Gluten and Cholesterol

[Kari]

http://www.living-gluten-free.com/cholesterol.html

I've had high cholesterol for several years. When asking my PCP what I could do diet wise to lower it, he said not to worry about it, that it was most likely genetic, and was not really high enough to cause concern.

Well, being the perfectionist that I am, that answer never really satisfied me, so there was always a nagging concern in the back of my mind. Anyhow, now that I have been gluten free for a year, my total cholesterol has "magically" and "drastically" dropped from 230 to 150 - yeah!!!

How can this possibly be a coincidence after several years of high readings???

I was looking for an explanation of the gluten/cholesterol connection and came across the above article, which seems to make some sense to me. What do you think???

Love,
Kari

[tex]

Kari,

I view this from a different angle. Consider this response that I wrote about bile salts, a few days ago:

Hi Ashley,

It's good to see a post from you again, but I wish that you were informing us that you have been in remission since the last time you visited, without the need for meds. I don't understand why the diet you described, (meats and cooked, pureed veggies), wouldn't get the job done - unless maybe you're getting too much fiber, or you happen to be sensitive to one of the veggies or one of the meats. Hopefully, you're peeling the veggies, first, because most of the fiber is in the peel.

Concerning bile - most of the theories attempting to explain the malabsorption of fat, are based on excessive amounts of bile, (thus causing D), and a few, (such as the one you quoted), are based on insufficient bile, (which can also cause D, because of all the unabsorbed fats in the fecal stream). All of these theories tend to ignore the fact that bile is not the only digestive element required in the chyme to allow the absorption of fats to proceed.

Yes, it's true that bile emulsifies fats to initiate the process, but the emulsified fat cannot be absorbed unless pancreatic lipase, (secreted by the pancreas), is also available, because pancreatic lipase is the primary enzyme that hydrolyzes, (breaks down), dietary fat molecules, converting triglycerides into monoglycerides and free fatty acids, so they are in an absorbable form. If the pancreas isn't functioning properly, then the fats will remain in the form of peptides, similar to gluten peptides, and they will not be in a suitable form to be absorbed. And if they should be absorbed, they would probably cause the same type of systemic problems that gluten peptides cause, whenever a leaky gut condition allows them to be absorbed, (because they cannot be utilized as fuel by any of the cells in the body, in peptide form).

Bile salts coat the fat droplets in the chyme, and break them into smaller droplets, (in a nutshell, that's really all that the emulsification process involves, in this instance), thereby increasing the overall surface area of the fat, which allows the pancreatic lipase better access, so that it can break down the fat more effectively, into free fatty acids and monoglycerides.

Of course, it's not quite this simple. Even though the pancreatic lipase is released into the duodenum in it's final, (ready to use), form, it can only work efficiently if colipase is present. Colipase is also secreted by the pancreas, but it's secreted in an inactive form, (procolipase), which requires activation by trypsin, before it can be used. Bile salts tend to inhibit the hydrolysis of long-chain triglycerides, and the colipase, (after activation), overcomes the capacity of bile salts to inhibit the reaction, so that the lipase can proceed with the breakdown process.

So, in consideration of the above facts, I seriously doubt that bile salts are ultimately responsible for most of the digestive irregularities attributed to them. I suggest that pancreatic enzymes play a much larger role, and are more likely to be ultimately responsible for fat malabsorption problems.

Normally, about 90% of excreted bile acids are reabsorbed from the intestinal system and recycled back to the liver and the gallbladder. The reabsorption takes place in the terminal ileum. I have a hunch that the reason why the bile fatty acids are not properly recycled when they get to the terminal ileum, (as they should be, if the digestive process were proceeding normally), is because they are still coating the fat colloids when they reach the ileum, and so they are in a state where they cannot be absorbed. IOW, if the pancreatic lipase does not hydrolyze the fats, then the bile salts cannot be reabsorbed. Since they cannot be absorbed and recycled, they pass on through, causing D. That doesn't mean that bile is the problem, though - the failure of the pancreatic enzymes to hydrolyze the fats, is almost surely the cause of the problem.

Also, consider this: If most of the bile is lost, rather than recycled, then the demand for bile is roughly 10 times the normal amount. In the long run, losing all that recycled bile is bound to place abnormal demands on the liver and gallbladder, just to keep up with the body's needs. This may be why so many of us with MC have gallbladder problems.

Of course, this is just my interpretation of what I think is happening, so I could be all wet.

Tex

That's from this thread:

http://www.perskyfarms.com/phpBB2/viewtopic.php?t=14319

Adding to that line of thought, consider this:

Those bile fatty acids are feedstock material that the body uses to manufacture cholesterol to supply it's needs. If 90%, (or whatever amount), of the bile salts that would normally be recycled, are lost, instead, (due to malabsorption), then the body would have to produce much more cholesterol from "scratch". Since that's roughly 10 times the normal production requirements, it would seem logical that cholesterol levels would go down, as a function of a long-term malabsorption issue.

