Stephanie Fein MD [00:00:00]:
Hello fabulous Dr. Stephanie Fein here with weight loss for fertility and do you need to remove gluten from your diet to improve fertility? Maybe today I'm telling you, if going gluten free is right for you and in general, if you've been around here any length of time, I do not remove food groups. That's not the way we lose weight around here. But this is the one exception in certain cases and I've had some of those cases come up and so I decided time to do one of these podcasts for it. But then I've also gone down celiac disease rabbit holes. First I do want to mention I myself have celiac disease. I do not eat gluten and I haven't for 17 years now. And my diagnosis was not made gracefully.
Stephanie Fein MD [00:00:52]:
It was 17 years ago and we have come a long way as per usual with medicine. And it took about two years. That was pretty standard back then. I just had a lot of GI weirdness things that I never had. I could always eat anything ever. And it started to not be the case and I got a lot of infections and I finally was so fed up and doctors were not being particularly helpful, which is usually that was the case back then is it's a whole bunch of non specific symptoms and doctors would do the things that they normally do and when all those things were normal, they shrugged. You might be familiar with this when it comes to unexplained infertility. It's a similar thing that when doctors don't know stuff it goes in a big pile and then the patients are left holding the bag.
Stephanie Fein MD [00:01:47]:
Not always. And that's why we look for fabulous doctors who listen to us and help us figure things out. So I one day I just got so frustrated and I was really not feeling well by that time and I just took everything out of my diet and it turned out that gluten was the thing that I could tell made a difference. And then once I did that I got some testing and the testing was equivocal some of but I was positive for the gene that looks like it was an inherited. I have the gene for celiac and because of my symptoms and all the rest of that stuff I am diagnosed with celiac and I am have been gluten free and very happy with it. And in fact recently I had a doctor because things were equivocal which just means they couldn't quite. It wasn't a very clear diagnostic case. Now that that was because I had been gluten free already.
Stephanie Fein MD [00:02:42]:
So I had treated it myself, I got better. Then we're like, maybe it was celiac. But by that point, I was not willing to go back on gluten, which is something that doctors offer. And I just recently had someone, even though it's been 17 years, say, oh, if you want to have a clear diagnosis, you could just do the gluten challenge for six to eight weeks. And that was no, thank you very much. The memory of those two years of discomfort are seared into me. I will not be doing that. Also, I have to say that being gluten free is not a big deal.
Stephanie Fein MD [00:03:19]:
It's very normal in my world. Now it's been 17 years. I'm in Southern California. It wasn't even particularly hard 17 years ago. And now they have gluten free everything. So I am perfectly fine. I feel so much better. So I will not be having gluten or doing a challenge.
Stephanie Fein MD [00:03:37]:
I'm mentioning all this because celiac disease is an autoimmune disease. Specifically, when people with celiac disease eat gluten, which is a protein found in wheat, rye and barley. Gluten is in wheat, rye and barley. Their bodies mount an immune response which attacks the small intestine, specifically the villi. So those are little mini mini projections in your small intestine. When the villi get damaged, which they do, they get completely wiped out due to this autoimmune reaction. Nutrients can't be absorbed properly in the body. And that's a problem that leads to hospitalization for some people who get diagnosed with celiac.
Stephanie Fein MD [00:04:21]:
But the sort of. The bigger issue, or the one that I think impacts a lot of people, is that the body experiences this chronic inflammation because there's a constant source of irritation, a trigger. And so the body is constantly in an immune response. That becomes a chronic immune response and that causes symptoms often. And when we actually have symptoms like fatigue, GI symptoms, skin symptoms, just like infections, because so the GI is now letting in to the bloodstream things that it normally wouldn't. And so you can just get other infections too. So a change would be something that would be noticeable. And that in and of itself is a problem when we have symptoms.
Stephanie Fein MD [00:05:20]:
In my mind, the way that kind of works. And we see this with other autoimmune diseases, diabetes type 1. And also we can see this profile that I'm about to talk about with diabetes type 2, which means the disease process is going on years before we see it. So there. And that would happen with celiac too, right? There would be. The immune response is happening. So it's happening on the cellular level inside the small intestine. But until the villi are completely gone, we're not getting symptoms that are big enough that we're noticing them on the outside.
