Having been classified as a chronic condition, celiac disease very clearly can put someone at an increased risk of complications. Sometimes, these complications can result in serious secondary conditions that will continue to have an impact on someone’s ability to lead a normal life – like coronary artery disease.
With celiac disease, in particular, researchers have paid special attention recently to the links between celiac disease and coronary heart disease. Although there are obvious differences between the two, such as how they are classified medically, they do have one thing that ties them together: inflammation.
Research is continuing, but there have already been some interesting studies with results that are worth reading if you have or know someone who suffers from celiac disease. While it’s easy to panic when reading the two conditions side by side, this article will take you through things in easy, bite-size pieces. From the inflammation link to how the two conditions can be managed, here is everything we know so far about celiac disease and coronary heart disease.
Quick Introduction To Celiac Disease
Celiac disease is a serious autoimmune condition that affects people whose bodies cannot process the protein gluten, which is why it’s sometimes referred to as gluten sensitivity (although celiac disease is a separate condition than a sensitivity to wheat). It goes without saying that this condition is most symptomatic during the food digestion process, where the consumption of gluten leads to widespread inflammation. Outwardly, this can present itself as bloating and can cause significant levels of discomfort to a sufferer for hours or even days after consuming gluten itself.
Internally, this discomfort is caused by the body’s immune response that has mistakenly began attacking the small, finger-like projections on the small intestine’s wall called villi. These are responsible for boosting nutrient absorption levels, and when they are attacked they are not taking necessary nutrients from the food you consume. In the long term, this can lead to malnutrition, which those living with the condition will recognize from being fatigued, having loose or hard stools, and suffering frequent illnesses that are hard to get rid of.
In fact, it’s malnutrition that is often behind why children with celiac disease frequently receive a diagnosis between 6 months and 2 years of age. With that being said, it’s important to note that this condition can occur at any age and is diagnosed throughout the life stages.
Quick Introduction To Coronary Heart Disease
Coronary heart disease is a condition categorized by the narrowing of the coronary arteries that bring oxygenated blood to the heart for it to function correctly. A degenerative condition, it begins once the inner wall has been damaged by conditions like high blood pressure, insulin resistance, and some chronic conditions, and it worsens over time.
Once this damage to the arteries has occurred, fatty deposits known as plaques will begin to stick and accumulate at the injury site, increasingly obstructing the flow of oxygenated blood to the heart muscle. This leads to a narrowing of the arteries which makes it more difficult to get enough blood to the heart muscle, leading to discomfort or pain known as angina during physical exertion.
In addition to this, people with the condition are at risk of plaque build-up rupturing at any time. When this occurs, platelets from blood will gather to try and repair the damage. The result of this is a blood clot that can completely cut off blood supply to the heart, causing a heart attack and irreversible damage to the muscle itself. This condition is most common in older people, with men over the age of 40 and women who’ve started menopause being most at risk. However, the numbers of younger people suffering from the condition are also increasing, with some estimates suggesting it could be as high as 1 in 5 cases among people under age 40.
How Does Celiac Disease Impact Heart Disease?
At first glance, celiac disease and coronary heart disease would seem unlikely to be related to medical conditions. Some of the major risk factors for heart disease, being overweight, smoking and having high cholesterol levels, do not seem to be related to celiac disease or those who suffer from it.
Although society’s attitudes towards health are changing, people with celiac who are receiving treatment tend to be a healthy weight, and a smaller proportion of them are smokers compared to the rest of the population. They also tend to have lower cholesterol levels, too.
Despite this, data analysis collected from over 24 million people, 24,000 of which had been diagnosed with celiac disease, suggests the condition can impact heart disease. One of the key figures from this data analysis showed that people with celiac disease were nearly twice as likely as those without the condition to get heart disease. This amounted to 9.5% of celiac disease sufferers having heart disease compared to just 5.6% of the general population in the study.
One risk factor of heart disease that carried over into the celiac disease population was that the risk was reduced by age, but this was still disproportionate to the general population. Figures showed that in those under 65, rates of coronary heart disease were at 4.5% compared to just 2.4% for those without CAD.
Inflammation – The Link Between Celiac Disease and Coronary Heart Disease
When most people think about celiac disease, their automatic thought is to think about how it affects the digestive system. Most people have no idea that it’s a condition that can also have a significant impact on other body systems, too. Because celiac is an autoimmune condition, it means that the body’s immune system has already misfired and has begun to attack its own cells. This type of immune system response isn’t necessarily restricted to one system. It’s this process that scientists believe is important when identifying the links between celiac disease and coronary heart disease, in a process, many have named the chronic inflammatory state. This state is thought to occur when the celiac-specific immune response drives inflammation to other parts of the body as well as to the digestive system, and the immune response particularly affects the coronary arteries. Although this has been a theory for some time, it wasn’t until recently that researchers began undertaking studies to prove this.
