Even though any day is a great day to start taking proactive health measures, the start of a new year is seen as the chance to really start focusing on health. In many respects, individuals with diagnosed celiac do not need Jan. 1 as a reminder because every day is about making choices to stay healthy by living a completely gluten-free life.
At the same time, while maintaining a gluten-free diet is necessary for one’s wellbeing with celiac, it’s only one piece of a much larger health puzzle. Gluten free or not, everyone needs to focus on taking care of themselves. The new year just happens to present a natural time to think about everything from the connection between food and disease to making healthy lifestyle choices such as not smoking and exercising regularly.
Health is a huge, overarching topic, and no article can cover every aspect of it. The goal here is to provide an overview of aspects to think about in the year ahead. As with everything health-related, speak with a health-care professional to figure out what your individual needs might be and how best to handle them.
The role of diet in health
Diet plays a significant part in staying healthy. For individuals with celiac, first and foremost, eating a completely gluten-free diet is crucial. “Staying on a strict gluten-free diet is key to being healthy in celiac disease,” explains Benjamin Lebwohl, MD, MS, director of clinical research at the Celiac Disease Center at Columbia University.
The types of foods included in one’s gluten-free diet, though, can be cause for concern. “While the gluten-free diet can result in alleviation of symptoms, it is not inherently healthy. Without a careful effort to have a diverse and fiber-rich food source, it can lead to nutritional deficiencies, constipation and weight gain,” says Lebwohl.
The food a person consumes has a direct connection to the development of other conditions. As a result, individuals with celiac need to make smart eating choices. “Having celiac disease does not preclude us from also getting diet-related diseases such as obesity, diabetes and heart disease,” notes Rachel Begun, MS, RDN, nutrition advocate and special diets expert.
In the long term, diet can play a huge role in health. “If someone does not eat a balanced diet, over time your body will pay the price,” says Laura Manning, MPH, RD, CDN, clinical nutrition coordinator at Mount Sinai Hospital in New York. “It is OK to have processed food here and there, but to have it on a regular basis will potentially add a lot more calories, salt, fat and sugar that you don’t need.” Eating such foods regularly has a cost. Manning explains, “When these foods are consumed too consistently, you can put yourself at risk for high blood pressure, high cholesterol and diabetes—all of which can lead to major medical issues that can be prevented with some simple dietary changes.”
Every individual has a different road to diagnosis and different needs because of it. “Everyone’s needs are going to be different, as some have nutrient deficiencies, some may have other conditions to consider, and some may be overweight while others are underweight,” Begun says. As a result, “I recommend that all people diagnosed with celiac disease see a registered dietitian knowledgeable in the gluten-free lifestyle so a healthy eating pattern can be established and the individuals’ needs can be addressed,” says Begun. When it comes to finding a registered dietitian well-versed in the gluten-free diet, Amy Keller, MS, RD, LD, emphasizes that “It’s worth doing . . . even if you have to travel a little bit.”
One of the overall health concerns that can arise on the gluten-free diet is weight. Lebwohl notes there are several reasons for weight gain following a celiac diagnosis. “When gluten is eliminated, the intestinal villi gradually heal, and this can result in an increased ability to absorb calories.” Then there is the issue of the ingredient profile of some gluten-free foods. “Gluten-free substitute foods often have more calories than their gluten-containing counterparts,” Lebwohl warns, and this is connected to another reason for weight gain—“a diet low in fiber may diminish the state of feeling full, increasing hunger and caloric intake.”
When it comes to eating, individuals sometimes try to find a substitute for everything they were eating. “The biggest thing I see, a lot of my patients kind of gravitate toward trying to replace everything they’ve ever enjoyed, and they end up with a diet full of high fat, high sugar,” explains Keller. As a result, “they take in less-nutritious foods or they end up taking in more calories than they intended.”
When it comes to patients who need to gain weight following the diagnosis, Keller notes, “You want to regain the weight in a healthy way—protein, healthy fats, whole grains, those types of things, rather than necessarily cookies, cakes and pretzels.”
A well-rounded diet
So what does a well-rounded diet include? “A well-rounded diet means that your meals are consumed on a timely basis and they contain the major food groups: whole grains/starches, fruits, vegetables, lean proteins and healthy fats,” says Manning.