Stephanie Fein MD [00:05:57]:
That's gonna be an important point in how I recommend eating or not eating gluten. It's that window of years when something's actually happening in the body, but we can't tell it's happening. That piece is really important, and I think for fertility, that's the place I want to make an impact when I recommend not having gluten. Now, remember, I am not telling everyone not to have gluten by any stretch. I'm gonna tell you who I do recommend it for and under what circumstances. In terms of celiac disease, though, I wanted to point out that it's 1 in 100 people in the US has it, and up to a third are undiagnosed. And that number is changing over time. It used to be much bigger that were not diagnosed.
Stephanie Fein MD [00:06:56]:
It's getting better and better. People are more aware of it now. But I will say 12% of people with untreated celiac disease have unexplained infertility. There is a big connection with celiac disease, untreated celiac disease, and infertility. And what that can come down to, we don't know exactly. But chronic inflammation is a problem. Now, we know that with endometriosis, how there's inflammation with that, and that would be connected to hormonal fluctuations. And of course, you go to your RAI to get that diagnosis, and it's often very difficult.
Stephanie Fein MD [00:07:36]:
That's another one of those ones that takes years to get to sometimes. But chronic inflammation seems to be the mechanism. What I mean by mechanism is the fact that there's inflammation in the body, in and around uterus, ovaries, fallopian tubes, makes fertility, makes pregnancy, conception more difficult. We don't know exactly how, but chronic inflammation can affect egg quality, egg transport, fertilization, implantation, and can impact miscarriage rates. What's interesting is estrogen and progesterone both suppress our immune system, which they would have to, because we're talking about having a foreign body come in and take up residence in your uterus. Foreign because the sperm is in there and creates the embryo. And so we need to have less of a trigger for inflammation in order to allow this foreign body to grow and implant and all the rest of that stuff. So if we have increased inflammation, that is not putting it in the right environment.
Stephanie Fein MD [00:08:58]:
Right. Increased inflammation would have a detrimental effect on conception, implantation, all that part. This is just how I think about it. So if you are someone that has symptoms, if you know you have symptoms with gluten, that's a really important thing to know. But if you're having symptoms, GI symptoms, skin symptoms, fatigue, brain fog, all that sort of thing, taking certain things out of your diet could be helpful. Now, of course, I want to say please do this with your doctor. Okay. You can certainly start with your infertility doctor, if that's the place that this is coming to light.
Stephanie Fein MD [00:09:47]:
But also your primary doctor and depending on your symptoms, a GI doctor. These are all really good people to see. Now, I have had clients. I had the one, I don't know if I mentioned her now, I had one that did in fact end up having celiac disease. But because I was very aware of it and because I heard what her symptoms are, we went gluten free right away. And she was then able, within a couple of months she was got pregnant, had her baby girl. So that one was a very clear case. It looked very linear, like it was because of the celiac disease.
Stephanie Fein MD [00:10:26]:
And then she treated it and then was able to get pregnant and carry a pregnancy. Dr. Natalie Crawford, I don't know if you know her, she is amazing. She's on Instagram at Natalie Crawfordmdash. She just came out with her book, the Fertility Formula and she's a wonderful person to follow. She tells the story of her own. She had four pregnancy losses and it turns out it was because of celiac disease. But she did not even get diagnosed until after her two kids that were born.
Stephanie Fein MD [00:11:03]:
She changed her diet and went gluten free and then was able to carry two pregnancies. She has great information in her book the Fertility Formula. She tells her story in there, but also tells you so much about fertility in general. But her story and my client's story are ones that I always keep in mind. Celiac disease in general is a simple fix. No gluten ever. Now, I'm not saying it's easy, but that's. It literally doesn't cure it.
Stephanie Fein MD [00:11:35]:
Like you never have it again, but you do not have any of the symptoms. If you never eat gluten again, I think that's amazing. Like I'm all for that one. Super cheap, very in your control and then it works. So if you are having symptoms, then it would be great to go to your doctor. But here's what I want to say if you've been to your doctor, because I also have clients like this and this is Again, why I'm doing this podcast episode. If you've been to doctors and it's equivocal, meaning they can't quite get all the information, it's this one's positive, but this one's negative and you don't really see a clear sign. To me, it's worth it to try to be gluten free when you're trying to get pregnant again, because we could be in that window before it shows up.
