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Kemp Randolph's comments are well taken, but I would like to add further
comment using one of his statements as a starting point:

>Still, the relative risk for getting a GI cancer from the
>gluten in a normal diet seems to be 10- 100 times the normal rate for these
>same cancers. (Based on the Holmes article and that Marsh chapter.)

The reason I sent my previous communication and follow up with this one is
because I feel that many celiac disease patients are likely to be scared out
of their wits by statements such as: your risk is 100 times the normal rate.
This statement is not incorrect, but it is possible to look at it from a
different perspective.  I suspect that the continual harping on cancer is
driving people into irrational and compulsive behavior with regard to diet
(my opinion of course--not proven fact).  I strongly recommend a good solid
gluten-free diet for celiac patients, but I don't think they should be
terrified of looking at the facts and making an intelligent decision with
regard to diet.  As Kemp Randolph said, "Yes, if you eat less gluten, your
risk will be less, but somewhere for each of us there'd be a point at which
the extra effort in excluding more wouldn't seem worth it."

With regard to cancer, let us just look at the coin from the other side--how
many will not develop cancer.  If I turn to the chapter by Holmes and
Thompson (in the book Coeliac Disease, edited by Mike Marsh, Blackwell
Scientific, 1992), I find in their Table 5.6 entitled "Cancer morbidity in
CD by diet group" that for the 108 patients in the normal diet or reduced
gluten diet group the number of all tumours was 2.6 times the expected
number whereas for the gluten-free diet group, it was 1.5 times the expected
number (the 1.5 was not considered significantly different from normal on a
statistical basis). The actual numbers of tumours of all kinds (all sites)
for the gluten-containing group was 14 for 108 subjects and the number for
the gluten-free group was 17 out of 102, thus 13% vs. 17%.  So despite the
significant increase in cancer for the group that was eating gluten over the
group that was not (except perhaps for the wheat starch as I discussed
yesterday), one could conclude that the vast majority of celiac patients
could pay no attention to diet whatsoever for their whole lives and still
never develop cancer.

In this same table, Holmes and Thompson indicate that the observed to
expected ratio of lymphoma was 78 times greater for the gluten-eating group.
Now we are getting close to that 100 times greater number.  But the expected
number was only 0.09 per 102 patients.  Therefore, the 78 times greater
number comes out to be 7.8 patients out of 100 (they actually observed 7
cases out of 102 patients studied for the gluten-eating group and observed 2
cases out of 108 patients in the gluten free group).  Now, I do not in any
way make light of these numbers.  Obviously, they are of concern to anyone
with celiac disease.  However, I thought it might be a good idea for people
to know a little bit more about where these numbers come from and what they
mean.

Sure hope I haven't made any mistakes.  As before, corrections and criticism
are welcome.  In the end, each and every one of us is responsible for making
arbitrary personal decisions about our behavior in regard to health,
frequently with incomplete information.  My goal is to try to make sure that
you do have at least what information is available.

Don Kasarda