{"id":726,"date":"2015-05-11T19:23:51","date_gmt":"2015-05-11T23:23:51","guid":{"rendered":"http:\/\/www.mynutriguide.com\/?p=726"},"modified":"2020-07-11T10:39:24","modified_gmt":"2020-07-11T14:39:24","slug":"peripheral-neuropathy-3","status":"publish","type":"post","link":"https:\/\/glutenfreeworks.com\/health\/peripheral-neuropathy-3\/","title":{"rendered":"Peripheral Neuropathy\u00a0"},"content":{"rendered":"<div id=\"attachment_8361\" style=\"width: 310px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/400px-Neuron.svg_.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-8361\" class=\"size-medium wp-image-8361\" src=\"https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/400px-Neuron.svg_-300x161.png\" alt=\"Drawing of a Neuron.\" width=\"300\" height=\"161\" srcset=\"https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/400px-Neuron.svg_-300x160.png 300w, https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/400px-Neuron.svg_.png 400w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-8361\" class=\"wp-caption-text\"><strong>Drawing of a Neuron.<\/strong><\/p><\/div>\n<h2>What Is Peripheral Neuropathy?<\/h2>\n<p style=\"text-align: justify\"><span class=\"dropcap\">P<\/span>eripheral neuropathy is a syndrome involving damage to one or more peripheral nerves characterized by impaired nerve transmission.\u00a0Peripheral nerves are nerves of the body outside the brain and spinal cord.<\/p>\n<p style=\"text-align: justify\"><strong>Q<\/strong>: Why is nerve transmission impaired?<\/p>\n<p style=\"text-align: justify\"><strong>A<\/strong>: Nerve transmission is impaired by inadequate nutrition needed for health, medications such as phenytoin, \u00a0autoimmune disease that attacks and damages various parts of neurons such as multiple sclerosis and celiac disease, metabolic disorders such as thyroid disease\u00a0<span style=\"line-height: 1.5em\">and diabetes<\/span><span style=\"line-height: 1.5em\">,\u00a0<\/span><span style=\"line-height: 1.5em\">and genetic\u00a0<\/span><span style=\"line-height: 1.5em\">disorders such as Charcot Marie Tooth Disease. \u00a0<\/span><\/p>\n<p style=\"text-align: justify\">Peripheral nerves are made up of individual neurons that do the work of transmitting nerve impulses for movement (motor) and receiving information from the senses (sensory) to and from the brain and spinal cord. \u00a0 Neurons have a cell body, dendrites and an axon. Dendrites are the part that receives information and axons transmit information. Axons are wrapped by Schwann cells that contain a of fatty substance that insulates and helps propel the \u00a0transmission.<\/p>\n<p style=\"text-align: justify\">In regards to treatment with pain relievers, a database review\u00a0investigating the analgesic effect and adverse events of oxycodone for chronic neuropathic pain found that no convincing, unbiased evidence suggests that oxycodone (as oxycodone CR) is of value in treating people with painful diabetic neuropathy or postherpetic neuralgia. &#8220;There is no evidence at all for other neuropathic pain conditions, or for fibromyalgia. Adverse events typical of opioids appear to be common.&#8221;<a href=\"#footnote_1_726\" id=\"identifier_1_726\" class=\"footnote-link footnote-identifier-link\" title=\"Gaskell H, Moore RA, Derry S, Stannard C. Oxycodone for neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. 2014 Jun 23;6:CD010692. doi: 10.1002\/14651858.CD010692.pub2.\">1<\/a><\/p>\n<h2>What Is Peripheral Neuropathy In Celiac Disease and\/or Gluten Sensitivity?<\/h2>\n<ul class=\"cp_check red\">\n<li style=\"text-align: justify\">\n<div id=\"attachment_13005\" style=\"width: 189px\" class=\"wp-caption alignright\"><a href=\"https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/canstockphoto19611558.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-13005\" class=\" wp-image-13005\" src=\"https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/canstockphoto19611558-300x300.jpg\" alt=\"Nervous System.\" width=\"179\" height=\"179\" srcset=\"https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/canstockphoto19611558-300x300.jpg 300w, https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/canstockphoto19611558-150x150.jpg 150w, https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/canstockphoto19611558-70x70.jpg 70w, https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/canstockphoto19611558.jpg 800w\" sizes=\"auto, (max-width: 179px) 100vw, 179px\" \/><\/a><p id=\"caption-attachment-13005\" class=\"wp-caption-text\">Peripheral Nerves Are Yellow. <em>Click.<\/em><\/p><\/div>\n<p><strong>Relationship between peripheral neuropathy and celiac disease.<\/strong> Peripheral neuropathy is an associated disorder of celiac disease and occurs in non-celiac gluten sensitivity.<\/li>\n<li style=\"text-align: justify\"><strong>Relationship between peripheral neuropathy and gluten.\u00a0<\/strong>Sensory ganglionopathy can be a manifestation of gluten sensitivity and may respond to a strict gluten-free diet.<a href=\"#footnote_2_726\" id=\"identifier_2_726\" class=\"footnote-link footnote-identifier-link\" title=\"Hadjivassiliou M, Rao DG, Wharton SB, Sanders DS, Gr&uuml;newald RA, Davies-Jones AG. Sensory ganglionopathy due to gluten sensitivity. Neurology. 2010 Sep 14;75(11):1003-8. doi: 10.1212\/WNL.0b013e3181f25ee0.\">2<\/a><\/li>\n<li style=\"text-align: justify\"><strong>Relationship between peripheral neuropathy and type.\u00a0<\/strong>Celiac disease-associated peripheral neuropathy may be of axonal or demyelinating type.<a href=\"#footnote_3_726\" id=\"identifier_3_726\" class=\"footnote-link footnote-identifier-link\" title=\"Wills AJ. The neurology and neuropathology of celiac disease&nbsp;Neuropathology and Applied Neurobiology. 2000:26:493-496.\">3<\/a> involving sensory loss, paresthesis (numbness), and muscle weakness, alone or in any combination.<a href=\"#footnote_4_726\" id=\"identifier_4_726\" class=\"footnote-link footnote-identifier-link\" title=\"Chin RL, Sander HW, Brannigan TH, et al. Celiac neuropathy. Neurology. May 27, 2003;60(10):1581-5.