Summary
In this episode of CareLab, Dr. Lawrence Schiller joins hosts Brandy Archie and Emilia Bourland to discuss Irritable Bowel Syndrome (IBS). He explains that IBS is a disorder of gut-brain communication rather than a purely physical or psychological illness. The discussion explores causes like food intolerances, bile acid malabsorption, and bacterial imbalance, as well as the role of stress, pain perception, and mental health. Dr. Schiller emphasizes individualized treatment involving dieticians, gastroenterologists, and sometimes psychotherapy for effective management.
Key Questions Answered
-
What is Irritable Bowel Syndrome (IBS)?
IBS is a chronic condition characterized by abdominal pain linked with changes in bowel habits such as diarrhea or constipation. It’s considered a disorder of gut-brain communication. -
Who is most commonly affected by IBS?
IBS is most common among adolescents and young adults, though it can occur at any age. Women are more frequently affected than men. -
What are the main causes or triggers of IBS symptoms?
Common triggers include food intolerances (like lactose or FODMAPs), bile acid malabsorption, bacterial imbalance, and heightened pain sensitivity in the gut. -
How is IBS diagnosed and managed?
Diagnosis often relies on symptom patterns rather than imaging or lab results. Management includes dietary modifications, medications, probiotics, and sometimes psychotherapy or cognitive behavioral therapy. -
How does the brain influence IBS symptoms?
The brain and gut are interconnected; stress, past trauma, and emotional processing can heighten sensitivity to gut discomfort, influencing the perception and severity of symptoms.
Transcript
Brandy Archie
What if those constant stomach issues aren't just stress, but your gut telling you something bigger? For many caregivers and people whom they support, symptoms like bloating or pain or unpredictable digestion can sometimes get brushed aside as something minor. But irritable bowel syndrome, or IBS, is more than an inconvenience. It's a complex gut-brain disorder that can shape mood, energy, and daily life. And today,
we're digging into how the gut and brain communicate and why IBS is often fairly misunderstood and what that means for improving comfort and quality of life at home.
Emilia Bourland, OTR, ECHM
We have with us here today Dr. Schiller. Dr. Schiller attended Pennsylvania State University and Jefferson Medical College of Philadelphia. He completed his internal medicine training at Temple University Hospital in Philadelphia and then served in the US Army Medical Corps for two years. He moved to Texas in 1978 for training in gastroenterology at Southwestern Medical School and then stayed on as the faculty at the medical school and was an attending physician at the Dallas VA Hospital for five years.
He moved to Baylor University Medical Center in 1985 and has been there ever since, lately, as an attending physician and chairman of the Institutional Review Board for Human Subject Protection at Baylor Scott and White Health, as well as clinical professor in the Department of Medical Education at Texas A &M University School of Medicine, Dallas Campus. He has served as program director of the Gastroenterology Fellowship for 24 years and trained 38 fellows.
He's been the president of the Texas Society for Gastroenterology and Endoscopy and the president of the American College of Gastroenterology. He's been elected to fellowship in the American College of Physicians and Master's in the American College of Gastroenterology. Dr. Schiller has won multiple fellow teaching awards and the Ralph Thompson Award for excellence in medical education at Baylor University Medical Center Dallas. He's received the Marcel Patterson Robert Nelson Award from the Texas Society for Gastroenterology and Endoscopy.
and the AGA Distinguished Clinician Award from the American Gastroenterological Association. So basically, Dr. Schiller really knows his stuff. Thank you so much for being here with us today.
Lawrence Schiller
Well, thanks, Simuely. My mom would be very proud of your introduction.
Emilia Bourland, OTR, ECHM
I bet. mean, if that were my son's introduction, I would be I would just like wear a t-shirt with it all the time.
Lawrence Schiller
Hmm.
Brandy Archie
Hahaha
Lawrence Schiller
So.
