Speaking of Women's Health
The Speaking of Women's Health Podcast is excited to bring you credible women's health information from host and Executive Director, Dr. Holly L. Thacker. Dr. Thacker will interview guest clinicians discussing relevant women's health topics and the latest news and tips.
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Speaking of Women's Health
Celiac Disease vs Gluten Intolerance
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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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 and I'm back in our sunflower house for a brand new episode. Happy May. May Day, mother's Month, nurse Awareness Appreciation Month, and osteoporosis, one of my medical passions. We have a lot of great information about bone health and osteoporosis and exciting osteoporosis therapies. Just basic nutrition information everything you wanted to know about calcium, vitamin D and K2. So this month, in honor of those important topics, please, if you've missed some of our prior episodes in Season 1 and Season 2, listen to those. Our prior episodes in season one and season two Listen to those. May is also Celiac Disease Awareness Month and I am taking some information on our website, some authored by our friends at the Celiac Disease Foundation.
Speaker 1:What is celiac? Well, it's a serious autoimmune disease that's triggered by containing food or substances that contain gluten. Gluten is a protein found in wheat, barley and rye and, according to the Celiac Disease Foundation, celiac disease can affect 1 in 100 people worldwide, but only 30% are properly diagnosed. I've diagnosed a number of people in my practice with celiac disease, in part because I'm an osteoporosis specialist osteoporosis specialist and celiac disease can affect absorption of nutrients and vitamin D and iron, and since I see a lot of women low in iron, potentially from pregnancy and breastfeeding and menstrual losses and I also practice in Northeast Ohio and people over age 40 tend to be low in vitamin D we're not close to the equator, so whenever I see someone with thin bones, low vitamin D and or low iron and or GI distress and or unexplained dermatitis or pediformis kind of a Christmas tree type rash dermatitis, 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 GI symptoms who just have unexplained bone loss and after they take out gluten from their diet, their skeleton and bone health improves. Now a lot of people do not have celiac disease, they're just gluten intolerant and I actually think some of that gluten intolerance is actually because of the way wheat is processed and a lot of pasta, at least in the United States, has substances that are banned in other countries, like azodicarbamide. Countries like azodicarbamide If you didn't listen to my last season in 2024, the fall of 2024's podcast on food freedom and all the different substances that are allowed in our United States food supply but banned in other countries. That's a must listen to, and since I did the research for that, I threw away all my American pasta. I'm just going to a place that imports from Italy and for years I always would hear friends say that they would go to Italy and they would eat whatever bread and pasta and drink the red wine and enjoy themselves and not gain any weight, not have any GI distress, sometimes even losing weight from all the walking around.
Speaker 1:So we're going to mainly focus today on celiac, and one of the columns that we have on speakinginwomenshealthcom on celiac disease was co -authored by a guest columnist who had suffered infertility and multiple miscarriages, had had many pregnancy losses and it wasn't until her celiac that was diagnosed and treated that she was able to conceive. And a lot of times autoimmune conditions are not even thought about in terms of infertility, and the more autoimmune conditions that one has, the more likely they would have other autoimmune conditions. And especially with fertility I mean fertility rates in the Western world are collapsing, absolutely collapsing. A lot of this is from socioeconomic and cultural reasons. Some of it may be biologic, but you Gen Zs out there and you young millennials, fertility and having robust eggs is a really pretty short period of time in your life, and I don't think we talk enough about that. And of time in your life and I don't think we talk enough about that. And certainly when I see women that have ovarian dysfunction or premature menopause, I also think about celiac disease. Most people think of it as GI problems and when people that have celiac disease eat gluten, their body mounts this big immune response that attacks the small intestines and these attacks can lead to damage in the small villi. They're like finger, like projections that line the small intestine that promote absorption of nutrients and, and when they're damaged, nutrients cannot be absorbed.
Speaker 1:So who's at risk for celiac? Well, males and females are at risk. People of any age or race can develop this autoimmune condition. But there are some factors that can increase your risk. The first one is having a biological relative with celiac. When you get together in the summer for cookouts and picnics on Memorial Day or, later in the year, thanksgiving, it's kind of good when you have your family assembled the biological relatives anyway to inquire about any new diagnoses or conditions, and most non-medical people really don't want to talk about their medical problems usually, but it is important to have a really accurate family history. I just saw a woman today in the office who had thought for years that she had a relative die from lung cancer. But it was really metastasis of another primary to the lung and that's why for non-medical people communicating with other non-medical people sometimes the history is not as accurate as we would like. So there is a big hereditary component to celiac disease and if you have a first degree relative, like a parent or a sibling or one of your own offspring, with celiac disease, then you have at least a one in 10 chance of developing celiac, of developing celiac.
