Many Patients With Irritable Bowel Syndrome Have Atypical Food Allergies Not Associated With Immunoglobulin E (2019) Fritscher-Ravens

Fritscher-Ravens A, Pflaum T, Mösinger M, et al. Many Patients With Irritable Bowel Syndrome Have Atypical Food Allergies Not Associated With Immunoglobulin E. Gastroenterology. 2019;157(1):109-118.e5. doi:10.1053/j.gastro.2019.03.046

https://www.gastrojournal.org/article/S0016-5085(19)34636-0/fulltext#articleInformation

 

Interesting study – it's about time researchers did some proper work on this problem. It can make people's lives a misery until they figure out their trigger(s), but it's been swept aside by far too many doctors as an 'internet ailment'.

 

Very interesting and important. Those with IBS and anyone with food allergies are so often treated as if it is a MUS. More evidence that MUS is a seriously flawed concept.

 

I echoed the need for more serious research on this, rather than the pointless rounds of inconclusive CBT research.

With me, avoiding certain food stuffs, drastically decreases the frequency of IBS, but I still have episodes associated with PEM and sometimes with migraines. Interestingly with migraines not associated with PEM or food intolerances, vomiting and/or an episode of IBS usually indicates the migraine is beginning to subside.

Though teasing everything apart can be confusing as some food stuffs cause simultaneously IBS, migraines and a worsening more generally of my ME symptoms. Also my food sensitivities can become more marked with PEM, and (though it is probable that my non celiac gluten intolerance started at the same time as the onset of my ME or just a month or so before the triggering viral infection) as my ME has deteriorated over the years additional intolerances have developed.

It has taken me decades to get my head around the interaction of PEM, the ME itself and food intolerances. This is not helped by the fact that the effect of the intolerances can be delayed, for example my caffeine related symptoms take four to six hours to kick in whereas gluten related symptoms takes almost exactly twenty four hours. In general services fail to equip us with tools to identify and manage the various triggers of our symptoms, other than pacing.

 

There's clearly growing evidence of a pathogenic origin for the broad concept of IBS. One of the things we are learning about COVID-19 is how good it is at opening up junctions, to leak through different places. It's getting even likely that it crosses the blood-brain barrier, a very good property to have for a pathogen.

A good pathogen will be good at surviving. It will cause as little damage as possible, just enough to survive and spread elsewhere. That requires opening up junctions, there's good evidence COVID-19 does that, as do other pathogens. Syphilis is famous for lodging itself in the brain. That means opening up backdoors and crossing many protections.

It would be natural for other stuff to leak along, even by simple sheer pressure. They just happen to be at the right place at the time a junction is opened up and slip through.

We know there is an increase in bacteria in the blood in some ME patients after exertion. Things that can leak through the blood and shouldn't be there are bound to cause a reaction. Probably not the same as an allergic reaction but still, it's a foreign presence against which the immune system must act.

But it's not a linear process, it does not follow a simple step-by-step recipe. Effects can be delayed. Very hard to observe. Very easy to miss.