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Tag: abdominal pain

  • Bariatric Surgery: Risks in the OR and Beyond | NutritionFacts.org

    The extent of risk from bariatric weight-loss surgery may depend on the skill of the surgeon.

    After sleeve gastrectomy and Roux-en-Y gastric bypass, the third most common bariatric procedure is a revision to fix a previous bariatric procedure, as you can see below and at 0:16 in my video The Complications of Bariatric Weight-Loss Surgery.

    Up to 25% of bariatric patients have to go back into the operating room for problems caused by their first bariatric surgery. Reoperations are even riskier, with up to 10 times the mortality rate, and there is “no guarantee of success.” Complications include leaks, fistulas, ulcers, strictures, erosions, obstructions, and severe acid reflux.

    The extent of risk may depend on the skill of the surgeon. In a study published in The New England Journal of Medicine, bariatric surgeons voluntarily submitted videos of themselves performing surgery to a panel of their peers for evaluation. Technical proficiency varied widely and was related to the rates of complications, hospital readmissions, reoperations, and death. Patients operated on by less competent surgeons suffered nearly three times the complications and five times the rate of death.

    “As with musicians or athletes, some surgeons may simply be more talented than others”—but practice may help make them perfect. Gastric bypass is such a complicated procedure that the learning curve may require 500 cases for a surgeon to master the procedure. Risk for complications appears to plateau after about 500 cases, with the lowest risk found among surgeons who had performed more than 600 bypasses. The odds of not making it out alive may be double under the knife of those who had performed less than 75 compared to more than 450, as seen below and at 1:47 in my video.

    So, if you do choose to undergo the operation, I’d recommend asking your surgeon how many procedures they’ve done, as well as choosing an accredited bariatric “Center of Excellence,” where surgical mortality appears to be two to three times lower than non-accredited institutions.

    It’s not always the surgeon’s fault, though. In a report entitled “The Dangers of Broccoli,” a surgeon described a case in which a woman went to an all-you-can-eat buffet three months after a gastric bypass operation. She chose really healthy foods—good for her!—but evidently forgot to chew. Her staples ruptured, and she ended up in the emergency room, then the operating room. They opened her up and found “full chunks of broccoli, whole lima beans, and other green leafy vegetables” inside her abdominal cavity. A cautionary tale to be sure, but perhaps one that’s less about chewing food better after surgery than about chewing better foods before surgery—to keep all your internal organs intact in the first place.

    Even if the surgical procedure goes perfectly, lifelong nutritional replacement and monitoring are required to avoid vitamin and mineral deficits. We’re talking about more than anemia, osteoporosis, or hair loss. Such deficits can cause full-blown cases of life-threatening deficiencies, such as beriberi, pellagra, kwashiorkor, and nerve damage that can manifest as vision loss years or even decades after surgery in the case of copper deficiency. Tragically, in reported cases of severe deficiency of a B vitamin called thiamine, nearly one in three patients progressed to permanent brain damage before the condition was caught.

    The malabsorption of nutrients is intentional for procedures like gastric bypass. By cutting out segments of the intestines, you can successfully impair the absorption of calories—at the expense of impairing the absorption of necessary nutrition. Even people who just undergo restrictive procedures like stomach stapling can be at risk for life-threatening nutrient deficiencies because of persistent vomiting. Vomiting is reported by up to 60% of patients after bariatric surgery due to “inappropriate eating behaviors.” (In other words, trying to eat normally.) The vomiting helps with weight loss, similar to the way a drug for alcoholics called Antabuse can be used to make them so violently ill after a drink that they eventually learn their lesson.

    “Dumping syndrome” can work the same way. A large percentage of gastric bypass patients can suffer from abdominal pain, diarrhea, nausea, bloating, fatigue, or palpitations after eating calorie-rich foods, as they bypass your stomach and dump straight into your intestines. As surgeons describe it, this is a feature, not a bug: “Dumping syndrome is an expected and desired part of the behavior modification caused by gastric bypass surgery; it can deter patients from consuming energy-dense food.

    Doctor’s Note

    This is the second in a four-part series on bariatric surgery. If you missed the first one, see The Mortality Rate of Bariatric Weight-Loss Surgery.

    Up next: Bariatric Surgery vs. Diet to Reverse Diabetes and How Sustainable Is the Weight Loss After Bariatric Surgery?.

