Inflammatory Bowel Disease Awareness | IBD and Mental Health

Hey there, everybody, and welcome to this presentation on inflammatory bowel disease and mental health. It is, after all, inflammatory bowel disease awareness day. I'm your host, Dr. Donnellice Snipes. In this brief presentation, I'm going to define inflammatory bowel disease, discuss the consequences of IBD on mental health, and relationships, help you identify some practical strategies to reduce the impact of IBD on your life. So let's start at the beginning. What is it? Inflammatory bowel disease. We've heard about Crohn's, we've heard about ulcerative colitis. Inflammatory bowel disease is both of those. It's an umbrella term that covers any condition that causes, guess what? Inflammation of the bowel, inflammation of the intestines. Symptoms of inflammatory bowel disease include diarrhea, abdominal pain, bowel urgency, fatigue, and even hormone imbalances. Now, let's think about how all this may play in. Probably going to talk about it more later, too. Well, when your bowel is inflamed, inflammation sends a signal via the vagus nerve to the brain that says, hey, things aren't going so well. The brain triggers the stress response system in order to try to address it or fix it or do whatever it needs to do to get the organism back into a place of homeostasis. So when the bowel is inflamed, stress response kicks off, stress response increases, releases a bunch of excitatory neurotransmitters, which we know are going to probably increase the motility of the gut, increase how quickly things go through the gut. When we're under stress, it's not time to rest and digest. It's time to fight or flee. So diarrhea makes sense. Abdominal pain, well, if you have increased motility, that's going to likely cause some cramping. If you have inflammation, that's going to cause pain. So that makes sense. Bowel urgency kind of goes along with diarrhea. If you have increased motility, your gut is working harder to move stuff through faster, then you may have a feeling that you've got to go to the bathroom more frequently. When all this is happening, when stuff goes through your intestines too quickly, when the intestinal walls are inflamed, both of those things contribute to your body's inability to effectively absorb nutrients. When you're not able to effectively absorb nutrients, guess what it's going to contribute to? Fatigue and mood changes and hormone imbalances. Additionally, when that HPA axis, that threat response system, is activated and chronically activated because of the chronic inflammation, that will also Contribute to fatigue. So these symptoms make sense, and they all kind of fold in on one another. According to the Crohn's and Colitis Foundation, 1.6 million Americans are diagnosed and nearly 70,000 new cases are diagnosed annually. That is a lot of people. I mean, think about how big your town is. More than 50% of people with inflammatory bowel disease experience significant anxiety and or depression. And that is really important. And they also have found that of those 50%, only about 12% actually receive any psychological help, any counseling help. A lot of times primary care providers may just say, hey, we're just going to throw meds at it, and not pay attention to the psychosocial impact and consequences of inflammatory bowel disease. What? What causes it? Well, they're starting to gain a greater understanding of what causes it. However, the short answer is it's an interaction of over 160 different genes. Your gut microbiome, which is impacted by your nutrition, stress, and antibiotics you are either taking or have taken, and the immune system and the environment. So there's a lot of stars that need to align, if you will. It's also another way of saying they're not 100% sure what causes it for any one individual. What is the impact? Well, I'm sure I missed some things here, but the biggies, Physically, people with inflammatory bowel disease experience increased pain. That's just the way it is. When you've got inflammation, you typically have pain. And that increased pain triggering the stress response can trigger an ongoing stress response, which contributes to increased systemic inflammation. Not just in the gut, but then we start seeing levels of inflammatory cytokines increase throughout the entire body. That we know is associated with increased depression, anxiety, and impaired sleep. So pain is a big deal. Pain. Pain is your body's way of saying something is not right here. Inflammation, obviously, as I mentioned, inflammation in the gut can eventually contribute to systemic inflammation. Sleep is impaired not only because the HPA axis, the threat response system, is active because of the inflammation, but because the person's in pain. They can't get comfortable, which contributes to sleep problems because they wake up in the middle of the night and they feel like they've got to go to the bathroom. There are a lot of reasons that sleep may become impaired when you are sleep