Cleo Libonati, RN, BSN

Health in Depth: Muscle Weakness in Celiac Disease

by Cleo Libonati, RN, BSN on July 3rd, 2010


Muscle weakness is the lack of muscle strength to perform physical work that we should be able to do, such as lifting objects, climbing steps or simply walking or getting up from a chair. Muscle weakness is different from muscle fatigue, which is the lack of energy to continue physical work once begun. Muscle weakness is also different from lassitude, or chronic fatigue, which is the feeling of tiredness or exhaustion but without loss of muscle strength.

Muscle weakness is common in celiac disease. It may stem from one or more nutrient deficiencies, associated disorders or complications. This article addresses only nutritional causes of muscle weakness resulting from malabsorption and/or loss of minerals from diarrhea or vomiting.

Good health does not automatically come with the elimination of gluten. Muscle weakness may persist despite the start of a gluten-free diet either because we have not regained normal function of the small intestinal lining or the food we choose does not contain the nutrients we lack.

This article explains the way nutrients interplay in building muscle, sustaining muscle function, and supplying energy for muscle work. It will help you identify missing nutrients and choose foods that contain them.

Muscle structure

Muscle tissue is composed of cells or fibers grouped together into bundles that are able to contract or shorten in length like a rubber band. This capability gives muscles the ability to make parts of the body move by pulling on them and to create movement within organs. The cells walls are made up largely of protein.

Knowing about our muscles, and how they work, helps us to better understand problems brought on by specific nutrient deficiencies. We have three types of muscles tissue: voluntary, smooth and cardiac.

1. Voluntary or striated muscle acts according to our decision to do something. These muscles contract to pull a movable part of our body toward an immovable part or to steady a part. Voluntary muscles attached to the bones of our skeleton are called skeletal muscles.

Skeletal muscles occur in opposing sets, acting in a give and take manner. That is, while one muscle group contracts to pull a movable part of the body one way, an opposing muscle relaxes to allow this action. Then, to move the opposite way, the relaxed group contracts while the contracted group relaxes.

For example, to drop our head down, the rope-like muscle groups on either side of the neck called sternocleidomastoid contract to pull the head (movable part) toward the chest. This muscle originates from the sternum and inner part of the clavicle (collarbone) and attaches to the mastoid area of the skull behind the ear.

To move our head back to an upright position, the opposing broad, and flat, triangular shaped muscle group called trapezius contracts. It originates from the upper back and shoulders and attaches to the base of the skull and neck. This example illustrates how voluntary muscles attached to a part of the skeleton move that part and that they work in opposition to another group of muscles.

Skeletal muscles are also found in our tongue, pharynx and upper part of our esophagus. We use these muscles to chew our food and swallow it. Once past our throat involuntary smooth muscles of the esophagus automatically and rapidly propel the food into the stomach.

2. Involuntary muscle is called smooth muscle.  It works without our conscious control, performing work unseen to maintain vital body functions. Smooth muscle is found mainly in internal organs within the walls of organs and structures such as the esophagus, stomach, intestines, bronchi, uterus, urethra, bladder, and blood vessels.

In the digestive tract, smooth muscles mechanically move the food down the esophagus, through the stomach and intestines and out the anus. In this complex process, smooth muscles manipulate the food mass to hold or advance it, while squirting digestives juices and hormones to dissolve and digest it, pumping millions of villi to absorb its nutrients and ultimately expelling the waste.

3. Cardiac muscle is unique to the heart. These fibers branch and come together to form a network that is controlled by Purkinje fibers. These fibers allow for synchronized conduction of nerve impulses originating in the pacemaker. The pacemaker is a specialized group of cells that sets the heart’s rhythm without any thought of our own while being very attentive to changing needs and emotions.

Muscle function

All muscle cells consume energy to do the work of contraction. The main source of their energy is glucose in the form of high energy ATP (adenosine triphosphate) present in cells and phosphocreatine, a secondary source of energy for making ATP also present in cells. Glycogen, a glucose rich substance made by the liver and stored there and in muscles, and lipids as free fatty acids in blood also provide energy to muscles.

Examination of skeletal muscles.

