Primal Nutrition and Fertility

First Place!Although for many of us starting a family simply happens (surprise!), others among us take an intentional approach. Maybe we delay having children for professional, financial or relationship reasons. Maybe we begin trying when we’re young. Regardless of timing, facing our fertility (so to speak) is an intensely personal and often emotional passage. It can inspire joy and wonder in our basic human capacities – our deep-seated physical impulse and emotional expansion toward parenthood. For some of us, however, the journey takes on anxiety and disappointment. Although varied and nuanced factors define our reproductive health (some not fully understood even today in the medical community), experts agree that lifestyle factors contribute to overall fertility.

I get emails from time to time on the fertility question, and I appreciate these readers’ stories and interest. The growing science of nutrigenomics, the study of how diet influences gene expression patterns, will undoubtedly offer more insights in the future. Research, however, offers plenty of suggestions already for enhancing reproductive results through dietary measures – a briefing of sorts on what to eat, what not to eat, what to consider supplementing, etc. For everyone who’s tried, is trying or interested in trying somewhere down the line, here’s a Primal primer for fertility nutrition.

For Both Men and Women…

Achieve a Normal Weight. Obesity is a known factor in infertility for both men and women. Obesity early in life presents the most reproductive risk.

Reduce Oxidative Stress. Oxidative stress from a whole host of factors, including oxidized fats, intense physical activity, alcohol, illness and regular metabolic functioning, negatively impact conception success and pregnancy outcomes. For men, oxidative stress has been shown to damage sperm DNA and lower sperm count and motility. For women, oxidative stress impacts conception ability by decreasing the permeability and function of the egg, impairing successful implantation of a fertilized egg in the uterine lining, and decreasing the viability of the embryo. (image)

Up your antioxidant and fish oil intake. We know antioxidants and anti-inflammatory fatty acids like omega-3 fight oxidative stress elsewhere in the body. The same goes for reproductive functioning. Research has shown time and again that antioxidants support fertility in both men and women. Vitamins C and E and cofactors like selenium, zinc and copper, appear to be especially key. There are probably many other antioxidants that can benefit as well. As for fish oil, sperm actually depend on a generous polyunsaturated fatty acid supply for well-functioning, fluid membranes that are required for fertilization.

For the Men…

As already suggested, the onus is on both halves of a hopeful couple. Here are a few key recommendations for men.

Avoid soy. I’ve never been a fan of soy, and prepping for pregnancy is a good time to reassess your intake. The issue with soy of course is the estrogenic effects, which animal and human studies have shown decrease sperm counts. The inevitable question is raised why Asian countries where soy is prevalent don’t suffer a fertility crisis. It’s a perfectly valid point – one which research hasn’t fully addressed. From my own perspective, I’d venture to guess that at least part of the discrepancy might be traced to the consumption of unprocessed, often fermented soy in Asian cuisine versus the heavily processed versions in Western menus.

Supplement strategically. Studies of male infertility have shown that zinc and vitamin C levels correlated with sperm count and quality. Additionally, L-carnitine and L-acetyl-carnitine have been useful supplements for enhancing sperm motility and quality.

For the Women…

Female infertility that can be traced to hormonal disruption, as in polycystic ovary syndrome (PCOS) or luteal phase deficiency, responds especially well to dietary intervention. A few years ago, a book called The Fertility Diet highlighted results obtained from studying 18,000+ women and the associations between their diets and respective fertility rates. Critics suggested that the study design was far from air tight and that the book’s findings were most useful for women with PCOS. The book, however, offered generally sensible recommendations for the most part. Somehow the findings related to carbs was re-spun to suggest “good carbs” as opposed to low carbs as the specific results suggested, but that’s of little surprise. Based on the bulk of research out there, here are a few recommendations for women.

Achieve Normal Insulin Levels. Excess insulin can impair ovarian function and increase hormone-binding globulin, which raises androgen levels and commonly decreases ovulation. Although getting insulin under control can help boost fertility, avoid chromium picolinate during the preconception period, since it has been linked to DNA mutation and sterility.

Supplement Strategically. Iron and zinc are particularly crucial for early cell division once the egg is fertilized. Folate (not folic acid) both pre-conception and in early pregnancy cuts the risk of neural tube effects. Higher iron levels have been linked to higher fertility.

Eat Clean Protein. The Fertility Diet authors suggests that balancing plant and animal protein corresponded with fewer fertility difficulties; however, no attention was given to the possible impact of livestock hormones, antibiotics, etc. If there’s any time to go organic, preconception is the time.

Eat Plenty of Good Fats. Trans fats are paramount in fertility impairment. One study showed that a 2% increase in trans fat intake resulted in a 75% increase in fertility risk. Full fat dairy showed a positive effect, but go for clean organic sources.

Go Low/No Alcohol and Caffeine. Both alcohol and caffeine have been shown to decrease fertility in women.

This has been sort of a brief, straight-to-the-point, text book overview of nutrition and fertility. Now it’s your turn. I know that many Mark’s Daily Apple readers have stories about going Primal and getting pregnant. Do you have recommendations and experiences for enhancing fertility? Share your thoughts and anecdotes in the comment board. Grok on!

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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118 thoughts on “Primal Nutrition and Fertility”

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  1. I knew there was something wrong with soy 🙂

    Some explanations I’ve heard concerning Asian consumption of soy vs. Western consumption of soy, is that, since it hasn’t been a part of the western diet traditionally, many Westerners have difficulty breaking it down and are more prone to soy allergies.

    1. There are a couple things about Asians and soy:

      1. Asians do not eat nearly as much soy as PETA thinks they do. It’s a condiment over there, not a main course. When they want meat, they just eat meat.

      2. The stuff is a ticking time bomb if you don’t handle it right. First off, they ferment most of it. Second off, they balance soy intake with iodine intake, particularly the Japanese. For example, if you have ever had traditional miso soup, you’ve noticed both tofu and seaweed in the bowl. The iodine in the seaweed helps head off the goitrogenic (sp?) chemicals in the soy.

      And with all that, the higher the tofu intake in Japan, the more likely the person is to suffer Alzheimer’s in old age. Who’da thunk.

