IBS is a functional gastrointestinal disorder (FGID) characterised by
Diarrhoea and/or constipation.
According to the International Foundation for Functional GI Disorders (IFFGD),”the term “functional” is generally applied to disorders where the body’s normal activities in terms of the movement of the intestines, the sensitivity of the nerves of the intestines, or the way in which the brain controls some of these functions is impaired. However, there are no structural abnormalities that can be seen by endoscopy, x-ray, or blood tests. “
IBS is a Functional GI Disorder characterised by disorders of the gut-brain axis (explanation later).
ADDITIONAL SYMPTOMS OF IBS
Nausea or vomiting
Abdominal pain immediately after food.
Abdominal pain relieved by passing a motion
SOME IMPORTANT FACTS ABOUT IBS
IBS is distinct from IBD (Inflammatory Bowel Disease, like Ulcerative Colitis and Crohn’s Disease). IBD are autoimmune diseases causing specific conditions in the intestine.
Altered bowel habits in IBS may have the following characteristics:
Constipation may result in complaints of hard stools or infrequent motions. Often the constipation may not respond to regular laxatives.
Diarrhoea may mean frequent passage of small volumes of loose stools.
Needing to use the toilet soon after a meal may be common.
Constipation or diarrhoea may be a predominant feature, but sometimes the symptoms may be mixed.
IBS can occur after a gastrointestinal infection with a bacteria, virus or parasite–post-infection IBS.
Though IBS is strictly not an infectious disease, microscopic inflammation has been detected in some people.
Food intolerances may have symptoms similar to IBS.
Early life stressors (High Adverse Childhood Experiences Score) is related to IBS.
According to the Rome IV criteria ,the following four patterns may be seen in IBS:
IBS-D -Diarrhoea predominant
IBS-M-mixed constipation and diarrhoea
(The Rome Foundation is an independent not for profit organisation that provides support for activities designed to create scientific data and educational information to assist in the diagnosis and treatment of functional gastrointestinal disorders).
CONDITIONS ASSOCIATED WITH IBS
Besides the common symptoms of IBS, which are abdominal (stomach) pain ,bloating, diarrhoea and/or constipation there may be other associated conditions like
Sexual dysfunction including poor libido
Urinary complaints, Interstitial Cystitis
Mucus discharge from anus.
CAUSES OF IBS
Though the exact cause of IBS is not known yet, the following are considered to be important:
Altered pain perception. People with IBS have been found to be more sensitive to pain sensations, particularly pain related to distension of the gut.
Increased intestinal permeability (leaky gut)
(In subsequent blog posts I will discuss how I approach the management of IBS as a Functional and Metabolic Medicine Consultant).
According to Psychologist and Neuroscientist, Dr. Richard Davidson PhD, “Well-being is a skill.”
What does this mean? This means that you can teach yourself to experience Well-Being!
WHAT IS WELL-BEING?
Without going into scientific definitions of hedonia (pleasure or momentary well-being) and eudaimonia (flourishing, living a meaningful life), I will simply state that Well-Being is a condition you are familiar with when you don’t have it! You certainly do not experience well-being when you are dealing with a chronic Autoimmune condition!
Dr. Davidson has been at the forefront of scientifically studying compassion and kindness practices and bringing this into mainstream science. He says that Well-Being includes 4 constituents. These 4 constituents are based on hard nosed neuroscientific evidence.
WHAT ARE THE 4 CONSTITUENTS OF WELL-BEING?
RESILIENCE: It is the ability to maintain high levels of well-being in the face of adversity. How soon do you recover from negative events? Research suggests that mental training in mindfulness meditation can increase brain circuits involved in resilience. However, these changes are evident in long-term meditators, in those who have six-or seven thousand hours of meditation. I have not reached there yet but it is certainly something I aspire for!
Though resilience requires many hours of cumulative practice, smaller doses of mindfulness practice or loving-kindness or compassion meditation have shown great benefits too.
ATTENTION:”A wandering mind is an unhappy mind.” This was the title of an article in Science (2010), by Dr. Matthew A. Killingsworth and Dr. Daniel T. Gilbert, from Harvard University. They studied mind wandering through an iPhone app and this is what they found:
People’s minds wandered frequently, regardless of what they were doing. Mind wandering occurred in 46.9% of the people studied.
The nature of people’s activities had only a modest impact on whether their minds wandered.
People were less happy when their minds were wandering than when they were not and this was true during all activities.
(This is profound): Mind wandering was generally the cause, and not merely the consequence, of unhappiness. What people were thinking was a better predictor of their happiness than was what they were doing.
