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IBS is not "all in the mind"

Discussion in 'Latest ME/CFS Research' started by cigana, Jan 13, 2011.

  1. Snow Leopard

    Snow Leopard Senior Member

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    The above study states "None of The endocrine measures were associated with experiencing a chronic stressor (see Table 3)". Despite this, they go on to trust their subjective measures of "chronic stressors".

    Btw, the participants replied to newspaper ads stating payment for participation. (And they were paid $800). 40% developed "colds". Does this bias the findings?

    They also note that the association was reduced when health variables (such as smoking) were subtracted from the results.
  2. Angela Kennedy

    Angela Kennedy *****

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    Good points. The issue of 'colds' is also a problem. Symptoms of inflammation/infection in response to being inoculated with a cold usually means the immune system is working! No symptoms is a bit odd, scientifically speaking.

    But then also- how is a 'cold' defined? Many symptoms of 'cold' are experienced without 'cold' infection as such (Sneezes and coughs, for example). Where does 'cold' become 'flu' is another problem. Both colds and flu are experienced subjectively and can be reported thus... These are all potential confounders not discussed in the 'stress causes colds' literature.
  3. Hip

    Hip Senior Member

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    I have just started a thread entitled: Irritable bowel syndrome (IBS) caused by Blastocystis hominis parasite?, which details the connection between Blastocystis hominis infection in the gut and IBS symptoms.

    Looks like Blastocystis hominis might possibly be proven as a cause of IBS.

    It may be a good idea for anyone with IBS to investigate whether Blastocystis is the cause in their case. There is the real possibly of a cure for IBS here.
  4. IamME

    IamME Too sick for an identity

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  5. Marco

    Marco Old blackguard

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    I spotted this quote on the Healingwell Forum.com discussion on this very study



    "Dr Drossman's comments on foods for IBS Health.


    Pity certain 'authorities' on ME/CFS can't get their heads around this simple concept.
  6. Sallysblooms

    Sallysblooms P.O.T.S. now SO MUCH BETTER!

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    For years I suffered with bad IBS pain. I wish just one doctor had told me to simply take peppermint pills. I rarely get IBS now. That is what worked for me. Sometimes help can be so simple.
  7. drex13

    drex13 Senior Member

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    I have IBS, it sucks. A few questions come to mind with this research. First, what is causing the inflammation ? Second, the article references an anti-histamine that was used as treatment. What was the drug they used ?
  8. biophile

    biophile Places I'd rather be.

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    Megapost alert

    Me either, but it should be approached with care. There is a mountain of "evidence" for psychological comorbidities and factors in various diseases (including various forms of heart disease) but it is often conflicted and it is an overwhelming task to analyse it all to decide which associations are not due to methodological artifacts or whether they are clinically meaningful vs merely an abstract statistical curiosity. Obviously well-conducted systematic reviews are preferable and make it easier, but still, these too are subject to bias.

    We also have the same problem with CFS and "stressors", no evidence for significant changes in endocrine measures prior to and during CFS onset, with limited prospective evidence that it does not occur.

    Yes, like the supposed association between personality and chronic pain, treating the pain can reverse the "personality traits" that were allegedly causing or contributing to the pain. Even longitudinal epidemiological studies can be confounded by shared factors (biological and environmental) in measured personality traits and illness/disease, rather than the former simply contributing to the latter via internal psychobiological mechanisms and external behavioural/lifestyle factors.

    I think pre-clinical manifestations of some organic diseases may include subtle changes which are detected by psychometrics, not because the psychological domain is contributing but as an epiphenomenon which is misinterpreted. AFAIK there is some evidence for this in many neurological diseases and I'm willing to bet it may also occur for other categories of disease. The human body is immensely complex with many interrelated systems and I don't see why the mind-brain would be uniquely independent and separate.

    There are also possibilities such as the (organic) "fetal origins of stress-related adult disease" and the effects of persistent organic pollutants on cortisol production, which seems important when considering many pregnant women may be "awash" in such chemicals.

    CBT for patients with medical disease is also applied to comorbid psychiatric diagnoses, whether that counts as "coping with illness" or specifically targeting a separate illness probably depends on the individual patient.

    Assuming the small positive response reported for CBT by some CFS patients is not due to being brainwashed into reporting less symptoms, the "coping with illness" part is a more likely explanation than "mind over body" and "abnormal illness beliefs" rationale because CBT does not seem to change the supposed factors in this rationale ie activity levels and belief in physical causes. Even if "psychological stress" contributes to a condition, it doesn't automatically follow that the mind can reverse it.