      1. Asian cultures do not eat the amount of soy that PETA advocates. In fact, being half-Thai and having grown up with mostly Southeast Asian cuisine, I can attest (and surely my Thai family in Thailand) that I rarely ate soy. When I did it was the fermented sort. What PETA will also not tell you is that Asians eat a lot of meat and fat. Most of my meals growing up consisted of beef, pork, or chicken with some rice on the side. But rice isn’t a complete staple either. Many traditional dishes have no rice at all. Its just meat and a vegetable side like raw cabbage. The truth is, at least in Thailand, soy is what you eat if you can’t get meat. If you go to any fresh/open market in Thailand you will be hard pressed to find a single soy dish. Its very apparent that no representative of PETA has ever been to Asia.

    2. Soy is also often fermented in Asia, which significantly changes it’s chemical makeup.

  2. Just wondering if 38 is to old to start trying for a baby. I wasted most of my life being fat and now that I am almost at a healthy weight I wonder if I should not even consider it.

    1. I don’t think your past your prime, if you want a child you should at least try to have one. I know a lady who is 46 and just had her first baby without any fertility treatments or anything.

      1. Do it now, the longer you wait the higher risk you have of complications for you and your baby. Downs is specifically associated with late pregnancy.

        On a plus side your chance of having twins is increased greatly by later pregnancies. I’ll let you decide if that is a good or bad thing 🙂

    2. I think it’s fine. My mom had my little brother when she was 38 (my dad was 36). Keep in mind that risks of nondisjunction syndromes like Downs increase with age (and spike dramatically at 40), so I would be diligent about pre-natal care and screening, but I think if you want children and think you’re ready for them, you ought to go for it.

    3. Go for it! If you want a baby then go ahead and try. If the kid moves out when he or she is 18 then you won’t be 60 yet 😉

    4. Read Weston Price’s work and Nourishing Traditions, and all those Weston Price Foundation folks and like-minded people–they really have a handle on this. Nutrition may play as big a role in how kids turn out when born to older women, as anything else. It can affect how your eggs ripen and we’ve already got age as a strike against us when it comes to that.

    5. My sister just got pregnant, easily, at age 42 and passed the 1st trimester with no problems for her or the baby. I’d recommend a genetic test if you DO become pregnant to spot problems early, because there are risks as we ladies age.

      That said, GO FOR IT! If you want to, 38 is definitely not too late 🙂

    6. 38 is definitely not too old. People warn you of the horrendous increase in Down’s syndrome and the like as you age, yet even in your 40s, you are much more likely to have a healthy baby than not!.

      I had a surprise baby at 44 when I wasn’t even eating primal. He has been a gift in every way.

    7. Hi. I’m 38 and just had a baby last year! I was fat my whole life too and recently lost weight. It’s NEVER too late! I work with a woman who is 52 and she has four year-old TWINS!

      I am actually trying to convince my man to have another one. 🙂 I really missed out!

      Good luck!

    8. Sounds like you’re concerned about the weight gain associated with pregnancy. Fear not!

      If you aim for the lower end of the recommended weight gain for pregnancy (25 lbs, a very doable goal IF you approach being pregnant as part of your diet and not an excuse to eat unlimited donuts, a mistake I made myself), here’s what will happen:

      In the week after giving birth, you will lose 10-12 of those pounds (I lost 15).

      If you breastfeed, you are likely to lose another 8-10 lbs (12 for me) in the next 6 months without much effort–mild exercise (think strolling around your neighborhood while cooing at your newborn) will do it.

      The last 5-7 lbs were, in my case, a matter of blood, sweat, and tears, but then I gained 43 lbs, not 25. And they did go away by the end of the year. Most people who gain the smaller amount of weight find that, after breastfeeding, they don’t have ANY further weight to lose.

      Anyway, if you’d like (say, twenty years from now) to have had a child–to have that other person in your family–I say, be bloody, bold, and resolute about that healthy diet for 9 piddly little months. You can do it. You’ve already done something MUCH harder.

      I can also say that nothing has made me like my body more than being pregnant and breastfeeding. The things our bodies do! Amazing, bizarre, outrageous; funny, embarrassing, and sometimes beautiful . . . it’s a physical adventure like no other. It’s small potatoes compared to the end product, of course, but as an experience, I’d recommend it.

      Best wishes,

      and sorry for the novel,


      1. As a certified childbirth educator and student midwife, I have to say: please, please don’t “aim for the lower end of the recommended weight gain for pregnancy”! Recommended weight gains are based on the same sort of flimsy evidence underpinning the Standard American Diet — only with even less justification for modern women: doctors originally advised food restriction to produce small babies, so they’d fit through pelvises narrowed by malnutrition. (Good way to perpetuate a cycle there 🙁 )

        A woman eating a healthy diet during pregnancy can gain thirty pounds, or sixty, or even lose weight if she’s obese before becoming pregnant. But aiming to restrict food intake while growing a human being is counterproductive; you want your baby well-nourished and healthy too.

        Average weight gain during pregnancy is on a bell curve with a midpoint around 30 pounds (also the exact midpoint of the healthy women I went through my teacher training with). That weight breaks down as: 8 pounds of baby, 2 of placenta, 2 of amniotic fluid, 2 of uterine growth, 2 for breast tissue, 4 of extra fluid in maternal tissues, 3 to 4 pounds of extra blood, and 7 pounds of stored fat/protein/nutrients.

        Personal data points: I’ve always been lean-to-average, and gained 26 lbs. during my first pregnancy, 40 during my second. In both cases nursing took me to 10-15 pounds *below* my pre-pregnancy weight by the time my kids weaned.

        Anyway, just eat what you know to be nutritious and don’t sweat the pounds; they’ll come off afterward.

  3. Great article Mark!

    I also think that getting plenty of sleep, regular exercise and having a positive attitude in general goes a long way. When our hormones work normally and optimally, there often is great progress made with aspects such as fertility.

    Those tips are good both for both fertility and a good sex life.

  4. Just had to add my 2 cents. I am overall healthy. Healthy weight my whole life, moderate exercise, good amount of fat, limited trans fats, moderate consumption of coffee (16oz a day). My husband is much the same, probably consumes less caffeine. We have no diagnosed reason for infertility yet we haven’t gotten pregnant in 8 years of marriage. I’m just saying….

