Irritable Bowel Syndrome and the MindBodySpirit Connection

An invaluable, hope-giving practical guide. Collaboratively written by digestive disorder specialists Dr. William Salt and Dr. Neil Neimark, and now available in a fully revised and updated new edition, Irritable Bowel Syndrome And The MindBodySpirit Connection is an invaluable, hope-giving, practical, non-specialist general reader friendly guide offering seven specific steps to improving one's quality of life and health when living with a functional bowel disorder, Crohn's Disease or colitis. Individual chapters focus on using the power of emotional and psychological attitude as well as more traditionally important habits of proper diet, exercise, water drinking etc. A thoughtful and attentive book and an excellent supplement to a doctor's care, Irritable Bowel Syndrome And The MindBodySpirit Connection, with its practical and whole mind and body approach to maintaining good health, is important even to those who are fortunate enough to have compliantly regular bowels. A very highly recommended addition to personal and community library personal healthy and medical reference collections. Midwest Book Review (see more about me) from Oregon, WI USA

The best available. This is the most comprehensive yet systematic, accessible, and intelligent book I've read on IBS (I had read 7-8 others before finding this one). You can waste much time and money on all sorts of herbal and medicinal products as well as alternative therapies with absolutely no gain--in fact, in many cases you may decide you feel worse. Salt and Neimark provide a complete analysis of the mind/body/spirit connection, taking you from the causes of your problem to the resolution of it that only knowledge and action can provide. Their approach employs all of the latest research in mainstream medicine as well as some bold and positive understandings that are unlikely to appear in the conventional literature. A reader from Kenosha, WI

By the time you pick up this book, you have probably spent an untold number of days and nights with recurrent abdominal pain and cramping, unexplained bloating, constipation, diarrhea or all of the above. You may have had multiple visits to your family doctor, gastrointestinal specialist, psychologist or even alternative healer, all with little or no lasting relief. You may have undergone dozens of blood tests, x-rays, endoscopies, CAT scans and biopsies, all showing that there is nothing wrong. If this sounds like you, do not despair, hope is just around the corner.

IBS is a major public health topic and receives much media attention in newspapers, magazines, radio and television. Many people recognize the acronym IBS and terms like spastic colon, spastic colitis, mucus colitis and nervous stomach. You will be hearing more and more about this common and troublesome condition, as well as about other functional GI disorders. If you suffer from the symptoms of IBS, the most important thing for you to know is that there is hope.

Though there is still no cure for IBS, dramatic healing is possible due to new understandings in mindbodyspirit medicine. This new multidisciplinary field of study draws upon the expertise of immunologists, physiologists, research scientists, psychiatrists, psychologists, clergypersons, neurobiologists, behavioral medicine specialists and more. Advances in mindbodyspirit medicine have given us new understandings of old problems, making powerful treatment options available for you. Though there is no magic pill available, relief from—and resolution of—many of your symptoms is now within your reach.

We (Bill & Neil) are truly honored to guide you on your journey through the pages of this book. It is our sincere hope that what you are about to read and learn will help you move from pain to peace, from frustration to freedom and from helplessness to hopefulness. The advice and recommendations given in this book have helped countless patients come to peace with their IBS and live a life filled with greater health, vitality and happiness.

Functional GI disorders are defined as "variable combinations of chronic or recurrent GI symptoms not explained by structural or biochemical abnormalities." This means that even after performing blood tests, taking x-rays, and examining the digestive tract with endoscopy, doctors cannot find a cause for your symptoms.

IBS is the most common functional GI disorder. The symptoms come from the large colon and include abdominal pain and bloating, as well as disturbances in defecation (the process of having a bowel movement). These symptoms are diarrhea, constipation, and/or alternating constipation and diarrhea. The stool form (bowel movement) is often altered, being lumpy and hard or loose and watery. Other symptoms include straining at having a bowel movement, urgent need to find a bathroom, or a feeling of not having emptied the rectum. Passage of mucus in the stool is also common. The symptoms can be continuous or intermittent.