\">4<\/a>\u00a0Autopsy tissue from 3 patients demonstrated inflammation in the dorsal root ganglia with degeneration of the posterior columns of the spinal cord.<a href=\"#footnote_2_726\" id=\"identifier_5_726\" class=\"footnote-link footnote-identifier-link\" title=\"Hadjivassiliou M, Rao DG, Wharton SB, Sanders DS, Gr&uuml;newald RA, Davies-Jones AG. Sensory ganglionopathy due to gluten sensitivity. Neurology. 2010 Sep 14;75(11):1003-8. doi: 10.1212\/WNL.0b013e3181f25ee0.\">2<\/a><\/li>\n<li style=\"text-align: justify\"><strong>Relationship between peripheral neuropathy and vitamin E.\u00a0<\/strong>A case report describes diagnosing celiac disease in a patient with neurological manifestations including myopathy (inflammatory infiltrates and rimmed vacuoles, similar to those found in inclusion-body myositis), polyneuropathy, and ataxia due to severe vitamin E deficiency. A gluten-free diet and vitamin E supplementation reversed both the clinical neurological manifestations and the abnormalities in the muscle biopsy.&#8221;<a href=\"#footnote_5_726\" id=\"identifier_6_726\" class=\"footnote-link footnote-identifier-link\" title=\"Kleopa KA, Kyriacou K, Zamba-Papanicolaou E, Kyriakides T. Reversible inflammatory and vacuolar myopathy with vitamin E deficiency in celiac disease. Muscle Nerve. 2005 Feb;31(2):260-5.\">5<\/a><\/li>\n<\/ul>\n<h2>How Prevalent Is Peripheral Neuropathy In Celiac Disease and\/or Gluten Sensitivity?<\/h2>\n<ul class=\"cp_bullet black\">\n<li style=\"text-align: justify\">Celiac disease is commonly associated with sensory neuropathy, occurring in 2.5% of all neuropathy patients.<\/li>\n<li style=\"text-align: justify\">Celiac disease should be considered even in the absence of gastrointestinal symptoms because 30% of patients with confirmed celiac disease had neuropathic symptoms alone without gastrointestinal involvement, and neuropathic symptoms preceded other celiac disease symptoms in another 10.5% of patients.<a href=\"#footnote_4_726\" id=\"identifier_7_726\" class=\"footnote-link footnote-identifier-link\" title=\"Chin RL, Sander HW, Brannigan TH, et al. Celiac neuropathy. Neurology. May 27, 2003;60(10):1581-5.\">4<\/a><\/li>\n<li style=\"text-align: justify\">Chronic axonal neuropathy occurs in 23.1% of patients with treated celiac disease.<a href=\"#footnote_6_726\" id=\"identifier_8_726\" class=\"footnote-link footnote-identifier-link\" title=\"Luostarinen L, Himanen SL, Luostarinen M, Collin P, Pirttila T. Neuromuscular and sensory disturbances in patients with well treated coeliac disease. Journal of Neurology, Neurosurgery, and Psychiatry. Apr 2003;74(4):490-4.\">6<\/a><\/li>\n<li style=\"text-align: justify\">Celiac disease was associated with a 2.5-fold increased risk of later neuropathy in\u00a0a nationwide population-based sample of patients with biopsy-verified celiac disease.<a href=\"#footnote_7_726\" id=\"identifier_9_726\" class=\"footnote-link footnote-identifier-link\" title=\"Thawani SP, Brannagan TH 3rd, Lebwohl B, Green PH, Ludvigsson JF. Risk of Neuropathy Among 28\u202f232 Patients With Biopsy-Verified Celiac Disease. JAMA Neurol. 2015 May 11. doi: 10.1001\/jamaneurol.2015.0475.\">7<\/a><\/li>\n<\/ul>\n<h2>What Are The Symptoms Of Peripheral Neuropathy?<\/h2>\n<p style=\"text-align: justify\">Peripheral neuropathy is marked by these symptoms:<\/p>\n<ul class=\"cp_bullet red\">\n<li>Burning.<\/li>\n<li><span style=\"text-align: justify;line-height: 1.5em\">Tingling.<\/span><\/li>\n<li><span style=\"text-align: justify;line-height: 1.5em\">Numbness in hands and feet with sensory loss.<\/span><\/li>\n<li><span style=\"text-align: justify;line-height: 1.5em\">Weakness of extremities.<\/span><\/li>\n<\/ul>\n<h2>How Does Peripheral Neuropathy Develop In Celiac Disease and\/or Gluten Sensitivity?<\/h2>\n<ul class=\"cp_check red\">\n<li style=\"text-align: justify\">Peripheral neuropathy results from an unclear immune mechanism and nutritional deficiencies that include thiamin (vitamin B1), niacin (vitamin B3), pyridoxine (vitamin B6), folic acid, vitamin B12, and omega-3 fatty acids.<\/li>\n<\/ul>\n<h2>Does Peripheral Neuropathy Respond To Gluten-Free Diet?<\/h2>\n<ul class=\"cp_bullet black\">\n<li style=\"text-align: justify\">Yes. Peripheral neuropathies may benefit from a gluten free diet.<a href=\"#footnote_8_726\" id=\"identifier_10_726\" class=\"footnote-link footnote-identifier-link\" title=\"Kaplan JG, Pack D, Horoupian D, DeSouza T, Brin M, Schaumburg H. Distal axonopathy associated with chronic gluten enteropathy: a treatable disorder. Neurology. Apr 1988;38(4)642-5.\">8<\/a><\/li>\n<li style=\"text-align: justify\">Of 15 study patients who went on a gluten-free diet, stabilization of the neuropathy resulted in 11. The remaining 4 had poor adherence to the diet and progressed, as did the 2 patients who did not opt for dietary treatment. Autopsy tissue from 3 patients demonstrated inflammation in the dorsal root ganglia with degeneration of the posterior columns of the spinal cord.<a href=\"#footnote_2_726\" id=\"identifier_11_726\" class=\"footnote-link footnote-identifier-link\" title=\"Hadjivassiliou M, Rao DG, Wharton SB, Sanders DS, Gr&uuml;newald RA, Davies-Jones AG. Sensory ganglionopathy due to gluten sensitivity. Neurology. 2010 Sep 14;75(11):1003-8. doi: 10.1212\/WNL.0b013e3181f25ee0.\">2<\/a><\/li>\n<li style=\"text-align: justify\">Caio et al. demonstrated that anti-gliadin antibodies of the IgG class disappear in patients with non-celiac gluten sensitivity reflecting a strict compliance to the gluten-free diet and a good clinical response to gluten withdrawal.<a href=\"#footnote_9_726\" id=\"identifier_12_726\" class=\"footnote-link footnote-identifier-link\" title=\"Caio G, Volta U1, Tovoli F, De Giorgio R. Effect of gluten free diet on immune response to gliadin in patients with non-celiac gluten sensitivity. BMC Gastroenterol. 2014 Feb 13;14:26. doi: 10.1186\/1471-230X-14-26.