Optimizing Male Fertility: Preconception Nutrition & Immunity

In this episode, Dr. Demeri shares her journey into naturopathic medicine and her specialization in fertility. She emphasizes the importance of a team approach in fertility, highlighting the emotional labor often placed on women.  

This discussion also covers: 

• The intricate relationship between nutrition, mitochondrial health, and male fertility  
• Specific nutrients like choline and vitamin D and how they play a role 
• Individualized treatment plans and the value of DUTCH testing in understanding male fertility  
• The importance of optimizing sperm quality, especially in the context of IVF  
• How holistic approaches can optimize preconception care  

Show Notes 

- Check out Dr. Demeri’s WeNatal Fertility Master Class and her course, Trimester Zero! 

- Explore more DUTCH resources on fertility and become a DUTCH Provider today to get access to free educational resources, expert clinical support, comprehensive patient reports, and peer-reviewed and validated research. 

Transcript

Dr. Jaclyn Smeaton
Welcome to the Dutch podcast where we dive deep into the science of hormones, wellness, and personalized healthcare. I'm Dr. Jacqueline Smeeten, Chief Medical Officer at Dutch. Join us every Tuesday as we bring you expert insights, cutting edge research, and practical tips to help you take control of your health from the inside out. Whether you're a healthcare professional or simply looking to optimize your own wellbeing, we've got you covered. The contents of this podcast are for educational and informational purposes only.

The information is not to be interpreted as or mistaken for medical advice. Consult your healthcare provider for medical advice, diagnosis or treatment. Welcome to today's episode of the Dutch podcast. I'm really excited about today's episode because I got the chance to talk with an expert on fertility, a field that I love so much. We talk a lot about fertility and reproductive health in women, but today's episode has an extra special spin because we're going to be talking more about men. Now, if you are a,

Practitioner who treats fertility or maybe you're a woman who's trying to conceive you probably know that most of the time women carry the educational emotional burden of Trying to conceive and not only that but more often they are going through more workup and more treatment But what's so interesting about today's episode is we're really coming at it from the point of view of the fact that it takes two to tango both male fertility and female fertility needs to be optimized in order to have a healthy baby

Today's guest is Dr. Afruz Demery. She's a globally respected naturopathic doctor and a women's health expert, and she's a leading medical voice behind the brand WeNatal. With over 18 years of clinical experience, she's helped thousands of couples improve their fertility and achieve healthy pregnancies. She's formerly the director of functional medicine at UC Irvine, and Dr. Afruz is dedicated to empowering women and really redefining whole body health starting before conception. She calls it trimester zero. So beautiful.

Dr. Afrouz Demeri (01:58.402)
Her work with WeNatal pairs science-backed ingredients with her own clinical insights to really deliver comprehensive prenatal approaches for both men and women. I think you're going to really get a lot out of today's episode. So let's go ahead and get started. Well, Dr. DeMery, I'm so excited to have you on here. I've seen you out and about. I've had the chance to see a lot of your work and it's so nice to actually get to make a connection today. So thanks for being here. I always like to start because we have a lot of providers that listen to our podcast.

Thanks for having me.

Dr. Afrouz Demeri (02:28.172)
I'd love to start by just asking you a little bit about how you ended up where you are as a naturopathic doctor. You've practiced at UC Irvine. You were in a very conventional setting. Can you just tell us a little bit more about your backstory so our listeners can get to know you?

Yes, well, I found naturopathic medicine mainly because I was sick and I always wanted to be a doctor. But I'll fast forward to how I got into the field of fertility. That is a field I never wanted to be in. I always thought it was just so heartbreaking and I loved kids. I always wanted to have like 10 children. And I had my first daughter and in the hospital sitting there after her seventh eye surgery, I started to realize this is not how my story was supposed to be.

I was super healthy, never drank, smoked. was 28, I was young, and this is not what I expected. And so that's when I guess she chose the path for me. Her coming made me realize there's so much missing and there was so much information I didn't have and I wish I had. And there was a lot of regret blaming myself and even the doctors were all focused on me and it was just

my problem and I felt very lonely. felt very depressed and it changed everything for me. And so that's how I got to really dive in and I created the concept of trimester zero back then because I realized we were buying a house at the time and we did so much digging in into this house, the roof, the foundation. I mean, we did not buy until like everything was fixed. And I realized

Nobody looked at me looked at my husband's like he was completely out of the picture and You know, she wasn't growing and so when a year or two Years of me being told it was my breast milk. It was me. was me I asked if they could run a Turner's test and lo and behold Unfortunately, I didn't like the results, but she did have Turner's and I thought what?

Dr. Jaclyn Smeaton (04:35.724)
I was supposed to miscarry her. That's where a lot of miscarriages come from, which I had had previously. And that's when I dug into research of meiosis and how could something come about without a whole X chromosome. And I was just told everything is chance. Everything is just, you know, it's never going to happen again. And then she had Peter's anomaly in her eye, which was also by chance. And I was always that girl that had that one in a million things go wrong. And I was like, wait a second.

And I was seeing it in my patients, I specialize in pediatrics from right from the start. And I realized we got to go back to the prenatal, the nine months. And then I would see these moms and I could like, wait, no, this is like before conception. And so I guess that my interest really chose me because I had to figure out what am I going to do? Cause I wanted to have more kids. So it was really because of my own self that I selfishly ended up being a specialist in this area. So

That's my different story than most people.

I appreciate you sharing your story. I think we're going to have a fabulous conversation today because as you know, this is a big passion area for me as well. I think one thing that really stands out to me in your story is you explaining like people are looking at you, people are pointing to you. It's your breast milk, your body, your body raising the baby. And I think one of the things that you've really focused on in your career, and I think this is a great place to start, that the approach to fertility is not just about mom, right?

Can we start there and can you share a little bit about why you're so passionate you work with this company, WeNatal, that you've formulated products for them? Tell us a little bit more about that experience that women have. I hear it too and I saw it in my practice. They're the ones that do the research, order the supplements, book the visits. Even if it's male factor fertility, infertility, women take on this disproportionate emotional labor, educational labor. Let's talk about that.

