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Celiac Disease and Women’s Health
The reality is, celiac disease can impact women’s health. And with 60-70% of the celiac population being women, it’s important we talk about the impacts of celiac disease and women’s health.
A quick note for my non-binary and transitioned celiac friends, this post applies to the health of those assigned female at birth too. Though for the sake of brevity and so this post is able to be found on the internet, I will be referring to the health of those assigned female at birth as “women’s health” for the rest of the post.
Holding space for the lack of inclusivity in SEO and celiac research.
Table of Contents
What is Celiac
First, before we talk about the connections, a quick primer on what celiac disease is. Celiac disease is an autoimmune disease that causes an abnormal immune response when gluten is eaten.
To protect the body from this damaging response to gluten, celiacs need to follow a strict gluten-free diet.
Celiac Disease Symptoms in Women
As we discuss women’s health and celiac disease, it’s important we understand how celiac disease can impact women.
Women are diagnosed with celiac disease more often than men, with about 60-70% of total diagnoses in most populations being female.
While there are many similarities in celiac symptoms between the sexes, it can be different depending on the individual due to the genetic variations of autoimmune diseases, especially compared between males and females.
In fact, a study done by Jansson-Knodell and others, results showed that symptoms were more unalike than alike in males and females who had celiac disease when researched. Women were shown to have more cases of constipation, bloating, hyperthyroidism, and anemia than their male counterparts.
Common symptoms that present in celiac women are:
- Abdominal pain
- Bowel changes
These are the symptoms that can raise red flags for doctors to suspect and test for celiac disease in those who ovulate.
Other symptoms that are not as well-known but can still be complications of celiac disease in women are:
- Iron deficiency anemia
- Bone health complications
- Dysfunctions of the liver
- Weight loss
- Menstrual irregularities
- Adverse pregnancy outcomes
Defining Women's Health
Now that we understand celiac and how it impacts women, let’s quickly get on the same page on what I mean by women’s health.
Women’s health is the sector of medicine that deals only with the health, diagnoses, diseases, and conditions that pertain to the female population. Some of the specific sectors of women’s health include:
- Birth control
- Hormone therapy
- Pregnancy and birth
Essentially, women’s health applies to that of which specifically impacts women.
How Does Celiac Disease Affect Women’s Health?
Celiac disease affects women’s health because nutrition is directly tied to our hormones. This in turn can impact a woman’s fertility, period, bone health, menopause status, and more.
Celiac Nutrition and Hormones
Nutrition for celiac disease is so important to the optimal functioning of our endocrine and reproductive systems. These systems are where the production of many vital hormones takes place.
Specific nutrients can impact the production, release, and efficacy of many hormones such as the relationship of selenium and iodine to thyroid health.
Varying levels of nutrients, ranging from inadequate to excess amounts, can impact our hormonal health and, thus, our overall health. This can be a major issue as it relates to celiac disease because going gluten-free can cause imbalances in our diet.
For example, removing gluten from the diet initially and without proper guidance can eliminate food groups that contain nutrients essential for optimal hormone production and function.
Additionally, consistent “glutening” can damage our gut lining and prevent the digestion and absorption of essential nutrients for hormone health, worsening the issue.
Thus, it is essential that you are maintaining a strict gluten-free diet to prevent gluten exposure. Additionally, it’s important you are appropriately balancing your diet to make sure you’re getting the nutrients needed to support hormone health.
However, I also want to note, as you live gluten-free your hormone activity should normalize. If it doesn’t it’s time to consider other autoimmune diseases linked to celiac.
Fertility and Celiac Disease
Untreated celiac disease can impact fertility. Additionally, if undiagnosed or unmanaged, celiac can impact pregnancy: it impacts a woman’s ability to get pregnant, remain pregnant for the full term, and have a safe delivery.In a study done by Moleski and others in 2015, results showed that women with celiac disease had higher rates of spontaneous abortion compared to non-celiac participants.
Celiac can further impact fertility if a women is malnourished due to intestinal damage. This is because nutrition is essential to support a healthy pregnancy and delivery for both herself and the baby.
Some key nutrients to monitor while pregnant or trying to get pregnant, especially with celiac, include:
Thus, gluten-free foods for fertility and pregnancy should include foods rich in those nutrients.
