Reversal of premature ovarian failure in a patient with Sjögren syndrome using an elimination diet protocol.

BACKGROUND: Premature ovarian failure is diagnosed with a picture of amenorrhea, elevated follicle-stimulating hormone (FSH), and age under 40 years. Twenty percent (20%) of patients with premature ovarian failure have a concomitant autoimmune disease. Cases of premature ovarian failure associated with Sjögren syndrome have been reported in the literature. PATIENT AND METHOD: We report a case of a 42-year-old white woman with Sjögren syndrome and premature ovarian failure who underwent a reversal of her premature ovarian failure and restoration of normal menses using an elimination diet protocol. The patient was diagnosed with her rheumatological condition in 2005 and started on disease-modifying antirheumatoid drugs, which were taken intermittently due to a concern over medication side-effects. Her menses became irregular at the time of initial diagnosis and finally ceased in 2006, with a dramatic elevation in her FSH, indicative of autoimmune-induced premature ovarian failure. In March 2009, she commenced an elimination diet protocol, eliminating gluten, beef, eggs, dairy products, nightshade vegetables, refined sugars, and citrus fruit for 4 months. RESULTS: Her repeat laboratory tests after 4 months showed a drop in FSH from 88 to 6.5 and a drop in erythrocyte sedimentation rate from 40 to 16. Her menses also resumed and her rheumatological symptoms significantly improved. CONCLUSIONS: It is hypothesized that the restoration of normal menses was caused by reduced inflammation in the ovarian tissue and supports the hypothesis that the gut immune system can influence autoimmune disease and inflammation.

Maternal supplementation differentially affects the mother and newborn.

Although studying the effect of supplementation on maternal health or the outcome of pregnancy was not a primary goal of the Institute of Nutrition of Central America and Panama Oriente Longitudinal Study, many important findings in these areas were produced. As part of the study, a food supplementation program was implemented. Two villages received Atole, a gruel containing protein and energy, and 2 matched villages received a refreshing, low-energy drink containing no protein. Both drinks contained micronutrients. Some women did not choose to consume the supplements and those who did consumed widely varying amounts. More volume of Fresco was consumed than Atole. The energy in the supplements improved birthweight, with no apparent additional benefit from protein or micronutrients. Researchers identified several groups of women who benefited from supplementation more than others by having babies with higher birthweights, including those with poorer current nutritional status and those who consumed high amounts of the supplement continuously from one pregnancy to the next. Results from the study provided an early indication that supplementation might increase the duration of gestation and, thus, reduce preterm birth. On the other hand, maternal supplementation did not substantially alter the duration of postpartum amenorrhea once concurrent infant supplementation was taken into account. Finally, findings from this study provided evidence of a biological trade-off between maintenance of maternal nutritional status and increasing fetal size that was responsive to both current maternal nutritional status and supplement intake but not to the mother's nutritional status earlier in life.

Development of a medical nutrition therapy protocol for female collegiate athletes.

Nutrition intervention can improve athletic performance and reduce the risk of nutrition related problems in women athletes. The current healthcare environment demands that dietitians document the outcomes of the medical nutrition therapy (MNT) they provide. This requires the development and validation of MNT protocols so that outcomes can be documented and compared in similar populations across multiple settings. The purpose of this project was to develop a sports nutrition management MNT protocol for collegiate women athletes. A registered dietitian currently working with collegiate women athletes collaborated with four dietitians from the community to develop an MNT protocol. Further testing and validation using this MNT protocol will help dietitians document the outcomes of their interventions in this population.

Energy and nutrient status of amenorrheic athletes participating in a diet and exercise training intervention program.

Chronic energy deficit is one of the strongest factors contributors to exercise-induced menstrual dysfunction. In such cases, macro- and micronutrient intakes may also be low. This study presents the results of a diet and exercise training intervention program. designed to reverse athletic amenorrhea, on improving energy balance and nutritional status in 4 amenorrheic athletes. The 20-week program provided a daily sport nutrition supplement and 1 day of rest/week. The program increased protein intakes for the 3 athletes with a protein deficit to within the recommended levels for active individuals. Micronutrient intakes increased, as did serum concentrations of vitamin B12, folate, zinc, iron, and ferritin. These results indicate that some amenorrheic athletes have poor nutritional status due to restricted EIs and poor food selections. A sport nutrition supplement may improve energy balance and nutritional status in active amenorrheic women.

Amenorrhea associated with carotenemia.

Data are presented for ten women with anovulation, nine of them with amenorrhea, who have associated carotenemia. Classic explanations for carotenemia in amenorrheic patients have been weight loss or anorexia nervosa, yet carotenemia in our patients appeared to be diet induced. All patients consumed a pure or predominantly vegetarian diet; there was no intake of red meats. Clinical and laboratory data of the patients are presented. The amenorrhea of the patient is consistent with hypothalamic hypogonadotropic anovulation (HHA). It appeared that diet modification not only led to reduction in carotene levels, but also improved the menstrual status. The association of carotenemia and menstrual disorders is reviewed. The possibility that carotenemia is related to the development of HHA is discussed.