Gastrointestinal (GI) function is paramount in providing optimal health and a strong immune system. Ultimately, the GI tract acts as a gateway connecting the outside environment to the delicate internal systems of the human body. Thus, aberrations in gut barrier function and permeability can and does lead to disruptions in homeostasis, including fertility (Fasano & Catassi, 2012). As a means of appreciating the connection between gut health and infertility, the following will explore how celiac disease (CD) negatively affects the female reproductive system. Nutritional interventions will also be explored to attenuate the affects of said conditions.
Once considered a disease mainly affecting white children, CD is now known to have a larger reach including individuals of different ages, races, and ethnic groups (Fasano & Catassi, 2012). CD is a systemic immune-driven disorder induced by the ingestion of dietary gluten in genetically susceptible persons (Fasano & Catassi, 2012). Gluten is a protein found in many foods including wheat, barley, and rye which stimulates an immune response that presents with many clinical presentations and damage to the small intestinal mucosa (Fasano & Catassi, 2012). Individuals that are susceptible to gluten reactivity have the HLA-DQ2 and HLA-DQ8 genes, which are expressed on the antigen-presenting cells that bind to gluten peptides. Such genetic predispositions with gluten ingestion can (not always) trigger GI inflammation and a systemic immune response including the female reproductive system (Fasano & Catassi, 2012).
Several studies have suggested that CD has associations with delayed menarche, early menopause, infertility, endometriosis, recurrent abortions, low birth rates, and vitamin/mineral deficiencies (Rajput & Chatterjee, 2010; Singh, Arora, Lal, Strand, & Makharia, 2016). It is postulated that infertility might be connected to vitamin and mineral deficiencies (zinc, folate, selenium) often associated with an inflamed small intestine (Rajput & Chatterjee, 2010). Such a hypothesis is plausible since folic acid, selenium, and zinc deficiencies are associated with maintaining pregnancy (Rajput & Chatterjee, 2010; Tersigni et al., 2014). Zinc deficiencies have been shown to impair luteinizing hormone (LH) and follicle-stimulating hormone (FSH), while selenium deficiencies negatively affects the secretion of LH and FSH (Tersigni et al., 2014). As an aggregate, said deficiencies likely hinder opportunities for conception and healthy births.
Fassano and Catassi (2012) suggested absence of gluten in the diet as a first approach due to the immunological and systemic manifestations of its presence in the genetically susceptible. Specifically, since the pathogenesis of CD involves a trigger (gluten), changes in intestinal permeability, HLA recognition, innate/adaptive immunological responses, and celiac enteropathy, cessation of gluten is likely to down regulate such a cascade (Fassano and Catassi, 2012). However, Fassano and Catassi (2012) indicated that abstinence from gluten-containing foods also tended to cause lower rates of fiber, calcium, iron, and folate ingestion. Thus, it is advisable to choose other foods/multivitamins that contain said nutrients when modifying an individual’s diet.
In conclusion, CD and infertility can share an intimate relationship conncected by the presence of gluten. However, cessation of gluten-containing foods and addressing vitamin and mineral deficiencies shows promise in attenuating CD, improving fertility, and elevating overall health and well being.
References
Fasano, A., & Catassi, C. (2012). Celiac disease. The New England Journal of Medicine. 367(25), 2419-2426.
Rajput, R., & Chatterjee, S. (2010). Primary infertility as a rare presentation of celiac disease. Fertility and Sterility, 94(7), 2771.
Singh, P., Arora, S., Lal, S., Strand, T. A., & Makharia, G. K. (2016). Celiac disease in romwn with fertility: A meta-analysis. Journal of Clinical Gastroenterology, 50(1), 33-39.
Tersigni, C., Castellani, R., De Waure, C., Fattorossi, A., De Spirito, M., Gasbarrini, A., … Di Simone, N. (2014). Celiac disease and reproductive disorders: Meta-analysis of epidemiologic associations and potential pathogenic mechanisms. Human Reproduction Update, 20(4), 582-593.
-Michael McIsaac