What can you do to stop mind wandering? If you are new to contemplative practice why not try a guided mindfulness app or CD or drop in on a workshop or go for a mindful walk? Find something that you like.
POSITIVE OUTLOOK:How do you look at your life? Is the glass half-empty or is it half-full? As Dr. Jon Kabat-Zinn, Professor Emeritus at University of Massachusetts, says “If you are breathing, then you have more things going right for you than wrong.”
GENEROSITY: When people engage in generous behavior they activate brain circuits that are important for Well-Being. You can try loving-kindness meditation. Most importantly, are you kind to yourself?
NEUROPLASTICITY: Why is this concept important?
Neuroplasticity means that your brain can change in response to training and experiences. It can change for the better or for the worse. Why not be deliberate about the way your brain changes, because it IS going to change anyway!
Until some years ago we were taught that the brain does not make new nerve cells as an adult (adult neurogenesis) and it cannot make new neural pathways. This concept has been turned around completely now. Studies have shown that we can make new nerve tissue! High levels of stress can destroy nerve tissue, but mindfulness practice has shown increase in brain tissue thickness in just 8 weeks of practice!
WHAT CAN YOU DO TO ENHANCE YOUR WELL-BEING?
Practice loving-kindness meditation, especially to yourself!
Stop watching negative news on television! (unless that’s your profession).
Did you check your ACE (Adverse Childhood Experiences) score? ACE Score
Richard J. Davidson is the William James and Vilas Professor of Psychology and Psychiatry and the Director of the Waisman Laboratory for Brain Imaging and Behavior and the Founder of the Center for Healthy Minds at the University of Wisconsin–Madison, USA.
Davidson, R. J., & Schuyler, B. S. (2015). Neuroscience of happiness. In J.F. Helliwell, R. Layard, & J. Sachs (Eds.), World Happiness (Chapter 5). New York, NY: The Earth Institute, Columbia University. PMCID: Policy Exempt.
Killingsworth, Matthew A., and Daniel T. Gilbert. “A wandering mind is an unhappy mind.” Science 330.6006 (2010): 932-932. The app is “Track Your Happiness” available on iPhone.
Hölzel BK, Carmody J, Vangel M, et al. Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry research. 2011;191(1):36-43. doi: 10.1016/j.pscychresns.2010.08.006.
Spalding, Kirsty L., et al. “Dynamics of hippocampal neurogenesis in adult humans.” Cell 153.6 (2013
Does stress induce Autoimmune Disease? Or is stress a cause of Autoimmunity? The precise answer to the question of whether stress is an inducing agent or a causative agent is in the realm of medical minutiae, but there is no doubt that stress has a major impact on your autoimmune disease. This is not new information for most of you. Many of you have experienced worsening of your symptoms soon after some stressful event in your life or you have even tried to blame your significant other for “causing” stress in your life! Though it is true that empathic stress (later blog post) can affect you, it is not stress that is the problem; it is how you deal with it that decides your health! We do need some amount of stress to be alive! Is it eustress (positive stress) or distress (negative stress) that is affecting you?
In my patient intake form I have a section that talks about how you gauge your stress levels. Most of you fill in your health-related stress as an 8 or 10 out of 10. (One lady said it was 11 out of 10!). For many of you this stress comes from the physical pain or the uncertainty of not knowing what happens tomorrow or from being unable to work or from the lack of response to a particular drug or various other factors. In this blogpost I would like to focus more on the solutions to address stress, rather than the problem.
WHAT IS STRESS?
Dr. Hans Selye, who is considered to be one of the pioneers of stress research, in 1936 defined stress as “The non-specific response of the body to any demand for change. Everyone knows what stress is, but nobody really knows.”
YOUR STRESS RESPONSE IS DECIDED BY MANY FACTORS.
Some of the important factors affecting your stress response are:
Intrauterine influences-your mother’s stress when she was pregnant with you.
Your childhood experiences (ACE score, explained below)
Your socioeconomic status
Your stress management strategies.
Intrauterine influences: Some of the factors that influence your stress response are operative when your mother was pregnant with you! There are many scientific studies that describe how stress experienced by women during pregnancy had adverse influence on the health of the children. The Dutch Winter Hunger Study and the Project Ice Storm study are among some of the often-quoted ones. The effects on the child depended on when during the mother’s pregnancy she had experienced the adversity. For example, children born to mothers who had experienced stress during the last part of their pregnancy were at higher risk for diabetes, heart disease and increased fat mass. The baby in the uterus predicted that it was being born into a world of scarcity and therefore needed to conserve fat! Some of these adverse health effects were trans-generational (affected at least 2 subsequent generations)! This is a truly fascinating field of study called Developmental Origin of Health and Disease (DoHAD).
