May is Celiac Awareness Month!

Going gluten free appears to be the latest fad for many people and celebrities alike however there is a lot of misinformation surrounding gluten free and the reasons to give it a try.  As May is Celiac Awareness Month, this article serves to answer the most common questions about celiac and gluten issues in regards to health and disease.  Not all people who have a problem with gluten containing foods have celiac’s disease so keep reading to learn more.

1.       Celiac is the inherited autoimmune disease that causes damage and destruction to the small intestines when gluten containing foods are eaten.  This damage causes a lot of malabsorption of vitamins and minerals leading to symptoms and long term health issues.  Currently, being 100% gluten free is the treatment to eliminate the symptoms and heal the intestines.

2.       It is estimated that 1 in 100 (give or take) people have celiac disease.  It is strongly associated with other endocrine conditions such as thyroid disease, type 1 diabetes, bone problems, skin problems, iron deficient anemia, growth problems, delayed-puberty, neurological complaints, infertility and miscarriage, and more.  Celiac is not just a disease of the intestines therefore some people do not have intestinal complaints.

3.     Testing for celiac is controversial and confusing – there are blood tests such as the tissue transglutaminase(tTG) or anti-endomysial antibody test (EMA) however false negatives are common.  Many doctors want an intestinal biopsy to determine if the intestinal cells are inflamed and damaged however those who are already gluten free will have to eat gluten again daily for several weeks to months in order for the damage to return on the biopsy results.  As celiac is genetic, the HLA-DQ2 and DQ8 gene tests can be ordered to see IF someone has the risk.  Having the gene does not mean celiac is positive (just like having the breast cancer gene does not mean someone develops breast cancer).  Talk with your health care provider about this.

4.        Diagnosis at a young age is critical.  The University of Chicago, Celiac Disease Center reports, “children who are diagnosed between the ages of 4 and 12 have a 17% risk; from 12-20 years of age the risk goes up to 27% and an individual diagnosed above the age of 20 has a 34% chance of developing another autoimmune disorder.”  It is estimated that some 3 million Americans have celiac disease but 97% are undiagnosed.

5.       A new category, commonly called ‘non-celiac gluten sensitivity’ or gluten intolerance is not an autoimmune disease causing intestinal damage however these people still have an unfavorable response when they eat gluten containing foods.  Therefore their celiac testing may be negative however a gluten free diet eliminates many of their symptoms.

If you suspect that gluten containing foods are causing your symptoms, or if you look back at your family history and several of the conditions overlap with the ones listed above, talk with your doctor about getting tested for celiac disease.  Do this first before considering a gluten free diet as you may feel better but will have to eat gluten foods again for the celiac testing.  If you are considering a gluten free diet, please consult an expert such as a dietician, nutritionist, or Naturopathic Physician and take advantage of the incredible online celiac/gluten-free websites and books to increase your awareness and education about making the switch while continuing to maintain a healthy, balanced diet.  Gluten free donuts or cookies do not make them any healthier!  It just makes them gluten-free.

 

Read more at the women's health website, Empowher!

References:

1.       Philip, R., Patidar, P, Saran, S., Agarwal, P., Arya, T., and Gupta, K.  (2012).  Endocrine manifestations of celiac disease.  Indian J Endocrinol Metab. 16(Suppl 2): S506–S508.

2.       University of Chicago, Celiac Disease Center.  (2013).  Fact sheets.  Retrieved from http://www.cureceliacdisease.org/living-with-celiac/guide/fact-sheets

Anti-Mullerian Hormone and Fertility

    There are several markers of a women’s reproductive health when it comes to making a baby.   Many are familiar with common hormone tests such as estrogen, progesterone and the follicle stimulating hormone (FSH).  New research is showing that the anti-mullerian hormone (AMH) might be a better predictor for those looking to undergo invitro fertilization (IVF) however it may also be advantageous to check this marker when looking to become pregnant in general.

    To compare, the FSH test is essentially a marker of communication between the anterior pituitary in the brain down to the ovaries.  When the FSH begins to rise on day 2 or 3 of the cycle, it stimulates the growth and development of the follicles such that a dominant follicle is formed  and with the trigger of luteinizing hormone  an egg can be released for pregnancy.  As a woman becomes older, her FSH levels rise as there are fewer and fewer follicles left in the ovary yet the pituitary continues to produce the hormone .  The higher the FSH levels (typically above 10), the less fertile a woman has become.

    Working with FSH is the anti-mullerian hormone that is produced directly by the ovaries in order to help with follicular development as well by controlling excessive follicle stimulation by FSH.  Those with lower AMH are thought to have lower levels of follicles therefore the potential for egg development is a lot less.  Unlike the FSH marker which should be drawn on day 2 or 3 of the menstrual cycle, the AMH can be checked any day as it does not typically vary throughout the month. 

    Research in the February 2013 Journal of Clinical Endocrinology and Metabolism suggests that AMH is a good predictive marker for those women looking to undergo IVF as it can predict the oocyte yield and oocyte quality which is important for a successful transfer.  The higher the AMH level (typically between 3-7 ng/mL depending on the lab and fertility center), translates to a better outcome for IVF which means a successful pregnancy.  Levels above 7ng/mL are indicative of polycystic ovarian syndrome.  Levels less than 2 ng/mL are indicative of lower fertility chances. 

    If you are currently trying to become pregnant, are having difficulty becoming pregnant or are thinking about it in the future, remember that you are more than a number.  There are several factors that contribute to the health of your body, ovaries and eggs however these tests may be powerful indicators of what’s to come.  Talk with your health care provider about getting a work-up and remember to be as healthy as you can be when it comes to making a baby.

References:

1)      Hand, L.  Antimullerian Hormone Levels Predict IVF Success.  Web.  20 February, 2013.

http://www.medscape.com/viewarticle/779410

2)      Jabbour, S., and Griffing, G.  Follicle Stimulating Hormone Abnormalities Workup.  Web.  20 February, 2013.

http://emedicine.medscape.com/article/118810-workup