Irritable Bowel Syndrome and Leaky Gut

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

Our digestive tract is the largest entry site to foreigners, especially microorganisms and proteins from foods that our body may think are invaders. The digestive tract lining is vulnerable to stress, foreign food proteins and bad bacteria. The lining of the digestive tract is protected by a single layer of cells called 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 diagnosed digestive disorder may be an inflammatory disease of the bowel, at least in part caused by and/or aggravated by stress and leaky gut.

Irritable bowel syndrome is the most common diagnosed gastrointestinal disorder. However, as a syndrome it is a diagnosis of exclusion based on a collection of symptoms. Until recently it was not felt to be an inflammatory condition of the bowel but more recent information suggests that at least subtypes of IBS are inflammatory in nature. It is now being proposed that diarrhea predominant irritable bowel syndrome (D-IBS) be thought of as an inflammatory bowel disease that is either caused or at least aggravated 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 an increase of a type of white blood cells in the intestinal lining. The found mildly increased intra-epithelial lymphocytes (IELs) and marked increased mast cells in patients with diarrhea predominant IBS. These individuals also had higher levels of psychological stress than normal volunteers.

The mast cell, an immune/allergy blood cell, is now linked to many cases of IBS.

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.

Mast cells cannot be seen on standard microscopic slides from intestinal biopsies.

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.

Our digestive tract is under constant attack and this could be causing you to be ill chronically?

Our digestive tract is now under constant attack and is frequently failing as a defensive barrier. Enemies of our digestive tract 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.