The Naturopathic View: Celiac Disease, Gluten Intolerance, and Fertility - by Judith Fiore (Winter 2011)

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CELIAC DISEASE, GLUTEN INTOLERANCE AND FERTILITY
by Dr. Judith Fiore, ND
Winter 2011

Celiac disease is a digestive disease that damages the villi which line the small intestine and prevents the absorption of nutrients, vitamins and minerals from food. Celiac disease is usually thought of as an allergy to gluten. This is because when celiacs eat foods containing gluten, the villi are flattened by the huge influx of antibodies produced by the immune system in the body’s attempt to digest the gluten.1 Without healthy villi, a person becomes malnourished in spite of eating a healthful diet.

Gluten is a complex mixture of proteins found in many grains, including wheat, barley, and rye. Gluten is the protein that allows bread to rise in the baking process and stirs our senses when we smell freshly baked bread. But gluten is not only found in food; it may surprise you to find out that it may also be found in medicines, vitamins, and lip balms.

Celiac disease is both a disease of malabsorption – meaning nutrients are not absorbed properly – —and an abnormal immune reaction to gluten. Celiac disease is often found to be genetic, in that it runs in families. It is also seen in higher percentages amongst people of European ancestry.2 Many of the research studies that have looked at celiac disease originate from Europe. Sometimes celiac disease is activated after surgery, pregnancy, viral infection, or even severe emotional stress or trauma.3.4

Symptoms of celiac disease vary, and may occur in the digestive system or in other parts of the body and may include: abdominal bloating and pain; chronic diarrhea; constipation; pale, foul-smelling or fatty stools; weight loss or weight gain due to water retention; irritability; unexplained iron-deficiency anemia; fatigue; bone or joint pain; arthritis; bone loss or osteoporosis; depression or anxiety; tingling and/or numbness in the hands and feet; canker sores in the mouth; itchy skin rash; and seizures.1 That is quite the list of possible symptoms, but what about possible effects on fertility?

For women, it is not unusual to suffer with amenorrhea (absence of periods) or to miss menstrual periods, resulting in irregular cycles.5 Recurrent miscarriage has also been linked to celiac disease.6 Other complications during pregnancy that are found four times more often in women with celiac disease are pregnancy-related hypertension, severe anemia and intrauterine growth retardation. It has been noted that men who are celiac have abnormal levels of reproductive hormones which often result in low sperm counts and motility, as well as higher percentages of abnormal morphology.7

In some cases, there are no symptoms. Sometimes the disease is silent and somehow the individual is enjoying what appears to be good health and fertility. There are no digestive problems, no signs of anemia, cycles are regular in women and men have good counts and motility. There is no history of miscarriage, and the only thing that a couple is hearing is that their fertility problem is unexplained. It may be years before symptoms of the disease appear, or, worse, illnesses such as liver diseases and intestinal cancers are diagnosed.8,9

For your health and the health of the ones you love, a simple blood test would be helpful to determine if you are producing antibodies to gluten. The test is called the anti-gliadin antibody test, and if you are having any of the above symptoms, or just being told that there’s no explanation for your inability to conceive or carry a pregnancy to term, I recommend you speak to your doctor and get tested. The most conclusive blood test is called the antitissue transglutamidase antibody with measurement of serum IgA levels.

Keep in mind that before having either test you should be consuming gluten daily for at least three weeks in order to determine if you have the antibodies to gluten. There are other tests, such as an intestinal biopsy, where very small pieces of tissue from the small intestine are removed to see if the villi are damaged. Whether you go through more tests will be something you will need to discuss with your physician.

Eating a gluten-free diet

The only cure for celiac disease is a gluten-free diet. While this presents a challenge, with time and experience most people find they are able to prepare and eat delicious meals.  More importantly, their health is better and research is showing that this may be enough to overcome infertility.10

To help get you started, I have included the following chart. It’s not the full list of foods that do or do not contain gluten. You can find those lists by simply googling “gluten-free foods” and “foods containing gluten”. I would also suggest that you google “gluten-free recipes” to find many websites to use as resources as you learn to avoid eating gluten. And while you are surfing the net, the following are websites that you can go to for more information:

www.celiac.ca
www.Celiac.com
www.Celiac.org
www.Celiaccentral.org
www.foodintol.com/celiac.asp
www.gluten.net
www.Glutenfreedom.net

*Oatmeal doesn’t contain gluten, but it is usually contaminated with wheat flour during processing in facilities that are not dedicated to being gluten free. Steel-cut oatmeal, because it is the least processed of the oatmeal types, is therefore the safest to eat. However, for celiac patients, oatmeal is not always a grain they are able to eat.
 
The Final Word

As a naturopathic doctor, I have found that at least half of my patients do better on a gluten-free diet, regardless of whether they had a positive or negative anti-gliadin antibody test result. Perhaps this is because removing gluten from the diet helps make it more likely that a person will avoid processed foods, trans fats and sugar and/or because it helps by increasing the variety of grains in our daily diets. Also, gluten is a protein that is fairly difficult to digest, in comparison to other grains. Once you have been gluten-free for a couple of months, and you experience no change in your health, then it's fine to resume eating foods that contain gluten.  However, I would still encourage you to also eat gluten-free grains like brown rice, buckwheat, quinoa and millet. After all, a typical day would have us eating toast and/or cereal for breakfast, a sandwich for lunch, crackers for the afternoon snack, and then pasta or bread with dinner. Four servings of wheat in one day, or maybe five if you have a piece of cake or a cookie for dessert. That’s a lot of gluten for our bodies to be dealing with, and most of us eat this way every day for all of our lives.

Just imagine what happens when you decide to not eat gluten. All of the convenience foods, like sandwiches, pastas, crackers, cookies, granola bars, etc., are now off limits. Instead you are eating whole grains like quinoa and brown rice with your meals. For breakfast, rather than eat a bagel that’s loaded with cream cheese and jam, you are having a bowl of steel cut oatmeal with berries and milk. Rather than eating a cereal bar for a snack, you grab an apple from the store. If you add plenty of vegetables, lean proteins, nuts and seeds, and healthy oils through the day you will be eating in a way that can dramatically improve your health.  

But for some of you, the best and most magical thing will be that avoiding gluten will allow you to greatly improve your fertility. Something as simple as that could be what gives you the joy of becoming a parent. It may take several months before you experience positive changes, but it is well worth the effort if you end up feeling healthy and well and are blessed with a child.

All references are listed on the IAAC website at iaac.ca/content/library

About the author
Dr. Judith Fiore, ND, owns and operates the Naturopathic Fertility Centre in downtown Toronto in close proximity to the Create and Lifequest fertility clinics. She offers naturopathic therapies and acupuncture to individuals and couples with fertility issues. Dr. Fiore and her associates provide on-site acupuncture treatment to IVF patients at TCART and Mount Sinai RBU. She is also at a second location in Mississauga as of October 1st, 2010. For more information, please visit her website at www.naturalfertility.ca or telephone 416-231-4477.