Does a Gluten-Free Diet Help with IBS Symptoms?

Does a Gluten-Free Diet Help with IBS Symptoms? By Juliette Frank The majority of patients seen for IBS treatment are either on a gluten-free diet, or have tried such a diet with mixed success. Marketing campaings have promoted a gluten free diet for a variety of common digestive symptoms ranging from abdominal bloating and pain, gas and altered bowel habits. However, the evidence for the effectiveness of such a dramatic dietary approach in the treatment of IBS is rather sparse and inconsistent. If you’ve been paying any attention to the bread aisle at your grocery store, you would have noticed how much it has expanded in the past few years with items labeled “gluten-free”. This is ideal for those diagnosed with celiac disease, which is an inherited autoimmune condition that is triggered by consuming foods containing gluten. Those affected by celiac disease often experience gastrointestinal symptoms such as bloating, diarrhea, unintentional weight loss and constipation after consuming gluten from wheat products and related prolamins from grains such as rye and barley due to the maladaptive response of the gut’s immune system to this protein and the gut, damaging the villi of the small intestine and if severe enough resulting in malabsorption of nutrients. Considering the prevalence of celiac disease is about one percent of the general population in the U.S., including both diagnosed and undiagnosed cases, there are clearly other factors causing the recent demand for gluten-free products. “Gluten free diets have become the latest health food fad…” Gluten free diets have become the latest health food fad, with more and more consumers decreasing their gluten intake regardless of their diagnosis or sensitivity to wheat products. A major contributing factor to the widespread adoption of this diet is the media’s role in sensationalizing a few studies claiming that avoiding gluten leads to weight loss, and improved cardiovascular and gut health. Various celebrities and athletes have touted the benefits of this diet which has created misconceptions about it’s nutritional effects and has accelerated it’s rise in popularity in the U.S. and much of the Western world. Without any scientific research backing up many of these claims, more and more people without celiac disease are adopting a gluten free diet in hopes it will improve their overall health and physical appearance. In a 2017 survey of 1,000 consumers of gluten-free products in the United States and Canada, 46% of those surveyed reported…

How to Be Happy During These Uncertain Times

How to Be Happy During These Uncertain Times By Emeran Mayer, MD The solstice in December, the day I am writing this, marks the first day of winter. In the Northern hemisphere, it is the shortest day and the longest night of the year. Ever since ancient times, this day has been celebrated across the world as a time of renewal, a kindling of hope, in the depths of darkness. It is something deeply embedded in the human mind that has been adopted by different religions and cultures for thousands of years. Lights on the Christmas tree and all the magical Christmas decorations tempting us to visit the local mall to buy a last-minute present are only one of the most popular versions of this ritual, co-opted by commercial interests which have made Christmas shopping one of, if not the most profitable time of the year. The ancient rituals of happiness have been replaced by a frenzy of pleasure-seeking activities. [caption id="attachment_7601" align="alignright" width="360"] Photograph of a nativity scene carved into a wooden mold in 1571. This mold was used by my father to make gingerbread cookies for the local Christmas market.[/caption]If we only judge by the daily flood of negative information in the media, there is little to be happy about moving towards the end of this unusual year. The beginning of the third year of the pandemic, with a new variant leading to the unexpected return of lockdowns and an overwhelmed healthcare system, extreme weather patterns around the world, with predictions of things to get much worse, millions threatened by starvation, heartbreaking stories of desperate refugees drowning in the freezing waters of the English Channel, out of control autocrats with return to cold war scenarios and continued paralysis of the political system here in the US, preventing any meaningful solutions to our most pressing problems. Unsurprisingly, in addition to the 800,000 COVID-related deaths in the US so far, and a continued death toll of about 2,000, we are witnessing an epidemic of mental illness in the form of anxiety, depression and PTSD that is overwhelming mental healthcare providers. Is this the right time to be happy? Instead of frantically engaging in last minute shopping sprees and focus on the transient pleasures we obtain from getting beautifully wrapped gifts, enjoying Christmas dinner and indulging on delicious sweets, we should reflect for a moment what a mental state of happiness…

Can Trauma Manifest in the Physical Body?

