Fluid Guide

WATER

Water intake is highlighted as a key component of chronic disease prevention. This might seem obvious since, after all, we are made up of 50-65% water (infants are made up of 70-85% water)! However, insufficient water intake is one of the most modifiable lifestyle choices we have at our finger tips. And studies show that water intake is directly correlated to a healthier diet. General recommendations for water intake are 2.5 L (80 fl oz)/men and 2.0 L (64 fl oz)/women-you may need more, particularly if you are exercising, drinking coffee or alcohol, or are part camel (like us!). We often use physical indicators to determine adequate hydration, such as the color/odor of urine, feelings of thirst, ability to sweat, or muscle cramping. 

Water Fast Facts

Fluids contribute 70%–80% of total water intake and food moisture accounts for 20%–30%, in the body. You can use combined fluids and food to hydrate. Food Sources of Fluid: Cucumber, watermelon, bell peppers, radishes, spinach, tomatoes. Filtered water, sparkling water (no added sugar, flavor, or salt), and non-caffeinated herbal tea are fluid sources that contribute to total intake and overall hydration status. Focus on these choices daily! 

Removing toxic contaminants and maintaining minerals are both important for drinking water, especially when consumed by pregnant women and children.

CAFFEINE

Caffeine is rapidly distributed throughout the body and is easily absorbed by humans, having approximately 100% of bioavailability when taken by oral route and reaching a peak in the blood within 15–45 min after its consumption.

Coffee

Coffee comes with known strengths -such an antioxidant (polyphenols) capacity. Polyphenols found in significant amounts within the seminal plasma act as natural antioxidants. But, are the polyphenols found in coffee the best choice for preconception or would tea be more appropriate? 

It is important to consider that fluids, like foods are more appropriate for your health at certain times than others and distinguishing between those moments is crucial, particularly in the setting of optimal preconception and pregnancy care.  

Women who consumed >400 mg (≥4 servings) of coffee pre-pregnancy daily experienced increased risk of miscarriage between weeks 8-19 in pregnancy compared to women who drank <50 mg daily or did not drink any coffee pre-pregnancy1. Decaffeinated coffee has some association with increased risk of miscarriage at ≥3 servings daily, as well, suggesting that there is unique aspect to the coffee itself that may increase miscarriage risk. 

Men with substantial daily coffee consumption have increased sperm DNA damage and men who consumed >4 cups of coffee daily had significantly lower sperm concentration11. It is important to note that most studies confirm that coffee intake does play a role in sperm DNA damage, but the quality of evidence may be biased. Taking into account a functional relationship between caffeine intake and sperm health, we do recommend that males keep their coffee intake to <4 cups, ideally no more than 2 cups daily. 

Teas, Soda, & Energy Drinks – A Caffeine and Sugar Conversation

Tea is undeniably powerful and contains nutritional constituents that have the power to balance hormones, reduce allergies, improve gut function, promote bowel regularity, enhance relaxation, aid in sleep and help detoxification. For that reason, we love the tradition of tea drinking that has existed throughout history. It is not uncommon for women to choose tea over coffee in the preconception and pregnancy time period, but shedding light on appropriate choices is important. Pre-pregnancy intake of caffeinated tea, caffeinated soda, and decaffeinated soda do not have any associations with increased risk of miscarriage in pregnancy, but certain caffeinated teas (>2 cups of black tea) do have an association with decreased fecundability, however that relationship is not seen with green tea intake. Sugar-sweetened and diet sodas are associated with increased risk of ovulatory infertility. These high sugar, artificially sweetened beverages are also associated with increased risk of obesity, metabolic syndrome and impaired fasting glucose, overall decreasing fecundability (chances of becoming pregnant). Artificially sweetened beverages also alter the sweet receptors in the brain and on the tongue-shifting preference and desire toward sweeter and sweeter things. 

Green tea contains numerous factors, such as vitamin C, carotenoids, and tocopherols (vitamin E); minerals, such as Chromium, Manganese, Selenium, and Zinc; and certain phytochemicals (nutrients found in the pigment of plants) such as EGCG-epigallocatechin gallate. These factors in green tea significantly increase the antioxidant capacity in blood levels as well as sperm after consumption of 2–6 cups/day.

Energy drink intake is associated with a 57% reduced fecundability at ≥1 can daily in males. Additionally, note that higher cola (caffeinated soda) intake (>2 cans) is associated with lower total sperm count, lower total volume and percentage of normal form, and lower concentration of total sperm. 