    My book How Not to Diet is focused exclusively on sustainable weight loss. Check it out from your local library, or pick it up from wherever you get your books. (All proceeds from my books are donated to charity.)

    Michael Greger M.D. FACLM

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  • Should We Fast for IBS? | NutritionFacts.org

    More than half of irritable bowel syndrome (IBS) sufferers appear to have a form of atypical food allergy.

    A chronic gastrointestinal disorder, irritable bowel syndrome affects about one in ten people. You may have heard about low-FODMAP diets, but they don’t appear to work any better than the standard advice to avoid things like coffee or spicy and fatty foods. In fact, you can hardly tell which is which, as shown below and at 0:27 in my video Friday Favorites: Fasting for Irritable Bowel Syndrome.

    Most IBS patients, however, do seem to react to specific foods, such as eggs, wheat, dairy, or soy sauce, but when they’re tested with skin prick tests for typical food allergies, they may come up negative. We want to know what happens inside their gut when they eat those things, though, not what happens on their skin. Enter confocal laser endomicroscopy.

    You can snake a microscope down the throat, into the gut, and watch in real-time as the gut wall becomes inflamed and leaky after foods are dripped in. Isn’t that fascinating? You can actually see cracks forming within minutes, as shown below and at 1:03 in my video. This had never been tested on a large group of IBS patients, though, until now.

    Using this new technology, researchers found that more than half of IBS sufferers have this kind of reaction to various foods—“an atypical food allergy” that flies under the radar of traditional allergy tests. As you can see below and at 1:28 in my video, when you exclude those foods from the diet, there is a significant alleviation of symptoms.

    However, outside a research setting, there’s no way to know which foods are the culprit without trying an exclusion diet, and there’s no greater exclusion diet than excluding everything. A 25-year-old woman had complained of abdominal pain, bloating, and diarrhea for a year, and drugs didn’t seem to help. But, after fasting for ten days, her symptoms improved considerably and appeared to stay that way at least 18 months later. It wasn’t just subjective improvement either. Biopsies were taken that showed the inflammation had gone down, her bowel irritability was measured directly, and expanding balloons and electrodes were inserted in her rectum to measure changes in her sensitivity to pressure and electrical stimulation. Fasting seemed to reboot her gut in a way, but just because it worked for her doesn’t mean it works for others. Case reports are most useful when they inspire researchers to put them to the test.

    “Despite research efforts to develop a cure for IBS, medical treatment for this condition is still unsatisfactory.” We can try to suppress the symptoms with drugs, but what do we do when even that doesn’t work? In a study of 84 IBS patients, 58 of whom failed basic treatment (consisting of pharmacotherapy and brief psychotherapy), 36 of the 58 who were still suffering underwent ten days of fasting, whereas the other 22 stuck with the basic treatment. The findings? Those in the fasting group experienced significant improvements in abdominal pain, bloating, diarrhea, loss of appetite, nausea, anxiety, and interference with life in general, which were significantly better than those of the control group. The researchers concluded that fasting therapy “could be useful for treating moderate to severe patients with IBS.”

    Unfortunately, patient allocation was neither blinded nor randomized in the study, so the comparison to the control group doesn’t mean much. They were also given vitamins B1 and C via IV, which seems typical of Japanese fasting trials, even though one would not expect vitamin-deficiency syndromes—beriberi or scurvy—to present within just ten days of fasting. The study participants were also isolated; might that make the psychotherapy work better? It’s hard to tease out just the fasting effects.

    Psychotherapy alone can provide lasting benefits. Researchers randomized 101 outpatients with irritable bowel syndrome to medical treatment or medical treatment with three months of psychotherapy. After three months, the psychotherapy group did better, and the difference was even more pronounced a year later, a year after the psychotherapy ended. Better at three months, and even better at 15 months, as you can see here and at 3:58 in my video.

    Psychological approaches appear to work about as well as antidepressant drugs for IBS, but the placebo response for IBS is on the order of 40%, whether psychological interventions, drugs, or alternative medicine approaches. So, doing essentially nothing—taking a sugar pill—improves symptoms 40% of the time. In that case, I figure one might as well choose a therapy that’s cheap, safe, simple, and free of side effects, which extended fasting is most certainly not. But, if all else fails, it may be worth exploring fasting under close physician supervision.

