Dian Shepperson Mills

Cert Ed., B.Sc., B.A., Dip ION, M.A.

Clinical Nutritionist

01323 846888

dian@endometriosis.co.uk

www.endometriosis.co.uk

Fertility and Nutrition: A review of data

The reproductive system

• The body is not a set of disparate organs

• The reproductive system is dependent upon the digestive and immune systems to maintain nutrient supply and health

Infertility

• In the USA 15-20 per cent of couples or 1:5 have fertility problems

• 65 per cent of these are helped by drugs and surgery to achieve a pregnancy

• Ballweg ML, Overcoming endometriosis NY p76

Fertility• In the UK 750,000 babies are born each year• 1:5 couples are sub-fertile• 40,000 babies are early and of low birth weight• 1:150 babies are lost through stillbirth• 1:4 pregnancies end in miscarriage

IVF• At present the success rate is only 10-30 per cent success

rate or

• 70 -90 per cent failure rate!!

Female sub-fertility

• Blocked fallopian tubes• Chlamydia/pelvic inflammatory disease• Hypothyroidism• Endometriosis• Amenorrhoea• Anovulation• Polycycstic ovaries• High pesticide or heavy metals

Chlamydia

• Chlamydia trachomatis

• Sexually transmitted pathogen

• More antibodies are found in infertile couples as opposed to fertile ones

• 50 per cent of infants born to chlamydia positive women develop infections

PolyCystic Ovary Syndrome

• Multiple follicles on ovary• Six or more immature ova• Hyperinsulinism• System loaded with insulin• Ovary produces testosterone instead of

oestrogen• Low chromium and zinc• Sugar/carbohydrate craving

Polycystic ovaries

• Hirsuitism

• Erratic menstrual cycle

• Acne

• Weight gain - thighs, hips, stomach

• Male pattern baldness

• Skin tags, nigra

Endometriosis

• Normal endometrium tissue begins to grow in the wrong place outside the womb

• Bleeding occurs within the peritoneal cavity giving rise to pain on intercourse, pain at menstruation and ovulation

• Ovarian ‘chocolate’ cysts may form

Symptomatology of EndometriosisDysmenorrhoea and/or pain throughout menstrual cycle

95%

Fatigue 87%Diarrhea, etc w/menstruation 83%

Abdominal bloating 84%Heavy/irregular bleeding 65%Dyspareunia 64%Nausea, etc w/menstruation 64%Dizziness/headaches w/menses 63%Low resistance to infection 43%

Infertility 41%Low-grade fever 32%

From 4,000 case histories from the Endometriosis Association Research Registry - compiled 1998

Women with Endometriosis are more likely to have:

• Auto-immune disorders - lupus, RA, MS

• CFS - 100 times more likely

• Fibromyalgia - twice as likely

• Hypothyroidism - seven times more likely

• Asthma, eczema, and allergies (atopic)

– Sinaii M et al, 2002, Human Reproduction, 17, 10, 2715-24

Male infertility

• Undescended testicles• Poor sperm quality• Low sperm count• Testicular cancer• Inaequate thyroid function• Impotence• Prostate problems• Genito-urinary infections• Malabsorption

Sperm

• 60 per cent of miscarriages are due to defective sperm

• 1: 20 men are subfertile

• Spermatogenisis in the human takes 120 days to recover if mutagens are around

– Skakkebaek N, KeildingN, Changes in semen and testes. BMJ 309:1316-17, 1994

Pregnancy outcomes

IDEAL - • Live birth - healthy & vigorous baby

ADVERSE -• Infertile• Miscarriage• Stillbirth• Perinatal death\sick baby

Terminology• infertility -no pregnancy after 12 months

unprotected intercourse• preterm - less than 38 weeks• low birth weight - less than 2500gm• congenital malformation

– 18 per 1000 births– foetal alcohol syndrome– infection syndrome - rubella– iatrogenic disaster - thalidomide

Ovaries

• All the eggs a woman will ever make are created in the foetal stage of her own development

• The egg that produces the grand-daughter was created by the grandmother

• New research suggests that women may be able to produce eggs throughout life

AnteriorPituitary

PosteriorPituitary

(+)

LH

(-)

Progesterone

(-)

Follicles

GranulosaCell

Ovary

CorpusLuteum

(+)

FSH

Oestrogen

Oocytes

Blood Vessels

Ovum

oxytoxin FSH LHprolactin

Oestrogen & Progesterone

Preconceptual care

• Assessment of the health and well-being of prospective parents to allow this to be optimised for conception

Who needs preconceptual care?

