Muscle pain, poor bone health: perhaps it’s gluten sensitivity?

Gluten is a controversial area these days. Many people believe it is simply a fad and those that are following gluten free diets are doing so because it is fashionable. If we were to accept that gluten is a problematic food then this would turn upside down the food recommendations we have been educated on from an early age, and the food pyramid would be all but out of the window.

This article is going to look at the association between gluten sensitivity and how it can affect musculoskeletal health. Many people these days suffer with osteoporosis/osteopenia, muscle soreness, myositis (inflammation of the muscles) etc, yet very few people address dietary factors to help reduce symptoms. This article will review some of the research linking gluten sensitivity and musculoskeletal dysfunctions.

What is gluten and what is it in?

Gluten is protein found within specific grasses. The most common are:

• Wheat
• Rye
• Barley
• Spelt
• Couscous

Here is a list of the most common and hidden sources of gluten:

Science and Prevalence of Celiac Disease and Gluten Sensitivity

“Gluten sensitivity and celiac disease is not the same thing”, many people will say, “if you do not test positive for celiac you are fine to eat gluten”. This is simply not the case. Many of us have adverse reactions to gluten yet do not fall into categorisation of celiac disease. There are many immunological reactions to foods. Most commonly tested and widely accepted is IgE reactions: this is a test like the skin prick test where it looks for an immediate negative reaction. Other reactions include IgG, IgM and IgA reactions and there are a number of scientific articles validating these immune mediate reactions that lead on to inflammatory responses. Often these reactions can be delayed and the symptoms can be vast.

Typically the diagnosis of gluten sensitivity is an intestinal biopsy. Over time gluten containing foods wear away the villi on the intestinal wall and this can lead to common celiac symptoms of blood in stools, diarrhea, constipation and bloating, yet while this is the most common diagnostic tool it is not the whole picture. The British Medical Journal suggests:

Patients with coeliac disease may have the silent or atypical form (no gastrointestinal symptoms) and the condition may present itself outside of the intestines. ⁽¹⁾

The New England Journal of Medicine stated that “every time the disease is clinically diagnosed in an adult, that person has for decades had disease in a latent or silent stage”. ⁽²⁾ This means you do not just get celiac disease overnight but it has been having some physiological effect on your body for quite some time. The fact that gluten sensitivity is still regarded as a disease of the bowel is a historical misconception ⁽³⁾, with the celiac disease out of the intestine being more common that within the intestine ⁽⁴⁾.

Gluten and Bone Health

Celiac disease is so high in those with osteoporosis that The Journal of Archives and Internal Medicine and the British Medical Journal both suggest that everyone with osteoporosis should be tested or considered for gluten sensitivity. ^{(5, 6)} Research has shown dramatic improvements in bone mineral density after adopting a gluten free diet, probably due to the improvements in mineral absorption because of the improved health of the intestinal lining. ⁽⁷⁾

Gluten and Muscle Health

In patients over 50 the most common cause of muscle pain is Sporadic Inclusion Body Myositis, and in one paper looking at this found that 100% of them had antibodies associated to gluten. Our muscles are also surrounded by something called the endomysium, and within the muscle belly is the actin and myosin that are critical for contraction of the muscle. Gluten sensitivity can cause antibodies to the endomysium, actin and myosin which in turn can lead to muscle aches and pain. In many forms of muscle diseases/conditions a large number of people will have reactions to gluten containing foods, a simply gluten free diet for a period of time has the potential to reduce these symptoms and in some cases remove them completely. ⁽⁸⁾

If you suffer from chronic muscle pain, osteopenia or osteoporosis removing gluten could be a missing link for you to consider. You have nothing to lose by removing it from your diet, there is no physiological need for gluten containing foods, so long as you replace the gluten containing foods with healthy food choices I am sure a large majority of you will experience improved health and for those of you that need to may reduce your body fat levels as a side effect of the removal of gluten contain foods.

Practical Solutions for avoiding gluten:

1. The best way to see if gluten is affecting you is to remove it for 8-12 weeks. If you have completely removed it for 8-12 weeks then you can challenge yourself with some gluten foods and look for any adverse reactions over the following 3-5 days. If no reactions you may be able to cycle it back into your diet on occasions.
2. The majority of your carbohydrate intake should come from root vegetables, fruits and some gluten free grains such as brown rice, buckwheat and quinoa.
3. Eat foods that are from plants, not made in plants. If it was made in a plant, eg a processed food, the likelihood is it has some form of gluten containing food in it.

If you want to know more about how you can eat a diet that is tailored to your specific needs please contact Steve Grant. Steve works out of Central Health Physiotherapy’s Farringdon branch and is available for consultations. Feel free to ask any questions you might have!

Sources: 1. BMJ Volume 330 April 2005 2. New England Journal of Medicine Oct 23; pp167 3. J Neurol Neuro Psychiatry, 2002, 72;560-563 4. Gastroenterology Vol 126, No1, Jan 2004 5. Arch Intern Med Vol 165, Feb 28, 2005 6. BMJ Vol 319, 24th Jul, 1999 7. GUT, 2003; 52: pp1229 8. Dr Thomas O’Bryan, Unlocking the mystery of wheat and gluten sensitivity, presentation notes, June 2006