Dr. Jaclyn Smeaton (06:32.512)
Yeah. Well, thank you for hosting this because I think it first starts with educating. Educating couples that fertility is a team sport. And when when Ronit and Vida, who are the founders of WeNado, came to see me at UCI as patients, I'm allowed to share as they've shared freely and they had had a miscarriage each separately. That's the first question I asked is like, OK, where are the men?

Let's look at the sperm and they were just shocked. They were like what really you think it could be him and I was like who's 5050, you know, and so even well educated women even though I was a naturopathic doctor at the time I was not getting the answers from the authority, you know the OBGYN and the Pediatricians and so I think first it starts with educating couples that fertility is a team sport and then

encouraging and normalizing preconception health optimization for men and focusing on their nutrition, their lifestyle, their environmental toxin reduction, their use of cell phones and radiation and EMFs. And, you know, it's not just about, his sperm counts were fine. You know, I hear that all the time. If they do get tested, it's like, it's not him. It's me. And women, realize, have this false belief. It's almost like

Sometimes it is them and we have proven that it's then like it's sticky the head, know I'm just looking at some patients I have today like the head morphology is so abnormal, you know, and it's it's shown in front of them and yet women still want to take on that burden and I don't know if this is just the You know nurturing side to us the the feminine within us. I don't know what it is, but I've also seen the mindset that

we take on the blame. And so I don't want to just blame the doctors. I also see in my practice that we have this nurturing quality of like wanting to fix things, you know, wanting to find out what's wrong so we can be in control and we can do something about it. Men typically my practice don't want to be seen as something's wrong, you know, and that they're broken or that there's something we have to fix. So

Dr. Jaclyn Smeaton (08:52.878)
Just bringing that balance of that feminine and that masculine within the relationship so it feels like a we. You know, that's why I love WeNATO because it's a we. We are creating life. We are gonna be parents together. We are going to have to decide what we're gonna do when it comes to vaccines and foods and things to buy and how to feed the kids and it has to be together.

Yeah, it's really interesting because I think that we're talking about what's different between men and women when it comes to how they address infertility, how they work on it together, and how there can be this natural inclination. And I'd love to share just a brief story of something that really changed my perspective. When I'd been in practice for about 15 years in the field of fertility, and I was actually at a professional networking event talking with a colleague of mine who I'd known for years. We were

friends, he and his wife had been trying to get pregnant and they asked me to like just take a look at their information and provide some feedback, which I had, and they got pregnant and had a miscarriage. And the miscarriage had been maybe three or four months before I saw him. And we were at this networking event and he broke down in tears about his own experience and that on his, and it was really an eyeopening experience for me because he shared the challenge of grief and loss for him.

but also this cultural focus on mom through the bereavement of a miscarriage and also his feelings as a partner where he wanted to support his wife. He knew she was grieving too and felt almost like he had to kind of put his own needs on hold to care for her. And it really gave me, where we see that imbalance, I think as women ourselves, we sometimes see that it's kind of an unfair burden put on women, but it really made me realize there's also an unfair missed opportunity.

that we culturally also put on men to not be as involved in the fertility journey. It was really just an eye-opening experience and really led me to be more inviting and really make sure I was very forward with an invitation to men in a very open way, not with any blame, but like this, you you can get as involved as your wife in this process. And many of them did, not everyone, but many did.

Dr. Jaclyn Smeaton (11:12.214)
Yeah, I do find that that compassion that what you're saying that inviting that maybe they are interested, they do want to learn, you know, I have a course on this. And I find usually the women, you know, will will say, Hey, do you want to watch this with me? And it depends on the intention. Are we to just become more well? Or are we here to find problems to fix? And I think that mindset of I'd like to call it it's called saluted Genesis, which means

Basically research has shown when we do things that bring wellness that bring you to more joy and Mindfulness and to be more present that helps the cortisol curve that helps your antioxidants It helps how you choose different foods. It helps how you suppress your emotions with alcohol or marijuana When you are coming at it from that angle of understanding compassion love

versus let's test everything and see like if we have high this high that you know and then figure out what we're going to do that is stressful in itself and I find my fertility and cancer patients those two are typically already coming in they're exhausted that the man does not want to be there he feels like you know he just is becoming robotic even you intercourse and the my job

is to make sure I'm helping first that reconnection. know, there's a sometimes my care of my patients say it's a little bit of therapy to just hear them just to listen, just to say, what do you guys think you need? You know, as sometimes it's the guys are not sleeping enough. You know, I can't tell you how important men, men's fertility is tied to sleep. They're sleeping late and research shows that if they are getting less than six hours of sleep, it's going to impact their sperm.

And you know, it's simple things like they'll sell he needs to go to bed. Well, why isn't he? You know, it won't what what is the reason instead of just telling someone because often they know, they know they're not eating well, they're know that they know that the fast food or the soda drinks that they're hiding from their wife, you know, and so there is a little bit of therapy involved in just getting us to come together and be honest, be real.

Dr. Jaclyn Smeaton (13:27.486)
And first see so when I am presenting you know sperm counts and Dutch results and this and that it's with it's with a different mindset and I didn't have that 10 years ago when I was practicing it was more I was the investigator and trying to figure out what's wrong so that I could give them tools to fix it you know it felt good to me it felt good to them it was measurable it was scientific but the more and more I practice now I realize there's such an art in how

naturopathic medicine excels and it's in the way we take a case. It's in the way we can put everything together and figure out like how to peel that onion. Where are the red flags? What are what I always say to my patients, which I love about what we do, the obstacles to cure and removing those first instead of here's the prenatal, I'm taking all this stuff, why isn't it working?

Yeah, it's interesting. feel like the longer you are in practice, the more simple your toolbox becomes where you're like, if I could just be really effective on nutrition and sleep and stress management, like everything else is going to fall into place. You need less. You focus on those basics so much more. I've really seen that same turnaround and not like the biochemical, you know, the chemistry, the labs that approach to medicine so critically important to especially to diagnose and understand the root cause. But it's we need to also be emphasizing that.

art as well, completely agree.

