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Gluten and Neuropathy

What Are the Links Between Celiac Disease, Gluten Sensitivity, and Neuropathy?

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Updated February 08, 2013

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Did you ever let your foot fall asleep and suffer from numbness and then from a tingling, pins-and-needles sensation while it "awakened"? People with peripheral neuropathy suffer from those types of sensations — numbness and painful tingling — all the time. And there's growing evidence that peripheral neuropathy is linked with celiac disease and gluten sensitivity.

About 10% of people newly diagnosed with celiac disease suffer from an associated neurological condition, usually peripheral neuropathy (which is quite common) or gluten ataxia (which is more rare), studies show.

Meanwhile, gluten sensitivity is a newly-recognized condition that's not universally accepted by all physicians, and there haven't been any studies looking at peripheral neuropathy as an associated medical condition. However, physicians who are performing research on this topic say tingling and numbness in the extremities represents one of the most common gluten sensitivity symptoms.

Peripheral Neuropathy Involves Nerve Damage

The tingling, numbness and pain of peripheral neuropathy generally stem from nerve damage in your hands and feet. The nerve damage — and the symptoms — generally start in your longest nerves, which is why you'll probably notice symptoms first in your feet and possibly your hands.

The weird sensations (sometimes your feet or hands can feel cold, or hot, or like someone's jabbing them with a sharp instrument) usually start at the farthest point and work inward, up your legs and your arms. You can have just one nerve affected, or multiple nerves.

Diabetes is the number one cause of peripheral neuropathy, since up to half of all diabetics will experience nerve damage. However, autoimmune conditions (celiac disease is autoimmune in nature) also have been linked with peripheral neuropathy.

Peripheral Neuropathy Gluten-Related In Some Cases

Peripheral neuropathy does seem to be related to anti-gluten antibodies in some cases.

In one study, researchers screened 215 patients with axonal neuropathy, a form of peripheral neuropathy involving damage to your axons, or bunches of nerves. A total of 140 of these had "idiopathic neuropathy," meaning there was no apparent medical reason for their peripheral neuropathy.

The researchers tested those 140 people for antibodies to gluten using two celiac disease blood tests, the AGA-IgA test and the AGA-IgG test. Although these tests are not thought to be very specific to celiac disease, they can detect if your body views gluten as an invader and is generating antibodies against the protein.

Thirty-four percent of those tested — 47 people — had high antibodies to gluten in one or both of those tests, compared with a 12% rate of high antibodies to gluten in the overall population. Those test results could indicate that the people had gluten sensitivity, since some experts are recommending the AGA-IgA and the AGA-IgG as gluten sensitivity tests.

The researchers also performed endoscopies and biopsies on those people in the study suspected to have celiac disease, and found that 9% of those in the "unexplained neuropathy" group actually had celiac. The celiac disease genes — i.e., HLA-DQ2 and HLA-DQ8 — were found in 80% of all peripheral neuropathy patients.

Peripheral Neuropathy Key Symptom of Celiac, Gluten Sensitivity

Peripheral neuropathy actually is one of the most common non-digestive symptoms of celiac disease, according to the University of Chicago Celiac Disease Center. In fact, it's possible to have no noticeable gastrointestinal symptoms of celiac disease, but instead to have mainly peripheral neuropathy and other neurological symptoms.

Neurological symptoms such as peripheral neuropathy, migraine and brain fog are even more common in non-celiac gluten sensitivity, according to the University of Maryland Center for Celiac Research director Dr. Alessio Fasano, one of the lead researchers in the field of gluten sensitivity. Dr. Fasano says up to 30% of people he's diagnosed with gluten sensitivity have neurological symptoms... a much larger percentage than people with neurological symptoms in celiac disease.

If you have peripheral neuropathy and you're diagnosed with celiac or gluten sensitivity, you may be able to improve or even resolve your symptoms by following the gluten-free diet — some studies have found the diet helps. However, other studies have found that "neurologic manifestations," including peripheral neuropathy, may continue or even develop after diagnosis, indicating that there may be a related inflammatory process involved.

The University of Chicago recommends that people with peripheral neuropathy induced by celiac disease make sure to consult with their physicians about discontinuing drugs that might cause peripheral neuropathy. The practitioners there also recommend that celiacs with peripheral neuropathy make lifestyle changes to reduce their pain, including avoiding long periods of standing or walking, wearing loose shoes (in some cases, insurance might cover special therapeutic shoes), and soaking their feet in ice water to ease pain and tingling.

Physicians also may be able to prescribe medication that can ease some of the discomfort of peripheral neuropathy, especially if it doesn't seem to respond to the gluten-free diet. Meanwhile, people with peripheral neuropathy, whether or not it appears to be related to celiac disease or gluten sensitivity, should make sure to be extra careful when they walk or move around, since the lack of sensation in their feet could lead to a risk of falls.

Sources:

Chin R. et al. Peripheral Neuropathy and Celiac Disease. Current Treatment Options in Neurology. 2005 Jan;7(1):43-48.

Hadjivassiliou M. et al. Neuropathy associated with gluten sensitivity. Journal of Neurology, Neurosurgery, and Psychiatry. 2006 Nov;77(11):1262-6. Epub 2006 Jul 11.

Rigamonti A. et al. Celiac disease presenting with motor neuropathy: effect of gluten-free diet. Muscle & Nerve. 2007 May;35(5):675-7.

University of Chicago Center for Peripheral Neuropathy. Types of Peripheral Neuropathy - Inflammatory - Celiac Disease. Accessed March 15, 2012.

Zelnik N. et al. Range of neurologic disorders in patients with celiac disease. Pediatrics. 2004 Jun;113(6):1672-6.

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