From: Ron Hoggan
Date: Thu, 11 Jul 1996 21:08:49 -0700 (MST)
Subject: non-Hodgkin's lymphoma

"Coeliac disease is sometimes referred to as a pre-malignant condition."(1)
"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."(2)  In fact, since 1971, we have known 
that the untreated celiac's immune system, lacks the normal lymphocyte 
reaction to malignant cells. Maclaurin et.al. placed blood samples in test
tubes, then added tumor cells from a lymphoma cell line. The blood from 
controls reacted in a cytotoxic manner, while the blood from celiacs 
reacted minimally or not at all.(3) In plain language, our immune systems 
seem to lack the necessary elements to attack malignant cells, and we are 
especially at-risk for lymphomas. I should point out that Maclaurin found 
no difference between treated and untreated celiacs, but this work was 
done prior to 1971, and many glutinous substances were still allowed in the
gluten-free diet of that time and place. 

Since that time, Holmes et.al. have demonstrated that the gluten-free 
diet does serve a protective role against malignancy.(4) In fact, Egan 
et. al. state: "Failure to recognize CS [celiac sprue] and exclude gluten 
from the diet of a patient with CAL will seriously jeopardize the chance 
of recovery."(5)  The most common celiac-associated lymphoma is T cell, 
usually occurring in the gastrointestinal tract. (6,7)  Another group has 
proposed that celiac disease itself is the result of a low grade 
lymphoma.(9) That would imply that the gluten free diet may have a 
reversing effect on the dynamic that leads to malignancy. Certainly that 
is suggested by several of the findings cited. 

Wright et. al. cite one case where the gluten-free diet resulted in full 
remission for a 59 year-old patient. Their claim is hotly debated in the 
literature, but since they have saved a resected segment of the bowel, 
which is malignant, there is little room for dispute(9). Another group 
reports the disappearance of a lyphadenopathy with a gluten-free diet. 
While they had originally diagnosed it as lymphoma, the fact that it went 
away on the gluten-free diet convinced them that it could not have been 
malignant.(10) 

I urgently suggest that you get tested for celiac disease, and if it is 
positive, follow the diet very strictly. My brother has B cell lymphoma, 
and because most celiac-associated lymphomas are T cell, the doctors have 
scoffed at my suggestion/request that they test him for celiac disease. 
Perhaps you can benefit from all the long hours I spent pouring over 
medical journals to find evidence to support my request. I wish you well,
and would welcome hearing from you in future. 

                           Sources:

1. Tigh M, Ciclitira P. "The implications of recent advances in coeliac 
disease" Acta Paediatr 1993; 82: 805-810

2. Collin, et. al. "Coeliac disease-associated disorders and survival"
Gut 1994; 35:1215-1218

3. Maclaurin et. al. "Inpaired lymphocyte reactivity against tumour cells 
in patients with coeliac disease" Gut 1971; 12: 794-800

4. Holmes, et. al. "Malignancy in coeliac disease - effect of a gluten 
free diet" Gut 1989; 30: 333-338

5. Egan et. al. "Celiac-Associated Lymphoma" J. Clin. Gastroenterol 1995;
21(2): 123-129

6. Wright D, "The major complications of coeliac disease" Bailliere's 
Clinical Gastroenterology 1995; 9(2): 351-369

7. Mathus-Vliegen et. al. "Malignant lymphoma in coeliac disease: various 
manifestations with distinct symptomatology and prognosis?" Journal of 
Internal Medicine 1994; 236: 43-49

8. Wright et. al. "Coelaic disease and lymphoma" Lancet 1991; 338: 318-319

9. Wright et. al "Coeliac disease and lymphoma" Lancet 1991; 337: 1373

10. de Boer et. al. "Disappearance of Mesenteric Lymphadenopathy with 
Gluten-Free diet in Celiac Sprue" J. Clin. Gastroenterol 1993; 16(4):
317-319


I trust that Don Wiss will include information on being tested for celiac 
disease. If you are one of us, the gluten-free diet might help you. 

I hope that is helpful, 

Ron Hoggan     RBHOGGAN@cbe.ab.ca