Irritable Bowel Syndrome (IBS) : Is it Autoimmune?

Read in 13 minutes

This blog post is a video that I recorded recently. The text below is the transcript of the video. I thought some of you may like to read rather than watch the video but the transcript takes 13 minutes to read! So reading the transcript versus watching the video will save you 2 minutes!

 

https://youtu.be/-hUP0Ie6g9Q

00:06               Hi,  I’m Dr Shabnam Das Kar a specialist in Functional and Metabolic Medicine from India. Welcome to the channel autoimmunity with Dr. Kar. So, uh, today’s the first episode and I’m going to discuss a very common condition that I come across in my patients called IBS, irritable bowel syndrome, and I’ll use a PowerPoint to share some of the IBS. So obviously as a functional medicine doctor, my perspective is going to be that of a functional medicine doctor. So they are going to look at IBS from, uh, from the perspective of through the Functional Medicine Lens. So what do I mean by that? Sorry. So through a functional medicine Lens, now obviously this is a little different from what traditional medicine focus because in traditional medicine, what would we do when we come across a patient with IBS? IBS is a condition where obviously if you’re somebody who’s suffering from that, you know what the symptoms are.

01:11               The commonest symptoms a week in a patient with IBS are pain, abdominal pain, the pain may be sometimes described as cramp, like sometimes it is sort of like a chronic pain. And this pain is usually something that is ongoing. So it depends, it maybe two months, three months, four months, sometimes much longer than that, and sometimes some of you described the pain as being relieved after, uh, going to the toilet. So after defecation, your pain is relieved. Now IBS is described as usually three different types. So IBS -D, which is diarrhoea predominant. So you may be having diarrhoea, you may be having constipation, you may be having a combination of both, which is IBS-M, mixed type. And IBS-C is the one where there is predominantly constipation. So you will have difficulty passing stools. Stools are hard. Now in a IBS diarrhoea where the predominant symptom is loose stools, sometimes you may have this terrible urgency where you need to use the washroom just after eating food.

02:22               So quality of life suffers quite a lot. Some of you also have bloating. You may have discomfort, so a lot of different symptoms. So what do I mean when I want to say that? Uh, when I, when I say that I’m going to look at it from a functional medicine Lens. So these are the different areas that we usually look at, and I’m going to cover them over the next few series of videos. But today the chief question I want to answer is because my areas of focus are autoimmunity and metabolic dysfunction, so is IBS and autoimmune condition? So it turns out now this was a paper that Dr. Mark Pimentel has published. This was in 2016, Dr Pimentel, he is a gastroenterologist and he’s Canadian, but he works at the Cedars Sinai Hospital in Los Angeles and many of you are familiar with Dr Pimentel and his work in Small Intestinal Bacterial Overgrowth causing IBS.

03:22               So what he found out is that yes it is a certain type of IBS could be auto immune. Now that is not a surprise because those of us who work in auto immunity, we, we say that, you know, most diseases are autoimmune until proven otherwise. So what does Dr Pimentel mean when he says about autoimmunity, in irritable bowel syndrome. Now IBS, all types of IBS and not necessarily autoimmune, but what Dr Pimentel found is in a certain subsection of people who have developed IBS following a gastrointestinal infection, that means following a gut infection, so you had acute gastroenteritis, maybe traveling at traveller’s diarrhoea or some kind of an infection like that and you probably had fever and you know, maybe vomiting after that you developed a pain and all these other symptoms of IBS. So that is called. That is an entity called post infection IBS. So normally, traditionally, what are you told?

04:33               You told that there is no one specific test for IBS, which is true because essentially the diagnosis is made based on your symptoms and by the time any of you come to me, you’ve already met the gastroenterologist, so he has already, he or she has already done the basic work. You’ve had the colonoscopy to find out if there is any problem, you might have had a biopsy and many of you have already been screened for Celiac disease. And I will talk about all of these briefly later on where the CELIAC disease and irritable bowel syndrome could coexist. So you’ve already had all that workup done and then you decide that you want to find out some more whether there is something else you can do because you are not 100 percent. Okay. So this is essentially post infectious IBS like I described before. You had traveller’s, traveller’s diarrhoea, maybe you had some kind of a gastrointestinal infection, which in countries like India is not uncommon.

05:36               And uh, so that is predominantly IBS, diarrhoea. So this autoimmunity does not necessarily apply to people with IBS, constipation, IBS-C, however, there have been some studies where they have found an auto antibodies to IBS-C as well. But I won’t go into all those details because if you are somebody who has IBS, what you are interested in knowing is what can you do. So is it important for you to find out whether you have an autoimmune IBS? That is a question I will answer. So Small Intestinal Bacterial Overgrowth is associated with IBS and that is something that Dr Pimentel has done a lot of work in and he is the person I learned a lot from, from his books, from his papers, from listening to his videos. So, uh, many of you have probably read his book called IBS Solution. So what does this, what does he mean by what do anyone.

06:37               Does anyone mean by Small Intestinal Bacterial Overgrowth? Most of you are familiar that there are these bacteria in your gut. Now most of the bacteria occupy your large bowel. That is your large intestine. So the small bowel or the small intestine is not supposed to have bacteria in normal circumstances. However, in certain conditions your small bowel may be, you know, containing bacteria, which is usually more so overgrowth, essentially more than that, there should be. So that itself can cause a whole bunch of problems and IBS is one of them. And again, what are the symptoms of SIBO? So SIBO symptoms sometimes overlap with the symptoms of IBS. So again, bloating, pain, diarrhoea, you know, things like that. You could also have belching, so Small Intestinal Bacterial Overgrowth and IBS are quite intimately related. So Dr Pimentel says if you do not treat the SIBO, your IBS will not go away.