Functional GI disorders are very common and affect approximately 35 million people in the United States. They account for 10% of visits to primary care doctors and at least 50% of visits to gastroenterologists. IBS affects nearly one out of five people in the United States including children, teenagers, young adults, the middle-aged, and the elderly. The average age of onset of IBS is between 20 and 29 years of age. Each year, 2.6 million people seek treatment for symptoms related to functional gastrointestinal disorders, and visits to physicians total 3.5 million.

IBS is a worldwide problem and is prevalent throughout China, the United Kingdom, Australia, New Zealand and Scandinavia. These disorders cost cost billions of dollars each year in visits to doctors, diagnostic testing, and treatments. Furthermore, because IBS is the second leading cause of industrial absenteeism, missed work days is costly to companies and employers, as well as to those who suffer with this disorder.

IBS and other funtional GI disorders cause symptoms and discomfort ranging from mild and inconvenient to severe and incapacitating. Current evidence shows that many people with IBS lead restircted lives in multiple areas: diet, social activities, energy level and sense of well-being. Unfortunately, traditional medical science has not been able to offer much relief to patients.

Just as the GI tract is unusually sensitive and irritable in patients with IBS, so too, many patients with functional GI disorders seem to have a sensitive or "irritable body." This may lead you to experience many of the constellation of bodily symptoms shown in Table 3. As in IBS, most of the time, these "irritable body" symptoms cannot be explained by physical examination, blood tests, x-rays, endoscopic examinations or biopsy results. When this happens, we refer to these disorders as "functional," "psychosomatic," or "somatization" symptoms. Most often, disturbances in the mindbodyspirit connection account for much of the trouble.

Unfortunately, terms like "functional," "psychosomatic," and "somatization" are often misconstrued to mean that the symptoms are "all in your head," phoney or imagined. The truth is that the symptoms are very real. In fact, virtually everyone experiences one or more functional symptoms from time to time. However, some people have symptoms that are frequent, constant and severe, which cause them to consult with doctors. The suffering is enormous.

What is going on here? What is the common denominator? The answer is that the problem is not "all in your head" but it is related to the connection between the mind, body and spirit.

You will learn that the mind, body and spirit are one. It no longer makes sense to classify problems as either stress/emotional related (mind) or physical (body). Furthermore, you will discover why it is essential that the mindbody connection include spirit. Scientific evidence continues to confirm the mysterious power of spirit and how affirming beliefs—particularly belief in a higher power and a higher purpose—can contribute significantly to your health.

You will study the neurochemical basis of the mindbodyspirit connection and learn how these new understandings can help you achieve better physical health, vitality and a sense of well-being. You will come to appreciate that the connection between mind, body and spirit can help you tap into the innate healing potential of your body and the powerful healing forces of your mind and spirit.

Most importantly, you will begin to understand that optimal physical health is only possible in the larger context of your emotional, mental and spiritual health. This is the mindbodyspirit connection, and with it, you will begin to discover new ways to achieve relief, growth and healing from your Irritable Bowel Syndrome.

The term colitis refers to colon inflammation and should not be used to refer to IBS, because in IBS the colon is not actually inflamed. However, inflammation is found in several important disorders called inflammatory bowel diseases (IBD). The two types of IBD are ulcerative colitis, which affects the rectum and colon, and Crohn’s disease, which can involve both the colon and the small intestine. Nearly one million Americans suffer from IBD. Although the treatments for IBS and IBD differ, many people with IBD also have IBS and can benefit from the treatment advice in this book.

There have been many new developments in the diagnosis and treatment of IBS and other functional GI disorders. Furthermore, new approaches involving the mindbodyspirit connection have opened up new opportunities for healing the symptom distress caused by IBS. As a board-certified gastroenterologist and a board-certified family practitioner, with more than 35 combined years of experience caring for people with IBS and other functional GI disorders, we will provide you with the information you need.

New restrictions in "managed care" are making it harder for your doctor to spend time with you. In fact, most doctor visits are now limited to 12 minutes or less! Also, it is becoming more difficult to gain access to medical specialists because managed care expects your primary care physician (family doctor) to handle most problems.

Due to these changes in medicine, you, the patient, must assume more responsibility in the management of your health care. You will need accurate and reliable information. This book will help.

You can learn to be healthy. Accurate information is the first step and is often more important than medication. With this book, you can explore your IBS symptoms and treatment options in the privacy of your home and on your own time. Armed with the proper information and the most up-to-date knowledge of mindbodyspirit medicine, you will be better able to partner with your doctor to augment the healing process.