One of the most definitive studies took place in 2017 and revealed that adults with celiac disease had higher levels of inflammatory markers than those without the condition. This generally supported the chronic inflammatory state medical professors had spoken about previously, but results didn’t stop there. To further demonstrate the link between inflammation and celiac, researchers found that the adults they studied also displayed the early signs of plaque build-up in their coronary arteries. This seems to suggest that the participants were showing early signs of coronary heart disease even though a diagnosis had not been provided at that time. This link between the inflammation of celiac disease and coronary heart disease is extremely worrying, as there is an increased risk of death with those who have both conditions. Although no definitive study has been able to determine exactly how much this is the case, there are some suggestions it could be as much as 50%.
It’s thought that following a gluten-free diet if you have celiac disease can reduce the risk of coronary heart disease, presumably because of lowered inflammation in the body, but this has not been proved.
On a more positive note, although celiac disease and coronary heart disease are linked, celiac disease has little impact on strokes. This was observed in a Swedish study of over 28,637 patients where they compared their stroke risk to 141,806 similar people without the condition. They did find that those with celiac disease had about a 10% higher risk of stroke overall, but this was concentrated in the first year after diagnosis. After five years, there was virtually no difference between patients with celiac disease and the general population in their chances of suffering a stroke.
With all this being said, it’s important to remember that while celiac disease and coronary heart disease are linked, having the former condition does not mean you will definitely get the latter. It does, however, mean you are at a higher risk and should take measures to manage your condition and protect yourself, which we will help you with below.
How To Manage Celiac Disease
For people with celiac disease, learning that there is no way to cure their condition after receiving a diagnosis can seem incredibly daunting. Especially if you’ve been dealing with severe symptoms for some time and have been warned of the dangers of continuing down the path you currently are, knowing where to go next can be terrifying. The reality is that the only way to manage the condition is to completely remove gluten from your life. This doesn’t just mean avoiding non-gluten-free food, but also things like medications and hygiene products that include the protein. The good news is that many people have made the decision to go gluten-free for health reasons in recent years, making it easier to find affordable gluten-free products in most stores.
On the other hand, this trend has led to a number of reveals about the dangers of a gluten-free diet, like vitamin deficiencies and an increased risk of developing diabetes. No one without a medical reason should cut gluten out of their diet unless absolutely necessary, these risks are nothing compared to what someone with celiac disease may encounter should they keep gluten in their diet. If you aren’t aware, these risks include worsening damage to the lining of your intestines and continued severity of the symptoms you may have experienced before diagnosis like diarrhea and stomach pain.
These effects could occur even if you only have a small amount of gluten in your diet, and it could take days before the food fully leaves your system and the symptoms subside. In the long run, refusing to cut gluten out of your diet will put you at an increased risk of developing osteoporosis and cancer in later life.
We do understand that completely cutting gluten out of your diet as a way of managing the symptoms of celiac disease isn’t an easy decision, however, and can seem daunting if you’ve never controlled your diet before. This is why organizations and gastrointestinal specialists throughout America recommend that you also have regular follow-up appointments with your physician to monitor your condition. In these appointments, your physician can carry out tests like blood tests to make sure that keeping a gluten-free diet isn’t putting you at risk of malnutrition through vitamin and mineral deficiencies. They may also weigh you and ask you questions about your diet to determine if further input is needed. In case you do need further support, you may be referred to a dietician who specializes in celiac disease. They will help to assess and modify your current diet in a way that allows you to get as many nutrients as possible from your diet and avoid malnutrition in the long run.
Your medical team may also recommend gluten-free supplements if it’s clear that you are going to need additional support to give your body everything it needs without adding gluten back to your diet.
Another option many people with celiac disease are given to help manage their condition is the referral to a psychiatrist or psychologist who can help someone process their diagnosis. These professionals can also be on hand to help someone with their mental health if it’s directly related to their disease, as this can often compromise their physical health in the long run.
Although managing celiac disease may seem daunting, once you have established your routine and know what you can and can’t use or consume, everything falls into place. The good news is that once you have started the process of managing your condition, you won’t need to worry about the symptoms of your condition as these will disappear for as long as you keep gluten out of your diet.
How To Manage Coronary Heart Disease
The links between celiac disease and coronary heart disease make it more important than ever that you know how to manage the condition. Even if you aren’t already suffering, the studies cited above show that many people are in the early stages without even realizing it, so it’s best to do what you can to remain healthy.