Common fertility issues in women with celiac most likely arise from nutrient deficiencies, low progesterone, low thyroid hormone, and high prolactin. This is tying us back to our discussion on celiac and hormone health
If we are getting enough nutrients from a balanced gluten-free diet or because of small intestinal damage, then we can’t properly support our hormones.
All of this is to say however, that as you heal and eat gluten-free with celiac, infertility and rate of birth complications drop.
However, a woman with celiac that goes untreated can be at a higher risk of fetal abnormalities, preterm births, and miscarriages. Study correlations indicate that the gluten proteins, when present in celiac mothers, interact and can disrupt the placenta in the developing fetus so a gluten-free diet should be followed.
But don’t take this and freak out if you’ve been glutened while pregnant. 1 accidental exposure is not going to ruin your pregnancy.
Periods and Celiac Disease
Celiac disease can impact women’s health by affecting periods. Celiac, especially when undiagnosed, can cause skipped and irregular periods and can even cause amenorrhea (3 missed periods in a row).
In fact, in a study comparing women with celiac disease to those without it, amenorrhea was 3x more likely to show up in celiac women than non-celiacs. In another study, ~25% of women reported a history of missing periods compared to 10% of non-celiac study participants.
However, women starting and adhering to a gluten-free diet is shown to greatly lessen or eliminate many amenorrhea cases.
Other period complications found in that study included very light periods, infrequent periods, strange spotting, or very heavy periods. Additionally, delayed menarche can also be a sign of celiac disease but cases show that beginning and adhering to a gluten-free diet will also improve and potentially eliminate complications.
Menopause and Celiac
Celiac disease can impact women’s health by causing early menopause in women with undiagnosed or mismanaged celiac.
In fact, a 2011 study on menopause development in celiac and non-celiac women found that celiacs developed menopause earlier. This is likely related to inadequate nutrition impacting proper hormone functioning in celiac women.
However in this study, they determined that diagnosis and treatment of celiac 10 years before menopause prolongs fertility of celiac women.
Meaning, swift diagnosis and adaptation to a gluten-free diet is imperative to fertility and the prevention of early menopause in celiac women.
Bone Disease and Celiac
Celiac disease can impact women’s health by affecting bone health. Low bone mineral density resulting in osteopenia and osteoporosis is common in women with celiac disease.
Celiac bone health complications are due to calcium, magnesium, and vitamin D absorption being impaired due to small intestinal damage from gluten in those still undiagnosed or still healing from a celiac diagnosis.
When women receive their initial celiac diagnosis, part of proper celiac testing should include a DEXA scan to check bone mineral density. This is so celiacs can either take precautions to prevent these conditions from occurring or slow their progression.
Celiac women are also recommended to keep a close eye on their calcium, vitamin D, and magnesium levels and ensure that they are getting enough of them via the diet or from supplementation.
The general recommendations for women for daily consumption of these nutrients are:
- 1200 mg of calcium per day for menstruating women, 1500 mg for menopausal and post-menopausal women either from gluten-free calcium-foods or supplements.
- 600 IU of vitamin D per day to meet needs but a doctor may recommend more if you are already vitamin D deficient with celiac.
- 320 mg of magnesium per day for women, 400 mg per day if pregnant or lactating
Here’s an example of a gluten-free supplement that has all of these nutrients that can help supplement a balanced diet in supporting bone health. When considering any supplement though, please be sure to consult your doctor to make sure they are safe for you to take.
UTIs and Celiac Disease
A common question about celiac and women’s health I get is “does celiac put you are higher risk for UTIs (urinary tract infections)”.
There is no conclusive evidence showing that celiac disease causes an increase in frequency of UTIs. Most studies are either done in a small sample size, done on a single case in a single patient, or do not show a strong correlation or causation.
It is thought to be a tertiary symptom of celiac disease, caused by symptoms caused by the celiac itself. For example, a possible explanation is that the malnutrition and dehydration that is a result of the celiac disease causes the presence of the UTI, not that celiac disease directly causes a UTI to occur.
Anemia and Celiac Disease
Another impact of celiac disease on women’s health is the higher frequency of anemia in celiac disease patients.
