Sorry gluten-lover, with the holidays just around the corner I hate to say this but … gluten is on the endo most-wanted list, no matter who you are, your ancestry, or if you think you tolerate it just fine. If you have endo-pain, endo-belly, systemic inflammation, or any other chronic disease issue, you are not tolerating gluten as fine as you think. And although I’m all about replenishment rather than restriction, sadly gluten makes the mandatory-restricted list in my practice with every. single. client.

How does gluten intolerance affect you?

In so many different ways it’s crazy. Gluten intolerance can come in the form of rashes, eczema, swelling, joint pain, allergies, inflammation, or any gastro issues like constipation or diarrhea, bloating, or an inability to lose stubborn weight (or “inflammatory weight”, as I might call it, that slightly puffy look). Gluten intolerance is a known fertility disruptor as well, potentially causing hormonal imbalances, ovulatory disorders, or an inability to get pregnant or carry a baby to term.

But humans evolved eating bread, what’s the deal?

Healthy humans made bread and ate it, mostly chronic disease free. #Truth.

However, this bread looked much different than your Costco bread today, more like a rock-hard, very chewy, grainy loaf. To make the bread, the ancestral wheat (that was low-gluten to begin with) was always fermented first to remove gut-damaging phytates and then “predigested” by fermenting it. This is akin to traditional sourdough today, where the fermentation process eats away much of the gluten.

Then, as for the remaining gluten, these ancestors of ours had a healthy + robust microbiome could continue to break it down, as well as less stress + more sleep. This allowed your healthy, ancient ancestor the ability to eat gluten. Oh, and drink beer.

Industrial bread products today are not fermented, and they are made with wheat that has been bred to have increased gluten content to boot - not to mention are often loaded with glyphosate (a pesticide). Increased gluten can directly damage the gut lining, leading to leaky gut and thus low-grade systemic inflammation. Wheat today is also less nutritious than the wheat of last century, with 19-28% lower amounts of zinc, copper, iron and magnesium. This means if you’re filling up on bread, pasta, pastries, or doughs, you’re at risk for body-wide inflammation AND malnutrition. Bummer.

Endometriosis, Celiac, and Infertility

Celiac is an autoimmune disease that links gluten consumption with an immune system attack on your small intestines, and women with celiac are shown to be at a higher risk for developing endometriosis. If you haven’t been diagnosed, it doesn’t mean you don’t have it, since it’s estimated around 95% of coeliacs haven’t yet been diagnosed. That’s a lot of folks, making coeliac disease one of the most under-diagnosed auto-immune disorders in the U.S., And even if you’re not in the 1% of people with coeliac, you can still be in the 6-8% of folk with non-celiac gluten sensitivity. These people measurably react to gluten consumption so much that they can be clinically diagnosed. This is no “fad diet.”

Undiagnosed coeliac disease itself is a significant contributor to infertility, miscarriages, or stillbirths. In one study,  women with undiagnosed coeliac were “12 percent more likely to have a miscarriage and 62 percent more likely to experience a stillbirth” than those without. This may be more due to the malnutrition associated with coeliac since your small intestine becomes so destroyed it’s unable to absorb the nutrients needed. If you’ve been diagnosed with endometriosis first, this may become a major issue in your fertility journey since doctors may delay a diagnosis fo coeliac by assuming your infertility issues stem from the endo instead. This is why it’s essential to cut off ALL gluten if you’re in baby-making mode.

Endometriosis pain + gluten

If endo pain is your bummer symptom, going gluten free may help a lot. In one study of women with endo, 75% of participants who cut out gluten had dramatic reductions in their pain from this act alone. The “why” of the study wasn’t clear, but if you’ve read through my site and ebook and understand how leaky gut causes systemic inflammation - and how gluten may directly contribute to leaky gut - you’re winning the diet-gut-endo-connection game. Yay for addressing endo-belly!

Gluten, the microbiome, and epigenetics

Gluten proteins may not just poke holes in your intestinal lining, but it’s been shown to actually change your microbiome for the worse.  One study was able to show in mice how gluten consumption led to an increase in diabetes by altering the gut microbiome, and how my following a gluten-free (GF) diet mice could prevent the onset of such disease. Another  study here illustrated how gluten increased inflammatory markers in ALL individuals, not just those with a diagnosed disease.

Then there’s epigenetics, the science of turning gene expression on and off. This mouse study was able to show how mama-mice with a high 64% chance of developing diabetes were fed a GF diet which reduced their baby’s chance of diabetes to 15%, then grand-babies chance reduced to 6%. In layman's terms, grandma with a huge chance of developing diabetes decreased their grandchildren’s chance to 6% by merely removing gluten - which is HUGE! This example is epigenetics at its core, that you can start to reverse trends of chronic disease in your genetic line by taking pregnancy and pre-pregnancy diets very seriously - with removing gluten being one of the core tenets. 

How to go Gluten-free for Endometriosis

I recommend all my clients go gluten-free. Really, anyone with endometriosis or any other inflammatory disorder should in my book. And because there won’t even be enough room on your plate for gluten when it comes to the Heal Endo approach, you may not miss it as much as you think! You’ll be so focused on whole foods veggies, fruits, meats, and fat that there won’t be room in your tummy for gluten or other processed goodies (said an overly enthusiastic nutritional therapist ;). Of course, change is never easy, so here are a few tips to start. 

• If you’re not an all-or-nothing gal, try focusing on one meal at a time. Maybe breakfasts are easiest for you to say no to gluten, so focus on that first. As you feel confident in your food substitutions, add another meal, until all your meals and snacks are carefully weaned.

• Focus on replacement rather than restriction. Instead of saying no to all gluten and suddenly feeling hungry and limited, make sure you have loads of whole foods alternatives that you like. Cauliflower or broccoli rice, potatoes or sweet potatoes, squash, greens, fruits, the list goes on! If you need a simple starch for the meantime for the IBS crowd, white rice can be helpful.

• If you need to use gluten-free subs as a crutch in the short term, that’s okay, but in the long-run focus on cutting out all processed fare, gluten-free included! We don’t just want to cut out gluten, but also reverse malnutrition so you can truly heal, and filling up on rice bread and crackers isn’t the best way to do this… No one said you have to replace a gluten product with an identical replacement either, like gluten-free pasta for pasta. Try pasta sauce over zucchini or squash, replace morning toast with a homemade sausage patty, replace chips for fruit with nut butter.

• Read labels. I don’t know how many times I accidentally poisoned myself when I was a gluten-free-learner-bee. Just because something says it’s made with corn or rice doesn’t automatically mean it’s not made with wheat. And even wheat-free labels don’t mean gluten-free

• Don’t give up if you don’t feel the effects right away! Some people take 6-12 months to fully feel a difference, which makes sense when we think about just how much gluten can disrupt hormones, the immune system, and the microbiome. If you tried GF before to no avail, try it again with all of these tips in mind.

• This will be a significant lifestyle swap for many of you, so go as slow as you need to make this habit stick. There’s nothing worse than burn out, so make this change as slowly as you need to make the swaps sustainable. Still, keep the goal the same: to eliminate gluten completely. Sadly, no 80/20 rule will apply here if you’re still battling with endo (which I assume you are if you’re reading this). So stick with, be okay with making mistakes and learning new flavors, but over the course of a year chances are removing gluten and increasing whole foods will make you feel better.