PCOS, Gluten & Fertility

by Amy Medling, founder of PCOS Diva

I am going to lay it unequivocally on the line here –   If you have PCOS and are struggling to get pregnant, then I believe you need to avoid gluten.

Many doctors don’t recognize that gluten might play a factor in infertility for reasons including improper nutrient absorption, negative immune system response, related inflammation and hormone imbalance.  It seems to me that before you take a woman down the road of expensive and invasive fertility treatments (IVF conservatively costs between $12,000 – $15,000 a cycle), it is worthwhile for her and her partner to give the gluten-free lifestyle a try.  Its holistic benefits may be just what the doctor ordered!

The Research:

There have been several studies done on males and females with celiac disease (a widespread autoimmune disorder tied to gluten).  However, there is not yet evidence that avoiding gluten would help people with non-celiac gluten sensitivity.  That is because, “The research on non-celiac gluten sensitivity is 10-20 years behind research on celiac disease,” says Alice Bast, founder of the National Foundation for Celiac Awareness.  “When we better understand why women with celiac disease suffer from infertility and pregnancy-related problems, it may shed light on non-celiac gluten sensitivity.”

A research team led by Stephanie M. Moleski, MD, of Thomas Jefferson University Hospitals in Philadelphia, presented an abstract of study data at the American College of Gastroenterology Annual Meeting 2012. In the abstract, Moleski pointed out that women with biopsy-proven celiac disease had significantly high rates of infertility and pregnancy complications, and gave birth to less children that those without this disease. The data showed that 41.2 percent of women with celiac disease had increased infertility, compared with 36.5 percent of the women without the disease. Women with celiac disease also had more consultations with fertility specialists and higher rates of miscarriages, preterm delivery, and cesarean sections, compared with the women who did not have celiac disease.

A separate study showed that gluten sensitivity can contribute to infertility and other obstetrical and gynecological problems.  Celiac patients who were not compliant with a gluten-free diet presented with “delayed menarche, secondary amenorrhea, a higher percentage of spontaneous abortions, anemia and hypoalbuminemia.”  Gluten-free diet compliance led to normal pregnancies.  The author of the study actually recommends that gluten sensitivity should be screened for women presenting with reproductive disorders. An author of a study in the Netherlands concurs, “Therefore, celiac disease must be seriously considered in the preconceptional screening and treatment of patients with reproductive disorders.” Yet another study shows a gluten-free diet that started at least 10 years before menopause prolongs the fertile life span of celiac women.

In short, studies have linked untreated celiac disease with the following:

• Absence of periods
• Early menopause
• Endometriosis
• Miscarriage
• Stillbirth
• Intrauterine growth restriction
• Low birth-weight babies
• Cesarean section

What’s Happening:

Researchers believe that in people with celiac or gluten-sensitivity, gluten’s effect may be indirect in that it damages the lining of the intestines and in turn reduces absorption of essential nutrients from food which are critical components for reproductive health. Without proper food absorption, nutrition hormones may not function as they should, which can cause irregular periods and/or ovulation. Nutrient deficiencies can impact the ability of a woman to conceive and may also impact the health of a fetus (e.g. low birth weight) due to insufficient availability of nutrients. This nutrient deficiency– whether this is due to gluten sensitivity or just plain lack or real nutrient dense food in your diet is a likely cause of infertility.   In addition, the gluten itself may trigger an undesirable immune response creating a cascade of hormonal and system wide issues further impeding fertility.

Going gluten free might be beneficial for your partner’s fertility too.

A study from 1982 showed that there may be a link between a higher rate of abnormal sperm and hormone levels in men with celiac disease.  In addition, 19 percent of men with celiac had infertile marriages. Another more recent study published in the Journal of Obstetrics and Gynecology Research, looked at the prevalence of celiac disease among couples with unexplained fertility in Iran. The researchers found signs of celiac disease twice as often in the infertile group as they did in the control group, both in men and women. They recommended that those infertile men and women with celiac disease follow the gluten-free diet in an effort to improve their fertility. Another study reported in the “World Journal of Gastroenterology” in December 2010 found that fertility improved in celiac men who adopted the gluten-free diet and followed it strictly.

Getting tested for celiac

If you are going to have yourself or your partner tested for celiac, it is strongly recommended that you get tested before going off gluten.  If you avoid gluten prior to the test, you may not have enough antibodies for the test to be accurate. Celiac disease can be tested for with a blood test which is relatively accurate as long as you have been consuming gluten regularly in the month or so before the test day. As soon as you cut gluten out of your diet, the volume of anti-gluten antibodies that your body produces may drop, which can make the test misleading. Keep in mind, many women are sensitive to gluten, but do not have an autoimmune reaction to gluten which makes testing and diagnosis even more tricky.

Where to Start:

Going gluten-free doesn’t mean you can go to the store and start eating gluten-free cookies and donuts.  It means committing to eating a plant-based, whole food diet with gluten-free grains. My Seasonal Meal Plans are a great place to start if you don’t know where to begin going gluten-free.  They are nutrient dense and delicious.  Hundreds of women have found success with my meal plans and Jumpstart program.

Amy Medling, best-selling author of Healing PCOS and certified health coach, specializes in working with women with Polycystic Ovary Syndrome (PCOS), who are frustrated and have lost all hope when the only solution their doctors offer is to lose weight, take a pill, and live with their symptoms. In response, Amy founded PCOS Diva and developed a proven protocol of supplements, diet, and lifestyle programs that offer women tools to help gain control of their PCOS and regain their fertility, femininity, health, and happiness.

 Resources:

(1) J Clin Gastroenterol. 2004 Aug;38(7):567-74. Gynecologic and obstetric findings related to nutritional status and adherence to a gluten-free diet in Brazilian patients with celiac disease. Kotze LM.

(2) Eur J Obstet Gynecol Reprod Biol. 2001 Jun;96(2):146-9. Coeliac disease and reproductive disorders: a neglected association. Rostami K, Steegers EA, Wong WY, Braat DD, Steegers-Theunissen RP.

(3) Menopause. 2011 Oct;18(10):1125-30. doi: 10.1097/gme.0b013e3182188421. From menarche to menopause: the fertile life span of celiac women. Santonicola A, Iovino P, Cappello C, Capone P, Andreozzi P, Ciacci C.

(4) Gut. 1982 Jul;23(7):608-14. Male gonadal function in coeliac disease: 1. Sexual dysfunction, infertility, and semen quality. Farthing MJ, Edwards CR, Rees LH, Dawson AM.

(5)  JObstet Gynaecol Res. 2011 Oct;37(10):1308-12. doi: 10.1111/j.1447-0756.2010.01518.x. Epub 2011 May 11 Fertility disorder associated with celiac disease in males and females: fact or fiction? Khoshbaten M, Rostami Nejad M, Farzady L, Sharifi N, Hashemi SH, Rostami K.

(6)”World Journal of Gastroenterology”; Reproductive Changes Associated with Celiac Disease; Hugh James Freeman; December 2010