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If you are one of the more than 25 million people in the United States with irritable bowel syndrome, chances are your symptoms have gotten worse at some point in the past two years. Or maybe you have developed symptoms for the first time.
“We found reports of increased constipation, diarrhea, and abdominal pain,” says Kendra Kamp, a researcher at the University of Washington School of Medicine. She IBS patients interviewed suffering from anxiety or depression about their experiences at the start of the pandemic. Over 90% reported an increase in stress and 81% reported an increase in anxiety. Another investigation sponsored by a pharmaceutical company revealed half of IBS patients say their symptoms have been more difficult to manage, and many have reported a first onset of IBS amid the pandemic.
“The pandemic has created an environment of uncertainty, isolation and reduced access to the support resources people have depended on for their well-being,” says Suzanne Smithnurse practitioner at UCLA Integrative Digestive Health and Wellness Program. The center combines diet and stress management treatment approaches, and Smith helps patients understand the brain-gut connection in IBS.
IBS was once thought to be a gut problem, but scientists now know that disruptions in the way the the nervous system, brain and gut interact can cause changes that lead to IBS symptoms, including stomach pain, gas, bloating, and abnormal bowel movements. “There’s a continuous feedback loop between the brain and the gut,” Smith says. Information travels along the vagus nerve, which connects the brain to the gut, so what happens in the mind affects the gastrointestinal system.
Find the triggers
Stress is a factor that can trigger symptoms or make them more difficult to manage. Diet, sleep, exercise and social relationships are also important. “All of these things play a role in digestive health,” Smith says.
Doctors also look for triggers such as an infection or bacterial overgrowth that may require antibiotics, but the goal, Smith says, is to integrate all of the elements into a holistic treatment approach.
Smith teaches a mindfulness course that can help patients ease anxiety related to their symptoms. In 2020, a study of patients who participated in the 8-week course, called Mindfulness-Based Stress Reductionfound that 71% of patients had robust improvements in their gastrointestinal symptoms. “There was a significant improvement in quality of life and general well-being,” Smith said. Participants learned a range of techniques to promote present-moment awareness, limit anticipatory anxiety, and stop the feedback loop that can amplify the unpleasant feelings and sensations associated with IBS symptoms.
“It changed my life,” says Vicki Mayer, 52, who participated in the study. She first noticed intermittent stomach problems in college, but in recent years her symptoms have worsened. “Every time I went out for dinner, lunch or coffee, I was overcome with a lot of anxiety and fear,” she recalls, anticipating that she might need to find a bathroom urgently. or leave the restaurant. She started avoiding going out.
When her doctor recommended the mindfulness course, she was hesitant. “I was probably the most skeptical person in the room,” she recalls. “I was like, ‘Oh, I’m going to have to lie down for an hour. I can’t keep my mind completely quiet.'”
But after the start of the course, she became addicted. “We practiced different types of meditation, whether it was body scanthree minutes breathing exerciseor a walking meditation,” says Mayer, further explaining that each of these techniques awakened a sense of calm and a new way of tuning into her body.
Meditation did not change her symptoms overnight, but she began to feel control over her emotional reactions. She realized that much of her anxiety was caused by thinking about the worst-case scenario, like anticipating an embarrassing incident at the restaurant. But, if she stayed in the moment, the situation really wasn’t that bad. And, instead of letting her mind weave a story about what might happen, she learned to reframe her thoughts.
“I’ll be fine, there’s always a bathroom available,” she told herself if she went out for a meal, acknowledging that missing the table wouldn’t hurt. “Once I changed my mindset, I had a much lower level of anxiety and was able to get through the meal with little to no issues.”
Studies show that mindfulness can increase both attention and emotional regulation. “If you have a better ability to regulate your attention, you can shift your attention to something more useful,” Smith says, just as Mayer learned.
Mayer says she feels much better these days. “Knowing how to change your mindset and seeing the physical results in a positive way is incredibly powerful,” she says. And, she continues the meditation practice: “You can do a one- or two-minute breathing exercise while you’re waiting in line at the grocery store.”
The power of good nutrition
Changing what’s on the menu is another key tool for people to manage IBS. “We have developed dietary strategies that can be very effective,” says Guillaume Cheya University of Michigan gastroenterologist who documented the benefits of integrative care.
Michigan has had a dedicated gastrointestinal nutrition program since 2007. “When I first started talking about diet as an important part of treating IBS patients back then, people literally laughed at me. me,” Chey said. “But now almost all gastroenterologists agree 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 somewhere between 52% to 86% of participants report a significant improvement in their symptoms after following the diet, including reducing gas and bloating. The FODMAP diet requires the elimination or reduction of certain foods, including gluten, lactose, excess fructose (found in some fruits and corn syrup), and certain nuts, beans, and starches. Researchers at Monash University in Australia explain that the FODMAP diet is based on the understanding that certain compounds in our diet cannot be completely digested or absorbed, so they can end up in the large intestine where they are fermented by gut bacteria. This leads to gas and bloating.
“I saw the benefits almost within the first week,” says Karen Beningo of Northville, Michigan, who received treatment at the University of Michigan. She started the FODMAP diet last October and found that her energy levels had improved dramatically. “The distention and bloating disappeared very quickly,” she says. After strictly following the diet, she has now added a few foods to her diet. She knows gluten is a trigger, so she stays gluten-free.
“I discovered other things, and most of them were things I was suspicious of anyway,” she says. She found that onions, broccoli and Brussels sprouts, along with a few nuts, made her gassy. “And only by calming my system and then reintroducing [them] which I pretty much confirmed, yes, I have a problem with these things,” she explains. Monash University FODMAP App can help people follow the diet, detailing which foods, in what amounts, are acceptable and which should be avoided.)
Where to get help
Beningo was lucky enough to live close to a large university center. The University of Michigan has registered dieticians in its GI program who can help patients through diet changes, which can be somewhat frustrating and confusing to follow. But what can people do if they don’t have access to this type of integrative care?
The majority of gastroenterology practices do not have a dietitian, psychologist or stress management professional on staff. “Most doctors don’t have the tools or the training to be able to effectively implement the science as it emerges into their practices,” Chey says.
To fill the gaps, there is a move towards virtual support to help people access behavioral care, stress management tools and dietary strategies. “The digital tools that will be brought online will help these integrated strategies expand to a more national level,” Chey said. He cites three examples. Mahana is an FDA cleared digital Cognitive-behavioral therapy application that doctors can prescribe to IBS patients to deal with stress. Zemedy is another CBT based digital app. There is also furiousa mobile app that offers gut-directed hypnotherapy to help manage symptoms.
“These three are all evidence-based, which means they’ve all done at least observational clinical trials to show their effectiveness,” Chey says. And there are a lot more digital products in development, he says, adding that he’s involved with some companies as an investigator. Chey says large-scale clinical trials with some of the tools are planned to better understand how to use them effectively. “It’s a very rapidly growing space,” he says.