deprived. It contributes to, guess what? Stress response activation and increased inflammation over the long term. So sleep deprivation actually works against the recovery process, which probably isn't a surprise. Malnutrition. When the gut is inflamed, it cannot effectively absorb the nutrients or even break them down. When the nutrients are moving through too quickly, the gut can't do what it needs to do. So the person experiences malnutrition. Why is that a big issue? Well, aside from the fact that none of us want to be malnourished, everything we eat is taken in and broken down into its component parts and then reassembled in the form of neurotransmitters and hormones and tissues and whatever else we need to live. So if your body is not able to use those nutrients, then it's not going to be able to make the neurotransmitters, the hormones, the everything else. So malnutrition is a big deal. And, you know, it's important to remember that, for example, tryptophan is an amino acid which comes from protein. Tryptophan is used to make serotonin, for example. But in order to convert tryptophan to serotonin, it requires a whole bunch of vitamins and minerals and other things in the to create this chemical reaction. Again, this is why nutrition is important. And fatigue. Well, let's think about it. If you're malnourished, you're probably running low, your blood sugar's probably all over the place. We know when people are in pain, their blood sugar tends to be all over the place. We know that when people are malnourished, they tend to be more fatigued. We know that when people get inadequate sleep, sleep, they tend to be more fatigued. We know that when we're fatigued, we tend to eat higher fat, higher carbohydrate, hint, more inflammatory foods, which can also contribute to worsening of symptoms and potentially indirectly worsening of fatigue. Affectively or emotionally. People with inflammatory bowel disease are at a much higher risk for, for anxiety and depression because that is associated with both systemic inflammation as well as nutritional imbalances and disruption of the gut microbiome. Many people with inflammatory or chronic conditions also struggle with anger. They're angry at the situation, they're angry at their disease, they're angry at their body. Sometimes they're angry at other people for not understanding what. But anger is a very common emotion. Grief and guilt. Grief at not having the quality of life or the lifestyle that maybe they used to have before they were diagnosed with the condition. So they have to grieve the fact that, okay, my body may need some modifications to the way I live my life, and that is very frustrating to some people. And guilt, when people are experiencing a flare up, especially their pain, their fatigue, their bowel urgency can make it more Difficult to engage in some of the activities that they used to engage in or that they feel they are should be doing, like going to a kid's recital or football game or going out with friends like they usually do. And they may start feeling guilty if they're not able to do it either at all or in the same way that they used to. They may feel guilty if they have to get up and leave in the middle of a recital because they gotta. And embarrassment. When we're talking about bowel issues, that's not something that we usually talk about, you know, in everyday company. And however, in order for significant others to understand what's going on, sometimes it's important to communicate to them to a certain extent what's going on and modifications that may be necessary. Additionally, the cramping, the inflammation, the urgency may also contribute to gas or even leakage, which can be embarrassing for some people. Cognitive when nutrition is not wonderful, when sleep is not wonderful, we see brain fog. We see people having difficulty remembering things, learning, thinking clearly. That is an expected byproduct of inflammation and malnutrition and fatigue or poor sleep. And relationally, people who are experiencing all of the symptoms that we've talked about, or even some of the symptoms that we've talked about, may have a reduced self esteem. They don't feel the same about themselves, or they're not as accepting of themselves because they feel like they should be doing something differently or, or they're afraid that other people are judging them and they're likely judging themselves very harshly for what they are or are not able to do at any point in time, which can really negatively impact self esteem when you are not being unconditionally accepting of yourself. And relational conflict because of the symptoms, because of the pain, because of the fatigue. Not everybody understands, even when we explain to them, even if you're great at explaining to them what's going on, sometimes they either may not be ready, willing, or able to hear, understand and empathize with your position. Children may be especially prone to this because they, they don't get it in some cases. In some cases they may get