Gluten and Fertility: Some Things You Might Want to Know

 

 

I’m always encouraging my patients to go “Gluten Free” and I found this article written by Aviva Romm MD Doctor, Herbalist, Midwife and Functional Medicine Practitioner with many years of experience in women’s health. She explains why you should go gluten free if you’re experiencing infertility.

Fertility challenges are so uniquely painful. There is the tremendous anguish of living with the uncertainty that comes with each attempt at conception and the sadness with each unwanted period that comes. There are the feelings of inadequacy, and the aching bittersweetness of meeting your friends’ and sisters’ babies that they seemingly pop out while you suffer, feeling alone, with a sense of wanting. There’s the stress that enters the marriage and makes sex outcome-based rather than juicy and pleasurable. It’s also often a long, expensive, time-consuming hormonal roller coaster of fertility treatments, doctor’s appointments, tests, and procedures. If you are struggling with fertility challenges right now, this article may offer an option you hadn’t considered.

While there are numerous reasons for fertility problems, one that is almost always overlooked by conventional fertility specialists, and that is easy to take into your own hands, is gluten intolerance. A recent study found that undiagnosed celiac disease may be the reason for “all cause” infertility in 3.5% of women, and unexplained infertility in 5.9% of women. It is possible that the rates are quite a bit higher, because celiac is so often underdiagnosed. Another study found that women undergoing fertility treatments had an increased success when they removed gluten from their diets.

While these studies were done looking at celiac disease, which most of us do not have in the full-blown form, many people are walking around with gluten intolerance – which day in and day out in my clinical practice I see causing the same spectrum of health problems as celiac disease.

The Latest Data on Celiac Disease & Gluten Intolerance

New research data shows us 5 things about celiac disease, and its little cousin gluten intolerance:

  1. Celiac disease is drastically under diagnosed. So is gluten intolerance. 
  2. It may be causing many more health problems than we previously realized.
  3. Our current standard testing methods are not adequate for detecting celiac disease, so many people go undiagnosed who have it. So while getting positive tests back gives you a definite diagnosis, normal tests don’t mean you don’t have celiac. So testing is probably not necessary at this time. But if you do want to get tested, my blog Is a Gluten Free Diet Right for You? 3 Ways to Find Out will tell you how.
  4. A substantial number of people have “subclinical” or “silent” celiac disease – there are no obvious or typical signs of digestive problems – and fertility problems may be the first time a gluten problem shows up.
  5. Celiac can show up for the first time at any age — and again, fertility problems may be the first sign!

Whenever a woman comes to me having faced the long, emotionally painful, and expensive road of fertility problems without success, and is now ready to try a natural approach, the first thing I turn to is not the pages of hormone and other lab test results she has brought to the appointment with her, but her diet and her symptoms.

While I do run lab tests for celiac disease, including checking for the common celiac genes HLADQ2 and HLADQ8 and gluten antibodies, again, tests often come back negative in spite of a potential problem with gluten – and a fertility problem is, in and of itself, a possible sign of celiac! Improvement on a gluten-free diet is also considered diagnostic for a problem with gluten – so an elimination diet, even in my medical practice, remains the “gold standard” that I use for testing – and it’s free!

Symptoms of Celiac Disease and Gluten Intolerance

Both gluten intolerance and celiac disease can cause a wide range of symptoms. While most people actually do not present with obvious, typical symptoms, here are the most common:

  • Mild to severe digestive symptoms including diarrhea, smelly stools, gas, bloating, fat in the stool
  • Dermatitis herpetaformis (a terribly itchy skin condition)
  • Irritable bowel syndrome
  • Burning, sore tongue or canker sores
  • Eczema
  • Acid reflux (also called heartburn or GERD)
  • Eosinophilic esophagitis
  • Crohn’s disease or ulcerative colitis
  • Nutritional deficiencies including anemia (iron deficiency), B-vitamin, vitamin D, and calcium
  • Osteopenia or osteoporosis due to nutritional deficiencies (calcium, vitamin D)
  • Weight loss
  • Fatigue
  • Hair loss or brittleness
  • Joint pain, carpal tunnel syndrome, muscle aches and pains
  • Numbness and tingling in your hands, feet, or other areas
  • Hashimoto’s thyroiditis, Rheumatoid arthritis, Type 1 diabetes, and other autoimmune conditions
  • Depression, anxiety, suicidal feelings, and other mental health problems
  • Migraine headaches
  • Elevated liver function tests
  • Menstrual problems
  • Infertility