Brandy Archie
So, Dr. Schiller, thank you first of all for coming back on the show. And last time we had this really interesting conversation about the gut brain connection and how that interacts with Parkinson's. But that's not the only thing. We all have a gut and we all have a brain. And so there's lots of other issues that you are working on and studying and giving us information on. And you said that you wanted to bring up irritable bowel syndrome. Tell me why.
Lawrence Schiller
Well, it's certainly the commonest diagnosis that gastroenterologists make in patients. GI symptoms are very common in people, and the tendency is to put the symptoms together and to try and call it something. And so years ago, people came up with this name of Udall-Ball syndrome to try and get a handle on some of these symptoms that are really common. I was just reading something the other day, 61 % of
everybody in the world has had some GI symptoms in the last year. So it's a very easy system to disturb and to produce some changes that people have. Now, not all those people have irritable bowel syndrome, but clearly anywhere from six to 10 % of the population has IBS or other disorders that we characterize these days as disorders of gut brain communication.
Brandy Archie
Whoa.
Emilia Bourland, OTR, ECHM
So what exactly is this cluster of symptoms that we call irritable bowel syndrome?
Lawrence Schiller
Yeah, if you look at the symptoms that are used to make the diagnosis, it's abdominal pain that's associated with a change in bowel habits. And the change in bowel habits may be having diarrhea or constipation. The thing that's interesting about IBS is that the pain and the change in bowel habits go together. The other important feature is it's a chronic problem.
It's not just having symptoms yesterday for the first time ever. You have to have symptoms for at least six months, and you have to have them fairly frequently to meet the criteria for the diagnosis.
Brandy Archie
So does that mean that if, let's say you do have IBS, but you're not diagnosed, you kind of have to be suffering for six months before it gets diagnosed and treated?
Lawrence Schiller
Well, before you get an official diagnosis, these are symptoms that are often sort of modest at first. And since GI symptoms are as common as they are, people just sort of ignore them. You know, with that filet of fish they had the other day that threw their stomach off and they live with it for a little bit. it's after you look back and see the picture as it develops over time.
it becomes clear that that's the ballpark you're playing.
Emilia Bourland, OTR, ECHM
That's interesting. So it's not like it comes on all of a sudden and people have the same intensity of symptoms is what you're saying. It's something that can kind of build gradually over time. Is there like a certain age range or a particular group of people that we see this more commonly in?
Lawrence Schiller
Well, it's particularly common in young people. So starting in adolescence and going through young adulthood is the prime time of onset, but it can strike at any age. Kids have similar problems. They're often called chronic abdominal pain when it affects kids under 12 or so. And old people can get it too. that
It's not unlikely, but all people start to have their bodies breaking down. So they have other things that can cause symptoms too. And we never run to a diagnosis of IBS in someone who's over 50 or 60, but it can happen.
Brandy Archie
So.
Okay, so if it's as common as it is, and the symptoms can be also associated with other things, what are the things that we should be paying attention to as caregivers to be like, okay, one, not jumping off the deep end and saying, my person definitely has IBS, I need to go take him to the doctor, and two, also just not ignoring things for a long time when it could be treated.
Lawrence Schiller
Sure. Well, it's a difficult position to be in. think the things that we look out for are so-called red flags or symptoms of concern. So, for instance, if you had bleeding, rectal bleeding, if you had weight loss, if you had additional problems like nausea or vomiting that would compromise your ability to eat, those sorts of things are signs that there may be something else going on.
it needs investigation more acutely. For people with sort of garden variety IBS, it's an annoyance and it's interesting. It causes as much distress as so-called real diseases like inflammatory bowel disease or cancer even. And it bothers people and affects their quality of life, but it doesn't kill them. And so the tendency is to be sort of gradual and
getting into that diagnosis.
Emilia Bourland, OTR, ECHM
So I mean, like honestly, I have so many questions about this. I'm not trying to throw us off, but like I just have, have a million questions about this. Is there a nutritional impact in people who have IBS and like their ability to absorb nutrition from food? Is that something that goes along with it?
Lawrence Schiller
That's why we're here.
