Cheating on a Gluten Free Diet? Increased Serious Risks May Occur

Linda J. Dobberstein, Chiropractor, Board Certified in Clinical Nutrition

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Cheating on a Gluten Free Diet? Increased Serious Risks May Occur
If you are gluten intolerant or have celiac disease and think you can cheat a little through the holidays, new and ongoing research may change your mind. Various studies and case reports show a higher risk of heart attack, stroke, blood clots, heart failure, and spontaneous tearing of coronary arteries in untreated or poorly managed gluten intolerance and celiac disease. Other risks and disorders certainly occur too, but the focus on this article is the risk of serious sudden cardiovascular and neurological events that occur with poor dietary management with celiac disease. This risk occurs in people of all ages including children and young adults. The research community will undoubtedly continue to explore and debate this relationship. For now if you are gluten intolerant and indiscretions occur, take this information to heart – literally.

Celiac disease and gluten intolerance has many faces. Statistics for North America and Europe estimates that five percent of the population suffers from celiac disease with millions more undiagnosed. The growing epidemic has many underlying causes including glyphosate (Roundup) exposure. When most individuals think of Celiac disease (CD) or gluten intolerance, symptoms of diarrhea, malabsorption, failure to thrive, underweight, and malnourishment come to mind.

Symptoms and disorders are far more than this and include several autoimmune diseases like type 1 diabetes, Hashimoto’s and Grave's disease, anemia, osteoporosis, dermatitis herpetiformis (skin rash), infertility, neurological (balance, neuropathy, neurodegeneration etc.) and psychiatric problems (depression, anxiety, schizophrenia, etc.), canker sores, collagen tissue damage, and inflammatory bowel disease. But the list is even more threatening. Several cardiac and stroke problems have been linked with gluten intolerance and celiac disease.

Increased Risk of Heart Attacks and Stroke


A recent systematic review and meta study published October 2015 reviewed cardiovascular disease in patients with celiac disease. They analyzed several studies involving 98,497 individuals with celiac disease. They evaluated the risk and occurrence of heart attack, cardiovascular death, and stroke. After eliminating common variables and other underlying concerns, the evidence pointed to a moderate increased risk of heart attacks, stroke, and death in patients with celiac disease. The authors recommended further study.

Gluten Intake, Blood Clots and Stroke


Celiac disease is a risk factor for blood clots and stroke. Researchers identified this in children with newly diagnosed celiac disease, who had not abstained from gluten. A pilot study published earlier this year identified this increased risk and prevalence of blood clots and stroke. They found that blood cells were stickier or had increased problems with coagulation. Elevated blood levels of thrombin were present which leads to blood clot formation. Once the gluten was removed from the children’s diet, blood stickiness levels improved. This information coincides with case reports of children of various ages who have experienced one or more strokes as a result of celiac disease and continued dietary intake of gluten.

Recent published case reports described young children, teens, and young adults who have experienced stroke as a result of celiac disease or gluten intolerance. In one case study two boys ages 2 and 16 experienced a stroke with celiac disease. Gastrointestinal symptoms were not present. It was identified that the boys were gluten intolerant and that the gluten exposure caused an inflammatory immune response to the vascular tissues within the brain and caused the strokes. Again there were no digestive symptoms present. Another study described an 8-year-old who developed cardiomyopathy (weakening of the heart muscle) and stroke. After a thorough medical evaluation and ruling out several disorders, it was determined that celiac disease caused the development of the stroke and weakened heart.

Adults are not immune to this risk. Deep vein venous thrombosis (DVT’s) or blood clots in the legs may occur as a result of celiac disease. Strokes from celiac disease can also happen in adults. Scientists recommend that celiac disease be considered a potential cause of stroke especially when the reason is unknown. They emphasize this in particular for young patients who have experienced stroke. The stroke can occur even in the absence gastrointestinal symptoms.

Heart Muscle and Endothelial Damage


Other studies have seen a link between changes in heart function and underlying celiac disease. A 27-year-old man developed cardiomyopathy with heart palpitations, shortness of breath, inflammation of the heart, and other symptoms. After an exhaustive medical work-up, testing revealed that the symptoms were due to celiac disease that created an autoimmune attack on the heart muscle. The patient did not comply with the medical treatment of a strict life-long gluten-free diet. He developed further worsening of the heart condition over the next several months and ultimately experienced serious cardiac complications and required invasive cardiac intervention. The study did not disclose what interventions were taken and if the patient survived, but clearly non-compliance caused critical and life-threatening health problems.

A 2012 cutting-edge study investigated the cause for increased risks of heart failure/cardiomyopathy and heart attacks in celiac disease patients. They found high levels of inflammation within the endothelial lining of the blood vessels stressing the heart. The endothelial lining is a delicate one-cell-thick lining that protects the lining of blood vessels. When this cell lining is damaged from inflammation, tissue injury occurs. This damage has been linked to the onset and development of heart disease, heart failure, and atherosclerosis.

Just a few years prior, endothelial damage and heart disease were identified but it was not completely understood as to all of the triggers. This cutting-edge study opens the door for further understanding and specific knowledge on the effects of gluten intake when sensitive. As the number of patients with heart disease and failure rise with simultaneous increase of celiac disease in the world-wide population, this raises questions. It also raises grave concern for those who are non-compliant with diagnosed gluten intolerance and for those who are undiagnosed.

