hypofertility and food intolerances : are there … · dr tatjana barras-kubski/ ch gp napro...

Dr Tatjana Barras-Kubski/ CH

GP

NAPRO Consultant

HYPOFERTILITY AND FOOD INTOLERANCES :

ARE THERE STRONG ARGUMENTS FOR

EXISTING LINKS ?

PARIS IEEF 4/5 October 2013

CENTRE DE SANTÉ « LA CORBIÈRE », ESTAVAYER-LE-LAC/CH

2

WWW.LACORBIERE.CH

3

1 MATERIAL AND METHOD

The 20 first cases of NAPRO were examined :

4 couples were excluded

1 prolactinoma,

3 stopped charting.

16 women:

In average 34.6 years old

trying to conceive since 37 months

0.8 past miscarriage /woman

4

Follow-up: 2 years.

Cycles 25 - 33 days,

Mucus score

5.5 - 9 points

Normal : 9 -16 points

Post peak phase

10 - 13 days (PPP)

62%♀ dysmenorrhea, half with a severe grade.

75% ♀ PMS requiring relief.

2 MATERIAL and METHOD

5

7 ♀ (44%) had a treated endometriosis,

2 ♀had no endometriosis,

1 patient had PCO (11 no)

7 ♀ had no laparoscopy.

8 (50 %) ♂: light to severe spermiogramme

deficiencies.

3 MATERIAL AND METHOD

6

FOOD INTOLERANCES

87% ♀

56% ♂

2♀ only dairy products (1 ♂)

1♀: only gluten (1 ♂)

0 patient had celiac disease

10 ♀: dairy and gluten products (6 ♂)

1♀: gluten, dairy and histamine products (1 ♂).

4 MATERIAL AND METHOD

7

7 conceptions with births (43%)

3 before 6 months

3 between 6 – 12 months

1 at 23 months

1 ♀: Clomid stimulation

8

RESULTS AT 2 YEARS (1):

3 spontaneous miscarriages:

62 % of conceptions!

1 ♀ in her first month of diet change (5th cycle)

but conceived again in her 7th cycle giving birth to a live

baby at term after 3 months of diet restrictions !

2 other natural conceptions

at 34 months

(3 months after treatment of endometriosis,

acupuncture and reflexology)

and at 35 months.

RESULTS AT 2 YEARS (2):

9

Surprise to find such a high level of food intolerances,

Mainly to both gluten and 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

patients

1. CONCLUSIONS

10

Already well known that PMS and

dysmenorrhea improve dramatically with

diet change.

Hypofertility is greatly boosted by an

adequate personalized diet.

It was suggested to avoid sexual

intercourse during the fertile period of

the first 3 cycles of diet change

2. CONCLUSIONS

11

CASE

A 38 yr. old patient wished to have a 2nd child for 4 years.

Had an irritable bowel syndrome. Skin of her legs was dry

“scaly“.

Operated for endometriosis,

3 inseminations

3 cycles stimulations without success.

Hormonal treatment: tiredness, nausea, bloating,

gained (12 lbs.).

After 5 months of diet change, spontaneously pregnant.

Treatment: natural progesteron first 14 weeks of pregnancy.

Nausea 3 months and premature contractions at end of

pregnancy, when she ate too much gluten or cow’s milk

products.

2nd boy at term : natural birth.

12

CASE

Intestinal villosities spread out equal: football field.

Lungs (tennis field) or the skin (2m2).

Intestines most exposed to external allergens (foods, pesticides

etc.)

Milk highly pasteurized ( >100 C°) : modified proteins;

uperized milk (165 C°) ?

Fresh milk: often no problem

13

WHY HAVE FOOD INTOLERANCES INCREASED

SO MUCH SINCE A FEW DECADES ? A)

Wheat modified several times to increase content in gliadin

(gluten):

increases its elasticity

(machine –made bread- more easy to make).

Before 1960, level of gluten constant over 10.000 years...

Gluten is composed of 2 proteins: prolamines and glutenines.

(Prolamines mainly toxic)

14

WHY HAVE FOOD INTOLERANCES … B)

Wheat*, spelt and kamut contain most gluten : 70%

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%

Cereals with little % of prolamines don’t ferment much.

15

PERCENTAGE OF PROLAMINES IN CEREALS

Allergy :

immediate reaction, IgE- mediated. (seldom)

Intolerance:

Symptoms appear in hours to 3 days after ingestion.

Coeliac disease:

highest degree of food intolerance with positive blood

antibodies (IgA or IgG) and/or duodenal biopsies.

(Symptoms stronger and faster)

Majority of patients:

food intolerances of different degrees

16

DIFFERENCE BETWEEN

FOOD INTOLERANCE AND ALLERGY?

General : fatigue, tiredness after a meal, headache, irritability,

vertigo, hypotension.

Digestive : diarrhea, vomiting, colics, bloating, or chronic

constipation, reflux, dry cough.

Dermatological: psoriasis, herpes dermatitis, alopecia,

stomatitis aftosa,…dry skin, itchiness of skin or scalp,

eczema, urticaria.

OA : cramps, myalgias, stiffness in the joints, restless legs

syndrome

ENT : runny or obstructive nose, mucus in the throat, dry lips,

dry throat

17

SYMPTOMS ASSOCIATED WITH COELIAC DISEASE AND

TO A LESSER DEGREE TO FOOD INTOLERANCES: A)

Hematological : Increase of abdominal ganglions. (low

ferritin - often linked to gluten intolerance ! low vit. B12

and/or folic acid,. low vit. D or zinc.