Lawrence Schiller
Well, that's an important point. And what we've realized in the last 20 years or so is that foods can be a trigger for symptoms. And this gets to something that's very important to keep in mind when talking about IBS and these other disorders where you have a lot of symptoms, but there aren't many physical changes that you would see on an X-ray or with endoscopy. Now, if someone has colitis,
They have bad diarrhea and pain, cramps, what have you. And you look inside and the lining of the colon is all inflamed. So, people, you know, understand that as sort of a cause and effect. If you have someone with IBS, they might have diarrhea and abdominal pain. In fact, that's likely for many of those patients. And yet, when you look inside, things look perfectly normal. And so, the tendency is to say, there's nothing wrong.
In the old days, people would say it's all in your head. Back in the 1940s, the era of psychosomatic medicine, this was thought to be another psychosomatic disorder and stress-related, as you mentioned at the beginning. And we used to treat people with tranquilizers. When I was in medical school in the 1960s, that was the treatment for this. You give people some sedative, and there were lots of people taking Librium and Valium and things like that.
to try and treat their IBS symptoms. And it made them feel less anxious perhaps, but it really didn't do too much for the bowel symptoms. What's developed is that people have tried to come to an understanding of what causes the symptoms. And that's important because if you think about what we call this, it's IBS syndrome. A syndrome is just a collection of symptoms. It doesn't really tell you it's a specific illness.
So, for instance, you could have a syndrome of going to the bathroom a lot, and it might be a urinary tract infection, or it might be a cancer or something like that. It's not just one thing that causes those symptoms. And so, as a result of that, when you lump these all together, people try to look for a singular cause for them. And again, stress was a big thing back in the 1940s.
Lawrence Schiller
Spasm of the intestine was big in the 1950s and 60s, and lots of medicines were given to relax the smooth muscle of the gut so that you didn't have as much pain. Later on, other things were looked on as potentially being a cause for IBS. We started to look at the brain in IBS in the 1990s. process pain differently when they have IBS.
different areas of the brain are involved. If you look at other causes that have come up over time, people have been concerned about problems with the bacteria in the bowel, that they're disturbed in some way, that there's a problem with the foods that people take and reactions, as you were just mentioning. So, there are all these things that come up and
The problem is every time someone has a new idea, they say, you know, that's the cause of IBS. But in fact, IBS is a bunch of different conditions that cause the same sorts of symptoms. So there's tremendous overlap. If you have a cough, you don't know if it's COVID or pneumonia or strep or what. mean, it's just, you know, a bunch of different things that cause similar symptoms. And I think
When all is said and done, that's how we're going to look at IBS rather than it being one thing that has one cause. And if you look at the common causes of it, about 40 % of people who have IBS symptoms have a problem with some of the foods that they eat. And it may be, as you suggest, a problem with digestion. For instance, the commonest food relationship is with digesting milk sugar, lactose.
Emilia Bourland, OTR, ECHM
Mm.
Lawrence Schiller
And it's an interesting story with lactose. know, lactose is baby mammal food. Every mammal rears its infants with milk. And that's, you know, the great perfect food for baby mammals. And each species has its own little recipe so that it grows into the right kind of animal it's supposed to be. But.
That's something that usually fades away. In ancient times, people didn't drink milk after they were weaned. So there were usually big ceremonies when the kid was weaned and went on regular food, but they never really encountered milk again after that. And the body tends to shut things down after a while. for most normal humans, it shuts off the production of lactase, the enzyme.
in your gut that digest milk sugar and lets it be absorbed. So that the normal human condition is that you can't drink milk successfully or a lot of milk. You can have a little bit usually and get away with it without symptoms. But if you have a problem with lactose digestion, then you end up having extra carbohydrate get down to your colon. The bacteria there converted to gas very efficiently, just a teaspoon full.
of lactose, five grams, will cause a liter of gas, a little more than a quart of gas to be produced. So it doesn't take much to get you bloated if you have a problem with lactose malabsorption. And that's, again, the normal state. Now, in the US, particularly, we're used to adults being able to drink milk. And that's because a lot of people who settled the United States came from Northwestern Europe, where there was a fortuitous mutation.
about 10,000 years ago that let them drink milk, which was a great boon if you think about it. You know, if you can steal some milk from a friendly cow, then you can get a nice high protein, you know, good source of calcium, you know, all the good things about milk that adults can benefit from too. And so that was a great mutation to have and it evolved in different forms a few times in Africa. But most of the world's population doesn't have that mutation and so.