    IamME made some excellent points about the inappropriate generalisation of (psychosomatic) causes of heart disease and how its carried over to CFS, how CBT is pushed onto ME/CFS patients with weak arguments that CBT is generally applicable to other diseases when in reality it is either not the same CBT or it is limited to a minority of cases with an obvious maladaptation to their disease rather than applied to all patients, and how hard earned knowledge gained from patient experience is patronisingly dismissed.

    I tend to think there are some genuine specific links but I am finding more and more how problematic the science is. The "in general" part can also be an issue, because it leads to generalisations where "everyone knows" stress causes and exacerbates diseases "in general", without much thought to evidence and specific situations. Sort of like how "everyone knows" CFS is "caused by stress" regardless of the evidence.

    Interesting points, Dolphin. The same issue may apply to reporting of CFS symptoms? In this IBS study there were no healthy controls or [childhood abuse/neglect but no adult IBS] controls, neither did they control for age! Childhood abuse/neglect could induce "disturbed sleep, somatic symptoms, and psychological distress" irrespective of the presence of IBS. The symptoms described in the abstract are non-specific, for example "among GI symptoms, only heartburn and nausea were significantly higher in women with abuse/neglect".

    IamME made a similar point: "(Sleep only makes a big difference on "disability" [as opposed to how crap you feel] if the disability is mainly chronic fatigue - or a sleep disorder. It's difficult to see how mood, depression or sleep can somehow maintain the actual illness rather than making what's already there more subjectively miserable.)" I mostly agree but I don't rule out the possibility that chronic mood and chronic sleep deprivation can have (relatively minor) catalytic contributions to pre-existing organic disease processes.

    Also, is it not widely accepted that too much exertion and adrenaline on a repetitive basis can worsen organic ME for a long time and even permanently? Assuming the ME/CFS communities have a similar rate of "anxiety disorders" as the generation population (ie not elevated but also not immune), I don't think it is absolutely impossible for psychological factors to influence the course of the disease. On the other hand, defining "anxiety disorder" is problematic and so is the blanket application of "possibilities" onto the whole patient population without the appropriate evidence. AFAIK there is no convincing evidence that ME/CFS involves elevated rates of "anxiety disorder" or that psychological factors reliably predict outcome.

    Yes, same problem would exist for research on PVFS too ie laboratory confirmed infection vs vague "GP-diagnosed illness".

    I am uncomfortable with how 1 of the 2 main definitions of "psychosomatic" in many dictionaries (mental factors causing or contributing to physical symptoms) lumps in "causing" and "contributing" as if these are the same. Is an illness/disease still technically "psycho>somatic" if otherwise-organic mechanisms are causing the abnormally elevated "connection" between the mind and the body that doesn't affect healthy people? I don't think so.
  9. oceanblue

    oceanblue Senior Member

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    oceanblue says: I have no problem with some role for psychological factors in illness.

    Good post, Biophile. I've been following this thread as well as doing some research online and clearly I have been too willing to accept prevailing wisdom and second-hand reports of research on the links between heart disease and psychological factors. The evidence is inconclusive not clearcut.

    One piece of research I'd been thinking of was the mega 'Whitehall' study following thousands of British civil servants over many years. This was reported as showing a link between stress and CHD (Coronary Heart Disease) but it seems that the link only held good for subjective reports of illness eg angina, not objective evidence e.g. change in cardiac enzymes and heart failure - as discussed in the wonderfully titled Pyjamas in Bananas blog. A research paper suggests a similar problem in another big study linking stress with CHD.

    The British Heart Foundation says 'Stress is not a direct risk factor for cardiovascular disease', and I'll take their word for it.

    Of course, if something like heart disease doesn't have the claimed link to psychological factors it makes you wonder which, if any organic-based illnesses really do. So I see what Angela Kennedy means when she said this discussion is not off topic.
  10. Dolphin

    Dolphin Senior Member

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    Exactly

    Good point. This reminds me of when there was a case of somebody who had been diagnosed with hysteria. It turned out the person had a serious neurological disorder (I think it was variantCJD). Sharpe, Stone* and others made up some dodgy argument that she could still have had both.

