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Bill Elkus stated in a recent communication:

>Some Celiac support groups warn that there is no established minimum
>level of gluten ingestion without damage.....

I think that although it isn't possible to find a clear statement to the
effect that there is a minimum level of gluten ingestion that will not cause
damage, I will put forward for the sake of argument that such a level has
been established by the studies of Holmes et al. (Malignancy in coeliac
disease--effect of a gluten-free diet, Gut 30:333-338, 1989).  In their
paper, Holmes et al. report that people (celiac patients) eating a diet
containing gluten had higher levels of lymphoma and some other cancers than
the population in general.  They also report that for patients consuming a
strict gluten-free diet for more than five years, there was no significant
increase in overall cancer risk.  What Holmes et al. do not say is that the
108 patients in their group on a strict gluten-free diet were probably
regularly consuming wheat starch products--because at the time their study
was carried out, such products were (perhaps still are in the UK) considered
acceptable in a strict gluten-free diet.  I think this is a reasonable
assumption although, of course, I cannot prove that the patients in the
gluten-free group of Holmes et al. were eating wheat starch products.

Commercial wheat starches almost certainly contain gliadin, which is part of
the gluten, although it is extremely difficult to put a number on how much
gluten they contain because of analytical problems.  I will make a very
rough estimate that a person eating 100 grams of wheat starch per day would
have a gliadin (gluten) intake of 10-50 mg per day depending on how well the
starch preparation had been washed.  Now this is a very small amount of
gluten.  Nevertheless, I interpret the results of Holmes et al., if they are
accepted as definitive, as indicating that there is a minimum amount of
gliadin intake that causes no harm for celiac patients.

Counter arguments and criticism of my logic as presented above will be
welcomed.

Don Kasarda, Albany, CA