Research, Nutritional Therapy is effective in woman with endometriosis

Nutritional counselling investigates food intolerance through IgG antibodies in women with endometriosis.

Author: Dian Shepperson Mills. Cert Ed. BA. Dip ION. MA.
The Endometriosis and Fertility Clinic, London, United Kingdom.

Enzyme Linked Immunoassay or ELISA method for IgG antibody detection has revolutionised the field of food intolerance treatment. Food intolerance is widespread in Western culture. Recent estimates in the UK suggest that 18 million people now have allergies and intolerances. 1 One hundred women with endometriosis, diagnosed surgically, took part in the trial to look for commonalities in food intolerance. The women reported a variety of symptoms associated with their endometriosis, including pain, fatigue and sub-fertility. Research shows consumption of certain 'reactive' foods can have profound effects on physical health. Women with endometriosis appear to have higher rates of autoimmune and endocrine disorders such as chronic fatigue syndrome, fibromyalgia and atopic disease. 2.

Cambridge Nutritional Sciences produces high quality diagnostic ELISA immunoassay finger prick blood test for food intolerance testing. The reduction or elimination of certain foods from the diet over 2-6 weeks is undertaken. A 59-microtitre plate is coated with extracts of 59 common foods wells and two for calibration standards (one positive and one negative control samples). The test involved taking a small measured sample of blood into a capillary tube, mixing with various agents in a square dish. A strong immune response gives a dark blue reaction, a weak immune reponse gives a pale blue reaction.

8 most reactive foods
Brazil nuts
Cocoa beans
Cow’s milk
Cola nut
Whole egg
Wheat
Yeast
Rye

8 foods show no reaction
chicken
tuna
broccoli
leeks
potato
celery
cucumber
melon mix
blackcurrant

Number of Reactions

The women showed a variety of reactions to certain foods; the minimum number of reactions being 4 and the maximum being 22. The graphs show that the majority of women have between 4 and 12 reactions out of the 59 common food wells. A significant number of women display excessive reactions. We looked specifically at the women who were having problems with fertility, they did not show any different reactions to those with endometriosis and pain.

Weight Classifcation

Patients complete a questionnaire which includes information regarding their height and weight. Their body mass index is calculated and one can see that over 50 per cent of the cohort are in the low and normal weight category. However, when we look at the people with fertility issues, there is a significant increase in the number of women in the low BMI range. This confirms the animal findings that low BMI implies dificulty in conception.

Low pre-pregnancy weight is a risk factor, with the risk increasing as the BMI falls below 24kp/m². American research shows that 50 per cent of infertile are below 20.7 kg/m² 3.

MYMOP Scores

The patients were all asked to complete a Measure Your own Medical Outcome Profile questionnaire at each visit. This is used to evaluate how the patient is improving from the treatment. Each patient selects two symptoms to monitor, an activity they are finding difficult and their sense of wellbeing etc

gG antibodies are only present if the allergen has been eaten recently. From our questionnaires we know that some foods have been excluded from the diet. The adjoining chart shows those that have either given a reaction during the test or avoided the foods.

The test result data and the MYMOP questionnaires taken together show that women with endometriosis are reacting to many common foods. Wheat cow's milk, cocoa, orange, lemon. All of the cohort reacted or had avoided one or more of wheat, cow's milk, and cocoa bean (chocolate).

Gold standard food allergy tests use a simple elimination diet for one month. This method can produce dramatic results, greatly motivating the patient to follow whatever therapeutic procedures are appropriate. This requires patient discipline and motivation. It is useful for people with limited resources. This can be measured using the MYMOP clinical audit sheets. ELISA is a patient convenient test, which could test both IgE and IgG antibodies. The bound reactor is visualized with chromogen solution, which gives a blue reaction where food antibodies are present. It now appears that IgG antibodies are actually involved in producing allergic symptoms. 4. IgG4 play a major role in atopic disease; acting as anaphylactic antibody, especially to food allergens.5. If the offending food is eliminated, the patient feels better, if not, he or she feels the same.

Multiple food intolerances were revealed. The women in the trial were self-selecting, opting to undertake nutritional therapy as a part of their treatment, and to take an ELISA food intolerance test. After excluding the foods shown up in the test and following a healthy diet and individualised supplement programme 95 per cent showed an improve score on their MYMOP. The one woman who scored worse on her third MYMOP had challenged her immune system by eating wheat after at least one month's exclusion diet. She had such an adverse reaction of vomiting and severe pain returning, and her scores reflect that reaction. There were five pregnancies among the group of 11 women who gave fertility as a symptom. 18 women had excluded wheat from their diet prior to the ELISA test as they had found it caused their endometriosis symptoms to worsen when it was re-introduced. The majority (more than 75 per cent) of patients who altered their diet based on the ELISA results of the 59 Food IgG test, found significant improvement in their condition. Pain levels dropped on their MYMOP forms by up to 85 per cent (measure yourself medical outcome profile - Medical Research Council), and digestion was reported as improved. Several fell pregnant over the trial. Patients who conformed to their diet regime reported the greatest improvements.

95 per cent of the women when on the altered diet showed an improved condition on their MYMOP forms.

88 per cent reported less pain, improved digestion and there were 5 pregnancies reported on their MYMOP forms. Many women had such improvement to their sense of well-being that they did not make a follow up appointment.

Adverse food reactions are widespread, often unrecognized cause of chronic ill-health and disease. Substantial experience has shown remarkable clinical response when the offending foods are recognized and eliminated from the diet. The primary challenge is the difficulty in making as accurate diagnosis. C reactive protein markers were raised after the food was reintroduced Women with endometriosis would benefit from food intolerance and allergy testing. Removing foods from the diet after they are shown to be triggering an immune reaction may have a profound effect on digestion, immune reactions and pain reduction. Multiple food intolerances were revealed. The most common were wheat, gluten and cow's dairy. Women with endometriosis commonly report autoimmune inflammatory diseases. Inflammatory markers for CRP (C reactive protein) show an increase after the foods were reintroduced. Drug treatments for endometriosis may damage gut flora and mucus membranes, compromising nutrient absorption, leading to food intolerances. This affects pain pathways and reproductive response. Healthy gut flora produces 80 per cent of the immuno- globulins in the body, when compromised poor immune response becomes the norm. 6. It would be beneficial to repeat this research under more clinic conditions, using a more randomised and larger selection of women with endometriosis and a control group. Funding would be required for both the nutritional consultations and the food intolerance tests as well as a research person who could ensure that follow up data was collected.

Research Abstract published in 10th World Endometriosis Society, Melbourne, Australia