May 28, 2025 • 31 mins
Can celiac disease be the hidden culprit behind your health issues? Discover the profound effects of this autoimmune condition on women's health as Host Dr. Holly Thacker unpacks its impact on nutrient absorption, particularly vitamin D and iron, and its connections to osteoporosis and infertility. Explore the hereditary aspects and understand why distinguishing between celiac disease and gluten intolerance is crucial.
This episode offers a comprehensive guide to recognizing how undiagnosed celiac disease might be influencing your health, especially if you're facing unexplained infertility or persistent nutrient deficiencies.
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Episode Transcript
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Speaker 1 (00:02):
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, I am the Executive Director of
Speaking of Women's Health andI'm back in our sunflower house
for a brand new episode.
Happy May.
May Day, mother's Month, nurseAwareness Appreciation Month,
(00:27):
and osteoporosis, one of mymedical passions.
We have a lot of greatinformation about bone health
and osteoporosis and excitingosteoporosis therapies.
Just basic nutritioninformation everything you
wanted to know about calcium,vitamin D and K2.
(00:51):
So this month, in honor ofthose important topics, please,
if you've missed some of ourprior episodes in Season 1 and
Season 2, listen to those.
Our prior episodes in seasonone and season two Listen to
those.
May is also Celiac DiseaseAwareness Month and I am taking
(01:12):
some information on our website,some authored by our friends at
the Celiac Disease Foundation.
What is celiac?
Well, it's a serious autoimmunedisease that's triggered by
containing food or substancesthat contain gluten.
(01:33):
Gluten is a protein found inwheat, barley and rye and,
according to the Celiac DiseaseFoundation, celiac disease can
affect 1 in 100 people worldwide, but only 30% are properly
diagnosed.
I've diagnosed a number ofpeople in my practice with
(01:56):
celiac disease, in part becauseI'm an osteoporosis specialist
osteoporosis specialist andceliac disease can affect
absorption of nutrients andvitamin D and iron, and since I
see a lot of women low in iron,potentially from pregnancy and
breastfeeding and menstruallosses and I also practice in
(02:20):
Northeast Ohio and people overage 40 tend to be low in vitamin
D we're not close to theequator, so whenever I see
someone with thin bones, lowvitamin D and or low iron and or
GI distress and or unexplaineddermatitis or pediformis kind of
(02:41):
a Christmas tree type rashdermatitis, herpetiformis kind
of a Christmas tree type rash,those are all things that make
me think about celiac.
And I've seen people with no GIsymptoms who just have
unexplained bone loss and afterthey take out gluten from their
diet, their skeleton and bonehealth improves.
Now a lot of people do not haveceliac disease, they're just
(03:04):
gluten intolerant and I actuallythink some of that gluten
intolerance is actually becauseof the way wheat is processed
and a lot of pasta, at least inthe United States, has
substances that are banned inother countries, like
azodicarbamide.
Countries like azodicarbamideIf you didn't listen to my last
(03:29):
season in 2024, the fall of2024's podcast on food freedom
and all the different substancesthat are allowed in our United
States food supply but banned inother countries.
That's a must listen to, andsince I did the research for
that, I threw away all myAmerican pasta.
I'm just going to a place thatimports from Italy and for years
(03:53):
I always would hear friends saythat they would go to Italy and
they would eat whatever breadand pasta and drink the red wine
and enjoy themselves and notgain any weight, not have any GI
distress, sometimes even losingweight from all the walking
around.
So we're going to mainly focustoday on celiac, and one of the
(04:14):
columns that we have onspeakinginwomenshealthcom on
celiac disease was co -authoredby a guest columnist who had
suffered infertility andmultiple miscarriages, had had
many pregnancy losses and itwasn't until her celiac that was
diagnosed and treated that shewas able to conceive.
(04:38):
And a lot of times autoimmuneconditions are not even thought
about in terms of infertility,and the more autoimmune
conditions that one has, themore likely they would have
other autoimmune conditions.
And especially with fertility Imean fertility rates in the
Western world are collapsing,absolutely collapsing.
(05:00):
A lot of this is fromsocioeconomic and cultural
reasons.
Some of it may be biologic, butyou Gen Zs out there and you
young millennials, fertility andhaving robust eggs is a really
pretty short period of time inyour life, and I don't think we
(05:22):
talk enough about that.
And of time in your life and Idon't think we talk enough about
that.
And certainly when I see womenthat have ovarian dysfunction or
premature menopause, I alsothink about celiac disease.
Most people think of it as GIproblems and when people that
have celiac disease eat gluten,their body mounts this big
(05:45):
immune response that attacks thesmall intestines and these
attacks can lead to damage inthe small villi.
They're like finger, likeprojections that line the small
intestine that promoteabsorption of nutrients and, and
when they're damaged, nutrientscannot be absorbed.
(06:09):
So who's at risk for celiac?
Well, males and females are atrisk.
People of any age or race candevelop this autoimmune
condition.
But there are some factors thatcan increase your risk.
The first one is having abiological relative with celiac.
When you get together in thesummer for cookouts and picnics
(06:34):
on Memorial Day or, later in theyear, thanksgiving, it's kind
of good when you have yourfamily assembled the biological
relatives anyway to inquireabout any new diagnoses or
conditions, and most non-medicalpeople really don't want to
talk about their medicalproblems usually, but it is
(06:55):
important to have a reallyaccurate family history.
