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A significant medical study reports that serious health risks continue for
people with Celiac Disease on the "Gluten-Free" diet.

We each need to:

1) Be sure our physician follows us closely because of our increased cancer
risk.

2) Seriously consider eliminating processed foods and foods prepared
outside our home, because it may be impossible for us to identify all those
which contain hidden gluten.

Some with Celiac Disease on this list have already eliminated processed
foods and foods prepared foods outside the home. There is now a real
possibility that this will become the standard diet for everyone with the
disease.

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A leading Celiac expert, Peter Green, said this about his research:

"The main implication [of these results] is that patients with
[celiac disease] need to be followed closely after diagnosis,"

  "In addition, it raises the possibility that despite the
patients adhering to a strict gluten-free diet they may in fact be
consuming gluten. This is because it may be very hard in the
U.S. to be on a strict gluten-free diet [because] gluten is frequently
present in processed food and in food that is prepared out of the home."

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Here is a news report on the journal article:

Risk of Cancer Is Increased in Patients With Celiac Disease
By Michelle Chard

NEW YORK (Reuters Health) September 19 - Patients with celiac disease
have an increased risk of several malignancies, according to a report in
the August 15th issue of the American Journal of Medicine.
Although European studies have found an increased risk of some
cancers, particularly non-Hodgkin's lymphoma, among patients with celiac
disease, no US study has been carried out. Dr. Peter H. R. Green, of
Columbia University, New York, and colleagues estimated the risk of
malignancy in celiac disease patients compared with the general US
population. In addition, they examined whether a gluten-free diet is
protective.

Three hundred eighty-one patients with celiac disease seen between
1981 and 2000 at a referral center were included in the study. The
researchers used data from the National Cancer Institute Surveillance,
Epidemiology, and End Results Program to calculate standardized
morbidity ratios (SMRs).  Of the 381 celiac disease patients, 43 (11%)
were diagnosed with cancer. Of these, 9 were after the diagnosis of
celiac disease, 7 were within a month of diagnosis, and 27 were before
the celiac disease diagnosis.

The researchers report that the standardized morbidity ratio for all
cancers was 1.5. Thirty-four malignancies were diagnosed before or
within a month of celiac disease diagnosis, versus 14 expected (SMR =
2.4).  Compared with expected rate, the team observed increased risks of
small bowel cancer (SMR= 34), esophageal cancer (SMR = 12),
non-Hodgkin's lymphoma (SMR = 9.1), and melanoma (SMR = 5.0).

"The most striking feature of our study is that the risk for
non-Hodgkin's lymphoma persisted despite diagnose and treatment with a
gluten-free diet," Dr. Green said in an interview with Reuters Health.
The non-Hodgkin's lymphoma included T-cell and B-cell types, and was
found in gastrointestinal sites in five patients and extraintestinal
sites in four patients.

"The main implication [of these results] is that patients with
[celiac disease] need to be followed closely after diagnosis," Dr. Green
explained. "

In addition, it raises the possibility that despite the
patients adhering to a strict gluten-free diet they may in fact be
consuming gluten," he noted. "This is because it may be very hard in the
U.S. to be on a strict gluten-free diet [because] gluten is frequently
present in processed food and in food that is prepared out of the home."

Am J Med 2003;115191-195.

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