•First time parents•Couples with fertility problems•Couples with previous poor pregnancy outcomes•Everyone?

The aims of preconceptual care

• to conceive

• to have an uncomplicated pregnancy

• to have a normal delivery

• to breast feed

• to adjust to a new baby

• to give children the healthiest start in life

Fertility assessment

• Genetic and family history

• Medical conditions

• Occupational risks

• Lifestyle - exercise, nutrition, toxin exposure, stress

Requirements for conception

• normal menstrual cycle & ovulation

• healthy sperm in sufficient numbers

• healthy reproductive organs

• normal sexual function

• timing

Importance preconceptual care

• Healthy gametes

• Before attachment to the placenta nutrients must be high in the endometrium

• Rapid embryonic growth rate

• Foetus almost fully formed by 8 weeks

A

B

C

D

E

F

G

Fallopian Tube

Ovary

Endometrium

Myometrium

A B C

D E F G

Ovum

Ligament

Uterus

Lumen (centre of uterus)

granulosa cellsSperm

Fertility• There is an endocrinal mechanism by which the females of

all mammalian species become infertile if food supplies are inadequate

• Down on the farm, in animal husbandry, it is well known that animals conceive on a rising body weight, not when weight is falling. All animals have a fertility threshold and in farming there still exists the practice of ‘flushing’. “The practice of giving ewes which are in fairly poor condition an improved diet for a few weeks before mating so that they are in a rapidly rising condition when they meet the ram. Flushing is not fattening up, it means supplying all the essential nutrients to make the hypothalamus and pituitary gland (and ovaries) provide an excellent hormone profile”.

– Coop IE. ‘Effect of flushing on reproductive performance of ewes’. 1966. J Agri Sci (Camb): 67:305-323

Poor Nutrition• Research into restricted calorie intake has been done at the

University of Pittsburgh, and it was discovered that ‘fasting for one day alone can change the suppression of luteininzing hormone (LH)

• The implication for slimmers is that even short-term deficiency can have a profound effect on endocrine function

• Other studies offer similar conclusions, suggesting that ‘restrained eating may be a marker for metabolic and emotional disturbances, and may also be associated with biological suppressed, no message would be sent.

• Women with abnormal menstrual cycles experienced ovulatory disturbances including low progesterone and short luteal cycles

• If you are restricting nutrient intake in order to lose weight, you may be damaging your chances of becoming pregnant

Fertility• Inability to ovulate is clinically called ‘luteinized

unruptured follicle syndrome’ or LUF.

• In the LUF syndrome, women will have the normal sequence of endocrine events and a normal menstrual period but their ovary will not release the egg.

• Non-steroidal anti-inflammatory drugs give rise to LUF, research has shown.

• In women with LUF syndrome, steroid hormone concentrations in the peritoneal fluid are much lower after the ovulatory cycle. It is felt that this may facilitate the development of endometriosis.– Konnninckx PR, DeMoor P, and Brosens IA, “Diagnonsis of the lutenized

unruptured follicle syndrome by steroid hormone assays on peritoneal fluid” in Eur J Obstet Gynaecol, 87:929-34, 1980

Fertility• “In pregnancy it is known that nutrient requirements alter.

Women on good diets are seen to have healthier babies than those on poor diets”.

