Testable theory
Before Dr. Spiegel “got up the courage” to submit his paper, he sent it to leading IBS researchers in the United States to get their honest opinion, he said.
“To my surprise, they wrote back and said this makes sense. And a few said this could have implications for other diseases,” he said in an interview.
Some of his patients with IBS have told him how the paper resonates and the specific ways they have noticed the impact of gravity and related air pressure on their IBS symptoms.
Some have reported that their symptoms get better when they scuba dive but worsen when they get out of the ocean; others said they feel much better up in the mountains versus at sea level; another said doing a headstand during yoga eases their GI symptoms.
“These may just be anecdotes, but they’re really striking,” Dr. Spiegel said.
His theory is not meant to replace any of the many existing theories of IBS, Dr. Spiegel emphasized. Rather, it’s an attempt to pull together the different theories under a single, potentially unifying explanation.
His paper includes a list of research projects that might help explore the gravity theory of IBS.
“It may be that none of this ends up being true, or bits and pieces of it are kind of true,” Dr. Spiegel said.
A research challenge
Dr. Spiegel has given researchers an “intriguing and interesting thought experiment and kind of a challenge to go out there and determine whether or not this hypothesis may actually be true,” Millie Long, MD, co–editor-in-chief of the American Journal of Gastroenterology, said in a podcast.
Dr. Long, a gastroenterologist and professor at the University of North Carolina at Chapel Hill School of Medicine, encouraged listeners to “dig deep into this hypothesis.”
The gravity hypothesis is provocative, “but the best thing about it is that it is testable,” Shelly Lu, MD, director of the Division of Digestive and Liver Diseases at Cedars-Sinai, Los Angeles, said in a news release issued by the medical center.
“If proved correct, it is a major paradigm shift in the way we think about IBS and possibly treatment as well,” said Dr. Lu.
Also weighing in, Brian Lacy, MD, PhD, a gastroenterologist with the Mayo Clinic, Jacksonville, Fla., noted that “our understanding of the etiopathophysiology of IBS has evolved over the past 50 years.”
“Once thought to be a psychiatric disorder (‘nervous colitis’) or a disorder simply of gut spasms (‘spastic colitis’), we now understand that symptoms of IBS develop for a multitude of reasons, including alterations in the gut microbiome, changes in gut sensation and motility, and modulation of the brain-gut axis, to name just a few,” Dr. Lacy said in an interview.
“Dr. Spiegel’s intriguing manuscript opens the door for us to think about IBS in a completely different way,” said Dr. Lacy.
“His novel hypothesis is a superb challenge to researchers and clinicians who can directly test his theory with a number of intriguing experiments. The results of these experiments may completely change the treatment paradigm for IBS patients,” Dr. Lacy added.
This research had no financial support. Dr. Spiegel and Dr. Lacy report no relevant financial relationships.
A version of this article first appeared on Medscape.com.