Diet combined with hypnosis therapy
#244667 - 02/07/06 10:16 AM
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DWS
Reged: 01/10/06
Posts: 20
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After reading different posts about the benefits and successes of hypnosis therapy, I'm curious to know if this is more of a neurological/psychological disorder as opposed to a diet problem. I'm not suggesting that any of us are making this up, I'm just wondering if somehow we've conditioned our bodies to react certain ways toward stress that now the slightest irriatation, be it certains foods or stress, can trigger an attack..?? I've been approaching this from strictly a diet perspective with moderate success. Just curious if somehow our brains have caused this physical condition, and if we maintain a IBS healthy diet while working at reprogramming our thoughts that eventually we'll be able to eat normal? By the way, I ordered the hypnosis CD's last night. I'm hoping for the best. I will appreciate anyone who has any thoughts or experiences with this.
Thanks, David
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David, neither foods or stress cause IBS, but both can make them worse.
Stressors both mental and physical and emotions and anxiety and depression even are tied into certain abnormalities found in IBS.
I asked one of the leading authorities on IBS this question.
Since I have suffered for thirty years of IBS I wonder what role foods play in IBS. So I asked Dr Douglas Drossman at the UNC Center for Functional GI and Motility disorders and here was his response. This is not a substitute for seeking medical advise from your doctor on any specific conditions you may have, but for educational purposes only.
Dr. Drossman is a Co-director of the Center and Professor of Medicine and Psychiatry at UNC-CH. He established a program of research in functional gastrointestinal disorders at UNC more than 15 years ago and has published more than 250 books, articles, and abstracts relating to epidemiology, psychosocial and quality of life assessment, design of treatment trials, and outcomes research in gastrointestinal disorders.
Dr Drossman's comments on foods for IBS Health.
Shawn, To say that people with IBS may get symptoms from food intolerances is an acceptable possibility, since the gut will over react to stressors of all types including food (high fat or large volumes of food in particular). Futhermore, there can be specific intolerances. So if you have a lactose intolerance for example, it can exacerbate, or even mimic IBS. Other examples of food substances causing diarrhea would be high consumers of caffeine or alcohol which can stimulate intestinal secretion or with the latter, pull water into the bowel (osmotic diarrhea). The same would be true for overdoing certain poorly absorbed sugars that can cause an osmotic type of diarrhea Sorbitol, found in sugarless gum and sugar substituted foods can also produce such an osmotic diarrhea. Even more naturally, people who consume a large amount of fruits, juices or other processed foods enriched with fructose, can get diarrhea because it is not as easily absorbed by the bowel and goes to the colon where it pulls in water. So if you have IBS, all of these food items would make it worse.
However, it is important to separate factors that worsen IBS (e.g., foods as above, stress, hormonal changes, etc.) from the cause or pathophysiology of IBS. Just like stress doesn't cause IBS, (though it can make it worse), foods must be understood as aggravating rather than etiological in nature.
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-gut 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. Doug http://www.ibshealth.com/ibs_foods_2.htm
This is something you should read.
http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease1&organ=6&disease=43&lang_id=1
My own severe pain predominate and alternating IBS has improved around 85 percent from the last five years, do to "MIke's Tapes."
I have since done major research on IBS and HT for IBS.
One abnormalities has to do with serotonin in the gi tract and specific cells that release it, where the majority of the bodies serotonin is stored. It intiates gut contractions, but also is involved in pain transmission from the gut to the brain. Its also involved in appetite, moods, sleep and other bodily functions. They kjnow something is not working properly with the 5HT 3 gut receptor.
The other has to do with what's called mast cells in the gut, that are directly connected to stress, the HPA axis or Hypothalamic-Pituitary-Adrenal.
These cells are also connected to food allergies, but IBS is not a food allergy, although they maybe a problem in some people as well. But true food allergies are rare.
"The hypothalamic-pituitary-adrenal axis (HPA axis) is a major part of the neuroendocrine system that controls reactions to stress and has important functions in regulating various body processes such as digestion, the immune system and energy usage. Species from humans to the most ancient organisms share components of the HPA axis. It is the mechanism for a set of interactions among glands, hormones and parts of the mid-brain that mediate a general adaptation syndrome."
Stressors both physical and mental can degrandulated gut mast cells without a pathogen and release histimine onto the smooth muscle which can contribut to pain in IBS.