\">9<\/a><\/li>\n<\/ul>\n<h2>6 Steps To Improve Peripheral Neuropathy In Celiac Disease and\/or Gluten Sensitivity:<\/h2>\n<ul class=\"cp_check green\">\n<li><em><span style=\"color: #800000\"><span class=\"dropcap\"><strong>1<\/strong><\/span><\/span><strong><span style=\"color: #800000\">Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:<\/span><\/strong><\/em><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<b>Treatment<\/b>. This condition responds to the complete elimination of gluten, which is the required treatment that improves both peripheral neuropathy and gut health.<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.<\/li>\n<li>A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.<\/li>\n<li>Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1\/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Correct Your Individual Nutritional Needs.<\/strong><\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Eat foods that can replenish missing nutrients. Find them under\u00a0NUTRIENT DEFICIENCIES.<\/li>\n<li>Take nutritional supplements as needed.\u00a0Find them under\u00a0NUTRIENT DEFICIENCIES.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Recovery<\/strong>. You should begin to feel better within a week and notice more energy as inflammation subsides and the \u00a0absorbing cells that make up the surface lining of your small intestine are better able to function.<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.<\/li>\n<li>Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.<a href=\"#footnote_10_726\" id=\"identifier_13_726\" class=\"footnote-link footnote-identifier-link\" title=\"Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease.&nbsp;Clinical Science. Apr 2001;100(4):379-86.\">10<\/a><\/li>\n<li>The intestinal lining may take up to a year to heal.\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<ul class=\"cp_check green\" style=\"text-align: justify\">\n<li><em><span style=\"color: #800000\"><span class=\"dropcap\"><strong>2<\/strong><\/span><\/span><strong><span style=\"color: #800000\">\u00a0Reduce Inflammation. Foods to Eat and Foods Not to Eat:<\/span><\/strong><\/em><\/li>\n<\/ul>\n<p style=\"text-align: justify\">Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).<\/p>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Here Are Major Inflammatory Food Types That Reduce Healing<\/strong>:<\/p>\n<ul class=\"cp_bullet red\" style=\"text-align: justify\">\n<li><strong>Damaging Foods<\/strong>. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.<a href=\"#footnote_11_726\" id=\"identifier_14_726\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">11<\/a><\/li>\n<li><strong>Allergenic Foods<\/strong>. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.<\/li>\n<li><strong>Shelf Stable Processed Foods.\u00a0<\/strong>Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.<a href=\"#footnote_11_726\" id=\"identifier_15_726\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">11<\/a><\/li>\n<li><strong>Fats.<\/strong>\u00a0Limit deep fried foods, trans-fats, saturated fats (animal fat\/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.<a href=\"#footnote_11_726\" id=\"identifier_16_726\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">11<\/a>.<\/li>\n<li><strong>Excessive Refined White Flours\u00a0<\/strong>(bran layer removed)<strong>.\u00a0<\/strong>Includes\u00a0products made from them such as cookies, bread, cakes, pies.\u00a0Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream.\u00a0Also disrupt intestinal permeability causing leaky gut.<a href=\"#footnote_11_726\" id=\"identifier_17_726\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">11<\/a><\/li>\n<li><strong>Refined Sugars.\u00a0<\/strong>\u00a0Includes white sugar, corn fructose and high fructose corn syrup.<\/li>\n<li><strong>Certain Spices<\/strong>. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.<a href=\"#footnote_11_726\" id=\"identifier_18_726\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">11<\/a><\/li>\n<li><strong>Alcohol and Caffeine<\/strong>. Disrupt intestinal permeability causing leaky gut.<a href=\"#footnote_11_726\" id=\"identifier_19_726\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">11<\/a>\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Here Are Important Anti-Inflammatory Food Types to Promote Health<\/strong>:<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li><strong>Fruits<\/strong>.\u00a0Contain ample amounts of vitamins, minerals and phytochemicals which are\u00a0naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.<\/li>\n<li><strong>Non-Starchy Vegetables.<\/strong>\u00a0Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.<\/li>\n<li><strong>High Quality Complex Carbohydrates<\/strong>. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.<\/li>\n<li><strong>Antioxidants<\/strong>. Protect the body from inflammatory oxidant molecules that continually occur and\u00a0help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as\u00a0nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.<\/li>\n<li><strong>Omega-3 Fatty Acids<\/strong>. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.<\/li>\n<li><strong>Probiotics.\u00a0<\/strong>Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.<\/li>\n<li><strong>Prebiotics\/ High Fiber Foods<\/strong>. \u00a0Food with fiber keeps our population of colonic microbes healthy.<\/li>\n<li><strong>Protective Herbs and Spices<\/strong>. \u00a0See below #6 below for examples.\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<ul class=\"cp_check green\" style=\"text-align: justify\">\n<li><em><span style=\"color: #800000\"><strong><span class=\"dropcap\">3<\/span>\u00a0Information Sheet You Can Take to Your Doctor or Other Health Professional:<\/strong><\/span><\/em><\/li>\n<\/ul>\n<p style=\"text-align: justify\">Click here.<\/p>\n<ul class=\"cp_check green\" style=\"text-align: justify\">\n<li><span style=\"color: #800000\"><strong><em><span class=\"dropcap\">4<\/span>\u00a0Manage Your Medications\u00a0Safely<\/em>:<\/strong><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t\n<p style=\"text-align: justify\">Certain medications deplete one or more of these nutrients that are causes of peripheral neuropathy: thiamin (vitamin B1), niacin (vitamin B3), pyridoxine (vitamin B6), folic acid, vitamin B12, and omega-3 fatty acids.