Going “gluten-free” has become a somewhat of a trend in the last decade, where adopting a gluten free-way can be used to indicate efforts made toward eating more healthily. But is going gluten free actually healthier? Today we’ll compare medical conditions requiring a strict lifelong gluten free diet, like Coeliac Disease, the growing focus on non-coeliac gluten sensitivity, and how these may impact fertility, pregnancy and beyond.
COELIAC DISEASE VS NON-COELIAC GLUTEN SENSITIVITY
Coeliac disease is an autoimmune condition where the immune system reacts abnormally to gluten. Gluten is the name for a group of proteins which provide the airy and fluffy characteristic to products like bread. Gluten is also found in other common products made from wheat, rye, barley and oats. Oats remains a controversial due to the lack of testing capabilities to detect the type of prolamin (sub-type of gluten proteins) which are contained in oats – but let’s not get too sciencey.
In Coeliac Disease, eating a gluten containing product leads to an attack on the villi of the small intestine, which are finger-like projections where many micronutrients are absorbed. This attack causes a flattening of the surface, causing malabsorption, and can be accompanied by various symptoms or be completely asymptomatic. Following a strict gluten free diet takes more than just cutting out commonly talked about sources of gluten as it is in many other hidden products like some stock powders, thickeners, ice-creams and sweeteners – just to name a few. Once gluten is properly eliminated for an appropriate amount of time, the villi can re-generate and go back to what they do best – absorb the good stuff!
How is it diagnosed?
Confirming coeliac disease can occur by either:
1) A biopsy positive for villous atrophy in the small intestine
2) Genetic testing of Human Leukocyte Antigen (HLA) genes AND a positive coeliac blood test
Something to note is that following a gluten free or diet with a low gluten load at the time of testing may present a false negative result, and may extend the time to diagnosis – a process which can really take a toll on physical and emotional health. So a higher load of gluten in the weeks prior to testing can ensure that you get the right result, as painful as that thought may be.
So how does this differ from non-coeliac gluten sensitivity (NCGS)?
Many patients who test out a gluten-free diet often report improvements in gastrointestinal symptoms, which can lead to a belief that gluten is the cause of the problem. However, for those who are not medically required to follow a gluten-free diet (i.e those with Coeliac Disease), there may be more to the story.
Given that a gluten-free diet, which is not well planned, can be low in fibre and other nutrients, it can cause a reduction in the variety and balance of the gut flora, and risk nutrient deficiencies. Therefore, going gluten-free for may not be the to long-term answer you are looking for. The research is still to find exact answers, as only a few well-designed studies have been conducted so far with mixed results in symptom improvement. What we don’t know is whether the gastrointestinal symptoms are a reaction to gluten, or to other proteins, or even specific carbohydrates (like the common FODMAP called Fructans) contained within the food product. Enter – the world of Irritable Bowel Syndrome (IBS).
Since NCGS falls into the category of IBS, it does not have a clear cut diagnosis like Coeliac Disease as it relies on self-reported symptoms like abdominal discomfort, bloating, nausea, and fatigue. Therefore, this makes it challenging to prove that it is gluten itself causing the problems, since there is more to bread and other such products than just gluten. Managing IBS needs investigation of various dietary and lifestyle components, and not just eliminating things here and there. But that is a topic for another future blog post!
FERTILITY, AND HOW AN ACCREDITED PRACTICING DIETITIAN CAN HELP
Research is now pointing out that women with undiagnosed or poorly managed coeliac disease can experience fertility issues. The inflammatory nature of Coeliac Disease, which reduces the surface area of the small intestine, leads to a state of malabsorption of key nutrients for mum and future baby.
Ensuring the body is in its optimal state to support a healthy pregnancy takes preparation. For those who have been on a gluten-free diet for a while, an experienced dietitian can help you to ensure that it is a healthy well-balanced gluten-free diet. For those with Coeliac Disease who ‘know they should be more strict’, and especially who are planning a pregnancy, it is important to allow enough time reverse any malabsorption issues. Taking a pre-natal supplement or boosting key pregnancy nutrients is great, but not if your body isn't going to absorb them!
Since pregnancy, even in those weeks prior to taking a pregnancy test, is a time of increased needs in nutrient and energy, an individualised diet and supplemental intake plan is essential. A key point to note is that unlike commercial bread which have mandatory fortification requirement of key pregnancy nutrients like folate and iodine, many gluten free breads are not required to be fortified with nutrients. Both pregnancy and breastfeeding are also a time of increased energy needs, and a focus on good quality grains is essential. Getting the support you need to can take the guess work and stress out of this equation and help make this journey a little easier.