Eating (Gluten-Free) for Two
Celiac disease is more than a reason for a fad diet, stomach ache or occasional gastrointestinal woes. Celiac disease is an autoimmune disorder that affects the whole body. The body views gluten as the enemy, mounting an intense immune response in the small bowel damaging the body's ability to absorb nutrients. But the consequences extend beyond the GI tract. If celiac disease is left untreated, serious complications can include additional autoimmune disorders, rashes, celiac-associated cancers, infertility or miscarriages.
But like most people, Rebecca Curry didn't know the disease could do so much damage. She had headaches and general GI problems for as long as she could remember. When more than one family member was diagnosed with colon cancer, she decided to be proactive about her health and get screened.
Diagnosis and Loss
At the time, Rebecca was a nurse practitioner in Jefferson’s operating room. She heard of Dr. Anthony DiMarino's reputation as division director of gastroenterology and hepatology and director of the Celiac Center through her colleagues at work.
At Rebecca's first appointment, Dr. DiMarino ordered a blood test which indicated Rebecca might have celiac disease. The diagnosis was confirmed with an endoscopic biopsy in March 2014. By that time, the disease had already caused changes in her intestinal lining.
Around the same time as her endoscopy, Rebecca found out she was pregnant, but suffered a huge loss when she had a miscarriage nine weeks later. This further motivated her to immediately address her celiac disease diagnosis to ensure her overall health and well-being for future pregnancies.
Accepting Celiac Disease
Rebecca and her husband met with Dr. DiMarino and Emily Rubin, a registered dietician at the Jefferson Celiac Center to start a life-long, gluten-free diet. Following a gluten-free diet is the only treatment for celiac disease and the only way to prevent many of the long-term effects, such as anemia, infertility, vitamin and mineral deficiencies, rashes, headaches and certain cancers.
In July of 2014, Rebecca had great news for Rubin and Dr. DiMarino. She was pregnant again. During that conversation, Dr. DiMarino told Rebecca about the connection between pregnancy and celiac.
“For women with celiac, a strict gluten-free diet is an absolute must for a healthy pregnancy,” Dr. DiMarino said. “Although there is not universal acceptance of the concept, most studies say there is two to three times greater difficulty in conceiving and carrying a baby to term if the mother has under-treated celiac disease. Doctors and scientists don’t know the reason for this, but the two theories point to the mother’s decreased nutrition absorption or the autoimmune component of the disease affecting the placenta function.”
Until that appointment, Rebecca didn’t know the two were connected. “I knew then that this isn't something where I can choose to be gluten-free some days and have a slice of pizza the next. This is serious. I vigilantly maintained a gluten-free diet.”
Throughout her pregnancy, Rebecca sought the advice of Rubin and Dr. DiMarino. “They provided excellent care,” she said. “Any time I had a question, everyone at the office was so responsive.”
Rubin educates and advises patients with celiac disease and other GI and hepatology conditions on proper nutrition. “If you are pregnant and have celiac disease, you must maintain a 100 percent gluten-free diet. I recommend increasing calcium, iron, folic acid, and vitamin B-rich foods,” Rubin said. “I also recommend trying to breast feed. While controversial, some researchers feel breastfeeding may delay or lessen the impact of celiac disease.”
A New Lease on Life
Despite the cravings pregnancy can cause, Rebecca says that a gluten-free diet is manageable with Rubin’s help. It’s also easy to find gluten-free options in stores, she said.
On April 15, 2015, Rebecca delivered a healthy, full-term baby girl. “She was eight pounds, so she was definitely getting enough nutrients,” she said with a laugh.
Rebecca advises others: “If you have celiac, especially if you are pregnant with celiac, please see a registered dietician to make sure you are eating the proper gluten-free nutritious foods. Eating gluten-free during this sensitive time is extremely important for the health of your pregnancy and baby. Once you get on track, it is very manageable with slight modifications.”