<\/p>\n<p style=\"text-align: justify\">Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below.\u00a0<strong>Do not stop prescribed medications without supervision.<\/strong><\/p>\n<p>\u00a0This is not a complete listing.<\/p>\n<p style=\"text-align: justify\"><strong>ANTACIDS \/ ULCER MEDICATIONS<\/strong><\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Pepcid\u00ae, Tagamet\u00ae, Zantac\u00ae deplete Folic Acid, Vitamin B12.<\/li>\n<li>Magnesium and Aluminum Antacid preparations (Gaviscon\u00ae, Maalox\u00ae, Mylanta\u00ae) deplete Folic Acid, Vitamin B12.<\/li>\n<li>Prevacid\u00ae, Prilosec\u00ae\u00a0deplete Vitamin B12.<\/li>\n<li>Alka Seltzer\u00ae, Baking Soda deplete\u00a0Folic Acid.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>ANTI-DEPRESSANTS<\/strong><\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Adapin\u00ae, Aventyl\u00ae, Elavil\u00ae, Pamelor\u00ae, and others\u00a0deplete Vitamin B12.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>ANTIBIOTICS\u00a0<\/strong>disrupt intestinal permeability which complicates celiac disease.<\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Gentomycin, Neomycin, Streptomycin, Cephalosporins, Penicillins\u00a0deplete\u00a0B Vitamins.<\/li>\n<li>\u00a0Tetracyclines deplete Vitamin B6.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>ANTI-INFLAMMATORIES<\/strong>\u00a0disrupt intestinal permeability which complicates celiac disease.<\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Corticosteroids (Prednisone, Medrol\u00ae, Aristocort\u00ae, Decadron) deplete Vitamin B6, Vitamin B12, Folic Acid.<\/li>\n<li>NSAIDS (Motrin\u00ae, Aleve\u00ae, Advil\u00ae, Anaprox\u00ae, Dolobid\u00ae, Feldene\u00ae, Naprosyn\u00ae and others) deplete\u00a0Folic acid.<\/li>\n<li>Aspirin and Salicylates deplete Folic acid.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>ANTICONVULSANTS<\/strong><\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Phenobarbital and Barbituates; and Dilantin\u00ae, Tegretol\u00ae, Mysoline\u00ae, Depakane\/Depacon\u00ae deplete Folic Acid, Biotin, Vitamin B12, Vitamin B1.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>ANTIVIRAL AGENTS<\/strong><\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Zidovudine (Retrovir\u00ae, AZT and other related drugs) deplete Vitamin B12.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>CARDIOVASCULAR DRUGS<\/strong><\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Antihypertensives (Catapres\u00ae, Aldomet) deplete Vitamin B6, Vitamin B1.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>CHOLESTEROL DRUGS<\/strong><\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Colestid\u00ae and Questran\u00ae deplete Vitamin B12, Vitamin E.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>DIABETIC DRUGS\u00a0<\/strong><\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Metformin\u00ae depletes\u00a0Folic acid, Vitamin B12.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>DIURETICS<\/strong><\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Loop Diuretics (Lasix\u00ae, Bumex\u00ae, Edecrin\u00ae) depletes Vitamin B1, Vitamin B6.<\/li>\n<li>Potassium Sparing Diuretics (Midamor\u00ae, Aldactone\u00ae, Dyrenium\u00ae and others) deplete \u00a0Folic Acid.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>FEMALE HORMONES<\/strong>\u00a0disrupt intestinal permeability which complicate celiac disease.<\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Oral Contraceptives (Norinyl\u00ae, Ortho-Novum\u00ae, Triphasil\u00ae, and others) deplete Vitamin B3, Vitamin B6, Vitamin B12.<\/li>\n<li>Oral Estrogen\/Hormone Replacement (Evista\u00ae, Prempro\u00ae, Premarin\u00ae, Estratab\u00ae and others) deplete Vitamin B6, Vitamin B12.<\/li>\n<\/ul>\n<p><strong>LAXATIVES<\/strong><\/p>\n<ul class=\"cp_bullet blue\">\n<li>Metamucil, FiberCon, Citrucel, Colace, Glycolax, Milk of magnesia, Dulcolax deplete: Vitamin E.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>MAJOR TRANQUILIZERS<\/strong>\u00a0<strong>\u00a0<\/strong><\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Thorazine\u00ae, Mellaril\u00ae, Prolixin\u00ae, Serentil\u00ae and others\u00a0deplete Vitamin B12.<\/li>\n<\/ul>\n<p><strong>WEIGHT LOSS DRUGS THAT BIND FAT\u00a0<\/strong>also interfere with absorption of some nutrients.<\/p>\n<ul class=\"cp_bullet blue\">\n<li>Zenicol (Orlistat\u00ae) depletes Vitamin E.<\/li>\n<\/ul>\n<p style=\"text-align: justify\">\n\t\t\t<\/div><\/div>\n<ul class=\"cp_check green\" style=\"text-align: justify\">\n<li><em><span style=\"color: #800000\"><strong><span class=\"dropcap\">5<\/span>Nutritional Supplements To Help Correct Deficiencies:<\/strong><\/span><\/em><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t\n<p style=\"text-align: justify\">The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.<\/p>\n<ul class=\"cp_bullet orange\" style=\"text-align: justify\">\n<li>Multivitamin\/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.<\/li>\n<li>Niacinimide\u00a0as prescribed for niacin deficiency.<\/li>\n<li>Vitamin B12 as prescribed following blood test for status.<\/li>\n<li>Folic acid as prescribed following blood test for status.<\/li>\n<li>Vitamin B6\u00a0as prescribed following blood test for status.<\/li>\n<li>Thiamin as prescribed following blood test for status.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Storage Note<\/strong>:\u00a0<em>Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet &#8211; not in the bathroom or on the kitchen table<\/em>.\n\t\t\t<\/div><\/div>\n<ul class=\"cp_check green\" style=\"text-align: justify\">\n<li><span style=\"color: #800000\"><em><strong><span class=\"dropcap\">6<\/span>Manage Natural Remedies:\u00a0<\/strong><\/em><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Hydration<\/strong>:<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.