Lawrence Schiller
They just turn off lactose or lactase production and then they don't tolerate milk. If you give them a glass of milk to drink, they'll start to get symptoms. And many people don't realize that. And as a result, since milk is pretty universal in the American diet, you you go to McDonald's, they probably use some milk to make the bread and they have a nice milkshake there for you and all sorts of other things.
some ice cream at the end. I people consume more lactose than they think. And if you don't have enough lactase enzyme to digest it, you'll get symptoms. So that's an example of a food related problem. And there are other carbohydrates too that we have trouble digesting or marginal capacity to digest. So that you've probably heard about the so-called FODMEMS diet.
And that's a diet that reduces other carbohydrates that have to be broken down like lactose. So, fructose is one of the carbohydrates that we have marginal capacity to absorb. And it's easy to overdose on that if you drink a lot of soda. Most of the soda in the US is sweetened with high fructose coin syrup. And so, if you drink a lot of regular soda, you may.
get a lot of fructose and that doesn't get absorbed much beyond 60 or 70 grams per day by most people. And so that all gets down to the colon and gets fermented, it'll make gas and cause you to have difficulties with that. there are lots of those things and the diet also bans some other carbohydrates like the carbohydrates.
that are in garlic and onions and whatever. So there are a lot of miscellaneous foods. It's not anything you can just look at and say, that food's bad for you. But there are dieticians who made careers measuring how many of these poorly digestible carbohydrates are in different foods. And they can design a diet to reduce those in people. And that works pretty well to relieve IBS symptoms.
Lawrence Schiller
in about 40 % of people with IBS with diarrhea. So it really can improve their quality of life dramatically to do that. The other big cause for IBS with diarrhea symptoms is what's called bile acid malabsorption. know, bile acids are interesting chemicals that we make in our liver from cholesterol. And it's actually how the body gets rid of cholesterol. You every day you eat some cholesterol and...
It's a useful substance that forms the cell walls of all the cells in your body. It's really important in your brain for having that work right. But you could have too much cholesterol and get problems with atherosclerosis and the body has to get rid of it. And so what it does is changes it into a substance that gets excreted by the liver into the bile and goes through the intestine and
Some of it is recycled, because that same bile acid is used to help digest normal fats in your diet. It's a little bit like a detergent. It lets the fat globules get broken down into small particles that can be absorbed by the lining. But about 5 % of it per day is lost into the stool. And that's fine. That balances out the cholesterol you ate that day. And so the body stays in equilibrium with that.
The problem is some people have difficulties with the reabsorption step. And they may malabsorb more bile acid that gets down into the colon. And there it can trigger diarrhea and contractions of the colon. And so about 30 % of people with IBS with diarrhea get better by trying a medicine that binds up the bile acid in their colon. So it can have that effect in stimulating diarrhea.
And then the third common cause is a problem with the bacteria, either bacteria overgrowing in the small intestine, where they're usually very few, or a different mix of bacteria in the colon. So about 10 or 15 % of people with IBS with diarrhea end up getting better with an antibiotic therapy. Now, these therapies are variable. You have to do them under the guidance of your doctor, because they don't.