    All my fasting videos are available in a digital download here.

    Check the videos on the topic that are already on the site here. 

    For more on IBS, see related posts below. 

    Michael Greger M.D. FACLM

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  • Fiber or Low FODMAP for SIBO?  | NutritionFacts.org

    It may not be the number of bacteria growing in our small intestine, but the type of bacteria, which can be corrected with diet.

    When researchers tested more than a thousand patients suffering for longer than six months from symptoms typical with irritable bowel syndrome (IBS), such as excess gas, bloating, diarrhea, and abdominal pain, but who do not appear to have anything more serious going on, like inflammatory bowel disease, a significant percentage were found to be suffering from lactose intolerance—intolerance to the milk sugar lactose. In infancy, we have an enzyme called lactase in our small intestine that digests milk sugar, but, understandably, most of us lose it after weaning. “Although genetic mutation has led to persistence of lactase in adults, about 75% of the world’s population malabsorbs lactose after age 30” and have lactose intolerance. However, a third of the patients were diagnosed with small intestinal bacterial overgrowth (SIBO).

    “The evidence for SIBO and IBS is shrouded in controversy, predominantly because of the fact that the [breath] tests used in clinical practice to diagnose SIBO are not valid,” as I’ve explored before. As well, the implications of having more versus fewer bacteria growing in the small intestine are unclear since the number doesn’t seem to correlate with the symptoms. It turns out it isn’t the number of bugs growing in the small intestine, but the type of bugs. So, it’s “small intestinal microbial dysbiosis”—not overgrowth in general, but the wrong kind of growth—that appears to underlie symptoms associated with functional gastrointestinal disorders, like IBS.

    How can we prevent this from happening? The symptoms appear to be correlated with a significant drop in the number of Prevotella. Remember them? Prevotella are healthy fiber feeders, “suggestive of a higher fiber intake in healthy individuals,” while the bugs found more in symptomatic patients ate sugar, which “may reflect a higher dietary intake of simple sugars.” However, correlation doesn’t mean causation. To prove cause and effect, we have to put it to the test, which is exactly what researchers did.

    “Switching a group of healthy individuals who habitually ate a high­-fibre diet (>11g per 1,000 calories) to a low­-fibre diet (<10g per day) containing a high concentration of simple sugars for 7 days produced striking results. First, 80% developed de novo [new] gastrointestinal symptoms such as bloating and abdominal pain that resolved on resumption of their habitual high-fibre diet. Second, diet­-related changes in the small intestinal microbiome were predictive of symptoms (such as bloating and abdominal discomfort) and linked to an alteration in duodenal [intestinal] permeability.” In other words, they developed a leaky gut within seven days. And, while some went from SIBO positive to SIBO negative and others from SIBO negative to SIBO positive, it didn’t matter because the number of bacteria growing didn’t correlate with symptoms. It was the type of bacteria growing, as you can see below, and at 3:12 in my video Fiber vs. Low FODMAP for SIBO Symptoms.

    No wonder their guts got leaky. Levels of short-chain fatty acids plummeted. Those are the magical by-products our good gut bugs make from fiber, which “play an important role in epithelial [intestinal] barrier integrity,” meaning they keep our gut from getting leaky.

    So, while we don’t have sound data to suggest that something like a low FODMAP diet has any benefit for patients with SIBO symptoms, there have been more than a dozen randomized controlled trials that have put fiber to the test. Overall, researchers found there was a significant improvement in symptoms among those randomized to increase their fiber intake. That may help explain why “high-fiber, plant-based diets can prevent many diseases common in industrialized societies.” Such diets have this effect “on the composition and metabolic activity of the colonic microbiota.” Our good gut bugs take plant residues like fiber and produce “health-promoting and cancer-suppressing metabolites” like short-chain fatty acids, which have profound anti-inflammatory properties. “All the evidence points to a physiological need for ~50 g fiber per day, which is the amount contained in the traditional African diet and associated with the prevention of westernized diseases.” That is approximately twice the typical recommendation and three times more than what most people get on a daily basis. Perhaps it should be no surprise that we need so much. Even though we split from chimpanzees millions of years ago, “there is still broad congruency” in the composition of our respective microbiomes to this day. While they’re still eating their 98 to 99 percent plant-based diets to feed their friendly flora with fiber, we’ve largely removed fiber-rich foods from our food supply. 