<\/li>\n<li>If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.<\/li>\n<li>Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.<\/li>\n<li>What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Carminatives.\u00a0<\/strong>The following \u00a0anti-inflammatory\u00a0plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.<\/p>\n<p style=\"text-align: justify\"><strong>Carminative Food Remedies<\/strong>:<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Raspberry.<\/li>\n<li>Carrot is also a cleansing digestive tonic.<\/li>\n<li>Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.<\/li>\n<li>Redbeets also stimulate and improve digestion and are easily digested.<\/li>\n<li>Cabbage also stimulates and improves digestion and is also a liver decongestant.<\/li>\n<li>Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.<\/li>\n<li>Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Carminative Herb Remedies:<\/strong><\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa. \u00a0Drink as tea or use in cooking.<\/li>\n<li>Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.<\/li>\n<li>Parsley also relieves indigestion.<\/li>\n<li>Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.<\/li>\n<li>Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Carminative Spice Remedies:<\/strong><\/p>\n<ul class=\"cp_bullet green\">\n<li>Cloves are also antispasmodic.<\/li>\n<li>Nutmeg is also useful for indigestion.<\/li>\n<li>Ginger.\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Exercise Helps<\/strong>:<\/p>\n<p>Exercise improves circulation and rids the body of toxins.<\/p>\n<ul class=\"cp_bullet green\">\n<li>Walking is aerobic exercise that reconditions the whole body to improve stamina.\u00a0Read more about<a href=\"https:\/\/glutenfreeworks.com\/health\/2014\/07\/08\/fitness-guide\/\">\u00a0Exercise and Fitness<\/a>.<\/li>\n<li>Weight training builds muscle.\u00a0Read more about\u00a0<a href=\"https:\/\/glutenfreeworks.com\/health\/2014\/07\/08\/fitness-guide\/\">Exercise and Fitness<\/a>.<\/li>\n<li>Stretching improves flexibilty.\u00a0Read more about\u00a0<a href=\"https:\/\/glutenfreeworks.com\/health\/2014\/07\/08\/fitness-guide\/\">Exercise and Fitness<\/a>.<\/li>\n<\/ul>\n<p><strong>Note<\/strong>: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. \n\t\t\t<\/div><\/div>\n<h2>What Do Medical Research Studies Tell About Peripheral Neuropathy\u00a0In Celiac Disease and\/or Gluten Sensitivity?<\/h2>\n<h4><strong>RESEARCH STUDY SUMMARIES<\/strong><\/h4>\n<p style=\"text-align: justify\"><strong>\u201cRisk of Neuropathy Among 28\u202f232 Patients With Biopsy-Verified Celiac Disease.\u201d<\/strong> This study investigating the relative risk and absolute risk of developing neuropathy in a nationwide population-based sample of patients with biopsy-verified celiac disease found an increased risk of neuropathy in patients with celiac disease. This statistically significant association in a population-based sample suggests that celiac disease screening should be completed in patients with neuropathy.<\/p>\n<p style=\"text-align: justify\">Data was collected between October 27, 2006, and February 12, 2008 on small-intestinal biopsies performed at Sweden&#8217;s 28 pathology departments between June 16, 1969, and February 4, 2008. The risk of neuropathy in 28\u202f232 patients with celiac disease (villous atrophy, Marsh 3) was compared with that of 139\u202f473 age- and sex-matched controls. Cox proportional hazards regression estimated hazard ratios (HRs) and 95% CIs for neuropathy defined according to relevant International Classification of Diseases codes in the Swedish National Patient Register (consisting of both inpatient and outpatient data).<\/p>\n<p style=\"text-align: justify\">Celiac disease was associated with a 2.5-fold increased risk of later neuropathy (95% CI, 2.1-3.0; P\u2009&lt;\u2009.001). We also found an increased risk (with results reported as HRs [95% CIs]) of chronic inflammatory demyelinating neuropathy (2.8; 1.6-5.1; P\u2009=\u2009.001), autonomic neuropathy (4.2; 1.4-12.3; P\u2009=\u2009.009), and mononeuritis multiplex (7.6; 1.8-32.4; P\u2009=\u2009.006), but no association between CD and acute inflammatory demyelinating polyneuropathy (0.8; 0.3-2.1; P\u2009=\u2009.68).<a href=\"#footnote_7_726\" id=\"identifier_20_726\" class=\"footnote-link footnote-identifier-link\" title=\"Thawani SP, Brannagan TH 3rd, Lebwohl B, Green PH, Ludvigsson JF. Risk of Neuropathy Among 28\u202f232 Patients With Biopsy-Verified Celiac Disease. JAMA Neurol. 2015 May 11. doi: 10.1001\/jamaneurol.2015.0475.\">7<\/a><\/p>\n<p style=\"text-align: justify\"><strong>&#8220;Effect of gluten free diet on immune response to gliadin in patients with non-celiac gluten sensitivity.&#8221;<\/strong> This study seeking to characterize the effect of the gluten-free diet on anti-gliadin antibodies of IgG class in patients with non-celiac gluten sensitivity demonstrated that anti-gliadin antibodies of the IgG class disappear in patients with non-celiac gluten sensitivity reflecting a strict compliance to the gluten-free diet and a good clinical response to gluten withdrawal.<\/p>\n<p style=\"text-align: justify\">Anti-gliadin antibodies of both IgG and IgA classes were assayed by ELISA in 44 non-celiac gluten sensitivity and 40 celiac disease patients after 6 months of gluten-free diet. The majority of non-celiac gluten sensitivity patients (93.2%) showed the disappearance of anti-gliadin antibodies of IgG class after 6 months of gluten-free diet. In contrast, 16\/40 (40%) of celiac patients displayed the persistence of these antibodies after gluten withdrawal. In non-celiac gluten sensitivity patients anti-gliadin antibodies IgG persistence after gluten withdrawal was significantly correlated with the low compliance to gluten-free diet and a mild clinical response.<a href=\"#footnote_9_726\" id=\"identifier_21_726\" class=\"footnote-link footnote-identifier-link\" title=\"Caio G, Volta U1, Tovoli F, De Giorgio R. Effect of gluten free diet on immune response to gliadin in patients with non-celiac gluten sensitivity. BMC Gastroenterol. 