Gluten consumption by those who are not diagnosed with Celiac Disease (CD) does not increase risk of coronary heart disease (CHD). In fact, avoiding all gluten-based foods, such as whole grains, by people without CD or gluten sensitivities may actually have a detrimental impact on health.
Gluten is a protein found in rye, wheat, and other grains. Consumption of gluten by those with CD may result in an increase of inflammatory gut issues. Gluten restrictive diets, however, have become popular in the last 5 years mostly because they have been touted to help maintain a healthy lifestyle. A recent prospective cohort study from the British Medical Journal (BMJ) by Benjamin Lebwohl, MD from the Celiac Disease Center at Columbia University in New York City along with a team of researchers from Harvard, examined data that apparently contradicts this widespread notion.
Utilizing data from participants of the longitudinal Nurses Health Study and the Health Professionals Follow-up Study, Lebwohl and his collaborators examined food frequency surveys for over 60,000 women and 45,000 men in their mid-fifties. Both of these studies run through Harvard, follow participants using a self-administered biennial questionnaire collecting health and lifestyle habits, medical diagnosis, and exposures to evaluate serious illness, heart disease, and other vascular disease development. Surveys were collected starting in 1986 and then follow-ups were conducted every four years, until 2010. Anyone diagnosed with Celiac Disease was excluded from analysis. The results were tabulated in hazard ratios. A hazard ratio is the measurement of impact of an intervention, in this case gluten consumption, on an outcome, in this case CHD over a specified period of time. A hazard ratio of 1 indicates that the comparison groups have the same effect on the outcome. The results of Lebwohl’s analysis showed that those who consumed high amounts of gluten containing foods, including whole grains, had a hazard ratio for CHD of 0.95 (includes adjustment for known risk factors; 95% confidence interval 0.88 to 1.02; P for trend=0.29). Further adjustments to examine refined grain consumption saw a similar HR for CHD was 1.00 (0.92 to 1.09; P for trend=0.77). Adjusting for whole grain consumption, the researchers noted a hazard ratio of 0.85 (0.77 to 0.93; P for trend=0.002).1 These results suggest that gluten consumption, by individuals not diagnosed with CD, does not have a significantly negative impact on the development of CHD. Furthermore, the authors note that avoidance of all gluten-based foods may actually eliminate the benefits of consuming whole grains such as fiber intake which has been shown to lower blood cholesterol, support weight management and reduce the risk for CHD.
Another study by Kim et al., examined data of 155 participants from the National Health and Nutrition Examination Survey that were not diagnosed with Celiac Disease and who followed a gluten-free diet.2 From 2009-2014 these participants had no statistical significance in total cholesterol, HbA1c or fasting glucose as compared to those not on a gluten-free diet. Moreover, this study saw that being on a gluten-free diet did not significantly impact metabolic syndrome prevalence or CVD risk.
Why is this Clinically Relevant?
Anyone not diagnosed with celiac disease does not need to avoid gluten for heart health. In fact, avoiding gluten containing whole grains may be detrimental.
- Gluten-free diets, by those who are not diagnosed with Celiac Disease, do not aid in the prevention of CHD
- Avoidance of whole grains that contain gluten may increase CHD risk for those not diagnosed with celiac disease
- Practitioners should educate their patients on why gluten free diets, particularly those that are deficient in whole grains, should only be utilized by patients with Celiac Disease or gluten sensitivities
1 Lebwohl B, Cao Y, Zong G, et al. Long term gluten consumption in adults without celiac disease and risk of coronary heart disease: prospective cohort study. Bmj. February 2017.
2 Kim H-S, Demyen MF, Mathew J, Kothari N, Feurdean M, Ahlawat SK. Obesity, Metabolic Syndrome, and Cardiovascular Risk in Gluten-Free Followers Without Celiac Disease in the United States: Results from the National Health and Nutrition Examination Survey 2009–2014. Digestive Diseases and Sciences. 2017.