Читать книгу Endometriosis: A Key to Healing Through Nutrition - Michael Vernon - Страница 12

All truth passes through three stages: First, it is ridiculed,

Second, it is opposed,

Third, it is accepted as being self-evident.

Arthur Schopenhauer, Philosopher

Everything you take for granted today was once revolutionary.

Professor John Crispo

How many infertile couples do you know? One? Maybe two? The rate of subfertility among couples of reproductive age in England and the USA is an amazing 15 to 20 per cent, about 1 in every five couples.¹ More than 2.4 million people in America alone have been robbed of the opportunity to conceive and have a family. It has been estimated that 30 per cent of subfertile couples may be infertile as a result of endometriosis.² One in 15 men and one in 10 women are thought to be struggling with their fertility – you are not alone.

Infertility is defined as lack of conception after at least 12 months of unprotected intercourse. This means that some couples may take up to two years to achieve a pregnancy, if 12 months is the mean. Infertility is a major health issue, often due to an illness, yet it receives very little attention from our society or from Parliament and Congress.

However, 65 per cent of these subfertile couples may be helped by drugs and surgery to achieve a pregnancy. By following the correct nutritional advice, the rate of success may be increased to 86 per cent, as shown by data from Foresight – the charity for preconceptual care.³ Thus, help is available for the couple struggling with their fertility. By combining good nutrition and conventional medicine endometriosis patients enhance their ability to conceive. Everything that we put into our bodies has health consequences. Poor nutrition has detrimental effects on endocrine and reproductive functioning.

Endometriosis is a complex disease that appears to have several different mechanisms through which it may trigger subfertility. It is not clear if one or more of these mechanisms is the cause of the subfertility associated with endometriosis, but endometriotic implants have several different effects on the reproductive system.

In medical schools, few doctors are taught about nutrition, body biochemistry and metabolic pathways. If they were to spend time studying subjects other than physiology, anatomy and pharmacology, they would fail their board examinations. What we need here is integrative medicine – medicine that merges the benefits of all approaches to healing patients. We must begin to heal the patient from within and offer the best from all Eastern and Western medical approaches. We need to make a paradigm shift to impartial evidence-based medicine.

ABDOMINAL ADHESIONS AND SUBFERTILITY

As the endometriotic implants grow and develop in the abdomen, where they do not belong, the body tries to surround them with fibrous connective tissue (scar tissue). The body does this in an attempt to isolate the implants and prevent them from doing harm by putting up a protective barrier. Adhesions can also be formed during surgery when abdominal tissue is traumatized. This fibrous tissue develops like moss growing on a stone and behaves like a Band-Aid on a wound. They solidify and thicken over time, and have the effect of making the implants stick to adjacent tissues.

Remember that blood is sticky and internal bleeding from the implant also forms adhesions, such that an implant may be stuck to several different tissues like a cat’s cradle, as if we placed some very sticky glue-like gum in the abdomen and several organs became stuck to each other by the very sticky strands. For example, an endometriotic implant on the top of the uterus may cause the ovary and small intestine to become attached at the site of the implant. If the adhesions pinch off the Fallopian tube or if they cause a blockage of the opening of the Fallopian tube, they could obstruct the union of egg and sperm and prevent fertilization and conception, or cause an ectopic pregnancy, if the embryo can’t travel to the womb. This type of obstruction can be easily diagnosed and surgically corrected.

However, this does not explain how patients with just a few implants and no adhesions can become infertile. Adhesions can also cause pain, as internal organs which normally slip and slide become firmly glued together. For example, if the bowel is stuck to a tender, painful ovary, flatulence could cause pain, and sexual activity may be uncomfortable due to constriction of movement. Operations, by their very nature, may trigger more adhesions to form even as others are removed – catch 22.

SECRETIONS FROM ENDOMETRIOTIC IMPLANTS

As we have already seen, the endometrium within the womb is a dynamic tissue that secretes a wide variety of nutrients and hormones required for normal conception. The endometriotic implants also secrete these same substances, but instead of depositing them into the lumen (centre) of the womb as normal, the implants release their chemical secretions into the abdominal cavity. Some of these substances, which are in effect strong hormones, could interfere with fertility. Recent studies suggest that endometriotic implants also produce cytokines.⁴ These inflammatory immune cells are in the peritoneal fluid and, in patients with endometriosis, this fluid has been shown to be toxic to the preimplantation embryo. It also contains macrophages and growth factors.