Iron deficiency anemia can be common in women, especially those with celiac disease. Even in women who have not fully developed iron deficiency anemia, many are still deficient or at risk of developing this condition.
This is because the damage to the small intestine from eating gluten with celiac can impair iron, folate, and B12 absorption. A deficiency in any of these nutrients can lead to anemia.
It is important that women with celiac disease get a complete blood count and iron panel to monitor for anemia. Additionally, it’s vital that celiac women consume a balanced gluten-free diet, and supplement if needed to prevent anemia and related symptoms from occurring.
How to Support Women’s Health with Celiac
- Consume a balanced gluten-free diet containing all necessary micronutrients and macronutrients needed for your body’s unique requirements. Consuming enough calories overall will greatly aid you in also consuming adequate amounts of necessary micronutrients for optimal bodily & hormonal functioning. Not to mention it will help you repair your small intestine to prevent any further celiac women’s health complications.
- Pay attention to your vitamin and mineral levels. Get regular blood work as needed & evaluate your diet every so often to ensure that you are getting in key nutrients such as calcium, magnesium, iron, and vitamin D.
- Engage in weight-bearing exercise. This will help to overload the bones and cause bone remodeling which can strengthen them to boost bone mineral density!
- Get in the sun! Show your wrists and ankles in the sun for 15 minutes every day during peak sun hours to maximize vitamin D synthesis.
- Eat your iron! Eat heme iron sources regularly for the most bioavailable form of the mineral. These sources mainly come from meats and poultry, especially red meats! If you are unable to consume heme sources, you can get non-heme iron from sources such as beans and legumes and fortified grain products. Be sure to pair your iron sources with vitamin C to boost absorption! Don’t forget to read my post on iron-rich gluten-free foods for more help.
- Adhere to a celiac diet as much as possible. This will greatly reduce any symptom flare-ups and long-term health complications that can result from persistent gluten exposure.
- Work with a celiac dietitian to make sure your current gluten-free lifestyle is supporting all aspects of health.
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Celiac Disease and Fertility
Celiac disease impacts fertility if left undiagnosed or untreated. The impact of celiac disease on fertility is related to both a gluten-free diet and the damage to the small intestine that occurs with celiac.
In this post, we will dive into fertility, celiac disease, what the research says, and how you can support your fertility with celiac disease.
Table of Contents
Written by Devorah Steinberg, revised by Tayler Silfverduk, RDN
What is Celiac Disease
Celiac Disease is an immune disease that causes damage to the villi of the small intestines. This can lead to nutrient deficiencies and a wide array of symptoms.
Symptoms of celiac include diarrhea, abdominal pain, and weight loss are just some of the examples of digestive problems that can be triggered when a person with this condition ingests gluten (a protein found in wheat, barley, and rye).
What is Fertility
Fertility is the natural ability to conceive a child. Infertility is when conception does not happen after 1 year of unprotected sexual intercourse. Approximately 11% of couples experience infertility, and of those couples 1 in 5 are diagnosed with unexplained infertility (the majority of infertility cases are the result of hormonal problems that stop the ovaries from producing or releasing mature eggs).
When you are unable to conceive a child, this is known as infertility. And unexplained infertility can be a sign of celiac disease.
What Impacts Fertility
Key factors that support fertility are age, hormonal health, nutrition, and genetics. However, there are many things that women can do to increase their fertility as well. Studies show that lifestyle factors such as cigarette smoking, or having an irregular sleep cycle can all negatively impact fertility.
Celiac Disease and Fertility
Many connections between celiac disease and fertility have been found in research. In fact, fertility is one of many women’s health factors impacted by celiac.
One of the largest studies to be done was a 2014 study from Nottingham University carried out over the course of 23 years, analyzing the data of over 2 million women between the ages of 15 and 45 in the UK. The study showed that women between the ages of 25 and 39 years of age did have an increased risk for fertility issues if they had celiac disease that was untreated or unmanaged.
A 2018 study from Denmark compared the medical records of 6,319 women with celiac disease to the record of 63,166 women without the disease. The study showed that women with undiagnosed celiac disease had 11 more miscarriages per 1000 pregnancies and 1.62 more stillbirths per 1000 pregnancies. Additionally, in the 2 years leading up to a diagnosis of celiac disease, women experienced 25 fewer pregnancies per 1000.
