• Staying Hydrated this Summer

    By Margaret Eich, MS, RDN

    We all know the importance of staying hydrated, but some of struggle more than others with this task. In the summer, it’s much easier to become dehydrated as we spend more time outside in the sun and heat. The Institute of Medicine recommends 91 oz (2.7 liters) fluids daily, and this requirement goes up to 100 oz (3 liters) during pregnancy. Of course, there are some variations in fluid needs based on body size with smaller bodies needing less fluid than larger bodies. These fluid requirements may seem high, but they include fluids from beverages and from food. About 80% of our fluid intake comes from beverages, so that means you should aim for about 72 oz fluid beverage when not pregnant and about 80 oz while pregnant. Monitoring the color of your urine and aiming for pale yellow urine is a good way to ensure you’re staying hydrated.  During the summer heat, we need to replace the fluids lost through sweating, so this further increases fluid needs.

    While trying to conceive or pregnant, our choices of fluids become somewhat more limited, as it’s best to avoid alcohol and caffeine. Of course, water is always a great choice, but understandably sometimes we want other options. Try these tips to stay hydrated this summer:

    • Focus on naturally caffeine-free beverages like water or water infused with fresh mint, cucumber, or fresh fruit.
    • Unsweetened coconut water is a great source of electrolytes and can be helpful for making mocktails.
    • Eat more soups and fresh fruits and vegetables, which naturally provide water.
    • As a substitute for alcohol, try drinking club soda or sparkling water with a splash of 100% fruit juice and a lemon or lime slice.
    • Instead of coffee or caffeinated tea, try unsweetened non-dairy milk like almond milk or flax milk with a little vanilla and/or cinnamon and/or cocoa powder. Add a teaspoon of honey or maple syrup for a little bit of sweetness.
    • Peppermint and ginger tea (and our ARTeas in-center!) are safe herbal tea choices for trying to conceive and during pregnancy.  Drink them hot or iced.
    • If you have trouble drinking enough fluids, try using a straw and take small sips throughout the day.
    • If you’re having trouble getting in enough fluids, it can also be helpful to track your fluid intake with an app, or simply by using a water bottle of known size. For example, if you have a 16 oz water bottle, if you drink 4.5 water bottles, then you’ll meet your 72 oz from beverages.
    • It can also be helpful to divide the day into 2 sections. For example, try getting in half of your water needs before 2 pm. If you haven’t met your first half of the day goal by 1:30 pm, it’s time to drink up. This can help you be more consistent with spreading your fluids out throughout the day.

    Book a Nutrition Consultation to learn more!  Try a Passport this summer and save!

  • Summer Lovin’

    by Stephanie Marynus LAc

    Summer Solstice is just around the corner! YAY! Street festivals, concerts, grilling and vacation – the last thing you want to think about is health. Summer is one of the times of year that most people fall off track with their routines the most, aside from the winter holidays. However, I believe in giving yourself some leeway here and there so you can enjoy life. As an acupuncturist, we believe it’s all about balance.

    You don’t have to deprive yourself, especially if you tend to be more active during the summer months. There are simple things  you can do to keep yourself from going overboard during summer. These things will help you stay on track this summer, so that you don’t have to start over at square one when September rolls around.

    1. Stay Hydrated

    If you have seen me for acupuncture you know I am a stickler for water. Being hydrated cleanses the body and gets it ‘moving’, so to speak. This is a simple method to reduce the side effects of fertility drugs that, energetically speaking, “dry” you out.  It improves your mood, reduce aches and pains, prevents constipation and bloating, and increases your energy.  Click Here to see what happens after drinking 1 gallon of H20 everyday for a month! The general guidelines for water intake state that you should drink at least half an ounce for every pound you weigh. For example, if you weigh 160 pounds you should be drinking at least 80 ounces of water a day. Strategically set water bottles around the house and at work to remind yourself to drink water throughout the day.

    1. Get Moving

    It’s time to get moving and release that energy that you built up during winter. Not only will workouts counteract any of your splurges over the summer holidays but they can also improve your happiness.  According to the international best seller, The Happiness Equation, by Neil Pasricha, “Pennsylvania State researchers reported in the Journal of Sports & Exercise Psychology the more physically active people are the greater their general feelings of excitement and enthusiasm.” It doesn’t take much: Half an hour of brisk walking three times a week improves mood. That is great news for a woman who can not exercise while undergoing stimulation. Something as simple as a daily stroll to check out the neighborhood’s new hip restaurants can keep you on track.

