Can Coeliac Disease affect fertility? | Nourish with Melanie #30

Can Coeliac Disease affect fertility? | Nourish with Melanie #30


Research tells us that women with undiagnosed
Coeliac Disease have an 8.9 fold increased risk of multiple spontaneous abortions, compared
with either those women who don’t have Coeliac Disease, or those women who have got well
treated Coeliac Disease. If you’ve got C.D., or if you’re someone who’s
struggling to conceive and don’t know why, stay tuned to meet expert Coeliac dietitian
Sally Marchini. Well today on Nourish, I’m so honoured to
have my friend and colleague Sally Marchini, who is a guru in Coeliac Disease and type
1 diabetes, join us on Nourish. So, welcome Sally! Thanks Mel. So, today we’re going to be talking about
Coeliac Disease and fertility. So can you tell me how did you come to become
such an expert when it comes to Coeliac Disease. Well, I have Coeliac disease. Ah, well that makes you an expert! It obviously gives me a special interest in
the area. So it was my diagnosis of Coeliac Disease
that inspired me to become a dietitian. Oh, that’s fantastic. And have you actually learnt a lot about diet
and Coeliac Disease since becoming a dietitian. Indeed I have. And it was interesting as a newly diagnosed
person with Coeliac Disease, seeing a dietitian who didn’t really understand Coeliac Disease,
and knowing what I know now, it really does make a lot of difference if dietitians study
it carefully, not just based on what they’re taught at uni. So, how common is it for women who are struggling
to conceive, to have undiagnosed Coeliac Disease. Well, undiagnosed Coeliac Disease presents
all kinds of problems. Coeliac Disease is an inflammatory condition,
and what it does, is that it causes inflammation in the small bowel area, which means there’s
less surface area for nutrients to be absorbed. So, it’s a condition of malnutrition. And if we’re malnourished, then we don’t have
the nutrients we need to feed a new baby. So I find that I see a lot of women, both
in my clinics, and also just online and so forth, who are now following a gluten-free
diet for fertility. Why do you think that might be? And do you think that it’s important for everyone
to follow a gluten-free diet, or just women with Coeliac Disease? That’s a really good point Mel, because if
someone does feel better on a gluten-free diet but they haven’t been checked for Coeliac
Disease, how do they know? I mean, Coeliac Disease can be asymptomatic,
you don’t need to have symptoms to have Coeliac Disease. And I think that’s a really important point
to get out. Yes, and also the fact that the gluten-free
diet is not healthier, as such. Mmm, right. It’s interesting to hear from somebody who
has Coeliac Disease. Yes, you can have a healthy gluten-free diet,
but there are lots of elements to consider in doing that. And so people who need to be strictly gluten-free,
because that’s the other point of course, if people just happen to have Coeliac Disease
and they don’t understand the strict gluten-free diet, they may be allowing cross-contamination. And even just one crumb of gluten-containing
grains a day, on an ongoing basis, is enough to cause damage, which can cause the malabsorption
of the nutrients. So it’s important that people are diagnosed,
or at least checked for Coeliac Disease while undergoing a gluten challenge, of 6 weeks,
the equivalent of 4 slices of bread a day, before embarking on a gluten-free diet for
any other reason. Right. So what about clients who actually have Coeliac
Disease. What do they need to do to optimise their
fertility? Well firstly, they need to really know that
they are following a strict gluten-free diet, and that’s where an accredited practising
dietitian who understands this can help. For example, I see people in my practice who
come in and they still have reactions in their bloods showing for Coeliac Disease, even though
they say they’re following a gluten-free diet. And maybe they’re missing those possible contamination
points from not understanding, or not having been perhaps taught it properly in the first
place. And the other thing that I find is that, women
who have got Coeliac Disease sometimes if they haven’t been following it strictly enough,
don’t meet their micronutrient requirements. So is there some particular micronutrient
requirements that you look out for, for women with Coeliac Disease? Well, the most common one if people aren’t
following a strict gluten-free diet, is iron. Because it’s easily measured by blood tests. But, really it’s all nutrients. Right, all micronutrients. Yep, okay. And just taking a pill, doesn’t help. Because the point is, the body’s not absorbing,
so you need to be following that very strict gluten-free diet. Yep. And so, if you’ve got a client who has had
