Ep 145: What You Didn’t Know About Celiac Disease with Jessica Lebovits, RD, CDN
Fertility Forward Episode 145:
Most people know (or have at least heard) of gluten and understand that some may be affected by an intolerance of it, but many are unaware that this immune reaction to eating gluten is actually called celiac disease. Today on Fertility Forward, Jessica Lebovits, RD, CDN, joins us to discuss her journey with celiac disease and how the diagnosis ultimately affected her fertility. Jessica is now a celiac disease specialist (among others) and she explains how her positive outlook on her diagnosis led her to pursue and embrace it as a specialization in nutrition. We discuss the ins and outs of celiac disease: what causes it, why it’s still relatively unknown, and how to treat it. Jessica then walks us through her fertility story and how a PCOS diagnosis sparked a lasting relationship with RMA’s very own Rena Gower. To end, here’s a gentle reminder that there is always something to be grateful for.
Rena: Hi everyone. We are Rena and Dara, and welcome to Fertility Forward. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our Fertility Ford Podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients because knowledge is power and you are your own best advocate.
Dara: Jessica Lebovits is a registered dietician living in New York City, who's passionate about helping those with digestive conditions. Jessica is an expert in celiac disease and other gluten related disorders and has celiac disease herself. She received her nutrition education from Cornell University and her training on a low FODMAP Diet by Monash University. Jessica also specializes in IBS, SIBO, GERD, gastroparesis, lactose and fructose intolerances, bone health, blood sugar control, and cardiovascular disease. She's been counseling patients for almost a decade through her own private practice, Jessica Nutrition and the Celiac disease Center at Columbia University. Her research involves dating, relationships, and quality of life among those with dietary restrictions, and she recently published guidelines for micronutrient considerations while on a gluten-free diet. She loves helping others meet their goals, live a healthy lifestyle, and enjoy food to the fullest. Amen to that, Jessica! I'm so happy to have you here today!
Jessica: Thank you so much for having me.
Dara: Thrilled to be chatting with you because this is a long time in the making. We'll be speaking also your personal experience on the other side in terms of fertility. But first I wanna hear from you in, in how did you get into nutrition and how did you come to specialize in GI issues and celiac disease?
Jessica: Yeah, so originally I didn't know what I wanted to do and I realized that the combination of counseling, science and food was just kind of a combination of all of my interests. So I ended up applying to Cornell as a nutrition major. Other schools I applied as a chemistry major. That would've taken me on a totally different journey, and I followed that path and really liked it and I was on the path to becoming a registered dietician. And it wasn't until my senior year of college that I actually received a diagnosis myself of celiac disease. So I was already going to work in this field. I had started out in hospitals trying to gain a broader knowledge of different disease states, but I started to become more passionate about GI conditions. Obviously having it myself, I was learning so much about it and I really love the GI world because I find that you're really listening to the patients, hearing their stories, which is exactly why I wanted to get into counseling as a dietician and kind of figuring out what the issue was yourself. You kind of get to be an investigator and listen to what is causing symptoms for different people and maybe finding the solutions. It felt like an area that was really exciting to me. And obviously having celiac disease myself, I know about all the food and restaurants and brands, so it has been so helpful to be able to relay that information to my patients.
Dara: It's so fascinating just how our trajectory in life ends up being. Like, getting into Cornell helps kind of get you under the path of nutrition and then having your own experiences further helped you hone in on something even more specific. It's just, it's, I just love how life really does take you where you need to be and also using your own personal experience to help you delve deeper into something to not only help you but also help the people you're working with.
Jessica: Yeah, absolutely. I don't think if you asked me in high school when I was applying for majors at all, that I would end up in this field and you know, I think that I'm lucky to be able to take this diagnosis and make a career out of it and enjoy what I do. But, you know, I would never would've expected to ended up on this path.
Dara: Yeah, I mean that's, that's kind of like the most interesting part of life is, like, it all happens when it needs to happen. The same thing, like similar, you know, I was just a, a general dietician until I had my own fertility struggles and then that kind of led me into, Hmm, like, are there dieticians that specialize in fertility? If I had my own issues, I'm sure I needed help. I'm sure so many other people could use help and support. So it's so nice also to, again, taking your own struggles, but using it for the people behind you.
