Doesn’t it seem like when it comes to nutrition there are more opinions than facts to go around? Every day we hear new theories about diets, and supplements, and the best foods to eat. My role is to take the mystery out of good nutrition, and look at the science. Welcome to the Nutrition Facts Podcast. I’m your host Dr. Michael Greger. And I’m here to bring you an evidence-based approach to the best way to live a healthier longer life.
On today’s show I discuss some of the latest research affecting women’s health starting with advice on cannabis use for pregnant and breastfeeding women.
Approximately one in six couples “are unable to conceive after a year,” despite trying, “and are labeled infertile.” And in up to half the cases, it may be the man’s fault. There are “several lifestyle factors that have been associated with diminished sperm production,” such as smoking cigarettes. But what about smoking marijuana?
“Regular marijuana smoking more than once per week was associated with about a 28 percent lower sperm concentration and lower total sperm count,” based on a study of more than a thousand men. But “no adverse association was found for irregular use,” meaning less than once a week.
Now, this wasn’t a randomized study. And so, there may have been other factors that go along with regular marijuana use that could have really been to blame. But, they took into account cigarettes and alcohol and other drugs and STDs and things like that. But, there’s always a possibility there was something else for which they didn’t control.
Findings were similar for women. Hundreds of infertile couples were studied in California, and just like men had about a quarter fewer sperm, a quarter fewer eggs were retrieved from women using cannabis more than 90 times in their lifetime, or using the year before. Again, there could have been confounding factors, but until we know more, couples that are trying to conceive may want to make the joint decision to turn over a new leaf.
What about during pregnancy? Medical authorities recommend that women even “contemplating pregnancy should be encouraged to discontinue marijuana use,” and not use during pregnancy or lactation, although the Academy of Breastfeeding Medicine suggests the known benefits of breastmilk currently outweigh any potential harms for women who continue to smoke it. Despite these warnings from authorities, marijuana use has increased among pregnant women in recent years, up 60 percent. But that’s only from about 2.5 percent up to less than 4 percent, less than half the frequency of non-pregnant women.
Why are OB/GYNs so down on getting high? You’ll see scary articles in the American Journal of Obstetrics and Gynecology, making claims like this: a large study supposedly documenting a significantly increased risk for a serious birth defect. But, if you don’t just take their word for it, and pull up the actual study, you’ll see that the association wasn’t statistically significant after all. “Objective education about marijuana and pregnancy is good, but biased education is not.”
There have been some risks identified: infants may be “more likely to be born anemic, or have a lower birth weight, or require intensive care,” compared to infants of mothers who do not use marijuana. But it’s “difficult to determine the direct effects of maternal cannabis use on the developing fetus because of” a variety of confounding factors, for which studies may not be able to completely control.
“Studies have also shown links between prenatal marijuana exposure and” learning problems later in life, manifesting years later at school, and that’s really where the greater concern lies: the potential long-term effects on brain development. So, even after weeding out the myths, there is enough concern that “pregnant and breast-feeding women should indeed probably “be advised to either decrease or where possible cease cannabis use entirely.”
In our next story, the salubrious effects of fennel and ginger for painful periods.
Ninety percent of women report having painful menstrual cramps at least some of the time. Around the Mediterranean, fennel seeds have been traditionally used to relieve painful menstruation. We call them seeds, but they’re actually whole little fruits. Hard to create placebo seeds, though; so, they used a fennel seed extract to put it to the test. The women started out with six out of ten pain, but down to four out of six within an hour, all better than placebo. 52% of the women rated the fennel seed treatment as excellent, compared to only 8% of women in the placebo group who were just unknowingly given capsules containing flour. But women don’t take flour for cramps; they take drugs like ibuprofen. Mefenamic acid is in the same class of anti-inflammatory NSAID drugs, and may actually work better than ibuprofen, but is not over-the-counter. How did it do against an extract of fennel seeds? Most started out in severe pain, but ended up pain-free after treatment, and the fennel worked just as well as the drug class considered the treatment of choice, without the side-effects of the drug, which include diarrhea, rashes, autoimmune anemia, and kidney toxicity.