Can Trauma Manifest in the Physical Body? By Sarah Abedi, MD When I learned about post-traumatic stress disorder (PTSD) in medical school, it was usually confined to my psychiatry courses. Because why else would it be anywhere else…it only affects the mind, right? I never really questioned this paradigm as I had no reason to until I started to see some particular diseases happen predominantly in patients with a significant trauma background. These anecdotal cases motivated me to see what the scientific literature suggested, and to my surprise maybe the mind was not the only place a trauma lives. My first introduction to trauma’s effect on the body came to me as I learned about adverse childhood experiences (ACEs). ACEs are traumatic events that occur in childhood that could include experiencing violence, abuse and neglect. These could include having a family member attempt or die by suicide, growing up in a household with substance use, mental health problems or instability due to parental separation. ACEs are linked to chronic health problems and there is a direct correlation with someone’s ACEs score (there is a quiz available on the CDC website to calculate one’s ACE score) and becoming affected by chronic diseases in the future. Toxic stress from ACEs can change brain development and affect learning, response to stress, decision-making, and attention. According to the CDC’s website, up to 1.9 million cases of heart disease and 21 million cases of depression could have been potentially avoided by preventing ACEs or by providing expert therapy. Adverse childhood experiences are common; about 61% of adults surveyed across 25 states reported that they had experienced at least one type of ACE and nearly 1 in 6 reported they had experienced four or more types of ACEs. According to the research, dysfunctional households and childhood abuse can increase the risk of chronic physical disease by up to 81%. As I learned more about this phenomenon, I wondered what other diseases may have a root cause of trauma. Looking deeper into a common ailment presenting with chronically recurring belly pain and altered bowel habits, a disorder called irritable bowel syndrome or IBS, I realized that there is a strong psychological component associated with it. IBS has been known as a “functional” disorder, meaning there is no detectable structural or biochemical cause responsible for the symptoms. Instead, the issues lie more in how the digestive tract functions-…

We Are Facing a Youth Mental Health Crisis

We Are Facing a Youth Mental Health Crisis By E. Dylan Mayer Last week, the United States surgeon general spoke out and warned that young people are facing “devastating” effects on their mental health as a direct result from challenges experienced by their generation, especially the COVID-19 pandemic. The US surgeon general, Dr. Vivek H. Murthy, released a 53-page report stating that the pandemic had intensified mental health problems, a trend that already started early on in 2020. The report cites significant increases in reports of depression and anxiety along with an increased rate for emergency room visits for mental health issues. Here in the United States, emergency room visits for suicide attempts rose 51% for adolescent girls in early 2021 compared to pre-pandemic levels in 2019. Although these rates were already on the rise, increasing 28% from 2011 to 2015, the increase from 2019 to 2021 is significantly more rapid than before. This report is not the first time an “influential voice” is calling for action. Back in October, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association, together, declared a “national emergency” in youth mental health. The blame is often put on increased use of social media, however it is difficult to conclude that overuse of social media is the primary reason these numbers are skyrocketing. As a matter of fact, researchers claim that increased screen time alone does not account for this crisis. The report states that adolescent brain chemistry, relationships with friends and family, and a fast-paced media culture all play significant roles in this mental health epidemic. One factor that one might add to this list is diet. As we have discussed many times in this newsletter, an unhealthy diet (including the increased consumption of comfort food eaten to combat anxiety) consumed in front of the TV, and without close social interactions can influence the brain through alterations in brain gut microbiome interactions and has been implicated in several mental health conditions. One important thing to note is that while screen time itself may not account for the crisis, it could be that increased screen time is taking away time from activities which are important for our mental health, including sleep, exercise and in-person socializing. Dr. Murthy claims that increased use and bombardment of messages through social media and pop culture erode people’s sense of self-worth…

Anxiety and IBS – Two Sides of the Same Coin?

Anxiety and IBS – Two Sides of the Same Coin? By Emeran Mayer, MD For as long as I can remember in my career as a gastroenterologist (30+ years) every new publication and every presentation about IBS which affects around 10% of the population has always started with the same caveats: IBS is a diagnosis based on (regularly changing) “subjective symptom criteria”, the pathophysiology is “incompletely understood” and available treatments are “unsatisfactory”. “Commonly used IBS treatments, ranging from dietary exclusion, motility modulating drugs to psychoactive medications, are largely ineffective…” The commonly used IBS treatments, ranging from dietary exclusion, motility modulating drugs to psychoactive medications, are largely ineffective (in most clinical trials they performed not better than 10% above placebo) and their variety (targeting smooth muscle, water secretion, gut microbes) reflects the uncertain etiology of the syndrome. Even though behavioral therapies have proven more effective than most medications, they have not been widely accessible even though web-based versions of cognitive behavioral therapy (CBT), gut directed hypnosis and mindfulness-based stress reduction are rapidly becoming available. Considering the number of efforts and funding invested in research studies aimed at identifying the cause of the syndrome and demonstrating effectiveness of a variety of medications (largely unsuccessful), it is surprising that the list of these caveats has remained virtually unchanged over more than 3 decades. Another recurrent theme in scientific and clinical meetings has been the debate about whether IBS is a gut disorder (a “real disease”) or is related to alterations in the brain (“just psychological symptoms”). Recent epidemiological data suggested that, in individuals developing both IBS and psychological features, the former preceded the latter in two thirds of cases and the latter preceded the former in one third. However, in my own practice, a thorough history taking reveals psychological factors often dating back to infancy in the majority of patients presenting with IBS symptoms, even those with so called post infectious IBS. “IBS has finally been officially recognized as a disorder of altered brain gut interactions” The good news is that after decades of these fruitless arguments and debates, and based on overwhelming clinical and scientific evidence, IBS has finally been officially recognized as a disorder of altered brain gut interactions. A recent study by a large group of investigators in the UK and US, provides new and strong evidence supporting the brain gut disorder concept. (Even though there have been many previous…