Gut Wisdom

In autoimmune diseases like rheumatoid arthritis and multiple sclerosis, the immune system goes into overdrive and attacks the body. Although treatments have vastly improved, there’s still great mystery surrounding these chronic illnesses.

“We don’t know what causes them,” says Charles Bernstein [MD/85], the distinguished professor of medicine who directs the Inflammatory Bowel Disease (IBD) Clinical and Research Centre in the Max Rady College of Medicine.

“It’s the same mystery in different organ systems.

For nearly 25 years, the Winnipeg-bred Bernstein, 56, has led the university’s efforts to understand and combat IBD, a term that includes Crohn’s disease and ulcerative colitis. In IBD, the immune system attacks the lining of the intestines, causing symptoms such as diarrhea, pain, fatigue and weight loss.

In 1995, Bernstein’s research group created one of the first population-based databases of IBD in North America. It also established a voluntary registry of Manitobans with IBD. These two innovations made many ground-breaking studies possible. The multidisciplinary centre has also participated in clinical trials for drugs that have transformed the treatment of several autoimmune diseases.

Bernstein, a globally recognized IBD expert, has earned many honours. He recently received the Dr. John M. Bowman Memorial Winnipeg Rh Institute Award and reflected on nearly a quarter-century of made-in-Manitoba research.

Many people would view your specialty as unsexy. What led you to make bowel disease your life’s work?

I was very interested in how the gut works, and I have family members with IBD. I started my career at UCLA – a mecca for IBD. When I moved back to Winnipeg in 1993, we developed a gastroenterology research program here from scratch. I’m very proud of the extraordinary Manitoba researchers who have made our group so successful. We have a university environment where it’s very easy to collaborate. My perception is that there’s less individual competition here than at many universities.

While cramps and diarrhea may not be sexy, the thing that has become very sexy in medicine is studying the gut microbiome – the bugs within our bowel.

Your centre led the way in showing that Canada has one of the highest rates of IBD in the world. What can you say about the reasons?

People likely have some genetic predisposition to developing IBD, but we believe that 90 per cent of it is environmental. The disease has been around for almost 100 years in the developed world, and has only really emerged in the last 30 years in the developing world. As countries become urbanized and industrialized, changes in diet, certain types of drugs (such as antibiotics) and perhaps what’s in the atmosphere or in food additives may play a role.

Basically, we believe IBD is caused by an immune response to disturbance of the gut’s microbiome.

In the first year of a baby’s life, the gut microbiome and gut immune system are developing. If you derange the microbiome with antibiotics, it’s possible you’re going to impact the gut immune system, and that may set the stage for the development of IBD. One of our studies showed that kids with IBD were significantly more likely to have had antibiotics in their first year of life than kids without IBD. We also know that diet plays a key role in shaping the microbiome. What babies are fed in their first year of life may have an impact.

What are some of your other notable discoveries?

We collaborated with Stanford University on a landmark 2005 study published in the journal Science. The Stanford researchers examined gene sequences from the colon tissue of three healthy Manitobans to define the normal gut microbiome.

We’ve also shown that people with Crohn’s disease have an increased risk of bone fracture, and that people with IBD have a high risk of venous thromboembolic disease. These findings have led to changes in how patients are managed clinically.

Tell us about one of the studies you’re pursuing now.

We’re about to initiate a national study funded by a $25-million SPOR (Strategy for Patient-Oriented Research) grant. We’re going to examine the intersection between IBD and irritable bowel syndrome (IBS), the role of gut bacteria and diet in IBD and IBS, and how mental health impacts those diseases.