    Michael Greger M.D. FACLM

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  • The Validity of SIBO Tests  | NutritionFacts.org

    Even if we could accurately diagnose small intestinal bacterial overgrowth (SIBO), if there is no difference in symptoms between those testing positive and those testing negative, what’s the point?

    Gastrointestinal symptoms like abdominal pain and bloating account for millions of doctor visits every year. One of the conditions that may be considered for such a “nonspecific presentation” of symptoms is SIBO, a concept that “has gained popularity on the internet in addition to certain clinical and research circles.” SIBO is “broadly defined as excessive bacteria in the small intestine” and typically treated with antibiotics, but “dispensing antibiotics to patients with the nonspecific, common symptoms associated with SIBO is not without risks,” such as the fostering of antibiotic resistance, the emergence of side effects, and the elimination of our good bacteria that could set us up for an invasion of bad bugs like C. diff—all for a condition that may not even be real.

    Even alternative medicine journals admit that SIBO is being overdiagnosed, creating “confusion and fear.” SIBO testing “is overused and overly relied upon. Diagnoses are often handed out quickly and without adequate substantiation. Patients can be indoctrinated into thinking SIBO is a chronic condition that can not be cleared and will require lifelong management. This is simply not true for most and is an example of the damage done by overzealousness.” “The ‘monster’ that we now perceive SIBO to be may be no more than a phantom.”

    The traditional method for a diagnosis was a small bowel aspiration, an invasive test where a long tube is snaked down the throat to take a sample and count the bugs down there, as you can see at 2:10 in my video Are Small Intestinal Bacterial Overgrowth (SIBO) Tests Valid?.

    This method has been almost entirely replaced with breath tests. Normally, a sugar called glucose is almost entirely absorbed in the small intestine, so it never makes it down to the colon. So, the presence of bacterial fermentation of that sugar suggests there are bacteria in the small intestine. Fermentation can be detected because the bacteria produce specific gases that get absorbed in our bloodstream before being exhaled from our lungs, which can then be detected with a breathalyzer-type machine.

    Previously, the sugar lactulose was used, but “lactulose breath tests do not reliably detect the overgrowth of bacteria,” so researchers switched to glucose. However, when glucose was finally put to the test, it didn’t work. The bacterial load in the small intestine was similar for those testing positive or negative, so that wasn’t a useful test either. It turns out that glucose can make it down to the colon after all.

    Researchers labeled the glucose dose with a tracer and found that nearly half of the positive results from glucose breath tests were false positives because individuals were just fermenting it down in their colon, where our bacteria are supposed to be. So, “patients who are incorrectly labeled with SIBO may be prescribed multiple courses of antibiotics” for a condition they don’t even have.

    Why do experts continue to recommend breath testing? Could it be because the “experts” were at a conference supported by a breath testing company, and most had personally received funds from SIBO testing or antibiotic companies?

    Even if we could properly diagnose SIBO, does it matter? For those with digestive symptoms, there is a massive range of positivity for SIBO from approximately 4 percent to 84 percent. Researchers “found there to be no difference in overall symptom scores between those testing positive against those testing negative for SIBO…” So, a positive test result could mean anything. Who cares if some people have bacteria growing in their small intestines if it doesn’t correlate with symptoms?

    Now, antibiotics can make people with irritable bowel-type symptoms who have been diagnosed with SIBO feel better. Does that prove SIBO was the cause? No, because antibiotics can make just as many people feel better who are negative for SIBO. Currently, the antibiotic rifaximin is most often used for SIBO, but it is “not currently FDA-approved for use in this indication, and its cost can be prohibitive.” (The FDA is the U.S. Food and Drug Administration.) In fact, no drug has been approved for SIBO in the United States or Europe, so even with good insurance, it may cost as much as $50 a day in out-of-pocket expenses, and the course is typically two weeks.

    What’s more, while antibiotics may help in the short term, they may make matters worse in the long term. Those “who are given a course of antibiotics are more than three times as likely to report more bowel symptoms 4 months later than controls.” So, what can we do for these kinds of symptoms? That’s exactly what I’m going to turn to next.