As Begun notes, “The ironic thing is that many of the foods we recommend to the general population for a healthy diet are naturally gluten free, including fruits, vegetables, dairy, beans, nuts, seeds, eggs, fish and moderate amounts of meat and poultry.” When it comes to the gluten-free diet, “The only category where recommendations must be tailored,” she points out, “are grain-based foods, and there are plenty of gluten-free whole grains to choose from, including all rices, quinoa, millet, corn and certified gluten-free oats.”
Whole grains are an important part of a well-rounded diet. Someone who is eating “the whole grain versus the packaged food,” says Manning, “will benefit from the higher fiber content, and all the nutrients remain intact before it is all processed away. This helps with better blood sugar control and [is] less likely to add unwanted pounds.”
Gluten-free whole grain products are more readily available these days. “It used to be it was very difficult to find a whole-grain gluten-free item, and that’s not the case anymore,” says Keller. The same can be said for fortified gluten-free foods. “The nutritional profile of some of these processed foods…are improving with fortification and things like that to make them similar to their gluten-containing counterparts. But people need to not assume. They need to read the label and look for iron-fortified cereal and look for something that is not high in sugar.”
An important aspect of one’s diet is to “eat a minimum of five fruits and vegetables a day,” explains Manning, and to think about variety as well as what types of produce are growing closest to your home. “It helps to also have lots of different colors in the fruits and vegetables you choose as well as trying to eat seasonally and locally. This will also optimize your nutrition because the nutrient retention will be at its highest.” When it comes to hydration, “drink mostly water, not sugary beverages,” she says.
Keller notes that “getting calcium and vitamin D are huge.” She says that anyone with lactose intolerance should find ways to obtain these nutrients from non-dairy foods, also citing protein as a vital component. “We know protein is satisfying, particularly if someone is trying to lose weight. Protein is a satisfying thing, so making sure they’re getting adequate protein in their meals [is key].”
Additionally, she says iron is something to think about. “Most of my patients end up sort of starting in that iron-deficient category, so making sure that they are getting good sources of iron [is crucial].” Keller shares that “you want to pair anything like that, that’s high in iron, with something that’s high in vitamin C. So my example is pairing a hamburger with a cup of tomato soup to help absorption of that iron with the vitamin C.”
Thinking about heart health
Taking care of one’s heart is very important. “Like anyone else, adults with celiac disease should have their blood pressure and cholesterol checked and addressed,” explains Lebwohl.
When it comes to heart health, getting checked out is the only way to know what is happening inside. “Most people walking around with elevated blood pressure [are doing so] without knowing it,” says Guy L. Mintz, MD, FACC, director of cardiovascular health and lipidology, North Shore University Hospital, associate professor of medicine, School of Medicine at Hofstra/Northwell and NYU School of Medicine. As a result, “it is important to have your blood pressure checked on a regular basis.”
Blood pressure is a concern because of its impact on the heart. “High blood pressure causes blood vessels to constrict instead of dilate,” says Mintz. “When the vessels constrict, more internal damage can occur, allowing for more cholesterol to build up inside these vessels.”
With cholesterol, Mintz explains, “It is important to know your cholesterol numbers. These are done as part of a routine blood test. There is total cholesterol, triglycerides, HDL cholesterol (good cholesterol that is protective for heart disease) and LDL cholesterol,” which Mintz explains is “bad cholesterol”—and a good way to remember that is “‘L’ is for lousy.”
This cholesterol is certainly lousy. “LDL is associated with heart disease,” Mintz says. “Think of LDL as ‘sticky cholesterol’ because it penetrates in the walls of blood vessels, causing progressive blockages in these arteries. You want to keep your LDL cholesterol level low and your HDL cholesterol high.”
Weight also plays an important role in heart health. “Being overweight is associated with multiple risk factors for heart disease,” says Mintz. “These include high blood pressure, high cholesterol, increased risk for prediabetes or metabolic syndrome, and diabetes. Some obese patients develop sleep apnea, which is when a patient temporarily stops breathing or develops shallow breathing at nighttime.” Sleep apnea can cause a number of problems and “is associated with irregular heartbeat” as well as “daytime fatigue and, in some cases, snoring.”
