Gluten, which is a protein, is unique in that the amino acids that make up the gluten protein are more tightly bound than is customary, making this protein difficult to digest. Celiac disease—once believed to have a prevalence of 1 in 10,000 but now believed to affect 1 in 100 individuals—is an extreme form of gluten intolerance. Celiac disease prevents an individual from absorbing nutrients through his or her small intestine. That is, these people may be consuming a sufficient amount of calories for a normal person, but because of malabsorption they are not getting the proper nutrition and energy to their tissues.

People are now calling celiac disease the new “great mimicker” because it can mimic many different diseases. For instance, if an individual is not absorbing calcium efficiently, they will present with osteoporosis (loss of bone density). If they are not absorbing vitamin B properly, they can present with numbness from neuropathy. And if they are failing to absorb iron, they can present with anemia.

What is gluten sensitivity?

Unlike celiac disease, gluten sensitivity cannot be diagnosed through blood tests or an examination of the small intestines. After excluding celiac disease, diagnosing gluten sensitivity requires that an individual next remove all gluten from the diet and then observe whether symptoms subside. If they do, the last step is to slowly reintroduce gluten and see if symptoms return. If they do, that is the telltale sign of gluten sensitivity, and helps point to which foods are causing most of the gluten-related issues.

Knowing this information is necessary to help prevent an individual from surpassing his or her “gluten threshold,” the point at which an individual suffers unwanted gluten-related symptoms as a result of diet choices.

Is celiac disease and gluten sensitivity a new problem?

Many people ask me, “Why is gluten suddenly presenting this huge problem? Is gluten sensitivity new?” And the answer is, No!

The big difference is that our food culture and our medical culture have changed. Compared to crops 100 years ago, most strains of wheat today contain more gluten. And now gluten is even used as an additive in flours to help improve its baking characteristics. As I mention in my book, gluten, being relatively inexpensive compared to other additives, is used for “fortifying” breads and other products in an attempt to increase their protein content.

Also, because of overuse and even abuse of antibiotics and over-the-counter anti-inflammatory drugs, the bacteria in our digestive system that are supposed to be helping us with digestion have changed. The deficiency of certain beneficial bacteria may be contributing to the inability to digest gluten, and therefore is indirectly causing increasing incidences of asthma, ear infections, and other problems associated with gluten.

So does everyone need to give up gluten?

My message is not that everyone should be gluten free forever, or that gluten is not a problem. My goal right now is to teach clinicians and patients to become gluten aware, not gluten phobic, and how to make the changes in their diets that are right for them.

So what are the links between gluten sensitivity and heart disease?

There is no doubt that for some people, removing gluten from one’s diet can help decrease the risk for heart disease. In my experience, there are a few important explanations for the link between gluten intolerance and heart disease. First, cutting out gluten means cutting out processed carbohydrates, and this is a key step in helping to maintain a healthy weight.

Second, an association exists between gluten intolerance and low HDL (good) cholesterol. The damage to the small intestine’s structure due to gluten intolerance hinders cholesterol production in that organ and may prevent the intestine from effectively producing something called Apo-A1, which is the protein precursor for HDL cholesterol that’s made in the liver and small intestine.

Third, gluten sensitivity is associated with an increased risk for autoimmune disorders, and autoimmunity means chronic inflammation. I also spoke with you earlier about adult-onset type 1 diabetes, which itself is an autoimmune condition. Diseases like this are themselves risk factors for heart disease, so controlling your gluten problem may improve your risk for heart disease in this way.

Inflammation may be the hottest topic in heart disease right now

It is well known that gluten intolerance places an individual in a highly inflammatory state. This explains the connection with diseases like arthritis and psoriasis. Interestingly, we now know that both rheumatoid arthritis and psoriasis specifically increase the risk for heart disease. The connection between gluten sensitivity and heart disease is still more anecdotal than objective, but some solid scientific evidence is emerging. For example, there is some proof that celiac disease, and the inflammation accompanying it, lead to increased coronary artery disease.

Who in particular needs to avoid gluten to lower their risk of heart disease?

I mentioned before that most people have no problem with gluten. If you suspect a gluten problem, the easiest thing to start a gluten free diet (millet, healthful corn, amaranth, flax, buckwheat … and gluten-free flours). If, for example, your back pains go away, if bloating improves, or if arthritis symptoms improve, some level of gluten sensitivity (and thus inflammation) is likely present.

In people like this, gluten reduction may improve the overall quality of life. It may also lead to a decrease in heart disease risk. This isn’t proven yet, but it is a fascinating hypothesis that we will learn a lot more about in the next 10 years!