    Michael Greger M.D. FACLM

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  • Cannabis To Calm An Upset Tummy

    Cannabis To Calm An Upset Tummy

    It can throw you off and spoil a perfectly good day – can marijuana help calm an upset stomach?

    From nausea to a rumbling tummy, nothing can spoil the day more. And an upset stomach when you are out and about it the worst. There are are ton of things which can cause your stomach to be upset, so moving it to a better place can be a bit tricky. Over 40 million people in the US and Canada have tummy issues annually a cost of $120 billion. But you use cannabis to calm an upset tummy. The answer is yes, for a few things.

    RELATED: This Natural Cannabinoid Makes You Feel Happy

    One of  the first things it helps with is nausea. Medical marijuana is known to help with it  for millennia. Science has shown its effectiveness for treating chemotherapy-induced nausea, it can also be used if it is caused by other issues. It has a high rate of effectiveness, but concerns around high-risk populations, such as pregnant women and children is still being researched. Concentrates and flower usually produces better results than vapes or edibles.

    it is also starting being seen for reducing abdominal pain. It can be especially useful for individuals taking opioid medications for abdominal pain, as research shows cannabis helps patients cut down on or eliminate their need for opioids and provides a treatment with fewer side effects. In the right dosage, it can reduce chronic abdominal discomfort, bloating, gas, and constipation or diarrhea.

    More research is being done about Irritable bowel syndrome (IBS), but currently it may help relieve some of symptoms. Medical marijuana has the potential to help reduce the pain coming from cramps, bloating, and other pressures associated with IBS

    RELATED: Is GERD Helped By Cannabis

    There is anecdotal evidence microdosing can help with motion sickness, a relief for those on head our for car trips.

    Marijuana also tends to releases endorphins which make you feel happy, relaxed and high. They are hormones released when we feel pain or stress. This could help you manage the anxiety around an issue which might last a bit longer.  Allows talk to a health care professional is the issue lingers.

    Amy Hansen

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  • CBD Provides Symptom Relief and Improvement in Gastroparesis – Medical Marijuana Program Connection

    CBD Provides Symptom Relief and Improvement in Gastroparesis – Medical Marijuana Program Connection

    Pharmaceutical-grade cannabidiol (CBD) relieved symptoms in patients with idiopathic and diabetic gastroparesis and increased tolerance of liquid nutrient intake after 4 weeks of treatment in a phase 2 randomized double-blinded, placebo-controlled study recently published in Clinical Gastroenterology and Hepatology.

    There is “significant unmet medical need in gastroparesis,” and compared with cannabis, which has been used to relieve nausea and pain in patients with the condition, CBD has limited psychic effects with the added potential to reduce gut sensation and inflammation, wrote Ting Zheng, MD, and colleagues at Mayo Clinic in Rochester, Minn.

    The researchers assessed the symptoms of 44 patients (21 randomized to receive CBD and 23 to receive placebo) – each of whom had nonsurgical gastroparesis with documented delayed gastric emptying of solids (GES) by scintigraphy for at least 3 months – with the American Neurogastroenterology and Motility Society’s Gastroparesis Cardinal Symptom Index (GCSI) Daily Diary.

    They measured GES at baseline, and at 4 weeks, they measured GES again as well as fasting and postprandial gastric volumes and satiation using a validated Ensure drink test. (Patients ingested Ensure [Abbott Laboratories] at a rate of 30 mL/min and recorded their sensations every 5 minutes.) The two treatment arms were compared via 2-way analysis of covariance that included body mass index and, when applicable,…

    MMP News Author

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  • The Marijuana-Legalization Conundrum – Medical Marijuana Program Connection

    The Marijuana-Legalization Conundrum – Medical Marijuana Program Connection

    … for their views about marijuana legalization.
    Laurie laments the … lack of regulation for marijuana advertising. Despite the multiple … that clearly show that marijuana adversely affects the developing … of alcohol, what makes marijuana different?
    Russell has been …

    Original Author Link click here to read complete story..

    MMP News Author

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  • Beware the Ozempic Burp

    Beware the Ozempic Burp

    On the November morning when the sulfur burps began, Derron Borders was welcoming prospective students at the graduate school where he works in New York. Every few minutes, no matter how hard he tried to stop, another foul-smelling cloud escaped his mouth. “Burps that taste and smell like rotten eggs—I think that’s what I typed in Google,” he told me.