This is also worth reading.
Visceral Sensations and Brain-Gut Mechanisms By: Emeran A. Mayer, M.D., Professor of Medicine, Physiology and Psychiatry; Director, Center for Neurovisceral Sciences & Women's Health, David Geffen School of Medicine at UCLA
http://www.aboutibs.org/Publications/VisceralSensations.html
The Neurobiology of Stress and Emotions (IBS) By: Emeran A. Mayer, M.D., UCLA Mind Body Collaborative Research Center, UCLA School of Medicine, California
http://www.aboutibs.org/Publications/stress.html
The Other Brain Also Deals With Many Woes By Harriet Brown ' August 23, 2005
Two brains are better than one. At least that is the rationale for the close - sometimes too close - relationship between the human body's two brains, the one at the top of the spinal cord and the hidden but powerful brain in the gut known as the enteric nervous system.
http://www.boston.com/yourlife/health/other/articles/2005/08/23/the_other_brain_also_deals_with_many_woes/
Hypnosis Treatment of Irritable Bowel Syndrome By: Olafur S. Palsson, Psy.D., Research Associate, Department of Medicine, University of North Carolina at Chapel Hill
http://www.aboutibs.org/Publications/HypnosisPalsson.html
Hypnotherapy for Functional Gastrointestinal Disorders By: Peter J. Whorwell, M.D., University Hospital of South Manchester, England
http://www.aboutibs.org/Publications/hypnosis.html
This is from a top IBS researcher as well and is a public website on HT for IBS.
http://www.ibshypnosis.com/
Mike is one of three top people in this field.
-------------------- My website on IBS is www.ibshealth.com
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Hi, David. I haven't tried the hypno CDs, but I don't think they provide a cure for IBS. I think you would still have to be careful about what and how you eat.
IBS is not a psychological or psychiatric disorder or a diet problem. The IBS Diet is important because it helps to regulate the digestive tract and provides guidelines on how to avoid foods that will irritate the colon or trigger a spastic colon. Changing your diet won't cure IBS, but it will minimize symptoms.
IBS is not caused by stress, although stress can aggravate symptoms because of the connection between the mind and the gut. "The symptoms of IBS are produced by abnormal functioning of the nerves and muscles of the bowel. In IBS there is no evidence of an organic disease, yet, something -- a "dysregulation" between the brain, the gut, and the central nervous system -- causes the bowel to become "irritated," or overly sensitive to stimuli. Symptoms may occur even in response to normal events." (There's more information about this at AboutIBS.org, which contains information and research provided by the International Foundation for Functional Gastrointestinal Disorders.)
I think this is a really good question, and I think recent studies have started to focus on serotonin, which is a neurotransmitter that is produced in the gut and acts on nerves in the digestive tract. So this suggests that it may be a neurological disorder (which is not the same thing as a psychological problem) in addition to being a physical disorder.
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I've been wanting to read more about this but wasn't sure where to start.
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David
#244680 - 02/07/06 10:58 AM
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Bevvy
Reged: 11/04/03
Posts: 5918
Loc: Northwest Washington State
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Oh yes, definitely. You are SOOOO onto it! Michael alludes to this fact in the CDs. I finished the 100-days, and it made a WORLD of difference for me! A WORLD of difference. I no longer have any anxiety, and when I feel cramps coming on, I know how to deal with it -- often without meds.
Michael will make a huge difference for you, especially since you obviously have the right mental attitude towards the program. Good for you!
-------------------- <img src="http://home.comcast.net/~letsrow/smily3481.gif">Bevvy
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Just fyi, but Gut focused HT has the highest reponce rate to date for IBS statistically.
It does not work for every single person, but for about 80 percent or more. It has also been shown to work after five years of treatment, which really suggests it is working on the actual physical problems.
"Why Consider Hypnosis Treatment for IBS? by Olafur S. Palsson, Psy.D.
Hypnosis is only one of several approaches to treating irritable bowel syndrome and may not be the most suitable option for all patients (click here for discussion of treatment options for IBS). However, hypnosis treatment has some advantages which makes it an attractive option for many IBS sufferers with chronic and severe symptoms:
- It is one of the most successful treatment approaches for chronic IBS. The response rate to treatment is 80% and better in most published studies to date.