Careful inspection of muscle mass or size and observation of tone, strength, and contraction can usually find the cause of muscle weakness. Beyond a physical examination, there are specific medical tests that a health care provider can order.

·Muscle mass or size. Your doctor inspects and feels your muscles for atrophy (loss of bulk), hypertrophy (enlargement), and asymmetry (different appearance or strength of groups on opposite parts of the body such as the upper arms).

Your lean body muscle mass can be estimated using the muscle area of your mid upper arm. The average midarm circumference is about 32 cm give or take 5 cm for males and 30 cm give or take 6 cm. A lower value indicates loss of muscle. Individual calculations are made using a formula for taking into account the estimation of skin fat in the upper arm by measuring the triceps skinfold (back of upper arm).

· Muscle tone. While you are relaxed, your doctor flexes the limbs and extends them, looking for floppiness or stiffness.

· Muscle strength. Your doctor looks to see how you begin a work and perform it.

o Arms and legs. Weakness is shown by difficulty holding your arms straight out and then the legs from a sitting position. How long you can keep them raised? If the examiner presses down on them, can the muscles resist pressure or do they drop easily?

o Hands and Fingers. Do you have a weak grip? How hard is it to untwist a lid? To wring a cloth? To button up?

o Thighs/ Upper Legs. Weakness is shown by difficulty getting up from a chair. Needing to use your arms to push your body up shows weakness in the quadriceps muscles of the thighs. How many steps can you climb? How many times can you get up from a squatting position?

o Lower legs. Can you walk on your heels and on your toes?

o Shoulders. Weakness is shown by swinging your body to move your arms while walking.

o  Pelvis. Weakness is shown by having to roll over from a back lying position on the floor, kneeling, and slowly pushing to stand up by climbing up the thighs with the hands.

o Torso. Weakness is shown by difficulty bending over and returning to a standing position or sitting up from a lying position.

· Abnormal movements. 

o Twitches are common involuntary movements of striated muscles under the skin. o Tremors are quivering movements that can be very strong. o Spasms are involuntary unpleasant contractions or over shortening of muscles that may alternate with relaxation of the muscle or be constant. o Cramps are strong and painful spasms. o Tetany is the worsening of cramps. o  Laryngospasms are life-threatening spasms that block air passage through the larynx thus preventing air exchange in the lungs. o Convulsions are the ultimate in cramping. They are sudden, severe alternating contractions and relaxations of muscles. They may affect one part of the body such as an arm or the entire body.

How do nutrient deficiencies cause muscle weakness? Nutrient deficiencies induce muscle malfunction by failing to provide 1) energy for power, 2) amino acids for building and maintain cells and 3) electrolytes for nerve conduction and muscle contraction and relaxation.

How can we build strong muscles?

Here are 9 important steps:

1. Be strict about your gluten-free diet. Remember, 1/8th teaspoon of flour can cause malabsorption without causing abdominal symptoms.

2. Choose food that deliver potassium, calcium, magnesium, phosphorus, protein, zinc, B vitamins, carbohydrates and fatty acids to nourish and maintain your muscles.

3. Get sufficient rest to allow muscles to regenerate properly.

4. Develop a balanced exercise regimen to build strong muscles that are evenly matched. Look in the mirror or at your photos to see problems such as wasted buttocks, stooped shoulders, protruding abdomen, or thin thighs/calves.

5. Pace your activities. Overworking muscles will damage their proteins, taking about 5 days to recover.

6. Drink at least 8 glasses of water a day to hydrate and take away waste materials from muscles.

7. Tone up your bowels with sufficient fiber and fluid to prevent constipation. Constipation allows build-up of substances that are noxious to muscles. Correct diarrhea at once. Diarrhea loses valuable minerals, such as potassium and magnesium, needed for proper muscle function.

Probiotics found in yogurt, kefir, buttermilk, unpasteurized honey, vinegar, and wheat-free tamari puts friendly bacteria back into our system. Prebiotics such as onion, banana, Jerusalem artichoke, maple sugar, and asparagus stimulate the growth of these good bacteria.

