work, you know, the majority of my practice is females. I do have some occasional male patients or couples, but I think it's that you gave them an action plan because a lot of times I talk with people that giving your partner the tools for success, because they often want to help. And if anything, I see the men feel left out of the process.
Rena: But then it's how do we involve them? And soI think you brought up such an important point about really giving something concrete and you're really calling attention like, Hey man, it is 50% you. And I think a lot of times men are really kind of scared or shy to speak up and say something. So I'm so glad that you got angry and researched, and then you have this tool to now give people the information.
Lauren: Thank you. And I also am finding that written information seems to work better for that population. Because like I said before, I certainly understand they don't want to sit and talk to me about their sperm motility. I mean, it's, it's an uncomfortable conversation for some people, but just having the information written out in easy language seems to be a better way to get the information out there. But certainly there are other avenues too. I mean, I think it's just a matter of, not just my book, there's so many other things that couples can do to get the information for the men. I think it's just a matter of really recognizing and understanding that men play a role, even if they're undergoing IVF. You know, I think they think also if they're undergoing IVF, then it's just the women's egg quality and the women’s body and the women's implantation, but there's data to suggest that men play a role in IVF success, men play a role in the baby's health long-term . I mean, there's so many things that men can do, even though they're not actively like going on the procedure table, you know?
Rena: Sure. Well, I think it is, it is really 50%, right? We can't make a baby without sperm and egg and we don't get the sperm without a man. And I think a lot of times people feel really, the men feel helpless because they want to like sub in their body and say, okay, let me take one for the team. Like you took last cycle, let me take this cycle. But they can't because obviously biology, the woman has to carry the child. And so I think that's when they get frustrated. And so I like to give my patients tools to help the man feel included, be it giving them a specific action plan to do with helping with injections or them being the one fielding phone calls from the doctor. Just so they feel like they really are in it with a partner instead of just kind of on the sidelines.
Dara: That's exactly it. I feel like bringing, bringing couples together. I think a lot of times we look at the woman and their struggle and we don't always focus that men can struggle as well and giving them yes, tools and tips and make them feel like they're a part of this process can make them feel secure, but also help them connect better with their partner.
Lauren: Yeah . The other side of it is with so much focus on the woman, the men can feel a lot of stress as well. You don't even know their body isn't going through all of the stress, but it can be a stressful time that, you know, my hope is bringing awareness to that also And letting couples know that the men are susceptible to that stress and just feeling of despair as well, which also isn't very fertility supporting, you know, you don't want anyone in the picture to go through that strife. So just like they want to play a role. They also can be the silent carriers of this stress undergoing the whole process too . And I've definitely seen that firsthand with some people that I've spoken to.
Dara: But I think that's good that you created this book because as you mentioned, sometimes it's tough for men to speak out loud and I think if they can read something, then they can help formulate some of those questions for discussion with their therapist or with their partner. But sometimes before they know what to say, you know, getting some knowledge from a book can really be helpful. And I think you also made it very approachable. It wasn't a 300, 400, 500 page book, which as a woman, I was like, Oh, this may be too small, but it's funny when I read it and I was like, this is perfect for a man. And I know from my experience with, with men and for my husband, I can use him as an example. He's always like, Oh my God, you write so much in an email. You talk a lot. And not to say that I want to put women and men in a box, but in terms of women tend to, you know, be quite emotional and, and have a lot to say. Whereas a lot of times men typically gravitate towards more concise, direct guidance. And I love that that's what you've done.
Lauren: So at the end, what I tried to do, and I used my husband as my muse, because he's always like, just get to the point, like just take away the fluff and get to the point. So I give all the research and all the evidence in the book. And then at the end I have all right, if you are struggling with low sperm count, here's a list of things to do. If you are undergoing IVF, here's a list of things to do. Pick three, just start with three, master those three, then move on to the next, because I know there's some people that aren't even going to read the short book. They just want to know what to do. So this is me just telling them, just do this, just eat a tomato and then in two weeks, start something else. What I also was combating is just like for the females, I'm seeing a lot of products focusing on men and some are great and some aren't so great. And a lot of these supplements to me are expensive fluff. And I find that a lot of people are turning to supplements and not looking at their diet and their lifestyle and their sleep. And it's not going to work. You know , if you're taking all these supplements, but you're sleeping five hours a night and not eating well, it's not going to be impactful. And a lot of these supplements in my opinion are just not evidence-based and they're not going to do anything for you.
