Take it or leave it.

Saturday, May 23, 2015


When I was a kid I used to get these really bad stomach aches. Each year from the 2nd through the 6th grades I'd be visited by incapacitating pain. It was always in the same place, just to the left of my belly button, where it would radiate down into my groin. It was crampy and achy and a major pain in the, well, belly. And when these stomach aches came, and it happened randomly, I'd be kept up all night, curled in a fetal position on the floor, unable to eat or sleep or think of anything but how much it hurt. Then the following morning, as if by magic, the pain would disappear.

My parents took me to the pediatrician, who was at a loss to explain it. Maybe growing pains? Food poisoning? Gastrointestinal upset, cause unknown was the diagnosis he gave me, I think. And GI upset is one of the most common childhood ailments, I'd come to find when I became a doctor myself. When treating a kid whose tummy hurt I'd usually just tell mom what my doctor told me, which was that the pain would go away on its own. And usually it did. This of course after I had ruled out conditions such as pancreatitis and kidney stones, which are thankfully rare.

But what happens when stomachaches occur in adults? And they occur oftener than you may think. Perhaps to you? These patients come in with a list of symptoms including bloat, gas, stomach upset, cramps, possibly diarrhea or constipation, seemingly unrelated to what they eat. I'd assemble a list of differential diagnoses and by examination aided with lab studies rule out possible culprits, which include inflammatory bowel disease (IBD), as both Crohn's and ulcerative colitis are more common in adults than in kids.

Usually there was no disease at work, and I felt powerless to help these poor people, who were clearly in great pain and distress. The diagnosis I'd pencil in in such cases was IBS, or irritable bowel syndrome. Back when I was in clinic there was no real effective treatment for IBS, and the underlying cause was unknown. I couldn't tell my patients that their symptoms would make like they appeared and go away on their own, because often IBS is a life-long condition.

As I bid goodbye to these individuals I secretly wished they'd never return with the same complaint. Because if they didn't come back, it meant they were cured - I hoped. But if they did return, it was only a reminder of how powerless the medical profession can be in the face of the most basic ailments. Go to the hospital with chest pain or a broken bone and get taken care of quick and effectively (albeit after a rather long wait in the ER). But suffer from headache, neck pain, the common cold, and yes, IBS, and you're likely as leave the doctor as stumped as you were when you came, and stuck with the bill.

Now however scientists may be onto something. A study published in the open-access journal PLOS ONE showed that IBS, which characteristically proves resistant to standard therapies such as dietary modifications, over-the-counter medications and fiber supplements, can improve with relaxation techniques, which the researchers call "mind/body intervention."

This makes sense. Consider that the GI tract in order to function properly requires an adequate blood supply. Your intestines and associate organs (liver and pancreas) are governed by the parasympathetic nervous system, whose functions are to "rest and digest."

By contrast, the sympathetic nervous system runs the "flight or fight" response which shunts blood from the organs to the muscles, heart and lungs. As you see, the two activities, digesting and fighting, oppose each other. Which is why mom says to wait a while after eating before you swim.

But the 21st century is one in which the sympathetic nervous system, primed to fight or flee, dominates. Because today's world is rife with stressors. The phone with its constant barrage of texts, tweets, emails and messages. Traffic. Work deadlines. Family functions. Your children's activities. Global warming. Taxes. Bills. Construction. Commercials. Fox News. TSA. (Add your top three stressors here.)

In a stress-filled climate our bodies surge with adrenaline, which charges the heart and flexes the muscles. Cortisol floods our arteries, shutting down the organs of rest and digest. This leaves the digestive system and its contents on hold until deadlines are met and bills get paid and the phone stops buzzing. In other words until life slows down, which may only come when you sleep, and God help you if you're one of the nearly 50% of people who experiences insomnia.

To help understand a colon starved for nutrients, consider what happens to muscles when they don't get enough oxygen. Go outside and run as fast as you can. Witness your quads as they burn and cramp, caused by a build-up of lactic acid, a byproduct of anaerobic respiration, which is the metabolic pathway your muscles must use when they run out of air. This same phenomenon occurs in the IBS sufferer, whose intestines get neglected as you attack the varied tasks of the day.

So slow down. The study, which followed 48 adult participants for nine weeks, included relaxation response training, defined as "a physiologic state of deep rest induced by practices such as meditation, yoga and prayer." It took only 15 to 20 minutes of such training each day to achieve "significantly improved disease-related symptoms, anxiety and overall quality of life, not only at the end of the study period but also three weeks later."

In only 20 minutes? That's the length of time some poor suckers spend on the shitter! If relaxation is effective in treating IBS's constipation, consider it so much time saved.

So take a chill pill today, and kiss that grumpy tummy away.

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