I was reading Melissa's McEwen's recent blog post on IBS (http://huntgatherlove.com/content/why-paleo-didnt-fix-my-ibs), which got me thinking about if this ambiguous "syndrome" is more organic or mental. I suffered from IBS for 7 LONG years and after some GAPs protocol and jumping on the Paleo bandwagon it seemed to help quit a bit, however, I could tell there was still some work to be done. Fast forward 2+ years and I still don't feel I have made much progress since my initial switch to Paleo and from a performance view that sucks! If I tried to increase my squat or deadlift, for example, and I only increased it 2-3% in 2+ years, while trying various techniques, routines, trainers, etc., I would get pretty frustrated and probably just accept the fact that I am a weak P@#%y!!! However, I refuse to give in and not be completely healed from this, so I continue to try new things as Melissa described in her blog post.
Now back to Melissa's blog post....it's seems a common theme that most IBS suffers are never fully cured regardless of how they manipulate their Paleolithic diets. Whether it's strict Paleo, 80/20 Paleo, Primal, SCD, Perfect Health Diet, GAPs, WAPF, etc., the same outcome is echoed over and over, GREAT results but still minor to moderate symptoms. Most of the discussion on Paleo Hacks, blogs and podcasts on IBS are about what and how we eat, but very few talk about the mental aspect. This is especially true when we talk about the cause of IBS. Most of the discussion is on damage to the gut and decrease in good bacteria or even overgrowth of bacteria. However, most experts believe IBS is often caused by emotional conflict or stress causing your body to go into a sort of fight or flight mode. Many believe even after that stress period or emotional conflict has gone, the IBS remains because mentally you have not recovered or healed, therefore, your body continues to respond in this manner. I will note that when I had IBS and was eating SAD, most of those same IBS experts suggested meditation, hypnosis, and stress avoidance. During those 7 years I tried those suggestions with only short term and minor positive changes. Since starting Paleo, I have also attempted meditation and stress reducing techniques, but again with the same short term and minor positive effects.
Let's take a look at when my IBS began. I was eating bodybuilding SAD at the time and definitely overtraining, however, I also remember I was going through one of the most stressful periods of my life (family death, marital issues, job issues, financial issues, etc.). I often wonder what was the true culprit? Was it inevitable, even without the stress (mental and/or physical), that the food was going to cause it or would I have remained "healthy" if I would have never experienced that amount of stress (mental and/or physical) or were they equally to blame?? It's almost a chicken and egg question, right?? It's obvious that this question can never be answered, but it's always been in the back of my mind.
As most IBS sufferers know, the fear of going back to that life, where you spend more time with your toilet more than anyone else, always resonates in your mind because it is such a miserable existence. So if you look at IBS in the way I described above, non-organic and stress/emotional related, then is the lack of focus on fixing the mental aspect and that fear of recidivism the reason why most of us in the Paleo community cannot get to the next level with our recovery?? For the few that have recovered 100%, do you recall experience any stress or emotional conflict when your IBS began or was it simply an allergy or intolerance to a food?? It also begs to question, if the mental aspect is holding us back, what will it take to completely healed and REMAIN healthy??
I'm not sure we can separate mental from physical causes. There is a lot of new research into the gut and its universe of bacteria, and what intrigues me the most is how these bacteria relate to, and may in fact control, many neurological functions. Add in the connection to the immune system, and things get interesting.
I've mentioned before that going Paleo eased my anxiety symptoms about 80%, but hasn't cured me. I still have some mood issues that I'm exploring. In addition, IBS has been a recent visitor only after being on Paleo for 9 months and in the absence of major stress (which is what triggered it years ago). It seems to be resolving for the most part after several months of frustration.
I think there's great value in meditation, yoga, mindfulness practice. But yes, it is something that requires discipline and consistency to see real results, which is hard for all of us in the real world.
Paleo is great, but it can't cure of us of everything. Which isn't to say we shouldn't keep trying to figure it out and learn what helps and what doesn't. Best of luck to you.