I just saw a woman today in theoffice who had thought for
years that she had a relativedie from lung cancer.
But it was really metastasis ofanother primary to the lung and
that's why for non-medicalpeople communicating with other
(07:18):
non-medical people sometimes thehistory is not as accurate as
we would like.
So there is a big hereditarycomponent to celiac disease and
if you have a first degreerelative, like a parent or a
sibling or one of your ownoffspring, with celiac disease,
then you have at least a one in10 chance of developing celiac,
(07:41):
of developing celiac.
Another risk factor for celiacis having the HLA-DQ2 and
HLA-DQ8 genes.
So 95% of people with celiachave the HLA-DQ2 gene and the
(08:11):
other remaining 5% have thatother HLA-DQ8 gene.
So medical genetic testing canhelp determine if you have
inherited one or both of thesegenes.
So having the gene means you'reat increased risk for the
disease, but it doesn't meanthat you definitely have the
disease.
So if you have a positivegenetic test, we generally
follow it up with a celiac bloodpanel and your genetic test.
(08:37):
If it returns with a negativeresult, most of the time you can
rule out celiac.
The third risk for celiacdisease is having autoimmune
disease, because if your body isattacking itself and women in
general have more autoimmunediseases than males because
(08:57):
testosterone seems to helpmodulate the immune system.
So if you have thyroid disease,like Hashimoto's or type 1
diabetes, those are examples ofother autoimmune conditions.
Sometimes premature ovarianinsufficiency with antibodies
directed against the ovaries isanother autoimmune condition.
(09:22):
Pernicious anemia, which canlead to trouble absorbing B12
because of antibodies againstthe stomach, the parietal cell
or the intrinsic factorantibodies.
So our friends at Beyond Celiac, which is a foundation, and we
have links on our website and inthe show notes and their
(09:45):
website is beyondceliacorg andthey have a nice disease symptom
checklist.
So if you think that you oryour child or your grandchild or
a relative may have celiacdisease, it's a good resource to
get started and you can sharethese results with your
physician and ask about gettingtested.
(10:07):
And Beyond Celiac is anon-profit organization working
to drive celiac diagnosis,advanced research and accelerate
the discovery of new treatmentsand potentially a cure.
Now the founder of BeyondCeliac, alice Bast, wrote a
(10:28):
column on our website that I wasmentioning and it's on
speakingofwomenshealthcom, which, if you don't have that
bookmarked on your cell phone oryour computer or laptop, it's a
good thing to bookmark, and thecolumn is women's health and
celiac disease, and then thesearch button.
If you just put celiac orgluten, information will pull up
(10:50):
, and so I want to share some ofthe content from that column,
as well as other information wehave on our website.
There's more than 300 symptomsof celiac disease, which is one
of the reasons it'sunderdiagnosed.
(11:11):
Some of the more common signsand symptoms are seen in lots of
other conditions like bloating,diarrhea, vomiting, low blood
count, anemia, anxiety,constipation, even delayed
growth in children, depression,discolored teeth, headaches or
(11:34):
migraines.
Infertility A lot of times withinfertility it's very technical
and IVF, in vitro fertilization, has increased that sometimes
some specialists just jump rightto the technical aspects of
fertility as opposed to maybelooking at the root cause.
(11:55):
A lot of times the root causeis simply aging.
Fertility declines after age 30.
I mean, you may look fabulousat 35, but ooh, things are
really going downhill.
35, it's going downhill.
40, 45, some programs won't eventake a woman past that age and
(12:15):
ovaries age at different rates.
So you may be in menopause at40 or maybe 60.
Most are around 51, 52.
The range that we considernormal is 45 to 55.
Premature is if it's under age40.
And that happens to 1% of women,there's this itchy skin rash
(12:37):
called DH or dermatitisherpetiformis, and up to a
quarter of individuals withceliac can get this rash, and it
can be itchy and bumpy or evenbulbous.
Sometimes there can be palemouth, sores, weight gain, thin
bones or osteoporosis orosteopenia, tingling, numbness,
(13:02):
and people with celiac diseasemay have other symptoms that
kind of overlap with a lot ofcommon symptoms in people in
general at midlife and certainlyaround the time of menopause,
like fatigue, brain fog, jointpain.
Anemia is not a menopausalsymptom, though, and anemia is
(13:23):
not normal, and if you're over40, even if you've had heavy
periods babies, breastfeeding,things that drain your iron,
other causes have to be lookedfor as well, other reasons
instead of just brushing it off,because your gastrointestinal
tract is very important for ironabsorption and you need iron to
(13:44):
build blood.
You'll run out of iron storesbefore your blood count drops.
So once your blood count drops,if you don't have any iron
stores, that's pretty darnserious.
The first podcast I did inseason one that wasn't my book,
the Cleveland Clinic Guide toMenopause or my medical CME was
all about iron everything youwanted to know about iron.
(14:04):
There are women and otherpatients that have impaired gut
absorption and they have vitaminand iron deficiencies and even
osteoporosis, but may not havesymptoms.
So it's not really one sizefits all.
If you don't treat celiac andtake the gluten out of the diet,
(14:24):
not only is osteoporosis andbroken bones a problem, but
dental problems and even certaincancers.
So early diagnosis of celiacdisease is very important.
You have been listening to theSpeaking of Women's Health
podcast all about celiac disease.
(14:47):
May is Celiac Awareness Monthand we are going over some
important information and I'msure most everyone has heard of
someone who says that they'regluten intolerant.
