Pandemic anxiety was hard on IBS patients. Here's how to find relief

Pandemic anxiety was hard on IBS patients. Here's how to find relief

Transcript¹

If you're one of the more than 25 million people in the U.S. with irritable² bowel³ syndrome⁴, there's a good chance your symptoms worsened at some point over the past two years. Or maybe you developed symptoms for the first time.

"We found reports of increased constipation, diarrhea and abdominal⁵ pain," says Kendra Kamp, a researcher at the University of Washington School of Medicine. She surveyed IBS patients with anxiety or depression about their experiences early in the pandemic. More than 90% reported increased stress and 81% reported increased anxiety. Another survey sponsored by a pharmaceutical⁶ company found half of IBS patients say their symptoms have been more challenging to manage, and many reported an initial onset⁷ of IBS amid the pandemic.

"The pandemic created an environment of uncertainty⁸, isolation⁹ and less access to supportive resources that people depended on for well-being," says Suzanne Smith, a nurse practitioner¹⁰ at UCLA's Integrative Digestive Health and Wellness program. The center combines diet and stress management treatment approaches, and Smith helps patients understand the brain-gut¹¹ connection in IBS.

IBS was once considered a problem of the gut, but scientists now know that disturbances¹² in the way the nervous system, brain and gut interact can cause changes that lead to IBS symptoms, including stomach pain, gas, bloating and abnormal bowel movements. "There's a continuous feedback loop between the brain and the gut," explains Smith. Information flows along the vagus nerve, which connects brain to gut, so what's happening in the mind affects the gastrointestinal system.

Finding the triggers

Stress is one factor that can trigger symptoms or make them harder to manage. Diet, sleep, exercise and social connections are important, too. "All these things play a role in digestive health," Smith says.

Doctors also look for triggers such as an infection or bacterial¹³ overgrowth that can require antibiotics¹⁴, but the goal, Smith says, is to wrap all the elements into a holistic¹⁵ treatment approach.

Smith teaches a mindfulness course that can help patients tamp¹⁶ down the anxiety linked to their symptoms. In 2020, a study of patients who participated in the 8-week course, called Mindfulness Based Stress Reduction, found that 71% of the patients had robust¹⁷ improvements in their GI symptoms. "There was a significant improvement in quality of life and overall well-being," Smith says. The participants were taught a range of techniques to foster awareness¹⁸ of the present moment, limit anticipatory¹⁹ anxiety, and halt the feedback loop that can amplify²⁰ the unpleasant feelings and sensations associated with IBS symptoms.

"It was life-changing for me," says Vicki Mayer, 52, who was a participant in the study. She first noticed stomach issues, on and off, back in college, but in recent years her symptoms worsened. "Any time that I was going out for dinner or lunch or coffee, I would be riddled²¹ with a lot of anxiety and fear," she recalls, anticipating that she may need to urgently find a bathroom or leave the restaurant. She began to avoid going out.

When her doctor recommended the mindfulness class, she was hesitant. "I was probably the most skeptical²² person in the room," she recalls. "I thought, 'Oh, I'll have to lay down for an hour. I can't keep my mind completely quiet.'"

But after the class began, she was hooked. "We would practice different types of meditation²³, whether it was a body scan, a three minute breathing exercise, or a walking meditation," Mayer says, further explaining that each of these techniques awakened²⁴ a sense of calm and a new way to tune²⁵ into her body.

Meditation didn't change her symptoms overnight, but she did begin feeling control over her emotional reactions. She realized much of her anxiety was caused by worst-case scenario²⁶ thinking, such as anticipating an embarrassing restaurant incident. But, if she stayed in the moment, the situation really wasn't so dire²⁷. And, instead of allowing her mind to weave a story about what might happen, she learned to reframe her thoughts.

"I'm going to be OK, there's always a bathroom available," she would tell herself if she went out for a meal, recognizing that excusing herself from the table would cause no harm. "Once I changed my mindset, I had a far reduced level of anxiety, and I could get through the meal with little to no issues."

