Coeliac Disease and Men’s health
Coeliac disease, like other autoimmune diseases, is diagnosed more frequently in females than in males. About 70% of coeliac disease diagnoses occur in females. A recent study found that in Ireland there are twice as many women with coeliac disease as men who have coeliac disease in Ireland. However, this does not mean that coeliac disease does not occur in males or that males should be forgotten when it comes to treatment and support in living with the condition.
Why is coeliac disease less prevalent in males than females?
It is not clear why coeliac disease is seen less in males than in females. Some research suggests it is because of genetics. However, a key reason thought to be behind the low diagnosis of coeliac disease in men is the fact that males are less likely to go to the doctor and to have regular health check-ups, compared to females. Reports suggest up to 50% of men aged 18- 50 don’t have a source of everyday health care. Females are more likely to be diagnosed at a younger age, than males. This is most likely because females attend health care early when they first notice symptoms while men persevere with burdensome symptoms for longer.
Men are also less likely to seek medical care when small health issues (such as abdominal pain, diarrhoea or constipation) arise, making diagnosis of coeliac disease less likely. Overall, this leads to less investigations of coeliac associated symptoms. Less investigation of symptoms means less diagnosis of coeliac disease. Some studies test for coeliac disease in people who are undiagnosed. In these studies, rates of coeliac disease in men are found to be higher than the rates that are reported in diagnosed populations. This shows that there are a lot of men out there who have coeliac disease and do not know it. It also shows the need for men to visit their doctor regularly. Furthermore, friends and family of any man should encourage them to attend all health care appointments and check-ups not just to find undiagnosed coeliac disease but for general health and well-being.
Common health issues of coeliac disease in males
Undiagnosed coeliac disease can have many health related consequences in both males and females. Typical symptoms include gut related issues such as diarrhoea, constipation, bloating, and abdominal pain. At first diagnosis, men are more likely to present with “classic” coeliac symptoms such as the ones listed above while women demonstrate a broader range of symptoms. Examples include other auto immune diseases, fibromyalgia or anxiety and depression. Women seem to have a broader range of symptoms associated with coeliac disease, most likely because they seek more health care for a broader range of issues. The more health care an individual seeks, the more investigation of those symptoms that will be carried out. More investigation leads to correct diagnosis, even with non-classical coeliac associated conditions. Here are some non-classical coeliac symptoms to watch out for in men;
- Infertility: Infertility linked to coeliac disease is often more associated with women. However, coeliac disease can cause fertility problems for men just as much as women. Fertility issues in men that are related to coeliac disease include; gonadal dysfunction and semen issues (changes in sperm number and/or mobility). Delayed puberty in boys can also be a sign of undiagnosed coeliac disease.
- Short stature: Short stature is when a person’s height is significantly below average compared to height of people their age. It is most commonly seen in children but can also be seen in adults. An individual can be considerably shorter than their peers and be perfectly healthy. However, individuals with undiagnosed coeliac disease have been shown to have shorter stature than those diagnosed with coeliac disease and those without coeliac disease. Some research looking at this has found an the older an individual is diagnosed with coeliac disease, the shorter they turn out. This shows the importance of early diagnosis and early start to the gluten free diet. Some studies have seen it more in males while others have seen it more in females.
- Osteoporosis: Osteoporosis is a bone disease where the body does not make enough or it loses too much bone (or both). It is most common in post-menopausal women due to changes in hormones at this stage of life. However, lack of calcium can also cause osteoporosis. Untreated coeliac disease can give rise to osteoporosis because gluten can damage the parts of the small intestine, responsible for absorbing calcium (nutrient needed for building and maintaining bones). With insufficient calcium bones become weak and brittle. Therefore, men with symptoms of osteoporosis should be tested for coeliac disease, especially when calcium intake is sufficient.
Important nutrients for men’s health
The only treatment for coeliac disease is a lifelong gluten free diet. Regardless if you are coeliac or not, to be a strong, healthy male it is important to have a balanced diet with the correct proportions of all nutrients including protein, healthy fats and carbohydrates. The gluten free diet, if not followed correctly can lack key nutrients needed for health. Some of the most common nutrients to be deficient in the gluten free diet are listed below;
- Fibre: Fibre is key for digestive health and helps prevent constipation. It can also help weight control by keeping you fuller for longer. It has also been associated with a lower risk of heart disease, stroke, type 2 diabetes and bowel cancer. We need 25-30g of fibre a day. Fruit and vegetables are great sources of fibre and are naturally gluten free. It is also important to get plenty of fibre from wholegrains. This can be difficult as many well-known sources of whole grains contain gluten. Some naturally gluten free whole grain sources include quinoa, brown rice, millet and amaranth (some of these unusual grains can be found in health food stores). There are gluten free alternatives of popular whole wheat products such as whole wheat pasta and whole grain bread which are available and provide dietary fibre. Check your food list for brands.