  5. The biggest factor by far in the growing problem of male fertility is plummeting testosterone. Average values of the hormone in men has been steadily declining for about a half-century in the United States.

    BPA is one well known factor in the process, but another important problem is a group of estrogen mimicking compounds (Alkylphenol-ethoxylates) which cross the skin barrier and exist in pretty much every grooming product you can imagine. Here’s a report (google cache of .pdf file):

    1. “Average values of the hormone in men has been steadily declining for about a half-century in the United States.”

      I think the increase in abdominal body fat and lack of activity for the last fifty years might have even more effect…

  6. @ Sally~ No, it is never to late… as long as you are healthy and have the ability to love and provide then by all means try! Follow the suggestions and go for it.

    @ Abby~ I’m not sure how long you have been eating primal, but you said “good amount of fat, limited trans fats” If you look in the article it says… “One study showed that a 2% increase in trans fat intake resulted in a 75% increase in fertility risk”

    1. Abby~ The rest was cut off… if possible try to eliminate it, except for maybe whole organic milk. Just 2% makes a factor. Also, STRESS.. I truly believe is a BIG factor in being able to conceive. For me, I conceived with both kids when there was a significant drop in my stress level and mind you I was at 334 with first and 385 pounds when conceived my second… so based upon Dr’s ideas I should not have been able to conceive at all , but that is a different story… have faith, and RELAX…

  7. I would also recommend all women to read the book Taking Charge of Your Fertility. The book explains how your menstrual cycle actually works and goes against some conventional wisdom. It explains both a helpful non-hormonal method of birth control and a helpful way to conceive or, if infertile, ways to pinpoint what the issue is (if it is a problem with the female). Since reading it, I really think all women should read it as it is very enlightening and helpful. I now understand my body and how it works, which is really empowering. The book does recommend a conventional ‘healthy’ diet in a small section, but other than than, the book is awesome!

    1. That is a very good book, I learned so much about my body when reading it. I never really knew much about the female body until I read this book, funny thing though I read it to use it as a form of birth control, well apparently I cant read very well because 3 months later I was pregnant!

    2. Ditto on the “Taking Charge of Your Fertility”. DH and I had trouble conceiving and two cycles after buying that book, we got pregnant!
      It has a ton of information that I wish I had known about years ago.

    3. _TCOYF_ really is an awesome book, and as a pregnancy/childbirth professional, I recommend it. It didn’t do anything for me in trying to conceive a third child, though, because it assumes a regular daily schedule (my sleep patterns vary drastically), which made charting extremely difficult. Your mileage may vary.

    4. Taking charge of your fertility is an amazing book. it should be required reading for all women. I couldn’t believe how much I did not know about the basic functioning of my body as a 32 year old woman. the human body is really a symphony.

      3 months later i was pregnant. I could have spent a lot less time and money on birth control than the ten years i poisoned myself with that stuff.

  8. eeeeeek! i am so interested in this post!

    as a former anorexic and currently infertile ‘specimen’ i am tryiing everything i can to restore my menstruation. i eat beef & chicken livers a few times a week but am wondering if iron/zinc supplements would help? you only touch on the obese and not the underweight… opinions?

    all my fats come from meat, coconut oil, butter and avocado, cream and occassional square of 100% chocolate

    i include kefir/goat yogurt a few times a week

    my BF currently says around 17%

    i have coffee in the morning with cream… is this worth giving up caffeine?

    1. I second this question- I am in pretty much the same exact boat as you, Mallory. I eat tons of calories but am having a hard time gaining/getting my period back… and I drink coffee every morning too! I hope I can keep that haha

    2. I don’t know if you are still trying to conceive (hopefully you already have a baby on the way!) but if not, cutting out caffeine might be a good option. Some studies show that it alone can reduce your fertility by half. I’ve also seen studies that your body fat needs to be between 18 and 22% to conceive, so maybe getting it a tiny bit higher might make a big difference too.

    3. i don’t know if you are still experiencing problems, but if so maybe i can help… i am also a former anorexic and had trouble getting my cycle back to normal despite having normalised my weight. i went to a woman’s nutrition expert who told me to eat butter, (tblsp)cod liver oil and (tsp)spirulina powder daily. within three weeks i had my first period in years. Goodluck

      1. I just wanted to second this comment in a big way, and to say THANK YOU KATIE (hopefully some people like me still check out this thread!). I actually read this three months ago. I am also recovering from low body weight (never anorexic per say, but living the high-carb-but-restrictive-diet-along-with-tons-of-distance-running lifestyle for a good seven years). Two years ago I stopped birth control and realized I had no period, while just starting to embrace a paleo lifestyle (and all that comes with it – no more crazy running, more play and weight lifting). I figured my body would right itself but even after getting back to a healthy weight and eating right (all the good fats, little to no carbs, lots of nice protein)…still nothing. So I saw this and got some cod liver oil and some spirulina pills and BAM – period one month later. No joke. I just got a second one so I think this might actually have worked. TRY IT! Best of luck 🙂

        1. oooops – by thank you Katie I meant thank you Anna – though I also think Katie has a point with the 18-22% BF being key too!

  9. Truthfully my biggest issue is that people think they are in control of their fertility. Don’t get me wrong, being healthy is going to be a bonus, but I know morbidly obese people who can get pregnant, and some who can’t. I know super skinny people who can get pregnant and some who can’t. Just like you Amanda, you said based upon Dr’s ideas, you should not have been able to get pregnant (congrats btw).
    As for the relaxing, I understand what you are saying about that, but ever since we adopted 2 years ago, we have been relaxed, promise. We are currently in the process of adopting another. So mythbusters here, relaxing doesn’t make babies and once someone adopts, they don’t get pregnant either. We are completely at peace with never getting pregnant (I forgot to mention I’m 29 and my husband is 31). I just wanted to encourage women that fertility is in the Lord’s hands, not yours.

    1. Well said! I’m 28, and after 2.5 years of trying, I have made peace that having a baby might not be my path and I can only do so much, the rest is not in my hands. We have been so relaxed about it now for about 5 month, and nothing has happened. I have come to realise that my happiness is not determined by wether I have a baby or not.