New Research on Heart Rhythm Problems


A study released earlier in Heart, Lung and Circulation September 2015 journal identified a higher level of atrial rhythm problems in celiac disease patients. The scientists used a marker called atrial EMD that is an early marker of atrial fibrillation. Atrial EMDs were identified by common cardiac tests – EKG and echocardiogram. Significantly higher levels of atrial EMD’s were present in celiac disease patients compared to healthy patients. Gluten consumption induced inflammation that led to the start and continuation of atrial fibrillation in celiac patients.

Newly discovered information from 2014 points to other parts of the heart being affected by gluten intolerance. For the first-time ever researchers found that left ventricle function of the heart and its ability to tolerate strain or work was less efficient compared to non-gluten patients.

In another first-time account, physicians reported that a link between coronary artery dissection, heart attack, and poorly managed celiac disease. A 41-year-old man had ongoing chest pain and presented to the emergency room. He was found to be having a heart attack related to life-threatening spontaneous coronary blood vessel tearing. He had been diagnosed with celiac disease 12 years prior, but stopped following dietary abstinence. He had resumed eating gluten one year prior to the near deadly events. Cause of life threatening symptoms was poorly managed celiac disease.

Historical Hindsight


Older studies give us further hind-sight information. A population study that included blood samples from nearly 7,000 Finnish citizens taken from 1978-1980 analyzed the samples for celiac disease with either endomysial (EMA) antibodies or tissue transglutaminase antibodies (tTG). Scientists compared information over a 28 year surveillance period on those who had positive antibodies to celiac disease to the rates in the general population. The retrospective analysis found definitive higher statistics for death from stroke, lymphoma cancer, or respiratory system diseases compared to the controls in the study.

The reasons for celiac disease causing cardiac events, blood clots, and stroke are under increasing investigation. After ruling out obvious risk factors for heart disease and stroke like smoking, alcohol, and obesity, etc. the scientists are making some clear observations and coming to conclusions. Gluten intake causes an inflammatory response within the brain and heart for those with celiac disease. It may be related to how the immune system reacts to the gluten, creating vascular inflammation within the brain or cardiovascular vessels which damages the integrity of the protective inner lining of the blood vessel. As a result stroke, blood clots, or heart problems occur. It can do this even in the absence of gastrointestinal symptoms which is also known as silent celiac disease in the medical literature.

Nutritional deficiencies as a result of the disease are of great concern and certainly play a role in the investigation. Celiac patients often struggle with iron deficiency anemia and insufficient folate, vitamin B2, B6, and B12. These B vitamins are related with processing homocysteine. Elevated homocysteine levels is a major risk factor stroke and heart disease. Research from the Scandinavian Journal of Gastroenterology showed that removal of gluten improved folate levels and normalized homocysteine lab values. Because of the serious risk of stroke and other problems, the authors recommended aggressive diagnosis and treatment of celiac disease, i.e. complete abstinence of gluten.

Methylation defects which cause changes in antioxidant status and usage may underlie several of these concerns. Methylation defects impair homocysteine metabolism and change needs of several nutrients like B6, B12, and folate.

The diagnostic terminology of celiac disease, silent celiac disease, cryptic gluten sensitivity, gluten intolerance or non-celiac gluten intolerance may be confusing with the different terms. It is imperative to know if you are gluten intolerant. Family history of celiac disease, or any of the disorders linked with celiac disease or gluten intolerance like Hashimoto’s, lymphoma, heart attack, stroke, or respiratory diseases provide strong clues to potential underlying gluten intolerance. You may be carrier of HLA-DQ 2 or DQ8 genes associated with celiac disease. Identification of non-celiac gluten intolerance or “cryptic gluten sensitivity” that occurs without direct evidence of small-intestine damage as seen in biospy should be identified. There are 24 different known immune reactive compounds now identified linked with wheat allergy, gluten intolerance, and celiac disease that trigger autoimmune inflammation. These compounds can be tested for and are found in a blood test called “Wheat/Gluten Proteome Reactivity & Autoimmunity”.

There are many risks outside of celiac disease and gluten-induced inflammation for these various disorders, but present research and historical perspective show that consuming gluten with celiac disease creates a higher risk of several major cardiac and neurological events. These events can occur suddenly without digestive complaints. The current studies statistics show risk is small to moderate, but it, however, is present, silently provoking and perhaps deadly. Many of the studies strongly advised aggressive and complete mandatory lifelong removal of gluten, i.e. there is no room for cheating or bending the rules. Get tested to determine if there is a problem.

The inflammation triggered by gluten intolerance is often subtle until the inflammation has significantly injured the tissue. The inflammation triggered doesn’t always act like the pain experienced like hitting your thumb with a hammer or stubbing a toe. The autoimmune immune inflammatory cascade can take hours, days, weeks, or months to reach full blown tissue damage even after just one exposure of gluten in gluten intolerance. The inflammatory exposure is like setting off one mouse trap in a gymnasium full of traps. It triggers a ping-pong effect that reverberates until it reaches the end-point or something stops it.

The treatment for celiac disease is complete removal of gluten. If you are exposed for whatever reason, taking DPP-IV enzymes can help you digest gluten and reduce some of the offense. Support gut, vascular, and brain health and address the underlying Leaky Gut Syndrome caused by the gut injury from gluten. Vitamin D, the omega-3 DHA fish oil, tocotrienols, quercetin, curcumin, and N-acetyl-d-glucosamine (NAG) are great nutrients to focus on. No one can predict if they will have a heart attack or stroke from unknown or other factors. You can reduce the risk by not cheating or complete disregard of dietary recommendations if you have celiac disease or are gluten intolerant.

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