Yeah, because 10 years ago, I was just telling them, hey, you just have to do this for 72 days. Okay, just, just give me that time. It's super easy. You know, your wife has to do this preconception nine months and maybe a year or two later. It's a lot. It's not fair. Come on, you can do this. You know, it was like, we were pushing them, like cut out the alcohol, just less coffee, don't smoke weed. Let's figure figure out how to like fix it for just this time. And then I realized

Dr. Jaclyn Smeaton (15:27.168)
years later seeing them as dads and the issues they were having now with their kids who have ADHD or have this and that and the disconnection between the family. was like, I'm doing a disservice if I'm just trying to optimize sperm, which used to be my focus is just have the healthiest sperm, the healthiest egg, get them pregnant, healthy pregnancy, healthy birth off, off you go. And often the research unfortunately stops there, you know,

In our practice, we get to see them 18 years, 20 years later. That's right. interesting. Even my own daughter, OK, she's got the eczema. She's got the allergies. Interesting. All the things we learn about. And then this kid doesn't. What did we do differently? How was their nutritional status of the mom and dad? How was their weight, their body fat percentage of mom and dad?

So yeah, the genetic stuff that we learned when we were in school versus the epigenetic and also just the lifestyle and the environment that the sperm and egg is in to me is fascinating. And the environment for me, a huge component, our emotions are how we feel. And I think that's my favorite part of preconception. Care is just meeting these two souls that want to have another soul. And it's like, let's get to know what are the obstacles? Why isn't it flowing?

I know that we're bombarded with our environmental toxins and what we find in the umbilical cord and all of that, but adding that to their story is only usually gonna make them more stressful. I know we think we have to inform, but we have to be so careful because often I do surveys on all my patients after they leave. When you see that they are now feeling less hopeful because now they got all the science.

That's where the art comes in. It's like, what can we measure that is changeable, that therapeutically is going to have better results? know, that's, think, the art. And that's when I'm mentoring a lot of doctors or at UCI. You know, we had the largest naturopathic residency group and also medical students sitting with us and learning. It was not just about testing, testing, testing everything. It's about what is linked to that patient's symptoms.

Dr. Jaclyn Smeaton (17:43.896)
physical exam findings, you know, if everything has to kind of be holographically linked so that we are clear on if we hypothesize that we're going to change this marker, it's going to have an outcome that we

Yeah, the other thing that's so interesting about fertility and male fertility is where the research is on this today, at least, is that infertility in men in their 20s, 30s, 40s is tied with higher rates of chronic disease. Alzheimer's disease, cardiovascular disease, several cancers. So it's really interesting because I was reading this article and I actually ended up putting together a presentation for AAMP one year where really infertility is kind of the canary in the coal mine for chronic disease.

first place that chronic health issues really show up. So I think that's another point of view where if you think about couples coming into you to conceive, if they're struggling, not only do we want to help them have a baby, but you don't want it to be just 72 days because the infertility is a sign that there's an opportunity for health promotion that could change the trajectory of their health. So not only to have a child, but to be around.

to enjoy a relationship with that child and to the child's adulthood. It's so critically important, so I love the frame shift that you introduce here about really thinking that whole person approach.

And what I see often isn't told to anyone, really. The patients who are having these miscarriages, they're not told.

Dr. Jaclyn Smeaton (19:15.18)
that it could be the sperm. could be that it's coming from that. mean, I'm one of those people that it's pretty rare to have a child with turners, you know? And so I dug into the meiosis. like, OK, well, she got one X chromosome. 80 % of the research shows most likely from me and didn't get dad's X chromosome. And I was like, what nutrients are needed for meiosis? You know, just going back to basic things like zinc, B12, all the methylation, all the magnesium.

that we need for ATP production, all that we know the mitochondria is so dense in sperm and eggs. So these basic things, and at UCI, just, my colleagues just finished doing a clinical study looking at couples before they conceive and their nutritional status, you know? It's like, how do we not have research on this? And lo and behold, of course, vitamin D is very low, you know? And so most prenatals don't have enough vitamin D. I didn't take enough vitamin D.

I didn't know about MTHFR back when I got pregnant. I was on a very high dose of folic acid and my kids both are unfortunately MTHFR and you know they cannot methylate very well. DHA was very low in these couples. Iron was low. It wasn't calcium. So a lot of times I'm educating my moms because I know some nutritionists out there are very big on taking calcium, calcium, calcium.

But I would say calcium is not something you need to supplement with. You should be getting your calcium from food. Vitamin K was low. Folate was low. So these things, yes, are very important in the right dose, at the right therapeutic form to be taken in a prenatal. But what's interesting, the data also shows that just because you're taking something, and let's say mom's levels look good, that doesn't always mean that it's going to make it through you.

through the placenta and into the baby. And so that's something that when I was pregnant, I remember thinking my mom would say, I Persian, oh, don't worry, she'll just take whatever she needs. You you're going to be the one that's deficient. And so when I was, you know, vomiting for the first three months, which also has been linked to sperm now, I was like, it's okay, she's getting everything she needs from me. I'll just become deficient. I'll sacrifice myself. That's what women do. That's fine.

Dr. Jaclyn Smeaton (21:40.194)
But the data shows now that it's important. You don't want to just stop birth control pill and take a prenatal and get pregnant. Often those stores, the mom will actually use it for herself first, then the placenta, then the baby. So I think nutrient status in both men and women is so important. And supplementation is really to supplement because we cannot get this stuff enough from food. With the microbiome and our low stomach acids and stress and

the environmental toxins and too much body fat and liver health that is, you know, out the door because it's so burdened. We do need to supplement and it's important, you know, that you're taking a good prenatal. And that's why I was so excited when they approached me, by the way, I am not, I'd have no affiliation with them. if people buy it or not, I don't get anything. I was just so happy to create something and help figure out this is how much folates needed. We need this much vitamin D.

We need copper for iron to become bioavailable and recycled. can't just take iron and zinc on its own. Zinc is going to be so important for fertility, but copper is what recycles iron. And iron is often recycled. We don't have usually true anemias. And if we do, we need to figure out why. And so I'm biased because I helped formulate it. I formulated it because I wish there was something like this out there when I was pregnant.

It's something I take now. I take it from my hair. I always say people who are trying to get pregnant typically, hopefully, are the healthiest. So things that are targeted for them usually are in the best forms, the best kind of B12 and folate. So it's something I say to really good multi, especially they're also fish oil. I take it from my brain health, you know, because we care so much about the baby's brain and their eyes. But then as soon as they're done, we just stop, you know.