He says, “Improving the risk factors for heart disease can reduce the chance of a heart attack by decreasing inflammation and cholesterol buildup in the blood vessels.” Part of reducing risk is diet. Mintz points out, “General dietary tips include reducing daily total cholesterol to less than 200 milligrams [mg] per day, no added salt and try to keep your sodium-salt intake to less than 2,300 mg of sodium per day.” One great way to reduce sodium intake is to cook at home because, as Manning notes, “eating more home-cooked meals can help to lower your chances of excessive salt and fat intake that so many processed foods contain.”
As with anything health-related, Mintz states that “each individual should have their risk factors and diet evaluated, to personalize a lifestyle program that will succeed for them.”
Risks of smoking
While the dangers of smoking are widely known, individuals continue to smoke, including individuals with celiac. “There are patients who take extensive measures to stay strictly gluten free and yet continue to smoke cigarettes,” says Lebwohl. In addition to causing cancer, smoking also damages the heart and blood vessels, along with just about every other organ in the body. “Smoking promotes irritation or inflammation of the blood vessels in the heart and further promotes cholesterol buildup,” explains Mintz. Additionally, “smoking has been associated with an increase in heart disease in women.”
The benefits of exercise are body wide. As Manning notes, “It is an integral part of wellness that needs equal attention to diet.” She points out that ”Getting daily exercise can help keep you mobile, build lean muscle mass, increase bone density, increase your cardiovascular level and lower your risk for chronic disease.” The concern about bone density is important, particularly as people get older. “Exercise helps to maintain muscle for balance and bone density to prevent fractures,” Manning explains. In addition to the physical benefits, “exercise is also a great way to relieve stress,” she says.
“Regular exercise can lower blood pressure, reduce cholesterol, lower blood sugar, promote weight loss and make the heart stronger,” explains Mintz. The heart is a muscle, and it becomes stronger with regular aerobic exercise, such as running, swimming or bicycling, leading to improvement of the risk factors for heart disease and reducing cholesterol plaque formation in the arteries of the heart.
So how much exercise is necessary for heart health? Mintz says, “I tell my patients to maintain the rule of 4s. This is 40 minutes of regular continuous aerobic activity 4 times a week to achieve 4 benefits: improvement in blood pressure, blood sugar, cholesterol and weight, as well as strengthening the heart.”
While 40 minutes might sound like a lot, it’s easier to achieve than one thinks. “You do not need to run,” says Mintz. “Walking is as good as running. The goal is to increase your heart rate above its resting level and continue for at least 40 minutes.” People can get creative with how they accomplish their exercise. “I have patients that live in apartment buildings and do not have access to [workout] facilities [so they] walk throughout the apartment for 40 minutes without stopping.”
Healthy changes take time
Change is always hard, especially when it comes to health. Keller notes, “Any little change you make that you can sustain is a good change—maybe it’s a change that you make over the next six weeks [such as] adding one or two fruits and vegetables every day. I mean, that’s a huge change for people.”
When it comes to working on health, doctors play an integral part and want their patients to succeed. Mintz sees the patient and doctor relationship “as a team approach, and I support [my patients] throughout the journey, including the highs and lows. Our goals are the same, and it’s important to understand that each person’s journey is unique.”
Steps for a healthier 2019
From eating a well-balanced diet to finding ways to be active, there are many steps that can be taken to be healthier in 2019. To figure out what is best for you, it’s important to speak with a health-care professional and come up with a plan together.
- A well-rounded gluten-free diet includes gluten-free whole grains, fruits and vegetables, protein from animal sources such as eggs, fish and poultry, as well as plant-based protein sources such as beans, nuts and seeds.
- Get your cholesterol and blood pressure checked.
- Quit smoking.
- Work a bit of physical activity into every day. It can be something as simple as walking, and the benefits extend across the body.
Remember, change takes time, and any positive change you make—and maintain—is a step in the right direction!
Susan Cohen is a New York freelance writer. She contributes regularly to Gluten-Free Living.