Gluten Intolerance, Celiac Disease, and Fertility
Although many of our readers may be aware of gluten and the difference between celiac disease and gluten intolerance, here’s a quick breakdown so we're all on the same page!
Gluten = a protein found in wheat and other grain products, responsible for the ‘elastic’ texture of dough [in latin, gluten = glue]. The grains that have gluten include wheat, barley, rye, oats, spelt, kamut, triticale (also bulgur, durum, farina, graham, and semolina – these are modified versions of the gluten-containing grains). Many processed foods also contain gluten, and it's not always listed in an obvious way. Soy sauce, processed meats and ice cream are examples.
Celiac disease = an autoimmune disease, where the immune system attacks the small intestine when gluten is digested. It can be diagnosed by blood tests that look for antibodies to gluten that your body may be producing, and a tissue biopsy of the intestines; actual physical damage to the cells that line the intestinal tract is diagnostic of celiac disease and avoidance of gluten must be strictly adhered to. This damage, over time, can lead to malabsorption issues and complications from malnutrition.
Gluten intolerance (aka. Non-celiac gluten sensitivity) = is diagnosed primarily on symptoms, which are not as severe as the symptoms of celiac disease and do not cause actual physical destruction of the intestinal cells. Symptoms can be vague and vary from person to person, but can include abdominal discomfort, diarrhea, bloating, headaches, brain fog, joint pain, hyperactivity, inability to gain weight and many others. Usually, celiac tests are negative but gluten avoidance provides symptom relief, and that’s how we diagnose an intolerance.
Numerous studies in the recent literature have shown a link between celiac disease (the autoimmune disease) and infertility for both men and women. It is not necessarily clear from the research why this link exists yet, but it isn’t hard to postulate some of the reasons gluten could be interfering with conception. Here I’ll list some thoughts on how celiac disease and/or gluten intolerance may be affecting your fertility:
1. Malnutrition from malabsorption of minerals is common in patients with celiac disease, especially those who are undiagnosed and still consuming gluten products. As we know, when trying to conceive and during pregnancy it is crucial to maximize what you absorb from your food in order to provide optimal nutrient levels to your developing baby.
2. Many women with celiac disease also experience iron deficiency anemia. Anemia is a reduction in the amount of hemoglobin, the oxygen-carrying pigment, in the blood. It can have a major impact on fertility because when the blood is busy carrying oxygen to all the vital organs to keep them going, there isn’t much reserve left for the non-essential reproductive organs. We want to increase the amount of blood and oxygen flowing to these organs to optimize your chances of conception.
3. In true celiac disease, women commonly suffer from menstrual abnormalities – for example, an Italian study showed nearly 20% of celiac women have amenorrhea (where they fail to ovulate during their cycle) versus 2.2% of control subjects. It is pretty obvious that we need the body to be ovulating in order to achieve pregnancy. This may be one of the main reasons it’s harder for celiac women to conceive.
4. In people with food allergies, we clinically see an increase in mucus production. This is your body’s typical reaction – increased release of histamine from the intestinal tract causes systemic inflammation and increased secretions. That’s why your nose gets runny if you’re allergic to hayfever, but it’s also possible that secretions elsewhere in the body are altered when you ingest a food you’re sensitive to. In this way, fertility of both men and women can be affected – in men, the consistency of their spermatic fluid is very important in maintaining viable sperm, and in women secretions throughout the reproductive tract must also be specific to facilitate the journeys of the egg and sperm toward each other.
5. Men (let’s not forget the other half!) with celiac disease also have a greater risk of infertility and reproductive issues, and they also have an increased risk of androgen (male hormone) deficiency. Adequate androgen levels are necessary for proper sperm production and sexual function.
At Acubalance, we screen all patients (especially those with "unexplained subfertility") for gluten sensitivity and/or celiac disease as another way to understand why you are having trouble conceiving. In many cases of unexplained subfertility, a diagnosis of gluten intolerance or celiac disease and subsequent avoidance of gluten can be exactly what’s required for a couple to become pregnant. Even if you don’t recognize digestive symptoms from eating gluten, remember that the symptoms of gluten intolerance are vague and variable. I can help you identify if you are sensitive to this protein, and help with the lifestyle changes necessary to cut it out of your diet.
If you’re not yet a patient, you are welcome to book a free 15-minute consultation with me, Dr. Kali MacIsaac, to discuss how we can increase your chances of conceiving!
Dr. Kali MacIsaac, ND HBSc
P. Collin et al. Infertility and coeliac disease. Gut. 1996;39:382-384. http://gut.bmj.com/content/39/3/382.abstract
Infertility and Celiac Disease. National Foundation for Celiac Awareness. Accessed Sept. 26, 2013.
K.S. Sher et al. Female fertility, obstetric and gynaecological history in celiac disease. A case control study. Digestion. 1994;55(4):243-6. http://www.ncbi.nlm.nih.gov/pubmed/8063029
A.V. Stazi et al. [Celiac Disease and its endocrine and nutritional implications on male reproduction]. Minerva Med. 2004. Jun;95(3):243-54. http://www.ncbi.nlm.nih.gov/pubmed/15289752