<<Disclaimer: Verify this information before applying it to your situation.>>

I've changed the name of this thread:  it's the fear of cancer that forces
many celiacs and their oft undiagnosed gluten allergic cousins to insist
on an absolutely gluten free diet for all who are sensitive to gluten.
That leads to commercial companies signing off on GF lists, as Kraft has
done. We can safely have some variety in our diets with the right
attitude.

I'm not denying that some among us react immediately to small amounts of
apparent gluten.  Regardless of what's said below, if it bothers you don't
eat it.  But I know of no evidence that immediate reactions  like
vomiting, nausea,  diarrhea etc,  in someone with a healed intestine go
through the damaging steps of celiac intestinal enteropathy.  I think of
these reponses as "sneezing by the gut", that is due to the massive
histamine release of a Type I hypersensitivity reaction mediated by IgE.
Some of us may be just celiacs, some gluten allergic, and some both.

Furthermore, I'm not advocating eating any gluten regularly. Stay tuned,
please.

Cancer is very real for all of us: many, just as  Ron and I, have had
cases in our immediate family. In the following I'll speak instead of the
"risk of cancer" as a probability percentage. This will be either in
absolute terms (10% of the celiacs will get cancer if they eat so much
gluten for so long, for example) or relative to the rate of otherwise
getting cancer. I take as given that gluten does cause extra cancer in
celiacs, but that just like any other chemical or toxic agent, its effect
scales with the accumulated dose here in gluten gram years. That common
sense idea has a simple scientific basis in an irreversible "seed" planted
by each micro-unit of the dose (whether initial effect of one molecule or
of one electronic bond broken by radiation). Each seed has an equal small
micro-chance of later leading to cancer: the total probability comes from
their sum. No repair mechanisms then. The resulting linearity of cancer
probability with total dose is well established for radiation and benzene,
for example. Twice the daily dose, twice the chance of cancer; Same dose,
half as long, half the risk, etc.

My conclusion first before I rebut Ron.

Conclusion: if the gluten intake is less than 5% of that in a normal diet
then  the extra risk of cancer is less than 5% (numerical coincidence) of
its normal occurrence (citations below). The real risk at such low levels
and below is instead in nutritional deficiencies. The latter can be
monitored. Unlike cancer, they are largely reversible: at low doses an
equilibrium builds up between the regrowth of the microvilli and their
destruction by whatever gluten is still being eaten.

In <[log in to unmask]>, on 03/22/97
   at 08:28 PM, Ron Hoggan <[log in to unmask]> said:

>>The incidence of malignancy is variously reported from 10% to 28% of
>>untreated celiacs. The malignancy rate among treated celiacs declines to
>>almost that of the general population by 5 years on a gluten-free diet.

The reference Holmes et al "Malignancy in coeliac disease--effect of a
gluten free diet" Gut (1989) 30, 333-338.

The correct comparison/conclusion is quoted even in the abstract: "A
two-fold relative risk of cancer was found and was because of an increased
risk of cancer of the..." (various  sites in the GI tract). So on a full
gluten diet, the totally non-compliant celiac's risk of cancer is an extra
100% that of those following a gluten free diet. Obviously unacceptable.

Pick your level of comfort now for whatever cancer risk you're willing to
live with. 5% of 40 grams of gluten/day is 2 grams/day, for example, for
that extra 5 % risk. Whether the very ambiguous "malt flavorings" or
vinegar, there's no 2 grams of gluten in a single portion. So once you do
that,  in choosing how much more carefully to eliminate gluten or verify
gluten free, watch instead your nutritional levels regularly: ferritin,
calcium, sodium, the B vitamins, etc. Monitor antibodies regularly if you
already know you display them, and biopsy as needed to verify a healthy
intestine.

Holmes has published since on that same group: it would be nice if he
could update that extra 100% value since he doesn't quote it directly
later.

>>Your three points open the door to increases in malignancy,
>>neuropathies, and autoimmune disease

Cancer, yes, but in proportion as detailed above. Neuropathy, only through
vitamin deficiency (K and E), which I'm advocating monitoring. Another
autoimmune caused by eating gluten? NO, NO, NO. Yes, the incidence of
normally rare autoimmune diseases is higher in celiacs than in the general
population. Genetic connection only: each autoimmune diease has one or
more pairs of genes plus an environmental stimulus that cause it. All have
one of these on the same chromosome. Nearby genes tend to stay together in
the dance of the chromosomes in sexual reproduction. Later generations
will retain the double pair even if neither disease was expressed
earlier.

Oh, I should add that I'm a biopsed celiac. I don't react to single doses
but don't consciously eat known gluten.
                                                Kemp Randolph
                                                Long Island

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Kemp Randolph <[log in to unmask]>
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