- B vitamins; You may have heard of this group of vitamins called by their different names such as B1, B2, B12 or folate. Essentially, B vitamins are a broad range of vitamins which help you get energy from food. B vitamins can be lacking in a gluten free diet because a huge proportion of the Irish population get B vitamins from fortified breakfast cereals, most of which are not gluten free. Luckily the best sources of these vitamins come from naturally gluten free sources such as meat, chicken, green leafy vegetables and dairy products. And there are some fortified gluten free breakfast cereals available on the market (great if you are a vegetarian). Check your food list to see some examples.
- Vitamin D; Vitamin D supports the absorption of calcium and therefore is important for bone and muscle health. With the ongoing pandemic, the role of vitamin D in immunity has become very topical. The vitamin D requirements for people with coeliac disease are the same as for the general population; however, achieving these requirements is especially important due to the increased risk of osteoporosis in coeliac disease. The best source of vitamin D is the sun but with Irelands poor climate, this can be difficult to achieve all year round. Therefore, a supplement may need to be considered.
Once diagnosed, it is important to see a dietitian to ensure you meet all your nutrient requirements. Another reason to see a dietitian on diagnosis, is to ensure there is no way that gluten is “sneaking” into your diet. If you are coeliac and ingest gluten, absorption of key nutrients will be affected which can have long-term health consequences. Some nutrients that are particularly important for men’s health are listed below;
- Zinc: Zinc is important for metabolism, immune function and protein production. It also plays a key role in male hormone production. Sources include Oysters, red meat, and poultry. If vegetarian, beans, chickpeas, and nuts also contain zinc. The best part about all of these sources is that they are naturally gluten free.
- Magnesium; Magnesium is an essential mineral for enzyme function, muscle and nerve function and blood pressure regulation. Although magnesium is often added to whole grain foods like breakfast cereals (that may not be gluten free), it is also abundant in many naturally gluten free foods. These include green leafy vegetables which are nice additions to sandwiches or burgers and nuts & seeds which can be added to breakfasts.
- Calcium: Calcium is really important to maintain strong bones and teeth. It is also important for nerve and muscle function. As discussed, bone health is not only important in women but in men too. Often when newly diagnosed with coeliac disease, calcium deficiency is common and this is most likely due to the mineral not being absorbed due to damage done to the gut by gluten. Research has shown many people following a gluten-free diet still develop osteoporosis. The cause of this may be due to gluten-free bread and cereal foods not being fortified with calcium, like their gluten containing alternatives do. However, some of the best sources of calcium are naturally gluten free such as cheese, yoghurt and milk. Try to get 3 servings of calcium sources over the course of the day. An appointment with your dietitian can ensure you are getting the correct amounts in your diet.
As you can see many key nutrients in the diet come from naturally gluten free sources. Try to vary your food as much as possible to get the broadest scope of nutrients. For a busy work/life schedule, try pack healthy and handy snacks that provide a delicious and nutritious kick. When looking for gluten free varieties of handy food products like pasta and bread, try to ensure they are high in fibre which is essential for a healthy gut and provides slow release energy in sports, physical jobs or life in general. Choose naturally gluten free protein foods like meat, beans and fish which are also high in vital vitamins and minerals needed for all round health.
If you think you or any males (or females) you know have coeliac disease:
It is well-known that early diagnosis and treatment can significantly improve a person’s overall well-being if they are suffering with coeliac disease. Coeliac disease tends to be underdiagnosed in men and symptoms such as osteoporosis, anaemia, fertility issues or a close family member with coeliac disease should flag a test for coeliac disease.
If you think you may have coeliac disease it is best to request a simple blood test from your GP. If this test is positive your GP will refer you for a biopsy. You need to have the biopsy to be diagnosed with coeliac disease: the blood test alone is not enough. It is very, very important that you continue to eat gluten until you have your biopsy. If you cut out some or all gluten before you have your test, then it will come back as negative even if you do have coeliac disease.
For advice and support or to make an appointment to see our dietitian, contact the Coeliac Society of Ireland at email@example.com or go to www.coeliac.ie.