Your mind, body, and spirit are connected and inseparable. You will learn that you are stronger than you think and that you have more control over your body than you ever realized. The goal of this book is to help you recognize that IBS is a mindbodyspirit syndrome. Once you understand the connection, you will learn about the various tools you can utilize to tap into the truly miraculous ability of your body to heal. Not only can you heal from IBS, but you can turn the negative of your illness into the positive of health and wellness. You can use your diagnosis of Irritable Bowel Syndrome to realize your ability to heal through the mindbodyspirit connection and become healthier than ever before.

Work with your doctor, and with unconventional practitioners if you so choose, to learn self-care habits. . . . I consider self-care anything an individual can do, independent of doctors or healers, to enhance his or her health.

– Timeless Healing, the Power and Biology of Belief
Herbert Benson, M.D. (with Marg Stark)

You can heal. You are the only one who can do it. It takes commitment and change, but not only can you heal from IBS, you can also be healthier than you have ever been before. You now have a strong awareness of your ability to do so by understanding the mindbodyspirit connection, accepting responsibility for your health, and making a commitment to self-care.

“Knowledge is power,” and you have both when you understand the mindbodyspirit connection. You know that mind, body, and spirit are inseparably linked. You know how your thoughts, feelings, attitudes, beleifs and imagination are transmitted throughout your body by chemical messenger molecules, called neurotransmitters (like serotonin, dopamine and norepinephrine), neuropeptides (like enkephalin and insulin) and steroids (like cortisol, testosterone, estrogen and progesterone).

You also understand that a biopsychosocialspiritual perspective is necessary in order to heal. To say something “is all in your head,” no longer makes sense, because what is “in your head” is also “in your body.” Your mind (thoughts, feelings, attitudes, beliefs and imagination) is not confined to your brain, but circulates through—and permeates within—every cell in your body.

Review the “cause” of IBS in and reflect upon what you have learned about your ability to heal in the last two steps. Healing comes from within you.

The model of interaction between patient and doctor is changing so that you, the patient, must now assume responsibility for your health in partnership with your doctor and caregiver. In order to do so, you will need accurate and reliable information. Accurate information leads to healing and is as important—and sometimes more—than medication.

A healthy diet, weight control, exercise, and stress management are essential for self-care and wellness. Effective treatment of IBS must include attention to the whole person: the mind, body, and spirit.

Remember that all forms of treatment require you to reach out for the best that medical science has to offer and reach within to mobilize your own internal resources for healing. Treatment of IBS directed to the body alone—without addressing the mind and spirit—may be well intentioned, but it is misguided, ignores self-care and wellness, and does not lead to enduring healing.

A sense of mastery or control is a vital pathway to your healing system. This sense of control comes by taking small steps in the direction of your goals. Don’t be a “weekend warrior” and try to heal in one weekend. Take small steps. Your perseverance and determination are as critical to mastery as lifting weights are to building big biceps. Mastery is obtained through gradual successes. Master musicians must first practice their routine and boring scales day in and day out, before they can play the masterpieces. Master healers must first practice the simple principles of health and wellness day in and day out, before they can master wellness.

Norman Cousins wrote, “In general, anything that restores a sense of control to a patient can be a profound aid to a physician in treating serious illness. That sense of control is more than a mere mood or attitude and may well be a vital pathway between the brain, the endocrine system, and the immune system. The assumed possibility is that it may serve as the basis for what may well be a profound advance in the knowledge of how to confront the challenge of serious illness” (Head First: The Biology of Hope, E.P. Dutton: New York, 1989).

You can gain power over your illness by taking small steps, one after another, in the direction of wellness. Remember that your commitment and decision to take control are just as important as the details of your strategy.

You are the only one who can do it. It takes commitment and change, but not only can you heal from IBS, you can also be healthier than you have ever been before.

That’s why we said in the Introduction, “You can ‘use’ IBS to change your life and health.” You can turn the negative of your illness into the positive of health and wellness. You can heal from IBS and become healthier than you have ever been before, but you must make the effort and set high standards for yourself.

