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  • Jefferson Adams

    Experts Recommend Celiac and Gluten Sensitivity Screens for Small Fiber Neuropathy Patients

    Jefferson Adams


    Reviewed and edited by a celiac disease expert.

      Patients with small fiber neuropathy should be screened for celiac disease and gluten-sensitivity, according to authors of new study.


    Caption: Image: CC PDM 1.0--SciTechTrend

    Celiac.com 08/27/2019 - Patients with gluten neuropathy often have peripheral neuropathic pain, indicating the involvement of small fibers. The most common types of peripheral neuropathy in people with celiac disease and gluten sensitivity are length-dependent symmetrical sensorimotor neuropathies and sensory ganglionopathies. 

    A team of researchers recently set out to describe the clinical characteristics of patients with celiac disease or gluten sensitivity and pure small fiber neuropathy (SFN). 



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    The research team included Pangiotis Zis, PG Sarrigiannis, DG Rao, DS Sanders, and M Hadjivassiliou. They are variously affiliated with the Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; and the Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust in Sheffield, UK.

    The research team reviewed the records for all patients referred to the Gluten-Related Neurological Disorders clinic with clinical and neurophysiological evidence of small fiber neuropathy. 

    Blood screens indicated that all patients were gluten sensitive prior to starting a gluten-free diet.  The team offered duodenal biopsy to all patients, except those patients with conditions that could cause small fiber neuropathy. 

    The researchers found 9 males and 5 females with small fiber neuropathy and gluten sensitivity. Eleven of those patients underwent duodenal biopsy, and ten of those showed evidence of celiac disease enteropathy.  Average age at onset of pain was 53.5 ± 11.4 years, while the average age of celiac disease/gluten sensitivity diagnosis was 50.8 ± 10.4 years. More than six out of ten patients reported feeling pain. 

    Neurophysiological assessment suggested a length-dependent small fiber neuropathy in 11 patients, whereas in 2, a non-length dependent pattern was identified, suggesting that the predominant pathology lies in the dorsal root ganglia. 

    This study reveals that small fiber neuropathy can be a feature of celiac disease and gluten sensitivity. The team recommends that patients with idiopathic small fiber neuropathy be screened for celiac disease and gluten sensitivity.

    Read more in Postgrad Med. 2019 Aug 6:1-5. doi: 10.1080/00325481.2019.1650609.


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    On 9/2/2019 at 7:05 AM, Guest DQM said:

    So what if we know we have this condition?  What can be done for the pain and numbness and loss of balance?

    Some people try physical therapy or acupuncture to see if it will help. Also many members on the forums suggest to ensure (especially if newly diagnosed to check for nutrient deficiencies.)

    I personally have to watch all the b vitamins, especially b-12 (sublingual best) vitamin d, magnesium, and zinc in the event gluten cc exposure occurs I often times will need to supplement while healing as I don't absorb them properly.

    Good luck 

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    10 yrs before dx of Celiac, I was diagnosed with Raynaud's after the doctor noticed my red hands, wrists and lower arm. After 6 mos on gluten-free diet, I went to pick up a pan off the stove as I always had (without a pot holder).  It felt so hot and instantly reminded me of a sensation of hot when I was a child. As I had grown into an adult, my mother said (who had the same skill) said that you become less sensitive as an adult, is all.  I also had ice cold feet that would often be close to purple in color in the winter. If it was hot, both hands and feet got too hot, so cool water was the solution. Not any more.  But, the foot issue was the longest healing- took another ten years to have warm feet when I wake up.  (I have- or was doing a lot of detoxing things- the last part was iodine supplement which may be part of this latest rejuvination. 

    At nine months in on the gluten free diet I got back my sense of touch- I went around the house feeling all the different textures of fabric, etc.  It was amazing to have my 43 y.o. hands feel young again.  Right away I looked up the connection to Raynaud's on a forum and found out it was not coincidental at all.  When the doctor dx'd me with Raynaud's he was treating me for a Vitamin D defiency--a renowned Vit D specialist at that-- never did he test for gluten and he overdosed me eventually with 100,000 IU weekly of Drisdol.  My symptom was having bone pain--I was thin despite eating, sick all the time--and had been on a vegetarian diet, using whole wheat to replace the meat protein. My diagnosis for the D problem was a long time in coming, because I have a bone disease--but I even told doctors and family that I often I felt better if I just didn't eat!

    Neuropathy and pain as Celiac Symptoms should be stressed as part of the diagnostic criterea.  One reason is, that until I went gluten free, I thought my GI problems were normal so when asked, if I wasn't having extreme problem, like gushing water or something, I would say "No, that is fine."  I couldn't believe the first week--and onward on the diet what normal really was. I'd considered my GI--BM the most normal of my immediate family as a child. Two other factors that didn't get diagnosed correctly or at all, were adult acne and bouts of depression or emotional behavior. In a week my skin stopped breaking out. And, in a month it felt like I had taken my brain out of a plastic bag- I could think without having to focus so much and I felt alive and happy to the point that I would not go back on gluten to have my intentine biopsied.

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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,500 articles on celiac disease. His coursework includes studies in science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

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