Did you know that women with untreated coeliac disease are more likely to have an early menopause? Menopause marks the end of a woman’s fertile life cycle and is a time of major hormonal changes. At this time there is a significant reduction in the hormones oestrogen and progesterone. Both of these hormones have roles in regulating not just the reproductive cycle but also in maintaining other body organs and systems. Menopause is a stage that eventually occurs for every woman. However, it is thought that when coeliac and not properly following a gluten free diet, this process occurs earlier in a woman’s life than in those who do not have coeliac disease or those who are coeliac and follow a strict gluten free diet.
It is estimated that 1% of the population have coeliac disease around 50,000 people. However, only around 15,000 people are actually diagnosed. This means that a large proportion of coeliacs in Ireland are undiagnosed. The only treatment for coeliac disease is following a strict gluten free diet. If undiagnosed, the likelihood of following this strict diet plan is reduced. Undiagnosed coeliac disease and in turn not following a gluten free diet has many consequences. A common consequence is the impact it has on fertility and the reproductive cycle.
Up to 70% of people diagnosed with coeliac disease are women. Untreated coeliac disease (not following a gluten free diet) can shorten the life span of a woman’s reproductive cycle. It can delay the start of a girl’s periods and it can cause early menopause. The reason why coeliac disease has this effect is still unknown. Consuming gluten when coeliac means the lining of the gut is damaged and this can affect how your body absorbs nutrients. Proper nutrition is needed for needed for healthy menstrual cycles. This is because nutrition affects body weight, energy balance and system function, all of which affect your menstrual cycle.
Important nutritional considerations when entering menopause
Most importantly, if you are coeliac you need to be following a gluten free diet. If you are consuming gluten when coeliac absorption of essential nutrients can be affected. This leads to nutritional deficiencies, despite following a healthy diet. Overall it is important to follow a healthy and balanced diet with correct amounts of all nutrients. Balance of all nutrients is needed for the reproductive cycle. Eating 3 meals a day made up of the correct proportion of all nutrients and supported by nutritious snacks, will ensure all of these nutritional requirements are being meet. A balanced meal includes foods containing protein, healthy fats, slow release carbohydrates and lots of fruit/vegetables. For breakfast this could be porridge topped with fruit and nuts. Lunch could be a sandwich made from wholemeal gluten free bread and filled with salad and leftover dinner meat while dinner could include potatoes, wholemeal gluten free noodles or brown rice, accompanied by a meat or pulses and a mix of vegetables. At each meal aim for half of your plate to be made up of fruit or vegetables. Include healthy snacks like fruit, nuts or seeds to keep energy levels topped up.
The hormonal changes that occur at the time of menopause have a significant impact on bone health. Loss of bone mass and strength can put an someone at a greater risk of osteoporosis and fractures. For this reason, it is really important that you are meeting calcium and vitamin D requirements to minimise this risk;
- Calcium: calcium is one of the most important nutrients for bone health. It is needed to build and maintain bone. Dairy products are the best sources of calcium such as one pot of yoghurt (125g), a matchbox size portion of cheese or a glass of milk (200mls). You should aim for 3-4 servings of calcium rich foods over the course of the day! Don’t try and get all of your calcium requirements from green vegetables. Although they are sources of calcium, you would have to eat a huge amount to help you meet your calcium requirements for the day.
- Vitamin D: Vitamin D is really important to help the body absorb calcium. Vitamin D can be found in oily fish, meat, eggs and fortified breakfast cereals or fortified milk. However, you need to eat a lot of these foods to get all your vitamin D requirements for the day. The best source is from the sun. Unfortunately, in Ireland we don’t get sufficient sunshine to meet our vitamin D needs so it is advised that during the months of November to March (at least) that we take a vitamin D supplement. People with Coeliac Disease need a vitamin D supplement of 10 micrograms per day. The FSAI advises everyone in Ireland over 65 should have 15 micrograms of vitamin D per day. Talk to your pharmacist to see what the best supplement is for you and your needs.
- Bone scan; A bone scan is important to make sure your bones are in good health and not deteriorating. It is recommended to get a bone scan both when you are diagnosed with CD and after you have gone through menopause. This is because both situations can affect calcium abortion and bone health. After this, a repeat bone scan will be recommended by your doctor. Ask your doctor to book you in for a scan.
Heart and blood health
Heart disease is normally associated with men; however, heart disease is just as common in women as it is in men. Many of the reproductive hormones in women are thought to have a protective affect against heart disease. However, when a woman goes through menopause and these hormones decline, the risk of heart disease increases. High blood pressure is one of the most common risk factors that affects women in the early postmenopausal years. Furthermore, the decline in reproductive hormones at menopause are said to lead to a sharp increase in cholesterol. That is why it is important to include some of the following in your lifestyle to make sure your heart is well looked after.
