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.