PROSTAGLANDINS

One major group of hormones secreted by the normal endometrium is the prostaglandins. These are oil-based hormones found in nearly all the tissues of the body and are required for many bodily processes, including several stages of the menstrual cycle and pregnancy. Prostaglandins are required for ovulation, regression of the corpus luteum (ending the monthly menstrual cycle), sperm motility, immune interactions, contraction of the uterus at birth and menstrual cramps. Endometriotic implants and the endometrium of the uterus are the richest source of prostaglandin production in the body.

However, the problem with endometriotic implants is two-fold:

1 Prostaglandins are released into the abdomen instead of inside the womb.

2 Prostaglandin release by the implants seems to be out of phase with their release by the uterus. Prostaglandins are produced at the wrong time sending the wrong message.

For instance, there is a natural surge in prostaglandin F production at the end of the menstrual cycle, causing the effects of the corpus luteum of the ovary to die down and signalling the start of a new menstrual cycle. The endometriotic implants produce their prostaglandin surge several days after that of the womb lining. This may be one of the main causes of very early miscarriage. Approximately 31 per cent of biochemically detected pregnancies fail to atain viability; of these, 50 per cent are lost prior to the first missed period due to defective implantation. The majority (60 per cent) of lost pregnancies are due to chromosomal aberrations.⁵ If a woman is a few days pregnant then the implant-produced prostaglandin F would wrongly tell the ovary to start a new menstrual cycle, causing the womb lining with the implanted egg to be sloughed off – an early miscarriage. Prostaglandins are messengers and like all messengers they sometimes get it wrong.⁶

Prostaglandins also play an important role in the contractions of the womb and Fallopian tubes. During the normal menstrual cycle the gentle contractions of the womb and Fallopian tubes aid the movement of egg and sperm to the outer third of the Fallopian tube where fertilization occurs. High concentrations of endometriotic implant prostaglandins at the wrong time could interfere with this and may prevent fertilization. An excess of PGF2 and PGE2 could cause contractions that are too strong and expel the egg too quickly. Series 2 prostaglandins are produced from the fats in dairy and meat products, and it is recommended that intake of these foods be kept to a minimum.

Series 2 prostaglandins are also responsible for the contractions of the uterus at the end of pregnancy, stimulating the powerful uterine muscle contractions required for the birthing process. Inappropriate concentrations of implant-produced prostaglandins could stimulate forceful uterine contractions (cramps) at the time of embryo implantation and lead to early expulsion of the embryo.⁷ Indeed, in both humans and domestic animals, prostaglandin F is used clinically to induce abortion or to hasten the birthing process.

Series 1 and 3 prostaglandins, enhance the immune response and, as we will discuss in chapter 9, they may even modify normal immune interactions that could prevent conception. Prostaglandins also stimulate sperm motility, and high levels of proinflammatory series 2 prostaglandins could lead to early ‘burn-out’ of the sperm, preventing fertilization.⁸

Although prostaglandin secretion into the peritoneal cavity is required for the reproductive process, it is clear that too much of the wrong type of prostaglandin in the wrong place, or prostaglandin production at the wrong time, could easily interfere with fertility. Exactly how or even whether prostaglandins play a role in the infertility associated with endometriosis is not known, but they do seem to be involved.

PROTEIN PRODUCTION

The endometrium of the uterus and endometriotic implants have ‘a prolific ability to produce hundreds of different types of proteins’.⁹ Although the roles of all these proteins are not known, some of them are used by the body as nutrition for the developing embryo, and some function as hormones or trigger hormone release.

