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Hi Don,
It is nice to hear from you again. Discussion with you is always interesting
and thought-provoking.  Your comments appear to contradict mine, so I wanted
to clarify a couple of points:

>>The first group, after 5 years, shows a significant reduction in risk. In
>>fact, it is quite close to the risk experienced by members of the general
>>population.
>>
>>The second group does experience some reduction in risk, but it remains
>>closer to the rate of malignancy in untreated celiac disease.
>>
>>The third group has a very high risk of malignancy.
>
>I point out that the people in the first group, which supposedly was
>adhering to a strict gluten-free diet, were likely to have been including
>foods made with wheat starch in their diet because that was, and is, common
>in England where the study was carried out.

1. I'm sure they were eating some other traces of gluten, and had some
accidental ingestions, as well. That doesn't obviate the fact that the
inceidence, by diet groups, was distributed as I indicated.

>  I have asked several celiac
>researchers in England if I am correct in this assumption.  They agreed that
>I am. Therefore these people in the stricty gluten-free group were likely to
>be eating a small amount of gluten each day. The amount is unknown because
>we don't know the amount of gluten in the starch (this varies according to
>the manufacturer and possibly according to lot) nor how much starch was
>ingested by which subjects.

2. From this I would extrapolate that perhaps the protective effect would be
even greater in the North American g-f diet. Doesn't that seem reasonable?

>The apparent small increase in cancer risk for the first group was not
>statistically significant for those who had been on the diet more than 5 years.
>
>In the group with a normal diet, the relative risk of lymphoma was increased
>78 fold, but it should be pointed out that the incidence of lymphoma of the
>gastrointestinal tract in the normal population is rather low.

True, but I did not see where they differentiated the lymphomas according to
tumour location. They only said: "In the great majority of patients the
tumour is widely disseminated at diagnosis....."

> For the 210
>patients in the study, the cancer morbidity was expected to be 0.21.  For
>the 46 patients in the normal diet group, 7 cases of lymphoma were observed.
>For the 108 patients on the strict gluten-free diet, 3 cases of lymphoma
>were observed. The statistical significance of the numbers is weak because
>of the relatively small numbers of patients involved.

Yes, but inclusion of the reduced gluten group, numbering 56, there were 5
cases reported. That, I think, provides a fuller picture.

If we look at the 108 who were strictly g-f, there were 3 cases of lymphoma
If we combine the other two groups not g-f,  there were 12 cases of lymphoma

The first group (strict except for wheat starch) looks like the one I want to
belong to. And if the wheat starch was a causative factor in the 3 cases, then
I like my odds, if I can get past the 5 years. :-)

The numbers are small, but the pattern is quite clear.

>I have no quarrel with those who wish to play it safe, but I don't think we
>can say for sure that small amounts of gluten in the range of a milligram to
>a few milligrams per day are harmful on the basis of any scientific study of
>which I am aware.

I agree with you, for two reasons:
1. I don't know how big a milligram is, and;
2. (and I believe it was you who pointed this out) the peptides that derive
from gluten may be pathogenic, while they can not, strictly be called gluten.

> They may be, or they may not be.

True

> If
>anything I have said is incorrect, I hope someone will point out my errors
>on the net.

Because you omitted mention of the numbers in the reduced gluten group, I
felt that the picture was less than totally clear.

Best Wishes,
Ron
Ron Hoggan   Calgary, Alberta, Canada