Right. Yeah, it's great to continue that. And really any cycling female who's having a menstrual bleed would benefit from a prenatal vitamin as a style of vitamin because it has the iron and a wide variety of other nutrients in it. Can you talk a bit about choline as well?

Dr. Jaclyn Smeaton (23:54.934)
Yes. So choline is something that I don't think any prenatal back when I was staying prenatal had it in there. Phosphatidylcholine, a lot of people have heard about, you we know that's really important for the brain and choline is something that often people will just think they'll just eat eggs and they'll get it from there. But we put 400 milligrams in here because that is what's actually recommended.

And believe it or not, that that's an actual recommendation for fertility for prenatals, except no one is getting that from eggs. So super important for brains, the brain function of the baby and mom. this is, think, one of the only prenatals that I know, or we were the first at least, to put 400 milligrams of choline in there.

Yeah, we know having experience in the supplement market and like interest in this product area, it is unusual to see, I mean, even more than 50 milligrams of choline because choline is typically added to a prenatal. So you might see it on the list, but it'll usually be like 25 or 50 milligrams. But you're right, you need hundreds. And you can tell how recently a formula was updated by whether or not the choline is.

sufficient because that research is quite new. So it's really definitely a critical critically important nutrient that I always recommend people check their prenatal for. Yeah, I love that vitamin D you mentioned as well because again most prenatals, excuse me, have only a low amount of vitamin D where we know most people that's not enough to achieve sufficient.

And that's probably the most important thing. think in my fertility journey, I've figured out that the most important thing I want couples, at least moms, to optimize for the future of that child and future, I'm thinking in their 20s, 30s, 40s, 50s, 60s, is their immune health.

Dr. Jaclyn Smeaton (25:46.298)
And when that is the wealth of your family is how strong your immune system is and the immune system of your kids. And I mean, we saw this with COVID. There will be things that come and just wipe people out. You know, it's like survival of the fittest. And that starts with your gut health. We know we do know that the microbiome is not just in your gut. It's everywhere, different microbiomes. And so.

I get parents to, because I find right now, like everyone is so worried and stressed since COVID and they're like, Lysol in everything and no one gets dirty and everything is just perfect and clean. And, you know, people are so worried about getting sick. They're so worried about, yeah, having a cold or a flu or anything, anything and everything. that fear has also shown to change the microbiome that's stressor. And so that's why.

going back to the Dutch test, it's important to see cortisol because if it's too low or if it's too high, and it's interesting because I think I've been told by the Dutch people that I've done the most Dutch tests in history since 2015. Most people are so worried about high cortisol, but that's not what I've seen. And so I think it's really important to measure these things to understand yourself.

not to again just lower it or increase it, to go, huh, interesting. I thought I would have had really high. feel so, you know, wired or tired or adrenaline, but I have make sense. I'm so exhausted and not having that resilience as a mother to be or a father to be and how that impacts your microbiome and how that impacts the immune system of the baby that now you're have to figure out, are you gonna?

vaccinate? Are you going to do all of them? When are you going to do them? What's going to happen with that first fever? Because I see you know, the moms coming in. And 20 years ago, I didn't see as many issues with kids as I do now. You know, it's, it's, it's quite scary. And often parents are worried, you know, they know someone who had a kid with pandas or Asperger's or autism, and you know, they're having their third or fourth, and they're worried, you know, these are things that

Dr. Jaclyn Smeaton (28:03.778)
We do have to, we have to optimize this, this has to become mainstream. It has to get taught in schools where you're not just educated on sex education and that's it. And you know how to prevent, we have to start talking about this to kids so that they know, I have a 12 year old boy that that pew.

puberty years and what they eat their lifestyle what they're putting in their body is so important later because he doesn't care about having kids right now, you know, but at least educating the parents to say this is a critical time for later on in their life when they become dads, you know, and even all the birth control pills and everything that's given to girls nowadays and how you know what can we control. I know we don't have the Teflons and hopefully all the

cookware and all that's cleaned, but our parents did. So our burden is already, I say our cup is like half full, you know, because my grandmother, I know, used it and I know my mom had it. And so, yes, we do need to do things differently and people who say, you don't need to detox, you don't need to do anything, our body does everything for us. No, we can't, our environment is not the way our grandmothers and their grandmothers had it. So.

It is a little scary if you look at the stats and I usually don't talk about those, especially to patients, because it's like, okay, I'm not sure if my kids' kids are going to be able to have kids. I'm not sure where my son is going to end up being with his sperm. But as a naturopathic mom, this is the stuff I talk to them about. They are reading labels when they were four or five. My son was saying, this has this much carbon hydrates. And it's good to educate just from a...

perspective of you learn about science you learn about mitochondria well do you want to learn about what effects the mitochondria you know

Dr. Afrouz Demeri (29:55.054)
That's right.

Yeah, it's interesting. have three teenage boys, they're 13, 15, 16, and then two younger children. But we found out recently, because we were asking our boys, like, why don't you have friends over the house more often? And they said, well, can we be honest with you, mom? Yeah. And they said, you have really terrible snacks. None of my friends want to eat the snacks at our house. Like, no one wants Greek yogurt. We want Cheez-Its or chips. And I was like, oh, you know. Yeah. Don't think about the social implications of a healthy diet. But that period, you're right. A lot of people don't know that that

Yeah.

Dr. Afrouz Demeri (30:26.594)
that pre-pubertal slow growth period is so critical for boys in particular, not so much for females, when it comes to the impact on their testicular health as adults. And it's a really interesting time period when it comes to epigenetic imprinting. Men and women, or males and females, have different times with highest risk. Like for females, it's what, perinatal, in the womb, and then for reconception.

Which I didn't even know I was pregnant, you yeah women don't know and right everything is not everything but almost everything is done That's right. I know. I'm pregnant and then women start changing things and so and 50 % like or unexpected unexpected So it's really important to educate girls, especially when they're in their teenage years in case there are those

oopsies, you know, that you know you did everything as best as you could, you know.

what we can't. Yeah, and then with males, one of them is that pre-pubertal period, which when you think about the health of the next generation being entrusted to 12-year-olds, we better find a way to make like ramen noodles more nutritious because otherwise we're in trouble.

