Cardiologist

The Link Between Celiac Disease and Your Heart

The link between celiac disease and your heart might be stronger than you know.

You may already know that 1 in every 133 people have celiac disease.

You may also be familiar with statistics regarding the incidence of heart disease – it accounts for roughly 1 in 4 deaths in the United States and kills someone every 60 seconds.

What you may not realize, however, is that there is a link between these two conditions.

Though celiac disease is commonly thought of as a digestive disorder, new research suggests that there could be a link between celiac disease and an increased risk for coronary artery disease (CAD). Let’s take a closer look at the connection.

Celiac Disease Causes, Symptoms, and Complications

Though many people think of it as a dietary sensitivity or intolerance, celiac disease is an autoimmune disease triggered by the consumption of gluten.

Gluten is a protein found in certain grains including wheat, barley, and rye. When someone with celiac disease eats gluten, it triggers an immune response in the small intestine. The immune system identifies   gluten as a threat. Over time, this misdirected immune reaction causes damage to the lining of the small intestine which produces a wide variety of symptoms.

Celiac disease presents differently in every patient and symptoms may vary depending how long the condition has gone undiagnosed. Here are some of the most common symptoms of celiac disease:

  • Digestive upset, diarrhea, constipation, and gas
  • Loss of bone density, osteoporosis
  • Iron-deficiency anemia, low red blood cell count
  • Itchy skin rash, dermatitis herpetiformis
  • Breakdown of dental enamel
  • Chronic fatigue and/or headaches
  • Numbness or tingling in the hands and feet
  • Chronic joint pain
  • Acid reflux and heartburn

Though the characteristic immune reaction is the underlying cause of these symptoms in cases of celiac disease, researchers have yet to identify a specific cause for that reaction. There is some evidence to suggest a genetic link for celiac disease, and there are certain risk factors which have been identified:

  • A family member with celiac disease
  • Concurrent type 1 diabetes
  • Turner syndrome or Down syndrome
  • Autoimmune thyroid disease
  • Microscopic colitis
  • Addison’s disease
  • Rheumatoid arthritis (RA)

Having an autoimmune disease can also increase your risk for developing another one. Again, this link is still not fully understood, but growing scientific evidence suggest it exists.

The only treatment available for celiac disease at this time is a gluten free diet.

Left untreated, celiac disease can develop some serious complications. Malnutrition is a major concern as damage to the lining of the intestines prevents the absorption of essential nutrients. Loss of calcium and bone density are also concerning. For women, untreated celiac disease may increase the risk of infertility or miscarriage, and it may also increase your risk for cancer and neurological problems.

New evidence also suggests that having celiac disease may increase your risk for developing heart disease. We’ll dig deeper into that later but first let’s take a closer look at the specifics of coronary artery disease.

Understanding the Basics About Coronary Artery Disease

There are many different types of cardiovascular disease or heart disease, and over 62 million Americans have one form or another. Coronary artery disease (CAD) is one of the most common forms, caused by a blockage in the coronary arteries which prevents the heart muscle from getting enough oxygenated blood to function properly.

Coronary artery disease is not an acute condition – it develops over the course of years or decades, beginning with damage to the coronary artery that could occur as early as childhood.

There are a number of factors that can contribute to initial coronary artery damage including smoking, high cholesterol, high blood pressure, diabetes, insulin resistance, and a sedentary lifestyle. Once the inner wall of the coronary artery is damaged, fatty deposits known as plaques tend to accumulate at the site of injury. As the plaque grows, more of the artery becomes obstructed which limits the flow of oxygenated blood to the heart muscle.

Not only does coronary artery disease cause reduced blood flow to the heart, but there is also a risk that the plaque could rupture. When that happens, platelets will gather around it in an attempt to repair the damage. The result, however, is a larger blockage of the artery which can cause a heart attack, or a piece of the plaque could break off create a blockage.

Coronary artery disease can affect anyone, but certain factors increase your risk. Here is an overview:

  • Age – The older you get, the higher your risk of damaged or blocked arteries.
  • Sex – Men generally have a higher risk for CAD than women.
  • Genetics – A family history of heart disease may increase your own risk.
  • Smoking – Tobacco use significantly increases your risk of developing CAD.
  • Hypertension – High blood pressure can thicken, harden, and narrow your arteries.
  • High Cholesterol – High cholesterol levels increases the risk of plaque formation.
  • Diabetes – Risk factors for CAD overlap significantly with risk factors for diabetes.
  • Obesity – Excess weight and a sedentary lifestyle worsen other risk factors.
  • High Stress – Chronic stress can damage the arteries and worsen other risk factors.
  • Unhealthy Diet – High intake of dietary fat may contribute to an increased risk for CAD.

