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Ask a doctor: tracking your fertility and the real deal on gluten

Ask a doctor: tracking your fertility and the real deal on gluten

We’re pretty sure we’re not the only ones who spend our annual physical trying to convince our doctor that we are the perfect picture of healthy living — we’re gobbling up kale salads, only have 3 drinks per week, and workout as religiously as Madonna. But with all that posturing, we always end up leaving without getting our burning questions answered and wind up turning to the Internet for clues (spoiler alert: according to WebMD you have a tropical parasite that can only be contracted from one specific lake in Lesotho).

So we enlisted the coolest doctor we know, Dr. Robin Berzin from Parsley Health, to get some answers. Have a question for Dr. Berzin? Email it to us at and we’ll answer it next month.

What are the different ways I can measure my baseline fertility? Then ongoing?
Measuring baseline fertility is tricky. There is a blood test called Anti Mullerian Hormone (AMH) which is best tested on day 3 of your menstrual cycle, that in theory measures egg reserve. It’s important to remember, however, that this test was developed in the context of IVF — it’s best use is to determine whether or not a woman is a good candidate for IVF, NOT whether or not she is fertile.

A normal AMH is 1.5 – 4. Higher than 4.0 is considered consistent with PCOS (Polycystic Ovarian Syndrome). 1-1.5 is considered “low normal” and less than 1 is considered low. If you are less than 0.6 it is recommended that you seek out a fertility consultation immediately. That said, I know plenty of women who get pregnant naturally with a low or low-normal AMH, so I don’t advise testing for this hormone as a “fertility screen” routinely, but only if you are older or concerned about fertility for some specific reason.

The best way to track ongoing fertility is to use an app like Period Tracker or Clue to track your cycles. Everyone’s cycle is a little different – anywhere from 24-32 days is considered normal and even if your cycle is a little longer, if it’s regular it doesn’t mean anything is wrong with you. But where your peak fertility days are going to depend on your cycle length so getting to know your cycle’s rhythms through tracking is a great first step.

From there if you want to go further you can get kits at the local drug store that test your urine for LH – luteinizing hormone – which surges mid-cycle triggering your ovarian follicle to release an egg. These kits can give you a better sense of when you are ovulating as many women do not feel ovulation. Other people use basal body temperature as a method of tracking ovulation – a surge in morning temperature can indicate ovulation and there are charts you can use to track that are freely available online.

Is it bad to regularly take over the counter painkillers (Advil, Tylenol etc.)?
Regularly taking painkillers is not a good idea. NSAIDs like ibuprofen are toxic to the lining of the digestive tract, potentially leading to ulcers, reflux and even the development of food sensitivities. Plus, all drugs impact the status of the microbiome – the trillions of bacteria that live in your gut and largely determine your overall health.

What vitamins should I take on a daily basis?
Everyone’s nutritional needs will differ based on what it is they’re trying to achieve. Other important considerations are things like health history, hormone balance, level of stress, physical activity, digestive function, microbiome status, etc. So, I can’t tell you what you “should” take no matter what. I think everyone should be tested for nutrient deficiencies and sub-optimal nutrient levels, and should supplement based on personalized precision testing.

I also remind people that not all supplements are created equal and that many off the shelf probiotics and vitamins are not what they claim to be – it’s a self regulated industry with a lot of marketing around it. Only take supplements that are professional grade, and recommended to you by a licensed health care professional. Also, your conventional doctor doesn’t know anything about supplements — I can’t tell you how many OBGYNs recommend low-quality prenatals filled with dyes, chemicals, synthetics and minimal nutrient value. So, work with a provider who is well-versed in supplements like a Functional Medicine professional. All the supplements we use at Parsley are professional grade, tested, safe, and effective.

All that said, here are the helpful things I find busy women generally fall short on, and feel better taking — meaning for more calm, a stronger immune system, stronger bones, better digestion, and better energy:

• Vitamin D3 with Vitamin K2 drops for a total of 5000 units daily (for bones and immunity)
• Magnesium Glycinate 400mg daily (for calm and sleep)
• A good probiotic like Prescript Assist, 2 daily (for digestive health and immunity)
• Methylated B-complex (for energy mood and detoxification)

How many times a day should I be pooping?
At least once! “Normal” is 1-2 times a day, and stool should be formed, but not hard, loose or in little pellets. If you’re going less that once a day, that’s constipation, but if you’re only going once a day that’s great.

Recently, I can’t turn a corner without meeting someone who’s off gluten. What’s the deal with gluten intolerance?
Gluten is a protein in wheat and certain other grains like spelt, barley and rye. Celiac disease is a severe intolerance to gluten, which affects 1% of the population, and can cause digestive issues, weight fluctuations and even skin and joint problems as well as malabsorption of key nutrients. Many more people, however, have “non-Celiac gluten intolerance,” which is where their bodies and immune systems react to gluten negatively.

Gluten intolerance can cause headaches, joint pain, fatigue, brain fog, gas, bloating, acne, eczema and other symptoms. I commonly see people in my practice who remove gluten from their diets and see huge improvement in these areas. It makes sense that like anything in the body, there is a continuum, and something like gluten is not a black or white issue, not a Celiac or non-Celiac issue, but a spectrum of response severity.

How do I know if I’m drinking enough water every day? Is it really 8 eight-ounce glasses a day?
You know if you’re drinking enough water if your pee is light yellow or clear. If it’s dark yellow, you feel dizzy when you stand up from sitting, your lips look cracked and dry, or you are prone to headaches, you may be dehydrated. You can pee up to 2 liters a day and you lose water through the skin. I recommend drinking 2 liters of water a day – ideally with a squeeze or two of fresh lemon juice in it — to stay well hydrated. And look for clear pee.