Irritable bowel syndrome = irritable immune system?
How your IBS may be linked to your autoimmune disease
Autoimmune disease is popping up doctors’ offices more often now than it ever has. Over the past 30 years alone, the rate of diagnosis of various autoimmune diseases has increased an average of 5.9% per year – it may not sound like much, but that is substantial. What has changed? There are a handful of theories, from lack of proper identification in the past, to new chemical exposures, changing genetics, the food supply etc, and they likely all have some small part to play.
I would like to shed light on one of these potential contributors, not because it is any more important than the others, but because there is something you can do about it. “Genetics loads the gun and environment pulls the trigger” - AKA if you can identify this pattern in yourself and successfully do something to change it you may be able to drastically affect your symptoms, or prevent the pull of the trigger in the first place.
IBS – coincidence or not?
“You have IBS, you’ll just have to live with it.” How many of you have heard this before? How many of you are also dealing with an autoimmune disease like type 1 diebetes, rheumatoid arthritis, thyroid diseases, MS, lupus etc? According to a study by Ford, et al if you have a functional gastrointestinal disorder (like IBS, acid reflux, or constipation), you are more likely to have an autoimmune disease than if your digestion was functioning normally. Other studies have suggested a similar correlation, so we know it’s on the radar now, but how exactly is this possible?
Multiple theories on the Digestion – Immunity link:
Until recently, IBS was somewhat of a mystery diagnosis. No one really knew why it happened, or what to do to fix it. Structurally there was nothing wrong with the digestive system, it just didn’t seem to work right, and it was left at that. Recent years of IBS research have revealed a connection to what you eat, and the activity of the microbes living in your gut, and there is new information being discovered still.
One group of researchers has even noted a possible state of immune activation in people with IBS. Whether the immune activation caused the IBS, or is a result of the IBS is still unclear, but this does tell us there is intestinal inflammation present. Think of a time you injured yourself and watched your skin swell up, all red and inflamed, and now picture that to some degree in your intestines. Naturally, you can understand how intestinal inflammation could disrupt normal digestive processes, impairing your normal ability to properly use your food and eliminate the waste. Again, we don’t know for sure if the immune activation in IBS is cause or affect, but at the very least we can say that it puts you in a more vulnerable state where your risk of triggering an autoimmune process is higher. If you happen to have all of those other contributing factors present, this may be the pull of the autoimmunity trigger.
What about food poisoning? Gastroenteritis has the ability to disrupt your intestinal microbial community when it hits, and in some cases this may be another potential trigger of an autoimmune disease. It is commonly known that some pathogens are associated with cross-reactivity. This means that parts of their cells look very similar to some parts of your cells, and as a result, your immune system gets confused and attacks healthy tissue, thinking it is an invader.
One research study has discovered this characteristic in a pathogen responsible for food poisoning (Campylobacter jejuni), where the immune system gets confused between the bug and a part of your intestinal lining. As you can imagine, when your immune system attacks, this results in inflammation, and again can set you up for a state of uncontrolled immune activity (autoimmunity).
Is there a link to SIBO, IBS and Autoimmunity? You know I had to mention it. This is a whole separate discussion, but my own personal theory currently is that the symptoms of SIBO may not always be due to a simple overgrowth of bacteria, but more an overgrowth of certain species and an undergrowth of others that disrupts the normal balance of your intestine and has the downstream effects we attribute to SIBO and IBS, and as explained above this may have autoimmune consequences. A small distinction, but I digress… To take it one step further, this change in the normal microbial community affects your intestinal immune centres (called GALT and MALT) which are responsible for developing tolerance to foreign substances. Basically, your bacteria normally train your immune guard dogs to know which particles/cells are the good guys and which are the bad guys, and if those microbes suddenly take an extended coffee break, that training can sometimes be lost.
One last tidbit of info for you: That booming trend of wheat sensitivity may actually have some effect on your immune function. Carroccio et al noted a significant correlation between the presence of ANA antibodies in the blood (a disease marker for a handful of autoimmune diseases) and the presence of a non-celiac wheat sensitivity (diagnosed based on a specific set of criteria, see study for more info). It turns out if you fit the criteria of having a non-celiac wheat sensitivity, you are more likely to also have an autoimmune disease according to these researchers.
Interestingly enough, they also compared these findings to patients with IBS, and the correlation was stronger in those with non-celiac wheat sensitivity. So it appears there is more than one way that your digestion and your immune system are related.
Regarding food sensitivity testing: I can’t comment on the accuracy of all of the testing out there to identify wheat sensitivity, but I can stand by the old tried and true method of elimination and challenge. While you’re eating it, you feel bad (be that digestion, joint pain, brain fog etc). You stop eating it for an extended period of time to allow full clearance from your body, your symptoms go away and you feel nice! You start eating it again and your symptoms come back. Conclusion? Wheat doesn’t agree with your immune system.
OK so I’ve just brain-dumped a pretty large amount of information here, but don’t freak out. Remember I said I wanted to talk about this because it happens to be one of those environmental factors you can change. You have the ability to make a difference in your health, and this knowledge might just be the stepping stone you need to get you closer to a life less controlled by your health.
If you think you need more help, feel free to seek guidance from a health care professional you trust to work with you towards your goals.
Al-Khatib, K. Lin, H. Immune Activation and Gut Microbes in Irritable Bowel Syndrome. Gut Liver. 2009. 3(1): 14–19.
Anonymous. Autoimmune Disease Statistics. American Autoimmune Related Diseases Association, Inc. 2018. Retrieved from https://www.aarda.org/news-information/statistics/
Carroccio, A. et al. High Proportions of People With Nonceliac Wheat Sensitivity Have Autoimmune Disease or Antinuclear Antibodies. Gastroenterology. 2015. 149(3): 596–603.e1
Ford, A. Talley, N. Walker, M. Jones, M. Increased prevalence of autoimmune diseases in functional gastrointestinal disorders: case–control study of 23 471 primary care patients. Alimentary Pharmacology and Therapeutics. 2014. 40(7): 827-834
Lechin, F. van der Dijs, B. Irritable Bowel Syndrome, Depression, and Th-1 Autoimmune Diseases. Digestive Diseases and Sciences. 2007. 52(1): 103–104
Lerner, A. Jeremias, P. Matthias, T. The World Incidence and Prevalence of Autoimmune Diseases is Increasing. International Journal of Celiac Disease. 2015. 3(4): 151-155
Pimintel, M. et al.Autoimmunity Links Vinculin to the Pathophysiology of Chronic Functional Bowel Changes Following Campylobacter jejuni Infection in a Rat Model. Digestive Diseases and Sciences. 2015. 60(5): 1195–1205