A Balancing Act: Women’s Health and Celiac Disease, with Sheila Crowe, MD

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Sheila Crowe, MD, CDF Medical Advisory Board Member, Vice President of the American Gastroenterological Association, and Professor in the Division of Gastroenterology in the Department of Medicine at the University of California, San Diego (UCSD), delivered her presentation, A Balancing Act: Women’s Health and Celiac Disease, at the 2015 Celiac Disease Foundation National Conference & Gluten Free EXPO. Though she focused on women’s health topics, such as the impact of celiac disease and treatment in women, as well as diagnosis and the gluten-free diet, men in the audience could still find value in her presentation, as celiac disease can also affect fertility in men.

Blood serology has shown to be very useful in the diagnosis of celiac disease, but current research has called in to question its accuracy when looking for intestinal healing in patient follow-up.

Dr. Crowe opened with a case study, and then touched on the effectiveness and interpretation of the anti-tTG blood test. Echoing what Joseph Murray, MD, spoke to earlier in the day, Dr. Crowe stressed the importance of understanding its results. An anti-tTG test result of a strong positive means you have an increased chance of having the disease. Dr. Crowe believes that women and men both have the same seroprevalence, or anti-tTG test rates, as men, but women tend naturally to seek out more healthcare. She advocates that celiac disease is multi-system, and more than just gastroenterologists should be familiar with the signs and symptoms so diagnosis for everyone improves.

She followed with a brief statement on fertility – that most women’s health and fertility issues caused by celiac disease are improved with the gluten-free diet. For women attempting to get pregnant, the question is whether or not to be screened for celiac disease. Dr. Crowe mentioned that there is an increased number of gynecologists screening for the disease, and overall, women with celiac disease need a diagnosis so they can be put on a gluten-free diet, a regimen of vitamins, such as folic acid, and additional supplements. Dr. Crowe also informed the audience that more supplements does not always mean more positive effects, and to check with your healthcare provider about dosage. She then answered another question about diagnosis: what if someone is gluten-free and needs to be tested for celiac disease? What do you do? Dr. Crowe explained you should be tested immediately, and believes some tests, such as the anti-tTG, the endoscopy, and especially the biopsy, have predictive value even months – up to a year – of refraining from gluten. She also recommended that younger siblings and children of those with celiac disease also be screened, as they can benefit from being diagnosed. Relatives who have the common symptoms of the disease should undergo diagnostic testing.

Gluten-Free-Grocery-Store-AisleDr. Crowe also discussed the basics of the gluten-free diet. She noted that the amount of household gluten-free kitchens is rising, and is now at 11%. For those who are gluten-free, foods have become more accessible in the past few years, but it is important to keep in mind that gluten-free food is something that those with celiac disease and gluten sensitivity need to stay healthy. Positive effects of the gluten-free diet include: feeling better sooner, symptom alleviation, and overall improved quality of life. Negative aspects include: the limitations of the diet when dining out, the cost of gluten-free food, and the potential for nutritional deficiencies, like anemia.

Dr. Crowe’s most important message for the evening was to advocate for yourself first and then your family. She reminded everyone that with a gluten-free diet, women with celiac disease have increased fertility and a better pregnancy. Celiac disease can be frustrating and disruptive, but proper information allows individuals to make more informed choices to positively impact their wellbeing.