Various laboratory studies have shown that most of these proteins are produced by both implants and womb endometrium. However, two proteins have been discovered that are produced only by the endometriotic implants¹⁰ – Endo I and Endo II. These two unique proteins may interfere with fertility. It is also possible that proteins that are common to both the uterus and implants, like prostaglandins, may be inappropriately produced by endometriotic implants, and have a bad effect on the reproductive system. These proteins may interfere with immune system surveillance so that implants are not removed by normal macrophages and natural killer cells. Isolated endometriosis stroma cells secrete more sICAM-1 than normal endometrium.¹¹

ABNORMAL OVULATION

The monthly maturation of eggs and the process of ovulation may be altered in the patient with endometriosis: ‘Women with endometriosis have been shown to have smaller, but many more, follicles maturing at the time of ovulation than controls’.¹² This suggests that the chemical secretions from endometriotic implants hamper the ability of the ovary to respond correctly to the message from the pituitary hormones, or that hormones secreted by the ovary do not give the correct message to the pituitary gland. Indeed, high prolactin levels are known to inhibit ovulation.

Under the influence of the pituitary luteinizing hormone, the follicular wall of the ovary close to the Fallopian tube thins and ruptures, releasing the ova. Endometriosis may prevent the completion of this ovulatory process. This inability to ovulate is called ‘luteinized unruptured follicle syndrome’ (LUF). In LUF syndrome, women have the normal sequence of endocrine events and a normal menstrual period, but their ovaries do not release any eggs at the time of ovulation.

This syndrome is difficult to diagnose since, from all external measurements (hormone concentrations and menstrual flow), nothing appears to be wrong. As the egg is but a single cell and the ovary wall repairs itself almost immediately after ovulation, the absence of ovulation usually goes unnoticed. However, some researchers have tried meticulously to check for ovulation with laparoscopic examination of the ovary at the presumed time of ovulation.¹³ They found that the incidence of signs of ovulation was lower in endometriosis patients than in fertile control patients.

The precise means by which endometriotic implants adversely affect the development of the egg within the ovary is not yet known, but it is suggested that implant secretions, such as prostaglandins and excess natural oestrogens, or even oestrogens from outside the body (xeno-oestrogens), are damaging to conception. 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.¹⁴

IMPAIRED FERTILIZATION

In addition to an alteration in follicular development and ovulation, the actual quality of the eggs in women with endometriosis may be different. Various in vitro fertilization (IVF) programmes have observed that the presence of endometriosis in the abdomen, and especially in the ovary, adversely affects the appearance of the egg and decreases its ability to fertilize.

Normally the eggs have a yellowish appearance with a smooth oatmeal texture. The eggs of the endometriosis patient are sometimes dark brown in colour and have a granular texture. In 1985 Wardle noted that the fertilization rate of eggs from endometriosis patients was significantly lower than in patients who had unexplained infertility or blocked Fallopian tubes.¹⁵ Again, this could be explained by the chemical secretions from the endometriotic implants which surround the ovary. Certainly it would seem that, from observation, women who have ovarian cysts should have them removed before undergoing ART (assisted reproductive technology). The quality of the ova is poor if ‘chocolate’ cysts are present and improves after they have been removed. More research is needed to look at this phenomenon. But it implies that women with endometriosis stand a better chance with ART techniques when their health has been improved.

Also, at the stage of conception, it is vital that the immune system does not react to the presence of the blastocyst. Normally, increased levels of progesterone from the corpus luteum quieten the immune system. Sperm appear in the Fallopian tubes 5–10 minutes after coitus, although some may take 48 hours. An organ on the head of the sperm releases enzymes which penetrate the ovum. If the woman’s immune system is overactive at this time, both the sperm and blastocyst could be harmed.¹⁶

EARLY MISCARRIAGE

The most common time for a miscarriage to occur is during the first three months (trimester) of pregnancy. At this time, the embryo is developing into a fetus and is undergoing truly amazing and dramatic changes, including the formation of most of its internal organs. This is a critical period of development that requires an appropriate nutrient-rich environment, a healthy placenta and a very delicate balance between the various hormones of pregnancy. It has been suggested that women with endometriosis have a greater chance of miscarriage than women with other types of reproductive dysfunction: ‘Miscarriage rates as high as 46 per cent have been reported in the scientific literature’.¹⁷ This area is currently being examined by other researchers who have not seen as dramatic an increase in the miscarriage rate of endometriosis patients.¹⁸ A high miscarriage rate among women with endometriosis would offer another explanation for endometriosis-associated subfertility.

