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While thereâs some debate about whether itâs safe to go gluten free without a celiac diagnosis, the question about the safety of a gluten free pregnancy seems to be another can of worms. Women naturally worry if a dietary change can cause harm during a time when restricting foods generally considered healthy arenât typically a great idea.
Questions swirl about missing key micronutrients (vitamins and minerals) by avoiding gluten. But thereâs truly more to this conversation than to keep eating gluten⌠just because. From food to toxins, Iâm exploring the spectrum of questions that will hopefully dispel some of the myths and shine light on the truth about a healthy gluten free pregnancy.
Truth about a Gluten Free Pregnancy with Aviva Romm, MD
COMPLETE TRANSCRIPT
Jennifer: Welcome back to the Gluten Free School podcast! Iâm your host, Jennifer Fugo.
And today weâre going to talk about fertility issues â and not just fertility as in, âCan I get pregnant?â or anything thatâs involved with just babies. Weâre talking about the health of the mom, pre-baby, post-baby, and how that may even affect the baby as far as being gluten-free, having gluten sensitivity and how gut issues can play a huge role in you having a healthy baby.
So if you have any questions around this issue, this is a great opportunity to check out an amazing expert, one who many were actually jealous that I was speaking to. Her name is Dr. Aviva Romm and she is a Yale trained, board certified family physician, midwife, herbalist and award winning author, an international authority on botanical and functional medicine for women and children with 30 years of clinical experience.
She is the author of seven books on natural medicine including âThe Natural Pregnancy Bookâ, âNaturally Healthy Babies and Childrenâ and the textbook âBotanical Medicine For Womenâs Healthâ, winner of a James A. Duke Award.
Aviva combines her medical and midwifery backgrounds to guide women in transforming their health and to do the same for their kids. Sheâs also a leader in the revolution to shift the current medical system into one that respects the healing capacities of the body and nature.
Now, she works at a bunch of different facilities including Tufts School of Medicine, sheâs on the advisory board at Yale Integrated Medicine Program. She has previously worked with Dr. Mark Hyman at the UltraWellness Center in Lenox, Massachusetts. Sheâs got a really amazing resume and Iâm blessed to have her on the program.
Welcome to the podcast Aviva!
Aviva: Thank you! Itâs my pleasure.
Jennifer: Now I have to ask, how exactly did you end up so interested in the health of moms?
Aviva: Oh, my gosh! This is a long story, but Iâll give you this, the little nut of it.
I was 15 years old and I was actually in college, and got ahold of this paper that a doctor had written a long time ago. He was a psychiatrist who wrote this paper about how the experience of being born can actually shape how we experience life.
So when I was really young and very idealistic, I had this idea that if I could influence birth to be a healthy or more peaceful, more beautiful experience for mom and for baby, I could actually change a whole generation and change the world!
Jennifer: I love it!
Aviva: That was my introduction.
When I was in college at 15, I actually left, became a midwife and practiced midwifery and herbal medicine for over 20 years before I went back and became a physician.
Jennifer: And does having that experience of being a midwife and then herbalist, do you find that thatâs helpful in your approach to the patients that see you now?
Aviva: Absolutely! I even wrote a blog one time called âHow being a midwife has made me a better doctorâ.
Because midwifery itself is really about listening to people and meeting women where they are and helping to get a woman to figure out what she needs to make her process work. Maybe in labor itâs a different position or food or maybe she has a past trauma that she needs to talk about.
So making the woman central to my care rather than it being about me and being the knight in shining armor in the white coat, coming in and fixing everything in these were a part of the typical medical model⌠just completely shifts the dynamic and makes it about the woman and her life and whatâs going on for her.
And then the herbal medicine, of course, adds a whole other set of tools. And herbal medicine isnât only about the herbs. Itâs about lifestyle and connection to nature, food, and health. There are so many components that go into herbal medicine beyond just giving an herbal supplement.
So those two approaches to healing have been transformative. And a lot of it is also about listening to the body and trusting nature.
So yes, absolutely!
Jennifer: As we transition into this topic, and I think itâs important to keep in mind that good digestive health is where your health begins. As far as how we can process and assimilate the nutrients that we eat. And for women who are really interested in becoming pregnant, we do know for sure if you have celiac disease, you definitely may have fertility issues. That is something thatâs been studied and is very clear.
But why is gut health, in your experience, so integral to having a healthy pregnancy?
Aviva: So I think of the gut like I think of the soil, and there are so many parallels between our bodies and whatâs going on with the natural world. But itâs easy to forget that weâre part of nature and connected to nature. And I think where this connects easily in peopleâs minds is the concept of the microbiome.