- The treatment often helps individuals who have failed to get improvements with other methods (see for example: Whorwell et al., 1984, 1987; Palsson et al., 1997, 2000).
- It is a uniquely comfortable form of treatment; relaxing, easy and generally enjoyable.
- It utilizes the healing power of the person's own mind, and is generally completely without negative side effects.
- The treatment sometimes results in improvement in other symptoms or problems such as migraine or tension headaches, along with the improvement in IBS symptoms.
- The beneficial effects of the treatment last long after the end of the course of treatment. According to research, individuals who improve from hypnosis treatment for IBS can generally look forward to years of reduced bowel symptoms."
http://www.ibshypnosis.com/whyhypnosis.html
This is one of the top senior gastroneterologists in the UK also.
"At a meeting this week of the World Congress of Psychosomatic Medicine, gastroenterologist Peter Whorwell, MD, will discuss more than 20 years of research showing that hypnosis can not only improve symptoms of irritable bowel syndrome, or IBS, but can even alter the underlying physical problems that cause the symptoms. "
http://www.webmd.com/content/article/34/1728_87469
It can also boost the immune system.
Its also has been shown to work on non gi symptoms.
with permission from the UNC
IBS – Beyond the Bowel: The Meaning of Co-existing Medical Problems
IBS – Beyond the Bowel: The Meaning of Co-existing Medical Problems Olafur S. Palsson, Psy.D. and William E. Whitehead, Ph.D. UNC Center for Functional GI & Motility Disorders Irritable bowel syndrome (IBS) is a disorder that is defined by a specific pattern of gastrointestinal (GI) symptoms in the absence of abnormal physical findings. The latest diagnostic criteria for IBS -- the Rome II criteria created by an international team of experts -- require that the patient have abdominal pain for at least 12 weeks within the past 12 months and that the pain meets two of the following three criteria: it is relieved after bowel movement, associated with change in stool frequency, or associated with stool form. It is becoming clear, however, that these bowel symptoms do not tell the whole story of symptoms experienced by IBS patients. People with this disorder often have many uncomfortable non-gastrointestinal (non-GI) symptoms and other health problems in addition to their intestinal troubles. SYMPTOMS ALL OVER THE BODY IN IBS Several research reports have established that IBS patients report non-bowel symptoms more frequently than other GI patients and general medical patients. For example, four studies that have asked IBS patients about a wide variety of body symptoms(1-4) all found headaches (reported by 23-45% of IBS patients), back pain (28-81%), and frequent urination (20-56%) to be unusually common in individuals with IBS compared to other people. Fatigue (36-63%) and bad breath or unpleasant taste in the mouth (16-63%) were found in three of these four studies to be more common among IBS patients, as well. Furthermore, a large number of other symptoms have been reported to occur with unusually high frequency in single studies. In our recent systematic review of the medical literature(5), we found a total 26 different symptoms, listed in Table 1, that are reported to be more common in IBS patients than comparison groups in at least one study. Table 1. Non-gastrointestinal symptoms more common in irritable bowel syndrome patients than in comparison groups(5). 1. Headache 2. Dizziness 3. Heart palpitations or racing heart 4. Back pain 5. Shortness of breath 6. Muscle ache 7. Frequent urinating 8. Difficulty urinating 9. Sensitivity to heat or cold 10. Constant tiredness 11. Pain during intercourse (sex) 12. Trembling hands 13. Sleeping difficulties 14. Bad breath/unpleasant taste in mouth 15. Grinding your teeth 16. Jaw pain 17. Flushing of your face and neck 18. Dry mouth 19. Weak or wobbly legs 20. Scratchy throat 21. Tightness or pressure in chest 22. Low sex drive 23. Poor appetite 24. Eye pain 25. Stiff muscles 26. Eye twitching OVERLAP WITH OTHER MEDICAL CONDITIONS Results from numerous studies (reviewed by Whitehead, Palsson & Jones, 2002(5)) also indicate that IBS overlaps or co-exists more often than would be expected with other medical conditions that appear to have little logical connection with the gut. The most researched example of such an overlap is the co-existence of IBS with fibromyalgia, a disorder characterized by widespread muscle pain. Fibromyalgia affects an estimated 2% of the general population, but 28-65% of IBS patients have the disorder. Similar results are obtained when this overlap is examined the opposite way, by studying fibromyalgia patients and looking for IBS -- 32-77% of fibromyalgia patients have IBS. Chronic fatigue syndrome (CFS) is another medical condition that has been found to have many times the expected co-occurrence with IBS. CFS is thought to affect only 0.4% of the general population, but it has been reported in 14% of IBS patients. Conversely, 35- 92% of chronic fatigue syndrome patients have IBS. Other conditions documented in multiple studies to have excess overlap with IBS are