Celiac disease can also cause pregnancy problems including miscarriage and gestational diabetes, the latter which can cause serious medical problems for mom, increases your risk of cesarean, and increases your baby’s lifetime risks of obesity, diabetes, and heart disease. It is possible that severe gluten intolerance in the absence of celiac disease can cause similar problems.

Since going gluten free is a relatively easy thing to do, why not try it? It’s an affordable, easy step to take.

How Does Gluten Intolerance Interfere with Fertility?

There are 4 primary ways that gluten intolerance and celiac interferes with fertility (and also optimal pregnancy health):

1. Chronic Inflammation: Gluten intolerance and celiac cause inflammation not just in the gut, but as a result, throughout the body. The chemicals that are produced when your body is in a chronic state of inflammation tell your body that it’s in a danger zone and so not a great time to get pregnant. Chronic inflammation is also associated with conditions that can interfere with getting pregnant – for example, endometriosis, which has also been associated with celiac disease. Inflammation is also associated with pregnancy problems, including gestational diabetes, high blood pressure, and preterm labor, so it’s important to get a handle on it before you get pregnant. Going gluten free and healing your digestive system, as described later in this article, will help you to do this!

2. Nutritional deficiencies: Your digestive system keeps you healthy in numerous ways, perhaps most obviously, through the digestion of food to provide you with nutrition. When you have gluten intolerance, inflammation develops in the lining of the small intestine that interferes with nutrient absorption. When the lining of our gut is damaged, for example by irritation due to gluten intolerance, the body is less effective at absorbing nutrients, including the ones needed for healthy conception. This includes protein, fats, zinc, vitamin D, iron, and selenium – all important for conception and healthy pregnancy.

3. Gut “dysbiosis”: It’s amazing how much our bodies mirror the natural world. In the human body there are layers of gut lining that, like soil in a garden, provide a home that feeds and nourishes the optimal bacteria, our microbiome, that we need to metabolize our food, break down, and absorb our nutrients, as well as get rid of waste.

The health of the vaginal flora is also dependent on the health of the gut flora. Like in garden soil, healthy microorganisms keep down the “bad bacteria” and other bugs in the soil that can harm the plant’s roots, damaging the whole plant. In the vagina, the good flora keep the vaginal environment at the right pH and sugar level at conception to support the passage of the sperm, and thus, facilitate conception. When the good flora aren’t hanging around in adequate numbers, the not-so-good guys that can contribute to or cause fertility problems become out of control. The wrong kind of gut flora can prevent conception, might reduce the effectiveness of IVF, and can lead to preterm birth when you do get pregnant, so now’s the time to get those flora in order. If you get regular vaginal infections, this is a sure sign that things are out of order down there, but even without those, if you are struggling to get pregnant, take an oral probiotic with Lactobacillus reuteri and Lactobacillus rhamnosus. You can additionally use these in the form of a vaginal suppository a few times weekly while trying to get pregnant. I recommend that my patients insert the capsules at night before bed; they will dissolve while you sleep. Several oral and vaginal suppository products are available on the market.

4. Autoimmunity: Because celiac disease is also an autoimmune condition, this can change the body’s ability to tolerate foreign cells including your partner’s sperm – or the baby. Additionally, celiac, both as a result of autoimmunity, and the selenium deficiency that it can cause, is associated with hypothyroidism, which can interfere with getting pregnant. If you have an autoimmune condition, gluten may be a culprit. Go gluten free, follow the 4R program below, and connect with a Functional or Integrative Medicine Doctor, or licensed Naturopath or Acupuncturist skilled in natural fertility treatment and gut health.