Lawrence Schiller
have only good effects. For instance, the diet therapy, it's a restriction on what you're eating. And some people take that too much to heart in a sense and get on a very restrictive eating habit, which can be bad for your general health because you need to have a variety of foods to maintain your health. And so if you get too restrictive without offsetting it with other sorts of foods, you can run into trouble. So
It's always worthwhile instituting those kind of diets under some sort of supervision by a dietician or an interested doctor. that's very important to realize that these are not sort of do-it-yourself remedies for things. You really should work with the people who know about this so that you can do these things effectively. But the bottom line is if you look at those three things, food intolerances of various kinds, it's not all.
just carbohydrates, there are some other things that can cause problems. The bile acid malabsorption problem and some problem with the bacteria that antibiotics will fix, that accounts for maybe two thirds, three quarters of people with IBS with diarrhea. So it's no longer this mysterious condition. It's symptoms that are due to a problem that can be treated or addressed to some extent.
And I think that's where we're going with IBS right now. You know, there's still great interest in how people with IBS process pain. That does seem to be different. And that may make the symptoms that you have more significant. If you're a guy with some extra bloating, you may not care about it too much one way or another. But if you have a problem with processing the pain message from having the gut stretched out by the bloating, then.
know, it becomes a bigger issue for you. So, the presentation of the disease may be affected by some of these problems with pain processing that have been found. But IBS becomes a much more understandable condition if you look for fundamental causes of it and try and take care of it. So, I think that's where we're going with this. For many years, it's been very hard to make these diagnoses, and so people have just avoided it.
Lawrence Schiller
you know, why send somebody to do a tough test or an expensive test for something that's not going to kill them. But that's to me not a great plan because we know the symptoms really bother people a lot. you know, our job is to try and make their life better by dealing with these medical problems. So I think we're going to transition to using some tests but
We need better tests and that's what a lot of the work is involved with now and looking at at IBS.
Brandy Archie
I'm glad you took it into that level of detail because my question after Amelia's was gonna be, well, should they just start doing an elimination diet? And you just basically told us like, no, one, it's not one food probably that's causing a problem. It's probably a class of or different types or carbohydrates. And two, you need to, if you misdiagnose yourself, for lack of better words, in your elimination diet, you could be leaving out.
Lots of things that you buy does actually need and you need to be working together with somebody to deal with that. So I'm really glad that you brought that up.
Lawrence Schiller
Yeah, dietitians are really trained in this now and do a good job with it. And certainly if someone was having significant issues with their IBS symptoms, which they would come to a doctor with them. But in real life, I would seek out a dietitian and work with them on that. We do do empiric trials though, and that's because the tests aren't so good. You know, if we had some sort of blood test you could do or even a stool test and say, well, this is the
thing that's causing your problem, you know, don't eat garlic and watermelon and, you milk and whatever is on the list for that. That would be one thing, but we don't really have good tests that way. And so, we often will say, okay, let's try a diet. I mean, if a diet is going to work, it's going to work quickly when you have a problem with food intolerances causing IBS symptoms. And that's because.
There's no structural change in the intestine that we know of. It's not an allergy per se. But if you stop taking the food, your symptoms should go away. know, within a week or two, if you're following the diet correctly, you should be better if that's the problem. So we often will try that out. But then the question becomes, well, what food is it? Because the FODMAPS diet restricts a lot of different foods. And generally what I tell my patients is add back the thing you miss the most.
and see if that bothers your symptoms or not. If it doesn't, then try something else. The difficulty, though, is it depends on the amount of the food to eat. You may tolerate some milk in your coffee without any problem. But if you go to drink a milkshake, you're going to be in great distress. It's just a question of dose as much as anything.
Brandy Archie
Mmm.
Brandy Archie
I know this very well.
Emilia Bourland, OTR, ECHM
you
Lawrence Schiller
There are a lot of nuances and again, I think it really is a good idea to talk with the dietician about modifying your diet if you're going in that direction. For bile acid problems, we have medicines that bind the bile acids. Some of them are more obnoxious to take than others. They're sort of the common one that we've had for years since the cheapest is sort of like taking a drink with sand in it, not particularly pleasant.