Studies show that mindfulness can increase both attention and emotional regulation. "If you have a better capacity to regulate your attention, then you can move your attention to something that's more helpful," says Smith, just as Mayer learned.

Mayer says she feels much better these days. "It's incredibly powerful to know how to change your mindset and see the physical results of that in a positive way," she says. And, she's keeping up the meditation practice: "You can do a one or two minute breathing exercise while you're standing²⁸ in line at the grocery store."

The power of the right diet

Changing what's on the menu is another key tool for people to manage IBS. "We've developed diet strategies that can be quite effective," says William Chey, a gastroenterologist at the University of Michigan who has documented the benefits of integrative care.

Michigan has had a dedicated²⁹ GI nutrition program since 2007. "When I started to talk about diet as an important part of treating patients with IBS at that time, people literally³⁰ laughed at me," Chey says. "But now almost every gastroenterologist accepts that diet is an important part of the solution."

Over the past 15 years, many studies have shown that dietary strategies can help control symptoms.

The FODMAP diet has gained the most attention from researchers. Studies show somewhere between 52% to 86% of participants report significant improvement in their symptoms after following the diet, including reduced gas and bloating. The FODMAP diet requires elimination³¹ or reduction of certain foods, including gluten, lactose, excess fructose (found in some fruits and corn syrup) as well as certain nuts, beans and starchy vegetables. Researchers at Monash University in Australia explain that the FODMAP diet is based on the understanding that certain compounds in our diet can't be completely digested or absorbed, so they can end up in the large intestine³² where they're fermented³³ by gut bacteria. This leads to gas and bloating.

"I saw the benefits almost within the first week," says Karen Beningo of Northville, Mich., who was treated at the University of Michigan. She started the FODMAP diet last October and found her energy level improved significantly. "The distension³⁴ and the bloating went away very quick," she says. After following the diet strictly³⁵, she's now added some foods back to her diet. She knows gluten is a trigger, so she remains³⁶ gluten-free.

"I discovered other things, and most of them were things that I was suspicious of anyway," she says. She realized that onions, broccoli³⁷ and Brussels sprouts³⁸, as well as some nuts, make her gassy. "And it was only through calming down my system and then reintroducing [them] that I pretty much confirmed, yeah, I've got a problem with those things," she explains. (This Monash University FODMAP app can help people follow the diet, detailing which foods, in which amounts, are ok, and which ones should be avoided.)

Where to get help

Beningo was fortunate to live near a major academic center. The University of Michigan has registered dieticians in their GI program who can support patients through diet changes, which can be somewhat frustrating³⁹ and confusing to follow. But what can people do if they don't have access to this type of integrative care?

The majority of gastroenterology practices don't have a registered dietician, psychologist or stress-management professional on staff. "Most doctors don't have the tools or the training to be able to effectively implement⁴⁰ the science as it's emerging in their practices," Chey says.

To fill in the gaps, there's a shift toward virtual support to help people access behavioral care, stress management tools and dietary strategies. "Digital tools that are coming online will help these integrated strategies scale up to a more national level," Chey says. He points to three examples. Mahana is an FDA-authorized digital Cognitive⁴¹ Behavioral Therapy app that doctors can prescribe to IBS patients to deal with stress. Zemedy is another CBT-based digital app. There's also Nerva, a mobile app that delivers gut-directed hypnotherapy to help manage symptoms.

"Those three are all evidence based, meaning that they've all done at least observational clinical trials to show efficacy," Chey says. And there are many more digital products in development, he says, adding that he's involved with some of the companies as an investigator⁴². Chey says large-scale clinical trials with some of the tools are planned to better understand how to effectively use them. "This is a very rapidly growing space," he says.

1 transcript   

n.抄本，誊本，副本，肄业证书

参考例句：

• A transcript of the tapes was presented as evidence in court.一份录音带的文字本作为证据被呈交法庭。
• They wouldn't let me have a transcript of the interview.他们拒绝给我一份采访的文字整理稿。

2 irritable   

adj.急躁的；过敏的；易怒的

参考例句：

• He gets irritable when he's got toothache.他牙一疼就很容易发脾气。
• Our teacher is an irritable old lady.She gets angry easily.我们的老师是位脾气急躁的老太太。她很容易生气。

3 bowel   

n.肠(尤指人肠)；内部，深处

参考例句：

• Irritable bowel syndrome seems to affect more women than men.女性比男性更易患肠易激综合征。
• Have you had a bowel movement today?你今天有排便吗？

4 syndrome   

n.综合病症；并存特性

参考例句：

• The Institute says that an unidentified virus is to blame for the syndrome. 该研究所表示,引起这种综合症的是一种尚未确认的病毒。
• Results indicated that 11 fetuses had Down syndrome. 结果表明有11个胎儿患有唐氏综合征。

5 abdominal   

adj.腹（部）的，下腹的；n.腹肌

参考例句：

• The abdominal aorta is normally smaller than the thoracic aorta.腹主动脉一般比胸主动脉小。
• Abdominal tissues sometimes adhere after an operation.手术之后腹部有时会出现粘连。

6 pharmaceutical   

adj.药学的，药物的；药用的，药剂师的

参考例句：

• She has donated money to establish a pharmaceutical laboratory.她捐款成立了一个药剂实验室。
• We are engaged in a legal tussle with a large pharmaceutical company.我们正同一家大制药公司闹法律纠纷。

7 onset   

n.进攻，袭击，开始，突然开始

参考例句：

• The drug must be taken from the onset of the infection.这种药必须在感染的最初期就开始服用。
• Our troops withstood the onset of the enemy.我们的部队抵挡住了敌人的进攻。

8 uncertainty   

n.易变，靠不住，不确知，不确定的事物

参考例句：

• Her comments will add to the uncertainty of the situation.她的批评将会使局势更加不稳定。
• After six weeks of uncertainty,the strain was beginning to take its toll.6个星期的忐忑不安后，压力开始产生影响了。

9 isolation   

n.隔离，孤立，分解，分离

参考例句：

• The millionaire lived in complete isolation from the outside world.这位富翁过着与世隔绝的生活。
• He retired and lived in relative isolation.他退休后，生活比较孤寂。

10 practitioner   

n.实践者，从事者；(医生或律师等)开业者

参考例句：

• He is an unqualified practitioner of law.他是个无资格的律师。
• She was a medical practitioner before she entered politics.从政前她是个开业医生。

11 gut   

n.[pl.]胆量；内脏；adj.本能的；vt.取出内脏

参考例句：

• It is not always necessary to gut the fish prior to freezing.冷冻鱼之前并不总是需要先把内脏掏空。
• My immediate gut feeling was to refuse.我本能的直接反应是拒绝。

12 disturbances   

n.骚乱( disturbance的名词复数 )；打扰；困扰；障碍

参考例句：

• The government has set up a commission of inquiry into the disturbances at the prison. 政府成立了一个委员会来调查监狱骚乱事件。
• Extra police were called in to quell the disturbances. 已调集了增援警力来平定骚乱。

13 bacterial   

a.细菌的

参考例句：

• Bacterial reproduction is accelerated in weightless space. 在失重的空间，细菌繁殖加快了。
• Brain lesions can be caused by bacterial infections. 大脑损伤可能由细菌感染引起。

14 antibiotics   

n.（用作复数）抗生素；（用作单数）抗生物质的研究；抗生素，抗菌素( antibiotic的名词复数 )

参考例句：

• the discovery of antibiotics in the 20th century 20世纪抗生素的发现
• The doctor gave me a prescription for antibiotics. 医生给我开了抗生素。

15 holistic   

adj.从整体着眼的，全面的

参考例句：

• There is a fundamental ambiguity in the use of word "whole" in recent holistic literature.在近代的整体主义著作中，“整体”这个词的用法极其含混。
• In so far as historicism is technological,its approach is not piecemeal,but "holistic".仅就历史决定论是一种技术而论，它的方法不是渐进的，而是“整体主义的”。

16 tamp   

v.捣实，砸实

参考例句：

• Then I tamp down the soil with the back of a rake.然后我用耙子的背将土壤拍实。
• Philpott tamped a wad of tobacco into his pipe.菲尔波特往烟斗里塞了一卷碎烟叶。

17 robust   

adj.强壮的，强健的，粗野的，需要体力的，浓的

参考例句：

• She is too tall and robust.她个子太高，身体太壮。
• China wants to keep growth robust to reduce poverty and avoid job losses,AP commented.美联社评论道，中国希望保持经济强势增长，以减少贫困和失业状况。

18 awareness   

n.意识，觉悟，懂事，明智

参考例句：

• There is a general awareness that smoking is harmful.人们普遍认识到吸烟有害健康。
• Environmental awareness has increased over the years.这些年来人们的环境意识增强了。

19 anticipatory   

adj.预想的，预期的

参考例句：

• An anticipatory story is a trap to the teller.对于讲故事的人而言，事先想好的故事是个框框。
• Data quality is a function of systematic usage,not anticipatory design.数据质量是系统使用的功能，不是可预料的设计。

20 amplify   

vt.放大，增强；详述，详加解说

参考例句：

• The new manager wants to amplify the company.新经理想要扩大公司。
• Please amplify your remarks by giving us some examples.请举例详述你的话。

21 riddled   

adj.布满的；充斥的；泛滥的v.解谜，出谜题(riddle的过去分词形式)

参考例句：

• The beams are riddled with woodworm. 这些木梁被蛀虫蛀得都是洞。
• The bodies of the hostages were found riddled with bullets. 在人质的尸体上发现了很多弹孔。 来自《简明英汉词典》

22 skeptical   

adj.怀疑的，多疑的

参考例句：

• Others here are more skeptical about the chances for justice being done.这里的其他人更为怀疑正义能否得到伸张。
• Her look was skeptical and resigned.她的表情是将信将疑而又无可奈何。

23 meditation   

n.熟虑，（尤指宗教的）默想，沉思，（pl.）冥想录

参考例句：

• This peaceful garden lends itself to meditation.这个恬静的花园适于冥想。
• I'm sorry to interrupt your meditation.很抱歉，我打断了你的沉思。

24 awakened   

v.（使）醒( awaken的过去式和过去分词 )；（使）觉醒；弄醒；（使）意识到

参考例句：

• She awakened to the sound of birds singing. 她醒来听到鸟的叫声。
• The public has been awakened to the full horror of the situation. 公众完全意识到了这一状况的可怕程度。 来自《简明英汉词典》

25 tune   

n.调子；和谐，协调；v.调音，调节，调整

参考例句：

• He'd written a tune,and played it to us on the piano.他写了一段曲子，并在钢琴上弹给我们听。
• The boy beat out a tune on a tin can.那男孩在易拉罐上敲出一首曲子。

26 scenario   

n.剧本，脚本；概要

参考例句：

• But the birth scenario is not completely accurate.然而分娩脚本并非完全准确的。
• This is a totally different scenario.这是完全不同的剧本。

27 dire   

adj.可怕的，悲惨的，阴惨的，极端的

参考例句：

• There were dire warnings about the dangers of watching too much TV.曾经有人就看电视太多的危害性提出严重警告。
• We were indeed in dire straits.But we pulled through.那时我们的困难真是大极了，但是我们渡过了困难。

28 standing   

n.持续，地位；adj.永久的，不动的，直立的，不流动的

参考例句：

• After the earthquake only a few houses were left standing.地震过后只有几幢房屋还立着。
• They're standing out against any change in the law.他们坚决反对对法律做任何修改。

29 dedicated   

adj.一心一意的；献身的；热诚的

参考例句：

• He dedicated his life to the cause of education.他献身于教育事业。
• His whole energies are dedicated to improve the design.他的全部精力都放在改进这项设计上了。