My older sister thought thatshe had celiac.
Every time she had gluten inher diet she had joint pain as
(15:10):
long as she took it out of herdiet.
She didn't.
She went and got tested, didn'thave any findings of it, but
she continues to maintain agluten-free diet and the disease
is different than intoleranceand I think there's probably
more than one reason forintolerance.
(15:32):
We're looking at at least 3million Americans that have
celiac, making it a relativelycommon autoimmune disease.
Making it a relatively commonautoimmune disease, and because
autoimmune conditions are morefrequently in women.
We do see this in women and thenumbers suggest about 70% of
(15:57):
all celiac patients are femalesand it can result in
reproductive health problemslike menstrual irregularities,
unexplained infertility,miscarriages and even
stillbirths.
There was a study several yearsago in the Journal of Human
Reproduction and it highlightedthe importance of physicians
considering celiac in thediagnosis of women's
(16:19):
reproductive problems in thediagnosis of women's
reproductive problems.
So women who are strugglingwith unexplained infertility
should consider getting testedfor celiac.
Any woman with persistently lowiron levels, low vitamin D
levels, that's not correctedwith adequate supplementation.
The most common reason I seepeople not getting normal
(16:43):
vitamin D levels after they'vebeen diagnosed with low vitamin
D is they don't take enough,they don't fill up the tank or
they get to a barely normallevel and then they stop.
And I podcast three of thefirst season was all about
vitamin D and that's a wondersubstance.
It's really not a vitamin.
It really affects the immunesystem, cancer risk, bone health
(17:07):
, mood.
So in women that have lowerbone densities than we expect
based on their age and theirweight and their hormonal status
, it rings a bell for secondarycauses and I will consider
testing people for celiac.
(17:28):
So if you think that you haveceliac or someone in your family
does that you're responsiblefor, it's good to make an
appointment with your healthcareteam.
You actually want to remain ona gluten rich diet?
Uh, because if you totally takeout the gluten from your diet
and reduce the inflammation, youmay not have positive blood
(17:51):
test or antibodies.
Uh, so that can lead to aninaccurate test.
So, uh, your physician or GIdoctor may recommend what's
called a gluten challenge, whichintentionally involves eating
gluten bread and wheat pasta.
(18:12):
Pizza and I'm not talking aboutthe cauliflower crust kind,
probably pizza with the crust isprobably one of the foods that
my patients that have celiacdisease tell me that they miss
the most.
A lot of people can easily takewheat and gluten out of their
diet and it's a lot easier nowthan it used to be.
There are more well-markedgluten-free dietary options and
(18:40):
it's easier to go out to manyrestaurants where they have the
little labels if it's glutenfree.
Unfortunately, if you takegluten and you have celiac, you
might get some really badsymptoms.
So people don't want to feelpoorly, but if you know you're
going in specifically to ask toget the celiac blood test, you
(19:05):
really should do this.
So some of the testingtypically begins with like a
blood panel looking for specificantibodies, and one of the
first things we look at is yourtotal IgA.
That's an immunoglobulin that'ssecretory.
Interestingly, though, 10% ofthe population has a low level,
(19:26):
and so if you're one of thosepeople one in 10 that has low
IgA levels we can't rely on theblood test.
Excluding things.
We also do an IgA-T-TG, whichstands for tissue
transglutaminase, and an EMA-IGA, but, as I mentioned, if IgA is
(19:50):
deficient then we might get theIgG-IgA-DGP test, and so that
can be done at the discretion ofa physician.
Genetic testing with haplotypescan be tested, because only
certain haplotypes are trulyassociated with the risk of
(20:10):
celiac disease.
So if you remain on a regulardiet that has gluten and wheat
prior to testing for celiac,don't change to a strict
gluten-free diet until afteryou've been evaluated.
If the blood test and symptomsstill indicate celiac and we
(20:31):
can't rely on the blood test,the more definitive test is a
lot more involved, and thatinvolves seeing a
gastroenterology GI physicianand, after having a gluten
challenge, an upper endoscopydone, a little scope about the
diameter of my finger isinserted down the back of the
throat into the stomach andesophagus, and a biopsy is done
(21:04):
of the duodenum to look underthe microscope.
If there's inflammation andloss of the villus architecture
keep in mind, though you canhave a normal biopsy just
because you've avoided glutenand you've helped heal your
intestines, um, and so it's veryimportant to get all this
coordinated with your physician.
So an upper endoscopy is alsocalled an
esophagogastroduodenoscopy, egd,and if your biopsy shows
(21:32):
inflammation, you're still notdone, because then we have you
take gluten out of your diet andthen re-biopsy you to prove
cure or remission actually notcure, because you still have the
condition but you can be inremission by totally removing
gluten, and you know gluten isin so many things.
(21:53):
It's even in someover-the-counter pain
medications.
It can be in certain alcohols,cosmetic products, fillers.
There's a lot of ways to beexposed to gluten, and even if
celiac runs in your family, itcan manifest differently in
different relatives.
So if you're persistently lowin iron, like you, have a low
(22:17):
ferritin, we like a level of atleast 50 to 70 for energy and
hair growth.
When I talk about hair people'swomen anyway it's attention
perks up, and if you haven'tlistened to my prior June of
2023 and 2024's podcast oneverything hair, or early in
(22:38):
this season three, I did one onbiotin, the vitamin, the hair
vitamin.