– Wynn AHA, Wynn M ‘The Case For Preconceptual Care in Men and Women’ AB Academic Publishers, Bicester, Oxon 1991

• “Riboflavin (B2) deficiency causes hormonal imbalances and is essential for the liver clearance of steroid hormones (oestrodial and progesterone). Deficiency inhibits the LH secretion from the pituitary and GnRH from the hypothalamus. Riboflavin (B2) works closely with vitamin B5 and if levels fall below 80 per cent then the reproductive system fails”.– Esch M.W., Easter R.A., Bahr J.M., ‘Effect of riboflavine deficiency on estrous

cyclicity in pigs’. Biol. Reproduction : 25 : 659-665. 1981

Fertility

• “Low intake of B vitamins may also slow down the ripening of the egg before conception and be affecting fertility. The hypothalamus in other mammals reacts to a severe deficiency of any of these B vitamins by inhibiting GnRH secretion and so causing infertility”.– Watteville H, Jorgens R, Pfalz H, ‘Einfluss von Vitaminmangel auf

Fruchtbarkeit, Schwangerschaft und Nachkommen’ Schweiz Med Wochenschr. 84. 875-882.1954

Research at Hackney Hospital looked at the weights of new babies

• “Mothers of low birthweight babies had been eating meat, meat products, white bread, refined sugars and soft drinks in greater amounts. Mothers of the healthy weight babies had been eating nutrient-rich foods, three regular daily meals, (breakfast being the most important), and wholegrain cereals, muesli, oats, nuts and seeds daily, eggs, egg dishes, wholemeal bread, dairy foods, and lots of fresh fruits and vegetables” (41).

– Doyle W et al, Maternal nutrient intake and birthweight’ in J Hum Nutri Diet, 2:415-22, 1989.

HEALTHY BABIES• Burke et al looked at mothers who had eaten good/excellent

diets, they gave birth to babies judged to be in good/superior health 94 per cent of the time. Contrasted with mothers whose diet were classified as poor and whose infants had good health only 8 per cent of the time.

– Burke BS, Harding VV, Stuart HC. ‘Nutrition studies during pregnancy’. J Paediatrics. 1943 Vol 23; 506-515

• “If the mother’s nutrition stores are inadequate during the time when the placenta is developing, then the placenta will develop poorly. As a consequence, no matter how well she eats later, her unborn baby will not receive optimum nourishment”.

– Aherne W, Dunhill MS. “Morphology of the human placenta’. British Medicine Bulletin. Vol22 (1) 5-12. 1966

Fertility Conclusion

• The conclusion is that a developing embryo/foetus requires abundant nutrients via the placenta, in order to become a healthy bouncing baby.

• High-calorie, empty-nutrient over-refined foods were obviously detrimental to the developing baby in the womb. “The hypothesis of the Hackney study, that the diet of the mothers of low birth weight babies had too few nutrients in their diets was supported”.

– Wynn AHA, Wynn M. ‘The need for nutritional assessment in the treatment of the infertile patient’, in J Nutri Med., 1:315-24, 1990

Pituitary

Thyroid

Thymus

Uterus

Ovary

Vagina

Hypothalamus GnRH

FSH LHOxytoxinProlactin

Thyroxine

Thymic hormone

Prostaglandins

Oestrogen Progesterone

AdrenalineOestrogenTestosterone

Adrenal glands (on top kidney)

Pineal GlandMelatonin

Liver

Gall Bladder

Kidney

Pancreas

The importance of sound nutrition on health

– Dr Weston Price, Dr. Francis Pottinger, Sir Robert McCarrison

• It is the quality of food eaten which confers good health on the recipient

• Healthy food was seen to emanate from healthy soil and good farming principles

• We are all biochemically different and that some individuals requirements for nutrients may be different due to body biochemistry