it even more. But a lot of times kids have a hard time understanding why caregivers can't just magically do whatever they want to do because they see us as much more powerful in many cases than we actually probably are in friendships. A lot of times when people have inflammatory bowel disease, it leads to canceling at the last minute or postponing activities, or having to change things because of a particular flare up which again, can cause conflict in relationships in which the person, in which the other person is less willing to be empathetic. And I didn't put job on here, and I probably should have because inflammatory bowel disease impacts people's work. I mean, think about a law enforcement officer out on patrol with inflammatory bowel disease. The amount of time my husband was on patrol for over a decade, the amount of time it takes them to get their equipment belt off and get their, all their stuff off so they can actually go to the bathroom is quite significant. If you're on patrol out in the middle of nowhere, that can be really difficult. That's just one example. A doctor that's working in an emergency room or in surgery or anything, A performer who's up on stage, you can't just say, hey, we're going to take a brief intermission here. So there are a lot of situations, professions that a sudden urge or inability to stay focused on the job may cause significant challenges. A lot of people mistakenly think of inflammatory bowel disease as an upset tummy, and that is so grossly inaccurate. It negatively impacts every area of a person's life, especially during a flare. But even between flares, when they're in a remission stage, a lot of people with inflammatory bowel disease have to alter their diet in order to prevent triggering another flare. So let's talk about what you can do. We've recognized now hopefully that it is a problem. Exercise has been found to reduce flare and fatigue. And you may be thinking, really, exercise makes me more tired. Low intensity, gentle exercise, increasing oxygenation, Yoga, easy walking, riding a stationary bicycle with little or no resistance, something that just gets the blood moving and gets your heart rate up a little bit and increases oxygenation is excellent for reducing cortisol, which is your stress hormone, and reducing flare and fatigue. Increasing energy, sleep, good quality sleep is really, really important. And talking with your doctor, your gastroenterologist, whomever you need to talk to, about strategies that you can use to improve your ability to fall asleep and stay asleep, stay in bed for seven to nine hours or as long as they think you can possibly do it. You know, not everybody can make seven hours is going to be very, very important. And there are a lot of strategies that can be used, including cutting off time when you're eating. You don't eat past XYZ time if you're going to go to bed at this other time. Reducing the amount of fluids you drink after a certain period of time. Reducing stress, making sure to go through a nighttime process to Try to prevent any unnecessary awakenings. There are a lot of things you can do to minimize sleep interruptions, but also just getting to sleep and staying asleep will be important. And that includes addressing sleep apnea if you've got it. Weight management is another physical intervention. And I know some people bristle at the notion of weight management. What we're talking about here is excess adiposity. Excess fat tissue contributes to increases in estrogen and increases in systemic inflammation. Excess is something that you will define based on your body structure with your physician. Okay, I'm not making a judgment about anybody's body type or weight, but it is well known in the research that excess fat tissue contributes to systemic inflammation. Smoking and alcohol have also been shown to be inflammatory, so abstinence from these things is definitely preferred. And improving vagal tone. You notice I didn't say the vagus nerve stimulation. Why? Because the research on auricular vagus nerve stimulation or transcutaneous vagus nerve stimulation through the ear has not been shown to be very effective at directly impacting the inflammation in the gut. Remember, the vagus nerve is the relaxation response. The HPA axis is your stress response, its alter ego is the vagus nerve. And vagal tone is assessed by heart rate variability. When you have good vagal tone, you can be relaxed, then you can respond to a stressor, then you can come all the way back down to that relaxed state. It's your vagus nerve, your sympathetic and parasympathetic nervous system ability to work with one another and alternate between one another instead of keeping yourself in that persistently stressed state or fighting to get back into a relaxation state. So anything. I know this is sort of mind blowing for some people. Anything that helps you trigger that relaxation response, anything that helps you de escalate when you experience physical or emotional stress is going to improve