Gluten and Fertility AR Blog

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 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.

16 Comments

  1. Thank you, THANK YOU 🙂 one question, I had tried paleo when it first seemed to “take off” due to my acne clearing, and other things, I stayed on it and have added grains but zero gluten back in. I actually have more weird issues now than ever before :/ oral allergy, almost hyper sensitive and more. Should I put it back in?? I do love Ezekiel sprouted but have stayed away. I would love to be tested but am afraid it would be neg. After years of having zero gluten. Wish we lived closer so I could visit you!! 🙂 thank you – peace!

  2. I struggled with secondary infertility and terribly long anovulatory cycles (45-60 days between periods was not uncommon for me). Dr’s were telling me that the only solution was more medication to try to get my body to do what it wasn’t doing. I knew, though, that there had to be a root cause to the issue. I began searching for natural remedies and when I finally heeded advice to try a gluten free diet, I ovulated literally 2 weeks later… the first time in over a year. I immediately started having normal cycles and was pregnant within 3 months. My son is an every day reminder to me just how much gluten can mess my body up! I had other symptoms too, but the fertility issue was what caused me to first try gluten free and now I live a much higher quality life.

  3. What is your stance on Gibson’s second study that showed that gluten intolerance does not actually exist? The current theory is that aside from those with celiac, and wheat allergy patients don’t need to go gluten free. However, FODMAPS seem to create quite a havoc in the gut.

  4. After 14 years of infertility (including infertility treatments- none of which worked) I went completely off gluten for 2 months at age 38 and got pregnant. I stayed off gluten until after my daughter was born and then when she was six months old decided to get tested for celiac even though I had no symptoms (except for infertility). The tests came back clear that I have celiac. I now am 6 months pregnant again.

    • Great I have infertility too. Failed IUI and IVF. Your story is inspiring. Can you please share your gluten free journey. I have spent a lot already. This June I’m 40years old. Please send your reply to narokia@yahoo.com.
      Thanks a ton.
      Nice.

  5. This is such a great article not only for women trying to get pregnant but for all. Very practical and easy to follow. I have been gluten free for 4 years now with only a few of the symptoms you listed above. The difference it has made to how I feel is huge. There is no way at all now that I return to eating gluten.

  6. How does MTHFR mutation fit into the picture of gluten intolerance and infertility? Can you recommend a good resource to learn more about that piece?

  7. I’m 17 and never had my period in more then 2 years. Recently I’ve had allergic reactions to everything I eat and I mean EVERYTHING. It’s horrible and I don’t know what to eat anymore. Eventually it got a bit better but some of my symptoms include itchy/swollen lips. Big white spots on my body. Irregular heart beat. Headaches. 2 weeks ago I noticed small white pimples on the back of my arms. I feel so bloated all the time and have horrible stomach pains. I galloped that symptoms and it brought me here. Im going to for blood tests tomorrow hopefully.

    • Hi Ashlee, This sounds like either a food allergy or a problem called histamine intolerance. Both can be quite serious and it’s important to see an allergist to have an epi-pen on hand should you need one. But in addition, some functional and integrative doctors can help with histamine intolerance, which can improve with the right treatments. But do see an allergist to avoid an emergency situation from arising without you knowing how to handle it if you’re developing a more serious food allergy.

  8. Hi I really want an answer to my problem , ice been diagnosed with hypothyroidism for almost 3 years now .. and I’ve heard there is a connection between hypothyroidism and celiac desease. . I don’t know if I have celiac desease but I’ve noticed that my belly is big compared to my thin body. . and I have a sort of skin problems like acne but only in the back of my arms and in my back. . so how do I know if I have celiac desease? are these symptoms enough to say that I have it?

    would really appreciate it if you answer!

    • Hi Serenity,

      This is Megan from Aviva’s team, if you do a search for celiac disease on her website you will find a number of really informative articles that I think you will find incredibly helpful.

      Warm wishes,
      Megan- Hi Shirley,

      What you are doing sounds AMAZING and inspiring! Thank you for sharing your story with ALL of us!

      Love,
      Megan- Aviva Romm’s Executive Assistant and Online Nutrition Expert

  9. I was diagnosed with Celiac three years ago. What is the chance my daughter age 28 has Celiac as well? Is it hereditary? She and her husband are having trouble conceiving. All test show she should be about to have a baby. I also have Hoshimoto’s.

    • Hi Bright,

      Yes, celiac is hereditary and encouraging your daughter to get tested would be a good next step!

      Warm wishes,
      Megan- Aviva Romm’s Executive Assistant & Functional Health Coach

  10. Thank you for this article and for your book “The Adrenal Thyroid Revolution”. I wish I had found resources such as this several years ago, but better now than never. We have been trying to get pregnant for 2 years now. After many tests and several rounds of failed fertility treatments (and 10k lost), I knew there had to be an answer for our undiagnosed fertility problems. I have a history of digestion issues and was starting to suspect hypothyroidism and adrenal fatigue. Also have a history of severe allergies, asthma and very low vitamin D. I decided to do an elimination diet and found out I have major food sensitivities to dairy, gluten and soy. After eliminating those foods for the past 4 months, I feel sooo much better. Also, my periods have normalized to 28 day cycles (which is very unusual. Since I was 13 (I am now in my 30s) my cycles ranged from 24 to 40 days, never consistent). No pregnancy yet, but am working on healing my body and we are hoping for the best.

    For now I am using your protocol to continue my healing process. I did however have very strange symptoms when taking a berberine supplement to kill off bad “bugs” in my intenstines. I took less than the recommended dosage in order to ease into it, but after 2-3 days I started getting incredibly rapid heart rate, feeling very strange and inability to sleep. Heart rate got so high I was worried I would have to go to the ER. I discontinued, waited a week and tried again. The same thing happened. I must be sensitive to it. Have you heard this happening with other patients before?

    I think for now I will just focus on intestinal healing and introducing more “good bugs” and pass on the killing the “bad ones”.

    Thanks for what you do. You are the type of MD I wish there were more of…..one that focuses on true health.

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