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onsdag, 01-12-2021

Barry Blackwell’s comment

Hector Warnes: The gut-brain axis

      

             I read Hector Warnes' erudite and thought provoking posting on the gut-brain axis and would like to share some anecdotal and non-scientific experiences of my own.

       I had a peculiar upbringing in India during the Second World War when, after a bout of amoebic dysentery in pre antibiotic days, I was sent away from Calcutta to boarding schools in the hill country hundreds of miles from home and parents. My response to unacknowledged “stress” was abdominal pain which persisted for a few days and remitted spontaneously, frequently diagnosed as “abdominal migraine."

       In medical school neuroanatomy class, I learned that the brain and gut both developed from the neural crest with shared neurochemical properties.

       In 1962, at age 28, I discovered the hypertensive interaction between MAOI and tyramine containing foodstuffs as a first year resident at the Maudsley. During a psychopharmacology fellowship I became interested in the absorption of amines from the gut into the blood stream and learned of Blaschko’s work on the distribution of tyramine oxidase (later monoamine oxidase) throughout the body, mainly gut and brain.

      I also became acquainted with Metchnikoff’s work on intestinal “autointoxication” and the controversy it provoked in Britain during the early 20th century. I read of the conference convened by the Royal Society of Medicine (in 1913, if I remember correctly) to discuss the topic. Arbuthnot Lane, surgeon to Queen Victoria, played a dominant role as someone who removed the colon for chronic constipation and other intractable “psychosomatic” disorders attributed to autointoxication. This was probably the basis for Bernard Shaw’s play, The Doctor’s Dilemma, when Sir Colenso Ridgeon removes the “nuciform sac” for similar clinical and financial reasons.

       After migrating to America in 1968, I ran the Psychosomatic Unit at the Cincinnati General Hospital (developed by George Engel) where I recruited and collaborated  with Bill Whitehead, a talented physiological psychologist. Most of our work was on anxiety disorders, hypertension and the use of benzodiazepines, but we also published a paper on illness behaviors in patients with Irritable Bowel Syndrome (IBS) and peptic ulcer (Whitehead et al. 1982). This suggested an alternative or supplementary etiology to the psychodynamic theory of unfulfilled dependency needs.

       When I left Cincinnati Bill was recruited by Johns Hopkins and went on to have a distinguished career, inviting me to give an opening talk to a Conference of gastroenterologists at the NIH. I was surprised at the pessimism they displayed about finding a drug to treat IBS, so I encouraged them by reminding them about schizophrenia before the discovery of phenothiazines and the fact that the gut and brain  shared an embryologic etiology.

       Late in life (after 75), I developed troubling diarrhea and occasional fecal incontinence which my internist and a G-I consultant diagnosed as late onset IBS that I did not believe, but was totally cured within two weeks by over-the-counter probiotics. A remedy I have since recommended with benefit to some friends and fellow residents. I seem to remember that some enzyme systems diminish with age. 

       Since that time much of the work you cite so well has provided a more complete and complex  analysis of the biochemical and clinical links between the brain and gut to the benefit of patients suffering from disorders of these interacting regions, sometimes responding to similar drugs.

      Thank you for sharing that on the INHN website. 

 

Reference:

Whitehead WE, Fedoravicius C, Wooley S, Blackwell B. Learned illness behavior in patients with irritable bowel syndrome and peptic ulcer. Digestive Diseases and Science. 1982; 27; 202-8.

 

November 2, 2017