Speaker 1:Another risk factor for celiac is having the HLA-DQ2 and HLA-DQ8 genes. So 95% of people with celiac have the HLA-DQ2 gene and the other remaining 5% have that other HLA-DQ8 gene. So medical genetic testing can help determine if you have inherited one or both of these genes. So having the gene means you're at increased risk for the disease, but it doesn't mean that you definitely have the disease. So if you have a positive genetic test, we generally follow it up with a celiac blood panel and your genetic test. If it returns with a negative result, most of the time you can rule out celiac.
Speaker 1:The third risk for celiac disease is having autoimmune disease, because if your body is attacking itself and women in general have more autoimmune diseases than males because testosterone seems to help modulate the immune system. So if you have thyroid disease, like Hashimoto's or type 1 diabetes, those are examples of other autoimmune conditions. Sometimes premature ovarian insufficiency with antibodies directed against the ovaries is another autoimmune condition. Pernicious anemia, which can lead to trouble absorbing B12 because of antibodies against the stomach, the parietal cell or the intrinsic factor antibodies. So our friends at Beyond Celiac, which is a foundation, and we have links on our website and in the show notes and their website is beyondceliacorg and they have a nice disease symptom checklist. So if you think that you or your child or your grandchild or a relative may have celiac disease, it's a good resource to get started and you can share these results with your physician and ask about getting tested. And Beyond Celiac is a non-profit organization working to drive celiac diagnosis, advanced research and accelerate the discovery of new treatments and potentially a cure. Now the founder of Beyond Celiac, alice Bast, wrote a column on our website that I was mentioning and it's on speakingofwomenshealthcom, which, if you don't have that bookmarked on your cell phone or your computer or laptop, it's a good thing to bookmark, and the column is women's health and celiac disease, and then the search button. If you just put celiac or gluten, information will pull up, and so I want to share some of the content from that column, as well as other information we have on our website.
Speaker 1:There's more than 300 symptoms of celiac disease, which is one of the reasons it's underdiagnosed. Some of the more common signs and 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 migraines. Infertility A lot of times with infertility it's very technical and IVF, in vitro fertilization, has increased that sometimes some specialists just jump right to the technical aspects of fertility as opposed to maybe looking at the root cause. A lot of times the root cause is simply aging. Fertility declines after age 30. I mean, you may look fabulous at 35, but ooh, things are really going downhill. 35, it's going downhill.
Speaker 1:40, 45, some programs won't even take a woman past that age and ovaries age at different rates. So you may be in menopause at 40 or maybe 60. Most are around 51, 52. The range that we consider normal is 45 to 55. Premature is if it's under age 40.
Speaker 1:And that happens to 1% of women, there's this itchy skin rash called DH or dermatitis herpetiformis, and up to a quarter of individuals with celiac can get this rash, and it can be itchy and bumpy or even bulbous. Sometimes there can be pale mouth, sores, weight gain, thin bones or osteoporosis or osteopenia, tingling, numbness, and people with celiac disease may have other symptoms that kind of overlap with a lot of common symptoms in people in general at midlife and certainly around the time of menopause, like fatigue, brain fog, joint pain. Anemia is not a menopausal symptom, though, and anemia is not normal, and if you're over 40, even if you've had heavy periods babies, breastfeeding, things that drain your iron, other causes have to be looked for as well, other reasons instead of just brushing it off, because your gastrointestinal tract is very important for iron absorption and you need iron to build blood. You'll run out of iron stores before your blood count drops. So once your blood count drops, if you don't have any iron stores, that's pretty darn serious. The first podcast I did in season one that wasn't my book, the Cleveland Clinic Guide to Menopause or my medical CME was all about iron everything you wanted to know about iron. There are women and other patients that have impaired gut absorption and they have vitamin and iron deficiencies and even osteoporosis, but may not have symptoms. So it's not really one size fits all.
Speaker 1:If you don't treat celiac and take the gluten out of the diet, not only is osteoporosis and broken bones a problem, but dental problems and even certain cancers. So early diagnosis of celiac disease is very important. You have been listening to the Speaking of Women's Health podcast all about celiac disease. May is Celiac Awareness Month and we are going over some important information and I'm sure most everyone has heard of someone who says that they're gluten intolerant. My older sister thought that she had celiac. Every time she had gluten in her diet she had joint pain as long as she took it out of her diet. She didn't. She went and got tested, didn't have any findings of it, but she continues to maintain a gluten-free diet and the disease is different than intolerance and I think there's probably more than one reason for intolerance.