temporomandibular joint disorder (TMJ), found in 16-25% of IBS patients(2,6), and chronic pelvic pain (35% of IBS patients(7). In addition to these well established relationships, many other medical conditions appear (judging from single study reports) to have an excess overlap with IBS, although the frequencies of most of them in IBS are much lower than for the disorders already discussed. In fact, we recently( compared the frequencies of a broad range of diagnoses in the medical records of 3153 IBS patients in a large health maintenance organization in the U.S. Northwest to an equal number of non-GI patients in the same HMO, and found that the IBS patients had a higher frequency of almost half of all non-GI diagnoses, or 64 of the 136 sampled diagnoses. In summary, non-GI symptoms and co-existing medical problems seen in many IBS patients far exceed what is typical for medical patients or GI patients in general. This raises important questions about what causes this phenomenon and what the implications are for IBS patients. WHAT EXPLAINS NON-GI SYMPTOMS AND CO-EXISTENCE OF OTHER DISORDERS IN IBS? There are several possible explanations for the preponderance of general symptoms and disorders in IBS. Our research group is engaged in several research studies that may help shed some light on this mystery, but it is still too early to come to definitive conclusions. We will list here some of the possible explanations, and discuss relevant data coming from work by our team and other investigators. 1. A common physical cause? One explanation for the high rates of co-existing symptoms and conditions in IBS patients would be that there is something biologically wrong in IBS patients that also causes other symptoms or conditions. There are a number of distinct physiological characteristics or "abnormalities" seen in many IBS patients, although none of them are found in all IBS patients. These include: heightened pain sensitivity in the gut, increased intestinal contractions (motility) or hyper-reactivity in response to meals or stress (too much movement of the intestines – this is the reason why IBS was called spastic colon in the past), patterns of dysfunction in the autonomic nervous system (that part of the nervous system that helps regulate our inner body functions), and vague signs of immune activation seen in some IBS patients. Although one could suggest ways in which these physiological abnormalities would play a role in some other disorders that co-exist with IBS, there is little evidence so far of a common pattern of physical abnormality that could link IBS and its most common coexisting conditions and symptoms. Patterns of autonomic dysfunction in IBS are not like the ones seen in fibromyalgia and chronic fatigue syndrome, for example. And, fibromyalgia patients do not show the same gut pain sensitivity as IBS patients, while conversely, IBS patients do not show the pain-sensitive tender points that are characteristic of fibromyalgia(9-10). Furthermore, as can be seen from reviewing the symptom list in Table 1, the non-GI symptoms that plague IBS patients are so varied and cover so many different organ systems, that it would be hard to identify a specific biological connection between them. On the contrary, it seems like the only overall commonality between these symptoms may be that they are non-specific – they are, in other words, not clear symptoms of any identifiable disease processes or diagnosable disorders. Indeed, the symptoms that are most common among IBS patients are generally those that are also common in the general healthy population – they just tend to occur at a higher level in people with IBS. 2. Physical expression of emotional discomfort? Another possible explanation for the high number of non-GI symptoms and disorders in IBS patients is the tendency to translate strong emotions into physical symptoms. This is sometimes called somatization ("soma" is the Greek word for "body" and somatization therefore literally means "to express in the body"). All people "somatize" to some degree; it is normal to feel butterflies in your stomach, to blush or go pale, get a lump in your throat, or feel the heart beating in your chest when you get very emotional. Shaky hands, stiff neck or excess sweating are likewise quite ordinary when people are under a great deal of stress. However, some people are more vulnerable than others to letting negative emotions express themselves physically. This is often thought to be an alternative and less healthy way of exhibiting or feeling emotional discomfort. Some people may develop a strong tendency to do this because they have a basic personality trait that shies away from interpersonal expressiveness. For others, it could be the result of growing up in the care of strict, repressive or abusive parents or caretakers, where normal expression of negative emotions was not allowed or would have been dangerous. Getting a headache or a stomach ache may be an alternative way to "give voice" to negative emotions under such circumstances. It seems that excessive habitual suppression of ordinary verbal and emotional expressions of negative emotions, regardless of the reason for it, may lead to the tendency to somatize. There is evidence that this tendency may be at work in IBS, at least among some women with the disorder. Dr. Brenda Toner has found in two studies(11-12) that women with IBS score higher than depressed women and healthy women on questionnaires measuring of the tendency to avoid the expression of negative emotions or views. 