Monday, June 21, 2010

Gluten Sensitivity & Infertility

A reader who is a clinician himself writes: “I believe that gluten sensitivity may be a risk factor in pregnancy contributing to complications such as miscarriage, preterm labor and even stillbirth. Have you seen anything to support this concept?”

I have seen a great deal of information supporting this. Studies going as far back as 1996 speak of the association between gluten and fertility. While most of the studies were done with celiac patients we have seen clinically that this association appears to be true for gluten sensitive patients as well.

In 2001, Gynecologic & Obstetric Investigation presented an article entitled: “Celiac disease: fertility and pregnancy”. The authors noted that celiac disease may manifest clinically with an array of non-digestive symptoms such as dermatitis herpetiformis; dementia; depression; various neurological symptoms, osteoporosis; dental enamel defects, and anemia of various types. They also stated that important data have accumulated regarding the association between celiac disease, fertility and pregnancy.

The critical observation was made that: Many primary care obstetricians, gynecologists and perinatologists are not aware of these important relationships.

The authors made a review of the scientific literature and what was revealed was that patients with untreated celiac disease sustain significant delayed menarche (age when a women begins menstruating), earlier menopause, and increased prevalence of secondary amenorrhea (absence of menstrual bleeding).

They continued to state that patients with untreated celiac disease incur higher miscarriage rates, increased fetal growth restriction and lower birth weights.

Their conclusion was that improvement of celiac, with implementation of a gluten-free diet, may decrease miscarriage rates, improve fetal nutritional support and overall prenatal (period from 20 weeks of pregnancy to 1 month old) outcome.

In the Italian medical journal, Minerva Ginecologica, an article entitled: “Celiac disease and spontaneous abortion” was published in 2002.

The authors very correctly pointed out that celiac disease is only diagnosed in a small percentage of adult cases compared to the real situation because it is manifested with few symptoms, is in an atypical form, or occurrence is completely silent.

The aim of their study was to investigate the association between celiac disease and abortion, and evaluate whether patients suffering from recurrent spontaneous abortion might present an atypical or subclinical form of the disease.

Five women were positive for celiac disease. Four of these women formed part of a group of patients with a positive history of spontaneous abortion and one was from the control group.

Analysis of the cases from this study and those reported in the literature shows that tests to identify celiac should be extended to the population with a risk of developing spontaneous abortion.
These subjects should include those with a family history or clinical symptoms, in particular women with a history of multiple abortions.

In 1996 the European Journal of Gastroenterology & Hepatology published an article entitled: “Gynaecological and obstetric disorders in celiac disease: frequent clinical onset during pregnancy or puerperium” (period after birth continuing for 6 weeks).

The author’s aims were to determine:
1. The prevalence of gynaecological and obstetric problems in patients with celiac disease and the influence of strict gluten restriction on their occurrence,
2. The effect of pregnancy on the clinical course of celiac disease, and
3. The clinical features of those patients with onset of celiac during pregnancy and puerperium.

As mentioned in earlier research findings, this study also found that untreated celiac patients exhibited significantly later menarche, earlier menopause, increased prevalence of secondary amenorrhea and increased incidence of spontaneous abortions.

Patients who had adhered, in the long term, to a gluten-free diet had gynecological and obstetric history indistinguishable from controls.

They summarized by stating that the early diagnosis and treatment of celiac disease may avoid significant gynecological and obstetric complications.

And finally, an article just released a couple of weeks ago, May 25, 2010 in Fertility & Sterility, “Primary infertility as a rare presentation of celiac disease.”
The authors reported a case of a 30-year-old woman presenting with primary infertility who on investigation was found to have celiac disease. After being on a gluten-free diet for 8 months she had a successful conception.
Their conclusions, much along the lines of the previous studies were as follows: We suggest that celiac disease should be checked in infertile patients of unexplainable etiology with anemia, as just changing their diet can solve their fertility problem.
Well that last sentence does sum it up very nicely. Let’s reiterate: Just changing the diet can solve the ______ problem.
Yes in this case we’re speaking of infertility, hormonal imbalance, spontaneous abortion, etc. But as you well know if you read this blog, there are very many symptoms/diseases we could insert into that sentence.
Infertility is a growing problem. It affects as many as 1 in 6 couples. Imagine if we could decrease those numbers by increasing the awareness of gluten intolerance. Now add delayed menarche, earlier menopause, and increased prevalence of secondary amenorrhea and spontaneous abortion to that list. How many women might that affect?