Note that my cholesterol level dropped significantly after part of my terminal ileum was removed last year - it went from a long-term average of around 225, down to 145, in 4 months. After that, it began to rise again, as my small intestine began to learn how to compensate for the loss of my colon and terminal ileum. After another month, it had increased to 169. I haven't checked it since then, but we plan to check it, (and all sorts of other items), this fall.

I predict that if my theory is correct, your cholesterol level will slowly return to "normal", as your terminal ileum continues to heal. Incidentally, my doc told me the same thing - that my cholesterol is mostly determined by my genes, and not to be overly concerned about trying to change it by diet.

IOW, if I'm right, it isn't actually gluten-sensitivity that causes cholesterol levels to drop - it's a malabsorption problem that actually causes the drop. Of course, that's just my theory, so I could be all wet.

Love,
Tex

[sarkin]

I think some third thing, which is still forming in my mind - I think cholesterol 'means' different things depending on the overall health context. A too low/dropped level might mean malabsorption, as Tex has explained. I suspect a too-high level might be the body attempting some defensive or protective action. (Say, against systemic inflammation initiated by gluten damage? - or maybe we just need a higher level as we age.) So it's possible (in my mind anyway), that for Kari's level to drop might be related to both of these possibilities, and perhaps a level that's lower than a year ago, but higher than 150, might be a new, age-appropriate "normal" value. (Or maybe 150 is enough cholesterol for a healthy, GF Kari?)

This is wildly speculative and I am not supporting these assertions with evidence, I realize. I'm awaiting the results of my blood draw, at which point I still won't have evidence, but may well have a new theory.

Love,
Sara

[Zizzle]

Kari,
I share your low-normal 150 cholesterol, after being 189 a decade prior. I like Tex's theory. I also feel my body is probably using more cholesterol in the disease process. I don't think I've had significant malabsorption with my MC, I never lost weight (before the diet), fecal fat levels were normal with Enterolab, etc. But who knows?

[sarkin]

Z,

My fecal fat score was normal as well. However, my hair has been un-graying since I adopted the diet. I am guessing that this means I am absorbing nutrients better (B-vites, maybe - D?)... I am guessing (and hoping) that a seriously high score on that particular measure occurs only after (more) severe damage. Before that point, though, I think a lot of sub-optimal absorption can be going on...

S

[Gloria]

I first had my cholesterol tested when I was in my 40's and it was 235. I retested after I was in menopause and it had jumped to 331. I have read that cholesterol in women does rise once they are in menopause. My doctor put me on a statin of course, and it lowered the numbers. I'm not at home, so I don't remember the exact scores. On Simvastatin, it went to 159 or so.

After I went GF and dramatically changed my diet to have very little fat and no dairy, I told my doctor that I wanted to see what my numbers would be without the statin. He said it would be fine to go off the statin for a while and retest. I did, and my cholesterol was 232, as I recall. I thought it would be much lower. My doc put me back on the statin. I have mixed emotions about being on it, but it is supposed to lower risk for strokes. Tex, I have read all of your posts about statins, but they don't dispute that statins lower stroke risks. I'm not concerned about having a heart attack, having a weight of 100 and low blood pressure, but I am at high risk for a stroke because both my parents had one when they were in their upper 60's. I've begun to take the statin every other day, and will probably cut the pills in half to take one-half every day.

A GF, CF, EF diet seems to have helped my cholesterol to the same degree that my menstrual cycle did, but no more.

Gloria

[tex]

I suspect a too-high level might be the body attempting some defensive or protective action. (Say, against systemic inflammation initiated by gluten damage?

I think you're right on target. Research shows that higher cholesterol levels are protective against infection and/or cancer, for example,so it would be logical to assume that it might increase in order to deal with increased inflammation.

I also agree with your thoughts on the fat malabsorption test. That test assumes that everyone who takes the test has a one-size-fits-all number that defines their dietary fat intake. It has to do that, because it measures malabsorption by comparing that arbitrary number with the actual quantitative result found during the test. As we all know, people have wildly varying rates of fat in their diet, and that changes not only from day to day, but it changes when we get MC, and discover that fat goes right through us, (so most of us cut down on our fat intake, thinking that it might help the D to slow down). Anyway, the point is, that test has to be interpreted with a huge grain of salt, because there are so many if's, and's, and but's involved.

Love,
Tex

[tex]

Tex, I have read all of your posts about statins, but they don't dispute that statins lower stroke risks. I'm not concerned about having a heart attack, having a weight of 100 and low blood pressure, but I am at high risk for a stroke because both my parents had one when they were in their upper 60's. I've begun to take the statin every other day, and will probably cut the pills in half to take one-half every day.

