The Wellness Primer

The Wellness Primer By Emeran Mayer, MD Wellness and the related state of optimal health are lofty goals for millions of Americans. Unfortunately, it is estimated that only about 5% of the US population fall into this category, while about 45% live in a suboptimal health/pre-disease state (without even being aware of it), 50% already live in a chronic disease state, dependent on multiple medications and interventions of our disease care system (an expression that in my opinion best characterizes our modern healthcare system). An overwhelming amount of epidemiological and scientific evidence supports the idea that the transition from optimal health to predisease and ultimately disease is caused in large parts by the increasing stress our brains and bodies are experiencing during a lifetime, often starting in childhood. While acute, transient stress improves our performance by increasing arousal, excitement and focus on a particular challenge, severe chronic stress engages maladaptive responses of the nervous and immune systems which are damaging to our health. With stress, I’m not only referring to the chronic psychological stresses that we are increasingly exposed to in our modern world; the current pandemic is an excellent example of this challenge. But I also include the chronic metabolic stress that millions of Americans are exposed to without knowing it: the stresses on the gut microbial ecosystem and the closely linked gut health caused by the unhealthy Standard American Diet. The combined influence of these growing psychosocial and dietary perturbations of the normal state of health (also referred to as allostatic load) that has become the new normal in the US population is stretching the resilience of our organism to its limits and is making more and more people dependent on the modern disease care system. In this short video clip above, I provide a brief explanation of the relentless transition that has been occurring in the US and increasingly in developing countries from a state of optimal health and the associated subjective feeling of wellness to the current epidemic of chronic non-infectious diseases. I also provide an understanding of how both psychosocial and dietary stresses interact to result in a maladaptive engagement of the immune system ultimately leading to organ dysfunction and disease. I will follow up in two weeks with the second part of this story, focusing on the preventive and therapeutic strategies supported by scientific evidence that are available to counteract this unhealthy development. If…

Understanding and Treating Irritable Bowel Syndrome

Understanding and Treating Irritable Bowel Syndrome By Emeran Mayer, MD We all know that the mind plays a role in disease, but it cannot be studied scientifically.” From the beginning of my medical career, I was interested in understanding how the brain and the mind interact with the body, and how a dysregulation in these interactions can result in a range of medical problems, ranging from heart attacks to unexplained abdominal pain, and from asthma attacks to non-cardiac chest pain. When I tried to find a thesis advisor for my dissertation in medical school in the early 70s, I typically got the answer from the leading professors that “we all know that the mind plays a role in disease, but it cannot be studied scientifically”. Luckily, after 5 failed attempts, I found the right mentor at the Institute of Physiology at the University of Munich, and embarked on a 4-year period of studying the influence of the brain and specifically the sympathetic nervous system on blood flow to the different layers of the heart. Even though I switched my focus from the heart to the gut during my subsequent clinical training in gastroenterology, I never lost my keen interest in studying brain gut interactions. Around 10% of the US population suffer from chronically recurring symptoms of abdominal pain, discomfort and altered bowel habits, which are the hallmark symptoms of IBS. Even though IBS is the quintessential disorder of brain gut interactions, it has only been very recent that experts of the largest professional IBS organization, the ROME Foundation, came to agree on this definition. “IBS is a disorder of neurotic housewives.” What I experienced during these 50 years could fill a whole book with entertaining anecdotes, hard-to-believe statements by leading authorities, and often conflicting dietary and other treatment recommendations. For example, at an international meeting in the 80s, one prominent thought leader referred to IBS as “a disorder of neurotic housewives”, while another stated that it isn’t “a real disorder” in the first place. Then came the long-lasting period of attributing symptoms to disorders of gastrointestinal motility, e.g. altered contractile activity and intestinal transit, followed by a period obsessed with “excessive intestinal gas production”. While the new theories about IBS that appeared every few years captured the imaginations of clinicians and investigators in the field, my early conceptualization of IBS as a brain-gut disorder was rejected by the majority of…