30 literally   

adv.照字面意义，逐字地；确实

参考例句：

• He translated the passage literally.他逐字逐句地翻译这段文字。
• Sometimes she would not sit down till she was literally faint.有时候，她不走到真正要昏厥了，决不肯坐下来。

31 elimination   

n.排除，消除，消灭

参考例句：

• Their elimination from the competition was a great surprise.他们在比赛中遭到淘汰是个很大的意外。
• I was eliminated from the 400 metres in the semi-finals.我在400米半决赛中被淘汰。

32 intestine   

adj.内部的；国内的；n.肠

参考例句：

• This vitamin is absorbed through the walls of the small intestine.这种维生素通过小肠壁被吸收。
• The service productivity is the function,including external efficiency,intestine efficiency and capacity efficiency.服务业的生产率是一个包含有外部效率、内部效率和能力效率的函数。

33 fermented   

v.（使）发酵( ferment的过去式和过去分词 )；（使）激动；骚动；骚扰

参考例句：

• When wine is fermented, it gives off gas. 酒发酵时发出气泡。 来自《简明英汉词典》
• His speeches fermented trouble among the workers. 他的演讲在工人中引起骚动。 来自辞典例句

34 distension   

n.扩张，膨胀(distention)

参考例句：

• Heat causes the distension of gases. 热使气体膨胀。 来自《简明英汉词典》
• Feeding too rapidly will cause abdominal distension and regurgitation. 喂得太快会引起腹胀和反流。 来自辞典例句

35 strictly   

adv.严厉地，严格地；严密地

参考例句：

• His doctor is dieting him strictly.他的医生严格规定他的饮食。
• The guests were seated strictly in order of precedence.客人严格按照地位高低就座。

36 remains   

n.剩余物，残留物；遗体，遗迹

参考例句：

• He ate the remains of food hungrily.他狼吞虎咽地吃剩余的食物。
• The remains of the meal were fed to the dog.残羹剩饭喂狗了。

37 broccoli   

n.绿菜花，花椰菜

参考例句：

• She grew all the broccoli plants from seed.这些花椰菜都是她用种子培育出来的。
• They think broccoli is only green and cauliflower is only white.他们认为西兰花只有绿色的，而菜花都是白色的。

38 sprouts   

n.新芽，嫩枝( sprout的名词复数 )v.发芽( sprout的第三人称单数 )；抽芽；出现；（使）涌现出

参考例句：

• The wheat sprouts grew perceptibly after the rain. 下了一场雨，麦苗立刻见长。 来自《现代汉英综合大词典》
• The sprouts have pushed up the earth. 嫩芽把土顶起来了。 来自《现代汉英综合大词典》

39 frustrating   

adj.产生挫折的，使人沮丧的，令人泄气的v.使不成功( frustrate的现在分词 )；挫败；使受挫折；令人沮丧

参考例句：

• It's frustrating to have to wait so long. 要等这么长时间，真令人懊恼。
• It was a demeaning and ultimately frustrating experience. 那是一次有失颜面并且令人沮丧至极的经历。 来自《简明英汉词典》

40 implement   

n.(pl.)工具，器具；vt.实行，实施，执行

参考例句：

• Don't undertake a project unless you can implement it.不要承担一项计划，除非你能完成这项计划。
• The best implement for digging a garden is a spade.在花园里挖土的最好工具是铁锹。

41 cognitive   

adj.认知的，认识的，有感知的

参考例句：

• As children grow older,their cognitive processes become sharper.孩子们越长越大，他们的认知过程变得更为敏锐。
• The cognitive psychologist is like the tinker who wants to know how a clock works.认知心理学者倒很像一个需要通晓钟表如何运转的钟表修理匠。

42 investigator   

n.研究者，调查者，审查者

参考例句：

• He was a special investigator for the FBI.他是联邦调查局的特别调查员。
• The investigator was able to deduce the crime and find the criminal.调查者能够推出犯罪过程并锁定罪犯。