Dara: They're band-aids. They're band-aids often for the work that needs to be done or the small changes need to be done. I think a lot of us, I think as humans in general, we often want to look for the, I wouldn't say the easy way out, but a shortcut to get to something that really needs to be focused on. And I think that maybe that fear of, wow, I need to actually sit with this and work on it can be overwhelming. And they turn to these products without really understanding what they're taking, why they're taking it. And if they can do it in another way through food or something that is more and not necessarily more natural, but not from a pill per se.
Rena: I think too people they are desperate and you want to reach for something. And I know you mentioned when you were going through it, you were doing crazy things to try and conceive. And I was doing the craziest stuff when I was going through IVF. I was told that if you eat herring row on new year's in the Japanese tradition, that will lead to fertility. So I was like running all around the lower East side, new year's Eve, trying to find herring roe so I could eat it at midnight, crazy, crazy stuff. And I think a lot of it is an element of control. So you think, okay, I do that. You know, I take these supplements and I'm in control of my fertility. When I think the reality is, as we all know, it's really out of our control.
Lauren: But there are certain things that while it is out of your control, there are certain things you can do that certainly aren't going to hurt anything and it may help. So to me, making lifestyle changes like, you know, as much as I want to talk about food, to me, the one of the biggest thing is getting good sleep for men and for women. It plays such a large role on your hormones. Even if it's not going to help get you pregnant or get your partner pregnant, you should be getting good quality sleep.
Dara: That's so true. It's so nice to hear from a dietician because I feel like people come to us and they think our role is to talk about food. But I always say, you can eat all the great food in the world, but if you're not getting good quality sleep, food can only help so much with your overall health. So it's nice to see that it's something broader than that.
Lauren: Yeah . It's the whole big picture. Just like with food. You know, I talk about tomatoes a lot when it comes to male fertility, I just, there's really amazing data surrounding antioxidants found in red, naturally red foods like tomatoes and watermelon, pink, pink, and red, whatever, you know. So if you're eating a ton of tomatoes, that's great. But you know, to your point, if you're drinking, if you're eating a ton of tomatoes, but you're drinking five whiskey drinks a day, it kind of counteracts the positive. So it certainly is big picture. And that goes back to the supplements with the big picture, just like if you're eating tomatoes all day, but you're not taking care of your body, same thing. If you're taking the supplements all day, but you're not taking care of your body, it's not going to do anything.
Rena: What other kind of concrete tips do you have that maybe you could share with listeners?
Lauren: So lycopene is an antioxidant naturally found in the red and pink foods. So I know guava isn't that popular in New York, but in South Florida, we do eat a lot of guava. Tomatoes, tomato products. So I mean, pizza to me counts if you're eating it with a red sauce. Watermelon, red peppers... that antioxidant, if you're taking that antioxidant and consistently it's been shown to have some positive effects on male fertility. There's also some decent data surrounding eating certain nuts. So walnuts, Hazelnuts and almonds every day.
Dara: Brazil nuts also.
Lauren: Yes. Yes.
Rena: What quantity for this?
Lauren: It's a large quantity. It's, it's about a handful a day, every day. So they have to treat it like it's a supplement, commit to it. You can't eat it once a week on your oatmeal and say, you're good to go. You know, you have to eat these foods consistently. You know, the whole thing, food is medicine. You're kind of treating it like that and treating that handful of nuts a day as your pills.
Dara: But I tell you interesting with the nuts, I feel like it's great for fertility. I think it's great in general. And I'm assuming, and I've at least heard from my patients that when people start incorporating nuts on a more regular basis, it fills them up. It's one of those great types of foods that, you know, with the fat and the protein combination can really sustain someone for a lot longer period of time than just eating a fruit alone. The fruit with the nuts can make a big difference. And I was also going to add in terms of the holidays, the Jewish holidays are coming up. I’m like pomegranates. Those are also another great red food that is super easy to get in.
