Last week was a long week. A stress-filled week. I went with a friend to BJs to try their new pumpkin ale, ate their margarita pizza, and thought about some dessert. Afterward, I went with a group of friends to Tucson's Fall Club Crawl. They have alcohol served on the streets, loud bars, and greasy foods (sonoran hot dogs ftw!). Just another college weekend. But why am I telling you this? I'm blogging about my weekend because this was my stress outlet and my social life. Consider someone with IBD. Which of these activities would that individual have to restrict because of their disease? We take for granted some of the normal, every day activities because we enjoy them without consequence.
Northwestern University's division of Gastroenterology emphasizes patient care and patient education. They are located in Chicago and accept a multitude of health plans. They have an inflammatory bowel disease clinic as well as GI laboratory. More importantly for this blog, the division offers extensive "pyshcosocial services." As we read in the article "Population-based Controlled Study of Social Support, Self-perceived Stress, Activity and Work Issues, and Access to Health Care in Inflammatory Bowel Disease," there are certain social implications for those with Inflammatory Bowel Disease. The first of which they consider, is stress:
In this study, there is evidence that, while work is the number one cause of stress, IBD patients more often marked personal, physical problems as a source of stress than the control group. The surprising trend found among those with IDB that is in remission feel LESS stressed than the control group. The researchers propose that this is due to their relieved symptoms after pushing through years of disease symptoms.
The next item addressed is social support: an patient with IBD is less likely to say they feel understood by another than the control group. Although this would seem to be a downturn in the lifestyle of patients with IDB, these patients, more often than the control group, had tangible, affective, and emotional support.
The IBD Center of Northwestern U describes "pyschosocial therapy" as their first alternative treatment for IBD. "Patients with IBD often have psychosocial concerns directly or indirectly associated with their disease. Coping with a chronic, unpredictable disease can be extremely difficult for patients and their loved ones." The center offers a health psychologist for patients with the disease to help individuals manage their relationships, employment, and educational goals. Interestingly enough, the study found that patients with IDB were often more educated than the control group AND more of them had a significant other in their lives. The Northwestern U program also emphasizes that their psycho-social treatment includes stress management because it is often involved in irritation of the GI system.
The program also offers "dietary therapy." As the research article mentions, there are a large number of IBD patients that consume alcohol. While the article does not cover dietary factors entirely, there are implications of sugary and greasy foods, as well as alcohol, that can irritate the bowels and can intensify symptoms (See other blog posts). The dietary therapies recommended are:
-Eat five small meals every 3 to 4 hours
-Limit your consumptions of milk or dairy products if you are lactose intolerant
-Reduce the amount of greasy or fatty foods in your diet
-Reduce certain high fiber foods such as nuts, seeds, popcorn, and some vegetables
Many websites provide information about IBD friendly diets.
One of the larger irritants is alcohol. As we know, long term alcohol use can have severe effects on the liver just by itself. As chronic liver disease is already a serious complication of the disease (affects 5-15% of people with IBD) the addition of alcohol to the diet can be detrimental. There is also evidence of alcohol having irritating effects on the GI tract epithelium that can cause nausea, vomiting, diarrhea, and bleeding. A common complication of alcohol is its interference with medications. All in all, alcohol can sound like a dangerous irritant of the disease. So just stop drinking, right?! Well wait a minute. What about those 20-30 year old patients with IBD? Do you think they should just stop drinking, save themselves the pain??? What are the social implications that follow??? No, really, I want to hear what you think!!! What about the positive effects of alcohol? There are studies that indicate (as discussed in Dr. Cohen's cardiology class) that 1 drink a day for women and 2 drinks a day for men can have positive effects on the coronary system, perhaps even preventing CAD. And consider the psychological and social benefits of having a drink at a party.
It is interesting to me that even the choice of having a drink at a party would add more stress to my life. Just once more thing to consider while enduring the disease. So last weekend, what choices would I have needed to make? What would this disease prevent me from doing? Would my friends understand my reason for making these choices? These are all interesting questions to consider when looking at the social implications of IBD. To learn more about Northwestern University's
Inflammatory Bowel Disease Center, please visit their website @ http://www.ibdcenter.org/index.html
No doubt there are a lot of life modifications needed for a person diagnosed with IBD. The important thing however, is to learn to cope with these changes and what better way to do it than with a support group. It was very comforting to see that in the science stress article that majority of these patients were receiving tangible and social support. It can be very difficult as Jen mentioned to be add stress to your life over the drink you chose, but as long as you have people behind you that support you it helps.
ReplyDeleteI have a couple friends with gluten allergies (what are the odds??), and while that makes going out and drinking more difficult, we have found some great alternatives. My personal favorite is 1702, which has gluten-free beer. It takes some extra work, but there are ways to accommodate certain health problems.
ReplyDeleteI am curious if one alcoholic drink per day is a major irritant to people with IBD, or if you have to drink excessively (12 drinks/week or binge drinking 5 drinks/day) to feel the detrimental GI effects of alcohol.
@Diana, I was pleasantly surprised that after a quick search that I found many programs with pyscho-social support for their patients. As you said, I think its important and awesome that the IDB patients in the Canadian population-based study felt that they had that support. It makes me curious about support systems for other chronic diseases. And with that support system, the medical coverage and health care access issue arises. Many of the patients in the study felt that they did not have proper access to health care.
