Hi susaloh, glad the information is helping and yes, is it every complex, so it does take some time to read everything. For me after thrity years of severe IBS I needed to know as much as I could about what was going on, as I was having suicidal thoughts from the IBS pain. I have read some of the informaation over and over so it starts to stick in my head. They do know that IBS education is as important as anything really.
I will try to answer the questions the best I can for you.
There are some 20 known serotonin receptors and probably some they don't know about yet, but the gut 5ht 3 and 5ht 4 are ones they really know about and are important to the digestion reflex and IBS.
This is on that.
"2. What is serotonin and what role does it play in IBS?
Serotonin, or 5-hydroxytryptamine (5-HT), is a peptide that is found throughout the body. Approximately 96% of serotonin is located in the gastrointestinal tract, 2% in platelets, and 2% in the CNS. More than 20 types of serotonin receptors at various locations in the human body have been described, but the receptors that seem to be most important in the gastrointestinal tract in general and in IBS in particular are the 5-HT3 and 5-HT4 receptors.
Because the structure of the receptor determines the function of the peptide, serotonin has slightly different functions when paired with each different receptor. Generally, these receptors are involved in controlling the motility of and secretions in the gut and the perception of abdominal pain. Typically, 5-HT3 and 5-HT4 receptor agonists promote motility and the antagonists decrease motility. Although the exact mechanism is not known, these receptors do not function properly in IBS."
The low pain threshold is called hypersensivity or viceral hyperalgesia, technically. The nerves that line the gut wall are sensitive to all stimuli, foods, stress, ect., and this is because there is the underlying dysfunction. In part because the brain does not seem to be releasing the bodys own endorphines to the gut as it does in normal people.
This is on that communication aspect.
"What would be an example of new understanding?
Well one example is that we're starting to understand how the brain is responding to the pain in IBS. There have been some studies done where they've artificially created a kind of an irritable bowel by placing a balloon to stretch the bowel, and that produces pain. Then they've compared people with IBS to non-IBS, or "normal" individuals. And what they've found is that when you stretch the bowel-and use PET scans to monitor the response-in normal individuals, certain areas of the brain that register pain respond and release chemicals called neurotransmitters that suppress and lower the pain. But it seems that doesn't happen as well in people with IBS. In fact, in people with IBS another area of the brain responds that is associated with anxiety. So what we find is that people with IBS, aside from having a bowel problem, may have some difficulty in terms of the way their brain is regulating the pain."
This is on the food and IBS from one of the most recgonized experts in IBS.
" the culprit is not the particular food but the biochemical conditions it encounters in our bodies that trigger the attack, isn't it?"
really this is where there at from the above.
"The cause of IBS is yet to be determined. However, modern research understands IBS as a disorder of increased reactivity of the bowel, visceral hypersensitivity and dysfunction of the brain-but axis. There are subgroups being defined as well, including post-infectious IBS which can lead to IBS symptoms. Other work using brain imaging shows that the pain regulation center of the brain (cingulate cortex) can be impaired, as well as good evidence for there being abnormalities in motility which can at least in part explain the diarrhea and constipation. So finding a specific "cause" of IBS has grown out of general interest in place of understanding physiological subgroups that may become amenable to more specific treatments. Hope that helps.
The 5htp supplement, maybe blocking signal is both the brain and spinal cord, but I don't know about this for sure.
It can also be lowering your anxiety, both concious and very importantly 'subconcious anxiety' or thoughts a person is not aware of, which are very much tied into gut function, pain and IBS symptoms and I will say more about this as I put it together. But something called the limbic system, which is involved in the fight or flight and also in infections is a player in all this, so it may be helping also that way as well. Probably not doing to much at the gut level problem however, but maybe in other ways.
"IBS is triggered by everything (foods, stress, viruses of any kind, hormone fluctuations, etc) "
This is really true of most IBSers, usally it is a combination of factors that set it off, although people certainly have specific triggers.
" I still haven't quite understood whether there is a kind of 'damage' in the brain? Or does research suggest that the changes in the brain are just a result of the communication problem? Or maybe they don't know yet? "
This gets more complex and not totally figured out yet.
The communication is a problem and it may long term make changes in the brain, but some can also be changed for the better. Nerve pathways to the brain can be changed really, antidepressants can do this and so can HT and CBT really and even relaxation.
This is a recent case study on this and the first of its kind really and pretty much a landmark study.
here they took a severee case and pet scaned her before treatment and after treatment and her brain had changed for the better. This study used antidepressants and cbt, and perhaps HT, but not sure on the exact phycological treatments used. So this shows though, that you can improve IBS from targeting the brain.
Gastroenterology 2003 Mar;124(3):754-61 Related Articles,
Click here to read
Alterations of brain activity associated with resolution of emotional distress and pain in a case of severe irritable bowel syndrome.
Drossman DA, Ringel Y, Vogt BA, Leserman J, Lin W, Smith JK, Whitehead W.
UNC Center for Functional GI and Motility Disorders, Division of Digestive Diseases and Department of Radiology and Biomedical Engineering, University of North Carolina, Chapel Hill, North Carolina 27599, USA. Drossman@med.unc.edu
BACKGROUND & AIMS: The association of psychosocial disturbances with more severe irritable bowel syndrome (IBS) is well recognized. However, there is no evidence as to how these associations might be mediated. Functional magnetic resonance imaging (fMRI) offers an opportunity to study whether activation of the cingulate cortex, an area involved with the affective and pain intensity coding might be linked to poorer clinical status with IBS. In this case report, we found an association between the severity of a patient's clinical symptoms and psychosocial state, with activation of the cingulate cortex. We also found that clinical and psychosocial improvement was associated with reduced cingulate activation. METHODS: Observational case report of a young woman observed for 16 years with a history of sexual abuse, psychosocial distress, and functional GI complaints. Psychosocial, clinical, and fMRI assessment was performed when the patient experienced severe symptoms and again 8 months later when clinically improved. RESULTS: During severe illness, the patient had major psychosocial impairment, high life stress, a low visceral pain threshold, and activation of the midcingulate cortex (MCC), prefrontal area 6/44, and the somatosensory cortex, areas associated with pain intensity encoding. When clinically improved, there was resolution in activation of these 3 areas, and this was associated with psychosocial improvement and an increased threshold to rectal distention. CONCLUSIONS: Activation of the MCC and related areas involved with visceral pain encoding are associated with poor clinical status in patients with severe IBS and psychosocial distress and appear to be responsive to clinical improvement.
So yes there are things to do and try and to target the predominate symptoms firsst can help a lot.
I will say some more on pain and IBS but the HT knocked by pain way way down from severe to discomfort on a regular basis although I have had a couple severe attack over the last foru years, they are no longer everyday,or twice a day sometimes like they use to be and all kinds of other symptoms I had improved, but it took a little time to get there and education helped also. CBT and HT are tools to use to manage your symptoms, as yet there is no total cure for IBS. So its how well you learn to live with it and all the things you can do to help it. So you are exactly right on self healing, that is hugely important, both physical and mental healing and balance.
Hope this helps.
My website on IBS is www.ibshealth.com