Alcohol

This is supplemental information for this topic marked by the little computer icon in the book, Irritable Bowel Syndrome and the MindBodySpirit Connection, by William B. Salt II, M.D. and Neil F Neimark, M.D. (Columbus: Parkview Publishing, 2002). Click here to learn more about the book and/or to purchase it.

Alcohol is the most commonly abused drug in the world. In the United States, alcohol is used by at least one-half of the adult population. Alcoholism affects up to 10% of the population, up to 20% of people who go to see doctors, and 10 to 40% of hospitalized patients. Alcohol is responsible for 100,000 deaths every year, and estimated costs to people and society are approximately $130 billion.

Alcoholism can contribute to the symptoms of IBS and other functional GI disorders, particularly dyspepsia and chronic diarrhea. Furthermore, alcoholism is associated with anxiety, depression, and other emotional problems. Doctors detect drinking problems in as few as 35% of patients who have them because most deny having a problem with alcohol.

What is moderation in alcohol?

The Dietary Guidelines for Americans, 2000, 5th Edition, United States Department of Agriculture advises that if you choose to drink alcoholic beverages, do so sensibly, and in moderation. Limit intake to one drink per day for women or two per day for men, and take with meals to slow alcohol absorption. Avoid drinking before or when driving, or whenever it puts you or others at risk.

Drinking alcohol in moderation is defined as no more than one drink per day for women and no more than two drinks per day for men. This limit is based on differences between the sexes in both weight and metabolism.

Count as a drink—
12 ounces of regular beer (150 calories)
5 ounces of wine (100 calories)
1.5 ounces of 80-proof distilled spirits (100 calories)

Drinking in moderation may lower risk for coronary heart disease, mainly among men over age 45 and women over age 55. However, there are other factors that reduce the risk of heart disease, including a healthy diet, physical activity, avoidance of smoking, and maintenance of a healthy weight.

Moderate consumption of alcohol provides little, if any, health benefit for younger people. Risk of alcohol abuse increases when drinking starts at an early age. Some studies suggest that older people may become more sensitive to the effects of alcohol as they age.

A screen for alcohol abuse

If you feel that you may have a problem with using alcohol to relieve your stress or feel you drink in a way that you have become dependent upon it, consider taking the following test, which includes two questions and the CAGE questionnaire.

Two questions

If you answer "yes" to either of these two questions, then you could have a problem with alcohol:

1. Have you ever had a drinking problem before?

2. Do you have more than two drinks on most days if you are man or more than one drink on most days if you are a woman?

The CAGE questionnaire

Here is a simple screen for alcoholism.

  1. Have you ever felt the need to Cut down on your drinking?
  2. Have you ever felt Annoyed by criticism of your drinking?
  3. Have you ever had Guilty feelings about drinking?
  4. Have you ever taken a morning Eye-opener?

(From Ewing JA. Detecting alcoholism: the CAGE questionnaire; Journal of the American Medical Association. 1984;252:1905–7.)

The more questions answered "yes," the more likely you have a problem with alcohol.

This may help you to determine whether you may be misusing or abusing alcohol to feel better. Genetics play a very strong role in alcoholism, so if you have a first-degree relative (mother, father, brother, sister) who has a problem with alcohol, then you are more likely to have one as well.

Click here to visit the website of MEDLINEplus Alcoholism – resources.

 


 

Allostasis and the Good Stress Response

This is supplemental information for this topic marked by the little computer icon in the book, Irritable Bowel Syndrome and the MindBodySpirit Connection, by William B. Salt II, M.D. and Neil F Neimark, M.D. (Columbus: Parkview Publishing, 2002). Click here to learn more about the book and/or to purchase it.

There is an important association of "stress" and the functional gastrointestinal syndromes, such as irritable bowel syndrome. Our book, Irritable Bowel Syndrome and the MindBodySpirit Connection explores this important link. But, what is stress? Is stress good, bad, or both? How often do we experience stress? Are we always conscious of stress?

A stressor is any situation that represents an actual or a perceived threat to the balance (homeostasis) of an organism. We may or may not be conscious or aware of a stressor and our response to it. Evolution has ensured that all animals and humans possess the adaptive capacity to respond to stressors in order to maximize chances for surviving the stressor. So in this way, the stress response is good stress.

Another way of saying this is that The MindBodySpirit Connection is in a constant state of maintaining an internal balance that is called "homeostasis." When we are challenged, subjected to change, or exposed to stressors – in essence, when we are threatened – the Connection generates internal chemicals and stress hormones, including cortisol and adrenalin, whether we are aware of it or not. This internal response helps us cope with the situation and survive the immediate challenge. This is "good stress." This active response also helps the body to re-establish balance or homeostasis.