vagal tone. Square breathing, yoga, exercise, meditation, painting, whatever it is for you that can help you de escalate after a stressor is going to improve your vagal tone. Nutrition. Now it's important to note that nutrition is probably going to be a little bit different for every single person with inflammatory bowel disease. So I'm not making a prescription. However, what we do know is an anti inflammatory diet. The gronogen anti inflammatory diet is one that has been studied extensively with inflammatory bowel disease. But generally sticking to a diet that's anti inflammatory in nature is going to be very, very helpful at reducing gut inflammation. Lean meat, especially not red meat. So lean meat, eggs, fish, plain, dairy, like milk, yogurt, Kefir, hard cheeses, fruit, vegetables, legumes, coffee, tea, honey, and for some people, wheat are able to be eaten. Now, I've said for some people, because remember wheat and wheat oats, any of your cereal grains have gluten in them. And some people are very, very sensitive to gluten. And that will cause inflammation and that will cause a flare up. So again, it's important to know what triggers your inflammation. Your gut inflammation, red meat, other dairy products like ice cream and soft cheeses and sugar should be limited and canned and processed foods should be. Alcohol and sweetened beverages should be avoided at pretty much all costs. Your processed foods often can contain high levels of nitrates, nitrites and sugars, all of which are inflammatory in nature. One article recommended low fiber during disease flares. Well, think about fiber. It's kind of like a scrubby brush going through your gut. I mean, it absorbs things and moves things through, so it's expanding the bowel sometimes. But some of your insoluble fibers also act sort of like a scrubby brush, for lack of a better term, in order to help clean and purify the intestines. But that's really hard on an area that's already inflamed. So a lot of times, low fiber during disease flavor flares, as well as addressing nutritional deficiencies, especially during flare periods. But even between flares, some people with significant inflammatory bowel disease may struggle with deficiencies of iron, calcium, vitamin D, B12, folate, zinc, magnesium, vitamin A, and potentially thiamine. We'll talk about thiamine in a minute. What do we know about some of these things? In addition to being important in the creation of neurotransmitters like serotonin and dopamine, iron helps bring oxygen throughout the body. Low iron contributes to fatigue. Low, low iron, low energy. Calcium is important in neurotransmission. A lot of our neurotransmitters go through calcium ion channels. Vitamin D has a lot of receptors in the emotion areas of our brain. But that aside, they've shown that vitamin D deficiencies are associated with with increased inflammation. Vitamin B12 helps with metabolism and energy usage, so if your B12 is low, you may feel fatigued. And folate, zinc, magnesium and vitamin A are all again, important nutrients in the creation of other hormones and neurotransmitters throughout the body. Now, thiamine is interesting. Thiamine is often normal in the blood plasma levels of people with inflammatory bowel disease. However, they found that thiamine supplementation in people with IBD often helps their energy level and their brain fog. They hypothesize that the thiamine receptors are not working as effectively as they need to. So there's enough thiamine there, but the receptors are not working. So by increasing thiamine levels, it sort of artificially stimulates or overloads or whatever words you want to use, but it gets thiamine levels to where they need to be downstream. So that was a really interesting article. Affective or emotional and cognitive interventions. Stress management is so huge. And if you've watched my other videos on the HPA axis or the impact of stress and trauma on mood, you know that chronic stress contributes to systemic inflammation. And I'm not going to go into the whole explanation right now, but chronic stress worsens inflammation. So stress management is huge, which means knowing what your triggers are for stress, what irritates you, what stresses you out, what causes you anger, anxiety, or just stress, being overwhelmed or burned out, figuring out what those triggers are, how to prevent them when possible, and how to cope with them when they actually occur so they have less of a negative impact is going to be important. Vulnerabilities are conditions that make you more vulnerable to a strong negative emotional reaction. When you are triggered during a flare up, you're likely more vulnerable to stress. It's harder to deal with all the crap life throws at you when you're already fatigued and in pain and not feeling well. But aside from a flare up, what other things make you more vulnerable to stress? It can be sleep deprivation, being overwhelmed certain times of year, whatever it is that you know, hey, during this time or in this