Although this process can seem overwhelming, a large part of managing coronary heart disease is about making lifestyle changes that will positively impact both your heart and overall physical health.
One of the biggest recommendations is that you make sure to maintain a healthy, balanced diet. Even if you are struggling with celiac disease, the rise in product availability means it can be very easy to find gluten-free foods that aren’t good for you in large quantities.
In general, it’s recommended that you should maintain a diet that is low in fat and high in fiber, including lots of fruit and vegetables and whole grains.
With coronary heart disease, in particular, you should also try and eliminate saturated fat from your diet as much as possible, and limit your salt consumption to no more than around 6g (or 0.2oz) a day. This is because too much salt can increase your blood pressure, which leads to another risk factor for developing or worsening coronary heart disease.
In addition to eating healthily, it’s also recommended that you be more physically active to manage your condition. This is around 30 minutes of moderate exercise a week. Although this is recommended to everyone, it’s especially important for sufferers of coronary heart disease as it will make your heart and blood circulatory system more efficient. It will also lower your cholesterol level, and prevent you from developing high blood pressure by keeping it at a steady level.
By combining the two risk factors above, you will hopefully be maintaining or reducing your weight to a healthy limit. If you don’t know what you should be looking at for a healthy weight, using a BMI calculator or visiting your physician will give you more of an idea. By keeping a healthy weight, you’ll be reducing the speed at which your coronary heart disease increases and puts less pressure on your heart muscle as it isn’t being overworked.
Although those with celiac disease smoke less than the general population, those that do are also advised to stop, as it can increase the risk of coronary heart disease and other health problems. In particular, smoking increases your risk of developing atherosclerosis, or furring of the arteries, and is the cause of the majority of blockages in the coronary arteries.
One final lifestyle change that you can make to either manage your coronary heart disease or prevent the condition altogether is to reduce your alcohol consumption. You may have found that this came naturally after being diagnosed with celiac disease as many types of alcohol like beer contain gluten, but if not, this is the time to work on it. This isn’t to say that you shouldn’t drink at all, but try not to exceed the U.S dietary guidelines for Americans that recommends only one drink per day for women and two drinks per day for men.
With coronary heart disease, however, changing your lifestyle only goes so far. Following diagnosis, it’s also likely that you will be referred to a specialist and advised on medication to help with your symptoms. The medications you may be prescribed to manage your condition are as follows:
- Antiplatelets: This type of medication, often aspirin, helps to reduce the risk of a heart attack by thinning your blood and preventing it from clotting.
- Statins: If you’ve got high cholesterol, statins are often prescribed to block the formation of it and increase the number of lipoprotein receptors to help remove existing cholesterol from your blood.
- Beta Blockers: In this instance, beta-blockers are prescribed to prevent pain or discomfort known as angina and treat high blood pressure by blocking the effects of a hormone. In turn, this slows down your heartbeat and improves blood flow.
- Nitrates: Available in many different forms including tablets, sprays and skin patches, Nitrates work by relaxing your blood vessels to allow more blood to pass through them. This will lower your blood pressure and relieve pain.
- Angiotensin-Converting Enzyme (ACE) Inhibitors: This is another medication used to treat high blood pressure, and they work by blocking the activity of a hormone that causes blood vessels to narrow. They also improve blood flow around your body.
- Calcium Channel Blockers: Calcium Channel Blockers work by decreasing your blood pressure, relaxing the muscles that make up your arterial walls. This makes the arteries wider, reducing your blood pressure.
If you are put onto medication by your specialist, this is likely something that you will be on for life to manage your condition and keep things stable for as long as possible. You should never try and come off these cold turkey, even if you think your symptoms have lessened or your side effects are difficult to manage, as this can be dangerous. It can also make symptoms worse in the long run.
Celiac disease is a debilitating autoimmune condition that prevents some people from being able to process gluten in their small bowel. If not diagnosed early, the inflammation caused by the disorder can put people at risk of developing other conditions.
One such example is the link between celiac disease and coronary heart disease, caused by a phenomenon many scientists have dubbed the chronic inflammatory state. As a result of the celiac-specific immune response, inflammation spreads to other parts of the body, impairing their function of other systems as well as that of the digestive system.
This means that despite those with celiac disease generally not having many of the risk factors associated with the condition, they are far more likely to have coronary heart disease. Even those who have yet to be diagnosed with the illness have shown signs of plaque in their arteries, as depicted in some pioneering studies. The good news is that those with celiac disease can minimize their chances of developing the condition as much as possible by living a healthy lifestyle. Even if someone does develop coronary heart disease, through careful management and medication, its progression can be slowed considerably.