So What Can You Do?

The bottom line is you’ve gotta’ go on a gluten free diet (GFD) for at least three months, preferably six, to maximize the potential benefit.

Three to six months might seem like a really long time when you feel that your fertility clock is ticking, but I promise you, with the experience of 30 years of working with women trying to get pregnant, and pregnant moms, that the healthier you are when you become pregnant, the better your chance of an optimally healthy pregnancy – and healthy baby.

During this time, as hard as it is to do, putting your fertility urgency on hold while you optimize your gut health and overall well-being can bring a breath of fresh air and energy into your eventual conception, and might just allow you to let go of some stress. It’s a great time to revitalize yourself!

This is really important because stress itself affects your fertility hormones by also telling your body that there’s an emergency going on! I’ve seen the fertility challenge enough to know that everything can get affected – even a lovely sex life can become fraught with tension, anxiety, and disappointments. So use this time to also get juicy with your mate, and have some fun with your sex life again.

I’ve seen amazing babies come from taking breaks like this!

How to Go Gluten Free and Optimize Your Digestive Health

Going gluten free is sometimes as simple as eliminating all food products that contain wheat (including all wheat flour and most breads, pastas, cereals), rye, and barley. There are some great websites out there to help you along, for example, Gluten Free School. If you are highly symptomatic to gluten, you might want to also remove all of the potentially cross-reactive foods from your diet, too, especially corn. If you have celiac, or even suspect that you do, you might need to take one additional step – avoid accidental environmental contamination through foods being prepared for others in the same kitchen you’re using (dish towels, cutting boards, sponges) and checking your cosmetics for gluten – shockingly, many contain gluten products – so read labels.

Many people make the mistake of assuming that gluten free products are automatically healthier than those containing gluten. Gluten free “junk food” is actually just as unhealthy because it is often loaded with empty calories, and the same extra sugar and salt in any pastries, cookies, pasta, etc. So be careful – quite a number of people actually gain weight when they go gluten free because of gluten free food binging! The best thing is to remove the gluten, and switch over to simple whole grains like millet and quinoa, and wild rice (brown rice can be healthy but concerns have recently been raised on the amount of arsenic in all rice grown in the US, so while you’re trying to get pregnant, keep brown rice to not more than a couple of times/week).

In addition to going gluten free, I highly recommend doing the 4R Program I’ve laid out for you here to optimize your gut health and heal inflammation. If you get pregnant on the 4R Program, no worries, simply discontinue the supplements when you realize you’ve conceived. It’s that simple. But stay gluten free – this is a perfectly safe thing to do during pregnancy – you can get your nutrition from other healthy, non-gluten containing grains.

Going gluten (and stress!) free may be all your body needs to regenerate your gut, cool down the inflammation, and become less autoimmune reactive. One of my fertility patient couples decided to take a “get healthy” vacation and voila! They came back feeling great – and with a belly bump! May their pregnancy success be yours, too!

 

References
Choi JM, et al. Increased prevalence of celiac disease in patients with unexplained infertility in the United States. J Reprod Med. 2011 May-Jun;56(5-6):199-203.

Collin P, et al, Infertility and coeliac disease. Gut 1996;39:382-384 doi:10.1136/gut.39.3.382

Shah, S and D Leffler. Celiac disease: an underappreciated issue in women’s health. Womens Health (Lond Engl). Sep 2010; 6(5): 753–766. doi:  10.2217/whe.10.57

Singh P, et al. Celiac Disease in Women With Infertility: A Meta-Analysis. J Clin Gastroenterol. 2015 Jan 1. [Epub ahead of print]

Sirota I, et al. Potential influence of the microbiome on infertility and assisted reproductive technology. Semin Reprod Med. 2014 Jan;32(1):35-42. doi: 10.1055/s-0033-1361821.

Stojanović N, et al Normal vaginal flora, disorders and application of probiotics in pregnancy. Arch Gynecol Obstet. 2012 Aug;286(2):325-32. doi: 10.1007/s00404-012-2293-7.