But if it helps your symptoms and your symptoms are causing enough problem, that's it. There are newer medicines that are a more expensive that are little better tolerated in that same category. So we can try that for a week. Again, this needn't be a real long drawn out trial. If it's going to make a difference, it'll make a difference quickly. And then for the bacterial one, we sometimes will give a trial of antibiotics. In fact,
One of the remedies that the FDA has approved for IBS is an antibiotic treatment. And you take it for a short period of time, a couple of weeks. And if you want to respond, you may get lasting relief for months. And then if it comes back, you take it again and that sort of thing. So, we do do empiric trials. Again, because the tests aren't particularly decisive with this. They're suggestive and.
We do them sometimes to see if there's a problem. For instance, if you're looking at food intolerances for the carbohydrates, you can do what's called a breath hydrogen test. If you give the person a dose of the specific carbohydrate, say fructose or lactose by mouth, and then collect their breath, the carbohydrate gets fermented in the intestine. And one of the fermentation products is hydrogen gas.
which isn't made by any human cells. It's only a bacterial product. And so you measure how much hydrogen comes out in the breath and you can see if they had a problem with malabsorbing that particular carbohydrate you get. Now it's not a perfect test, but it is a way to try and approach it and sort of find out what the underlying problem is. But there lots of different carbohydrates and you can spend a lot of money doing tests looking at all of them and we don't have.
Lawrence Schiller
good ways of sorting that out just yet. But sometimes, you know, if you're convincing someone who loves to drink milk that they shouldn't be drinking milk more than just say, try not drinking milk, that's one way of doing it. You can give them a lactose breath test and say, see, your hydrogen gas went up a whole lot after you took the milk. You're not absorbing it well in your intestine and it's getting down to the colon and getting fermented. there are lots of things we can do.
What we should do in terms of testing is still being defined right now. And eventually that'll get sorted out. But I think the important concept is that we shouldn't just take IBS as the be-all and end-all diagnosis for someone's symptoms. We should at least think about what might be causing them and how we can approach it in other ways. We currently use a lot of symptomatic therapy for people. Something to check the diarrhea if they have that.
help with constipation if they have that. And that will help a lot of people who have those symptoms. But if you apply it across the board to people who have IBS, the results are a little bit disappointing. It may only be a 10 or 15 % improvement over what the placebo response would be. And no one wants to spend a lot of money on a medicine that doesn't help that much. So these things are worth trying. But
It really is something you have to work with your doctor for a while and don't expect them to hit a home run with the first pitch. That's the key thing. A lot of people feel, I have a diagnosis now and you should be able to treat this and I should be better tomorrow. And it rarely works out that way. It's an effort to get to the right path for each individual person who has a problem like this.
Brandy Archie
Mm-hmm.
Emilia Bourland, OTR, ECHM
Yeah, I really appreciate you saying that actually, because I think so often, and especially like even more so in our culture now, like we want an answer, we want a magic pill, we want, you know, things to be instantaneous. And the fact is that bodies are really complicated. We don't understand everything about how the body functions. And so putting those pieces together is both a science and an art form.
And so it really does take time. And even though I think from a patient perspective and a caregiver perspective, that can feel really, really frustrating, like going in with the right expectation that actually this is probably more complicated than a single cause and a single solution. And, but if you have a great provider who's going to work with you in partnership to kind of go through all those steps and really get down to what the best options are for you.
Lawrence Schiller
Yeah.
Emilia Bourland, OTR, ECHM
then you can have good results, but it takes commitment from everyone in the relationship, provider, caregiver, if there's one involved, and patient too. So I just really appreciate you kind of laying that out and saying that there. I wanted to ask you a little bit more about this brain connection here. And you had talked specifically about pain and kind of perceptions of pain.
Let's kind of dig down a little bit more into that. Can you explain what you mean by like some people feel pain differently?
