Former Visiting Professor Patrick Holford Head of Science and Education at Biocare so, presumably, they believe that he has scientific credibility and they persist in this belief despite the stack of evidence that might prompt them to revise their estimation of his scholarship, his level of discourse or hyperbolic styling as a in the field of health and nutrition. Holford is particularly obdurate on the topic of IgG tests for the diagnosis of food intolerance. Dr Robert Burton would probably find Holford’s continuing enthusiasm an interesting case-study for the next edition of Believing You Are Right Even When You’re Not. However, it may be understandable that Holford cleaves to this despite the explicit advice from actual immunologists and allergy researchers and clinicians because it makes up part of the platform that allows him to sell tests, pills and special diets that are guided by his books.
In his blog, Patrick Holford writes: resistant weight loss may be due to hidden allergies.
Time and time again I meet people who tell me that their excess weight vanished after discovering, and eliminating, their food intolerances. Mary is a case in point. She was intolerant to gluten grains, especially wheat, and also extremely sensitive to sugar. By eliminating these foods she lost 7 stone in weight, she claims!
Dictu mirabile! Somebody gives up all grains that contain gluten, and that probably means all sorts of packaged and processed foods that contain gluten, and she gives up sugar and somehow, even though this means that she might be eating around 500-1000 fewer calories a day, she manages to lose 7 stones (she claims). Why is this news restricted to a blog post rather than a journal – it’s a conspiracy, surely, as Patrick Holford has yet more anecdotes to support that one. This must be worthy of publication in something along the lines of the Journal of things some bloke told me in the pub.
The most common kind of food intolerance leads to the production of IgG antibodies, which activate an immune reaction when you eat an offending food. This, in turn, increases inflammation in the body, raising certain known markers for inflammation such as TNF-a and C-reactive protein (CRP).
HolfordWatch is going to have to interrupt Patrick Holford’s flow here to mention something that he does not address. When you eat food, you will develop IgG antibodies, it’s what we do: see, e.g., high serum levels of IgG4 against common food antigens in healthy people.
Common occurrence of asIgG-4 against food allergens in healthy persons (without any symptoms which could suggest allergy or food intolerance) argues against the possible participation of these antibodies in the pathogenesis of food allergy.
Even YorkTest acknowledges that their (arbitrary scale of) measurement of IgG levels is not related to the alleged severity of the alleged food intolerance that they allegedly diagnose with their blood test despite the informed opinion to the contrary of the above linked learned bodies of opinion.
We should also mention that the commonest cause of the inflammation outlined by Holford is smoking, alcohol consumption, the ratio of fatty acids that are consumed, obstructive sleep apnoea, intermittent hypoxia and various other lifestyle factors. Oddly enough, obesity is itself pro-inflammatory, and it is probable that adipose tissue stimulates the release of various inflammatory biomarkers.
It’s very unfortunate that Patrick Holford stops at naming two and we don’t have his insight into just what type of inflammation he is claiming to be influenced by IgG rather than a portmanteau of lifestyle and other factors. He has named a cytokine (tumour necrosis factor alpha) and a chemokine (C-reactive protein) but what about cell adhesion molecules such as intercellular adhesion molecule-1 and selectins, other cytokines such interleukin 6 or chemokines such as interleukin 8? Do these not count in the Holford Pantheon of Inflammatory Demons?
Increased inflammation also increases water retention and bloating, as well other classic signs of food intolerance, including aching joints, headaches, blocked nose, IBS and skin problems…[Delayed onset of symptoms means that] it isn’t easy to know what you react to just by observing how you feel after eating a particular food. Nor is it easy to work out what you’re intolerant to just by observing how you feel by short-term elimination of the food because some people get withdrawal symptoms when they elminate certain intolerant foods. To make matters worse some potential offending foods, especially wheat and milk, have an immediate pay-off by producing opiod-like chemicals called gluteomorphins and caseomorphines that make you feel good so…The same is true with sugar which, in the short-term, promotes energy, but actually encourages inflammation and weight gain in the long-term.
Hard to know where to start here. Those symptoms are common and they may or may not be related to what people experience as food intolerance – it does not, however, follow, that their symptoms are related to their IgG levels or that IgG levels are an appropriate method for diagnosing food intolerance. Given that Patrick Holford and other similar writers list more than a hundred ill-defined symptoms, the usefulness of this shopping list is meaningful only to those who are medicalising human experience and seeking to sell a test and solution for it. Dr Peter Jung gives a good potted overview of allergies and appropriate interventions and diagnosis based on best practice guidelines. Jung notes that, “Allergies are complex and can be confused with COLDS as they present very similarly”.
There is no clear indication that there is any link between musculo-skeletal pain, mood and the perception of food intolerance, even for people with irritable bowel syndrome: Perceived food intolerance in subjects with irritable bowel syndrome – etiology, prevalence and consequences.
There were no associations between the tests for food allergy and malabsorption and perceived food intolerance. Perceived food intolerance was unrelated to musculoskeletal pain and mood disorders.