Jessica: Yeah, exactly. I think that there, you can dwell in the negative of having these diagnoses and these struggles or you can see the positive and make the best of it and try to help others. And it's not every day that I have the most positive attitude about it, but I think overall, I really feel like as a practitioner, we're able to do a lot for other people. And even just, you know, if you don't work in this field, just being a support person for someone else with these diseases or these struggles can just make a huge difference in someone else's life.
Dara: Yeah. And especially, like, when it comes to the GI tract, it's, you know, there's a lot that potentially can be troublesome or tricky. And especially with celiac disease, it's something that we both learned in school when we, in our internship, however, it is one of the more, I feel like, trickier parts to work with, especially because there's such a wide variety of potential signs and symptoms. So I kind of wanna hone in on celiac disease because I'm sure many people have heard of like the gluten-free diet, but they're not necessarily super aware of what celiac disease is. And people can be on a, I want, you know, I want you to share with people, like people could be, anyone could be on a gluten-free diet, but why is it so important for people, people with celiac disease to be on a gluten-free diet?
Jessica: Yeah, and in all honesty, I did not learn that much about celiac disease in my training. I even had a friend with celiac disease and at the time I really didn't know much about it. It wasn't until it became part of my own life that now I know so much about it, but there wasn't that much. And so, I'm happy to share because I think a lot of people don't know as much about it as they might think that they do or, you know, gluten is such a popular term, but what actually gluten is. So, you know, I think a lot of people think of celiac disease as the GI tract, so they think of the diarrhea, the abdominal pain, constipation, malabsorption, or failure to thrive. But that's only one piece of it. And that may happen, but that may not happen. Some other symptoms are neurological, so things like headaches, numbness or tingling, brain fog. And there are also symptoms that are totally outside of the GI tract. Things like anemia, osteoporosis, arthritis, skin manifestations, canker sores, dental enamel defects. And of course we'll talk more about infertility.
Dara: That's crazy. Like, and that's why I think sometimes people can just feel off and they I'm sure have a, a wide variety of different symptoms, but sometimes those symptoms can also be a sign of something else. So I think that's what can be really tricky in terms of people not necessarily understanding if they have celiac disease or not.
Jessica: Yeah. It's really hard because these are not so specific to just celiac disease. This could be so many different conditions and as a dietician, I don't envy my doctors who have to decide, you know, who definitely has celiac disease or not. But there is testing that really confirms what that is. So celiac disease, just for those who don't know, it is a genetic autoimmune disease where gluten triggers inflammation and therefore damage in the small intestine. And so gluten itself is actually a protein that's found in wheat, ,and rye that provides structure and elasticity to food. So to ever develop celiac disease, you have to have the genes. You have to be eating gluten and there needs to be some sort of stressor or trigger that actually turns those genes on. So you know, you may develop it. 30 to 40% of the population actually does carry these genes. But only 3% will actually go on to develop celiac disease if they have the gene. And of the general population, only 1% actually has celiac disease. If you're being tested for celiac, you'll need to be eating gluten in order for the tests to be accurate. For the most part, testing involves blood testing, which looks for the presence of antibodies to gluten. And then you'll have an endoscopy to biopsy the small intestine to look for that damage that we talked about.
Dara: Yeah. So it's interesting, there's the two factors, the blood test and then also doing that scope to see if there's potentially damage in the, in the GI tract. But it's interesting that this is a great fact for me that I didn't realize that even though you may have the gene, it may not necessarily be expressed. And do we know yet whether, is it stress, is it an age factor? Do you know what can potentially turn it on more so than not?
Jessica: So yeah, it's a really interesting topic because it could be so many different things and I don't think the, they're, you're really able to know. So I have no idea what turned mine on, but they do hypothesize that it's maybe a virus or a major stress event, things like that. Some sort of stressor in your life. Just maybe an accident or something like that where your body is stressed to a certain degree, but it's hard to know because you don't know the exact point in time. So, you know, I got diagnosed at a certain point in time, but when I actually developed celiac disease, I have no idea.
Dara: Well, yeah 'cause perhaps people could have had it a lot earlier, but maybe didn't go to their doctor until certain symptoms came up or certain symptoms that they didn't like and didn't wanna live with anymore.