Yeah, absolutely. We're just educating them on electronics and SNFs. We were measuring, we had a Tesla and we were wondering because there's a lot of testicles sitting on heated batteries for a long time. And I was having a lot of my GiveLegacy, I would ask them, like, I've noticed, have you guys done any studies? Because I have my male Tesla drivers and I'm looking at their

Dr. Jaclyn Smeaton (32:04.974)
motility more than anything being slowed and slowed down. And so we bought all these gadgets and we were measuring our car and different locations and the actually I didn't find it to be too bad which I was surprised.

did you find?

Dr. Afrouz Demeri (32:18.264)
then I had never thought about that before.

Yeah, I had heard a lot of NDs talk about it being really bad for sperm. My husband's testosterone was too high. And so was like, huh, interesting. But that doesn't always mean that sperm is going to be impacted. But I've seen many men with low T who were Tesla drivers. And I was curious. I don't think we can. I mean, this is an N equals 1 of my testing.

they can be I mean, that's just a Tesla and I don't know, I don't know if it takes the battery is longer and older. Okay, but these are things that we need to really think about because it's so sensitive to the environment. It's outside the body. And that's why you need millions because so many of them are so sensitive that they die, you know, and they're small versus eggs and egg quality is so important. I know you were talking about men's

sperm and and how it's linked to their mortality and all these other things that we're seeing that no one's ever thought about because I know my husband when I tell him this or I'm writing a book right now on this he's like oh well we don't want to have more kids I'm like this is your longevity this is your health you know maybe one day it'll be like a biomarker screening test just

Absolutely. mean, that's been suggested because it is so sensitive and it's a downstream measurable that takes into account all the factors of your exposure. It's curious. I've thought about that. Should every man 30 and up have a semen analysis every five years or two years or whatever?

Dr. Jaclyn Smeaton (33:53.75)
I think that would that would tell me a lot because I also always think that they're doing you know, they'll say I well, I'm good I'm exercising some of them are over exercising. They're overdoing it and it's having a stressful response

We'll be right back.

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Well, I want to talk a little bit more about male fertility. And really, one of the things that I want to talk about, tying this in with Dutch, is when we look at fertility, of course, we care a lot about female hormone balance. Yes. Tell me a little bit about what we think about with male hormone balance and fertility. What matters? Does it matter as much as females? What should we be thinking about or looking at?

Dr. Jaclyn Smeaton (35:16.622)
Yeah, I think what most people don't realize is yes testosterone is important for growing the gonads and growing a lot of things, but it's actually FSH that matures the sperm and so your count has a lot to do with this follicle stimulating hormone, which most menopausal women get tested, but I love running FSH on men through blood and LH. So these are two that we are looking at from this level. Prolactin, believe it or not, in 11 % of men who are infertile,

has been shown to be also just like we've seen women an issue. So that's something I might add on thyroid hormone, which I think everyone should get tested. I've seen men with Hashimoto's with their TPO's elevated. And I think that's important to address just like we would for miscarriage prevention in women. And there's data showing that going on thyroid hormone replacement can help. Same thing with men.

Estradiol. Estradiol is also super important. We always think of that as a female hormone, but that is very important for the maturation of the sperm. And then we need to have enough for also libido. So I love the Dutch test. And one of the fortunate things that I was able to do at UCI in the years that I was there was everyone's blood work was covered through insurance. I always ran a gamut of blood tests and then they would do the Dutch test at the same time. So I got to see

I worked a lot with the conventional endocrinologist who were a bit more, you know, didn't believe in anything else but serum. So I kind of had to prove myself and say, look, you know, it's very similar and it's useful information. And it's looking at metabolites that I can't get. it's, so I'm seeing now with what my men, this gives me the full picture of why something could be off.

You know, is it because of the oxidative stress that we see is elevated? Is it because glutathione? Is it because B6 is low? Is it because their melatonin is low, which is important also for men as well? So I love the Dutch because of that testosterone. And now I know it's changed a lot there. We've got the Fav Alpha reductase at the top too, which also can show me the androgen metabolism, you know, but just having that baseline testing, I think for men, even if they're not trying to conceive,

Dr. Jaclyn Smeaton (37:40.266)
is so important because men typically like to see something, you know, it's like they'll they'll even bring me Excel sheets of like, you know, values over the month and how it's changed with what they've done, especially the engineers out there. But yeah, I love seeing the aromatization of alpha reductase activity, and then just all the other biomarkers that are on there. And I'm sure every year

they're just expanding Dutch is just always surprising us who have been with them forever, which is

always looking at new things, that's for sure.

Yeah. Yeah. So I would say the other ones would be LH, FSH, prolactin, TSH. What am I missing? Testosterone. And then I like to always add in the HSCRP and homocysteine. And that's good. Yeah. inflammation markers at UCI, was nice because I was able to add in IL-6 and TNF-alpha and other, you know, hallmark inflammation markers and see how their diet would change.

So those are inflammation markers.

Dr. Jaclyn Smeaton (38:43.702)
And so that was what was nice is here. Just do this for three weeks and let's see what it changes.

motivating and that's like one of the pieces with some labs that aren't insurance covered can still add value if it helps provide feedback to the patient that they're on the right track. Yeah.

Yes, but I would say most often I see estradiol being too high in a lot of at least the population I'm seeing, whether they're the beer drinkers or just the late night stress eating and figuring out why their testosterone is lower or going towards estrogen and what can we do but first before fixing it and lowering it or making them detox it out.

I love to always just have that conversations and they understand, they understand like what's happening with this hormone. know, hormones are like, I always say like the little whispers, like someone's whispering and saying, Hey, we need to do this, but we have to understand why they're whispering that, you know, they're, they're just the messengers and we can't kill them and like push them this way or that way. There's such a harmony that we have to look at the whole orchestra and having kids is helpful because often I find if they're emotional, if they're mad, if they're sad,

I'm not trying to fix it and tell them like not to be mad and not to cry. I'm trying to understand. And so that's what the Dutch does to me. It really helps me get like a big picture from far back and then go, okay, interesting. I found that this was low or a lot of times I'll see everything is low. And if everything is low, then I'm wondering about nutritional status and what's, what's not being fed and mitochondrial dysfunction. And, know,

Dr. Jaclyn Smeaton (40:24.93)
Maybe they need more nitric oxide support through beets and things that they can do and things they can choose. That would help their blood pressure also. It would also help because they're so hot. Often the men that are coming in there, they have a lot of internal heat. In Chinese medicine, often from suppressed emotions, suppressing everything in, being the fixer and the provider. And so that heat is also not very good for sperm.

