Gluten-free diet may alleviate neuropathic pain

Panagiotis Zis

A strict gluten-free diet may be protective against common painful symptoms linked to gluten neuropathy, according to a study that will be presented at the upcoming American Academy of Neurology annual meeting.

“In our clinical practice, we commonly see patients with peripheral neuropathy of various etiologies that complain of pain,” Panagiotis Zis, MD, PhD, from the University of Sheffield, England, told Healio Internal Medicine. “We aimed to identify any determinants of pain and establish the prevalence of pain in a group of patients with a specific type of neuropathy called gluten neuropathy. This is neuropathy due to gluten sensitivity.”

Zis and colleagues enrolled 60 patients (76.7% men; mean age, 69.9 years) with gluten neuropathy. They assessed participants’ pain using the Douleur Neuropathique 4 (DN4) questionnaire and the visual analogue scale, neuropathy severity using the Overall Neuropathy Limitations Scare and general mental health status using the Mental Health Index (MHI-5). Participants were asked whether they adhered to a strict gluten-free diet.

The researchers found that 55% of patients experienced neuropathic pain. There were no significant differences between painful and not painful groups in age, gender, neuropathy severity and neuropathy type. Mental health scores were significantly lower in participants with painful gluten neuropathy (MHI-5 score, 75.9 vs. 87.4).

A strict gluten-free diet may be protective against common painful symptoms linked to gluten neuropathy.

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Following a strict gluten-free diet was associated with greater odds of having painless gluten neuropathy (55.6% vs. 21.2%). In an analysis adjusted for age, sex and mental health status, patients who adhered to a strict gluten-free diet had an 88.7% less likelihood of having peripheral neuropathic pain.

“Gluten sensitivity is probably one of the most common causes of peripheral neuropathy,” Zis said. “It is important for physicians to appreciate that gluten neuropathy can exist even in the absence of small bowel inflammation seen in celiac disease. As a consequence of this, it is important to ensure that patients are tested using the appropriate serological markers... Our advice to clinicians is that patients with gluten neuropathy will benefit from being on a strict gluten free diet.”

The results of the study are “exciting” and suggest that a simple change in diet can relieve pain associated with gluten neuropathy; however, they do not prove that a gluten-free diet causes less pain, Zis said in a press release.

“We are currently looking at the presence of small fiber dysfunction in patients with gluten sensitivity,” Zis said. “There are ongoing projects looking at the whole spectrum of neurological manifestations, such as gluten ataxia and gluten encephalopathy, as well as laboratory work examining novel biomarkers that may allow better diagnosis of the gluten related neurological manifestations.” – by Alaina Tedesco

Reference:

Zis P, et al. “Gluten neuropathy: Prevalence of pain and the role of gluten-free diet.” Presented at: American Academy of Neurology annual meeting. April 21-27, 2018; Los Angeles.

Disclosure: Healio Internal Medicine was unable to confirm relevant financial disclosures at the time of publication.