Jessica: Right. I didn't go to the doctor until around my senior year or junior year of college and I had really gone for acid reflux and I didn't really think much of it, you know, I was in college at the time, so having reflux didn't really seem all that unusual given my lifestyle in college. But that was the thing that brought me in. But looking back, there definitely were some signs, but nothing, it's possible it could have been celiac disease or it's possible I didn't actually have it until I was diagnosed.
Dara: That's fascinating. Yeah. The one person I know that's really close to me is my cousin, and he is, I wanna say he's in his mid to late forties. He was diagnosed a couple of years ago, and for him particularly, he was losing weight, unexplained weight loss, even though he was eating a lot of food. And it took a while for him and he didn't wanna believe it at first because he, his wife is Italian and he's like, oh my god, she makes homemade pastas and she's a great cook and a great baker. That was a big change to his lifestyle. But you know, I think nowadays, you know, it's interesting how there's a trend towards more gluten-free foods. And this is, I think the, the really challenging thing about celiac is, is the best way to treat it per se, is just going on a gluten-free diet? Is there anything else that we can do?
Jessica: So the gluten-free diet is the treatment. And the great thing about celiac disease is that there is a clear treatment and it doesn't involve medications. It is a diet. But of course the diet really impacts quality of life. So I had the same shock. I had been eating tons of bread and pasta. I had just gotten back from studying abroad in Italy. So I was totally shocked by it and most of our patients are. But luckily because it is a trend, there is a lot of gluten-free options available and more and more awareness out there that can be tricky because with celiac disease, even very small amounts so the types of preparation do oftentimes matter for most of our patients. And sometimes when restaurants may not take it as seriously if they think it's a trend. So that can be tough. So overall, I think the thing that is most helpful is the gluten-free diet. But we work with patients to manage all of their symptoms that may be related to celiac disease, but may be related to other things and really optimize their nutrient intake as well as manage their quality of life. So we want them to live as normally as possible, eat out, travel, do all of the things while still healing on a gluten-free diet.
Dara: I think that's great. Yeah. And it's good. I I, I'm happy that you mentioned that. And what makes it easier nowadays, you go to a restaurant and typically they say, do you have any allergies or food restrictions? At least in New York. But I think most restaurants, right?
Jessica: New York is really good. So I mean, we're biased with New York. Europe's amazing, but definitely we see people from all over and not as easy in certain areas.
Dara: Yeah. And also people don't know exactly what celiac, I think it's a disease is, it's so important to really take ownership and let them know, you know, when you go to restaurants, I have celiac disease, that means that I can't have the wheat, rye, barley and also contamination. Like if, if I, if you're using the same cookware that has previously used, and that's where it gets, I'm sure a little tricky is if you're using, you know, bread on a pan and then you're cooking something that doesn't have bread, but you're still being served, someone who has celiac disease still may have the contaminants in their dish.
Jessica: Yeah. So we really go through, and this is what I teach my patients about, you know, specific questions to ask and how to advise restaurants or waiters or chefs, what to do in terms of preparing their food safely. So for example, a condiment, so like something like butter. If somebody takes the butter, spreads it on their wheat bread or bagel, dips it back in and then spreads it and then you try to spread it on yours that might be something that we talk about trying to prevent. There has been some research showing that that could be enough to potentially cause a problem for someone. But just as you bring this up, I'm thinking of, tougher situations come up too, where family members, where they're not a restaurant that's trained in some of these things and we have to teach our family members, you know, holidays can be pretty tough. So these are all the different types of life situations. The diet itself and knowing what is gluten-free and what isn't isn't all that difficult. But how to navigate all these social situations is a big part of our counseling.
Dara: I was gonna say, that's why it's so important to, to meet with someone like you who really can help guide social situations and helping people feel confident and less worrisome. Like, I wish you were there to meet my cousin when he was first diagnosed 'cause he literally thought his life was over. He was like, great - can't enjoy anything. And again, I do, it's nice that in this day and age, especially if you're living in a big city, that there are a lot of ways to accommodate.
Jessica: Yeah. Yeah. And he is pretty common. I mean, a lot of our patients go on the internet, and the internet can be really helpful, but it also has a lot of fear mongering and, you know, I got sick from this or that. That seems a little bit out there. And then people don't wanna leave their house, they don't wanna do anything. So we really talk about what is the research behind these things. Luckily I'm, I've been seeing so many celiac patients for years, so I have a very good sense. And obviously I'm a walking experiment, so I can really advise patients on what do they need to do to be safe and heal their intestines and what is a little bit overboard so that they're able to still enjoy their life.
