Some Idiopathic Neuropathies may be due to Gluten Sensitivity
It is estimated that about 1% of the population has celiac disease, a gastrointestinal disorder caused by an autoimmune reaction to the wheat protein, gluten. (1) Celiac disease is definitively diagnosed by antibodies in the blood and intestinal biopsy, but most cases are thought to be undiagnosed. A growing number of individuals, about 8% of the population, avoid gluten and wheat because they feel that they are sensitive to the wheat protein. Gluten sensitivity in the absence of diagnosed celiac disease or intestinal issues is becoming increasingly recognized. (2) Neuropathy is associated with both gluten sensitivity and celiac disease. (3) The presence of antibodies to wheat or gluten in the blood is a useful diagnostic clue that symptoms of neuropathy are wheat or gluten-related, but antibodies may not always be present in patients who have a sensitivity to gluten.
Therefore, gluten sensitivity should be considered in anyone with unexplained or “idiopathic” neuropathy even in the absence of gastrointestinal symptoms or antibodies. Pain is a very prevalent symptom of neuropathy associated with gluten sensitivity, and a strict gluten-free diet may result in reduced painful symptoms. (3) A trial of gluten elimination is a relatively straightforward and risk-free intervention that may help with both the diagnosis and symptom relief. If improvement in the symptoms is noted with a gluten-free diet, then lifetime removal of gluten from the diet is recommended.
1. Rubio-Tapia A, Ludvigsson JF, Brantner TL, Murray JA, Everhart JE. The prevalence of celiac disease in the United States. Am J Gastroenterol. 2012;107(10):1538-1544; quiz 1537, 1545.
2. Carroccio A, Mansueto P, Iacono G, et al. Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity. Am J Gastroenterol. 2012;107(12):1898-1906; quiz 1907.
3. Zis P, Sarrigiannis PG, Rao DG, Hadjivassiliou M. Gluten neuropathy: prevalence of neuropathic pain and the role of gluten-free diet. J Neurol. 2018;265(10):2231-2236.
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