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The recent paper by Atkinson and colleagues (Gut 2004;53:1459–1464) regarding IgG food antibodies and irritable bowel syndrome (IBS) fails to compare like with like. Regardless of the IgG results, the treatment group excluded significantly different foods to the control group, particularly those foods which appear to exacerbate symptoms of IBS. Of particular concern is the “yeast exclusion” diet. A low yeast diet is not a recognised diet in standard textbooks of dietetics and nutrition. However, alternative practitioners offering such a “yeast exclusion diet” sometimes recommend exclusion of a wide range of foods, such as: bakery products, alcoholic beverages, many other beverages including commercial fruit juices, cereals, condiments, dairy produce, fungi, meat products (hamburgers, sausages, and cooked meats made with bread or breadcrumbs), yeast extracts (Bisto, Marmite, Oxo, Bovril, Vegemite, gravy browning, and all similar extracts), all B vitamin preparations, and sometimes, most worryingly, “sugar foods” (sugar, sucrose, fructose, maltose, lactose, glycogen, glucose milk, sweets, chocolate, sweet biscuits, cakes, candies, cookies, puddings, desserts, canned food, packaged food, hamburgers, honey, mannitol, sorbitol, galactose, monosaccharides, polysaccharides, date sugar, turbinado sugar, molasses, maple syrup, most bottled juices, all soft drinks, tonic water, milkshakes, raisins, dried apricots, dates, prunes, dried figs, and other dried fruit).
Therefore, regardless of IgG antibody status, the dietary restrictions in one group are not controlled for by the other group, and hence the conclusion may not be valid.
It would also be helpful to know if any of the patients with IgG antibodies to a particular antigen also had IgE antibodies to the same antigen.
Conflict of interest: None declared.
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