Lauren: And high in antioxidants.
Lauren: So, yeah, it's a great food. There are a lot of choices to make. Eating a big variety of different colors on your plate. You know, really nothing that original, it's all the information that you've heard before on how to eat well and a healthy lifestyle, you know, balanced food, not eating the processed food and going for more of the fresher meats, lots of produce, lots of healthy oils and seeds. It's really a lifestyle that men and women should be embracing together. Even if you don't have fertility struggles, if you are going to be parents, you need to take care of your body and take care of yourself. You want to be around for your kids. So again, it's not going to hurt anything. Is it going to get you pregnant maybe, but you have to eat anyways and you should be taking care of yourself if you're going to be a parent.
Dara: And I think that's a hard thing. It's nice to see someone else. And that's, I think part of the reason why I connected with you so nice to see someone else who has a similar approach in a fact that it isn't a crazy out there type of diet. It really is a lifestyle that is great for life. This is often the impetus for men and women to start changing their habits. But this isn't something that once, okay, sperm is , is where it needs to be, eggs where it needs to be. We're done. We are, we're creating a child. We don't need to worry about this anymore. I feel like this is a perfect opportunity to be more aware of it, but to continue it.
Lauren: Yes, absolutely. Even if you're just holding onto one or two of the changes that you've made, it's a great start to the rest of your life. And so I agree. Really one other area that has a lot of data surrounding the benefits that is a surprise to some men is seafood. That eating seafood twice a week, the lower mercury options, I mean, the outcomes are amazing in terms of male fertility and the improvements that researchers have seen when men start incorporating more fish and seafood into their diet is really, to me an easy thing that I don't know why a lot of men are not that excited about, but they give it a shot. I think that's one of the best things they could do.
Dara: I think, you know, especially when it comes to men, I see a lot of men who gravitate towards meat and I'm not, I would love to hear after your philosophy on that. But for me, my whole thing is if you have too much of anything, not great. But I think sometimes when men often focus on the meat, something else is lacking. And when you're able to say, it's not that you're not having meat, it's that you are including the fish, the shellfish perhaps here and there having a day or two where it's, you're having, or a meal or two where you're having something that's more plant-based beans, lagoons, good quality organic soy on occasion, but also good quality meat products too. I think that it's more focusing on grass fed as opposed to the corn fed, but I think it's less about what you shouldn't be having, but more about the things that you should be including.
Lauren: And that's exactly, that's the variety. You know, I , I'm not against red meat at all. I mean, I, I have not read anything that says that eating a hamburger once in a while is going to be detrimental to anybody's fertility. What I have read is eating those processed meats, the sausages, the hot dogs, the lunch meats. So again, getting back to the quality of course, cost can play a role as well. So, you know, wanting to be mindful of that, but really getting away from those processed meats and getting more into the natural meats in moderation to me is a great thing to do. I would never tell anyone to cut red meat out of their diet, unless there there's another reason, a cardiac reason, or just any reason that their physician's telling them to . So, yeah, definitely for men trying to support their fertility, it doesn't mean giving up their meat and potatoes. I mean, by all means, eat your meat and potatoes just not every day.
Dara: And add in a salad if you can!
Rena: A lot of concrete things for men to do to really play a role in this and easy changes that will help them feel better. You know, again, moving forward and not just in the fertility journey, but as you mentioned, you know, in the path to parenthood, you know. Sleep is so important, fueling your body the right way so you can be there for your kids.
Dara: And even caffeine and alcohol, that's something that I get asked a lot, especially my female patients come in and tell me off, my husband is drinking so much and having caffeine, how do I approach it and great to hear your perspective. I often say that, you know, it goes back to the meat. The tough part is a lot of us can't do things, not can't , but it's more challenging to do things in moderation. Anything in large quantities, something else often is lacking. Oftentimes water you're drinking, alcohol or coffee. You forget to drink your water. And then the habits that surround it. When your inhibitions are lowered, you typically make poor food choices in larger volumes and, you know, absorption I'm sure with too much caffeine. What's your viewpoint on those two things?
