Thursday, August 29, 2013

Effects of a gluten free diet on blood lipids: A case study


A client with no history of sensitivity to gluten or abnormal blood cholesterol levels suddenly developed significant gastrointestinal pains and discomfort.  Upon testing from her doctor, her blood lipids were fond to be abnormal.  Removing gluten from her diet lead to an improvement in her symptoms and her blood lipids improved dramatically within 2 months.  The mechanisms behind these changes are also discussed.

Client History

Client is a 62 year old female who has begun to experience gastrointestinal distress over the last few months.  Prior to this she has had no problems with the foods she eats.  She explains that all of a sudden she started experiencing gut wrenching pain whenever she would eat.

Her doctor initially put her on low dose Prilosec(20mg/day) but had to increase the dose to 60mg/day as it lost effectiveness.  She was then put on Nexium with no relief,  This is not surprising since Nexium converts to the same drug as Prilosec in the acidic environment of the stomach and thus has the same effect.

Other relevant history

Blood lipids were drawn and she had the following values:

  • Total Cholesterol: 259 mg/dL
  • LDL Cholesterol: 151 mg/dL
  • HDL Cholesterol: 58 mg/dL
  • TC: HDL ratio: 4.5
  • Triglycerides: 251 mg/dL

Client was asked which foods gave her the most trouble.  She stated that beer would give her the most stomach pain followed by broccoli, pork, and anything fried.  I recommended the Paleo diet to cut back on the amount of problematic proteins in her digestive tract.  If she tolerated dairy she could continue eating dairy.

Client removed all grains, basically going on a gluten free diet.  Her legume consumption was pretty low to begin with so she continued to keep it low.  Five days after starting the diet she began to feel much better and reported not being "gassy" or having that "sick" feeling in her stomach.  She ended up losing a total of 24lbs even though she didn't want to lose any weight and the arthritis in her hands improved significantly.

She has been off Nexium and Prilosec for a couple of weeks.  Two months after being on the diet she had her blood lipids tested again, a total of 6 months from the previous testing.  Her values are listed below.

  • Total Cholesterol: 213 mg/dL
  • LDL Cholesterol: 132 mg/dL
  • HDL Cholesterol: 53 mg/dL
  • TC: HDL ratio: 4.0
  • Triglycerides: 142 mg/dL


This client's great improvement in her blood lipid results is fairly common for people switching to this diet, and she was elated to see these improvements.  While there is still more progress to be made, she has made huge strides in improving her digestion and general health.  Cholesterol is a part of the immune system and when the body gets attacked, these numbers typically go up as the immune system initiates a response.  Outside of this instance, the LDL numbers in a standard cholesterol panel are worthless and tend to be inaccurate since they are estimates and not directly measures.

In the case of gluten, gluten causes the tight junctions between cells of the intestinal wall to dissolve, allowing undigested food particles to enter the blood circulation.  This causes the immune response and could be the cause of her higher LDL numbers.  Going on a gluten free diet typically improves blood cholesterol numbers in the vast majority of people, probably even better than is seen with statin drugs.

Many people believe that gluten only causes a problem for people with gluten sensitivity or celiac disease.  The fact is, gluten causes the tight junctions between intestinal cells to dissolve in everybody.  The difference between people with celiac disease and people without celiac disease is that the tight junctions get repaired much more quickly in people without celiac disease, but this would be dependent on teh dosage ingested and the immune system of the person.  As we age our ability to deal with this becomes impaired as our immune system weakens.  Digestive enzymes also decrease with age and can make things that were not previously problematic an issue.  In addition, being sedentary causes food to stay in the intestines longer.  Since gluten cannot be broken down by humans, the likelihood of a problem arising increases with dosage, age, and sedentary behavior.  This could perhaps be the link between both age and sedentary behavior with Type 2 Diabetes and/or heart disease. 

While most physicians recommend against a gluten free diet for who knows what reason, it would be in the best interests of most people to avoid or limit gluten as well as all grains and legumes.  While we are most familiar with gluten, there are other storage proteins in grains and legumes that are both difficult for humans to digest and that cause an immune response.  This client's improvement in the arthritis in her hands is more than likely attributed to a dampening of the immune response caused by gluten in her diet.  It is interesting to point out that in her younger years she had no problems with gluten.  While age and the increased sedentary time that comes with it could certainly be the causative factor, it could also be that the dosage of problematic proteins she is exposed to on a daily basis has been increased as processed foods have become more commonplace.