2014 Feb 13;14:26. doi: 10.1186\/1471-230X-14-26.\">9<\/a><\/p>\n<p style=\"text-align: justify\"><strong>\u201cOxycodone for neuropathic pain and fibromyalgia in adults.\u201d<\/strong> This study investigating the analgesic efficacy and adverse events of oxycodone for chronic neuropathic pain found that no convincing, unbiased evidence suggests that oxycodone (as oxycodone CR) is of value in treating people with painful diabetic neuropathy or postherpetic neuralgia. There is no evidence at all for other neuropathic pain conditions, or for fibromyalgia. Adverse events typical of opioids appear to be common.<\/p>\n<p style=\"text-align: justify\">On 6 November 2013, CENTRAL, MEDLINE and EMBASE databases were searched. Randomised controlled trials with double-blind assessment of participant outcomes following two weeks of treatment or longer (although the emphasis of the review was on studies of eight weeks or longer) that used a placebo or active comparator were reveiwed. Two review authors independently extracted efficacy and adverse event data, examined issues of study quality, and assessed risk of bias.<a href=\"#footnote_12_726\" id=\"identifier_22_726\" class=\"footnote-link footnote-identifier-link\" title=\"Gaskell H, Moore RA, Derry S, Stannard C. Oxycodone for neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. 2014 Jun 23;6:CD010692. doi: 10.1002\/14651858.CD010692.pub2.\">12<\/a><\/p>\n<p style=\"text-align: justify\"><strong>&#8220;Sensory ganglionopathy due to gluten sensitivity.&#8221;<\/strong> This is a retrospective observational case series of 17 patients with sensory ganglionopathy and gluten sensitivity. All patients had been followed up for a number of years in dedicated gluten sensitivity\/neurology and neuropathy clinics. This investigation found that sensory ganglionopathy can be a manifestation of gluten sensitivity and may respond to a strict gluten-free diet.<\/p>\n<p style=\"text-align: justify\">Out of a total of 409 patients with different types of peripheral neuropathies, 53 (13%) had clinical and neurophysiologic evidence of sensory ganglionopathy. Out of these 53 patients, 17 (32%) had serologic evidence of gluten sensitivity. The mean age of those with gluten sensitivity was 67 years and the mean age at onset was 58 years. Seven of those with serologic evidence of gluten sensitivity had enteropathy on biopsy.<\/p>\n<p style=\"text-align: justify\">Fifteen patients went on a gluten-free diet, resulting in stabilization of the neuropathy in 11. The remaining 4 had poor adherence to the diet and progressed, as did the 2 patients who did not opt for dietary treatment. Autopsy tissue from 3 patients demonstrated inflammation in the dorsal root ganglia with degeneration of the posterior columns of the spinal cord.<a href=\"#footnote_2_726\" id=\"identifier_23_726\" class=\"footnote-link footnote-identifier-link\" title=\"Hadjivassiliou M, Rao DG, Wharton SB, Sanders DS, Gr&uuml;newald RA, Davies-Jones AG. Sensory ganglionopathy due to gluten sensitivity. Neurology. 2010 Sep 14;75(11):1003-8. doi: 10.1212\/WNL.0b013e3181f25ee0.\">2<\/a><\/p>\n<p style=\"text-align: justify\"><b>\u201cClinical and neurological abnormalities in adult celiac disease.\u201d<\/b> This study investigating the occurrence of neurological signs and symptoms in adult patients with\u00a0celiac disease\u00a0and the correlation between neurological features and diet found that neurological signs and symptoms are associated with\u00a0celiac disease\u00a0and can be ameliorated by a gluten-free diet.<\/p>\n<p style=\"text-align: justify\">A total of 176 patients and 52 age-matched controls underwent a semistructural interview and a neurologic examination. The effect of gluten-free diet was evaluated by comparing the prevalence of signs and symptoms among patients adhering to a gluten-free diet and patients on an unrestricted diet. The occurrence of peripheral neuropathy was significantly higher in patients with\u00a0celiac disease\u00a0than in control subjects. Adherence to a strict gluten-free diet was associated with a significant reduction of headache, dysthymia (sadness), cramps and\u00a0weakness, but did not modify the occurrence of paresthesia.<a href=\"#footnote_13_726\" id=\"identifier_24_726\" class=\"footnote-link footnote-identifier-link\" title=\"Cicarelli G, Della Rocca G, Amboni M, Ciacci C, Mazzacca G, Filla A, Barone P. Clinical and neurological abnormalities in adult celiac disease. Neurol Sci. 2003 Dec;24(5):311-7.\">13<\/a><\/p>\n<p style=\"text-align: justify\"><strong>\u201cDistal axonopathy associated with chronic gluten enteropathy: a treatable disorder.\u201d<\/strong>\u00a0This case report of a patient and literature review reveals that patients with chronic gluten enteropathy and severe steatorrhea may develop a generalized peripheral neuropathy of the distal axonopathy type. Vitamin levels are usually normal and the neuropathy appears to respond to gluten restriction.<a href=\"#footnote_14_726\" id=\"identifier_25_726\" class=\"footnote-link footnote-identifier-link\" title=\"Kaplan JG, Pack D, Horoupian D, DeSouza T, Brin M, Schaumburg H. Distal axonopathy associated with chronic gluten enteropathy: a treatable disorder. Neurology. Apr 1988;38(4)642-5.\">14<\/a><\/p>\n<p style=\"text-align: justify\"><strong>\u201cCeliac neuropathy.\u201d<\/strong> This study of patients with biopsy confirmed Celiac Disease and neuropathy demonstrated all patients had burning, tingling, and numbness in their hands and feet, with distal sensory loss. 45% had diffuse paresthesias and 10% had weakness. Agglutination assay revealed 65% were positive for ganglioside antibodies. Results of electrophysiologic studies were normal or mildly abnormal in 90% of the patients. 23% of well treated study patients showed an increased axonal neuropathy. Sural nerve biopsies from 3 of the patients revealed mild to severe axonopathy. Celiac Disease should be considered even in the absence of GI symptoms because 30% of patients had neuropathic symptoms alone without GI involvement, and neuropathic symptoms preceded other Celiac Disease symptoms in another 10.5% of patients.