3. Learned over-attention to body symptoms and excess disease attribution? All people ignore most of the sensations from their bodies most of the time. This is necessary so that we are not overwhelmed by the vast amount of information our senses supply to our brains every moment of our lives. For example, if you are reading this sitting down, you have probably not been at all aware of the sensations of the seat under your body until right now. Our brains constantly sift through the mass of incoming body information and decide what is important for us to become consciously aware of, based on such things as our past experiences and how likely the information is to indicate a threat to our health or well-being. Most minor symptoms (those that might be uncomfortable and bothersome if they would get our attention), are simply dismissed in our busy everyday lives, because other things win out in the moment-to-moment competition for our limited attention resources. More frequent attention to mild physical symptoms can be learned, however, and can become a habit. As with most things, such habitual over-attention is probably most easily learned in childhood. It would seem reasonable, for example, that a child could get into the habit of noticing physical symptoms more if his or her parents are always talking about their own symptoms. We have recently found(13) that the more medical problems the parents in the childhood home had, the more general physical symptoms adult IBS patients report. The possible consequence of a childhood where the child grew up with parents or others who were seriously ill, is a tendency to interpret common normal physical sensations as symptoms of serious illness. Such a serious view of symptoms can also be modeled after the parent's approach to common illness. Dr. Whitehead and colleagues found in a telephone survey of 832 adults 20 years ago(14) that people whose parents paid more attention to cold or flu symptoms in childhood were more likely to view such symptoms as serious in adulthood and to visit doctors for them. They were also more likely to have IBS diagnosis. Evidence that IBS patients interpret physical sensations differently than others is emerging from brain imaging studies. This type of research takes a "snapshot" of the amount of activity in different parts of the brain in response to sensations, using techniques such as PET scans (positron emission tomography) and fMRI (functional Magnetic Resonance Imaging). By examining which parts of the brain react the most to painful sensations, it is possible to deduce to some degree how the brain processes the information. In one such study, by Silverman and colleagues(15), IBS patients but not control subjects reacted to physical sensations from a painful balloon inflation in the rectum with increased blood flow in the left prefrontal cortex, a part of the brain known to process personally threatening information. In contrast, this study and others(16-17) found that IBS patients do not show activity in the anterior cingulate cortex that is indicative of general discomfort in healthy subjects. IBS patients are also more likely to respond to physical stimuli in the GI tract by activating brain centers that handle emotional events. Collectively, this suggests that IBS patients may process body information associated with bowel sensations (and perhaps other physical sensations, as well) differently than other people, interpreting them as personally threatening and more emotionally relevant events rather than just ordinary discomfort. Such different interpretations of physical sensations would also explain hyper-attention to such sensations. 4. Faulty neurological filtering? After entering the spine (the information highway from the body to the brain), information destined for the brain about body pain is sent along nerves through gates that control how much of this information passes through. Our brains continually send signals down these spinal gates to cause them to block signals that are of too low intensity to provide valuable information (you do not want to constantly know about all of your minor aches and discomforts from regular body activity). This is one of the ways the brain uses to limit the vast amounts of information constantly streaming in from millions of nerve sensors throughout our bodies. A current popular hypothesis in the field of IBS research is that an inadequate amount of this "descending inhibition" of incoming pain information is, at least partly, to blame for the hypersensitivity to intestinal discomfort and pain seen in IBS patients. Some researchers have further suggested that the same kind of slack traffic control could be more widespread in IBS patients and may explain the observed proneness to headaches, back pain or muscle aches. People who have more open pain gates because of faulty inhibition would theoretically be like the princess in "The