Dr. Bruce McEwen from Rockefeller University in New York calls this active and adaptive process "allostasis." The word, "allostasis" is derived from Greek with "allo" meaning variable and "stasis" meaning stability. The term literally means, "achieving stability through change." This constant internal response is critical in re-establishing balance and homeostasis. It is a dynamic process. This is good stress.

You can further explore Dr. McEwen’s important concepts regarding stress and the stress response:

This landmark review of the human stress literature in the world’s most prestigious medical journal explains the key concept of the protective and damaging effects of the response of the MindBodySpirit Connection to stress. There are many mechanisms, but among the most prominent are the manifestations of physiological stress responses as a result of living and working conditions, inter-personal conflict, as well as the sense of control of one’s environment and optimism/pessimism toward the future. "Allostatic load" refers to the cost of adaptation to a stressful environment, which elicits repeated and sometimes prolonged adaptive responses ("allostasis") that preserve homeostasis in the short run but can cause wear- and-tear on the body and brain. Functional symptoms and syndromes, decreased cognitive function during aging, abdominal obesity, increased risk for hypertension and cardiovascular disease, insulin-dependent diabetes and decreased immune responses are all manifestations of allostatic load.

We have powerful ways of modulating the harmful output of the stress response systems that include belief systems and behaviors. An important quote attributed to Dr. McEwen is, "We must also remember that the biggest problems for the human race in the future are those associated with our own behavior and misbehavior and the impact of the social and physical environment on our bodies and brains."

 


 

Allostatic Load and the Bad Stress Response

This is supplemental information for this topic marked by the little computer icon in the book, Irritable Bowel Syndrome and the MindBodySpirit Connection, by William B. Salt II, M.D. and Neil F Neimark, M.D. (Columbus: Parkview Publishing, 2002). Click here to learn more about the book and/or to purchase it.

 

There is an important association of "stress" and the functional gastrointestinal syndromes, such as irritable bowel syndrome. Our book, Irritable Bowel Syndrome and the MindBodySpirit Connection explores this important link. Be sure that you have read the nugget, Allostasis and the Good Stress Response first.

Unfortunately, the good stress response can turn bad, and a chronic stress response can be too much of a good thing! The way our bodies work presents us with a paradox: what can protect can also damage.

This "bad stress" is what stress researcher, Dr. Bruce McEwen calls "allostatic load." This term refers to a disturbance in the internal response system, balance, and homeostasis. For example, the stress response chemicals and hormones may not be turned off appropriately or they become active when they should not be, such as when you are home after a long day’s work and still feeling stressed out. The load is the damaging effects of these internal stress mediators. It's the price the body has to pay for either doing its job less efficiently or simply being overwhelmed by too many challenges.

You can further explore Dr. McEwen’s important concepts regarding stress and the stress response:

This landmark review of the human stress literature in the world’s most prestigious medical journal explains the key concept of the protective and damaging effects of the response of the MindBodySpirit Connection to stress. There are many mechanisms, but among the most prominent are the manifestations of physiological stress responses as a result of living and working conditions, inter-personal conflict, as well as the sense of control of one’s environment and optimism/pessimism toward the future. "Allostatic load" refers to the cost of adaptation to a stressful environment, which elicits repeated and sometimes prolonged adaptive responses ("allostasis") that preserve homeostasis in the short run but can cause wear- and-tear on the body and brain. Functional symptoms and syndromes, decreased cognitive function during aging, abdominal obesity, increased risk for hypertension and cardiovascular disease, insulin-dependent diabetes and decreased immune responses are all manifestations of allostatic load.

We have powerful ways of modulating the harmful output of the stress response systems that include belief systems and behaviors. An important quote attributed to Dr. McEwen is, "We must also remember that the biggest problems for the human race in the future are those associated with our own behavior and misbehavior and the impact of the social and physical environment on our bodies and brains."

 


 

BMI Calculator

This is supplemental information for this topic marked by the little computer icon in the book, Irritable Bowel Syndrome and the MindBodySpirit Connection, by William B. Salt II, M.D. and Neil F Neimark, M.D. (Columbus: Parkview Publishing, 2002). Click here to learn more about the book and/or to purchase it.

 


 

Boundaries

This is supplemental information for this topic marked by the little computer icon in the book, Irritable Bowel Syndrome and the MindBodySpirit Connection, by William B. Salt II, M.D. and Neil F Neimark, M.D. (Columbus: Parkview Publishing, 2002). Click here to learn more about the book and/or to purchase it.

Having clear boundaries is essential to a healthy, balanced lifestyle. A boundary is a personal property line that marks those things for which we are responsible. In other words, boundaries define who we are and our responsibilities.

Click here to learn more about the book, Boundaries: When to Say YES, When to Say NO to Take Control of Your Life, by Henry Cloud and John Townsend (Grand Rapids: Zondervan, 1992).

