Keith Roach, M.D., syndicated columnist

DEAR DR. ROACH: I was diagnosed with small fiber neuropathy in my feet about 10 years ago. After blood tests and urinalysis, the doctors couldn’t find a cause for it, so I was prescribed gabapentin.

I also take alpha-lipoic acid daily. About two years ago, I was diagnosed with celiac disease, which was a total surprise because I never had any symptoms.

My neurologist at the time said that celiac disease could possibly be a cause of the neuropathy. What are your thoughts on this, and if I was to go gluten-free, how long would it take to start seeing effects, if at all? — J.B.

ANSWER: Celiac disease is caused by a sensitivity to components of gluten, found in most cereal grains. While most people with celiac disease will have gastrointestinal symptoms, especially diarrhea and weight loss, others have no gastrointestinal symptoms. It is well-described that people with celiac disease may experience neuropathy.

Up to 50% of people with celiac disease may have these symptoms, especially burning, tingling or numbness in the feet.

Doctors know to think of diabetes as a cause of these symptoms, but we sometimes forget that celiac disease can have these symptoms, without any gastrointestinal symptoms, or with very mild symptoms such as abdominal discomfort after eating.

Patients and physicians alike may incorrectly think of these as reflux symptoms of functional stomach pain.

A gluten-free diet has been shown to improve other neurological and psychiatric symptoms of celiac disease, such as headache and depression.

But, unfortunately, once small nerves are damaged, they usually do not get better despite a completely gluten-free diet.

So, symptomatic treatment of the kind you are taking remains the only effective one.

I am publishing your letter because there are many people with undiagnosed celiac disease, and newer blood tests for celiac disease, such as transglutaminase-immunoglobulin-A (tTG-IgA) and endomysial-immunoglobulin-A (EMA-IgA) antibody tests, are easy to get.

People with relatives who have celiac disease, those with autoimmune thyroid disease, and those with Type 1 diabetes are at a particularly high risk.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.