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---------- Forwarded message ----------
Date: Fri, 8 Mar 1996 00:04:14 MST=20
From: Ronald Hoggan, Queen Elizabeth High School <[log in to unmask]>
To: [log in to unmask]
Subject: A personal perspective on NHL=20
Fellow Listmembers:
I am sorry for the length of this post, but it seems necessary. After 30
years of ulcer diagnoses which were unsupported by x-ray, or any other
tests, (accompanied by two separate bouts of intestinal bleeding) I was
finally diagnosed correctly with celiac disease. I have since made it a
point to learn about this genetic illness, in part, because I want to get
better. I spent many months pouring over every book and journal article I
could find on the subject.
I was surprised to learn that a diagnosis of adult cd (celiac disease) is
associated, within five years, with a 10% incidence of malignancy, and over
the age of 50, that number rises. The majority of these malignancies are
Non-Hodgkin's Lymphomas, about 70% of which occur in the GI tract.(8,9,10)
In fact, one study states: "An increased risk of malignancy has been
definitely established in coeliac disease; these patients are reported to
have a = 40 to 100 fold risk of developing non-Hodgkin's lymphoma. (12)
About 10 months after my cd was diagnosed, my brother was diagnosed with
mixed, cleaved-cell, low grade, follicular, non-Hodgkin's lymphoma at early
stage III. I did some reading, and found that latent celiac disease has a
45% likelihood in a sibling of a celiac. (8, 13) Latent celiac is where
there are some of the intestinal signs of celiac ( such as crypt
hyperplasia) present, but the defining characteristic, villous atrophy, is
not.(8,10,5,13, 22) By current standards, this is insufficient evidence to
diagnose celiac disease. There is much evidence to suggest that a variety
of associated health problems are more likely, even in latent
celiac.(5,8,10) Full blown celiac may be in the offing for one third of
these patients who cannot yet be diagnosed.(21,22)
It seems reasonable to suspect that celiac might be at the root of my
brother's lymphoma. I apprised his doctor of my illness. I also provided
him with a sheaf of studies that supported my suspicion. I also asked him
to take a blood sample for serum antibody tests associated with cd.
The doctor indicated that he would be recommending to my brother that he not
try a gluten-free diet (the treatment for cd) because he felt it would
interfere with the quality of my brother's life during the time he had left.
It is now 7 months after my brother's diagnosis. He has finished five
months of chemo. There has been some reduction in tumour size, but it is
still quite large. He is experiencing a great deal of pain. He has finally
begun the diet, but I am worried about him. I'm not sure that any diet
would have helped him, even back when the lymphoma was first diagnosed. But
maybe it could have. One study showed that a gluten-free diet had a
preventive role FOR CELIAC PATIENTS, and I see considerable cause to suspect
celiac in my brother.
I have turned my anger and heartbreak in the only direction that I don't
feel totally helpless. I have been reading about celiac disease, cancer,
and a variety of related topics. That reading is the basis for the idea I
now postulate:
Dr. Lutz, in the face of epidemiological studies that failed to support the
current belief that fat intake was at the root of coronary disease and
cancer, has done his own explorations of epidemiological data. His findings
show a clear, inverse relationship between these civilisatory diseases and
the length of time the people of a given region of Europe have had to adapt
to the high carbohydrate diet associated with the cultivation of cereal
grains that was begun in the Near East, and spread very slowly through
Europe. (4)
Further evidence to support his perspective is offered by a randomized study
done on blood samples with antibody tests related to celiac disease. It was
conducted in Iceland, a country that lacks the natural environs to provide
for a cereal rich diet, and was, until recently, relatively isolated from
the increasingly glutenous diets of the bulk of Europe. Thus it is not
surprising that with the luxury of modern transportation, this population
showed antibody levels that would suggest a rate of silent celiac disease in
about 15% of their population. (14)
In celiac disease, there is a malabsorption of vitamins and nutrients that
arises out of the associated villous atrophy. It is this shortage of
vitamins and minerals that may have led to the assumption that increased
malignancies result, in part, from the general condition of ill health