<a href=\"#footnote_4_726\" id=\"identifier_26_726\" class=\"footnote-link footnote-identifier-link\" title=\"Chin RL, Sander HW, Brannigan TH, et al. Celiac neuropathy. Neurology. May 27, 2003;60(10):1581-5.\">4<\/a><\/p>\n<p style=\"text-align: justify\"><strong>\u201cNeuromuscular and sensory disturbances in patients with well treated coeliac disease.\u201d<\/strong> This study of well-treated patients with Celiac Disease demonstrated an increased occurrence of axonal neuropathy.\u00a0There were no significant differences in warm, cold, or vibration thresholds between patients with Celiac Disease from controls, but means of heat pain thresholds and tactile thresholds were significantly higher in Celiac Disease patients. This study further indicates that neurological manifestations occur even in patients without overt malabsorption.<a href=\"#footnote_6_726\" id=\"identifier_27_726\" class=\"footnote-link footnote-identifier-link\" title=\"Luostarinen L, Himanen SL, Luostarinen M, Collin P, Pirttila T. Neuromuscular and sensory disturbances in patients with well treated coeliac disease. Journal of Neurology, Neurosurgery, and Psychiatry. Apr 2003;74(4):490-4.\">6<\/a><\/p>\n<h4 style=\"text-align: justify\"><strong>CASE REPORT SUMMARIES<\/strong><\/h4>\n<p style=\"text-align: justify\">&#8220;<strong>Celiac disease manifested by polyneuropathy and swollen ankles<\/strong>.&#8221; This is a case study revealing celiac disease in a 27-year-old male who started to have his ankles swollen during his military service. He was examined at a military hospital where electromyoneurography showed the signs of distal sensory-motor polyneuropathy with axon demyelinization and weak myopathic changes, whereas histopathological examination of gastrocnemius muscle biopsy revealed some mild and nonspecific myopathy. Besides, he was found to have subcutaneous ankle tissue edemas and hypertransaminasemia. Due to these reasons, he was dismissed from the military service and examined at another hospital where bone osteodensitometry revealed low bone mineral density of the spine. However, his medical problems were not resolved and after the second discharge from hospital he was desperately seeing doctors from time to time. Finally, at our institution he was shown to have celiac disease by positive serology (antitissue transglutaminase and antiendomysial antibodies) and small bowel mucosal histopathological examination, which showed total small bowel villous atrophy. Three months after the initiation of gluten-free diet, his ankle edema disappeared, electromyoneurographic signs of polyneuropathy improved and liver aminotransferases normalized. Good knowledge of CD extraintestinal signs and serologic screening are essential for early CD recognition and therapy.<a href=\"#footnote_15_726\" id=\"identifier_28_726\" class=\"footnote-link footnote-identifier-link\" title=\"Djuric Z, Kamenov B, Katic V. Celiac disease manifested by polyneuropathy and swollen ankles. World J Gastroenterol. 2007 May 14;13(18):2636-8.\">15<\/a><\/p>\n<p style=\"text-align: justify\"><strong>\u201cReversible inflammatory and vacuolar myopathy with vitamin E deficiency in celiac disease.&#8221;<\/strong> This case report describes diagnosing celiac disease in a patient with neurological manifestations including myopathy, polyneuropathy, and ataxia. Laboratory investigations showed anti-gliadin antibodies and severe vitamin E deficiency. Muscle biopsy revealed inflammatory infiltrates and rimmed vacuoles, similar to those found in inclusion-body myositis.<\/p>\n<p style=\"text-align: justify\">A gluten-free diet and vitamin E supplementation reversed both the clinical neurological manifestations and the abnormalities in the muscle biopsy. Anti-gliadin antibodies were no longer present. \u201cThis case illustrates the spectrum of neurological complications of celiac disease and documents the occurrence of reversible pathology resembling inclusion-body myopathy in the muscle.\u201d<a href=\"#footnote_5_726\" id=\"identifier_29_726\" class=\"footnote-link footnote-identifier-link\" title=\"Kleopa KA, Kyriacou K, Zamba-Papanicolaou E, Kyriakides T. Reversible inflammatory and vacuolar myopathy with vitamin E deficiency in celiac disease. Muscle Nerve. 2005 Feb;31(2):260-5.\">5<\/a><\/p>\n<ol class=\"footnotes\"><li id=\"footnote_1_726\" class=\"footnote\">Gaskell H, Moore RA, Derry S, Stannard C. Oxycodone for neuropathic pain and fibromyalgia in adults. <em>Cochrane Database Syst Rev<\/em>. 2014 Jun 23;6:CD010692. doi: 10.1002\/14651858.CD010692.pub2.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_1_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_2_726\" class=\"footnote\">Hadjivassiliou M, Rao DG, Wharton SB, Sanders DS, Gr\u00fcnewald RA, Davies-Jones AG. Sensory ganglionopathy due to gluten sensitivity. <em>Neurology<\/em>. 2010 Sep 14;75(11):1003-8. doi: 10.1212\/WNL.0b013e3181f25ee0.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_2_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_5_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_11_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_23_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_3_726\" class=\"footnote\">Wills AJ. The neurology and neuropathology of celiac disease\u00a0<em>Neuropathology and Applied Neurobiology<\/em>. 2000:26:493-496.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_3_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_4_726\" class=\"footnote\">Chin RL, Sander HW, Brannigan TH, et al. Celiac neuropathy. <em>Neurology<\/em>. May 27, 2003;60(10):1581-5.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_4_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_7_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_26_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_5_726\" class=\"footnote\">Kleopa KA, Kyriacou K, Zamba-Papanicolaou E, Kyriakides T. Reversible inflammatory and vacuolar myopathy with vitamin E deficiency in celiac disease. <em>Muscle Nerve<\/em>. 