    * think he was involved. There were some "usual suspects" with Sharpe.
  11. WillowJ

    WillowJ Senior Member

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    thanks so much for the excellent discussion. I hadn't had the cognitive function to do any better than "stress isn't scientific", so I couldn't contribute, but I've enjoyed following
  12. biophile

    biophile Places I'd rather be.

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    Even the reported associations don't justify the hyped psychobabble

    Thanks for the links. Hope the thread hasn't gone too cold, I had to step back for a while after too much posting. I found some similar studies and have also seen a similar problem for "neuroticism" and "depression" (the latter may also confound measurement of the former) regarding subjective vs objective measures in heart disease.

    Summarising from research on psychosocial factors in heart disease I have seen, some systematic reviews do find an association but it is small. Others conclude there is little evidence or no clinically meaningful association. One finds a higher association for "Type D (distressed) personality" as prognosis of current disease. Other research (not sure how it fits into the other meta-analyses) suggests depression and PTSD increase mortality rates from heart attack, while SSRI medication does not reduce the mortality risk that depression imposes on heart disease and actually increases it slightly. At least some of the risk that psychosocial variables pose may be mediated by behavioural changes such as smoking and physical inactivity. A large twin study finds a modest bidirectional relationship between major depresssion and coronary artery disease, but CAD was a significantly higher risk for subsequent MD than MD was for subsequent CAD, especially for myocardial infarction.

    As for "colds", I found two systematic reviews on psychosocial variables and upper respiratory infection which included prospective studies, Falagas et al 2010 and Pedersen et al 2010. Taking these at face value, there does appear to be a link but an effect size of 0.21 for psychological stress is small.

    My critique style of "stress and disease" so far has mostly been limited to arguing that relatively weak associations don't justify the hyped psychobabble and have also been reported in dozens of diseases that are not usually thought of as "stress-related illnesses". It will take a long time to look into deeper into this sort of research to determine whether even this approach has been unsafe due to methodological artifacts, the whole field may be in question.
  13. oceanblue

    oceanblue Senior Member

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    Wow, that's a lot of digging and throws more light on the situation. Thanks. As you say, even if the reported associations are correct they are relatively unimportant - and from what you've reported there is clearly stll some doubt as to whether or not the associations are correct.
  14. Angela Kennedy

    Angela Kennedy *****

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    Thanks for this biophile.

    i can't access the papers unfortunately.

    Does the 0.21 refer to relative risk? And if so, are they talking 0.21 relative risk overall of ANY 'psychological' variable included together as a category? The reason I say that is because they seem to be saying in the abstract that there were correlations with only some variables?

    Or am I reading that wrong? I've not had me breakfast yet ; )
  15. Esther12

    Esther12 Senior Member

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    I think agree with biophile's understanding here (edit - nope, biophile was saying something totally different, I'm going my own route here). It seems like there is growing evidence of stress/trauma/etc having a damaging impact upon all manner of different aspects of health. There was this very general news report on the BBC a little while back mentioning arthritis, heart disease, etc: http://www.bbc.co.uk/news/health-10965862

    That doesn't remotely serve to justify the notion that CFS patients deserve to be singled out and placed under the psychosocial 'care' of the sort of people we currently have working at many of the NHS CFS centers.
  16. Angela Kennedy

    Angela Kennedy *****

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    I don't think that biophile is arguing what you've said here, Esther. Contrary to the idea of 'growing evidence' of 'stress' impacting all maaner of health aspects, what I think biophile is arguing (and this is certainly what I myself argue) is that any 'evidence' used to support claims of 'stress' causing or perpetuating illnesses is highly unsafe, because of various methodological errors in the research, and theoretical errors around how to define 'stress'. The case for 'stress' causing or perpetuating all sorts of illness or health problems has been grossly overstated at best.
  17. Esther12

    Esther12 Senior Member

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    Sorry... I'm struggling to follow all the interesting threads on this forum, and seem to keep getting different strands of people's arguments confused (especially when I've been reading a thread over a number of days).

    I agree that measuring 'stress' etc is difficult, and this this sort of research could easily be distorted by the presumptions of those involved or the various other biases which can distort medical papers... but I don't think that means we should assume all the research linking stress/etc to health problems is likely to be wrong. Our brains are mighty resource hogs, and it's difficult to assume that prolonged and extreme psychological strain would have no impact upon the rest of our bodies, especially given the role our brains play in regulating so many of our our bodily functions.