That's not really a hairvitamin.
Those are good ones to go backto.
So you want a good iron level.
You want a good vitamin D level.
If you've got bone loss, thatneeds to be monitored by a
physician who's got someexpertise in osteoporosis.
(23:01):
If you have infertility orpremature ovarian insufficiency
or recurrent miscarriage, ask tobe tested.
I mean it's really sad when yousee women who've gone through
six pregnancy losses beforethey've been diagnosed, when
they could have been taking thegluten out of their diet.
If you're dealing withinfertility, don't just take
(23:23):
gluten out of your diet on yourown.
I mean you want to go in andget a medical, hormonal,
gynecologic and reproductiveevaluation.
And as far as infertility, ifyou're under the age of 30, we
usually recommend at least ayear of trying to become
pregnant, which is having sexualactivity without any kind of
(23:44):
contraception or rhythm,intentionally around the time of
ovulation.
But if you're over age 30, weonly give you six months, and
that's because that clock isreally ticking.
If you've been told that youhave irritable bowel syndrome or
especially inflammatory boweldisease, ibd, like Crohn's, or
(24:08):
ulcerative colitis, you may wantto ask about being tested for
celiac as well and, as Imentioned, there's many people
who do not have celiac but theystill are gluten intolerant and
they still want to avoid gluten,and that's called non-celiac
gluten sensitivity and I'mconcerned that some of it has to
(24:31):
do with how we might processwheat and pasta the pastas that
use wheat in our food supply.
So there are many ways toalleviate the discomfort and
reduce the chance ofcomplications from celiac.
If your intestines is damaged,the villi the architecture, and
(24:58):
your physician's concerned aboutyour nutritional intake, you
may need certain supplements oreven vitamin injections, and you
will have to take all glutenout of your diet and be
counseled, perhaps, by anutritionist.
Some of the more commonnutritional deficiencies in
celiac include not just iron andvitamin D, but zinc and copper
(25:20):
and folic acid and B12 andvitamin K, and your physician or
health team can order bloodwork to see what you may be
deficient and if you're veryendemic you may actually even
have to get an iron transfusionand this has to be done in a
(25:40):
responsible center because therecan be anaphylaxis to iron
infusions.
It's not as easy as other typesof fluid infusions or other
therapies that we give by veingive by vein Many times.
(26:02):
Your nutritional deficienciesshould go away as your
intestines heal, so hopefullyyou can be weaned off some of
these supplements or injections.
If you've got that itchydermatitis herpetiformis, talk
to your physician ordermatologist about dapsone,
(26:24):
which is one of the more commonmedicines used to treat
dermatitis herpetiformis.
Medicines could ease the itching, but if you wanted to go into
remission you must follow astrict gluten-free diet, and
many people with celiac diseasedo have GI distress, and that's
not fun to have nausea orvomiting or diarrhea.
So you must stay hydrated, getenough water and electrolytes.
(26:46):
Electrolytes and liquids,including coconut water, and
some fruit and vegetable juicesmay be helpful.
Warm tea might help settle yourstomach.
Ginger can be an anti-nauseant.
You just have to make sure,though, what you're drinking is
gluten free.
If you tend to struggle withconstipation, we want hydration,
(27:11):
plenty of fiber, leafy greensand whole grains that do not
include gluten, and also enoughmagnesium.
Probably after vitamin D, themost common deficiency I see is
the mineral of magnesium andthen other foods that aren't
necessarily gluten-containingfoods that can still irritate
(27:32):
the gut sometimes can irritatepeople that are sensitive Things
like fried foods and very spicyfoods, coffee.
If you have celiac, you have tobe aware of medications or other
supplements that can havegluten in them, so you must talk
(27:55):
to your physician pharmacistbefore taking any new
medications or changing youryour diet.
And this podcast, of course, isnot medical advice.
It's just information toempower you to be strong, be
healthy and be in charge.
For those people that aresuffering with continued GI and
(28:17):
celiac symptoms, there is hopeon the horizon.
A number of potential therapiesare being studied, but right
now, the main focus to heal theintestines and reduce the risk
of complication, includingosteoporosis, infertility and
also intestinal lymphoma, is tofollow a strict gluten-free diet
(28:39):
.
Now, thankfully, this isgetting easier.
Not all restaurants will labelfor gluten, not all foodstuffs
will, but I've seen over thelast several years, in many
grocery stores and restaurantsthat I have frequented, sections
or highlights on what isgluten-free, and we have a lot
(29:04):
of gluten-free recipes on ourspeakingofwomenshealthcom
website.
So if you're on our site, clickon the recipes at the top of
the website and you can use thefilter to find the gluten-free
recipes.
And when I am out shopping atthe grocery store, I frequently
(29:25):
will take a look at recipes tofigure out what other
ingredients that I might need,and sometimes I'll even post
things that I've made at homefrom our recipes on our Facebook
page or Instagram page.
So we're on all the socialmedia, all of our social media,
(29:48):
just like this podcast, iscalled Speaking of Women's
Health.
I've had a few of my patientssay, uh, is it the Sunflower
House?
I'm like, no, no, we're in theSunflower House because the
sunflowers are a logo, buteverything that we do is
speakingofwomenshealthcom.
And so thank you for joining mein the Sunflower House, and if
(30:10):
you don't already subscribe toour podcast, hit, follow or
subscribe on Apple Podcasts,spotify, tunein or wherever you
listen, feel free to share thispodcast with friends and family.