Human reproduction is inefficient, with an estimated 50 per cent of conceptions failing, and 10–12 per cent of pregnancies ending within 12–14 weeks after the last menses. Many are associated with antiphospholipid antibodies, placental insufficiency, impaired fetal growth or fetal distress.¹⁹

However, the real enigma of a first trimester miscarriage is that if it occurs during the first six weeks of the pregnancy, there is a good chance that you may not even be aware that you are pregnant. You may think your period is late. It is very difficult to determine pregnancy rates in normal healthy women and in endometriosis patients. In fact, this lack of pregnancy information is one of the main reasons for the confusion in the scientific literature.

Regardless of whether or not there is a high miscarriage rate in endometriosis patients, it is imperative that you eat the right sort of nutrient-rich foods to try to ensure the maintenance of your pregnancy. Nutrition in both parents even before pregnancy has a profound effect on the state of the egg and sperm, as well as on the nature of the secretions within the peritoneal cavity. Your choice of foods, particularly fats and oils, may be a crucial factor as these affect the production of prostaglandins, cell membranes, steroid hormones, and neurotransmitters etc. (see chapter 4).

Thus, there are many reproductive problems associated with endometriosis, and scientific investigations have yet to determine exactly how endometriosis causes infertility. However, 40–60 per cent of women with endometriosis do appear to become pregnant. There are many positive ways that we can successfully attempt to correct the problem of infertility.

FERTILITY AND THE ALERT IMMUNE SYSTEM

‘The leading question we should be asking here is whether or not the presence of antibodies can cause infertility and early miscarriage, by interfering with implantation.’²⁰ Reproductive tissues contain large numbers of immune cells and produce large amounts of cytokines, which are implicated in the fertilization process. Chapter 9 explains this in more detail.

To achieve pregnancy, sperm has to enter the body. The sperm can be judged as ‘alien’ by a woman’s immune cells, because it is ‘non-self’. If pregnancy is achieved, the woman’s immune system has to adapt to the presence of ‘alien’ tissues growing inside her for nine months. However, there must be some mechanism which tells the female immune system that this alien tissue is not a danger to avoid damage to the embryo. Perhaps when the immune system is malfunctioning in endometriosis, this mechanism fails and causes an immune attack on the embryo and sperm, thus leading to infertility. Correcting or strengthening the immune system may help to achieve fertility. Healthy ovaries which produce the right amounts of progesterone are crucial in this process as progesterone dampens down a woman’s immune system.

Scientists at University College London have discovered a protein (iscollin) inside sperm which is released as egg and sperm fuse, and starts a chain reaction that causes the embryo to form. Chemical interactions trigger calcium deposits inside the egg to vibrate and begin the cell-splitting process that leads to formation of the embryo. Defective sperm or eggs could not begin this chain reaction. This exciting area may lead to more research into egg quality in women with endometriosis.²¹

YOUR FERTILITY: NUTRITIONAL EFFECTS

Healthy parents usually have healthy babies. Once conception has happened, there is no changing what will be. We think of conception as the beginning of life, the time when sperm and egg collide and the magic of life begins. However, the egg and the sperm are not made in an instant; the parents’ bodies have been working hard to prepare them for the previous three months. Women are born with all their eggs ready and waiting inside their ovaries (see here.). At birth, female babies have around one million eggs, but by puberty, only about 400,000 are still viable. Each month, five to ten eggs begin to ripen, but only two or three fully mature. Over the normal 28-day menstrual cycle, the mature eggs ‘pop’ out at ovulation and are sucked up by the Fallopian tubes to begin their journey to reach a healthy sperm. The ripening of the egg is supported by the mother-to-be eating a diet rich in essential nutrients.

