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On March 1, Jim Lyles asked:

>How much gluten is acceptable? I believe the goal should
be NONE.<

On Jan. 31 Don Kasarda reported on a published study:

>  There was no evidence of small intestinal mucosal damage in
>our patients with coeliac disease, who had been on wheat
>starch-containing gluten free products for a mean of 14
>years and for 10 years after the diagnosis was confirmed."
>... Daily gliadin intake was considered to be
>between 4 and 8 milligrams.

In deciding how much if any gluten to let into the diet, it's
important to distinguish between cancer or cancer-like long term
outcomes that depend on cumulative "dose" and the more immediate
overt damage to the intestines and effects on nutrition.

The former are probabilistic by their nature. (Most of us
don't get such celiac specific cancers.) Unless and until
someone either finds a repair mechanism for such latent cancer
or measures its consquence, a more reduced probability of getting
cancer at lower gluten intake, the simplest model consistent with
the data is that the risk of cancer is exactly linear in
the cumulative amount of gluten eaten. For this, Jim
Lyles is right in a sense then when he said

>If it is only a small amount of gluten, then there is only a small
amount of damage...<: just reinterpret that as a smaller probability
of getting cancer (or whatever other long term effects are found)
if you eat less gluten.

I suspect the risks of such cancers at least are small if we're
at all careful on the gluten intake. Does anyone know the
incidence rate found in that study? Was it more like 1%, 10%,
or 100% of the rate for getting not lymphoma, but all other cancers?

For the more overt gluten damage to the intestines and impaired
nutritional uptake, apparent repair is known to occur - we
all experienced this in the first year or so after going on a
gluten free diet. This certainly suggests as Don Kasarda
implies that there may be some low level of gluten eaten safely. In
this  stable long term state the new gluten damages the intestinal
villi at the same rate as others are repaired. In saying this,
be careful: the study cited followed only 11 patients; wheat
starch was the only gluten involved; like all "no effects" there's a
+\- about that "zero" that really gives you an upper bound on effects;
was there any nutritional comparison made to a control group?

In any case, how does that estimated daily amount of gliadin (4-8 mg.)
compare to some common gluten containing food portions we might
eat? "Lists of ingredients", etc. are of no use.  In fact a
list of such foods or food ingredients with approximate
gliadin content would be helpful to us all as we wrestle
with how much attention to pay to every last ingredient on
a label.

       Kemp Randolph
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