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PRACTICE: Jocelyn Anne Silvester and Mohsin Rashid Coeliac disease and a gluten-free diet BMJ 2009; 338: b380 [Full text]

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Migraine Amelioration on Gluten-Free Diet

Timothy J. Frohlick   (22 February 2009)

Need for non-invasive diagnosis

Pat Hoddinott   (2 March 2009)

Migraine Amelioration on Gluten-Free Diet 22 February 2009
Timothy J. Frohlick, Physician Associate, Retired Lovelace Urgent Care Clinic 87112 Send response to journal: Re: Migraine Amelioration on Gluten-Free Diet	My first manifestations of gliadin allergy were malodorous stools and most recently dermatitis herpetiformis twelve years ago. Interestly, I developed diarrhea as a final presentation at the age of fifty. It is noted that I began having migraine headaches in my late 30s with no other obvious symptoms. Now that I follow a gluten-free diet assiduously, I am not bothered by migraine headaches other than infrequent auras and occasional scotomatae that do not progress to full blown migraines. I do not have diarrhea unless a medication or food has surreptitious gluten included. The dermatitis herpetiformis is much reduced and I do not use any chemoprophylactic Dapsone to lessen it. At its worst the celiac disease included pellagra-like patches and skin thickening on the soles of my feet. This has totally abated and I only have mild psoriatic patches that I treat with oral turmeric and turmeric poultices. To know Celiac Disease is to know medicine, Respectfully, Timothy J. Frohlick, Physician Associate,Capt.ret.USAF Competing interests: None declared
Need for non-invasive diagnosis 2 March 2009
Pat Hoddinott, Senior clinical research fellow and general practitioner Public Health Nutrition Research Group, University of Aberdeen, AB25 2ZP Send response to journal: Re: Need for non-invasive diagnosis	My personal story of self diagnosed gluten intolerance is very similar to that of Jocelyn Anne Silvester - if you omit the barium investigations and substitute cholecystectomy (probably unnecessary). I had a positive family history of presentation in mid 40's, a negative endomysial antibody test and after several deliberate and inadvertent gluten challenges I decided not to proceed with a biopsy as I did not want to suffer needlessly for a test which would adhere to the guidelines, but would not alter my management. I too would have needed to take time off work if I had resumed a gluten diet. Fortunately, I had a specialist who supported me in this decision. As a GP, I am identifying more cases than previously and more patients are presenting with self diagnosis. However I feel a hypocrite when I reiterate the current recommendation - to remain on a normal diet until biopsy - knowing that this often entails weeks of unnecessary suffering and that I did not follow this recommendation myself. Is it not time for more consideration to be given to non-invasive methods of prompt diagnosis? Competing interests: I have self diagnosed gluten intolerance