ADVERSE CHILDHOOD EXPERIENCES (ACE) AND HEALTH
Dr. Vincent Felitti and Dr. Robert Anda’s landmark study of 1998 found a strong relationship between exposure to abuse or household dysfunction during childhood and multiple risk factors for many diseases in adults, including Autoimmune Disease. The higher the ACE score, the higher the incidence of disease. This effect was more pronounced in women and Autoimmune Disease.
We know that factors like sexual or physical abuse have a lot of adverse health effects, but when you check your ACE score you will realize that factors like living with an alcoholic caregiver or someone with mental illness or even being insulted or put down often has many adverse health influences. The point of this study is not to blame your parents but to realize how your health challenges may have an explanation in your childhood experiences and more importantly, these effects are not permanent! You can get better! A recent book Childhood Disrupted: How Your Biography Becomes Your Biology and How You Can Heal by Donna Jackson Nakazawa is a good book to read. Nakazawa is an award winning author who shares her journey through successfully dealing with Guillain Barre Syndrome (GBS).
Do you know your ACE score? Check here to download the form and find out.
IS IT ADRENAL FATIGUE?
During consultation some of you tell me that you have “Adrenal Fatigue” or that your “Adrenals are fired”. Is that true? In medical terms what you mean is that you have a dysregulated stress response or the medical terms HPA Axis (Hypothalamo-Pituitary-Adrenal Axis) dysfunction or Allostatic Load. What does it mean? (I will explain this concept in details on a webinar/series of blog posts later. On this post I’d like to focus on the solutions rather than the problem). Humans have had to deal with stress since time immemorial. What has changed now? Stress for our hunter-gatherer ancestors involved physical stress and was usually short-lived. Our bodies were used to short-lived stress and not the type of ongoing stress that we experience now.
WHAT CAN YOU DO TO TAKE CARE OF YOUR DYSREGULATED STRESS RESPONSE?
MBSR (Mindfulness Based Stress Reduction)
As a long-term meditator and someone who has read many scientific papers on the neurobiology of meditation, this is my number one go-to when it comes to dealing with your dysregulated stress response. As I always say, the side effects of meditation are all good!What type of meditation should you do? My suggestion is to try several different ones and find out which one you like.
However, there are a few things to keep in mind when we talk about “therapeutic meditation”. • You need to elicit the Relaxation Response (RR) According to Dr. Herbert Benson from Harvard the relaxation response is a state of deep rest that elicits the following changes
Decreased heart rate
Decreased blood pressure
Decreased rate of breathing, and
Decreased muscle tension.
A Relaxation Response occurs when you meditate for at least 30-45 minutes. If you have never meditated before, start with 5-10 minutes of a guided meditation on an app or CD.
The best results of meditation have been shown in long-term meditators but meditating for as little as 8 weeks have shown many benefits!
MBSR (Mindfulness Based Stress Reduction):
According to Dr. Jon Kabat Zinn “Mindfulness is awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally”. Dr. Kabat Zinn is Professor of Medicine Emeritus at the University of Massachusetts Medical Centre, where they have done many clinical studies on the health effects of MBSR. In one study of patients with psoriasis, MBSR along with photo therapy (UVB) or photo chemotherapy (PUVA) was found to show faster clearing of skin lesions.
Professor James Pennebaker PhD, Professor of Psychology at the University of Texas, in a study found that writing about traumatic events was associated with fewer visits to the health center! It also improved immune function. No one has to read your writing and please don’t bother with punctuation or grammar!Check here to read about the guidelines for Expressive Writing.
Schulz, Laura C. “The Dutch Hunger Winter and the developmental origins of health and disease.” Proceedings of the National Academy of Sciences 107.39 (2010): 16757-16758. Cao-Lei, Lei, et al.
“DNA methylation signatures triggered by prenatal maternal stress exposure to a natural disaster: Project Ice Storm.” PLoS One9.9 (2014): e107653.
Felitti, Vincent J., et al. “Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study.” American journal of preventive medicine 14.4 (1998): 245-258.
Benson, Herbert, Martha M. Greenwood, and Helen Klemchuk. “The relaxation response: psychophysiological aspects and clinical applications.”The International Journal of Psychiatry in Medicine 6.1-2 (1975): 87-98.
Kabat-Zinn, Jon, et al. “Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing photo therapy (UVB) and photo chemotherapy (PUVA).” Psychosomatic medicine 60.5 (1998): 625-632.
Pennebaker, James W. “Writing about emotional experiences as a therapeutic process.” Psychological science 8.3 (1997): 162-166.
Book: Expressive Writing: Words that Heal by James W Pennebaker.