NOTE: Sugar-sweetened beverages (SSB) are the leading source of added sugars in Western diets. SSB intake is associated with the development of major health complications for children and adults36.  And there is a positive association between obesity and artificial sweetener (diet soda) consumption38. The good news? 2017 – marked the 13th consecutive decline in the volume of carbonated soft drinks purchased in the US…and we couldn’t be more excited about this trend! 

Kombucha

Kombucha is a traditional beverage usually created from the fermentation of black or green tea (sweetened with 5–8% of sugar) through a combination of bacteria and yeast. It is growing in popularity, although its first preparation is dated all the way back to 220 B.C. It is used as an alternative to both soda and alcohol (although it does contain some), and is favored as a probiotic-rich fluid source. Kombucha’s nutritional content will differ based on what foundational medium (type of tea or food) was used in the fermentation process. Ironically, as a result of the fermentation process a ball of bacteria and yeast is left which is affectionally known as the “mother.” Animal studies looking into Kombucha are promising; showing protection against food borne pathogens, improved glucose signaling, cholesterol-lowering properties, and liver detoxification support.  The popular and effervescent drink has a multitude of antioxidant, anti-microbial and anti-inflammatory characteristics, however only one study has been applied in human-subjects research, examining the health benefits of kombucha.  Kombucha is approved for preconception, but we do not know enough to say that we approve of this “mother” in pregnancy. 

Alcohol

This is a conversation for both parents because…

Alcohol consumption by the mother or the father during preconception and the mother during pregnancy can affect the epigenome (offspring’s genetic expression) across the lifespan and for generations. Alcohol use disorder has consistently been shown to have a high heritability of ~50%. The effects of alcohol exposure preconceptionally can alter behavior and increase chronic disease risk. Recognize that mental well-being can play a mediating role in alcohol intake, particularly in the case of depression. It is possible to manage alcohol intake by addressing your stress, triggers, mediators, nutritional needs, and movement habits. 

 A 2017 study from JAMA Psychiatry showed that alcohol use rose from 65% to 73% (adult population), which is about an 11% increase with the greatest increases seen in minorities and women.  Additionally, high risk drinking (defined as >4 or more standard drinks/daily [women] & >5 drinks/daily [men]) increased by almost 30% with even higher numbers seen in minorities and women.

It is estimated that at least 57% of US women drink. Alcohol intake during preconception increases the risk of miscarriage, neural tube defects, and esophageal atresia with or without tracheo-esophageal fistula (can prevent normal feeding and swallowing). This all sounds dire, until we also acknowledge that your effort during this preconception time to educate yourself regarding the effects of lifestyle and finding the support (hopefully easily found with your partner and your community) to implement these changes significantly decreases the risk of adverse outcomes.   

A meta-analysis including 57 studies and 29,914 subjects found a significant association between alcohol, semen volume, sperm morphology and sperm motility.  Chronic and excessive alcohol intake seems to have a detrimental effect on male reproductive hormones, decreasing testosterone and increasing estrogen, affecting the estradiol/testosterone ratio. Aside from fertility concerns, there is data to suggest that paternal drinking during the preconception period affects behavior, development, and gene expression in the following generations of their offspring.

Recommendations for both Partners

CAFFEINE: We align with the American College of Obstetrics of Gynecology which is to limit caffeine intake to <200 mg daily in preconception and pregnancy to decrease risk of miscarriage and low birth weight and improve sperm parameters and decrease sperm oxidative damage in males3. Switch to tea instead of coffee (even decaf) in during preconception and pregnancy. 

ALCOHOL: Remove it. This is a temporary (or maybe long-term lifestyle change), but a necessary part of optimal preconception health for both parents and your decision to remove alcohol promotes health and resilience in your family for generations.

SODA: Ditch the sugar-added and artificial. The recommendation for added sugar in the diet ranges from <25 grams (in children) to <50 grams (in adults). One single can of soda contains 32-40 grams of added sugar. And artificial sweeteners are not an alternative or healthy choice. Alarmingly, artificial and sugar sweetened beverages are associated with an overall increased risk of early mortality when consumed daily vs. 1X per month.

Apply It!

Fluid focus: Filtered and Clear water is best, no added sugar, no artificial sweetener, limit caffeine, green tea is a great choice for tea. Carbonated water is ok-no added sugar/salt.

Skip: plastic—refill your glass or stainless steel with filtered water 

Add: lime, lemon, orange, grapefruit, cucumber, coconut water, mint, and rosemary 

Need sweet? honey or real maple syrup 

________

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