There is a wonderful story (that was circulating on the internet recently) of an elderly carpenter who was about to retire after a long and satisfying career. His employer—disappointed at the timing of his retirement—asked him one last favor: to build one more house that he had promised to someone, before he retired. The carpenter—feeling obligated to his long-time employer—somewhat grudgingly agreed. As he began his duties, it was clear that his heart was not in the job. He used inferior materials, shoddy worksmanship, cut corners and clearly, did not live up to his previous high standards of craftsmanship. When the job was complete, the employer came out to inspect the house, and as he approached the carpenter at the front door, he handed him the keys to the house, saying, “This is my gift to you. I wanted to provide you with one final thanks for all the good work and kindness you have shown me over the years.”

So it is with the house called our body. We can cut corners, use inferior materials and shoddy worksmanship, but this is our house, the one we must live in, the gift we were all given.

As you read through the upcoming chatpers, remember that each small step of self-care you take, helps you to build a stronger, healthier and more joyous body, a beautiful house for your mind and spirit to dwell in.

The greatest revolution of our time is the
knowledge that human beings, by changing
the inner attitudes of their minds, can
transform the outer aspects of their lives.

If a precious jewel accidentally fell into the mud, you would have to slowly chip away at the dirt, facet by facet, until you uncovered the precious and shining jewel hidden within. Healing is like chipping away at the attitudes, beliefs, memories, worries and stresses that obscure the precious core of who you are—the authentic you—the priceless jewel within that is deserving and ready to heal. Some parts of you are already shining through, while other parts lie waiting to be uncovered. Healing is the process of revealing your authentic self—the precious core of who you are—worthy, lovable and made in the Divine image.

If you find that your symptoms are not improving adequately, it is critical that you really incorporate all that you have learned into an action plan for health and wellness. Reading about exercise will not make your body strong. Likewise, reading about the mindbodyspirit connection will not bring you healing. Stephen Levine, author of Healing into Life and Death, tells the delightful story about the man who thought he could learn everything by reading. He read a book on astronomy and became an astronomer. He read a book on biology and became a biologist. He read a book on swimming and he drowned.

You cannot read your way to healing. You have to incorporate what you read by taking action. You must exert the full force of your will and determination to heal. This level of commitment is necessary for healing. When you know there is a precious jewel buried in the mud, you will not stop digging until you find it.

Another vital element for success in applying the principles of mindbodyspirit medicine is honesty. You must be completely honest with yourself regarding your feelings, your pain and your hurts. All studies show that the honest expression of who you are is more important than pretending to be upbeat or positive. Margaret Kemeny, Ph.D. in Healing and the Mind (by Bill Moyers) showed that the honest expression of emotion, whether it be negative (like fear, anger, resentment and jealousy) or positive (like happiness, peacefulness, joy and laughter) results in an increase in the number and activity of natural killer cells (an important part of your immune system that helps fight off viruses and some forms of cancer). Simple “positive thinking” will not keep you well, nor will “negative thinking” necessarily make you ill. You must be honest about what you feel and think, and express that honesty kindly and lovingly to yourself and others.

In Remarkable Recovery, Marc Ian Barash and Caryle Hirshberg examined the characteristics of patients who experienced spontaneous remissions from cancer or who lived beyond the expectations of doctors. What they found was that the one most compelling quality of those patients graced by miraculous healings was “congruence.” They defined congruence as a way for patients to be “deeply true to themselves, manifesting a set of behaviors growing from the roots of their being.”

If you are not reaching the level of health and well-being you desire, ask yourself if you are being true to yourself. Do your behaviors grow from the roots of your being? Are you living your very own life? Or, are you trying to live the life everyone else wants you to live? You can’t heal and develop your fullness of expression, if you don’t know who the real you is. You can’t live your very own life if you are too busy living someone else’s life.

If you are not improving as well as you had hoped, check your expectations. Perhaps your expectations for healing and improvement are unrealistic? Remember that the body always has some limitations. Perfect health is unattainable. You are looking for a reasonable measure of peace and balance in a world filled with imperfection and endless uncertainty.

