Upload
others
View
4
Download
0
Embed Size (px)
Citation preview
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:
( 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
32