    Eventually, Borders learned that his diabetes medication was to blame. Sulfur burps appear to be a somewhat rare side effect of semaglutide, tirzepatide, and other drugs in their class, known as GLP-1 receptor agonists. Over the past several years, these medications have become more popular under the brand names Ozempic, Wegovy, and Mounjaro, as a diabetes treatment and a weight-loss drug. And as prescription numbers rise, a strange and unpleasant side effect has been growing more apparent too.

    GLP-1 receptor agonists are well known to cause gastrointestinal symptoms, including abdominal pain, diarrhea, and vomiting. In clinical trials of semaglutide for weight loss, 44 percent of participants experienced nausea and 31 percent had diarrhea. (The same conditions afflicted only about one-sixth of participants who received a placebo.) Burping, a.k.a. “eructation,” showed up in about 9 percent of those who got the drug, versus less than 1 percent of those who took a placebo. The FDA lists eructation as a possible side effect for semaglutide and tirzepatide alike.

    But I couldn’t find any information in the clinical-trial reports or FDA fact sheets about sulfur burps in particular, and neither Novo Nordisk nor Eli Lilly, the companies that make these drugs, responded to my inquiries. Laura Davisson, the director of medical weight management at West Virginia University Health Sciences, told me that more than 1,000 of her clinic’s patients are currently on a GLP-1 receptor agonist, and about one-fifth experience sulfur burps at first. For all but a handful of these patients, she said, the issue goes away after a few months. Holly Lofton, an obesity-medicine specialist at NYU, guesses that it affects just 2 percent of her patients.

    Experts aren’t sure why taking GLP-1 receptor agonists might lead to having smelly burps, but they have some theories. Davisson proposed that semaglutide boosts the number of bacteria in patients’ digestive tracts that produce hydrogen sulfide, a gas that can be expelled from either end of the digestive tract, and that smells (as Borders found) like rotten eggs. She also noted that the drugs slow down digestion, which could give the stomach more time to break down food and produce gas. In this situation, Lofton told me, the putrid air may escape most readily up through the mouth, because it’s lighter than the liquids and semi-solids that also fill the stomach. “Whatever’s on top will come up,” she said.

    Read: We’ve had a cheaper, more potent Ozempic alternative for decades

    Eating more than usual while on the medications seems to be a common trigger. Davisson said that certain foods, such as dairy, may also lead to more odorous emissions. “Sometimes it’s a matter of trial and error,” she said. “Some tips that we give people are things like: Don’t eat really heavy meals; don’t eat large portions at once; don’t eat right before bed.” In addition to these behavioral approaches, Craig Gluckman, a gastroenterologist at UCLA Health, told me he recommends antacids and anti-gas medications to patients with GLP-1-agonist-related sulfur burps. (Online, apple-cider vinegar is commonly recommended as a fix, but Gluckman said he would not recommend it.)

    The providers I spoke with said that, in general, patients tend to experience sulfur burps when they’re first starting an Ozempic-like drug, or raising their dose. That was the case for Crystal Garcia, an HR administrator in Texas who started taking semaglutide from a compounding pharmacy after her doctor told her she was prediabetic. (Garcia vlogs about her experience with weight-loss drugs.) Three months later, while out to breakfast at a restaurant, Garcia’s family started to complain about a gross and eggy smell. Garcia figured that the smell was coming from the food, but it lingered in the car after the meal. The family wondered whether Garcia’s young son had had an accident. “I was like, it could not be me. There’s no way,” she told me. But when she burped again, she was forced to change her mind.

    Many patients are unaware that sulfur burps are a possible side effect of their medication until they start, well, burping sulfur. For a while, Borders had no idea that his diabetes medicine might be the culprit; when he saw a physician’s assistant to discuss his issue, “Ozempic didn’t even come up,” he said. The side effect is relatively new to physicians. Earlier GLP-1 agonists didn’t seem to produce sulfur burps so frequently, Lofton said. In her practice, the phenomenon wasn’t really apparent until Ozempic hit the American market in 2018, and even then, she learned about it only from her patients. “I’d never heard of sulfur burps before I started prescribing this medicine,” she said.

