Celiac Disease and Reproductive Health

Bast A, O’Bryan T, Bast E

PRACTICAL GASTROENTEROLOGY • OCTOBER 2009

Hey guys, I have listed several more points that usual and in truth I could have listed every point in this article. My suggestion is that you read this article. This article, I thought did a great job at breaking down how celiac affects the body and then specifically as it relates to our reproductive system, that is why I included so many here, for me it was like a 2 for 1.

  • Until 2004, medical schools taught that celiac disease was a rare disease of childhood. However, current estimates state that nearly three million Americans suffer from celiac disease, but 95% of them remain undiagnosed, making celiac disease the most common, and one of the most under diagnosed, hereditary autoimmune diseases in the United States 
  • When celiac disease patients consume gluten, the inflammatory cascade is initiated within hours result- ing in a compromise of barrier integrity, followed by tissue degradation and eventual inhibition of nutrient absorption. Celiac disease (CD) has a multifactorial pathogenesis
  • Patients with celiac disease may have the “silent” or “atypical” form with no gastrointestinal symptoms and the condition may present outside the intestines and can affect any organ system
  • Numerous authorities have identified that the majority of celiac patients visit five or more doctors prior to diagnosis, with a median time for diagnosis of five-to-11 years after initial presentation 
  • The diagnosis of celiac disease requires the presence of small intestinal mucosal villous atrophy and crypt hyperplasia, (Marsh III). However, evidence suggests that small bowel mucosal damage in celiac dis- ease develops gradually from mucosal inflammation to crypt hyperplasia and, finally, to partial and subtotal villous atrophy. Mucosal intraepithelial lymphocytosis evincing normal villous architecture (Marsh I) precedes this lesion. From the pathologist’s point of view, an increased number of intraepithelial lymphocytes in an architecturally normal duodenal mucosa always suggests potential celiac disease
  • Celiac disease patients contract other autoimmune disorders 10 times more commonly than the general population
  • Thyroid autoimmune diseases are the most frequent autoimmune diseases in the population with a prevalence rate of 7%–8% of the general population, (approximately 24 million people) in the U.S. Patients with celiac disease are at risk for developing thyroid disease with an overall three-fold higher frequency than in controls. Between 30% and 43% of celiac disease patients will present with thyroid disorders.
  • During the first trimester, pregnant women with an increase in thyroid autoimmunity (TAI) carry a significantly increased risk for a miscarriage compared to women without TAI, even when euthyroidism was present before pregnancy.
  • Antiphospholipid syndrome is a syndrome of arte- rial and venous thrombotic disease, thrombocytopenia, and fetal wastage.  Fourteen percent of untreated celiac disease patients will have an elevation of antiphospholipid antibodies, and, as a result, be at a higher risk of pregnancy loss.
  • Nearly one third of all pregnancy losses are the result of undiagnosed, treatable diseases.
  • Researchers have found the rate of celiac disease to be 2.5 to 3.5 times greater in women with unexplained infertility than in women with normal fertility.
  • Studies have shown an increase in miscarriages and stillbirths in women with celiac disease who are not on a gluten-free diet, illustrating the need for a proper diagnosis and the education of obstetrics, gynecologists and fertility specialists.
  • Cumulatively, these studies provide evidence that there is a strong correlation between incidences of mis- carriage, stillbirth and undiagnosed celiac disease, while also indicating that maintenance of the gluten- free diet is imperative to maintaining reproductive health in celiac disease patients
  • Despite the strong recommendation of many studies prompting a strict dietary treatment to prevent neoplastic and systemic complications, decrease mortality and reverse the risk to many complications of pregnancy, neither the American College of Obstetricians and Gynecologists (ACOG) nor the March of Dimes officially recommend testing for celiac disease. Both groups are waiting for more studies in the United States as their knowledge of celiac disease’s causal effects on fertility is continually evolving. Despite this argument, the cost-to-benefit ratio of testing for celiac disease is clear. The only negative repercussion to test- ing for celiac in unexplained infertility is the comparatively nominal cost of the test, whereas testing positive may give potential parents the answer to the problem without the use of costly and invasive procedures. Above all, it is imperative that those with celiac disease are diagnosed and begin their gluten free diet as soon as possible in order to maintain their health in all respects.

Reading this article I was both sad and excited at the same time because you see I had a miscarriage several years ago before I had any clue as to what was going on with my body. So my first thought when reading this was, what if my doctors knew this? What if I had changed my diet sooner, would I then have a child? No one really knows and I generally try not to live in the past or in what if land because it certainly does not serve me. 

I believe I am here today because of all that I have gone through and I’m grateful to be where I am now. And my hope is maybe just maybe this article can help someone who is having a tough time having a family of their own.

I certainly know from my own experience I certainly would not have need additional proof just like the American College of Obstetricians and Gynecologists (ACOG) or the March of Dimes are looking for. Had I known this I would have demanded that I be tested and would have keep searching until I found a doctor who would run the test and/or be open to this as a possibility for my challenges. I had many, but to think that by just removing gluten from my diet that it could have eliminated a huge road block, I would have certainly tried it without a single moment of hesitation. 

How about you? Would you be willing to change your diet, improve your health and gee possibly having the family you always wanted? For me there is not even a question.

Just something to think about and to consider when making food choices that could have a significant affect on your health and the possibility of starting a family.

* Here’s my little disclaimer, I’m not a doctor, researcher, immunologist, just someone deeply concerned and trying to help as many peeps as I can make conscious, good, healthy choices for their health and their bodies when living life with gluten challenges. I have not been compensated or obligated to write this article, and as always, all thoughts and opinions are honest and my own!