In my previous practice as an emergency room doctor, I saw numerous people with back pain. It was often due to a traumatic injury related to lifting, a fall or a car accident. However, sometimes we could not pinpoint exactly why someone was suffering. We evaluated and treated the back pain, even when the true cause could not be identified.
Fast forward 10 years to my current integrative medicine practice. Many of my patients have celiac disease or gluten sensitivity. As they tell me their medical history, many recount back pain so severe it required MRI’s, medication and therapy. Some had mysterious pain that no one could explain. In many cases, the back pain in these patients simply resolved with a gluten-free diet. I often wonder how many of them made trips to their practitioner for back pain and were given a variety of treatments that did not address that root cause.
Clearly most back pain is not attributable to gluten; there are far more common reasons to experience it.* But I think the connection between back pain and celiac disease is worthy of discussion. For most health care practitioners back pain would not evoke any thought of celiac disease or gluten sensitivity.
Do people with celiac disease experience more back pain?
There is scant information in the medical literature on the relationship between low back pain and celiac disease, but what is available is worthy of mention. In a 2010 study evaluating back pain and sacroiliitis (inflammation in the joints around the tailbone), 70% of adult celiac patients were found to have changes or involvement of the sacroiliac joints. All of these people were on a gluten-free diet and had no gastrointestinal symptoms, yet these changes were still seen.
There are a few other case reports on celiac patients with osteopenia or osteoporosis who had back pain as their initial presenting symptom of celiac disease. Beyond that, there is very little information to say what the incidence of low back pain is in celiac disease prior to or after diagnosis. Anecdotally, I do see low back pain as a manifestation of celiac disease and it commonly resolves after diagnosis and initiation of a gluten-free diet. It also frequently recurs if gluten is ingested.
Why would people with celiac disease experience back pain?
Celiac disease is an autoimmune condition, so it is possible there is some autoimmune reaction involved in the creation of low back pain. Or, perhaps generalized inflammation is at the root of the symptoms. Whatever the mechanism, the one study cited earlier suggests there is some inflammatory process at work in the spine of a large majority of patients with celiac disease.
Does it resolve on a gluten-free diet?
Symptomatic relief or improvement often occurs with initiation of a gluten-free diet. Of course, there may be other reasons contributing to the back pain that will not be affected by initiating a gluten-free diet. A 2014 Case report discusses a case of chronic low back pain that is unresolved with traditional therapy. Once an integrative medical approach is taken, the back pain resolved. A gluten-free diet was one component of the treatment and the patient was not evaluated for celiac disease prior to initiating the diet but the case is interesting none the less. It emphasizes the importance of thinking outside of the box when traditional treatments do not relieve chronic low back pain.
What if it doesn’t completely resolve on a gluten-free diet?
If back pain was one of your symptoms related to your celiac disease and it recurs, it is important to consider gluten exposure as a cause. If the pain did not lessen or completely resolve after instituting a gluten-free diet, further evaluation for additional causes should be undertaken.
Should everyone with low back pain be evaluated for celiac disease?
No. As mentioned before, there are far more common reasons for experiencing low back pain. However, my hope is that in the evaluation of patients whose back pain has no clear cause, that celiac disease is considered. This is especially true if the remainder of the clinical picture is suggestive of celiac disease. I have seen back pain as the only outward symptom of celiac disease in some patients. One must cast a wide net when considering symptoms related to celiac disease because it is associated with approximately 300 symptoms, many of them subtle and seemingly unrelated.
What about non-celiac gluten sensitivity and back pain?
Due to the rapidly evolving research on other gluten and wheat related disorders I hope we will have more information on this correlation in the near future. In my practice, I have seen a relationship between gluten sensitivity and back pain, but until the causes of gluten and wheat sensitivity are clearly delineated this will be challenging to prove at a scientific level. If you are experiencing back pain, have been tested for celiac disease and are consuming gluten, a trial of a gluten-free diet may be warranted. Please assure you have been appropriately tested for celiac disease before eliminating gluten.
* Common reasons for low back pain
– Lumbosacral strain: strain or injury to the muscles of the lower back
– Herniated disc or degenerative disc
– Spondylolisthesis: abnormal minor shift of the bones of the spine, which can occur with aging
– Autoimmune conditions such as rheumatoid arthritis or ankylosing spondylitis
– Hormonal fluctuations: i.e. premenstrual symptoms
THIS ARTICLE IS COPYRIGHTED BY AMY BURKHART, MD, RD.
Past columns by Dr. Burkhart:
November 2015: Cold Sores, Canker Sores and Gluten
July/August 2015: A New Home Test To Monitor Gluten Exposure
February/March/April 2015: Arsenic in the Gluten-Free Diet: Facts and Tips
December 2014/ January 2015: The Microbiome and Celiac Disease: A Bacterial Connection
October 2014: Should You Trust Gluten-Free Labels?
September 2014: Triggers for celiac disease: One possible answer
July/August 2014: Ten Tips for a Healthier Gluten-Free Diet
June 2014: Back Pain and Gluten
April 2014: Update on Restaurants and Gluten-Free Dining
January 2014: Four Vitamin Toxicities on a Gluten-Free Diet
December 2013: Move Over Gluten-Free, Low FODMAP is Next
November 2013: SIBO, Gluten and IBS: What Is The Connection?
September 2013: Is gluten really the culprit in gluten sensitivity?
August 2013: Clarifying the Gluten-Free Labeling Rule
June/July 2013: No such thing as Mild Celiac Disease
May 2013: Magnesium Deficiency
March 2013: Why am I having migraines?
February 2013: What is fructose malabsorption?
January 2013: Educating doctors about celiac disease
December 2012: Are supplements to digest gluten safe and useful?
Photo by www.michaelandersongallery.com
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