Speaker 1:We're looking at at least 3 million Americans that have celiac, making it a relatively common autoimmune disease. Making it a relatively common autoimmune disease, and because autoimmune conditions are more frequently in women. We do see this in women and the numbers suggest about 70% of all celiac patients are females and it can result in reproductive health problems like menstrual irregularities, unexplained infertility, miscarriages and even stillbirths. There was a study several years ago in the Journal of Human Reproduction and it highlighted the importance of physicians considering celiac in the diagnosis of women's reproductive problems in the diagnosis of women's reproductive problems. So women who are struggling with unexplained infertility should consider getting tested for celiac.
Speaker 1:Any woman with persistently low iron levels, low vitamin D levels, that's not corrected with adequate supplementation. The most common reason I see people not getting normal vitamin D levels after they've been diagnosed with low vitamin D is they don't take enough, they don't fill up the tank or they get to a barely normal level and then they stop. And I podcast three of the first season was all about vitamin D and that's a wonder substance. It's really not a vitamin. It really affects the immune system, cancer risk, bone health, mood. So in women that have lower bone densities than we expect based on their age and their weight and their hormonal status, it rings a bell for secondary causes and I will consider testing people for celiac.
Speaker 1:So if you think that you have celiac or someone in your family does that you're responsible for, it's good to make an appointment with your healthcare team. You actually want to remain on a gluten rich diet? Uh, because if you totally take out the gluten from your diet and reduce the inflammation, you may not have positive blood test or antibodies. Uh, so that can lead to an inaccurate test. So, uh, your physician or GI doctor may recommend what's called a gluten challenge, which intentionally involves eating gluten bread and wheat pasta. Pizza and I'm not talking about the cauliflower crust kind, probably pizza with the crust is probably one of the foods that my patients that have celiac disease tell me that they miss the most. A lot of people can easily take wheat and gluten out of their diet and it's a lot easier now than it used to be. There are more well-marked gluten-free dietary options and it's easier to go out to many restaurants where they have the little labels if it's gluten free.
Speaker 1:Unfortunately, if you take gluten and you have celiac, you might get some really bad symptoms. So people don't want to feel poorly, but if you know you're going in specifically to ask to get the celiac blood test, you really should do this. So some of the testing typically begins with like a blood panel looking for specific antibodies, and one of the first things we look at is your total IgA. That's an immunoglobulin that's secretory. Interestingly, though, 10% of the population has a low level, and so if you're one of those people one in 10 that has low IgA levels we can't rely on the blood test. Excluding things. We also do an IgA-T-TG, which stands for tissue transglutaminase, and an EMA-IGA, but, as I mentioned, if IgA is deficient then we might get the IgG-IgA-DGP test, and so that can be done at the discretion of a physician. Genetic testing with haplotypes can be tested, because only certain haplotypes are truly associated with the risk of celiac disease.
Speaker 1:So if you remain on a regular diet that has gluten and wheat prior to testing for celiac, don't change to a strict gluten-free diet until after you've been evaluated. If the blood test and symptoms still indicate celiac and we can't rely on the blood test, the more definitive test is a lot more involved, and that involves seeing a gastroenterology GI physician and, after having a gluten challenge, an upper endoscopy done, a little scope about the diameter of my finger is inserted down the back of the throat into the stomach and esophagus, and a biopsy is done of the duodenum to look under the microscope. If there's inflammation and loss of the villus architecture keep in mind, though you can have a normal biopsy just because you've avoided gluten and you've helped heal your intestines, um, and so it's very important to get all this coordinated with your physician. So an upper endoscopy is also called an esophagogastroduodenoscopy, egd, and if your biopsy shows inflammation, you're still not done, because then we have you take gluten out of your diet and then re-biopsy you to prove cure or remission actually not cure, because you still have the condition but you can be in remission by totally removing gluten, and you know gluten is in so many things.
Speaker 1:It's even in some over-the-counter pain medications. It can be in certain alcohols, cosmetic products, fillers. There's a lot of ways to be exposed to gluten, and even if celiac runs in your family, it can manifest differently in different relatives. So if you're persistently low in iron, like you, have a low ferritin, we like a level of at least 50 to 70 for energy and hair growth. When I talk about hair people's women anyway it's attention perks up, and if you haven't listened to my prior June of 2023 and 2024's podcast on everything hair, or early in this season three, I did one on biotin, the vitamin, the hair vitamin. That's not really a hair vitamin. Those are good ones to go back to. So you want a good iron level. You want a good vitamin D level. If you've got bone loss, that needs to be monitored by a physician who's got some expertise in osteoporosis.