associated with celiac disease. This does seem reasonable. Unfortunately,
that assumption may have overshadowed a dynamic that is operating in both
celiac disease and latent celiac disease. That dynamic is sometimes
referred to as a "leaky gut." There is intestinal damage that allows
macromolecules of undegraded food particles to move through the intestinal
wall and into the bloodstream. These particles are identified as invaders
by the immune system, and specific antibody production ensues. (2,3)
Because some of these food particles might have molecular similarity to some
of the body's own tissues, there are investigators who suspect that this is
the root of many autoimmune diseases. (15)
One study has demonstrated the "Passage of Undegraded Dietary Antigen
into the Blood of Healthy Adults." (3) As I will point out shortly, the
term "healthy" may only apply temporarily. Another study has shown a
"High prevalence of celiac disease in healthy adults revealed by
antigliadin antibodies." (2) This does not mean that everyone who has a
leaky gut will get celiac disease. Quite the contrary, most will develop
other ailments. For the moment, though, I would like to focus on the
incidence of celiac disease. Extensive testing in Europe, and some
humble, but important testing in the US has demonstrated an incidence of
celiac disease that is ten to twelve times as many as are diagnosed.
(16,2,17) That means that there are literally millions of Americans
walking around with celiac disease, and they will never know it. Given
the cancer statistics for celiac disease, (5,6,7,8,9,10,12) I think it
reasonable to project that a lot of cases of undiagnosed celiac disease
are eventually diagnosed as cancer, usually NHL.
As for the latent celiac, which is more prevalent, (19) and cannot be
diagnosed, I think that is a condition that is growing even more cancers.
One study has shown a 4.75% incidence of elevated antigliadin antibodies in
the USA. (17) Let us examine the process at work in the absorption of
dietary antigens, and what impact they have on some of the systems in the
body:
1) Zioudrou et al. demonstrated the "isolation of some purified peptides
with opioid activity from the pepsin digests of wheat gluten and a
casein." These opioids originate outside the body and have a
morphine-like activity. (1)
2) Serum levels of antigliadin antibodies (gliadins are proteins in wheat)
would rise in persons with a leaky gut, because the body would accelerate
production of these antibodies in response to increases in the passage of
pepsin digests of wheat into the blood. (3,19)
3) We have numerous studies that show elevated anti-gliadin antibody levels
in from 4% to 15% of the populations studied. (16,14)
4) With our North American preoccupation with processed foods, we have shown
a 20% increase in per capita, annual wheat consumption from 1972 to
1992. (20)
5) Dr. Paul H. Black, has demonstrated a downregulation of the immune
system in response to the presence of opioids in the blood which attatch
to the HPA axis and effect its function. He says: "Indeed, changes in
the natural killer cell activity can be mimicked by administering
morphine itracranially...." (11)
In other words, the intestinal condition that leaks these undegraded
antigens into our blood is going undiagnosed. This condition may incite the
development of autoimmune diseases, and/or downregulate the immune system,
especially reducing the activity of the natural killer cell. This is the
very cell that is responsible for attacking and killing mutant cells that
could multiply and become tumours.
1) Since a gluten-free diet can be demonstrated to have a protective role
against malignancy in celiac disease, would it not make sense to try it
with cancer cases in general? They may not known to be associated with
cd, but cd can hardly be ruled out, in view of the evidence that less
than 10% of the celiac disease out there is ever diagnosed. And that
ignores people with latent celiac disease. In fact, I have found two
reports in medical journals of cases where lymphomas disappeared
following adherence to a gluten-free diet. The specific nature of one of
these conditions is hotly debated in the literature by other
practitioners, but the group who made this claim has a resected
intestinal segment to support their position. (18) In the other case,
because the tumour went away, the authors do not make the claim that it
was malignant, but they had previously diagnosed it as a lymphoma, based
on CT scan. (5)
2) I am sick about this whole situation. I should be having fun, teaching
my students. As it is, I am spending countless hours pouring over
medical journals because feel compelled to tell people what I have found.