      The best thng about unexplained infertility… it has brought me so much health, in seeking solutions to be healthier I found Mark’s website, and for that I a grateful.

    2. That may be true, but I know someone that tried for ages.. did everything they could, finally decided it wasn’t in the cards and started renovating their house. She was pregnant within 6 months. There is a story for everything. All you can do is try to get healthier and relax.

  10. Good response Abby.

    There are few things more frustrating to someone struggling with fertility problems than being spoon-fed the “just relax” “go on vacation” “don’t stress” platitudes. Vacation has not solved my recurrent miscarriage problem. Not being stressed hasn’t solved it. Nor has relaxing. And no, adoption won’t solve it either.

    It is possible to be of sound mind and body, and still have fertility problems. Truly, if stress were THAT huge of a factor, explain to me, please, how it is that women suffering famine and disease in other countries manage to both get pregnant and carry to term?

  11. Yes Junebug, you said it better than I could.
    I am not disagreeing with MDA or the primal lifestyle. I just wanted to point out there is no certainty that if you do this and this you’ll get pregnant.
    I think women can stress themselves out way too much trying to figure out the why. When sometimes it is what it is. Plus, as Christians, adoption is part of the Gospel.

    1. Abby – thanks for your response. I too am dealing with infertility that has no known cause. I’m healthy, eat right, exercise and still haven’t had a cycle in over 5 years; nothing, nada, zilch. I’m 31, 20% bf and all tests come back normal. We have just accepted that if God wanted us to have a baby, He would make it happen, primal or not. We feel like He is leading us toward adoption and are perfectly content to let His plan unfold.

    2. All right I’m going to dispute this, because there are enough heartbroken mamas and confused adoptees out there without making this a religious crusade.

      Moses was indeed adopted, but his life was in danger or he never would have been given up by his mother. And Moses’s story is not in the Gospel. The Gospel is the first four books of the New Testament, not the whole Bible.

      Overwhelmingly, if you look throughout the Bible, kids stay with their parents, even if their parents are poor. The Bible explicitly calls for believers to care for the “widowed and fatherless”–to care for widows and orphans, NOT to take the orphans away from the widows and hurt those a second time.

      For every person who’s drunk the adoption Kool-Aid–first mama or adoptee–and says it was the best thing that ever happened to them, I could point you to ten other people in either category who will tell you they wish it didn’t happen. The adoptees may even love their adoptive parents but that doesn’t discount the losses they have suffered.

      My daughter knew who I was at birth, so the “blank slate” argument doesn’t wash either.

      I guess what I am trying to say is be careful before you take advantage of someone’s bad situation for your own benefit. And that adoption IS NOT a cure for infertility. You could take all the children of the poor away and raise them yourself and guess what? You still didn’t give birth to them. You’re still infertile.

      And don’t assume everyone here is a Christian, either. Pardon me for saying so, but Christianity isn’t exactly Primal and the Primal lifestyle appeals to a lot of other people too.

      1. Dana,
        I am assuming your comments are directed at me. So I will respond accordingly.
        First of all, no one is assuming everyone here is a Christian. I am a Christian so I am free to talk about it. Also, I agree with most of the PD so no need to make assumtions as to what is or isn’t “christian.” Also, I am well aware that even thought I’ve adopted, I’m still infertile (wow, did you really need to write that?)
        My only point during this discussion is an encouragment to infertile women that most of the time, their infertility is not their fault. Which is something that is being beat into their heads all the time. You need to eat this, you need to do this, start doing this, stop doing this. If you did all this, you would get pregnant (ie, it’s your fault).
        A woman can be very healthy and young and still be infertile (without a male factor too).
        I encourage women to try this diet, but just don’t pin all your hopes on it to get pregnant.
        Lastly, I am also aware of what the Gospel is. I’m not sure what your point is about Moses either. And I’m glad your daughter knew who you were at birth. All points that are unneccessary in this discussion.

      2. @Dana- I don’t think Abby meant that adoption is a necessity of the Gospel, rather it can be seen as a definitive part of Christianity (James 1:27).

        @Abby- I’m not trying to put words in your mouth. The above assumption was based on observation.

      3. I, too, understand that most on these boards are not Christian, but I have never once commented against someones religious beliefs, despite how much I disagree with them. And I do think the primal lifestyle is Christian!

        Eat the foods that God designed for us to eat and move in ways that He created our bodies to move!

        And thanks for reminding me that I’m infertile, I must have forgotten.

  12. Of course, I agree with the lifestyle too, that’s why I practice it. And I think it *does* help. However, it can only help up to a certain degree. Everyone here loves epigenetics and gene expression, right? Well, my reproductive fate was determined before I was even born due to my mom’s low estrogen levels during pregnancy. All the bacon and spinach in the world cannot undo that. I am working with a naturopath as well as a fertility doc. The naturopath recommended essentially the primal diet (which I was already doing, except I finally did cut the dairy) and made me cut back on the Crossfitting (like Mark’s mention of exercise contributing to oxidative stress). I’m also doing acupuncture and supplements.

    We’re just now trying again – we took a 6 month break after the last miscarriage. I’ve yet to see if these changes – minor though they are – help, though I cannot help but feel like if my body wasn’t healthy enough already, it never will be. There really and truly is only so much that is within our control.

  13. I have PCOS, and at one time I had gone without having a period at all for a year and a half! I then adopted a more low-carb lifestyle, lost 30 pounds, and my body was able to regulate itself. It’s so frustrating to me when I go to PCOS forums to see the typical low-fat dogma recommended there. A low-carb/paleo diet is THE best thing you can do for PCOS, aside from losing weight (good thing the two go hand-in-hand!)

    1. I’m so glad I’m not the only one who’s noticed this! When I first learned I had PCOS and started obsessively reading everything about it, it was the weirdest thing: first they’d say it was primarily an insulin resistance problem, then they’d gaily recommend a low-fat diet with whole grains. So irritating! I come from a whole family of diabetics, so I KNOW what insulin resistance means. So instead of taking the stupid PCOS sites’ advice, I went low-carb. And I lost 30 pounds and got a regular cycle back. It makes me so angry to see the “low-fat, whole-grains, and then when that doesn’t work go on diabetes meds…” advice 🙁 The problem is too much insulin screwing with your hormones. The answer is to keep your insulin levels low by not spiking your blood sugar.