    Read: Ozempic is about to be old news

    Though the sulfur burps are (physically) harmless, some patients do stop taking their diabetes or weight-loss drugs because of them, Lofton told me. But most, including Garcia and Borders, end up sticking with their program. As bad as the side effects may be, patients think the drugs’ benefits are worth it. “I have had a patient say that her burps smelled like poop,” Davisson said. But even then, she did not want to stop the medication.

    Rachel Gutman-Wei

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  • Can Gravity Make People Sick?

    Can Gravity Make People Sick?

    Bad things happen to a human body in zero gravity. Just look at what happens to astronauts who spend time in orbit: Bones disintegrate. Muscles weaken. So does immunity. “When you go up into space,” says Saïd Mekari, who studies exercise physiology at the University of Sherbrooke, in Canada, “it’s an accelerated model of aging.” Earthbound experiments mimicking weightlessness have revealed similar effects. In the 1970s, Russian scientists immersed volunteers in bathtubs covered in a large sheet of waterproof fabric, enabling them to float without being wet. In some of these studies, which lasted up to 56 days, subjects developed serious heart problems and struggled to control their posture and leg movements.

    Weightlessness hurts us because our bodies are fine-tuned to gravity as we experience it here on Earth. It tugs at us from birth to death, and still our intestines stay firmly coiled in their stack, blood flows upward, and our spine is capable of holding up our head. Unnatural contortions can throw things off: People have died from hanging upside down for too long. But as a general rule, the constant push of g-force on our body is a part of life that we rarely notice.

    Or at least, that’s what scientists have always thought. But there is another possibility: that gravity itself is making some people sick. A new, peer-reviewed theory suggests that the body’s relationship with gravity can go haywire, causing a disorder that has long been a troubling mystery: irritable bowel syndrome.

    This is a rogue idea that is far from widely accepted, though one that at least some experts say can’t be dismissed outright. IBS is a very common ailment, affecting up to an estimated 15 percent of people in the United States, and the symptoms can be brutal. People who have IBS experience abdominal pain and gas, feel bloated, and often have diarrhea, constipation, or both. But no exact cause of IBS has been pinned down. There’s evidence behind many competing theories, such as early-life stress, diet, and even gut infections, but none have emerged as the sole explanation. That is a problem for patients—it’s difficult to treat a condition when you don’t know what to target.

    Brennan Spiegel, a gastroenterologist at Cedars-Sinai Medical Center, in Los Angeles, has a different idea: People with IBS are hypersensitive to gravity as a result of any number of factors—stress, weight gain, a change in the gut microbiome, bad sleep patterns, or another behavior or injury. The idea came to him after watching a relative confined to a nursing-home bed develop classic symptoms of IBS. “We’re upright organisms,” he told me. “We’re not really supposed to be lying flat for that long.” The hypothesis, published late last year in The American Journal of Gastroenterology, is just that, a hypothesis. Spiegel hasn’t conducted any experiments or patient surveys that point to a “mismatch” in our body’s reaction to gravity as the cause of IBS, though the mechanics are all based in firm science. But part of what makes the theory so alluring is that it might encompass all of the other conventional explanations for the disease. “It’s meant to be a new way of thinking about old ideas,” he said.

    So exactly how would someone’s relationship with gravity get off-kilter? Consider serotonin, a chemical that carries messages from the brain to the body. Spiegel sees serotonin as an “anti-gravity substance” because of the role it plays in so many important bodily functions influenced by g-force, such as blood flow. Serotonin can cause blood vessels to narrow, slowing circulation. It can make certain muscles contract or relax. It’s also crucial to digestion, helping with bowel function, getting rid of irritating foods, and regulating how much we eat. Without serotonin, gravity would turn our intestines into a “flaccid sac,” Spiegel writes. Because 95 percent of the body’s serotonin is produced in the gut, if levels spike or plummet from factors such as stress, then the chemical’s possible handling of gravity would be thrown into chaos, affecting digestion. The result, he theorizes, is IBS.

    Other parts of our body that respond to gravity can also be in on the problem. We are hardwired to react negatively to situations in which the pull of gravity might harm us; walk to the edge of a cliff and your body will tell you something. The amygdala in our brain is key to fear responses, and stress of various kinds can cause it to go into overdrive. Spiegel thinks that when stress taxes the amygdala, a person begins overreacting to potential threats, including from gravity. The digestive issues that make up IBS are a manifestation of that overreaction. Sure enough, people with IBS have been shown to have a hyperactive amygdala.