Returning to Holford’s list of assertions, the fact that some people with a genuine food intolerance might get some withdrawal symptoms on ceasing to eat a particular foodstuff is neither here nor there, particularly when this ‘risk’ is unquantified. It is not a sufficient reason to abandon the only well-attested method for managing food intolerance that has high-quality clinical evidence behind it: the eliminate and challenge method is clinically validated. It should, however, be conducted with the guidance of a Registered Dietitian who can provide appropriate supervision and guidance, particularly if a number of food groups appear to be problematic and substituting for them needs to be handled carefully.
If Patrick Holford would address himself to the issue of understanding why Dr Andrew Wakefield’s research is flawed, then he might have a greater understanding of why his concerns about “gluteomorphins and caseomorphines” are over-stated and over-generalised at best.
As for the claim about sugar, see above for confounding lifestyle factors and we would argue that it is calories consumed in excess of expenditure that may be of greater relevance than unvalidated assertions about a particular role for sugar.
The more foods you eat that provoke an IgG antibody reaction…the worse it is for your health and your weight. Your immune system should not produce large amounts of IgG antibodies and, if it does, you are likely to suffer from some degree of general malaise and symptoms that just don’t seem to shift, as well as resistant weight loss.
There is no evidence for the first assertion and it is doubtful that even YorkTest would support this. This is one of the first times that we have seen the implicit assertion that all food intolerance has an adverse impact on weight. The remainder of that section is essentially unclear and unhelpful which renders it meaningless.
We would emphasise that there are repeated clinical indications that high levels of IgG4 may even have a protective function. See, e.g., this example of successful oral immunotherapy that increases IgG4 levels of a substance to which children were successfully desensitised from a confirmed IgE allergy: A randomized, double-blind, placebo-controlled study of of milk oral immunotherapy for cow’s milk allergy; or similar findings of increased IgG4 levels following desensitisation of IgE hazelnut allergy.
However, Holford continues:
For example, a recent study found that obese children had much higher IgG antibody levels than normal weight children. ‘Anti-food IgG antibodies are tightly associated with low grade systemic inflammation and with the thickness of carotid arteries’ the study authors report. The researchers conclude that having IgG antibody reactions may be involved in the development of both obesity and atherosclerosis, and that a diet based on eliminating IgG positive foods may be the way forward. Inflammation also affects the gut, potentially making the gut wall more leaky or permeable, which, in turn, may increase food intolerances.
For the claims about the gut wall, we would, again, refer Patrick Holford to the well-documented indications that Andrew Wakefield’s work is irreparably flawed. To give Holfordthe benefit of the doubt, it is acknowledged that gastro-enteric infections may make the gut wall more permeable for some time but Holford’s assertions are unhelpful unless he quantifies his estimate of how many people are likely to be affected by this on a medium to long-term basis.
Yes, the over-enthusiastic authors of the paper about obese juveniles and intima media thickness do make those claims with some occasional nuance. However, there is no prospective trial or even clinical support from other studies to support the wishful thinking that a diet that lowered (unspecified) levels of IgG against (unspecified) food substances would result in a reduction in intima media thickness which is no more than a proxy for atherosclerosis and cardiovascular problems.
[T]he impact of anti-food IgG in regard to metabolic changes which contribute to type 2 diabetes and atherogenesis, like elevated serum lipid levels and insulin resistance remains elusive. As described above, our study addresses a relationship between anti-food IgG, obesity, systemic inflammation and early atherosclerosis. Therefore our results need to be reproduced in larger cohorts, including adults with more advanced stages of atherosclerosis. However, once confirmed, our findings might have important implications in the clinical management of weight reduction and prevention of atherosclerosis. Especially, as described for the IBS above, a dietary elimination therapy based on the presence of IgG antibodies to food components may be indicated. Such a dietary therapy may be effective in reducing low grade inflammation and thereby preventing clinical consequences like type 2 diabetes and atherogenesis. [Emphasis added.]
We would point out that the same authors noted that Obesity reduces the bioavailability of nitric oxide in obese juveniles and it is not clear whether some of the subjects in that paper are also the subjects of the IgG paper in which there may well be a missing Bonferroni correction that might alter the trend or significance of any findings. However, this study does highlight the substantial number of factors that contribute to atherosclerosis and other findings that make it unwise to propose simple solutions such as the reduction if IgG levels through dietary manipulation.
Holford finishes his
advertisement post by advising his readers to buy a YorkTest blood test that he endorses, and to follow his recommendations that involve taking specific supplements that he endorses and are available from the manufacturer for which he works. Dictu mirabile again.
The House of Lords Report called upon responsible professionals to stop lending their support to IgG blood tests inter alia various other dubious tests because there is no clinical support for their claimed relevance or utility in the diagnosis of food intolerance. Patrick Holford continues to promote these very expensive IgG tests (they would be expensive at a quarter of the the price because they have no demonstrable clinical value) and claims that they have diagnostic value for food intolerance.
Mundus vult decipi, ergo decipiatur. But please, don’t suborn science to support the deception.