It’s exciting to think of the good effects that could be created by making the women who suffer as well as the doctors who treat them aware of this association.
It’s frustrating that we haven’t arrived at that awareness level yet…
Not meaning to be redundant as I say this at the end of most posts, but we have to continue our grass roots movement. Awareness IS increasing, we just have to continue to work hard.
Speaking of increasing awareness, check out the July issue of “Better Homes & Gardens”, page 202. The article is called “Gluten’s Laws” and yours truly is featured. “Better Homes & Gardens” has the third largest distribution of all magazines in this country. See, we ARE making headway!
Please let me know if I can be of any further assistance.
To your good health,
Dr Vikki Petersen
Founder of HealthNOW Medical Center
Co-author of “The Gluten Effect”



References:

Gynecol Obstet Invest. 2001;51(1):3-7. “Celiac disease: fertility and pregnancy”
Minerva Ginecologica, 2002 Apr;54(2):151-9. “Celiac disease and spontaneous abortion”
Eur J Gastroenterol Hepatol. 1996 Jan;8(1):63-89. “Gynaecological & obstetric disorders in CD: frequent clinical onset during pregnancy or puerperium”
Fertil Steril. 2010 May 25. [Epub ahead of print] “Primary infertility as a rare presentation of celiac disease.”

Thursday, June 17, 2010

Is Gluten in Sprouted Grains? Truth Revealed

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A reader asks: “Do sprouted or germinated grains contain gluten? I am gluten sensitive and want to know if they can affect my health.”

I’m very glad this question was asked.  I address it one on one with patients frequently and there definitely seems to be some false information out on the internet that is likely propagating the confusion.

So here you go; the definitive answer:
Sprouted glutinous grains (wheat, rye, barley and contaminated oats) still have the protein gluten present. I believe the confusion comes from the fact that the act of sprouting begins some enzymatic breakdown of the protein and for those who are not gluten intolerant but merely have difficulty digesting certain grains, sprouting can make that process of digestion easier.  These people notice that they don’t have the same symptoms from eating sprouted bread as they do from eating non-sprouted regular bread.

But in NO WAY does sprouting eliminate gluten from the grain and these sprouted grains are NOT SAFE for anyone with gluten intolerance – celiac nor gluten sensitivity.

Do realize that one of the major problems associated with gluten intolerance is the “silent”, insidious nature of it.  While many people notice immediate symptoms when eating gluten, about 75%  notice no digestive symptoms, and some notice very little symptoms at all.  Unfortunately that doesn’t lessen your chances of developing autoimmune diseases, nervous system damage and intestinal cancer, to name a few.  Some of these serious conditions do develop silently and your first knowledge of the damage comes with the diagnosis of a disease. 

I’m not trying to scare you but the theme of early diagnosis rings out in much of the scientific research being performed during the last decade.  We know the association with gluten and autoimmune disease.  What’s the recommendation?  Diagnose the problem with gluten early in life so as to prevent its development. 

We know the association between gluten and depression in children and adults.  What’s the recommendation?  Diagnose the problem with gluten early in life so as to prevent the needless suffering and use of dangerous anti-depressants.

To you see the theme?  It goes on and on.  From osteoporosis to infertility, from psoriasis to obesity - the list of symptoms is very long and the recommendations are always the same. 
So please do not fall into the trap of eating gluten (even in a slightly predigested fashion) and thinking it’s okay because it doesn’t initiate certain symptoms.  If you’ve already determined that you are gluten intolerant then don’t play Russian roulette with your health.

And lastly, not to confuse the matter, but the grass of the grain is gluten-free for approximately the first 10-14 days of growth.  Beyond that point “jointing” occurs which is the development process whereby the grain forms and gluten becomes present. This means that if you drank wheat juice made from the grass only (and it was less than 10 days old – pre-jointing phase) it would be a gluten-free product.  But I must emphasize that would be consuming the grass only, NOT the grass PLUS the rest of the grain such as what is used in sprouted breads.

I would recommend that if you do choose to ingest a greens drink that you ensure that the company tests their products thoroughly to ensure that they are gluten-free. 

I hope that helps. I am bound and determined to clear up this misinformation!

Please let me know if I can be of any further assistance.

Yours in health,

Dr Vikki Petersen