Give us a five-star rating,please.
That helps us move up.
(30:31):
If you'd like to watch thepodcast and interviews, you can
go on YouTube or our Rumblechannel on Speaking of Women's
Health.
Thanks again and I'll see younext time in the Sunflower House
.
Be strong, be healthy and be incharge.
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, I am the Executive Director of
Speaking of Women's Health andI'm back in our sunflower house
for a brand new episode.
Happy May.
May Day, mother's Month, nurseAwareness Appreciation Month,
(00:27):
and osteoporosis, one of mymedical passions.
We have a lot of greatinformation about bone health
and osteoporosis and excitingosteoporosis therapies.
Just basic nutritioninformation everything you
wanted to know about calcium,vitamin D and K2.
(00:51):
So this month, in honor ofthose important topics, please,
if you've missed some of ourprior episodes in Season 1 and
Season 2, listen to those.
Our prior episodes in seasonone and season two Listen to
those.
May is also Celiac DiseaseAwareness Month and I am taking
(01:12):
some information on our website,some authored by our friends at
the Celiac Disease Foundation.
What is celiac?
Well, it's a serious autoimmunedisease that's triggered by
containing food or substancesthat contain gluten.
(01:33):
Gluten is a protein found inwheat, barley and rye and,
according to the Celiac DiseaseFoundation, celiac disease can
affect 1 in 100 people worldwide, but only 30% are properly
diagnosed.
I've diagnosed a number ofpeople in my practice with
(01:56):
celiac disease, in part becauseI'm an osteoporosis specialist
osteoporosis specialist andceliac disease can affect
absorption of nutrients andvitamin D and iron, and since I
see a lot of women low in iron,potentially from pregnancy and
breastfeeding and menstruallosses and I also practice in
(02:20):
Northeast Ohio and people overage 40 tend to be low in vitamin
D we're not close to theequator, so whenever I see
someone with thin bones, lowvitamin D and or low iron and or
GI distress and or unexplaineddermatitis or pediformis kind of
(02:41):
a Christmas tree type rashdermatitis, herpetiformis kind
of a Christmas tree type rash,those are all things that make
me think about celiac.
And I've seen people with no GIsymptoms who just have
unexplained bone loss and afterthey take out gluten from their
diet, their skeleton and bonehealth improves.
Now a lot of people do not haveceliac disease, they're just
(03:04):
gluten intolerant and I actuallythink some of that gluten
intolerance is actually becauseof the way wheat is processed
and a lot of pasta, at least inthe United States, has
substances that are banned inother countries, like
azodicarbamide.
Countries like azodicarbamideIf you didn't listen to my last
(03:29):
season in 2024, the fall of2024's podcast on food freedom
and all the different substancesthat are allowed in our United
States food supply but banned inother countries.
That's a must listen to, andsince I did the research for
that, I threw away all myAmerican pasta.
I'm just going to a place thatimports from Italy and for years
(03:53):
I always would hear friends saythat they would go to Italy and
they would eat whatever breadand pasta and drink the red wine
and enjoy themselves and notgain any weight, not have any GI
distress, sometimes even losingweight from all the walking
around.
So we're going to mainly focustoday on celiac, and one of the
(04:14):
columns that we have onspeakinginwomenshealthcom on
celiac disease was co -authoredby a guest columnist who had
suffered infertility andmultiple miscarriages, had had
many pregnancy losses and itwasn't until her celiac that was
diagnosed and treated that shewas able to conceive.
(04:38):
And a lot of times autoimmuneconditions are not even thought
about in terms of infertility,and the more autoimmune
conditions that one has, themore likely they would have
other autoimmune conditions.
And especially with fertility Imean fertility rates in the
Western world are collapsing,absolutely collapsing.
(05:00):
A lot of this is fromsocioeconomic and cultural
reasons.
Some of it may be biologic, butyou Gen Zs out there and you
young millennials, fertility andhaving robust eggs is a really
pretty short period of time inyour life, and I don't think we
(05:22):
talk enough about that.
And of time in your life and Idon't think we talk enough about
that.
And certainly when I see womenthat have ovarian dysfunction or
premature menopause, I alsothink about celiac disease.
Most people think of it as GIproblems and when people that
have celiac disease eat gluten,their body mounts this big
(05:45):
immune response that attacks thesmall intestines and these
attacks can lead to damage inthe small villi.
They're like finger, likeprojections that line the small
intestine that promoteabsorption of nutrients and, and
when they're damaged, nutrientscannot be absorbed.
(06:09):
So who's at risk for celiac?
Well, males and females are atrisk.
People of any age or race candevelop this autoimmune
condition.
But there are some factors thatcan increase your risk.
The first one is having abiological relative with celiac.
When you get together in thesummer for cookouts and picnics
(06:34):
on Memorial Day or, later in theyear, thanksgiving, it's kind
of good when you have yourfamily assembled the biological
relatives anyway to inquireabout any new diagnoses or
conditions, and most non-medicalpeople really don't want to
talk about their medicalproblems usually, but it is
(06:55):
important to have a reallyaccurate family history.
I just saw a woman today in theoffice who had thought for
years that she had a relativedie from lung cancer.
But it was really metastasis ofanother primary to the lung and
that's why for non-medicalpeople communicating with other
(07:18):
non-medical people sometimes thehistory is not as accurate as
we would like.