When you think about a gardenâIâm an organic gardenerâ you need a really good soil for the plants to grow well, right?
Really good soil contains all the nutrients that the plants need and it also contains a variety of microorganisms that help break those nutrients down so that the plant can get the nutrients it needs in the most useful form.
And interestingly, the soilâs organisms actually affect the immunity of the plant. They protect the plant and give the plant an added boost of immunity.
So when you translate that to our bodies, and you think about whatâs going on in our gut, some the most important things are the ability to break down nutrients and assimilate those nutrients which requires a good gut lining. So kind of like that good soil, we require healthy microflora. Just like those microorganisms in the soil, they help break down our food into particles that we can use. But when that goes wrong, we end up with nutritional deficiencies that can interfere with our ability to get pregnant because we need some core nutrients which we can talk about specifically if you like.
And also it changes our entire immunologic state. And once we enter into a state of inflammation, a whole lot of things can go wrong in our bodies.
Jennifer: And thatâs not a good state to be in, I would assume, if you want to carry a healthy baby to term.
Aviva: That is definitely true.
So we know that inflammation can prevent us from getting pregnantâand celiac particularly is unique when I talk about inflammation. Itâs not just something thatâs causing inflammation; itâs actually an autoimmune disease.
And the data is really clear that autoimmune diseases can cause fertility problems. And itâs a relatively resolvable one, so thatâs the beauty of this. You know there are a lot of steps that it takes to get from point A, of having a condition in point B, reversing it in point C and getting pregnant if thatâs the underlined cause.
But there are a lot of new data coming out on the effects of inflammation specifically in pregnancy. So one of the things that we know is that when we have more inflammation, we tend to, for example, carry more weight around the waistline and more belly fat and we know that that belly fat can actually pump out chemicals that can cause not only toxicity in the body, but can make us more likely to develop diabetes.
And diabetes in pregnancy, or something called gestational diabetes, carries a whole host of problems. It can cause cardiac problems in the baby along with birth defects, pre-term birth⌠It can cause women to go over due and have babies that are too big increasing the risk of caesarian section. The increased risk of caesarian section increases risks to momâs safety, but then you end up in a vicious cycle.
Because we know that caesarian section carries the increased risk of getting guess what?âproblems for the babyâs microbiome.
And so then you end up with a baby whoâs got problems. And if thereâs already a mom with a sensitivity to gluten, then sheâs getting a double whammy of passing that on to the baby and giving the baby problems with gut flora.
Another interesting thing, if you donât mind adding it in, is that there is new data coming in on the risk of inflammation in the mom and higher rate of autism in the baby. So thereâs some things that happen during pregnancy that are supposed to actually cut back on the growth of brain cells and when those brain cells donât get cut back in the normal way because of inflammation that allows them to keep growing (these things are called growth factors that cause them to keep growing) which may be one of the contributing factors that causes autism in kids.
This can be seen in bigger head sizes which is our common finding in kids on the autistic spectrum, so itâs actually pretty significant.
Jennifer: I have a question for you because just yesterday, I was speaking with a woman who has a real severe problem with gluten. She maybe celiac, but sheâs not sure. The test never came back conclusive, yet her daughter has a lot of symptoms of celiac disease. She knows she has an issue with gluten, but she refuses to stay gluten free.
Aviva: Hmmm⌠the daughter does?
Jennifer: The daughter. And she wants to get pregnant and is having a very hard time. And so thereâs a lot of women out there who say, âWell, I donât have a celiac diagnosis or an autoimmune diagnosis, Iâm just gluten intolerant.â Does that increase your chances having fertility issues? Do you find that thereâs any incidence of the two existing together or at least gluten intolerance affecting fertility?
Aviva: Yeah. I have a couple of thoughts on that.
One is that increasing data is coming out telling us very clearly in the medical world that celiac is grossly under diagnosed much more than we ever thought it was.
So not just gluten intolerance, but celiac too. And at the same time, increasing data is emerging telling us as physicians that the tried and true test we thought we were relying on for detecting celiac disease is not really reliable. That we are grossly missing cases of celiac disease. Those are just not good parameters that weâre looking at. And even what has been considered the gold standard test, which is the endoscopy with biopsy, can actually miss it.
So what I tell my patients quite literally is âIf it walks like a duck, quacks like a duck, itâs probably a duck!â So we have a lot of patients that come in with all kinds of weird conditions. I jokingly call our practice the âlast resortâ because people come there with so many complicated health conditions including fertility problems and Iâm shocked at how few of them have been tested for celiac or of the ones who have been tested who had negative findings, but their symptoms are so clearly related.