    80/20 Rule

    I am not going to tell you that you should skip every ice cream outing that you are invited too. Life is all about balance and eating right a majority of the time. The key is knowing when to allow yourself a treat and when you should make healthy choices. Simple things like swapping out unhealthy choices for healthier ones can make a huge difference. When grilling out, instead of choosing that bacon cheeseburger, swap it out for grilled chicken. Instead of potato chips choose carrots and celery. In choosing healthy alternatives you won’t feel so bad about having that ice cream snack later on. Food was made to fuel our bodies, but treating yourself every now and then is not a crime.

    Ferris Bueller, a Chicago favorite, once said, “Life moves pretty fast. If you don’t stop and look around once in a while, you could miss it.” Let your hair down and enjoy yourself this summer. After all, you have been waiting for this time all year. Keep your goals in the forefront so when fall comes around you won’t be regretting 3 months of slacking. Just remember the 80/20 rule, and keep your body moving. If you follow these easy tips, you will not have a problem staying on track with your health.

    Try our Summer Passports this season to make the most of the season and save!

  • To Grill or Not to Grill?

    by Elizabeth DeAvilla RD

    It’s finally (almost!) summer time, so you know what that means! Backyard BBQs with family and friends, picnics, and this dietitian’s favorite way to eat, alfresco! Many of us will turn to not only dining outside, but do cook our meals outside too, which means it’s time to fire up the grill. But before we do, let’s take a step back and make sure we’re still on the path to our optimal fertility.

    While we all know that certain foods may affect our fertility outcomes, one to definitely keep in mind, especially with our guys out there, is that of the correlation between some of the more commonly grilled foods, and that of semen quality. In a recent study published in 2017 processed red meat was negatively associated total sperm count in young healthy men. Organ meat (liver from beef, calf, pork, chicken, and turkey) consumers were reported as having more normal sperm.  Chicken however, did not relate to any sperm parameter in young men. So what does this all mean? The more processed meats, the worse off they are for our guys, chicken however, can have either no effect, while those organ meats can actually have a positive effect!

    Now let’s get to the more important question, how are we cooking that meat? Most commonly, especially in the nicer weather nights, you’ll find the guys all huddled around the grill and this is where is can get tricky. Research has shown that the consumption of Polycyclic Aromatic Hydrocarbons (PAHs) are chemicals considered to be “genotoxic” or highly damaging to our genetic material. Studies have shown that higher levels of PAHs in the urine are associated with poor sperm quality and cancer in men, and sadly, grilling is one of those cooking methods that can create them. This is formed from the combination of not only the amino acids from the meat, but the addition of sugars and an extremely high temperature (think open fire!)

    So does this mean I’m done with our Weber forever? No, no, don’t jump to any conclusions just yet.

    • While we don’t recommend grilling on a daily basis, once or twice a week is a much better option.
    • Consider adding a healthy vegetable, filled with those great antioxidants that can work to protect our cells and combat those nasty PAHs.
    • Discard the charred! When meat becomes charred, increased PAHs are found.
    • Control your temps while cooking. Many times, a drip of sauce or fat from the meat can cause a flare up of flame, this only raises the likelihood that PAHs will be formed.
    • Avoid smoking meats, which prolongs the cooking process and adds to the PAHs found in the prepared meats.

     

    Enjoy your summers, All! Try to keep those alfresco dinners healthy and fertility-friendly! 

    Want to learn more?  Meet with a nutritionist today! (Elizabeth is available Tuesday evenings and every other Saturday, while Robin is available on Wednesday evenings.) Questions?  Call us at: 312-321-0004!

    Dietary habits and semen parameters: a systematic narrative review

    1. Ricci-S. Al-Beitawi-S. Cipriani-A. Alteri-F. Chiaffarino-M. Candiani-S. Gerli-P. Viganó-F. Parazzini – Andrology – 2017

    Photo by Skitterphoto 

  • Celebrating the Arrival of Spring Produce

    By Margaret Eich, MS, RDN

    Spring is finally here in the Midwest, and things are starting to get greener. Crocuses and daffodils are blooming, and it seems people are starting to have a little more of a spring in their step as the promise of summer and warmer weather approaches. That also means that soon we will have local fruits and vegetables once again.