      Or at any rate, it worked pretty well for me.

      1. When I was diagnosed with PCOS at age 19, I was lucky to be sent to a nutritionist who recommend a high-protein, high good-fat, low (15-30 g/meal) refined-carb diet. When I stuck to it, I lost 20 pounds and improved my LDL/HDL, triglycerides, and androgen levels. Since I stopped sticking to it, I’ve gained weight. I started CrossFit a few months ago, and have already started leaning out, but am now going to go Primal to really dial it in.

        My question is for the PCOS ladies – did any of you take metformin before going Primal, and did you stop taking it after going Primal? I’m given it somewhat preventatively (I’m *only* about 20 lbs overweight, which for PCOS, isn’t bad), but I’d love to get to a healthy lean body mass and come off the drugs.


        1. Wish I could help, there. I did not take any drugs for it, just dove headlong into low-carb. Maybe invest in a glucometer to help you regulate diet and get off the drugs?

        2. Hi, Yes I have been prescribed metformin for PCOS which has been a real wake-up call for me and brought me to this website and starting a new journey. In fact I am not at all overweight but nevertheless clearly ‘insulin resistant’ and finding things *fairly* easy with the meds.
          I am worried about when I stop taking them though… I am guessing the cravings might be harder to manage…
          Has anyone else experienced this?

  14. I think I wrote you, Mark, once upon a time to gain advice in the fertility dept and how this diet plays a role.

    As someone who was trying to conceive for 3 years, I knew part of the equation was in my hands but I also NEEDED help from a Dr. There are 2 (maybe even 3) directions infertility can take you. One being a metabolic dysfunction in which managing your blood sugar could play a key role. Another would be the physical dysfunction such as block fallopian tubes or a malformed uterus, in which diet will NOT help. One more area would be the diagnosis of “unknown infertilty”, which is me. I was on top of my diet and activity levels, at a healthy weight, of a reasonable age, etc, etc(aka “normal, normal, normal”). It took one of the best fertility Drs in the country to get me knocked up.

    I am 7 months pg now and have continued my Primal eating, moving, living….so far!

  15. I love the fact that living by the primal blueprint – replicating how our ancestors lived but doing it in the modern day simply improves quality of life for every single thing.

    If you want to get better in anything – live by the primal blueprint.

    Anytime someone asks me how to do this or that in a better way I will just advise them to read PB and point them to this blog (and mine).


    I feel lucky to be venturing into this lifestyle at such a young age (22 on May 11!!). Knowing it improves fertility is another reason to truly be 100% primal.


  16. Age is the biggest issue. In human history, women have always been conceiving the most between 15 – 25. These days, a lot of people only consider kids after 30-35, and that alone reduces fertility by ~ 90%

    1. I suspect that happens because these folks haven’t been taking care of themselves. If you’ve spent your twenties not eating right, the thirties is when it starts catching up with you. I’m beginning to see, in the entertainment news (you can’t avoid it, I’m afraid), my fellow Gen Xers beginning to drop like flies because all the partying they did ten-fifteen years ago is finally shutting them down.

      If people are going to delay childbearing then they need to do it sensibly and take good care of themselves rather than think “I’m young and can handle it and I’ll take care of myself later.” Every time you make a bad choice you are chipping away at your foundational health. I found that out the hard way.

      There IS fertility after thirty. There is even *healthy* fertility that doesn’t produce chromosomal defects. As long as nothing’s wrong with the equipment, there’s no reason it can’t happen. You just have to make smart choices.

      It is not like the culture supports people having babies that early anymore. I laugh every time I hear someone rant about teen moms because mine was 19 and had been married two years. That’s really frowned upon now.

      1. So agreed! I was married at 21, and had my first daughter at 23 – by far the first in my group of friends to do so, and looked a bit askance at by some people (at least until they realized that I have an very good head on my shoulders as it were LOL). I had a different experience than most people anyway – I had known my husband since I was 16, so while we were young, we had still been “together” for 5 years. It was odd!

        The funnier thing though is how relevant it is to culture. A few years before I got married, I was working in Crown Heights, for a Hasidic Jewish accountant who worked out of her home. I went to my coworker’s house for seders, for Pesach, etc. – and got the interesting perspective of going to my boss’ daughter’s wedding (at 20), seeing a number of other girls married and with kids by 19-20, and not at all unusual in that community – in fact her other daughter was considered an old maid and was quite undesirably unmarried at 27 (this was considered quite a problem, and serious time and money was being put to solving it!)

        1. The best time for women to bear children is late teens to early twenties. With modern day lifestyle, toxins in the food, boat loads of estrogen from birth control, plastics and parabenes from make-up etc, health in the 30s will be inferior unless you pay attention to it early enough.

      2. You’re wrong again, and this was Abby’s entire point about how women are told to do this, don’t do that, eat this, don’t eat that, and it will magically solve their infertility problem. The major giant glaring factor you neglect to take into account is plain old dumb luck. Some women have no trouble conceiving and carrying to term in their late 30s. Some have trouble conceiving and carrying to term in their early 20s. Of the former group, some have led healthy lifestyles their entire lives; many have not. Of the latter, some have led healthy lifestyles their entire lives; many have not.

        Fertility decline is directly and indisputably linked to age *regardless* of eating habits, lifestyle, etc. Otherwise we could all be 100% primal starting at birth and still conceive naturally at the age of 60, right?

  17. Three of my 4 pregnancies happened when I was on a low carb diet. When I wasn’t dieting I had fertility problems. I definitely agree that insulin levels are a big part of fertility issues.

  18. oh my gosh guys this is so depressing.
    i am ONLY 24 years old i am and should be at my PRIME for fertility.

    i did once have a period, before the eating disorder, and lost it at age 19-20 and have yet to have one since.

    as i catholic i totally understand the putting of my health and fetility in Gods hands BUT that is not acceptable to me.

    b/c i blame myself for becoming so sick and twisted it is MY fault i don’t have a period(not God’s) and after this many years of eating low-carb and primal with no period i just dont know what to think.

    junebug can i ask why you cut out dairy when Mark said in the post full fat is good? is there a link between fertility and dairy!>>!???