Stephanie Fein MD [00:12:34]:
The antibody tests that are done, and if they're positive, then you know you have celiac disease. You may be just starting that process and your immunoglobulins aren't high enough to register, there could maybe you just smolder, meaning it's chronic inflammation, but it's not registering. That would be good information to find out, but we may not be able to with a blood test. So definitely get your doctors involved. And also you may want to do a trial of gluten free eating. When it comes to infertility, to me it's like a no brainer if you're having symptoms, because it really could make a huge impact. If you're having chronic inflammation due to gluten and you take out gluten, the chronic inflammation can go away. And if it does, that may be all that's needed to get and stay pregnant.
Stephanie Fein MD [00:13:45]:
And wow, wouldn't that be amazing. So anyone I'm working with that has symptoms with gluten, I highly recommend a trial without gluten if you don't have symptoms. That is not something I routinely recommend. Weight loss in general is effective for decreasing inflammation. That's actually one of the main ways that it helps because fat in and of itself, fat tissue in and of itself is pro inflammatory, meaning it, it causes inflammation, so losing fat will decrease it. But I do not recommend going off of gluten to lose fat. We do that, the weight loss for fertility way with the hunger scale, the food date and the mind work that goes with it. That's how we have permanent weight loss.
Stephanie Fein MD [00:14:36]:
That will help the milieu, the internal state, and that also can help. So all of this is affecting chronic inflammation. That is what we do. But I'm talking particularly if you have symptoms when you eat gluten. And like I said, I don't normally exclude food groups, but this is the exception to that rule. I do think a trial without gluten makes a lot of sense. And a trial would be two weeks at the minimum, four weeks better. In terms of someone with celiac, they're usually signs of Healing in six months, in three months, you certainly can make a profound difference to your reproductive system if in fact that's what's going on.
Stephanie Fein MD [00:15:34]:
So to recap this idea, there's no reason to be gluten free if you don't have to be. That is not the weight loss technique. If you're just taking gluten to lose weight, I wouldn't recommend it because now there's so many gluten free options that are just the same. And so it's not helping anything if you don't need to be gluten free, don't be gluten free, lose weight, the weight loss or fertility way. If, however, you have symptoms or you have celiac disease, then yes, you should try being gluten free. If you have symptoms. GI symptoms, skin systems, joint systems, like feeling bloated, brain fog, fatigue, which can be non specific. If you have them, especially if you notice you have them when you have more gluten, then I do think a trial is a really good idea.
Stephanie Fein MD [00:16:36]:
But I recommend seeing your GI doctor or your PCP to get the blood tests while you're still on gluten because that's when they're going to be most positive. If you stop eating gluten and then go in for the tests, they won't be positive. Now here's the tricky thing. Sometimes we can't get in appointments with our doctor for a long time. If you are doing transfers, if you're in the process of doing fertility treatments, I wouldn't wait. Maybe your infertility doctor can do the test before you go gluten free. But I wouldn't postpone going gluten free if you can't get a GI appointment for four weeks. Now that may be controversial and your doctor may not be happy with that.
Stephanie Fein MD [00:17:21]:
So you certainly can talk with them. Sometimes what you can do is talk to them via an email and then they can order it and you can go in and get that and then have a appointment set up with them later. So do what's right for you and your doctor to get the diagnosis. And also I want you to be able to heal yourself if in fact gluten is causing a problem. So give it a trial. Now the thing about not having gluten is it seems straightforward, but it's not completely. I highly Recommend going to celiac.org and that's C E L I A C.org that's the website has so much good information on there and I will link it up in the show notes. It's the foods you can have and the foods you can't.
Stephanie Fein MD [00:18:14]:
There's so many foods you can have. Every vegetable, every fruit, beans, meats, so many things. What you cannot have is wheat. And I'm just going to go through a little bit of what that looks like. So wheat and derivatives of wheat, which are things like semolina, spelt, farrow, there's wheat berries, rye you cannot have. Barley you cannot have. And malt you cannot have. Brewer's yeast.