Princess and the Pea." who could feel a pea through 20 mattresses. The problem with this as an explanation for symptom overabundance among IBS patients is that it would explain only excess in pain-type symptoms, which are just one of many types of overabundant symptoms in IBS. There are also no direct data on IBS patients to prove how valid this view is. 5. Result of greater psychological distress? As was explained earlier, it is normal for people who are emotionally distressed to experience more physical symptoms. At least half of IBS patients who have consulted doctors have been diagnosed with an affective ("emotional") disorder – generally either depression or an anxiety disorder. Additionally, many people with IBS who have no affective disorder diagnosis have significant symptoms of anxiety and depression. One might, therefore, ask whether the physical symptoms reported could simply be a side effect of psychological distress. We have addressed this question in two studies presented at the 2003 Annual Meeting of the American Gastroenterological Association(18-19). In the HMO data mentioned earlier (1, we found that having a psychological diagnosis was associated with increased numbers of physical diagnoses that these IBS patients had received (from an average of 7.1 to 9.7). However, we also found that even patients with no psychiatric diagnosis had more physical diagnoses per person than the other HMO patients (7.5 vs. 5.5), so the presence of psychological problems is not the whole answer. In the other study(19), we examined the relationship between depression and anxiety scores of 795 people with IBS and the number of physical symptoms they had experienced over the past month. Statistical methods that estimate how much of the variability in one measured characteristic can be explained by other measured factors tell us that the psychological symptoms roughly accounted for 25-30% of physical symptoms of these people. In short, psychological distress is almost certainly part of the explanation for greater body symptoms in IBS, but not nearly the whole story. Further research will have to determine which of the above explanations are applicable in IBS, but it is likely that more than one of them, and maybe some other factors unrecognized so far, work together to account for the high frequency of symptoms and disorders that co-exist with IBS. THE IMPACT OF EXTRA PHYSICAL SYMPTOMS AND DISORDERS ON IBS PATIENTS. What do these extra ("non-IBS") symptoms and co-existing medical conditions mean in practical terms for patients with IBS? The first thing to note is that not all IBS patients experience additional health problems and symptoms, so it is not a concern for all people with IBS. For those who do, however, symptoms and disorders beyond the bowel can add measurably to the overall burden of illness for the individual and also lead to greater health care needs and health care costs for IBS patients. It is by now well established that IBS patients visit doctors more than the general population. Only recently has it been recognized, howver, that most of the extra health care visits that people with IBS make are not for their bowel problems. Levy et al.(20) reported that IBS patients had about twice as many doctor visits compared to other patients in the same HMO, but they found that 78% of the additional visits were due to problems other than IBS. It seems quite likely that these extra non-GI doctor visits of IBS patients are due to the tendency to experience more general body symptoms over time, based on study results we presented at the Annual Meeting of the American Gastroenterological Association last year(21). Using a scale asking patients about the 26 physical symptoms in Table 1, we found that those IBS patients who report an unusually high number of these symptoms over the past month missed six times as many days from school or work due to illness (see Figure 1) compared to those with low or moderate (normal) symptoms. The "high-symptom" IBS patients also had twice as many doctor visits and more hospital days (Figure 2), and their quality of life was furthermore measurably poorer on the average. A general tendency to have a large number of body symptoms is, therefore, very costly in terms of the IBS patient's overall wellbeing and ability to function normally in life, and increases substantially the health care costs for these individuals. These findings clearly underline the need to find a way to help the many IBS patients who score unusually high on body symptom questionnaires to reduce that tendency. IS IT POSSIBLE TO REDUCE NON-GI SYMPTOMS IN IBS? It is unknown to what degree standard medical treatment for IBS, when successful, also results in improvement in non-GI symptoms. The problem is that most IBS treatment research has not examined how non-IBS symptoms change. Non-IBS symptoms have also not been a focus of standard IBS treatment. An exception to this is psychological treatment trials for IBS, which sometimes have included general physical symptom questionnaires among the measures of treatment effects. We, therefore, know from our two studies of hypnosis treatment for IBS(22) as well as from research in England(23) that hypnosis treatment