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The following was posted recently:

>I would like to suggest that you check out some of the information on
>malignancy and celiac disease, especially lymphoma. One of the studies
>established 3 categories: One for those who adhere to the diet strictly; one
>for those who follow the diet, but not very strictly; and one for those who
>do not follow the diet.
>
>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.  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.

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.  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.  These are extremely
valuable and well-done studies. No criticism is intended.  To arrange a
study with larger numbers will be extremely difficult although a group in
Leiden (The Netherlands) is trying to arrange such a study.

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. They may be, or they may not be.

I offer these comments only with the intent of providing as much information
to celiac patients as possible so that they can make informed decisions. If
anything I have said is incorrect, I hope someone will point out my errors
on the net.

Don Kasarda, Albany, CA