The Nutrient Content of and nutrient availability from the modern food supply is

different from that of palaeolithic times

• Reduction of omega-3 fatty acids from fish• Intensive livestock farming = nutrient deficiencies of

these animals and problems with infections• Intensive farming techniques = soil demineralisation,

overuse of pesticides• Agrichemicals and environmental pollutants find their

way into the food chain• Reduced nutrient content of foods = compromise of

nutritional status = reduction in individual adaptation

Fats and Oils

VegetablesNutsSeeds

MeatDiary products

Fish oilsWalnut oilLinseeds

Linoleic Acid Arachidonic Acid Linolenic Acid

GLAZincB6 BiotinMagnesiumVit CCalcium

{Prostaglandin

series 1Prostaglandin

series 2

Prostaglandin series 3

Anti-inflammatory PGE 1

Pro-inflammatory (inflammatory leukotrines)

Anti-inflammatory Reduces blood

clotting

Omega 3 and Omega 6 Essential fatty acids and pain reduction

• In a group of Danish women, a higher intake of omega 3 fatty acids or a higher ratio of omega 3/omega 6 fatty acids was associated with reduced Menstrual pain.– Deutch B. Menstrual pain in Danish women correlated with low omega

3 polyunsaturated fatty acid intake. Eur J Clin Nutri 1995;49: 500-16

• Women should reduce their saturated and trans fatty acid intake by half - then oestrogen levels will be around 20% lower

Omega 3 and Omega 6 Essential fatty acids and pain reduction

• Animal fats from meat and dairy foods and manufactured foods should be reduced

• Omega 3, omega 6 and omega 9 cis fatty acids should be eaten to maintain levels of anti-inflammatory prostaglandins PGE1 and PGE3

• Use oily fish, nuts and seeds, dark leafy vegetables, cold-pressed extra virgin olive and walnut oils

Gastric Disorders Survey

• 69% of the population surveyed showed signs of one gastro-intestinal disorder over the previous three months

• In the USA annual medical costs for gastro-intestinal disorders are $41M (£25.6M)

• Constipation affects 4 million Americans each year

• Americans spend $725M a year on laxatives

Gut Flora

• 2-4 lbs of gut bacteria live in the intestines.• 100 trillion organisms make up this flora• 400-500 different species provide an active

metabolic action equivalent to the liver• They provide a protective atmosphere and are a

critical factor in immune stimulation• Antibiotics, oral contraceptives, hormone

replacement therapy and steroids, non-steroidal anti-inflammatories disrupt flora.

Gut Associated Lymphoid Tissue (GALT)

• GALT tissue and Peyers patches exclude all infectious agents, allergenic material, toxic substances from entering the bloodstream

• GALT makes the GI tract the largest lymphoid tissue/immune organ in the body

• 1010 immunoglobulin producing cells per metre of small bowel account for 80% of all immunoglobulin cells in the body

• GALT is the bodies first line of defence against alien invasion

Immune System

• Research has shown that subclinical autoimmune disease may be involved with reproductive failure. “Forty-four per cent of women who miscarried were seen to have antibodies implicated with anti-cardiolipin, it has also been speculated that two thyroid autoantibodies are involved with reproductive failure. Thyroid autoantibodies have been used as as guides to point to women at risk from miscarriage”.

– Singh A, Nery Danta Z., Stone S.C., Asch R.H., ‘Presence of thyroid antibodies in early repproductive failure: biochemical versus clinical pregnancies.’ Fert. and Ster. 1995: Vol 63(2) 277-281

Food Allergies/intolerances

• One man’s meat is another man’s poison

Common allergies - fish, peanuts

• Common intolerances - wheat, bovine dairy, citrus, deadly nightshade family

• Chemicals

• Pollens, dusts, moulds

Immune system

• Research suggesting a link between coeliac disease and autoantibodies to the thyroid warrants further investigation. “Adults tend to present with these problems in their 30’s and 40’s, tiredness, mouth ulcers, malaise, fertility problems and malabsorption being the main problems” (22).

