Like Crohn’s Disease, Irritable Bowel Syndrome (IBS) is an untreatable, debilitating illness affecting 15-25% (some researchers estimate closer to 30%) of Americans. Unlike Crohn’s, it’s rarely fatal. However the chronic diarrhea and severe stomach pain associated with the condition can be just as disabling. The total annual cost of IBS (from medical expenses and days off work) to the US economy is estimated at $40 billion.

Research Linking IBS and Crohn’s

New evidence (related to DNA fingerprinting technology) suggests that IBS may actually be a mild, early form of Crohn’s – that eventually progresses to Crohn’s in later life. This hypthesis is based on three separate lines of research. The first relates to epidemiological studies showing high numbers of Crohn’s cases from age 13 to 30 and between age 50 to 70 – with very low numbers in between. The only explanation epidemiologists can find for such an unusual age distribution is that people between 30 and 50 are being given some other diagnosis – either IBS or a related condition called microscopic colitis – only to be later diagnosed with Crohn’s in later life as the illness progresses.

The second line of evidence pertains to studies revealing that Mycobacterium Avium Paratuberculosis (MAP) can be isolated from the intestines of IBS patients at almost equal rates as Crohn’s patients.

The third relates to similarities in the underlying pathophysiology (in other words how MAP causes the intestine to malfunction) of the three illnesses. There is clear evidence of dysfunction of the enteric nervous system (the complex web of nerves that regulate the passage of undigested food through the intestine). This seems to involve a problem with neurotransmitter receptors. In fact several drugs targeting serotonin receptors (the same neurotransmitter implicated in depression) have been patented for treatment of both IBS and microscopic colitis (and subsequently withdrawn from the market for dangerous side effects.

The potential link between IBS and MAP is very exciting because it raises the possibility that early treatment of IBS patients with evidence of MAP infection could prevent the development of full blown Crohn’s and severe intestinal damage that can only be corrected by surgical removal.

Public Pressure is the Only Answer

Obviously none of this can happen if the public and the medical profession are denied access to the dozens of new studies linking Crohn’s with Mycobacteria avium paratuberculosis infection.

In addition to warning parents about boiling milk (and water in “hot spots” in areas of intensive dairy farming), avoiding dairy products that can’t be heat treated and properly cooking beef, there needs to be public pressure on the FDA, USDA and the farm lobby to adopt compulsory regulations (the voluntary ones aren’t working) to reduce the level of MAP infection in cattle. The Australian model seems to be the most cost effective – in that mandatory testing and reporting is only required in areas where outbreaks of Johne’s Disease (the name for MAP infection in cattle) have been identified. However more aggressive education of American farmers regarding MAP prevention is also clearly indicated, as most European countries have found simple calf hygiene measures enormously effective in reducing outbreaks of MAP among their herds.

Examples of simple, cost-effective calf hygiene measures used in Europe include

• only purchasing bulls tested for MAP and demonstrated to be MAP free
• ensuring young stock are at least 2 years old prior to contact with adult stock
• changing bedding in maternity pens between cows
• avoiding manure contamination of feed and water sources
• only using colostrum from MAP negative animals and not pooling colostrum
• identifying and removing MAP super-shedders from herds

(tomorrow I will post links to research for readers who want more information – also some new research about links between MAP and Type I Diabetes in children)

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