Expert Postings, Jan - Mar 1997

Copyright by Michael Jones, Bill Elkus, Jim Lyles, and Lisa Lewis 1997 - All rights reserved worldwide.

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This file contains postings made by the following professionals: 
Donald D. Kasarda, Ph.D.--a research chemist with the United States 
   Department of Agriculture.  Dr. Kasarda has worked on grain proteins 
   in relation to grain quality for 30 years.  He has colloborated with 
   medical groups working on celiac disease for about 25 years and has 
   often been used as an informal consultant by support groups. 
Joseph Murray, M.D.--a gastroenterologist at the University of Iowa, 
   USA, where they have a mutidisciplinary service for the clinical care 
   of people with celiac disease.  They are also involved with clinical 
   research and medical education related to celiac disease. 
Phil Sheard, Ph.D.--researcher in the Developmental Biology Unit, 
   Department of Physiology, University of Otago Medical School, in 
   Dunedin, New Zealand. 

Date: Wed, 8 Jan 1997 09:33:00 CST From: Murray@INTMED-PO.INT-MED.UIOWA.EDU From: Re: Mouth Ulcers Mouths ulcers have been described in untreated celiacs and usually go away or get much better after going on the gluten free diet. Why these occur is not known it may be a direct effect of the gluten on the lining of the mouth, a nutritional deficiency , or an autoimmune process. Chelitis, or angular stomatitis( sore corners to the mouth) are also common and relate to the iron deficiency. A sore tongue may be due to Vitamin def, esp B12 or Folate. Not Medical advice Joe Murray ========================================================================= Date: Thu, 9 Jan 1997 20:00:04 PST From: "Donald D. Kasarda" (kasarda@PW.USDA.GOV) From: small amounts of gluten 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 ========================================================================= Date: Wed, 15 Jan 1997 10:59:54 +0000 From: Phil Sheard (phil.sheard@STONEBOW.OTAGO.AC.NZ) From: how big is a milligram? Hi all, In the recent discussion on small amounts of gluten, Ron Hoggan indicated that he was unsure how much was represented by a milligram. It occurred to me that this was a good question, since few of us deal with such small amounts on a regular basis. To contribute to this issue, I have weighed a number of small objects to give you some sense of perspective on these small amounts. Remember, in that discussion, 100mg of gluten per day was quoted as the smallest amount producing a detectable response. For you non-metric people, one pound is equal to about 454grams. If you wish to be more precise, and to put this into milligrams, a pound is 453592mg! 1 gram is 1000mg. 1 American 1 cent coin weighed 2492mg 1 M&M candy weighed 895mg 1 grain of white rice, uncooked, weighed 20mg (long and short grain weighed about the same) 1 California raisin weighed 418mg 1 kernel of popping corn weighed 217mg Hope you find this helpful Cheers Phil Philip Sheard Developmental Biology Unit, Department of Physiology, University of Otago Medical School, Dunedin, New Zealand. Ph (64 3) 479-7344 Fax (64 3) 479-7323
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