Coeliac Disease for many, many years. So knows how to follow a gluten-free diet,
they were taught when they were in their late teens, early twenties, and now are in their
thirties, wanting to try and conceive. Why do you think it’s important for them to
go back and see a dietitian now? Well, for them, actually I would say if they
really are following a strict gluten-free diet, it’s the same reason as any person who’s
trying to conceive. It’s preparation so that your body is in the
right state to bring another human being into the world, and we’re thinking about the mother’s
generation as well as the child’s generation. And also, I find, I mean I see a lot of people
with Coeliac Disease, who’ve had it for a long time, who don’t necessarily understand
the healthy gluten-free diet, and that can impact cardiovascular risk in both the mother
and child. As well as you know, many other health conditions,
just because of some of the poorer quality carbohydrates and fats that are found in some
of the gluten-free processed foods. So do you have any idea, or maybe just a gut
feel about the percentage of people with Coeliac Disease who don’t follow a strict gluten-free
diet. Not really. I don’t know of any statistics, and the people
who I see in practice, they wouldn’t know. How would you measure it? But you know, I do see a lot of things like
for example, people might not recognise that cold and flu tablets contain gluten. Many of them, not all of them. You know, pharmaceuticals that say no gluten
added, really means may contain gluten. So you see points of contamination that people
just aren’t aware of. Just coming back to women who don’t yet have
Coeliac Disease. Do you have any idea of the rates of undiagnosed
Coeliac Disease? Well, in Australia it’s thought to be 80%
people with Coeliac Disease go undiagnosed. Wow, that’s huge! So really, then what you’re saying is that
if you’re planning to conceive in the next few years, then it might be worth having a
test for Coeliac Disease? Certainly, if there’s any in your family,
you have an increased rate of about 10%. Okay. So, if there’s any Coeliac Disease anywhere
in your family, it’s worth getting checked. Right. Okay, fantastic. And if you have any of the recognized symptoms,
I mean the range of symptoms for Coeliac Disease is enormous, it’s not just gastrointestinal
symptoms. There’s headaches, neurological conditions,
skin-related conditions, anything that could be related to Coeliac Disease, it”s worth
doing a gluten challenge and at least having the blood tests. Right, fantastic. And I would also add that if a woman had been
trying to conceive and was struggling to conceive, that would also be another time to consider. It wouldn’t hurt to have it done. Yep, exactly. It’s a pretty simple test. Yeah, well that’s a great question actually. How does somebody go about finding out if
they’ve actually got Coeliac Disease or not. So you need to first make sure that you have
enough gluten in your diet for the body to be reacting to it. Because we can’t test the reaction if there’s
nothing to react to. So how much do you have because I know that’s
often a problem for my clients who have irritable bowl syndrome. It’s the equivalent of 4 slices of wheat bread
a day. But, for example with irritable bowel syndrome,
if you’re working with a dietitian who understands both. The dietitian, for example, I do help people
with that, can help you work out a diet that will have enough gluten in it, that I still
low-FODMAP. So, it’s definitely possible. You need to be having that gluten in your
diet for 6 weeks before a blood test can check to see if you have antibodies and the raised
IgA numbers. And how reliable is the blood test as a diagnoses
tool? It’s not used as a diagnoses tool, it’s used
as a guide to see whether the gold standard diagnosis of an endoscopic biopsy is required. And that is the gold standard, because that
shows, with the villi, where the inflammation is and how much surface area and you know
the lymphocytes, and everything that’s going on in that area. Fantastic. Well thank you so much for sharing all of
your knowledge with us today. It’s my pleasure Melanie. Absolutly fantastic. And as always, if you have any personal experience
that you’d like to share, if you’ve got any comments or questions, please just type them
in the chat box below. And I look forward to seeing you again next
week on Nourish.

1 thought on “Can Coeliac Disease affect fertility? | Nourish with Melanie #30”

  1. A huge thanks to Sally Marchini for sharing her expertise. If you have friends who are struggling to conceive, I'd highly recommend that you share this session with them. Sharing is caring!! 😉

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