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58th Annual Meeting - Seattle, Washington - October 2002
Mark Perloe, MD: “I’m Mark Perloe from Georgia Reproductive Specialists and we’re here in Seattle at the American Society of Reproductive Medicine meeting and I’m here with Dian Mills who is a Clinical Nutritionist at the Endometriosis and Fertility Clinic, part of the Hale Clinic in London.”
Dian Mills, Cert. Ed., BA, Dip. ION, MA: “Yes, indeed.”
Mark Perloe, MD: “And thank you for coming and joining us today. I’m particularly interested because there are some new clues in the role that nutrition may play in recurring pregnancy loss and I wonder if you could tell me a bit more?”
Dian Mills, Cert. Ed., BA, Dip. ION, MA: “Yes indeed, I’m getting several people who are coming now to the clinic and they’ve had three or more miscarriages or failed IVF treatment several times. In England fertility is not investigated until you’ve had three miscarriages. I begin by going through their health history of course, but many of the times I’m finding that we have hypothyroid problems, which haven’t been picked up, or a sensitivity to gluten or dairy foods. So I suggest that these women and their partners have an IGg or IGe gluten sensitivity test or a lactose intolerance test. If that comes up positive we take them off that food for a month and then challenge them with the food and see what happens. And it’s quite interesting that for many women when we find out exactly what the problem is, for example if there is a food intolerance that is upsetting the immune system, they do get pregnant once they are off that food. We obviously have to replace the food with a similar food substance so that they are getting all their nutrients through their digestive system.” Obviously having a calm immune system must have an effect upon fertility. Research suggests that there is a 50 per cent increase in conception rate on a strict gluten-free diet in males and females who are gluten sensitive.
Mark Perloe, MD: “Well, as an average diet, if there is such a thing, is it sufficient or are there nutrients that in general most people are missing?”
Dian Mills, Cert. Ed., BA, Dip. ION, MA: “Well, the average diet is wheat for breakfast. Toast, Weetabix or something like that with dairy, milk and then at lunchtime they’ll have a sandwich with a KitKat and then in the evening they’ll have pizza or pasta. So, they’re having wheat, several times a day. We need to try to get couples to eat more fruit, vegetables, nuts, seeds, berries and fish, at three regular meals a day, try and keep wheat to one meal a day only, so that the other two meals you are having root vegetables, or other grains like rye, oats, corn, rice. Plenty of vegetables, I usually say two portions of green, leafy vegetables as they contain indoles which help balance oestrogen in the body. So green, leafy vegetables are very good. Try also to have rainbow meals so, two red vegetables daily, like beetroot, tomatoes, peppers, they contain carotenoids, which are very helpful with fertility. Also eating berries, containing proanthacyanidins, in blue, red-coloured berries, because those are anti-inflammatory and also diuretic so that can be quite helpful with endometriosis and fertility, We are trying to improve the way the reproductive system works.”
Mark Perloe, MD: “I think probably most physicians aren’t taking the time, and feel that the prescription of a prenatal vitamin is sufficient to get people on the right nutritional track. We know that there’s good evidence on the folic acid and reduction of birth defects, are the remainder of the components really doing anything?”
Dian Mills, Cert. Ed., BA, Dip. ION, MA: “Well, yes they are because if you are taking folic acid on its own, it being a B complex vitamin, you are putting the levels of all the other B vitamins down as they are antagonistic to one-another. Folic acid itself cannot be absorbed correctly into the body without it being in the presence of zinc. So trying to take a very good quality, rather than a poor quality, multi-vitamin can be helpful. We need B vitamins to help the immune and reproductive systems. They are needed for the gut flora to help in the production of immuno-globulins. It would be crucial if you are on folic acid, on its own, to take a yeast-free multi-vitamin-mineral alongside.” Many other nutrients are essential to the reproductive system. The ovaries are high in iodine, magnesium, zinc and manganese, vitamin C and E. Vitamin A supplements in a multi-vitamin must be below 2000iu or 600 ug, as an excess of vitamin A can be harmful in pregnancy. Eating a healthy diet and having excellent digestion is essential to the uptake of all nutrients. High hydrogenated fats and high sugars can be detrimental to reproduction. High sugar can affect the ovary as it creates high insulin in the body and this can make the ovary produce an excess of testosterone instead of the usual estrogen and that can stop the eggs maturing properly. If you are trying to get pregnant keep sugar at a low level. Hormones are made from fats and proteins, so it is crucial to eat good quality fats and oils as they occur in nature and best to avoid all manufactured fats and oils. Try eating a palm-full of nuts and seeds daily and deep sea oily fish twice a week as this can help the body to produce good quality hormones and aid fertility.
Mark Perloe, MD: “Now, when a patient first comes in to see you, obviously a history and a dietary history is important. Are there laboratory studies, do they play a role in nutritional evaluation?”
Dian Mills, Cert. Ed., BA, Dip. ION, MA: “Yes, I do various laboratory studies. I send people to the Doctor’s Laboratory or to Biolab in London. We can look at hair mineral analysis if necessary to look for heavy metals. I also send them for gluten sensitivity tests; IGe being true wheat gluten allergy and IGg being wheat intolerance. I send them for various tests, like red cell magnesium, white cell zinc and B vitamin levels. We can look at digestion and check for gut permeability and liver enzyme function etc. It is also crucial to look at the thyroid and check T3, T4, TSH and auto-antibodies to the thyroid if you are sub-fertile .So we check the whole thing.” All IVF units should check for these things, couples need to be healthy before undergoing expensive IVF treatment and a 3-month nutrition program would benefit them. Sperm production in man takes 120 days to recover if there have been mutagenic chemicals around. In women it takes 100 days for ova to mature, so planning 3 months in advance before trying to conceive would seem to be essential in the production of a healthy bouncing baby. As I say in my book, it takes 12 months to make a healthy baby.
Mark Perloe, MD: “Is that something that’s done fairly routinely, all those tests, or is it something like history that you pick up?”
Dian Mills, Cert. Ed., BA, Dip. ION, MA: “Yes. If there’s something in particular going wrong then we go for the tests. I prefer people to spend their money on good quality food and supplements and if we feel a test is needed, we do it. But if it is not needed I don’t want to waste the money on a test unnecessarily. I will also send people back to their own GP because on the National Health Service in the UK their GP can do the tests and I like the GPs to work alongside what we’re doing.”
Mark Perloe, MD: “And do you find physicians are supportive? Are they referring patients or are patients coming to you directly?”
Dian Mills, Cert. Ed., BA, Dip. ION, MA: “I’m getting a bit of both. I get patients coming directly because of the book “Endometriosis the key to healing through nutrition” published by Harper Collins, and the website; but I also get doctors and gynaecologists sending me patients.”
Mark Perloe, MD: “If someone wanted to learn more, where…what is the website address so that they can find it?”
Dian Mills, Cert. Ed., BA, Dip. ION, MA: “The website address is www.endometriosis.co.uk and there is also www.makingbabies.com which has all the fertility information on it.”
Mark Perloe, MD: “Thank you so much Dian.”
Dian Mills, Cert. Ed., BA, Dip. ION, MA: “Thank you very much.”