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If you are one of the more than 25 million people with irritable bowel syndrome in the United States, your symptoms have a better chance of getting worse at some point in the last two years. Or you may have developed symptoms for the first time.
“We have received reports of increased constipation, diarrhea and abdominal pain,” said Kendra Camp, a researcher at the University of Washington School of Medicine. He surveyed IBS patients with anxiety or depression about their experiences early in the epidemic. More than 90% reported increased stress and 81% reported increased anxiety. Another study sponsored by a pharmaceutical company found that half of IBS patients said managing their symptoms was more challenging and many reported an early onset of IBS in an epidemic.
“The epidemic has created an environment of uncertainty, isolation and low access to resources that people rely on for wellness,” said Susan Smith, a nurse practitioner at UCLA’s Integrative Digestive Health and Wellness Program. The center coordinates diet and stress management treatment approaches and helps Smith patients understand the brain-intestinal connection of IBS.
IBS was once thought to be an intestinal problem, but scientists now know that it can interfere with the nervous system, brain and intestinal interactions, leading to symptoms of IBS, including abdominal pain, gas, bloating and abnormal bowel movements. “There’s a constant response loop between the brain and the intestines,” Smith explained. Information flows along the vagus nerve, which connects the brain to the intestines, so what is happening in the brain affects the gastrointestinal system.
Find the trigger
Stress is a factor that can trigger symptoms or make them difficult to manage. Diet, sleep, exercise and social connections are also important. “All of these things play a role in digestive health,” Smith said.
Physicians also look for triggers such as infections or bacterial overgrowth that may require antibiotics, but Smith said the goal is to wrap all components in a holistic treatment approach.
Smith teaches a mindfulness course that can help patients reduce the anxiety associated with their symptoms. In 2020, a study of patients participating in an 8-week course called Mindfulness-Based Stress Reduction found that 71% of patients had a strong improvement in GI symptoms. “There has been significant improvement in quality of life and overall well-being,” Smith said. Participants were taught a variety of strategies to raise awareness of the present moment, limit anticipated anxiety, and close the response loop that may extend the unpleasant feelings and sensations associated with IBS symptoms.
“It was a life-changing experience for me,” said Vicky Mayer, 52, who took part in the study. He first noticed stomach problems in college, on and off, but his symptoms have gotten worse in recent years. “Every time I went out for dinner or lunch or coffee, I suffered a lot of anxiety and fear,” he recalls, assuming he would urgently need to find a bathroom or leave the restaurant. He avoided going out.
When her doctor recommended a Mindfulness class, she was hesitant. “I was probably the most suspicious person in the room,” he recalls. “I thought, ‘Oh, I have to lie down for an hour. I can’t keep my mind completely calm.'”
But after the class started, he got caught. “We practiced a variety of meditations, be it body scans, three-minute breathing exercises, or walking meditations,” Mayer said, adding that each of these techniques evokes a calm feeling and a new way to tune. A new way. His body.
Meditation did not change her symptoms overnight, but she began to feel control over her emotional reactions. He realized that most of his worries were due to thinking of the worst case scenario, such as the expected incident at an embarrassing restaurant. But, if he stayed in this moment, the situation was not really so terrible. And, instead of letting his mind weave a story about what might happen, he learned to rearrange his thoughts.
“I’m fine, there’s always a bathroom there,” he would tell himself if he went out for a meal, acknowledging that there would be no harm in excusing himself from the table. “Once I changed my mindset, my anxiety levels dropped a lot, and I was able to go through the meal with little to no problem.”
Studies show that mindfulness can enhance both attention and mental control. “If you have a better ability to control your attention, you can turn your attention to something that is more helpful,” Smith said, as Mayer learned.
Mayer says she’s feeling much better these days. “It’s incredibly powerful at how to change your mindset and look at its physical consequences in a positive way,” he says. And, he continues to practice meditation: “You can do one or two minute breathing exercises while standing in line at the grocery store.”
The power of proper diet
Changing what is on the menu is another key tool for people to manage IBS. “We’ve developed diet strategies that can be quite effective,” said William Che, a gastroenterologist at the University of Michigan, who documented the benefits of integrated care.
Michigan has had a dedicated GI nutrition program since 2007 “When I started talking about diet as an important part of treating IBS patients, people literally laughed at me,” Che said. “But now almost every gastroenterologist acknowledges that diet is an important part of the solution.”
Over the past 15 years, many studies have shown that dietary strategies can help control symptoms.
The FODMAP diet has received the most attention from researchers. Studies show that 52% to 86% of participants reported significant improvement in their symptoms after following a diet with gas and bloating reduction. The FODMAP diet requires the elimination or reduction of certain foods, including gluten, lactose, excess fructose (found in some fruit and corn syrups) as well as some nuts, beans and starchy vegetables. Researchers at Monash University in Australia have explained that the FODMAP diet is based on the understanding that certain compounds in our diet may not be fully digested or absorbed, so they may end up in the large intestine where they are fermented by intestinal bacteria. This results in gas and bloating.
“I saw the benefits in almost the first week,” said Karen Benningo of Northville, who was treated at the University of Michigan. She started the FODMAP diet last October and noticed that her energy levels improved significantly. “The extent and swelling went away very quickly,” he says. After strictly following the diet, he has now added some foods to his diet. He knows gluten is a trigger, so he stays gluten-free.
“I’ve discovered other things, and most of them are things that I doubted anyway,” he says. He realized that onions, broccoli and Brussels sprouts as well as some nuts made him gassy. “And that was just to calm down my system and then restart it [them] I’m pretty sure, yes, I’ve got a problem with these things, “he explains. .)
Where to get help
Benningo was fortunate to be near a large academic center. The University of Michigan has enlisted dietitians in their GI program who can help patients with dietary changes, which can be a bit frustrating and confusing to follow. But what can people do if they do not have access to such integrated care?
Most gastroenterology practitioners do not have staff registered dietitians, psychologists or stress-management professionals. “Most physicians don’t have the tools or training to be able to apply science effectively because it’s getting into their practice,” Che said.
To fill in the blanks, there is a shift towards virtual support to help people access behavioral care, stress management tools and dietary strategies. “The digital tools that are coming online will help scale these integrated strategies to a more national level,” Che said. He gives three examples. Mahana is an FDA-approved digital cognitive behavioral therapy app that doctors can prescribe to IBS patients to cope with stress. Zemedy is another CBT-based digital app. There is also Narva, a mobile app that provides intestinal-guided hypnotherapy to help manage symptoms.
“All three are evidence-based, which means they have all undergone at least observational clinical trials to show effectiveness,” Che said. And there are many more digital products in development, he says, as he is involved with some agencies as an investigator. Che says the plan is designed to better understand how large-scale clinical trials can be used effectively with some tools. “It’s a very fast-growing space,” he says.