    Saying all that, I've never found stress to have any short-term impact upon my own fatigue levels (unless it coincides with needing to increase activity levels).
  18. Angela Kennedy

    Angela Kennedy *****

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    Well - there might be evidence of specific 'stress' responses related to adrenalin, homeostasis etc. The fundamental problems are, firstly, trying to separate which stresses (think of all the thousands, millions of physical 'stresses'- both positive and negative- into 'physical' (illness itself and sexual excitement and pleasure both cause 'stress' responses, in that the HPA axis has to make physiological adjustments to maintain a homeostasis) and millions of 'psychosocial' events (both negative and positive).

    Then you have to show exactly how a specific event (or series of events deemed 'stressful' by subjective self reports by people who have a tendency to adopt stress explanations for health problems: a historical example was the attribution of Down's syndrome to 'a shock in pregnancy' before Trisonomy 21 was discovered) has specific, suitably significant (let's say high Relative Risks) associations with a physiological condition like arthritis, cancer, the different heart diseases etc. etc.

    I've simplified this- but the actual subject is a hell of a lot more complex than that. Indeed, these problems around establishing 'stressful' precipitators of disease alone have been critiqued (though you wouldn't know it to read, say, the BBC, let alone the journal articles where these critiques are totally ignored). Proponents of psychogenic explanations for a wide range of somatic (that is, bodily) illnesses have therefore resorted to blaming patient's responses to 'stress' for somatic illness, and this is where claims of personality traits, negative attitudes, neuroticism, or personality disorders, come in.

    With these, you have to consider the problem of direction of causation (chicken or egg came first?), not to mention psychologist's fallacies in deeming negative appraisals of predicaments 'maladaptive' or 'irrational'.

    Also- there's the problem with conflating 'mind' with 'brain'. They are different things. 'Mind' is actually a metaphysical concept, usually denoting the act of 'thinking'. Trying to locate a 'mind' or a Freudian 'unconscious mind' is pretty much like locating a 'soul' (I know, I've simplified things. Daniel Dennett and Kant are probably cursing me for my gaucheness. But try and substitute 'mind' for 'brain' in everyday language - or vice versa).

    In the circumstances ,the vast amount of claims around 'stress' causing somatic illness are grossly overstated. They tend to be 'black-boxed' to hide lack of specific knowledge, and therefore often become almost appeals to ignorance. That these over-stated assumptions have such damaging effects on patients (psychogenic dismissal, construction as deviant and maladaptive) is why we can't allow 'them' the luxury of assuming one day they MIGHT be right, without our making objection to the fact they are currently mistaken in their assumptions.
  19. WillowJ

    WillowJ Senior Member

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    another thing that was pointed out by biophile is that the amount of risk attributed to stress seems to be small.

    in a complex system such as real life, we can't control all the variables. It isn't always the variable we thought we were testing in the experiment, that produced the effect.

    especially when the result is small, we should be careful about drawing conclusions. but that's not what has been done with the stress idea. stress is a well-accepted idea which is thought to be a major contributor (or even the main factor) in a number of diseases, but we really don't have compelling evidence for that.
  20. Esther12

    Esther12 Senior Member

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    Sure. Just because I've only written brief posts, I really don't want to give the impression that I think this is an easy topic to understand.

    I think I'm on Dennet's side with the mind/brain stuff ("We have a soul, it's just made up of lots of little robots"), but I also agree with a lot of your final paragraph. I just don't think the valid criticisms you've made of the stress/health stuff is enough to add up to a debunking. It could be I'm getting caught up in my own cognitive biases here, and allowing my own beliefs to be guided by a tidal wave of poor papers (they can't all be wrong!) or my own misguided memories of people seeming to suffer health problems following a period of emotional hardship (I certainly think our minds could create an impression of these sorts of links even if they were not truly present) but to me it seems really plausible that something which placed significant additional strain upon your brain could also lead to other health problems too... and a number of studies purport to support this association for a wide range of health problems.

    I should really go away and look more closely at those studies, and try to find the one I find most convincing so as to give you a chance to pick it apart. I am feeling a bit lazy with 'serious' googling at the moment though, so I might have to bow out instead. (My PC's been dodgy recently, and I'm using that as an excuse for not doing anything to educate myself about the world... it's excellent!) It is a bit rude to fail to back oneself up in a discussion though - sorry. Forgive me!

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