Part 3 Of 12 Part Series: Sensory Symptoms (Vision, Hearing, Taste, Smell, and Touch) In Undiagnosed Celiac Disease.
This is the third in a series of posts discussing the variety of symptoms that can be caused by undiagnosed Celiac Disease (CD). In this post, five sensory symptoms (vision, hearing, taste, smell, and touch) will be discussed. In many with undiagnosed CD, the intestinal villi, responsible for absorbing nutrients, becomes damaged, creating a flattened mucosal surface (villous flattening) that is less able to absorb nutrients. Autoimmune reactions to ingested gluten cross-react with intestinal villi and create this damage. Various nutrient deficiencies can occur and this, along with inflammation and other autoimmune factors, can lead to various sensory symptoms (8,71,72,74).
Vision Symptoms
Functional vision is reliant on a healthy nervous system, vascular system, muscular system and structural eye integrity. Since these systems are dependent on nutrients, it is thought that vision loss may result from nutrient deficiencies that cause pathological changes in these systems. Multiple nutrient deficiencies can exist in CD and theoretically this along with autoimmune factors may cause a variety of symptoms. Vitamin A deficiency is well researched and can be common in CD. A deficiency is thought to be primarily responsible for many of the pathological changes that can occur to the conjunctiva, cornea, and retina. Some of the symptoms may only occur if the deficiency is chronic, this is probable in CD since misdiagnosis can occur for years (1,2,3,4,8,72,75).
Visual symptoms may include difficulty seeing in a dimly lit room, night blindness, conjunctival xerosis (dryness of the eye), corneal xerosis (cornea rough, dry, and hazy), keratoconjunctivitis sicca (dry cornea & conjunctiva), bitot’s spots (pearly foamy patch on conjunctiva and cornea), keratomalacia (corneal necrosis, corneal ulceration), corneal scar, formation of corneal opacity (cornea white or clouded over), xerophthalmia (dry and inflamed eye), xerophthalmic fundus (white or grey linear or oval opacities in the retina), blindness, conjunctivitis with corneal vascularization and lens opacity, blepharitis (inflammation of the eyelids), styes, and eye infections. As well, red (bloodshot) eyes or central retinal vein occlusion may occur if coagulation problems exist (1,3,4,76,78,87).
Optic neuropathy is another complication that could arise from nutritional deficiencies. Symptoms usually present symmetrically and simultaneously, and are not painful. One eye may have visual symptoms prior to the other, but symptoms in the other should follow. Dyschromatopsia (defect in color vision) may be the first symptom. Colors (one or more) may not seem as bright and vivid as they were previously. Foggy, cloudy, or blurred vision may occur and may be more prevalent at the point of fixation. Vision may deteriorate rapidy. Centrocecal or central scrotomas (blind spots) may also occur (2).
Vision symptoms resulting from muscular problems could occur. Ocular myopathy in a 12 year old girl with CD has been documented. The ocular myopathy corrected itself with a gluten-free diet and vitamin supplementation (86). In theory, extraocular palsy and nystagmus could also occur due to a thiamine deficiency causing a central nervous system lesion (2).
There may also be a correlation between CD, macular degeneration and cataracts since these conditions tend to improve with supplementation of nutrients, such as vitamins A, C, E, zinc, lutein, zeaxanthin, and omega #3 (when they are given collectively) (6,77). Perhaps individuals who show improvement with supplementation suffer from malabsorption issues with CD. More research is needed.
Nutrient deficiencies contributing to the above symptoms can include vitamin A, B complex, C, E, K, zinc, copper, iron, taurine, and essential amino and fatty acids (1,2,3,4,5,7). More research is needed to specifically identify which nutrients are directly involved in each visual symptom and to investigate how common each symptom is in CD.
My visual symptoms included night blindness, blurred vision, bitot’s spots, flashes of light, occasional partial loss of vision (I was told this was likely due to ocular migraines), and periodically it appeared as if a cloud of fog was in the room. I also suffered occasionally from styes, and dry eyelids. I used prescription glasses in University to see the blackboard and to drive. I have perfect vision now and do not require glasses. My mother, also with CD, has some visual impairment and wears glasses.
Auditory (Hearing) Symptoms
Functional hearing is reliant on a healthy nervous system, vascular system, and skeletal system. Since these systems are dependent on nutrients, it is theorized that hearing loss may result from nutrient deficiencies that cause pathological changes in these systems (9-14). Multiple nutrient deficiencies can exist in CD and theoretically this may cause a variety of symptoms.
In humans and animals with nutritional deficiencies many types of auditory dysfunction has occurred (14,17). Auditory symptoms associated with possible malabsorption in CD could include tinnitis or ringing in the ears (14,15,23), auditory hallucinations (14,16), middle ear infections, loss of hearing, dizziness, and other hearing impairments (14).
In human studies, vitamin A (3,4), B-12 (14,18-21,60), folate (14,22-26,60), vitamin D (14,27-33), calcium (34,35), and iron (7,36,37) deficiency is associated with an alteration in hearing (14). In animal studies vitamin B-12 (39), thiamine (40), riboflavin (40), vitamin B-6 (40-44), vitamin A (40), vitamin C (40,45), vitamin D (40,46-48), vitamin E (40,49), copper (50), iron (38,51-54), magnesium (55-58), and zinc (59) deficiencies have had various effects on hearing (14).