    1. Mark doesn’t necessarily advocate regular dairy. He just gives recommendations if YOU DECIDE to consume dairy.

    2. Mallory:
      Don’t blame yourself! I know I did…for anorexia, and the resultant amenhorrhea, and bone loss, etc. I konw what you are going through. I do. And I also know how hard it is to add all that fat back into your diet…so congratulations on that!!!!

      It just takes time. I had my first normal menstural cycle 3 years after I started the eating disorder; and over 1 year from having achieved and maintained a healthy weight. The longer you had the ED, the longer it will take to heal.

      I also think that for some people who have injured reproductive systems (and this is especially true for women, who usually get an ED when their reproductive system is finally getting all settled) you need supplementation from herbs. Vitex and maca are two that you might look into; maca is actually a root related to the sweet potato, so it’s just kind of a “super food.” It helped me tremendously.

    3. Mallory,
      My naturopath recommended I cut out dairy. I protested a bit (I love my Greek yogurt), saying that I don’t have any lactose intolerance issues. She said even absent obvious symptoms of such, our bodies simply have a hard time digesting cow dairy. She did say goat dairy was fine (blech). It was just one small part of an overall plan to improve my adrenal function and thereby (hopefully) improve my ovarian function. It was a recommendation specific to my case and my problem – not necessarily a blanket recommendation.

      1. There has been a link between infertility and dairy – but low fat dairy. I steer clear from dairy when I can, and especially non-organic dairy.

      2. People probably do have trouble with cow dairy–if nothing’s been done to it.

        Humanity has lasted as long as it has consuming foods it has not evolved to consume because it predigested those foods. Overwhelmingly, across the world you will find that traditional cultures ferment their seed-based and dairy foods. That’s where things like sourdough and yogurt come from.

        Yogurt and kefir cultures not only eat up lactose but also break down the fats and proteins to be more easily digested in the body. And while not all naturopaths are vegetarian, a lot of them are biased in that direction. You might ask yours where she stands on the issue.

        1. My naturopath is not remotely vegetarian, at all. She is a doctor, with a medical degree from a naturopathic school of medicine, not some 3rd generation curandera who learned from the elders. One of the very first things she had me do was keep a diet diary for her for a week. She enthusiastically approved of my Paleo diet, with the exception of cow dairy. We’re she anti-meat, I’d imagine that would have come out at the same time.

  19. I have had multiple friends with fertility problems until they cut all grains and sugars out of their diet. Lo and behold, they are all with children since dietary changes. I’m sure this doesn’t work for everyone, but it is definitely worth a try. I think it has a lot to do with malabsorption issues and not enough of the right nutrients to support conception. It seems insulin is a factor as well. Not sure of the answers, but I’m about to go on a SAD diet so I can STOP getting pregnant. I’m having #3, my SECOND totally unplanned pregnancy, and I’m thinking even a vasectomy won’t stop us from conceiving. Damn Primal diet!!!

  20. I am 42, been eating Primal/Paleo for a year, off all gluten since I was having so many issues with it. I am now pregnant for the first time without fertility treatments (5 months). baby looks great, having a easy pregnancy too. I have occasionally eaten some rice or quinoa during my first trimester when I had some mild nausea. I honestly think this way of eating has made a huge difference. I have been feeling better than ever eating this way! My doctor says all my blood tests came back great and to keep up whatever I am doing…….

  21. This has been an ongoing issue for us, we’ve sort of given it a month or two more, and then it’s back to the R.E. Chalk up another one for “unexplained”. I am overweight, but all my levels are within the healthy range. It’s been eight years.

    I can tell that something is different though, since I have started eating Primal. Some crazy hormonal mumbo-jumbo seems to be afoot. My husband made it clear that it’s not just me. He has been eating about 60% Primally, and just informed me that “this stupid Blueprint of yours is making me notice breasts EVERYWHERE!” (Nice excuse man- but I get your meaning!)

  22. Mark, do you think women who have been on birth control for a long time would have more problems conceiving from all the estrogen load?

  23. Losing weight can often solve fertility problems, due to its effect on insulin sensitivity.

    However, increasing insulin sensitivity/decreasing insulin resistance alone (independent of obesity) can greatly increase one’s chances of getting pregnant who’ve previously had fertility problems.

    Here’s an interesting read:

  24. Insulin levels played a huge role in me not being able to get pregnant for over 10 years. I developed PCOS and endometriosis. Once I got my PCOS under control (by going low carb), my fallopian tubes were too scarred from the endo to conceive naturally. So, we did IVF, which worked on the first try, and now have 15-month old twins. I am trying to raise them primally, too. My PCOS and endo are now gone and we might try for a little girl next year.

  25. okay so should i like be monitoring my insulin?? the only think i know is when mine is outta whack mytemples are beating out the side my head. i will start prickin if there is hope in it!

    1. I don’t think they make at-home insulin test kits. You could test your glucose though. There are usually a few free meter offers going around the Internet at any given time. Walgreens and CVS have their own store brand monitors that are pretty inexpensive too, although I have no information about their accuracy.

  26. The cleaner I got my diet, the more potent I got! After a 4 month zero carb/all meat diet (grass fed, local beef and wild game) well, on April 15th we had a boy! Fritz is the product of Primal livin!

  27. I think its so funny that you posted an article on Primal and fertility today.

    I have PCOS, Insulin Resistance, and have had amennorrhea for 3+ months now.

    I started eating Primal a couple weeks ago because I want to get healthy again. The dh and I going to try for our first child in the next 6 months or so.

    In addition to doing primal I also started supplementing with a pre-natal vitamin that contains Folic Acid and Iron.

    And the reason why this is all so funny?? This morning, my 3 month stretch of amennorrhea came to an abrupt end 🙂 I attribute it to going primal two weeks ago!