Lawrence Schiller
Yeah, well, it's really pretty evident that there are lots of people who have chronic pain. And it's tragic when it happens. One of my wife's best friends has bad back pain and really gets incapacitated by it every now and then. And there's no reason why she should, you know, have that much problem with it, but she does. And lots of people with bad pain will have
changes with pain processing over time so that they become hypersensitive, if you will, to what's happening in the body. And we think some of that is what goes on with IBS. If you have a situation where you're having something that will cause pain, say you get bloated and your gut gets expanded with all this gas that you made because you had a glass of milk or something. Well, for some people,
No, they'll just pass on that. It's just a one-time thing. But if you're having a day after day, your brain is paying attention to that a lot more than it otherwise would. And so you end up having a situation where just a little bit of abnormality will cause a big response. And that's due to the architecture of the pain system. We're starting to understand how that works. know, pain is a...
a processed sense, you have nerve endings out in your body that are set up to detect tissue damage or extra pressure or different things like that. That goes up to the spinal cord. And instead of it just being sort of like a game of telephone where someone says something hurts and then the next one says something hurts and goes down the line, which is what we used to think of for this at each step along the way.
There's modifications that take place. So for instance, in the pain systems, the sensory nerve comes into the spinal cord. And then there is a relay nerve that takes it up to the brain where it gets interpreted. But there are also nerves that come from the brain down to the spinal cord level and that modify the signal. They may release various neurotransmitter chemicals that change the sensitivity of that relay nerve.
Lawrence Schiller
to the pain message and that's called the gate theory of pain. we actually use that in treating pain. We often use a lot of medicines that are ordinarily characterized as antidepressants because they affect serotonin in the brain and that affects your mood. But they also affect serotonin in your spinal cord. And at least for some of them, we use them to modify pain perception, to sort of turn the dial down and.
make it less painful. You still have feelings. It's not like an anesthetic medicine, but it reduces the intensity of the pain message. And the interpretation of the brain seems to be different too when people did interesting brain scans where they would put a balloon in the rectum, sounds terrible, and blow it up with air, sounds even worse. And
Brandy Archie
Yeah
Lawrence Schiller
If you do that, that produces sensation of your intestines being bloated. People who have IBS process that message in different areas of the brain. Now, the brain is hard to get to to understand that we've made tremendous progress in understanding how it functions. But we still don't know all the details of that. people who have IBS problems tend to activate some of the emotional centers in the brain.
which is another interesting observation because it probably reflects how much impact the pain has had on their mood and depression and things like that. There's also an interesting relationship with abuse. You know, it's a curiosity that the majority of people with IBS are women. About 60 % of IBS patients are women.
Men are less likely to have it. And part of that thought is that that may have to do with physical or sexual abuse, sensitizing the brain areas that deal with these things to the sensations coming from the gut or the lower part of the pelvis. And that's really a very dramatic observation.
and pretty consistent in different places around the world. So, it becomes a very important key to how people interpret their symptoms and what effect it has on their life. may bring back, you know, deep memories, if you will, of bad things. And that may affect how it affects your affect, if you will, changes your perception of the world and your sense of well-being. So,
There's a lot of action in that area as far as research, but it's a very tough area to sort out exactly why that all happens. it's pretty clear that, you know, your life events impact how you interpret symptoms later in life. And even if the symptom may be due to some food aid or some bile acid you're malabsorbing or some bacterial change, your brain impact
Lawrence Schiller
may be modulated by your previous life experience. So I don't think it's particularly novel observation, but I think it's a real one.
Emilia Bourland, OTR, ECHM
I think it's unique that we're acknowledging that now in healthcare though. I think for a long time, I think it was not acknowledged and so many people with chronic pain were just told like, it's all in your head, it's all in your head. And of course we do perceive pain in our brain. That doesn't mean that that perception is incorrect. It just means that it's different for different people because we have different experiences, we get wired differently. That's that neuroplasticity effect.
Brandy Archie
Yeah.
Lawrence Schiller
Yeah.
Lawrence Schiller
And you have to be open to that. mean, one of the most effective therapies for IBS symptoms is actually psychotherapy. We don't do it very much because it's not that widely available. But cognitive behavioral therapies, the hypnosis, things like that actually help people as much as any of the medicines do. Again, we're lumping all these folks together with different things. But that seems to...
Brandy Archie
Mm-hmm.
