Nottingham and Sheffield are less than 50 miles apart, but clearly patients are managed very differently in the two cities when it comes to searching for the neurological complications of coeliac disease or gluten sensitivity. Whilst the observational epidemiological arguments rage backwards and forwards, the proof that patients are benefited – or not – by a gluten free diet will only come from randomised trials. After all, observational epidemiology can get the wrong answer, for example with hormone replacement therapy and the risk of stroke. However, these trials will probably have to be done by neurologists who are much less certain of their position than those in Sheffield and Nottingham who have already made up their minds to treat or not to treat.
The proliferation of publications on the neurological manifestations of gluten sensitivity reflects a surge of interest in this fascinating group of immune-mediated diseases. Thorough knowledge of the
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