If you’ve ever had butterflies in your stomach or an attack of nerves that sent you racing for the bathroom, you already know that the intestinal tract has a mind of its own. The millions who suffer from irritable bowel syndrome, or IBS, perhaps know it best.
IBS, with its symptoms of bloating, abdominal pain, flatulence, diarrhea or constipation or an alternating cycle of the two, can seriously impair the ability to work and enjoy leisure activities. Up to 15 percent of the population is affected, though only half seek medical help.
The gut and brain are intimately connected, with more nerve cells in the intestines than in the central nervous system. The gut has been called the body’s second brain, containing 95 percent of the body’s neurotransmitter serotonin and direct nerve connections to the brain.
So it is no surprise that this common disorder of intestinal function has a strong mind-body connection. This does not mean IBS is a psychosomatic condition caused by emotions, but rather that emotional upsets can aggravate symptoms in someone with a hyper-reactive bowel.
It also means that learning to minimize stress and emotional disturbances can reduce the symptoms of IBS, perhaps more effectively than medications, recent research has indicated. Yet much educational material about this condition underplays the mind-body connection and the vital role that emotional retraining can play in controlling it.
This is perhaps an overreaction to the past when most patients with IBS were told there was nothing physically wrong with them — it was all in their heads. After all, they had no obvious organic cause like a tumor, infection or ulcer.
In the modern era of medicalization, the pendulum swung the other way. Gastroenterologists now recognize that IBS is a real physiological, or “functional,” disorder, though no specific cause has been discovered.
Recent studies have implicated serotonin as one factor, since patients with IBS have reduced receptors for this chemical. And studies have shown that low levels of selective serotonin reuptake inhibitors can sometimes relieve its symptoms.
In many patients, symptoms can be set off by large meals or certain foods, among them wheat, rye, barley, chocolate, milk products, alcohol, coffee, tea and colas. By keeping a food diary and recording symptom flare-ups, patients can identify their sensitivities and avoid the culprit foods.
REUNITING MIND AND BODY
A small but growing number of specialists are seeking to reunite mind and body by treating patients with a combination of medications, dietary precautions and emotional re-education. Their early studies indicate that this mind-body approach is more effective than either alone.
Charles D. Gerson, a gastroenterologist affiliated with Mount Sinai Medical Center, works with his wife, Mary-Joan Gerson, a psychotherapist, and their daughter, Jessica, a hypnotherapist, at the Mind-Body Digestive Center in New York.
Gerson said in an interview that for patients who are seriously impaired by IBS, medications help but “there is no magic pill that solves the whole problem. Patients need a more holistic approach. Those who accept emotional as well as physical causes of their condition do better.”
While it is destructive for patients with IBS to be told it is all in their heads, it is also wrong to ignore the psychosocial factors that play a role, he said.
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