    Focusing on increasing fruits and vegetables, especially from local sources is a great way to focus on improving your overall health and fertility. Certain fruits and vegetables like leafy greens, avocados, and oranges are rich in folate, which is important for preventing neural tube defects. In general, fruits and vegetables are rich in vitamins, minerals, antioxidants, and potential anti-inflammatory compounds. These may be supportive of both female and male fertility. Did you know that women going through ART have higher levels of oxidative stress that may be offset with antioxidants? Loading up on the fruits and vegetables is a great way to do this. Increasing fruits and vegetables also increases your fiber intake, which feeds your beneficial gut bacteria (fertility nutrition starts in the gut!). Try to choose organic when possible, as eating higher pesticide fruits and vegetables has been linked to longer time to pregnancy.

    Farmer’s markets are great way to work eating more fruits and vegetables, as the freshness and quality is often superior to the produce found in grocery stores, where it may have been shipped many miles. At the farmer’s market, your produce may have been picked just that morning or the previous day! Another great option is gardening if you have the space. Studies on gardening show that it may help combat stress, boost your mood, and it’s good exercise! Live in an apartment or condo and don’t have outside space? Seek a community garden, or try growing some herbs in your window or in a pot on your balcony. Other options for a deck or balcony could be salad mix in a pot.

    Eating more vegetables is a great way to boost your overall health and fertility, by increasing fiber and nutrient density of your diet.

    Try these tips to increase the amount of vegetables you’re eating:

    1. Add vegetables to your eggs at breakfast (or any time of day).
    2. Add cauliflower rice to chili, curry, or stir-fry.
    3. Add greens like kale to soups, chili, taco meat, or stir-fry toward the end of the cooking time.
    4. Have a big meal salad with protein.
    5. Add sautéed onions, mushrooms, and greens (like spinach, kale, or chard) to tomato sauce.
    6. Use spaghetti squash or oodles instead of pasta.
    7. Add cucumber, celery, and/or greens to a smoothie.
    8. Use cauliflower, spaghetti squash, or zucchini to make pizza crust.
    9. Use zucchini or eggplant instead of noodles in lasagna.
    10. Roast carrots, beets, broccoli, or cauliflower with olive oil.

    Check out some seasonal nutrition recipes! Learn more by consulting with a nutritionist!  Book today!  Questions?  Call us at: 312-321-0004.

     

  • Choline: Are You Getting Enough?

    By Margaret Eich, MS, RDN

    Are you getting enough choline in your diet? Most women are not, and most women may not have even heard of choline. Choline plays an important role in fetal development, including brain development. Most people have heard they need to get enough folic acid (or folate) before and during pregnancy to prevent neural tube defects, but did you know that choline may also play a role in preventing neural tube defects, like spina bifida? Research has produced conflicting results in this area, but ensuring adequate choline intake makes sense while the research sorts itself out, especially given choline’s other benefits.

    In addition to a potential role in preventing neural tube defects, choline deficiency may also play a role in the development of fatty liver. Choline is also a precursor to the neurotransmitter acetylcholine, which is involved in muscle control and memory. In addition, choline is converted to betaine in your body, which assists in the conversion of homocysteine to methionine, thus preventing homocysteine levels from becoming elevated. Elevated homocysteine is associated with increased risk for cardiovascular disease and miscarriage.

    Choline is not technically considered a vitamin, since our bodies make small amounts, but our bodies don’t make enough to meet our daily choline needs. Therefore, we need to get choline in our diet. Non-pregnant women need 425 mg choline daily, and this goes up to 450 mg during pregnancy, and 550 mg while breastfeeding. In the US, average choline intake is well below this recommended level with women on average only taking in 260 mg choline per day!

    The best food sources of choline include liver, eggs, meat, seafood, legumes, and cruciferous vegetables like Brussels sprouts, and broccoli. One egg provides almost 150 mg choline, which underscores how helpful eggs are in meeting your choline needs. Not only are eggs rich in choline, but they are also just a very nutrient dense food to support your overall health, fertility, and pregnancy. Because choline is most concentrated in animal foods, vegans or vegetarians who eat limited eggs and dairy products are at highest risk for choline deficiency. Since so many US women struggle with getting enough choline, it’s a good idea to take a prenatal vitamin that contains choline, especially if you are vegan or vegetarian with limited intake of eggs.