    1. i am sure the primal diet is great for PCOS, but in your case I think it was a bit too premature to be the result of your diet change 🙂 with PCOS the growth of the follicule is stopped before ovulation, probably due to high insulin level. The idea would be that primal diet=normalization of insulin level=normal growth of the follicule=ovulation=14 days later if not pregnant you get your periods. When you started your new diet you had or were probably just ovulating, meaning your diet didn’t have the time to have an influence on insulin level and ovulation. But I am no expert, just someone with PCOS: maybe the primal diet had an impact on your hormone levels anyway and your body reacted by getting rid of the old uterus lining. (in that case though it still didn’t have an impact on ovulation, it could have been a cycle without ovulation).

  28. Beer should also be avoided for men (even though most do if they’re primal). The hops that are used to brew beer are one of the most estrogenic plants going around. There’s a whole history of the temperance movement changing the brewing ingredients that promoted vitality and sex to the hops that dissuade sex and energy.

  29. I just got done reading Real Food For Mother and Baby by Nina Planck. Fabulous book! It is the first book I’ve read that talks about how important it is to eat healthy BEFORE you concieve not just after. I also have PCOS and my husband and I have been trying to conceive Thing #2 for about 7 months with no luck. I have been trying to eat primal for about a year now but there is still room for improvment. Thanks for the great article Mark!

    1. I want to also say that Nina Planck’s books are fabulous!

      I too have PCOS (as well as endo). I had lap surgery to remove the cysts, fibroids and endo. My tubes were clear which is a plus. I’m 37 so they are putting me on Metformin/Clomid. Primal eating, IMO, is crucial to keeping mom and baby healthy. I was able to avoid metformin for quite some time by cutting out grains/starches. I hope to get off of it soon enough.

  30. Ahh a timely post. We take so much for granted!
    After being on the Pill for 12 years, when my Hubby and I decided to try for a baby we got Preg right away..and miscarried…and got preg less than a month later. Full term, easy Pregnancy, delivery etc..Decided to “have them close together” and 17 months later had baby #2. I was still nursing my first, but she started sleeping through the night at 3 weeks! Easy pregnancy again, she was almost born in the car, quick, natural birth. Nursed her for 11 months. They are now 6 and 7.
    We are about to make the BIG decision…about #3. I am torn..I need to make a decision because my Merina expired over a year ago (I KNOW!) and it needs to come out and be replaced..or not.(I would rather give birth naturally than to have that instrument of torture inserted into my uterus again..OOWW) I do not like ANY of my options for BC and DH will not consider a Vasectomy. My point is that at age 37 (Hubby is 39) we just assume we would get knocked up again if we tried! What if we wore out our luck? What if things didn’t go quite so well this time? What if we are too old?!!
    I just relly have been avoiding making any kind of progress here…thoughts anyone? Thanks for discussing such a sensitive matter! XOXO

    1. I don’t like any options for BC either, and so I am not using any. My husband and I decided to try natural family planning.

      Before you get freaked out and think I am talking rhythm method, you should check out a few websites, helped me, and I am using the “Justisse” method of fertility management (a google search for it should find it no problem).

      I like this method because it’s about body awareness, and what could be greater than being aware of your body! No hormones, no barriers, no vasectomy, and no babies.

      1. Thanks for this link, the site is great! I also really like the Taking Charge of Your Fertility program – I read the book first and use the software. I like it because I can chart electronically without having to be online, which was nice when we were roadtripping in Mexico and didn’t have daily access.

        I will definitely take a poke around the Fertility Friend site. We are currently using the “Fertility Awareness Method” for birth control, not conception, but the basics are the same…

  31. Does being on the Pill effect your fertility after you’ve stopped taking them? I’ve been on it for about 4 years but I do want to be trying for a baby by the time I’m 28, so less than 7 years. If it’s going to cause problems for me then I’ll definitely consider stopping it.

    1. Birth control pill will always deplete vitamin/mineral levels toa greater extent, especially zinc. You should be on a good bio-available multi-vitamin.

    2. It is hard to determine whether being on the pill for an extended period of time affects fertility, since increase in age is a counfounding variable. However, from what I’ve read and heard from OB/GYNs, being on BC should not affect your chances of getting pregnant once you are off it. This is why some women miss just 1 day of BC pills and end up preggers. However, I still feel uneasy about being on the patch, having been on it for the past 7 years straight. Have definitely been thinking about this more and more since I am 26 and getting married in a few weeks (though we’re not planning on trying for a baby ASAP). But the patch is just such a damn convenience, ugh!

      1. You might want to use a barrier method for a month or two after coming off the patch, just to be sure. While studies haven’t been conclusive, some hormonal methods like Depo-Provera have shown increased risk of birth defects in pregnancies conceived within a month or two of stopping the method. (In the case of Depo-Provera, the problems include low birth weight, chromosomal anomalies and polysyndactyly.)

  32. I would actually prefer no fertility, but, thanks for the info!!! 😉

    1. Just eat and drink more soy and grains and you should be well on your way there.

      1. Soy and grains is what killed my reproductive system! You have to go with what works for your body, there is no ONE solution for everyone! My estrogen levels were already so high that adding soy contributed to the development of fibroids, menorrhagia, endometriosis, and ovarian cysts. Grains contributed to a host of other problems leading to the inability to support a fetus, even though I was extremely fertile. Everyone has different needs. One person’s cure is another person’s poison.

      2. I didn’t say I wanted to get fat and experience the diseases of civilization, just that I’m not using any fertility I may currently possess, and would prefer to have none.


  33. I have struggled with infertility and PCOS my whole life. I was put on the pill at 14 for PCOS. Since I have been primal, I have noticed a difference in my periods and I am not on the pill anymore to control PCOS. It seems like I encounter so many people who have infertility issues. It is scary.

    I think that BPA plays a big roll because we encounter it in so many places, the biggest being receipts. I just wrote a whole post on BPA and how the government is hiding or at least delaying research that proves this is a BAD chemical.

    I hope that all of you that have fertility problems can have your baby dreams come true someday.