Dara: Yeah, that's a good point is, is how can you reassure patients. Yeah, help 'em navigate day to day so they don't have to be living in fear. They can be living their life the way they wanna live their life. Which is so interesting that Jessica and I became well acquainted when you wanted to start building a family.
Jessica: Yeah. So we bonded immediately and I was so excited. I was like, oh, there's a dietician on board, I'm all for it. And then we started meeting and you started filling me in on the world of fertility, which I was not as familiar with before.
Dara: Were you aware that potentially celiac disease impacted your fertility success?
Jessica: Yeah, so there definitely is a relationship between fertility and celiac disease. We'll go into more of the research on it, but what most of the research shows that untreated celiac disease is going to be the issue. And that's why it's so important for people to kind of explore, you know, what might be going on before they go into all of this. But luckily, I, I've been on a gluten-free diet for about a decade now. And you know, I have been healed. I've managed my celiac disease, so it was always in the back of my mind as a possibility, but I wasn't too concerned about the, the fertility aspect from a celiac disease perspective. So of course something else had to pop up. So, and that's what connected us.
Dara: Yeah. I feel like you are pretty an unbelievable case in terms of, you had a lot going on and it's amazing how you've been able to have such a great attitude and really get to know your body and get, get to know yourself. So I would love for you to share with our listeners kind of your, your fertility experience at RMA and what kind of you learned through it.
Jessica: Yeah. So now looking back, I realize I did get my period at a pretty late age. I was 16 years old when I got my first period. And after that I did have some irregular periods, but I really just didn't think much of it. Now wondering, was that celiac disease? Was that PCOS, which we'll talk about as well? I don't know, and I don't think I'll ever know. But then as I, we said, you know, in my senior year I got my celiac disease diagnosis. A few years later I found out that I had another autoimmune condition, which you've talked about on the podcast, Hashimoto's, a type of hypothyroidism. So my thyroid hormones weren't too low, so I was told I would just monitor them, but I absolutely would need to take medication once I was pregnant. And then more recently I went off my birth control. I didn't get my period, but I didn't really think this was so strange. I thought I had heard this from so many people, I didn't really think anything of it again. And I finally mentioned it to my gyno and she suggested various testing and eventually told me I likely had PCOS. This really brought me back to the shock I had with my celiac disease diagnosis. I didn't really think anything was wrong. I didn't really think I had symptoms of PCOS. But after that, I reached out to my peers, I was then referred to see Dr. Lucky Sekhon, who later confirmed the diagnosis. And she confirmed this based on my hormone levels, including an elevated testosterone, irregular periods, and the classic string of pearls in my ovaries. So once I saw that ultrasound, I realized, okay, I definitely have PCOS. But I was also super surprised to see that my hemoglobin A1C or my blood sugar level had jumped up over the year. And so Dr. Sekhon suggested I start metformin, start levothyroxine for my thyroid hormones, and manage my blood sugars through diet, which is where you came in.
Dara: Amazing. So it's great that you kind of, you went to your gynecologist and it was great that they started the blood work to see exactly what was going on in your body. And then it's great that also you were, you were connected with Dr. Sekhon who further explained to you in terms of PCOS, the reason behind the importance of, or the potential benefit of metformin and levothyroxine. And then it's great that you also took the steps of, okay, I'm a dietician, I know what I should be eating for celiac disease or for GI issues, but this is something else. You know, there's a dietician on staff, let's have a chat. And I mean, this definitely started our friendship and our connection, which I mean, I could see from day one I was like, she is so passionate about living her life and living in joy and also having a healthy relationship with food. And so I really did, I've enjoyed working with you because you were open to new ideas. And also, and I think this is what's great, is it's great to specialize in something that you're passionate about and then also be able to, to seek out support in areas that you may not be super aware. And I've learned a lot from you, too, in terms of, you know, in terms of celiac disease and Hashimoto's and what you do. But it's great that you said, okay, what are the areas that I can work on? Because there's a lot of things, you know, especially when it comes to autoimmune issues, there's a lot of things that are out of your control per se. But what are the things that you, in your day-to-day lifestyle can really prioritize? And so like you've, I've seen a huge change in what you do day- to-day after we connected. We definitely had a conversation about proteins and, and good quality fats, mindfulness practices. And it's amazing to see you really hone in on these things and really make changes in your day to day.