07:45               So what did he find the from his studies, he found that there were two antibodies. Now, as many of you know, for any auto immune condition to be diagnosed, you need an antibody to be present. So what’s were these antibodies, one was the anti-Cytolethal distending toxin and the second one was anti vinculin antibodies. Now don’t bother if you don’t remember the names. So obviously most of you in particularly my audience in India, you want to know can you get this test done? Yes, you can get the tests done in the US, it’s called IBS. Um, I can’t remember the name now, but it’s done by a lab in Massachusetts, but as far as I know, the anti Cytolethal, distending toxin antibody and the anti-vinculin antibody test is not available in India yet. Yeah, it’s a blood test. So what happens if you find out whether you have autoimmune IBS or not?

08:40               Well, as a functional medicine doctor, truthfully I don’t need to necessarily tests you to know what, what type of IBS you have because my, my approach is a functional medicine doctor would always start with food first and I’m going to talk about that a little bit later, but what does it mean to have post infections IBS in India. So this is a paper by Dr Uday Ghoshal, who is from a very prestigious institution in India and he’s got a lot of papers on IBS and several other gastrointestinal conditions because gastrointestinal infections like acute gastroenteritis, these are fairly common in countries like India where we still have a relatively larger burden of waterborne diseases. So what do I mean by waterborne diseases? That means essentially the drinking water gets contaminated by faecal matter and that faecal matter can come from somebody who has an infection. So therefore the water gets contaminated and you won’t  know that seeing the water so that can cause gastrointestinal infection.

09:49               So in, uh, in the Indian population or what Dr. Ghoshal has found is there is another condition called post infectious malabsorption syndrome. So you may not be absorbing a lot of your nutrients. Now again, I don’t want to go into the details of the medical minute about what testing you should do to see whether you have fat malabsorption or you have nutrient malabsorption, but by doing a blood test for vitamin B 12, Iron, all these things you can know whether you have you nutrient deficiencies. However, sometimes the malabsorption syndrome or your nutrient deficiency may not be because of malabsorption alone, because as is well known, a lot of people in India are vegetarians and you’re culturally vegetarian, vegetarian from birth. So people who are vegetarians have a much higher incidence of B 12 deficiency. So it is not easy to differentiate whether it is your gut which is not absorbing the vitamins.

10:53               B vitamins or your diet itself doesn’t contain the B vitamins. So if you are vegetarian and you do not supplement with a B 12, then very likely you are going to be deficient. And B 12 deficiency is one of the things that I’m deficiency is very common in India even amongst men because normally our deficiencies considered to be a women’s disease. And I was an OBGY before, so we used to get a lot of iron deficiency anaemia in women, but it turns out even a lot of my men patients have iron deficiency, so obviously it’s not just one or two nutrient deficiencies, multiple deficiencies. So the malabsorption syndrome, which back in the days was also called tropical sprue, is also another common thing that happens because in countries like India, there is a background of, you know, chronic inflammation of the gut in a lot of people because of the water contamination.

11:50               So what type of infections can cause this when  we are talking about the post infectious IBS, so it could be bacterial, it could be viral, it could be parasitic to. And for those of you who are not, who don’t live in countries where there’s a problem of water contamination, you have to keep in mind traveller’s diarrhoea. Many of you travel a lot nowadays, so traveller’s diarrhoea is another thing to keep in mind. So it could be that you had a GI infection while you are on your holiday and then you came back and you had IBS. And another interesting thing is how long do do these, you know, does the effects last  .And what had happened in Walkerton, so Walkerton is  a place in Ontario Canada. So in the year 2000, there was a massive flood there and the water got contaminated. Now for people, for my listeners in India, you’re probably wondering how could that happen?

12:46               But it’s, it’s, it’s, uh, this was, uh, this was a natural calamity and massive, massive disaster. A few people lost their lives unfortunately. And a lot of the elderly. So in countries like Canada, you can drink tap water because in India you know that we don’t usually drink tap water unless we’ve boiled it or put it through a filter. And if you’re traveling you usually drink bottled water. We won’t ever drink tap water directly from the tap. Versus in countries like Canada and the US and these countries, you can actually drink tap water and not worry about getting a waterborne disease. So unfortunately there was water contamination with E. Coli and another called Campylobacter Jejuni So what they found is eight years after that event, of course a lot of people had diarrhoea and they had vomiting and you know all those things, even after eight years, some of the symptoms persisted.

13:48               And another very interesting fact was some of these people who were in Walkerton at that time and had taken the contaminated water, they also had mood disorders like depression and anxiety later on. So you know that we talk about the gut brain immune system very being very intimately related. So some of you with IBS, you’ve gone to your doctor and you’ve been told, oh, it’s all in your mind. Now mind and brain are different things. So it’s not like a personal shortcoming. There is bio biology behind all of this. So the gut brain and the immune system are intimately related and the gut brain immune system is related also to mood disorders. So it’s not just, you know, oh, it’s all in your mind kind of thing there. There are actually reasons behind that. So that is my point. If you’ve been told it’s all in your mind, well it’s probably not in your mind.

14:43               It’s, it’s all in your brain, gut and immune system that are in, that are influenced. But my point is there are solutions available and this is not something you have to live with all your life. Now, the modalities of treatment may differ in each one of you and I, you know, kind of talk about small different aspects of this whole thing over a period of a few videos. And, uh, in case you have any questions, please feel free to email me at info@betterforlife.in. So that’s all for today on the first edition of Autoimmunity With Dr Kar. Bye now!