One definition for stress is the gap between your expectations and reality. If your expectations are unrealistic—and you are trying to be or feel perfect all the time—you will always be unhappy and you will never reach the fullness of expression that is your very birthright. Life is complicated enough without expecting the unreasonable. Accept some of your limitations and at the same time, continue to seek new ways to heal and grow. This is the way to peace. This is the way to reveal the precious jewel within you. As for the things you cannot understand or change, remember to ask God or your higher power for help, for guidance and for understanding. We can never understand it all. None of us. Why we suffer, why we hurt, why things don’t make sense. But we can, like the biblical Job, accept our lack of understanding and trust that God understands, and one day we will too.

We all need one another. Remember that no one can do it all alone. If you are doing the best you can on your own, managing your stress, exercising and eating well—and you are still not feeling well—then it is time to seek out others who can help you. We all need help in order to learn, to grow and to achieve the important goals in life. We all need others—at times—to nurture and care for us, especially when we have exceeded our ability to care for ourselves.

The next several chapters will introduce you to other specialists and “Centers for Excellence” that can offer you multidisciplinary and comprehensive help. To heal more deeply, you may want to consult a body worker to help you heal your body, a therapist to help you heal your mind, and a spiritual mentor (minister/priest/pastor/rabbi/guru) to help you heal your soul.

But before you go on to learn more about these healers, consider some of the following suggestions to help you move to the next level of healing.

· Review Step 1 and think about the power of the mindbodyspirit connection. Are you “using” your IBS symptoms to learn more about your self and your stresses? Or, are you just taking on more and more stress? Are you learning how to accept some of the limitations of your body, at the same time that you see the limitless possibilities of your soul? Have you incorporated the importance of spirituality into your plan for wellness? Are you trying to build your relationship with a higher power? Are you utilizing your special gifts to find a sense of meaning and purpose in life?

· Review Step 2 and focus on the amazing interconnectedness of mind, body and spirit. Are you effectively chasing away the “tigers in your mind?” Are there any “crouching tigers in your path?” Are you doing all you can to keep your life as balanced as possible in order to avoid excessive allostatic load?

· Review Step 3 and take time to reflect on the mind/gut connection. Are you letting your gut express the stress that you are too afraid to deal with? Are you using your awareness of triggers and stressors to begin eliminating them from your life? Are there certain triggers you can avoid, but you choose not to? Are there certain triggers you can’t avoid, but you pretend that you can? Are you trying to become more consciously aware of your feelings, so that they don’t silently wreak havoc on your body by remaining unconscious and out of sight?

· Review Step 4 and focus on the Health Mug. Are you aware of the things that are filling up your mug? Is it overflowing already? Are you letting other people dump their “stuff” into your mug? Are you dealing with your unfinished business? Are your lifestyle choices healing or harming you? Are you draining off your unresolved grief or sadness, before it causes your mug to overflow? Have you said goodbye to the people who don’t support you in your efforts to heal? Are your spiritual choices bringing you a greater sense of connection, purpose and meaning in your life?

· Review Step 5 and really develop a plan for health. Get your exercise program going. Start eating consciously and nutritionally. Build your physical strength with a good weight-training program. Building strong muscles will help you to feel emotionally and spiritually strong. Are you taking care of your body as the temple that houses your soul? Have you stopped drinking caffeine and alcohol?

· Review Step 6 and really take care of your mind and spirit. Are you keeping a journal yet? Are you spending 5 minutes at the end of the day reviewing all the things you have to be grateful for? Are you doing your deep breathing exercises? Are you practicing invoking the relaxation response? Are you watching your negative thoughts and eliminating your cognitive distortions? Are you using the ABCDE technique to change your attitudes and beliefs?

· Review Step 7 and see if there are other functional GI disorders that are complicating your healing. Learn more about these disorders and the methods of self-care that may help you heal. Knowledge is power only when you apply it to your daily life. Take small steps and be patient. You are cleaning away the mud, one facet at a time.

Healing is about being your self, not the part of you covered in mud, but the part of you that shines through like a precious jewel.

Table 3 Bodily Symptoms: The "Irritable Body"
Fatigue and low energy	Insomnia and difficulty sleeping
Headache	TMJ pain (pain in the jaw)
Dizziness	Feeling faint
Difficulty thinking and concentrating	Shortness of breath
Chest pain	Abdominal pain
Back pain	Pelvic pain
Painful menstrual periods	Decreased sex drive
Bladder problems