Dr. Elisabeth Schartner: Looking for clues in irritable bowel syndrome

They’re up Irritable bowel syndrome-Patients specialized; Who exactly comes to your practice?

DR. ELISABETH SCHARTNER: More women than men, but increasingly the latter too. I recently had an abdominal hypnosis group for the first time that had more male participants. Patients have often already had three or four colonoscopies and come with thick folders full of findings. It always says they have nothing. But they’re just not doing well.

What exactly are they suffering from?

They usually complain of diarrhea, constipation, flatulence, nausea and vomiting, heartburn, abdominal pain or difficulty emptying.

So so-called functional gastrointestinal complaints?

Exactly. This means that conventional examinations, which you should definitely do first, cannot find a cause because organically everything is okay. It is estimated that 40 percent of the world’s population suffers from such disorders.

Is it misleading to think that it has become almost socially acceptable to talk about digestion?

Intestinal cleansing and the microbiome are totally in vogue. But most people don’t like to talk about what happens in the toilet. Often, not even your partner knows that you constantly have diarrhea. Especially for couples who haven’t been together that long.

And then you overcome yourself, go to the doctor and hear: “You have nothing.”

Which makes many people feel like hypochondriacs – and then start looking for the trigger themselves. A supposedly unfavorable composition of intestinal bacteria or certain foods are often identified as the problem – and there are quite a few people who slip into an eating disorder in this way. I once had a patient who only ate three foods: potatoes, rice and white meat.

Gluten is also suspected quite often.

The relatively rare celiac disease, a genetic autoimmune disease that leads to lifelong hypersensitivity to gluten, can be clearly detected during a gastroscopy. In addition, there is a small number of people who are gluten sensitive. This means you don’t have celiac disease, but you do appear to react to foods containing gluten. If you want to test this, you could ask a trusted person to put together a basket of bread mixed with and without gluten and then compare when digestive problems arise.

Does that mean you trick your mind a bit?

If the focus has been on the stomach for years, it’s difficult not to associate symptoms with certain foods. If it is indeed a single food that triggers the symptoms, then I would suspect it to be primarily in the FODMAP group (see below).

So people with functional digestive disorders also listen to themselves too much?

It has actually been proven that irritable bowel syndrome patients feel stretches in the gastrointestinal tract more strongly – stimuli that other people process more unconsciously. On the one hand, this has to do with the digestive tract itself, but on the other hand it also has to do with processing in the brain. Negative emotions cause this to release messenger substances that make us perceive everything much more clearly.

That means: intestinal problems and negative experiences are closely related?

Certainly not all people with irritable bowel syndrome have suffered trauma. But: We experience everything that happens to us in life as our entire body. The brain, as a higher-level organ, stores the accumulated experiences – the feeling plus heart rate, breathing, digestion – in neural networks. Through certain stimuli, what has been stored is then recalled as a complete image.

Do you have an example?

I was sitting in front of a plate of pastasciutta when my parents told me that my best friend had died. For the next ten years, the smell of ground meat made me sick.

Is this the gut-brain axis?

The two are strongly connected – and 80 percent of information comes from the bottom up.

The famous gut feeling.

Exactly. Our bodies are always more efficient and faster than our minds. If we intuitively know what is right or wrong, then it is primarily our body that tells us. We suddenly get goosebumps – and only later do we cognitively understand that the other person may have reminded us of someone with whom we had bad experiences. Or we feel sick at the thought of sausages because we recently upset our stomachs.

The latter in particular makes a lot of sense.

That’s exactly what I’m trying to say: the body is very smart. And it’s not smart in the long run to simply wipe away your marks.

So what should irritable bowel syndrome patients do?

First of all: It is very important to have a trusting relationship with a doctor in order to carry out appropriate examinations and discuss them. Being heard works small miracles. There are also some very effective medications available for functional digestive problems. There is also general nutritional advice: for example, eat slowly and carefully, not too much, not too rarely, and steaming and boiling rather than frying and deep-frying. In addition, those affected should live as healthily as possible, maintain a balance between stress and relaxation and make time for things that are good.

And if your stomach still rumbles?

Anything that helps to interrupt automatic processes is good. For example, you can try using mindfulness or gratitude exercises to shift your focus to something else. Also interesting to try: Let’s see what happens when you change your posture or your breathing.

What role does breathing play?

When we are stressed, we only breathe into our chest. Try to get back to diaphragmatic breathing, in which the chest remains completely still and the stomach bulges outwards as you inhale. This immediately relieves the load on the entire system. Also make sure that exhaling takes longer than inhaling – this often leads to noticeable relaxation very quickly.

You also recommend abdominal hypnosis, which you also offer yourself. What is that?

I guide the participants to put themselves into a trance. The conscious mind is somewhat shut down; However, those areas of the brain that deal with memories, emotions and involuntary body processes are more active. Then I weave in suggestions and metaphors that specifically relate to the intestines.

For example?

A flow that finds its way, with the right pace and the right intensity. Or we work with laying on of hands, where the patients imagine how the heat and pressure relax the entire digestive tract. If you practice this for a few weeks, this conditioning will eventually work in everyday life.

This diet can help

The FODMAP diet

FODMAP is the abbreviation for “fermentable oligo-, di-, monosaccharides and polyols”, i.e. fermentable multiple, disaccharides, simple sugars and polyhydric alcohols. These carbohydrates and sugar alcohols, which are found in many foods, are poorly absorbed in the small intestine and are therefore fermented by bacteria in the large intestine. This can lead to digestive problems in sensitive people. In the so-called FODMAP diet, foods rich in FODMAPs (e.g. wheat, many legumes, dairy products, onions, apples, meat) are completely omitted for a while so that the digestive system can calm down. After six to eight weeks, however, you should gradually return to normal eating habits with a varied diet. This is best done with the support of a nutritionist.

Tip: A module on the low-FODMAP diet also contains the “CaraCare” app, which can be prescribed with a prescription so that the health insurance company covers the costs. The app also offers hypnosis units. But be careful: DIY hypnosis programs like these are not suitable for people with trauma!

Dr. Elisabeth Schartner is a specialist in internal medicine, hypnosis and psychosomatics. Her book is called “This is how digestion works” (192 pages, 19.90 euros, Springer).

Bridget