Gluten and Endometriosis: Is There A Connection?

Chances are you know at least one person who has chosen to turn their back on gluten and has instead turned to a gluten-free diet. More than ever, we are seeing the “GF” labels on just about every possible food item, even food items that never had gluten containing ingredients in the first place but are now being marketed as gluten-free products. Although gluten-free diets are often necessary for those suffering from Celiac disease, an autoimmune disorder that damages the small intestine, only about 2 million of Americans, or about 1% of the world, is said to be affected by Celiac disease. That being said, researchers have estimated that about 25% of Americans currently follow some form of a gluten- free diet. Many of those who have chosen to follow a gluten-free diet, Celiac or non Celiac, report improvements in a variety of health concerns including abdominal discomfort, chronic bloating, skin conditions like eczema, autoimmune related thyroid disorders (Hashimoto’s) and even hormonal conditions like Endometriosis. In today’s blog post, I wanted to look specifically into the connection between Endometriosis and Celiac disease as it is something we have noticed a possible connection in our naturopathic medical clinic. 

Endometriosis, a leading endocrine disorder and a major cause of infertility impacts over 6.5 million American women. Although common, the root cause is still very unclear. Endometriosis is often a painful pelvic disorder that occurs when the lining of the uterus, specifically the endometrium, grows outside of the uterus. Women with endometriosis may experience endometrial tissue that has traveled to the ovaries, fallopian tubes, as well as the rectum and intestines. With endometriosis, the endometrial-like tissue acts in a similar fashion as the endometrial tissue in the uterus and will thicken, break down and bleed with each menstrual cycle. Although your doctor may have suspected endometriosis due to years of debilitating menstrual cramps, some more mild cases will not be diagnosed until a patient struggles to conceive. Although laparoscopic surgery can be used to diagnose and treat endometriosis, the endometrial -like tissue is often extensive and can grow back leading to repeat surgeries. This can leave many women frustrated, overwhelmed and hopeless about their condition.  

Although the exact cause of endometriosis is still unclear, researchers believe endometriosis is likely multi factorial and may involve a few important theories including: 

  • Peritoneal cells - the idea that hormones or immune factors promote transformation of the cells that line the inner side of the abdominal and turn them into endometrial-like cells. 

  • Retrograde menstruation - menstrual blood containing endometrial cells flow back through the fallopian tubes and into the pelvis rather than out the body. During this process, the endometrial cells may stick to the pelvic wall and surfaces of the pelvic organs. 

  • Embryonic cell transformation - hormones, especially estrogen, are thought to transform cells (specifically embryonic cells) early in development into endometrial like cells. 

  • Surgical scar implantation - endometriosis may occur after pelvic related surgeries like hysterectomy or C-section and attach to the surgical incision. 

  • Immune system dysfunction - the immune system mistakes endometrial tissue as a foreign invader and promotes an immune response that destroys endometrial - like tissues. 

Although the root cause is still not completely understood, many researchers agree that there is likely some form of immune dysfunction involved in endometriosis. It is also the reason endometriosis is often considered to act like an autoimmune disease. 

Since having one autoimmune disease can predispose you to developing other autoimmune disorders, researchers were particularly interested in women with Celiac disease and determine whether they were more predisposed to developing endometriosis and if this had an impact on their symptoms and disease process. The researchers investigated 11,000 Swedish women with diagnosed Celiac disease to determine the occurrence or development of endometriosis. The researchers found that there was a clinical significant higher risk of developing endometriosis in patients with Celiac disease. Although the exact cause is not fully understood, it appears that they likely share similar immune stimulation and immune mediated inflammatory responses. 

Now although going gluten-free will not magically resolve your endometriosis related symptoms, this type of research gives us some interesting insight on how we should not only be evaluating a patient’s diet but also the development of pharmaceutical medications that could be directly targeting the immune system and improving patient care.. At NMD Wellness of Scottsdale, we will often screen patients suffering from endometriosis for Celiac disease. Although the gold standard for diagnosing Celiac disease is a biopsy of the small intestine, a tTG-IgA (Tissue transglutaminase IgA antibody) blood test can often be used as a primary test for Celiac screening. Although we still need more research to expand our understanding of the connection between Celiac disease and endometriosis, at NMD Wellness of Scottsdale, we have found that screening for Celiac disease in patients suffering from endometriosis to be extremely helpful and allows us to provide better patient outcomes for those suffering from debilitating pelvic pain. Following a gluten-free, and in some cases, a grain-free diet, could be considered an appropriate dietary change in those suffering from endometriosis. Again, remember the study was done on patients with Celiac disease, and it is still unclear if gluten-free diets would be beneficial in the treatment of endometriosis in non-Celiac women. 

Now, before you go adding “gluten-free” items to your cart, I highly encourage consulting your doctor directly and consider adding a dietician to your healthcare team to help provide you dietary support as well. If you have never been screened for Celiac disease, but have endometriosis or endometriosis like symptoms, do not take gluten out of your diet completely until after completing a tTG-IgA blood test. The accuracy of this test is dependent on the presence of gluten in your diet. 

About the Author: Meet Dr. ZenAlissia Zenhausern- Pfeiffer, NMD, FABNE, (commonly known by her patients as Dr. Zen), is a licensed naturopathic doctor board certified in naturopathic endocrinology and the founder of NMD Wellness of Scottsdale, a premier naturopathic medical practice that focuses on helping women to take a proactive approach to their hormone and fertility health. Dr. Zen has been featured as a lead expert in Forbes, Shape Magazine, and Instyle and is deeply passionate about bridging the gap between traditional and natural medicine in the world of fertility. She works with a variety of hormone related issues including PCOS, endometriosis and unexplained infertility. Her goal is to help more women get back into the driver’s seat of their own health to make lasting transformational changes to their health to bring more cute and adorable babies into this world. Read More About Dr. Zen...