    Looking for more information about nutrition for fertility and pregnancy? Book a nutrition consult today!

    References:

    1. Linus Pauling Institute at Oregon State University: Choline
    2. Caudill, et al. Pre- and Postnatal Health: Evidence of Increased Choline Needs. J Acad Nutr Diet. 2010; 110:1198-1206

     

  • Spring Cleaning – Pantry Edition

    By Elizabeth DeAvilla RD

    Now that that warmer weather is starting to roll in, (thankfully!) many of us will get the itch to start that good ‘ole spring cleaning! Here at Pulling Down the Moon’s nutrition department, we always suggest a great pantry clean out to help everyone with their nutrition goals for the year.

    Up to date?

    One of the first things I find myself looking for at the start of any clean out is that of expiration dates. May people still think that spices and other dry ingredients can last forever… not true! As a safety precaution, ensure that all your ingredients are not expired. Spices can tend to lose potency after as little as 6 months!

    Ditch the processed stuff

    You’ll hear this time and time again, the less processed the better, especially during the journey of fertility. The more processed the food is, the more likely it is to contain ingredients that may not be to enticing, especially to our bodies. Additives and preservatives can commonly cause negative effects like inflammation, as well as some intolerances within our systems, and best strategy to avoid? Ditch the processed stuff! This can commonly include things like canned meals, meats, and dried foods as well.

    Get it organized

    I’m not sure about you but I don’t always have hours upon hours to prepare meals. If I have to spend a large amount of time in the pantry looking for something, I’m almost more likely to run out and replace the item, thus why I always end up with multiple staples! Taking the time to organize, take things out of the boxes if possible, and creating a system can be so beneficial from not only a time perspective, but a food safety aspect as well. Storing whole grain cereals in Tupperware (BPA free of course!)  or rice in glass jars not only looks appealing, but is helpful for inventory!

    Restock your shelves with the essentials.

    If you were to go into your pantry today, could you put together a healthy meal that people would enjoy? This was always a struggle for me in my own pantry, until I started stocking the essentials. Things like dried beans, sauces, spices/seasoning, healthy rice, and usually have the potential to save the day when I just don’t have it in me to venture out to the store…. one more time! Keeping things such as heart healthy (and fertility friendly!) oils such as olive and avocado oil, whole grains such as wild rice and whole grain bread, as well as beans such as Lentils are not only meal staples, but are all supportive to our fertility journey.

    The staples to keep/include:

    Grains/breads: Whole grains! We can’t stress this enough, adequate fiber is so beneficial to both men and women in health, especially in fertility. Complex carbohydrates will always take more time to digest and won’t spike your blood sugar. Whole grains have also been shown to curb hunger and balance some hormones. Choosing whole grain pastas, breads, cereals, and flour whenever possible is really the goal!

    Oils: Healthy fats are your friend, and cooking oils are a great place to start when adding them into your diet. Heart healthy oils such as olive, avocado, as well as coconut oils are great sources of omega 3’s. These oils will have great anti-inflammatory effects, as well as work as absorb all those important nutrients. Decreasing the amount of hydrogenated oils such as canola or palm, will always be beneficial, as they can have the reverse effect, causing inflammation, as well as containing high amounts of saturated fat.

    Canned goods: Overall, fresh or frozen foods are always my go-to grabs when it comes to vegetables, however especially during the winter months, I like to have a few cans of vegetables just in case. Always look for reduced sodium, as well as, single ingredients. Many have added preservatives to increase shelf life, avoid those!

    Want to learn more?  Schedule your nutrition consultation today!  Book online via Mind Body Online or call us at: 312-321-0004!

  • Awaken your Yoga Practice this Spring

    by Alison Lautz RYT

    Is it over! Winter? Have we made it out of the trenches or is it going to snow again in May? One will never know in this city! Flowers and vegetation will start to grow (we hope), the birds MAY sing, and Chicagoans will start to strip off their boots and puffy coats. Spring is in the air! Now how can we bring spring and a new vibe into our yoga practice? I love spring…. it signifies a time of letting go of our old tired way to make room for the new and another chance to re-start, like a second chance on new year’s resolutions or intentions that we made four months ago.  The spring energy is all around us, and these four tips will help you awaken the spirit of spring in your yoga practice.