Stephanie Fein MD [00:18:45]:
So no malted milk or malted barley flour or beer is also in there. So the common foods that contain gluten are pastas, noodles, like ramen, udon, soba, chow mein, egg noodles. There's like breads and pastries, crackers, baked goods, cereals and granola. Cornflakes and rice puffs often have malt extract. So that makes it that you can't have it. But like Cheerios are now gluten free. So you know, you have to be start being really good at looking at the labels. Breakfast foods like pancakes, breading and coating.
Stephanie Fein MD [00:19:29]:
That is a big one. Where there's wheat. So that avoid. So most like fried nuggets of any kind are usually not gluten free. Croutons can't have sauces and gravies. And this is an important place where people don't really remember to look. Traditional soy sauce has wheat in it. So anything with soy sauce will have wheat in it.
Stephanie Fein MD [00:19:55]:
And cream sauces are often made with a roux, which is a wheat and butter combination. And so if it has, that would be something to avoid. Also flour tortillas. And I talked about brewer's wheat. Those are the big. I am just looking@the celiac.org site. It's really a good place to go to start looking where you need to look. I would take those things out of your diet.
Stephanie Fein MD [00:20:23]:
Of course there's like a learning curve. It's not a problem. We're just going to learn how to do that. The other thing I would do is keep a symptom log. So how you're feeling every day, how those symptoms are and if they're improving over time. If you take away gluten, you don't have any gluten for a couple of months and your symptoms are the same. That wasn't it. If they're better, amazing.
Stephanie Fein MD [00:20:48]:
How will you remember? You wouldn't unless you keep a log. We forget things so easily. Like how many times did I have a headache? How many times? Like as you're getting better, you're like, oh, you know, it wasn't that bad. Yeah. You used to have headaches four times a week, and now you have them one time a week. That's amazing. But if you didn't write it down, you may not remember. Keeping a symptom log is very helpful in this sort of scenario.
Stephanie Fein MD [00:21:15]:
Your doctor will really appreciate it, too. If, however, you take out the gluten and your symptoms improve, any at all, I would recommend staying off of gluten through your retrievals and transfers and pregnancies because it directly impacted how you're feeling. And even if the blood tests are. If they're again, equivocal, meaning we can't quite tell, then it just makes sense to be on the safer side. And because it's really simple and inexpensive to not eat gluten, to me, it would be something that's worth it. Certainly you get to make your decision, but this is what I would recommend in conjunction with your doctors, your rei, your pcp, maybe a GI doctor. Okay, that's it. I do think that it has the potential to make a big difference in your fertility journey.
Stephanie Fein MD [00:22:16]:
I have seen it over and over again. Dr. Natalie Crawford is a public example. I've had it with my clients. It really can be something that can work if there are symptoms. It is not something that I recommend for just everyone going through fertility treatments or everyone trying to lose weight. I don't think removing gluten from your diet is the answer if you're not having symptoms or you're not diagnosed with celiac. If you are diagnosed with celiac, it is the answer.
Stephanie Fein MD [00:22:47]:
It's certainly the answer for treating celiac, and it likely greatly impacts your fertility. But if you're just symptomatic and you become asymptomatic by being off of gluten, to me, that has to also impact your fertility in some way. Maybe not completely, but one of the, you know, three things that are contributing to it, and if we can do anything about it, it's. It feels good to. To be able to do something about it. And having an answer feels really good, too. That's it. If you have any questions, I am more than happy to answer them.
Stephanie Fein MD [00:23:27]:
You could Always find me @stephaniefeinmd on Instagram or LinkedIn or stephaniefeinmd.com There's a contact me and you can contact me. You can also lose weight with me there. I'm gonna link up in the show notes about the celiac.org website. And also Dr. Natalie Crawford with her new book, the Fertility Formula, which I highly recommend if you're interested in all things. Fertility. She's excellent at explaining things. And it will be a great resource for you.
Stephanie Fein MD [00:24:01]:
I am sending you so much love. If you're having symptoms, a trial of being gluten free with your doctor's knowledge might just be something that works out well for you and your growing family. I'm sending you so much love until next week.
