In the late 70s, irritable bowel syndrome (IBS) became the quintessential disorder of brain gut interactions, almost 50 years before a major professional IBS organization, the ROME foundation, came to the same conclusion. Around 10% of the US population suffers from chronically recurring symptoms of abdominal pain, discomfort and altered bowel habits which make up the symptom criteria defining the syndrome.
What I experienced during these 50 years could fill a whole book with entertaining anecdotes, hard to believe statements by leading authorities, dramatic changes in hypothesized underlying biological mechanisms, 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”. In between came periods when some experts postulated a smooth muscle disorder and an inflammatory disorder, and most recently a microbiome-related disorder. What has always fascinated me was the fact that research studies performed in experimental animal models of IBS, and sometimes in human patients, actually reported findings supporting these various different disease mechanisms. And the pharmaceutical industry often spent millions of $$ developing medications aimed at these elusive mechanisms, none of which has ever been confirmed. Treatment recommendations over the decades have ranged from drugs aimed at slowing or speeding up transit through the gut (so called motility drugs), from high fiber diets to today’s promotion of the “low FODMAP diet”, a diet devoid of many fiber containing foods. And most recently, treatments have been proposed which are aimed at the microbiome from non-absorbable antibiotics to cocktails of pre- and probiotics.
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 IBS experts. While the ROME Foundation aimed to provide a systematic approach to the functional GI disorders by splitting them into some 40 different separate entities, each of them with their own postulated mechanism and treatment recommendation, we suggested from early on that alterations in the bidirectional brain gut interactions, including increased perception of visceral signals (“visceral hypersensitivity”) and aberrant autonomic nervous system responses, provided a unifying framework for all the different clinical manifestations affecting every part of the GI tract from the esophagus to the end of the large intestine.
It is ironic that while these various concepts promoted over the years have primarily benefited the careers of up-and-coming investigators, the pharmaceutical industry, and supplement companies, they have not provided consistent and lasting relief for the millions of patients suffering from symptoms of chronic abdominal pain and discomfort, often accompanied by anxiety, depression and other chronic pain conditions. With exceptions, the great majority of treatments have not been much more successful than a placebo pill (usually about 10% better in controlled studies).
In order to empower IBS patients to manage their own symptoms effectively, without worries about the latest IBS-focused diet and without having to go through trials of unsatisfactory medications often with unpleasant side effects, I have developed an online educational program for IBS patients titled, Intuitive IBS: A Personalized Approach to Healing Your Gut. The class has three elements which I feel are essential for an effective therapy:
- Understanding the mechanisms that cause symptoms.
- Empowering you to become your own IBS expert.
- Providing you with simple tools to manage your symptoms.
The contents of this class are based on 40 years of clinical experience working with some of the most severe IBS patients, and research performed in our center at UCLA, as well as a few outstanding investigators around the world. While I have often been told by colleagues that this information is too complicated for patients to understand, I still have yet to meet a patient who didn’t embrace this information, and who has not experienced significant symptom improvement.
Don’t miss the opportunity to sign up for the Intuitive IBS class which will become available in the coming weeks!
Dr. Emeran Mayer is a Distinguished Research Professor in the Departments of Medicine, Physiology and Psychiatry at the David Geffen School of Medicine at UCLA and the Executive Director of the G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA.