I was really interested to hear what a cardiologist had to say about the relationship of gluten to cardiovascular disease. Most cardiologists subscribe to the current guidelines, which we know are leading us down a treacherous path. I was so impressed with Dr. Houston, I just have to tell you about this lecture!
Dr. Mark Houston is the Associate Clinical Professor of Medicine at Vanderbilt University School of Medicine, Director of the Hypertension Institute and Vascular Biology, Medical Director of the Division of Human Nutrition at St. Thomas Medical Group, and a cardiologist who specializes in nutrition.
That was a mouthful. He is also extremely well published and has given over 10,000 lectures, as well as being the author of several books — recently What Your Doctor May Not Tell You About Heart Disease. I’m going to read this book.
It took a full 5 minutes for Dr. O’Brien to get through all the accolades and credentials.
Where Cardiac Abnormalities Start
According to Dr. Houston, coronary heart disease (CHD) starts in utero when the mother is exposed to poor nutrition, malnutrition and toxins. Environment and genetics also play a role in the progression. In today’s American teenagers, there is a 30% incidence of subclinical coronary heart disease (CHD).
Contributing factors are obesity, metabolic syndrome, type 2 diabetes, and sedentary lifestyle.
There is an epidemic of vascular disease in American children — with abnormal lipid profiles, type 2 diabetes, hypertension and overweight.
The two predominate mitigating factors are poor nutrition and lack of proper exercise. They are simply just eating too many fast foods and frozen foods and not enough fresh vegetables and not getting proper exercise.
But we know that.
The Gluten Connection
There is a correlation between gluten sensitivity which occurs in the gut and Celiac and metabolic syndrome. There is also a connection to vascular problems, endothelial dysfunction, coronary heart disease, congestive heart failure and arrhythmias of the heart. According to Dr. Houston,
If you don’t know how to clean up the digestive tract, you can never be a good cardiovascular physician and get the patients fixed.
The Role of Diet and Exercise
Dr. Houston believes and has found that medical problems will start to correct themselves when proper nutrition is followed. Exercise enhances the result. In his clinical experience, he was able to get 62% of his patients off medications with diet and lifestyle changes alone.
That’s pretty powerful when you think about, as a cardiologist, how sick many of his patients have to be.
He uses the DASH-2 diet that involves food with high potassium, low sodium, high magnesium, lots of vegetables, and low glycemic fruit, as well as minimal to no grains or dairy. The program also involves, lots of fiber, resistance and aerobic exercise, no tobacco or alcohol and restricted caffeine intake.
Autoimmunity and Development of Cardiovascular Disease
I found this part of the talk fascinating. I never thought of autoimmunity as a factor in heart disease. According to Dr. Houston,
The blood vessel has an infinite number of insults, but only three finite responses to the insults. And the three finite responses are inflammation, oxidative stress and vascular autoimmune dysfunction.
Autoimmune disease is a newly considered factor in the development of endothelial dysfunction (the endothelium is the inner lining of the blood vessel), peripheral vascular disease, coronary heart disease, heart failure, and other types of cardiovascular illness.
When there are anti-bodies to tissue transglutaminase, (a blood marker of gluten intolerance for Celiac) — those antibodies can also affect the inner lining of the blood vessels, the endothelium.
When the gluten sensitive patient eats gluten, the body sees this as an invader and responds in the three ways outlined above; inflammation, oxidative stress and vascular autoimmune dysfunction.
The blood vessel is an innocent bystander and it develops disease in response to the assault from the response to gluten. It is gluten that is the trigger.
For example, Dr. Houston has found that idiopathic cardiomyopathy (swelling of the heart) reverses on a gluten-free diet in gluten sensitive people.
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Cardiovascular Disease in Response to Gluten
Any type of cardiovascular disease such as coronary heart disease, myocardial infarction, congestive heart failure, cardiac arrhythmias, diastolic dysfunction or systolic dysfunction and many others can be a response to the assault from gluten on the blood vessels.
Gluten sensitivity may soon become a risk factor for heart disease. Presently there is evidence that a low serum HDL is indicative for gluten sensitivity.
Dyslipidemia is the general term for abnormalities in lipids, lipid particles, sizes and numbers. There is now advanced testing on lipids in the blood. More then just numbers, it is important that the HDL works and is functional.
Dyslipidemia may be due to three things: infection, bad micronutrient intake (like an irritant such as gluten) and/or toxins.
To protect itself, the body produces a lipoprotein to try to encapsulate and excrete the offending agent. When this happens, the blood levels of LDL can go up, the HDL can go up or down and/or the HDL can become dysfunctional entirely.
Dr; Houston found that when you remove the insult, the lipid profile returns to normal over time.
He believes that the cause of dylipedemia is a normal response to an invading insult (except in the genetic form). This appears to be supportive of the notion that cholesterol is a protective agent and will go up when there is a need for healing.
Total HDL is no longer meaningful — because it may go up or down with an insult. If the HDL is over 60 in males, and over 85 in females, there is a 50% chance of it being dysfunctional. Harumph, my HDL is upwards of 98. I wonder…
There is a need to measure HDL functionality. We also need to know how large the particle is (the larger the better) and how many HDL particles are there (more is better).
We now have to ask the question, does the HDL even work? — this requires a more sophisticated test.
I need to get that test. Don’t you?
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Testing for Dysfunctional HDL
This testing can be very complicated, but Dr. Houston uses the myeloperoxidase (MPO) test. Myeloperoxidase is a response of a white blood cell to bacteria, micronutrients or other invaders. MPO produces substances that oxidize and damage apolipoprotein A which is the carrier for HDL. High MPO numbers may indicate dysfunctional HDL.
If this is the case, you must identify and remove the offending agents –you have to find out what is making the white blood cells react and cause this inflammatory cascade of events.
Dietary Contributions to Elevated MPO Levels
Remember the concept of infinite insults that result in three finite responses? Gluten can be the insult.
Gluten attaches to the zonulin receptor and sets off the three responses of inflammation, oxidative stress and vascular autoimmune dysfunction. Other inflammatory substances such as, MPO, cytokines, chemokines, TNF-alpha, and interleukins cause further damage.
Gluten can directly cause MPO elevations causing dysfunctional HDL.
Identification of Gluten Sensitivity in Patients
According to Dr. Houston, routine checking for gluten sensitivity is now necessary, because it can be a cause of so many problems. It’s useful to have detailed questionnaires and clinical history and these reveal that gluten sensitivity is much more common that previously thought.
Defining Risk Factors
Conventional medicine looks at the top 5 risk factors: blood pressure, cholesterol. dysglycemia (sugar metabolism), obesity and smoking. According to Dr. Houston, this is incorrect because 50% of the people with coronary heart disease or heart attack (MI) do not have these risk factors.
We need to go beyond the current understanding and test for the presence or absence of vascular injury and disease with non-invasive vascular testing that will actually help prevent the development of coronary heart disease or heart attack.
The next phase is to redefine the top five risk factors and include other risk factors such as gluten sensitivity which are now being explored.
Vascular Medicine is the Key
There are people who have risk factors and no disease, and people with no risk factors and a lot of disease. You have to measure the vascular function and heart function. These tests are both non-invasive and invasive. They include, Endothelial dysfunction tests with the endoPAT, CT angiograms, 2D echoes, Carotid IMT, Coronary tear grams and MRI.
The tests are here, they just need to be understood by physicians and patients and implemented.
I learned some startling information about cardiovascular disease and the role gluten may play!
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