A 2010 study from Sweden of 11,495 women found that fertility was reduced during the two years before the women were diagnosed with celiac disease. Once treated with a gluten free diet, however, normal occurrences of fertility were restored.
This 2014 study came to the same conclusion: Women with untreated and/or undiagnosed celiac disease showed a higher risk of miscarriage, intrauterine growth restriction (fetus not growing as expected), babies born with a low birthweight, and preterm delivery. However the risk for all these conditions are significantly reduced by following a gluten free diet.
The major difference between an undiagnosed or untreated individual with celiac disease and an individual living with managed celiac is the consumption of gluten.
Without the immune response in the small intestine that gluten consumption causes, a person with managed celiac disease will be able to lead a symptom free life. Not only will they physically feel better, but their body should be able to absorb nutrients properly – which is one of the most important factors for fertility.
Nutrition, Celiac, and Fertility
Undiagnosed or untreated celiac disease results in a damaged duodenum in the small intestines. This in turn, lowers the body’s ability absorb key nutrients – including nutrients needed for reproductive health, such as folic acid, zinc, iron, and B12. A lack of these vitamins have been shown to negatively impact fertility in the following ways:celiac
- Folic acid: Folic acid deficiency has been strongly associated with birth defects.
- Zinc: Zinc deficiency has been shown to negatively affect the early stages of egg development.
- Iron: Low iron levels result in poor egg health, as well as possibly diminishing a woman’s ability to ovulate properly. .
- B12: Becoming pregnant with a B12 deficiency has been associated with higher risk of miscarriage. It also may add to impaired development of the egg and cause abnormal ovulation.
- Calcium: a preventative measure, making sure you are getting enough calcium supports bone health with celiac disease. This is because as your body will prioritize homeostasis and your babies development over maintaining bone density.
Celiac Infertility can be Reversed
Based on the studies above, and numerous other (smaller) studies carried out worldwide, celiac Infertility can be reversed by adhering to a completely gluten-free diet and restoring nutrient stores. This reversal is likely due to a gluten-free diet promoting intestinal healing and reduction in inflammation. This will restore the body’s ability to absorb nutrients – a much-needed process for reversing infertility.
So rest assured, as you heal, you should be able to get and maintain a healthy pregnancy with celiac disease.
Can Celiac Affect Sperm?
Though there is more data on Celiac Disease’s effect on women’s infertility readily available, there is some information regarding Celiac’s Disease on male infertility as well. An old study from 1982 found that 19% of married men with Celiac Disease experienced sperm morphology (size and shape) and sperm motility (the ability of sperm to move). However, a later study done in Sweden in 2011 of 7121 men, concluded that men with Celiac Disease do not seem to have impaired fertility, either before or after diagnosis.
How to Support Fertility with Celiac Disease
During a woman’s childbearing years there are a number of things to do to support fertility. As per this study, nutrition is of key importance, along with being aware of alcohol and caffeine consumption, smoking, stress, and long-term exposure to environmental pollutants.
If you’re fertility experiences are tied to celiac, the best thing you can do is heal your small intestine, heal your relationship with food, and focus on supporting any nutrient gaps you may have related to a damaged small intestine or learning to balance a gluten-free diet.
A reminder: zinc, folic acid, iron, B12, and calcium are all nutrients of concern with celiac and can help support fertility.
Celiac Fertility 3-Day Meal-Plan
Below is a 3-day meal-plan example for what it might look like to incorporate gluten-free foods for fertility. For more support, consider working with a celiac registered dietitian.
- Day 1
Breakfast – Vegetable Frittata
Lunch – Fertility Salad
Dinner – Liver and Onions, with a baked sweet potato and steamed broccoli
Snack – Berry Avocado Smoothie
- Day 2
Breakfast – Breakfast Lentils with Poached Eggs
Lunch – Vegan Roasted Sweet Potato Salad with Cashew Dressing
Dinner – One-Pan Salmon Asparagus with quinoa
Snack – Sunflower Seed Energy Bites
- Day 3
Breakfast – Greek Yogurt with Honey and Walnuts
Lunch – Lentil Carrot Tacos with Chipotle Sunflower Cream
Dinner – Hormone Balancing Meatballs with quinoa and kale chips
Snack – Crunchy Ranch Chickpeas
Celiac and Fertility - The Bottom Line
You only need to worry about celiac impacting your fertility if you are recently diagnosed, you’re not healing, or you’re inconsistent in staying gluten-free.
