Market analysis shows that sales of gluten-free foods have been growing at 34 percent per year. By 2019, annual total sales are projected to surpass $2.3 billion. This growth can be attributed to both an expanding array of gluten-free products entering the marketplace as well as more interest in the category among non-celiac consumers. Clearly, gluten free is here to stay, and gluten-free foods are likely to remain widely available in the marketplace. This is great news for celiac disease patients, for whom going food shopping has never been easier.
Unfortunately, despite consumer assumptions to the contrary, gluten-free foods are not automatically better for you. Potato chips and many sugary cereals are gluten free. So is a Caramel Brulée Latte from Starbucks (all 440 calories of it). So people with celiac disease and those simply trying to avoid gluten could be walking into a giant dietary trap if all they look for is a notation that a product is certified gluten free. And as a cardiologist, I can tell you the stakes could not be higher.
According to a Cleveland Clinic study, celiac disease is associated with a significantly increased risk of heart disease. This conclusion was reached after the researchers evaluated over 22 million electronic health records, including those of nearly 25,000 patients with celiac disease. This big data analysis found that, compared to non-celiac “controls,” celiac patients were nearly twice as likely to be affected by coronary artery disease (CAD, blockages in heart arteries) as their non-celiac counterparts, regardless of age. This is comparable to the increased cardiovascular risk associated with diabetes, smoking or high cholesterol. The study was not designed to address why this excess risk exists, but researchers speculate that the generalized inflammation associated with celiac disease may be at fault.
The big takeaway message? Celiac patients not only need to avoid gluten, but they also need to be highly vigilant about preventing heart disease.
Minimizing your risk
Heart disease remains the No. 1 killer of Americans and is driven by seven well-recognized lifestyle-related risk factors: smoking, inactivity, high cholesterol, high blood pressure, diabetes/prediabetes, excess weight and poor diet. Smoking and inactivity are distinct. But the remaining five risk factors are nutrition related, and their prevalence reveals a lot about the status of our dietary health. The data are truly depressing: Fewer than 1 percent of American adults adhere to an optimal heart-healthy diet.
As a side note, notice that although high cholesterol, high blood pressure and diabetes/prediabetes are all nutrition-related, they are by and large relatively well controlled, despite the dismal diet scores. This paradox exists because doctors are really good at placing patients on medications.
But simply putting people on statins to normalize cholesterol readings—without addressing what patients eat—is not a cure. It is only masking the risk. Paradoxically, this masking actually enables the continuation of poor dietary patterns, perpetuating the underlying stimulus, creating a vicious cycle.
Patients with celiac disease are not immune to this dysfunctional status quo. In fact, they are especially vulnerable given the pervasiveness of low-fiber, high-salt and high-fat products, all proudly displaying a gluten-free label. These are exactly the types of foods that contribute to high cholesterol, blood sugar abnormalities and high blood pressure.
Choosing heart-healthy foods
From a cardiologist’s perspective, it is imperative that people with celiac disease not only pay attention to avoiding gluten but that they also optimize their diets for heart health and actively incorporate the nutrients that are essential to reducing heart risk. These include:
- Whole-food fiber
- Omega-3 fatty acids derived from fish, nuts and seeds
- Antioxidants from whole fruits and vegetables
- Plant sterols
These “building blocks of heart health” have been shown to dramatically affect outcomes. They are also far more impactful than drugs or supplements.
For example, according to the Zutphen Study, which followed nearly 1,400 initially healthy men for more than 40 years (or 56,000 person-years), every 10-gram increase in daily whole-food fiber intake was associated with a 17 percent reduction in death from heart disease and a 9 percent reduction in death from any cause. By the way, this differs greatly from outcomes associated with the use of statin drugs in otherwise healthy individuals with high cholesterol. An analysis encompassing more than 65,000 such patients over 244,000 person-years showed no mortality benefit from statin use.
A diet high in omega 3-rich flaxseeds and walnuts not only lowers cholesterol in a way that impacts outcomes, but also positively affects blood vessel function, yielding as much as a 3-point reduction in diastolic (bottom number) blood pressure readings. Maintained over time, this decrease in blood pressure is associated with a 28 percent reduction in stroke, 25 percent reduction in dying from heart disease and 22 percent reduction in death from any cause.
Long-term, large-scale, population-based studies have found that higher circulating levels of diet-based vitamin E, vitamin C and carotenoids are associated with a lower risk of CAD. The key here is that these antioxidants must come from food. No rigorous supplement trial has ever shown a mortality or heart disease outcome benefit, with some actually showing harm.
Finally, at levels of 2 to 2.4 grams per day, plant sterols (naturally occurring plant compounds that block cholesterol absorption in the gut) have been shown to reduce LDL cholesterol by 10 to 14 percent. A 12 percent reduction in LDL translates into a 24 percent reduction in death due to heart disease and a 19 percent reduction in non-fatal heart attacks.
Add this all up, and you’ve more than neutralized the higher heart risk associated with celiac disease.
Healing power of food
It was the overwhelming consistency of the preventive power of nutrition—as well as the realization that simply putting people on medications was a crutch and not a cure—that led me to found Step One Foods. Our mission is to make eating strategically for heart disease prevention easy and delicious. Certified gluten free, every Step One product contains all of the building blocks of heart health at clinically meaningful levels. And, on average, we have demonstrated LDL cholesterol reductions of 39 points in just 30 days. That’s a pharmaceutical level effect and a true testament to the power of food in reducing cardiovascular risk.
We all know that what we eat has a significant impact on our health. In fact, no one experiences the adverse effects of eating the wrong foods more acutely than celiac patients. However, we can’t just approach nutrition with a strategy to merely avoid harm. Whether you are a celiac patient or someone simply trying to eat better, actively incorporating foods and ingredients with documented health benefits is the most effective approach to ensuring long-term health and vitality—especially if you are at increased risk for heart disease.