Jessica: Yeah. I mean I obviously as a dietician, I know the value of a dietician, so I was like, I'm all in. I can't wait to see her. I came with like millions of questions every time and took way too much of your time. But yeah, you taught me a lot. I mean, I remember coming into you being totally being a low fat dairy girly and you explained to me why, you know, for fertility purposes that might not be the best solution for me. You know, different nutrients to focus on. It's funny that despite all my barriers, I just love carbs. I'm such a pasta, bread person, that they took, you know, I had to go gluten-free with all of it. And now with the PCOS, you know, I was on Metformin for a few first few weeks and then, you know, now I'm just managing it on my own because actually I am three months pregnant now! And so all the things you taught me, I am managing my blood sugars and you know, being careful because I do understand that there is a higher risk of gestational diabetes with PCOS. So obviously Diet plays an important role here and I'm trying to do what I can to protect myself.
Dara: You're like the perfect patient, like you came, you know, ready with questions and curiosity and challenge me too in terms of, you know, showing you research and really pointing you in the direct, right direction. And I'm happy. You mentioned even like making sure that you had the nutrients that you needed for your health. And that's something even with celiac disease, especially for people who are newly diagnosed before they're on a gluten-free diet. Do you see a lot of patients who are nutrient deficient? And if they are, like, are there certain nutrients in particular that they typically are deficient in?
Jessica: Yeah. So obviously with the malabsorption of, in the small intestines where we absorb a lot of the nutrients, it is obvious that there would be nutrient deficiencies associated with celiac disease. So untreated celiac and patients who are recently diagnosed may be deficient in certain nutrients. Some of the major ones would be iron, vitamin D, calcium, vitamin B12, and Folate. And we all know how important folate is during pregnancy. Nutritional deficiencies like iron, folate, zinc, and selenium deficiencies may be linked to infertility, which again may resolve with a gluten-free diet. Malabsorption of zinc, selenium, folic acid, and fat soluble vitamins may induce sperm abnormalities, which can contribute to male infertility. And as you mentioned in my bio, I did recently publish guidelines in the journal Practical Against Gastroenterology on micronutrient considerations for celiac disease. This was just to help practitioners provide evidence-based recommendations for nutrient evaluation and supplementation so they know how to advise their patients.
Dara: That's great that you've done that, but it's interesting, a lot of those potential vitamins that are malabsorbed are also linked to fertility. So it's, it's amazing. And then also a lot of those micronutrients are also linked to thyroid, your thyroid. There's so much overlap. So it it, you know, it makes me wonder, you know, a lot of people who are coming in with potential fertility problems, not to say again, it's 1% of the population that has celiac. But it, you know, and it's interesting also, I, I see a lot of overlap in terms of general autoimmunity, autoimmune issues. So people that have underactive thyroid or Hashimoto's and a link with PCOS and then also the link to infertility. There's a lot of potential overlap. So it's interesting once people are diagnosed and they can hopefully get in the nutrients that they need, whether it's through food and/or through supplementation. That's why the first thing I, I typically tell patients, go on a prenatal vitamin. It's a great safety net. And then of course for me, if you can really focus and hone in on foods that give you a wide variety of vitamins and minerals, that's the ultimate too.
Jessica: Right, right. We really wanna be correcting those deficiencies way before we're getting to pregnancy. And a big overlap with fertility and celiac disease is actually, it's a predominantly female disease. So the majority are female with a ratio of three to one female to male. So, you know, we will see a lot of female disturbances. So things like menstrual problems such as a significant delay in getting your period for the first time. Something that, you know, I had loss of a period more often and also a tendency towards early menopause
Dara: That I knew about. I, in terms of, it's funny, I knew that the link of like later getting your period later can often be related. But that's just so fascinating how it can all be somewhat interconnected. But that's great to hear that you got the clarity in terms of, okay, these are my issues. These are the, or these are the considerations that I need to look at. What are the things that I can, can do on my own? Who do I need to reach out to for support and for guidance? And you did all those steps and, and it's so nice to see how far you've come and where you are now. Like, you're pregnant! It's so nice to see to, to work with someone going into a pregnancy and throughout a pregnancy. It's great. So you've really worked so hard on changing your, your day-to-day, your diet. For me, what I'm so impressed with you, 'cause one of the things that we spoke about was, the importance of having a variety in your diet. And I'm sure this also links back to GI issues. One of the most important things for, for our gut is to have the diversity.
