Sept. 13, 2016
Functional bowel disorders — irritable bowel syndrome (IBS) and nonulcer dyspepsia — are chronic, debilitating conditions that affect 10 to 15 percent of people in the United States. In the absence of reliable biomarkers, about half of all adults who consult a primary care physician or gastroenterologist for chronic abdominal symptoms, (pain, bloating, nausea, diarrhea or constipation, are diagnosed with a functional disorder.
The pathogenesis of these conditions is multifactorial and includes alterations in gut motility, small intestinal bacterial overgrowth (SIBO), infections, microscopic inflammation, psychosocial stress and visceral hypersensitivity. Many of these factors have similar effects. For example, the immune response to endotoxins secreted by bacteria in patients with SIBO can lead to increased gut motility and hypersensitivity.
Similarly, low-grade mucosal inflammation can cause the release of inflammatory mediators that alter gut function and sensory perception. Psychological stress can significantly affect intestinal sensitivity, motility, secretion and permeability, activate the mucosal immune system, and alter the gastrointestinal microbiota.
More recently, a growing number of studies have implicated dietary factors in the pathogenesis of IBS; by some estimates, more than half of people with IBS have symptoms related to malabsorption of small-molecule, short-chain carbohydrates — fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs). These carbohydrates are fermented by intestinal bacteria, producing gas and increased fluid in the intestines.
The heterogeneity of patients and mixed results of therapeutic trials make the management of functional bowel disorders frustrating for both physicians and patients. Standard therapies such as antidepressants and antacids have no effect on SIBO, which in some patients responds well to a short course of rifaximin, for example. Similarly, antibiotics are unlikely to do a thing for psychological stress or FODMAP sensitivity.
Given the limitations of standard therapies for functional bowel disorders, some centers are emphasizing diet and lifestyle changes as important management strategies. The Healthy Living Program at Mayo Clinic's campus in Rochester, Minnesota, offers this approach for patients with medical conditions as well as for people who are fundamentally healthy.
Healthy Living Program
For people interested in maximizing their physical, mental and emotional health, the program provides immersive wellness experiences tailored to meet individual goals, such as weight loss, improved physical conditioning or stress management. For patients with gastrointestinal disorders, including weight-related conditions such as nonalcoholic fatty liver disease, the program offers personalized diet, exercise and weight-loss plans that may improve not only symptoms but also quality of life, which in turn increases the ability to meet the challenges of living with a chronic illness.
"Many people realize their health would improve if they changed their diet and physical activity, but saying it and doing it are two different things. Similarly, most physicians see patients who would benefit from lifestyle changes but aren't able to implement those changes on their own. In the Healthy Living Program, multidisciplinary teams of experts work one-on-one to design individualized wellness plans and provide ongoing support so participants' success continues after they return home and are immersed in the realities of their busy lives," explains Donald D. Hensrud, M.D., M.P.H., the program's medical director.
The program is based on three areas of wellness — diet, physical activity and resilience — and offers three on-site plans that address each area with varying degrees of comprehensiveness. The most extensive is the four-day Signature Experience; there is also a daylong wellness experience and a two-day program focusing on weight management.
People interested only in improving fitness or athletic performance can choose the physical activity assessment, which ranges from three to eight hours and includes a biometric evaluation, cardiac stress test, strength test, body composition scan and a movement assessment. Individual classes in nutrition, cooking, yoga, Pilates and mind-body relaxation techniques also are available.
Some research suggests that appropriate physical activity alone may improve stamina and quality of life during and after chemotherapy. Data from Australian researchers published in 2007 in Cancer Causes & Control demonstrated that modest increases in physical activity can significantly improve quality of life in patients after treatment for colorectal cancer. Increased physical activity can also benefit most patients with functional gut disorders, particularly when incorporated into a comprehensive program of stress management and individualized, evidence-based diet plans.
"Like everything else at Mayo, the Healthy Living Program uses an evidence-based approach, although there are no clinical tests or treatments," Dr. Hensrud says. "We have an excellent, physician-led staff who are well-versed in both clinical medicine and wellness and health promotion. If a medical issue is identified while an individual is participating in the program, the medical services of Mayo Clinic are available to assist. We have only been in existence two years, so don't have published data yet, but so far, outcomes for the vast majority of participants and patients have been extremely positive."
For more information
Lynch BM, et al. Associations of leisure-time physical activity with quality of life in a large, population-based sample of colorectal cancer survivors. Cancer Causes & Control. 2007;18:735.
Mayo Clinic Healthy Living Program Offerings