 


Centers of Excellence

This is supplemental information for this topic marked by the little computer icon in the book, Irritable Bowel Syndrome and the MindBodySpirit Connection, by William B. Salt II, M.D. and Neil F Neimark, M.D. (Columbus: Parkview Publishing, 2002). Click here to learn more about the book and/or to purchase it.

Some gastroenterologists have a special interest in functional gastrointestinal syndromes. We recommend that you contact the International Foundation for Functional Gastrointestinal Disorders to locate local centers of excellence and expertise.

International Foundation for Functional Gastrointestinal Disorders (IFFGD)
Nancy Norton, President and Founder

IFFGD, PO Box 17864, Milwaukee, WI 53217
(888) 964-2001
(414) 964-1799

Click here to visit the website of the IFFGD.

Centers of Excellence in functional gastrointestinal disorders and syndromes include:

A multidisciplinary program dedicated to the practice, teaching and science of mind, brain and body interactions and women's health.

 


 

Chronic Pain Program

This is supplemental information for this topic marked by the little computer icon in the book, Irritable Bowel Syndrome and the MindBodySpirit Connection, by William B. Salt II, M.D. and Neil F Neimark, M.D. (Columbus: Parkview Publishing, 2002). Click here to learn more about the book and/or to purchase it.

 


 

Cognitive Behavioral Therapy

This is supplemental information for this topic marked by the little computer icon in the book, Irritable Bowel Syndrome and the MindBodySpirit Connection, by William B. Salt II, M.D. and Neil F Neimark, M.D. (Columbus: Parkview Publishing, 2002). Click here to learn more about the book and/or to purchase it.

 

Remember that cognitive behavioral therapy teaches that:

  1. Many of the moods you feel are based on your thoughts about situations, rather than the situation itself.
  2. When you feel stressed-out, anxious or depressed, your thoughts are often irrational, negative or based on distorted perceptions.

Cognitive therapy helps you to identify your distorted thoughts and perceptions, and in so doing, helps you to actively change the way you feel about potentially hurtful or unhealthy situations in life. Let’s take a look at how it works in a very common situation.

Imagine someone says something mean or unkind to you and you feel hurt and angry in return. Before you react in kind to them, you may want to question your thoughts about the situation. Initially, like most everyone, you would tend to think that this person is criticizing who you are and diminishing who you are. Your ego is hurt, causing you to feel angry in return. So, in summary: your thought that this person’s actions to you means you are in someway being demeaned or humiliated causes you to feel angry and hurt. This feeling then predisposes you to react angrily back, fighting them with words or actions.

But let’s look at another possibility, another thought. Perhaps their unkind words or actions are really much more a reflection of who they are, rather than who you are. With this thought in mind, you can, through practice and growth, come to see what others do and say to you as a learning opportunity rather than an opportunity for self-flagellation or reactive anger. By changing your thoughts about the situation from "their anger is a reflection on me" to "their anger is a reflection on them," you begin to change the way you feel about situations that used to trigger automatic reactions in you.

Another possible thought is that "perhaps some of what they are saying is true and I can learn to become a better person by hearing them out rather than reacting." As we grow in our inner strength and self-esteem, we are better able to see and admit our own imperfections. In so doing, situations that used to cause us anger or shame, now lead us to growth and healthy self-examination. All the spiritual masters teach us the importance of self-examination and character development. If something someone says is true, then take it to heart and learn from it. If it is not true, then choose to see their anger more as a reflection of their own insecurities, fears and inappropriateness.

There is a wonderful saying: "Many birds will fly over your head, you don’t have to give them all a nest there." Part of getting well physically, emotionally and spiritually involves not letting "everything" and "everyone" get to you. You must learn, through cognitive processes, reasoning and discernment to choose those attitudes and beliefs that most empower you to become a more loving, compassionate and healthy person. Your peace of mind, body and spirit depend upon it. In the final analysis, peace is available to us at any moment when we learn to see things differently. Cognitive behavioral therapy is one of many means that helps us to see more clearly through the fog of our cognitive distortions.

Here are several resources for cognitive behavioral therapy:

 


 

Complementary & Alternative Medical Treatments for IBS

This is supplemental information for this topic marked by the little computer icon in the book, Irritable Bowel Syndrome and the MindBodySpirit Connection, by William B. Salt II, M.D. and Neil F Neimark, M.D. (Columbus: Parkview Publishing, 2002). Click here to learn more about the book and/or to purchase it.

 

A discussion of IBS, including treatment with herbs and natural therapies, is available on the Internet in the Patient Resource Center at UpToDate's home page (http://www.uptodate.com/) where it will be updated as needed every four months. Click here to review patient treatment information on IBS.