And so what I tell those patients is that it doesnât really matter at this point whether you have consider yourself as having gluten intolerance or celiac. If your symptoms improved when youâre off gluten, thatâs the thing to pay attention to.
And if you have enough symptoms like infertility, I feel like itâs worth it to just consider yourself celiac. I tell my patients to stay off it for a good long time, like even three to six months to see if that really makes a difference.
So I think we canât rely on the tests. We canât rely on the diagnosis. And given that, so many more people have it than has ever even been thought possible and the numbers are going up. Itâs worth it to just try to convince women in this circumstance to go off gluten for a while and see if that makes a difference.
Jennifer: Yeah, and Iâm curious too if she say she doesnât. And she does somehow get pregnant. Could there be long term implications or even complications for the baby if mom doesnât go off gluten really should or has other food allergies and continues to eat things that are creating inflammation while sheâs pregnant?
Aviva:Â I donât want pregnant women or potential grandmas listening to us talk and think, âOh my God the sky is falling!â But at the same time, I think we really need to take the inflammation in pregnancy issue and give it a hard look. And the reason is even just a few years ago, like five years ago, the statistics on autism were one in 250 kids. Then it went down to one in 152 kids, and then two years ago, it was one in 88 kids. And now the new data is that itâs one in 68 kids.
Jennifer: My gosh!
Aviva: Yeah! I was talking to my husband the other day because Iâm working on this course on natural health care for kids that parents can do to learn how to take care of their kids more naturally at home.
And I was going over the section with him on food and environmental toxins, and he said, âDo you think this is going to be scary to moms?â
And I said, âWell, at what point do we get a little scary? When the rates are one in 32 or one in 24 or one in 12 or one in 5?â
So to me itâs almost like, do we say fire when we see smoke or do we wait until the house is burning?
And right know I think with that rate of kids on the autistic spectrum, the rate of allergies that has gone up exponentially in kids, kids with increasing rates of autoimmune disease⌠Kids with diabetes at the age of 9 and 10 and 12 when diabetes used to just be type 2 diabetes and an adult diseaseâŚ. And the rates of obesity expected to be one in two people, so 50% of all people in the next decade⌠all of these are disorders that can be tied back to inflammation. And we know that disorders that can be tied back to inflammation in pregnancy and then baby getting it because baby is gestating in that environment.
And we also know that in the presence of celiac disease or gluten intolerance, the damage that can happen to the gut can also lead to disorders in the gut bugs that are growing, the good ones, right? So it can cause dysbiosis or damaged gut flora. And damaged gut flora in itself even without celiac just due to, for example, the overuse of antibiotics or mom getting exposed to antibiotics for C section and baby getting exposed⌠Even just that without the gluten, without celiac, also predisposes to all those conditions I just mentioned.
So I think we have to take it pretty seriously, and yes those are all implications of what can happen. We definitely need to look more closely that this is a problem during pregnancy.
Jennifer: If a woman finds out sheâs pregnant and at say 12 weeks, 14 weeks, and realizes sheâs having a lot of issues in gluten, all of a sudden comes up as a red flag. Is it safe for her to remove gluten while sheâs pregnant?
Aviva: Absolutely!
So we as species are not dependent on gluten in anyway, and thereâs no nutrition that we get from gluten that we canât get from other grains. And itâs not actually just the gluten containing foods directly (so the barley, wheat and rye) for women who are pretty symptomatic. Sometimes we need to look at gluten cross reaction as well, and thatâs where it can get a little more complicated.
AÂ woman can get through pregnancy, get all the carbs that she needs to grow a healthy baby and get the B vitamins she needs by broadening out to the other grains. We donât have to eat wheat, barley or rye to get them.
But if sheâs really symptomatic and sensitive, it maybe that she also needs to think about taking out corn, millet, and rice, and thatâs where it can start to get a little more limited in her diet.
And if she has to go to that extreme, she can get all the carbs she needs from vegetables and starchy vegetables like squashes and sweet potatoes. But she may need to tolerate and include a little bit of grain when sheâs feeling like sheâs not getting enough.
If she has to go to that extreme of eliminating those things, that would be a really good time to work with a midwife or a functional nutritionist who is very well versed in prenatal nutrition.
Jennifer: Because you donât want to just cut out, especially in major groups, I mean I know that when youâre not pregnant you have a little more leeway of what you can tinker around with.
But pregnancy is a different story. Your body is a container for this incredibly complex little human being thatâs going to spring into the world and you have to take that into account and I think that goes back to what you were saying about inflammation that, if the container itself is not quite right because of whatâs coming in and what itâs being bombarded with.