2005 Feb;31(2):260-5.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_6_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_29_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_6_726\" class=\"footnote\">Luostarinen L, Himanen SL, Luostarinen M, Collin P, Pirttila T. Neuromuscular and sensory disturbances in patients with well treated coeliac disease. <em>Journal of Neurology, Neurosurgery, and Psychiatry<\/em>. Apr 2003;74(4):490-4.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_8_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_27_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_7_726\" class=\"footnote\">Thawani SP, Brannagan TH 3rd, Lebwohl B, Green PH, Ludvigsson JF. Risk of Neuropathy Among 28\u202f232 Patients With Biopsy-Verified Celiac Disease. <em>JAMA Neurol<\/em>. 2015 May 11. doi: 10.1001\/jamaneurol.2015.0475.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_9_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_20_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_8_726\" class=\"footnote\">Kaplan JG, Pack D, Horoupian D, DeSouza T, Brin M, Schaumburg H. Distal axonopathy associated with chronic gluten enteropathy: a treatable disorder. <em>Neurology.<\/em> Apr 1988;38(4)642-5.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_10_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_9_726\" class=\"footnote\">Caio G, Volta U1, Tovoli F, De Giorgio R. Effect of gluten free diet on immune response to gliadin in patients with non-celiac gluten sensitivity. <em>BMC Gastroenterol.<\/em> 2014 Feb 13;14:26. doi: 10.1186\/1471-230X-14-26.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_12_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_21_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_10_726\" class=\"footnote\">Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease.\u00a0<em>Clinical Science<\/em>. Apr 2001;100(4):379-86.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_13_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_11_726\" class=\"footnote\">Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.\u00a0<em>Journal of Gastroenterology and Hepatology<\/em>. 2003;18:479-91.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_14_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_15_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_16_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_17_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_18_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_19_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_12_726\" class=\"footnote\">Gaskell H, Moore RA, Derry S, Stannard C. Oxycodone for neuropathic pain and fibromyalgia in adults. <em>Cochrane Database Syst Rev.<\/em> 2014 Jun 23;6:CD010692. doi: 10.1002\/14651858.CD010692.pub2.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_22_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_13_726\" class=\"footnote\">Cicarelli G, Della Rocca G, Amboni M, Ciacci C, Mazzacca G, Filla A, Barone P. Clinical and neurological abnormalities in adult celiac disease. <i>Neurol Sci<\/i>. 2003 Dec;24(5):311-7.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_24_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_14_726\" class=\"footnote\">Kaplan JG, Pack D, Horoupian D, DeSouza T, Brin M, Schaumburg H. Distal axonopathy associated with chronic gluten enteropathy: a treatable disorder. <em>Neurology<\/em>. Apr 1988;38(4)642-5.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_25_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_15_726\" class=\"footnote\">Djuric Z, Kamenov B, Katic V. Celiac disease manifested by polyneuropathy and swollen ankles. <em>World J Gastroenterol.<\/em> 2007 May 14;13(18):2636-8.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_28_726\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><\/ol>","protected":false},"excerpt":{"rendered":"<p>What Is Peripheral Neuropathy? Peripheral neuropathy is a syndrome involving damage to one or more peripheral nerves characterized by impaired nerve transmission.\u00a0Peripheral nerves are nerves of the body outside the brain and spinal cord. Q: Why is nerve transmission impaired? A: Nerve transmission is impaired by inadequate nutrition needed for health, medications such as phenytoin, &#8230;<\/p>\n","protected":false},"author":29,"featured_media":8361,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[4,779,105,1682,119,208,49,127,107,143,122],"tags":[101,1074,1904,776,874,676,1914,1963,734,981,1905,1925,106,543],"class_list":["post-726","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-conditions-2","category-associated-disorder","category-folic-acid","category-malabsorption-disorders","category-omega-3-fatty-acids","category-peripheral-nerves","category-nervous-2","category-thiamin","category-vitamin-b12","category-niacin","category-pyridoxine","tag-associated-disorders","tag-burning-pain","tag-folic-acid","tag-health-conditions","tag-nervous-system-disorders","tag-numbness","tag-omega-3-fatty-acids","tag-peripheral-nerves","tag-peripheral-neuropathy","tag-vitamin-b1-thiamin","tag-vitamin-b12","tag-niacin","tag-vitamin-b6","tag-weakness"],"_links":{"self":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts\/726","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/users\/29"}],"replies":[{"embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/comments?post=726"}],"version-history":[{"count":28,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts\/726\/revisions"}],"predecessor-version":[{"id":14729,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts\/726\/revisions\/14729"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/media\/8361"}],"wp:attachment":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/media?parent=726"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/categories?post=726"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/tags?post=726"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}