for IBS regularly improves non-GI symptoms substantially in addition to its beneficial effects on bowel symptoms. Less is known about improvement in non-GI symptoms from cognitive-behavioral therapy (CBT), which is the other widely researched psychological treatment for IBS. However, there is every reason to believe that CBT can reduce the tendency to experience a lot of general physical symptoms, based on a review of over 30 such treatment studies(24). These benefits of psychological treatment for IBS point to extra value of such treatments for the subgroup of IBS patients who have many non-GI symptoms. Research in coming years will hopefully identify other ways to improve the well-being and life functioning of IBS patients by reducing non-GI symptoms. This is likely to become an integral part of managing IBS effectively in the subset of patients who suffer many symptoms and conditions beyond the bowel. References: 1. Whorwell PJ, McCallum M, Creed FH, Roberts CT. Non-colonic features of irritable bowel syndrome. Gut 1986; 27:37–40. 2. Jones KR, Palsson OS, Levy RL, Feld AJ, Longstreth GF, Bradshaw BH, Drossman DA, & Whitehead WE. Comorbid disorders andsymptoms in irritable bowel syndrome (IBS) Compared to other gastroenterology patients. Gastroenterology 2001:120:A66. 3. Zaman MS, Chavez NF, Krueger R, Talley NJ, Lembo T. Extraintestinal symptoms in patients with irritable bowel syndrome (IBS). Gastroenterology 2001; 120(Suppl 1):A636. 4. Maxton DG, Morris J, Whorwell PJ. More accurate diagnosis of irritable bowel syndrome by the use of "non-colonic" symptomatology. Gut 1991; 32:784–786. 5. Whitehead WE, Palsson O, Jones KR. Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications? Gastroenterology 2002 Apr; 122(4):1140-56. 6. Aaron LA, Burke MM, Buchwald D. Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder. Arch Intern Med 2000; 160: 221–227. 7. Walker EA, Gelfand AN, Gelfand MD, Green C, Katon WJ. Chronic pelvic pain and gynecological symptoms in women with irritable bowel syndrome. J Psychosom Obstet Gynaecol 1996; 17:39–46. 8. Whitehead WE, Palsson OS, Levy RL, Von Korff M, Feld AD, Turner MJ. Excess comorbidity for somatic disorders in irritable bowel syndrome (IBS) is related to hypervigilance. Gastroenterology 2003 (abstract in press). 9. Chang L. The association of functional gastrointestinal disorders and fibromyalgia. Eur J Surg Suppl 1998 ;( 583):32-6. 10. Chang L, Mayer EA, Johnson T, FitzGerald LZ, Naliboff B. Differences in somatic perception in female patients with irritable bowel syndrome with and without fibromyalgia. Pain 2000 Feb; 84(2-3):297-307. 11. Toner BB, Garfinkel PE, Jeejeebhoy KN. Psychological factors in irritable bowel syndrome. Can J Psychiatry. 1990 Mar; 35(2):158-61 12. Toner BB, Koyama E, Garfinkel PE, Jeejeebhoy KN, Di Gasbarro I. Social desirability and irritable bowel syndrome. Int J Psychiatry Med 1992; 22(1):99-103. 13. Whitehead WE, Palsson OS, Jones KR, Turner MJ, Drossman DA. Role of parental modeling in somatization of adults with irritable bowel syndrome. Gastroenterology 2000; 122 (Suppl 1): A502. 14. Whitehead WE, Winget C, Fedoravicius AS, Wooley S, Blackwell B. Learned illness behavior in patients with irritable bowel syndrome and peptic ulcer. Dig Dis Sci 1982 Mar;27(3):202-8. 15. Silverman DH, Munakata JA, Ennes H, Mandelkern MA, Hoh CK, Mayer EA. Regional cerebral activity in normal and pathological perception of visceral pain. Gastroenterology 1997 Jan; 112(1):64-72. 16. Bonaz B, Baciu M, Papillon E, Bost R, Gueddah N, Le Bas JF, Fournet J, Segebarth C. Central processing of rectal pain in patients with irritable bowel syndrome: an fMRI study.Am J Gastroenterol 2002 Mar;97(3):654-61. 17. Bernstein CN, Frankenstein UN, Rawsthorne P, Pitz M, Summers R, McIntyre MC. Cortical mapping of visceral pain in patients with GI disorders using functional magnetic resonance imaging. Am J Gastroenterol 2002 Feb;97(2):319-27. 18. Whitehead WE, Palsson OS, Levy RL, Von Korff M, Feld AD, Turner MJ. Comorbid psychiatric disorders in irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). Gastroenterology 2003 (abstract in press). 19. Palsson OS, Levy R,Von Korff M, Feld A, Turner MJ, Whitehead WE. Comorbidity and psychological distress in irritable bowel syndrome (IBS). Gastroenterology 2003 (abstract in press). 20. Levy RL, Whitehead WE, Von Korff MR, Feld AD. Intergenerational transmission of gastrointestinal illness behavior. Am J Gastroenterol 2000; 95:451–456. 21. Palsson, O.S., Jones K.R., Turner M.J., Drossman D.A., & Whitehead, W.E. (2002). Impact of somatization and comorbid medical conditions on health care utilization, disability, and quality of life in irritable bowel syndrome (IBS). Gastroenterology, 122 (Suppl 1): A501-502. 22. Palsson OS, Turner MJ, Johnson DA, Burnelt CK, Whitehead WE. Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms. Dig Dis Sci 2002 Nov; 47(11):2605-14. 23. Gonsalkorale WM, Houghton LA, Whorwell PJ. Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness. Am J Gastroenterol 2002 Apr; 97(4):954-61. 24. Kroenke K, Swindle R. 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One more, IBSers have different pet scans and fmri's then normals. This is very important.