- Fruit and Vegetables: Fruit and vegetables are full of antioxidants which are substances that can reduce plaque build-up and cholesterol. Fruit and vegetables are also great sources of fibre which is another key nutrient for a health heart. Aim for 5 to 7-a-day and try to vary vegetable and fruit type as well as colour. Add leafy greens to salads, root vegetables to soups and try replacing an after dinner chocolate bar with a piece of fruit. Make sure ½ of your plate at every meal is filled with fruit, vegetables or salad.
- Oily Fish: Aim to have oil-rich fish like salmon, mackerel or sardines twice a week as they are excellent sources of the omega-3 fats which keep your heart nice and healthy. They also help to lower triglyceride (a type of fat that is similar to cholesterol).
- Gluten Free Wholegrains: Gluten free wholegrain foods are high in fibre and nutrients needed for a healthy heart. High fibre carbohydrates provide slow release energy and help you to stay feeling full for longer. This helps manage blood sugars and weight. Choose wholegrain and high fibre gluten free bread, rice or gluten free pasta (in the right amounts!). If you can tolerate oats, try adding gluten free oats to your breakfast or try some overnight oats. Oats contain a special type of fibre called Beta-Glucan that helps to lower cholesterol. Wholegrains like quinoa are also great to use.
- Nuts: nuts are an ideal food to add into a healthy diet. They are a great source of protein and full of vitamins and minerals. Almonds are rich in B vitamins, vitamin E, iron, copper and zinc. And nuts are linked to a reduced risk of heart disease. Add a handful of unsalted almonds, hazelnuts, brazil nuts or cashews to your day – just watch your portions!
- Cut back on processed meats, butter and cream; all of these are associated with negative effects on the heart. Processed meat like sausages, bacon and black and white pudding is high in salt and saturated fats. Too much salt can have an impact on blood pressure and is linked with an increased risk of stroke. Choose lower fat meat options like fish, lean red meat or turkey and remember to limit the amount of salt you add when you are cooking. Butter and cream are high in saturated fat and are not great for cholesterol. Try to choose milk and yoghurt instead. Cheese is okay although it is high in saturated fat. If your cholesterol is high do limit cheese to around twice a week.
- Reduce alcohol intake: Alcohol can raise blood pressure and can lead to weight gain. It is recommended that women consume no more than 11 alcoholic units a week. A unit includes one pub measure of spirits, a glass of beer (half a pint) or a small glass of wine (100mls).
- Avoid or quit smoking: Smoking can lower good cholesterol, increase blood pressure and damage circulatory organs. If you are a smoker, contact your GP for help in quitting.
Other lifestyle considerations;
Exercise: Exercise is important for all aspects of health. Weight-bearing exercise is especially important for bone health as it encourages the building and maintenance of bones. Examples include brisk walking, pilates, yoga, lifting weights – any exercise that carries weight. Regular exercise helps reduce blood pressure, improve cholesterol levels and reduce the narrowing of your arteries. We are encouraged to get at least 30 minutes of moderate physical activity five times a week! Even walking is great and can easily be built up to 30 minutes.
Weight management: being a healthy weight is really important for overall health. High body weight puts pressure on bones and joints, increasing the chance of osteoarthritis. Being overweight is associated with increased blood pressure and high cholesterol. A healthy body weight is also important for healthy reproductive cycles. Combining a healthy balanced diet with adequate exercise, will help you work towards a healthy weight. Talk to your registered dietitian about working out a plan that will help you reach your desired weight.
What to do if you think you might be coeliac.
Reports have shown that if coeliac and if diagnosed at an early stage there is a better chance of following a strict gluten free diet. A gluten free diet in coeliac disease may be effective in preventing early menopause by returning nutritional status to normal. If you think you are coeliac, book a blood test with your doctor to check for this. When diagnosed, it is important that you visit a CORU registered dietitian to learn how to avoid letting gluten sneak into your diet and to ensure you are getting the right balance of all other nutrients. Proper nutrition is very important for the reproductive cycle. If a woman is suffering with any form of reproductive issues, such as late periods, infertility or early menopause, it is important she is tested for coeliac disease as a gluten free diet could be the best form of treatment. Never try a gluten free diet without checking for coeliac disease first – going gluten free will make any coeliac tests come back negative even if you are coeliac! Keep eating gluten until you are fully diagnosed or coeliac disease has been fully ruled out.
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