And I would love too to ask you about toxins and some of the environmental things that weâre exposed to and how they may affect a baby thatâs growing.
I like what youâre saying about this idea like, when do you say that thereâs a fire? Because it does behoove of a woman if she wants to get pregnant to try to improve the quality of her health, to reduce inflammation as much as possible, to give that child the best start humanly possible.
Aviva: Absolutely.
And thereâs really no great value that we get from gluten that you canât get somewhere else. Itâs totally and absolutely safe to just take out all gluten containing foods while youâre pregnant. Thatâs not a worry.
Jennifer: As to my point about the toxins, are those a concern for you with your patients that people are exposing themselves to a lot of plastics, like they eat out of Tupperware and all of these different chemicals in hand sanitizers. And you know, I know that women oftentimes get very nervous about getting sick and we can certainly just touch on that as well.
But do you find that we should also be mindful of how much we are exposing ourselves to different substances and chemicals pre pregnancy and during pregnancy as well?
Aviva: Absolutely!
There is a study done some of years back by the Environmental Working Group where they looked at the random sampling of about ten babies around the United States. They just went to different hospitals and they got samples of umbilical cord blood right at the time of birth.
And theyâve found that babies at the time of birth already had over three hundred environmental chemicals that could be found in the umbilical cord blood.
And we know that these chemicals can have a tremendous impact on everything from fetal development and the subsequent development of birth defects if weâre exposed prenatally or even before pregnancy to neurologic problems, early puberty, obesity, diabetes, and autoimmune conditions.
So a lot of the toxins have some of the same impact that you can get from gluten for example, because theyâre both causing toxicity and inflammation in the body.
So what I recommend moms ideally do is if you have time, even before you get pregnant, clean out your pantry, cosmetics and body products. Do everything you can in your environment because you canât really control whatâs in the air, the water, and all of these variables of what major companies are pumping into our environment. But you can control a lot of things like what youâre eating and whatâs in what youâre eating along with what packaging that youâre using. You can get purified water. What I tell moms and dads to do, because the help of the dad is important too, is to control what you can.
Jennifer: I was also going to ask you- for a woman who is gluten free and sheâs staying gluten free, what does she do about her baby? How do you manage being gluten free? Could you raise your baby gluten free? Is that safe?
Iâve heard all those warnings like, âDonât go gluten free if you donât have celiac disease, donât do this, donât do that.â But practically speaking from your experience, is it okay for a woman to raise her baby gluten free if she is?
Aviva: Absolutely.
Again, thereâs nothing that we nutritionally require from gluten that we canât get from other healthy whole grains.
The gluten issue is not one to be concerned about in terms of does baby need it for nutritional reasons. However, there is a lot of flux around the area of whether babies should be raised gluten free in terms of whether or not theyâll be more likely to become gluten intolerant or develop celiac. And thereâs still some controversy and new data emerging around this all the time.
So, back in the day when I was raising my kids, if you were more alternative, you were doing extended breast feeding so a lot of kids didnât really get gluten because they were breastfed for a long time. They often got kind of a little bit of what we were eating. While the adults were eating, older babies could also be eating so they may have had some inadvertent gluten exposure.
And then it got to be when the sort of theory of kids totally avoiding wheat would prevent them from developing antibodies when they were little and then prevent them from becoming gluten intolerant or celiac.
But now, that pendulum is swinging a little bit based on a number of studies that have been done in Europe. With pretty large number, like a large numbers of kidsâstudies using numbers of kids in thousandsâthat have shown that the introduction of gluten between the ages of four months and seven months while the mom is breastfeeding and then having the mom continue to breastfeed after for another six months is probably whatâs most likely to prevent the development of gluten intolerance compared to kids who have absolutely no gluten exposure or compared to kids who have gluten exposure, but were not breast fed.
There may be some protective effect of exposing baby while babyâs still developing antibodies to these foods, but in a way thatâs protected by momâs antibodies too even if mom is intolerant of gluten.
This pendulum is still swinging and yet another answer may emerge. Where I depart from that and say donât give gluten is if mom or dad is allergic, has a lot of allergies, had eczema, has asthma, and now baby is born and has colic, eczema, allergies or asthma. Because that baby is more probably much more likely to be more gluten intolerant and itâs most likely just aggravate.
Also, if baby has started getting food and is developing allergies, rashes, eczema, asthma, gets sick a lot, has a lot of congestion⌠I would also remove gluten and see if the issues go away. And if they do, then Iâd keep baby gluten-free.