Ron Hoggan, Calgary, Alberta, Canada
References
----------
1. Zioudrou, et. al. "Opioid Peptides Derived form Food Proteins" The
Journal of Biological Chemistry. Vol. 254, No. 7, pages 2446-2449, April
10, 1979.
2. Grodzinsky, et. al. "High prevalence of celiac disease in healthy adults
revealed by antigliadin antibodies" Annals of Allergy. Vol. 69, pages
66-70, July, 1992
3. Husby et. al. "Passage of Undegraded Dietary Antigen into the Blood of
Healthy Adults" Scandanvaian Journal of Immunology. Vol 22, pages 83-92,
1985
4. Lutz, W.J. Medical Hypotheses. Vol. 45, pages 115-120, 1995
5. de Boer, et. al. "Disappearance of Mesenteric Lymphadenopathy with
Gluten-Free Diet in Celiac Sprue" Journal of Clinical Gastroenterology.
Vol. 16 (4), pages 317-319, 1993
6. Wright, et. al. "Coeliac Disease and Lymphoma" The Lancet Vol. 338,
page 1373, June 8, 1991
7. Swinson, et. al. "Coeliac Disease and Malignancy" The Lancet. January 15,
1983
8. Tigh, et. al. "The implications of recent advances in coeliac disease"
Acta Paediatrica. Vol. 82, pages 805-810, 1993
9. Holmes, et al. "Malignancy in coeliac disease - effect of a gluten free
diet." Gut. Vol. 30, pages 333-338, 1989
10. Goggins, et. al. "Celiac Disease and Other Nutrient Related Injuries to
the Gastrointestinal Tract" The American Journal of Gastroenterology.
Vol. 89, No. 8, pages S2 - S13, 1994.
11. Black, Paul "Psychoneuroimmunology: Brain and Immunity" Scientific
American SCIENCE & MEDICINE. Vol. 2, Issue 6, pages 16-25, Nov./Dec.,
1995
12. Collin et. al. "Coeliac disease-associated disorders and survival" Gut.
Vol. 35, pages 1215 to 1218, 1994
13. Holm et. al. "Immunohistochemical changes in the jejunum in first degree
relatives of patients with coeliac disease and the coeliac disease marker
DQ genes. HLA class II antigen expression, interleukin-2 receptor
positive cells and dividing crypt cells." Gut. Vol. 35, pages 55-60, 1994
14. Arnason, et. al. "Do adults with high gliadin antibody concentrations
have subclinical gluten intolerance?" Gut. Vol. 33 (2), pages 194-197,
Feb, 1992
15. Freedman, "Celiac-associated autoimmune thyroid disease: A study of 16
patients with overt hypothyroidism" Canadian Journal of Gastroenterology.
Vol. 9, No. 5, pages 242-246 July/Aug, 1995
16. Catassi et al "Coeliac disease in the year 2000: exploring the iceberg"
Lancet. Vol. 343, pages 200-203 Jan. 22, 1994.
17. Not, et. al. "Endomysium Antibodies in Blood Donors Predicts a High
Prevalence of Celiac Disease in the USA" Gastroenterology. accepted for
publication
18. Wright, et. al. " Coeliac disease and lymphoma" The Lancet. Vol. 338,
pages 318-319, Aug. 3, 1991
19. Arranz, et. al. "Intestinal antibody pattern of coeliac disease" Gut.
Vol. 35, pages 476-482, 1994
20. Rosenvold, Can a Gluten-Free Diet Help? Keats Publishing, New Canaan,
Connecticut, ISBN 0-87983-538-9, 1992
21. Colin, et. al. "Follow-up of patients positive in reticulin and gliadin
antibody tests with normal bowel findings" Scandanavian Journal of
Gastroenterology. Vol. 28 (7), pages 595-598, July, 1993
22. Ferguson, et. al. "Spectrum of expression of intestinal cellular
immunity: Proposal for a change in diagnostic criteria of celiac disease"
Annals of Allergy. Vol. 71 (1), pages 29-32, July, 1993
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