8. Take a daily supplement that provides 100% of a variety of vitamins and minerals because nutrients rely on each other for best operation. A word of caution – read these labels, too. One person reported thinking she was taking 100% of B vitamins because the product name said B-100. In fact, she was taking more than 3,000 times the daily amount because the name on the bottle was misleading. The nutrition facts listed the actual contents.

9. Tailor specific vitamins and/or mineral supplementation to your own needs and response. Seek the advice of your doctor who would definitely monitor iron supplements.

Foods to eat.

Calcium. Milk products or fortified non-dairy such as soy, rice or almond, canned salmon and sardines with bones, bok choy, brown rice, English walnuts, almonds, green leafy vegetables such as broccoli, collards, turnip greens, beet greens and dandelion.

Potassium. Fruits and vegetables are a richer source than animal foods. Try bananas, beans, pumpkin, chick peas, romaine lettuce and endive. Good animal sources are milk products, meat, poultry, and fish.

Iron. This mineral is well absorbed from kidney, liver, oyster, seafood, meat, fish, poultry, and egg yolk. Plant sources are not as easily absorbed. Try brown rice, peas, lentils and beans.

Magnesium. Rich plant sources are soybeans, buckwheat, black-eyed peas, almonds, cashews, lima beans, Brazil nuts, pecans, whole grain rice, peanuts, walnuts and bananas. Rich animal sources are halibut, them haddock with less in other fish, shellfish and chicken.

Phosphorus. Milk products and liver. Rich plant sources are peanuts and tree nuts like almond, cashew and walnut. Good amounts are in chickpeas, lentils, lima beans, cocoa and chocolate

Selenium. Brazil nuts, pork kidneys, lamb kidneys, beef kidneys, pacific oysters, turkey giblets, snapper, lamb liver, halibut, chicken giblets, mussels – blue, chicken liver, tuna – canned, salmon, scallops, bacon, liverwurst, pork liver, crimini mushrooms – raw, sunflower seeds, shitake mushrooms, oyster mushrooms, corn bran, rice bran, corn flour, white rice flour.

Protein. Meat, fish, shellfish, milk and eggs are rich in protein. Best plant sources are tree nuts, soybeans, peanuts, legumes and seeds.

Vitamin B1. Pork, whole or 2% milk, salmon, halibut, chicken, beef and egg. Plants are pecans, sunflower seeds, filberts, walnuts, chestnuts, beans, peanuts, avocado, peas and brown rice.

Vitamin B3. Liver then oyster, milk, clams, pork, beef, chicken, egg, and trout. The richest plant source is almond. Good plants are brewer’s yeast, black-eyed peas, spinach, peanuts, chestnuts, avocado, asparagus, broccoli, soybeans, beans, brown rice, and orange juice.

Zinc. Highest animal source is the oyster. Rich animal sources include canned salmon, beef, liver, turkey neck, shellfish, poultry and fish. Good plants are soybeans, pumpkin seeds, dry peas and beans, brown rice and sunflower seeds.

What are some other causes of muscle weakness?

In the general population, there are many disorders and diseases that cause muscle weakness. Those that have been found to be celiac disease-related disorders include:

· Primary hyperparathyroidism - overproduction of hormone by the parathyroid glands. · Secondary hyperparathyroidism · Addison’s disease - insufficiency of the adrenal glands. · Hypothyroidism - malfunction/ insufficiency of the thyroid gland. · Hyperthyroidism – overproduction of thyroid hormone by the thyroid gland. · Dermatomyositis – autoimmune disorder of skin and muscles. · Rheumatoid arthritis – autoimmune disorder of joints. · Systemic lupus erythematosis – autoimmune disorder of skin and other organs. · Diabetes mellitus type I – autoimmune destruction of the insulin producing cells of the pancreas.

The above disorders need to be treated by your health care provider.

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Author Information: Cleo Libonati, RN, BSN *Cleo Libonati is president/CEO and co-Founder of Gluten Free Works, Inc. She is the author of Recognizing Celiac Disease. She can be reached by E-mail.


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One Response to “Health in Depth: Muscle Weakness in Celiac Disease”

  1. no fax advances says:

    Super job on the article. Several thanks for sharing it with us, you need to have gone via loads of work to complete it so well.

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