Yes, I agree that the evidence shows that statins lower stroke risk, and I don't see any evidence to contradict that finding. I'm hoping that Plavix, metoprolol tartrate, and lisinopril will be sufficient to do the job for me, sans statins, since I don't have a family history that includes stroke.

IMO, the reason why your cholesterol settled back down at 232 is because that's your normal level. When it increased to 331, that may have been due to a response to a state of inflammation, so it was only natural that the diet would bring it back down to a normal level, (but not below). At least, that's how I see it.

Tex

[sarkin]

This is very interesting - we all must do our own best thinking, and we must base that thinking on sometimes flawed studies... and compare that against our perceived hereditary and real-life risks. My slightly elevated BP has dropped down to consistently low-normal, in my several months GF/DF/*F. I have always thought that higher BP was a risk *in itself* - but now I wonder whether or not that, too, might actually be an indicator of other stress in the body. It does seem clear that lowering BP to normal reduces stroke & other health risk, but maybe those drugs have additional effects that get closer to some (arguably more primary) cause?

Gloria, while it is possible that you have already greatly migitated the risk factors that caught up with your parents (by discovering your gluten sensitivity and strictly eliminating it and other provoking foods), I absolutely understand why you'd be reluctant to take a chance that exposes you to stroke risk.

[tex]

I absolutely understand why you'd be reluctant to take a chance that exposes you to stroke risk.

I don't know about Gloria, but one of the big motivators here is that I sure don't want to have some supercilious doctor staring down on me, and saying, "See, I told you so".

That would probably be worse than the stroke itself.

Tex

[sarkin]

Tex, you're just going to have to outlive these doctors. That'll show 'em. Goodness knows you know a lot more about health than they do!

[Kari]

Here is what really caught my eye in the article I linked to:

"If you are gluten-intolerant, your body may be producing large quantities of LDL and cholesterol to heal the damage. Getting off all gluten will allow your body to heal itself because the irritant is no longer present, and your serum cholesterol levels will gradually return to normal. If they don't, either you are still consuming gluten somewhere (cosmetics? lotions? vitamins?) or you have other sensitivities you need to identify and rectify.

I have seen my own chronically high levels drop to within normal parameters after going completely gluten-free. It took most of a year for the chronic damage to heal, but my numbers have remained normal for four years now. This is of course merely empirical evidence, but it is strong enough evidence for me to tell you to talk to your health-care provider about doing a gluten challenge, and ultimately getting off statins with his or her supervision."

If that's true (a big IF), then my "new" cholesterol level should remain low/normal - time will tell. My mother had several strokes, as did my sister, and even my niece - so they run in the family. Lower cholesterol readings definitely puts me more at ease.

Love,
Kari

[sarkin]

Yikes, Kari - strokes for your niece. That is a hard thing.

If your 150 is in the range of your younger cholesterol, I bet it's a true number - or near enough. My number in my late thirties was something like 163. I'm less than six months into my GF diet correction, and believe I am still tweaking diet to an extent that might either raise OR lower my total cholesterol number... but I am hopeful. My mother had a small, mini- and micro-strokes, which all added up to a lot more than minor damage. I would bet my grandmother (maybe bother grandmothers) also had significantly damaging stroke events, though the strokes themselves weren't of the catastrophic, attention-demanding variety (for that era).

What did your sisters make of the slender/healthy new you, on your visit? It must have been impossible not to notice...

Health to you and the extended clan,

S

[Kari]

Yes, Sara, it was quite shocking - she is the daughter of the sister who has had several strokes. It's interesting that she is also the one who has thyroid disease. It seems that every other one of us here in the PP family has thyroid problems.

I wish my success with diet would inspire my sisters to do some gluten elimination experiments - I feel certain that they are all gluten intolerant, since they have the stomach bloating, frequent D, etc. Anyhow, I think they feel it would be too difficult, and they are not willing to give up anything at this point in their lives. They are all older than me, and are not nearly as health conscious. Then again, they don't have MC either.

I have always been slender, so it was nothing new for my family to see me thin. Some of them commented that I should be careful not to lose more weight, which I basically agree with. I'd like to gain a few pounds, but as you know, that's very difficult when I eat almost no sugar, and mostly whole foods. The only meat I eat is chicken, so I don't get the benefit of much fat in my diet either.

Love,
Kari

[tex]

It's interesting that she is also the one who has thyroid disease. It seems that every other one of us here in the PP family has thyroid problems.

I have a hunch that's a key ingredient, (regarding stroke and cardiovascular issues). I made a surprising discovery about myself, recently, and I'm mulling it all over in my mind, and doing a little resesarch, before posting about it. I have to go work for a while, but when I get back, I'll try to post my thoughts on why I feel that untreated and undertreated hypothyroidism is at the bottom of a lot of health issues, (both minor and life-threatening), that doctors just never seem to connect with hypothyroidism.

Love,
Tex