LOS ANGELES - A strict gluten-free diet may protect against peripheral neuropathic pain associated with gluten sensitivity, according to researchers in England.
A rigidly enforced, gluten-free diet was associated with lowering the odds of peripheral neuropathic pain by 88.7%, reported Panagiotis Zis, MD, PhD, of the University of Sheffield, and colleagues in an early-release abstract from the annual meeting.
"We think of gluten sensitivity as an immune disease triggered by eating gluten in susceptible people," said Zis. "Ingestion of gluten causes an immune reaction that, in this case, damages nerves, which can be painful. A strict gluten-free diet removes the main factor triggering the inflammation, allowing the immune response to calm down and alleviating the neuropathic symptoms, including pain."
Action Points
- Note that this study was published as an abstract and will be presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Gluten neuropathy is idiopathic and is the second most common neurological manifestation of gluten sensitivity after cerebellar ataxia. "Celiac disease and gluten sensitivity are often diagnosed as the cause of a peripheral neuropathy when other causes, such as diabetes and vitamin deficiencies are excluded, and in the setting of seropositivity to gliadin antibodies," said Kourosh Rezania, MD, of the University of Chicago Medicine, who was not involved in the study.
"Treatment of neuropathy pain can often be very challenging, often including use of multiple medications, and the finding of this study that compliance with a gluten-free diet may help the pain is very important," he told 乌鸦传媒.
For this research, Zis' group recruited 60 patients with gluten neuropathy. Their average age was 70 and 76.7% were men.
The researchers used Douleur Neuropathique 4 Questions () and visual analogue scales (VAS) to assess pain, and Overall Neuropathy Limitations Scales () to measure neuropathy severity. They also looked at Mental Health Index () scores to gauge general mental health status. The MHI-5 has a range of 0 to 100; a higher score represents a better mental health status.
More than half of the sample (55%) had neuropathic pain. There were no significant differences in age, gender, neuropathy severity, or neuropathy type between patients who had pain and those who did not.
Patients with painful gluten neuropathy had significantly worse MHI-5 scores (75.9 versus 87.4, P<0.001). And patients without pain were more likely to be following a strict gluten-free diet (55.6% versus 21.2%, P=0.006).
After adjusting for age, gender and MHI-5, the researchers found that a strict gluten-free diet was associated with lowering the odds of peripheral neuropathic pain by 88.7% (95% CI 47.2%–97.6%, P=0.006).
"It's important for physicians to appreciate that gluten neuropathy can exist independently of small bowel inflammation -- that is, in people without celiac disease," Zis noted.
"The diagnosis of gluten neuropathy depends on testing the appropriate serological markers," he told 乌鸦传媒. "In the cases described in our paper, antigliadin antibodies were used to define the presence of sensitivity to gluten. Our advice to clinicians is that patients with painful neuropathy and serological evidence of gluten sensitivity may benefit from being on a strict gluten-free diet, with relief of pain. "
More research is needed to confirm these results and determine whether a gluten-free diet actually led to the reduction in pain, he added.
Primary Source
American Academy of Neurology
Zis P, et al "Gluten neuropathy: Prevalence of pain and the role of gluten-free diet" AAN 2018.