"Examines the observed high prevalence of psychiatric disorders in patients with irritable bowel syndrome (IBS). The published literature indicates that fewer than half of individuals with IBS seek treatment for it. Of those who do, 50% to 90% have psychiatric disorders, including panic disorder, generalized anxiety disorder, social phobia, posttraumatic stress disorder, and major depression, while those who do not seek treatment tend to be psychologically normal. Both physiologic and psychosocial variables appear to play important roles in the development and maintenance of IBS. Recent information suggests that the association of IBS and psychiatric disorders may be more fundamental than was previously believed. A brain-gut model for IBS is presented, and the role of traumatic stress and corticotropin-releasing factor as modulators of the brain-gut loop is discussed. Finally, the rationale for the use of psychotropic agents in the treatment of IBS with or without psychiatric symptoms is presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)"
I think it depends on the person. It's possible that people with brains susceptible to emotional problems have overall a dysfunctional nervous system (which includes the gut). But for me my stomach problems haven't tracked with emotional issues or stress.
But overall, the idea that IBS is mainly emotional has done a lot of damage to me personally. Because of that idea, in high school I was also given anti-anxiety pills for my IBS that had some pretty serious side effects and did nothing for my stomach. I've been told so many times that it's all in my head and it's been implied that the reason I was sick was because I was emotionally unhealthy or something. But I think it's different for everyone. It just really hurt to go to the doctor and be told it was all in my head. That's actually how I ended up in the ER, because I had been having worsening symptoms and the doctor just dismissed them until I finally collapsed and ended up on an IV in the ER for severe salmonella.
I don't feel like I have IBS at the moment. As long as I stick with a decent protocol that avoids the FODMAPs I'm sensitive to and other foods that seem to make me sick, it doesn't crop up no matter what happens to me. It has made some stressful situations, like moving three times in one year and breaking up a serious relationship, not as stressful.
It's worth checking out cognitive behavioral therapy though. I did a year of CBT for serious panic attacks in college and it really helped with those, but the stomach problems continued until I made dietary changes. It's also worth trying non-paleo foods like rice, which REALLY helps me. WHenever I do something stupid and it seems like things are going wrong in the gut, rice pretty much clears it up for me.
Actually, the more I think about it, the more I tend to think that IBS causes emotional disorders, not the other way around. For me, I remember having my life being really great, but when my stomach was messed up, I'd just feel so freaking depressed and miserable no matter what I did. It makes sense to me because endotoxins are associated with depression.
I have had IBS literally my whole remembered life, and believe me, if it had been possible to think my way out of it at any point, I would have figured it out. It would get 'better' and much much worse, fairly irrespective of stress (although any big IBS flare-up time was, by definition, super-stressful).
Within one week of truly quitting gluten, my symtoms diminished, then vanished. I may always have a more tender and picky gut than someone who spent the first 34 years of their life with healthy digestion, but I'm pretty sure my IBS was 100% food caused and not a byproduct of my thoughts or stress.
Now, the inverse question: did my IBS cause my mental problems? By all means yes! Starting with auditory hallucinations as a kid and progressing to depression and oervasive anxiety by the time I was twenty. Meds, mindfullness, therapy...nothing cured me like eating right.
I am convinced it has a lot to do with gut bacteria. (They affect your brain, too, by the way.) The fecal transplants done to cure people with C. diff infections are also effective at helping IBS.
I also would not differentiate between "organic" and "mental." Everything going on in your brain is organic.
In all topics regarding "mental vs physical"... don't forget the fact that your brain is also physical, it isn't an invisible "aura". I see this often here in PaleoHacks and other websites. People seem to think that your mind is not part of your body.
When I started eating Paleo my stress vanished (meaning, there were still stressful things going on in my life, but I could deal with them better) and so did my IBS, but..
I had IBS that made me give up lots of things in my life, for example, I did NOT go to Christmas, Thanksgiving, etc. It was too embarrassing to be around family.
I suffered with IBS for about... 5-6 years, and after one month of Paleo (or rather, my mom's diet), it was all gone. It's been almost a year, and I never had any problems since.