And so literally their temperature is, is high and they'll say that I feel hot. And so, you know, things like beet juice or celery juice or things that cool cucumbers, yogurt, you know, changing their diet, depending on their disposition versus if I have a guy who's pale and, know, more on the cold side, their diet's going to be different. I'm not going to give them things that's going to make them feel more low blood pressure and, you know, faint on me. So yeah, just individualizing it.

after I do these tests can be really helpful because they feel empowered. They feel sane. They feel like this is just for me. Of course. On top of the prenatal for men, which by the way is also a great multi because it's got the N-acetylcysteine, it's got the CoQ10, it's got the acetylalkarnitine. And then I can add on top of that if I need something that I know they're not going to be able to get from food alone. know, often I find they'd have to be eating gallons of so many things to absorb and assimilate a lot of these things. So

for

Dr. Jaclyn Smeaton (41:51.192)
Yeah, it doesn't work. The doctors that I used to work with who would say, they don't need all that. They can just eat well. And I'm like, they do eat well. But our well is not really well anymore. Our food will grow things. And I'm looking at this and I'm like, these tomatoes don't taste. I'm using organic soil. I'm composting. But it's still not that great. And I thought that was not.

But probably leaps and bounds above the conventional produce you find in the grocery store. I actually had a friend over that does all of her organic gardening and she asked me for a tomato. She made like a sandwich and she sliced a tomato and she said, I can't believe, I don't know how you can eat this tomato. I'll bring you some real tomatoes next time. And it's just cause we were short on it and they didn't have anything like any heirlooms at the store. It's just not quite in season yet. And when you compare the home gardener to just conventionally grown produce, you can be making really great choices.

in the store and still not get the nutrition you think you're getting.

Yeah, I mean, I love going to Greece for just the tomatoes, the Greek salad. It tastes so different and not necessarily always what we add to it. It is the whole concept of obstacles of cure. think in Europe, so many things are banned, you know, on skin products and shampoos and things that we use here, the chemicals, you know, and so that goes into the water, it goes into the air, it gets into our food. And so maybe that's why it tastes better is because of the things that are not using.

Could be. Now you touched upon mitochondrial health and oxidative stress. Can you speak about what those are, maybe first of all, if listeners are new to that concept and why they're important for male fertility?

Dr. Jaclyn Smeaton (43:27.97)
Yeah, so the way I describe this to my kids because my daughter not having an X chromosome, that's where all our mitochondria come from. So from a very young age, I had to figure out how am I going to optimize her, these little fuel boxes of herself that give her energy, you know, because she already was born without half of what other girls have.

And so I did a lot of digging in into the research of what feeds the mitochondria, which is where most of the research comes from, like CoQ10 and things like that. But then I thought, wait a second, a lot of patients that I see in practice who had fibromyalgia, chronic fatigue syndrome, or just poor sperm, is it that the mitochondria is not getting fed? Or is it that it's broken and it's damaged and we are not making new ones?

And so I was looking at some data on chronic fatigue syndrome of fibromyalgia patients and seeing what they were using to help them. And there was a great product, if I can mention products, ATP Fuel by Research Nutritionals, which had great results. And so I started using ways to help upcycle, recycle, and just regenerate new mitochondria and not just feed them.

Thank

Dr. Jaclyn Smeaton (44:45.036)
That's something that I might look out for my male fertility is antioxidants to help. So what can we do to feed them? But if I find that they've had a lot of viruses like cytomegalovirus, herpes virus, Epsom bar virus, know, all the herpes family viruses. And then they had, know with COVID where most people had no sperm. but just viruses in general can be very damaging, right? And that's why it's so important to have in your staples, things that help the mitochondria. So

nutrition, good nutrition, foods, but sometimes we need supplementation. It's not enough. know my husband was hit hard with COVID and it affected his memory. You know, like he wasn't the same. He would say things and I was like, you just told me that, you know, and he's had this long COVID. I've been really working on his mitochondria help. or guys will say like, you know, they, get sore after they work out, you know, so there are lots of ways we don't have to do these advanced testing on mitochondria, which

most clinicians don't have access to, but just symptoms, know, just fatigue, especially after working out, memory, mitochondria is everywhere. It's what we need to feel alive to have energy and it's our fuel. And so the antioxidant tests that we can do can help because that's what's going to feed the mitochondria, you know? And so I love the 8-OH-DG test on the Dutch test. That's one of the biomarkers I've been using for a long time.

I like this great on have that and then on the Boston heart test, I usually would see as a glutathione and coq 10 and I love the Boston heart on my men too because often they're worried about heart health or they got a lipid panel and they're wanting to take a statin which destroys mitochondria and I'm like, no, wait, let's figure out why your cholesterol is high first. And so the Boston heart test is great for telling us if it's

What's on the boss? What do you remember? What markers are on the boss? Okay.

Dr. Jaclyn Smeaton (46:41.794)
the list very long names, but there's four tests and two of them will tell you if it's a basically how Cox two inhibitors work. it being it's production where the liver is making too much cholesterol or is it reabsorption which is a gut and that's where food and fiber helps and sometimes you see a statin which helps the production go down.

is not needed because they are not over producers. They're actually over absorbing and they're not pooping out the cholesterol. Yeah. So things like bergamot and fiber and the microbiome and even dietary changes on that person who's got high absorption would be optimal. Sometimes it's a mix. So they're genetically just over producers. And sometimes you have that like I had an Asian woman, very thin, you

very low body fat percentage, at least viscerally, maybe there have been some, but not externally. her cholesterol, her LDL-C was 190. And so she was surprised and she was told, you know, that she needs to go vegan. And in her case, no, she was overproducing. It's genetically an overproducer. So the Boston Heart Test can be very helpful in figuring out why someone has high cholesterol. And then once you know the why, what else is going on? What else?

the right.

host sizes, is it oxidized, is inflammation there? And then we can do a parotid ultrasound and see is the plaque actually hard? Is it gonna lodge? Is it open here before we jump in and statin? So this brings me to a good point for fertility. I find often it's medications that men are taking. Even just NSAIDs, even something they think is, you know, it's over the counter or the Zyrtex or whatever they're doing, but they're doing it often.

