by Beth Heller M.S.
You may be surprised to think of your digestive system as part of your immune system, but our gut actually functions as our body's first line of defense - eliminating bacteria and other bugs before they can infect our internal environment. When the digestive system is challenged, by such conditions as stress, illness or food sensitivity, inflammation can result. Frequent bouts of diarrhea, constipation, intestinal bloating/cramping and heartburn can all be symptoms of an inflamed digestive tract. Chronic inflammation of the digestive tract can impair our body's ability to break down and absorb the nutrients in the food we eat. In addition, gut inflammation may affect other organ systems, including the reproductive organs, which are in close proximity. These factors, taken together, are why we take a very close look at digestion, and symptoms of food sensitivity, as they relate to fertility.
Celiac disease, a condition in which an individual cannot tolerate gluten (a protein found naturally in wheat and used as an additive in many foods), is the classic example of a food sensitivity that is associated with infertility. Population studies suggest that about 1 person in 100 has celiac disease, but studies also suggest that celiac is also under-diagnosed and may be 2.5-3.5% more prevalent in women with unexplained infertility (http://www.ncbi.nlm.nih.gov/pubmed/17592443?log$=activity)
In people with celiac disease, dietary intake of gluten (a protein found in many grains) causes a two-fold attack in the small intestine. Antibodies first attack the gluten protein and this attack triggers an autoimmune response in which antibodies attack the endomysium, a smooth muscle component in the small intestine, and damage the tiny, fingerlike protrusions on the wall of the small intestine that serve to absorb nutrients from food called villi. This leads to the most likely link between celiac disease and infertility - the malabsorption of nutrients.
New research is emerging that suggests that there is a spectrum of gluten sensitivity and that celiac disease gluten sensitivity can cause symptoms similar to Inflammatory Bowel Disease which may negatively impact nutrition status and quality of life in ways similar to Celiac Disease. (http://www.ncbi.nlm.nih.gov/pubmed/19455131?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=21 ) Other common food sensitivities besides gluten sensitivity include eggs, soy, peanuts and dairy. Symptoms of food sensitivity are diverse: diarrhea, constipation, rashes, gas and bloating and headaches - just to name a few. At the Moon, in cases of repeated miscarriage, multiple failed ART cycles, unexplained infertility and/or Irritable Bowel Syndrome our nutritionists will often recommend our ART Recovery/Preparation Program, an ultra-healing diet that eliminates common allergens from the diet and track any change in digestive function and other symptoms.
Remember, though, that we do not want to throw the baby out with the bath water. Potentially allergenic foods, like dairy and soy, are also important sources of vitamins, minerals and dietary protein. They should never be removed from the diet without a solid nutrition plan. Studies have also shown that one side-effect of a gluten free diet can be a reduction of healthy gut flora (http://www.ncbi.nlm.nih.gov/pubmed/19445821?log$=activity) . As we've written before, healthy gut bacteria is critical for optimal digestive function and hormonal regulation, so any plan to eliminate gluten must support the gut. Don't forget that any elimination diet should also include a strategy for reintroduction and symptom assessment as the goal of any elimination diet is to determine which foods are causing problems.
If you suspect food sensitivity may be part of your fertility issues, we highly suggest you seek out treatment with a trained fertility nutritionist. Eliminating foods from the diet can be hard work, and is not necessary for everyone. However, at the Moon, we've seen that for some patients the potential benefits may indeed be worth the inconvenience.
To learn more about our nutrition programming, call 312-321-0004 (Chicago-Area) or 301-610-7755 (DC Metro).
Evans KE et al. Be vigilant for patients with coeliac disease. Practitioner. 2009 Oct;253(1722):19-22, 2.
Pellicano R et al. Women and celiac disease: association with unexplained infertility. Minerva Med 2007 Jun; 98 (3):217-9.
Verdu et al. Between celiac disease and irritable bowel syndrome: the “no man’s land” of gluten sensitivity. Am J Gastroenterol. 2009 Jun;104 (6):1587-94.