Jessica: Yep, yep. Something I talk about with almost every patient too.
Dara: And then sometimes we, we also need to have, like, reminders. I need reminders too. That's why I, I love doing what I do because I'm constantly reminding myself of Oh wow, am I eating the same breakfast day in and day out? Am I mixing it up? But really to see the changes that you've made and where you are today is, is pretty incredible. And now, hopefully, you can help your patients, your GI patients, you know, in terms of family planning too, if it's something that comes up with the people that you see.
Jessica: Yeah, absolutely. You know, would I maybe have liked an easier transition to all this? Sure. But I think I'm really grateful for the opportunity to have met all of the people I've met between you and Dr. Sekhon. Her team, especially her nurse Nicole, have just been so helpful and made this experience so great for me through RMA. So I wouldn't take back any of it and now I can use all of it to help others.
Dara: Yeah, that's, that's a great way of looking at it. Is there anything or any type of advice that you would want to give to anyone who's potentially going through something similar to what you are, like what you went through?
Jessica: Yeah, I think my takeaways from all of this would be to be proactive. I think that I feel comfortable that I was doing a lot of this testing and finding these doctors way before I was ready to conceive. And it's hard to think about that so far in advance, but I think it really set me up for success to kind of look into all of these things way beforehand. And that way I had my doctors on board, I had the medications that I needed to be on. My hormone levels were finally, you know, where they needed to be. So I think that really set me up for success with that and seeking out support from others. There's no way I would've gotten here without the support from my friends, my peers, you know, the team. I think I learned so much. I got advice and recommendations. This is my first pregnancy, so I had no idea what I was doing. So being open and being willing to reach out and get information I think brings you a lot further. And then the last one I would say - I have to - is that diet plays a huge role. As we talked about, you know, on this session, obviously being on a gluten-free diet for somebody with celiac disease can make a huge difference in fertility and pregnancy outcomes and other types of dietary changes, like, blood sugar management, optimizing certain nutrients can really also, you know, improve outcomes as well.
Dara: Yeah. So I mean, you made some great points, like being your best advocate. You know, if something doesn't feel right or if you have questions like don't hesitate to ask, don't hesitate to reach out. And also look at your lifestyle. What are the things that you can do that really can make you not only physically and mentally feel better, but also can potentially help you in your journey to health, wellness, fertility? It's amazing really. It's so amazing to see how far you've come. You know, you've learned so much. I've learned so much from you too, which is pretty remarkable. And I can only imagine that your, you know, the people that you come across, your patients I'm sure adore you. What's the best way to find you if people are interested in learning more about what you do?
Jessica: Yeah, so you can contact me. My email is [email protected]. I'm on social as @gfree_rd. And you know, those are my takeaways for patients and anyone going through the fertility process. But just for practitioners, you know, who treat patients, I would say, you know, it's important to maybe recognize that celiac disease does have all these diverse manifestations and it's not just the classical presentation that we think of. So any women you see with menstrual issues, infertility and adverse pregnancy outcomes, you know, you can suspect celiac disease there. Screening for celiac disease should be considered as part of treatment for patients with unexplained infertility, recurrent spontaneous abortions, and unexplained intrauterine growth restriction. And the good news is that treating the condition is really helpful and can prevent these symptoms, improve fertility, and also improve quality of life.
Dara: I'm happy you mentioned that because I, I do still wonder how much is going undiagnosed. Like, I wouldn't like that 1%? I was actually surprised how low the percentage of people that have celiac disease. I wonder if there's just a big part of this population that still hasn't been uncovered?
Jessica: Yeah. It's interesting because the awareness has definitely been increasing a lot over the years. But I think based off studies that they do, you know, that might even include some of the people who are undiagnosed, but there's still a lot of people out there who don't know about their celiac disease diagnosis.
Dara: And then there's also, I mean we didn't even talk about this, but like there's even gluten intolerance, which I know is different and I believe it's, it's not a diagnosis of celiac disease, but that doesn't necessarily ne negate the fact that there's a lot of people that still can't tolerate gluten.
