The list of symptoms related to celiac disease covers the entire body. While gastrointestinal symptoms are often at the forefront, the nervous system can also be affected by the disease.

But many patients with neurological symptoms and their doctors don’t make the connection.

“There is a lack of general awareness of the neurological manifestations of celiac disease among patients as well as physicians,” explains Norman Latov, M.D., Ph.D., a professor of neurology and neuroscience and the director of the Peripheral Neuropathy Clinical and Research Center at Weill Cornell Medical College.

“Adult patients often present with neurologic symptoms in the absence of gastrointestinal symptoms, so celiac disease may not come to mind,” according to Latov, who has a clinical and research interest in peripheral neuropathy and has done celiac disease research.

Small fiber neuropathy is the common symptom involving the nervous system. “It typically presents with numbness, tingling or painful burning, stinging or electric-shock like sensations, usually in the arms or legs, but sometimes [in] the torso or face,” Latov says. Small fiber neuropathy can also cause dizziness or feeling faint when standing up, sexual dysfunction, abnormal sweating, bladder symptoms, hair loss or skin changes.

General lack of familiarity with small fiber neuropathy complicates the picture for patients with undiagnosed celiac disease. Their symptoms are often dismissed or misdiagnosed as fibromyalgia, so the association with celiac disease may be missed, according to Latov.

And small fiber neuropathy is only one of the neurological symptoms of celiac disease. “Less-common neurological conditions include cerebellar ataxia with unsteadiness or incoordination, seizures or neuropsychiatric disorders,” he says. Headaches are another potential symptom, but their prevalence adds a layer of complexity when it comes to diagnosis. “Headaches are common in the general population, however, so that it’s difficult to know whether gluten is the cause or only an aggravating factor,” Latov says.

The presence of neurological symptoms raises questions about whether there is a connection between the brain and the gut.

“As in the gut, the neurological manifestations are also thought to also be due to inflammation,” Latov notes. Currently there are two theories on why neurological symptoms develop. In both, Latov says, “stimulation of the immune system by gluten in the diet would increase the inflammation in both the gut and nervous system.”

The good news is neurologists are beginning to become more aware of this brain-gut connection. “It is improving but very slowly,” Latov says, noting education of both patients and doctors is important. “Perhaps with greater awareness, neurologists will play a larger role in the diagnosis of celiac disease.”

—Susan Cohen

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