Immune Defenses Exist as Plants in the Soil of the Bowel Contents
Majid Ali, M.D.
A Bowel Ecology Series Article
The ancients seemed to have known this intuitively. We seem to have taken a very circuitous route to grasp this most fundamental of all aspects of the immune system. I remember that the hakim (folk-doctor) in my village always prescribed laxatives for a headache. He prescribed remedies that seemed to work on the bowel for problems of the skin, joints, liver and other organs. Of course, I, then a medical school student, found it very amusing. It never occurred to me then why these folk-doctors would prescribe year after year remedies that couldn’t work. More important, from my present perspective, I never wondered why people accepted those remedies year after year if they afforded no relief. I was into the science of medicine then. I wasn’t into finding out what worked and what didn’t. Nor did I ever doubt the science of my professors who doled out prescriptions for drugs by the dozens for sheer symptom suppression. That was then. And that was poor Pakistan. Now I question the science of an average American family practitioner when he prescribes drugs for chronic bowel symptoms. How scientific is his use of antacids for symptoms of burning or pain in the pit of the stomach? How scientific is his use of antispasmodic drugs for abdominal cramps? How scientific is his use of antidiarrheal drugs for diarrhea? How scientific is his use of steroids for inflammatory bowel disorders? Steroids suppress the immune system. How scientific is it to further suppress the immune system for problems caused by an errant immune system in the first place? How scientific is the use of anti-inflammatory agents, anxiolytic drugs, antidepressants, antispastic agents, antihistamines, and, of course, broad-spectrum antibiotics for treating various types of bowel disorders that we — by our own admission — do not understand the causes of?
Be Kind to your bowel so it can be kind to you.
THE BOWEL PERPLEXES A PATHOLOGIST
How many different things can the bowel do? It cramps. It obstructs. It turns and twists. It ulcerates. It bleeds. How does the bowel know when to cramp and when to obstruct or bleed? And when to turn and twist?
For many years I have studied a host of clinical syndromes in which the symptom-complexes can be related to events occurring in the bowel. As a hospital pathologist, I have had the opportunity to examine more than 11,000 bowel biopsies during the last 25 years. Every time I peered at a bit of bowel through a microscope and saw inflammation — colitis in common jargon — I wondered where and how it might have started. We pathologists know quite a bit about how a damaged bowel looks, but we know little, if anything, about the initial energetic-molecular events that set the stage for tissue damage. What is the cause of ulcerative colitis? Pathologists will tell you it is not known. What is the cause of Crohn’s colitis? The answer: unknown. What is the cause of irritable bowel syndrome and spastic colitis? Unknown. What is the cause of microscopic colitis and collagenous colitis? The answer is the same.
Why is it that we do not know the cause of any of these types of colitis? The reason is we search for answers in the damaged structure after the fact rather than in the events preceding the damage. None of these “diseases” can be understood except with ecologic thinking.
During the early 1980s, my research colleague, Dr. Madhava Ramanarayanan, and I introduced the micro-elisa assay for allergen-specific IgE antibodies. This research interest and several subsequent studies gave me important insights into immune and nonimmune events that inflict tissue injury. It also raised serious questions about many of the prevailing concepts regarding the role of food and mold allergy in the causation of numerous bowel disorders. As a clinician, I have cared for a fairly large number of patients with autoimmune and immunodeficiency syndromes. These microscopic, immune, molecular, and clinical observations — as disparate as they appeared in the usual clinical setting — began to take coherent and integrated forms before me. I began to recognize that events taking place in the bowel were clearly related to many clinical syndromes that seemed to have nothing to do with the bowel according to the prevailing concepts of pathogenesis of disease. The single most important insight into the workings of the human immune and nonimmune defense systems for me has been this: The integrity of human molecular defenses cannot be preserved except through preservation of the gut ecology. My clinical work with chronic fatigue states allowed me to test and validate this fundamental concept with therapies founded on my view of injured bowel ecosystems.