Many ethnic groups have a period of time when a new bride is well fed before becoming pregnant; an early study on nutrition mentions how ‘the Masai tribe had specific times for marriage to ensure that the bride had a few months on a nutritious diet’.²² Even Queen Esther in the Bible had a special diet for a year before her wedding.²³ Leah became pregnant after eating mandrakes, which were believed to promote fertility.²⁴ In the book of Judges, an angel gave preconceptual advice to Samson’s mother: ‘Take care not to drink any wine or beer, or eat any forbidden food’.²⁵

If the mother has a poor diet, consisting of highly refined foods, containing excessive sugar, fat and processed carbohydrates, the amount of nutrients available to the developing egg, or embryo, will be low. Poor nutrition at this time may lead to miscarriage.

Think of the womb lining as a nest. Birds build their nests to keep their young safe and warm; a place where they can be nurtured, fed and watered. A woman’s womb plays a similar role. Each month the womb lining develops a lush, nutrient-rich, blood-engorged tissue; the womb is ready to receive the embryo and build a healthy placenta to supply all the nutrients the embryo needs to grow strong and healthy. If the mother’s diet that month is poor, the womb lining will be poor, and a weak placenta is less likely to sustain an embryo. So the eggs and womb lining are both dependent upon a good diet.

Successful implantation depends upon a complex two-way ‘conversation’ between the blastocyst and the endometrium, which enables the embryo to implant at a site that is receptive. The nutrition producing hormonal balance, sperm and ova maturation, and a receptive endometrium, all at the same time, needs to be sound to achieve a pregnancy.

• CASE STUDY •

Wendy M of London

Tears of undiagnosed endometriosis had led to the removal of a large ovarian cyst. Conventional treatments for the endometriosis and infertility had been to no avail. A visit to the nutritionist meant a substantial change to my diet and some vitamin supplements were taken. Within a few months period pains and bloating were less severe, PMS had virtually gone and I became pregnant. Yippee!

WHY IT TAKES 12 MONTHS TO MAKE A BABY

We have touched upon the nutritional needs of the mother, but what of the man, the father? He is not going to nurture the baby inside his body, but the health of his sperm is also dependent upon his diet for the three months before conception. That is how long it takes the testes to make healthy sperm. Too much alcohol, cigarettes and drugs, working with certain harmful chemicals, eating too many processed foods and too few vegetables and fruits may lead to sad-looking and possibly defective sperm. A low sperm count may be due to environmental factors, such as oestrogenic pesticides, but a poor diet will also lead to weakened or deformed sperm.

Research has shown that some chemicals can cause mutations to the sperm. Instead of the head of the sperm being oval, it can be too large or too small, or become pear-shaped, and these changes also cause chromosomal abnormality. Moreover, ‘it takes 120 days for sperm production to recover after exposure to chemicals’.²⁶

Putting a sorry-looking sperm into a starving egg and implanting the resulting embryo into a sick womb is a recipe for disaster. In the UK about 750,000 babies are born each year, but more than 40,000 are born early and are too small. One in 150 babies is lost through stillbirth, and one in four pregnancies ends in miscarriage, up to 60 per cent of which are due to defective sperm.²⁷ Every miscarriage is a bereavement, the loss of a loved one. It is a very unhappy and traumatizing experience for everyone involved. Time can heal the grief, but there is always a part of the sad experience which lingers on.

For a healthy pregnancy, a healthy diet and digestive system are essential. Your diet counts for both the potential mother and father. Let that be the message to remember. Healthy babies are what everyone wants most of all. All children deserve the best start in life and, by eating nutritious food for at least three months before you contemplate becoming pregnant, you are making a commitment to improve the health of your future child.

• CASE STUDY •

Mary F of Chicago

I cannot for the life of me remember exactly what nutritional measures I made and what supplements I took (outside of evening primrose oil) when I was trying to conceive; it was three years ago. I wish I could be of more help because you certainly helped me! All I can tell you is that I believe that the nutritional measures you suggested played an integral role in my conceiving my second child.

I did have surgery for my endometriosis, but very little was found. After being on your suggested regime for three months, I conceived naturally and eventually bore a beautiful daughter. I only wish I had known more about nutrition and the role it plays in endometriosis when I was trying to conceive for the first time. I’d had a wonderful son, but not until I had taken an ART hormone therapy, which I would have liked to have avoided. You enabled my husband and me to complete the perfect family we always dreamed of having.