ReplyDelete@Sierra, I too have a few friends with gluten allergies (including my roommate). After doing a quick search using the UA resources, I didn't find any study concerning the hypothesis of excessive drinking, though there is the blog that Kayla posted about the sugar content of the drink and the severity of symptoms that you might find interesting. :)
This is very interesting to read after the weekend I just had. My close friend just got diagnosed with gluten allergy which was causing her to be anemic. It was her first weekend out with it and I could tell she was having a hard time. She had to explain her situation multiple times and gluten allergy is not a very embarrassing situation so it was just annoying to her. If someone had IDB and they were asked why or why not they were doing something a little different than normal I know it would be hard for me to explain that to ponderers. She is having to change everything she eats and drinks. At the bars she got a rude response when she asked if they had any gluten free beer and she also said when she was at dinner and asked a question about the food she also got a rude response.
ReplyDeleteI am sure once she is taught well, which she has not been, she will have to ask less questions but as of now she feels like this is causing major changes in her lifestyle. I personally do not know anyone with IBD but I am sure that those feelings are stronger for them. I feel that many college students outlets are hanging out with friends either eating or drinking and to have to explain yourself constantly would be quite a hassle and bring you down instead of pick you up.
I think its so important for people with these chronic diseases to have a support group. As the article and the blog pointed out, issues like IBD cause marked stress in a person's life, but they find ways to cope with it. If a person affected by IBD is able to find alternatives to live with less stress, it'll be easier to have as normal of a life as possible. Plus, it's always easier to interact with others who know what you're going through.
ReplyDeleteClearly there are tremendous pressures surrounding the social aspects of diet ( and alcohol intake) that may override the medical implications of a persons actions for those with IBD or celiac. Alcohol and IBD meds can be a nasty combo- Imuran can cause pancreatitis as can alcohol, in addition to the potential for liver toxicity already mentioned. In addition, Crohns and celiac are known to be associated with a leaky gut, which is worsened by both alcohol and ibuprofen. " Cheating" on the gluten free diet for some people with celiac can leave them debilitated for days with GI complaints. The person with the disease has to decide if it is worth it. Do you consider it a sacrifice to give certain things up if the alternative is a colectomy, or severe pain and diarrhea?
ReplyDeleteThe flip side is that more and more people are following "alternative" diets. Recent data from Denver is showing that up to 1 person in 30 has celiac disease antibodies, whether or not they are symptomatic yet. If this trend is reflected nationwide, gluten free lifestyles will become more mainstream as they have in Denver. 70% of the world is lactose intolerant and does not ingest any significant amount of dairy. There is an adjustment period to avoiding these things in the diet for sure, but one could view it as a blessing in disguise...look at the average american diet and the average american. Do you really want to fit that profile?
Hey TomF, I was a little confused by your last post. Where did you get the information showing that 70% of the world is lactose intolerant? That is quite surprising. Also, where is that Denver study? 1-30 is interesting, as the literature I can find only suggests 1-105. What do you mean by "Crohns and celiac are known to be associated with a leaky gut..."? Are you talking about the possibility of ulcers? A "leaky gut" to me sounds fatal! Finally, what did you mean by "cheating on the gluten free diet"? I am not trying to be rude by any means, just a little puzzled.
ReplyDeleteI believe that IBD would be profoundly embarrassing and depressing, and the social implications are probably the most important problems for the newly diagnosed. It is a life-changing disease and, personally, I would feel deeply depressed that I wouldn't be able to participate in the activities I loved. It is definitely on par with diseases such as diabetes for their social changes.
Solely addressing the issue of alcohol consumption, I think the risk of liver disease or further inflammation would more than counter the cardiovascular benefits of drinking. Inflammation is a precursor to a ton of diseases, including cancer, and could further exacerbate the IBD itself. The benefits of a drink or two a day have ONLY been linked to reduced atherosclerotic lesions, the other mechanistic models are purely speculation. If you want the benefits of healthier vasculature, modify your diet, not your drinking habits.
ReplyDeleteFor data on worldwide lactose intolerence, ref Journal of pediatrics 2006 by Heyman et al.
ReplyDeletethe denver study on 3% blood test positive celiac is awaiting publication by Liu et al. Most of the current literature for celiac is around 1:100, still pretty common.
Leaky gut refers to increased intestinal permeability, which can be tested by the absorption of lactulose from the gut ( a sugar that should be nonabsorbable). There are thoughts that a leaky gut, letting in big proteins that should not be exposed to your antigen presenting cells is partially responsible for symptoms of IBD and celiac as well as eczema and other allergic diseases. This used to be only in alternative medicine, but is gaining evidence in western medicine as well.
"cheating" on the gluten free diet means knowingly eating (or drinking) gluten containing foods or beverages. The symptomatic response for someone with celiac who cheats on their diet is pretty variable, but can be severe, with cramping, pain, diarrhea and overall weakness and feeling awful.
IBD ( crohn's and UC) are nasty diseases, and can ruin someone's quality of life for sure, which is why compliance with the GI docs medication and lifestyle/diet recommendations are so important. There are pro athlete's and musicians (Gerrard of the Jacksonville Jags, McCready of pearl jam)and many other successful people who manage it though.