Dr. Jaclyn Smeaton (48:32.936)
And typically I say, and they'll say, my doctor said this one's fine for fertility, even women. You know, this one's okay. You know, there's no teratogenic effects. And I often keep it simple. say, if I wouldn't give this to my kid, you know, often it's probably their, their liver is not going to be able to metabolize, but obviously it's a psychiatric drug or something that's very serious and you can't just suddenly stop it. This is a conception. This is the preconception time to see.

How can we optimize? If I have symptoms, if I'm on meds, how can I see if there's alternatives, if there's other ways of addressing the root cause so I don't need to be on these meds? Because often they're band-aiding. They're not fixing the reason why there was that imbalance to begin with. And so yes, the test can tell us, here's where you're at. This is your assessment of your fertility, but also just of your health, your nutritional status, your...

antioxidant status, a lot of it is outside the brain. So norepinephrine and some of the neurotransmitters, this is coming out through the kidneys in the urine. So it's not 100 % that that's what's happening in your brain, but it can give us lots of clues, you know, and I think an experienced doctor when they're listening to the symptoms, they're able to extract, okay, there's a history, you know, of this man, often I'm finding so much information of just what happened to them in the utero.

What was your mom's health like when she was pregnant with you? What number were you? You know, the first child often gets a lot of the mercury from mom because back then we had a lot of feelings and really the detoxification from others occur when they give birth. That is one of the ways that we rid ourselves a lot. And so that first child is going to get a lot more than that.

I hate thinking about that, but you're so right.

Dr. Jaclyn Smeaton (50:24.472)
But that's what I didn't know with my daughter. I had so many feelings, and I was told that it was more dangerous to take them out. So I left them all in. And when I measured my mercury levels in my blood, which should be zero in everyone, after I had had her, because I wanted to have another one, but I was so terrified, it was five. And yes, I would have sushi, but not that much. And I didn't really love tuna that much.

And so these are little things that we can test that are important. Heavy metals are important. Things that you don't want to look back once that child is made and go, shoot, I wish I had done a little. I wish I had.

Part of it is I think a lot of parents end up questioning like should I have done more right because we have the presence of so many childhood chronic illnesses now. Even things like childhood obesity can be linked back to preconception care. So it's about like how your metabolism responds to food. can feed two and actually there's some really interesting mouse studies, epigenetic studies with the agouti mouse model where two moms that are

genetically identical, these are mice, fed exactly the same number of calories of chow during the pregnancy and postpartum. One mouse was given folic acid or folic, maybe it was, it wasn't methylfol, I think it was folic acid. And choline, the other one was not. So it had like methyl donors and not. And then when you look at the offspring, the mouse of the supplemented mom was a normal weight and actually the coat was brown, which is what it's supposed to be. And the one without the folic acid and choline was

obese and yellow, which is a disease state. It's like a diabetic mouse. And this was only 20 or 30 days after birth. And otherwise, the mice had exactly the same environment. So it's really fascinating when you look at these mouse studies at just how impactful nutrition is in that preconception and perinatal time. It's so, so impactful. And for both male and female partners, for sure.

Dr. Jaclyn Smeaton (52:28.554)
Yeah, so the health that you're making me realize just it goes back to if we're being very scientific and anatomical, it really is that the wealth you pass on is the wealth and the health of that cell, every cell of your body. And that's why we love sperm and eggs, because we are creating these things often, you know, and they're impacted. So we can measure a lot so that phospholipid bilayer, which is why it's so important that the shape

of that cell is proper and that layer has to do with fat and how much good fat, healthy fats you're eating. But that's where the choline comes in and that's where the EPA and DHA and the fish oils come in, which everyone needs. mean, no one is eating enough fish skin, which is often polluted anyway. So you want a third party tested good cod liver oil is one of my favorites, fish oils, to get that retinol, to get that vitamin A, which is needed.

for iron to be absorbed for mitochondria. So, you know, my kids were on cod liver oil when they were young and they, you know, if moms are worried about taste, you just have to keep exposing. They say what, like 15 or 17 times, but trying to get their first food was liver, you know, cause we're Persian, we eat a lot of liver. I know that's gross to a lot of my friends who don't eat liver, but liver is just so full of nutrients and

bone broth and just lots of soups and stews and things that are just full of minerals. Everything just leaches hopefully good stuff into that liquid and it's easy to absorb. So for my fertility patients often I say keep it simple. Eat like ancestors, eat in season. If it's really cold and it's winter, you're probably hopefully not having cucumbers and watermelon and too much salad, which is cooling and it's actually hard to digest salads. We don't give kids

at six months or a year, like here's a raw cauliflower, a raw broccoli, raw lettuce, raw, they would be very gassy and uncomfortable. just nutritionally keeping it like your grandmother and their grandmother, how did they eat? And making it fun, getting creative in the kitchen, and using this creating life in other aspects of life as well, whether it's your business, your garden, a painting.

Dr. Jaclyn Smeaton (54:49.814)
something where that creative energy feels like it's fueling you. It's not just nutrients. And my doctor said I have to take an extra zinc and copper and this, this, and this, and all these pills, because that can cause stress. And waiting for the result of that next sperm analysis to kind of get the go from me to say, OK, you're good, It can take away the beauty of reproduction.

Yeah, absolutely. I want to ask just a couple more questions, a little bit different. One of them is that we're seeing this big rise in testosterone replacement therapy in men, even young men who are looking to boost their testosterone. Have you seen that a lot in your practice and what's the impact of TRT on fertility?

I think I attract pretty well-versed women who probably have educated their men, and they know that, you know, that negative feedback loop is not going to help. You know, I think if they're done having babies, then yes, they will be on TRT. Most often I find they're on the DHEA and trying to get their own body, or at least they've probably heard me speak about that. I always prefer for my men and women to get their own body to make it.

And if it's not making it, why is it soft making it? And often in the men and the younger men, there is a stressor on the body that's making them not make it as much. Whether the stressor is real physiological emotional stress or it's the stressor of nutrients being depleted. You know, I find boron can help men. I've seen that used and it helps. But most men that are

trying to conceive are not coming to me on TRT. They already know that hopefully their urologist or someone has told them that that's not going to work.