NUTRITION COUNSELLING

In 1971 Agnes Higgins described the Montreal Diet Dispensary Study: ‘Twenty-three years ago, we were impressed by the research findings concerning the relation between maternal nutrition and birth weight, infant mortality and morbidity. Accordingly we decided to develop, for disadvantaged pregnant women, a nutrition counselling method that would compensate for individual differences in income, nutrition, weight, and special conditions of stress, with a view to improving the weight and condition of the newborn’.²⁸ Why then, so many years later, are we still debating the same point and not putting it into action?

Foresight (The Charity for Preconceptual Care of Great Britain), has looked at research by Dr Weston Price, Dr Francis Pottenger and Sir Robert McCarrison into the influence of sound nutrition on health.^{29, 30, 31} Their conclusions are that the quality of the food you eat confers good health. Healthy food emanates from healthy soil and good farming principles. Dr Roger Williams also points out that we are all biochemically different and that individuals’ requirements for recommended daily amounts of nutrients may differ due to their unique body biochemistry.³² A recent study noted that ‘in pregnancy it is known that nutrient requirements alter. Women on good diets are seen to have healthier babies than those on poor diets’.³³

In the UK, Foresight has reported pregnancy outcomes for 367 couples who, from 1990 to 1992, followed their suggested nutrition programme. The average ages were 34 for women (22–45 years) and 36 for men (25–59 years). Fifty-nine per cent of the couples had a previous history of reproductive problems; 37 per cent had suffered from infertility for between one and 10 years; 38 per cent had had between one and five miscarriages; 3 per cent had given birth to a stillborn child. Of the children born, 40 were small for dates, 15 were of low birth weight, and seven were malformed. Forty-two per cent of the men had reduced sperm quality.

After both partners followed the Foresight nutrition programme, an astounding 86 per cent of the women had become pregnant by 1993, and 327 children had been born (137 males and 190 females), all of them healthy at birth. Birth occurred at a mean of 38.5 weeks of gestation and the average birth weight was 3,265gm (7lb 3oz). None of the infants was malformed and none had to go into special-care baby units.³⁴ This shows what can be achieved by dietary changes and by addressing genitourinary infections (such as chlamydia) which may be preventing conception. The programme involves no drugs and no expense save that of buying good food, and requires minimal guidance.

REPRODUCTIVE SYSTEM SUSCEPTIBILITY TO VITAMIN B-COMPLEX

The hypothalamic–pituitary–gonadal axis is highly sensitive to the intake of the B vitamins (see figure 2.1). This axis is the main highway along which the hormones (chemical messengers) travel. The vital hormone messages which pass from one end of the highway to the other must be correct. As a recent study explains: ‘Low intake of B vitamins depresses gonadotrophin releasing hormone (GnRH) secretion from the hypothalamus and thereby affects the development of the eggs and sperm in the gonads (ovary and testicles).’³⁵ Moreover, as another source elaborates: ‘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 (particularly riboflavin [B2]) by inhibiting GnRH secretion and so causing infertility.’³⁶

The liver has an important role in maintaining the body’s oestrogen level within a normal range, and B vitamin deficiency may impair the liver’s oestrogen-inactivating capacity. A healthy liver is vital for normal hormone balance.³⁷

Many people eat a diet of overrefined foods. Convenience foods are low in essential nutrients, such as magnesium, zinc, selenium and iodine, which are removed during the food-processing techniques. Fresh, unrefined foods are always the most nutritious.