So there is a big hereditarycomponent to celiac disease and
if you have a first degreerelative, like a parent or a
sibling or one of your ownoffspring, with celiac disease,
then you have at least a one in10 chance of developing celiac,
(07:41):
of developing celiac.
Another risk factor for celiacis having the HLA-DQ2 and
HLA-DQ8 genes.
So 95% of people with celiachave the HLA-DQ2 gene and the
(08:11):
other remaining 5% have thatother HLA-DQ8 gene.
So medical genetic testing canhelp determine if you have
inherited one or both of thesegenes.
So having the gene means you'reat increased risk for the
disease, but it doesn't meanthat you definitely have the
disease.
So if you have a positivegenetic test, we generally
follow it up with a celiac bloodpanel and your genetic test.
(08:37):
If it returns with a negativeresult, most of the time you can
rule out celiac.
The third risk for celiacdisease is having autoimmune
disease, because if your body isattacking itself and women in
general have more autoimmunediseases than males because
(08:57):
testosterone seems to helpmodulate the immune system.
So if you have thyroid disease,like Hashimoto's or type 1
diabetes, those are examples ofother autoimmune conditions.
Sometimes premature ovarianinsufficiency with antibodies
directed against the ovaries isanother autoimmune condition.
(09:22):
Pernicious anemia, which canlead to trouble absorbing B12
because of antibodies againstthe stomach, the parietal cell
or the intrinsic factorantibodies.
So our friends at Beyond Celiac, which is a foundation, and we
have links on our website and inthe show notes and their
(09:45):
website is beyondceliacorg andthey have a nice disease symptom
checklist.
So if you think that you oryour child or your grandchild or
a relative may have celiacdisease, it's a good resource to
get started and you can sharethese results with your
physician and ask about gettingtested.
(10:07):
And Beyond Celiac is anon-profit organization working
to drive celiac diagnosis,advanced research and accelerate
the discovery of new treatmentsand potentially a cure.
Now the founder of BeyondCeliac, alice Bast, wrote a
(10:28):
column on our website that I wasmentioning and it's on
speakingofwomenshealthcom, which, if you don't have that
bookmarked on your cell phone oryour computer or laptop, it's a
good thing to bookmark, and thecolumn is women's health and
celiac disease, and then thesearch button.
If you just put celiac orgluten, information will pull up
(10:50):
, and so I want to share some ofthe content from that column,
as well as other information wehave on our website.
There's more than 300 symptomsof celiac disease, which is one
of the reasons it'sunderdiagnosed.
(11:11):
Some of the more common signsand symptoms are seen in lots of
other conditions like bloating,diarrhea, vomiting, low blood
count, anemia, anxiety,constipation, even delayed
growth in children, depression,discolored teeth, headaches or
(11:34):
migraines.
Infertility A lot of times withinfertility it's very technical
and IVF, in vitro fertilization, has increased that sometimes
some specialists just jump rightto the technical aspects of
fertility as opposed to maybelooking at the root cause.
(11:55):
A lot of times the root causeis simply aging.
Fertility declines after age 30.
I mean, you may look fabulousat 35, but ooh, things are
really going downhill.
35, it's going downhill.
40, 45, some programs won't eventake a woman past that age and
(12:15):
ovaries age at different rates.
So you may be in menopause at40 or maybe 60.
Most are around 51, 52.
The range that we considernormal is 45 to 55.
Premature is if it's under age40.
And that happens to 1% of women,there's this itchy skin rash
(12:37):
called DH or dermatitisherpetiformis, and up to a
quarter of individuals withceliac can get this rash, and it
can be itchy and bumpy or evenbulbous.
Sometimes there can be palemouth, sores, weight gain, thin
bones or osteoporosis orosteopenia, tingling, numbness,
(13:02):
and people with celiac diseasemay have other symptoms that
kind of overlap with a lot ofcommon symptoms in people in
general at midlife and certainlyaround the time of menopause,
like fatigue, brain fog, jointpain.
Anemia is not a menopausalsymptom, though, and anemia is
(13:23):
not normal, and if you're over40, even if you've had heavy
periods babies, breastfeeding,things that drain your iron,
other causes have to be lookedfor as well, other reasons
instead of just brushing it off,because your gastrointestinal
tract is very important for ironabsorption and you need iron to
(13:44):
build blood.
You'll run out of iron storesbefore your blood count drops.
So once your blood count drops,if you don't have any iron
stores, that's pretty darnserious.
The first podcast I did inseason one that wasn't my book,
the Cleveland Clinic Guide toMenopause or my medical CME was
all about iron everything youwanted to know about iron.
(14:04):
There are women and otherpatients that have impaired gut
absorption and they have vitaminand iron deficiencies and even
osteoporosis, but may not havesymptoms.
So it's not really one sizefits all.
If you don't treat celiac andtake the gluten out of the diet,
(14:24):
not only is osteoporosis andbroken bones a problem, but
dental problems and even certaincancers.
So early diagnosis of celiacdisease is very important.
You have been listening to theSpeaking of Women's Health
podcast all about celiac disease.
(14:47):
May is Celiac Awareness Monthand we are going over some
important information and I'msure most everyone has heard of
someone who says that they'regluten intolerant.
My older sister thought thatshe had celiac.
Every time she had gluten inher diet she had joint pain as
(15:10):
long as she took it out of herdiet.
She didn't.
She went and got tested, didn'thave any findings of it, but
she continues to maintain agluten-free diet and the disease
is different than intoleranceand I think there's probably
more than one reason forintolerance.