situation, I tend to be more stress prone or I tend to react more strongly. That's good to know because then you can figure out how to best protect yourself or buffer against those stressors during that time. Hardiness. I've talked about this in other videos. Commitment, control and challenge. It was a concept that was really introduced back in 78 by Kabasa. Hardiness has been found to reduce stress reactivity and inflammatory cytokines. People who are heartier when they encounter stress react less strongly, go back to baseline or downregulate more quickly and have fewer inflammatory cytokines released into their system. So that is really, really awesome. Now hardiness, remember, commitment, control and challenge involves knowing all of the things in your life to which you are committed. People, places, things, activities that make your life rich and meaningful. Being able to look at that landscape and say, oh, look at these are all the things that are important. And 80% of those are going really well right now, 20% could use a little work. But recognizing being able to see the whole picture, not just what's going wrong, that's the first one. Control is your ability to recognize what aspects, this landscape you have control over the things that are going well. In what ways can you control that to keep them going well? Continue nurturing those relationships, continuing doing your best at work, whatever it is. Other things that are not going well, what aspects of that can you control? You may not be able to directly make your inflammation go down if you're having a flare up and that's one of the things that's not going well. However, being angry about it and fretting about it and having increased levels of anxiety over this particular condition is going to make it worse. So your reaction to that situation might be something you can control and challenge. Once you've identified what you can control, viewing that as a challenge, how can I optimize, how can I best use my energy to continue maintaining the things that are going good and to alter or mitigate the things that are not going well, seeing it as a challenge, an opportunity instead of, well, something else. Guided imagery has been successful for pain perception, fatigue and mood improvement, but not direct reduction of inflammatory cytokines. They hypothesize in the article that guided imagery can help increase serotonin, dopamine and endorphin levels which help us reduce our perception of pain and may increase our energy levels. As dopamine goes up, energy goes up. As serotonin goes up, we may see an increase in energy. But definitely, definitely with dopamine, as dopamine and serotonin go up, mood goes up. So guided imagery may impact the neurotransmitters that are responsible for those three things. But the inflammatory cytokines don't reduce as quickly as we may see in other situations. The inflammatory cytokines may being prompted not only by thoughts, but, well, definitely are prompted not only by thoughts but other things going on in the body which may take longer to adjust, such as the microbiome. Environmentally, bergamot, eucalyptus, lavender, thyme, ylang ylang fir, balsam and hyssop have all been found to have anti inflammatory properties. Now this is systemic. Anti inflammatory properties aren't able at this point to particularly target one area. And remember, with essential oils you're not ingesting them, you're just inhaling them, dispersing them in the environment. But they have been found to be calming to help down regulate that HPA axis, that threat, stress response as well as to be anti inflammatory in nature, particular particularly the terpenes, beta caryophylline, linalool and borneal. They've also found that just being out in nature, at a park, surrounded by trees, breathing the air and the terpenes and whatever else is volatile, organic essential oils I believe they call them, that are emitted by plants, also secrete these particular terpenes. And they found as a result that being out in nature is associated with a reduction in pain perception, improvement in mood, improvement in cardiovascular parameters and a reduction in inflammation. So score one for mother nature. Over 1.6 million people deal with inflammatory bowel disease. It's vital for everyone to understand that it's far more than just an upset stomach. Inflammatory bowel disease significantly impacts every aspect of a person's life during a flare and still moderately impacts their life between flares. Inflammatory bowel disease and mental health influence each other. As mental health improves, as stress improves, inflammation tends to improve. As stress gets worse, inflammation tends to get worse. As anxiety gets worse, inflammation tends to get worse. As depression gets worse, inflammation gets worse. You see where I'm going here? Well, each person with inflammatory bowel disease is different. Common treatment themes revolve around sleep, exercise, stress management, healthy nutrition, and for some people, medication.