Lymphoma, B-Cell Non-Hodgkin’s

What Is B-Cell Non-Hodgkin’s Lymphoma?

[dropcap]B[/dropcap]cell non-Hodgkin’s lymphoma is a malignant, monoclonal (arising from a single cell) proliferation of lymphocytes that is preceded by lymphadenopathy and characterized by varying, less predictable spread than Hodgkin’s disease.

Lymphadenopathy is enlargement of lymph nodes greater than 1.5 cm caused by activation and increased production of lymphocytes and phagocytes (type of white blood cell that engulfs pathogens during infection) or invasion by a tumor.

Q: How does this type of lymphoma develop?

A: 80% to 85% of non-Hodgkin’s lymphoma arise from B-lymphocytes (B-cells).

What Is B Cell Non-Hodgkin’s Lymphoma In Celiac Disease and/or Gluten Sensitivity?

• Relationship between B-cell non-Hodgkin’s lymphoma and celiac disease.  B-cell non-Hodgkin’s lymphoma is a severe malignant complication of celiac disease.
• Relationship between B-cell non-Hodgkin’s lymphoma and risk. A study investigating the distribution and risk of lymphoma subtypes in celiac disease demonstrated that most lymphomas complicating celiac disease are related to the disease and are not of the enteropathy-type T-cell lymphoma (ETTL). 44% of patients with B-cell non-Hodgkin’s lymphoma had a history of other autoimmune/inflammatory diseases.¹
• Relationship between B-cell non-Hodgkin’s lymphoma and dermatitis herpetiformis. Study patients with dermatitis herpetiformis who developed lymphoma (1%) had not adhered as strictly to the gluten free diet as the control patients without lymphoma. Of eleven cases, eight patients had B-cell lymphoma.²
• Relationship between B-cell non-Hodgkin’s lymphoma and mucosal healing. A Swedish nationwide study investigating the association between mucosal healing in celiac disease and subsequent lymphoma found that the risk for B-cell lymphoma was not increased in patients at follow-up biopsy. Among 7625 patients with celiac disease and follow-up biopsy, 3308 (43%) had persistent villous atrophy. The overall risk for lymphoproliferative malignancy was higher than that in the general population and was greater among patients with persistent villous atrophy than among those with mucosal healing but not for B-cell lymphoma.³

How Prevalent Is B Cell Non-Hodgkin’s Lymphoma?

There is a significant increased risk for B-cell non-Hodgkin’s lymphoma in celiac disease patients with 9% rate for intestinal B-cell non-Hodgkin’s lymphoma and 20% for non-intestinal B-cell non-Hodgkin’s lymphoma of total incident malignant lymphomas.⁴

What Are The Symptoms Of B-Cell Non-Hodgkin Lymphoma’s?

B-cell non-Hodgkin’s lymphoma is marked by these symptoms:

• Painless lymphadenopathy (swollen lymph nodes) in two-thirds.
• Anemia in many patients.
• In some, night sweats, fever, and weight loss.

How Does B-Cell Non-Hodgkin’s Lymphoma Develop In Celiac Disease and/or Gluten Sensitivity?

• B-cell non-Hodgkin’s lymphoma results from gluten sensitive enteropathy.
• Multiple nutrient deficiencies due to malabsorption in celiac disease may predispose including protein, selenium, vitamin A, vitamin E and omega-3 fatty acids.

Does B-Cell Non-Hodgkin’s Lymphoma Respond To Gluten-Free Diet?

• The risk of B-cell non-Hodgkin’s lymphoma depends on how strictly the gluten free diet is followed. Study patients with dermatitis herpetiformis who developed lymphoma had not adhered as strictly to the gluten free diet as the control patients without lymphoma. Of eleven cases, eight patients had B-cell lymphoma.²
• Persistent villous atrophy was found not to increase risk of B-cell non-Hodgkin’s lymphoma in patients on a gluten free diet.³

6 Steps To Improve Risk For B-cell Non-Hodgkin’s Lymphoma:

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both risk for B-cell non-Hodgkin’s lymphoma and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.⁵
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2[/dropcap] Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.⁶
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.⁶
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.⁶.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.⁶
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.⁶
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.⁶[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

 

• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

 

• [dropcap]4[/dropcap] Manage Your Medications Safely:

[box type=”shadow” ]Certain prescription drugs can cause nutritional deficiencies that increase risk for B-cell non-Hodgkin’s lymphoma. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

This is not a complete listing.

CHOLESTEROL DRUGS

• Colestid® and Questran® deplete Vitamin A, Vitamin E.

FEMALE HORMONES  disrupt intestinal permeability.

• Oral Contraceptives (Norinyl®, Ortho-Novum®, Triphasil®, and others) deplete Selenium.

ANTI-INFLAMMATORIES disrupt intestinal permeability.

• Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) deplete Selenium.

ANTICONVULSANTS

• Phenobarbital and Barbituates; and Dilantin®, Tegretol®, Mysoline®, Depakane/Depacon® deplete Selenium.

ANTACIDS / ULCER MEDICATIONS

• Pepcid®, Tagamet®, Zantac® deplete Vitamin A, and others.
• Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) deplete Vitamin A.

