Abstracts & Literature Review 3

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Improvement in Chronic Muscle Fasciculations With Dietary Change: A Suspected Case of Gluten Neuropathy

Brian Anderson DC, CCN, MPH, Adam Pitsinger DC
Journal of Chiropractic Medicine (2014) 13, 188–191

JACO Editorial Reviewer: Keith R. Kamrath, DC, FACO

Published:

Journal of the Academy of Chiropractic Orthopedists
June 2015, Volume 12, Issue 2

The original article copyright belongs to the original publisher. This review is available from: http://www.dcorthoacademy.org ©2015 Kamrath and the Academy of Chiropractic Orthopedists. This is an Open Access article which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Author’s Abstract:

Objective: The purpose of this case report is to describe a patient with chronic, multisite muscle fasciculations who presented to a chiropractic teaching clinic and was treated with dietary modifications.

Clinical features: A 28-year-old man had muscle fasciculations of 2 years. The fasciculations began in his eye and progressed to the lips and lower extremities. In addition, he had gastrointestinal distress and fatigue. The patient was previously diagnosed as having wheat allergy at the age of 24 but was not compliant with a glutenfree diet at that time. Food sensitivity testing revealed immunoglobulin G–based sensitivity to multiple foods, including many different grains and dairy products. The working diagnosis was gluten neuropathy.

Intervention and outcome: Within 6 months of complying with dietary restrictions based on the sensitivity testing, the patient’s muscle fasciculations completely resolved. The other complaints of brain fog, fatigue, and gastrointestinal distress also improved.

Conclusions: This report describes improvement in chronic, widespread muscle fasciculations and various other systemic symptoms with dietary changes. There is strong suspicion that this case represents one of gluten neuropathy, although testing for celiac disease specifically was not performed.

JACO Editorial Summary

  • The article was written by authors at the National University of Health Sciences, Lombard, IL and in Private Practice, Polaris OH.
  • The article is a case report of a 28- year-old man with widespread constant muscle fasciculations of 2 years duration that presented at a chiropractic teaching clinic. The patient also reported a constant “buzzing” or “crawling” feeling in his legs.
  • The authors described 3 known types of adverse reaction to wheat proteins: wheat allergy (WA), gluten sensitivity (GS), and celiac disease (CD).
  • CD presents with autoimmune reactivity, generation of antibodies, and damage to the intestinal mucosa. WA involves the release of histamine and becomes symptomatic within a few hours after intake of wheat products. GS is considered a diagnosis of exclusion and does not have a standard definition for diagnosis.
  • Treatment for all 3 types of wheat protein reactivity is the same: Gluten Free Diet. The patient’s symptoms resolved within 6 months of strict adherence to a gluten free diet. The authors gave no mention of any other chiropractic treatment.
  • The prevalence of WA ranges from 0.4-9% of the population. GS ranges from 0.55-10% of the population. CD has an overall prevalence of 0.71%.
  • The most common neurologic manifestations include: ataxia, peripheral neuropathy, myopathy, headaches, paresthesia, hyporeflexia, weakness, and reduced vibratory sensation.

Summary

This patient presented with an unusual set of symptoms that might lead the clinician to suspect a nutritional/chemical component. However, chiropractors commonly treat conditions, such as headaches and paresthesia, and may incorrectly assume a biomechanical cause of these symptoms. Nutritional and chemical sensitivities should always be considered.

It appears that the authors did not employ chiropractic spinal manipulation in this case. Since the symptoms presented in focal anatomical areas, there may be some indication that chiropractic spinal manipulation may have improved the outcome. Perhaps the chemical effects of wheat protein sensitivity are facilitated or exacerbated by suboptimal nerve function.