Emilia Bourland, OTR, ECHM
Mm.
Lawrence Schiller
be true, that you can modify the impact of the symptoms by working on the brain rather than working on the gut. it's not proper these days to view this as a psychosomatic disease because that sort of implies that it's a bad thing. You're making up symptoms or whatever. That's not what we're talking about here. But
I think it's overreaction to say that the brain has nothing to do with it and that it's all with what's happening out in the gut that's triggering the symptoms.
Brandy Archie
I think it's that nuance that we don't like as human beings, I think, of the grayness of it. And like what you were talking about earlier, Amelia, about it being a science and an art, is that yes, there's physiological things happening. Yes, there's also psychological things happening. And that means that how you feel and how she feels are maybe two different things, even though the physiological things are the same, because we have multiple variables happening there.
Lawrence Schiller
Thank
Brandy Archie
And you can tell me if you think this is a bad example, but people often think that when you're looking with your eyes, you're taking a picture and you're seeing, you and I see the exact same thing all the time. But when you do those little visual tricks where you see a face or you see an optical illusion, some people see a face, some people see a different shape, it's the same thing. But.
Lawrence Schiller
Yeah, optical illusions.
Brandy Archie
it's based on your experiences as to how your brain is interpreting it, even though your eyeballs are taking in the same information. And so that feels like a good, know, simile essentially to like how our bodies experience pain and then layering that on top of like IVS and the symptoms that go with that. And then all the other things that happen in your life before that. yeah.
Lawrence Schiller
Yeah.
Lawrence Schiller
Yeah, I think that's a very good example. know, our visual fields are pretty big in general. You can see something moving way out in the periphery of your vision. But we only really pay attention to the stuff immediately in front of us. And that's why a lot of those magician's tricks work, because we're watching the hand or the baton tapping the hat, and you don't see the rabbit being put in the hat. And so it's
It's very, very interesting, the relationship of things and that old idea that, there's psychological things and there's physiological things and never the twain shall meet is completely wrong. When you're dealing with one creature and both things are operating on it, their perception of symptoms and their life and all that is influenced by physical factors in the body and vice versa. You know, it's a...
Stage fright is a real phenomenon. People do get a little heartburn or cramp when they have to go give a talk. mean, that stuff is not fake. It's real. It's all because we're one body that has a lot of different things going on at once.
Emilia Bourland, OTR, ECHM
This is, honestly, I could sit and listen to you for literally like hours. I, no, I wouldn't, I wouldn't. Cause I really find all of this endlessly fascinating. And I learned so much from you whenever I've seen you speak or having you here on the show. We're about to the end of our time, so we have to wrap up.
Lawrence Schiller
You probably fall asleep though. My wife does, I don't know.
Emilia Bourland, OTR, ECHM
if and we'd love to have you back again to talk about anything else that you'd ever ever like to if you had one kind of final takeaway message about ibs you know before we wrap up today what would that be for listeners
Lawrence Schiller
Sure, I'm happy to do it.
Lawrence Schiller
Well, I think the key thing is that each person is different with their IBS, both in what's triggering it and what their body's reaction is to it and what their brain's reaction is to it. And so it's a complex problem. As was mentioned earlier, you really need to share your troubles with someone who's interested in them and can help guide you, whether it be a dietitian for the food part of things, whether it be a gastroenterologist or
some of the more specific peripheral problems. They can make a big impact and make your life better by getting your symptoms under better control.
Emilia Bourland, OTR, ECHM
Thank you so much for being here with us on another episode of Care Lab, Dr. Schiller. Dear listener or viewer, if you made it to the end of the episode, please take a moment to like, subscribe, leave a comment, leave a review, and most importantly, share this episode with someone who you think could benefit from this information. Those are the best ways to help us reach more people who would benefit from, you know,
getting the kind of resources and info that we try to share here on CareLab. Until next time, we'll see you right back here next Friday. Bye.
Brandy Archie
Bye everybody.
Lawrence Schiller
Bye bye.
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