Hypofertility and food intolerances: Are there strong arguments for existing links?
Dr Tatjana Barras-Kubski /CH FMH méd . int. GP and NAPRO-consultant
INTRODUCTION:
It is already well-known that the premenstrual syndrome and dysmenorrhea improve greatly with a healthy food diet. Dr Thadée Nawrocki /France also specialist in embryology and genetics, made me aware of the close link between food intolerances and mainly endometriosis but also with polykystic ovaries.
MATERIAL AND METHOD:
I examined my 20 first cases of NAPRO to find out the clinical importance of such links. (Four patients were excluded: 1 prolactinoma, 3 stopped charting in the first cycle ). The follow-up was of 2 yrs. The 16 remaining women were in average 34,6 yrs. old, they were trying to concieve since 37 months and there were 0,8 past miscarriage /woman .
My best diagnostic tools are:
-observation of a dry skin (fish scales-like or whitish) pre-tibially and often a raspy skin above the elbows.
- a deep food anamnesis and trials of food exclusion for 3 weeks for gluten products then add the exclusion of cow’s milk products for 3 further wks. (or vice-versa) and observe if the symptoms get better after 3-4 wks. It is also important to avoid acidic products : alcohol, sodas, coffee, black tea, orange juice. If the patient suffers from a high gastric acidity, foods with histamine should be avoided as well if the patient doesn’t tolerate such as wine, beer, blue cheese, chocolate, walnuts, sardines, spinach, strawberries, etc.)
-observation of symptoms of food intolerance which appear mainly within 1 to 3 days after the ingestion of certain foods.
Simple blood tests give a clue as to the possible presence of food intol : low ferritin < 30 ng /ml ( often linked to gluten intolerance !), low vitamine B12 and /or low vit. D (ileal flora disturbed), or low folic acid or zinc.
RESULTS:
7 women (44%) had a treated endometriosis, 2 women had no endometriosis, 1 patient had a PCOS and 7 women had no laparoscopy. 62% of these women suffered from dysmenorrhea, half of them with a severe grade and 75% had a PMS requiring relief.
The cycles lasted between 25 and 33 days, the mucus score was between 5,5 and 9 points and the PPP( post pic phase) lasted 10 to 13 days.
Food intolerances: (87% of the women, 56% of the men)
10 women (6 men) had a cow’s dairy and gluten intolerance
2 women (1 man): dairy products only
1 woman (1 man): gluten products only ( None had coeliac disease)
1 woman: gluten, dairy and histamine products (1 man).
56 % of the men had light to severe spermiogramme deficiencies
There were 7 (43%) live pregnancies during the first 2 yrs of follow-up.
The time till conception of these live babies was : before 6 mo: 3 couples, between 6 and 12 mo: 3 couples and 1 couple at 23 mo. : (only 1 woman needed a hormonal stimulation with Clomid ; 2 other women had had previously ≥ 3 hormonal stimulations without success.)
Case:
A 38 yr. old patient wished to have a 2nd child for 4 yrs. She had been operated for her endometriosis and her legs had a dry, “scaly” skin. Her digestion was poor since she was a baby. She had had 3 inseminations and 3 cycle stimulations without conception. The hormonal treatment had caused her nausea, bloating, tiredness and she gained 6 kilos (about 12 lbs.). After 5 months of diet change, she became spontaneously pregnant and was she took only a natural progesteron during the first 14 weeks of pregnancy. Despite the diet, she had nausea the first trimester and premature contractions at the end of her pregnancy, especially when she ate too much gluten or cow’s milk products. She had her 2nd boy at term through a natural birth.
DISCUSSION:
There were 3 spontaneous miscarriages ( 62 % of conceptions): one woman in her first month of diet change (5 th cycle of observation) but she conceived again in her 7 th cycle giving birth to a live baby- after 3 mo of diet restrictions ! I suggest to avoid sexual intercourse during the fertile period of the first 3 cycles of diet change in order for the body to recover from the deficiencies. There were several miscarriages later in my following over 100 women who didn’t follow this advice. Later two other women had natural conceptions at 34 and 35 mo. pursuing the diet change ! The link between hypofertility and food intolerances is due to the fact that at least 30 % of the Caucasian European population has a genetically predisposition to psoriasis (dry, thick scaly skin) confirmed by the research of HLA and its specific sub-groups ; these subgroups reveal for many a predisposition to intestinal malabsorptions responsible for food intolerances.( Dr T Nawrocki)
Why have food intolerances increased so much since a few decades ?
