Nutritional therapy provides an effective method of improving fertility rates and reducing abdominal pain in women with endometriosis. "What is one man's meat is another man's poison, may presumably have a chemical basis." Integrated medicine at the point of diagnosis may enhance treatment of women with compromised fertility and abdominal pain
Author: D. Shepperson Mills
The Endometriosis and Fertility Clinic, London, United Kingdom.
Methodology
One hundred and ninety-eight women with clinically diagnosed endometriosis treated at least three times over six months with nutritional therapy form the cohort. They completed a MYMOP questionnaire at each clinic. They record a score in the range 0 (as well as could be) to 6 (as bad as could be) for up to two symptoms, an activity and a sense of well-being. They also complete a nutritional health profile questionnaire at the start of their treatment. This study will look at a variety of information from these questionnaires in the attempt to prove our hypothesis.
Fertility: Sixty-seven of these women had been trying to fall pregnant over several years before using nutritional therapy. To ensure that accurate fertility rates have been recorded this group of patients were followed over time.
Pain: One hundred and fifty-two of these women chose pain as one of their symptoms. This pain varied from abdominal pain, to ovarian, leg, back or period pain, cramps, twisting or stabbing or throbbing pain, through to ruptured ovarian cyst pain.
Explanation of Measure Yourself Medical Outcomes Profile (MYMOP)
The cohort of one hundred and ninety-eight women are self-selected after attending three or more consultations. All the women had been medically diagnosed with endometriosis. MYMOP is a subjective clinical audit questionnaire filled in by the patient at each consultation, usually once a month.
There are varied and complex reasons why women with endometriosis may seek help from complementary and nutritional therapy. The main reasons given were that orthodox medicine had been ineffective or was unacceptable due to adverse side effects. These patients proactively wanted to help themselves improve their health.
Digestive problems were present in most of the cohort, along with a wide variety of symptoms linked with endometriosis. The nature of nutritional therapy means that each patient received a unique course of treatment and dietary recommendations according to their individual needs after testing. After an initial exclusion diet for one month, the food is reintroduced to assess symptom reoccurrence. It is easier to exclude the food from the diet, once it's full effect has been felt. This multicultural patient group were paying for treatment and also for their supplements. This may have given them incentive to follow the recommendations and the course of the treatment.
MYMOP makes an attempt to rationalise and score the outcome of the treatment that is individualised to each patient. At the outset the MYMOP questionnaires were explained to the patient's as a clinical audit, designed to judge how their treatment had impacted on their health. MYMOP attempts to encompass and measure the treatment effects each interviewee considered important to them.
MYMOP is growing in respect within the orthodox and complementary therapy field as a means of evaluating patient response to therapy.
Age
The cohort range from the age of twenty-three to fifty-two years. The sixty-seven with fertility issues are in the age range of twenty-three to forty-five. The majority of the women with fertility issues are in their thirties, with a small number in their forties.
BMI and fertility
The BMI of the patients at first presentation has been recorded, not the BMI at conception. There is a link between fertility rate and BMI. More women fall pregnant with a BMI of less than twenty-three. The nutritional advice given helps to raise or lower the BMI to the optimum level of around twenty-three as suggested in research.
The implication of fertility when off wheat
Sixty-three per cent of the women who became pregnant had avoided wheat products, and eighty two per cent of those who still trying to fall pregnant are avoiding wheat.
There is a noticeable variation. A few of the women who became pregnant whilst avoiding wheat, began to eat it again after conception. A number of these women miscarried when wheat gliadin was re-introduced into the diet. Tests for gluten sensitivity show that some of these women should be off all gluten grains.
Implication of fertility when off bovine dairy
The high number attending consultations who were initially off bovine dairy foods indicates that many women were conscious of the effect certain foods have on their bodies. Many linked bovine dairy to eczema, excess mucus, and diarrhoea, and were therefore avoiding that food. There is no significant difference in fertility from those on or off bovine dairy foods.