    That is hardly anything close to proof. The thought that this painful and prolonged condition could be a gravity disorder is a major stretch, relying on a renegade interpretation of basic biology. “People just think I’m crazy,” Spiegel said. Many of his fellow doctors are not sold on the idea. The gravity hypothesis is another in a long parade of unconvincing theories about IBS, Emeran Mayer, a gastroenterologist at UCLA, told me. He’s heard them all: “It doesn’t exist; it’s a hysterical trait of neurotic housewives; it’s abnormal electrical activity in the colon.” He added, “I don’t think there’s any other disease that has gone through these peaks of attention-grabbing new theories.”

    Spiegel’s idea has clear holes. If a faulty reaction to gravity triggers IBS, says David C. Kunkel, a gastroenterologist at UC San Diego, then you would expect to see higher rates of IBS among populations living at sea level versus at high altitudes, where g-force is slightly weaker. But that doesn’t seem to be the case: About a quarter of Peruvians live high in the mountains and most Icelanders live at sea level, yet both countries have high rates of IBS. Likewise, IBS rates appear to decrease with age, “which would not be expected if the disease was caused by a constant gravitational force,” Kunkel told me.

    Spiegel is aware that the gravity hypothesis has little support in the field and no proof. But the gravity hypothesis has some logic behind it. The fact that the weightlessness of space travel can drastically change the body lends credence to the idea that other shifts in our relationship to gravity could do the same, says Declan McCole, a biomedical scientist at UC Riverside.

    And the gut may be particularly sensitive to gravity changes. McCole has found that weightlessness made epithelial cells—which line the gut and stop invaders from entering the body—easier to evade. So if our internal chemistry can change in a way that makes us hypersensitive to gravity, then, to McCole, it stands to reason that such a shift could hit the gut hard. He’s less sure of whether that hypersensitivity exists. If it does, then why haven’t we identified any chemicals that help handle gravity, as we have for fear or sex drive or hunger? That molecule may indeed turn out to be serotonin, but right now there’s no proof.

    The gravity hypothesis really matters only if it is meaningful for people with IBS. And that’s not guaranteed. Tying the very real pain of IBS to such a fantastical idea may seem closer to mythology than medicine, leaving patients feeling dismissed or belittled. Or they may throw up their hands in despair and prepare for a lifetime of pain: If the immovable force of gravity is the enemy, then why bother fighting?

    But if there is some truth to it, then the hypothesis could also provide a possible starting place for treatments. Some of Spiegel’s suggestions are already common, such as weight loss and medications that decrease serotonin, but he also advocates for some gravity-specific therapies. “I do talk about it with my patients,” Spiegel said. “I recommend certain yoga poses; I recommend tilt tables.” People who have IBS may balk at his more radical ideas, such as moving to a higher altitude or farther from the equator.

    The gravity hypothesis may never be anything more than a hypothesis. We have a long way to go before truly knowing whether the human body can develop a hypersensitivity to gravity that can make us ill, or whether some of us are better equipped to handle gravity than others. But the weight of evidence is enough to make us think twice before ignoring the idea that our body’s relationship to gravity can go awry—including for those of us not coping with IBS. If gravity might contribute to IBS, why not other ailments too? And then, why can’t it also be harnessed for good? Mekari and his colleagues recently found that lying at a six-degree downward angle sped up response times to cognition tests—pointing to a possible link between gravity and executive functioning. Antigravity treadmills, which help astronauts prepare for weightlessness, are being studied for the treatment of cerebral palsy, Parkinson’s disease, and sports injuries.

    All of these unknowns about gravity can feel haunting. Life on Earth has changed a lot since its first forms appeared about 4 billion years ago, but through it all, gravity has seemingly remained constant—perhaps the single thing that connects every organism that has ever lived. What if there’s still much we have to learn about what it’s doing to us? After all, right now your body is coping with gravity, just as it has been for every other second of your life. Perhaps it would be weirder if gravity wasn’t doing anything to us over time. “Every fiber in our body is straining to manage this force,” Spiegel said. You don’t need to spend 56 days in a bathtub to figure that out.

    Jessica Wapner

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