Thursday, October 11, 2007

Mast cells, leaky gut, gluten, and IBS linked?

Digestive tract is the largest barrier to outside attack and only one cell thick.

Our digestive tract is the largest defensive barrier to outside attack. It is vulnerable to stress, foreign food proteins and bad bacteria. The lining of the digestive tract is protected by a single layer of epithelial cells. In the small intestine these are called enterocytes and in the colon they are called colonocytes. The small intestine is long enough to wrap around your waist about eight times whereas your colon is about as long as you are tall.

Irritable bowel syndrome (IBS), the most common digestive disorder, may be an inflammatory disease of the bowel caused by stress and leaky gut.

Irritable bowel syndrome is reported to be the most common gastrointestinal disorder. We need to start thinking of diarrhea predominant irritable bowel syndrome (D-IBS) as a disease caused by stress, food and or bad gut bacteria induced intestinal irritation resulting in leaky gut. In Gut, Guilarte et al. from Barcelona, Spain report finding mildly increased intra-epithelial lymphocytes (IELs) and marked increased mast cells in patients with diarrhea predominant IBS who also had higher levels of psychological stress than normal volunteers.

Allergy cell, the mast cell, may be the link to many causes of IBS but requires special intestinal stains.

A stress-mast cell axis has been proposed for possible cause of IBS. Mast cells release chemicals in response to triggers such as allergy and parasites typically in the body but have been linked to stress. Increased mast cells have been found in the large and small bowel of patients with IBS especially when a stain for tryptase, an enzyme specific for mast cells, is performed.

Mast cells can cause leaky gut resulting in increased pain and diarrhea in IBS.

Mast cells can increase intestinal permeability (cause leaky gut), increase visceral sensitivity (increased pain sensation and intensity) and increase motility (contractions of the intestine). This results in diarrhea and abdominal pain.

Increase in lymphocytes noted possibly explain the link to gluten noted in IBS.

The finding of increased lymphocytes or intraepithelial lymphocytosis in the patients of this most recent study was of particular interest to me. I am seeing this very commonly in my patients who do not meet criteria for celiac disease yet respond to a gluten-free diet who have previously been labeled IBS. Sometimes I find this in small intestine biopsies and sometimes in the colon of patients. Some have had a colonoscopy in the past but no biopsies were done because the colon "looked normal". In a recent post I discussed a study that noted IBS defining symptoms in over 50% of patients with microscopic colitis.

Is your digestive tract under attack and causing you ill health?

If you are not experiencing optimal health, consider the proposition that our digestive tract is now under constant attack and is frequently failing as a defensive barrier. Our enemies increasingly appear to be genetically modified or prepared foods and bad bacteria. The bad bacteria have taken over due to excess hygiene practices and liberal use of antibiotics. Our defense must include consideration of dietary changes such as reduction or elimination of gluten, eating organic foods, and the liberal use of probiotic supplements.

Copyright © 2007, The Food Doc, LLC, All Rights Reserved.

Diarrhoea-predominant IBS patients show mast cell activation and hyperplasia in the jejunum. Guilarte, M et al. Gut February 2007; 56:203-209.

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