That means if you’ve had the proper follow-up testing and have confirmed healing with celiac (both gut and nutrient deficiency wise) then you should not have to worry about your fertility. Unless however, you have another condition that’s playing a role in your fertility health.
Worried about if your eating to support your fertility? Let’s work together to come up with a plan that will leave you feeling good.
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Sweet Potato Fry Casserole
This gluten-free and dairy-free Sweet Potato Fry Casserole adds a sweet twist to traditional potato casseroles. If your family likes sweet potatoes, then this casserole is sure to be a hit!
Why Sweet Potato Fries?
I love a good white potato based recipe, don’t get me wrong, but there is just something about sweet potatoes that makes dishes so delicious.
Perhaps it’s because they are a little sweeter or nuttier, but sweet potatoes really add a lot. Not to mention they’ve got beta carotene to boost vitamin A in your diet.
So basically, I made this casserole with sweet potato fries to add a fun twist to your stereotypical french fry or tater tot casserole.
Not to mention it’s a gluten-free recipe. Making this delicious casserole to pack a serving of in order to enjoy at holiday dinners (especially if you’re not comfortable or your family isn’t able to accommodate a gluten-free Thanksgiving).
Sweet Potato Fry Casserole Ingredients
When I think of sweet potatoes, I think of the holidays from November through December. Warm cozy meals that leave you full through the evening. Which is why I used a lot of ingredients from the holiday season in this Sweet Potato Fry Casserole.
To keep this dish a gluten-free Thanksgiving or Christmas dinner treasure for my celiac friends I was sure to include the American holiday favorites: turkey, green beans, sweet potato fries, and cranberry sauce.
If you’re trying to keep this dairy-free Sweet Potato Casserole gluten-free, be sure to use gluten-free sweet potato fries. Sometimes frozen french fries can be coated in wheat or come into cross-contact with wheat. I personally used gluten-free crinkle cut sweet potato fries by Ore Ida.
If you’re unsure of how to check for food labels for gluten, remember the “CANS” and “BROWS” acronyms.
Ways to Enjoy Sweet Potato Fry Casserole
If you like sweet potatoes, then this gluten-free and dairy-free Sweet Potato Casserole is easily one of the most delicious casseroles you will eat. It’s also an easily modifiable recipes. Below are a few creative ways to enjoy this gluten-free casserole recipe:
- Swap out the green beans for frozen broccoli if you’re note a green bean fan.
- Swap the ground turkey for ground beef to make this a gluten-free iron-rich recipe.
- Use shredded chicken or leftover turkey instead of ground turkey. (Just skip the turkey browning step)
- Make this recipe with a Scandinavian twist by using lingonberry sauce instead of cranberry sauce.
- Not a fan of bitter berries? Swap the cranberry sauce for gluten-free cream of chicken soup. (Be aware this recipe will no longer be dairy-free if you do)
- Make an extra batch to keep in your freezer for a rainy day.
- Bring a serving to holiday dinners as your safe gluten-free meal.
Sweet Potato Fry Casserole
- 1 tbsp oil
- 2 stalks celery, fresh and chopped
- 1 onion, chopped
- 1 apple, chopped
- 1 lb ground turkey
- 14 oz can of cranberry sauce
- 32 oz bag of sweet potato fries, frozen
- 16 oz can of green beans, drained or 16 oz frozen bag of green beans
- Pre-heat the oven to 350F
- Add oil to a saute pan and begin cooking onions, apple, and celery until starting to become translucent.
- Add the ground turkey to the pan and brown it (or skip this step if using leftover turkey or shredded chicken)
- Add the cranberry sauce to the pan of
- In a large casserole dish combine half of the bag of sweet potato fries, all of the cranberry sauce, green beans, and browned turkey with celery and onions.
- Then layer the rest of the sweet potato fries on top of the casserole dish
- Bake for 40-50 minutes until bubbly and thickened