Speaker 1:If you have infertility or premature ovarian insufficiency or recurrent miscarriage, ask to be tested. I mean it's really sad when you see women who've gone through six pregnancy losses before they've been diagnosed, when they could have been taking the gluten out of their diet. If you're dealing with infertility, don't just take gluten out of your diet on your own. I mean you want to go in and get a medical, hormonal, gynecologic and reproductive evaluation. And as far as infertility, if you're under the age of 30, we usually recommend at least a year of trying to become pregnant, which is having sexual activity without any kind of contraception or rhythm, intentionally around the time of ovulation. But if you're over age 30, we only give you six months, and that's because that clock is really ticking.
Speaker 1:If you've been told that you have irritable bowel syndrome or especially inflammatory bowel disease, ibd, like Crohn's, or ulcerative colitis, you may want to ask about being tested for celiac as well and, as I mentioned, there's many people who do not have celiac but they still are gluten intolerant and they still want to avoid gluten, and that's called non-celiac gluten sensitivity and I'm concerned that some of it has to do with how we might process wheat and pasta the pastas that use wheat in our food supply. So there are many ways to alleviate the discomfort and reduce the chance of complications from celiac. If your intestines is damaged, the villi the architecture, and your physician's concerned about your nutritional intake, you may need certain supplements or even vitamin injections, and you will have to take all gluten out of your diet and be counseled, perhaps, by a nutritionist. Some of the more common nutritional deficiencies in celiac include not just iron and vitamin D, but zinc and copper and folic acid and B12 and vitamin K, and your physician or health team can order blood work to see what you may be deficient and if you're very endemic you may actually even have to get an iron transfusion and this has to be done in a responsible center because there can be anaphylaxis to iron infusions. It's not as easy as other types of fluid infusions or other therapies that we give by vein give by vein Many times. Your nutritional deficiencies should go away as your intestines heal, so hopefully you can be weaned off some of these supplements or injections. If you've got that itchy dermatitis herpetiformis, talk to your physician or dermatologist about dapsone, which is one of the more common medicines used to treat dermatitis herpetiformis.
Speaker 1:Medicines could ease the itching, but if you wanted to go into remission you must follow a strict gluten-free diet, and many people with celiac disease do have GI distress, and that's not fun to have nausea or vomiting or diarrhea. So you must stay hydrated, get enough water and electrolytes. Electrolytes and liquids, including coconut water, and some fruit and vegetable juices may be helpful. Warm tea might help settle your stomach. 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 with constipation, we want hydration, plenty of fiber, leafy greens and whole grains that do not include gluten, and also enough magnesium. Probably after vitamin D, the most common deficiency I see is the mineral of magnesium and then other foods that aren't necessarily gluten-containing foods that can still irritate the gut sometimes can irritate people that are sensitive Things like fried foods and very spicy foods, coffee.
Speaker 1:If you have celiac, you have to be aware of medications or other supplements that can have gluten in them, so you must talk to your physician pharmacist before taking any new medications or changing your your diet. And this podcast, of course, is not medical advice. It's just information to empower you to be strong, be healthy and be in charge. For those people that are suffering with continued GI and celiac symptoms, there is hope on the horizon. A number of potential therapies are being studied, but right now, the main focus to heal the intestines and reduce the risk of complication, including osteoporosis, infertility and also intestinal lymphoma, is to follow a strict gluten-free diet. Now, thankfully, this is getting easier.
Speaker 1:Not all restaurants will label for gluten, not all foodstuffs will, but I've seen over the last several years, in many grocery stores and restaurants that I have frequented, sections or highlights on what is gluten-free, and we have a lot of gluten-free recipes on our speakingofwomenshealthcom website. So if you're on our site, click on the recipes at the top of the website and you can use the filter to find the gluten-free recipes. And when I am out shopping at the grocery store, I frequently will take a look at recipes to figure out what other ingredients that I might need, and sometimes I'll even post things that I've made at home from our recipes on our Facebook page or Instagram page. So we're on all the social media, all of our social media, just like this podcast, is called Speaking of Women's Health.
Speaker 1:I've had a few of my patients say, uh, is it the Sunflower House? I'm like, no, no, we're in the Sunflower House because the sunflowers are a logo, but everything that we do is speakingofwomenshealthcom. And so thank you for joining me in the Sunflower House, and if you don't already subscribe to our podcast, hit, follow or subscribe on Apple Podcasts, spotify, tunein or wherever you listen, feel free to share this podcast with friends and family. Give us a five-star rating, please. That helps us move up. If you'd like to watch the podcast and interviews, you can go on YouTube or our Rumble channel on Speaking of Women's Health. Thanks again and I'll see you next time in the Sunflower House. Be strong, be healthy and be in charge.