Jennifer: Just for a mom who might be listening to this and going, âWait, I should maybe take the gluten out.â How long would you do that for with a baby? Like a couple of weeks and see what they do, a month? Whatâs a good timeframe?
Aviva: I would say to really see a difference that six weeks is a good timeframe because it gives the body a chance to heal, the antibodies and inflammation a chance to settle down, and you can really see if it makes a difference.
And then if you reintroduce a little bit and the symptoms flare again, you got a dead ringer of an answer. If the symptoms donât go away after four to six weeks then thatâs probably not the answer.
Jennifer: Well, I want to just thank you, Aviva because this has been a wealth of knowledge and because I am an aunt and I love my little niece and I have many friends with little babies as well and I get to enjoy in them.
This is a part of life that I didnât really care so much about before. When Iâm going about my day, working, caring about getting through school and doing different things, but now, I really do care and I realize the value of how we treat ourselves and how we feed ourselves and nourish ourselves and how that has long term effects of little ones when they come along.
And so Iâm glad that youâre able to be an amazing resource to all the women out there who are looking for a more natural way and also, taking that sense of personal advocacy so seriously, that you can balance your body with nature. I love your approach and Iâm glad that you were able to join us and share all of this information.
Aviva: Thank you. Thank you for giving me the opportunity too. Itâs so important what youâre doing, what weâre bringing together, itâs really about the health of not just the next generation, but the multiple generations to come.
Jennifer: You have a really great newsletter that goes out weekly, and people can go to your website and sign up, but when they sign up, they also get a really nice gift. You have a printed handout that they can get and itâs called âDetox Your Medicine Cabinet.â
And that has got some different things that theyâll be able to go through their medicine cabinet and take out and know what theyâre taking, I guess.
Aviva: Yes. So, there are actually two free gifts now. One is thatâso basically it gives you the safe herbal alternative for common things like, Ibuprofen. Here are some of the things that you can do instead of taking Ibuprofen and hereâs the dose, and here are the safety considerations. So, it will say, for example, what not to take during pregnancy or not to take during breast feeding if thatâs not appropriate.
And then the other free gift thatâsince weâre talking about pregnancyâthat mommas or mommas-to-be might really like is also free. You just sign up and you get my eBook thatâs called, âHerbal Medicines For Kidsâ and thatâs just really nice self-care for basic things that come up from colic to colds to fevers, that kind of stuff.
Jennifer: Oh, thatâs amazing! Because I know that, even myself, I might not be thinking about babies right now, but a lot of this stuff is important and I do get questions about what people can do for their kids and itâs nice to have a resource to be able to direct them too.
Thank you so much for all of this information and I hope that we can have you back sometime because I know that thereâs so much more to this conversation and you have such a vast array of experience. Iâd love to be able to share that again with the audience.
Aviva: Love too, thank you!
Jennifer: Thank you!
Remember to stay in touch with Aviva. Sheâs got an amazing website thatâs very user friendly and as I said sheâs got some gifts to give you if you sign up for her newsletter, which I highly recommend you to do as well as some amazing books. Iâll put all of the links below this podcast.
And then, please if you havenât, subscribe, rate, and review this podcast. Head on over to Gluten Free School and leave any questions or comments about the information that we have talked today, underneath this podcast. Weâd love to answer your questions.
Thank you guys, so much for joining us and I look forward to seeing you the next time.
Bye, bye!
IMPORTANT LINKS
BUY Avivaâs books â> âThe Natural Pregnancy Bookâ, âNaturally Healthy Babies and Childrenâ, & âBotanical Medicine For Womenâs Healthâ
Aviva Rommâs Website:Â www.avivaromm.com
Facebook:Â https://www.facebook.com/AvivaRommMD
Twitter:Â https://twitter.com/AvivaRomm
LinkedIn: http://www.linkedin.com/in/avivaromm
This article scared me, but I want to thank you for that. You have answered some questions I have had since I diagnosed myself with Celiac in late 2012. I have avoided all things with gluten since Jan. 2013 and chose to take the herbal way of life as well. You answered so many of the questions I have had since becoming Gluten Free. You touched base on my biggest wonder, what to do do with raising you children GF or not? From what was said about this topic, I would go with not giving gluten to my children at all. The struggles of raising them gluten free is not something my husband and I worry about but it is something we worry that others will not take seriously. I have always been worries that because of me, my children will also suffer from Celiac, dairy intolerance, and other food sensitivities. I signed up for Avivaâs newsletters and am looking forward to learning more herbal ways. I am not off to reading everything there is on your site!
Thank you again for this valuable knowledge.
Amanda
Hello Jennifer, nice post to share. Keep sharing such useful articles on pregnancy. Thanks and regards.