  34. I dont promote soy and dont buy it but I have to point something out: When people say “1. Asians do not eat nearly as much soy as PETA thinks they do. It’s a condiment over there, not a main course. When they want meat, they just eat meat.” I have to debate it. I lived in Japan for 4 years and so I am only talking about Japan. They eat a ton of soy. It is not just a condiment. It is in everything including their meat dishes. I would order a pork dish and it would come with tofu in it. Soup would be made with miso and often still contained chunks of tofu. Soy noodles were common. I ate at many homes and soy was always served in some form. I rarely ordered anything at a restaurant that didnt contain soy even though it wasnt in the meal description.Then there were the soy drinks and dont get me started on soybean ice cream and the edamame. It is not mostly “fermented.” I bought these yummy meat sauces in a packet and when I used them they all contained tofu. When I was younger I worked as a nanny for a vietnamese family, born/raised in Vietnam, in their home and they ate tofu daily. Big blocks fried in oil. The other family members would come to visit and they cooked the same way. Not a condiment and not fermemted. I personally prefer meat but I do think we need to be more honest about the amount of soy asians eat and stop trying to pretend it is small amounts.

  35. For me, the Fertility Awareness Method has been a big part of “going primal” for me, swearing off hormonal birth control and instead learning to trust my body.

    My husband and I have been using this method (as birth control) for 2 years without incident and will surely use it as means to conceive if and when we reach that stage in our life.

    1. Woops, I just posted a reply about this up above. Fertility awareness rocks, and for me, going Primal was just another step on “being more natural”!

      1. I am familiar with it..I just don’t think I/we have the control to go without sex because it is a “fertile” day. Our time alone together is precious and we like to make the most of it…and after being pregnant 3 times in two years, I don’t know if I will be playing with

        1. My husband and I use condoms during my fertile time, or just treat ourselves to enjoying things less risky. Barriers aren’t that expensive and (at least here in Ontario) most cities have a sexual health clinic that distributes both male and female condoms for free.

          Along with fertility awareness, it I have never felt happier or more in control of my body. My periods involve only minor discomfort and are 100% regular – 28 days – since going off the pill 2 years ago. I was diagnosed at 14 with PCOS and this is the first time, even with birth control, that I have had regular periods. My PMS symptoms have nearly vanished. Actually, I’m much more likely to be emotionally distraught and “moody” around my ovulation date.

          When we first started, we thought it would be really difficult to keep track of everything and have the necessary self-control, but 2 years later, so far so good!

  36. I just wanted to add this. I will be 38 in July. I have 2 daughters age 16 and for many years we tried to have another child but it never happened. I was told about 10 years ago that I have PCOS (I am very overweight) and would not be able to have another child without the use of fertility treatments. As we already had 2 daughters I felt that was unnecessary and after a period of mourning my infertility I accepted it.

    My husband and I split 3 years ago and I have a new boyfriend. He was diagnosed with Diabetes in October 2009 and therefore decided to go on a low carb meal plan. In January I heard that 70% of women with PCOS will develop diabetes if they do not lose weight.

    That was enough for me. I joined him on his low carb diet and have lost 80 pounds. I am also now 2 months pregnant. Keep in mind I have not used any form of Birth Control in 16 years. Even before I found this awesome site, I knew that my getting pregnant was because of the weight loss. I am still VERY overweight and am working at losing another 120 pounds or so. 🙂

    The hardest thing is staying low carb when the pregnancy cravings want McDonalds! lol

    1. Congrats to you Amy on your weight loss and pregnancy! I myself have lost 130 lbs on a low carb and now Primal diet. I love to hear about people really turning their weight issues around and not resorting to really drastic ways out like gastric bypass. I am sure you will lose the rest of the weight you are aiming to. Good luck to you!

  37. In addition to the items mentioned above, vitamin D is also very important for fertility.

  38. I was diagnosed with PCOS 15 years ago. I was told i would never get pregnant. I’m 32 years old, been strict paleo for 8 months and am happy to report i am 9 weeks pregnant.

    All things are possible!

  39. Thank you for this post. Although I wouldn’t wish infertility on anyone, let alone my worst enemy, it’s nice to know their are others who understand this challenge that faces 1 in 10 couples. After 4 yrs of a gluten free lifestyle, 2 yrs eating primal, we have had no luck. However, I FEEL 100% better on a day to day basis, and that is worth it.

    I have had endometriosis & ovarian cysts since I was 18 if you want to hear how primal eating changed that, the link is below.

  40. I’m pretty sure that beer, twinkies and frozen pizza are the key to fertility. Have you been to MalWart lately? :/ The stigma that infertility is a diet issue alone SUCKS. There are so many factors and a million different reasons and combinations…some of which are environmental, genetic or structural…or a combination. Fish and frogs are becoming infertile and I’m pretty sure they didn’t change their diet in the last century…unless they are in the ocean eating left over french fries.

    All kidding aside, be careful who you take advice from. It’s easy for someone to give you advice and claim to know the solution to every fertility obstacle on the planet…but unless they have been there and battled infertility or PCOS or Thrombosis or blocked tubes, their opinion means nothing. Take it with a grain of salt. Don’t try Paleo because it is the magic ticket to conception. Try Paleo because you have been through ENOUGH and it’s time to be selfish and focus on yourself.

  41. I have only read a couple of the posts on Soy in Western vs Eastern cultures, but I would just like to make note that Eastern cultures appear to eat a lot more fresh foods and prepare meals from scratch, whereas Western cultures are eating a lot of packaged, refined, heavily processed foods. If you look at the ingredients list of almost anything packaged, you will see “soy” protein, or “soy lecithin”, or any other form of “soy” they can use to bulk things up. Also, food advisories have made a big deal about “Tofu” and other soy products as a replacement for people who do not wish to eat meat. I am thinking that most eastern cultures don’t care for vegetarianism and just eat meat instead, as the first few comments suggest.

  42. Getting pregnant is never as easy as shown in the movies.Although some women do conceive very easily, but owing to our fast paced and hectic lifestyle in today’s age, not everyone is that fortunate. On an average, it takes about 5-6 months of trying to actually conceive while for a little older women in their thirties, it might take more time.

  43. with your roots and herbs you have enveloped my frown face with smile, slung to stand,tube tie burned alive, i used your herbs and root according to the instruction given it materialized,i have conceive now and delivered a baby boy,from letter A-z can’t speak how joyful i’m. contact him via on facebook (Oduduwa Ajakaye)