FEMALE ENDOCRINE HEALTH

The length and frequency of the menstrual cycle is an important biological marker when looking for toxic chemical effects on reproduction, but these effects are difficult to distinguish from the effects of poor nutrient intake. As a published report explains, ‘The highest susceptibility to nutrient deficiency in the female ovary is during ovulatory maturation and embryonic development; the first 30 days after conception are crucial’. The research indicates that ‘a 70-fold increase in sensitivity in the ovary (to nutrient deficiency) occurs between 11.30 a.m. and 7 p.m. on the day preceding ovulation. It is therefore calculated that the period of highest susceptibility could be as long as 60 hours prior to ovulation’.³⁸ This suggests that women should eat a healthy diet and reduce toxic overload at least one month before attempting to conceive, as should men. A recent study explains: ‘Most of the defects in ova leading to miscarriage are already present in the embryo immediately after fertilization, and they have their origin in male and female ova and sperm before fertilization’.³⁹ This implies that the couple should both make sensible lifestyle changes for up to three months before trying to conceive to enhance their chances of achieving a successful pregnancy. The same study notes: ‘The ova lie dormant from 15 to 45 years in a mother’s ovaries until their turn comes to ripen, and when the dormant chromosomes are tightly packed and apparently very resistant to any external influence’.⁴⁰ Keeping chemical exposure to a minimum would seem to be advisable. If you or your partner work with or near strong chemicals, take the recommended precautions. The one-month period of ripening in the follicle before ovulation is the susceptible time-frame.

The future reproductive potential of the developing fetus can also be affected by your nutrition, and exposure to harmful chemicals before and during pregnancy. So avoid exposure to anything harmful; perfumes, bactericides, pesticides, petroleum, phthalates, household cleaning materials, paint strippers and some food additives – these could affect the health of your children and grandchildren. These chemicals may have a detrimental effect on the immune system. Use more eco-friendly products or non-biological versions of these products.

The Dietary and Nutritional Survey of British Adults in 1990 used a category of persons – eating affected by being unwell, which involved 9.5 per cent of women in the survey, aged from 16 to 64 years. Calorie intake in this category was some 18 per cent below average, with nutrient intake similarly reduced. The survey concluded: ‘Ten per cent of women may not be eating well enough to sustain a pregnancy’.⁴¹

When recovering from amenorrhoea (cessation of periods due to poor nutrient intake), there are menstrual cycles that are too long and luteal phases that are too short. Research at the University of Sydney suggested ‘a recovery period of at least six months from amenorrhoea before attempting a conception’.⁴² This allows all the body systems to recover sufficiently from the lack of nutrients. It takes the individual cells some time to regain their full capacity and be able to work at what is known as ‘enzyme saturation level’, when all the enzymes are working at their optimum rate.

Research into restricted calorie intake has been done on monkeys at the University of Pittsburgh, and it was discovered that ‘fasting for one day alone can change the hormone profile the following night’; moreover, ‘missing a single meal could override the suppression of luteinizing hormone (LH)’ … ‘The implication for slimmers is that even short-term deficiency can have a profound effect on endocrine function.’⁴³ 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 consequences, as the LH should take a message from the pituitary to the ovary. If suppressed, no message would be sent. Women with abnormal menstrual cycles experienced ovulatory disturbances including low progesterone and short luteal cycles’.^{44, 45, 46} If you are restricting nutrient intake in order to lose weight, you may be damaging your chances of becoming pregnant.

BODY MASS INDEX

A body mass index (BMI) measure shows that women’s weight:height ratio is a rough indicator of nutritional status. The body mass index chart has been designed as a result of feasibility testing. Low pre-pregnancy weight is a risk factor, with the risk increasing as the BMI falls below 24kg/m². American data shows that 50 per cent of infertile women are below 20.7kg m². In a Hackney hospital study the mothers of the healthy weight babies had a BMI, on average, of 23.7kg/m². A tool for determining BMI is based upon:

• Low BMI or underweight is	< 19.8kg/m2
• Normal BMI is	19.8–26.0kg/m2
• High BMI or overweight is	26.1–29.0kg/m2
• Obese is	> 29.0kg/m2

The BMI is a good general guide to fertility. Indeed, nearly 80 per cent of infertile women have been judged to be underweight.⁴⁷

To work out your BMI:

BMI = weight in kilogrammes ÷ height in metres squared

So if you weigh 52.5kg and are 1.52m tall, your BMI will be 22.7kg/m² which is just below the optimum range.