Dr. Afrouz Demeri (56:38.082)
Yeah, great. And then what about everything that we've talked about today? Do you think any differently when a couple is going through IVF? I think particularly like IVF about 30 % of the time, maybe it's even higher now. They're using ICSI, intracytoplasmic sperm injection, where the lab is selecting a sperm to penetrate an egg and fertilize artificially. Do you think anything different about the suggestions that you give to men in that situation?

Yeah, I mean, I see a lot of egg freezing. I think that's gone huge on the rise. I prefer if the couple can come see you, me, or someone before the egg sees. So I have time to optimize that sperm that is still going to go through that testing. And the other thing is I always like to see a DNA fragmentation test. Just like I said, we look at the house. We look at the foundation.

I wish I had done that test or I had had access to that, you know, because that is something that we didn't have good tests back in the days. so I have.

The methodology was poor and it had negative research around it for a very long time.

Yeah, but now I am seeing and there is research coming out saying that men with poor parameters usually do have more DNA fragmentation. So just the quality of the sperm for those, you know, my patients I know watch the Dutch podcast. But that would be a test I would do before I see before IVF, I still want to optimize the egg and sperm as much as possible, especially in my women who are doing egg freezing. I can't tell you how heartbreaking it is.

Dr. Jaclyn Smeaton (58:12.77)
when I have had a patient not know they had PCOS, not know that the equality was not good and they were like, I had so many and it was, said it was amazing. And now they find their life partner, they go through the IVF, they go through the, none of them take and it's devastating. So it's even more important because now you are spending a lot of money, a lot of it's stressful on the body, it's stressful emotionally. It's not a natural process. So the environment also with implantation,

has to be optimized. So I'm even more careful with my IVF patients. I'm absolutely recommending acupuncture. I used to do acupuncture in Canada on all my patients' day of, and very, very, very important to do that. But often with implantation, if things are not flowing to the uterus, really important to increase nitric oxide precursors. So I might add in for the men and women some citrulline and arginine and beets.

Neo 40 is a product I use a lot. love for heart health, but it's also really helpful for fertility. And the main ingredient is beets, just beets. But yeah, for IVF, I'm usually on top of it. And I say, wait, give me a chance. Let me work with your reproductive endocrinologist. And let's have a good, good just feeling that this is going to be the best because we did the best on both ends. And not to chance.

Dr. Jaclyn Smeaton (59:46.233)
more than anyone else apparently in the world

know. Well, this is why I'm asking you this question. Do you have any good stories or like patients that come to mind, fertility cases where their results of the Dutch test maybe surprised you but were really important for that case?

I have three men coming today and actually had my assistant pull their results just in case I wanted to talk about something. One of the cases I can think of at the top of my head that was a star, one of your patients that will tell you, they come in to see you and you feel a little flattered that they picked you because they're famous and you're surprised to find that it's the male.

But online on social media and to the millions of their followers, that's not what they're saying that it's the woman, you know, so in this case, I can think I did the Dutch test on them and the antioxidant level was very low in the man. And let me think what marker was though, because I thought that they needed a sperm analysis after that. And they were like, no, I don't need a sperm analysis. And I was like, based on these parameters that I'm seeing, there's just, it's probably poor sperm.

And the agglutination was very high on this patient and they were told that everything was normal. And I said, you know, could this be immune? And I had seen all their biomarkers. I didn't think it was immune related. So, you know, steroids is, which is typically used, which I don't really like for men. And so I just increased vitamin E, C and selenium and we saw the agglutination come down to zero. They had a child and it's so interesting that

Dr. Jaclyn Smeaton (01:01:28.93)
They didn't disclose to the world that it was because of this, but that it was the female that, know, spiritual timing and it could have been, you know, but again, two things with this is the Dutch helped me with the oxidative stress marker. That was very subtle. make me, made me think that I'm sure this is impacting sperm. And then you, that what you see online is not always the truth and that men still

have a hard time or maybe it's a woman protecting, don't know. But I thought that would have been a really good place to tell the world, hey, like the reason we haven't been able to conceive was because of male factor, you know, but it's something that's still, I think, hard for people to tell. Yeah, yeah. Especially if you're, guess, very famous, I don't know, but I wanted people to know that because often they'll blame themselves. They'll think it's me. And a urologist told them that

bit more of a stigma still.

Dr. Jaclyn Smeaton (01:02:26.52)
their sperm numbers looked good and everything was good. But they had missed that or I said, know, like if it's different than being sticky, they're just all basically clumping together and there's not a lot of movement up where we want it to go. Again, you ask why and right. You know, we could do more market marker testing for vitamin C and E and selenium and see all these things inside a cell. But

That's one that comes to the top of my head. I see a lot of high estrogens that don't necessarily always cause male infertility. But to me, just like a woman who is very much relative estrogen dominant, it's going to have an impact. And often that goes with other things. That goes with high body fat percentage, high toxicity, where all the fat is storing the toxins.

And so it's nice because it gives me clues as to the whole picture. And then I can display it to them in that way so they understand what's happening. So I have hundreds of those.

Yeah, wonderful. Well, Afruz, it's been awesome to have you on the Dutch podcast. Thank you for your support and of our business, but also for your time today. It was really lovely to get the chance to speak with you. If people want to learn more about you, mean, when they can find information at WeNatal with the link in the show notes, where else can they find you if they were interested in following you or connecting with you to join your practice?

Thank you. Thanks, everyone.

Dr. Jaclyn Smeaton (01:03:54.7)
Yeah, I just want to mention we natal has a free masterclass on fertility. That's phenomenal. So they can go to be natal comm slash masterclass to that for that. I'm just dr. DeMari calm, just Google my name. I am on Instagram. Most of the time I have a course called trimester zero, and hopefully a book coming out soon on how to optimize your trimester zero.

Wonderful. And thank you all for listening today to the Dutch podcast. If you liked what you heard here and you want to learn more, you can also follow us on every social at Dutch test, or we encourage you to follow us and subscribe to our podcast anywhere that you stream our podcast. We release one every Tuesday. And with that, we'll see you next Tuesday. Thanks everyone.

Thanks for joining us on the Dutch Podcast. Join us every Tuesday for new conversations with leading functional health experts. If you like what you've heard, be sure to like, follow, and subscribe wherever you get your podcasts.