Thirty-seven per cent of the women who got pregnant avoided bovine dairy compared to forty-eight per cent of the group who had not fallen pregnant. Forty-three per cent of the pregnant group never avoided bovine dairy. Forty-nine per cent of the group who had not fallen pregnant had never avoided bovine dairy.
Reduction of pain
Of the one hundred and ninety-eight women with endometriosis one hundred and fifty-two recorded a symptom of pain. Looking at the average scores for pain at each visit this graph was obtained. This shows that on average pain scores were reduced from an initial value of 4 to 1.9. This shows an average pain reduction of 2.1 in recorded pain scores. On average there was a fifty per cent reduction in pain. Seventy-eight per cent of the women showed a reduction in pain scores when following a healthy eating plan. Four point eight per cent (or thirteen women) showed an increase in pain, this was due to external adverse events, e.g. stress after redundancy, bereavement, moving house etc..
The change in pain scores for those off wheat.
Eighty-two per cent of the women stayed off wheat. Of these women eighty-one per cent had a reduction in pain scores and four point eight per cent had an increase in scores. Thirteen per cent (or twenty women) never stopped eating wheat, but reduced their intake. Of these women, sixty-five per cent had an improvement in pain scores and twenty-five per cent had a worse score. Four point six per cent (or seven of the one hundred and fifty-two women) went back to eating wheat after avoiding it for some time. These had a mixed outcome, with four women showing worse scores or no improvement.
The mean reduction in pain for those off wheat is 1.96. The mean reduction in pain scores for those eating wheat is 1.05.
The change in pain scores for those off bovine dairy
Fifty-five per cent of the women stayed off bovine dairy. Of these women seventy-six per cent had a reduction in pain scores and eleven point nine per cent had an increase in scores. Thirty-three per cent (or fifty-one women) never stopped eating bovine dairy. Of these women, seventy-eight per cent had an improvement in pain scores and five point eight per cent had a worse score. Eleven point two per cent (or seventeen of the one hundred and fifty-two women) went back to eating bovine dairy after avoiding it for some time. This group had a reasonable outcome, with eighty-two per cent showing an improvement in their pain scores.
The mean reduction in pain for those off bovine dairy is 1.7. The mean reduction in pain scores for those eating bovine dairy is 1.9.
Change in pain scores for those off wheat and dairy.
Wheat avoidance has a significant effect on pain scores. The cohort was divided into five groups in order to differentiate between the effect of wheat exclusion and dairy exclusion scores.
This clearly shows that those off both wheat and bovine dairy have larger reductions in pain scores. Those just off wheat still show a significant reduction in pain. Those who tried avoiding wheat and/or dairy did improve their pain scores. Those still eating wheat, but either on or off bovine dairy have only a negligible improvement in pain scores
Improvements in the MYMOP scores for the cohort
This graph shows the changes in the normalised MYMOP scores from the first visit to the latest visit. This takes into account the two symptoms recorded, the activity and the general sense of well-being. The cohort show on average a 1.74 reduction in scores, which implies a real benefit from nutritional therapy.
Results
Pain:
Fertility
Conclusion
Integrated medicine involves a patient combining orthodox and complementary medicine in order to promote the individual's well-being, health and to improve quality of life. Nutritional therapy highlights and attempts to correct possible pain mechanisms that affect women with endometriosis. Immune reactions to certain food stuffs may well affect the way in which the body's immune system is able to deal with endometriosis. We observe a cohort that displays adverse reactions to seemingly normal foods. Nutritional therapy provides a cost effective treatment, which improves pain reduction and enhances fertility.
Foods affect the ability of the body to excrete oestrogen. Certain fibres form anti-oestrogen compounds, enterolactone and enterodial, which are protective.
The Endometriosis and Fertility Clinic is committed to working towards the provision of integrated medicine and works with collaborative projects in the field of nutrition.