From back in 97
http://www.ibs.med.ucla.edu/Articles/PatientArticleFl97Brain.htm
Since then they have observed abnormalities in the anterior cinculate cortex in IBS in the way it responds to pain arising from the gut. This is called viceral hypersensivity.
Three componets bring on the symptoms of IBS.
Altered motilty
viceral hypersensivity
and brain gut axis dysregulation.
Altered motility alone does not explain IBS.
-------------------- My website on IBS is www.ibshealth.com
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No problem Maria, I have a lot of information on it all, any questions ask away.
-------------------- My website on IBS is www.ibshealth.com
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Thanks for the info. You've got me thinking now. My father was diagnosed with bipolar disorder about 12 years ago after having dealt with his problem for years with alcohol. I wonder if there is any connection between his bipolar disorder and my IBS-D-pain??
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I suppose it could be possible, but unless you have bipolar, probaly not a connection to it physically, but having to deal with it, is possble mentality.
There is a connection to people who get an enteric gut infection which resolves (Post Infectious IBS) and a person later develops IBS. Part of that are people who are stressed at the time of infection, because the stress system, also helps fight infections. Which is one reason why when you have a cold and are tired or stress it can make it worse, for example.
I also want to add here diet is very important as triggers to the underlying IBS and as a means to nromalize gut functioning. There is also problems in IBS from the "ACT of Eating." Especially in d predominate IBS, from the gastro colonic respone, which basically is the stomach telling the lower colon food is on the way and the sigmoid colon over reacts and cause d. The amount of calories and fats are a big part of this process.
This is also in heathers book.
normal 15 minutes after eating and the lower colon. The food is still in the upper gi tract.
and IBS
There are also some twenty five functional gi disorders and many can overlap in the same person.
FUNCTIONAL BOWEL DISORDERS
http://www.acg.gi.org/patients/gihealth/functional.asp
IRRITABLE BOWEL SYNDROME
Kevin Olden, MD Mayo Clinic
What is the Irritable Bowel Syndrome?
http://www.acg.gi.org/patients/gihealth/ibs.asp
This is a brain scan of IBS.
Neuroimaging has provided evidence of physiological differences between normal individuals and those suffering from IBS in the way a visceral stimulus (ie, rectal distention) is processed in the brain.[14,15] Initial data from positron emission tomography (PET) scans demonstrated increased activation of the anterior cingulate cortex (ACC) among normal individuals, compared to IBS patients. The ACC is a cerebral cortical area that is rich in opiate receptors and is thought to be a major component of cognitive circuits relating to perception as well as descending spinal pathways involving pain. More recently, fMRI was used to demonstrate increased activity in the ACC, prefrontal (PF), and insular cortex areas, and in the thalamus of IBS patients compared to normal individuals."
That front part lite up in red is an "anxiety" part of the brain. However another part which they are stuying carefully is the Anteior Cinculate Cortex.
They also believe by the way Hypnosis effects the ACC and is one reason why HT helps pain in IBS. They are doing research and pet scans on this as we speak.
-------------------- My website on IBS is www.ibshealth.com
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