• All women with unexplained infertility should request these very basic tests.– Howard S., ‘Module 16: Current Thinking in Coeliac Disease:’ Pharmacy

Magazine Feb. 1997: CEI - CEVIII

Dietary Strategies

1. Substantial breakfast - some of the following:wholegrain cereals, eggs, nuts, seeds, fruits, dairy foods

2. Regular unhurried meal patterns

3. Shopping frequently for fresh fruits and vegetables

4. Adequate intake of fresh fruits and vegetables, particularly green leafy vegetables

5. Avoidance of stimulants - tea, coffee, coke, chocolate, alcohol, cigarettes

6. Use of unrefined, cold-pressed unhydrogenated vegetable oils e.g. sunflower, safflower, olive, organic butter

7. Use of oily fish in the diet8. Drinking plenty of fresh filtered or mineral water

SupplementationTake a course of basic supplements for 3-6 months, whilst the diet is being corrected.

Multi-vitamin/mineral (yeast, gluten, dairy and sugar free)

• Vitamin C with bioflavinoids 1000mg• Evening primrose and fish oils 2000mg• Acidophilus 4 billion• Slippery elm tablets• Digestive enzyme with each meal• Magnesium malate 300mg• Zinc, vitamin E and vitamin B6

Kelp tablets (optional for metabolism increaseAgnus castus for PCO/irregular periods

Common social poisons• Smoking

– Increases the risk of cleft lip and palate– Minor brain damage

• hyperactivity,• deafness• squints, asthma, sids

• Alcohol• Increased risk of:• Short length / small head• Lowered IQ / retardation, hyperactivity• Extreme nervousness, facial malformation, • Heart defects• Street drugs• Central nervous system damage• Chromosome damage• Heart defects• Behavioural problems

Vitamin A deficiency • Eye defects, heart problems, hydrocephalus,

urogenital deformities, diaphragmatic hernia• Excess can cause facial deformities and floppy

baby syndrome ie. over 7,500iu. keep to 2000iu per day

B complex deficiency• Sterility, small birth weight, perinatal death, low

mental ability, blood disorders, short limbs, malformed jaw, cleft palate/lip, kidney problems, limb and heart defects, lack of myelination, damage to eyes, lungs &central nervous system disorders, stomach & liver damage

Vitamin C

• deficiency poor teeth

• gums and bone weakness

• anaemia

• vulnerability to infections

Vitamin D deficiency

• Poor tooth & bone development

• Deformities of skull

• Jaw & palate deformity

• Low mental ability

Vitamin E deficiency • Miscarriage• Exencephally hydrocephalus• Neonatal jaundice

Essential fatty acid deficiency• Poor growth• Damage to kidneys• Brain and blood vessel damage

Calcium deficiency• Rickets• Poor tooth and bone development• Cramping of maternal uterus

Magnesium deficiency • Calcium deposits• Heart abnormalities• Anorexia• Convulsions• DeathCopper deficiency• Poor growth• Depigmentation• Anaemia• Fragile bones• Ataxia• Small brainIodine deficiency• Slow growth• Abnormal mental development

Iron deficiency • Eye defects• Bone defects• Brain defects• Learning difficultiesChromium deficiency• Eye abnormalities• Blood sugar imbalance• Polycystic ovariesManganese deficiency• Malformation of inner ear• Ataxia• Bone malformation• Poor co-ordination• Head retraction• Tremor• Hyper-irritability• Cartilage & heart problems• Learning difficulties

Nickel deficiency • Liver problems• Kidney and heart abnormalitiesSelenium deficiency• Lung disorders• Chromosome abnormalities• USA research links it with Down’s syndromeZinc deficiency• Growth retardation• Anorexia• Loss of hair & seborrhoea• Apathy

– defects in eyes, kidneys, brain, bone– heart problems

Toxic metals • High lead, cadmium, aluminium linked to:

– infertility - miscarriage, stillbirth, premature birth

– skeletal deformity

– learning difficulties/behavioural problems/mental retardation

To detox heavy metals• Lead - vitamin C, iron and zinc• Cadmium - vitamin C and zinc• Mercury - selenium, zinc, iron, sulphur• Arsenic - sulphur and selenium• Aluminium - zinc and silica

‘The important thing is not to stop questioning.’

Einstein

“Endometriosis: a key to healing and fertility through Nutrition

Dian Shepperson Mills &Michael Vernon

Thorsons

ISBN 0-00-713310-3