DEAR DR. ROACH: I am a 58-year-old female. About 10 years ago, I was diagnosed with Guillain-Barre syndrome after having flu symptoms. I had paralysis from my elbows to my fingers and from my knees to my feet. I was not diagnosed right away and did not receive any treatment. It took about three to four months to recover. I have since had a small amount of tingling or numbness in my toes and fingers. I have no energy, and I push myself to get up and go to work every day.

Recently I seem to be having some memory problems and dropping a lot of things, and have stumbled for no reason. I cannot explain my fatigue. Could my symptoms be an effect of the GB, or could there be another problem? Also, is there any relation between GB and other autoimmune disorders? — D.C.

ANSWER: Guillain-Barre syndrome causes muscle weakness. It usually starts in the legs, then progresses to the arms and face. Sometimes the respiratory muscles are involved, requiring a ventilator for artificial breathing. GBS often occurs after a viral illness, like influenza. The symptoms progress over two to eight weeks. Only 60 percent of people have a full recovery after one year, and up to 10 percent will have relapses of muscle weakness.

Because there are several subtypes of GBS, it certainly is possible that your continued numbness and tingling are part of the lingering effects of your illness. While the weakness you describe could plausibly be a relapse, I don’t think the memory problems are likely to be due to the GBS.

GBS certainly has an autoimmune component, and so other autoimmune diseases are more common. Fatigue and memory problems often occur with hypothyroidism, another autoimmune disease, but those symptoms are not specific.

DEAR DR. ROACH: My wife is always cold, and she has to wear thermal tops under her blouse if we go out to eat, or if we go to the movies, she also wears a hooded jacket. It seems that the cold comes from inside out, and after a while, she just gets numb. Our doctor has taken blood, and on the last test she had, her TSH and T4 were in the normal range. Are there some other tests she should take? — W.R.

ANSWER: There is an uncommon form of hypothyroidism in which only the T3 level is low. T3 is the active form of thyroid hormone.

Intolerance of cold also can come from anemia or just iron deficiency without anemia. Low cortisol levels is another uncommon cause.

However, some people are just always cold, without identifiable medical problems.

DEAR DR. ROACH: I have irritable bowel syndrome, and my colon typically goes “90 miles an hour.” I have been eating more walnuts. Since walnuts slow down your digestion, is it possible that they have helped my IBS? I am tolerating this diet extremely well. — A.F.

ANSWER: Irritable bowel is a condition with very diverse symptoms. It can be most prominently diarrhea, constipation or, in some people, it can alternate. It makes sense, then, that different foods have contradictory effects in one person versus another.

Nuts do tend to slow down the digestive tract. The healthy fat they contain slows down stomach emptying. So they are more likely to be helpful in people with IBS with mainly diarrheal symptoms. Conversely, they can worsen symptoms of constipation.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from

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