BMI = 52.5 ÷ (1.52 × 1.52) = 22.7

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 called ‘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’.⁴⁸ Dieting is a common cause of infertility. If the BMI is above 30, then fertility may be compromised. However, you need to lose weight first and then try to become pregnant when the BMI is around 23 to 28.

• CASE STUDY •

Claire C of London

In early 1996 I experienced dreadful pain on the left side of my stomach, which got worse midcycle and premenstrually, and I experienced some discomfort on intercourse. In March of that year, I was diagnosed as having pelvic inflammatory disease and was treated with antibiotics. The pain continued, but my husband and I were delighted to discover in September 1996 that I was pregnant. I suffered a miscarriage at 14 weeks in December that year, and after I had got over the immediate pain of that, Peter and I resolved to try to conceive again as quickly as possible.

In the spring of 1997, I was referred to a consultant gynaecologist because I was still suffering the same pain on the left side of my stomach, which a further course of antibiotics had not cleared up. I underwent a diagnostic laparoscopy and hysteroscopy in June 1997, which revealed extensive endometriosis and secondary adhesions, which were divided and ablated by laser. I underwent further laser treatment in August and October of 1997 because I was still in pain, and was told that I had extremely aggressive endometriosis, and was advised to conceive as soon as I could, because ‘a pregnancy would be ideal to settle things down’.

Easier said than done, I thought! However, to our great delight, I conceived again in November 1997, but once again miscarried, this time at 10 weeks, in January 1998. After this second miscarriage, I resolved to try to do something about my endometriosis because conventional medicine was obviously not working for me. I read everything I could on the subject, visited every website I could find, went to a naturopath, had acupuncture and even visited a lady who claimed to be able to heal me and get me pregnant by hypnosis! By sheer chance, I came across Dian Mills’ name one weekend in The Sunday Times, and managed to get an appointment with her at the Institute for Optimum Nutrition in Putney – she seemed to me like the light at the end of a very long and dark tunnel.

Dian spent an hour with me going over my history and my eating habits, and then devised a healthy eating plan for me and a regime of supplements, which I was to take for one month and then review. We agreed that my endometriosis did not seem to be affected by wheat or dairy products, as many people are, so luckily I was not advised to cut them out, but simply to increase other foods. I increased my intake of fresh vegetables, fish, live yoghurt, eggs, berries, nuts and seeds, and cut out citrus fruits, chocolate (as much as I could!) and caffeinated drinks; and reduced my alcohol consumption to less than five units a week. For breakfast I would eat (and still do) a chopped-up banana and pear, covered in live yoghurt and sprinkled with nutty and seedy muesli – yum! Lunch was salad with tuna or chicken, and dinner in the evenings was grilled fish or chicken with spinach, lots of garlic and herbs.

Dian prescribed vitamins C and E to work with the immune system and aid ovarian function; B6, magnesium and zinc to support the pituitary and ovaries; and evening primrose and fish oils (Efamarine) to aid hormone production and have an anti-inflammatory effect.

At the time I was working long, unsociable hours as a finance lawyer for a large US law firm, so had very little time to think about preparing food and making sure I had just the right ingredients. I’m certainly no Jamie Oliver in the kitchen, but there are so many interesting things you can do with food nowadays, and preparing a tasty nutritious meal does not have to take forever – just remember to always use the freshest ingredients, and get organized enough to plan what you’re going to eat so that you’re not snacking on things that are bad for you.

To our absolute joy, I became pregnant just over a month after my first consultation with Dian. The pregnancy was uncomplicated and stress-free (after I finally allowed myself to believe – when my consultant told me at 28 weeks that I was carrying a viable fetus! – that I was actually going to have a baby), and I continued my healthy eating habits all the way through my pregnancy. Our son Scott was born in June 1999, weighing a hearty 8lb 6oz, and at 15 months is still thriving.

In addition to Dian’s ‘bible’ Endometriosis: A Key to Healing Through Nutrition, I have invested in a book to help me get Scott into the habit of eating healthily – Optimum Nutrition for Babies and Young Children by Lucy Birnie. Both books are packed with tons of advice about how food can help you stay healthy, and interesting recipe suggestions which don’t take forever to prepare or think about.