Truth about a Gluten Free Pregnancy with Aviva Romm, MD: GFS Podcast 061

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While there’s some debate about whether it’s 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 aren’t typically a great idea.

Questions swirl about missing key micronutrients (vitamins and minerals) by avoiding gluten. But there’s truly more to this conversation than to keep eating gluten… just because. From food to toxins, I’m 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! I’m your host, Jennifer Fugo.

And today we’re going to talk about fertility issues – and not just fertility as in, “Can I get pregnant?” or anything that’s involved with just babies. We’re 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 ‘The Natural Pregnancy Book”, “Naturally Healthy Babies and Children” and the textbook “Botanical Medicine For Women’s Health”, 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. She’s 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, she’s on the advisory board at Yale Integrated Medicine Program. She has previously worked with Dr. Mark Hyman at the UltraWellness Center in Lenox, Massachusetts. She’s got a really amazing resume and I’m blessed to have her on the program.

Welcome to the podcast Aviva!

Aviva: Thank you! It’s 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 I’ll 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 that’s helpful in your approach to the patients that see you now?

Aviva: Absolutely! I even wrote a blog one time called “How being a midwife has made me a better doctor”.

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 it’s 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 what’s going on for her.

And then the herbal medicine, of course, adds a whole other set of tools. And herbal medicine isn’t only about the herbs. It’s 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 it’s 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 that’s 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 what’s going on with the natural world. But it’s easy to forget that we’re part of nature and connected to nature. And I think where this connects easily in people’s minds is the concept of the microbiome.

When you think about a garden—I’m an organic gardener— 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 soil’s 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 what’s 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 that’s 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 pregnant—and celiac particularly is unique when I talk about inflammation. It’s not just something that’s causing inflammation; it’s actually an autoimmune disease.

And the data is really clear that autoimmune diseases can cause fertility problems. And it’s a relatively resolvable one, so that’s 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 that’s 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 mom’s safety, but then you end up in a vicious cycle.

Because we know that caesarian section carries the increased risk of getting guess what?—problems for the baby’s microbiome.

And so then you end up with a baby who’s got problems. And if there’s already a mom with a sensitivity to gluten, then she’s getting a double whammy of passing that on to the baby and giving the baby problems with gut flora.

Another interesting thing, if you don’t 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 there’s some things that happen during pregnancy that are supposed to actually cut back on the growth of brain cells and when those brain cells don’t 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 it’s 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 she’s 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 there’s a lot of women out there who say, “Well, I don’t have a celiac diagnosis or an autoimmune diagnosis, I’m just gluten intolerant.” Does that increase your chances having fertility issues? Do you find that there’s 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 we’re 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 “If it walks like a duck, quacks like a duck, it’s probably a duck!” So we have a lot of patients that come in with all kinds of weird conditions. I jokingly call our practice the “last resort” because people come there with so many complicated health conditions including fertility problems and I’m 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 doesn’t really matter at this point whether you have consider yourself as having gluten intolerance or celiac. If your symptoms improved when you’re off gluten, that’s the thing to pay attention to.

And if you have enough symptoms like infertility, I feel like it’s 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 can’t rely on the tests. We can’t 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. It’s 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 I’m curious too if she say she doesn’t. And she does somehow get pregnant. Could there be long term implications or even complications for the baby if mom doesn’t go off gluten really should or has other food allergies and continues to eat things that are creating inflammation while she’s pregnant?

Aviva: I don’t want pregnant women or potential grandmas listening to us talk and think, “Oh my God the sky is falling!” 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 it’s one in 68 kids.

Jennifer: My gosh!

Aviva: Yeah! I was talking to my husband the other day because I’m 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, “Do you think this is going to be scary to moms?”

And I said, “Well, 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?”

So to me it’s 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 disease…. 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 she’s pregnant and at say 12 weeks, 14 weeks, and realizes she’s 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 she’s pregnant?

Aviva: Absolutely!

So we as species are not dependent on gluten in anyway, and there’s no nutrition that we get from gluten that we can’t get from other grains. And it’s 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 that’s where it can get a little more complicated.

A 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 don’t have to eat wheat, barley or rye to get them.

But if she’s really symptomatic and sensitive, it maybe that she also needs to think about taking out corn, millet, and rice, and that’s 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 she’s feeling like she’s 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 don’t want to just cut out, especially in major groups, I mean I know that when you’re 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 that’s 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 what’s coming in and what it’s being bombarded with.

And I would love too to ask you about toxins and some of the environmental things that we’re exposed to and how they may affect a baby that’s growing.

I like what you’re saying about this idea like, when do you say that there’s 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 there’s really no great value that we get from gluten that you can’t get somewhere else. It’s totally and absolutely safe to just take out all gluten containing foods while you’re pregnant. That’s 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 they’ve 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 we’re 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 they’re 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 can’t really control what’s 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 you’re eating and what’s in what you’re eating along with what packaging that you’re 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 she’s 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?

I’ve heard all those warnings like, “Don’t go gluten free if you don’t have celiac disease, don’t do this, don’t do that.” But practically speaking from your experience, is it okay for a woman to raise her baby gluten free if she is?

Aviva: Absolutely.

Again, there’s nothing that we nutritionally require from gluten that we can’t 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 they’ll be more likely to become gluten intolerant or develop celiac. And there’s 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 didn’t 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 kids—studies using numbers of kids in thousands—that 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 what’s 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 baby’s still developing antibodies to these foods, but in a way that’s protected by mom’s 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 don’t 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 it’s 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 I’d keep baby gluten-free.

Jennifer: Just for a mom who might be listening to this and going, “Wait, I should maybe take the gluten out.” How long would you do that for with a baby? Like a couple of weeks and see what they do, a month? What’s 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 don’t go away after four to six weeks then that’s 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 didn’t really care so much about before. When I’m 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 I’m glad that you’re 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 I’m 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. It’s so important what you’re doing, what we’re bringing together, it’s 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 it’s called “Detox Your Medicine Cabinet.”

And that has got some different things that they’ll be able to go through their medicine cabinet and take out and know what they’re taking, I guess.

Aviva: Yes. So, there are actually two free gifts now. One is that—so 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 here’s 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 that’s not appropriate.

And then the other free gift that—since we’re talking about pregnancy—that mommas or mommas-to-be might really like is also free. You just sign up and you get my eBook that’s called, “Herbal Medicines For Kids” and that’s just really nice self-care for basic things that come up from colic to colds to fevers, that kind of stuff.

Jennifer: Oh, that’s 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 it’s 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 there’s so much more to this conversation and you have such a vast array of experience. I’d 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. She’s got an amazing website that’s very user friendly and as I said she’s 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. I’ll put all of the links below this podcast.

And then, please if you haven’t, 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. We’d 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 Aviva’s books –> ‘The Natural Pregnancy Book”, “Naturally Healthy Babies and Children”, & “Botanical Medicine For Women’s Health”

Aviva Romm’s Website: www.avivaromm.com

Facebook: https://www.facebook.com/AvivaRommMD

Twitter: https://twitter.com/AvivaRomm

LinkedIn: http://www.linkedin.com/in/avivaromm

Author: Jennifer Fugo

https://jenniferfugo.com

Jennifer Fugo, MS, CNS is an integrative Clinical Nutritionist, the founder of Skinterrupt.com + the host of the Healthy Skin Show. She works with women who are fed up with chronic gut and skin rash issues discover the root causes and create a plan to get them back to a fuller, richer life.

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