Lauren: So the alcohol and the caffeine I'm with you that I don't think they need to cut it out. I think, you know, one drink, one drink. I mean really when I say one drink, it's one drink. We're not one drink plus just another one a few hours later. Caffeine I think one cup of coffee a day is fine as well. What I will say and I really don't have a lot of foods that are no's on my list, but I have some, and one is the energy drinks. I don't know if I could say brand names on here. You could cut it out if you have to. Something like a red bull really doesn't have a place in a male fertility plan. Also the sugary, caffeinated sodas. So like traditional Coke or Mountain Dew. I just don't see it having a place in a fertility plan for men, but
Rena: Is that myth true because I've always heard, I don't know if this is an old wives tale, but you know that mountain Dew destroys sperm. I feel like I started hearing that when I was in middle school, which is crazy.
Lauren: That you’re talking sperm in middle school also.
Rena: I know I don't know what we were doing, but yeah.
Lauren: I have not read any research on it. I just know in general, the caffeinated sodas, there's a connection between having less quality sperm and consistently drinking those drinks.
Dara: Well, they're tough. They're often very concentrated in caffeine. And then for me, what I tell people is on top of it, the sugar and on top of it, I mean the colorings and the chemicals and the additives. And also people let's say if men are taking a prenatal vitamin, and I think this goes for women too, if we're taking some sort of multivitamin or prenatal vitamin men and women, and then they're taking also these drinks that often are fortified with more. People often get the misconception that more is better, more of the good stuff or what people assume to be the good stuff is better, but that's often not the case.
Lauren: Agreed, water's your best bet. But a lot of people aren't water drinkers, and I can appreciate that. So, you know, there's so, I mean, it's crazy the amount of alternatives out there that people could try that don't give a lot of calories, but you know, we're not even talking calorie. I shouldn't have said the word calories, cause we're not, that's really not the focus right now. Of course you want to keep a healthy weight, but the focus is to get in as much nutrition as you can. You know, every bite you're taking is doing something for your body instead of just satisfying your sweet tooth. So, you know, if you're finding a drink like a coconut water that maybe has some calories, but it's also giving you other nutrients and it's keeping you hydrated and keeping you away from the heavy amounts of caffeine in this case, to me, it's worth it.
Rena: So what else is on your no list?
Lauren: Drugs like cocaine or even marijuana. I don't think that there's a place for marijuana. I'm sure there's a cooler way to say marijuana, but I'm not that cool. I'm a mom now. The processed foods. Believe it or not, organ meat has been shown to not be a great choice for men trying to conceive. So like liver, things like that. But other than that, I don't have a no list. I mean, there are things that I definitely want people to eat in moderation. So things like the refined carbs, like the white breads, I would never say to never have a white bagel because that's just cruel, but you want to balance it out between the whole grains, you know , even sugar in moderation to me is okay. Especially if it means you're eating the sugar with something that's nutritious. So like you have to add some sugar to a Greek yogurt, but you're getting that Greek yogurt in to me. It's worth it. So really other than that, there aren't any foods that I really say definitely no to .
Dara: That's great. In terms of where you see this research going in terms of male, female, health and wellness in the fertility realm, is there anything that you feel like you wish there was more research on? I'm sure there's a lot, but are there any specifics, whether it's maybe research on vitamin D and fertility, is there any area that you kind of want to see more on?
Lauren: I think what a lot of people want to see is specific foods. I think people want that specific food, eat this and you'll get pregnant, but people don't eat that way. So I think what I would like to see is more of those lifestyle stories and what impacts fertility and I am seeing more of those. So I think we're on the right track. I think what the researchers are doing is actually the information that people need versus eating a pineapple a day, you know, because we don't eat like that and you might eat a pineapple a day and eat fast food. The rest of the day, some of the data that's coming out, we're not that thrilled about, but it just is what it is. I , one study just came out where the results showed that ovarian reserve isn't really impacted by a healthy diet versus a not healthy diets . So it's kind of a bummer that you don't have that much control over ovarian reserve, but we know. So they're doing more studies like that. So I'm just excited to see what comes out.
