Can Gluten Impact Fertility?
You probably have a friend who stopped eating gluten, and they experienced a big change in their overall health. I see it all the time in the clinic as well – everything from digestive disorders, fatigue, skin complaints, brain fog, and more have been dramatically improved with these dietary changes. So, what about fertility then? Would avoiding these foods make a difference?
WHAT IS GLUTEN?
Gluten is a protein found in some grains – wheat, rye, barley and spelt. Commercial breads, pastas and pastries all have gluten. Gluten is also found in a lot of sauces and dressing, most commonly soy sauce.
Celiac disease is an autoimmune reaction to gluten that causes damage to the small intestine, and subsequent nutrient malabsorption. In Canada, celiac disease affects about 1% of the population, but almost 90% of people remain undiagnosed[1]. This is critical information for fertility because eating gluten will contribute to infertility and miscarriage in people with celiac disease. There is also an increased prevalence of celiac disease in women with “unexplained infertility” and all-cause infertility[2]. It is important to note that about half of patients with celiac disease will not have any digestive complaints, which can be why diagnosis takes so long. In any woman who has been diagnosed with infertility, I think it is very worthwhile to do a screening blood test for celiac disease (you do have to be consuming gluten before the test for the results to be accurate). Women who are at increased risk include those who have a family member with celiac disease or another diagnosed autoimmune condition.
What if you don’t have celiac disease?
If you have ruled out celiac disease, then the decision of whether or not to avoid gluten becomes less clear. However, gluten has been shown to aggravate other autoimmune conditions.
For example, in women with autoimmune thyroiditis (the most common cause of hypothyroidism), avoidance of gluten helps to lower thyroid antibodies[3]. This is important because the presence of thyroid antibodies has been implicated as a risk factor for infertility and miscarriage and is also associated with a lower AMH value.[4]
Endometriosis is not classified as an autoimmune condition but is associated with immune dysregulation. In one study 75% of women with endometriosis who followed a gluten-free diet had a reduction in pain scores[5].
Anti-phospholipid syndrome (APLS) is an autoimmune clotting disorder that has been linked to repeated pregnancy losses. Studies have shown a higher incidence of celiac disease in women with APLS[6].
WHAT ABOUT SOURDOUGH?
Sourdough is a healthier alternative. It has less of an impact on your blood sugar levels, and does contain less gluten than traditional breads and pastas due to the natural fermentation process. This fermentation is what also helps make sourdough more easily digestible. That being said - if gluten is something that causes a reaction for you even the smaller amounts found in sourdough can still be problematic. People with celiac disease should avoid sourdough breads made from gluten-containing flours.
GLUTEN – THE TAKE-HOME:
If you are just starting to try to get pregnant, I don’t see any reason to avoid gluten. If you have been trying for a while, it is very prudent to get screened for celiac disease part of your advanced fertility work-up. In the absence of celiac disease, women with auto-immune disorders will most likely benefit from avoiding gluten in their diet. If you don’t have any known autoimmune conditions, you can do a trial gluten avoidance for 4 weeks to help you understand if gluten may be contributing to any symptoms for you. If you don’t notice a difference, then gluten is fine to include in some amount in your diet, and choose sourdough if possible :)
[1] Jamnik et al., “Prevalence of Positive Coeliac Disease Serology and HLA Risk Genotypes in a Multiethnic Population of Adults in Canada.”
[2] Singh et al., “Celiac Disease in Women With Infertility.”
[3] Krysiak, Szkróbka, and Okopień, “The Effect of Gluten-Free Diet on Thyroid Autoimmunity in Drug-Naïve Women with Hashimoto’s Thyroiditis.”
[4] Marziali et al., “Gluten-Free Diet.”
[5] Marziali et al., “Gluten-Free Diet.”
[6] Jorge, Jorge, and Camus, “[Celiac disease associated with antiphospholipid syndrome].”