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Some comments from Don Kasarda (Albany, CA) on continuing discussion
about whether or not small, perhaps trace, amounts of gliadin are harmful
to celiac patients.

First of all, I thank Jim Lyles and Peter Hyatt for their thoughtful,
well balanced statements.  There is much key information we don't have
yet and even professionals differ in their opinions.  I have no problem
at all with people making informed decisions about what they are willing
to risk or not risk in the way of foods.  I certainly would not encourage
anyone to cheat on the diet, but when it comes to malt flavoring and
wheat starch and white vinegar, I think there is room for a decision to
risk it, at least once in a while.

Just as an example, let us consider the cancer question.  The studies
carried out in England indicated an increased risk of lymphoma (small in
absolute terms, but nevertheless a significant rise over background) in
celiac patients who do not follow a gluten-free diet or who cheat
regularly.  In the control group, on a strict gluten-free diet there was
no increased risk.  Yet, because, during the period of this study, wheat
starch was considered an allowable part of the celiac patient's diet in
England, the control group on a strict gluten-free diet was very likely
eating one-to-ten milligrams of gliadin per day.  This study involved
hundeds of patients.  I wrote some time ago to Dr. Holmes (the senior
author of the study) asking him if he agreed with my analysis.
Unfortunately, he hasn't replied.  But I would be interested to hear
comments from those in England familiar with the recommended diet in the
1970's and 1980's.

There is a seemingly good study carried out in Switzerland showing that
ingestion of wheat starch over a period of years was not harmful in the
small group (12) of patients studied.  There may well be people with
higher sensitivities who just didn't end up in the experimental group.
The amount of gliadin (strictly speaking, hordein peptides) that might
end up in barley malt flavoring is small, and not likely to be more risky
than eating wheat starch.  Personally, I think the attitude in the UK
towards foods is the more realistic one and that the US attitude is too
extreme, but that is obviously an opinion.  Anyway, from my analysis of
the literature, if you decide to eat Rice Krispies, or MacDonald's french
fries, or white vinegar, you are on about as firm ground as the people
who choose not to.  The solid information just isn't there in my opinion.
I know some physicians will take issue--they tend to follow the old
adage, "Give 'em an inch and they'l take a mile, " and probably figure
you will be putting croutons on your salads before long if they don't
scare you thoroughly.  As usual, each person must make his or her own
decision.  I would just like to have that decision made in as informed an
atmosphere as possible.

Finally, just to roil the waters even more, the latest studies of oats
(by Irish and Finnish groups) seem to be coming up non-toxic!  The
results have not been published yet, but from what I have been told, they
seem to have been carefully done.  So the scorecard on oats is:  one
seemingly good study (although no biopsies) says toxic, and two other
seemingly good studies (that included biopsies) say non-toxic.  (This
doesn't include the Finnish study about which I have no experimental
details.)