Because coronary artery disease develops over a long period of time, it doesn’t always present with obvious symptoms. Unfortunately, in some cases, a heart attack is the first indication that the heart isn’t receiving adequate blood flow. In many cases, however, angina or chest pain is a frequent symptom.

As blood flow to the heart becomes reduced, patients may experience worsening or more frequent angina. Angina feels like a pressure or tightness in the chest, often triggered by physical or emotional stress. You may also experience shortness of breath with minimal exercise – this is a sign that your heart isn’t getting enough blood to meet your body’s oxygen demands.

Heart attack is the most common (and severe) complication of untreated coronary artery disease. Other complications include arrhythmia or abnormal heart rhythm, worsening angina, and heart failure.

Is There a Link? What Does the Science Say?

Before getting into the details of the research that supports a link between celiac disease and coronary artery disease, there is another interesting point to make.

People with celiac disease tend not to have the typical risk factors for CAD. The most common risk factors for heart disease are obesity, high cholesterol, and smoking. According to numerous studies, however, people with celiac disease don’t fit that familiar picture. They tend to weigh less, have healthier cholesterol levels, and use fewer tobacco products.

It is true that obesity levels are on the rise and the once-typical picture of a person with celiac (underweight from malnutrition) is not always accurate. That being the case, what is the driving factor behind the link between celiac disease and heart disease?

Scientists believe that it has something to do with chronic inflammation.

As you may recall, celiac disease is a condition in which the immune system turns against the body’s own healthy tissue triggered by gluten. In this case, it is the targeted tissues line the small intestine. There is evidence to suggest that this process may increase inflammation in other parts of the body as well, including the coronary arteries, and that inflammation could speed the development of plaques.

This theory is supported by the results of a 2017 study which showed that adults with celiac disease had higher levels of inflammatory markers as well as the early stages of plaque buildup in the coronary arteries. As those same adults switched to a gluten free diet, their inflammation dropped over time.

Though the nature of the link between celiac disease and heart disease is still being studied, there is a wealth of scientific evidence that supports the existence of that link.

For example, an analysis of data collected from over 22 million people, 24,000 of which had been diagnosed with celiac disease, showed that people with celiac disease have nearly a twofold increased risk of heart disease in comparison to people without celiac disease. Among celiac disease patients, the overall rate of heart disease is 9.5% - only 5.6% among people without the disorder. In people under 65, the risks were lower, but the variation is still evident – 4.5% for celiac suffers versus 2.4%.

Having celiac disease does not guarantee that you will develop heart disease as well, but the risk seems to be higher. Keep reading to learn how to protect yourself.

Tips for Preventing Heart Disease

Though researchers are still working to understand the specific connection between celiac disease and heart disease, inflammation is thought to be a driving factor.

If you recall the study mentioned in the previous section, inflammation dropped significantly in celiac disease sufferers after they switched to the gluten free diet. So, it would seem that a way to protect against heart disease as someone with celiac is to always stick to the gluten free diet. As many celiac disease sufferers know, even the smallest bit of gluten can trigger a reaction. What you may not know is that, under the surface, your immune system is reacting as well and doing inflammation-causing damage to your digestive tract.

In addition to following a gluten free diet, there are some other steps you can take to reduce inflammation and protect yourself against heart disease. Here are a few:

  • Stop smoking. Though you may not be able to reverse the damage you’ve already done, your risk for heart disease drops significantly after 1 year of quitting and approaches the level of a nonsmoker after 15 years. By quitting tobacco, you can also reduce chronic inflammation.
  • Get regular exercise. A combination of cardiovascular and strength training exercises is best for your health, and you should aim for 30 minutes of exercise at least 5 times a week.
  • Follow a heart-healthy diet. Though you’ll need to avoid whole grains that contain gluten, most of the other components of a heart-healthy and anti-inflammatory diet are gluten free – think healthy fats, fresh fruits and veggies, beans, legumes, and low-fat dairy.
  • Watch your weight. Increasing your activity and improving your diet may come with the added benefit of weight loss but you may still need to take additional steps to achieve and maintain a healthy body weight.
  • Get plenty of sleep. Sleep deprivation can increase your blood pressure as well as your risk for obesity, diabetes, and heart attack – it can also increase inflammation in the body.
  • Drink enough water. In addition to hydrating your cells and tissues, drinking water can help maintain the proper pH balance in your body which is essential for fighting off inflammation.

Though the discovery of a link between heart disease and celiac disease is certainly unnerving, there is no need to panic. If you’ve already switched to the gluten free diet, then you are taking steps to mitigate that risk. Follow the tips above to further reduce your risk and always be sure to make frequent checkups with your doctor to monitor your health.