I had intermittent tinnitis, and at times it felt like my hearing abilities would decline for a few minutes (sometimes up to a half hour), then return.
Olfactory (Smell) And Gustatory (Taste) Symptoms
It is thought that nutrients are important for gustatory and olfactory function since the epithelial cells in these areas have high metabolic needs. More research is needed to identify specific nutrient requirements. Vitamin A (63,64,65), thiamine (3,4,14,62), riboflavin (63), pantothenic acid (63), pyridoxine (63), niacin (63), cobalamin (14,62), folic acid (63), vitamin E (63,79), copper (63,67,79) iodine (63,68), iron (63,78), zinc (63,66), and nickel (66) deficiencies have been identified as possible contributing factors to smell and taste impairments (63). Since all of these nutrients can be deficient in CD, taste and smell impairments may be possible.
Theoretically, CD olfactory (smell) symptoms could include anosmia (unable to smell), hyposmia (decreased detection of odours), dysosmia (incorrect identification of odours), parosmia (perception of smell is altered), phantosmia (false odour detected), agnosia (can smell, but difficulty in identifying odour). Taste symptoms affecting the 5 tastes (salty, sweet, bitter, sour, and umami) could include ageusia (unable to taste), hypogeusia (decreased taste function), or dysgeusia (taste function is distorted/altered). If gustatory and olfactory senses are impaired, then appetite may be decreased leading to further malnutrition (66). Other symptoms may include lesions in the oral mucosa (esp. dorsal tongue), dry nose and mouth, papillary atrophy and degeneration of the tongue, atrophic glossitis, or pica cravings (63).
I found that I couldn’t smell as well as others. I often had a strange taste in my mouth (like metallic tin) and a bad breath taste that I couldn’t get rid of with mouthwash. Occasionally, I would experience phantosmia. Once eating gluten-free, these symptoms disappeared.
Touch Symptoms
Peripheral neuropathy can be the only symptom in CD and can occur without bowel symptoms or weight loss (70). Symptoms can include burning, tingling, numbness, or a loss of feeling in the hands and feet. These sensations can spread to the arms, legs, face, and body. Pain may also occur and may feel like an electric shock. Some feel an increased sensitivity to touch (70,80,81). As well, many other neurological symptoms can occur with CD. These additional symptoms will be discussed under the post about neurological symptoms.
Nutrient deficiencies contributing to peripheral neuropathy can include vitamins E, B complex, amino and fatty acids, calcium, magnesium, phosphorus, copper, electrolytes, and inositrol. Malabsorption of these nutrients in CD can lead to these symptoms (3,4,79,81,82).
I had intermittent tingling, numbness, vibrations, cold and burning feelings, and pain in my head, face, arms, and legs. I also had carpal tunnel for awhile and had to wear a brace. My daughter had tingling and numbness in her feet. These symptoms have disappeared now.
Other Influencing Factors
Other factors that may contribute to sensory symptoms are diabetes (diabetic retinopathy and neuropathy), certain medications, occupational exposures, smoking, diet, past eye surgery, age, low or high blood pressure, increased homocysteine levels, upper respiratory infections, trauma, infections, alcoholism, certain medications, candiasis, gingivitis, genetic differences, and brain surgery. The presence of other autoimmune diseases or conditions, such as scleroderma, downs syndrome, alzheimer’s disease, huntington’s disease, multiple sclerosis, parkinson’s dementias, idiopathic parkinson’s disease, complex of guam, epilepsy, age, muti-infarct dementia, schizophrenia, tumors, lupus, crohn’s disease, kidney disease, liver disease, or hypothyroidism can add to the symptoms (1,2,8,10,14,61,62,63,80,81).
Do You Have Any Of The Above Symptoms?
Many individuals with undiagnosed CD will have no bowel symptoms (3,4). Weight loss may or may not occur, and is dependent on the amount of the intestine that is damaged (72,75,83). Therefore, the symptoms in this post could occur in the absence of weight loss or bowel symptoms.
The presence of sensory symptoms as discussed in this post, indicates that you should talk to your MD about tests for CD and tests to rule out other possible causes of your symptoms. Testing for CD is important because undiagnosed CD increases the risk of developing other autoimmune diseases, lymphomas (skin, brain, lymph nodes, intestine), cancers (thyroid, esophageal, mouth, tongue, pharynx, tonsil, and small intestine), allergies, complications from malabsorption issues, possible decreased immune response to other illnesses (8,72,75,84,85), and many other health complications that will be discussed in the posts about CD symptoms. It is my hope that if you have sensory symptoms, you can print out this post complete with medical references to take with you to the MD when you request a CD test. Highlight or underline the sections that apply to your symptoms. I’ll be posting a simplified summary and checklist in the 12th post.
I recommend waiting until CD testing is complete before initiating a gluten-free diet because it may create a false negative. Discuss this with your MD or specialist. USE CAUTION WITH SUPPLEMENTS. Toxicities can occur with over supplementation and this can lead to permanent damage. Consult your MD, Registered Dietitian, or other medical specialists involved in your care to determine which nutrients should be supplemented and to identify appropriate dosages for you. Review your symptoms and everything in this post with a Medical Doctor and your specialists before you make any changes. Your MD knows your medical history and the treatments that are appropriate for you.
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