Jessica: Yeah. So I would probably say, you know, there's celiac disease, there's wheat allergy, there's something called non celiac gluten sensitivity or non-celiac wheat sensitivity, which gets diagnosed when you have very similar symptoms, very similar manifestations to celiac disease, but it's definitely not celiac disease. Say like you don't have the gene for it, so it's not that, but you absolutely really can't tolerate gluten. And then there's also people with kind of maybe more of this general gluten intolerance where maybe it's gluten, maybe it's wheat. In our realm we kind of talk about FODMAPs, which people may have heard of, some people can, you know, have IBS-type symptoms and certain things like wheat or gluten might bother them. So we really try to manage symptoms based off of what is causing them and how lenient can we be? Someone with gluten intolerance might be able to have a sourdough wheat bread, whereas someone with celiac disease, we would absolutely not recommend that.
Dara: Yeah, that's great that you were able to distinguish that because there are those little minute or maybe not that so minute, but there are definitely differences. And depending on your diagnosis, medical treatment, nutrition treatment would be slightly different. And so it's really important to know exactly what's going on in your body.
Jessica: Right. Knowing whether you have an autoimmune disease that needs follow up and has malabsorption you, you know, really monitoring your bone health over the years compared to having a gluten intolerance, you might not need to focus as much on the medical follow up and can we have some gluten here and there? That makes a huge difference in your long-term treatment and quality of life.
Dara: Well, just another reason why it's so important to go to someone who specializes in this like you Jessica who really can again, help guide you depending on, you know, where you're at, if you've been diagnosed, if you haven't been, what are the steps to see where you're at and then afterwards like whatever, whatever is going on with you, what can you do nutritionally and otherwise to really help feel better and really, yeah, optimize your health and wellness. And as you said, quality of life, making sure that you're living the life that is the best for you.
Jessica: Yeah. We don't want the treatment to be worse than the disease is what we say, so
Dara: Heck no. Well I'm, I'm just so happy to see that you're feeling great and you have this beautiful story now to share and also to, you know, realize that you, you're on the other side in many ways and it's beautiful to see.
Jessica: Yeah, I, I still can't believe it. I think every time I'm still in shock Now we're at three months, I'm still in shock that I am feeling good. I expected to be a total nightmare because I already had GI symptoms. Again, we're only three months in, but I am very, very grateful to be here and I hope that, you know, this is inspiring for other people as well.
Dara: I know it will be. So how we like to end our podcasts is with wordsof gratitude. So Jessica, what are you grateful for right now?
Jessica: Well, I have to say, I mean obviously I'm very grateful for the pregnancy and I am really just grateful to be connected to the RMA team. You know, I think I gained friends out of you, and Dr. Sekhon, and Nicole, and the whole team. It was just a really good experience to have in my life that, you know, now I can understand what a lot of women go through and be able to incorporate that into my practice. And, you know, that would never would've happened if I didn't get diagnosed with PCOS. So I do think I have learned so much from it and will be in touch. And now I'm on this amazing podcast, so I just appreciate all of where I'm at right now.
Dara: How beautiful is that? Going back to the beginning when I spoke about like synchronicities, how like, things happen the way they need to, like I'm really so grateful that you came into my life in terms of, I'm always been very fascinated with GI Nutrition. It's, it's very, it's a very challenging area because there are so many very nuances when it comes to your GI track and I've learned so much from you and even to in today's discussion, I was really excited because it is something that, you know, I see here and there, but it is one of those areas that is still not something that I see day in and day out. So I'm grateful for people like you really, who are here to teach me, teach our listeners. And it actually makes me want to delve deeper into the subject 'cause I do think it's, it's something that unfortunately I think we're gonna see a lot more of, but it's so hopeful that there are ways to really help feel good. Yeah. And there's so many treatment options.
Jessica: Right. Well, I'm not going anywhere. I'm sure I have a lot to learn a lot from you. I'm happy to help anyone who wants to learn more about celiac disease and gluten-free diet. So, you know, I think this, this is just the end of one chapter and beginning of another.
Dara: Amen. Love that. Thank you so much for coming on, Jessica. I appreciate it.
Jessica: Thank you so much for having me.
Dara: Thank you so much for listening today. And always remember: practice gratitude, give a little love to someone else and yourself, and remember you are not alone. Find us on Instagram @fertility_forward and if you're looking for more support, visit us at www.rmany.com and tune in next week for more Fertility Forward.