The intestinal villosities spread out equal to the surface of a football field. The intestines are more exposed to external allergens (foods, pesticides etc.) than the lungs (tennis field) or the skin (2m2). In addition, the quality of foods has greatly decreased these last decades (for ex. wheat has been modified several times to increase its content in gliadin (gluten) thus increasing its elasticity- and rendering machine –made bread more easy to make. Before 1960 , the level of gluten had remained constant over 10.000 years... Milk highly pasteurized ( >100 C°) has already modified proteins ; what about uperized milk (165C°) ?
Wheat*, spelt and kamut contain most gluten : 70% ( mainly the prolamines are toxic) Barley* : 50 % and rye* 30-50 % (*:most toxic)
Corn : 55 % and millet :40 % : but are much less toxic.
Oats : 10 %, teff : 12 % rice : 5 % are rarely not tolerated.
Not cereals but seeds : quinoa, buckwheat, amaranth : 0%
Difference between food intolerance and allergy?
An allergy is an immediate reaction and IgE- mediated. (no patient)
Coeliac disease is the highest degree of food intolerance with positive antibodies and/or duodenal biopsies (< 3 % of my patients). Breath or blood tests for lactose intolerance are easy to perform. Genetic tests : seldom.
The majority of the patients have food intolerances of different degrees and may ask for food intolerance tests ( Ig G or lymphocyte tests whose inter-pretation may be questionable) but which may be helpful for some persons. Blood Di-amino-oxydase < 10-15 U/ml (histamine intol.) may also help.
Symptoms associated with coeliac disease (and to a lesser degree to food intolerances) :
General : fatigue, (tiredness after a meal, headache, irritability, migraines vertigo. (I suspect food intol. if hypotension !) Car- or seasick : histamine intol.
Digestive : colics, diarrhea ( reflux, epigastric trouble, bloating, or chronic constipation, vomiting, quickly full or hungry, dry cough).
Dermatological: psoriasis, herpes dermatitis, alopecia, stomatitis aftosa, ( dry skin, itchiness of the skin or of the scalp, eczema, urticaria).
OA : strong cramps, ( muscular pains : shoulders etc, stiffness in the joints, RLS)
ENT : (runny or obstructive nose, mucus in the throat, dry lips , dry throat).
Hematological : Increase of abdominal ganglions. (low ferritin - often linked to gluten intolerance ! low vit. B12and/ or folic acid, low vit D or zinc.
Endocrinological : retarded growth or puberty.
TT :
Avoid gluten products and/or dairy and /or histamine containing products till the 3-4 th month of pregnancy (more or less strictly according to the patients symptoms). Then reintroduce progressively gluten products 2-3x /wk on alternating days (on even days), and after a month introduce cow’s milk products ( or v-versa on uneven days) and follow patients symptoms !
Complements: omega 3 and cold pressed oils : 3 tbl/d, vitamin and mineral complex with folic acid, vit B12 if<-250 pmol/l, vit B –complex, mg, zinc and vit B if necessary.( Iron is recommended to be avoided during the 3 first months of pregnancy and later give just what is necessary. DrT.N.)
CONCLUSION :
It was a surprise to find such a high level of food intolerances, (mainly to both gluten and cow dairy products) especially in women with endometriosis (less if PCO). Half of the men also suffered from food intolerances. This proportion remains high in my following over 100 hypofertile patients. I postulate that patients with « normal investigations who can’t conceive or have repeated miscarriages» have probably often food intolerances! I observed that treating food intolerances or coeliac disease :
· Helps to treat amenorrhea (is linked to coeliac disease) and cycle problems such as luteal insuff. etc.
· Increases the quality of cervical mucus.
· Decreases vulvo-vaginitis (mycosis) and pseudo- cystitis (germ-free).
· Helps to conceive and reduces miscarriages (increases the « fecundability » of the ovocycte, its nidation and the evolution of the pregnancy, oral communication of Prof. Dr Karl Reichelt/ Oslo )
· Pregnancy: Decreases vomiting, high weight increase , post-partum depression and maybe premature contractions and premature births.
· Offers a breast milk without colics ( if the baby has no symptoms of food intol., loosen the diet according to mother’s symptoms).
t.barras@bluewin.ch ( workshops over skype or by phone in E, F, G, S)
References:
Spectrum of gluten-related disorders:consensus on new nomenclature and classification. Anna Sapone et al. BMC Medicine 2012,10:13 www.biomedcentral.com/1741-7015/10/13
Effects of histamine and diamine oxidase activities on pregnancy . a critical review Laura Mintz et al Natalija Novak Human reproduction update, Vol.14, No.5 pp. 485-495, 2008
Histamine and histamine intolerance Laura Maintz, Natalija Novak Am J Clin Nutr 2007; 85:1185-96