"My gynaecologist never mentioned nutrition." [Note: Allopaths don't do Nutritional Medicine, especially surgeons such as gynaecologists.]
Eat less pasta and the pelvic pain will vanish
by JEROME BURNE -
Last updated at 13:46pm on 17th April 2007
Pernilla hatter, a 35- year-old solicitor from Northamptonshire, has endometriosis, a debilitating disorder of the womb.
"The pain was so severe I could barely stand up - and I felt so sick I couldn't eat." Two million women in the UK have the condition - many suffer such excruciating pain that work, let alone a social life, becomes impossible. Its cause is unknown.
Tissue that normally forms the lining of the womb starts flowing out into the abdominal cavity.
These growths, or 'implants', can stick organs together, for instance, joining the uterus to the bowel, causing pain and, sometimes, infertility.
Drug treatment can reduce the pain, although there can be side-effects, including weight gain, loss of libido, thinning of the bones and an artificial menopause.
Although that fourth side-effect is not permanent, it is a serious concern for women such as Pernilla.
"When I was diagnosed with endometriosis, I was faced with a terrible dilemma," she says. "I desperately wanted a baby, but the pain I was getting across my abdomen was so severe it was almost impossible to consider trying to conceive.
"My gynaecologist offered me drugs to reduce the pain, but they would have made me infertile. The other option was an operation to laser the implants, but in at least 20 per cent of cases the implants come back. I was desperate."
Another option is to change your diet. Research presented to a major conference on reproduction recently found that nutritional treatment could reduce pain by 50 per cent and also greatly increase a sufferer's chance of pregnancy.
Conventional doctors are often sceptical of such an approach to disease due to lack of evidence. Yet these findings - presented to the annual conference of the American Society for Reproductive Medicine - seem impressive.
The work was done by British nutritionist Dian Mills, who has herself suffered from endometriosis.
She reported on the experiences of 198 women with the condition, who were 'treated' with nutrition for six months.
During that time, the women regularly completed a standard medical audit called MYMOP, developed by the Medical Research Council to record how their symptoms changed.
As well as halving their pain rating from an average of 4 to 1.9, just over 50 per cent of those who had been trying unsuccessfully to get pregnant for several years succeeded.
Pernilla went to see Dian Mills.
"My gynaecologist never mentioned nutrition," says Pernilla.
"Dian told me not to eat wheat and dairy, and to take several vitamin and mineral supplements, including vitamins B, C and E and magnesium and chromium.
"It was hard at the beginning; I had to check labels all the time. But after about nine months the pain had gone. It was unbelievable how well it worked.
"There was no doubt the wheat was having an effect on my pain. If I strayed from the diet, I suffered.
"One evening, for instance, I was out for dinner and I ate something which I hadn't realised contained pasta. Within an hour I was in agony. I feel generally better and have more energy, too. Best of all, I'm now pregnant."
It's not just patients who are enthusiastic about this nutritional approach.
"It's difficult to do proper randomised controlled trials with diet, but that doesn't mean the therapy doesn't have value," says Chris Mann, a gynaecologist who specialises in endometriosis surgery and female cancers at Birmingham's Women's Hospital.
"Dian's results do seem impressive. All my patients who have seen her have been very positive about it. They are much more confident, and some of them have got pregnant."
Dian, who is director of The Endometriosis and Fertility Clinic in London, was offered a hysterectomy 17 years ago when, aged 37, her own endometriosis was diagnosed.
"I was in so much pain I couldn't walk," she says, "so I know what it's like for these women. But I wanted to find another way to help my body heal. It seemed to make sense to start with the least harsh approach and work up from there."
Dian already had a degree in nutrition, so she knew that her digestion had been compromised by taking lots of painkillers and antibiotics.
"I started taking probiotics - to boost the levels of good bacteria in my gut." On average, it takes ten years from the time a woman notices something is wrong before she is diagnosed with endometriosis.
Drugs can provide temporary relief from pain, but potential side-effects, include migraines, weight gain, breast tenderness, sweats, loss of libido, thinning of the bones, muscle cramps, acne, bloating and shrinking breasts.
The surgical alternative is to laser the growths. If they return, the final option is a hysterectomy - removal of the womb. A study published last year found that only 15 per cent of women with endometriosis were satisfied with the treatment they had received.
After discovering the importance of digestion, Dian identified which foods were most often linked with pain in her patients.
"Eighty-six per cent pointed to wheat," she says. She believes it could be related to the phytic acid it contains - in some people this locks up minerals such as calcium, magnesium, iron and zinc, and stops them from being absorbed.
Gluten from wheat is also thought to damage the walls of the small intestine, reducing the area available for absorbing minerals and vitamins from the diet.
These nutritional deficiencies may have such a dramatic effect for a reason. First, because a lack of both vitamins C and E makes the pain more severe - these vitamins help reduce inflammation.
Second, too few nutrients could trigger endometriosis in the first place. One of the immune system's jobs is to break down implants that form after each menstruation.
"To function properly the immune system needs a range of nutrients, including selenium, iron, zinc, magnesium and all the vitamins."
Although many endometriosis sufferers claim their lives have been transformed by Dian's recommendations, there is still a lack of scientific evidence that nutrition actually affects the condition.
"It could be that improving a patient's nutrition just makes them healthier and so better able to cope," says Dr David Farquharson, of the Royal College of Obstetricians and Gynaecologists.
"Nutrition may be useful to support conventional therapy and for controlling symptoms caused by drugs."
Few gynaecologists consider nutrition - a recent guide to treating endometriosis in the medical journal The Lancet didn't even mention it. However, Chris Mann believes it's worth combining it with other approaches.
All of Mann's patients who have seen Dian eventually had surgery.
"It was as an adjunct to the main treatment, which is surgery," says Mann.
"Nutrition can significantly reduce the pain without the unpleasant side-effects of drugs, but the implants are still there.
"We need more evidence of the effectiveness of these methods for doctors to take them seriously."
Lindsay McMillan, a consultant gynaecologist in London's Wimpole Street, specialises in difficult and advanced cases of endometriosis.
He also believes that nutrition can make a difference - and refers his patients to nutritionists.
"The evidence seems to be quite good that symptoms can be reduced by good nutritional advice and supplements. Endometriosis is hard to treat and, as clinicians, we don't know all the answers. I'm glad of anything that can help."
Endometriosis She Trust (UK), www.shetrust.org.uk.
Endometriosis and Fertility Clinic 0845 009 4171 or firstname.lastname@example.org.