Is there a relationship between gluten and fertility?

What is gluten?

Gluten is a protein found in grains such as wheat, rye and barley. Many commonly consumed foods contain gluten including cereals, pasta, breads, pasties, even beer. Interest in gluten-free diets has exploded over the past few years, with some suggesting that everyone can benefit from a gluten-free diet. Infertility is one such situation where reports of a gluten-free diet to help fertility or gluten-free fertility success stories have emerged. Here we delve into the research and explain if there is really a link between gluten and fertility.  

Undiagnosed Coeliac disease and fertility

Most people can tolerate gluten with no problems. However, for people with the autoimmune condition Coeliac disease, when gluten is ingested, the body’s immune system attacks itself causing damage to the lining of the gut, impairing nutrient absorption causing a range of gastrointestinal symptoms. Luckily, a gluten-free diet can manage the condition and prevent complications if correctly followed strictly for life.

Women correctly managing their Coeliac disease do not appear to have a greater risk of fertility problems than women without coeliac disease (1) however, undiagnosed or untreated coeliac disease may be an underlying cause of some fertility problems such as irregular periods, i.e. consuming gluten being unaware you have Coeliac disease (2). We are not entirely sure why this is as research is lacking however, nutrient deficiency due to malabsorption of fertility promoting nutrients such as selenium, zinc, and folate could be part of the puzzle.  It is also thought that the antibodies released due to the immune response triggered could lead to problems with placental function (3). For women with the symptoms of coeliac disease, a gluten-free diet following a positive coeliac disease test would be recommended to improve both this condition and fertility outcomes. If you are struggling to find a reason for your infertility, you could request a Coeliac screen from your GP.

Gluten, inflammation and fertility

Non-coeliac gluten sensitivity is a reported condition where gastrointestinal and other symptoms related to gluten ingestion are present, after diagnoses of coeliac disease and wheat allergy have been ruled out. Due to this link between gluten containing cereals and inflammation in both non-coeliac gluten sensitivity and Coeliac disease (4–6) it has been implied that gluten induced inflammation can have a negative effect on fertility outcomes. There is however no evidence to support these links with infertility in people without Coeliac disease, and embarking upon a gluten-free diet is not generally recommended as a first-line treatment.

Gluten, PCOS and fertility

Due to the suggested links between gluten and inflammation there are suggestions that eliminating it can benefit those with PCOS. However, although there may be anecdotal reports of PCOS improvement, similarly to above, no scientific evidence exists to support these claims. It is possible that a gluten-free diet could contribute to a reduced carbohydrate intake which could in turn be positive for women suffering from PCOS however, so it could be the reduced carbohydrate intake not the lack of gluten having the beneficial effect. More evidence is needed to establish the link between gluten itself and PCOS.

Endometriosis-related pain on the other hand could actually be improved after a long-term gluten-free diet (7) so a gluten-free diet could be a consideration in this group. 

Disadvantages of a gluten-free diet

When completely cutting anything out of your diet there are risks associated with it. Avoiding foods containing gluten can potentially lead to deficiencies in essential nutrients including iron, calcium, folate, thiamine, riboflavin, and niacin. Many cereals and breads are fortified with these and are a major source of these fertility promoting nutrients in our diets. Cutting out gluten also drastically reduces fibre intake. Higher intakes of fibre and wholegrains are associated with increased probability of pregnancy and positive fertility outcomes (8) (9).

There is currently no definitive evidence to suggest that anyone other than those with diagnosed Coeliac disease or wheat allergy benefits in overall or reproductive health from a gluten-free diet. Avoiding gluten has the potential to impair health and fertility if nutrients are not replaced. If you would like to follow or trial a gluten-free diet, it would be recommended to see a Dietitian or Registered Nutritionist to ensure your diet remains nutritionally adequate to promote health and fertility. 

References

1.       Dhalwani NN, West J, Sultan AA, Ban L, Tata LJ. Women With Celiac Disease Present With Fertility Problems No More Often Than Women in the General Population. Gastroenterology [Internet]. 2014 [cited 2020 Oct 6];147:1267-1274.e1. Available from: http://dx.doi.org/10.1053/j.gastro.2014.08.025
2.       Martinelli D, Fortunato F, Tafuri S, Germinario CA, Prato R. Reproductive life disorders in Italian celiac women. A case-control study. BMC Gastroenterol [Internet]. 2010 Aug 6 [cited 2020 Oct 6];10(1):89. Available from: http://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-10-89
3.       Tersigni C, Castellani R, De waure C, Fattorossi A, De Spirito M, Gasbarrini A, et al. Celiac disease and reproductive disorders: Meta-analysis of epidemiologic associations and potential pathogenic mechanisms. Hum Reprod Update [Internet]. 2014 Jul 1 [cited 2020 Oct 6];20(4):582–93. Available from: https://academic.oup.com/humupd/article/20/4/582/833777
4.       Schuppan D, Pickert G, Ashfaq-Khan M, Zevallos V. Non-celiac wheat sensitivity: Differential diagnosis, triggers and implications [Internet]. Vol. 29, Best Practice and Research: Clinical Gastroenterology. 2015 [cited 2020 Oct 22]. p. 469–76. Available from: https://www.sciencedirect.com/science/article/pii/S1521691815000499
5.       Capannolo A, Viscido A, Frieri G. Non-Celiac Gluten Sensitivity among Patients Perceiving Gluten-Related Symptoms Role of glycogen synthase kinase-3β and PPAR-γ on epithelial-to-mesenchymal transition in DSS-induced colorectal fibrosis View project. 2015 [cited 2020 Oct 6]; Available from: www.karger.com/dig
6.       Uhde M, Ajamian M, Caio G, De Giorgio R, Indart A, Green PH, et al. Intestinal cell damage and systemic immune activation in individuals reporting sensitivity to wheat in the absence of coeliac disease. Gut [Internet]. 2016 Dec 1 [cited 2020 Oct 13];65(12):1930–7. Available from: http://dx.doi.org/10.1136/gutjnl-2016-311964
7.       Marziali M, Venza M, Lazzaro S, Lazzaro A, Micossi C, Stolfi VM. Gluten-free diet: A new strategy for management of painful endometriosis related symptoms? Minerva Chir [Internet]. 2012 [cited 2020 Oct 13];67(6):499–504. Available from: https://pubmed.ncbi.nlm.nih.gov/23334113/
8.       Willis SK, Wise LA, Wesselink AK, Rothman KJ, Mikkelsen EM, Tucker KL, et al. Glycemic load, dietary fiber, and added sugar and fecundability in 2 preconception cohorts. Orig Res Commun [Internet]. [cited 2020 Jun 19]; Available from: https://academic.oup.com/ajcn/advance-article-abstract/doi/10.1093/ajcn/nqz312/5696748
9.       Gaskins AJ, Chiu YH, Williams PL, Keller MG, Toth TL, Hauser R, et al. Maternal whole grain intake and outcomes of in vitro fertilization. Fertil Steril [Internet]. 2016 Jun 1 [cited 2020 Sep 21];105(6):1503-1510.e4. Available from: /pmc/articles/PMC4894002/?report=abstract