    Awaken new vibrations

    Spring is full of spiritual energy and more energy vibrations than any other season. This may be because the earth is working to shed the drab of winter and cultivate a more lively state of being. You may find that this is contagious, like when you see a coworker putting some colors into their outfit, you may want to do the same. Open up your energy to the season by having an open mind to any positive changes or the opportunity to try something new outside of your comfort zone.  Try Journaling for the Journey!

    Practice outside

    Let’s celebrate the fact that we can roll our mats outside of the four walls that we spend most of our days within. It does not matter if it’s in your backyard, on a roof deck, or on a small balcony in a city high rise. Any of these options presents a great chance to connect to nature. Breathe in the fresh air and celebrate the ability to get out of the house. My favorite pose to do outside is Vrkasana (Tree Pose). I truly feel how rooted I am to the earth in this pose from my feet to the crown of my head. Learn more about how to use your breath to reduce stress with this FREE Prana webinar!

    Detox your gut

    April and May are the perfect time for some big spring cleaning. Most of us hold our old habits, negative emotions, and holiday/winter vacation indulgences in our gut. Try some twists in your yoga practice. Change your diet around a little bit. Drink more water with lemon, try some kombucha…and as always EAT MORE GREENS.

    Be playful

    During spring, joy and fun are all around as new life begins. Watch the birds above or lay with your dog or cat in the grass! New life inspires a sense of playfulness that we can embrace in yoga practice as well. Embody playfulness in your practice by going for poses you normally skip and try some laughing instead of cringing whenever you fall out of a pose. Take everything even the TTC journey a little less seriously because we will all get through this. Come check out Yoga for Fertility at Pulling Down the Moon to work on some serious spring awakening. Meet new friends and a whole community of other women working on conceiving! Join the next Yoga for Fertility series on Wednesday, April 24th at 7pm or online starting on Monday, April 29th at 6pm! During National Infertility Awareness in April, try Yoga for Fertility and get 50% off!

  • Can Acupuncture Help Treat My Endometriosis?

    Endometriosis is a condition in which the endometrial tissue that normally makes up the uterine lining, is displaced and found outside the uterus. This can present with an array of symptoms which includes painful periods, ovarian cysts, heavy periods, spotting before the period, and/or even infertility. Acupuncture and Chinese medicine can be very effective in treating it.
    According to traditional Chinese medicine (TCM) endometriosis is a condition that is termed as “blood stagnation”, and your acupuncture practitioner will determine the cause of it after your initial consultation. It can arise from the body’s inability to properly absorb the old stuck blood that is lingering in body. There are a myriad of acupuncture points and herbs which help break up this stagnant blood as well as strengthen the body so that it can deal effectively with the problem. The general recommendation is to come in for weekly acupuncture for at least 3 menstrual cycles. Herbs help accent the acupuncture’s therapeutic effect and treat on another level. The most notable changes that are observed, is a reduction or elimination of painful periods, regulate cycles so that there is no spotting before the onset of the period, shrink ovarian cysts, reduce the excessive flow of blood during the period, and helps increase the odds of pregnancy in those trying to conceive.
    In addition to acupuncture and herbs, it is highly recommended that the patient seek a nutrition consultation with us. In TCM we advise patients with endometriosis to have an anti-inflammatory diet, which means avoiding foods that are spicy, deep-fried, dairy, ice-cold foods/drinks, beef, grapefruits, raw foods, and do not over-eat. Include foods like dark leafy greens, chicken, pork, mint or jasmine tea, beets, seaweed, zucchini, asparagus, berries, apples, eat until you feel 80% full, to name a few helpful tips. Please feel free to email me with any questions in regards to acupuncture and the treatment of endometriosis at anna@pullingdownthemoon.com. I am available Tuesdays and Fridays at the Chicago location, but our office is open everyday of the week in the city for acupuncture appointments.  We have Acupuncture, Massage, Nutrition, Yoga available in Chicago, Highland Park, and Buffalo Grove.  Call us to learn more at: 312-321-0004 today!
    Anna Pyne LAc, MSOM, FABORM

  • Vitamin A: Are you getting the right amount?