WEIGHT LOSS DRUGS THAT BIND FAT also interfere with absorption of some nutrients.

• Zenicol (Orlistat®) depletes Vitamin A.

[/box]

• [dropcap]5[/dropcap]Nutritional Supplements To Help Correct Deficiencies:

[box type=”shadow” ]

The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multivitamin/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
• Vitamin A as prescribed following a blood test for vitamin A status.
• Vitamin E as prescribed following a blood test for vitamin E status.
• Fish oil supplement to provide omega-3 fatty acids.
• Selenium supplement cautiously to avoid overdose as prescribed.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6[/dropcap]Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About B-Cell Non-Hodgkin’s Lymphoma In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“Mucosal healing and risk for lymphoproliferative malignancy in celiac disease: a population-based cohort study.” This nationwide population study investigating the association between mucosal healing in celiac disease and subsequent lymphoproliferative malignancy found increased risk for lymphoproliferative malignancy (LPM) is associated with the follow-up biopsy results, with a higher risk among patients with persistent villous atrophy.

The risk for LPM was compared with that of the general population by using expected rates. The rate of LPM in patients with persistent villous atrophy was compared with that of those with mucosal healing by using Cox regression.

RESULTS: Among 7625 patients with celiac disease and follow-up biopsy, 3308 (43%) had persistent villous atrophy. The overall risk for LPM was higher than that in the general population (standardized incidence ratio [SIR], 2.81 [95% CI, 2.10 to 3.67]) and was greater among patients with persistent villous atrophy (SIR, 3.78 [CI, 2.71 to 5.12]) than among those with mucosal healing (SIR, 1.50 [CI, 0.77 to 2.62]). Persistent villous atrophy compared with mucosal healing was associated with an increased risk for LPM (hazard ratio [HR], 2.26 [CI, 1.18 to 4.34]). The risk for T-cell lymphoma was increased (HR, 3.51 [CI, 0.75 to 16.34]) but not for B-cell lymphoma (HR, 0.97 [CI, 0.21 to 4.49]). Follow-up biopsy may effectively stratify patients with celiac disease by risk for subsequent LPM.⁷

“Malignant lymphomas in celiac disease: evidence of increased risks for lymphoma types other than enteropathy-type T cell lymphoma.” This study investigating the distribution and risk of lymphoma subtypes in celiac disease demonstrated that most lymphomas complicating celiac disease are related to the disease and are not of the enteropathy-type T cell lymphoma (ETTL). 44% of patients with B cell non-Hodgkin’s had a history of other autoimmune/inflammatory diseases.⁸

“Lymphoma in patients with dermatitis herpetiformis and their first-degree relatives.” This study investigating the occurrence of lymphoma in a large series of patients consecutively diagnosed with dermatitus herpetiformis (DH) during 1969 to 2001, and their first degree relatives, demonstrated that patients with DH can have both B- and T-cell lymphoma. The DH patients with lymphoma (1%) had not adhered as strictly to the gluten free diet as the control patients without lymphoma. Of eleven cases, eight patients had B-cell lymphoma.⁹

Sources:

1. Smedby KE, Akerman N, Hildebrand H, Glimelius B, Ekbom A, Askling J. Malignant lymphomas in celiac disease: evidence of increased risks for lymphoma types other than enteropathy-type T cell lymphoma. Gut. Jan 2005;54(1):54-59. [↩]
2. Hervonen K, Vornanen M, Kautiainen H, Collin P, Reunala T. Lymphoma in patients with dermatitis herpetiformis and their first-degree relatives. British Journal of Dermatology. Jan 2005;152(Issue 1):82,5p. [↩] [↩]
3. Lebwohl B, Granath F, Ekbom A, Smedby KE, Murray JA, Neugut AI, Green PH, Ludvigsson JF. Mucosal healing and risk for lymphoproliferative malignancy in celiac disease: a population-based cohort study. Ann Intern Med. 2013 Aug 6;159(3):169-75. doi: 10.7326/0003-4819-159-3-201308060-00006. [↩] [↩]
4. Smedby KE, Akerman N, Hildebrand H, Glimelius B, Ekbom A, Askling J. Malignant lymphomas in celiac disease: evidence of increased risks for lymphoma types other than enteropathy-type T cell lymphoma. Gut. Jan 2005;54(1):54-59. [↩]
5. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
6. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
7. Lebwohl B, Granath F, Ekbom A, Smedby KE, Murray JA, Neugut AI, Green PH, Ludvigsson JF. Mucosal healing and risk for lymphoproliferative malignancy in celiac disease: a population-based cohort study. Ann Intern Med. 2013 Aug 6;159(3):169-75. doi: 10.7326/0003-4819-159-3-201308060-00006. [↩]
8. Smedby KE, Akerman N, Hildebrand H, Glimelius B, Ekbom A, Askling J. Malignant lymphomas in celiac disease: evidence of increased risks for lymphoma types other than enteropathy-type T cell lymphoma. Gut. Jan 2005;54(1):54-59. [↩]
9. Hervonen K, Vornanen M, Kautiainen H, Collin P, Reunala T. Lymphoma in patients with dermatitis herpetiformis and their first-degree relatives. British Journal of Dermatology. Jan 2005;152(Issue 1):82,5p. [↩]