Your Gut's Mental Health

I was 9 when Kurt Cobain was found dead in 1994. As a white, suburban kid, I remember being mesmerized by Nirvana's naked-baby-in-the-pool cover (Nevermind, 1991), but I had no clue what the band was about or who the heck Kurt Cobain was. I related to "Smells Like Teen Spirit" only because I actually wore some version of the anti-perspirant in my teens until I decided that my pits should not smell like fruity candy perfume. Still, Cobain has always been a kind of dirty-blonde, weirdo-grungy, heroin-addicted, Courtney Love-obsessed mystery to me.

The mystery unfolded a bit when I came across "The Brain-Gut Connection" in Maclean's, Canada's weekly affairs magazine. The article details plans for a new study on the treatment of an array of gastrointestinal issues, which is set to begin in the coming year. Everything from severe diarrhea to gas and bloating to nausea and "chronic constipation where you have excruciating cramps [that feel] like labour pain" will be addressed.

The study is another to add to the growing body of research that not only considers the mind-body connection, but highlights it.

“Most of us, when we’re under stress, respond with a GI symptom,” says Brenda Toner [a psychologist and co-head of social equity and health research at the Centre for Mental Health and Addiction, who is leading the investigation], up to 70 per cent of people, in fact. Think about how sick to your stomach you felt before that big meeting or when you were worried about someone you love. Gut discomfort is one of the biggest reasons people miss school or work, second only to the common cold. And for people whose pain is persistent, which is typical because many GI disorders are chronic, the psychological impact can be devastating.

As a person who has recently developed (what I assume to be) an intolerance to lactose after having consumed a glass of milk with 90% of my dinners for 20 years, this hit home pretty hard. The more sensitive my stomach has become, the more painful and embarrassing eating is. Some days I can eat 20 slices of cheese pizza (or 3) and be completely fine; other days I have a teaspoon of milk in my coffee in the morning and I can barely eat the rest of the day.

In any case, people with severe irritable bowel syndrome (IBS) or similar disorders generally suffer from intense, persistent pain that may not be easily explained. Besides the toll on mental health that chronic pain can take, the social embarrassment and shame can be equally large, often leading to anxiety and depression. However, it's still unclear if gut problems lead to the anxiety, or if the anxiety leads to the gut problems.

A 2006 study published in the Archives of Internal Medicine showed that people with mental disorders have double the chance of having a digestive illness; 20 per cent of patients suffering from a GI disorder have anxiety, compared to eight per cent of people with a healthy gut. One of the study’s authors, Jitender Sareen, thinks the relationship is bidirectional. “The anxiety leads to more GI problems, the GI problems lead to more anxiety,” says the University of Manitoba psychiatry professor. “It becomes a kind of cycle.”

So where does Kurt Cobain fit into this? Well it turns out that Cobain suffered from chronic GI problems that were never diagnosed. The issue was particularly debilitating to him emotionally, developing the problems as a teenager. Maclean's quotes Cobain as saying,

"It had been building up for so many years that I was suicidal. You know, waking up starving, forcing myself to eat, barfing it back up . . . just crying at times, ‘Urgh, I’m in pain all the time.’"

According to the Wikipedia article, Cobain was never able to find an effective remedy in the medical field, so after years of using drugs recreationally, he turned to heroin as a way to self-medicate and ease the GI pain.

Ultimately, it was this "self-medication" that contributed to his death, which was deemed a suicide.

Cobain is an extreme example of the effects of chronic GI problems, which were undoubtedly exacerbated by anxiety and depression, stress, fatigue and substance abuse. It also appears that his condition was never completely taken seriously, and the present study aims to address this issue in the medical community. Which is where a type of talk therapy called cognitive behavioral therapy (CBT) comes in.

A few years ago, she and colleagues discovered that CBT was more effective in helping patients cope with moderate to severe gut problems than no talk therapy at all. CBT sees the patient work with a psychologist to identify triggers that set off the worst symptoms. Patients talk about what’s going through their mind when they are in the throes of pain or feeling overcome by anticipatory anxiety and figure out techniques to reduce symptoms such as relaxation exercises. “It’s not magical or mysterious,” says Toner. “It’s practical, and that’s why people like it.”

Talking about diarrhea will make it go away? Well alright then. Can you guys just talk about it amongst yourselves... please? I kid, I kid. A big part of the shame that those with GI problems experience is because of the stigma and unwillingness to talk about these issues (Maclean's says especially in women). Everyone can understand the need to have a sympathetic ear, and the relief (no pun intended) a person feels when they're able to find a confidant.

Maclean's guides readers to the Irritable Bowel Syndrome Self Help and Support Group at www.ibsgroup.com which offers forums and groups to share experiences, articles, videos and books to gather more information, and even a section to sign up for a Pen Pal! Fantastic!

So please, "Come as you are, as you were, as I want you to be..." I'm 99% sure that song IS NOT about GI problems, but it seemed appropriate.