For women with gluten sensitivity (celiac disease or non-celiac gluten sensitivity), even trace amounts of gluten can drive or worsen endometriosis, adenomyosis, amenorrhea, migraines, and thyroid disease.
For women with FODMAP sensitivity (as opposed to gluten sensitivity), a full serving of wheat or other FODMAP food can cause digestive bloating and potentially worsen premenstrual mood symptoms and polycystic ovary syndrome (PCOS). Small amounts of wheat are usually fine.
When trying to decide whether to strictly avoid gluten, the first step is to understand the difference between FODMAP sensitivity and gluten sensitivity. In short, if wheat causes digestive bloating, it’s likely to be a problem with FODMAPs. If wheat worsens brain fog, psoriasis, autoimmunity, or migraines, it’s likely to be a problem with gluten.
FODMAP sensitivity causes digestive bloating
FODMAPs are short-chain, fermentable carbohydrates that can cause irritable bowel syndrome (IBS). FODMAP-containing foods include wheat, milk, legumes, certain vegetables, and fruit. The term FODMAP is an acronym invented by researchers at Monash University in Australia and stands for fermentable oligo-, di-, and monosaccharides and polyols.
👉🏽Tip: Spelt is easier to digest than wheat because it’s low in FODMAPs. But spelt does contain gluten.
Untreated, FODMAP sensitivity can contribute to problems with the microbiome, impair estrogen clearance, and activate mast cells — all leading to inflammation that can worsen period problems such as premenstrual mood symptoms and PCOS.
The solution is to 1) temporarily cut back on FODMAPs and 2) work on the underlying cause of FODMAP sensitivity, such as stomach acid medication, underactive thyroid, and small intestinal bacterial overgrowth (SIBO).
With SIBO and a FODMAP sensitivity, it’s usually enough to just temporarily reduce wheat and other FODMAPS, without needing to strictly avoid wheat or any other food.
Gluten sensitivity can drive or worsen immune dysfunction
Gluten, on the other hand, is not a carbohydrate and often does not cause digestive symptoms. (If bloating is your main symptom, refer to the FODMAP section above.)
Instead, gluten is a protein that can cause deep-seated immune dysfunction, even in trace amounts. But only in people with gluten sensitivity.
👉🏽 Tip: Wheat, spelt, rye, barley, and possibly oats contain gluten. Rice, corn, millet, quinoa, or potatoes do not contain gluten.
Gluten sensitivity can take the form of either celiac disease or non-celiac gluten sensitivity. Of the two, celiac disease is more severe and can be diagnosed with a blood test (celiac serology) followed by an intestinal biopsy. It’s important to have the blood test before eliminating gluten from your diet because avoiding gluten can cause you to test negative even if you have celiac disease.
Non-celiac gluten sensitivity (NCGS), on the other hand, cannot be diagnosed (or ruled out) by the celiac serology blood test.
How to assess for non-celiac gluten sensitivity
First, consider whether you or anyone in your family has any of the symptoms of non-celiac gluten sensitivity:
- depression
- brain fog
- psoriasis
- infertility
- migraines
- osteoporosis
- autoimmune disease.
Hashimoto’s autoimmune thyroid disease, in particular, is strongly linked to gluten. A family history of thyroid disease (or other gluten symptoms) is a good indicator that you could benefit from a trial of a gluten-free diet.
Next, speak to your doctor about the “celiac gene” or “celiac genotype” blood test, known as HLA-DQ2 and HLA-DQ8. If you test positive for a celiac gene, you have a 4 percent chance of developing celiac disease but a much higher risk of developing other autoimmune conditions such as autoimmune thyroid disease. Testing positive for a celiac gene is another good indicator that you could benefit from a trial of a gluten-free diet.
Finally, you could just try strictly avoiding gluten for at least eight weeks and see how you feel. Strictly avoiding means avoiding even trace gluten, which is different from just reducing wheat as you can do with FODMAPs. For conditions associated with gluten sensitivity (endometriosis, autoimmune thyroid disease, and migraines), there is no such thing as partially gluten-free.
| Likely to require strictly gluten-free | Unlikely to require strictly gluten-free |
|---|---|
| endometriosis and adenomyosis | polycystic ovary syndrome (PCOS) |
| autoimmune thyroid disease | hypothalamic amenorrhea (HA) |
| migraines | premenstrual mood symptoms |
How wheat affects periods
In summary, periods can be affected by FODMAP sensitivity and/or gluten sensitivity (including non-celiac gluten sensitivity).
Some cases of amenorrhea (lack of periods) are caused by celiac disease or non-celiac gluten sensitivity which is why every woman with unexplained amenorrhea should be screened for celiac disease. In that case, strictly avoiding gluten is the main treatment. However, most cases of amenorrhea are caused by undereating and have nothing to do with gluten.
Migraines can be worsened by gluten sensitivity because an inflammatory reaction to gluten can lead to antibodies against the enzyme glutamate decarboxylase (GAD), resulting in high glutamate and low GABA. Most (but not all) women with migraines can benefit from strictly avoiding gluten. Read Natural treatment of hormonal migraines.
Hashimoto’s autoimmune thyroid disease is strongly linked with gluten sensitivity. Untreated, thyroid disease can contribute to heavy periods. Almost without exception, testing positive for “thyroid antibodies” means you should strictly avoid gluten.
Most types of PCOS do not require avoidance of either FODMAPs or gluten. The inflammatory type of PCOS can require temporary avoidance of FODMAPs and only sometimes the strict avoidance of gluten.
Finally, endometriosis and adenomyosis are usually worsened or driven by gluten sensitivity. That’s because (according to reproductive immunologist Dr Jeffrey Braverman), most women with endometriosis have the celiac genotype (the genes associated with gluten sensitivity). So strictly gluten-free can be an important part of treatment for endometriosis. Read Immune treatment for endometriosis.
