Is Gluten-free Dangerous for Your Heart?

Can a gluten-free diet be dangerous?

Here’s the summary:

Yes, there is research demonstrating that those consuming the least amount of gluten increased their incidence of heart disease.

No, you don’t need to decide between eating gluten, when you clearly have celiac disease or non-celiac gluten sensitivity, and protecting your heart.

There truly is no bad news here, but understanding why the research showed what it did is worth exploring and it will help you to be healthier.

What did the 2017 research show?

The British Medical Journal published a 2017 study designed to examine any association between eating gluten and developing heart disease. The study followed about 65,000 women and almost 45,000 men who filled out food frequency questionnaires in 1986. The surveys were updated every 4 years through 2010 – a study spanning 26 years total.

The findings? Those eating the least gluten had a higher coronary heart disease incidence than those eating the most gluten.

What do these findings mean?

The researchers had this to say: “The avoidance of gluten may result in reduced consumption of beneficial whole grains, which may affect cardiovascular risk. The promotion of gluten-free diets among people without celiac disease should not be encouraged.”

Interpretation? When you don’t eat wheat, and are a typical American, your fiber intake drops precipitously. Fiber is protective of your heart.

How did the press misinterpret the findings?

The press had a field day with the study, leading with such headlines as:

• “The Dangerous Link between a Gluten-Free Diet and Heart Disease”, and
• “Why a Gluten-Free Diet is Bad for Your Heart”

The titles aren’t wrong, they’re just terribly misleading. They make it seem like a gluten-free diet is going to kill you from heart disease.

The truth is: a diet low in fiber will increase your risk of developing heart disease. If wheat is your main source of fiber, then yes, failing to replace it will increase your risk. Apparently 78% of Americans derive their prebiotics from wheat consumption. This is a problem.

Dietary fiber is the problem, not gluten

Is it hard to get healthy fiber? Not at all.

Are Americans deficient in fiber? Absolutely. It’s estimated that 97% of Americans are deficient in fiber. Apparently the little fiber they are consuming is in grains such as wheat, despite how refined they are.

It’s a sad testament to the Standard American Diet that eliminating wheat could tip the scales towards increased heart disease. If the American diet was robust in fiber, the body wouldn’t miss the fiber provided from refined wheat.

The bottom line – there is nothing unique in wheat’s fiber that is protective of your heart. Healthy fiber can readily be gotten from a fresh, whole-food, plant-based diet.

Eating white flour is not good for your heart

Those reading only headlines could assume that white bread, pasta, and cookies, protect them from heart disease. Nothing could be farther from the truth.

Remember, heart disease is our #1 killer. Gluten consumer or not, the number one cause of Americans dying is heart disease.

A 2014 study also showed an increased risk

The 2017 study wasn’t the only one to make the correlation. In 2014 The Journal of the American College of Cardiology published a study entitled, “Coronary artery disease prevalence is higher among celiac disease patients”.

Those diagnosed with celiac disease showed nearly twice the risk for coronary artery disease, 9.5% compared to 5.6%. The elevated risk was thought to occur from inflammation persisting despite adherence to a gluten-free diet. That likely is the case, but the cause(s) of the inflammation needs to be identified. These particular researchers did not make the connection between loss of dietary fiber and its effect upon a healthy microbiome.

A 2009 study had an interesting viewpoint

A 2009 study, also published in the Journal of the American Medical Association, was titled “Small-Intestinal Histopathology and Mortality Risk in Celiac Disease”. It was quite fascinating, this time from a rear-view perspective.

The researchers discovered a strong increased risk of death from all causes (but remember heart disease is our number one killer) when a person reacted to gluten.

They evaluated those with what I call “classic” celiac disease as well as those with latent celiac disease (positive blood tests but no villous atrophy), plus what we now call non-celiac gluten sensitivity, meaning there was inflammation in the intestine but no villous atrophy nor any positive celiac blood tests were found.

Their conclusion was this: “Risk of death among patients with celiac disease, inflammation, or latent celiac disease is modestly increased”. What is worth noting is they chose to leave out a very major finding.

Why did they alter their findings?

Here was their comment and justification: “Since HRs [hazard ratios] in the first year of follow-up were so different from that of later follow-up, we excluded the first year of follow-up from all subanalyses. Celiac disease is a lifelong disorder, and relative risks excluding the first year better estimate the long-term mortality risk.”

In other words, they couldn’t figure out why the hazard ratio for mortality was so dramatically increased during the first year. The risks were incredibly high during the first year after diagnosis. They couldn’t discern why the implementation of a gluten-free diet caused higher mortality, so eliminated the data.

“Inflammation”, as they termed it, today we say gluten sensitivity, had a 4.66-fold increase risk of mortality. This, in the first year of implementing a gluten-free diet. Celiac patients had a 2.80-fold increase and those with latent celiac a 1.81-fold increase.

These increases dropped substantially after the first year to 1.41, 1.26, and 1.27 respectively.

Why did the risk of death drop after the first year?

Did patients start eating more fiber? We don’t know why their risk diminished so dramatically across the board after their first year, but I can tell you this from clinical experience. It is quite common for patients who first eliminate gluten from their diet to become extremely constipated.

You now understand why – Americans don’t consume much fiber and what little they do eat tends to come from wheat. No one likes to be constipated so patients tend to quickly figure out they need more fiber and make efforts to improve the situation.

They eat more fiber, make their gut flora happier, reduce inflammation, and reduce the risk of heart disease. But remember, this is only a reduction down to the average American, still high risk.

It’s worth reiterating that the “typical” risk of heart disease is already ridiculously high and scary since it’s our number one killer. We are simply discussing lessening an elevated risk down to the “normal” American risk. This is very far from what a health risk factor would and should look like.

If you want to reduce your risk of heart disease you should consume more fiber in the form of fresh vegetables, fruits, beans and legumes, and whole grains, but if you have celiac disease or gluten sensitivity, those whole grains need to be gluten-free.

[Note: fiber pills do not provide the same benefits as the fiber found in whole foods.]

Here’s the summation of the research

1. A healthy gut is made up of healthy microbes that are anti-inflammatory and reduce our risk of degenerative disease, including heart disease.
2. One dietary factor affecting the health of the gut is adequate dietary fiber.
3. Americans are highly deficient in fiber, which is a reason most Americans are so unhealthy.
4. Americans get most of their fiber from wheat.
5. Ninety-seven percent of Americans need more fiber. This is best gotten from fresh, whole foods that are plants including vegetables, fruits, beans, legumes, nuts, seeds, and whole grains.
6. A gluten-free diet does not need to be deficient in fiber and is health-promoting when done correctly.

How’s your health?

• Are you concerned about your health?
• Does heart disease worry you?
• Do you wonder if gluten is affecting your health?

We can help.

Contact us for a Free Consultation – Call (408) 733-0400.

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References:

1. The Journal of the American College of Cardiology, “Celiac Disease Linked to Increased Risk of Coronary Artery Disease” Mar 29, 2014
2. Jonas F. Ludvigsson, MD, Ph.D.; et al, JAMA, “Small-Intestinal Histopathology and Mortality Risk in Celiac Disease”, September 16, 2009
3. Benjamin Lebwohl, assistant professor, British Medical Journal, “Long term gluten consumption in adults without celiac disease and risk of coronary heart disease: a prospective cohort study” May 2, 2017