Should I follow a Gluten-Free diet when TTC?
Should you follow a gluten free diet when trying to conceive (TTC)? In this article I am hoping to offer some guidance, but remember to always speak to your GP or a registered healthcare professional if you have any doubts or questions about your health.
First, we much look at what a gluten-free diet is, and why someone may choose this.
A gluten-free diet is not just a fad 'health' trend that some people might find themselves considering. For people with coeliac disease, a gluten-free diet is the only way to improve their symptoms and gut health.
Coeliac disease is an autoimmune disorder whereby the body reacts to gluten; a protein found in wheat, barley, and rye. The treatment for coeliac disease is a strict gluten-free (GF) diet. It is estimated that 1 in 100 people in the UK has coeliac disease (1). Plus, an estimated 30% of people with coeliac disease are undiagnosed.
What is the big deal when TTC? Why is this important? Well, coeliac disease has been hypothesized to be linked with conditions such as endometriosis which can make trying to conceive more difficult.
Endometriosis is the condition where cells similar to the ones in the lining of the womb (uterus) are found elsewhere in the body. (2)
WHEN TO GET TESTED
In the UK, if a person has consistently low vitamin D, iron, or B12 levels, the GP may wish to run tests for coeliac disease. In fact, the NICE guidelines state that people with unexplained subfertility or recurrent miscarriages should be screened for coeliac disease (3).
When order for this blood test to be effective, the person being tested must have gluten-containing foods in more than one meal daily for at least 6 weeks. (4) This daily equivalent is around: 2 slices of bread; a small bowl of pasta; or 2 Weetabix.
WHAT TO DO IF YOU ARE DIAGNOSED WITH COELIAC DISEASE
If this test comes back positive, when you first receive a diagnosis of coeliac disease, you might breathe a sigh of relief that you finally have an answer for your symptoms.
Perhaps you have been having IBS type symptoms or had low vitamin B12 or low iron levels which encouraged your doctor to test you for coeliac disease. You may have had no bowel symptoms at all, which means that the diagnosis could be quite confusing and shocking for you.
In this case, the first recommended action is seeking advice from a dietitian or a registered healthcare professional who can explain what the next steps are.
Dietitians are healthcare professionals who give evidence-based diet advice tailored to you and your lifestyle. Your dietitian will be able to assess your symptoms and give you guidance on your diagnosis, including how to live a gluten-free life so that you can reduce the inflammation in your gut caused by coeliac disease.
OTHER KEY NUTRIENTS FOR A GLUTEN-FREE DIET
It is important to include calcium containing foods such as dairy or a fortified dairy alternative if you have coeliac disease. Adults with coeliac disease should aim to have 1,000 milligrams (mg) of calcium each day to support their bone health. This can help to reduce the risk of bone disease such as osteoporosis.
Calcium can be found in dairy foods (e.g. milk, cheese, and yoghurt), fortified dairy alternatives (e.g. soy, coconut, and almond milk) in addition to several other foods (e.g. sardines with bones, spinach, and kidney beans). The British Dietetic Association has created a simple resource to ensure you meet your calcium needs (5).
In general, all foods are allowed as long as they do not contain gluten, and as long as they have not been exposed to gluten cross-contamination.
It’s worth noting that some foods are naturally gluten-free such as rice, fruit, meat, beans, pulses, vegetables, and potatoes, so you do not need to buy lots of specific gluten-free products in order to have a varied and balanced diet.
To save money, you can buy gluten-free food when it is on sale or at a reduced price as many of the items can be frozen to eat at a later date (always check manufacturer instructions for storage guidance though).
SUPPLEMENTS FOR PEOPLE WITH COELIAC DISEASE
Vitamin D3 would definitely be worth considering, it is important for your bone health as it helps your body to absorb calcium. In the UK, vitamin D is predominantly generated by our bodies from sun exposure during the months of March - October however we don't usually get enough vitamin D in our diet all year round. Therefore, it is recommended by SACN to take 10mcg of Vitamin D daily, especially if you do not go outside much in the spring/summer (6), or if your skin is covered up when you are outdoors. (Side note: Please do protect your skin and cover up if you're out in the sun for long periods to reduce the risk of skin damage and skin cancer).
If you are planning a pregnancy and you have coeliac disease, then it is recommended to have your folic acid levels checked by your doctor as you may need a higher daily dose of folic acid. If you're in the UK and want to see if I can support you on your journey with coeliac disease and TTC send me a message or book a free discovery call with me.
TREATMENT FOR COELIAC DISEASE
A normal healthy balanced diet would be the most appropriate in order to have a variety of vitamins, minerals, and fiber. A balanced diet includes all the major foods groups: carbohydrates, protein, dairy and/or alternatives, and healthy fats. Aim to have ~⅓ of your diet as fruits and vegetables, ~⅓ as whole grain carbohydrates (brown rice, corn, and gluten-free oats* all count as wholegrain), the remaining portion of the diet should be your dairy or dairy alternatives and other protein sources such as beans, lentils, eggs, meat and poultry (always check the labels to ensure that these are gluten-free – especially things coated in breadcrumbs).
*Please note: oats are naturally gluten-free, however there is a risk of cross contamination when oats and gluten-containing grains are grown, harvested and processed in close proximity.
THE BOTTOM LINE
A gluten-free diet is not required routinely when you're TTC. However, if you have had chronically low levels of B12, vitamin D, or you have endometriosis, then a trial of a gluten-free diet may help to reduce inflammation.
Ultimately, gaining an accurate diagnosis of coeliac disease is the best practice and course of action. Not sure if a GF diet is for you? Speak to a fertility dietitian about your unique nutrition journey.
Coeliac UK has a great website and a whole host of resources to support people with coeliac disease, including an annual directory, an app for eating out, and common supermarket items which are gluten-free.
If you are in the US https://celiac.org/ has some helpful resources.
SEE IF I CAN HELP YOU:
Please note: The information in this article is not a substitute for professional medical or dietetic advice - if you have concerns regarding your health, please speak to your doctor. See my full disclaimer here.
Dietitian Kirsty is a registered UK-based dietitian and the founder of the ‘Gut Instinct Community’ Facebook group. Kirsty has a passion for helping people resolve their digestive issues through diet and lifestyle. In addition to her work supporting people to heal their gut, Kirsty also helps women break up with dieting, the scales & counting calories, by teaching them how to eat intuitively, live a balanced life & enjoy food without shame & guilt.
1. Coeliac UK. Coeliac Disease. Available online from:
https://www.coeliac.org.uk/information-and-support/coeliac-disease/ [Last accessed: 9th October 2021]
2. Endometriosis UK (2021) Understanding Endometriosis. Available online from: https://www.endometriosis-uk.org/understanding-endometriosis)
[Last accessed: 9th October 2021]
3. NICE (2015). National Institute for Health and Care Excellence. Coeliac Disease: Recognition, assessment, and management. Available online from: https://www.nice.org.uk/guidance/ng20/chapter/Recommendations [Last accessed: 9th October 2021]
4. Coeliac UK (2021) Coeliac disease blood tests and biopsy . Available online from: https://www.coeliac.org.uk/information-and-support/coeliac-disease/getting-diagnosed/blood-tests-and-biospy/ [Last accessed: 9th October 2021]
5. British Dietetic Association (2021) Calcium Food Fact Sheet. Available online from: https://www.bda.uk.com/resource/calcium.html [Last accessed: 9th October 2021]
6. The Scientific Advisory Committee on Nutrition (2015). SACN vitamin D and health report. Available online from: https://www.gov.uk/government/publications/sacn-vitamin-d-and-health-report [Last accessed: 9th October 2021]