(15:32):
We're looking at at least 3million Americans that have
celiac, making it a relativelycommon autoimmune disease.
Making it a relatively commonautoimmune disease, and because
autoimmune conditions are morefrequently in women.
We do see this in women and thenumbers suggest about 70% of
(15:57):
all celiac patients are femalesand it can result in
reproductive health problemslike menstrual irregularities,
unexplained infertility,miscarriages and even
stillbirths.
There was a study several yearsago in the Journal of Human
Reproduction and it highlightedthe importance of physicians
considering celiac in thediagnosis of women's
(16:19):
reproductive problems in thediagnosis of women's
reproductive problems.
So women who are strugglingwith unexplained infertility
should consider getting testedfor celiac.
Any woman with persistently lowiron levels, low vitamin D
levels, that's not correctedwith adequate supplementation.
The most common reason I seepeople not getting normal
(16:43):
vitamin D levels after they'vebeen diagnosed with low vitamin
D is they don't take enough,they don't fill up the tank or
they get to a barely normallevel and then they stop.
And I podcast three of thefirst season was all about
vitamin D and that's a wondersubstance.
It's really not a vitamin.
It really affects the immunesystem, cancer risk, bone health
(17:07):
, mood.
So in women that have lowerbone densities than we expect
based on their age and theirweight and their hormonal status
, it rings a bell for secondarycauses and I will consider
testing people for celiac.
(17:28):
So if you think that you haveceliac or someone in your family
does that you're responsiblefor, it's good to make an
appointment with your healthcareteam.
You actually want to remain ona gluten rich diet?
Uh, because if you totally takeout the gluten from your diet
and reduce the inflammation, youmay not have positive blood
(17:51):
test or antibodies.
Uh, so that can lead to aninaccurate test.
So, uh, your physician or GIdoctor may recommend what's
called a gluten challenge, whichintentionally involves eating
gluten bread and wheat pasta.
(18:12):
Pizza and I'm not talking aboutthe cauliflower crust kind,
probably pizza with the crust isprobably one of the foods that
my patients that have celiacdisease tell me that they miss
the most.
A lot of people can easily takewheat and gluten out of their
diet and it's a lot easier nowthan it used to be.
There are more well-markedgluten-free dietary options and
(18:40):
it's easier to go out to manyrestaurants where they have the
little labels if it's glutenfree.
Unfortunately, if you takegluten and you have celiac, you
might get some really badsymptoms.
So people don't want to feelpoorly, but if you know you're
going in specifically to ask toget the celiac blood test, you
(19:05):
really should do this.
So some of the testingtypically begins with like a
blood panel looking for specificantibodies, and one of the
first things we look at is yourtotal IgA.
That's an immunoglobulin that'ssecretory.
Interestingly, though, 10% ofthe population has a low level,
(19:26):
and so if you're one of thosepeople one in 10 that has low
IgA levels we can't rely on theblood test.
Excluding things.
We also do an IgA-T-TG, whichstands for tissue
transglutaminase, and an EMA-IGA, but, as I mentioned, if IgA is
(19:50):
deficient then we might get theIgG-IgA-DGP test, and so that
can be done at the discretion ofa physician.
Genetic testing with haplotypescan be tested, because only
certain haplotypes are trulyassociated with the risk of
(20:10):
celiac disease.
So if you remain on a regulardiet that has gluten and wheat
prior to testing for celiac,don't change to a strict
gluten-free diet until afteryou've been evaluated.
If the blood test and symptomsstill indicate celiac and we
(20:31):
can't rely on the blood test,the more definitive test is a
lot more involved, and thatinvolves seeing a
gastroenterology GI physicianand, after having a gluten
challenge, an upper endoscopydone, a little scope about the
diameter of my finger isinserted down the back of the
throat into the stomach andesophagus, and a biopsy is done
(21:04):
of the duodenum to look underthe microscope.
If there's inflammation andloss of the villus architecture
keep in mind, though you canhave a normal biopsy just
because you've avoided glutenand you've helped heal your
intestines, um, and so it's veryimportant to get all this
coordinated with your physician.
So an upper endoscopy is alsocalled an
esophagogastroduodenoscopy, egd,and if your biopsy shows
(21:32):
inflammation, you're still notdone, because then we have you
take gluten out of your diet andthen re-biopsy you to prove
cure or remission actually notcure, because you still have the
condition but you can be inremission by totally removing
gluten, and you know gluten isin so many things.
(21:53):
It's even in someover-the-counter pain
medications.
It can be in certain alcohols,cosmetic products, fillers.
There's a lot of ways to beexposed to gluten, and even if
celiac runs in your family, itcan manifest differently in
different relatives.
So if you're persistently lowin iron, like you, have a low
(22:17):
ferritin, we like a level of atleast 50 to 70 for energy and
hair growth.
When I talk about hair people'swomen anyway it's attention
perks up, and if you haven'tlistened to my prior June of
2023 and 2024's podcast oneverything hair, or early in
(22:38):
this season three, I did one onbiotin, the vitamin, the hair
vitamin.
That's not really a hairvitamin.
Those are good ones to go backto.
So you want a good iron level.
You want a good vitamin D level.
If you've got bone loss, thatneeds to be monitored by a
physician who's got someexpertise in osteoporosis.
(23:01):
If you have infertility orpremature ovarian insufficiency
or recurrent miscarriage, ask tobe tested.
