In the past I posted about coeliac disease and it’s impact on fertility. I had a handful of very worried people reach out about the impact their coeliac disease might have on their fertility. There is only so much you can fit into an Instagram graphic and caption, so I thought I should explain things a little further in a blog! If this was you, please read on, and ease your concerns! To answer the question of how coeliac disease may impact fertility, it is important to first understand what coeliac disease is.
What is Coeliac disease?
Coeliac disease is an autoimmune reaction to eating gluten. Gluten is a protein found in wheat, barley, rye and some oat products. Gluten damages the lining of the small intestine and causes inflammation in the body in those who have coeliac disease.
How is the small intestine affected?
In the small intestine, there are small long finger-like projections called villi. The villi assists with absorbing the nutrients we get from the food we eat. In coeliac disease, the repeated consumption of gluten causes the villi to flatten. This decreases the surface area available for the absorption of nutrients, and makes it more difficult for nutrients to enter the bloodstream. This severely impacts the bodies ability to use these nutrients leading to deficiency.
As coeliac disease is an autoimmune condition, there is very little we can do to prevent it from developing. Up to 50% of people in Australia are born with a genetic code for development of coeliac disease. Only one in forty of this group will go on to develop coeliac disease, with environmental factors contributing to this chance.
The key risk factor for coeliac disease is having a close family member (parents or siblings) who has it.
Symptoms of coeliac disease:
Symptom severity does not equal severity of illness. This makes is very important you are tested if you suspect you have coeliac.
Symptoms of coeliac disease include:
- Nutritional deficiencies (especially vitamin B12 and/or iron)
- Altered bowel habits
- Abdominal pain
- Bloating
- Fatigue
- Weight changes (weight loss, or weight gain)
- Nausea and vomiting
It is important to test for coeliac disease in specific cases, as coeliac disease often exists in people who have another autoimmune condition, or other health conditions such as:
- Osteoporosis (early onset)
- Recurrent miscarriage / Unexplained infertility
- Type 1 diabetes
- Thyroid condition
- Raised liver enzymes with no cause
How is coeliac disease diagnosed?
Coeliac disease can be misdiagnosed as being IBS (irritable bowel syndrome), so it is important that it is diagnosed correctly.
Often the first step for diagnosis is through a blood test. This group of tests is referred to as coeliac serology. This measures antibody levels in the blood which are often high in those who have coeliac. After this test is completed, you should be referred to a gastroenterologist who will then take a biopsy sample of the small intestinal lining through gastroscopy (a camera down the throat into the tummy). If this result is positive, it definitively diagnoses coeliac disease.
The next step should be to a dietitians appointment to learn about how to read nutrition labels for hidden gluten. The only treatment for coeliac disease is a lifelong adherence to a strict gluten free diet, including high quality gluten free foods.
Coeliac Disease vs. Gluten Intolerance
Like coeliac disease, a wheat allergy is also an autoimmune reaction. Gluten is just one protein that is found in wheat. A wheat allergy encompasses an immune reaction to all components of wheat. An allergy to a food means the body treats the food like an “invader” and several reactions occur within the body to both protect it and alert the body systems that they are at risk. Common symptoms of allergy include itching, abdominal pain, swollen lips or tongue, rashes, difficulty breathing either due to swelling or generally, nausea and anaphylaxis. A person who is allergic to wheat may also be able to consume other gluten containing foods such as rye. You can have a wheat allergy and coeliac disease.
Gluten sensitivity and/or gluten intolerance are terms that can be used interchangeably to describe a non-autoimmune related gastrointestinal reaction to gluten. Symptoms of this inflammation in the gut are often bloating, change in bowel habits and abdominal discomfort. These symptoms will often resolve as the gluten leaves the body. It has been thought that gluten may not be the problem in this case but the malabsorption of fructans, which is a FODMAP and can cause trouble in those with IBS. It is thought that gluten intolerance could be more aligned with a branch of IBS, but there is still more research needed.
Interestingly wheat allergy, coeliac and gluten intolerance are all generally treated in the same way – by following a strict gluten free diet. Having a gluten sensitivity, or gluten intolerance is not likely to affect your fertility.
How does all of this link to fertility?
Anecdotally, those who have well managed coeliac disease DO NOT seem to have an increased risk of fertility problems than those without coeliac disease. However, undiagnosed coeliac disease may be an underlying cause of unexplained fertility and recurrent miscarriage. This can have different impacts on men and women.
For both women and men, having undiagnosed coeliac disease can decrease the body’s ability to absorb key nutrients. These nutrients include folic acid, iron, zinc, B12 and selenium.
Females
For women, coeliac disease may have an impact on their fertile window. Women with coeliac disease are more likely to have:
- A late first period (menarche)
- Early menopause
- Loss of periods (amenorrhea)
- Diagnosis of other autoimmune conditions that affect fertility such as type 1 diabetes, thyroid conditions, PCOS and endometriosis.
Not only does this impact fertility, but there is research to say that undiagnosed or unmanaged coeliac disease can lead to lower rates of pregnancy, low birth weight babies and premature birth.
And of course you are wondering the WHY and the HOW behind all of this. All it really comes down to, is the body’s impaired ability to absorb key nutrients to nourish both mum and baby appropriately. As coeliac disease causes chronic inflammation in the body, it makes it difficult for embryos to “stick” and does not contribute to an optimal uterine environment.
Males
In males, coeliac disease has an impact on all parameters of sperm quality, including
- Shape of sperm (morphology)
- Movement of sperm (motility)
- Sperm count
This extends to issues with the actual structures of the male reproductive system such as the testes (gonadal dysfunction) and overall reduced sexual activity. This again is largely due to the nutrient deficiencies in those with coeliac disease. As with most conditions to do with fertility, much more research is needed. Surprisingly, not much more research has really been done in the area in the last 30 years.
The key finding from the research, is that once a strict gluten free diet has been adhered to improvements can be seen in both male and female fertility.
In summary, when thinking about your fertility, and preconception health, it is so important that you are seeking support earlier rather than later. If you suspect you have coeliac disease, or have a family history of coeliac disease, don’t hesitate in starting the conversation with your GP or dietitian.
Remember that WELL-MANAGED coeliac disease should not impact your ability to conceive, and carry a pregnancy to full term. If you have an autoimmune condition like coeliac disease, click here to book an initial consultation or Pregnancy Pro package.
