Stress and Its Impact on the Common Stomach and Intestinal Conditions GERD (Gastroesophageal Reflux Disease), IBS (Irritable Bowel Syndrome), and IBD (Inflammatory Bowel Disease - Colitis and Crohn's Disease)

My recent lead author publication was just published in the March/April issue of Explore: The Journal of Science and Healing, entitled, “Perceived Stress in Patients with Common Gastrointestinal Disorders:  Associations with quality of life (QOL), symptoms and disease management.”  Explore 2017;13:124-8.

Here are the Important Study Findings:

1.     Perceived stress in people with GERD, IBS and IBD is higher than 84 % of the general population.

2.     The quality of life, both mental and physical, is at least one half to a full standard deviation below general population normative values.

3.     Perceived stress significantly correlated with average and worst pain in people with GERD and IBD – since these are indicators of disease management, stress may be an important marker of disease management in these conditions.  Note – there was not a correlation between perceived stress and pain in IBS, but I believe that this is due to the ability of stress to contribute to worse diarrhea in some people and worse constipation in others.

4.     While stress management should be included in the care of people with GERD, IBS and IBD, an integrative medicine or holistic approach, which also includes effective dietary guidelines and exercise, would be more important to study and include in GI care in order to get the best health outcomes.

Here is the Abstract:

ABSTRACT

Objective and Methods:  Research supports relationships between stress and gastrointestinal (GI) symptoms and disorders. This pilot study assesses relationships between perceived stress, quality of life (QOL) and self-reported pain ratings as an indicator of symptom management in patients who self-reported gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). Results:  In the full sample (n=402) perceived stress positively correlated with depression (r=0.76, p<0.0001), fatigue (r=0.38, p< 0.0001), sleep disturbance (r=0.40, p<0.0001), average pain (r=0.26, p <0.0001) and worst pain (r=0.25, p< 0.0001).  Higher perceived stress also correlated with lower mental health-related QOL.  Similar correlations were found for the participants with GERD (n=188), IBS (n=132) and IBD (n=82).  Finally, there were significant correlations in the GERD cohort between perceived stress, and average pain (r=0.34, p<0.0001) and worst pain (r=0.29, p<0.0001), and in the IBD cohort between perceived stress, and average pain (r=0.32, p<0.0001) and worst pain (r=0.35, p<0.01).

Conclusions:  Perceived stress broadly correlated with QOL characteristics in patients with GERD, IBS, and IBD.  Perceived stress also appeared to be an indicator of symptom management (self-reported pain ratings) in GERD and IBD, but not IBS.  While future research using objective measures of stress and symptom/disease management is needed to confirm these associations, as well as to evaluate the ability of stress reduction interventions to improve perceived stress, QOL and disease management in these GI disorders, integrative medicine treatment programs may be most beneficial to study.

March, 2017 Blog: Challenges and Opportunities for Advancing the Field of Nutrition in Today's Healthcare Environment

Editor’s Note:  This has been a particularly busy time for me and so I did not get to post my March blog but here it is.  My planned topic for April’s blog was Nutritional and Holistic Stress Management in honor of April being Stress Awareness Month and I will post that it in June.  As for my May blog – this will be a discussion of my recent first author publication that was just published in the March/April issue of Explore: The Journal of Science and Healing, entitled, “Perceived Stress in Patients with Common Gastrointestinal Disorders:  Associations with quality of life (QOL), symptoms and disease management.”

Challenges and Opportunities for Advancing the Field of Nutrition in Today’s Healthcare Environment

Nutrition has always been pretty controversial and difficult to pin down given how complex a scientific discipline it is and given the competing models of care and approaches that are taken.  This may be best illustrated by the conventional medical model and its disease management system, in comparison to the integrative medicine model and its preventive and holistic approach to healthcare.  It is always difficult to change a model that is well entrenched but it is changing slowly.

It is generally accepted that conventional medicine is great for emergency and acute care, and does rather poorly with chronic disease care because it does not do a very good job with lifestyle characteristics such as nutrition, fitness and stress management, as well as sustainable behavioral change approaches.  Integrative or holistic medicine is an approach that includes the whole person and addresses physical, emotional and spiritual well-being.  Unfortunately, while there is research to support an evidence base for practice, the research is difficult to do and there is not the funding needed to more quickly support changes in care.  Much of the progress has also been supported by public demand and that is likely to continue.

Dietary Guidelines

There are good dietary models that are being promoted in general with the Mediterranean Diet being the best example and a good prototype for a healthy dietary plan.  Not only does it support a good dietary composition with vegetables, fruits, whole grains and beans, but it also effectively balances these foods with less animal products, and sugars and refined flour products, and it has an important philosophic approach suggesting a focus on fresh foods and unprocessed foods as much as possible.

What is not well supported is the importance of food intolerance or food allergy, and the importance blood sugar regulation and insulin resistance, which is described below.   These approaches will hopefully get more attention and research support in the near future.

Food intolerance and food allergy

The most common foods in this category is sugar, dairy and wheat and my work with clients and patients suggest that they need to be limited because they contribute to a variety of symptoms and problems such as stomach and intestinal symptoms, headaches, fatigue, as well as autoimmune disorders, allergies and other health issues.  It is also that these foods tend to be quick and easy to eat and can be addictive, which often decreases the amount of fresh vegetables and fruit in a diet.  This combination effect can have serious health consequences.  One of the best approaches to evaluate these health effects is to follow an elimination challenge diet that cuts out sugar, dairy and wheat, as well as many other potentially allergenic and intolerant foods for one to four weeks – foods are then added in one at a time to see if they produce reactions.

Hypoglycemia, abnormal glucose tolerance and insulin resistance

While this is well recognized to be important in healthcare, the problem is that there is not as much consideration of the fact that a higher protein, lower carbohydrate diet can be an important, healthy and practical approach for many people.  Again, this can get complicated because there are many approaches that can be considered and it should still be in the context of a fresh food and unprocessed diet.  When I worked at the Atkins Center for Complementary Medicine, I got a great training in these diets and saw how helpful they can be for weight, diabetes, cardiovascular disease and other disorders such as GI problems (GERD, IBS and IBD) and neuropsychological disorders (depression, anxiety and others) – it is again important to individualize the guidelines for each client or patient to insure that it is healthy and that people get the best results and outcomes.

Targeted Nutritional Supplements

This is the other important nutritional area where good progress still needs to made as a part of a more natural and preventive healthcare system.  Most of the public are open to and want to use more natural products but the entrenchment of the pharmaceutical industry in healthcare and the resistance of the healthcare system is making this difficult and slowing the progress down.  More and effective research would be helpful but again, this can be difficult research to do and not enough funding to make great progress.

The most common supplements that I recommend are a multivitamin and mineral, fish oil (omega 3 fatty acids), vitamin D, magnesium and calcium (these last three can also be combined in an osteoporosis or bone building formula).  Then there are specific and targeted supplements that can be useful for GI disorders (eg. a probiotic and digestive enzyme), heart function and heart related disorders (eg. coenzyme Q10 and hawthorne, in addition to fish oil and magnesium), and targeted supplements for a range of other health issues.

Moving Forward

Progress will continue to be slow with so much uncertainty in healthcare but this will continue to be most effectively promoted by integrative and holistic medicine, as well as the continued demand by the public.  Another big and important step will be the effective inclusion of prevention in medicine but it is hard to predict when that will really occur.