And, the drug doesn’t help with the other symptoms of bad periods. Women can feel nauseated too not just in pain, out-of-sorts, weak, achy, and diarrheic. But fennel seeds seem to help, though the control group wasn’t given a placebo; so, you don’t know how much of that was the placebo effect.
One downside is that on fennel, women bleed about 10% more. See, menstrual cramps are caused by the uterus contracting so hard that its own blood supply is compromised. And, the way we think fennel works is through muscle relaxation, because it also helps with infant colic, which is thought to be due to intestinal spasms.
The advantage of fennel here, too, is the lack of side effects, unlike the drug that’s used, which, they note, unfortunately can work a little too well to get your baby to stop crying by developing side effects like death.
Ginger, on the other hand, is effective for cramps and reduces bleeding, when an eighth of a teaspoon of ginger powder is taken three times a day during one’s period. This is important, since up to 18 million young women in the United States experience iron deficiency anemia due to heavy menstrual bleeding. The amount of blood loss was estimated using a scoring system that gives points for level of saturation and clot size, and on ginger, they went from like a half a cup per period down to a quarter cup. Ginger appears to be a highly effective treatment in the reduction of menstrual blood loss. It is cheap—about 6 cents a month— easy to use and may have fewer side effects than other chemical medications and invasive approaches even sometimes fewer than placebo. They used lactose, milk sugar for the sugar pills, which may have caused the flatulence.
Ginger may also work better for premenstrual syndrome. An eighth of a teaspoon twice a day of ginger power for a week before one’s period yields a significant drop in PMS mood, physical, and behavioral symptoms, whereas fennel may help with PMS anxiety and depression, but not with the emotional or physical symptoms. There are other dietary interventions that can help, like a reduction in salt and animal fat consumption, something I’ve addressed before. Whatever works, since sometimes, evidently, PMS symptoms can lead to murder. And, indeed, there are cases like Christine English who, at that time of the month, ran down her husband. Accepting PMS as a defense, she was released with one-year probation.
Can cannabis and ginger be considered safe and effective treatments for hyperemesis gravidarum (severe morning sickness during pregnancy)? Let’s find out.
Nausea and vomiting are common during pregnancy, affecting 70 to 85% of women worldwide, but not in all countries. Population groups that eat more plant-based diets tend to have little or no nausea and vomiting in pregnancy, though. For example, on a nationwide basis, the lowest reported rates in the world are in India, at only 35%.
Sometimes, symptoms are so severe it can become life-threatening; a condition known as hyperemesis gravidarum. Each year, more than 50,000 pregnant women are hospitalized. What can we do, other than reducing our intake of saturated fat, for example, cutting the odds five-fold by cutting out one daily cheeseburger?
The best available evidence suggests that ginger is a safe and effective treatment. The recommended dose is a gram of powdered ginger a day. That’s about a half a teaspoon, which is equivalent to about a full teaspoon of grated fresh ginger, or four cups of ginger tea. The maximum recommended daily dose is four grams, though; so, no more than about two teaspoons of powdered ginger a day.
Cannabis was rated as extremely effective or effective by nine out of ten pregnant women who used if for morning sickness, but cannabis use during pregnancy may be regarded as potentially harmful to the developing fetus. This is not your mother’s marijuana. Today’s marijuana is six to seven times more potent than in the 1970s, and may cause problems both for the developing fetus, and then later for the developing child. The bottom line is that pregnant and breastfeeding cannabis users should be advised to either decrease or, where possible, cease cannabis use entirely.
What do they mean by “where possible”? Under what circumstances would it not be possible? People don’t realize how bad it can get. This is how one woman described it. Hyperemesis gravidarum can lead to such violent vomiting you can rupture your esophagus, bleed into your eyes, go blind, or comatose. And so, there are certain circumstances where cannabis could be a lifesaver for the mother and the baby, as women sometimes understandably choose to terminate otherwise wanted pregnancies.
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