I mean it's really sad when yousee women who've gone through
six pregnancy losses beforethey've been diagnosed, when
they could have been taking thegluten out of their diet.
If you're dealing withinfertility, don't just take
(23:23):
gluten out of your diet on yourown.
I mean you want to go in andget a medical, hormonal,
gynecologic and reproductiveevaluation.
And as far as infertility, ifyou're under the age of 30, we
usually recommend at least ayear of trying to become
pregnant, which is having sexualactivity without any kind of
(23:44):
contraception or rhythm,intentionally around the time of
ovulation.
But if you're over age 30, weonly give you six months, and
that's because that clock isreally ticking.
If you've been told that youhave irritable bowel syndrome or
especially inflammatory boweldisease, ibd, like Crohn's, or
(24:08):
ulcerative colitis, you may wantto ask about being tested for
celiac as well and, as Imentioned, there's many people
who do not have celiac but theystill are gluten intolerant and
they still want to avoid gluten,and that's called non-celiac
gluten sensitivity and I'mconcerned that some of it has to
(24:31):
do with how we might processwheat and pasta the pastas that
use wheat in our food supply.
So there are many ways toalleviate the discomfort and
reduce the chance ofcomplications from celiac.
If your intestines is damaged,the villi the architecture, and
(24:58):
your physician's concerned aboutyour nutritional intake, you
may need certain supplements oreven vitamin injections, and you
will have to take all glutenout of your diet and be
counseled, perhaps, by anutritionist.
Some of the more commonnutritional deficiencies in
celiac include not just iron andvitamin D, but zinc and copper
(25:20):
and folic acid and B12 andvitamin K, and your physician or
health team can order bloodwork to see what you may be
deficient and if you're veryendemic you may actually even
have to get an iron transfusionand this has to be done in a
(25:40):
responsible center because therecan be anaphylaxis to iron
infusions.
It's not as easy as other typesof fluid infusions or other
therapies that we give by veingive by vein Many times.
(26:02):
Your nutritional deficienciesshould go away as your
intestines heal, so hopefullyyou can be weaned off some of
these supplements or injections.
If you've got that itchydermatitis herpetiformis, talk
to your physician ordermatologist about dapsone,
(26:24):
which is one of the more commonmedicines used to treat
dermatitis herpetiformis.
Medicines could ease the itching, but if you wanted to go into
remission you must follow astrict gluten-free diet, and
many people with celiac diseasedo have GI distress, and that's
not fun to have nausea orvomiting or diarrhea.
So you must stay hydrated, getenough water and electrolytes.
(26:46):
Electrolytes and liquids,including coconut water, and
some fruit and vegetable juicesmay be helpful.
Warm tea might help settle yourstomach.
Ginger can be an anti-nauseant.
You just have to make sure,though, what you're drinking is
gluten free.
If you tend to struggle withconstipation, we want hydration,
(27:11):
plenty of fiber, leafy greensand whole grains that do not
include gluten, and also enoughmagnesium.
Probably after vitamin D, themost common deficiency I see is
the mineral of magnesium andthen other foods that aren't
necessarily gluten-containingfoods that can still irritate
(27:32):
the gut sometimes can irritatepeople that are sensitive Things
like fried foods and very spicyfoods, coffee.
If you have celiac, you have tobe aware of medications or other
supplements that can havegluten in them, so you must talk
(27:55):
to your physician pharmacistbefore taking any new
medications or changing youryour diet.
And this podcast, of course, isnot medical advice.
It's just information toempower you to be strong, be
healthy and be in charge.
For those people that aresuffering with continued GI and
(28:17):
celiac symptoms, there is hopeon the horizon.
A number of potential therapiesare being studied, but right
now, the main focus to heal theintestines and reduce the risk
of complication, includingosteoporosis, infertility and
also intestinal lymphoma, is tofollow a strict gluten-free diet
(28:39):
.
Now, thankfully, this isgetting easier.
Not all restaurants will labelfor gluten, not all foodstuffs
will, but I've seen over thelast several years, in many
grocery stores and restaurantsthat I have frequented, sections
or highlights on what isgluten-free, and we have a lot
(29:04):
of gluten-free recipes on ourspeakingofwomenshealthcom
website.
So if you're on our site, clickon the recipes at the top of
the website and you can use thefilter to find the gluten-free
recipes.
And when I am out shopping atthe grocery store, I frequently
(29:25):
will take a look at recipes tofigure out what other
ingredients that I might need,and sometimes I'll even post
things that I've made at homefrom our recipes on our Facebook
page or Instagram page.
So we're on all the socialmedia, all of our social media,
(29:48):
just like this podcast, iscalled Speaking of Women's
Health.
I've had a few of my patientssay, uh, is it the Sunflower
House?
I'm like, no, no, we're in theSunflower House because the
sunflowers are a logo, buteverything that we do is
speakingofwomenshealthcom.
And so thank you for joining mein the Sunflower House, and if
(30:10):
you don't already subscribe toour podcast, hit, follow or
subscribe on Apple Podcasts,spotify, tunein or wherever you
listen, feel free to share thispodcast with friends and family.
Give us a five-star rating,please.
That helps us move up.
(30:31):
If you'd like to watch thepodcast and interviews, you can
go on YouTube or our Rumblechannel on Speaking of Women's
Health.
Thanks again and I'll see younext time in the Sunflower House
.
Be strong, be healthy and be incharge.
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