Dara: For me. I feel like, yeah, it's , there is so much, I think that we , I would love to see, but it's great that you mentioned that it isn't, it . Sometimes we hone in on one specific thing. It negates looking at the big picture and even the connection between lifestyle. Lifestyle includes daily activity includes what you eat, includes the relationships you have, how you manage stress, the sleep. And I think sometimes when we hone in on that one thing, you lose the big picture and it gives us something to grasp onto, but then we often lose sight of all the other areas. So that's so nice.
Lauren: But I do think it goes back to what you were saying before about the control. If you're eating that one Brazil nut a day, you have control over your fertility is just because, especially when you're going through assisted reproduction, I at least felt completely out of control that I just needed something that I felt like I could play a role in. So I certainly understand the desire to have that one thing you can do, but that's just not how the body works. Unfortunately.
Rena: I think I like to try and help people reframe it as, as how to feel in control when really we're not. And I think that can be helpful. And I think, you know, now it applies even to broader picture, right to the pandemic, you know, we're all in a situation we can't control, but how do we almost fool ourselves into thinking we can control in ? And there are so many things we can, and it's so easy to lose sight of that when our kind of macro feels out of control. But I think also to , to point out too, it's so wonderful that I think all three of us share the connection of getting into our respective fields. That's specializing in fertility because of our own personal experiences. Um , and I think the longer I've been in the field, the more I see that, and I think it's so great because there's so many like-minded individuals who, because of our experience, we saw a gap and then wanted to make it better and then created this. And I think it's so great because you meet other people with so much passion and who really care so much about the field. And it's so clear, you went into this and created these tools and you're putting out this information because you saw a gap. And I just think it's so great to find other people like that. And hopefully, you know, together, all of our work will be able to change the, the voice of fertility and make it, you know, more spoken about less of a stigma, less shame , um, and help more people understand it because I think that will also be helpful too .
Lauren: Yeah . I'm so happy to connect with you ladies also.
Dara: We are thrilled, Lauren, what is the best way in terms of, so I know you, you are a ghost writer and your lactation education counselor. You do a lot of things. Are you speaking with patients now or are you seeing patients?
Lauren: Due to the pandemic and childcare I am not seeing clients at this time. I try and give information on my Instagram and I'm happy to answer small questions if anything comes up. Hopefully the situation that we're in changes at some point, and I could open up a little more.
Dara: But the best way to get in touch with you would be to go on your website, to connect with…
Lauren: They could connect on my website. They could connect on Instagram and there, there are tons of ways. So probably the website would be the best bet.
Dara: So how we like to end all of our sessions is to ask to go around and see what we're grateful for today. So Lauren, it could be anything what you've brought into at this very moment. It could be that it's sunny outside.
Lauren: I am grateful that I got eight hours of sleep last night.
Dara: It goes full circle.
Lauren: Yes. Think about how lovely that feels, especially as a mother, that's pretty unbelievable.
Lauren: Are you guys going to say it too?
Dara: I did get about eight hours so yes, I'm grateful for that. And just working in this field and I believe I'm sure I've said this before, but especially with you, Lauren, I felt like we met at such a perfect time. I've wanted you on for so long, but it was worth the wait. I just, I love being in this field and love learning from other people and coming together, sharing our stories, our experiences, our knowledge, because that's powerful. And that's how we really can help others when we all come together and work together and support each other.
Lauren: Absolutely. 100% agree.
Rena: You know, we were talking a little bit before we recorded just about being moms and the pandemic. So I'm going to go with, I'm grateful that today's Monday. I still don't know my kid's plan for school, but she is out of the house, she’s with my nanny. I'm here, I'm working. I'm where I'm supposed to be. One day at a time today is going as planned. And so I am grateful for today.
Lauren: I like it.
Dara: A-woman to that.
Rena: Thank you so much Lauren. I think it would be so pretty amazing. I mean , we've had three moms during a pandemic together, uninterrupted. It’s a big feat right there.
Lauren: I appreciate you having me. Good luck with your Monday. What can I say?
Rena: 12:48 we’re doing well. On schedule, getting it done.
Dara: Thank you so much for listening today. And always remember, practice gratitude. Give a little love to someone else and yourself. And remember, you are not alone. Find us on Instagram @fertility_forward. And if you're looking for more support, visit us at www.rmany.com and tune in next week for more Fertility Forward.