Endocrinological : retarded growth or puberty.

Neuro-psychiatric: depression, hyperactivity, epilepsia,

schizophrenia, autism (Prof Dr Karl Reichelt, N)

Pseudo-allergy or histamine intolerance: migraines, car- or

seasick, gastric acidity, urticaria etc.

18

SYMPTOMS ASSOCIATED… B)

>30 % of the Caucasian population has a genetical

susceptibility (HLA DQ2 or DQ8) to gluten intolerance:

Dr T. Nawrocki / F

2/5 Coeliacs : classical, atypical or silent: antibodies pos

and /or int. biopsy pos. with or without symptoms.

3/5: latent Coeliacs or healthy persons: tests negative but

genetic predisposition: could appear with stress, fast-food,

hormones (pill, previous pregnancy) pesticides etc.

19

THE COELIAC ICEBERG

Patients with « normal» gynaecological

investigations who can’t conceive

often have food intolerance.

Food intolerance affects the « fecundability » of the

ovocycte, its nidation and the evolution of the

pregnancy (oral communication of Prof. Dr Karl

Reichelt/ N )

20

• a) -observation of a dry skin (fish scales-like or

whitish) on legs (predisposition to Psoriasis linked to

food intolerance: Dr T. Nawrocki)

-often a raspy skin above the elbows

21

MY BEST DIAGNOSTIC TOOLS: A)

22

23

• b) a deep food anamnesis : How much milk,

yoghurts, soft or hard cheese (less lactosis). Bread

and pasta? Coffees? Black tea? Which fruit or

vegetables don’t you tolerate? etc.

• c) Which symptoms of food intolerance?

• d) Trials of food exclusion: gluten products for 3

weeks: bread, pasta, pizza, cakes etc. (wheat, rye,

barley)

add cow’s milk products restriction for 3 further

wks. (or vice-versa)

24

MY BEST DIAGNOSTIC TOOLS: B1)

Important to also ↓or avoid acidic products : alcohol, sodas,

coffee, black tea, orange juice, red meat ( rather white

meat or fish)

↑ alkaline foods: vegetables, potatoes,, chestnuts, bananas

etc

Eat equilibrated foods: rice, quinoa, buckwheat and oats.

Observe effect of corn and millet.

If high gastric acidity, migraines, urticaria etc.:

Pseudo-allergy to foods with histamine for ex: wine,

beer, blue cheese, chocolate, nuts, sardines,

spinach, strawberries, pineapples, or kiwis etc.)

25

MY BEST DIAGNOSTIC TOOLS: B2)

• e) After 6-8 weeks meet the couple again: Which symptoms

improved?

Which appear mainly within 1 to 3 days after the

ingestion of certain foods?

• f) Simple blood tests :low ferritin < 30 ng /ml : increases

often only after a diet without gluten. (exclude heavy

menses)

low vitamine B12: (low folic acid, zinc, vit. D: treat if

necessary)

IgA anti-Transglutaminase, IgG deaminated Gliadin peptide,

total IgA

26

MY BEST DIAGNOSTIC TOOLS: C)

Breath lactose tests. (Ig G anti-casein: casein intolerance is much

less frequent.)

Genetic tests for gluten and lactose intolerance: expensive,

only predisposition

Histamine intolerance: di-amino-oxydase (DAO) blood

< 10-20 U/ml (suspect if high gastric acidity).

27

MY BEST DIAGNOSTIC TOOLS: D)

Omega 3 : 2 tsp/d

Cold pressed oils : colza or sunflower 1 tbsp /d and

olive oil 1 tbsp/d

Vit B12 : if <250 pmol/l ( ileal flora disturbed: probiotics)

with vit B –complex

Folic acid, Mg., zinc

Vit C and B 6 if histamine intolerance.

Iron: avoid 3 first months of pregnancy (organogenesis);

later if possible per os > iv (same result after 3 months).

Dr.T.Nawrocki/F.

28

TREATMENT: A

Avoid gluten products and/or dairy and /or histamine

containing products 3 first mo. of pregnancy (avoids

miscarriages).

4 th mo: reintroduce progressively cow’s milk products 2-3x

/wk on alternating days

5th mo: reintroduce progressively gluten products 2x / wk (

or v-versa ) on other days

Follow patients symptoms !

29

TREATMENT: B

Helps to treat amenorrhea ( 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

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 intolerance, loosen the diet according to

mother’s symptoms).

30

CONCLUSION: TREATING FOOD INTOLERANCES:

t.barras@bluewin.ch

( WORKSHOPS OVER SKYPE IN

ENGLISH, FRANÇAIS, GERMAN, CASTELLANO)

LITTERATURE:

1) 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

2) 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

3) Histamine and histamine intolerance Laura Maintz,

Natalija Novak Am J Clin Nutr 2007; 85:1185-96

31

LITT:

Immunological and non-

immunological

approaches to dietetic

interventions in

infertility treatment.

Jolanta Wasilewska MK.

Tadeusz Wasilewski

ISSN 1392-6373

SVEIKATOS MOKSLAI

2011, VOL 21 NO3 P40-

44

jolanta.wasilewska@wp.eu

32