    By Margaret Eich, MS, RDN

    Vitamin A is a fat-soluble vitamin that is essential for reproduction, vision, immune system function, and embryo and fetal development. There are two main types of vitamin A: preformed vitamin A known as retinoids, which are found in animal products, and are converted to retinoic acid, which regulates transcription of a number of genes. The second type of vitamin A is called carotenoids, which includes beta-carotene and hundreds of others. Only about 10% of carotenoids are capable of being converted to retinol and further to retinoic acid. Beta-carotene, alpha-carotene, and beta-cryptoxanthin are all capable of being converted to retinoic acid, though only small amounts are converted.

    Most women hear about vitamin A in terms of toxicity – that you shouldn’t take too much vitamin A prior to and during pregnancy, as it may cause birth defects, which is true. We recommend limiting the amount of preformed vitamin A from supplements to no more than 5000 IU (which is equivalent to 1500 mcg RAE). RAE stands for Retinol Activity Equivalents and is the standard way of expressing vitamin A requirements and amounts in food, as it accounts for the differential bioavailability of preformed vitamin A and carotenoids. Supplement labels usually use International Units (IU) to list vitamin A doses, which can sometimes make sorting out your vitamin A intake confusing! There is no limit for carotenoids like beta-carotene, as they haven’t been shown to be capable of causing vitamin A toxicity or birth defects. Some prenatal vitamins do contain preformed vitamin A, such as retinal palmitate, which is fine and maybe helpful if you struggle to meet your vitamin A needs, as long as the preformed vitamin A is less than 5000 IU. Make sure to check all of your supplements for vitamin A, as other combination formulas aside from your prenatal vitamin may contain vitamin A.

    The daily recommendation for vitamin A is 700 mcg RAE and increases to 770 mcg RAE in pregnancy. In the US, women are getting on average only 580 mcg per day – in other words, US women are not getting enough vitamin A. So while it’s important to make sure you’re not taking in excess vitamin A from supplements, it’s also important to make sure you’re getting enough vitamin A due to its essential role in reproduction, embryo development, and organ formation during fetal development.

    Your best sources of preformed vitamin A include liver, fish, dairy, kidneys, eggs, poultry skin, butter, and dark meat chicken. Your best (plant) sources of carotenoids include: sweet potato, pumpkin, carrots, cantaloupe, spinach, kale, collards, and butternut squash. Absorption and conversion of carotenoids to active vitamin A is variable based on the food it’s contained in, and an individual’s ability to digest and absorb it. Because of the variable in absorption, it makes sense to include a mix of preformed vitamin A and carotenoids to meet your vitamin A needs.

    Need some help sorting out your vitamin A intake. Book a nutrition consult today!

     

  • Nutrition Strategies for Endometriosis

    By Margaret Eich, MS, RDN

    March is Endometriosis Awareness Month, and today we’re sharing some nutrition tips to support endometriosis. If you have endometriosis, work with your doctor on an appropriate treatment plan, but try these lifestyle tips to help manage your endometriosis as well:

    The omega-3 fatty acids, EPA and DHA, have anti-inflammatory properties and thus may help reduce inflammation in endometriosis. Cold water fatty fish and fish oil supplements are the best sources. In addition, taking omega-3 fatty acids during pregnancy may help to prevent preterm labor and are important for baby’s developing brain and vision. Fish oil is great, but we shouldn’t forget about also eating seafood, which is very nutrient rich and supportive of fertility and a healthy pregnancy. It’s just important to focus on low mercury fish and limit to 12 oz per week. Some good choices include wild salmon, sardines, whitefish, herring, and oysters.

    Consider a trial of a gluten free diet. One study showed that a gluten free diet helped to reduce endometriosis pain. Gluten is in wheat, rye, and barley and relatives of wheat like spelt and kamut. Instead substitute naturally gluten free grains and starches like quinoa, sweet potatoes, potatoes, butternut/acorn squash, brown rice, and legumes.

    Maximize your fruit and vegetable intake. This one is a no-brainer, as high fruit and vegetable is associated with better overall health and reduction in risk for many chronic diseases. Aim to include vegetables with both lunch and dinner and breakfast when possible. Include fruit to satisfy sweet cravings after meals or paired with protein at snacks.

    Want to learn more?  Schedule with a nutritionist today!

    Sources:

    1. Halpern G, et al. Nutritional aspects related to endometriosis. Rev Assoc Med Bras. 2015; 61(6): 519-23.
    2. Marziali M, et al. Gluten-free diet: a new strategy for management of painful endometriosis related symptoms? Minerva Chir. 2012;67(6): 499-504.