I have recovered 100%, even with stress in my life. At first, if I cheated, I'd have mild diarrhea (but still mild enough that I could say "Oh, I'll go to the bathroom after I finish this", instead of "OMG I'm gonna crap my pants!")
Now that I take digestive enzymes (Twin Labs) I can eat whatever I want with no toilet side-effects (which is no excuse, I shouldn't be eating junk food :P)
When my IBS started, yes, there was much stress in my life. BUT that stress lead to eating bad foods. So which one caused it? I say it is the food. I had much stress in my life before, but those times, back home, I ate healthier food: my moms cooking. When I was on my own, I could eat whatever crap I wanted. I'm sure this is the difference.
Let me tell you something else that might cause lots of drama: back in my home country, I was a "normal" person. When I moved to USA and started eating SAD, I became Asperger's. This tells me that had I been raised here on SAD foods, I might have been Asperger's since I was born. All the symptoms are now gone after Paleo. Your brain IS part of your BODY.
In that same manner, I say the cause of IBS is food. Yes, anyone could possibly have occasional stress-related "accidents", but this is not the same as chronic/daily IBS. No matter what I ate, I had (or nearly had) accidents, even if I wasn't particularly stressed.
Did I have mental problems while I had IBS? Yes, my personality changed so much; I went from a wonderful, bright person, to a person who could not even go get the mail or do simple errands; I could not wash more than a couple dishes before crying and wanting to stab myself with a knife; couldn't do simple subtraction/addition, put more than a couple words together, crippling depression and anxiety and panic attacks, problems which I had never had before in my life; not to mention the Asperger symptoms (and the light/sound/touch sensitive + more) and it's now all gone after paleo.
You seem like you do your research, so I assume that you know that damaged intestines can cause mental problems?
What's happening to you? I don't know. Maybe your intestine lining is so damaged that even GAPS won't heal it? No idea. Maybe you need need to look elsewhere. CBT or a support system (family, friends, help around the house, sleep more, less hours at work... umm... I don't know).
I'm pretty sure that my sister's constant tummy grumblies and discomfort, even after eliminating all possible foods on the "GAPS" protocol are not mental. She has seen endocrinologists, allergy specialists, had ultrasounds and the gamut of blood tests. Everything messes up her guts. She has high-blood pressure, when pregnant, and is morbidly obese. She eats maybe 2,000 calories per day, when she can stomach food. She says her doctors have ruled out parasites. Maybe she just needs to reset her leptin?
Here's what UpToDate.com says about IBS:
INTRODUCTION — Irritable bowel syndrome (IBS) is a gastrointestinal disorder characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause. It is the most commonly diagnosed gastrointestinal condition and accounts for approximately 30 percent of all referrals to gastroenterologists. The pathophysiology of IBS remains uncertain. It is viewed as a disorder resulting from an interaction among a number of factors. Despite multiple investigations, data have been conflicting and no abnormality has been found to be specific for this disorder.
UpToDate is a respected source in the medical community. Many physicians go straight to it when we need a quick refresher on a particular illness.
I think it REALLY depends on who you listen to.
A recent post on Sci-ence! blog "Don't Perpetuate the Stigma." claims a lot of unspecified chronic pain diseases can be linked to clinical depression.
On the other hand, multiple questions here on PaleoHacks seem to point to just plain eating right will make most of the symptoms disappear ...
I found how this very topic was explored on Chris Kresser's podcast very interesting, and it seems congruent with some of the ideas thrown out there in this thread, in terms of the gut issues affecting the brain, and vice-versa.
Kresser posits a cyclical mechanism that seems to reinforce itself as it progresses (the "vicious circle" or "feedback loop" construct). If you accept this premise, then no, we absolutely cannot disentangle the brain from the gut. I find this feedback loop concept a reasonable suspect to consider in a wide spectrum of gut issues, including ones not nearly as serious or debilitating as IBS.
You can listen to the podcast, or read the full transcript* here:
*Keep in mind that transcripts often contain minor mistakes that can significantly change the meaning of a sentence, depending on what the transcriber thinks s/he hears. A volunteer prepares these transcripts, from what I understand. But one gets the picture pretty well, I think.