If you have celiac disease and you don’t strictly adhere to a gluten-free diet, you greatly increase your risk for two serious cancers falling under lymphoproliferative malignancy (LPM): non-Hodgkin’s lymphoma and T-cell lymphoma. We’ve known that celiac disease and cancer have a strong association, but the evidence is becoming more specific and more compelling.
Recent research published in the Annals of Internal Medicine suggests if you aren’t vigilant in your gluten-free diet you may greatly increase your risk for cancer. The study was conducted by Dr. Benjamin Lebwohl and Dr. Peter H.R Green of the Columbia University Celiac Disease Center and their colleagues from the Mayo Clinic and Örebro University Hospital in Sweden. The study is entitled, “Mucosal Healing and Risk for Lymphoproliferative Malignancy in Celiac Disease: A Population-Based Cohort Study“.
Dr. Lebwohl stated, “Our study shows that celiac patients with persistent villous atrophy — as seen on follow-up biopsy — have an increased risk of lymphoma, while those with healed intestines have a risk that is significantly lower, approaching that of the general population.”
Dr. Lebwohl also conjectures that the results of this study may indicate a greater risk for additional, similar gastrointestinal cancers, such esophageal cancer, when patients experience persistent celiac disease symptoms.
This research suggests you should obtain follow-up biopsies to make certain the mucosal lining of your small intestine has healed and remains healed.
This elicits two important thoughts:
1) If you are diagnosed with celiac disease, you must be vigilant in removing gluten from your life and maintaining a gut-healthy diet.
2) You need to obtain follow-up biopsies. Prior to this research, many doctors didn’t feel follow-up biopsies were necessary. But now we understand these biopsies are necessary for determining whether or not our mucosal lining is healing. You can’t guess or assume you’ve healed.
With this second point, I feel it’s important to appreciate other recent research concerning gluten cross-contamination.
In research published in the June, 2010, issue of the Journal of the American Dietetics Association, we discovered how gluten cross-contamination affected many gluten-free grains previously assumed safe. And in February, 2013, a study published in BMC Gastroenterology illuminated how many patients with non-responsive celiac disease could heal on a highly restrictive diet designed to avoid all possible sources of gluten cross-contamination.
When taken altogether, these studies should invigorate your vigilance and persuade you to appreciate the critical importance of follow-up biopsies. Even if you feel better a few months into your gluten-free diet, you can’t know for certain that your diet has fully eliminated your villous atrophy.
This also highlights the importance of diagnosis. If you choose to forgo a gluten challenge and thus forgo an accurate intestinal biopsy, you won’t be able to monitor the affect of your gluten-free diet on the health of your small intestine.
Non-Hodgkin’s lymphoma and T-cell lymphoma are serious and potentially deadly forms of cancer. Avoid gluten and get follow-up biopsies to make sure you’re healing and minimizing your risk for these cancers.